Introduction: Hernia repair is one of the most common operations performed by general surgeons worldwide. Despite the frequency of this procedure, no surgeon has ideal results and complications such as those related to mesh repair and those related to without mesh repair such as post operative pain, nerve injury, seroma, surgical site infection, chance of recurrence with time and CGPS (Chromic Groin Pain Syndrome) suggest that hernia is a chronic disease process effecting Patients over their lifetime. The aim of present study is to compare gold standard technique of Lichtenstein’s Hernioplasty versus Desarda’s biological repair (Both by open technique) in our Medical College. Materials and Methods:  This double blinded randomised controlled study was conducted with a total of sixteen patients, including eight patients who underwent Lichtenstein’s Hernioplasty using polypropylene mesh and another eight patient underwent Desarda’s biological repair using absorbable suture material, vicryl. Using Inclusion and exclusion criteria–All the patients who underwent surgery by either method were followed up closely for eight months, possible complications and the data was recorded, analysed and synthesised narratively. Results:  Considering population sample size and age of the sample; Mean-SD were calculated. The mean for the entire sample is 39.875 and SD is 3.332; variance is 1.825; co-efficient of variation is 8.356

	Mean	SD	Variance	CV
Lichtenstein’s	39.375	3.079	1.754	7.819%
Desarda’s	40.375	3.466	1.861	8.584%

Again, two sample paired t-test is located weather the mean of the population has a value specified in null hypothesis. t= ; Degree of freedom is n-1. By the central limit theorem; if the observations are independent and the second moment exists, then it will be approximately normal N (0-1).bHere values of student t-tests are 0.897 (total sample). Study quality is assessed by oxford quality rating scale (JADAD SCALE). Yielding two points for randomisation, one for double blinding and one for dropout rate: 4/5; suggesting high quality. However, it does not include an assessment item for allocation concealment. As a result of the growing influence of evidence based medicine Heterogeneity value is taken nil-significant (all patients from the same geography).Above data shows Mean SD of the Desarda’s group is slightly higher than Lichtenstein’s, but the difference was statistically not significant. Conclusion: Present study suggests that uncomplicated hernia repairs by means of Desarda’s technique are relatively pain free yielding the same success rate as that of Lichtenstein’s and obviously not carrying complications of mesh repair (Hernioplasty). However, O.R. time is more and also considering the limited sample size, same geographical pattern sampling- large sample size may be required to be studied along with long duration follow up as well.

Objectives: The present study was to evaluate and compared the serum levels of gamma-glutamyl transferase, aspartate aminotransferase (AST), alanine transaminase (ALT), AST: ALT, and bilirubin in patients with chronic Hepatitis with control. Methods: A detailed history of all the participants was taken on a pre-designed questionnaire. For the evaluation of blood serum GGT, AST, ALT, AST:ALT ratio, and bilirubin, 5 ml blood sample was withdrawn from the anticubital vein of all participants and were collected in a sterile, dry, and plain vial. The serum utilized in the estimation of biochemical assays was separated from the blood sample by centrifugation at 3000 rpm for 10 minutes. The IFCC method was used to estimate the serum levels of the parameter using a commercially available kit from Transasia Pvt. Ltd. The tool used was an ERBA 5 chem semi-auto analyser. Results: A total of 50 chronic hepatitis patients were enrolled in a case group and 50 healthy individuals were included as control group. Mean age of the patients in case group was 50 ± 12.87 years. And mean age of healthy individual in control group was 48 ± 14.76 years.  In case group, males were 37(54%) and females were 23(46%). And in control group, males were 28(56%) and females were 22(44%). When we compared the Gamma-glutamyl transferase between case and control. which was highly significant differences (P<0.0001). Similarly other enzymes such as Aspartate aminotransferase, Alanine transaminase, and AST: ALT were also highly significant differences (P<0.0001) between cases and control. Serum level of Bilirubin was also highly significant differences (p<0.0001) in case as compared to control subjects. When we  correlated the different parameter of chronic hepatitis patients. GGT level was not significant differences (p=0.868). ALT level was highly significant differences (p<0.000). AST level (P=0.000), AST: ALT ratio (P=0.020) and bilirubin level was significant differences (P=0.012). Conclusions: Gamma-glutamyl transferase, Aspartate aminotransferase, Alanine transaminase, AST: ALT ratio and serum level of bilirubin was extreme significantly higher in patients with chronic hepatitis as compared to control (healthy subjects). Hence, GGT, AST, ALT, AST:ALT ratio, and bilirubin, are prominent indicators of chronic hepatitis.

Background: Although relatively rare, anterior tibial spine fractures are becoming more common due to increased participation in athletic activities and motor vehicle accidents. These fractures often require operative intervention for proper knee stability and functionality. Arthroscopic suture fixation is a minimally invasive technique that offers several benefits, including anatomic reduction and early mobilization. Aim and Objective: To evaluate the functional outcomes of arthroscopic suture fixation for tibial eminence fractures of the anterior cruciate ligament (ACL) using the pull-through suture technique. Materials and Methods: This prospective study was conducted at the Department of Orthopaedics, Gandhi Medical College, Bhopal, and Hamidia Hospital, Bhopal, from December 2020 to September 2022. Twenty patients aged 8 to 60 years with anterior tibial spine avulsion fractures classified as Meyers and McKeever Type II and III were included. Preoperative evaluations included knee instability tests, X-rays, MRIs, and routine laboratory investigations. Arthroscopic-assisted pull-through suture ligation was performed, followed by a structured postoperative care and rehabilitation protocol. Patients were followed up at 1, 3, 6, and 9 months. Functional outcomes were assessed using the Lysholm Tegner score. Results: The mean age of the patients was 25.4 years (SD ± 9.88), with a male predominance (90%). The right side was affected in 60% of cases. Students were the most commonly affected group (35%). The primary mode of injury was sports-related (50%). Preoperative Lysholm Tegner scores were uniformly below 65, indicating poor knee function. Postoperatively, 70% of patients achieved excellent scores (>90), and 25% achieved good scores (84-90). The mean preoperative score improved significantly from 51.05 (SD ± 8.53) to 92.10 (SD ± 4.59) at the 9-month follow-up (p < 0.0001). Complications were minimal, with only two cases of knee stiffness and one minor extension lag. Conclusion: The arthroscopic pull-through suture technique for tibial eminence fractures of the ACL is highly effective, resulting in significant improvements in knee function and stability with minimal complications. This technique offers the advantages of anatomic reduction, secure fixation, and early mobilization, making it a preferred method for managing these fractures. Further studies with larger sample sizes and longer follow-up periods are recommended to validate these findings.

Background: Normally both kidneys are supplied by a pair of renal arteries which arises from abdominal aorta at the level of intervertebral disc between L1 and L2 vertebrae. Presence of additional renal arteries are most frequent variation which is to be considered in doing the interventional radiological procedures, renal surgeries & renal transplantation. Our Purpose of the study is to observe the presence or absence of accessory renal artery, their number, side of origin presence or absence of extrarenal branches. Materials and Method: The cross-sectional study was conducted in 50 cadaver (50 male & 50 female) fixed in a formalin which were allotted for undergraduate teaching in the Department of Anatomy, Kanyakumari Govt. Medical College, Tamilnadu, South India during the year 2018- 2021. The kidneys with the variation of renal artery, renal veins are removed along with the part of abdominal aorta & Inferior vena cava. The presence of variation of accessary renal arteries and branches to extrarenal part were noted. Result: Variations noted in 22 cadavers (44%). Bilateral variations-12% triple renal arteries on left side and in right side-16% suprarenal artery and renal artery arose as a common trunk from abdominal aorta. Unilateral double renal arteries were present on left side in 20% and right side in 8%. Branches to suprarenal gland from left aberrant renal artery seen in 4%. Right Inferior phrenic artery arose from right upper renal artery in 6%. Conclusion: Awareness of such variant is important while doing investigational and surgical procedures related to kidney.

Background: Musculocutaneous nerve is one of the key nerves of the upper limb which supplies the flexor muscles of arm. Its variations are commonly encountered in brachial plexus dissection. Sound knowledge of its normal anatomy and variations are clinically significant in diagnosing neurological weakness, preplanning surgeries of arm, axilla and management of shoulder joint traumatology. The purpose of the study was to observe the same and to discuss its clinical significance. Materials and Methods: The present study was conducted at Department of Anatomy, Kanyakumari Government Medical College, Tamilnadu, India. 25 right and 25 left upper limbs (50 specimens) from 25 cadavers with age ranging from 25 to 60 years irrespective of sex were studied. Results: Musculocutaneous nerve arose from lateral cord of brachial plexus and was present in all the specimens studied. It didn’t pierce coracobrachialis in 10 (20%) specimens. Coracobrachialis, brachialis and biceps brachii were supplied by musculocutaneous nerve in all the specimens. Single communicating branch to median nerve was observed in 9 (18%) specimens and it did not pierce the coracobrachialis. Venieratos Type 1and Choi Type2a pattern of communication were observed in 7 (14%) specimens. In 2 (4%) specimens Venieratos type 3 and Choi type 2 b pattern of communication were observed. Conclusion: Awareness of the variations of musculocutaneous nerve in its origin, course, muscular branches, termination and anastomoses is important to the neurosurgeons, orthopaedicians and general surgeons while examining, diagnosing and managing peripheral nerve lesions or injuries of the upper limb.

Introduction: Thrombocytopenia is characterized by a low platelet count as a result of marrow hypo proliferation or peripheral platelet breakdown. Several diagnostic techniques have been proposed to identify the underlying cause of thrombocytopenia. The aetiology might include febrile illnesses including dengue fever and malaria, as well as other infectious diseases. The purpose of this research was to assess the clinical characteristics, mean platelet volume (MPV), and platelet distribution width (PDW) of febrile individuals with thrombocytopenia. Material and Methods: Ninety-eight cases of both genders suspected with thrombocytopenia with acute febrile infections above 21 years of age were included. 5 ml of peripheral venous blood was collected to analyse the parameters including complete blood count, platelet distribution width, and mean platelet volume were estimated and recorded. Results: The severity of thrombocytopenia was severe in 24.48%, moderate in 55.10% and mild in 20.40% of cases. The mean difference of platelet value, mean platelet volume, PWD, and PWD/PLT were statistically significant (p<0.05). Infectious conditions such as dengue fever (30.61%), malaria (10.20%), leptospira (7.14%) and other conditions (52.04%) were observed in participants. Conclusion: Mean platelet volume and platelet distribution width are the potential screening tools for diagnose and differentiating the cause of thrombocytopenia. However, Early suspicion, screening, diagnosis and prompt management of thrombocytopenia will effectively lower morbidity and mortality related dreaded illness.

Background: Polytrauma patients admitted to the intensive care unit (ICU) often experience immune dysregulation and increased risk of complications. This study aimed to investigate the immunological effects of parenteral nutrition (PN) and the potential benefits of immunonutrition and early enteral nutrition (EN) in this patient population. Methods: A prospective, randomized controlled study was conducted with 50 polytrauma patients admitted to the ICU. Patients were randomly assigned to receive either standard PN (n=25) or immunonutrition PN (n=25). Immunological parameters and clinical outcomes were assessed. A subgroup analysis based on the timing of EN initiation (early EN, n=30; late EN, n=20) was also performed. Results: The incidence of infectious complications (32% vs. 56%, p=0.047), sepsis (20% vs. 40%, p=0.032), and MODS (16% vs. 32%, p=0.041) was significantly lower in the immunonutrition PN group compared to the standard PN group. The length of ICU stay (14.6 ± 5.8 vs. 18.4 ± 7.2 days, p=0.028) and 28-day mortality (8% vs. 20%, p=0.039) were also significantly reduced in the immunonutrition PN group. Early EN initiation was associated with reduced incidence of infectious complications (30% vs. 65%, p=0.012), sepsis (20% vs. 45%, p=0.025), MODS (17% vs. 35%, p=0.038), length of ICU stay (15.2 ± 6.1 vs. 19.8 ± 7.4 days, p=0.021), and 28-day mortality (10% vs. 20%, p=0.046) compared to late EN initiation. Conclusion: Immunonutrition PN and early EN are associated with improved clinical outcomes and attenuated inflammatory response in polytrauma patients admitted to the ICU. These findings support the use of immunonutrition and early EN as strategies to optimize nutritional support and improve outcomes in critically ill polytrauma patients.

Background: Foot injuries are prevalent among active individuals, often leading to significant functional impairments. These injuries, although rarely life-threatening, require proper management to prevent long-term complications and disability. Aim and Objective: To investigate the patterns of foot injuries among patients presenting at Hamidia Hospital, Bhopal. Materials and Methods: This observational study was conducted from January 2021 to June 2022 in the Department of Orthopaedics at Gandhi Medical College, Bhopal. Patients of all ages and both genders presenting with foot injuries and who consented to participate were included. Data were collected through patient interviews, physical examinations, and medical record reviews, including demographic details, mode of injury, type of injury, location, side of injury, and severity. Radiographic assessments confirmed the presence and type of fractures and dislocations. Descriptive statistics were used to analyze the data. Results: The study included 955 patients, with a mean age of 34.97 years. The majority of patients were young adults, with the highest incidence in the 21-30 age group (24.5%), followed by the 31-40 age group (23.4%). A higher incidence was observed in males (76.6%) compared to females (23.4%). Road traffic accidents were the leading cause of foot injuries (68.8%), followed by falls from height (13.4%) and slips and falls (9.1%). Most injuries involved a single region (92.1%), with the forefoot being the most commonly affected region (55.22%). Bilateral injuries occurred in 7.64% of cases. Associated injuries were present in 46.0% of patients, and 61.6% of injuries were open. Foot fractures without dislocations were observed in 91.62% of cases, with the remaining 8.38% having single or multiple dislocations. Conclusion: Foot injuries predominantly affect young and middle-aged males, with road traffic accidents being the primary cause. Most injuries involved the forefoot and were often isolated. The high prevalence of associated and open injuries highlights the need for enhanced traffic and workplace safety measures, public awareness campaigns, and prompt medical intervention to reduce the incidence and severity of foot injuries and improve patient outcomes.

Background: Post-operative pain may produce deleterious effects on respiratory, cardiovascular, neuroendocrine and gastrointestinal systems of our body. Epidural anaesthesia reduces the incidence of many major post-operative complications. The advantage of epidural anesthesia is the ability to maintain continuous anaesthesia after placement of an epidural catheter which can be extended into post-operative period for analgesia using lower concentration of local anaesthetic drugs alone or in combination with different adjuvants. Materials and Methods: 100 cases undergoing elective lower extremity surgery between ages 18-60 years of both sexes with ASA grade I were selected randomly and divided into two groups of 50 cases each. All patients received Tab Diazepam 10mg orally the night before surgery. Inj. Ondansetron 4 mg iv and Inj. Ranitidine 50 mg (slow iv drip) were given half an hour before operation. One group received 20 ml of 0.75% ropivocaine hydrochloride (Group A) and other group received 20 ml of 0.5% bupivacaine hydrochloride (Group B). Onset, duration, peak height and time taken for the sensory block to regress by 2 dermatomes was recorded. Onset, duration and degree of motor block, hemodynamic parameters and side effects were recorded. Quality of post-operative analgesia was recorded. Students t test (Unpaired t test), Chi square test or Fishers exact test were used for statistical analysis. Results: The onset and duration of sensory block , hemodynamic effects after administration of the drugs, the quality of post-operative analgesia produced and the incidence of side effects like hypotension, bradycardia, nausea, vomiting, pruritus and shivering produced by 0.5% bupivacaine and 0.75% ropivacaine are similar. The onset of motor block is similar for both the drugs, but the duration of motor block is considerably longer with bupivacaine. Bupivacaine produces a greater degree of motor block. Conclusion: Bupivacaine (0.5%) and ropivacaine (0.75%) produce similar epidural anaesthesia with the only exception that the degree and duration of motor block is less with ropivacaine.

Background & Methods: The aim of the study is to observe the functional changes (obstructive or restrictive) in pulmonary systems among patients with CKD over a period of six months. Detailed clinical history and clinical examination of all patients fulfilling the inclusion and exclusion criteria. CBC, Serum Creatinine, USG of whole abdomen and pelvis (Size, structural abnormality of kidney etc.) Results: Majority of the cases were from stage 3 of CKD i.e.63.5% at baseline and 52.6% after 6 months. Proportion of cases from stage 4 were 25.4% at baseline and 42.4% after 6 months. Conclusion: Chest x ray was normal at baseline and after 6 months, 5 patients i.e. 4.2% had bilateral mild pleural effusion. Epworth daytime sleepiness risk assessment revealed that proportion of high-grade cases were 16.1% at baseline that increased to 35.6%. Proportion of cases from low grade were 83.9% that are decreased to 64.4% after 6 months. The difference in the proportion of cases in high grade and intermediate grade was statistically significant(<0.05). Epworth daytime sleepiness risk assessment revealed that proportion of high-grade cases were 16.1% at baseline that increased to 35.6%. Proportion of cases from low grade were 83.9% that are decreased to 64.4% after 6 months. The difference in the proportion of cases in high grade and intermediate grade was statistically significant(<0.05).

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized system for assessing malignancy risk in salivary gland lesions, aiding in accurate diagnosis and treatment. Continuous evaluation is necessary to validate its efficacy in various clinical scenarios. Methods: This retrospective cohort study at the Bhagwan Mahavir Institute of Medical Science included 100 patients with salivary gland lesions assessed using the MSRSGC over 2 years. Data from medical records quantified malignancy risk and evaluated system accuracy using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Twenty-five percent of patients were high-risk for cancer, and 45 had histological confirmation. The MSRSGC predicted malignancy with 88.9% sensitivity, 96.2% specificity, and 94% accuracy. Conclusion: The MSRSGC is a reliable tool for assessing malignancy risk in salivary gland lesions, particularly in high-risk categories. Recommendation: While the MSRSGC shows high efficacy, it should complement clinical and histopathological evaluations, especially for intermediate-risk cases, to enhance diagnostic precision.

Background: Umbilical hernia has gained little attention from surgeons in comparison with other types of abdominal wall hernias (inguinal, postoperative); however, the primary suture for umbilical hernia is associated with a recurrence rate of 19–54%. Aim and Objectives: To analyze the results of the umbilical hernia repair and to assess the independent risk factors influencing umbilical hernia recurrence. Materials and Methods: A retrospective analysis of patients who underwent surgery for umbilical hernia in the Shri Jagannath Medical College and Hospital, Puri over a period of two years from January 2022 to December 2023. Age, sex, hospital stay, hernia size, patient’s body mass index, and postoperative complications were analyzed. Postoperative evaluation included pain and discomfort in the abdomen and hernia recurrence rate. Hernia recurrence was diagnosed during the patients’ visit to a surgeon. Two surgical methods were used to repair umbilical hernia: open suture repair technique (keel technique) and open mesh repair technique (only technique). Every operation was chosen individually by a surgeon. Results: A total 194 patients (62 males and 132 females) with umbilical hernia were examined. The mean age of the patients was 57.1±15.4 years, hernia anamnesis – 7.6±8.6 years, hospital stay – 5.38±3.8 days. One hundred eighty four patients (94.8%) were operated on using open suture repair technique and 10 (5.2%) patients – open mesh repair technique. Only 7% of patients whose BMI was >30 kg/m2 and hernia size >2 cm and 4.3% of patients whose BMI was <30 kg/m2 and hernia size <2 cm were operated on using onlay technique (P>0.05). The rate of postoperative complications was 5.2%. Sixty-seven patients (69%) answered the questionnaire. The complete patient’s recovery time after surgery was 2.4±3.4 months. Twenty eight patients (20.9%) complained of pain or discomfort in the abdomen, and fourteen patients (10.4%) had ligature fistula after the surgery. Ninety patients (67.2%) did not have any complaints after surgery. The recurrence rate after umbilical hernia repair was 8.9%. The recurrence rate was higher when hernia size was >2 cm (9% for <2 cm vs 10.5% for >2 cm) and patient’s BMI was >30 kg/m2 (8.6% for < 30 vs 10.7% for >30). There were 10 recurrence cases after open suture repair and one case after onlay technique. One hundred twelve patients (83.6%) assessed their general condition after surgery as good, 18 patients (13.4%) as satisfactory, and only 4 patients (3%) as poor. Conclusions: We did not find any significant independent risk factors for umbilical hernia recurrence. However, based on reviewed literature, higher patient’s body mass index and hernia size of >2 cm could be the risk factors for umbilical hernia recurrence.

Background: Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Aim and Objectives: The present study was done to identify the sociodemographic characteristics and related risk factors in patients with diabetic foot ulcers. Materials and Methods: This hospital-based retrospective study was conducted on  adult patients with diabetic foot ulcers observed on their first visit to the Department of Surgery, Shri Jagannath Medical College and Hospital, Puri over a three-year period from October 2021 to September 2023. The sociodemographic charecteristics and  underlying risk factors datas were collected from the included cases. Results: A total of 137 patients presented with DFU among which majority of patients were male 98 (71.5%).Out of total cases, 64 (46.7%) DFU patients had diabetes for more than five years. Poor glycemic control was found in 109 (79.6%) of the patients. Footwear and loss of preventive foot were the most common precipitating factors. Most common site of DFU was fore foot (non-plantar 73%). Conclusions: Advanced age, duration of diabetes, and poor glycemic control are associated risk factors for developing foot ulcers. Implementing organized screening programs for diabetic foot neuropathy and promoting awareness can help address these complications.

Aims and Objectives: To study the effect of altered thyroid hormone (FT3&FT4) and TSH levels on Sepsis related neonatal mortality. Study Design: It was a hospital based observational, Analytical study, 32 Term babies with sepsis were taken, Thyroid hormones (FT3&FT4) and TSH levels from the blood collected between 18 and 24 hr after birth were measured by Chemiluminescence immunoassay. Outcome results were analysed using chi square, and ROC curve. P value <0.05 was considered significant. Results: Cases of Neonatal sepsis expired had significant low level of S.FT4 (1.22 + 0.27 ng/dl) as compare to discharged (1.58+ 0.38 ng/dl), but there was no significant difference observed in S.FT3 and TSH level. Cut off value of S. FT4 ≤ 1.39 ng/dl & S. TSH ≤  3.8 8uIu/ml combined was having a good predictive value ( SN- 77.2, SP- 90, PPV- 94.44 & NPV- 64.29) for Sepsis related neonatal mortality. Conclusions: Cut off value of combined S. FT4 ≤  1.39 ng/dl & S.TSH ≤  3.8 8uIu/ml have best predictive value for Sepsis related neonatal mortality.

Background: Tooth brushing is the most common method for maintaining oral hygiene, but it also leads to toothbrush contamination with bacteria, blood, saliva, and oral debris. This study aims to isolate and identify bacteria contaminating toothbrushes among female students at Qassim University, Saudi Arabia. Materials and Methods: This observational cross-sectional study randomly collected toothbrush samples from female students at Qassim University and included new toothbrushes as controls. Toothbrushes were divided into two groups and processed differently to optimize microbial yield. Samples were inoculated onto suitable media and incubated. Bacteria were identified using the Phoenix Automated Microbiology System (30 brushes) and MALDI T of Mass Spectrometry (32 brushes). Data analysis was performed using SPSS 20. Results: The Phoenix Automated Microbiology System isolated 6 bacterial species, with 13.3% showing growth of Micrococcus and 36.7% showing no growth. MALDI-Tof-MS detected 24 bacterial species in the second group and unused new brushes, including Enterobacter cloacae in 37.5% of used brushes and Stenotrophomonas maltophilia in 6.25% of unused brushes. Conclusion: The identified bacteria were predominantly commensal. Individuals with HIV, undergoing chemotherapy, genetic disorders, and neonates are particularly susceptible to these bacteria. Enhanced hygienic practices, such as thorough hand washing by healthcare personnel, are essential to minimize potential organism transfer, particularly from tap water.

Background: Infants with Congenital Hypothyroidism (CH)  may present with subtle or nonspecific clinical signs initially, as residual maternal thyroid hormones can temporarily mask symptoms. Materials and Methods: 3ml of Cord blood was drawn after the 3^rd stage of labour and Thyroid Function tests were performed by Electrochemiluminescence method, Patients were recalled if the Thyroid stimulating Hormone (TSH) Value was > 60 mIU/L. Results: 8 babies had Congenital Hypothyroidism (CH) of which 2 were Downs syndrome babies and 1 baby had heart anomalies. incidence has been calculated to be 1 in 2402 live births, in the period from April 2012 to March 2013 in Qassim region of Saudi Arabia. Conclusion: Umbilical cord blood TSH proves to be an effective screening tool in identifying congenital hypothyroidism, thereby preventing mental retardation and other adverse effects associated with untreated CH.

Objective: To compare the effect of expressed breast milk (EBM), versus 10% dextrose on procedural pain in neonates as assessed by the Neonatal Infant Pain Scale (NIPS), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying. Design: Prospective, double blind randomized controlled trial. Setting: Postnatal ward of a tertiary-care hospital. Participants: 60 neonates who required heel prick were recruited into the study according to the inclusion and exclusion criteria after written parental informed consent. Methods: The enrolled neonates were randomized into intervention groups –EBM and 10% Dextrose. Two ml of test solution was given to baby by paladay 2 minutes before heel prick by a nurse. The heel prick was later administered by one of the blinded investigators. The face and crying of baby were video graphed by another blinded investigator. The facial response to pain was analyzed from the video. Outcome variable: NIPS score, heart rates and SpO2 at pre procedure. 30 seconds, 2 minutes and 4 minutes and duration of cry were recorded. Results: 60 babies were considered for final analysis with 30 in 10% D, and 30 in EBM group. The median NIPS score of neonates in EBM group was 4 at 30 seconds while it was 6 in the 10% D group which was statistically significant. The duration of cry in the EBM group (44.53 ± 28.63 seconds) was lower than that of 10% D group (52.46±43.58) though not statistically significant. On subgroup analysis, there was a significant difference between NIPS scores (p<0.00001) across the timelines in each group. There was a significant change in heart rate across the timelines in each group (p<0.00001). Conclusions: This study has established that both 10%D and expressed breast milk are efficacious in reducing pain in neonates. More studies are required on a larger scale to identify the best non pharmacological agent/method and set up robust clinical guidelines to be followed uniformly in all NICUs.

Background and Objectives: Diabetic peripheral neuropathy is a severe condition that lowers quality of life and has social repercussions. Early diagnosis and treatment of neuropathic processes might change their trajectory and significantly lower the morbidity and death that go along with them. This research investigates the impact of long-term control of blood sugar on diabetic peripheral neuropathy in individuals diagnosed with type 2 diabetes. Material and Methods: From July to September of 2023, a hospital-based research was conducted at the NCR Medical College Hospital in Meerut, Uttar Pradesh, India. Those who had Type 2 diabetes for less than ten years and were older than eighteen were all recruited. The BMI, HbA1c level, as well as nerve conduction studies (NCS) were determined using established methods. The statistical package for social sciences (SPSS), version 25.0, was used to analyze the data. A P-value of less than 0.05 was deemed significant. Results: Fifty-two of the 95 T2DM patients were men. According to our research, the sensory velocity decreased from 64.069 ± 3.221 to 54.001 ± 5.339 and the motor nerve decreased from 63.391 ± 2.379 to 53.869 ± 2.081 (P = 0.0501, P = 0.0031, respectively) as the length of diabetes increased. Furthermore, a significant reduction in motor nerve amplitude from 8.789 ± 3.109 to 6.941 ± 1.839 (P = 0.0501) and sensory nerve amplitude from 25.711 ± 5.701 to 19.511 ± 6.509 (P = 0.0031) was seen with longer duration of diabetes. Additionally, when HbA1c was greater than 6, all NCS parameters (amplitude and velocity) reduced: motor velocity dropped from 63.001 ± 2.589 to 51.439 ± 1.661 (P = 0.021), and sensory velocity declined from 63.961 ± 2.359 to 55.489 ± 2.431 (P = 0.029). Moreover, the motor amplitude dropped from 6.879 ± 3.551 to 6.609 ± 3.289 (P = 0.0509), whereas the sensory amplitude dropped from 26.909 ± 1.261 to 20.849 ± 2.101 (P = 0.0509). Furthermore, there is a significant (P = 0.0509) link between the BMI and the motor and sensory amplitudes. Conclusion: All of the nerve conduction testing parameters were negatively impacted by high BMI and poorly treated (high HbA1c) long-term diabetes.

Background: Through the facilitation of early extubation and optimum pain management, fast tracking plays a key role in lowering perioperative morbidity and length of hospital stay following surgery. Enhancing recovery also greatly benefits from reducing the stress reaction to surgery. A novel method for chest wall analgesia has been described recently: serratus anterior plane block (SAPB). To determine the efficacy of SAPB analgesia for minimally invasive cardiac surgery (MICS), further information is needed. Aim and objectives: The purpose of the research was to evaluate the safety and effectiveness of SAPB guided by ultrasonography in comparison to fentanyl for the management of post-thoracotomy pain and stress in patients receiving MICS. Setting and Design: This was a prospective, observational, and comparative research that was time-framed. Materials and Methods: Two groups were randomly allocated to patients receiving MICS for coronary artery bypass grafting while under general anaesthesia. Patients in the SAPB group (Group A) received 0.2% of 20 ml ropivacaine before having a catheter inserted for ongoing infiltration at the conclusion of the surgery. Patients in the fentanyl group (Group B) received fentanyl intravenously as postoperative analgesics. The main result assessed how much pain was evaluated using the visual analogue scale (VAS) and how much stress response was quantified using cortisol levels in both groups. Results: In comparison to Group B, Group A’s VAS score was considerably lower (P < 0.0001). The SAPB group also had decreased cortisol levels. Group A exhibited more stability in hemodynamic measures, including oxygen saturation, pulse rate, diastolic blood pressure, and systolic blood pressure, and required fewer top-up analgesics. Conclusion: When it came to treating post-thoracotomy pain following MICS, SAPB worked better than fentanyl. The group that took SAPB had reduced cortisol levels.

Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer. Recent data from Western and Asian countries have shown an increase in the number of CRC cases among patients under the screening age of 50 with late stage presentation leading to poor survival. Aim and Objectives: To analyze the pattern of histopathological presentation in rectal cancer between patients younger than 50 years old and older than 50 years age. Material & Method: This hospital based retrospective study was conducted on patients who histopathologically diagnosed rectal cancer and came to Department of Medical Oncology, AHPGIC, Cuttack for their management over a period of five years from January 2019 to December 2023.The histopathologically details of patients were collected and compared between <50 and >50 years age. Results: During the study period, a total of 84 rectal cancer patients were encounted. Out of included cases, males were predominated 43(51%) with a male to female ratio of 1:1. The majority of patients were between the ages of 41 to 50 years old. Young age patients had more aggressive disease in terms of advance stage disease at presentation and poorly differentiated tumors; 53.6% patients had T3/T4 disease and 53.6% patients with poorly differentiated tumors in contrast to patients with age more than 50 years. Conclusion: This study found a higher number of younger rectal cancer patients (under 50 years old). These younger patients also tended to have more aggressive tumors or be in a later stage of the disease. To improve the situation, we need a combined effort (multi-sectorial approach) based on strong evidence. This should focus on catching rectal cancer early and giving the best treatment (effective management) possible.

Background: To investigate the pathological variations in appendectomy specimens and identify potential demographic associations, a retrospective analysis was performed focusing on: (1) the range of histopathological diagnoses, (2) patient characteristics linked to these diagnoses, and (3) the incidence of ruptured appendices, unnecessary surgeries (negative appendectomy rate), and unexpected pathology discovered during appendectomy. Materials and Methods: The clinicopathological details of patients who underwent appendectomy at Shri Jagannath Medical College and Hospital, Puri, between January 2022 and December 2023 were reviewed retrospectively. Results: There were 214 cases found to have histopathology proven appendicitis among which 129 (60.2%) males and 85 (39.7%) females with the male: female ratio of 1.5:1. The mean age for male was 28.9 ±11.3 yrs with a range of 1 to 68 yrs and for female was 31.7±7.08 yrs with a range of 2 to 71 yrs and the mean age for The peak age incidence of appendicitis was found in the age group of 21 to 30 years. More than 90% cases of appendicitis occurred below the age of 40 years. Most of the positive appendicitis cases 58 (45.0%) were reported as acute appendicitis in the final histopathology report. Acute appendicitis showed a peak incidence among patients aged 11 to 30 years. Conversely, chronic, recurrent, resolving, and eosinophilic appendicitis were more prevalent in the 21 to 40 year age group. Acute appendicitis and perforated appendicitis was seen more commonly in females at the age interval of 11-30 yrs. Conclusion: Appendicitis is most common in young adults, slightly more frequent in males. Laparoscopy during appendectomy in women helps identify unsuspected pelvic issues, lowering unnecessary surgeries. Examining appendix tissue post-surgery is crucial to avoid missing other problems. Surgeons should recognize rare appendix pathologies that may require further treatment. Effective management of appendix issues requires considering clinical details, imaging (CT scans), and tissue analysis.

Background: Cellulitis is a non-necrotizing inflammation of the dermis and subcutaneous tissues. It is scarcely reported in medical literature. Aim and Objective: To document the clinicopathological details of lower limb cellulitis at a tertiary care hospital in Odisha. Materials and Methods: This study investigated patients admitted with lower limb cellulitis between January 2022 and December 2023.We analyzed their medical records to understand factors like age, gender, underlying conditions, symptoms, treatment received, and treatment success. Results: One hundred nine (109) patients with lower limb cellulitis were admitted during the study period. Of these patients, 56 (51.3%) were males and 43(48.6%) were females. The mean age of the patients was 46.6 years (standard deviation 19.2). Among males, the majority (39%) were in their Fifth decade of life, while the majorities (41%) of females were in their fourth decade. The most of the cases were particularly among people in field jobs 57(52%). All patients presented with swelling of the lower limb, with 54(49.5%) having swelling in the left leg and 49(45%) in the right leg. followed by diabetes mellitus and smoking. The mean duration of swelling before admission was 13 days (SD 3.9). Over half 45(41.3%) of the cases were managed conservatively (Antibiotic treatment) resulted in complete resolution. However, complications occurred in 62(56.9%) of cases, requiring surgical intervention. Abscess formation was the most frequent complication, observed in 45(41.3%) of cases. The average hospital stay in this study was 8.2 ± 1.3 days. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy.

Introduction: Blood Transfusion-transmitted Diseases (TTDs) refer to Diseases that can be transmitted through blood transfusions. Transfusion is an irreplaceable therapeutic modality, widely applied to medical care which is a life-saving procedure. The purpose of this study is to evaluate the Seroreactivity of HIV, HBV, and HCV among blood donors. Materials and Methods: A retrospective study was carried out over a period of 4 years from January 2019 to Dec 2022. Serum samples were screened for Hepatitis B surface antigen (HBsAg), antibodies to Human Immunodeficiency Virus (HIV) 1 and 2, Hepatitis C virus (HCV). Results: A total of 12498 blood donors were included out of which majority of donors were male (96.31%). The overall Seroreactivity was 1.49%, whereas the Seroreactivity of HIV, HBV and HCV were 0.45%, 0.67% and 0.37%, respectively. Conclusion: For reducing transfusion transmitted diseases, the strict selection criteria of blood donors and comprehensive screening of donor’s blood using standard methods should be highly recommended for ensuring the safety of blood for recipient and judicious use of blood products should be emphasized.

Background: Osteoporosis is decrease in the overall amount of bone. It is not at all the same as bone decalcification. It is not only prevalent among postmenopausal women but also occurs in men and women with underlying conditions or major risk factors associated with bone demineralization. Objective: To study the role of Zolendronic acid (IV Bisphosphonate)therapy in providing good pain relief in osteoporotic fragility fractures. Methods: This Prospective single arm, Observational Cohort Study was conducted among 50 Patients above the age of 40 years of either sex presenting with osteoporotic fracture to Department of Orthopedics St. Martha’s Hospital, Nrupathunga road, Bengaluru. Duration of study was December 2015 to December 2017. Results: In the initial six months, ZA provided significant improvement in back pain as depicted by VAS in patients with VCF. ZA being an IV yearly dose regimen is well accepted and tolerated by the patients compared to other oral bisphosphonates. Febrile reactions, myalgia, minor maculopopular rashes were the adverse effects noted in 2 patients who were symptomatically addressed. No other significant adverse effects noted during the study period in any of the patients. All the patients found excellent clinical improvement in terms of pain in the initial 6 months post infusion. At the end of one year, all the patients were willing for a second dose. This study noted ZA therapy had significant decrease in pain intensity. Conclusions: ZA being an annual IV dosing regimen has better compliance than other oral bisphosphonates. ZA provides significant improvement in patients backpain in the initial 6 months and also prevents the incidence of new VCF in patients having Osteoporotic VCF.

Introduction: Effective postoperative pain management is crucial for patient recovery, particularly in minimally invasive surgeries such as laparoscopic gynecologic procedures. This study evaluates the efficacy of pre-surgical local infiltration of bupivacaine for reducing post-surgical wound pain, hypothesizing that bupivacaine provides superior pain control compared to placebo. Methodology: In this double-blind, randomized controlled trial at Government Medical College, Rajouri, 128 patients undergoing elective laparoscopic gynecologic surgery were randomly assigned to receive either 20 mL of 0.25% bupivacaine or a saline placebo injected at the surgical site before the incision. Pain intensity was as-sessed using the Visual Analog Scale (VAS) at multiple time points post-surgery. Patient satisfaction and the incidence of adverse events were also recorded. Results: The bupivacaine group reported significantly lower VAS pain scores at all postoperative time points than the placebo group (p < 0.001). Additionally, 53% of patients in the bupivacaine group were very satisfied with their pain management, compared to only 22% in the placebo group. The incidence of adverse events was low and comparable between groups. Conclusion: Pre-surgical infiltration of bupivacaine significantly reduces postoperative pain and improves pa-tient satisfaction in laparoscopic gynecologic surgeries without increasing the risk of adverse events. These find-ings support the inclusion of bupivacaine as a standard component of pain management protocols in similar surgical settings.

Purpose: To assess work – life and family balance among ophthalmologist in Bihar, with significance on identifying gender differences. Material and Methods: A questionnaire based format was designed using forms app. The study included professional and personal life balance, gender biases, average income, career breaks, paper written and published, etc. Results: Among the subjects females were affected by temporary break in career (P=0.01), females earned less than males(P=0.001), males pursued fellowship unlike females(P=0.02) , female faced gender biasness at workplace unlike males(P=<0.001) these results were found to be statistically significant. Conclusion:  Hereby it is concluded that there still exist difference in the practice pattern and personal life of male and female ophthalmologists.

Objectives: The present study was to evaluate the sociodemographic profile of anomaly positive women, prevalence, and type of congenital abnormalities in second and third trimester on ultrasonography scanning. Methods: The Radiologist performed all the transabdominal ultrasonography on a ‘Z6- Mindray color Doppler ultrasound system’ after taking verbal consent from the patient. A questionnaire was used containing the following information e.g. women’s age, parity, gravidity, date of last menstrual period. The questionnaire form also included about the result of transabdominal USG examination which included the following: singleton or multiple, dead, or alive foetus, gestational age, and presence or absence of congenital anomalies. Results: A total 954 women of 2^nd and 3^rd trimester pregnancy were enrolled. Rate of prevalence of congenital abnormalities was 1.57%. Majorities of fetus anomaly positive women 10(66.67%) were in age group of 20-35 years. Most of the women had primary school level of education. Most of the women were nulliparous 7(46.67%) and primiparous 5(33.33%).  Most of the women 9(60%) were in 2^nd trimester of pregnancy. Live foetus at time of scanning were seen in 13(86.67%) women. Intra uterine death foetus at time of scanning was seen in 2(13.33%) women.  Multiple pregnancy was seen in 2(13.33%) women. central nervous system anomalies 10(66.67%), gastro-intestinal anomalies 5(33.33%) and others anomalies 5(33.33%) were the most common. Anencephaly 4(26.67%) and hydrocephalus 2(13.33%) were the common CNS anomalies. Duodenal atresia 2(13.33%) was the common gastro-intestinal anomaly. Conclusions: Rate prevalence of congenital abnormalities was 1.57%. Central nervous system anomaly was the most common followed by gastro-intestinal anomalies.  Anencephaly and hydrocephalous were the most common central nervous system anomalies. Duodenal atresia was the common gastro-intestinal anomalies. Hence, the routine ultrasonography scanning is one of the best choices of diagnostic tool during the 2^nd and 3^rd trimester of pregnancy to detect foetal abnormalities.

Background: Trace elements contribute in a multitude of physiological as well as metabolic processes in humans, regardless of their source. For roughly one quarter of the body’s enzymes to accomplish their metabolic tasks, metal ions have to trigger them. It is yet unclear how trace elements contribute to the creation of liver cirrhosis and its ramifications. Materials and Methods: By applying a plasma sequential spectrophotometer, the serum amounts of zinc, copper, manganese, and magnesium were determined in 96 unaffected volunteers and 96 unhealthy individuals that is suffering from alcoholic liver cirrhosis.  Statistical analysis employing Wilcoxon and Kruskal-Wallis non- -parametric tests were carried out to evaluate the serum amounts of these trace elements amongst the individuals of both the groups. Results: Zinc levels in serum in liver cirrhosis sufferers were substantially lower than in controls (P<0.001). Patients with liver cirrhosis exhibited significantly higher serum amounts of manganese and copper with the value of P<0.001.  Between individuals suffering from liver cirrhosis and controls, there was no discernible difference in the magnesium levels (P=0.126). Zinc, copper, manganese, and magnesium concentrations were similar in patients with liver cirrhosis who were male or female. The only factor that varied substantially (P=0.027) across the Child-Pugh groups was the manganese concentration. Compared to cirrhotic individuals without encephalopathy, patients with hepatic encephalopathy had significantly lower zinc concentrations (P=0.002). Conclusion: Optimizing the amount of trace elements may help forestall complications and maybe reduce the beginning of liver cirrhosis. It would be advisable to routinely offer trace element analysis.

Background: Universal flexion is the most common attitude of the fetus at birth which allows normal progression of labor. The attitude of the fetus head during the active phase of labor is generally identified by per vaginal digital examination. Recently a newer ultrasound parameter, Occiput spine angle can aid our conventional clinical examination to assess fetal head deflection. Objectives: (1). To measure occiput spine angle during first stage of labor using Tran’s abdominal ultrasound. (2).To determine whether this occiput spine angle has a relationship with course and outcome of labor. Methods: This was a prospective observational study conducted at the Obstetrics and Gynecology department Velammal Medical College and Research Institute, Madurai from January 2024 to June 2024. Women aged 18 (or) above with uncomplicated pregnancies at term (37 weeks and above) in cephalic presentation were subjected to trans abdominal ultrasound during the first stage of labor in fetuses with occipitoanterior and occipitotransverse position. The angle between fetal C1 cervical spine and occiput of fetal head was measured in the sagittal plane using trans abdominal ultrasound by two investigators. The mean value of the two measurements was taken as occiput spine angle (OSA). The correlation between the occiput spine angle and progression of labor along with mode of delivery were evaluated. Results: A total of 200 pregnant women were assessed. Out of which 143 participants underwent normal vaginal delivery and 57 study participants required obstetric interventions (44 lower segment cesarean and 13 instrumental deliveries). The mean value of occiput spine angle was 127°.19±4°.27 during the active phase of the first stage of labor among the women who underwent normal vaginal delivery. The occiput spine angle was markedly lesser in women who underwent obstetric intervention. The mean OSA value for instrumental delivery was 111°.46±2°.93. Whereas mean value of OSA for LSCS delivery was 110°.61±3°.37. The inter observer reliability was moderate, identified by Cohen’s kappa statistics (0.41-0.61) for measuring the occiput spine angle. A larger occiput spine angle measurement >127° showed shorter duration of a first and second stage of labor which resulted in normal vaginal deliveries (P<0.001). Conclusion: Measuring occiput spine angle during first stage of labor using ultrasound is an effective predictor of course and outcome of labor. The OSA>126° was associated with more incidence of normal vaginal delivery & shorter duration of first and second stage of labor whereas occiput spine angle less than 120° was associated with higher incidence of obstetric intervention & increased duration of first stage of labor. Narrower occiput spine angle would alert the obstetrician even in primary care center regarding labor dystocia and less likelihood of normal vaginal deliveries. Hence this newer ultrasound parameter occiput spine angle may be used as an adjunct to predict the course and outcome of labor thereby the need for obstetric interventions.

Introduction: Although the exact origin of FC is unknown, a number of environmental and genetic variables have been suggested. The greatest age at which FC occurs is 14–18 months, which coincides with the age at which anaemia due to iron deficiency (IDA) is most prevalent. Iron is necessary for the synthesis of myelin, which is needed for nerve cells and can alter the amplitude and sensitivity of a neuron’s excitation, as well as for the metabolic processes of the brain and neurotransmitters. Aims/ Objective: To compare the incidence of IDA and haematological parameters in children with febrile convulsion (FC) versus patients with febrile illness without convulsion (control). Materials and Method: In this observational study, 50 patients with FC and 50 patients without FC were evaluated for haematological parameters.   Children’s anaemia was classified by the Ministry of Health and Family Welfare Guidelines as Hb < 11g/dl.  For children under one year old, the normal amount of iron levels was defined as Fe greater than 40 µg/dl, and for those over one year old, Fe greater than 50 µg/dl. The TIBC normal range was defined as 210–430 µg/dl. Transferrin saturation greater than 15% was defined as normal.  Results: There were significantly greater cases with family history of febrile convulsion in FC group (p<0.05). Patients with febrile convulsions had significantly lower serum iron and transferrin saturation as compared to patients with febrile illness without convulsion (p<0.05). There were significantly more cases of iron deficiency anaemia (46%) in febrile convulsion group as compared to 22% in control group (p<0.05). Conclusion: The results indicate that low serum iron and iron-deficiency anaemia affect a significant portion of children with febrile convulsion essentially, this suggests that anaemia and low blood iron levels can reinforce febrile seizures in children.

Background and Objective: Though pregnancy and labor are considered a physiological process the potential for catastrophic complications is constant and may develop in a matter of minutes. One indicator of pronounced maternal morbidity is obstetric admission into the ICU. This study was done to evaluate the risk factors and maternal and fetal outcome of ICU admissions. Materials and Methods: This was a retrospective study done in 6 bedded ICU, Department of Obstetrics & Gynaecology, PMCH, Patna, Bihar over a period of 2 yrs from January 2017 to December 2018. Analysis of the causes of obstetric ICU admission, interventions required, duration of ICU stay and maternal and fetal outcome done. Results: Out of total 17147 labour room admissions 2139 patients were admitted in ICU. Patients of eclampsia / HDP had maximum occupancy followed by obstetric haemorrhage. 238 patients died while 1891 survived 10 patients were taken to other hospital, by patient’s relatives. Mean duration of ICU stay was 5.8 days. Perinatal death was 21.55%. Conclusion: The major cases admitted in ICU were of Antepartum eclampsia/HDP, pregnancy with heart disease, obstetrics haemorrhage, septic abortion, severe anaemia and severe jaundice with pregnancy. Multiparity, lack of ANC, delayed reporting to hospital were the major risk factors associated and also influencing the maternal and fetal outcome.

This study investigates the relationship between lipid profiles and cognitive function in vascular dementia (VaD) patients. Lipid analysis revealed significant associations: higher total cholesterol and LDL-C levels correlated with poorer cognitive scores, while elevated HDL-C levels showed a positive correlation with better cognitive performance. These findings underscore the potential of lipid management strategies, such as reducing LDL-C and increasing HDL-C, to mitigate cognitive decline in VaD. Future research should focus on larger, longitudinal studies to validate these associations and develop targeted interventions.

Background: Recent evidence indicates that serum lipids, apart from hypertension, may potentially hasten the deterioration of renal function. Aim: The aim of this study is to investigate the association between low to high-density lipoprotein ratio and renal function in elderly hypertensive patients in a tertiary care hospital. Hypothesis: We hypothesize that a higher low to high-density lipoprotein ratio is associated with worse renal function in elderly hypertensive patients in a tertiary care hospital. Results: During the investigation, renal function declined by an average of 3 percent; hypertension accelerated this decline. Individuals whose low-to-high-density lipoprotein cholesterol ratio was greater than 4.5 experienced a 30% more rapid decline in cholesterol levels than those whose ratio was below 3.5. Statistical analyses revealed, both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant. The contribution of lipids to the investigation of joint effects was limited to participants who experienced concurrent increases in blood pressure and lipid levels. Conclusion: The findings indicate that blood lipids, apart from hypertension, exert an influence on the deterioration of renal function.

Background: Increasing antimicrobial resistance is a cause of concern in health care and needs to be addressed with immediate effect to prevent future consequences. Evaluation of prescribing patterns at regular intervals facilitates the identification of problems related to drug use, sensitizes physicians, and helps in formulating guidelines for the rational use of medicine. Material and Methods: This prospective, cross-sectional study was conducted in a tertiary care hospital over a period of 6 months. The WHO indicators were used to evaluate the prescriptions. Results: A total of 930 prescriptions were collected. The average number of drugs per encounter was 3.1. The percentage of antibiotics prescribed was 40.7%.  1% of prescriptions have an injectable antibiotic prescribed, and 99% of drugs were prescribed from the essential medical list. Only 12.1% of antibiotics were prescribed by their generic name. Conclusion: the prescriptions deviate from the recommended values set by the WHO. Continuous education and training activities for physicians and the appointment of clinical pharmacists in the wards are recommended to improve the rational use of medicines.

Background: Beta Thalassemia is hemolytic disease requiring regular blood transfusion which causes iron deposition in various organs of body in this study we study affect of iron deposition on lungs through pulmonary function test. Aims & Objective: To do pulmonary function test in Thalassemia major patients to assess the association between amounts of blood transfusion with results of pulmonary function test in Thalassemia major patients to assess the association between S. Ferritin level and with results of Pulmonary Function test in Thalassemia major patients. Study Methodology: This study is Observational study where pulmonary function test is carried out on 40 patients of Thalassemia major receiving blood transfusion and various results of test are compared and with pearson correlation results were obtained. Results: The correlation of pulmonary function test parameters of Thalassemia children between the BMI, Hemoglobin, S. Ferritin and chelation therapy were statistically not significant. Meanwhile, correlation of FEV1% with age and number of blood transfusion were statistically significant Remaining parameters of PFT were not significant between age and Number of Blood transfusion.

Aim: The aim of the present study was to assess the biochemical parameters in patients with psychiatric disorders. Methods: The cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from July 2015 to September 2017 and 126 patients were included in the study. Results: The majority of patients 78(61.9%) were in the age group of less than 40 years and there were 48(38.1%) cases who were aged more than 40 years. Majority of cases were females 67(53.2%) and 59(46.8%) cases were males. 56(44.4%) cases were illiterates, 36 patients (28.6%) were educated upto primary level, 14(11.1%) were from higher secondary level,12(9.5%) were graduates and 8(6.3%) were educated upto secondary level. 71(56.35%) cases were having elevated triglycerides and 55(43.65%) cases were having triglyceride level under normal range. 83(65.9%) patients showed reduced HDL and 43(34.1%) cases were having HDL under normal range. 86(68.25%) were having their LDL under normal range and 40(31.75%) were having elevated LDL. 91(72.22%) cases were having their cholesterol under normal range and 35(27.78%) had increased cholesterol levels. 100(79.37%) cases were normotensive and 26(20.63%) were hypertensive. Conclusion: The blood tests to be demanded for vitamin deficiencies are of high importance in terms of early diagnosis, treatment and prognosis. In clinical practice, the diagnosis of psychiatric patients it depends on physician’s clinical experiences, clinical symptoms and patient’s self-assessments. In the current study, these biochemical parameters are objective and the composite information from these routine biochemical markers may improve the diagnostic effectiveness of depressive disorder.

Background: Labor, birth and immediate postnatal care are the most critical period for newborn and maternal survival. Unfortunately, the majority of mothers and newborns in low- and middle-income countries do not receive optimal care during these periods. Postnatal period being the first six weeks after birth is critical to the health and survival of a mother and her newborn. Material & Methods: A cross-sectional study was carried out among all women who delivered during the study period. Deliveries were traced telephonically and with the help of Anganwadi worker and health workers and were interviewed using pre-designed pretested interview schedule. Categorical data was analysed using Chi square test. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Majority (90.4%) deliveries were vaginal. Most of the deliveries (91.3%) were institutional deliveries and majority (62.0%) of them were conducted in a government institute. Majority 98.6% of new borns cried after birth. Skin to skin contact during delivery was practiced in only 34.6% of cases. Majority of new-borns, 95.7% were dried and wrapped immediately after birth. More than ninety percent babies (95.4%) were massaged and kajal was applied on eyes of 92.5% of babies. Conclusion: In the end the study concludes that though some practices like percentage of institutional deliveries, drying of baby after birth, colostrums feeding, bedding in were good but still some practices likes early initiation of breast feeding, birth vaccination, pre-lacteal feeding needs improvement.

Background: Acute cerebrovascular accidents (CVA) have a significant social and economic impact and ranks third in terms of morbidity and mortality after cancer and coronary heart disease. Electrolyte disturbances, particularly hyponatremia, are common in patients with acute cerebrovascular accidents which significantly worsens clinical outcomes. The main objective of this study was to estimate the different serum electrolytes, sodium, potassium and chloride and to determine the degree of hyponatremia with the clinical outcome in cerebrovascular accident patients. Material and Methods: A cross-sectional study was conducted in department of biochemistry, S.V. medical college, Tirupati on 40 acute cerebrovascular accident patients. Serum electrolytes were estimated and outcome was measured in terms of discharge or death based on degree of hyponatremia. Results: Out of the 40 study participants, 24 (60%) patients had altered serum sodium levels, of these 21(87.5%) had hyponatremia, 3(12.5%) had hypernatremia. Among 21 cases, 13 (61.9%) had mild, 6 (28.6%) moderate and 2 (9.5%) severe hyponatremia. The serum sodium concentration was notably decreased in the ischemic stroke (127.17 ± 6.83 mEq/L) in comparison to the hemorrhagic stroke (139.25 ± 6.73 mEq/L) with p-value: <0.001. Whereas serum potassium level was elevated in hemorrhagic stroke (3.24 ± 0.37 mEq/L) in contrast to the ischemic stroke (3.71 ± 0.46 mEq/L) with p-value 0.02. When outcome measures (death or discharge) were stratified, the overall deaths in patients with hyponatremia were 14.28%. Of this 7.69% deaths were with mild hyponatremia, 16.7% with moderate hyponatremia and 50% with severe hyponatremia with a significant P-value <0.001. Discussion: Our study highlights the necessity for heightened awareness and proactive management of hyponatremia, a common electrolyte disturbance in stroke patients. Regardless of mild, moderate, or severe, it has been shown to exacerbate the clinical course of stroke patients, leading to increased morbidity, prolonged hospital stays, and higher mortality rates. Conclusion: Hyponatremia is a critical determinant of clinical outcomes in CVA patients. Its presence significantly increases the risk of mortality, morbidity, and poor functional recovery. Early recognition and appropriate management of hyponatremia are vital to mitigate its adverse effects.

Introduction: Hepatitis B adds to the disease burden due to increased number of cases rising from past decade and is associated with increased morbidity and mortality. S -Adenosylmethionine regulates the cellular proliferation and plays an important role in the early diagnosis of Hepatitis B associated liver disease. Objective: To assess the correlation between S-Adenosylmethionine (SAM) levels with severity of Hepatitis B and to correlate S-Adenosylmethionine levels with Aspartate aminotransferase, Alanine aminotransferase and alkaline phosphatase. Methodology: A total of 118 Hepatitis B positive serum samples were collected from Microbiology laboratory from a tertiary care hospital. Blood samples of 5cc in plain tubes were collected from all patients. The serum was separated by centrifugation method and stored at -80⁰ C until S- Adenosylmethionine assay was done by Enzyme Linked Immunosorbent Assay (ELISA) technique and the values will be correlated with Aspartate Aminotransferase (AST), Alanine transaminase (ALT) and Alkaline phosphatase (ALP) levels of the patients. Result: Out of 118 Hepatitis B positive patients, 74 patients had normal AST , ALT and ALP levels, whereas 32 patients have deranged AST and ALT levels of more than 45 IU/L and 50 IU/L respectively and 12 patients had deranged ALP levels of above 140 IU/L. In patients with deranged Liver function test (LFT), SAM levels by ELISA showed an increase in concentration in 20 patients ( P = 0.03), whereas 22 patients had normal levels of SAM (P < 0.05). In 75 patients with normal LFT, SAM levels were within the normal range. Conclusion: The serum S -Adenosylmethionine levels can be correlated with the severity of Hepatitis B associated liver disease and it can be a potential non-invasive marker which helps in diagnosis of the patients.

Background: Blood stream infections (BSI) lead to significant morbidity and mortality, more so in immunocompromised group of patients like cancer patients. BCID 2 was evaluated for diagnosis of BSI and identification of organisms and resistance genes by comparing it with conventional culture methods followed by identification and susceptibility testing with VITEK-2 ^®COMPACT. Aims: The study aimed at evaluating the performance of BCID 2 panel and its comparison with VITEK^® 2 COMPACT with a primary objective of evaluation of performance for monomicrobial cultures and polymicrobial cultures along with net reduction in time to results and secondary objective of detection of resistance genes and comparison of susceptibility results with VITEK-2 ^®COMPACT. Settings and Design: It was conducted in the department of Microbiology ACTREC Tata memorial Centre, Navi Mumbai for a period of two months from 15^th January 2024-15^th March 2024.Retrospective analysis of database from microbiology records and hospital information system (HIS) was done for a period from 1^st November 2020 to 30^th November 2023. Methods and Material: Results of flashed positive blood cultures of sepsis patients from all Disease Management Groups (DMGs) and all age groups were included. Conventional agar media plating followed by VITEK^® 2 COMPACT were performed on all flashed positive blood culture bottles while BCID 2 was performed only on = positive blood cultures which were requested by clinicians as a part of treatment protocol. Demographic parameters were evaluated from HIS. Statistical Analysis used: Agreement statistics between BCID2 and VITEK^® 2 COMPACT methods were calculated for each BCID 2 target for monomicrobial samples with results from VITEK^® 2 COMPACT as reference standard in form of  positive percent agreement (PPA) and a negative percent agreement (NPA) at 95% confidence intervals. Concordance percentage was calculated as percentage of monomicrobial and polymicrobial results reported by BCID 2 which matched with that of VITEK^® 2 COMPACT and culture methods. For antibiotic resistance genes, categorical agreement, very major error and major error were calculated. Results and Conclusions: BCID 2 performed reasonably fair for identifying clinically relevant pathogens and providing reasonable concordance with the existing methodologies in our laboratory A total of 116 blood cultures were included in the study. PPA and NPA for Gram positive probes were 100% and majorly 100% for Gram negative probes accept. 91.6% for Escherichia coli and 98.9% for Enterobacter Cloacae complex. Discordance in results of 17/109(15.6%) monomicrobial samples was seen samples. Concordance was seen in 4/6(66.7%) polymicrobial samples. Total antibiotic resistance gene markers were detected in 66/116(56.9%)-63Gram negative and three Gram positive isolates. Most common resistance gene marker detected singularly were NDM 16/63(18.2%), followed by CTX-M 14/63(16%) and in combination was CTX-M +OXA-48 Like.8.16% isolates reported discordance in carbapenem resistance detection.

Introduction: Enterobacter species are gram negative bacilli  belonging to Enterobacteriaceae family.  Enterobacter spp  are one of the most common bacteria to cause nosocomial infections. Multidrug Resistance (MDR) is on increasing trend among Enterobacter spp which leads to difficulty in treating the patients that would result in increased mortality and morbidity associated with Enterobacter spp infection. Aims and Objectives: To determine the prevalence and antimicrobial susceptibility  pattern of Enterobacter spp isolated from pus samples over a period of  30 months. Materials and Methods:  This study was a cross sectional descriptive study. Enterobacter  spp was identified based on standard biochemical tests. Antibiotic susceptibility testing was done for all isolates by Kirby Baeur Disk Diffusion test as per CLSI guidelines. Results: Enterobacter spp infection was found to be increasing among pus samples and the antimicrobial resistance was  also  increasing to commonly used antibiotics and Multidrug resistance were also increasing trend. Conclusion: Therefore, the monitoring of the trend of Enterobacter spp infection and its antimicrobial resistance pattern should be done and strengthening of Hospital infection control practices should be practiced in order to prevent the nosocomial spread of highly multidrug resistance bacteria and also in the community.

Background: Age is an important determinant of mental illness. The overall prevalence of mental and behavioural disorders tends to increase with age due to the normal aging of the brain, deteriorating physical health, and cerebral pathology. Disorders such as depression and cognitive disorders have a high prevalence in the elderly. Due to socio-demographic changes, older adults are forced to shift from their own place to some institutions/old age homes. The prevalence of these mental health disorders in old age homes is not well studied. Methods: A descriptive study was conducted in seven old age homes of Urban Field Practice Area and 265 inmates participated in the study. The data was collected using a pretested, semi structured questionnaire. It was analysed using descriptive statistics. Results: The majority of the inmates were of >80 years accounting for 38.49%. Females (63.39%) outnumbered the males (36.6%) and widows/widowers were 40.37%. 41.07% of female inmates were literate. Prevalence of diabetes mellitus and hypertension was 58.86% and 22.26% respectively. The prevalence of depression and dementia was 43.39% and 60.75% respectively. Conclusion: The inmates of old age home have a high prevalence of depression and dementia. It is important to recognize these issues and manage them appropriately in the form of counselling, psychotherapy and essential medicines for better quality of life.

Background: Medical practitioners and researchers must prioritize research on anemia because it significantly impacts hemodialysis patients’ overall prognosis and quality of life. Objective: This study set out to address this by collecting data on the frequency of anemia in hemodialysis patients and comparing the effectiveness of different iron, folic acid, and erythropoietin regimens in treating anemia in tertiary care hemodialysis patients. Hypothesis: When it comes to treating anemia, we anticipate that hematinic medications will work for many hemodialysis patients suspected of having the condition. Materials & Methods: Lakhimpur Medical College and Hospital (LMCH), located in North Lakhimpur, Assam, was where this retrospective study with a cross-sectional design was carried out. The Dialysis Register and Case sheet kept at the dialysis unit of LMCH was the primary source of documented information for patients who have had hemodialysis between 1^st January 2021, and, 31^st December 2023. For this study, fifty patients diagnosed with chronic renal disease and who presented with anemia was included. Results: During the research, fifty patients were incorporated into the investigation at various times. With a mean age of 48.3 years and a standard deviation of 2.54 years, their ages ranged from 15 to 70[years]. The mean age fell somewhere in the middle. The total number of individuals consisted of 31 males, which constitute 62% of the total, and 19 females, which constitutes 38% of the total. Before therapy, the mean mean corpuscular hemoglobin was determined to be 32.54 ± 3.3; after treatment, it climbed to 34.21 ± 1.8 respectively. This improvement was statistically significant since its p-value was lower than 0.05, indicating that it was noteworthy. When comparing the changes in other hematological parameters that occurred before and after treatment with the hematinic combination (iron, folic acid, and EPO), there is no statistically significant difference between the two data sets. Conclusion: In addition to highlighting the efficiency of hematinic drugs, the study reveals the prevalence of anemia and its implications in patients undergoing hemodialysis. Future research might investigate the impacts over a more extended time and customize treatment options.

Background: Trigeminal neuralgia (TGN) is a brief, paroxysmal intense pain syndrome which involves one or two branches of the fifth cranial nerve, triggered by cutaneous stimuli. Severity of TGN can be analysed by visual analogue scale scores (VAS) and disability adjusted life years (DALYs). The primary management of TGN is medical. Surgical management can be considered at failed medical management. Objective: To compare the VAS scoring and DALY index after surgery in refractory TGN. Also, to estimate and compare the patient medical expenses in preoperative and postoperative period. Methods: This was a prospective study conducted in a tertiary healthcare facility, Chennai, India with effect from January 2022 to March 2023. A total of ten patients were included. Patients with refractory (to medical management) idiopathic trigeminal neuralgia were enrolled and evaluated for disease severity based on VAS scores and economic burden was captured for pain management in the preoperative and postoperative period. Results: The results showed that after six months follow up, in the postoperative period, the mean VAS scores had reduced from 6.5 to 2.5 in 7 out of 10 patients with medical management. Three patients had persistence of symptoms with VAS scores more than 5. Two patients developed pseudo meningocele in the immediate postoperative period. The average expenses per month in the preoperative period was Rupees 1200 and that in the postoperative period was Rupees 800. Two patients developed 7^th nerve palsy and one patient developed sensory hearing loss of nearly 60 decibels in the operated side. Conclusion: After surgery, the refractory TGN pain VAS scores had improved. Cost benefit analysis showed that postoperative expenses were economical. The surgical outcomes of the patients were good.

Background: Dengue is the most widespread vector-borne infectious disease of humans. Over half of the world’s population now live in tropical and subtropical zones that place them at risk of infection. Objectives: To assess the level of knowledge and attitude about the cause of dengue, its spread and symptoms. Also, to assess the practices related to prevention of dengue and its complications. Methods: This was a cross-sectional study carried out in the Department of General Medicine for a period of 3 months. Both patients and bystanders who were aged more than 18 years, attending the OPD during the study period and gave informed consent were the study participants. The sample size was estimated to be 356. The data was collected using a semi structured questionnaire. Statistical analysis was done using descriptive statistics. Results: 31.4% were found to have good knowledge and 48.3% moderate knowledge. 95.6% thought dengue to be transmitted through mosquito and 84.3% had answered its common symptoms. 97.6% thought dengue to be a serious illness, and 96.3% reported it will be possible to control mosquitos. 89.9% reported to use mosquito control aids, 81.5% reported that they covered drinking water container, and 70.3% reported that they kept themselves hydrated during the illness. Conclusion: Many had good knowledge and the attitude pattern was also positive among the participants. Certain practices like source reduction activities and wearing full sleeve clothing have to be encouraged among the study population.

Introduction: Tobacco use disorder is a global health concern, causing eight million deaths annually and significantly impacting disability-adjusted life years (DALYs). The prevalence of tobacco use disorder is 2–4 times higher among psychiatric patients. Youth with tobacco use disorder often have high rates of ADHD, bipolar disorder, anxiety, depression, and schizophrenia, and consume tobacco more than healthy individuals. This study aimed to examine the prevalence and severity of tobacco use and access to tobacco cessation among psychiatric patients in a tertiary care hospital in Gujarat. Materials & Methods: This cross-sectional study was conducted among 400 psychiatric patients at a tertiary care psychiatric hospital in Gujarat. A consecutive sampling technique was used, and informed consent was obtained from each participant. Demographic and clinical data were collected using a pre-designed proforma, and the Tobacco Craving Questionnaire-Short Form (TCQ-SF) was used to measure tobacco cravings. Results: The prevalence of tobacco use among psychiatric patients was notably high at 45%. Schizophrenia-related disorders were more prevalent (38.3%) compared to mood disorders (26.3%), behavioral syndromes (18.0%), and anxiety and stress-related disorders (17.5%). Higher tobacco use was observed among males, divorced or widowed individuals, those with lower education, employed individuals, and rural residents. Despite the psychiatric setting, the assessment and implementation of interventions for tobacco cessation or reduction remained suboptimal. Conclusion: To address the high prevalence of tobacco use among psychiatric patients, comprehensive screening should be enhanced across all patient groups, with targeted cessation programs for high-risk populations such as males, divorced or widowed individuals, and employed individuals. Training for healthcare providers on effective cessation strategies is essential, and inpatient admissions should be utilized as opportunities for screening and intervention.

Background & Methods: The aim of the study is to compare the postoperative analgesia of ropivacaine with dexmedetomidine and ropivacaine with fentanyl on intraperitoneal instillation in patients undergoing laparoscopic cholecystectomy. After explaining the procedure and obtaining written/informed consent, a total of 60 patients fulfilling the inclusion criteria, scheduled to undergo elective laparoscopic surgeries under general anaesthesia (GA), were included in the study. Results: There is not significant deference in all the vitals (pulse rate, systolic bp, diastolic bp, MAP, SpO₂, Respiratory rate) before surgery. p-value in all vitals more than 0.05 which is  not significant. In this study Mean NRS score was significantly higher in fentanyl group then dexmedetomidine group during follow-up.  Conclusion: Our study is that in patients whom posted for elective laparoscopic cholecystectomy intraperitoneal instillation of 0.25% ropivacaine along with dexmedetomidine 1mcg/kg provide more effective and prolong analgesia compared to intraperitoneal instillation of 0.25% of ropivacaine with fentanyl 1mcg/kg postoperatively up till 24 hours. It also decrease the dose of rescue analgesia require and provide improved quality of analgesia in first 24 hours postoperatively.

Background and Objective: Though pregnancy and labor are considered a physiological process the potential for catastrophic complications is constant and may develop in a matter of minutes. One indicator of pronounced maternal morbidity is obstetric admission into the ICU. This study was done to evaluate the risk factors and maternal and fetal outcome of ICU admissions. Materials and Methods: This was a retrospective study done in 6 bedded ICU, Department of Obstetrics & Gynaecology, PMCH, Patna, Bihar over a period of 2 yrs from January 2017 to December 2018. Analysis of the causes of obstetric ICU admission, interventions required, duration of ICU stay and maternal and fetal outcome done. Results: Out of total 17147 labour room admissions 2139 patients were admitted in ICU. Patients of eclampsia / HDP had maximum occupancy followed by obstetric haemorrhage. 238 patients died while 1891 survived 10 patients were taken to other hospital, by patient’s relatives. Mean duration of ICU stay was 5.8 days. Perinatal death was 21.55%. Conclusion: The major cases admitted in ICU were of Antepartum eclampsia/HDP, pregnancy with heart disease, obstetrics haemorrhage, septic abortion, severe anaemia and severe jaundice with pregnancy. Multiparity, lack of ANC, delayed reporting to hospital were the major risk factors associated and also influencing the maternal and fetal outcome.

Objective: To compare the efficacy and safety of Silodosin and Tamsulosin in treatment of Benign Prostatic Hypertrophy. Methods: Our study is an observational and comparative study of 120 patients. The patients were divided into two groups of 60 patients each – Silodosin Group and Tamsulosin Group. During the study 11 patient from the Silodosin group and 12 patients from the Tamsulosin group dropped out and 49 & 48 patients respectively from the groups were available till the end of the study. Results: The mean age, mean weight and duration of symptoms in both the groups was comparable and statistically not significant. The rate of improvement in the QLS was similar in both the groups, with gradual improvement towards the end of the study period, indicating that the onset of improvement in the QLS corresponds to the decrease in IPSS. There was insignificant difference in Qmax from baseline, the mean change was 0.12 mL/s (1.07%) & 0.25 mL/s (2.11%) for Silodosin and Tamsulosin group respectively. There were no significant changes in prostate volume and postvoid residual volumes in either group. Significant improvement was observed in different parameters in both the groups by the end of the study period. Six of the seven parameters were significantly improved. Regarding adverse events in our study, both treatments were well-accepted as assessed by various parameters. The events encountered were both mild in nature and transient. The most specific adverse reaction was retrograde ejaculation found in 3 patients in Silodosin group (and none in Tamsulosin group). Conclusion: Silodosin is comparable to Tamsulosin in the treatment of symptomatic BPH in Indian men. Both offer symptom relief without affecting prostate size in the short-term. Retrograde ejaculation was encountered only with Silodosin. This may influence the choice of drug – Tamsulosin for comparatively younger sexually active men. Further clinical studies, of longer duration, are needed to confirm whether this comparability in the treatment of BPH is sustained in the long term.

Introduction: Tranexamic acid (TXA) injections due to its antifibrinolytic properties can be used as a treatment for postpartum hemorrhage (PPH) on a global scale along with uterotonics. Aims and Objectives: The purpose of this study was to evaluate the safety and effectiveness of TXA and to identify potential side effects if any in preventing PPH following vaginal delivery. Material and Methods: This randomized controlled trial, conducted in a multispecialty Dhiraj hospital in Vadodara, India, involved 300 term patients over one year from February 2023 to March 2024. Subjects were randomly assigned into two groups. Each cohort received 10 prophylactic units of oxytocin. One group received 1 gm of intravenous TXA, while the other received 10 mL of normal saline intravenously within 2-3 minutes after delivery. Blood loss was measured using calibrated drapes, and mean changes in hemoglobin (Hb) and packed cell volume (PCV) were assessed from pre-delivery to postnatal day 2. Data analysis was done using SPSS (Statistical Package for the Social Sciences) software. Results: Patients in the research had an average age of 23.43 years with a standard deviation (SD) of 3.26 years. The occurrence of PPH was observed in 10 individuals (6.66%) in the TXA group and 17 individuals (11.33%) in the placebo group (p = 0.226). Furthermore, the mean blood loss was significantly lesser in the TXA group, measuring 250.10 mL with an SD of 133.54 mL, compared to 334.2 mL with an SD of 141.78 mL in the placebo group (p < 0.0001). Conclusion: Tranexamic acid can serve as a supplementary treatment alongside uterotonics during the third stage of labor, as demonstrated in this study.

Fine needle aspiration cytology is an easy and quick procedure to make a diagnosis in variety of lesions, especially in differentiating a benign lesion from a malignant one. Histopathology remains the gold standard in making a definitive diagnosis. Warthin’s tumor is the second most common benign salivary gland tumor of the major salivary glands. It mostly occurs in the 6th to 7th decade of life. It is more common in male patients (4:1 male: female ratio). It is histologically characterized by bilayered oncocytic epithelium with a lymphoid stroma. Superficial lobe of parotid gland is more commonly affected by warthin’s tumor. This case report discusses a case of a 58-year-old patient with warthin’s tumor where there was a diagnostic dilemma on cytological evaluation. The diagnosis was confirmed after histopathological examination. This paper highlights a discussion on differentials on cytology in the current case and emphasizes the importance of histopathological examination in the definitive diagnosis of this benign entity.

Background: In this study, we wanted to study the outcomes and follow up of ABO and Rh(D) incompatible neonates, to Study the incidence of ABO and Rh(D) incompatible setting, to follow up the neonates with ABO and Rh(D) Incompatible setting, to study the clinical outcomes among them and to initiate a prompt treatment, to propose a discharge plan for neonates with ABO and Rh(D) incompatible setting. Methods: This was a Hospital Based Prospective Observational Study conducted among 166 neonates with ABO incompatibility and 28 neonates with Rhesus (D) incompatibility between 24 to 44 weeks of gestational age delivered at Mediciti Institute of Medical Sciences, from 1st January 2021 to 30th June 2022, after obtaining clearance from Institutional ethics committee and written informed consent from the study participants. Results: The prevalence of ABO blood groups in mothers was O > B > A > AB. The prevalence of ABO blood groups in neonates was B > O > A > AB. SGA neonates are more prone to higher serum bilirubin levels. Neonates in whom elder siblings received phototherapy are prone for higher serum bilirubin levels. There was no correlation between mean serum bilirubin value and sex of the neonate. There was no correlation between mean serum bilirubin value and maternal factors like mode of the delivery and age of the mother. There was no significant difference in hyperbilirubinemia between OA and OB incompatible setting. Severity of hemolysis was more among neonates with Rh(D) incompatible setting than ABO incompatible setting. Maximum number of admissions among neonates with incompatibility is within the first three days of life. After 3rd day of life, maximum admissions are on 6th day of life. Early identification of ABO and Rh(D) incompatibility reduced the mortality and morbidity due to hyperbilirubinemia. Phototherapy as a mode of treatment was found to be effective in the management of hyperbilirubinemia. However, longer duration of phototherapy was required in neonates with evidence of positive DCT among ABO incompatibility. Cord bilirubin level above 2.6mg/dl has statistically significant association with the need for phototherapy with area under curve showing 0.77. Conclusion: As maximum number of admissions is on day 3 of life, the neonates with ABO and Rh(D) incompatible setting should be observed in the postnatal ward or should be followed up every day for at least 3 days of life. As serum bilirubin again peaks on day 6 of life, there should be a follow-up visit on day 6. As cord bilirubin is a reliable predictor of hyperbilirubinemia, it should be done all neonates born to Rh negative mothers.

Background: Across the world, poisoning from pesticides and other chemicals used in agriculture is a serious public health hazard, especially in poor countries. Weedicides such as paraquat, 2,4-D, and glyphosate have been shown to be among the several compounds that significantly contribute to higher rates of sickness and mortality. Publications about weedicide toxicity are few. Aims and Objective: To investigate the biochemical, haematological, and demographic characteristics of weedicide poisoning. Materials and Methods: The current study, which is a retrospective observational study, involves individuals who suffered weedicide poisoning and were admitted at a tertiary health care facility. From the patient’s medical records, the researchers collected information on biochemical markers, clinical presentations, haematological parameters, and demographics. Result: There were a total of 28 cases of weedicide poisoning, of which 19 (67.86%) included paraquat, 7 (25%), and 2 (7.14%) used 2,4-D. In terms of results, 10 (35.74%) of them were discharged, 6 (21.43%) of them died, 12 (42.86%) got referred to a higher centre for hemoperfusion/hemodialysis, and 1 (3.57%) absconded. Conclusion:  There is evidence linking weedicide consumption to high rates of sickness and fatalities. The prompt underscores the need of expeditiously detecting and executing preemptive actions to tackle instances of weedicide toxicity, considering the lack of a specific remedy.

Background and Objectives: Thrombocytopenia is a problem commonly encountered in the elderly with a variety of etiology. Causes of thrombocytopenia is not well studied in the elderly. Both Chronic Idiopathic Thrombocytopenic purpura and Myelodysplastic syndrome are two hematological conditions that can present as chronic persistent thrombocytopenia. Both these entities have different prognosis, predictive survival and treatment. The objective of this study was to find the causes of thrombocytopenia in patients above 50 years and to distinguish Chronic Idiopathic Thrombocytopenic purpura from Refractory thrombocytopenia of Myelodysplastic syndrome in patients coming to Department of Clinical Pathology, Govt. Medical College Kozhikode during the study period. Materials and Methods: In this descriptive observational prospective study, a total of 150 cases of thrombocytopenia coming to clinical pathology department were selected by simple random sampling. Study group was patients above 50 years. Study period is from January 2017 to September 2018. Morphological study of peripheral smear, Bone marrow aspirate, imprint, and trephine biopsy was done in these patients. Special stains PAS and Perls were done, on marrow aspirate IHC for CD34 on bone marrow Trephine to look for increase in blasts in Myelodysplastic syndrome. Results: The most common cause of thrombocytopenia in this study was infections 35(23%) followed by Chronic persistent thrombocytopenia, Acute Leukemia and Megaloblastic Anemia. The commonest infections were Dengue fever, Leptospirosis, Sepsis, etc. On follow up there were 28 cases of Chronic Persistent Thrombocytopenia. Out of these there were 20 cases of Chronic ITP where thrombocytopenia persisted and 8 cases which can be either Chronic ITP or MDS. Micromegakaryocytes was observed in 13 cases (65%) of Chronic ITP compared to Chronic ITP/MDS (p value 0.06). Megakaryocyte proliferation was observed in 10 (50%) cases of Chronic ITP compared to cases of Chronic ITP/MDS. Conclusion and Limitation: From this study it was found that the most common cause of thrombocytopenia above 50 years was infections. Both ITP and MDS can cause morphological alterations in the megakaryocytes. In true cases of ITP, majority of megakaryocytes are micro or hypolobated forms, whereas in MDS, majority are normally lobated and hypolobated forms. A better distinction is possible only with a long follow up and cytogenetic study.

Stillbirths are a cause for concern globally. Stillbirth rate is a key indicator of quality of care given during antenatal and intranatal period. High prevalence of stillbirths in India necessitates analysis of risk factors of stillbirths both at national and local level. Aim: To determine the  maternal and fetal factors causing stilbirths. Methods: The present study was conducted in the department of Obstetrics and Gynecology, Andhra Medical College, Visakhapatnam. It was a hospital based observational study for a period of one year from January 2023 to December 2023. Case sheets were analysed for risk factors of stillbirths. Results tabulated and analysed using Microsoft excel. Results: A total of 5,912 births occurred during the period of one year and 146 were stillbirths. The still birth rate was 24.69 per 1000 births. The maximum number of still births occurred in the age group below 20 years (54.1%). Multigravida had increased risk of stillbirths with 87 cases (59.58%). Still births were maximum in low socioeconomic status  (56.16%). Stillbirths were highest in gestational age 28-32 weeks and was 58(39.72%).The maximum number of cases seen in the birth weight category above 2000-3000 grams, 68 cases (46.57%). Conclusions: The corner stone of preventing stillbirths is good antenatal care. Prevention of anemia by iron folic acid supplementation, early identification of hypertension in pregnancy and its appropriate management is essential.

Orientation and foundation program for MBBS students at the entry level, as suggested by the MCI, helps reduce students anxiety and boosts their confidence. It facilitates their smooth transition from high school to an undergraduate medical course. The enthusiastic participation of newly admitted students in various sessions during the program and their feedback was very encouraging. The feedback undoubtedly indicated that students were very happy and satisfied with the program. Similar results were obtained by various previous studies. A structured foundation course, such as ours, can help alleviate students worries, and help them cope with forthcoming professional demands.

Background: Persistent allergic rhinitis (PAR) is a chronic condition affecting the nasal mucosa, leading to significant morbidity and impaired quality of life (QoL). This study evaluates the impact of immunotherapy and surgical intervention on QoL in PAR patients. Methods: A prospective clinical study was conducted over 18 months at two medical centers. Patients aged 12 and older with refractory allergic rhinitis were included. Detailed history, clinical examination, and necessary investigations were performed. Initial treatment involved azelastine and fluticasone nasal sprays and oral prednisolone. Refractory cases underwent surgical interventions based on anatomical abnormalities. Follow-up was conducted monthly for three months. Results: Significant symptom burden was observed in the study population. Pre-treatment Day-Time Nasal Symptom Score (DTNSS) had a mean of 8.76. Post-surgical intervention, the mean DTNSS decreased to 3.24 after one month and 0.86 after three months (p < 0.001). Mean scores for sneezing (2.48), itching (1.62), nasal obstruction (2.64), and rhinorrhea (2.14) indicated significant symptom impact. Surgical interventions led to substantial symptom relief and improved QoL. Conclusion: Immunotherapy combined with surgical intervention significantly improves QoL in PAR patients. Personalized treatment plans addressing both immunological and anatomical factors are crucial for optimal patient outcomes.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is also called COVID-19 has had a profound impact on human lives, reshaping societies and altering the course of daily existence. The virus, which spread rapidly across the globe, led to widespread illness and a significant loss of life. Healthcare systems were strained, exposing vulnerabilities and prompting urgent adaptations. Objective: The present study aimed to examine the incidence and possible association between age and gender among positive COVID-19 patients (aged <75 years), and to explore the possible reasons for variations observed across different age groups and genders. Methods: This was a retrospective hospital based analytical study. After an elaborate consent process, nasopharyngeal & oropharyngeal swabs were collected in Viral Transport media (VTM) and sent to the testing laboratory for confirmation by nucleic acid–based reverse transcription polymerase chain reaction (RT-PCR). Descriptive statistics, Chi-square tests were done and significance of tests was decided at P=0.05. Results: Data regarding patients details were collected in the hospital facility. A total of 94, 672 (Assam – 92,511 and Arunachal Pradesh-2161) samples were collected from patient’s and tested for COVID-19 (October 2020 to March 2021). During this period a total of 2,210 positive cases were detected at the laboratory from Assam (n= 2,095, 94.8%) and Arunachal Pradesh (n= 115, 5.2%) respectively. Sonitpur district (n=1416) of Assam reported the highest number of positive cases followed by Udalguri district (n=306). Males (n=1761, 79.7 %) was affected more than females (n= 449, 20.3 %).  In both male & female the age group which was affected the most was between 16-30 years and 31-45 years. Conclusions: Early diagnosis by real time PCR has helped in the identification of the pathogen in individuals at an early stage, which has facilitated the containment of positive cases.

Background: Urinary Tract Infections (UTIs) caused by Multidrug-Resistant (MDR) gram-negative bacteria, specifically Enterobactericeae, are a growing concern because of limited therapeutic options. Fosfomycin as a novel oral therapeutic option against the MDR uropathogens has been widely discussed recently. Objectives: To know the local antimicrobial susceptibilities and to evaluate the activity of Fosfomycin against Extended-Spectrum Beta-Lactamase (ESBL) producing, Carbapenem-Resistant (CR) and MDR Uropathogens in Southern India. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital from April to September 2023. Pathogenic organisms were identified from urine samples by conventional biochemical tests. Antibiotic sensitivity testing and ESBL production was tested for urinary isolates.. Minimum Inhibitory Concentration (MIC) for Fosfomycin was determined by E-test. Data were analysed using Microsoft Excel 2016. Frequencies and percentages were determined for categorical variables. Results: Out of the 58 positive isolates yielded after the urine culture, 36(68.6%) were E. coli, 16(10.16%) were Klebsiella spp., 4(6.77%) were Pseudomonas spp., 2(4.23%) were Proteus spp. Among 54 Enterobacteriaceae isolates, 41(75.93%) were ESBL producers, of which 31 were E. coli and 10 were K.pneumoniae. Among 54 Enterobacteriaceae isolates, 20(37.03%) were Carbapenem resistant Enterobacteriaceae and 19 (35.18%) isolates were found to be MDRE. However, all the isolates were found to be Fosfomycin susceptible both by disc diffusion method and by E-strips. Conclusion: Fosfomycin might be a promising antibiotic for the treatment of uncomplicated UTIs due to E. coli. It has also shown good activity against ESBL-producing, CR, and MDR uropathogens.

Introduction:  Alcohol dependence is a major chronic relapsing disorder. Relapse is a phenomenon which is multifactorial. It is mostly due to the combination of various factors such as patient characteristics, environmental and the drug rein forcers. Risk Factors for relapse are intrapersonal factors and interpersonal factor. Intrapersonal factors reside within the person. It has various subdivisions like coping with anger or frustrations, coping with emotional states which are harmful, coping with physical states due to previous use of substance, coping with other physical states which are harmful, testing personal control, to enhance positive emotional state, cue mediated temptation and giving in to temptation even in the absence of cues. Interpersonal factors are interpersonal conflicts that resulted in anger or frustration,, direct and indirect social pressures and to enhance positive emotional states in a situation related interpersonally like celebrations. Aim: To assess the association between the coping strategies and self-efficacy with relapse in alcohol dependent patients. Materials and Methods: Sample Size: 120 subjects. Type of study: Prospective study. Study tools: Alcohol abstinence self-efficacy scale, Coping Behaviours Inventory. Results: The subjects with good coping behaviour have more chance to remain abstinent, and the subjects with poor coping behaviour have more chance for relapse. Positive coping strategies to the situations that lead to relapse help the individual to remain abstinent for more periods.

Background: Resilience is the capacity to bounce back from adversity. Severe mental illnesses are associated with poor and heterogeneous functional outcomes. Objective: To compare the resilience between patients diagnosed with schizophrenia and bipolar affective disorder. Materials and Methods: The present study was conducted in a tertiary mental care hospital. It is a hospital based cross sectional comparative study done in patients diagnosed with schizophrenia and bipolar affective disorder with the help of Resilience scale and qualitative interpretation of resilience scale. Statistical analysis was done by using IBM Statistical package for the social science version26. Results: In this study resilience scores in schizophrenia were lower than in bipolar patients and there was significant difference in resilience scoring between the two groups. Conclusion: The resilience of an individual is an important factor to assess the patient’s wellbeing. The aim of the treatment plan should include developing resilience in a patient and the need to plan for additional health care support during crisis periods when resilience is low.

Background: The use of vasoconstrictors in local anesthetics during minor oral surgical procedures is a common practice to control bleeding and prolong the anesthetic effect. However, there is concern regarding their impact on arterial blood pressure (ABP), especially in patients with underlying cardiovascular conditions. This retrospective study aims to evaluate the effects of vasoconstrictors on ABP during minor oral surgical procedures. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent minor oral surgical procedures over one year at Darbhanga. Patients were divided into two groups: those who received local anesthetics with vasoconstrictors (Group A, n=50) and those who received local anesthetics without vasoconstrictors (Group B, n=50). ABP was measured pre-operatively, intra-operatively at 5-minute intervals, and post-operatively. Data were analyzed using paired t-tests to determine the significance of changes in ABP within and between groups. Results: In Group A, the mean systolic blood pressure (SBP) increased from 120 ± 10 mmHg pre-operatively to 130 ± 12 mmHg intra-operatively and returned to 122 ± 11 mmHg post-operatively. The mean diastolic blood pressure (DBP) increased from 80 ± 8 mmHg pre-operatively to 85 ± 9 mmHg intra-operatively and returned to 82 ± 8 mmHg post-operatively. In Group B, no significant changes in SBP or DBP were observed. The increase in intra-operative SBP and DBP in Group A was statistically significant (p < 0.05) compared to Group B. Conclusion: The use of vasoconstrictors in local anesthetics during minor oral surgical procedures is associated with a transient increase in ABP. Although the increase is statistically significant, it remains within clinically acceptable limits for the majority of patients. Caution is advised when using vasoconstrictors in patients with pre-existing cardiovascular conditions.

Background: Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered; however, epidemiologic data on pediatric urticaria are limited. Aim: The objective of this study was to study the clinico‑epidemiological profile of children with chronic urticaria. Methods: A retrospective study including children less than 14 years with chronic urticaria was conducted. Detailed history, clinical examination, investigation results, treatment taken, and follow‑up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders. Results: 148 children with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 56.7% children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in (16.2%) patients; Antinuclear antibody was negative in all patients. 107 (72.3%) children responded to nonsedating antihistamines alone, 30 (20.3%) required addition of a sedating antihistamine, 4 (2.7%) required addition of Montelukast, 1 (0.67%) ranitidine and 5(3.4%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long‑term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months. Limitations: The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated. Conclusions: Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long‑term antihistamines.

Introduction: Pranayam is the most ancient basis of yoga practice. Regular practice of Pranayam and Om chanting can affect different body systems, especially the respiratory system. This research is designed to study the effectiveness of age-old practices like Alternate Nostril Breathing (ANB) and Om chanting on the respiratory system. Aim: To evaluate the effectiveness of ANB and Om chanting on spirometric parameters and respiratory endurance. Materials and Methods: An interventional study was conducted in the Department of Physiology at the Faculty of Medicine and Health Sciences, SGT University, Gurugram, Haryana, India. The study duration was eight weeks, and a total of 149 subjects, including both male and female participants aged between 18 and 25 years, were included in this study. Baseline recordings of anthropometric parameters, spirometric parameters like FEV₁, FEF_25-75%, and respiratory endurance parameters like BHTi, BHTe, and 40mmHg were recorded before the start of the study and again after eight weeks of intervention. A comparison of spirometric parameters and respiratory endurance was done using the paired t-test. Results: Comparison of spirometric parameters (FEV₁, FEF_25-75%) at baseline and after eight weeks of yogic practice showed statistically significant results (p-value < 0.001*). Respiratory endurance parameters (BHTi, BHTe, and 40mmHg) were also found to be statistically significant (p-value < 0.001*). Conclusion: There was a significant increase in all the above parameters after the intervention of 8 weeks. Both ANB and Om chanting are yogic breathing forms that can also be used as complementary alternative medicine in people with chronic obstructive lung diseases along with drugs.

Background: Adnexal mass is a common clinical presentation among females of all age groups, but predomi-nantly in reproduction age. It may be gynecological, non-gynecological, benign, or malignant. A clinical-pathological study can diagnose these adnexal masses. Method: 190 females aged between 14 years to 60 years were studied. The types of adnexal pathology were ovarian: 38 (20%) non-neoplasm, 97 (57%) benign and 37 (19.4%) malignant. In fallopian 12 (6.3%) ectopic pregnancy, 3 (1.5%) Hydrosalpinx-Blood ligament had 3 (1.57%) fibroids (true). Histopathologically malignant adnexal was found in 38 cases. Clinical findings versus histopathological findings were correlated. Conclusion: The present study of adnexal mass in reproductive females and the correlation between histopatho-logical ultrasonographic and clinical diagnosis will help the obstetrician and gynecologist treat such patients efficiently to avoid morbidity and mortality.

Background: Association between serum uric acid (SUA) and the outcome of acute ischemic stroke is debated and needs to be evaluated. The present study was conducted to study the serum uric acid concentration as an indicator of outcome among acute ischaemic stroke and to determine the role of serum uric acid as a risk factor for acute ischemic stroke. Methods: An observational study where 80 patients who presented within 48 hours of onset of stroke admitted to medical wards/ICU of MG hospital Bhilwara were selected for the study. Results: Out of 80 patients included for the study, Majority were male (68.7%) and 54.5% of the males and 52.0% of females showed raised serum uric acid levels. 34 out of 80 patients were diabetic (i.e. 42.5%) Among them 18 had raised serum uric acid (ie.52.9%), 58.8% of the patients were hypertensive and among them 55.3% were found to have raised serum uric acid, 29 out of 50 patients had bad outcome, with elevated uric acid levels found 21 among them. In the present study, outcome of Stroke were significantly associated with Serum Uric acid levels. Conclusions: Serum uric acid levels can be used as a prognostic indicator as a marker for increased risk of stroke.

Background: Pancytopenia is an important clinico- hematological entity worldwide but with different patterns in clinical presentation. Alterations in peripheral blood counts resulting in Pancytopenia are commonly encountered in pediatric practice and etiology in these patients are quite varied. Objective: To find out and analyze the various causes of pancytopenia in Pediatric population attending in R.I.M.S, Ranchi. Methods: The present study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences, and Ranchi. The permission to conduct this study was obtained from the central research committee of R.I.M.S and the Institutional Ethical Committee (IEC). Results: Age & sex distribution of patients with pancytopenia in this study was consistent with the findings in other studies. Megaloblastic anemia was the commonest cause of pancytopenia in the present study. 2nd most common cause was Hpoplastic anemia A significant percentage of them had a history of intake of bone marrow suppressant drugs, which could be avoided easily. Other causes were hypersplenism, Mixed nutritional deficiency anemia, Acute leukaemia and. Among them, megaloblastic anemia & mixed nutritional deficiency anemia are easily preventable. Rare causes like Gaucher’s disease have also been identified in our study.

Conclusions: Bone marrow study of patients with pancytopenia usually helps in identification of the etiology. It is very important to diagnose the cause of pancytopenia early in the disease process, so that adequate intervention could be done on time for the patient.

Introduction: The Bombay blood group lacks H antigen on red blood cells and is marked by anti-H antibodies in serum. It was discovered in Mumbai, India in 1952 and is rare, occurring at 1 in 10,000. Individuals with this phenotype can only receive blood from others with the same group due to severe transfusion reactions. Alternative techniques like acute normovolemic hemodilution may be used during surgery. Aims and Objective: To analyze the blood and other parameters individuals with bombay blood group. Methods:This retrospective study analyzed 35 patients with fatigue, dividing them into Group 1 (Bombay Blood Group) and Group 2 (other blood groups). It compared various blood parameters including hematological, coagulation, liver and renal function, electrolytes, and serum glucose. Inclusion criteria encompassed patients with complete blood reports, diagnosed and followed up in the hospital. Statistical analysis employed SPSS 27, with significance set at p<0.05. Results: The study found significant differences in baseline characteristics and blood parameters between patients with Bombay Blood Group (Group 1) and those with other blood groups (Group 2). Group 1 exhibited lower hemoglobin and red blood cell levels, implying distinct blood compositions. Additionally, Group 1 showed prolonged prothrombin time, suggesting impaired clotting, and higher hepatic parameters, indicating potential liver dysfunction. Despite slight variations, electrolyte and kidney function parameters were largely comparable between the two groups. Conclusion: Patients with the Bombay Blood group exhibit distinct hematological and hepatic profiles, but comparable electrolyte and kidney function parameters, compared to those with other blood groups.

Background: Acute myocardial infarction is the most common type of coronary artery disease with variable prognosis. This study sought to determine the clinical, electrocardiographic, echocardiographic, and coronary angiographic profile in patients with inferior wall ST-elevation myocardial infarction to establish the correlation of these parameters with the observed outcomes. Material and Methods: This observational, prospective study was conducted in 102 patients admitted with inferior wall ST-elevation myocardial infarction (STEMI) at Silchar Medical College, Silchar within 12 hours of onset of symptom. The data for all the patients were collected and eligible patients were assessed for electrocardiography, echocardiography, coronary angiography and clinical profile to correlate them with in-hospital and one-month follow-up outcomes. Results: The mean age of the study population was found to be 57.98 ± 9.02 years and majority were male (80.4%). The outcomes noted in patients during hospitalization were requirement of temporary pacemaker implantation (18.63%), cardiogenic shock (12.75%), hemodynamically significant ventricular tachycardia/ventricular fibrillation (9.8%), heart failure (5.88%) while the outcomes observed after follow-up were post MI angina in 15.22% of patients, heart-failure readmission (5.43%) and few patients developed reinfarction and other mortality (2.17%). In the study population, lower rate of mortality was observed in patients with single vessel disease (SVD) than multi vessel disease (MVD)(p=0.013); similarly, lower rate of post MI angina was observed in patients with SVD than MVD (p=0.02). Conclusion: To take rational therapeutic decisions in the management of inferior wall STEMI, it is paramount to identify the risks and outcomes using indicators such as clinical profile, electrocardiography, echocardiography, and coronary angiography parameters.

Anemia in pregnancy is one of the most common ailments affecting mothers worldwide. The condition has been estimated to affect around a quarter of the global population, with the majority of women being from the developing countries of Southeast Asia, including India. Anemia in pregnancy is caused by a multitude of factors. Of them, the most important is the increase in the demand for iron and other vitamins in the body. Populations of developing countries such as India have an already high burden of nutritional deficiencies, of which one of the most prevalent is iron deficiency.

Background: “Infertility is the inability of a couple to achieve pregnancy over an average period of one year (in a woman under 35 years of age) or 6 months (in a woman above 35 years of age) despite adequate, regular (3-4 times per week), unprotected sexual intercourse. A complete infertility work up is done before a treatment plan can be developed. The work up is streamlined, focused and completed shortly so that treatment can be started expeditiously. The success depends on age, duration and type of infertility, follicular count, semen quality and endometrial receptiveness. Studies on endometrial parameters in IUI cycles are insufficient to predict their role in successful pregnancy outcome. Therefore, the purpose of this study was to analyze the association of various ultrasound parameters of endometrial receptivity, including endometrial thickness, morphology and blood flow on the day of Beta HCG injection to predict outcome in IUI Cycles. Aim of the study is to assess the predictive value of endometrial thickness, morphology and vasculature using two-dimensional Doppler ultrasound and Transvaginal Sonography after IUI. Methodology: Prospective Non randomized Open labeled Clinical Study in women undergoing IUI cycle at Government Maternity Hospital, Sri Venkateswara Medical College, Chittoor District, Andhra Pradesh. The study was conducted from 1st October 2021 to 30 September 2022. Results and Conclusion: In the present study, women with EMT 7-10 mm had higher pregnancy rates compared to EMT 10-14 mm. Women with endometrial blood flow in Zone 3 had higher pregnancy rates than Zone 1. Overall pregnancy rate in present study was 9.8%. Higher pregnancy rates were observed when the duration of infertility was <5 years, and the TMSC was between 10 and 20 million. Pregnancy rates decreased with advancing male and female age. Better pregnancy rates were observed in patients with anovulation and malefactor infertility. Most pregnancies occur within the first 3 IUI cycles, after which couples are counselled regarding further assisted Reproductive techniques such as IVF.

Objective: The objective of our study was to evaluate the percentage of graft uptake and mean healing time of split thickness skin grafts (STSGs) in treatment of non-healing leg and foot ulcers of different etiologies and to assess the impact of non-healing ulcerations on the quality of life and the self-esteem of the patients and to evaluate whether STSGs for ulcers will have positive impact on patient’s quality of life and self-esteem. Materials and Methods: This is a prospective clinical observational study conducted in the department of general surgery, Government Kilpauk Medical College and Hospital from January 2016 to September 2016 on 49 patients selected by random sampling method. Percentage of graft uptake and mean healing time, HAQ-8 score and RSES score, both preoperatively and postoperatively were measured and recurrence, if any, was also noted. Result: A total of 49 patients with non-healing leg and foot ulcers of various etiology (diabetes mellitus, venous, trauma, burns) who met the inclusion criteria for this study were included in this study ranging of average age 50.55 years. Thirty-two (65.3%) patients were male and seventeen (34.7%) patients were female. There was a significant difference between the graft uptake and the mean healing time with an inverse relationship (P<0.0001). The present study showed there is a significant improvement in both quality of life as measured by HAQ-8 scale and self-esteem of the patient as measured by RSES scale after application of split-thickness skin graft for non-healing leg and foot ulcer patients. Conclusion: The present study concluded that STSGs is a simple, effective way for faster healing of ulcerations and it helps in improvement of quality of life and self-esteem of the patients.

Background: The most prevalent mental disorder in the world, depression is on the rise. Patients who stop their therapy or do not take their antidepressants as prescribed have poor treatment outcomes, a high relapse rate, and a bad quality of life. Aims and Objectives: The purpose of the current study is to examine the drug use patterns seen in psychiatry department patients taking antidepressants as well as the adverse drug reactions (ADR) seen in these individuals. Materials and Methods: The PSM hospital in psychiatry department was the site of the investigation. Data on demographics, diseases, and medications were gathered from 198 antidepressant prescriptions using a specifically created pro forma. Moreover, ADRs, if any, were recorded throughout their follow-up. Following a statistical analysis of the data, percentages and numbers were used to express the findings. Findings: 598 patients in all were examined. Of them, 42.13% were women and 57.86% were men. The age range between 41 and 60 was the most frequently afflicted and the one that received the highest dosage of antidepressants. The antidepressant that was prescribed the most was fluoxetine (48.32%). There were 957 prescriptions written overall, averaging 1.60 prescriptions per patient. In our analysis, generic versions of 75.65% of medications were prescribed. Conclusions: Drug usage studies are necessary to promote the responsible and reasonable use of medications. Monitoring and analyzing adverse drug reactions (ADRs) and drug interactions related to antidepressant drug patterns is also becoming increasingly important. Antidepressant use in patients was determined to be appropriate in this investigation.

Introduction: The global healthcare systems have faced substantial challenges since the onset of the COVID-19 outbreak in December 2019. While numerous trials and studies have been launched to comprehend and address the acute phase of the disease successfully, understanding the long-term consequences of COVID-19 has lagged, and the epidemiology of post-COVID conditions remains unclear. Post-acute COVID-19 is characterized by manifestations persisting beyond three weeks from symptom onset, and chronic COVID-19 extends beyond 12 weeks. Aim: To assess pulmonary function and other physiological parameters in patients recovered from COVID-19 to identify long term complications and sequelae. Material and Methods: Following the receipt of ethical clearance from the institutional review, an observational cohort study was conducted by establishing an Outpatient COVID-19 Follow-up Clinic. This clinic catered to all individuals who had been admitted to Terna Specialty Hospital and Research Center for COVID-19 treatment between June 2021 and August 2021. In cases where patients were managed at home post-discharge, a trained physician conducted telephonic consultations to determine the necessity of a follow-up visit. Result: Among the study participants, 44 individuals, constituting 44.0% of the total, were classified as having normal lung function. Twelve participants, accounting for 12.0%, were identified with Small Airway Disease, while six individuals (6.0%) exhibited characteristics indicative of Obstructive Disease. 45 participants, constituting 45.0% of the total, were identified as having diabetes, while the remaining 55 participants, representing 55.0%, did not have diabetes. Additionally, the table includes mean values for relevant glycemic indicators. The mean HbA1c on Day 1 was 6.14 with a standard deviation of 1.15, reflecting the average long-term blood sugar levels. Conclusion: Based on our current research, a substantial number of individuals who contracted COVID-19 experienced lingering symptoms after their recovery. Notably, fatigue emerged as the predominant concern, followed by cough and breathlessness.

Background and Aim: Both gabapentin and pregabalin have been demonstrated to be effective in the treatment of diabetic peripheral neuropathy and post herpetic neuralgia. In order to evaluate the efficacy of pregabalin and gabapentin in the treatment of neuropathic pain at a government tertiary care hospital in India, the current study was conducted. Material and Methods: Pregabalin was administered to 50 patients, while gabapentin was administered to the remaining 50. The Douleur Neuropathique 4 questionnaire (DN4) was employed to diagnose patients with neuropathic pain. The efficacy of the substance was determined by its ability to reduce neuropathic pain at consistent intervals. Results: The mean pain rating score of group 1 and group 2 is 7.92 and 7.95, respectively, on the first day of OPD (baseline). There is no significant difference between the two groups. However, the pain rating of group 1 is significantly different from that of group 2 (gabapentin) at the fourth week, as evidenced by the two-tailed test. (p<0.05) In the same vein, group 1 (pregabalin) is statistically significantly more efficacious than group 2 (gabapentin) at the 12th week. (p<0.05) In the same vein, group 1 (pregabalin) is more efficacious than group 2 (gabapentin) at the 24-week mark, with a statistical significance level of 0.001. Conclusion: The study determined that pregabalin is a superior medication for the treatment of neuropathic pain compared to gabapentin. However, the results of the current study may require further validation in a larger sample size.

Introduction: The meniscus is a vital structure to normal knee function re­sponsible for body weight distribution, shock absorption, pro­prioception, stabilization, lubrication of the knee joint, and pressure resistance. A variety of recent re­search has focused on the loss of circumferential hoop tension as the main precursor of onset and progression of osteoarthritis. Aim: To investigate the incidence of root tears of the posterior horn of the medial meniscus and cartilage loss in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears and cartilage loss. Materials and Methods: There were 101 knees of 74 enrolled patients who had undergone total knee replacement arthroplasty between January2023 and December 2023 in Viswabharathi Medical College and Hospital, Kurnool. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, body mass index (BMI), varus deformity and activity of the patient. Results: Meniscal tears were observed in 101 patients with complete root degeneration in 55 patients (P value <0.05), thin roots in 9 patients and with intact root in 37 patients. The Patients with complete root tear showed tricompartmental cartilage loss compared to other 2 groups. Conclusions: Factors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn and cartilage loss. Female sex, sedentary activity, Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn.

Background: Glycated haemoglobin (HbA1c) is a critical biomarker for assessing long-term glycemic control and diagnosing diabetes. However, factors unrelated to glucose metabolism, such as iron deficiency anemia (IDA), can influence interpretation.

Aim and Objective: To investigate the impact of IDA on HbA1c levels in non-diabetic individuals.

Materials and Methods: A case-control study involved 200 non-diabetic participants, 100 diagnosed with IDA and 100 without anaemia. Blood samples were collected to measure complete blood count (CBC), serum ferritin, serum iron, total iron-binding capacity (TIBC), and HbA1c levels. Descriptive statistics, independent t-tests, and correlation analyses were performed using SPSS version 25.0.

Results: The mean HbA1c levels were significantly higher in the IDA group (6.0 ± 0.5%) compared to the control group (5.4 ± 0.4%) (p < 0.001). A significant negative correlation was found between HbA1c and haemoglobin (r = -0.48, p < 0.001), serum ferritin (r = -0.55, p < 0.001), and serum iron (r = -0.52, p < 0.001), while a positive correlation was observed with TIBC (r = 0.38, p < 0.001).

Conclusions: Iron deficiency anaemia significantly impacts HbA1c levels in non-diabetic individuals, potentially leading to misdiagnosis of diabetes. Clinicians should consider iron status when interpreting HbA1c levels to ensure accurate diagnosis and appropriate management.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) and Hypothyroidism are prevalent conditions with significant metabolic implications. The relationship between these two disorders, particularly concerning gender differences and associated risk factors for NAFLD among Hypothyroid patients, remains underexplored. Aim and objective: This study takes a unique approach by aiming to determine the prevalence and risk factors of Non-Alcoholic Fatty Liver Disease (NAFLD) among Hypothyroid patients, irrespective of gender. Materials and Methods: This cross-sectional study, conducted with meticulous attention to detail, enrolled 300 adult patients diagnosed with Hypothyroidism, including 150 males and 150 females aged 18-65. Participants underwent a comprehensive clinical evaluation, including thyroid function tests, liver ultrasound for NAFLD diagnosis, and assessment of metabolic parameters such as BMI and diabetes. The robustness of our statistical analyses, which included descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression to identify NAFLD-related factors, further ensures the validity of our findings. Results: The prevalence of NAFLD among Hypothyroid patients was 40% (95% CI: 34.5% – 45.5%), with no significant gender difference observed (p = 0.95). Factors independently associated with NAFLD included older age (adjusted odds ratio [OR] 1.08, 95% CI: 1.02 – 1.15), higher BMI (adjusted OR 1.25, 95% CI: 1.12 – 1.40), longer duration of Hypothyroidism (adjusted OR 1.15, 95% CI: 1.05 – 1.26), and presence of diabetes (adjusted OR 2.50, 95% CI: 1.80 – 3.48). Conclusion: This study’s findings underscore the substantial prevalence of NAFLD among patients with Hypothyroidism, independent of gender. The results highlight the importance of metabolic screening and tailored management strategies for NAFLD in Hypothyroid patients, with the potential to significantly improve clinical outcomes and mitigate associated risks.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are significant events that can lead to increased hospitalizations, healthcare costs, and mortality. NT-Pro-BNP, a biomarker of cardiac stress, and serum magnesium levels have been associated with COPD exacerbations. Aim and Objective: This study investigates the correlation between NT-Pro-BNP and serum magnesium levels with clinical outcomes in AECOPD patients. Materials and Methods: This prospective observational study included 150 patients admitted with AECOPD. NT-Pro-BNP and serum magnesium levels were measured within 24 hours of admission. Clinical outcomes assessed included length of hospital stay (LOS), requirement for non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and in-hospital mortality. Correlation analyses, group comparisons, and multivariate logistic regression were performed to evaluate the relationships between biomarkers and clinical outcomes. Results: Elevated NT-Pro-BNP levels (>500 pg/mL) were found in 63.3% of patients, and low serum magnesium levels (<1.8 mg/dL) in 46.7%. NT-Pro-BNP levels positively correlated with LOS (r = 0.45, p < 0.001), NIV requirement (r = 0.38, p < 0.001), and IMV requirement (r = 0.29, p = 0.001). Serum magnesium levels negatively correlated with LOS (r = -0.31, p < 0.001) and NIV requirement (r = -0.27, p = 0.002). Patients with elevated NT-Pro-BNP had longer LOS (12 ± 5 vs. 8 ± 4 days, p < 0.001) and higher NIV (55% vs. 20%, p < 0.001) and IMV (28% vs. 8%, p = 0.001) requirements. Patients with low serum magnesium had longer LOS (12 ± 4 vs. 9 ± 5 days, p < 0.001) and higher NIV requirements (50% vs. 30%, p = 0.01). Multivariate analysis identified elevated NT-Pro-BNP (OR 1.58, 95% CI 1.15-2.17, p = 0.004) and low serum magnesium (OR 1.42, 95% CI 1.03-1.96, p = 0.03) as independent predictors of prolonged LOS. Conclusion: Elevated NT-Pro-BNP and low serum magnesium levels are significantly associated with worse clinical outcomes in AECOPD patients. These biomarkers can serve as valuable tools for early risk stratification and guiding clinical management in AECOPD. Further research is warranted to confirm these findings and explore potential therapeutic interventions.

Background: Traditionally external skin incision was used for distal obstruction of nasolacrimal duct which was replaced by endoscopic dacryocystorhinostomy after the introduction of nasal endoscope. Aim: To study advantages, complications and comorbidities of endoscopic dacryocystorhinostomy. Materials and Methods: The study was done in fifty patients diagnosed with chronic dacryocystitis. This study included men, women and children of various age group who presented with chronic epiphora. Patency of nasolacrimal duct was checked by lacrimal sac syringing with normal saline at follow up visits at the end of first, second and third week. Results:  The maximum number of cases of chronic dacryocystitis belonged to the age group of 41-60 years. A female preponderance was noticed with 28 (56%) females. There were 2 cases (4%) with epistaxis, 3 cases (6%) with nasal synechiae and 8 cases (16%) with postoperative crusting. Rest of the patients had uneventful postoperative period. The patency of lacrimal passage was investigated by sac syringing with normal saline. All 50 (100%) cases were patent on lacrimal syringing at the end of the 1^st and 2^nd week and 47 (94%) at the end of 3^rd week. Conclusion: Endoscopic Dacryocystorhinostomy is a minimally invasive, safe procedure without major complication. It can be performed as a day care procedure with excellent results and is preferred by patients as it is cosmetically acceptable compared to external dacryocystorhinostomy.

Aim: To study the antibiotic susceptibility pattern of the bacteria isolated in Tubo-tympanic (TT) type of Chronic suppurative otitis media (CSOM). Materials and Methods: Based on predetermined inclusion-exclusion criteria,189 patients were enrolled in the study. Ear discharge samples were collected and subjected to aerobic bacterial culture procedure. Kirby-Bauer disc diffusion method was used for assessing antibiotic susceptibility. Results: Staphylococcus aureus was the most prevalent isolate (32.78%) followed closely by Pseudomonas aeruginosa (25.00%). The Antibiotic Susceptibility Profile of S. aureus revealed Linezolid, Teicoplanin and Ampicillin-Sulbactam as the most effective options, with sensitivities of 98.31%, 94.92%, and 94.92% respectively. Levofloxacin and Ciprofloxacin exhibited the highest resistance levels at 81.36% and 79.66% respectively. For P. aeruginosa, Doripenem and Meropenem emerged as the most effective options, displaying sensitivities of 91.11% and 86.67% respectively. Ciprofloxacin and Levofloxacin exhibited resistance to these drugs, with values of 20.00% and 28.89% respectively. nConclusion: Because of the high prevalence of fluoroquinolone, penicillin, and macrolide-resistant S. aureus we should cautiously use these groups of antibiotics in patients of CSOM. To reduce the occurrence of resistant strains and encourage the efficient use of antibiotics, culture is recommended in all actively discharging cases of a TT Type of CSOM.

Background: The most common cause of delayed discharges and readmissions from hospitals during the first week of life is neonatal jaundice. Early detection of neonatal hyperbilirubinemia is crucial to preventing serious complications. The aim of this study was to investigate the clinical profile and etiology of neonatal jaundice. Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU), Department of Paediatrics, Government Medical College, Srikakulam, over a period of 1 Year (August 2022 to July2023). A total of 100 cases were enrolled for the study. Data collection was done by history taking, clinical examination and relevant laboratory investigations. Results: In this study, out of 100 jaundiced neonates, 65%) were males and 35% were females, 82 % were born at term and remaining 18% were preterm babies. Among 100 neonates studied, majority (83%) had birth weight ≥2500 gm. Only 17 % had birth weight less than 2500 gm. Physiological jaundice was seen in 54% of the total cases. This was followed by ABO incompatibility (18%), Rh incompatibility (13%), sepsis (2%), idiopathic (1%), prematurity (6%), cephalhematoma (4%) and breastfeeding jaundice (2%). Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This was followed by ABO incompatibility, Rh incompatibility and sepsis. This highlights the importance of appropriate monitoring of neonates with these underlying risk factors.

Background: Advancement in minimally invasive nephron sparing surgeries require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney. But the study in the variations in arrangement of structures at the renal hilum has not gained much interest up till now compared to literature available on the intra-renal vascular pattern of the kidneys. Aims and Objective:  So, the study was conducted to observe the arrangements of the renal hilar structures from anterior to posterior and from above downwards just before entering into the hilum. Materials and Methods: 100 embalmed cadaveric kidneys (44 left kidneys; 56 right kidneys) with intact renal hilar structures were studied for a period of 6 years. Grossly damaged kidneys were excluded for the study. The arrangement of the structures in the hilar region were noted and classified into various patterns. Results: In 75% of the cases the anterior division of renal artery is the uppermost structure in the hilum. The classical pattern of renal hilar structure arrangement from anterior to posterior as renal vein, renal artery & renal pelvis was observed in 65%. A high incidence (4.167%) of renal arterial variations in comparison to 2.083% incidence of variations of renal veins were observed. Conclusion: Renal hilar structures variations are useful for operating surgeons to identify and individually to clamp the hilar structures. This is advantageous over en-bloc clamping. Branching pattern of the renal artery is very important in analysing radiographic interpretation of renal vasculature for planning surgical procedures.

Background: Chronic otitis media is a common condition seen in patients attending the otolaryngology clinic and is an important public health problem. It is a chronic inflammatory disease of the middle ear causing conductive hearing loss that can range in severity up to 60dB. Pure tone audiometry is used to determine the degree, type and the configuration of hearing loss and to know a person’s hearing threshold to provide a basis for diagnosis and management. Aim: To study the audiological outcome after underlay tympanoplasty in mucosal type of chronic otitis media. Material & Methods: A prospective observational study was carried out in ENT department of PMCH, Udaipur from December 2022 to May 2024. Informed written consent was taken from all the patients. Seventy patients of chronic otitis media were selected as per inclusion and exclusion criteria.  Thorough history and clinical examination of ear, nose and throat was done. Preoperative hearing level was evaluated by pure tone audiometry. Underlay Type-I Tympanoplasty was done under local/ general anaesthesia by post-aural approach using temporalis fascia as graft material. Patients were followed up after 3 months for graft uptake and hearing assessment. Results: In our study majority of patients were in the age group of 21-30 years. 27 patients are male and 43 are females. Most common presenting complaints was otorrhea (100%), followed by hearing loss (97%), earache (37%), vertigo (2.9%) and tinnitus (7.4%). Majority of patients had mild conductive hearing loss 26-40dB loss in 36 patients (51.4%), followed by moderate hearing loss 41-54 dB loss in 32 patients (45.71%). After underlay tympanoplasty 54 patients (77.14%) came under normal hearing range followed by 26-40 dB loss in 16 patients (22.8%). Graft uptake was seen in 68 patients (97.14%). Conclusion: It can be concluded from our study that there is significant hearing improvement in patients who underwent underlay tympanoplasty as there is gain in hearing threshold after 3 months follow-up.

Aims and Objective: 1. To compares the advantages, complications, morbidity, mortality rates associated with each of the procedures. 2. To Study the recovery to physical independence in each of the procedures with respective approaches. 3. To compare results with other studies. Methodology: a Retrospective study of 42 patients undergoing hemiarthroplasty in Department of orthopaedics in Raichur institute of medical sciences, Raichur, Karnataka from September 2022 to September 2023. Results: Of the 42 participants, 17 (77.3%) of the individuals were female, while 5 (22.7%) were male performed LA [lateral approach], similarly 15 (75%) of the subjects were female, while 5 (25%) were male performed PA [posterior approach]. The average length of surgery in the lateral group was 70±15 minutes, while in the posterior group it was 90 ± 15 minutes which was found statistical significance, LA patients found less blood loss compare to PA patients which was statistical significance. The lateral group had a mean drain output of 90 ± 48 ml, while the posterior group had a mean drain output of 150 ± 22 ml. The difference in Drain Output between groups was significant. 2 % of the lateral group and 10% of the posterior group experienced dislocation. The lateral group’s median hospital stay was 6 days, while the posterior group’s median hospital stay was 9 days which was found statistical significance. Post-operative pain was completely mild in both groups: the lateral group (22) and the posterior group (20). In our current study, infection was found in 13.6% of the lateral group and 15% of the posterior group. There was no statistically significant relationship between pain and infection rate among groups. The post-operative mobilization was immediately on POD 2 in hardinges approach whereas it was POD 5 in post-approach groups which were statistical significance. Conclusion: This study indicated that there was statistically significant difference in rate of dislocation, length of surgery, blood loss between the lateral and posterior approaches for hemiarthroplasty of the hip joint. However early mobilization on the second day in the majority for the lateral group, early mobilization on the 5^th day in the majority for the posterior group, there was a substantial difference in hospital stay duration between the groups and participants of both groups showed mild pain.

Aims and Objective: To study the functional outcome in high grade spondylolisthesis of lumbar & sacral vertebrae patients post-surgery. Methodology: a Retrospective study of 30 all patients who underwent posterior instrumentation of lumbar & sacral spine surgery in Department of orthopaedics in Raichur institute of medical sciences, Raichur, Karnataka from September 2022 to September 2023. Results: 30 patients with high-grade spondylolisthesis at L5-S1 were operated using this progressive reduction technique, representing 14 patients grade III (28%), 15 patients grade IV (57%) and one patient grade 1 (15%). All procedure was performed in a single operation using a posterior approach. All patients were upright on the second postoperative day. The median follow-up was 12 months. Six months after surgery, 6 patients were pain free and able to stay home without disability. Only one patient presented persistent L5 sciatalgia. Even if, there was one patient with persistent pain, all of them maintained or improved their daily activities. All patients had good outcomes and returned to their full normal activities within 6 months after surgery. None patient developed deep or superficial infection. Conclusion: The purpose of this study was to describe technique reduction and results for treatment of high-grade spondylolisthesis with a progressive, single-staged, posteriorly and without forced reduction, sometimes combined to trans-vertebral trans-sacral for restoration of lumbosacral alignment and analyses functional and radiological outcomes.

Introduction: Haemorrhoids are a severe and common problem with severe bleeding along with pain, which needs extensive treatment. Two type of surgery includes for the treatment, one is Minimal invasive procedure for haemorrhoids and the other one is Open haemorrhoidectomy. There was a surgical method followed traditionally, the Milligan-Morgan technique which is characterized by severe pain and more duration for recovery.  Longo introduced MIPH which shows effective pain reduction with less duration of recovery. Aims and Objective: To evaluate the post-operative recovery of the hemorrhoids patients who received either open haemorrhoidectomy or minimal invasive procedure. Method: The random study trial was conducted among 60 patients having two surgical procedure, one is open haemorrhoidectomy and Minimal invasive procedure for haemorrhoids. 18  to 80  years of age of patients along with baseline , testing parameter and complications before & after the surgery was considered. VAS was used for pain measurement, surgery duration and time for staying in hospital was also measured. Chi-square test , students ‘t’ test was used for analysis of data and was evaluated using SPSS with P value <0.001. Results: The study shows that all patients undergoing minimally invasive procedures were male (100%), while the open haemorrhoidectomy group had 80% male and 20% female patients. For grades, 95% of open haemorrhoidectomy patients had Grade III haemorrhoids compared to 85% in the minimally invasive group. Minimally invasive procedures had significantly shorter mean procedure times (24.45 vs. 39.1 minutes), lower VAS pain scores on the first (2.05 vs. 5.95) and third days (1 vs. 3.35), and shorter hospital stays (2.1 vs. 4.15 days), all with P values <0.0001. Conclusion: The main conclusion from the findings is that minimally invasive procedures for haemorrhoids offer significant advantages over open haemorrhoidectomy.

Objective: To compare the efficacy of letrozole 5 mg and letrozole 7.5 mg in anovulatory infertile patients. Methods: A retrospective, an open label interventional, single center study. Total 50 women were divided into two groups of 25 each.1″ group is of Letrozole 5 mg with or without Gonadotropins and 2nd group is of Letrozole 7.5 mg with or without Gonadotropins who have previous unsuccessful ovulation with 2.5 mg of Letrozole. Study participants are of age 22 to 39 years. Study began in Feb 2022 and was completed in November 2022. Results: The main objective of successful ovulation is achieved in 44 out of 50 (88.00%). In women who received 5 mg Letrozole, ovulation rate was (21/25) [84.00%) (P- value= <0.05) and pregnancy rates (2/25) [8.00%] (P-value= <0.05). In the subsequent group of 7.5 mg of Letrozole out of 25 patients 23 patients has achieved ovulation (23/25) [92.00%] (P-value= <0.05) and successful pregnancy outcome (9/25) [36.00%]. Overall, with 7.5 mg Letrozole group has higher success ratio in term of Ovulation rate and successful pregnancy outcome. Another key observation was in 5mg group almost 92% patients required HP-hMG administration while in 7.5 mg group only 24% required HP-HMG intervention and multi-follicular development was observed in Letrozole 7.5 mg group. There was no any single case of Ovarian hyperstimulation syndrome (OHSS) in any of the group. Conclusion: In this study, we observed that high dose of Letrozole (5 mg or 7.5 mg) associated with higher ovulation rate and successful pregnancy outcome.

Plantar fasciitis is a common and painful condition affecting millions worldwide, characterized by heel pain. Despite advancements in diagnostic tools, managing patients with prolonged and resistant plantar fasciitis remains challenging. This study evaluated the therapeutic effects of Extracorporeal Shock Wave Therapy (ESWT) and Ultrasound Therapy (UST) in conjunction for patients with chronic plantar fasciitis unresponsive to conventional treatments. A total of 57 patients participated in this prospective, single-center comparative analytical study. The study assessed pain intensity using the Visual Analog Scale (VAS) and functional limitation using the Plantar Fasciitis Pain Scale (PFPS). The results of this study provide valuable insights into the efficacy of combining ESWT and UST in treating resistant plantar fasciitis, highlighting the potential for improved treatment outcomes and quality of life for patients with this debilitating condition. Further research is recommended to explore complementary therapies and ensure long-term treatment effectiveness.

Background: Doctors deal with human life and saves patient’s live and in doing so  the tough  Combined with this working environment and lifestyle related factors affect the mental health of doctors. So this study tries to measure the anxiety level of doctors and assess the factors affecting the health status of doctors. Material and Methods: A cross sectional observational study was done among the  Consultants and Post graduate residents of Mahatma Gandhi Medical College &  Hospital Jaipur. Demographic, health related factors, work related factors etc were noted and anxiety level was measured using HAM-A scale. Results: The mean HAM-A score of the study subject was 5.89 (SD 7.85). Anxiety is more prevalent in residents though not clinically significant. Significant anxiety was present is female and unmarried doctor (p<0.05). More duty hours, more number of night duties and higher work pressure were mainly responsible for higher anxiety among residents (p<0.05). Moreover and taking outside meal, taking meal when they get time and doing  less exercise were mainly responsible for higher BMI among doctors. Conclusion: Work related factors as duty hour, number of night duties, life style related factors as outside meal, irregular meals, less exercise affect physical health and mental health of doctors.

Background: Pancytopenia, the simultaneous reduction of all three major blood elements-hemoglobin, leucocytes, and platelets- is a common hematological finding in clinical practice. This study focuses on the sensitivity of clinical features and hemogram in diagnosing Megaloblastic Anemia in pancytopenic patients, integrating epidemiological data and etiopathogenesis within the Indian context. Materials and Methods: This prospective hospital-based observational study was conducted at the Department of Medicine, Mahatma Gandhi Medical College and Hospital, over 18 months from October 2022 to March 2024. The study included patients admitted under the Department of General Medicine who met the criteria for pancytopenia. They were appropriately investigated and treated as per case. Results: Out of 202 patients, 25.2% were diagnosed with Megaloblastic Anemia, making it the most prevalent cause of pancytopenia. The study highlighted generalized weakness and pallor as the most common clinical features, with pallor showing significant diagnostic sensitivity (84.93%) and specificity (24%). Conclusion: The study underscores the critical role of clinical features in diagnosing Megaloblastic Anemia among pancytopenic patients in a resource-limited setting. As well as using a hemogram and reticulocyte count to differentiate megaloblastic anemia from other causes of pancytopenia. This emphasizes the need for critical awareness to improve early diagnosis and management of Megaloblastic Anemia, particularly in regions with high nutritional deficiencies.

Background: Sepsis is a life threatening and body’s extreme response to an infection and is a medical emergency which may cause coagulation disorders like hypo coagulation and hyper coagulation state, using parameters like PT, aPTT, Fibrinogen, D-dimer and Thromboelastography which helps in early detection of these disorders so mortality and morbidity can be prevented. This study tries to find their relationship in identifying these blood coagulation state. Material and Methods: A descriptive cross-sectionalhospital-based study was done in Department of General Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur on sepsis patients admitted in ICU or HDU. Blood coagulation parameters were noted, and TEG was done and relationship between them was sought. Results: In sepsis patients PT, aPTT, D dimer and serum lactate levels were disarranged and were significantly positively correlated with R value, K value and CL30 and significantly negatively correlated with Alpha and MA of TEG. Also, fibrinogen level, WBC and serum albumin was significantly negatively correlated with Rvalue, K value and CL30 and significantly positively correlated with Alpha and MA of TEG. Conclusion: TEG parameterscorrelate well with blood coagulation defects in sepsis patients. Blood coagulation parameters and TEG can effectively detect the coagulation defects in sepsis patients to reduce mortality and morbidity.

Background: Chronic otitis media (COM) refers to an inflammatory condition affecting the middle-ear space, characterized by lasting and irreversible alterations in the tympanic membrane. Tympanoplasty is a procedure to remove disease from middle ear and reconstruct hearing with or without tympanic membrane grafting. Objective: The main aim of surgery is to eradicate infection and decrease the hearing disability in the patient. Materials and Methods: This hospital based randomized control trial study was carried out among all patients attending the OPD in ENT and Head & Neck Surgery Department of Rohilkhand Medical College & Hospital, Bareilly Uttar Pradesh in the stipulated period fulfilling the inclusion criteria. Results: There was no significant relevance in age of patients in between group A and Group B. There was no significant divergence in type of diagnosis of patients in between Group A and Group B. There was no significant difference in perforation size of patients in between Group A and Group B. The graft uptake rate was more in Group A as compared to Group B but there was no significant difference between Group A and Group B. There was no significant difference in graft uptake time of patients in between Group A and Group B. Conclusion: Although the graft uptake and hearing improvement were similar between the endoscopic and microscopic groups, the differences observed were not statistically significant. Furthermore, no complications were detected in either group. Therefore, this study affirms that both endoscopic and microscopic tympanoplasty procedures demonstrate comparable success rates in grafting and hearing enhancement. Conclusion: TEG parameterscorrelate well with blood coagulation defects in sepsis patients. Blood coagulation parameters and TEG can effectively detect the coagulation defects in sepsis patients to reduce mortality and morbidity.

Background: “Co-induction refers to the simultaneous administration of more than one drug that enhance the process of inducing anaesthesia, resulting in a synergistic effect. “Auto-co-induction” refers to the practice of administering a predetermined amount of an induction agent before administering a full dosage of the same agent. This approach is sometimes referred to as “the priming technique”. Our study aimed to compare effect of propofol priming and midazolam pre-dosing on demand of total induction dose of propofol and peri-intubation hemodynamics. Method: Total 105 patients of ASA grade I & II, aged 18-65 years were registered to this study and divided into three groups: Group P (Propofol), M (Midazolam) and N (Normal Saline). 1mcg/kg, Inj. Fentanyl was injected to all patients, 5 minutes prior to the induction and preoxygenated with 100% oxygen. The study group P received priming dose of Propofol 0.5 mg/kg, study group M received Midazolam 0.05mg/kg and study group N received Normal Saline 3ml followed by inj. 1% Propofol, at the rate of 30 mg/10 seconds till the loss of verbal command. Inj. Succinylcholine (2mg /kg) was given and appropriate size endotracheal-tube is used for intubation. No surgical stimuli were applied during 5 min after intubation. The values recorded: Total dose of propofol required, Heart Rate, Systolic BP, Diastolic BP, Mean BP and pulse-oximetry (SpO₂) measured before induction, after induction, immediately after intubation and 5 min after the intubation. Further anaesthesia was maintained on O₂ / N₂O (35% / 65%), inhalational agent isoflurane and Inj. Vecuronium. Following surgery, patients were extubated after reversing with Inj. Neostigmine and Inj. Glycopyrrolate. Statistical analysis: Analysed with the help of SPSS 20 software for windows. Appropriate univariate and bivariate analysis and ANOVA for comparing more than two means will be carried out and use of Student’s t-test and 2 test for categorical data will be applied to check the hypothesis according to the type of data i.e. continuous and categorical. Result: All three groups were similar regarding age, weight, sex, ASA status, baseline vitals. The mean total dose requirement of propofol was 69.2+12.3 mg in group M, 136.9+27.4 mg in group N and 89.5+18.7 mg in group P. The value showed statistically significant difference among the groups. The least requirement of propofol was seen in group M and maximum in group N. No statistically significant difference was seen among group in SBP, DBP and MAP, 5 minutes after intubation. Conclusion: Midazolam Pre-dosing (co-induction) was found better than pre-dosing with propofol (auto-coinduction) as far as demand of induction dose of propofol and cardiovascular stability were concerned, although delayed recovery and discharge to home due to sedation in day care surgeries were seen.

Background: The goal of preemptive analgesia is to provide an analgesic medication before a noxious stimulus is initiated in order to prevent the brain system from becoming more sensitive to subsequent stimuli that might exacerbate pain perception. A derivative of gabapentinoid, which has analgesic effects, is pregabalin. The purpose of this clinical trial was to assess pregabalin’s efficacy for postoperative analgesia following infraumbilical surgeries. Materials and Methods: With clearance from the institutional ethics committee and informed written agreement from the chosen patients, a one-year prospective clinical trial was carried out in a medical college hospital. Using an online randomization technique, a total of 60 patients with ASA grades I/II between the ages of 20 and 40 were randomly assigned into two groups (n = 30 each group). An hour before to the induction of anaesthesia, patients in Group P received oral Pregabalin 150 mg, while patients in Group D received oral Diazepam 10 mg. A 1gm tablet of paracetamol was given to each group equally two hours after the procedure was finished. As a last resort, patients with pain scores of at least three on the visual analogue scale (VAS) received an injection of 100 mg of tramadol. At intervals of 2, 4, 6, 12, and 24 hours, outcome variables such as the requirement for rescue analgesia, sedation, VAS score, and other adverse events were recorded. Results: Over the course of the first 24 hours following surgery, the mean VAS ratings for patients in Group P were considerably lower than those in Group D (P<0.0001). Tramadol was administered as a rescue analgesic injection after 12.329±3.471 hours in Group P, but it took 3.471±8.189 hours in Group D (P<0.0001). The patients in Group P and D required a total of 133.559±49.271 mg and 210.731±63.349 mg during a 24-hour period, respectively (P<0.0001). Conclusion: Pregabalin 150 mg during the preoperative phase offers better analgesia after surgery and significantly lowers the requirement for rescue analgesia thereafter.

Background: Globally, coronary artery disease (CAD) is still the primary cause of morbidity and death. Therefore, effective diagnostic techniques are required to determine the best course of treatment. When a patient has a clinical suspicion of coronary artery disease (CAD), non-invasive cardiological testing is essential to their first evaluation. These examinations offer insightful diagnostic data that supports treatment decision-making and risk assessment. Study Design: Observational study. Setting: Outpatient Department of Cardiology, Desun Hospital & Heart Institute, Kolkata. Participants: 100 patients clinically suspected of having CAD based on symptoms such as chest pain and shortness of breath. Interventions: Electrocardiogram (ECG), Echocardiography, and Cardiac CT Angiography. Result: The findings of the study are as mentioned, 64.2% of smokers had CAD, 82.5% of diabetics had CAD, 32.5% of patients with CAD reported a family history of the disease. And findings with reference to severity of CAD, Minor CAD (31%), Single vessel disease (26%), Double vessel disease (33%), Multi vessel disease (10%). Conclusion: Preventing and treating modifiable risk factors like as diabetes and smoking is crucial for the management of CAD. By concentrating on these areas, public health initiatives can greatly lower the prevalence of CAD and enhance cardiovascular health. It is advised to conduct more multi-center research with bigger sample numbers to confirm these results.

Introduction: Rise of blood pressure during pregnancy (gestational hypertension or pregnancy induced hypertension- ‘PIH’) is one of the most common causes of altered physiological process in pregnancy. There are very few scientific works in support of such hypotheses. Since placenta acts as a mirror to the disease process in mother and fetus or both we decided to study gross and microscopic placental structure in PIH. Aim: The principal aim of the present study was to perform a case-control study on comparison of morphological and histological examination of placentae obtained by delivery of pregnant mothers who suffered from pregnancy induced hypertension (as ‘PIH’ cases) with that of placentae obtained from delivery of pregnant mothers who had an uneventful ante-natal period (as ‘normal’ controls). To record and compare relevant histomorphometric details of two groups of placentae and to evaluate the data for statistical significance in order to reach at a conclusion. Materials and Methods: The present study entitled “Morphological & histological study of placenta in pregnancy with hypertension” was undertaken at department of Anatomy with co-operation of department of Obstetrics & Gynaecology of our Institution. The chief study material was placenta. Forty (40) placentae were collected from Institutional labour room immediately after term delivery of mothers having uneventful antenatal period (as control ‘C’). Another forty (40) placentae were collected after term delivery of pregnant mothers who had clinically proven   hypertension (pregnancy induced hypertension- PIH) during antenatal period [as cases or Experimental ‘E’]. Serial numbers were given to all the placentae of each group and all the entries were made with reference to same number throughout. Method of Histo-Morphometry: To quantify certain parameters we did morphometric study in histological sections. We used square and linear graticules (Haugh 1955) to be fitted in microscope ocular and stage micrometer to calibrate the linear graticule. Results: Volume Proportion of Calcification: The control placentae were showing the mean volume proportion of calcification 0.645 and the figure in PIH placenta was 4.954. The increased calcification in PIH cases was statistically significant. Conclusion: There was significantly increased of volume proportion of calcified areas was significantly increased in experimental group of placentae.

Introduction: Thyroid gland is unique endocrine gland and is vulnerable to the lesions. USG is primary choice of imaging technique to evaluate thyroid morphology due to its high sensitivity for nodular detection. FNAC is a sensitive investigative tool with 97% of diagnostic accuracy. This study was aimed to evaluate the USG and FNAC in the diagnosis of cases with thyroid lesions. Methods: A total 100 cases with thyroid disorders between age group 2^nd to 7^th decades were recruited. All the cases were subjected to detailed clinical examination and then subjected to ultrasonographic evaluation. Radiologically confirmed cases with thyroid lesions were subjected to FNAC. Results: Microcalcification was seen in 35.2% cases, Macrocalcification in 14.7% and no calcification in 26.4% cases. In USG diagnosis, 53.7% nodules were >1cm in size, Isoechogenic nodules was seen in 32.3%, Hyper echogenic in 29.4%, Hypoechogenic in 17.6% and anechoic nodules in 23.5% cases. USG findings was correlated with FNAC findings in 3% of medullary carcinoma cases, 5% of papillary carcinoma, 41% of thyroiditis cases, 14% of MNG cases, 25% of colloid goiter cases and 12% of adenomatous nodule. Conclusion: USG is a non-invasive procedure when compared to FNAC. In this study, USG showed best outcome in related to diagnose the features of thyroid nodules such as size, echogenesity, peripeheral halo, calcification and vascularity. USG is best image based diagnostic tool in the diagnosis of malignant and benign type of thyroid lesions, when it combines with US guided FNAC it can give still accurate results.

Introduction: Prostate cancer is the second most cancer type in men globally. Multiparametric MRI (mpMRI) PI-RADS scoring has an important role not only in the diagnosis and also estimate the lesion extent and severity of prostatic cancer. Aim: To assess the multiparametric 3T MRI in the diagnosis of prostatic lesions in cases with elevated PSA levels and its correlation Gleason’s score. Materials and Methods: This prospective observational study consists of a total of 36 cases with chief complaints of obstructive lower urinary tract symptoms above 50 years of age; with raised prostate specific antigen (PSA) levels were recruited. Radiological examinations included 2D T2 weighted images (T2W-MRI), dynamic contrast enhancement score (DCE-MRI), and diffusion weighted images (DWI) were assessed. Results: The mean ADC values of tumors with Gleason’s score >7 was 0.67 ± 0.12 x 10-3 mm2/s, tumors with Gleason’s score 7 was 0.78 ± 0.10 x 10-3 mm2/s, and tumors with Gleason’s score <6 was 0.84 ± 0.28 x 10-3 mm2/s. The mpMRI PIRADS score 3 was noticed in 8.33% cases, PIRADS score 4 was seen in 41.67% cases and PIRADS score 5 was seen in 50% cases. The overall outcome values of Gleason’s score and mpMRI PI-RADS score showed a sensitivity of 70.12%, specificity of 84.65%, positive predictive value of 79.36%, negative predictive value of 87.94% and kappa value of 0.57. Conclusion: There is a positive correlation between Gleason’s score and PIRADS score and a significant negative correlation between Gleason’s score and mean ADC value of prostatic tumor. This approach is effective in distinguishing the extent and severity of the condition. The implication of mpMRI PIRADS scoring in the context of elevated PSA levels can reduce the unwanted biopsy and economic burden to the patients.

Aim & Objectives: This study aims to evaluate the prevalence, contributing causes, and consequences of Cardiorenal syndrome (CRS) in patients with heart failure (HF) admitted to medical wards of a tertiary care hospital. Material & Methods: The research employed a cross-sectional design. During a 15-month period, patients who met the specific requirements and were at least 18 years old were recruited individually. In addition to the essential first blood tests, such as blood profile, CBC, urine analysis, eGFR, ECG, echocardiography, and renal USG, a comprehensive medical history and physical examination were conducted. The urine protein creatinine ratio was evaluated in individuals with proteinuria. At the initial presentation, serum creatinine, urea, and electrolyte levels were assessed. Subsequently, over the course of heart failure therapy, identical measurements were repeated. The precise description and categorization of heart failure and CRS were achieved utilising acceptable criteria. Statistical analysis conducted with the SPSS programme. Results: Out of the 100 patients examined, the average age was 50.639±13.401, with 62 being men and 38 being females. Out of the total, 53 individuals had cardiorenal impairment, whereas 47 individuals were exclusively in the heart failure patient group. The CRS group, including 86.8% of the participants, consists of individuals aged 40 and above (p=0.0401) who have a high prevalence of diabetes. In contrast, the non-CRS group, accounting for 76% of the participants, does not smoke. The majority of individuals impacted suffer from type 1 CRS, and 72.5% of CRS cases are classified as moderate CRS. High levels of serum urea (>120 mg/dl) and serum creatinine (>1.91 mg/dl) can be used to predict mortality. Individuals diagnosed with CRS exhibited significantly greater mortality rates compared to those who did not have the illness. Conclusion: Patients with heart failure exhibited markedly elevated rates of CRS. Individuals who were beyond the age of 40 and classified as NYHA class 4 were found to be independent predictors of CRS. Individuals with chronic rhinosinusitis (CRS) had significantly prolonged hospital stays compared to individuals without CRS. Within a hospital setting, the death rate for individuals with CRS is significantly elevated. Serum urea and creatinine serve as crucial indicators of mortality.

Background: Hepatic encephalopathy (HE) is a severe neurological complication of liver dysfunction, frequently seen in patients with cirrhosis or acute liver failure. Bowel wash and gut sterilizing agents have emerged as potential treatments to alleviate HE symptoms by targeting gut-derived neurotoxins, such as ammonia. Aim and Objectives: To evaluate the effectiveness of bowel wash and gut sterilizing agents in improving clinical outcomes and reducing recovery time in patients with hepatic encephalopathy. Materials and Methods: This prospective observational study was conducted over one year at Gandhi Medical College and Hamidia Hospital, Bhopal, including 100 HE patients graded using the West Haven criteria. Patients received bowel wash and gut sterilization therapy based on HE severity. Clinical and biochemical parameters were monitored, and data analyzed using Chi-square and one-way ANOVA tests. Results: The study included 100 HE patients with a mean age of 46.8 years (SD 14.387); 85% were male, and 77% had a history of alcohol consumption. Additionally, 8% tested positive for Hepatitis B and 2% for Hepatitis C. Clinical parameters revealed a mean hemoglobin level of 9.188 g/dL, total leukocyte count of 8265.30 cells/mm³, and a platelet count of 1.4897 lakh/mm³. Mean serum bilirubin was 2.5415 mg/dL, serum urea 43.314 mg/dL, and creatinine 0.9325 mg/dL. The mean prothrombin time was 23.310 seconds with an INR of 1.6143. Among the patients, 54% were in stage 2 HE, 34% in stage 3, 9% in stage 1, and 3% in stage 4. Most patients (83%) received bowel washes 3-4 times per day, 13% received them 2-3 times, and 4% received them 4-5 times. The mean recovery duration was significantly different across HE stages, with 1.89 days for stage 1, 3.79 days for stage 2, 5.97 days for stage 3, and 12 days for stage 4 (P < 0.001). In terms of outcomes, all stage 1 patients recovered. In stage 2, 52 patients recovered while 2 left against medical advice (LAMA). In stage 3, 28 patients recovered, 3 LAMA, and 3 died. In stage 4, 1 patient recovered and 2 died (P < 0.001). Conclusions: Bowel wash and gut sterilizing agents significantly improve recovery time and clinical outcomes in HE patients, particularly in early stages. These interventions are effective in reducing neurotoxins and managing HE symptoms, highlighting their potential as essential components in HE treatment protocols.

Objectives: The present study was to evaluate the high-resolution computed tomography lung spectrum in symptomatic adult HIV positive patients. Methods: General physical and respiratory system examination of all patients was done. Then a meticulous record of all the available laboratory investigations including HIV status, CD4 counts, routine blood examination, sputum examinations, pleural fluid analysis, FNAC, and other available investigations was kept. Chest x-rays of the patients were studied for the presence of any abnormality. HRCT scans of the chest were done using mentioned HRCT protocol. The patient was kept supine on the gantry table and was scanned cephalocaudal in the axial axis. Scans obtained with patients’ supine were adequate in most instances. Prone scans were taken when needed. The scanogram or to pogram was first taken and then the whole lung was scanned from apex to the base. The scans were performed on Siemens Somatom Emotion 16 Slice Multidetector scanner. Results: Out of 30 cases of HIV positive patients, most of cases were males 21(70%). Majorities of the cases 11(36.67%) were in age group of 18 to 30 years. 8(26.66%) cases were in age group of 31 to 40 years.21(70%) cases were diagnosed with pulmonary tuberculosis followed by 5(16.67%) bacterial infection. And 4(13.33%) cases had not significant abnormalities.Out of 21 pulmonary tuberculosis cases, 14(66.67%) cases were nodular opacities. HRCT pattern in bacterial infections cases were lobar Consolidation 3(60%), nodular opacity and bronchiectasis 1(20%). Conclusions: HIV positive cases were greatly seen in young age male population. Pulmonary tuberculosis was the most common clinical manifestation of HIV positive cases. Scans with Single finding and two findings, and three findings, nodules, Consolidation with pleural effusion, and nodules with cavitation with GGO with lymphadenopathy were the common HRCT pattern. Centrilobular with tree in bud, clustered with centrilobular with tree in bud, centrilobular and random were the common nodular distribution. Lobar Consolidation, nodular opacity and bronchiectasis were the common HRCT pattern of bacterial infection in HIV positive patients. Hence, HRCT is one of the best choice of investigations of lungs parenchyma in symptomatic HIV positive patients.

Background: Stroke is a leading cause of morbidity and disability in Asian population. Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. The present study was designed to evaluate the triglyceride (TG) and very low density lipoprotein (VLDL) levels of ischemic stroke and correlates it with National Institute of Health Stroke Scale(NIHSS)  and prediction of outcome based on Modified Rankin Scale (mRS) scoring system after 28 days from day of admission. Material and Methods: A Hospital based Prospective Observational study included 150 Patients of Acute ischemic stroke visiting  OPD and IPD of  Medicine department of  MGMC&H Jaipur. We estimated serum TG and VLDL levels of these patient and compare them with severity of stroke according to NIHSS scale and correlated the outcome based on Modified Rankin Scale (mRS) scoring system after 28 days from day of admission. Results: Increased TG and VLDL levels positively and significantly (p <0.001) correlated with NIHSS scale. Increased TG and VLDL levels positively and significantly (p <0.001) correlated with MRS scale. Conclusion: It could be concluded that higher TG, VLDL levels can be considered as a risk factor for ischemic cerebral events and higher levels of triglyceride and VLDL is associated with the more severe stroke and poor outcome.

Background: In CKD kidney is damaged in due course to a level that patient need regular dialysis. It put a lot of stress on dialysis patients. Multiple factors affect the mental health of CKD patients on hemodialysis. So this study tries to measures their  level of anxiety and depression and study the associated factors. Material and Methods: A cross sectional observational study was done among patients more that 18 years of age diagnosed as end stage renal disease on maintenance haemodialysis in department of General Medicine and Department of Nephrology, Mahatma Gandhi Medical College & Hospital, Jaipur. Socio-demographic factors , associated co-morbidities and  dialysis related factors were noted and anxiety and depression  level was measured using HAM-A scale and HAM-D scale respectively. Results: In the study family income, family type, number of co-morbidities, duration of CKD and number of dialysis per week were all significantly related to HAM-A (p<0.01) and HAM-D scale (p<0.01) and there was no relationship of gender, residence, marital status and  education level of CKD patients with HAM-A and HAM-D scale. Conclusion: Economic and social support along with prompt treatment is needed to prevent anxiety and depression among CKD patients as low family income, number of co-morbidities, duration of CKD and number of dialysis per week may be risk factors for deterioration mental health  of CKD patients.

Background: Long duration elevation of blood sugar can lead to damage to blood vessels, kidneys, retina, nerves etc. It may damage pulmonary vasculature and via inflammatory mediators reduce the lung function. So this study tries to find out relationship between diabetes and lung function. Material and Methods: A Hospital based observational descriptive study with cross – sectional design was done among patient with Type 2 Diabetes Mellitus attending OPD and being admitted in the Department of General Medicine, Mahatma Gandhi Medical College and Hospital Jaipur during the period of study . Detail history was taken, BMI was noted, diabetic parameters were investigated and spirometry was done to note the PFT values. Results: The increase in BMI lead to significant decrease in lung function (p<0.05). Poor diabetic control (increase in HbA1c ) and increase in duration of diabetes is significantly negatively correlated to FVC, FEV1 and TLC (p<0.05). Even PPBS is significantly negatively correlated to FVC and FEV1 (p<0.05) Conclusion: Increase in blood sugar level and poor control along with increase in BMI significantly reduce lung function. Hence strict control of blood sugar level is essential to halt the progress of decline in lung function in type2 diabetes patients.

Introduction: Colourful kites filling the sky on “Uttarayan” is a mesmerizing sight. It is that time of the year when celebrations ring in the air and happiness touches every heart. However, despite all the happiness, there can be accidental injuries due to glass powder-coated string (“MANJA”) that can wreck a fun-filled day. Injuries could range from superficial lacerations to profound muscle, artery, or nerve injuries, which can further lead to minor oozing to life-threatening complications. Materials and Methods: Fifty medical records were reviewed retrospectively for patients with injuries due to kite string who presented to the Emergency Department at GMERS Medical College and Hospital, Navsari, from January 2021 to January 2024. Patients with direct kite string injury to the neck were included; other cases were excluded. All patients had varying degrees of injuries and were managed in GMERS, Navsari. Results: In total, 50 patients (Forty-two men and Eight women) were evaluated in the present study. Out of 50 patients, 3(6%) cases of cutaneous vascular injuries, 11(22%) cases of cutaneous and Platysma laceration, 8 (16%) cases of strap muscle injury, 12 (24%) cases of Sternocleidomastoid muscle injury, 13 (26%) cases of vessels injury, 3 (6%) cases of laryngotracheal injury were observed. There was One(2%) mortality. Conclusion: Kite flying can be a high-risk activity due to penetrating and life-threatening injuries to vital organs. However, injuries related to kite flying can be prevented by taking proper precautions.

Background: Drug utilization studies conducted at regular intervals help to guide the physician in prescribing drugs rationally. Methods: A prospective, observational study was conducted in the outpatient of department of general medicine of Gims kalaburgi a tertiary care teaching hospital. Data was collected from patients who have been diagnosed with hypertension as per JNC-8 guidelines and patients receiving or prescribed with antihypertensive medica-tions were included. Frequency and proportions of utilization of antihypertensive medications in were figured. Results: A total of 200 prescriptions were analysed during the eight-month study period. The age of the patients with range 18-80 years. 53.5% (107) of patients were male and 46.5% (93) of patients were female. The most common medication prescribed for hypertension in the study was CCBs 19.5%, significantly higher than dual therapy, triple therapy and poly therapy. The CCBs prescribed pattern was followed by BBs, ACEIs and CCBs. The most frequently prescribed anti-hypertensive fixed dose combination therapy was CCBs+ARB, CCBs + BBs followed by CCB+Diuretic. Among 200 patients’ only 43 patients were reported ADR. Maximum no of ADRs were reported from patients receiving ACE inhibitor. Conclusion: This type of studies gives the base line idea of prescription pattern and ADRs of antihypertensive drugs. These helps to design policy for rational use of drugs and motivation of physician for rational use of drugs.

Background and Objectives: Tubercular pleural effusion (TPE) and Parapneumonic pleural effusion (PPE) are usually distinguished by cellular predominance and pleural fluid adenosine deaminase (ADA) levels. However, both diseases may occasionally show similar cellular predominance and moderate or high ADA levels. In such cases, differential diagnosis between TPE and PPE is challenging. Our objective is to assess the role of Pleural fluid ADA/Serum CRP ratio in differentiating TPE and PPE. Methods: This Hospital based Retrospective Case Control Study is conducted on TPE and PPE patients. A total of 36 patients were included in the study, comprising 16 TPE patients and 20 PPE patients. Patient demographics and laboratory data were collected through a retrospective review of both groups and compared. The pleural fluid ADA to serum CRP (C – reactive protein) ratio was calculated. Receiver operating characteristic (ROC) curves were constructed for identifying TPE. Results: Pleural fluid ADA/S-CRP ratio provided diagnostic accuracy with an area under the ROC curve of 0.78. At a cutoff value of 3.2 ADA/S-CRP ratio had a sensitivity of 75%, specificity of 85%, positive likelihood ratio of 5, and negative likelihood ratio 0.29. Conclusion: Pleural fluid ADA/S-CRP ratio, a simple method using routine laboratory tests, may be helpful in discriminating between TPE and PPE patients.

Background: Pleuraleffusionis defined as abnormal and excessive accumulation of fluid in pleural space.[1]. Presence of effusion always denotes an underlying pathological process. Due to the diverse causes of pleural effusion establishing the etiology is always challenging. Radiological (CXR, USG, CT), biochemical, cytological and microbiological analysis of the effusion obtained by thoracentesis provides the initial clue. If even after this initial investigation no etiology could be identified, the case is labeled as undiagnosed effusion. Method: It was an observational study conducted in pulmonary medicine department of Guwahati medical college. Seventy Patients with undiagnosed exudative pleural effusion were subjected to FOB. Results: Thirty four out of 70 patients had FOB findings. 14 patients had endobronchial growth (20%), 4 had mucosal irregularity (5.7%), 16 patients had CBNAAT positive lavage fluid (22.8%). Eighteen out of these 34 patients (52.9%) had haemoptysis. (10 in neoplastic group, 8 in TB group). Conclusion: FOB may be a useful initial non-invasive tool in undiagnosed exudative pleural effusion before opting for a more invasive procedure like thoracoscopic, which carries a substantially more mortality. The yield of bronchoscopy is more if patient has endobronchial symptom like haemoptysis. So haemoptysis can be an important clinical clue to select patients for FOB.

Background: The COVID-19 pandemic has resulted in significant acute respiratory illness, but the long-term impact on pulmonary functional capacity among survivors is not well understood. Aim and Objective: To evaluate the long-term effects of COVID-19 on pulmonary function and quality of life over 24 months. Materials and Methods: A prospective, longitudinal cohort study was conducted with 200 adult participants with laboratory-confirmed COVID-19. Participants were recruited from two large hospitals and one community clinic. Baseline assessments, including pulmonary function tests (PFTs), six-minute walk tests (6MWTs), and patient-reported outcome measures, were performed at enrollment (3 months post-acute COVID-19). Follow-up assessments were conducted at 6, 12, and 24 months. Statistical analyses included repeated measures ANOVA and paired t-tests. Results: Of the 200 participants initially enrolled in the study, 180 completed the 24-month follow-up. Over this period, significant declines in pulmonary function were observed. The Forced Vital Capacity (FVC) decreased from 95.3% at baseline to 89.2% at 24 months (p < 0.001), and the Forced Expiratory Volume in 1 second (FEV1) decreased from 94.8% to 88.3% (p < 0.001). The Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) also showed a notable decline, from 85.4% to 79.1% (p < 0.001). Additionally, exercise capacity, as measured by the Six-Minute Walk Distance (6MWD), decreased from 520.3 meters to 465.6 meters (p < 0.001). Patient-reported outcomes indicated increased dyspnea, with the mMRC Dyspnea Score rising from 1.5 at baseline to 2.2 at 24 months (p < 0.001). There were also significant declines in health-related quality of life, as evidenced by decreases in both the SF-36 Physical Component Score (from 48.7 to 43.1, p < 0.001) and the SF-36 Mental Component Score (from 50.1 to 45.3, p < 0.001). Furthermore, 35% of participants reported new respiratory symptoms or diagnoses during the follow-up period, including bronchitis (12.5%), asthma (10%), and pulmonary fibrosis (7.5%). Conclusions: COVID-19 has a substantial long-term impact on pulmonary functional capacity and quality of life. Significant declines in FVC, FEV1, DLCO, and exercise capacity were observed over 24 months. These findings underscore the importance of long-term follow-up and the need for targeted rehabilitation programs to manage the ongoing respiratory health needs of COVID-19 survivors.

Background: The COVID-19 pandemic has profoundly impacted globally, with various comorbidities influencing patient outcomes. Diabetes mellitus has been identified as a significant risk factor for adverse outcomes in COVID-19 patients. This study aims to evaluate the association between diabetes mellitus and clinical outcomes in patients with COVID-19. Aim and Objectives: To determine the impact of diabetes mellitus on the severity of COVID-19, hospitalisation rates, ICU admission, need for mechanical ventilation, and mortality. Materials and Methods: This retrospective cohort study analyzed medical records of 500 COVID-19 patients admitted to a tertiary care hospital between January 2022 and December 2023. Patients were categorized into two groups: those with diabetes mellitus (n=200) and those without (n=300). Demographic data, clinical characteristics, and outcomes were compared between the two groups. Statistical analysis was conducted using chi-square tests for categorical variables and t-tests for continuous variables, with a significance level set at p<0.05. Results: Diabetic patients had significantly higher rates of severe and critical COVID-19 compared to non-diabetic patients (p<0.001). The hospitalization rate was higher in the diabetic group (85%) compared to the non-diabetic group (60%) (p<0.01). ICU admission rates were 40% in diabetic patients versus 25% in non-diabetic patients (p=0.02). The need for mechanical ventilation was also higher in diabetic patients (30%) compared to non-diabetic patients (15%) (p=0.03). Mortality rates were significantly higher in diabetic patients (20%) compared to non-diabetic patients (10%) (p=0.04). Conclusions: Diabetes mellitus is associated with worse clinical outcomes in COVID-19 patients, including increased severity of disease, higher rates of hospitalization, ICU admission, need for mechanical ventilation, and mortality. These findings underscore the importance of rigorous management of diabetic patients with COVID-19 to improve clinical outcomes.

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition associated with various vascular complications, including peripheral arterial disease (PAD). Poor glycemic control is a known risk factor for PAD, but the extent of this association remains under-explored. Aim and Objectives: To evaluate the prevalence of PAD in patients with T2DM and investigate the correlation between PAD and poor glycemic control. Materials and Methods: A cross-sectional study was conducted with 200 patients with T2DM attending the diabetes outpatient clinic at [Hospital/Clinic Name] from [Start Date] to [End Date]. Participants were assessed for PAD using the Ankle-Brachial Index (ABI). HbA1c levels measured glycemic control. Participants were categorized into two groups based on HbA1c levels: good glycemic control (HbA1c ≤7%) and poor glycemic control (HbA1c >7%). Statistical analyses were performed to determine the prevalence of PAD, its severity, and its correlation with glycemic control. Results: Of the 200 patients, 70 (35%) had PAD. The prevalence of PAD was significantly higher in patients with poor glycemic control (38.6%) compared to those with good glycemic control (26.7%) (p = 0.046). Among those with PAD, 54.3% had mild PAD, 34.3% had moderate PAD, and 11.4% had severe PAD. A significant positive correlation was observed between HbA1c levels and PAD severity (r = 0.68, p < 0.01). Additional factors such as smoking, hypertension, and dyslipidemia were also associated with a higher prevalence of PAD. Conclusions: Poor glycemic control is significantly associated with an increased prevalence and severity of PAD in patients with T2DM. The findings highlight the importance of maintaining optimal glycemic control to reduce the risk of PAD and suggest that regular screening for PAD should be a priority in diabetic management. Further longitudinal studies are needed to confirm these associations and explore potential interventions.

Background: Polymorphic light eruption (PLE) is a skin condition caused by exposure to UV radiation, and its development is often associated with auto-immune processes. Thyroid dysfunction has been observed in people with sunlight- induced skin conditions such as melasma and polymorphic light eruption (PLE). Aim: (1) To assess the levels of TSH in patients who have polymorphic mild eruption. (2) To establish a relationship between autoimmune thyroiditis and polymorphic light eruptions by estimating anti-TPO  antibodies. Methods: The study comprised of 40 cases of PLE who attended our skin outpatient department. The clinical characteristics were documented, Thyroid-stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4) and anti-Tpo antibody levels were measured. Results: Mean (SD) age of the participants was 39.9 (14.8) years. 18 (45%) were male and 22 (55%) were female. Mean (SD) TSH levels were 3.15 (2.52). Mean (SD) anti TPO antibodies was 49.16 (107.6). 8 cases (20%) had increased TSH and 9 (22.5%) cases had increased anti TPO antibodies. Conclusion: Patients with PLE should undergo evaluation to determine if they have thyroid disorder, so that proper treatment can be given instead of only treating the discernible.

Background: Thyroidectomy is a commonly conducted surgical procedure on a global scale. Hypocalcemia, resulting from either transitory or permanent hypoparathyroidism, is one of the most prevailing complications after thyroid surgery. The present study was done with the primary objective to know the prevalence of hypocalcemia through serum calcium levels in post-thyroidectomy patients. Methods: The cross-sectional study was conducted among 100 patients admitted for thyroidectomy from August 2022 to August 2023 in the General Surgery Department of Government Medical College, Ernakulam. Demographics and clinical data were taken. A data capture sheet designed using Excel, was used to obtain and record data only relevant to this study was used. Statistical analysis was performed with statistical software SPSS version 25.0. Results: The mean age of patients was 47.7±7.8 years. The percentage of male patients was 8% and female patients were 92%. Maximum patients were diagnosed with MNG (84%). The mean serum calcium levels at the pre-operative period were 9.08±2.1 and it was subsequently compared with day 1 (8.4±0.81), day 3 (8.5±0.63), day 5 (8.6±0.69), week 2 (8.9±0.81) and at 6 months (9.2±0.78) and the results were statistically significant (p<0.05). Conclusion: Thyroidectomy is a surgical procedure that is generally safe and has minimal problems when conducted by a proficient surgeon. Hypocalcemia has emerged as a  prevailing consequence following thyroidectomy. These issues lead to extended hospitalizations and increased expenses and burden on medical resources. Moreover, individuals who underwent total thyroidectomy exhibited the highest susceptibility to the development of post-thyroidectomy hypocalcemia.

Intracranial aneurysms are rare in paediatric population. They have different pathophysiology, location, type, outcome than adults. Long life expectancy, more denovo formations and their tendency to recur necessitate the long term follow up in these cases. Here we summarize our experience in treating these aneurysms in a tertiary care hospital from 2014 to 2021. We found 4% of our total aneurysm population to be under 18 years with a male to female ratio of 1.5:1. 13.3% patients had multiple aneurysms and 38.9% had posterior circulation aneurysms. Most common site of aneurysm was ICA bifurcation. Most of the patients were treated endovascularly with favorable outcome at follow up.

Introduction: Renal failure is a situation in which kidney fails to function adequately. There are two forms of renal failure: acute and chronic. End-Stage renal disease is the final stage of chronic renal failure where there is a progressive, irreversible deterioration in renal function which can be substituted by renal replacement therapy, haemodialysis (HD), peritoneal dialysis, or transplantation. During HD, patients‟ blood comes in direct contact with the  non-physiological environment of the dialysis membrane which may elicit a series of changes in the blood cells and in haemostasis. Material and Methodology: For the present study 62 cases of uraemia were selected attending in Medicine and Nephrology unit outpatient department (OPD)/Indoor ward and from dialysis unit of Burdwan Medical College and Hospital during the period from 1st February 2011 to 31st January 2012. The methods were selected: (1) Hemoglobin Estimation. (2) Hemoglobincyanide (HiCN) Method. (3) Westergren Method. (4) Macro Method (Wintrobe Method). Results: The present study is a hospital based longitudinal study. This study was conducted with 62 patients, whose specific blood and urinary parameters were measured before and after dialysis. The parameters that were measured here were Total Leucocyte Count (T.L.C.), Erythrocyte Sedimentation Rate(E.S.R.), haemoglobin, hematocrit, Mean Corpuscular Volume (M.C.V.), Mean Corpuscular Hemoglobin (M.C.H.),Mean Corpuscular Hemoglobin Concentration (M.C.H.C.), Bleeding Time (B.T.), Clotting Time (C.T.), Platelet Count, Prothrombin Time (P.T.), Activated Partial Thromboplastin Time (a.P.T.T.), Fasting Blood Sugar(F.B.S.), Post prandial Blood Sugar (P.P.B.S.), serum urea and creatinine, 24 hours urinary protein, serum  erythropoietin level, differential count and urine routine analysis with culture sensitivity. Conclusion: The present study entitled as “Study of hematological changes in patients with chronic renal failure undergoing hemodialysis (pre and post)” is a hospital based longitudinal study. The study was conducted to study the hematological changes in patients before and after dialysis. In doing so, we compared the reports of complete hemogram, coagulation profile and blood biochemistry in patients before and after dialysis.

Introduction: Diabetes mellitus (DM) is an endocrine disorder characterized by chronic hyperglycemia. Managing DM without side effects remains a challenge, drawing researchers to explore plant-based products. Some studies have found that the leaves of Gymnema sylvestre possess anti-diabetic, anti-obesity, anti-sweetener, anti-inflammatory, and antioxidant properties, which are attributed to saponins, glycosides, and flavonoids. Therefore, further investigation into its benefits is warranted. Aim and Objectives: This research aimed to assess the antidiabeticeffect of Gymnema sylvestre in patients with type 2 diabetes. Materials and Methods: Two hundred patients with type 2 DM were randomly divided into two groups. Group I (n = 100) received a placebo powder, while Group II (n = 100) was supplemented with 6 g/day of gurmar leaf powder. The patients continued taking their anti-diabetic medications as before, and patients were blinded to their treatment allocation. Fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c) levels were recorded at baseline and after 3 months. Results: In Group I FBS decreased non-significantly from 190.67 ± 59.53 mg/dl to 184.59 ± 57.46 mg/dl whereas in Group II FBS reduced significantly from 189.93 ± 55.21 mg/dl to 157.77 ± 44.84 mg/dl after 3 month of gurmar intervention. Similarly, HbA1c in Group II reduced significantly from 8.65 ± 1.16% to 7.70 ± 1.09% after 3 months (P < 0.05), while a non-significant decrease from 8.51 ± 1.04% to 8.33 ± 1.08% was recorded in Group I. Conclusion: The supplementation of Gurmar leaf powder significantly improves glycemic control in individuals with type 2 diabetes mellitus.

Introduction: Diabetic neuropathy, a common and troublesome complication of diabetes, causes significant morbidity and burdens diabetes care. Early detection and intervention can slow its progression. Nerve conduction studies are sensitive indicators of neuropathy severity, aiding in lesion localization and assessment of the pathophysiologic process, including clinically unrecognized alterations. Due to the chronic nature of diabetes and its impact on quality of life, many people are turning to complementary therapies. Gymnema sylvestre, a medicinal herb used in traditional Indian Ayurvedic medicine, has gained attention for its potential benefits in managing type 2 diabetes and its complications, such as diabetic neuropathy. Aim and Objectives: This research aimed to assess the effect of Gymnema sylvestre on diabetic neuropathy. Materials and Methods: Two hundred patients with type 2 DM were randomly divided into two groups. Group I (n = 100) received a placebo powder, while Group II (n = 100) was supplemented with 6 g/day of gurmar leaf powder. The patients continued taking their anti-diabetic medications as before, and patients were blinded to their treatment allocation. Latency, amplitude and sensory nerve conduction velocity (SNCV) of median and ulnar nerves of both left and right upper limbs were recorded at baseline and after 3 months of gurmar intervention. Results: All parameters of the sensory nerve conduction study for the medial and ulnar nerves showed no statistically significant differences when compared between baseline and after 3 months. Conclusion: Gymnema sylvestre therapy for three months did not demonstrate effectiveness in treating diabetic neuropathy.

Introduction: Rabies remains a significant public health concern, particularly in India where it is endemic and predominantly transmitted through dog bites. Despite being preventable with timely post-exposure prophylaxis (PEP), rabies claims thousands of lives annually, primarily in Asia and Africa. Aim: This hospital-based cross-sectional study aimed to assess the delay in initiating immediate post exposure prophylaxis and investigate factors contributing to this delay among animal bite victims. Methodology: The study was conducted at the Anti-Rabies Clinic of Maharana Bhupal Government Hospital in Udaipur, Rajasthan. A total of 126 participants were interviewed, and the data was collected using a modified predesigned questionnaire. Results: The study revealed a demographic profile inclined towards young adults (21-30 years) and children (<10 years), with males comprising 60.32% of the sample. The dogs were the primary biting animals (69%). Notably, 57.14% of bites were categorized as severe (Category III). The study found a high prevalence (88.9%) of delayed PEP initiation (>6 hours) among participants. Factors significantly associated with delays included younger age groups and the unavailability of vaccines at hospitals. Reasons cited for delays included lack of vaccine/immunoglobulin at peripheral centres (19.64%), absence of a companion (16.96%), and inadequate awareness about rabies severity (11.61%). Work-related constraints (10.71%) and misconceptions regarding rabies transmission (3.57%) further contributed to delayed treatment. Conclusion: These findings focus on the critical need for improved vaccine accessibility, enhanced public education on rabies prevention, and targeted interventions to address logistical barriers in both urban and rural settings. Recommendations include implementing robust education campaigns, enhancing vaccine availability at peripheral health facilities and developing policies to ensure equitable access to PEP, particularly for vulnerable populations.

Background: Giant cell tumors of bone often occur around the knee, and since most patients have long-term survival, there is a significant demand for maintaining limb function. The ideal treatment method for such cases is controversial. This study was done to evaluate the radiological and functional outcomes of treating GCT of the distal femur and proximal tibia through extended curettage, chemical cauterization with phenol, cavity filling with bone cement, and fixation with screws or a locking plate. Methods: This retrospective observational cohort study was carried out between 2015 and 2022. Preoperatively patients were evaluated clinically and radiologically. Magnetic resonance imaging was done in all the cases to know the extent of tumour. FNAC was conducted of all the patients and after confirmation of GCT, surgery was performed. Demographic and clinical data were noted. The MSTS 93 score had been used for functional evaluation at the last follow‑up in our study. The patients were followed up for a mean period of 2 years (range 1–3 years). Results: Eighteen patients met the inclusion criteria, with a mean age at surgery of 31.3 years (range 18–65 years). Most patients (71.7%) were in their third and fourth decades of life. There was a slight predominance of males, with a male-to-female ratio of 1.25:1 (10 men and 8 women). The study included 8 cases involving the distal femur and 10 cases involving the proximal tibia. Campanacci grade III was seen in six cases, grade II in ten, and grade I in two cases. The average follow-up period was 2 years (range 1–3 years). Chemical cauterization was performed in all cases. No instances of recurrence or pathological fracture were noted. Furthermore, there were no cases of metastasis or malignant transformation seen during the study. The mean MSTS 93 functional score at the last follow-up was 25.8. Conclusions: This study concludes that while the distance between cement and subchondral bone may predict future arthrosis, it does not affect functional outcomes. Based on these findings, we recommend extended intralesional curettage, cauterization, and cementation with implant fixation following GCT curettage. This approach offers ease of implementation, best recovery of limb function, a low short-term recurrence rate, and high patient acceptance in clinical practice. With a median follow-up of 30 months in this study, further research involving larger cohorts and longer follow-up periods is called for in the future.

Introduction: Yoga being promoted as a path for a healthy lifestyle to improve quality of life, is found to have beneficial effects in individuals practicing yoga, they reap the long-term benefits of practice in the form of reduced stress levels, well equipped coping mechanism, nature of calm and composed, enhanced cognitive abilities by affecting the autonomic function. Considering this we were interested in exploring the immediate effect of yogic techniques on autonomic function, so we intended to study the immediate changes in autonomic function test in the form of Heart Rate Variability (HRV) due to Isha Kriya Meditation (IKM). Materials and Methods: Continuous HRV recording for 45 minutes was done in volunteers between the age of 20-40 years, The recording was segregated into 3 phases of 15 minutes each including Pre-IKM, During IKM and Post IKM respectively. HRV analysis was done, data was compiled in excel sheet and statistical analysis was done using Jamovi to compare the changes in HRV parameters induced by IKM. Results: 42 volunteers willing to practice IKM were included with an average age of 23 ± 1.2 years. There was an increase in time domain parameter SDNN and the frequency domain parameter the power of LF which was significant with confidence interval of 95% and p value of 0.03 immediately after the practice of isha kriya. Conclusion: Practice of IKM sequentially tilts the autonomic balance towards sympathetic predominance, providing better attention and mental clarity.

Introduction: The rising Cesarean section rate is a matter of global concern. In 1985, WHO recommended an optimal CS rate of 10-15%. Unless medically indicated, the true long- and short-term risks and benefits associated with the procedure are questionable. Hence, every case should be scrutinized. Aims and Objective: To analyse and compare CS rates between a secondary and tertiary healthcare facility in Assam using the Robson classification system and subsequently suggest possible measures to address them. Method: It is a descriptive study of 583 and 2939 cesarean deliveries conducted at a district hospital and Medical College in Assam respectively. The data was analyzed and compared using Robson’s ten group classification system. Results: The cesarean section rate at the district hospital was 22.17% and at AMCH it was 51.06%. In both settings, the top 3 contributors to the overall CS rate were group V, followed by group II and group I. However, the cases in subgroup IIA and IVA were nil in the district hospital. Group X contributed 9.62%, compared to 0.85% at district hospital. Conclusion: Factors like patient profile, infrastructure, and facilities that influence the decision to perform cesarean sections vary in district hospital and medical college. Constant audits using Robson classification will help us target the main contributory groups and adjust institutional policies accordingly. Introducing labour induction and augmentation techniques in district hospital can reduce many avoidable CS. Reducing primary CS and encouraging VBAC will help reduce the overall CS rate.

Background: India face significant risks from infections with multi-drug resistant (MDR) bacteria, which are linked to antibiotic overuse and misuse. The antibiogram profiles of bacteria isolated from infections in patients of tertiary care hospital Morbi were determined in this study. Methods: A hospital-based cross-sectional study was done between February 2024 and June 2024. Various clinical specimens were sampled from patients and analysed for aerobic bacterial isolation and Kirby–Bauer disk diffusion susceptibility testing. Results: From the 239 clinical specimens processed, 61 (25.5%) were culture-positive for aerobic bacterial pathogens. Culture-confirmed positivity was higher in urine (29.03%), pus (28.95%) and blood (24.39%) samples. Escherichia coli 18 (29.51%) and 16 (26.23%) of Klebsiella pneumoniae from Gram-negative bacteria were the predominant bacterial isolates, while Staphylococcus aureus 12 (19.67%) and Staphylococcus sp. 3(4.92%) were from Gram-positive bacteria. Overall, 72.1% of the isolates were found to be MDR. The proportion of MDR among Escherichia coli, Staphylococcus sp., Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa was 100%, 1005, 93.755, 50% and 33.3% respectively. Gram-positive bacteria demonstrated resistance rates of 58.3%, 40%, 37.5%, 35.7% and 29.4% for cefoxitin, gentamicin, azithromycin, ciprofloxacin, erythromycin, respectively. While Gram-negative demonstrated resistance rates of 85.7%, 75%, 69.7%, 66.7%, 65.9%, 61.8%, 61.1%, 60.5% were recorded for ampicillin cefotaxime, ceftriaxone, cefoperazone piperacillin/tazobactam, ceftazidime, ampicillin/sulbactam, ciprofloxacin respectively. Conclusion: The main problem is infections caused by bacterial isolates, resistant to most antibiotics. With an alarmingly high number of MDR isolates, the majority of the bacteria that were found to be resistant to the commonly used medicines. Antimicrobial susceptibility testing should therefore be used as a guide for treatment decisions and physicians should use reason when selecting medicines.

Introduction: Leprosy also known as Hansen’s disease is one of the oldest diseases known to mankind. It is a chronic infectious disease caused by Mycobacterium leprae. It still remains as a major public health problem facing India. Nearly, 52% of all world leprosy cases are reported from India. The spectrum of presentation of leprosy is very wide. Histopathology is an important tool in making a definitive diagnosis. Aim: To study the clinicopathological spectrum of leprosy in a Medical College Hospital in Banthra, Shahjahanpur, Uttar Pradesh. Materials and Methods: A prospective hospital-based study of clinically diagnosed Hansen’s disease [leprosy] cases was conducted over a period of 13 months from March 2023 to March 2024 comprising of 209 cases. Lesional skin biopsies obtained were formalin fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Wade-fite staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: A total of 209 cases were studied. Highest incidence was in the age group of 21 to 30 years for both males and females. Males were more affected (M:F=3.4:1). Most common clinical feature was loss of sensation. The commonest reported histopathological type was borderline tuberculoid (33.3%) followed by lepromatous leprosy (43%). Overall Wade-fite staining was positive in 62 (29.9%) cases. Conclusion: The spectrum of presentation of leprosy is very wide and there is clinical overlap between different types of leprosy. Histopathology still remains the gold standard for early diagnosis and classification of the disease. Accurate diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance.

Background: Liver abscesses, caused by bacteria, amoebae, and fungi, can significantly impact health, particularly in tropical regions. Traditional management involved extensive surgeries, leading to high morbidity and long hospital stays. Recent advancements have shifted the focus to less invasive techniques like ultrasound-guided pigtail catheter drainage. Methodology: This Prospective study, conducted over a year at Nalanda medical college and Hospital, included 60 adult patients with solitary liquefied liver abscesses. Comprehensive pre-intervention investigations were performed. Under local anesthesia, a 10 Fr pigtail catheter was inserted into the abscess cavity, guided by ultrasound. Post-procedure, patients were monitored and discharged after confirming no complications. Weekly follow-ups with USG and CBP continued until abscess resolution. Data were analyzed using SPSS version 25.0. Results: The study showed that 92% of patients experienced right upper quadrant pain, 83% had fever, and 88% had abscesses in the right lobe. Pus cultures revealed no growth in 70% of cases. The abscess cavity volumes ranged from 100 to 350 ml. Complications included pain at the catheter site (93%) and catheter blockage (18%). All patients had successful abscess resolution without requiring laparotomy. Conclusion: Ultrasound-guided pigtail catheter drainage is an effective, safe, and minimally invasive method for managing solitary liver abscess, reducing the need for open surgery, hospital stay, costs, and complications. This technique offers a preferable alternative to traditional surgical approaches.

Background: Incidental cerebral microbleeds (CMBs) are asymptomatic brain hemorrhages detected via MRI, linked to various cerebrovascular risk factors. This study investigates the correlation between CMBs and risk factors such as hypertension, smoking, diabetes, hyperlipidemia, alcohol consumption, and family history in a young and middle-aged population aged 18-50 years, along with their regional distribution. Methods: A retrospective cohort study was conducted with 200 participants aged 18-50 years, selected between May 2022 and December 2023. Participants with positive MRI findings for CMBs underwent detailed risk factor analysis, including age, gender, hypertension, diabetes, smoking, previous stroke history, medication usage, and family history. The regional distribution of microbleeds in deep, lobar, or both locations was also assessed. Results: The prevalence of CMB was highest in the 40-50 age group, followed by the 30-39 group, and then the 18-29 group. There was a significant male predominance, with a larger proportion of males affected compared to females. Risk factors included hypertension (43.5%), smoking (63.5%), diabetes (23%), hyperlipidemia (31.5%), and alcohol consumption (27%), while 12% had no risk factors. CMBs were found in both deep and lobar regions in the majority (63% of cases), followed by the deep or lobar region alone. Additionally, some individuals had a history of stroke, a history of drug use, and a positive family history. Conclusion: This study highlights significant correlations between incidental CMBs and common risk factors in a young population. The high prevalence among smokers and hypertensive individuals, along with a notable male predominance, underscores the need for early risk factor management to mitigate CMB impact. Further research should explore additional factors contributing to CMBs, especially in those without conventional risk factors.

This study investigates the prevalence of anxiety and depression in patients with pemphigus and psoriasis and its impact on their quality of life (QOL). Using a prospective longitudinal design, 100 participants (50 with psoriasis, 50 with pemphigus) were assessed at SCB Medical College, Cuttack. The findings reveal significant psychiatric comorbidities, particularly higher rates of depression and anxiety in pemphigus patients compared to those with psoriasis. The study underscores the importance of integrated care to improve patient outcomes.

This prospective longitudinal study examines the prevalence and patterns of psychiatric comorbidities among 100 male patients with substance use disorder (SUD) at SCB Medical College, Odisha. Using the MINI International Neuropsychiatric Interview (DSM-5 Version 7.0.2), patients aged 18-60 years were assessed for dual diagnosis over a one-year period. Results indicate a high prevalence (77%) of dual diagnosis, predominantly involving psychotic and mood disorders alongside SUD. Cannabis and alcohol were the most common substances used. Sociodemographically, patients were primarily young, Hindu, and from lower socioeconomic backgrounds. Initial care pathways often involved consultation with medical practitioners or faith healers. Follow-up assessments at 3, 6, and 12 months showed significant improvement in both groups, emphasizing the need for integrated treatment approaches to enhance long-term outcomes.

Objective: This study aims to characterize bacterial isolates and evaluate antibiotic resistance patterns in endotracheal secretions of mechanically ventilated patients in intensive care units (ICUs). Methods: A total of 120 endotracheal aspirate samples were collected from ICU patients at MGM Medical College between June 2018 and May 2019. Bacterial identification was performed using Gram staining, culture on selective media, and biochemical tests. Antibiotic susceptibility was assessed using the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was conducted using SPSS software version 20. Results: Bacterial growth was detected in 86 samples (71.67%), with 52 samples (43.33%) showing monomicrobial growth and 34 samples (28.33%) exhibiting polymicrobial growth. The predominant isolates were Klebsiella pneumoniae (35.83%), Acinetobacter baumannii (24.16%), and Pseudomonas aeruginosa (23.33%). High resistance rates were observed, particularly among Klebsiella pneumoniae and Acinetobacter baumannii. Extended Spectrum β-Lactamases (ESBL) were present in 54.54% of Escherichia coli and 18.60% of Klebsiella pneumoniae. Methicillin-resistant Staphylococcus aureus (MRSA) constituted 87.50% of the Staphylococcus aureus isolates. Conclusion: The study highlights a significant prevalence of multi-drug-resistant organisms, including ESBL-producing strains and MRSA, in endotracheal secretions from ICU patients. These findings underscore the necessity for targeted antimicrobial therapy and robust infection control measures to address the high levels of resistance and improve patient outcomes in critical care settings.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, often due to uterine atony. Traditional uterotonic drugs like oxytocin have limitations, particularly in low-resource settings. Carbetocin, a heat-stable, long-acting synthetic analogue of oxytocin, offers potential advantages. Objective: This study aimed to compare the efficacy and safety of carbetocin versus oxytocin for PPH preven-tion following vaginal delivery. Methods: A double-blind, randomized controlled trial was conducted with 200 antenatal women at the Chhattisgarh Institute of Medical Sciences. Participants were randomized into two groups: Group C (carbetocin) and Group O (oxytocin). Primary outcomes measured were blood loss, additional uterotonic requirement, and hemoglobin levels. Secondary outcomes included neonatal parameters. Results: The carbetocin group demonstrated significantly lower mean blood loss (264.63 ± 38.97 mL) com-pared to the oxytocin group (341.40 ± 31.12 mL) (p = 0.001). The requirement for additional uterotonic agents was also lower in the carbetocin group (5%) versus the oxytocin group (13%) (p = 0.04). Post-operative hemo-globin levels were higher in the carbetocin group (9.19 ± 0.79 g/dL) than in the oxytocin group (8.86 ± 0.81 g/dL) (p = 0.005). Neonatal outcomes were comparable between groups. Conclusion: Carbetocin is more effective than oxytocin in reducing blood loss and the need for additional uter-otonic agents for PPH prevention. Its longer duration of action and stability in higher temperatures make it a valuable option, especially in low-resource settings. However, individualized patient care remains crucial for optimal outcomes.

Objective: To assess the effectiveness of tranexamic acid (TXA) compared to placebo in reducing postpartum hemorrhage (PPH) among women undergoing caesarean section. Methods: This double-blind randomized controlled trial enrolled 200 patients undergoing caesarean section. The TXA group received 1 gram of tranexamic acid intravenously before skin incision, while the placebo group received saline. Blood loss, need for additional medications, blood transfusions, and hemoglobin levels were compared between groups. Results: TXA significantly reduced total blood loss up to 2 hours postpartum (346.7 ml vs. 385.85 ml, p=0.001) and the incidence of blood loss exceeding 500 ml (3% vs. 12%, p=0.02). There was no significant difference in the need for additional uterotonics but fewer patients in the TXA group required blood transfusions (3% vs. 17%, p=0.01). TXA patients also maintained higher post-operative hemoglobin and hematocrit levels. Conclusion: TXA effectively reduces blood loss and the need for blood transfusions after caesarean section, improving patient outcomes and safety.

Background: The liver is the largest site of metabolism in the body. It also provides the primary site for alcohol metabolism. It leads to oxidative damage due to alcohol, which causes a decrease in anti-oxidant enzymes and chemicals. Method: 60 alcoholic liver disease patients were compared with the same number of healthy (controlled) groups. Clinical and laboratory investigations were carried out using venous blood plasma vit. E levels by Baker Hatal method, ascorbic acid by the Teitz method, and SVD by the Beers-Seizer method. Results: The comparison of non-enzymatic oxidant parameters. Ascorbic acid, vitamin E, and the comparison of anti-oxidant enzymes SOD, GP_X in both groups were statistically highly significant (p<0.00). Conclusion: The present study indicates that alcohol promotes oxidative stress, a major cause of alcohol toxicity in liver Vitamin E is a potential therapeutic agent for alcohol-induced oxidative damage in liver.

Background of the Study: Medical and educational methodologies and strategies have advanced worldwide in recent decades. The contemporary method places greater emphasis on the student, emphasizing the development of skills. The undergraduate course curriculum for the National Medical Commission (NMC) has been recently updated to follow a competency-based approach, known as competency-based medical education (CBME), instead of the old outcome-based curriculum Embracing innovative teaching-learning and educational methodologies is crucial for achieving the goal of competency-based medical education (CBME). Objective: To investigate the perspectives of students on an innovative pedagogical approach in medical education. Materials & Method: The research study was conducted on final MBBS phase – 1 student studying ophthalmology at Government Medical College in Nellore, India. The study was conducted 109 final years Phase – 1 MBBS Students. An innovative teaching-learning technique was used. A topic in ophthalmology, “glaucoma,” was taught using a teaching method that incorporated online movie screenshots, with the help of an analogy from a Telugu movie episode (Vinodam, 1996), the characters were compared to Glaucoma, an ocular condition, Glaucoma Patient and an Ophthalmologist, the scene was explained with the help of a movie screenshot. After the activity, students’ feedback was obtained using a self-designed; pilot tested and validated eight item closed-ended questionnaires with options based on a 5-point Likert scale. Results; 60 out of 109 students responded to the questionnaire about movie screenshot-based teaching methods. 41(68.3%) students agreed that they were more satisfied. 13(21.67%) students disagreed that they were more satisfied. 6(10 %) remained neutral.41(68.3%) students agreed that they felt motivated to learn. 10(16.67%) students disagreed that they felt motivated to learn. 9(15%) remained neutral.41(68.3%) students agreed that they prefer the movie screenshot method. 17(28.33%) students disagreed that they prefer the movie screenshot method. 2(3.33%) remained neutral.36(60%) students agreed that their learning experience was enriching.10(16.67%) students disagreed that their learning experience was enriching. 14(23.33 %) remained neutral. Conclusion: Applying a movie-based scenario in films has demonstrated its efficacy and entertainment value in increasing students’ understanding of Facilitating learning tough topics like “Glaucoma” in Ophthalmology.

Introduction: Epidural anaesthesia gives adequate surgical anaesthesia, longer postoperative analgesia with minimal hemodynamic changes. Ropivacaine is suitable local anaesthetic drug. With Dexmedetomidine the anaesthetic and analgesic requirements get reduced because of its analgesic properties and increase of local anaesthetic effects. Aim: To compare the sensory and motor blocking effects of epidurally administered 0.75 percent Ropivacaine using Dexmedetomidine and 0.75 percent Ropivacaine with normal saline in lower abdomen and lower limb procedures. Materials and Methods: Sixty individuals of ASA classes I and II, ranging in age from 18 to 65 years, were allocated into two groups randomly with 30 patients. The epidural space was identified, an epidural catheter was inserted, study drug was given. The beginning of sensory block, the beginning of motor block, the maximal sensory level attained, the length of sensory block, the length of motor blockade, vital parameters were recorded. Results: The Ropivacaine Dexmedetomidine group had a faster sensory onset than the Ropivacaine Normal saline group (5.70 ± 1.26 min vs 9.73 ± 1.64 min), (p˂0.001). The Ropivacaine Dexmedetomidine group had motor block onset earlier than the Ropivacaine Normal saline group (10.57 ± 1.52 min vs 13.90 ± 2.02 min), (p˂0.001). T6 in the Ropivacaine Normal saline group and T4 in the Ropivacaine Dexmedetomidine group were maximum sensory level (p˂0.001). Ropivacaine Dexmedetomidine group had a motor block intensity of 4, whereas Ropivacaine Normal saline group had a motor block intensity of 3 (p˂0.001). Ropivacaine Dexmedetomidine group had a longer sensory block duration than the Ropivacaine Normal saline group (366.67 ± 35.07 min vs 186.17 ± 7.84 min), (p˂0.001). Ropivacaine Dexmedetomidine group had a longer motor block duration than the Ropivacaine Normal saline group (262.33 ± 29.21 min vs 148.83 ± 5.97 min), (p˂0.001). Ropivacaine Dexmedetomidine group had higher sedation scores than the Ropivacaine with Normal saline group (4 vs 3), (p˂0.001). There was no significant variation in the hemodynamic parameters and the side effects reported were minimal. Conclusion: It can be concluded that Ropivacaine plus Dexmedetomidine causes sensory and motor block more quickly, had longer sensory and motor block duration than Ropivacaine with Normal saline. Ropivacaine plus Dexmedetomidine also induced a stronger motor blockade and is higher on sedation than Ropivacaine with Normal saline with minimal side effects.

Introduction: Children receive antibiotics more frequently since children are frequently victims of ailments of diverse etiology. Growing antimicrobial resistance (AMR) among them necessitates specialized methods for identifying, treating, and preventing resistant infections. Antimicrobial resistance trends in adults and children can vary greatly. Material and Method: The study is a Retrospective observational study. A total of 587 samples were taken randomly from microbiology laboratory culture and sensitivity during the years 2019, 2020, and 2021 from the pediatric department. Resistance against antimicrobial drugs was recorded from the data received. Result: Out of 587 samples included in the study, 248 (42.85%) were infected. The number of samples and infectivity gradually increased in subsequent years. Blood and urine samples were the most frequently received samples. 80% of all samples were resistant to ampicillin (AMP) whereas resistance for Vancomycin (VA) was lowest at 4.4%, followed by Linezolid (LZ) at 6.4%. Conclusion: Antimicrobial drug resistance is a big hurdle for doctors and health care workers, there should be judicious use of antimicrobials in pediatric patients.

Introduction: There is increased risk of developing Diabetes with progressive rise in Body mass Index. Dyslipidemia in Diabetes is one of the major reasons for sudden cardiac death in diabetic patients. Life style modifications along with good dietary habits are extremely essential to prevent Obesity and development of dyslipidemia in Diabetes. Aim: This study aims to look for the association between Body mass Index and dyslipidemia in patients with type-2- Diabetes Mellitus.  Materials and Methods: This Cross- sectional study included 100 patients with type-2 Diabetes mellitus. Blood samples were analysed for assessing Fasting and Post Prandial blood sugar, serum Total Cholesterol, serum HDL and serum LDL Cholesterol levels. Body mass Index was calculated from height in meters and weight in kilograms. Statistical analysis was done using Chi square test and pearson’s correlation. Statistical significance with p-value less than 0.05 was considered as significant. Results: Our results displayed a significant positive association between serum Total Cholesterol, serum LDL Cholesterol levels and BMI (Body Mass Index), with (r=0.40 and r=0.17) respectively; and a significant negative correlation between serum HDL Cholesterol levels and BMI (Body Mass Index), with (r=-0.19) in diabetic patients with increase in BMI (Body Mass Index). Conclusion: Diabetic patients with increased Body mass Index are more prone to develop dyslipidemia, which is the most important risk factor for developing atherosclerosis and coronary artery disease. Thus, from our study, we recommend appropriate life style changes in patients with type-2 Diabetes, which will definitely lower the risk of development of dyslipidemia and cardiovascular side effects in Diabetes.

Introduction: Pregnancy and the birth of a child is a transformational phase in the life of the parents. Knowledge and awareness among antenatal women during this period are critical to reduce maternal and neonatal mortality. Birth Preparedness and Complication Readiness (BPACR) is the process for planning normal birth, and anticipating the actions needed in case of emergency. Aim: This study was conducted in view of assessing the level of Birth Preparedness and Complication Readiness among antenatal women and to determine the factors associated with BPACR, which will be helpful in improving the ongoing maternal and child health programs. Materials and Methods: This was a hospital based cross sectional study conducted in Government RSRM hospital, Chennai. The study subjects were antenatal mothers in second and third trimesters. Results: Among 144 antenatal women, 49.31% of the study participants were found to have optimal BPACR practice. Women’s education level showed a significant association with BPACR (p=0.0000). Women who had experienced complications in their previous pregnancies had increased BPACR (p=0.0030). Unsatisfactory BPACR practice among women was due to poor knowledge of key danger signs. There was a significant association between BPACR and women who were taken care of in their mother’s house (p=0.0060). Conclusion: Increasing Birth Preparedness and Complication Readiness (BPACR) awareness is very crucial among women with lower educational levels and those for whom prenatal care givers are not their mothers. Further, there is an unmet need for specific health literacy among all antenatal women about the key danger signs of pregnancy, delivery and postpartum.

Introduction: The rates of cesarean section (CS) have increased steadily all over the world in the past two decades. Trial of labour after cesarean delivery (TOLAC) is an alternative to repeat CS and vaginal birth after cesarean section (VBAC) is an accepted practice. Current evidence suggests that women who undergo repeated CS have significantly higher risk of maternal and perinatal morbidity compared with women who deliver vaginally after CS. Aims and Objective: To detect the maternal factors associated with successful trial of vaginal birth after cesarean delivery. Materials and Methods: This is a hospital based observational study done in Assam medical college, Dibrugarh, over a period of 1 year from March 2023 to February 2024. A total of 54 women were eligible for TOLAC according to departmental protocol were included in this prospective study. Results: There were 54 candidates for VBAC, Out of which 41 patients delivered vaginally. Trial of labour was successful in 75.93%.

Angio (neo) genesis is an important phase in the pathogenesis of psoriasis vulgaris and CD 34, a molecule expressed on endothelial cells play an important role in this important step. In this cross sectional study among 60 non-infectious erythematous papulosquamous skin disorders, 28 cases histopathologically diagnosed as psoriasis vulgaris were kept for CD 34 immunohistochemical analysis for study of vascular changes. Result and Conclusion: Among 28 histopathologically confirmed cases of psoriasis vulgaris which were subjected to CD 34 immunohistochemical marker study, 11 cases show strong positivity, 13 cases show moderate positivity and 4 cases show weak positivity. CD 34 is an essential angio genesis marker and has revealed the enlarged cutaneous vasculature associated with psoriasis. As a result specific therapies directed against CD 34 can be developed in future which can offer better disease control.

Papulosquamous disorders are a diversified cluster of skin disorders that often poses a diagnostic dilemma to both clinicians and pathologists. In this cross sectional study, 60 consecutive cases of non-infectious erythematous papulosquamous skin disorders which initially presented in skin outpatient department were histopathologically confirmed in pathology department and association of these orders with their age, sex and overall frequency of occurrence was determined. Result and Conclusion: Out of 60 patients, 40 were male and 20 were female with a ratio of 2:1 and mean age was 37.7 years. Among all papulosquamous disorders psoriasis vulgaris was most common followed by lichen planus.

Background: Altered sensorium poses a significant and challenging diagnostic task for emergency physicians in managing patients promptly. Non-traumatic causes of altered mental status are diverse and require compre-hensive clinical knowledge for effective management in the emergency room (ER), aiming to reduce morbidity and mortality. Therefore, understanding the clinical profile, triaging, treatment, and outcomes is crucial to op-timize ER resources, especially in settings with limited resources. Objective: This study aimed to investigate the clinical profile, emergency management, and outcomes of pa-tients presenting with altered sensorium. Materials and Methods: A prospective observational study was conducted on 50 patients who presented with acute altered mental status in the ER of a tertiary care hospital in western India between July 2023 and Decem-ber 2023. Details of clinical presentation, management, and outcomes were recorded using a standardized form. Data analysis was performed using IBM SPSS version 26.0. Results: The mean age of the study population was 59.88 ± 16.65 years, with the majority being over 60 years old, and males comprising 62%. Among the 50 patients, 27 (54%) had non-neurological causes contributing to altered mental status. The most common factor leading to altered mental status was cerebral vascular accident (CVA), accounting for 32% of cases. The study observed a mortality rate of 38%, with a mean length of stay (LOS) in the ICU of 4.26 days. Conclusion: The study revealed a higher incidence of altered mental status among older adults, with a predom-inance of males. Non-neurological causes were more prevalent than primary neurological causes, although CVA was the leading neurological cause identified. These findings underscore the importance of early recognition, comprehensive assessment, and prompt management of altered sensorium in the ER to improve patient out-comes.

Pilomatrixoma is a benign neoplasm which originates from the hair matrix. Fine-needle aspiration cytology has been delineated as an important preoperative diagnostic test. Pilomatrixoma cytologically usually due to predominance of one component over another results in diagnostic dilemma. We report this case to highlight the difficulties faced by a pathologist to rule out the differential diagnosis and diagnose a case of PMX cytologically.

Introduction: Antibiotics are double-edged swords. They save countless lives when used for the right indications; however they also promote the spread of drug resistant strains by exerting selection pressure on microbial populations. The study was done in critical care areas where antibiotics are maximally used and resistance rates are the highest. Aim: This study was conducted to evaluate the frequency of antimicrobial resistance of commonly isolated bacterial pathogens in intensive care units (ICUs) of our tertiary-care hospital. Materials and Methods: Our retrospective study covers a one-year period from February 2023 to January 2024, and examines records of 750 critically ill adult patients. The species distribution and resistance pattern of clinical isolates from urine, blood, pus, endotracheal tube (ET) aspirate, and broncho-alveolar lavage (BAL) fluid were analysed. Relevant patient particulars were collected from our hospital information system (HIS). Results: Out of 750 specimens, 324 (43.2%) were positive for bacterial pathogens. Urine (47.5%) was the commonest specimen followed by blood (29.0%), ET (15.4%), pus (7.4%), and BAL (0.6%). Most of the isolates were Gram-negative bacilli (GNB) including Escherichia coli (28.7%), Klebsiella spp. (19.1%), Acinetobacter calcoaceticus baumannii complex (ACBC) (14.8%), and Pseudomonas aeruginosa (8.6%). Most Gram-positive isolates were Enterococcus spp. (12.03%) and Staphylococcus aureus (10.8%). Among Gram-negative bacilli, resistance was most common to third generation cephalosporin (82.6%) and least common to carbapenems (21.6%) and polymyxins (0%). Gram-positive bacteria were most often resistant to fluoroquinolones (74.8%) whereas only 9.5% were resistant to teicoplanin. Conclusion: This study showed high levels of antimicrobial resistance in our ICUs. Therefore, vigilant infection control practices and a robust antimicrobial stewardship programme are needed for favourable clinical outcomes.

Background: The choice between dynamic hip screw (DHS) and proximal femoral nail (PFN) for the treatment of stable intertrochanteric fractures of hip remains controversial. This study aimed to compare the outcomes of these two implants in terms of early mobility, complications and functional recovery. Methods: A retrospective comparative study was conducted on 100 patients with stable intertrochanteric fractures (AO/OTA 31-A1) treated with either DHS (n=50) or PFN (n=50). Intraoperative, postoperative, radiographic, and functional outcomes were assessed. The minimum follow-up period was 12 months. Results: The PFN group had significantly shorter surgical times (55.2 ± 10.8 min vs. 68.4 ± 12.5 min, p<0.001), less blood loss (135.4 ± 38.7 mL vs. 180.6 ± 45.3 mL, p<0.001), earlier mobility (2.5 ± 0.9 days vs. 3.8 ± 1.2 days, p<0.001), better weight-bearing status at discharge (full: 48% vs. 20%, p=0.002), and shorter hospital stays (6.8 ± 1.9 days vs. 8.5 ± 2.3 days, p<0.001) compared to the DHS group. At 12 months, the PFN group had higher Harris Hip Scores (87.2 ± 5.9 vs. 84.6 ± 6.8, p=0.042) and Parker Mobility Scores (7.8 ± 1.3 vs. 7.2 ± 1.5, p=0.033). Complication rates were lower in the PFN group, but the differences were not statistically significant. Conclusion: PFN may be associated with better outcomes compared to DHS in the treatment of stable intertrochanteric fractures, particularly in terms of early rehabilitation and long-term functional recovery. Larger prospective studies are needed to confirm these findings.

Background: Around 60% of patients have moderate to severe pain after mastectomy in the immediate post-operative period and 20-50% of patients develop chronic post mastectomy pain. This randomised controlled double blinded study was conducted to compare the pectoral nerves block (PECS) and the Erector Spinae Plane block (ESPB) for post-operative analgesia in patients undergoing modified radical mastectomy. Methods: 60 ASA grade I–II female patients of 18–65 years, undergoing modified radical mastectomy under general anaesthesia were divided into two groups. Group ESPB patients received ultrasound guided erector spinae plane block and Group PECS patients received ultrasound guided PECS block on the affected side after induction of general anaesthesia. The 0-10 scaled Visual analogue scales (VAS) was recorded at 0, 2, 4, 6, 8 and 24 hours post-operative period. The time to first rescue analgesia, number of patients requiring rescue analgesic, complications of block, adverse events and patients’ satisfaction score by Quality of Recovery (QoR) survey were recorded. Results: There was no statistically significant difference in VAS scores between the two groups. However, number of rescue analgesics needed was less in PECS group and the median time to first rescue analgesia was longer for PECS than ESPB group [P<0.001]. Conclusion: Both PECS and ESPB are effective in modified radical mastectomy as there is no difference found between both groups.

Introduction:  Sickle Cell Disease (SCD) is an inherited disorder of Hemoglobin. SCD is highly prevalent in many parts of India including Chhattisgarh & predominantly affects the tribal & under privileged sections of the society. In SCD Adult Hemoglobin gets polymerized & alters its Physio-Chemical properties manifested by change in the normal shape of RBC to shape of a sickle. Aim: To compare the Hematological & Biochemical parameters in sickle cell homozygous patients (SS) with & without Hydroxyurea therapy. Materials and Methods: A case control prospective study was carried out in the Department of Pediatrics, Surgery, Biochemistry & Pathology, Late Shri Lakhiram Agrawal Memorial Government Medical College & Associated Sant Baba Guru Ghasidas Ji Memorial Govt. hospital Raigarh, Chhattisgarh. Results: Total 120 subjects in this study were categorized into four groups 30 (AA), 30 (AS), 30 (SCD with HU therapy) & 30 (SCD without HU therapy). Hb concentration, Hb F level, RBC count, RBC indices like MCV & MCH levels, Electrolyte Potassium levels were significantly improved in SCD with HU therapy groups as compared to SCD without HU therapy groups. The improvements were statically significant. Conclusions: We found a significant improvement of Hb concentration, RBC count, MCV, MCH & HbF level with decrease reticulocyte count in SCD with HU therapy groups as compared to SCD without HU therapy.

Background: Population ageing is an inevitable and irreversible demographic reality. With longevity and declining fertility rates, the population of persons 60 years and above is globally growing faster than the general population. The proportion of the elderly in India has been increasing swiftly in recent years. The trend is likely to continue in the coming decades. The share of population over the age of 60 years is projected to increase from 10.5 percent in 2022 to 20.8 percent in 2050. By the end of the century, the elderly will constitute over 36 percent of the total population of India. Health professionals refer to the ability or the inability to perform the Activities of daily living (ADLs) as an important measurement of functional status of an individual, particularly people with disabilities and the elderly. The objective of the study is to assess ADL of the elderly in an urban area of Western Maharashtra. Methods: This cross-sectional descriptive study was conducted in an urban community in Western Maharashtra. The demographic data was collected after taking informed consent. A total of 300 elderly people who met the inclusion criteria were included in the study. Data was collected as per a pre-tested and validated questionnaire administered by the investigators. It consisted of two parts – personal particulars and Katz Index of Independence to assess ADL. This questionnaire assesses the index of independence in ADL directed towards the activities of bathing, dressing, feeding, transferring and toileting. Results: About 60.66% of the subjects belonged to the 60–70 years age group.The study cohort was predominantly male (56.33%) while the remaining were females (43.67%). The highest level of dependence among all activities was observed in continence (26.67%) followed by feeding (24.67%), transferring (23%), toileting (22.67%), bathing (22.33) and dressing (20.67%). Conclusion: The dependency increases with the age.  As the aging population expands, so do the challenges in addressing disability and unmet needs among the elderly.

Background: Eclampsia is the convulsive manifestation of the hypertensive disorders of pregnancy and is among the more severe manifestations of the disease. It is derived from a Greek word meaning “like a flash of lightening”. Hypertensive disorders of pregnancy contribute to 14% maternal deaths globally. Eclampsia is one of the leading causes of intensive care unit (ICU) admission. The maternal complications and outcomes were studied in this study. Methods: The present study was a hospital based descriptive study conducted in the Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh. The duration of study was 1 year with effect from 1st May 2023 to 30th April, 2024. The study comprised of all patients who fulfilled the inclusion exclusion criteria and gave written and informed consent and details were recorded in a predesigned proforma. Results: The incidence of eclampsia was 2.4%. The major complications developed in 55% eclamptic patients in our study. These were pulmonary oedema (47.27%), hematuria (23.64%), ARF (14.55%), elevated liver enzymes (40%), electrolyte imbalance (21.82%), DIC (7.27%), abruptio (7.27%), cardiomyopathy (5.45%), CVA (1.82%), HELLP (5.45%) and fever in 14.55% cases. 12.73% were admitted to ICU and 14.55% cases died. The leading cause of death was pulmonary oedema (100%) followed by AKI (62.5%), MODS (62.5%) and aspiration pneumonitis (12.5%). Conclusion: Prevention of eclampsia can be done by regular antenatal care, early recognition of warning signs and its prompt treatment. Health awareness, improvement in literacy status, upliftment of socioeconomic conditions, and healthcare services play an important role in reduction in incidence of eclampsia and its complications.

Introduction: Cobalamin deficiency is a commonly faced issue now days with varying prevalence globally and different aetiological factors. Some of them may be easily correctable like consumption of cobalamin rich diet and avoidance of medications like Metformin and gastric acid lowering agents. This may lead to different clinical and haematological features with unexpected financial burdens.  Aim: Our study was aimed to observe the effect of age and gender on cobalamin level and the effect of age, gender, and level of cobalamin on the three cell lines. Method: We selected a hundred patients after going through the inclusion and exclusion criteria. Their age, gender, serum cobalamin level and haemogram parameters were noted and correlated statistically. Result: Out of the hundred patients, we had 58 males, and 42 females and the maximum were in the age between 41 to 60 years (25%). Here, male patients and the elderly had more severe deficiency of cobalamin compared to their counterparts. We observed bi-cytopenia more commonly than isolated anaemia or pancytopenia. Out of the three variables (age, gender, and severity of cobalamin level) only male gender was statistically associated with cytopenia. Conclusion: We observed anaemia as the most common cytopenia in cobalamin deficiency and the severity of its deficiency was more in male gender and elderly people. There was no significant association between cobalamin deficiency and the type of cytopenia either in isolation or in combination. As we could see a high percentage of anaemia and bi-cytopenia in cobalamin deficient state, serum cobalamin should be assessed in all those with such cytopenias.

Background: Maternal hypertension is a common pregnancy complication that can adversely affect fetal growth and development. Aim and Objective: to assess the impact of maternal hypertension on fetal growth parameters and neonatal outcomes. Materials and Methods: A prospective observational cohort study was conducted from January 2023 to May 2024, involving 200 pregnant women (100 hypertensive and 100 normotensive) at the Department of Obstetrics & Gynaecology. Data on maternal characteristics, fetal growth parameters (biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight), Doppler ultrasound indices (umbilical artery resistance index, pulsatility index, and middle cerebral artery Doppler indices), and neonatal outcomes (birth weight, gestational age, Apgar scores, NICU admissions, and neonatal complications) were collected and analyzed using SPSS version 25.0. Results: Fetuses of hypertensive mothers showed significantly lower growth parameters compared to those of normotensive mothers: biparietal diameter (87.4 ± 3.2 mm vs. 89.8 ± 3.0 mm, p<0.001), head circumference (308.5 ± 12.4 mm vs. 317.1 ± 11.6 mm, p<0.001), abdominal circumference (280.3 ± 14.1 mm vs. 292.4 ± 13.5 mm, p<0.001), femur length (68.2 ± 2.8 mm vs. 70.1 ± 2.5 mm, p<0.001), and estimated fetal weight (2780 ± 320 g vs. 3050 ± 290 g, p<0.001). Doppler indices indicated higher resistance in the umbilical artery (RI: 0.68 ± 0.05 vs. 0.60 ± 0.04, p<0.001; PI: 1.35 ± 0.12 vs. 1.18 ± 0.10, p<0.001) and lower pulsatility in the middle cerebral artery (PI: 1.45 ± 0.10 vs 1.55 ± 0.12, p<0.001) in the hypertensive group. Neonates born to hypertensive mothers had lower birth weights (2780 ± 320 g vs. 3050 ± 290 g, p<0.001), lower gestational ages (37.5 ± 2.1 weeks vs. 38.8 ± 1.7 weeks, p<0.001), lower Apgar scores at 1 minute (7.5 ± 1.2 vs. 8.2 ± 1.1, p<0.001) and 5 minutes (8.5 ± 0.9 vs. 9.0 ± 0.8, p<0.001), higher NICU admission rates (30% vs. 10%, p<0.001), and more neonatal complications (25% vs. 10%, p=0.007). Conclusion: Maternal hypertension significantly impairs fetal growth and development, as evidenced by lower fetal growth parameters, altered Doppler indices, and adverse neonatal outcomes. These findings highlight the importance of early detection and management of hypertensive disorders in pregnancy to improve maternal and fetal health.

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries. The prevalence and risk factors associated with PCOS in young women aged 18-30 remain under-explored. Aim and Objective: To determine the prevalence of PCOS and identify associated risk factors in young women aged 18-30. Materials and Methods: This cross-sectional observational study was conducted from January 2024 to June 2024. Five hundred young women aged 18-30 were recruited from urban and rural settings. Participants completed a structured questionnaire, underwent clinical examinations, and had biochemical tests and transabdominal or transvaginal ultrasounds. PCOS was diagnosed based on the Rotterdam criteria. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and logistic regression to identify associations between risk factors and PCOS. Results: The prevalence of PCOS among the participants was 24.0%. The highest prevalence was observed in the age group 23-26 years (30.0%). Significant risk factors associated with PCOS included a BMI ≥ 25 kg/m² (Odds Ratio [OR]: 2.6, 95% Confidence Interval [CI]: 1.8-3.7), family history of PCOS (OR: 2.5, 95% CI: 1.7-3.6), sedentary lifestyle (OR: 2.4, 95% CI: 1.6-3.5), high-sugar diet (OR: 2.1, 95% CI: 1.4-3.1), and insulin resistance (OR: 2.8, 95% CI: 1.9-4.1). Clinically, women with PCOS had significantly higher serum testosterone, LH levels, and ovarian volume compared to those without PCOS. Conclusion: PCOS is prevalent among young women, with significant associations with obesity, family history, lifestyle factors, and insulin resistance. These findings underscore the need for targeted interventions to address modifiable risk factors and improve early diagnosis and management of PCOS.

Background: Understanding patterns of contraceptive use and the factors influencing contraceptive choices is crucial for improving reproductive health services. Aim and Objective: To analyze these patterns and identify the key determinants affecting contraceptive choices among women of reproductive age in both urban and rural settings. Materials and Methods: A cross-sectional study was conducted with 1,200 women of reproductive age (18-49 years) from urban and rural areas. Participants were selected using stratified random sampling. Data were collected through a structured questionnaire covering demographics, contraceptive use patterns, and factors influencing contraceptive choice. Statistical analyses, including descriptive statistics and logistic regression, were used to evaluate the data. Results: The study found that 45% of women used oral contraceptive pills, 30% used condoms, and 15% used intrauterine devices (IUDs). Accessibility and availability were the most significant factors influencing contraceptive choice, reported by 70% of participants. Knowledge and awareness influenced 60% of the women, while perceived side effects, cultural and religious beliefs, partner influence, and healthcare provider recommendations also played notable roles. Higher education levels and urban residence were associated with increased use of modern contraceptive methods. Conclusions: Contraceptive use patterns are significantly influenced by accessibility, knowledge, and perceived side effects. Addressing these factors through targeted educational campaigns and improving access to contraceptive methods can enhance reproductive health outcomes. Policymakers and healthcare providers should consider these determinants when designing and implementing family planning programs.

Background: Hemorrhoids are abnormal engorgement of arteriovenous plexus in anal cushions lining the anal canal. As per the theory of sliding anal canal lining, weakening of supporting tissues of anal cushions lead to blood vessel descent. Present study was carried out to study the surgical profile of patients with hemorrhoidectomy so that we can throw a light on the etiopathogenesis of the patients with hemorrhoidectomy. Subjects and Methods: Present cross-sectional study was carried out at a tertiary care hospital in the department of General Surgery, Venkateshwara Institute of Medical Sciences, Gajraula among 200 patients who presented with symptoms suggestive of hemorrhoids. Information on socio demographic variables, types and degrees of hemorrhoids, age at diagnosis, risk factors, clinical manifestations, associated co-morbidities, methods used for diagnosis, management practices, and outcome of management was noted down by the investigators. Dietary history was taken they were classified as having vegetarian diet or mixed diet based on the answers given by them. Results: The incidence of hemorrhoids was more in upper class compared to the lower class where only 46% were found to be affected. But statistically the difference might not be significant. Incidence of hemorrhoids was less i.e. 24% among those who took only vegetarian diet compared to 76% among those who took mixed diet. Bleeding was present in the majority i.e. 95% of the patients followed by constipation in 90% of the cases which was followed by pain in the anal region in 86% of the cases and prolapse was seen in 84% of the cases. Conclusion: Hemorrhoids are one of the common diseases observed in patients below 40 years of age, especially if they are under stress. Proper diet, which is inclusive of adequate quantities of fiber as well as with less spice, is essential to prevent this disease.

One of the common presentations to the Surgical OPD is Pain in abdomen and the commonest region is often the Right iliac fossa. The differential diagnosis for this symptom is varied and requires a skill and knowledge to define and diagnose. The present study was aimed at analysing the symptoms and etiologies for Pain/mass in right iliac fossa cases presenting at a tertiary care center in Uttar Pradesh. The patients were selected from among the ones presenting in OPD and Emergency ward of VIMS, Gajraula. The study revealed that there was a common thread in the presentation and varied etiologies were causing a single symptom.

Background: Cervical cancer caused by human papillomavirus (HPV) is heterogenic in nature with a regional variation in its distribution. It is crucial to detect high-risk HPV, and thus, the present study aims to find the distribution and prevalence of HPV genotypes by DNA testing and its correlation with cervical cytology. The results of this study would be helpful in the development of newer and efficacious HPV vaccine to make it regionally more specific. Materials and Methods: A cross-sectional study was conducted in a tertiary-care hospital. A total of 217 women presented at the outpatient Department of Obstetrics and Gynecology with different clinical conditions. Women with history of malignancy and pregnancy were excluded from the study. Detailed history was taken on a preformed proforma, and cervical samples were detected for abnormal cytology by Pap smear and genotyping by HPV DNA testing by polymerase chain reaction. Observations: The overall prevalence of HPV was 5.5% (12/217), and HPV types 59, 56, 51, 33 and 18 were found prevalent in this study. The higher number of HPV DNA positivity found was in low-grade squamous intraepithelial lesion constituting (66.6%), followed by inflammatory smear (20.6%) and normal cytology with (1.1%). Conclusion: It has been observed that there is a high prevalence of HPV genotypes 59, 56, 51, 33, and 18. Our study highlights the importance of considering other high-risk genotypes which are not covered by the vaccines currently available in India; therefore, it is necessary to redesign the vaccine by including these genotypes to reduce the incidence of carcinoma cervix.

Acute Suppurative Otitis Media (ASOM) is a primary reason for prescribing antibiotics in children. The near closeness of the middle ear to the brain, coupled with the growing resistance of pathogenic organisms associated with otitis media, renders this condition highly concerning in youngsters. The present study was done “to study the bacteriology of the disease in detail followed by Antibiotic Sensitivity patterns of the most common etiological organisms”. Material &Methods: The current prospective research was conducted at Ear, Nose & Throat Department of RIMS Hospital, Raichur from April 2017 to June 2017, among all the selected 50 patients of ear discharge. Clinical details of patients presenting with ear discharge of less than 3 weeks duration diagnosed as ASOM at first presentation were collected for age, gender, bacteriology, clinical presentation & management taken. Results were analyzed using SPSS version 25.0. Results: In the present study the maximum numbers of patients were in the age group of 0 to 5 years (10). Female patients (27) were more in number as compared to male (23). The symptom & signs of ASOM present in patients were otorrhea (48) & perforation of tympanic membrane (49). In 11 patients ASOM was present on one side while in 39 patients ASOM was present bilaterally. The most common micro-organism was Staphylococcus aureus (21) & least common was Streptococcus viridians (3). Conclusion: A systemic antibiotic that is effective against bacteria that produce beta-lactamase, along with anti-histamine treatment & local ear treatment, is recommended to achieve better results in stopping ear discharge & reducing the likelihood of developing a chronically discharging ear (CSOM) with its associated issues.

Background and Objectives: Meconium stained amniotic fluid has been considered a sign of fetal distress in presentations other than breech and associated with poor fetal outcome but others considered meconium passage by fetus as physiological phenomenon and produces environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study and aim of it was to find out the maternal risk factors associated and its correlation with the fetal outcome in terms of morbidity and mortality. Methods: 100 women in labour with meconium stained amniotic fluid studied considering the inclusion criteria in the Department of Obstetrics and Gynecology, Anugarh Naarayan Magadh Medical College, Gaya. Cases divided into two – ‘thin’ and ‘thick’ meconium stained group. Maternal and Fetal monitoring, uterine contraction assessed and Apgar score, birth weight, resuscitation of baby noted. All babies of both group followed up to first week neonatal life. Results: In our study, among 100 cases, 45% of the cases had thin meconium and 55% had thick meconium. Increased incidence of meconium staining was seen in crossed dates. The other risk factors were hypertension, anemia, oligohydramnios, IUGR. 56% went in for cesarean section due to intrapartumfetal distress. Perinatal death was seen in 4 cases, one due to birth asphyxia and the other three due to MAS. Interpretation and Conclusion: Infants with meconium aspiration syndrome are to be managed in NICU for close monitoring. and vigorous treatment. Cooperation and coordination of the obstetrician and pediatrician is required to prevent perinatal morbidity and mortality. Based on this study we conclude that meconium-stained amniotic fluid is associated with increased incidence of caesarean section, low APGAR score, meconium aspiration syndrome and increased NICU admission.

Background: Gestational diabetes mellitus (GDM) poses problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women. Study Design: A case–control study with 140 cases and 140 age-matched controls was conducted for a period of 10 months (December 2021- October 2022) in Dept of Obg and Gynae, ANMMCH, Gaya. Materials and Methods: Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed. Statistical Analysis: Univariate analysis was done by means of t test, Odd’s ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant. Results: The frequency of induction of labor was significantly higher than spontaneous labor. 40.1% GDM mothers and 35.8% of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor Babies of diabetic mothers had a positive trend toward prematurity Hypoglycemia was the most common neonatal complication and nine babies of diabetic mothers were macrocosmic. Conclusions: Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.

Background: Subclinical hypothyroidism (SCH) during pregnancy has been associated with adverse maternal and fetal outcomes. This study aimed to investigate the effects of levothyroxine (LT4) therapy on pregnancy and neonatal outcomes in women with SCH. Methods: A prospective, randomized controlled trial was conducted on 200 pregnant women with SCH, who were allocated to either the LT4 treatment group (n=100) or the control group (n=100). Thyroid function tests were monitored throughout pregnancy, and pregnancy and neonatal outcomes were assessed. Results: The incidence of miscarriage (4% vs. 11%, p=0.06), preterm birth (7% vs. 15%, p=0.07), gestational hypertension (6% vs. 13%, p=0.09), and fetal growth restriction (5% vs. 12%, p=0.08) was lower in the LT4 treatment group compared to the control group, although the differences were not statistically significant. The mean neonatal birth weight was significantly higher in the LT4 treatment group (3285 ± 458 g vs. 3142 ± 527 g, p=0.04). Thyroid function tests were significantly better in the LT4 treatment group throughout pregnancy (p<0.01). Conclusion: LT4 treatment in pregnant women with SCH may have potential benefits in reducing adverse pregnancy outcomes and improving neonatal birth weight. Regular thyroid function screening and appropriate management of SCH during pregnancy are important for optimizing maternal and fetal outcomes.

Introduction: The study focuses on predicting post-spinal anaesthesia hypotension in patients undergoing various infraumbilical surgeries by assessing the inferior vena cava collapsibility index as a tool to predict post spinal hypotension. Aim and Objectives: Predicting hypotension before and after spinal anaesthesia induced with 0.5% hyperbaric bupivacaine for infraumbilical surgeries using inferior vena cava collapsibility index and to determine the effect of preloading on changes in the incidence of post spinal hypotension as directed by the inferior vena cava collapsibility index. Materials & Methods: The study conducted at Sri Siddhartha Medical College and Research Centre, Tumkur, Karnataka, India, over 24 months was a prospective, longitudinal study using purposive sampling. It focused on patients aged 18-60, ASA Class I & II, undergoing elective infra-umbilical surgeries under spinal anesthesia. Patients were divided into two groups: one where the Inferior vena cava collapsibility index (CI) was measured before anesthesia and another where it was not. If IVCCI measurement was >40%, fluid boluses were given. Hemodynamic were monitored intraoperatively, and post-spinal anesthesia hypotension was managed with fluids and vasopressors. Data analysis employed unpaired t-tests to compare outcomes between the groups. Results: 166 ASA I and II patients undergoing elective infraumbilical procedures were divided into CI and NCI groups. The CI group underwent assessment of the Inferior Vena Cava (IVC) collapsibility index, with administration of crystalloids (0.9% Normal Saline) until the index was ≤40%. Patients in the NCI group did not undergo IVC collapsibility index measurement and proceeded directly to surgery following standard protocol. The overall incidence of post-spinal hypotension was 41%, notably higher in the NCI group (29%) compared to the CI group (12%). Patients in the CI group received a higher volume of preoperative fluids (587.35±123.92), whereas intraoperative fluid administration was higher in the NCI group (801.81±353.76). These findings indicate that adequate preloading based on the IVC collapsibility index in the CI group contributed to reducing the incidence of post- spinal hypotension to 12% within that cohort. Conclusion: Assessing post-spinal anesthesia hypotension using the inferior vena cava collapsibility index before and after administering 0.5% hyperbaric bupivacaine reduces its occurrence. The group where the inferior vena cava collapsibility index was measured received significantly lower perioperative intravenous fluids and vasopressors compared to the group where it was not measured. Preloading fluids guided by the inferior vena cava collapsibility index before spinal anesthesia induction effectively reduces the incidence of post-spinal hypotension.

Introduction: Chronic suppurative otitis media (CSOM) constitutes a significant public health concern globally, especially prevalent in regions with limited healthcare access and resources. It imposes various societal implications, including hearing impairment, language and speech development, intracranial and extra cranial complications. Effective management includes infrastructure improvement, medication access, hygiene education, and antimicrobial stewardship. Early prevention and management are critical to reducing CSOM’s global impact. Material & Methods: This cross-sectional study was conducted in the Department of Microbiology of a tertiary care centre for duration of 6 months to identify the bacterial isolates causing CSOM and their antibiogram profile. Isolation and identification was done by standard microbiological techniques and antimicrobial susceptibility testing by Modified Kirby-bauer disk diffusion method on Muller Hinton agar (MHA) medium, as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Pseudomonas aeruginosa was the most common organism isolated, followed by Staphylococcus aureus, Klebsiella spp., Acinetobacter spp., Coagulase-negative Staphylococci (CONS), & Escherichia coli. Pseudomonas aeruginosa was most susceptible to Meropenem, Ciprofloxacin and Gentamicin. Staphylococcus aureus was highly susceptible to Vancomycin. Conclusion: Knowledge of the predominant organisms implicated in CSOM and their antibiotic susceptibility profiles is essential for establishing effective antibiotic policies and initiating empirical therapy. The alarming upward trend in multi-drug resistant organisms emphasizes the critical need for continuous and stringent surveillance of resistant bacteria, thereby advocating against the indiscriminate use of antibiotics. In addition, having insight of risk factors, seasonal changes, and the local antibiotic susceptibility policy helps in achieving optimal outcomes in the medical management of CSOM.

Background: Urinary albumin excretion has been strongly associated with cardiovascular events in hypertensive patients. This study evaluated the prevalence of microalbuminuria in patients with essential hypertension and its relationship with target organ damage, as previous research has not extensively explored the correlation between microalbuminuria and target organ damage beyond cardiovascular events. Methods: sixty cases of essential hypertension were enrolled sequentially.  The prevalence of urinary albumin excretion and its correlation with target organ damage (left ventricular hypertrophy, retinopathy, and stroke) were analyzed. Microalbuminuria was examined using the immunoturbidimetric method using Erba Chem 5 Plus V2 Semiautomated Analyzer. Results: Our data show a higher prevalence of hypertension in the 41-50 age group, predominantly affecting males. Microalbuminuria, an early indicator of kidney damage, was significantly linked to hypertension, especially in patients with a longer duration of the disease and those with inadequate medication control. The result of this study shows a strong association between essential hypertension and its complications. Additionally, patients with microalbuminuria were more likely to develop target organ damage, including stroke, retinopathy, and left ventricular hypertrophy. Conclusion: Microalbuminuria in hypertensive patients could be a useful predictor for evaluating target organ damage. Managing preventable risk factors, such as maintaining regular hypertension treatment, controlling weight, and keeping lipid levels normal, may help reduce the occurrence of microalbuminuria. Prompt screening for microalbuminuria in individuals with known hypertension, followed by adequate treatment, could potentially decrease the incidence of chronic kidney disease and cardiovascular disease.

Objective: To observe the total analgesic requirement in the first 24 hrs of the postoperative period, if there is any prolongation of the time to rescue analgesia and incidence of complications in patients given Magnesium sulphate and the control group. Methods: The study comprised 50 patients undergoing lower limb orthopaedic surgery who were ASA Grade I & II and were between the age of 20 and 65. After receiving spinal anaesthesia, 25 of these patients (Group A) got Magnesium Sulphate at a dose of50 mg/kg in 100 ml bottles of normal saline, while the other 25 patients (Group B) received only NS (Group B). It was recorded when the first dose of analgesia was needed. Patients were watched for signs of sedation, hypotension, shivering, nausea, vomiting and pruritus. The total amount of analgesics needed in the first 24 hours following the operation was noted. Results: In Group A and Group B, the mean ± SD of the time to rescue analgesia was 444±130 minutes and 287± 55 minutes, respectively. The total analgesic requirement of Group A was significantly less as compared to Group B in the first 24 hours of the surgery. Incidence of complications were not significantly higher in the study group.

Conclusion: We come to the conclusion that patients receiving spinal anaesthesia for lower limb orthopaedic procedures can safely receive IV magnesium sulphate in a bolus dose of 50mg/kg to reduce initial postoperative pain with a minimal incidence of complications.

Introduction: Postoperative pain control after cesarean delivery (CD) is an important issue for patients and health care providers. The plan for analgesia after CD must facilitate bonding between the mother and her neonate and allow safe breastfeeding. Aims: The present study compared the effects of plain 0.25 percent ropivacaine; 0.25 percent ropivacaine with dexmedetomidine and 0.25 percent ropivacaine with clonidine in Transversus abdomen is plane block for post cesarean section analgesia. Methods: Patients admitted to JLNMCH, Bhagalpur undergoing elective and emergency (where no maternal and fetal compromise exists) lower segment cesarean section were included in the study after ethical committee clearance and informed written consent. Results: The total dose of Inj. Ketorolac used in 24hours in Group II was 39.6±14.3mg; in Group III was 81.6±18.4mg; and in Group I was 94.8±16.6mg. There was a statistically significant difference between the three groups (p<0.0001). Group II had the lowest analgesic consumption in 24 hours and this was statistically significant when compared to Group III (p<0.0001) and Group I (p<0.0001). Conclusion: To conclude TAP block is a safe and effective way of relieving postoperative pain in LSCS patients and addition of dexmedetomidine to ropivacaine significantly enhances its effect in terms of block quality and duration of analgesia. Also addition of dexmedetomidine to ropivacaine in TAP block reduces the overall analgesic consumption in a multimodal approach to pain when compared to plain ropivacaine or clonidine addition to TAP block.

Introduction: Increased intravenous hydration reduces the labor duration and oxytocin augmentation when oral fluid is restricted. Aims: The objective of this study is to compare duration of labor, need for oxytocin augmentation and the mode of delivery in women with unrestricted intake of oral fluids. Methodology: On randomization, out of 60 women, 30 will be allowed to take unrestricted oral fluids and the remaining 30 were encouraged to take more fluids along with IV fluids. Results: There was no difference in the labor duration (147.40 vs 138.33 min), the need for oxytocin augmentation (90% vs 93%), the normal delivery rate (93.3% vs 93.3%), operative delivery rate (6.7% vs 6.7%) between the two group. Conclusion:Increased intravenous hydration does not decrease the labor duration when oral fluid is unrestricted.

Introduction: Newer α-2 agonist agents have opened a new chapter in prolongation of duration of neuraxial block and postoperative analgesia. Material and Methods: Sixty adult patients of ASA grade I-II were randomly divided into two groups of thirty each. Group Dexmedetomidine and group Clonidine. All patients received hyper baric bupivacaine 0.5% (heavy) 15 mg intrathecally with dexmedetomidine 10 µg and with clonidine 15 µg respectively (30 each). Sensory block, motor block, intra-operative hemodynamic changes, two segment regression and total duration of analgesia was assessed. Result and Conclusion: Onset time of sensory and motor block was shorter in group D compared to group C. Two segment regression time was significantly higher in group D (100.67 ± 17.798 min) as compared to group C (71.167 ± 23.44 min). Total duration of analgesia was significantly prolonged in group D (97.73 ± 27.43 min) as compared to Group C (32.33 ±21.96min). Heart rate and mean arterial pressure remained at lower level in both groups but was not statistical significant. It can be concluded that though both clonidine and dexmedetomidine prolonged duration of sensory and motor block of bupivacaine, dexmedetomidine is better in terms of longer duration of action.

Background: Primigravida are potential group at risk for unengaged head, monitoring of labour is done in these patients and comparison on mode of delivery was done. Aim: To study the outcome of labour and foetus in primigravida patients with unengaged head at term. Method: It is prospective interventional study, carried out at JLNMCH, Bhagalpur. 50 primigravida patients with unengaged head were observed in last 3 months. Results: In the present study out of 50 women, in 54.00% of women had Normal Delivery, 10% were by instrumental delivery whereas remaining 36.00% women required LSCS. 5% new born were admitted in NICU. Conclusion: Proper monitoring if done in primigravida in labour rate of operative interference can be cut down.

Introduction: Supraclavicular brachial plexus block provide important advantages including excellent pain control, reduced side effect and shortened stay in the post anaesthesia care unit. This study was aimed to compare anesthetic characteristics along with side effects of bupivacaine and bupivacaine with dexamethasone in supraclavicular block. Aims and Objectives: This study was aimed to compare anasthestic characteristics, hemodynamic pareameters and associated side effects among bupivacaine and bupivacaine with dexamethasone in supraclavicular brachial plexus block for forearm surgeries. Methodology: Sixty patients of ASA I and II scheduled to undergo elective forearm surgery were randomly divided into two groups, Group A (n=30) patients received Inj. bupivacaine 0.5% 20ml + Inj. Normal saline 2ml and Group B (n=30) patients received Inj. bupivacaine 0.5% 20ml + Inj. Dexamethasone (8mg) 2ml in supraclavicular block. Anaesthetic characteristics, vitals and side effects were observed intra operatively and 20 hr postoperatively. Results: The onset of sensory and motor block for group B is faster and duration of sensory and motor block is prolonged when compared with group A. The time for duration of analgesia is 642.73 ± 54.09 (min) in group A and 898.37 ± 92.98(min) in group B. (p<0.001) Thus, duration of analgesia is significantly prolonged in group B when compared with group A. Conclusion: In supraclavicular block total duration of analgesia can be prolonged by addition of dexamethasone to levobupivacaine without increasing significant complications.

Background: Laryngoscopy and endotracheal intubation are associated with increased sympathomimetic response. Aim: To compare and evaluate the efficiency of Esmolol and Labetalol in attenuating the haemodynamic response to Direct laryngoscopy and endotracheal intubation. Materials & Methods: It is a Prospective, randomised, double-blind study in   50 patients of ASA grade I or II aged between 20–60 years of either sex who were scheduled for elective surgeries under general anaesthesia and divided into two groups (each group containing 25 patients). Group L (Labetalol): patients received injection Labetalol, 0.25 mg/kg IV bolus diluted to10 ml with 0.9% saline. Group E (Esmolol): patients received injection Esmolol 0.5 mg/kg IV bolus diluted to   10 ml with 0.9%saline.All the selected patients are subjected to the same anaesthesia technique. HR, SBP, DBP and MAP were recorded before intubation, and then during intubation   0 minute, 1 min, 3 min, 5 min of intubation. Results and Conclusion: In lower doses, Labetalol provides better protection than Esmolol in attenuating the sympathomimetic response to laryngoscopy and intubation.

Medulloblastoma is the most common malignant brain tumour affecting children. These tumours are high grade with propensity to metastasize within the central nervous system and, less frequently, outside the neuraxis. Recent advancements in molecular subgrouping of medulloblastoma refine diagnosis and improve counseling in regards to overall prognosis. Both are predicated on the molecular drivers of each subgroup—WNT-activated, SHH-activated, group 3, and group 4. The traditional treatment for medulloblastoma includes a multimodal approach with surgery, radiation, and multiagent chemotherapy. Certainly, the known neurological, developmental, endocrine, and psychosocial injury related to medulloblastoma and its associated therapies motivate ongoing research towards improving treatment for this life-threatening tumour while at the same time minimizing long-term side effects. We found a case presenting with posterior fossa medulloblastoma with multifocal intracranial drop metastasis hence making it a rare case with a challenging approach towards its management.

Patient with low ejection is considered a challenge to the anaesthesiologist. Dilated cardiomyopathy (DCMP) with poor ejection fraction (EF) is a constant threat to the peri-operative morbidity and mortality. Dilated cardiomyopathy is a progressive disease characterised by the enlargement of the ventricular chambers and contractile dysfunction. In this case report, we present a 55 yr old female with idiopathic dilated cardiomyopathy and low output congestive heart failure (EF ≈ 10%) who underwent emergency laparotomy for gut perforation under general anaesthesia combined with neuraxial anaesthesia without any apparent complications. Combination of evidence based and customized anaesthetic management can be of help in resource constrained emergency settings.

Background: Acute appendicitis remains one of the most common surgical diseases faced by the surgeons in practice. It is most common surgical emergency that performed.  The diagnosis of acute appendicitis is however challenging, it remained essentially clinical knowledge, a mixture of observation, radiological imaging and reminder of art surgical diagnosis. The main aim to conduct this prospective observational study of acute appendicitis is for early diagnosis and intervention to avoid complications. This studies aim is to early diagnosis and management of acute appendicitis patients admit under General Surgery Dept. Gauhati Medical College & Hospital, Guwahati, Assam. Materials and Methods: The study was conducted in the Department of Surgery; Gauhati Medical College during the period 1st may 2021 to 30th April, 2022. It was a prospective observational study. Total 50 patients admitted with clinical and radiological diagnosis of acute appendicitis, under the Department of Surgery were included in the study. Results: Acute appendicitis is more common in males than females and the highest incidence is in 2nd and 3rd decade of life. 26 Male and 24 Female patients having a ratio of 1.08:1. The patients presented with symptoms of pain in RIF (98%) of patients followed by anorexia (54%), nausea and vomiting (66%). RIF tenderness present in 100% of patients. The patients were examined clinically thoroughly by using modified Alvarado Scoring system, 48% of the patients shown modified Alvarado score >7and among 71.4% in male and 70% were female patients. The patients were subjected to investigation like routine blood examination, total count >10000 in 56% of patients. Ultrasonography has diagnosed 58% of cases as acute appendicitis 19 of the total cases which had Alvarado score of >7 was managed surgically and the remaining all patients with score of <7 also operated because of clinical symptoms and signs. C T scan was advised for selected patients only. All the cases were confirmed for diagnosis of acute appendicitis based on intraoperative and histopathological findings. Out of 50 patients 45 patients did not have any complication, 3 patients were having gangrenous appendix and 2 patients were having perforated appendix intraoperatively. Histopathologically confirmed cases were 70.8% and overall negative appendicectomy rate in 6% in females and 4% in male. Conclusion: Ultrasonography increases the diagnostic accuracy in the patients with suspected acute appendicitis. The modified Alvardo scoring system combined with ultrasonography can therefore be used as an inexpensive way of confirming acute appendicitis reducing negative appendicectomy rate. Currently, CT and graded compression colour Doppler ultrasonography are generally employed to aid in the diagnosis.

Background: Diabetes mellitus is a disease of inadequate control of blood levels of glucose. Diabetes mellitus is a metabolic disease, involving inappropriately elevated blood glucose levels. Objectives: To identify and assess drug utilization on patients suffering from diabetes mellitus in a tertiary care setup. To analyze the influence of various modifiable and non-modifiable factors on the effects of drugs prescribed to the patients. Methods: A Retrospective and Observational study was conducted at Jagannath Gupta Institute of Medical Sciences and Hospital, Budge Budge, Kolkata, West Bengal, India by a group of 6 students of batch 2020-21. A total of 160 responses were generated from past six months of hospital records. All adult patients (≥18 years) diagnosed and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using IBM Statistical Package for the Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY) and results were expressed as counts and percentages. Results: Out of 135 DM patient’s enrolled, male population (56.30%) and females (43.70%). Comparison out of 135 responses, comorbidities of diabetes patents had Hypertension 77 (57%) at higher rate than others. Obesity 8 (5.9%), Dyslipidemia 75 (55.6%), and others 52 (38.5%). Conclusion: After compiling the data it was seen that most common oral medication used was metformin. Hypertension and Dyslipidemia prevailed as the most common comorbidities. There was predominant family history of Type 2 DM in 59.9% of cases. Most common observed HbA1c level was found to be ranging between 7.0 to 8.0.

Background: Dermatophytosis is a group of superficial fungal infections that affect the skin, hair, and nails. For the past few years, there has been a rise in the number of cases, along with changing trends in clinical and epidemiological patterns due to inadequate knowledge and practices. Methods: This is a cross-sectional study of 200 patients with dermatophytosis attending the outpatient department of Dermatology in a tertiary care hospital over a period of 2 months. Basic information of the patient, demographic data, duration of lesions, and careful examination of sites affected, similar lesions in the past were recorded. Questionnaire on knowledge about dermatophytosis, transmission, attitude of patients towards the superficial fungal infection, and practices followed are filled. Results: A total of 200 patients were recruited in the study. Male to female ratio is 3:2. 57.5% belonged to rural areas and 42.5% urban areas. 52.5% responded that it spreads by touch, 77% and 76% responded that sharing towels, bed sheets, combs, and washing clothes of all family members together increases the chances of infection. 83.5% responded that it spreads from person to person and 98% believed that the disease should be treated. Most of the female respondents (n = 71/80) change sanitary napkins at least twice a day. The majority of the respondents in this study demonstrated practices that perpetuate the spread of fungal infection, such as sharing of clothes, towels, soaps, hats, hairbrushes, combs and wearing tight fitting clothes. Conclusion: Patients should be educated about personal hygiene, clothing, skin care, corticosteroid abuse, adherence to general measures, and compliance with treatment to ensure a successful outcome.

Background: Lymphadenopathy is a common clinical presentation. It may be a primary or secondary manifestation of numerous diseases, characterized by abnormalities in size and character of lymph nodes occurring as a result of invasion or propagation of either inflammatory or neoplastic cells into lymph node. Clinical evaluation, aspiration cytology and open biopsy are some of the methods to diagnose the cause of cervical Lymphadenopathy. Aims & Objectives: To study the prevalence of cervical Lymphadenopathy in respect to age and sex, various clinical presentations, and to correlate the pathological findings with the clinical diagnosis. Methodology: The study was conducted in 50 selected patients presented with neck swelling in GGH, Kurnool during one year period from Jan 2022 to Jan 2023. Results & Conclusion: 33 patients (66%) had lymphadenitis caused by tuberculosis, 2 patients (4%) had lymphomas, Reactive lymphadenitis in 5, malignant secondaries in 5, and chronic non-specific lymphadenitis in 5. The age range of 31 to 40 years had the highest percentage of patients (36%). The study included 23 female patients and 27 male patients. Only 15% of those who developed tubercular lymphadenitis had a history of the condition. The level 2 lymph nodes were enlarged in the majority of cases of tubercular lymphadenitis (48.48% of cases with tuberculosis), and numerous lymph node groups were involved in 33.33% of cases. Multiple levels of the neck nodes were involved in every case of lymphoma. One of the two instances with histological confirmation is Hodgkin’s lymphoma, whereas the other is not. The most typical cause of cervical Lymphadenopathy is tuberculosis. The conclusive inquiry involves an open biopsy and a histological study.

Background: Integrated Child Development Services (ICDS) one of the world’s largest early child health programme, had been launched in India in 1975 to promote integrated development of children from prenatal to six years of age. One of the major objectives of the scheme is to improve the nutritional status of children in the age group of 0-6 years through anganwadi centres. The present study is an attempt to assess the nutritional status of pre-school children in anganwadi centres in rural Nandyal. Aims and Objectives: (1). To study the socio-demographic profile of children availing ICDS services. (2). To assess the nutritional status of children of age group 0-72 months enrolled in Anganwadi centres. Materials and Methods: A community-based, observational, cross-sectional study was conducted in the rural Nandyal. A total of 160 anganwadi centres were selected in rural area using epi-info software. From each Anganwadi centre, 25 children were selected by simple random sampling. Weight for Height was calculated to assess the nutritional status of children. Children who were more than 2 SD above the reference median (i.e. a Z score of more than –were considered to be normal. Results: The present study revealed that male children are comparatively more under nourished (50.5%) than female children (47.6%). Christians are less under nourished (25%) when compared to Hindus (49.5%) and Muslims (47%). Children of illiterate mothers (50.4%) are more under nourished when compared to children of graduate and post graduate mothers (25%). Conclusion: The study noticed that there is need for more health awareness campaigns at village level. It also reiterates the importance of female literacy in family for focusing on the nutrition aspects of children.

Background: Drug-induced liver injury (DILI) accounts for almost every second acute liver failure and often leads to drug withdrawal, boxed warnings or drug non-approval. Dose-related and thus predictable DILI is a rarity, making a quantification of the hepatotoxic risk of drugs necessary. Materials & Methods: Consecutive 100 patients who were admitted in the medicine ward and with abnormal LFT results satisfying the inclusion & exclusion criteria after obtaining informed consent were enrolled for the study and evaluated using structured questionnaire and clinical examinations. Abnormal liver function test was defined as Total Bilirubin> 1mg/dl, ALT > 41 U/L, AST > 38 U/L, GGT > 58 U/L, ALP > 96 U/L. Results: In this study we found out that among 100 study participants, the most common diagnosis of abnormal LFT was Viral Hepatitis (41%). Drug induced Hepatitis (DILI) & Alcoholic hepatitis were also responsible for a significant proportion at 26% & 24% respectively. In this study it was revealed that Drug induced Liver Injury (DILI) most commonly caused by rifampicin at standard dosage used in treatment of pulmonary tuberculosis (23%) followed by antifungal drugs (19.2%), isoniazid & pyrazinamide (both 15.3%). Conclusion: In summary, our study identified a large number of drugs as possible causes of DILI. In all patients with newly developed jaundice or abnormal laboratory results of liver tests drug aetiology must be included as a differential diagnosis and a precise medication history has to be taken.

Background: Cervical cancer is one of the leading causes of mortality among women worldwide. However, cervical cancer is preventable, if detected at an early (preinvasive) stage. Pap smear test is a very important, simple, non-invasive and cost effective test for assessing female reproductive health by early detection of any cervical abnormality. Hence, this study was carried out with an aim to study the spectrum of cervical smears (obtained through Pap smear) in females aged 21-65 years. Materials and Methods: This hospital based prospective study was carried out for a period of one year at Silchar Medical College and Hospital. Pap smears (conventional method) were collected from 100 women, aged between 21 and 65 years, attending gynaecology OPD with various complaints, after obtaining their consent. The smears were immediately fixed with 95% ethyl alcohol, stained and later reported according to Bethesda system (2014) in the Department of Pathology, S.M.C.H. Pregnant women and other women who did not give consent were excluded from the study. Results: 86.7 % of the Pap smears were reported as NILM. 5% of the smears were unsatisfactory for evaluation while 1.7% showed ASCUS, 2.5% showed LSIL, 1.7% showed HSIL and the remaining 0.83% showed SCC. Conclusion: Pap smear is a simple, non-invasive and cost-effective method for detecting pre-cancerous lesions of cervix and thus helps in preventing the development of invasive malignancies. It can thus be established as a routine screening procedure to reduce the burden of cervical morbidity and mortality.

Introduction: Due to their size and position within the skull, giant intracranial meningiomas present a challenge for neurosurgeons. They are very difficult to be removed due to the challenging tumor dissection and encasement of crucial neurovascular systems. This study aims to present our giant intracranial meningioma series and to compare our experience using advanced surgical technology with the current literature. Materials and Methods: A retrospective assessment was conducted on the data pertaining to patients diagnosed with massive intracranial meningioma between 2023 and 2024 who underwent surgical management. Patients’ radiological, surgical, and demographic details were recorded. A thorough analysis was conducted on the location and size of the tumors as well as the surgical approach. Results: The study findings indicate that throughout a 1-year period, 30 patients with intracranial meningioma underwent surgical treatment. Of these, 8 (26.7%) had tumors greater than 5 cm in diameter, which were categorized as giant meningiomas. With a mean age of 64.4 years, there were 5 female and 3 male patients. There were 3 tumors near the base of the skull. 5 patients had Simpson grade 1 resection, whereas 3 patients had grade 2 resection. There was no death reported. In conclusion, giant intracranial meningiomas require careful surgical planning. The excision level of these massive tumors is influenced by their location, the neurovascular structures nearby, and the vascular supply. Skull base meningiomas rarely allow for Simpson grade 1 excision.

Background: Painful erections are a postoperative complication of penile and urethral reconstructive surgeries. Objectives: The primary objective of the present study was to evaluate the efficacy of Ketoconazole to inhibit painful postoperative erections after penile and urethral reconstructive surgery. The secondary objectives were to evaluate the incidence of side effects with Ketoconazole including variations in liver function tests. Methods: This was a hospital based retrospective study conducted in the Department of General Surgery, tertiary healthcare facility in South India between January and June 2024 among males more than or equal to 16 years of age (up to 60 years of age) with phimosis or balanoposthitis who had undergone penile or urethral surgery. Results: The baseline characteristics of our study groups, including age and type of surgery, did not show significant differences. The results showed that the difference in incidence of erections and painful erections between the study groups was found to be statistically significant (p<0.05). It was found that the study groups did not vary significantly (p>0.05) by incidence of nausea/vomiting and liver function test results. Also, the lower mean (SD) VAS scores observed in the study group at all measured timepoints (24 hours, 48 hours, 72 hours, and 1 week postoperatively), in comparison with the control group were statistically significant at all timepoints (p<0.05). Conclusion: Ketoconazole is effective in significantly reducing the incidence of postoperative erections and the associated pain following penile and urethral reconstructive surgery. However, the findings underscore the importance of monitoring for adverse effects, particularly hepatotoxicity, to ensure patient safety.

Backgrounds: Laparoscopic cholecystectomy is a widely used procedure. The use of prophylactic antibiotics in elective laparoscopic cholecystectomy is debatable. Aim of this study: to study whether prophylactic antibiotics could prevent surgical site infection after elective laparoscopic cholecystectomy and to identify any risk factors for surgical site infection. Methods: This study included 300 patients undergoing laparoscopic cholecystectomy between January 2021 and January 2024. Group A patients (180) received third generation cephalosporin 1 g intravenously after induction of anesthesia, and group B patients (120) were not given prophylactic antibiotics. The surgical site infection rates of the patients were compared and analyzed among the two groups. Results: The overall rate of surgical site infection was 1.69% for the total of 300 patients. The incidence of surgical site infection was similar for the two groups: 4 of 180 patients (2.22%) in Group A, 3 of 120 patients (2.5%) in Group B (p=0.913). All of the patients with surgical site infections were well treated under conservative treatments without any sequelae. The preoperative albumin level (p=0.027) contributed to surgical site infection. Conclusions: Prophylactic antibiotics have no role for elective laparoscopic cholecystectomy except for patients with poor nutritional state.

Background: The position of laparoscopic cholecystectomy for acute cholecystitis isn’t always but sincerely set up. The aim of this prospective randomized have a look at became to evaluate the protection and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the consequences with behind schedule cholecystectomy. Methods: among January 2023 and January 2024, forty patients with a diagnosis of acute cholecystitis had been randomly assigned to early laparoscopic cholecystectomy within 24 h of admission (early organization, n = 20) or to preliminary conservative remedy accompanied via behind schedule laparoscopic cholecystectomy, 6 to twelve weeks later (delayed group, n = 20). Results: there was no significant difference within the conversion costs (early, 25% vs not on time, 25%), running instances (early, 104 min vs behind schedule, 93 min), postoperative analgesia necessities (early, 5.3 days vs delayed, 4.8 days), or postoperative headaches (early, 15% vs behind schedule, 20%). but, the early group had significantly greater blood loss (228 vs 114 ml) and shorter hospital live (four.1 vs 10.1 days). Conclusions: Early laparoscopic cholecystectomy for acute cholecystitis is secure and possible, offering the additional benefit of a shorter sanatorium stay. It has to be offered to sufferers with acute cholecystitis, furnished the surgery is performed inside 72 to 96 h of the onset of symptoms.

Background: This retrospective cross-sectional research aims to assess the degree of adherence to ARV regimens among victims of animal bites, identify socio-demographic characteristics related with adherence, and investigate the role of healthcare personnel in impacting patient adherence. The study was conducted in a hospital setting. Aim: The purpose of this study was to ascertain the degree to which victims of animal bites adhered to the Anti-Rabies Vaccine ARV regimen and to describe the type of exposure present among animal bite patients. Materials & Methods: In Assam, the Lakhimpur Medical College and Hospital may be found in North Lakhimpur. The ARV section of the LMCH Central Pharmacy, which uses a systematic approach to monitor patients and their medicines, provided us with the information we gathered throughout our investigation. A total of six months were spent doing the research, beginning on July 1, 2023 and ending on December 31, 2023. This study utilized a retrospective cross-sectional design, and the data was taken from hospital records. Results: A significant number of participants were bitten by an animal (n = 259, 95% confidence interval: 52–62%) than scratched by an animal (n = 185, 95% confidence interval: 37–46%), the most prevalent kind of attacker was a dog (51%, n = 230, 95% confidence interval: 45–55%), followed by a cat (43-52%). Majority of the victims were male of age group 18-30 years. Most of the patients received intradermal regime of vaccination while 22% preferred intramuscular regime. During the course of the research, a total of 192 individuals were given rabies immunoglobulin with the initial dose of the post-exposure vaccination. 379 out of 450 patients completed the full course of vaccination., Most received the vaccination within 24 hours while in 18.6 % the vaccination was administered between the first and third day, with 54 individuals citing other obligations as the reason for the deferral. Conclusion: High rabies PEP compliance was discovered in the study, which may be attributed to victims’ knowledge and the availability of free vaccination. However, delay in 1^st dose, default and Nonadherence to vaccine schedule has come to light. To provide adequate protection of PEP, addressing difficulties and being aware of potential impediments is essential.

Introduction: Coronary artery disease (CAD) is a significant cause of morbidity and mortality worldwide, particularly in India. Elevated plasma homocysteine levels have been implicated in the pathogenesis of CAD, yet their role in the Indian population remains underexplored. This study investigates the correlation between plasma homocysteine levels and CAD in an Indian population at a tertiary care hospital. Methodology: This cross-sectional analytical study included 236 participants, divided into two groups: 118 CAD patients and 118 age- and gender-matched controls. Demographic and clinical data were collected using a structured questionnaire, and plasma homocysteine levels were measured using high-performance liquid chromatography (HPLC). Statistical analyses, including independent t-tests, Pearson’s correlation, and multivariate logistic regression, were performed using SPSS software. Results: The mean plasma homocysteine level was significantly higher in CAD patients (18.4 ± 5.6 µmol/L) compared to controls (12.2 ± 4.7 µmol/L), with a p-value of <0.001. Correlation analysis revealed significant positive correlations between plasma homocysteine levels and BMI (r = 0.20, p = 0.01), smoking status (r = 0.25, p < 0.001), hypertension (r = 0.22, p = 0.002), diabetes mellitus (r = 0.18, p = 0.03), total cholesterol (r = 0.27, p < 0.001), LDL cholesterol (r = 0.30, p < 0.001), and triglycerides (r = 0.21, p = 0.01), and a significant negative correlation with HDL cholesterol (r = -0.24, p = 0.002). Multivariate logistic regression identified BMI (OR = 1.12, p = 0.001), smoking status (OR = 1.50, p = 0.01), hypertension (OR = 1.45, p = 0.01), HDL cholesterol (OR = 0.98, p = 0.001), and plasma homocysteine levels (OR = 1.15, p < 0.001) as significant independent predictors of CAD. Conclusion: This study demonstrates a significant correlation between elevated plasma homocysteine levels and CAD in the Indian population, suggesting that homocysteine could be an essential biomarker for CAD risk assessment. Further research is needed to explore the potential benefits of homocysteine-lowering interventions in reducing CAD risk.

Introduction: Inflammatory lesions of gastrointestinal tract (GIT) are most common conditions with high degree of morbidity. The variety of GI lesions using endoscopic biopsies was divided as esophageal, gastric, duodenal, and colonic lesions. In present study, we aim to understand and analyze histopathological spectrum in inflammatory lesions of gastrointestinal tract in tertiary care center of north Maharashtra. Materials and Methods: This was a retrospective observational study including tissue samples of 244 cases, submitted for histopathological evaluation from June 2022 to June 2023. The various inflammatory conditions were analyzed with reference to age, gender, clinical findings, gross and histopathology. Also hematoxylin and eosin stained formalin fixed and paraffin embedded tissue were received to study the histopathological features, microscopically. Observations and Results: The present study included a total cases of 244 cases out of which there were 77 cases (31.55%) of upper GI tract biopsies and remaining 167 cases (68.45%) were of lower GI tract biopsies. 57.79% were males while 42.21% were females while peak incidence in 3^rd and 4^th decades . Among 77 (100%) cases of upper GI biopsies, chronic duodenitis (22.07%) was the most common in inflammatory lesions followed by chronic gastritis (18.19%). In lower GI tract biopsies, out of 167 (100%), Acute on chronic appendicitis (35.92%) was the most common. Conclusion: The present study provides a reasonable picture of the demographic features and clinicopathological manifestations of patients of tertiary care center in north Maharashtra for inflammatory lesions in GIT. Histopathological evaluation is a gold standard for early detection of GI lesions enlightens on early diagnosis by histopathology beneficial for the patients in north Maharashtra.

Introduction: Quality microbiological, antimicrobial sensitivity reporting (AST) is helpful to prescribe appropriate antibiotic and ultimately beneficial to curb down antimicrobial resistance. Even the resulting antibiogram is crucial in monitoring antimicrobial resistance (AMR) and the basis for formulation of antibiotic policy. Microbiology laboratories follow CLSI & EUCAST guidelines which are vast & exhaustive.  Further, these guidelines are frequently updated with few changes. To follow these guidelines in daily microbiological reporting especially at heavily burdened laboratories may have chances of error in AST reporting by missing few points. To evaluate the overall AST pattern for minimizing errors, improvement in adherence to guidelines and also to maintain uniformity in AST reporting, we need handy tool for daily reporting of AST and easy referral. Material & Methods: Concise tables were prepared for present study using recent CLSI 2024 guidelines & few points from EUCAST guidelines. Tables for Disc diffusion test & MIC values were prepared for ready reference, this will be useful for daily routine Reporting of AST for all commonly encountered pathogens. For easy understanding, codes in the form of symbols, colors & abbreviations were described. Results: For present study, results were discussed as per charts & tables (applied for copyright) & following points were highlighted. The charts with tables are prepared for Enterobacterales spp., Nonfermenters spp., Staphylococcus spp., Enterococcus spp., Streptococcus spp., Haemophilus spp. & Neisseria species. The following AST points are included in the Tables – Disc diffusion & MIC breakpoints, Tier wise cascade reporting, Intrinsic resistance, Intermediate zone/SDD zone, lack of disc diffusion guidelines for different drug-bug combination, Marking of page numbers for quick and easy reference, Equivalent/surrogate agent for routine AST workup, Antibiotics not useful in CSF & urine samples. Conclusion: This study depicts easy instructions & referral of guidelines which can be edited as per different laboratory practices. The quality AST reporting & antibiogram are helpful to strengthen antibiotic stewardship which is also highlighted in recent NMC guidelines for hospital-based colleges & ICMR at National level healthcare practices.

Objective: The aim of this study is to compare the intra- and postoperative time and bleeding, postoperative pain and duration of hospitalisation, postoperative clinical outcomes viz. stenosis, recurrence and patient satisfaction Stapler Haemorrhoidopexy and Laser haemorrhoidoplasty in the management of second-degree and third-degree piles. Methods: This randomized prospective comparative study was done in the department of General surgery at RKDF Medical College Hospital and Research Centre, Bhopal. The work  started after the review and approval of protocol of study by Institutional Ethics and Research committees. All patients fulfilling the inclusion criteria were studied pertaining to disease under study. The allocation of patients to the two surgical techniques was randomized. The details of the cases was recorded as per the proforma. The patients were followed up for a duration of 6 month. Operative time, postoperative pain and complications, resolution of symptoms, and length of return to daily activity were prospectively evaluated. Results: The most common presenting features were bleeding (93%), pain (89%), and prolapsed haemorrhoids (69%). Most of the patients have grade II haemorrhoids (60.7%) (Table 1). No patients suffered from spontaneous bleeding after surgery. While 112 patients (65%) experienced post-defecatory bleeding the day one after surgery, and 49 patients (28.3%) on postoperative day 3. The average VAS score 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively. There was no deviation in any patient from the normal postoperative course or any need for pharmacological treatment or surgical, endoscopic, and radiological interventions in this study. Conclusion: Laser haemorrhoidoplasty appears to be a promising and effective non excisional surgical procedure in the treatment of symptomatic haemorrhoidal disease with high patient satisfaction, acceptable postoperative symptoms, minimal complications, and short operating times. MMH + ND-HAL was a satisfactory surgical modality for treating II/III haemorrhoids.

Background: The purpose of this study was to investigate the role of allergic rhinitis in the success of tympanoplasty. Methods: The study was prospective and the study population was selected from patients admitted for middle ear pathology in ENT ward at Katihar Medical College. Total 40 patients, 20 from each group (AR-allergic rhinitis; NAR- nonallergic rhinitis) were undergone through type 1 tympanoplasty. Results: Success rate of tympanoplasty was measured in terms of Graft uptake rate, which was 90% in NAR group and 80% in AR group. However, the difference between groups was not statistically significant (p=0.747). Conclusions: These findings suggest that allergic rhinitis decreases the graft uptake rate, although a statistically significant difference was not found.

Background: After septoplasty operations patients mainly complain about facial pain and discomfort. It is due to various causes such as excision of the cartilage causing septal deviation, sutures or anterior nasal packing placed for stabilization and surrounding tissues damage. Aim: To evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and patient satisfaction. Method: 100 patients between 18 and 60 years of age who were scheduled for elective septoplasty were enrolled in a double-blind randomized controlled study. The patients were randomly divided into 2 group, group T and Group P. In Group T, at the end of surgery following hemostasis, 2mg/kg tramadol was applied as submucosal infiltration to both surgical site i.e. 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Post-operative pain was evaluated using Visual analogue scale (VAS) scores at 1, 2, 4, 6, 12 and 24 hours(h) following surgery. Results: Post-operative pain intensity was significantly lower in group T in comparison with group P during the first 24 hours after surgery (P < 0.001). Conclusion: Submucosal infiltration of tramadol in septoplasty patients can decrease post-operative pain, analgesic consumption, and the time to recovery without significant side effects.

Introduction: Several meta-analyses investigating morbidity following tonsillectomy have demon  strated that a single intravenous dose of Dexamethasone (DX) is an effective, safe and inexpensive method of reducing the incidence of postoperative nausea and vomiting (PONV) following tonsillectomy in children[1-5]. We undertook the study to find out the effectiveness of intraoperative single IV dose of dexamethasone on the risk of postoperative haemorrhage in tonsillectomy patients. Objective: To assess whether dexamethasone dose-dependently reduces or increases the risk of postoperative haemorrhage in tonsillectomy patients. Methods: This study was conducted with 200 patients who underwent tonsillectomy. Patients were divided into four groups of 50, where one group (n=50) received intraoperative dexamethasone of 0.05mg/kg, second group (n=50) received intraoperative dexamethasone of 0.15mg/kg, third group (n=50) received intraoperative dexamethasone of 0.5mg/kg and the fourth group(n=50) were given placebo injection Normal Saline. Bleeding episodes of all the groups were recorded in first 7 days following surgery. Children were randomly assigned to receive dexamethasone injection (0.05, 0.15 or 0.5mg /kg) and place bointravenous Normal saline after induction of anaesthesia. Acetaminophen and ibuprofen were given as postoperative analgesics. Follow up continued untilthe7th postoperative day. Results: At 24 hours, 2 of the 50 children who received placebo (4%; 95% CI, 0.5%- 13%), 6 of 50 (12%; 95%CI, 4%-23%) who received dexamethasone, 0.05mg/kg, 2 of 50 (4%; 95% CI, 0.5%-13%) who received dexamethasone 0.15 mg/kg, and 12 of 50 (24%; 95% CI, 13%-38%) who received dexamethasone, 0.5 mg/kg, had at least 1 bleeding episode (P=.003). The largest dose of dexamethasone 0.5mg/kg was associated with the highest risk of bleeding (24%; 95% CI, 13%-38%). Children who received dexamethasone received significantly less ibuprofen. There were 26 postoperative bleeding episodes in 22 children. Dexamethasone 0.5mg/kg was associated with the highest bleeding risk. Conclusion: A single dose of intraoperative intravenous dexamethasone was significantly associated with increased risk of postoperative haemorrhage in tonsillectomy patients.

Background: Deviated nasal septum results in nasal obstruction. Many surgical procedures are available in correcting the disorder. It is a well-known fact that such problems are treated using septoplasty. Along with these conditions, the patients also experience turbinate hypertrophy, treated by septoplasty plus turbinectomy. Both treatment procedures are advocated in patients depending on the medical history of patients and physicians’ clinical judgments. Aim: Therefore, this paper compares the outcomes of the patients undergoing these two treatment procedures. The paper aims to judge which method is more useful in the context of health outcomes. Method: Thirty patients were divided into two groups. Group A was the one that underwent septoplasty only based on the inclusion and exclusion criteria. Group B included 15 people who underwent septoplasty along with turbinectomy. All medical precautions were taken during surgery. The preoperative and post-operative NOSE scores were compared along with the calculation of their P-value. Result: P-value seems to be less than 0.05 in all the cases. Along with this, the post-operative examination reveals that there was no patient with both side blockages after turbinectomy was performed along with septoplasty. Septoplasty alone lead to 3 cases of one-side blockage and five patients with two-side blockage. Compared to these findings, the group B patients were only 2 in number who reported one side blockage only. Conclusion: It is concluded in the paper that septoplasty with turbinectomy is a better treatment option than septoplasty alone in patients having nasal problems.

Background: A Prospective Randomised Control Trial was done to evaluate the effect of Magnesium Sulfate on haemodynamic parameters in patients undergoing elective laparoscopic abdominal surgeries. Materials and Methods: 80 patients were divided into 2 groups of 40 each. Group A received Magnesium Sulfate 50 mg/kg and Group B received 50 mL Normal Saline. Statistical Analysis used- The statistical difference in age, weight, height of the subjects and haemodynamic parameters such as pulse rate, systolic blood pressure, diastolic blood pressure and sedation were compared. Quantitative data is summarised using mean and standard deviation. The difference in mean between quantitative variable was tested using student’s ‘t’ test. Results: The baseline characteristics of the Intervention and Control groups were comparable and there was no significant difference between the groups. Systolic and Diastolic BP were higher in Control group than magnesium group. There was no significant difference in sedation levels in both groups. Conclusion: In our study, we conclude that IV magnesium sulfate, when given before pneumoperitoneum attenuates arterial pressure increase during elective laparoscopic abdominal surgeries. This attenuation is apparently related to reductions in the release of catecholamine, vasopressin or both by magnesium sulfate. We also found that there is no adverse effect of magnesium like sedation or prolonged neuromuscular blockade at the dose we used.

Background: Lung cancer is a major public health concern in India as well as globally with high fatality rates. This study aims to compare the efficacy of bronchoalveolar lavage, bronchoalveolar brushing with biopsy findings in the diagnosis of lung carcinoma. Methods: The study was a tertiary health care centre based cross sectional study conducted at the Department of Pathology at Sardar Patel Medical College and Associated Group of Hospitals, Bikaner over a period of two years between January 2022 and December 2023.  All the bronchoalveolar lavage and bronchial brushing and bronchial biopsy specimens were examined. Results: Brushing cytology has a sensitivity of 65.45% and bronchoalveolar lavage (BAL) cytology has a sensitivity 43.64%. The most commonly reported carcinoma in our study was squamous cell carcinoma (61.82%) followed by small cell carcinoma (21.82%) and adenocarcinoma (14.54%). Conclusion: Bronchial brushing emerges as an inexpensive and minimally invasive technique with a good diagnostic yield, exhibiting both high sensitivity and specificity, and outperforming.

Introduction: Shivering is one of the most common complications of the central neuraxial blockade due to impairment of thermoregulatory control. Many agents have been used to eliminate post – op shivering such as meperidine, tramadol, ketanserine, clonidine, Propofol, physostigmine, nefopam, dexamethasone, magnesium sulfate, & fentanyl. Aims: the aim is to study the efficacy between dexmedetomidine and tramadol in preventing shivering post sub arachnoid block. Methods and Materials: A Prospective, randomized study, Group T patients received inj. Tramadol0.5mg/kg diluted in100mlnormal saline & Group D received inj. Dexmedetomidine 0.5µg/kg diluted in 100ml normal saline, both drugs were infused over a time period of 5mins before giving spinal anaesthesia. Result: The mean shivering score in Group D was 0.4±.21 at T0 interval, the mean shivering score in Group T was 0.13± 0.34 at T0 interval. After 2hrs the shivering score was 0.02±0.15 in Group D & 0.11±0.32 in Group T. Both drugs dexmedetomidine & tramadol were effective in preventing shivering after spinal anaesthesia.

Introduction: Nasal blockage, dryness, crusting, bleeding, itching, rhinorrhea, anosmia, headache, cosmetic complaints are the symptoms and signs that accompany septal pathology. Septoplasty, one of the most common surgical procedure sin the otorhinolaryngology, is performed for correction of the septal deviation. Outcomes of Septoplasty can be divided into objective or subjective patient reported outcome measurements. Thus there is a need for the formation of standard protocol to assess the efficacy of Septoplasty. Materials and Methods: A prospective study, which included 60 patients diagnosed with DNS, was conducted in the Department of Otorhinolaryngology, Katihar Medical College, between June 2018 to January 2019. NOSE Scale which is brief, valid, reliable, and responsive survey was used in the present study to assess the outcome of septal surgery. Results: On analysing the NOSE score it was observed that, at the end of 6 months of follow up period patients had significant improvement with respect to Nasal obstruction, headache, Nasal discharge, facial pain, and hyposmia. Conclusion: Surgical correction of the obvious anatomic deviation can significantly improve clinical outcomes including nasal obstruction, headache, facial pain and nasal discharge.

Lipomas are benign tumors predominantly composed of mature adipose tissue. While commonly found in subcutaneous locations, their occurrence within the ovary is exceedingly rare. We present a detailed histopathological examination of a lipoma of the ovary in a 45-year-old female patient. The specimen was subjected to gross and microscopic analysis, revealing the characteristic features of mature adipocytes and confirming the diagnosis of ovarian lipoma. This case report provides insights into the histological presentation of ovarian lipomas and emphasizes the importance of accurate diagnosis through histopathological examination.

Background: Hypertensive emergency in pregnancy is defined as per sistent acute-onset, severe hypertension (Systolic BP>160 mmHg or diastolic BP >110 mmHg or both) in the setting of preeclampsia or eclampsia. Objective: Compare safety and efficacy of oral nifedipine and intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy Study Design: a randomised comparative hospital based study conducted in Department of Obstetrics and Gynaecology, J.L.N Medical College, Bhagalpur from April 2020 to December 2020 in 80 women with hypertensive emergencies. Method: Divided into 2 groups of 40 each. Nifedipine group received 10mg tab every 20 min till maximum of 5 doses and labetalol group was given iv labetalol in escalating doses of 20, 40, 40, 80and 80mg every 20 min till a target BP was achieved. Results: In our study, mean time required to achieve target BP in nifedipine and labetalol group was 4514.84 and 54+18.22 minutes (p value 0.018) respectively. Mean decrease in SBP after treatment was 59 ± 21.1 mmHg in Nifedipine group as compared to 42.25 ± 22.7 mmHg in Labetalol (p – value = 0.001). Also the mean decrease in DBP in nifedipine group was 37.5 ± 11.49mmHg as compared to 27.75 ± 15.34 mmHg in labetalol group (p – value = 0.001). There were no significant differences between side effects and fetomaternal outcome. Conclusion: Oral Nifedipine controls hypertension more rapidly and with fewer doses and is as safe as iv Labetalol.

Background: Severe acne vulgaris, a chronic inflammatory skin condition, often proves resistant to conventional treatments such as antibiotics and hormonal therapies. Oral isotretinoin, a retinoid, is known for its efficacy in treating severe and recalcitrant acne but requires careful monitoring due to potential side effects. Objective: This prospective study aims to evaluate the effectiveness and safety of oral isotretinoin in patients with severe acne vulgaris resistant to conventional treatments. Methods: Fifty patients with severe acne vulgaris, unresponsive to at least two systemic therapies, were enrolled. The mean age of participants was 22.4 years, with 60% being female. All patients received oral isotretinoin for 24 weeks. The primary outcomes were the reduction in the number of inflammatory and non-inflammatory lesions, and the overall acne severity, measured using the Global Acne Grading System (GAGS). Adverse effects and patient satisfaction were also assessed. Results: Significant improvements were observed in all primary outcomes. The mean number of inflammatory lesions decreased from 45.8 to 12.3 (73.2% reduction, p < 0.001), and non-inflammatory lesions decreased from 68.5 to 25.4 (62.9% reduction, p < 0.001). The GAGS score reduced from 30.2 to 8.6 (p < 0.001). Common adverse effects included dry skin and lips (90%), cheilitis (80%), epistaxis (20%), transient elevation of liver enzymes (10%), and muscle and joint pain (30%). Despite these side effects, patient satisfaction was high, with 70% reporting being highly satisfied. Six months post-treatment, 16% of patients experienced a relapse requiring a second course of isotretinoin. Conclusion: Oral isotretinoin is highly effective in treating severe acne vulgaris resistant to conventional treatments, with significant reductions in both inflammatory and non-inflammatory lesions. The treatment is generally well-tolerated, and patient satisfaction is high, although careful monitoring for adverse effects is necessary.

Background: Oral cancer is the sixth most common malignancy worldwide, and it is characterized by high morbidity and mortality rates. Oral squamous cell carcinoma (OSCC) accounts for more than 90% of all oral malignancies. Aims & Objectives: The present study was done to analyse the immune-expression of PD-L1 in OSCC and precancerous oral epithelial lesions. Also, the statistical association between PDL-1 expression and clinicopathological features with special reference to tumour size, histological grade, tumour depth, stromal lymphocyte reaction, nodal status and tumour stage was done to determine the significance of PD-L1 expression as a predictive and prognostic biomarker in OSCC. Materials & Methods: It was a prospective study conducted on 232 cases (211 OSCC + 21 premalignant lesions) of which 86 cases (65 OSCC + 21 premalignant lesions) were selected, and results analyzed with clinical parameters. Immunohistochemistry (IHC) for Programmed death ligand 1 (PD-L1) molecules was applied. Results: In our study a significant statistical correlation was found between the immuno-expression of PD-L1 in tumour cells and tumour grade, degree of stromal lymphocyte reaction, tumour size, cervical lymph node status and tumour stage. Higher tumour grade and higher TNM stage were significantly associated with higher expression of PD-L1. Conclusions: Significant correlation of PD-L1 with different clinico-pathological variables especially tumor grade and TNM stage can help in the prediction of the prognosis of these patients and can also help guide the response to the treatment given in higher stage tumour, specially with the promising PD-L1 monoclonal antibodies.

Introduction: Flexible fibre optic bronchoscopy has become an essential procedure for diagnosing and managing various respiratory conditions. Persistent lung collapse or collapse of small air sacs in the lungs is sometimes evaluated using bronchoscopy. The cause maybe a blockage from thick mucus, foreign body or a tumor. Many diagnostic procedures can be performed using flexible bronchoscopy such as bronchial washings, bronchoalveolar lavage, bronchial brushings, endobronchial biopsy, transbronchial lung biopsy and transbronchial needle aspiration. The role of flexible bronchoscopy in therapeutic and diagnostic management of lung collapse is still under scientific evaluation. Aim: To study the role of Flexible Fibre optic bronchoscopy in therapeutic and diagnostic management of lung collapse. Materials and Methods: A hospital based retrospective observational study was done on 36 patients who were admitted with lung collapse at Government Hospital for chest and communicable diseases, Visakhapatnam. Patients with acute lung collapse that failed to re-expand with conventional methods were taken in the study. All the cases were subjected to complete history taking, clinical examination, chest X ray, thoracic ultrasound followed by bronchoscopy. Results: 36 patients who met the eligibility criteria were subjected to bronchoscopy. Malignancy was confirmed by endobronchial biopsy in 19 out of 36 cases. Infective etiology was confirmed in 12 cases. 5 cases out of the 36 did not show any significant etiology by bronchoscopy. Conclusion: In cases with lung collapse, early bronchoscopic airway evaluation should be considered especially if the patients have known risk factors for malignancy.

Background: Perinatal outcome has been shown to be jeopardized by prolongation of pregnancy beyond 40 weeks with an increase in perinatal morbidity and mortality being ascribed to uteroplacental insufficiency and cord compression. Consequently, the question of whether a pregnancy that proceeds to more than 40 weeks should be considered a high-risk pregnancy remains a controversial issue. Objectives: To assess the foetal outcome in pregnancies beyond 40 weeks and to compare with foetal outcome in pregnancies between 37-40 weeks. Methods: A prospective case controls study of 100 cases of women who delivered beyond 40 weeks of gestation and 100 cases of women who delivered between 37-40 weeks respectively in Government General Hospital, Government Medical College, Srikakulam, AP, during June, 2023-June, 2024. Result: The incidence of meconium, low Apgar score, foetal distress, NICU admission and caesarean section increases significantly beyond 40 weeks. Compared to 37-40 weeks. Conclusion: Risk to both mother and infant increases as pregnancy progress beyond 40 weeks of gestation.

Background: Schwannomas are benign peripheral nerve sheath tumors that may occur throughout the body. They rarely occur in the nasal cavity. Paranasal schwannomas are uncommon lesions, representing less than 4% of all head and neck schwannomas. A rare case of Schwannoma is reported in a 37-year-old female who presented with a history of nasal blockage for six months. The tumor mass was removed successfully without any postoperative complications and there was no recurrence during the 3 month follow up period. Aim of the Study: To report an unusual presentation of Schwannoma occurring in the nasal cavity. Materials: A 37-year-old female presented with nasal blockage; more on the right side. Rhinorrhea and headache was reported since 6 months. On examination of the nasal cavity showed pale polypoid mass, insensitive to touch and no bleed on touch. Probe could be passed all around the mass. CT scan revealed mild enhancement of the soft tissue density arising from the roof of the nasal cavity extending anteriorly till axilla of middle turbinate and posteriorly extending till the sphenoethmoid recess. Excision of nasal mass was done by trans nasal endoscopic approach. Bone destruction was not seen. The mass was removed completely and sent for histopathological examination. Results: S-100 immunostaining was expressed, which is diagnostically significant. There were increased number of mitoses and cellular atypia observed in the HPE slides.  The tumour was deep seated rather than superficial which is the case for most PSs. Conclusions: The prognosis for sinonasal schwannoma is generally favourable. The tumour is believed to be slow-growing and mostly benign in nature. However, considering the significant morbidity associated with tumour growth, reported favourable surgical outcomes and the reported malignant potential of schwannomas. The treatment of choice for sinonasal schwannoma should be complete surgical excision.

Background: Penetrating neck injuries are not uncommon, while penetrated foreign bodies involving the larynx are rare. Both the types of injuries could be critical and challenging to the ENT surgeon. Penetrating neck injuries comprise of 05% to 10% of all trauma cases. Multiple vital structures are involved following such injuries as the neck is a relatively small anatomical area of the body. Surgical treatment is based on the zone involved. The neck is divided into three zones for convenience. Initially the general conditions of the patient with the neck injuries are assessed. Management varies from routine exploration to selective exploration. Injury to food and air passages and major blood vessels are commonly seen. Aim of the Study: To present an unusual case of penetrating foreign body into the Neck in the area of Subglottic. Materials: A 19-year-old man presented to our emergency outpatient clinic with pain in throat, hemoptysis and bleeding from anterior aspect of neck. He was construction worker who accidentally injured his neck while doing chipping work two hours prior to being shifted to the Emergency room. Results: A thorough patient history taking was done and prompt imaging studies; CT scan and flexible fibreoptic laryngoscopy were done. An endoscopic approach was chosen, and the foreign body was found lodged in the posterior wall of the subglottic region and it was removed with foreign body grasping forceps. Conclusions: Surgeons may be called on to manage penetrating neck injuries in the emergency room and hence be trained in skills enabling them to the following: 1. Assess and achieve an adequate and stable airway 2. Stabilize a collapsing circulation 3. Assess the head and neck injury swiftly in a logical manner prior to surgical exploration.

Purpose: The purpose of this study was to correlate the dimension of Nd: YAG laser capsulotomy with visual acuity and refraction. Materials and Methods: This was a retrospective study. 100 eyes were included in the study. All the patients had undergone Nd: YAG laser capsulotomy for Posterior Capsular Opacification between April 2022 to March 2023. The patients were divided into 4 groups based on the size and shape of capsular opening after laser. Group A) Circular opening ≤4mm, Group B) Circular opening >4mm, Group C) Cruciate opening ≤4mm, Group D) Cruciate opening >4mm. Results: 100 eyes had pearl type of P.C.O. The mean age at presentation was 58.5 years with standard deviation of 6.8 years. Group D required highest laser energy (mean 1.8 millijoule) while in Group A least laser firing was needed (mean 1.1millijoule). Post laser the vision improved but there was no statistically significant changes in refraction and spherical equivalent amongst the 4 groups (p = 0.9) Intra ocular pressure was within normal limits post laser. Conclusion: The size and shape of laser capsulotomy opening doesn’t affect the refractive outcome although bigger opening may result in complications due to increased laser firing.

Introduction: Physiology lays the foundation of future clinical sciences. In the traditional system of medical education, it was mainly taught by means of didactic lectures, tutorials & practical classes. For comprehensive medical education goals, introducing new modalities is essential. Early clinical exposure (ECE) alongside traditional lectures can spark interest, enhance understanding & promote active learning. Study type: Educational interventional study. Place of study: SIMSR, Kalol, Gandhinagar. Duration: 4 Months. Participants: 150 students, Phase -1 MBBS (Academic batch 2023 – 2024). Data collection tool: Pre – validated questionnaire in Google forms, Pre – validated perception questionnaire for students & faculty members. Five ECE topics were covered with the help of case-based scenarios, hospital visits & calling of specific patients with clinical signs to the classroom. Results: MCQ marks with traditional teaching learning methods were 5.70 + 1.89. Marks of students with ECE sessions were 7.18 + 1.89. Students unpaired t – test was used to compare post test scores between exposure group & non-exposure group, which comes 6.433. P value was obtained as P < 0.0001. Discussion: In my study significant difference found between scores obtained by exposure group & control group. Students trained by ECE were benefitted more when compared with students trained with traditional methods on learning modules of heart emergencies, Shock, Diabetes mellitus etc. Conclusion: ECE can help in improved understanding of topic. ECE can be an effective technique in creating learning environment and help in achieving objectives.

Introduction: There has been a paradigm shift in the teaching, learning methodologies after CBME was introduced for undergraduate medical curriculum in 2019. It was designed aiming at better outcomes with practical proficiency of concepts learned in MBBS. Self-directed learning was introduced to sensitize and facilitate the student for andragogy and lifelong learning.Various methods of teaching like problem based learning(PBL),team based learning (TBL), ability based education were brought into limelight to aid in achieving andragogy. It will be thus good to know what students prefer and think about learning styles; thereby a faculty can plan a teaching session accordingly. Gamification is one of the novel tools where students enjoy learning with critical thinking and application of knowledge. The does level in the Bloom’s taxonomy requires a good, knowledgeable physician who can apply the knowledge and act appropriately by applying the content learnt. Thus, it is inclusive to understand what the students perceive about learning methods like CWP. Materials and Methods: This prospective study was conducted in the department of Physiology in April 2024 from at Mamata Medical College, Khammam. 66 students of first year MBBS participated voluntarily in the activity. After the routine teaching hours by one faculty dealing with all objectives on Endocrine physiology, a Google form comprising of 10 multiple choice questions pertaining to the objectives was circulated. A CWP activity on endocrine glands was conducted in the class. A follow up Google form was also sent after the group activity, for their views on it. A post test was conducted a week later by another Google form on the same competencies from endocrinology. Perceptions of students on CWP were analyzed; the pre and post-test scores were compared by chi-square test. Results: There were a total of 66 students of which 35 were females and 31 were males. It was observed that more than 50% of the students had agreed to the usefulness of the activity for their learning. In the feedback obtained, 43.93% strongly agreed that the CWP activity was interesting, all gave an affirmation on group discussion on CWP gave a better understanding of the topic. The pre and post test scores showed significance of p<0.00001, thus the post test scores improved after the CWP activity. Conclusion: Students perceived that activities like CWP made learning interesting and made them think critically which will lay a good foundation if implemented regularly in the curriculum.

Background: Cigarette smoking remains a global health concern, with significant implications for perioperative outcomes. Methods: This prospective study aimed to investigate the impact of smoking on perioperative cardiopulmonary complications in patients undergoing major surgery under general anesthesia. Demographic characteristics, including age distribution and ASA grades, were recorded. Perioperative adverse events, such as heart rate changes during intubation, cough severity, oxygen desaturation, and bronchospasm, were meticulously monitored from induction to post-anesthesia care unit discharge. Results: We enrolled 120 patients, including 60 smokers and 60 non-smokers, and assessed demographic characteristics, ASA grades, and perioperative adverse events. Smokers exhibited a higher incidence of adverse events, including elevated heart rates during intubation, severe coughing, bronchospasm, and lower oxygen saturation levels post-extubation. Longer smoking duration exacerbated these risks. Conclusion: These findings underscore the importance of tailored perioperative management strategies for smokers, including smoking cessation interventions and preoperative respiratory optimization, to mitigate complications and improve outcomes. Despite limitations, this study provides valuable insights into perioperative risks associated with smoking and highlights the need for further research in this area.

Introduction: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal illnesses, characterized by non-specific symptoms such as abdominal pain and abnormal bowel habits but no recognized organic cause. Its prevalence varies between communities. The current study was conducted to determine the sociodemographic and clinical profile among patients with IBS. Materials and Methods: A cross sectional retrospective was done at Warangal hospital and diagnostic centre, Warangal during the period from December 2021 to December 2023. Age, gender, Place of residence, education and occupation level, socioeconomic status as classified using Kuppuswamy scale, lifestyle habits (smoking, alcohol consumption) were assessed as part of sociodemographic profile. Clinical profile of patients included presence of Intestinal and extra-intestinal symptoms, and signs. Results: Fifty patients were part of this study. The mean age of the patients was 42.6 ± 18.3 years, ranging from 12 to 72 years. 35 (70%) patients were males & 15 (30%) patients were females. The majority 28 (56%) patients belong to the age group of 30-45 years. The majority 27 (65.9%) patients belonged to rural areas. Majority 15 (30%) patients had primary education. A large proportion of the patients 18 (36%) were unemployed. Most of the patients 17 (34%) were upper lower class. Most of the patients were non-smokers and non-alcoholics. The most frequent presenting symptoms were abdominal pain (60%), constipation (58%) and diarrhoea (40%). Conclusion: IBS is a public health issue that lowers the quality of life for individuals affected. The most common presenting symptoms were abdominal discomfort and constipation. Various mental health problems and psychosomatic disorders must be screened and treated as part of the management process.

Background: Skin adnexal tumors (SATs) are uncommon lesions and include diverse group of tumors, both benign and malignant. Benign tumors are more common compared to the malignant ones. Although the malignant tumors are rare, they are locally aggressive, have high propensity to distant metastasis and are associated with poorer prognosis. The diagnosis is established essentially by histopathological examination which is still considered as the gold standard technique. Aims and objectives: Skin adnexal tumors (SATs) are rare neoplasms infrequently encountered in the routine surgical pathology practice. This study aimed to find the clinical presentation and the histopathological features of SATS along with differentiating benign from malignant tumors. Materials and Methods: This was retrospective study done in a tertiary care hospital over a period of two years (June 2022 to May 2024). All the SATs reported during this period were analyzed for their clinical features, age, sex incidence and their gross and histopathological features. Results: The total number of cases diagnosed as SATs were 48 which included pigmented eccrine poroma, eccrine spiradenoma, syringocystadenoma papilliferum, nodular hidradenoma, proliferating trichilemmal cyst, trichoepithelioma, pilomatrixoma, Trichoblastoma and epidermal cysts. Conclusion: SATs are uncommon entities most of which are benign. Malignant neoplasms are extremely rare and have a very poor prognosis including reduced survival and high rate of distant metastasis. This study emphasizes on proper categorization of skin adnexal tumors which helps in optimal patient management and better patient outcome.

Background: The emergency department (ED) provides immediate care to patients, and identifying the challenges and understanding the process flow helps establish an efficient ED, for improving outcomes and meeting standards. This study aims to analyze the ED patient population, quantify wait times, and map the process flow. Methods: A cross-sectional study was conducted on 349 willing patients selected from consecutive sampling, across all time frames. Demographic details, presenting complaints, wait times and process flow were manually collected using Epicollect software version 5.1 & analysed using Jamovi and R software. Results: Among 349 patients, 238 were males and 111 were females, majority were 41 -60 years. 48%medical, 21% surgical and 29% trauma cases were reported. 83% were below poverty line & 32.95% were unemployed, 20.3% unskilled laborers & rest were homemakers, skilled laborers, students. Median waiting times for triage and initial physician assessment in medical, surgical, and trauma emergencies were 4, 3, and 3.5 minutes, and 1, 1.2, and 1 minute, respectively. Wait times for initial lab tests were 24, 253, and 121 minutes, respectively. Reassessment by a doctor and CT scan wait times were 129, 194.5, 115 minutes, and 35, 108, 84.5 minutes, respectively. Conclusion: Among 349 patients, the majority were unemployed males 41-60 age, 83% below the poverty line. 48% medical, 21% surgical and 29% trauma cases . While triage and initial physician assessment wait times were satisfactory, they were prolonged for lab tests, radiological investigations, and reassessment.

Background: Cutaneous granulomatous lesions encompass a wide range of dermatological conditions with diverse etiologies, including infections, foreign bodies, and systemic diseases. Accurate diagnosis is critical for effective management, necessitating a thorough understanding of their clinical presentation and histopathological features. Aim and Objectives: To evaluate the frequency and patterns of different cutaneous granulomatous lesions with its clinico-histopathological correlation to reach etiological diagnosis. Materials and Method: This study was descriptive, observational study aimed at assessing the etiological, clinical, and histopathological characteristics of different cutaneous granulomatous lesions. The study was conducted at Department of Pathology, for duration of one year. Ethical approval was obtained from the Institutional Review Board (IRB) before the commencement of the study and after meeting inclusion and exclusion criteria. Results: Majority of the patients were from the age group of 10-20 years. male to female ration was 2.43 : 1. Skin and Subcutaneous were major was major site of granuloma, most common Etiology among study population was due to tuberculosis. Conclusion: This study highlights the diverse etiological spectrum and clinical presentations of cutaneous granulomatous lesions. Histopathological examination remains indispensable for accurate diagnosis, providing essential insights into the underlying causes.

Background: Helicobacter pylori, often known as H. pylori, a gram negative, flagellate, helical bacterium is responsible for a persistent bacterial illness that affects more than 50% of people worldwide. Countries with lower per capita incomes appear to have higher rates of this illness. Like other bacterial illnesses, the elimination of refractory infections is impacted by the increasing prevalence of antibiotic resistance and ultimately impacts human health. Aim: The main aim of this investigation was to reassess the effectiveness of the conventional triple therapy plan for H. pylori. Materials & Methods: 330 individuals who tested positive for a H. pylori stomach infection through Rapid urease test (RUT) and/or Giemsa staining of gastric biopsy specimens without any history of PPI or antibiotic use in last two weeks were split into two treatment groups using a 50/50 randomization ratio. One group (Group LVX) consisted of members who were administered 500 mg of levofloxacin once daily, 1 g of amoxicillin twice daily, and 40 mg of esomeprazole twice a day for fourteen days while the other group (Group CLARI) consisted of members who received twice-daily doses of amoxicillin (1 g), clarithromycin (500 mg) and esomeprazole (40 mg) for the same duration. Following a period of six-week after the completion of the courses of therapy, each patient in both the groups had an endoscopy and RUT or biopsy to determine if the H. pylori infection had fully resolved. Results: 330 individuals who tested positive for H. Pylori were included in the study and divided in two groups consisting of 165 each. The baseline characteristics of the patients included in the two groups were matched. Of the 330 patients initially included, a data of a total of 5 patients (3 in Group LVX and 2 in Group CLARI) were not found and could not be followed. 27 patients had recorded adverse effects and decided to terminate treatment. 298 individuals finally completed the treatment. The eradication rate of H. pylori in Group LVX was found to be 71.62% based on RUT or biopsy while 81% showed clinical improvement and 79% showed endoscopic improvement. On the other hand, 68.65% of patients in Group CLARI showed eradication based on RUT or biopsy, while 79% and 77% demonstrated a clinical and endoscopic improvement respectively. Conclusion: Both Levofloxacin and Amoxicillin based triple therapy was found to equally effective; but both the regimens exhibit rates of eradication that are less than optimum and low efficacy in the groups we studied. In the future, research should concentrate on determining the elements that may affect the results of therapy and investigating alternate first-line regimens to enhance eradication rates.

Objectives: To evaluate the effectiveness of recombinant human platelet-derived growth factor (rh-PDGF) in comparison with hydrogel and normal saline dressing in diabetic foot ulcers. Methods: This was an observational, comparative cross-sectional study conducted in the Department of General Surgery, in a tertiary healthcare facility located in South India between January 2021 and December 2021 among patients diagnosed with diabetic foot ulcer. Results: The study involved 150 diabetic foot ulcer patients divided into three groups: Group A received rh-PDGF, Group B received hydrogel dressings, and Group C received normal saline dressings. Baseline characteristics like age, gender, lifestyle factors, comorbidities, and ulcer severity didn’t differ significantly among the groups. Initial ulcer sizes were comparable. However, after four and ten weeks, Group A and B showed significantly smaller ulcer sizes compared to Group C. Group A had the smallest ulcers at both intervals. Need for secondary interventions were similar among groups, but hospital stays differed significantly, with Group C having the longest stay. Groups A and B had significantly higher rates of completely healed ulcers compared to Group C. Conclusion: This suggests that recombinant human platelet-derived growth factor and hydrogel dressings may be more effective than normal saline dressings in reducing ulcer size and promoting healing in diabetic foot ulcers.

Background: Anemia is defined as a reduction of the total circulating red cell mass and is a major public health problem in India. More than 1.6 billion anemic people have manifestations of iron deficiency anemia (IDA). The best and most sustainable strategy for preventing micronutrient (iron and folic acid) deficiency is dietary supplement. Adolescent age group is the window of opportunity to correct their nutritional status by providing additional food supplements and prevent future consequences of nutritional deficiencies. Aims and Objectives: This study aims to evaluate the effectiveness of jaggery and raisins as supplements in treating iron deficiency anemia. Materials and Methods: This is a prospective interventional clinical endpoint study conducted among 50 female medical undergraduate students. They randomly received oral nutritional supplement (jaggery balls – 5 g and raisins – 5 g) once daily in the morning for 8 weeks. Body weight and complete blood count were assessed before and at the end of 8 weeks of intervention. Results: After 8 weeks of daily supplementation of jaggery and raisins, we observed that there was a significant rise in the mean hemoglobin (Hb) level to 11.79 ± 1.07 (P < 0.0001) and also a significant rise in the mean red blood cell count to 4.22 ± 0.30 (P < 0.0001) compared to baseline values. Conclusion: The outcome of this study proved the effective role of the nutritional supplementation in improving the Hb status in IDA. Combination of jaggery with raisins proved to be a better natural food supplement to overcome IDA without prominent side effects as observed with oral and parenteral iron preparations. It can also be used as a prophylactic strategy to combat iron deficiency in vulnerable population.

Background: Perforation of tympanic membrane in Chronic Suppurative Otitis Media is usually surgically corrected by Tympanoplasty. Various graft materials are tried for its reconstruction like periosteum, perichondrium, cartilage, vein & fat. The cartilage with perichondrium was used as a composite graft to study the long term results. Aim of the Study: To evaluate and compare the results in terms of uptake, auditory gain and complications using umbrella technique (perichondrium with cartilage) composite graft versus temporalis fascia graft in the patients who underwent Type–1 tympanoplasty. Materials: A prospective observational study was conducted on 60 CSOM patients with Tubotympanic type of disease. In 30 patients cartilage graft and in another 30 patients Temporalis fascia graft was used for Tympanoplasty Type-I. The graft uptake, Air conduction hearing threshold gain and complications were observed over a period of 06 months and the data was analysed. Results: The graft uptake was 100% in the cartilage graft group and 93.3% in the Temporalis fascia group. Air conduction hearing gain was unequivocal in the two groups and the p value was <0.05. Conclusions: The graft uptake in Umbrella technique (Perichondrium with cartilage composite graft) showed 100% success rate when compared with temporalis fascia graft. it was 93.3%. The hearing improvement in Umbrella technique (perichondrium with cartilage composite graft) was almost equal without any significant difference when compared with temporalis fascia graft technique group.

Background: Malnutrition is a silent killer that is usually underreported, under addressed, and as a result under prioritized. It continues to be major cause of morbidity and mortality in children especially 6 months to 5 years. Severe acute malnutrition is a medical and social problem as it accounts for 6.4% of children below 60 months. Children after treatment at a Health facility have to be followed up to find out the outcome. This study was done to screen the under five children at District Early Intervention Centre (DEIC), GMCH, Thiruvallur for malnutrition and to follow them over a period of 24 months. Methodology: After obtaining Institutional Ethical committee clearance, Children less than 5 years were screened for malnourishment using the standard IAP guidelines and categorised as SAM and MAM and treatment was started as per the IAP guidelines. Around 148 children were found malnourished and followed up at regular intervals for 24 months. Results: 148 children were found to be malnourished.75 were girls and 73 were boys.49 of them were below 1.5years of age, 56 were below the age of 3years and 43 were below the age of 5 years. All of them were investigated and advised to follow the diet regime planned according to their weight and followed up at regular intervals to assess their nutrition status and any other morbidities. At the end of 24 months, there was a significant increase in the weight of all children (p value < 0.001, paired t-test) Conclusion: Identifying the children with malnutrition and mere advice shall not bring about the change in nutritional status of the under-five children. Regular follow-up and continuous monitoring shall improve the Physical and Mental status of the under-five children which is the crucial age of development.

Aim: To analyze first-trimester uterine artery doppler to predict pre-eclampsia for early detection and diagnosis of PIH. Objective: (1). To evaluate the usefulness of uterine artery doppler screening in first-trimester to predict the risk for preeclampsia. (2). To know the outcome of pregnancy and its relation with the uterine artery Doppler indices. (3). To study effect on maternal mortality and morbidity of early prediction of pre-eclampsia to prevent maternal mortality and morbidity. Methodology: This hospital based prospective longitudinal study was carried out at the Department of Obstetrics and Gynaecology, Muzaffarnagar Medical college, Muzaffarnagar for a duration of 18 months. A total of 100 cases were enrolled from Gynae OPD, presenting for a routine prenatal ultrasound examination by simple random sampling technique. Transabdominal Doppler Ultrasound scan was done at 11 to 14 weeks. The basic parameter monitored in our study was the pulsatility index = peak systolic velocity – end diastolic velocity/mean (PI = S-D/Mean) and the presence of bilateral notch in the uterine artery. Results: Overall mean PI among the study subjects was 1.81±1.85, on Right Uterine Artery it was 1.77±1.88 and on Left Uterine Artery it was 1.84±1.82. There were 28 subjects (28%) with abnormal PI i.e., ≥1.5 and remaining 72 (72%) had normal PI (<1.5). In 72 subjects with PI <1.5, one subject (1.39%) each Gestational hypertension, Oligohydramnios and Stillbirth; 2 females (2.78%) had Preeclampsia; and Fetal growth restriction (FGR) was present in 5 subjects (6.94). There was statistically significant difference (p<0.01) in Gestational hypertension, Preeclampsia, Oligohydramnios and FGR when two groups were compared. Conclusion: According to the results of the current study, uterine artery color doppler is a useful and non-invasive method for predicting preeclampsia at term in healthy pregnancies.

Background: One of the most prevalent forms of adult leukemia is chronic lymphocytic leukemia (CLL), which can proceed in a variety of ways and present with a wide range of signs and symptoms. In this study, we looked into the correlation and frequency of laboratory results for CLL patients, such as cellular Immunophenotyping, bone marrow aspiration and biopsy, and peripheral blood smear. Methods: All 161 patients with a confirmed diagnosis of CLL had their laboratory data retrieved for this cross-sectional, retrospective analysis. Descriptive statistics were used to assess the frequency and correlation between various laboratory parameters. Techniques with the Jamovi software update (2022). Results: 161 individuals had their laboratory and demographic characteristics, including thrombocytopenia, anaemia, white blood cell count, lymphocyte percentage, and patterns of bone marrow involvement, assessed. There was a substantial correlation between the percentage of atypical lymphocytes in peripheral blood and the percentage of FMC7 marker expression in the bone marrow. Conclusion: A variety of diagnostic methods can be used to identify chronic lymphocytic leukaemia, a common kind of leukaemia linked to significant death and morbidity. Examining the frequency of certain diagnostic tests and analysing their findings these symptoms in those who have the illness can be very helpful for an early diagnosis and prognosis assessment in those who are affected.

Background:  In haematological disorders morphological changes in RBCs plays a vital role. The RBCs indices were always correlated with peripheral smear findings. This study was done to understand the importance of histogram and peripheral smear findings. Materials and Methods: EDTA blood sample from patients of anemia was run on Nihon Kohden Five part automated cell counter and peripheral smears were prepared for 3 months in tertiary hospital. The correlation between microscopic findings in RBCs morphology with cell counter histograms was done. Result: Total 176 patients of anemia were studied. The females were 130 (73.86%) and males were 46 (26.17%). Microcytic hypochromic anemia was common and was seen in 64.77% followed by Normochromic normocytic anemia which was seen in 19.31%, Dimorphic anemia in 11.93%, Macrocytic anemia in 2.84%, and Pancytopenia in 1.13%. In microcytic anemia the curve was shifted to left, in macrocytic anemia the shift was towards right side, and dimorphic anemia shows bimodal peak. Conclusion: For diagnosis of anemia peripheral smear findings were definitive and histogram can be used as supplementary tool.

Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status. Recently identified parameters, including fractional uric acid excretion and plasma copeptin concentration, may further improve the diagnostic approach. The treatment for hyponatremia is chosen on the basis of duration and symptoms. For acute or severely symptomatic hyponatremia, both guidelines adopted the approach of giving a bolus of hypertonic saline. Although fluid restriction remains the first-line treatment for most forms of chronic hyponatremia, therapy to increase renal free water excretion is often necessary. Vasopressin receptor antagonists, urea, and loop diuretics serve this purpose, but received different recommendations in the two guidelines. Such discrepancies may relate to different interpretations of the limited evidence or differences in guideline methodology. Nevertheless, the development of guidelines has been important in advancing this evolving field.

Globally, obesity is a severe medical condition that requires novel strategies and acknowledged international agreement to treat illnesses that result in morbidity. Examining the diverse relationships between the different adult obesity phenotypes was the goal of this review. To distinguish between biomarkers, an analysis was conducted on proteins and related genes in each group. There is currently no clear consensus in nomenclature, despite the fact that a number of terminologies are used for classification and characterisation within this disorder. The most important categories that were examined were sarcopenic obesity, metabolically abnormal, normal weight, metabolically healthy obese, and metabolically abnormal obese. These phenotypes don’t specify specific genotypes, epigenetic gene regulation, or inflammatory protein combinations. Numerous other genes have been related to obesity, yet it is still worthwhile to check. Since there are no meaningful biomarkers, the outcomes of those for diagnosis are not very predictive. It is critical to reach agreement on the nomenclature and attributes applied to obesity subtypes. Finding certain molecular biomarkers is also necessary for more accurate detection of obesity subtypes.

Background: The morphological development of human fetal kidney have been subject of increased awareness for the assessment of fetal growth and development in a high risk pregnancy, prematurely delivered normal baby and also in prenatal diagnosis of renal diseases and possible intervention. Objectives: The aim of the study was to determine the morphological development of the kidneys during the fetal period. Methods: The present study was carried out in the department of Anatomy, Regional Institute of Medical Sciences, Imphal, Manipur. The material for the study consisted of 60 spontaneously aborted and still born human fetal specimens free from any gross congenital anomalies with gestational age between 11th to 38th weeks were collected from Obstetrics and Gynaecology Department, RIMS. The kidneys were taken out from fetal specimens and studied. Results: Surface of the kidney is found to be lobulated from 13 weeks of gestation with gradual increase in lobulation and maximum number of lobulation was observed at 30 weeks thereafter a declination was noticed till the term pregnancy. The kidney of 11th and 38th weeks of gestation was observed to have smooth surface without any surface lobulation. Shape of the pyramid changes from nodular to triangular with advancing gestational age except at 11th of gestational age where the pyramid is not identifiable. Conclusions: The present work made an initial attempt to analyze the morphological growth pattern of kidney in human fetuses, which may prove useful in defining the prematurely delivered normal baby, high risk pregnancies and fetal kidney diseases and age determination of fetuses during post mortem autopsy.

Background: Altered mental status is very common yet highly non-specific presentation of patients to the Emergency Medicine Department (EMD). Altered mental status is broad general term which includes disorders associated with mental dysfunction ranging from slight confusion to coma [1]. Acute presentation of altered mental status may be the presentation of a patient as a result of underlying disease conditions including structural, metabolic, vascular or other conditions [2-4] or may be a late manifestation due to hypoxia or hypo perfusion to the brain⁽⁵⁾. Patients generally present with very vague complains; so their diagnosis and treatment are highly challenging for Emergency Physicians. Aim: To study the clinico-demographic profile and outcome of patients presenting with atraumatic altered mental status to ER of the tertiary care hospital. Methodology: This is prospective observational study. Total 139 Patients, presenting with acute onset altered mental status and meets inclusion criteria were included and studied. GCS (Glasgow coma scale) was calculated on admission. Patients were managed according to standard treatment guidelines. Patient’s outcome and length of hospital stay were recorded. All data was entered in Microsoft excel sheet and analysed in Epi info software version 7.2.6.0. Results: Out of 139 patients of altered mental status, 91 (65.46%) were males and 48(34.53%) were females. The mean age of the patients with altered sensorium was 55.06±15.82 years. Maximum number of the patients was from 60 years and above age group, n=55 (39.56%). Ischemic stroke (20.14%) was most common aetiology among neurological causes followed by haemorrhagic stroke (13,66%), and hepatic encephalopathy (18.7%) was most common aetiology among metabolic causes followed by uremic encephalopathy(17.26%). Mortality rate and length of hospital stay were inversely related to on admission GCS score. Conclusion: Overall mortality rate was 21.58%. Early identification of aetiology and prompt management shows favourable outcome. GCS calculation can help to determine prognosis of patients presenting with altered mental status to the Emergency Room.

Objective: This study was planned to analyze the educational interventions on ADR reporting by health care professional in a tertiary care hospital located in western Uttar Pradesh. Methods: It is a questionnaire-based study in which pre-test was conducted then session on pharmacovigilance was taken followed by post-test. Scores of pre-test and post-test was compared using chi-square test. Result & Discussion: It was observed in this study that educational intervention has made an impact on knowledge and increased the awareness among the study participants which has made them to realize the importance of ADR reporting. Conclusion: ADR reporting by health care professionals has increased after the educational intervention was made. In order to raise awareness and change in attitude regarding ADR reporting, educational interventions at regular interval have played a very important role.

Early thrombolytic therapy can reduce the associated morbidity and mortality in acute ischemic stroke. Many factors are there which contribute to delaying the arrival of patients to hospital. Aims: To understand Causes of Delayed Presentation in Stroke Patients to ED of Tertiary Care Hospital. Subjects and Methods: Observational and Cross Sectional study involving 100 patients with symptoms of stroke at Tertiary care hospital with stroke unit, Ahmedabad, Gujarat, India between December 2023 to July 2024 was conducted. Data from Hospital Information System entered in a clinical record form. From this case record form data were entered in Ms excel sheet. Data analysed with appropriate software. Observation and Result: We observed that the maximum number of patients were male and within the age group of 50-80 years. Out of 100 patients 75% were presented after 4.5 hours of onset of symptoms and ignorance of symptoms (32%) and consulting to non-stoke unit (22%) were major reasons for delayed presentation. Other less common causes were financial problems, transportation problems, living alone and living in rural areas in descending manners.

Introduction: Unique feature of cervical vertebra is the presence of foramen transversaria, which is present in the transverse process of the vertebra and transmits vertebral vessels and autonomic nerves. However sometimes there may be presence of accessory foramen usually seen behind the foramen transversaria knows as accessory foramen transversaria (AFT). The present study was aimed to find out the incidence of (AFT) and to study the morphometry of Accessory Foramina Transversaria in dry human cervical vertebrae. Methodology: 200 dry human cervical vertebrae available in the department of Anatomy, Sri Aurobindo medical college Indore, were observed macroscopically for the presence of accessory foramen transversarium and morphometric study was carried out by using digital vernier calipers. Results: Out of 200 cervical vertebrae, accessory foramen transversarium was found in 24 cervical vertebrae. Among 24 cervical vertebrae, 21 were typical cervical vertebrae and 3 were atypical cervical vertebrae. In atypical cervical vertebrae, we found accessory foramina transversaria only in C7 and not in C1 and C2. Conclusion: Unilateral AFT was more common than bilateral as well as oval shaped AFT was found to be more common than round. The knowledge of incidence, shape and size of AFT is clinically important for neurosurgeons, radiologists, anthropologists and anatomists. 

Background: Globe injuries are a major cause of visual impairment and blindness worldwide. Ocular trauma is frequently associated with facio-maxillary and/or head injuries. The present study was therefore conducted at tertiary care center to study the effectiveness of USG scan in assessing the posterior segment in patients with ocular trauma, so that further treatment plan can be decided and prognosis can be improved. Methods: The study was conducted at Regional Institute of Ophthalmology, Gauhati Medical College and Hospital, Guwahati during the study period of one year i.e. from 1^st July 2022 to 31^st June 2023. The data was compiled using Ms Excel and analysed using IBM SPSS software version 20. Results: A total of 50 patients with history of blunt ophthalmological injury resulting in closed globe injuries and satisfying the inclusion & exclusion criteria were taken up for this study. The socio-demographic data reveals that the age group of 21-30 years (Range-8 to 70 years) were the most commonly affected (28% of all cases) with males having higher incidence than females (70% as compared to 30%). The most common anterior segment morbidity was Subconjunctival Hemorrhage (48%), followed by lid injury (46%). Vitreous hemorrhages (32%) followed by retinal detachment (16%). Conclusion: USG B-Scan greatly supplements the general clinical approach by detecting, locating, and finding the extent and nature of the lesion.

Aims and Objective: To evaluate morbidity and mortality profile in children admitted to pediatric intensive care unit (PICU) and to assess the usefulness of PRISM III score in predicting mortality in PICU. Materials and Methods: It is a cross sectional; hospital based prospective observational study done in department of pediatrics, PICU, MKCGMCH, Berhampur from October 2019 to September 2021 taking 105 cases. Information collected on study population during admission to PICU included patient details, provisional diagnosis, primary system involved, PRISM III scoring (systolic BP, temp, heart rate, mental status, pupillary response, blood gas analysis, glucose, potassium, creatinine, hematological parameters) was done. Patient’s course of hospitalisation in PICU was monitored and requirement of ventilator and type (invasive/ non-invasive), duration were recorded. Final outcome was whether shifted to general ward / discharged/ death/ LAMA/ referral to higher centre were recorded. Statistical analysis was done between PRISM III score value and outcome of patients and discriminative power of the score between survivor and death was analysed. Results: Total 105 patients were analysed. Most common age group was infancy and male to female ratio of 1.4:1. Most common indication for admission to PICU was respiratory diseases (n=38,36%)followed by neurological diseases(19,18%). Total death was (n= 27, 25%) among case studied. Among respiratory cases majority was pneumonia (n= 26, 68.4%). Total 63 cases (60%) required assisted ventilation during PICU stay and among them 58.7% were on invasive mode of ventilation. Common indications for intubation were respiratory failure, shock and low GCS. Mortality rate among those on assisted ventilation due to respiratory causes was lower 21.9% as compared to neurological and cardiovascular causes with mortality rate of 57.1% each. Most common complication found in ventilated patients was nosocomial pneumonia 14.3%. Minimum PRISM III score in study was 0 and maximum was 42. Mortality risk among those with score 8 and below was (n= 63, 6.3%) and having score above 8 was (n= 42, 54.7%). Mortality risk was 100% when score was 30 and above. Area under the curve for PRISM III score was 0.91 (95% CI) reflecting good discriminative power of score between survivor and death. Conclusion: Our study found that the mortality rate of PICU was 25% during the study period. A higher mortality rate was associated with more severe condition of patients during admission to PICU. PRISM III score was found to be an excellent predictor of mortality and had good discriminative power between survivor and death.

Background: This anatomical study aimed to conduct morphometric analysis of desiccated lumbar vertebrae in human cadavers. Methods: The study examined adult dry lumbar vertebrae bones and MRI images at PSG Institute of Medical Sciences and Research, with approval from the Institutional Ethics committee. The study lasted three years and involved anthropometric measurements of 100 vertebrae from L1 to L5 using Vernier Caliper. Results: The incidence of round, oval, triangle, and trefoil shapes varied across different levels of the data. No significant difference was observed between pedicle length of right and left side. Highly significant differences were observed between vertebral body anteroposterior and transverse diameters of L1 vertebrae with other vertebrae. The study found that the vertebral body’s anterior length was longer at the inferior border, and lamina length was greater on the right (p < 0.01). Left-sided specimens had higher lamina height and other parameters. Conclusion: The study provided crucial anatomical dimensions for lumbar vertebrae, essential in surgical practice, enabling the manufacturing of implants based on the specific sample population.

Background and Aim: Vesical calculi are often associated with incomplete bladder emptying symptoms, although a combination of other urinary symptoms, such as terminal hematuria, suprapubic pain, weak stream, dysuria, etc., can also be present. Present study was done with an aim to evaluate the outcome of minimal invasive surgical procedure for vesical calculus. Material and Methods: The present study was conducted in the department of general surgery in a tertiary care hospital presenting with features of vesical calculus during the period of 1^st January 2018 to 30 June 2019 in 30 patients. Collection of data is from clinical history, physical examination, relevant investigation and imaging modalities. Evaluation done on the basis of Post-operative pain, Hospital stays, Occurrence of infection, Cost effectiveness and Post op catheterization. Results: Males were more affected than females; alkaline reaction of urine favors ed UTI and stone formation. Commonly encountered organism in UTI was Escherechia Coli. X Ray KUB and Ultrasonography were the cost-effective methods to detect in patients who came with ureteric colic. Patients in whom calculi ranged from2-4cm showed good results with spcl. Patients in whom calculi ranged from 2-4cm showed good results with cystolitholapexy. Conclusion: The Minimal invasive management of vesical stones is safe and practicable in majority of patients provided the pain and infection remain under control. Cystolitholapaxy is safe, simple and effective method of fragmentation of small sized stones and spcl for medium to large size stone.

Introduction: The accumulation of unused and expired medicines at home creates environmental dangers due to a lack of information about proper pharmaceutical disposal practices. Aim: The current study is to assess students’ knowledge, attitudes, and disposal processes for unused or expired medicines, as well as to create an awareness session. Materials and Methods: This cross-sectional, questionnaire-based investigation was undertaken with undergraduate medical students. The questionnaire contains demographic information about the students, questions about their knowledge of safe disposal of expired/unused pharmaceuticals, questions about their attitudes towards safe disposal of expired/unused drugs, and questions about their practices regarding safe disposal of expired/unused drugs. Results: A total of 100 medical undergraduate students participated, with 53% female and 47% male. 83% of pupils indicated that they are aware of pharmaceutical waste. Sixty-one percent of pupils knew how to dispose of narcotics safely. The majority of students (93%) agreed that hazardous disposal of expired or unused pharmaceuticals would harm both the environment and human health. 58% of students strongly agreed that the public and students should be educated about the adverse impacts of improper methods of disposing of unused, expired, and leftover pharmaceuticals on human and environmental health. When the survey participants were asked if they store unneeded or leftover medications at home, 66% replied yes, while 44% said no. According to study participants’ responses, topical formulations (60%) were the most prevalent type of drug stored in houses, followed by antipyretics (17%), antibiotics (13%), antacids (4%), analgesics (4%), and antihistamines (2%). When asked about how they dispose of leftover medications, the majority of students (73%) said they toss them in dust bins at home, which would be collected by the municipality. Few participants (7%) stated that they would return to the chemist and rinse down into the sink for safe disposal, whereas 6% and 3% of students preferred to flush down the toilet and give away to friends and family. Self-discontinuation is the most common cause for drug storage among participants (39%). Other survey participants reported that they had gathered the drugs because they had purchased them over the counter for common colds and headaches (16%), and that many of the drugs had expired (25%). Conclusion: In the current study, medical undergraduate students were aware of the risks associated with inappropriate disposal of expired or unused medications. Whereas, due to a lack of understanding about safer procedures, the majority of students used unsuitable techniques to dispose of leftover or expired medication at home.

Aim: To explore the demographic, etiological, clinical characteristics & outcome of cases presented to emergency department with poisoning. Materials & Methods: This retrospective study conducted at ACSR Govt Medical College. Totally data from medical records of 100 patients with OP poisoning were retrieved. Clinical, demographical & laboratory investigation were recorded. Glasgow coma scale (GCS) & Poisoning severity score (PSS) were estimated within 24 hours of admission. Results: Higher poisoning seen in Males (71%) than females (29%), and most commonly seen in the age group of 21-30 years (59%) where pre-hospitalization period was <6 hours in most of the patients (67%). Significant association was observed between GCS (P<0.001), PSS (P<0.001) & outcome of OP poisoning. No significant association was observed with pseudocholinesterase level and OP poisoning severity.  A total of 83% patients were improved after treatment and mortality rate observed was17%. Out of these 83% severe complications were observed in 14% of the cases. Suicidal poisoning is the major cause of poisoning in majority cases. Conclusion: Current study shows that both GCS & PSS were similar in predicting the outcome whereas pseudo cholinesterase levels which was used as mainstay approach to assess the prognosis shows no significance at all. GCS being less time consuming and can be done easily can be used in peripheral areas to identify high risk patients for urgent referral to tertiary care centers. It has shown that usage of certain compounds like chlorpyriphos and methyl parathion can be reduced to reduce the morbidity and mortality rate.

Aim: To evaluate the performance of SOFA and qSOFA scoring system at time of presentation to measure the mortality risk estimates in critically ill patients in emergency department of ACSR GMC/GGH Nellore. Methods: All critically ill patients requiring intubation & mechanical ventilation in ED at our tertiary care teaching hospital were studied. Results: Mean age of the present study population was 60.12±15.7 years. Mean duration of hospital stay in expired cases was 4.2 days & among survived cases was 8.95 days. The mortality rate observed in our study was 25%. The mean SOFA score was 7.1±2.7 and 4.1±1.98 in non-survived & survived cases (p<0.0001). The mean qSOFA score was 1.9±0.69 and 1.5±0.69 in non-survived & survived cases (p<0.0001). The mean duration of hospital stay was 4.2±3.9 days and 8.95±6.9 days in non-survived & survived cases. ROC-curve of SOFA shows an area of 0.85 (95% CI: 0.685-0.991; p<0.0001) with a cut-off of SOFA score >6 with a sensitivity and specificity were 87% and 62% respectively. ROC-curve of qSOFA shows an area of 0.74 (95% CI: 0.598-0.862; p<0.0001) with a cut-off of qSOFA score >2 with a sensitivity and specificity were 84% and 57% respectively. This concludes that SOFA score is the better prognostic scoring system in predicting in hospital mortality than qSOFA scoring system. The area under ROC curve of SOFA at the time of admission for predicting mortality in critically ill patients who requires intubation in emergency department was 0.85 (95% CI;0.685-0.991) is significantly higher than qSOFA with area under ROC curve 0.74(95% CI; 0.598-0.862). Conclusion: SOFA score is the better prognostic scoring system in predicting in hospital mortality than qSOFA scoring system in patients who requires intubation.

The study of Spinal lesions is greatly improved with the use of computed tomography (CT) and magnetic reso-nance imaging (MRI). However, modern imaging is essentially morphologic; its low specificity only allows for etiological diagnosis in a few patients. Therefore, biopsy should remain the last step of staging for definite di-agnosis and treatment planning for patients with spinal lesions our aim was to evaluate the incidence and severi-ty of complications associated with computed tomography guided percutaneous aspiration and biopsy of spine and characteristics of spinal lesion on computed tomography with its histopathological correlation CT had sen-sitivity of 85.71% and specificity of 93.54% for the diagnosis of malignancy and sensitivity of 85.71% and specificity of 86.48% for the diagnosis of tuberculosis, The most common pathogen isolated was Staphyloccous aureus (n = 40 34%). Other common pathogens included coagulase-negative Staphylococci (n = 23, 18%) and Mycobacteria (n = 18 16%; Mycobacteria tuberculosis n = 37). Fourteen of 105organisms (6%). Conclusion Image guided Biopsy done with a good technique helps in achieving accurate diagnosis, ensures correct treat-ment at the earliest and has minimal complications. In conclusion, the diagnostic culture yield for CT-guided biopsies in cases of suspected spinal infection is low.

Background: Frequent injuries that can cause severe disability, deformity, and neurological deficiency are thoracolumbar spine fractures. The purpose of the study was to assess the outcomes of surgical treatment for traumatic paraplegia, categorizing the condition as complete or incomplete using Frankel grading. Methods: This prospective study was conducted in patients attending outdoor and emergency department of orthopaedics of Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar with traumatic paraplegia involving the dorsolumbar spine from June 2020 to May 2022. The duration required for the recovery of different functions, such as sensory, motor, bowel, and bladder function, the comparison of early and late decompression, the outcomes of posterolateral fusion, and the amount of time needed for solid bone fusion following surgery, are all significant goals. Four of the 46 patients that were chosen within the minimum 6-month follow-up period after surgery were lost to follow-up. Information gathered from patient records, such as age, gender, length of stay in hospital after injury, Frankel score at the time of admission, MRI results, type of surgery done, postoperative course, neurological status upon release, and most recent follow-up. Analysis of the results did not include patients who were lost to follow-up. Results: Eighty percent of patients with partial paraplegia who had decompression within the first week had returned to grade 3 power. In cases of full paraplegia, 11% of patients showed a return to power up to grade 3 within a week following decompression, but no cases showed a recovery to grade 3 power after the second or third week. Conclusion: In both total and incomplete paraplegic cases, the earlier surgical decompression following spinal shock recovery occurs, the better the outcome for neurological and bowel/bladder function recovery. Reduction in early decompression is easier, faster, and better than in late decompression. After decompression, motor recovery may last longer than six months.

Background: Fractures with an arterial injury requiring vascular repair are severe injuries. This type of fracture is often associated with severe soft tissue compromise and damage of neurological structures. Aim: To study the pattern of fractures and dislocations associated with vascular injury of extremities and outcomes of fracture union, function of the limb and complications in relation to fracture pattern and modality of treatment. Methods: A total of 31 patients admitted in the emergency ward with fractures and associated with vascular injury was taken into this study. All patients have been taken up for surgical intervention both for vascular repair by vascular surgeons and skeletal fixation by us. Results: Mode of injury was road traffic accidents in 27 patients (87%) of which fall from riding a two-wheeler predominated. Lower limb was most commonly involved (26 cases) and most common bone fractured was tibia. Closed fractures with vascular injury occurred in 10 cases and open injury in 21 cases. Most common artery to be involved was popliteal artery (21 cases). Conclusion: Initial management with external fixation allows time to assess the viability of limb, edema to subside and soft tissue to recover. Delay in surgery and extensive soft tissue injury are associated with increased amputation rate.

Introduction: The accurate assessment of knee joint injuries is paramount in orthopedic medicine to facilitate effective treatment strategies and optimal patient care. Magnetic resonance imaging (MRI) has emerged as a pivotal diagnostic tool, offering detailed anatomical insights without invasive procedures. However, the standalone utility of MRI may sometimes be limited in providing a comprehensive understanding of knee injuries. Combining MRI with arthroscopic correlation has gained recognition to overcome this limitation, offering a synergistic approach for precise diagnosis and treatment planning. Methodology: In this prospective study conducted at a tertiary care hospital in Chengelpet district, Tamil Nadu, 42 patients with traumatic knee injuries underwent MRI evaluation followed by arthroscopic examination. The MRI protocol included various sequences to assess different knee structures comprehensively. The MRI findings were meticulously correlated with arthroscopic results, and diagnostic parameters were computed. Result: Our study revealed a male predominance (76%) among the participants, consistent with existing literature on knee injuries. ACL tear was the most prevalent abnormality detected on MRI, followed by joint effusion. Medial meniscal injury was the predominant meniscal pathology, with grade 3 tears involving the posterior horn of the medial meniscus frequently observed. Complete ACL tears were more common than partial tears. Discussion: These findings underscore the clinical significance of integrating MRI with arthroscopic correlation for accurate diagnosis and treatment planning in knee injuries. The high prevalence of ACL tears, joint effusion, and medial meniscal injuries highlights the importance of tailored management strategies. This integrated approach facilitates a comprehensive understanding of knee pathology, ultimately optimizing patient outcomes.

Introduction: Hematuria, characterized by an elevated number of red blood cells (RBCs) in the urine, can manifest as either visible blood or be detectable only through microscopic examination, often identified incidentally. The incidence of microscopic hematuria is approximately 4–5% in routine clinical assessments of children aged 6–12 years. A thorough understanding of the clinical patterns and outcomes associated with hematuria is essential for optimizing management strategies in affected children. This study aimed to evaluate the outcomes of hematuria in children treated at an Indian tertiary care hospital. Methods: A prospective follow-up study was conducted involving 178 children, aged between 1 month and 12 years, who were admitted with hematuria. Data were collected using a pre-designed and piloted questionnaire, including clinical history, physical examinations, relevant investigations, and follow-up assessments over a one-year period. A biopsy was performed on 35 patients by a qualified pathologist. Results: Of the 178 children with hematuria, 43 had a history of renal disease, while 135 had no prior renal conditions. After one year of follow-up, 81.63% of those without previous renal issues experienced resolution of hematuria, while 18.37% had persistent renal impairment. In contrast, among those with pre-existing renal conditions, 75% (27) continued to exhibit renal problems. The condition was more prevalent in school-aged children with a higher incidence in females. The predominant cause was acute post-infectious glomerulonephritis, followed by IgA nephropathy and systemic lupus erythematosus. Conclusion: Hematuria is a prevalent clinical issue, with majority of cases being identified at the time of admission. Following basic and relevant investigations, a clinical diagnosis can be established in most of the patients. The remaining require referral to subspecialties for further evaluation. Early renal biopsy is recommended for cases where indicated, to facilitate effective management. This approach will assist clinicians in providing enhanced care for children with hematuria.

Background: Second stage caesarean section are associated with more complications than first stage due to fully dilated cervix and deeply engaged head. Aims and Objectives: To study the intraoperative as well as postoperative complications associated with caesarean section performed in the second stage of labor. Methods: Data was collected from the hospital records of Assam Medical College. It included all the term pregnancies i.e. >37 weeks from April 2023 to March 2024. Results: Out of total 11781 deliveries 5658 was caesarean section, out of which 1150 was performed in the second stage. The most common cause was arrest of descent (44%) followed by fetal distress (19.6%), occipito posterior position (14.1%). The most common complications were blood transfusion (21%) followed by uterine incision extension (15.0%). The most common postoperative complications were prolonged catheterization (5.6%), abdominal distension (3%), febrile illness (2.1%). Conclusion: Complications are common in second stage caesarean section and trained    obstetricians should perform it to minimize the complication.

Objective: To review the anatomical features of conventional sites of compression of ulnar nerve & discuss the probable influence on ulnar neuropathy. Methods: Total of 67 embalmed cadaveric upper limbs were studied in Dr. B.R. Ambedkar Medical College, Bengaluru, for the course of ulnar nerve in upper limb. special attentions were given to its course in arm underneath struthers arcade, at elbow in cubital tunnel& at hand in guyons canal. Results: Struthers arcade showed a 100% incidence, among which 86.7% is thickened form of intermuscular septum,19.2% was ligamentous at its distal end (internal brachial ligament). Osborne’s ligament continued from medial epicondyle to olecranon process to also connecting between FCU heads (62%), between FCU & FDP (22%), between FCU &PT (16%). The cubital tunnel roof was also reinforced by anconeus epitrochlear is in (17%) specimen. Conclusion: The different anatomical variants of these conventional sites of compression should be kept in mind which would help in the diagnostic & prognostic recovery of ulnar neuropathy.

Background and Objectives: Systemic lupus erythematosus (SLE) and Rhuematoid arthritis (RA)are both chronic inflammatory diseases of autoimmune origin. They are both characterized by the presence of autoantibodies such as ANA and antiphospholipid antibodies among others. Some of these antibodies interfere with in vitro clotting tests and predispose to thrombosis and can lead to complications. In the present study, PT, APTT and mixing tests were done which are simple tests to determine if any coagulation abnormality exists in  SLE and RA patients and to assess any role of inhibitors in the group of these patients with altered PT and aPTT. Material and Methods: The present study was for a period of 2 years. A total of 72 diagnosed cases of SLE and RA irrespective of age were included in the study. SLE and RA patients with co-existing connective tissue diseases and other autoimmune diseases were excluded. Relevant demographic and clinical data like age, sex, weight, height, relevant personal history and provisional diagnosis were obtained. Complete hemogram (haemoglobin, total leucocyte count, haematocrit MCV, MCH, MCHC, platelet  count differential leucocyte count, ESR), Prothrombin Time (PT), Activated partial thromboplastin (aPTT) were performed in all the cases. Mixing studies were performed whenever indicated. Result: Out of a total of 74 patients included in the study, majority were females (89.2%, n=66). Maximum number of patients were seen to belong to the age group 31-40 years (27%, n=20)followed by age groups21-30 years and 41-50 years (20.3%, n=15). Majority of the patients in both males and females had mild anemia i.e., 62.5% (n=5) and 41.9% (n=31), respectively. In case of SLE patients, Majority (82.5%, n=47) showed normal PT and only 17.5% (n=10) participants show prolonged prothrombin time. Majority of SLE patients (86%, n=49)  hadnormal aPTT and only 8 out of 57 (14%) show prolonged aPTT. In case of rheumatoid arthritis patients, only 4 (23.5%) patients had prolonged prothrombin time (>16 seconds) and showed a mean of 13.9 ± 2.7 seconds and majority (88.2%, n=15) of them had normal aPTT and only 2 out of 17 (11.8%) show prolonged aPTT. Only 2 (20%) out of 10 patients showed prolonged prothrombin time after mixing test among SLE patients whereas 2 (50%) out of 4 patients showed prolonged prothrombin time after mixing test among RA patients. 5 (37.5%) out of 8 participants show prolonged aPTT even after mixing test in SLE patients and all of 2 (100%) patients with prolonged activated partial thromboplastin time (aPTT) were corrected after mixing test in RA patients. Conclusion: Our study showed 91.2% of SLE and 82.5% of RA patients as female. Out of the total, prolonged PT was seen 17.5 % of patients in SLE and 23.5 % in RA and prolonged APTT was seen in 14% of the SLE patients and 11.8 % of RA patients. Nevertheless, thromboembolic events when they occur, can be life-threatening and mixing tests not correcting the prolonged clotting times should raise high degree of suspicion for diagnosis of circulating factor inhibitor or anticoagulant. Those patients with persisting prolonged clotting times could be followed up to note if any thromboembolic or hemorrhagic events occur in the future and correlate with the abnormal coagulation profile.

Background: COVID‑19 pandemic was declared as an international public health emergency by World Health Organization in January 2020. High infectivity and mortality rate was a great concern for all. The frontline healthcare professionals (HCPs) were at the risk of developing infection following direct contact with Covid-19 infected patients. Objectives: To evaluate the psychological morbidity among different healthcare workers during Covid-19 pandemic. Methodology: This cross-sectional study was conducted at Diphu Medical College & Hospital from April 2020 to Sept 2020 covering 98 healthcare workers. Data were collected once in a week following Covid protocol using self-administered questionnaire. Socio-demographic profile and anxiety, stress and depressive symptoms were assessed by using Depression, Anxiety and Stress Scale (DASS-21). Chi-square test and other inferential statistics were used to analyze data. Results: Study showed, the prevalence rates of anxiety, stress and depression were respectively 63.3%, 18.4%, and 44.9%. Higher literacy was directly proportional to psychiatric morbidity. Female gender and nurses had more psychiatric morbidity compared to other study groups. Conclusion: Prior to pandemic situation, context specific programme strategies and policies are utmost necessary to protect healthcare workers to minimize psychiatric morbidity.

Background: UTI in pregnancy may lead to many complications such as prematurity, low birth weight, death and other adverse foetal sequelae (Gilstrap et al, 2001). It may also cause pyelonephritis and sepsis in mothers. Now a days, many UTI-causing organisms are resistant to different commonly used drugs. Only a few Indian studies have been published on this topic. So, it is reasonable to evaluate pregnant women for UTI during their antenatal checkup in this Institution and give them proper antibiotics to avoid pregnancy complications. Materials and Methods: This Descriptive Observational Study comprised 246 Antenatal Patients had urine for routine examination and Culture and Sensitivity testing and their Antibiogram prepared. Results: Out of 246 patients, 174 had no growth (70.73%) and 72 (29.27%) had Bacteriuria, mostly Symptomatic – showed maximum sensitivity to Co-trimoxazole Ciprofloxacin, Amikacin, Gentamycin and Cephalosporins. Conclusions: Periodic urine culture should be performed routinely throughout pregnancy especially during the 1^st and 3^rdtrimester patients. Patients were advised to maintain proper care and hygiene, early detection & treatment. Early detection of UTI and rational use of antibiotics Trimester-wise will help us achieve the best therapeutic advantage for the patients and prevent development of Antibiotic-Resistant Bacterial strains arising from Injudicious use of random antibiotics.

Arterio-Venous Malformations and Invasive Mole rarely coexist causing Heavy and Irregular Uterine Bleeding. One such multigravida attended OBGYN Emergency dept. with a previous h/o Dilatation and Evacuation of uterus. Beta hCG was raised. TVS suggested AV Malformation and uterine artery aneurysm and suspected Placental Site Trophoblastic Tumor. PAP smear showed Negative for any Intraepithelial Lesion or Malignancy. Histo-pathology report of Hysterectomy specimen showed Invasive Mole. Follow up serial beta hCG levels after TAH BSO showed gradual decline and by 6 months it was undetectable.

Introduction: Flexible fiberoptic bronchoscopy has become an essential procedure for diagnosing and managing various respiratory conditions. Persistent lung collapse or collapse of small air sacs in the lungs is sometimes evaluated using bronchoscopy. The cause may be a blockage from thick mucous, a foreign body, or a tumor. Many diagnostic procedures can be performed using flexible bronchoscopy such as bronchial washings, bronchoalveolar lavage, bronchial brushings, endobronchial biopsy, transbronchial lung biopsy, and transbronchial needle aspiration. The role of flexible bronchoscopy in the therapeutic and diagnostic management of lung collapse is still under scientific evaluation. Aim: To study the role of flexible fiberoptic bronchoscopy in the therapeutic and diagnostic management of lung collapse. Materials and Methods: A hospital-based retrospective observational study was done on 36 patients who were admitted with lung collapse at Government Hospital for chest and communicable diseases, Visakhapatnam. Patients with acute lung collapse who failed to re-expand with conventional methods were taken in the study. All the cases were subjected to complete history taking, clinical examination, chest X-ray, thoracic ultrasound followed by bronchoscopy. Results: 36 patients who met the eligibility criteria were subjected to bronchoscopy. Malignancy was confirmed by endobronchial biopsy in 19 out of 36 cases. Infective etiology was confirmed in 12 cases. 5 cases out of the 36 did not show any significant etiology by bronchoscopy. Conclusion: In cases with lung collapse, early bronchoscopic airway evaluation should be considered especially if the patients have known risk factors for malignancy.

Background: Multiple myeloma is a clonal malignant neoplasm of plasma cells originating in the bone marrow along with the presence of monoclonal immunoglobulin in the blood and/or urine associated with end-organ damage. Methods: The present study was done prospectively in 52 patients of multiple myeloma diagnosed over a period of 1 years from 01 January 2023 to 31 Dec 2023 in our teaching hospital. All newly diagnosed patients of Multiple Myeloma with relevant data during the above mentioned period were collected from the records and included in the study. Results: Generalised weakness was the most common presenting complaint seen in 84.61% patients followed by bone pain in 76.92%. Hematological features were anemia in 38 patients(73%), total leucocyte count(TLC) was raised in 5 patients (10%), pancytopenia was seen in 01 patient(1.9%), Erythrocyte sedimentation rate(ESR) was raised in 37 patients(71.1 %), Rouleaux formation was observed in 31 patients (59.6 %). Conclusion: In our study, generalized weakness is the most common clinical presentation followed by bone pain. Anemia is the most common hematological manifestation.

Background: Diabetic retinopathy (DR) is a significant microvascular complication of type 2 diabetes mellitus (T2DM), leading to vision impairment if untreated. With diabetes prevalence rising globally, including India, early detection and management of DR are critical to prevent severe outcomes. This study aims to evaluate the prevalence of newly diagnosed DR among T2DM patients and its association with disease duration and glycemic control. Methods: A cross-sectional observational study was conducted over one month, involving 100 T2DM patients. Data collected included demographic details, diabetes duration, treatment regimens, and HbA1c levels. Comprehensive dilated eye exams assessed DR presence and severity. Results: The prevalence of DR was 37%. Among affected patients, 40.54% had mild non-proliferative retinopathy, 32.43% had moderate non-proliferative retinopathy, 18.92% had severe non-proliferative retinopathy, and 8.11% had proliferative retinopathy. Significant associations were found between DR and longer diabetes duration (p < 0.001) and higher HbA1c levels (p = 0.001). Conclusion: The high prevalence of DR among T2DM patients highlights the need for regular eye screening. Effective glycemic control and early detection are essential to prevent severe DR and associated visual impairment.

Introduction: India has reportedly shown the highest burden of acute coronary syndromes in the world. The ECG is the easiest and useful tool in the identification and management of acute MI. In inferior wall MI lesion is present in left circumflex artery and right coronary artery. In involvement of left circumflex artery ecg changes are ST-segment elevation in one lateral lead (V5, V6, or aVL) with an isoelectric or elevated ST segment in lead I and in involvement of right coronary artery ecg changes are ST-segment elevation in lead III greater than that in lead II. Early diagnosis and prediction of the culprit vessel helps in identifying the patients in whom aggressive reperfusion strategy is needed. When both the RCA and LCX are occluded then deciding which the culprit vessel is for acute MI is difficult and many a times angioplasty done on a chronic lesion and the acute occlusion was missed. In such circumstances, ECG is helpful in predicting the culprit artery. Aim: To assess the value of ECG in predicting culprit vessels in acute inferior wall MI and correlating with coronary angiogram findings. Objective: To evaluate sensitivity and specificity of ECG criteria in identification of culprit vessels in acute inferior wall Myocardial Infarction. Study Design: Prospective observational study. Methodology: Cases of Acute inferior wall MI diagnosed by ECG and Cardiac enzymes in patients aged more than 18 years admitted to tertiary care hospital are taken in study according to inclusion and exclusion criteria. Brief history was taken in each case following admission with reference to symptoms like chest pain and or dyspnoea, and the presence of risk factors like diabetes, hypertension, smoking and alcohol. A 12 lead ECG was done at admission and troponin I level was done in all patients admitted to the hospital. Then these patients were followed up after CAG (coronary angiography) and occluded vessel in angiography and patient’s ecg changes were compared. All the above data were collected and recorded in a standard proforma. Result: Total 70 patient of inferior wall MI were included in study as per inclusion and exclusion criteria. out of that 57 patients were male and 13 were females. Maximum number of patients was between age 51-60 years of age group. Out of total patient 26 patient have addiction of smoking. Out of total 70 patient 51 patient had left circumflex lesion in coronary angio from which in 27 patient also had changes of LCX involvement in ecg (true positive – sensitivity 52%). Out of 70 patient 57 patient had right coronary artery involvement in coronary angio from which 43 patient had changes of RCA involvement in ECG (true positive – sensitivity 75.43%). Sensitivity, Specificity, PPV, NPV of the ECG in identifying RCA occlusion were 75.43%, 100% , 100%, 48.14% respectively and Sensitivity, Specificity, PPV, NPV of the ECG in identifying LCX occlusion were 52%, 100%, 100%, 44.18% respectively. From 70 patient 11 patient were thrombolysed with inj. tenecteplase, 53 patients were thrombolysed with inj. streptokinase and in 6 patients inj. heparin was given and after cag stent placement in LCX done in 20 patients, rca stent placement done in 27 patients ,stent placement in RCA + LCX done in 11 patient. Conclusion: In the present study we conclude that the ECG was found to be a sensitive and specific tool in identifying the involved coronary artery in acute inferior ST elevation MI and gives important information to guide management and to determine the prognosis of patients. So in rural area where facilities are not available, on admission ecg can help in diagnosing patient that can receive early thrombolysis therapy and further help in diagnosing patients who are at a high risk of developing complication which can be further shifted to higher center as early as possible.

Background: During the research period, 4,300 patients gave birth; of these, 70 had TB diagnosis during the prenatal period, resulting in a 16.2 out of every 1,000 pregnant women have this condition. Anemia, intrauterine growth restriction, and premature birth were all significantly more common in TB patients. Our research revealed that the place, the severity of the illness, the gestation at diagnosis, and the TB complication all affect the mother and the results of pregnancy in TB-affected women. Materials and Methods: A prospective monitoring study was done in a tertiary care center from March 2022 to March 2023, spanning one year. Our study looked at pregnant women between the ages of 20 and 45 who had been identified with tuberculosis during the fetal phase. This way, we could see how the disease affected both the mother and the baby. The study did not look at pregnant women who had tuberculosis (TB) in the past but were cleared after getting the right treatment. It also did not look at TB-positive women who did not give birth during the study time. Age, number of children, social position, date of diagnosis, and problems during pregnancy, childbirth, and the time after giving birth were all listed in each case file. In addition to the perinatal result, the kids’ average birth weight, the number of preterm births, stillbirths, baby sadness, stays in the neonatal intensive care unit (NICU), and deaths as soon as they were born were all tracked. Results: 4,300 patients gave birth Seventy of them received a tuberculosis (TB) diagnosis during the prenatal phase of the trial; this means that the prevalence rate per pregnant woman was 16.2/1,000. Among TB patients, anemia, intrauterine growth restriction, and preterm delivery were all markedly more prevalent. According to our research; a pregnant woman with tuberculosis may experience different perinatal outcomes depending on the location, severity of the illness, gestation at diagnosis, and TB complication. Conclusion: At our facility, the rate of tuberculosis among expectant mothers was 16.2/1,000. It takes a strong suspicion to recognize the broad range of diseases and consequently the repercussions of tuberculosis (TB) in pregnant women, as well as to initiate treatment early for better outcomes.

Background: Uterine fibroids or myomas or leiomyoma of uterus are the most common type of benign tumor of uterus and also most common pelvic tumor in women. They may have unusual presentations in the form of location or undergo various degenerative changes posing great diagnostic difficulties. Aim: To identify the various secondary degenerative changes and histopathological variants of uterine leiomyomas. Material and Methods: The study included a total of 120 cases of leiomyomas diagnosed in the department of pathology for a period of six months. Detailed gross and microscopic examination was carried out and the data recorded. Results: Out of total 120 cases of leiomyoma, intramural was the most common (51.6%) location. Age of the patients ranged from 18-60 years with peak incidence in 41-50 years (38.3%). Secondary changes were observed in 16(13.3%) cases. Out of which hyaline degeneration was the most common type of degeneration and observed in 68.75% cases. Other secondary changes observed were myxoid degeneration, calcific degeneration, hydropic degeneration and hemorrhagic infarction. Only 1 cases of cellular leiomyoma were identified as histological variant. Conclusion: Leiomyomas of female genital tract are common benign tumors. Degenerative changes are more common in intramural leiomyomas. Secondary changes and histological variants may pose diagnostic difficulties. A complete gross and histological examination is mandatory to rule out malignant transformation.

Background: Breasts have various disorders, like developmental abnormalities, epithethial and stromal prolif-eration, and inflammatory lesions. Neoplasm’s patients with BBP have fear and anxiety about presuming that these lesions are malignant. Method: 55 (fifty-five) female adults aged between 20 to 60 years were studied. Routine blood examinations, radiological investigations (USG/mammography), and pathological investigations (FNAC/HPE / discharges) were also carried out wherever necessary. Results: 47 (85.4%) BBD from menarche to menopause, 6 (10.9%) in lactating, 2 (3.63%) in post-menopause 2 (3.6%) breast abscess, 5 (9.09%) in lactating women, 1 (1.8%) cold abscess, 2 (3.63%) cyclical mastalgia, 19 (34.5%) fibro-adenoma, 15 (27.2%) mastaliga, and 3 (5.45%) fibro-adenoma. Conclusion: As BBD is non-malignant and can be managed with medication. In resistant cases, surgery inter-vention is required. In certain cases, the clinician has to wait and watch.

Background: Pulmonary embolism is an important cause of morbidity and mortality, despite advancements in clinical understanding and diagnostic facilities. Hence, CT angiography evaluation is an ideal tool for diagnosis pulmonary embolism (PE). Method: 45 adult patients aged between 20-70 years with PE were studied. The angiography was done with a 256-slice CT scanner. The intravenous Contrast administered was non-ionic, low-osmolar iodinated contrast medium, Iopamira 300 mg iodine/ml. Results: A high prevalence of PE was observed in 41–50 age groups. The highest clinical manifestation was respiratory distress 42 (93.3%) followed by chest pain, 37% and least was hemoptysis. The highest location of emboli was 20 (44.4%) central, followed by 12 (26.6%) lobar, and the least was 4 (8.8%) sub-segmental. The highest associated risk factor was 37 (82.2%) immobility, followed by 34 (75.5%) H/O surgery, and the least was 12 (26.6%) COPD. Conclusion: A CTA study is an ideal tool to evaluate pulmonary embolism, but clinicians should be aware of the accuracy and limitations of the test. Diagnostic algorithms will be helpful for diagnostic strategy.

Background: Postoperative pain management is crucial in laparoscopic cholecystectomy to enhance patient recovery and satisfaction. This study aims to compare the efficacy of 0.25% bupivacaine plus dexmedetomidine versus 0.25% levobupivacaine plus dexmedetomidine for local infiltration at the port site in providing postoperative analgesia. Materials and Methods: A prospective study was conducted from September 2023 to June 2024 at ESIC Medical College, Bihta. A total of 150 patients undergoing laparoscopic cholecystectomy were randomly assigned into two groups, with 75 patients in each group. Group A received 0.25% bupivacaine plus dexmedetomidine, while Group B received 0.25% levobupivacaine plus dexmedetomidine. The primary outcome was postoperative pain, assessed using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours post-surgery. Secondary outcomes included the duration of analgesia, total analgesic consumption, and incidence of side effects. Results: The mean VAS scores at 1, 6, 12, and 24 hours post-surgery were significantly lower in Group B compared to Group A (p < 0.05). The duration of analgesia was longer in Group B (12 hours) than in Group A (8 hours) (p < 0.01). Total analgesic consumption was also lower in Group B (50 mg) compared to Group A (80 mg) (p < 0.01). Both groups reported minimal side effects, with no significant difference in the incidence between the two groups. Conclusion: Levobupivacaine plus dexmedetomidine provides superior postoperative analgesia compared to bupivacaine plus dexmedetomidine for port site infiltration in laparoscopic cholecystectomy. This combination results in lower pain scores, prolonged analgesia, and reduced analgesic consumption, with a similar safety profile.

Background: Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high mortality rate, necessitating early diagnosis and intervention. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system, Doppler study, and microbial study aims to early diagnosing and management of NF. Objective: This study aims to assess the diagnostic performance of the LRINEC scoring system with Doppler study and microbial study for early diagnosis and management of NF to prevent morbidity and mortality. Methods: A prospective descriptive study enrolling 99 patients  with soft tissue infection admitted to MKCG medical college and hospital, Berhampur, Demographic characteristics and clinical data were collected, and LRINEC scores were calculated based on laboratory parameters, including CRP, WBC count, hemoglobin, sodium, creatinine, and glucose levels. The association between LRINEC scores and NF diagnosis was analyzed, and diagnostic performance metrics such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated along with Doppler study, microbial flora and management analysed. Results: The majority of participants were aged over 50 years (55.5%) and male (55.5%). The most prevalent comorbidities were diabetes mellitus (25%) and hypertension (30%). Higher LRINEC scores (>=8) were strongly associated with confirmed NF cases, showing high sensitivity (95%), specificity (90%), PPV (85%), and NPV (92%). Culture results identified Klebsiella, Staphylococcus, and E. coli as the most common pathogens, with significant sensitivity to Amikacin. Conclusion: The LRINEC scoring system demonstrates high diagnostic performance in identifying NF cases. Integrating the LRINEC score, with Doppler study, microbial study and multidisciplinary management into clinical practice can improve early diagnosis and intervention, leading to better patient outcomes. Further studies are recommended to validate these findings in diverse patient populations.

Introduction: An infection of the meninges that encircle the brain and spinal cord is known as meningitis. Usually, bacterial, viral, or fungal infections are seen. One of the most dangerous illnesses that affect people of all ages likes bacterial, viral, or fungal meningitis is linked to both immediate consequences and long-term morbidity. Aim and Objective: The present study was undertaken to analyze Cerebrospinal Fluid (CSF) parameters and to determine the type of meningitis infection, which will guide the physician to treat various type of meningitis accordingly. Materials and Methods: This was a cross-sectional study conducted over June 2023 to November 2023 in Department of Pathology at P.D.U. Medical College and Hospital in Rajkot, Gujarat, India. Study participants included 478 cerebrospinal fluid samples from clinically suspected meningitis cases across all age groups admitted to the hospital on CSF Chemical examination and microscopic examination was done. Results: Out of total 478 cases majority of the patients between 19-60 years and slight male predominance was seen. Examination of Cerebrospinal Fluid sample showed that 60.25% were turbid and 38.91% were clear. Total White blood cell count 1-200 cells/cu mm were seen in majority of cases. Protein levels >50 mg/dl were seen in 32% of cases, glucose level <45mg/dl were seen in 28% cases. Diagnosis of study subjects showed that majority 66.94% were normal, 16.31 % had viral meningitis, 8.31% had bacterial meningitis and 7.32 % had tubercular meningitis.

Conclusion: Meningitis remains a major health care problem with incidence rising in adults and children. An early pathological analysis and providing appropriate antibiotic therapy are life-saving and they also reduce morbidity and mortality.

Introduction: Haemolytic anaemia is a group of disorders that cause significant morbidity in children. Method: A cross sectional study was conducted at district hospital, Rajkot for a period of 1 year. All cases of newly diagnosed and old cases of haemolytic anaemia on follow up were included. A total of 232 cases from all age group were enrolled. Complete demographic and clinical details of all the patients were noted. Classification of the patients was done based on etiologic profile. Separate recording of the etiologic profile was done for subjects with acute and chronic haemolytic anaemia. Clinical profile of all the subjects was noted. Results: While assessing the patients with acute haemolytic anaemia, it was seen that Inherited, Autoimmune, Infections (malaria, dengue, viral hepatitis, enteric fever) and Malignancy, HELLP sx causes were the etiologic profile in 40%, 7%, 12% and 12%, 20% of the patients respectively. While assessing the patients with chronic haemolytic anaemia, it was seen that Inherited (Sickle cell disease/Thalassemia), Blood transfusion complications, Autoimmune conditions, and Bone marrow failure, causes were the etiologic profile in 94%, 0.5%, 1.09% & 1% of the patient respectively. The mean haemoglobin at presentation was 7.39 gm/dl. Massive splenomegaly & hepatomegaly causing discomfort, gall stones were seen in 105 cases. In thalassemia major, 60 cases required frequent transfusions [10-12 per year]. 15 came for less frequent transfusions [6 per year]. Sickle thalassemia & thalassemia intermedia, required one transfusion every 1-2 years. Occasional transfusions were given in sickle cell anaemia also. Conclusion: Haemoglobin electrophoresis remains the main investigation of choice in diagnosis of haemolytic anaemia. Thalassemia major is the most severe among other haemolytic anaemia encountered in this series. The study conclude that the need to improve awareness regarding hemoglobinopathies among population also prenatal screening, blood transfusion policies, chelation. policies to prevent complications in transfusion dependent patients.

Background: Anemia is one of the most common hematologic abnormalities found in newborns and children. It leads to increased morbidity and mortality, neurologic complications, risk of low birth weight, infection, and heart failure. While approaching a child having anemia, detailed history, particularly diet, environmental factors are helpful leading to diagnosis. Aims and Objectives: The present study was undertaken to describe etiological factors, age, sex, severity of anemia, for which study of anemia was done in “Central Clinical Laboratory (CCL), Department of Pathology, P.D.U Medical College & Hospital, Rajkot, Gujarat which is a tertiary care hospital in western India. Materials and Methods: A prospective study was conducted among 1348 pediatric patients who attended clinic one year between June 2023 to May 2024 in a tertiary care hospital at whose blood samples and socio-demographic information were collected. Hemoglobin, indices, WBC & RBC counts were counted using automated hematology cell counter. Grading was done by WHO criteria and morphology was studied by peripheral blood smear examination. Result: A high prevalence 463 (34.34%) of anemia was observed among 1348 pediatric patients commonly seen in age group (2-6 years) in which 775(57.50%) were males and 573 (42.50%) were females. According to blood indices and peripheral blood smear analysis hypochromic microcytic anemia 835(61.94%) was the commonest morphological type of anemia followed by normochromic normocytic anemia 375 (27.81%), dimorphic anemia 63(4.67 %), macrocytic anemia 48(3.56%), hemolytic anemia 27 (2.0%). Conclusion: Hypochromic microcytic anemia was found to be the most common cause of anemia in pediatric patients this study. Identifying of etiologies of anemia can be helpful in defining diagnostic and therapeutic strategies, which contributes toward the better management of patients.

Background: People over age 60 are one of the risk groups for anemia. Anemia often leads to weakness and fatigue. Anemia in the geriatric population can be caused by various factors, including nutritional deficiencies (such as iron, vitamin B12, or folate deficiency), chronic diseases (like chronic kidney disease or cancer), medications, and bone marrow disorders. When geriatric population has these symptoms, it contributes to in overall health decline. People having anemia might be less active physically. Material and Methods: A prospective study was conducted among 1392 geriatric patients who attended clinic and were hospitalized between June 2023 to May 2024 in a tertiary care hospital whose blood samples and socio-demographic information were collected. Haemoglobin concentration, blood indices, RBC counts were determined by automated haematology cell counter. Grading was done according to WHO criteria and morphological typing was done on the basis of peripheral blood smear examination. Result: A high prevalence (59.8%) of anemia was observed among 839 men commonly seen in age group (60-65 years). According to blood indices and peripheral blood smear analysis normochromic normocytic anemia (47.6%) was the commonest morphological type of anemia followed by hypochromic microcytic anemia (30.6%). Conclusion: The present study concluded that management of geriatric anemia involves identifying and treating the underlying cause, which may include addressing nutritional deficiencies, managing chronic diseases, adjusting medications, and sometimes, administering blood transfusions or erythropoiesis-stimulating agents to boost red blood cell production. Regular monitoring and management of anemia are essential for the overall health and well-being of elderly individuals.

Background: Malaria is one of the most prevalent parasitic infections in the world including India. It is a tropical, endemic protozoal infection. In most countries, its diagnosis is challenging. Microscopy is the gold standard method for its diagnosis in clinical practice as well as for research purpose. However, it is laborious, requiring significant skills and time, causing therapeutic delays. Rapid malaria diagnostic tests (RDTs) have made possible to obtain quick results from the blood examination. Various fast, reliable and easy to use RDTs are available which can detect Plasmodium falciparum and non-falciparum infections or both. Objective: To study about different techniques for detection of malaria in a tertiary care hospital in Western India. Materials and Methods: Study was conducted in the Central Clinical Laboratory (CCL), Department of Pathology, PDU Medical College, Rajkot, Gujarat, India over one year period between June 2023 to May 2024. Peripheral blood smear stained by Hematoxylin and Eosin Stain, Leishman stain and Field stain technique for conventional smear and thick smear preparation and commercially available rapid antigen detection kits were used for the diagnosis of malaria. Results: During the 1-year period, rapid card test method showed 150 positives for malarial parasite. Of these, 127 cases were positive for P. vivax and 20 cases for P. falciparum. Peripheral blood smear method showed 139 cases positive for malarial parasite. Of these, 120 cases were positive for P. vivax and 17 cases for P. falciparum and 2 cases of co-infection. 24 cases were reported with thick smear preparation. 11 cases reported were peripheral blood smear negative. Among the cases, there were 46 females and 104 males. 20 – 29 years is the most affected age group which is followed by 30 – 39 years. Maximum samples were from the month of September with a positivity rate of 26%. Conclusion: RDTs based on detection of malaria antigen from whole blood are as specific as and more sensitive than microscopy (being considered as the gold standard method). However, peripheral blood smear method remains superior for accurate species differentiation, quantitation of parasite and maintenance of a permanent record. Other tests such as Flow cytometry, PCR, ELISA can be considered.

Background: The immediate postpartum period following caesarean delivery is a critical phase in obstetric care, requiring vigilant monitoring of maternal physiological parameters to ensure optimal recovery and early detection of potential complications. Shock index (SI) and heart rate (HR) are crucial indicators of cardiovascular function, providing valuable insights into hemodynamic stability. This study aims to determine standard reference values for shock index and heart rate during the immediate postpartum period following caesarean delivery. Methods: A total of 200 women who underwent caesarean delivery were included. Vital signs, including heart rate and systolic blood pressure, were measured at admission, and at 30 minutes, 1 hour, and 2 hours postpartum. Shock index was calculated as the ratio of heart rate to systolic blood pressure. Data were analyzed using SPSS version 21.0. Results: The mean shock index values were stable and within normal ranges at 30 minutes (0.69 ± 0.06), 1 hour (0.68 ± 0.06), and 2 hours (0.68 ± 0.06) postpartum. Vital parameters such as heart rate, systolic and diastolic blood pressure, mean arterial pressure, and pulse pressure remained within normal limits. No statistically significant changes in packed cell volume (PCV) and hemoglobin (Hb) levels were observed over the monitoring period. Conclusion: The study established stable and normal reference values for shock index and heart rate during the immediate postpartum period following caesarean delivery. These findings underscore the importance of continuous monitoring to ensure maternal hemodynamic stability and prompt intervention if abnormalities are detected. Recommendations: Healthcare providers should adopt the established reference values for shock index and heart rate to improve monitoring and management of postpartum women. Further research is recommended to validate these findings in diverse populations and settings.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent condition that significantly impacts patients’ quality of life. It is managed through medical treatments or a combination of surgical and medical interventions. This study aims to compare the outcomes of medical management alone versus combined surgical and medical management in patients with CRSwNP, focusing on symptom severity, endoscopic findings, quality of life, recurrence rates, and the need for additional interventions. Methods: A comparative observational study was conducted involving 117 patients with CRSwNP. Participants were randomly assigned to receive either medical management (n=58) or combined surgical and medical management (n=59). Data on symptom severity, endoscopic findings, quality of life, recurrence rates, and additional interventions were collected at baseline, 3-, 6-, and 9-months post-treatment. Statistical analysis was performed using SPSS version 23.0. Results: Patients in the combined surgical and medical management group showed significantly greater improvements in symptom severity, endoscopic findings, and quality of life at 3, 6, and 9 months post-treatment compared to the medical management group (p < 0.001). Recurrence rates were lower in the combined group (8.5%) than in the medical group (27.6%) (p=0.002), and fewer additional interventions were required in the combined group (3.4% vs. 19.0%, p=0.005). Conclusion: The study concluded that combined surgical and medical management provides superior outcomes for patients with CRSwNP compared to medical management alone. This approach leads to better symptom control, enhanced endoscopic outcomes, improved quality of life, and lower recurrence rates. Recommendations: Based on the findings, it is recommended that patients with CRSwNP, especially those not responding adequately to medical management alone, consider combined surgical and medical management for more effective and sustained results.

The study of Spinal lesions is greatly improved with the use of computed tomography (CT) and magnetic resonance imaging (MRI). However, modern imaging is essentially morphologic; its low specificity only allows for etiological diagnosis in a few patients. Therefore, biopsy should remain the last step of staging for definite diagnosis and treatment planning for patients with spinal lesions aim was to to evaluate the incidence and severity of complications associated with computed tomography guided percutaneous aspiration and biopsy of spine and characteristics of spinal lesion on computed tomography with its histopathological correlation CT had sensitivity of 85.71% and specificity of 93.54% for the diagnosis of malignancy and sensitivity of 85.71% and specificity of 86.48% for the diagnosis of tuberculosis, The most common pathogen isolated was Staphyloccous aureus (n = 40 34%). Other common pathogens included coagulase-negative Staphylococci (n = 23, 18%) and Mycobacteria (n = 18 16%; Mycobacteria tuberculosis n = 37). Fourteen of 105organisms (6%). Conclusion Image guided Biopsy done with a good technique helps in achieving accurate diagnosis, ensures correct treatment at the earliest and has minimal complications. In conclusion, the diagnostic culture yield for CT-guided biopsies in cases of suspected spinal infection is low.

Background: Surgical site infections (SSIs) are a major problem in medicine because they raise the risk of infection, lengthen hospital stays, and increase medical expenses. Reducing SSIs requires optimal scheduling of preoperative antibiotic prophylaxis. In a group of surgical patients, this study sought to determine how shorter preincision antibiotic infusion times affected the incidence of surgical site infections. Methods: A retrospective cohort analysis of one hundred patients undergoing different surgical procedures was carried out. Patients were split into two groups, Group A (reduced period) and Group B (standard time), according to when they received their antibiotic infusions. Information was gathered about SSI rates, antibiotic timing, surgical technique, and demographics. The statistical analysis was done with SPSS 23.0. Results: SSI rates were substantially lower in Group A (8%) than in Group B (20%) (p = 0.04). A lower incidence of SSIs was found to be independently correlated with a shorter preincision antibiotic infusion period, according to multivariate logistic regression analysis (OR = 0.35, 95% CI = 0.12-0.97, p = 0.04). Furthermore, Group A’s hospital stay was shorter (5.2 ± 2.1 days) than Group B’s (6.3 ± 2.5 days, p = 0.02), and there was no discernible difference in the number of postoperative complications (p = 0.67). Conclusion: Reducing the preincision antibiotic infusion time significantly decreases SSI rates and shortens hospital stays without increasing postoperative complications. Optimizing antibiotic timing is a simple yet effective strategy to enhance surgical outcomes. Recommendations: Revised protocols for antibiotic administration timing should be considered to further reduce SSI rates. Prospective studies are recommended to validate these findings and establish standardized guidelines.

Background: Cervical cancer remains a substantial health challenge in India, with early detection being crucial for effective management and reduction of mortality rates. Liquid-based cytology (LBC) is a modern screening method offering improved sensitivity over conventional techniques. This study evaluated the effectiveness of cervical cancer screening using liquid-based cytology in a secondary care hospital in India. Methods: Sixty women aged 21-65 years attending the gynecology outpatient department were included. Data collection involved structured interviews and medical record reviews. Cervical samples were collected using LBC and analyzed for cytological abnormalities. Statistical analysis was performed using SPSS version 23.0. Results: Of the 60 participants, 70% had normal cytology results, while 30% had abnormal results, categorized as ASC-US (10%), LSIL (13.3%), HSIL (5%), and SCC (1.7%). The highest incidence of abnormal results was in the 41-50 age group (50%). A significant association between age and abnormal cytology results was found (χ² = 11.24, p = 0.023). Conclusion: The study demonstrates the efficacy of liquid-based cytology in detecting cervical abnormalities in a secondary care setting. The significant correlation between age and abnormal results suggests the need for targeted screening strategies.

Background: A common minimally invasive diagnostic method for assessing a variety of soft tissue tumours and tumor-like abnormalities is fine-needle aspiration cytology (FNAC). Its ability to provide a quick and precise diagnosis is essential for timely action and patient care. Aim: The purpose of this study is to evaluate the diagnostic value of FNAC in identifying specific tumour types and in distinguishing between benign and malignant soft tissue tumours and tumor-like lesions. Methods: This retrospective research assessed the utility of FNAC in diagnosing soft tissue tumors and tumor-like lesions at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Bihar, over 10 months. FNAC was performed on 150 patients using a 23-24 gauge needle and a 10 mL syringe. Stained smears were prepared and compared with histopathological diagnoses from subsequent surgical excisions. Inclusion criteria included informed consent, adequate cellularity in FNAC, and availability of USG reports. Results: The study included 150 patients, with FNAC providing definitive diagnoses in 88% of cases. Of these, 60% were benign and 28% malignant. Histopathological examination of 132 cases showed 69.7% benign and 30.3% malignant lesions. FNAC demonstrated high diagnostic accuracy with a sensitivity of 92.5%, specificity of 95.7%, PPV of 93.2%, and NPV of 95.4%. The concordance between FNAC and histopathology was substantial, with a Cohen’s kappa coefficient of 0.89. Conclusion: In the initial assessment of soft tissue tumours and tumor-like abnormalities, FNAC is a very useful diagnostic technique. It can accurately identify between benign and malignant tumours thanks to its high sensitivity and specificity, which helps to determine the best course of treatment for each patient.

Background: Gonococcal infections caused by Neisseria gonorrhoeae are a significant global health concern, particularly in HIV-positive patients due to their immunocompromised state. The interplay between HIV and gonococcal infections necessitates effective diagnostic techniques to manage these co-infections. This study aims to compare the effectiveness of biochemical and molecular techniques in detecting gonococcal genitourinary infections among HIV-positive and HIV-negative patients. Methods: There were 80 participants in the cross-sectional study (40 HIV-positive and 40 HIV-negative). Polymerase Chain Reaction (PCR) and basic biochemical culture techniques were used to gather and analyse genitourinary materials. Chi-square and t-tests were used in comparative statistical analyses of the data, which were conducted using SPSS version 23.0. Results: According to biochemical analysis, 70% of HIV-negative patients and 80% of HIV-positive patients had positive cultures (p=0.29). Using PCR, 87.5% of HIV-positive patients and 75% of HIV-negative patients tested positive, indicating greater detection rates according to molecular analysis (p=0.16). For both groups, there were no statistically significant differences in the findings of the molecular and biochemical tests. Conclusion: The study found that the prevalence of gonococcal infections is similar in HIV-positive and HIV-negative patients, with molecular techniques demonstrating higher sensitivity. The presence of HIV does not significantly impact the detection rates of gonococcal infections using either method. Recommendations: It is recommended to integrate both biochemical and molecular diagnostic techniques in clinical practice to enhance the detection and management of gonococcal infections, particularly in settings with high HIV prevalence. Further research is needed to explore the clinical outcomes of these diagnostic approaches in different patient populations.

Background: Salmonella Typhi and Salmonella Paratyphi are the main causes of enteric fever, which is a serious public health issue, especially in developing nations. Antimicrobial resistance (AMR) is becoming more common, which makes treatment plans more difficult to implement and calls for ongoing surveillance of resistance patterns. The purpose of this study is to evaluate the current patterns of antimicrobial susceptibility to Typhoidal Salmonella in children and young people with enteric fever who attend school. Methods: Prospective observational research with 300 people diagnosed with enteric fever between the ages of 5 and 25 was carried out. The Kirby-Bauer disc diffusion method was used to determine the antibiotic susceptibility of the blood samples after Typhoidal Salmonella was isolated through culture. SPSS version 23.0 was used to analyse the data, and chi-square tests and descriptive statistics were used. Results: Out of 300 participants, 270 (90%) had positive blood cultures for Typhoidal Salmonella. High resistance was observed to Ampicillin (33%), Chloramphenicol (40%), and Cotrimoxazole (30%), while susceptibility to Ciprofloxacin, Ceftriaxone, and Azithromycin was 90%, 100%, and 97%, respectively. A significant association between age and resistance to Ampicillin was found (p = 0.015), with higher resistance in younger age groups. Conclusion: The study highlights significant resistance to traditional antibiotics and underscores the continued efficacy of Ceftriaxone and Azithromycin for treating enteric fever. The findings emphasize the need for ongoing surveillance of antimicrobial resistance and rational antibiotic use to prevent further resistance development.

Background: Urinary tract infections (UTIs) are among the most prevalent bacterial infections, significantly impacting public health, especially among women, children, and the elderly. The rise of antimicrobial resistance (AMR) among uropathogens has complicated treatment regimens, leading to increased morbidity and healthcare costs.This study aims to investigate the bacteriology and antimicrobial susceptibility patterns of UTIs. Methods: There were sixty patients in all who had UTI symptoms. Urine samples obtained midstream were cultured to determine the presence of bacterial isolates. The testing for antibiotic susceptibility was carried out according to established procedures. SPSS version 23.0 was used to analyse the data. Results: Out of 60 participants, 83.3% showed bacterial growth. Escherichia coli was the predominant pathogen (60%), followed by Klebsiellapneumoniae (20%), Proteus mirabilis (10%), Enterococcus faecalis (6%), and Pseudomonas aeruginosa (4%). E. coli exhibited high sensitivity to nitrofurantoin (90%) and gentamicin (83.3%), while amoxicillin showed the least effectiveness (20%). Statistical analysis revealed no significant association between bacterial isolates and patient gender (p > 0.05). Conclusion: E. coli remains the leading cause of UTIs, with significant sensitivity to nitrofurantoin and gentamicin. The study underscores the necessity for continuous monitoring of antimicrobial resistance patterns to inform effective empirical treatment strategies. Recommendations: Empirical treatment of UTIs at PMCH should consider nitrofurantoin and gentamicin as first-line therapies. Ongoing surveillance of AMR patterns is crucial to update treatment guidelines and mitigate the impact of resistant uropathogens.

Background: Bloodstream infections (BSIs) are a significant source of morbidity and mortality in cardiac intensive care units (CICUs). The use of invasive devices and the critical condition of patients contribute to a high risk of these infections. Understanding the epidemiology, risk factors, and outcomes of BSIs in CICUs is essential for improving patient care. Aim: This research aims to analyze the incidence, risk factors, and outcomes of BSIs in the CICU of a tertiary care centre and to develop targeted strategies to prevent and manage these infections. Methods: A retrospective observational research involving 150 CICU patients was carried out. Patient demographics, clinical traits, microbiological results, therapy, and results were all recorded. SPSS version 23.0 was utilised for the statistical analysis, and logistic regression was employed to find independent risk factors for BSIs. Results: Out of 150 patients, 45 (30%) developed BSIs. The most common pathogens isolated were Staphylococcus aureus (40%), Escherichia coli (22%), and Klebsiellapneumoniae (18%). Significant risk factors for BSIs included the presence of central venous catheters (OR = 3.2, 95% CI: 1.8-5.6, p < 0.001) and prolonged CICU stays (>7 days) (OR = 2.7, 95% CI: 1.5-4.9, p = 0.002). Patients with BSIs had longer CICU stays (mean 15.4 ± 6.8 days) compared to those without BSIs (mean 8.2 ± 4.5 days, p < 0.001) and a higher mortality rate (35.6% vs. 15.2%, p = 0.005). Conclusion: BSIs are a significant burden in CICUs, associated with prolonged hospital stays and increased mortality. Central venous catheters and prolonged CICU stays are major risk factors. Effective infection control practices are essential to mitigate these risks. Recommendations: Implementing strict aseptic techniques, using antimicrobial-coated catheters and continuous surveillance are recommended to reduce the incidence of BSIs. Further research is needed to explore additional preventive measures and optimize patient outcomes.

Background: While an Endoscopy provides a unique opportunity to visualize the mucosal surface of the gas-trointestinal tract, the histopathology of the biopsy sample by an experienced pathologist is vital to correct the disorders of the alimentary tract. Our study aims to determine the histopathological spectrum of the gastrointes-tinal tract lesions and to correlate the endoscopic diagnosis and histopathological diagnosis. Methods: It is a retrospective observational study done in the Department of Pathology at SIMS and RC, on all upper gastrointestinal (GI) biopsies for duration of one year May 2022 to May 2023. Inadequate specimens, superficial biopsies, hemorrhagic tissue samples, and fibro collagenous tissue observed on the biopsy segments were excluded from the study. In a semi-structured proforma, the demographic details, endoscopic findings, and histopathological findings in upper gastrointestinal biopsies. The data was entered into a Microsoft Excel spreadsheet and was analyzed using SPSS v26.0. Results: The study included a total of 120 study participants who underwent upper gastrointestinal endoscopy. There were 64 male and 54 female patients with a male: female ratio of 1.14:1. The most common sites from which the lesion was observed, and biopsy was sought were in the stomach 44 cases (Body of stomach, An-trum, Fundus, and Pylorus) 36 cases (40%) were neoplastic,84cases (60%) were non-neoplastic. Among the non-neoplastic lesions, most were of chronic non-specific gastritis, ulcers, and polyps, and among neoplastic lesions squamous cell carcinoma and adenocarcinoma were commonly observed. The sensitivity and specificity of histopathology when compared to endoscopic findings, was observed to be 96.34% and 83.89% respectively. Conclusion: Endoscopic biopsy is an initial investigation of choice in patients with upper GI symptoms which permits exact diagnosis along with providing an opportunity to see the lesion status and helps in deciding spe-cific therapy. The histopathological study helps to detect mucosal lesions at an early stage like atrophy, intesti-nal metaplasia, and dysplasia to prevent their progression into invasive cancers; hence histopathology remains the gold standard for the diagnosis.

Background: Haemodynamic changes during laryngoscopy and intubation are the major concern during induction under general anaesthesia. This study aims to compare the effects between inj PROPOFOL, inj ETOMIDATE and inj ETOFOL (etomidate and propofol) during induction and intubation in elective surgeries. Objectives: To evaluate and assess the effects of the 3 different induction agents, on the variation in heart rate (HR) and mean arterial pressure (MAP) were noted. They are baseline (T1), after induction (T2), before intubation (T3) and immediately after the intubation (T4) and T5, T6, T7, T8, T9 & T10 at 1st, 2nd, 3rd, 4th, 5th and 10th minutes after intubation. Material And Method: After obtaining Ethical committee clearance taken, 90 patients aged 15 to 60 years of either sex and ASA physical status I and II scheduled for elective surgery under general anesthesia were taken up for the study. Written and informed consent was obtained from the patient. Design of this study was a prospective randomised control study. The patients were randomly placed into three groups, of each 30 in number. Group p induced with Inj. Propofol (2.5 mg/kg IV), Group E with Inj. Etomidate (0.3 mg/kg IV) and Group PE with Inj. Propofol (1.25mg/kg iv) and Inj. Etomidate (0.15mg/kg iv). Heart rate (HR), mean arterial blood pressure (MAP) were noted at different time interval (T1- baseline, T2-after induction, T3- before intubation, T4- immediately after intubation, T5-T10 represent 1,2,3,4,5,10 mins after intubation and it was compared. Results: Stata version 17.0 software were used for analysis of the data. Anova test used for analysing HR, MAP and AGE whereas fishers exact test done for gender. In the results demographic data were comparable. On comparing, MAP mean arterial pressure in all 3 groups with their baseline value, there was a significant fall in group P (p<0.000) was noted at T4, T5 time interval when compared to group E, and group PE. MAP of group PE (p < 0.000) at T4, T5 time interval was noted higher when compared to other two groups. Conclusion: The combination of etomidate and propofol (etofol group PE) has better hemodynamic stability with minimal changes compared to Etomidate and Propofol alone. It is would be recommended that (Etofol) the combination of Etomidate and Propofol can be used in suitation where haemodynamic stability warranted.

Aim: To assess the association of Lactate, Lactate Albumin Ratio, Procalcitonin and Immature Platelet Fraction on admission as markers of severity in sepsis patients. Objectives:  (1) To assess Lactate / Albumin Ratio (LAR) in patients with sepsis. (2) To assess Lactate value in patients with sepsis. (3) To assess Procalcitonin (PCT) value in patients with sepsis. (4) To assess Immature Platelet Function (IPF) value in patients with sepsis. (4) To compare Lactate, LAR, PCT and IPF with MAP >65mmhg and MAP <65mmhg at tertiary care hospital in patients with sepsis for prognostication. Material and Methods: Hospital based Observational Cross-Sectional Study was conducted at Mahatma Gandhi Hospital, Jaipur between September 2022 to December 2023. Data of 180 patients was collected according to inclusion criteria. Sepsis biomarkers that is Lactate, LAR, IPF, PCT were calculated and were compared with MAP >65mmhg and MAP <65mmhg at tertiary care hospital in patients with sepsis for prognostication. Result: Procalcitonin emerges as a robust biomarker for stratifying infection severity and prognosis in sepsis patients across different MAP categories, underscoring its potential clinical utility. The findings highlight the importance of integrating multiple biomarkers and clinical parameters to enhance prognostic accuracy and guide therapeutic decisions tailored to individual patient needs in critical care settings. Conclusion: In our study MAP scores are significantly associated with Procalcitonin levels. Furthermore, the observed relationships between MAP scores, and Procalcitonin underscore the pivotal influence of hemodynamic status on metabolic responses and patient prognoses. These findings collectively underscore the importance of integrating comprehensive clinical and biochemical assessments to refine management strategies and enhance patient outcomes in cases of severe septic conditions.

Aims: To study the prevalence of thyroid dysfunction as risk factor associated with severity of NAFLD. Objectives: Primary Objective: To assess prevalence of hypothyroidism in NAFLD patients. Secondary objective: To assess association of hypothyroidism as risk factor in NAFLD patients. Methodology: Present study was an observational prospective study between January 2023 to June 2024 in patients between age group 25-65 years attend OPD/IPD services at Department of Medicine, Mahatma Gandhi Hospital, Jaipur. Results: The study observed significant associations between thyroid function parameters and non-alcoholic fatty liver disease (NAFLD), particularly with thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) levels. Lower levels of fT3 and fT4 were found to be associated with increased odds of NAFLD (p < 0.001). Thyroid hormones play a crucial role in regulating hepatic lipid metabolism. They modulate the expression of genes involved in lipogenesis, β-oxidation, and cholesterol metabolism in the liver. Reduced thyroid hormone levels, as observed in hypothyroidism or subclinical hypothyroidism, can lead to impaired lipid metabolism, promoting hepatic steatosis. Conclusion: Thyroid hormones influence insulin sensitivity and glucose metabolism, with hypothyroidism often associated with insulin resistance and dysglycemia. Insulin resistance is a key pathogenic factor in NAFLD development, contributing to excessive hepatic lipid accumulation. Thus, alterations in thyroid function may exacerbate insulin resistance and further predispose individuals to NAFLD (36). Thyroid hormones exert anti-inflammatory and antifibrotic effects in various tissues, including the liver. Hypothyroidism is associated with increased pro-inflammatory cytokine levels and oxidative stress, which can promote hepatic inflammation and fibrogenesis, contributing to NAFLD progression.