This study aims to provide a comprehensive gross and histopathological analysis of lung findings in medicolegal autopsies, focusing on diverse causes of death. A total of 562 autopsies were conducted in the Department of Forensic Medicine and Toxicology of a tertiary care medical college, situated in Malwa region of west-central India, over a nine-month period from October 2023 to July 2024. The study population included a diverse demographic, encompassing all age groups and both genders. Each case underwent a meticulous gross examination of the lungs, followed by histopathological analysis. The findings were categorized based on the nature of death, which included trauma, poisoning, asphyxia, infectious diseases, and natural causes. Gross examination revealed significant pathological changes in the lungs, such as pulmonary oedema, congestion, haemorrhage, and emphysema. Histopathological evaluation further identified conditions like pneumonia, interstitial lung disease, pulmonary thromboembolism, and neoplastic lesions. Notably, cases of trauma frequently exhibited pulmonary contusions and lacerations, while poisoning cases often showed acute respiratory distress syndrome (ARDS) and chemical pneumonitis. The study underscores the critical role of detailed pulmonary analysis in medicolegal autopsies. The spectrum of lung findings provides valuable insights into the pathophysiological mechanisms underlying various causes of death, aiding in the determination of cause and manner of death. These findings highlight the necessity of incorporating comprehensive lung examinations in forensic pathology to enhance the accuracy of medicolegal investigations. This research contributes to the existing knowledge base and offers a framework for future studies in forensic pulmonary pathology.

Background: Oral leukoplakia is a common potentially malignant disorder characterized by white patches in the oral mucosa. Effective management is crucial to prevent malignant transformation. Aim and Objective: To evaluate the efficacy of intralesional triamcinolone in reducing the size and severity of oral leukoplakic lesions. Materials and Methods: A prospective study was conducted on 50 patients with histopathologically confirmed oral leukoplakia. Patients received intralesional triamcinolone (40 mg/mL) injections bi-weekly for three months. Clinical response was assessed through lesion size measurement and histopathological evaluation at baseline, one, two, and three months. Adverse effects and recurrence rates were also monitored. Results: The mean age was 45.2 ± 12.3 years, with a male-to-female ratio of 3:2. At three months, 50% of patients showed a complete response, 30% had a partial response, 16% had no response, and 4% exhibited progressive disease. A significant reduction in lesion size was observed: 21.1% at one month, 44.0% at two months, and 67.1% at three months (p<0.05). Post-treatment, 20% of patients showed no dysplasia, 60% had mild dysplasia, 16% had moderate dysplasia, and 4% had severe dysplasia. Mild mucosal irritation (10%) and dryness (8%) were the most common side effects. A recurrence rate of 10% was noted during the six-month follow-up period. Conclusion: Intralesional triamcinolone effectively reduces the size and severity of oral leukoplakic lesions with minimal adverse effects. While it shows promise as a treatment option, long-term follow-up is necessary to monitor for recurrence and potential malignant transformation.

Background: Sudden sensorineural hearing loss (SSNHL) is an otologic emergency characterized by rapid hearing loss. While systemic corticosteroids are a standard treatment, intratympanic dexamethasone injections offer a targeted alternative with potentially fewer systemic side effects. Aims and Objectives: To evaluate the efficacy of intratympanic dexamethasone injection in improving hearing outcomes in patients with SSNHL. Materials and Methods: This prospective, observational study included 50 patients with idiopathic SSNHL, aged 18 years and older, and with onset of hearing loss within the past 14 days. Patients received intratympanic dexamethasone injections (4 mg/mL) using a 25-gauge spinal needle through the tympanic membrane into the middle ear on Days 1, 3, and 5. Hearing outcomes were assessed using pure tone audiometry (PTA) and speech recognition scores at baseline, 2 weeks, 4 weeks, and 3 months post-treatment. Results: The mean baseline hearing threshold was 80.6 ± 15.7 dB. Significant improvements were observed at 2 weeks (60.4 ± 18.3 dB, p < 0.001), 4 weeks (55.2 ± 16.7 dB, p < 0.001), and 3 months (50.1 ± 15.4 dB, p < 0.001). Speech recognition scores improved significantly from 42.8 ± 12.5% at baseline to 70.2 ± 12.8% at 3 months (p < 0.001). Patient-reported symptoms of tinnitus and vertigo decreased markedly, with no serious adverse effects reported. Conclusion: Intratympanic dexamethasone injections significantly improve hearing thresholds and speech recognition scores in patients with SSNHL, offering a safe and effective treatment option with minimal systemic side effects.

Introduction: Balanced General Anesthesia is a state that encompasses multiple components like amnesia, analgesia, hypnosis, muscle relaxation and reduced reflex responses. To achieve this balanced state, anesthesiologists carefully combine different combination of drugs. Aim and Objectives: Primary objective of present study comparative evaluation of propofol – ketamine, propofol – fentanyl and propofol – dexmedetomidine in terms of hemodynamic variables and recovery characteristics in upper abdominal studies under general anaesthesia. Secondary objective is to evaluate and compare the hemodynamic variables and associated side effects after administering the combination of above mentioned drugs. Materials & Methods: After approval of Institutional Ethical Committee, a prospective comparative study was conducted on 114 patients belonging to ASA Physical Status I & II patients in an age group of 18-60years, undergoing elective upper-abdominal surgeries under general anaesthesia after taking informed consent. Patients were grouped into 3 groups of 38 each depending upon the drug combinations used. Propofol 2mg/kg of induction dose followed by 2mg/kg/hr of maintenance dose along with ketamine 2mg/kg for induction & 1mg/kg/hr for maintenance in Group A, fentanyl 2mcg/kg for induction & 1mcg/kg maintenance dose in Group B, dexmedetomidine 2mcg/kg of induction dose& 1mcg/kg/hr for maintenance in Group C. Heart rate, blood pressure, oxygen saturation, sedation score assessed at specified time intervals. Post-operative recovery, post-operative complications, pain, analgesic requirement were recorded. Hemodynamic parameters were compared using ANOVA. Results: Demographic characteristics were comparable between all three groups. Significant decrease in heart rate, blood pressure with propofol-dexmedetomidine (p<0.05) compared to propofol-ketamine, propofol-fentanyl observed. Early recovery observed with group B followed by group A and C. Better sedation noted in group C followed by group A and B. Patients in propofol-fentanyl, propofol-dexmedetomidine group had early onset pain, and need for analgesia was more compared to propofol-ketamine group. Conclusion: Propofol-dexmedetomidine, propofol-ketamine combination is extensively effective in maintaining hemodynamic stability, with faster recovery observed with propofol-fentanyl compared to other combinations. Propofol-dexmedetomidine, propofol-ketamine combination comparatively provided better analgesia peri-operatively.

Introduction: Laparoscopic cholecystectomy is a common surgical procedure for the management of symptomatic cholelithiasis. However, complications can occur during the surgery, when there are anomalies in the extrahepatic biliary tree and vascular anatomy. Aim: This study was done to document the complications of laparoscopic cholecystectomy in relation to the normal anatomy and variations in the extrahepatic biliary tree and vascular anatomy. Material and Methods: A cross-sectional study was conducted in the Department of General Surgery at our hospital. The study duration was of one year. Adult patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis were included. Preoperative workup included a complete history, physical examination, relevant laboratory tests, abdominal ultrasound and CT abdomen and MRCP where required. The surgical procedure followed the standard technique and anomalies in the extrahepatic biliary tree and vascular anatomy were documented. Both intraoperative and postoperative complications and time taken for surgery were recorded. Results: In a study of 76 patients, anomalies in the extrahepatic biliary tree and vascular anatomy were found in 27.6% of cases. Intraoperative complications occurred in 5.2% of patients, including vascular and bile duct injuries, while postoperative complications were identified in 3.9% of patients. The distribution of patients based on anatomy and complications were documented. The complication rate was higher among patients with anatomical variations, accounting for 19.04% (4 patients out of 21 patients) compared to patients with normal anatomy, where the complication rate was 3.64% (2 out of 55 patients). Overall out of 76 patients, 70 (92.10%) were found to be without complications, while 6 (7.689%) developed overall complications. The calculated p value of 0.02 indicated a statistically significant relationship between anatomy and complications. Conclusion: This study highlights the importance of understanding the variations in the extrahepatic biliary tree and vascular anatomy during laparoscopic cholecystectomy. The presence of anomalies can increase the risk of complications during and after surgery. Accurate identification of the variations in the extrahepatic biliary tree and vascular anatomy are crucial for successful laparoscopic cholecystectomy. Therefore, awareness of these anomalies, which can occur upto 66% can help the surgeon adapt their surgical approach to minimize these.

Background: Searching of better and effective uterotonic is required to prevent postpartum haemorrhage [PPH] in pregnancy. This study was conducted to compare the efficacy of Carbetocin and Oxytocin in preventing PPH following vaginal delivery. Materials & Methods: An RCT was conducted among 260 singleton pregnancy without complications. Each half received Inj. Oxytocin 10 I.U. intramuscular and Inj. Carbetocin 100mg intravenous immediately after vaginal delivery of the baby. The investigator placed a calibrated drape under the woman’s buttock & blood loss was measured for 1 hr or 2 hrs postpartum if the bleeding continued beyond 1 hour. The research team provided (three) pre-weighed standard sanitary pads to each pregnant woman to measure the blood loss in 24 hrs postpartum period. Women were advised to preserve the soaked pads in a sealable container which was provided by the study staff members. The amount of blood was measured in grams by digital postal scale and multiplied by a constant value 1.06 to get the amount of blood loss in milliliters [ml] within 24 hrs. of delivery. Data was analysed using Jamovi Ver. 2.4. Chi-square test was used for categorical data and t-test for continuous data. p-value of <0.05 was taken as significant. Results: Oxytocin group had more PPH (37.7%) compared to Carbetocin group (11.5%). Severe PPH was seen only in the Oxytocin group in this study. Mean blood loss was also more in the Oxytocin group (487±204 ml) compared to the Carbetocin group (315±149 ml). There was more use of additional uterotonics and uterine massage in the oxytocin group. Conclusion: Carbetocin is more effective in preventing PPH amongst pregnant women with singleton pregnancy following vaginal delivery. Further multicentric and meta-analytic study needs to be performed to increase its robustness.

Glomerular disease (GD) is a common forms of renal diseases that can result from many inherited or acquired disorders. Renal biopsy plays an important role in the diagnosis of kidney disease. . Profiling the glomerular diseases from different areas in and around the country helps understand the spectrum and the trend of disease over a time period. The present study was done to evaluate the histopathological spectrum of biopsy proven kidney diseases in patients of Rohilkhand region. This was a retrospective single centre study done at Department of Medicine, Division of Nephrology, SRMS institute of Medical Sciences, Bareilly, Uttar Pradesh. Total 108 patients included in this study. The mean age of patients was 45.2± 14.3 year. Males outnumbered females; there were 62% males and 38% females. Most common indication for renal biopsy was Nephrotic syndrome in 43.54% (N=47) followed by Nephritic syndrome (28.7% (n=31). Primary glomerular disease was present in 71.3 %( n=77) and secondary glomerular disease was present in 28.3 %( n=31).IgA nephropathy (n=25, 32.46%) was the most common primary glomerular disease. Membranous nephropathy (n=21, 27.27%), Focal segmental glomerulosclerosis (n-12, 15.58%), Minimal change disease (n=9, 11.68%) and C3 glomerulonephritis/ immune complex MPGN (n=8, 10.38%) were the other common primary glomerular disease. Among secondary glomerular disease, lupus nephritis was most common (n=10, 32.25%). Thrombotic microangiopathy (n=8, 25.8%), diabetic nephropathy (n=5, 16.1%), ANCA associated vasculitis (n=4, 12.9%) and Amyloidosis (n=3, 9.67%) were the other common secondary glomerular disease. Spectrum of kidney biopsy from different part of country help to understand prevalence of glomerular disease and its geographical variation.

Background: Chronic kidney disease (CKD) encloses a range of different pathophysiological procedures. Kidney is involved in the metabolism and eradication of the thyroid hormone, consequently the decline in the kidney function is assisted by changes in the synthesis, secretion, metabolism and elimination of the thyroid hormones leading to thyroid dysfunction. Material and Methods: In this prospective cross-sectional study all the patients admitted or attended OPD in Department of medicine SRMSIMS Bareilly between March 2021 to August 2022 and diagnosed as chronic kidney disease were included. Patients with known case of thyroid disease and those CKD patients were on dialysis excluded. Serum creatinine, Triidothyronine (T3), Thyroxine (T4) and Thyroid stimulating hormone (TSH) were measured with and aim to evaluate Thyroid profile in patients of CKD. Results: A total of 100 patients with CKD were included. The mean age of study was 54.26±16.92 years. 54% patients were male, and 46% patients were female. 28% of patients were diabetic and 54% of patients were hypertensive. 54% of patients were smoker and 36% of patients were alcoholic Total 30% patients had low, 57% patients had normal, and 13% patients had high T3 levels. 21% patients had low while 79% patients had normal T4 levels. 1% patients had <0.25, 82% patients had 0.25-5.50, and 17% patients had >5.50 TSH levels. Conclusion: In this study it was observed that the patients with severe renal disease had a significantly lower T3 levels (P<0.0001). Although, we could not found significant association between T4, TSH and severity of renal disease but small sample size and single centre study was our limitation.

Background: Cannabis use is a significant public health concern, with growing evidence linking it to the de-velopment of psychosis. This study investigates cannabis-related psychosis (CRP) in the Indian context, focus-ing on clinical presentation, pathway to care, effects of abstinence, and follow-up. Methods: A prospective observational study was conducted at a tertiary referral center in India. Participants di-agnosed with CRP (n=100) were assessed using standardized instruments to evaluate symptoms, pathway to care, and motivation for change. The effects of abstinence and psychotherapy were followed over one year. Results: CRP patients presented with a predominantly positive symptom profile, including suspiciousness, hallucinations, and hostility. Abstinence from cannabis led to a significant reduction in both positive and nega-tive symptoms. The pathway to care differed from developed countries, with many patients initially consulting religious healers. Psychotherapeutic interventions showed promise in improving motivation for change. Conclusion: Cannabis-related psychosis presents with distinct symptoms, and abstinence can significantly im-prove outcomes. Cultural factors influence the pathway to care, highlighting the need for public education and culturally sensitive treatment strategies. Future research should explore the role of dopamine receptors, non-pharmacological interventions, and larger, more diverse samples.

Background: Hypothyroidism is one of the most prevalent forms of thyroid dysfunction in which the disease causes generalized slowing of metabolic processes. Thyroid dysfunction frequently disturbs mineral metabolism. The aim of the present study was to evaluate the levels of serum calcium, magnesium and phosphorus in patients with hypothyroidism. Materials and Methods: We conducted the present study on 100 lab-diagnosed cases of hypothyroidism based on the thyroid profile. 50 healthy controls were included in the study. We estimated serum calcium, magnesium and phosphorus in both cases and controls. Results: This study found that in people with hypothyroidism, the mean levels of calcium and magnesium in blood were significantly (p value<0.001) lower than in controls, while the levels of phosphorous were significantly (p value<0.001) higher. We found a significant negative correlation between both serum calcium and magnesium and serum TSH levels, and a significant positive correlation between serum phosphorous and serum TSH levels. Conclusion: The current study concluded that hypothyroidism alters the metabolism of minerals. Estimation of these minerals in hypothyroid patients will be of great benefit in the prevention and treatment of subsequent clinical manifestations.

Introduction: Typhoid fever is a significant public health concern in developing countries, transmitted mainly through contaminated water or food and can lead to severe complications such as intestinal perforation. Diagnosis involves clinical symptoms, imaging tests, and serological assays. Surgical intervention is necessary in cases of perforation, with primary repair, resection anastomosis or ileostomy being common procedures depending on the severity. Challenges in managing the disease include late presentation, antibiotic resistance, and limited resources in rural areas. Aim: To study the management of typhoid bowel perforations. Materials and Methods: It is a cross sectional study done in the Department of General Surgery, Rohilkhand Medical College and Hospital Bareilly from 1 November 2022 to 31 October 2023. 54 patients with confirmed typhoid bowel perforations who underwent clinical evaluation, diagnostic investigations and operative intervention were in the study. Data was analyzed using descriptive statistics and appropriate tests. Results: The study revealed that the majority of patients (81%) were males in the third decade of life, 35% presenting within 2-3 weeks of the onset of typhoid fever with symptoms of peritonitis, diagnostic tests included widal test, typhoid test and blood culture aided in the confirming the diagnosis. Surgical procedures varied based on intraoperative findings, with ileostomy being the most common. Post-operative complications such as electrolyte imbalance, weight loss, and surgical site infection were observed. Mortality rate was influenced by the premorbid conditions. Conclusion: Typhoid bowel perforation remains a significant clinical challenge, particularly in resource-limited settings. The study underscores the need for comprehensive management strategies including early diagnosis, appropriate surgical intervention and adherence to evidence based guidelines. Better results were obtained with primary repair patients instead of ileostomy or resection anastomosis. Mortality of the disease does not depend on the selection of surgical procedure but can affect the morbidity.

Introduction: Antepartum fetal surveillance is of immense importance for detecting fetal compromise in utero in high-risk pregnancies. The non-stress test (NST), contraction stress test (CST), biophysical profile (BPP), modified BPP (MBPP), and Doppler velocimetry are among the various tests used to evaluate high-risk pregnancies. This study was conducted to compare the diagnostic efficacy of the cerebroplacental ratio (CPR) and the non-stress test (NST) in predicting fetal compromise in hypertensive disorder of pregnancy (HDP). Methods: This is a prospective study in which 110 pregnant women between 32 and 37 weeks of gestation with hypertensive disorder of pregnancy were evaluated by Doppler ultrasound and non-stress testing. In the study, the final ultrasound and Doppler indices prior to delivery were taken into account. The outcome of pregnancy was recorded according to Group A (n = 67, CPR and NST normal), Group B (n = 9, CPR normal and NST abnormal), Group C (n = 26, CPR abnormal and NST normal), and Group D (n = 8, CPR and NST both abnormal). The perinatal outcome was measured in terms of admission to the NICU, LBW, Apgar <7 at 5 minutes, MSL, and stillbirth. Qualitative variables were correlated using the Chi-square test or Fisher exact test. Sensitivity, specificity, NPV, and PPV were calculated, and a p-value <0.05 was considered statistically significant. Data analysis was done using social sciences (SPSS) licensed version 21.0. Results: The sensitivity of Doppler (68.57%) was better than that of NST (34.28%), while the specificity of NST (93.33%) was better than that of Doppler (86.66%) in predicting perinatal outcomes. When both CPR and NST were abnormal, there was a larger fetal compromise in terms of APGAR scores, NICU admissions, birth weight, and other metrics. Conclusion: CPR had greater diagnostic accuracy in terms of higher sensitivity than NST in predicting adverse perinatal outcomes in women with hypertensive disorders of pregnancy; however, both tests are complementary to each other, and both tests must be performed to identify a range of foetuses that are compromised at different stages of women with HDP.

Background: Burnout is a very common phenomenon which is experienced by almost all of the healthcare professionals in certain period of time in any field. Psychiatry is also one of the subject in which professionals may feel burnout very frequently; as psychiatrists had to deal with emotions of patients and their caregivers daily. Empathy, which is a core aspect of healthy patient doctor relationship and it is highly necessary for a psychiatrist for achievement of good therapeutic outcome. Aim and Objective: To assess level of burnout and empathy among psychiatrists practicing in Gujarat state. Materials and Methods: A cross sectional study was conducted by circulating online questionnaire survey among Psychiatrist of Gujarat state from December 2023 to April  2024, questionnaire was made by using maslach burnout inventory & Jefferson scale for physician empathy & sociodemographic factors. Total 31 psychiatrists had participated in study from Gujarat state. Results: In our study mean score of burnout was 55.77 ± 9.88, while mean score for empathy was 82.35 ± 7.49. Overall around 16-19% of Psychiatrists had moderate to high scoring in 3 subscales of MBI. Conclusion: Although burnout is not a disease  some measures are needed to prevent  frequent burnout among psychiatrists.

This case-series was compiled in a span of 11 months to identify most common cause of Primary Amenorrhea among cases attending GOPD and to depict the various modalities of treatment in such cases in MGM Medical College, Kishanganj, a Rural Tertiary Care Hospital in North-East Bihar. The mean age was found to be14.8 years, most of them (58.3%) were in Upper Lower Class. The incidence of Primary Amenorrhea was 5.5% among adolescent patients attending gynae OPD and the most common cause of Primary Amenorrhea was Mullerian Agenesis (16.6%). Management was done by Multidisciplinary approach based on aetio-pathology.

Background: Mullerian Duct Anomalies (MDAs) are congenital abnormalities of the female reproductive system resulting from anomalous embryological development of the Mullerian Ducts. Among MDAs, a didelphys uterus, often referred to as a “double uterus,” is one of the rarest. It occurs when two separate Mullerian Ducts develop independently, leading to the formation of two hemi-uteri, each with its own fallopian tube, ovary, and cervix. This anomaly can potentially lead to obstetric complications. The Case: A 20-year-old primigravida presented at 30 weeks and 1 day for the first time in our OBGYN emergency department with preterm labor. History and records suggested that antenatally, she was suspected to have a uterine anomaly, possibly septate or bicornuate uterus and cervical incompetence based on findings from her first trimester ultrasound. The patient underwent assisted vaginal delivery with a right mediolateral episiotomy. A non-communicating thick longitudinal vaginal septum was unexpectedly discovered, with a wider vaginal segment noted on the right side.Vaginal speculum examination revealed the presence of two separate cervices. Neither the patient nor her husband had prior knowledge of this condition. 3 days post-delivery, pelvic MRI confirmed the presence of a didelphys uterus with a longitudinal complete vaginal septum. Subsequent abdominal CT scans showed no renal anomalies. The patient denied experiencing dyspareunia, dysmenorrhea, or chronic abdominal pain in the past. Discussion: Achieving term pregnancies in cases of uterine didelphys is uncommon. Given the high incidence of obstetric complications and poor pregnancy outcomes associated with this condition, vigilant monitoring is essential both prenatally and throughout pregnancy.

Background and Objectives: To analyze refractive errors and its relationship with ocular biometry in children with retinopathy of prematurity (ROP) treated with laser and to find out possible associations of type of refractive error. Material and Methods: This research included children who had previously had laser photocoagulation for retinopathy of prematurity (ROP) and had been followed up for at least one year. The records were examined for gestational age, birth weight, zone and stage of illness, and the presence of APROP. All children underwent comprehensive ophthalmic examination. Streak Retinoscopy was used to measure refractive error. The biometric profile including the axial length (AL), anterior chamber depth (ACD) and Lens thickness (LT) were measured using A- scan Biometry. The primary outcome measures were amount of refractive error {spherical equivalent (SE)}, and type of refractive error. SE was measured as spherical error + half cylindrical error. Myopia was defined as SE ≤−0.5 D; high myopia >-6 D and hyperopia +0.5D. Association between refractive error and ocular biometric profile was analyzed. Results: Total 48 eyes were studied at mean age 24 months. Refractive error (SE) ranged from +4.50 to -19.75D. 64.58% were myopic, 37.5 % were hypermetropic, and Astigmatism was seen in 16.6%. Mean myopia was -3.19D (range -0.50 to -19.75D). Lens thickness was significantly associated with myopic refractive error (p=0.0043). Conclusion: Substantial numbers of children treated for ROP with laser photocoagulation develop myopia and astigmatism. Hence, based on our research, we may deduce that identifying and treating refractive errors at an early stage is crucial for these children.

Introduction: Spinal anesthesia is the most frequently used method for lower abdominal surgeries, however, achieving postoperative analgesia still a problem because using pure local anesthetics without additives leads to a short duration of action and the early need for rescue analgesia in the postoperative period. Intrathecal injection of adjuvants to topical anesthetics can enhance the effects of anesthetic drugs and reduce their demand. Aim and Objectives: The objective of this study was to compare the onset of sensory and motor blockade of morphine and dexmedetomidine and to compare their analgesic effect postoperatively when used as adjuvants to hyperbaric 0.5% heavy bupivacaine for spinal anesthesia. Materials & Methods: After approval of Institutional Ethical Committee, this prospective comparative study was conducted on 72 patients aged 18-60 years posted for elective lower abdominal surgeries under spinal anaesthesia after taking informed consent. Patients were randomly divided into two groups; Group M received 15mg of 0.5% hyperbaric bupivacaine with 250mcg of morphine, while Group DM received 15mg of 0.5% hyperbaric bupivacaine with 5mcg of dexmedetomidine. The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables and any untoward side effects were noted in both groups. Results: The duration of sensory and motor blockade was significantly longer in the dexmedetomidine group than in morphine group. Time for first rescue analgesia and total analgesic dose were similar in both groups. The pruritus was noticed only in morphine group, and there was no respiratory depression occurred in the two groups. Conclusion: Intrathecal dexmedetomidine and morphine both provided good postoperative analgesia. Intrathecal dexmedetomidine produced prolongation of sensory and motor block of spinal anesthesia with less undesirable side effects than intrathecal morphine, thereby increasing the time for first rescue analgesia.

Background: Ropivacaine is a novel long-acting amide local anaesthetic that is comparable to bupivacaine in terms of its structure and pharmacodynamics. ln comparison to bupivacaine, ropivacaine has a reduced propensity to affect the central nervous system and a lower cardio-toxicity. Aims and Objectives: The aim of our study was to compare and assess the effectiveness and compare the block characteristics of hyperbaric ropivacaine 0.5% (18mg) versus hyperbaric bupivacaine 0.5% (18mg) for elective lower abdominal surgeries under spinal Anaesthesia. Materials & Methods: After approval of Institutional Ethical Committee, this prospective comparative study was conducted on 60 patients aged 18-60 years posted for elective lower abdominal surgeries under spinal anaesthesia after taking informed consent. Patients were randomly divided into two groups; Group B: received 18 mg (3.6 ml) of 0.5% Hyperbaric Bupivacaine intrathecally, while Group R received 18 mg (3.6 ml) of 0.5% Hyperbaric Ropivacaine, prepared aseptically by adding 1.2 ml (300 mg) of autoclaved 25% dextrose from a 10 ml ampoule to 2.4 ml of commercially available sterile preservative-free isobaric 0.75% Ropivacaine solution immediately prior to injection. The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables and any untoward side effects were noted in both groups. Result: The onset of sensory and motor blockade was similar in both groups. Hemodynamic variables were found to be more stable in the Ropivacaine group. Conclusion: Hyperbaric Ropivacaine demonstrated comparable block quality to commonly used hyperbaric 0.5% bupivacaine when administered intrathecally for elective lower abdominal surgeries under spinal anesthesia.

Objective: This study investigates the histopathological characteristics of psoriasis, focusing on both epidermal and dermal features, and evaluates the expressions of tumor necrosis factor-alpha (TNF-α) and prolactin receptor using immunohistochemistry. Methods: Skin biopsies from clinically confirmed cases of psoriasis were collected and processed for histopathological examination and immunohistochemical analysis at the Department of Pathology, Ramaiah Medical College and Hospitals, from March 2021 to October 2022. Histopathological features such as Munro’s micro abscesses, parakeratosis, spongiosis, thinning of the parapapillary dermis, and elongation of rete ridges were documented. TNF-α and prolactin receptor expression levels were semi-quantitatively assessed based on the number of positively stained cells and staining intensity. Results: Munro’s micro abscesses were observed in 54.4% of cases, while parakeratosis and spongiosis were noted in 28.1% and 19.3% of cases, respectively. Dermal changes included thinning of the parapapillary dermis in 47.4% of cases and elongation of rete ridges in 36.8% of cases. Immunohistochemical analysis revealed significant TNF-α expression in keratinocytes, endothelial cells, and inflammatory cells, and prolactin receptor expression in keratinocytes and endothelial cells. Conclusion: The findings highlight the characteristic histopathological features of psoriasis and underscore the roles of TNF-α and prolactin in its pathogenesis. TNF-α is implicated in immune cell recruitment, while prolactin appears to influence keratinocyte proliferation and angiogenesis. These insights contribute to a better understanding of psoriasis pathology and suggest potential therapeutic targets.

Background: With improvements in internet’s availability and affordability has led to its overuse and addiction. Increased internet usage can lead to habituation, addiction, adverse academic, physical, mental and social effects. It is important to investigate the seriousness of internet addiction in medical students as they are in the field related with the physical and mental wellbeing of human. Aim and Objective: The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students. Materials and Methods: A cross-sectional study was conducted in 380 undergraduate medical students of Siddhartha Medical college, Vijayawada with the help of semi structured questionnaire consisting of questions related to demographic information, information related to internet use, and Young’s internet addiction test. Results: We found prevalence of internet addiction among medical students to be 24.2% and significantly associated factors with internet addiction being female gender, lesser age , using mobile for internet access, excess time spent on internet, and using internet for studying, downloading and social networking. Conclusion: In the present study it was found that the internet addiction is highly prevalent in medical students. There is a need for controlling internet addiction by engaging the students in extracurricular activities, providing healthy living environment, and to provide counselling to those with addiction.

Background: Vestibular migraine (VM) is a frequently diagnosed condition in neurotology, however it has only lately been acknowledged as a distinct disease. The primary aim of this study was to monitor and analyze the clinical and epidemiological characteristics of patients with vestibular migraine. Methods: The present cross-sectional study was conducted at department of ENT of a tertiary care center among 90 patients with vestibular migraine symptoms attending the OPD during the study period of one year. Detailed history, sociodemographic details, duration, frequency, family history and precipitating factors of migraine was enquired. Results were analysed using SPSS version 25.0. Results: In the present the mean age of patients was 39.4 years. The number of female patients was 94.4%) and male patients were 5.6%. Out of 90 patients family history was present in 62% of cases. Tinnitus was the only symptom in 9.2%, hearing loss the only symptom in 10% and both hearing loss and tinnitus were present in 20.8%. Conclusion: Vestibular migraine is a disorder that is not diagnosed frequently in India. There is limited research and awareness about this ailment. Therefore, the purpose of this study is to address these limitations. The majority of the patients were women in their middle age. The majority of patients underwent a physical examination, which yielded normal results.

Background: Preeclampsia is a significant pregnancy complication characterized by hypertension and proteinuria. Thyroid dysfunction has been implicated in its pathophysiology. Aim and Objective: To investigate the association between thyroid dysfunction and preeclampsia. Materials and Methods: This observational study included 50 preeclamptic and 50 normotensive pregnant women. Data were collected on antenatal care weeks, blood pressure, pulse rate, random blood sugar levels, urine protein, serum TSH, T3, and T4 levels, kidney function (urea and creatinine), liver function (SGOT, SGPT, and bilirubin), and thyroid status (euthyroid, hypothyroid). Statistical analysis was performed to compare these parameters between the two groups. Results: There was no significant difference in antenatal care weeks between the case and control groups (P = 0.580). Blood pressure measurements showed significantly higher systolic and diastolic pressures in the case group compared to the control group (P < 0.001). The pulse rate was found to be similar in both groups (P = 0.796). Urine protein levels were significantly higher in the case group (P < 0.001), indicating renal involvement. Thyroid hormone analysis revealed higher TSH and T3 levels in the case group, with TSH levels showing a significant difference (P < 0.001) and T3 levels also being significantly higher (P = 0.010). There was no notable difference in T4 levels between the groups (P = 0.639). Kidney and liver function tests showed no significant differences in serum urea, creatinine, SGOT, SGPT, and bilirubin levels between the case and control groups. Thyroid status analysis indicated a higher incidence of hypothyroidism in the case group (P = 0.001). Conclusion: Thyroid dysfunction, particularly elevated TSH and T3 levels, is significantly associated with preeclampsia. Monitoring thyroid function during pregnancy may be crucial for managing preeclampsia and improving pregnancy outcomes. Further research with larger sample sizes and longitudinal designs is necessary to confirm these findings and explore underlying mechanisms.

Background: Dengue is an acute febrile illness caused by Dengue virus. The main vector is the female mosquito Aedes albopictus. Dengue fever ranges from a mild asymptomatic form to severe dengue haemorrhagic fever (DHF) with or without dengue shock syndrome (DSS). The aim of the study was to know the prevalence of dengue and its seasonal trend in western Maharashtra. Materials and Methods: The present study is a retrospective analytical study conducted at Tertiary care Hospital, from January 2019 to December 2022. Descriptive analysis was done and data was presented as numbers and percentages. Total 53302 blood samples were analysed during the study period. Rapid positive serum samples (2621) samples were subjected to ELISA for detection of NS1Ag and IgM Ab. Result: A total of 53302 blood samples were analyzed during this study period, of which 2621 samples were positive for dengue fever by immunochromatographic rapid test out of which 1763 samples were positive for Dengue by ELISA for different serological markers like NS1 and IgM antibody. Overall prevalence was 67.26%. In the present study, prevalence of dengue positive cases was 1134 (77.24%) in 2019, 75 (32.90%) in 2020, 263 (52.90%) in 2021, 291 (67.99%) in 2022.Out of 1763 samples prevalence of NS1 (Ag) was 71.25% and IgM was 61.57%. Most number of dengue cases were in the month of September & October. Conclusion: The overall prevalence was 67.26%. The period of COVID-19 pandemic was associated with the decline in Dengue cases and prevalence probably due to decreased testing or similarities in presentation of both diseases leading to delayed testing. The seasonal variation matches with breeding time of mosquitos, which shows an increased prevalence of dengue cases in monsoon.

Introduction: Adenoid hypertrophy refers to the enlargement of the adenoid, causing mechanical blockage and inflammation in the nasopharynx, predominantly in children aged 1-6 years. Symptoms include oral breathing, snoring, and hyponasal voice. Treatment varies from adenoidectomy for severe cases to intranasal corticosteroids for less severe cases. Systemic steroids are effective but have significant side effects, unlike topical nasal steroids which are safer with minimal systemic effects. Aims and Objectives: To investigate the role of steroids in adenoid hypertrophy. Methods: This prospective 18-month study at the National Institute of Medical Sciences & Research Hospital in Jaipur examined adenoid hypertrophy frequency. Using purposive sampling, 242 participants aged 2-12 were chosen based on specific criteria. Data was collected via clinical exams, X-rays, and interviews. Adenoid hypertrophy was graded into three levels. Statistical analysis with SPSS 27 assessed clinical and psychosocial parameters, comparing symptom improvement between groups over time. Results: Before treatment, the distribution of adenoid hypertrophy grades showed that Grade 3 hypertrophy was the most prevalent with 136 patients, followed by Grade 2 with 55 patients and Grade 1 with 51 patients. Nasal symptoms such as obstruction and discharge were more common in females, with 102 females (80.95%) experiencing these symptoms compared to 89 males (76.72%). Snoring and mouth breathing were less common but still present in both genders. After treatment, the number of patients with Grade 1 hypertrophy increased significantly to 99, while those with Grade 2 and Grade 3 hypertrophy decreased to 39 and 94, respectively. These changes in patient numbers were statistically significant for Grade 2 (p=0.048) and Grade 3 (p=0.031), indicating effective treatment outcomes. Additionally, 9 patients showed no hypertrophy post-treatment. The effectiveness of oral steroid treatment was further supported by a significant improvement in grading (p=0.036) and a reduction in the need for adenoidectomy (p=0.0344). Conclusion: The study concluded that oral corticosteroids can significantly decrease the grading of adenoid hypertrophy from higher to lower grades and that early medication with oral steroids can be used to avoid adenoidectomy.

Introduction: World Health Organization declared the COVID-19 crisis as a pandemic in March 2020. World Health Organization as well as various authorities issued health advice to prevent spread of COVID-19. Wearing face mask is regarded as one of the most effective ways to prevent COVID-19 transmission. It is essential to look into the factors influencing people’s willingness to wear masks. Objective: To explore the preference of community towards various types of face masks and the extent of adoption towards it. To determine the protective effect of various types of facemasks. Methodology: 30 Cases were randomly selected from each zone of Surat city, so total sample size was 240 Cases and 240 Controls were selected by matching. Pre-designed, semi-structured questionnaire was used along with self-design Likert’s scale at the end of interview to collect the information about community willingness and hurdles about mask wearing for face mask acceptance. Data was entered in MS Excel and was analyzed and compared using appropriate statistical methods. Results: Participants who wore mask were having 92% less risk of COVID-19 as compared to those who did not wear mask (OR: 0.0862, 95% CI: 0.0852-0.0872) and the difference between these two groups was statistically significant. (χ2: 51.2007, DF: 1, p=0.00001) Participants who wore triple layer and N-95 were having 79% less risk of COVID-19 as compared to those who wore cloth or cloth mask (OR: 0.213, 95% CI: 0.11-0.31) the difference between these two groups was statistically significant. (χ2: 52.4879, DF: 1, p=0.00001) There was also various factors contributing towards community willingness for face mask wearing. Effectiveness, comfort level, affordability, troublesome, appearance, health consciousness, misbeliefs, personal habits, fear, government action etc. factors were significantly contributing in prevention of COVID-19 infection.  Conclusion: Protective effect of N95 mask is substantially higher as compared to no mask or cloth mask. Mask-wearing can be helpful in reducing the risk of silent transmission. There was a significant role of prophylactic measures like face masks in prevention and control of COVID-19 infection.

Background: Iron deficiency anaemia (IDA) is a serious global health issue that, particularly in pregnant women, can cause problems for the fetus as well as the mother. For the purpose of supporting fetoplacental growth and maternal adaption to pregnancy, there is a threefold increase in the physiological demand for iron during pregnancy. The purpose of this study was to determine the shortcomings of the existing management of IDA, the inadequacies of traditional oral iron therapy, and the need for safe and efficient remedies. Objective: Understanding the gaps in the available treatments for IDA management, as well as its shortcomings and potential useful approaches for improved management, was the aim of this study. Materials and Methods: A questionnaire-based opinion survey in Tertiary care hospital. The survey aimed to gather data on the challenges faced with conventional oral iron therapy, the desire for a change in oral iron salts, and the preference for novel oral iron prescriptions for their patients. Results: Data obtained from the survey showed that 82% of gynaecologists and obstetricians noticed challenges with conventional oral iron therapy. 86% wanted to change the oral iron salts, and 70% would like to prescribe novel oral iron for their patients. Ferric maltol, a novel form of chelated oral iron, was introduced as a potential solution for IDA management. It has been studied in various clinical indications, such as IDA associated with inflammatory bowel disease, chronic kidney disease, and pulmonary hypertension, showing significant improvements in haemoglobin and iron indices with good tolerability throughout treatment duration. Conclusions: The study results demonstrate that ferric maltol is a suitable and convenient treatment option for individuals seeking long-term, convenient, and well-tolerated management of IDA.

Introduction: Preeclampsia is best described as a pregnancy – specific syndrome that can affect virtually every organ system. Incidence of Preeclampsia is identified in 4 to 5% of all pregnancies. Hypertension in pregnancy is diagnosed, Preeclampsia is defined as increase in blood pressure, severe preeclampsia is characterized by the presence of evidence of multi organ involvement. The more profound the imminent signs and symptoms, the most likely that delivery will be required. This study has been conducted to study the effect of severe preeclampsia on pregnancy and maternal and neonatal outcome. Aim of the Study: To study the prevalence of severe preeclampsia in relation to age, Parity and immunized. To study the incidence of various maternal complications and indications of preeclampsia, fetal outcome and complications, reduce the maternal mortality and morbidity. Material and Methods: This is prospective observational study conducted at department of Obstetrics and Gynaecology of a tertiary care hospital. It includes analysis of methods and indications of induction in severe preeclampsia, maternal and neonatal outcome in severe preeclampsia All patients with severe preeclampsia admitted in labour ward at our hospital who meet the below mentioned criteria were included in the study. Complete history taking, signs and symptoms of imminent eclampsia are noted. All patients required termination of pregnancy for various reasons. General condition of the patient was evaluated obstetric examination was carried out. PIH investigations were carried out. Results: Pre-eclampsia is more prevalent in both developed and developing countries contributing to maternal and perinatal morbidity and mortality. It will produce maternal syndrome. It includes Hypertension, proteinuria and with or without edema. Fetal syndrome includes foetal growth restriction, reduced amiotic fluid, and abnormal placentation. Conclusion: Early booking and regular antenatal BP checkup and monitoring imminent symptoms plays a major role in reducing the complications of severe preeclampsia. Earlier detection of complication and proper management plays a key role in the management of severe preeclampsia. Termination of pregnancy should be considered in all cases of severe preeclampsia based on maternal and neonatal condition. The maternal and neonatal morbidity and mortality was reduced significantly with effective management at all levels of health centers.

Aims and Objectives: According to WHO, the prevalence of infertility is about 10%–15% of reproductive age couples. Our aim of this study is to assess the demographic details of the patients of infertility, the role of hysteroscopy and laparoscopy in the evaluation of female anatomical etiology of infertility and the therapeutic role of these endoscopic modalities to correct anatomical pathology responsible for female infertility. Material and Method: This retrospective data analysis of 70 cases of female infertility was conducted at Department of Obstetrics and Gynaecology, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, Western India. Women aged 19-45 years with normal hormone profile without male factor infertility were included. Results: Out of 70 cases, 46 (65.7%) patients had primary infertility. While laparoscopy detected abnormalities in 62.8% of the cases, significant hysteroscopy findings were noted in 18.6% of cases. While the most common laparoscopic abnormality was adnexal adhesion (17.1%), hysteroscopy synechiae as the most common abnormality in both groups. Conclusion: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities. It has proved to be diagnostic as well as therapeutic procedure for female pelvic pathologies responsible for infertility.

Background: Medical nutrition therapy and exercise play an integral role in overall diabetes management as per American Diabetes Association. This study was conducted to have an insight on dietary and exercise practices in diabetic patients thereby to provide comprehensive diabetes care. Aims and Objectives: To assess the awareness of nutrition therapy and exercise in Type 2 diabetes mellitus patients. To assess food perceptions, dietary practices and level of exercise in diabetic patients. To determine the association of diet and exercise awareness with socio-demographic factors like education, gender, occupation and economic status and glycemic control. Methods: This study is a Hospital based, Cross-sectional, Observational Study. 100 T2DM patients coming to Sir T. General Hospital, Bhavnagar fulfilling the eligibility criteria were enrolled. They were interviewed with standard questionnaire that included questions on socio-demographic characteristics, disease details, diet and physical activity. A level of p <0.05 was considered significant. Results: 71% participants were aware regarding importance of dietary modification and 42% about exercise importance in diabetes management. 13% participants were aware about glycemic index and proportion of food in food plate. Nutrition therapy was limited to avoiding certain food items like sugar, sweets, potatoes and rice. 44% participants did exercise and 29% among these did it regularly. Walking was the most preferred form of exercise. There was significant association of awareness regarding diet and exercise importance with gender, education and socio-economic status. Conclusion: Although participants had awareness regarding role of diet and exercise in diabetes management, their knowledge about its practical implementation was poor. There is need to implement hospital based strategies to improve education on life style modification in diabetic patients.

Background: Cardiovascular autonomic nervous system dysfunction (CAD) is a common observation in fibromyalgia patients. This study is intended to investigate the cardiac autonomic function status in patients with fibromyalgia and their level of inflammatory markers and disease severity, as there aren’t many studies available on the subject. Objectives: To investigate inflammatory markers, heart rate variability (HRV), and controls in fibromyalgia. To evaluate the correlation between heart rate variability (HRV) and inflammatory markers patients with fibromyalgia. Material and Methods: Thirty controls and thirty diagnosed cases of fibromyalgia participated in the study. The short-term variability of heart rate was used to measure autonomic function. Inflammatory markers, namely TNF-α and IL-10, were measured from 3 millilitres of overnight fasting serum. The degree of fibromyalgia was evaluated by IL-1 and TNF-alpha. Results: Patients with fibromyalgia disease showed a substantial reduction in HRV frequency domain parameters, such as LF (p = 0.00*), HF (p = 0.00*), LF/HF ratio (p = 0.00*), and time domain parameters, namely RMSSD (p = 0.00*), SDNN (p = 0.00*), NN50 (p = 0.00*), and total power (p = 0.00*). They had higher levels of TNF-α. TNF-α and the LF/HF ratio have a have a significantly positive correlation. Conclusions: In patients with fibromyalgia, there is a significant correlation between HRV and both inflammations. The use of HRV as a reliable screening tool for autonomic disturbance in fibromyalgia patients may significantly lower their future morbidity and death risk.

Aim: Deficiency of vitamin B12 causes megaloblastic anemia, retardation of growth, and delay in neuromotor maturation. Newborns whose mothers have vitamin B12 deficiency are born with low vitamin B12 storages, and are at risk in terms of vitamin B12 deficiency symptoms during infancy. The aim of our study was to investigate the frequency of anemia and deficiency of vitamin B12, folic acid, and iron in pregnant women living in our region, in their newborn babies, and during the infancy period of these babies. Material and Methods: In our study, 250 pregnant women at 38–42 gestational weeks, who were admitted for delivery to Obstetrics & Gynecology Dept and their babies with a birth weight over 2500 g were included in the study.  Results: We determined that 24.8% of the pregnant women had anemia, 28% had low ferritin levels, 90.4% had vitamin B 12 deficiency, and 22.4% had folic acid deficiency. Some of the newborns had anemia, 2.8% had low ferritin levels, and 72.4% had vitamin B12 deficiency. Among the infants who presented for a follow-up visit at 6 months of age, 22.3% had anemia, 14.9% had low ferritin levels, 40.4% had vitamin B12 deficiency, and 1.06% had folic acid deficiency. In addition, we found that the levels of vitamin B12 and folic acid in newborns were related to the levels of vitamin B12 and folic acid in their mothers. Conclusion: Development of low vitamin B12 stores in newborns and the development of vitamin B12 deficiency during infancy, which may result in irreversible complications including neurologic complications, can be prevented by preventing vitamin B12 deficiency during pregnancy.

Aim: To compare the effect of complete denture fabricated using selective pressure impression and functional impression technique on masticatory efficiency and oral health-related quality of life (OHRQoL) in patients with resorbed ridges. Materials and Methods: Forty-eight participants with set inclusion and exclusion criteria were randomly allocated into two groups. Complete denture was fabricated in Group A and Group B using selective pressure and functional impression technique, respectively. The follow-up was done at 3 months. Masticatory efficiency was measured by color-changing chewing gum, and OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI) Hindi Version. Statistical Analysis Used: The Wilcoxon signed-rank test was applied to check the intergroup analysis for the GOHAI scores of both impression techniques. The Mann–Whitney U test was applied to compare intragroup analysis for masticatory efficiency and the GOHAI scores of both the techniques. Results: A total of 45 participants completed the follow-up. The mean age of the total participants was 62.7 ± 3.8. No statistically significant difference (P > 0.05) was observed between the masticatory efficiency and post-GOHAI scores of both the impression techniques. Conclusion: Selective pressure and functional impression techniques may be successfully used to fabricate complete dentures for patients with resorbed ridges.

Introduction: Complete edentulism is an eventual oral health outcome and results from the combined pathology of dental caries, periodontal disease, or faulty method of rehabilitation due to reduced cost. Complete edentulism has a significant concern and leads to reduced quality of life (QoL) along with impact on general health. However, it has been observed that due to wider and better oral health services globally, edentulism rate is decreasing every decade. Edentulism is directly related to masticatory and nutritional problems, and some authors regard it as a good mortality indicator. Methodology: The sample population consisted of 100 individuals comprising 63 males and 37 females who fulfilled the inclusion criteria. Geriatric oral health assessment index (GOHAI) was administered by a single investigator at baseline (pre-insertion) and also 6 and 9 months post-denture insertion. Sociodemographic data, including age and gender, were also collected. Results: It was observed that the overall oral health‑related QoL (OHRQoL) scores of the sample improved significantly at 6 and 9 months postinsertion (P < 0.001) when compared to baseline scores. When GOHAI scores were compared individually for males and females (pre- and post-insertion), it was observed that there was statistically significant improvement in OHRQoL postinsertion of denture in both the groups. Conclusion: OHRQoL in patients improved after complete denture rehabilitation. There was an upward shift in score for each item in GOHAI from preinsertion to 6 and 9 months postinsertion of dentures, reflecting improvement in OHRQoL of the sample.

Background: Although the reasons for pulmonary edema in preeclamptic females are mostly unclear, this condition can occur. Respiratory edema is among the most dangerous side effects. It is a sign that a pregnancy should be terminated immediately. This phenomenon is still poorly understood, despite the fact that several ideas, such as pulmonary capillary leakage, left ventricular failure, and hypervolaemia, have been put out to explain it. However following proper care, the prognosis is usually favourable, and the symptoms go away entirely in a few days following birth. The purpose of the current investigation is to determine if pre-eclampsia and pulmonary edema is related, and to provide an analysis based on the study’s findings. Methods: The hospital carried out a case-control study of preeclamptic women for a year, beginning from April 1, 2022, and ending on March 31, 2023. The patients (n = 28) were preeclamptic women who, while hospitalized for the index birth, experienced pulmonary edema on a plain X-ray or chest CT scan. The 64 patients in the control group had preeclampsia but were not diagnosed with heart failure or pulmonary edema during their index stay for delivery. Each woman’s data was used to determine the research variables via electronic medical record and paper chart. A final set of significant predictors was selected via backward elimination and multivariable logistic regression. Results: Roughly prior to birth, pulmonary edema occurred in 50% of all patients. The usage of magnesium sulphate and a fall of A platelet count of 10 × 109 /L or a rise in peak serum uric acid content of 10 μmol/L were substantially linked to pulmonary edema. Pulmonary edema incidence was shown to be decreased in cases of multiparity and with every increased intravenous crystalloid by 500 mL dosage. Conclusion: The study found a number of early risk factors for pulmonary edema in preeclamptic women. To learn more about how these and other variables affect the likelihood that pulmonary edema may occur in preeclamptic women, more research is required.

Introduction: Gall bladder is very important part of hepatobiliary system and cholecystectomy is most common procedure performed in gall bladder lesion. This study was done with a purpose to determine the group of histopathological lesions found in electively operated cholecystectomy specimens. Females in their forties are more prone to develop cholecystitis along with cholelithiasis. The gall bladder pathology ranges from  chronic cholecystitis to highly lethal adenocarcinoma. Aims and Objective: This study was undertaken with a purpose to determine the frequency and classify different histopathological lesions encountered in cholecystectomy specimens in Dr. KNS Memorial Institute of Medical Sciences, Barabanki. Material and Methods: This is a prospective study conducted on 200 cholecystectomy specimens received in the Department of Pathology of Dr KNS Memorial Institute of Medical sciences Barabanki, over a period of 18 months from January 2023 to June 2024. Clinical details and histopathological data were retrieved from the hospital records. Results: There were 200 cases in total, consisting of 48 males and 152 females. Male: female ratio was 1:3.1. Age of the patients from 10 to 70 yrs with a mean age of 40 years. Maximum number of patients were in fourth decade of life (55%). Conclusion: The outcome of this study suggest that females were found to be more commonly affected in all pathologies of gallbladder. We found chronic cholecystitis with cholelithiasis to be the most common histopathological diagnosis followed by cholesterolosis.

Background: The supraclavicular brachial plexus block is a safe, effective, and cost-efficient method of anesthesia. To extend its effects into the postoperative period and provide analgesia, adjuvants such as clonidine, dexamethasone, and adrenaline are often added. This study was conducted to compare the efficacy and safety of clonidine combined with levobupivacaine for supraclavicular brachial plexus blockade. Methods: A randomized single-blind controlled trial was conducted with 40 patients of ASA Grade I or II undergoing upper limb surgery. Group A (n = 20) received 30 ml of 0.5% levobupivacaine and 1 ml of normal saline through the supraclavicular approach for the brachial plexus block, while Group B (n = 20) received 30 ml of 0.5% levobupivacaine with 0.3 ml clonidine (50 µg), diluted with normal saline to make up the solution to 1 ml. Vital parameters were recorded 10 minutes before block placement and every 3 minutes afterward until the end of the procedure. The onset and duration of both sensory and motor blocks, as well as sedation scores, were recorded. All patients were monitored in the post-anesthesia care unit and received a tramadol injection of 100 mg IV in 100 ml of saline as soon as they reported pain as a rescue analgesic. The duration of analgesia was measured from the time of block placement until the administration of the rescue analgesic. Results: In Group B, the onset of motor and sensory blockades was faster. No statistically significant difference was observed in heart rate, blood pressure, and oxygen saturation between the groups. Sedation scores were higher in Group B, and postoperative analgesia lasted for 946.17 ± 137.99 minutes compared to 655 ± 159.39 minutes in Group A, which was statistically very significant (p < 0.0001). Conclusion: Our study concluded that levobupivacaine is an effective drug for supraclavicular brachial plexus block, providing a long duration of pain relief with minimal disturbances in hemodynamic variables. Adding 50 µg of clonidine as an adjuvant to levobupivacaine prolongs the duration of sensory and motor blocks while reducing the latency period.

Background: The study of liver variations in cadavers is crucial for enhancing anatomical knowledge, as the liver exhibits significant variability in its lobes and blood supply. Understanding these variations is vital for surgical planning and diagnostic procedures. Cadaveric studies provide direct insights into anatomical differences, aiding clinicians in managing liver-related conditions and reducing intraoperative complications. Methods: This observational study was conducted on 50 formalin-fixed human livers that were removed from cadavers during routine dissection for medical undergraduates and were preserved in 10% formalin.  Livers with a normal configuration were included and damaged and deformed livers were excluded from the study.  The livers were examined on a flat, sterile surface under adequate lighting. Each lobe of the liver was observed in detail, focusing on the size, shape, and anatomical variations. The lobes were classified according to the Netter classification system. Results: Out of the total 50 livers studied in this study 29 (58%) specimens showed variations. Accessory fissures on the right lobe were found in 26.7% of the cases. Morphological variations based on Netter’s classification, found approximately 42% of the livers examined were classified as normal (Type I). Types II (very small left lobe, deep coastal impression) and VI- Very deep renal impression and corset constriction were found in 8%, and IV (transverse saddle liver, relatively large left lobe) in 12% were the most common variations after the normal type. No type III livers were found in this study. Conclusion: The current study highlights the frequent occurrence of morphological variations on the surface of the liver. These variations are important in the case of laparoscopic removal/thermal ablation of the liver mass; therefore, knowledge of these variations is important for surgeons and gastroenterologists in planning and performing surgical procedures for radiologists to prevent possible misdiagnosis and for anatomists to find new variants.

Background: Hyperlipidemia is commonly observed during the active phase of nephrotic syndrome and typically resolves after proteinuria subsides. However, hyperlipidemia may worsen renal damage. This study aims to identify lipid abnormalities and examine the relationship between blood lipid and serum albumin levels in individuals with nephrotic syndrome. Methods: This cross-sectional study involved 30 children with nephrotic syndrome who were admitted to pediatric wards for the first time and a control group of 10 children without liver or renal issues. The treatment Protocol followed was the International Study Group on Kidney Diseases in Children (ISKDC) guidelines. Prednisolone is administered at 60 mg/day in three divided doses for four weeks, followed by 40 mg/m² on alternate days for an additional four weeks. Results: A statistically significant direct relationship was found between total and LDL cholesterol (low-density lipoproteins) (p=0.001). There was a notable reduction in the mean values of pretreatment total cholesterol and LDL cholesterol after 4 weeks of steroid therapy in children with their first episode of nephrotic syndrome (p=0.001). At the end of 8 weeks of steroid treatment, a significant reduction in the mean levels of pretreatment total cholesterol and LDL cholesterol was observed in first-episode nephrotic syndrome (p=0.001). Additionally, there was a significant decrease in mean pretreatment triglycerides (p=0.016). Conclusion: The study also shows that after steroid therapy, blood cholesterol levels in first-episode nephrotic syndrome return to normal. However, in cases of recurrence, cholesterol levels remain elevated, possibly leading to the progression of renal failure. This underscores the need for appropriate treatment. Lipid-lowering medications have not been proven beneficial in children.

Background: The diagnosis of breast disease is largely based on triple assessment which includes clinical examination, radiology and tissue biopsy. The presence or absence of cancer in a suspicious clinically or mammographically detected abnormality can only be reliably diagnosed by tissue biopsy. This study evaluated the hormonal status and molecular classification of breast carcinoma cases, and its correlation with clinical parameters. Materials and Methods: This prospective study was carried out in the department of Pathology, which included all the modified radical mastectomy (MRM)/lumpectomy/biopsy (BCS) specimens which were received in Pathology department during study period, with clinico-radiological suspicion of breast cancer. All the Hematoxylin and Eosin (H&E) stained slides and block were retrieved from the records and reviewed to study the histological features. Histopathological categorization of breast carcinoma was done under CAP protocol. Size of tumour, histological type, and tumour grading under the Nottingham modification of the Bloom–Richardson system were recorded. Results: Majority of females were above 40 years of age, and 85.4% of them presented with advanced disease (Tumor size >2cm). Maximum cases 71.56% belonged to Nottinghams grade II and III. Association between large tumor size and poor prognosis was statistically significant. Her2 enriched and triple negative breast cancer were most common. TNBC category had higher percentage of grade II and grade III tumors (77.27%). Conclusion: A large proportion of population were TNBC in our study, with higher grade (Grade II+III). Proportion of patients aged below 50 years with poor survival was higher in TNBCs as compared to Non-TNBC breast cancers.

Background: The present Randomized Controlled Trial (RCT) was conducted in the Postgraduate Department of Anatomy, Government Medical College Srinagar after taking ethical clearance from Institutional Ethical Committee. Materials and Methods: Fourteen albino rats weighing on an average 150 grams were taken from the animal house of Govt. Medical College Srinagar for the present study. These animals were randomly divided into 6 groups with 7 rats in each group. All groups of rats were kept under uniform husbandry condition in iron cages separately in groups. The processes of administration of these ingredients were continued for 36 weeks. The animals were sacrificed in six sittings with duration of 6 weeks between each sitting at 6^th, 12^th, 18^th, 24^th, 30^th, & 36^th week. Results: Kashmiri Namkeen Tea extract mixed with sodium chloride, and sodium bicarbonate caused premalignant changes in esophageal mucosa in the form of inflammation, Keratinsation, mucosal erosions, mucosal bleeding. These histopathological changes started to appear at 6^th week and become more marked with further exposure in a duration dependent manner. Conclusion: Kashmiri Namkeen tea is carcinogenic; it produces premalignant changes in esophagus of Albino rats when exposure exceeds 6 weeks in a duration dependent manner.

Background: Pancreatic diseases and their complications are common in the Indian Subcontinent. The exact prevalence of the pancreatic ascites is not known. Estimated prevalence is 3.5% in patients with chronic pancreatitis and 6%–14% in patients with pseudocyst. Aim: To study the clinical profile of patients with pancreatic ascites and to identify the cause of patients with pancreatic ascites. Material and Methods: Prospective, descriptive study. Consecutive patients with pancreatic ascites admitted between January 2023 and January 2024 were enrolled. Data retrieved included demographic, clinical profile and etiology of pancreatic ascites. Results: Total number of study subjects was 26, majority were males (25/26), with mean age of 36.8 years. Most common symptom was abdominal pain and abdominal distension in 18 patients (69%). Majority of patients had chronic pancreatitis (88.7%). Alcohol is the most common etiology in 23 (88.7%) patients. Conclusion: The results of our study suggest that the majority of patients with pancreatic ascites were having chronic pancreatitis with pseudocyst and alcohol consumption as a leading cause.

Background: Globally, Inguinal hernia forms the major entity among all other hernias. Chronic groin pain can be a result of nerve entrapment while operating. Mesh repair leads to an inflammatory reaction over a period of time, though the exact cause of pain remains elusive. Aim of study: To compare the effectiveness of polyglactin vs prolene sutures in the reduction of postoperative pain in inguinal hernia surgeries. Methods: A one year hospital prospective study in Shri Jagannath Medical College & Hospital, Puri, Odisha. A total of 60 adult patients were divided into two groups of 30 each. Mesh fixation with polyglactin sutures was Group A (30) and prolene sutures was Group B (30) and their post-operative pain was assessed. Follow up was for 3 months. Collected data was analyzed using Chi square test and T test. Results: Our analysis showed that the incidence of postoperative groin pain in the polyglactin research group was significantly lower. From the start of the first follow up to the fourth, the mean pain score decreased on average more in Group A (0.770.63) than in group B (1.300.79) with a significant difference (p=0.0023). Conclusion: The post-operative chronic groin pain was significantly reduced in the study group in whom polyglactin sutures were placed instead of prolene sutures and hence routine usage of polyglactin sutures to fix a mesh is a safe and effective alternative to polypropylene sutures in Lichtenstein hernia repair.

Background: Brachial plexus block acts as sole anesthetic technique to provide painless upper limb surgery. Many approaches have been mentioned of which the classical supraclavicular approach is most common to brachial plexus for the whole upper limb surgeries because of compact arrangement of the nerve trunks. Dexamethasone is a potent synthetic member of the Glucocorticoid class of steroid drugs. When given by intrathecal or perineural injection steroids induce a degree of vasoconstriction thereby reducing the local anesthetic absorption thus prolonging their effect. Material and Methods: This prospective, randomized controlled, clinical study was conducted with 60 patients posted for elective upper limb surgeries having expected duration of surgery of 150 mins. Patients were randomly divided into two groups of 30 patients. Group S received Inj. 0.5% bupivacaine 23 ml plus 0.9% normal saline 2 ml making a total volume of 25 ml. Group D received 0.5% bupivacaine 23 ml plus dexamethasone 2 ml (8 mg) making a total volume of 25 ml. the patients were observed vigilantly for any procedure related complications and for the toxicity of the drugs injected. Result: The addition of dexamethasone to local anesthetics (Bupivacaine) in US-guided supraclavicular approach of brachial plexus block prolongs the duration of sensory, motor and time for requirement of 1st rescue analgesic. Conclusion: the addition of dexamethasone to local anesthetics (Bupivacaine) in US-guided supraclavicular approach of brachial plexus block over plain Bupivacaine hastens the time of onset of sensory and motor blockade, hastens the time to achieve peak of sensory and motor blockade, prolongs the duration of sensory and motor blockade, delays the need of rescue analgesia and provides stable hemodynamic without any unwanted side effects in perioperative period.

Irrational prescriptions can lead to unnecessary drug interactions, emergence or reinforcement of drug resistance, adverse drug reactions, increase in the cost and duration of treatment. Irrational use of medications is a major health concern increasing the morbidity and mortality of the patients, particularly in the developing countries. According to World Health Organisation (WHO), more than half of all medications globally are inappropriately prescribed, dispensed or sold. The current investigation was a single-centric, hospital-based, cross-sectional, observational study that aimed at investigating the quality and improving the rationality of prescriptions through prescription auditing using WHO core prescribing indicators and NHM (National Health Mission) prescription audit guidelines. A total of 530 prescriptions were evaluated in the study. The average number of medications prescribed per patient was 4.7. Only 4.2% medications were prescribed by generic names. All the prescriptions had the OPD registration number, date of consultation, age and gender of the patient, and contained medications as per the essential medicine list and available in the hospital dispensary.

Background: Both Ropivacaine and Bupivacaine are relatively new long acting amide local anesthetics. Both are pure s-enantiomers of the parent drug racemic Bupivacaine. Little is known as the efficacy of epidural action of Bupivacaine with Fentanyl when compared with Ropivacaine. Method: Out of 90 patients, 45 received 10 mg hyperbaric Bupivacaine with 20 micrograms of Fentanyl, and 45 (group RF) received 15 mg hyperbaric Ropivacaine with 20 micrograms of Fentanyl. We compared the AP-GAR scores for hemodynamic parameters, sensory, and motor blockage in both groups. Results: Demographic profile, i.e., weight, height, BMI The duration of surgery was the same in both groups (p > 0.001 was insignificant), and motor and sensory blockades were highly significant (p<0.001). VAS scores at 4 hours, 6 hours, and 8 hours had a significant p value (p<0.001). Agar score at 1 minute was also highly significant (p<0.005). Conclusion: In the present study, it was proved that hyperbaric Ropivacaine with Fentanyl is a better alterna-tive to hyperbaric Bupivacaine with Fentanyl in LSCS patients of c-section.

Background: Mass in right Iliac fossa is multi pathological entity. Sometimes mass can be treated with con-servative treatment; on the other hand surgical emergency of right line fossa is, if not operated on at proper time it becomes life-threatening. Method: 60 (sixty) adult patients having mass in the right iliat fossa were studied; physical, clinical, patholog-ical, and radiological techniques were used for proper diagnosis. Appendectomy, right hemicolectomy, limited resection, incision, and drainage, and some are treated conservatively. Results: 35 (58.3%) had appendicular mass, 10 (16.6%) had appendicular abscess, 4 (6.6%) had Ileo-ceacal tu-berculosis, 4 (6.6%) had Ca of ceacum, 3 (5%) had Ca of ascending colon, 1 (1.6%) had psoas abscess, 1 (1.6%) had non-Hodgkin’s lymphoma. 2 (3.3%) had Intussusceptions, 60 (100%) pain, 33 (55%) had fever, 31 (51.6%) had vomiting, and 6 (10%) had weight loss. 4 (6.6%) had mass, 7 (11.6%) had bowel disturbance, and 4 (6.6%) had Ba Enema. 5 (8.3%) had CT scans, and 2 (3.3%) had CT scans performed. Patients with appen-dicular mass initially treated with conservative treatment. If not responded surgical corrections are done. Conclusion: The present study will be helpful to surgeons to differentiate various pathologies and treat effi-ciently to prevent morbidity and mortality.

Purpose: Aim of this study is to estimate the incidence of retinopathy of prematurity (ROP) in infants born with respiratory distress and to assess the respiratory variables leading to it at a tertiary care center. Methodology: Infants born with respiratory distress during the time period of August 2021 to August 2023 were selected for this retrospective study. A total of 550 high risk infants were studied and inference formulated based on evaluation of pulmonary variables such as – respiratory distress, oxygen dependency, mechanical ventilation, apnea, asphyxia, etc. Data was collected and analyzed. Results: Out of 550 infants screened, 12 developed retinopathy of prematurity. Pulmonary distress was found to be the predominant risk factor. We found association of respiratory distress in 50% infants who received oxygen supplementation. Other associated risk factors we found were apnea in 6.25%, mechanical ventilation in 6.25% and asphyxia in 3.12% infants. Conclusion: We conclude that respiratory distress is the most important risk factor for causing retinopathy of prematurity and all low birth weight infants need to be screened for ROP to prevent childhood blindness.

Background & Methods: The aim of the study was to evaluate the Synergy of Bronchoscopy and HRCT in Predicting Disease Activity in sputum negative Pulmonary Tuberculosis. HRCT scans were assessed for the presence of centri-lobular nodules, tree in bud pattern, larger nodules, masses, lobular consolidations, cavities, bronchoceles, ground glass opacities and mediastinal lymph node enlargement. Results: The most frequently observed CT findings (in order of decreasing frequency) were consolidation, mediastinal lymphadenopathy, tree-in-bud appearance, and nodules. Tree-in-bud nappearance was the only significant finding associated with active PTB status (P < 0.001, OR = 5.10 [2.37–10.99, 95% CI]). Of the 21 PTB-confirmed patients, 16 (71.6%) patients were rapidly diagnosed in less than 1 week by bronchial washing AFB smear, CBNAAT and/or biopsy, and 5 patients were confirmed several weeks later by bronchial washing or sputum culture results. The sensitivity of FOB in the rapid diagnosis of active PTB was 75.9% (95% CI, 69.0–78.6%). Conclusion: HRCT alone was limited for the diagnosis of active PTB, but the combination of FOB and HRCT may improve the sensitivity of FOB in the rapid diagnosis of sputum smear-negative PTB. Based on our results, we suggest that physicians actively consider performing FOB and HRCT in sputum smear-negative patients suspected of TB.

Introduction: Breast cancer, now the most prevalent cancer among women globally, surpasses lung cancer in incidence and mortality, particularly impacting low-income regions due to diagnostic delays and treatment access. Its burden extends beyond physical health, affecting survivors’ quality of life and professional engagement. Innovations in surgical and reconstructive techniques, such as less invasive surgeries and advanced oncoplastic procedures, aim to improve aesthetic and functional outcomes, enhancing psychological well-being. This study investigates the preferred methods for immediate breast reconstruction post-mastectomy, considering individual needs and feasibility. Method: This cross-sectional study, conducted over a year from November 2022 to October 2023 at the Department of General Surgery, Rohilkhand Medical College and Hospital, Bareilly, focuses on immediate breast reconstruction for patients with operable breast tumors. It excludes individuals with recurrent, bilateral, or metastatic breast cancer, or those with locally advanced disease. The study includes 45 patients, using a calculated sample size formula to ensure statistical reliability. Data collection involves a detailed clinical history and examination, with initial diagnostics including mammography or ultrasound based on age, and biopsy to confirm diagnosis. Pre-operative tests such as hemoglobin, complete blood count, liver function tests, and imaging like chest X-rays prepare patients for surgery, choosing between TRAM and LD flaps based on breast size and defect. Statistical analyses are conducted using SPSS version 25.0, focusing on means, standard deviations, and categorical data frequencies to assess the efficacy of surgical outcomes Result: The study highlighted that breast reconstruction patients predominantly fell within the 31-40 age range, making up 42.2% of the sample. Diabetes (35.6%) and hypertension (28.9%) were the most frequent pre-existing conditions. Every participant presented with a breast lump, with 57.7% experiencing pain and 42.2% having nipple discharge. Clinical findings included nipple retraction and ulceration in lesser percentages. Breast cancer was diagnosed in 73.3% of cases, predominantly at advanced stages (T3N1M0 and T4bN1M0), via FNAC/TRUCUT biopsy. The Latissimus Dorsi (LD) flap was the most common surgical technique used (62.2%), while the Transverse Rectus Abdominis Myocutaneous (TRAM) flap was less frequent (26.7%). Post-surgery, wound infection was the most common complication, noted in 6.7% of cases, with lesser occurrences of flap necrosis and partial loss. Hospital stays and surgery duration were longer for TRAM flap procedures, which also presented higher rates of donor site infection and deformity compared to LD flap procedures. Additionally, seroma formation varied between procedures, with the LD flap showing a lower incidence of significant seroma compared to the TRAM flap, indicating potential benefits in post-operative recovery and complication management with the LD technique. Conclusion: This study emphasizes the importance of early detection and personalized treatment strategies in managing breast reconstruction, especially for women aged 31-40 who are commonly affected by diabetes and hypertension. The prevalence of advanced breast cancer at diagnosis underlines the urgent need for enhanced public health measures focusing on symptom awareness and improved screening techniques. The comparative effectiveness and complications associated with Latissimus Dorsi and TRAM flap procedures highlight the necessity for meticulous surgical planning and post-operative care to optimize patient outcomes and minimize complications.

Background: The advantages of using regional anaesthetic methods are widely known. These advantages can be extended by using additives with local anaesthetics. This investigation sought to determine the impact of mixing dexmedetomidine with bupivacaine for supraclavicular block. Methods: Supraclavicular block was given using ultrasound guidance to 60 patients of ASA I & ASA II of either sex undergoing elective upper limb surgeries in this randomized, double-blind study. Group C (n = 30) received 29 mL 0.25% bupivacaine + 1 mL normal saline while Group D (n = 30) received 29 mL 0.25% bupivacaine +1 µg/kg dexmedetomidine (1 mL). Patients were watched for any adverse effects, hemodynamic changes, the onset, duration of sensory and motor block, and total analgesic duration. Results: Compared to group C, group D experienced a faster onset (P<0.001), longer sensory and motor block durations, and longer analgesia (P < 0.0001). In group D, there was a substantial decrease in heart rate (HR) at 30, 60, 90, and 120 minutes compared to the baseline (P < 0.05). Still, not a single patient’s heart rate dropped below 50 beats per minute. The Mean Arterial Pressure (MAP) did not change. Group D patients experienced more effective sedation than group C patients (P < 0.05). In both groups, there were no recorded adverse events. Conclusion: Faster onset, prolonged duration of sensory & motor block, prolonged analgesia with hemodynamic stability, and sufficient sedation were the outcomes of using dexmedetomidine as an adjuvant to bupivacaine in supraclavicular block.

Aim of The Study: This study is aimed to assess the advantages of addition of Dexmedetomidine, an alpha-2 agonist to Ropivacaine 0.75%, by observing the block characteristics of ultrasound-guided axillary brachial plexus blocks. Methods: For this study a total of sixty patients belonging to Anaesthesiologists physical status I and II, posted for forearm and hand surgeries were selected and randomly allocated into two study groups, with 30 individuals allotted to each group. Patients in Group A were administered ultrasound guided axillary brachial plexus block with 20 ml of Ropivacaine 0.75% along with 1 ml of normal saline and those in Group B: received ultrasound guided axillary brachial plexus block with 20 ml of Ropivacaine 0.75% combined with 1 mL of Dexmedetomidine (50 µg). The onset and duration of motor and sensory block, total duration of analgesia, hemodynamic parameters and any side effects were all monitored in the patients. Results: There was no statistically significant difference in demographic data, intraoperative hemodynamics and surgical characteristics of patients in both groups. Onset of sensory and motor block was faster in group B (P <0.05). Sensory block’s duration and time to first analgesic use was significantly prolonged in group B (P < 0.05). Adverse effects related to regional anaesthesia procedure or drugs were not observed in patients of either group. Conclusion: In this study, adding dexmedetomidine to ropivacaine for axillary brachial plexus block shortens sensory block onset time. It also prolongs sensory block duration and time to first analgesic use, and with less total analgesic use with no side effects.

Introduction: The treatment of proximal humerus fractures has been the subject of much controversy and confusion. Because of the complexity of these injuries, fracture displacements are difficult to see without special radiograph views and associated soft tissue injuries. Our prospective study evaluated the functional results of the method of surgical management of displaced fractures of the proximal end of the humerus.  Methods: 38 patients with displaced fractures of the proximal humerus in adults underwent surgical management. Patients were followed from 6 weeks -15 months on OPD basis with radiological, clinical and functional evaluation. Results: The most common type observed in our series was a three-part fracture for 28 of 30 patients (73%). Neer’s score evaluated the results at the end of clinical and radiological union and full functional recovery. Of the 38 patients 12(31%) had excellent results, 18(47%) had satisfactory results, 5(13%) had unsatisfactory results and 3(7%) was a failure. Conclusions: Clinical evaluation, obtaining proper radiological views, the age of the patient, and activity levels are keys to a realistic approach in the management of fractures of the proximal humerus. Anatomical reduction is an essential feature in these fractures. Open reduction and internal fixation with a PHILOS plate, as well as pinning; have given good results with good post-operative rehabilitation.

Introduction: Adverse events following immunization (AEFI) are a critical concern in public health, impacting vaccine safety and acceptance. The Universal Immunization Program (UIP) of India aims to provide equitable access to essential vaccines, yet monitoring and managing AEFI remains a challenge. This study investigates the incidence, types, and management of AEFI in an Immunoprophylaxis Clinic of a tertiary care hospital in Maharashtra, India. Methodology: This cross-sectional study was conducted over six months, enrolling 204 children who received vaccinations under the UIP at a tertiary care hospital. AEFI data were collected using standardized reporting forms, documenting the type of vaccine administered, the occurrence of AEFI, and the management provided. The sample size was calculated to ensure a 95% confidence level with a 3% margin of error, resulting in a required sample size of 204. Descriptive statistics were used to summarize the data, and chi-square tests were applied to analyze the association between demographic factors and AEFI incidence. Results: The overall incidence rate of AEFI was 6.10%, with 25 cases recorded out of 410 doses administered. The highest incidence rate was observed with the BCG vaccine (10.20%), followed by the PCV vaccine (5.90%) and the MR vaccine (5.20%). The 0-1 year age group experienced the most AEFI cases (10), indicating higher susceptibility in infants. Fever (36.00%) and local reactions (28.00%) were the most common types of AEFI, primarily managed with home care, while moderate reactions such as rash (16.00%), vomiting (12.00%), and abscess (8.00%) required medical intervention. All patients recovered successfully. Conclusion: The study highlights a relatively low but significant incidence of AEFI, with variations among different vaccines and age groups. The effective management of AEFI, with all patients recovering, underscores the robustness of current protocols. Continuous AEFI surveillance, targeted education for healthcare providers, and policy improvements are essential to further enhance vaccine safety and public confidence in immunization programs.

Introduction: Peritonitis secondary to hollow viscous perforation is a potentially life-threatening condition. Hollow viscus perforation is a common abdominal emergency faced by the general surgeons worldwide. The prognosis is still poor for patients with peritonitis caused by hollow viscus perforation, despite improvements in diagnosis, treatment, and critical care. Early grading of the severity of peritonitis may improve the management of severely ill patients, which can be done by means of scoring systems. Aim: To evaluate Mannheim peritonitis index in predicting the prognosis of hollow viscus perforation. Materials and Methods: This Prospective observational Study included 62 patients with hollow viscus perforations who met the inclusion criteria and were admitted to the surgical department of Rohilkhand Medical College and Hospital between 1 November 2022 and 31 October 2023. Observation of these individuals and gathering data on the number of deaths and illnesses throughout this period was thought to be the study’s ultimate goal. Risk variables discovered in the MPI were categorized based on the values shown using the history, clinical examination, and lab results. Individual variable scores were then summed to determine the MPI score. Every characteristic in the scoring system was analysed both as a system-wide predictor of morbidity or mortality using statistical package for social sciences (SPSS) software version 16. Results: In the present study, the mortality rate for patients with an MPI score of > 29 was 62.5% (5 deaths), 20% (3 deaths) for patients with an MPI score of 21–29, and 0% for patients with an MPI score of < 21, all of which are statistically significant (p =0.011). Conclusion: The MPI scoring system for estimating morbidity and death in patients with hollow viscous perforation is being validated in this study. The study’s findings show that the MPI scoring system is an easy-to-use and reliable instrument for evaluating this patient population. It can also be a useful tool for making decisions about a patient’s care at every stage of the healthcare system.

Background: Vitamin D is essential for humans for calcium homeostasis and bone health. Vitamin D deficiency causes osteoporosis and other musculoskeletal disorders. This study is aimed to evaluate the levels of vitamin D among the elderly males and post-menopausal females, and prevalence of vitamin D deficiency in Konaseema region. Materials and Methods: This correlational study was conducted on men and women above 50 years attending the hospital OPD in Konaseema Institute of Medical Sciences Hospital for a period of 2 years. Blood samples for serum 25-(OH) vitamin D, calcium and phosphorus were collected from the patients by venipuncture observing all safety and aseptic precautions. Data collected was analyzed for any correlation in the values between the biochemical parameters and vitamin D and calcium supplementation. Result: Our study found that Vitamin D levels and bone mass density are inversely related to age which is more evident in post-menopausal women due to steep fall in estrogen levels after menopause. In this study, the individuals are supplemented with calcium (calcium carbonate) 1000mg per day and 800 IU of vitamin D (daily dose), and they were followed up at 3^rd, 6^th, and 12^th month. In the present study, following vitamin D supplementation in osteoporotic elderly people, there was a significant increase in the bone mineral density, analyzed by T scores. Our study mainly relied upon serum calcium, serum vitamin D levels and T scores, whose improved values were significant (p < 0.001). Our study follow up was done for 1 year in 3 phases (3^rd, 6^th, 12^th months). Conclusion: The vitamin D deficiency is common in poor and lower middle class likely due to under nutrition. This study points out higher prevalence of Vitamin D inadequacy and low BMD in post-menopausal women and elderly persons in Konaseema region. It can be concluded with the recommendation that post-menopausal women and elderly males, especially from lower socioeconomic group in Konaseema region, should be administered vitamin D and calcium regularly.

Objective: The aim of this study was to study the impact of COVID-19 related lockdown and practice of social distancing on post-operative rehabilitation in patients after ACL reconstruction taking into account the impact on postoperative recovery, kind of rehabilitation being performed, equipments and facilities which were available for rehabilitation. Methods: In this questionnaire based study, every patient who had undergone ACL reconstruction from May 2019 to October 2019 was categorized in control group (pre- COVID group) and patient who had undergone ACL reconstruction from March 2020 to August 2020 was considered in COVID-group. Questions regarding the utilization of health care professionals for rehabilitation management and the mode of service delivery (face-to-face or tele-health), regarding the type and frequency of rehabilitation exercises being performed as well as the facilities and equipment available for rehabilitation, and regarding the effect of COVID-19 on their recovery. Results: Most patients in control group (86%) maintained face-to-face rehabilitation whereas this figure significantly dropped in patients studied in 2020. Near about one- third of the surveyed patients during COVID-19 period thought that it would delay their return to sporting activities Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Conclusion: Patients who had ACL reconstruction before COVID-19 pandemic were able to maintain face-face contact with their health professional for physiotherapy. Patients operated during COVID-19 pandemic felt that the social distancing and restrictions ultimately led to delayed return to sporting activities.

Background: Pain associated with the surgical procedure is the major dreadful aspect for the patients. Postoperative pain and side effects impart significant strain on the recovery of the patients and tends to increase the hospital stay. Evaluation of analgesics is essential to identify the efficient analgesic that can provide effective pain management with minimum side effects. Objective: The present study was aim to analyze and compared the pain and side effects associated with the buprenorphine and midazolam drugs among the patients undergoing the abdominal surgeries. Methodology: Total 56 patients undergoing the abdominal surgeries (ASA grade I & II) were enrolled in the study. Total patients were randomly divided into the two groups of 28 patients each using the block randomization. In first group, patients received the buprenorphine drug and in second group patients received the midazolam drug. duration of analgesia, pain and side effects of drugs were compared between the two groups. Results: The mean duration of analgesia was 19.29 ± 2.94 hours in midazolam group which is significantly higher than the buprenorphine group in which mean duration was 14.50 ± 5.49 hours. VAS score was found to be decrease significantly over the duration of 24 hours in midazolam group as compared to the buprenorphine group. The midazolam group observed to have fewer side effects as compared to the buprenorphine group but the difference was not statistically significant. Conclusion: Midazolam was found to be more effective analgesic as compared to the buprenorphine for abdominal surgeries as it provides prolonged duration of anesthesia with lower pain and side effects. Further studies are needed to be conducted to validate the findings of this study.

Background: Thyroid hormones have a very significant role in the metabolic processes that occur in the human body. Hypothyroidism is the commonest form of thyroid dysfunction. Mineral metabolism is frequently disturbed in thyroid dysfunction. Aim: To evaluate the Serum calcium, magnesium in the newly diagnosed cases of hypothyroidism as compared to the euthyroid subjects. Methods: The present study was conducted 60 cases and 60 healthy subjects who attended the OPD of Rohilkhand Medical college and Hospital, Bareilly. The serum calcium levels were done by Ortho-cresolphthalein complexone method and serum Magnesium was assessed by calmagite method. Data was analyzed statistically using SPSS software. Result: We found decreased levels of serum calcium and increased levels of serum magnesium in hypothyroidism patients as compared to the euthyroid subjects. Our study shows statistically insignificant positive correlation of serum magnesium with TSH and there is no correlation between serum TSH and serum magnesium was observed in hypothyroid cases as compared to the controls. Conclusion: Our study found that serum Calcium levels are lower and serum Magnesium are higher in hypothyroid cases when compared to healthy subjects. A strong negative correlation between serum TSH levels and serum calcium was observed among hypothyroid individuals.

Background: Refractive errors are the most common cause of visual disorders. Amongst them, myopia is the most common disorder. In myopia as the axial length increases, the refractive power of the eye changes, causing images of distant objects to appear blurred. Understanding this relationship is crucial for diagnosing and managing myopia, especially in children and adolescents, where the progression of axial length can be rapid. Interventions, such as orthokeratology and pharmaceutical treatments, aim to slow the progression of myopia by targeting axial elongation. The current study aimed to study the correlation between axial length, age, sex, and complications associated with the degree of myopia. Methods: Anterior segments of 110 eyes of patients were examined using a slit lamp biomicroscope. Visual acuity, cycloplegic refraction, retinoscopy, and fundoscopy were performed on all the selected patients after obtaining informed consent. The axial lengths that were obtained using A-scan were correlated with the degree of myopia. They were further sub-classified based on age, sex, familial factors, and complications. Results: The results of myopia and axial length revealed a higher prevalence of myopia in females (65.57%) compared to males (34.43%). The majority of cases (50.82%) exhibited mild to moderate myopia (O to -3D), with a positive correlation between myopia degree and axial length. Common ocular complications included myopic crescent (32.73%), tessellated fundus (35.45%), and vitreous changes (16.36%). While less frequent, conditions like retinal detachment (2.73%), posterior staphyloma (1.82%), macular scar (2.73%), and central serous chorioretinopathy (1.82%) were also observed, emphasizing the importance of regular eye examinations for myopic individuals. Conclusions: Within the limitations of the current we found that most cases of myopia were observed in females. A strong positive correlation exists between axial length and degree of myopia. Longer axial lengths were associated with a higher degree of myopia, and shorter axial lengths were associated with a lower degree.

Background: Thoracic epidural anaesthesia is commonly used for providing adequate perioperative analgesia in patients undergoing abdominal surgeries. Adding adjuvants to local anaesthetics can enhance analgesic efficacy and prolong the duration of sensory and motor blocks. This study compares the effectiveness and safety of Dexmedetomidine and Fentanyl as adjuvants to Ropivacaine in thoracic epidural anaesthesia in abdominal surgeries. Aim and Objectives: To compare the onset and duration of sensory and motor blocks, analgesic efficacy, hemodynamic stability, and incidence of complications between Dexmedetomidine and Fentanyl as adjuvants to Ropivacaine in patients undergoing elective abdominal surgeries. Materials and Methods: This study employed a unique prospective, randomized, double-blinded, controlled trial design to compare the effectiveness and safety of Dexmedetomidine and Fentanyl as adjuvants to Ropivacaine in thoracic epidural anaesthesia. The trial was conducted with 80 ASA grade I-II patients aged 25-60 years scheduled for elective abdominal surgeries. Patients were randomly assigned to two groups: Group A received 20 ml of 0.75% Ropivacaine with Dexmedetomidine 1 µg/kg, and Group B received 20 ml of 0.75% Ropivacaine with Fentanyl 1 µg/kg. The onset and duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and postoperative complications were assessed and compared between the groups. Results: Patients in Group A (Ropivacaine with Dexmedetomidine) had a significantly faster onset of sensory block (p = 0.0001) and longer duration of sensory (p = 0.0001) and motor blocks (p = 0.0001) compared to Group B (Ropivacaine with Fentanyl). The total duration of analgesia was also significantly longer in Group A (p = 0.0001). Hemodynamic parameters were well-maintained in both groups, though Group B exhibited slightly better hemodynamic stability. Postoperative complications were minimal and comparable between groups, with pruritus occurring only in Group B. Conclusion: Dexmedetomidine, as an adjuvant to Ropivacaine in thoracic epidural anaesthesia, provides faster onset and longer duration of sensory and motor blocks, as well as superior analgesic efficacy compared to fentanyl. Despite slightly better hemodynamic stability in the Fentanyl group, dexmedetomidine proves to be a more effective adjuvant for enhancing the quality of anaesthesia in elective abdominal surgeries.

Background: Cesarean section has been postulated to have a theoretical advantage over vaginal delivery in premature infants. This benefit may be the result of the avoidance of prolonged labour, allowing a less traumatic birth, but preterm cesarean section can be technically difficult and may require performing a classical Cesarean section with adverse risks like scar dehiscence and increased bleeding and adhesions in future pregnancy. Objectives: To estimate the maternal and fetal outcomes of preterm cesarean sections. To determine the indications of preterm cesarean sections. Methods: This was an observational study conducted among 410 study subjects who were admitted to the department of Obstetrics and Gynecology during the study period of 12 months (January 2022 – December 2022) and underwent preterm cesarean section (gestational age <37 weeks). Data regarding the mothers and newborns were collected from patient case sheets, labour room registers, NICU registers. Results: A total of 410 mothers and 453 newborns were recruited in our study. Most common indication for preterm cesarean section was found to be previous cesarean section (in labour or PPROM) followed by fetal distress. Most common maternal and fetal outcomes were intraoperative hemorrhage and respiratory distress respectively. Conclusion: Preterm cesarean sections definitely increase the maternal morbities. But as per our study it is very difficult to interpret whether the fetal complications are due to prematurity perse or conditions like comorbidities/complications leading to the preterm cesarean sections.

Introduction: Aplastic anaemia initially delineated by Paul Ehrlich in 1885, is a grievous bone marrow failure syndrome characterized by significant mortality if left untreated. Patients predominantly present with pancytopenia, evidenced by a marked decrease in hemoglobin levels (<12 g/dL), white blood cell counts (<4×10^9/L), and platelet counts (<100×10^9/L). The incidence of this disorder is substantially higher in Asian populations compared to Western counterparts. Etiologies encompass direct marrow insults, inherited constitutional syndromes, and immune-mediated mechanisms. Materials and Methods: This cross-sectional study spanned four months within the Department of Pathology at SCB Medical College and Hospital, Cuttack. Diagnostic criteria included comprehensive clinical histories, physical examinations, complete blood counts (CBC), reticulocyte counts, peripheral blood smears, and bone marrow biopsy findings. Participants ranged from 12 to 65 years old, all presenting with pancytopenia. Exclusion criteria encompassed non-consenting individuals and those with cellular bone marrow or neoplastic infiltration. Results: The cohort comprised 10 patients, with a male predominance (6 males, 60%; 4 females, 40%), yielding a male-to-female ratio of 1.5:1. The 16-30 years age group exhibited the highest incidence (40%). Clinical manifestations included breathlessness(40%), generalized weakness (30%), fever (20%), and bleeding tendencies (10%).All cases have been further sub-divided into very severe(50%),severe(40%) & non-severe cases(10%). Discussion: The study corroborates a male predominance and heightened prevalence among younger adults. The male-to-female ratio was 1.5:1, with the peak incidence in the 16-30 years age bracket. Clinical symptoms primarily included breathlessness, generalized weakness, fever, and bleeding. The classification of aplastic anemia severity was based on complete blood counts and bone marrow study. It is categorized into non-severe, severe, and very severe types. These observations are consistent with extant literature, reinforcing the pivotal role of pancytopenia in the clinical presentation of aplastic anemia. Comparative analyses reveal congruent gender ratios and age distribution trends. Conclusion: The clinico-hematological profile of aplastic anemia elucidates profound hematological anomalies necessitating prompt, tailored therapeutic interventions. Bone marrow examination remains indispensable for accurate diagnosis. Continuous research is imperative for the advancement of targeted therapies, enhancing patient outcomes and survival rates. The integration of innovative diagnostic methodologies and therapeutic protocols holds promise for significantly improving the quality of life for individuals afflicted with aplastic anemia.

This retrospective observational study conducted at a tertiary care center in Odisha, India, assessed the incidence and spectrum of adverse events induced by L-asparaginase in 109 young patients treated for acute lymphoblastic leukemia (ALL) over six months. The study found that 34% of patients experienced adverse effects, with hyperglycemia (35%) and hypersensitivity (30%) being the most common, followed by pancreatitis, hypoglycemia, thrombosis, and other effects. Age-specific analysis revealed a higher incidence of hyperglycemia in patients older than 14, underscoring the need for age-tailored monitoring and management strategies. The findings emphasize the importance of vigilant surveillance and proactive management of adverse events to optimize treatment outcomes for ALL patients.

Idiopathic intracranial hypertension (IIH), formerly known as benign intracranial hypertension and pseudotumor cerebri, is a neurological condition with an unidentified cause. Many patients are adult females who present with a variety of clinical signs and symptoms, such as headache, nausea, and vomiting as well as papilledema and sixth nerve palsy. The majority of the time, a neurological examination reveals no abnormalities; nevertheless, a CSF analysis reveals increased CSF opening pressure upon lumbar puncture. Imaging plays a critical role in these situations, assisting physicians with diagnosis, excluding complications, and patient follow-up. Here, we discuss the case of a 34-year-old female patient who had symptoms and signs of IIH, and whose magnetic resonance imaging (MRI) not only helped to diagnose IIH but also revealed the involvement of optic nerve and venous sinuses.

Objective: Balance is essential for daily activities, especially in the elderly, as it significantly impacts their risk of falls and quality of life. Age-related declines in muscle flexibility, sensory information processing, and neurological function contribute to balance deficits, increasing the incidence of falls. This study aims to evaluate the effectiveness of backward walking training in improving balance among the elderly compared to Pilates mat exercises. Methods: Sixty participants aged 60-70 years, experiencing balance issues, were randomly assigned to two groups: Group A (backward walking training) and Group B (Pilates mat exercises). Each group underwent a 12-week supervised exercise program with bi-weekly sessions. Balance was assessed using the Berg Balance Scale and the Timed Up and Go Test at baseline and subsequently every 15 days until the end of the study. Results: At baseline, there was no significant difference between the groups. By Day 30, Group A showed a mean score improvement to 40.5, significantly higher than Group B’s 38.8 (p < 0.0001). By Day 90, Group A achieved a mean score of 52.6 compared to Group B’s 53.5 (p = 0.0053), indicating sustained and slightly superior improvement in balance in Group A. Conclusion: Backward walking training significantly enhances balance in the elderly, offering greater improvements in muscle strength and functional mobility compared to Pilates mat exercises. Integrating backward walking into rehabilitation protocols can optimize patient recovery and reduce fall risk.

Stroke is one of the most commonly occurring disease which leads to hemiparesis along with other symptoms like spasticity, sensory disturbances etc. considered to be a part of positive signs of upper motor neuron (UMN) syndrome. The aim of the present study was to co- relate the MTS and Hmax/Mmax ratio in the assessment of wrist flexors spasticity in the patients with chronic stroke. It was an observational study which consisted of 32 chronic stroke patients. Both male and female with age group 35-70 years and stroke duration more than 3 months were included in the study. After the approval for the study from the ethical committee, 32 stroke subjects who were diagnosed as having spasticity of wrist flexors of upper limb were selected for the study who fulfilled the inclusion and exclusion criteria and written consent was taken who were willing to participate in the study. All the measurements have been taken in morning hours between 9:00 to 12:00am. To see the effect of spasticity on Hmax/Mmax ratio, Hmax/Mmax ratio was taken in 33 normal individuals also in same age group under similar testing conditions. Statistical analysis was done using SPSS 14for windows. The correlation between Hmax/Mmax ratio and dynamic angle component of Modified Tardieu Scale (MTS) were evaluated using Pearson’s correlation coefficient test. Similarly, correlation between Hmax/Mmax ratio and quality of muscle reaction component of Modified Tardieu Scale (MTS) was evaluated using Spearman’s correlation coefficient test. It was suggestive of moderately negative correlation(r=-0.308) between Dynamic angle component of Modified Tardieu Scale and Hmax/Mmax ratio. And moderately positive correlation(r=0.338) between Quality of muscle reaction component of Modified Tardieu Scale and Hmax/Mmax ratio. And comparison between Hmax/Mmax ratio of stroke patients and normal individuals was done using unpaired-t test, which suggested that there was statistically significant increase in Hmax/Mmax ratio in stroke patients (t=3.517, p=0.001) so, the result of the present study rejects the null hypothesis. So, it can be concluded that MTS and Hmax/Mmax ratio can reliably use in the assessment of wrist flexors spasticity in the patients with chronic stroke. And it is also providing good electrophysiological evidence to assess wrist flexors spasticity in chronic stroke patients.

Neurodynamic techniques play a significant role in the restoration of neural tissue’s ability to stretch and tension, as well as in the stimulation of the reconstruction of normal physiological function of nerve cells. A study is carried out to find the effectiveness of the individual and combination of Nerve Flossing Technique (NFT) and Trans Cutaneous Electrical Nerve Stimulation (TENS) on pain and disability in cervical radiculopathy patients. This study was experimental study, where 60 subjects with chronic cervical radiculopathy with age group 30-55 years were selected by inclusion and exclusion criteria. Subjects who were willing to participate in the study were requested to fill the consent form. Group-A which received TENS and isometric neck exercise, Group-B, received nerve flossing technique and isometric neck exercise and Group C received TENS, NFT and isometric neck exercise. Neck disability index and VAS were taken before the intervention and after the intervention. Data were analysed by SPSS 21.0 software applying, paired t test for within group comparison of NDI and Wilcoxon signed-rank test was used for the VAS & ANOVA and POST HOC test was used for the between group analysis of neck disability index and VAS. The result showed that NFT, TENS & conventional exercise protocol is effective in reduction of score of NDI & VAS after the intervention. This study concluded that Nerve flossing technique Along with TENS and conventional exercise protocol showed more beneficial effect on pain and radiating symptoms in the patients with Cervical radiculopathy with comparison to conventional and only Nerve flossing technique group. Hence NFT can be incorporated in home program with conventional physiotherapy for betterment of patient.

Background and Aim: Caudal epidural analgesia is a common regional anesthesia technique for lumbosacral region surgeries. This study aimed to compare the efficacy of ropivacaine 0.2% with clonidine versus ropivacaine 0.2% in caudal epidural analgesia in lumbosacral spine surgeries under general anesthesia. Materials and Methods: This prospective, randomized, double-blinded study was conducted, on 72 patients who underwent lumbosacral spine surgery. The patients were aged 18–65 years, of either gender, American Society of Anesthesiologists (ASA) grade I and II, and randomly allocated into two groups (36 in each group). Group A received ropivacaine (0.2%) 18 ml + normal saline 2 ml, whereas Group B received ropivacaine (0.2%) 18 ml + clonidine 1μg/kg in normal saline 2 ml (total volume 20 ml) administered in caudal epidural block in prone position after the administration of general anesthesia. Hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), visual analog score (VAS), duration of analgesia, sedation score, and side effects were recorded at regular intervals postoperatively for 24 hours. Student’s t-test and Chi-square tests were used for statistical analysis. Results: Mean VAS was significantly lower in Group B than in Group A for the first 12 hours postoperatively. Group B showed a significantly prolonged duration of analgesia as compared to Group A. No significant differences were observed with respect to hemodynamic parameters, sedation score, or side effects between the groups. Conclusion: Clonidine is a safe and effective adjuvant to 0.2% ropivacaine in caudal epidural block for postoperative analgesia.

Background: Topical treatments are the initial therapeutic option among individuals with palmoplanter psoriasis that affects both the palms and soles. Despite being used for over a decade, there are no reports of research directly comparing the effectiveness of calcipotriol with tazarotene. Aim: The objective is to assess the relative effectiveness and safety of calcipotriol and tazarotene for treating palmoplantar psoriasis. Methodology: This study was an observational, open-level, comparative study with two groups. It was conducted over a period of 12 weeks, with follow-up visits every 4 weeks. Group A consisted of 40 patients who administered calcipotriol 0.005% ointment twice daily, whereas Group B consisted of 40 patients who applied tazarotene 0.1% ointment once daily. The effectiveness of the treatment was evaluated by assessing the severity of psoriatic lesions using the ESIF score, which measures erythema, scaling, fissuring, and infiltration on a scale from 0 to 3. The evaluation was conducted at the beginning of the therapy (0 week), as well as after 4 weeks, 8 weeks, and 12 weeks into the treatment. After 12 weeks, the reduction in the ESIF score was compared between patients in both groups. The safety of this trial was assessed by comparing the incidence of adverse medication reactions in each group. Results: A total of forty-one patients in group A, also known as the Calcipotriol group, successfully finished the research. The group of patients treated with topical calcipotriol showed a substantial reduction in ESI score after 12 weeks, resulting in a moderate-to-marked improvement (P< 0.0001). Lesions treated with calcipotriol in group B (Tazarotene group) showed similar improvement to those treated with 0.1% tazarotene after 12 weeks of topical therapy. The detected adverse effects, including burning, pruritus, and irritation, were modest. These symptoms were more frequently observed in the lesions treated with tazarotene compared to those treated with calcipotriol. However, the difference in occurrence between the two treatments was not statistically significant. Nevertheless, no patients discontinued the therapy due to adverse effects. Conclusion: Overall, both topical 0.005% Calcipotriol and topical 0.1% Tazarotene are effective in treating palmoplanter with similar safety profiles.

Abnormal uterine bleeding produces a load of about 30% of all gynecological outpatient departments. It plays a major role in the rise in maternal morbidity and mortality. Thus it becomes important to make prompt and accurate diagnoses. Analysis of histopathological patterns in such cases can reveal many valuable insights. In this observational study, 376 cases satisfying inclusion criteria were selected. Samples were received in 10% formalin solution, processed by routine process, and stained using H&E. Slides were then reported by a trained pathologist. Chi-Square, ROC, AUROC, and other appropriate statistical tools were applied to analyze the data. The most common age group was 41-50. Multipara with parity 3 or more was reported for 285 cases. Menopause was attained in 25 cases. The most prevalent histological finding was the proliferative phase, which was followed by the secretary phase. Cut-off was determined to be 44.5 using ROC. Menorrhagia (63.13%) was the most prevalent menstrual disease, followed by meno-metrorrhagia and metrorrhagia. In this study, functional factors are more prevalent than organic causes (84.04%). Menorrhagia (63.13%) is the most frequent presenting ailment in this study, followed by metrorrhagia.  Using immunohistochemistry for confirmation of malignancies can increase the strength of the study in the future. The association between the benign and malignant lesions with menopausal status was not significant. Role of histo-morphological pattern of endometrium diagnosis plays a major role in early diagnosis and further management of AUB. Post-menopausal bleeding should be dealt with cautiously due to the higher incidence of malignancy in this age group.

Background: In the modern era of medical science, advancements in early diagnosis, interventions, and rehabilitation have significantly reduced neonatal mortality rates. Central to this progress is the use of oxygen, a crucial tool for saving the lives of preterm infants. However, the increased use of oxygen in neonatal care has introduced its own challenges. Retinopathy of Prematurity (ROP) is a severe consequence of oxygen therapy, leading to significant visual impairment and blindness in affected infants. ROP primarily affects premature infants, especially those weighing less than 2000 grams, and can be mitigated through timely screenings and interventions. Objective: To study the risk factors leading to development of Retinopathy of Prematurity. Method: The prospective observational study was conducted in the Department of Pediatrics at Rohilkhand Medical College and Hospital from November 2022 to October 2023. All participants were enrolled after obtaining informed consent from the guardians or parents, with clearance from the institutional ethics committee. Participants in the inclusion criteria were screened for ROP based on the protocol. Result: The study sows positive association between Retinopathy of Prematurity and as gestational age, birth weight, oxygen exposure, blood transfusions, sepsis, and phototherapy with the following p values 0.001, 0.017, 0.0001, 0.006, 0.004 and 0.004 respectively. Conclusion:  Retinopathy of Prematurity (ROP) continues to be a significant challenge for the care of preterm infants, with its occurrence and associated risk factors extensively documented in the literature. The study provides valuable insights into the multifaceted nature of ROP. The study highlights the association between ROP and various factors such as gestational age, birth weight, oxygen exposure, blood transfusions, sepsis, and phototherapy.

Introduction: Dengue fever is a vector borne disease manifesting in many clinical ways. It is a well-studied disease, and many research aims to understand various aspects of its severity and prognosis. Hepatic dysfunction, especially when accompanied by encephalopathy, significantly increases the risk of mortality. In addition, liver dysfunction can exacerbate bleeding manifestations and disseminated intravascular coagulation, both of which are associated with poor outcomes. Early detection and prompt supportive care are crucial to reducing mortality and morbidity. This study aims to explore the correlation between the severity of dengue fever in children and their total leukocyte count and liver function test. Method: The prospective observational study was conducted in the Department of Pediatrics at Rohilkhand Medical College and Hospital from November 2022 to October 2023. 55 participants were enrolled after obtaining informed consent from the guardians or parents, with clearance from the institutional ethics committee. Readings of LFTs and total leucocyte count was obtained. All children were further followed up for minimum 3 months or normalized LFT and Total leukocyte count whichever is earlier. Result: Laboratory tests revealed significant changes in the average Total Leukocyte Count (TLC) during the follow-up period, particularly among patients with Dengue Shock Syndrome (DSS). There were also notable differences in liver enzyme levels (SGOT and SGPT) between the initial and follow-up tests, reflecting the considerable impact of dengue on liver function. Additionally, average platelet counts varied with disease severity, highlighting a clear link between thrombocytopenia and the seriousness of dengue. However, no statistically significant changes were observed in leucocyte count or other laboratory parameters, such as PCV, Alkaline Phosphatase, Total Protein, and Albumin levels, across different forms of dengue. Conclusion: This study underscores the complex diagnostic and laboratory features of dengue virus infection in children, emphasizing the need for careful patient monitoring and tailored care strategies to improve outcomes based on the severity of the disease.

Objective: Balance is crucial for daily activities and overall well-being, involving the ability to maintain the line of gravity within the base of support (BOS) while stationary or moving. Aging significantly impacts balance due to decreased reaction times and muscle flexibility, increasing the risk of falls and related injuries. Effective balance is essential for performing daily tasks and recreational activities. This study aims to compare the effectiveness of backward walking and Pilates mat exercises in improving balance in the elderly. Methods: This comparative study involved 60 independently living individuals aged 60-70 years, experiencing balance problems. Participants were randomly assigned to two groups: Group A (n=30) received backward walking training and Group B (n=30) received Pilates mat exercises. Balance was assessed using the Berg Balance Scale and the Timed Up and Go Test at baseline and every 15 days over a 12-week period. Each group participated in two 60-minute supervised sessions per week, including warm-up and cool-down exercises. Results: On Day 15, Group A showed a significantly greater improvement in balance (mean=37.5, SD=1.70) compared to Group B (mean=33.8, SD=1.80), with a t-value of 5.9730 (p<0.0001). By Day 60, Group A’s mean score increased to 48.5 (SD=1.70) versus Group B’s 42.73 (SD=1.40), with a t-value of 14.3505 (p<0.0001). On Day 75, Group A’s mean score was 51.5 (SD=1.64) compared to Group B’s 46.8 (SD=2.29), with a t-value of 9.1395 (p<0.0001). Group A consistently outperformed Group B, indicating superior improvements in balance through backward walking. Conclusion: Backward walking demonstrates significant therapeutic benefits in enhancing balance among the elderly, showing superior efficacy compared to Pilates mat exercises. The results suggest that incorporating backward walking into rehabilitation programs can optimize patient outcomes and reduce fall risks in the elderly population.

Background: Unilateral neglect significantly impairs spatial awareness and functionality in stroke survivors. Swiss Ball Training (SBT) offers a dynamic rehabilitation method that may enhance recovery outcomes more effectively than conventional therapy by utilizing proprioceptive feedback and balance enhancement exercises. Methods: This experimental study included 30 participants with unilateral neglect, divided equally into Swiss Ball Training (SBT) and Conventional Therapy (CPT) groups. Using a convenience sampling method, participants were evaluated on the Berg Balance Scale (BBS), Line Bisection Test (LIB), Star Cancellation Test (SCT), and Functional Independence Measure (FIM). Assessments were conducted pre- and post-intervention over four weeks, with data analysis facilitated by independent and paired t-tests. Results: Initial assessments showed minimal differences between groups. Over four weeks, SBT participants demonstrated significant improvements in BBS (pre: 17.93 to post 4th week: 48.63), indicating superior balance and stability. Statistical tests highlighted significant advancements in SBT over CPT, particularly from the second week onwards (p = 0.011, week 2). Conclusion: Swiss Ball Training significantly improves balance and functional independence in patients with unilateral neglect more effectively than conventional therapies. This study underscores the potential of SBT in complex rehabilitation scenarios, suggesting its broader application in neurorehabilitation.

Introduction: Magnetic Resonance (MR) spectroscopy is a valuable tool in the differential diagnosis and management of various neurological diseases. MR spectroscopy plays a significant role in differentiating brain tumors from nonneoplastic lesions, obtaining definitive diagnoses, identifying optimal biopsy sites, monitoring treatment responses, and distinguishing treatment-induced changes from recurrent tumors. Its high sensitivity and specificity in differentiating tumors and identifying molecular subtypes of gliomas highlight its diagnostic precision. Aims and Objective: This study is aimed to investigate the utility of MR spectroscopy (MRS) in differentiating benign and malignant brain tumors compared to conventional MR imaging. Materials & Method: Thirty patients with suspected brain tumors underwent magnetic resonance imaging (MRI) and proton MRS examinations. MRS techniques included PRESS and multivoxel chemical shift imaging (CSI). This study was performed on Seimens Magnetom Spectra Whole body Scanner. Results: The present study was a prospective study and done with 30 cases of intracranial SOL over a period of 1 year attending department of General medicine and Radiology of AGMC GBP Hospital. Among the 30 patients, there were 26 males and 4 females. The highest incidence was found in the peak age of 31-40 (23%) and 61- 70 (23%). Among types of Brain Space Occupying Lesions (SOL) Glioma was most common (44%), followed by metastasis (20%).Brain space occupying lesion occurs in intra-axial and extra-axial locations of brain. In present study shows 87% lesions intraaxial and 13% lesions extra-axial. Conclusion: Magnetic Resonance Spectroscopy provided valuable information about tumor characterization, which can aid in differentiating benign and malignant brain tumors. It’s an imaging approach that allows for the non-invasive molecular characterization of a region of interest this information, when used in conjunction with conventional MRI, can improve diagnostic accuracy. Lesions with different underlying causes often appear similar on MRI scans, making MR imaging and MR spectroscopy complementary tools. Together, they provide a comprehensive picture for diagnosing diseases, monitoring their progression, and evaluating treatment responses.

Aim: To find occurrence of dry eye and to assess the severity of dry eye after manual small incision cataract surgery with cornea sclera tunnel incision. Material and Methods: A total of 100 patients were selected who came for manual small incision cataract surgery each patient was questioned per operatively about dry eye symptoms and examined with schirmers test 1 and tear film break up time. Following this, the patients underwent small incision cataract surgery with a superior incision of 6-7mm depending on grade of cataract schirmers test 1 and tear film breakup time test were repeated on post operative day 1st, 7th and 30th day. Dryness of eye was analysed and graded as per DEWS CLASSIFICATION 2007. Results: Out of 100 samples, 26% had dry eye preoperatively which increased to 89% post operatively on 1st day out of these 89 patients having dry eye post operatively, 35 were male and 54 were female mean schirmers 1 value -16.78mm preoperatively after 1st day of surgery- 7.03, 1week of surgery-7.15mm, 1month -10.45 mm. Difference of values between preoperative and postoperative are significant p less than 0.001. In TBUT STUDY-mean TBUT per operatively was 17.89 sec and decreased to 7.24 sec at 1st post operative day and after 1week to 7.84 sec after a month increased to 13.23 seconds.

Introduction: Lesions of eyelid are common in histopathological practice. These lesions are diverse and different in behaviour. Most of them are usually benign in nature. A preoperative diagnosis and confirmation of the diagnosis using histopathological examination is very important in treatment of benign as well as malignant lesions of eyelid. Aim of the Study: to assess the incidence of various eyelid lesions on histopathology and to compare it with similar studies. Methodology: This is a 5 year hospital based retrospective study carried out in the Pathology Department of Silchar Medical College and Hospital, Silchar. Statistical analysis is done on the basis of various parameters like age, sex and histopathological type. These findings are analysed using various statistical methods and compared with findings of other authors to derive relevant conclusion. Results: Out of 105 cases of eye lid specimens taken, 94 cases are found to be benign while only 11 cases proved to be malignant. Majority of them are in the age group of 40- 59 years. Females (56 /105) are found to be more affected than males (49/105). Benign lesion occurs in middle aged group (40 – 59 years) while malignant lesions are common after 60 years of age. Amongst the benign eyelid lesions, chalazion (19%) is the highest followed by epidermal cyst (16%), pyogenic granuloma and squamous papilloma with equal distribution (13% each), sebaceous cyst (12.7%), sebaceous adenoma (10.6%), intradermal nevus (5.3%), hemangioma and seberrhoeic keratosis with equal distribution (4.1%), lastly syringoma and dermoid cyst with 1.1% distribution. each. Amongst the malignant eyelid lesions, there is an equal frequency in cases of both Sebaceous gland Carcinoma (SGC) and Basal cell carcinoma (36% each) while Squamous cell carcinoma (SCC) comprised of 28% of all the malignant cases. Conclusion: Majority of the cases are benign in nature with a female preponderence. Benign lesion occurs in middle age group while malignant lesions mostly occur in older individuals. Patients will benefit from early diagnosis and treatment with a better prognosis for these tumours if there is a high index of suspicion for malignant lesion. The diagnosis made by histopathology is crucial since advanced tumours might result in functional or cosmetic issues, or in the case of malignant tumours, metastases may happen.

Background: Lymphatic filariasis is targeted for elimination in India through mass drug administration (MDA) with Diiethylcarbamazine (DEC), Albendazole (ABZ) and Ivermectin. MDA were done in Katihar district as well by government. MDA campaign was conducted in February 2024 in Katihar district. Post MDA, a survey was conducted: (i) To estimate the coverage, effective coverage, and compliance of MDA in study area. (ii) To estimate the reasons for non- offering and non-consumption of MDA. Methods: A training session conducted to conduct survey. Survey was done in 5 blocks having 4 villages in each block. Altogether 600 households were surveyed which caters sample size of 2707.Block were selected by lottery methods. Systematic random sampling methods were adopted for the selection of 30 households in each village/urban area. Pretested questionnaire were given to volunteers to collect data. After collecting data it were analyzed. Results: After analyzing the data it was found that percentage of people received Albendazole were 76.1%. And DEC were received by 75.8%. It was also found that 7.5% people have not received even single dose till date even after multiple round of MDA conducted by government. Even after providing MDA some people did not consume the drug. Those who did not consumed Albendazole and DEC were 2.8% & 2.6% respectively. Reason for not consuming the drug were fear of side effects and bad taste mainly. Conclusion: Currently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance, health education, managing side effects, and logistics are not given enough attention. It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.

Fine needle aspiration study is a very useful technique for detecting palpable lesions. In our study, 164 patients hailed from rural areas with salivary gland enlargement referred to the Department of Pathology were included and Fine Needle Aspiration Cytology (FNAC) investigation yielded 82 (50%) non-neoplastic lesions, 78(47.56%) neoplastic lesions and 4 (2.4%) inconclusive lesions on cytology. The most commonly involved site was parotid gland (110, 67.07%), followed by submandibular gland (50, 30.48%) and minor salivary glands (4, 2.4%). 60 (36.5%) patients underwent surgical excision and specimens were available for histopathological correlation. Grading of salivary gland tumors were done according to the Milan System for reporting salivary gland cytology. Accuracy rate for non-neoplastic lesion was 61.53%, for benign neoplasms 85.3%, and for malignant neoplasms 66.6%.

Aim: To evaluate the analysis of keratometric readings and astigmatism in patients with different grades of pterygium. Materials and Methods: A total of 64 patients(124 eyes) were selected who presented with pterygium. Assessment of pterygium using slit lamp biomicroscopy to establish type, grade, size of pterygium. Autorefractometry was evaluated to determine astigmatism. Refraction was assessed by using a retinoscope. Keratometry-by Bausch and Lomb keratometer. Results: 60 patients presented with bilateral pterygium while 4 were having unilateral pterygium out of 64 patients with pterygium half of the patients were between the ages of 41-50 years mean age of patient was 45.14+/-9.93 years Overall mean magnitude of astigmatism was 1.429+-0.6225 SD.

Background: Endotracheal intubation, a common procedure in anesthesia and critical care, often triggers a significant hemodynamic response characterized by increased heart rate and blood pressure. This response can lead to complications, particularly in patients with cardiovascular comorbidities. Labetalol, a combined alpha and beta-adrenergic blocker, has been proposed as an effective agent to attenuate these hemodynamic changes. Objective: To evaluate the efficacy of intravenous labetalol in attenuating the hemodynamic response to endotracheal intubation. Material and Methods: A prospective, randomized, controlled clinical trial conducted at Mamata Medical College, Khamam, from March 2023 to March 2024. Patients scheduled for elective surgery requiring endotracheal intubation were enrolled. Inclusion criteria included adults aged 18-65 years, ASA physical status I or II. Exclusion criteria were significant cardiovascular, hepatic, or renal disease, pregnancy, and known hypersensitivity to labetalol. Participants were randomized into two groups: the labetalol group (Group L) and the placebo group. Group L received intravenous labetalol (0.30 mg/kg) five minutes before intubation. Group p received a placebo (normal saline). Results: The study included 96 patients, with 48 in each group. Baseline demographic and clinical characteristics were comparable between the groups. Group L exhibited a significantly lower increase in HR post-intubation compared to Group C (p < 0.05). SBP was significantly lower in Group L at all-time points post-intubation (p < 0.05). Both DBP and MAP were attenuated in Group L compared to Group p. Conclusion: Intravenous labetalol effectively attenuates the hemodynamic response to endotracheal intubation, making it a valuable agent in managing perioperative hemodynamics, particularly in patients at risk of cardiovascular complications.

Background: This study was undertaken to determine the prevalence of Minor Physical Anomalies in Schizophrenic patients and to compare that with normal healthy controls. Materials & Methods: The study sample comprises of 50 consecutively selected subjects admitted in the Department of Psychiatry, Guwahati Medical College and Hospital and diagnosed as having schizophrenia and meeting the selection criteria. This study aimed to compare prevalence of minor physical anomalies in schizophrenics and normal healthy population. Semi-structured interview schedule for collection of socio-demographic data was captured. ICD–10 criteria were used for the diagnosis of schizophrenia and WALDROP Scale for assessment of minor physical anomalies. Results: Schizophrenic patients have significantly more minor physical anomalies than normal controls in head circumference (p = 0.0070), hypertelorism (p<0.0001), low set ears (p<0.0001), high steepled palate (p<0.0001) and longer 3^rd toe than 2^nd (p = 0.0078). The analysis is further extended in to see if these items have specificity in discriminating schizophrenics from normal controls. Using Fisher’s exact test, P values, sensitivity and specificity of these individual Waldrop items are calculated. Conclusion: Male and female schizophrenic patients didn’t differ regarding mean total anomaly score. Schizophrenic subjects had significantly more Minor Physical Anomalies than normal controls. Wider head circumference, hypertelorism, low set ears, high-steepled palate and 3^rd toe longer than second had significantly higher prevalence in schizophrenic patients, and also predicted schizophrenic status with adequate sensitivity and specificity. Early onset schizophrenia cases had significantly more anomalies than late onset cases.

Background: A large number of ENT surgeries are done under local anesthesia and patient should be calm and quiet. At the same time response to verbal command to be maintained. Low BP and reduced pulse rate are other essential requirement to reduce bleeding .The haemodynamic response occurs due to increase in sympathetic and sympatho-adrenal activity. It has become evident that, a_2-adrenoceptor agonists may be a useful class of drugs to reduce this response. In this study we observed the effects of dexmedetomidine, a highly selective and potent a₂ agonist on haemodynamic variability and sedation score during different ENT surgeries under local anesthesia. Materials & Methods: About 60 patients undergoing elective ENT surgery under local anesthesia (tympanoplasty, mastoidectomy and septoplasty) were included in this study and were divided equally into two groups in a randomized double blind protocol. Group D were received 0.5 μg/kg/hr dexmedetomidine by syringe pump as maintenance dose 10 min before and was stopped 10 min before the end of operation and Group P were receive 0.9% NS at same rate by syringe pump as per Group D. Requirement of supplemental and subsequent doses of fentanyl (1μg/kg every time) in both group were recorded. Results: In Group D, MAP was between 65-75 mm of Hg and in 90% of cases sedation score were 3 (as per Filo’s numerical score). In Group P, MAP was between 90-98 mm of Hg and in 70% of cases sedation score was 1. Conclusion: To conclude   dexmedetomidine is a very effective drug in reducing intraoperative BP and maintaining a proper sedation.

Background: This study aims to use multimodal imaging techniques to understand retinal structural changes in patients with retinitis pigmentosa. Advancements in imaging techniques like MRI and OCT can provide insights into disease pathogenesis and develop therapeutic interventions. The integration of these techniques could improve diagnosis and management of the condition, enhancing the understanding of retinal degeneration. Methods: A cross-sectional study was conducted at a tertiary care hospital in Tamil Nadu, India, between January 2022 and December 2022. Participants were patients with retinitis pigmentosa, confirmed by a comprehensive ophthalmological examination. They underwent a comprehensive multimodal imaging assessment, including Optical Coherence Tomography (OCT), Imaging, and diffusion tensor imaging. Quantitative parameters were extracted and compared between the retinitis pigmentosa group and the healthy control group. Results: The mean best-corrected visual acuity (BCVA) was 0.19 ± 0.12, with a median of 0.18. The analysis included 160 eyes and 77 (96%) had both eyes affected, contributing to 154 affected eyes. Cystoid macular edema in RP was present in 16 out of 80 patients. The study found a significant correlation between best-corrected visual acuity (BCVA) and structural parameters in retinopathy (RP), with a negative correlation with central macular thickness (CMT), autofluorescence ring, Optos AF ring, and ISOS line length, and a positive correlation with perifoveal thickness (inferior). Conclusions: The research highlights the importance of integrating multimodal imaging techniques like optical coherence tomography, fundus autofluorescence imaging, and diffusion tensor imaging to better understand the structural characteristics of retinitis pigmentosa.

Objective: This study aimed to evaluate the Serum Thyroid Profile in between different stages of Chronic Renal Failure. Materials and Methods: 70 patients aged 18-60 years who were diagnosed as Chronic Kidney Disease on the basis of e-GFR and 70 healthy individuals as controls. Overnight fasting venous blood samples were collected from both groups for Thyroid Profile estimation. Urea and Creatinine estimation were also done to test for renal function. Results: Our study advances our knowledge thyroid hormone in CRF that these patients have decreased serum T3 and serum T4 & increased serum TSH levels compared to different stages of CRF. Conclusion: Alterations in thyroid hormone may underline many of the aspects of path-physiology and clinical characteristics of CRF. It is worthwhile to check thyroid hormone and  T3, T4 and TSH values frequently in CRF patients during the course of the treatment and to treat them accordingly which will result in decreased morbidity and mortality.

Fahr’s syndrome is a rare neurodegenerative disorder associated with bilateral symmetric calcification in basal ganglia, thalami, deep cerebellar nuclei and subcortical white matter. The clinical presentations of Fahr’s syndrome are pyramidal signs, Parkinsonism, gait disorders, cognitive disorders, movement disorders and psychotic symptoms. Here, we report a case of chronic hypocalcemia due to primary hypoparathyroidism diagnosed with Fahr’s syndrome.

Background: Critically ill patients pose a significant diagnostic challenge for emergency physicians, who must manage them promptly. Advances in diagnostic tools and scoring systems, such as the APACHE II score and initial arterial blood lactate levels, facilitate patient assessment, guide therapy, and improve outcome prediction and counselling from the day of hospital admission. Objective: To study to predict outcome in critically ill patients with APACHE II score >14 in Emergency Department with high Lactate Level (>2mmol/L). Materials and Methods: A cross-sectional observational study was conducted from October 2023 to December 2023 involving 50 patients presenting to the Emergency Department with lactate values greater than 2.0 mmol/L in arterial blood gas analysis and an APACHE II score greater than 14. Results: In this study involving 50 patients, the mean age was 61.8±14.65 years. The overall mean blood lactate level was 5.31±3.3. Patients who survived had a lower mean blood lactate level of 3.64±1.36 compared to non-survivors, who had a mean of 6.12±3.84. Additionally, the mean APACHE II score was 22.25±5.82 overall. Survivors had a lower mean APACHE II score of 19.5±4.6, whereas non-survivors had a mean score of 23.71±5.97. Out of the 50 patients, 18 (36%) survived while 32 (64%) did not. Conclusion: To conclude higher lactate values are associated with higher hospital mortality. Initially taken blood lactate level was very helpful for stratifying critically ill patients presenting to emergency department.

Background: Vitamin D is essential for humans for calcium homeostasis and bone health. Vitamin D deficiency causes osteoporosis and other musculoskeletal disorders. This study is aimed to evaluate the levels of vitamin D among the elderly males and post-menopausal females, and prevalence of vitamin D deficiency in Konaseema region. Materials and Methods: This correlational study was conducted on men and women above 50 years attending the hospital OPD in Konaseema Institute of Medical Sciences Hospital for a period of 2 years. Blood samples for serum 25-(OH) vitamin D, calcium and phosphorus were collected from the patients by venipuncture observing all safety and aseptic precautions. Data collected was analyzed for any correlation in the values between the biochemical parameters and vitamin D and calcium supplementation. Result: Our study found that Vitamin D levels and bone mass density are inversely related to age which is more evident in post-menopausal women due to steep fall in estrogen levels after menopause. In this study, the individuals are supplemented with calcium (calcium carbonate) 1000mg per day and 800 IU of vitamin D (daily dose), and they were followed up at 3^rd, 6^th, and 12^th month. In the present study, following vitamin D supplementation in osteoporotic elderly people, there was a significant increase in the bone mineral density, analyzed by T scores. Our study mainly relied upon serum calcium, serum vitamin D levels and T scores, whose improved values were significant (p < 0.001). Our study follow up was done for 1 year in 3 phases (3^rd, 6^th, 12^th months). Conclusion: The vitamin D deficiency is common in poor and lower middle class likely due to under nutrition. This study points out higher prevalence of Vitamin D inadequacy and low BMD in post-menopausal women and elderly persons in Konaseema region. It can be concluded with the recommendation that post-menopausal women and elderly males, especially from lower socioeconomic group in Konaseema region, should be administered vitamin D and calcium regularly.

Introduction: PCOS is a one of the most common endocrine disorders in women of reproductive age group. It affects 5%-10% women worldwide. In India, prevalence of PCOS is around 3.7% to 22.5%. PCOS has 2 phenotypes- the obese and the lean, the latter being a much less common presentation of the disease. Both these groups present with visceral adiposity hence, they have deranged metabolic profile. Aim and Objective: To compare the lipid profile of obese and lean women with polycystic ovary syndrome (PCOS). Method: It is a hospital-based comparative cross-sectional study of 60 PCOS women (30 in obese group and 30 in lean group) in the age group of 18-40 years in Department of Obstetrics and Gynaecology, at a tertiary hospital of NE, India. PCOS women were selected according to Revised Rotterdam Criteria (2003). Results: The mean Total cholesterol, LDL cholesterol was higher in the obese group. Whereas, the mean HDL cholesterol was higher in the lean group. The difference in triglyceride in both the group was not statistically significant. Conclusion: Obese PCOS is said to have a more atherogenic lipoprotein pattern but we cannot rule out the fact that even lean PCOS women have deranged lipid profile compared to normal control. PCOS patients have a more atherogenic lipid profile which is related to obesity, but lean PCOS patients should also be screened as there are differences of lipid profile from non PCOS women.

Background: Over the past decade, our comprehension of the pathophysiology of PCOS has advanced significantly. However, despite our increasing familiarity with this condition, certain fundamental aspects of PCOS remain inadequately recognized and understood. Obesity has been identified as a significant factor contributing to the long-term risk of developing PCOS. Our study underscores that anthropometric measures, particularly BMI and WHR, exhibit significant correlations with lipid profiles in PCOS patients, emphasizing the critical role of early obesity management in preventing future complications. Our objective was to examine anthropometric measurements, hormonal status, and biochemical parameters in females diagnosed with PCOS, investigate their and compare them with a control group. Methods: In this case-control study, we enrolled 100 women clinically diagnosed with PCOS and 100 healthy female controls matched for age (18-40 years). We assessed body mass index (BMI), waist-to-hip ratio (WHR), fasting blood glucose, lipid profile, and hormonal levels in both groups. Result: We observed significant elevations in TSH, and prolactin levels, TC, TG, LDL, and TC/HDL ratio levels in females with PCOS compared to healthy females. Conclusion: There is notable disruption in the hormonal and biochemical profiles of women affected by PCOS, resulting in altered energy metabolism and an endocrinological cascade.

This article aims to investigate the ethical considerations associated with providing information and obtaining permission from the patient in Intensive Care settings. When providing information to a patient, it is important to ensure that the information is accurate, clear and understandable. Patients have the right to be fully informed about their health condition, treatment options and potential risks and benefits. It is important to communicate in a language that is easily understood by the patient. Obtaining permission from the patient is also crucial before conducting any medical intervention. This includes explaining the purpose of the procedure, the potential risks and benefits and any other alternative options if available.

Introduction: The development of foetus is mainly dependant on normal placental development Pregnancy induced hypertension (PIH), a well-known complication of pregnancy is significantly responsible for perinatal morbidity and mortality due to its effects on the growing foetus. Pregnancy induced hypertension causes considerable changes in the histopathology of placental tissue. The main aim of the present study record the data on the morphology and histology of placenta from mothers with PIH and correlate the findings with the birth weight of the new born babies, severity of hypertension, age of the patient and parity. Materials and Methods: The present study was a retrospective study of 23 cases of pregnancy induced hypertension (PIH) conducted in Department of Pathology in collaboration with Department of Obstetrics and Gynecology, Kurnool medical college, Kurnool from January 2024 to February 2024. The statistical significance between different histologic findings and severity of PIH calculated. Results: Of the 23 cases of pregnancy induced hypertension analysed in the present study 10 cases were of mild pregnancy induced hypertension, 5 cases were of moderate pregnancy induced hypertension and 7 cases were of severe pregnancy induced hypertension and one case with recurrent PIH in all the three previous pregnancies. Incidence of pregnancy induced hypertension was found to be more above 21 years of age (82.6%) and was found to be almost equal in both primi parous and multiparous women. Foetal outcome was worst in severe PIH (IUGR of 6% and IUD of 5%). The gross abnormalities noted were retroplacental hematomas (30.4%) and small sized placentae (21.7%); and were more often seen in severe PIH. The consistent histological changes observed include intra-villous and extra-villous fibrin deposition (82.6%), inter-villous haemorrhage 16 (69.5%), chorangiosis (47.8%), fibrinoid necrosis of villi (34.7%), increased syncytial knots (30.4%) and calcifications (30.4%). Conclusion: The present study helps in evaluating the various morphological changes in placenta in the hypertensive disorder of pregnancy. Irrespective of the parity, the prevalence of pathological changes in the placenta seen in PIH patients was almost equal. The present study helps in anticipating the occurrence of changes in the subsequent pregnancy induced hypertension cases.

Introduction: AUB is the most common cause for which women seek medical help and presents to Gynaecology OPD. About one third of women experience AUB once in their lifetime. Globally, its prevalence in the reproductive age group is 3 to 30%. Aims and Objective: To analyse the histopathological outcome of patients undergoing hysterectomy for AUB. Methods and Methodology: It is a hospital based retrospective study conducted in Assam Medical College & Hospital for a period of 3 months from 1stDecember2023 to 29^th February2024. Data for women who had undergone hysterectomy for AUB were traced from the Gynaecology OT register. Subsequently the case records of these patients were collected from the medical records department. Demographic data, relevant history and key examination findings were obtained from each of the case file. Where possible, relevant imaging and endometrial biopsy reports were also collected. Histopathological reports of post-operative specimens were gathered from the pathology department. Results: Most of the patients were in the age group of 41-45years comprising 45% and were multiparous. 55% were with parity 3and above. About 45% presented with heavy menstrual bleeding as the main complaint. It was seen that in 57.5% the post-operative histopathological specimen showed Leiomyoma. Conclusion: Hysterectomy is one of the common gynaecological surgical interventions done for AUB. Unnecessary hysterectomy adds to the morbidity. Procedures which preclude hysterectomy should be adopted.

Introduction: The menisci are crescent-shaped fibrocartilage located on the medial and lateral surfaces of the tibial plateau. Each meniscus is divided into three parts: an anterior horn, a body, and a posterior horn. The Anterior Cruciate ligament originates along the medial aspect of the posterior lateral femoral condyle within the intercondylar notch and inserts onto the tibial eminence, with fibres oriented parallel to the roof of the intercondylar notch when the knee is extended. It consists of two separate bundles: the anteromedial bundle and the posterolateral bundle. The posterior cruciate ligament originates from the lateral aspect of the medial femoral condyle within the anterior intercondylar notch and inserts distally on to the posterior tibial intercondylar fossa adjacent the root of the medial meniscus Advancement in MRI have improved the accuracy of detecting cruciate and meniscal tears which have helped in classification of injury and treatment accordingly. This study aims to present association between meniscal and cruciate ligament tears using MRI. Materials and Methods: In a retrospective observational study conducted in a tertiary care hospital at department of radio diagnosis, All MRI knee scans conducted between January 2024 to June 2024 were analysed. After exclusion of digitally inaccessible, ill eligible and unclear records, total of 50 cases were selected. Results: All the data collected was analysed using RevMan(R) Version 5.3 and P value <0.05 was considered statistically significant.  The most common injured ligament was anterior cruciate ligament. (48%).  Highest number of tears was found in the age group 20-29 years followed by 30-40 years and other subsequent age groups. Ligament injuries were more common in males (68%) compared to female (32%). Among the meniscal tear, Most commonly found tears were of medial meniscus (64.7%) and among the ACL tears partial thickness ACL tears were commoner (62%).  There was evidence of significant association of lateral meniscal tears and ACL tears (P value < 0.05). No statistically significant association found between medial meniscus and ACL tears, medial meniscus and PCL tears and lateral meniscus and PCL tears. Conclusion: The study emphasizes that tears of the menisci should be carefully looked for the presence of ACL tear, since they are commonly associated (especially lateral meniscal tears). This helps in repairing both the ACL and meniscal injuries in the same sitting, thereby reducing patient discomfort and improving patient care.

Introduction: Alcohol consumption is a major contributor to liver diseases, including fibrosis and cirrhosis. Early detection and management are crucial for preventing disease progression. Liver biopsy remains the gold standard, but non-invasive methods like FibroScan and APRI scores offer safer, cost-effective alternatives. Methods: This observational cross-sectional study, conducted at Dr. D.Y. Patil Medical College, evaluated the efficacy of APRI scores compared to FibroScan for liver fibrosis assessment in alcoholic liver disease patients. Data from 92 participants were analysed, with APRI scores calculated from AST levels and platelet counts, and FibroScan used to measure liver stiffness. Results: Participants’ ages ranged from 23 to 79 years, with a mean age of 46.49 years. APRI scores ranged from 0.10 to 11.70, indicating varied fibrosis levels. FibroScan scores ranged from 2.1 to 70.6, reflecting significant fibrosis variability. The Pearson correlation between APRI and FibroScan scores was 0.331 (p = 0.001), showing a moderate positive relationship. ROC analysis of APRI demonstrated an AUC of 0.657 for predicting significant fibrosis. Conclusion: APRI is a useful tool for liver fibrosis assessment but should be complemented by FibroScan for more comprehensive evaluation. Further research is needed to refine these methods and validate their effectiveness across diverse populations.

Background: Breast lumps or masses are very common, particularly among women of reproductive age. Over 25% of women are affected by breast disease in their lifetime, and the vast majority of these cases will present initially as a new breast mass in the primary care setting. Objective: To evaluate fine needle aspiration cytology of palpable breast lesions with histopathologic correlation at a tertiary care centre. Methods: This Observational study was conducted among all the samples received in Pathology Department of patients attending OPD and IPD of a Medical college and a tertiary care hospital in Eastern Maharashtra. Results: The mean age was 37.28 ± 13.91 years. 55 cases were from the left side (58.51%) and 39 cases were of right-side mass (41.49%). The most common diagnosis on FNAC was fibroadenoma seen in 33 cases (35.11%). Followed by Ductal carcinoma in situ in 13 cases (13.83%). Atypical ductal hyperplasia was seen in 9 cases (9.57%). FNAC showed that we had 63 benign cases (67.02%) 22 were malignant cases (23.40%) and 9 were premalignant cases (9.57%). The most common diagnosis on histopathology was fibroadenoma seen in 29 cases (30.85%). Conclusions: FNAC is a great tool for the screening of the breast lesions. It is less invasive, cheap and can be done even at peripheral centers. We observed that FNAC showed good sensitivity, specificity and accuracy in diagnosing breast lesions.

Background: Sepsis, a life-threatening condition, involves a dysregulated immune response to infection, leading to inflammation and potential organ failure. Serum cortisol, a glucocorticoid hormone, modulates the stress response, including inflammation and immune function. Understanding serum cortisol’s role in sepsis and its potential as a biomarker for disease severity is crucial for effective treatment strategies. Objective: This study investigates serum cortisol level differences between septic patients with and without chronic liver disease (CLD), explores its potential as a sepsis severity biomarker, and evaluates treatment implications based on cortisol levels. Methodology: A cohort of septic patients, with and without CLD, was enrolled. Serum cortisol levels were measured at admission and periodically during treatment. Clinical outcomes, including intensive care needs, septic shock development, and mortality, were monitored. Statistical analyses assessed the correlation between cortisol levels, disease severity, and patient outcomes. The benefits of corticosteroid therapy tailored to individual cortisol levels were also evaluated. Results: Septic patients with CLD had significantly higher serum cortisol levels than those without CLD. Elevated cortisol levels correlated with increased sepsis severity and poorer clinical outcomes, including higher intensive care needs and mortality risk. Patients receiving corticosteroid therapy based on their cortisol levels showed improved clinical outcomes, highlighting the potential of personalized treatment approaches. Conclusion: Serum cortisol significantly influences sepsis pathophysiology, affecting inflammation, immune response, and hemodynamic stability. The differences in cortisol levels between patients with and without CLD emphasize the need for individualized treatment strategies. Serum cortisol effectively indicates sepsis severity and can guide therapeutic interventions, particularly corticosteroid therapy. These findings support incorporating cortisol level monitoring into sepsis management to enhance patient outcomes. Further research is needed to optimize treatment strategies and fully leverage serum cortisol’s potential in sepsis care.

Droplet transmission is one among the most common methods of transmission of communicable diseases. Respiratory hygiene practices are effective to break the transmission. This study was aimed at assessing the effectiveness of nurse education and display materials in improving the respiratory hygiene practices among admitted patients. Visual alerts were placed at strategic locations in the ward and trained nurses explained cough hygiene practices to all the admitted patients. With the help of a pre-designed questionnaire the patients were enquired about their cough hygiene practises before and after implementation of the intervention. Results show that pre-interventional only 16.7% participants covered their cough always. After the intervention was implemented, there was an increase in compliance to the cough etiquette maneuvers- tissue usage increased by 26.2% and usage of flexed elbow by 54.74% from 7.1% and 3.6% respectively. Thus the study shows that nurse education and display materials are effective measures that help in increasing the awareness of respiratory hygiene.

Introduction: Laparoscopic cholecystectomy (LC) is considered the gold standard treatment for most of the gallbladder diseases. The advantages of LC bowel function returns normal very early, reduced post-operative pain, cosmetic, shorter hospital stay and early return to full activity. At times LC has becomes difficult. It is very difficult to predict preoperatively, whether it is easy or difficult. The degree of difficulties in LC is again impossible to predict. At present, there is no standard scoring system to predict the degree of difficulty preoperatively. In this study, we have made out a scoring system for predicting the difficulty preoperatively and correlate with our intraoperative degree of difficulty. Methodology: This study was done as a prospective observational study among patients admitted to Tirunelveli Medical College for a period of 18 months and classify them as EASY/DIFFICULT based on surgical outcome by various factors by “MAKM Vivek et al” scoring system, which includes 44 factors. Perioperative factors like age, sex, BMI, previous surgeries, altered biochemical parameters and features of USG were evaluated followed by intraoperative factors. Procedure were defined as easy or difficult as below: Easy: time taken around 60 -90 mins, no bile spillage, no injury to duct, artery. Difficult: Time taken > 90 mins, bile/stone spillage, injury to duct, conversion to open. Results: In our study population of 30 patients, 11 were less than 40 years, 10 were 51-60 years, 8 were in 41-50 years rest one patient was above 60 years. 11 were male and rest 19 were female in our study. On USG, distended gall bladder was seen in 27% of patients. In our study population 19 patients, required less than 90 minutes for surgery and 11 patients required more than 90 minutes for surgery.  Adhesion was seen in 33% of patients. Calculi was present in 27% of patients, bile stone/bile duct injury was seen in no patients. In our study, population in two patient’s laparoscopy was converted in open. Drainage removal was done in more than 1 week in 2 (7%) of patients. Comparing with Vivek et al scoring, we had   similar outcome, during our surgery too, all cases predicted as difficult by Vivek et al had difficult surgeries. Conclusion: Elderly patients are more likely to have a difficult LC. Females undergo this surgery more frequently but males tend to have a higher number of difficult cases. Recurrent cholecystitis is a predictor obese patient and those with recurrent cholecystitis tend to have more difficulties during surgery. Previous surgery predisposes towards difficulties in cholecystectomy.

Introduction: Dacryocystorhinostomy (DCR) is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct obstructed. This study aimed to compare the success rates of two different techniques in endonasal endoscopic DCR; namely single and double mucosal flap techniques. Methods: After getting Institutional Ethical Committee approval, retrospective analysis of records of patients who underwent External DCR for primary nasolacrimal duct (NLD) obstruction was done. Patients were divided into the single-flap technique and the double-flap technique groups. Success was defined as the achievement of patency of the NLD throughout the period of follow-up with significant improvement in epiphora. Time taken for the surgery was analysed. Results: The mean age in group A was 50.6 yrs and 51.25 yrs in Group B. The surgical time was 39.7minutes AND 40.5yrs in Group A and Group B respectively. There was no recurrence in any of the cases. Conclusion: In our study, there was no difference in surgical success in patients undergoing single and double flap external DCR surgery.

Background: Cystoid Macular Edema (CME) is a significant postoperative complication following cataract surgery. This study aimed to comprehensively analyze the incidence of CME and its correlations with diabetic status, retinopathy grades, surgical complications, and Non-Steroidal Anti-Inflammatory Drug (NSAID) use. Methods: A prospective cohort study was conducted at the Regional Institute of Ophthalmology, Trivandrum, spanning one year. The study included 325 patients aged over 40 years undergoing cataract surgery. Various factors, including diabetic status, retinopathy grading, surgical complications, and NSAID use, were assessed for their correlation with CME development. Results: Analysis of the demographic data revealed a predominant representation of patients aged 50 to 69 years (72%) and a slightly higher proportion of females (59.4%). The study demonstrated a higher incidence of CME in diabetic patients across different postoperative intervals, with statistically significant differences observed at the 6th week (34.1%) and 3rd month (29.7%) compared to non-diabetic individuals. Moreover, associations were observed between previous uveitis, surgical complications, and increased risk of CME post-cataract surgery. The study highlighted a potentially reduced incidence of CME in patients using NSAIDs postoperatively, especially in the early postoperative period. Conclusion: This study provides critical insights into the intricate associations between various factors and the incidence of CME following cataract surgery. The findings underscore the heightened risk of CME in diabetic patients and the potential impact of NSAID use, previous uveitis, and surgical complications.

Introduction: The most common extrapulmonary manifestation of tuberculosis (TB) is Tuberculous lymphadenitis. Extrapulmonary Tuberculosis is challenging due to the pauci bacillary nature of the disease and limited tests. The role of Cartridge based Nucleic Acid Amplification test (CBNAAT) in the diagnosis of lymphnode TB combined with Conventional Fine Needle Aspiration Cytology (FNAC) helps in early identification of Rifampicin resistant cases and initiating treatment at the earliest. Aim: To determine the significance of CBNAAT as an adjunct to Conventional FNAC to diagnose extrapulmonary Tuberculosis. Materials and Methods: This cross sectional observational study was conducted in the Department of Pathology in collaboration with the Department of Respiratory Medicine at Government Thoothukudi Medical College Hospital, Tamilnadu, India for a period of 12 months (from January 2023 to December 2023) on 120 samples of Head and Neck palpable lymph node lesions. From the fine needle aspirates smears were prepared for Haematoxylin and Eosin staining. The residual material from the aspirate will be rinsed into normal saline in Falcon tube, incubated at room temperature and processed for CBNAAT testing. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: A total of 120 cases were included in the final analysis. In our study youngest patient was 10 months and oldest was 65 years. Female preponderance was noted. Maximum number of cases was in 3^rd decade. Out of 35 cases with FNAC findings favouring EPTB, 9 were CBNAAT positive and 26 were CBNAAT negative. Out of 85 cases with negative FNA findings, CBNAAT was positive in 1 case. The sensitivity of CBNAAT in our study was 25.7% and specificity was 98.8%. Positive predictive value was 90%, Negative predictive value was 76.3% and Diagnostic accuracy was 77.5%. Conclusion: CBNAAT can be added with FNAC to get more specific results. Use of CBNAAT alone for diagnosis of EPTB may result in missing the diagnosis. Combined modality incorporating FNAC and CBNAAT is the best approach for diagnosis of EPTB.

Aim & Objectives: The aim of this study is to determine the imaging characteristics of acquired white matter diseases on Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) and also to determine age and sex distribution of different acquired white matter diseases in patients at Silchar Medical college and Hospital. Material & Methods: The main source of data for this study was the patients referred from the Department of Medicine and other departments of Silchar Medical College and Hospital. All Patients referred for radiological evaluation with clinically known or suspected pathologies of various acquired white matter diseases were included in the study. The study was carried out for a period of 1 year from March 1, 2023 to February 29, 2024. MRI evaluation was carried out using SIEMENS TIM AVANTO 1.5T SCANNER. Various conventional and advanced MR pulse sequences with/without contrast was used. MRI and MR Spectroscopy was done in all cases and DWI was done whenever indicated. Results: A total of 50 patients with different acquired white matter diseases on MRI were studied over a study period of 1 year. Out of 50 patients, those diagnosed with infections were 23 (46%), vascular causes were 16 (32%), inflammatory causes were 8 (16%) and toxic causes were 3 (6%). Males were more affected in our study (58 %) as compared to females (42 %). Among male patients, the highest number of acquired demyelinating disease were found between 41-50 years age-group and among female patients, most commonly affected age group were 31-40 years. In most of the acquired demyelinating diseases, patchy and asymmetrical involvement of lesions is noted. Periventricular white matter involvement is more commonly seen than subcortical white matter. Almost all acquired demyelinating diseases have “decreased N-acetylaspartate (NAA)” level and “increased choline (Cho)” levels. Lactate peak is observed in acute phases of the demyelinating diseases. “Decreased N-acetylaspartate/Creatine (NAA/Cr) and increased choline/creatine (Cho/Cr) ratio” was noted in all acquired demyelinating diseases. Conclusions: The recognition of new mechanisms of disease and recent advances in therapy, with refinements in MRI diagnosis and follow-up, make white matter diseases one of the most rapidly evolving fields of knowledge.

Tuberculosis is caused by Mycobacterium tuberculosis, an acid-fast bacillus. The most common form of TB is pulmonary tuberculosis and can also cause extra pulmonary Tuberculosis. Nowadays we are facing the co-infection with HIV and the emergence of MDR-TB, XDR-TB. In developing countries like India, it causes major public health problem. The delay in diagnosis and the improper treatment are the important causes of mortality. In India, in our health care setup we mainly depend upon the Sputum Microscopy. The sputum microscopy and culture both of the diagnostic methods are very important for the diagnosis of Tuberculosis. This study was conducted to compare and evaluate the efficacy of Microscopy (Zeihl Neelsen Technique) and conventional Culture methods (Solid medium-Lowenstein Jensen Medium, Liquid Medium-Middle Brook 7H9 Broth supplemented with OADC) in suspected 150 cases of pulmonary tuberculosis attending Thoracic Medicine and General Medicine OPD at Thanjavur Medical College. Sputum samples were collected and processed for acid fast staining(ZN)and culture(Solid medium-Lowenstein Jensen Medium and Liquid medium-Middle Brook 7H9 Broth).Among the 150 sputum samples, AFB positivity in concentrated sputum AFB staining by Zeihl Neelsen Technique-37(25%), Culture positivity in Lowenstein Jensen Medium(Solid egg based medium)- 48 (32%), Culture positivity in Middle Brook H9 broth (Liquid based medium)- in 54 samples (36%). All Sputum samples were processed for CBNAAT (Catridge Based Nucleic Acid Amplification Tehnique-Gene Xpert-MTB/RIF), 54 samples detected positive, among this Rifampicin Resistance (rpo B gene mutation) positivity is detected in one sample. This study confirmed that combination of Sputum microscopy by Zeihl Neelsen Staining Technique, culture by solid or liquid medium and CBNAAT is the gold standard method for the diagnosis of pulmonary tuberculosis.

Background and Aim: It is widely reported that pain is a very common issue experienced by individuals after undergoing surgery. Various techniques are used to reduce pain, promoting early mobility and faster recovery. In this study, we aimed to compare the effectiveness of transversus abdominis plane block and local wound infiltration in providing pain relief after caesarean section. The study was conducted in a randomised double-blind manner, with the use of bupivacaine and clonidine. Material and Methods: A group of one hundred women between the ages of 18 and 35, who are members of the American Society of Anaesthesiologists (ASA) The study included individuals who had undergone a lower segment caesarean section and were classified as having a physical status of I or II. The patients were divided into two groups of 50 each, Group A and Group B, using a computer-generated random list. Group A was administered TAP Block with 40 ml of 0.25% Bupivacaine on both sides, along with 1 µg/kg clonidine in divided doses. In contrast, Group B received 40 ml of 0.25% Bupivacaine and B µg/kg clonidine. The VAS score was evaluated at regular intervals, as is customary in health journalism. The duration of pain relief and the amount of tramadol needed within a 24-hour period were measured and compared. Results: it was observed that there was a notable decrease in VAS score values between 2-6 hours in group A compared to group B. The statistical significance level was found to be less than or equal to 0.05. No significant difference was observed at 8, 12, and 24 hours. The highest mean VAS score values were observed at 8 hours in both groups. Group L had a score of 5.37±0.68, while group T had a score of 5.45±0.88. Group B had a VAS score of >4, with a mean of 4.71±1.12 at the 4-hour mark. There was no notable distinction between the two groups, indicating that both groups had similar pulse rates. No instances of bradycardia were observed in either group. Conclusion: The TAP block has proven to be a highly effective method for providing postoperative pain relief to patients who have undergone a caesarean section. In addition to extending the duration before the first rescue analgesic is needed, the TAP block also reduces the overall amount of analgesics required.

Students adopt multiple learning styles in internalizing information. Some like to learn by visual (V), auditory (A), read/write(R) and kinesthetic (K) modalities. A cross-sectional study was conducted among 60 medical students of the first year MBBS students of PGS IMSR to determine the prevalence of learning styles among students. VARK inventory questionnaire was administered to determine the preferred instructional mode based upon the four sensory modalities. Results of the study revealed both male (52%) and female (60%) students preferred unimodal information presentation, and 48% of males and 40% of females followed multiple modes of information presentation In our study, no gender differences in any of the specific preferences tested and none of these differences reached statistical significance. Understanding a student’s learning style preference is an important consideration when designing classroom instruction. It is the responsibility of the instructor to address this diversity of learning styles and develop appropriate learning approaches.

Introduction: Obesity is a condition characterized with an increase in size and amount of fat cells in the body. Obesity is caused by imbalance of energy intake (“Diet”) and energy expenditure (“physical activity”). In the present world, there is a major epidemic of Obesity and many obese patients suffer with respiratory symptoms and disease. Obesity can affect the thorax, diaphragm and abdominal muscles, thereby resulting in altered respiratory functions. In this retrospective study, BMI was correlated with COPD (Chronic Obstructive Pulmonary Disease) and the variations in respiratory parameters were noted down. Objectives: (1) Primary objective: To assess the significance between BMI and COPD. (2) Secondary Objective: To propagate the results among the general public about the correlation between Obesity and COPD. Methodology: The pulmonary function test data were randomly selected. This is a retrospective study. The data was obtained from the procedure performed for the diagnosis of patient’s condition. About 60 spirometric values were used for the study (40 subjects with COPD / 20 subjects with normal PFT values). The criteria for COPD diagnosis was airflow limitation irreversible with bronchodilator or only partially reversible with bronchodilator. The best PFT indicator is low FEV1 / FVC ratio below 70% of predicted values. Result: The association between pulmonary function test and BMI was done. There is moderately positive correlation between FEV1 and BMI and similarly between FEV1/ FVC % and BMI. Pearson correlation coefficient analysis was done. P – Value <0.05 was considered to be statistically significant. Conclusion: The purpose of this paper is to determine if there is an association between obesity level and prevalence of COPD. The obesity epidemic poses a new challenge to health professionals caring for patients with chronic respiratory diseases. The impact of obesity on COPD has been much less studied. So there should be an increase in quantity and quality of studies on the association between BMI and COPD in the medical world.

Background: This study investigated the impact of lifestyle habits such as smoking and alcohol consumption on semen quality. Semen analysis is a crucial, cost-effective method of evaluating male infertility. Methods: The study was conducted at Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, from January 2023 to June 2024, which included 139 male participants aged 20 years and above. Semen samples were collected and analysed for various parameters, such as semen volume, sperm concentration, sperm motility, and morphology. Results: Significant differences were observed between smokers and non-smokers, as well between alcoholics and non-alcoholics. Non-smokers and non-alcoholics exhibited higher semen quality compared to their counterparts did. Statistical analysis revealed that sperm concentration was significantly different (p < 0.001) between non-alcoholics and alcoholics. Conclusion: Lifestyle choices such as smoking and excessive alcohol consumption adversely affect semen quality. Abstinence from these habits can enhance reproductive health and semen quality.

Adoption of healthy lifestyle by using Sudarshan kriya yoga, meditation and physical exercise interventions in the early course of development of hypertension i.e. in prehypertension stage is useful to prevent emergence of hypertensive cases and improvement of their quality of life. A randomized controlled trial was performed to assess the effect of Sudarshan Kriya Yoga (SKY) and Physical Exercise (PE) on SBP, DBP, PR and QOL in prehypertensive subjects. In this study 100 prehypertensive subjects of either gender, age group (30-60 years) were divided into SKY and PE groups having 50 subjects in each group at SP Medical College Bikaner. They were undergone regular practices of SKY and PE respectively, one hour daily for the duration of three months. Statistically significant decrease was noted in SBP, DBP, PR and improved QOL score (p<0.001) after three months of regular SKY practices. Physical exercise performed was brisk walking which after three months showed statistically significant decrease in SBP, DBP and PR along with improvement in QOL of the participants. SKY and PE interventions have resulted in decreased blood pressure and pulse rate along with improved quality of life. This is indicative of autonomic nervous system balance with increased parasympathetic activity, sympathetic inhibition and improvement of many systemic functions so they can be applied as a mass approach for prevention & control of hypertension and improvement of quality of life.

Introduction: The significance of non-communicable diseases (NCD) in public health is increasing globally, particularly in urban areas. This study focuses on the occurrence and predictors of NCD risk factors among the adult population. The findings aim to reveal a range of behavioural and socio-demographic traits that contribute to NCDs risk thus providing important information for targeted treatment measures. Methods: A multistage random sampling technique was employed in conducting a cross-sectional survey among selected individuals. A structured table was used to collect data on NCDs risk factors. Various risk factors including smoking, alcohol consumption, physical activity level, occupation and poverty status were analysed. Logistic regression method was employed by researchers to identify major causes of these risks. Results: It was found that most individuals had behaviours that were not optimal for their health. Majority smoked tobacco, consumed alcohol while some are poor diets and had weight problems. Out of every four persons, 25% were obese or overweight whereas 29% had high blood pressure readings. Males took more alcohol than females did. Overweight and obesity was common between ages 30-60 years, married people, and certain ethnic groups. Conclusion: This study concluded that public healthcare policies need to be put in place rapidly given these results as it shows the rise in number of chronic conditions that are difficult to prevent or manage like cardiovascular diseases due to lifestyle practices such as smoking and unhealthy dieting which can easily be avoided through simple education campaigns programs. Monitoring strategies should be well implemented alongside interventions aimed at minimizing the occurrence of NCD risk factors.

Background:  Small intestinal perforation peritonitis is a surgical emergency that has been a challenge for surgeons for centuries. Regardless of its cause, all cases of small intestinal perforation present similar clinical features leading to peritonitis with severe secondary bacterial infection, making it necessary to study this condition as a single entity. The present study was undertaken to determine the outcome of surgical management of small intestinal perforation. Methods: Following the diagnosis of perforation peritonitis, patients were resuscitated and prepared for exploratory laparotomy. During surgery, pathological findings were observed and addressed accordingly. Data was recorded using a comprehensive working proforma, which included relevant demographic details, clinical findings, and radiological and pathological information. Patients were monitored postoperative to assess complications, morbidity, and mortality rates. Results: Non-traumatic small intestine perforations predominantly affected young to middle-aged adults, with males accounting for 65% of cases. Abdominal pain was the universal presenting symptom in 100% of cases. Other common symptoms included vomiting (75%), constipation (55%), fever (47.5%), and loose motions (12.5%). Significant abdominal signs were guarding and rigidity (97.5%), rebound tenderness (87.5%), distension (95%), obliteration of liver dullness (87.5%), and absent bowel sounds (90%). Typhoid and nonspecific inflammation were the most common causes, accounting for 37.5% and 35% of cases, respectively. Tuberculosis, jejunal diverticulosis, and Meckel’s diverticulum were less frequent, representing 20%, 5%, and 2.5% of cases, respectively. Simple closure with drainage was the most common surgical procedure. Conclusions: Small intestinal perforation is a severe condition with high morbidity and mortality, predominantly affecting young and middle-aged males. Key symptoms include deep abdominal pain, vomiting, and fever, often caused by typhoid or nonspecific inflammation. Early diagnosis, surgical intervention, and strict aseptic care are crucial for improving outcomes.

Background: Infected wounds, especially those involving antimicrobial-resistant microorganisms, impose a substantial physical, psychological, and economic burden on patients and society. The considerable resources required to treat such wounds. The objective of the current study was to determine the rate of soft tissue infections and perform antibiotic susceptibility testing on bacterial pathogens isolated from soft tissue-infected patients at a Teaching Hospital in South India. Methods: A total of 190 wound specimens (open and closed), including pus and wound swabs, were processed in the laboratory of Teaching Medical College. The specimens were cultured on Blood Agar and MacConkey agar and incubated at 37°C for 24 hours. Antibiotic Susceptibility Testing was performed using the modified Kirby-Bauer disc diffusion method, identifying multidrug-resistant (MDR) bacteria and methicillin-resistant Staphylococcus aureus (MRSA). Results: A total of 190 samples were collected for the study and 100 samples showed growth of microorganisms. Age-related variations in the incidence of soft tissue infections were observed, with a higher prevalence among the 31- 40 age group. The predominant strain isolated was Staphylococcus aureus, followed by Gram-negative bacteria like E. coli and Pseudomonas aeruginosa. There was a high prevalence of antibiotic resistance among key pathogens, such as E. coli, K. pneumoniae, and Acinetobacter spp. These infections are increasingly difficult to treat due to rising antibiotic resistance, particularly among Gram-negative organisms. While newer antibiotics are effective, prudent use is crucial to prevent further resistance development. Conclusion: The antibiotic susceptibility pattern indicated that Gentamicin, Amikacin, Levofloxacin, Piperacillin/Tazobactam, and Doxycycline were effective against Gram-negative bacteria. For Gram-positive organisms, Amikacin, Teicoplanin, Linezolid, Doxycycline, Gentamicin, and Azithromycin were most effective. Thus, these antibiotics may be recommended for empirically treating soft tissue infections.

Background: The most prevalent metabolic disease in pregnancy is gestational diabetes. Risk factors for gestational diabetes are not being fully recognised. Several studies have found a link between higher iron reserves and an increased chance of developing type II diabetes in non-pregnant people, which has led to grave worries about this possible risk factor in pregnancy also. Objective: With the goal of measuring serum iron, TIBC, and ferritin levels in patients with diabetes in pregnancy and in pregnant women who appear to be in healthy conditions, this study seeks to determine if diabetes in pregnancy, including GDM, is connected with the iron status. Method: A hospital-based observational, cross-sectional study involving 50 diabetes in pregnancy cases and 50 controls who appeared to be in good health was conducted. In both cases and controls, the mean serum ferritin, iron, and TIBC levels were assessed. Results: In this study, we discovered that the mean serum ferritin levels in cases of pregnancy with diabetes were 200.7 ± 6.66, while they were 133.3 ± 6.04 in normal pregnant controls. This difference was statistically significant, indicating an increase in serum ferritin levels in DM patients compared to normal pregnant women. However, when the mean blood iron levels and mean Total Iron Binding Capacity values of cases and controls were examined, it became clear that there were no appreciable differences between the groups of patients with pregnancy-related diabetes and the controls in these parameters. Conclusion: According to the current study’s findings, a significant risk factor for the onset of gestational diabetes is a high plasma ferritin level. This could pose issues with the advice to all pregnant women to take routine iron supplements.

Context:  Direct  laryngoscopy and endotracheal intubation directly affect severe sympathoadrenal responses, which increase arterial blood pressure, catecholamine levels, heart rate, and dysrhythmias in some cases. Aims: This study was aimed to compare the effect of dexmedetomidine and esmolol on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing Laparoscopic surgeries under general anaesthesia. Settings & Designs: Interventional tertiary care hospital based prospective randomised study. Materials & Methods: A total of 70patients were selected and randomised into two groups. Group A received inj. Dexmedetomidine 0.5mcg/kg IV diluted with 10ml normal saline and injected IV slowly over 10minutes and Group B patients will receive inj. Esmolol bolus 0.5mg/kg diluted to 10 ml. 3minutes after the completion of infusion patients were induced with general anaesthesia Baseline parameters such as heart rate(HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure(MAP), were recorded before administration of study drugs and at 1,3,5,7, and 10minutes after intubation. Results: Mean HR, SBP, DBP, MAP values remained significantly lower in Group A than that of Group B at all time intervals up to 10minutes after intubation. Conclusions: Both drugs suppressed  hemodynamic response to intubation, but dexmedetomidine is more effective than esmolol in maintaining hemodynamic stability following laryngoscopy and intubation.

Introduction: Ambulatory surgery stands as a vital component within global healthcare systems, offering patients elective procedures with discharge within 72 hours. It serves as a crucial link between inpatient and outpatient surgeries, fueled by technological advancements, patient preferences for shorter hospital stays, and cost-effective healthcare delivery models. The approach yields benefits such as reduced complications; shorter hospital stays, and improved resource allocation. Aim: To assess the feasibility, benefits, and complications associated with ambulatory surgeries. Objective: To Evaluate acceptability and practicality of ambulatory surgery. (1) Safety of the patients. (2) Different types of ambulatory surgeries. (3) Post-operative complications. (4) Readmissions. (5) Safety of the patients. Methods: It was an observational study done in the department of the general surgery in Rohilkhand Medical College and Hospital, Bareilly from 1 December 2022 to 31 November 2023. The study analyzed data from 360 adult patients undergoing various types of ambulatory surgeries over one year. Result: The mean age of the patients was 39.74 years, with an almost equal distribution of males (51%) and females (49%). Overall, 8% of patients experienced postoperative complications, with only 2.2% requiring extended hospital stays (>72 hours). Surgical complications accounted for 68% of total complications, while anesthesia-related complications constituted 32%. Conclusion: In conclusion, the study indicates that ambulatory surgeries are safe, beneficial, and feasible, with minimal mortality and a low rate of extended hospital stays and unplanned readmissions. Nevertheless, challenges persist, including patient selection appropriateness and post-operative complications. Addressing these hurdles demands multidisciplinary collaboration, standardized guidelines, and comprehensive care strategies. Key elements encompass preoperative evaluations, patient education, and postoperative monitoring. Advancing ambulatory surgery necessitates on-going research, exploring regional and institutional nuances to refine patient identification, post-operative care, and overall satisfaction. With dedicated efforts for continuous improvement, healthcare systems can harness the advantages of ambulatory surgery while effectively managing its challenges, ultimately enhancing patient outcomes and system-wide efficiency.

Background: Approximately 3% of all babies worldwide have experienced respiratory distress, which can take many different forms, including respiratory and non- respiratory illnesses. Objective: To determine the various etiology of the respiratory distress in neonates and to study the spectrum of initial clinical presentation, progression and recovery of the respiratory distress with respect to scoring system.  Methods: This cross-sectional study was conducted in all neonates with respiratory distress admitted to Neonatal intensive care unit at Rohilkhand medical college and hospital, Bareilly, Uttar Pradesh Duration of study was 1st November 2022 – 31st October 2023. Results:  Among 144 neonates, males were predominant at 68.75% (90 babies), while females were 31.25% (54 babies). The majority of the neonates (62.5%) weighed between 1500-2500 grams.  Out of 144 neonates, a significant portion (65.97%) was preterm (born before 37 weeks). For neonates with respiratory distress, the survival rate was 56.94% (82 out of 144), while the mortality rate was 13.88% (20 out of 144), underscoring the serious impact of respiratory conditions. Respiratory distress syndrome was a major cause with 74.07% survival (40 out of 54). The severity of respiratory distress in preterm neonates showed 54.73% (52 out of 95) had moderate distress, and 31.57% (30 out of 95) severe, indicating a substantial need for targeted medical interventions. A majority of neonates showed mild distress (61.22% or 30 out of 49), with 14.28% (7 out of 49) exhibiting severe distress, providing insight into the variability of distress severity. Neonates with an APGAR score greater than 7 had a high survival rate of 93.75% (90 out of 96), reinforcing the APGAR score’s predictive value for neonatal survival. Conclusions: Using the Silvermann Anderson and Downe scoring systems, the study effectively categorized the severity of respiratory distress, aiding in the customization of treatment plans. The outcomes data underscored a high rate of neonate discharges but also a concerning mortality rate, highlighting the need for ongoing enhancements in neonatal care.

Introduction: Hyponatremia, characterized by a lower-than-normal concentration of sodium in the blood, stands as one of the commonly encountered electrolyte imbalances in clinical settings. Its prevalence among hospitalized adults underscores its clinical significance and warrants the necessity for a deeper understanding of its manifestations and prognostic implications. Aim: A clinical study of hyponatremia on presentation and its prognostic outcome in patients admitted to a tertiary care hospital. Materials and Methods: It is a cross-sectional study done in the Department of General Medicine, Rohilkhand Medical College and Hospital Bareilly from 1 November 2022 to 31 October 2023. 100 patients with hyponatremia on presentation admitted to Medicine IPD were included in the study. They were evaluated for cause of hyponatremia based on history, clinical examination and laboratory investigations. Data was analyzed using descriptive statistics and appropriate tests. Results: This study of 100 hyponatremia patients revealed a balanced gender distribution (1:1 male-to-female ratio) and a unique age profile, with the most common age group being 18-30 years, likely due to regional factors such as dengue fever and tuberculosis. Nausea and vomiting were the most prevalent symptoms, and patients presenting with these symptoms had a better prognosis compared to those with severe symptoms like altered sensorium or seizures. Euvolemic hyponatremia was most common, with tuberculosis being a major cause, and high urinary sodium levels (>20 mmol/L) were prevalent, aiding in diagnosis. Severe hyponatremia was more common than moderate, and treatment varied based on the underlying cause, including normal saline for hypovolemic cases and tolvaptan for hypervolemic cases. Conclusion: In conclusion, this study provides valuable insights into the demographic, clinical, etiological and prognostic aspects of hyponatremia in a specific regional context. The clinical physician should always be aware to identify early on the patients presenting with hyponatremia and they should be intricately evaluated for etiology. A deep understanding of clinical presentation, pathophysiology and regional variations are key in management of hyponatremia.

Introduction: The pancreas is an important part of the gastrointestinal system because it digests food and produces enzymes that break down fats. Acute pancreatitis is an inflammatory illness characterised by the death of acinar cells and inflammation in both the local and systemic domains. The disease ranges from mild to severe. The Neutrophil-Lymphocyte ratio (NLR) is an effective predictive indicator in acute pancreatitis, showing cellular immunological activation, stress, and systemic inflammation. This study intends to fill a gap in research on NLR in acute pancreatitis in India, allowing for better disease management and timely intervention. Aim: To determine the Neutrophil to lymphocyte ratio (NLR) among acute pancreatitis patients and evaluate its prognostic significance. Methods:  The study was conducted on 227 patients, where patient data was collected on day 0, 1 and 2 and analysed for the viability of the neutrophil to lymphocyte ratio in predicting the adverse effects of AP. Results:  The study had the following findings. (1) The proportion of males having AP (84.58%) was higher than females (15.42%). (2) Mean age for AP was 42 years. (3) The severity among patients was mild (150) and severe (40). (4) Change from Day 0 to day 2 was only significant in severe category of Atlanta classification. Conclusions: My study has shown that NLR is a reliable indicator of necrosis in situations of acute pancreatitis.  As a basic investigation, it incurs no additional fees for the patient. NLR has a high association with the prediction of necrosis in patients of acute pancreatitis. Consistent daily observation will provide a dynamic represent of the host’s immune response to pancreatitis, allowing for the prediction of necrosis in the patient. The NLR ratio evaluates the severity of acute pancreatitis on multiple days (day 0, 1, 2) and predicts the patient’s prognosis and outcome in terms of acute pancreatitis.

Objectives: The present study was done to see the histopathological changes in the placenta of Pre-Eclampsia (PE) mothers when compared to that of the normotensive mothers. Methods: A comparative study was done on 100 fresh placenta were collected from the labour room of NRI institute of medical sciences [50 normal (controls), 50 Pre-Eclampsia (cases)] and they were observed for any gross structural changes like presence of calcifications, retro-placental haematomas. Sections were taken from the placenta and histopathological study was done to see the presence of syncytial knots, fibrinoid necrosis, stromal fibrosis and calcifications in HE staining under compound microscope. The results were analysed using SPSS 17 software. Results: In the present study pre-eclampsia was found to be more common in females of the age group 21-25 yrs (36 out of 50 cases i.e, 72%). Out of the 50 placenta collected from pre-eclampsia cases 20(40%) have shown infarction, 26(52%) have shown calcifications, 11(22%) have shown retroplacental clots macroscopically and 27 (54%) cases have shown syncytial knots, 22 (44%) cases have shown fibrinoid necrosis, 26(52%) have shown stromal fibrosis 18(36%) have shown calcifications and,14(28%) have shown infarcts as microscopic features. The mean foetal birth weight  (1946.32) and mean placental weight (420.04) is significantly low in the cases when compared to the  mean foetal birth weight (2854.04) and placental weight (504.00) in the controls with a p- value less than 0.001 making the study statistically significant. The Apgar score after 5 min was reduced in the babies of pre-eclampsia cases ( p value<0.001) suggesting hypoxia and 3 out of 50 babies were admitted in NICU for further management. Conclusion:  Based on the histopathological changes noted in the study it can be concluded that preeclampsia has adverse effect on morphology of placenta and consequently affects the foetal outcome. Hence the knowledge about the histopathological changes would be important to the gynaecologists in treating the subsequent pregnancies. Every effort should be made to prevent PE and severe forms of PE by giving prophylactic medications like low dose aspirin and calcium supplements in their subsequent pregnancies and women at high risk of developing PE.

Background: Caudal epidural anesthesia has many applications, including surgical anesthesia in children and adults, as well as the management of acute and chronic pain conditions. The addition of various adjuvants (such as epinephrine, opioids, ketamine, alpha-2 agonists) to the local anesthetics during caudal block can improve the quality of anesthesia while providing consistent analgesia and thus reducing the risk of emergence delirium. We aimed to compare caudal ropivacaine alone versus combining dexmedetomidine to caudal ropivacaine in controlling pain in children and thereby preventing emergence delirium, a distressing adverse effect of anesthesia. Methods: In this prospective, randomized, parallel group study, sixty children (aged 1-6 years) belonging to American Society of Anaesthesiologists physical status I & II scheduled for elective lower abdominal surgeries were were randomly assigned into two groups:
Group RD (n=30) – Caudal 0.25% Ropivacaine 1ml/kg with Dexmedetomidine 2µg/kg;
Group R (n=30) – Caudal 0.25% Ropivacaine 1ml/kg, volume according to body-weight and type of surgery. Caudal block was given after induction of general anaesthesia using sevoflurane. The patient was observed for appearance of post-anaesthestic agitation (Watcha score), duration of analgesia, pain scores (FLACC, CHIPPS SCALE), intra-operative and post-operative complications. Results: The mean duration of analgesia in RD group (13.66 ± 0.79) hours was significantly higher than in R group (8.32 ± 0.66) hours. The WATCHA score for emergence delirium was significantly lower in RD group (1.47 ± 1.13) compared to R group (2.57 ± 1.04) with a p-value of < 0.001. Post-operative pain scores (CHIPPS and FLACC Score) were drastically lower in RD group. Conclusion: Dexmedetomidine when added to Ropivacaine as adjuvant to caudal blocks, prolongs duration of analgesia and prevents emergence agitation in pediatric patients.

Background: The latest anti-tubercular drug resistance surveillance data show that 3.5% of new and 18% of previously treated tuberculosis cases in the world are estimated to have multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). India accounts for about one-fourth of the global burden of MDR-TB. Emergence of drug resistant has been a serious threat to eliminate tuberculosis, End TB 2025. The estimated number of MDR/RR – TB cases in India is 124000 (9.1/lakh population). A total of 109 countries are using all – oral longer regimens for the treatment of MDR/RR – TB. Objective: To assess the effectiveness of the Bedaquiline containing regimen. To analyse the factors affecting treatment outcomes of rifampicin resistant, multi drug resistant pulmonary tuberculosis patients treated with Bedaqulline containing regimens. Methods: We studied cases of rifampicin and multidrug resistant tuberculosis registered at drug resistant tuberculosis centre, Mysore. During the time period of January 2021 to march 2022. (14months) Patients were treated according to programmatic management of drug resistant tuberculosis guidelines. (PMDT) followed up with NIKSHAY mobile application. Results: 115 cases were studied, out of which 104 were drug resistant pulmonary tuberculosis, Based on line probe assay(LPA), drug susceptibility (DST) reports 50.96% RR -TB 31.7% MDR TB, 17.30% Pre XDR. 31 cases were treated with shorter Bedaquiline regimen, 73 cases were treated with all oral longer regimen. 86% patients had past history of treatment with first line antitubercular treatment under national programme. 4 cases were co-infected with tuberculosis and human immune deficiency virus. 53 cases cured, 20 cases treatment complete, 8 lost follow up, 3 failure, 20 died. Cure rate of Bedaquiline containing regimen in RRTB-50.9%, MDRTB-54.5%, Pre XDRTB-44.4%. Most common comorbidity associated was diabetes, most common adverse reaction was associated with linezolid-anaemia, bicytopenia; Cycloserine – psychiatry issues, clofazimine -hyperpigmentation. In 4 cases regimen was changed from shorter to AOLR regimen based on LPA, DST reports. In 6 cases AOLR regimen was modified due to adverse events. Conclusion: In our present study treatment cure rate was 50.96%. Patients treated with Bedaquilline regimen for DRTB showed lower mortality, and fewer manageable adverse events, indicating improved tolerance and compliance compared to previous treatments.

Post-menopausal women presenting with features of hyperandrogenism is a diagnostic challenge for clinicians. Female virilisation can be caused by androgen excess originating either from the adrenal gland or ovary. Adrenal hyperandrogenemia is caused by primary adrenal tumors, adrenocorticotropic hormone-producing tumors such as Cushing disease, or congenital adrenal hyperplasia, while ovarian hyperandrogenism is caused by PCOS or androgen-producing tumours of the ovary. We present a rare case of Lipid cell tumour which needs to be considered in the differential diagnosis in a postmenopausal woman presenting with virilizing symptoms and highlight the importance of early diagnosis and management.

Objectives: The present study was to evaluate the therapeutic efficacy of tacrolimus in vernal keratoconjunctivitis patients of different age group in a tertiary care center. Methods: Tacrolimus 0.03% ophthalmic solution was administered to patients twice daily after discontinuation of all previous topical medications. The duration of treatment ranged from 1 month to 9 months. The variation in the duration of treatment with topical tacrolimus solution was attributed to the differences in the response to treatment among patients. The treatment was continued during active disease with periodic attempts to withdraw tacrolimus eyedrops whenever possible. On the last follow-up visit, all patients were evaluated for improvement in subjective symptoms, including itching, redness, foreign body sensation, and discharge. They were also evaluated for improvement in clinical signs, including conjunctival hyperemia, conjunctival papillary hypertrophy, limbal infiltration, Trantas dots, and superficial punctate keratopathy. Results: A total of 50 patients with age group 5 to 45 years were included.  Most of the patients were in age group of 5 to 15 years 20(40%) and 16 to 25 years 14(28%). Most of the cases 36(72%) were males. The main presenting symptoms were itching in 42(84%) patients, redness in 40(80%) patients, discharge in 28(56%) patients, and foreign body sensation in 11(22%) patients. Each of the symptoms were significantly (p<0.05) reduced by the application of topical tacrolimus 0.03%. Clinical signs included conjunctival hyperemia in 34(68%) patients, conjunctival papillary hypertrophy in 29(58%) patients, Trantas dots in 28(56%) patients, limbal hypertrophy in 31(62%) patients, and superficial punctuate keratitis in 13(26%) patients. Each of the clinical signs were significantly reduced (p<0.05) by the application of topical tacrolimus 0.01%. which was evaluated in last follow up.  Conclusions: The male childhood to young age populations is preponderance to VKC. And the 0.03% topical tacrolimus is the most effective for treatment of clinical signs and symptoms of all levels (mild to severe) of Vernal keratoconjunctivitis patients.

Background: Major orthopaedic surgeries including TKA, THA, and spinal surgeries often cause severe perioperative blood loss. This can cause consequences, including risky blood transfusions. In orthopaedic procedures, tranexamic acid, an antifibrinolytic, reduces blood loss. Aim: To evaluate the efficacy of tranexamic acid in reducing perioperative blood loss and the need for blood transfusions in patients undergoing major orthopedic surgeries at a tertiary care center. Methods: A retrospective observational study was conducted involving 130 patients who underwent major orthopedic surgeries, including TKA, THA, and spinal surgeries. Tranexamic acid was administered as part of the standard perioperative care protocol. Data were collected on demographic characteristics, perioperative blood loss, transfusion requirements, and any adverse events. Statistical analysis was performed using SPSS version 23.0, with significance set at p < 0.05. Results: Tranexamic acid treatment resulted in a considerable reduction of perioperative blood loss; the mean estimated blood loss for all procedures was 550.4 mL (SD±145.8). With only 19.2% of patients in need of transfusions, there was a dramatic decrease in the requirement for blood transfusions. Patients having TKA showed the greatest reduction in blood loss and need for transfusions. 3.8% of individuals experienced minor adverse effects, and no significant thromboembolic events were reported. Conclusion: Tranexamic acid is highly effective in reducing perioperative blood loss and the need for blood transfusions in major orthopedic surgeries, with a favorable safety profile. Its use should be considered a standard component of perioperative care in these procedures. Recommendations: Further research is recommended to standardize the dosage and administration protocols of tranexamic acid across different orthopedic surgeries to maximize its efficacy and safety. Additionally, prospective studies with larger sample sizes are warranted to confirm these findings.

Background: Elderly patients undergoing total joint arthroplasty frequently experience postoperative delirium, a serious complication that can result in higher morbidity, longer hospital stays, and long-term cognitive deterioration. Finding delirium risk factors that can be changed is essential to enhancing patient outcomes. Aim: To investigate whether a postoperative decrease in serum albumin levels independently predicts the development of delirium in elderly patients undergoing total joint arthroplasty. Methods: In this retrospective observational study, ninety senior patients (aged 65 and above) who underwent total joint arthroplasty were included. We gathered demographic information, serum albumin levels before and after surgery, and delirium rates. After adjusting for confounders, delirium and serum albumin reduction were examined in connection to each other using logistic regression. The statistical software SPSS 23.0 was used. Results: Of the patients, 24.4% experienced postoperative delirium (22 out of 90). Serum albumin levels decreased substantially more in delirium-affected patients (1.1 ± 0.4 g/dL) than in non-delirium-affected patients (0.6 ± 0.2 g/dL), with a p-value of less than 0.001. A almost fourfold increase in the probability of delirium was linked to each 1 g/dL drop in serum albumin, according to a logistic regression analysis (OR: 3.96, 95% CI: 2.02 – 7.76, p < 0.001). The best cut-off for delirium prediction, according to Receiver Operating Characteristic (ROC) curve analysis, was a serum albumin drop of >0.9 g/dL, with an AUC of 0.81, sensitivity of 72.7%, and specificity of 83.8%. Conclusion: A postoperative reduction in serum albumin strongly predicts delirium in elderly total joint arthroplasty patients. Monitoring serum albumin levels may help identify individuals at risk for postoperative delirium, allowing early management. Recommendations: Clinicians should regularly monitor older patients’ serum albumin levels after total joint arthroplasty and intervene to prevent large declines. Further prospective trials are needed to validate these findings and investigate postoperative serum albumin maintenance techniques.

Introduction: Medical education is currently undergoing experimentation with newer learning methods such as Self-Directed Learning (SDL). SDL has been promoted as a highly effective learning approach for medical students to attain competency. The purpose of this study is to introduce self-directed learning as new teaching learning method in gross anatomy for 1st MBBS students and to compare the score of students of SDL with that of traditional didactic lectures. Material and Methods: The present analytical study was conducted at Department of Anatomy, Malla Reddy Medical College for Women, Hyderabad among 150 first year MBBS students during the study period of one year (2020-2021). Selected students were divided into two batches A & B, with 75 students in each batch. A topic and a faculty was allotted to each batch. Learning outcomes and knowledge were assessed in both the methods. At the end of SDL session and didactic lectures, feedback was taken from the students on Likert scale. The data were analyzed using the SPSS software version 25.0. Results: It was found that the mean score of students in Batch A on self-directed learning was 8.41±1.83 and of Batch B in didactic lecture was 7.5±1.44 for the topic “Posterior triangle” and results were statistically significant with p value 0.0025. Mean score of Batch A on didactic lecture was 7.8±0.9 and of Batch B in self-directed learning was 8.9±1.9 for the topic “Muscles of mastication” and the results were statistically significant. Most of the students were neutral or agreed to the questions asked in the feedback form. Conclusion: Self-directed learning is new to medical students. Students liked this innovative learning strategy. Early medical education should include self-directed learning. This will boost the cognitive and psychomotor development of the student. Self-directed learning outperformed didactic teaching in assessment.

The tumours of posterior cervical space in posterior triangle of neck region are rare. Whereas benign tumours rarely occur in posterior cervical space, the metastatic squamous cell carcinoma is the most common lesion of posterior cervical space. The lesions occurring in this space can be characterized on the basis of features exhibited on different radiological diagnostic modalities, however final diagnosis can be made only on histopathological examination. Here CT findings of neurofibroma of posterior cervical space are reported which presented as a swelling in lateral aspect of neck. The contrast enhancement was comparable to the skeletal muscle and the lesion lacked fat density areas, necrotic areas and calcification. The mass had displaced the major neck vessels anteromedially.

Background: Hearing impairment in newborns, particularly those with high-risk factors, is a significant concern as it can impact speech, language, and cognitive development. Early detection through otoacoustic emission (OAE) testing is crucial for timely intervention. This study aims to assess the efficacy of OAE in detecting hearing impairment among high-risk infants and to identify associated risk factors. Methods: This prospective observational study was conducted over 18 months in the NICU of Owaisi Group of Hospitals, involving 50 high-risk infants. Infants were screened using OAE testing before discharge, with a follow-up screening for those referred. Further evaluation using Brainstem Evoked Response Audiometry (BERA) was conducted for infants who failed the second screening. Data were analyzed using SPSS, with statistical significance set at p < 0.05. Results: Out of 50 infants screened, 2 were referred, resulting in an incidence of hearing impairment of 4%. Meningitis was significantly associated with hearing impairment (p = 0.01), while other factors such as prematurity, low birth weight, and craniofacial anomalies showed no significant association. The study demonstrated the effectiveness of OAE as a screening tool in high-risk newborns. Conclusion: OAE testing is effective in early detection of hearing impairment in high-risk infants, particularly those with meningitis. Incorporating OAE into routine neonatal screening, especially in resource-limited settings, can facilitate timely intervention and improve developmental outcomes.

Background: POP Casts that are placed or applied for fractures and immbolisation. Throughout and following period during which casts are applied and after removal – cutaneous discomfort, itching, pain, and malodor are frequent, particularly in warm and damp surroundings. Clotrimazole is a synthetic imidazole with a broad spectrum of antimycotic activity. Methodology: A total of 60 patients were recruited with fractures of various parts of body such as of the distal radius, tibia, radio-ulnar shaft, as well as other limb components. The patients were included sequentially and divided into two groups: the Control group (n=30) and the Experimental group (n=30). A predesigned structured proforma was designed for the study which included the demographic profile of the patient, type of fracture experienced by the patient, type of cast placed, and positive or negative KOH prep test. Statistical analysis was done using SPSS (version 21.0) software. A level of p<0.05 was considered statistically significant. Results: Among 60 individuals with fractures, the control group included 21 (70 %) male patients and 9 (30 %) female patients, whereas the experimental group had 18 (60 %) male patients and 12 (40 %) female patients. The control group’s average age was 31 years, whereas the experimental group’s average age was 28 years. The most common site of fracture was the forearm in both control (63.33%) and experimental groups (50%). The KOH staining test of the skin scrapings of the patients in the control group and experimental group revealed significant differences in positive KOH staining. Conclusions: The alteration of skin texture and color following cast placement was discovered to be due to the development of mycotic infection underneath the cast which was identified with a positive KOH staining test. The application of clotrimazole powder before cast placement was associated with better skin conditions than skin conditions without applying clotrimazole powder.

Background: Hoarseness of voice is a common symptom that can be a precursor to a range of pathologies, from benign to potentially life-threatening conditions. This study aims to elucidate the demographic characteristics, occupational influences, and clinical outcomes associated with hoarseness, highlighting its significance in medical diagnostics. Methods: Conducted at the Department of ENT, Shadan Institute of Medical Sciences and Research Center from December 2016 to June 2018, this prospective study involved 60 patients presenting with hoarseness. Data collection followed a structured proforma, with diagnostic evaluations including direct and indirect laryngoscopy and biopsies where necessary. The study focused on adults with hoarseness, excluding those below 5 years or with neurological voice disorders. Results: The majority of cases were males (63.3%), predominantly within the 41-50 age range (28.3%). Occupational data indicated a higher prevalence of hoarseness among labourers (48.3%). Rural residents were more affected (58.3%) than urban dwellers. The most common laryngoscopic findings were ulceroproliferative growths (33.3%) and vocal fold congestion (30.0%). Conclusion: Hoarseness is influenced by demographic and environmental factors and can often indicate serious underlying conditions. The findings advocate for early diagnostic evaluation in patients presenting with hoarseness, particularly those engaged in high-risk occupations or living in rural areas.

Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus (DM) associated with significant morbidity and mortality. The current research aims at evaluating the clinical profile, precipitating factors and outcomes of DKA patients who are admitted to a tertiary care center. Methods: A prospective observational study was conducted on 33 DKA patients. Data on demographic characteristics, clinical features, precipitating factors, biochemical parameters, and outcomes were collected and analyzed. Results: The average age of the patients was 44.7±14.3 years, with a male predominance (57.6%). Type 2 diabetes (T2DM) was more common (75.8%) than type 1 diabetes (T1DM)(24.2%). The symptoms that presented most frequently were nausea/vomiting (66.7%), abdominal pain (45.5%), along with weakness (36.4%). Infections (57.6%) and noncompliance to treatment (45.5%) were the most common precipitating factors. The average blood glucose at admission was significantly greater in patients with T1DM than in T2DM (512.4±98.6mg/dl VS. 442.8±112.3mg/dl, p=0.041). The in-hospital mortality rate was 6.1%. Conclusion: DKA is a dangerous complication of diabetes with a varied clinical presentation. Infections and non-compliance to treatment are the most common precipitating factors. To lower the morbidity and death rates linked to DKA, early diagnosis, prompt treatment, and patient education are essential.

Objective: To evaluate the efficacy and safety of adrenaline use in nasal surgery and address common misconceptions surrounding its application. Methods: A retrospective review of 100 patients who underwent various nasal surgeries with the use of adrenaline at a tertiary care centre from January 2022 to December 2022 was conducted. Data on intraoperative blood loss, surgery duration, postoperative complications, and systemic effects were collected and analysed. Results: Adrenaline was effective in reducing intraoperative bleeding, facilitating clearer surgical fields, and reducing overall surgery time. Minimal systemic effects were observed, and no significant complications such as tissue necrosis or cardiovascular events were reported. Conclusion: Adrenaline, when used appropriately, is both effective and safe in nasal surgery. This case series provides evidence to debunk several myths associated with its use.

Objectives: To evaluate the postoperative knee function and results of retrograde nailing for distal third femoral shaft fractures. Methods: Between January 2015 and December 2023, a consecutive series of 87 patients (with 94 fractures) who underwent retrograde nailing were prospectively evaluated. Outcome measures were union time, initiation of weight bearing, deformity and shortening, functional length of the nail, knee function assessed using a modified Knee Society Knee Score. Correlations between union time and other variables were also studied. Results: In these patients, 88 (93%) of the 94 fractures achieved union, of which 12 underwent dynamization; the mean union time for the other 76 fractures was 4.4 months. Angular malalignment was present in 10 patients and shortening in 9 others. There was negligible correlation between union time and variables of nail-canal diameter mismatch, functional length of nail, fracture geometry, or initiation of partial weight bearing ambulation. Knee flexion of more than 100 degrees was achieved in 81 patients. 29 patients had anterior knee pain and 10 had instability. By the end of one year, excellent or good scores for pain and function were recorded in 87% and 73% respectively, of the 88 patients. Conclusion: In view of such favourable union rates but significant deterioration in overall knee joint function, at best retrograde nailing is a reliable alternative in the management of selected complicated fractures of the distal femoral shaft.

Background: Fractures of the humeral shaft account for 1 to 3% of all fractures and are among the more common types of fractures. Objectives: To compare the functional and radiological outcomes in patients with humeral shaft fractures treated with Plate Osteosynthesis versus those treated with Intramedullary Interlocking Nailing. Methods: A prospective comparative study on the management of acute humeral shaft fractures was conducted in the Department of Orthopedics at the Pondicherry Institute of Medical Sciences, Puducherry. The study included two groups of participants: Group A, who underwent plate osteosynthesis, and Group B, who received antegrade intramedullary interlocking nailing. Results: In a study of patients aged 21 to 69 years (mean age 37.7 years), 70.5% were male. The majority of fractures (65.38%) were caused by road traffic accidents, with 74.4% involving the right humerus. Subtype A2 was most common, with 51.3% of cases. Surgery occurred within a week for 90% of patients. Pre-operative radial nerve palsy was present in 3.84%, with all cases recovering. Post-operative complications included wound infections (4.2% plating, 3.3% nailing) and shoulder movement restrictions (16.7% nailing). The plating group showed superior shoulder outcomes (p<0.05), though overall outcomes were similar between groups (p>0.05). Radiologically, 70% of patients in the nailing group and 80% in the plating group achieved fracture union by 16 weeks. Non-union rates were higher in the nailing group (10%) compared to the plating group (4.16%). Conclusion: Both the treatment methods achieved similar union rates; however, the interlocking nailing group had a higher incidence of secondary complications.

Introduction: Thoracic surgeries pose significant challenges due to high surgical trauma and associated ipsilateral shoulder pain (ISP), affecting 21–97% of patients. ISP impairs recovery, increases hospital stay, and is influenced by surgical and patient-specific factors. Effective management requires a multimodal approach encompassing preoperative screening, optimized intraoperative techniques, and combined pharmacological and non-pharmacological postoperative strategies. Aims and Objective: To analyze various factors and their association with ISP in patients undergoing Thoracic Surgeries. Method: This prospective observational study was conducted at hospital ,from February 2023 to January 2024, involving 120 patients undergoing thoracic surgeries. Patients were assessed for ipsilateral shoulder pain (ISP) using the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Inclusion criteria included patients aged 20-65 with consent; exclusion criteria included pre-existing shoulder pain. Statistical analyses utilized Shapiro-Wilk, chi-square, and regression models, with P < 0.05 considered significant. Result: The baseline characteristics reveal no significant gender differences in ipsilateral shoulder pain (ISP) occurrence (P-values: 0.0855 for males, 0.0954 for females). ISP patients were older (mean age: 55.48±13.56 years) and had a higher BMI (35.42±5.55). Thoracotomy was more common among ISP patients (P=0.095), with epidural analgesia (P=0.003) and lower epidural block levels (P=0.004) showing significant associations. ISP predominantly caused dull aching pain, particularly in the anterior shoulder region. Conclusion: The study concluded that there was 56.67% of patients with ipsilateral shoulder pain (ISP) and it is most commonly associated with dull aching and is frequently localized to the anterior and superior parts of the shoulder. ISP is more prevalent in older patients with higher BMI and is significantly associated with epidural analgesia and thoracotomy procedures.

This study presents a detailed investigation into the prevalence, patterns, and unique characteristics of kidney and ureter anomalies among cadavers from the Nashik region of Maharashtra. Through meticulous cadaveric dissections, comprehensive anatomical observations, and thorough documentation, we unveil a spectrum of anomalies including polycystic kidney, lobulated kidney, and a variant of horseshoe kidney. Among 48 specimens, 24% exhibited renal and ureteric anomalies, with 18% showcasing kidney anomalies and 10% displaying double ureter. Noteworthy specimens were meticulously numbered, photographed, and analysed, revealing complex variations in renal position and ureteric architecture. This study contributes valuable insights into the local prevalence and characteristics of kidney and ureter anomalies, deepening our understanding of regional anatomical diversity.

Background: Secondary intraocular lens (IOL) implantation is a common procedure for managing aphakia or failed primary IOLs. The choice between anterior chamber IOL (ACIOL) and posterior chamber IOL (PCIOL) in the sulcus influences both visual outcomes and complication rates. This study aimed to compare the visual outcomes and complication rates between secondary ACIOL and PCIOL implantation in a clinical setting. Methods: Sixty eyes (30 in each group) undergoing secondary IOL implantation were included. Group 1 received ACIOLs, and Group 2 received PCIOLs in the sulcus. Preoperative and postoperative visual acuity, as well as complications, were recorded. Statistical analysis was performed using SPSS version 23.0. Results: The PCIOL group demonstrated significantly better visual acuity at all postoperative intervals compared to the ACIOL group. At 6 months, the mean visual acuity in the PCIOL group was 0.20 LogMAR, compared to 0.25 LogMAR in the ACIOL group (p = 0.018). Additionally, the PCIOL group had a lower overall complication rate (10%) compared to the ACIOL group (30%) (p = 0.010). Minor complications occurred in 6.7% of the PCIOL group versus 20% of the ACIOL group, and major complications were observed in 3.3% of the PCIOL group compared to 10% in the ACIOL group. Conclusion: PCIOL implantation provides superior visual outcomes and a safer postoperative profile compared to ACIOL implantation. These findings support the use of PCIOL as the preferred option for secondary IOL implantation, offering better visual recovery and reduced complication rates. Further studies with larger sample sizes and longer follow-up periods are recommended to confirm these results. Recommendations: Surgeons should consider both ACIOL and PCIOL options based on anatomical and patient-specific factors, as both methods provide effective visual restoration with similar safety profiles. Further studies with larger sample sizes and longer follow-up periods are recommended to confirm these findings.

Introduction: Facial nerve paralysis or paresis is a debilitating condition that impairs facial expression, mechanisms that protect the eye, ability to eat or drink, and communication. Erosion of the bony fallopian canal can occur in active mucosal COM but probably more commonly in squamosal COM in up to19% case [1] .Idiopathic facial palsy, accounts for 75% of acute facial paralysis.  Decompression of the facial nerve can aid the restoration of facial nerve function for appropriately selected patients. Methods: In the present study, we have assessed improvement in facial paralysis, in patients undergone facial nerve decompression from July 2023 to July 2024 at Narendra Modi Medical College. Demographics, duration between onset of symptoms and surgical decompression, grade of facial nerve dysfunction pre- and post-operatively was assessed using clinical scale the House-Brackmann (HB) scale and follow up was recorded. Results: In the present study, we have operated 10 patients having facial nerve paralysis with less than 4 months duration of onset. Facial physiotherapy was given to all post-operative patients. Most of patients required oral steroids and/or anti-viral treatment after surgery. Out of 10 patients, 5(50%) patients improved up to grade1 HB scale, 4(40%) patients improved up to grade 2 HB scale while slow recovery was noted in only 1(10%) patient.   Conclusion:  Chronic condition of ear pathology like squamosal chronic otitis media and/or traumatic causes of facial palsy refractory to oral steroids and anti-viral treatment requires facial nerve decompression surgery  with or without medical support for better outcome.

Background & Methods: The aim of the study is to compare the efficacy of fentanyl versus clonidine with ropivacaine 0.5% in supraclavicular brachial plexus block in terms of duration of sensory and motor blockade. All 80 patients underwent thorough preoperative assessment, which encompassed a comprehensive review of medical history, a detailed general physical examination, systemic evaluation, airway assessment, and standard laboratory investigations including hemoglobin levels, total and differential white blood cell counts, bleeding time, clotting time, platelet count, blood glucose levels, blood urea levels, and serum creatinine levels. Additionally, electrocardiography and chest X-ray examinations were conducted. Results: Duration of Motor Block: The mean duration of motor block was 417.43 ± 68.55 minutes for the Ropivacaine + Fentanyl group and 481.08 ± 66.76 minutes for the Ropivacaine + Clonidine + NS group, with a P-value of 0.0001. This indicates a statistically significant difference, with the Ropivacaine + Clonidine + NS group having a longer duration of motor block. Duration of Sensory Block: The mean duration of sensory block was 460.60 ± 66.10 minutes for the Ropivacaine + Fentanyl group and 529.10 ± 69.54 minutes for the Ropivacaine + Clonidine + NS group, with a P-value of <0.0001. This shows a statistically significant difference, with the Ropivacaine + Clonidine + NS group having a longer duration of sensory block. Conclusion: The findings of this study suggest that both clonidine and fentanyl, when added to 0.5% ropivacaine for supraclavicular brachial plexus blocks, enhance the efficacy of the block, but with distinct differences. Fentanyl significantly shortened the onset of both sensory and motor block but clonidine prolonged the both duration of sensory and motor block compared to fentanyl. This aligns with existing literature, which also supports the superior efficacy of clonidine as well as dexmedetomidine as adjuvants in prolonging block duration and enhancing analgesic effects.

Background: Lumbar laminectomy is a commonly performed procedure in neurosurgical and orthopedic practice. Postoperative pain relief helps in early mobilization, initiation of physiotherapy, provides satisfaction to the patients and plays an important role in reducing the morbidity and mortality. This prospective study investigated the simple technique of instillation of wound with bupivacaine and leaving a contact time of 60 seconds on postoperative pain following lumbar laminectomy. Methods: 32 ASA I and II patients scheduled for laminectomy were randomly allocated to receive either20 ml of normal saline (group I) or 0.25% of bupivacaine (group II) into the wound after securing hemostasis. After a dwell time of 60sec the wound was closed in layers without mopping or suctioning. After extubation, the pain scores were evaluated by visual analog scale at every 4 hrs. For 24hrs and also the time for first demand of analgesia, number of analgesic demands and the total amount of analgesia consumed were noted by an independent observer. Results: The median duration of analgesia in group I was 8.8 [5-11] and in group II 13 [8.5- 16] hrs. with a p=0.04. The number of demands and the amount of analgesia consumed was also statistically significant. Conclusion: Wound instillation technique is simple, safe and effective in management of acute pain management after lumbar laminectomy and can be used as one among the multimodal armamentarium in pain management.

Introduction: Infant and childhood hearing loss is associated with significant speech and language developmental delays, affecting social and economic outcomes. Low birth weight (LBW) has been indicated as one of the neonatal risk factors for hearing loss; however, an association between LBW and hearing impairment is not well defined. Methods: This study was carried out from November 2022 to October 2023 among 240 neonates with a mean age of 13.41 days. The cochlear function was assessed using otoacoustic emission screening. Data for the second screening test attempt were considered to guarantee accuracy. All statistical analyses were done using SPSS version 12.0, and comparisons were made by t-test, Mann-Whitney U-test, and analysis of covariance. Results: Of the total of 240 neonates, 33.75% were less than 10 days old, 63.33% were between 10-24 days, and 2.91% were aged 25-30 days. The mean birth weight was 2320.73 grams. At the initial postnatal screening test, 194 neonates passed while 46 neonates were referred for further assessment, and at follow-up, 188 neonates passed while 51 showed abnormalities that require further evaluation. Only weight showed a significant effect on DPOAE outcome, with very low p-values for both the postnatal and follow-up assessments. No significant associations were identified for sex, presentation, or type. Conclusion: This study supports the presence of a significant association between low birth weight and hearing impairment thus allows emphasizing the role of weight in audiometric assessments. Future research needs to determine the mechanisms by which low birth weight is associated with hearing loss, study the long-term outcomes of auditory function, and develop targeted interventions. Neonatal hearing screening may be incorporated into public health programs with a view to early detection and management of hearing loss.

Background: Snakebite is one of the major public health problems in the world, affecting several million people each year. Snake bite is a common medical emergency and occupational hazard, especially prevalent in tropical India where agriculture is the primary occupation. The majority of snakebites result from 4 species namely Russell’s viper, Cobra, Krait, and Saw-scaled viper. Increased fatality is due to delayed visits to the hospital and a preference for traditional healers. There are limited studies available on the demographic and clinical profiles of snake bites from rural parts of Maharashtra, India. Aim: To study the clinical and demographic profile of patients presenting with snake bite in a tertiary care hospital in Western Maharashtra.  Materials and Methods: A record-based retrospective study was carried out at VVPF’S Medical College and Hospital, Ahmednagar, north Maharashtra, India. All patients above 15 years of age admitted for snakebite in last one year were included in the study. Demographic, clinical profile, complications, management and outcome were recorded. The data were entered into a Microsoft Excel sheet and analysed using Statistical Package for Social Services (SPSS) software Version 23. Results: Out of 79 snake-bite cases, 52% were males and 48% were females. Most snakebites were observed in the 36-45 (25%) age group. Snakebites commonly occurred during monsoon season (68%). Most of the people were farmer (71%). 56% of the bites happened during nighttime. The lower limb (68%) was the commonest site. Most of the patients developed neuroparalytic symptoms and krait (52%) was the common snake responsible for envenomation. Ptosis (15%) was the most common clinical feature followed by pain at the bite site (20%), and abdominal pain (13%), difficulty in breathing (11%). ASV was administered in 88% of the patients and 15% required mechanical ventilation. The majority of the patients survived (94%) and three patients died (6%). Mean ICU stay was 7 days. Conclusion: Patients of middle age, mostly males are vulnerable to snakebite due to outdoor activity like farming during Monsoon at night time; Common krait was the commonest type of snake bite. Most of the patients recovered.  Awareness must be created among the public on the early visit to health care after a snake bite. There is an urgent need to strengthen primary and secondary health care centres to manage snake bite cases. Training of healthcare workers is essential to identify snake bite cases when the history of the bite is not obvious. The mortality is directly proportional to the clinical severity and delay in seeking medical attention. This study highlights the importance of rapid diagnosis, and initiation of early treatment.

Background: Bell’s Palsy, a sudden-onset facial nerve paralysis, has been increasingly reported in COVID-19 patients, raising concerns about the virus’s neurotropic potential. This study investigates the incidence, clinical features, management, and outcomes of Bell’s Palsy in COVID-19 patients. Aim and Objective: Our primary goal is to investigate the incidence, clinical features, management, and outcomes of Bell’s Palsy in COVID-19 patients. We are particularly focused on identifying factors associated with recovery outcomes, to provide a clearer understanding of this condition. Materials and Methods: An observational retrospective study was conducted on 50 COVID-19 patients diagnosed with Bell’s Palsy. Data on demographics, COVID-19 severity, Bell’s palsy onset, treatment, and recovery outcomes were collected and analyzed. Results: The incidence of Bell’s Palsy among COVID-19 patients was 2.5%. Most patients had mild COVID-19, with a mean onset of Bell’s Palsy at 7.4 days post-diagnosis. Right-sided facial paralysis was more common. Corticosteroid therapy was administered to all patients, with 90% achieving complete recovery by six months. Severe COVID-19 and delayed treatment were associated with poorer outcomes. Conclusions: Bell’s Palsy is a potential neurological complication of COVID-19, with early intervention crucial for favourable outcomes. The results of this study highlight the need for further research to fully understand the pathophysiological mechanisms underlying this association and to improve patient care.

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and potentially malignant condition of the oral cavity, primarily caused by chewing areca nut. The condition leads to significant morbidity, including restricted mouth opening and a burning sensation. While triamcinolone acetonide (Kenacort) is commonly used in its management, the potential benefit of combining it with placental extract has yet to be thoroughly explored. Aim and Objective: To compare the effectiveness of Kenacort with placental extract versus plain Kenacort in the treatment of Oral Submucous Fibrosis (OSMF). Materials and Methods: This randomized controlled trial included 60 patients diagnosed with OSMF, divided into two groups. Group A received intralesional injections of Kenacort (triamcinolone acetonide) mixed with placental extract, while Group B received plain Kenacort. Both treatments were administered weekly for 8 weeks. The primary outcomes measured were improving mouth opening and reducing burning sensation, which were assessed using a vernier calliper and Visual Analog Scale (VAS). Patient satisfaction was also evaluated through a structured questionnaire. Data were analyzed using paired t-tests and ANOVA. Results: Both groups showed significant improvements in mouth opening and reduced burning sensation. Group A (Kenacort with placental extract) demonstrated a more significant increase in mean mouth opening (7.7 ± 2.2 mm) compared to Group B (plain Kenacort) (5.7 ± 2.6 mm), with a statistically significant difference (p = 0.01). The reduction in VAS score was also greater in Group A (4.6 ± 1.3) compared to Group B (3.5 ± 1.4), with a significant difference (p = 0.02). Patient satisfaction was higher in Group A, with 83.3% of patients reporting being “very satisfied,” compared to 63.3% in Group B (p = 0.04). Conclusion: Combining Kenacort with placental extract significantly improves clinical outcomes in patients with OSMF compared to plain Kenacort alone. This combination therapy offers a promising treatment for enhancing mouth opening and reducing the burning sensation associated with OSMF.

Background: Medical emergencies are the critical conditions that demand prompt healthcare action to avoid immediate or long-term morbidity and mortality to the patients. Therefore, it is essential to analyze the pattern of medical emergencies with respect to local demographics so that the healthcare system could be well-equipped to deal with such critical conditions. Objective: Present study was aimed to analyze the symptomatic and etiological pattern of medical emergencies of tertiary care hospital of north India and to study the final outcomes of these medical emergencies. Methodology: All patients that presented with a medical emergency were admitted in medicine unit from emergency department. Total 287 patients were enrolled in the study over the duration of 1 year. Data regarding the socio-demographic determinants, symptoms, system involvement/etiology and comorbidities was noted. Patients were then followed up to analyze the final outcomes of these medical emergencies. Results: The mean age of the patients was 52.79±15.33 years with a M: F ratio of 1.14:1. Prehospital delay in most of the patients (47.39%) was up to 24 hours. Most common symptom was shortness of breath (26.83%). Infectious etiology (20.91%) was found to be most common among patients. The most common comorbidity found in the current study was hypertension (51.57%), followed by type II diabetes mellitus (29.27%). Out of the total 287 patients, 71.78% recovered and got discharged from the hospital successfully whereas mortality occurred in 11.15% cases and 17.07% cases did not continue with medical therapy despite adequate counselling. Conclusion: Present study provides insights about the pattern of medical emergencies in north India. The results of this study will not only create awareness among healthcare workers of emergency departments regarding the pattern of medical emergency, but will also help them to handle these emergencies more efficiently. Improving the quality of emergency medical care will help in reduction in morbidity and mortality due to these emergency medical conditions.

Appendix is one of the commonest sites for a carcinoid tumor. There are usually no specific clinical presentation of these tumors and clinically, patients often present with features suggestive of appendicitis. They are usually diagnosed incidentally after appendectomy during histopathological examination of the resected specimen of appendix. Most of the carcinoid tumors are < 1 cm in its greatest diameter and are frequently located at the tip of the appendix. The treatment and prognosis of appendiceal carcinoid tumors depends on a few factors including the tumor size, tumor location, depth of invasion, mitotic rate, Ki 67 proliferative index, presence of lymphovascular and perineural invasion. Early histopathological diagnosis and grading of carcinoid tumors plays an essential role in the choice of treatment modalities to be undertaken for these patients. Carcinoid tumors of the appendix behave as benign tumors in most instances. However, some may possess the potential to metastasize Therefore, the possibility of carcinoid tumor need to be considered in all resected appendectomy specimens from patients diagnosed preoperatively as appendicitis. The long term prognosis of appendiceal carcinoid is excellent and in most cases appendectomy proves to be curative for these group of patients.

Introduction: Hypertension is one of the most common clinical complications during pregnancy, complicating 6-10% of all pregnancies. Ophthalmic artery provides an accessible window for easy monitoring of maternal cardiovascular changes especially in pregnancy complicated hypertension cases. Aims and Objectives: To correlate maternal and perinatal outcome with the Ophthalmic Artery Doppler (OAD) parameters observed in the Pre-eclamptic subjects with those observed in Normotensive subjects. Material and Methods: A prospective case-control study was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, in 126 pregnant subjects (63 Pre-eclamptic patients and 63 Normotensive pregnant controls) in their 2^nd and 3^rd trimester. They underwent serial OAD velocimetry between 20 weeks to term at three different points of time. OAD parameters, such as Pulsatility Index, Resistance Index, Peak Systolic Velocity, Peak Diastolic Velocity, End Diastolic Velocity and Peak Ratio were measured on transorbital triplex ultrasound scan with 10 MHz linear transducer. These parameters were correlated with maternal and perinatal outcomes. P < 0.05 was considered to be statistically significant. Results: Pulsatility Index and Resistance Index were significantly reduced and Peak Ratio was significantly higher in the Pre-eclamptic subjects than the Normotensive subjects. Maternal and perinatal complications were statistically significantly more frequent in subjects with OAD changes rather than those who were hypertensive without OAD changes or were normotensive. Conclusion: Ophthalmic Artery Doppler velocimetry, in conjunction with other parameters for monitoring maternal and perinatal wellbeing, can be a useful predictor of pregnancy outcome when used accurately and judiciously.

Introduction: The purpose of this study was to examine the role of surface application or infiltration of ropivacaine on severity of post tonsillectomy pain, start of oral intake, hospital stay and to investigate any complication associated with use of ropivacaine. Material and Method: A randomized single blind control study was carried on 100 patients to evaluate the effects of ropivacaine on post tonsillectomy pain. They were categorized into 2 equal groups(50 each). In group 1 ropivacaine was used in the form of surface application or infiltration. In group 2,50 patients were taken as control without use of ropivacaine. Ropivacaine infiltration was done before tonsillectomy and ropivacaine surface application in tonsillar fossa was done after tonsillectomy. Result: It  was found that ropivacaine infilteration or surface application has a definite role in reducing pain score, early start of oral intake, reducing post operative stay in hospital and reducing analgesia requirement in post tonsillectomy patients without any significant harm to the patient. Conclusion: Ropivacaine infilteration or surface application has a definite role in reducing pain score, early start of oral intake, reducing post operative stay in hospital and reducing analgesia requirement in post tonsillectomy patients without any significant harm to the patient.

Intestinal stoma is a surgically created opening in the bowel  that allows the diversion of bowel contents. A study is performed to describe the various indication for which stoma is performed electively or performed as a emergency procedure at tertiary care centre. The common type of intestinal stomas are ileostomy and colostomy. Each of these are performed for a different type of aetiology to divert the faecal matter. It could be temporary to facilitate healing by giving rest to the distal part of the intestinal or permanent if the complete resection is performed and reanastomosis is not possible, depending upon the underlying medical conditions and the outcome of the patient. Research is performed to study about the different aetiology for which stoma is performed and type of stoma given for the same including every age group performed in a tertiary care centre. Aim and Objective: Aim of the study is to study the various indication of stoma and type of stoma performed as emergency procedure or elective procedure at tertiary care centre.

Background: Preterm birth, defined as delivery before 37 weeks of gestation, is a major cause of neonatal morbidity and mortality. It also poses significant risks to maternal health. Aim and Objective: To evaluate the fetomaternal outcomes of preterm births in a tertiary care hospital setting. Materials and Methods: A retrospective study reviewed medical records of 350 women who delivered preterm between January 2018 and December 2022 at a tertiary care hospital. Preterm births were categorized into three groups: extremely preterm (<28 weeks), very preterm (28-32 weeks), and late preterm (32-36 weeks). Data on maternal demographics, obstetric history, pregnancy complications, mode of delivery, and neonatal outcomes were collected. Statistical analyses included descriptive statistics and comparative analyses across gestational age categories. Results: Of the 350 preterm deliveries, 14.3% were extremely preterm, 34.3% were very preterm, and 51.4% were late preterm. The overall neonatal mortality rate was 10.0%, with the highest rate observed in the extremely preterm group (40.0%). NICU admission was required for 42.9% of the neonates, and respiratory distress syndrome was diagnosed in 25.7%. Maternal outcomes showed a cesarean section rate of 57.1%, with postpartum haemorrhage occurring in 11.4% and puerperal infections in 8.6% of cases. Comparative analysis revealed that extremely preterm births were associated with significantly higher rates of both neonatal and maternal complications. Conclusion: Preterm birth, especially at earlier gestational ages, is associated with significant risks for both neonates and mothers. The findings highlight the need for enhanced prenatal care and targeted interventions to improve outcomes. The study also underscores the importance of specialized neonatal care, particularly for extremely preterm infants, to reduce the incidence of adverse outcomes.

Background: Pathologists play an important role in patient care and management but yet they are under recognized by the patients. Aim: The objective of this study was to evaluate the level of awareness regarding the medical specialty of pathology and the role of pathologists in patient care among inpatients, patient attendants, and the general public. Methodology: This was a questionnaire based observational study conducted in a tertiary referral hospital in Chennai and online, over a period of two months, July and August 2023. A validated questionnaire was used to collect data which was then analysed utilizing SPSS software version 29. Results: On analysis of the 785 survey forms received, 735 were included in the study out of which only 312 (42.44%) of the people identified a pathologist to be a medical doctor. About 263 (35.76%) participants were not aware or disagreed with the fact that physicians used the work of pathologist in the form laboratory reports for treating patients and about 197 (26.79 %) respondents did not know or accept that pathologist had a significant influence on the choice of treatment for patients. Only about 312(20%) rightly identified that the duty of the pathologist included microscopic assessment of tissues, 233(14.9%) were aware that pathologists performed blood tests and 226 (14.4%) were aware that pathologists analysed body fluids collected by doctors. Conclusion: Apart from lack of recognition of the work of pathologist, these misconceptions may result in patients doubting the validity of the laboratory results and delaying their treatment.

Background: Endotracheal intubation during general anesthesia can lead to post-intubation complications due to tracheal mucosa damage from the endotracheal tube (ETT) cuff. High-volume low-pressure cuffs expand with minimal pressure increase until fully inflated, after which the pressure rises rapidly due to the inelasticity of the material, potentially damaging the tracheal mucosa. When lignocaine is used for cuff inflation, it diffuses to the tracheal mucosa, reducing local irritation and inflammation through its anesthetic action. Alkalinizing lignocaine enhances its diffusion rate across the ETT cuff and reduces the required dose for effective results. Aims and Objectives: The study aimed to evaluate the benefits of filling the ETT cuff with 2% alkalinized lignocaine versus normal saline, focusing on preventing ETT-induced emergence phenomena and reducing post-intubation complications such as sore throat. Materials and Methods: This prospective, double-blind, randomized, comparative study was conducted at Mamata Medical College in Khammam, Telangana, a tertiary hospital, from March 2023 to March 2024. Informed consent was obtained from all participants prior to enrollment. The study evaluated adult patients aged 18-60 years, classified as American Society of Anesthesiologists (ASA) physical status 1 or 2, undergoing elective surgery under general anesthesia lasting more than two hours. Patients were randomly divided into two groups using a computer-generated randomization table. Group S had their ETT cuffs filled with 0.9% normal saline, while Group L’s cuffs were insufflated with 2% lignocaine alkalinized with 7.5% sodium bicarbonate in a 19:1 ratio. Observations and Results: Group S initially had lower ETT cuff pressures, which rose significantly higher at extubation compared to group L (p < 0.001). At extubation, HR and systolic blood pressure (SBP) increases from baseline were significantly greater in group S than in group L (p < 0.001 and p = 0.001, respectively). Group L experienced less coughing and restlessness compared to group S (p < 0.001 and p = 0.002, respectively). Mean extubation and emergence times were longer in group S than in group L (p < 0.001). Conclusion: Continuous monitoring of ETT cuff pressure is essential to keep it below the tracheal mucosa capillary occlusion pressure. Using alkalinized lignocaine for cuff inflation further reduces extubation responses and post-intubation complications.

Background: Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. Aim: The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. Materials and Methods: Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.7 mcg/kg/h. Group P received propofol 1 mg/kg over 15 minutes as a loading dose, followed by 1-3 mg/kg/h. Group M received midazolam 0.04 mg/kg over 15 minutes as a loading dose, followed by 0.08 mg/kg/h. Heart rate, mean arterial pressure, sedation level, fentanyl requirement, ventilation and extubation time were recorded. Results: Adequate sedation level was achieved with all three agents. Dexmedetomidine group required less fentanyl for postoperative analgesia. In group D there was a decrease in HR after dexmedetomidine infusion (p<0.05), but there was no significant difference in HR between group P and group M. After administration of study drug there was a significant decrease in MAP comparison to baseline value in all groups at all-time intervals (p<0.05), except postextubation period (p>0.05). Extubation time was lowest in group P (p<0.05). Conclusion: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements.

Background: Avascular necrosis of the femoral head is a disorder that can lead to the collapse of the femoral head and can progress to secondary osteoarthritis, which would ultimately require a total hip replacement. It can be avoided if the disease is diagnosed at an early stage. Various modalities of treatment available for AVN, conservative modalities like observation and non-weight-bearing, pharmacotherapy like Bisphosphonates, Enoxaparin were found to be effective , Hyperbaric oxygen therapy and Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e.synthetic bone grafting, biologic adjuvants – Platelet Rich Plasma, Mesenchymal Stem cells, BMAC etc. and rotational osteotomies) and replacement surgeries. Objective: This study was done to know the clinical outcomes of treating early stages of AVN with Core decompression and PRP infiltration. Materials and Methods: This study was done at tertiary care teaching hospital in the Department of Orthopaedics at Great Eastern Medical School, Srikakulam, and Andhra Pradesh, India from January 2022 to November 2023. 20 patients were included as per the eligibility criteria. Harris Hip Score was assessed. Results: Most of the patients were males aged 31-40 years; Alcohol being the most common causative factor. 61.5%cases were classified under type IIA according to Ficat & Arlet staging. Clinical outcome is excellent and good in 65% of cases. The mean pre-operative Harris Hip Score of our study was 67.4, and the mean post-operative Harris hip score of our study was 86.8. Out of 20 cases, 8 patients (30%) showed limitation of the progression of the disease, 5 (15%) patients progressed to the further stages of the disease and 7 patients (55%) had remission of the disease. Conclusion: This study concludes that Core decompression along with PRP infiltration is safe can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting. Good preliminary results were obtained in patients with early stages of the disease.

Japanese Encephalitis (JE) continues to pose a serious and significant public health problem in medium-endemic Central India. JE is mainly affects humans with an estimated 70,000 cases every year, of which 86% are from two Asian countries, India and China. The national incidence rate of JE was 1.08 cases per 1,000,000 populations during 2013–2021. In Bihar, the annual incidence rate was 0.55–1.78 per 100000 population during 2009–2014, indicating higher incidence than national rate. Affected person show mild to severe clinical illness with permanent neurologic or psychiatric sequelae among survivor and till now there is no effective antiviral drug exists. Therefore, an enhanced surveillance system is essential for planning and development of control/preventive measures against JE. The aim of the present study is to estimate cases of JE and their seasonal trends in Gaya region of Bihar. The seroprevalence data of one year (January 2021 to December 2021) in samples obtained from suspected JE patients from A.N.M. Medical College & Hospital, Gaya were analyzed. A total number of 35 suspected pediatric cases were studied. Out of these 35 suspected samples tested for JE IgM antibody by IgM-capture ELISA test, 04 (11.42%) were found to be positive for IgM antibody against JE virus. In this study of JE burden a male preponderance were found and all are in pediatric age group (< 16 Yrs). Till now there is no effective antiviral agent against JE virus, therefore effective JE vaccination remains as the sole strategy for control and prevention of JE. The case surveillance should have mandatory notification system that requires all medical practitioners to report clinically suspected and laboratory-confirmed cases within 24 hours, which may help to find out focus of infection and thus to control the spread.

Background: The internet is now an integral part of daily life, making it easy to communicate and to share information. However, spending too much online can lead to Internet addiction causing anxiety, functional impairment, and health issues like lack of sleep from extended hours spent chatting, gaming and social media use. Aim: To estimate the prevalence of internet addiction and to assess various factors associated with internet addiction among college students in Chennai. Methodology: This cross-sectional study was conducted among 110 college going students in a selected college in North Chennai between August to November-2023 (3 months) through simple random sampling using validated pretested structured questionnaire by face-face interview consisting of Standard Young’s Internet Addiction test questionnaire (IAT). Data was entered in Microsoft Excel and analysed in SPSS 23 version. p value <0.05 was considered as statistically significant. Results: In our study among 110 participants, the mean total score for internet addiction was 49.86±13.38. Only 7.3% of participants showed no signs of internet addiction, while 37.3% had mild addiction, 54.5% had moderate addiction, and 0.9% had severe addiction. Significant associations were found between internet addiction and factors such as gender, mode of internet usage, internet expense and earning money for internet access. Conclusion: The study found high internet addiction prevalence, with significant associations between addiction levels and gender, internet usage mode, expense, and earning own money.

Pneumomediastinum is a very rare presentation of pulmonary tuberculosis and can pose great challenges in the diagnosis and management of the patient. Children comprise a significant proportion of the global TB caseload, and experience considerable TB-related morbidity and mortality. The subtle signs of disease may delay the diagnosis and consequently progression to a significantly more devastating form. Our case of disseminated tuberculosis presenting with features of pneumomediastinum was subjected to detailed history taking, clinical examination and relevant investigations. History of anorexia, weight loss and low grade fever was elicited. On clinical examination patient was found to have BMI of 10.28 kg/m^2. Other features of malnutrition such as cheilosis, loss of buccal fat, saggy skin, sunken eyes, gross muscle wasting, skeletal prominence in thoracic cage, and scaphoid abdomen were marked. Bilateral subcentimetric cervical lymphadenopathy; and kyphosis were also observed. Chest examination revealed mild volume loss and few basal crepitations on right side. Imaging revealed multiple air bubbles in the neck, extending within the retro pharyngeal, parapharyngeal, prevertebral and carotid spaces, extending inferiorly into the superior and middle mediastinum, and into the neural foramina on the right at the level of C5 vertebra. Sub segmental Fibrobronchiectactic changes with bronchiolitis within the posterior basal segment of bilateral lower lobe; and few cavitary lesions were observed in the right lower lobe with one of the lesions having developed direct communication into the mediastinal cavity. On laboratory investigations, differential leucocyte count, platelet count were deranged, Serum calcium, serum potassium, serum phosphorus, total proteins, and LDH were also deranged. Testosterone, T3, T4 and ACTH were reduced, while CEA was raised. Based on the clinical and laboratory profile, a diagnosis of Disseminated Tuberculosis with secondary hypocortisolism was made. Patient was managed with weight based antitubercular drugs as per national guidelines, levothyroxin, low dose steroid and other supportive therapy.
Patient was discharged after around 15 days of hospitalisation. Patient was followed up every month to monitor progress of his clinical condition. He gradually started eating with exercise tolerance of 5 kms; and normal liver function tests. His evaluation after two months of completion of ATT revealed, he is cheerful, going to school, started studying, regularly eating homemade food and gained 22 kg of weight and his parents were also relieved of their anxiety.

Introduction: Fentanyl synergistically enhances propofol effects and reduces hemodynamic response during induction. Fentanyl and propofol administration timing affects propofol dose and associated side effects. Aim and Objectives: Primary objective is to calculate the total dose of propofol required to achieve loss of consciousness during induction of anesthesia. Secondary objective is to examine the Incidence of hypotension during induction and to examine any Incidence of any movement or Bucking or Any vocalization after initial dose of propofol. Materials & Methods: After institutional ethical clearance, 68 ASA status I & II patients, aged 18-65 years, undergoing elective surgery under general anesthesia were randomized into two groups; Fentanyl 2 mcg/kg was administered immediately prior to, 5 and 7 min before induction with propofol in Groups A and B, respectively. The requirement of propofol induction dose and hemodynamic parameters was recorded. Statistical analysis was performed using software SPSS, P-value <0.05 was considered statistically significant. Results: Demographic characteristics were comparable in both the groups. Total dose of propofol required for induction was higher in Groups A than group B (Group A vs. 85.88±14.221mg vs. 56.52±12.530 mg). Incidence of movement, vocalization, bucking is higher in Group A than Group B (P=<0.000001, P=0.002, P=0.007 respectively). Incidence of hypotension during induction was significantly lower in Group B (5.9%) than Group A (94.1%; P =<0.00001). Conclusion: Administering fentanyl 7 min prior to propofol causes marked reduction in the dose requirement of the propofol along with a significantly decreased incidence of hypotension during induction.

Introduction: Cirrhosis of liver is one of the leading causes of hospitalization and mortality worldwide. It is defined by fibrosis of liver parenchyma and formation of regenerative nodules. The rate at which chronic liver disease progresses into cirrhosis is variable and depends upon the underlying etiology and patient characteristics. Aim: This study was conducted in a tertiary care hospital of Punjab (North- West India) on patients of liver cirrhosis. The aim of the study is to highlight the demographic profile, etiology, clinical presentation and disease severity of liver cirrhosis. Objectives:  (1) To study the demographic profile of patients of liver cirrhosis. (2) To study the etiology of liver disease in the patient population. (3) To estimate the severity of liver disease using Child Pugh Score and MELD-Na score. Materials and Methods: This cross-sectional study was conducted from May, 2021 to July, 2022 at a tertiary care hospital on 150 patients of liver cirrhosis. The demographic profile and clinical history were obtained. Ultrasonographic findings were noted. Serum biochemical parameters were sent and Child Pugh and MELD- Na score was calculated for each study participant. The cumulative data was analysed during the study period. Result:  (1) Highest incidence of cirrhosis of liver was found in the age group 51-60years. (2) Males were affected more commonly than females with a Male: Female ratio of 5.8: 1. (3) Most common etiology of cirrhosis was Alcoholic liver disease. Hepatitis C was the second most common cause, followed by Nonalcoholic Steatohepatitis and Hepatitis B. (4) Hepatic encephalopathy and ascites were the most common complications, followed by splenomegaly, variceal bleed and spontaneous bacterial peritonitis. (5) The mean serum albumin, bilirubin, prothrombin time and platelets were 2.42± 0.67 g/dl, 4.88± 3.15 mg/dl, 20.94± 8.34 sec and 1.64± 0.98lac/ml respectively. (6) Out of total 150 patients, 10.67% were in Child Class A (n=16), 38% were in Child Class B(n=57) and 51.33 % patients(n=77) were in Child class C(n=77). (7) 52% patients (n=79) were in MELD-Na category 10-19 (n=79), 32% patients(n=48) were in MELD-Na category 20-29 (n=48),8.67% were in MELD-Na category <9 (n=13) and 6.67% patients were in MELD-Na category 30-39 (n=10) and no patient was found in MELD-Na category >40. Conclusion: The study indicates that Alcoholic Liver Disease is the most common etiology of liver cirrhosis in Punjab (North- West India). Males are affected more than females. Highest prevalence is found in the age group of 51-60years. Hepatic encephalopathy and ascites are the most common complications of liver cirrhosis. Maximum number of patients present to hospital in Child Class C and MELD-Na score category 10-19.

Background: Platelets are primarily concerned with haemostatic function but there are accumulating evidences to suggest their role in the pathophysiology of different clinical conditions that can be correlated with platelet parameters to some extent. This study was aimed to find out the relationship between WBC count in conditions of leucocytosis and platelet count and platelet parameters namely mean platelet volume, platelet distribution width and plateletcrit. Method: Complete blood count records of total 1000 cases were evaluated dividing them in Group 1 (500 cases with WBC count within normal range) and Group 2 (500 cases with raised WBC count). Result: There was significant difference between Group 1 & Group 2 in platelet count, PCT value & MPV values; platelet count & PCT values were higher in Group 2 while MPV was higher in Group 1. However, there was no statistically significant difference between these groups in PDW values. Conclusion: Platelet count and PCT values increase in conditions of leucocytosis so can be considered as markers of infection but the exact mechanism for this association & clinical significance remains to be proved by further large scale studies.

Introduction: Semen analysis is an indispensable diagnostic tool in evaluating the male partner of infertile couples. This study aimed to assess seminal patterns in male partners of infertile couples and identify the possible contribution of male factors to the overall infertility problem. Methodology: This prospective study was conducted from July 2016 to June 2018 in the Department of Pathology at NRI Medical College, Chinakakani, Guntur, Andhra Pradesh, India. Results: Among the 200 cases, 125 patients (62.5%) were aged over 30 years, and 66 of these (33%) had abnormal semen analysis. In contrast, 75 patients (37.5%) were aged 30 years or younger, with 44 (22%) having abnormal semen analysis. Of the 200 cases, 49 patients were smokers, with 37 (76%) showing abnormal seminal parameters. Among 53 alcoholics, 31 (58%) had abnormal seminal parameters. Nine patients were both smokers and alcoholics, and all presented with abnormal seminal parameters. Of the 89 nonsmokers and nonalcoholics, 33 cases (37%) had abnormal seminal parameters. The most common seminal abnormality in the present study was oligoasthenozoospermia (20%), followed by oligozoospermia (7.5%). Conclusion: The study found that age, smoking, and alcohol consumption are risk factors for male infertility.

Background: Hypertension is a sustained elevation of systemic arterial pressure. Hypertension is a risk factor for cardiovascular mortality and morbidity, prevention of its complication, and early diagnosis and intervention are warranted. Serum uric acid has been proposed to be an index of severity as well as the risk factor for morbidity and mortality of essential hypertension. Objective: To assess the possibility of detecting serum uric acid level and lipid profile status as risk factors in borderline essential hypertension. Method: Hypertensive subjects were taken up for the study who attended the department of General Medicine with the age group 30-70 years and controls were selected from the staff members of the same college. Selection of subjects was done on basis of recently established hypertensive patients with elevated lipid profile. Blood was drawn after an overnight fast of 10-12 hours. Serum was separated and stored at -20°C till further analysis of parameters i.e. Total Cholesterol, Triglycerides, HDL-Cholesterol, LDL-Cholesterol, VLDL-Cholesterol and Serum Uric Acid. Results: The comparative analysis of the parameters provided with significant relation with hypertensive patients when compared to controls. Conclusion: The results of the study were comparable to the other studies performed related to the subject and backing the theory of hyperuricemia detected in one-third of the patients with essential hypertension and Hyperuricemia is positively correlated to hypertriglyceridemia and hypercholesterolemia.

Background: The present study was conducted for evaluating for assessing anxiety and depression among patients with dry eyes. Materials & Methods: A total of 50 patients with presence of dry eyes since once year were enrolled. Another set of 50 subjects who reported for routine medical check-up were enrolled as healthy controls. Complete demographic and clinical details of all the patients were obtained. For evaluation of depression, Montgomery-Asberg Depression Scale (MADRS) was used. For assessment of anxiety, Hamilton Rating Scale for Anxiety was used. Both the scales were based on questionnaire pertaining to assessment of anxiety and depression. All the results were recorded and analyzed using SPSS software.  Results: Mean age of the patients of the dry eyes group and control group was 43.5 years and 45.9 years respectively. Majority proportion of patients of both the study groups was males. Among dry eyes group, anxiety and depression were seen in 42 percent, and 52 percent of the patients respectively while among control group anxiety and depression were seen in 10 percent, and 14 percent of the patients respectively. Dry eyes patients were associated with significantly higher incidence of anxiety and depression. Conclusion: Depression and anxiety are more prevalent in DED patients than in controls.

Introduction: Neuroendocrine neoplasms are a heterogeneous group of malignancies showing various non-specific clinical symptoms, different morphological features, molecular involvement which makes it an important differential for all rapidly growing malignancies in our body since it has got a greater propensity to metastasize. The clinical symptoms depend on both the “neuro” and “endocrine” properties. Histopathologically, they form broader two groups of well differentiated and poorly differentiated neuroendocrine carcinomas and hence needs accurate grading depending on mitosis and Ki 67 counts. Hormonal and non-hormonal biomarkers like serum serotonin, urine 5-HIAA, gastrin and VIP are of equal relevance as well as histology. IHC markers for neuroendocrine neoplasms include synaptophysin, chromogranin, CD56 among others. Herein, we report all the neuroendocrine neoplasms detected in our setting for a period of 12 months and discuss extensively on the same. Materials and Methods: This is a retrospective cross sectional study carried out in the histopathology section of Department of Pathology, SCB Medical College and hospital, Cuttack. The total duration of the study was 12 months spanning from June 2023-June 2024. All the histopathological confirmed cases of neuroendocrine neoplasms based on recent 5th edition of WHO classification of endocrine and neuroendocrine tumors was analysed. Clinical data (age, sex, anatomical site) and histopathology along with IHC were studied. Results: We found a total of 12 patients diagnosed with neuroendocrine neoplasms involving various organs of the body. The mean age of patients was 51.83 years with age varying from 7yrs to 80 yrs. Majority were females with male to female ratio being 7:5. Majority of cases in our setting had involved adrenal glands with three cases diagnosed as pheochromocytoma followed by carotid body tumor (paraganglioma) and medullary carcinoma of thyroid, each with 2 cases respectively and rest all the organs presented with one case each i.e. pituitary, gastric, duodenal, rectum and appendix. Conclusion: In our cohort, the preponderance of pheochromocytomas was more followed by medullary carcinoma of thyroid and paraganglioma, with a notable female predominance. The diagnosis of neuroendocrine tumours necessitates meticulous radiological examination including USG, CT and MRI. Histopathology along with immunohistochemistry is imperative for arriving at a final diagnosis, accurate grading, and the formulation of an optimal management for the patient.

Pathological lesions in vulva and vagina include a wide range of inflammatory, benign as well as malignant tumors, some of which are challenges for a proper diagnosis. Histopathology has a great and significant role in early and appropriate diagnosis. In the present study, we present four interesting and rare cases involving the female genitalia. The first case is of an elderly female who presented with persistent vulvar eczema. Detailed examination revealed it to be a case of primary cutaneous mucinous carcinoma of vulva, an extremely rare adnexal tumor. The second case was of a young female who presented with a vulvovaginal mass and bleeding per vaginum. Biopsy revealed it to be a case of pleomorphic rhabdomyosarcoma. The third case presented with a right labial mass associated with itching and it was diagnosed to be case of epithelioid sarcoma. The final case was of a young female who presented with multiple black swellings over vulva and was histopathologically diagnosed as vulvar syringoma.

Background: The Purpose of this study is to assess the Effectiveness of Dobutamine Intravenous Infusion in Acute Myocardial Infarction in Presence of acute Mitral Regurgitation. Methods: This prospective pre post interventional study was carried out among 50 Patients admitted to Coronary care unit of the Department of Cardiology, KAPV Government Medical College, Trichy with first episode of acute Myocardial infarction in Presence of Acute Mitral Regurgitation within 24 hrs of Symptom onset were recruited for the study. Patient’s Age and Gender and examine to identify the signs of Acute MR. Ecg and ECHO assessment of MR was performed as early as possible within 24 hrs of onset of symptoms. Results: In the present study the mean age of the Patients was 63.7±12.4 and 62% of them were Male and 38% were Female. Among the study Participants, 12% had Anterior Wall Myocardial Infarction and 40% had Inferior and 48% have Inferoposterior wall Myocardial Infarction. In Acute MI With Acute MR after Dobutamine Infusion there is an increase in hemodynamic parameters of Heart Rate (p value 0.001), Systolic BP (p value 0.002), Diastolic Blood Pressure (p Value 0.001), Spo2 (p value – 0.001), S4 (p Value – 0.001). In the Present study there was also strong association that after Dobutamine infusion in Acute MI with Acute MR there was significant improvement of MR Which was substantiated by the following Echocardiographic Parameters of Jet Length (p value 0.001), Jet Area (0.003), ERO (p value 0.001), Vena contracta (p value 0.002), Cradiac output (p value 0.004), Ejection Fraction ( p value 0.001 ), Regurgitant Volume (p value 0.002). Regurgitant fraction (0.001). Conclusions: The comprehensive echocardiographic evaluation of Acute MR in the context of acute myocardial infarction, after dobutamine infusion has resulted in favourable Haemodynamics and recuded mortality. From the results of the present study, it can be said that dobutamine is a positive inotropic agent that works also as “medical annuloplasty” since it not only increases forward cardiac output but also decreases mitral anular size and mitral regurgitant volume effectively.

Introduction: Preoperative anxiety in pediatric patients undergoing surgery is a common issue that can lead to negative psychological and physiological outcomes. Effective premedication can reduce anxiety, facilitate smooth parental separation, and improve mask acceptance during anesthetic induction. This study aimed to compare the effectiveness of intranasal dexmedetomidine (1 μg/kg) and intranasal midazolam (0.2 mg/kg) in children aged 2-8 years undergoing elective surgeries under general anesthesia. Materials & Methods: Ninety pediatric patients were randomly assigned to two groups: Group D (dexmedetomidine) and Group M (midazolam). The primary outcomes assessed were sedation scores, parental separation anxiety, and mask acceptance. Secondary outcomes included hemodynamic parameters and the incidence of adverse effects. Data were collected at baseline and various intervals after premedication. Statistical analyses were conducted using IBM SPSS 20.0 software, with a p-value of less than 0.05 considered significant. Results: Group D had significantly higher sedation scores 30 minutes after premedication (2.85 ± 0.22) compared to Group M (1.10 ± 0.13). Parental separation anxiety scores decreased more in Group D (from 2.90 ± 0.26 to 1.85 ± 0.44) than in Group M (from 2.95 ± 0.30 to 2.15 ± 0.28). The mean mask acceptance score was higher in Group D (3.85 ± 0.21) compared to Group M (2.50 ± 0.47). Hemodynamic parameters such as heart rate and mean arterial pressure remained stable and comparable between the two groups at baseline and various intervals. Respiratory rate and SpO2 levels were similar in both groups with no significant differences. Importantly, no significant side effects were observed in either group, highlighting the safety profile of both medications. Conclusion: Intranasal dexmedetomidine is more effective than intranasal midazolam for premedication in children undergoing elective surgeries. It provides better sedation, reduces parental separation anxiety, and improves mask acceptance without compromising hemodynamic stability or respiratory function. These findings suggest dexmedetomidine as a superior option for pediatric premedication.

Introduction: Premalignant cervical lesions have a high risk of developing into cervical cancer. Cervical cancers among women are very common but greatly preventable using simple cervical screening. Women with HIV infection present with increased incidence of cervical cancers but the results are variable. Thus the present study was done to assess the prevalence of premalignant lesion and their association with HIV infections. Materials and Methods: This cross sectional study was done for duration of 1yr from May 2023 to April 2024 in a tertiary care centre. The case group comprised on 192 randomly selected HIV+ve women and control group comprised on 192 HIV-ve women visiting the tertiary care centre. The socio demographic details of the participants were collected and venous blood was used to check the CD4+ count. The cervical smears were collected using cytobrush and stained with Pap stain and reported according to Bethesda system by a general pathologist as LSIL, HSIL and ASCUS. A p value of <0.001 was considered as statistically significant. Results: 66% of women were > 50yrs in both Case and control group, 58% in case group and 75% in control group were married (p=0.002). 77% in case group and 69% in control group has completed their schooling and 48% in case group and 34% belonged to low income group (p<0.05). 64% of case group and 57% of control were from rural area and 8% of case and 4% of control were smokers (p>0.05). 44% of case and 32% of controls had their 1^st sexual encounter <18yrs; 42% of cases and 28% of controls had multiple sexual partner and 55% of cases and 37% of control used oral contraceptive (p=0.001).  28% of case group showed premalignant cervical lesion of which 72% were LSIL followed by HSIL and ASCUS and 11% of control group showed premalignant cervical lesion of which 71% were LSIL, 19% HSIL and 10% ASCUS (p=0.001). 57% of HIV+ve women had CD4+ count <200/µL and 43% had CD4+ count >200/µL and 79% of HIV+ve women were on HAART therapy. Conclusion: There was a high prevalence of premalignant cervical lesion in HIV+ve women and LSIL was the most prominently noted grade. There were no cases of squamous cell carcinoma noted. Thus there should be compulsory cervical screening of HIV+ve women along with imparting knowledge and awareness.

Introduction: The need for safe motherhood is one of the criterions for good MCH practices. The normal pregnancy may land up in a complication if not anticipated at early stages and may have a bad perinatal, maternal outcome. One such pathophysiology which can disturb the pregnancy is pre-eclampsia. Platelets play a vital role in response to the hypoxic insult at the uteroplacental junction by initiating coagulation cascade. The pro inflammatory trigger also increase the CRP levels in response to the signals caused by oxygen insufficiency at the vascular endothelium. Thus analysing the parameters in relation to platelet indices, CRP may be useful in prevention of adverse pregnancy outcomes. Aims and Objectives: To study the platelet indices and Hs- CRP levels in healthy antenatal women. To explore any correlation of altered platelet indices, Hs CRP in pregnancies with preeclampsia. Materials and Methods: Healthy antenatal women at 11-14 weeks GA were recruited and followed up till delivery. Blood investigations of platelet count, PDW, PCT, Hs-CRP were taken at the time of beginning of study. Then they were followed up till 28-30 weeks watching for onset of PE according to ACOG guidelines, later followed till delivery of the fetus. Unpaired t test was used to study the significance of the variations of the parameters to females who developed pre- eclampsia. Results: A statistically significant mean difference was observed between cases and controls in platelet count, platelet distribution width .The levels of HS-CRP also had a significant difference in the patients who developed pre-eclampsia when compared to normotensives. Conclusion: Screening of antenatal women for pre-eclampsia can be postulated by platelet indices, Hs-CRP as a cost effective tool for prevention of adverse maternal, perinatal outcomes.

Background: Recalcitrant dermatophytosis presents a significant diagnostic challenge, particularly in tropical regions where it is prevalent. Traditional diagnostic methods are often time-consuming and may delay treatment. Methods: This cross-sectional study evaluated 240 patients with chronic, recurrent dermatophytosis at Belagavi Institute of Medical Sciences, Karnataka, India. Dermoscopic patterns were analyzed and correlated with results from KOH examination and fungal cultures to assess the effectiveness of dermoscopy as a diagnostic tool. Results: Significant correlations were found between specific dermoscopic patterns and traditional diagnostic tests. Peripheral scales were significantly associated with KOH positivity (p=0.005), and a reddish-grey background was correlated with culture positivity (p=0.013). Conclusion: Dermoscopy enhances the diagnostic accuracy for recalcitrant dermatophytosis, supporting its integration into routine clinical practice to improve treatment outcomes.

Introduction: Magnetic resonance imaging (MRI) is critical for detecting tuberculous spondylodiscitis. Because of its high sensitivity and specificity, which may exceed 90%, it is an effective diagnostic tool for early diagnosis of spondylodiscitis. Computed tomography (CT)-guided biopsy is an excellent tool in the same field. Thus, the goal of this study was to discriminate between tuberculous and non-tuberculous spondylodiscitis using MR imaging and CT-guided biopsies. Material and Methods: Fifty cases with suggestive finding of spondylodiscitis by MRI, referred to CT guided biopsy for suspected spondylodiscitis. Results: There was no statistically significant difference between paravertebral infiltration, subligamentous spread, IVD involvement, and epidural involvement (P>0.05). The comparison of paravertebral abscesses was statistically significant (p <0.05).  The diagnostic accuracy, specificity, and sensitivity for paravertebral infiltration to identify tuberculous spondylodiscitis are 90.6%, 78.2%, and 99.5%, respectively. Diagnosis accuracy is 86.8%, specificity is 93%, and sensitivity is 84% for subligamentous spread. Conclusion: Magnetic resonance imaging (MRI) may differentiate between tuberculous and non-tuberculous spondylodiscitis by examining the presence of paravertebral infiltration, paravertebral abscess development, and subligamentous dissemination. A CT-guided biopsy is the most reliable method for finding pathogens in spondylodiscitis.

Background: Gallstone disease represents a significant burden for healthcare systems making laparoscopic cholecystectomy one of the most common surgical procedures performed in the world. Enhanced Recovery after Surgery (ERAS) protocols, recognized for lowering surgical stress and complications including length of hospital stay, are increasingly adopted for their postoperative benefits. Aims and Objectives: To compare the outcome of the Enhanced Recovery After Surgery (ERAS) program and conventional care in patients undergoing laparoscopic cholecystectomy, in hospital setting in rural North India, with respect to their post-operative pain, bowel movements, complications, total opioid used, readmissions, surgical site infection (SSI) and the post-operative length of stay. Materials and Methods: This prospective study was conducted at the Surgery Department of Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, U.P., India. from May 2022 to April 2024. All patients above 18 years of age undergoing laparoscopic cholecystectomy with American Society of Anaesthesiologists (ASA) I and II were included. A total of 100 subjects, 50 subjects in the Group A (ERAS protocol) and 50 subjects in the Group B (Conventional approach), were included based on computer-generated random numbers with concealment of allocation. Key parameters, including length of hospital stay, morbidity, postoperative pain, and protocol compliance, were evaluated between both groups. Continuous variables were presented as means with standard deviations and analyzed using unpaired t-tests. Categorical variables were expressed as percentages and compared using chi-square tests. Results: The mean age of the study population in ERAS and conventional was 38.6±6.8 years and 37.3±8.7 years, respectively. Similarly, 19 male participants were from the ERAS group and 17 were from the conventional group, whereas among female participants 31 were from the ERAS group and 33 were from the conventional group. The ERAS group demonstrated significant advantages: shorter hospital stays (92% vs. 68%, p=0.01), and reduced postoperative pain (p=0.01), Surgical Site Infection (SSI), no increase in readmissions. Conclusion: The ERAS group exhibited notable benefits, including a shorter hospital stay, and lower postoperative pain. These findings suggested the potential for enhanced recovery outcomes with ERAS protocol implementation in laparoscopic cholecystectomy patients.

Background: Dipeptidyl Peptidase 4 (DPP-4), a ubiquitous serine peptidase, cleaves N-terminal dipeptides from various substrates, such as GLP-1 and GIP, which are involved in controlling energy homeostasis. DPP-4 is identified as an important target for glycemic control due to its direct and indirect effects on glucose and lipid metabolism. There are various reports of DPP-4 release from adipose tissue, the liver and the pancreas. It is also known as T-cell antigen CD 26. DPP-4 polymorphisms are important targets for understanding the pathogenesis and genetics of diabetes mellitus. Aim: To study the association between SNP in the DPP4 gene in patients with type 2 diabetes mellitus. Methods: 50 patients with type 2 diabetes mellitus and 50 healthy controls were recruited, and blood parameters were assessed (RBS, AST, ALT, and ALP). The blood sample was subjected to DNA extraction, amplification was done by ARMS PCR, and polymorphism identified using agarose gel electrophoresis. The results were statistically analyzed and tabulated. Results: The mean random blood sugar level among the participants with T2DM was 222.4 mg/dL, and among healthy participants, it was 116.37 mg/dL. The mean AST among T2DM and healthy controls was 26.74 IU/L and 25.04 IU/L, respectively, with no significant difference (p = 0.278). The mean ALT among T2DM and healthy controls was 28.83 IU/L and 20.96 IU/L, respectively. There was a highly significant ALT among the participants with T2DM (p = 0.001). Genotype distribution for DPP-4 at rs12617656 among T2DM and controls does not obey Hardy-Weinberg law. The dominant model and recessive model showed a significant association of rs12617656 with the south Indian population, with odds ratio of 6.0 (1.242–28.99) and 1.601 (0.613–4.176), respectively. Conclusions: We found an increase in the frequency of homozygous patients (C/C) for DPP-4 (rs 12617656) single nucleotide polymorphism in patients with T2DM. Identification of single nucleotide polymorphisms of DPP-4 among families contributes to the early identification of susceptible individuals to start a specific DPP4 inhibitor drug that will be more effective than other anti-diabetic drugs.

Placenta is the organ belonging to the developing mammalian conceptus which is never incorporated in the body of foetus but it is vital to the well-being of the baby in the womb and it offers protective, nutritional, respiratory, synthetic and excretory functions as well. Thus it exists as a vital link between mother and developing fetus. During pregnancy, maternal body in general and the uterus in particular, get acquainted to several physiological changes and after successful termination of pregnancy return back to the pre-pregnant stage. The outcome of pregnancy depends on many factors. One such factor is the health and wellbeing of mother throughout pregnancy. Any deviation from normal physiology would adversely affect not only the mother and foetus but the other gestational tissues as well.
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.
The diagnosis of gestational hypertension is made in women whose blood pressure reaches 140/90 mm Hg or greater for the first time during pregnancy.

This retrospective study evaluated the management outcomes of adhesive small bowel obstruction (ASBO) in 62 patients at Gauri Devi Institute of Medical Sciences and Hospital over two years. The study compared the effectiveness of conservative and surgical interventions, finding a higher resolution rate with surgical treatment (95.8%) compared to conservative management (68.4%). Complications were more prevalent among surgically treated patients, highlighting the need for careful patient monitoring. The study also identified previous abdominal surgeries as a significant predictor of the necessity for surgical intervention. These findings suggest that early and tailored surgical approaches could enhance outcomes for ASBO patients, reducing recurrence rates and improving overall management efficiency.

Introduction: Deviated nasal septum (DNS) significantly impacts quality of life, with symptoms ranging from nasal obstruction to headaches. Despite the use of clinical exams and imaging for diagnosis, there’s often a disconnect between subjective complaints and objective findings. Various classification systems and measurement techniques, like rhinomanometry and acoustic rhinometry, aim to better correlate these aspects for improved diagnosis and treatment. Aims and Objective: To correlate between the subjective symptoms and objecitve findings in deviated nasal symptoms. Methods: This prospective research aimed to determine the impact of deviated nasal septum (DNS) on nasal obstruction. The study involved clinical evaluations, diagnostic procedures, and both subjective and objective assessments of nasal blockage using anterior nasal rhinomanometry and a nose scale questionnaire. Patients meeting specific inclusion criteria were analyzed, with data statistically processed using SPSS and Excel, focusing on objective-subjective correlations with a significance threshold of p < 0.05. Results: The study included 127 men and 129 women, ensuring gender parity. Nasal obstruction/snoring was reported by 196 patients (76.56%), nasal discharge by 225 patients (87.89%), and sneezing by 197 patients (76.95%). Average vital signs showed systolic blood pressure at 134.53 mmHg and diastolic at 94.64 mmHg. Physical exams revealed 100% nasal septum asymmetry and 83.98% vestibule narrowing. The NOSE score highlighted varying severity levels of nasal symptoms across the sample. Conclusion: The study has concluded that a considerable number of the patients have shown significant nasal and respiratory health issues, with widespread abnormalities in nasal structure and function, as evidenced by high rates of nasal septum asymmetry, vestibule narrowing, and positive nasal airflow tests.

Background and Aim: Even with significant advancements in primary prevention, diagnostic procedures, and treatment, stroke remains one of the principal causes of death. In spite of published findings suggesting that stroke in young is not as common as that in elderly; it should be considered a differential diagnosis in young people with acute neurologic symptoms. The characteristics knowledge gained from research in older patients cannot always be applied to young adults, as the etiology of stroke in this age group differs from that of older patients and influences both diagnostic evaluation and treatment. Following stroke, young adults are incapacitated during their prime years of productivity; therefore, stroke in the young has a disproportionately greater economic impact than stroke in the elderly. Hence this article focuses on the patterns of risk factors, etiology and outcomes in stroke in young adults. Materials and Methods: We selected 100 patients with stroke in the age group of 15-45years and followed up these patients from time of admission to time of discharge with thorough history, medical assessment and laboratory and imaging tests. We calculated the NIHSS (National Institute of Health Stroke Scale) score at admission and also modified Rankin score (MRS) of neurological disability at admission and at time of discharge. We tried to evaluate the common risk factors, etiology, hospital outcomes and relation between the NIHSS score at admission to MRS score at discharge. Results and Discussion: Majority of the study participants were male with a mean age of 38.94 years with an increased prevalence of ischemia stroke. In the haemorrhagic group, male preponderance could be seen however equal incidence was seen in ischemia stroke in both males and females. The most common risk factors in our study population were found to be hypertension, dyslipidaemia, diabetes mellitus and smoking and alcohol consumption was also found to be significant in this young stroke population. Most common etiology however remained undetermined as per TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification due to constraints in complete evaluation and loss to follow up but a few other determined aetiologies like SLE (Systemic Lupus Erythematosus) vasculitis, Oral contraceptives, Tubercular infective endarteritis, Homocysteinemia, cardioembolic stroke in Rheumatic heart disease (RHD) patients were found to be predominant. Conclusion: Stroke in young adults is a major public health concern. Prevention is the primary therapeutic strategy for reducing the morbidity and mortality linked to adolescent stroke. Our study’s findings suggest that the risk factors for stroke in younger individuals are similar to those previously found in older populations. Young stroke incidence may be considerably reduced by population-based risk factor-focused preventive strategies and interventions.

Introduction: Psoriasis, a chronic immune-mediated disorder, has been associated with various comorbidities, including obesity and dyslipidemia. To investigate this correlation, we conducted a prospective case-control study in collaboration with the Departments of Skin and STD and General Medicine at Government Medical College, Amritsar.. Chronic plaque psoriasis, the most prevalent form of psoriasis, is known to impact patients both physically and emotionally. The aim of this study is to explore the potential correlation between chronic plaque psoriasis and metabolic factors, specifically obesity and dyslipidemia. Understanding these associations can provide valuable insights into the multifactorial nature of psoriasis and guide comprehensive patient management. Methodology: Patients meeting the inclusion criteria underwent detailed clinical examinations, including the assessment of psoriasis severity. Additionally, anthropometric measurements and lipid profile assessments will be performed. Data from both groups will be compared to identify any significant correlations between chronic plaque psoriasis, obesity, and dyslipidemia. The study was approved by the Institutional Ethics Committee. Conclusion: In conclusion, the study reveals noteworthy associations between chronic plaque psoriasis severity and both obesity and dyslipidemia. While a positive correlation was observed between psoriasis severity and waist circumference, suggesting a potential link with obesity, dyslipidemia exhibited a higher prevalence in psoriasis cases. These findings emphasize the intricate relationship between psoriasis, systemic inflammation, and metabolic disturbances. Addressing obesity and dyslipidemia should be integral to psoriasis management strategies, offering a comprehensive approach to improve patient outcomes and mitigate the risk of associated cardiovascular complications.

Background: Understanding the prescription patterns of anti-diabetic drugs in Type 2 Diabetes Mellitus patients is crucial for optimizing treatment outcomes and addressing variations in clinical practices, ensuring effective disease management. Aim: To evaluate the prescription pattern of antidiabetic drugs in patients with type 2 diabetes mellitus. Materials & Methods: A prospective observational study was conducted at Konaseema Institute of Medical Sciences (KIMS) Hospital, from July 2022 to December 2022 after getting approval from the Institutional Ethics Committee (IEC). A total of 200 patients aged 18-75 years of both genders and with Type 2 Diabetes Mellitus currently on OHA medication was included in the study after taking informed consent. All the patient’s demographic data and medical data were collected using a case report form. Data was entered into an MS Excel spreadsheet, and analyzed by descriptive statistics. Results: A total of 200 patients with T2DM were included in the study, among which males were 52% and females were 48%. The age group 46 – 55 years has the maximum number of patients (33%). About 92.5% of patients were treated only with oral hypoglycaemic agents (OHA) whereas, 5.5% were treated with both OHA and Insulin and 2% were treated only with Insulin. Metformin and Glimepiride are the most commonly prescribed fixed-dose combination. Metformin is the most commonly prescribed drug in patients with type 2 Diabetes Mellitus (96.5%) followed by Glimepiride (38%), and Voglibose  (6%). Human Actrapid was the most prescribed insulin preparation among the study participants. The average number of drugs per prescription was 4.2. About 16.87% of drugs were prescribed from the National List of Essential Medicines – 2015 (NLEM) and 12.42% of drugs were prescribed from the WHO Essential List of Medicines – 2021 (WHO ELM). Conclusion: Metformin (Biguanides) was the most commonly prescribed drug in patients with type 2 diabetes mellitus followed by Glimepiride (Sulfonylureas). Metformin with Glimepiride is the most commonly prescribed FDC in combination therapy. The average number of drugs per prescription was found to be 4.2 and the majority of the drugs were prescribed with their brand names.

Background and Aim: There are different adjuvants that are being utilised alongside local anaesthetics to extend the duration of pain relief during and after surgery. Dexmedetomidine, a highly selective α2 adrenergic agonist, is becoming increasingly popular as a new neuraxial adjuvant. For this study, we examined and assessed the impact of using dexmedetomidine and fentanyl alongside intrathecally administered hyperbaric bupivacaine during lower extremity surgeries performed under subarachnoid block anaesthesia. Our goal was to determine the most effective perioperative approach. Material and Methods: For this study, a group of 100 patients who were scheduled for elective lower limb surgeries under spinal anaesthesia were divided into two groups at random. Group A patients were administered a combination of 0.5% hyperbaric bupivacaine (12.5 mg) and dexmedetomidine (5 mcg). Group B patients were administered a combination of 0.5% hyperbaric bupivacaine (12.5 mg) and fentanyl (25 mcg). Comparisons were made between both groups regarding the onset, duration, regression of sensory and motor blockade, as well as any haemodynamic variations and side effects. Results: Group A had a slightly faster onset of sensory block compared to Group B (6.80±1.80 min vs. 7.20±2.32 min). On the other hand, Group B had an earlier onset of motor block compared to Group A (11.80±0.48 min vs. 11.90±2.26 min). There was a slightly longer motor block duration in Group B compared to Group A (155.74±14.65 min vs. 151.42±14.57 min), but this difference was not statistically significant (P >0.05). There was no significant difference in analgesic demand between the two groups during the immediate postoperative period. The p-value is greater than 0.05. Conclusion: the addition of dexmedetomidine as an adjuvant to intrathecally administered hyperbaric bupivacaine provides a notable increase in the duration of sensory and motor block. This combination also offers superior perioperative analgesia while maintaining excellent haemodynamic stability and minimising side effects.

Objectives: Comparison of Results of Various Types of Instrumentations in Fractures of the Dorsolumbar Junction and Determination of the Optimum Type of Instrumentation, Type of Decompression and Type of Reconstruction for Different Types of Fractures of the Dorsolumbar Junction. Material and Methods: This was a study of 60 patients with dorsolumabar junction fractures who were treated with open reduction and internal fixation at our institute. These patients were subjected to detailed neurological examination according to the proforma. The study was conducted between 32 patients (fixed with Harrington rod Group A) and 28 (pedicle screw rod Group B) with dorsolumbar spine fractures. Results: In our study, 60% fractures occur T11 to L2. Fall from tree were the common mode of injury in rural population, while in urban area, it was due to road accident followed by fall. Fractures of spine are more common in males as compared to females. Fixation with pedicle screw rod associated fast recovery and did not need any type of brace during postop rehabilitation, complication like implant failure, infection, etc. were less in pedicle screw group. Conclusion: Although, pedicle screw fixation is technically demanding procedure, requires image intensifier facilities and implant is more costly than Harrington instrumentation, but in benefit of patient, it is better than Harrington instrumentation, but in benefit of patient, it is far better than Harrington instrumentation.

Background and Aim: Supraclavicular brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Adjuvants are added to local anesthetists to improve various block characteristics. The present study aimed to compare the clinical efficacy of butorphanol and dexmedetomidine in supraclavicular brachial plexus block when given with 0.5% levobupivacaine. Material and Methods: Present observational study was carried out in 54 adult patients posted for various elective upper limb surgeries. Total patients taking part into study were divided into two groups: Group D: Patients received 24 ml of 0.5% levobupivacaine + 50 µg(1ml) of dexmedetomidine = 25 ml. Group B: Patients received 24 ml of 0.5% levobupivacaine + 2 mg(1ml) of butorphanol = 25 ml. Onset and duration of sensory and motor block and duration of analgesia were noted and any side effects were observed. Results: The mean Onset of sensory block was significantly faster in Group D as compared to Group B (P<0.05). The mean Onset of motor block was significantly faster in Group D as compared to Group B (P<0.05). Hemodynamic parameters were comparable in both the groups at all-time intervals (p>0.05). Mean duration of sensory block was significantly prolonged in Group D (591.87±75.71 minutes) as compared to Group B (391.31±59.60 minutes) (P<0.05). Mean duration of analgesia was significantly prolonged in Group D as compared to Group B (P<0.05). Conclusion: Dexmedetomidine when added to Levobupivacaine in supraclavicular brachial plexus block has faster onset, longer duration of sensory and motor block and prolonge duration of analgesia as compared to Butorphanol that too without any complications. Thus, Dexmedetomidine is better adjuvant than Butorphanol when added to Levobupivacaine in supraclavicular brachial plexus block.

Background and Aim: Kangaroo Mother Care (KMC) implies placing the newborn baby in intimate skin-to-skin contact with the mother’s chest and abdomen coupled with frequent and preferably exclusive breast feeding. The objective of our study was to assess the physiological state of LBW babies during KMC in a teaching hospital setting, to study the weight gain pattern and the duration of stay of these neonates in whom KMC was implemented in a tertiary care setting. The broader intention is to generate data to recommend wider implementation of the strategy. Material and Methods: The present study was carried out in the Neonatal Intensive Care Unit, Department of Pediatrics, GMERS Medical College, Gandhinagar. 150 neonates selected from study population. The length was measured at birth, at enrolment in study and thereafter at the time of discharge by using an infantometer. Head circumference (HC) was measured first after 24 hours of birth, at enrolment in study and weekly thereafter at the time of discharge by standard method via measuring tape. Enrolled neonates were followed up till 3 months of age. At the end of 3 months, neonates were divided into 2 groups. Group A: Neonates who had received KMC at home and Group B: Neonates who had not received KMC at home. At 3 month of age – neonate weight, head circumference and length were measured; from which average weight gain/day, head circumference/week, length increment/week was calculated in both groups. Results: At the time of initiation of KMC during hospital stay, the feeding type BF, KSF and RTF noted in 7.3%, 14% and 50.7% participants respectively. Mean height, Lenth, Weight and Head Circumference value of group A differed statistically significantly between time points at initiation of KMC, at discharge and follow-up visit (P < 0.05). KMC at home was given in 70% participants who came for follow-up. Practice of KMC continued at home provides better neuro-stimulation and intact neuro-development outcome at corrected gestational age. Conclusion: KMC has significant role in growth improvment, exclusive Breastfeeding rate, decreasing morbidities, reducing the need of extra equipments, antibiotics, artificial milk and empowering the mother as primary care provider; KMC has major role in conserving the scarce resources and personnel in limited resources area.

Introduction: Frozen sectioning using cryostat plays a vital role in the rapid diagnosis of intraoperative surgical procedures. Since the diagnosis is made within less than 20-30 minutes it helps the surgeon to make intra operative decision when the patient is on table for surgery. Aim: The present study aims to assess the role of cryostat in diagnostic histopathology and by comparing the frozen section (FS)diagnosis with that of formalin fixed routinely processed paraffin tissue section (PTS) diagnosis and to analyse the causes of discordance and thereby to minimise the errors. Materials and Methods: This retrospective study for 10 years duration includes 263 cases received for of FS diagnosis in dept of pathology at GMKMC, Salem, Tamilnadu. FS were taken using cryostat at -17^◦C and stained with haematoxilin and eosin. The FS diagnosis was compared with their corresponding PTS diagnosis and analysed for concordance and discordance. Results: Out of total 263 cases of frozen sections studied, 250 were concordant and 13 were discordant with their corresponding paraffin tissue sections. The discordant cases could be due to interpretation error, sampling error and communication error. Conclusion: By improving the technique of grossing the specimen sent for frozen section, maintaining adequate needed temperature of -17 ^◦C inside the cryostat, quality of frozen tissue sections, staining quality, pathologist having good rapport with the operating surgeon all will improve the concordance rate and by minimising the various errors need of resurgery will be reduced and patient can be treated more efficiently.

Background: Laparoscopic surgery is a widely preferred technique due to its minimally invasive nature, offering benefits such as reduced recovery time and minimal scarring. However, complications associated with laparoscopic port sites, though generally low, can significantly impact patient outcomes. Objective: This study aimed to identify the incidence, types, and risk factors associated with laparoscopic port site complications, focusing on how surgical techniques and patient demographics influence these outcomes. Methods: A prospective observational study was conducted involving 220 patients who underwent various laparoscopic procedures at MKCH MCH Berhampur from June 2022 to June 2024. Data on postoperative complications, patient demographics, and surgical details were collected and analyzed to identify patterns and correlations. Results: The study was conducted on 220 patients out of which 18 patients developed complications, I,e the complication rate was 8%, with superficial surgical site infections such as subcutaneous abscess, erythema and sinus tract formations being the most common. Tight skin sutures were significantly associated with higher complication rates. While trends were observed in complication rates among different age groups and genders, these were not statistically significant. Conclusion: The study highlights the crucial role of surgical technique, particularly suture management, in minimizing complications at laparoscopic port sites. Future surgical guidelines and training should emphasize optimizing suture techniques and considering individual patient risk factors to enhance postoperative outcomes.

Background: Approximately 5000 individuals every year succumb to death from burns, accounting for roughly 2 million hospital admissions. The amount of the total body surface area affected is a crucial factor that influences the outcome in burn cases. Most fire-related fatalities are unintentional, typically the result of negligence. Suicidal burns are more common in women and in household settings. Homicidal burns are uncommon; they are typically caused by acts of retaliation or criminal concealment. Objective: This study sought to determine the method of death in burn cases, as well as the amount of body surface area affected, survival time, and length of hospital stay. Materials and Methods: A year-long descriptive study was carried out in the Departments of Forensic Medicine and Pathology, Government Medical College, Thiruvananthapuram, Kerala, India. The study took place between February 2012 and February 2013. Inclusion criteria constituted all post-mortem cases brought with alleged history of burns whereas exclusion criteria constituted dead bodies with burns brought in any stage of decomposition and burns due to electrocution and radiation. Study variables including demographics data (age, gender, height, nutritional status, marital status, occupation, educational status and the socioeconomic status of the deceased) and clinical history data (cause of burn, percentage of body surface area involved, degree of burns, period of survival and the complications if any that aroused during the hospital stay) was captured in the study proforma. Autopsy of all the study subjects (n=100) was conducted by the Modified Rokitansky method. Result: In the age category of 20 to 29 years, there were the most instances (30%), with 28 females and 2 males. Suicide accounted for the majority of instances (58%), with accidental deaths coming in second with 37% of occurrences. Homicidal burns were seen in 4 cases. The period of survival in majority of the cases (27%) was between 1 to 3 days. This was followed by 26 cases and 21 cases in whom the period of survival was <1 day and 3 to 7 days, respectively. There were 6 cases in whom the period of survival was >28 days. Conclusion: The bulk of these cases (84%) involved females and had burn injuries ranging from 51% to more than 90% of the body surface area (BSA). Hospital stays of one to seven days were recorded in 48% of cases. Of the instances, 26% of the deaths occurred within a day. The bulk of deaths were suicide (58%), then accidents (37%), and the fewest were homicidal (4%).

Background: Cranioplasty is crucial for repairing cranial defects but carries significant risks and complications. This study aimed to identify complications and risk factors associated with cranioplasty at a tertiary care center. Methods: A prospective observational study was conducted over 12 months with 150 adult patients undergoing cranioplasty. Data on demographics, clinical characteristics, indications, materials used, and postoperative complications were collected. Statistical analyses, including logistic regression, identified significant risk factors. Results: The mean age was 45.6 years, with 61.33% males. Indications for craniotomy included traumatic brain injury (56.67%), stroke (26.67%), and tumor resection (13.33%). Materials used were autologous bone (40.00%), titanium mesh (36.67%), and custom 3D implants (23.33%). Immediate complications occurred in 30.00% of patients, including infections (12.00%) and hematomas (8.00%). Long-term complications included bone flap resorption (14.67%) and chronic pain (11.33%). Significant risk factors were higher age, BMI, diabetes, hypertension, smoking, autologous bone use, and longer surgery duration. Custom 3D implants were associated with fewer complications. Conclusion: Cranioplasty poses substantial risks, with age, BMI, co-morbidities, and surgery duration as key risk factors. Custom 3D implants may reduce complication rates. Identifying these factors can improve patient outcomes and guide clinical practices.

Abiotrophia defectiva is a rare cause of infective endocarditis (IE). It is formidable to diagnose due to the gradual presentation of the disease and the organism’s fastidious nature. These fastidious pathogens are extremely important even if they are uncommon since they have been linked to an increased risk of morbidity and mortality. Consequently, it is critical to understand the variety of clinical manifestations and crucial factors to consider when managing individuals with atypical microorganism-associated infective endocarditis. Here, we present a case series involving two different clinical presentations of prosthetic valve and native valve endocarditis with Abiotrophia defectiva. Even with recent advances, managing IE is still a difficult and complex issue. Patients with endocarditis need more accurate clinical evaluation along with accurate identification of etiological agents and appropriate antimicrobial therapy.

Background: Breast cancer is a significant health concern globally, with varying prevalence and characteristics across different populations. This study aims to analyze the histomorphological spectrum of breast neoplasms in a central Indian tertiary care hospital, highlighting the distribution of benign and malignant lesions and associated demographic factors. Methods: A prospective observational study was conducted from May 2022 to April 2024, involving patients presenting with breast lesions. Inclusion criteria included all patients with histopathologically confirmed breast neoplasms. Data were collected through clinical evaluations and histopathological examinations. Statistical analysis was performed using SPSS software version 25, employing descriptive statistics, chi-square tests, and t-tests, with a significance level set at p < 0.05. Results: Out of 174 cases, 72.42% were benign, and 27.58% were malignant. The mean age for benign lesions was 25.56 years (SD 10.56), and for malignant lesions, it was 49.79 years (SD 13.38). Rural areas accounted for 90.80% of cases, while 9.19% were from urban areas. All male breast lesions were malignant, while 73.68% of female lesions were benign. The left breast was more commonly affected (47.13%) than the right (43.12%), with 9.77% being bilateral. The upper-outer quadrant was the most frequently involved (32.18%). Fibroadenoma was the most common benign lesion (76.19%), and infiltrating ductal carcinoma NOS was the most prevalent malignant lesion (54.17%). Conclusion: The study underscores the higher prevalence of benign breast lesions and the significant rural-urban disparity in breast neoplasm cases. The findings highlight the need for targeted screening, early detection programs, and improved healthcare access, especially in rural areas. Further research is essential to enhance breast cancer management strategies.

Background and Objectives: Intracapsular fracture neck femur account for a major share of fractures in the elderly. The primary goal of treatment is to return the patient to their pre-fracture functional status. Hemiarthroplasty has been considered the treatment of choice in femur neck fractures in elderly. This study plans to compare the safety, effectiveness and clinical results of cemented and uncemented bipolar hemiarthroplasty in treating fracture neck of femur in patients aged >60yrs of age. Methodology: The present comparative study includes 30 cases of intracapsular fracture neck of femur in elderly aged more than 60y, who were divided into 2 groups with 15 patients in each group; the groups were being assigned based on Dorr’s Index. One group was treated by hemiarthroplasty using uncemented prosthesis whereas the other group was treated with hemiarthroplasty using cemented prosthesis. Patients were followed up for 6 months and functional outcome was assessed at the end of this period. Results: There was no statistical difference in the functional outcome between the two groups in our study (p=0.53). Despite the known physiological effect of cement upon the cardiopulmonary system, we found no clinical morbidity or mortality because of this in our study. Surgical time (80.66minutes versus 31.53 minutes) and blood loss (281.33ml versus 226.66ml) was statistically significant for the cemented cohort than the uncemented (P=<0.001). Post-operative pain after 6weeks was less in the cemented group (p=0.013) Conclusion: In femur neck fractures, both the cemented and uncemented bipolar prosthesis have a similar functional outcome in our study. Although the operative time and blood loss was higher in the cemented group, post-operative pain was less. We suggest both the types of hemiarthroplasties as good treatment options for treatment of femoral neck fractures in elderly.

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Material and Methods: This study was conducted at a tertiary care centre in North India which caters mostly rural population of Uttar Pradesh, Bihar, Madhya Pradesh and Jharkhand. Demographical, clinical and radiological data were collected and analyzed with various biostatistical tools. Result: Cumulative smoking (pack years), previous history of exacerbations, total duration of illness and CAT scores are important predictors of mortality and need of post hospital support. Low Glasgow Coma Score (<15), High respiratory rate, cyanosis, baseline low arterial pH, high pCO2 are predictors of mortality and morbidity. B type natriuretic peptide, ie, BNP is significant predictors of in hospital mortality. CRP was positively correlated to high total leucocyte count suggesting role of infections in AECOPD. Conclusion: These are simple prognostic factors for use in patients with COPD exacerbations presenting to the emergency department. The corresponding variables are very easy to measure at entry in the real-life context, and represent powerful predictors of the risk of both death and need for post-hospital support.

Background: CSOM and accompanying hearing loss are significant in our society, and an effort to assist those afflicted is worthwhile. The selection of the technique remains debatable and relies on the presence or absence of cholesteatoma, its location, the state of the middle ear mucous membrane, and auditory thresholds. Method: A prospective analytical study carried out from October 2018 to June 2020 on patients attending the ENT outpatient department of a tertiary health care center. Results: The mean age of patients was 27.84 ±10.62years & male-to-female ratio was 1.28:1. In Group I post-operative hearing improvement was seen among 26 (55.3%) patients. While in Group II, 13 (39.4%) of the patients had hearing improvement. Conclusion: Patient satisfaction in term of dry ear, pain, & hearing improvement was found better in CWU than in CWD mastoidectomy. Also, disease control in terms of dry ear & hearing improvement post 6 months was found better in CWU than CWD.

Introduction: Lower Gastrointestinal(GI) bleeding refers to blood loss of recent onset originating from a site distal to the ligament of Treitz.1It usually presents as hematochezia i.e. passage of maroon or bright red blood or blood clots per rectum. Lower GI bleeding (LGIB) accounts for almost 20% of all cases of acute GI bleeding. 2 The etiology and the epidemiology of LGIB varies according to the environmental conditions depending upon the life style, dietary habits, the prevalence of smoking, history of drug intake, age and longevity of the population etc.2 Most of the studies pertaining to the etiologies of Lower GI bleeding are from the West. Data relating to the incidence and etiologies of Lower GI bleed in India is scarce hence this study was undertaken to identify the etiological profile of patients presenting with Lower GI bleeding in a tertiary care hospital in the northern part of India. Materials and Methods: It is a Cross-sectional study done over a period of 1 year from January, 2023 to December, 2023. All the patients above 18 years of age with first presentation of Lower GI bleeding to the Department of General Surgery, SJ Medical College & Hospital, Puri, and Odisha during the period of study are included in the study. Results: A total of 116 patients meeting the inclusion criteria were included in the study. Majority of the patients were males (69.8%). Hematochezia (86%) was the most common presenting feature and was commonly associated with constipation (46%), abdominal pain (32%) and loss of weight (11%). 8% of the patients had a history of Diabetes. Alcohol consumption was seen in 17% of the patients while 26% of the patients had a history of smoking. The most common etiology of Lower GI bleed seen was Hemorrhoids (35.3%), followed by Inflammatory Bowel disease (16.3%), Malignancy (12%) and Radiation proctosigmoiditis (11.2%). Conclusion: LGIB is a common and alarming presenting condition in the practice of gastroenterology. It was found that Lower GI bleed is more common in males, usually in the 3rd to 4th decade of life and most commonly presents with hematochezia. Haemorrhoids, IBD and Malignancy were the major causes of Lower GI bleed.

Introduction: Appendix in a finger like projection situated just near the caecum. It is located in the right iliac fossa of the abdomen. The most common pathology which arises is appendicitis and is mostly treated surgically. Although appendix is considered to be a vestigial organ, it accounts for immune function up to some extent. Objectives: To study and analyse the various histopathological forms of appendicitis. Materials and Methodology: A descriptive study was undertaken to analyse the different histopathological forms of appendicitis over a period of one year in the Department of General Surgery, SJ Medical College & Hospital, Puri, and Odisha. The acquired data was fed into Microsoft Excel and analysis was done. Result: A total of 100 specimens were analysed during the study period. Maximum number of cases (62% of cases) was reported amongst females. The most common age group which was affected was 9 years to 19 years. The most common histopathological form of appendicitis was analysed to be acute appendicitis (76% of cases). The statistical data for various histo pathological types of appendicitis are as follows subacute appendicitis – 10 cases; acute appendicitis – 76 cases; chronic appendicitis – 13 cases; Granulomatous appendicitis – 1 case. Conclusion: The incidence of appendicitis is higher in the second decade of life and is remarkably high amongst females. Among the pathological types, incidence of acute appendicitis is the highest and that is seen in the second decade of life.

Background: A thorough knowledge of the immunological processes underlying these conditions is essential to develop diagnostic and therapeutic strategies appropriate for preeclampsia and eclampsia. Aim: This study aims to understand the immune processes behind preeclampsia and eclampsia and identify possible therapy targets. Hypothesis: Compared to a normal pregnancy, eclampsia is thought to have significantly greater T cells and HLA alloantibodies. Moreover, we speculate that eclampsia and preeclampsia markedly change the T lymphocyte ratio to T cells. Materials & Methods: The current study was started once the institutional human ethics committee approved the study protocol, which was submitted for approval. The study was conducted in the RDJM medical college and hospital, Turki, Muzaffarpur. A total of 183 samples will be tested in each of the following three categories: 100 normotensive samples, 83 pre-eclamptic and eclamptic samples, and so on. a) Normal Pregnancy: This describes a pregnancy that is singleton and devoid of any evident problems. If blood pressure is 140/90 mm Hg or above, or if it has increased by 15 mm Hg diastolic or 20 mm Hg systolic over the previous blood pressure that was detected on at least two occasions six hours apart, then hypertension is considered to be present in the presence of b) preeclampsia and c) eclampsia. Results & Conclusion: The research provides crucial information for comprehending the relationship among HLA alloantibodies, T lymphocytes, and eclampsia. The results show that these immunological components are significantly different in preeclampsia and eclampsia compared to a normal pregnancy and that the ratio of Th to Ts is also considerably changed. These results have significant implications for diagnosing and managing eclampsia and preeclampsia; more research is needed to realize these implications fully. Future studies should identify specific HLA alleles and T cell subsets associated with preeclampsia and eclampsia and explore the potential benefits of altering the immune response to provide novel therapies for the illness.

Background: Anesthesia for knee surgeries can be administered by various modes. Spinal anesthesia is most commonly used technique because of its quick onset, excellent blockage, low infection risk and affordability. Most widely used drug is hyperbaric Bupivacaine (0.5%). Method: Out of fifty (50) patients, 25(Group F) were administered isobaric levobupivacaine (0.5%, 2.8ml) and fentanyl (25mcg, 0.5ml), total volume: 3.3 ml. 25(Group D) were administrated isobaric levobupicaine (0.5%, 2.8 ml) and Dexmedetomidine (10mcg, diluted in normal saline), total volume 3.3 ml. The analgesic effects of both drugs were monitored post operatively. The VAS score for both drugs was noted and compared. Results: Comparison of time to give first rescue analgesia ,time to reach peak sensory level, total duration of motor blockade, time to 2 sensory level regression, hemodynamic parameters between two group had a signifi-cant p value (p<0.001) and the least side effects were noted in GROUP D. Conclusion: Time to give first dose of post-operative rescue analgesia was more in GROUP D with prolonged sensory and motor blockade, with more side effects in GROUP F as compared to GROUP D, GROUP D drug preferred over GROUP F drug in patient undergoing knee surgeries.

Background: Neonatal septicemia is a serious cause of morbidity and mortality among neonates. Either EOS (early onset sepsis) or LOS (late onset septicemia) if not treated with proper sensitive antibiotics in proper duration. Method: 292 neonates admitted to the NICU were studied. Blood specimens were drawn aseptically before starting any antibiotic therapy and inculcated in Bact. Alert/PPF plus blood culture bottles, which are incubated at 37 degree C aerobically in BacT Alert 3D 120 automated conventional methods and were identified by microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: Out of 292 neonates admitted to NICU, 196 (67%) were found to be positive, of which 134 (68.3%) were gram-positive, 56 (28.5%) were gram-negative, and 6 (3%) were candida infection. Staphylococcus aureus and Klebesiella pneumonia were the commonest isolates. Conclusion: The present pragmatic study of gram-positive, gram-negative, and candidiasis will certainly help the pediatrician to treat neonatal sepsis efficiently to prevent morbidity and mortality.

Background: Pseudo exfoliation (PEX) is an age-related systemic disorder in which fibrillar extracellular mate-rial is synthesized and deposited in the anterior segment of the eye. Hence, cataract surgery in PEX poses a chal-lenge to ophthalmic surgeons. Method: 50 patients above fifty years of age with PEX were studied; planned manual small incision cataract surgery with rigid posterior chamber intraocular lens implantation under peribulbar anesthesia was carried out. Results: 22 (44%) patients had intraoperative complications. The major postoperative complications were 16 (32%) corneal oedema with sk’s, 15 (30%) had severe AC reactions, and 7 (14%) Iris pigment dispersion. Conclusion: It is concluded that proper preoperative evaluation and modification of surgical technique are es-sential to manage intraoperative complications and successful cataract surgery with PEX.

Introduction: One of the most important steps in cataract surgery is the development of a continuous curvilinear capsulorrhexis (CCC) in the anterior capsule and in mature cataract patients due to absence of red reflex, it is challenging to determine the spreading edge of the capsulorrhexis. In such cases, to perform CCC, anterior capsule is stained briefly with any vital dye like trypan blue. So this study was conducted to see the effectiveness and safety of trypan blue dye and to observe outcomes of small incision cataract surgery (SICS) in mature cataracts. Material and Method: The present study was a prospective cohort study conducted on 100 patients having mature senile cataract in single eye with age from 50-70yrs posted for SICS Detailed demographic and clinical history of the subjects was taken. Preoperative, intraoperative and postoperative evaluation was done and findings like uncorrected visual acuity (UCVA) & best corrected visual acuity (BCVA), slit lamp, fundus, intra-ocular pressure (IOP), keratometry, B-scan etc. findings were noted and analyzed using SPSS version 20. Result: The present study showed mean age of 60.99+5.97years. The study depicted female dominance and 96% of the patients had mature cataract. 10% had corneal edema without any increase in IOP and all patients responded well to the treatment. In 95% cases, easily and safely complete CCC was performed. No significant variation was seen in IOP during follow up visits. The final visual outcome was satisfactory with 90% achieving UCVA of 6/12 or better and 95% attaining BCVA of 6/12 or better. Conclusion: Our study has shown that the use of trypan blue as an adjunct to SICS is a safe and effective approach, which simplifies capsulorrhexis in mature cataract patients, as it has a low incidence of intraoperative problems and easily treated postoperative difficulties.

Background: Neurocysticercosis, caused by the larval stage of Taenia solium, remains a significant cause of neurological morbidity in endemic regions. Antiparasitic therapy, including albendazole and praziquantel, is central to treatment, yet the efficacy and safety profiles warrant continual evaluation. This prospective study aims to assess the clinical outcomes and safety of antiparasitic treatment in patients with neurocysticercosis. Materials and Methods: A prospective study was conducted at the Department of Neurology, Super Specialty Hospital, Govt. Medical College, Jammu, from April 1, 2023, to March 31, 2024. Sixty patients diagnosed with neurocysticercosis were included. Diagnosis was confirmed through clinical evaluation and neuroimaging. Patients were administered albendazole (15 mg/kg/day) and praziquantel (50 mg/kg/day) for 14 days. Adverse events were monitored and recorded. Clinical outcomes were assessed at baseline, 3 months, and 6 months post-treatment using the Engel Epilepsy Surgery Outcome Scale and MRI imaging. Results: Of the 60 patients, 45 (75%) demonstrated significant clinical improvement, categorized as Engel Class I and II outcomes. MRI scans revealed a reduction in cystic lesions in 40 patients (66.7%). Adverse effects were reported in 18 patients (30%), with the most common being gastrointestinal discomfort and headache. No severe adverse reactions necessitated discontinuation of therapy. Statistical analysis showed a significant correlation between treatment duration and lesion reduction (p < 0.05). Conclusion: Antiparasitic therapy with albendazole and praziquantel is effective and generally well-tolerated in patients with neurocysticercosis. The majority of patients exhibited substantial clinical improvement and lesion reduction. Continuous monitoring for adverse effects is recommended to enhance patient safety and treatment outcomes.

Background: Depression is a common mental disorder that contributes to disability and mortality. There is observed female preponderance in the prevalence of neurotic disorders and depression in particular. The prevalence of depression in urban populations is not extensively studied in the state of Kerala. Objective: The objective of this study is to estimate the prevalence and determinants of depression among adult women in an urban population of Kochi. Methods: The present Cross – sectional study was conducted among 1,210 adult women of Kochi from 2016-2017. Cluster sampling was used as the sampling method and a total of 1,210 women were screened for depression using PHQ-9. Sociodemographic data and history of domestic violence were also included. Descriptive statistics and univariate and multivariate analysis were done for factors associated with common mental disorder. Results: The prevalence of depression was 13.6% among the urban women population. Women who were diabetic had 4.76 times the odds of having depression compared to non-diabetic women (95% CI 3.27 – 6.9, P<0.001). The final model included seven variables, of which the following were found to be the determinants of depression: having never married, being widowed, divorced, or separated (OR 1.89; 95% CI 1.29 – 2.77); mental illness among family members (OR 3.41; 95% CI 1.64 – 7.02); having had major surgery in the past (OR 1.83; 95% CI 1.12 – 2.96); having experienced adverse life circumstances in one’s own life (OR 2.64; 95% CI 1.35 – 3.01); diabetes (OR 2.15; 95% CI 1.27 – 3.62); hypertension (OR 2.84; 95% CI 1.61 – 5.01) and perceiving oneself as ill (OR 2.01; 95% CI 1.24 – 3.31). Conclusions: Depression is a common mental disorder with high prevalence and various sociodemographic and psychological determinants. Adverse life events, family history of depression and comorbidities are important determinants of depression.

Background: Psoriasis is commonly linked to specific elements of metabolic syndrome, including hypertension, dyslipidemia, insulin resistance, and obesity. Conventional anthropometric measurements of obesity, including waist circumference (WC) or body mass index (BMI), fail to distinguish among subcutaneous fat versus visceral fat. However, it is important to note that visceral fat is linked to cardiovascular risk factors. This study aims to evaluate the levels of visceral fat markers, such as the Lipid accumulation product (LAP) index, Visceral adiposity index (VAI), and Plasma Atherogenicity Index (PAI), in individuals with psoriasis. Methods: This study was conducted with 40 patients diagnosed with psoriasis, using a prospective cross-sectional design. Patient history, including demographic data, was gathered. The disease’s severity was evaluated by computing the Psoriasis Area Severity Index (PASI). Along with other relevant investigations, a fasting lipid profile was completed. In addition, the LAP, VAI, and PAI indices were calculated using the relevant formulas and the outcomes were documented. Results: 18 (45%) were males and 22 (55%) were females. The mean (SD) age of the patients was 44.77 (7.02). Mean (SD) LAP was 190.82 (94.21), VAI was 5.16 (1.59) and PAI was 0.48 (0.14). The moderate-to-severe psoriasis group had a statistically significant (p=0.0065) higher LAP index (230.21 ± 91.1) than the mild psoriasis group (151.43 ± 81.56). Conclusion: The LAP index, VAI, and PAI estimates can be suggested as a possible biomarker for early detection of cardiometabolic diseases that are common in people with psoriasis.

Objective: To study efficacy of epidural infusion of two solutions (bupivacaine +fentanyl +adrenaline and bupivacaine +fentanyl) for post operative analgesia in upper and lower abdominal surgeries. Methods: The study was conducted on adult patients of both sexes in age group of 18 – 60 years belonging to ASA I and II physical status undergoing elective abdominal surgery under epidural and general anesthesia. Two groups: Group BFA: 0.1% bupivacaine +2mcg/ml fentanyl + 2mcg/ml adrenaline Group BF: 0.1% bupivacaine + 2mcg/ml fentanyl. Results: The total dose requirement of local anesthetics and opioids in Group BFA was significantly lower than Group BF. Post operative analgesia in Group BFA was significantly greater than Group BF initially at 1, 3 & 6 Hrs. but similar quality of analgesia present in both the groups later. VAS score and quality of pain relief was better in Group BFA as compared to Group BF. The level of sensory blockade did not differ significantly between two study groups. The requirement of rescue analgesics was similar in both the groups and was not significant. The degree of motor block assessed using Modified Bromage score was similar and non-significant between two groups. Change in hemodynamic parameters like HR, SBP, DBP, MAP, Respiratory rate after surgery were not statistically significant in both the groups. Conclusion: Adding adrenaline helps in improving quality of analgesia in first 6 hrs when pain is of high intensity. It is safe to add adrenaline as evident by minimal and equal side effects and no systemic effects of adrenaline were seen. Quality of pain relief improved on first 6 hrs of post operative period which can help reducing overall morbidity.

Vaginal bleeding at any stage of pregnancy is a distressing occurrence for both patients and physicians. In the first trimester, vaginal bleeding is classified as obstetric hemorrhage before 12 completed weeks of gestation, excluding women who experience subsequent miscarriage or induced abortion.
In this study, 41.9% of pregnant women who experienced first trimester vaginal bleeding were able to continue their pregnancies, indicating that just over half of these pregnancies ended successfully. Research by Snell et al. observed that vaginal bleeding occurs in 15-25% of pregnancies, with approximately half of these pregnancies continuing. The primary causes of first trimester bleeding include ectopic pregnancy (EP), and trophoblastic disease as well as spontaneous abortion.

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Abdominal obesity, measured by waist-hip ratio (WHR) and waist-height ratio (WHtR), has been shown to be a better predictor of CAD than body mass index (BMI). This study aimed to investigate the association of WHR and WHtR as independent factors of CAD in an Indian population. Methods: A prospective observational study was conducted on 110 patients (aged 18-80 years) suspected of having CAD based on non-invasive methods. Anthropometric measurements, including BMI, WHR, and WHtR, were obtained. The association between these indices and CAD was analyzed using odds ratios (OR) and 95% confidence intervals (CI). Results: The prevalence of CAD was 88% (n=97). WHtR > 0.52 (OR=2.1, 95% CI: 0.65-6.77), WHR > 0.81 in females (Relative Risk [RR]=1.05), and WHR > 0.88 in males (OR=2.0, 95% CI: 0.61-6.47) were strongly associated with CAD. WHtR was a better independent factor of CAD compared to WHR (p<0.00001, 95% CI: -0.4889 to -0.4072) and BMI (p<0.00001, 95% CI: -25.6647 to -24.1011). Conclusions: WHtR is a better independent factor of CAD compared to WHR and BMI in an Indian population. The strong association of WHtR with CAD, along with its simplicity and ease of measurement, makes it a valuable tool for the early identification of individuals at risk for CAD in resource-limited settings.

Background and Objectives: Carbapenem resistance mediated by metallo beta lactamases (MBL) in Acinetobacter baumannii is a global challenge due to its rapid spread and limited therapeutic options. To determine the prevalence of MBL in A. baumannii isolates in hospitalized patients by both phenotypic and genotypic methods. Materials and Methods: The clinical samples were collected from in patients and subcultured on routine culture media for growth. Identification of bacteria along with antimicrobial sensitivity testing was done by VITEK -2 Compact (bioMerieux). Antibiotics that were not tested by VITEK-2 were tested manually by Kirby-Bauer disk diffusion method according to CLSI 2017 and EUCAST 2016 guidelines. The isolates which were resistant to carbapenem (imipenem and/ or meropenem) were tested by phenotypic (imipenem-EDTA combined disk method) and genotypic method for presence of common metallo beta lactamases genes (blaIMP, blaNDM, blaGIM, blaVIM, blaSPM and blaSIM). Conclusion: The prevalence of MBL in carbapenem resistant isolates of A. baumannii was 87.7%. blaNDM was the most common gene detected. No significant difference was found in the ability of phenotypic and genotypic methods for MBL detection. The resistance rate of the A. baumannii is high for most antibiotics except for polymyxins (E&B) and tigecycline.

Acute non-traumatic abdominal pathologies in the pediatric population depend on the age of the patients and symptoms. The common complaint in pediatric emergency departments (ED), abdominal pain is sometimes hard to assess in ill children due to the variation of pain degree, the difficulty in describing it, and being localized to the abdomen. Although most children with abdominal pain have a self-limiting course, some critical medical and surgical emergencies may occur in the ED. The aim of the present case series is to describe the varied imaging manifestations of acute pain abdomen etio-pathology. Also to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. Case presentation This is a retrospective review of imaging findings in ten patients with intra-operative proven case of various etiology in case of acute pain abdomen in our institute from February 2023 to February 2024. This article summarizes the imaging approach to pediatric patients with acute abdominal pathologies presenting to the emergency department. Herlyn warner Wunderlich’s syndrome, duplication cyst, Acute appendicitis, inguinal Hermia, midgut volvulus, Hirschsprung disease, Wandering Spleen with Splenic Ischemia, intussusceptions were the cases. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

Objectives: (1). The newly proposed IAC Yokahama reporting system breast cytology to categorize our samples according to this classification. (2). To assess diagnostic accuracy as well as the diagnostic yield of breast FNAB with corresponding risk of malignancy (ROM) for each category and risk of onsite evaluation (REM). Materials and Methods: This is a retrospective study of breast cytology cases done at Department of Pathology. A Total of 722 FNA cytology specimens from January 2016 to December 2020 were obtained. These were studied and reclassified according to newly proposed IAC Yokohama system of reporting system of breast cytology into five categories. Results: Total of 722 cases of breast FNAC, 67(x %) were male and 655 (x %) were females. All the FNAB breast cytology smears were retrospectively reviewed and categorized according to IAC Yokohama system respectively The respective ROM for each category was  0 % for category1 (insufficient material), 3.8% for category 2 (benign), 57.% for category 3 (atypical), 46% for category 4 (suspicious for malignancy), and 99 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94.9%, 99.9 %, 98.6%, 96.1%, and 98.69%, respectively. Conclusion: IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.

Background: Preeclampsia is a significant cause of maternal and perinatal morbidity and mortality. Emerging evidence suggests that thyroid dysfunction may contribute to the development of preeclampsia, but the relationship remains incompletely understood. Aim: This study aimed to investigate the association between maternal thyroid hormone levels and the incidence of preeclampsia in pregnant women. Methods: 200 expectant mothers participated in a prospective cohort study. Measured thyroid hormone levels (TSH, T3, T4) were divided into tertiles. Preeclampsia development was observed in the participants. SPSS version 23.0 was used to analyse the data, and logistic regression was employed to assess the relationship between thyroid hormone levels and preeclampsia risk. Results: The incidence of preeclampsia was 15%. Higher TSH levels were significantly associated with an increased risk of preeclampsia (OR 3.72, p=0.012), while higher levels of T3 and T4 were associated with a reduced risk (T3 OR 0.15, p=0.006; T4 OR 0.11, p=0.002). Conclusion: Elevated maternal TSH levels are associated with an increased risk of preeclampsia, whereas higher T3 and T4 levels appear protective. These findings underscore the importance of monitoring thyroid function during pregnancy. Recommendations: Pregnant women, especially those who are at high risk for thyroid dysfunction, should think about routinely screening their thyroid function. In order to define guidelines for thyroid hormone management during pregnancy and to investigate the mechanisms underlying these associations, more research is required.

Background: In our fast-paced lives, the consumption of packed and processed food is on the rise. Front of Packed food Label (FOPL) can be a population-based strategy and a potential instrument for effective nutrition communication by assisting consumers to make healthy food choices at a glance. Hence, FOPL are essential to decrease the consumption of unhealthy processed food. Aim of the Study: To assess the knowledge, perception and practices about FOPL among the consumers in Warangal district. Materials: A cross-sectional study was conducted among 330 residents under urban training health center of a medical college in Warangal, Telangana from June 2023 to November 2023. Data was collected using self-administered questionnaire and interview after obtaining informed consent by systematic random sampling technique. Collected data was entered into Excel sheet and analysed using SPSS V 20. Descriptive and inferential statistical test were used for analysis. P value <0.05 was considered statistically significant. Results: Approximately two-thirds (64%) of the sample population had a strong understanding of FoPL. 89.4% of the participants saw packaged food as beneficial. Only 25.8% of participants considered packaged food to be healthy. 72.7% respondents would read food labels while buying packaged food. Conclusions: Awareness regarding Front of Package Labelling was good among 64% respondents. Among the various food labels, Multiple Traffic light seemed quick to understand by 56.4% respondents. 72.7% Respondents in the study read the food labels while buying packaged food. Majority respondents (>92%) who shopped looked only at the brand name, manufacturing date, and expiration date.

Background: Hypocalcaemia following Thyroid surgeries is one of the commonest complications all over the world. The amount of ionized calcium (Ca2+), contributes to the physiological and biochemical processes at the cellular level, rather than the total calcium.  Hypocalcaemia was defined as a serum calcium level of <2.00 mmol/L in Post-thyroidectomy patients. Management of Hypocalcaemia was variable and dictated by variations in practice rather than patient needs and had its effect on the length of hospital stay as well as symptoms and signs. Aim and Objectives of the study:  To assess the occurrence of hypocalcaemia following Total thyroidectomy. To study various clinical presentations of post total thyroidectomy hypocalcaemia, day of appearance of its symptoms or fall in serum (Ca+) levels,  correlation of the symptoms with the serum calcium levels, correlation of post total thyroidectomy hypocalcaemia with other indications of total thyroidectomy and its prevalence in relation to the age and gender. Materials: 83 patients undergoing Total Thyroidectomy were included in the study. Serum Calcium levels were estimated at 4 to 6 hours postoperatively and again on day 1 and on day 2 postoperatively. Serum calcium levels were estimated every 2 weeks and then at 6 weeks after stopping supplemental therapy. If the patient becomes symptomatic original regimen restarted. Results: Among the 83 patients majority of the patients belonged to the age group intervals of 36 to 45 and 46 to 55 years; 58 (69.87%). There were 61 (73.49%) females and 22 (26.50%) male patients among the total 83 patients in the study. The male to female ratio was 2.77:7. Hypocalcaemia developed in 13 (15.66%) on the first post-operative day, 19 (22.89%) on the second post-operative day and 23 (27.71%) developed on the third post-operative day. It was found that earlier the development of Hypocalcaemia shorter was the Hospital stay. The Mean Hospital stay was statistically lower and significant in the patients without developing Hypocalcaemia than those developing Hypocalcaemia (p value was 0.001). Conclusions: The incidence of post-operative Hypocalcaemia was high on the 3^rd Postoperative Day.  The clinical manifestations of Hypocalcaemia were predominantly Perioral numbness and Paraesthesia, affecting a considerable proportion of patients. The symptoms were more prevalent in the age groups of 36-45 and 46-55 years. A statistically significant decrease in serum calcium levels was observed post-operatively, directly correlating with the development of clinical symptoms. These findings emphasize the critical role of early identification and management of Hypocalcaemia to mitigate patient discomfort and potential complications. Further research is warranted to explore the underlying mechanisms contributing to post-operative Hypocalcaemia and to identify potential predictive factors. Regular serum calcium monitoring and early intervention in patients undergoing. Total Thyroidectomy helps in to prevent the development of symptomatic Hypocalcaemia and improve overall patient outcomes.

Background: Rational use of medicines is the most crucial part of medical care provided to a patient. Things like polypharmacy overuse of antibiotics and injectable drugs, and prescribing medicines without following relevant guidelines can lead to irrational medicine use. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system. Methodology: This study was conducted to audit the quality of OPD prescriptions by using a step-by-step methodology (prescription audit guidelines, National Health Mission, MoHFW) and WHO core prescribing indicators and finding root cause of the problem in the prescriptions of Dermatology, Venereology & Leprosy (DVL) OPD of teaching hospital in Eastern India after taking approval from IEC, IIMSAR over 3 months. A total of 96 outpatient prescriptions have been randomly sampled, irrespective of patient characteristics, diagnosis, and Department of DVL. Responses from each prescription have been evaluated against WHO guidelines (27 points structured checklist) in the form of observed responses as ‘YES’ or ‘NO’ and the data has been expressed as % of total responses recorded, and a number of medicines prescribed per prescription as mean ± SD. Results: The audit responses before and after sensitization indicate a significant improvement in several criteria. Notable enhancements include an increase in the recording of weight in pediatric patients (from 23% to 48%, p = 0.0245*), improvement in legible handwriting in capital letters (from 36% to 75%, p = 0.001*), and an increase in the prescription of medicines by generic names (from 21% to 59%, p = 0.026*). The salient features of clinical examinations recorded also showed improvement (from 58% to 76%, p = 0.034). However, there were areas with no significant change, such as the prescription of antibiotics as per the facility’s policy. On the contrary, a decrease was observed in the prescription of injections (from 11.4% to 18%, p = 0.0368). Overall, these findings underscore the positive impact of sensitization on the quality of audit responses, with several parameters showing statistically significant improvements. Conclusion: The prescription audit showed that there is a need to train prescribing doctors as per the standard MoHFW step-by-step methodology (prescription audit guidelines and World Health Organization core prescribing indicators) for rational prescription writing to minimize the chance of major errors like not writing the dose of the drug, not writing it in capital letters, drug-related instructions, diagnosis and so on. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system.

Introduction: Globally an estimated 40.5 million people struggle with opioid use disorder. Opioid substitu-tion therapy [OST] with methadone or buprenorphine is the mainstay long-term management. Adverse effect such as sedation, constipation and sexual dysfunction lead to discontinuation of maintainance medications. Transdermal patch of buprenorphine obviates the need for daily dosing and may act as a short-term OST bridge while transitioning to other modalities. Methodology: A case series of three opioid dependent patients successfully treated with OST approach is pre-sented. We have discussed patient characteristics that may predict success with this novel OST strategy. Results: First case was unable to attend daily clinic due to work schedule, started with transdermal buprenor-phine 10mcg/hour weekly patch, had successfully transited to oral naltrexone at 4-week follow-up and at 6 months remained engaged in treatment. Second was a case of opioid dependence with bipolar disorder, with history of frequent missed doses. Started with transdermal buprenorphine 20mcg/hr, at 3months was abstinent from opioids and could be switched to sublingual buprenorphine-naloxone as mainatainance therapy. Last case was of heroin dependence without any treatment due to social stigma, started with transdermal buprenorphine 10mcg/hr, which was well tolerated and later switched to buprenorphine-naloxone maintainance therapy. Conclusion: Transdermal buprenorphine helps to individualize care based on patient’s unique need and circum-stances and may act as a bridging therapy for opioid dependent patients, who are remaining out of care.

Introduction: Leading cause of death is  Heart disease worldwide. Myocardial infarction or birth anomalies persisting later part of life complicates and either from heart failure or from electrical MA activity leading to end the life. In between birth and end moment of life the tests performed for screening may unravel the exact pathology lying. Aim: In present study we had  studied ECG, Echocardiography and Coronary Angiogram reports of patients and analysed the results of individuals. Method: Reports of the said examinations collected with history sheet from cath Lab. For a period of one year. Observation: Normal non-invasive examination reports having individuals revealed very poor prognostic Coronary Angigraphy. Conclusion: Electrocardiogram and echocardiogram reveal limited information regarding coronary artery status in majority of population.

Introduction: Lateral epicondylitis results from repetitive strain on the extensor and supinator muscles of the wrist and forearm. Magnetic resonance imaging (MRI), known for its superior soft tissue contrast resolution, has shown satisfactory sensitivity, specificity, and accuracy in diagnosing lateral epicondylitis. The purpose of this research was to assess the effectiveness of MRI in patients diagnosed with lateral epicondylitis. Materials and Methods: A randomized investigation was performed on a cohort of 123 consecutive patients, including 82 males and 41 females, all clinically diagnosed with chronic lateral epicondylitis. Each patient underwent a 3.0 T MRI scan, and the extent of tendinopathy was evaluated using a dedicated MRI scoring system. Clinical symptoms were measured using the Patient Rated Tennis Elbow Evaluation (PRTEE). The statistical analysis was carried out using SPSS version 21 software. Results: MRI identified tendinopathy in all 123 elbows: 52 (42.3%) were grade 1, 38 (30.9%) grade 2, and 33 (26.8%) grade 3. Intra-observer agreement averaged 80.2%, with weighted kappa values of 0.79, 0.74, and 0.89 (P < 0.001) for individual radiologists, reflecting good reliability. Inter-observer reliability had a weighted kappa of 0.72. The median PRTEE score was 77 (range 8-96), with scores of 19, 23, and 60 for grades 1, 2, and 3, respectively. PRTEE scores increased with tendinopathy severity, showing a significant positive correlation (Spearman’s r = 0.94, P < 0.01). Conclusion: MRI serves as a reliable imaging modality for evaluating the radiological severity of chronic lateral epicondylitis, with the severity of MRI-detected signal changes correlating positively with the patient’s clinical symptoms.

Smartphone use has been related to health problems. Studies have indicated that the use of smartphones is associated with Sleep disturbances. However, little is known about the association between Smartphone addiction and sleep quality in adolescents and young adults. This Smart phone addiction is affecting their lifestyle in such a manner that they find it ok to compromise with their sleep which is not good at all for their mental as well as physical health. The current study examined the relationship between problematic mobile phone use and sleep quality. A cross-sectional study was conducted among the 50  Young  male and female adolescents and young  adults aged 16 to 24 years. The participants completed a self-administered questionnaire. Objectives of the study was to compare the effects of mobile phone on quality of sleep in smart phone users using Pittsburgh Sleep Quality Index (PSQI)  and Smartphone Addiction Scale – Short Version (SAS-SV). Two scales were adopted in our study. 44% subjects used phones for 3-5 hours daily, 30% used for 2-3 hours, 16% used for more than 5 hours. 10% used for 1-2 hours. A high SAS-SV score was found to be a significant indicator of poorer sleep quality. 64% subjects were low users and 36% were high users according to Short Version (SAS-SV) scores of smartphone addiction scale. 60% subjects had poor sleep quality and 40% had good sleep quality as per Pittsburgh Sleep Quality Index (PSQI). Our study showed a high prevalence of smartphone addiction and poor sleep quality for the participants. Younger age, being single, and heavy usage hours of smartphones seem to be indicators for poorer sleep quality.

Background: Treatment of hydatid cyst typically involves a combination of medical, radiological and surgical approaches. Surgery is the primary and gold standard for hydatid disease. Surgical techniques for hydatid disease are conservative and radical. Radical procedures are open cystectomy, near total open cystectomy, subadventitial cystectomy, non-anatomical liver resection, anatomic liver resection, cystectopericystectomy & total cystopericystectomy; additional procedures are lobectomy & cholecystectomy. Methods: This was a prospective observational study conducted in the postgraduate department of general surgery at SMHS hospital, Gmc Srinagar J&K India over period of 18 months. The study included 25 patients who met the specified inclusion & exclusion criteria. Ethical clearance was obtained from the institutional ethical committee prior to commencing the study. Once diagnosed, patients were counselled on further management and treatment opitions available at the hospital. Results: The mean age in our study was 32.1±11.50 with range of 18-65 years. the most common age group involved in this disease was 18-35years (72%), followed by 35-50 years(24%) and >50 years had 4%. in our study most of patients were females 15 cases (60%) and males 10 cases(40%). Male: Female ratio in our study was 1:1.5. Most common organ involved in our study, liver in 24 cases (96%) followed by spleen in 1 case (4%). In 24 cases (96%) single cyst were found and multiple cysts only in 1 case (4%) .Laparoscopic hydatid cystectomy (LHC) in 6 cases, Open hydatid cystectomy in 16 cases, open hydatid cystectomy with left lateral segmentectomy in 2 cases and open splenectomy in 1 case (4%) was done. External tube drainage for management of residual cavity was done in 11 cases (68.7%) followed by omentopexy in 2 cases (12.5%)  capitonnage in 1 cases (16.2%) and primary repair of CBC with omentopexy. Wound infection was seen in 2 cases, prolonged drainage in 1 case, CBC in 1 case, and recurrence in 1 case. Conclusion: The surgical approach may vary depending on factors such as cyst location, size, presence of multiple cysts and cystobiliary communication (CBC).Hydatid cystectomy with external tube drainage is commonly used technique that offers effective management with less complication.

Background and Aim: Intravenous cannulation is the most common invasive procedure in hospitals. Phlebitis is the most frequent complication of intravenous therapy. We aimed to compare the effect of heparin ointment and hirudoid cream on treating intravenous catheter-induced superficial thrombophlebitis and multidrug infusions. Methodology: This prospective randomized study was conducted on 160 patients of both genders, above 18 years of age, who had superficial thrombophlebitis and had given informed consent, were randomly assigned into two groups: Group-A (Heparin ointment) and Group-B (Hirudoid cream). Heparin ointment or Hirudoid cream was applied thrice daily over the surface of the phlebitis lesion. Phlebitis grading was assessed for each patient from the first day of treatment to the seventh day of treatment or till the complete resolution of symptoms. The effectiveness of the treatment was assessed using the Visual Infusion Phlebitis Scale (VIP). Result: In the Heparin ointment group the mean VIP score after treatment was significantly lower (p=<0.001) than hirudoid cream group from day 3 to day 5. The quality of treatment was excellent in 77.5% of patients in the heparin group than 58.75% of patients in the hirudoid group (p=0.009). The mean duration of treatment days was significantly less p=<0.001 in the heparin group (5.79 days) compared to the hirudoid group (6.30 days). Conclusion: Heparin ointment administered topically thrice daily is better in comparison to Hirudoid cream application for treatment of superficial thrombophlebitis due to intravenous catheter insertion.

Objective: The purpose of this study is to assess the diagnostic performance of O-RADS ultrasound and IOTA simple rules in pre-operative discrimination of ovarian and adnexal masses as benign and malignant and to compare the accuracy of ORADS with IOTA simple rules and DW- MRI. Methods: The study was conducted from March 1^st 2023 to February 28^th 2024 in the department of Radiodiagnosis at Silchar Medical College and Hospital, Silchar. The study group includes 40 patients with adnexal masses referred by gynecologists discovered during pelvic examination or by previous sonographic examination. For USG transducer having frequency of 3-12 MHz used for transvaginal sonography and curved transducer having frequency of 1-12MHz used for transabdominal sonography. MRI was performed using a Siemens 1.5 T MR system. Various conventional and advanced MR sequences DWI and ADC was used. Conventional Routine sequence was done in all cases and contrast study was done whenever indicated. Results: In our study, we utilized two ultrasound classification systems, O-RADS and IOTA simple rules, as well as DW-MRI, to categorize benign and malignant adnexal masses. The sensitivity, specificity, PPV and NPV of O-RADS, IOTA simple rules and DW-MRI were calculated and compared by considering histopathological diagnosis as the gold standard in adnexal masses. 40 patients with adnexal masses were evaluated. Among 40 women who participated in this study, 27 patients had benign adnexal mass lesions and 13 patients had malignant adnexal mass lesions proven by HPE. ORADS had sensitivity of 100%, specificity 88%, PPV 81% NPV 100% and accuracy 92.50%. The sensitivity, specificity, PPV, NPV and accuracy of the IOTA simple rules were 92%, 92%, 85%, 96% and 92.50% respectively. For DW-MRI, the sensitivity was 100%, specificity 92%, PPV 86%, NPV 100% and accuracy 95%. Conclusion: Accurately predicting the risk of malignancy in adnexal masses before surgery is crucial for optimizing patient treatment. The two well-established classification systems for distinguishing adnexal masses are O-RADS and IOTA. The IOTA simple rules are easy to use and offer high sensitivity and specificity, but they yield inconclusive results in 10% of cases. O-RADS have a higher sensitivity than IOTA simple rules in preoperative discrimination of between benign and malignant lesions, but it has a slightly lower specificity. DW-MRI with ADC values along with conventional MRI demonstrates very high sensitivity and specificity in predicting the risk of malignancy preoperatively. It can serve as a problem-solving tool for characterizing indeterminate adnexal masses.

Dry eye is a multifactorial disorder, affecting the preocular tear film. Dry eye is an ocular surface disorder which damages the interpalpebral area of the eye due to either deficiency or excessive evaporation of tears. There is wide flexibility of the incidence of dry eye due to lack of standardized diagnostic procedures and patient selection. There is great association between environmental risk factors, use of visual display and drugs with dry eyes. The interesting thing is that all these risk factors are modifiable. So by modification of these risk factors dry eye disease prevalence can be reduced which gives patients better quality of life as well as reduced economic burden.

Introduction: Thyroid gland plays a critical role in regulating metabolic functions such as cardiac rate, cardiac output, lipid metabolism, skeletal growth, other metabolic activity such as heat production. Thyroid swelling is one of the common clinical problems routinely encountered in the outpatient department (OPD). Most of them are due to diffuse enlargement of thyroid gland (diffuse colloid goiter) commonly seen at puberty and lactation, predominantly in females. Clinical evaluation of the thyroid is not always sufficient. Hence, the clinician has to depend on various other diagnostic modalities such as Thyroid profile study, ultrasonography, FNAC etc. to achieve a confirm diagnosis. Aims and Objectives: To assess the validity of ultrasonography findings of thyroid lesions by correlating with FNAC findings. To study the ultrasonographic features of various thyroid lesions in patients with thyroid disorders. Correlate the sonographic findings with FNAC in the diagnosis of thyroid lesions. Methodology: It was prospective observational type study conducted in Jehangir hospital, Pune. Total 62 candidates were selected, who came for Ultrasonography of neck for thyroid gland swelling or who are having abnormal thyroid profile study. Ultrasonography of neck for thyroid was done after getting informed consent regarding study. Mapping of findings like anatomy, size, shape and morphology were recorded and compared later with the FNAC findings. Results: In this study of 62 patients, female preponderance (71%) was noted. Among the study population, maximum patients were in the age group of 50 to 60 years. Out of 62 patients, most of the patients were having thyroid swelling. In most of cases physical examination can give limited information regarding thyroid lesions. Therefore, ultrasonograhic examination can provide accurate characteristic of thyroid lesions. The ultrasonograhic findings were correlated with FNAC findings. Strong correlation was observed between ultrasonography and FNAC results. Conclusion: Ultrasound has a clear cut utility in evaluating thyroid lesions and can be used as an adjunct to clinical examination and should be offered to all patients presenting with thyroid nodules. It has got other added advantages of being safe, reproducible, economical and portable technique without hazards of radiation. Sonographic diagnostic accuracy of thyroid lesions was 88.7% in our series, when correlated with FNAC suggest strong agreement between ultrasonography and FNAC.

Background: Both testes are located superficially within a cutaneous bag scrotum. Though it is accessible for clinical examination, it is challenging to distinguish benign and malignant swellings and intra-testicular from extra-testicular swellings, and hydrocele makes it harder to determine the condition of the underlying testis. The acute scrotum is a clinical picture of sudden-onset of scrotal pain, redness, and swelling, most frequently caused by acute epididymo-orchitis, torsion of the testicular appendages, or testicular torsion, differentiation of these conditions is necessary for determining appropriate treatment. Objective: to determine diagnostic accuracy and differentiation of various scrotal and testicular diseases using grey scale ultrasound and color Doppler findings, so that timely management can be offered to the patients and to avoid unnecessary complications. Methodology: A prospective observational study was carried out on 50 patients who came to radio-diagnosis department with clinical signs and symptoms related to scrotal and testicular diseases. Patients were selected according to the inclusion and exclusion criteria’s over a period of 1 year. All the patients underwent grey scale ultrasonography of the scrotum and color Doppler was supplemented to it to increase the diagnostic accuracy. Findings were noted and the patients were guided further and were asked to contact the referring physician/surgeon, so that timely treatment can be done and unnecessary complications can be avoided. Results: Out of 50 cases studied, the mean ± SD of age of cases studied was 39.58 ± 21.97 years and the minimum – maximum age range was 1 day to 91 years. The most common symptom was swelling which was seen in 14 cases (28.0%), 13 cases (26.0%) had pain, 12 cases (24.0%) had pain and swelling, 5 cases (10.0%) had scrotal heaviness, 2 cases (4.0%) each had empty scrotal sac, infertility and the trauma. Out of 50 cases studied, 5 cases (10.0%) had Normal diagnosis, 8 cases (16.0%) had Epididymitis, 6 cases (12.0%) had Epididymo- orchitis, 4 cases (8.0%) had Orchitis, 4 cases (8.0%) had Funniculitis, 2 cases (4.0%) had Varicocele, 3 cases (6.0%) had Hydrocele, 3 cases (6.0%) had Hernia, 4 cases (8.0%) had Epididymal cyst and 11 cases (22.0%) had other diagnosis in the study group. Conclusion: High-frequency ultrasonography and color Doppler sonography is an extremely valuable tool in the diagnosis of scrotal and testicular pathologies. It provides a number of benefits over other imaging techniques, including as ionizing radiation abstinence, non-invasiveness, ease of use, accessibility, and repeatability.

Diabetes Mellitus is a global disorder that specifies the hyperglycemic condition in an individual, which is related to the secretion and action of insulin hormone. Many Epidemiological studies have significantly manifested the prevalence of being affected by different types of cancer by a diabetic patient. Many Signaling pathways were shared by diabetes and cancer. Signaling pathways like TNF–α, IL–1b, IL-8, PI3K, MAPK/ERK, VEGF, VEGFR, Estrogen/ER/SHBG, IRS I, PI3K, PIP3, AKT, SOS, RAS, C-Raf, MEK1/2, ERK, etc were disturbed in hyperglycemia which leads to the root cause of deadly diseases like Lung cancer, Hepatocellular cancer, Endometrial cancer, Breast cancer, Pancreatic cancer, etc. Besides many observational studies shows that some drugs used to treat diabetes were related to higher and lower risk of cancer. Recent studies have explained the role of the antidiabetic drug in reducing the effect of cancer. Common antidiabetic drugs like Metformin and thiazolidinediones (TZDs) were found to give a good result in reducing the risk of cancer. On the other hand, some studies have shown the effect of anti-diabetic drugs like Insulin, Sulfonylureas, and GLP – I agonists can develop tumorigenesis in the IGF -1 Signaling pathway. To identify the interlinking pathways and common medications for Diabetes and cancer, a systemic review was performed. By this review, it is found that the Synchronism of the deadly disease cancer and diabetes mellitus could be related in regards to the interlinking pathways and medications. But the results from most of the studies are dubious and colliding. Hence strong research work should be made shortly to relate diabetes and cancer which can be reliable.

Background and Objectives: A serious ailment that impairs quality of life and has societal ramifications is diabetic peripheral neuropathy. Early detection and intervention might alter the course of neuropathic processes and dramatically reduce associated morbidity and mortality. This study looks at how long-term blood sugar management affects diabetic peripheral neuropathy in people with type 2 diabetes. Material and Methods: Medical College Hospital in India hosted a hospital-based study. All participants older than eighteen who have suffered from Type 2 diabetes for no more than ten years were recruited. The BMI, HbA1c level, and nerve conduction studies (NCS) were computed using established methodologies. The data were analyzed using SPSS, version 25.0, a statistical programme for social sciences. P-values less than 0.05 were deemed statistically significant. Results: Of the 95 T2DM patients, 52 were male. Our findings indicate that as the duration of diabetes grew, the motor nerve reduced from 63.392 ± 2.378 to 53.868 ± 2.082 (P = 0.0029), and the sensory velocity fell from 64.068 ± 3.222 to 54.002 ± 5.338 (P = 0.0502, P = 0.0032, respectively). Additionally, greater duration of diabetes was associated with a substantial drop in motor nerve amplitude from 8.788 ± 3.108 to 6.942 ± 1.838 (P = 0.0502) and sensory nerve amplitude from 25.712 ± 5.702 to 19.512 ± 6.508 (P = 0.0032). In addition, both NCS parameters (amplitude and velocity) decreased when HbA1c was greater than 6: sensory velocity decreased from 63.962 ± 2.358 to 55.488 ± 2.432 (P = 0.028), and motor velocity decreased from 63.002 ± 2.588 to 51.438 ± 1.662 (P = 0.022). Additionally, the sensory amplitude decreased from 26.908 ± 1.262 to 20.848 ± 2.102 (P = 0.0508), whereas the motor amplitude decreased from 6.878 ± 3.552 to 6.608 ± 3.288 (P = 0.0508). Moreover, a significant (P = 0.0508) correlation has been seen between the motor and sensory amplitudes and BMI. Conclusion: Elevated BMI and inadequately managed (elevated HbA1c) chronic diabetes had a detrimental impact across all of the nerve conductivity evaluation metrics.

Introduction: Chronic otitis media (COM) is a prevalent middle ear disease in developing countries, especially in rural India, with a prevalence ranging from 2-15%. COM is characterized by recurrent suppurative discharge and structural abnormalities, such as tympanic membrane perforation and ossicular chain pathologies, leading to mild to moderate conductive hearing loss. Pure tone audiometry (PTA) is a crucial tool for assessing hearing loss, but intraoperative findings remain essential for accurate diagnosis and surgical planning. Objective: To compare preoperative pure tone audiometry findings with intraoperative findings in tubotympanic chronic otitis media. Materials & Methods: A cross-sectional study was conducted on 110 patients with tubotympanic chronic otitis media undergoing tympanoplasty at the Department of Otorhinolaryngology, tertiary care hospital, Gujarat. Data were collected on perforation characteristics, ossicular condition, and audiometric assessments. Results: The mean age of the patients was 29.9 ± 10.87 years, with 70.9% being female. Ear discharge (96.4%) was the most common symptom. Otoscopy detected perforation in 95.8% of cases, while surgery confirmed it in 100%. ll patients exhibited conductive hearing loss, with 48.2% having mild and 48.2% having moderate hearing loss. The air-bone gap and overall hearing loss were significantly greater in larger and posterior perforations. No significant differences in hearing metrics were noted between patients with and without ossicular defects. Conclusion: Otoscopy and PTA provide valuable initial insights, but intraoperative examination is more comprehensive. The size and site of perforations significantly impact hearing loss, with larger and posterior perforations leading to greater impairment.

Background: The main objective of the present study was to assess the significance of NT pro-BNP in identification of diastolic heart failure and its association with echocardiography. Methods: Analytical and observational study conducted in a hospital setting on 65 individuals with diastolic heart failure who met the clinical inclusion criteria. The patients included in the study had an average age of 64.5 years, with a higher distribution of females. The patients received clinical assessment and echocardiography testing. Quantification of NT pro-BNP was performed using an automated analyzer. Patients were categorized into different levels of diastolic dysfunction based on echocardiography testing. The relevance of levels of NT pro-BNP and its link with the grade of diastolic heart failure was determined by statistical analyze. Results: Statistically substantial elevations in serum NT pro-BNP levels were seen in individuals with diastolic heart failure, and these increases were directly correlated with the degree of diastolic dysfunction. The average concentration of NT pro-BNP rose from 361.079±140.649 pg/ml to 3570.001±436.989 pg/ml as the degree of diastolic dysfunction increased. Conclusion: Serum NT-proBNP levels provide reliable diagnostic accuracy to detect diastolic heart failure and it correlates well with increasing severity of diastolic dysfunction as assessed by well-established modality of echocardiography.

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and the cause of approximately 20% of all dizzines.  In this study we provide an overview of role of vestibular rehabilitation Programme in BPPV. Aims and Objectives: (1). To evaluate efficacy of particle repositioning maneuver (Epley’s Maneuver) in benign paroxysmal positional vertigo. (2). To evaluate efficacy of adaptation/domiciliary habituation exercises (Semont’s maneuver, and Brandt – Daroff exercises) in benign paroxysmal positional vertigo.

Introduction: Education is an ever changing system and medicine is one of its most crucial domains. MCI has been changed to NMC and CBME, SDL, AETCOM etc. are some newer concepts introduced for the benefit of the medical students and the society. Technical advancements have also been propagating at a faster pace, which of course can act as a double edged sword for the students. Advances in simulation technology and virtual learning environments provide realistic clinical scenarios and interactive experiences that can substitute or complement traditional classroom learning. Students may find these methods more engaging and effective than passive classroom teaching. This present scenario has created doubts regarding the importance of physical attendance in didactic lectures. Easy availability of study material demotivates students to attend the regular classes. Multiple factors have been proposed responsible for absenteeism. Studies regarding the attendance and its correlation with academic performance have been done in past in different streams, but very few are available in the speciality of Ophthalmology. Hence, this study was carried out with the aim to explore the correlation between the academic performance and lecture attendance among phase III part I MBBS students. We have also tried to analyse the factors which prevent the students from attending the lectures on the basis of questionnaire provided to them. Methodology: Attendance of the 96 students of phase III part I was recorded for first 4 months and based on the percentage of attendance two groups were made i.e. Group A (>75% attendance) and Group B (<75% attendance). The students in both the groups were further categorized on the basis of marks obtained in the theory paper of Ophthalmology subject in the first terminal examination.  Based on their marks obtained they were split into two sub groups -1 (>60% marks) and 2 (<60% marks). Analysis was done using Chi square test and Pearson correlation to observe the relationship between lecture attendance and the marks obtained in Ophthalmology subject in the first terminal examination. Semi open ended questionnaire was used to explore the causes of short attendance. Result: Among 96, 39 students had >75% attendance and out of which 25 (64.10%) attained more than 60% marks, while only 6 (10.41%) out of 57 students of group B (having <75% attendance secured >60%) marks. Conclusion: Attendance and academic performance are closely linked in educational settings. This study shows a positive correlation between physical attendance and academic performance. Students who attend classes regularly tend to perform better academically compared to those with poor attendance. Strict or inflexible attendance policies may sometimes have unintended consequences, discouraging attendance rather than encouraging it. Encouraging students to attend classes regularly and addressing any underlying issues affecting attendance can contribute positively to their academic performance.

Objectives: None of the study has addressed the demographic and clinical characteristics of chronic pain patients in the Eastern India.  Study was done to determine the characteristics of patients presenting with chronic pain in Dedicated Pain Clinics at Eastern India. Methodology: Initial pain assessment scale and questionnaires was used as a screening interview for the selection of eligible participants. Brief pain inventory included a total of 9 questions and survey required approximately 8-10 minutes. This questionnaire assessed worst, least and average pain intensity of last 24 hrs and how pain has interfered basic functions of their life. Pain Detect Pain screening Questionnaire helped to identify neuropathic components in patients with chronic pain. An appropriate case report form (CRF) was designed to gather the baseline and end-of-intervention data. This CRF gathered information about prevalence of pain, frequency of pain during the past week, intensity of pain during the last episodes and at present (during OPD visit/ follow-up visit), sites of pain, radiation, and the main causes of pain. Results: The overall mean intensity of pain on NRS scale which was found to be lower [(4.92), NRS scale; 0 to 10] in group 1 as compared to group 2 (5.32) and group 3 (5.47) initially. There was a significant decrease in mean pain intensity (p<0.01) in each group after 2 & 6 months of treatment follow-up from the baseline. Improvement of pain intensity on presentation was significantly higher in group 3 as compared to group 1 & 2 (p<0.01). Conclusion: Future studies should aim to determine the prevalence of chronic pain, and those utilizing a larger sample size and conducted in pain clinics and health care centres are needed to develop better understanding of this important clinical condition.

Background: In the last four decades, western medical schools have witnessed an exponentially increased progress in the field of medical educational research to pave the way for better learning, teaching and assessment of the various medical subjects. However the developing countries like India couldn’t reflect the similar change. Unless we have knowledge about the attitudes of the medical educators towards educational research, the actions towards improving research in medical education cannot be planned and implemented in an institution. Objectives: The Research article aimed to know the perception of the educators towards the medical education research in the institution and there-by identifying the barriers. To know the attitude of medical teachers towards educational research. To assess the relationship of age, gender, years of experience, subject of teaching, training in medical education technology and their attitudes towards educational research. To identify the barriers in conducting the medical education research. Methodology: The attitude of the medical teachers towards education research was ascertained through a 17 item likert scale, where in the participants had to give their opinion regarding 17 statements on education research based on whether they strongly disagree, disagree, agree, strongly agree or are neutral about the statement. The total score of the likert scale (MEATER score: Medical Educators’ Attitude Towards Educational Research) were then compared for the age groups, gender, professional year of teaching, designation and attendance in the MET workshop.  The participants were also asked for the common barriers that they notice while planning educational research. Results: In all 103 participants successfully submitted their completely filled forms. The mean age of the 103 participants was 40.40 ± 9.23 and the male (n=62) / female (n=41) ratio was found to be 1.51. The mean MEATER score of the 103 participants was 66.17 ± 11.85, range being 29-79.  In our study we found that the age and the designation does influence the attitude towards educational research. Participants with ages more than 40 years and those on the post of professors had more favourable attitude towards educational research. Also the participants who had attended MET workshop were more favourable towards educational research as compared to those who had not. The subject that they teach, whether pre-clinical, para-clinical or clinical and their gender did not influence the attitudes towards educational research. Educational research is very infrequently conducted as only 3.8% participants had done so. Among the barriers lack of time was the most common barrier. Conclusion: In our study we found that the age, designation and attendance in MET workshop does influence the attitude towards educational research. Educational research is very infrequently conducted as only 3.8% participants had done so. Among the barriers lack of time was the most common barrier.

Background: In developing countries like India, a lack of awareness about contraceptive methods often leads to misconceptions, limited choices, and improper family planning. This knowledge gap not only disrupts maternal and child health complications but also disrupts the economy of society and the nation. Therefore, the purpose of this study was to investigate the knowledge, awareness and perception of contraception among the rural and urban population. Materials and Methods: This observational study conducted in the Department of Obstetrics and Gynecology at a tertiary health care centre, in Punjab, India. A total of 500 women were evaluated with the help of a pre-designed questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Kalol. Results: In the present study, a total of 492 participants were included, of whom 387 were from rural areas and 105 were from urban areas. This study revealed, 100% of participants were aware of contraception. In terms of the source of information, social circles were identified as the primary channel (46.34%), followed by the media (33.94%), health workers (16.87%), and educational institutes (2.85%). Conclusion: This study highlights contraceptive methods, including condoms, oral contraceptives, and intrauterine devices (IUDs), as primary choices. Therefore, it’s important to bridge the gap between awareness and action. Hence, this study, advocate the awareness program on interventions to ensure everyone can access effective family planning resources without barriers.

Background: Photoaged skin, characterized by wrinkles, hyperpigmentation, and rough texture, poses a significant cosmetic concern. Topical retinoids are widely used for their anti-aging properties, but their efficacy and safety in diverse populations need further investigation. Objective: To evaluate the impact of topical retinoid therapy on skin aging in patients with photoaged skin. Methods: This cross-sectional study included 100 participants (mean age 55 years, range 40-70 years; 60% female) with photoaged skin. Participants applied topical tretinoin 0.05% cream once daily at bedtime for 6 months. Clinical outcomes assessed included wrinkle depth, skin texture, and hyperpigmentation. Subjective assessments were also conducted via a self-reported questionnaire. Statistical analysis was performed using paired t-tests. Results: Significant reductions in wrinkle depth (mean reduction 30%, 80% of participants, p < 0.01), skin texture improvement (mean improvement 35%, 75% of participants, p < 0.01), and hyperpigmentation reduction (mean reduction 25%, 70% of participants, p < 0.05) were observed. Subjective assessments indicated that 85% of participants perceived noticeable improvement, and 90% were satisfied with the treatment. Mild irritation and redness were reported by 40% of participants during the initial weeks, with no severe adverse effects. Pre-treatment and post-treatment scores showed significant improvements in all measured outcomes. Conclusion: Topical retinoid therapy significantly improves the clinical signs of aging in photoaged skin, with high patient satisfaction and minimal side effects. These findings support the use of topical retinoids as an effective treatment for aging skin. Further studies are recommended to validate these results and explore long-term benefits.

Background: Urolithiasis, the formation of stones in the urinary system, affects over 12% of the global population and presents significant recurrence rates. Ureteric calculi, a subset of urolithiasis, are the primary cause of renal colic, causing distinct abdominal pain and other symptoms based on their location. Aim and Objective: To evaluate the effectiveness of tamsulosin, with or without deflazacort, as a medical expulsive therapy (MET) in patients with middle and lower ureteric calculus. Materials and Methods: A prospective observational analytical study was conducted with 170 patients diagnosed with middle or lower ureteric calculus at the Department of General Surgery, People’s Hospital & Research Center, Bhopal. Patients were randomly assigned to two treatment groups: Group A received tamsulosin (0.4 mg once daily at bedtime) and deflazacort (6 mg twice daily for 2 weeks and then tapered to 6mg once a day for additional 2 weeks), while Group B received only tamsulosin (0.4 mg once daily at bedtime). Follow-ups and evaluations were conducted during the 2nd, 3rd, and 4th weeks of MET via ultrasonography or X-ray KUB. Results: The mean age and gender distribution were comparable between groups. The expulsion rate after 3 weeks was significantly higher in Group A (23.5%) compared to Group B (7.1%). By the end of 4 weeks, Group A showed an 88.2% expulsion rate compared to 52.9% in Group B. Group A also required significantly fewer analgesic doses (4.59 vs. 6.38, p < 0.01). Adverse reactions were comparable between groups, with no significant differences. Conclusion: The combination therapy of tamsulosin and deflazacort significantly enhances stone expulsion rates and reduces the need for analgesics compared to tamsulosin monotherapy, making it an optimal therapeutic approach for managing middle and lower ureteric calculi.

Background and Objectives: Paralleling the increasing prevalence of obesity, diabetes mellitus, and the metabolic syndrome This study aimed to evaluate the burden of NAFLD and severe fibrosis among DM population. Methods: It was a hospital based observational and cross-sectional study. department of General Medicine, AIIMS, Patna. Results: Out of 100 patients 48 patients did not have NAFLD while 52 patients had NAFLD. Thus proportion of NAFLD in diabetic patients was quite high (52%). Out of 52 NAFLD patients 27 patients (51.9%) had mild liver fibrosis, 14 patients (26.9%) had significant fibrosis and 11 patients (21.2%) had severe liver fibrosis. Thus proportion of NAFLD patients with significant and severe fibrosis was quite high (26.9% and 21.2% respectively). Conclusion: From the study it can be concluded that the prevalence of NAFLD in adult patients with type 2 diabetes mellitus in department of medicine at AIIMS, Patna is 52% and moderate and severe fibrosis is found in 26.9% and 21.2% patients respectively among them. BMI and the waist circumference are the factors in our study that have shown association with the incidence of NAFLD in type 2 DM patients.

Background and Objectives: Pulmonary TB and Heart- when we hear both these terms together, the thing which crosses our mind immediately is pulmonary fibrosis and corpulmonale. Pulmonary TB and Cardiac dysfunctions are major causes of morbidity and mortality with overlapping symptomatology like cough, dyspnea. But whether there is any correlation between these remains largely unclear. Study aimed to assess any Cardiac dysfunction in Healed Pulmonary TB by means of 2D Echocardiography and to manage both Lungs & Heart simultaneously in a better way. Materials and Methods: it was a cross sectional observational study. 200 Healed Pulmary TB patients were evaluated by 2D Echocardiography for LVH, LVEF%, PASP and left ventricular functions. LVDD was determined by ratio of E/E’ (standard mitral inflow maximal velocity/ mitral annular relaxation velocity) which correlates with LV filling pressures. [Systolic function was assessed by LVEF (Left Ventricular Ejection Fraction). PASP (mmHg) was measured by Tricuspid regurgitation. Result: Significant Left Ventricular Cardiac dysfunction is seen in patients of healed Pulmonary TB. Conclusion: We generally forget to treat the heart when treating the pulmonary TB or healed TB. This study makes us focus on heart and lungs both simultaneously in healed Pulmonary TB patients. To avoid unnecessary medications for the overlapping symptoms like cough, dyspnea and also to focus the late cardiac complications in healed TB.

Background and Objectives: Pain is defined by the international association for study of pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage, Based on the present clinical comparative study epidural analgesia with bupivacaine 0.5% along 25 mcg fentanyl with bupivacaine 0.5% with dexmedetomidine 25 mcg in radical cholecystectomy. Material and Methods: This study was an interventional, prospective, double blind, parallel group, randomized clinical study conducted on patients undergoing elective lower limb and upper abdominal surgeries.in Department of Anaesthesiology at NMCH Jamuhar, Rohtas. Conclusion: Based on the present clinical comparative study, Epidural analgesia bupivacaine 0.5% with 25 mcg dexmedetomidine  when administered for radical cholecystectomy was superior to bupivacaine 0.5% with 25 mcg fentanyl  in providing longer duration of pain relief. we conclude that isobaric 0.75% Ropivacaine, when administered through epidural route, provides adequate anaesthesia for gall bladder surgeries.

Gangrene is defined as macroscopic death of tissues in situ with or without putrefaction. Digital gangrene of the upper limb is relatively rare in comparison with those of the lower limb. It may be most commonly due to ischemia (decreased blood supply). A large number of diseases can affect the arterial tree of upper limb. Upper extremity vascular reconstruction is much less common than the lower limb and it accounts for less than 5% of patients with upper limb ischemia. The good collateral around the elbow and shoulder explains the reason why most of the chronic occlusive diseases are asymptomatic. Upper extremity vascular diseases can be classified based on anatomic location or on the basis of etiology. Limb arterial tree are rare and may present with ischemia due to emboli and thrombosis.

Introduction: Thyroid is afflicted by various pathologies ranging from diffuse enlargement to nodular lesions. Nodules in thyroid are of greatest concern as they may have an underlying malignancy. Ultrasound is considered an initial investigation in diagnosing thyroid nodules and cytology remains confirmatory. Due to lack of a standardized system for reporting, interpretation of cytology reports was difficult for clinicians. So for the provision of uniform diagnostic terminology a standardized category based evaluation was proposed as The Bethesda System of Reporting Thyroid Cytology (TBSRTC). The combination of TIRADS with TBSRTC together was found to have high sensitivity and specificity. Our study aims to analyse the diagnostic utility of TIRADS and TBSRTC in reporting thyroid cytology and to observe the concordance. Result & Conclusion: The Sensitivity, Specificity, PPV and NPV were found out to be 83.33% and 87.5% 62.5% and 95.45% respectively. The test and the gold standard agree on 52 out of 60 having a diagnostic accuracy of 86.66%. Stratification of thyroid nodules according to TIRADS, can help in limiting the FNAC only on suspicious nodules, thus avoiding unnecessary aspiration. FNAC is a minimally invasive and inexpensive tool but such invasive procedure can be avoided for patients belonging to TIRADS I and II. FNAC as a confirmatory test should be performed in TIRADS III, IV, V nodules.

Background: With improvements in internet’s availability and affordability has led to its overuse and addiction. Increased internet usage can lead to habituation, addiction, adverse academic, physical, mental and social effects. It is important to investigate the seriousness of internet addiction in medical students as they are in the field related with the physical and mental wellbeing of human. Aim and Objective: The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students. Materials and Methods: A cross-sectional study was conducted in 380 undergraduate medical students of Siddhartha Medical College, Vijayawada with the help of semi structured questionnaire consisting of questions related to demographic information, information related to internet use, and Young’s internet addiction test. Results: We found prevalence of internet addiction among medical students to be 24.2% and significantly associated factors with internet addiction being female gender, lesser age, using mobile for internet access, excess time spent on internet, and using internet for studying, downloading and social networking. Conclusion: In the present study it was found that the internet addiction is highly prevalent in medical students. There is a need for controlling internet addiction by engaging the students in extracurricular activities, providing healthy living environment, and to provide counselling to those with addiction.

Background and Aim: This study aimed to evaluate the prevalence of amblyopia and identify the factors that contribute to its development in school-aged children from the Visnagar region of Gujarat. Additionally, the study aimed to implement appropriate treatment methods based on the type of amblyopia and monitor the patients for any signs of improvement. Material and Methods: This study was conducted at the Department of Ophthalmology in a Tertiary Care Teaching Institute in India. It involved observing 1000 school-going children over the course of one year. Every child attending school between the ages of 5 and 16 within a 3km radius of the Visnagar region in Gujarat was included in the study. There were a total of 25 cases of amblyopia that were detected and thoroughly studied. The patient’s complaints were documented in the order they occurred, and a thorough history of their current illness was obtained. Results: The most common risk factor associated with amblyopia was anisometropia, accounting for 53.33% of cases. A majority of patients experienced unilateral amblyopia, with a significant number falling into the moderate category. Out of the 25 amblyopic cases, a significant improvement in visual acuity of more than 2 Snellen lines was observed in 16 cases. The relationship between the length of occlusion therapy and visual improvement in children with amblyopia did not reach statistical significance (p>0.05). Conclusion: Anisometropia was identified as the most common causative risk factor for amblyopia in relation to refractive error. Detecting and treating amblyopia at an early age is crucial for preventing long-term vision problems and minimising the risk of permanent vision loss.

Introduction: Majority of patients present in ED having complain of respiratory distress. In India most of the cases of ARDS are due to pneumonia. There are so many radiological and blood investigations are used to diagnose such condition but lung ultrasonography is modern imaging modality which has been studied in the emergency department setting. It is cheaper, safer and does not require expert to operate. This study was aimed to assess the accuracy of BLUE protocol. We compared it prospectively to a composite standard which was chest radiograph, USG chest, and HRCT. Aims: To determine the utility of bedside lung ultrasound in emergency (BLUE) protocol as a diagnostic tool in patients with acute respiratory distress presenting in the emergency department. Methodology: Cases of patients presenting with acute respiratory distress aged more than 18 years admitted in tertiary care hospital in India with study period of February 2024 to June 2024 were included in the study. On admission covid 19 positive patients and pregnant females were excluded in the study. Brief history was taken in each case following admission with reference to symptoms like breathlessness, pedal oedema, chest pain or gabharaman and the presence of risk factors like hypertension, diabetes, smoking and alcohol. Radiological investigations like x ray chest, HRCT and other blood investigations were done. All the above data were collected and recorded in a standard proforma. Result: Total 150 patients of acute respiratory distress were included in study as per inclusion and exclusion criteria. Out of that 94 patients were male and 56 were females. Out of 150 patients most common cause of acute respiratory distress is pulmonary oedema (30%), COPD or asthma (14.67%), pulmonary embolism (4%), pneumothorax (10%) and pneumonia (40%). For pulmonary edema, the B profile had 97% sensitivity and 94% specificity. For COPD or asthma, the normal profile had 90% sensitivity and 97% specificity. For pulmonary embolism A profile plus venous thrombosis showed 83.3% sensitivity and 97% specificity. For pneumothorax, absent anterior lung sliding, anterior A lines, and a positive search for lung point yielding 86% sensitivity and 98% specificity. For pneumonia, sensitivity and specificity were respectively,11% and 98% for B’ profile,14% and 98% for the A/B profile, 22% and 98% for C profile, 44% and 97% for the A profile plus PLAPS. These four profiles indicated pneumonia with 90% sensitivity and 93% specificity. Conclusion: Lung ultrasound can help the ED physician make a rapid diagnosis in patients with acute respiratory distress. And it is feasible, affordable and allows fast, accurate, bedside examinations of most acute respiratory disorders. Lung ultrasound immediately provides diagnosis of acute respiratory failure in the majority of cases.

Background: Survival, growth and development in the earliest years of life are fundamental for the future of every individual and for the future of the societies into which those individuals are born. However, these crucial formative years remain a time of peril and loss -disease and malnutrition not only claim the lives of millions of children throughout the world, but they also damage their growth and development, diminish their quality of life in the present and compromise their future. Aim: To study the nutritional status of under-five age group children. Objectives: To assess the prevalence of malnutrition and the factors associated with it in under-five age group. Materials and Methods: A community based cross-sectional study was conducted in the rural field practice area between August and November 2017 among children under five years age group. A multi-stage random sampling technique was done to select the required sample size of 350.  The children were examined and anthropometric measurements were taken. Data were entered and analysed using Microsoft Excel 2010 version and Epi-Info version 7. Chi-square test was used to test the significance of association. Results: The present study shows prevalence of underweight (37%), wasting (24%) and stunting (35%). The sociodemographic, environmental and other health related factors had significant association with malnutrition. Conclusion: The significant risk factors associated with malnutrition were identified. Health education regarding preventive practices to be adopted by the mothers to improve the nutritional status of children.

Background: Adverse neonatal outcomes are affected by maternal and fetal factors; it is the occurrence of Low Birth Weight (LBW), preterm delivery, low Apgar scores at first and fifth minutes after birth, early or late neonatal death, small for gestational age, and/or severe neonatal conditions. Methods: The case-control study was conducted in obstetrics and gynaecology department of MMCH, Madhubani, Bihar from July 2023 to June 2024 over 210 singleton pregnant women following 1975 Helsinki declaration and its later amendment. Cases (n=105) were considered as having any adverse birth outcome, while controls (n=105) had none of the adverse birth events. Data were recorded in separated case-record form and analyzed by SPSS-24. Results: Mean age of cases and controls were 28.98±5.48 (SD) years and 28.65±4.65 years, respectively (p=0.635). Preterm labour (64.8%), low birth weight (LBW, 41.9%) and neonatal intensive care unit (NICU) admission (31.4%) were the common adverse outcomes. Cases had significantly higher prevalence of obesity (24.8% vs 13.3%, p=0.035), gestational diabetes mellitus (49.5% vs 33.3%, p=0.017), pregnancy-induced hypertension (PIH, 40% vs 17.1%, p<0.001) and premature rupture of membrane (PROM, 15.2% vs 4.8%, p=0.011). Maternal age >35 years (adjusted odds ratio=3.77, 95%CI=1.12-12.65), PIH (AOR=3.602, 95%CI=1.797-7.22), and PROM (AOR=5.74, 95%CI=1.83-18.00) were the significant risk factors for adverse foetal outcome. Besides, PIH had significant odds ratio for preterm labour (AOR=2.21, 95%CI=1.13-4.33), LBW (AOR=4.19, 95%CI=1.93-9.12) and NICU (AOR=8.93, 95%CI=3.73-21.38). Maternal age >35 years (AOR=3.21, 95%CI=1.04-9.88) and PROM (OR=3.65, 95%CI=1.18-11.3) were associated with LBW, while previous caesarian section (CS) was responsible for preterm labour (AOR=2.298, 95%CI=1.09-4.87). Conclusion: Pregnancy with advance maternal age, PIH, previous CS and PROM were the determinants of adverse birth outcomes.

Background: The most prevalent cause of peritonitis, which is an inflammation of the peritoneum, is a localized or widespread infection. In India, this is the most frequent surgical emergency. In India, perforated stomach or duodenal ulcers are the most frequent causes. If not properly diagnosed and treated, peritonitis of any kind can be extremely dangerous and even fatal. An important factor in the prognosis of peritonitis is the patient’s state of health at the start of treatment. Numerous prognostic scoring systems are currently in use, and they can be used to initially make accurate predictions about the course of the disease. The purpose of the study is to use the APACHE – III scoring method to predict the prognosis of patients with perforated peritonitis. Methods: This study was carried out on 72 patients who were diagnosed with perforation peritonitis between December 2017 and November 2018 and were hospitalized to the emergency ward (general surgery) of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Within 24 hours of their hospitalization, all patients had evaluations using the APACHE – III grading system. Every patient brought to the emergency room had a clinical examination before any necessary investigations were carried out. Range of total scores for APACHE III (0-299). Results: Majority of survivors belong to age group 20- 60 yrs. In this series, male patients were 55 (76%) and female patients were 17 (23%). Mortality was higher in females (23.5%) as compared to male (7.2%). Most common cause of perforation peritonitis was gastric/duodenal perforations (55%) followed by small bowel perforations (20%), blunt abdominal trauma (11%), appendicular perforation (4%), colon perforation (2.7%), gall bladder perforation (2.7%), stab injury abdomen (1.3%) and firearm injury abdomen (1.3%). Most of the patients (72%) were managed with primary repair of perforations. Mean duration of hospital stay is 13 days. Major causes of postoperative complications were wound infection (25%), wound dehiscence (15%), septicemia (8%) and faecal fistula (2.7%). Patients with lower scores have more favourable prognosis than patients with higher score. Observed mortality rate was 41.6% in the group with APACHE –III score of >60, which was comparable to predicted mortality of 42.6%. Conclusion: The prognosis for patients with lower scores is better than that of those with higher scores. Thus, the study’s conclusion was that patients with lower scores fare better than those with higher scores.

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

Background: Oral health issues and diseases can have a negative impact on a child’s overall health and development as well as their quality of life. While having healthy teeth is not the only aspect of having good oral health, uncontrolled and active caries is a major cause of poor oral and general health in many children. The aim of the present study was to find the prevalence of Early Childhood Caries and associated risk factors among 3-6 years preschools children in Delhi/NCR. Methods: The present study was carried out in Department of Pediatrics Dentistry, Shree Bankey Bihari Dental College and Research Centre, Masuri, Ghaziabad. This descriptive cross- sectional study was based upon oral examination of children of study population with parent’s perception on the basis of questionnaire. This study was conducted in the various preschools taking care of children in Delhi/NCR randomly and in the Department of Preventive and Paediatrics Dentistry of Shree Bankey Bihari Dental College, Masuri, Ghaziabad. Results: Four region Delhi, Ghaziabad, Noida and Greater Noida comprising of 500 children from different preschools in each region were selected, total of 2000 children were examined out of which 1072 were male and 928 were females. Among them, 2.02 mean age, 560 were caries active and 1440 were caries free. Overall ECC prevalence was 28% with highest prevalence in Greater Noida and Noida which have similar value and least prevalence was found in Delhi (11%). Mean def value was found to be 2.02 and Mean DMFT 0.13 respectively. The difference in the prevalence of ECC was found between different age groups, highest value of 32.7% at age group 3 years, 4 years 28.2% followed by equal distribution in age group 4 and 6 years to be 25%. The difference between the age group was not significant. The caries prevalence was more in females as compared with males. Conclusion: Epidemiology of any disease is a very helpful tool to assess the actual status of the disease among population. Diversity in population of India with respect to dental caries provides a very beautiful condition for the study of different factors associated with dental caries. However this work is a small effort towards understanding of factors associated with dental caries, but this study fails to correlate the data with other studies in this study sample population.

Background: Adnexal mass pathologies are mostly benign. Given the extremely low five-year survival rate of adnexal malignant tumors, early detection is imperative. There isn’t a single, gold-standard investigation that can be used to diagnose adnexal cancer. The menopausal status (M), ultrasound scores (U), and serum CA 125 (U/ML) is combined to create the Risk of Malignancy Index (RMI) scoring system. The purpose of this research is to evaluate how well the Risk of Malignancy Index-3 (RMI-3) scoring system distinguishes between benign and malignant adnexal masses in order to aid in the early detection and treatment of malignant ovarian masses. Methods: This is a prospective, observational study conducted from June 2019 to May 2020 at Obstetrics and Gynaecology department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar, among 50 female patients over the age of 25 who had been diagnosed with an adnexal mass. Each study participant underwent a comprehensive clinical examination, an in-depth history taking, an abdominal and pelvic ultrasonography, and indicators such CA 125. A correlation was established between the Risk of Malignancy Index and the histopathological (HPE) results of the removed tumors. Results: When the RMI score of 149.2 is used as the cutoff point for diagnosing malignancy, the results show a 92.3% specificity, 79.2% sensitivity, 90.47% positive predictive value, 82.78% negative predictive value, and 86.01% diagnostic accuracy. Conclusion: The Risk of Malignancy Index score is a straightforward diagnostic tool that can be used as an effective screening tool to separate malignant lesions from adnexal masses.

Background: Worldwide, anemia is the most prevalent treatable condition in pregnant women, and it raises the risk of both maternal and neonatal death. The purpose of this study is to compare intravenous ferric carboxymaltose with intravenous iron sucrose in terms of their effectiveness, safety, and compliance in treating iron deficiency anemia in pregnant patients. Methods: This study, which involved 100 pregnant women, was randomized and prospectively conducted in the department of obstetrics and Gynecology at Darbhanga Medical College and Hospital in Laheriasarai, Bihar, between June 2019 and May 2020. Ferric carboxymaltose was administered intravenously to 50 pregnant anemic individuals, while iron sucrose was administered intravenously to the remaining 50 patients. Prior to and three weeks following therapy, measurements of hemoglobin, packed cell volume, and blood indices were made. Both intravenous substances’ safety and effectiveness were investigated. Results: Pregnancy-related anemia was shown to be more common in the 20–24 age range and in multigravida women during the 22–28 week gestational age range. Three weeks following therapy, the mean hemoglobin difference was 2.34 g/dl for ferric carboxymaltose and 1.32 g/dl for iron sucrose. Compared to iron sucrose, the other metrics likewise increased significantly for ferric carboxymaltose. Conclusion: When treating iron deficiency anemia in pregnancy, ferric carboxymaltose is a more effective and superior option with fewer adverse effects and the added benefit of a single dosage schedule.

Background: Acute respiratory infection is a major public health problem particularly in developing countries like India where most of people belong to poor economic strata and reside in slums and are exposed to fatal illnesses. Under-five children are particularly vulnerable to this Sort of infections and it has posed a great economic burden to the developing world particularly in the urban slums. Aim of this study to assess prevalence of acute respiratory infections amongst children in an urban slum; sociodemographic profile of study population and assess health seeking behaviour of parents for these morbidities. Methods: It was a Cross-sectional study carried out in 256 under-five children which was conducted in vulnerable urban slum in UHC field practice area of tertiary care hospital for 12 months duration. Results: The overall prevalence of ARI was found to be 30.4%. Children in age group of 1-3 years were most commonly affected with ARI (57.1%). In social class IV & V, prevalence of ARI was highest with 40.70 %. There was a significant association between immunization status, birth weight, family composition, malnutrition status and Occurrence of ARI in under-five children. Conclusion: The present study found poor birth weight, low socio economic class, delay in initiation of breast feeding, pre-lacteal feeding, and immunization status as significant risk factors for ARI in under-fives.

Background: Addressing anterior knee pain post-total knee arthroplasty (TKA) remains a significant concern. This study aims to present early outcomes of employing patelloplasty to alleviate such pain in TKA patients. Methods: A prospective review was conducted on 38 knees from 35 patients who underwent TKA between 2018 and 2022. Knee and function scores according to the Knee Society assessment, patellar scores using Feller’s questionnaire, knee range of motion, and patient satisfaction were evaluated preoperatively and postoperatively. Results: Preoperative and final follow-up knee scores averaged 50.2±9.1 and 85.4±10.1, respectively, while function scores averaged 47.3±11.2 and 80.7±13.1, respectively. Preoperative patellar score averaged 17.9±3.2, increasing to 24.6±2.7 at final follow-up. Notably, knees with Grade 3 chondropathy exhibited significantly higher mean patellar scores compared to Grade 4 chondropathy knees. Preoperative knee range of motion averaged 82.7±11.5, improving to 115.2±8.9 at final follow-up. Conclusion: Employing patellar decompression with patelloplasty in TKA presents a viable option for alleviating anterior knee pain.

Introduction: Spinal anaesthesia is the technique of choice for elective caesarean section, because it avoids risks associated with general anaesthesia. Spinal block induced sympatholysis leads to hypotension. Perfusion Index (PI) is a new parameter tried to predict hypotension during spinal anesthesia in caesarean section. This study, aimed at investigating the correlation between baseline perfusion index and incidence of hypotension following spinal anaesthesia. Method: In this prospective observational study,120 parturients were divided in two groups on the basis of baseline PI. Group I included parturients with PI>3.5 and group II parturients PI<3.5.Spinal anaesthesia was given using 10 mg hyperbaric bupivacaine at L2-L3 or L3-L4 space. Hypotension defined as decrease in systolic BP greater than 20% of baseline treated with fluid bolus and inj mephentermine. Statistical analysis was performed using student’s unpaired t-test. Results: There is a significant correlation between baseline perfusion index and incidence of hypotension following spinal anaesthesia. The incidence of hypotension in group I(PI >3.5) is 71% compared to 41% in group II (PI <3.5). Conclusion: We concluded that there is a significant correlation between baseline perfusion index and perfusion index after spinal anaesthesia. We also concluded that hypotension is more likely to develop after spinal anesthesia for caesarean section in parturient with higher baseline perfusion index and it can be used as an early non-invasive parameter for predict hypotension in healthy parturients undergoing elective caesarean section under spinal anesthesia.

Aim & Objectives: The aim of the study is to study the sensitivity and diagnostic accuracy of ADC mapping as a quantitative assessment tool in the detection and characterization of traumatic versus pathological fractures, and benign versus malignant spinal fractures using apparent diffusion coefficient maps. Material & Methods: The main source of data for this study was the patients referred from all the departments of Silchar Medical College and Hospital. All Patients referred to the radiology department with suspected or known vertebral pathologies will be eligible for inclusion in the study. According to the case input to the department, the study was planned to be conducted with at least 40 cases but it was later expanded to 62 cases due increase in the number of eligible patients The study was carried out for a period of 1 year from March 1, 2023, to February 29, 2024. MRI evaluation was carried out using SIEMENS TIM AVANTO 1.5T SCANNER. Various conventional and advanced MR pulse sequences were used. Images with multiple b-values, between 0,400,800 s/mm², should be acquired. DWI was done at a freehand region of interest and was drawn over the lesion, sampling the restricted areas, and ADC values were calculated from the generated apparent diffusion coefficient maps using advanced post-processing software. ADC values will be measured in predefined ROIs that include vertebral lesions identified on anatomical images. Results: The mean ADC values provided statistically significant differentiation among these conditions. Malignant spinal fractures had a mean ADC of 0.78, significantly lower than benign fractures, which had a mean ADC of 1.48. Tuberculous spondylodiscitis had a mean ADC of 1.31, while pyogenic spondylodiscitis had a mean ADC of 1.09. These differences were statistically significant, with p-values less than 0.0001 for benign versus malignant fractures and p < 0.009 for pyogenic versus tuberculous spondylodiscitis. The diagnostic accuracy of ADC values, compared to conventional MRI, was also evaluated. For fractures, ADC showed a higher reliability sensitivity of 92.3%, specificity of 83.3%, PPV of 80%, NPV of 93.75%, and overall diagnostic accuracy of 87.1%. Conventional MRI had a sensitivity of 84.6%, specificity of 77.8%, PPV of 73.33%, NPV of 87.5%, and overall accuracy of 80.65%. For “infections, ADC with a sensitivity of 75%, specificity of 78.5%, PPV of 67%, NPV of 84.6%, and overall accuracy of 77.27%. Traditional MRI showed a sensitivity of 50%, specificity of 71.4%, PPV of 50%, NPV of 71.4%, and overall accuracy of 63.6%. ROC curve analysis further emphasized the superiority of ADC in diagnostic performance, with an AUC of 0.122 for fractures and 0.768 for infections, significantly higher than conventional MRI’s AUC of 0.188 for fractures and 0.607 for infections. Conclusion: the study found that ADC values had better diagnostic accuracy than conventional MRI in differentiating between malignant and benign spinal fractures and pyogenic versus non-pyogenic infections. Including ADC in routine diagnostic schedules could enhance the accuracy and reliability of spinal pathology evaluations, directly benefiting patient care and management.

Background: Cervical cancer remains a significant health issue globally, with cervical intraepithelial neoplasms (CIN) being precursors to invasive cervical carcinoma. p16, a cyclin-dependent kinase inhibitor, has emerged as a potential biomarker for the detection and progression of cervical neoplasms. This study aims to evaluate the expression of p16 in cervical intraepithelial neoplasms and invasive cervical carcinoma using immunohistochemical analysis. Materials and Methods: A total of 100 cervical tissue samples were collected, comprising 50 cases of CIN (graded I-III) and 50 cases of invasive cervical carcinoma. Immunohistochemical staining for p16 was performed on formalin-fixed, paraffin-embedded tissue sections. The intensity and distribution of p16 staining were evaluated and scored. Statistical analysis was conducted to assess the correlation between p16 expression and the grade of cervical neoplasms. Results: p16 expression was observed in 80% of CIN cases and 95% of invasive cervical carcinoma cases. Specifically, p16 positivity was detected in 60% of CIN I, 80% of CIN II, and 90% of CIN III cases. Among invasive cervical carcinoma cases, 95% showed strong p16 positivity. A significant correlation was found between the grade of cervical neoplasm and p16 expression (p < 0.01). The mean p16 staining intensity score was significantly higher in invasive carcinoma compared to CIN (7.5 ± 0.5 vs. 5.0 ± 0.7; p < 0.001). Conclusion: The study demonstrates that p16 expression increases with the severity of cervical neoplasms, making it a reliable biomarker for distinguishing between CIN and invasive cervical carcinoma. The significant correlation between p16 expression and neoplasm grade suggests its potential utility in diagnostic pathology for the early detection and management of cervical cancer.

Background: Breast carcinoma remains a leading cause of cancer-related mortality among women worldwide. The expression of p53, a tumor suppressor protein, has been implicated in various cancers, including breast carcinoma. This study aims to compare the expression of p53 with hormonal receptor status, specifically estrogen receptor (ER) and progesterone receptor (PR), using immunohistochemical (IHC) methods. Materials and Methods: A total of 150 breast carcinoma tissue samples were collected from patients undergoing mastectomy between January 2023 and December 2023. Immunohistochemistry was performed to evaluate the expression of p53, ER, and PR in the collected samples. The intensity and percentage of positively stained cells were scored. Statistical analysis was conducted using chi-square tests to assess the correlation between p53 expression and hormonal receptor status. Results: Out of 150 breast carcinoma samples, 90 (60%) showed positive expression for p53. Among these p53-positive cases, 55 (61.1%) were also positive for ER, and 45 (50%) were positive for PR. In contrast, among the 60 (40%) p53-negative cases, 20 (33.3%) were ER-positive, and 25 (41.7%) were PR-positive. A statistically significant correlation was found between p53 expression and ER status (p < 0.05), but not with PR status (p > 0.05). Conclusion: This study highlights a significant association between p53 expression and estrogen receptor status in breast carcinoma, suggesting that p53 may play a role in the hormonal regulation of breast cancer. Further studies are warranted to explore the underlying mechanisms and potential therapeutic implications of this association.

Introduction: Tobacco smoking is the reason for killing 8 million people every year with the greatest burden on low- and middle-income countries. Studies have reported the relation between smoking and personality traits. In present study, we aimed to evaluate the differences in personalities of smokers and non-smokers in the rural area of Rajasthan. Materials & Methods: Study included 80 adolescents and adult subjects, of which 40 each were smokers and non-smokers. The personality assessment of the subjects were done through NEO-FFI (Costa & McCrae, 1992). Collected data was imported from Excel sheets to SPSS software ver. 26.0. Results: Neuroticism trait was significantly associated with smokers (67.5% vs 35%) while non-smoking behavior was associated with Conscientiousness (p<0.05). Conclusion: Present study found a notable correlation between neuroticism and the habit of smoking while conscientiousness seems to act as a protective factor against the progression and continuation of smoking. Thus, specific personality traits, particularly neuroticism, should be evaluated and potentially addressed in intervention programs targeting smoking behaviour.

Background: In Laparoscopy the most commonly used gas for Pneumoperitoneum is carbon dioxide. Capnography is a non-invasive method of continuously measuring ETCO₂, which reflects PaCO₂. This study was done to see how Pneumoperitoneum affects the PaCO₂-EtCO₂ gradient during laparoscopic appendicectomy and cholecystectomy in adults. Material and Methods: Sixty ASA status 1 and 2 patients of both sexes, 20 to 60 years of age undergoing elective laparoscopic appendicectomy or laparoscopic cholecystectomy were chosen in a prospective observational study, conducted at tertiary care centre, Vijayawada after approval from institutional ethics committee, between January 2021– June 2022. Patient data was analysed for Systolic blood pressure, Diastolic blood pressure, mean arterial blood pressure, End tidal CO₂ (mmHg), PaCO₂(mmHg), pH, Bicarbonate, PaCO₂-ETC0₂(mmHg) gradient and Peak airway pressure (cmH₂O). Results: There was significant increase in mean arterial blood pressure, heart rate, end tidal carbon dioxide and PaCO₂, but was clinically within normal range. There was significant increase in PaCO₂-ETCO₂ gradient after CO₂ insufflation but within normal range. There was significant increase in peak airway pressure after CO₂ insufflation. Conclusion: The arterial and end tidal carbon dioxide pressure gradients are normal even after CO₂ Pneumoperitoneum in ASA 1 and 2 patients. The normal PaCO₂-ETCO₂ pressure gradient implies adequate ventilation to alveoli and perfusion (blood flow to pulmonary capillaries). Hence end tidal Capnography and pulse oximetry can be used as non-invasive techniques for monitoring CO₂ elimination and arterial oxygenation during laparoscopic surgery patients.

The MBBS curriculum is more stressful as it requires students to complete theory lessons in various subjects in a short period. Again, it takes some stress to learn. MBBS students are a bit stressed as they are new to the subject. Through a survey, 300 students were selected for the study. A questionnaire for medical students was used. In this study, female students have highly significantly more stress in Academic Related Stressors, Interpersonal and Intrapersonal Related Stressors, Teaching and Learning Related Stressors, Social Related Stressors, Dive and Desire Related Stressors, and Group Activities Related Stressors.

Introduction: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases. A reported incidence of 17.6/100,000/year has more than doubled in the past 25 years in parallel with an aging population. Surgical drainage is the mainstay of treatment, with variable recurrence risks. The purpose of this study is to assess the clinical outcome and recurrence following single burr hole drainage of CSDH patients in our centre.
Methods: It is a retrospective study which was conducted in the Department of Neurosurgery, CN Center, Gauhati Medical College and Hospital from January 2023 to December 2023. In our study we included 80 patients, age group from 21-90 years (mean 59.1 years). All patients were managed with single burr hole evacuation of Chronic SDH. Postoperatively patients were kept in supine position without pillow for 48 hours. Inclusion Criteria: Symptomatic presence of CSDH on the NCCT head. Exclusion Criteria: (1) Presence of acute SDH. (2) Craniotomies with primary etiology other than an SDH (e.g., abscess drainage, tumor resection). (3) Unknown patients. (4) Patients with missing information. Results: Preoperative and postoperative neurological statuses of the patients were recorded as per Glasgow outcome scale. Out of 80 patients (mean age: 59.1 years; range: 21-90 years; male: 51; female: 29) with CSDH underwent single burr hole drainage with peri-procedural mortality and morbidity were 1.25%(n=1) and 2.5% (n=2), respectively. Overall, among our patient population, recurrence was seen in 7.5% (n=6). The mean total hospital stay was 3.5±1.5 days. Conclusions: The study showed single burr hole drainage for chronic SDH evacuation showed satisfactory level of resolution of hematoma and clinical and neurological improvement and acceptable level of recurrence and it is safe and effective with acceptable level of cost.

Background: Oral tongue squamous cell carcinoma is a prevalent head and neck cancer with a high potential for regional metastasis. The management of clinically node-negative (N0) neck remains contentious, with debates surrounding the benefits of elective neck dissection versus observation. Methods: This prospective study compared two management strategies for early-stage tongue SCC without clinically palpable neck nodes. Fifty patients were randomized into two groups: one undergoing elective neck dissection and the other observed post-primary tumor treatment without immediate surgical intervention. Outcomes assessed included development of neck node metastasis, disease-free survival, overall survival, and post-treatment complications. Results: Elective neck dissection resulted in a lower incidence of neck node metastasis (8% vs. 16%) and higher median disease-free (24 months vs. 18 months) and overall survival (30 months vs. 24 months) compared to the observation group. Complications in the surgical group included lymphedema (12%) and surgical site infections (4%). Conclusion: Elective neck dissection may offer a survival advantage for patients with early-stage oral tongue SCC by reducing the incidence of regional metastasis. However, the associated morbidities underscore the need for careful patient selection. The results advocate for a tailored approach based on individual risk profiles to optimize treatment outcomes in this patient population.

Background: Neck dissection is a fundamental treatment for lymph node metastases in head and neck cancer, with varying implications for the spinal accessory nerve (SAN) function, which is crucial for shoulder mobility. Methods: This prospective study at Gujarat Cancer & Research Institute involved 100 patients undergoing neck dissection. The study assessed SAN function, shoulder dysfunction, and electromyography (EMG) of the trapezius muscle pre- and post-operatively at 3 weeks, 3 months, and 6 months. Patients were divided into groups undergoing elective neck dissection and observation. Results: Initial SAN function was significantly impaired in the elective dissection group but showed improvement over time. Shoulder dysfunction and EMG findings varied with the type of dissection, with radical dissections causing more significant impairments. Physiotherapy significantly improved pain and shoulder mobility. Conclusion: Elective neck dissection impacts SAN function and shoulder mobility, with recovery influenced by the extent of dissection and rehabilitative interventions. Tailoring surgical approaches and reinforcing postoperative rehabilitation are vital for optimizing patient outcomes.

Introduction: Sepsis and multi-organ failure arising from it are among the leading cause of death in patients admitted to the intensive care unit. Several scoring systems have been formulated to assess the severity of illness and provide the prognostic information to the treating physician for critically ill patients in medical intensive care unit (ICU). These severity scores help orient the limited resources towards more suitable patients. However, no consensus has been established regarding the superiority of the scoring system. APACHE (acute physiology age chronic health evaluation) and SOFA (sequential organ failure assessment) scores are the widely used scoring systems to predict the clinical outcome of critically ill patients in the ICU. Objective: To compare and determine the reliability of APACHE II and SOFA scoring system in predicting the clinical outcome in terms of mortality or survival in ICU patients with sepsis with MODS. Methodology: The present observational study was carried out in medicine intensive care unit at a tertiary care center involving 60 cases of sepsis. Results: Mean APACHE II score in survivors was 16.81±4.52 and in non survivors was 25.63±5.78. we compared the APACHE II score between two groups and found that the difference was statistically significant (p<0.05). Mean APACHE II score in survivors was 16.81±4.52 and in non survivors was 25.63±5.78. we compared the APACHE II score between two groups and found that the difference was statistically significant (p<0.05). The p value was found to be significant. Hence a higher mean SOFA score indicates a higher probability of mortality. Conclusion: Both the APACHE II score and SOFA scores were noted to have significant correlation with mortality in cases of sepsis – multi organ dysfunction syndrome. Higher values of APACHE 2, SOFA scores were associated with higher mortality.

Introduction:  Chronic rhinosinusitis (CRS) is a persistent inflammatory disease of the nasal and paranasal sinuses affecting 5% to 12% of the population, leading to significant morbidity. Accurate diagnosis using nasal endoscopy and CT scans is crucial for effective management. This study explores the correlation between these diagnostic tools to optimize CRS treatment, particularly in resource-limited settings. Aim and objectives: This study aims to correlate between the diagnostic nasal endoscopic features (Lund-Kennedy) and CT features (Lund-Mackay) in patients with chronic rhinosinusitis. Method: This 18-month prospective study at the National Institute of Medical Sciences and Research, Jaipur, involved 162 participants to investigate Chronic Rhinosinusitis (CRS). A comprehensive approach was used, incorporating clinical history, Diagnostic Nasal Endoscopy (DNE) with the Lund-Kennedy score (≥2), and CT scans with the Lund-Mackay score (≥4) for diagnosis. Inclusion criteria included patients over 14, excluding those with facial abnormalities and pregnant women. Results: The study involved 162 participants, predominantly in the 15-34 age group. Gender distribution was nearly equal, with 83 males and 79 females. The study has shown that that the most patients had mild to moderate sinus involvement, with 48.8% scoring 2 on the Lund-Kennedy Endoscopic Scoring System and 41.4% scoring 3, while a small subset exhibited severe pathology. Significant correlations were found between facial pain/pressure and sinusitis severity (p=0.000), and nasal discharge/purulence (p=0.004). Elevated heart rate and blood pressure were also noted. Conclusion: The study concluded that there is statistically significant correlation between the diagnostic nasal endoscopic features (Lund-Kennedy) and CT features (Lund-Mackay) in patients with chronic rhinosinusitis.

Introduction: Perforated appendicitis is an acute illness that requires emergent surgery. Open appendectomy (OA) or laparoscopic appendectomy (LA) is common procedure for appendicitis. While LA has grown in use and application as a surgical procedure and it is less invasive, there are still debates regarding its efficacy over OA especially for perforated appendicitis. Methods: Participants were patients diagnosed with perforated appendicitis who underwent either open OA or LA surgery, according to the type of research. The primary assessed outcomes were the surgical time of operation being conducted, length of stay in hospital as well as recovery time. The experimenters conducted the research for a time period of 1 year. Results: The rate of postoperative infections increased in the patients who had open surgery compared with laparoscopic surgery. Hospital time of stay for both the types of surgeries was comparable. The mean time for laparoscopic surgery was significantly less than the traditional open technique of surgery. Conclusion: LA has benefits such as fewer hospital days and faster recovery in instances of perforated appendix, though there may be a higher risk for the development form intra-abdominal abscess. It also remains a viable alternative, especially for those at risk of complications. Further prospective studies are needed to aim at a more objective selection between OA and LA.

Background: The latest anti-tubercular drug resistance surveillance data show that 3.5% of new and 18% of previously treated tuberculosis cases in the world are estimated to have multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). India accounts for about one-fourth of the global burden of MDR-TB. Emergence of drug resistant has been a serious threat to eliminate tuberculosis, End TB 2025. The estimated number of MDR/RR – TB cases in India is 124000 (9.1/lakh population). A total of 109 countries are using all – oral longer regimens for the treatment of MDR/RR – TB. Objective: To assess the effectiveness of the Bedaquiline containing regimen. To analyse the factors affecting treatment outcomes of rifampicin resistant, multi drug resistant pulmonary tuberculosis patients treated with Bedaqulline containing regimens. Methods: We studied cases of rifampicin and multidrug resistant tuberculosis registered at drug resistant tuberculosis centre, Mysore. During the time period of January 2021 to march 2022. (14 months) Patients were treated according to programmatic management of drug resistant tuberculosis guidelines. (PMDT) followed up with NIKSHAY mobile application. Results: 115 cases were studied, out of which 104 were drug resistant pulmonary tuberculosis, Based on line probe assay (LPA), drug susceptibility (DST) reports 50.96% RR -TB 31.7% MDR TB, 17.30% Pre XDR. 31 cases were treated with shorter Bedaquiline regimen, 73 cases were treated with all oral longer regimen. 86% patients had past history of treatment with first line antitubercular treatment under national programme. 4 cases were co-infected with tuberculosis and human immune deficiency virus. 53 cases cured, 20 cases treatment complete, 8 lost follow up, 3 failure, 20 died.  Cure rate of Bedaquiline containing regimen in RRTB-50.9%, MDRTB-54.5%. Pre XDRTB-44.4%. Most common comorbidity associated was diabetes, most common adverse reaction was associated with linezolid -anaemia, bicytopenia; Cycloserine – psychiatry issues, clofazimine -hyperpigmentation. In 4 cases regimen was changed from shorter to AOLR regimen based on LPA, DST reports. In 6 cases AOLR regimen was modified due to adverse events. Conclusion: In our present study treatment cure rate was 50.96%. Patients treated with Bedaquilline regimen for DRTB showed lower mortality, and fewer manageable adverse events, indicating improved tolerance and compliance compared to previous treatments.

Depression, a globally prevalent and intricate mental health challenge, necessitates novel therapeutic approaches. Depression is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in daily activities. Traditional antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, have demonstrated efficacy, but their side effects and variable response rates necessitate the search for alternative treatments. Curcumin, the active compound in turmeric, has recently garnered attention for its potential therapeutic effects in depression. In this comprehensive review, we delve into the potential of curcumin, as a promising candidate for the treatment of depression. The review meticulously synthesizes existing literature to provide a nuanced understanding of curcumin’s multifaceted attributes, encompassing its mechanisms of action, preclinical evidence, clinical studies, safety profile, and future directions and potential as an adjunctive or standalone treatment.

During COVID pandemic studies have indicated social functioning is impaired in general population due to the perceived threat of COVID-19  and related lockdown measures. Studies have also suggested that patients with severe mental illness are disproportionately vulnerable to the COVID-19 pandemic effects on social functioning as compared to general population. Few studies have also suggested that social functioning in patients with severe mental illness was impaired prior to pandemic and there was no exacerbation in the social functioning deficits due to the pandemic. This study was done to assess the social functioning in patients with Schizophrenia and Bipolar disorder during the pandemic and to assess the relation between perceived threat due to COVID-19and the social functioning in severe mental illness patients. Materials and Methods: A crossectional assessment in 92 patients with severe mental illness comprising of Schizophrenia and Bipolar Disorder was conducted. Sociodemographic data and clinical data was collected using specifically designed proforma, Brief Psychiatric Rating scale, Young Mania Rating Scale, Hamilton Depression rating scale, Clinical global impression scale, Modified COVID-19 Threat scale and Work and Social Adjustment Scale were administered. Descriptive statistics were used to describe the data, Spearmann’s rank correlation was used to find correlation between WSAS and BPRS, YMRS, HAM-D, CGI and CTS and Mann- Whitney U test was used to compare WSAS and the sociodemographic variables. Results: In this sample of 92 patients with severe mental illness 65 patients(70.7%) had significant social functioning impairment and 27 patients( 29.3%) had good functioning during the pandemic. The mean WSAS score was 13.15±7.498. There was more functional impairment for male gender(15.08±6.42) as compared to female gender(11.67±5.976) and it was statistically significant (p=0.024) There was more functional impairment for Bipolar disorder patients(14.78±6.273 ) as compared to Schizophrenia patients (11.30± 6.416) and it was statistically significant (p=0.024). The CTS had a positive correlation with WSAS and was statistical significant (p<0.001) and suggest that COVID-19 related fear and anxiety was associated with significant functional impairment in patients with severe mental illness during the COVID-19 pandemic. Conclusion: This study suggests that patients with severe mental illness had their social functioning affected during the pandemic and it was significantly more affected in males as compared to females, Bipolar disorder patients had more impairment in social functioning as compared to schizophrenia patients during the pandemic and social functioning deteriorates as COVID-19 related fear and anxiety increases.

Aim: To compare the effect of aspheric Intra Ocular Lens (IOL) on post-operative quality of vision, which includes visual acuity, contrast sensitivity, and ocular aberration, versus conventional spherical IOLs after phacoemulsification cataract surgery. Material and Methods: A single centre, hospital-based prospective observational comparative study was by enrolling a total of 181 patients who met the inclusion criteria. Participants were divided into two groups based on the type of IOLs. The data on the preoperative and postoperative outcome including assessment of visual acuity, on the 1st, 10th, and 30th days, and measured their IOP whereas intra ocular pressure,  spherical aberrations, and contrast sensitivity at the 1-month postoperative day. Results: There was no significant difference between the two study groups in terms of age, gender, or laterality of the eye. The mean age of the patients in this study was 62.77 ± 9.03 years, with no significant difference in gender distribution (p = 0.368) or laterality of eyes (p = 0.997) between the groups. At the 1-month post-operative visit, there was no statistically significant difference in uncorrected as well as corrected visual acuity, IOP between the two groups. However, there was a significant difference in the mean spherical equivalent (p = 0.015), suggesting that IOL designs influence spherical equivalent. Under photopic and mesopic luminance conditions, the contrast sensitivity of patients in the aspheric group was significantly better (P value <0.05), but not significantly different under scotopic conditions. There were no significant difference in the mean Modulation Transfer Function (MTF) and Strehl Ratio (SR) at 3 mm in the optical zone between the two groups. The mean spherical aberration (SA) at 4 mm was 0.11±0.09, in group in comparison to group 2 0.04±0.14 (p-value < 0.001). The remaining eye aberrometry measurements showed no statistically significant difference, i.e., lower order (p = 0.275), higher order (p = 0.481), and total (p = 0.379) aberrations between the two groups. Conclusion: Aspheric IOLs, designed to correct positive corneal astigmatism, demonstrated superior contrast sensitivity at low spatial frequencies compared to spherical IOLs. However, no clinically relevant difference in best-corrected visual acuity (BCVA) was observed between groups, suggesting no overall difference in final visual quality.

NCDs have a substantial impact on our community, and the government’s health services are a cost-effective and efficient strategy to prevent and reduce the burden of NCDs. The identification of factors influencing the utilization of NCD clinics is critical for determining the gap between the goals of these programs and their implementation. It can be used to evaluate the efficacy of various strategies.
The aim of this study was to determine the percentage of people who prefer public sector NCD programmes along with the factors affecting the utilization of the same. in Malappuram, Kerala. Cross-sectional research of 100 people selected using multistage systematic random sampling was carried out in Kerala’s Malappuram district. The obtained data were analysed using descriptive and analytical statistical approaches using Jamovi version 2.3.
NCDs are a major health burden in our society, and treating and preventing them is critical. Many factors influence the selection of health care facilities for chronic diseases, and the study found that education, occupation, awareness of government programs, distance to the health center, and insurance coverage all influenced these decisions. The cost of therapy also plays an important part in selecting a health care facility.

Background: Nail changes are frequently associated with various dermatological conditions, including papulosquamous disorders, and serve as an important diagnostic tool. Specific alterations in the nails can provide vital clues to differentiate between different papulosquamous diseases. However, the extent and type of nail changes vary among disorders, and understanding these differences is essential for effective diagnosis and management. Aim and Objectives: This study aims to assess the clinical significance of nail changes in patients with papulosquamous disorders and correlate them with disease severity.  Materials and Method: A cross-sectional observational study was conducted on 60 patients diagnosed with papulosquamous disorders, attending the dermatology outpatient clinic. A thorough clinical examination of the nails was performed, and findings were documented. Specific nail changes such as pitting, subungual hyperkeratosis, onycholysis, and others were noted. The severity of nail involvement was correlated with the severity of the underlying disorder using established clinical criteria. Results and Observations: Nail changes were most frequently observed in psoriasis (60%), followed by lichen planus (16.7%) and pityriasis rubra pilaris (10%). The most common nail findings included pitting A strong correlation was observed between the extent of nail involvement and the severity of the underlying disease. Conclusion: Nail changes form an integral part of papulosquamous disorder manifestations and are more prevalent in psoriasis, lichen planus, and pityriasis rubra pilaris. Clinicians should consider nail examination an essential part of the diagnostic process to guide effective disease management.

Background: Skin, the largest organ of the human body, is extraordinarily vibrant regarding diversity and complexity of function it serves. Long term exposure to harmful UV rays and pollutants and the environment helps in the development of pigmented lesions on the skin. Diagnosis of skin disease requires clinical details such as site, distribution, color and regional arrangements in most of the clinical findings but making diagnosis solely on clinical symptoms is quite challenging and must be supplemented with biopsy and histopathology almost always. Materials and Methods: This is a hospital based retrospective study carried out for seven months in Department of Pathology RMCH, where clinical histopathological evaluation of 80 cases of dermatological pigmentary lesions with subsequent available biopsies was studied. Results: Among 80 cases of pigmentary skin lesions analyzed, 71 were non-neoplastic and only 9 cases were of neoplastic origin. These cases were further categorized, into hyper-pigmented (53 cases, 66.3%), hypo-pigmented (19 cases, 23.7%) and both hyper/hypo-pigmented (8 cases, 10%) skin lesion. The lesion comprised of 33 infectious skin lesions, 14 cases of immune mediated skin lesions, 24 cases of inflammatory skin lesions, 4 benign neoplastic skin lesions and 5 cases of malignant neoplastic skin lesions. The age range was from 1 to 75 years with slight male predominance (58.8%) and limbs being the most common site involved. Clinicohistopathological correlation showed positive correlation in 54 cases (67.5%), negative correlation in 13 cases (16.2%) and inconclusive in 13 cases (16.2%). Conclusion: The incidence of skin lesions in the study population was higher than assumed, with prevalence of non-neoplastic and neoplastic skin disease increasing with age. In cases where skin biopsy delivered a non-specific diagnosis, neoplastic etiology was ruled out. Histopathological studies are needed to help assess the pattern of skin disease based on pathological evaluation to develop public health strategies and to have clinicopathological correlation.

Background: Traumatic brain injury can present in various ways, with high rates of energy transfer leading to more damage. Routine CT imaging for mild head trauma with only loss of consciousness may not be necessary. Objective: To determine the correlation between LOC and CT findings in Traumatic Brain Injury Patients. Methods: This is a observational study to be conducted in the Emergency Department of BLDE (DU), Shri B.M Patil Medical College Hospital, Vijayapur, Karnataka. Patients coming to Emergency Department BLDE, Shri B.M Patil Medical College Hospital and Research Centre, Vijayapura from August 2022 to April 2024 who met the inclusion Criteria. Result: Among the total of 145 participants, 6 (4.1%) had positive CT findings, while 139 (95.9%) had negative results. Specifically, when examining the subgroup of participants with a GCS score of less than 15 and LOC, 5 out of 58 (8.6%) had positive CT findings, whereas 53 (91.4%) had negative results. The odds ratio (OR) for sex was 3.346 with a p-value of 0.067, indicating a trend toward a higher likelihood of abnormal CT findings in one gender, though this result did not reach conventional statistical significance. Conclusion: the associations between Glasgow Coma Scale (GCS) scores, loss of consciousness (LOC), and positive CT scan findings in 145 participants with head trauma. However, the overall prevalence of positive CT findings was low (3.5%), with only 7.4% of participants with LOC showing abnormalities.

Introduction: Narcissism characterized by authority, exhibitionism, superiority, entitlement, exploitativeness, manipulative self-sufficiency and vanity has not been studied enough among physicians, let alone medical students. Empathy is important for both diagnosis and patient care. Empathy is important for the physician as well as his patient simply because it is protective against physician burnout. Aim and Objective: (1). To assess the prevalence of narcissism amongst medical students. (2) To assess the prevalence of empathy amongst medical students. (3) To analyze association between narcissism and empathy amongst medical students. Materials and Methods: A cross sectional study was conducted by circulating online questionnaire survey among medical students studying in C U Shah Medical College from October 2023 to December 2023, questionnaire was used for narcissism was PNI 52 and for Empathy was QCAE and sociodemographic factors. Association between narcissism and empathy was done using Shapiro- wilk normality testing &pearson correlation. An informed consent was taken before filling the online form. Total of 112 medical students participated in the study. Results: In this study prevalence of pathological narcissism was found to be 30.36%. Prevalence of cognitive & affective empathy was found to be 69.64% and 68.75%. There was a weak, negative correlation between Cognitive Empathy and Grandiose Narcissism, which was statistically significant. There was a weak, positive correlation between Affective Empathyand Grandiose Narcissism, which was not statistically significant. There was a weak, negative correlation between Cognitive Empathy and Vulnerable Narcissism, which was statistically significant. There was a weak, negative correlation between Affective Empathy and Vulnerable Narcissism, which was not statistically significant. Conclusion: According to above results, correlations suggests that individuals with higher cognitive empathy tend to have lower level of narcissistic tendencies and individuals with higher cognitive empathy tend to be less vulnerable. By promoting empathy and addressing narcissistic tendencies, medical professionals can provide better patient care and improve health outcomes.

Background: The Patients with type 2 diabetes mellitus are greatly impacted by diabetic nephropathy (DN), a major cause of end-stage renal disease (T2DM). Thyroid function, even in the euthyroid range, may have an impact on the development of DN, according to new research. Aim: This study aims to investigate the association between serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels with urinary albumin excretion in euthyroid subjects with T2DM. Methods: Fifteen euthyroid T2DM individuals were included in a cross-sectional investigation. Patient interviews, examinations of medical records, and laboratory tests to measure HbA1c, fT4, serum TSH, and urine albumin-to-creatinine ratio (ACR) were used in the data collection process. Using SPSS version 23.0, Pearson correlation analysis was performed to evaluate the associations between these variables. Results: The participants’ average age was 55.3 ± 8.2 years, and the male to female ratio was 9:6. Urinary ACR was 45.6 ± 22.4 mg/g, fT4 was 1.2 ± 0.2 ng/dL, and mean serum TSH was 2.3 ± 0.8 µIU/mL. Urinary albumin excretion and blood TSH levels were shown to be significantly positively correlated (r = 0.642, p = 0.009). Urinary albumin excretion and fT4 levels did not significantly correlate (r = -0.213, p = 0.456). Males had a higher correlation (r = 0.751, p = 0.021) than females (r = 0.528, p = 0.095) according to gender-based analysis. Conclusion: In euthyroid patients with type 2 diabetes, elevated urine albumin excretion is linked to higher serum TSH levels, indicating a possible connection between thyroid function and diabetic nephropathy. There was no discernible correlation between fT4 levels and excretion of albumin in the urine. Recommendations: To determine who is more likely to develop diabetic nephropathy, it is advised that patients with type 2 diabetes have their thyroid function regularly monitored. Larger sample sizes and additional research are required to confirm these results and investigate underlying mechanisms.

Background: Precision public health is an innovative approach that integrates genomic and biological data to tailor public health interventions to specific population subgroups. This method contrasts with traditional one-size-fits-all strategies, aiming to enhance the effectiveness of interventions and improve health outcomes. As genomic technologies become more accessible, there is growing interest in their application within public health settings. Aim: This study aims to evaluate the impact of leveraging genomic and biological data on customized health interventions and their effectiveness in a general outpatient department (OPD) setting. Methods: A cross-sectional study was conducted. A total of 500 participants were randomly selected from the OPD patient population. Data were collected from electronic health records, patient surveys, and genomic data. Statistical analysis was performed using SPSS version 23.0, with Chi-square tests, t-tests, ANOVA, and multivariate regression analyses to assess the association between genomic markers and health outcomes. Results: Participants with genomic risk markers showed significantly improved health outcomes compared to those without such markers (60% vs. 50%, p = 0.01). Age was also identified as a significant predictor, with younger participants more likely to experience better outcomes. The regression model explained 25% of the variance in health outcomes, highlighting the importance of genomic data in tailoring interventions. Conclusion: The study demonstrates the potential of integrating genomic data into public health strategies to enhance the effectiveness of interventions, particularly for individuals with genetic predispositions. The findings support the need for broader implementation of precision public health approaches to improve population health outcomes. Recommendations: Future research should explore the long-term impacts of genomic-driven interventions and address the ethical and logistical challenges of integrating precision public health into routine care.

Objective: To investigate the clinico-epidemiological profile and antimicrobial sensitivity patterns of blood culture-positive sepsis in neonates at a tertiary care hospital in central India. Methods: This prospective observational study was conducted over a two-year period from January 2021 to December 2022. A total of 227 neonates with clinical signs of sepsis admitted to the neonatal intensive care unit (NICU) were included. Data were collected on demographic characteristics, clinical features, and blood culture results. Pathogens were identified, and their antibiotic susceptibility was tested using standard methods. Statistical analyses were performed to determine associations between clinico-epidemiological factors and sepsis outcomes. Results: The study found a predominance of male infants (52.4%). Low birth weight was present in 70.5% of the neonates. Late-onset sepsis (LOS) was more common than early-onset sepsis (EOS), with LOS accounting for 58.6% of the cases. The most frequently isolated pathogens were Gram-negative bacteria, particularly Klebsiella pneumoniae (23.35%) and Pseudomonas aeruginosa (22.03%), gram-positive bacteria like Staphylococcus aureus (21.59%) and Enterococcus (8.81%), along with Candida species (5.29%). Antibiotic sensitivity testing revealed high resistance to ampicillin among Staphylococcus aureus isolates, but high sensitivity to vancomycin. Escherichia coli and Klebsiella pneumoniae showed moderate resistance to ciprofloxacin and gentamicin. Significant associations were found between low birth weight, preterm birth, and increased incidence of sepsis (p < 0.05). Conclusion: The study highlights a predominance of late-onset sepsis and multidrug-resistant pathogens in neonates, emphasizing the need for targeted antimicrobial therapy and enhanced infection control measures. Regular surveillance and tailored treatment strategies are crucial to improving neonatal outcomes in NICUs.

Hanging is a prevalent method of ending one’s life, which can result in various pulmonary complications such as post-obstructive pulmonary edema, aspiration pneumonia, acute respiratory distress syndrome (ARDS), pneumothorax, and cardiogenic pulmonary edema caused by Takotsubo cardiomyopathy. A one-year prospective study was conducted, including all cases of near hanging presented to our center between January 1, 2022, and December 3, 2022. Ten patients were included in the study, ranging in age from 13 to 30 years, and their Glasgow Coma Scale (GCS) score on presentation varied between 3 and 12. All patients were managed with cervical spine immobilization and other supportive measures, and each underwent computed tomography (CT) of the cervical spine and brain. All ten patients had leukocytosis, tachycardia, and tachypnea, and six required mechanical ventilation, while three required vasopressors. The number of days of mechanical ventilation ranged from 1 to 4 days. One patient developed a rare pneumothorax, while another developed hanging-induced stress cardiomyopathy. Eight patients were discharged in room air, and two died. Recognizing negative-pressure pulmonary edema, which is common in hanging patients and can be mistaken for ARDS, is crucial for pulmonologists. This condition responds well to supportive treatment and differs from ARDS in terms of its treatment effectiveness.

Among patients with and without catheters, urinary tract infections (UTIs) are among the most prevalent infections in humans. In the bladder, Uro-pathogenic organisms can form intracellular bacterial communities known as biofilm. These communities are primarily made of polysaccharides and block the entry of white blood cells, antibodies, and antibiotics. Because the biofilms reduce the susceptibility to antimicrobial drugs, they are of great medicinal value. Additionally, close-knit cell groups inside a biofilm can promote plasmid exchange, which in turn accelerates the spread of antibiotic resistance. To establish, standardise, and validate several in vitro phenotypic detection techniques and procedures for urine isolates’ biofilm formation screening and confirmation. We evaluated 161 urinary isolates by four methods (that can be used in routine clinical laboratories) for their ability to form biofilms. Out of the 161 isolates, the TCP method detected biofilm in 45 isolates (27.95%), TM detected biofilm in 45 isolates (27.95%), CRA detected biofilm in 39 isolates (24.22%), and MCRA detected biofilm in 32 isolates (19.87%). The TCP was found to be most sensitive followed by the TM, CRA and the MCRA method. TCP method is the ideal method for detection of bacterial biofilm formation by uropathogens. MCRA method is superior to CRA and not to TCP or TM for detection of the staphylococcal biofilm formation.

Background: This test is based on the principle that fatal heart rate accelerates in response to fatal movement, reflecting the connection between fatal neurological function and cardiovascular reflexes. As fatal compromise progresses, this association is one of the first to be disrupted. Methods: A study was conducted to evaluate the predictive value of the Non-Stress Test (NST) for fatal outcomes in high-risk pregnancies. The research was carried out on 100 women with high-risk pregnancies between 2014 and 2015 at the Department of Obstetrics and Gynaecology, B.R.S.H., Kolkata. The NST was performed using Cardiotocography (CTG) in accordance with the National Institute for Health and Care Excellence (NICE) guidelines to predict favourable or adverse fatal. Results: Out of 100 patients as per NST result 22% were found non-reactive and 78% were found reactive. The risk of less liquor quantity was2.01 times more for patients with non-reactive NST result as compared to the patients with reactive NST and risk was not significant. NICU admission was 2.5 times more for patients with non- reactive NST result as compared to the patient with reactive NST result Risk of death was 3.66 times more for patients with non- reactive NST result as compared to the patients with reactive NST results (OR=3.66 (0.22,61.11);p=0.91)and risk was not significant. Conclusion: Further studies are needed to set the validity and reliability standards for NST.

Introduction: The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, including the management of antimicrobial resistance (AMR) in hospital settings. Previous research has highlighted the challenges faced by hospitals in India during the pandemic, such as weak infrastructure, inadequate infection control measures, and financial constraints that have affected patient safety and overall hospital performance (Wang & Wang, 2023). This study aims to investigate the impact of the COVID-19 pandemic on antimicrobial resistance among blood culture isolates in a tertiary care hospital in North India. Aim and Objective: This study aims to investigate the impact of the COVID-19 pandemic on antimicrobial resistance among blood culture isolates in a tertiary care hospital in North India during precovid, pandemic period and post pandemic period. To determine the trends in antimicrobial resistance patterns among blood culture isolates in a tertiary care hospital in North India during the COVID-19 pandemic period. Materials and Methods: This retrospective study analyzed data on blood culture isolates collected from patients admitted to the hospital during the study period from July 2019 to December 2023. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method, and the results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines and NCDC, New Delhi. NCDC resistnace patterns were used. Results: The results of the study will provide insights into the impact of the COVID-19 pandemic on antimicrobial resistance patterns among blood culture isolates in the tertiary care hospital. The data will be analyzed to identify any significant changes in the prevalence of antimicrobial-resistant pathogens during the pandemic period compared to the pre-pandemic, pandemic and post-pandemic periods. The findings of this study are expected to contribute to the understanding of the effects of the COVID-19 pandemic on antimicrobial resistance in a hospital setting in North India, which can inform future strategies for managing antimicrobial resistance and improving patient safety during public health emergencies. Conclusions: The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, including the management of antimicrobial resistance in hospital settings. This study aims to investigate the impact of the COVID-19 pandemic on antimicrobial resistance among blood culture isolates in a tertiary care hospital in North India. The findings of this study are expected to contribute to the understanding of the effects of the COVID-19 pandemic on antimicrobial resistance in a hospital setting in North India, which can inform future strategies for managing antimicrobial resistance and improving patient safety during public health emergencies.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD), connected to obesity, insulin resistance, and metabolic syndrome, is a global health issue. Management requires understanding its biochemical and clinical properties in diverse geographical contexts. Methods: Katihar Medical College in Bihar’s Koshi area undertook this two-year prospective observational study. Clinical evaluations of 100 NAFLD patients included anthropometric measures, demographic information, and biochemical analyses of lipid profiles, insulin resistance indicators, inflammatory indices, liver function tests, and insulin resistance. FibroScan measured liver fibrosis non-invasively. Results: Research indicates that male patients in the middle age group are more likely to have central obesity (BMI 29.7 kg/m², waist size 96.5 cm). Liver damage was detected through hyperlipidemia (total cholesterol 215.2 mg/dL, LDL cholesterol 145.3 mg/dL, triglycerides 175.4 mg/dL), insulin resistance (fasting glucose 110.7 mg/dL, insulin 15.3 µU/mL, HOMA-IR 4.1), and increased liver enzymes (ALT 55.3 U/L, AST 47. A high C-reactive protein of 6.5 mg/L and an average FibroScan score of 8.2 kPa suggested severe fibrosis. Conclusion: Koshi NAFLD patients had metabolic and liver disorders, as shown in this study. The findings emphasise early detection, lifestyle changes, and coordinated management to slow disease progression and its impacts. These findings should be confirmed in bigger, multi-center trials, ethnic and regional variances investigated, and fresh therapeutic targets for personalised treatment found.

Objective: Pilonidal sinus, a clutter of the sacrococcygeal region which influences predominantly more youthful people with a higher hair and weight distribution. Different surgical modalities are accessible for the treatment. Open procedure and Limberg Flap are two commonly performed surgical methods. In our study we have compared the recurrence and related morbidity with both the procedures. Method: The study is conducted over a period of 1 year, at Mahatma Gandhi hospital, Jaipur, Rajasthan, India. Entirely following to the inclusion and exclusion criteria. Sample estimate 40 randomly allocated into 2 groups ‘A’ and ‘B’. Results: Our comes about appeared that both methods are comparable in terms of wound infection with no measurable significance in the rate of post-operative infections, between the two surgeries.

Background: The purpose of this study is to shown efficacy of vacuum- assisted closure (VAC) therapy compared with conventional wound dressings for fast healing of non-healing lower limb ulcers in lower socio-economic group patients. Methods: Our study was conducted on 40 patients divided in 2 groups of 20 each to compare VAC dressing with conventional dressings. Results: Majority of wounds in VAC group got closed in average 6 weeks. Patient satisfaction was excellent in the majority of patients in VAC group compared to those in conventional dressing group. Conclusions: So, VAC dressing was found to be more beneficial to patient than conventional dressings. Patient satisfaction was excellent in the majority of patients in VAC group compared to those in conventional dressing group.

This study investigates the relationship between Fine Needle Aspiration Cytology (FNAC) findings and Thyroid Function Tests (TFTs) in patients diagnosed with lymphocytic thyroiditis, commonly referred to as Hashimoto’s thyroiditis. Over the course of a year, the study was carried out on 85 patients. The study was carried out in the department of Pathology, Narayan Medical College and Hospital, Jamuhar, Sasaram. The severity of lymphocytic infiltration was assessed using FNAC, and these results were then compared to the levels of Thyroid Stimulating Hormone (TSH) and anti-thyroid peroxidase (anti-TPO) antibodies. The findings revealed a clear link between increased levels of lymphocytic infiltration and higher TSH and anti-TPO levels, emphasizing the importance of FNAC as a valuable tool for diagnosing and predicting thyroid dysfunction in cases of lymphocytic thyroiditis. The correlation highlighted here emphasizes the significance of incorporating FNAC with TFTs in order to achieve precise diagnosis and efficient management of this autoimmune thyroid disorder.

Purpose: Occupational exposure is one of the most common causes for corneal foreign body in India. Our study provides information regarding different occupations and settings that contribute to superficial corneal foreign body in the patients visiting Karnataka Medical College and Research Institute, Hubli OPD. This study also analyzes the risk factors, outcomes, demographic characteristics and attitude of workers with superficial corneal foreign body injury. Aim: Our study aims to identify the basic knowledge, attitude, beliefs and behaviours of workers towards occupational corneal foreign body injury. Methods: This is a prospective hospital-based study done on 60 patients who presented with superficial corneal foreign body to the OPD at Karnataka Medical College and Research Institute, Hubli. The patients were asked to answer a questionnaire to assess their knowledge, attitude and practice pertaining to occupational corneal foreign body and were examined to determine the nature of the injury. Apart from this, all patients also underwent a comprehensive eye examination and appropriate methods were undertaken to remove the corneal foreign body under aseptic precautions. Results: 95% of the patients were male with a mean age of 35.07 years. The metal industry (welding) was responsible for 58.3% of presentations, with 43.3% of them having completed middle school education. 93.3% of patients had not used any protective eye wears and 36.7% attempted self removal of the foreign body. Only 35% had knowledge on harm to the eye caused by self removal of foreign body, and only 45% of the patients had receive health education at their workplace on prevention and complications of occupational corneal foreign body. Conclusion: Occupational corneal foreign has become a common preventable ocular morbidity and this can be easily prevented by proper usage of protective measures. Health education plays a vital role in creating awareness about the importance of using protective eye wears and possible complications of corneal foreign body among the workers irrespective of their level of education.

Background: Surgeon positioning during open colorectal surgeries is a critical factor influencing surgical efficiency, complication rates, surgeon fatigue, and patient outcomes. Despite the growing emphasis on surgical ergonomics, the impact of specific positioning strategies on clinical and postoperative outcomes remains underexplored. This study aims to evaluate the effect of different surgeon positions during open colorectal surgeries. Methods: A prospective observational study was conducted, involving 182 patients undergoing open colorectal surgery. Surgeon positioning was categorized into four groups: right-side dominant standing, left-side dominant standing, seated, and alternating standing. Data on surgical time, intraoperative complications, surgeon fatigue, and patient recovery were collected. Statistical analysis was performed using SPSS version 23.0, with a p-value of <0.05 considered significant. Results: The right-side dominant standing position was associated with the shortest mean surgical time (160 minutes) and the lowest complication rate (8%). Surgeons in this position reported the lowest fatigue scores (mean = 4.2), and patients had the shortest hospital stays (mean = 7.2 days). In contrast, the seated position had the longest surgical time (210 minutes), highest complication rate (20%), and highest fatigue scores (mean = 7.5). Conclusion: The right-side dominant standing position is the optimal surgeon positioning during open colorectal surgeries, significantly enhancing surgical efficiency, reducing complications, and minimizing surgeon fatigue, leading to faster patient recovery. Recommendations: Surgeons should be trained and encouraged to adopt the right-side dominant standing position during open colorectal surgeries to improve surgical outcomes. Further research is recommended to explore the long-term benefits of optimal surgeon positioning on the surgeon’s health and career longevity.

Background: Cervical insufficiency is a significant cause of preterm birth, which is related with increased perinatal morbidity and mortality. Cervical cerclage, a surgical procedure used to sprevent premature cervical dilation, is commonly employed in high-risk pregnancies. The study assessed the efficacy of cervical cerclage in prolonging pregnancy and improving perinatal outcomes among women at risk of preterm birth. Methods: An ambispective cohort study was conducted, involving 144 women who underwent cervical cerclage either prophylactically or as an emergency intervention. Data on demographic characteristics, cervical dilatation, gestational age at cerclage, cerclage-delivery interval, gestational age at delivery, neonatal survival, and maternal complications were gathered. Statistical analysis was performed using SPSS, employing descriptive statistics and logistic regression to assess associations between key variables. Results: The average gestational age at cerclage was 18.2 weeks, with a cerclage-delivery interval of 17.3 weeks. The overall neonatal survival rate was 91%, and the average birth weight was 2.65 kg. Preterm complications were observed in 21% of neonates. Maternal complications, including cervical laceration and infections, were reported in 10% of cases, with no maternal deaths. Statistical analysis revealed a significant association between cervical dilatation at cerclage and neonatal survival (OR = 0.75, p < 0.01), and a positive correlation between gestational age at delivery and birth weight (r = 0.68, p < 0.01). Conclusion: Cervical cerclage effectively prolonged pregnancy and enhanced neonatal survival in high-risk pregnancies. Although preterm complications persisted, the procedure demonstrated a favorable safety profile with minimal maternal complications. Recommendations: Cervical cerclage should be considered a valuable intervention in managing high-risk pregnancies with cervical insufficiency. Further research is recommended to refine the criteria for cerclage placement and explore adjunctive therapies to reduce preterm complications.

Background: Timely surgical intervention in emergency abdominal conditions is critical for reducing morbidity and mortality. Delays in surgery can exacerbate complications and worsen patient outcomes, making it essential to understand the impact of time intervals between symptom onset and surgical procedures. This study aims to evaluate the effects of the time interval between the onset of symptoms and surgical intervention on patient outcomes in emergency abdominal surgery. Methods: Eighty patients who required emergency abdominal surgery were included. Data on demographic characteristics, clinical presentation, laboratory findings, time from symptom onset to surgery, length of hospital stay, post-operative complications, and outcomes were collected and analyzed. Statistical analysis included correlation tests and receiver operating characteristic (ROC) curve analysis. Results: The mean age of the patients was 46.8 ± 15.3 years, with 72.50% being male. The mean time from symptom onset to surgery was 56.58 ± 30.31 hours. The average hospital stay was 11.31 ± 4.88 days. Post-operative complications were observed in 40% of patients, with surgical site infections being the most common (23.75%). A significant positive correlation was found between the length of hospital stay and time from symptoms to surgery (correlation coefficient: 0.308, p-value: 0.009). The ROC analysis indicated that delays beyond 48 hours significantly increased the risk of complications and mortality (AUC: 0.798). Conclusion: Delays in surgical intervention beyond 48 hours from symptom onset are associated with increased morbidity and mortality in emergency abdominal surgery. Prompt surgical intervention is crucial to improve patient outcomes. Recommendations: Implement standardized protocols for rapid diagnosis and surgical intervention in emergency abdominal cases. Enhance resource allocation and management to reduce in-hospital delays, especially in resource-limited settings. Conduct further research to develop global standards for the timing of emergency surgeries.

Background: Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for gallbladder diseases due to its minimally invasive nature and reduced recovery time. However, some cases present significant challenges, leading to increased operative time, higher conversion rates to open surgery, and elevated risks of complications. The study aims to invesigate the preoperative predictors in difficult laparoscopic cholecystectomy. Methods: A total of 100 patients undergoing LC were included based on specific inclusion and exclusion criteria. Pre-operative factors such as age, gender, BMI, previous hospitalization, palpable gallbladder, biochemical markers, and ultrasonographic findings were analyzed. The difficulty of each surgery was recorded, and a scoring system was developed to predict the operative difficulty. Results: Out of 100 patients, 64% had easy surgeries, 33% had difficult surgeries, and 3% had very difficult surgeries. Significant predictors of difficult LC included male gender (p=0.0001), previous hospitalization (p=0.001), palpable gallbladder (p=0.0001), elevated biochemical markers (p=0.0001), thickened gallbladder wall (p=0.005), and pericholecystic collection (p=0.0001). The developed scoring system demonstrated high predictive values, with an AUC of 0.86, sensitivity of 89.9%, and specificity of 81.8%. Conclusion: The study successfully identified several pre-operative predictors of difficult laparoscopic cholecystectomy. The scoring system developed provides a reliable method for pre-operative assessment, allowing better surgical planning and improved patient counseling. Recommendations: Future studies should focus on further validating the scoring system in larger and more diverse populations. Incorporating additional predictors such as advanced imaging techniques may enhance the accuracy of the scoring system. Surgeons should consider these predictors when planning for LC to minimize complications and improve outcomes.

Background: Breast cancer is the most common malignancy among women globally, with increasing incidence in rural India. Understanding the correlation between tumor characteristics and hormone receptor status is crucial for effective management and improved patient outcomes. Aim: This study aimed to investigate the correlation between breast cancer grading and staging with hormone receptor status in a rural Indian population. Methods: A study with a retrospective observational design was carried out on eighty female patients with breast cancer. SPSS version 23.0 was used to gather and analyse information on the histopathological grades, clinical stages, and hormone receptor statuses (ER, PR, and HER2). The correlation between the variables was assessed using Chi-square testing and Pearson’s correlation coefficient. Results: The average age of the study population was 52.3 years, and 65% of them were postmenopausal. Clinically, 50% of tumours were Stage II, while histopathologically, 55% were Grade II. HER2 positivity was detected in 25% of cases, but ER and PR positivity were seen in 60% and 50% of cases, respectively. Higher histopathological grades and ER status showed a significant inverse connection (r = -0.38, p < 0.01). Negative ER and PR statuses were substantially correlated with advanced clinical stages. More often, higher-grade and advanced-stage tumours were HER2 positive. Conclusion: The study demonstrated significant correlations between higher histopathological grades and advanced clinical stages with negative hormone receptor status and positive HER2 status. These findings highlight the aggressive nature of hormone receptor-negative and HER2-positive breast cancers in the rural Indian population. Recommendations: Efforts should be made to enhance early detection and provide access to targeted therapies in rural areas. Tailored screening programs and education on breast cancer awareness are crucial to improve outcomes.

Background: Breast lumps are a common clinical presentation, raising concerns about potential malignancy, particularly given the rising global incidence of breast cancer. Differentiating between benign and malignant breast lesions is critical for appropriate management and improved patient outcomes. This study aimed to analyze the clinicopathological characteristics of breast lumps, focusing on the prevalence of benign and malignant lesions and their correlation with patient demographics and clinical presentation. Methods: A total of 130 patients presenting with palpable breast lumps were included. Data were collected from medical records, including demographic details, clinical features, imaging, and histopathological diagnoses. Statistical analysis was performed using SPSS version 24.0, with chi-square tests and t-tests to assess associations between variables. Results: Out of 130 patients, 65.4% had benign lesions, with fibroadenoma being the most common (42.3%). Malignant lesions were present in 34.6% of patients, with invasive ductal carcinoma accounting for 26.9%. Age was significantly associated with malignancy (p = 0.002), with patients over 50 years more likely to have malignant lesions. Larger lump size was also associated with malignancy (p = 0.01). Malignancy was more frequent in females than males (p = 0.03). Conclusion: Most breast lumps in this study were benign, but a significant proportion were malignant, particularly in older patients and those with larger lumps. Early detection and thorough diagnostic evaluation are essential for improved prognosis. Recommendations: Regular screening, particularly in older populations and for patients presenting with larger lumps, is recommended. Increased awareness of male breast cancer is also crucial for timely diagnosis.

Background: Myeloproliferative neoplasm (MPN) includes clonal hematopoietic stem cell disorders defined by the proliferation of cells of one or more myeloid lineage. WHO defined most commonly found MPNS are divided as BCR-ABL positive which includes CML and BCR-ABL negative which includes PV, ET and MF. Alternations in megakaryocytic morphology are hallmark of MPNs. Aims: To assess the utility of megakaryocytic morphology in MPNs in peripheral blood smear, bone marrow smears and bone marrow biopsy. Design & Setting: This is a hospital based cross sectional study was conducted in department of pathology at tertiary care centre  from Jan 2019 to May 2021 with a sample size of 52 cases. Material and Methods: The study focused on clinical manifestation, hematological parameters, megakaryocyte number and morphological types, pattern, localization along with other hematopoietic cells in bone marrow aspirate and bone marrow biopsy in already cytogenetically proven cases. MPN show characteristics alternations in megakaryocytic morphology. BMA and BMB were studied with emphasis on morphology and pattern of megakaryocytes. Statistical Analysis: Data was analysed using tables, proportions and interobserver comparison for morphological features. Results: CML constituted highest number of cases of all MPNs, 35 out of 52 cases. In CML megakaryocyte showed hypolobated nuclei  in 85.7% cases. Megakaryocytic alternations play a key role in recognition of MF and ET. ET showed staghorn and hyperlobated nuclei and cases of MF showed cloudlike nuclei and hyperlobated nuclei. PV had many overlapping features with ET. Conclusion: Specific morphological features exhibited by Megakaryocytes in various category of MPNS, can aid in accurate diagnosis of different subcategories of myeloproliferative neoplasm.

This study investigates the predictive value of the Pancreatic Attenuation Index (PAI) in assessing post-pancreatectomy outcomes and its significance in preoperative risk assessment. A prospective cohort analysis was conducted on 12 patients undergoing elective pancreatectomy at a single institution over one year. Preoperative PAI measurements were correlated with postoperative complications and hospital stay duration. The results demonstrate a significant association between lower PAI scores and increased postoperative complications, particularly pancreatic fistula, as well as prolonged hospital stays. These findings suggest that PAI offers valuable insights into pancreatic health and prognosis, informing surgical decision-making and optimizing patient care pathways. Further research is warranted to validate these findings in larger cohorts and elucidate underlying mechanisms.

Background: Metabolic syndrome includes central obesity, hypertension, dyslipidaemia, and insulin resistance. Failure to control these disorders can cause diabetes and cardiovascular disease. Metabolic syndrome is more common in cities than in the country. This study looked at the metabolic syndrome and subtype frequency in rural and urban areas. Method: From March 2022 to September 2023, this study looked back at 150 people. People from both cities and country areas were evenly split. Lifestyle factor polls, medical record checks, and diagnostic tests like waist circumference, blood pressure, lipid profiles, and fasting glucose were used to collect the data. Logistic regression, chi-square tests, t-tests, and descriptive statistics were used to look at the difference between the two groups’ rates of occurrence. Result: The study found that metabolic syndrome was more common in urban (53.3%) than rural (48.0%) groups, but this difference was not statistically significant. More people in cities had central obesity, high blood pressure, dyslipidaemia, and insulin resistance than people who lived in rural areas. There was no statistically significant difference between the groups when the results were compared. Conclusion: Metabolic syndrome and its subtypes were a little more common in cities than in rural places, but the difference wasn’t statistically important. Based on these results, lifestyle choices and access to health care should be taken into account when choosing if living in a city increases the risk of metabolic syndrome. More study is needed to fully understand these connections and come up with solutions for people living in cities and rural areas.

Background: Blunt abdominal trauma (BAT) is a significant cause of morbidity and mortality worldwide, often resulting from road traffic accidents, falls, and assaults. The liver and spleen are commonly affected organs in such injuries. Despite advancements in diagnostic and treatment modalities, the management of BAT remains complex. This study aims to analyze the patterns and outcomes of solid organ injuries resulting from blunt abdominal trauma. Methods: A prospective observational study was conducted on 50 patients presenting with blunt abdominal trauma. Data collection included patient demographics, clinical examination, diagnostic investigations (USG and CT scans), and treatment approaches. Statistical analysis was performed using SPSS software. Results: The study included 50 patients, predominantly young males (76%) with a mean age of 26.26 years. Road traffic accidents were the leading cause of injury (60%). The liver was the most commonly injured organ (40%), followed by the spleen (35%). USG detected free fluid in 80% of cases, while CT scans provided detailed information on the extent of organ injuries. Conservative management was employed in 60% of patients, while 40% required surgical intervention. The overall recovery rate was 85%, with a 10% complication rate and 5% mortality rate. Conclusion: Young males involved in road traffic accidents are the most affected by blunt abdominal trauma. Early and accurate diagnosis using USG and CT scans, combined with appropriate management strategies, can significantly improve patient outcomes. Conservative management is effective in hemodynamically stable patients, while surgical intervention remains crucial for severe cases. Recommendations: Improved trauma care systems, preventive measures to reduce road traffic accidents, and public awareness campaigns are recommended to decrease the incidence of blunt abdominal trauma. Further research is needed to refine diagnostic and management protocols to enhance patient survival and reduce complications.

Introduction: Effective postoperative pain management is crucial for recovery after abdominal and lower limb surgeries. Epidural analgesia, using ropivacaine or bupivacaine, is common, with ropivacaine often paired with tramadol to improve pain relief while minimizing side effects. This study compares the efficacy and safety of 0.25% ropivacaine plus tramadol versus 0.25% bupivacaine. Methodology: A prospective observational study of 120 adult patients undergoing elective abdominal or lower limb surgeries. Patients were divided into two groups: one received 0.25% ropivacaine plus tramadol, the other 0.25% bupivacaine. Pain was assessed using the Visual Analogue Scale (VAS) at 1, 4-, 8-, 12-, and 24-hours post-surgery. Side effects were also evaluated. Results: The ropivacaine plus tramadol group had significantly lower pain scores at 1 and 4 hours (p<0.05). Pain levels were similar at later time points. Nausea and vomiting were significantly lower in the ropivacaine plus tramadol group (p<0.05), with no significant difference in other side effects. Conclusion: Ropivacaine plus tramadol offers better early postoperative pain control and fewer side effects than bupivacaine, while both regimens are effective for longer-term pain management. Recommendation: Ropivacaine plus tramadol is recommended for better early pain relief and fewer opioid-related side effects.