Background: Community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality worldwide. Objectives: To determine and compare the utility/diagnostic accuracy of pneumonia severity scores (CURB-65, NEWS, NEWS-L, and pneumonia severity index) to predict mortality in patients diagnosed with pneumonia in the emergency department. Methods: This was a hospital based analytical cross-sectional study conducted the Department of Emergency Medicine of a tertiary teaching healthcare facility in India between January 2023 and June 2024. Results: This study included 210 patients with CAP, with a mortality rate of 10.5%. Non-survivors were older, predominantly female, and had more comorbidities. They exhibited significantly lower systolic and diastolic blood pressure, oxygen saturation, and bicarbonate levels, but higher pulse and respiratory rates, blood urea nitrogen, creatinine, glucose, liver enzymes, sodium, and lactate levels compared to survivors. While haemoglobin, haematocrit, and white blood cell counts were similar between groups, non-survivors had elevated blood glucose, sodium, and lactate levels, and lower blood pH. Mortality prediction scores revealed that non-survivors had significantly higher CURB-65, PSI, NEWS, and NEWS-L scores. Specifically, the NEWS-L score had the highest predictive accuracy, with an area under the curve (AUC) of 0.898, a sensitivity of 85.8%, and a specificity of 96.2%. The NEWS score followed closely with an AUC of 0.890. Both scores outperformed CURB-65 and PSI, highlighting their superior diagnostic accuracy in predicting mortality. Conclusion: The study demonstrates that elevated vital signs, biochemical markers, and severity scores are associated with higher mortality in pneumonia patients, with NEWS and NEWS-L providing the most accurate predictions.

Objective: Post operative pain remains a problem worldwide, resulting in delayed post operative mobility and recovery. The aim of this study was to compare analgesic efficacy of oral flupirtine maleate with oral clonidine in diagnostic laparoscopy for gynaecological procedures. Material and Methods: This is hospital based, randomised, double blind, comparative study. After receiving approval from ethical committee, 50 cases were allocated to two groups using sealed envelope method to receive capsule flupirtine (200 mg) or clonidine (0.2 mg) orally, 1 hr prior to surgery with a sip of water. Mean of total number of rescue analgesia required, median visual analog scores(VASs)  at 0, ½, 1, 2,4, 6 hr post operatively were compared and analysed by using non parametric Mann Whitney U test using primer version 7 software. Results: VAS score was lower during entire duration of study in flupritine group having significant difference at 4 & 6 hrs. Requirement of rescue analgesia was comparable in both groups. Conclusion: Flupritine is superior to clonidine as it provide long duration of post operative analgesia without causing significant changes in hemodynamic variables and better tolerance to patient.

Pin worm (Enterobius vermicularis) is common intestinal nematode infection in India and with a disproportionate number of cases among children. Mostly they affect gastrointestinal tract. Genital enterobiasis rarely occur and chronic infection of urinary tract even rarer. At night, adult female pin worm migrates to perianal area and after laying egg goes to genital tract due to proximity of anal canal in female patients. Here we report a case of 26-year-old female presented with urinary frequency, dysuria, lower abdominal pain, and adult motile pin worm identified on urine sample.

Introduction: Gender profoundly shapes society. Socially constructed norms cause chaos, leading to inequality. Women in low and middle-income countries lack access to resources like employment, education, and healthcare compared to men, affecting their status and lifespan. This study addresses this inequality. Aim and Objectives: The study aimed to assess gender inequality and its correlates in healthcare seeking, by associations, if any, between gender and healthcare utilization, gender prioritization, household decision-making power, and sociodemographic factors in Burdwan, West Bengal. Methods: This study was a descriptive cross-sectional study conducted in 7 randomly selected slums of Burdwan Municipality, WB. The study included calculated subjects of 252 adults, with 36 households (18 males & 18 females) randomly selected from each slum. Interviews were conducted to assess socio-demographic characteristics, healthcare access and utilization, household member prioritization for medical treatment, healthcare, and economic decision-making power. Descriptive statistics and chi-square tests were performed using IBM SPSS Statistics 23.0. Results: Women reported higher underutilization of healthcare than men (13.5% vs. 8.7%) and were more likely to prioritize men, especially sons, for medical treatment (68.3%). In contrast, men showed equitable prioritization (49.2% prioritized men). Women were less likely to be the primary healthcare decision-makers for themselves than men (42.9% vs. 55.6%) but men were reported as primary decision-makers for children’s health and healthcare payments. Conclusion: This study reveals how societal norms and attitudes marginalize women and favour men’s health, leading to significant gender disparities in health among Burdwan’s slum dwellers. Women’s reduced access to care results from both internal and external gender discrimination.

Background: Cardiac disease is a major cause of maternal mortality after PPH and eclampsia. Undiagnosed left to right shunt over a long duration causes development of pulmonary artery hypertension leading to reversal of the shunt. This process of Eisenmengerisation is a cause for cardiac failure and death. Methodology: The study conducted over one year at Vani Vilas hospital, Bengaluru. All the women who were newly diagnosed with Eisenmenger syndrome were considered into the study. Their details, mode of presentation, mode of termination, gestational age at presentation, pulmonary artery hypertension and maternal outcomes was documented and analysed. Result: Seven cases of newly diagnosed Eisenmenger syndrome were admitted. The mean age was 23.16 years. The mean gestational age at presentation was 30+4 weeks. The maximum pulmonary artery pressure was 88mm Hg. 100% maternal mortality was noted.

Febrile seizure (FS) is a common cause of seizure in young children and occurring in 3-4% children under 5 years of age. Iron deficiency is reported as commonest micro-nutritional deficiency worldwide and has been associated with febrile seizures. The aim was to evaluate role of Iron deficiency as a risk factor of febrile seizure. Methodology: 170 children (6m – 5 years) were included in the study. 70 cases had febrile seizure as defined by International League Against Epilepsy and rest 100 controls had short history of febrile illness (< 3 days) without seizures. Anemia was defined as decrease of the Hb <11gm%, and serum ferritin <12ng/ml. Discrete variables are expressed as counts (%) and compared using the Chi-square tests, significance is set at p < 0.05. Observations: In the present study, 34.3% cases belong to 6-16 months age group and male to female ratio in cases was 1.69:1. 65.7% of cases and 45% of controls were iron deficient. On correlating iron deficiency with gender, male preponderance was observed in children with febrile seizure. The study observed 65.7% cases of FS had iron deficiency as compared to 45% of control group. (OR-2.34; p<0.05). Also, there was statistically significant association between recurrence of FS and iron deficiency. Conclusion: Early detection and timely correction of iron deficiency may be helpful for prevention of febrile seizures in children of this age group.

Objective: To study various presentations, investigations and complications of acute pancreatitis and their management. Methods: prospective study of complications of acute pancreatitis (local and systemic) and its management. The study randomly enrolled the patients of acute pancreatitis as determined by clinical, biochemical, and radiological diagnosis. The following parameters were considered complicated pancreatitis. Development of systemic complications and development of local complications. In follow- up all the discharged patients were advised to come for follow up weekly for a period of 3 months. Results: The study includes a total of 50 patients of complicated pancreatitis. 42 male and 8 female. The peak incidence in male is 4^th decade in life and in female 3^rd decade in life. Alcohol accounts 80% total cases where as gall stone contributes 16%. Most systemic complication were managed in general wards except few patients in ICU those were associated with septicemia and ARDS. Systemic complication were managed with supportive and conservative management. Local complications were managed conservatively and with operative procedures. Pseudocyst <6 cm were managed with regular USG abdomen follow up 75% resolved Pseudocyst >6 cm undergone operative procedure. All the patients with pancreatic necrosis were kept in ICU. Pancreatic abscess were managed by USG/CT guided aspiration. Conclusion: Most systemic complication were managed in general wards except few patients in ICU those were associated with septicemia and ARDS. Systemic complication were managed with supportive and conservative management. Local complications were managed conservatively and with operative procedures. In general mortality from local complications was 13% mortality from systemic complication was 4%.

Unnatural deaths among tea garden workers poses a serious challenge to the health authorities and brings forth socio economic differences to the fore. The present study aims to study the pattern of unnatural deaths among tea garden workers in Sonitpur district of Assam, India. A cross sectional retrospective study was done in cases brought for medicolegal autopsy to a tertiary medical college for a period of 3 years. A total of 248 cases were included in the study. Males constituted the highest number of cases. The age group of 21-30 years and 31-40 years were most commonly involved. Road traffic accidents (47.18%) and Suicides done by hanging (19.36%) were the leading cause of such deaths. Deaths occurred more in the months of October, December and January.

Introduction: Chronic kidney disease (CKD) is a global health issue affecting over 10% of adults and up to 50% in high-risk groups, such as the elderly and those with diabetes or HIV/AIDS. CKD often leads to anemia due to decreased erythropoietin production by the kidneys, increasing mortality and reducing quality of life. Aims and Objective: To examine the hematological profile of CKD patients and correlate blood count measures with CKD stages in a tertiary care hospital. Material and Methods: This cross-sectional study, conducted from January to June 2024, included adult CKD patients at various stages, excluding those with conditions causing anemia unrelated to CKD. Data were collected through patient interviews, clinical examinations, and medical records. Hematological parameters were analyzed to assess anemia type and severity, with statistical methods determining prevalence across CKD stages to guide better management strategies. Results: Out of 256 CKD patients, 82% had normocytic normochromic anemia and 18% had microcytic hypochromic anemia, with no significant age (p > 0.05) or sex differences (p > 0.05) between the groups. Most patients were employed in the private sector (17.2%), were farmers (17.6%), housewives (20.7%), or shopkeepers (16.0%), with occupation differences being statistically significant (p = 0.032) but not influencing anemia type. Weakness was the most common complaint (86%), with no significant difference between anemia types (p > 0.05). Anemia was most prevalent in CKD stage 5 (86%), with no significant variation by anemia type across stages (p > 0.05). Significant differences were observed in mean MCV and MCH values between anemia groups (p < 0.05), and correlations of RBC count, Hb, hematocrit, MCHC, blood urea, and serum creatinine with CKD stages were also significant (p < 0.05). Conclusion: Chronic Kidney Disease (CKD) is a prevalent global health issue, often leading to anemia, which worsens with disease severity. The most common types of anemia in CKD are normocytic normochromic (due to erythropoietin deficiency) and microcytic hypochromic (due to iron deficiency). Evaluating hemoglobin and RBC parameters in CKD patients is crucial for accurate anemia classification and appropriate treatment selection, preventing unnecessary iron overload.

Background: The abdomen is commonly compared to a Pandora’s Box, and for a good reason. Since the abdomen contains within it in-numerable viscera and other anatomical components, the diseases of the abdomen give rise to a lot of clinical curiosity. A meticulous examination of the abdomen and clinical correlation is one of the most important diagnostic tools and becomes cornerstone of management in many conditions presenting with abdominal pain. Objective: To study the Association between Gender, M. Alvarado Scoring System, and Tzanaki’s Scoring System with Status of HPR in Acute Appendicitis Patients. Methods: An Observational study was conducted in our institute in 100 patients with the clinical diagnosis of AA undergoing emergency appendectomy over a period of 1 year 4 months. The MASS & Tzanaki’s score was obtained at the time of admission and the histopathological diagnosis of AA was considered as final diagnosis. Result: There is a Male predominance with a ratio of 1.8:1. There is a higher prevalence of AA in second decade (62%). RLQ Pain (100%) and Nausea/Vomiting (98%) were the consistent symptoms. The negative Appendectomy rate is 6%. Conclusion: This study shows that Tzanaki’s scoring system can be used as an effective modality in the establishment of accuracy in diagnosis of acute appendicitis.

Background: Osteoporosis, characterized by decreased bone density and increased fracture risk, is a significant health concern among older adults. This systematic review aims to evaluate the efficacy of vitamin D and calcium supplementation in preventing postmenopausal and senile osteoporosis. Methods: This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive literature search was conducted across multiple databases, including PubMed, Science Direct and Cochrane Library to identify randomized controlled trials (RCTs) published from 2014 to 2024. The search terms included “calcium”, “vitamin D”, “postmenopausal osteoporosis”, “senile osteoporosis” and “fracture”. Studies were included if they assessed the effects of calcium and/or vitamin D supplementation on postmenopausal and senile osteoporosis in older adults. Results: Sample sizes in the selected studies ranged from 79 to 7195, indicating both large population studies and smaller focused trials. Participants’ ages range from approximately 50 to 86 years old. The interventions varied significantly across studies, involving different dosages of calcium and vitamin D: calcium dosages ranged from 300 mg to 1200 mg per day and Vitamin D dosages varied from 400 IU to 10,000 IU per day, with multiple forms (e.g., cholecalciferol). The studies generally suggest that adequate dosages of calcium and vitamin D, either alone or in combination with other factors like exercise and nutrition, can have significant benefits for bone health, particularly in vulnerable populations like postmenopausal women and the elderly. Conclusion: This systematic review concludes that calcium and vitamin D supplementation plays a vital role in preventing postmenopausal and senile osteoporosis and reducing fracture risk in older adults. The evidence supports the combined use of these nutrients, particularly in populations at risk for deficiency.

Significant advancements in neonatology, coupled with an enhanced understanding of the physiology of preterm infants, have notably improved the survival rates of low birth weight (LBW) preterm babies. This study was undertaken to find out the morbidity and mortality profile as well as growth pattern and neurological development of low birth weight babies in South Rajasthan, India. Methods: A prospective observational study conducted on low birth weight babies born at the PIMS, Udaipur and followed up when attending the hospital for routine check-ups or treatment of minor illnesses up to one month of age. All neonates with birth weight between 1500gms and 2500gms were included and all their parameters were recorded in a predesigned Performa for study period of 1 year. Observation:  Among 268 neonates studied , mean gestational age was 36.2±2.1 weeks, and the mean weight was 2178±89 grams. 54.4 % participants were appropriate for gestational age, i.e., pre-term LBW, while 45.5 % were small for gestational age. Neonatal jaundice (47.76 %) was the most common morbidity encountered. The study group had a significant delay in somatic growth and neurodevelopment. Conclusion The prevalence of preterm delivery and SGA as a result of IUGR is higher if the mother is primiparous, younger than 20 or older than 35 years, belonging to lower socioeconomic status, or having a comorbid condition during pregnancy. Preterm LBW babies experience more severe morbidity and higher mortality rates compared to SGA babies.

Artificial intelligence (AI) is being increasingly integrated into healthcare systems to enhance treatment, diagnosis, and patient care. This review evaluates the significant applications of AI in healthcare, particularly its impact on medical imaging, genomics, and early diagnosis, as well as its role in reducing errors and increasing efficiency. Deep learning, Machine learning, and natural language processing (NLP) are among the most impactful AI technologies being deployed. While AI holds immense promise, challenges, such as ethical concerns, bias, and regulatory hurdles, must be addressed to ensure equitable and safe implementation. Future directions include explainable AI, greater interdisciplinary collaboration, and regulatory reform, which will shape the future landscape of AI in healthcare. This review provides a comprehensive overview of AI applications in healthcare, particularly in diagnostics, medical imaging, and personalized medicine. It also examines the benefits that AI brings to healthcare, such as increased accuracy, efficiency, and cost-effectiveness, while addressing the ethical, legal, and technical challenges that must be overcome for widespread adoption. The review concludes by exploring future directions for AI in healthcare and highlighting trends such as explainable AI, interdisciplinary collaboration, and regulatory evolution, which will shape the future of AI in clinical practice.

Background: Dexmedetomidine and Dexamethasone shows benefits of prolonging the action of local anaesthetics. We compared the efficacy of Dexmedetomidine vs. Dexamethasone as an adjuvant to 0.5% ropivacaine in ultrasound guided Supraclavicular Brachial Plexus Block (SCBP) in upper limb orthopedic surgeries. Methodology: After Institutional ethical clearance (Ref No.: SSMC/MED/IEC-138/July-2022) 60 ASA grade I & II allocated into two groups Group A (n=30): Inj. Ropivacaine 0.5% 30ml + inj. Dexamethasone (8mg) Group B (n=30): Inj.Ropivacaine0.5% 30ml+ inj. Dexmedetomidine (1µg/kg). Primary & secondary outcomes were to evaluate the onset, duration of sensory & motor blockade, respectively. Statistical analysis performed in SPSS software. Results: Demographic variables were comparable among both the groups. Statistically significant difference was observed in terms of onset and duration of sensory and motor block in Group B (inj. Ropivacaine + inj. Dexmedetomidine) as compared to Group A (inj ropivacaine + inj. Dexamethasone) (P<0.05), group B had quicker onset as well as prolonged duration of sensory and motor blockade. VAS score was significantly low among group B compared to group A at the end of the 12 hours (p=0.008). Conclusion: Dexmedetomidine has faster onset and prolongs the duration of sensory and motor blockade and also declines post-operative analgesia requirement as compared to dexamethasone when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block without any adverse effects.

Patients satisfaction is an important parameter for assessing the quality of patient care services. There is a need to assess the health care systems regarding the patient’s satisfaction as often as possible. To assess the patient’s satisfaction regarding the services provided in our outpatient department in terms of clinical care, availability of services, waiting time, and cost. A 30-item pre-tested questionnaire was given to 300 patients (caretakers in pediatric patients) at the end of their O.P.D visit from 11 to 1 pm for 30 days from June1st, 2024 to June 30, 2024. The items in the questionnaire referred to particulars of the patients such as age, sex, occupation, department requested, lab, and medical stores. While analyzing, they were grouped into categories like availability, clinical care, waiting time, and cost. The responses were expressed in proportions. Recommendations are required for reduction of time spent in the pharmacy and the cost of investigations to improve patient’s satisfaction.

Background: Polycystic Ovary Syndrome (PCOS) is a multisystemic disorder characterized by endocrine, met-abolic, and reproductive system abnormalities. The diagnostic criteria include chronic anovulation and hyper-androgenism. The autonomic nervous system plays a role in pathogenesis. Women with PCOS often experience conditions like oscillatory sleep apnea, hypertension, depression, obesity, and type 2 diabetes linked to an auto-nomic nervous system imbalance. Objectives: The aim and objective of this study are to evaluate the use of cardiovascular reflex testing in pa-tients with PCOS and in healthy controls. Material and Methods: Out of 60 individuals, 30 of whom were diagnosed with PCOS, and 30 healthy con-trols, we conducted autonomic function tests, including handgrip tests, cold pressor tests, deep breathing tests (DBT), lying-to-stand assessments (LST), and the Valsalva maneuver. Statistical analysis was performed using SPSS edition 21, with Mann-Whitney and unpaired t-tests used for normal and atypical distributions of parame-ters. The study aimed to identify potential health issues. Results: The study found that PCOS patients had a significantly lower (p = 0.00*) delta HR (DBT) and E:I ratio (DBT) compared to healthy individuals. In PCOS patients, the Valsalva ratio was significantly lower (p = 0.00*). The 30:15 ratio decreased significantly (p = 0.00*) in PCOS patients compared to the healthy control group. PCOS patients had a higher heart rate (LST) than the control group (p = 0.00*). The cold pressor test showed statistical significance in PCOS patients (p = 0.00*), while the handgrip test was statistically insignifi-cant. Conclusions: The increasing prevalence of PCOS, along with obesity and hypertension, increases the risk of cardiovascular disease. Therapeutic modalities may adversely affect the cardiovascular system, highlighting the need for ways to reduce these risks. Cardiovascular reflex test can be used to assess cardiac autonomic function in PCOS patients.

Introduction: Dysphagia is a common complication of stroke and is a major risk factor for developing aspiration pneumonia. Oro-Pharyngeal-Oesophageal scintigraphy, helps to access functional aspects and it is also a semi-quantitative study of the various stages of swallowing, it can also detect tracheobronchial aspiration. Hence the study is done to assess the role of Oro-Pharyngeal – Oesophageal Scintigraphy in the evaluation of stoke patients for starting on oral feed. Materials and Methods: This observational study was done among 60 stroke patients who passed water swallow test, in a tertiary care hospital, Madurai, for the period of two months from December 2023 – January 2023 and Oro – Pharyngeal – Oesophageal scintigraphy was done after administrating 5mci of Tc99m Sulphur colloid mixed with semi solid instant cereal food.  Results and Discussion: 30% of stoke patients showed signs of aspiration in Oro-Pharyngeal-Oesophageal scintigraphy even though they have passed the water swallow test. Mean of Oral transit time (1.1s), Pharyngeal transit time (1.7s), Oesophageal transit time (16s), Retention index- oropharyngeal region (7.55%) and oesophageal region (26.15%) has increased in the study participants than the normal. There was a statistically significant (p value-0.000) increase in these parameters among patients those who had aspiration than those who did not had aspiration. Percentage of oesophageal emptying at 10sec has decreased in the study participants than the normal and there was a statistically significant (p value-0.003) decrease in this parameter among those who had aspiration than those who did not had aspiration. Mean aspiration rate in our study was 31.6%. Conclusion: Evaluation of swallowing in assessing readiness to start oral feeds in stroke patients can be done using Oro-Pharyngeal – Oesophageal scintigraphy in canters with gamma Camera.

Background: Cervical cancer is the second most common cancer in India and leading cause for cancer related deaths among women in our country. Screening by Pap smear has reduced its incidence in developed countries but implementation of this screening technique has not been successful in developing countries. Aim: To assess female healthcare professionals regarding their knowledge, attitude and practice towards cervical cancer and screening. Methodology: This is a cross sectional study conducted at Department of Obstetrics and Gynecology, Velammal Medical College and Research Institute, Madurai from January 2024 to June 2024 among female healthcare professionals – doctors, nurses and Auxiliary Nursing Midwifery(ANM). A simple random sampling method was used for recruitment. A standardized questionnaire was used to collect the required data. Results: Out of 332 participants majority were doctors 46.4%(154) remaining 30.1%(100) and 23.5%(78) were staff nurses and ANM. The mean age of study participants was 28.65 years.54.8%(182) were married.69.6%(231) and 20.8%(69) appeared to have good and fair level of knowledge respectively.292 participants (88%) believed that cytology test is useful for detection of carcinoma cervix and 53 participants (16%) undergone screening test (Pap smear).Only 21.4% (71) have been vaccinated for HPV. Conclusion: Our study population showed overall good and fair knowledge about cervical cancer and screening. However, only less than one fourth of the participants had undergone screening and HPV vaccination. Hence our study highlights the gap between knowledge and practice which has to be met by appropriate health education programs and mass campaign. Government should take initiatives for provision of HPV vaccines in a subsidiary price and also to include HPV vaccination in Indian immunization schedule.

Background: An annual issue for millions of people worldwide are urinary tract infections (UTIs), which are a frequent and chronic medical condition. The most prevalent bacterial illness among women overall, and among postmenopausal women specifically, is urinary tract infection (UTI). Regarding age and general state, two groups of elderly women with recurrent UTIs should be distinguished: elderly institutionalized women with or without a catheter and healthy, young postmenopausal women between the ages of 50 and 70 who are neither institutionalized nor catheterized. Methods: A study population of 134 post-menopausal women, attending OPD or admitted to Department of General Medicine, Gauhati Medical College and Hospital and study duration was from December 2023 to July 2024. The co-morbidities, recurrence of UTI and the type of organisms isolated from urine sample were studied. Data were analysed using PRISM software, version 8.0. Results: The most common age group of prevalence of UTI in the most menopausal female was in 44-52 years (44%). The overall the recurrence rate was 41.3% and the rate was highest in the >80 years age group (77%). There was statistically significant association between diabetes mellitus and UTI recurrence with p value of 0.03. The most common organism isolated was E. coli 76.8%, in urine cultures. It was also responsible for adverse outcomes. Conclusion: The study revealed a higher recurrence rate with advanced age among postmenopausal women. There was two times more risk of developing UTI in patients with Diabetes Mellitus. E. coli was the most common organism responsible.

Background: WhatsApp is a popular instant messaging application which allows millions of people to keep in contact with each other and also helps anyone to create and publish content. It has the potential to influence the several domains of medical education. Objectives: To assess the effectiveness of WhatsApp as a medical teaching learning tool in comparison with traditional lecture method and to assess the perception of medical students towards use of WhatsApp as a teaching learning tool. Methodology: Students were divided into 2 groups and analysed for the effectiveness of WhatsApp as a teaching learning tool in comparison with lecture method. Perception of students towards use of WhatsApp as teaching learning tool was collected using validated feedback form. Results: It was observed from the study that there was no statistically significant difference between use of WhatsApp and traditional lecture as a teaching learning tool. Majority of students perceived that WhatsApp helped to improve their enthusiasm in academics along with making difficult concepts simple and increased interaction between students and facilitator. High expectation of teacher’s availability and group maintenance were most agreed challenges in use of WhatsApp as a teaching learning tool. Conclusions: From the study finding we can conclude that use of WhatsApp as a teaching learning tool was equally effective as didactic lecture.

Background: WHO defined postpartum anaemia as Haemoglobin level of <10gm% during postpartum period. The prevalence of postpartum anaemia is high and it ranges from 4 to 27%. In developing countries higher prevalence, 50-80% has been reported. Prevalence of postpartum anaemia at 6 weeks has been quoted as 70% in India. Aim and Objectives: To compare the Haemoglobin levels in Postpartum Anaemia patients receiving I.V Iron sucrose and I.V Ferric carboxymaltose. Material and Methods: A prospective open labelled study was conducted at Government Maternity Hospital, Petlaburz after the approval from Institutional Ethics Committee. The study included 100 patients diagnosed with post-partum anaemia. The patients were divided into 2 groups .Each group included 50 patients. Group I received I.V iron sucrose 1000mg on alternate days till the required dose is completed. Group II received I.V Ferric Carboxymaltose once in a week. In both groups Haemoglobin levels done before treatment and 2 weeks after the treatment. Observation and Results: On comparing both groups using student t test, we found that increase in Haemoglobin concentration and serum ferritin level in group receiving Ferric Carboxymaltose was found statistically significant over Iron sucrose group. Conclusion: In this study, administration of ferric carboxymaltose increased the haemoglobin level more rapidly as compared to iron sucrose in women with Iron deficiency anaemia in post-partum period. Ferric carboxymaltose is well tolerated, safe and effective alternative to blood transfusion in the treatment of iron deficiency anaemia in the post-partum period.

Introduction: Citrobacter species is gram negative, enteric bacilli that colonize in moist environment and found mostly in water, soil, food, and the intestines of animals and humans. They cause a wide spectrum of infections involving the urinary tract, liver, biliary tract, peritoneum, intestines, one, respiratory tract, endocardium, wounds, soft tissue, meninges, and the bloodstream. Increasing resistance to beta-lactam drugs especially the 3rd-generation cephalosporin in Citrobacter species is predominantly due to the production of multidrug resistant enzymes in particular extended spectrum beta-lactamases (ESBLs). Material & Method: This was a hospital lab based observational study carried out from the 500 samples, – 100 from each sample type (100 Urine, 100 Pus, 100 Sputum, 100 Blood and 100 Body fluid) collected over a period of 6 months from 13-08-2022 to 23-02-2023 at NMCH, Patna Bihar. Among these processed samples positive isolates of Citrobacter species are recovered and for further study sent to the department of Microbiology. First find out Antimicrobial susceptibility pattern and ESBL producing strain from isolated Citrobacter species then find out total prevalence and ESBL, non-ESBL prevalance. Antimicrobial susceptibility pattern tested against different antibiotics and determine the antibiogram of these isolates. ESBL production in all these isolates are detected by using double disc synergy test (DDST). Result: Out of 500 samples, 44 (8.80%) were detected positive for Citrobacter species isolates. Out of these 44 clinical isolates of Citrobacter species recruited for this study, 26 isolates (i.e. 59%) were confirmed to be ESBL producers by the DDST method and rest 18 (41%) non-ESBL producer. AST pattern shows high resistance rate to Cefotaxime, Cotrimoxazole, Ciprofloxacin, Gentamycin and more sensitive to Imipenem and with Colistin no resistant found in this study. Conclusion: From our results, it could be deduced that 59% of Citrobacter isolates harbour or express ESBLs; and they are resistant to commonly used antibiotics inclusive of some beta-lactams and non-beta-lactam antibiotics. There is therefore need for proper AST monitoring and detection of resistant antibiotics from clinically important bacterial pathogens so as to guide therapy and to contain their nefarious effect.

Background and Aim: Diabetic foot infections rank high among the most prevalent skeletal and soft tissue infections in individuals with diabetes. Oral antibiotics with high oral bioavailability and localised delivery of antibiotics in bead form are currently being utilised. This study aimed to evaluate the efficacy of antibiotic-impregnated beads in the treatment of osteomyelitis in patients with diabetic feet in an Indian setting. The study also examined the microbiological profile of the wounds. Material and Methods: In our current main study, the total sample size was 100. The participants were assigned at random to the two groups. In the ‘bead’ group, antibiotic beads were utilised, while the ‘no bead’ group received oral antibiotics. Both groups received intravenous antibiotics as a precautionary measure. All patients were evaluated for a period of six months, and ulcers that did not heal within this timeframe were considered as unsuccessful treatment. Results: The mean age, body mass index, random blood sugar, and HbA1c values did not show any significant differences between the two groups. Our study examined the healing of ulcers in two groups. Out of the 100 patients in both groups, 87 patients experienced healing, while 13 did not. Out of the nine that did not heal, nine were from the group without beads and four were from the group with beads. Among the 87 individuals who experienced healing, 41 were from the group without beads, while the remaining 46 were from the group with beads. The healing association had no significant statistical impact. Staphylococcus aureus was the most commonly found organism. Conclusion: Individuals in the ‘no bead’ group faced challenges in accessing hospitals on a daily basis, and some even had to skip their daily dressings due to personal inconveniences. When antibiotic beads are delivered locally, they can increase the concentration of the antibiotic in the surrounding tissue while keeping serum levels low. This helps to minimise any systemic side effects that may occur.

Background: Ileostomy is a common surgical procedure performed as either a protective or emergency measure in various clinical scenarios. While ileostomy closure is typically performed three to six months after the initial surgery, the timing of this procedure remains a subject of debate. The distinction between early and delayed ileostomy closure is critical as it can significantly impact patient outcomes, including morbidity, mortality, and quality of life. Objectives: This study aims to compare the morbidity and mortality associated with early (4-6 weeks) versus delayed (8-12 weeks) ileostomy closure. Specifically, it seeks to evaluate post-stoma closure complications, the indications for stoma formation, complications related to the stoma, intraoperative parameters, and the duration of hospital stay between the two groups. Methodology: This prospective observational study was conducted from September 2022 to March 2024 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. A total of 60 patients who underwent ileostomy closure were included and divided into two groups: early closure (4-6 weeks post-surgery) and delayed closure (8-12 weeks post-surgery). Patients were selected based on specific inclusion criteria, including age, gender, and the absence of postoperative complications prior to closure. Data were collected on intraoperative parameters such as operative time and adhesion formation, as well as postoperative outcomes including hospital stay duration and stoma-related complications. Statistical analysis was performed to compare outcomes between the two groups, with a significance level set at p<0.05. Results: The study analyzed 60 patients who underwent ileostomy closure, divided into two groups: early closure (30 patients) and delayed closure (30 patients). The mean hospital stay was slightly shorter in the early closure group (6.98±2.71 days) compared to the delayed closure group (7.25±2.62 days), although this difference was not statistically significant. Intraoperative adhesion was found to be significantly higher in the delayed closure group (36.7%) compared to the early closure group (10.0%), with a p-value of 0.015. Post-stoma closure complications were also more common in the early closure group, particularly wound infections, which were the most frequent complication. There was no mortality reported in the early closure group, whereas one death was recorded in the delayed closure group​. Conclusion: Early ileostomy closure appears to be a feasible and effective alternative to the conventional delayed approach, with the potential to reduce stoma-related morbidity and enhance the quality of life for patients. However, careful patient selection is crucial to minimize the risks of complications, particularly wound infections. Further research is recommended to refine patient selection criteria and optimize the timing of ileostomy closure.

This case report presents a 7-year-old girl with acute retinal necrosis (ARN) secondary to suspected viral infection. The patient presented with decreased vision, pain, and a history of fever, headache, and hearing loss. Despite previous treatment for uveitis, the patient’s condition deteriorated, leading to severe inflammation and vision loss in the right eye. The left eye also showed signs of involvement. The case highlights the importance of early diagnosis and prompt management of ARN to prevent further visual impairment.

Aims: To compare the outcomes of Onlay and Preperitoneal mesh repair in case of ventral hernia. Settings and Design: This comparative study was conducted in the General Surgery Department OPD at Mahatma Gandhi Medical College & Hospital, Jaipur, from September 2022 to March 2024. It involved 66 patients undergoing open ventral hernia repair. Methods and Material: The study included 66 patients who underwent open ventral hernia repair. Participants were selected based on specific inclusion and exclusion criteria. The inclusion criteria were patients aged above 18 years, those undergoing repair for ventral hernias (including incisional, umbilical, paraumbilical, and epigastric hernias), and those who provided written consent. Exclusion criteria included planned concurrent gastrointestinal surgery, immunosuppressive disorders, chronic diseases such as diabetes, severe renal or hepatic failure, and obstructed or strangulated hernias. Ethical approval was obtained from the Institute Ethics Committee, and informed consent was secured from all participants. Statistical analysis used: Continuous variables were reported as mean ± standard deviation, and categorical variables as frequency and percentage. Differences between groups were evaluated using the Mann-Whitney U Test for continuous variables and the Fisher Exact Test for categorical variables. A p-value <0.05 was considered significant. Results: The pre-peritoneal mesh repair group demonstrated significantly lower complication rates compared to the onlay mesh repair group. Incidences of seroma formation and wound infections were reduced (p < 0.05). The pre-peritoneal group also experienced shorter hospital stays (mean ± SD: 4.2 ± 1.1 days vs. 6.5 ± 1.4 days, p < 0.05) and lower recurrence rates (p < 0.05). Conclusions: Pre-peritoneal mesh repair is associated with lower complication rates, shorter hospital stays, and lower recurrence rates compared to onlay mesh repair for ventral hernias.

Background: Appendicitis is a lymphatic organ; it is much longer in children than adults because other lymphatic organs are not well developed to combat infection. Hence, appendix is more commonly infected in children. It leads to a surgical emergency. Materials and Methods: 90 children with appendicitis aged between4-10years. A total of 90 children were studied, with 45 being male and 45 being female. Appendicitis symptoms were noted and confirmed with a USG/ST scan, were operated on by general anesthesia and the dissected part was sent to histopathology examination to rule out the exact pathology. Result: The highest prevalence of acute appendicitis was observed in both sexes. 26 (57.7%) in males, 23 (51%) in female children. The least number of perforations was observed in both sexes i.e. 12 (26.6%) in males and 6 (13.3%) in females. Conclusion: The present study will help the surgeons classify the types of appendicitis and treat the surgical emergency of appendicitis in children efficiently to avoid morbidity and mortality in children.

Background: In pulmonary tuberculosis study of fungal diseases attained importance because not only prolonged use of antibiotics is required to treat this disease but also, tuberculosis leaves residual lesions which form fungal super infection. By the presence of cavities and necrotic tissue which favor colonization of fungi and whether this super infection with fungi is responsible for persistent morbidity and symptomatic state even after completion of chemotherapy. This study aims to determine the prevalence and pattern of fungal diseases in patients who completed antitubercular therapy and has sequalae of the disease particularly cavities. Aims: To study the various fungi that can be isolated in sputum of patients who had pulmonary tuberculosis and who had taken anti tubercular drugs. Objectives: 1) Isolation of various fungi and its association with variables like type of disease, age, sex, presence of cavities. 2). Clinical significance of fungi thus isolated in regard to secondary mycotic disease. Materials and Methods: This is a prospective observational study conducted from may 2023 to April 2024 at Department of pulmonary medicine, Kurnool medical college and government general hospital, Kurnool. A total of 100 patients satisfying the inclusion and exclusion criteria were included in the study. Results: The study group consists of 100 patients among which 74(74%) are males and 26(26%) are females. Most common symptoms was cough with or without expectoration followed by wheeze, hemoptysis, SOB.Most common radiological findings were cavity (62%), followed by fibrosis and fibro-cavitary disease.Fungal isolation was more common in patients with disease duration 1 to 2(49%) years and 2-4(47%) years. More no. of cases seen within 4 years of disease duration.It is observed that in 43% of patients the interval between completion of chemotherapy and symptom onset is 1-2 years.Fungal isolation is more common in patients with diabetes mellitus than in patients without diabetes.It was observed that candida alone is isolated from 15% of cases and Asperigillus alone from 34%.  No fungus isolated in 51% of cases.

Conclusion: The occurrence of fungal infections in treated pulmonary Tuberculosis cases poses a significant challenge with occurrence of dreaded symptoms like hemoptysis that can pose danger. This study helps in determining the prevalence of these infections and the most common fungal species isolated there by guiding the management.

Background: Penetrating keratoplasty in children is a complex and demanding procedure, often carrying a high risk of graft failure or unsuccessful amblyopia treatment, even in cases with clear grafts. Despite these challenges, keratoplasty remains the preferred surgical option for managing pediatric corneal stromal opacities or edema. The current study was done to determine the indications and clinical outcomes of pediatric penetrating keratoplasty. Methods: This prospective study was conducted in the Department of Ophthalmology,  Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabad. A detailed history was taken to determine the etiology of corneal insult, associated symptoms, and duration followed by a general examination, best corrected visual acuity using Snellens/ LogMAR charts, and slit-lamp biomicroscopy for anterior segment evaluation. Further, the patients were subjected to syringing for patency of lacrimal apparatus, and B scan ultrasound to rule out posterior segment pathologies. Results: The most affected age group was 6-10 years, accounting for 40% of cases. The youngest (1-5 years) and oldest (16-18 years) age groups had the lowest representation. There was a slight male predominance, with males accounting for 55% of cases and females for 45%.  The majority of patients (65%) experienced improved vision following PKP. A smaller proportion (20%) maintained unchanged visual acuity. A limited number of patients (15%) experienced either no assessable or worsened visual outcomes. The data suggests that PKP is generally effective in improving visual function in pediatric patients. Graft acceptance: 60% of cases (12 out of 20) demonstrated successful graft acceptance. 35% of cases (7 out of 20) experienced graft rejection. 5% of cases (1 out of 20) resulted in graft failure. Regarding surgical interventions, the majority of cases required a single grafting procedure. Conclusion: In conclusion, penetrating keratoplasty is still the best operation that can be done in children with corneal opacities and ectasias because there are no other options available. Even though the process gives low potential for graft rejection and an average amount of vision enhancement, timely intervention, professional surgery, and adequate post-operative treatment can contribute much to positive results.

Background: Severe Acute Malnutrition (SAM) remains a significant public health challenge, particularly in low- and middle-income countries, where it is a leading cause of morbidity and mortality among children under five years of age. Understanding the clinical and demographic factors contributing to SAM is crucial for effective prevention and intervention strategies. Aim and Objective: This study aimed to identify key clinical and demographic risk factors associated with Severe Acute Malnutrition in children aged 6 to 59 months. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital and its affiliated community health centers CAIMS, Karimnagar. A total of 110 children diagnosed with SAM, based on WHO criteria, were enrolled. Data collection involved a structured questionnaire addressing demographic profiles, clinical histories, and household characteristics. Statistical analyses included bivariate analysis and multivariate logistic regression to determine independent risk factors for SAM. Results: The study found that low parental education, large family size, and low socioeconomic status were significant demographic risk factors for SAM. Clinically, a history of recurrent infections, poor immunization coverage, and inadequate breastfeeding practices were strongly associated with SAM. Multivariate analysis indicated that recurrent infections and low socioeconomic status were the most significant predictors of SAM. Conclusion: The findings suggest that both clinical and demographic factors play a crucial role in the development of SAM. Public health interventions should focus on improving maternal education, enhancing healthcare access, and promoting optimal feeding practices to reduce the incidence of SAM and improve child health outcomes.

Background: Preeclampsia (PE) remains a significant contributor to both maternal and fetal death. According to available data, the prevalence of PE in developing countries is significantly elevated. Aim: The present study was designed to know the effect of serum uric acid level on outcome of pregnancy in PE patients. Materials & methods: A study was conducted at MVJ Medical College and  Research Hospital department of OBG between the period of 1 year using a case-control design. A purposive sampling method was used to select 150 pregnant women in their third trimester. 60 individuals diagnosed with PE were chosen as cases, aged 18-35, while 60 healthy pregnant women were selected as controls, aged 18-36.   Results: The study involved 80% of participants aged 21-30 years, with a mean standard deviation of 26.17±4.82 years and 25.79±4.13 years, respectively. The gestational age was 35.61±3.41 weeks and 35.9±3.06 weeks, respectively. Most participants were primiparous, with no significant difference. A significant proportion had irregular prenatal check-ups in both groups. Uric acid significantly raised after 28 weeks of gestation in PE women were observed to have intrauterine growth restriction (IUGR) in our study than the PE women who had normal levels of uric acid after 28 weeks of gestation. Conclusion: High serum uric acid levels are linked to poor pregnancy outcomes in PE, including increased need for early birth and worse neonatal outcomes. Serum uric acid may be a significant prognostic marker in managing PE, but further large-scale investigations are needed to develop clinically applicable thresholds.

Background: Carpometacarpal (CMC) joint fracture dislocations are extremely rare, representing less than 1% of all hand and wrist fractures. These injuries are frequently missed or misdiagnosed, occurring primarily in young adults due to axial loading injuries or in the elderly following falls. Early diagnosis and appropriate management are crucial for optimal recovery. Cases: This series presents 12 cases of CMC joint dislocations in patients aged 19 to 50, including both males and females. The injuries resulted from various mechanisms such as falls, sports injuries, and accidents. The majority of cases involved dorsal dislocations of the 2nd, 3rd, and 4th CMC joints. Treatment included closed reduction, K-wire fixation, and cast immobilization. Result: All patients achieved good functional recovery with minimal stiffness and satisfactory alignment within six to ten weeks. Regular follow-up and structured physiotherapy played significant roles in ensuring optimal outcomes. The consistent application of early intervention techniques proved effective in managing these complex injuries. Conclusion: Despite their rarity, CMC joint dislocations require a high index of suspicion for diagnosis and prompt, precise treatment. This case series highlights the importance of early intervention, demonstrating that with appropriate management, excellent functional outcomes can be achieved in patients with CMC joint dislocations.

Background: Surgical site infection is one of the leading cause of Hospital acquired infections in developing countries. Surgical site infection rates ranges from 0.5% to 15% globally, 23% to 38% in India.⁷ Hence identification of bacterial pathogens and their antibiotic susceptibility testing is required for successful treatment of SSI. Aim & Objectives: To evaluate the bacterial spectrum, antibiotic sensitivity pattern and  drug resistance Of  isolated organisms in surgical site infections. Materials and Methods: Total of 110 pus samples were collected over a period of one year from surgical site infections. Detection of Organisms was done by Conventional culture and Biochemical methods, antibiotic sensitivity pattern of the isolates was studied by Kirby-bauer disc diffusion technique following CLSI guidelines. Results: Of the 110 clinical isolates 28 (25.45%) were pus/swab culture positive. Gram Positive organisms 15 (53.57%) were the predominant causative agents of SSI compared to Gram negative organisms 13 (46.42%) in the cases. Prevalence of MRSA is 9 (86%) of the isolated Staphylococcus aureus. ESBL production was observed in 6 (46.1%), MBL production was observed in 2(15.38%) of Gram negative isolates. Conclusion: The study gives an insight into bacterial pathogens and their antibiotic sensitivity patterns isolated from SSI. Preparation of antibiogram suitable for the hospital and its strict implementation is required in order to prevent antimicrobial resistance (AMR).

Background: Thyroid swelling is a common clinical finding with a quiet high prevalence among Indian population. Risk stratification of these thyroid swellings into benign and malignant hence become a crucial part in the management of these cases. Here comes the role of ultrasonography, with its added benefits of portability, cost effectiveness, lack of ionizing radiations and non-invasiveness. To standardize ultrasound findings Thyroid Imaging Recording and Data System (TIRADS) classification are used. Methods: History and physical examination were done in all cases of thyroid nodule. Serum TSH, T3, T4, pre and post operative calcium on post operative day 3 were done in all cases. Ultrasonography and fine needle aspiration Cytology (FNAC)/ultrasonography guided if nodule size less than 1cm were done in all cases. All patients underwent surgical intervention, and specimens were sent for Histopathology examinations. Result: Common age groups were 25 to 44 years, and more than 80% cases were female. 65% cases were less than TIRADS 4 and 35% cases were more than TIRADS 4. Patients with TIRADS score of 4 and more were having higher chance of being suspected with malignancy on histopathology examination than the patients with score of less than 4. On the basis of sonographic findings, half of the subjects among solid components were found to be having malignancy, whereas, more than half of the subjects with micro-calcifications were having malignancy and all the subjects with irregular margins were diagnosed with malignancy on HPE. Conclusions: Thyroid ultrasound plays a key role in diagnosis, and   it allows for the morphological characterization of Thyroid nodules, thereby facilitating adequate selection of those nodules amenable to FNAB cytological diagnosis. There is paucity of data regarding TIRADS score and its relationship with thyroid pathology in this part of the world. This study was an honest attempt to fill this gap, which would be helpful in managing the thyroid disorder more efficiently and will be convenient for risk stratification.

Background: Diabetes Mellitus denotes to a cluster of common metabolic disorders that segment the phenotype hyperglycemia. Type 2 Diabetic Mellitus is a diverse group of disorders considered by inconstant degrees of insulin resistance, compromised insulin secretion, and augmented hepatic glucose production. Purpose: The purpose of study is studying clinical correlation of diabetic retinopathy and diabetic nephropathy in Type two diabetes mellitus. Methods: We have conducted cross sectional observation study in patients attending GGH outpatient department of ophthalmology during  the period May 2023 to May 2024 on hundred patients. Results: Early detection of screening factors for retinopathy, nephropathy may prevent the progression of disease. Conclusion: The vision loss in diabetic retinopathy can be prevented by periodic fundus examination and blood glucose levels  and timely intervention. Diabetic nephropathy can be prevented by periodic checking of blood albuminuria.

Background: Chronic migraines are a prevalent and debilitating condition significantly impacting patients’ quality of life. Preventive therapy is commonly used to manage chronic migraines, with various pharmacological approaches showing differing levels of efficacy. Understanding the biochemical profiles of patients on preventive therapy can help optimize treatment strategies. Methods: This retrospective cross-sectional study evaluated 150 patients with chronic migraines undergoing preventive therapy. Data were collected on biochemical markers (e.g., CGRP, serotonin, CRP) and pharmacological profiles (e.g., medication types, dosages). Statistical analyses were performed to identify associations between biochemical markers and therapeutic outcomes. Results: The study found elevated CGRP levels in 45% of patients, with reduced serotonin levels observed in 33%. Beta-blockers were the most commonly prescribed preventive therapy (44%), followed by antiepileptics (35%) and antidepressants (28%). Significant associations were noted between elevated CGRP levels and the use of CGRP inhibitors, and reduced serotonin levels with antidepressant use. CGRP inhibitors showed greater efficacy in reducing headache frequency compared to other therapies. Conclusion: The findings emphasize the importance of personalized treatment based on biochemical profiles in chronic migraine management. Elevated CGRP levels and reduced serotonin levels can guide the selection of more effective preventive therapies. Despite the study’s limitations, such as its retrospective design, the results support targeted therapeutic approaches and highlight the need for further research to refine treatment strategies.

Background: Given the significance of the burden of sino-nasal abnormalities faced by inhabitants of the south west region of Satpuda Range, our study sought to ascertain the prevalence of these abnormalities and the related socio-demographic factors in the region. Material and Method: In this hospital-based cross-sectional study, patients who reported to the outpatient department of ENT at CIMS Medical College and Hospital in Chhindwara, MP, India, with a complaint of craniofacial discomfort between February 2022 and January 2024 were included. A comprehensive history and ENT examination were conducted to identify the sino-nasal source of craniofacial discomfort. The chosen cases had computed tomographic (CT) scans of the sinuses and preliminary diagnostic nasal endoscopy. An association was shown between age, gender, smoking status, and history of trauma and the occurrence of craniofacial discomfort caused by sino-nasal pathology. Results: Among a group of 200 patients experiencing craniofacial discomfort, 130 of them had a sino-nasal malfunction. Among the 100 patients, 80 were male and 50 were female. A mean age of 34.859±4.846 years was recorded among the research participants. The most prevalent sino-nasal pathology seen in these individuals was deviated nasal septum (DNS), followed by nasal polyps and chronic sinusitis. Application of binary logistic regression revealed an association between smoking and history of trauma with the existence of sino-nasal cause among patients with craniofacial complaints. Conclusion: Sino-nasal anomalies were a primary factor contributing to craniofacial discomfort in patients seeking treatment at the ENT outpatient department. Particular focus should be given to individuals who engage in cigarette smoking and those with a reported history of facial trauma.

Objectives: To identify the cause of maternal mortality in a tertiary care centre. Methods: maternal mortality studied for 10 years. Information was retrieved from case notes available in medical records section of hospital patient relatives, records from district health centre and primary health care. Results: there were total 60 maternal deaths and 68,850 live births. Majority of deaths occur in age group of 20-29 years which is about 73% and during post-natal period 65%. Majority of deaths were due to haemorrhage 40% followed by hypertensive disorder of pregnancy 20%. Conclusion: haemorrhage is the most common cause of death leading to maternal mortality. These deaths can be avoided by health education, early referral and active management of labour and puerperium.

Psoriasis is a papulosquamous, proliferative condition of the skin, in which both genetic and environmental influences have a critical role. Psoriasis with metabolic syndrome causes significant physical and psychological morbidity to the patient. Therefore, the present study was conducted to study prevalence of metabolic syndrome in chronic plaque psoriasis at tertiary care centre. The present study was case control study carried out at Department of Dermatology of tertiary care centre during November 2021 to October 2022. A total of 50 50 cases of chronic plaque psoriasis diagnosed clinically above 18 years were enrolled while 50 age and sex matched controls were included. Metabolic syndrome is defined based on the revised criteria from NCEP ATP III. The statistical software namely SPSS 22.0 used for the analysis of the data. The mean age in Cases was 40.34±12.50 years and Control was 41.50±13.28 years with no significant difference. Both the group shows male dominance. Percentage of metabolic syndrome in patients with psoriasis in cases (42%) was more as compared to controls (2%) was statistically highly significant (P<0.0001) The present study concludes that there is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to general population.

Introduction: Airway management is of prime importance during delivery of general anaesthesia. Patients, who have been anaesthetized, are unable to maintain an adequate airway on their own and artificial airway maintenance devices are employed. Aims of the study are to compare classic LMA with endotracheal portex cuffed tube intubation in 60 patients undergoing surgeries under general anesthesia. Methods:  This prospective, randomized clinical study was carried over a period of two and half years. 60 patients aged 20-60 years, belonging to ASA grade I-II scheduled for elective surgical procedure were included in this study. Informed written consent was obtained from each patient and the procedure was explained to the patients. All the quantitative data were analyzed using unpaired t-test. The results were expressed, as Mean + SD. ‘P’ value < 0.05 was taken as statistically significant. Results: This prospective randomized clinical study comprised of 60 patients belonging to ASA Grade I – II undergoing elective surgical procedure. 30 patients were studied with Group A (LMA classic) and 30 patients were studied as a Group B (ETT). No. of attempts, ease of insertion, hemodynamics response and other relevant parameters were studied and analyzed. Conclusion: We concluded that LMA classic is safe and useful alternative to endotracheal intubation in elective fasted adult patients undergoing elective surgeries under general anaesthesia. It is judge by stable haemodynamic, adequate oxygenation & ventilation and ease of insertion.

The role of Forensic anthropology to derive alternative and newer modes of identification is increasing every day. Estimation of stature is one of the important initial steps during forensic analysis of human skeletal remains. The aim of the present study was to derive a linear regression formula for estimating stature from length of the sternum. The study included 170 male & female sternums of Indian origin dissected from cadavers during medico-legal autopsies. The regression equation for both sexes was “Stature= 94.228 + 4.474 × (Combined Length of Manubrium and Body of Sternum)”, with a standard error of 3.901 cm and a strength of correlation of 0.858. This early study shows that the length of the sternum can be utilized for estimating stature.

The determination of sex from skeletal remains is highly significant in forensic medicine, physical anthropometry, and anthropology. Exact sex determination from bones has been a key issue in medico-legal issues, and accuracy is dependent on the type of material available and the methods used. Several earlier studies have shown that the sternum is an essential tool for determining sex in mutilated, fragmented carcasses at an advanced stage of decomposition. The sternum is a bone that is easily retrievable, even from the advanced decomposed corpse and the bundle of bone.

In individuals with the established disease, type 2 diabetes mellitus raises the risk of morbidity and death and is a risk factor for incident heart failure. A rising illness burden is predicted by secular trends in the prevalence of heart failure and diabetes mellitus, which emphasize the need for efficient treatment approaches. The purpose of the study is to examine the clinical features of individuals with and without diabetes mellitus in Heart failure. Methods: The cross-sectional study was on 35-70 years old adults with and without in DM. Indicators of Cardiovascular diseases (CVD) risk factors, including gender, age, blood pressure, dyslipidaemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity were collected in the study. Results: The 1852 participants were included. Triglycerides, alcohol intake, and smoking were found to be the variables linked to diabetics. Our study’s findings indicate that there was a substantial prevalence of cardiovascular risk factors in diabetes mellitus. In this area, it is advised to cut back on alcohol and tobacco use in addition to managing hypertension, hyperlipidemia, and obesity.

Background: Cerebral venous sinus thrombosis (CVST) refers to occlusion of venous channels in the cranial cavity, including thrombosis of Dural Venous Sinuses or the smaller feeding cerebral veins. It is more prevalent among young to middle-aged people and is more common in females. It is a potentially life-threatening condition requiring early clinical suspicion and prompt treatment. Material and Methods: The present prospective observational study was conducted in the Department of General Medicine, HBT medical college and Dr. R.N. Municipal General Hospital, Juhu, Mumbai. The study included confirmed cases of cerebral venous sinus thrombosis based on clinical history and neuroimaging. Results: Presentation was acute in 29 (54.72%), subacute in 14 (26.42%) and chronic in 10 (18.87%) cases. Headache (73.58%), focal deficit (56.60%), altered sensorium (52.83%), convulsions (39.62%), fever (28.30%), diplopia (22.64%), papilloedema (37.74%), pallor (41.51%), cranial nerve involvement (24.53%), dehydration (16.98%) and dysphasia (11.32%) was reported among the subjects respectively. Puerperium was the most common identified risk factor seen in 18 (33.96%) followed by Hyper-Homocysteinemia (15.09%) and infection (13.21%). Conclusions: Study revealed that focal neurological deficit, altered sensorium and fever at the time of presentation were associated with poor outcome on follow up. No significant association was found with age, sex, seizure at presentation, papilloedema, number of sinuses involved, and parenchymal lesions in brain imaging. Isolated headache at the time of presentation was associated with good prognosis (p<0.05).

Background: India grapples with a rising diabetes burden, prompting concern over treatment costs. The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide affordable generic medicines, particularly for underprivileged populations. Aim: This study compares Jan Aushadhi generic antidiabetic drugs with branded counterparts to analyze cost discrepancies and their impact on treatment expenses. Methods: Prices of Jan Aushadhi generics and branded drugs were compared, revealing substantial variations. Cost ratios and variations were computed, underscoring the need for informed decision-making. Results: Over 70% of Jan Aushadhi generics were cheaper, though exceptions existed such as Sitagliptin tablets. Significant cost disparities were observed, with Canagliflozin showing the highest difference. Cost ratios ranged widely, emphasizing the importance of cost-conscious choices. Variations in costs highlighted the need for effective drug marketing management. Conclusions: Selectively opting for Jan Aushadhi generics could alleviate medication costs in India, prompting a review of pricing policies. Price differences between generics and branded drugs underscore the necessity for better management. Increased awareness among stakeholders is crucial, and transitioning to PMBJP generics could enhance healthcare affordability.

Introduction: With the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognize otitis media and treat its complications early. Herein, we present our institution’s experience with patients who required emergency surgical intervention for complications of otitis media. Methods: All 15 patients of COM with intra or extra cranial complication who were admitted in the Department of Otorhinolaryngology, Narendra Modi Medical College Ahmedabad, from April 2023 to April 2024 were included in this retrospective analytic study. Results: Out of 15 patients 6 were male patients and 9 were female patients. We have done HRCT temporal bone in all 15 patients and only 2 patients required MRI BRAIN scan.13 patients had extracranial complications and Only 2 patients had intracranial complications. 4 patients had facial weakness. All patients were treated with intravenous antibiotic and underwent surgery. Conclusion: Otitis media can still result in serious complications in the post antibiotic era due to resistance and over use of antibiotics. Patients with otitis media should be monitored, and surgical intervention should be performed whenever necessary to attain good outcomes. Life threatening complications of COM are still occurring in modern antimicrobial era in developing countries like India because of lack of awareness regarding the symptom like ear discharge and progressive hearing loss.

Background: Among various treatment options available at present for tibial plateau fractures, Joshi’s external stabilization system (JESS) is one of the established modalities for external fixation. While open reduction and plate fixation gives better reduction of articular fragments, closed reduction and JESS fixation has advantage of soft tissue preservation and early initiation of rehabilitation. Objective: Main purpose of this study was to compare the functional outcome between plate and JESS fixation method. Design: This was a comparative prospective analysis nonrandomized study. Materials and Methods: Among total enrolled 33 patients, 10 and 23 patients were treated by JESS and Plating methods respectively. Modified Rasmussen functional score (MRFS) was used for assessing the patients at each follow up. Statistical analysis was done by Microsoft excel and statistical software SPSS 21. Student t- test was applied to find if difference was significant between the groups. Results: In the study majority of the patients were between 20-30 years (mean 35.72 years) of age. Males were affected more than females, road traffic accident was the main cause (84.84% cases). There were 23 closed and 10 open fracture cases. Of the total, 60% cases were schatzker^’s type VI and 18.18% were schatzker^’s type V. The follow-up period was 6 months. On comparative analysis of the two groups at 2 weeks and 6 weeks, there was significant relationship at p value<0.001. At the period of 3 month and 6 months, both the groups are equally effective and there was non-significant relationship at the p value of >0.05. While at the latest follow-up, both the groups were significant at p value of <0.001. Conclusion: The study shows that the functional outcome of plating for the management of tibial plateau fractures is better than JESS.

Introduction: Accurate knowledge of variations in the fissures and lobes of the lungs is of paramount importance for cardiothoracic surgeons to perform lobectomies, segmental resection of the infected bronchopulmonary segments, and to lessen post- operative complications like air leaks. Likewise, it is equally important for radiologists to correctly interpretate Chest-X-ray, CT scans MRIs of the chest. Aim: To observe and describe the variation in fissures and lobes in human lungs. Material and Methods: The study was conducted on 54 lungs (28 right and 26 left), well preserved in formalin, from various medical colleges of Patna, Bihar. A gross examination was done to find out the presence of incomplete oblique fissures of the right and left lungs; incomplete horizontal fissures of the right lung; along with their grades. The absence of a horizontal fissure in the right lung and the presence of accessory fissures were also observed. Photographs of the observed variations were taken. The Percentages of the variations were calculated and compared with the previous studies. Result:  Among the right-sided lungs, complete oblique fissures and complete horizontal fissures were found in 28.5% (8/28) and 35.7% (10/28) respectively. Four out of twenty-six (15.3%) left-sided lungs had complete oblique fissures.  Incomplete oblique fissures and incomplete horizontal fissures in right-sided lungs were found in 71.4% (20/28) and 42.8% (12/28) respectively. 84.6% (22/26) of the left-sided lungs had incomplete oblique fissures. Absence of oblique fissure was not found in any of the lungs examined (0/54), while 21.5 % (6/28) of the right-sided lungs had absent horizontal fissure. Left median fissure, a type of accessory fissure, were found in 6 out of 26 lungs examined (23.1%). Conclusion: The present study has found high percentages of incomplete oblique fissures; low percentages of complete oblique fissures and complete horizontal fissures; compared to many studies done so far. This highlights the possibilities of a wider range of variations and necessitates more research to find out the extend of variations.

Introduction: The incidence of shaft humerus fractures remains 1% to 2% of all fractures and 14% of all humerus fractures. The gold standard of surgical management is open reduction and internal fixation with DCP. But it has complications like wound infections, iatrogenic radial nerve injury, and large scar which is a cosmetic concern for the patient. In the case of antegrade interlocking humerus nails, it is a biological preservative technique with union rates similar to that of DCP plate fixation. Materials and Methods: Patients with fracture shaft of Humerus, who were admitted in Government General Hospital, attached to rangaraya Medical College, Kakinada was be taken for study after obtaining their informed consent. This was a prospective study from December 2020 to December 2022. Results: Majority of patients were Males between 31-40 years.RTA is the most common mode of injury (75%). The commonly seen injuries were transverse fractures of Middle1/3rd of shaft of humerus. Majority (95%) patients had solid union in an average of 15.25weeks, 90% of patients had full range of shoulder movements. Shoulder stiffness and superficial skin infections were the only complications encountered. Discussion: 95% patients attained solid bony union within 15.25 weeks. 1 case (5%) went into non-union which was subjected to DCP fixation with bone graft at united at 32 weeks. When compared with plating, nailing had a least infection rate in postoperative period and minimal hospital stay. As the fracture site hematoma was preserved during surgery, the time required for the fracture consolidation and union would be less with higher union rates in nailing procedures.

Background: Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction/ischemia. They should be aware of the fact that, these ECG changes are taking place due to acute stroke and not due to myocardial infarction/ischemia. Objective: The objective of the present study was to study ECG changes in patients with acute stroke. Methods: A hospital based cross sectional study was carried out for a period of 6 months at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda. A total of 100 patients were included who were eligible for the present study as per the inclusion and exclusion criteria. Detailed history taking, Clinical examinations, vital records, ECG at regular intervals and neuroimaging were done. Results: Present study showed that the majority of stroke cases (75%) were seen in 51-70 years of age groups. 44 patients with acute stroke in our study showed ECG changes. Out of 44, 16 (80%) of patients with intra-cerebral hemorrhages, 25 (33.78%) of patients with infarct had changes and 3 (50%) of patients with SAH had ECG changes. ST segment and T wave changes were most commonly noted after cerebral hemorrhage. Conclusions: T wave inversion, left axis deviation along with left ventricular hypertrophy and QT prolongation were common ECG changes in patients with acute stroke.

Background: The prognosis of breast cancer depends on the histological type, size of the tumor, tumor necrosis, skin, nipple and chest wall invasion, lymphovascular invasion, grade, stage, the status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), cell proliferation marker (ki-67), and type of therapy. Estrogen receptor and progesterone receptor expression in breast cancer is, so far, the most useful predictive marker. Hormone receptor expression has been reported to be low in breast cancer patients from developing countries including India. The pattern of progesterone receptor expression in cancer breast subjects from rural areas is not well studied. Materials and Methods: Immunohistochemistry was used for evaluation of PR expression in the mastectomy specimens. Tumour size from the mastectomy specimen was recorded; number of lymph nodes was noted. Tissue processing and staining with haematoxylin & eosin was to be done. Post mastectomy grading of the malignant breast lesion was done according to Scarff-Bloom- Richardson‘s grading (SBR) system in haematoxylin & eosin stained slides. Results: Among the histopathological types of the tumours, IDC NOS constituted 40 cases (86.9%), Invasive lobular carcinoma constituted 2 cases (4.3%), medullary carcinoma 2 cases (4.3%), invasive papillary carcinoma and mucinous carcinoma 1 case each (2.2%). The total no of ER positive and negative cases were 21(45.7%) and 25(54.7%) respectively. The total no of PR positive cases was 18(39.1%) and that of negative cases was 28(60.9%). This indicates majority of the tumours did not have hormonal receptor expression. Conclusion: A significant inverse association between ER and PR expression and higher tumour grades and axillary lymph node metastases was seen. No significant association was found between ER & PR expression and the rest of the clinicopathological parameters.

Background: Arterial blood gases (ABG) are technically more difficult to obtain, more painful, and expensive. They are associated with hazards like bleeding, arterial spasm, and thrombosis. Performing a Venous blood gas (VBG) rather than an ABG is particularly convenient in the intensive care unit since many patients have a central venous catheter from which venous blood can be quickly and easily obtained. Objectives: The primary objective was to correlate venous pH and pCO2 to arterial pH and pCO2 in critically ill patients in the Pediatric Intensive Care Unit (PICU). The secondary objective was to study the accuracy of VBG for the diagnosis of acid-base balance in children admitted to the Pediatric Intensive Care Unit (PICU) at a tertiary care hospital. Methods: In a prospective interventional study, 85 children admitted to the Pediatric Intensive Care Unit (PICU) in whom clinicians had advised ABG were recruited. ABG and VBG were obtained from the same patient at an interval of 5-10 minutes. ABG and VBG reports were later compared. The mean difference was studied by Paired t-test. The correlation of the values was tested by the Karl Pearson correlation test. Bland Altman’s method was used to study the agreement. Results: In 85 patients, the majority of the subjects belonged to <1 yrs (57.6%), with a male preponderance (46 males). The majority of the cases had respiratory system involvement. Pneumonia cases were 61.8%. The mean difference for pH between VBG and ABG was -0.01 with a Pearson correlation of 0.92. The mean difference for pCO2 between VBG and ABG was -5.32 mm Hg with a Pearson correlation of 0.97. Points in the Bland Altman were uniformly scattered between the lines of agreement which suggested good agreement and correlation between arterial and venous pH and pCO2. Conclusion: Venous pH and pCO2 showed a significant correlation and agreement with arterial pH and pCO2. Venous pH and pCO2 showed a significant correlation and agreement with arterial pH and pCO2. Thus venous pH and pCO2 estimation is an acceptable substitute for arterial measurement and may reduce the risks of complications both for patients and health workers.

Introduction Since human beings are obligate bipedals, the body weight is transmitted to the ground through lower limbs. The talocrural joint is one of the major weight bearing joints in our body. The Ankle joint is the most frequently injured one. Morphometric study of facet for talus is useful for reconstructive surgeries of the ankle joint. Methods 50 fibula bones (25 right & 25 left) were taken from the Department of Anatomy, Tirunelveli Medical College, Tirunelveli. Results The mean anteromedial distance of facet for talus is on right side 24.79 mm ± 5.13, and on left side 19.13 mm ±2.97. The mean posteromedial distance of facet for talus is on right side 26.12mm±5.78 and on left side 19.17mm±2.03. The mean maximum width of facet for talus is on right side 25.88 mm±5.60 and on left side 18.54mm±2.36. The mean maximum height of facet for talus is on right side 27.63 mm±6.28 and on left side 20.94 mm±2.59. 90% of the facets for talus are triangular, 8% triangular and 2% circular in shape.

Background: Appendicitis is the second most common abdominal pathology necessitating emergency surgery, with a 7-10% lifetime risk in the general population. The primary cause of appendicitis is lumen obstruction, predominantly due to fecoliths. Other causes of lumen obstruction include lymphoid hyperplasia, intestinal worms, and tumors, which can also lead to acute appendicitis. Laparoscopic Appendectomy has become the gold standard for appendectomy, even in cases of complicated appendicitis. With the increased adoption of Laparoscopic Appendectomy, there have been variations in procedural techniques such as port placement, types of anesthesia, criteria for converting to open surgery, and methods for ligating the appendix stump. Ligating the base of the appendix is a critical step in Appendectomy. In Laparoscopic Appendectomy, where tactile feedback is limited, the choice of method for stump closure becomes particularly important for ensuring safety. Polymeric clips have emerged as a new technique for stump closure in Laparoscopic Appendectomy due to their ease of application, adaptability, rapid application time, and cost-effectiveness. Methods: The research involved 50 patients who underwent laparoscopic appendectomy from September 2023 to August 2024. Data on patients’ demographics, surgical duration, hospital stay length, and complications were retrospectively gathered from medical records. Based on the method used for stump closure, patients were categorized into two groups: one with polymeric endoclip closure and the other with extracorporeal knot. Results: Our results demonstrate that using a polymeric clip to close the base of the appendix during Laparoscopic Appendectomy is a feasible and safe technique, proving effective for patients with appendicitis. This method offers a practical alternative to the conventional approach of using an extracorporeal knot for stump closure in Laparoscopic Appendectomy. Conclusion: Our study aimed to evaluate and compare the effectiveness of polymeric clips versus extracorporeal knots for closing the stump during Laparoscopic Appendectomy.

Background and Aim: The most common cause of respiratory distress in newborn is respiratory distress syndrome and respiratory distress syndrome is common cause of morbidity and mortality in preterm neonates. The current study aimed to evaluate the efficacy of locally developed BUBBLE CPAP as a non-invasive strategy for managing respiratory distress in newborns within resource-limited settings. Material and Methods: Present Prospective interventional study conducted on Preterm babies’ birth with respiratory distress syndrome at A tertiary care hospital and medical college, Bhuj, Gujarat, India. A total 96 eligible babies were included in this study. Need for intubation, need for surfactant therapy, Hospital stay and Mortality. Immediate complication like Pneumothorax and Pulmonary hemorrhage were recorded. Results: The study involved 96 preterm newborns, with 43.8% between 34-36 weeks gestational age, 35.4% weighing between 1-1.5 kg, 52.1% females, and 47.9% males. Of these, 67.7% were inborn and 32.3% were outborn, with 30.2% having a hospital stay between 6-10 days. Regarding CPAP administration, 69.7% received early CPAP, while 30.3% received delayed CPAP. Antenatal steroid coverage varied, with 5.2% having full coverage, 29.9% partial, and 65.6% no coverage. Surfactant administration was as follows: 9.4% received prophylactic, 8.3% late rescue, 16.7% early rescue, and 66.6% no surfactant. Intubation was required for 39.5% of the newborns, while 60.5% were not intubated. Conclusion: The findings highlight variations in outcomes based on the timing and type of surfactant administration, emphasizing the risks associated with intubation and the potential benefits of early CPAP in reducing need of surfactant, mortality, intubation, hospital stay, complications.

Background and Aim: Ascariasis is the most common helminthic disease in humans. It has global distribution and is most prevalent in tropical countries where the temperature and humidity favor the development of eggs in the soil. Ascaris is transmitted through fecal-oral route. Most of the affected are asymptomatic or present with nonspecific abdominal symptoms. However, because of the high prevalence of infection, complications can occur such as intestinal obstruction due to massive infestation, biliary colic, gallstone formation, cholecytitis, liver abscess recurrent pyogenic cholangitis and pancreatitis. Material and Methods: Patients presented to the hospital with hepatopancreatobiliary and gastrointestinal ascariasis during the study period was included after taking due informed consent. A total of 100 adult patients were enrolled in the study. A detailed clinical history was taken from all the patients. Ultrasonography of whole abdomen was done in all patients. X-ray abdomen in erect and/or supine posture was done in patients presenting with features of intestinal obstruction. Upper gastrointestinal endoscopy was done in some patients. Results: The patterns of diseases could be classified into 4 broad categories namely: biliary colic, acute pancreatitis, acute cholangitis and intestinal obstruction. Ninety percent of patients (90/100) could be managed successfully conservatively. Endoscopic removal of worms from biliary tract was done successfully in 6 patients. 4 patients underwent surgery for unrelenting cholangitis due to dead worms in the common bile duct. Conclusion: Gastrointestinal and hepatopancreatobiliary ascariasis has a high disease burden in study area. The disease reflects sanitation habits of the population and has a wide spectrum of manifestations. Management is predominantly conservative and the prognosis good. Sanitary habits should be advised and the family dewormed if an index case of ascariasis is found in the population.

Background and Aim: Magnesium sulphate (MgSO4) has emerged as a promising adjuvant in brachial plexus block, yielding positive outcomes. Nevertheless, the medical community has yet to reach a consensus on the ideal dosing parameters. This study aimed to evaluate the effectiveness of adding magnesium sulphate (150 mg) and fentanyl (50 microgrammes) to 0.375% bupivacaine compared to a placebo in the context of supraclavicular brachial plexus block. Material and Methods:  A prospective study was carried out following the approval of the institutional ethical committee at a Tertiary Care Teaching Institute in India, spanning a duration of one year. A total of 150 patients, regardless of gender, classified as American Society of Anaesthesiologists (ASA) grade I or II, were included in the study. These patients were scheduled for upper limb surgeries located distal to the mid-humerus, which were performed using an ultrasound-guided supraclavicular brachial plexus block. In this study, participants were randomly assigned to one of three groups, each consisting of 50 individuals. Group A received 20ml of 0.375% Bupivacaine, Group B was administered 150 mg of Magnesium sulphate alongside Bupivacaine, and Group C received 50 microgrammes of Fentanyl in combination with Bupivacaine. The main objective of the study was to evaluate the onset and quality of both sensory and motor blockade across all three groups. Results:  A statistically significant difference in VAS scores was observed among the three groups from 6 to 18 hours following the block procedure. The VAS scores did not show significant differences at the 6 and 24-hour time points, with the mean post-operative VAS score being lower in Group C compared to Groups B and A. The onset time of sensory blockade showed no significant difference between groups C and B (p>0.05). However, group A exhibited a markedly shorter onset time when compared to both groups C and B individually (p<0.001). The average time for motor blockade to begin was similar in groups C and B (p value>0.05), while group A experienced a significantly quicker onset of motor block. Conclusion: The findings indicate that fentanyl, when used as an adjuvant, offers enhanced analgesic effects compared to both magnesium sulphate and placebo, particularly in terms of the duration of motor and sensory blockade.

This case report presents the clinical course and management of lateral impaction shoulder injury in a tertiary hospital setting. A then 42-year-old male presented with left shoulder deformity with global restriction of movements at the affected shoulder joint. Detailed examination revealed dropping of left shoulder with minimum ROM at the joint. Diagnostic workup confirmed fracture of medial end of ipsilateral clavicle with ipsilateral scapula fracture with ipsilateral ribs fracture, and treatment consisted of open reduction and plating for clavicle and scapula keeping in consideration of shoulder suspensory ligament complex. Follow-up assessments after 6 months demonstrated correction in drooping of shoulder and complete functional ROM. This report highlights fractures associated with lateral impaction of shoulder and discusses relevant literature to underscore the management challenges and outcomes associated with it.

Introduction: Breast lesions are most prevalent cancer type among women globally that require early diagnosis for successful management and to avoid biopsies. Ultrasonography (USG), elastography and combined Ultrasono elastography are effective diagnostic modalities for characterization of breast lesions. This study was focused on characterization of the breast lesions by ultrasono elastography and comparison with FNAC findings. Material and Methods: Sixty women with palpable breast masses above 21 years were subjected to detailed clinical examination. Cases with palpable breast lesions to ultrasound imaging and elastography. The FNAC was performed to accurate the ultrasound findings. Results: The combined diagnostic outcome of grey scale USG and elastography showed 100%, 95.65%, 94.28%, 100% and 97.48% of sensitivity, specificity, PPV, NPV and diagnostic accuracy respectively. Conclusion: The concurrent use of grey scale ultrasonography and elastography is advantageous in most cases for the enhanced characterization of palpable lesions, leading to a diagnosis with high accuracy. These imaging methods relieve patient anxiety and prevent unnecessary procedures in cases where the imaging results are definitively benign.

Background: This study aims to access the level of awareness and attitude towards organ donation among undergraduate students, interns and postgraduate students in a Government medical college and Hospital, Chandrapur. Methodology: A questionnaire-based cross-sectional study was conducted in July 2024 at a Government medical college and Hospital, Chandrapur, involving 920 undergraduate students, interns, and residents. The study aimed to examine attitudes, awareness levels, and beliefs regarding organ donation. Results: In this cross-sectional study conducted in July 2024 at a Government medical college and Hospital, Chandrapur, 920 participants were surveyed to understand their attitudes and awareness towards organ donation. Among them, 698 (75.8%) were undergraduate students, 78 (8.47%) were residents, and 144 (15.65%) were interns, with an average age of 21±2 years. The study revealed that 79.8% of participants were willing to donate their organs, primarily motivated by a desire to help others in need. Conversely, the main reason for hesitancy towards organ donation was the fear of misuse or trafficking of organs. Interestingly, 60.4% of respondents expressed indifference regarding who receives their organs after donation. Moreover, the survey highlighted gaps in knowledge regarding organ donation laws, with only 38.9% of participants correctly aware of the Transplantation of Human Organs Act, 1994 in India. Furthermore, nearly a quarter (24.9%) of the participants felt that the current educational curriculum lacked sufficient coverage on the topic of organ donation, suggesting a need for enhanced education in this area. Conclusions: The study revealed a strong willingness among participants to donate organs driven by altruistic motives. Concerns about organ misuse were identified as a significant barrier. However, there was limited awareness of organ donation laws, indicating a need for improved education and transparency. Addressing these issues through targeted initiatives could enhance understanding and trust in organ donation processes, potentially increasing donation rates and benefiting those in need of transplants.

Introduction: Endometrial carcinoma typically causes postmenopausal women to experience abnormal vaginal bleeding. Women with suspected endometrial pathology were investigated initially with 3D-TVUSG and later with endometrial biopsy. Objectives: To assess the diagnostic value of three-dimensional transvaginal ultrasound (3D-TVUSG) for detecting endometrial carcinoma among postmenopausal women. Methods: A prospective observational study among 61 post-menopausal women was conducted in a tertiary care hospital in North India. All of them underwent 3D-TVUSG and were given provisional diagnosis after that endometrial biopsy was done and final diagnosis was given as per histopathological reports. Results: Mean age of study participants was 59.4+/-4.3. Endometrial carcinoma was detected in about one tenth (8.2%) of participants by 3D-TVUSG while only (6.5%) of participants were diagnosed by histopathology. The histopathological diagnosis was considered the gold standard for detection and accuracy. Sensitivity, specificity, positive and negative predictive value of 3D-TVUSG were 100%, 98.2%, 80% and 100% respectively. Diagnostic accuracy of 3D-TVUSG was 98.3%. Conclusion: Three-dimensional transvaginal ultrasound (3D-TVUSG) has high diagnostic accuracy, sensitivity and specificity for endometrial carcinoma among postmenopausal women. Postmenopausal women should be regularly screened for endometrial carcinoma with the help of 3D-TVUSG.

Background: CT scan has modified imaging especially in maxillofacial region having a complex and intricate anatomy in human body. It is now the most acceptable choice of imaging modality for diagnosis of facial bone fractures produced due to trauma. Aim of the study: The study aimed to outline the benefits of utilizing 3-Dimensional and coronal reformatted images compared to axial images when assessing frontal bone fractures. Materials and methods: This study was carried out in the tertiary care centre located in North India. Frontal bone, using a 128 –Slice CT scanner; GE Revolution machine 128. Coronal multiplanar reformatted (MPR) and 3D volume-rendered images were also reconstructed to assess and characterize its benefits over standard axial images. Results:  For the majority of patients, 3D images were on par with or better than axial images. It was discovered that coronal images were either comparable to or better at detecting fractures. Conclusion: This study showed the benefits of 3D and coronal images over axial images for the assessment of frontal bone fracture as well as the usefulness of multidetector CT in the evaluation of frontal bone fractures.

Background: The postpartum period is a critical time for initiating effective contraception to prevent unintended pregnancies and promote maternal health. Intrauterine contraceptive devices (IUCDs), particularly the copper T device, are favored for their long-term efficacy and minimal maintenance. However, the expulsion of postpartum IUCDs (PPIUCDs) remains a significant concern, potentially compromising their effectiveness. This study aims to investigate the association between the expulsion of PPIUCDs at 6 weeks and 12 weeks post-insertion and their location as confirmed by ultrasonography. Methods: This was a prospective cohort study of 100 postpartum women who underwent normal vaginal delivery followed by PPIUCD placement was studied. IUCD positioning was confirmed via ultrasonography and expulsion rates were recorded at 6- and 12-weeks post-insertion. Results: The mean age of the participants was 25.3 years. 67 IUCDs were correctly positioned at the fundus and 33 mispositioned (11 lower, 11 lateral, and 11 mid-cavity). At 6 weeks, 5 women experienced IUCD expulsion, with 4 of these expulsions occurring in mid-cavity positions. By 12 weeks, an additional 9 expulsions were recorded, distributed across various mispositions. Statistical analysis revealed a significant association between IUCD location and expulsion rates, while age and parity were not significantly associated with expulsion. Conclusion: The study highlights the critical role of IUCD location in determining expulsion rates. Ensuring correct fundal placement and routine ultrasonographic follow-up can significantly improve the success rates of PPIUCDs, enhancing postpartum contraception efficacy and reducing unintended pregnancies.

Background: Chronic kidney disease (CKD) is a worldwide health problem, affecting millions of people. Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, lupus, and other forms of cardiovascular diseases. Serum Carbohydrate Antigen 19-9 (CA 19-9) is a tumor marker for conditions such as benign ovarian tumors, malignancies of pancreas, colorectum, lung, chronic hepatitis, liver cirrhosis, diseases of bile duct but its level is also high in chronic renal disorder. Our study was aimed to assess and compare the status of serum CA 19-9 level in chronic kidney disease subjects and healthy controls. Materials and Methods: The present study is a case-control study, conducted on 220 CKD patients. Cases were selected from the Medical ward of Jawahar Lal Nehru Medical College and Associated Group of Hospitals, Ajmer. Age and sex-matched healthy controls (n = 100) were selected from MOPD. The present study is approved by Institutional Ethical Committee. All samples were collected under aseptic conditions from the antecubital vein. Results: The mean activity of Serum CA 19-9 was significantly higher in CKD subjects as compared to healthy controls (p < 0.0001). The observations of this study also revealed that 150 out of 220 CKD patients have higher serum CA 19-9 levels (>35 U/mL). Positive pearson correlation between serum creatinine and serum CA 19-9 was found (r= 0.76). Conclusion: Serum CA 19-9 can be used as a biomarker for the early detection of CKD in the general population to prevent the morbidity and mortality which are associated with CKD. If CKD is detected early and managed appropriately the deterioration in kidney functions can be slowed and the risk of cardiovascular diseases in renal patients can be reduced.

Introduction: The selection of mesh material is a critical factor influencing patient outcomes in hernia repair, potentially outweighing the impact of the surgical technique employed. Research has compared polypropylene mesh with modified composite mesh (a combination of polypropylene and polyglactin), showing that composite mesh results in fewer foreign body reactions, reduced post-operative complications, and improved long-term quality of life. This study aimed to evaluate and compare the early outcomes of non-absorbable polypropylene mesh versus partially absorbable composite mesh in laparoscopic inguinal hernia repair. Methods: The study included 78 patients with elective reducible indirect inguinal hernias. The participants were divided into two groups of 39 each: Group A, which received partially absorbable composite lightweight meshes, and Group B, which received non-absorbable polypropylene meshes. All patients underwent laparoscopic inguinal hernia repair using the transabdominal preperitoneal (TAPP) approach. Post-operative comparisons between the groups were made based on parameters such as age distribution, inguinodynia, analgesia requirements, foreign body sensation, presence of lumps (hematoma or seroma), and return to work activities, and recurrence rates. Results: The average age of the patients was 51.14 ± 12.91 years, with the majority falling in the 51–60 years age group. Initially, no significant difference in transient neuralgia was observed between the two groups. However, at six weeks post-operation, Group A reported significantly less pain. Foreign body sensation was notably higher in Group B, though this difference was not significant over time. Conclusion: The findings suggest that composite mesh may be preferable for laparoscopic inguinal hernia repair, as it is associated with reduced pain, less foreign body sensation, and a quicker return to work compared to polypropylene mesh.

In patients undergoing mechanical ventilation for the acute respiratory distress syn- drome (ARDS), neuromuscular blocking agents may improve oxygenation and de- crease ventilator-induced lung injury but may also cause muscle weakness. We evalu- ated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS. Materials and Methods: In this multicenter, double-blind trial, 340 patients presenting to the intensive care unit (ICU) with an onset of severe ARDS within the previous 48 hours were ran- domly assigned to receive, for 48 hours, either cisatracurium besylate (178 patients) or placebo (162 patients). Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of less than 150, with a positive end-expiratory pressure of 5 cm or more of water and a tidal volume of 6 to 8 ml per kilogram of predicted body weight. Results: The hazard ratio for death at 90 days in the cisatracurium group, as compared with the placebo group, was 0.68 (95% confidence interval [CI], 0.48 to 0.98; P= 0.04), after adjustment for both the baseline PaO2:FIO2 and plateau pressure and the Simplified Acute Physiology II score. Conclusions: In patients with severe ARDS, early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness.

Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community- acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP. Materials and Methods: We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model. Results: A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia. Conclusions: The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.

Background: Karnataka ranks as the 9th most populous state in India and the second-most populous state in South India. This study aims to evaluate the undiagnosed cases of prediabetes and diabetes in Karnataka, specifically analyzing the most frequent age groups. Method: The cross-sectional study conducted from June 2023 to May 2024 collected data at screening camps held in both urban and rural areas of Karnataka. Participants aged 13 to 95 years who visited designated data collection centers and had their blood glucose levels assessed were included if they had not been previously diagnosed with diabetes. Results: A total of 2806 individuals from Karnataka were screened, categorized into the following age groups: 13-19 years (n=26), 20-39 years (n=1259), 40-64 years (n=1188), 65-79 years (n=309), and 80-95 years (n=24). Within this cohort, 30.18% (n=847) were diagnosed with diabetes and 36.21% (n=1016) with prediabetes. Prediabetes was most common in the 20-39 age group (57.58%), while diabetes was highest in the 40-64 age group (54.07%). Conclusion: The study highlights alarming rates of diabetes and prediabetes in Karnataka, emphasizing the need for urgent public health interventions. Future efforts should focus on enhancing healthcare infrastructure, promoting healthy lifestyles, and increasing diabetes awareness to mitigate the growing burden of diabetes in India.

Background: Pulmonary tuberculosis is one of the oldest disease affecting the human race since ancient times. However, even with the advent of recent advances in diagnosis and treatment, the morbidity and mortality due to this disease remains high. The primary reason being the increasing incidence of drug resistance and the human immunodeficiency virus infection. Objective. To study the levels of serum cholesterol, HDL-C, LDL-C levels in patients with pulmonary Tuberculosis and study the correlation of serum cholesterol, HDL-C, LDL-C with radiological extent of disease and Sputum positivity. Methods: 104 patients diagnosed as pulmonary tuberculosis were included in the study after considering the inclusion and exclusion criteria. History was taken, clinical examination was done, relevant investigations were done for all eligible patients. DSP and DRED were calculated and compared with Serum Cholesterol, HDL-C, LDL-C Levels. Result: The levels of all the lipids were found to be significantly lower in the advanced tuberculosis group (stage III) as compared with stage II and I. in comparison with DSP , total cholesterol values were 158.6±14.1 (DSP I), 134.9±6.4 (DSP II), 114.5±14.9 (DSP III). HDL-C values were 41.6±5.3 (DSP I), 33.0±4.0 (DSP II), 28.0±5.0 (DSPIII). LDL-C values were 100.4±8.7 (DSP I), 87.3±7.5 (DSP II), 77.0±9.0 (DSP III). The difference between the group was statistically significant (p<0.001). In comparison with DRED the values of total cholesterol were 161.0±8.8 (DRED I), 136.8±8.9 (DRED II), 125.8±17.5 (DRED III). HDL-C values were 42.2±4.3 (DRED I), 33.8±4.2 (DRED II), 30.9±6.0 (DRED III). LDL-C values were 101.5±6.7 (DRED I), 89.3±7.3 (DRED II), 82.3±11.1 (DRED III). The difference between the group was statistically significant (p<0.001). Conclusion: Pre-treatment serum level of TC, HDL-C, LDL-C, have positive correlation with DRED and DSP in PTB patients.

Background: Pulmonary Hypertension is a chronic, progressive and a fatal disease. Gold standard test for diagnosis and clinical assessment of the patients with pulmonary hypertension is Right heart catheterisation. Recently the usefulness of cheaper and non-invasive tests in the follow-up of PH patients is being studied. The aim of the present study was to evaluate the relationship between serum uric acid levels and severity of pulmonary hypertension in PH patients. Objective: To study the correlation between serum uric acid levels and severity of pulmonary hypertension and to study serum uric acid levels in pulmonary hypertension as an independent predictor of its severity. Methods: Study was conducted in KIMS hubli on patients with clinical and echocardiographic features of Pulmonary Hypertension and total of 106 patients were included in the study based on inclusion and exclusion criteria. They were divided into 3 groups based on severity. Statistical analysis were conducted and results were drawn. Result: Serum uric acid levels were found to be higher in pulmonary hypertension patients with severe Right Ventricular dysfunction, compared to mild and moderate dysfunction. Serum uric acid levels were significantly correlated with pulmonary arterial systolic pressure. Serum uric acid levels also had significant correlation with World Health Organization functional class of the patients. Conclusion: From the study it can be concluded that serum Uric Acid levels are very well correlated with the severity of symptoms and right ventricular dysfunction in patients with pulmonary hypertension

Background: Diabetes mellitus is a chronic metabolic disorder which can lead to multiorgan complications, broadly divided into microvascular and macrovascular complications. The estimates in 2019 showed that 77 million individuals had diabetes in India, which is expected to rise to over 134 million by 2045. Lungs are a potential target organ for diabetic microvascular complications and so this study was undertaken to see the impairment of pulmonary functions using spirometry in patients with diabetes mellitus. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in type II diabetic patients and compare them with age and gender matched healthy subjects. Correlation between forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) in diabetic patients with duration of the disease was also analyzed. Materials and Methods: Pulmonary function tests (PFTs) were recorded in 100 type 2 diabetic patients and 100 normal healthy controls aged between 30 – 60 years by using Medspiror. The PFTs analysed statistically were – Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV₁) to find the correlation between diabetics and non – diabetics. Glycemic status (FBS & PPBS) of subjects were determined by Glucose oxidase & peroxidase methods. PFTs of diabetic patients and controls were compared by applying Student’s unpaired t test. Associations between FVC and FEV₁and duration of illness in diabetic patients were analyzed by applying Pearson’s coefficient. Results: The mean FVC in the total diabetic group is 2.25±0.64 L which is lower than that of the total non-diabetic control group (2.64±0.81L) and the decreased value in the total diabetic control group is very highly significant (p<0.001). The mean FEV₁ in the total diabetic group is 1.72 ± 0.51 L and it is significantly lower than that of the total non-diabetic control group which is 2.14 ± 0.59 (p<0.001). There is negative correlation between the FVC as well as FEV₁ with the duration of disease among the total diabetic group and this is statistically not significant. Conclusion: Lung function tests are likely to be impaired in patients with diabetes mellitus.

Background: Aphakia, the condition of having no lens in the eye, poses significant visual challenges and requires effective surgical intervention. Objectives: To compare the long-term efficacy and the rate of complications of anterior and posterior Iris IOL implantation for the treatment of aphakia without sufficient capsule support. Methods: This was a hospital based retrospective study conducted in the outpatient department and/or inpatient wards of the Department of Ophthalmology, in a tertiary teaching healthcare facility in North India between January 2021 and June 2024. Results: The study involved 240 patients divided into two groups. The mean age for Group A was 68.1 years and 69.4 years for Group B (p>0.05). Gender distribution was similar, with Group A having 67 males (55.8%) and Group B having 69 males (57.5%). The involvement of right and left eyes was comparable between the groups, and the etiologies of aphakia showed no significant differences. Preoperative corrected distance visual acuity (CDVA) was 0.4 (logMAR) in both groups, improving significantly postoperatively to 0.1 by the third year. Preoperative intraocular pressure (IOP) was similar between the groups, with postoperative measurements showing an initial increase at one week, which normalized by the third year. Corneal endothelial cell density (CECD) decreased slightly over time in both groups, with no significant intergroup differences. Early complications (first week to third month) included wound leaks, hyphema, pupil ovalization, IOP elevation, pigment precipitates, and other complications, none of which differed significantly between the groups. Late complications (first to fifth year) such as elevated IOP, IOL dislocation, pigment precipitates, and retinal tear/detachment were also not significantly different between the groups. Conclusion: Anterior and posterior iris-claw IOL implantations showed comparable efficacy and safety profiles, with no significant differences in visual outcomes, IOP, CECD, or complication rates between the two techniques.

Background: Fibroadenomas are the most common benign breast diseases in country. Aim of study: To determine some demographic factors & the clinical summary of fibroadenoma cases in our tertiary care hospital. Material & Methods: A retrospective cytological study of fibroadenoma for period of 2years from medical records of January 2022 to December 2023. Results: All 142 cases were females. Most common age group was 21 to 30 years (50%) followed by 31 to 40 years (38%). Right breast was commonly involved and most fibroadenomas were confined to upper and outer quadrant. Conclusion: FNAC of breast is economic, safe, and highly accurate method for diagnosis of breast lump preoperatively to avoid undue surgery and inconvenience during biopsy. Health education, Breast self-examination and FNAC is recommended for early diagnosis and management.

Introduction: Peripheral lymhadenopathy is common presentation of inflammatory and neoplastic lesions. FNAC is one of the first-line investigations of management for the evaluation of lymphadenopathy. Enlargement of Lymph node is seen in variety of reactive inflammatory to neoplastic conditions related to regional or systemic diseases. It is very useful, easy, rapid, minimal invasive, cost effective and accurate approach in diagnosing various lymph node lesions and helpful in the workup of management of patients with nodal enlargement. Methods: A total of 175 patients were included in our study from Department of General Surgery, Shri Jagannath Medical College and Hospital, Puri, Odisha in the period from January 2023 to Dec 2023. Alcohol fixed and air dry smears were prepared and stain with H&E, PAP, and MGG. The special stain like PAS, ZN (20%) etc were done whenever required. Results: In present study total 175 cases of lymphadenopathy were studied. The presentation of various lymph node lesions on cytomorphological findings were Acute non-specific lymphadenitis cases were 5 (2.85%), Chronic non-specific lymphadenitis cases were 11 (6.28%), Granulomatous lymphadenopathy cases were 6 (3.42%), Tuberculous lymphadenitis cases were 60 (34.28%)’ Reactive lymphadenitis cases were 48 (27.42%), Metastasis to lymph node cases was 36 (20.57%), and Lymphoma cases were 9 (5.14%). Unsatisfactory smears (11) were excluded from the study. The detailed clinical material data, relevant investigations were taken for supporting the diagnosis. Conclusion: Cytomorphological features of lymph node FNAC, used in conjunction with clinical details, laboratory test investigations, radiology imaging study will be very helpful for diagnosing various disorders. It will be rapid, cost effective, safe, and reliable method for early diagnosis and treatment of the patients.

Background: The emergence of metallo -beta – lactamase in NF-GNB is becoming a therapeutic challenge worldwide. Metallo beta lactamase producing bacteria are popularly known as superbugs due to their increased development of drug resistance to carbapenems. MBL producing bacteria mainly cause healthcare associated infections. Detection of MBL is also a challenge for routine microbiology laboratories. The aim of this study was to compare the different phenotypic methods for detecting MBL producing NF-GNB. Methods: Total 307 clinical isolates of NF -GNB including Pseudomonas aeruginosa, Pseudomonas fluorescents, pseudomonas spp, Acinetobacter boumannii. These isolates were screened for imipenem resistance by Kirby Bauer disk diffusion methods and further tested for MBL detection by Disk-potentiation test, Double disk synergy test, Hodge test, Modified Hodge test, and E- Test. Result and Analysis: Out of the 307 NF-GNB, 161 were found to be Imipenem resistant by Kirby -Bauer disk diffusion method and further imipenem resistant isolates tested for the MBL production which were 45 isolates are MBL producer. When these 45 isolates tested for MBL production by Hodge test 22(13.66%), by Modified test 31(19.25%), 34(21.11%) by Disk potentiation test, 41 (25.46%) by DDST and by MBL E test 45(27.95%) of the isolates were MBL producers. Conclusion: The phenotypic methods are effective to detect MBL production in NF -GNB isolates. The sensitivity of MBL E -test (97.77%) was highest followed by DDST (91.11%) followed by DPT (75.55%) followed by MHT (68.88%) and lastly by Hodge test (48.88%). The E-test and DDST was very closely effective to detect MBL production.

Background: Lung cancer is a leading cause of cancer-related deaths worldwide. Early detection through screening is crucial, especially in high-risk populations, to reduce mortality rates. Objective: This study aimed to assess the impact of lung cancer screening on mortality rates among high-risk populations at Teerthanker Mahaveer Medical College and Research Centre. Methods: A prospective study was conducted from January 2017 to December 2019, involving 154 high-risk patients. All participants underwent low-dose computed tomography (LDCT) screening. Patients were monitored for lung cancer detection and outcomes, including stage at diagnosis, treatment modality, and survival rates over three years. Results: A total of 154 patients screened, 32 (20.8%) were diagnosed with lung cancer, with 25 cases (78.1%) detected at early stages (stage I or II). Among those diagnosed early, 20 patients (80%) underwent curative surgery or stereotactic body radiation therapy (SBRT). Five patients (15.6%) were diagnosed at advanced stages (stage III or IV). Mortality rates in early-stage patients were significantly lower, with a 3-year survival rate of 65%, compared to 20% in late-stage patients. The overall lung cancer-specific mortality rate was reduced by 18% compared to historical data in similar populations. Conclusions: LDCT screening in high-risk populations significantly improves early detection and reduces lung cancer mortality rates. Early-stage diagnosis offers a better prognosis and highlights the importance of screening programs.

Background: Smoking is a leading cause of chronic respiratory diseases, significantly impairing pulmonary function. Understanding the impact of smoking cessation on long-term pulmonary health is critical for effective treatment strategies. Objective: This study aims to evaluate the effects of smoking cessation programs on long-term pulmonary function in chronic smokers, focusing on improvements in lung health over time. Method: Conducted at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, from June 2018 to December 2020, this study involved 234 chronic smokers. Participants were enrolled in a comprehensive smoking cessation program, including behavioural therapy and pharmacotherapy. Pulmonary function tests, including FEV1 and FVC, were administered at baseline, 6 months, and 12 months post-cessation. Statistical analyses were performed to assess changes in lung function and the impact of various cessation strategies. Results: After 12 months, 78% of participants showed significant improvements in FEV1, with an average increase of 12.5% from baseline (p < 0.01). FVC increased by 10.2% in 70% of participants (p < 0.05). The overall quit rate was 65%, with participants adhering to both behavioural and pharmacological interventions experiencing the highest improvements. Specifically, 85% of those in the combined intervention group showed notable gains in pulmonary function (p < 0.01). Participants with longer smoking durations had a 6.8% smaller average increase in FEV1 compared to those with shorter durations, though improvements remained significant (p < 0.05). Conclusions: Smoking cessation programs significantly enhance long-term pulmonary function in chronic smokers, with substantial improvements observed in FEV1 and FVC. Comprehensive cessation strategies yield the most substantial benefits.

Background: COVID-19 has posed unprecedented challenges to healthcare systems worldwide, with severe cases often exhibiting abnormalities in hematological and biochemical parameters. This study aimed to assess the hematological, inflammatory, and organ function markers in COVID-19 patients and correlate these findings with disease severity and outcomes. Methods: This descriptive study was conducted at Government Medical College and District Hospital, Palakkad, over a period of 6 months. A total of 170 COVID-19 patients, aged 15 to 87 years, were included. Blood investigations, including hemoglobin (Hb), total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, urea, creatinine, and serum albumin, were measured. Data were analyzed using descriptive statistics to examine the relationships between these parameters, disease severity, and mortality. Results: The mean age of patients was 46.76 years, with 62% being male. Anemia was observed in 30% of patients, leukocytosis in 25%, neutrophilia in 40%, and thrombocytopenia in 15%. CRP was elevated in 70% of patients, with a mean value of 30 mg/L. D-dimer was elevated in 45% of patients, and hypoalbuminemia was seen in 55%. ICU admission was required in 35% of cases, with a mortality rate of 15%. Comorbidities such as diabetes, hypertension, and chronic kidney disease were significantly associated with severe outcomes. Conclusion: This study highlights the importance of blood investigations in predicting COVID-19 severity and outcomes. Elevated inflammatory markers, lymphopenia, and neutrophilia were associated with worse outcomes, especially in patients with comorbidities.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent, preventable, and treatable condition marked by persistent and progressive airflow limitation, stemming from an enhanced chronic inflammatory response of the airways and lungs to harmful particles and gases. Individuals with COPD are susceptible to psychiatric disorders that significantly impact their morbidity. This study aimed to assess the psychiatric comorbidity and quality of life among individuals with COPD, addressing the notable gap in Indian literature on this subject. Aim: To estimate the prevalence of psychiatric comorbidity and assess the quality of life in individuals with COPD. Material and Methods: 140 patients identified with COPD were categorized as per the severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria by the pulmonary medicine consultant. Subsequently, patients were referred from the Pulmonary Medicine Department to the Psychiatry OPD for further evaluation. A semi-structured interview was used to collect socio-demographic and clinical data. Upon consenting, patients underwent a comprehensive history taking and physical examination conducted by a resident psychiatrist. The Mini International Neuropsychiatric Interview (MINI) was employed to identify psychiatric comorbidities. The Quality of Life (QOL) of the patients was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. The data was statistically analyzed using SPSS software version 23.0. A p value of less than 0.05 was considered statistically significant. Results: Patients constituted 42.9% (n=60) in GOLD 1, 45% (n=63) in GOLD 2 and 12.7% (n=17) in GOLD 3 stage. Psychiatric comorbidity was noted in 65.7% of the sample, with in varying prevalence across GOLD stages: 26.7% in GOLD1, 93.7% in GOLD2, and 100% GOLD3. Among these comorbidities, the frequency for major depressive episode affecting 36.9% of patients was the highest followed by generalized anxiety disorder (GAD) 21.7%, panicdisorder 17.3%, and dysthymia 3.2%. Quality of life scores declined significantly with increasing COPD severity. The mean scores in physical health, psychological health, social relationships, and environment domains were 45.14±11.98, 44.86±10.86, 49.39±11.64, and 51.10±11.22, respectively. A significant correlation was found between psychiatric comorbidity and poorer quality of life (p<0.001). Conclusion: These results highlight the wide-ranging effects of COPD, which include respiratory health as well as physical, mental, and social well-being. It is essential to use a holistic approach to therapy, which includes patient education, psychological support, early identification, prevention, and thorough treatment techniques.

Background: Patients suffering from Obsessive Compulsive Disorder tend to stigmatise themselves which had been linked to poor adherence to treatment. Aim: To study internalized stigma and medication adherence in patients of obsessive-compulsive disorder (OCD). Material and Methods: A cross-sectional study was conducted on 115 patients diagnosed with OCD at the Department of Psychiatry of Rohilkhand Medical College and hospital, Bareilly, Uttar Pradesh. Samples were collected from patients willing to participate in the study. Patients diagnosed with OCD according to International Classification of Diseases 10th Revision (ICD-10), were included in the study. Upon enrolment, participants provided socio-demographic details after providing written and informed consent. They were then assessed for OCD severity using the Yale-Brown Obsessive Compulsive Scale following this, participants completed the Internalized Stigma of Mental Illness Scale (ISMI) and Medication Adherence Rating Scale (MARS). Results: The mean age of the patients were 30+10.38years. Mean duration of illness was found to be 7±3.13 year’s. On ISMI scale, the mean score was calculated as 77.84 ± 16.219.The mean Y-BOCS score was determined to be 22.71 ± 5.72. The mean score of medication adherence on MARS scale was 6.01 ± 2.087. There is significant relationship seen between all domains of self-stigma with the severity of OCD psychopathology (p-value<0.001) however, no significant relationship found with severity of OCD with medication adherence. A negative correlation found between all domains of self-stigma with medication adherence. Conclusion: Self stigma is found in OCD and can be significant barrier towards road to recovery by affecting medication adherence, more focus should be given on decreasing the internalized stigma and raising the medication compliance through family members, psychoeducation of patients and public.

Introduction: National medical council introduced new regulations for internship program in 2021, making it mandatory for interns to get exposed to blood bank/ transfusion medicine training during postings in clinical departments.  This is in line with other countries introducing competency-based medication education in blood bank/ transfusion medicine to train interns/ residents to have adequate knowledge and skill in ordering blood/ blood products, initiating transfusion and managing any adverse event/ complications during the procedure. Aim: To identify the knowledge gap in the interns regarding safe transfusion practices after introduction of competency based medical education in internship training. Material and Methods: The study was conducted in an urban medical college in South India. 150 students of the outgoing internship batch were given a Google form survey of 15 MCQs/ responses containing questions related to assessment of competency and knowledge. Results: 101 students were included in the study based on inclusion and exclusion criteria. 84.15% of interns agreed that the education/ training received was adequate. 80.2% of interns felt competent enough to identify and manage complications. 53.46% of interns self-assessed themselves to be competent to initiate and monitor the transfusion of blood and blood products. Regarding theoretical knowledge, the average correct answers related to various topics were blood products (52.47%), blood donation (62.37%), screening/ serology (45.54%), and practical transfusion aspect (27.32%).  Overall average answers related to knowledge was 58.09%. Conclusion: The discrepancy in self-assessed competency to actual knowledge was worrisome. In the actual world, this could be catastrophic issues regarding patient safety. Interns need to understand the importance of this life-saving procedure and the limited availability of blood/ blood products. Focussed education and training with direct observation by faculty during procedures with regular/ immediate feedback could help in following National Medical Council guidelines to make the outgoing interns, an Indian Medical Graduate, who can effectively act as a physician of first contact of the community while being globally relevant.

Background: Intraoperative hemodynamic changes, post-operative nausea and vomiting (PONV), and post-operative pain are common challenges in middle ear surgeries. This study compared the effects of oral clonidine and gabapentin as premedication on these parameters. Objectives: The study aimed to evaluate and compare the effects of a single dose of oral clonidine (150mcg) and oral gabapentin (300mg) on intraoperative hemodynamics, PONV incidence, post-operative pain relief, and adverse effects in patients undergoing middle ear surgeries. Methods: A prospective, randomized, double-blind study was conducted on 180 ASA I and II patients divided into three groups (n=60 each): clonidine, gabapentin, and placebo. The study drugs were administered one hour before surgery. Intraoperative hemodynamics, PONV incidence, post-operative pain scores (VAS), and adverse effects were recorded. Results: Clonidine and gabapentin significantly reduced heart rate and blood pressure compared to the placebo group (p<0.05). PONV incidence was significantly lower in the clonidine and gabapentin groups (p<0.05), with clonidine showing better results. Post-operative VAS scores were significantly lower in the clonidine and gabapentin groups (p<0.05), with clonidine providing better pain relief. No significant adverse effects were noted. Conclusions: Premedication with oral clonidine (150mcg) or gabapentin (300mg) effectively attenuates intraoperative hemodynamic changes, reduces PONV incidence, and provides better post-operative pain relief compared to placebo in patients undergoing middle ear surgeries. Clonidine showed superior results compared to gabapentin.

Background and Aim: Accurate diagnosis of acute appendicitis based on symptoms is essential in minimizing morbidity and mortality associated with perforation and other complications. This study aimed to explore the important factors that surgeons take into account when making decisions regarding suspected appendicitis cases. Material and Methods: The study included a total of one hundred patients, with a predominance of male participants. During the operation, the surgeon described the macroscopic appearance and assessed the severity of the appendicitis using the grading scale established by Ditillo and colleagues in 2006. We closely monitored important parameters, including the duration from hospital arrival to surgery (HI) and the total interval (TI), which measures the time from the onset of symptoms to the surgical procedure. Patients who presented with an intra-abdominal abscess or perforated appendicitis during surgery received extended courses of antibiotics after the procedure. Results: Significant correlation was observed between higher pathology grades and older age (p = 0.001). The mean temperature recorded was 37.26 degrees Celsius, falling within the range of 37.06 to 38.1 degrees Celsius. Notably, a significant correlation was observed between temperature and the advanced pathological degree. A positive correlation was observed between the prevalence of advanced pathology and prolonged PI, which varied from 25 to 40 hours. Conclusion: The decision-making process in cases of suspected appendicitis is largely based on a systematic approach. This approach involves the use of “hard” data, such as the results of laboratory tests and the findings of radiological investigations, which play a significant role.

Background: Neonatal sepsis is one of the most common cause of morbidity as well as neonatal mortality. Thrombocytopenia of varying severity is one of the common finding in neonatal sepsis which may be a predictor of adverse outcome. Material & Methods: The present study is a hospital based study. A total of 50 neonates admitted in the Hospital with clinical diagnosis of sepsis during the study period were included. Platelet count and indices along with blood culture was done for the patients. Results: Thrombocytopenia of varying severity was noted in 100% cases of neonatal sepsis, of them, 68% had mild thrombocytopenia, whereas 22% and 10% cases had moderate and severe thrombocytopenia. Conclusion: Although blood culture is a gold standard method for diagnosis of sepsis, utility of platelet count in neonatal sepsis should be observed carefully as it was sterile in certain neonates. Platelet indices and platelet count may aid in early diagnosis of sepsis and determining the prognosis and severity of sepsis. However, platelet count and platelet indices such as Mean Platelet Volume, Platelet Distribution Width and Plateletcrit (PCT) are not associated with neonatal risk factors and organism responsible for neonatal sepsis.

Background: The Circle of Willis (CoW) is a vital anastomotic arterial network at the base of the brain that serves as a collateral circulation system, ensuring adequate blood flow to the brain in case of occlusion. However, it exhibits significant anatomical variations across individuals, impacting cerebral blood flow and susceptibility to neurological disorders. This systematic review aims to comprehensively evaluate the prevalence, types, and clinical implications of anatomical variations in the Circle of Willis. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Science Direct and Cochrane databases. Studies published from 2014 to 2024 that focused on anatomical variations of the CoW were included. A total of 14 studies met the inclusion criteria after a rigorous screening process. Data extraction involved identifying variations, their prevalence, and potential associations with clinical outcomes such as ischemic stroke and aneurysm formation. Results: Sample sizes in the selected studies ranged from 73 to 1,864 participants. The average age of participants in different studies ranges from approximately 36 to 72 years, indicating varying demographics across studies. The prevalence of a complete Circle of Willis ranges broadly, with values from as low as 12% in Norway to as high as 74.23% in South Africa. Conclusion: This systematic review indicates a complex landscape of anatomical variations in the Circle of Willis, with significant differences in the prevalence of complete and incomplete configurations across various populations.

Background: Axillary plexus block is a common technique for upper limb surgeries, providing adequate analgesia and muscle relaxation. Ropivacaine and levobupivacaine are widely used local anaesthetics, with differences in onset time, duration of the block, and postoperative analgesia. Aim and Objective: To compare the efficacy of ropivacaine with 0.75% and levobupivacaine with 0.5% in ultrasound-guided axillary plexus block. This comparison is crucial for understanding the differences in onset time, duration of the block, and postoperative analgesia between these two widely used local anaesthetics. Materials and Methods: This prospective, randomized, double-blind clinical trial was conducted at SVBP Hospital, affiliated with LLRM Medical College, Meerut, involving 80 patients aged 18-65 with ASA physical status I and II. Patients were randomly assigned to Group A (Ropivacaine 0.75%, 25 ml) and Group B (Levobupivacaine 0.5%, 25 ml). The primary outcomes included the onset and duration of sensory and motor blocks. Secondary outcomes were postoperative analgesia, hemodynamic parameters, and complications. Data were analyzed using SPSS version 20.0, with a p-value of <0.05 considered statistically significant. Results: The mean onset time for sensory block was significantly faster in Group A (7.92 ± 1.01 min) compared to Group B (10.35 ± 1.17 min, p = 0.011). Similarly, motor block onset was faster in Group A (9.10 ± 0.87 min) than in Group B (11.27 ± 1.11 min, p = 0.005). The duration of the sensory block was shorter in Group A (9.21 ± 0.87 hrs) compared to Group B (12.25 ± 1.20 hrs, p = 0.032). Motor block duration was also shorter in Group A (8.54 ± 0.87 hrs) than in Group B (11.41 ± 1.17 hrs, p = 0.023). Postoperative analgesia lasted longer in Group B (12.93 ± 1.08 hrs) compared to Group A (9.93 ± 0.86 hrs, p = 0.038). Two patients in Group A experienced nausea and vomiting, while no complications were observed in Group B. Conclusion: Ropivacaine 0.75% provides a faster onset of sensory and motor blocks, while Levobupivacaine 0.5% offers a longer duration of both blocks and postoperative analgesia. Both agents were well-tolerated, with minimal complications. The choice between these two anaesthetics should be guided by the clinical scenario, depending on whether a faster onset or longer duration of block is required.

Background: The purpose of study is to study the profile, methods of assessment and trial of various low vision devices of low vision patients in our tertiary eye institute. Methods: A prospective, non- interventional observational study of 150 patients with low vision satisfying the WHO criteria for low vision was conducted over a period of 5 months in our tertiary eye institute after obtaining informed consent and considering the relevant inclusion and exclusion criteria. Patients were subjected to detailed history taking, a thorough ophthalmic examination and low vision assessment at low vision clinic. The suitable type, power and magnification of low vision devices was identified for each patient and trial given. The improvement in the optical performance with the low vision device was noted. The data thus obtained was recorded in excel sheet and analyzed using descriptive statistics. Results: Out of 150 patients, males were 56.7% and 43.3% were females with mean age of 29.4 years. Most common cause of low vision was pathological myopia. 49.3% patients had difficulties in near tasks followed by combined near and distance tasks, difficulties in distance activities, issues with mobility and night vision. Dome magnifier was most common and accepted device prescribed [37.3%] for near tasks and binocular telescope for distance tasks [76.3%]. Conclusion: A thorough clinical evaluation of low vision patients is very important to identify their functional vision and needs. Tailored prescriptions based on individual clinical profiles and preferences are crucial for optimal outcomes.

Background: Benign soft tissue swellings (BSTS) are a common clinical presentation in tertiary care settings. Accurate diagnosis and management rely heavily on a combination of clinical assessment and radiological imaging. This study aims to evaluate the clinicoradiological approach to diagnosing BSTS in a tertiary teaching hospital. Methods: A prospective study was conducted on patients presenting with soft tissue swellings at a tertiary teaching hospital over nine months. Clinical examination and history-taking were followed by radiological evaluations, including ultrasound (USG), magnetic resonance imaging (MRI) and computed tomography (CT) and histopathology when necessary. Data on patient demographics, clinical features, radiological and histopathological findings and final diagnoses were collected and analyzed. Results: A total of 100 patients were included in the study. USG was the first-line imaging modality used in all cases, providing definitive diagnoses for 98% of benign, and 2% malignant lesions. MRI was employed in 3% of cases with equivocal or suspicious lesions, offering superior detail for deep-seated and vascular swellings. HPE was utilized in 10% of cases to assess atypical cases to confirm the findings obtained from USG. The most common benign lesions identified were lipomas, epidermal inclusion cysts and ganglion cysts. Radiological findings were consistent with clinical diagnoses in 90% of the cases. Conclusion: The integration of clinical and radiological evaluations is crucial for the accurate diagnosis and management of benign soft tissue swellings. USG remains the primary imaging tool, with MRI and histopathology and detailed insights when necessary. Early and precise diagnosis through a clinicoradiological approach ensures optimal patient care and management outcomes.

Palmoplantar warts are quite resistant to treatment, so treating them is a challenge as ablative modalities lead to pain, temporary immobility, secondary infections, and scarring. The treatment of warts using immunotherapeutic methods and cytotoxic methods is being increasingly used to overcome drawbacks in the treatment of warts. Aim: To evaluate the efficacy and safety of intralesional mumps‑measles‑rubella (MMR) vaccine versus 5‑fluorouracil (5‑FU) in the treatment of palmoplantar warts. Materials and Methods: A total of 36 patients were divided into two groups of 18 each, MMR and 5‑FU groups, respectively. The patients in the MMR group were given 0.1ml ‑ 0.5ml of intralesional MMR vaccine in each lesion depending on the dimensions of the lesion and was repeated at 2 weekly intervals until complete clearance or a maximum of six doses. The patients in the 5‑FU group were given 0.1ml ‑ 0.5ml of intralesional injection of a solution containing 4 mL of 250 mg/mL of 5‑FU and 1 mL of a mixture of 20 mg/mL (2%) lidocaine and 0.0125 mg/mL of epinephrine, which was given at 2 weekly intervals until complete clearance or maximum six doses. Results: In our study, warts had resolved in all 18 (100%) patients belonging to the MMR group by the 12^th week, whereas 11 (61.11%) patients still had warts among the patients belonging to the 5‑FU group (i.e., warts had resolved only in 7 (38.89%) patients at the end of 12^th week), which was found to be statistically significant (P‑value < 0.05). Conclusion: MMR vaccine is a safe and effective treatment modality for palmoplantar warts compared to 5‑FU in the selected study population.

Objective: The current study was done to compare the embryo quality of an uninterrupted embryo culture compared to conventional embryo culture and assessment on clinical outcomes in couples undergoing Assisted Reproductive Technology (ART). The study will compare the fertilization and cleavage rates and implantation rate between conventional culture system and uninterrupted culture. Methods: A total of 1000 patients were included in this study who have enrolled for ART for various etiologies, among which 500 patients (Group A) belonged to conventional culture system and 500 (Group B) belonged to the uninterrupted culture system group who fulfilled the criteria were included in the study. Embryo morphology evaluation in group-A. After ICSI, injected oocytes are transferred to 4- well dish kept in groups with 1-well filled with 500μl of cleav media kept in standard bench top incubator (MINC). Results: The study found no significant age difference between Group A (mean age 32 years) and Group B (mean age 31 years). Male factor infertility was more common in Group A, while female factor infertility was more common in Group B, though neither difference was significant. Group B showed better outcomes in embryo quality, implantation, and ongoing pregnancy rates, despite Group A having better oocyte and sperm grading. Fertilization and cleavage rates were similar, but Group B had more top-quality embryos and a significantly higher number of embryos per patient, indicating the benefits of an uninterrupted culture system. Conclusion: This study shows that uninterrupted culture systems can enhance embryo quality, implantation efficiency and clinical pregnancy rate in ART. Consequently, these findings pose the uninterrupted culture system as a plausible candidate for enhancing ART success, which may translate into improved overall patient outcomes in fertility treatments.

Introduction: Pediatric femoral shaft fractures are more commonly seen in children of age 1-6 years. Different treatment approaches are used based on the age, fracture characteristics, and preferences of the surgeon. Previously Spica casting was the primarily used treatment option but other treatment options like intramedullary nailing and plate osteosynthesis have become common in recent years. Aim and Objective: To evaluate the demographics and treatment trends in pediatric femoral shaft fractures in children aged 1-6 years. Methods: Data was collected from 87 patients with femoral shaft fractures in children with age 1-6 years retrospectively. Demographic data like age, sex, ethnicity, and treatment modalities were analyzed. Treatment options like Spica casting, intramedullary nail, plate osteosynthesis, brace, splinting, external fixation and others were included. The statistical was performed using ANOVA, chi-square test, and t-test. Results: Spica casting was the most often used treatment (71.2%), and the majority of patients were males (77%), were between the ages of 1-3 years (72.4%). By age group, however, treatment trends differed considerably. While older children (ages 4-6) were more likely to receive intramedullary nails (37.5%) or plate osteosynthesis (25%), spica casting was more common in younger children (92% in ages 1-3). Spica casting has been less common over time, but intramedullary nails and plate osteosynthesis have become more common from 2016 to 2020. Conclusion: Patients aged 1-3 years are more likely to receive non-surgical methods like spica casting, whereas children aged 4-6 years are more likely to have surgical procedures like plate osteosynthesis and intramedullary nails.

Aim: To elucidate correlation between serum vitamin D levels and iron status in pregnant women and to generate hypothesis for supplementation of vitamin D in iron deficient patients. Methods: It is a prospective observational study of 100 pregnant women, recruited at the Dept of OBGY at Pacific Institute of Medical Sciences, Umarda, Udaipur. Descriptive analysis was performed for the demographic characteristics. Spearman’s correlation test was used to determine the strength of correlation between vitamin D and the complete blood count parameters. Each outcome variables whose levels were with a P (< 0.05) is significant. Results: For the 100 recruited patients, the mean haemoglobin level was 9.35±0.89 g/dL, iron at 73.0±15.3 microgram/dL, ferritin at 13.0±3.8 ng/mL. There was a moderate positive correlation observed between vitamin D and haemoglobin (rs = 0.49, n = 101 p< 0.001). A strong positive correlation was noted between vitamin D and iron (rs = 0.788, p< 0.000), transferrin (rs = 0.740, p< 0.001), ferritin (r = 0.783, p< 0.001), hematocrit (r = 0.729, p< 0.001). A strong negative population of pregnant women, it is suggestive that the low vitamin D levels are correlated with lower hemoglobin and ferritin levels. Further investigations needs to be conducted to elucidate whether there is a direct causal effect of vitamin D deficiency and iron deficiency anaemia.

Background: Orthopaedic hip fractures are the predominant condition among aged people. An optimal preoperative pain management that reduces the use of opioids and mitigates their negative consequences is crucial in this specific group. Aim and Objectives: The purpose of this study is to assess the effectiveness of Ultrasound guided Fascia Iliaca Compartment block (FICB) compared to Pericapsular nerve group (PENG) block in enabling the positioning for spinal anaesthesia and post-operative analgesia during surgeries for hip fracture. Material and Methods: Following the approval of institutional ethical committee, a prospective interventional study was conducted on 46 patients aged 18-80 years, of either gender, who were classified as ASA class I, II, and III. These patients were randomly selected to receive either an Ultrasound guided PENG block (Group A, n=23) or a FICB block (Group B, n=23) using 40ml of 0.2% Ropivacaine. Prior to and after 30 minutes of the block, as well as while placing the patient for spinal anaesthesia, the blinded observer evaluated Visual Analogue Scale (VAS) scores at rest, with passive leg raise to 15°. The duration of postoperative pain relief and the level of patient acceptability were also documented. An analysis of the data was conducted using SPSS version 20. Statistical analysis was conducted on continuous and categorical data using the suitable statistical approach. A significance level of P ≥ 0.05 was used to determine statistical significance. Result: Subjected to a passive leg raise to 15° when at rest, the VAS scores in the PENG and FICB groups showed a substantial reduction (P<0.001). Following 30 minutes of administering the PENG block, the VAS scores at rest and passive leg raise were 0.4±0.5 and 1.01±0.7, respectively. In contrast, the VAS scores at rest and passive leg raise with the fascia iliaca block were 1.1±0.7 and 1.6±0.8, respectively, with statistically significant p-values of 0.001 and 0.022, respectively. The Visual Analogue Scale (VAS) score 30 minutes after the block during placement was 2.1±0.6 in the FICB group and 1.6±0.7 in the PENG group (P=0.008). A substantial difference was seen in the duration of analgesia between the PENG group (487.73±38.61 minutes) and the FICB group (431.74±25.16 minutes) (P<0.001). Requirement for postoperative opioid rescue analgesia was much lower (P=0.011) in the PENG group compared to the FICB group. Superior patient acceptability was noted in the PENG group (P=0.028). Conclusion: The effectiveness of PENG block in delivering analgesia before positioning the patients awaiting hip surgery under spinal anaesthesia surpasses that of fascia iliaca block. However, both the blocks successfully maintained haemodynamic stability without any significant adverse consequences.

Background: In placenta previa, the placenta attaches lower in the uterus. This results in some portion of the placental tissue covering the lower uterine segment. It can result in bleeding during the pregnancy or during or after delivery. Objective: to determine the frequency of placenta previa and to determine the risk factors and feto-maternal outcomes in placenta previa in previously unscarred and scarred uterus groups. Methods: This is an observational study which involved 130 patients diagnosed with placenta previa after satisfying the inclusion criteria. The demographic data, maternal morbidity indicators, maternal mortality, fetal parameters morbidity parameters like prematurity, low birth weight and need for ICU admission as well as mortality parameters such as still births and neonatal mortality rates. Results: Mean age of the study population was 27.12±4.426years. Incidence of placenta previa among scarred uterus was 1.32% and in unscarred uterus was 0.67%. High parity, high abortion rate, multigravida status, less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Causes of scarred uterus in this study was previous LSCS (54.61%), previous D&C (10.8%) and previous myomectomy (10%). Complete placenta previa, anterior placental position and adherent placenta were significantly associated with scarred uterus compared to unscarred uterus. Antepartum hemorrhage and postpartum hemorrhage was higher in scarred uterus compared to unscarred uterus. Rate of caesarean hysterectomy was higher in scarred uterus, along with statistical association to previous LSCS. Maternal ICU admission rate was higher in scarred group, also showed its statistical association with previous LSCS. Neonatal outcomes in terms of pre-term birth, still birth, NICU admission and neonatal death though higher in scarred group, did not differ statistically among both the groups. Conclusions: This study highlighted the therapeutic implication of placenta previa and its management along with risk factors in scarred uterus compared to unscarred uterus.

Background: Air pollution, particularly from vehicular emissions, is a significant public health concern globally, with respiratory disorders being one of its major health impacts. Traffic police, due to their long-term exposure to traffic-related air pollutants, are at an increased risk of respiratory issues. In India, the increasing number of vehicles and inadequate pollution control measures have exacerbated air quality problems, particularly in urban areas (NAAQMS, 1989-1993; GPCB, 2007-2011). Prior studies have demonstrated that vehicular pollutants like particulate matter (PM), nitrogen oxides (NOx), and sulfur dioxide (SO2) contribute to impaired respiratory function and increased respiratory morbidity. Objectives: This study aims to assess the impact of long-term exposure to vehicular air pollution on the respiratory health of traffic police officers in Ahmedabad, with a focus on key respiratory function indicators such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Peak Expiratory Flow Rate (PEFR). Methods: A cross-sectional study was conducted involving 100 male traffic police officers aged 20-60 years. Participants were divided into two groups: the exposed group, comprising 50 officers with more than five years of exposure to vehicular emissions, and the control group, comprising 50 officers with minimal exposure, working in administrative roles. Pulmonary function tests (PFTs) were performed using a spirometer to assess FVC, FEV1, and PEFR. Participants were further divided into smokers and non-smokers to examine the combined effects of smoking and pollution exposure on respiratory health. Results: The study found that traffic police exposed to vehicular pollution had significantly lower lung function compared to the control group. The FEV1 levels in the exposed smokers were significantly reduced (1.95 ± 0.27 L) compared to the control non-smokers (2.75 ± 0.35 L), indicating an obstructive pattern of respiratory impairment. The FEV1/FVC ratio was also lower in the exposed group, particularly among smokers, suggesting compromised lung capacity due to prolonged exposure to pollutants. PEFR values also showed a marked reduction in the exposed group. Conclusion: Prolonged exposure to vehicular emissions has a significant negative impact on the respiratory health of traffic police, especially in smokers. The study highlights the need for protective interventions, such as regular pulmonary function monitoring and the provision of protective masks, to reduce the health risks associated with air pollution exposure. Urban planning and pollution control measures must be strengthened to mitigate these health hazards in high-exposure occupations (WHO, 2000).

Background: Laparoscopic surgeries often involve insufflation of the peritoneum to create a pneumoperitoneum, which can cause significant physiological changes. These include alterations in end-tidal carbon dioxide (ETCO₂) and hemodynamic parameters such as blood pressure and heart rate. This study compares these effects before and after insufflation, enhancing understanding of how pneumoperitoneum impacts patient safety during laparoscopic procedures. Methods: Patients received a standard anesthetic technique with continuous monitoring (ECG, NIBP, Pulse Oximeter) recorded every 5 minutes. Premedication included ondansetron, glycopyrrolate, and midazolam. General anesthesia was administered, and baseline, intraoperative pulse rate, ECG, NIBP, SpO₂, and ETCO₂ were monitored. ETCO₂ values were recorded at baseline and intervals after pneumoperitoneum. Post-surgery, patients were reversed and extubated, with any complications related to pneumoperitoneum noted. Results:  Pneumoperitoneum leads to a significant increase in ETCO₂ levels. The rise in ETCO₂ is more pronounced at higher intra-abdominal pressures and with longer durations of insufflation. ETCO₂ levels gradually returned to baseline after the pneumoperitoneum was released. Pneumoperitoneum was associated with a significant increase in systolic and diastolic blood pressure. Heart rate also increases following the introduction of pneumoperitoneum. Mean arterial pressure (MAP) rises due to the combined effects of increased systolic and diastolic blood pressure. Conclusions: Pneumoperitoneum has a significant impact on both respiratory and cardiovascular parameters during laparoscopic surgery. The introduction of pneumoperitoneum can lead to hypercapnia (increased ETCO₂) and a hypertensive response. The effects of pneumoperitoneum on ETCO₂ and hemodynamic parameters are generally transient, with a return to baseline levels after the pneumoperitoneum is released.

Background: Oxytocin is the main uterotonic drug for avoiding post-partum hemorrhage (PPH), which is a major cause of morbidity for mothers. Clinical studies have shown that carbetocin can reduce PPH risk without increasing the risk of major side effects. The purpose of current investigation was to evaluate carbetocin’s potential for PPH prophylaxis. Methods: In this observational analysis, 100 women who had blood loss and major PPH incidents during vaginal (n=50) and cesarean (n=50) deliveries were included. Of these, half had carbetocin at tertiary care facility over the course of study period, which lasted for 2 years from January 2022to December 2023. With SPSS version 25.0, the blood loss was approximated, and the findings were examined. Results: Between the groups having vaginal and cesarean deliveries, the mean age (~31 years), mean body mass index (~27kg/m2), and mean parity (~1.4) were comparable between those who received prophylactic carbetocin and those who did not. The intrapartum blood loss during vaginal birth was 227.28±157.32ml and 249.17±179.35ml, respectively; p=0.0873 for women treated with and without carbetocin. During CS, women who received carbetocin prophylaxis had significantly less mean± SD blood loss [651.47±321.58ml] than those who did not [831.38±361.96ml; p=0.0001]. Overall, total blood loss was considerably lower in women getting carbetocin prophylaxis than in those not (p<0.001). Conclusion: The preventive use of carbetocin significantly decreased blood loss during caesarean sections in cases of PPH when compared to vaginal deliveries.

Background: Pre-eclampsia (PE), characterized by hypertension and proteinuria, poses significant risks to maternal health, including eclampsia and mortality. Vitamin D, essential for immune modulation and vascular health, showed potential in reducing the risk of pre-eclampsia and showed to potentially prevent hypertensive complications during pregnancy. This study aims to evaluate the role of vitamin D in preventing pre-eclampsia and eclampsia, along with finding out its correlates and associated maternal and perinatal outcomes. Methodology: This study was conducted in the department of obstetrics and gynaecology at Calcutta National Medical College and Hospital, Kolkata, over one and a half years among 111 ante-partum women admitted through the obstetric emergency or referred to the hospital, fulfilling inclusion & exclusion criteria. Ethical clearance and informed consent were sought. Data were collected by using a predesigned pretested semi-structured questionnaire following clinical examination and biochemical tests. Data were analyzed using SPSS, summarizing categorical variables as counts and percentages. Inferential statistics measured by Chi-square test. P-value <0.05 was considered statistically significant. Result: Pre-eclampsia and eclampsia were observed in 15.3% and 6.3% of women respectively. About 24.5% of mothers who had developed pre-eclampsia had suboptimal levels of Vitamin D. Most pre-eclamptic mothers delivered by caesarean section (47.1%), with one-fourth of their babies being low-birth weight and 41.7% required SNCU admission. Conclusion: The potential link between suboptimal vitamin D levels and pre-eclampsia emphasized the importance of antenatal supplementation and further research to establish standard guidelines to prevent pre-eclampsia.

Introduction: This study assesses the efficacy and safety of Total Turbinectomy, Partial Turbinectomy, and Microdebrider Turbinoplasty in treating inferior turbinate hypertrophy. Methodology: Conducted at the Gayatri Vidya Parishad Institute of Health Care & Medical Technology, Visakhapatnam, the retrospective analysis involved 120 patients, divided into three groups based on the surgical technique employed. Results: Total Turbinectomy provided the highest nasal airway improvement (85%) but also the highest complication rates. Conversely, Microdebrider Turbinoplasty, with the lowest improvement rate (75%), had the fewest complications, suggesting a safer profile. Conclusion: While Total Turbinectomy is more effective at improving airway functionality, its higher risk of complications makes Microdebrider Turbinoplasty a safer alternative for those with less severe symptoms or higher-risk aversions. Recommendation:  Surgical choices should align with individual patient needs and risk profiles to optimize safety and effectiveness.

Background: Hemoglobin measurement is a critical diagnostic tool in clinical practice, traditionally performed using laboratory methods like the cyanmethemoglobin technique. However, these methods require significant time and resources, which may only be feasible in some healthcare settings. Digital haemoglobin meters offer a rapid, point-of-care alternative, but their accuracy compared to standard is always a point of discussion. Aim and Objective: To evaluate the diagnostic accuracy of HB SPOT (Proactive Health Inc.) a digital haemoglobin measurement meter, focusing on its sensitivity, specificity, and bias compared to the cyanmethemoglobin method. Materials and Methods: A cross-sectional study was conducted on 150 participants at Department of Pathology, GMERS Medical College, Porbandar, Gujarat, India a tertiary care Hospital of Western India between October 2023 to April 2024. Haemoglobin levels were measured using both a digital haemoglobin meter and the cyanmethemoglobin method. Sensitivity, specificity, and bias were calculated and assessed using the Bland-Altman method. The HB SPOT performance was evaluated for its sample volume requirement (<10 µL), rapid measurement time (within 10 seconds), reagent-free technology (microcuvette), auto-calibration, and wide measuring range (0-25 gm/dL). Results: The HB SPOT demonstrated a sensitivity of 86.7% and a specificity of 88.4%. The mean bias was 0.03 gm/dL, with limits of agreement from -1.00 gm/dL to 1.06 gm/dL. These results align closely with the reference method, indicating the HB SPOT reliability in clinical settings. Conclusion: The HB SPOT demonstrates high diagnostic accuracy, with sensitivity and specificity exceeding 80% and minimal bias compared to the reference standard. Its features, including minimal sample volume, rapid reading time, reagent-free operation, auto-calibration, and broad measuring range, make it a valuable tool for point-of-care haemoglobin assessment, especially in resource-limited or urgent care settings. The findings of this study underscore the potential of digital haemoglobin meters to revolutionize clinical practice, particularly in settings where rapid diagnosis is crucial.

Objectives: The present study was to evaluate the prevalence and assess the severity of diabetic retinopathy associated with HbA1C level in a tertiary care center, Muzaffarpur, Bihar, India. Methods: Ophthalmic evaluation comprises of measurement of best corrected visual acuity was recorded using Snellen chart for distant vision and near vision using Jaeger chat. A Goldman applanation tonometer was used to measure the intraocular pressure. Slit lamp bio microscopy was used to evaluate anterior segment. HbA1C level estimation was performed by withdrawing 3 ml of blood sample of patient’s peripheral vein collected and sent to the pathology laboratory. According to HbA1C level patient were grouped into good control, fair control and poor glycaemic control. Results: A total of 50 type 2 diabetes mellitus patients were enrolled. Most of the cases 16(32%) were in age group of 46-55 years. Mean age of the cases was 52.45 ±12.65 years. Most of the cases 34(68%) were males. Mean duration of cases with type 2 diabetes mellitus was 13.12± 1.76 years. HbA1c level of 13(26%) patients had less than 7, 10(20%) had 7-8. And HbA1c level of most of the cases had greater than 8. out of 22 NPDR cases, 7 cases were with CSME and 15 were with without CSME. HbA1c concentration was significantly higher in the NPDR and PDR groups compared to the No DR group patient. Conclusions: Older age male patients with type 2 diabetes mellitus patients are preponderance to retinopathy. Increase level of HbA1C corresponds to a higher prevalence of diabetic retinopathy. And statistically significant association is seen between increase level of HbA1C and severity of retinopathy in type 2 diabetes mellitus patients.

Background:  Pleural effusion is an excessive accumulation of fluid in the pleural space  . Pleural effusion is not a disease entity per se rather it’s a manifestation of a complication of the pulmonary or non-pulmonary diseases. The causes of Pleural Effusion are too many. Pleural fluid analysis by cytology and cell block remain the mainstays for diagnosing etiology of pleural effusion. Objectives: This study aimed to perform cytological analysis of pleural fluid to find out its etiology and to find prevalence of these etiologies with respect to age and sex. Materials and Methods: This cross-sectional study was carried out at tertiary care hospital of ASMC, Firozabad, Uttar Pradesh on 100 patients of Pleural Effusion coming to the Department of Pathology for cytological analysis of the Pleural fluid over a period of 1 year from January 2023 to December 2023. Results: Out of total 100 cases of pleural effusion studied ,our study found Tuberculosis to be the most common cause of pleural effusion in Firozabad region(82%) followed by malignancies  in which most common was Lung Adenocarcinoma (8%) followed by Carcinoma breast(2%) and Ovarian Adenocarcinoma. Conclusion: Most common cause of pleural effusion in Firozabad region is Tuberculosis followed by malignant pleural effusion.

Introduction: VACTERL association is a rare and complex congenital disorder characterized by the presence of anomalies in at least three organ systems. Case Report: A male neonate, delivered at 35 weeks of gestation via elective lower segment Cesarean section (LSCS) due to severe maternal polyhydramnios, presented with multiple congenital anomalies shortly after birth. The constellation of these anomalies led to the diagnosis of VACTERL association. A multidisciplinary neonatal care team, post-operative course was complicated by a transient period of neonatal sepsis, successfully treated with broad-spectrum antibiotics. Finally the patient was discharged.

Introduction: The metabolic syndrome is a concept rather than a disease in itself. It is a prothromboitic and pro inflammatory state that is associated with increased risk of cardiovascular disease and type 2 diabetes mellitus. Serum Ferrtin is a well-established biomarker used to assess degree of inflammation in various clinical conditions. Hence, aim of our study was to explore the association of serum ferritin levels with the components of metabolic syndrome (abdominal obesity, dyslipidemia, hypertension, and hyperglycaemia) and insulin resistance and comparison with healthy controls. Material and Method: Present study was conducted at SMS Medical College, Jaipur from April 2021 to August 2022.30 cases of metabolic syndrome (Group 1) and 30 healthy controls (Group 2) were enrolled. Detailed history, clinical examination and anthropometric measurements were taken of all the subjects of both groups. Serum ferritin was measured and its association with various components of metabolic syndrome and insulin resistance was investigated. Study parameters were analyzed by statistical tests including student’s t-test, X² analysis, multiple regression analysis. Results: Serum ferritin level was considerably (p<0.001) higher in cases (mean 552.9±464.44 mcg/L)) compared to controls (mean 212.77±74.07 mcg/L) and it has significant correlation with waist circumference (p<0.01), neck circumference (p<0.02), fasting blood glucose (p<0.002), fasting insulin level (p<0.05) , level of insulin resistance (HOMA IR) (p<0.01), S. Triglycerides (p<0.05) and S. VLDL (p<0.04) in the case group when analyzed by linear regression analysis. Conclusion: Our findings based on community-based data showed that higher serum ferritin levels though in the normal range are associated with obesity, components of the metabolic syndrome and insulin resistance. These observations not only suggest a good correlation with serum ferritin, but also emphasize that serum ferritin can also be used as a marker for insulin resistance and metabolic syndrome.

Background: Palliative care patients are vulnerable to a range of psychological and mental health problems, including depression and anxiety. The patient usually undergoes various stages of treatment before reaching the Palliative care Centre. A variety of factors related to the cancer and its treatment are likely to impact on the development of depression and anxiety, including the type of cancer, stage and prognosis. The present cross-sectional study was planned to estimate the prevalence of depression and anxiety and to assess the associated factors in patients attending palliative care center, SMS Jaipur. Aim: To screen patients with various malignancies for the presence of depressive and anxiety disorders using standardized rating scales. Materials & Methods: Five hundred and twenty-seven (n = 527) patients admitted in the Palliative Care Centre, SMS Hospital, Jaipur were included in the study who completed the Patient Health Questionnaire‑9 and Generalized Anxiety Disorder‑7 (GAD‑7) Questionnaire. Results: Out of 527 patients, majority of patients (73.06%; n=385) were suffering from one or more psychiatric co-morbidity in the form of either isolated anxiety or depression or both. 31.5% had both anxiety and depression, 26.57% had only depression and 14.99% had only anxiety. In 46.49% cases anxiety was present (GAD score ≥8). Prevalence of anxiety was more in younger population i.e. ≤40 years (48.25%, n=55), rural population (52.74%, n=154), patients with advanced or metastatic stage of malignancy (54.19%; n=168), patients receiving multiple modalities (53.81%) of treatment were more likely to suffer from anxiety followed by those receiving radiotherapy (45.71%) and chemotherapy (41.58%). In 58.06% cases depression was present with PHQ score ≥10, the mean age of cases having depression was 50.60 years. Prevalence of depression was more in rural population (65.75%, n=192), patients from lower socioeconomic status (60.56%, n=261), patients with advanced or metastatic stage of malignancy (65.16%; n=202), patients receiving multiple modalities (86.02%, n=203) of treatment were more likely to suffer from depression followed by those receiving radiotherapy (48.57%, n=17) and chemotherapy (41.58%, n=42). Conclusion: Compared to the general population, the prevalence of anxiety and depression is often higher among people with cancer, but estimates vary due to a number of factors, such as demographic factors (age, sex, residence, socioeconomic status), the type of cancer, stage of cancer and received treatment.

The destructive potential of tyre blast accident has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. We report a case of a 50 year old mechanic who sustained chest wall injury due to blast of truck tyre while insufflation. He was having multiple fracture of ribs on both the sides. He was known case of DM, Hypertension, COPD, Peptic ulcer disease and CLD. The patient was managed initially with positive pressure ventilation and bilateral intercostal tube drainage and showed improvement. Later on, he developed sepsis and ultimately succumbed to his illness. This case report highlights the destructive potential of high energy blast in civilian society.

Introduction: There is significant changes in thyroid gland in pregnancy. Numerous outcomes for the mother and the foetus are impacted by maternal thyroid problems. Preterm labour, abruptio placenta, abortion, and pre-eclampsia are the main obstetric complications, whereas prematurity, low birth weight, stillbirth, and perinatal mortality are the main foetal issues. Untreated mothers have a significant impact on their offspring’s future intellectual development. Objective: To study the maternal and fetal outcomes of antenatal women with deranged thyroid functions. Methodology: All antenatal pregnant females coming in MYH antenatal OPD in their first trimester reporting to the Department of Obstetrics and Gynecology, MGM Medical College and MY hospital, Indore were included in this study. The patients having deranged thyroid profile (S.TSH level- >2.5ug/dl) were followed up for all the three trimester till delivery. Result: A total of 300 cases were studied. In present study majority of the women were euthyroid (60%), followed by 30% of women with sub-clinical hypothyroidism and 6.3% with hypothyroidism. The most common maternal complication were preterm labor and PIH. Majority of the newborn with low birth weight, NICU admission, Meconium stained liquor and respiratory distress belong to sub-clinical hypothyroid mothers. Conclusion: Maternal thyroid dysfunction is associated with significant adverse effects on maternal and fetal outcome emphasizing the importance of routine antenatal thyroid screening in first trimester.

Background: Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. In this article emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Tears of ankle ligaments have been elaborated. Materials and Methods: In a retrospective observational study, patient’s data was collected from tertiary care unit from period of January 2024 to June 2024. Ankle MRI was performed using standard protocol on 100 cases. Results: In this study, 50 percent cases had injury to lateral ligament complex of which 35 percent were anterior talofibular ligament, 5 percent were posterior talofibular ligament and 10 percent were calcaneofibular ligament. It concluded that lateral ligament complex tears are more common than medial ligament complex. Conclusion: MRI visualizes ligamentous anatomy and pathology at the ankle and is being used with increasing frequency in patients following ankle sprains.MR images of ankle ligaments from a sample of patients with ankle pain or injury are presented and reviewed.

Introduction: Osteogenesis imperfecta (OI) and hypophosphatasia (HPP) are examples of inherited bone disorders resulting in bones that fracture — crumble — and ruin. OI results from mutations in the COL1A1 or COL1A2 genes encoding type I collagen, whereas HPP is caused by gene defects affecting bone mineralization, specifically the ALPL gene. In cases of dual mutations, diagnosis and treatment varies between patients. Management is informed by genetic testing, bisphosphonates (for OI), and enzyme replacement therapy (for HPP). Aims and Objective: To analyze various parameters related to multiple fractures, low bone mass, and severe osteomalacia in paediatric patients diagnosed with osteogenesis imperfecta and hypophosphatasia. Method: This prospective observational study evaluated low bone mass, fracture prevalence, and osteomalacia severity in 64 children with Osteogenesis Imperfecta (OI) and Hypophosphatasia (HPP) compared to healthy controls. Bone biopsies were collected and analyzed using histomorphometry and light microscopy imaging after tetracycline labelling. Bone samples were prepared, stained, and evaluated. Result: The study revealed significantly lower height (p = 0.01) and BMD Z-scores (lumbar spine: p < 0.001) in patients with OI and HPP. Elevated serum ALP (p < 0.001), pyridoxal-5′-phosphate (p < 0.001), and changes in pyridoxal (p < 0.001) levels were observed post-treatment. Other findings included significant differences in serum phosphate (p = 0.05), 25-hydroxyvitamin D (p = 0.02), magnesium (p = 0.04), and urinary biomarkers between groups, indicating altered bone metabolism in patients. Conclusion: The study has concluded that there is a significant difference in bone density, metabolic parameters, and bone remodelling rates between patients and controls, indicating distinct bone metabolism profiles. These differences suggest a need for targeted therapeutic strategies for patients with OI and HPP.

Introduction: Carcinoma Cervix, a prevalent malignancy in young women, necessitates early detection and accurate staging for effective management. This study explores the correlation between Magnetic Resonance Imaging (MRI) staging and International Federation of Gynecology and Obstetrics (FIGO) staging for Carcinoma of Cervix. Aims/Objectives: To study the correlation between MRI staging and FIGO staging in Carcinoma of Cervix. To assess the utility of MRI in evaluation of primary invasive carcinoma with respect to location, size, local extent and staging. Study Design: Cross-sectional observational. Results: 60 females were participants in the study with 45% falling in the 41-50 years range. Parity and HPV infection were identified as prominent risk factors. The most prevalent stage of the disease in the study was stage IIA. Staging comparison between clinical examination and MRI revealed varying degrees of correlation across FIGO stages. Interrelated agreement using Kappa statistics was calculated to check for agreement between clinical staging and MRI staging. Kappa value was found to be 0.656 indicating moderate agreement between two investigations. Conclusion: MRI is proven to be more sensitive and specific in detecting early disease as well as early tumour invasion to adjacent structures. MR findings help in early detection and accurate staging of the disease which ultimately help the clinician to tailor the treatment suited for individual patient.

Introduction: The four main types of NCDs are cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes which account for over 80% of all NCD deaths before age 70. Even though it is understood that NCD risk factors are commonly shared, a single risk factor could contribute to several NCDs, and conversely, a single NCD could be the outcome of multiple risk factors. Therefore, understanding the simultaneous presence of risk factors can guide coordinated health system strategies. Aim: This study was conducted with the objective of estimating the prevalence and clustering of risk factors of common NCDs among industrial workers of Upper Assam. Materials and Methods: A community based cross-sectional study was done among permanent employees of a public sector undertaking with an estimated sample size of 330. The study tool was adapted from WHO STEPS wise approach which was used to estimate the prevalence of risk factors. Results: 244 (76.7%) of the study participants were in the 45–59-year age group and 287 (90.3%) were males. Current tobacco use was found in 62.3% of study participants. Harmful use of alcohol was observed in 5.7% of study participants. 98.4% study participants consumed <5 servings of fruits and vegetables. Low physical activity was found in 24.2% of study participants. Overweight and obesity was observed in 51.6% and 12.3% of study participants respectively. Hypertension and raised fasting blood glucose was found in 48.4% and 31.1% study participants respectively. Raised total cholesterol and raised triglycerides was found in 18.6% and 56.9% of study participants respectively. Overall clustering was found in 272 (85.5%) of study participants. Conclusion: The prevalence of most of the behavioural and biochemical risk factors and clustering in the study population was high as compared to studies on different population subgroups across the country. The baseline information on the prevalence of risk factors provided by this study can help this population and their health policymakers in devising proper strategies to reduce the impact of NCDs on the population.

Background: Shoulder discomfort is a prevalent global health issue, affecting 16-26% of the population. Rotator cuff disease, a common cause of shoulder pain, has seen evolving treatment strategies, including both surgical and non-surgical options. Diagnostic imaging is crucial in managing rotator cuff disorders, with ultrasound (USG) and magnetic resonance imaging (MRI) being primary modalities. While MRI is the gold standard, USG offers a cost-effective and accessible alternative. Introduction: This study aims to evaluate the efficacy of USG and MRI in diagnosing rotator cuff tendon abnormalities. USG is favoured for its affordability and convenience, though its diagnostic sensitivity and specificity vary. MRI provides detailed insights but is more costly and less accessible. This study compares these imaging modalities in terms of their diagnostic accuracy for rotator cuff tears. Methodology: A cross-sectional study was conducted over two years at ERA’s Medical College, Lucknow. Forty patients aged 18 and above, suspected of rotator cuff pathology, were included. Patients underwent both USG and MRI evaluations. Exclusion criteria included recent shoulder surgery, ongoing treatment for rotator cuff lesions, and MRI contraindications. Statistical analysis was performed using SPSS software to compare the diagnostic efficacy of USG and MRI. Results: MRI identified partial thickness supraspinatus tears in 57.50% and full thickness in 30.00% of patients. USG detected partial thickness supraspinatus tears in 54.84% and full thickness in 35.48%. For partial thickness supraspinatus tears, USG showed a sensitivity of 65.22%, specificity of 88.24%, and an accuracy of 75.00%. For full thickness supraspinatus tears, USG had a sensitivity of 83.33%, specificity of 96.43%, and an accuracy of 92.50%. The agreement between USG and MRI ranged from moderate to substantial, with Kappa values of 0.511 for partial thickness and 0.817 for full thickness supraspinatus tears. Conclusion: MRI remains the gold standard for diagnosing rotator cuff tears. However, USG demonstrates substantial promise as an effective and cost-effective alternative, particularly for assessing supraspinatus tears. The study highlights that rotator cuff injuries predominantly affect younger males and right-sided shoulders. Incorporating USG into routine orthopedic practice, especially in settings with limited MRI access, could improve early diagnosis and patient outcomes.

Background: Male genital lichen sclerosus (MGLSc) is a chronic, acquired inflammatory skin condition that is strongly associated with significant sexual dysfunction as well as urological morbidity and mortality. The incidence of MGLSc is traditionally considered biphasic, with peaks in infancy and adulthood. However, a recent review suggests the presence of two peaks in adulthood, making the incidence pattern triphasic—an observation consistent with our extensive clinical experience. Additionally, while a possible link between MGLSc and smoking has been proposed, this has not been supported by our clinical findings. Objectives: The primary objective was to clarify the age-specific incidence of genital lichen sclerosus in adult men, while the secondary objective was to investigate the potential relationship between MGLSc and smoking. Methods: We conducted a retrospective review of the medical records of 484 adult MGLSc patients from a specialized male genital dermatology clinic, extracting data on age at diagnosis and smoking history. Results: A biphasic U-shaped age distribution was observed, with two distinct peaks—one in the late 30s and another in the 60s (Hartigan’s dip test: dip-stat = 0.03; p < 0.01). Additionally, 36% of the patients had a history of smoking at some point in their lives. Conclusions: These findings confirm the biphasic nature of MGLSc incidence in adults, supporting earlier theories. Including the well-established pediatric peak, the overall incidence pattern is thus triphasic. The smoking data appear unremarkable compared to existing data on smoking habits in the UK. These results indirectly support the proposed pathogenesis of MGLSc, which involves factors such as urinary micro-incontinence, occlusion, and epithelial susceptibility.

Background: Atopic dermatitis (AD) is driven by a complex etiology involving Th2 polarization, characterized by cytokines such as IL-4, IL-5, IL-13, and IL-31, along with Th17, Th22, and Th1 cells in chronic lesions. Tofacitinib targets this complexity by selectively inhibiting JAK1 and JAK3 receptors, thereby blocking cytokines associated with Th1, Th2, and Th17 responses. We conducted a multicenter, retrospective chart review to evaluate the efficacy and safety of tofacitinib in patients with moderate to severe refractory AD. Materials and Methods: We included 16 adult patients (over 18 years old) with moderate to severe atopic dermatitis (AD) who had previously received systemic therapy with inadequate response. At baseline, we recorded demographic information, prior treatment history, severity scores (using the Eczema Area and Severity Index [EASI] and Scoring Atopic Dermatitis [SCORAD]), and quality of life scores (Dermatology Life Quality Index [DLQI]). Baseline blood tests included a complete blood count, liver function tests, renal function tests, a lipid profile, and an interferon gamma release assay for tuberculosis. Patients were monitored monthly for 6 months, with assessments including severity scores, blood tests, and DLQI scores. Adverse events, if any, were also documented. Results: All 16 patients completed the 6-month trial. Prior to the study, they had been treated with cyclosporine (n = 10), methotrexate (n = 3), or both (n = 3). At baseline, the mean Eczema Area and Severity Index (EASI) score was 23.38 ± 9.56, which improved to 8.50 ± 7.57 by the end of the study. The mean Scoring Atopic Dermatitis (SCORAD) score decreased from 41.25 ± 8.69 to 14.93 ± 7.82 over the same period. Quality of life also showed significant improvement, with the mean Dermatology Life Quality Index (DLQI) score rising from 15.18 ± 2.73 at baseline to 5.31 ± 4.11. No severe adverse reactions were reported; however, three patients experienced dyslipidemia and two had altered bleeding times.

Conclusion: Tofacitinib is both a safe and effective treatment for recalcitrant moderate to severe atopic dermatitis in adults.

Introduction: Diabetes mellitus is the leading cause of end-stage renal disease, non-traumatic lower-limb amputation, and blindness. Furthermore, diabetic retinopathy (DR) is the primary cause of visual impairment worldwide. Another complication stemming from diabetes is generalized atherosclerosis, which may manifest as ischemic heart disease, cerebrovascular accidents, or peripheral vascular disease. Utilizing CIMT measurements has been instrumental in predicting cardiovascular outcomes in diabetic patients. Materials and Methods: This observational, cross-sectional study was conducted in tertiary care Hospital and, Kolhapur over a period of 24 months after institutional ethical committee approval. A total of 121 patients satisfying the below inclusion and exclusion criteria were involved in the study. Results: The gender distribution of the study population showed a predominance of males (67.8%) compared to females (32.2%). The mean age was 54.83 years, indicating a middle-aged population. This age group is often associated with an increased risk of chronic diseases such as diabetes and hypertension. The mean CIMT on the right side (CIMT(R)) was 0.8802 mm, while on the left side (CIMT(L)), it was 0.8620 mm, indicating slightly higher measurements on the right side. Subjects with non-proliferative diabetic retinopathy (NPDR) had higher mean CIMT values (0.9436 mm on the right and 0.91 mm on the left) compared to those without retinopathy (0.8346 mm on the right and 0.82 mm on the left). Those with proliferative diabetic retinopathy (PDR) exhibited even higher values (1.1500 mm on the right and 1.00 mm on the left). Conclusion: The present study provides valuable insights into the gender distribution, demographic and clinical parameters, and prevalence of chronic diseases in a population with Type II Diabetes Mellitus (T2DM). The associations between increased CIMT, diabetic retinopathy, poor glycemic control, and demographic factors underscore the need for comprehensive and personalized management strategies to mitigate the risk of complications in T2DM patients. CIMT, being a non-invasive procedure, should be incorporated into routine examinations of type 2 DM patients at least once or twice a year to look for atherosclerotic changes.

Introduction: In medical education, acquisition of psychomotor skills is critical for patient care, and conventional teaching method (CTM) attains poor acquisition & retention. Therefore, this study aimed to evaluate effectiveness of George & Doto’s five-step method (FTM) compared to the CTM in teaching intravenous (IV) injection skill to undergraduate medical students. Methods: It was a double-blinded randomised controlled trial involving 60 students divided into two equal groups using computerised random number table. Control group was taught IV injection skill using CTM by co-investigator while test group was taught using FTM by investigator with student-teacher ratio of 15:1. Pre-validated feedback forms were given to both groups after teaching sessions & responses were collected. Objectively Structured Practical Exam (OSPE) was conducted using pre-validated checklist & timer after one month by independent examiners. Data were collected & analysed with descriptive statistics, chi-square test & Mann-Whitney U-test using Graph pad 10.2.3 (403). Results: 29 students from each group appeared for OSPE. Statistically significant difference was observed between mean scores of test group (8.5±1.28) & control group (6.1±1.74) (p < 0.001, Mann Whitney U-test). Number of students correctly performed most steps were significantly higher in test group compared to control group (p < 0.05, χ² test). Mean number of students responded, “Strongly agree” in feedback form was 17.9 in test group compared to 12.4 in control group. Conclusion: FTM found to be more effective than the CTM for teaching IV injection skill, however, further research with larger sample sizes and diverse skills is recommended to validate these findings.

Background: Chronic insomnia, a frequent sleep disorder, causes problems sleeping or staying asleep, impairing daytime performance. EEG can be utilised to study insomnia’s neurophysiology and EEG lab architecture. This study examines chronic insomniacs’ clinical variables and sleep EEG patterns. Methods: A cross-sectional study was conducted at Netaji Subhash Medical College in Amhara, Bihta, from February 2024 to July 2024. The sample included 60 chronic insomniacs. Electroencephalogram (EEG) recordings were examined for beta, Slow-Wave Sleep (SWS), and spindle activity during sleep. The researchers employed independent t-tests and Pearson correlation coefficients to find links between EEG patterns and age, treatment history, insomnia severity, and sleep quality. Results: Chronic insomnia patients had considerably higher beta activity at sleep onset and NREM stages (p < 0.01) and reduced SWS (p < 0.01). Lower density and frequency of spindles were observed (p < 0.05). Lower SWS was linked to older age (r = -0.49, p < 0.01), longer insomnia duration (r = -0.38, p < 0.05), and enhanced beta activity significantly associated with worse insomnia severity (r = 0.61, p < 0.01). Pharmaceutical therapy impacted EEG patterns by increasing beta activity and decreasing SWS. Conclusion: The study shows that chronic insomnia is associated with EEG abnormalities such increased beta activity and decreased SWS, reflecting cerebral hyperarousal and altered sleep architecture. These findings support the use of EEG patterns as diagnostic markers and the need for personalised treatment. Researchers can better understand these associations and develop more effective treatments with larger longitudinal studies.

Background: Managing postoperative pain in laparoscopic surgery patients is crucial for recovery and patient satisfaction. The TAP block, using long-acting local anesthetics like ropivacaine and levobupivacaine, offers a promising solution by reducing reliance on systemic opioids. Methods: This randomized study at Dr. Babasaheb Ambedkar Memorial Hospital compared the analgesic efficacy and safety of 0.5% ropivacaine and 0.5% levobupivacaine in 100 patients undergoing laparoscopic surgeries. Patients were monitored for heart rate, blood pressure, and pain over 24 hours post-surgery. Results: There were no significant differences in heart rate, systolic or diastolic blood pressure between the two groups at any time point, indicating similar efficacy and safety profiles for both anesthetics. Conclusion: Both ropivacaine and levobupivacaine provide effective and safe analgesia for TAP blocks in laparoscopic surgeries, with no significant differences in hemodynamic responses or analgesic outcomes.

Background: Chronic rhinosinusitis (CRS) is a prevalent condition that significantly impacts the quality of life and productivity, necessitating precise diagnostic and therapeutic approaches. Functional Endoscopic Sinus Surgery (FESS) is a common intervention for CRS, where accurate preoperative imaging is crucial for effective management. This study aims to assess the correlation between preoperative computed tomography (CT) findings and intra-operative observations during FESS. Methods: A prospective, comparative study was conducted at Jhalawar Medical College, involving patients with CRS who failed medical management. Preoperative CT scans were evaluated for anatomical variations such as deviated nasal septum, concha bullosa, paradoxical middle turbinate, and medialised uncinate process. These findings were compared with intra-operative observations during FESS. Statistical significance was determined using chi-squared tests. Results: The study included 50 patients, with a perfect correlation observed in the identification of deviated nasal septum and concha bullosa (100% concordance). Paradoxical middle turbinates and medialised uncinate processes showed slightly lesser concordance rates, yet significant with chi-squared values exceeding 130 and p-values less than 0.0001, demonstrating the high predictive value of CT in identifying critical anatomical variations influencing surgical outcomes. Conclusion: The study confirms the reliability of CT in preoperatively identifying anatomical variations in CRS, supporting its indispensable role in planning FESS. The high concordance between CT findings and intra-operative observations underscores the importance of CT scans in enhancing surgical precision and patient outcomes.

Introduction: COVID-19, caused by SARS-CoV-2, has led to significant mortality globally and is associated with various hematological abnormalities. This study evaluates the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as predictive factors for critical illness in COVID-19 patients. Methods: 500 COVID-19 patients admitted to R. D. Gardi Medical College, Ujjain, from 2020 to 2022 were analyzed. Inclusion criteria involved adults aged over 18 with confirmed COVID-19 via RT-PCR. Exclusion criteria included recent blood transfusions and pre-existing hematological disorders. Hematological parameters were assessed upon admission. Results: Significant differences in hematological parameters were noted among patients categorized by disease severity. Key findings included elevated NLR and decreased hemoglobin levels in severe cases compared to mild and moderate cases (p < 0.001). PLR did not show significant variation across severity levels (p = 0.879). Conclusions: NLR appears to be a valuable predictive marker for disease severity in COVID-19 patients, while PLR may not provide additional prognostic information. Further studies are needed to confirm these findings and explore their clinical implications.

Introduction: Gestational diabetes mellitus is defined as “Carbohydrate intolerance of variable severity with the onset and first recognition during the present pregnancy”. Aims and Objectives: This prospective study conducted over 1 year aimed to investigate the incidence of glucose intolerance in pregnancy by universal screening by DIPSI criteria as a single step procedure with 75 grams oral glucose and its maternal and perinatal outcomes. The study included antenatal patients between gestational age of 14 and 38 weeks irrespective of parity, excluding known case of diabetes, twins, intrauterine fetal demise at initial visit and gestational age less than 14 weeks and more than 38 weeks. Results: The incidence of GDM was more with advanced maternal age, obesity and family history of diabetes mellitus. The patients who tested positive by single step screening method were advised MNT and only few patients diagnosed GDM required Insulin as their line of management. The prevalence of polyhydroamnios and hypertensive diseases was more in glucose intolerant patients compared to normal patients. Also, the study highlights the increased risk of preterm birth and increase in the birth weight of the babies. Conclusion: Glucose challenge test by DIPSI criteria is highly sensitive in ruling out GDM cases. Hence the universal screening by single step procedure is convenient, economical and suitable without sacrificing the sensitivity expected for the ideal screening test. In this study the glucose intolerant patients were closely monitored and Medical Nutritional Therapy (MNT) was advised in all which helped to reduce the adverse obstetric and perinatal outcome.

Background and Aims: Evaluation of patients’ satisfaction is an important aspect for monitoring quality improvement in anaesthesia services which is affected by the preoperative anaesthetist visit significantly. This study aimed to determine the level of patients’ satisfaction with the preoperative anaesthetist visit. Materials and Methods: The present cross-sectional, observational study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, after obtaining approval from Institutional Ethical Committee. Patients of either sex aged between age group 20-70 years (40.62±13.48 years) who underwent elective surgeries in various surgical specialties were included. Data were collected using a questionnaire for patients’ satisfaction with the preoperative anaesthetist visit. Collected data were analysed using SPSS software. Result: In the present study, proportions of males and females were 52.8% and 47.3% respectively among total 400 patients. Regarding satisfaction level of patients with preoperative anaesthetist visit, we found that 92.4% males and 90.5% females were satisfied, 92.6% urban patients were satisfied while 90.3% rural patients were satisfied. 93.0% patients were satisfied in the age range of 20-30 years followed by 91.4% in the range of 30-40, 62.2% in the range of 40-50, 91.2% in the range of 50-60, and 90.5% in the range of 60-70. Patients who had previous exposure to surgery and anaesthesia were more satisfied. Statistical analysis of all these categories were comparable among each other and found to be not significant (p>0.05). 87.8% patients were satisfied with time given by anaesthetist, 90.8% patients were satisfied with anaesthetist answers to questions, 91% patients felt comfortable after anaesthetist visit and 91.5% patients were satisfied with preoperative anaesthetist visit. Conclusion: It is concluded that most of the patients were satisfied with preoperative anaesthetist visit.

Background: Ocular aesthetics, previously sacrificed at the altar of visual function, have an appreciable influence on patient satisfaction. This study assesses how the appearance of one’s eyes and its adnexa affect their perception of themselves, social confidence, and general well-being. Methods: In this study, 300 subjects were recruited from the in-patient department of cosmetic surgery and ophthalmology of SUM Hospital II and IMS. Qualitative insights were obtained from focus groups and in-depth interviews. The quantitative data were obtained from patient satisfaction surveys and VAS evaluations. The patients received different types of ocular aesthetic treatments, such as non-invasive services, blepharoplasty, and eyelash enhancement. Follow-up evaluations after performing the treatment were conducted at one, three, and six months. Results: All measures of post-treatment satisfaction significantly improved (p < 0.001)); the mean overall satisfaction score increased from 2.8 to 4.2, self-perception score increased from 3.0 to 4.3 and the social confidence score increased from 3.1 to 4.4. VAS scores also significantly improved from a baseline of 4.5 to post-treatment scores of 8.2 (p < 0.001). A significant, strong positive correlation (r = 0.82, p < 0.001) was observed between aesthetic improvements and the rise in self-confidence. Themes summarized from the qualitative data: increased self-esteem, positive impact on society, and trust in the medical field. Conclusions: Ocular aesthetic therapies greatly affect patients’ happiness, self-concept, and social confidence. These data on ocular aesthetics justify the rehabilitation of aesthetics in practice by ophthalmologists and within cosmetic medicine, allowing for a holistic concept of health and improvement in global outcomes.

Background: Among the two most common complications of pregnancy, GDM and PE complicate pregnancies in a fashion that highly influences the health of mothers and fetuses. The principal objective of this study is thus to explore the relationship between GDM and PE based on maternal and fetal outcomes. Methods: This is a prospective observational study conducted at M.K.C.G. Medical College & Hospital from August 2022 to June 2024. We enrolled pregnant women diagnosed with GDM and followed them for the development of PE. Maternal outcome markers included change in blood pressure, adverse events, and mode of delivery. Fetal outcomes included birth weight, Apgar score, and neonatal complications. Results: Early data analysis indicates that GDM is strongly associated with the incidence of PE. The incidence of hypertension was also higher among women with GDM compared to those without GDM, reflecting a poor maternal outcome. Fetal outcome was varied regarding birth weight and Apgar scores, hence the maternal glucose influence on neonatal health. Conclusion: This study confirms that close follow-up of women with GDM prevents the onset of PE for the optimization of maternal and fetal outcomes. The underlying mechanism linking both conditions and strategies of intervention need further evaluation.

Introduction: Type II diabetes (DM II) is becoming an epidemic in India with more than 62 million diagnosed diabetics and an increase of nearly 2 million per year.¹ Poor adherence to medication regimens increases the probability of adverse outcomes in type 2 diabetes patients. Therefore, improving medication adherence is a growing priority in controlling this epidemic. Hence, this study was conducted to determine the level of adherence to medication in Type II diabetic patients and to study the various factors affecting medication adherence. Methods: A cross-sectional study was conducted at the medicine outpatient department (OPD) of a tertiary care teaching hospital, in Nuh Haryana among 172 type II diabetic patients for 1 year using a validated structured predesigned proforma and a validated structured scale The Medication Compliance Questionnaire (MCQ) was used to measure adherence to oral hypoglycaemic drugs. Results: A total of 172 participants were included. About 54.65% were males, 87.21% were married, 76.75% were from rural areas, 44.19% had formal education, and 65.70% were unemployed. Medication adherence was seen in 33% participants while 65% were not adherent. Conclusion: The prevalence of medication adherence was 33%. There is a need to improve adherence among type 2 diabetes patients.

Background: One of the most challenging abdominal disorders to treat is chronic discomfort. Persistent abdominal pain is a challenging complaint. The majority of patients in this group would have already had numerous diagnostic tests performed. Without a doubt, diagnostic laparoscopy serves as a crucial bridge between performing a laparotomy and declining to examine a patient’s abdomen. The aim of our study was to evaluate the role of diagnostic laparoscopy in chronic abdominal pain and its correlation with clinical and radiological finding. Methods: 48 patients who were admitted to surgical wards participated in our study. The study included all patients with chronic abdominal pain; patients with acute abdominal pain, uncorrectable coagulopathy, uncorrectable hypercapnia, and pregnant women were not included. Detailed history, physical, baseline blood, and radiographic examinations were done to come the diagnosis. Patients underwent diagnostic laparoscopy, and following informed written agreement, the appropriate surgical therapeutic procedures were performed during the procedure in accordance with the etiology. An assessment was conducted on the effectiveness of laparoscopy in validating the diagnosis and providing clinical care for individuals experiencing persistent abdominal pain. Result: For both sexes, the prevalence of persistent abdominal discomfort was nearly equal. The age range of 31-40% was observed to have the highest frequency. The most frequent laparoscopic discovery was Koch’s abdomen, which was followed by persistent or recurrent appendicitis. Forty-eight patients had a definitive diagnosis made, and 38 individuals had demonstrated pain relief following a diagnostic laparoscopy. Conclusion: High diagnostic and therapeutic efficacy can be achieved with diagnostic laparoscopy. Laparoscopy not only helps identify a condition, but it also has the benefit of typically allowing therapeutic intervention to be performed in the same session, saving the need for a follow-up hospital stay or abdominal investigation.

Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Aim of this study to evaluate the outcomes of open lateral internal sphincterotomy and closed lateral internal sphincterotomy with a cataract knife in terms of operation time, postoperative pain, faecal and flatus incontinence, and hospital stay. Methods: A total of 100 patients with chronic anal fissure were enrolled in this study. Of these, 50 patients underwent open lateral sphincterotomy, and 50 underwent closed sphincterotomy. They were followed up for 8 months post-surgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to flatus were significantly lesser in the closed group (P< 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: In the treatment of chronic anal fissures, closed lateral internal sphincterotomy is superior than open sphincterotomy.

Background: This study compared expectant management (EM) up to 41 weeks to elective induction of labor (e-IOL) in overdate pregnancies (40 1/7 to 40 6/7 weeks). It was a prospective observational study. The primary objective was to compare the rate of Caesarean section in the two groups. Methods: In this study women who met the inclusion and exclusion criteria at 40 weeks of pregnancy were enrolled in the study. There were 112 women in total in the sample. 56 participants in the e-IOL group 1 were induced between 40 1/7 and 40 6/7 weeks of gestation, while 56 participants in the EM group 2 received expectant care until 41 weeks of gestation. Group 2 was further subdivided as follows: Group 2a consisted of women who spontaneously went into labor while under expectant care, and Group 2b consisted of women who were induced for maternal or fetal reasons or at least 41 0/7 weeks gestation while under expectant management. Result: The chance of spontaneous labor increased when expectant care was continued to 41 weeks of gestation past the due date, without negatively impacting the perinatal outcome. In the EM group, 73.2% of participants experienced spontaneous labor, and 78% of them gave birth vaginally. In our study, the rates of cesarean sections using EM (37.5%) were lower than those using e-IOL (58.9%) (p=0.002). Conclusion: Comparing elective induction of labor to expectant management, women with post-date pregnancies undergoing expectant management had lower rates of Caesarean section. There was no discernible difference in the perinatal outcomes of the two groups. Those on expectant management who experienced spontaneous labor had a higher chance of vaginal delivery.

Background: A colostomy is a surgically created opening, or stoma, in the colon, the large intestine. The purpose of this study is to assess colostomy indications and examine associated complications. Methods: From February to July of 2024, a prospective study was conducted in the general surgery department of Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar. This study comprised 118 patients who had colostomies performed in an emergency or elective setting for any reason. Results: Of the 118 cases, males (n = 87 out of 74%) and females (n = 31 out of 118) (26%), were the most usually affected. Thirty-one percent (n=35 out of 118) of the cases were in the age group of 51 to 60. Intestinal blockage (n=28, 23.7%) was the most frequent reason for colostomy development, followed by cancer (n=55, 46.6%). 54 patients, or 46.4% of the total number of colostomy patients, had problems. The study revealed that 25% of the complications were local sepsis, 7% were prolapse, 4% were retraction, 4% were necrosis, 1.6% were parastomal hernia, 1.6% were stenosis, 1.6% were intestinal obstruction, and 1.6% were bleeding.

Conclusion: The most frequent reason for a colostomy is carcinoma of the colon and rectum. The most frequent side effect is local sepsis.

Background: Burn injuries pose a serious health risk due to their high rate of morbidity, disability, and mortality among young and middle-aged individuals. There are societal issues related to burn damage as well. It might be associated with unintentional, suicidal, or homicidal reasons. In India, there is a dearth of study on burn injuries despite their significance from a clinical and societal standpoint. In order to determine the causes of burns, their clinical characteristics, and the outcomes of burn patients’ treatment at our institute, we thus attempted to draw attention to our findings in this study. Methods: From February to July of 2024, patients with burn injuries hospitalized to the surgery wards and burn ICU of SKMCH, Muzaffarpur, Bihar, participated in this observational study. We have examined 226 burn patients who were admitted to our institute’s burn unit and general surgery units. Both sexes and burn patients older than 18 were included in the study. Results: 226 patients in all suffered burn injuries. 162 male and 64 female made up the M:F ratio of 2.53:1.The majority of affected males (71.68%) were compared to females. In this study, the majority of burn patients were between the ages of 21 and 30.that is, 42.02%. Patients in the 50–75 age range were less numerous. Regarding the causes, the greatest number of patients are observed during household activities, with electricity accounting for the second-highest number of cases (26.99%). Suicidal thoughts account for a smaller percentage of patients (3.53), and seven instances have an unclear etiology. Conclusion: Preventing burn injuries is extremely difficult, but it is necessary to reduce the high morbidity and mortality that follow a burn injury. We must take all necessary steps to reduce its occurrence. There is only so much that social workers, physicians, paramedics, and administrators can do to reduce the number of burn injuries that occur in India.

Background: Mifepristone is a steroidal compound that has antiglucocorticoid and antiprogesterone properties. It increases uterine activity, causes cervical effacement and dilatation, needed for the delivery. An attempt is made in the present study to assess the efficacy of single dose of oral mifepristone in third trimester as cervical ripening for induction of labor, fetomaternal outcome in term pregnancy and to know the side-effects of oral mifepristone. Method: 100 women with term pregnancy (37-40 weeks) and Bishop score <6 were recruited, and allocated into two groups. Women who received Tab. Mifepristone 200 mg orally were assigned in Study Group (n = 50) and who received placebo orally were assigned in Control Group (n = 50) At the end of 24 h, change in the Bishop’s score was assessed and Tab. Misoprostol 25 μg was administered intravaginally every 4 h, maximum 6 doses for induction/augmentation of labor. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome. Result: 64% of the patients were observed with improved Bishop’s score. Induction delivery interval was shorter in the study group and noteworthy feature is 46% patients did not require even a single dose of Misoprostol after cervical ripening with Mifepristone suggesting that only Mifepristone may be only drug required in future for induction. Among the babies, 12% in the control group required baby unit admission as compared to 04% in the study group. Conclusion: In the present study, the women who were induced with mifepristone 200 mg per orally showed drastic improvement in cervical score within 24-48 hours and decreased the cesarean rate in the study group and amount of dose requirement of augmentation of labor with Misoprostol or Oxytocin, lesser NICU admission and maternal complication.

Background: Puberty Menorrhagia is a common gynecological disorder among adolescent girls. Puberty menorrhagia when accompanied by anemia and hypoproteinemia poses substantial difficulties among gynecologists to manage. Aims of this study is to find out the haematological status in cases of puberty menorrhagia, evaluate the frequency of haematological disorder in these cases and determine the relative frequency of different haematological disorder. Methods: This observational cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from March 2022 to February 2023. Adolescent girls of age group 11 – 19 years attending Gynaecology OPD or Emergency with excessive Menstrual bleeding who conform to the Inclusion criteria were recruited for the study. Results: The patients under study were adolescent girls of age group 11 – 19 years. The majority of patients (80%) were Between 11 – 15 years and belonged mainly to rural area (50%) and low socio-economic status (50%). Most of the girls (52%) had menarche between 10 – 12 years of age and 70% of Adolescent girls had complaints of menorrhagia with duration of symptomatology of less than 6 months (70%). The cases (84%) had moderate degree of anemia with symptom like weakness, Anorexia, palpitation along with menorrhagia. 6% of cases had low platelet count (<1 lakh) of which all 6% cases were diagnosed as Idiopathic thrombocytopenic purpura. Conclusion: Reassurance, counselling of adolescent girls about reproductive physiology, regular follow- up balanced diet and long-term iron therapy go a long way in treatment of puberty menorrhagia.

Background: Diabetes mellitus and gestational diabetes are complications that may be associated with preterm premature rupture ofmembrane (i.e. PPROM) during pregnancy. We have investigated the impact of gestational and overt diabetes on PPROM through a statistical campaign. Methods: This study was conducted in two parts: In the first part, the PPROM patients (211 cases) were classified into three groups, without diabetes (W/ODM=126 cases), gestational diabetes (GDM=69 cases consist of 44 cases under insulin therapy and 25 cases of diet controlled), and diabetes mellitus (ODM=16 cases). PPROM complications were studied and compared between these three groups. In the second part, GDM patients under insulin therapy or diet control were compared to W/ODM patients in terms of PPROM complications. Results: There were no significant statistical differences between the groups regarding pregnancy outcomes, except for mean gestational age at rupture of membrane and delivery. For maternal outcomes, there were significant changes between groups in terms of labor duration, hospital stay after childbirth, and severe preeclampsia. Fetus and neonatal outcomes suggested that the newborn weight, neonatal hyperglycemia, Apgar score, revive need, infant death, and umbilical cord blood gas test results (except BE) were significantly different between the three groups. Results of the second part of the study, in terms of statistically significant differences between insulin therapy, diet control, and W/ODM are consistent with the first part, for all discussed factors. Conclusion: Results revealed that PPROM protocol management on PPROM cases who have gestational or overt diabetes is applicable and does not have any further risk.

Introduction: Paclitaxel, one of the robust anticancer agents, frequently cause chemotherapy‐induced peripheral neuropathy as an adverse effect leading to dose limiting or withdrawal of the drug. Till date no effective treatment or preventive agents for chemotherapy induced neuropathic pain has shown significant clinical efficacy. Aim: In this present study we evaluated the effect of Phytoestrogen compound Genistein against paclitaxel induced neuropathic pain in wistar rats. Materials and Methods: The animals were divided as four groups with six animals each: Group-I: control group, Group-II: Paclitaxel only group (2 mg/kg i.p.) and Group III & IV received Genistein (10 and 20 mg/kg po) along with Paclitaxel. Paclitaxel induced pain behaviours such as cold allodynia and thermal hyperalgesia were assessed on Day 14 and Day 28 using tail immersion test, tail flick test and Eddy’s hot plate. Results: The present study showed a statistically significant (p<0.01) attenuation of the paclitaxel induced decrease in latency by Genistein (20 mg/kg) in Tail flick test as well as in Eddy’s hot plate compared to Paclitaxel group by Day 28. Conclusion: Our findings suggest the beneficial role of Genistein in the treatment of Paclitaxel induced neuropathic pain.

Background: Isolates of Klebsiella pneumoniae resistant to Carbapenem appears to be most commonly transmitted by hospitalized patients. This may cause infections which lead to mortality. Objective: To investigate the molecular characterization of carbapenem-resistant Klebsiella pneumoniae isolates from various clinical samples. Materials and Methods: The present study was conducted in Pacific Medical College and Hospital. Udaipur, Rajasthan, india.156 consecutive non-repetitive, clinically significant isolates of Klebsiella pneumoniae from various clinical specimens was included in the study. In our study we included clinical samples i.e Urine, Bronchial aspirate, Blood, Pus, Pleural fluid and Sputum. Clinical samples were collected aseptically and transport to Microbiology lab. For the isolation of Klebsiella pneumonia specimens were inoculated onto Nutrient agar, Blood agar and MacConkey agar plates. All plates were incubated aerobically at 37°C and observed    for microbial growth at 24 and 48 hours. Results: Our study indicates that out of 156 isolates of Klebsiella pneumonia, 78 (50%) were isolated from urine samples, 18 (11.53%) were isolated from bronchial aspirate samples. 32 (20.51%) were isolated from sputum culture, 10 (6.41%) were isolated from pleural fluid. 10 (6.41%) were isolated from blood culture, 8 (5.12%) were isolated from pus culture. Highest resistance pattern of Klebsiella Pneumonia was observed against Erythromycin (66.66%) followed by Polymixin B (65.38%), Ampilcilin (61.53%), Amikacin (58.97%) and Gentamycin (53.84) respectively. Conclusion: Our research highlighted high incidence rates for carbapenem-resistant Klebsiella pneumoniae in our tertiary care hospital. Klebsiella pneumoniae increases resistance to the carbapenem group of antimicrobials by producing carbapenemase. For the reservoir of resistance, carbapenemase non-producing isolates act to MBL and KPC production, which were associated with increased mortality and morbidity and can spread within healthcare settings and communities.

Background: Atrophy of spiral ganglion neurons and vestibulocochlear nerve demyelination have been observed in diabetic patients. This demyelination is considered an early pathological change in the peripheral nerves of the extremities, indicating that myelin metabolism disturbances may significantly contribute to diabetic neuropathy. The study aims to identify the early onset of subclinical hearing impairment in children diagnosed with Type 1 Diabetes Mellitus (DM). Materials and Methods: A total of 134 pediatric patients aged 6 to 17 years with a confirmed diagnosis of Type 1 DM, having an average disease duration exceeding one year, were included in the study. Another 134 healthy children, matched by age and sex, served as the control group. Each participant underwent a thorough ENT evaluation, and auditory function was assessed using Pure-tone Audiometry (PTA) and Otoacoustic Emissions (OAE). The evaluation of hearing thresholds involved pure tone audiometric tests, measuring bone and air conduction thresholds across the frequency ranges of 250–4000 Hz and 250–8000 Hz, respectively. Results: Sensorineural hearing loss (SNHL) was identified in 9.70% of the Type 1 DM patients, while no cases were found in the control group. Additionally, a significant positive correlation was observed between SNHL and the patients’ glycemic profiles. Conclusion: Routine hearing assessments may be a critical component of the standard care for children with Type 1 DM. By incorporating hearing evaluations into routine clinical monitoring, healthcare providers can track auditory function in addition to managing glycemic control and other diabetes-related issues, thus adopting a more integrated approach to the overall well-being and quality of life in pediatric Type 1 DM patients.

Background: Pregnancy involves the maternal body’s adaptation to meet the increasing physiological demands of a developing fetus. This process induces numerous visible and subtle changes in the body, and it is one of the prime examples of selective adaptation within respiratory physiology. The objective of this study is to evaluate and compare specific pulmonary function parameters, particularly forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), between healthy pregnant and healthy non-pregnant women. Materials and Methods: A total of 492 women were categorized into four groups (123 each): non-pregnant women and pregnant women in their 1st, 2nd, and 3rd trimesters. The inclusion criteria were women aged 20-30 years, without systemic illnesses affecting pulmonary function, capable of performing pulmonary function tests. Exclusion criteria were individuals with a history of respiratory disorders, healthy women with a history of substance use, and prior history of lung disease. Pulmonary function assessments were performed using computerized spirometry. Results: A statistically significant reduction in FEV1 and FVC was observed across all three trimesters in the pregnant cohort compared to the non-pregnant group. The study indicates a marked increase in weight during pregnancy, particularly in the second and third trimesters, along with a significant decline in pulmonary function, as reflected by reduced FEV1 and FVC values as pregnancy progresses. Conclusion: FEV1 and FVC were notably reduced throughout pregnancy. These changes are likely attributed to the mechanical influence of the expanding uterus and the hormonal effects of estrogen and progesterone on respiratory physiology in pregnant women.

Background: Effective management of pain following spine surgeries is essential to enhance functional outcomes, facilitate early ambulation, expedite recovery, and avert the onset of chronic pain. Epidural analgesia is regarded by many as a fundamental component of postoperative analgesia for lumbar spine surgeries. A unique interfacial plane block that has lately gained popularity is the erector spinae plane block. Aim and Objectives: The goal of this research was to evaluate the analgesic effect of ultrasound guide bilateral erector spinae block and ultrasound guided caudal block in lumbar spine surgeries for post-operative analgesia. Material and Methods: Following the approval of institutional ethical committee, this randomized controlled study was done on 40 patients presenting for lumbar spine surgery in Sri Siddhartha Medical College and Research Institute, Tumkur, Karnataka, India. Patients were randomly assigned equally to receive either ultrasound guided caudal block (Group C) or receive bilateral ultrasound guided lumbar ESP block (Group E) after induction of general anaesthesia. Time to first analgesia request postoperatively was recorded. VAS score and VCS score was used to assess quality of postoperative analgesia. An analysis of the data was conducted using SPSS version 20. Statistical analysis was conducted on continuous and categorical data using the suitable statistical approach. A significance level of P < 0.05 was used to determine statistical significance. Result: The mean time to 1st analgesia request in group E (ultrasound guided bilateral Erector spinae block) was found to be 7:28±1.00 hrs while the mean time to 1^st analgesia request in group C (ultrasound guided caudal block) was found to be 4:04±1.00 hrs (P<0.001). Conclusion: Ultrasound-guided bilateral erector spinae block (ESPB) has been shown to be effective for lumbar spine surgeries by extending the duration of postoperative pain relief and reducing the need for first rescue analgesia compared to patients who received an ultrasound-guided caudal block without any complications. The block’s simplicity and safety contribute to its growing popularity.

Background: Diabetic retinopathy (DR) is a leading cause of vision impairment among working-age adults globally. Recent technological advancements offer promising improvements in the diagnosis and management of DR. Objective: To evaluate the efficacy of advanced imaging techniques, novel therapeutic agents, and telemedicine services in transforming patient care for diabetic retinopathy. Methods: A randomized controlled trial was conducted with 200 patients diagnosed with non-proliferative diabetic retinopathy. Participants were assigned to either a control group receiving standard care or an experimental group receiving interventions with advanced technologies. Outcomes measured included diagnostic accuracy, treatment efficacy, and patient satisfaction over a 12-month period. Results: Advanced imaging techniques significantly improved diagnostic accuracy (p < 0.001). Novel therapeutic agents resulted in better visual acuity and reduced retinal thickness compared to standard care (p = 0.005 and p = 0.003, respectively). Telemedicine services markedly increased patient satisfaction scores (p < 0.002). Conclusion: The integration of pioneering technologies in DR management significantly enhances diagnostic precision, treatment outcomes, and patient satisfaction, indicating a transformative potential in patient care.

Introduction: Physical activity provides multiple benefits to the patients with diabetes mellitus (DM) as it can increase cellular insulin sensitivity by reducing inflammation and obesity. Moderate habitual physical activity has positive impact on health in diabetes mellitus, pre-diabetes and people with increased insulin resistance ¹. Different studies has shown that structured physical exercise can reduce glycated haemoglobin (HbA1c) to the extent of 0.6%. Non-structured physical activities like strolling, gardening, household tasks are also beneficial. Tripura is having high prevalence of diabetes (9.4%) and pre-diabetes(14.7 %). So this study is highly relevant in the context of the region. Materials and Methods: The study was started with scientific and ethical approval on 1^st April 2017 as a project work for the Distance Fellowship in Diabetes Management (DFID) from the Endocrinology Department, Christian Medical College, Vellore). The study had been continued till 31^st March 2024 at two different clinics of the authors. 920 patients considering inclusion (age group of 18 years to 64 years) and exclusion criteria (co-morbidities contraindicated for exercise, physical condition causing limitation, acute and poor general condition and not willing to participate) were included in the study with primary objective to estimate the impact of structured physical exercise on glycaemic status and secondary objective to estimate the impact on weight, body mass index (BMI) and lipid profile. Subjects were enrolled after obtaining informed written consent. After ensuring benefits of Medical Nutrition Therapy (MNT), patients were randomised by simple lottery to intervention (Gr A) and non-intervention (GrB) groups. Intervention group received detail counselling on structured exercise. All the subjects were followed for 3 months. A total of 870 patients completed the study. Results: There was greater weight and BMI reduction in intervention group with statistically significant difference. HbA1c, Fasting and Post prandial blood sugar reduction was also better in exercise arm in the study though change of these parameters in both the groups were significant. In addition, there was improvement in lipid parameters. Conclusion: This study demonstrates significant improvement of anthropometric and metabolic parameters in the intervention group which imply additional benefit of physical exercise in addition to benefits of MNT. All these benefits were independent of effect of metformin.

Background and aim: Conscious sedation offers numerous advantages, including the promotion of stable hemodynamics and reduction of intraoperative bleeding [1].The purpose of our study is to compare the efficiency of sedation between two infusions dexmedetomidine and propofol in patients having middle ear procedures with conscious sedation. Methodology: The research was performed at Silchar Medical College with consent from the Institutional Ethical Committee. It was constructed as a prospective randomized controlled experiment with a double-blinded methodology. Eighty patients having middle ear procedures ranging in age from 18 to 60, were split into two groups at random. Group P received an infusion of propofol commencing with a loading dosage of 75 mcg/kg over 10 minutes followed by a sustained dose of 50 mcg/kg/hr, whereas Group D received an infusion of dexmedetomidine with a loading dose of 1 mcg/kg over 10 minutes and a sustained dose of 0.4 mcg/kg/hr. Hemodynamic parameters and patients’ requirement for rescue analgesia were documented. Any adverse events, including bradycardia, hypotension and respiratory depression, were promptly identified and managed according to established protocol. Result: In our study, we noted that Group P achieved adequate sedation more quickly (11±1.5 min) than Group D (16.4±1.7 min), with a p-value of <0.001 indicating significant difference between the two. Notably, Group D experienced a pronounced change in heart rate following the loading dose administration, whereas Group P showed a significant alteration in mean arterial pressure (MAP) after receiving its loading dose. Group P exhibited a higher need for rescue analgesia due to higher VAS score and lower IOWA patient satisfaction score. Conclusion: Our study suggested that dexmedetomidine is a superior sedative agent compared to propofol for middle ear surgeries, as it maintains relatively stable hemodynamics and requires less rescue analgesia, resulting in an improved IOWA score.

Appendiceal Mucinous Neoplasm (AMN) belongs to a rare group of gastrointestinal malignancy. AMN with minimal cytological atypia on histopathology constitutes Low grade Appendiceal Mucinous Neoplasm (LAMN). These are mostly incidental findings detected by histopathological examination post appendicectomy. We present three such cases presenting with vague abdominal pain with palpable lump in the right iliac fossa. After necessary hematological and radiological investigations, all of them underwent surgery. The postoperative period was uneventful. A diagnosis of Low grade Appendiceal Mucinous Neoplasm was established based on histopathology in all patients. They are in regular follow-up with annual abdominopelvic CT and tumor markers with no notable complications.

Hypothyroidism is an endocrine disorder more commonly in older adults. Simultaneously, this population has an increased incidence of cardiovascular risk factors and disease, which remains the leading cause of death worldwide. This article has assessed relationship between hypothyroidism and cardiovascular disease (CVD). Materials & Methods: This observational study was conducted among 100  patients >18 years of age. Data were collected through medical records, including demographic information, thyroid function tests, cardiovascular risk factors, and cardiovascular outcomes. Results: Bradycardia was noted in 25.00% (19 patients), while hypertension affected 30.00% (23 patients) of the cohort. Heart failure was documented in 15.00% (12 patients), with pericardial effusion present in 10.00% (8 patients). Coronary artery disease was identified in 20.00% (15 patients) of the study population. Conclusions: This study highlights the significant burden of cardiovascular manifestations in patients with hypothyroidism.

A prospective randomized single blinded study was carried out in 60 patients of ASA grade I and II, aged between 20 to 60 years weighing >50kgs scheduled for laparoscopic cholecystectomy. The patients were randomly allocated into three groups based on sealed envelope method as: Group R received Inj. Ropivacaine 0.5% 20 ml, Group B received Inj. Bupivacaine 0.5% 20ml Study drug was injected by the surgeon into the gall bladder bed and sub diaphragmatic area at the time of port closure. After instillation of study drug patients were put in trendelenburg position for 10-15 mins. Then, the outcome measures, like time to first analgesic (time for post-op analgesia), total rescue analgesic consumption in the first 24hrs period and the adverse effects were noted. Post-op pain was assessed with VAS score of 0 to 10 (0 = no pain, 10= worst imaginable pain). Vas scores of 4 or more were treated with Inj. tramadol 50mg i.v as Rescue analgesic, repeated as necessary. efficient analysis, t-test from independent samples, t-test from paired samples and repeated measure ANOVA using SPSS for windows (v20.0) ‘p’ value of less than 0.05 was considered statistically significant Time for first analgesic request was prolonged in Group B(Bupivacaine) 505 ± 19.61 when compared to Group R was 318.67 ± 20.8. There was a significant difference in mean Duration of Analgesia comparison between two groups (p value <0.01). There was no significant difference in Number of doses of rescue analgesia distribution in 24 hrs between two groups. There were no significant haemodynamic adverse effects. Our study has provided superior analgesia with use of 0.5% bupivacaine when compared to sub diaphragmatic and gall bladder bed instillation of 0.5% ropivacaine in laparoscopic cholecystectomy.

A prospective randomized single blinded study was carried out in 60 patients of ASA grade I and II, aged between 20 to 60 years weighing >50kgs scheduled for laparoscopic cholecystectomy. The patients were randomly allocated into three groups based on sealed envelope method as:  Group R received Inj. Ropivacaine 0.5% 20 ml, Group B received Inj. Bupivacaine 0.5% 20ml Study drug was injected by the surgeon into the gall bladder bed and sub diaphragmatic area at the time of port closure. After instillation of study drug patients were put in trendelenburg position for 10-15 mins. Then, the outcome measures, like time to first analgesic (time for post-op analgesia), total rescue analgesic consumption in the first 24hrs period and the adverse effects were noted. Post-op pain was assessed with VAS score of 0 to 10 (0 = no pain, 10= worst imaginable pain). Vas scores of 4 or more were treated with Inj. tramadol 50mg i.v as Rescue analgesic, repeated as necessary. efficient analysis, t-test from independent samples, t-test from paired samples and repeated measure ANOVA using SPSS for windows (v20.0) ‘p’ value of less than 0.05 was considered statistically significant Time for first analgesic request was prolonged in Group B(Bupivacaine) 505 ± 19.61 when compared to Group R was 318.67 ± 20.8. There was a significant difference in mean Duration of Analgesia comparison between two groups (p value <0.01). There was no significant difference in Number of doses of rescue analgesia distribution in 24 hrs between two groups. There were no significant haemodynamic adverse effects. Our study has provided superior analgesia with use of 0.5% bupivacaine when compared to sub diaphragmatic and gall bladder bed instillation of 0.5% ropivacaine in laparoscopic cholecystectomy.

Background: Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality and morbidity globally, especially in underdeveloped countries, including India. Method: Out of 700 pregnant women, 90 (ninety) women with PPH were studied. Apart from biochemical and haematological studies, IV fluid, use of oxytocin, epidosin, PV exam, episiotomy, blood transfusion, and manual removal of the placenta were also tried. Clinical manifestations were noted and treated accordingly. Results: Out of 90 PPH cases, 33 (36.6%) were prima gravida, 57 (63.3%) were multigravida, 57 (63.1%) were stable, 33 (36.6%) had unstable haemodynamicity status, 21 (23.3%) had vaginal delivery, 36 (40%) had caesarean delivery, 6 (6.4%) had assisted breach delivery, 12 (13.3%) had induction, 9 (10%) had prolonged delivery, and 6 (6.6%) had macrosomia. Conclusion: As PPH is a major cause of mortality and morbidity, early diagnosis of risk factors and etiology of PPH can prevent morbidity and mortality in such cases.

Background: Cisatracurium, a non-depolarizing neuromuscular blocking agent, is commonly used during general anaesthesia to facilitate tracheal intubation. However, determining the optimal dosing regimen to achieve favorable intubation conditions with minimal hemodynamic disturbances is essential for safer anaesthesia practice. Neuromuscular function monitoring through Train of Four (TOF) provides a reliable way to assess the depth of blockade and ensure smooth intubation. Aims and Objectives: The primary objective of this study was to compare the effects of two different doses of cisatracurium (0.15 mg/kg and 0.20 mg/kg) on intubating conditions, including jaw relaxation, vocal cord mobility, and ease of laryngoscopy, along with the hemodynamic parameters such as blood pressure, heart rate, and oxygen saturation, using TOF neuromuscular monitoring. Materials and Methods: This was a prospective, randomized, double-blinded clinical study conducted at the Department of Anaesthesiology, LLRM Medical College & SVBP Hospital, Meerut, India, over 18 months. A total of 80 patients, aged 18 to 65 years, classified as ASA I and II, were randomly divided into two groups of 40 patients each. Group A received 0.15 mg/kg of cisatracurium, while Group B received 0.20 mg/kg. TOF monitoring was used to assess neuromuscular blockade at intervals after drug administration, and intubation conditions were scored based on jaw relaxation, vocal cord mobility, and laryngoscopy ease. Hemodynamic parameters were recorded pre- and post-intubation. Results: Patients in Group B (0.20 mg/kg) had significantly better intubating conditions, with 90% exhibiting easy jaw relaxation compared to 65% in Group A. Vocal cord mobility was better in Group B, with 90% of patients showing open vocal cords, compared to 68% in Group A. Laryngoscopy was easier in Group B (90% easy cases vs. 73% in Group A). Hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, and oxygen saturation showed no significant differences between the groups. Group B had a significantly shorter onset time of blockade (154.4 seconds vs. 180.63 seconds) and a longer duration of blockade (41.58 minutes vs. 27.75 minutes). Conclusion: Increasing the dose of cisatracurium from 0.15 mg/kg to 0.20 mg/kg improves intubation conditions without significant adverse hemodynamic effects. The higher dose provides faster onset and prolonged neuromuscular blockade, making it a more effective choice for achieving optimal intubation conditions.

Background: Cutaneous manifestations often accompany respiratory diseases, reflecting systemic involvement. These skin signs can provide vital clues for early diagnosis and management of pulmonary disorders. Objective: This study aims to evaluate the prevalence and nature of cutaneous manifestations in patients with respiratory diseases at Hamdard Institute of Medical Sciences and Research, India. Method: A cross-sectional study was conducted from April 2023 to August 2024, involving 110 patients diagnosed with various respiratory diseases. Detailed dermatological examinations were performed, and findings were correlated with clinical, radiological, and histopathological data. Statistical analysis was conducted to determine the relationship between cutaneous manifestations and respiratory diseases. Result: Out of 110 patients, 45% presented with cutaneous manifestations. The most common skin presentations included eczema (25%), erythema nodosum (10%), and digital clubbing (5%). Among patients with chronic obstructive pulmonary disease (COPD), 40% had associated skin conditions. In patients with sarcoidosis, 60% exhibited cutaneous signs, primarily erythema nodosum. In lung cancer patients, paraneoplastic skin conditions, including dermatomyositis, were seen in 15%. A significant correlation was found between the severity of respiratory diseases and the extent of skin involvement (p < 0.05). Early recognition of these dermatologic findings aided in timely diagnosis and improved clinical outcomes. Conclusion: Cutaneous manifestations are frequent in respiratory diseases, offering critical diagnostic and prognostic value. Clinicians should integrate dermatologic evaluations into routine respiratory disease management to enhance patient care.

Background: Alcohol dependence syndrome (ADS) is a major health problem globally, with a significant gender gap in consumption patterns. Widows with ADS are at high risk for developing psychiatric comorbidities and poor quality of life. This case series highlights the impact of spousal death as a major stressor leading to ADS and associated psychiatric morbidities among widows. Methods: Four widows diagnosed with ADS according to ICD-11 criteria were assessed using structured interviews, including sociodemographic data, CIWA-Ar, SADQ, MINI-PLUS, and WHO QoL-BREF scales. The cases were presented to the outpatient department at Subbaiah Institute of Medical Sciences between January and July 2024. Results: All four widows initiated or developed alcohol dependence following the death of their spouse. SADQ revealed moderate severity of dependence, while MINI-PLUS showed moderate to severe depression. WHO QoL-BREF indicated a decline in physical, psychological, social, and environmental domains. Poor family support and negative outlook for the future were common among these women. Conclusion: Widows with ADS are at high risk for developing psychiatric comorbidities and poor quality of life. Death of a spouse is a major stressor, and poor coping skills, negative outlook, and lack of family support are potential contributory factors. Further prospective studies are needed to evaluate the occurrence of psychiatric morbidities in widows with and without ADS, and to identify potential risk factors for ADS development.

This study evaluates the impact of a community-based, pathology-focused screening program on the early detection and management of infectious diseases in Bihar from 2021 to 2024. A total of 200 patients were screened, identifying significant cases of tuberculosis, hepatitis, and typhoid fever. The integration of pathological diagnostics led to a 40% rate of early detection and a 30% reduction in disease progression, demonstrating the effectiveness of targeted screening in resource-limited settings. Challenges included resource constraints and cultural barriers, yet the outcomes suggest substantial public health benefits, advocating for expanded implementation of similar models in comparable regions.

Background: Laparotomy is an incision made into the abdominal wall to visualise and explore the viscera inside of the abdominal cavity. Break in continuity of the skin with or without deeper tissues, following laparotomy, results in abdominal wound dehiscence. This study is done to evaluate the factors affecting healing of incision site of laparotomy. Aims and Objectives: 1. To identify various factors affecting postoperative wound healing.2.To study various wound complications occurring following laparotomy.3. To observe the measures for preventing the wound complications. Material and Methods:  This study is a Prospective study conducted on 100 patients who undergoing laparotomy ( both emergency and planned) between June 2020 to January 2022 in General Surgery  Department of S.C.L Hospital Ahmedabad. A detailed history was taken from all the patients. Result: In this study the various Factors affecting healing of incision site after laparotomy, which occurred in 100 patients who underwent laparotomy in the Department Of General Surgery  S.C.L. Hospital Ahmedabad were analysed. Patients above 15 years  were included in this study. Patients aged > 60 years developed more wound complications as compared to patients < 60 years  suggesting that increasing age acts as a risk factor. Development of wound complications were more in females compared with male .All patients who had hypoproteinemia ,malnourishment (BMI <18.5) and were on steroid therapy developed more wound complications. 9 out of 11 patients  developed complications who had BMI >30 (obese). 7 out of 13 anemic patients developed wound complications. Out of 100 patient, 55 patients had comorbidities (i.e. DM, HTN, IHD, COPD). Conclusion: This study was conducted to study the factors affecting wound healing. Wound healing after laparotomy is influenced by a variety of factors like timing of laparotomy, age, comorbid conditions, malnutrition, obesity, anemia, hypoproteinemia, immunosuppressive states, indication of laparotomy, postoperative abdominal condition, length of hospitalisation. Optimisation of these factors as far as possible will reduce the incidence of wound complications.

Introduction: Acute cholecystitis is an inflammatory condition commonly caused by gallstones impacted in the cystic duct and surgical approach is mainstay of management. Our objective was to assess and compare pre – operative and post-operative outcomes between early laparoscopic cholecystectomy (ELC); conducted within 72 hours and delayed laparoscopic cholecystectomy (DLC); conducted after 72 hours, in acute calculus cholecystitis. Materials and Methods: The present study was a Prospective comparative study conducted from month of December 2022 to November 2023 at tertiary care centre of Assam state of India. Total 60 patients were included in this study. Result: ELC was associated with shorter duration of hospital stay (5.7±1.46 days in ELC vs7.5±1.38 days in DLC) with lesser intraoperative duration (60.5±12.95 minutes in ELC vs 81.1±14.48 minutes in DLC). It was also observed that ELC had less intraoperative blood loss (61.3±18.5 ml in ELC vs 84.3±18.2 ml in DLC and lesser risk of conversion to open cholecystectomy (10% in ELC vs 20% in DLC). Conclusion: Based on the findings of the study ELC is safe, time saving feasible and less post operative complications for management of acute calculus cholecystitis preferably performed within 72 hours of duration of onset of symptoms.

Introduction: Intestinal obstruction (IO) is one of the most common surgical emergency worldwide which is predisposed by varying underlying anomalies and diseases, which are difficult to define preoperatively. Since there was lack of data of IO in north eastern part of India hence we planned to determine the causes of intestinal obstruction, clinical presentation and age related factors and management of intestinal obstruction which might give insight for better patient outcome. Materials and Methods: The present study was a Prospective observational study which was conducted from December 2022 to November 2023 at Department of General Surgery in tertiary care hospital of Assam, India. Total 60 patients with clinical and radiological findings of IO were included in this study. Results: The study showed peak incidence of IO in the age group of 31- 40 years of 21.7% and 41 to 50 years of 21.7 %. The male to female ratio was 1.14:1. In our study, Majority of patients presented with Pain abdomen 57 (95.0%) and distension 53(88.3%). most common diagnosis in IO was adhesion which were present in 31.7% patients whereas Mesenteric ischemia were only in 1.7 % patients. The most common USG findings was Distended small bowel (DSB) which were present in 40.0% patients. Majority of patients (28.4 %) were treated conservatively and 71.6% patient of the IO undergone operative procedure, among which 18% underwent adhesiolysis, 20% underwent Resection and anastomosis. Conclusion: Early recognition and aggressive treatment are crucial in preventing irreversible ischemia and transmural necrosis and thereby in decreasing mortality and long-term morbidity. The evaluation of patients with suspected bowel obstruction endeavours not only to confirm the diagnosis but also to determine the need for and timing of surgery.

Background: Approximately 280 million people in the world have depression. Depression is 50% more common among women. Suicide is the fourth leading cause of death in 15-29 year age group. Barriers to effective care include lack of investment in mental health care, lack of trained health- care providers and social stigma. Lack of mental health training among PHC doctors is the leading cause for under diagnosis of patients with depression. The perceptions and attitudes of health professionals is a direct outcome of the type of mental health training they have undergone. To improve the management of depression in the community, two group of health care persons i.e., doctors and nurses should have adequate knowledge and attitude towards depression. Hence, study on the assessment of perceptions and attitudes towards depression is thus needed. Methods: A cross sectional study was done after obtaining informed consent. The study participants were adults (>18 years).We employed unknown population sample size formula with a population proportion of 50%, relative error of 10% and a confidence interval of 95%. The sample size required was 384. Convenience sampling method was used. Data was collected by interview method by using semi-structured pre-tested questionnaire. It has three sections. The first collected socio-demographic information. The second comprised questions to assess knowledge about various aspects of depression. The third section utilized the Depression attitude questionnaire (DAQ).  Data was analysed in MS Excel software. Categorical data were described using frequencies and proportions. Mean and standard deviation was used to describe quantitative data. Z – test for two population proportion was used to determine difference between the frequencies. A p-value of 0.05 or less was considered statistically significant. Results: Out of 458 students, 217 were medical and 241 were nursing students. 63.6% of the medical students (n=138) felt that about 10% of the adult population suffer from depression, while 74.7% of the nursing students (n=180) felt about 5% of the adults suffer from depression. The difference is significant. A substantial proportion of medical (84.3%) and nursing (75.5%) students think that depression is a more significant problem. 125 medical (57.6%) and 88 nursing students (36.5%) consider young adults to be vulnerable to depression. 78.3% of medical (n=170) and 66.0% of nursing students (n=159) identify the elderly as a demographic at risk for depression. 159 (73.3%) medical and 142 (58.9%) nursing students knew that females were more at risk of depression compared to males. A majority of medical (83.4%, n=181) and nursing students (69.3%, n=167) believe that depression is more common among urbanites. Conclusion: The gaps in knowledge is different for medical and nursing graduates. A good number of nursing students believed majority of the depression cases originated from recent misfortune. Discriminatory attitudes and stigma has been shown to limit depressed patients to seek help. Variations in perceptions on depression is strongly influenced by social and cultural factors. The nursing students held more of a compassionate attitude. Majority of the respondents preferred depressed patients to be managed by specialist and anti-depressants produces satisfactory result. If we provide adequate training in mental health to nursing and medical graduates, they can provide better mental health services.

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, leading to organ dysfunction and high mortality rates. This study aimed to investigate the association between serum lactate levels and 28-day mortality in patients with sepsis. Methods: A prospective observational study was conducted in the intensive care unit of a tertiary care hospital. Adult patients with sepsis (n=80) were enrolled, and serum lactate levels were measured at baseline and at 12, 24, and 48hours. The primary outcome was 28-day mortality. Logistic regression analysis and Cox proportional hazards regression were used to assess the association between lactate levels and mortality. Results: Non-survivors had significantly higher initial serum lactate levels compared to survivors (4.3 mmol/L vs. 3.2 mmol/L, p<0.001). The optimal cut-off value for initial serum lactate in predicting 28-day mortality was 3.8 mmol/L (sensitivity 78.6%, specificity 71.2%, AUC 0.81). Patients with serum lactate levels >3.8 mmol/L had a significantly lower 28-day survival rate (39.3% vs. 82.4%, p<0.001). In the multivariate analysis, APACHE II score (hazard ratio 1.09, 95% CI 1.03-1.16, p=0.003) and initial serum lactate (hazard ratio 1.58, 95% CI 1.23-2.03, p<0.001) were independent predictors of mortality. Conclusion: Serum lactate levels and lactate clearance are significant predictors of 28-day mortality in patients with sepsis. Incorporating lactate measurement into sepsis management protocols can help guide treatment decisions and improve patient outcomes.

Background: Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms that account for 2-5% of all spinal tumors. They can lead to significant neurological deficits due to their location within the spinal cord. IMSCTs primarily include ependymomas, astrocytomas and hemangioblastomas, with clinical outcomes highly dependent on the extent of resection and preoperative neurological status. This case series presents eight patients with rare IMSCTs, discussing the surgical management, postoperative outcomes, and the role of adjuvant therapies. Methods: A retrospective case series was conducted by reviewing eight cases of IMSCTs treated in a tertiary hospital over four years. Data on demographic details, clinical presentation, surgical interventions, histopathology, and postoperative outcomes were collected. Intraoperative neuromonitoring was used in some cases to minimize neurological injury during tumor resection. Results: Eight patients underwent surgical resection for IMSCTs, with histopathological findings ranging from subependymoma to high-grade gliomas. Gross total resection was achieved in five cases, while the remaining three underwent subtotal resection due to the diffuse nature of the tumors. Postoperatively, four patients demonstrated significant neurological improvement, while two remained stable, and two were lost to follow-up. Four patients required adjuvant radiotherapy due to high-grade tumors. Conclusion: Surgical resection remains the mainstay of treatment for IMSCTs, with gross total resection offering the best prognosis, especially for low-grade tumors. In high-grade cases, adjuvant therapies are essential due to the high potential for recurrence. Early diagnosis and intervention, coupled with intraoperative neuromonitoring, are crucial for optimizing neurological outcomes.

Background: Supraglottic airway devices (SGAs) like LMA-Supreme and i-Gel are increasingly used for airway management during elective surgeries. This study compares the efficiency of these two devices, focusing on airway sealing pressure, ease of insertion, hemodynamic stability, and incidence of adverse events. Aim and Objectives: To compare the performance of the LMA-Supreme and i-Gel in adult patients undergoing elective surgeries with primary objective being to evaluate airway sealing pressure, and secondary objectives were to evaluate their efficiency in ease of insertion, hemodynamic changes, and postoperative complications. Materials and Method: This randomized controlled trial involved 80 adult patients undergoing elective surgery, divided into two groups: Group A (LMA-Supreme, n = 40) and Group B (i-Gel, n = 40). Hemodynamic parameters (heart rate, systolic and diastolic blood pressure, oxygen saturation), airway sealing pressure, ease of insertion, and adverse events were monitored. Statistical analysis was performed using the Student’s t-test and chi-square test, with significance at p < 0.05. Results: There was no statistically significant difference in BMI or gender distribution between the groups, although Group B had older patients (p = 0.005). LMA-Supreme demonstrated a significantly higher airway sealing pressure (27.90 ± 1.97 cm H2O) compared to i-Gel (22.30 ± 2.05 cm H2O) (p = 0.000). Difficulty in insertion was reported in 20% of LMA-Supreme cases versus 5% in the i-Gel group (p = 0.042). First-attempt success was 90% for LMA-Supreme and 97.5% for i-Gel (p = 0.160). No significant differences in heart rate, systolic or diastolic blood pressure, or oxygen saturation were observed between the two groups at any time (p > 0.05). Both devices showed similar incidences of blood on the device (2.5%) and sore throat (5% in LMA-Supreme vs. 2.5% in i-Gel, p = 0.025). Conclusion: LMA-Supreme offers better airway sealing, making it more effective for maintaining airway patency, while i-Gel is easier to insert with fewer difficulties. Both devices demonstrated comparable hemodynamic stability and safety profiles with minimal adverse events. These findings suggest that either device can be safely used depending on clinical requirements, with LMA-Supreme being advantageous in sealing efficiency and i-Gel being preferable for ease of use.

Background: Dynamic Hip Screw (DHS) has been demonstrated to yield positive outcomes especially in cases of unstable intertrochanteric fracture. The DHS device, however, works less effectively in unstable fractures and has a comparatively greater incidence of internal fixation failure. Contrary, one of Proximal Femoral Nailing (PFN’s) benefits is that it acts as a buttress to prevent the proximal fragment from translating laterally. The implant is more resilient to the binding force because of the intramedullary placement of the nail and lag screw interface. Aim: To compare DHS and Plating PFN for Trochanteric fracture of Femur. Method: For the comparative study of DHS and PFN groups data on intraoperative, early (within the first month following hip fracture surgery), and late (beyond the first month) difficulties was acquired and analysed. Their functional result was assessed using the Harris Hip Scores. The unpaired t-test and the Fisher exact test were used to compute and compare the groups. Results: The Nonunion complication was found in 1 patient in both PFN and DHS group and implant failure was found among 3 patients of PFN and 4 patients of DHS group. Moreover, deep inflation was found in 1 patient of both groups. Intraoperative complications like improper insertion of compression screw were found in 3 patients, and varus angulation was found in 4 patients of DHS group. On the other hand, complications like failure to achieve closed reduction was found in 3 patients, and failure to put de-rotation screw was reported in 3 patients in PFN group. There were no statistically significant differences between the study groups when comparing the intra-operative findings (p = 0.324 for intra-operative complications). Conclusion: PFN works better in unstable fractures while DHS yields functional outcomes that are compared in this study. Blood loss was observed to be lower in the PFN group, indicating a statistically significant correlation (p<0.005). Furthermore, there are less negative results after PFN surgery. As a result, it is thought that the PFN technique of surgery is more precise and advantageous for patients to heal more quickly.

Endometriosis was first described by Karl Von Rokitansky in 1860. It is a chronic gynecologic disorder where the functional and morphological endometrial glands and stroma are present outside the uterine cavity. The most common sites of involvement, in decreasing order of frequency, are the ovaries, pelvic peritoneum, deep pelvic subperitoneal spaces, the intestinal system, and the urinary system .Hereby presenting a case series of patients with scar endometriosis and its management. Overall outcome of the case with scar endometriosis with early diagnosis with prompt management is highlighted in these studies.

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by an abnormal inflammatory response of airways. The disease progress can be diagnosed at the early stage of pulmonary inflammation by using a novel biomarkers like soluble urokinase-type plasminogen activator receptor (suPAR) and Interleukin-6. Materials and Methods: Study participants were grouped into cases- COPD (n=35) and healthy controls (n=35) and recruited for the study after obtaining informed consent. As specified by GOLD criteria, COPD group participants were graded into grades I-IV. Serum suPAR and IL-6 assays were done for all the study participants. Results: The level of suPAR among COPD grades I-IV (5.75±0.544 ng/ml; 5.88±0.942 ng/ml; 6.78±1.05 ng/ml; 15.0±15.8 ng/ml respectively) were high compared to healthy controls (4.12± 6.17 ng/ml) and was statistically significant. The levels of IL-6 among COPD grade I-IV (8.06± 0.839 pg/ml; 11.0±2.40 pg/ml; 12.9±3.76 pg/ml; 13.4±2.67 pg/ml respectively) were high compared to healthy controls (4.37± 1.44 pg/ml) and was statistically significant. The spirometry readings- FEV1, FVC values were significantly lower among patients with COPD when compared with the healthy controls (P<0.05). It was observed that an inverse correlation was found between serum level of suPAR, IL-6 levels versus FEV1, FVC values which was statistically significant ( p<0.05). Our study indicated that serum suPAR and IL-6 may play an important role in the inflammatory process of COPD particularly in grades II, III and IV COPD. Hence, serum suPAR and IL-6 measurements may be useful for the evaluation and prognosis of COPD patients. Conclusion: We conclude that cases of moderate to severe grades of COPD with greater degrees of obstruction of the airways have higher levels of suPAR, IL-6 in serum. The serum levels of these cytokines can therefore be utilized as the clinical and prognostic parameters for evaluation of the disease severity and tailored therapy for the same.

Background: Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. It is rarely performed under regional anesthesia and studies regarding use of regional anesthesia for laparoscopic abdominal surgeries are very limited. Therefore, present study was designed to compare the feasibility and safety of laparoscopic appendicectomy under spinal anesthesia VS general anesthesia. Method: A total 50 patients of either sex, aged between 18–65 years, who underwent laparoscopic appendicectomy, were randomly allocated into two groups: the spinal anesthesia (Group I; n=25) and general anesthesia (Group II; n=25) group. Peri-operative and postoperative adverse events, postoperative pain level (VAS scores), and patient satisfaction were compared between the groups. Results: Both the groups were comparable and found no significant difference with respect to patient characteristics (p>0.05), intra and post-operative adverse events, (p>0.05), except total procedure time (p=0.023). There were significantly lower postoperative VAS scores in the group I immediately after the operation and at 12 and 24 h after the surgery (p<0.001). However, the VAS score at 6 h was not significantly different (p=0.591). None of the patients needed conversion to an open procedure or conversion from spinal to general anesthesia. Conclusion: Spinal anesthesia is effective and safe in patients undergoing laparoscopic appendicectomy. It is cost effective and efficient approach. Less postoperative pain, less postoperative nausea, vomiting, and shoulder pain are the advantages of spinal anesthesia compared to general anesthesia.

Introduction: Fine Needle Aspiration Cytology (FNAC) is a simple and a rapid diagnostic technique in cytopathology. It is now being considered as a valuable diagnostic aid because of the early availability of results, its simplicity, minimal trauma and complications. Ancillary techniques such as flow cytometry, cytogenetics, and cell block preparations with immunocytochemistry can be applied for the further characterization of tumours. Aim of this Study: To study various head and neck lesions using FNAC technique. Method: The present study was conducted in Department of General Surgery, S.J. Medical College & Hospital, Puri, Odisha, from January 2023 to December 2023 and included 122 patients with palpable head and neck lesions. OPD as well as IPD patients with head and neck swellings which were referred to pathology department for FNAC. Results: Patients with head and neck lesions from various departments comprising of OPD as well as IPD patients. Age group of patients ranged from 1 year to 72 years. Maximum no. of patients were in the age group of 21-30 years (30.3%). Out of 122 patients 76 (62.3%) were females and 46 (37.7%) were males. Site wise distribution of head and neck FNAC shows lymph nodes lesion (58.2%) as the predominant site of FNAC followed by soft tissue and miscellaneous (17.2%), thyroid lesions (14.8%), and salivary glands (9.8%). Conclusion: FNAC as a rapid, relatively cheap diagnostic tool now-a-days with overall high accuracy rate in differentiating non-neoplastic lesions from neoplastic lesions i. It saves cost and time to reach to final diagnosis. It is therefore concluded that FNAC is a useful tool in diagnosis of head and neck lesions with good certainty.

Objective: To Report five psoas abscess cases we treated and review the management of psoas abscess cases. Method: Five patients who were diagnosed and treated with psoas abscess between January 2023 – December 2023 were evaluated retrospectively. Results: Five patients were discharged with stable clinical condition after an average of 12 days following surgical treatment. Conclusion: Psoas abscesses are rare but there is increase in incidence in recent years due to the improvements in radiological imaging. We think that for the diagnosis of psoas abscess, it is necessary to suspect the diagnosis and keep this rare condition in mind.

Background: Prostate is Fibromuscular glandular organ encircling the neck of the urinary bladder. Prostate cancer is the most common form of malignancy and the second leading cause of cancer death among men. It accounts for about 15.1 % of male cancers and nearly of all malignancies. Methods: Total 40 prostatic lesions were received and studied in the department of General Surgery, S.C.B. Medical College, Cuttack, Odisha for a period of 12 months (January 2023 to December 2023). TURP, TRUS guided biopsies, radical prostatectomy along with cysto-prostatectomy specimen were examined. The prostate lesions range from inflammatory, non- neoplastic and neoplastic. Modified Gleason’s grading was used to grade all the prostatic adenocarcinoma cases. Results: In the present study, majority benign lesions were observed to be benign prostatic hypertrophy, out of which 13 cases had BPH alone as a primary feature and 20 cases had BPH associated with prostatitis, 3 cases showed only prostatitis and the remaining 3 cases were of adenocarcinoma. In our study, the peak incidence of benign and malignant lesions was in the age group of 61-80 years. All the cases of prostatic carcinoma were graded with modified gleason’s criteria. The most common primary pattern found to be pattern 4 and the secondary pattern 5 were observed in 2 cases out of 3 cases making it the total sum of 9 while single case had the total sum of 10 with the primary and secondary pattern to be 5 hence both went to the grade group of 5. Conclusion: This study highlights the importance of identifying the nonneoplastic conditions from neoplastic conditions where biopsy still remain the gold standard.

Background: After the Covid-19 pandemic, usage of electronic auditory gadgets has increased exponentially for academic and recreational purposes among the medical students which impairs hearing. Hence it is important to create awareness among them about these gadgets. Aim of the Study: To evaluate the loss of hearing in medical students by subjective and objective assessment methods and correlating the degree of hearing loss with the nature of electronic gadgets used by them. Materials: 132 Students of all phases were given a subjective questionnaire which had details of gadget usage and symptoms related to the loss of hearing. Pure tone audiometry was done in all. Association of degree of hearing loss with type of gadgets used, duration of usage and related symptoms were documented and analysed. Results: There were 84 female (63.6%) students and, 48 male students (36.4%). The mean age of the participants was 21.15±2.50 years. The primary purpose for using hearing gadgets was for education 81(61.3%). Ear Pods were used in 67(50.8%) and was the most popular type of hearing gadget, followed by earphones 34(25.8%) and headphones in 19(14.4%). 54 (40.9%) of them had used the gadget for more than three years. The most common symptom was itching sensation in the ears in 41(31.1%) followed by burning sensation in the ear 40(30.3%). Tinnitus complained by 32(24.2%) and pain in the ear by 19(14.4%). Only 39(29.5%) participants have experienced decreased hearing. Conclusion: In the study, the type of gadgets used, duration of usage of gadgets in years and usage hours per day had no significant association with hearing loss. Hearing loss was detected more at 8000 and 4000Hz indicating noise induced hearing loss. Auditory gadgets should be used cautiously by students as it damages their hearing which further has deterrent effects on their learning and communication.

Background: Intranasal corticosteroids and oral antihistamines are both effective in the treatment of seasonal allergic rhinitis. Reports between intranasal steroid fluticasone furoate as a first line therapy and newer second generation oral anti-histamine Bilastine rarely exists. Aim of the Study: To compare the efficacy and safety of fluticasone furoate nasal spray (FF NS) and oral Bilastine in the treatment of seasonal allergic rhinitis. Materials: A retrospective study was conducted on 45 patients diagnosed and treated for Allergic Rhinitis with fluticasone furoate nasal spray (FF NS) and oral Bilastine for one month. Total patients were divided as two groups; Group A only fluticasone furoate nasal spray (FF NS) was used and in Group B patients only oral Bilastine was used. Demographic data and nasal symptom scores were recorded and analysed for their efficacy. Results: Total nasal symptom scores were significantly lower (P < .001) in the group A (FF INS) than in the group B (oral Bilastine) for blockage, discharge, itching, and sneezing. Conclusions: In the treatment of seasonal allergic rhinitis, FF NS 110 μg once daily was superior, well tolerated and more effective to Bilastine.

Background: Urinary tract infection is one of the most common bacterial infections in humans and a major cause of morbidity. The etiology of UTI and the antimicrobial sensitivity pattern varies with the widespread availability of antimicrobial agents; UTI has become difficult to treat because of appearance of pathogens with increasing resistance to antimicrobial agents. Methods: A descriptive study done during August 2023 to July 2024. All positive urine culture and sensitivity reports of males and females aged 20-70years were included. A total of 373 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department and details were entered using a questionnaire. Results: Out of 373 adults, males were 137 (36.7%) and females were 236 (63.3%). E. coli (74.3 %) was the most common organism, followed by Klebsiella (15.8%), Enterococcus, Pseudomonas and Staphylococcus. The incidence of UTI was more in patients in the age group of 60-70years. E. coli and Klebsiella were sensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%). Conclusion: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.

Background: The fungal infections have become a persistent health problem, still always remain under reported. A change in species distribution has been observed now a days with the emergence of many non-albicans candida species. Our study aimed at evaluating the incidence of invasive Candidiasis (Candida albicans and non-albicans) and to assess the risk factors and predictors of mortality in seriously ill patients. Method: This prospective, observational study was conducted at Intensive Care Unit, PJMC, Dumal, Jharkhand during the period of August 2023 to July 2024. Patients with >8 out of 16 risk factors, e.g. prolonged antibiotic use, IV cannulation, steroid use etc, Candida scores (CS) > 2, Age >12 years and ICU stay >2 days were included in the study. Those with Candida scores > 3 were prophylactically given fluconazole. A case report Performa was completed for each patient, including demographic characteristics, dates of hospital and ICU admission and of discharge, vital sign status at discharge, previous treatment with antibiotics or immunosuppressive agents, presence of risk factors. Patients were followed till discharge from the ICU or death. Results: Candida was isolated from blood in 53/206 patients. The P-value calculated in five risk groups, e.g. diabetics, patients receiving TPN, neutropenic patients, HIV and malignancy was significant (P<0.05). For all other risk factors P-value was >0.05. Over half of the Candida isolates recovered from blood were non-albicans species. The overall mortality in candidaemia patients was 37/53 (69.81%). Mortality was low with Candida tropicalis (57.7%) but number of patient was high among candida species. Conclusion: Multiple risk factors were found to be associated with invasive fungal infection in critically ill patients. In the ICU population studied, candidemia was due to non-albicans spp. The importance of Candida scores on predicting mortality was also observed.

Introduction: Neuroendocrine neoplasms/tumors (NETs) of digestive system represent 2% of all GI tumors. It has been seen that incidence of NETs are steadily increasing. Neuroendocrine neoplasms can be challenging to diagnose. Objectives: were to study the histopathological features neuroendocrine neoplasms of the digestive tract and to classify them according to histomorphological subtypes and staging as per WHO criteria and TNM staging. Materials and Methods: This was a cross-sectional study on 31 cases of primary NETs of digestive tract, which were diagnosed and operated between 2008 to 2017. All slides were diagnosed by two senior histopathologists. Staging was done using WHO 2010 criteria and TNM staging as per American joint cancer committee criteria. Results: The most common age of presentation of patients with neuroendocrine neoplasms of digestive system was between 41-60 years, mean age being 53.12 years. The commonest location of digestive system neuroendocrine neoplasms was colon and rectum (19.3%), followed by stomach (13%), appendix (13%) and ampullary region (13%). Most of the cases presented with polypoidal growth (38.9%). On microscopic examination the most frequent pattern of cellular arrangement was of nests of tumor cells (48.38%). The cell showed characteristic monomorphic nuclei with stippled chromatin and granular eosinophilic cytoplasm Invasion into muscularis propria was noted in 66.6% cases. Perineural invasion was observed in more cases (91.3%) compared to lymphovascular invasion (73.9%). Majority (64.5%) of patients had Grade III tumour. Most common tumor type was NEC (39%), followed by NET (35%) and MANEC (26%). Conclusion: Colon and rectum followed by stomach are the most common site for neuroendocrine neoplasms of digestive system. Majority of the neoplasms were of grade 1 according to WHO 2010 classification.

This study evaluates the impact of a community-based, pathology-focused screening program on the early detection and management of infectious diseases in Bihar from 2021 to 2024. A total of 200 patients were screened, identifying significant cases of tuberculosis, hepatitis, and typhoid fever. The integration of pathological diagnostics led to a 40% rate of early detection and a 30% reduction in disease progression, demonstrating the effectiveness of targeted screening in resource-limited settings. Challenges included resource constraints and cultural barriers, yet the outcomes suggest substantial public health benefits, advocating for expanded implementation of similar models in comparable regions.

Accurate early identification and appropriate prognostication are crucial in the treatment of sepsis, a life-threatening illness with high death and morbidity rates globally. One common tool for gauging organ failure in sepsis patients is the Sequential Organ Failure Assessment (SOFA) score. Its modest specificity, however, suggests that more biomarkers are required to raise its predictive power. One useful biomarker for the diagnosis and prognosis of sepsis is serum procalcitonin (PCT), which is known to be increased in bacterial infections. Using 100 adult patients suspected of having sepsis, researchers from Sarvodaya Hospital and Research Centre looked at how well SOFA scores and PCT levels predicted death and morbidity when used together. While SOFA and PCT may both predict sepsis outcomes on their own, the results show that the combination of the two provides far better sensitivity and specificity. With a sensitivity of 78.1% and specificity of 86.8%, the prediction of mortality is greatly improved when the SOFA score is more than 7 and the PCT level is over 8 ng/mL. When used together, these methods provide a powerful instrument for the early detection of individuals at high risk of sepsis, which allows for more precise and expedited treatment.

Background: Surgical site infections (SSIs) afflict elective general surgeries, affecting healthcare costs and patient outcomes. SSIs are classified by their depth and impact on nearby tissues and organs. Many factors can affect surgical site infection frequency and categorization, including surgical technique, patient health, and infection control. This study examines SSI patterns after elective general surgeries at Nalanda Medical College & Hospital in Patna, Bihar. The goal is to identify what causes these infections and how well infection control strategies worked during the trial. Methods: Elective general procedures were performed on 110 people between January 2023 and August 2024. The study was retrospective cross-sectional. Medical records and patient files contained demographics, operations, SSIs, and postoperative follow-up. The study examined surgical details, patient demographics, SSI rates, and operation type. Descriptive statistics, trend analysis, and procedure comparisons revealed significant patterns and risk variables. Results: Twenty-seven patients (24.5%) had SSIs. The total number of infections was 58.3% superficial, 33.3% deep, and 8.4% organ or space. Patients were 42% female and 58% male, averaging 56 years old. Comorbidities included diabetes (35%), obesity (25%), and hypertension (30%). The deployment of new infection control strategies reduced SSI rates from 30% in the first half to 18% in the second. SSI rates for colorectal surgeries were 40%, hernia repairs 22%, cholecystectomies 15% and appendix 25%. Conclusion: The study stresses that elective general procedures, especially colorectal surgery, have a high SSI rate. The drop in SSI rates shows that infection control methods worked. These data show that surgical methods and infection control must be constantly improved. Larger, prospective studies are needed to assess infection prevention methods and identify SSI risk factors.

Background: Though hepatitis B prevalence varies by region, it remains a global health issue. Routine blood testing helps spot abnormalities early, which helps control and avoid them. This study examines how often North Indians have hepatitis B infection accidentally discovered during blood tests. Method: Patna’s Netaji Subhash Medical College & Hospital Bihta conducted a 2020–2022 retrospective cross-sectional study. One thousand routine blood investigation of patients were sampled. Demographics, HBSAg status, and other factors were collected. We examined demographic variations and prevalence using descriptive statistics. Results: 55 out of 1000 people were HBsAg positives, indicating 5.5% accidental hepatitis B infection. Older people and women had the highest prevalence rates. There were minimal prevalence fluctuations during the study. Conclusion: The findings suggest frequent blood tests can diagnose hepatitis B early. The 5.5% incidence, especially in older women, emphasizes the need for careful screening. Better screening and public health activities are needed for hepatitis B treatment.

Background: Heart disease, diabetes, and stroke are more likely in metabolic syndrome patients. Sleep length affects metabolic health, although its relationship to metabolic syndrome markers in middle-aged people is unclear. This study aims to determine how sleep duration affects metabolic syndrome risk variables. Methods: This retrospective, cross-sectional study analysed 150 middle-aged (45–65) medical records from 2022 to 2023. Medical records showed patients’ sleep duration. We studied waist size, blood pressure, fasting glucose, lipid profile, and HDL cholesterol as metabolic syndrome indicators. Sleep time was correlated with metabolic markers using Pearson and Spearman correlations. Results: An average of 6.8 hours of sleep per night was found in 150 middle-aged people (55.2 years old, 60% female). 60% were overweight around the midsection, 55% were hypertensive, 50% had high triglycerides, 45% had poor HDL cholesterol, and 40% had poor glucose tolerance. Significant negative relationships were found between reduced sleep duration and waist circumference (r = -0.32), systolic blood pressure (r = -0.29), diastolic blood pressure (r = -0.23), fasting glucose (r = -0.25), and triglycerides (r = -0.30). On the other hand, longer sleep duration is connected with higher HDL cholesterol (r = 0.27). Conclusion: Middle-aged people need enough sleep to maintain metabolic health. Longer sleep duration improves lipid profiles, but shorter sleep duration increases metabolic syndrome markers. These findings suggest that better sleep may help prevent metabolic syndrome.

Background: The ovary is a vital reproductive organ. It is now believed that most tumors of ovary arise ultimately from one of three ovarian components namely surface epithelium, germ cells and stromal cells, all of these components can give rise to benign and malignant tumors. The aim of the study is to assess the histopathological spectrum of various ovarian lesions and their age wise distribution. Materials and Methods: The study was carried out at GMERS Medical College and hospital, Himmatnagar in the Department of Pathology, during November 2022 to January 2024. Routine gross examination done and representative sections were taken and stained with hematoxylin and eosin stain for histopathological examination. Results: Out of 134 cases studied, 102 (77%) were non-neoplastic and remaining 31 (23%) were neoplastic. The most common non-neoplastic lesion found was corpus luteal cysts – 52 cases (51%). Among the 32 neoplastic ovarian lesions, 27 (85%) cases were benign, four (12%) cases were borderline and 1 (3%) case was malignant, serous cystadenoma of the ovary constituted the predominant neoplastic lesion noted. Majority of samples were received from the age group of 30-40 years and were benign and unilateral. Conclusion:  Corpus luteal cyst is the most common ovarian lesion observed in this study and among the ovarian tumors, surface epithelial tumors are commonest followed by germ cell tumors. Majority of cases belonged to age group of 30-40 yrs.

Background & Objectives: During the early nineteenth century, ulcer formation in long standing wounds and scars was well recorded. Soon the malignant nature of these ulcers was realised and despite the varying histology, these ulcers were grouped as Marjolin’s ulcers. Since then, elaborate research was done describing these lesions. A distinctive property being long latency periods, that were reported most of the research articles. Despite this, we encountered an unusually early occurrence of malignancy in the hilly population of Uttarakhand. Hence, our objective was to do an observational study the epidemiology of Marjolin’s ulcers in this population subgroup.  Methods: Epidemiological data was collected on patients reporting with Marjolin’s ulcer scars from the hilly regions of Uttarakhand both in retro and prospectively. Results: Patients from various hilly districts of Uttarakhand were evaluated. Majority had burns scar as the aetiology. All of the patients presented within 4 yrs of initial insult. Earliest was 9 months. The changes in the scar tissue were observed by the patients for which they took treatment from local physicians. The usual time of diagnosis by histopathology examination ranged from 1 month to 6 months. Interpretation & Conclusions: In hilly population of Uttarakhand, Marjolin’s transformation in scar tissue were recorded quite early as compared to data available. This is an unusual trend that is seen in this subgroup of population. As some of these patients presented with highly aggressive types, the end results were deleterious. Though the sample size was small, inaccessible hilly terrane and lack of previous studies could mask the prevalence of problem in this population.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by oxidative stress and free radical damage. This study aims to investigate the oxidative stress marker, serum malondialdehyde (MDA), and the antioxidant status of vitamin C in patients with atopic dermatitis. Materials and Methods: This cross-sectional control study was conducted in the Department of Biochemistry in collaboration with the Department of Dermatology at Burdwan Medical College and Hospital. The study was conducted over 18 months, from July 2019 to January 2021. A total of 50 AD patients (Group A) and 40 age- and sex-matched healthy volunteers (Group B) were recruited. Inclusion criteria involved AD patients diagnosed by suitable criteria, while exclusion criteria included conditions or habits that could affect oxidative stress or vitamin C levels. Serum malondialdehyde (MDA) and vitamin C levels were measured using colorimetric and ELISA methods, respectively. Statistical analysis was performed using Student’s t-test and chi-square tests to determine significance. Results: The study found no significant difference in the age and sex distribution between the case and control groups. In Group A, 68% of patients were female, and a mixed diet was the most common dietary habit (76%). Family history was positive in 24% of cases, while 32% reported sun allergy. The mean serum vitamin C level was significantly lower in the case group (0.846±0.1 mg/dl) compared to the control group (0.918±0.04 mg/dl, p=0.005). Conversely, the mean serum MDA level was significantly higher in the case group (4.429±0.04 nmol/ml) than in the control group (3.432±0.13 nmol/ml, p=0.01). A negative correlation was observed between MDA and vitamin C levels in the case group (correlation factor = -0.467, p < 0.001). Conclusion: The findings indicate that atopic dermatitis is associated with increased oxidative stress and decreased antioxidant status, as evidenced by elevated MDA and reduced vitamin C levels. The negative correlation between MDA and vitamin C suggests that oxidative stress plays a significant role in the pathophysiology of AD, highlighting the potential benefit of antioxidant therapy in managing this condition.

A seizure is defined as a transient occurrence of signs and/or symptoms accompanied by motor manifestations or may manifest by other changes in neurologic functions like sensory, cognitive or emotional events. Seizures with symptoms occur in the acute state (provoked seizure) or in epilepsy (two or more unprovoked seizure).The integrated interpretation of symptoms, EEG report and total serum creatine kinase (CK) level in interictal period (within 15 days from last attack) can compensate for clinical uncertainty between CK level and epileptic seizures before having to resort to more sophisticated and expensive investigations.To find out the association of total serum creatine kinase (CK) concentration in patients of seizures and epilepsy. Hospital based descriptive epidemiological study Cross-Sectional in design. We were included 200 patients presented with history of seizures and epilepsy from OPD and IPD of RNT Medical College and Attached Group of Hospital, Udaipur (Rajasthan) between age of 18-65 years (both genders). Exclusion Criteria: (i) those patients who has current medical history other than seizures and epilepsy, (ii) history of smoking, (iii) patients on medication other than antiepileptics and (iv) those patients who were not willing participate in study. In present study we were taken the history of disease duration, seizure frequency per month, duration of attack in minutes and EEG (Electroencephalogram) were performed by MPEG-4, Allengers Global Health care system, India. The total creatine kinase was performed by Creatine Phosphokinase-N Acetyl Cysteine (CK-NAC) reagent test, which is standardized to the International Federation of Clinical Chemistry (IFCC) by RXL dimension. In result the mean CK-NAC rise in patients from normal limits (20-200U/L to 279.7±166.8) in mean interictal duration of 4.38±2.8 days form last attack. Male patients of seizures and epilepsy were shown greater frequency of disease and higher CK-NAC level as compare to female patients (Male 283.2±174.5, 56.5%, female 275.2±157.1,43.5% p=0.74) and maximum level of CK-NAC was reported in between age of 35-45 years(314.1±149.2) with mean age of 33.02±13.19 years.The CK-NAC level was significantly increased in patients presented with longer history of disease (1^st time 163.4±114.8U/L to by birth 476.5±166.9U/L, p-value<0.001) and higher frequency of seizure per month (1^st time 164.8±112.4U/L to 11-20 / month342.3±194.2U/L, p-value<0.001).  In conclusion the elevation of serum CK-NAC than its absolute level related to the intensity of muscular activity in patients, it shows an association between them. Therefore, an increase in creatine kinase, may be used to confirm a diagnosis and also help to predict onset of next seizure and epilepsy when the entire picture was considered in our study.

Hypothyroidism is a prevalent thyroid gland disorder where the gland fails to meet the body’s demand for thyroid hormones, specifically triiodothyronine (T3) and thyroxine (T4). Hypothyroidism is categorized into overt (OH) and subclinical (SbH) forms. Overt hypothyroidism is characterized by elevated thyroid-stimulating hormone (TSH) levels and reduced T4 levels, whereas subclinical hypothyroidism presents with elevated TSH levels but normal T4 levels. The objective of this study is to assess the levels of malondialdehyde (MDA) and certain minerals—calcium, magnesium, and phosphorus—in patients diagnosed with SbH and OH. A total of 100 patients from index medical college Indore participated in the study, with half diagnosed with OH and the other half with SbH. The study also included 50 healthy controls of comparable age, and all three groups comprised 50% males and 50% females. Anthropometric examinations revealed significant (p<0.05) alterations in body mass index (BMI) and waist-to-hip ratio (WHpR) among the control, OH, and SbH groups. MDA levels were significantly elevated in hypothyroidism patients, with OH patients exhibiting the highest levels. SbH patients showed significantly (p<0.05) lower MDA levels compared to OH patients but significantly (p<0.05) higher levels compared to the control group. Levels of magnesium and phosphorus were significantly (p<0.05) elevated in OH patients compared to SbH patients and the control group, while the levels in SbH patients were not significantly different (p>0.05) from the control group. Conversely, serum calcium levels were significantly (p<0.05) reduced in OH patients compared to both SbH patients and controls, with no significant difference (p>0.05) between SbH patients and the control group. Additionally, MDA was found to be significantly (p<0.05). Correlated with WHpR in OH patients. Receiver Operating Characteristic (ROC) analysis demonstrated the utility of MDA in prognosing OH and SbH with excellent sensitivity. In conclusion, the increase in MDA levels due to lipid peroxidation may contribute to the progression of subclinical hypothyroidism to overt hypothyroidism.

Introduction: Autism spectrum disorder is a neurobiological disorder and its presentation can very significantly from one individual to others. Early detection of ASDs can help in improving quality of child’s life. Modified checklist for Autism in Toddlers, Revised with Follow up (MCHAT R/F) score is one of the screening tool to assess risk of Autism Spectrum Disorders. Objectives: To identify and classify Autism Spectrum Disorders using Modified checklist for Autism in Toddlers, Revised with Follow up (MCHAT R/F) score. Methods: This study was performed in all children aged between 16 to 30 months came in routine pediatric OPD in C.U. Shah Medical College, Surendra Nagar, Gujarat. MCHAT-R score was applied to all individuals and whenever required MCHAT R/F score was applied to get additional information. Result: Out of total 200 children, 176 children were found under low risk category and 3 were found in high risk category. While remaining 21 children came under medium risk. To whom MCHAT R/F  score was applied and amongst them 1 child was found under high risk category, and according to categorisation appropiate actions were taken. Conclusion: As currently no any biomarkers were available for ASDs, MAHAT-R/F score is an effective tool to screen ASDs as early as possible and promote early interventions.

Background: Managing postoperative pain is essential in laparoscopic abdominal surgeries to enhance recovery, minimize complications, and reduce hospital stays. Intraperitoneal administration of local anesthetics like ropivacaine has become a popular approach to managing visceral and somatic pain post-surgery. Recent studies suggest that combining local anesthetics with opioids like tramadol can further improve pain relief, although it might be linked to adverse symptoms including nausea. Aim: To assess the intraperitoneal 0.5% ropivacaine’s postoperative analgesic efficacy in laparoscopic abdominal procedures in terms of pain scores, the need for rescue analgesia, and side effect profiles, both with and without tramadol. Methods: A randomised controlled trial with double blinding was carried out on 100 patients receiving laparoscopic abdominal surgery in a prospective manner. Patients were randomly assigned to Group A (15 ml of 0.5% ropivacaine with 15 ml saline) or Group B (4 ml tramadol, 15 ml of 0.5% ropivacaine, and 11 ml saline). At several times after surgery, pain was assessed using the Visual Analogue Scale (VAS). The duration of the first rescue analgesia, the total amount of analgesics used, and any side effects were noted. An analysis using statistics was done. Results: Group B (ropivacaine + tramadol) had significantly lower VAS pain scores compared to Group A (ropivacaine alone) at most time intervals, particularly during the first 12 hours post-surgery (p < 0.05). Group B also required significantly less rescue analgesia and had lower total morphine consumption within 24 hours (p < 0.001). While nausea was more common in Group B (12% vs 2% in Group A, p = 0.045), no other significant adverse effects were observed. Conclusion: Better pain management is achieved in the early postoperative phase when intraperitoneal 0.5% ropivacaine plus tramadol is used instead of ropivacaine alone. Although this combination is linked to a higher rate of nausea, it is a useful strategy for managing pain after laparoscopic procedures since it lowers the requirement for rescue analgesia and the overall amount of opioids used. Recommendations: Further research is recommended to optimize tramadol dosing to balance effective pain relief with minimal side effects. This combination therapy could be integrated into enhanced recovery protocols to improve patient outcomes post-laparoscopic surgery.

Introduction: Anal fissures are commonly encountered in routine clinical practice. Anal fissure has traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study we compare symptomatic relief, healing and side effects of topical 2% Nifedipine and Lignocaine gel and lateral internal sphincterotomy in the treatment of chronic fissure in ano. Materials and Methods: In this prospective trial, 60 OPD and/or IPD patients with chronic fissure in ano were randomly divided into Group 1 (Nifedipine and Lignocaine gel) and Group 2 (lateral internal sphincterotomy) with 30 patients in each Group. Patients were followed up at weekly intervals for 6 consecutive weeks and biweekly for subsequent 3 months. Results: Fissure was completely healed in 86.48% of patients in Group 1 and in 100% in Group 2. The mean duration required for healing of fissure was 5.1 weeks in Group 1 and 3.5 weeks in Group 2. 77.46% patients were free from pain in Group 1 whereas 86.28% patients were free from pain in Group 2. No patient had any side effects in either group. Conclusion: Topical Nifedipine and Lignocaine should be considered as first line treatment in chronic fissure in ano. Lateral Internal sphincterotomy should be reserved for patients with relapse and therapeutic failure to prior pharmacological treatment.

Background: Microfilaria, the tropical parasitic larvae of filarial nematodes parasite is the major public health problem in most of the state of India that are typically found in the bloodstream, skin and lymphatic system. However, our research reveals an unprecedented presence of microfilaria at unusual sites, challenging the conventional understanding of their habitat. Aims: This study was investigated and to document these incidental findings of microfilaria at unusual sites in a different pathological sample such as FNAC, fluid cytology and Histopathological examination, shedding light on the unexplored territories of microfilaria infestation. Material and Methods: This 4 year’s Retrospective study was done from January 2019 to December 2022. All the cytological fluids, FNAC smears and histopathological slides were reviewed.  Result: Total 16 cases were diagnosed as Microfilaria. Out of which 8 cases found in FNAC, 5 cases in Fluid cytology and 3 cases in Histopathological examinations. Among them different sites were breast, thyroid, scrotum, lymph node and nodular swelling in forearm including pleural and ascitic fluid. Conclusion: Swelling at any part of the body should be considered as differential diagnosis of microfilaria. So, FNAC, fluid cytological smears and histopathological examination should be done carefully. Our findings highlight the need for an expanded diagnostic approach and improved treatment strategies.

Introduction: Dense band-like infiltration at the dermo-epidermal junction and damage to basal cells are hallmarks of lichenoid dermatitis, a very common dermatological condition. Lichen planus is the prototype lesion, but a wide variety of lesions fall under this category. This study set out to investigate the histopathological spectrum of lichenoid tissue reaction conditions as well as the clinicopathological concordance of lichenoid lesions. Materials and Procedures: In a tertiary care facility, a retrospective study was carried out on all skin biopsy cases that were identified as having lichenoid dermatitis for two years (2020–2022) based on clinical and/or histological diagnoses. From the corresponding case sheets and biopsy reports, demographic information, clinical diagnosis, histological diagnosis, and the various histological features were gathered and placed into an Excel worksheet. To depict the data, frequency and percentages were employed. Results: Of the 82 patients that were clinically diagnosed as lichenoid dermatitis, 76 instances had a diagnosis that agreed with the histological diagnosis. Nine instances were classified as lesions lacking lichenoid features because there was a discrepancy between the clinical and histological diagnosis. Only the histological investigation revealed the seven cases’ lichenoid dermatitis diagnosis; no clinical differential diagnosis of this kind was made. Of the 82 instances that were diagnosed as lichenoid dermatitis, there were two cases of lichen planopilaris, five cases of lichen planus pigmentosus, four cases of hypertrophic lichen planus, three cases of lichenoid dermatitis, and 35 cases of lichen planus. Lichenoid dermatitis was most frequently observed in people aged 40 to 52. Compared to men, females were more frequently impacted. Conclusion: In conclusion, the prototype lesion of lichenoid dermatitides is lichen planus. Making decisions about the patient’s prognosis and treatment approach depends on obtaining a definitive diagnosis of the particular entity among the lichenoid lesions. Together with clinical correlation, which indicates that clinicopathological correlation is the key, histopathological testing is essential for the final diagnosis.

Background: Thyroid swellings are very frequently encountered in ENT practice, ranging from a simple nodule to a malignant tumor. Disorder of structure of thyroid gland, due to various etiological factors, will give rise to swelling in the neck region. Clinical signs and symptoms are inadequate to diagnose thyroid disorders as similar presentations are seen in various thyroid disorders. So, this study of thyroid swellings was done to know different clinical presentations, age and sex distribution, correlation between thyroid swellings and thyroid function tests, analyze various thyroid swellings and etiological factors based on pathological reports. Aims & Objectives:  To study demographic profile of thyroid masses, To study symptomatology and clinical features of thyroid masses, To study correlation between clinical findings and pathological findings of the thyroid neck masses. Methods & Materials: A prospective observational study conducted on patients attending the E N T opd, ipd and casualty of Dr SCGMC Nanded Govt medical college & hospital, from July 2022-January 2024.Patients with neck swellings between the age group of 11-70 years with thyroid swelling were in the inclusion criteria. The clinical presentations of patients were tabulated and analyses by descriptive statistics. Results: A total number of 137 patients with neck swelling were evaluated. The incidence most common in 31-40years, and most prevalent among females 65.7%, males being 34.3%most common clinical feature being neck swelling followed by symptoms of hyperthyroidism (7.2%), symptoms of hypothyroidism (3.6%), dysphagia (13.9%), change in voice (5.8%), cough (8.7%), and dyspnea (4.4%). Majority of the patients presented more than 6 months 2years. Clinically majority of patients were Solitary thyroid nodule (35.8%) followed by Diffuse thyroid goiter (27.7%). Based on the FNAC results the most prevalent diagnosis had been colloid goitre (29.2%).Majority of specimens on HPE were diagnosed colloid goitre (21.9%). Conclusion: In all cases of thyroid swellings, detailed clinical history, thorough clinical examination is required. Thyroid function test, USG and FNAC reports help to reach the definitive diagnosis. Histopathological report confirms and gives final diagnosis.

Background: Anemia, characterized by insufficient red blood cells to meet physiological needs, is a significant public health issue in India, particularly among marginalized groups such as women in tribal villages. Objectives: Objective of this study is to estimate the prevalence of anemia among non-pregnant women of reproductive age in tribal areas and identify associated factors. Materials and Methods: A cross-sectional study was conducted over six months, involving 1050 non-pregnant women of reproductive age in the hilly Thally block, Krishnagiri Health Unit District. Data were collected using an interviewer-administered semi-structured questionnaire, covering height, weight, blood grouping, BMI, blood pressure, capillary blood glucose levels, and hemoglobin levels via the cyanmethemoglobin method (Drapkin solution). The WHO criteria for anemia severity were applied to evaluate prevalence. Results: Among the 1050 women, the prevalence of anemia was 45.90% (n=482). According to WHO criteria, 1.05% (n=11) were severely anemic, with 27.27% (n=3) of them being undernourished. Additionally, 21.14% (n=222) were moderately anemic, of which 25.68% (n=57) were undernourished, and 23.71% (n=249) were mildly anemic, with 19.68% (n=49) undernourished. Conclusion: To alleviate anemia among reproductive-age women in hilly regions, regular screening should extend beyond pregnant women to all women of reproductive age. Prophylactic drug administration, tailored health education on nutrition and hygiene, and other appropriate interventions should be implemented to address their specific needs. This approach aims to significantly reduce the anemia burden in this vulnerable population.

Introduction: Frontal sinus outer plate fractures present a spectrum of clinical challenges, often requiring individualized treatment strategies based on the severity and displacement of the fracture. This case series outlines the management and outcomes of four patients with frontal sinus outer plate fractures, each treated with a different approach. Case 1: An 18-year-old male presented with a displaced frontal sinus outer plate fracture following a road traffic accident (RTA). The fracture was managed surgically using open reduction and internal fixation with titanium plates, leading to successful stabilization and restoration of contour. Case 2: A 20-year-old male sustained a complex frontal sinus fracture with tissue loss following blunt trauma. A galeal turnover flap was utilized to reconstruct the defect and provide soft tissue coverage, resulting in a satisfactory aesthetic and functional outcome. Case 3: A 27-year-old male with a depressed frontal sinus fracture following an RTA was treated with fat grafting to restore the contour. Post-operative results showed effective contour restoration and symptom relief with no complications. Case 4: A 45-year-old male with an undisplaced frontal sinus fracture and concomitant right maxillary alveolar fracture was treated conservatively for the sinus injury and underwent interdental wiring for the maxillary fracture. Both injuries healed successfully without the need for surgical intervention. Conclusion: This case series highlights the importance of tailored management strategies for frontal sinus outer plate fractures, ranging from conservative approaches to surgical reconstruction. Each treatment method demonstrated favourable outcomes, emphasizing the role of individualized decision-making based on fracture characteristics and patient factors. These cases contribute to the growing body of evidence supporting diverse management techniques for frontal sinus fractures.

Mucociliary clearance is an essential mechanism in maintaining the overall health and homeostasis of the respiratory system. Disruptions or impairments in mcc can lead to various respiratory pathologies and illnesses, including chronic rhinosinusitis, cystic fibrosis, and primary ciliary dyskinesia. As a result, understanding the status of mcc in individuals with nasal pathologies is of great clinical significance. A cross-sectional study done on patients attending the out-patient department, emergency department or getting admitted under ENT with nasal obstruction. This study is aimed to detect the nasal mucociliary clearance timing in nasal pathologies. To study mucociliary clearance of different individual with different nasal pathologies.

Background: Thyroid lesions are prevalent endocrine disorders with an increasing incidence globally. Accurate diagnosis is critical for guiding appropriate management strategies. Fine-needle aspiration cytology (FNAC) is widely used for initial evaluation, and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a standardized classification system for FNAC results. Despite its widespread adoption, the diagnostic accuracy of FNAC varies across different clinical settings, necessitating ongoing evaluation and refinement. Aim: This study aimed to evaluate the diagnostic accuracy of FNAC in thyroid lesion reporting using the TBSRTC system and to assess the cytohistopathological correlation in a multicentric setting. Methods: This was a multicentric, observational, and retrospective study conducted over 24 months, including 315 patients who underwent FNAC followed by histopathological examination after surgical resection of thyroid lesions. FNAC results were categorized using the TBSRTC system, and their correlation with histopathological findings was analyzed. Statistical analysis was performed using SPSS version 23.0 to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy. Results: The study included 315 patients, with a mean age of 45.2 years and a female predominance (74.6%). FNAC results were categorized as benign in 57.1% of cases, with 78 cases (24.8%) histopathologically confirmed as malignant. FNAC demonstrated a sensitivity of 80.6%, specificity of 91.8%, PPV of 81.6%, NPV of 91.3%, and an overall accuracy of 87.0%. The kappa coefficient of 0.75 indicated substantial agreement between FNAC and histopathological findings. Conclusion: FNAC, categorized by the TBSRTC system, is a reliable diagnostic tool for thyroid lesions, particularly effective in ruling out malignancy. However, the moderate sensitivity highlights the need for careful follow-up in cases with indeterminate or benign cytology. The findings underscore the importance of histopathological confirmation, especially in cases with clinical suspicion of malignancy despite benign cytology. Recommendations: Further studies should focus on improving the diagnostic accuracy of FNAC in indeterminate cases and exploring advanced techniques to complement FNAC in thyroid lesion evaluation. Regular training and quality control measures are recommended to enhance the consistency and reliability of FNAC results across different clinical settings.

Background: Soft tissue tumors are a heterogeneous group of neoplasms that can present significant diagnostic challenges. Accurate and timely diagnosis is critical for effective treatment planning and improving patient outcomes. Fine-Needle Aspiration Cytology (FNAC) is a minimally invasive diagnostic tool that has gained prominence for its utility in evaluating these tumors, offering a rapid and reliable method for distinguishing between benign and malignant lesions. Aim: This study aims to assess the diagnostic accuracy of FNAC in the diagnosis of soft tissue tumors and tumor-like lesions across multiple healthcare centers. Methods: A retrospective, multicentric study was conducted over 24 months, involving 95 participants diagnosed with soft tissue tumors or tumor-like lesions. Data were collected from patient records, including FNAC results and final histopathological diagnoses. The diagnostic accuracy of FNAC was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Statistical analysis was performed using SPSS version 23.0. Results: Out of 95 cases, FNAC demonstrated an overall diagnostic accuracy of 84.2%. The sensitivity and specificity of FNAC in diagnosing malignant tumors were 85% and 83.3%, respectively. The PPV was 77.3%, and the NPV was 89.7%. A significant association was found between patient age and the likelihood of malignancy (p < 0.05), while no significant association was observed between gender and tumor type (p = 0.45). Conclusion: FNAC is a reliable and effective diagnostic tool for soft tissue tumors, particularly in distinguishing between benign and malignant lesions. The high NPV makes it especially useful in ruling out malignancies, reducing the need for more invasive procedures. The study highlights the importance of considering patient age in the diagnostic evaluation, as older patients are more likely to have malignant tumors. Recommendations: FNAC should be utilized as a first-line diagnostic tool in the evaluation of soft tissue tumors, with particular attention to patient age. Further research with larger sample sizes and prospective designs is recommended to validate these findings and explore the integration of FNAC with advanced imaging and molecular techniques.

Introduction: Xeroderma Pigmentosum (XP) is a rare autosomal recessive genetic disorder characterized by defective DNA repair which leads to clinical and cellular hypersensitivity to ultraviolet radiation and other carcinogenic agents. Aim: Xeroderma pigmentosum being a rare disorder, there is very less literature published on this from our region. Hence, we aim to study XP patients attending at our hospital. Materials and Methods: Observational study was done on all the XP patients for duration of 6 months attending our hospital, proper history and examination was done. Results: We observed 15 cases of XP, Of 15 patients, 5 were children of which 3 were from one family( figure 1) and 2 from another family( figure 2). Of the rest 10 adult patients, 6 were females and 4 were male patients of which 2 adult patients presented with squamous cell carcinoma. All patients had increased photo hypersensitivity and ocular involvement with some cutaneous manifestation. Neurological involvement was seen in 3 patients. Conclusion: As various malignancies may occur at an early age, early diagnosis and management may prove fruitful. Advantage of genetic counseling implicating the effect of consanguineous marriages can prevent mortality and morbidity associated with this disorder and emphasis is to be done to same as it’s an autosomal recessive disorder.

Introduction: Trabeculectomy, has been the surgery of choice for the management of glaucoma not controlled with medications. Anti-fibrotic agents, such as Mitomycin C(MMC), has become widely accepted to reduce the amount of fibrosis. Amniotic membrane may be an acceptable replacement to MMC; as it can also provide as a space-occupying component. Aims And Objectives: To evaluate the Intraocular pressure(IOP) lowering effect of Trabeculectomy with the use of Amniotic membrane transplant(AMT) compared with the standard Trabeculectomy with Mitomycin-C(MMC) in patients with Primary  glaucoma. Materials and Methods: Intraocular pressure lowering effect of Trabeculectomy with the use of Amniotic membrane transplant was compared with the standard Trabeculectomy with Mitomycin-C in patients with Primary  glaucoma. It was carried out on the patients attending Glaucoma Department of a tertiary hospital. Results: Comparison of the two groups with respect to IOP at Post Operative Day(POD) 1 and 1 week, showed no difference, but both groups reached a level of target IOPs. At 1 month follow up, mean IOP control in Group A(underwent Trabeculectomy with Amniotic membrane) was 14.72mmhg with SD +/-3.78 and in Group B( Trabeculectomy with MMC) was 17.60mmhg with SD +/-4.65 with a p value of 0.0203 which was statistically significant. But further follow ups at 3 months and 6 months showed no difference in IOP between Group A and Group B and had reached target IOP levels. Conclusion: It was observed that both Amniotic membrane and MMC in trabeculectomy proved to be effective adjuvants and results are comparable with minor modifications to the bleb.

Introduction: Surgically induced astigmatism (SIA) is often the cause for poor recovery following Small Incision Cataract Surgery (SICS). The present study is an observational study assessing the incidence of surgically induced astigmatism with Supero-Temporal Anti Smile (Frown) incision in small incision cataract surgery. Materials and Methods: 100 individuals with significant visual loss due to cataract were included in the study and all have undergone Small Incision Cataract Surgery (SICS) through supero-temporal incision with Anti Smile (Frown) and were followed up for One month for surgically induced astigmatism. Results: There was a low incidence of surgically induced astigmatism of 7% and mean value of astigmatism of 1.107Diopters. Conclusion: Supero-temporal Anti Smile (Frown) incision with small incision cataract surgery gives a low incidence of surgically induced astigmatism and is highly suitable for beginners who learn SICS superiorly with assistance of Superior Rectus, as the approach to the Supero-Temporal is quite easy and for ALL SICS practitioners in rural centres where phacoemulsification is not feasible.

Background: Traffic police personnel are often exposed to high levels of noise due to their occupational environment, which may adversely affect auditory function. This study aims to evaluate the detrimental effects of chronic traffic noise exposure on auditory brainstem responses (ABR) among traffic police personnel in Jammu, India. Methods: This comparative cross-sectional study included 136 traffic police personnel with a minimum of 5 years of experience, regularly exposed to noise levels ≥85 dB for at least 6 hours daily. A control group of 120 age- and gender-matched individuals with no noise exposure was also assessed. ABR testing was performed using the Biologic Navigator Pro system, measuring latencies of waves I, III, and V, along with interpeak intervals. Noise exposure levels were assessed using a calibrated sound level meter. Results: Traffic police personnel exhibited significantly prolonged latencies for waves I (1.88 ± 0.23 ms), III (4.27 ± 0.25 ms), and V (6.45 ± 0.34 ms) compared to controls (p < 0.05 for all). The prevalence of tinnitus and difficulty in hearing was significantly higher in the traffic police group (54.4% and 44.9%, respectively) versus controls (10.0% and 7.5%, respectively). Correlation analysis revealed significant associations between noise exposure levels and ABR latencies (r values from 0.432 to 0.541, p < 0.05). Conclusion: Chronic exposure to high traffic noise among traffic police personnel is associated with significant auditory dysfunction, as reflected by altered ABR parameters. The findings underscore the need for regular auditory assessments and protective measures to mitigate the impact of noise exposure in this occupational group.

Introduction: Lymph node fine needle aspiration Cytology (FNAC) is a useful diagnostic tool in the initial evaluation of lymphadenopathy of unknown etiology. The new Sydney System (2020) for classification and reporting of lymph node FNAC has put forth guidelines for a categorical classification using uniform terminology and morphologic criteria, a major step towards standardization for unified reporting language among cytopathologists and clinicians. Aim: The study was aimed to evaluate cytopathology of lymph node lesions by applying the proposed Sydney system and to assess the category wise Risk of Malignancy (ROM) by comparing with histopathology diagnosis in available cases. The present study aimed to analyze the utility of the proposed system in cytopathology reporting in our institution. Materials and Methods: This is a retrospective observational study, conducted from Aug 2022 to May 2024, on lymph node aspirates obtained in the department of Pathology of a tertiary care hospital. FNAC of 75 lymph node aspirates were evaluated. Smears were reviewed and categorized as per the Sydney System of reporting as, L1: non-diagnostic/inadequate, L2: benign, L3: atypical cells/atypical lymphoid cells of undetermined significance, L4: suspicious for malignancy, L5: malignant. The diagnostic accuracy of cytology and ROM in each category was assessed comparing with the gold standard histopathology diagnosis where available. This study has been undertaken to investigate the different lymph node cytopathology by the use of fine-needle aspiration cytology (FNAC). To standardize the FNAC results Sydney System of classifying and reporting was used. Results: This is a retrospective study carried out from Aug 2022 to May 2024 at a tertiary care hospital. A total of 75 patients between 1 month to 99 years of age were included. Male preponderance was found. Commonest group of LN involved was cervical group. According to Sydney system LN cytology cases were categorized into L1: inadequate/nondiagnostic (09), L2: benign (52), L3: atypical cells of undetermined significance/atypical lymphoid cells of uncertain significance (02), L4: suspicious (03) and L5: malignant (09). Conclusion: The Sydney system of structured reporting in lymph node cytology provides a clear-cut terminology, uniformity, and reproducibility of reports. It enhances the role of FNAC by alerting the clinician for follow-up and ancillary studies in atypical and equivocal cases. The Sydney system is an excellent system for accurately categorizing lymph node aspirates with greater reproducibility of reports and better patient management through improved communication between cytopathologist and clinician.

Introduction: Even with advancements in surgical techniques and a better understanding of gastrointestinal physiology, intestinal obstruction remains a frequent and challenging issue for surgeons. Objective: This study aims to analyze the epidemiology, frequency, treatment methods, and outcomes associated with intestinal obstruction. Materials and Methods: This research involved 200 patients diagnosed with small intestine and colon disorders who received treatment over a period exceeding one year at Mahatma Gandhi Medical College, Jaipur. Diagnosis was based on comprehensive patient history, clinical evaluation, radiological imaging (primarily abdominal), and histopathological examination. Advanced imaging techniques like contrast-enhanced studies and tomography were used selectively. Exclusion criteria included patients with intestinal and anorectal malformations. Results: Colon cancer was identified in 6.88% of admissions. Patient ages ranged from 10 days to 82 years, with the highest incidence observed in individuals aged 25-60 years (30.81%). Men were more frequently affected than women. Mild abdominal pain was reported in 80% of cases, with severe pain in 20%. Adhesions were the most common cause of intestinal obstruction (40%), followed by unspecified causes (14%), hernias (9%), and bolus obstruction (7%). Conclusion: Adhesions are the predominant cause of intestinal obstruction, often resulting in significant abdominal discomfort. Treatment should be tailored to individual patient needs, with conservative management considered before resorting to surgical intervention.

Clavicle is a modified long bone. Its morphology is important in determining upper limb locomotion behavior. The morphometric parameters of this bone vary between left and right side and also between races and sex. It is a commonly fractured bone. Improved benefits derived from use of fixatives have resulted in renewed interest in interventional procedures in clavicle fracture. The knowledge of variation in curvatures and other parameters is indispensable for designing the intramedullary and external fixatives.

Background: Acne vulgaris is a chronic inflammatory disease affecting majority of the adolescent population with a considerable impact on the psychosocial well-being of a person. Aim: 1) To assess the psychological impact of acne vulgaris. 2) To analyse their beliefs about acne and outlook about treatment of acne. Materials and Methods: This was a cross sectional study conducted at a tertiary government hospital involving 448 cases of acne, who were analyzed using a predesigned questionnaire and Cardiff acne disability index (CADI). Results: Out of 448 cases 220 were males and 228 were females. 210 cases diagnosed with grade 2 acne and 173 replied they had acne on and off. Inspite of this 228 cases had never taken any treatment in past. Of the 220 cases who had taken treatment, 91 cases had been treated by a dermatologist and 60cases had taken treatment based on a friend’s suggestion. Only 53 replied that cost is immaterial. 158 patients preferred using only night cream. 321 were aware that dermatologist was the qualified person to treat acne. 80 subjects had CADI scores > 8 indicating significant psychological impact and 368 showed < 8 score, implying no psychological impact. Conclusion: This study shows that the psychological impairment due to acne is not so severe in our set up compared to other reports. It is important to take into account the cost of therapy and counsel adequately regarding the mode of therapy while treating acne which can improve the compliance and outcome.

Background: Thyroid disorders are the second most prevalent endocrine conditions worldwide, with India facing a significant burden. This retrospective study investigates the histopathological spectrum of thyroid lesions at a tertiary care center in Western Rajasthan over one year. Results: The study involved 37 patients, aged between 10 to 86 years, with a mean age of 40.16 years. Females were predominantly affected, accounting for 94.6% of cases, with a male-to-female ratio of 17.5:1. Histopathological analysis revealed that 59.4% of the lesions were non-neoplastic, while 40.5% were neoplastic. Among non-neoplastic lesions, multinodular goiter (27.0%) was the most common, followed by adenomatous goiter (13.5%). Neoplastic lesions were primarily benign (27.0%), with follicular adenoma being the most frequent (13.5%). Malignant lesions constituted 13.5% of the total cases, with papillary carcinoma being the most common (5.4%). Conclusion: In conclusion, this study underscores the importance of periodic evaluation of thyroid swellings, particularly in middle-aged women, to detect potential carcinomatous changes early. The high incidence of neoplastic lesions at this tertiary center suggests the need for enhanced diagnostic protocols and awareness programs, particularly in iodine-deficient regions.

Background: Worldwide, heart diseases are of concern perennially. The field of Obstetrics is also considered as a sensitive field, encompassing the maternal as well as the neonatal well-being. Hence, undoubtedly, Cardiology, Obstetrics, and other medical specialities face a formidable obstacle in the one to three percent of pregnancies that are complicated by heart disease. The increasing incidence shall be attributed to the increasing diagnostic modalities available across the country and easy availability to the public at the primary and the secondary care level. Cardiac disease of pregnancy is a significant cause of or morbidity and mortality and has been cited to be present between 1 to 4% of all pregnancies. Hence a study of prevalence and outcomes of cardiac disease in a prescribed location becomes a mandatory tool in provision of expertise in management of heart disease, thus helping in reducing maternal mortality and morbidity. This study is conducted in Government Medical College Hospital, Karur to obtain a clear picture of epidemiology and outcomes of cardiac disease in pregnancy. Aims: 1) To study the prevalence of congenital and rheumatic heart disease complicating pregnancy in GMCH Karur. 2) To study the maternal and perinatal outcomes of heart disease in pregnancy. 3) To study the pattern and frequency of occurrence of complications as a result of heart disease. Settings and Design: This study was carried out in the dept of Obstetrics and Gynecology of Govt. Karur Medical College Hospital in Karur district of Tamilnadu, India, from Jan 2023 to Dec 2023 as a retrospective study. Materials and Methods: In all patients detailed history – medical history, obstetric history were taken. Vital parameters checked and basic investigations done. Weight of the patient checked. Detailed general examination and obstetric examination done. Gestational age confirmed by USG. All the patients attending OPD, Casualty and Labour ward are included in the study. Screening Echocardiogram was done routinely for all patients in the OPD and inpatient was done. Also, diagnostic Echocardiography was also performed in patients who presented with cardiac symptoms. In addition to the patients diagnosed in the facility, the patients who were referred from primary and secondary care institutions, who had findings in Echocardiography were included in the study. All the pertaining details are maintained in a register, and they were consolidated at the end of study period, and statistical analysis done to arrive at the results. Results and Conclusion: This study found the prevalence of heart disease in pregnancy to be 4.4 %, which is comparable to Indian standards and various other research studies. Where, the prevalence of rheumatic/ valvular disease is found to be 3.9%, which is as usual and as expected higher than congenital, which is only 0.5%. From this study, it is evident that, the prevalence of heart disease remains the same throughout developing countries. With improvement in early detection and implementation of school health programmes, many school children are screened and underlying heart diseases are corrected, which has caused an increase in prevalence OD operated heart diseases in the community, which again are of concern.

Background: For a long, medical students have not been posted for compulsory management of public health emergencies of international concern. Hence globally, there is a paucity of data on the risk of infection among medical students who are posted for field duty at primary health centres. This study evaluates risk factors of COVID-19 among medical students posted for management of covid-19 pandemic at the primary healthcare level. Methods:  This retrospective case-control study was conducted on 221 medical students who were posted at a primary healthcare facility for COVID-19 management during March-May 2021. Students positive for SARS-COV-2 were the cases (n=71) and those negative for SARS-COV-2 were the control (n= 150). Univariate analysis was followed by multivariate analysis for key epidemiological variables. Results: On univariate analysis, type of duty, place of duty, history of migration, history of high-risk contacts, academic standard, place of residence during duty, use of air conditioning, etc. were found to be significantly associated with Covid positivity. On multivariate analysis, type of duty (p < 0.00001) and place of residence during duty (p < 0.0033) were significantly associated with Covid-19 infection among students. Two-dose immunization against COVID-19 (OR = 0.63) and satisfaction regarding preplacement training (OR = 0.43 – 0.80) emerged as protective factors. Conclusion: Duty at mass COVID testing centers and staying in a hostel during duty period predisposes medical students to COVID-19 infection while being fully immunized and a high level of satisfaction regarding pre-placement training protects them from infection.

Background: Chronic groin pain following hernia repair is a significant complication after inguinal hernia surgery. To mitigate this issue, some suggest routinely excising the ilioinguinal nerve. This study aimed to compare the outcomes of routine ilioinguinal nerve excision versus nerve preservation on chronic groin pain and other sensory symptoms following Lichtenstein inguinal hernia repair. Methods: This research was carried out at the Department of General Surgery, Mahatma Gandhi Medical College, over 12 months from March 2023 to March 2024. Sixty patients with uncomplicated inguinal hernia who met the study criteria and were scheduled for Lichtenstein hernioplasty were randomly assigned to two groups: 30 patients underwent ilioinguinal nerve preservation (Group A), and 30 patients had elective nerve excision (Group B). Patients were followed for up to one year, with assessments focusing on pain, hypoesthesia, and numbness. Data were compared and analysed. Results: At one year, the incidence of post-operative neuralgia was 23.33% in Group A and 6.67% in Group B (p=0.05), indicating a significant difference in pain outcomes between the two groups. However, the incidence of post-operative hypoesthesia was 10% in Group A versus 16.67% in Group B (p>0.05), and the incidence of numbness was 11.11% in Group A versus 16.67% in Group B (p>0.05), with no statistically significant difference between the groups for these symptoms. Conclusions: Elective excision of the ilioinguinal nerve during Lichtenstein hernia repair significantly reduces the incidence of chronic groin pain post-surgery.

Background: Congenital talipes equinovarus (clubfoot) occurs in one in 1000 live births and is one of the most common birth defects involving the musculoskeletal system. Ponseti method involves weekly manipulation of the deformity followed by a long-leg cast is the time proven method of management. Modified accelerated treatment protocols were designed to reduce the total duration of treatment involved in correcting deformity. This study was conducted to compare the functional outcome of CTEV achieved between conventional and accelerated Ponseti methods. Methods: A two-arm prospective study was conducted with participants randomized to two groups- Study group and Control groups. A total of 60 children (30 in each group was participated). All feet were scored using Pirani score, recorded by an independent assessor at each visit. Plaster treatment was continued until clinical correction achieved. The data was collected using pre-structured proforma and analyzed using frequency, percentage, mean and standard deviation, Chi square and unpaired t test. Results: There were 65% males ins study group and 60% males in control group with a mean age of 12.5±5.35 weeks and 10.86±6.21 weeks respectively for control and study group. Accelerated Ponseti technique has relatively shorter duration of manipulation compared to the standard Ponseti technique and it was statistically significant (0.001). Total number of casts used is not significantly different for accelerated Ponseti technique compared to the standard Ponseti technique. Conclusion: Accelerated Ponseti technique for club foot management was equally effective compared to the standard Ponseti technique in managing idiopathic congenital talipes equinovarus with relatively shorter duration of manipulation compared to the standard Ponseti technique. Total number of casts used was not significantly different for accelerated Ponseti technique effectiveness compared to the standard Ponseti technique.

Background: Knee ligament reconstruction is widely performed all over the world and graft choice for the same has been always an area of research. Currently the most preferred grafts include the bone-patellar tendon-bone graft (BPTB) and the hamstring graft. However, there are some significant donor site morbidities associated with these grafts. Thus, we have used peroneus longus tendon as the graft which was found to have similar functional outcomes compared to hamstring graft and assessed functional outcome at the donor site associated with it. Methods: Patients who required a knee ligament reconstruction were selected and Peroneus longus tendon was harvested as graft. The patients were followed up for 12 months post operatively. Functional scoring was done with AOFAS Ankle and Hindfoot scoring and Visual Analogue Scale – Foot and Ankle (VAS-FA) were used. Also, the power of foot eversion and plantar flexion was tested and recorded clinically by MRC grading. Results: 30 patients fulfilled the inclusion criteria (22 male and 08 female patients). Follow up period was 12 months. The mean pre and postoperative AOFAS -AH score was 99.27 ± 0.94 and 99.13 ± 1.01 respectively at 12 months follow up. The mean pre and postoperative VAS-FA score was 98.53 ± 1.38 and 98.00 ±1.34 respectively at 12 months follow up (p value > 0.05). The 12 months postoperative power of eversion and plantar flexion were grade 5 in all patients. Conclusion: There was no significant difference of functional outcome and muscle power was noted postoperatively (at one year follow up) at the donor site following PLT graft harvest.  Also, the surgical procedure of graft harvest was simple with less operative time with early wound healing and no complications postoperatively. Thus, we conclude that peroneus longus tendon can be used safely as a graft for ligament reconstruction with no significant donor site morbidities.

Introduction: Abnormal uterine bleeding (AUB) is defined as deviation in normal menstrual cycle. Perimenopause is the age 2-8 years before and 1 year after final menses. This age group is more prone for anovulatory cycles. Aim: To determine the factors associated with development of abnormal endometrial pathology in perimenopausal women with abnormal uterine bleeding at Kottayam medical college. Objective: To determine the risk factors for abnormal endometrial pathology in perimenopausal women with abnormal uterine bleeding. Methods: This is a prospective observational study conducted among 500 Perimenopausal women with AUB attending Gynecology Outpatient unit of Government medical college Kottayam from 30^th September 2022 to 30^th September 2023. Patients were evaluated. Endometrial sampling was done. Study variables assessed, includes BMI, Parity, Period of lactation, History of infertility, pcod, thyroid disease, diabetes mellites, Dyslipidemia etc. Odds ratio for each variable calculated. The study tool used was detailed Proforma. The data analysis was done using SPSS software version 20. Results: 16% of the study population had endometrial pathology. High prevalence of AUB was found in subjects with a BMI corresponding to class I obesity. Around 81.8% of those with history of breast cancer .Presence of diabetes and hypertension showed similar results. Presence of thyroid disorders also showed 25.7% prevalence. Patients with dyslipidemia also showed a prevalence of 47.4%. Conclusion: It was found that history of ART, PCOS had a protective effect on endometrium. History of breast cancer, Dyslipidaemia, diabetes, hypertension and thyroid disorders were found to be risk factors.

Background: The assessment of prescribing pattern in clinical setting is a useful tool to improve patient care and effectiveness of the drugs. This is more important in Obstetrics and Gynaecology specialty where sensible use of medicines with appropriate prescription has to be ensured owing to potential impact on foetuses and new-borns. Hence evaluating the prescription patterns among patients attending to Obstetrics and Gynaecology OPD will help in achieving the rational prescription behaviour. Material and Methods: A prospective, cross-sectional study of 3 months duration in which 300 prescriptions were collected from the outpatient department of Obstetrics and Gynaecology after taking patients’ informed consent. The prescriptions were collected and data was recorded in prescribed Performa in tabulated form. The data was analysed in terms of different indicators and compared with established prescribing guidelines to draw the conclusion. Results: Out of 300 patients, 113 (37.66%) patients were pregnant whereas 187 (62.33%) were non-pregnant. Among pregnant patients anaemia was common and among non-pregnant patients menstrual disorder was most common. Out of total 300 patients, 105 (35%) were prescribed 3 drugs, 4 drugs to 88 (29.33%) patients, 2 drugs to 42 (14%) patients and 5 drugs to 28 (9.33%) patients. Among all drugs, nutritional supplements were most commonly prescribed 242 (25.79%) out of which Iron 88 (36.36%) and Folic acid 60 (24.79%) were the most prescribed drugs. Conclusions: The current study aimed to analyse the prescription pattern of drugs used in OB-GYN outpatients department. The overall drug use pattern in our study correlates with various gynaecological diseases in the study. This study highlights the need for standardized treatment guidelines for OB-GYN conditions and helps us to focus on the deviation from rational prescribing standards by prescribers.

Background: The most common nutritional deficiencies in the world iron deficiency anemia (IDA). Regardless of the type of anemia, autonomic nervous system (ANS) dysfunction is a result. Because there are few related studies, this study assessed the ANS function in adolescents with IDA. Objective: The objective of this study is to assess the cardiac autonomic functions using cardiovascular reflex tests in iron deficiency anemia (IDA). Material and Methods: Thirty adolescents and with IDA and thirty controls of same age group 12 to 18 years were enrolled in this cross sectional study. We performed tests of autonomic function, such as the Valsalva maneuver, deep breathing tests (DBT), lying-to-stand assessments (LST), handgrip tests, and cold pressor tests. The statistical analysis was carried out using SPSS edition 21, and for normal and atypical parameter distributions, Mann-Whitney and unpaired t-tests were employed. The purpose of the study was to find possible health problems. Results: When compared to the healthy group, the IDA group’s delta HR (DBT) and E:I ratio (DBT) were found to be significantly lower (p = 0.00*). The Valsalva ratio was significantly lower (p = 0.00*) in the IDA group. In the IDA group, the 30:15 ratio was significantly lower (p = 0.00*) than in the healthy control group. Heart rate (LST) was higher in the IDA group compared to the control group (p = 0.00*). The handgrip test was statistically insignificant, but the cold pressor test in the IDA group demonstrated statistical significance (p = 0.00*). Conclusions: Sympathetic hyperactivity resulting from increased tissue oxygen demand is responsible for ANS dysfunctions, which are common side effects of IDA in adolescents. Patients with IDA may benefit from a cardiovascular reflex test to evaluate their cardiac autonomic function.

Venomous snake bite causes significant morbidity and mortality if treatment, especially antivenom therapy, is delayed. The case series discussed here throws insight not only into the presentation of a venomous snake bite to the emergency but also describes the different clinical courses the patient may undergo and management of complications during their hospitalization. One out of 5 patients presented early within 1 hr of bite and other 4 were delayed presentations to our emergency team. Out of them 3 patients had neurotoxic symptoms and one patient developed coagulopathy. One patient underwent fasciotomies for compartment syndrome. One patient required hemodialysis. Four patients underwent intubation for respiratory compromise, and one expired despite of all efforts.

Background: One of the cornerstones of competency based medical education (CBME) curriculum is assessment as per dictum “assessment drives learning” which involves introduction of various assessment methods like writing skills, OSPE, multiple choice questions (MCQs), viva etc among medical students. Assessment and evaluation are the most important components of medical education which focuses mainly on improving learning of the students. Aims and Objectives: To determine and to evaluate the most preferred method of assessment among first year MBBS students. Materials and methods: The study was conducted among 150 students studying in first MBBS. Student’s performance in first internals was assessed by different methods of assessments like writing skills, OSPE, MCQs, viva, etc and were informed about the purpose of the study. Results: Among all different assessment methods, 82% of the students preferred OSPE to score good marks (76-100%) over other methods of assessment. Writing skill denotes the depth of presentation but medical students cannot overlook importance of traditional writing skill which is the least preferred method to score the marks. Conclusion: The study concludes that, OSPE could be a preferred method followed by Viva in comparison to other methods for better understanding, easy way of learning and higher order of thinking which highlights the importance of skill lab establishment. MCQs and writing skills need to be improved. Student assessment is a comprehensive process related to teaching learning effectiveness and helps in developing educational concept.

Background: Acne vulgaris is a chronic inflammatory disease affecting majority of the adolescent population with a considerable impact on the psychosocial well-being of a person. Aim: 1) To assess the psychological impact of acne vulgaris. 2) To analyse their beliefs about acne and outlook about treatment of acne. Materials and Methods: This was a cross sectional study conducted at a tertiary government hospital involving 448 cases of acne, who were analyzed using a predesigned questionnaire and Cardiff acne disability index (CADI). Results: Out of 448 cases 220 were males and 228 were females. 210 cases diagnosed with grade 2 acne and 173 replied they had acne on and off. Inspite of this 228 cases had never taken any treatment in past. Of the 220 cases who had taken treatment, 91 cases had been treated by a dermatologist and 60cases had taken treatment based on a friend’s suggestion. Only 53 replied that cost is immaterial. 158 patients preferred using only night cream. 321 were aware that dermatologist was the qualified person to treat acne. 80 subjects had CADI scores > 8 indicating significant psychological impact and 368 showed < 8 score, implying no psychological impact. Conclusion: This study shows that the psychological impairment due to acne is not so severe in our set up compared to other reports. It is important to take into account the cost of therapy and counsel adequately regarding the mode of therapy while treating acne which can improve the compliance and outcome.

Background: Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, leading to organ dysfunction and high mortality rates. This study aimed to investigate the association between serum lactate levels and 28-day mortality in patients with sepsis. Methods: A prospective observational study was conducted in the intensive care unit of a tertiary care hospital. Adult patients with sepsis (n=80) were enrolled, and serum lactate levels were measured at baseline and at 12, 24, and 48hours. The primary outcome was 28-day mortality. Logistic regression analysis and Cox proportional hazards regression were used to assess the association between lactate levels and mortality. Results: Non-survivors had significantly higher initial serum lactate levels compared to survivors (4.3 mmol/L vs. 3.2 mmol/L, p<0.001). The optimal cut-off value for initial serum lactate in predicting 28-day mortality was 3.8 mmol/L (sensitivity 78.6%, specificity 71.2%, AUC 0.81). Patients with serum lactate levels >3.8 mmol/L had a significantly lower 28-day survival rate (39.3% vs. 82.4%, p<0.001). In the multivariate analysis, APACHE II score (hazard ratio 1.09, 95% CI 1.03-1.16, p=0.003) and initial serum lactate (hazard ratio 1.58, 95% CI 1.23-2.03, p<0.001) were independent predictors of mortality. Conclusion: Serum lactate levels and lactate clearance are significant predictors of 28-day mortality in patients with sepsis. Incorporating lactate measurement into sepsis management protocols can help guide treatment decisions and improve patient outcomes.

Background: Globally, a significant factor in neonatal mortality is birth asphyxia. Birth asphyxia is still a serious illness that causes a high rate of morbidity and mortality in India. The purpose of the study was to evaluate the relationship between newborn outcome and birth asphyxia prevalence and risk factors. Methods: The cross-sectional study was carried out on 131 neonates during September 2021 to august 2022. Data were collected using a questionnaire, check list and chart review, which was used to retrieve medical information and mother’s data. Data analyzed using SPSS-25 software. Results: It was shown that 19.3% of babies had birth asphyxia overall. Among the 181 cases of births, there were 23.04% with meconium-stained labor, 16.85 with obstructed labor, 11.77% with malpresentation, 14.12% with prolonged labor, 8.3% with anemia, 9.55% with premature delivery, 5.67% with PROM, 3.3% with preeclampsia, and 1.75% with umbilical cord prolapse. In this study, the prevalence of moderate newborn asphyxia was 59.6% and severe birth asphyxia was 40.4% overall.26 cases (49.0%) of severe newborn asphyxia were discharged, and 27 cases (51%) died; in contrast, 61 cases (70%) of moderate birth asphyxia were discharged, and 17 cases (30%) died. Conclusion : Findings indicates that birth asphyxia is still prevalent and fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid, obstructed labour and prolonged labour were significantly associated maternal risk factors for birth asphyxia in neonates. Improved maternity care is required, as is raising awareness of the causes of birth asphyxia.

Introduction: Cervical cancer is the fourth most common cause of death and morbidity for women worldwide. It is the second most common malignancy in India between ages 15-44 years. The gold standard screening test for early diagnosis of cervical epithelial cell abnormalities, mild to severe dysplasia, precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer is the Pap smear. Aims and Objectives: To Evaluation of spectrum of Pap smear cytology according to Bethesda system and to assess the usefulness of the cytological study in the diagnosis of cervical lesions. Material and Methodology: Retrospective study of 400 cases of Pap smear verified by microscopic examination by expert pathologists in the department of pathology at PSH from April 2023 to August 2023. Result: In our study the results is divided into categories: NILM and Epithelial cell abnormality. In NILM Inflammatory smear, NILM with Bacterial vaginosis and NILM with trichomonas vaginalis were included. In Epithelial cell abnormality ASCUS, HSIL, LSIL, ASC-H, SCC and AGUS were included. Conclusion: Pap smear is proven tested tool for making an early diagnosis and treating cervical cancer in early stage. Thus, Pap smear is simple, less expensive diagnostic tool suitable for implementation in India.

Introduction: The term ‘acute abdomen’ describes the abrupt onset of severe abdominal pain and tenderness, typically requiring immediate medical evaluation and often necessitating emergency surgical intervention. The abdomen is often likened to Pandora’s box due to the potential for unforeseen discoveries during surgical exploration. Consequently, laparotomy, or surgical opening of the abdomen, is sometimes the final recourse for diagnosing abdominal conditions accurately. We highlight the importance of clinical examination in forming a preliminary diagnosis, the role of ultrasound, CT in refining differential diagnoses, and the planning of appropriate surgical treatments. Aim: To study the non-traumatic causes of acute abdomen with the aid of advanced radiological imaging for the early management. Objectives: a) To study about non-traumatic causes of acute abdomen in defined age groups. b) To study the aid of Radiological diagnostic tools i.e. X ray, Ultrasonography, CT scan in the diagnosis and management of the emergencies. c) To study about the mode of management of non-traumatic acute abdomen. Methods: A Randomised prospective study was conducted at the Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur. It included all the patients of defined age group (18 to 65years) presenting to OPD and Emergency department with non-traumatic acute abdomen between September 2022 to March 2024. Conclusion: The acute abdomen is frequently encountered as a surgical emergency, presenting a significant clinical challenge for surgeons. Acute abdomen predominantly afflicts males, occurring 1.5 times more often than in females. Acute appendicitis stands out as the leading cause of acute abdomen. Perforations most commonly occur in the small bowel, particularly in the duodenum. Obstructed hernias are the most frequent cause of intestinal obstruction. CT abdomen plays a critical role in diagnosing acute abdomen, especially when other methods fail to yield a definitive preoperative diagnosis, ensuring prompt patient management. Surgical intervention remains the cornerstone of management for the majority of patients.

Background: Hydration is crucial for cognitive function and general health, but less is known about how it affects cognition, especially in young adults. Under hydration has been proven to impair memory, attention, and executive function. However, many complex ways hydration status affects these processes in youth are unknown.  We must understand these effects to design tailored hydration methods to boost cognitive performance and well-being. Method: In this cross-sectional study, 125 young adults (mean age 23.4 years) were assessed for hydration and cognition. Blood biomarkers and urine osmolality tested hydration, whereas the Wisconsin Card Sorting Test, Continuous Performance Test, and Stroop Test tested memory, attention, and executive function. Multiple regression and correlation analysis were utilised to study hydration and mental sharpness. Results: According to mean urine osmolality, 40% of individuals were mildly to moderately dehydrated. Cognitive tests showed that under hydration impaired verbal and working memory. Hydration level had moderate negative relationships with Rey Auditory Verbal Learning Test and Digit Span Test results. Hydrated people had better cognitive control on the Stroop Test, but attention tests were not statistically significant. Dehydrated people have lower memory, especially women. These findings emphasise the need of hydration for cognitive performance, notably memory. Conclusion: Hydration is crucial for cognitive function, especially memory. The result supports earlier findings that hydration improves cognition. However, it highlights the need for more research on how hydration affects different cognitive domains and groups.

Introduction: Pediatric seizures impact developmental trajectories significantly. This study evaluates combined therapy versus medication alone for managing seizures in children in Kishanganj. Methodology: A two-year prospective observational study involved 80 pediatric patients treated with either single medications or a combination of medications and dietary interventions. Data were analyzed using SPSS software. Results: Combined therapy showed an 85% response rate, outperforming Medication A (75%) and Medication B (50%), with significant improvements noted in neurological, cognitive, and behavioral development. Conclusion: Combined therapy is more effective than medication alone, enhancing seizure control and developmental outcomes in pediatric patients.

Recommendation: Clinicians should consider holistic treatment approaches that integrate pharmacological and dietary interventions for optimal management of pediatric seizures.

Background: HELLP syndrome is a form of preeclampsia in which endothelial dysfunction is manifested by the activation of coagulation and liver dysfunction, as detected through laboratory tests. ‘HELLP’ stands for hemolysis, elevated liver enzymes, and low platelet count. Tertiary care hospitals are in charge of managing both high-risk pregnancies and the potentially fatal HELLP condition. Aim: The aim of this study was to ascertain the mode of presentation, diagnosis, severity, and along with feto-maternal outcome in pregnant women diagnosed with HELLP syndrome at a tertiary healthcare facility. Materials & Methods: In the current study, which was conducted at the M.K.C.G. Medical College & Hospital in Berhampur, 62 people with HELLP syndrome were the participants who were admitted to the wards through the labor room using purposive selection. The researchers selected study participants based on the MISSISSIPPI classification amongst those having either evident preeclampsia or eclampsia features with HELLP syndrome. Results: The research indicates that HELLP syndrome was present in most patients (61.3%) between the ages of 21 and 30. There was a wide range of gestational ages, with 27.4% of women diagnosed at 28-32 weeks, 12.9% having 33-34 weeks, 19.3% having 35-36 weeks, 25.8% having 37-38 weeks, 12.9% having 39-40 weeks, and 1.6% being post-term. Pain in the abdomen was the primary complaint of a large number of patients who were brought to the hospital. These patients were from both high and low socioeconomic strata. Fits, headaches, hematuria, visual changes, reduced urination, shortness of breath, weakness, vomiting, leaking or bleeding per vaginum, irritability, head reeling, jaundice, and pedal oedema were some common symptoms. Conclusion: To effectively diagnose and treat pregnant women who have HELLP syndrome, it is essential to have a thorough understanding of the sociodemographic factors, gestational age, and presenting difficulties that these women experience. Enhancing treatment options and minimizing the number of unfavourable outcomes by early detection and rigorous monitoring is possible.

Background: Ectopic pregnancy is a chief causal factor to maternal morbidity and mortality, particularly in developing nations. This condition occurs when a fertilized egg implants outside the uterine cavity, requiring swift diagnosis and intervention to prevent life-threatening complications. The incidence, risk factors, clinical manifestations, management approaches, and outcomes of ectopic pregnancies vary significantly depending on demographic and healthcare factors. Aim: The aim of this study is to examine the clinical presentation, associated risk factors, treatment modalities, and outcomes in patients diagnosed with ectopic pregnancies. Methods: This prospective observational study was conducted over two years, from August 2022 to July 2024, at MKCG Medical College and Hospital, involving 180 patients diagnosed with ectopic pregnancies. Comprehensive patient data, including demographics, risk factors, clinical presentations, and past surgical or obstetric histories, were collected. Management was categorized as either medical or surgical, depending on the patient’s condition. Statistical analysis was performed using Microsoft Excel and SPSS Version 21.0. Statistical significance was evaluated using the Student’s t-test and Chi-square test. Results: The incidence of ectopic pregnancy was found to be 1.17%, with the highest occurrence in women aged 26-30 years. Hemoglobin levels between 7-9.9 gm% were observed in 41.6% of the patients. Ampullary tubal pregnancy was the most common site of implantation (85%), and 81.1% of cases involved ruptured ectopic pregnancies. Unilateral salpingectomy was the most frequently performed surgical procedure (88.3%). Blood transfusions were necessary in 53.8% of cases, and the mortality rate was 1.6%. Conclusion: Ectopic pregnancy continues to pose a serious health challenge with notable morbidity and mortality. Early diagnosis and timely management are essential to improving outcomes. Surgical intervention remains the primary treatment option, especially in cases of ruptured ectopic pregnancies. Recommendations: To reduce the morbidity and mortality associated with ectopic pregnancies, it is recommended to strengthen antenatal care, promote early ultrasound screening, and raise awareness among healthcare providers and patients regarding the risk factors for ectopic pregnancies.

Introduction: Effective spinal anesthesia is crucial for cesarean sections. This study compares the efficacy, safety, and patient outcomes of hyperbaric bupivacaine and levobupivacaine, focusing on their cardiovascular safety profiles. Methodology: A prospective observational study was conducted at Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital over three months, involving 80 female patients randomized into two groups. Group B received hyperbaric bupivacaine 0.5%, and Group L received levobupivacaine 0.5%. Parameters such as onset and duration of anesthesia, incidence of hypotension, patient satisfaction, and neonatal outcomes were measured. Results: Both anesthetics proved effective in providing adequate anesthesia with no significant difference in onset and duration. However, levobupivacaine was associated with a significantly lower incidence of hypotension (45% vs. 62.5% in bupivacaine; p=0.04). Patient satisfaction and neonatal outcomes were comparable between the groups. Conclusion: While both agents are effective, levobupivacaine offers a better safety profile concerning hypotension, making it potentially preferable for use in cesarean sections.

Recommendation: Further research should focus on expanding these findings across different populations and exploring dose adjustments to optimize safety and efficacy.

Background: Salivary gland lesions present a diagnostic challenge due to their diverse pathological spectrum, ranging from benign conditions to aggressive malignancies. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced to standardize the reporting of fine needle aspiration cytology (FNAC) results and improve diagnostic accuracy and clinical management. Aim: This study aims to evaluate the diagnostic performance and clinical utility of the Milan scoring system in assessing the risk of malignancy in salivary gland lesions in a multicentric tertiary care setting. Methods: A retrospective cohort study was conducted including 205 patients who underwent FNAC for salivary gland lesions. The lesions were categorized according to the Milan system, and FNAC results were correlated with histopathological outcomes where available. Statistical analysis was performed using SPSS version 23.0 to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the risk of malignancy (ROM) for each category. Results: The Milan scoring system demonstrated a sensitivity of 87.5% and specificity of 95.7% in diagnosing malignancy. The highest risk of malignancy was observed in Category VI (Malignant) with a ROM of 100%, followed by Category V (Suspicious for Malignancy) with a ROM of 80%. Strong concordance was found between FNAC results and histopathological diagnoses (kappa = 0.85), indicating the reliability of the Milan system in clinical practice. Conclusion: The Milan scoring system is a valuable tool for the risk stratification and management of salivary gland lesions, providing high diagnostic accuracy and strong agreement with histopathological outcomes. It effectively guides clinical decision-making, particularly in cases with a high risk of malignancy. Recommendations: Further studies are recommended to refine the criteria for intermediate categories such as Atypia of Undetermined Significance (AUS) and Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) to enhance clinical utility. Additionally, the Milan system should be integrated into routine practice across diverse clinical settings to ensure standardized patient care.

Background: This study investigates the prevalence, risk factors, and clinical characteristics of Gastroesophageal Reflux Disease (GERD) and Inflammatory Bowel Diseases (IBD) in the urban population of Jharkhand. Methods: 250 participants from Ranchi, Jamshedpur, and Dhanbad were included in this cross-sectional study. Demographic data, lifestyle habits, and clinical histories were collected and analyzed. Results: The prevalence of GERD was found to be 26%, while IBD, comprising ulcerative colitis and Crohn’s disease, had an overall prevalence of 18%. Key risk factors associated with GERD included smoking (46.1%), alcohol consumption (53.8%), and a diet high in spicy and fatty foods (61.5%). IBD was significantly associated with high-stress levels (77.7%) and similar dietary patterns. Obesity also contributed to both conditions, affecting 38.5% of GERD and 22.2% of IBD patients. Conclusion: The study highlights the impact of urbanization and lifestyle changes on the increasing prevalence of GERD and IBD in Jharkhand, comparable to global trends. These findings underscore the need for public health strategies focusing on lifestyle modifications, early diagnosis, and stress management while increasing awareness of IBD among healthcare providers.

Background: Eclampsia, characterized by seizures during pregnancy, remains a major health challenge in developing countries. This study evaluates the maternal and perinatal outcomes of eclampsia in a tertiary care   center at Darbhanga Medical College & Hospital, Bihar. Methods: A retrospective analysis of approximately 100 eclampsia cases at Darbhanga Medical College and Hospital from September 2023 to January 2024 was conducted. Data on incidence, treatment efficacy, and    maternal and perinatal outcomes were collected and analyzed. Results: The incidence of eclampsia was 0.7%. Maternal and perinatal mortality rates were reported at 10% and 40%, respectively. Magnesium sulfate, used as the primary treatment, prevented seizures in 85% of cases. The study highlights the critical impact of timely access to prenatal care on improving outcomes. Conclusion: Eclampsia continues to pose significant risks to maternal and child health, particularly in resource-limited settings. Despite effective seizure management with magnesium sulfate, high mortality rates indicate the need for improved healthcare services and prenatal care accessibility.

Background: Meconium-stained liquor (MSL) is a common occurrence during labor that can significantly impact neonatal outcomes. This study aims to identify maternal risk factors associated with MSL and evaluate their effects on neonates. Methods: About 100 pregnant women with MSL participated in a Darbhanga Medical College and Hospital retrospective observational study from August 2023 to December 2023. Maternal demographics, risk factors, and neonatal outcomes, including Apgar scores, Meconium Aspiration Syndrome (MAS) incidence, and NICU admission, were gathered. Results: Post-term pregnancy (25%) and maternal hypertension (20%) were the most common risk factors in 100 cases. Meconium was thick in 35% of instances. Neonatal outcomes showed 25% had poor Apgar scores, 10% had MAS, and 20% had respiratory distress. 18% of newborns needed NICU hospitalization, highlighting the link between thick meconium and unfavorable outcomes. Conclusion: The study highlights the significant impact of maternal risk factors, particularly post-term pregnancy and hypertension, on neonatal outcomes in cases of MSL. Timely identification and management of these risk factors are essential to improve neonatal health and reduce complications.

Background: PCOS is a prevalent endocrine illness that causes hormonal imbalance, chronic inflammation, oxidative stress, and infertility. Vitamin D may help PCOS women by reducing inflammation and oxidative stress. Objective: This study examined how vitamin D supplementation affected inflammation, oxidative stress, and hormonal balance in PCOS-infertile women. Methods: From March to July 2024, Darbhanga Medical College and Hospital conducted prospective observational research on 100 infertile PCOS women. A regular vitamin D supplement was given. At baseline and after the four-month intervention, inflammatory markers (hs-CRP, TNF-α, IL-6) and oxidative stress markers (TAC, MDA, GPx) were evaluated. Hormone levels, menstrual regularity, and ovulation were evaluated. Results: Vitamin D treatment significantly reduced inflammatory markers (hs-CRP, TNF-α, IL-6) and improved oxidative stress markers (TAC, MDA, GPx) (p < 0.05). Improved hormonal balance, including lower LH, LH/FSH ratio, and testosterone levels (p < 0.05). Ovulation and menstrual regularity rose from 30% to 55% and 40% to 78%, respectively. Conclusion: In PCOS-infertile women, vitamin D treatment greatly lowers inflammation, oxidative stress, hormonal imbalance, and reproductive health. Vitamin D’s long-term effects on fertility need further study.

Background: Pre-eclampsia is a significant pregnancy-related disorder characterized by the onset of hypertension and proteinuria, with implications for both maternal and fetal health. This disorder’s resolution in the postpartum period is critical for long-term health outcomes. Objective: To assess the postpartum resolution of hypertension, proteinuria, and serum N-terminal B-type natriuretic peptide (NT-proBNP) levels among women diagnosed with pre-eclampsia. Methods: This prospective observational study involved 100 patients diagnosed with pre-eclampsia at Darbhanga Medical College and Hospital. Participants were monitored for 12 weeks postpartum, with evaluations at 1 week, 6 weeks, and 12 weeks to measure blood pressure, proteinuria, and NT-proBNP levels. Results: At 1 week postpartum, 65% of patients continued to experience hypertension, and 72% had persistent proteinuria. By the end of the study period, 95% showed a resolution of hypertension, and 90% had a resolution of proteinuria. NT-proBNP levels were elevated in 78% of the patients at 1 week but normalized in 92% by 12 weeks. However, 8% of patients maintained elevated NT-pro BNP levels, indicating potential long-term cardiovascular risks. Conclusion: While the majority of women with pre-eclampsia experience resolution of clinical symptoms by 12 weeks postpartum, a small subset continues to show signs of potential long-term cardiovascular complications. These findings highlight the importance of continued monitoring and possible interventions for women with unresolved clinical markers of pre-eclampsia. Further studies are needed to fully understand the long-term impact of this condition on cardiovascular health.

Background: Placenta previa is a serious obstetric issue that can harm mother and child. This study examined placenta previa location on pregnancy outcomes. Methods: About 100 pregnant women with placenta previa participated in a prospective observational study at Darbhanga Medical College and Hospital from December 2023 to April 2024. Placental location—anterior, posterior, or lateral—determined maternal and fetal outcomes. Results: Patients with anterior placenta previa had a greater incidence of antepartum hemorrhage (60%), caesarean births (80%), and lower mean birth weights (2.5 kg) than those with posterior (40%, 50%, and 2.9 kg) and lateral (30%, 40%, and 3.1 kg). NICU hospitalizations (30% anterior) and poorer Apgar scores were more common in the anterior group. Conclusion: Antecedent placenta previa enhanced maternal and foetal risks, according to the study. These findings emphasize the need for placenta previa-specific monitoring and management.

Background: 25(OH)D, a crucial nutrient for bone health and immune system regulation, has been increasingly linked to mental health. Deficiency in 25(OH)D is prevalent among psychiatric patients and may exacerbate mental health conditions. This study aims to evaluate the 25(OH)D levels in female psychiatric patients at a tertiary care center and investigate the prevalence of 25(OH)D deficiency in this population. Methods: A cross-sectional observational study was conducted involving 100 female psychiatric patients. Data on demographic characteristics, psychiatric diagnoses, and serum 25(OH)D levels were collected. Statistical analysis, including one-way ANOVA and Pearson correlation, was performed using SPSS version 23.0 to identify significant differences and relationships. Results: The mean serum 25(OH)D level among participants was 40.5 ng/mL (SD = 15.3). Levels varied significantly across diagnoses, with the lowest in schizophrenia (mean = 35.2 ng/mL, SD = 12.8) and the highest in anxiety disorders (mean = 50.1 ng/mL, SD = 13.5). 25(OH)D deficiency (<20 ng/mL) was found in 45% of patients, insufficiency (20-30 ng/mL) in 35%, and sufficiency (>30 ng/mL) in 20%. ANOVA indicated significant differences among diagnoses (F(3, 96) = 5.67, p = 0.001), with post hoc tests showing lower levels in schizophrenia compared to MDD and anxiety disorders. There was no significant correlation between age and 25(OH)D levels (r = -0.12, p = 0.18). Conclusion: 25(OH)D deficiency is highly prevalent among female psychiatric patients, with significant differences in levels across various psychiatric diagnoses. These findings highlight the need for regular monitoring and management of 25(OH)D levels in psychiatric care. Recommendations: Routine screening for 25(OH)D deficiency should be implemented for psychiatric patients, particularly those with schizophrenia. Further research is needed to explore the causal relationship between 25(OH)D levels and psychiatric conditions and to develop targeted interventions.

Introduction: Distal radius fractures often co-occur with ulnar styloid fractures, leading to varied treatment approaches and debates on their impact on functional outcomes. This study aims to assess whether surgical repair of ulnar styloid fractures contributes to better functional outcomes in patients with distal radius fractures. Material and Methods: Conducted at the Central Institute of Orthopaedics in New Delhi over 18 months, this prospective, comparative analysis included 60 patients with concurrent distal radius and ulnar styloid fractures. Patients were randomized into two groups: one undergoing distal radius fixation without ulnar styloid intervention and the other receiving fixation for both fractures. The study focused on evaluating postoperative complications, pain management (VAS scores) and functional recovery (DASH scores). Results: No significant difference in age distribution was observed between the groups. Surgical duration was notably longer in the group receiving ulnar styloid fixation. However, this group demonstrated significantly better outcomes in pain reduction and functional recovery over time, without an increase in postoperative complications. Conclusion: Surgical repair of ulnar styloid fractures, in conjunction with distal radius fractures, leads to improved pain management and functional outcomes without compromising safety. These findings suggest that addressing ulnar styloid fractures in the surgical protocol may enhance recovery and quality of life for patients with distal radius fractures.

Background: Spinal anaesthesia is widely acknowledged as a safe and effective method for providing anaesthetic in surgeries involving the infraumbilical region and lower limbs. The objective of the present study was to evaluate the efficacy of two different doses of intrathecal clonidine as an adjunct to bupivacaine for spinal anesthesia. Methods: This randomized double-blinded study was conducted in the Department of Anaesthesiology at our tertiary care hospital from February 2023 to June 2024. Seventy patients were divided into: Group I and Group II. Postoperative analgesia was evaluated using the visual analog scale with a 0-10 cm range. The hemodynamic parameters and the number of significant events (bradycardia, hypotension, sedation) were documented and analyzed for comparison. Results: The mean time for the onset of sensory and motor block in group II was less than group I (p0.05). The duration of analgesia was significantly prolonged in Group II. The mean VAS score of Group II was lower at every follow-up in Group II .Minimal side effects observed in both the groups which was non-significant. Conclusion: The administration of spinal anaesthesia utilizing 0.5% bupivacaine heavy combined with 30 mcg of clonidine noted superior efficacy as an adjuvant in achieving an earlier onset of sensory and motor blockade during surgery, as well as extending the duration of effective postoperative analgesia, in comparison to the use of 15 mcg of clonidine.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major global health issue, recognized as the third leading cause of death worldwide. It imposes significant economic and social burdens, with rising mortality rates in industrialized nations. Acute exacerbations of COPD (AECOPD) are critical events that worsen patient outcomes and are associated with increased cardiovascular risks, including elevated cardiac Troponin-T levels. Objectives: This study aims to determine the levels of cardiac Troponin-T in patients experiencing acute exacerbations of COPD and to investigate the correlation between Troponin-T levels and the severity of these exacerbations. Methodology: A hospital-based cross-sectional study was conducted at the National Institute of Medical Sciences and Research, Jaipur, Rajasthan, from July 1, 2022, to December 31, 2023. The study included 180 COPD patients aged 40 years and above. Data collection involved clinical profiles, laboratory investigations including cardiac Troponin-T levels, spirometry for pulmonary function tests, and statistical analyses using Karl Pearson’s correlation coefficient and linear regression. Results: Of the 180 patients, 61.67% were male and 38.33% were female, with a mean age of 44.38 ± 10.50 years. A majority (84.44%) resided in rural areas, and 82.78% were Hindu by religion. The study found that 60% of the COPD patients had elevated Troponin-T levels (>0.04 ng/dl). There was a significant negative correlation between Troponin-T levels and spirometry parameters: FEV1 (r= -0.644, p=0.00001) and FEV1/FVC (r= -0.56, p=0.00001). Patients with higher Troponin-T levels exhibited more severe respiratory impairment, indicated by lower FEV1 and FEV1/FVC ratios. Elevated Troponin-T was associated with a greater need for assisted ventilation. Conclusion: Elevated cardiac Troponin-T levels in COPD patients are significantly correlated with the severity of acute exacerbations, serving as a potential marker for early diagnosis and prognosis. The findings suggest that measuring Troponin-T levels can aid in assessing disease severity and guiding clinical management of COPD exacerbations. Further research is needed to explore the mechanisms linking cardiac injury and COPD to enhance patient care.