Background: Basic Life Support (BLS) seeks to preserve respiration and circulation in cardiac arrest victims, emphasizing cardiopulmonary resuscitation (CPR) while utilizing minimal supplementary equipment. As per new Curriculum based medical education guidelines by National Medical Commission, foundation course for the Undergraduate has been started since 2019, in which skill component include 180 minutes for Basic Life Support. However, this much is not sufficient to learn about BLS and CPR. The elevated standards of care need that knowledge of BLS/CPR be updated and encompass both laypersons and medical professionals who may serve as educators in this skill. Objectives: The aim of the study was to evaluate the knowledge and attitudes of MBBS Phase – 1 medical students about Basic Life Support (BLS). Methods: This health education related descriptive, cross-sectional study was done by department of Physiology, among Phase 1 MBBS students of CIMS Chhindwara, MP, India, after institutional ethics committee approval. A Pre designed, pre-validated, self-reported questionnaire forms consisted of two sections were used for assessing the knowledge and attitude of MBBS students. Knowledge component assessment questionnaire form included questions related to steps of BLS, components of CPR and their details, sequence of CPR steps to follow, general awareness about examining pulse, respiration, etc. Attitude component assessment questionnaire form included questions related to CPR performed, willingness to learn BLS, willingness to teach BLS to family members, opinion on adding BLS training in medical and paramedical courses, etc. Data was entered in excel sheet. Means and proportions were calculated for quantitative & qualitative data respectively. Suitable statistical analysis done depending on the distribution of data. Results: Total number of sample size was 99 Phase 1 MBBS students. 98.99% of participants had poor knowledge, 1.01% of participants had average knowledge and none of the participant had good knowledge regarding Basic Life Support. Present study revealed a positive attitude of students towards BLS. Of the participants, 92.93% students have not done CPR before and 94% students feel that their knowledge about BLS is insufficient. 90.9% students think that all health care workers should be trained in BLS and 93.94% are likely to attend BLS training in workshop with hands on practice under supervision. Conclusion: The Study highlights that the knowledge of MBBS phase 1 students regarding BLS was not satisfactory. A significant portion of students do not acquire adequate knowledge in a single session of training in present curriculum. There is need to include frequent BLS training at regular intervals in medical curriculum of first year MBBS students. Progression of knowledge can also be done by inclusion of different teaching methods.

Background: Tibial shaft fractures are common orthopedic injuries, often resulting from high-energy trauma in younger individuals and falls in older adults. These fractures present a clinical challenge due to their complex nature and associated complications. Intramedullary nailing, particularly with the Expert Tibial Nail (ETN), has emerged as a preferred surgical technique for effective management. Methods: A prospective observational study was conducted over 18 months at a tertiary care hospital to assess the clinical outcomes of proximal tibia shaft fractures treated with intramedullary interlocking nailing using the ETN system. A total of 30 patients aged 18-75 were included, with follow-ups conducted at intervals up to six months post-surgery. Outcomes were evaluated using radiological assessments and functional criteria (Johner and Wruh’s). Results: The study demonstrated a high rate of successful outcomes, with 72% of patients achieving excellent functional recovery and 24% good results. Fracture healing times correlated with severity, ranging from 18 to 22 weeks. Early mobilization and partial weight-bearing were initiated within 11-12 weeks. Complications were minimal, with joint stiffness being the most frequent (10%). Conclusion: Intramedullary interlocking nailing with ETN is an effective treatment for proximal tibial fractures, offering superior functional and radiological outcomes. While complications such as knee stiffness and infection were observed, their incidence was low, emphasizing the importance of precise surgical techniques and early intervention.

Distal end radius fractures are among the most common upper extremity injuries, particularly in adults. The management of these fractures can vary significantly, with external fixation emerging as a viable option for cases that are displaced and complex. This article reviews the radiological outcomes of displaced distal end radius fractures treated with external fixators, emphasizing recovery metrics, patient satisfaction, and long-term implications.

Response to Ceftriaxone was assessed in resistant uncomplicated E. coli UTI cases as Ceftriaxone concentrates more than 10-fold in urinary bladder. 30 subjects were selected out of which 18 were females and 12 males. 14 resistant cases responded with a follow up negative culture and lowering of urinary pus cells and WBC counts whereas 3 resistant cases failed to respond. Out of 4 non-growers, 3 responded to CTO. This brings promise of initial treatment of uncomplicated UTI with Ceftriaxone prior to arrival of culture results.

Background: The thyroid gland synthesizes primarily two hormones, triiodothyronine (T3) and thyroxin (T4) which are vital to maintain numerous functions especially metabolic, mineral and thermogenic homeostasis in body. The disorders of thyroid function especially hypothyroidism is important it can cause of disturbance in Calcium & Phosphorus metabolism. Objectives: This study was designed to estimate serum T3, serum T4, serum TSH, serum Calcium and serum Phosphorus in hypothyroid patients and control subjects. Materials and Methods: After ethical committee approval, a case control study was conducted in the Department of Biochemistry in Govt. Medical College and associated group of Hospital, Kota (Raj.). A total of 144 subjects included in this study were divided into two groups – control and hypothyroid. Result: The significant (p < 0.001) decreased mean value of serum Calcium and serum Phosphorus in hypothyroid patients when compared with control subjects. Conclusion: In our study we found that serum Calcium and serum Phosphorus were altered in hypothyroid patients. Hence estimation of serum Calcium & Phosphorus may be supportive for better management to avert further problems from mineral metabolism dysfunction.

Aim: This study aimed to evaluate the effects of PRP on pain, joint function, and cartilage thickness in patients with knee OA over 12 months. Methods: In a randomized controlled trial conducted from 2020 to 2023 at IGIMS and PMCH in Patna, 100 patients with knee OA were assigned to either a PRP group (n=50) or a control group (n=50). PRP patients received three intra-articular injections, while controls received saline. Pain (VAS), function (WOMAC), and cartilage thickness (MRI) were measured at baseline, 3, 6, and 12 months. Results: PRP significantly reduced pain (p<0.001) and improved function (p<0.001) compared to control. MRI showed a modest increase in cartilage thickness in the PRP group, suggesting possible regenerative effects. Conclusion: PRP therapy provides effective pain relief and functional improvement in knee OA patients, with the potential for cartilage regeneration, indicating its promise as a non-surgical treatment option.

Introduction: Placenta previa and placenta accreta spectrum disorders are serious obstetric complications associated with increased maternal morbidity and mortality, largely due to postpartum hemorrhage (PPH). Intrauterine balloon tamponade (IUBT) has emerged as a less invasive method to manage severe PPH, potentially reducing the need for hysterectomy and preserving fertility. While included in treatment guidelines, the efficacy of IUBT varies across studies. This study evaluates the effectiveness of IUBT in cesarean deliveries complicated by placenta previa and placenta accreta spectrum. Material and Methods: This 12-month prospective study included women undergoing cesarean deliveries complicated by placenta previa or placenta accreta spectrum (PAS). Diagnoses were confirmed via ultrasonography, MRI, or intraoperative findings. Patients with coagulopathies, infections, or incomplete follow-up were excluded. IUBT was standardized using the Bakri balloon or equivalent devices, with data on usage, blood loss, and additional interventions systematically recorded. Statistical analysis was conducted using SPSS, with p < 0.05 considered significant. Results: In our study, intrauterine balloon tamponade (IUBT) was successfully used in 92% of cases with placenta previa and placenta accreta spectrum, with a peripartum hysterectomy rate of 8% and no maternal mortality reported. Blood transfusions were required intraoperatively in 60% of cases, postoperatively in 30%, and preoperatively in 10%, reflecting the severity of hemorrhage. Emergency cesarean sections accounted for 82% of cases, while 18% were elective. Among comorbidities, gestational hypertension was most common (26%), followed by diabetes (10%) and severe pre-eclampsia (5%). Neonatal outcomes showed a survival rate of 92%, with a mean birth weight of 2.372 ± 0.37 kg. Intrauterine fetal demise occurred in 5% of cases, early neonatal death in 4%, and 3% of neonates were referred to the SNCU, emphasizing the high-risk nature of these pregnancies. Conclusion: In conclusion, intrauterine balloon tamponade proved effective in managing postpartum hemorrhage in placenta previa and accreta spectrum cases, with a high success rate, low peripartum hysterectomy rate, and no maternal mortality. These findings highlight its role as a valuable, less invasive intervention in high-risk obstetrics.

Background: Cervical lymphadenopathy is a common clinical condition involving the enlargement of cervical lymph nodes due to various causes, including infections, malignancies, and systemic diseases. Its presentation often poses diagnostic challenges. This study explores the etiologies, clinical profiles, diagnostic approaches, and management strategies for cervical lymphadenopathy, aiming to improve patient outcomes through evidence-based interventions. Methods: Patients presenting with cervical lymph node enlargement. Data collection involved a structured proforma, which included detailed patient history, thorough clinical examination, and relevant investigations to establish a provisional diagnosis. Routine investigations included fine-needle aspiration cytology (FNAC) and blood tests. In cases where FNAC yielded inconclusive results, lymph node biopsy specimens were collected and subjected to histopathological examination (HPE). Results: The study included 40 cases, of which 24 were male (60%) and 16 were female (40%). A minority of cases (28.5%) had a history of tuberculosis contact. The most common site for reactive lymphadenitis was level I, while secondaries were most common at level II. All lymphoma cases were classified as Hodgkin’s lymphoma, with no cases of non-Hodgkin’s lymphoma. Squamous cell carcinoma (SCC) was the most frequent primary malignancy (13 cases), followed by papillary carcinoma of the thyroid (3 cases). FNAC demonstrated 100% sensitivity and specificity for diagnosing secondaries and lymphoma, with high sensitivity (85.7%) for tubercular cervical lymphadenitis and 100% specificity. Conclusion: This study provides valuable insights into the epidemiology and management of cervical lymphadenopathies. The findings highlight the diversity of etiologies, ranging from infectious causes, such as tuberculosis, to malignant conditions, such as metastatic squamous cell carcinoma. FNAC remains a highly effective diagnostic tool, and the treatment outcomes depend significantly on the underlying pathology.

Background: Management of severely calcified coronary artery disease (CAD) poses significant procedural challenges during percutaneous coronary intervention (PCI). Rotablation-guided PCI, which uses a high-speed rotational atherectomy device, has emerged as an important technique to facilitate stent deployment in these complex lesions. However, data regarding its safety outcomes, especially in resource-constrained settings, remain limited. Methods: We conducted a mixed-design cohort study in the Department of Cardiology at MDM Hospital (Dr. S.N. Medical College, Jodhpur) from January 2023 to December 2024. Consecutive patients aged >18 years with significant (>70% stenosis) calcified coronary lesions were included. Procedural details—particularly comparing radial (RRA) and femoral (RFA) access routes—were recorded. Immediate and 3-month post-hospital complications were assessed. Statistical analyses were performed using chi-square and t-tests, with p<0.05 denoting significance. Results: A total of 82 patients underwent rotablation-guided PCI. Baseline demographics and clinical characteristics were statistically comparable between RFA (60.98%) and RRA (39.02%) groups (p>0.05). The left anterior descending artery (LAD) was the most commonly treated vessel (78.05%). TIMI 3 flow was achieved in 100% of cases. Immediate complications included cardiac perforation (9.76%) and other minor complications (12.19%), with no statistically significant difference between access routes (p=0.368). All patients were free from post-hospital complications at the 3-month follow-up. Conclusion: Rotablation-guided PCI in calcified coronary lesions demonstrated favorable safety outcomes in this single-centre study, with no significant differences between radial and femoral access routes. The technique appears to be a safe adjunctive therapy in managing complex calcified lesions, enabling successful stent deployment and excellent short-term outcomes.

Background: Hemophagocytic lymphohistiocytosis is a deadly hyper inflammatory syndrome resulting from immune dysregulation. This study aimed to outline the clinical, pathological, and biochemical profiles of suspected HLH, comparing patients with pediatric and adult conditions; it also aimed to evaluate the diagnostic utility of the HLH-2004 criteria and the H-score. Methods: SCB Medical College, Cuttack, included 48 suspected HLH cases between September 2020 and October 2022. Clinical presentations, laboratory findings, and bone marrow examination were analyzed. The HLH-2004 diagnostic criteria and the H-score with a cut-off of ≥169 indicated probable HLH. Results: The percentage of adults was 77%, while the pediatric cases were 23%. The median age of pediatric cases was 7 years. Fever was the most common symptom (100%), followed by splenomegaly (39.6%) and hepatomegaly (29.2%). Ferritin levels were elevated in 81.8% of pediatric and 91.9% of adult cases. Bone marrow hemophagocytosis was present in 38.2%. According to HLH-2004 criteria, 22.9% of cases satisfied all diagnostic criteria, while 50% had an H-score ≥169. Infections were the most common trigger (47%), followed by autoimmune disorders and malignancies. Conclusion: It brings out the diagnostic challenge in HLH and says the value of employing combined criteria in diagnosing cases. More importantly, the earliest identification of HLH and its many precipitants give the largest benefit in terms of timely intervention and improved outcome.

Background: Fine-needle aspiration cytology (FNAC) has been one of the most common diagnostic techniques to assess thyroid lesions using minimal invasiveness and efficiency. It remains a worthwhile tool, although with limitations, primarily with respect to indeterminate categories, and thus warrants careful assessment of its diagnostic performance as well as its own limitations. Methods: This study analyzed 250 cases of thyroid lesions, correlating FNAC findings categorized using the Bethesda System for Reporting Thyroid Cytopathology with final histopathological diagnoses. The diagnostic accuracy, sensitivity, specificity, and rates of cyto histo concordance were calculated. Discordant cases were examined to identify sources of diagnostic errors. Results: The overall diagnostic accuracy of FNAC was 91.6%, with sensitivity and specificity of 89.7% and 93.0%, respectively. The highest concordance rates were seen in Bethesda II (94.5%) and Bethesda VI (97.0%) categories. Malignancy rates for indeterminate categories (Bethesda III and IV) were 31% and 40%, respectively, with lower concordance rates (69.0% and 60.0%). Sampling errors and misinterpretation of cytological features were the main causes of discordance. Cyto Histopathological correlation stressed the reliability of FNAC in diagnosing benign and malignant lesions while throwing a challenge in the indeterminate cases. Conclusion: FNAC is a good diagnostic modality for thyroid nodules but limitations in the indeterminate categories necessitate adjunctive diagnostic strategies, including molecular testing and sophisticated sampling techniques. Cyto Histopathological correlation is crucial for improving diagnostic accuracy and optimal management of the patient.

Background: Infectious disease epidemiology has experienced a profound transformation in response to the COVID-19 pandemic. Advances in molecular, genomic, and digital technologies have allowed better tracking of pathogen spread, improved causal inference, and enhanced public health decision-making. Methods: This review discusses the emerging trends in infectious disease epidemiology, including integration of genomic sequencing, digital surveillance systems, and advanced statistical methodologies. It covers the progressive use of predictive modeling, disease susceptibility through the human microbiome, and causal inference techniques in the evaluation of vaccines and antimicrobial therapies. Results: Integration of real-time genomic surveillance, digital health monitoring, and predictive modeling significantly improved the tracking and managing of infectious diseases. It has included a proof-of-concept of the monitoring of SARS-CoV-2 variants by applying genomic sequencing, an observation on the efficacy of the vaccine in preventing severe cases, and the increased interest of the microbiome’s influence on the susceptibility of individuals to infectious diseases. Critical insights on the need for hospitals during outbreaks have been made with predictive models, making it very efficient in health systems when outbreaks occur. Conclusion: The post-pandemic landscape highlights the call for innovative epidemiological approaches to infectious diseases. Incorporation of new data sources, refined statistical methods, and host-pathogen interactions into the study would shape public health strategies of the future. Continued research and advancement in technology will be crucial in addressing challenges and increasing preparedness of global health.

Background: Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze the risk factors associated with the cases of salpingitis and its relation with histopathology of fallopian tubes. Materials & Methods: This descriptive observational study was done at Department of Obstetrics & Gynaecology, North Bengal Medical College & Hospital; district Darjeeling over a period of one year (May 2018– April 2019). Study Population was women who had salpingectomy and tubal ligation at NBMCH. Specimens of salpingectomy from clients who underwent, tubal ligation or along with hysterectomy/oophorectomy were taken. Taking into consideration the fall out, we added 10% extra to the sample size. So the final sample size came to be 102.Gross abnormalities like paratubal cysts were encouraged to be taken in the specimen. Specimen was then preserved in 10% formalin, labelled properly and taken to Pathology Department of NBMCH. Results: Out of 102 cases, maximum cases (81) were contributed by ligation, ligation done during the caesarean being the highest. The chronic nonspecific salpingitis is accounts for 9.8% of the various histological findings. Of the total 10 cases, 6 were obtained after ligation, and the remaining 4 had ectopic pregnancy with the background of chronic salpingitis on histology. Amongst all cases of ligation done along with caesarean 80% had normal fallopian tube histology whereas only 6.4% had salpingitis. This proportion of salpingitis is higher in cases of MTP with ligation to around 20%. All the users of IUCD had normal tubal histology and 10% of non-users had salpingitis. The relation between the IUCD use and occurrence of salpingitis is statistically insignificant. Conclusion: The most common pathological lesion was chronic non-specific salpingitis (9.8%). Amongst cases of ruptured tubal ectopic pregnancy 44.4% were associated with chronic salpingitis. The relationship of history of dilatation and evacuation in past with chronic asymptomatic salpingitis is substantial (p value 0.02). However, the use of IUCD (p value – 0.41), use of OCP (p value – 0.62), any visit to STI clinic in past (p value – 0.25), had no significant relation with the occurrence of salpingitis.

Introduction: Adequate postoperative analgesia is critical following lower segment cesarean section (LSCS) to support early recovery, facilitate breastfeeding, and enhance maternal-infant bonding. The transversus abdominis plane (TAP) block has proven effective for postoperative pain management in abdominal surgeries. This study compares dexamethasone (4 mg) and magnesium sulphate (MgSO₄) (150 mg) as adjuvants to bupivacaine (0.25%) in TAP blocks for postoperative analgesia in LSCS. Materials and Methods: This triple-blinded randomised controlled trial included 60 patients undergoing elective LSCS, divided into Group D (bupivacaine + dexamethasone) and Group M (bupivacaine + MgSO₄). Both groups received bilateral ultrasound-guided TAP blocks following spinal anaesthesia. Pain intensity was assessed using the visual analogue scale (VAS), time to first analgesic request, total rescue analgesia required, hemodynamic stability, patient satisfaction, and side effects over 24 hours. Statistical analyses were performed using SPSS version 26.0. Results: Group D demonstrated a significantly longer time to the first analgesic request (800 ± 60 vs. 620 ± 55 minutes, p < 0.001) and reduced tramadol consumption (1.0 ± 0.4 vs. 1.8 ± 0.6 doses, p < 0.001). VAS scores at rest and movement were consistently lower in Group D at all time intervals (p < 0.01). Hemodynamic parameters remained stable in both groups, with minimal side effects. Patient satisfaction was higher in Group D (86.7% “highly satisfied” vs. 63.3%).

Conclusion: Dexamethasone as an adjuvant to bupivacaine in TAP blocks offers superior postoperative pain control, reduced analgesic requirements, and higher patient satisfaction than MgSO₄, with a comparable safety profile.

Introduction: Spinal surgeries often involve significant blood loss due to extensive dissection and vascularized bone exposure, leading to postoperative anaemia, increased transfusion requirements, and heightened infection risk. Tranexamic acid (TXA), an antifibrinolytic agent, has proven efficacy in reducing perioperative blood loss across surgical disciplines. However, optimal dosing in spine surgeries remains unclear. This study evaluates the effectiveness and safety of varying TXA doses (10 mg/kg, 15 mg/kg, and 20 mg/kg) in minimizing intraoperative and postoperative blood loss and transfusion needs. Materials and Methods: A prospective, randomised study was conducted at Mamata Medical College, Telangana, involving 75 patients undergoing elective spine surgeries. Participants were assigned to receive TXA intravenously at 10 mg/kg, 15 mg/kg, or 20 mg/kg. Blood loss was measured intraoperatively and postoperatively (24 hours), while transfusion requirements, hemodynamic parameters, and adverse events were recorded. Statistical analysis included ANOVA and chi-square tests, with a significance threshold of p < 0.05. Results: Group C (20 mg/kg) demonstrated the least intraoperative (350 ± 30 mL) and postoperative blood loss (150 ± 10 mL), compared to Groups A (650 ± 50 mL, 300 ± 20 mL) and B (480 ± 40 mL, 220 ± 15 mL) (p < 0.05). Transfusion requirements were significantly lower in Group C (4 patients) than in Groups A (16) and B (10) (p = 0.002). No major thromboembolic events were observed. Conclusion: A TXA dose of 20 mg/kg effectively minimizes blood loss and transfusion needs during spine surgeries without increasing adverse events, supporting its use for optimal perioperative blood conservation.

Introduction: Pain management in femur fractures is critical to alleviating discomfort and preventing complications such as muscle spasms and neurogenic shock. While systemic analgesics like paracetamol and tramadol are widely used, their side effects limit their utility. Ultrasound-guided lateral femoral cutaneous and femoral nerve blocks (LFCN+FNB) offer a promising alternative by providing precise, regional analgesia with minimal systemic effects. This study compares the efficacy of LFCN+FNB versus intravenous paracetamol and tramadol in managing pain for femur fractures. Materials and Methods: This prospective, randomised comparative study included 60 adult patients (18–65 years, ASA I–II) with femur fractures undergoing surgical fixation at Mamata Medical College from July 2023 to July 2024. Patients were divided into two groups (n=30 each): Group A received ultrasound-guided LFCN+FNB, and Group B was administered intravenous paracetamol (1 g) and tramadol (100 mg). Pain scores (NRS) were recorded at 0, 6, 12, and 24 hours. Secondary outcomes included time to first analgesia, total analgesic consumption, side effects, hospital stay, and QoR-15 scores. Statistical analyses were performed using SPSS v26.0. Results: Group A showed significantly lower pain scores at all time points (p<0.001), extended time to first analgesia (10.5 vs. 4.2 hours, p<0.001), reduced total analgesic consumption (50 mg vs. 150 mg, p<0.001), and shorter hospital stay (4.8 vs. 5.5 days, p=0.006). Group A also demonstrated lower nausea rates (3.3% vs. 20%, p=0.044) and higher QoR-15 scores (130.5 vs. 120.3, p<0.001). Conclusion: Ultrasound-guided LFCN+FNB offers superior pain relief, reduced analgesic use, and enhanced recovery compared to paracetamol and tramadol, highlighting its efficacy and safety for femur fracture management.

Introduction: Intertrochanteric fractures are a common and serious issue in geriatric patients, necessitating adequate postoperative analgesia to facilitate early mobilisation and improve outcomes. Traditional systemic analgesics such as opioids and NSAIDs pose significant risks in this population, prompting the need for alternative strategies. Regional anaesthesia, specifically combined femoral and lateral femoral cutaneous nerve blocks (FNB + LFCNB), has shown promise. This study compares the efficacy of FNB + LFCNB versus intravenous paracetamol for postoperative pain management in geriatric patients with intertrochanteric fractures. Materials and Methods: A prospective, randomised, controlled trial was conducted at Mamata Medical College with 60 geriatric patients undergoing surgery for intertrochanteric fractures. Participants were randomised into two groups: one receiving FNB + LFCNB using bupivacaine and the other intravenous paracetamol. Pain was assessed using the Visual Analog Scale (VAS) at 6, 12, and 24 hours postoperatively. Secondary outcomes included analgesic consumption, time to ambulation, hospital stay duration, and adverse events. Statistical significance was set at p < 0.05. Results: The FNB + LFCNB group demonstrated significantly lower VAS scores at rest and during movement (p < 0.05) and required less supplemental analgesia (12.4 ± 3.8 mg vs. 22.6 ± 4.5 mg, p < 0.001). Time to ambulation and hospital stay were shorter, and the nerve block group had higher patient satisfaction scores. Side effects were fewer and not statistically significant. Conclusion: Combined femoral and lateral femoral cutaneous nerve blocks provide superior analgesia, faster recovery, and better functional outcomes than paracetamol in geriatric patients with intertrochanteric fractures, supporting their broader clinical use.

Introduction: Neuromuscular blocking agents (NMBAs) are integral to modern anaesthesia but carry postoperative residual neuromuscular blockade (PRNB) risks, leading to complications like respiratory distress. Neostigmine, traditionally used for NMBA reversal, has limitations, including delayed recovery and muscarinic side effects. Sugammadex, a selective relaxant-binding agent, offers rapid and predictable reversal, potentially enhancing safety and efficiency. This study evaluates the efficacy and safety of Sugammadex compared to neostigmine in adult surgical patients. Materials and Methods: Sixty adult patients undergoing elective surgery under general anaesthesia were randomised into Sugammadex (Group S, n=30) and neostigmine with glycopyrrolate (Group N, n=30). Neuromuscular function was monitored using acceleromyography. The primary outcome was the time to achieve a Train-of-Four (TOF) ratio ≥ 0.9. Secondary outcomes included PRNB incidence and adverse events. Data were analysed using independent t-tests and chi-square tests, with p<0.05 considered significant. Results: Sugammadex achieved significantly faster recovery to TOF ≥ 0.9 (2.1 ± 0.5 minutes) compared to neostigmine (12.8 ± 3.2 minutes, p<0.001). PRNB occurred in 43.3% of Group N patients but was absent in Group S (p<0.001). Postoperative nausea and vomiting were more frequent with Sugammadex (23.3% vs. 6.7%, p=0.071). Urinary retention and dyspnoea were noted only in Group N. Both agents were well tolerated, with no serious adverse events. Conclusion: Sugammadex demonstrates superior efficacy in rapidly reversing NMB and reducing PRNB incidence compared to neostigmine. Despite higher costs, its favourable safety profile and operational benefits position it as a transformative agent in perioperative care. Further, multicentre studies are warranted to validate these findings.

Introduction: Postoperative pain management in shoulder surgeries, such as arthroscopic procedures, is crucial for recovery and early rehabilitation. Interscalene block (ISB) with bupivacaine is effective but limited by its short duration of action. Adjuvants like dexamethasone and dexmedetomidine have shown promise in prolonging analgesia. This randomised controlled trial aimed to compare the efficacy and safety of these adjuvants in ISB. Materials and Methods: The study was conducted at Mamata Medical College, Khammam, India, with 60 patients undergoing elective shoulder surgeries. Participants were randomised into two groups: Group A received bupivacaine 0.5% (20 mL) with 10 mcg of dexmedetomidine, and Group B received bupivacaine 0.5% (20 mL) with 8 mg of dexamethasone. Pain was assessed using the Visual Analog Scale (VAS) at 6, 12, and 24 hours postoperatively. The duration of analgesia, adverse effects, and patient satisfaction were recorded. Statistical analysis was performed using SPSS version 25, with p < 0.05 considered significant. Results: Group A demonstrated a significantly longer analgesic duration (14.5 ± 2.3 hours vs. 12.8 ± 2.1 hours, p < 0.001) and lower VAS scores at 6, 12, and 24 hours postoperatively (p < 0.05). Patient satisfaction was higher in Group A (8.9 ± 0.8 vs. 8.4 ± 1.0, p = 0.005). Adverse effects were mild and comparable between groups, with no severe complications. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant to bupivacaine in ISB, offering longer analgesic duration, better pain control, and comparable safety. These findings support its use in postoperative pain management for shoulder surgeries.

Introduction: Emergency laparotomy for perforation peritonitis is a critical surgical procedure requiring swift diagnosis and management due to its significant morbidity and mortality risks. Peritonitis, a severe inflammation of the abdominal cavity, arises from various causes, including gastrointestinal perforations. Despite advancements in medical care, managing this condition remains challenging, particularly in resource-constrained settings. Objective: To evaluate risk factors influencing outcomes in patients undergoing emergency laparotomy for perforation peritonitis, focusing on clinical, biochemical, and intraoperative parameters to improve prognosis and management strategies. Methods: This hospital-based observational cohort study, conducted over 18 months, included 60 patients diagnosed with perforation peritonitis and treated with emergency laparotomy. Clinical presentations, biochemical markers, and intraoperative findings were analyzed. Exclusion criteria encompassed patients aged below 18 or above 65 years, those with postoperative anastomotic leaks, and those who declined consent. Outcomes were compared based on ICU admissions, mortality, and hospital stays. Results:  Middle-aged adults (51–60 years, 43.3%) were most affected, with a higher prevalence in females (61.7%). Common operative findings included duodenal ulcers (53.3%) and typhoid ulcers (26.7%). Elevated TLC, hypoalbuminemia, and raised CRP levels were significantly associated with poorer outcomes. ICU patients exhibited higher temperatures and pulse rates but lower systolic blood pressure. Non-survivors had significantly prolonged hospital stays, hypoalbuminemia (100%), and higher inflammatory markers. Conclusion: Perforation peritonitis predominantly affects middle-aged adults, presenting with abdominal pain, tenderness, and systemic signs of sepsis. Key prognostic markers include elevated TLC, hypoalbuminemia, and raised CRP, emphasizing the importance of early intervention and tailored care. Improved strategies for timely diagnosis and management are crucial to reducing morbidity and mortality.

Introduction: Local anesthetics (LAs) block pain signals by inhibiting sodium channels in nerve cells. Long-acting LAs like bupivacaine (BP) and ropivacaine (RP) are preferred for extended regional anesthesia. This study compares 0.5% BP and RP, evaluating sensory/motor blockade duration, efficacy, and adverse effects, including cardiotoxicity and neurotoxicity, to assess their safety profiles. Aim and Objectives: The aim of this study is to compare the duration of sensory and motor blockade, as well as the adverse effects, of 0.5% Ropivacaine and 0.5% Bupivacaine in patients undergoing brachial plexus anesthesia. Method: This randomized, double-blind study compared 0.5% bupivacaine (Group A) and 0.5% ropivacaine (Group B) in 60 ASA I/II patients aged 20-60 years. Following ethical approval and consent, patients received 25 ml of the assigned agent for supraclavicular brachial plexus block. Sensory and motor block onset/duration, vital signs, and adverse events were monitored to assess efficacy and safety. Result: The study compared 0.5% bupivacaine and ropivacaine in 60 patients, balanced for age, weight, and gender. Group A showed significantly longer sensory (446.43 min) and motor (406.97 min) block durations (p<0.001). Both groups maintained stable SPO2 (99.6-100%) and heart rates, with minimal differences, confirming comparable safety profiles and cardiovascular stability for both anesthetics. Conclusion: The study found ropivacaine had a faster onset of sensory and motor blocks, while bupivacaine provided longer block durations. Both anesthetics were effective, with no significant adverse events or vital sign changes.

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. However, managing diabetic patients poses unique challenges due to the systemic effects of diabetes, including altered gallbladder motility, increased inflammation, and delayed wound healing. Understanding the intraoperative findings and outcomes of LC in diabetic patients is crucial for improving surgical care in this population. Aim: To assess how diabetes affects surgical complexity and recovery, as well as to compare the intraoperative findings and results of laparoscopic cholecystectomy in patients with and without diabetes. Methods: This prospective comparative study was conducted at Rani Durgavati Medical College, Banda, Uttar Pradesh, India, over two years, including 60 patients (30 diabetics and 30 non-diabetics). Data were collected on demographic characteristics, intraoperative findings (operative time, gallbladder wall thickness, adhesions, bile spillage), and postoperative outcomes (hospital stay, wound infections, complications). Statistical analysis was performed using SPSS version 23.0, with significance set at p < 0.05. Results: Diabetic patients had significantly longer operative times (75.2 ± 10.5 minutes vs. 65.3 ± 9.8 minutes, p < 0.001) and thicker gallbladder walls (4.8 ± 0.6 mm vs. 3.6 ± 0.5 mm, p < 0.001). Adhesions (60% vs. 27%, p = 0.012) and bile spillage (40% vs. 13%, p = 0.005) were more frequent in diabetics. Postoperative hospital stays were longer in diabetics (3.8 ± 1.2 days vs. 2.5 ± 0.8 days, p < 0.001), and patient satisfaction scores were lower (7.2 ± 1.5 vs. 8.4 ± 1.2, p = 0.021). Conclusion: Diabetic patients undergoing laparoscopic cholecystectomy exhibit increased surgical complexity and prolonged recovery times compared to non-diabetics. Despite these challenges, LC remains a safe and effective procedure for diabetic patients with appropriate perioperative management. Recommendations: Optimizing preoperative glycemic control, enhancing intraoperative techniques, and implementing tailored postoperative care protocols can improve outcomes for diabetic patients undergoing LC. Future studies should explore the role of advanced surgical technologies and protocols in mitigating the challenges observed in diabetic populations.

Background: Primary membranous nephropathy is an important cause of nephrotic syndrome whose outcome may vary from benign to end-stage renal failure. However, the role of serum Anti-Phospholipase A2 Receptor antibody in predicting the outcome remains under study. The present study assesses the predictive value for anti-PLA2R antibodies in terms of the clinical outcome of PMN. Methods: The prospective observational study was carried out from May 2021 to May 2023 in S.C.B. Medical College and Hospital, Cuttack. Forty-nine patients with biopsy-proven PMN and positive anti-PLA2R antibody tests were enrolled in this study. Clinical data at baseline and after six months of follow-up were collected. Key parameters such as serum creatinine, serum albumin, 24-hour urine protein, and eGFR were assessed. In the present study, the relationship of anti-PLA2R antibody level to clinical remission was evaluated in patients managed either conservatively or with immunosuppressive therapy. Results: It was found that patients with a lower anti-PLA2R antibody level had higher spontaneous remission rates compared to those at high levels. Specifically, 80% of patients with low anti-PLA2R levels reached remission after receiving conservative therapy, which was much higher compared to 33% of those with high levels. Among the patients who received immunosuppressive therapy, 83.3% of those with low anti-PLA2R levels reached remission compared with 27.3% of those with high anti-PLA2R levels. These results indicate that the anti-PLA2R antibody level is a strong predictor of treatment response and disease outcome. Conclusion: Anti-PLA2R antibody levels are a useful biomarker for predicting the clinical outcome of primary membranous nephropathy. Low levels of anti-PLA2R antibodies could indicate better responsiveness to both conservative and immunosuppressive treatments. Anti-PLA2R antibodies, if incorporated into routine practice, may promote individually tailored treatment decisions and strategies for the optimization of management.

Background: HPV infection attributed cancers are more common among women in low- and middle-income countries, while men are more commonly affected in high-income countries. There is a gap in knowledge about HPV infection, HPV vaccine and preventive strategies among the health care providers which will determine the future trends of HPV infection in India. Hence, this study was conducted with the aim of assessing the level of knowledge regarding HPV infection and the role HPV vaccine as a preventive strategy among the medical students. Materials & Methods: Between January 2018 and March 2018, data were collected using a pre-structured questionnaire, approved by the ethics committee that was distributed through an online web portal. Responses were stored in a cloud-based format on Qualtrics, and analyzed in SPSS. All participants completed informed consent prior completion of the survey. Results: of the 498 participants who completed the survey, 114 (22.9%) were in pre-clinical, 151 (30.3%) in preclinical and 233(46.8%) were in clinical stage of their medical training. The level of knowledge among medical students increased with the number of years spent in medical school across all domains (p < 0.0001). However, in key areas crucial to understanding the transmission of HPV and its impact on disease prognosis, students demonstrated poor knowledge. Of the female students, only 7.5% (17) had been vaccinated against HPV. Conclusion: The knowledge gap among future healthcare providers significantly hinders the effective implementation of preventive strategies. It is essential to take comprehensive measures, addressing everything from policy-making to raising awareness among high-risk populations, and equipping healthcare providers with the necessary training and knowledge to achieve the WHO cervical cancer elimination goal by 2030.

Aim: This study aims to check the pulmonary functions of healthy working women exposed to inhaled chemicals in hospital laboratories and to compare that with the non-exposed healthy women. Materials and Methods: The study was carried out in 50 healthy working women in the age group of 20-40 years who are working in hospital chemical laboratories and in other 50 healthy working women of same age group who are working in the administrative section. Volunteers were selected on basis of inclusion criteria. The volunteers were chosen in both case as well as control group in order to minimize the confounding factors and make the study reproducible. Informed written consent was obtained from all the volunteers before testing. Volunteers were explained in detail about the test procedure and a diagram was shown for the better understanding of the tests. Result: In females exposed to laboratory chemicals as compared to the unexposed, all parameters were significantly reduced. FVC, FEV1 & FVC/FEV1 were significantly reduced in exposed as compared to unexposed indicating that the lung volume, flow and resistive properties of the bronchopulmonary tree were affected. The difference was also significant for static lung function tests as TV, IRV and SVC in exposed females and indicated that lung volume was affected along with lung elasticity and mobility. Significantly decreased PEFR and FEF 25-75 in the exposed group indicated that upper as well as small airways might be affected due to exposure to lab chemicals. Lung age was more than chronological age in both the groups but the gap was huge for exposed females. The difference in lung age in exposed and non-exposed females was highly significant and pointed towards the decreased function. No single chemical was found to lead to the cause rather it was the cumulative effect of multiple chemicals and reagents used in the laboratory. We found out that inhaled chemical exposure during hospital laboratory work resulted in detrimental effects on static lung volumes as well as flow rates amongst the exposed group. Conclusion: This study concluded that risk factors for respiratory dysfunction significantly increase in females who are exposed to laboratory chemicals. Thus, there is a need for regular pulmonary function testing and taking preventive measures to avoid chemical exposure in laboratory workers.

Background: The gut microbiota plays a crucial role in maintaining metabolic health, with imbalances in microbial composition increasingly linked to metabolic disorders such as type 2 diabetes, obesity, dyslipidemia, and metabolic syndrome. However, the prevalence and specific associations between microbiota profiles and these disorders remain inadequately explored. Methods: A 100-person cross-sectional study was conducted from March 2023 to July 2024. Stool sample analysis and next-generation sequencing examined microbiota composition, while clinical evaluations and blood testing detected metabolic abnormalities. We used statistical analysis to estimate metabolic disorder prevalence and microbiome profile correlations. Results: Substantial correlations between metabolic diseases and intestinal microbiota patterns were identified in the cross-sectional study of 100 individuals. Obesity was 35%, type 2 diabetes 22%, dyslipidaemia 28%, and metabolic syndrome 18%. Participants with greater Firmicutes/Bacteroidetes ratio had a 1.5-fold increased risk of obesity (95% CI: 1.2-1.8, p < 0.01), while raised Proteobacteria levels increased type 2 diabetes risk by 2.3-fold (95% CI: 1.7-3.0, p < 0.01). Lower microbial diversity was related with 1.8 times greater risks of dyslipidaemia (95% CI: 1.4–2.4, p < 0.01). Prevotella abundance was also linked to a 40% decreased metabolic syndrome risk (95% CI: 0.5–0.8, p = 0.04). These findings recommend microbiota-based markers may help diagnose and treat metabolic diseases. Conclusion: The study highlights the potential of microbiota-based biomarkers in the early detection and management of metabolic disorders. It underscores the need for further longitudinal research to establish causality and explore microbiota-modulating interventions for improving metabolic outcomes.

Background: Intraocular pressure (IOP) is a crucial factor in the development of glaucoma and other eye conditions, with various physiological, environmental, and systemic factors influencing it. Anxiety, through the activation of the body’s stress response, has been linked to elevated IOP, potentially contributing to ocular pathologies such as glaucoma. This study aims to evaluate the impact of anxiety severity and symptom duration on IOP in patients diagnosed with chronic anxiety. Methods: A cross-sectional, observational study was conducted on 72 patients with chronic anxiety attending the Psychiatry OPD. Anxiety severity was assessed using the Hamilton Anxiety Rating Scale, categorizing patients into mild, moderate, and severe anxiety groups. IOP was measured using a Goldmann Applanation Tonometer, and the results were statistically analyzed to determine the relationship between anxiety severity, symptom duration, and IOP. Results: The study found that IOP was highest in the severe anxiety group (17.90 ± 2.20 mm Hg) and lowest in the mild anxiety group (14.42 ± 1.85 mm Hg). Duration of symptoms influenced IOP, with the highest IOP recorded in the 3-6 months duration group for severe anxiety and the >12 months group for mild anxiety. Statistically significant differences were observed between the severe and mild anxiety groups (p < 0.05). Conclusion: The study indicates that increased severity of anxiety is associated with higher IOP, and the duration of symptoms also influences these levels. Chronic anxiety could contribute to increase IOP, potentially heightening the risk for glaucoma and other ocular conditions. Routine glaucoma screening is recommended for chronic anxiety patients.

Introduction & Objective: Most maternal and infant deaths occur in first 42 days after childbirth.² Proper utilization of postnatal care services plays an important role in reducing the maternal mortality rate. The objective of the study was to assess the utilization of the postnatal services provided to mothers and associated factors. Materials and Methods: A community based, cross sectional study using multistage sampling methodology was carried out from 1st May, 2016 to 30th April, 2017, in Southern Odisha. Married women with 6 weeks to 6 months old baby were included in the study. Results: 85.5% of women received postnatal visit by the health personnel within 42 days of delivery. The main reason for non-utilization was no-one visited their house and unawareness about the PNC. The factors associated with low utilization were education, socio economic status and parity of mother, frequency of ANC and place of delivery. Conclusion: The study highlighted gap in the post-natal services received by the mother which could be strengthened by counselling to all mothers attending the VHND Sessions and involvement of the family members.

Background: Hypertension in pregnancy is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Objective: to find out whether the lateral location of placenta as seen by ultrasound at 18-24 weeks of gestation can be used to predict the development of preeclampsia. Methods: This Prospective study was conducted among 100 pregnant women of 18-24 weeks of gestational age attending the outpatient department for antenatal care at government maternity hospital, Hanamkonda during the period of November 2019 to October 2021. Result: Out of the 100, 50 had lateral placenta of which 21 developed preeclampsia and 50 had central placenta of which 10 developed preeclampsia. None of the patients were diagnosed with gestational hypertension. Of the total 31 patients with preeclampsia, 3 had urine albumin trace, 15 had urine albumin of 1+ and 13 had urine albumin of 2+ Majority of the preeclampsia was diagnosed preterm between 32-36+6 weeks period of gestation. Of the 31 preeclampsia patients 17(55%) are P1, 8(25%) are primigravida, 4(13%) are P2 and 2(7%) are P3. Of the 31 preeclampsia patients 19(61%) underwent LSCS and 12(39%) underwent vaginal delivery but the overall incidence of vaginal delivery is 74% and LSCS being only 26% among 100 patients. Conclusion: Our study shows correlation between lateral placenta and preeclampsia, many previous studies have shown a positive correlation and hence a strict vigilance and follow up of these patients needed for earlier identification and diagnosis of preeclampsia and to prevent the complications for fetus and mother.

Introduction: Radiology plays a crucial role in modern healthcare, aiding in diagnosis, treatment planning, and disease monitoring. Despite technological advancements in imaging modalities such as CT, MRI, and ultrasound, errors in radiological image interpretations and reportings remain a significant concern. These errors, categorized into perceptual and interpretative types, can result in delayed diagnoses and inappropriate treatments, highlighting the need for strategies to minimize such mistakes. Materials and Methods: This cross-sectional study, conducted over six months at a tertiary care hospital, included 100 radiological cases with confirmed errors identified through multidisciplinary meetings and retrospective chart audits. Errors were categorized by imaging modality (CT, MRI, ultrasound, plain radiography) . Descriptive statistics and logistic regression analyses were used to analyze error frequencies and contributing factors. Results: CT scans accounted for 40% of errors, followed by MRI (30%), ultrasound (20%), and plain radiography (10%). Perceptual errors were more common (60%) and linked to fatigue, subtle findings, and inadequate training, while interpretative errors (40%) were associated with cognitive biases and insufficient clinical data. Discussion: Perceptual errors were the most frequent, primarily due to fatigue and missed subtle findings. Interpretative errors, though less frequent, had a greater impact on patient management and were often influenced by cognitive biases. AI tools have potential to assist in reducing these errors, but must complement human expertise. Effective communication and structured reporting between radiologists and referring physicians were also found to be essential in minimizing errors. Conclusions: Errors in radiological interpretation remain prevalent, with perceptual errors being more common. Addressing these challenges through technological advancements, improved training, and enhanced communication between healthcare providers can lead to more accurate and reliable radiological reporting.

Background: Endodontic treatment often leaves teeth weakened, necessitating prosthodontic restorations to restore function and aesthetics. While advancements in dental materials and technology have enhanced the aesthetic potential of such restorations, understanding patient satisfaction remains critical for improving care. Objective: To evaluate patient satisfaction with the aesthetic outcomes of prosthodontic restorations on endodontically treated teeth, considering factors such as gender, age, and restoration type. Materials and Methods: A cross-sectional study involving 200 patients aged 18–70 years was conducted at a tertiary dental care center. Patient satisfaction was assessed across four aesthetic domains—shade matching, translucency, shape, and overall appearance—using a 5-point Likert scale. Clinical data on restoration type and material were correlated with satisfaction scores. Results: The mean satisfaction score was 4.5 (SD ±0.4). Female patients and those aged 18–35 years reported higher satisfaction. Shade matching and overall appearance were the highest-rated domains. Statistical analysis revealed significant correlations between demographic factors and satisfaction scores. Discussion: Findings highlight the importance of patient-centered approaches in prosthodontics, emphasizing the role of advanced materials and effective clinician-patient communication. Challenges in achieving translucency suggest areas for further innovation. Conclusions: Prosthodontic restorations achieve high aesthetic satisfaction, with significant influences from age, gender, and material selection. Advances in material science and patient-centered care can further enhance outcomes.

The primary goal of this article is to emphasize the critical role of emergency coronary artery bypass surgery in cases involving entrapped stents and guidewires. We present two cases in which surgical intervention was required due to guidewire entrapment, necessitating both rescue and revascularization. In one case, the procedure involved the use of cardiopulmonary bypass, with the heart arrested and the aorta opened, and followed by revascularization. In contrast, the second case was managed off-pump, involving removal and revascularization without the need for cardiopulmonary bypass.

Background: Surgical management of pediatric abdominal conditions such as intussusception, volvulus, and pyloric stenosis has evolved significantly with the increasing adoption of laparoscopic techniques. Minimally invasive surgery (MIS) is associated with improved outcomes, but open surgery remains the preferred approach in certain complex cases, particularly emergencies like volvulus. Objective: This study aims to evaluate the trends in the use of laparoscopic versus open surgery in the treatment of intussusception, volvulus, and pyloric stenosis, comparing patient outcomes in terms of operative time, hospital stay, and postoperative complications. Materials and Methods: A retrospective analysis was conducted with a sample size of 330 pediatric patients who underwent surgery for intussusception (n=150), volvulus (n=80), and pyloric stenosis (n=100). Each group was subdivided based on the surgical approach: open or laparoscopic. Patient outcomes such as operative time, length of hospital stay, and complications were analyzed and compared between the two approaches. Results: Laparoscopic surgery was predominantly used for intussusception (80%) and pyloric stenosis (20%), while open surgery was more common for volvulus (70%). Laparoscopic procedures resulted in shorter operative times (75 vs. 85 minutes, p=0.02), reduced hospital stays (3.1 vs. 5.2 days, p<0.001), and fewer complications (10.3% vs. 18.7%, p=0.04) compared to open surgery. Conclusion: Laparoscopic surgery offers significant advantages in the management of intussusception and pyloric stenosis, including shorter hospital stays and fewer complications. However, open surgery remains the preferred approach for volvulus due to its technical complexity and emergency nature.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women. It is associated with metabolic abnormalities such as obesity, insulin resistance, and thyroid dysfunction. This study aims to evaluate the correlation between body mass index (BMI), thyroid-stimulating hormone (TSH) levels, and glycated hemoglobin (HbA1c) among women females  diagnosed with PCOS aged between 18 – 50 yrs. Menstrual irregularities and infertility are more prevalent in obese PCOS women. Obesity is also closely associated with PCOS, which affects 6–12% of women of reproductive age. A cross-sectional study was conducted involving 100 women aged 18 – 50 yrs diagnosed with PCOS based on  Rotterdam criteria. Data on BMI, TSH levels, and HbA1c were collected and analyzed to assess correlations using SPSS paired t- test, 2-tailed spearman correlation. In present study, it was found that TSH has positive correlation with BMI( r=0.3, p=0.002). HbA1C has positive correlation with BMI ( r=0.266, p=0.007). TSH has a positive correlation with HbA1C (r=0.29, p=0.003). In conclusion this study shows the significant correlation between BMI, TSH levels and HbA1c among diagnosed PCOS females. These correlations emphasize the need for integrated management strategies targeting obesity, thyroid dysfunction, and insulin resistance to improve metabolic outcomes in this population.

Background: Vitamin B12 deficiency during pregnancy has been associated with various adverse pregnancy outcomes, including preterm birth. This study aimed to investigate the prevalence of vitamin B12 deficiency in early pregnancy and its association with preterm birth among pregnant women attending a tertiary hospital in India. Methods: This prospective cross-sectional study included 236 pregnant women between 14 and 20 weeks of gestation. Serum vitamin B12 levels were measured using the Electro Chemi-Luminescence-Immuno-Assay method, with deficiency defined as levels <200 pg/ml. Gestational age at delivery was recorded, and preterm birth was defined as delivery before 37 completed weeks of gestation. The association between vitamin B12 deficiency and preterm birth was analyzed using the chi-square test. Results: The mean serum vitamin B12 level was 231.0556 pg/ml (SD 104.2277), with 32.63% of the participants being deficient. The prevalence of preterm birth was 15.25%. A significant association was found between vitamin B12 deficiency and preterm birth (p=0.015732), with 50% of the women who had preterm deliveries being deficient in vitamin B12, compared to 29.50% of the women who had term deliveries. Conclusion: This study found a high prevalence of vitamin B12 deficiency in early pregnancy and a significant association between vitamin B12 deficiency and preterm birth among pregnant women in India. The findings highlight the importance of screening for vitamin B12 deficiency in early pregnancy and the need for interventions to improve vitamin B12 status among pregnant women, particularly in developing countries.

Background: Dengue fever is caused by dengue virus of Flaviviridae family which is transmitted by Aedes aegypti mosquito. Dengue haemorrhagic fever  (DHF) clinically presenting as epistaxis, oral/gum bleeding. Thrombocytopenia may be linked to DHF illnesses, with risks that can vary from severe bleeding or blood clotting to no risk at all. Thrombocytopenia is characterised by a platelet count that falls below the lower threshold of the normal range. The present study was carried out on 17 DHF with Epistaxis patients to established clinical profiling/ management of epistaxis in dengue haemorrhagic fever. Materials and Methods: This prospective study was conducted at Tertiary Care Centre (HIMS), Ataria, Sitapur, UP from June 2021 – August 2021.Complete blood count including differential blood count, packed cell volume (PCV) and absolute platelet count (APC), PT/INR with NS1 card test were done. PCV and APC were monitored serially, at least once a day and if necessary more frequent intervals. Renal functions and liver enzymes were done routinely for all patients by using an auto-analyser. Ultrasonography of abdomen and radiograph chest was done by an experienced sonologist and radiograph chest were done for all patients. Fluid management of patient was according to WHO guidelines. Results: A total of 17 dengue haemorrhagic fever (NS1 positive) with epistaxis cases were studied. Out of 17 cases, 14 cases were male (82.35%) and 3 cases were female (17.65%). Male: female was 4.67, aged 18-70 years, and mean age was 40 years. The mean and median patient ages were 40 and 35 years, respectively (95% confidence interval [95% CI]: 35.3-41.2 years). Platelet count range 12k to 150k with mean of 30.76k. Mean platelet count among patients with epistaxis those were not required nasal packing (9 Cases) was 44k and subsequently mean platelet count of those were required nasal packing (8 cases) was 22.25k. It was Observed, Hb range from 8.6 gm/dl to 14.7 gm/dl with mean of 11.24 gm/dl. Pt/INR was also observed, range from 13.67 Sec to 14.13 Sec with mean of 13.81 Seconds. Transfusion was required in 6 cases (35.3%) and subsequently non required cases were 11 (64.7%).The mean platelet count upon hospital discharge was 111.2 × 109/L (95% CI: 97.8-124.7 × 109/L). The mean lowest leukocyte count was 4.6 × 109/L (95% CI: 3.8-5.3 × 109/L), with a minimum value of 0.7 x 109/L and a maximum value of 57.0 × 109/L. Plasma leakage was observed in 100% of the cases (95% CI: 99.9) and hypotension and hemodynamic instability occurred in 89.9.0% and 99.87% of these cases respectively. Regarding the CBC, anemia was observed in 68.0% of the cases (95% CI: 77.8-89.4), and the mean lowest hemoglobin level of all patients who received any type of transfusion during hospitalization was 8.6 g/dL. Conclusion: The present study was carried out in 17 patients with DHF-Epistaxis, so far it was done in a large samples as compared to reported case studies on DHF-Epistaxis. Hence, our results, on thrombocytopenia, platelet counts, Haematocrit levels, HB values, transaminase levels Lymphocyte counts, transfusions, and Nasal Packing etc could be considered as a land mark cut-off for the treatment and management of Dengue Hemorrhagic Fever with Epistaxis.

Objectives: Microorganisms can be transmitted from animated resources to inanimate environmental assets. They can also emerge as secondary reservoirs if they meet transmitted pathogens as they needs to live and multiply. In the present study aim Role of fomites in the health care associated infections in tertiary care hospitals. Methods: A retrospective cross-sectional study was performed among 100 sample were randomly collected between June – July, 2022from, Katuri Medical College Guntur. We were taken the sample from the Mobile, stethoscope, pen, watch, apron and key chain of health care workers such as Doctors, Pg students, intern and nurses at high-risk area like ICCU, MICU, SCIU and NICU. These fomites are the most frequently used and contaminated easily with fingers. Rolling over the exposed surfaces of each fomite and using sterile swabs soaked with sterile 0.9% NaCl allowed samples to be collected aseptically. Results: Majority of bacteria isolated from HCW’s mobile phones were Methicillin resistant Staphylococcus aureus (30.7%).23% of the pseudomonas aeruginosa isolated from HCW’s mobile phones.2.5% clostridium spp were identified on mobiles phone of HCW’s. Conclusions: Necessitate for educating the patients and their attendees about the risk of hospital acquired infections and self-measures required to be taken by them. Monitor the screening of the hospital and its environment for the pathogenic bacteria presence.

Background: Colorectal adenocarcinoma is a major cause of cancer-related mortality worldwide, necessitating detailed histopathological evaluation for accurate staging and management. This case series aims to elucidate the clinicopathological features of colon adenocarcinoma in surgically resected specimens, highlighting variations in tumour site, histopathology, and staging. Methods: This prospective case series analysed eight adult patients who underwent surgical resection for colorectal adenocarcinoma at Department of Pathology, ICARE Institute of Medical Sciences and Research, Haldia. Data were collected on patient demographics, surgical procedure type, tumour location, histopathological diagnosis, tumour grade, and TNM staging. Results: The patients ranged from 31 to 87 years old, with a male predominance. Histopathological examination revealed mostly moderately differentiated adenocarcinoma. Staging varied from Stage IIA to IVB. Conclusions: The findings demonstrate the predominance of moderately differentiated adenocarcinoma in various segments of the colon and rectum, often diagnosed at advanced stages. This underscores the importance of early detection and comprehensive histopathological evaluation to improve prognostic outcomes. Future studies with larger cohorts are needed to further explore the correlations between histopathological characteristics and clinical outcomes in colorectal adenocarcinoma.

Introduction: Fluid cytology plays a pivotal role delineating benign from malignant effusions, tumor staging and diagnosing recurrences. Objectives are (1) To assess Risk of Malignancy of The International System for Reporting Serous Fluid Cytopathology on cytospin smears. (2) To assess the Diagnostic Utility of Cytospin Preparations with Cell Block method. Material and Methods: This was a retrospective study done during the period of 12 months (July 2023 to June 2024) in the department of Pathology, ESIC Medical College and Hospital, Kalaburagi, Karnataka. Serous fluids (pleural and peritoneal fluids) were received and analysed by cytospin smears and cell block preparation, following conventional smear cytology. Cytospin preparations were reported using The International System for Reporting Serous Fluid Cytopathology (ISRSFC). Cell block preparations were taken as gold standard. Results: Of the 461 samples studied during the study period, using the ISRSFC on cytospin smears, 8 cases (1.73%) were categorised as Non-Diagnostic (ND), 437 cases (94.79%) as Negative for Malignancy (NFM), 4 cases (0.86%) as Atypia of Unknown Significance (AUS), 03 cases (0.65%) as Suspicious for Malignancy (SFM) and 09 cases (1.95%) as Malignant (MAL). 145 cell blocks were prepared, of which 139 cases were available for cytospin vs. cell block correlation. Risk of malignancy of The International System for Reporting Serous Fluid Cytopathology (ISRSFC) on cytospin smears were 0% for ND, 0.86% for NFM, 25% for AUS, 66% for SFM and 100% for MAL. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cytospin preparations with cell block method were 92.85 %, 100 %, 100 %, 99.2 % and 98.5 % respectively. Conclusion: Risk of Malignancy on cytospin smears using The International System for Reporting Serous Fluid Cytopathology (ISRSFC) exhibits high accuracy values for serous effusion cytology. The utility of cytospin smears in comparison to cell block in delineating malignant effusion from the non-malignant effusion were similar.

Background: Essential hypertension is a prevalent condition globally and a leading cause of morbidity due to its association with cardiovascular and renal complications. Early detection of renal impairment in hypertensive patients is crucial to prevent progression to chronic kidney disease (CKD). Serum creatinine and urine microalbumin are widely used markers for assessing renal function and detecting early renal damage. Aim: This study aimed to evaluate serum creatinine and urine microalbumin levels in patients with essential hypertension and to explore their correlation with disease duration and severity. Methods: A cross-sectional study was conducted over 12 months at the VSS Institute of Medical Sciences and Research, Burla, Odisha, involving 200 hypertensive patients. Participants’ demographic and clinical data were collected. Serum creatinine levels were measured using the modified Jaffe method, while urine microalbumin levels were assessed using an immunoturbidimetric method. Statistical analyses were performed using SPSS version 23.0, with Pearson’s correlation and t-tests applied to identify associations between variables. Results: The mean serum creatinine and urine microalbumin levels were 1.15 ± 0.29 mg/dL and 48.6 ± 22.4 mg/L, respectively. Elevated serum creatinine levels were observed in 21% of participants, while 40% had elevated urine microalbumin levels. A significant positive correlation was found between serum creatinine and urine microalbumin levels (r = 0.51, p < 0.001). Participants with a longer duration of hypertension (>5 years) exhibited significantly higher levels of both markers (p < 0.05). Conclusion: A considerable proportion of hypertensive patients exhibited elevated serum creatinine and urine microalbumin levels, indicating early renal impairment. The strong correlation between these markers emphasizes their utility in detecting renal dysfunction at an early stage. Recommendations: Routine monitoring of serum creatinine and urine microalbumin levels should be incorporated into the management of hypertensive patients to enable early detection and intervention. Further longitudinal studies are recommended to assess the progression of renal damage and evaluate the impact of targeted therapeutic measures.

Background: Retinopathy is a complication of chronic diabetes mellitus and other systemic diseases. This often impacts the patient’s mental health, especially in newly diagnosed conditions. Depression and anxiety are commonly prevalent among these individuals due to the threat of loss of vision, disease burden, and reduced quality of life. We undertook this study to understand the prevalence and associated factors for developing psychological conditions. Methods: This study included patients newly diagnosed with various retinopathies. The diagnosis of retinopathy was done using an ophthalmoscope. The validated [Hospital Anxiety and Depression Scale (HADS), and Generalized Anxiety Disorder 7-item (GAD-7) scale for anxiety] were used to assess symptoms of depression and anxiety. These are widely used and validated self-report measures.  Other Relevant Factors: Questions related to social support, coping mechanisms, perceived impact of retinopathy on daily life, and access to healthcare services. Results: The study included 100 participants (62 males, 38 females; mean age: males 62.55 ± 5.3, females 61.25 ± 8.54 years). Retinopathy prevalence increased with age, with the 61–70 age group most affected. Socioeconomic analysis revealed higher prevalence in lower socioeconomic classes. Diabetic retinopathy (44%) was most common, followed by hypertensive retinopathy and age-related macular degeneration (AMD). Anxiety and depression levels, assessed via HADS and GAD-7 scales, showed moderate/severe anxiety in 33% of hypertensive retinopathy cases and 29% of diabetic retinopathy cases. Depression was moderate/severe in 14–17% of these groups. AMD cases exhibited milder anxiety and depression symptoms. Conclusion: In conclusion, this study highlights a significant prevalence of anxiety and depression among patients with various retinopathies, particularly diabetic and hypertensive retinopathy. Diabetic retinopathy was the most common, followed by hypertensive retinopathy, with cases predominantly in older age groups and lower socioeconomic classes. Moderate to severe anxiety was observed in 29–33% of diabetic and hypertensive retinopathy patients, while 14–17% exhibited moderate to severe depression.

Background: Nausea and vomiting following Regional Anaesthesia in pregnant women undergoing Caesarean section is a major clinical problem. The present study was undertaken to compare the safety, efficacy and anti-emetic effect of Ondansetron and Metoclopramide in prevention of Post operative Nausea and Vomiting in LSCS under Spinal Anaesthesia. Material and Methods: After obtaining the approval of institutional ethical committee permission, a prospective randomized observational study was conducted on 50 women patients aged above 18 years of ASA I or II Grade undergoing elective LSCS under Spinal anaesthesia. They were assigned randomly into two groups of 25 each. Group-O received Inj. Ondansetron 4mg I.V. and Group- M received Inj. Metaclopramide 10 mg I.V.  ten minutes before Spinal Anaesthesia. Anaesthetic management was standardized. Incidence of post operative vomiting and retching as number of episodes was studied, Nausea was graded depending on the severity and need of rescue anti-emetic was recorded in all patients for 24 hours post operatively and the safety, efficacy and anti-emetic effect of Ondansetron to Metaclopramide in the prevention of post operative nausea and vomiting was evaluated. Results: The mean age, weight and ASA grading was not significantly different when compared Group- O parturiants with Group M. Number of episodes of Nausea ,Retching and Vomiting were recorded at time intervals of 0 hour, 1 hour,2 hour,4 hour,6 hour,8 hour,12 hour and 12 hour for all the patients in both groups .Incidence of  Nausea was more in Group- M than Group- O at 0 hour, 1 hour and 2 hour, but was statistically significant (p<0.05) at 2 hour only. Incidence of Retching was more in the 0 hour, 1 hour and 2 hours in Group- M and incidence of retching was reduced significantly in Group -O patients at 2 hours. Incidence of Vomiting was decreased in Group -O than Group- M, but was not statistically significant. It was found that Inj. Ondansetron was more efficient than Inj. Metaclopramide in preventing Post-operative Nausea and Vomiting in patients undergoing LSCS under Spinal Anaesthesia. Conclusion: The study concluded that the safety, efficacy and anti-emetic effect of Injection Ondansetron is more than Injection Metaclopramide in the prevention of Post-operative Nausea and Vomiting in Patients undergoing LSCS under Spinal Anaesthesia.

Background: Schizophrenia, a complex and chronic mental health disorder, characterized by disturbances in thought, perception and behavior. Insight in schizophrenia is critical in influencing the prognosis and management of the disease. Aim: To study the level of insight in patients with schizophrenia. Materials and Methods: 40schizophrenia patients who met inclusion criteria were included for the study. Study was conducted for a period of 18 months. ICD-10 diagnostic criteria, BPRS for assessing symptom severity, and SUMD (scale for assessment of unawareness in mental disorders) to assess the level of insight were used for the current study. Results: Mean age of patients was 36.9 years, mean insight scores of all items of SUMD showed statistically significant improvement in insight scores at 4weeks follow up. On comparing the insight and severity of psychotic symptoms we found a positive correlation between 1c, 1p,2c,2p items of SUMD and BPRS. No statistical significance was established on comparing the duration of illness and insight in schizophrenia. Conclusion: the study concluded that insight improves with treatment and poor insight is associated with severe psychotic symptoms.

Introduction: Neonatal hyperbilirubinemia (NNH) is an ongoing problem that requires medical attention and hospital readmission in newborns. Approximately 5-10 percent of all newborns require intervention for pathologic jaundice. Exchange Transfusion (ET) is an effective emergency intervention to lower the S. bilirubin (SBR) levels in neonates at high risk of bilirubin encephalopathy. Aim: To evaluate the efficacy of whole blood and whole blood reconstituted used in Exchange transfusion in NNH due to HDFN (hemolytic disease of newborn). Materials and Methods: 40 neonates with ABO and Rh (Rhesus) Hemolytic Disease of Fetus and newborn were included in this study and ET was done in both groups either using Whole Blood (WB) or Whole Blood Reconstituted (WBR) being selected by randomization. Results: In the present study, the efficacy of exchange transfusion between whole blood and whole blood reconstituted among 20 cases of NNH with ABO HDFN revealed improvement in haemoglobin and fall in SBR level was evident in 7 out of 14 cases with WB and in all 8 cases of ABO HDFN with WBR. Improvement in haemoglobin level and a fall in SBR were observed in both groups of Rh HDFN. Conclusion: In cases of ABO HDFN, better outcome happened with whole blood reconstituted than whole blood alone for exchange transfusion to bring back desired level of Hb and SBR. In cases of Rh HDFN, no difference was observed between WBR and WB groups. However, to avoid failure in achieving the desired results with ET, in cases of ABO HDFN using O Whole blood, it is essential to use “O Whole Blood” with antibody titre less than the critical level. Further, to avoid unexpected exposure to anti-D in cases of Rh HDFN WBR exchange transfusion, it is necessary to use AB plasma only from male donors without the history of prior transfusion.

Background: The use of laparoscopy has gained widespread popularity in surgical approaches to abdominal wall hernias and intestinal and solid organ resection. However, no other operation has been as profoundly affected by the advent of laparoscopy as cholecystectomy. To evaluate the feasibility and safety of the minilap cholecystectomy (MLC) and to compare the clinical benefits experienced by patients who undergo MLC with those who undergo laparoscopic cholecystectomy (LC). Materials & Methods: From July 2010 to September 2011 patients were recruited at Surgery OPD of a tertiary care teaching Hospital, Kolkata, into this prospective randomized control trial. Eligible patients must have experienced at least one attack of typical biliary colic, associated with nausea and vomiting, have USG proven cholelithiasis, in the age group of l0- 69 years and presented for elective cholecystectomy. Results: Mean age in the LC group is 37.22±11.37 years (range 11-69 years) and MC group 38.54±11.62 years (range 10-63 years). Mean OT time for MLC was 54.84 mins versus 63.92 mins for the LC group. Median values for LC were also longer 75 mins vs 48.33 mins. Modal values are 75.5 and 45.5 mins for LC and MLC groups respectively. Three out of 50 cases of LC ended in conversion giving an overall conversion rate of 4 out of 50 cases of MLC resulted in conversion to standard open cholecystectomies by extension of incision; i.e. a conversion rate of 7%. The observed difference is however, not statistically significant, (p>0.05). Overall complications rates were 6% for LC’s and 8% for MLC’s (not significant, p>0.5) and was comparable to the morbidity of the most series of LC’s and MLC’s. Time for full ambulation for LC patients was on an average 22.56±6.70 hrs vs 26.30±5.809 hrs for MLC patients (significant p<0.5), I.e. almost 5 hrs ahead of the MLC patients. Conclusion: Minilap cholecystectomy has been found to be safe with several advantages in terms of time, cosmesis, and post-operative morbidity and wound pain shortened hospital stay leading to cost benefit. Mini-laparotomy cholecystectomy is an alternative to laparoscopic approach in the surgical treatment of acute and chronic cholecystitis.

Background: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by insulin resistance and chronic inflammation. The most prevalent kind of diabetes is Type 2 Diabetes, or non-insulin dependent diabetes mellitus (NIDDM). Non-insulin dependent diabetes mellitus (NIDDM) accounts for more than 90% of diabetes and typically features insulin resistance or insulin secretory defects. Objectives: In this study, we aimed to assess serum insulin, insulin resistance and inflammatory markers in T2DM patients and healthy controls. And also investigate the relationship between insulin resistance and inflammatory markers in T2DM patients. Materials and Methods: A total number of 100 patients were included in the hospital based analytical cross–sectional study. This includes 50 subjects of NIDDM and 50 healthy control of age group of 20 to 65 years. After an overnight fast of 10-12 hours, venous blood sample was drawn from anticubital vein of each subject by using standard aseptic techniques. Serum was separated by centrifugation and used for the following biochemical analysis. Serum Insulin and inflammatory markers (CRP, IL-6, serum ferritin) was estimated using Fully Automatic Analyzer and Insulin Resistance was calculated using HOMA-IR. Statistical analysis was analyzed using Student’s t-test. Results: There is highly significant increase in the levels of serum insulin, serum insulin resistance index, serum ferritin, CRP and IL-6 in subjects of NIDDM as compared to healthy controls (p < 0.0001). Conclusion: Our study revealed hyperglycemia, hyperinsulinemia, and dyslipidemia in non-insulin dependent diabetes mellitus (NIDDM) subjects and inflammatory markers are also high due to low grade inflammation. These findings have implications for understanding the pathophysiology of T2DM and developing therapeutic strategies to target insulin resistance and inflammation.

Background: Echinococcosis, or hydatid disease, is caused by the larval forms of taeniid cestodes belonging to the genus Echinococcus. Echinococcus granulosus and E. multilocularis are the primary species responsible for human echinococcosis, and mostly they affect the liver. The disease course is typically slow, and the patients tend to remain asymptomatic for many years. Case presentation: A 8 year old male child with Right upper quadrant pain & swelling since 6 months. USG whole abdomen shows multiple septated cystic lesions (honeycomb) within hepatic segment VI, VII & II), CE2. The CT scan shows Smooth SOL with several septations. Echinococcal IgG raised. Preoperatively 3 cycles of tab Albendazole, 2 wks each given. Partial cystopericystectomy done in both lobes. Post op uneventful, discharged after 3 days. Conclusions: Hydatid disease in the liver may persist without symptoms and often goes undiagnosed due to the slow growth of the cysts. The diagnosis needs careful history reporting, physical examination, and appropriate imaging investigations.

Background: Diabetes mellitus (DM) significantly increases the risk of coronary artery disease (CAD) due to metabolic and vascular dysfunction. Objective: This study aimed to compare the clinical, echocardiographic, lipid, and angiographic profiles of diabetic and non-diabetic CAD patients. Methods: A cross-sectional study was conducted in a tertiary care center, including adult CAD patients. Participants were categorized into diabetics (Group A) and non-diabetics (Group B). Data on clinical presentation, lipid profiles, ECHO findings, and angiographic patterns were collected. Results: The mean age of Group A was 55.63 years, and Group B was 55.33 years, with no significant difference (p = 0.748). Group B had a significantly higher proportion of males (80.0%) compared to Group A (71.2%) (p = 0.036). AWMI was the most common presentation in both groups, followed by IWMI with no significant differences in clinical presentations (p = 0.257). Lipid profiles revealed significantly higher triglycerides (median: 151 vs. 125 mg/dL) and LDL (median: 86 vs. 56 mg/dL) and lower HDL (median: 43 vs. 64.5 mg/dL) in group A (p < 0.0001) compared to group B. Angiographically, Group A had more double-vessel (27.4%) and triple-vessel disease (16.4%), while Group B had more single-vessel disease (72.5%) (p = 0.001). ECHO findings were similar between groups (p = 0.810). Conclusion: Diabetic patients demonstrated more severe coronary artery disease, worse lipid profiles, and a higher prevalence of AWMI compared to non-diabetic patients. These findings emphasize the need for targeted prevention and management strategies.

Background: Supraclavicular brachial plexus block is a widely used technique for upper limb surgeries. This study compares the efficacy and safety of the conventional technique versus the ultrasound-guided technique. Methods: A randomized, single-blinded, prospective study was conducted on 60 patients, aged 18–60 years, classified as ASA I or II, undergoing elective upper limb surgeries. Patients were divided into two groups: Group C (conventional technique) and Group US (ultrasound-guided technique). Demographic data, procedural time, onset and duration of sensory and motor blockades, intraoperative analgesic requirements, block effectiveness, and complications were analyzed. Statistical significance was assessed using appropriate tests, with a p-value < 0.05 considered significant. Results: Demographic characteristics were comparable between groups. The time to perform the block was shorter in Group C (6.1 ± 2.1 min) than in Group US (9.1 ± 3.2 min) (p < 0.01). Onset of sensory (9.1 ± 3.1 min) and motor blockade (9.9 ± 4.9 min) was faster in Group US (p = 0.002, p = 0.02, respectively). Group US also exhibited longer sensory (6.9 ± 1.1 hrs) and motor block durations (6.9 ± 0.9 hrs) compared to Group C (4.5 ± 2.3 hrs and 6.1 ± 2.1 hrs, respectively) (p < 0.05). Intraoperative analgesic requirements and complication rates were significantly lower in Group US (p < 0.05). The success rate was higher in Group US (100% vs. 93.1%), with no cases requiring conversion to general anesthesia. Conclusion: Ultrasound-guided supraclavicular brachial plexus block offers faster onset, prolonged blockade, reduced analgesic requirements, and fewer complications compared to the conventional technique, making it a superior choice for upper limb surgeries.

Background: Since Jardao’s 1857 discovery of the link between diabetes and hearing loss, numerous studies have been conducted on the subject, with both favorable and unfavorable findings. High blood sugar levels primarily affect the auditory system. Increased glucose in diabetes patients can damage the auditory system, both anatomically and physiologically. This study aims to compare the auditory acuity in hyperglycemic and normoglycemic individuals. Methodology: This is a hospital-based case-control study. The study participants will be randomly recruited from OPD and IPD of various departments in GIMS, Kalaburagi. 200 subjects were divided as Group A with 100 normoglycemic and Group B with 100 hyperglycemic. FBS, PPBS and HbA1c values were measured. Pure tone audiometry and OAE was performed for subjects. Results: A total of 200 individuals were randomly selected: 100 normoglycemic (Group A) and 100 hyperglycemic (Group B), aged 30-60. The age distribution was similar, with 33 in Group A and 46 in Group B aged 51-60. Both groups had equal sex distribution. Out of 39 individuals with hearing loss, 32 (82%) were in Group B. Severity was lower in Group A (6% mild, 1% moderate) compared to Group B (21% mild, 9% moderate, 2% moderately severe.) 30 patients in Group B had mild to moderate hearing loss, compared to 7 in Group A. Higher HbA1c levels correlated with increased severity of hearing loss. Conclusion: Hyperglycemic individuals showed higher prevalence and severity of hearing loss compared to normoglycemic controls, suggesting a link between glycemic control and auditory health.

Introduction: Complete Blood Count (CBC) and Peripheral Smear (PS) study are the basic common blood investigations requested by clinicians and we can diagnose the various clinical conditions like acute or chronic infections, Leukemoid reaction, and leukemia through WBC counts, Anemia sub types and bleeding disorders. Though the bio-markers of inflammation are numerous, the least expensive test of CBC can be used as a risk predictors of cardiovascular diseases (CVD). Methodology: A prospective cohort study conducted on 60 study participants in whom 40 were taken from cases admitted with chest pain in emergency medical ward and 20 healthy individuals were taken as controls. This study was conducted at Chengalpattu Medical College for the period of 2 months [June 2024 to July 2024]. Results: The WBC count, Neutrophil Count, Lymphocyte Count, Neutrophil Lymphocyte Ratio (N/L), Platelet Lymphocyte Ratio (P/L) showed statistical significance with the p value of < 0.05. Majority of the peripheral smear picture showed Neutrophilia. Discussion: CBC offers variety of information to suggest the pathogenesis of many diseases. WBC count and Neutrophil lymphocyte ratio (NLR) can reflect systemic inflammation. Our study results showed that there is significant association with the parameters of WBC count, neutrophil count, lymphocyte count, Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio with the CVD risk. The peripheral smear picture also provides supportive evidence of neutrophilia in majority of the cases reflecting strong association with cardiovascular events. Many studies also stated these similar association of certain CBC parameters and CVD risk. Conclusion: CBC parameters such as elevated WBC count, N/L ratio, P/L ratio and peripheral smear can be considered as predictors as risk for cardiovascular events. However further larger studies are needed to support the potential role of CBC parameters and peripheral smear as these are least expensive and routinely assessed set of investigations for CVD risk in previously healthy populations.

Background and Objectives: This observational prospective study was carried out to assess and compare the outcome of non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) therapy as respiratory support in patients suffering from acute hypoxemic respiratory failure. Methods: This study included 137 patients. The modality of respiratory therapy was determined by the treating physician, and 60 and 77 patients received HFNC and NIV as initial respiratory support, respectively. The patients were followed for 28 days or till death (whichever was earlier). The primary outcome was number of ventilator-free days and secondary outcomes were duration of respiratory support, need for intubation, and duration of ICU stay and hospital stay and 28-day mortality after initiation of respiratory support. Results: It was observed that the number of ventilator-free days (primary outcome) at day 28 was similar in both HFNC group (median 28 days) and NIV group (median 28 days). The 28 day mortality was found to be lower in HFNC group (28.3%) than in NIV group (39%) but it was not statistically significant (p 0.26). The intubation rate was also lower in HFNC group (33.3%) compared with NIV group (48.1%) but this difference was not statistically significant (p 0.12). The duration of initial support with HFNC (3 days, IQR 3-7) was significantly less than with NIV (5 days, IQR 1.25-6; p<0.05). The duration of ICU stay [8 days (IQR 5-12) vs 13 days (IQR 7.5-17.5)] and hospital stay [13 days (IQR 11-18) vs 18 days (IQR 11-25)] was significantly lower in HFNC group compared with NIV group (p<0.05). Conclusion: It is concluded that HFNC was a better modality of respiratory support, as its use is associated with shorter ICU and hospital stay, more number of support-free days and it is required for lesser duration than NIV, though there is no difference in number of ventilation-free days, endotracheal intubation rate, or mortality rate at day 28 from initiation of respiratory support.

Background: Cataract surgery is one of the most frequently performed ophthalmic procedures worldwide. Peribulbar block is a commonly used regional anesthesia technique for these surgeries due to its safety and efficacy, particularly in elderly patients with comorbidities. This study aimed to evaluate the effectiveness of a combination of lignocaine, bupivacaine, and hyaluronidase with and without clonidine at two doses (0.5 µg/kg and 1 µg/kg) for enhancing the quality and duration of analgesia during peribulbar anesthesia. Materials and Methods: This randomized, double-blind, prospective study was conducted on 120 patients aged 40–80 years undergoing cataract surgery at a tertiary care hospital in Pune, India, over one year. Patients were randomized into three groups of 40: Group A received a mixture of lignocaine, bupivacaine, and hyaluronidase; Group B received the same mixture with 0.5 µg/kg clonidine; and Group C received the mixture with 1 µg/kg clonidine. The onset of sensory and motor blockade, duration of analgesia, and hemodynamic parameters were assessed. Statistical analyses included Bartlett’s χ² test, Kruskal-Wallis one-way ANOVA, and paired Student’s t-test. Results: The addition of clonidine significantly reduced the onset time for sensory blockade (Group A: 4.7 ± 2.1 min; Group B: 3.7 ± 1.5 min; Group C: 3.2 ± 1.2 min) and motor blockade (Group A: 7.3 ± 2.6 min; Group B: 4.2 ± 2.4 min; Group C: 3.5 ± 1.2 min). Clonidine also prolonged the duration of analgesia, with values of 187.6 ± 23.1 min, 243.2 ± 27.0 min, and 341.3 ± 32.1 min for Groups A, B, and C, respectively. Hemodynamic parameters and side effects, including mild sedation and dry mouth, were within acceptable limits. Conclusion: Clonidine is an effective adjuvant in peribulbar block, enhancing the quality of anesthesia by reducing onset time and prolonging analgesia. The 0.5 µg/kg dose provides an optimal balance of efficacy and safety, making it a preferred choice for cataract surgery. Further studies with larger populations are recommended to validate these findings.

Background: Visual impairment in childhood has a negative impact on socio-emotional competence and academic development. As the real India is in villages, hence rural eye health status of rural school-going children was evaluated. Method: Out of 350 (three hundred and fifty) school-going children, 220 (62.8%) were male, and 130 (37%) were female and had ocular morbidities. Visual acuity was measured by Snell’s chart. The Hirschberg test, a cover-uncover test for the detection of squint, was done. A torchlight was used to examine the anterior chamber, iris, and pupil. Retinoscopy was used to study refraction. Ophthalmoscopy is the study of the fundus slit lamp for the anterior segment. Any pathology of the eye is treated with suitable antibiotics.  Results: 256 (73.1%) refractive errors, 138 (39.4%) simple myopia, 64 (18.3%) hypermetropia, 52 (14.8%) strabismus, 45 (12.8%) alternate convergent squint, 18 (5.1%) Vit. A deficiency is noted. Conclusion: The visual morbidities refractive error is a common eye health problem.  These findings will help the ophthalmologist to treat and prevent blindness in children.

Background: Tuberculous lymphadenitis presents significant diagnostic challenges, particularly in high tuberculosis (TB) burden settings. Traditional diagnostic methods like fine-needle aspiration cytology (FNAC) are widely used but often lack sensitivity and specificity. Methods: This cross-sectional observational study compared the diagnostic accuracy of GeneXpert/CBNAAT with FNAC in 970 patients suspected of having tuberculous lymphadenitis at a tertiary care center from January 2022 to December 2024. Data on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed and compared between the two methods. Results: GeneXpert/CBNAAT demonstrated significantly higher sensitivity (96.4%) and specificity (98.1%) compared to FNAC, which showed a sensitivity of 84.9% and specificity of 95.2%. The turnaround time for GeneXpert results was approximately 2 hours, compared to 48 hours for FNAC. GeneXpert also provided immediate insights into rifampicin resistance, enhancing the management of potential drug-resistant cases. Conclusion: GeneXpert/CBNAAT outperforms FNAC in both diagnostic accuracy and turnaround time, supporting its use as a primary diagnostic tool for tuberculous lymphadenitis in tertiary care settings. The rapid, accurate detection and added capability of assessing drug resistance make GeneXpert a valuable asset in the effective management and control of tuberculosis.

Background: Gestational diabetes mellitus (GDM), a common pregnancy condition, causes insulin resistance and harms the mother and foetus. We need early prevention to reduce its impact. Myoinositol, a naturally occurring sugar alcohol, may prevent GDM due to its role in insulin signaling and glucose metabolism. Objective: This study examined whether myoinositol supplements could lower the risk of gestational diabetes mellitus (GDM) in high-risk pregnant women and improve mother-child health. Method: Nalanda Medical College & Hospital conducted Retrospective observational research on 100 pregnant women from September 2022 to September 2023. Participants chose myoinositol supplements or prenatal care. We examined maternal-fetal outcomes, GTTs, and baseline characteristics. We used chi-square tests, paired t-tests, and logistic regression to determine how well myoinositol reduces GDM and affects mother and baby health. Results: Compared to the control group, myoinositol significantly reduced GDM from 36.7% to 14.3% (p = 0.01). The intervention group significantly improved (p < 0.05) glycaemic indices, including fasting glucose, postprandial glucose, and 2-hour OGTT levels. Myoinositol supplementation lowers the risk of preeclampsia (adjusted OR: 0.32; p = 0.04) and improves neonatal outcomes like Apgar scores and macrosomia. We found no major adverse effects. Conclusion: Myoinositol is safe and helpful for preventing GDM and producing a healthy baby. When used in prenatal care, it is feasible and cost-effective, especially for high-risk women. These findings need further study to determine long-term benefits.

Background: Mental health disorders include unfavorable drug effects, cognitive impairments, and decreased treatment adherence, making it harder to manage Diabetes Mellitus (DM), a chronic condition that requires ongoing management. This study will evaluate diabetic and mental patients’ glycaemic control and treatment results based on HbA1c levels, adherence, and lifestyle changes. Methods: 100 patients with diabetes for six months or more participated in the cross-sectional observational study. There were 50 mental patients and 50 community members. Participants were at the age range from 30–50. A structured questionnaire collected data on medication adherence, HbA1c levels, and lifestyle factors like food and exercise. Our statistical analysis was conducted using SPSS with a significance criterion of p<0.05. Results: General population HbA1c levels were 7.2 ± 1.0%, while psychiatric patients had significantly higher levels at 8.5 ± 1.2% (p<0.01). Compared to the general Population (7.8 ± 1.7), people with a mental health condition exhibited significantly worse treatment adherence (5.2 ± 2.3) (p<0.01). Psychiatric patients reported lower levels of physical activity (32% vs. 64%, p<0.05) and adherence to healthy nutrition (42% vs. 72%, p<0.01). No significant differences were found in alcohol and smoking rates. Conclusion: This study found that mental health patients are less likely to adjust their lifestyle, control their glycaemic levels, and follow treatment regimens. These findings suggest that mental diabetes patients need extra attention to medication adherence and lifestyle promotion. Integrated care techniques for patients with mental illness and diabetes are needed for better long-term outcomes.

Background and Aim: In light of the growing global awareness and advancements in socioeconomic and living conditions, there has been a concerning rise in the prevalence of diabetic osteomyelitis (DOM) and its associated complications. This research aimed to evaluate the efficacy of antibiotic-impregnated beads for the treatment of osteomyelitis in individuals with diabetic foot conditions within an Indian context. The research additionally examined the microbiological characteristics of the wounds. Material and Methods: The study included all diabetic patients who had a chronic foot ulcer persisting for over three weeks, along with confirmed underlying osteomyelitis through culture results. The current main study involved a total sample size of 120 participants. The participants were assigned to the two groups in a random manner. Patients were divided into two distinct categories: the ‘bead’ group and the ‘no bead’ group. In the study, the ‘bead’ group received antibiotic beads, while the ‘no bead’ group was administered oral antibiotics, alongside empirical intravenous antibiotics for both groups. Patients underwent a comprehensive review over a six-month period, with ulcers that did not show signs of healing within this timeframe classified as instances of treatment failure. Results: The findings of our study revealed a comparison of ulcer healing between two groups. Out of 120 patients involved, 102 experienced healing, while 18 did not achieve this outcome. Among the nine cases that did not heal, 14 were from the no bead group, while 4 were from the bead group. Among the 102 individuals who demonstrated healing, 46 were part of the group without beads, while 56 were in the bead group. The association regarding healing showed no statistically significant results. (p>0.05) The average healing time for the group without beads was 75.25±29.40 days, while the bead group recorded an average of 80.97±28.36 days, a difference that did not reach statistical significance. Conclusion: The application of antibiotic beads enhances patient convenience by minimizing hospital visits and the necessity for daily dressing changes, all while maintaining an effective healing rate. The group without beads faced challenges in accessing hospitals on a daily basis, with some individuals even opting to forgo their daily dressings due to personal inconveniences.

Background: Chronic suppurative otitis media is a very common middle ear disorder, particularly in developing nations like India. The surgical treatment of chronic suppurative otitis media primarily aims at the eradication of the disease process and reconstruction of the conductive hearing mechanism. Tympanoplasty is a surgical procedure to reconstruct sound-conducting apparatus, tympanic membrane, and ossicular system with or without grafting. Aim: Comparing the effectiveness of endoscopic cartilage shield tympanoplasty and endoscopic temporalis fascia, as well as the anatomical perforation closure and audiological improvement following cartilage and temporalis fascia. Methods: 40 people with a clinical diagnosis of chronic suppurative otitis media tubotympanic illness participated in the study. They were split into two groups at random: the temporalis fascia group and the cartilage group. A cartilage or temporalis fascia graft was used for tympanoplasty. Results: A lower failure rate was observed in the cartilage group than in the temporalis fascia group. The audiological gain between two groups showed statistically significant (p-value = 0.769). Impedance audiometry showed a ‘B’ curve in all cartilage tympanoplasty patients. Conclusion: For tympanic membrane repair, cartilage is a dependable and long-lasting graft that can resist harsh environments for an extended length of time. Better anatomical and functional outcomes are obtained with cartilage tympanoplasty.

Background: Metabolic syndrome is constellation of many different disorders. The common conditions associated with metabolic syndrome are obesity, hypertension, and dyslipidemia and insulin resistance. These conditions do play some role in developing cardiovascular disease beyond traditional risk. Metabolic syndrome have been commonly seen in patients of many skin diseases including psoriasis, lichen planus, acne inversa and even in skin malignancies. In chronic skin disorder and even in metabolic syndrome chronic inflammation has been shown to play some role in the pathogenesis of disease. The present study is designed with a view to know any association between skin diseases especially psoriasis and metabolic syndrome. Materials and Methods: Present study was conducted on 100 clinically confirmed cases of Psoariasis & 100 age and sex matched healthy controls. Detailed history and clinical examination was conducted for both cases & controls. Blood pressure, waist circumference & body mass index were recorded. Blood fasting glucose levels and lipid profiles were also measured for both groups. Statistical analysis was done using descriptive statistics and Chi-square tests were used to assess the significance of the differences between the two groups. Data analysis was performed using SPSS and EPI info software. Results: Among psoriasis patients 26/100 had metabolic syndrome. The incidence of metabolic syndrome with skin disease was high as compared to control population and it was also statistically significant. Conclusion: It was concluded from this study that metabolic syndrome is an important co-morbidity with psoriasis which requires screening to avoid complications in later life.

Background: Androgenetic alopecia is a very common clinical condition encountered by the dermatologists in their daily practice. Aims: To study the efficacy of platelet rich plasma in treatment of androgenetic alopecia in male patients. Settings and Design: Observational and interventional study. Methods: A total of 30 cases of clinically diagnosed male patients with androgenetic alopecia in the age group of 15-50 years constituted the subject material for present study. Detailed history and clinical examination of cases was done. All the routine investigations were carried out. Statistical analysis used: Data analysis was done by using statistical package for social sciences (SPSS) and “paired t test”. Results: A total of 30 patients were studied. Large number belonged to the age group 26-30(36.7%) years and 21-25 years (33.3) respectively. Majority are from class 2 to 5, Hamilton Norwood classification of AGA. The family history was positive in 19 cases (63.3%). Frontal, parietal and occipital areas were involved in maximum number of patients i.e. in 20 patients (66.7%). The patients reported clinical improvement in the form of hair count, hair thickness, hair density with statistically significant p-value (p<0.05) after an average of 2-3 sessions. Conclusion: In our study of 30 patients, 20 patients showed improvement of varying degrees ranging from +1 to +7 according to Jaeschke scale with significant p-value (p<0.05) after treatment with platelet rich plasma(PRP) based upon which we conclude that platelet rich plasma(PRP) is efficacious in the treatment of androgenetic alopecia.

Background: Approximately 10% of preterm births occur globally (before the 37th week of pregnancy). Research on ROP occurrence in populations is a difficult task due of the wide variation in research design, gestational age, and survival rates among those who participate in these studies. Therefore, our goal was to study  the prevalence of retinopathy of prematurity & associated risk factors. Objectives: To determine the prevalence of retinopathy of prematurity in preterm babies in Neonatal intensive care unit and to understand the link between ROP development and risk variables. Methodology: preterm less than 35 weeks newborns delivered between April 2023 to March 2024 were included in the study. Preterm newborns who need cardiorespiratory assistance, extended oxygen treatment, apnea of prematurity, anaemia necessitating blood transfusions, and neonatal infection might be considered high-risk. Results: Out of 100 patients, 58 were males and 42 were females. The prevalence of ROP in this research was found to be 27%.Stage 1 ROP was found in 8% of patients, stage 2 ROP was found in 19% of cases, and stage 3 ROP was found in 73% of cases. In the present study, risk factors for ROP are low APGAR score, HIE stage, capillary refilling time, NBS score, RDS, neonatal hyperbilirubinemia, and ionotrope usage.

The human forearm is a unique structure in that the movements of pronation and supination occur at the forearm. This is primarily due to the curved anatomy of the radius which helps it to glide over the ulna. In the anatomical position, the medial cortex of the radius is concave while the lateral cortex is convex. This curve otherwise called the ‘radial bow’ of the radius, gives the forearm the ability to pronate and supinate resulting in a ‘screwing motion’. In our study we aimed to assess the radial bow in a subset of Indian population. This study looked at the amount of radial bow present and its location on the radial diaphysis. We tried to find out whether Gender and Hand Dominance affected radial bow and its location.

Background: Tuberculosis (TB) remains a major global health challenge, particularly in low- and middle-income countries, with India bearing the highest burden of cases worldwide. Zinc, an essential micronutrient crucial for immune function, has been implicated in TB susceptibility and treatment outcomes, yet its role in pediatric TB remains underexplored. Objectives: The primary objective of the study was to estimate the levels of serum zinc among patients with childhood pulmonary tuberculosis and TB lymphadenitis. The secondary objectives were to determine the correlation between serum zinc levels and patients’ nutritional status, clinical type of TB and duration of ATT. Methods: This was a hospital-based case control study conducted in the Department of Paediatrics, Vinayaka Missions Medical College and Hospital, Karaikal, over a two-year period from August 2016 to June 2018. Results: The study evaluated serum zinc levels among 48 children with tuberculosis (cases) and 12 healthy children (controls). The mean serum zinc levels were significantly lower in cases (79.56 ± 13.40 µg/dl) compared to controls (120.97 ± 20.73 µg/dl; p<0.001). Decreased zinc levels were observed in 27.1% of cases, while none of the controls had low zinc levels (p=0.042). Among cases, children under 5 years had the lowest mean zinc levels (73.61 ± 12.22 µg/dl), followed by those aged 10–15 years (77.26 ± 15.02 µg/dl) and 5–10 years (83.11 ± 12.76 µg/dl), though differences were not significant. Gender differences in serum zinc levels were also not significant in either group. In cases, malnourished children had slightly higher serum zinc levels (81.14 ± 11.96 µg/dl) than well-nourished children (77.98 ± 14.81 µg/dl; p=0.421). In controls, however, malnourished children had significantly lower zinc levels (100.23 ± 8.71 µg/dl) compared to well-nourished children (127.89 ± 18.89 µg/dl; p=0.038). Cases with extrapulmonary TB showed higher zinc levels (82.15 ± 11.39 µg/dl) than those with pulmonary TB (78.14 ± 14.37 µg/dl; p=0.326). Zinc levels increased significantly with longer ATT duration, ranging from 68.04 ± 10.07 µg/dl (0–1 month) to 93.64 ± 8.82 µg/dl (3–4 months; p<0.001). No significant correlation was observed between serum zinc levels and age in either group. Conclusion: Serum zinc levels were significantly lower in children with tuberculosis compared to healthy controls, with malnutrition contributing to the severity of zinc deficiency. Zinc levels improved with the duration of anti-tubercular therapy, highlighting its potential as a marker for nutritional and treatment recovery.

Simulation based medical education is defined as any educational activity that utilizes simulation aides to replicate clinical scenarios. The use of simulation has been in practice from a long time in fields like aviation, but as far as medical science is concerned its use is relatively new. Although expensive, its judicious use can go a long way in helping both students and teachers teach and learn various skills in a safe and controlled setting without harming the patients. In this article we present our experience in simulation based teaching to undergraduate medical and nursing students at our skill labs over a period of 2 years.

Background: Administering sedation during endoscopic therapy is crucial due to the significant amount of time it takes. Despite being less intrusive and time-consuming compared to endoscopic treatment, endoscopic examination typically causes patients to suffer pain and discomfort in the absence of sedation. Conscious sedation is often achieved by the administration of a narcotic and/or a benzodiazepine. Midazolam, with the briefest half-life among traditional benzodiazepines, is commonly provided either on its own or in conjunction with opioids like fentanyl or pethidine in several countries. Dexmedetomidine is a potent alpha2-adrenoreceptor agonist that specifically targets these receptors, resulting in sedation, pain relief, and reduced saliva production. Dexmedetomidine provides cardiovascular stability, exerts low impact on respiration, and has negligible effects on cognitive functions. Objective: To compare Dexmedetomidine and Midazolam for a conscious sedation in patients undergoing Upper Gastrointestinal Endoscopy. Methodology: The present study was carried out at Department of Anesthesiology at MIMER Medical College, Talegaon Dabhade involving the patients undergoing diagnostic and therapeutic upper gastro intestinal endoscopy procedure. A total of 44 patients were randomly divided in to two groups, 22 each group; Group M received Inj. Midazolam IV and group D received Inj. Dexmedetomedine IV by computer generated random number table. Results: Mean time to achieve sedation i.e. Ramsay sedation grade 3-4 was 8.91 mins for Dexmedetomidine and 8.82 mins for Midazolam, with no difference between study groups (p=0.797). Mean Ramsay sedation score at baseline, after 5 min, after 10 min, after 15 min, after 20 min, after 25 min, after 30 min, after 35 min, after 40 min, after 45 min, after 50 min, after 55 min, after 60 min was recorded. We observed that the mean scores were comparable between the groups during the initial phase of the procedure. However, the mean sedation score was significantly higher in the dexmedetomidine group compared to the midazolam group during the latter part of the procedure i.e at 55 minutes and 60 minutes time interval, indicating that sedation was more effectively maintained with dexmedetomidine group. Additional sedation was required in 5 cases managed by midazolam as compared to only 1 case managed by dexmedetomidine (22.7% vs. 4.5%; p – 0.03). Conclusion: Present study observed that both Dexmedetomidine in a dose of 1 mcg/kg/iv bolus over 10 min followed by infusion 0f 0.2 mcg/kg/hr and Midazolam in a dose of 0.06 mg/kg required similar amount of time to achieve sedation, however, the sedation was sustained more effectively with Dexmedetomidine, and additional sedatives were required more often in patients that were sedated with Midazolam.

Melioidosis is caused by a gram-negative bacterium called Burkholderia pseudomallei which can be contracted through contaminated soil and water. Mostly prevalent in Southeast Asia and south India, northeast India. It has varied presentations like pneumonia, septicaemia, abscess, encephalopathy, arthritis and so also fulminant and chronic courses of illness. A 40 year old, diabetic male presented with high grade fever for 10 days, burning micturition for 10 days and hiccups for 2 days and next day developed altered sensorium, irrelevant talks. Patient was febrile (temp. 101.4^⸰F), oriented to time, place and person but the next day he was disoriented euphoric. Lab investigations showed pancytopenia, Hyponatremia (Na+ 126), deranged KFT (creatinine -2), deranged LFT, raised CRP (58). CSF culture was negative. MRI brain was showing Grade 1 Fazekas white matter changes. Blood CST showed Burkholderia pseudomallei. Gram negative bacilli were seen on Gram stain. He was treated with inj Meropenem, inj Doxycycline, inj Ceftazidime Avibactam, oral Amoxicillin and clavulanic acid. Eventually his sensorium improved, was conscious oriented, fever subsided. The patient was discharged with oral Cotrimoxazole DS (800/160) as maintenance therapy for 6 months and is currently doing well.

Background: Epistaxis is commonly encountered problem in ENT OPD but few require medical attention. Aims: To find out the incidence of epistaxis, age & Sex distribution of patients, month of presentation, duration of hospital stay among the patients, etiology of epistaxis, and modalities of management of patients admitted for Epistaxis in the Department of ENT, Lakhimpur Medical College, Assam. Methods: This study is retrospective review of patients admitted in the Dept of ENT, Lakhimpur Medical College, Assam from the period 1^st Jan 2022 to 31^st Dec 2023. Result: The incidence of patients admitted with epistaxis was found to be 17.6%. Most patients were found in the age group 41-50 years [24.5%]. Male to female ratio was 2.2:1. Incidence of epistaxis increased in the winter months. Predominant causes of epistaxis was found to be hypertension [49%] followed by Trauma [19%]. Majority of the cases were managed by Anterior Nasal Packing [ANP] with antibiotic lubricant gauge pack & Merocele [64%]. 20% cases were controlled with conservative management. Surgical intervention was required in 13% cases. Conclusion: Epistaxis causes significant contribution to morbidity. Control of bleeding, reduction of hospitalization, low complications are the goals of treatment. Major causes of epistaxis are Hypertension and Trauma. Primary modality of management is ANP followed by surgical intervention. Endoscopic cauterization of bleeding point & endoscopic cauterization of Sphenopalatine artery gives promising results.

Introduction: Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. The proximal tibial fractures are one of the commonest intraarticular fractures. They result from indirect coronal or direct axial compressive forces. The majority of tibial plateau fractures are secondary to high speed velocity accidents and fall from height. This study evaluates the functional outcome of high energy tibial articular fractures treated with use of single/dual plating. Material & Methods: The prospective study conducted in the Department of Orthopaedics, MLB Medical College Jhansi from May 2019 to Oct. 2020 on 40 patients of proximal tibia fractures. The cases who were 19-49 years, unilateral, closed fractures, proximal tibial fractures (Schatzker type 1 to VI) with no previous involvement of ipsilateral leg in surgery were included in the study. Results : The youngest patient was 19yrs old and the oldest was 47 yrs. Majority of the fracture were found to be type IV,V and VI fracture types. Most fracture union occurred between 4-5 months. Most of the cases were fell under good modified Rasmussen clinical score 45.0%, followed by excellent 30.0%. Most of the cases were fell under excellent modified Rasmussen radiological score 47.50%, followed by good 30.0%. Knee stiffness, knee instability, implant prominence and infection are the complications occurred in study.

Conclusion: Locking compression plate is mechanically and biologically an advantageous implant in tibial plateau fractures and is effective in prevention of collapse after osteosynthesis, thus allowing early mobilization.

Introduction: Diabetes mellitus is a chronic, metabolic disorder characterized by hyperglycemia. The overwhelming increase of obesity is the first cause of Diabetes which is closely linked to the insulin resistance and associated with hypertension along with dyslipidemia, stress and altered antioxidant level. Yoga and meditation have beneficial effect in diabetic and hypertensive patients. Hence, the aim of this study is to assess the effect of yoga and meditation on lipid profile and antioxidant status in patients with Diabetes mellitus and Hypertension. Material and Method:  This  Prospective study, done at  MGM Medical college ,Mumbai , include 60 healthy control subjects and patients with Diabetes mellitus and diabetes with hypertension , enrolled from both MGM hospital kamothe, Navi Mumbai and International Sahaja which Yoga Meditation and Research centre ,Mumbai. After  overnight fast, blood samples was collected from each subject by venipuncture with standard blood collection technique in a plain vial for  the analysis of lipid profile and MDA, SOD and Nitric oxide.  The Blood pressure (systolic/diastolic) was measured by Sphygmomanomete. Result: The concentration of MDA, Triacylglycerol (TG), Cholesterol and LDL-cholesterol were decreased significantly in diabetics and diabetic hypertensive subjects as well as in healthy individuals after Sahaja yoga meditation over a period of six month. The HDL-cholesterol, SOD, Nitric oxide concentration were increased significantly in healthy individuals as well as in diabetics and diabetic hypertensive subjects participated in Sahaja yoga meditation. Conclusion: This study confirms the health promoting effects of yoga meditation on lipid profile and antioxidant status in type 2 diabetic and diabetics with hypertensive patients over a period of six month, so it may be included as part of treatment regimen along with regular medication in patients of Diabetes with hypertension to improve the quality of life and to prevent the complications of diabetes.

Background: Ophthalmic pathology is unique in many aspects as it encompasses wide range of tissue – epithelial, connective tissue and specialized tissue. Knowledge of spectrum of ophthalmic lesions would contribute to the better management. Complete diagnosis is based on clinical as well as histopathological features. Clinico Pathological correlation is essential for early diagnosis and setting up proper management. Material and Methods: It was a retrospective study carried out at the department of pathology, North Bengal Medical College, and Hospital for a period of 3 years. Total 68 specimens were reviewed that were surgically operated at the department of ophthalmology. Results: In this study period total 68 histologic cases of ophthalmic lesions were observed. A wide spectrum of conditions ranging from non-neoplastic to benign, pre-cancerous and malignant lesions were detected. Eyelid was the most common site of lesion (64.70%). Neoplastic lesions were more in number in surgical specimen (79.5%). Epidermal cyst was most common lesion and basal cell carcinoma was the most frequently detected neoplastic lesion. Age range was from 4yrears to 81years, and highest numbers of cases were among 31-40 yeas age group. Conclusion: This study revealed the occurrence of wide range of non-neoplastic and neoplastic lesions in this region. Every surgically removed ocular specimen must undergo histopathological examination for definite diagnosis.

Objective: The purpose of this study is to investigate the relationship between a placenta that is laterally placed on ultrasonography and the onset of pre-eclampsia in maternal patients. Methods: A prospective longitudinal study was conducted at Hoskote tertiary center from August 2023 to August 2024. A total of 215 pregnant women between 18 and 24 weeks of gestation, who met the inclusion criteria, were recruited. Placental location was determined via ultrasound, and participants were followed up regularly until delivery. Data on the development and severity of pre-eclampsia, maternal complications, neonatal outcomes, and NICU admissions were collected and analyzed. Results: Out of 215 women, 27 (12.56%) developed pre-eclampsia, with a significantly higher proportion (70.38%) having a placenta (lateral) compared to a placenta (central) (29.62%) (p = 0.0014). Severity of pre-eclampsia was greater in the placenta (lateral) group, with 42.11% of severe cases compared to 25% in the placenta (central) group (p = 0.0056). Maternal complications such as eclampsia, IUGR, HELLP syndrome, and PPH were more frequent in pre-eclamptic women with placenta (lateral). Neonatal outcomes showed lower APGAR scores at the 1st minute and higher NICU admissions for pre-eclamptic women with placenta (lateral) (p = 0.0003 and p = 0.0008, respectively). Conclusions: Placental (lateral) location is significantly associated with the development and severity of pre-eclampsia. This association underscores the potential of using placental location as an early screening tool for predicting pre-eclampsia, enabling timely intervention and management to improve maternal and neonatal outcomes.

Asthma is the most common childhood disease and is rising in developing countries. The accessibility of latest diagnostic methods helps to improve knowledge of the pathophysiology of bronchial asthma. Interaction between genetic and environmental factors is seen to influence development of asthma. The assessment of severity of asthma is essential to decide the initial treatment and to know response of therapy later on. In emergency room, major drawback to attend acute asthma patient is non-availability of special equipment for spirometry and well-trained staff for performing the test and subsequent interpretation of results, so in such cases PEFR used for severity assessment. Other asthma scoring systems are being used that club together physical signs. These include respiratory rate and accessory muscles use in younger children and children with severe airway obstruction. In these patients it is not easy to perform both Spirometry and PEFR as they have difficulty in performing expiratory maneuvers. There are up to 16 severity scoring systems. Most of them use parameters like the blood gas analysis and others require challenging parameters such as inspiratory /expiratory ratios. Hence, for children with acute asthma exacerbation, mPIS provides an easy tool for assessing the severity. Inclusion Criteria: (1) 6-18 years aged Children with mild to moderate Exacerbation of asthma. (2) Children 8 years and above and Parents willing to give signed informed consent. Exclusion Criteria: (1) Refusal of consent. (2) Conditions affecting the pulmonary function like immunosuppressive, cardiac & neurological condition. (3) Children with Chronic pulmonary disease. (4) Acute respiratory infection. (5) Children who are not able to perform peak expiratory flow rate. Results: The mean predicted PEFR improved with treatment by 15.26% (from 112.7% to 172.9% of predicted) (p<0.0001) at 15 min. The mean mPIS improved by 4.2 (from 5.5 to 1.31) (p<0.0001) at 15 min. Pre & post-treatment mPIS’s were significantly correlated with PEFR. The correlation of pre-treatment PEFR and mPIS is r = -0.534 (p=0.000), that for post-treatment at 15 min is r = -0.403 (p=0.000). Conclusion: The mPIS is a handy method for evaluation of airway obstruction. This has higher post-treatment association for smaller airway obstruction than larger airway obstruction. This is a better method to evaluate the mild severity of the disease. It also helps to know treatment response. Most scoring systems are imperfect. So, when spirometry testing & PEFR can’t be performed some alternate technique of checking the severity is necessary. The mPIS appears to be easy tool for the evaluation of airway obstruction. It can be used to asses post-treatment response and to standardize the treatment protocol.

Background and aim: Anemia is the most common hematologic abnormality identified in infants and children. The present study was conducted to evaluate the hemoglobin values in pediatric age group by Sahli’s acid hematin method, cyanmethemoglobin method and automated hematology analyser and to compare and contrast sahlis acid hematin method and automated analyser with respect to cyanmethemoglobin method for hemoglobin estimation and to evaluate the diagnostic accuracy of both. Material and Methods: This is a cross-sectional study. Blood sample was collected in two EDTA vials from 100 outdoor patients in the age group 1 year to 12 years attending CCL Pathology .The hemoglobin values of the collected blood samples was analysed by Sahlis Acid Hematin ,cyanmethemoglobin method in the Department of Physiology and Automated Hematology Analyser(Elite 580,ERBA manheim) in the Department of Pathology. The methods were compared and analysed for diagnostic accuracy through chi-square tests and ANOVA. A value of <0.05 was regarded as statistically significant. Results: In our study, all three methods exhibit a similar level of repeatability, with standard deviations around 1.94–1.95. This indicates that all methods are consistent in their measurements with minimal variability. Sahli’s Method has a narrower prediction range (3.55–11.32), which might suggest lower reliability for measurements across the full spectrum of possible values. Cyanmethemoglobin and Automated hemoglobin show wider and more similar prediction ranges, indicating better capability to accommodate a broader range of hemoglobin values. Conclusion: In our study, all three methods exhibit a similar level of repeatability which indicates that all methods are consistent in their measurements with minimal variability. The Automated hemoglobin and Cyanmethemoglobin methods are likely more suitable for applications requiring higher reliability and coverage of a wide range of hemoglobin values. The Sahli’s Method, while consistent, might be less reliable for extreme or high values due to its narrower range.

Background: The hallmark of mild cognitive impairment (MCI) is impairment in one or more cognitive domains, which might make it difficult to carry out daily tasks while retaining one’s independence and autonomy. Lack of sleep has been demonstrated to affect the efficiency of general anesthetics in rats, resulting in delayed emergence from anesthesia or hypersensitivity to induction of anesthesia. Aim: To analyze effect of mild cognitive impairment (MCI) and MCI with sleep disorders on the potency of sevoflurane anaesthesia. Method: The GMERS Medical College, Junagadh, Gujrat Hospital’s Ethics Committee examined and authorized this clinical investigation. The patients and their families completed an informed permission form after being properly told about the study before it was carried out. Individuals between the ages of 60 and 75 who had a body mass index (BMI) between 18.5 and 23.9 kg/m² were chosen for unilateral radical mastectomy. The statistical program SPSS 26.0 was utilized to analyze the data. A two-sample t-test was used to compare groups, and measurement data with a normal distribution were displayed as mean ± standard deviation (x¯±s). Result: numbers of patient in both group M = 25 and MS = 26. The mean age of these group members was 65.22 ± 2.62 for M group and 64.31 ± 3.37 for MS group. Moreover, the BMI of these groups was 21.63 ± 1.32 for M and 21.36 ± 0.21 for MS. The analysis has also suggested MCH value which was 36.11 ± 3.12 for M and 22.24 ± 3.14 for MS group. Conclusion: Patients with MCI and sleep issues received larger doses of sevoflurane than patients with MCI alone. We also found a correlation between serum MCH level and the sevoflurane MAC value.

This prospective observational study focuses on patients diagnosed with hypokalemic periodic paralysis, with the objective of analysing their etiological, clinical, and metabolic profiles. The study population comprised patients admitted to the medical wards and the medical intensive care unit of a tertiary care center in Mumbai. The research was conducted over a duration of 18 months. Hypokalemic paralysis is a significant, treatable, and reversible cause of acute flaccid paralysis. However, limited Indian studies are available to guide the investigation and treatment within the Indian context hence the study was planned. This condition is also referred to as “sporadic paralysis” in some literature and, due to its recurrent nature, is classified as a type of “periodic paralysis.” Most cases are sporadic, while non-sporadic instances are exceedingly rare. Management strategies vary based on individual case scenarios Early diagnosis, prompt treatment, and necessary lifestyle modifications can lead to remarkable improvements in patient outcomes. These steps play a crucial role in the effective management of hypokalemic paralysis, reducing its recurrence and ensuring better quality of life for affected individuals.

Objective: To compare between the different doses of phenylephrine for the prevention of hypotension and which dose regimen is more responsible for producing adverse effects like bradycardia after spinal in caesarean section. Methods: A prospective, observational, comparative study in which 54 patients were included in the study with 18 patients in each of the three group. Group A: include cases which get 25mcg/min infusion of phenylephrine. Group B: include cases which get 50mcg/min infusion of phenylephrine. Group C: include cases which get 100mcg/min infusion of phenylephrine. The baseline blood pressure was measured . The Phenylephrine infusion was started just after giving the spinal anaesthesia at a dose as per the patient’s group. Heart Rate and Blood Pressure were measured at every 1minute interval intra-operatively till the delivery of the baby, and Apgar Score were measured at 1minute and 5 minute after the delivery of the baby. Any intervention like administration of atropine or administration of phenylephrine bolus were also noted. Results: Demographic differences between the three study groups were not significant. The decrease in heart rate (bradycardia) was statistically significant between three groups. (p value < 0.05) The episodes of hypotension were also statistically significant between the three groups. (p value <0.05). Bradycardia, Nausea, Vomiting were also not present with infusion dose of 50mcg/min. Conclusion: Phenylephrine infusion dose of 50mcg/min, prevents hypotension more effectively, after administration of Spinal anesthesia in Caesarean Section, as compare to infusion dose of 25mcg/min and 100mcg/min. Bradycardia, Nausea, Vomiting were also not present with infusion dose of 50mcg/min. Hence, Phenylephrine infusion dose of 50mcg/min, prevents hypotension more effectively.

Background: Selective nerve root block (SNRB) and Facet joint infiltration (FJI) are procedures that can be used as therapeutic modality for lumbosacral radiculopathy. Our study aims to investigate the clinical effectiveness of the use of fluoroscopically guided therapeutic selective nerve root block as a non-surgical symptom management of lumbosacral radiculopathy. Patients and Methods: This is an observational study of therapeutic nerve root block and Facet joint infiltration administered in 50 patients with low back pain and/or sciatica at tertiary care hospital. Data was collected by independent clinical interviewers, and The Modified Oswestry Low Back Pain Disability Questionnaire was used to measure pain severity and for post procedure relief of symptoms. Results: A total of 50 patients, 28 (56%) males and 22 (44%) females, underwent SNRB and FJI. 60% patients had good outcome whereas 34% patients had fair outcome. 64% patients had reduction in symptoms post-operatively. The difference between the outcome and post-operative symptoms was statistically significant (X² =4.24, p =0.38). Conclusion: Therapeutic SNRB with FJI is an important procedure in the pain management of patients with lumbar radiculopathy caused by lumbar disc prolapse and foraminal stenosis. Our study showed that 17 out of 28 males had good outcome whereas 13 out of 22 females had good outcome. 60% patients had good outcome whereas 34% patients had fair outcome. pain relief for at least 6 months was achieved in up to 64% of patients after a single SNRB with FJI. This makes it a very good second line of management after conservative treatment and a possible method to delay, and sometimes cease, the need for surgery.

Background: Supracondylar humerus fractures are among the most prevalent elbow injuries in children, accounting for 65–75% of all elbow fractures, particularly in those aged 5 to 8 years. These fractures commonly result from falls onto an outstretched hand, leading to posterior displacement. This study aims to evaluate the functional and radiological outcomes of displaced supracondylar humerus fractures treated with lateral K-wiring. Methods: This prospective cross-sectional study analyzed 50 cases of displaced supracondylar humeral fractures in children, treated with closed reduction and lateral pinning using Kirschner wires. Conducted at a tertiary care orthopedic department from July 2022 to December 2024, the study included children aged 3-13 years with Gartland Type 2 and Type 3 fractures. Exclusions included open fractures and neurovascular compromise. Postoperative assessments utilized Flynn’s criteria to evaluate outcomes at 4, 12, and 24 weeks post-surgery. Results: The cohort had an average age of 7.78 years, with a male predominance (78%). Falls were the primary cause (76%), and Type 3 fractures were most common (72%). The average interval from injury to surgery was 1.4 days, with an average hospital stay of 2.9 days. Postoperative complications included a 4% rate of pin tract infections and minimal restrictions in elbow flexion (average 5.1 degrees). According to Flynn’s criteria, 76% of patients achieved excellent outcomes, and 98% were classified as satisfactory. Conclusion: Closed reduction and lateral percutaneous pinning are an effective treatment for displaced supracondylar humerus fractures in children, yielding excellent functional outcomes with low complication rates. The findings underscore the necessity for preventive measures against falls in this demographic and support the continued use of this surgical technique in clinical practice.

Background: Total knee arthroplasty has revolutionized the care of patients with end stage arthritic conditions. Increasing life expectancy, growing demand and success of this surgery have lead to signicant increase in the number of total knee replacements. The present study was conducted to assess cases of total knee replacement in a tertiary care centre. Material and Methods: The present prospective study was conducted in the department of Orthopedics. It comprised of 30 patients of both genders in which TKA was performed. A thorough clinical examination and Radiological assessment was performed. All patients were assessed clinically using the Range of Motion and Knee Society Score pre operative and post operative. Statistical analyses were performed using SPSS 20.0. P value less than 0.05 was considered significant. Results: In the present study total participants were 30 in which 66.67% were male and 33.33% were females. The functional outcome was evaluated using Knee Society Scoring which showed significant increase in KSS at 1,6 and 12 months with improving knee function and patient quality of life over the course of a year. Conclusion: The present study concluded that maximum cases of total knee replacement were in males and functional outcome was excellent in maximum cases.

The femur forms knee joint at it’s lower end by articulating with tibia and patella, which is a complex synovial joint. It plays a crucial role in weight bearing and undergoes severe wear and tear and age related changes that may require interventional surgeries. Morphometry of distal end of femur is vital for designing prosthesis for knee joint, considering the variations in different ethnic groups. The present study is designed to analyse the morphometric parameters of distal ends of 60 dry non-pathological femur using Vernier calipers. The results were analysed for statistical significance. The data obtained from the present study, when compared with those obtained from studies done on different ethnic population showed difference in measured parameters which must be kept into account while designing prosthesis for population of different countries.

Background: Exercise exerts multifaceted effects on the human body, including potential impacts on cognitive function and psychomotor speed. Existing research suggest that effects on these dimensions is quite ambiguous. Reaction time has emerged as a simple, non-invasive and reliable marker of the speed of sensorimotor integration and processing and even cognitive functions. It has been validated in numerous studies. However, literature on the effect of exercise on reaction time remains inconclusive. This necessitated the present study. Objectives: The study was done with the objective of ascertaining the effect of a short-duration exercise program, comprising both isometric and isotonic contractions, on visual and auditory reaction times in young adults. It also sought to quantify the change observed. Methods: A descriptive, observational study was conducted on 60 healthy young adults. Visual and auditory reaction times were recorded using a multiple-choice reaction time apparatus before and after the exercise session. Exercise intensity was graded based on post-exercise heart rate. The data was analyzed using SPSS. Before-after comparison of mean values was done with paired t-test. Linear regression was used to quantify the change and find out factors which could consistently predict the outcome in terms of percentage of change in the reaction times. Results: Both visual and auditory reaction times significantly decreased after exercise. The average decline in Visual (VRT) and Auditory (ART) Reaction times were approximately 18% and 21% respectively. Baseline reaction times and exercise intensity both were significant predictors for ART and together accounted for 40% of the decrease. In VRT, only baseline values emerged as a significant predictor contributing to 24% of the variance. Conclusion: Short-duration exercise significantly improves psychomotor processing speed, as evidenced by reduced reaction times. Exercise intensity significantly affects the auditory reaction times. This improvement is likely mediated by mechanisms such as enhanced cerebral blood flow, faster neural transmission, and improved cognitive function.

Background: A reliable intraoperative pathological diagnosis is necessary before a proper surgery of breast lesions. Frozen section and imprint cytology are two most important techniques used for intraoperative diagnosis of breast lesions. When frozen section and touch imprint cytology are widely used together, the sensitivity, specificity and diagnostic accuracy can be very well increased. Objectives: This study was conducted in GMKMCH, Salem to evaluate the role of frozen section in diagnosing both benign and malignant breast lesions, to find out the diagnostic accuracy of frozen section in breast lesions by correlating it’s findings with those of touch imprint cytology and Histopathological examination. Materials and Methods: This is a prospective study conducted in the department of pathology in Govt. Mohankumaramangalam medical college, Salem for a period of 2 years from November, 2016 to June 2018 after getting approval from the institutional ethical committee with the inclusion criteria being all patients of both genders of all age groups presenting with breast lesions to the department of surgery and referred to the department of Pathology and exclusion criteria being infective pathology. Both frozen section and touch imprint cytology were done from the breast lesions immediately on the day of surgery. Then the results of both the techniques were correlated with one another keeping paraffin section diagnosis as the gold standard. The data collected were analyzed with IBM.SPSS Statistics software 23.0 Version. Results: In this study, the sensitivity of touch imprint cytology was 93.1 %, specificity was 100 %, positive predictive value was 100%, negative predictive value was 92.3% and accuracy was 96.55%. and the sensitivity , specificity, positive predictive value and negative predictive value of frozen section were 100 % thus proving frozen section is a better technique than touch imprint cytology. Conclusion: In this study, although the results of Touch imprint cytology correlates with frozen section and paraffin section in terms of benignity and malignancy, the ability of imprint cytology in diagnosing individual lesions is inferior to that of frozen section study and paraffin section examinations. Though the frozen section study had some limitations, it was proved to be a highly accurate diagnostic modality with an accuracy rate of 100%. Thus a judicious and proper selection of these diagnostic modalities is essential for proper management of the patients.

Background and aim: Distal Radius fracture is a very commonly encountered fracture in adults. Malunion is very common in such fractures in either neglected, poorly treated by conservative method or even in some surgically managed patients; with restricted functional ability and pain. Corrective osteotomy with fixation is a surgical treatment option in such cases. In our study we evaluated the functional outcome of corrective osteotomy and fixation with volar locked plate without application of bone graft. Methods: An observational study was conducted at Agartala Govt. Medical College during February 2022 to July 2024 including 19 adult patients with malunited extraarticular distal radius fracture with restricted functional ability. All patients were managed surgically by corrective osteotomy and volar locked plating without application of bone graft via Modified Henry Approach. Functional outcome assessment was done using Patient-Rated Wrist Evaluation (PRWE) score and radiological assessment done on Xray of the effected wrist Antero-posterior and Lateral View. Results: Among 19 patients who were included 7 were male & 12 female; mean age 51.8 years. Complete fracture union was seen in 18 patients without any further intervention, only one patient showing nonunion was reoperated and achieved union subsequently. Mean postoperative improvement in flexion was 24.9 degree, extension 22.2 degree, pronation 23.3 degree and supination 23.2 degree, ensuring functional range of motion. Only two patients showed early osteoarthritis. All patients achieved excellent functional outcome by the end of the study; the mean Pre-Operative PRWE score was 55.4 and the Mean Post-Operative PRWE score was 10.7 which is found to be statistically significant. Conclusion: Corrective osteotomy and fixation by distal radius volar locked plate without application of bone graft is an effective, reliable and easily reproducible treatment option for malunited extraarticular distal radius fracture in adults which provides an excellent clinical, radiological and patient related functional outcome with improved grip strength and with minimal complications. This outcome reinforces the utility of this approach in its treatment.

Background: Acute Undifferentiated Febrile Illness (AUFI) is a significant health concern, especially in tropical regions like India, where it poses diagnostic challenges due to its nonspecific symptoms. Scrub typhus, caused by Orientia tsutsugamushi, is a common but underdiagnosed infectious disease in these regions, leading to severe complications and high mortality if untreated. Objective: To characterize the clinical, demographic, and molecular features of scrub typhus in southern Rajasthan, India, and assess the correlation between laboratory parameters, strain identification and patient outcomes. Material & Methods: A prospective, analytical study was conducted at the Pacific Institute of Medical Sciences, Udaipur, from November 2020 to November 2024. Blood samples from patients with acute febrile illness were tested for scrub typhus using serological (ELISA) and molecular (PCR) diagnostic methods. Clinical features, demographic data, laboratory parameters, strain variability and disease outcome were analyzed. Results: A total of 350 scrub typhus cases were confirmed. The majority of patients (55.71%) were female, with the highest prevalence observed in the 21-50 years age group (68.28%). Rural and tribal backgrounds predominated (86% combined). The most common clinical manifestations were fever (100%), myalgia (98%), headache (88.57%), and rash (75.14%). Eschar was present in 23.71% of cases. Hepatomegaly and splenomegaly were observed in 41.14% and 41.42% of cases, respectively. Laboratory findings included raised liver enzymes (33.14% for SGPT and 32% for SGOT), thrombocytopenia (36.85%), and raised ESR (48%). Complications: Major complications included ARDS (38.28%), Multi-organ Dysfunction Syndrome (MODS) (40.28%), jaundice (31.14%), and acute kidney injury (17.42%). The mortality rate was 14%, with male patients (18.06%) showing higher mortality than females (10.76%). Agricultural workers had the highest mortality (15.83%). Laboratory parameters correlated significantly with mortality, with elevated ESR, urea, creatinine, SGOT, SGPT, and bilirubin levels in deceased patients. Molecular Findings: PCR sequencing revealed the presence of Kato-like genes in 70% of deceased patients and Karp-like genes in 80%. The Gilliam strain was not detected in any sample. Conclusion: Scrub typhus is a significant cause of febrile illness in southern Rajasthan, with high mortality, particularly among males and agricultural workers. Early diagnosis, prompt treatment, and management of complications are crucial for improving patient outcomes. Molecular studies reveal strain-specific variations that may influence disease severity and outcomes.

Background: Tuberculosis (TB) remains a global health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major concern. Early and accurate detection of Mycobacterium tuberculosis (MTB) and rifampicin resistance is crucial for effective treatment and control of TB. This study aimed to compare the diagnostic utility of Ziehl-Neelsen (ZN) smear microscopy and GeneXpert MTB/RIF, a rapid molecular test, in detecting MTB and rifampicin resistance. Methods: A total of 1,959 clinical samples (including sputum, bronchial alveolar lavage, CSF, pleural fluid, pus, lymph node aspirates, and other extrapulmonary specimens) were processed from January 2024 to December 2024 at Pacific Institute of Medical Sciences, Udaipur. Samples were analyzed using both ZN smear microscopy and the GeneXpert MTB/RIF assay for the detection of MTB and rifampicin resistance. Results: Among the 1,959 samples, 389 (19.85%) tested positive for acid-fast bacilli (AFB) using ZN staining, while 475 (24.25%) tested positive by GeneXpert. Rifampicin resistance was detected in 16 samples (0.81%). The highest rifampicin resistance was found in sputum samples (0.62%). GeneXpert identified MTB in 6.43% of smear-negative samples, with 5 of them being rifampicin-resistant. GeneXpert showed higher sensitivity and specificity compared to ZN smear microscopy, especially in smear-negative and extrapulmonary TB cases. Conclusion: The GeneXpert MTB/RIF assay offers a reliable and rapid diagnostic solution for detecting MTB and rifampicin resistance, surpassing the limitations of ZN smear microscopy. Incorporating this molecular diagnostic method into routine laboratory practices will significantly improve the detection of drug-resistant TB, facilitating better treatment outcomes and the containment of MDR-TB.

Background: Even though minimal invasive techniques (Laparoscopy) are prevalent in treating or diagnosing acute abdominal surgical emergencies or Non-specific Abdominal Pain (NSAP), but their adoption as a routine procedure has been slower compared to elective procedures. It is due to concerns about inadvertent injuries and longer operative times. Laparoscopy has proven to be a safe and effective diagnostic tool for patients with unexplained abdominal pain. For conditions like appendicitis, perforated peptic ulcers and Cholecystitis, minimally invasive surgery is now considered the preferred approach. In trauma cases, laparoscopy has demonstrated utility and may eliminate the need for laparotomy in certain situations. Aim of the Study: To examine the diagnostic and therapeutic role of early laparoscopy in the management of acute abdominal surgical emergencies or Non-specific Abdominal Pain (NSAP). Materials: The study involved 57 patients admitted with acute abdominal emergencies clinically presenting with pain in the abdomen supportive laboratory and radiological investigations. They were randomly divided in to two groups: Group A (29 patients): In this early Laparoscopy was done within 18 hours. In Group B (28 patients):  clinical Observation and Lab reports follow up done for 48 hours followed by Laparoscopy after 48 hours in the patients with persistent situation. Data were collected on postoperative hospital stay, laparoscopy-related complications, hospital readmissions, final diagnoses, and response rates. Results: The mean patient age was 28.14±09.20 years, with a male-to-female ratio of 1:85:1. 39/57 (68.42%) patients were aged between 20 and 35 years. The most common presenting symptoms were abdominal pain, nausea, and vomiting. Laparoscopic findings revealed appendicitis in 20/57 (35.08%), gynecological pathologies in 18/57 (31.57%) and intestinal obstruction due to bands and adhesions in (24.56%) patients, Blunt trauma to GIT, spleen and liver and penetrating trauma were noted in 05/57 (08.77%) patients. In Group ‘A’ patients had low radiation exposure than in Group B patients (p-0.021) which was significant noted. Diminishing VAS scores of pain on the 1^st, 3^rd and 7^th days was noted in Group B (p-0.001) which was significant noted. Consumption of analgesics was significant in both the group A and B (p-0.001) and Nil analgesics (p<0.01), and nil-by-mouth status (p- 0.01). In Group A patients Hospital stay was shorter with p value less than 0.001, in comparison to Group B patients it was extended stay (p value <0.05) The overall definitive diagnosis was achieved in 27/29 (93.10%) of cases in Group A patients and 22/28 (78.57%) in Group B. Conclusion: Early laparoscopy intervention proved to be significantly effective in managing acute emergencies of the abdomen. The procedure provided a superior diagnostic accuracy to the surgeon, facilitated early discharge, and reduced the chances of not indicated laparotomy procedures.

Background: Neonatal hyperbilirubinemia, or neonatal jaundice, results from elevated bilirubin due to immature liver function and rapid red blood cell breakdown. It affects 60% of full-term and 80% of preterm infants, manifesting as yellowish discoloration of skin and eyes. Classification includes physiologic, breastfeeding, breastmilk, and pathologic jaundice. High bilirubin levels risk kernicterus and brain damage. Diagnosis relies on bilirubin assessment, with phototherapy as the first-line treatment. Though effective, phototherapy may cause mild side effects, including rare cases of hypocalcemia, especially in preterm infants. Objective: This study evaluates serum electrolyte and calcium changes, including hypocalcemia, in neonates with hyperbilirubinemia before and after phototherapy. Design: A Hospital based observational study. Setting:  Department of Paediatrics, Jhalawar Medical College, Jhalawar. Participants: Neonates admitted in Neonatal Intensive Care Unit in SHKBM Hospital receiving phototherapy for neonatal hyperbilirubinemia without any comorbidities. Results:   In this study, 57.9% of neonates were male, with a male-to-female ratio of 1.375:1. Low birth weight was observed in 32.2% of neonates, and preterm births accounted for 24%. Phototherapy significantly reduced bilirubin, sodium, and calcium levels (p<0.001), with hyponatremia (15%) and hypocalcemia (38.3%) increasing after >48 hours of phototherapy. Potassium and chloride changes were non-significant. Conclusions Neonatal hyperbilirubinemia requires prompt treatment to prevent complications. Phototherapy is effective for reducing bilirubin levels but should be used cautiously, considering its risks and benefits. Further research on its safety is needed.

Background: Beta-thalassemia itself is an inherited disorder associated with beta-globin production deficiency. In this case affected children often require an urgent need of regular blood transfusion often results in secondary bone-related complications and iron overload. Regarding bone turnover, calcium itself is an important factor. Among thalassemia patients, their levels are typically below. Methods: A cross-sectional study has been conducted among 65 thalassemia major patients of 5 to 15 years of age. The study duration was from September 2018 to July 2019. The main target was to estimate the levels of serum alkaline phosphatase (ALP) and calcium among patients with beta-thalassemia major and their correlative action regarding the frequency and duration of transfusion itself. Results: There is a high incidence of hypocalcemia (98%) in beta-thalassemia patients. The calcium levels are decreased with association of significant rise in frequency and duration of transfusion. The parameters and transfusion did not show any significant correlation with serum levels of calcium. Levels of ALP were seen to be within normal limits in most of the patients. Conclusions: Since the aforementioned study shows prolonged transfusion as one of the criteria in the patients associated with beta-thalassemia, estimation of levels of calcium should be regularly checked among these subjects, and steps to improve homeostasis of calcium may also be required to avoid various complications.

This current review explains the complex relationship between gut microbiota and metabolic syndrome, focusing on the significant role of gut microbiota along with genetics, and environmental factors in the pathogenesis of the metabolic syndrome. This microbiota with beneficial bacteria plays a pivotal role in the balance of metabolic health by supporting gut barrier integrity, immune function, and the production of short-chain fatty acids (SCFAs), which regulate glucose and lipid metabolism. Any imbalance in the delicate relationship between gut bacteria and the host’s immune system increases the gut permeability and drives chronic inflammation. This leads to Insulin resistance characteristic of metabolic syndrome, which promotes pro-inflammatory adipokines thereby significantly raising the risk of cardiovascular diseases and type 2 diabetes. Host genetics, specifically genetic variations in NOD2 and FUT2 can influence both microbial populations and metabolic consequences. Lifestyle also increases the likelihood of developing metabolic syndrome particularly with diets rich in refined sugars and fats, exacerbating dysbiosis. This study demonstrates the addition of gut microbiota based therapeutic strategies in animal and human studies, including probiotics, prebiotics, and fecal microbiota transplantation (FMT), all of which have demonstrated promising results in lowering inflammation and re-establishing microbial balance . It also focuses on diet modifications like Mediterranean diet can enhance metabolic health and encourage microbial diversity. Considering all of the above, this review article focuses on the requirement of personalized microbiome-focused strategies in preventing and treating metabolic syndrome .Further research works are required on microbiome targeted therapies and their usage clinically.

Background: The lipid profile consisting of lipoprotein and triglyceride (TG) concentration reflects lipid metabolism that is modulated by genetic and environmental factors. The value of lipid profile parameters like TC, TG, LDL, HDL alters in dyslipidemia which can be due to some intrinsic & extrinsic factors, physical inactivity, genetic predisposition or the combination of aforesaid factors. Myeloperoxidase (MPO), a product of systemic inflammation plays important role both in the process of oxidative stress and inflammation and promotes oxidation of lipoproteins. Atherogenic index of plasma (AIP) is defined as the logarithm of the ratio of plasma triglyceride concentration to the HDL concentration. (AI= log TG/HD). It is based on TG and HDL concentrations, both of which are independent risk factors for CAD. [7] Recently, AIP is used as a predictor of atherosclerosis. Objectives: This study was done to find out the myeloperoxidase and paraoxonase1 activity and the association between athrogenic index with Paraoxonase1 activity in dyslipidemic individuals in a population attending tertiary care hospital in eastern India. Methods: Dyslipidemic patients attending the Department of Biochemistry for measurement of Serum lipid profile & belonging to the working age group of 20 – 60 years were included in the study. Patients were identified to be dyslipidemics based on National Cholesterol Education Programme (NCEP) guidelines. The sample size for the study was calculated using Open Epi (Version-3) software and was found to be 280 (140dyslipidemics&140 non dyslipidemics) Serum HDL, LDL were measured by automated analyser using ERBA XL 640 system pack reagents. The calculation of atherogenic index was performed by the formula log₁₀ (Triglyceride/HDL) for each dyslipidemic individuals (atherogenic index1) Estimation of serum myeloperoxidase activity was done by using standardized kit (Elabscience) Myeloperoxidase activity assay kit. Results: The aim of the present study was to compare the Paraoxonase 1 (PON1) and Myeloperoxidase (MPO) activity in dyslipidemic and non dyslipidemic individuals and to find the ratio of MPO and PON1 activities in serum of both the study groups and the correlation of MPO/PON1 and the atherogenic index of plasma (AIP). Statistically significant differences (p<0.05) had been found between dyslipidemics and non dyslipidemics in LDL, HDL, MPO, PON1, MPO/PON1 ratio and the atherogenic index of plasma in our study In our study there was significantly decreased PON1(Z value +10.6, p value <0.05) level and increased level of AIP ( Z value -0.06, p value <0.001)in dyslipidemics in comparison to non dyslipidemics. Conclusions: Therefore, it may be safely concluded that low levels of PON1 activity and high level of MPO activity may be associated with high cardiovascular risks. In future, the cardiovascular risk may be predicted by estimation of these parameters in the serum.

Introduction: Mitral stenosis (MS) is a progressive valvular disease that significantly affects the right ventricular (RV) function. RV strain, assessed using speckle-tracking echocardiography, has emerged as a sensitive marker for evaluating RV dysfunction. This study aimed to evaluate the role of RV strain as a marker of disease severity in MS and its implications in pregnant and non-pregnant patients for guiding early treatment. Methods: This prospective observational study included 60 patients with moderate to severe MS, including 24 pregnant women. Patients underwent detailed echocardiographic evaluations including RV strain, TAPSE, and fractional area change (FAC), RV tissue Doppler. RV strain abnormalities were categorized and correlated with MS severity and outcome. Results: Abnormal RV strain was observed in 63.3% of the patients and 54.2% of the pregnant women. Patients with severe MS had significantly impaired RV strain compared with those with moderate MS (p < 0.001). Post-BMV and RV strain values improved significantly, highlighting their role in monitoring the treatment response. Conventional parameters, such as TAPSE and FAC, RV tissue Doppler remained normal in all patients, underscoring the superior sensitivity of RV strain in detecting subclinical RV dysfunction. Conclusion: RV strain is a cost-effective, non-invasive marker for the early detection of RV dysfunction in MS. It provides valuable insights into disease severity and treatment response, particularly in high-risk groups, such as pregnant women. Integrating RV strains into routine evaluation can improve risk stratification and early management.

Background: Dengue is a mosquito-borne viral infection that has become a significant global public health concern, with a wide range of clinical manifestations. It is a leading preventable cause of morbidity and mortality among both children and adults, particularly in tropical and subtropical regions. Early diagnosis is essential for administering appropriate care, which can significantly reduce morbidity. Evaluating both serological and hematological parameters plays a vital role in the diagnosis and prognosis of the disease. Aims and Objectives: To find out correlation between serological and hematological parameter of dengue. Methodology: A study was conducted over six months, from September 2023 to February 2024, Total 646 suspected cases of dengue were included in the study and their hematological and serological profiles were recorded. The study was conducted at the Department of Microbiology, C.U. Shah Medical College and Hospital, Surendranagar, Gujarat. Result: Out of 646 samples, a total of 128 samples were found positive for dengue NS1 antigen, IgM, and IgG antibodies using the Dengue Combo Rapid Test, a qualitative detection method based on rapid chromatographic immunoassay. The most prevalent hematological abnormality observed was thrombocytopenia, affecting 79% of cases, followed by leucopenia in 47% of cases.

Background: Endoscopic variceal ligation (EVL) is a crucial procedure for the primary and secondary prevention of variceal bleeding. The objective of this study was to evaluate the efficacy and tolerability of EVL in the prevention of variceal bleeding. Methods: This was a retrospective, single-center study from March 2023 to December 2024, including all patients who came for EVL in primary or secondary prevention. Results: A total of 100 patients (male/female: 72/28) were included. The mean age of the patients was 39.00±7.14 years (range: 18–70). Portal hypertension was secondary to cirrhosis in 22 patients (22%) and to a non-cirrhotic cause in 78 patients (88%). EVL was indicated for primary and secondary prevention in 5% and 95%, respectively. All patients had received propranolol with a mean daily dose of 108.07±38.52 mg (extremes: 80–160). Eradication of varices was achieved in 58 patients (58%) with an average of 2.02±0.50 sessions (extremes: 1–4) and an average duration of 9.12±1.23 months (extremes: 1–18). Eighteen patients (18%) had variceal bleeding. There was no significant difference between patients with cirrhotic and non-cirrhotic portal hypertension in terms of varices eradication, variceal bleeding. Dysphagia (74%) and retrosternal pain (79%) were the main adverse events after ligation. Conclusion: EVL is an efficient technique to eradicate varices. Its tolerance is good with post-ligation signs that are rapidly regressive.

Bartter syndrome is a rare, salt-wasting tubulopathy with loss-of-function mutations in the ion channels of the thick ascending limb of the loop of Henle cause renal salt wasting, resulting in hypokalemia, hypochloremia, and hypercalciuria. It is an autosomal recessive disorder that affects one in 1,000,000 people. Clinical manifestations vary in severity and range from polyhydramnios and hypovolemia in the antenatal variant to polyuria and fatigue in the adolescent or adult-onset variant. It results from mutations in several genes, including KCNJ1, CLCNKB, CLCNKA, BSND, and ROMK, which encode ion transporters. We report a rare presentation of adult-onset Bartter syndrome. A 32-year-old man presented to the hospital with bilateral upper and lower limb weakness since 4 days. Patient also had complain of twitching and perioral numbness of face and polyuria. On presentation power in all 4 limbs were reduced, he was normotensive, His serum electrolytes revealed hypokalemia, hypocalcemia , hypomagnesemia ,urine analysis suggestive of raised urinary chloride, raised urinary potassium to creatinine ratio & raised 24 hour urinary calcium. ABG revealed metabolic alkalosis. Bartter syndrome was suspected based on serum and urinary electrolytes assessment and arterial blood gas analysis. The patient was initiated on potassium chloride (KCL) infusion and potassium chloride syrup to correct hypokalemia, calcium correction was given to correct hypocalcemia, indomethacin and spironolactone was started to prevent recurrent loss of potassium followed by which patient’s symptoms resolved completely.

Background: Antidepressants and anxiolytics are commonly prescribed medications among clinicians, reflecting both their professional knowledge and personal coping strategies. Understanding patterns and attitudes toward their use can provide insight into mental health trends and barriers to seeking help. Objective: To assess patterns of and attitudes toward antidepressant and anxiolytic use among clinicians and identify factors influencing their use. Methods: An online survey with a sample size of 200 clinicians was conducted. Data on demographics, medication use, attitudes, and perceived stigma were collected and analyzed using descriptive and inferential statistics. Results: Of the respondents, 38% reported using antidepressants, 42% reported using anxiolytics, and 26% reported using both. A significant proportion (62%) cited stigma as a barrier to seeking treatment. Factors such as age, specialty, and prior mental health diagnoses were significantly associated with medication use patterns. Conclusion: Despite high levels of knowledge about mental health, clinicians face barriers such as stigma in seeking treatment. Targeted interventions to normalize mental health care within this population are warranted.

Objective: The study aimed to examine the improvements in anthropometric indicators, such as weight gain and mid-upper arm circumference (MUAC), among children who were treated at the Nutritional Rehabilitation Center (NRC) in the district hospital of Koppal. Methodology: This prospective observational analysis was conducted over 12 months, from January 2024 to December 2024. Children with SAM were identified according to World Health Organization (WHO) guidelines, defined as a weight-for-height Z-score of less than -3 standard deviations (SD) or the presence of nutritional edema. Children with MAM were defined as those with a weight-for-height Z-score between -2 SD and -3 SD. Children with both SAM and MAM diagnoses who were admitted to the NRC and completed the entire nutritional rehabilitation program were included in the study. Data were collected through hospital records, structured interviews with caregivers, and direct anthropometric measurements. Results: In the severe acute malnutrition (SAM) category, a total of 50 children were included. The mean weight of this group was 5.4 ± 0.9 kg, with a mean height of 60.3 ± 3.5 cm and a mean MUAC of 10.4 ± 0.4 cm. These measurements reflect the severe nutritional deficits characteristic of SAM. In the moderate acute malnutrition (MAM) category, which included 165 children, the mean weight was significantly higher at 7.6 ± 1.2 kg. Similarly, the mean height and MUAC were also greater in this group, recorded at 73.2 ± 4.2 cm and 11.8 ± 0.8 cm, respectively. The differences between the two groups were statistically significant for all three parameters, with p-values <0.0001. The substantially lower weight, height, and MUAC in the SAM group emphasize the critical severity of malnutrition in this category. Conclusion: In conclusion, the findings of this study underscore the effectiveness of nutritional interventions implemented at the Nutritional Rehabilitation Center (NRC) in Koppal in addressing malnutrition among children.

Introduction: Endometrial carcinoma is a common gynecological cancer, particularly in developed countries, though it is less prevalent in India (4.3 per 100,000). It predominantly affects women in their 60s to 70s, with cases in those under 35 being rare. Despite its frequency, the prognosis is favorable, with a 10-year survival rate of 75% due to early detection, as most cases are identified at an early stage through symptoms like postmenopausal bleeding. Material and Methods: This study involved 50 patients with suspected endometrial carcinoma, conducted from January 2024 to September 2024. The study group consisted of mainly patients from different parts of Gujarat, neighbouring states of Rajasthan and Madhya Pradesh. The research was carried out in the Department of Radiology at Gujarat Cancer Research Hospital and BJ Medical College in Asarva, Ahmedabad. Results:- (1) Study Overview: 50 patients with endometrial lesions were evaluated using 3T MRI, providing excellent image quality and tumour characterization. (2) Histopathology: Endometrioid adenocarcinoma was the most common type (84%), followed by high-grade serous adenocarcinoma (10%) and other rare types (2% each). (3) Patient Profile: Endometrial carcinoma was most frequent in menopausal women. Peaking in the 5th and 6th decades, with vaginal bleeding as the most common symptom (100%). (4) MRI Accuracy: MRI showed 88.89% accuracy in local tumour staging compared to post-operative histopathology and effectively assessed lymph node involvement. (5) MRI Findings: Tumours typically appeared hypointense on T1W, hyperintense on T2W, and heterogeneously enhanced post-contrast. MRÍ was superior in evaluating myometrial involvement. Conclusion: MRI is having Superior soft-tissue contrast, Multiplanar imaging (axial, coronal, sagittal), Excellent at detecting soft tissue extensions and extraserosal spread with No ionizing radiation and safe for patients with kidney dysfunction or contrast media contraindications As compared to other modalities MRI Offers 83-92% accuracy in staging, making it the preferred imaging technique. Recent improvements in magnetic field strength and coil technology have greatly enhanced MRI’s performance, further solidifying its position as the primary imaging tool for managing endometrial carcinoma.

Background: Spinal neoplasms present a significant diagnostic challenge, manifesting with a spectrum of symptoms that can mimic various spinal pathologies. This study explores the pivotal role of Magnetic Resonance Imaging (MRI) in diagnosing and characterizing spinal tumors. MRI’s exceptional resolution and multiplanar imaging capabilities make it the gold standard for evaluating spinal neoplasms. Methods: comprehensive analysis of 60 patients with suspected spinal lesion, MRI was done to compare tumor characteristics, and discuss the implications for treatment planning and prognosis. Results: study shows distribution of tumours by age and gender, compartmental distribution and tumoral characteristics. Conclusion: Study shows the critical importance of MRI in diagnosing and characterising of spinal tumor.

Introduction: The aim is to introduce flipped classroom as teaching learning method and to assess its effectiveness for Final MBBS students. Methods: The present study was conducted after taking institutional ethical clearance and informed consent of the participants. 150 final MBBS students participated and were divided into two Groups A and B. Two topics were taught to both groups using either FC-assisted self-directed learning (SDL) sessions or online lecture classes. A cross-over of groups was done to prevent any bias. Pretest and posttest scores of all topics were assessed using multiple-choice questions (MCQs) and feedback was taken. Program evaluation was done. Results: There was no significant difference in performance in pretest MCQ examinations between the two groups. Students of both Groups A and B performed significantly better in posttest MCQ examinations as compared to pretest MCQ examinations. However, the posttest results of the FC group were better. 46.40% strongly agree that there will be increased interest in subject by FC method. 47.40% agree that enhancement in learning by FC method. 43.30% agree that FC should be preferred teaching learning method. 40.20% feel there is improved understanding and course satisfaction. 42.30% agree that exam performance will improve by FC method Conclusion: Faculty and students provided positive views in support of the sessions. Students were highly satisfied with the program. The flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction More than 40% students believe that it is a better teaching tool and will improve their performance. Teacher’s feedback is the same but they fear that too much effort and resources are required in this FC method.

Background: Gastroesophageal Reflux Disease (GERD) is a common condition characterized by chronic symptoms or mucosal damage secondary to the abnormal reflux of gastric contents into the oesophagus. When GER affects the laryngopharynx it is called Laryngopharyngeal Reflux Disease (LPRD). LPR is known to be associated with many clinical entities such as chronic laryngitis, chronic dysphonia, laryngotracheal stenosis, head and neck carcinoma, cough, asthma, otitis media, dental caries and erosion, laryngeal papilloma, vocal fold granulomas and ulcers, laryngospasm, recurrent croup, paradoxical vocal fold movement disorder and laryngomalacia. LPRD is a common condition in patients attending ENT OPDs. Although esophageal manometry and 24 h pH monitoring is considered the gold standard for diagnosis, it is an expensive and time consuming investigation. Newer clinical scales have been developed for diagnosing LPR such as RSI, RFS, Carlsson-Dent, ReQuest, GerdQ, etc. Aim and Objectives: The aim and objectives of this study was to compare RSI with RFS and to establish its effectiveness in quick diagnosing of LPRD among the study subjects. Material and Methods: A total of 150 patients who visited ENT department (OPD), Hind Institute of Medical Sciences, Safedabad, Barabanki, UP, India, with features of LPRD were asked to fill RSI proforma (score C ≥13 abnormal), after which they were subjected to indirect laryngoscopy to obtain the RFS (score C≥ 7 diagnostic of LPRD). RSI was compared with RFS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of RSI were noted. Results: Out of 150 patients, 82, 54.66% were females. Mean RSI scores in males and females were 12.3 and 12.7 and mean RFS scores were 6.7 and 6.9 respectively. RSI had 80.1% sensitivity and 84.2% specificity in diagnosing LPRD with PPV 76.9%, NPV 87.2% and accuracy 86.6% (Chi square value 65.2, P ≤ 0.05). There was substantial agreement between RSI and RFS (Cohen’s kappa: 0.627, P ≤ 0.01). RSI is a simple tool to diagnose LPRD which doesn’t mandate invasive procedures such as endoscopy or esophageal manometry. Conclusion: It is concluded that the RSI was used effectively to diagnose LPRD in ENT outpatients and subsequently initiated the treatment accordingly at the earliest.

Breast fibroadenomas are common benign lesions usually seen in women below 30 years of age. This cross sectional study aimed to evaluate the ultrasonographic characteristics of fibroadenomas among 114 women, attending the Surgery and Gynaecology outpatient departments of Agartala Government Medical College. Data were collected through informed consent, ultrasonographic features of breast lump on radiological reports who’s having pathologically confirmed diagnosis. The majorities of fibroadenomas were located in the upper outer breast quadrant (58.77%) and measured less than 3 cm (50.88%). Ultrasound findings revealed that most fibroadenomas were round (97.37%), had circumscribed margins (78.07%), and were hypoechoic (89.47%). Classification according to the BIRADS reporting system indicated that 71.13% of cases were benign (BIRADS 2 or 3). These findings align with existing literature and show the effectiveness of ultrasonography as a non-invasive, radiation-free modality for the assessment of fibroadenomas, particularly in younger women.

Background: Non-alcoholic fatty liver disease (NAFLD) is a growing concern among patients with type 2 diabetes mellitus (T2DM). This study aimed to assess liver stiffness using FibroScan in newly diagnosed T2DM patients and investigate its correlation with various risk factors. Methods: This cross-sectional study included 200 newly diagnosed T2DM patients. Liver stiffness was measured using transient elastography (FibroScan). Comprehensive data including demographics, anthropometric measurements and biochemical parameters were collected. Statistical analysis was performed to determine correlations between liver stiffness and various risk factors. Results: The study revealed a NAFLD prevalence of 41% in the newly diagnosed T2DM population. Notably, 8% of subjects exhibited severe fibrosis (F3-F4). The majority of patients (32%) were in the 41-50 years age group. BMI analysis showed that 47% of subjects were either overweight (27%) or obese (20%). Statistical analysis demonstrated significant positive correlations between liver stiffness and body mass index (BMI) (r=0.38, p<0.001), fasting blood sugar (FBS) (r=0.62, p<0.01), aspartate aminotransferase (AST) (r=0.29, p=0.035) and alanine aminotransferase (ALT) levels (r=0.32, p=0.027). Interestingly, lipid profile parameters did not show significant correlations with liver stiffness. Conclusion: A substantial proportion of newly diagnosed T2DM patients present with significant liver fibrosis. The study highlights the importance of BMI, FBS and liver enzymes as indicators correlated with increased liver stiffness. These findings suggest that early screening for NAFLD using non-invasive methods like FibroScan could be beneficial in the management of T2DM patients.

Background: Hypothyroidism can significantly affect renal function, but its relationship with proteinuria is not well established. This study aimed to evaluate proteinuria in severe primary hypothyroidism and assess the effect of thyroxine replacement therapy on proteinuria and renal function. Methods: This prospective observational cohort study included 40 adults aged 18-60 years with severe primary hypothyroidism (TSH >50 μIU/mL). Thyroid function tests, renal parameters, lipid profile, and 24-hour urine protein were measured at baseline and after 3 months of thyroxine replacement therapy. Results: After 3 months of thyroxine replacement therapy, significant improvements were observed in thyroid function tests and renal parameters. Mean TSH levels decreased from 5.88±0.77 to 1.73±0.49 mIU/mL (p<0.01), while Free T4 increased from 0.52±0.14 to 0.93±0.17 ng/dL (p=0.013). Mean 24-hour urine protein excretion decreased significantly from 136.35±18.64 mg/day at baseline to 85.19±13.37 mg/day after treatment (p<0.01), representing a 37.5% reduction. Estimated glomerular filtration rate (eGFR) increased from 57.83±10.23 to 76.25±12.60 mL/min/1.73m2 (p=0.007). Serum creatinine levels decreased from 1.39±0.41 to 1.16±0.32 mg/dL (p=0.009), and serum uric acid levels reduced from 7.38±1.56 to 5.11±1.09 mg/dL (p=0.005). No statistically significant changes were observed in lipid profile parameters, although there were trends towards improvement in LDL (138.22±36.45 to 126.51±31.80 mg%, p=0.09) and HDL (36.89±5.77 to 41.22±6.02 mg%, p=0.06) levels. Conclusion: Severe primary hypothyroidism is associated with increased proteinuria that improves significantly with thyroxine replacement therapy. This therapy also improves renal function parameters, suggesting hypothyroidism may cause reversible alterations in renal function and protein handling.

Introduction:  The median and musculocutaneous nerves, key components of the brachial plexus, exhibit notable anatomical variations that hold significant clinical importance. This study explores these variations and their implications for surgical interventions, diagnosis, and management of nerve injuries. Materials and Methods: The study examined 50 upper limbs from 25 cadavers over a two-year period (January 2023–December 2024) at Dr. B R Ambedkar Medical College and affiliated institutions. Systematic dissections were performed to document variations in the formation, branching patterns, and communication of the median and musculocutaneous nerves. Nerves were stained and preserved for detailed analysis. Observations were categorized into groups based on the nature of the variations. Results:  Ten distinct groups of anatomical variations were identified in this study. Group I consisted of specimens with normal nerve anatomy, showing no communications. Groups IIa and IIb highlighted variations in the formation of the median nerve, including differences in the number of medial and lateral roots. Groups III through VI demonstrated communications between the musculocutaneous and median nerves, with variations in the location, length, and course of the communicating branches. Group VII included specimens with communication between the median and ulnar nerves, an important consideration for procedures involving the forearm and hand. Finally, Group X described specimens where the musculocutaneous nerve was absent, with the median nerve compensating by providing branches to muscles typically innervated by the musculocutaneous nerve. These findings underscore the significant variability in upper limb nerve anatomy and its potential impact on clinical practice. Key findings included the presence of communicating branches (e.g., in 15-20% of specimens), absence of the musculocutaneous nerve (2% of specimens), and deviations from typical nerve courses, such as failure of the musculocutaneous nerve to pierce the coracobrachialis. Conclusion:  This study provides comprehensive insights into the anatomical variations of the median and musculocutaneous nerves, emphasizing their clinical significance. Awareness of these variations is critical for optimizing surgical outcomes, accurate diagnoses, and effective treatment of upper limb conditions.

Background: Human papillomavirus (HPV) is the one of the most common cause of sexually transmitted infec­tions. In 2018, approximately 43 million individuals were infected with HPV. Vaccination against HPV is an effective way to reduce the transmission of infection irre­spective of genders and can effectively combat cervical cancer prevalence. Aim: the primary aim of this study is to assess the knowledge level about HPV, attitudes, and practices to­wards HPV vaccine among the young health professionals and students with the aim to identify areas that require addi­tional attentions which may increase the accept­ability of the vaccine among general population and reduce the disease burden. Materials and Methods: This cross-sectional survey was carried out at MVJMC and Research hospital between August 2023 to August 2024, where 600 medical professionals /students were asked to fill a structured questionnaire that consisted of four extensive areas; socio-demographic characteristics, HPV knowledge, attitude, and practices regarding vac­cination. The compiled data was then analyzed using descriptive statistics and the responses were summarized. Results: A substantial majority (77.5%) correctly identified HPV as a common sexually transmitted infection, 89.3% believed there is a need for the HPV vaccine even for sexually inactive individuals. Awareness that almost all cervical cancers are caused by HPV was high in 54%. A majority (70.3%) correctly identified high HPV incidence in women in their thirties. Knowledge about the symptomatic nature of genital HPV was mixed. While 44.5% believed most people with genital HPV are symptomatic, 39.3% disagreed. Significant misconceptions were seen about genital warts, with only 41.5% correctly identifying that they are caused by the different HPV types than that of cervical cancer. Knowledge about the availability of HPV vaccines for both genders was high. Attitudes toward HPV vaccination revealed mixed sentiments. Cost concerns were significant, 22.9% with worrying about the vaccine’s cost while majority being unaware of the same. 42.3% expressed willingness to provide education about HPV. Conclusion: The study revealed generally good knowledge and positive attitude towards HPV vaccination among healthcare providers, with significant areas for improvement.

Background: The clinical spectrum of COVID-19, caused by SARS-CoV-2 varies from asymptomatic illness to severe multi-organ dysfunction. Emerging evidence suggests lipid metabolism alterations, including reduced cholesterol, HDL, LDL, and increased triglycerides, may influence disease severity. Understanding these lipid profile changes is crucial for risk stratification and management. Aim: To assess fasting lipid profile in COVID-19 patients and evaluate its correlation with disease severity parameters, including SpO2, respiratory rate, and CT severity scores. Methods: A cross-sectional study of 106 COVID-19 inpatients was conducted over six months in a tertiary care hospital in Chennai. The disease severity was evaluated using respiratory rate, SpO2, and CT severity scores. Patients with co morbidities (diabetes, hypertension, and dyslipidemia), those currently on statin therapy, pregnant individuals, or those under 18 years were excluded. Fasting lipid profile (total cholesterol, triglycerides, HDL, LDL), inflammatory markers (CRP, ferritin, D-dimer) and disease severity via SpO2, respiratory rate, and CT severity scoring were measured. Statistical analysis was performed using ANOVA, and Pearson’s correlation using IBM SPSS v28. Results: Mean lipid levels: total cholesterol (167.83 ± 31.80 mg/dL), HDL (40.43 mg/dL), LDL (88.58 mg/dL), triglycerides (194.63 mg/dL). Total cholesterol, HDL, and LDL levels negatively correlated with disease severity (p < 0.001). Triglycerides positively correlated with severity parameters (p < 0.001). Respiratory rate showed no significant correlation with lipid levels (p > 0.05). Conclusion: COVID-19 patients exhibit significant alterations in their lipid profiles, including decreased levels of total cholesterol, HDL, and LDL, along with elevated triglycerides. These lipid profile changes correlate with disease severity, suggesting their potential role in COVID-19 pathogenesis. Further research is needed to explore lipid-targeted therapeutic strategies.

Background: Aim of the Study: To assess the usage of integrating the Ultra sound, and CT scan in detecting and undertaking FNAC to confirm cell pathology from non-palpable supra-clavicular lymph nodes metastasis in patients newly diagnosed with malignancies of the lung, pleura and mediatinum. Materials: A prospective analytical study between June 2022 and May 2024 was conducted on 46 patients with suspected malignancies of lung, pleura and mediastinum with query cervical supra-clavicular lymph nodes. 05/46 (07.35%) Five patients had bilateral involvement, hence total was 51 supra-clavicular lymph nodes among the 46 subjects. Reference standards were used in diagnosing metastasis by cytological analysis from lymph nodes identified by sonography guided fine-needle aspiration (n-46). In 03/46 (04.41%) patients it was normal initially and after follow-up with ultrasound and CT scan chest. There was no change in the size of lymph nodes in 03/46 (04.41%) patients. Supra-clavicular lymph node metastasis was observed in the remaining 40/46 (58.82%) patients. The Ultrasound definition was the presence of short-axis diameter of 5 mm or more. The cytological diagnosis was based on standard operative procedures for diagnosis. Results: Cytological analysis confirmed supra-clavicular lymph node metastasis in 18/46 (26.47%) lesions. The diagnostic accuracies for detecting supra-clavicular lymph node metastasis were 73.65% for integrated PET/CT and 69.30% for contrast-enhanced CT, with no statistically significant difference. (p >0.05) Cytological definition of malignant cells on FNAC combined with ultrasound was found to be having higher accuracy of 89.65% in the study. Conclusion: Integrated Ultrasound, PET/CT, with cytological examination showed higher predictive value, and proved to be a valuable tool in the diagnosis and characterization of non-palpable supra-clavicular lymph node metastasis in lung cancer, pleural cancers and mediastinal malignancies.

Background: Cytological examination of aspirated pleural fluid helps in rapid, efficient, and non-invasive diagnostic technique. It helps in differentiating the malignant from non-malignant diseases involving the lung and pleura. In turn helps in not only identification of the malignant effusions but also the decision making for the correct treatment and predicting prognosis at the earliest. Aim of the study: to analyze the distribution of cytopathologic diagnoses in pleural effusions and assess the correlation between cytology and histopathology results. Material: This retrospective study included 68 patients whose pleural fluid was analyzed and diagnosed between 2020 and 2021 in a tertiary care Hospital. The reports were labeled as five diagnostic groups: inconclusive, benign, atypical, suspicious, and malignant. Cytology results were then compared with biopsy findings. Results: Among the 68 pleural fluid cases, 44 (64.70%) were females, and 24 (35.29%) were males. The patients were aged between 15 and 89 years, with a mean age of 53.10 ± 8.80 years. Among the 68 cases studied 06 (08.82%) were classified as inadequate, 26 (38.23%) as benign, 18 (26.47%) as atypical, 08 (11.76%) as suspicious, and 10 (14.70%) as malignant by cytology. Of the malignant cases, 08 (11.76%) were diagnosed as metastatic carcinoma, and 03 (04.41%) were diagnosed as malignant mesotheliomas. Among the 08 atypical cases, 02 (02.94%) were confirmed as malignant mesotheliomas upon biopsy. Of the 08 (11.76%) suspicious cases, 01 (01.47%) case, which had a biopsy result available, was diagnosed as epidermoid carcinoma metastasis. Conclusion: Cytological examination remains a highly valuable diagnostic tool for pleural effusions, which can result from a variety of etiological factors. In our region, the most common cause of pleural effusions is metastatic carcinoma, particularly from lung, breast, and ovarian cancers, followed by malignant mesothelioma.

Background: Acne vulgaris is chronic inflammatory disease of pilosebaceous units characterized by comedones, papules, pustules, nodules, cysts and abscesses. Many attempts have been made to classify acne on the basis of the severity of the disease. In 1997, Doshi, Zaheer and Stiller 7 devised a Global Acne Grading System (GAGS). This system gives more accurate evaluation of the disease and has been used by many authors in research work and studies. Methods: The study was randomised open label, comparative study. A total of one hundred and ten consecutive patients of moderate and severe acne vulgaris, attending the Outpatient Clinic as above and satisfying the inclusion criteria were included in the study. The subjects were divided into Group A (55 patients) to be treated with low dose continuous regimen of Cap. Isotretinoin 20 mg administered orally, for a period of 16 weeks and Group B (55 patients) to be treated with low dose intermittent regimen of Cap. Isotretinoin 20 mg orally once daily, for 1 week out of every 4 weeks, for a period of 16 weeks. Patients of 18-35 years age, who presented with moderate to severe grade acne vulgaris as per Global Acne Grading System of Doshi et al and willing to take isotretinoin therapy were included in study. Results: The study included a total of 110 patients. Total of 7 patients lost in follow-up. Final group size of study was 50 patients in each group A and B. There was no significant difference in both groups demographically. In Group A (low dose continuous Isotretinoin) statistically significant change from baseline was observed from week 4 itself and at week 16 majority of patients (96%) scored none on GAGS. In Group B (low dose intermittent Isotretinoin) change from baseline was observed from week 4 itself but statistically significant change was seen from week 8 only and at week 16, 72% patients scored none on GAGS and 28% were in mild score on GAGS. At week 4, 42 (84%) patients in Group A had moderate and remaining 8 (16%) had severe grade whereas in Group B, 30 (60%) had moderate and 20 (40%) had moderate grade. Statistically, the difference between two groups was significant (p=0.008, highly significant). At week 8, 20 (40%) patients in Group A had mild grade and remaining 30 (60%) had moderate grade whereas in Group B, 3 (6%) had mild, 40 (80%) had moderate and 7 (14%) had severe grade. Statistically, this difference between two groups was significant (p<0.001, very highly significant). At week 12, 43 (86%) patients in Group A had mild and remaining 7 (14%) had moderate grade whereas in Group B, 29 (58%) had mild and 21 (42%) had moderate grade. Statistically, this difference was significant (p=0.002, highly significant). At week 16, all the 48 (96%) patients in Group A were normal and 4% had mild grade whereas in Group B, 36 (72%) were normal and 14 (28%) had shifted to mild grade. (p=0.001, highly significant). Discussion: Oral isotretinoin is highly effective in treatment of moderate and severe acne vulgaris. Low dose continuous isotretinoin regimen was faster, more efficacious in treatment of moderate and severe acne vulgaris and relapse rate was also significantly lower after 8 weeks of stoppage of treatment than low dose intermittent isotretinoin regimen. Low dose intermittent Isotretinoin was effective in causing remission in moderate acnevulgaris but relapse of acne vulgaris occurred in almost half of the patients within 8 weeks of stoppage of treatment.

Background: Ropivacaine has different sensory and motor blockade with motor function recovering earlier then sensory function. The aims of this study was to evaluate the sensory and motor block characteristics of commercially available 0.75% hyperbaric ropivacaine and effect of  fentanyl  on block characteristics, postoperative analgesia and side effects when used as  adjuvant intrathecaly. Methods: This prospective, randomized, controlled and double blinded study was conducted on sixty patients of ASA grade I-III, aged 18 to 60 years, of either gender undergoing urological surgery under spinal anaesthesia. All patients were randomized in two groups of 30 patients each: Group R received hyperbaric ropivacaine (0.75%) 2.5 ml with 0.9% normal saline 0.5ml and Group F received hyperbaric ropivacaine (0.75%) 2.5 ml with fentanyl 25 µg (0.5 ml). Sensory and motor block characteristics, postoperative analgesic drug requirement, hemodynamic parameters and incidence of side effects were assessed. Results: The onset time of sensory block and motor block, time to complete motor block and duration of motor block were comparable in both the groups. The mean time to reach maximum height of sensory block in group F was significantly earlier than in group R (p =0.003), whereas two segment regression time was significantly earlier in group R (83.70±21.22) as compared to group F (109.13±43) p=0.003. The time of first requirement of rescue analgesia (min)  was found to be significantly prolonged in Group F as compared to Group R (280±55.15 vs215.1±63.4); p=0.0001. Conclusion: Fentanyl when used as an adjuvant with hyperbaric ropivacaine seems to prolong the duration of sensory block and postoperative analgesia without affecting hemodynamics and motor block.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder and leading global health challenge, particularly in low- and middle-income countries. India, often referred to as the “diabetes capital of the world,” bears a significant burden, with over 62 million affected individuals. Marginalized communities, such as tea garden workers in Assam, face heightened vulnerability due to socio-economic disadvantages and limited healthcare access. Aims & Objectives: To determine the prevalence of T2DM and its associated lifestyle related risk factors among adults in tea garden areas of Dibrugarh District, Assam. Materials and Methods: A community-based cross-sectional study was conducted over one year in five tea gardens of Lahowal block, Dibrugarh District. A sample of 400 participants, aged 20–59 years, was selected using multistage random sampling. Data were collected through structured interviews, anthropometric measurements, and fasting blood glucose tests. Statistical analyses, including logistic regression, were performed to identify significant predictors of T2DM. Results: All the data were analyzed and statistical significance was determined using SPSS software. The prevalence of T2DM was 11.8%, with 6.5% of cases newly diagnosed. Significant predictors included age ≥50 years, physical inactivity, high BMI, and elevated waist-hip ratio (p<0.01). Dietary patterns characterized by high carbohydrate consumption and low fruit and vegetable intake were also risk factors. Socio-economic deprivation and family history of diabetes were independently associated with increased risk. Conclusion: The findings highlight a substantial burden of T2DM in tea garden communities and emphasize the need for targeted interventions, including routine screening, lifestyle modification programs, and improved healthcare access to address this growing epidemic.

Background: Chronic Liver Disease or Liver Cirrhosis is an irreversible disease that is predominantly caused by the necrosis of hepatocytes, the loss of the reticular network, and the regeneration of the remaining liver tissue by nodules. Transient elastography (FibroScan; Echosens, Paris, France) is a non-invasive, rapid, and innovative method for assessing liver stiffness. Cirrhosis of the liver is believed to be associated with ineffective elimination of hormones by the dysfunctional liver, which causes variety of endocrine system disturbances, including variation in Serum prolactin. Aims & Objectives: The investigation of serum prolactin as an emerging marker for the severity of chronic liver disease and its correlation with the grading of liver fibrosis by FibroScan or Transient elastography. Materials & Methods: An observational cross-sectional analytical Study with a total of 50 patients was conducted at SMS Medical College and attached group of hospitals, Jaipur for a time period of twelve months. Patients with more than 18 years of age and with an established diagnosis of liver cirrhosis were included. The study excluded pregnant and lactating women, patients with history of cranial surgery or irradiation, endocrine disorders, concomitant renal failure, and medications that affect prolactin levels (e.g., antipsychotics, antidepressants, D2 blockers, OCPs, H2 antagonists, etc.). Results: In alcoholic cirrhosis patients, the mean serum prolactin level was 49.2 ng/ml, while in non-alcoholic cirrhosis patients, it was 46.6 ng/ml. In all patients, the mean Liver Stiffness Measurement (LSM) was highest (14.9 kPa) in cases with prolactin levels higher than 35 ng/ml, followed by 9.8 kPa in cases with prolactin levels between 20 and 35 ng/ml, and 7.5 kPa in cases with prolactin levels between 3 and 19 ng/ml. Serum prolactin was significantly raised in patients witn advanced fibrosis. Conclusion: S. Prolactin levels have a substantial association with the severity of chronic liver disease, particularly in patients with decompensated liver functions. Additionally, there was a positive correlation between S.Prolactin and the grading of liver fibrosis carried out by FibroScan.

Background: Subarachnoid block is the preferred technique for lower abdominal procedures, with additives to local anaesthetics supplemented to improve efficacy. Aims and Objectives: To assess, compare and evaluate the effect of Intrathecal Hyperbaric Levobupivacaine (0.5%) and Dexmedetomidine (5 micrograms) versus Intrathecal Hyperbaric Levobupivacaine (0.5%) and Morphine (250 micrograms) for Infraumbilical surgeries. Primary Objective: Onset and duration of sensory and motor block. Secondary Objective: Perioperative analgesia, hemodynamic parameters, sedation, and adverse effects like respiratory depression, pruritus, vomiting etc. Study Design: Prospective, randomized, double-blind study. Materials And Methods: With ethical committee clearance and informed written consent, 44 patients, aged between 18-60 years, of either gender belonging to American Society of Anesthesiologists (ASA) physical status I & II scheduled for infraumbilical surgeries of various specialties were included and categorized into two groups (n = 22). Group LM received 3.4 mL 0.5% Hyperbaric Levobupivacaine with 250 micrograms Morphine and Group LD received 3.4ml of 0.5% Hyperbaric Levobupivacaine with 5 micrograms dexmedetomidine intrathecally. Statistical Analysis: The data were analysed using student t-test, chi-square test, Fisher exact test. The results were analysed and compared with previous studies. SPSS software version 22 was used. Results: Onset and duration of sensory blockade was faster in LD group compared to LM group. Onset of motor blockade was faster in LM group compared to LD group but duration of blockade was longer with LD group. However, duration of post-operative analgesia was also longer with LM group with pruritus as an adverse effect. Conclusion: Dexmedetomidine is preferred over morphine as it provides faster sensory onset, dense motor blockade, effective postoperative analgesia, with arousable sedation and minimal adverse effects.

Hemorrhoids are a prevalent anorectal disorder, affecting a substantial proportion of the population. This study aims to conduct a comprehensive comparative analysis of close hemorrhoidectomy and laser hemorrhoidectomy as treatment modalities for 2nd and 3rd-degree hemorrhoids. The research encompasses a cohort of 100 patients, comprising 60 males and 40 females, adhering to specific inclusion and exclusion criteria. Follow-up evaluations are scheduled at post-operative intervals of 1 week, 1 month, 6 months, and 1 year, enabling a thorough assessment of each procedure’s efficacy and long-term outcomes.

Background and Objectives: Ovarian malignancy is one of the leading cause of death from gynaecological malignancies. The incidence of ovarian cancer is steadily increasing over the past few years, now with an overall lifetime risk is 1.8%. Due to our inability to detect malignancy when it is confined to ovary (stage I disease) the majority of women (75%) are diagnosed when there is already widespread metastatic dissemination throughout the abdominal cavity, To correlate this provisional diagnosis on the basis of ultrasonography and color Doppler, with histopathological diagnosis. To assess the value of ultrasonography and color Doppler as a diagnostic tool in differentiating benign and malignant lesions. Material and Methods: Prospective study Patients with clinically suspected ovarian masses and referred for USG examination. Department of Radio diagnosis  in collaboration with the Department of Obstetrics  & Gynaecology and Pathology, Patna Medical College And Hospital. Study period Dec 2 018- Sept 2020. Altogether sixty (60) patients, who formed the patient population of this study, were taken from the Obstetrics & Gynaecology outpatients, indoor and emergency department of this Hospital with clinical symptoms and signs suggestive of ovarian pathology(neoplastic) and referred for USG and Colour Doppler. Conclusion: our study confirms that morphological assessment of ovarian tumours is able to differentiate benign from malignant masses with high degree of accuracy ( sensitivity 80% and specificity 87.8%). The sonographic diagnosis(morphological features and color Doppler findings combined together) of benign disease is 92.6.% accurate in our study.

Background and Objectives: Caesarean section (CS) is a common surgical procedure, and post-CS scar defects can lead to significant morbidity. (1) To determine the incidence of post-CS scar defects. (2) To identify associated risk factors for the development of post-CS scar defects. Methods: This was hospital based prospective study conducted in the Department of Obstetrics & Gynaecology, PMCH, Patna. Study duration is Two years. 100 women were recruited either before caesarean delivery in case of elective surgery or within 3 days after the operation in case of emergency caesarean delivery. Women age more than 18 yrs, post caesarean section and giving consent were included in the study. All data were analyzed by Epi-info software. Results: Mean age of women who had niche was 27.84 ± 51 yrs and those without niche was 26.55 ± 2.72 yrs (p=0.04) i.e. increasing age was associated with increased chance of development of niche, while gestational age was not associated with niche formation. GDM (p=0.04) and higher birth weight (p<0.01) is associated with niche formation while emergency LSCS, induction of labour, PROM, multiple pregnancy was not associated risk factors in our study. Increasing number of previous LSCS were significantly(p<0.001) associated with niche formation. Conclusion: History of previous caesarean delivery was main independent risk factor for niche formation. Other risk factors identified were GDM, before caesarean delivery, increasing age of mother and high birth weight of baby.

Objective: To compare the analgesic effects, duration of analgesia, haemodynamic parameters of tramadol and buprenorphine, administrated once epidurally with l-bupivacaine against the control group of l-bupivacaine alone. Methods: The patients were divided into three groups according to the drugs administered for epidural block. In Group I : 15 ml of 0.5% L-bupivacaine + 25 mg tramadol. In Group II : 15 ml of 0.5% L-bupivacaine + 150 ug buprenorphine. In Group III : 15 ml of 0.5% L-bupivacaine. The patients of three groups were comparable at demographic data. For the assessment of postoperative pain using numerical scale of one hour interval until the end of analgesia explained to all the patients to make them able to express pain in terms of scale. Results: The duration of analgesia obtained following epidural tramadol administration (10.72± 2.84 hours) is statistically highly significant than following l-bupivacaine administration (2.88 ± 0.55 hours).The duration of analgesia obtained following epidural buprenorphine administration (14.02 ± 2.45 hours) is statistically significantly more than tramadol (10.72 ± 2.84 hours).The duration of analgesia obtained by epidural buprenorphine (14.02 ± 2.45 hours) is statistically highly significant than analgesia obtained by bupivacaine alone (2.88 ± 0.55 hours).Nausea and vomiting was seen in both groups. But more often in tramadol group (40%) than buprenorphine group (30%) within 8 hours which then gradually decreased. Nausea and vomiting were not seen with bupivacaine alone. Conclusion: Both tramadol & buprenorphine can be used effectively for post operative analgesia but buprenorphine is superior than the tramadol regarding duration of analgesia. There are some side effects like nausea -vomiting, in both the groups & pruritis in buprenorphine group.

Background: Surgically  induced  astigmatism  is  common  after  SICS  which  could  be  reduced by taking proper sclerocorneal incision. It is necessary to study which incision is better in terms of visual outcome and post operative astigmatism. Hence comparison of various shapes of the incision require study to improve the visual outcome with respect to astigmatism. Methods: A prospective randomized observational study was done on a total of 150 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (50 each). Each group received a particular type of incision (Straight, Frown or Inverted funnel shaped incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared on day 1, 1week, 6 weeks post operatively for slit lamp examination, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program (SPSS version 15.0 statistical analysis software). Results: The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant. Conclusion: Inverted funnel (inverted U shaped) incision in SICS gives minimal SIA. It gave astigmatism comparable to that in phacoemulsification. It can be done in peripheral hospitals without facility of phacoemulsification machine.

The development of an advanced prosthetic human body capable of sustaining a living human head and brain represents a transformative leap in biomedical science. This innovation opens another avenue into the future in comparison to the traditional concept of head transplantation, which faces insurmountable challenges such as spinal cord fusion, immunological rejection, and systemic complications. This paper explores advancements in prosthetic technology, neural integration, artificial organ systems, and circulatory innovations designed to support a living brain and head, transcending the traditional concept of cyborg technology. Modern innovations in biomedical engineering, neural science, and surgical practices have surpassed the cyborg paradigms of the past, moving towards a seamless biological-prosthetic continuum. By addressing potential causes of mortality unrelated to the brain and integrating artificial systems that function as natural extensions of the human body, this approach offers an only viable option for patients with catastrophic injuries below the neck.

Background: Dengue viruses, transmitted by Aedes aegypti mosquitoes, are the leading cause of arboviral disease globally. Cardiovascular involvement in dengue is more common in patients with severe disease compared to those with mild or asymptomatic infection. Despite the increasing recognition of cardiovascular involvement in dengue, there is no standardized approach for cardiac assessment in dengue patients. This study aims to address this research gap by thoroughly evaluating the cardiac manifestations associated with dengue fever. Materials & Methods: This hospital-based prospective observational study was conducted on 150 patients the study included subjects aged 18 years or older who were Dengue NS1 positive and IgM antibody positive, as detected by ELISA test. All participants underwent a comprehensive clinical evaluation, including medical history, physical examination, and laboratory tests (tourniquet test, ECG, ECHO, cardiac enzymes) were performed, and the results were recorded. After appropriate data filtration, the data sheet was transferred and analysed using Statistical Package for Social Sciences (SPSS vs. 22.0). Results: In a study of 150 patients, comprising 56% male and 44% female with a mean age of 43.34 years, fever was the most common symptom, present in all cases. The diagnoses included 97.4% Dengue Fever, 1.3% Dengue Haemorrhagic Fever Stage 3, and 1.3% Dengue Shock Syndrome. Patients with severe manifestations exhibited elevated Troponin I and CK-MB levels, a left ventricular ejection fraction (LVEF) < 55%, and ST elevation on ECGs. Laboratory results revealed significantly lower platelet and white blood cell counts in these patients compared to the non-cardiac group. Conclusion: Our study highlights the considerable impact of dengue fever on cardiac health, particularly in patients presenting with severe manifestations such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Approximately 8% of the cohort demonstrated evidence of cardiac involvement, which was significantly correlated with thrombocytopenia and haemoconcentration.

Introduction: Postpartum depression can contribute to behavioural, emotional, cognitive and interpersonal problems in mother’s life. Postpartum depression which is left untreated may have long term adverse effects. Aim: To estimate the prevalence of postpartum depression by Hamilton depression rating scale and identify associated factors. Methodology: The study was designed as a hospital-based cross-sectional investigation, conducted at the Department of Obstetrics and Gynaecology, PBM Hospital in Bikaner, a tertiary care facility serving a significant portion of Rajasthan, India. Result: In our study, the prevalence of postpartum depression (PPD) was 12%, with significant differences in depression scores across age groups and associated factors. Higher depression scores were linked to bad obstetric history, lack of social support, and antenatal anxiety, while planned pregnancy and supportive relationships were protective factors. Conclusion: Postpartum depression significantly impacts mothers and families, with social factors like age and unplanned pregnancy being key correlates. Clinical implications stress the need for tailored antenatal and postnatal care, including domiciliary visits, to address psychosocial factors and prevent severe outcomes.

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The mean platelet volume (MPV), a marker of platelet size, the plateletcrit (PCT), a measure of total platelet mass, and the platelet distribution width (PDW), which increases during accelerated platelet turnover, are all platelet indices. These are accessible, affordable criteria that can be found on a comprehensive hemogram, thus we conducted a study to evaluate the role of platelet count and Platelet indices as predictors of outcome in patients with sepsis at a tertiary care hospital. This cross sectional-observational study was conducted at a tertiary care centre in northern India. Patients(n=140 cases) and controls (n=70 controls) were analysed between October 2020 and October 2022. Complete hemogram parameters were obtained within 48 hours of admission. Hemogram parameters consisted of TLC, Hb, and platelet indices(including  platelet count, MPV, PDand W, PCT). Also assessed for serum creatinine, bilirubin. Clinical parameters included body temperature, pulse rate, respiratory rate, GCS, mean arterial pressure.
Statistical analysis done by using SPSS version 16.0. Continuous variables are expressed as mean±SD or median and categorial variables as percentage. Chi-square and Fischer exact test were used for analysing categorial variables . Paired t test was used  for 2 groups with continuous variables . ROC curves were used for prediction of mortality. Patient with sepsis had tachycardia, increased total leucocyte counts, decreased platelet counts (138892.09±115024.049 in cases versus 220,044.78± 2,28,478.262 in controls with p value) and increased PDW (17.24±1.3 VS 16.573± 0.673 with p-value of 0.0001).SIRS was present in 92% in cases vs 42% in controls (p value0.001) but amongst the sepsis patients SIRS presence was not associated with increased mortality(91.5 % in non-survivor vs 92 % in survivor). We found PLT and PCT can be helpful in identifying patients with sepsis from other patients in ICU setup on the basis of baseline parameters. But at baseline that is within 48 hours of admission or at the time of sepsis diagnosis none of these platelet indices differ significantly amongst survivors and non-survivors, which shows that we can’t relate these parameters to outcome in early course of illness.

Introduction: The physicochemical properties of saliva play a major role in the development of dental caries. Application of fluoride helps in preventing dental caries in both extrinsic and intrinsic pathway. However, their effects on the physicochemical properties of saliva have not been studied extensively. High caries risk group predisposes to early childhood caries. Thus, the purpose of this study was to evaluate the effect of topical fluoride agents on the physicochemical properties of saliva in caries free and caries active children. Aim: To evaluate and compare the effect of topical fluoride agents on the physicochemical properties of saliva in caries free and caries active children among selected North Indian population. Materials and Methods: 80 children of 6 to 12 years age group were included in the study. They were divided into two groups of 40 children each. Group I children with active caries (DMFS/defs > 5) Group II – children without caries (DMFS/defs=0). They were further divided into subgroups each. Subgroup A and B for caries active children and subgroup C and D for caries free children. Each subgroup includes 20 children. Subgroup A and C received 2 % neutral sodium fluoride gel and subgroup B and D received 5 % sodium fluoride varnish. The saliva samples were collected at two different time i.e. first, at the base line and second after the application of topical fluoride agent. Subsequently, they were analyzed for various physicochemical properties. Statistical analysis of the results was done using Student ‘t’ test to compare the mean values between caries free and caries active groups. Results: At baseline level the difference in pH, flow rate and total protein of saliva in caries free and caries active group were found to be statistically significant. After intervention with fluoride the difference between the two groups in respect to total protein level became statistically insignificant. In caries free group, application of fluoride gel and varnish showed statistically significant difference in all the salivary parameters. However, the total antioxidant capacity with fluoride varnish was statistically insignificant. In caries active group, application of fluoride gel and varnish showed statistically significant difference in the salivary flow rate, pH and buffering capacity. However total antioxidant capacity with fluoride gel was statistically significant. The difference in total protein level after application of fluoride varnish or gel was statistically insignificant. The result also showed that both fluoride gel and fluoride varnish were almost equivocal in their efficacy in both the groups. Conclusion: Overall, caries active children showed lower flow rate, pH and buffering capacity in comparison to caries active children. Whereas the total protein and total antioxidant were higher in caries active children. Thus, it can be concluded that application of fluoride either varnishes or gels overall augment the physicochemical properties of saliva which is considered to be one of the major factors in the development of dental caries.

Objectives: To retrospectively analyse the clinical outcomes and safety of retrograde intrarenal surgery (RIRS) for renal stone management at a tertiary care centre. Methods: This retrospective study included 40 patients who underwent RIRS for renal stone management between December 2023 to November 2024 at Madurai medical college. Data were collected on patient demographics, stone characteristics (Size, Location and Hardness), procedural time, stone-free rates, complications, and post-operative recovery (hospital stay). Statistical analyses were performed to evaluate clinical outcomes. Results: The mean procedural time was 57.8 ± 10.5 minutes. Stone-free rates on postoperative day 2 was 80%, which increased to 95% by postoperative day 30. Complication rates were 17.5%, including postoperative fever, haematuria, urosepsis requiring additional antibiotics, steinstrasse, and no major complications like ureteral injuries or septic shock. The mean length of hospital stay was 2.3±0.6 days. Conclusion: RIRS is a safe and effective modality for managing renal stones with high stone clearance rates and minimal complications. Careful case selection and preoperative preparation are essential to achieving optimal outcomes in the early phase of implementing RIRS in a tertiary care setting.

Introduction: Empathy plays a crucial role in delivering effective healthcare. It involves both cognitive and emotional aspects that help healthcare providers understand and respond to patients’ feelings. In medical education, fostering and sustaining empathy among students is essential, as it has been linked to better patient outcomes, improved diagnostic accuracy, and higher patient satisfaction. However, studies suggest that empathy levels in medical students may decline over time, highlighting the importance of evaluating and understanding empathy trends throughout their training. Objective: To assess the empathy levels of medical students at tertiary care centers in Tamil Nadu using the Toronto Empathy Questionnaire (TEQ). Methods: A cross-sectional study was conducted between June and December 2024, involving 605 MBBS students from both government and private institutions. Data was collected using Google Forms through a snowball sampling method. The TEQ, consisting of 16 items rated on a 5-point Likert scale, was used to measure students’ empathy levels. Results: The study found that the average empathy score among participants was 43.06 ± 7.16, with only 44.3% scoring above the cutoff value of 45. Female students exhibited significantly higher empathy levels, with 51.7% scoring above the cutoff compared to 33.9% of male students (p<0.001). Among different academic years, fourth-year students had the highest proportion of scores above the cutoff (48.5%), followed by third-year (47.7%) and first-year students (45.7%). Notably, students engaged in part-time work demonstrated significantly lower empathy levels, with only 9.1% scoring above the cutoff compared to 44.9% of those without part-time work (p=0.027). However, no significant differences were observed based on the type of institution or family background. Conclusions: Overall, empathy levels among the students were moderate. Significant differences were observed based on gender, with female students showing higher empathy, and part-time work, which appeared to negatively impact empathy levels. The findings suggest that clinical exposure during later years may contribute to maintaining or slightly improving empathy. These insights emphasize the need for targeted strategies to enhance empathy development in medical students, particularly among male students and those juggling part-time work.

Background: Pancytopenia represents a significant hematological challenge characterized by simultaneous reduction in all three major blood cell lines – erythrocytes, leukocytes, and platelets. This study aimed to analyze the clinico-hematological profile of pancytopenia patients in central Rajasthan. Methods: This cross-sectional observational study included 100 patients with pancytopenia attending the Medical OPD and Indoor Department of JLN Medical College, Ajmer from January 2023 to December 2023. Detailed clinical history, physical examination, and relevant investigations including complete blood count, peripheral blood smear, and bone marrow examination were performed. Results: Male predominance was observed (59%) with mean age of 41.19±9.28 years. The most common presenting symptom was fatigability (83%) followed by weight loss (55%) and fever (49%). Pallor was the most common physical finding (73%). Megaloblastic anemia was the leading cause (41%) followed by aplastic anemia (23%) and hepatitis B (16%). Bone marrow examination revealed hypocellular marrow with fat cells in 71.8% of examined cases. Majority had hemoglobin between 5-8 g/dl (39%), TLC >3000/mm3 (64%), and platelet count <50,000/mm3 (57%). Conclusion: Megaloblastic anemia emerged as the predominant cause of pancytopenia in this region, followed by aplastic anemia. Early detection of underlying conditions through comprehensive clinical and hematological evaluation helps in improving patient outcomes.

Objectives: To assess the demographic profiles and therapeutic options in breast cancer patients based on their hormone receptor status and assess the treatment outcomes in breast cancer patients being treated in our institute. Methods: A retrospective, observational, non-interventional study was conducted among breast cancer patients in the Barpeta Cancer Centre linked to Fakhruddin Ali Ahmed Medical College & Hospital, Barpeta, Assam. Ethical clearance was obtained from the Institutional Ethics Committee prior to the study. The data was collected and entered in specially designed patient data entry forms and the prescription parameters necessary for the study were recorded. Results: Of the 128 patients studied a majority (68%) was between 45 to 70 years of age, the majority (91.5%) were multiparous women, while a majority (61%) presented with left sided cancer. Under staging a majority (43%) belonged to T2, majority (29.5%) belonged to N2 stage, while a majority (78%) belonged to M0 stage. A majority (40.5%) of cases belonged to luminal subtype B. Most patients (66.5%) underwent Modified Radical Mastectomy (MRM) while 19% patient did not undergo any surgical treatment. A majority (54.6%) did not receive neoadjuvant chemotherapy. 54% of cases received adjuvant chemotherapy, 59.4% of cases received adjuvant radiotherapy and 58% of cases did not receive any hormonal therapy. Conclusion: Breast cancer is still an emerging epidemic in a third world country like India. What makes the situation more challenging is the social stigma associated with malignancy and the hesitation to show a male doctor. Campaigns to increase breast cancer screening and increase awareness of breast self-examination is the need of the hour. This is because in our study, as in most others, most of the cases presented with the disease at an advanced stage. In our study we attempted to identify the disease burden and presentation as this aids in understanding and planning specific measures to target this disease. Only through these and other concentrated efforts it will be possible for early detection and more effective treatment for breast cancer patients.

Acute mesenteric venous thrombosis (MVT) is an uncommon but life-threatening condition, accounting for 5–15% of mesenteric ischemia cases. The hypercoagulable state of pregnancy, combined with venous stasis and other risk factors, significantly increases the risk of thrombosis. However, MVT remains extremely rare in pregnancy, with only a handful of cases documented in the literature. This report presents the case of a 25-year-old woman at 24 weeks and 1 day of gestation who developed an acute abdomen caused by extensive intestinal ischemia due to MVT. Despite emergency laparotomy, bowel resection, and hysterotomy, the patient succumbed to irreversible shock. This case highlights the diagnostic and therapeutic challenges of managing MVT in pregnancy and emphasizes the need for early recognition and prompt intervention to improve outcomes.

Introduction: An uncommon placental defect called placental mesenchymal dysplasia (PMD) is typified by placentomegaly and grapelike vesicles that resemble molar pregnancy. According to reports, the prevalence of PMD is 0.02%, with a clear female preponderance. To avoid needless pregnancy termination, it’s critical to distinguish PMD from its mimics, particularly molar pregnancy. Unlike molar pregnancies, PMD usually features a normal fetus. However, PMD is distinct in that it has a high incidence of fetal growth restriction (FGR) and intrauterine fetal death (IUFD). Case report: A 22-year-old primigravida at 24 weeks and 5 days of gestation, with sudden intrauterine fetal demise. She presented to this hospital with a complaint of not perceiving fetal movements for the last 3 to 4 days. Ultrasonographic evaluation showed a single dead fetus with marked tissue edema, ascites, and pleural effusion and a large hyperechoic mass suggestive of hydrops fetalis with placental SOL with multiple loculated cysts. MRI revealed a single intrauterine gestation of average gestational age 21 weeks 4 days with mesenchymal dysplasia of the placenta and hydrops fetalis. Conclusion: The differential diagnosis of placental cystic lesions by sonography should include PMD if a fetus with a phenotypically normal appearance can be identified. The fetal death in this case might be due to the marked vascular changes in the placenta leading to cardiac decompensation, hydrops fetalis, and intrauterine death.

Introduction: In the current scenario, HIV itself is a major health problem with extreme social and economic association, though India got its first case far much later as compare to other parts of the world. HIV can be transmitted through different routes like anal or vaginal sex without condom, having sexually transmitted infection such as Herpes, Syphilis, Gonorrhea etc, use of alcohol or drugs, by using contaminated needles, syringes etc for injecting drugs or any accidental needle stick injury, but transfusion of contaminated blood is one of the main route of transmission. With the upcoming latest and effective treatment and prevention programs globally, a new ray of hope has lightened in global aids epidemic. NACO has increased access to services and productive connection for behavior changes, thus leading to vast challenge of HIV threat. Aim and Objective: The main objective of our study is to determine the overall prevalence of HIV infection among blood donors attending blood bank in SIMS, Hapur, UP. Materials and Method: The duration of the study was for a period of one year i.e. from February 2023 to January 2024. Total numbers of donors taken for this study were 1456. We included immunocompetent donors of 16-60 years of age. Rapid immunochromatographic kits were used to screen the donors followed by ELISA test in blood bank for the confirmation. Result: A total of 1456 donors were screened for HIV infection, where we documented 03 positive cases with overall prevalence of 0.20%. Male dominance (0.20%) was observed as compared to female. Higher HIV infection incidence was observed in Pilakhua followed by Hapur. Conclusion: HIV prevalence of 0.20% among blood donors has alarmed a need to spread the public awareness, diligent donor selection and screening with newer techniques.

Background: The term “post-cholecystectomy syndrome” (PCS) refers to the continuation of right upper quadrant stomach discomfort or biliary colic along with a range of gastrointestinal symptoms that resemble those suffered by patients who had cholecystitis before cholecystectomy. This condition might be a continuation of symptoms brought on by gallbladder pathology or the emergence of new symptoms, as the name implies. Intolerant to fatty foods, heartburn, nausea, vomiting, flatulence, indigestion, diarrhea, jaundice, and sporadic bouts of abdominal discomfort are among the symptoms. Assessing the impact of surgery on patients’ symptoms is the purpose of this study. Methods: This prospective study was conducted at Department of General Surgery, SKMCH, Muzaffarpur, Bihar from August 2023 to February 2024. Total 80 patients undergoing Cholecystectomy were evaluated using standard questionnaires. Results: The incidence of postcholecystectomy syndrome was reported to be 30% in 80 patients with gallstone disease who had two or more symptoms prior to surgery. Conclusion: With the exception of diarrhea, all post-operative pain and non-pain symptoms were considerably decreased.

Background: Following a laparotomy, the objective of wound closure is to restore the abdominal wall’s functionality. Layered closure, the modified Smead-Jones technique, mass closure, retention suture, or a combination of these methods are the methods used to close the anterior abdominal wall. The advantage of mass continuous sutures is that they retain the fascia together, according to research that contrasted interrupted and continuous suture procedures. In this study, patients undergoing laparotomy by midline incision in a tertiary care hospital are compared between two techniques: layered closure and single layer closure (mass closure). Methods: The study included 97 patients undergoing either emergency or elective midline laparotomy. Of these, 64 patients had laparotomy closure done in a single layer using polypropylene 1-0, and 33 patients had layered closure, with polygalactin 2-0 being used to close the peritoneum and polypropylene 1-0 to close the linea alba. Without employing any sort of randomization, patients were divided into two groups based on the operating surgeon’s convenience. Results: The single layer closure method took 18.2±3.2 minutes, which is statistically significantly less time than the conventional layered closure method of 26.4±4 minutes (p <0.001). Postoperative complications were also observed to be relatively lower in the single layer closure group (17.18%) than in the layered closure group (42.42%). Conclusion: In terms of operating time and post-operative problems, the single layer closure technique is still superior to a conventional layered closure technique for laparotomy wounds.

Background: Typhoid perforation, a serious complication of typhoid fever, typically manifests in the second or third week of the illness and is brought on by the necrosis of payer’s patches in the terminal ileum, which results in severe peritonitis. It is always treated surgically and has a high morbidity and mortality rate in underdeveloped nations. This study compares the clinical result and post-operative complications of primary repair and ileostomy in patients with typhoid ileal perforation. Methods: From March 2022 to February 2023, 110 patients included in this study, which was carried out at the Department of Surgery, SKMCH, Muzaffarpur, Bihar, using a consecutive non-probability sampling technique. Based on the history, physical examination, and tests such as leukocytosis, positive typhidot, and pneumoperitoneum on X-ray erect abdomen, typhoid ileal perforation was identified. The lottery approach was used to split the patients into two groups. Group B had an ileostomy, while Group A had primary repair. Highly skilled surgeons carried out the surgeries. Following surgery, patients were monitored for two weeks, one month, and three months. SPSS version 22 was used to analyze the data. The independent t test was used to compare hospital stays in both groups, and the chi-square test was used to compare post-operative problems. Results: Each group consisted of 55 patients, 90 of whom were male (81.82%) and 30 of whom were female (27.27%). 42±10.47 years was the average age. We found that 24 patients (43.63%) in the ileostomy group and 12 patients (21.81%) in the primary repair group developed wound infections (p<0.05). Five patients (9.09%) in the ileostomy group and two (3.63%) in the primary repair group developed wound dehiscence (p >0.05). Fecal fistulas developed in two (3.63%) of the patients in the main repair group and none in the ileostomy group (p>0.05). In contrast to none in the primary repair group, four (7.27%) patients in the ileostomy group developed stoma retraction (p<0.05). We found that 35 patients (63.63%) in the ileostomy group and 17 patients (30.90%) in the primary repair group developed problems (p<0.05). The mean hospital stay after the primary repair was 6.78±2.1 days compared to 9.29± 2.88 days after the ileostomy (p=0.000). Conclusion: Typhoid ileal perforation can only be successfully managed with early surgery and sufficient resuscitation. We found that primary repair superior ileostomy.

Background: An emergency laparotomy is a life-saving treatment that is typically performed in urgent situations with little to no patient preparation. Despite being one of the most common urgent surgical procedures, it still proves to be a challenge for the surgeons of the world. Methods: From April 2023 to September 2023, 100 patients who had emergency laparotomies at SKMCH, Muzaffarpur, and Bihar, participated in this prospective study to assess the various reasons for laparotomy as well as the morbidity and mortality related to it. Results: The majority of the circumstances for which emergency laparotomy was performed were perforation peritonitis. Other causes included intestinal blockage (25%), abdominal trauma (19%), and appendix rupture (5%), and so forth. Post-operative fever (68%) was the most common complication followed by nausea and vomiting(56%),chest infection(38%), wound complications (33%) and paralytic ileus (26%) to name a few. The study mortality rate was 4%. Conclusion: Compared to elective laparotomies, emergency laparotomies are more likely to result in post-operative problems. Patients who presented later or who had any related co-morbidities experienced the most difficulties. Therefore, postoperative problems can be minimized by early detection, prompt intervention, and improved postoperative care.

Introduction: Disorder language is a hallmark feature of schizophrenia. Varying degrees of aberrant language can be observed in up to 80% of patients with schizophrenia. Language disturbances in schizophrenia may negatively affect social relations in several ways. Thought language Communication disorder was once thought to be specific to schizophrenia but it is now established that it is seen in other psychosis, mood disorder and in organic conditions. This study was aimed at finding the effect of first generation and second-generation antipsychotics in treating formal thought disorder in schizophrenia patients. Methodology: A cross sectional study with retrospective data collection from case sheets and standardized psychiatric clinical interview was conducted in fifty in-patients of Institute of Mental health, Chennai over a period of three months. 25 Patients diagnosed as Schizophrenia as per ICD-10 on FGAs and 25 patients on SGAs who are in admission as in-patient for more than two years, on continuous anti-psychotic medication of both sexes were included. Results: Most common Thought language communication disorder is tangentially in both groups prior to treatment whereas group 1 (First generation) has illogicality as most common TLC after treatment. Tangentially is common in-group 2 (Second generation) after treatment. Word approximation and stilted speech is not reported in both the group. We also measured the Nancy and reason scale of severity of thought language disorder Patients in whom they were on Typical there was not much reduction in severity of TLC disorder while patient on atypical antipsychotics had a significant reduction of score post treatment. Conclusion: Prospective studies with large sample is required in future to decide the antipsychotic of choice for treating thought language communication disorders. Also categorizing thought language Communication disorder with more sophisticated neurolinguistics methods for understanding the neurobiology and considering medications other than Anti- psychotics in treatment of formal thought disorder in future will give throw a light in management of thought language communication disorders in schizophrenia.

Background: One surgical emergency that casualties commonly encounter is acute appendicitis. Ignoring acute appendicitis can have several potentially deadly repercussions. Appendiceal perforation or abscess formation may occur when diagnostic difficulties result in missed appendicitis or negative appendicectomies. Clinical professionals often miss the mean platelet volume (MPV) during a routine blood count. The Aim of this study is to evaluate the diagnostic value of platelet indices (mean platelet volume and platelet distribution width) and its predictive value in determining the complication/severity of acute appendicitis. Methods: This study comprised of 126 adult patients of Acute Appendicitis who were operated in the department of Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar during the period of 6 months starting from February 2024 to October 2024. Patients below 12 years, pregnant female, patients on steroid/chemotherapy, immuno-compromised patients and those who are not willing to participate were excluded. Results: The Mean Platelet Volume (MVP) of less than 7.6 was found in 73 (57.9%). The mean MPV was 7.98+/-1.29. Platelet Distribution Width (PDW) was more than 18 patients (23.7%). Out of which 16 and 14 were females and males respectively. The mean PDW was 16.99±2.30. Total Leucocyte Count (TLC) was raised (taking 1100 as cut-off value) in 82 patients (65.1%). 11 patients were associated with perforated appendix and 10 patients had intraoperative finding of periappendiceal collection. Gangrenous appendix was found in 16 (12.7%) patients. Conclusion: MVP did not have higher sensitivity compared with TLC in the diagnosis of acute appendicitis but PDW have higher sensitivity than TLC and is found higher in complicated appendicitis. Therefore, PDW may be used in the diagnosis of acute appendicitis and has a significant role in predicting complicated appendicitis.

Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS). Methods: This is a prospective study comparing MAD and LAS in the treatment of chronic anal fissure at SKMCH, Muzaffarpur, and Bihar from March 2022 to February 2023. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, postoperative complications, hospital stay, recurrence rates and compliance. Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS. Conclusions: MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group.

Background: A stoma is an exteriorization of the colon or ileum to the front aspect of the abdominal wall that develops surgically. Fecal stomas can develop for a number of reasons, but the most frequent ones are inflam-matory bowel disease, carcinoma, and blunt abdominal trauma. A stoma can cause both physical and psycholog-ical discomfort to the person. Complications during stoma are extremely common in accumulation. Methods: 50 patients participated in the study, which was conducted at the Department of General Surgery, SKMCH, Muzaffarpur, Bihar, from March 2023 to February 2024. The study population consisted of all pa-tients who had stoma closure and met the inclusion criteria. The study covered patients of all ages who had stoma closure for a non-malignant disease. The study did not cover stoma closure for patients who had surgery for TB, inflammatory bowel illness, or cancer. Various problems, complications in various procedures, and complications in various stoma closure intervals were found in this study group. Results: Early stoma closure and intraoperative use of the direct stoma closure approach were associated with fewer postoperative problems. We can lower the risk of wound infection and wound dehiscence by employing the subcutaneous drain implantation. Conclusion: By using the right procedure and closing the stoma at the right time, postoperative complications can be minimized.

Background: Fissure-in-ano is a frequent anal condition that primarily manifests as excruciating pain. Currently, the primary therapeutic method is lateral internal sphincterotomy. Either an open or closed strategy can be used for this, or each has its own set of challenges. This study compares the open and closed lateral sphincterotomy techniques in patients with persistent anal fissures. Methods: Present study was conducted at Department of Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from August 2023 to January 2024. This study included 64 participants who had chronic anal fissures. Of these, 30 patients had closed sphincterotomy and 34 patients had open lateral sphincterotomy. After surgery, they were monitored for six months. The two groups’ outcomes and issues were contrasted and statistically analyzed. Results: The two groups were compared in terms of post-operative complications, including pain, bleeding, infection, incontinence, and recurrence. There was no difference in the frequency of infection and recurrence between the two groups, although the closed group experienced significantly reduced pain, bleeding, and incontinence to flatus (P < 0.05). Conclusion: When treating persistent anal fissures, closed lateral internal sphincterotomy is a better option than open sphincterotomy.

Background: Bipolar disorder is a complicated psychological disorder that affects patients on an individual and social level. The purpose of this study is to evaluate the effectiveness of lithium and divalproex sodium in treating patients with bipolar illness who are receiving combination therapy. Methods: The effectiveness of lithium and divalproex sodium in the treatment of bipolar disorder was compared in a prospective, comparative trial. The study included patients with bipolar disorder of either sex who were between the ages of 18 to 65. The YMRS scale was used to analyze efficacy at baseline and four weeks later. Results: The study included 68 bipolar disorder patients who were experiencing manic episodes at the time of the trial. Two groups were formed out of them. One group took lithium, and the other group took divalproex sodium. The medications that were given to both groups at the same time were similar. There were eighteen female patients and fifty male patients. At baseline and at the conclusion of four weeks, YMRS scoring was completed. The baseline and 4-week YMRS scores for the Divalproate sodium group were 31.22 and 29.13, respectively. The baseline and 4-week YMRS scores for the lithium group were 30.88 and 28.93, respectively. The YMRS scores in both groups significantly decreased over the course of four weeks, with a p-value of less than 0.05. Nevertheless, there was no statistically significant difference between the two groups’ YMRS scores after four weeks. Both groups experienced the same level of efficacy.  Conclusion: After four weeks of medication, lithium and divalproate sodium were equally effective in treating bipolar illness. By the end of four weeks, patients had significantly improved with both medications.

Background: A prevalent chronic disorder that recurs frequently, gastroesophageal reflux disease (GERD) has a high risk of serious morbidity and even death from its aftereffects. Although they continue to be the cornerstone of GERD treatment, proton pump inhibitors (PPIs) have no part in raising the tone of the lower esophageal sphincter, which is the primary pathophysiology of GERD. In this context, adding a prokinetic medication, such as itopride, may help alleviate GERD symptoms. In order to assess the healing rates of esophagitis and the decrease in GERD symptom scores between Pantoprazole monotherapy and Pantoprazole + itopride combination, the current study was conducted. Methods: One hundred GERD patients were divided into two groups, Group A and Group B, at random. For four weeks, group A was given 40 mg of Pantoprazole twice a day by itself, while group B was given 40 mg of Pantoprazole twice a day together with 50 mg of Itopride three times a day, 30 minutes before meals. After four weeks, the patients were contacted again and given the questionnaire used to determine their FSSG ratings. Following the recording of endoscopy and FSSG scores, the proportion of responders in each group was compared. Results: Both groups showed comparable endoscopic indications of esophagitis healing (72% in Group A and 74% in Group B). After four weeks, the Pantaprozole plus Itopride group experienced a considerably greater reduction in symptoms (74.5%; 4.2±1.6) than the Pantaprozole alone group (62.5%; 6.4±1.1) (p < 0.001).Group B saw less side effects than group A (22% vs. 30%, p=0.172). Conclusion: Endoscopic healing of esophagitis is more successful when pantoprazole and itopride are used together. The combination of itopride and pantoprazole is more effective than pantoprazole alone at reducing GERD symptoms.

Background: Poor maternal and perinatal outcomes are more likely to occur in pregnant women with polycystic ovarian syndrome, according to some research. Pregnancy outcomes for women with polycystic ovarian syndrome are not well-documented in India. The purpose of this study was to evaluate the results of pregnancies in women with polycystic ovarian syndrome. Methods: In this descriptive study 135 pregnant women with polycystic ovarian syndrome selected from January 2024 to October 2024. Data on polycystic ovarian syndrome, the current pregnancy, and maternal/perinatal outcomes were analyzed using SPSS version 20. As categorical predictors, parity and different maternal and perinatal outcomes were assessed. Results: With an average age of 26.8 years, a high body mass index of 77%, and 88% of individuals having a history of primary infertility over the course of their lives, The prevalence of PROM (18.5%), low APGAR scores at 5 minutes (13%) and gestational diabetes (13%) was higher in pregnant women with hypertensive diseases than in those without. Additionally, they had higher rates of perinatal mortality (2%) and NICU hospitalization (20%), low birth weight kids (2%), macrosomia (0.7%), PPROM (8%), miscarriage (2.2%), preterm birth (10.4%), and cesarean delivery (30.4%). Conclusion: As compared to the general pregnant population, pregnant women with PCOS had either similar or lower rates of GDM, miscarriage, preterm delivery, meconium stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission, and congenital anomalies.

Background: In several patient populations, preemptive Paracetamol has been demonstrated to reduce the need for postoperative analgesia; however, there is insufficient data to support its use in laparoscopic cholecystectomy. Our goal was to ascertain how preemptive Paracetamol affected the need for postoperative analgesia in individuals having laparoscopic cholecystectomy. Methods: Three groups of 90 patients with physical status I or II, according to the American Society of Anesthesiologists, were chosen at random. One gram of Paracetamol was injected intravenously into Group I half an hour before surgery, one gram was injected into Group II during skin closure, and Group III was the control group and did not receive any Paracetamol. Up to six hours after surgery, the three groups’ postoperative pain scores, by VAS and analgesia required, were compared. Results: For the majority of the trial, the three groups’ postoperative pain levels were similar. Compared to Group III, Groups I and II consumed much less Fentanyl after surgery. The incidence of PONV and the sedation scores did not differ between the two groups. Conclusion: Postoperative discomfort following laparoscopic cholecystectomy can be effectively managed with preemptive intravenous paracetamol.

Background: Among the many benefits of laparoscopic surgery are its rapid recovery and low level of invasiveness. Nevertheless, the use of carbon dioxide for pneumoperitoneum during laparoscopic surgery raises blood pressure, heart rate, and systemic vascular resistance. In this study, the effects of esmolol and dexmedetomidine on hemodynamic responses during laparoscopic cholecystectomy were examined. Methods: Two groups of 50 patients each were randomly selected from a total of 100 patients scheduled for laparoscopic cholecystectomy. The Dexmedetomidine group received a bolus dose of 1 mcg/kg iv Dexmedetomidine over 10 minutes prior to pneumoperitoneum, followed by an infusion of 0.6 mcg/kg/hr. The Esmolol group received a bolus dose of 1 mg/kg intravenous Esmolol shortly before pneumoperitoneum, followed by an infusion of 200 mcg/kg/min. At various intervals, hemodynamic measures such as heart rate, mean arterial pressure, systolic blood pressure, and diastolic blood pressure were measured. Results: It was found that in Dexmedetomidine group there was a statistically significant decrease in heart rate before pneumoperitoneum (84.24±9.17) and10 minutes after pneumoperitoneum (79.40±7.41) compared to Esmolol Group before pneumoperitoneum (91.40±5.98) and 10 minutes after pneumoperitoneum (95.18±14.17). There was statistically significant decrease in Mean arterial pressure in Dexmedetomidine group at 30 minutes (86.53±6.13), 50 minutes (77.95±4.85) , after release of pneumoperitoneum (92.42±3.91) and after extubation (99.50±11.81) compared to Esmolol group at 30 minutes (91.23±8.97), 50 minutes (94.34±12.64) after release of pneumoperitoneum (102.5 ±10.44) and after extubation (112.39±11.15). Conclusion: Dexmedetomidine was found to be more effective than Esmolol in attenuating the hemodynamic responses following pneumoperitoneum during laparoscopic cholecystectomy.

Introduction: The 7th report by the Joint National Committee on Prevention, Detection, Evaluation and Management of High Blood Pressure (BP) defines hypertension (HTN) as having systolic blood pressure of at least 140 mmHg and diastolic blood pressure of at least 90 mmHg. Of these hypertensive individuals, 95% have essential hypertension (EH), unfortunately little is known about the precise etiology and pathophysiology of EH. Stress, a high-salt diet, obesity and a lack of vitamin D have all been identified as environmental risk factors. We conducted the current study at Adesh Medical College in Shahbad to measure the levels of vitamin D in cases of essential hypertension due to the dearth of information on the causative relationship between hypo-vitaminosis D and patients with essential hypertension. Aim: To determine the levels of Vitamin D in cases of essential hypertension. Objectives: 1: To measure Vitamin D levels in stage 1 and stage 2 cases of essential hypertension. 2: To compare severe deficiency (<10ng/ml) of Vitamin D in stage 1 and stage 2 cases of   essential hypertension. Methodology:150 cases of newly diagnosed hypertension attending OPD/IPD of Adesh Hospital were included in the study. Results: Total cases of vitamin D deficiency was 70.7% (106) cases out of total cases of essential hypertension. Of the vitamin D deficient subjects 26.4%(28) were in stage 1 and 73.6%(78) were in stage 2 hypertension. Total cases of severe vitamin D deficiency were 23.3% (35),out of which 28.6%(10) were in stage 1 and 71.4%(25) were in stage 2 hypertension. Conclusion: The findings of our investigation point to a high frequency of hypo-vitaminosis D in hypertension patients.  There is a tendency for low vitamin D levels to be correlated with elevated systolic blood pressure.

Aim of this study is to discuss various incidental/interesting cases in autopsy including neoplastic/non neoplastic lesions. Pathologist plays an important role in finding out the real cause of death in the suspicious cases. Histopathological examination in postmortem cases have role in finding out cause of death. The aim of this study is to discuss various incidental / interesting findings in autopsy including neoplastic/ nonneoplastic lesions over a period of one year from March 2023 to March 2024 in a tertiary care centre with the help of Forensic specialists. The specimens were received from our forensic medicine department, they were grossed and the findings are recorded. The specimens are further processed as per standardized protocols and cases reported as per guidelines.

Introduction: Eco-pharmacology addresses the critical issue of health hazards associated with the improper disposal of unused or discarded medicinal products in the environment. The rising incidence of diseases, along with the easy accessibility of over-the-counter medications, contributes to the accumulation of surplus medicines and their inadequate disposal, resulting in significant environmental contamination. Aims and Objectives: To assess the knowledge, attitudes, and management practices of healthcare professionals regarding the disposal of medicines and pharmaceutical waste management. Materials and Methods: A questionnaire-based study was conducted using a structured Google Form, distributed via online platforms. The study involved 92 participants, including doctors, pharmacists, nursing staff, lab technicians, and medical students from various healthcare facilities. A 11-question questionnaire was shared with participants. The data were compiled using Google forms, and the results were analyzed. Results: The findings indicated that 83.7% of participants viewed expired medications as unsafe, with 64.1% acknowledging their reduced effectiveness and 31.5% considering them potentially toxic. Awareness of the consequences of improper disposal was high at 97.8%. Additionally, 59.8% were familiar with various disposal methods, and 96.7% reported adherence to biomedical waste management protocols. Furthermore, 48.9% were aware of national take-back policies in certain countries.

Objective: Gallbladder carcinoma is the most common malignant tumour of the biliary system. There were 145,203 new cases of GBC in the world, accounting for 1.1% of all cases of the new malignant tumours in 2008. Studying MUC1 profile in every gall bladder lesion and its surrounding mucosa will help to understand the biology of disease and tumorigenesis pathways enabling us to identify cancer risk in patients which could aid in better management. Method: This is a prospective cross-sectional study conducted from October 2023 to September 2024 in the department of Pathology in Gauhati Medical College and Hospital. H&E and immunohistochemical staining was performed in 300 surgically resected cholecystectomy specimen. Result: Out of the 300 cases, 290 were diagnosed as non-neoplastic lesions and the remaining were found to be neoplastic. Gall bladder lesions were predominantly found to occur in the age group of (41-50) years. However, malignancies commonly occurred in the elderly aged between (51-60) years in male and in female. Out of this, 78% were females and 22% cases were males, thus presenting a female predominance. In the present study, out of the 10 neoplastic GBL, 90.2% cases showed positivity for MUC-1. 11 dysplastic gall bladder epithelium were found, out of which, 86.33% showed positivity for MUC1. Out of the 290 cases of non-neoplastic lesions, only 12.8% cases expressed MUC-1. Conclusion: As the disease’s severity advanced from hyperplasia to carcinoma in situ to gall bladder cancer, a higher proportion of patients exhibited MUC-1 expression. Therefore, routine histopathological examination of all gall bladder specimens along with mucin immunohistochemistry, regardless of the clinical characteristics of the patient or macroscopic aspect of gallbladder, is the current approach to detect the presence of gall bladder carcinoma.

Introduction: Psoriasiform dermatoses refers to a group of disorders and the disease coming under this group of disorders have a very common histological and clinical presentation from psoriasis itself. In psoriasis there is accelerated epithelial turnover and these keratinocytes are resistant to apoptosis. Hence, a nuclear Ki67 protein is expected to be increased in psoriasis in comparison to other psoriasiform reaction. Our study is intended to analyse the clinical features and histopathology of Psoriasiform Dematoses and to evaluate the immunohistochemical expression of Ki67 in Psoriasiform Dermatoses and to evaluate the diagnostic utility of Ki67. Methodology: This is a study on evaluation of clinical features and histomorphology of Psoriasiform Dermatoses with immunohistochemical evaluation undertaken in the department of pathology in a tertiary care teaching hospital over a period of 1 year. A punch biopsy including both lesional and perilesional area was taken so as to compare the normal and the diseased skin. The biopsy is kept in 10% neutral buffered formalin immediately in a well-closed container and transported to the histopathology lab with adequate measures. Immunohistochemical staining for anti-Ki67 antibody marker is done as per procedure. Results: In the present study out of 50 cases, psoriasis constituted the most common psoriasiform dermatoses cases constituting 40% followed by parapsoriasis 20%.  In the present study moderate to severe ki67 % expression was seen most commonly among parapsoriasis cases. Mild and moderate ki67 % expression was seen in pityriasis rubra pilaris. Lichen simplex chronicus also showed with mild ki67 % and moderate ki67% expression. Both pityriasis rosea and chronic superficial dermatitis showed nil to minimal expression in all of cases. Conclusion: In the present study, psoriasis constituted the most common case of psoriasiform dermatoses lesion followed by parapsoriasis and pityriasis rubra pilaris. Among expression of Ki67 immunohistochemistry, Psoriasis has the highest percentage of expression. All the cases of histopathologically confirmed psoriasis cases showed moderate to severe percentage of anti Ki67 antibody expression in the basal and suprabasal keratinocytes. Expression of Ki67 is positive in 75% of total cases of parapsoriasis when constituted the most common case with moderate Ki67 expression among non-psoriasiform psoriatic dermatoses cases.

Introduction: Incidence of Prostate Cancer (PCa) is higher in western countries compared to Asian countries. The cancer detection rates in India have been lower than the western world for serum PSA values less than 20 ng/ml. The reported cancer detection rate of Trans-Rectal Ultrasonography (TRUS) biopsies has been around 30 percent in western countries. However, it is much lower in Asian countries, including India. This study was conducted to find out the TRUS biopsy yield in Indian population at different PSA Cut-off values. Aim of our study is to find out the cancer detection rate of TRUS biopsy in Indian population at different serum Prostate-Specific Antigen cut off levels. Materials and Methods: A prospective study was carried out our institute. All symptomatic patients who underwent TRUS guided biopsy for indication of raised serum PSA level (>4 ng/ml) or suspicious DRE findings from March 2017 to March 2019 were included. Serum PSA estimation was done using fully automated chemi-luminescent immune assay method. 12-core biopsies were taken in all cases. Biopsy was taken using end-firing transrectal ultrasonography probe (7.5 MHz). All patients were given tablet bisacodyl (10 mg) along with tablet ciprofloxacin (500 mg) one night prior to biopsy. Post-biopsy, oral antibiotics were continued for three days. Result: Out of the 75 patients included, 28 patients had malignancy .overall cancer detection rate was 37.33%. The cancer detection rate for PSA ranges of (4-10) and (10-20) ng/ml was as low as 0% and 3.7% respectively. Patients with malignant disease had significantly smaller prostate gland size than patients with benign disease. On the other hand, cancer detection rate was 100% for PSA greater than 100ng/ml. Conclusion: The current serum PSA  cut offs of 4 ng/ml derived from western literature have a lower positive predictive value in Indian patients as compared to western population, especially for serum PSA range of (4-10) and (10-20)ng/ml . This leads to a large number of patients undergoing unnecessary biopsies. Hence increasing the present serum PSA cut-off for TRUS biopsy in Indian patients may help in avoiding unnecessary biopsies. Also Serum PSA being prostate specific and not cancer specific, we should look forward for a better tumor marker in future which is cancer specific to avoid unnecessary biopsies.

Background: Tissue repair after surgical skin incisions are rapid acquisition of strength, least tissue damage, no inflammation, and an aesthetically acceptable scar. This can be achieved by obliteration of dead space, layered tissue closure, and eversion of skin margins. The perfectness of tissue approximation and type of approximation influences the tissue healing rate, postoperative early and late complication of surgical wound and economic burden of the hospital. Aims and Objective: A disposable skin stapler was compared with conventional nylon (ethilon) sutures in respect of time taken for wound closure, cosmetic result and ease of application and removal. Methods and Material: The study was conducted on 100 patients undergoing clean and clean contaminated surgical procedures, divided in 2 groups (A & B), each consisting of 50 cases. Group A selected for Stapler closure, Group B for skin suturing with interrupted ethilon suture (2-0). Results: The mean length (cm) in stapler group was 9.34±5.62 and in ethilon was 9.36±4.80. Stapler group vs Ethilon Group was also NS as t=0.191 and p=0.9848. In Stapler group, the mean number of staples was 11.88±6.75 and in Ethilon group, the mean number of sutures was 7.8±4.37. Number of sutures compared for stapler group vs ethilon group t=3.5827 and p=0.0005 was extremely significant. The mean time taken (in sec.) per staple was minimum with value of 7.4±1.1 and time taken for one suture of ethilon was 25.0±3.4. Conclusion: Result of the study indicates that stapler is cosmetically better to ethilon with overall less complication as compared to ethilon.

Introduction: Vitamin D sources originate from skin after exposure to ultraviolet rays, dietary resources, and supplementation. The role of vitamin D in the respiratory infections prevention and treatment (particularly tuberculosis) has already been well-established. There has been a dramatic increase in the prevalence of vitamin D deficiency around the world. There is association of Vitamin D insufficiency with increased risk and severity of respiratory infections. The high prevalence of osteoporosis and osteopenia in COPD patients may be an indication of a link between Vitamin D deficiency and COPD. Vitamin D can be beneficial in reducing exacerbations when taken in adequate amount and for a prolonged period of time. Aims: To find out the vitamin D deficiency and insufficiency in Hospitalized COPD patients. Main objective of the study was to compare different parameters including intensity of symptoms in COPD between vitamin D deficiency/ insufficiency group and that of Vit. D sufficient group in Hospitalized COPD patients. Materials and Method: This Institution based cross sectional observational study was done in patients admitted in the Department of Respiratory Medicine, CNMCH, Kolkata with a diagnosis of COPD or a presumptive diagnosis of COPD with acute exacerbations(AE) and fulfilling the inclusion criteria was studied from April 2020 to September 2021 (18 months duration)were included in this study. Result: In our study the mean age in Vit. D deficient and insufficient patients were about 54 years. 51.7% patients were Vit. D deficient and 16.7% were Vit D. insufficient. Vit. D deficient patients were mostly male (93.5%) and insufficient were all female (100%). in Vit. D deficiency group, 54.8% patients had habit of smoking. It was found that most patients (Total 96.7%) among Vit. D deficiency were having CAT Score 9 and 10. It was found in our study that Vit. D deficient patients were having mean CAT Score of 9.61 and insufficient patients had 7.2, whereas in Vit D sufficient group, mean CAT Score was 7.7. Most patients (Total 93.5%) among Vit. D deficiency were having mMRC Score 3 and 4, with mean mMRC Score of 3.54. Vit. D deficient patients were all (100%) having GOLD Stage III and most insufficient patients were having GOLD Stage II (80%). Vit. D deficient patients were having mean FEV1 of 39.67 and insufficient patients had mean FEV1 of 60.5, whereas in Vit D sufficient group, it was 82.52. Conclusion: In COPD patients severe vitamin D deficiency was related to more severe disease exacerbations. The patients with COPD admitted for exacerbation are a risk group for vitamin D deficiency and insufficiency, which is associated with worse disease characteristics.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is an important etiology for development of chronic liver disease worldwide. NAFLD encompasses a range of conditions, including steatosis, steatohepatitis, cirrhosis, and the development of hepatocellular carcinoma. NAFLD is associated with multiple risk factors such as obesity, type 2 diabetes, dyslipidemia, a diet rich in fat, sedentary habits, and a combination of genetic, epigenetic, and environmental influences, with dyslipidemia playing a significant role. Given the observed variations in lipid profile parameters among the Indian population compared to Western populations, our research aims to investigate the distribution of various lipid profile parameters in Indian individuals with NAFLD. Additionally, we plan to assess hs-CRP levels alongside lipid profiles. Results: Mean age of the study population was 45.3 years ranging from 22 years to 68 years. Dyslipidemia was found in 48 patients in our study population. Mean value of total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein were 185.5 mg/dl, 179.2 mg/dl, 120.5 mg/dl and 48.3 mg/dl respectively. Total cholesterol, triglyceride and low-density lipoprotein were increased in 38.3%, 56.7% and 38.3% respectively. High-density lipoprotein was decreased in 23.3% cases. The study showed elevated hs-CRP levels in 53 patients. The median value of hs-CRP was 6.36 mg/L and the interquartile range was 11.55 mg/L. Among 60 patients enrolled in the study, 27 were detected with NAFLD as an incidental finding. The rest of the patients had different symptoms related to NAFLD. No association was found between dyslipidemia and elevation of hs-CRP levels in our sample of NAFLD patients. Conclusion: Dyslipidemia in the form of hypertriglyceridemia is common among Indian NAFLD patients. Although dyslipidemia occurs along with hs- CRP elevation in NAFLD patients, the degree of hs-CRP elevation doesn’t correlate with degree or type of dyslipidemia, indicating the presence of other factors besides dyslipidemia in the development of inflammation in NAFLD.

Hip joints have significant role in human locomotion. Measurement of different parameters of proximal ends of femur help the clinicians for treatment of proximal femur fractures and also helpful for biomechanical engineers to formation of prosthetic limb. To measure different parameters. 1.) Head Transverse Diameter, 2.) Neck Transverse Diameter, 3.) Femoral Neck Length, 4.) Head Vertical Diameter, 5.) Neck Vertical Diameter. Knowledge of the which may help the orthopedic surgeons to insert intramedullary nails, plates, screws, pins etc. more accurately to avoid neurovascular complications. A total of 83 dried non pathological femur bones of both right & left side collected from department of Anatomy of KPC Medical College and Hospital. Different parameters are measured by a digital vernier caliper. The variables Head Transverse Diameter, Neck Transverse Diameter, Femoral Neck Length, Head Vertical Diameter, and Neck Vertical Diameter are measured. Standard deviation and mean values are calculated accordingly of both sides of femur.

Objective: To ascertain the results of surgical therapy in individuals with depressed skull fractures. Study Design: Prospective Study. Place and Duration of Study: Conducted in the Neurosurgery Department of Guwahati Medical College and Hospital in Guwahati from March 15th, 2024 to December 15th, 2024. Methodology: The study comprised 70 patients of both genders, ranging in age from 12 to 70 years. The patients’ ages ranged from 12 to 70. After obtaining informed written consent from all patients/parents/guardians, detailed demographic information such as age, gender, BMI, cause of fracture, type of fracture, and fracture site were recorded. All patients underwent a CT scan. Patients were subjected to evaluation for 10 weeks. The Glasgow Coma Scale (GCS) was utilized to determine the final outcome. The data was analyzed using SPSS 27.0. Results: Male patients constituted 45 (64.28%) of the total, while female patients made up 25 (35.71%). The study reordered 35 participants (50.00%) under 30, 25 (35.71%) between 30 and 50, and 10 (14.28%) over 50. The average body mass index was 22.04 ± 3.14 kg/m2.The most prevalent cause of injury was a traffic accident 47 (67.14%), followed by a fall from a height 23 (32.85%). 42 (60.00%) were complicated fractures, while 28 (40.00%) were closed fractures. 58 cases (82.85%) were treated surgically, whereas 12 (17.15%) were handled conservatively. 48 patients (68.57%) were fully healed, 12 (17.14%) were moderately impaired, 7 (10.00%) were severely disabled, and 3 (4.28%) died. Conclusion: Most instances with complex depress skull fractures showed favorable results if treated immediately, although the prognosis of the depress skull fracture was dependent on the severity of the injury and the absence or presence of an intracranial lesion.

Background: Gallbladder diseases represent a common clinical and pathological condition, frequently encountered in surgical practice. These conditions range from benign non-neoplastic lesions, such as cholecystitis, to malignant neoplasms, including adenocarcinoma. Comprehensive histopathological examination of cholecystectomy specimens is essential for diagnosis and management. Methods: This retrospective study analyzed 1,086 cholecystectomy specimens received over three years at Sardar Patel Medical College, Bikaner. Gross and microscopic features were evaluated, focusing on non-neoplastic and neoplastic lesions. Clinical and demographic data were also collected and analyzed. Results: The mean age of patients was 45.93 ± 14.95 years, with the majority (49.42%) in the 41–60 age group. A significant female predominance was noted, with a female-to-male ratio of 3.9:1. Non-neoplastic lesions comprised 98.5% of cases, with chronic non-specific cholecystitis being the most prevalent (82.6%). Rare findings included xanthogranulomatous cholecystitis (4.9%) and eosinophilic cholecystitis (1.2%). Neoplastic lesions were identified in 1.5% of cases, predominantly adenocarcinomas (66.7%). A significant association between increased gallbladder wall thickness and malignancy was observed. Conclusion: Chronic non-specific cholecystitis was the most common histopathological diagnosis, with a clear female predominance and peak incidence in the fifth to seventh decades of life. Gallbladder carcinoma, though rare, exhibited significant associations with gallstone presence and increased wall thickness. This study emphasizes the critical importance of thorough histopathological examination of all cholecystectomy specimens to ensure accurate diagnosis and early detection of malignancies.

Introduction: It is the first unpaired anterior branch of the abdominal aorta. The coeliac trunk is a short, wide artery about 1.25cm long. It arises from the front of the aorta immediately below the aortic opening of the diaphragm, opposite to the lower border of T12 vertebra. The trunk of artery proceeds forward, somewhat to the right & divided into three branches-left gastric, splenic, common hepatic artery. It supplies the abdominal foregut derivatives -distal oesophagus, stomach, proximal 1/3^rd of duodenum, liver, gall bladder, pancreas and spleen. Aim and Objectives: It is of great importance for the surgical intervention & interventional radiological procedures to be aware of the variation of the coeliac trunk & its branches during surgical & radiological procedures in upper abdomen. The main objective of the present study is to know the level of origin & variation in the branches of the coeliac trunk. Methods: The present study was undertaken on 22 formalin fixed cadavers (20male&2female) used for undergraduate dissection from department of Anatomy, Osmania medical college over a period of 2 years. Result: The hallers tripod was found in (2=9.09%), left inferior phrenic artery arises from celiac trunk in (1=4.5%) and common inferior phrenic artery arises from the coeliac trunk in(1=4.5%), gastroduodenal artery directly arises from celiac trunk in(1=4.5%), unusually aberrant left hepatic artery arises from left gastric artery in (1=4.5%),an accessory left gastric artery arising from left hepatic artery in(1=4.5%). Conclusion: From this study we conclude that variation in the branches of coelic trunk is very common. Knowledge about these variations is important for surgeons during liver transplantation, liver resection for liver cancer, cholecystectomy, gastrectomy for gastric cancers & pancreatic resection for pancreatic cancer, also important for radiologists during diagnostic and therapeutic conventional angiography.

Background: FNAC is a valuable, rapid, accurate and cost-effective diagnostic tool in breast lesions with excellent patient acceptance and low or no morbidity. It guides the surgeons to plan further treatment in most cases without proceeding for biopsy Objective: This study was designed to evaluate the role and diagnostic utility of FNAC in breast lesions in correlation with histopathological examination. Materials and Methods: This is a prospective study conducted in the department of pathology in GMKMCH, Salem from the period of November 2016 to June 2018 after getting approval from the institutional ethical committee. All patients of all age groups of both genders were included in the study. The results of FNAC were correlated with histopathological diagnosis and the data was analyzed with IBM.SPSS Statistics Software 23.0 Version. Results: In this study the sensitivity of FNAC was found to be 86.21%, the specificity was 95.83%, Positive predictive value was 96.15%, Negative predictive value was 85.19% and accuracy was 91.02%. Conclusion: This study has concluded that FNAC has a high degree of sensitivity, specificity and accuracy in the diagnosis of breast lesions.

Background: In general, fungal infections are one of the contributors of disease burden in the community and Variation in drug response and day by day increasing burden of ADRs, this study emphasis on need of effective evaluation and need of reporting of ADRs. Aim & Objectives: The present study was designed to analyze various clinical pattern of ADRs due to antifungal drugs in the dermatology department of a tertiary care teaching hospital. Methods: After getting permission from the ethics committee, this prospective observational cross-sectional study was conducted for seven months in the dermatology outpatient department of a tertiary care teaching hospital in western India to evaluate various clinical patten of ADRs due to antifungal drugs. Results: Total 24 ADRs were reported out of 900 patients. Most common ADRs noted were epigastric pain in 11 patients, followed by hair fall in 9 patients. Itraconazole is most commonly responsible for hair fall and Fluconazole is most commonly responsible for epigastric pain. Conclusions: For reduction of mortality and morbidity monitoring and reporting and assessment of ADRs were necessary. For better patient care, drug safety and rational use of medicines knowledge of various drugs responsible for ADRs are must for health care professionals.

Introduction –Snake bites are a significant public health concern, particularly in rural and impoverished regions where children are disproportionately affected. The World Health Organization (WHO) has classified snakebite envenoming as a Neglected Tropical Disease, highlighting its severe impact on global health. Each year, millions of people suffer from snake bites, with children being especially vulnerable due to their smaller body mass and higher likelihood of encountering snakes during outdoor activities. Effective prevention and management strategies are crucial to reduce the burden of snake bites among children. This study aims to explore the epidemiology, clinical features, and outcome of paediatric snake bites, emphasizing the need to protect this vulnerable population. Methods: This study is a retrospective single centre study conducted in Government Medical College in Raigarh Chhattisgarh from July 2022 to December 2024 including 71 paediatric patients below 14 years of age, who presented with a history of snake bite. Clinical data about age, sex, clinical manifestations, complications, management and outcome were collected and analysed. Results: In our study including of 71 patients, maximum snake bites incidents were noted in age group of 6-10 years (38.0%) with male predominance (64.2%). Most of the bites occurred during monsoon season (42.3%) in day time (57.7%) during outdoor activity (85%). Site of bite was mainly on lower limbs (80.3%) of patients. Almost 100% were unprovoked bites. Among all patients 35 (49.9%) children had signs of envenoming. Among those who had signs of envenoming majority of the bites were neuroparalytic (93.9%) and maximum cases responded to 10-20 vials of anti-snake venom (ASV). Mortality was 11.4% and it was higher among children who received ASV after 6 hours. Conclusions: This study provides a comprehensive analysis of the clinical profile and outcomes of snake bites among children. Our findings indicate that early intervention and appropriate management significantly improve recovery rates and reduce complications. The data underscores the importance of public health initiatives aimed at educating communities about snake bite prevention and first aid measures. The serious clinical features of snake bite in children also warrant early referral and management in tertiary care centres.

Background: The anatomy of the extra-hepatic biliary tree (EHBT) is crucial for surgeons, as it is a common site for both anatomical variations and surgical procedures. This study aimed to find the prevalence of anatomical variations of extrahepatic biliary system in patients undergoing laparoscopic cholecystectomy. Methods: This cross-sectional observational study was conducted in patients of either gender and >18yrs of ages, with USG finding of cholelithiasis and was treated by laparoscopic cholecystectomy. Patients of gall bladder perforation, biliary peritonitis and who refused to participate were excluded out. Structures mainly asses during laparoscopic cholecystectomy for gall bladder, cystic duct, common bile duct, cystic artery and hepatic artery and was recorded in proforma. Results: The vast majority of participants, 173 out of 198 (87.4%), have no anatomical variations in their gallbladder. Intrahepatic gallbladders were found in 20 (10.1%) individuals. Only one individual (0.5%) has a cystic duct that enters the right hepatic duct, a rare variation. Three participants (1.5%) have a cystic duct that inserts along the medial aspect of the common bile duct. A small percentage of cases exhibited variations. Specifically, “Moynihan’s Hump” was found in 3 (1.5%) cases. One individual (0.5%) has double cystic arteries, one case (0.5%) has cystic artery originating anterior to cystic duct and the one case (0.5%) has where cystic artery originated from accessory right hepatic artery. Only 1 (0.5%) of the cases, displayed a pre duodenal portal vein variation. There was no incidence of injury to biliary tree or episode of abnormal bleeding from hepatobiliary vasculature. Conclusion: This study contributes valuable insights into the demographics, conditions, and anatomical variations associated with gallbladder diseases. While it reflects established trends and provides useful data for clinical practice.

Introduction: Cataract and glaucoma often coexist in elderly patients, impacting the treatment and prognosis of both conditions. This study aims to identify the risk factors associated with poor intraocular pressure (IOP) control following combined small incision cataract surgery (SICS) with trabeculectomy. Materials and Methods: Seventy five patients operated for SICS with Trabeculectomy were included in study. A detailed history, preoperative and postoperative evaluation including visual acuity, slit lamp examination, applanation tonometry, gonioscopy, automated perimetry and fundus examination was done. Patients were followed up for one year. Statistical analysis was performed by using Correlation coefficient and Relative risk. Results and Discussion: Among 81 eyes operated, 58 eyes had good IOP control and 23 eyes had poor IOP control at the end of one year. Postop IOP >10mmHg on day 5 (p = 0.002) and IOP >13mmHg on day 10 (p = 0.001) and an increase of IOP of 4 mmHg between day 1 and 1 month of surgery (p = 0.04) were significant risk factors for poor prognosis at one year. Complete success rate of procedure was 60.5%, and qualified success rate of procedure was 96%. Conclusion: Combined SICS with trabeculectomy shows 96 % success in managing cataract with glaucoma in elderly patients. IOP >10 mmHg in the first week and an increase in IOP of 4 mmHg in the first month were significant risk factors for poor IOP control at 1 year. Further studies with longer follow-up periods and a larger sample size are recommended to validate these findings.

Introduction: Urinary tract infection is the most common bacterial infection in all age groups. By delaying the administration of antibiotics there is decrease in survival by 8% every hour. So the aim of the study is to analyse the rapid diagnostic tests like Urine microscopy and Dispstick assays by comparing with urine culture. Materials and Methods: This is a prospective study where 1081 urine samples of suspected UTI cases were included for analysis. Dipstick assays like Urine nitrate and Leukocyte esterase, Urine microscopy and Culture results of these patients were obtained. All these parameters were compared statistically by using excel. Results and Discussion: Out of the 231 culture positive cases 23.8% were nitrate positive, 30.7% were leukocyte esterase positive and 56.7% were positive in urine microscopy. The sensitivity increased to 64.9% if all the three tests considered together. The sensitive of rapid diagnostic tests were highest in Enterobacteriaceae family (73.8%). Similar studies by Taneja et al and Sadika et al showed still higher sensitivity values. Conclusion: Combination of Urine microscopy and dipstick tests improve the sensitivity of detecting urinary tract infection.

Objective: To assess the prevalence of’ deranged liver function test in pregnant patients presenting with hypertensive disorders regularly attending the antenatal clinic and to identify its effect on foeto-maternal outcome. Material and Method: it was a prospective study of 115 pregnant women who were attending the antenatal clinic during their second trimester and third trimester with hypertensive disorder with deranged liver function test. They were also evaluated for liver function test like serum transaminases and alkaline phosphatase. All the enrolled mothers were under close follow-up and they were checked for the development of any intrapartum, postpartum complications, mode of delivery and development of any foetal complications. Results: Present study shows the occurrence of’ Deranged LFT in hypertensive pregnancy was 37.39%. 62% of’ the pregnant mothers with hypertension with abnormal LFT developed antenatal complication; most common Antenatal complications were eclampsia. 21% developed postnatal complication. 42 subjects developed foetal complication in which 25.5% had NICU stay. Conclusion: In a sub Himalayan region like Jalpaiguri where the occurrence of Hypertension in pregnancy is comparatively high. Deranged liver function test is associated with adverse foeto-maternal outcomes.

Introduction: Antimicrobial resistance (AMR) is a global problem due to widespread and irrational use of antimicrobial agents. Healthcare workers (HCWs) can reduce this problem by following antimicrobial stewardship (AMS) programmes. Aim: This study was carried out to assess the Knowledge, Attitude, and Practice (KAP) of HCWs regarding antimicrobial stewardship. Material & Methods: This cross-sectional study was conducted over 3 months with 165 participants, of whom 55% were resident doctors, 17% were consultant doctors, 18% were nurses, 10% were pharmacists. Data were collected with a validated self-administered electronic questionnaire and analysed using SPSS 16. Knowledge, Attitude and Practice scores were analysed with Shapiro-Wilk test and found not to be normally distributed. Pearson Chi-square test was used for categorical data with a significance level set at p <0.05. Results: Our study showed that knowledge and attitude score in pharmacists was the best among all groups. Practice score was not good in any groups. Knowledge, but not attitude and practice had significant correlation with work experience. A gap between knowledge and practice was found in 46.7% of participants. Conclusion: Our study highlights the wide gap between knowledge and practice of AMS among HCWs. Various factors, including exposure to AMS during training, and total years of working experience, were found to be important predictors of KAP among the HCWs we surveyed. Our findings suggest the need for continuing education to bridge these gaps and promote rational antibiotic use to combat AMR.

Introduction: Many adjuvants like opioids are added to the local anaesthetic agents for better and prolonged postoperative analgesia for orthopaedic surgeries done under spinal anaesthesia. In our study, we compared the efficacy of Fentanyl versus Nalbuphine as intrathecal adjuvant to hyperbaric Bupivacaine in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: A randomized double-blinded study was conducted at a Tertiary care center on 100 ASA grade I and II adult patients divided into two groups, A and B, having 50 patients each, scheduled for lower orthopaedic surgeries under spinal anaesthesia. Group A received 3 ml Bupivacaine with 25 mcg Fentanyl, whereas Group B received 3 ml Bupivacaine with 0.5 mg Nalbuphine intrathecally. The onset and duration sensory and motor blockade, duration and quality of analgesia, hemodynamic changes and adverse effects were studied statistically, using Graph pad prism version 3.0. The quantitative variables were compared using unpaired t-test whereas qualitative variables were compared using Chi-square test. Results: The differences between onset of sensory and motor blockade between two groups is significant (p < 0.05). The duration of sensory blockade, motor blockade and analgesia were significantly prolonged in Group B compared to Group A (p<0.05). Not a single patient from Group B required rescue analgesia whereas 15 patients from Group A required rescue analgesia. No complications seen in both the groups. Conclusion: Nalbuphine is better intrathecal adjuvant to hyperbaric bupivacaine than Fentanyl, having faster onset of sensory and motor block with better analgesia, with hemodynamic stability and without any side effects.

Acne vulgaris is a widespread dermatological condition characterized by the presence of comedones, papules, pustules, and cysts, affecting a substantial portion of the global population, particularly adolescents and young adults. The pathogenesis of acne involves a multifactorial process, including hyperseborrhea, follicular hyper keratinization, microbial colonization, and inflammation. Conventional treatments, such as antibiotics, retinoids, and hormonal therapies, are often associated with adverse effects, including skin irritation, dryness, and antibiotic resistance. Consequently, there is a growing interest in exploring alternative therapeutic approaches that offer efficacy with minimal side effects. Herbal medicines have been traditionally used for centuries to treat various skin conditions, including acne. The natural compounds in herbs exhibit a broad spectrum of biological activities, such as anti-inflammatory, antimicrobial, antioxidant, and sebum-regulating properties. However, the clinical application of herbal extracts is often limited by their poor solubility, stability, and bioavailability. Recent advances in nanotechnology have introduced nanoemulsions as a promising delivery system for herbal medicines, addressing these limitations and enhancing their therapeutic potential. Nanoemulsions are colloidal dispersions of oil and water stabilized by surfactants, with droplet sizes typically ranging from 20 to 200 nm. The unique physicochemical properties of nanoemulsions, such as increased surface area, kinetic stability, and enhanced solubility, make them ideal carriers for delivering lipophilic and hydrophilic herbal compounds. This review aims to comprehensively explore the formulation, characterization, and therapeutic efficacy of herbal nanoemulsions in the treatment of acne vulgaris.