Microalbuminuria is an important predictor of renal and cardiovascular complications1 in patients with type 2 diabetes mellitus (T2DM). Early detection of microalbuminuria in recent-onset T2DM provides an opportunity to delay or prevent the progression to diabetic nephropathy and cardiovascular morbidity2. This study aims to determine the incidence of microalbuminuria in patients with recent-onset T2DM using spot urinary albumin-to-creatinine ratio (ACR) testing.

DOI: 10.5281/zenodo.

Background/Introduction: Adverse drug reactions (ADRs) are a significant challenge in pharmacovigilance, often underreported due to reliance on spontaneous reporting systems. Active surveillance provides a systematic approach to monitor and report ADRs, enhancing detection and reporting quality. This study assesses the impact of active surveillance on COVID-19 vaccine-related ADR reporting at a designated monitoring center. Aim/Objective: To analyze the impact of active surveillance on the reporting of COVID-19 vaccine-related adverse drug reactions compared to passive surveillance. Methodology: This retrospective observational study was conducted at the ADR monitoring center of Pt. JNM Medical College and Associated Dr. BRAM Hospital, Raipur, Chhattisgarh, under the Pharmacovigilance Program of India. The study included all adverse events following immunization (AEFIs) related to COVID-19 vaccination reported from January 10, 2021, to December 31, 2022. Data were collected through both passive and active surveillance methods. Active surveillance involved contacting beneficiaries via telephone within 7±3 days post-vaccination. All identified AEFIs were documented, analyzed, and compared for completeness and accuracy. Statistical analysis was performed using descriptive statistics, and results were presented in graphs and tables. Results: During the study period, 94,294 doses of COVID-19 vaccines were administered, and 4,480 telephone calls were made to beneficiaries. A total of 685 ADRs were reported, with 353 (51.5%) related to COVID-19 vaccines. Of these, 334 (94.6%) were reported in 2021 and 19 (5.4%) in 2022. Active surveillance identified 312 (93.4%) AEFIs in 2021 and 8 (42.1%) in 2022, while passive surveillance accounted for 22 (6.6%) AEFIs in 2021 and 11 (57.9%) in 2022. Most AEFIs were associated with the first dose (91.5%), followed by the second dose (6.5%) and the third dose (2.0%). Gender distribution showed a higher reporting rate among females (53.75%) compared to males (44.31%). Conclusion: Active surveillance significantly improved the detection and reporting of COVID-19 vaccine-related AEFIs compared to passive surveillance. The proactive approach facilitated timely identification of ADRs, contributing to enhanced patient safety and informed decision-making in pharmacovigilance.

DOI: 10.5281/zenodo.

Anal fissures are a common yet distressing condition characterized by a painful linear tear in the anoderm, often leading to severe discomfort, bleeding, and altered bowel habits. Although acute fissures can resolve with conservative treatment, chronic fissures frequently require targeted intervention to break the cycle of pain, sphincter spasm, and ischemia.
The management of anal fissures primarily revolves around two approaches: pharmaceutical therapy aimed at reducing sphincter spasm and promoting healing, and surgical intervention, which remains the definitive treatment for refractory cases. Pharmaceutical options such as topical nitrates, calcium channel blockers, and botulinum toxin aim to relax the internal anal sphincter and enhance perfusion, whereas surgical options, particularly lateral internal sphincterotomy (LIS), directly relieve sphincter pressure, often providing long-term relief. However, concerns about postoperative complications, particularly fecal incontinence, continue to fuel debate over the ideal management strategy.
This systematic review critically evaluates and compares pharmaceutical and surgical management of anal fissures by analyzing their efficacy, recurrence rates, side effects, and patient satisfaction. By examining the latest evidence, we aim to provide clarity on the optimal treatment approach, balancing effectiveness with safety to guide clinical decision-making. Anal fissures are small tears in the lining of the anal canal, often causing significant pain and bleeding during defecation. Management strategies for chronic anal fissures primarily include pharmaceutical interventions and surgical procedures, notably lateral internal sphincterotomy (LIS). This systematic review aims to compare the efficacy and safety of pharmaceutical treatments versus LIS in the management of chronic anal fissures.

DOI: 10.5281/zenodo.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is closely linked to insulin resistance, obesity, and Type-2 Diabetes Mellitus. The progression of NAFLD from steatosis to Non-Alcoholic Steatohepatitis (NASH), and cirrhosis is a significant health concern. Prediabetes, characterized by elevated blood sugar levels, is often associated with an increased risk of developing NAFLD. Objective: To assess the effect of Saroglitazar, a dual-activity PPAR-α/γ agent, on the Fibrosis-4 (FIB-4) score and safety in prediabetic patients with NAFLD, highlighting the score’s cost-effectiveness and accessibility compared to invasive diagnostic methods. Methods: This six-month prospective, single-center, observational study was conducted at the Department of Pharmacology, MGM Medical College, Aurangabad. It included 65 prediabetic individuals with NAFLD, confirmed by ultrasonography. Patients were administered 4 mg of Saroglitazar once daily. The FIB-4 score was calculated at baseline, 3 months, and 6 months to assess the effectiveness of the treatment. Results: The study included 65 participants (41 males, 24 females) with a mean age of 54.4±7.83 years. The baseline FIB-4 score was 2.132 ± 0.34. A statistically significant reduction in FIB-4 scores was observed at 3 months (1.723 ± 0.27) and 6 months (1.514 ± 0.24). Adverse events were minimal, with only two patients reporting nausea and gastrointestinal upset. Conclusion: Saroglitazar significantly reduced the FIB-4 score in prediabetic patients with NAFLD over a 6-month period, indicating an improvement in liver health. The treatment was well-tolerated with minimal adverse events. This study supports the potential of Saroglitazar as a non-invasive, effective treatment option for NAFLD in prediabetic individuals, particularly in resource-constrained settings like India.

DOI: 10.5281/zenodo.

Introduction: Intrauterine growth restriction (IUGR) is a major obstetric concern, contributing to increased perinatal morbidity, mortality, and long-term neurodevelopmental impairment. Identifying growth-restricted fetuses and implementing timely interventions is a critical aspect of antenatal care. While ultrasonography is useful for fetal growth assessment, Doppler velocimetry provides a non-invasive means of evaluating feto-placental circulation, offering crucial insights into fetal hemodynamic status. This study evaluates the utility of umbilical artery and middle cerebral artery (MCA) Doppler indices in predicting IUGR and adverse perinatal outcomes. Materials and Methodology: A prospective observational study was conducted over eight months on 120 antenatal women with clinically suspected IUGR in the second and third trimesters. Doppler ultrasonography was performed to assess umbilical artery pulsatility index (PI), MCA PI, and cerebroplacental ratio (CPR). The correlation between these Doppler parameters and perinatal outcomes, including birth weight and NICU admission, was analyzed. Statistical significance was determined using chi-square tests. Results: Umbilical artery PI exhibited the highest sensitivity (81%) for predicting IUGR, while CPR demonstrated the highest specificity (79%). Abnormal umbilical artery and MCA PI were significantly associated with low birth weight (p = 0.009, p = 0.017) and NICU admission (p = 0.021, p = 0.028). A reduced CPR was also strongly correlated with adverse perinatal outcomes (p = 0.006). Conclusion: Doppler ultrasonography is a valuable tool for assessing fetal well-being in IUGR cases. Umbilical artery PI serves as a sensitive predictor, while CPR is highly specific for adverse outcomes. Integrating Doppler assessments into routine antenatal care can aid in timely interventions and improved perinatal outcomes.

DOI: 10.5281/zenodo.

Objectives: To study the outcome and risk factors in neonates of premature rupture of membranes delivery and to study the mortality and morbidity in neonates caused by premature rupture of membranes due to such causes as early onset sepsis, asphyxia, respiratory distress, preterm born, lbw. Methods: The methodology for this study was conducted at the Index Medical College and Hospital in Indore, Madhya Pradesh, from January 2018 to June 2019. From January 2018 to June 2019, all 105 newborns who were admitted to the hospital with symptoms of respiratory distress syndrome, early onset sepsis, pneumonia, and low birth weight were included in the study. A comprehensive checklist was utilized to gather demographic information about both the neonates and their mothers during the data collection process. Neonatal information included preterm, rds, birth asphyxia, neonatal sepsis, pneumonia, neonatal jaundice, seizure, hospitalization in Nicu. Results: most of the babies that were delivered were girls (57.1%), while 42.9% were boys. The ratio of males to females in the study was approximately 2:1. 33. Most common illness associated with mother was iron deficiency anemia (15. 2%) followed by megaloblastic anemia (7.6%), oligohydramnios in (5.7%), diabetes oligohydramnios in 4.8%. Among the 105 newborns, 60 (60%) tested positive for sepsis, while among the 105 mothers, 38. 1% tested positive. Conclusion: PROM is a significant factor contributing to neonatal mortality. Maternal health conditions linked to prom were iron deficiency anemia, megaloblastic anemia, diabetes, and oligohydramnios. A substantial number of mothers and newborns tested positive for sepsis. Neonatal morbidities and mortality, including jaundice, seizures, fever, and pneumonia, were significant issues, with one-third of neonates experiencing these complications.

DOI: 10.5281/zenodo.

Background: Thrombocytopenia is a commonly encountered hematologic condition necessitating a comprehensive assessment to ascertain its underlying etiology. The aim was to study platelet parameters and their correlation with clinical findings, other laboratory tests, and causes of thrombocytopenia. Material and Method: This was a descriptive cross-sectional study conducted in the Department of Pathology at GITAM Institute of Medical Sciences and Research, Visakhapatnam for a period of one and a half years from September 29, 2022, to March 28, 2024. Patients with a platelet count of less than 150,000/µL were included in the study. Results: A total of 308 thrombocytopenia cases were analyzed in this study. The most common age group with thrombocytopenia was between 20 and 40 years (51.6%). The male-to-female ratio is 1.6:1. Most patients (37%) had platelet counts ranging from >75,000-150,000/cu mm (Grade 1). Of the 308 cases, 62% had high Mean Platelet Volume, and 64% had high Platelet Distribution Width. We encountered 98% of cases with fever. Dengue was the most common cause of thrombocytopenia (64.5%), followed by viral fever (25%), malaria (6.1%), chronic liver disease (CLD) (3.5%), idiopathic thrombocytopenic purpura (ITP) (0.6%), and acute leukemia (0.3%). Conclusion: Infectious diseases are the leading cause of thrombocytopenia, with dengue being the most common, followed by viral fever and malaria. Evaluating platelet counts and related indices is essential for the early diagnosis and treatment of medical conditions.

DOI: 10.5281/zenodo.

Endometrial sampling is a crucial diagnostic procedure for women with suspected endometrial pathology presenting with abnormal uterine bleeding (AUB). Conventional uterine curettage (CUC) and manual vacuum aspiration (MVA) are two common methods used for endometrial sampling. This study aimed to compare the efficacy, safety, and patient satisfaction of CUC and MVA for endometrial sampling in women with suspected endometrial pathology presenting with AUB. A prospective, randomized controlled trial was conducted at a tertiary care hospital, involving 100 women with suspected endometrial pathology. The results showed that MVA was superior to CUC in terms of efficacy, safety, and patient satisfaction. MVA had a higher success rate (96% vs. 82%), lower complication rate (4% vs. 18%), and higher patient satisfaction rate (92% vs. 76%) compared to CUC.

DOI: 10.5281/zenodo.

Background: Inguinal hernioplasty is a frequently performed surgical procedure associated with moderate to severe postoperative pain. Effective postoperative analgesia is essential to prevent adverse outcomes. The ultrasound-guided transversus abdominis plane (TAP) block targets the anterolateral abdominal wall’s innervation from T6-L1, which can enhance analgesia duration, delay the first analgesic request, lower overall analgesic consumption, and reduce opioid-related side effects. Adjuvants like dexmedetomidine, clonidine, dexamethasone, and fentanyl are often used to prolong the effects of bupivacaine. This study evaluated the addition of two doses of dexmedetomidine (0.5 mcg/kg and 1 mcg/kg) to bupivacaine for the TAP block, with the objective of determining which dose provides optimal postoperative analgesia. Aims and Objectives: Aim of the study is to evaluate two doses of dexmedetomidine(0.5mcg/kg and 1 mcg/kg) in ultrasound guided transversus abdominis plane block for postoperative analgesia in patients undergoing unilateral inguinal hernioplasty. Primary objective was to identify optimal doses of dexmedetomidine added to bupivacaine for postoperative analgesia in unilateral inguinal hernioplasty while secondary objectives were to observe the time and average dose of rescue analgesics , level of sedation and other adverse effects related to drugs and technique, if any. Materials and Methods: A prospective hospital based study was conducted at Gandhi Medical College , Bhopal comprising of 80 patients between age group 18-60 years , male,  belonging to ASA grade I to II, scheduled for elective unilateral inguinal hernioplasty under the subarachnoid block (SAB) after informed consent. GROUP 1- 40  patients received a unilateral TAP block using 22 ml solution— consisting of 20 ml 0.25% bupivacaine and 0.5 mcg/kg dexmedetomidine dissolved in 2 ml normal saline. GROUP  2 – 40 patients received a unilateral TAP block using 22 ml solution— consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg dexmedetomidine dissolved in 2 ml normal saline. Diclofenac 75mg was used as rescue analgesia. Post operative pain is evaluated by VAS score for pain at 0,2,4,8,12 and 24 hrs postoperatively, time to 1st request of analgesia ,total analgesia sedation by ramsay sedation score and any complications were noted. Result: There was no statistical significant difference between the two groups in demographic characteristics (age, weight, side of surgery, duration of surgery, ASA), Group A consistently exhibited higher mean pulse rates and systolic blood pressure compared to Group B at various postoperative intervals especially at 1 and 2 hrs, with statistically significant differences. However, diastolic blood pressure and mean arterial pressure showed significant differences only at specific time points(1 and 2 hrs) postoperatively, with no significant variances at other intervals. Group A had lower VAS scores at rest and during coughing compared to Group B postoperatively at all time points, indicating better analgesia quality in Group B. Group B showed a longer mean time to first rescue analgesic (11.45 hours)compared to Group A (6.53 hours), indicating more effective pain management in Group B. Additionally, Group B had significantly lower total analgesic consumption in 24 hours (159.38 mg) compared to Group A (270 mg), suggesting better pain management efficacy or patient response in Group B. all 80 patients exhibited a Ramsay Sedation Score of 2. Only 5.0% of patients in Group B experienced bradycardia, which was successfully managed with atropine. Notably, neither group reported any instances of nausea, vomiting, or hypotension. Conclusion: This study elucidated that addition of 1 mcg/kg Dexmedetomidine to Bupivacaine in ultrasound guided TAP block for postoperative analgesia in unilateral inguinal hernioplasty gives better quality and longer duration of post- operative analgesia than 0.5 mcg/kg Dexmedetomidine. It provides longer first analgesia request time and lesser total analgesia consumption in 24 hours with minimal side effects like sedation, bradycardia, nausea and vomiting.

DOI: 10.5281/zenodo.

Background: Hepatitis C virus (HCV) remains a critical public health issue, especially among haemodialysis patients who are at higher risk of infection due to prolonged vascular access. The virus, a positive-sense RNA virus from the Flaviviridae family, can lead to chronic liver disease and complications if not detected and treated promptly. Aim: This study aimed to determine the seroprevalence of HCV among haemodialysis patients at a tertiary care center, analyze liver function parameters, and evaluate the correlation between HCV infection and patient demographics using statistical analysis. Methods: A prospective study was conducted between June and August 2021 at Department of Microbiology, Saveetha Medical College and Hospital, Chennai, India. A total of 86 haemodialysis patients were screened for anti-HCV antibodies using Chemiluminescence Immunoassay (CLIA). Positive samples were further confirmed using Real-Time Polymerase Chain Reaction (RT-PCR) to detect viral RNA and determine genotype distribution. Liver function tests (SGOT, SGPT, total bilirubin, and direct bilirubin) were assessed, and statistical significance was determined using appropriate tests (p-value <0.05). Results: Among the 86 patients, 11 (12.8%) were seropositive for HCV antibodies, of which 9 (81.8%) were confirmed positive by RT-PCR. Additionally, 16 (21.3%) seronegative patients tested positive for HCV RNA, emphasizing the limitation of antibody screening. The overall prevalence of HCV among haemodialysis patients was 29.1%. Elevated liver markers were observed in HCV-positive patients compared to seronegative individuals: SGOT (mean 68.4 ± 12.5 IU/L vs. 42.7 ± 8.9 IU/L, p = 0.002), SGPT (mean 72.3 ± 14.2 IU/L vs. 45.6 ± 9.3 IU/L, p = 0.001), total bilirubin (mean 1.8 ± 0.4 mg/dL vs. 1.0 ± 0.2 mg/dL, p = 0.003), and direct bilirubin (mean 0.9 ± 0.2 mg/dL vs. 0.5 ± 0.1 mg/dL, p = 0.004). Genotype analysis revealed genotype 3 as the most prevalent (62%), followed by genotype 1 (38%). Conclusion: The study highlights a high burden of HCV among haemodialysis patients, emphasizing the urgent need for routine screening using more sensitive methods such as RT-PCR. Infection control measures, including stringent sterilization protocols, staff education, and patient awareness programs, are critical in reducing the nosocomial transmission of HCV in dialysis centers. The findings call for policymakers to strengthen healthcare policies to ensure better diagnostic facilities and treatment options for high-risk groups.

DOI: 10.5281/zenodo.

Background: The COVID-19 pandemic has highlighted the significance of inflammatory markers in assessing disease severity and guiding clinical management. Among these, serum ferritin and interleukin-6 (IL-6) have emerged as key indicators of hyper inflammation and disease progression. This study evaluates the role of these markers in COVID-19 patients at a tertiary care centre. Objectives: This study aims to study the role of inflammatory markers with special reference to Serum Ferritin and IL-6 in COVID 19 patients in a tertiary care centre and to determine whether the associated factors correlate with the severity of COVID-19 disease. Materials and Methods: An observational cross-sectional study was conducted at a tertiary care centre, analysing 135 COVID-19 patients admitted. Patients were categorized into mild, moderate, and severe cases based on clinical and laboratory parameters as per ICMR guidelines. Serum ferritin, IL-6, CRP, D-dimer levels and LDH were measured at admission and correlated with disease severity, inflammatory response, and patient outcomes. Statistical analysis was performed using SPSS software, with significance set at p<0.05. To evaluate the diagnostic accuracy of IL-6 and ferritin in predicting disease severity, receiver operating characteristic (ROC) curves were generated. Results: Serum ferritin levels were significantly higher in moderate to severe cases compared to mild cases (p<0.01). IL-6 levels strongly correlated with disease severity (p<0.001). Ferritin demonstrated a higher AUC compared to IL-6, suggesting it may be a more reliable biomarker for disease severity in COVID-19 patients. However, both markers exhibited significant potential in distinguishing severe cases from mild/moderate ones. Conclusion: Serum ferritin and IL-6 levels serve as important biomarkers for assessing COVID-19 severity. Routine measurement of these markers in clinical settings can facilitate early risk stratification and guide therapeutic decisions. Future research should focus on targeted interventions to modulate these inflammatory responses and improve patient outcomes.

DOI: 10.5281/zenodo.

Introduction: The young cricket players who have ambitions of playing at the national or international level or various leagues need to maintain high fitness levels regarding the Yo-Yo intermittent recovery (IR) test scores. Sprint interval training which consists of short duration high-intensity exercise for few sessions per week is a time-efficient protocol for improving the aerobic capacity and repeated sprint ability. Present study was undertaken to assess the effect of sprint interval training on the Yo-Yo intermittent recovery (IR) test scores in club level cricket players and also to compare the YYIT scores with VO2max scores. Material and Method: The present study is a Randomised Controlled Trial was conducted on male cricket players aged 18 to 30 years playing more than 5 years of club level cricket. Study was conducted at a tertiary care hospital during year 2018-2020. Results:  In this study 18 subjects (9 in each group) were enrolled to take care of loss to follow up. In the sprint interval training group, the YYIT score improved from 14.73 ±0.71 level to 15.61±0.48 level. There was a statistical significant difference (p= 0.0005) after the intervention period of 8 weeks in the YYIT score in this group. Similarly, the VO2max values (ml/kg/min) improved from 46.0±4.48 level to 51.41±3.25 level. This was a statistical significant difference (p= 0.0018) after the intervention period of 8 weeks in the VO2max in this group. The YYIT score was 0.1±0.22 in the regular training group, and 0.88±0.46 in the sprint interval training group. This difference was also statistically significant with p value of 0.0003. Thus, sprint interval training improved the YYIT score significantly as compared to the regular training. Conclusion: There was a significant improvement in YoYo intermittent test scores and aerobic capacity with the addition of sprint interval training of 10 minutes thrice a week. So, the study results are encouraging and we recommend that the protocol should be used for all the players at the cricket academies.

DOI: 10.5281/zenodo.

Introduction: Epilepsy is a neurological condition characterized by recurrent seizures, impacting a considerable number of individuals and leading to substantial morbidity, mortality, as well as economic and social challenges. Objective: To evaluate the efficacy and safety of valproate and lamotrigine combination therapy in patients with resistant epilepsy. Method: A Prospective observational study was conducted during January 2022 to December 2023 at Department of General Medicine, Government Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India of 43 patients of resist any epilepsy with a mean age of 28.44 years. Results: Male 65.1% patients were predominant than female patients 34.9%. Out of 43 epilepsy patients, majority of patients i.e. 32.6% of patient’s observed excellent outcome, followed by 30.2% of patients were observed good outcome and fair outcome in 23.2% of patients and 13.9% of patient’s outcome was poor. None of our patient reported any adverse effect. Conclusion: This study extends previous evidence that Valproate and lamotrigine can be safely combined show a favorable therapeutic interaction in patients with resistant epilepsy.

DOI: 10.5281/zenodo.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. In that posterior canal BPPV is the most common compared to horizontal canal BPPV and superior canal BPPV respectively.  Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful canalith repositioning maneuvers for BPPV. This study evaluated the role of labyrinthine sedative, Meclizine hydrochloride in treating residual dizziness after successful canalith repositioning by Epley maneuver in posterior canal BPPV. Objectives: Role of Meclizine hydrochloride, a labyrinthine sedative in treating residual dizziness after successful canalith repositioning by Epley maneuver in posterior canal BPPV. Material and Methods: A total of 60 patients were included in the study. They were divided into two groups: 30 to group A which received Epleymaneuver with Meclizine and 30 to group B who received only Epleymanuever. Results: Of the 60 patients, on Day 1, Day 2, Day 3 for both the groups, in group A, by the 3^rd day 25 patients had no symptoms and 2 had a mild handicap, 3 had severe handicap. In group B, by 3^rd day, 24 patients had no symptoms, 3 patients had a mild handicap, 2 patients had a moderate handicap, and 1 patient had a severe handicap. The p value between the two groups was more than 0.05 and it was statistically not significant. Conclusion: Addition of labyrinthine sedative like meclizine after successful Epley maneuver does not seem to significantly improve the residual dizziness so it is advisable not to prescribe unnecessary medications after successful Epley maneuver.

DOI: 10.5281/zenodo.

Background: Type-II Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance, hyperglycemia, and β-cell dysfunction. Oxidative stress plays a significant role in diabetes pathogenesis and complications by promoting lipid peroxidation, DNA damage, and chronic inflammation. This study aims to investigate the correlation between biochemical markers and oxidative stress in T2DM patients compared to healthy individuals. Methods: A case-control study was conducted at Index Medical College, Hospital, and Research Center, Indore, under Malwanchal University (2022–2024). The study included 100 T2DM patients (cases) and 100 age- and sex-matched healthy individuals (controls). Oxidative stress markers (Malondialdehyde [MDA], Superoxide Dismutase [SOD], Catalase [CAT], and Glutathione Peroxidase [GPx]) were measured using spectrophotometric assays. Glycemic and lipid parameters were assessed, and statistical analysis was performed using SPSS v25.0 (p < 0.05 considered significant). Results: T2DM patients exhibited significantly higher MDA levels (4.5 ± 0.6 nmol/L) compared to controls (2.3 ± 0.4 nmol/L, p < 0.001). Antioxidant enzyme levels (SOD, CAT, GPx) were significantly reduced in cases (p < 0.001). MDA positively correlated with HbA1c (r = 0.62, p < 0.001), while SOD and CAT negatively correlated with fasting glucose (r = -0.58, p < 0.001). Conclusion: Oxidative stress is significantly elevated in T2DM, as indicated by increased lipid peroxidation and decreased antioxidant defenses. Strong correlations between oxidative stress markers and glycemic control suggest that antioxidant-based interventions could mitigate diabetes complications. Further research should explore personalized antioxidant therapies for improved diabetes management.

DOI: 10.5281/zenodo.

Aim of the Study: To study the clinical profile of patients with new onset seizures after 40 years of age. Material & Methods: A 100 cases of Clinical Etiological and radiological profile in late onset seizures patients admitted in the Department of General Medicine, Government Tertiary Care Hospital. Results: In present study majority of the patients were lying in the age group of 50 – 60 Years of age which was 40%, followed by 40-50 years (34%) and  26% of the patients were found in the age group of more than 60 years of age. Conclusion: Out of 100 cases, 56 patients (56%) had significant imaging findings pointing towards the diagnosis. So every patient with new onset seizures should undergo some form of imaging, CT- Plain/ contrast or MRI- Brain depending on the situation as part of evaluation. Smoking and Hypertension are most common risk factors for seizures. From the study, it is clear that most of the seizures in late adulthood are symptomatic (86%). So every care must be taken to evaluate the cause of new onset seizures in adults.

DOI: 10.5281/zenodo.

Background: Laparoscopic abdominal surgery, also known as minimally invasive surgery (MIS), has revolutionized the management of various abdominal conditions, offering benefits such as smaller incisions, reduced postoperative pain, shorter hospital stays, and faster recovery compared to traditional open surgeries. The widespread adoption of laparoscopic techniques for procedures like cholecystectomy, appendectomy, and hernia repair has significantly advanced surgical practice. Despite these advantages, laparoscopic surgery is not without risks, and port site complications are among the most common issues encountered postoperatively. Aim of the Study: To study the incidence and clinical outcome of port site complications following elective laparoscopic abdominal surgeries. Material & Methods:  This study was a prospective observational study conducted to evaluate the incidence, types, and management of port site complications in patients undergoing laparoscopic abdominal surgeries. Total No. of 50 cases was done and the study was conducted at Osmania General Hospital, Hyderabad from January 2022 to June 2023 and was approved by the institutional ethics committee. Results: The results of a prospective study conducted on 50 subjects undergoing various types of laparoscopic abdominal surgeries. The analysis focuses on the distribution of complications based on the type of surgery, the influence of port size and access technique, and the role of patient-specific factors such as age and BMI. By identifying and understanding the determinants of port site complications, this research aims to contribute valuable insights into the field of minimally invasive surgery and guide future surgical practices to achieve better patient outcomes. Conclusion: Laparoscopic abdominal surgeries offer numerous advantages, the management of port site complications remains a significant challenge. Continued research efforts aimed at refining techniques, identifying risk factors, and developing effective prevention and management protocols are crucial to advancing patient care and enhancing outcomes in this evolving field of surgery.

DOI: 10.5281/zenodo.

Introduction: Diabetes is a chronic condition with long-term complications and multisystem involvement. The prevalence of diabetes is increasing globally, posing a significant public health challenge. The coexistence of other comorbidities not only complicates disease management but also increases financial burdens and negatively impacts the quality of life. This study aims to evaluate the impact of musculoskeletal conditions on individuals with diabetes compared to those without the disease. Materials and Methods: A comparative study was conducted in community medicine and medicine department at Swaminarayan Institute of Medical Sciences and Research, a tertiary-level hospital located in Kalol, Ahmedabad among patients visiting tertiary care hospital.  The objective was to assess the prevalence of musculoskeletal disorders in individuals with and without diabetes. A total of 100 patients with diabetes and an equal number of non-diabetic individuals were sequentially enrolled. Results: The prevalence of musculoskeletal comorbidities was significantly higher in individuals with diabetes (46.2%) compared to the non-diabetic group (25.1%). The overall odds ratio (OR) for musculoskeletal disorders was 2.5 times higher in diabetes patients than in those without diabetes. Specifically, the OR for rheumatoid arthritis, chronic back pain, and osteoarthritis was 3.6, 2.9, and 1.7, respectively. Additionally, diabetic patients with musculoskeletal comorbidities experienced a poorer quality of life and higher direct treatment costs compared to those without such conditions. Conclusion: Musculoskeletal comorbidities are highly prevalent among individuals with diabetes, significantly affecting their quality of life and increasing treatment costs. Integrating musculoskeletal screening into routine diabetes complication assessments could facilitate early detection and timely intervention, ultimately improving patient outcomes.

DOI: 10.5281/zenodo.

Objectives: This mixed-methods study aimed to explore the experiences of 62 participants diagnosed with tuberculosis (TB), 57 individuals with direct contact with TB patients, and 61 members of the general public regarding TB-related stigma. Materials and Methods: The study used both qualitative and quantitative methods to understand TB stigma. A representative sample of 62 TB patients, 57 contacts, and 61 individuals from the general public was selected. Data were collected through structured questionnaires and in-depth interviews. Trends and patterns were analyzed using descriptive statistics and the Chi-Squared test. Results: Over half of the TB patients reported internalized stigma, including feelings of shame and fear of being perceived as contagious or different. 68% expressed anticipated stigma, fearing discrimination and avoiding open discussion of their illness. 10% reported enacted stigma, citing a lack of respect from medical staff. Females were more likely than males to experience both anticipated stigma and avoidance of discussing the disease (p-value). There was no significant association between gender and respect from medical professionals (p-value = 0.172). Among contacts, 30% believed poverty caused TB, and 79% feared community infection risks. Most contacts viewed TB patients with compassion (63%) and were willing to associate with them (82%). Male contacts were more likely to fear infection risks (p-value < 0.001). Among the general public, 72% feared infection, and 28% believed poverty caused TB. Education levels and sociodemographic characteristics, including gender and economic status, were linked to stigmatization, with significant differences in the perception of TB patients. Conclusion: The study highlights the persistent stigma surrounding TB, underlining the need for programs that reduce stigma, enhance public awareness of TB, and educate medical professionals to treat patients with respect. Public education on TB causes is essential to reduce stigma, and targeted interventions to support TB patients’ social integration are necessary.

DOI: 10.5281/zenodo.

Introduction: Neuromuscular blocking agents (NMBAs) optimize intubation, reduce tissue trauma, and aid surgical relaxation. Rocuronium, a non-depolarizing aminosteroidal NMBA, provides rapid onset without histamine release. Cisatracurium, a potent benzylisoquinolinium, offers slower onset with Hoffman elimination. This study compares rocuronium and cisatracurium’s effects on hemodynamic stress during intubation. Methods: This prospective, randomized, double-blind study compared rocuronium and cisatracurium in elective surgeries under general anesthesia. Patients were randomized into two groups and administered the respective muscle relaxants. Hemodynamic parameters and neuromuscular monitoring guided dosing and intubation. Post-surgery, residual blockade was reversed, and patients were transferred to recovery. Results: The study included 60 participants, evenly divided between groups. Most (36.7%) were aged 31–40 years, with a male-to-female ratio of 0.93. Pre-intubation HR, SBP, DBP, and MAP showed no significant intergroup differences. Intubation duration was significantly shorter in group R. Post-intubation hemodynamic parameters showed no significant differences between groups. Conclusion: Rocuronium and cisatracurium demonstrated comparable hemodynamic stability during intubation and surgery. Rocuronium provided a significantly shorter intubation duration, making it advantageous in situations requiring rapid airway management. Both agents are effective and safe for elective surgeries, with choice depending on clinical context and individual patient considerations.

DOI: 10.5281/zenodo.

One of the most common causes of morbidity and mortality in ICU patients is the condition of Sepsis, that possesses a constant challenge to the treating and/ or the critical care physician. In that scenario, use of a basic blood investigation such as Complete Blood Count (that includes the Platelet Indices) may play a pivotal role in early prediction of the course of sepsis. Thus, in this study we have studied the role that Platelet Indices have in predicting the severity of sepsis patients in ICU, so as to use them as a marker of sepsis in peripheral as well as tertiary centres.
Total 102 patients of both sexes were included in the study, out of which 32 patients (31.4%) succumbed to sepsis, whereas a larger portion of the cohort, comprising 70 patients (68.6%), demonstrated clinical improvement during their stay in the ICU. It was found that Platelet Count (PLT), Platelet to Large Cell Ratio (PLCR) and Platelecrit (PCT) tend to increase in patients who recover from sepsis and have a decreasing trend in those who ultimately succumb. Whereas, Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV) behaved in the opposite way, as both of these indices increased in patients who ultimately died due to sepsis and decreased in cases of improved ones. Thus, it can be concluded that Platelet Indices do have a role in predicting sepsis and its severity and hence, these indices from a routine Complete Blood Count (CBC) may be used as markers for predicting the progression of Sepsis.

DOI: 10.5281/zenodo.

Objective: Effective communication is a cornerstone of quality healthcare, with significant implications for patient satisfaction, diagnostic accuracy, and clinical outcomes. This study assesses the knowledge, attitudes, and practices (KAP) of final-year medical students regarding communication skills, aiming to identify areas for improvement in medical education. Methods: A cross-sectional questionnaire-based survey was conducted at GMERS Medical College, Junagadh, involving 163 final-year MBBS students. The questionnaire, which was pre-validated and pilot-tested, assessed students’ knowledge of communication principles, attitudes towards patient-centered communication, and self-reported practices in clinical settings. Results: The results show that students possess strong theoretical knowledge, particularly in active listening (96.9%) and the importance of clear communication (95.7%), with some gaps in understanding the role of empathy (84.4%) and trust in patient care (88%). Most students expressed confidence in their communication abilities (52.8% very confident), and a majority recognized the importance of empathy (75.5%) and active listening (87.1%) in patient care. However, self-reported practices revealed variability in applying these skills, with only 46.6% consistently engaging in small talk with patients and 60.1% practicing active listening frequently. Conclusion: The study underscores the need for targeted interventions to bridge the gap between knowledge and practice, such as role-playing, feedback mechanisms, and simulation-based training. The findings suggest that enhancing communication skills training can better prepare students for patient-centered care, thereby improving healthcare outcomes.

DOI: 10.5281/zenodo.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by complement-mediated intravascular hemolysis, thrombosis, and bone marrow failure. It results from a somatic mutation in the PIG-A gene, leading to deficient synthesis of glycosylphosphatidylinositol (GPI) anchors and subsequent absence of GPI-linked proteins on hematopoietic cells. Clinically, PNH presents with hemolytic anemia, hemoglobinuria, and a heightened risk of thromboembolic complications. Diagnosis involves flow cytometry to detect populations of GPI-deficient blood cells, particularly CD55- and CD59-negative cells. Eculizumab, a monoclonal antibody targeting terminal complement activation, has transformed treatment outcomes by reducing hemolysis and preventing thrombosis. Despite these advancements, challenges persist in managing bone marrow failure and minimizing long-term complications.

DOI: 10.5281/zenodo.

Background: Uterine fibroids are the most common benign smooth muscle tumors of the female reproductive system. It accounts for one-third of all gynecological hospital admissions and is the most common indication (making up approximately 40%) for hysterectomy in premenopausal women. Mifepristone (RU 486) effectively reduces menorrhagia and other fibroid-related symptoms, and its size. Objectives: To study the effect of low dose Mifepristone for 3 months on improvement of fibroid related symptoms and its size. Materials and Methods: This was a hospital-based prospective cross-sectional study which was conducted in the Department of Obstetrics and Gynecology in Silchar Medical College and Hospital, Assam. 246 women were enrolled and divided into two groups. Patients in Group 1 received Tab Tranexamic acid (500 mg) and Tab Mefenamic acid (500 mg) thrice daily during menstrual bleeding for a period of 3 months. Patients in Group 2 received Tab Mifepristone 25 mg daily for 3 months. Results: Mean PBAC score reduced by 96.03%, Mean Numeric Pain Rating Scale Score for dysmenorrhea reduced by 82.87%, fibroid area reduced by 34% and hemoglobin concentration increased by 10% at 3 months in Group 2. These changes in Group 2 were found to be statistically significant (p<0.001) compared to Group 1. Conclusion: Mifepristone has proven to be safe and effective as compared to treatment with tranexamic acid and mefenamic acid for management of uterine fibroids.

DOI: 10.5281/zenodo.

Hypertension, or elevated blood pressure, is a significant global health burden affecting over 1.28 billion individuals. It is a major risk factor for cardiovascular diseases such as heart failure, stroke, and coronary artery disease. While its hemodynamic effects, such as increased arterial stiffness and left ventricular hypertrophy, are widely studied, the impact of hypertension on heart metabolism is less understood but equally critical. Hypertension, a prevalent cardiovascular disorder, significantly impacts cardiac structure, function, and metabolism. The chronic elevation of blood pressure imposes a sustained increase in cardiac workload, leading to pathological changes such as left ventricular hypertrophy (LVH), myocardial fibrosis, and capillary rarefaction. These structural adaptations disrupt the heart’s ability to maintain metabolic efficiency and flexibility. This manuscript provides a comprehensive review of the mechanisms by which hypertension alters cardiac metabolism, highlighting its profound effects on substrate utilization, mitochondrial function, and energy homeostasis. A key metabolic hallmark of hypertensive hearts is a shift in substrate utilization from glucose oxidation to an overreliance on fatty acid oxidation (FAO). While FAO typically serves as the primary energy source for the heart, its upregulation in hypertensive conditions is inefficient, oxygen-intensive, and associated with the accumulation of toxic lipid intermediates, leading to lipotoxicity. Concurrently, glucose uptake and oxidation are impaired due to reduced activity of glucose transporters, insulin resistance, and dysregulated signaling pathways. This metabolic inflexibility exacerbates energy deficits and compromises cardiac performance. Mitochondrial dysfunction emerges as a central feature in hypertension-induced metabolic derangements. The overproduction of reactive oxygen species (ROS), mitochondrial DNA damage, and impaired oxidative phosphorylation disrupt ATP generation, creating a state of energy starvation. Dysregulation of key molecular pathways, including the AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptors (PPARs), and mammalian target of rapamycin (mTOR), further impairs energy sensing, substrate utilization, and mitochondrial biogenesis. Additionally, neurohormonal activation—particularly the renin-angiotensin-aldosterone system (RAAS) and sympathetic overdrive—drives oxidative stress, inflammation, and maladaptive remodelling, further compounding the metabolic burden on the heart.

DOI: 10.5281/zenodo.

Aim of the Study: To evaluate the role of interventional radiology in post-living donor liver transplant complication management. Material and Methods: This prospective study was undertaken in Interventional Radiology Department Of Mahatma Gandhi Medical College & Hospital, Jaipur from January 2023 to December 2024. Total 20 patients referred from Liver transplant department for management of post LDLT complications. All patients evaluated for complications on 128 slice optima GE CT scan and on Allura clarity XperFD Philips medical system. Results: In our study complications of total 20 cases of post living donor transplant liver were managed, 18 male & 2 females with age range from 20 yrs. to 70 yrs. Complications including biliary stenosis 35%, hepatic vein stenosis 15%, portal vein stenosis 5%, hepatic artery stenosis 10%, hepatic artery thrombosis10%, biliary leakage 10%, cholangiolar abscess 10% and lymphatic leak 5%. We had seven cases of biliary stenosis, six were successfully treated with insertion of internal-external drain and stenting. We had three cases of hepatic venous occlusion, successfully treated with venoplasty and stenting, two cases of hepatic artery stenosis treated with angioplasty and stenting and two cases of hepatic artery thrombosis treated with catheter directed thrombolysis. One case of portal vein stenosis treated with portal venoplasty and stenting. Two cases of cholangiolar abscess with aspiration. Two cases of biliary leakage and one case of lymphatic leak treated with percutaneous pigtail insertion. Finally, in our study, we had 100% success rate in hepatic artery stenosis, portal vein stenosis and hepatic vein stenosis, 85% in biliary complications and 50% in hepatic artery thrombosis. Conclusion: Interventional radiology plays a crucial role in management of post-LDLT complications. It offers a safe and effective alternative to surgery in terms of minimal invasiveness with faster recovery, targeted treatment for specific area without damaging surrounding tissues and lower morbidity with improved outcomes.

DOI: 10.5281/zenodo.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder requiring effective glycaemic control to prevent complications. Among newer pharmacological agents, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated efficacy. Empagliflozin, an SGLT-2 inhibitor, promotes urinary glucose excretion and offers cardiovascular benefits, whereas linagliptin, a DPP-4 inhibitor, enhances incretin-mediated insulin secretion. This study compares the efficacy and safety of empagliflozin and linagliptin in T2DM management. Materials and Methods: This prospective, open-label, randomized controlled trial was conducted at Chirayu Medical College and Hospital, Bhopal, over 12 weeks. A total of 150 patients with T2DM were randomly assigned to receive empagliflozin (10 mg daily; n=75) or linagliptin (5 mg daily; n=75). Primary outcomes included changes in HbA1c, fasting plasma glucose (FPG), and postprandial glucose (PPG). Secondary outcomes included weight change, hypoglycemia incidence, urinary tract infections (UTIs), gastrointestinal side effects, and lipid profile changes. Statistical analysis was performed using SPSS version 26.0. Results: Empagliflozin resulted in a significantly greater reduction in HbA1c (-1.2% vs. -0.9%, p=0.002), FPG (130.5 ± 18.7 mg/dL vs. 140.3 ± 20.2 mg/dL, p=0.01), and PPG (190.2 ± 25.6 mg/dL vs. 200.8 ± 28.4 mg/dL, p=0.03) compared to linagliptin. More patients in the empagliflozin group achieved HbA1c <7% (77.3% vs. 61.3%, p=0.04). Weight reduction was greater with empagliflozin (-2.1 ± 1.5 kg vs. -0.3 ± 1.1 kg, p<0.001). The incidence of hypoglycemia (6.7% vs. 10.7%, p=0.41) and UTIs (9.3% vs. 4.0%, p=0.21) were comparable. Conclusion: Empagliflozin demonstrated superior glycaemic control and weight reduction compared to linagliptin without significantly increasing adverse events. These findings support the preferential use of empagliflozin in T2DM patients, particularly those requiring weight management.

DOI: 10.5281/zenodo.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder requiring effective glycaemic control to prevent complications. While long-acting basal insulins such as insulin glargine and insulin degludec are widely used, their comparative efficacy and safety in patients with uncontrolled T2DM warrant further investigation. The objective of the study is to compare the glycaemic control, insulin requirements, incidence of hypoglycemia, weight changes, and quality of life outcomes between insulin glargine and insulin degludec in patients with uncontrolled T2DM over a 12-week period. Materials and Methods: This prospective, randomized, comparative study was conducted at Chirayu Medical College and Hospital, Bhopal, from September 2023 to October 2024. A total of 150 patients with uncontrolled T2DM were randomized into two groups: insulin glargine (n=75) and insulin degludec (n=75). Primary outcome measured was the reduction in HbA1c levels after 12 weeks. Secondary outcomes included changes in fasting plasma glucose (FPG), daily insulin dose requirements, hypoglycaemic episodes, weight changes, and quality of life scores. Data were analyzed using SPSS version 26. Results: Both groups showed significant HbA1c reduction, with insulin degludec (-1.45±0.9%) demonstrating a greater decline compared to insulin glargine (-1.09±0.8%), though not statistically significant (p=0.124). More patients in the insulin degludec group (69%) achieved HbA1c ≤7% compared to insulin glargine (41%) (p<0.05). Insulin degludec required a lower daily insulin dose (18.6±4.8 vs. 25.7±5.4 units, p=0.002) and had fewer hypoglycaemic episodes (12 vs. 40, p<0.05). Weight gain was lower in the insulin degludec group (0.85±0.4 kg vs. 1.65±0.5 kg, p=0.082), and quality of life scores improved significantly (p<0.05). Conclusion: Insulin degludec demonstrated superior glycaemic target achievement, lower insulin requirements, and a significantly reduced risk of hypoglycemia compared to insulin glargine. These findings suggest insulin degludec as a favourable option for optimizing diabetes management in uncontrolled T2DM patients.

DOI: 10.5281/zenodo.

Background: The DV plays a crucial role in maintaining optimal oxygenation and nutrient delivery during early fetal development. Doppler ultrasound studies have demonstrated that the velocity and volume of blood flow through the DV change with gestational age. During the course of pregnancy, the DV undergoes significant structural changes. Our study aims to establish normogram of RI and PI of ductus venosus between 11–14 weeks of gestation in North Indian population. Methods: A cross sectional study of 210 antenatal women using observation cross sectional study was carried out at Era’s Lucknow medical college and hospital, Lucknow. RI and PI of ductus venosus was obtained in pregnant females of gestation age 11 – 14 weeks having singleton pregnancy and no structural abnormalities on ultrasound examination. Results: Mean DV PI values for 11-12, 12-13- and 13–14-week gestational ages were found to be 0.946±0.132, 0.946±0.112 and 0.951±0.117 respectively. Statistically, there was no significant difference among different gestational ages for DV PI values. Mean DV RI values for 11-12, 12-13 and 13-14 week gestational ages were found to be 0.717±0.100, 0.717±0.094 and 0.717±0.094 respectively. Statistically, there was no significant difference among different gestational ages for DV RI values. Conclusion: Normative range for DV PI or RI for 11 to 14 weeks gestational age can be used effectively with single representation for the entire span of this gestational age. Non-dependency of DV PI and RI on age, anthropometry and gravida status was reflective of its universal applicability for different ages, anthropometric and gravida strata.

DOI: 10.5281/zenodo.

Background: The term “asthma” originates from Greek, describing breathlessness. Bronchial asthma has been since time immemorial and is defined as paroxysmal dyspnoea with intervals of healthy breathing. In India, asthma prevalence ranges from 2-17%. It’s a leading chronic respiratory illness in childhood, escalating globally due to pollution and industrialization. Diagnosis relies on methods like FEV1 and peak expiratory flow. Early detection is crucial to prevent complications. Peak expiratory flow rate (PEFR) is a vital diagnostic tool, especially in children, reflecting airway obstruction severity and treatment response. Aim: (1) To study the peak expiratory flow rate in healthy school going children between 6-12   years. (2) To study the correlation between PEFR and age, sex, weight, height and maximum chest circumference and to construct a Nomogram. Materials and Methods: This cross sectional study was done on 350 subjects between 6 to 12 years of age who attended a school in urban area of Patna over a period of six months from October 2023 to March 2024. All patients who fulfilled the inclusion criteria were examined and their weight, height, chest circumference and PEFR were measured. For the determination of PEFR we used Mini Wright Peak Flow Meter. Results: A total of 350 patients were included in the study of which 175 (50%) were males and 175 were females. Prediction equations were derived for PEFR with height in boys and girls. Normograms were plotted based on the observed values of PEFR in the study population. Conclusion: Significant correlations were found between PEFR and biological variables like age, sex, weight, height and maximum chest circumference. Maximum positive correlation was seen for height, followed by age, weight and the least positive correlation was found for maximum chest circumference.

DOI: 10.5281/zenodo.

Aim: The Incidence and pattern of mandibular fractures may vary according to the geographical area, religion, and socioeconomic status. The aim of this cross-sectional retrospective study is to evaluate the cause, risk factors, characteristics and clinical epidemiology of mandibular fractures in eastern part of Uttar Pradesh. Materials and methods: The data collected included age, gender, mode of injury, mandible fracture location and associated fracture and treatment. In this study, various statistical techniques were employed to analyse the distribution and characteristics of cases across multiple variables. Descriptive statistics were utilized to summarize demographic data and percentages and proportions were calculated to provide a clear understanding of the relative prevalence of each category. Results: Total 181 mandibular fractures were found in 132 patients. Majority of participants were male and belonged to the 20–30 years age group, comprising 54 individuals (40.9%). most common mode of injury was road traffic accidents (RTA) involving drivers, accounting for 47.7% cases with 68.3 % not wearing helmet and 31.7% wearing open face helmet. Parasymphysis fractures were the most prevalent, accounting for 37.6% of cases. This was followed by condyle fractures with 17.7% cases, angle fractures of 16.0% cases, and symphysis fractures of 15.5% cases. Less frequent were body fractures at 8.8%, ramus fractures 2.2%, and both coronoid and dento-alveolar fractures, each occurring 1.1% cases respectively. Conclusion: The study provides important epidemiological data to formulate better future plans for preventing and treating mandibular injuries. The major populations at risk are young men and those driving two-wheelers with an open faced helmet or without one. Prevention is the key to reducing the incidence of maxillofacial fractures and it involves multiple strategies. This include the consistent use of protective gears like helmets and mouthguards, adherence to traffic rules, workplace and sports safety protocols.

DOI: 10.5281/zenodo.

Introduction: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated airway obstruction during sleep, leading to fragmented sleep and increased cardiometabolic risks. This study examines the association of lifestyle, dietary habits, and metabolic factors with OSA prevalence in a tertiary care center in Western Gujarat. Materials and Methods: A cross-sectional study was conducted on 50 adult participants, assessing OSA risk using the Modified Berlin Questionnaire. Demographic data, anthropometric measurements, comorbid conditions, dietary patterns, and lifestyle habits were analyzed. Polysomnography and metabolic markers were evaluated in high-risk individuals. Results: Among the 50 participants, 64% were classified as high risk for OSA, with a significant association observed with obesity (100%), hypertension (100%), dyslipidemia (66%), and abnormal 2D echocardiography findings (91%) (p < 0.05). High-risk individuals had a mean age of 60.81 years, with significantly higher BMI (36.18±2.99), neck circumference (43.94±6.01 cm), and waist-hip ratio (1.41±0.31) compared to lower-risk groups. Stored food consumption (87.5%) was significantly associated with higher OSA risk, while processed food intake showed a trend toward increased risk but was not statistically significant. Frequent fried food consumption (>2 times/week) was linked to increased OSA prevalence, while meal frequency, meal timing, and dinner-to-sleep intervals showed no direct correlation. Smoking and alcohol intake did not exhibit significant associations with OSA risk, though moderate-risk individuals reported higher addiction rates. Additionally, Grade 1 fatty liver (75.8%) and elevated triglyceride levels (159.56±26.84 mg/dL) were significantly prevalent among high-risk OSA participants. Conclusion: OSA risk is significantly influenced by obesity, metabolic disorders, and dietary habits, emphasizing the need for early screening and lifestyle modifications to reduce associated health risks.

DOI: 10.5281/zenodo.

Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality especially if it progresses to bowel ischemia. The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergencies that a general surgeon can come across. The study was conducted in the department of general surgery with symptoms and signs of acute intestinal obstruction admitted in the surgical ward. Fifty cases of intestinal obstruction have been studied. Patients belonged to above 20  age groups are included in present study. Our study shows causes of intestinal obstruction,  Post operative Adhesions 36%, Obstructed Hernia 12%, Peritonitis 16%, Kochs Abdomen 12%, Volvulus 08%, Intussception 04%, Stricture 04%. In our study  Out of 18 Post operative Adhesions 14 cases managed by Conservative methods, 4 by surgery. 4 cases of volvulus by surgery. 06 cases of Obstructed Hernia by surgery. 4 malignancy cases by surgery. Out of  8 Peritonitis cases 1 case by surgery and 7 by Conservative methods. Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon its early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

DOI: 10.5281/zenodo.

Right iliac fossa mass is one of the most common clinical scenarios a surgeon encounters during their surgical practice. It poses a critical diagnostic dilemma for surgeons and requires considerable diagnostic skills. The mass arises from different anatomical structures with varied aetiologies that require a high clinical suspicion in its management. The reason being that the mass may range from being benign to most aggressively malignant lesion which encompasses various specialities of surgery like genitourinary, vascular, gynaecological and colorectal surgery. A total of 50 cases with mass in the right iliac fossa (RIF) were included in this observational study. Most common causes of mass in RIF were Appendicular mass (40%), Appendicular Abscess (18%), Ileocecal Tuberculosis (18%). Most common presenting symptoms were Pain (100%), fever (54%), Vomiting (48%). RIF mass is a challenging clinical scenario for the surgeons. Keeping in mind the various differential diagnosis with good clinical acumen supported by appropriate investigations, patients with RIF mass can be managed appropriately either by conservative or surgical management.

DOI: 10.5281/zenodo.

Background: Adductor canal block (ACB) is commonly used for postoperative analgesia in lower limb surgeries. Adjuvants such as midazolam and dexmedetomidine are added to local anesthetics to prolong analgesia and improve block characteristics. Aim and Objectives: This study compares the efficacy and safety of midazolam versus dexmedetomidine as adjuvants in ACB. Materials and Methods: A randomized controlled trial was conducted on 100 patients undergoing lower limb surgery under spinal anesthesia. Patients were randomly allocated into two groups: Group M (n=50) received midazolam as an adjuvant to local anesthetic, and Group D (n=50) received dexmedetomidine. The primary outcomes were the duration of sensory and motor block, time to first analgesic request, and total analgesic consumption in 24 hours. Secondary outcomes included hemodynamic parameters and adverse events. Results: The sensory block duration was significantly longer in Group D (9.01±2.64 hours) compared to Group M (6.31±2.34 hours) (p<0.001). The motor block duration was also prolonged in Group D (7.05±1.14 hours) versus Group M (4.47±1.62 hours) (p<0.001). Group D had a delayed time to first analgesic request (10.47±2.24 hours vs. 7.13±2.36 hours; p<0.001) and reduced total analgesic consumption (61.45±7.26 mg vs. 90.32±8.61 mg; p<0.001). However, Group D experienced more bradycardia, hypotension, and sedation. Conclusion: Dexmedetomidine as an adjuvant in ACB provides prolonged sensory and motor block, superior analgesia, and reduced analgesic consumption compared to midazolam but is associated with higher hemodynamic alterations. Careful monitoring is recommended when using dexmedetomidine in regional anesthesia.

DOI: 10.5281/zenodo.

Background: Supraclavicular brachial plexus block is widely used for upper limb surgeries, providing effective anesthesia and postoperative analgesia. This study aimed to compare the duration of analgesia between Ropivacaine and Bupivacaine in supraclavicular brachial plexus block. Methods: A randomized, controlled study was conducted on patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were divided into two groups: one receiving 0.5% Ropivacaine and the other 0.5% Bupivacaine. The primary outcome was the duration of analgesia, and secondary outcomes included sensory and motor block durations, hemodynamic stability, and total analgesic consumption. Data were analyzed using appropriate statistical tests. Results: The duration of analgesia was slightly prolonged in the Bupivacaine group (9.34±1.65 min) compared to the Ropivacaine group (8.97±1.80 min), though the difference was not statistically significant (p=0.236). Sensory and motor block durations were also comparable between the two groups (p>0.05). Hemodynamic parameters remained stable throughout the study, with minor fluctuations observed in both groups. The total analgesic consumption did not differ significantly between groups. Conclusion: Both Ropivacaine and Bupivacaine provided effective analgesia for supraclavicular brachial plexus block, with no significant difference in duration of analgesia. Ropivacaine demonstrated better hemodynamic stability, suggesting its potential as a safer alternative. Further large-scale studies are warranted to confirm these findings.

DOI: 10.5281/zenodo.

Background: Effective postoperative pain management is crucial for patient satisfaction and recovery. Aim and Objectives: This study evaluates the impact of adjuvant fentanyl on postoperative analgesia and patient satisfaction in nerve blocks. Materials and Methods: A comparative study was conducted on 120 patients undergoing surgery under nerve block anesthesia. Patients were divided into two groups: Group A (n=60) received a nerve block without fentanyl, while Group B (n=60) received a nerve block with fentanyl as an adjuvant. The duration of postoperative analgesia, total analgesic consumption, pain scores, patient satisfaction, and adverse events were assessed. Results: The mean duration of postoperative analgesia was significantly longer in Group B (8.85 ± 1.63 hours) than in Group A (6.11 ± 1.14 hours) (p<0.001). Total analgesic consumption was lower in Group B (98.97 ± 25.27 mg) compared to Group A (149.44 ± 30.0 mg) (p<0.001). VAS scores were comparable at different time intervals; however, patient satisfaction was significantly higher in Group B (p=0.049). Adverse events, including nausea, pruritus, and respiratory depression, were slightly more frequent in Group B but were clinically manageable. Conclusion: The addition of fentanyl to nerve blocks significantly prolongs analgesia duration, reduces analgesic consumption, and enhances patient satisfaction. While adverse events were slightly more common, they did not outweigh the benefits. These findings support the use of fentanyl as an adjuvant in regional anesthesia for improved postoperative pain management and patient comfort.

DOI: 10.5281/zenodo.

Background: Effective postoperative analgesia is essential for early rehabilitation following total knee arthroplasty (TKA). This study compares the efficacy of ultrasound-guided adductor canal block (ACB) and femoral nerve block (FNB) in postoperative pain management. Methods: A randomized comparative study was conducted on patients undergoing TKA, divided into ACB and FNB groups. Pain scores were assessed using the Visual Analog Scale (VAS) at multiple time points postoperatively. Total opioid consumption, time to ambulation, quadriceps strength, and patient satisfaction were also evaluated. Results: Both techniques provided effective analgesia, but ACB demonstrated superior outcomes in key parameters. The ACB group had significantly lower VAS scores at 12 hours (p = 0.027) and reduced opioid consumption (p = 0.041) compared to the FNB group. ACB also facilitated earlier ambulation (p = 0.008) without significant compromise in quadriceps strength (p = 0.253). Additionally, patient satisfaction scores were significantly higher in the ACB group (p = 0.031). Conclusion: ACB is an effective alternative to FNB for postoperative analgesia in TKA, offering better pain control, lower opioid requirements, earlier mobilization, and improved patient satisfaction without impairing quadriceps strength. These findings support ACB as a preferred analgesic technique for enhanced recovery following TKA.

DOI: 10.5281/zenodo.

Background: Neonatal small bowel obstruction (SBO) is a critical surgical emergency requiring timely diagnosis and intervention to prevent morbidity and mortality. This study aimed to evaluate the etiology, clinical presentation, and diagnostic approaches for neonatal SBO in a tertiary care centre. Methods: A prospective study was conducted in a neonatal surgical unit, enrolling neonates presenting with features of SBO such as bilious vomiting, abdominal distension, and failure to pass meconium. Clinical examination, laboratory investigations, and imaging modalities, including abdominal radiographs, ultrasonography, and contrast studies, were utilized for diagnosis. Surgical findings and histopathological reports were documented. Results: Among 290  neonates, Intestinal atresias accounted for 152 (52.41%) of the 290 neonates, making it the most common cause of SBO. With 48 cases (16.55%), malrotation was the second most common cause. 144 cases (49.66%) had a combination of vomiting and abdominal distension, which was the most frequent symptom. Abdominal x-ray suggested the most common finding was the multiple bubble sign, seen in 113 neonates (38.97%), indicative of distal small bowel obstruction. Conclusion: Congenital intestinal atresia and malrotation are the leading causes of neonatal SBO. Imaging plays a crucial role in preoperative diagnosis, enabling timely surgical management. Early recognition and comprehensive evaluation in a tertiary care setting improve outcomes.

DOI: 10.5281/zenodo.

Background: Road traffic accidents (RTAs) are a major global public health issue, with head injuries being the leading cause of death. Despite the protective role of the skull, high-impact trauma in RTAs often results in severe or fatal traumatic brain injuries (TBIs). This study aims to analyse the patterns of fatal head injuries sustained in RTAs at a tertiary care center, providing insights into their severity, distribution, and associated risk factors. Methods: This retrospective, cross-sectional study examined 100 cases of fatal head injuries due to RTAs between June 2024 and September 2024 at the Department of Forensic Medicine and Toxicology, Ratlam. Data were obtained from autopsy reports and investigating authorities, analysing demographic distribution, injury patterns, and contributing factors using Microsoft Excel. Results: Males accounted for 87% of cases, with the highest fatalities in the 21–30 age group (36%). Most accidents occurred between 6 PM and 12 AM (38%). The majority of skull fractures involved both the cranial vault and base (63%). Subdural and subarachnoid hemorrhages were the most frequent intracranial hemorrhages (78.57%). Two-wheeler accidents were the most common (71%), with low helmet usage (2.81%). Conclusion: The findings underscore the urgent need for improved road safety regulations, stricter helmet enforcement, and enhanced emergency trauma care to reduce the incidence and severity of fatal head injuries in RTAs.

DOI: 10.5281/zenodo.

Background: The Bispectral Index (BIS) is a valuable tool for monitoring the depth of anesthesia. Isoflurane and halothane are inhalational agents with distinct pharmacological profiles. This study compares BIS values produced by isoflurane and halothane at equal end-tidal minimum alveolar concentrations (MAC) to enhance anesthetic management during surgery. Methods: In a double-blinded, randomized comparative study, 50 patients were divided into two groups: Group I (isoflurane) and Group H (halothane), each with 25 patients. BIS and hemodynamic parameters were recorded at end-tidal MAC values of 0.5, 1.0, and 1.5 after stabilization periods of 10 minutes at each concentration. Results: BIS values decreased with increasing MAC in both groups. At equivalent MAC levels, isoflurane produced significantly lower BIS values than halothane (p < 0.05). Hemodynamic parameters remained stable and comparable between groups. Recovery times were slightly shorter in the isoflurane group, but differences were not statistically significant. Conclusion: Isoflurane results in lower BIS values compared to halothane at equal MAC concentrations, indicating a deeper hypnotic effect. BIS monitoring should be interpreted cautiously, considering the specific anesthetic agent used.

DOI: 10.5281/zenodo.

Background: Hip fractures are a significant cause of morbidity and disability among older adults, often requiring surgical intervention. THA and Hemiarthroplasty are the two primary surgical options, each with distinct advantages and limitations. This study retrospectively analyses and compares the outcomes of THA and Hemiarthroplasty in hip fracture patients to determine the most effective approach based on functional recovery, complications, and overall patient outcomes. Methods: A retrospective observational study was conducted at PMCH from March 2023 to September 2024, including 50 patients who underwent either THA or Hemiarthroplasty. Patients were selected based on inclusion and exclusion criteria, with data collected from medical records, radiographic findings, and post-operative assessments. Outcome measures included functional recovery (Harris Hip Score, mobility status), postoperative complications (dislocation, infection, mortality), length of hospital stay, reoperation rates, pain levels, and patient satisfaction. Statistical analysis was performed to compare the results between the two groups. Results: THA demonstrated superior functional recovery, with significantly higher Harris Hip Scores and better mobility at six months. However, it was associated with a higher risk of dislocation and longer hospital stay compared to Hemiarthroplasty. Patients who underwent Hemiarthroplasty had a lower incidence of dislocation but experienced higher residual pain and an increased need for revision surgery due to acetabular cartilage wear. Mortality rates were similar in both groups, indicating that preoperative health status played a crucial role in survival outcomes. Conclusion: THA provides better functional outcomes and lower long-term pain, making it the preferred choice for younger, active patients. Conversely, Hemiarthroplasty remains suitable for older, frail patients with limited mobility due to its lower surgical complexity and reduced risk of dislocation. A patient-centered approach is essential in surgical decision-making to optimize clinical outcomes.

DOI: 10.5281/zenodo.

Background: Due to their intricacy, distal femur fractures are difficult to treat. Surgery is typically needed to improve mobility, joint stability, and limb alignment. External Fixators, Retrograde Intramedullary Nails (RIN), and Locking Compression Plates are employed according on the fracture, patient, and surgeon. Choosing the optimal fixing method requires more clinical and radiological investigation. Objective: This study aims to compare the effectiveness of different fixation techniques for distal femur fractures in terms of functional recovery, radiological healing, complication rates, and rehabilitation outcomes. Methods: A retrospective cohort study at Patna Medical College and Hospital (PMCH) from March 2023 to September 2024 included 50 surgically treated distal femur fracture patients. Participants had to be 18 years old and follow up for six months after surgery. Polytrauma, pathological fractures, and poor medical records were excluded. Demographics, fracture classification (AO/OTA), fixation method (LCP, RIN, External Fixator), functional outcomes (knee range of motion, pain score, weight-bearing status), and complications were collected and analysed. Statistical comparisons were made using t-tests and chi-square tests with a significance level of p<0.05. Results: Among 50 patients with distal femur fractures, LCP fixation showed superior outcomes, with a mean knee ROM of 110° ± 15 (p=0.012) and lower pain scores (VAS: 2.5 ± 1.2, p=0.021). Full weight-bearing was achieved faster in LCP (80%) than RIN (65%) and External Fixators (40%) (p=0.018). LCP had the shortest healing time (14.2 ± 3.1 weeks, p=0.026), lower complications, and shorter hospital stay (7.5 ± 1.8 days, p=0.029). These findings indicate LCP as the most effective fixation method, promoting faster recovery and better functional outcomes. Conclusion: The study suggests LCP is the best distal femur fracture repair method due to its lower complications and faster recovery. RIN can still treat non-articular fractures, although external fixation should only be utilized in extreme cases for temporary stabilisation or soft tissue damage. These findings require more prospective trials to establish that customized treatment selection improves patient outcomes.

DOI: 10.5281/zenodo.

Background: Benign Breast Disease (BBD) such fibroadenomas, breast cysts, and fibrocystic changes cause most breast pathology. Up to 30% of women will get these diseases. Rural healthcare access, health literacy, and diagnostic resources might delay diagnosis and treatment, lowering quality of life. Methods: An observational study was conducted at Safdarjung Hospital, affiliated with Vardhman Mahavir Medical College, in New Delhi from October 5, 2017, to October 4, 2020. In the sample were 75 women with noncancerous breast problems. Data collection covered demographics, clinical presentation, diagnosis, and treatment. All women with BBD were included, but those with malignancies or poor medical records were excluded. Data analysis used descriptive statistics to synthesise clinical findings and patient characteristics, and chi-square testing to uncover statistically significant relationships. Results: Fibroadenomas led the study’s benign breast disorders with 40% frequency. The cases had 20% fibrocystic changes and 33.3% breast cysts. The majority of women experienced breast lumps (73.3%), discomfort (40%) and nipple discharge (6.7%). Mammography was used by 60% of patients, second to ultrasound (93.3%). Fibroadenomas were usually surgically removed, while cysts were drained or treated conservatively. The study found that mammography supplemented ultrasonography for initial evaluation and surveillance in elderly patients. Conclusion: This study on Benign Breast Diseases in rural areas emphasises the importance of readily available diagnostic and treatment options. The results suggest rural communities should focus breast health education and awareness campaigns and improve healthcare systems to diagnose and treat breast cancer faster. These methods may improve benign breast disease outcomes and reduce anxiety. Future research should include a larger sample size and additional factors affecting benign breast disease appearance and therapy.

DOI: 10.5281/zenodo.