Background: Medical education in India is very stressful. Psychological well-being of medical undergraduate students may help them to deal with this stress. Aims and Objectives: To estimate prevalence of stressors and psychological well-being among medical undergraduate students. To determine the association between various socio-demographic characteristics and socio-economic status with stress and psychological well-being. Material and Methods: The cross-sectional study was conducted among medical undergraduate students of Government medical College. A Google form with participants information sheet, socio-demographic information, modified Kuppuswamy’s socio-economic status scale, Medical Students Stressor Questionnaire (MSSQ) with 40 items, and 18 item version of Ryff’s psychological well-being scale were sent to all 500 students. Descriptive statistics was used to describe socio-demographic characteristics, stressors and psychological well-being. Bivariate correlation analysis was used to assess determine association between socio-demographic characteristics, stressors, stress and psychological well-being. Results: The overall response rate was 60.6% (303 out of 500 students). Mean age of undergraduate medical students was 20.74±1.796. 50.2% of students were males, and 47.9% were females. 83.5% of students were Hindu. 47.5% of students were from upper middle socio-economic status. Mild, moderate, severe and very severe stress was found in 32.0%, 39.6%, 23.4% and 5.0% of the students respectively. High psychological well-being was found in 97.4% of the students. Significant correlation of stress in medical undergraduate students was found with socio-economic status, residence, father and mother relationship, relation with parents, dealing with daily stress, exercise time, internet time, memory and attention problems and sleep difficulties. Psychological well-being is significantly associated with intra and inter personal stressors, group activities and social related stressors but not with academic and teaching learning related stressors. Conclusions: Medical undergraduate students need social, intra and inter personal relationships skills training. Workshops and group activities need to be conducted on the large scale at college and community levels. Special arrangements need to be done for students from rural areas, with disturbed family relations and lower socio-economic status.

DOI: 10.5281/zenodo.

Introduction: Lithium along with imipramine has a pivotal role in Psychopharmacology in disease like mania, schizo affective disorders etc. Lithium being on ion is unique and it possesses narrow therapeutic index. Aim & Objectives: Imipramine as Coad ministered with Lithium in Psychiatric disorder. In previous studies found to lower the C_max & T_{max .} Further, loperamide is commonly used OTC drugs for various GIT problems. This study was planned to evaluate loperamide   effect on Lithium bioavailability in healthy volunteers. Material & Methods: 30 normal human volunteers were enrolled & randomised in 3 groups of 10 each. Assigned drug to the particular group was administer and samples to estimate lithium were taken & serum level of lithium were determined by using ion selective electrode(Synchron EL-ise). Objectives & Results: Loperamide accentuated the imipramine induced reduction in absorption rate of Lithium, as evidenced by a further reduction in C_max & increased in T_max. Fall in AUC of lithium has also been observed. Conclusion: Sustained release preparation of lithium to retard   its absorption & minimize the drug interaction of Lithium seems the only solution.

DOI: 10.5281/zenodo.

The skin is represented as the Mirror of the Mind which responds to both endogenous and exogenous stimuli. Psychodermatology is a recent subfield of Psychosomatic Medicine which addresses the interaction between Mind(Psyche) and skin. The two disciplines are interconnected at the embryonal level by their origin from ectoderm and influenced by reciprocal action of neuroendocrine and immune systems. Patients with cutaneous disorders face emotional problems like shame, distorted self-image and a reduced self-esteem. The impact on the individual depends   on   various   factors   which   include   the   patient’s   Sociocultural background, demographic profile, personality of the patient, life stressors and how the disease is perceived by others in society. Therefore this study was done to know the Impact of Vitiligo on Psychiatric Manifestations and to assess the frequency and pattern of psychiatric illness in patients with vitiligo and to assess the relationship of Psychiatric illness, Life Stressors, Hostility and Direction of Hostility and Quality of Life in Patients with Vitiligo. Materials and Methods: 70 patients clinically diagnosed to have vitiligo between 18 and 65 years of age  attending the Outpatient Department of Dermatology, Venereology and Leprosy, Shri Atal Bihari Vajpayee medical college & research institute were enrolled for the study.  A detailed clinical history including age, sex, socio-economic status, occupation, duration of the disease, marital status, other co-morbidities and any other psychiatric co-morbidities was taken. Results: Most patients were between 36 and 50 years of age (39%). 47.1% of the population were males and 52.9% were females. Majority of the patients i.e. 68.6% belonged to Upper Lower Socioeconomic status. 70% were suffering from Nonsegmental type/Generalised type whereas 30% suffering from Localised/Segmental type of vitiligo. Among the 49 patients who had psychiatric illness the most common psychiatric illness was major depression constituting 31.4% followed by generalized anxiety disorder constituting 11.4%, mixed anxiety 8.6%, dysthymia 7.1%. Conclusion: The study findings revealed that no difference in gender was found in prevalence of psychiatric illness among the patients with Vitiligo. Major depression disorder was the most frequent psychiatric disorder seen in patients with vitiligo. Longer duration of vitiligo was associated with increased prevalence of   psychiatric illness. Patients with vitiligo who had psychiatric illness had a lower quality of life when compared to those who did not have psychiatric illness.

DOI: 10.5281/zenodo.

Tinea corporis is a superficial fungal infection of keratin tissue caused by Dermatophytes. It is exceedingly common worldwide. It is very common in tropics and may present in epidemic proportions in areas with high rate of humidity, over population, and poor hygienic conditions. Hence the present study was undertaken to find out the clinical patterns of Tinea corporis and to find out fungal species causing Tinea corporis in Bangaluru. Materials and Methods: One hundred patients clinically presenting with Tinea corporis attending the Dermatology outpatient Department of Dermatology, Venereology and Leprosy, Shri Atal Bihari Vajpayee medical college & research institute were enrolled for the study. Scraping was taken from scaly plaques and papules over the glabrous skin excluding groin for KOH mount and fungal culture. Results: Out of 100 patients, maximum were in the age group of 16-30 years (44%), male to female ratio was 1.6:1 . Annular type was the commonest clinical type (45%), followed by Tinea incognito (7%) and Bullous type (4%). Overall positivity by culture was 40%, and direct microscopy (KOH) 96% . T. rubrum was the predominant species isolated(31%) followed by T. mentagrophyte (8%), 54.0% of culture report showed no growth. Conclusion: Tinea corporis annular type was the commonest clinical type followed by Tinea incognito and bullous type. Trichophyton rubrum was the commonest organism isolated. The present study showed no significant difference in the clinical type, the age distribution, sex distribution and etiological agents causing Tinea corporis infection in this part of  Karnataka in agreement with reports from other parts of India.

DOI: 10.5281/zenodo.

Background: Essential newborn care and appropriate referral are major determinants of the survival and well-being of the newborns. This study was conducted to find the newborn care practices in an urban community and to explore the associated factors. Methods: The present community based cross sectional study was conducted upon children born within past six months in the Tangra area of Kolkata. Mothers were interviewed using pretested proforma. The research was carried out between January 2024 to June 2024. The statistical data were analyzed using SPSS V.25.0 and Microsoft Excel. Results: Mean age of the mothers was 27.4±3.2 years. Almost 112 (74.67%) mothers lived in joint families. Maximum mothers i.e. 112 (74.67%) were having >4 ANC visits, TT coverage was 138 (92%) and all deliveries were institutional delivery. About 98 (65.33%) newborn was cared by their mothers while rest were taken care of by the grandmother and father. Rooming in was well practiced by 142 (94.67%) mothers. Almost 122 (81.33%) children were kept warm by keeping them close to their mothers. 100% of children were given vaccine at birth and umbilical stump hygiene was maintained in 108 (72%) cases. Early initiation of breastfeeding was done in 84 (56%) newborns, colostrum was given to 78 (52%) children and exclusive breastfeeding was done in 72 (48%). Conclusions: The methods used to care for newborns are far from optimal. Therefore, behavior change communication and other strategies should be used to encourage parents and others to exercise correct behavior.

DOI: 10.5281/zenodo.

Background: Postoperative pain substantially impacts of patients’ quality of life and functional recovery. Higher-than-expected pain levels after some surgeries were identified by Gerbershagen et al., mostly in obstetrics and gynecology. Effective postoperative pain management is crucial, often involving a multimodal approach to reduce acute pain and prevent its transition to chronic pain. Aim: The purpose of this study was to evaluate the efficacy of a fixed-dose combination of 100 milligrams of diclofenac sodium and 10 milligrams of serratiopeptidase for the treatment of pain during various obstetric and gynecological procedures. Methodology: This prospective study enrolled 70 patients in two groups, each group consisted of 35 patients. Group 1 received Serratiopeptidase, while Group 2 received Aceclofenac. Pain intensity was assessed using the visual analogue scale, and limb swelling was measured at baseline, one week, and two weeks post-treatment. Statistical analysis was performed using SPSS software. Results: Both groups demonstrated reductions in swelling and improvements in VAS scores over time. Group 1’s average swelling decreased from 270.45 ml to 258.30 ml, while Group 2’s decreased from 319.85 ml to 307.10 ml, with no significant differences between groups (p-values > 0.05). However, Group 2 exhibited significantly lower VAS scores in smaller limb volume categories at both one and two weeks (p-values ≤ 0.0001). Conclusion: Although both treatments led to improvements in swelling and pain management, Group 2 showed superior efficacy in smaller limb volumes. The findings suggest that more research was required to maximize treatment approaches for managing pain following surgery, particularly with regard to limb volume changes.

DOI: 10.5281/zenodo.

Background: Smoking constitutes a significant risk factor for cardiovascular diseases, primarily through its impact on the autonomic nervous system. Heart rate variability (HRV) serves as a sensitive and non-invasive measure to assess autonomic function and smoking has been associated with adverse effects on HRV, indicating potential cardiac autonomic dysfunction. Aims and Objectives: This study aims to assess the correlation between smoking and HRV in urban population of Meerut. Materials and Methods: A cross-sectional study was conducted on 50 male smokers and 50 non-smokers, drawn from the urban population of Meerut, within the age range of 18-60 years, based on district census data from 2011. HRV was recorded using a Physio-Pac device. Subjects were categorized into two age groups: ≤30 years and >30 years. Data included cardiovascular parameters, time domain analysis, and frequency domain analysis. Statistical analysis was performed using Student’s unpaired t-test. Results: Urban smokers in the ≤30 year age group exhibited significantly higher LF and LF/HF ratio, alongside significantly lower HF, compared to non-smokers. Similarly, urban smokers in the >30 year age group demonstrated a significantly higher LF/HF ratio compared to non-smokers. Conclusion: Our findings indicate a significant dominance of sympathetic activity and a notable reduction in parasympathetic activity among urban smokers. These results underscore the detrimental impact of smoking on cardiovascular health, highlighting the impairment of autonomic function associated with smoking.

DOI: 10.5281/zenodo.

Menopause is the transitory period of decrease ovarian activity and decreased oestrogen level associated with increased chances of obesity and increased comorbidities like hypertension, hypercholesterolemia, impaired cognitive function and cardiovascular dysfunction. Hypertension is one of the major cardiovascular risk factors for the excess mortality and morbidity in postmenopausal females. Aim of our study was to evaluate association between BMI and Blood Pressure in pre- and post-menopausal women. Study was conducted in 30 Post Menopausal women in age group of 50 – 55 years and 30 pre-menopausal women in age group of 40 – 45 years. Standardised measurement of weight, Height and blood pressure were done. Statistical analysis was done by Student T- test. In Present study we found that post-menopausal women had higher BMI, (p<0.05) as compared with the pre-menopausal women; p<0.05. Blood pressure was elevated in postmenopausal women when compared with Pre -menopausal women p<0.01. Results of present study suggest that post-menopausal women were obese and had increased Blood Pressure, when compared with pre-menopausal Women.

DOI: 10.5281/zenodo.

Introduction: It has been reported that the cervical spine is injured in 2.4% of blunt trauma patients. Subaxial cervical spine fractures can be the result of high-energy mechanisms such as motor vehicle accidents and falls from heights to moderate energy mechanisms such as contact and non-contact sports. Aims: To estimate the clinical, radiological and functional outcome of management of subaxial injury with anterior cervical discectomy and fixation Materials and Method: It is an institutional based prospective study was conducted in Orthopaedics department of Burdwan Medical College and Hospital. This period of study was 18 months. 15 patients were included in this study. Result: The distribution of mechanism of injury 66.7% of the patients had history of RTA and 33.3% had history of fall from height. The value of z is 1.8257. The value of p is .06724. The result is not significant at p <.05 the various diagnosis of the fractures. Majority of the fractures were C5-C6 Subluxation (26.7%) followed by C3-C4 Subluxation (13.3%), C4 Compression  (13.3%), C4-C5 Compression (13.3%), C5 Compression (13.3%), C6 Compression (13.3%) and C7-C7 Subluxation (6.7%). The value of z is 1.4697. Conclusion: In conclusion, anterior cervical discectomy and fixation has proven to be an effective method for the operative management of subaxial cervical spine injuries in the short term. This approach not only provides reliable stabilization but also facilitates neural decompression and promotes fusion. The study demonstrates favourable outcomes in terms of pain relief, functional recovery, and minimal complications. However, long-term follow-up is essential to assess the durability of these results and to evaluate any potential risks of hardware failure or adjacent segment disease. Overall, this technique remains a valuable option in the surgical treatment of subaxial cervical spine trauma.

DOI: 10.5281/zenodo.

Introduction: OA is an age-related chronic degenerative joint disorder of multifactorial cause. It is mainly characterized by wear and tear of joint articular cartilage, joints marginal hypertrophy of bone, reduction in joint space and subchondral sclerosis. Aims: To assess how effective HA injections are in reducing pain and improving joint function in patients with early-stage knee OA in the North Bengal population. Materials and Method: The present study was a Prospective, Observational based study. This Study was conducted for 1 year. Total 50 patients were included in this study. Result: In our study, 22 (44%) patients were Male and 28 (56%) patients were Female. In our study, 27 (54%) patients were   45-55 years of age, 12 (24%) patients were  55-65years of age, 11 (22%) patients were   >65 years of age. In our study, 23 (46%) patients had Left side of knee, 25 (50%) patients had Right side of knee and 2 (4%) patients had bilateral side of knee. In our study, 18 (36%) patients had Grade 1 KL grade, 21 (42%) patients had Grade 2 KL grade, 11 (22%) patients had Grade 3 KL grade. Conclusion: In conclusion, intra-articular viscosupplementation with hyaluronic acid (HA) in early primary knee osteoarthritis (OA) among the North Bengal population shows promising short-term outcomes. Patients experienced significant improvements in pain relief, joint function, and overall quality of life. These findings suggest that HA injections can be an effective early intervention for managing knee OA, potentially delaying the need for more invasive treatments. However, further studies with long-term follow-up are needed to confirm sustained benefits and broader applicability.

DOI: 10.5281/zenodo.

Background: Chronic renal failure (CRF) often leads to a range of skin-related manifestations, influenced by both the underlying disease and its treatment. The cutaneous manifestations are widespread in chronic kidney disease (CKD). The manifestations vary depending on the stage of CKD. They include widespread xerosis and pruritus to less frequent conditions like hyperpigmentation in exposed areas, acquired perforating dermatosis, and nail abnormalities. The current study aimed to study in detail the various cutaneous manifestations of CKD patients reporting to our hospital. Methods: This cross-sectional study was conducted in the Department of General Medicine in collaboration with the Department of Nephrology and Dermatology, Institute of Medical Sciences. Patients diagnosed with chronic kidney disease (CKD) are defined according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines. The classification of patients with CKD was based on the presence of kidney damage and the glomerular filtration rate (GFR), following the KDOQI CKD classification standards. Staging was performed according to the estimated GFR (eGFR) using the MDRD (Modification of Diet in Renal Disease) formula. CKD stage V patients were further categorized as stable CKD or hemodialysis-dependent CKD (D-CKD). Results: A total of 50 patients were included in the study. The stages range from 2 to 5, representing the increasing severity of CKD. A significant majority (50%) of the patients had CKD stage 5, indicating advanced kidney disease. 10% of the patients were newly diagnosed with CKD, and a small proportion (6%) had been diagnosed within the past year. A significantly higher proportion of patients in later CKD stages (3, 4, and 5) experienced pruritus (itching), xerosis (dry skin), and pallor compared to those in earlier stages (2 and 3). These manifestations were less common and did not show significant differences between CKD stages. Most of the patients in this study had pruritus in stage 5 and it was also reported more commonly in patients above the age of 50 years. Conclusion: The results of this study showed that cutaneous manifestations were common and significant problems in patients with CKD, particularly those in the advanced stages. There is a strong association between the severity of chronic kidney disease (CKD) and the prevalence and severity of cutaneous manifestations. Pruritus, xerosis, and pallor were commonly observed in stages 4 and 5. It also appears that a longer duration of CKD is associated with higher skin complications.

DOI: 10.5281/zenodo.

Introduction: Oral cavity is significantly more prone to an enormous number of environmental insults because of its exposure to the external environment and making it common site for many tumors and tumor like conditions. The expression of Ki67 correlates well with the disease progression from dysplasia to carcinoma of oral cavity. It is therefore marker of malignant transformation and carcinogenesis in oral premalignant lesions and in future it may serve as prognostic tool in early detection of malignancy. The aim of this study is to identify an association between Ki67 protein expression and histological grades of Oral Epithelial Dysplasia – Oral Squamous Cell Carcinomas, and the role of Ki67 protein in the prognostic index of different histological grades of Oral Epithelial Dysplasia and Oral Squamous Cell Carcinomas. Material and Methods: The present Observational and Prospective study was to examine the Expression of Ki67 as Proliferative Index in Malignant and Premalignant Squamous Cell Lesions of Oral Cavity. This study conducted for 2 years (June 2022 –May 2024) and all biopsies reported as premalignant or malignant squamous cell lesions of oral cavity from patients in all age groups were included in the study. The relationship between various parameters such as Age, Gender, Addiction history, Histologic type, Histologic grade and the expression of Ki67 index were studied and Proliferation Index was calculated. Results: In the present study total 62 biopsies of oral lesions were studied. It was observed that most common lesion among Oral Epithelial Dysplasia was Moderate Dysplasia (12.9%) and among Oral Squamous Cell Carcinoma was Well Differentiated Squamous Cell Carcinoma [WDSCC] (41.9%). Ki67 Proliferative Index (PI) was categorized into Low, Moderate and High proliferative Index (PI). It was observed that most cases were showing Mild proliferation in 29 cases (46.8%), Moderate proliferation in 20 cases (32.3%) and High proliferation was seen in only 13 cases (21%). Conclusion: It was concluded in present study that Ki67 has an Inverse correlation between the degree of tumour differentiation and rate of cell proliferation. Ki67 antigen can be used as a marker for the histological reviewing of Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC). Ki67 expression expands with the severity of Epithelial Dysplasia and it was found that expression of Ki67 is significantly higher in tissues with Poorly Differentiated Squamous Cell Carcinoma and Severe Oral Epithelial Dysplasia.

DOI: 10.5281/zenodo.

Background: Uterine fibroids, or myomas, are benign tumors of smooth muscle in the uterine wall, affecting 20–60% of women of reproductive age. While they are generally asymptomatic, approximately one-third can lead to serious clinical manifestations, necessitating treatment and impacting obstetric outcomes. Aim: The goal of this study was to look into the obstetric outcomes of pregnancies complicated by uterine fibroids and associated complications. Methodology: This hospital-based, retrospective observational cohort study was conducted at Narayan Medical College and Hospital, Bihar, India, involving 82 clinically suspected pregnant women diagnosed with uterine fibroids through prenatal ultrasound. Data collected included demographic, antenatal, intrapartum, and postpartum histories. Obstetric and neonatal outcomes were analyzed using descriptive statistics and multiple logistic regression. Result: The demographic analysis showed a majority of participants aged 26–30 years (45.12%) and experiencing 2 to 3 pregnancies (43.90%). Subserous fibroids were the most prevalent type (68.29%), located primarily in the fundus (73.17%). A significant proportion of pregnancies (86.59%) reached term (37–40 weeks), with cesarean sections being the primary mode of delivery (70.73%). Complications included preterm labor (23.17%) and blood transfusions (20.73%). Notably, low birth weight was observed in 13.41% of cases. Conclusion: The study revealed a notable association between adverse obstetric outcomes and uterine fibroids, particularly concerning preterm labor and low birth weight. These findings highlight the importance of careful monitoring and management of pregnancies affected by fibroids to improve maternal and fetal outcomes.

DOI: 10.5281/zenodo.

Background: Patient satisfaction is a main indicator of healthcare quality, particularly in anesthesia management during surgical interventions. Regional anesthesia (RA) and general anesthesia (GA) are commonly used techniques, each with unique implications for patient satisfaction, pain management, and postoperative recovery. Aim: To compare the levels of patient satisfaction, pain management effectiveness, and postoperative outcomes comparing patients administered regional anesthesia (RA) with those subjected to general anesthesia (GA) for upper limb procedures. Methodology: A comparative cross-sectional study was conducted at the Department of Anaesthesiology, Vydehi Institute of Medical Sciences, Bangalore. Eighty adult patients scheduled for elective upper limb surgeries were recruited and divided equally into two groups (RA: n=40, GA: n=40). Data on demographic characteristics, satisfaction, pain levels (NRS scale), recovery time, and postoperative complications were collected and analyzed using IBM SPSS 27.0. Results: ‘Patients in the RA group expressed significantly higher satisfaction (75%) than those in the GA group (50%) (p=0.041). Better pain control was another benefit of RA; 80% of patients reported tolerable pain levels, compared to 60% in the GA group (p=0.035). In comparison to the GA group (10%), the RA group had less postoperative problems (2.5%)’. Conclusion: Regional anesthesia is associated with higher patient satisfaction, better pain management, and fewer postoperative complications compared to general anesthesia in upper limb surgeries.

DOI: 10.5281/zenodo.

Background: Gestational Diabetes Mellitus is an increasing worldwide health concern, impacting 10-14.3% of pregnant women. Neonatal hypoglycemia is a common consequence linked to gestational diabetes, making it pertinent to address in assessments of maternal therapy. Aim:  This research aimed to evaluate the ‘neonatal outcomes’ of mothers with ‘gestational diabetes mellitus’. A cross-sectional study that assesses insulin, metformin, and medical nutritional therapy. Materials and Methods: This cross-sectional research included 60 women with gestational diabetes mellitus, identified by medical records, and was conducted at the ‘Department of Obstetrics and Gynecology, ANMMCH, Gaya, Bihar, India’. Women aged 18 and older who were diagnosed with gestational diabetes mellitus, undertaking singleton pregnancies, and adhering to frequent follow-up appointments were included in the study. Results: The research examined the distribution of perinatal variables in 60 neonates, indicating that 43.33% were full-term, 36.67% were preterm, and 56.67% were delivered vaginally. Neonatal hypoglycemia occurred in 30%, ICU hospitalization in 36.67%, and seizures in 26.67% of cases. The Metformin + Insulin cohort exhibited the greatest risk for newborn problems, including hypoglycemia, cesarean deliveries, seizures, and big for gestational age (LGA) outcomes, with a higher incidence of lower Apgar scores in this group. Conclusion: Metformin, whether administered alone or in conjunction with insulin, demonstrated neonatal results similar to those achieved with insulin alone. Exercise caution during births in gestational diabetes mellitus for best health outcomes.

DOI: 10.5281/zenodo.

Background: Anal fissure is a painful condition characterized by a longitudinal tear in the anoderm. It can cause significant physical discomfort and emotional stress, reducing patients’ quality of life. Treatment methods for chronic anal fissures range from conservative medical management to surgical interventions like lateral internal sphincterotomy (LIS). Aim: The study aims to evaluate the safety, effectiveness, and patient satisfaction following LIS for chronic anal fissures. Methodology: This retrospective study was conducted over a year at Jannayak Karpoori Thakur Medical College and Hospital, Bihar. A total of 100 patients with chronic anal fissures unresponsive to medical treatments were included. LIS was performed, and patients were followed up postoperatively to assess pain relief, complications, and recurrence rates. Statistical analysis was conducted using SPSS, and significance was determined with a p-value < 0.05. Results: Of the 100 participants (mean age: 45.77 years), 90% experienced pain relief by the eighth week post-surgery. Complications were minimal, with only 1.1% reporting rectal bleeding. No cases of perianal abscess, hematoma, or incontinence were observed. Patient satisfaction was high, with 96.7% expressing positive outcomes and 97.8% achieving complete fissure healing. Conclusion: LIS is a highly effective treatment for chronic anal fissures, with minimal complications and high patient satisfaction. The procedure provides significant long-term relief from pain and promotes healing, making it a preferred option for patients unresponsive to conservative management.

DOI: 10.5281/zenodo.

Aim: This research aims to assessed the clinical and functional outcomes of meniscus repair using different techniques. Methods: The current investigation was carried out and presented at the Department of orthopaedics, MRMCH Medini Nagar, Palamu, Jharkhand, India. Following the diagnosis of meniscus damage based on MRI results and clinical assessment, the patients underwent meniscal repair procedures. In the study population, there were 35 knees with meniscal lesions on the side and 25 knees with medial side lesions. Results: The study involved 60 participants, predominantly male (75%), with a higher incidence of right knee (66.67%) and lateral meniscus tears (58.33%). Medial meniscus tears were more common overall, except for bucket handle tears, which were evenly distributed. The “All Inside” methods was favored for radial, posterior, and horizontal horn tears, while complex tears like bucket handle injuries were treated using hybrid techniques. Conclusion: The clinical and functional outcomes were comparable when all three meniscus repair techniques that are all inside, within, and out of the body combined, and there was no statistically significant difference in the results.

DOI: 10.5281/zenodo.

Background: The right of every newborn to be born undamaged, both mentally and physically, underscores the significance of maternal-fetal medicine, primarily aimed at ensuring safe pregnancy outcomes. Pregnancy-induced hypertension remains a critical challenge, especially in developing countries, where it complicates approximately 7 to 15 percent of pregnancies and is the second leading cause of maternal mortality. Aim: To explore the efficacy of Doppler studies in detecting ‘pregnancy-induced hypertension’ (PIH) and ‘intrauterine growth restriction’ (IUGR) in primigravida (first-time mothers) by evaluating the correlation between Doppler parameters and maternal-fetal outcomes. Methodology: This study was conducted over six months at Narayan Medical College and Hospital, Sasaram, Bihar, India the prospective study involved 70 women beyond 34 weeks of gestation with diagnosed PIH. Participants underwent detailed obstetric examinations and Doppler ultrasonography of the umbilical artery to assess blood flow dynamics, with follow-up until delivery to classify newborns based on growth parameters. Results: An even distribution of participants was noted between low-risk and high-risk categories (35 patients each). Key findings indicated that a prior history of hypertensive disorders was prevalent in 48.57% of high-risk patients. Notably, abnormal Pulsatility Index (PI) was linked to a significant increase in hypertension progression in both low-risk (50%) and high-risk (66.66%) groups, with a P-value of 0.000 underscoring this correlation. Doppler ultrasonography exhibited high specificity and moderate sensitivity in identifying preeclampsia, particularly beneficial for high-risk groups. Conclusion: The integration of Doppler ultrasonography improves the management of high-risk pregnancies complicated by PIH and IUGR. Abnormal PI serves as a critical indicator for hypertension, necessitating individualized care strategies. The study advocates for continued exploration of innovative antenatal care methods, particularly in resource-limited settings, to enhance maternal and neonatal health outcomes.

DOI: 10.5281/zenodo.

Background: Necrotizing fasciitis (NF) is a life-threatening infection that leads to the destruction of the skin and soft tissues. This condition is associated with several underlying systemic disorders, such as malignant neoplasms, chronic alcohol abuse, and diabetes mellitus (DM), all of which are considered potential risk factors for its development. This study aims to compare clinical characteristics between patients with surgically confirmed NF and those without diabetes. Materials and Methods: A prospective descriptive study was conducted to investigate NF in patients with DM. Cases of NF were identified using the International Classification of Diseases-9 code for NF (728.86) in a tertiary care facility. The study population consisted of 91 patients diagnosed with Type II DM and extremity NF. Results: The study included 91 participants with a mean age of 56.96 ± 10.51 years. Among them, 72 patients (79.12%) were male, and 19 (20.88%) were female. The Wagner score was employed to assess clinical presentation, with the majority of patients showing a maximum score of 3. Furthermore, the most common presentation was a score of 0 (57.14%), which corresponded to pre-ulcerative lesions, healed ulcers, and skeletal deformities. Conclusion: This study highlights the severity of NF, particularly in patients with diabetes. Poorly controlled DM was associated with a worse prognosis for NF. Hence, early detection and aggressive treatment are crucial. Heightened awareness of the disease’s atypical presentation, combined with a high degree of clinical suspicion and direct fascial examination, are essential, especially in diabetic individuals.

DOI: 10.5281/zenodo.

Background: Propofol, commonly used for induction, induces alterations in blood pressure and heart rate (HR) during laryngeal mask airway (LMA) insertion. Sevoflurane, however, presents a promising alternative as an induction agent. This study compares the effectiveness of propofol and sevoflurane for facilitating LMA insertion in adult patients undergoing minor surgeries. The main aim of the study was to assess and compare the ease of LMA insertion and related characteristics in adult patients undergoing minor elective surgeries with intravenous propofol versus inhalational sevoflurane. Materials and Methods: This prospective, observational study included a total of 145 patients using consecutive sampling and divided into two groups: group A (propofol) and group B (sevoflurane). Key variables, such as anesthesia induction time, jaw relaxation time, and LMA insertion time, were recorded. LMA insertion conditions were evaluated using a 3-point scale across six variables, with a total score calculated for each group. Hemodynamic responses and induction-related complications were also documented. Results: There were no significant differences between the groups in terms of demographic data, American Society of Anesthesiologists classification, Modified Mallampati Grading, or LMA size. The LMA insertion times were comparable between both groups. Regarding complications, while there were no cases of coughing, minor gagging and laryngospasm were observed exclusively in the sevoflurane group. Final score evaluation indicated excellent insertion conditions for propofol and sevoflurane, with no statistically significant difference between them. Conclusion: Sevoflurane can be considered a viable alternative to intravenous propofol for LMA insertion in adult patients undergoing minor elective surgeries.

DOI: 10.5281/zenodo.

Background: Postoperative pain management in children is critical, as inadequate relief can lead to lasting negative effects. Clonidine, an α2-adrenergic agonist, may enhance analgesia when used with local anesthetics. The main objective of the study is to evaluate the effects of clonidine as an adjunct to caudal bupivacaine and ropivacaine in terms of analgesic efficacy, duration of analgesia, sedation levels, hemodynamic changes, and complications. Methods: A prospective study was conducted involving 100 children aged 1-7 years undergoing elective infraumbilical surgeries. Patients were divided into four groups: Group A (bupivacaine), Group B (bupivacaine + clonidine), Group C (ropivacaine), and Group D (ropivacaine + clonidine). Pain was assessed using the FLACC scale, and the duration of analgesia was defined as the time from injection to first rescue analgesic requirement. Results: The duration of analgesia was significantly longer in the clonidine groups: Group B had 9.89±1.72 hours compared to Group A’s 6.13±1.28 hours (p < 0.0001). Group D had a duration of 9.3±1.3 hours versus Group C’s 5.84±1.08 hours. Sedation levels and hemodynamic stability were monitored, with some observed side effects including sedation and hypotension. Conclusion: Clonidine significantly prolongs the duration of postoperative analgesia when added to caudal bupivacaine and ropivacaine in pediatric patients. This adjunctive use may improve pain management strategies in pediatric anesthesia.

DOI: 10.5281/zenodo.

Background: Postoperative pain management in children is critical, as inadequate relief can lead to lasting negative effects. Clonidine, an α2-adrenergic agonist, may enhance analgesia when used with local anesthetics. The main objective of the study is to evaluate the effects of clonidine as an adjunct to caudal bupivacaine and ropivacaine in terms of analgesic efficacy, duration of analgesia, sedation levels, hemodynamic changes, and complications. Methods: A prospective study was conducted involving 100 children aged 1-7 years undergoing elective infraumbilical surgeries. Patients were divided into four groups: Group A (bupivacaine), Group B (bupivacaine + clonidine), Group C (ropivacaine), and Group D (ropivacaine + clonidine). Pain was assessed using the FLACC scale, and the duration of analgesia was defined as the time from injection to first rescue analgesic requirement. Results: The duration of analgesia was significantly longer in the clonidine groups: Group B had 9.89±1.72 hours compared to Group A’s 6.13±1.28 hours (p < 0.0001). Group D had a duration of 9.3±1.3 hours versus Group C’s 5.84±1.08 hours. Sedation levels and hemodynamic stability were monitored, with some observed side effects including sedation and hypotension. Conclusion: Clonidine significantly prolongs the duration of postoperative analgesia when added to caudal bupivacaine and ropivacaine in pediatric patients. This adjunctive use may improve pain management strategies in pediatric anesthesia.

DOI: 10.5281/zenodo.

Introduction: The progressive respiratory ailment known as chronic obstructive pulmonary disease (COPD) is linked to a high rate of morbidity and death. Inhaled corticosteroids (ICS) and bronchodilators are commonly used in combination treatment for pharmacological management. The purpose of this research is to examine the effects of dual therapy (LAMA-LABA) and triple therapy (LAMA-LABA-ICS) on individuals with COPD. Aims: To compare the effects of LABA-LAMA and LABA-LAMA-ICS combination in the two treatment groups; to comprehend the effects of individual LABA + LAMA and LABA+LAMA+ICS in COPD patients; and to investigate various COPD variables such as FEV1/FVC ratio, FEV1, DLCO, 6-minute walk test, and frequency of exacerbations in COPD at one-, three-, and six-month intervals. Materials and Methods: The present study was a comparative clinical trial. The study Period will be July 2023 to August 2024 And Data Collection from July 2023 to July 2024 Analysis August 2024 at department of the department of respiratory medicine, IPGME & R and SSKMH, Kolkata. Total 100 patients were included in this study. Result: We found that, FEV1 Change after 12 weeks  was less in LABA LAMA [.0336± .0165] compared to LABA LAMA ICS [.0600 ±.0326] but this was statistically significant (p<0.0001). Our study showed that, FEV1 Change after 24 weeks was more in LABA LAMA [.1008 ± .0314] compared to LABA LAMA ICS [.0878±.0383] but this was statistically significant (p<0.0001). We observed that, FEV1 Change after 52 weeks was lower in LABA LAMA [.0500± .0182] compared to LABA LAMA ICS [.1508±.0397] but this was statistically significant (p<0.0001). We found that, 6 MWD Change after 52 weeks (Meteres) was lower in LABA LAMA [153.0204 ± 48.7239] compared to LABA LAMA ICS [229.2553 ±54.3985] but this was statistically significant (p<0.0001). In our study, Improvement in Dyspneoa SGRQ Scoring was more in LABA LAMA ICS [22.0040 ±7.2832] compared to LABA LAMA [16.6800 ± 4.8379] but this was statistically significant (p<0.0001). Conclusion: We came to the conclusion that a comparative research offers strong evidence for triple therapy’s (LAMA-LABA-ICS) advantage over dual therapy (LAMA-LABA) in the treatment of COPD. Triple therapy is superior to dual therapy in terms of improving lung function, symptom management, and quality of life outcomes. It also reduces the incidence of flare-ups. These results emphasize the need of maximizing COPD therapy through individualized therapeutic strategies catered to the requirements of each patient.

DOI: 10.5281/zenodo.

Suicide remains a major cause of mortality worldwide, reflecting a region’s living conditions as well as its social and psychological dynamics. This study aims to analyse the prevalence, trends, and factors associated with hanging deaths referred for medico-legal autopsies in Dibrugarh, Assam. We assessed the incidence of hanging deaths, identified contributing factors, and examined relevant autopsy findings. A retrospective analysis was conducted on hanging cases autopsied at the Department of Forensic Medicine, Assam Medical College and Hospital, Dibrugarh, from January 1, 2022, to December 31, 2023. Data was collected following appropriate permissions from the college authority, and statistical methods were employed for analysis. Among the 3,716 autopsies performed, 524 cases (14.1%) involved hanging. Males accounted for 304 cases (58.01%), while females comprised 220 cases (41.9%), with the most affected age group being 20 to 30 years (176 cases, 33.58%). Family disputes were identified as the leading cause in 164 cases (31.29%), followed by romantic relationship issues in 104 cases (19.84%). Tea garden workers constituted 156 cases (29.77%), and students represented 122 cases (23.28%). Nylon rope was the most common ligature material, used in 104 cases (19.84%). The study highlights suicide as a critical public health issue, underscoring the need for the medical community’s involvement in prevention efforts. Initiatives promoting education, compassion, and reducing societal pressures may decrease suicide rates among young individuals, ultimately enhancing their productivity and benefiting developing economies like India.

DOI: 10.5281/zenodo.

Introduction: The definition of pain is “an unpleasant sensory and motor experience related to or characterized by actual or potential tissue damage.” In order to improve pain relief, balanced multi-modal analgesia has been popular recently. One of the most significant issues facing healthcare today is post-operative pain, and pain management is a hot topic right now. Aims: To evaluate the post-operative analgesic effects of peri-incisional local anesthetic infiltration and transversus abdominis plane (TAP) block in cases of infra-umbilical abdominal surgeries. Materials & Methods: The study was conducted in a tertiary care hospital, i.e., Burdwan Medical College & Hospital, Purba Bardhaman, and West Bengal. The study was primarily set in the Department of General Surgery and Department of Gynaecology & Obstetrics of this medical college. Result: According to our research, the TAP rescue analgesic was administered to the group 514.70±45.10 minutes after surgery, whereas the LAI group received it at 419±29.40 minutes. There was a statistically significant difference in the mean initial dosage of rescue analgesic between the two groups (p<0.001). Conclusion: When it comes to postoperative analgesia following non-traumatic abdominal procedures, the TAP block works better than peri-incisional infiltration with 0.25% bupivacaine. Its application in clinical practice for this patient population may result in better pain management, less opioid usage, and increased patient satisfaction.

DOI: 10.5281/zenodo.

Background and Aim: Abnormal uterine bleeding refers to any bleeding from the uterus that deviates from the typical volume, duration, regularity, or frequency expected during a menstrual cycle. Transvaginal sonography provides a comprehensive evaluation of anatomical irregularities within the uterus and the pathologies affecting the endometrium and myometrium. The study aimed to assess the underlying causes of abnormal uterine bleeding through the utilisation of transvaginal sonography, hysteroscopy, and endometrial curettage, with the goal of attaining the highest level of diagnostic precision. Material and Methods: This cross-sectional study involved 150 perimenopausal women aged 35 to 45 years, who sought care at the outpatient department of obstetrics and gynaecology at a Tertiary Care Teaching Institute in India over the course of one year. Details concerning the woman’s menstrual and obstetric history were requested. A comprehensive systemic examination, along with a gynaecological assessment and targeted investigations such as transvaginal sonography (TVS) and hysteroscopy, were conducted. Results: The findings indicate that the average endometrial thickness measured via transvaginal ultrasound for endometrial hyperplasia was 15.40±6.32 mm. In contrast, uterine leiomyomas presented an average thickness of 13.43±2.21 mm. For a normal endometrium, the mean thickness was recorded at 7.40±3.11 mm, while polyps exhibited an average thickness of 10.22±3.43 mm. A total of 150 women experiencing perimenopause underwent hysteroscopy to investigate abnormal uterine bleeding (AUB). A normal endometrium was observed in 77 women, accounting for 51.33% of the cases examined. A polyp was identified in 39 women, representing 26% of the population studied. Hyperplasia was identified in 27 women, accounting for 18%, while Leiomyoma was observed in just 7 women, representing 4.6%. Conclusion: Hormonal imbalance, endometrial polyps, endometrial hyperplasia, and leiomyomas are significant contributors to abnormal uterine bleeding in perimenopausal women. Hysteroscopy demonstrates a range of accuracy in identifying endometrial pathology, outperforming transvaginal ultrasound in this regard.

DOI: 10.5281/zenodo.

Introduction: Tibia is the most commonly fractured long bone. Because one third of the tibial surface is subcutaneous throughout most of its length, open fractures are more common in the tibia than in any other major long bone. High-energy tibial fractures may be associated with compartment syndrome or neural or vascular injury. On the basis of location, distal tibia fractures are second in incidence next to tibia diaphyseal fractures. The distal tibia due to its subcutaneous blood supply pose a challenge to treating surgeons in terms of choosing an appropriate implant to achieve adequate union and return to early preinjury levels. Aims: To analyse the functional outcome of patients with extraarticular distal tibia fractures treated by intramedullary nailing. Materials and Methods: It was a prospective observational study this study was conducted from April 2021to October 2022 Burdwan Medical College & Hospital in Department of Orthopaedics and Radiodignosis. 20 Patients were included in this study. Result: In our study 1 Patient had Gustilo Anderson classification 1, 3 Patients had Gustilo Anderson classification 2, 1 Patient had Gustilo Anderson classification 3A. In 2(10%) Patients had Infection, 9(45%) Patients had Malunion, 1(5.0%) Patient had Non-Union, 2(10%) Patients had Delayed Union. Out of 20 patients, 15 had sustained closed fractures and 5 patients have sustained open fractures. Conclusion: The hypothesis of our study is that intramedullary nailing in distal tibia fractures achieve consistent union and earlier return to work. This objective has been achieved.

DOI: 10.5281/zenodo.

Introduction: Intergluteal pilonidal disease (IPD) is a skin and subcutaneous infection near the upper part of the natal cleft of the buttocks, affecting 26 cases per 100,000 populations, with men being 2 to 4 times more prone. Risk factors include obesity, local trauma, prolonged sitting, deep natal cleft, and a positive family history. Aims: The study’s goal is to compare the results of the Limberg flap and Karydakis flap and discover the best techniques for treating Pilonidal Sinus illness Patient satisfaction. Materials & methods: This is a hospital based prospective randomized clinical trial, to compare Limberg flap and Karydakis flap. This study was conducted at the Bokaro General Hospital, Department of General Surgery. The study covered over a period of one and half year (October 2019 to Mar 2021). Numbers of the patients taken for the study were 70 Result: There are 70 patients, 35 in each Limberg and Karydakis. Discharge is present in all the patients of both Limberg and Karydakis. The Routine Blood Investigation is normal in all patients of both flap Limberg and Karydakis In puss culture, Staph Aureus is highest in both flap Limberg and Karydakis, 13 in each flap. Mixed Growth and Proteus Mirabilis is lowest in both flap, 2 in each flap. The Bacteroides Fragilis is 12 in Limberg and 12 in Karydakis. E.Coli is 6 in Limberg and 6 in Karydakis. Conclusion: The Limberg flap is recommended for treating recurrent pilonidal sinus illness, as it reduces complication rates, short hospital stays, lower pain scores, and improves patient satisfaction.

DOI: 10.5281/zenodo.

Introduction: Fractures of the distal end of radius are amongst the most common fractures. They occur in middle-aged and elderly women commonly. It also occurs in young men with high velocity injury though less in number. With increase in longevity and activity in middle-aged to elderly population, there is increase in number of these fractures. Various surgical interventions are currently available, like percutaneous pinning, intra-focal pinning, external fixator and plate fixation. The present study management of fractures of distal end of radius by external fixators using the principle of ligamentotaxis was undertaken in the Department of Orthopedics at our institute to study functional outcomes. Materials and Methods: With distal end radius fracture treated with external fixator were recruited from the orthopedics OPD and casualty, HSK hospital, based on the inclusion/exclusion criteria and diagnosed as per Frykman classification. Research study was conducted for 18 months from April 2022 to October 2023.The research study was supported by primary data source. Primary source of data: The material for the present study is from patients with distal end radius fracture treated with external fixator. To meet the objectives of our study, a primary source of information technique was adopted with direct interview method using pre-tested semi-structured. Secondary source of data Secondary data source was used to estimate the sample size and also to frame the questionnaire. The sources of secondary data were multiple- journals, academic books, research articles and review articles, all of which are listed in the bibliography. Result: Present case series study was to done for a period of 18 months among 30 patients with distal end radius fracture treated with external fixator who visits Orthopaedics OPD and casualty of S. Nijalingappa Medical College and Research Centre, Bagalkot to study the functional outcome of distal end radius fractures treated with static external fixators. There was consistent improvement in ROM over time for all movements. Pre-operatively, initial ROM was severely limited in all directions. Pronation had the highest initial ROM (24.8±3.2°), followed by supination (19.9±3.2°). Flexion (14.8±3.2°) and extension (10.5±2.3°) were the most restricted. At 1 year, maximum ROM achieved for all movements. Supination and pronation both reached about 85° (84.9±3.2° and 84.8±3.2°). Flexion improved to 79.9±3.2°, and extension to 69.9±3.2. Conclusion: In conclusion, our study demonstrates that static external fixation is an effective treatment option for distal end radius fractures, offering good functional outcomes, high patient satisfaction, and an acceptable complication rate. While our results are promising, further large-scale, comparative studies are warranted to definitively establish the role of static external fixators in relation to other treatment modalities for distal end radius fractures.

DOI: 10.5281/zenodo.

Introduction: Apoptosis maintains cellular balance by eliminating damaged cells, and its dysregulation is key in cancer progression. Survivin and Caspases regulate apoptosis via the extrinsic and intrinsic pathways. Survivin aids cancer cell survival by blocking apoptosis, while high caspase-3 levels link to poorer breast cancer survival, highlighting its potential prognostic significance as a biomarker. Aims: To assess the expression of survivin and capase-3 in paraffin-embedded breast cancers samples and examine its association with the clinicopathological characteristics of the patients and the Nottingham prognostic index. Materials & Methods: The present study was a Cross sectional observational study. This Study was conducted from 18 Months at Department of General Surgery, IHC lab and Department of Pathology IPGMER and SSKM hospital, Kolkata. Total 219 patients were included in this study. Result: According to statistical analysis, Pearson Correlation Coefficient (r) value was higher in Survivin as compared to Caspase-3. Prognostic significance was more specific in Survivin as compared to Caspase-3 which was statistically significant. Conclusion: We also conclude that inhibition Survivin may decrease tumour progression in patients and may block breast carcinogenesis, reducing the incidence of breast carcinoma in patients at high risk. To evaluate this fact further study with large sample size is to be contemplated.  Further research is warranted to explore the clinical implications of our findings and to translate them into improved outcomes for breast cancer patients.

DOI: 10.5281/zenodo.

Introduction: Shivering is a common side effect of spinal anesthesia. It is a physiological response of body by which heat production occurs to increase the core body temperature. It is defined as involuntary, repetitive action of skeletal   muscle. Incidence of shivering has been found up to 40-50% in different studies. Aims: To study the efficacy, hemodynamic changes and adverse effects of prophylactic administration of Clonidine and Tramadol Hydrochloride for prevention of shivering during surgeries of Lower abdomen and Lower Limbs under Spinal Anesthesia. Materials and Methods: The present study was an Analytical and Cross- Sectional Observational Study. This Study was conducted from July 2021 to June 2022 at Department of Anesthesia of North 24 Parganas District Hospital. Total 120 patients were included in this study. Result: Distribution of mean Sedation score at 0 min with Group was statistically significant (p<0.0001). Distribution of mean Sedation Score at 5 MIN with Group was statistically significant (p<0.0001). Conclusion: Therefore, to conclude our study, we found that there was no difference of Shivering between the groups, however the patients in Clonidine group was more sedated which may cause a temporary fall in Spo2 so strict monitoring is needed while using it and had less nausea and vomiting than the patients in Tramadol group. This observation enables us to administer these drugs more judiciously, if used at all. (Example: where we know a high-risk group of PONV we can avoid administering Tramadol and rather opt for Clonidine, and where less sedation is required, we can administer Tramadol).

DOI: 10.5281/zenodo.

Background: Doctors are ultimately required to perform in a real-life setting that does not offer a list of choices. The goal of assessment in medical education is usually to support learning and to establish the competence of individual doctors. This study was conducted on MBBS undergraduate students of Bankura Sammilani Medical College during August – October 2019 to compare the preferences between Multiple Choice Questions (MCQ) and Modified Essay Type Questions (MEQ) for theoretical evaluation. Materials and Methods:  190 students of different professional years of MBBS in Bankura Sammilani Medical College were given a pre-designed, pre-tested Google form questionnaire and their responses were collected. Results: Mean age of the 190 students was 21.61 ± 1.17 (SD) years. Majority of the students (84.2%) were in the age group 21-24, male (62.1%), belonged to Hinduism (87.9%) and studying in MBBS 2^nd professional. 57.4% students preferred Short Answer Questions (SAQ) for theoretical assessment. Preference of the type of questions for theoretical assessment was significantly associated with the professional year of MBBS (p = 0.016), class attendance (p = <0.001) of the students etc. 57.4% students thought MCQ is the preferred type of question for testing of knowledge.  62.1% students thought MCQ is the preferred type of question for testing the ability to apply knowledge. 43.7% students thought MCQ is the preferred type of question for testing the skills. Conclusion: The present study findings can clearly infer the less popularity of essay type questions among undergraduate students.

DOI: 10.5281/zenodo.

Introduction: The clinical relevance of mastoid surgery in the context of safe CSOM management is multifaceted. Firstly, it directly targets the underlying disease process by removing infected tissue, thereby reducing the bacterial load and promoting a healthier environment for the middle ear. Secondly, surgical intervention can significantly improve auditory function, which is a critical consideration given that hearing impairment can adversely affect communication and quality of life. Materials & Methods: A cross-sectional study was conducted in which a total of 50 study subjects were selected based on purposive sampling. Based on the clinical diagnosis of dry and tubotympanic disease (Quiescent/Inactive) and the mastoid pneumatization status, patients were divided into two groups, all of whom exhibited normal Eustachian tube function. 25 patients underwent tympanoplasty categorized as Group A while the remaining 25 patients underwent tympano-mastoidectomy categorized as Group B. Results: The study showed preoperative mean A–B gap in Groups A and B was (29.45 ±11.56dB) and (33.61±8.89dB) respectively. Postoperatively mean AB gap was (14.33±9.31dB) in Group A and (9.78±6.64dB) in Group B. Overall AB gap gain was (15.89±10.22dB) for Group A and (23.83±7.68db) for Group B. There was a significant improvement seen in the ABG in our study in patients who underwent tympan mastoidectomy. Conclusion: By addressing the underlying pathology and facilitating improved auditory function, mastoid surgery significantly enhances patient outcomes and reduces the risk of recurrent infections. While surgical intervention is not without risks, careful patient selection and individualized treatment plans can optimize benefits and minimize complications.

DOI: 10.5281/zenodo.

Aim: This study examines open mesh inguinal hernia repair at Rural tertiary care hospital, in BMIMS Pawapuri, Nalanda, Bihar to determine its efficacy and limitations in a resource-limited situation. Method: The Surgery Department of Department of General Surgery, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, from 20-7-2023 to 21-8-2024 conducted this cross-sectional study. The purposive sample chose 86 inguinal hernia patients who underwent open mesh surgery. All participants gave written consent before data collection. Patients having complete surgical records and follow-up data were studied. Patients under 18, those with chronic disorders including constipation, cough, or prostatism, and those with irreducible, blocked, or strangulated hernias were excluded. All participants provided demographic and clinical data, which was analyzed using MS Office. Result: Most of the 86 patients were male (67.44%) and 51-65 years old (37.20%). 93.02% of patients had no intraoperative problems. Postoperative problems included numbness (26.41%), hematoma (24.52%), and scrotal edema (22.64%). A wound infection occurred in 3.77% of cases. Hernia recurrence occurred in 3.6% of patients, and 2.4% needed surgery. Conclusion: A Rural tertiary care hospital, in BMIMS Pawapuri, Nalanda, Bihar had low rates of significant problems and recurrence after open mesh inguinal hernia surgery. Numbness and hematoma are typical after the operation, yet it works in resource-constrained environments. Improved surgical techniques and postoperative care could improve patient outcomes and satisfaction in similar scenarios.

DOI: 10.5281/zenodo.

Aim: This study seeks to evaluate lipid profile anomalies in newly diagnosed T2DM individuals, emphasizing the importance of early identification in reducing cardiovascular morbidity and death. Methodology: A retrospective study research was performed at Ajay Sangaal Institute of Medical Sciences & Research, encompassing 74 consecutive patients aged 18 to 85 with newly diagnosed Type 2 Diabetes Mellitus (T2DM). Demographic data, diabetes duration, anthropometric measures, and laboratory findings (HbA1C, fasting plasma glucose, lipid profiles) were gathered. Dyslipidemia and hyperlipidemia were evaluated according to established lipid irregularities. Statistical analysis employed SPSS software, with p-values less than 0.05 being substantial. Results: The participants had an average age of 58.2 years and an average A1C of 7.8%. Significantly, 65% had aberrant A1C values, whereas 51% presented with hyperlipidemia. Dyslipidemia impacted 57% of the population, marked by increased total cholesterol (51%) and LDL (43%), in conjunction with decreased HDL (49%). Only 41% received statin medication, despite 46% qualifying under the American Diabetes Association criteria for this treatment. Conclusion: The research underscores notable lipid profile irregularities and inadequate glycemic regulation in recently diagnosed T2DM patients. The insufficient use of statins in at-risk individuals highlights the necessity for enhanced management techniques, encompassing lifestyle changes and compliance with treatment protocols, to improve cardiovascular health outcomes in this demographic.

DOI: 10.5281/zenodo.

Aim: This study aims to compare the efficacy of catheter drainage vs needle aspiration in treatment of liver abscesses. Method: This study presents a comparative examination of 97 individuals who received treatment in both outpatient care and the Department of General Surgery, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. The individuals were randomly randomized into two groups: one group had percutaneous needle aspiration, while the other group received pigtail catheter drainage. The surgeon who performed the surgeries was unaware of the group designations, which were determined by an independent assessor. The effectiveness of each treatment was evaluated by considering the duration of hospitalization, the time required to achieve decrease in clinical improvement, abscess cavity size, and total or almost complete elimination of the abscess cavity. Result: The group that underwent catheter drainage had a significant improvement in their success rate. The individuals who had pigtail catheter drainage experienced rapid clinical improvement and a reduction in the size of the abscess cavity, unlike those who experienced percutaneous needle aspiration. Conclusion: Percutaneous catheter drainage is more effective than percutaneous needle aspiration when it addresses larger abscesses that have pus that is either completely thick or partially liquefied.

DOI: 10.5281/zenodo.

Aim: This study seeks to examine the risk factors and the crucial function of mothers in mitigating nutritional anemia during early childhood. Methodology: A retrospective study, conducted at Darbhanga Medical College and Hospital in Bihar, India, involved 74 children aged 6 months to 2 years. The inclusion criteria included children hospitalized during the research period, but those with chronic diseases were excluded. Data were gathered using a standardized questionnaire that encompassed demographics, medical history, nutritional status, and mother knowledge of anemia. Blood samples were examined to distinguish iron deficiency anemia from other forms of anemia. Results: Demographic analysis indicated an equitable gender distribution, with 59.5% of participants aged 13 to 24 months. A notable percentage (24.3%) exhibited chronic malnutrition, while just 8.1% had received previous iron supplementation. Laboratory results revealed a mean hemoglobin concentration of 9.1 ± 1.5 g/dL, demonstrating a significant incidence of iron deficiency anemia (IDA). Maternal awareness was significantly elevated, with 78.4% identifying IDA; however, understanding of risk factors and symptoms was comparatively deficient. Discussion: The findings highlight the need for improved maternal education on anemia, emphasizing risk factors and dietary patterns, as well as the execution of specific nutritional treatments to mitigate the significant impact of iron deficiency anemia in early children.

DOI: 10.5281/zenodo.

Background: ADHD (attention deficit hyperactivity disorder) is a prevalent neurodevelopmental disorder among children, with both genetic and environmental risk factors, including nutritional deficiencies. Previous research has suggested that micronutrients like vitamin D and iron play important roles in cognitive function and brain development, potentially affecting ADHD symptoms. However, the specific impact of nutritional deficiencies on ADHD symptoms, particularly in children, remains inadequately explored. Aim: This study aims to explore the relationship between nutritional deficiencies, specifically serum ferritin and vitamin D levels, and ADHD symptoms in children. It seeks to assess whether children with ADHD exhibit lower levels of these micronutrients compared to healthy controls. Methodology: A case-control study was conducted involving 35 children diagnosed with ADHD and 35 healthy controls. ADHD was diagnosed using the INCLEN diagnostic tool, and serum levels of ferritin and vitamin D were measured using the Enzyme-Linked Fluorescent Assay (ELFA). Data were statistically analysed using SPSS version 22, with comparisons made between the two groups and ADHD subtypes. Results: The research showed that children diagnosed with ADHD exhibited notably lower serum ferritin levels in comparison to the control group (p=0.037). In the study, low serum ferritin was observed in 45.71% of ADHD cases, whereas it was present in 22.86% of the control group. No statistically significant difference was observed in serum vitamin D levels between the groups (p=0.573). Both groups exhibited a significant prevalence of vitamin D deficiency, with 71.43% of ADHD cases and 65.71% of controls presenting with low levels. Conclusion: According to this study, low serum ferritin levels, a sign of iron deficiency, may exacerbate children’s ADHD symptoms. Despite being common, vitamin D deficiency does not seem to significantly affect ADHD. These results highlight how crucial it is to take nutritional status into account while managing ADHD and indicate that more study is required to evaluate the possible advantages of dietary treatments.

DOI: 10.5281/zenodo.

Background: Preterm neonates exhibit a high vulnerability to respiratory distress resulting from lung immaturity, which contributes to considerable morbidity and mortality rates. Nasal Continuous Positive Airway Pressure (CPAP) is increasingly utilized for the management of respiratory distress syndrome (RDS), effectively minimizing the requirement for invasive mechanical ventilation. Data regarding the efficacy and long-term outcomes of these interventions, especially in developing countries, remain limited. Aim: This research evaluates the efficacy and long-term outcomes of non-invasive respiratory support versus invasive ventilation in preterm neonates experiencing respiratory distress. Methodology: A retrospective descriptive study was carried out at Department of Paediatrics, Darbhanga Medical College and Hospital in Bihar, India, over a period of 10 months. The research involved 92 preterm neonates born before 37 weeks gestation who exhibited respiratory distress. Neonatal characteristics, respiratory support, maternal factors, and outcomes were systematically collected and analyzed utilizing SPSS. Outcomes of non-invasive ventilation (NIV) and invasive ventilation (IV) groups were compared using Chi-square and Fisher’s exact tests. Results: Among the 92 neonates, 65.2% were provided with non-invasive support, whereas 34.8% needed invasive ventilation. Neonates in the NIV group exhibited significantly reduced mortality (8.3% vs. 59.4%, p < 0.001) and morbidity, including necrotizing enterocolitis (8.3% vs. 28.1%, p = 0.001), disseminated intravascular coagulation (5.0% vs. 31.3%, p < 0.001), and sepsis (33.3% vs. 75.0%, p < 0.001) when compared to the IV group. Complications, including intraventricular haemorrhage (0% vs. 12.5%, p = 0.001) and nasal trauma (10.0% vs. 31.3%, p = 0.001), were significantly reduced in the NIV group. Conclusion: Non-invasive respiratory assistance for premature infants with respiratory distress is linked to improved clinical outcomes and reduced complications relative to invasive ventilation. The results indicate that non-invasive strategies should be prioritized for respiratory support in this population to minimize mortality and morbidity.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to isolate causative pathogen in infectious keratitis. Methods: This study was conducted in Department of Ophthalmology and Department of Microbiology, Sir Sunderlal Hospital, Institute of Medical Science, Banaras Hindu University, Varanasi. This study was conducted from May 2019 to September 2020. Results: Amongst 30 patients, the age group most commonly affected, was found to be between 31 – 40 years i.e. 6 (20.00%) in our study, 41-50 years i.e. 8 (26.70%), 21-30 years i.e. 4 (13.30%), followed by >50-year patients i.e. 11 (36.70 %). The least commonly involved age group be in less than or equal to 20 i.e. 1 (3.30%). Gender wise analysis of corneal ulcer cases in our study showed 66.60% cases were Male and 33.30 % cases were Female. Our study showed a more common predisposition of corneal ulcer in right eye 20 cases (66.70%) as compared to left eye 10 cases (33.30%). In our study, 9 cases (30%) were known cases of diabetes mellitus and rest were nondiabetic. Out of 30 patients enrolled in our study, 8 (26.70%) had a history of instillation of corticosteroid drops at least once during course of disease and rest 22 cases (73.30%) had not used steroid drops. Amongst the included cases, 17 (56.70%) had already used antibiotic drops before presenting to our OPD, while 13 (43.30%) did not receive any form of treatment. Hypopyon at the time of presentation in OPD was present in 36.70% (11 cases) of cases and rest 63.30% (19 cases) were hypopyon free. In our study, 12 (85.70%) cases were gram stain positive while rest were gram stain negative 2 (14.30%). Conclusion: Thus, the present study concludes that Aspergillus species are the most common cause for fungal keratitis in our region, with A. fumigatus and A. flavus being the prevalent species, followed by Fusarium. Bacterial isolates are responsible for considerably fewer cases of keratitis. Routine surveillance of fungal keratitis is necessary to know the existing and emerging pattern of pathogens. Trauma with vegetative matter was identified as the most common risk factor.

DOI: 10.5281/zenodo.

Background: Neonatal sepsis is a severe systemic infection in newborns, predominantly caused by bacterial, viral, or fungal pathogens. It is a major health issue, especially in preterm or low birth weight infants, due to their underdeveloped immune systems. Despite improvements in neonatal care, the diagnosis of sepsis remains challenging due to its non-specific symptoms and overlaps with other neonatal conditions. The haematological profile, including white blood cell count, platelet count, and inflammatory markers, offers valuable insights for the early identification of sepsis. Aim: This study aims to evaluate the role of haematological parameters in diagnosing neonatal sepsis, comparing septic and non-septic neonates to determine significant differences in blood profiles and their diagnostic value. Methodology: A cross-sectional observational study was conducted in the neonatal intensive care unit (NICU) of a Department of Pathology and Pediatrics, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India,The study included 50 neonates diagnosed with sepsis and 50 healthy controls who were matched for gestational stage and age. Samples of blood were examined for the presence of cytoplasmic vacuolations or toxic granules, Band-to-neutrophil ratio, micro erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count, and total leukocyte count (TLC). In order to identify statistically significant differences between the categories, statistical analysis was implemented. Results: Septic neonates showed significantly elevated TLC (19.25 ± 5.80 x10³/μL), CRP (30.15 ± 8.60 mg/L), micro ESR (25.40 ± 11.20 mm), and band-to-neutrophil ratio (0.42 ± 0.18) compared to the control group (p < 0.001 for all). Platelet count was markedly lower in the sepsis group (95.00 ± 30.25 x10³/μL) than in the control group (270.00 ± 45.10 x10³/μL). Additionally, toxic granules were present in 66% of septic neonates, and positive blood cultures were found in 52%. Conclusion: The haematological profile, particularly elevated leukocyte count, reduced platelet count, high CRP levels, and the presence of toxic granules, is a crucial diagnostic tool for early detection of neonatal sepsis. The findings highlight the importance of combining these markers to improve diagnostic accuracy and facilitate prompt treatment.

DOI: 10.5281/zenodo.

Aim: The aim of the study was to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH). Methods: This was a prospective observational study conducted at Department of General Medicine, Rama Medical College Hospital and Research Centre, Hapur, Uttar Pradesh, India from March 2022 to Feb 2023. A total of 100 patients were recruited in this study. Results: Mean ± SD age, BMI and WC were 44.46±12.48 years, 25.35±4.76 kg/m2 and 93.17±10.75 CM, respectively. There was no significant age, BMI and WC difference between male and females’ group. Central obesity was present in 85%, 83.34% and 85.71% all, males and females respectively and there was no significant difference between males and females. Diabetes mellitus (DM) was present in 32%, 53.34% and 22.85% all, males and females respectively. Anti-TPO antibody was present in 35%, 16.66% and 42.85% all, males and females respectively. Prevalence of DM was significantly more in males as compared to females. TSH <6 was present in 40%, 53.34% and 34.28% all, males and females respectively. Prevalence of autoimmunity was similar in two groups. Mean ± SD value of total T3, total T4 and TSH at baseline were 114.56±24.06 ng/dl, 7.63±1.43micro gm/dl and 6.56±1.68 IU/L respectively. There was no significant difference of TT3, TT4 and TSH between males and females’ group. Conclusion: In a cohort of 50 patients followed for one year only the presence of anti-TPO antibody was predictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to observe the antepartum cardiotocography and fetal outcome in high-risk pregnancy. Material & Methods: It was a prospective cross-sectional study carried out in the department of Obstetrics and Gynaecology, Jannayak Karpoori Thakur Medical, College and Hospital, Madhepura Bihar, India for one year. Thereafter, they were scrutinized according to eligibility criteria and 50 patients were finalized. Sixty consecutive CTG tracings were collected from patients who were advised to perform CTG after admission. Statistical analysis was carried out by chi-square test. Level of significance was set at p value <0.05. Results: The highest percentage was 22 (44%) of age group 26-30 years. Shows that majority patients 39 (78%) were housewife. That educational status, 3 (6%) had illiterate, 10 (20%) had primary level of education, 22 (44%) had secondary, 14 (28%) had higher secondary and 1 (2%) had graduate level. Method of delivery, 17 (34%) were spontaneous and 33 (66%) were caesarean section. The fetal heart condition 37 (74%) had normal CTG and 13 (26%) had abnormal CTG. The differentiation was statistically significant (p<0.05). The liquor 31 (62%) were normal colour, 13 (26%) were light meconium and 6 (12%) were deep meconium stained. The pregnancy status of the study subjects 3 (6%) had chronic hypertension 2 (4%) had gestational HTN, 16 (32%) had preeclampsia, 8 (16%) had eclampsia, 8 (16%) had diabetes, 1 (2%) had heart disease, 6 (12%) had anaemia 3 (6%) had BOH, 3 (6%) had IUGR and 1 (2%) had other disease. The birth weight 18 (36%) were <2.5 kg and 32 (64%) were >2.5 kg. The APGAR score 13 (26%) had <7 and 37 (74%) had >7 at one minute. 16 patients were spontaneous delivery and 21 patients were caesarean section in normal CTG. On the other hand 12 patients were caesarean section and 1 patient had spontaneous delivery in abnormal CTG. The difference was statistically significant between normal CTG and abnormal CTG. Conclusion: This study shows lower APGAR score and low birth weight were associated with abnormal CTG. CTG can be continued as a good screening test of fetal surveillance but it is not the sole criteria to influence the management of high-risk pregnancies. Abnormal CTG should be supplemented with other test before intervention.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to find out the neonatal outcomes of eclamptic mothers and their significance in a rural tertiary health care in Bihar region. Methods: This prospective, cross-sectional, observational, and epidemiological study was conducted in the Department of Pediatrics, Jannayak Karpoori Thakur Medical, College and Hospital, Madhepura, Bihar , India for one year. The study comprised newborn babies born to 100 consecutive mothers admitted with eclampsia or with pre-eclampsia but subsequently developing eclampsia along with those born to 100 consecutive non-eclamptic mothers (considered as control) with normal BP. Results: A total of 90% of both eclamptic mothers took full course of iron-folate supplementation while 52% received at least three antenatal visits at local government subcenters. A total of 70% had hemoglobin of 10 g% or more, as evidenced from their antenatal records. The majority of eclamptic mothers were primigravida (86%), <20 years of age (66%), non-tribals (78%), having body weight of mean 41.19±5.0 kg, height of mean 148.34±6.33 cm, and socioeconomic status of Class IV (90%). There was no significant difference observed in respect of age, weight, height, religion, caste, parity, and socioeconomic status between eclamptic and control mothers and thus, the two groups were statistically matched. Conclusion: This study emphasizes the need to prevent development of eclampsia at a community level through ANC’s and to enhance neonatal care facilities in outreach areas to reduce the high incidence of perinatal morbidity and mortality due to eclampsia.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the risk of GDM in antenatal mothers with previous history of PCOS. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, NMCH, Patna, Bihar, India from June 2023 to May 2024 and including 975 pregnant women, the medical records of 100 women diagnosed with PCOS were evaluated. Results: 100 women reported PCOS. Older, higher BMI, and assisted reproductive technology usage were more common in women with PCOS before early pregnancy. The adjusted OR 1.55, 95% CI: 1.14–2.09, showed that women with PCOS had a greater risk for GDM than those without PCOS. PCOS was strongly linked to premature birth (adjusted OR 1.69, 95% CI: 1.08–2.67). The adjusted OR for GDM among women with PCOS adopting assisted reproductive technology was 1.44 (95% CI: 1.03–1.92) and among those who conceived spontaneously was 1.60 (1.18–2.15) in the stratified analysis using multivariable logistic regression (Figure 1). Preterm birth was also more likely in PCOS women independent of assisted reproductive technologies. Other bad birth outcomes were similar. Conclusion: Our findings indicate that PCOS increases the risk of GDM and premature delivery. Further longitudinal research is required to understand PCOS during gestation and create effective preventative measures to protect mother and child.

DOI: 10.5281/zenodo.

Background and Aim: Traumatic injuries to the abdomen or pelvis can damage retroperitoneal structures such as the kidneys, ureters, pancreas, major blood vessels, and duodenum. Accurate diagnosis of retroperitoneal injuries is crucial for proper intervention and management. The main objective of this research was to assess the effectiveness of contrast-enhanced MDCT, in identifying injuries, in the area for patients who had pelvic trauma. Additionally, we examined the CT results that are often associated with retroperitoneal trauma. Material and Methods: This retrospective observational study was carried out over a period of one-year in 50 patients diagnosed with abdominal trauma. Detailed clinical history was elicited from the patients/ attendants and findings of general physical examination were recorded. Renal Function Tests were performed in all the patients and the study performed with minimum 6 hours fasting. CT examination was performed using MDCT machines. Multiplanar and 3-D reconstructions were performed on dedicated work station. The lesions were evaluated with respect to site of origin, consistency, components of the lesion and pattern of enhancement. Results: The primary mechanisms of injury were assaults (58%) and falls (42%). Most patients (58%) presented within six hours post-injury, with a majority of CT scans performed within the same timeframe (48%). Predominant symptoms were abdominal pain or tenderness (90%), vomiting (38%), respiratory distress (24%), and abdominal guarding (16%). CT imaging revealed high prevalence of retroperitoneal injuries: renal lacerations (58%), extraperitoneal urinary bladder rupture (12%), pancreatic lacerations (12%), duodenal lacerations (10%), and adrenal lacerations (8%). Conclusion: MDCT is a highly effective imaging modality for the evaluation of retroperitoneal trauma, offering superior sensitivity and specificity in detecting injuries.

DOI: 10.5281/zenodo.

Background: The induction of general anaesthesia and endotracheal intubation can activate the sympathetic nervous system, resulting in haemodynamic instability, notably tachycardia and hypertension, which presents a difficulty for patients with a history of hypertension. Pharmacological treatments such as dexmedetomidine, an alpha-2 adrenergic agonist, are employed to regulate these responses. This study evaluates the effectiveness of intranasal (IN) and intravenous (IV) dexmedetomidine in preserving haemodynamic stability throughout the induction of anaesthesia. Methodology: This prospective, randomised, double-blind trial was performed at Darbhanga Medical College and Hospital in Bihar, India. A total of 120 patients (aged 18–55, ASA grade I/II) scheduled for elective surgery with general anaesthesia and endotracheal intubation were included. Participants were randomly assigned to two groups: Group A received intranasal dexmedetomidine at a dosage of 0.75 mcg/kg, whereas Group B received intravenous dexmedetomidine at the same dosage. Haemodynamic measures (heart rate, blood pressure, mean arterial pressure) and the Ramsay Sedation Scale (RSS) were documented at many times throughout the perioperative period. Results: No significant changes were seen in systolic and diastolic blood pressure between the two groups (p > 0.05). Group A exhibited a markedly reduced heart rate at 20 minutes following injection (p < 0.001). The respiratory rate in Group A was markedly elevated at 20, 25, and 30 minutes (p < 0.05). No notable disparities in mean arterial pressure were seen across the groups. Conclusion: Both intranasal and intravenous dexmedetomidine successfully mitigate sympathetic reactions during laryngoscopy without causing considerable haemodynamic instability. The intranasal approach shown benefits in lowering heart rate, indicating its potential as a feasible option for premedication in anaesthesia induction. Additional research is necessary to validate these findings in more extensive populations.

DOI: 10.5281/zenodo.

Background: Labour pain is one of the most intense experiences for women during childbirth, and effective analgesia is crucial for maternal comfort and safety. Epidural analgesia (EA) is widely considered an effective method for pain relief, using local anaesthetics such as Bupivacaine, Ropivacaine, and Levobupivacaine. However, the comparative efficacy of these agents in managing labour pain requires further evaluation. Objectives: This study aims to evaluate the anaesthetic efficacy of three commonly used local anaesthetics—Ropivacaine, Bupivacaine, and Levobupivacaine—when combined with fentanyl for epidural analgesia during labour, assessing their effectiveness in pain relief, sensory blockade, and side effects. Methods: A randomized controlled trial was conducted at Darbhanga Medical College and Hospital, India, over two years, with 90 primigravida women in established labour. Patients were assigned to three groups, each receiving a combination of a local anaesthetic (0.2% Ropivacaine, 0.125% Bupivacaine, or 0.125% Levobupivacaine) with fentanyl (2 mcg/mL). Outcomes were assessed using the Visual Analogue Scale (VAS), heart rate, blood pressure, and mean arterial pressure (MAP), along with the time to onset and duration of analgesia. Results: Levobupivacaine demonstrated superior pain relief at 5, 15, 30, and 60 minutes post-administration compared to Bupivacaine and Ropivacaine, with statistically significant differences (p < 0.0001). Levobupivacaine also resulted in less cardiovascular instability and better sensory-motor differentiation. Conclusions: Levobupivacaine offers superior analgesia and fewer cardiovascular side effects than Ropivacaine and Bupivacaine, making it a safer and more effective choice for epidural analgesia during labour.

DOI: 10.5281/zenodo.

Background: Effective airway management is critical in anesthesiology, with supraglottic airway devices (SGADs) like I-gel® offering significant advantages over traditional methods. This study assess the haemodynamic state and I-Gel insertion circumstances with Propofol induction following pretreatment with either Ketamine or Dexmedetomidine. Methods: At Darbhanga Medical College & Hospital, 60 ASA Grade I/II patients between the ages of 18 and 60 who were having elective procedures were split into two groups for this randomised, double-blind study: Group D received dexmedetomidine, whereas Group K received ketamine. Patients received the respective study drug followed by propofol induction. I-gel® insertion conditions, jaw relaxation, propofol requirements, and adverse events were recorded. Statistical analysis was conducted using SPSS version 24, with p < 0.05 considered significant. Results: Anthropometric and demographic traits of both groups were comparable (p > 0.05). Group D demonstrated significantly better I-gel® insertion conditions (p < 0.01), less requirement for additional propofol, and shorter apnoea durations compared to Group K. Fewer adverse events, including laryngospasm and gagging, were observed in Group D. Conclusion: Dexmedetomidine provides superior conditions for I-gel® insertion under propofol anesthesia compared to ketamine, with better jaw relaxation, reduced propofol dose, and fewer complications. This makes dexmedetomidine a preferred pre-treatment for SGAD placement in elective surgeries.

DOI: 10.5281/zenodo.

Background: The inadequacy of current pain management techniques after abdominal surgery results in insufficient analgesia, prolonged hospital stays, delayed recovery, and elevated healthcare costs. Epidural analgesia with patient-controlled analgesia (PCA) pumps has progressively emerged as the preferred method for successful pain management. The local anesthetics comprise ropivacaine and bupivacaine. Few comparative studies have explicitly investigated these drugs in conjunction with fentanyl in PCA pumps for abdominal surgery. Aim: This study is to evaluate the safety and effectiveness of administering ropivacaine and fentanyl via PCA pumps against bupivacaine and fentanyl for postoperative analgesia following abdominal surgery. Methodology: An observational study was conducted with 60 individuals scheduled for abdominal operations. Patients were categorized into two categories. Group A got ropivacaine (0.15%) combined with fentanyl (2 µg/ml) intravenously using PCA pumps, whereas Group B was administered bupivacaine (0.1%) with fentanyl (2 µg/ml). Pain severity was assessed using the Visual Analog Scale (VAS), and side effects were meticulously recorded. Results: Group A exhibited a significantly prolonged duration of analgesia (363.81 ± 16.9 hours) compared to Group B (230.07 ± 11.88 hours) (p < 0.0001). Pain ratings at important postoperative intervals (20 minutes and 20 hours) were much lower in Group A. Group A exhibited a lower incidence of adverse events, including bradycardia and motor blockade, whereas Group B experienced a higher frequency of problems, such as bradycardia, hypotension, and motor blockade. Conclusion: The medication offers superior postoperative analgesia with few adverse effects and is clinically more effective than bupivacaine-fentanyl in patient-controlled analgesia pumps after abdominal surgery.

DOI: 10.5281/zenodo.

Background: Inguinal Hernia Repair (IHR) is a common surgical procedure that can be performed under General Anesthesia (GA), Regional Anesthesia (RA), or peripheral nerve block (PNB). RA methods offer benefits such as the absence of unconsciousness, reduced respiratory depression, and faster recovery compared to GA. Both GA and RA are considered safe for lower abdominal surgeries. While GA is associated with patient satisfaction and suitability for longer surgeries, RA is preferred for its reduced blood loss, better operating conditions, and fewer cardiovascular and thromboembolic complications. Aim: This study aims to evaluate the efficacy of postoperative analgesia in Paravertebral Block versus Spinal Anesthesia for unilateral inguinal hernia repair. Methods: A randomized controlled trial was conducted at Darbhanga Medical College & Hospital over two years, enrolling 100 ASA Grade I and II patients aged 18–60 years. Patients were randomly assigned to receive either PVB (Group PVB) or SA (Group SA). Primary outcomes included postoperative analgesia, measured by VAS scores, time to ambulation, and hospital stay duration. Secondary outcomes included hemodynamic stability, complications, and patient satisfaction. Results: Both groups showed comparable age and gender distributions. There was no significant difference in VAS scores between PVB and SA (P = 0.83), and both techniques had similar hemodynamic profiles and complication rates. However, PVB was associated with faster recovery and less postoperative pain. Conclusion: PVB and SA are both effective anesthetic techniques for IHR. PVB offers advantages in terms of quicker recovery and reduced pain, making it a suitable alternative for patients, especially those with cardiovascular co-morbidities.

DOI: 10.5281/zenodo.

Background: Endotracheal intubation is essential for airway management during general anesthesia. While direct laryngoscopy (DL) is the standard technique, the LMA Blockbuster™ (blind technique) offers an alternative for patients with difficult airways. This study aims to compare the effectiveness, safety, and complications of these two intubation techniques in adults undergoing elective surgeries. Aim: To evaluate and compare the performance of LMA Blockbuster™ (blind technique) and direct laryngoscopy (under vision) in terms of ease of intubation, time to successful intubation, and postoperative complications in adults undergoing general anesthesia. Methods: A randomized controlled trial was conducted at Darbhanga Medical College from July 2022 to June 2024. Sixty adult patients were randomly assigned to either Group L (LMA Blockbuster™) or Group D (Direct Laryngoscopy). Parameters such as time to intubation, number of attempts, and complications (pain, hoarseness, bleeding, coughing) were recorded. Data were analyzed using Chi-square, Student’s t-test, and Mann-Whitney test. Results: The LMA Blockbuster™ group showed significantly fewer post-operative complications (pain, hoarseness, bleeding, and coughing) compared to the direct laryngoscopy group (P < 0.05). Both groups had comparable intubation times and success rates. Conclusion: The LMA Blockbuster™ technique is a viable alternative to direct laryngoscopy, offering reduced immediate postoperative complications, making it a safer and more comfortable option for airway management in elective surgeries under general anesthesia.

DOI: 10.5281/zenodo.

Background: Intraoperative shivering is a common complication of spinal anesthesia (SA), often resulting from disrupted thermoregulatory control. Shivering can increase metabolic demands, interfere with surgical monitoring, and compromise patient comfort and safety. Various pharmacological agents have been studied for their management, but their comparative efficacy remains inadequately addressed. Objective: This study aims to evaluate and compare the efficacy of tramadol, ketamine, and dexamethasone in managing intraoperative shivering following spinal anesthesia. Methods: A prospective, randomized, double-blinded study was conducted on 300 patients undergoing elective and emergency surgeries under SA. Participants were divided into three groups (100 each) and administered tramadol, ketamine, or dexamethasone as anti-shivering agents. Shivering severity was graded on a 4-point scale, and outcomes were assessed at 0-, 5-, and 15-minutes post-intervention. Primary endpoints included shivering cessation, while secondary endpoints included the onset of action, hemodynamic parameters, and rescue drug requirements. Results: The groups were comparable in demographic and anthropometric characteristics. All three agents effectively reduced shivering, with dexamethasone showing the fastest onset and highest success rate. Ketamine demonstrated comparable efficacy to tramadol but was associated with mild psychomimetic effects in some patients. Rescue drug requirements were minimal, and hemodynamic parameters remained stable across groups. Conclusion: Dexamethasone emerged as the most effective agent for intraoperative shivering management due to its rapid onset and high success rate, followed by ketamine and tramadol. These findings support its preferential use in resource-constrained settings to improve intraoperative patient comfort and outcomes.

DOI: 10.5281/zenodo.

Background: Spinal anesthesia is crucial for anesthetic practice for cesarean sections, with bupivacaine being the predominant local anesthetic utilized. This study assesses the hemodynamic impacts of hyperbaric ropivacaine compared to hyperbaric bupivacaine for spinal anesthesia in cesarean sections. Aim: This study aims to evaluate the hemodynamic stability, start time, duration of action, and safety profile of hyperbaric ropivacaine against hyperbaric bupivacaine in cesarean sections performed under spinal anesthesia. Methodology: In a randomized, controlled experiment, 100 parturients undergoing elective cesarean section were allocated to receive either hyperbaric ropivacaine or hyperbaric bupivacaine for spinal anesthetic. Hemodynamic measures, such as systolic blood pressure, heart rate, and the occurrence of hypotension, were observed. The initiation and duration of sensory and motor blocks were documented, along with any detrimental effects seen. Results: Ropivacaine exhibited enhanced hemodynamic stability relative to bupivacaine, characterized by a reduced occurrence of hypotension and decreased heart rate variability. The initiation of sensory and motor block was somewhat postponed with ropivacaine; nevertheless, its extended duration of action and decreased cardiovascular and central nervous system toxicity provided significant benefits for maternal safety and recovery. Conclusion: Hyperbaric ropivacaine offers superior hemodynamic stability compared to hyperbaric bupivacaine, rendering it a safer and more efficacious option for spinal anesthesia in cesarean deliveries. These data endorse the utilization of ropivacaine as a recommended anesthetic agent to enhance maternal outcomes.

DOI: 10.5281/zenodo.

Background: Percutaneous nephrolithotomy (PCNL) is a widely recognized surgical technique for managing large kidney stones, including staghorn calculi and stones resistant to extracorporeal shock wave lithotripsy (ESWL). Spinal anesthesia, particularly using local anesthetics like bupivacaine and ropivacaine, has gained favor for its benefits in reducing pulmonary complications and improving patient recovery. However, the safety and efficacy of different anesthetics, especially ropivacaine combined with intrathecal additives, need further exploration. Aim: The study aimed to compare the efficacy and safety of spinal anesthesia using intrathecal isobaric ropivacaine 0.75% and hyperbaric bupivacaine 0.5% in patients undergoing PCNL surgeries. Methodology: This prospective study was conducted over one year at Department of Anesthesiology and Critical care ,Anugrah Narayan Magadh Medical College, Gaya, Bihar. This study involved 100 critically ill patients, with 50 enrolled based on specific inclusion and exclusion criteria. Parameters such as anesthesia quality, intraoperative hemodynamic stability, duration of motor blockade, and postoperative pain relief were measured. Additionally, the Extravascular Lung Water Index (EVLWI) and Pulmonary Vascular Permeability Index (PVPI) were assessed in critically ill patients to explore the impact of these factors on pulmonary function. Results: The study population had an average age of 39.5 years, with a predominant male participation (60%). ARDS was present in 50% of the patients. Significant correlations were found between EVLWI and chest radiograph scores, as well as PVPI, indicating the importance of these metrics in evaluating pulmonary edema and vascular permeability. However, weak correlations with gas exchange parameters suggest these measures alone may not fully capture the complexity of ARDS. Conclusion: The study underscores the utility of EVLWI and PVPI in assessing pulmonary dysfunction in critically ill patients with ARDS and septic shock. However, their weak association with gas exchange measures highlights the need for a more integrated diagnostic approach. These findings stress the importance of combining clinical, radiological, and physiological assessments to better guide treatment and improve outcomes in ARDS patients.

DOI: 10.5281/zenodo.

Background: Urinary tract infection (UTI) is a prevalent illness globally, caused by uropathogen. Effective treatment of UTI requires accurate identification of the underlying cause and appropriate administration of medications. In this age of evolving antibiotic susceptibility trends, it is essential to raise knowledge of regional antibiotic resistance patterns among prescribing physicians. Aim: The aim of this research was to determine the prevalent uropathogen linked to instances of UTIs as well as their pattern of antibiotic susceptibility. Materials and Methodology: This was a cross-sectional study that included all inpatients of above 18 years of age and diagnosis with the UTI. The identification of urinary tract infections, midstream urine samples were collected, cultured, and subjected to pertinent biochemical assays at the ‘Department of Pharmacology, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Results: The distribution of uropathogen in 80 cases shows that E. coli was the most common (27.5%), followed by Enterococcus spp. (22.5%) and Klebsiella spp. (18.75%). Antibiotic resistance patterns revealed varying resistance levels, with Staphylococcus and Enterococcus showing resistance to Linezolid, Ampicillin/Amoxicillin, and Vancomycin. Gram-negative bacteria like Klebsiella, Proteus, E. coli, and Pseudomonas exhibited resistance to Meropenem, Gentamycin, Norfloxacin, and Ceftazidime. E. coli demonstrated the highest resistance overall among Gram-negative pathogens. Conclusions: Almost all of the test organisms exhibited resistance to multiple antibiotics. The research uncovered a significant amount of antibiotic resistance in uropathogen, which were previously used as the primary treatment for UTI in infants.

DOI: 10.5281/zenodo.

Background: Extravascular lung water (EVLW) reflects the lung fluid outside the pulmonary vasculature and is critical in conditions such as hydrostatic pulmonary edema and acute respiratory distress syndrome (ARDS). Its quantification using transpulmonary thermodilution (TPTD) has been validated and provides valuable insights into lung injury. Objective: This study aimed to evaluate the utility of EVLW and PVPI (pulmonary vascular permeability index) in managing lung injury in critically ill patients, exploring their correlation with oxygenation parameters, radiographic assessments, and differentiation between ARDS and other pulmonary conditions. Methods: In a prospective observational study conducted between Department of Anesthesiology and Critical care, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 12 months, 20 patients aged 18–60 years with septic shock requiring mechanical ventilation were included. EVLW and PVPI were measured using the Volume View® and EV1000® Clinical Platform. Oxygenation indices (PaO₂:FiO₂, AaDO₂) and chest radiograph scores were correlated with EVLW and PVPI. Statistical analysis included Pearson correlation and subgroup analyses for ARDS and non-ARDS cohorts. Results: EVLW and PVPI showed strong correlations with chest radiograph scores (r = 0.75, p < 0.0001; r = 0.63, p < 0.0001) and significant negative correlations with PaO₂: FiO₂ (r = -0.28, p = 0.0003; r = -0.35, p = 0.0005). A positive correlation with AaDO₂ was also observed (r = 0.34, p = 0.001; r = 0.37, p = 0.0011). These parameters differentiated ARDS from non-ARDS with notable accuracy, aiding targeted fluid management and prognostication. Conclusion: EVLW and PVPI are valuable tools for characterizing pulmonary edema, assessing oxygenation, and guiding fluid management in critically ill patients. Their integration into ICU protocols may enhance ARDS diagnosis and treatment precision.

DOI: 10.5281/zenodo.

Background: HIV, a retrovirus causing AIDS, often leads to ocular complications, with retinal diseases being a significant cause of vision loss. Retinal disorders in HIV-positive individuals can be classified into infectious and non-infectious categories. The prevalence and nature of these conditions vary based on geographic and socioeconomic factors. Aim: The present study aimed to determine the status of retinal disease or involvement in patients diagnosed with HIV. Methodology: A cross-sectional study was conducted with 52 HIV-positive participants, selected based on specific inclusion criteria. Comprehensive ophthalmic examinations were performed, including visual acuity testing, slit-lamp evaluation, fundus examination, and optical coherence tomography (OCT). Retinal disorders were categorized and analyzed using SPSS version 27. Result: The study found 69% of participants were male, with 54% aged 45–60 years. HIV-associated retinopathy was most prevalent (40%), followed by cotton wool spots (16.7%), retinal hemorrhages (12.5%), CMV retinitis (8.3%), and macular edema (4.2%). Notably, 35% of participants showed no retinal abnormalities, indicating variability in disease manifestation. Conclusion: The study underscores the high prevalence of retinal diseases among HIV-positive individuals, with HIV-associated retinopathy being the most common. Middle-aged males appear particularly susceptible. Regular ophthalmic screening and targeted interventions, including secondary prophylaxis for opportunistic infections, are vital for preserving vision and improving the quality of life in this population.

DOI: 10.5281/zenodo.

Background: The brachialis muscle, primarily responsible for flexion of the elbow joint, exhibits considerable morphological variations in its insertion. These variations can influence its relationship with key neurovascular structures in the arm, including the musculocutaneous nerve, median nerve, and brachial artery. Understanding these variations is critical for surgical approaches, trauma management, and neurovascular interventions. Objective: To examine the morphological variations in the insertion of the brachialis muscle and its anatomical relationships with the neurovascular structures of the arm, providing clinically relevant insights. Methods: This cadaveric study was conducted on 50 upper limbs from 25 adult human cadavers at  Department of Anatomy, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India and sample collection from Shaheed Nirmal Mahto Medical College Dhanbad and Sheikh Bhikhari Medical College Hazaribagh, Period should be from  January 2020 to July 2024.The brachialis muscle was dissected to assess the site and pattern of insertion, its relationship to the musculocutaneous nerve, and its proximity to the median nerve and brachial artery. Morphological variations were documented, and their potential clinical implications were analyzed. Data were recorded and analyzed using descriptive statistics. Results: Out of the 50 specimens, 84% demonstrated typical insertion of the brachialis muscle into the coronoid process and tuberosity of the ulna, while 16% showed variations, including bifurcated or accessory tendons extending to the radius or surrounding soft tissues. The musculocutaneous nerve consistently passed through or near the brachialis in all cases, with 12% exhibiting variations in its trajectory. The median nerve and brachial artery were found to be in close proximity to the brachialis in 24% of cases, posing potential risks during surgical interventions. Conclusion: Morphological variations in the insertion of the brachialis muscle and its relationships with neurovascular structures highlight the need for detailed anatomical understanding to reduce iatrogenic complications during surgical procedures. The findings provide critical insights for orthopedic surgeons, neurologists, and anatomists.

DOI: 10.5281/zenodo.

Aim: This study focuses on investigating the maternal and fetal outcomes of women with previous lower segment cesarean section histories in comparison to those women who have had previous deliveries via the vaginal route while underscoring the risks and complications accompanying them. Methodology: A prospective, comparative, observational study involving 70 pregnant women, with 35 having had previous LSCS and 35 having had previous vaginal deliveries. Pregnant women were selected to participate in the study if they had been admitted after 28 weeks of gestation. Still, those who had classical cesarean sections, uterine surgery of any kind, or multifetal pregnancies were excluded from the study. Maternal and fetal outcomes were calculated through SPSS v.20.0. Results: The results showed that in the LSCS group, complication rates were higher compared to others, such as postpartum hemorrhage at 5.7% and wound sepsis at 8.6%. Of the cases, 11.43% needed neonatal resuscitation. However, no increased rate was found for newborns with low birth weight or poor Apgar scores. Instead, the mean birth weight of newborns for the LSCS group was lower, which was 2.81 kg, differing significantly from the control mean birth weight of 2.87 kg at p-value of 0.04. Conclusion: Women with a history of LSCS have worse maternal outcomes, and therefore careful monitoring and management are required to prevent the risk of complications associated with repeated cesarean deliveries.

DOI: 10.5281/zenodo.