Background: Thrombocytopenia frequently presents as a common clinical condition in routine medical practice. Due to the multitude of potential causes, evaluating and treating patients with thrombocytopenia can be challenging. This study aimed to identify the diverse etiological factors and clinical characteristics of fever with thrombocytopenia in children aged 1 month to 12 years admitted to our hospital. Methods: Acute febrile illness lasting for 5 days. Demographic data collection included age, gender, geographical location, and a detailed medical history. The investigations included Complete blood count, peripheral smear study, urine albumin, blood urea, serum creatinine, liver enzymes and serum bilirubin, xray chest depending upon detailed examination on suspicion of tropical infections MP smear, dengue IgM, scrub typhus 20 IgM ELISA, widal test, leptospirosis IgM were performed along with blood culture and urine culture. Results: Distinct etiologies exhibit varying thrombocytopenia severities. Undiagnosed fever has the highest proportion of severe cases (53.12%). Dengue fever consistently presents with moderate or severe thrombocytopenia. Scrub typhus commonly has moderate (42.5%), mild (25.00%), and severe (9.37%) cases. Acute Lymphoblastic Leukemia (ALL) shows only moderate thrombocytopenia in 2 out of 8 cases. Malaria, enteric fever, viral encephalitis, and septicemia demonstrate low thrombocytopenia prevalence. Among 80 children, 77 improved with treatment, 2 were referred for hematological malignancy, and 1 for multiorgan dysfunction. Conclusion: Febrile Thrombocytopenia, a benign illness in children, is characterized by common GI symptoms and is prevalent. Infants with thrombocytopenia often experience shock and an altered level of consciousness. Severe thrombocytopenia correlates with bleeding, primarily presenting as petechiae. Treating the primary condition led to a prompt improvement in platelet count, particularly in non-bleeding cases. Despite encountering platelet counts as low as five thousand cells/cumm, most of the cases improved.

DOI: 10.5281/zenodo.10955936

Background:  Thalassemia is a heterogeneous group of mendelian disorders. Thalassemia itself and complications due to iron overload can damage multiple organ systems. Objective: Aim of our study was to correlate between serum ferritin level & liver functions in multiple blood transfused thalassemia patients. Materials and Method: This was an observational study conducted in the department of pediatrics in a tertiary care hospital, Jaipur, Rajasthan. All those patients who received more than 50 blood transfusions are considered as multiple transfused patients and were included in this study. The Pearson correlation coefficient was applied to observe the correlation between serum ferritin level and liver function tests. A p- value of < 0.05 was considered statically significant. Result:  A total of 50 patients were enrolled in this study. 92% patients were under 15 years of age and male to female ratio was 2.33:1. There was significant correlation between serum ferritin level > 1000ug/L and serum transaminases levels (p value < 0.001) with strongly positive correlation coefficient was SGPT r = +0.622 and SGOT r = + 0.704. The correlation between serum bilirubin level with serum ferritin level <1000ug/L was static but further increase when serum ferritin level more than 1000ug/L a p-value <0.001 and r = +0.784. Conclusion: Patients having abnormal liver functions in thalassemia patients due to iron over-load. Iron over-load in the body, which turn to lead to increased serum ferritin levels in multiple transfused thalassemia patients. High serum ferritin levels is associated with liver functions derangement. Serum ferritin levels should be monitoring routinely in multiple transfused thalassemia patients. Chelation therapy should be started as early as indicated to prevent liver functions derangement.

DOI: 10.5281/zenodo.10955984

Introduction: Ulcero-membranous lesions of oral cavity and oropharynx are common ENT complaint we encounter in OPD and also pose effect on health of the patients and so it is important to establish proper diagnosis and to provide appropriate treatment. Aims: To determine the proportion of patients presenting with various clinical features of ulcero-membranous lesions in oral cavity & oropharynx. Materials and Methods: it is a prospective study done in department of ENT over a period of 18 months. Patients with complaints of ulceromembranous lesions attending otorhinolaryngology OPD who are willing to participate in study were considered for study. Results: In present study, most common age group involved were 41-60 years constituting 45.09% and males outnumbered females constituting 65.69%.Most common throat symptom was odynophagia followed by burning sensation, dysphagia and throat pain. Associated ear complaints were present in 14.7% and nose complaints in 5.9%.General symptoms like fever was present in 10.7%,loss of weight was present in 23.5%, general weakness was present in 15.6%,skin lesions were present in 6.9%.Systemic diseases like diabetes was present in 34.3%,hypertension was present in 25.4%,HIV was present in 3.9%.Risk factors like smoking present in 43.1%,alchohol consumption present in14.7%,tobacco chewing present in 17.6%,prior radition exposure present in 0.9%. Most common site affected in present study was tongue 44.1% followed by palate 29.4%, buccal mucosa 15.6%, tonsils 8.8%, lips 7.8%,alveolus 2.9%, RMT 1.9%. Most common etiology found was neoplastic etiologywhich constitute 41.1%, followed by inflammatory etiology 31.3%, infective etiology 20.5% and miscellaneous 6.8%. 52.9% patients were managed conservatively and among patients with neoplastic etiology, 36.2% were treated surgically by oncosurgery team and 10.7% patients were managed with radiotherapy. Conclusion: With increase in habits like smoking and chewing nicotine in any form in adult population there is rise in incidence of malignancies .So high index of suspicion is needed while treating an oral ulcer especially chronic ulcers. Biopsy and histopathological examination are always gold standard to confirm the diagnosis.

DOI: 10.5281/zenodo.10956474

Background: Limited research has explored the impacts of concurrent administration of corticosteroid (CS) and hyaluronic acid (HA) for adhesive capsulitis (AC) of the shoulder. This study examines the combined effects of simultaneous intra-articular injections of CS compared to injections of CS or HA alone. Methodology: A randomized, placebo-controlled trial was conducted with sixty AC patients. They were assigned to one of four groups: saline, CS, HA, and CS with HA. The primary outcome measure was changes in the Shoulder Pain and Disability Index (SPADI) scores after one month. Secondary measures included alterations in pain, range of motion, muscle strength, and overall satisfaction at various intervals up to six months post-injection. Results: At the one-month mark, SPADI score changes were significantly greater in the CS with HA group (−30.3 ± 11.6) compared to the saline (−4.4 ± 21.1) and HA (−7.8 ± 23.1) groups. The CS with HA group exhibited a larger score change than the CS group (−25.6 ± 11.2). Moreover, regarding pain reduction and range of motion improvement, the CS with HA group demonstrated superior and more rapid effects compared to the saline and HA groups. Additionally, functional scores favored the CS with HA group over the saline and HA groups. Conclusion: In the management of AC, simultaneous CS and HA injections proved more efficacious in enhancing SPADI scores after one month compared to single CS or HA injections.

DOI: 10.5281/zenodo.10956581

Background: Open fractures are very commonly encountered in orthopaedics. Type III open fractures proved the most difficult to treat owing to the varied injury patterns, increased morbidity from associated injuries, massive soft tissue damage or loss over the fracture sites, compromised vascularity, wound contamination, and fracture instability and sometimes require secondary procedures like grafting and flaps. Similar is the case with wounds that remain after debridement. These wounds especially over a subcutaneous bone like tibia take a long time to heal due to less availability to soft tissue to bridge the wound margins and presence of infection. Vacuum assisted closure (VAC) dressing is an effective way of treating these kind of wounds which are hard to heal and provide a faster way to heal the infection and provide healthy granulation tissue over which secondary procedure like skin grafting can be done. It reduces the time for wound healing. Conventional VAC dressing is costly and not everyone can afford it. Here we describe an inexpensive method for customised VAC dressing. Methods: 48 patients were included in the study with various size and grade of wounds and treated with customised VAC dressing for various duration depending on the wound size. Results: most of the wounds healed with the application of VAC dressing and could be closed with primary closure. 13 patients required split thickness skin grafting and 2 patients required flap for the closure of the wounds. Conclusion: The customised VAC dressing was as effective as conventional VAC dressing in healing the wounds.

DOI: 10.5281/zenodo.10956852

Introduction: Dermatoglyphics is a science that deals with ridge patterns of volar aspect of hands and feet. It may be helpful indicator for screening of asthma in the mass population because both things are related to gene. The objective of the study was to compare the dermatoglyphic angles of palm in bronchial asthma patients and controls. Method: Prints were collected from both hands of 230 patients of bronchial asthma and 230 controls. In these prints angles of palm “atd”, “tad”, and “tda” were studied. Result: In present study there is significant increase in the mean value of ‘atd’ in both hands of patient (p<0.0001). The mean value of ‘atd’ is 42.27 in right hand of patient and 40.26 in controls and the mean value of ‘atd’ is 43.76 in left hand of patient and 41 in controls. Mean value of ‘atd’ is more in right (42.08) and in left (43.14) hand of male patients as compared to right (40.15) and left (41.28) hand of male control.Mean value of ‘atd’ is more in right (43.37) and in left (43.68) hand of female patients as compared to right (40.52) and left (40.68) hand of female control. Conclusion: In the comparison to controls, patients’ right and left hands showed a significant increase in the mean “atd” and “tad” and a decrease in the “tda”.In comparison to male controls, male patients’ right and left hands showed increase in the mean “atd” and “tad” and a decrease in the “tda”. In the comparison of female controls, female patients’ right and left hands showed not significant decrease in the “tad” angle, but decrease in the “tda”angle with significance.

DOI: 10.5281/zenodo.10956915

Background: The purpose of this study was to ascertain the frequency of urinary tract infections in malnourished children, to identify the causal organisms, and to investigate the antibiotic sensitivity pattern of these organisms. Methods: A Hospital-based Cross-sectional Observational Study was carried out on 160 moderately and severely malnourished children admitted to the Paediatrics department of the Nutritional Rehabilitation Centre (NRC), District Hospital Tumkur, over the course of a 12-month period from January 1, 2021, to December 31, 2021. The study was approved by the Institutional Ethics Committee, and participants provided written informed consent. Results: In 45 (28.13%) of the children had severe acute malnutrition, while 115 (71.88%) had moderate acute malnutrition. 25 children (15.63%) were < 3SD, and 135 (84.38%) were < 2SD. The mid-upper arm circumference of 25 children (15.63%) was less than 11.5 cm, whereas the mid-upper arm circumference of 135 children (84.38%) was between 11.5 and 12.5 cm. Of the children, 146 (91.25%) had no oedema, 131 (81.88%) had no visible severe wasting, and 29 (18.13%) had visual severe wasting. The most frequent presenting symptom was fever (42.5%), which was followed by convulsions (26.68%), vomiting (26.78%), and cough (26.78%). Abdominal discomfort (6.88%), diarrhoea (6.88%), urinary bladder soreness (3.75%), increased frequency of micturition (2.5%), and renal angle tenderness (2.5%) were present in fewer than 10% of the cases. In 29 (18.13%) of the children, the urine cultures were positive, and in 131 (81.88%), they were negative. Therefore, 18.13% of the sample had a UTI. Of the 29 children whose urine cultures were positive, E. Coli was found in 15 (51.72%), Klebsiella in 5, (17.24%), Proteus in 4, (13.79%), Pseudomonas in 4, (13.79%), and Acinetobacter in 1 (3.45%). E. Coli was the most often isolated organism. E. coli was completely susceptible to Imipenem, followed by Meropenem (93.3%), Nitrofurantoin (87%), Amikacin (86.6%), Gentamicin (73.3%), Co trimoxazole (26.66%), Cefixime (20%), Co-Amoxiclav (13.33%), Cefotaxime (13.33%), and Ceftriaxone (6.67%). Conclusion: E. coli is the most frequent gram-negative bacilli isolated. Imipenem, Meropenem, Amikacin, Nitrofurantoin, and Gentamicin are the most effective antibacterial medicines against these species. These observations have served as the foundation for the current diagnostic and therapeutic guidelines for clinicians treating children with complex Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM).

DOI: 110.5281/zenodo.10956999

Inhaled corticosteroid (ICS) therapy has emerged as a cornerstone in the pharmacological management of asthma, exerting potent anti-inflammatory effects within the respiratory tract. Despite its efficacy, the occurrence of dysphonia, characterized by alterations in voice quality, represents a prevalent local adverse event associated with ICS administration, affecting a substantial proportion of patients, with reported incidence rates ranging from 5% to 58%.The precise pathophysiological mechanisms underlying dysphonia secondary to ICS therapy remain incompletely elucidated. However, it is hypothesized that dysphonia may be attributed to the deposition of active corticosteroid particles within the oropharyngeal region during inhalation. Subsequent local effects, such as myopathy or mucosal irritation in the laryngopharynx, are postulated to contribute to the development of dysphonia. In the clinical evaluation of dysphonia, a comprehensive assessment must incorporate considerations of concurrent ICS use, given its potential role as a contributing factor. In order to mitigate this adverse effect, several pragmatic strategies have been proposed. These include the judicious utilization of the lowest effective dosage of ICS, the implementation of spacer devices during medication administration to optimize drug delivery to the lower airways while minimizing oropharyngeal deposition, and adherence to post-inhalation hygiene practices, such as gargling, mouth rinsing, and facial washing, aimed at mitigating local corticosteroid accumulation. Regular maintenance of spacer devices through meticulous cleaning procedures is also advocated to prevent the accumulation of medication residues.

DOI: 10.5281/zenodo.10957028

Background: Thyroid dysfunctions invariably lead to disturbances in lipid metabolism and significantly contribute to the development of other cardiovascular risk factors. Despite this, the effects of subclinical hypothyroidism on lipid metabolism remain undetermined. In the present study, we aimed to identify the etiological factors and lipid abnormalities associated with subclinical hypothyroidism. Methods: This hospital-based cross-sectional study was conducted in the outpatient Department. Adult patients meeting the biochemical criteria for subclinical hypothyroidism were included in the study. None of the patients were recruited from routine screening programs. Only diagnosed cases of subclinical hypothyroidism who met the predefined inclusion and exclusion criteria were enrolled. Inclusion criteria included all diagnosed cases of subclinical hypothyroidism with normal levels of T3, T4, and fT4, but with TSH levels greater than 4.5 µIU/mL. Results: The most common cause of subclinical hypothyroidism in our study was autoimmune thyroiditis, as suggested by the presence of thyroid peroxidase antibody, seen in N=32 cases (64%). N=40 cases (80%) were having TSH in the range of 10 to 20. N=6 patients(12%) had TSH between 5 and 10. N=4 cases(8%) were having TSH above 20. N=32 cases (64%) had positive thyroid peroxidase antibodies while 18 (36%) were negative for TPO Ab. There were significant elevations of Total cholesterol, LDL- cholesterol, and serum triglycerides in cases of subclinical hypothyroidism as compared to controls, the levels of triglycerides were also found to be elevated however the values were not significant. Conclusion: Subclinical hypothyroidism patients exhibit lipid abnormalities characterized by notable increases in total cholesterol, LDL levels and alongside alterations in triglycerides. Administration of thyroxine is anticipated to be beneficial in correcting these lipid abnormalities.

DOI: 10.5281/zenodo.10957056

Background and Aim: The effect of maternal underweight on obstetric performance is less clear. While some researchers have found increased incidences of preterm delivery, low birth weight and increased perinatal loss in these women, others have reported a protective effect of maternal underweight on certain pregnancy complications and interventions. By performing this study it would be possible to evaluate the association between BMI and its adverse effect on pregnancy outcome. Material and Methods: A total of 500 women with uncomplicated complications were included in the study. With the help of a predesigned questionnaire, basic information including weight and height was collected in the first checkup and BMI calculated accordingly. Patients were divided into 4 groups such as Underweight (<18.5 kg/m 2), Normal (18.5-24.9), Overweight (25-29.9) and Obese (30 and above). Weight gain during each visit was recorded and development of any antenatal complications throughout pregnancy was noted down. Information regarding postnatal complications, gestational age at delivery and also birth weight and Apgar score of the neonate was collected from the case sheets following delivery. Results: The mean age of the subjects in our study was 26 years. Maximum percentage of LGA babies were born to obese women compared to women with normal BMI. Likewise maximum percentage of SGA babies were born to women in the underweight group. There was a significant association between BMI and birth weight. Conclusion: In India, previously the problems during pregnancy were more related to low BMI but with changing lifestyle, obesity is increasing rapidly especially in urban set ups and may become a major health problem in the future.

DOI: 10.5281/zenodo.10961309

Background and Aim: There is a strong link between diabetes mellitus (DM) and an increased risk of periodontal disease. In fact, periodontitis is often considered as the sixth complication of DM. This study aimed to evaluate the understanding, perspectives, and behaviours of medical practitioners who treat diabetes towards diabetes and periodontal disease. Additionally, it explored their willingness to recommend dental treatment to their patients. Material and Methods: A survey was conducted to gather information on the awareness, attitude, and practice of general dental and medical practitioners in Bhuj Town, Gujarat, India, regarding the relationship between Diabetes Mellitus and Periodontitis. The survey utilised a self-administered, structured questionnaire to collect data. Participants were questioned regarding specific periodontal complications, their understanding, and their perspective on the reciprocal connection between diabetes and periodontal disease. Results: In the study, 100 general practitioners took part, with 50 being physicians and the other 50 dentists. Dentists demonstrated a higher level of awareness about the impact of diabetes complications on periodontal health compared to physicians, with a statistically significant difference. Most dentists preferred to refer their patients to physicians for medical evaluation, unlike physicians. They were particularly interested in understanding the connection between diabetes mellitus and periodontal health. Healthcare professionals in the dental field tend to stay informed about the connection between Diabetes Mellitus and Periodontal Health by attending conferences or continuing dental education programmes. On the other hand, medical practitioners tend to rely on professional journals as their primary source of information. Conclusion: Dentists demonstrated a greater understanding and application of the bidirectional relationship between diabetes and periodontitis compared to physicians.

DOI: 10.5281/zenodo.10961350

Introduction: Internal hemorrhoids are classified on the basis of degree of prolapse and manifestation into Grade I-IV. Hemorrhoidectomy is the standard surgical treatment for Grade III and IV hemorrhoids. The study was done to compare hemorrhoidectomy performed using electrocautery with harmonic scalpel. Material and Methods: The study was double blind randomized trial conducted in the Department of General Surgery, Government RDBP Jaipuria Hospital from January, 2023 to September, 2023. Patients with Grade 3 and Grade 4 hemorrhoids above 18 years of age were randomly divided into two groups to undergo Milligan Morgan hemorrhoidectomy using either electrocautery or harmonic scalpel. Intraoperative and postoperative variables were evaluated in both groups. Result: There were 30 patients in each group. There was no significant difference in the two groups with regard to grade of hemorrhoids, sex or age. Significant difference in groups was noted in terms of intraoperative and postoperative bleeding and average postoperative pain score with result being better in harmonic scalpel group. Conclusion: Hemorrhoidectomy performed using harmonic scalpel is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Harmonic use reduces the operative time, the postoperative blood loss and most importantly, postoperative pain in comparison to conventional electrocautery based hemorrhoidectomy.

DOI: 10.5281/zenodo.10961402

Aim: The aim of the present study was to find the prevalence of SNHL in type 2 diabetes patients and to find the effect of duration and control of diabetes on hearing loss. Methods: The present analytical cross-sectional study was conducted in Department of ENT for period of two years . The present study was conducted on 100 type 2 diabetes patients and age and gender matched 100 non- diabetic controls in the age group of <50 years. Results: In the present study, 65% were females and 35% were male. The mean age of patients was 43.17, mean fasting blood sugar was 131.49±28.52, mean PP blood sugar was 170.20±40.25 and mean HbA1c was 7.43±0.49. Mean age of patients was 36.54, mean fasting blood sugar was 109.01±3.14, mean post-prandial blood sugar was 124.56±9.81 and mean HbA1c was 6.006±0.222. The result showed that only 26 patients had normal hearing and 74 patients had SNHL whereas 14 patients in this group had minimal hearing, 20 had mild SNHL, 48 had moderate, 5 had severe SNHL and 13 patients had profound SNHL. 70 patients had DPOAE refer whereas 30 patients had DPOAE pass. Wave V grossly delayed in DM group as compared to non-DM with all frequencies (i.e. 70, 80 and 90) whereas interpeak latencies of wave I-V at 70 db frequency is almost equal in DM and non-DM group but it increase with increase in frequencies (i.e. 80 and 90 db). Conclusion: This study concluded that the diabetics are at definite risk of developing auditory dysfunction, therefore it is recommended that all newly diagnosed diabetic patients should undergo a complete audiological evaluation at the time of diagnosis and a regular half yearly or yearly follow up is warranted for early detection of damage to auditory functions. Although factors other than diabetes contribute to hearing loss, early glycemic control for type 2 diabetic patients may reduce the incidence rate of this disease.

DOI: 10.5281/zenodo.10961429

Initially, acute loss of smell (anosmia) and taste (ageusia) was not considered important symptoms for coronavirus disease 2019 (COVID-19). Evidence has demonstrated that an abrupt absence of smell and taste has been observed even when other general symptoms of COVID-19 infection are not present. This may act as another gateway to the early identification of patients with COVID-19. In this study, we aim to describe the features of loss of smell (anosmia) and loss of taste (ageusia) in COVID-19 patients. This retrospective study was done in year to assess the features of loss of smell and taste sensations in Covid 19 infected subjects. 80 subjects participated in this study. Questions regarding features of loss of smell and taste sensations in covid 19 patients were asked with help of Google forms. 47.5 % had Loss of smell , 31.25 % had loss of taste . 21.25 % had Loss of both smell and taste. In conclusion, anosmia and ageusia seem to be part of important symptoms and clues for the diagnosis of COVID-19, particularly in the early stage of the disease.

DOI: 10.5281/zenodo.10961466

Lack of appropriate biosensors for precise local real-time measurement of extracellular ATP content in the pericellular space from individual cells under healthy and pathological settings has until now prevented a thorough understanding of the role of ATP as an extracellular signal. The relationships between neurons and glia as well as the transmission of purinergic neurotransmission to no muscular cells are discussed. Both the ontogeny and phylogeny of purinergic signaling are considered to demonstrate the ancient and pervasive nature of purinergic neurotransmission. We describe here how to immobilize firefly luciferase (Fluc) coupled with green fluorescent protein (GFP) on the plasma membrane of HEK 293 cells to create a straightforward, sensitive, and dependable dual-function biosensor for the local real-time measurement of extracellular ATP concentration in the pericellular space in living cells.

DOI: 10.5281/zenodo.10961570

Background: Dengue virus infection in children is a major health problem in many parts of the world. Its manifestations range from mild fever to severe and life-threatening disease. Although cardiac involvement has been reported in DVI. Objectives: We conducted this study to analyze association between Clinical Profile, Cardiac Functions and Troponin I and CPK-MB (cardiac biochemical markers) in children with Dengue Fever. Methods: This was a prospective observational study in which 100 paediatric patients who were hospitalized and diagnosed to be having Dengue fever were included. All patients were stratified into either of the 3 groups- Dengue without warning signs, Dengue with warning signs and severe Dengue. A detailed history and thorough clinical examination were done for all patients. Cardiac function was assessed by ECG, 2D Echo, CPK-MB and Troponin-I. Results: Dengue with and without warning signs was seen in 42.3% and 40% cases respectively whereas severe dengue was seen in 17% cases. Majority of patients were male. Mean duration of fever was 6 to 9 days.  Among serological profile of dengue patients 36.9% were positive for IgM, 34.2% were positive for Ns1Ag and 28.9% positive for IgM+NS1. Among total dengue patients in this study, 21 (58.3%) had ECG changes, the majority of which belonged to the dengue with warning signs group. A significant correlation was noted between the cardiac markers, ECG and 2D ECHO findings with the severity of dengue (P<0.05). Conclusion: Cardiac markers (CPK-MB and Troponin-I) have significant correlation between Dengue without warning signs, Dengue with warning signs and severe Dengue.

DOI: 10.5281/zenodo.10961649

Background: Hospitalization of a neonate is quite stressful for parents specially mothers. Aims & Objectives: To assess the stress levels in mothers of admitted newborn in NICU and to identify demographical and obstetric profile of mother and clinical profile of newborn that affects the stress level. Methodology: This cross- sectional study was carried out between September 2022 and august 2023 in a tertiary care hospital. A validated scale, The Parental Stressor Scale (PSS): NICU questionnaire was used to measure the stress among 125 mothers of admitted newborns. The stress scores were quantified using Likert scale. Results: The mean stress scores for the subscales sight and sounds of unit, looks and behaviour, parental role alteration and staff behaviour and communication   were 1.98±0.766, 2.99±0.577, 2.94±1.011, 1.40±0.562 respectively. Stress was significantly higher in mothers who were younger, illiterate, primigravida, had LSCS, with previous NICU exposure and those with pregnancy complications. Mothers of newborn admitted within 24 hours of birth, with lower gestational ages, female gender, lesser birth weights, those requiring oxygen and ventilator support have higher stress scores. Conclusions: NICU mothers are under moderate stress and an appropriate interventional programme targeted towards specific stressors is required to alleviate their stress.

DOI: 10.5281/zenodo.10961730

Introduction: Congenital hemophilia predominantly affects males and is characterized by mutations in clotting factor genes located on the X chromosome. This study aims to evaluate the quality of life (QoL) of pediatric patients with hemophilia. Materials and Methods: A cross-sectional comparative analysis was conducted involving 78 children with hemophilia treated at an Indian Hospital. A questionnaire encompassing demographic and socioeconomic information, along with a separate questionnaire focusing on quality of life, was utilized to gather data from the studied cases and their accompanying parents. Results: The majority of patients experienced joint bleeding, yet most expressed satisfaction with their QoL. A significant portion of patients were able to complete homework, engage in daily activities, and move around freely. However, many patients reported difficulties and annoyances affecting their lifestyle, with some experiencing emotional challenges but not depression directly related to hemophilia. Despite these challenges, most children enjoyed school, had friends, made future plans, and were not apprehensive about their future. Although most patients could engage in muscle activities, some felt discomfort about visiting the hospital. Conclusion: Hemophilia profoundly influences the health-related quality of life (HRQoL) in the studied cohort. Disease severity, bleeding frequency, joint bleeding occurrences, financial constraints, and therapeutic interventions collectively impact hemophilia-related HRQoL. Routine hemophilia management should include psychological assessments and caregiver support, integrating outcome measures that assess both HRQoL and caregiver burden.

DOI: 10.5281/zenodo.10961851

Background and Objectives: Oral verrucous carcinomas are uncommon tumours and they have favourable outcomes. They have a long latency period. This study was conducted to evaluate the surgical outcomes of oral verrucous carcinoma patients in a tertiary cancer hospital in South India. Methods: This retrospective  study was conducted in biopsy proven oral verrucous carcinoma patients who underwent treatment at the surgical oncology department of a tertiary care center in south India, from January 2014  to December 2020. The patients were followed up until December 2023. Results: 133 patients underwent surgery for oral carcinoma during the study period. Of these, 8 patients had oral verrucous  cancer. The mean age of presentation was 55.3 years. Buccal mucosa was the most common subsite affected, seen in 6 patients. Three patients had pT1, four patients had pT2, and one patient had pT3. Reexcision was done in two patients. None of our patients had recurrence in the follow up period. Conclusion: Verrucous carcinoma is characterised by inherently favourable prognosis. It displays local aggressive behavior and uncommon regional or distant metastasis. Surgical excision with adequate margin is the most effective and standard treatment. There should be special emphasis on close follow up in view of high recurrence.

DOI: 10.5281/zenodo.10961906

Introduction: Posterior reversible encephalopathy syndrome is a clinical and radiological syndrome which develops in patients with severe preeclampsia and eclampsia. Posterior reversible encephalopathy syndrome is commonly manifested as headache, visual disturbances, altered consciousness and seizures typically in patient with new onset hypertension. Aims and Objectives: To determine incidence and maternal outcome of PRES in severe pre-eclampsia and eclampsia patients. Materials and Methods: A prospective study was done in patients with severe preeclampia and eclampsia and developed PRES in a tertiary care center during year April 2022 to April 2023 at  RIMS Adilabad. Patients demographics, gestational data, outcome were studied. CT Brain was done for all this patients, patients presenting in antenatal period CT Brain was done after delivery. Results: Out of 280 severe preeclampsia and 84 eclampsia patients admitted during this period. Out of which 18 patients developed PRES. Out of these 12 were primigravida. The diagnosis was common in age group < 25 years. Of these 18 cases, 14 patients presented with multiple seizure episodes, 11 cases were controlled with mgso4 only, remaining 7 cases controlled with mgso4 and phenytoin. It is most commonly seen in gestation age >36 weeks and its incidence is mostly seen in postpartum eclampsia. Perinatal mortality was seen in 5 patients. No maternal deaths were seen during this period. Conclusion: Timely identification and prompt initiation of medical intervention in patients with PRES can minimize the potential for adverse outcome. Prognosis of patients with PRES was favorable.

DOI: 10.5281/zenodo.10961977

Aim: The aim of the present study was to evaluate the reasons and the risk factors for postoperative ICU admissions in a tertiary care hospital in Bihar region. Methods: This case-control study was conducted at Department of Anesthesiology and Critical Care for the period of 12 months. A total of 100 patients were included in our study and 50 patients as cases and 100 patients as controls. Cases were defined as the patients who required postoperative ICU admission within 24 h after surgery during the study period. Controls were the patients who did not require ICU admission following a surgical procedure during the same study period. Results: Among cases, 45 (90%) patients had GA followed by 4 regional blocks/neuraxial blocks and one sedation only. Among controls, 85 (85%) patients had GA followed by 7 cases of regional, 6 neuraxial block and two sedation only. 38 (76%) of cases were known hypertensive vs. 40 (40%) in controls. 35 (70%) of cases were diabetic vs 46 (46%) among controls. 11 (22%) of cases had respiratory diseases vs. 43 (43%) in controls. 14 (28%) of the patients among cases were ventilated in ICU. The most common reasons for ICU admission among cases was for neuro-observation 18 (36%) cases followed by requirement for cardiovascular monitoring 14 (28%), sepsis 10 (20%), intraoperative cardiac events 3 (6%), prolonged surgery 2 (4%), intraoperative arrest 1 (2%), Diabetic ketoacidosis 1 (2%) and increased Oxygen requirement postoperatively 1 (2%). In univariate analysis, the risk factors for ICU admission included age, ASA class, hypertension, DM, IHD, respiratory disease, renal dysfunction, neurological abnormality. We then constructed a final multivariate logistic regression; we found ASA and presence of neurological disease or abnormality as risk factors for postoperative ICU admission. Conclusion: In conclusion, ASA class and perioperative neurological abnormalities are most significantly associated with ICU admission in the postoperative period.

DOI: 10.5281/zenodo.10962020

Aim: The aim of the present study was to assess the lipid profile of Decompensated chronic liver disease. Methods: This observational study was carried out amongst 50 Decompensated chronic liver disease patients that fulfils the inclusion and exclusion criteria and attended the gastroenterology OPD of IGIMS, Patna, Bihar, India. Results: 43 (86%) were male and 7 (14%) were female. The age range was from 16 to 76. The average age of the patients in the study was 48.72±12.58 yrs. 34% of the patients were between 40 and 50 years of age. 91.67 % of the patients were alcoholic. Abdominal distension and ascites were most common presenting complaints. Pallor was present in 32 (64%) cases. Splenomegaly was present in 24 (48%) patients of Decompensated chronic liver disease. Renal dysfunction was present in 18 (36%) cases. Icterus was present in 12 (24%) cases. 33 (66%) of the patients had decreased platelet count. The comparisons between lipid profile of Decompensated chronic liver disease patients and healthy controls was significant (p<0.05). Conclusion: Lipid abnormalities are commonly seen in patients with Decompensated chronic liver disease and screening for the same is essential for intervention with appropriate treatment to prevent adverse cardiovascular events. The levels of serum total cholesterol, TG, LDL and HDL in patients with Decompensated chronic liver disease are related to the advancement in Decompensated chronic liver disease. It helps in diagnosis of severity of liver disease and also acts as a good prognostic sign.

DOI: DOI: 10.5281/zenodo.10962040

Aim: The aim of the present study was to study clinical spectrum of dengue patients admitted in a tertiary care hospital in Bihar. Methods: The present study was conducted in the Department of General Medicine for the period of 1 year. A total of 200 hospitalized patients (Age >15 years) diagnosed as dengue were enrolled in our study. Results: A total of 200 hospitalized patients (Age >15 years) diagnosed as dengue were enrolled in our study out of which 150 patients were males (75%) and 50 patients were females (25%). Mean age of presentation was 39.51 years (19-68 years). Maximum number of cases was found in age group 30-40 years (37%) followed by 23% in 41-50 years age group. Out of 200 cases with distribution in antigenic presentation, 56% patients were NS1 positive, IgM positive in 29% of cases, NS1 & IgM positive in 11% patients and IgG positive in 3% of cases which indicated secondary cases and 2 cases with all NS1, IgM, IgG for Dengue positive. In our series in clinical manifestations, all cases (100%) presented with fever, myalgia(75%), headache(50%), rashes in 15% cases others clinical features are nausea, pain abdomen(20%) loose motion(15%), puritus etc. None of our patient have visual complains. Retro-orbital pain was noted in 5 patients (5%). Bleeding manifestations in any form was seen in 40% cases. In spectrum of bleeding manifestations bleeding in skin manifestations like Purpura or Petechia predominates (26%). Gasto-intestinal bleeding like malena (21%) and hematemesis in 2% cases and other bleeding features like epixtasis in 6% cases, Gum bleeding in 3%, Hematuria in 1%, and Ophthalmic bleeding like sub conjunctival hemorrhage, intra-vitreal hemorrhage in 8% cases. The commonest organ involvement is Liver (hepatopathy) in 52% cases. Conclusion: With the rise in incidence in dengue fever, there is necessity to understand dengue fever, now more than ever, and this study brings out the intricacies of symptomatology, platelet counts relation with bleeding, complications and antigen antibody variation with regard to dengue.

DOI: 10.5281/zenodo.10962052

Aim: The aim of the present study was to assess the clinical significance of serum uric acid, serum calcium, serum creatinine and serum electrolytes in patients with kidney stone. Methods: The present study was conducted in the Department of Surgery and 200 patients were included in the study. The patients were divided into two groups according to serum UA levels: the UA-high group with hyperuricemia (serum UA ≥ 7.0 mg/dL) or the UA-low group with normal UA levels (serum UA < 7.0 mg/dL) groups. Results: Patient background was significantly different between the UA stone patients and the patients with Coax/CaP stones in age, sex, body mass index, HTN, DM, CVD, hemoglobin, serum Alb, serum UA, hyperuricemia, triglyceride, and stage 3 CKD. The UA-low group comprised 50 control subjects and pair-matched 25 patients with UA stones. There were no statistically significant differences in background between UA stone patients and control subjects.  The UA-high group comprised 10 patients with UA stones and 20 pair-matched control subjects. There were no statistically significant differences in background between UA stone patients and control subjects. The UA-low group comprised pair-matched 20 patients with CaOx/CaP and 20 patients with UA stones. There were no statistically significant differences in background between UA stone patients and CaOx/CaP patients.  The UA-high group comprised 10 patients with CaOx/CaP and pair-matched 10 patients with UA stones. There were no statistically significant differences in background between UA stone patients and control subjects. Conclusion: Patients with UA stones had significantly worse renal function than controls and CaOx/CaP patients regardless of hyperuricemia. Urolithiasis (CaOx/CaP and UA stone) and hyperuricemia had an association with impaired renal function. Our findings encourage clinicians to initiate intensive treatment and education approaches in patients with urolithiasis and/or hyperuricemia in order to prevent the progression of renal impairment.

DOI: 10.5281/zenodo.10962187

Aim: The aim of the present study was to assess the distribution and antimicrobial susceptibility patterns of lower respiratory tract infections in the medical and surgical intensive care units of Nalanda Medical College and Hospital, Patna, Bihar, India. Methods: This was a retrospective study conducted at Department of Anaesthesia & Intensive Care, for the period of 12 months. However, this study was restricted only to the medical and surgical ICUs. Total number of patients (medical and surgical admissions) seen at our Institute during the study period was 1200; out of whom, 200 patients required intensive care. One hundred patients were enrolled for the study after considering the inclusion and exclusion criteria. Results: A total of 100 patients were included in the study, out of which 70 (70%) were males. Amongst different age groups, maximum patients were above 60 y (30%) and the least were between 18–30 y (12%). The underlying major medical conditions of the LRTI were diabetes mellitus (30%), respiratory pathology (20%), nephrological pathology (18%) and malignancy (14%). The bacteria were isolated predominantly from the tracheal aspirate (85%), compared to broncho–alveolar lavage (15%) with a statistically significant difference between them. Out of all the isolated organisms, A. baumannii (n = 30; 30%), P. aeruginosa (n = 24; 24%) and Klebsiella (n = 22; 22%) were the most positive isolates, S. aureus and Enterococcus were equal (n = 4; 4%). In the gram–negative isolates, A. baumannii was most susceptible to colistin (93.34%) followed by minocycline (80%) and amikacin (66.66%). With regard to P. aeruginosa, it was observed that only around half of the isolates were susceptible to doripenem (62.5%) and it was also observed that most of the isolates were resistant to all the commonly used antibiotics. In the gram–positive isolates, S. aureus was equally susceptible to linezolid (75%) and vancomycin (75%); and 100% of the isolates of Enterococcus were susceptible to vancomycin. Conclusion: Gram–negative pathogens were predominantly responsible for lower respiratory tract infections. Moreover, antimicrobial resistance rate was high with the most commonly used antibiotics and also to higher antibiotics such as carbapenems.

DOI: 10.5281/zenodo.10962290

Background and Aim: Enhanced recovery after surgery (ERAS) is an evidence-based, multi-disciplinary approach throughout preoperative, intraoperative and postoperative period. The ultimate goal of ERAS is to enhance recovery, to improve the maternal and neonatal outcome and reducing perioperative complications. Material and Methods: This is a prospective, randomized study involving 92 patients 46 in each group. In Group A ERAS protocols were applied and in Group B conventional care was given. Data evaluation was done by VAS (visual analog scale) score at 6-hour, comparison of CRP level at 24 hour and length of hospital stay. Results: Post-operative pain was significantly less in ERAS group (p value 0.00008). There was no change in post op CRP level at 24 hours in both groups (p value 0.11). There was decreased duration of hospital stay in ERAS group (p value 0.000000042). Post-operative complications like nausea- vomiting and severe pain was significantly (p value0.0076 and .015 respectively) less in ERAS group while there was no change in postoperative headache and wound infection rate (p value 0.62 and 0.557 respectively). Conclusion: We discovered that ERAS protocols significantly reduces hospital stay and decreases post-operative pain. ERAS protocols can be used to make tertiary hospital more efficient and speedier. ERAS protocol significantly improves overall patient satisfaction and reduces perioperative complications.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to identify predictors for difficult Laparoscopic cholecystectomy. Methods: A retrospective cross-sectional review of surgical records was done for all patients who underwent laparoscopic cholecystectomy on an elective basis at Department of General surgery, Lord Buddha Kosi Medical College & Hospital, Saharsa, Bihar, India for the period of 2 years. A total of 250 patients who underwent laparoscopic cholecystectomy (50 patients with difficult and 200 patients without difficult LC) were studied during the study period. Results: The majority of patients were female. The median age was 48 years. When we assessed different preoperative and intraoperative variables in two groups (difficult LC and non-difficult LC), we found differences based upon age, gender, past history of acute cholecystitis, gallbladder wall thickness, fibrotic gallbladder, and adhesion at the triangle of Calot (P < 0.05). However, We did not observe significant differences in other variables (P > 0.005). We had also evaluated different factors associated with difficult LC. In logistic regression analysis, on multivariate analysis gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4–5 mm), fibrotic gallbladder, and adhesion at the triangle of Calot were significantly associated with an increased risk of difficult laparoscopic cholecystectomy (P < 0.05). Conclusion: Gender (male), past history of acute cholecystitis, gallbladder wall thickness ( 4–5 mm), fibrotic gallbladder, and adhesion at Calot’s triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to assess the one-year outcome of Pulmonary Thromboendarterectomy surgery. Methods: The present study was conducted in newly diagnosed consecutive patients with CTEPH from a period ranging from May 2011 to May 2014. 90 patients were selected in the study. Results: Of the 90 subjects who qualified for inclusion in the study, there were 63 males (70%) and 27 females (30%). The majority of the patients were in the 21 – 50 years group, with almost equal numbers in the 21 – 35 year and 36-50-year age group. Two third of the patients were admitted with NYHA Class 3 (66.67%). Patients recorded with NYHA Class 2 were 27.78%, while patients recorded with NYHA Class 4 were only 5.56%. No patient was recorded with NYHA Class 1. Cough was also a common symptom, being present in 70 patients (77.77%). Haemoptysis was also a fairly common symptom, being present in 39 patients (43.33% of patients), at some point in their history. Only 4 (4.44%) of the patients were diabetic. Functional status according to the Karnofsky Performance Status score in 90 patients at late follow‐up after pulmonary endarterectomy and in 70% of the patients, the Karnofsky Performance Status score was 80% or higher (i.e., “able to carry on normal activity”). Conclusion: Success of PTE has now been confirmed. It remains the primary treatment for CTEPH.  Longer life expectancy is expected in these patients. PTE is safe and effective operative procedure. PTE is successful, curative alternative to lung transplant. Compared to lung transplant, PTE offers lower surgical mortality rate, better long term survival and fewer chronic complication.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to explore the impact of pursuing tissue diagnosis by endoscopic ultrasound (EUS)  guided biopsy for primary diagnosis in patients with Pancreatic ductal adenocarcinoma. Methods: The present study was conducted at Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India in patients who were diagnosed and/or treated with PC at our high-volume tertiary  center  were prospectively included in a patient database. 50 patients were included in the study. Results: Median age at diagnosis was 66 years. A majority of patients were male (56%; n = 28); had a good performance status and initially presented with synchronous metastatic disease. Most patients were treated with single-agent gemcitabine or gemcitabine-containing combination chemotherapy, followed by 5-FU-based regimens. We calculated TTI as time from first imaging study showing a suspicion of advanced PC and administration of the first cycle initiation was 29 days (range: 1–124 days), with a 75th and 90th percentile of 43 and 60 days, respectively. Prior to the conduct of our study, we assumed that a TTIinterval of more than 21 days represents a “treatment delay”. Applying this strict definition, a delay in treatment initiation was found in 30 patients (60%). Treatment delay was significantly more frequent in patients who initially presented with synchronous metastatic disease than in patients who relapsed after surgery in curative intent. Conclusion: EUS biopsy significantly impacts time between suspicion and treatment of PDAC. This may be exacerbated by clinical practices increasingly favoring neo-adjuvant therapy that necessitates biopsy-proven disease. Time to treatment may also be impacted by access to tertiary centers and racial disparities.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to determine whether there is a significant difference in the prevalence of systemic diseases in patients with periodontal disease and patients without periodontal disease. Methods: This case-control, epidemiological study was carried out in the Department of Dentistry. The study was conducted for period of one year. Among these patients, 200 patients with periodontal disease (cases) and 100 patients without periodontal disease (controls) were included in the study. Results: Prevalence of systemic diseases in cases was 51% i.e. 102 patients have systemic disease among 200. In periodontal patients, highest prevalence is in 50- 59 age group (78.57%) and other age groups in decreasing order was; >60 (55.88%), 40- 49 (548.14%), 30- 39 (40%) and 18- 29 (20%). In controls, prevalence was 18% i.e. 18 patients have systemic diseases among 100, which is considerably less than cases group. Highest prevalence is in 50- 59 age group (33.33%) and other age groups in decreasing order is; 40- 49 (30%), 18- 29 (17.39%), 30- 39 (13.15%) and >60 (0%). Among cases, 65 patients are beginning destructive periodontal disease, 60 patients are Established destructive periodontal disease, and 75 patients are in Terminal disease. Patients with periodontal diseases (cases) had higher prevalence of hypertension, diabetes, CVS disorders. There were 10 males and 8 females in controls. Conclusion: Due to the high frequency of medical conditions, thorough evaluation of patients medical history should be a mandatory first step in the diagnosis and management of dental diseases. Dental practitioners may also contribute their expertise in assessing risk for several systemic conditions. The fact that the oral diagnostic samples (saliva, crevicular blood) can be readily obtained non-invasively, and at potentially lower costs, may offer important advantages to some traditional medical testing.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to evaluate the role of diffusion MRI in differentiating pediatric posterior fossa tumors. Methods: This study was a retrospective study and conducted in the Department of Radiodiagnosis. The inclusion criteria were pediatric patients less than 20 years of age with posterior fossa tumor who had performed MRI and DWI/ADC prior to any treatment. The study period was of one year. During the study period, there were 100 patients with posterior fossa tumors. Results: There were 52% male as compared to females. 70% had high grade tumor and 30% had low grade tumor. In high grade tumor, 25 had medulloblastoma and in low grade tumor, 15 had Pilocytic astrocytoma. The ADC ratio cut-off level for differentiation medulloblastoma from ependymoma, medulloblastoma from ATRT, medulloblastoma from pilocytic astrocytoma and medulloblastoma from diffuse midline glioma were noted. The ADC ratio of medulloblastoma was significantly lower than ependymoma, pilocytic astrocytoma and DIPG. The ADC cut-off ratio of ≤ 1.115 allowed discrimination medulloblastoma from other posterior fossa tumors with sensitivity, specificity, PPV and NPV of 94.6%, 82%, 68.4% and 96.8%, respectively. Conclusion: In Conclusion, diffusion MRI has a significant role in diagnosis of various types of pediatric posterior fossa tumors. ADC ratio can be used to differentiate medulloblastoma from other posterior fossa tumor in pediatric patients with good level of diagnostic performance.

DOI: 10.5281/zenodo.10962356

Aim: The aim of the present study was to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Material & Methods: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, NMCH, Patna, Bihar, India for the period of 1 year .A total number of 200 patients were enrolled in the study and among them, 100 children with bronchiolitis were considered as cases, and 100 healthy children without bronchiolitis were considered as control, who were matched with age. Results: Majority of the patients were in the age group between 13-18 months. The mean age was found 13.087±5.735 months in cases and 15.125±7.963 months in controls. The mean age difference was not significant between the two groups (p>0.05). Male participants (65%) were the predominant group in the study and female participants (35%). Exclusive breastfeeding was found in 39 cases and 64 controls respectively. The differences were statistically significant (p<0.05) between the two groups in the chi-square test. Overcrowding was found in 76 cases and 60 controls respectively. There was a significant difference in Hb (gm/dl) between cases and controls followed by MCV (fl) between cases and controls. The MCH (pg) level was statistically and significantly lower in cases compared to controls; followed by MCHC (g/dl) which was statistically and significantly   lower   in   cases compared to controls. S. Iron (µg/dl) was statistically and significantly lower in cases compared to controls. Transferrin Saturation (%) was statistically and significantly lower in cases compared to controls. RDW-CV (%) was statistically and significantly higher in cases compared to controls. Among the 200 study subjects 80 cases had anemia, followed by 60 controls had anemia. Their difference was statistically significant between the two groups (p<0.05). Conclusion: Anemia caused by a lack of iron has been shown to have a substantial correlation with bronchiolitis. The recommendation was made for a larger and more comprehensive research.

DOI: 10.5281/zenodo.10962356