Introduction: Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in mechanically ventilated patients, leading to increased mortality, ICU stays, and healthcare costs. VAP is primarily caused by the aspiration of oropharyngeal organisms into the distal bronchi, either directly or via reflux from the stomach. Less common routes include hematogenous spread from remote infections or contamination from medical equipment. The incidence of VAP ranges from 6.8% to 44%, significantly impacting hospital stay length, mortality rates, and financial burden. Effective preventive strategies are crucial in managing this condition. Methods:  This study was conducted in SGRDIMSR, Vallah, Amritsar. Patients were selected from ICUs based on inclusion and exclusion criteria. Clinically suspected patients, according to CDC criteria, were scored using the Chronic Pulmonary Infection Score (CPIS), considering clinical, microbiological, and radiological signs. Variables noted for each patient included age, gender, CPIS, diagnosis at ICU admission, duration of ventilation, antibiotics received, samples submitted for confirmation of etiological agents, endotracheal aspirate, suction tip culture, type of organism recovered, susceptibility profile, and clinical outcome. Results: Out of 362 patients, 231 (63.8%) were males and 131 (36.2%) were females, with a male-to-female ratio of 1.76:1. The most common comorbidities observed were hypertension (53.9%), type 2 diabetes mellitus (52.8%), coronary artery disease (19.06%), obstructive sleep apnea (14.08%), cerebrovascular accident (6.4%), chronic obstructive pulmonary disease (4.14%), and bronchial asthma (3.59%). Supine position was a risk factor in 99.7% of patients, with nasogastric tube use at 99.44%, and sedation at 98.1%. While 39.2% of patients had a CPIS score greater than 6, the majority (60.8%) had a CPIS score less than 6. Among the patients, 39.23% developed VAP after being intubated and mechanically ventilated for 48 hours or more. The majority of isolates obtained were gram-negative bacteria (98.44%), with only 1.56% being gram-positive. Among the 128 organisms isolated, the most common was Klebsiella Pneumoniae (41.40%), followed by Acinetobacter Baumannii (21.09%). Among the 142 patients who developed VAP, 42.25% had successful outcomes, while 57.74% did not survive. The most common clinical features of VAP included fever, crepitation, and tachypnea. The mean duration of mechanical ventilation for patients who developed VAP was 9.09 ± 2.747 days, compared to those who did not develop VAP. Patients with VAP had notably longer ICU and hospital stays compared to those without VAP. Conclusion: This study provides a comprehensive analysis of ventilator-associated pneumonia (VAP), including its epidemiology, microbial etiology, antibiotic resistance, and patient outcomes. Key prognostic indicators such as body temperature, total leukocyte count (TLC), inotropic support, tracheal secretion characteristics, and the presence of VAP are identified. The findings underscore the importance of tailored prevention and management strategies to improve patient outcomes and advocate for ongoing surveillance and evidence-based approaches to address this challenging infection.

DOI: 10.5281/zenodo.

Background: Inflammatory bowel disease (IBD) is an immune mediated chronic intestinal disease. It is of two major types, Ulcerative Colitis (UC) and Crohn’s Disease (CD). Though IBD is primarily an intestinal disease, it involves various organ systems such as eyes, skin, musculoskeletal and hepatobiliary systems. Sensorineural hearing loss is one of such extraintestinal manifestations which is attributed to the autoimmune inner ear disease. The objective of this study is to find the prevalence of sensorineural hearing loss in patients of inflammatory bowel disease. Materials and Methods: 28 patients of inflammatory bowel disease in the age group of 18-50 years visiting outdoor patient department or admitted in the Department of Gastroenterology, IGMC Shimla over a period of one year (August 2014 to July 2015) fulfilling the inclusion and exclusion criteria were included for the study. The subjects were then subjected to a battery of audiological tests: Tuning fork tests, Pure Tone Audiometry and Brain Stem Evoked Response Audiometry (BERA). The data was tabulated in Microsoft Excel spread sheet and Epi Info version 3;4,3 statistical software was used for statistical analysis. Results: A total of 28 patients were included in the study, 15 of the which were females and 17 males. Mean age of the study population was 37.79 ± 8.14years. 23 (82.14%) patients were diagnosed to have Ulcerative Colitis while 5 (17.85%) patients were diagnosed to have Crohn’s disease on endoscopy and further histopathological examination. A total of 8 (28.57%) patients were found to have sensorineural hearing loss. Out of these 8 patients of SNHL, 6 (75%) had UC and 2 (25%) had CD. 6 (75%) patients had Cochlear type of hearing loss while 2 (75%) had Retrocochlear type of hearing loss. The mean Duration of IBD of the patient population with SNHL was 6.37 ± 4.90 years while that of the patients without SNHL was 1.34 ± .82 years. Conclusion: Inflammatory bowel disease is a treatable cause of otherwise permanent sensorineural deafness. Early audiometric evaluation may be advised in all inflammatory bowel disease patients.

DOI: 10.5281/zenodo.

Coronavirus is a huge virus family which includes Middle East respiratory syndrome and severe acute respiratory syndrome. All of these are recognized to be the root of the common cold and more severe infections. On 30 January 2020, the World Health Organization (WHO) declared that the outbreak of SARSCoV-2 constituted a Public Health Emergency of International Concern (PHEIC). Compared to seasonal flu, covid 19 is more contagious, has a much longer incubation period, and is association with higher hospitalization, and mortality rates. There is a rapid unpredictable deterioration of the patient, therefore it requires timely prediction of the course and severity of the illness. Due to their simplicity of measurement, availability, affordability, and reliability, the differential blood cell counts can be employed as a measure of the intensity of the immune response. Neutrophil- lymphocyte ratio (NLR) plays a predictive function in a number of inflammatory illnesses and oncological processes.For Covid-19 patients, NLR has been demonstrated to be an independent risk factor for severe disease. The elevated NLR may be due to dysregulated expression of inflammatory cytokines.In this study we aim to study the correlation of NLR ratio with Covid 19 Positive patients.

DOI: 10.5281/zenodo.

Introduction: Anxiety has a significant prevalence in chronic obstructive pulmonary disease (COPD) patients, impacting their quality of life. This study aims to estimate the prevalence of anxiety in COPD patients and examine the correlation with various socio-demographic factors. Methods: A cross-sectional study was conducted at Bundelkhand Medical College, Sagar, Madhya Pradesh with 160 COPD patients. Anxiety levels were assessed using the GAD-7 questionnaire and socio-demographic data were collected through structured interviews. Results: The prevalence of anxiety among COPD patients was 36.25%, with mild anxiety (21.25%) being the most common. Significant correlations were found between anxiety and certain socio-demographic factors, including age, marital status, BMI, family income, and number of dependents. Conclusion: The high prevalence of anxiety in COPD patients suggests the need for regular screening and appropriate interventions to improve their overall well-being.

DOI: 10.5281/zenodo.

It is common for solubility, a critical feature that governs the bioavailability and therapeutic efficiency of pharmacological compounds, to be a barrier to the creation of new drugs. As a result of their low solubility, pharmaceutical researchers have a great deal of difficulty when attempting to develop medications that are both more soluble and more sustained (BCS class II). There are issues with the solubility of medications that fall within BCS Class II and Class IV. When it comes to the world of pharmaceutical research, solubility enhancement is of great significance because its primary objective is to improve the solubility and bioavailability of medications that have a poor solubility by increasing their solubility. Because of their propensity to exhibit inadequate absorption, bioavailability, and therapeutic efficacy, medicines that are poorly soluble present a significant problem in the process of drug development. There are a few different approaches that may be taken in order to improve the bioavailability as well as the solubility of drugs that are already poorly soluble. In this review, we will be discussing two of the most essential techniques, which are the Liquisolid technique and the Self Emulsifying Drug Delivery System (SEDDS).

DOI: 10.5281/zenodo.

Introduction: Non fermenting bacteria are considered as opportunistic nosocomial pathogens that are capable of causing severe chronic persistent infections. One of the main virulence factors of these bacteria is biofilm formation. Biofilms are association of planktonic bacterial cells in extra polymeric matrix. They are the most common mode of bacterial growth in nature and are also important in clinical infections. Aim: of this prospective study was to isolate non fermenting Gram-negative bacilli (NFGNB) from wound infection, to study their biofilm forming ability along with antimicrobial susceptibility pattern. Samples were processed according to standard protocol & Tissue Culture Plate (TCP) method was used for detection of biofilm formation. Results: A total of 400 pus samples were studied during study period. Out of these 121 (39.6%) were NFGNB. Biofilm production was seen in 55.3% isolates. It was observed antimicrobial resistance was higher in biofilm producing isolates as compared to non-biofilm producing isolates. This association was found to be statistically significant. Conclusion: Treatment and preventive strategies for infection against pathogenic bacteria with biofilm formation is by early initiation of appropriate antimicrobial therapy, by avoiding microbial attachment to the surface, disrupting biofilm development and maturation in order to enhance antimicrobials penetration. In addition, routine testing of biofilm formation in microbiology laboratory should be encouraged for timely diagnosis and better management of such infections.

DOI: 10.5281/zenodo.

Introduction: Chronic Kidney disease (CKD) is a condition that causes damage to the kidney or its gradual impairment involving the loss of glomerular and tubular function that lasts longer than three months. Dyslipidemia is a well-established risk factor for CVD. With an ever increasing CKD burden worldwide, providing treatments for modifiable risk factors, like dyslipidemia, becomes an essential component for improving outcomes. Therefore it is important to screen all patients with CKD for dyslipidemia and treat them as they are considered a very high risk group for CVD.  Materials and Methods: This study is a single centre observational study conducted in the Dept. of General Medicine, Agartala Government Medical College and GB Pant Hospital for 1- and ½ years study periods.226 patients are studied who met the inclusion criteria following  assessment of Serum Creatinine, Serum Urea, fasting  Serum lipid Profiles (S. Cholesterol, S. Triglyceride, S. HDL,  S. VLDL, S. LDL) ECG, Thyroid profile were done. GFR was estimated for each patient using the CKD-EPI equation. Mean values were obtained for LDL, HDL, TGL & Total cholesterol VLDL separately. Then standard deviations were calculated for each category of observations. P value of <0.05 was considered significant. To study the correlation between stages of CKD and lipid profiles Pearsion correlation coefficient was used. Results: In our study, most common lipid abnormalities found were Low HDL levels and Hypertriglyceridemia, Hypercholesterolemia, High LDL and VLDL levels were in decreasing order respectively. 84% of total study population the mean HDL cholesterol is significantly decreased and negative correlation is found between CKD stages and HDL level. 70.3% of study populations were having high triglycerides levels and positive correlation is found between CKD stages and triglycerides level. LDL level, total cholesterol, VLDL levels were elevated in 44.6%, 44.2%, 15.9% of total study population respectively and Positive correlation were found between CKD stages and their levels. Conclusion: HDL level was lower and Triglycerides, LDL, Total cholesterol and VLDL levels were higher in the study population. Predominant lipid abnormalities were reduced HDL levels and elevated Triglycerides. Triglycerides, LDL, Total Cholesterol and VLDL were showing positive correlation as CKD stages increases there is increase of mean lipid profile values. There was a negative correlation between serum HDL level and GFR levels which was statistically significant.

DOI: 10.5281/zenodo.

Background: Prediabetes, a state of impaired glucose regulation, is recognized as a significant risk factor for cardiovascular diseases, including acute coronary syndrome (ACS). This study aims to assess the influence of prediabetes on the clinical presentation and lipid profiles of patients presenting with ACS. Methods: This cross-sectional study was conducted at MGM College & MY Hospital, Indore, from February 2022 to September 2023. A total of 240 consecutive patients diagnosed with ACS, aged 18-44 years, were enrolled. Patients were categorized into non-diabetic and prediabetic groups based on ADA guidelines. Clinical symptoms and lipid profiles were compared between the groups. Results: Our study of 240 acute coronary syndrome patients revealed a 25% prevalence of pre-diabetes. Pre-diabetics demonstrated higher mean fasting and postprandial blood glucose levels compared to non-diabetics. They also experienced a greater incidence of arrhythmias and cardiogenic shock. No significant differences were noted in other clinical outcomes. These findings highlight the increased cardiovascular risk in pre-diabetics, suggesting a need for targeted strategies to manage and mitigate these risks. Conclusion: Prediabetes was associated with more severe lipid profile disturbances in ACS patients. These findings highlight the need for aggressive cardiovascular risk management in patients with prediabetes.

DOI: 10.5281/zenodo.

Background and Objectives: Infections involving the CNS, particularly meningitis and encephalitis are likely to arouse tremendous anxiety in both the physician and patients. Reliable, cost effective, rapid diagnostic tests which can be performed in any standard pathology laboratory could be of help in the differentiation of various types of meningitis in adults. In this regard, C – reactive protein level and Adenosine deaminase activity can be used as rapid tests in the differential diagnosis of meningitis. ADA estimation is useful in diagnosis of tuberculous meningitis. CRP estimation has been documented to be helpful in diagnosing pyogenic meningitis. The levels of both ADA and CRP are low in cases of viral meningitis. Aim of the Study: Assessment of cerebrospinal fluid Adenosine deaminase and C Reactive protein in the differential diagnosis of meningitis in adults. Methods: CSF samples were obtained from 50 patients who presented to the casualty and Outpatient department of Osmania General Hospital. Diagnosis of meningitis was based on the clinical presentation and CSF analysis. Results: In our study, out of a total of 50 patients, 25 patients were diagnosed as tubercular meningitis based on the clinical features and CSF analysis. The mean ADA activity was 14.36 in the Tuberculous meningitis group, the result being statistically significant (p<0.001). The sensitivity and specificity were 72% and 100% respectively when a cut-off value of ADA of 10U/l was used. CSF-CRP is significantly higher in pyogenic meningitis compared to non-pyogenic meningitis. The sensitivity and specificity of the test was 90% and 100%respectively with an accuracy of 98%. Conclusion: 2 rapid diagnostic tests-CRP and ADA activity in the CSF can help in the differential diagnosis of pyogenic from non-pyogenic and tubercular from viral meningitis respectively. CRP being elevated in pyogenic meningitis and ADA activity noted to be higher in tuberculous meningitis. The levels of ADA and CRP are low in viral meningitis. However, these tests should be interpreted judiciously in the light of the patients’ clinical manifestations and the results of CSF analysis.

DOI: 10.5281/zenodo.

Background: Vaginal candidiasis (VC) is a leading cause of abnormal vaginal discharge after bacterial vaginosis at gynecologic clinics. The most common causative organism is Candida albicans, which is one of the vaginal normal floras. Objectives: aim of this study was to compare the treatment effect of fenticonazole versus clotrimazole on vaginal candidiasis patients. Methods: A total of 100 patients clinically compatible with Vulvovaginal candidiasis, diagnosis were confirmed by laboratory examination for Candida species were enrolled. All patients were randomly divided into two groups, group A received intra-vaginal Fenticonazole (600 mg) and Group B received intra-vaginal Clotrimazole (500 mg). Both group are followed up for four weeks and compared the treatment effects in terms of clinical and mycological features. Results: Majority of the subjects (37%) were 31-45 years age group. No significant difference between the fenticonazole and clotrimazole group in terms of age, BMI, residential and socio-economic status (p>0.05).Common risk factors of fungal vulvo-vaginitis are factors of frequent micturition, vulvar cleaning, and associated sexually transmitted diseases. Complete cure rate and recurrence rate were almost similar in both the group. Therapeutic efficacy of both the agents was similar after first week of treatment, but efficacy was significantly higher in fenticonazole group after 2^nd or 4^th week of treatment (p<0.05). Conclusion: Fenticonazole has a broad spectrum antifungal agent highly effective and well tolerable against treatment of Vulvo-vaginal candidiasis.

DOI: 10.5281/zenodo.

Aim: To find out the prevalence of specific risk factors among babies who received exchange transfusion for severe neonatal jaundice and to note their clinical outcome at the end of one month post procedure. Materials and Methods: Retrospective Observational Study done in NICU, SNCU and Level-3 ICU at Niloufer Hospital for Women and Children from 18 months. 56 neonates who received exchange transfusion for severe neonatal jaundice. Results: Majority of the babies were admitted on the day of birth (39%) followed by 1^st DOL (14%) followed by 5^th DOL (13%). Majority of the babies underwent ET on 1^st DOL (18%) followed by day of birth (16%) followed by 5^th DOL (16%) neonates. %). Maximum admissions for hyperbilirubinemia occurred on birth day itself. Mean TSB on DOA was 24.58±4.68 mg/dl. Most common risk factors found during the study were absence of breast feeding (63%), Rh incompatibility (35.7%), ABO incompatibility (25%), Birth Asphyxia (14%), Sepsis (9%), GDM (9%), Preeclampsia (7%). Among the outcomes studied, 4 cases underwent mortality (7%). Of the cases that died, 2 were born preterm at 32 weeks and 35 weeks respectively. All babies had the uniform risk factor of lack of breastfeeding. Two cases had Rh incompatibility, of which one also had a positive sibling history. One case showed ABO incompatibility. 39.2% cases showed no morbidity. 53.5% cases showed morbidities, of which most commonly noted morbidities were thrombocytopenia(23%) followed by sepsis (21%) . Hypocalcaemia was found in 14.2 % cases. Conclusions: Exchange Transfusion, though a lifesaving procedure, effective in rapidly bring down bilirubin levels is not bereft of complications. Significant morbidities identified after the procedure must prompt us to be more stringent in preventive care aspects for severe neonatal jaundice.

DOI: 10.5281/zenodo.

Painful diabetic neuropathy (PDN) is a frequent and debilitating complication of diabetes mellitus, significantly affecting the quality of life of the patient as well as their family. The therapeutic burden of this ailment contributes to a socioeconomic burden on the community. Different therapeutic agents with varying therapeutic and adverse profiles are available to manage this condition.  The usage of these therapeutic agents depends on prescribers’ clinical experience and understanding. This study aims to evaluate the prevalence of PDN, its impact on the quality of life, and the patterns of drug usage for neuropathic pain alleviation in Kerala, India. Data were collected from diabetic clinics across Kerala through surveys and medical records. The data analysis of this cross-sectional survey analysis indicates a high prevalence of PDN, with substantial impacts on both the physical mental, and socio-economic well-being of the patients affected. Most physicians reliance on a variety of pharmacological treatments, predominantly gabapentinoids, and antidepressants. The findings highlight the need for enhanced pain management strategies and increased awareness of PDN among healthcare providers and patients.

DOI: 10.5281/zenodo.

Introduction: Breast cancer is the first most common cancer in women in India. Early diagnosis and treatment of breast cancer have significantly higher survival rates and significantly reduced themprobability of the cancer being fatal. The main objective is to study the Knowledge about breast cancer, assess the Practice of Breast Self-examination (BSE), and compare the existing knowledge and practice among women in urban and rural areas. According to GLOBOCAN, Breast Cancer is fairly common in the younger age group (25 to 49 years), accounting for almost 37.7% of all cases. Since very few community-based studies including both rural and urban areas were done in south India, I have undertaken this study in females of the reproductive age group. Methodology: A community-based cross-sectional study was conducted among 110 Females of the reproductive age group residing in the field practice area of Chengalpattu Medical College,55 from rural and 55 from urban areas. Multi-stage random sampling was done. Institutional Ethical committee approval was obtained. After getting informed consent, data collection was done using a structured questionnaire. The data was entered in Microsoft Excel and analyzed using SPSS version 25. Results: The mean age of the study participants was 32.91±8.21years. All the study participants had heard about breast cancer.44.5% of the study participants had adequate knowledge about breast cancer. Among those who had adequate knowledge about breast cancer majority 52.7% (n=29) were from urban areas and 36.4% (n=20) were from rural areas .13.6% had performed BSE, and 10.9% Practiced BSE once a month. Study participants with educational status higher secondary and above had adequate knowledge of breast cancer than those with lesser education (p-value 0.010*). There was a statistically significant association between knowledge about breast cancer and the practice of BSE (p-value 0.000*). Study participants in urban areas practiced BSE more than in rural areas (p-value 0.024). Conclusion: The study concludes that less than half (44.5%)of the study participants had adequate knowledge about breast cancer but only 13.6% had practiced BSE, and 10.9% of the study participants practiced BSE once a month. Study participants in urban areas practiced BSE more than those in rural areas. Intensive Behaviour Change Communication is to be given to the general public regarding breast cancer awareness and the importance of BSE. Improving access to clinical breast examination and Imaging techniques for screening breast cancer in all health facilities enables the detection of breast cancer at the earlier stage.

DOI: 10.5281/zenodo.

This study evaluates the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in reducing anxiety and depression in patients with pemphigus and psoriasis. Conducted at SCB Medical College, Cuttack, the prospective study followed 100 participants over one year. Results show significant improvements in psychiatric symptoms and quality of life, particularly in psychological domains, highlighting the benefits of integrated dermatological-psychiatric care.

DOI: 10.5281/zenodo.

The preferred route for drug delivery is oral administration owing to its convenience, patient compliance, and cost-effectiveness but the researchers are in trouble in the bioavailability. This study was in the aspect of improving the solubility and dissolution rate of Rosuvastatin calcium using the solid dispersion technique with various natural polysaccharides. Both the kneading and solvent evaporation methods were employed to create Solid dispersion formulations with neem gum and tamarind seed powder as natural polysaccharide carriers. The prepared Solid dispersion formulations underwent thorough evaluation, and the most optimized formulation underwent tablet formulation via the direct compression method, followed by quality control testing. Among the various natural polymers screened, Solid dispersion formulations utilizing neem gum demonstrated a significant enhancement in solubility and dissolution. Of the investigated ratios (1:0.5, 1:1, and 1:2), the Solid dispersion formulation with a 1:1 ratio showed the highest solubility enhancement and maximum drug release, alongside favorable surface characteristics as confirmed by Scanning Electronic Microscopic analysis. Subsequently, the prepared core tablet exhibited improved dissolution efficiency, with a 92.34% drug release observed at 60 minutes, outperforming comparative formulations including Physical Mixture-1 (69.5%), Physical Mixture-2 (79.5%), Core Tablet-1 (89.99%), and, Core Tablet-2 (92.34%) the Marketed tablet (88.44%). These results highlight the effectiveness of the optimized Solid dispersion formulation employing natural polysaccharides in significantly improving solubility and dissolution rates, potentially enhancing the solubility and bioavailability of Rosuvastatin calcium. This study contributes to the advancement of pharmaceutical research aimed at enhancing the efficacy and therapeutic outcomes of poorly soluble drugs through innovative formulation strategies.

DOI: 10.5281/zenodo.

Background: Comorbidities have been linked to higher in-hospital complications and fatality rates in individuals with COVID-19. Aims and Objectives: We aimed to examine the body of research on the effects of COVID-19 and comorbidities on health and the economy, particularly as they relate to emerging nations like India. Materials and Methods: Database of Covid -19 patients was assessed. It is a record based retrospective cohort study. The information used in this study is anonymous and covers only age and gender data. Results: In present study, most common co morbidity was hypertension in which 43.80% patients were discharged and death in 31.80% patients. Most common double co morbidity was hypertension+diabetes in which 72.70% patients were discharged and death in 72.70% patients and the most common triple co morbidity was hypertension+diabetes+heart disease in which 58.70% patients were discharged and death in 58.10% patients. Conclusion: Low-income nations with limited resources and an average socioeconomic background need to implement stringent policies for reasonably priced testing programs to locate, evaluate, diagnose, and quarantine asymptomatic individuals at home.

DOI: 10.5281/zenodo.

This study aims to analyze the demographic distribution, treatment patterns, drug utilization, and adverse drug reactions in patients with osteoarthritis and rheumatoid arthritis. Osteoarthritis was more common in males (56.07%) than females (43.92%), while rheumatoid arthritis was more prevalent in females (67.07%) compared to males (32.96%). Osteoarthritis was most prevalent in the 51-65 years age group (45.32%), followed by 36-50 years (37.61%). Rheumatoid arthritis was predominantly found in the 51-65 years age group (89.02%), followed by 66-80 years (6.09%). For osteoarthritis, NSAIDs (44.45%) were the most prescribed, followed by analgesics (25.68%). For rheumatoid arthritis, NSAIDs (26.58%) were also common, with significant use of DMARDs (16.76%) and antacids (19.42%).Oral administration was predominant in both osteoarthritis (94.11%) and rheumatoid arthritis (95.29%).Mono-therapy was more common in osteoarthritis (79.23%) than in rheumatoid arthritis (71.11%), where combination therapy was more prevalent (28.88%).Old age (28.73%) and obesity (13.31%) were primary risk factors for osteoarthritis, while family history (45.12%) and old age (39.02%) were significant for rheumatoid arthritis. Gastric discomfort and abdominal pain were noted adverse reactions to NSAIDs, more frequent in rheumatoid arthritis patients (12.19% and 3.65%, respectively) than in osteoarthritis patients (1.86% and 0.93%). Treatment approaches and drug utilization patterns vary considerably between the two conditions, with a higher incidence of adverse reactions observed in rheumatoid arthritis. These findings underscore the need for tailored treatment strategies to optimize patient outcomes and minimize adverse effects. Further research is recommended to explore the underlying causes of these disparities and to develop more effective management protocols.

DOI: 10.5281/zenodo.

Background: The maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. This study aimed to determine the maternal mortality ratio (MMR), identify various risk factors, and analyze the causes of maternal mortality. Methods: This is a prospective, observational hospital based study at a tertiary care center in Visakhapatnam from June 2022 to May 2023. The research analyzed the causes and contributing factors of each maternal death. Results: A total of 46 maternal deaths occurred during the study period, resulting in a mean MMR of 144 per 100,000 livebirths. Most maternal deaths (30.43%) occurred among women aged 13-19 years, with 56.52% occurring in multiparous women and 82.61% among unregistered patients. Direct causes accounted for 73.91% of the deaths, with hypertension (44.12%) and hemorrhage (26.47%) being the major contributors. Conclusion: Improving rural healthcare facilities, upgrading referral centers, and enhancing transport systems are essential to reduce maternal mortality.

DOI: 10.5281/zenodo.

Background: During pregnancy, changes in heart rate variability (HRV) reflect alterations in the regulation of the autonomic nervous system (ANS). While many previous studies have demonstrated the impact of gestation on ANS control of heart rate in Western populations, this phenomenon is not well understood in the Indian population. Understanding these changes is crucial for insights into maternal autonomic cardiovascular control during normal pregnancy. Our study aimed to analyze cardiac autonomic control throughout different stages of pregnancy using HRV. Methods: we recorded beat-to-beat variations in SA nodal discharge, recorded by ECG, and were analyzed using  HR software to determine the spectral indices of HRV. The assessment occurred between 8:30 AM and 12:00 noon in an isolated examination room. ECG recordings for beat-to-beat heart rate variability analysis were taken after at least 5 minutes of supine rest, with the subjects in a supine position and breathing freely. The ECG was recorded from the precordial leads and transferred online to a microcomputer for HRV analysis. Only stationary time series of approximately 5 minutes, free of arrhythmia and artifacts, were used. Results: The important findings of this study were that overall heart rate variability, as reflected by time-domain (SDNN, RMSSD, SDSD) and frequency-domain (VLF, LF, HF) measures, was significantly decreased in pregnant women compared to non-pregnant controls.  A reduction in high-frequency (HF) power and an increase in low-frequency (LF) power suggest a shift towards sympathetic dominance during pregnancy. The point-care plot parameters (SD1 and SD2) indicated a reduction in both short-term and long-term heart rate variability in pregnant women. Conclusion: The analysis of HRV parameters across different pregnancy trimesters and between primiparous and multiparous women reveals significant alterations in autonomic nervous system function. A consistent reduction in HRV measures was observed throughout pregnancy, indicative of a shift towards sympathetic dominance. These findings underscore the physiological adaptations necessary for sustaining pregnancy.

DOI: 10.5281/zenodo.

Introduction: Dyslipidemia is defined as the imbalance in the plasma levels of lipids such as cholesterol, low density lipoprotein (LDL-C), trigylycerides, and high-density lipoprotein (HDL). It is an important risk factor for atherosclerosis and atherosclerosis-induced complications such as coronary heart disease, myocardial infarction, stroke and peripheral vascular disease. Aims: This study aims to review and analyze the prescription pattern of this new oral hypolipidemic drug in a small Indian cohort population in a central Indian city, to observe its current prescribing trends and adherence to prescribing guidelines and WHO/INRUD prescribing indicators with the aim of validating its use in the Indian population. Materials and Methods: This was a cross –sectional observational study conducted at Jabalpur city, India after getting due permission from the Institutional Ethics Committee. The study was conducted from one month from August 2023 to September 2023. Result: 98 prescriptions were screened for the purpose out of which 90 prescriptions were selected for final evaluation after prescription audit/ meeting exclusion and inclusion criteria. Out of these 90 patients enrolled, there were total 46 males (51.11%) and total 44 females (48.89%). The age distribution of the patients was as following: The average age of the patient cohort was 59.31 ± 8.17 years, with the maximum prevalence in the age group of 46-64 years. The average of baseline LDl –C levels was found to be 131.2 ± 6.7mg/dl. The average duration of dyslipidemia was found to be 14.15±12.16 years. Conclusion: In conclusion, our study provides valuable insights into the prescription patterns of bempedoic acid among outpatient populations in a central Indian city. We found that [summarize key findings]. These findings underscore the importance of [mention any implications for clinical practice]. However, it is essential to acknowledge the limitations of our study, including [list any limitations]. Moving forward, further research may be necessary to [suggest areas for future investigation]. Overall, this analysis contributes to the growing body of evidence regarding the use of bempedoic acid in real-world clinical settings and highlights its potential role in managing hypolipidemia.

DOI: 10.5281/zenodo.

Background and Aim: Despite safety education campaigns, efficient law enforcement, better technology to prevent motor accidents, better helmets and seat belts, and a large increase in vehicle accidents, violence, and falls, traumatic brain injury (TBI) is a serious global problem. Current study’s goal was to determine how well prognostic markers predicted outcomes in cases of traumatic bone injury. Material and Methods: The present analysis was done to study the prognostic indicator on the outcome in the cases of traumatic brain injury. For the purpose of additional analysis, the data from the 100 patients that were included were gathered. All potential predictors with the highest predictive value were chosen, and consideration was given to the core group basis. The three most powerful indicators of the result were demography, puffery reactivity, and GCS. Results: Automobile accidents accounted for the bulk of instances, with assault and fall coming second. While the age range of 40 to 59 years accounted for the largest number of fatalities overall, the study’s patient population with ages above 70 had the greatest mortality rate. 66.67% of people died in the GCS 6 group. The mortality rate in the GCS 7–13 category was 27.10%. Of the 100 patients, 51 showed normal pupillary reactivity, 37 had a slow pupillary response, and 12 had no pupillary responsiveness at all. Conclusion: Patient mortality was 100% for those with a GCS of 5 or below at presentation. The death rate was 100% for patients who also had dilated pupils, hypotension, and hypoxia. When early surgery was performed on patients with uneven pupils, the results were significantly better than when no surgery was performed.

DOI: 10.5281/zenodo.

Introduction: Glue ear, or secretory otitis media, is the leading cause of hearing loss in children. The insufficient management of acute otitis media with antibiotics has resulted in an increased incidence of secretory otitis media (SOM) in recent years. This study aimed to assess the impact of adenoidectomy on children diagnosed with SOM. Materials and Methods: A cohort of 98 children aged between 4 and 12 years, including both genders, with a history of SOM were examined before and after adenoidectomy. Otoscopic evaluations were conducted, and pure tone audiometry (PTA) was used to measure hearing thresholds in both ears. The data obtained were analyzed statistically using the Mann-Whitney U test. A p-value of less than 0.05 was regarded as significant. Results: Among the 98 participants, there were 52 boys and 46 girls. The prevalent symptoms included nasal discharge in 62 children, nasal obstruction in 43, sore throat in 52, a sensation of ear fullness in 33, and hearing difficulties in 48. Otoscopic findings revealed tympanic membrane retraction in 10 cases, air bubbles in 28, and a dull, amber-colored appearance in 59. Hearing loss ranged from 16-25 dB (minimal) in 54 children and 26-40 dB (mild) in 35. Impedance audiometry demonstrated a peak in 17 cases and no peak in 81. Complications included sinusitis in 15 children and tonsillitis in 19. The mean air-bone gap (AG gap) before surgery was 22.3 dB, which decreased to 11.7 dB at 1 month, 10.4 dB at 3 months, and 10.1 dB at 6 months, with significant differences (P < 0.05). Conclusion: Adenoidectomy is an effective surgical intervention for pediatric patients with SOM, significantly improving hearing and reducing associated symptoms. This study underscores the value of early diagnosis and surgical management in mitigating SOM’s adverse effects and enhancing patient outcomes.

DOI: 10.5281/zenodo.

High-Performance Liquid Chromatography (HPLC) is a pivotal analytical technique extensively employed in various scientific fields. This review delves into the foundational principles of HPLC, exploring its instrumentation, method development, and optimization strategies. Furthermore, it examines the wide-ranging applications of HPLC in pharmaceuticals, environmental monitoring, food safety, and clinical diagnostics. The article also highlights recent advancements in HPLC technology, addresses the challenges and limitations faced by practitioners, and forecasts future trends in the integration of HPLC with emerging analytical methods.

DOI: 10.5281/zenodo.

Background: Abdominal tuberculosis (TB), a form of extra-pulmonary TB, is rising and poses diagnostic challenges due to non-specific symptoms. It often results from ingestion of contaminated materials or spread via hematogenous, lymphatic, or direct routes. Risk factors include latent TB, chronic diseases, immunosuppressive conditions, and lifestyle factors. Methods: A retrospective analysis was conducted on 100 patients admitted with subacute intestinal obstruction (SAIO) due to right-sided colonic mass. Clinical presentations, investigation findings (USG, CECT Abdomen, Colonoscopy), procedures performed, and outcomes were evaluated. Results: Demographics: 50% had large bowel obstruction; most were middle-aged males (40-60 years). Symptoms: Common symptoms included absence of fecal passage (80%), abdominal pain (70%), and reduced appetite (90%). Investigations: Laboratory tests showed anemia, thrombocytosis, leukocytosis, and hypoalbuminemia. CT scans were more diagnostic than USG or X-rays. Diagnostics: CT scans, colonoscopy, and biopsies were key in diagnosing intestinal TB, especially in stable patients. Surgical Interventions: Procedures included elective hemicolectomy (30 cases), emergency hemicolectomy (5 cases), and emergency stoma (15 cases). Intestinal TB was confirmed in 25 patients via histopathology. Conclusions: In TB-endemic regions, abdominal TB should be considered for bowel obstruction due to its non-specific symptoms. Anti-tuberculous therapy is effective for uncomplicated cases, while surgical intervention is necessary for complications. Early diagnosis and prompt treatment are crucial for positive outcomes.

DOI: 10.5281/zenodo.

Background: Kidneys are pair of retroperitoneal excretory organs situated in posterior abdominal wall because of which difficulties are faced in management of renal disease by surgeons. The variation in size of the kidney is an important clinical sign for kidney diseases such as congenital anomalies, vascular disease, and neoplasia. Therefore knowledge of Morphometric dimensions of kidneys is necessary for clinicians and surgeons to diagnostic and surgical intervention. Material and Methods: 50 formalin fixed kidney specimens (right-25, left 25) obtained from human cadavers, from Department of anatomy, Sri Siddhartha Medical College, Tumkur. The morphometric parameters like length, breadth and thickness of the kidneys were measured by using vernier callipers and weight was measured on digital weighing machine. Aim: To study morphometric variations of kidneys in human cadavers with no known renal disease. Results: The means of length, breadth of superior pole and inferior pole, thickness of superior pole and inferior pole of right kidneys were 8.80±1.04, 3.32±0.49, 3.08±0.38, 2.35±0.21, 2.0±0.28 respectively whereas left kidneys were 8.55±0.82, 3.53±0.27, 3.29±0.40, 2.06±0.36, 2.17±0.41 respectively. The morphometric parameters were more in left kidney compared to right kidneys. Conclusion: There were variations in the length, breadth and thickness of both right and left kidneys. The detailed knowledge of renal dimensions is required for the surgeons and radiologists to avoid clinical complications.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the pulmonary function tests in patients of metabolic syndrome and to record the effects of metabolic syndrome on pulmonary function tests. Methods: The study was conducted in the Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India for 12 months. 100 patients of metabolic syndrome presenting in the OPD/IPD of Pramukhswami Medical College, Karamsad, Anand, Gujarat, India for related or unrelated problems were selected for the current study and were included in the study group after applying inclusion and the exclusion criteria and after taking written informed consent. The NDD spirometer was used to conduct pulmonary function tests in this study. Results: Majority of the patients were male (75%) while female constituted 25% of the patients. Most patients were 61-70 years old, followed by 41-50. 41% of patients had 4 positive components out of 5, whereas 37% had 3. 22% of patients had all 5 components positive. Most patients (45%) were restricted. 36% of individuals exhibited mixed patterns and 14% had typical ones. Obstructive patterns were seen in 5% of patients. FEV1 and FVC associated adversely with BMI, FBS, waist hip ratio, and SBP. Only FEV1 and FVC correlated negatively with Hba1c and waist circumference, respectively. Conclusion: We found that obesity contributes to pulmonary function deterioration and that metabolic syndrome affects lung function. Metabolic syndrome patients mostly exhibit restrictive pulmonary function impairment.

DOI: 10.5281/zenodo.

Fetal and neonatal morbidity and death are significantly increased by intrauterine growth restriction (IUGR), a condition that can arise for a number of reasons. According to its definition, it is a fetal growth rate that is below average given the infant’s potential for growth. IUGR and small for gestational age (SGA) are sometimes used synonymously in literature, despite the fact that they differ slightly. SGA is defined as a birth weight that is less than the 10th percentile of a population-specific birth weight for a given gestational age or fewer than two standard deviations below the mean. These newborns suffer from perinatal hypoxia, hypothermia, hypoglycemia, and polycythemia, among other acute neonatal issues. When IUGR infants grow up, they are likely to experience long-term difficulties such as growth retardation, significant and subtle neurodevelopmental disabilities, and developmental origins of health and illness.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the prevalence of febrile seizures in children in DMCH. Methods: The present study was conducted at pediatric department of Darbhanga medical college and Hospital, Darbhanga, Bihar, India. Total 100 children were studied for various demographic characteristics like age and sex, type of febrile seizure, risk factors of febrile seizures like family history of febrile seizure, associated infection and length of hospital stay. Results: Of the 100 children 55 (55%) were boys and 45 (45%) were girls. 18 (18%) were in below 1 years of age, 30 (30%) were in 1-2 years of age, 35 (35%) were in 2- 3 years of age and 17 (17%) were in 3-5 years of age. Mean age of occurrence was 2.2 years (±1.5 years). In this study, 80% (80) of the patients had simple and 20% (20) had the complex form of febrile seizure. In our study, 60% (60) of affected children had positive family history of febrile seizure. Acute gastroenteritis (AGE) (24%) followed by upper respiratory tract infection (URTI) (20%) was the most common co- morbidity. 48% children were hospitalized for 1-3 days, 32% for 4-7 days and 20% for more than 7 days. Conclusion: Most of the children had a positive family history and the most common causative factor was acute gastroenteritis – morbidities/risk factors in the form of URTI, LRTI, AGE etc. are associated with febrile convulsion and these diseases can be managed effectively thereby reducing the occurrence of febrile convulsion.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate various prognostic factors and their impact on the outcome of patients with bilateral frontal brain contusions. Methods: The present prospective study was done with 100 patients admitted in Department of Neurosurgery, I.G.I.M.S., Patna, Bihar, India from March 2020 to March 2024. All head injury patients with computed tomography (CT) scan evidence of bilateral frontal brain contusions in all age groups were included in the study. Results: Most of the patients were between the ages of 16 and 45. The youngest patient was 8 years old, while the oldest was 79, and the mean age of the patient is 39.5 years. Of all the patients studied, 80% were male and 20% were female. Road traffic accidents were observed as the major cause of concern, constituting about 70%, followed by falls, train traffic accidents, and assaults in our study, implicating high-velocity injuries resulting in bilateral frontal contusions. The mechanism of injury is assessed as coup or contrecoup injury. About 65% of the patients in this study group had a contrecoup type of injury. The age of the patient has an important bearing on the outcome of the patient. Patients aged more than 46 years had worse outcomes when compared with younger patients. Patients with contusion volume of more than 51 cc (cubic centimeter) and patients with contusion volume of 26 to 50 cc had poor outcomes with the GOS score of 1 and 2, respectively. Conclusion: The present prospective study concluded that critical volume of bilateral frontal contusion that warrants prophylactic surgical intervention irrespective of the admission GCS is 30cc. Younger age and good admission GCS were independent predictors for a better outcome.

DOI: 10.5281/zenodo.

Aim: The objective of this study was to compare patient satisfaction between supraclavicular block and general anaesthesia (GA) in patients undergoing upper limb surgeries. Methods: The present study was conducted in the Department of Anaesthesiology, Jagannath Gupta Institute of Medical Sciences, Kolkata, West Bengal, India and evaluated to compare patient satisfaction following RA and GA. The study’s patient recruitment period took place, 50 patients from each group with RA and GA were enrolled in the study. Results: There were 67 male in general and regional anaesthesia respectively and majority of the patients were in ASA I followed by ASA II. There was no statistically significant difference between the groups in the types of procedures performed. A larger number of patients in the GA group fell into the ASA 1 category. In our study population, the overall patient satisfaction score for RA was greater than GA lists the scores of the various patient satisfaction items compared between the groups. The compassion exhibited to them, information offered, feeling of safety, satisfying demands, giving attention, and feeling of wellbeing all had higher mean ratings in RA. Postoperative nausea and vomiting as well as feelings of worry received higher marks from the GA group. After 12 hours, 24 hours, and 48 hours of surgery, the mean pain scores on the VAS were considerably lower in patients with RA. In comparison to GA, RA had considerably longer analgesic duration. Additionally, RA had a considerably shorter average hospital stay than GA. Conclusion: RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

DOI: 10.5281/zenodo.

Aim:  The aim of the present study was to find out various clinical manifestations and laboratory diagnosis of Rickettsial disease in paediatric age group. Material & Methods: A prospective observational study was conducted in the Department of Paediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India for the duration of february 2023 to January 2024 , involving patients admitted between 2 months to 14 years of age with a diagnosis of Rickettsial fever. A total of 100 cases who were admitted with complaints of fever and presence of one or more of the following clinical features: Rash, edema, eschar, headache, convulsions and altered sensorium, hepatosplenomegaly, lymphadenopathy, History of contact with pets and history of tick bite. Results: Most common age group observed was 1-10 years accounting to 66%. The youngest affected patient was 2-month-old. Males (65%) were most commonly affected group in our study. 78% of the patients hailed from rural background. Fever was the most common symptom present in all the cases enrolled in the study followed by rash in 59 (59%) cases. Eschar though a characteristic feature of rickettsial infection was found in only 11 (11%) of the cases. Clinical examination revealed hepatomegaly in 91 (91%) cases, followed by lymphadenopathy in 32 (32%) cases and splenomegaly in 25 (25%) of cases Investigations done in our study subjects showed that out of the 100 cases, 95 (95%) had thrombocytopenia. Hypoalbuminemia was seen 93 (93%) cases and hyponatremia was seen in 85 (85%). Anemia was seen in 55 (55%) of the cases. Conclusion: A proper history and careful physical examination help in the diagnosis of Rickettsial disease. Laboratory tests can be carried out to support the diagnosis. ELISA test can be carried out for  detection of suspicious case.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare the parenteral iron therapy (intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy. Methods: This was a prospective, single center, comparative interventional randomized hospital-based study carried among antenatal mother admitted in antenatal ward in the department Obstetrics and Gynecology. Pregnant women aged 18 year and above with iron deficiency anemia admitted in the antenatal word of the above hospital. After taking informed consent, the pregnant women who met the eligibility criteria were included in the study. Total 200 pregnant women were selected and divided into two groups i.e. group- A (100 pregnant mother) and group- B (100 pregnant women) received FCM and iron sucrose respectively. Results: More than one third of patients of both FCM (40%) and iron sucrose (40%) had gestational age 26-30 weeks. The mean gestational age of patients of FCM and Iron sucrose was 25.85±4.46 and 24.96±4.68 weeks respectively. 23% patients in the FCM group and 33% in Iron sucrose group were nulliparous. 78% in FCM group and 67% patient in iron sucrose group had previous history of childbirth. 8% patient in FCM group and 1% patient in Iron sucrose group were in upper class. More than half of the patient in FCM group 58% and approximately three fourth of the patient in IRON SUCROSE group 74% belonged to low socio-economic status which clearly indicate that anemia is prevalent in low socio-economic status. There was significant (p=0.001) difference in Hb level between the groups at post treatment 3 and 6 weeks. There was significant (p=0.001) mean change in Hb level in both the groups from pre-treatment to 3 and 6 weeks. The mean change in Hb level was higher among patients of FCM compared to Iron sucrose. Conclusion: The study concluded that Ferric carboxymaltose was safer and more efficient in treatment of iron deficiency anemia in pregnant women as compared to iron sucrose with lesser adverse effect and better patient compliance.

DOI: 10.5281/zenodo.

Complete androgen insensitivity syndrome (CAIS) is a rare condition that is often misdiagnosed. Before puberty, it can be mistaken for an inguinal hernia. This case report discusses a 19-year-old phenotypically female patient with CAIS. Karyotype analysis revealed a 46, XY chromosome pattern. Open bilateral orchiectomy was done. Patient was then started on Hormone replacement therapy (HRT-Tab. Progynova 1 mg OD) and advised for vaginoplasty on a later date. This report also reviews the current understanding of CAIS diagnosis and treatment options.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the hypoalbuminemia in paediatric intensive care unit admitted children. Methods: This study was conducted on pediatric patients, ranging from 2 months to 12 years of age, who were admitted to the Pediatric Intensive Care Unit (PICU) at the Department of Pediatrics, DMCH, Darbhanga, Bihar, India, during a span of 24 months. The study included a total of 200 patients. Results: In this study, 55% (n=110) of patients were 2 months-5 years old, 45% (n=90) were 5-12 years old respectively. 120 males and 80 girls comprised 60% and 40% of 200 cases. The most common PICU symptom in children was fever (72%), followed by vomiting (52%). Other symptoms included convulsion, dyspnea, and stomach pain in 29%, 28%, and 24% of children. In 42% (84) of children, generalized edema occurred. Hypotension and Ascites afflicted 38% and 22% of kids. 110 (55%) of 200 patients had hypoalbuminemia and 90 (45%) had normal albumin. Hypoalbuminemia cases have higher mortality (12.7%) than normal albumin case (4.4%). Conclusion: PICU admitted patients having serious illness often have hypoalbuminemia. Low albumin level found in critically ill patients with Sepsis, acute infection, and respiratory infection and other systemic inflammatory disease. Serum albumin is a straight forward, sensitive, specific, commonly available, and low-cost test for early prognosis and outcome in critically ill patients.  PICU fatality is linked to hypoalbuminemia.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to investigate the incidence and location of meniscal tears in relation to complete vs partial anterior cruciate ligament (ACL) injury. Methods: We collected MRI of 200 patients (200 knees) diagnosed with combined ACL and meniscal injury with a follow up 3 months to 2 years of knee injury at Department of Orthopaedics  Jagannath Gupta Institute of Medical Sciences and Hospital, Budge Budge, Kolkata, West Bengal, India. Results: In partial ACL damage (100 knees), 46% (46 of 100 knees) had medial meniscal tears, 43% (43 of 100 knees) had lateral tears, and 11% had bilateral tears. Medial meniscal tears were identified in 60% (60 of 100 knees) of total ACL injuries, lateral in 31% (31 of 100 knees), and bilateral in 9% (9 of 100 knees). According to Cooper, partial ACL injuries were often present in zones E and F, the middle to posterior lateral meniscus. However, rips in zones A and B the middle to posterior medial meniscus—increased in the total ACL group. Conclusion: Medial meniscus tears were above 50% in total ACL tears. Lateral meniscus injury was linked to partial ACL tear more than total. In total ACL tears, medial meniscus tears were more prevalent in posterior horn than middle horn, whereas lateral tears were virtually equal in anterior and posterior horn.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse of post-operative pain management in elective laparotomies in a tertiary care centre. Methods: This study was conducted in the PG Department of General Surgery, Jawaharlal Nehru Medical College And Hospital, Bhagalpur, Bihar, India. The present study was conducted for period of 24 months. A sample size of 200 patients fulfilling eligibility criteria was taken for the study. Results: The patients who underwent elective laparotomies were aged between 21 and 75. (35%) patients were in the age group of 40-50 years. The 20 different types of surgeries were recorded. The most common surgery performed in our study was open appendectomy which included 48 (24%) patients followed by open cholecystectomy (for carcinoma gall bladder and other indications) which included 16 (8%) patients. Most common was general anaesthesia with transverse plane block which was used in 84 (42%) patients, followed by general anaesthesia with quadratus lumborum block which was used in 36 (18%) patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 110 patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 76 patients. 14 (7%) patients were on transdermal patch on post-operative day 2 and 2 patients were on diclofenac patch and 10 patients were on fentanyl patch. Conclusion: Multimodal analgesia was used in most of the patients for management of post -operative pain combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

DOI: 10.5281/zenodo.

Meditation is now recognized as a different physiological state scientifically as relaxed & calm mind with parasympathetic dominance. Galvanic Skin Response (GSR) is one of the physiological indicators of autonomic nervous system balance and mental status. This study was designed to assess the effect of OM meditation on GSR. 25 healthy individuals in age group 30-45 years were selected. This subjects did OM meditation daily 30 minutes for 3 months. 25 healthy individuals in age group 30-45 years were selected as control group , they did not do OM meditation. It is seen that GSR value increased after 3 months of regular OM meditation in meditation group. Practicing OM meditation increases the galvanic skin response and hence decreases the stress level of the individual.

DOI: 10.5281/zenodo.

Aim: To study the clinical characteristics of patients diagnosed with inguinal hernia in a tertiary care hospital. Material and Methods: This Prospective longitudinal study was conducted in the Department of General Surgery, Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for 12 months.  60 (30 Laparoscopic and 30 Open) were included in this study. Patients with clinical evidence of inguinal hernia were admitted and were subjected to full history and examination, routine investigations like complete blood count, blood sugar level, serum creatinine, chest X-ray, ECG etc. Results: Sixty patients were included in the study, out of which 59 were male patients (98.33%) and only one female patient (1.67%). Majority of the patients in the study were agriculturists by occupation (33.33%). Around 20% were small scale businessmen, 10% were factory/tea garden workers and 10% were unemployed. 70% of the cases presented with the swelling confined to the inguinal region whereas the remaining 30% presented with an Inguinoscrotal swelling. 50% of the cases enrolled in this study presented with a swelling within a duration of 1 to 6 months of its onset. Around 23% came within 6 to 12 months and around 17% presented after 1 year of the onset of swelling. 71.67% of the total cases in the study were indirect inguinal hernias, whereas the remaining 28.33% were direct ones. Conclusion: Highest incidence of inguinal hernia was seen in males (59 males and 1 female were part of the study). The overall mean age of presentation was 45.86 years (SD±15.64). Majority of the cases were involved in an occupation demanding moderate to hard strenuous physical activates. 70% of the cases had the swelling confined to the inguinal region and the rest 30% presented with an Inguinoscrotal swelling.

DOI: 10.5281/zenodo.

Background: Geriatric dermatoses are common among elderly individuals, with facial skin being particularly susceptible to various dermatological conditions due to chronic sun exposure, aging processes, and underlying comorbidities. Understanding the pattern of facial dermatoses in the elderly is crucial for improving diagnostic accuracy and treatment outcomes. This study investigates the pattern and prevalence of facial geriatric dermatoses in patients attending in Department of Dermatology, Venereology and Leprosy,  Patna Medical College and Hospital, Patna, Bihar, India. Methods: A cross-sectional study was conducted over 12 months at Department of Dermatology, Venereology and Leprosy,  Patna Medical College and Hospital, Patna, Bihar, India. A total of 100 elderly patients aged 60 years and above, presenting with facial dermatoses, were included. Clinical evaluation, dermatological examination, and relevant investigations were performed to diagnose the conditions. The study analyzed the prevalence, types, and associated risk factors of facial dermatoses in this population. Results: The most common facial dermatoses observed were seborrheic keratosis (25%), actinic keratosis (20%), and rosacea (15%). Other conditions included xerosis (10%), lentigines (10%), and melasma (5%). There was a significant association between sun exposure and actinic keratosis (p<0.01), while xerosis was strongly associated with the use of harsh soaps and detergents (p<0.05). Conclusion: Facial dermatoses are prevalent among the elderly population in Bihar, with seborrheic keratosis and actinic keratosis being the most common. Preventive measures such as sun protection and the use of mild skincare products are recommended to reduce the incidence and severity of these conditions.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to analyse the incidence of surgical site infection in obstetrics and gynecological surgeries and to identify associated risk factors. Methods: We conducted a prospective study at the Department of Obstetrics and Gynecology in RDJM Medical College & Hospital, Turki, Muzaffarpur, Bihar, India. The study was carried out for a period of 1 year. Results: We selected a total of 2340 patients of which 1540 patients underwent emergency cesarean section, 120 underwent gynecological surgeries. Prevalence of the surgical site infection was 34.18%. More wound complication on day 7 in Anemia followed by in Diabetes and Hypertension. It was seen that out of 16 anaemic patients. Its association with operative morbidity in the study was statistically significant with p < 0.0001. On day 14, among 40 wound complication patients in anaemic group 4 had hematoma, 2 stitch abscess observed. Out of 40 wound complication patient more wound complication on day 7, Total Abdominal Hysterectomy was observed in 84 patients followed by in exploratory laparotomy and open ovarian cystectomy. Out of 40 wound complication patient on day 14, in Total abdominal Hysterectomy 4 patients had hematoma observed, 2 patients had stitch abscess observed. Conclusion: In obstetrics cases, surgical wound site complications are common in cesarean section. In gynecological surgeries we found that Anemia and Diabetes are the pre-operative factors which increase wound infection rate. Controlling Diabetes and correcting anemia prior to surgery would decrease the morbidity.

DOI: 10.5281/zenodo.

Background and Objectives: Effective postoperative analgesia is critical for patient recovery following lower segment cesarean section (LSCS). The standard use of intrathecal bupivacaine for spinal anesthesia is well-established; however, the addition of adjuncts such as midazolam may enhance and prolong analgesic effects. This study aimed to compare the efficacy of postoperative analgesia using intrathecal bupivacaine plus midazolam versus bupivacaine alone in patients undergoing LSCS. Understanding the impact of this combination could lead to better pain management strategies in the postoperative period. Methods: This prospective study was conducted in Department of Anaesthesiology, SNMMCH, Dhanbad, Jharkhand, India from January 2021 to December 2023, involving 100 patients scheduled for elective LSCS. Patients were randomly assigned to one of two groups: Group A received intrathecal bupivacaine (10 mg) plus midazolam (2 mg), while Group B received intrathecal bupivacaine (10 mg) alone. The efficacy of postoperative analgesia was assessed using the Visual Analog Scale (VAS) at various intervals, as well as the time to first analgesic request and the total analgesic consumption within 24 hours postoperatively. Adverse effects were also monitored to evaluate the safety profile of the analgesic regimens. Results: Patients in Group A experienced significantly longer durations of analgesia, with the mean time to first analgesic request being 6.2 ± 1.1 hours, compared to 4.5 ± 0.9 hours in Group B (p < 0.001). VAS scores were consistently lower in Group A at all postoperative time points, indicating superior pain control. Additionally, total analgesic consumption within the first 24 hours was significantly lower in Group A (35.2 ± 7.5 mg) compared to Group B (52.6 ± 8.3 mg; p < 0.001). The incidence of adverse effects was comparable between the two groups, with no significant safety concerns observed. Conclusion: The addition of intrathecal midazolam to bupivacaine significantly enhances postoperative analgesia in patients undergoing LSCS, providing prolonged pain relief and reducing the need for additional analgesics. Given its effectiveness and safety, this combination may be considered a superior option for postoperative pain management in LSCS patients.

DOI: 10.5281/zenodo.

Background and Objectives: Acute febrile illness (AFI) is a common clinical syndrome characterized by a rapid onset of fever and a wide range of potential etiologies. Understanding the biochemical profiles associated with AFI can help predict complications and guide management strategies. This study aims to compare the biochemical profiles of patients with uncomplicated AFI to those with complications, identifying key markers that may predict adverse outcomes. Methods: A cross-sectional study was conducted in  Department of Medicine, Government Medical College. Bettiah, West Champaran, Bihar, India for 12 months involving 100 patients presenting with AFI at a tertiary care hospital. Patients were categorized into two groups: those with uncomplicated AFI and those who developed complications such as organ dysfunction, shock, or prolonged hospitalization. Biochemical parameters including liver function tests, renal function tests, serum electrolytes, and inflammatory markers were measured and compared between the two groups. Results: Patients with complications had significantly higher levels of liver enzymes (AST, ALT), serum creatinine, and inflammatory markers (CRP, procalcitonin) compared to those with uncomplicated AFI (p < 0.001). Electrolyte imbalances, particularly hyponatremia and hyperkalemia, were also more prevalent in the complication group. Multivariate analysis identified elevated CRP and serum creatinine as independent predictors of complications (adjusted OR: 3.2; 95% CI: 1.9-5.4). Conclusion: Biochemical markers such as elevated liver enzymes, renal dysfunction, and inflammatory markers are associated with complications in patients with acute febrile illness. Early identification of these markers can help in the prompt management of patients at risk for adverse outcomes.

DOI: 10.5281/zenodo.

Background and Objectives: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder among women of reproductive age, with its onset often occurring during adolescence. Despite its prevalence, awareness and understanding of PCOS among adolescents remain limited. This study aims to assess the level of awareness, knowledge, and perceptions of PCOS among adolescent girls, highlighting gaps in awareness that could be addressed through educational interventions. Methods: This cross-sectional study was conducted involving 500 adolescent girls aged 13-19 years from Department of Obstetrics and Gynaecology, Jagannath Gupta Institute of Medical Sciences and Hospital (JIMSH) Budge Budge,Kolkata, West Bengal, India for one year  . Participants were asked to complete a structured questionnaire assessing their awareness of PCOS, its symptoms, risk factors, and treatment options. The data were analyzed using descriptive statistics, and associations between demographic factors and awareness levels were explored. Results: Only 35% of the participants were aware of PCOS, with significant variations in awareness based on age, education level, and family history of the condition. Among those who were aware, knowledge about the symptoms and complications of PCOS was limited, with 50% identifying irregular menstruation as a symptom, but only 20% recognizing the associated risk of infertility. Awareness of lifestyle modifications and treatment options was similarly low, with only 15% aware of the importance of diet and exercise in managing PCOS. Conclusion: The study reveals a significant gap in awareness and understanding of PCOS among adolescents, particularly regarding its symptoms, complications, and management strategies. These findings highlight the need for targeted educational interventions to improve awareness and empower adolescents to seek early diagnosis and management of PCOS.

DOI: 10.5281/zenodo.

Background: Deviated nasal septum (DNS) is a common cause of nasal obstruction, significantly affecting quality of life. Septoplasty is the surgical intervention used to correct DNS, traditionally performed using a conventional approach. Recently, endoscopic septoplasty has gained popularity as a minimally invasive alternative. This study compares the effectiveness of endoscopic septoplasty and conventional septoplasty in alleviating nasal obstruction by evaluating preoperative and postoperative nasal obstruction symptoms. Methods: A prospective, comparative study was conducted over one year at Department of ENT,Nalanda Medical College and Hospital, Patna, Bihar, India . A total of 100 patients with symptomatic DNS were randomly assigned to undergo either endoscopic septoplasty (n=50) or conventional septoplasty (n=50). Nasal obstruction was evaluated preoperatively and at 1 month, 3 months, and 6 months postoperatively using the Nasal Obstruction Symptom Evaluation (NOSE) scale. Secondary outcomes included intraoperative blood loss, operative time, postoperative complications, and patient satisfaction. Results: Both surgical methods significantly improved nasal obstruction. However, endoscopic septoplasty resulted in a greater reduction in NOSE scores compared to conventional septoplasty (70% vs. 60%, p<0.05). The endoscopic approach also had shorter operative time (45 vs. 60 minutes, p<0.01) and reduced intraoperative blood loss (45 mL vs. 75 mL, p<0.01). Postoperative complications were fewer in the endoscopic group, and patient satisfaction was higher. Conclusion: Endoscopic septoplasty is more effective than conventional septoplasty in improving nasal obstruction, with additional benefits of shorter operative time, reduced blood loss, and fewer complications. These findings suggest that endoscopic septoplasty should be considered as a preferred option for DNS correction.

DOI: 10.5281/zenodo.

Aim: The aim to evaluate subaxial cervical spine injuries due to trauma. Methods: The present study was conducted in the Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. This study is Descriptive and retrospective study of patient case files only. Patients were managed first in casualty with primary resuscitation with trauma protocol and spine immobilization. Total 200 cases records were analysed. Results: 70% were male and 70% had RTA and job injury. Our research included 64 cervical vertebrae body fracture patients. Other injuries in 136 individuals included disk disruption, posterior longitudinal ligament and other ligament injuries, facet joint fracture and dislocation, locking, and posterior element fracture. The body fractures were c3 in 4, c4 in 6, c5 in 20, c6 in 12, and c7 in 12. Conclusion: It may be established that anterior approach patients had better spine fixation and fusion, and reconstruction. With anterior technique, decompression and neurologic improvement are better. Well-trained neurosurgeons do anterior surgery better.

DOI: 10.5281/zenodo.

Background and Objectives: Hollow viscus perforation is a critical surgical emergency that requires prompt diagnosis and intervention. The Predictive Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) is a widely used scoring system designed to predict postoperative morbidity and mortality. This study aims to evaluate the effectiveness of the POSSUM scoring system in predicting outcomes in patients with hollow viscus perforation. Methods: A prospective study was conducted in Department of General Surgery, Katihar Medical College and Hospital, Katihar, Bihar, India for one year.   100 patients diagnosed with hollow viscus perforation who underwent emergency surgery. Data on physiological parameters, operative details, and postoperative outcomes were collected. The POSSUM score was calculated for each patient, and its predictive accuracy for morbidity and mortality was analyzed. Results: The mean POSSUM morbidity score was 39.2 ± 12.5, and the mean POSSUM mortality score was 27.4 ± 10.3. The observed mortality rate was 15%, while the predicted mortality rate was 18%. The observed morbidity rate was 35%, with a predicted morbidity rate of 40%. The POSSUM scoring system demonstrated good predictive accuracy for both morbidity and mortality, with a strong correlation between predicted and observed outcomes (p < 0.05). Conclusion: The POSSUM scoring system is a valuable tool for predicting postoperative morbidity and mortality in patients with hollow viscus perforation. Its use can aid in risk stratification, surgical planning, and informed patient consent. However, further studies are needed to refine the scoring system for better accuracy in different patient populations.

DOI: 10.5281/zenodo.

Aim: Assessing the efficacy of pre-operative abdominal ultrasonography in predicting the need for conversion to open cholecystectomy. Material and Methods: This observational study was conducted was conducted in Department of Surgery, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from January 2020 to December 2020. written informed consent was obtained from all the patients prior to enrollment. Patients were explained the risks and benefits of the procedure. Patients aged between 20 and 75 years with a diagnosis of cholelithiasis/cholecystitis were included. Patients with choledocholithiasis on USG, having co-morbid conditions like uncontrolled diabetes mellitus, uncontrolled hypertension, coagulopathies, chronic obstructive pulmonary disease, severe cardiac failure, jaundice, cholangitis, body mass index (BMI) >30 kg/m² and a history of upper abdomen surgery were excluded. The data was collected by pre-tested study proforma, which included general information, clinical details of the patient and investigations. Every patient underwent USG. The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, the size of the calculi, presence of adhesions/fibrosis, pericholecystic fluid collection and common bile duct diameter was recorded. Results: The present research was an observational study to find the utility of abdominal USG parameters which can predict the conversion from laparoscopic to open cholecystectomy. A total of 90 patients were included in the study. Of 90 patients, 7 (7.8 %) had a conversion to open cholecystectomy. There was no statistically significant difference between the two groups in relation to age groups and gender. There was no statistically significant difference between the two groups in relation to abnormal gallbladder, presence and number of calculi, size of the calculus (>6 mm), gallbladder thickness (>4 mm), pericholecystic collection, adhesions/fibrosis and size of the common bile duct. Conclusion: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.

DOI: 10.5281/zenodo.

Background: Pre-malignant oral lesions (PMOLs) are critical indicators of potential progression to oral cancer. Early detection and management of these lesions are essential for preventing malignant transformation. This study aims to identify the prevalence of various PMOLs and the factors associated with their development in patients at a tertiary  care center. Methods: A prospective observational study was conducted in 12 months at Department of ENT,Nalanda Medical College and Hospital, Patna, Bihar, India . A total of 100 patients with clinically diagnosed PMOLs were enrolled. The study assessed the prevalence of different types of PMOLs, including leukoplakia, erythroplakia, oral lichen planus, and oral submucous fibrosis. Associated factors such as tobacco use, alcohol consumption, and dietary habits were also analyzed. Biopsy and histopathological examination were performed to confirm the diagnosis. Results: Leukoplakia was the most common PMOL, observed in 45% of the patients, followed by oral submucous fibrosis (30%), oral lichen planus (15%), and erythroplakia (10%). A significant association was found between tobacco use and the occurrence of leukoplakia and oral submucous fibrosis (p<0.01). Alcohol consumption was significantly associated with erythroplakia (p<0.05). Dietary habits, particularly low intake of fruits and vegetables, were correlated with an increased risk of developing oral lichen planus (p<0.05). Conclusion: This study highlights the significant prevalence of pre-malignant oral lesions (PMOLs) in patients attending a tertiary health care center, with leukoplakia and oral submucous fibrosis emerging as the most common lesions. The findings underscore the strong association between tobacco use and the development of these lesions, particularly leukoplakia and oral submucous fibrosis. Additionally, the study identifies alcohol consumption as a significant risk factor for erythroplakia, while poor dietary habits, specifically low intake of fruits and vegetables, are correlated with an increased risk of oral lichen planus. These results emphasize the critical need for targeted public health interventions aimed at reducing tobacco and alcohol use and promoting healthier dietary habits to prevent the onset of PMOLs and their potential progression to oral cancer. Routine oral screenings, especially in high-risk populations, are essential for the early detection and management of these lesions. The study’s conclusions contribute valuable insights into the epidemiology of PMOLs and reinforce the importance of early intervention in reducing the burden of oral cancer. Future research should focus on exploring the molecular mechanisms underlying these lesions and developing effective prevention and treatment strategies tailored to high-risk populations.

DOI: 10.5281/zenodo.

Background and Objectives: Diabetic foot infections (DFIs) are a common and severe complication in patients with diabetes, leading to significant morbidity and potential limb loss. The initial site of infection and the associated etiological factors play a crucial role in the progression and management of DFIs. This study aims to analyze the distribution of initial infection sites in diabetic foot cases and identify the primary etiologies contributing to the onset of these infections. Methods: A cross-sectional study was conducted in  Department of General Surgery, Shaheed Nirmal Mahto medical College and hospital Dhanbad, Jharkhand, India  for 12 months. 100 diabetic patients with confirmed foot infections. Data on the initial site of infection, associated initiating factors, comorbid conditions, and microbiological findings were collected and analyzed. The distribution of infection sites and their correlation with etiological factors were examined using statistical analysis. Results: The plantar surface was the most common initial site of infection (40%), followed by interdigital spaces (25%) and the dorsum of the foot (20%). The most frequent initiating etiology was trauma (35%), followed by improper footwear (30%) and peripheral neuropathy (25%). The presence of comorbid conditions such as peripheral arterial disease (PAD) and chronic kidney disease (CKD) significantly influenced the site and severity of infections. Conclusion: Understanding the distribution of initial infection sites and their associated etiologies in diabetic foot infections is essential for developing targeted prevention and management strategies. Early identification and intervention at the initial site of infection can help reduce the progression to more severe complications.

DOI: 10.5281/zenodo.

Aim: A comprehensive clinical and microbiological investigation of non-fermenting gram negative bacilli in a tertiary care hospital. Material and Methods: This study had a cross-sectional design and was conducted Department of Microbiology, at Jawaharlal Nehru medical college and Hospital, Bhagalpur, Bihar, India for 20 months. A total of 4025 clinical samples including urine, pus, blood, wound swab and body fluids were received in the laboratory and inoculated on blood and MacConkey agar or CLED agar and incubated aerobically at 37°C for 18 to 24 hours. The isolates which were non-lactose fermenting and showed alkaline change (K/NC) reaction in triple sugar iron agar media were provisionally considered as NFGNB. Results: Acinetobacter baumannii was the predominant isolate, 211 (51.34%) followed by Pseudomonas aeruginosa 173 (42.09%) and Burkholderia cepacia complex (BCC) 18 (4.38%). Burkholderia pseudomallei, Acinetobacter lwoffii and Stenotrophomonas maltophilia altogether accounted for 2.19%. Among the NFGNB isolated from high-risk areas including intensive care units and dialysis units, A. baumannii (60.36%) was the most prevalent pathogen, followed by P. aeruginosa (28.40%). Chi-squared (χ2) value is 9.341 and p-value <0.05. In other clinical areas P. aeruginosa accounted for 51.65% followed by A. baumannii (45.04%). A. baumannii was more prevalent in high-risk areas (ICUs and Dialysis Units) in comparison to other clinical areas. Chi-squared (χ2) value is 9.341 and p-value < 0.05. Similarly, P. aeruginosa is more prevalent in other clinical areas, than in high-risk areas. Chi-squared (χ2) value is 22.069 and p-value < 0.05. Conclusion: To conclude, despite earlier being regarded as contaminants, NFGNB are now emerging as important pathogens causing a wide range of nosocomial infections. Identification of NFGNB and monitoring of their susceptibility profiles are essential due to their variable sensitivity patterns and to help in proper management of the infections caused by them.

DOI: 10.5281/zenodo.

Background: Osteoporotic hip fractures have become a pressing public health issue, especially among the aging population. These fractures, often resulting from low-energy falls, lead to high mortality rates and complicate post-fracture recovery, particularly in regaining pre-fracture mobility. Aim: This study aims to identify specific comorbid conditions impacting the capacity to restore pre-fracture mobility after hip fracture repair in geriatric individuals and assess their contribution to delayed recovery. Material and Methods: A retrospective observational cohort study was conducted at Department of  Orthopaedics, Narayan Medical College and Hospital, Sasaram, Bihar, India from January 2023 to December 2023. reviewing medical records of 75 patients aged over 65 who underwent hip fracture surgery. Data on demographics, clinical characteristics, comorbidities, and postoperative mobility were collected and analyzed using SPSS version 25.0. Results: Significant differences were found between patients who regained pre-fracture mobility and those who did not. Factors such as older age (73.9 vs. 71.5 years, p=0.03), higher BMI (27.0 vs. 25.2, p=0.01), and a greater number of comorbidities (80% vs. 62%, p=0.02) were associated with worse mobility outcomes. The mean modified Functional Independence Measure (mFIM) scores significantly declined in the group with worse mobility (62.5 vs. 79.8, p<0.001). Conclusion: This study underscores the multifactorial nature of mobility recovery post-hip fracture surgery. Factors such as age, BMI, comorbidities, ASA score, and waiting time for surgery significantly affect functional recovery. Addressing these risk factors may enhance postoperative rehabilitation strategies.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the epidemiology and burden of sepsis acquired in hospitals and intensive care units. Methods: This study was conducted in the Department of Trauma Surgery and Critical Care, AIIMS, Patna, Bihar, India SIRS with organ dysfunction due to an infection (severe sepsis) was noted in 200 patients. Results: There were 55% male and 45% females. Mean APACHE II (IQR) was 24 (16−28) and Median hospital stay from diagnosis of severe sepsis (IQR) was 7 (3‑17). The most frequent site of infection among severe sepsis patients was respiratory tract (60%), followed by abdomen (17%), blood stream (16%) and urinary tract infection (14%). Majority of infections were caused by Gram‑negative organisms; 10 severe sepsis patients had fungal infections (candidemia, aspergillosis), whereas tropical diseases (malaria, dengue, leptospirosis) were documented in 12 severe sepsis patients. Conclusion: Severe sepsis is common in Indian ICUs and is mainly due to Gram‑negative organisms. ICU mortality is high in this group and care is resource intensive due to increased length of stay.

DOI: 10.5281/zenodo.

Aim: The objective of the study is to assess the awareness of pap smear screening, cervical cancer, and human papillomavirus infection among urban women. Method: A cross-sectional study of female patients seen at gynecology outpatient department (OPD). Participants’ socio-demographic information, level of understanding of cervical cancer, and awareness of screening modalities were all recorded in a performance. Result: Of the 58 women (32% of the total) who were knowledgeable about ways to avoid cervical cancer, 16 (5.3% of the total) were aware of the vaccination. The percentage of women who have undergone cervical cancer screenings is low, at 37.9% out of 100. Financial difficulties, carelessness, and fear of discovering a serious disease were the most common reasons given for not obtaining a Pap screening test. Conclusion: The results of this study show that women know very little about cervical cancer and much less about how to protect themselves from getting the disease. The disease burden might be reduced with the implementation of a countrywide program that incorporates Pap smears and comprehensive health education on cervical cancer screening procedures.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the blunt trauma abdomen with respect to management and outcome in a tertiary care hospital. Methods: It was an observational study of 100 patients presented to Department of Trauma Surgery and Critical Care, AIIMS, Patna, Bihar, India with history and presentation of blunt trauma abdomen and filtered through the pre-determined inclusion and exclusion criteria. Results: About one third of the patients were of 20-30 years age (32%) followed by 31-40 (26%), >40 (25%) and <20 (17%) years. The mean age of patients was 36.24±16.32 years. Among all the patients, 85 (85%) were males. About half of the patients had RTA (47%) followed by assault (31%) and fall (22%) as their mode of injury. There were 26% patients with injury involved spleen followed by liver and intestines. In spleen injury, Spleen pancreatectomy procedure was done, in liver hepatic resection procedure was done and in intestines, Primary bowel repair /Mesenteric tear repair/Resection anastomosis/ stoma formation procedure was done. All the mortality were in the patients who had Hb<8. The association of outcome with Hb was significant (p=0.001). 34% of the patients underwent emergency laparotomy because of pneumoperitoneum, or hemodynamic instability or peritonitis. 66% patients were managed conservatively. In univariate analysis, duration of injury, clinical symptoms, any complications, pre-op ventilation, and organs involved in the injury were found to be possible factors for mortality. In multivariate analysis, out of the above variables, only two variables i.e. duration of injury and associated injury showed significant and independent risk factor for patient mortality. Conclusion: It was observed that road traffic accidents was the most common cause of blunt abdominal trauma in this study, involving younger age group between 30-35 years most commonly. Males sustaining blunt abdominal trauma outnumbered the females. Among the solid organs, spleen and liver were the most commonly injured organs and bowel injury was also seen in a significant number of patients. Early diagnosis, aggressive resuscitation and timely surgical intervention may improve the outcome in trauma patients.

DOI: 10.5281/zenodo.