Objective: This prospective study aimed to evaluate the efficacy of percutaneous needle plantar fascia release with corticosteroid injection as an outpatient procedure for chronic plantar fasciitis unresponsive to conservative treatments. Methods: Forty-three patients meeting specific inclusion criteria underwent the percutaneous needle release procedure. Demographic characteristics, Visual Analog Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and fascia thickness measurements were recorded preoperatively and at 1, 3, and 12 months postoperatively. The surgical procedure involved sterile preparation, ankle block anesthesia, precise needle-based release, and corticosteroid injection. Patient assessment included VAS, FADI, and Roles and Maudsley score. Ethical considerations and institutional review board approval were adhered to throughout the study. Results: Over the 12-month study period, a significant reduction in VAS scores (from 7.523 ± 0.817 to 0.944 ± 1.726, p<0.001) indicated pain relief. FADI scores demonstrated substantial improvement (from 36.028 ± 12.786 to 93.297 ± 13.641, p<0.001), reflecting enhanced functionality. Fascia thickness decreased significantly (−0.0214 cm, p<0.001), suggesting structural modifications. Demographic data provided a comprehensive understanding of the study population. Conclusion: Percutaneous needle plantar fascia release with corticosteroid injection emerged as a promising intervention for chronic plantar fasciitis resistant to conventional treatments. Significant improvements in pain, function, and structural changes support its potential as a breakthrough therapy for persistent heel pain. Despite limitations, including a small sample size and absence of a control group, this study contributes valuable insights to the evolving landscape of interventions for resistant plantar fasciitis. Further research with larger, randomized controlled trials is warranted to validate its efficacy and safety.

DOI: 10.5281/zenodo.

Background: Dengue fever  has a changing distribution trend and variable clinical presentation. The global incidence of dengue is rising. So, clinical profile and laboratory parameters should be assessed thoroughly for better outcome. Method: A retrospective type observational study was conducted in navsari civil hospital during June 2022 to October 2023. Total 370 patients were studied fulfilling inclusion and exclusion criteria. Aim: To study epidemiology of dengue fever for better prognosis. Result: In this study dengue infection was common in young adults(56.75%) and male (62.16%). The most common symptoms were  fever (100%), headache (94.59%), myalgia (89.18%). Most common serology finding was NS1 positive (73%). Laboratory findings were leucopenia (61.8%), neutropenia (56.48%), lymphocytosis (61.08%), thrombocytopenia (71.89%), raised alanine aminotransferase (67.56%), raised aspartate aminotransferase (87.5%). Conclusion: Dengue fever has varied clinical presentation and laboratory findings that may affects diagnosis. So, we should  cautiously study clinical presentation and laboratory findings of dengue fever.

DOI: 10.5281/zenodo.

Breast cancer detection has significantly advanced with the integration of digital mammography and Computer-Aided Detection (CAD) systems. This study explores the performance of four deep learning architectures—Efficient Net-B7, DenseNet-201, Mobile NetV3-Large, and ResNet-50—in classifying mammographic images of breast lesions. We used three well-established datasets: CBIS-DDSM, Brest Cancer MNIST, and UCI Mammography, evaluating models based on accuracy, precision, recall, and F1-score. EfficientNet-B7 achieved the highest accuracy of 98.5%, demonstrating superior performance in distinguishing between benign and malignant lesions. DenseNet-201, MobileNetV3-Large, and ResNet-50 also exhibited strong results, with accuracies of 97.8%, 96.9%, and 97.4%, respectively. The study highlights the effectiveness of these architectures in enhancing diagnostic accuracy and providing valuable insights into their application in clinical settings. The results suggest that deep learning models, especially EfficientNet-B7, can significantly improve the reliability and efficiency of breast cancer screening and diagnosis through advanced mammography analysis.

DOI: 10.5281/zenodo.

Pancreatic pseudocysts, usually are the sequel of an acute attack or chronic pancreatitis due to gallstones or chronic alcoholism, besides other less common causes e.g. abdominal trauma, post-ERCP, abdominal surgery, etc. Majority of pseudocysts resolve with conservative management, but in few cases, they fail to regress and add to complications viz. gastric outlet obstruction, abdominal discomfort or pain, infection and other compression effects. We present here, a series of 5 (five) cases of pancreatic pseudocyst managed by image-guided percutaneous (trans-abdominal) drainage at our centre. Material and Methods: We present a retrospective study of 5 cases of pseudocysts managed by image-guided percutaneous (transabdominal) drainage only using a pigtail catheter. The patients were followed up for 1 to 2 months in the Surgery outpatient department with repeat abdominal ultrasound. The catheter was removed once the total output from the drain was less than 15 ml. Results: All the 5 patients (100%) showed remarkable improvement with reduction in the size of the pseudocyst and negligible morbidity, without being subjected to the extensive surgical intervention.

DOI: 10.5281/zenodo.

Background and Aim: Furthermore, there has been a noticeable increase in the occurrence of ileal perforation. This can be attributed to more patients seeking medical attention at the emergency department and better identification and reporting of such cases. This study aimed to identify the clinical characteristics, causes, common types of perforations, presentations, and surgical procedures used on these patients. Material and Methods: A total of 136 patients underwent exploratory laparotomy, specifically for ileal perforation. The clinical instructor was in charge of creating the form used to document the investigations, clinical examinations, and complaints. The patients who took part in the study underwent a thorough history-taking and physical examination. In certain cases, four quadrant abdominal paracentesis was performed. In some cases, ultrasonography and abdominal CECT were conducted if it was considered appropriate. Results: Most of our patients were in their thirties and forties, totalling 85 patients, with an additional 38 patients falling between the ages of 41 and 60. In this study, researchers observed a total of 85 cases of gastroduodenal perforations, followed by 30 cases of appendicular perforations. The most notable symptom of ileal perforation was typhoid fever, and 107 patients had gas under the diaphragm. After receiving preoperative treatment, a laparotomy was performed for each case to identify and treat the primary cause based on the findings. Conclusion: Early diagnosis and treatment of the disease is linked to lower morbidity and mortality rates, as well as a reduced need for extensive procedures. Another significant factor was the presence of inflammation in the terminal ileum. Interestingly, the only time similar findings to those seen in typhoid ulcer were observed was during surgery on the patient. A laparotomy is typically the most common surgical procedure used for peptic perforations.

DOI: 10.5281/zenodo.

Introduction: Human placenta is a transient organ which plays a key role during gestation. It’s also called “diary of gestational life”. As shape of cavity and blood supply varies across different areas of uterus, placental location can be associated with adverse pregnancy and perinatal outcomes. Only a few studies have evaluated these aspects of placental position and possible impact on pregnancy outcomes. Aims and Objectives: 1. To study the impact of relationship between placental location and maternal and neonatal outcomes. 2. To assess the impact of placental location on pregnancy in terms of preterm birth, preeclampsia, gestational diabetes mellitus, mode of delivery, stillbirth, low birth weight, APGAR score, etc. Material and Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology in a tertiary care hospital in Karwar. Data was retrieved from hospital records for a period of one year. Results: During the study period of 1 year, there were total 1076 deliveries in our hospital. 176 women were excluded from the study as per exclusion criteria. Placental position had significant impact only on pre-term delivery. Any pregnant women with fundal placenta, lateral placenta, posterior placenta had 4.002 times, 6.855 times, 1.989 times more chances of having pre-term delivery respectively as compared to any women with anterior placental presentation. Birth weight, APGAR score at 1min and 5mins are significantly associated with placental position. Conclusion: In summary, lateral placentation is associated with higher risk of PTB compared with central placentation in our study. Additional research is needed to elucidate the effects of lateral placentation on other pregnancy and perinatal outcomes and to determine whether these pregnancies may benefit from increased surveillance.

DOI: 10.5281/zenodo.

Diabetes Mellitus (DM) is a metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs. Diabetic neuropathy is a descriptive term that encompasses a spectrum of clinical and subclinical syndromes with different anatomical distributions, clinical courses, and possibly, different underlying pathogenic mechanisms. Diabetic peripheral neuropathy (DPN) is by far the most common type of diabetic neuropathy. In clinical practice, diabetic peripheral neuropathy is synonymous with diabetic neuropathy. The present study was undertaken with  subjects, both males and females aged between 40-60 years. The study group consisted of 30 diabetic patients, with history of diabetes for 1-10 years and controls (Non Diabetics) were 30 age and sex matched healthy individuals. Comparison of sensory nerve parameters in Control Group (non-diabetics) and diabetics there is highly significant slowing of sensory nerves median & ulnar and decrease in amplitude of Median nerve and ulnar nerve in diabetics compared to controls. There is a progressive neuronal involvement in the diabetic process which is accelerated by poor glycaemic control. Therefore, nerve conduction studies can be employed for testing and for the early indication of neuropathy in diabetic patients.

DOI: 10.5281/zenodo.

Background: Alvarado and Modified Alvarado scores (MASS) are the commonly used scoring systems for diagnosis of appendicitis, but its performance has been found to be poor in certain populations. This study compared the efficacy of RIPASA score with MASS in diagnosing acute appendicitis in Indian population. Materials and Methods: This prospective study included 50 patients who presented with right iliac fossa (RIF) pain. Patients were evaluated by both RIPASA and MASS scoring systems. The final diagnosis was confirmed through ultrasonography (USG), a computed tomography (CT) scan if the USG results were inconclusive, intra-operative findings, or post-operative histopathological examination (HPE), which were then compared with both the RIPASA and MASS scores. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated for both the scoring system. Results: It was found that RIPASA was better than MASS in terms of Specificity (96.3% v/s 89.28%) and Positive Predictive Value (91.67% v/s 78.57%), and also to some extent in terms of Diagnostic Accuracy (74% v/s 72%). Conclusion: RIPASA is a more specific and accurate scoring system in our local population, when compared to MASS. It reduces the number of missed appendicitis cases and also convincingly filters out the group of patients that would need a CT scan for diagnosis.

DOI: 10.5281/zenodo.

Aim: To assess the functional and clinical outcome of fragment-specific plating for distal radius multi-columnar fractures. Methods and Methodology: This is a prospective study. Patient admitted to SRM Medical College Hospital & Research Centre from December 2022 to December 2023 Pre-op radiological assessment using X-ray Radiograph and post operative functional and radiological outcome has been assessed .Fifteen patients have been included in this study. Results: The results were found to be age in bimodal distribution between 20 years to 54 years and more prevalent among the males than females and the most common mode of injury was found to be road traffic accidents than fall from height, most the cases were presented within 1 day, Intra articular fractures with fragment specific fractures are difficult to fix, but fragment specific plates help in good reduction by using low profile plates, intraoperatively thereby minimizing the trauma to soft tissues, and decreasing the surgical time. Radiological outcome is better with FSP, but functional outcome partially depends on rehabilitation given to the patients. Conclusion: In complex fractures, FSP always plays a superior role in the reduction of fragments and reduced intra-op tissue handling. Patients with FSPs are moving to rehabilitation sooner and the recovery period/rate is fast.

DOI: 10.5281/zenodo.

Background and Aim: Chronic lymphocytic thyroiditis is a frequently encountered cause of acquired hypothyroidism. The clinical management of thyroid nodules, whether or not accompanied by chronic lymphocytic thyroiditis, primarily relies on clinical data, ultrasonography, and fine-needle aspiration cytology (FNAC). FNAC is considered the most reliable method for diagnosing thyroid nodules prior to surgery. Our study sought to assess the range of cytomorphological features observed in lymphocytic thyroiditis and examine its correlation with clinical factors, thyroid hormone levels, and ultrasound results. Material and Methods: The study was conducted in two stages. All patients with goitre who presented to the department of pathology and underwent FNA cytology were included in Step 1 of the study. This served as the sampling frame for identifying study participants for this study. In the next phase of the study, all patients who were diagnosed with lymphocytic thyroiditis on cytology were included for further evaluation. An analysis was conducted on the demographic characteristics, clinical features, biochemical, and radiology findings of the patients. Results: During the study period, 200 individuals were referred for fine-needle aspiration (FNA) of the thyroid gland. Lymphocytic thyroiditis was diagnosed in 50 patients based on cytological findings. In 4 (8%) cases, there were associated features of pain in the neck. Out of the patients experiencing pain, there were two individuals with hypothyroidism, one with euthyroidism, and one with hyperthyroidism. Two patients were found to have cervical lymphadenopathy. Reactive hyperplasia was observed in the cytology of these. The most common cytomorphological finding was Grade II thyroiditis, which was observed in 40 (80%) of cases. Grade I was found in 8 (16%) cases, while Grade III was seen in 2 (4%) cases. Conclusion: The correlation between cytological grading of thyroiditis and clinical, biochemical, and ultrasonographic findings is quite poor. Our patients show strong serological evidence of autoimmunity through the presence of TPO antibody, which also has a strong correlation with cytology.

DOI: 10.5281/zenodo.

Peripheral arterial disease (PAD) is a critical cardiovascular condition characterized by impaired blood flow to the lower extremities, primarily due to atherosclerosis. Early and accurate diagnosis of PAD is essential to prevent complications such as limb ischemia and amputation. This study compares Duplex Doppler Ultrasonography (DUS) and Digital Subtraction Angiography (DSA) in diagnosing PAD, evaluating their effectiveness in determining the presence, location, and severity of stenosis. Additionally, the segmental agreement between these modalities in assessing the arterial tree is analyzed.

DOI: 10.5281/zenodo.

Background:   Potassium (K) is an important electrolyte that has proven essential for normal functioning of the cardiovascular system, skeletal muscle, internal organs, and nervous system. both hypo and hyperkalemia are known to induce potentially lethal arrhythmias and cardiac dysfunction, as well as other complications. Methods: Data Consists of primary data collected from the patients who are admitted in GMERS Valsad Hospital in September 2023 to July 2024 and 100 patients were taken. Outcome: In present study, Severity of hypokalemia is accociated with increased mortality in critically ill patients. Conclusions: Early detection and correction of hypokalemia reduce the overall mortality and improve outcome in critically ill patients.

DOI: 10.5281/zenodo.

Introduction: This review analyzes the possibility of breast ultrasound as a primary screening modality for breast disease, particularly in resource-limited area. It examines 50 patients and underlines ultrasound’s advantages, including radiation-free imaging. Methods: This was hospital based observational study of 50 patients done in the department of radiodiagnosis, bhavsinhji general hospital, Porbandar with use of ultrasound machine (Esaote, MY LAB X8 EXP, 8200657). Results: Breast Disease, affecting both genders, but mostly females, exhibits shifting demographic patterns, with an increasing incidence in younger age groups. Early identification through mammography, clinical examinations, and breast self-exams enhances treatment efficacy, but challenges persist in low- and medium-income area due to limited imaging resources. This review assesses breast ultrasound as the primary breast disease screening method, particularly in resource-constrained regions. Conclusion: Breast ultrasound is a commonly accepted and reliable diagnostic method for women with clinically or radiologically suspicious breast lesions. Breast ultrasound, distinct from mammography, offers advantages like radiation-free imaging, suitability for repeated screenings, and preference for younger populations.

DOI: 10.5281/zenodo.

Objective: To evaluate the laterality of antrochoanal polyps and determine the preponderance of right-sided occurrence in a study of 50 cases. Methods: A retrospective analysis of 50 cases diagnosed with antrochoanal polyps was conducted. Data on patient demographics and polyp laterality were collected and analyzed. Results: The study found a statistically significant preponderance of right-sided antrochoanal polyps. Conclusion: The findings suggest a notable right-sided dominance in the occurrence of antrochoanal polyps, warranting further investigation into underlying causes and clinical implications.

DOI: 10.5281/zenodo.

The drugs having low aqueous solubility but have high permeability is categorized in BCS Class II. The low solubility of these sorts of drugs may develop certain kinds of complications in this exclusive era of commercial pharmaceutical sciences. Whether industrial or confined system of pharmacy the hurdles of solubility sometimes arises the unavoidable risks. So, to overshadow the current or upcoming rigidity in solubility the engaged one should emphasize on the current issue to make this rigid system somewhat lenient by using certain methods such as use of cosolvents, micronization, hydrotrophy, inclusion complex and many more which are discussed in this review for efficient formulations of dosage forms which further contributes the pharmacokinetics. Some recent technologies like size reduction, porous microparticle, new drug delivery, and lipid based delivery systems are discussed separately. So, these methods or technologies are ice breaking factors regarding solubility.

DOI: 10.5281/zenodo.

Background: Polypharmacy, defined as the concurrent use of five or more medications, is increasingly common among the elderly population. While polypharmacy is often necessary to manage multiple comorbidities, it has been associated with adverse health outcomes, including cognitive decline. This study investigates the relationship between polypharmacy and cognitive decline in elderly patients. Aims and Objectives: To assess the impact of polypharmacy on cognitive function in elderly patients and to explore the association between the number of medications and the severity of cognitive decline. Methodology: A cross-sectional observational study was conducted at a Geriatric Medicine OPD in an urban setting, including 200 elderly patients aged 65 years and above. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Polypharmacy was defined as the use of five or more medications. Data on demographics, comorbidities, and medication use were collected. Statistical analysis was performed to examine the association between polypharmacy and cognitive decline. Results: The prevalence of polypharmacy in the study population was 62%. Patients with polypharmacy had significantly lower MMSE scores compared to those without polypharmacy (p < 0.01). A linear relationship was observed between the number of medications and the severity of cognitive decline, with each additional medication associated with a 0.5-point decrease in MMSE score. Conclusion: Polypharmacy is significantly associated with cognitive decline in elderly patients. This finding underscores the importance of regular medication review and deprescribing strategies to mitigate the risk of cognitive impairment in this vulnerable population.

DOI: 10.5281/zenodo.

Menopause is a phase from where bone mineralisation becomes critics because of various physiological and hormonal changes. Oestrogen deficiency and age related processes alter the rate of calcium turnover in bone that aging woman faces. Osteoporosis especially in postmenopausal women is a well-documented problem. In India lack of nutritional and health awareness makes its prevalence like tip of iceberg phenomenon. Changes in sex hormones during the menopause transition period have an impact on calcium homeostasis. This cross-sectional study was conducted in women of age 40–75 years. It is observed that serum calcium levels are low in post-menopausal as compared to pre-menopausal women. In postmenopausal women significant decrease in serum calcium level indicate remarkable risk towards negative calcium balance. They should be monitored for serum calcium levels, for reducing the risk of bone resorption.

DOI: 10.5281/zenodo.

In our institute, we came across a few unusual cases which we compiled in this case series. These cases were unlike those which we encounter in our daily practice here. These were epidermal inclusion cyst in the submandibular region, bezold abscess and jugular bulb dehiscence.

DOI: 10.5281/zenodo.

Percutaneous nephrolithotomy (PCNL) has become the preferred treatment for kidney stones larger than 2 cm in size and an alternative for smaller stones (10-20 mm) in the lower renal pole. The purpose of this dissertation is to carry out a comprehensive assessment and comparison of miniaturized percutaneous nephrolithotomy (Mini-PCNL) and the traditional standard percutaneous nephrolithotomy (standard PCNL) for treating renal stones. The study was conducted in Muzaffarnagar Medical College and Hospital, Muzaffarnagar, U.P. on 100 indoor patients of the General Surgery department by following inclusion and exclusion criteria, clinical examinations, and interpretation of laboratory results. The data obtained was analyzed by SPSS software 20.0. Mini PCNL offers a substantial advantage over Standard PCNL in that it allows the use of a ureteroscope. Mini PCNL offers a longer operating time and a better stone-free rate as compared to Standard PCNL, making it an effective treatment for renal calculi. Mini PCNL was found to be safe and equally effective in the realm of surgical treatment of renal stones considering all the parameters that make one favourable over the other.

DOI: 10.5281/zenodo.

Background: Breast cancer is a global health problem with more than 1 million cases diagnosed worldwide each year. Axillary lymph node (ALN) status is one of the most important prognostic indicators in breast cancer. Axillary lymph node dissection (ALND) is the most accurate method for evaluating the Axillary lymph node (ALN) status. Objectives: To study various Clinicopathological and radiological factors influencing Axillary lymph node metastasis in carcinoma breast. To compare clinical, pathological and radiological factors with histopathological examination report. Methodology: Hospital based case series study. Sample size is 45. Females above 18 years admitted to HSK Hospital, Bagalkot with breast cancer [stage I, II, III] from 1st August 2022 to 29th February 2024 are taken. With the consent of patients, Clinical factors like age, menstrual status, palpable, ALN, tumor size. Radiologically BIRADS, breast density, tumor size. FNAC preoperatively is assessed. These factors are compared with HPR postoperatively. Results: ALN metastasis was significantly present in menopausal women and in females with palpable ALN and in women with >4 cm tumor size clinically and radiologically. It was present significantly in women with BIRADS of 6. ALN metastasis did not vary with density of breast. Most of malignant tumors in FNAC have ALN metastasis according to HPR. Conclusion: Predicting ALN metastasis in carcinoma breast involves evaluation of various clinical and biological factors. Tumor size, age, number of palpable ALN, BIRADS, FNAC, and menstrual age play pivotal roles in assessing ALN spread and guiding treatment decisions. ALN metastasis did not vary with *reast density in our study.

DOI: 10.5281/zenodo.

Background: Anxiety disorders are the most prevalent psychiatric illnesses in the general community. Anxiety is diffuse, unpleasant, and highly vague feeling of apprehension with one or more bodily symptoms. Zinc is an essential micronutrient. It plays an important role in central nervous system physiology. Studies suggest the role of zinc in the pathogenesis of neuropsychiatric disorders. The study was undertaken to study the anti-anxiety activity of zinc oxide in animal models of anxiety and its comparison to Diazepam. Aim and Objectives: The present study aims to evaluate the anxiolytic effect of zinc oxide in albino rats. Material and Methods: Healthy albino rats of either sex weighing between 150 to 250 g were used and were divided into 7 groups. Group 1: Normal saline 0.5ml/rat Group 2: Diazepam 1mg/kg Group 3: Diazepam 2mg/kg Group 4: Zinc oxide 7.5mg/kg Group 5: Zinc oxide 15mg/kg Group 6: Zinc oxide 30mg/kg Group 7: Zinc oxide + Diazepam 7.5 + 1mg/kg. Light and dark arena model of anxiety was used. Results: Significant anti-anxiety effect is seen in the rats treated with Zinc Oxide 15mg/kg body weight. Zinc oxide was also able to potentiate the effect of low-dose diazepam as an anxiolytic. This was evident by the increase in time spent in the light arena, the number of entries in the light arena, and a decrease in time spent in a dark arena. Conclusion: The present study concludes that ZnO is an effective anxiolytic and can potentiate the action of Diazepam.

DOI: 10.5281/zenodo.

Objectives: (1). To gather feedback from 1st-year MBBS students regarding the difficulties they face in learning Embryology. (2). To identify contemporary learning needs that could help improve student performance. Materials and Methods: Participants: The study involved 150 MBBS students of 1st year MBBS. Data Collection: A specially designed questionnaire was used to collect input. The questionnaire focused on various aspects such as the curriculum and teaching methodologies used in the Embryology section of the Department of Anatomy. Results: Ease of Learning: While most students found Embryology relatively easy, a significant number of them preferred to keep the subject optional. Preferred Study Materials: Lectures were considered the best source of study material, followed by textbooks. Email information about embryology models was particularly beneficial for revision. Suggestions for Improvement: (1) Increasing the number of lectures and practical demonstrations. (2) Incorporating more visual aids, including 3D videos. (3) Conducting revision lectures at the end of the curriculum. (4) Introducing part-completion tests for Embryology. (5) Adding seminars and Multiple Choice Question (MCQ) sessions to the routine teaching. Conclusion: Students believe that integrating multimedia technology with traditional lectures would significantly enhance their understanding of Embryology. This approach is also expected to improve their exam performance and contribute to better diagnosis of congenital anomalies in the future. This study underscores the importance of adapting teaching methods to meet the evolving needs of students, particularly in challenging subjects like Embryology.

DOI: 10.5281/zenodo.

Introduction: Haemorrhoids are one of the most common afflictions of human beings from ages. Haemorrhoids are common disease affecting people of all ages and both sexes. With evolution of time multiple procedures are seen to be done for haemorrhoidectomy like laser surgeries, Stapled haemorrhoidectomy, rubber band ligation, open haemorrhoidectomy and closed haemorrhoidectomy. Even after evolution of new techniques grade 3 and 4 haemorrhoids are preferred to be done by either closed or open haemorrhoids. Aim: To compare post- operative outcomes with related to complications in open vs closed haemorrhoidectomy. Methodology: Randomised control study. 50 patients admitted to our institute with proven diagnosis of grade 3 and 4 hemorrhoids and admitted from 1st August 2022 to 31st January 2024 were included in the study, and were subjected to randomized group of 25 each and had been operated for open and closed hemorrhoidectomy respectively. Results: Closed haemorrhoidectomy had advantage of lesser post-operative pain thus lesser hospital stay and earlier return to work, also less of wound site infection. Rest all post-operative complications did not make much difference in both open vs closed groups. Conclusion: According to our study both open and closed haemorrhoidectomy are equally effective and safe. Closed haemorrhoidectomy has upper hand with respect to post-operative pain, shorter hospital stay and wound infection but has longer operative period. Result all post -operative complication in both groups showed insignificant difference.

DOI: 10.5281/zenodo.

Background and Aim: One of the commonest causes of anemia in pregnancy is iron deficiency. This study aims at understanding and exploring the association between fetal and maternal iron status. This study evaluated various maternal and neonatal factors that influence iron status at birth and at four weeks. Material and Methods: Mother-infant pairs were enrolled in the study by following specific inclusion and exclusion criteria. Maternal demographic details, complications during pregnancy, intrapartum details, and neonatal details were recorded. The maternal and cord blood samples were collected for measurement of haemoglobin, serum ferritin, serum iron, total iron-binding capacity, and transferrin saturation. If failed to collect the cord blood sample, the first 24hour sample of the baby was taken into consideration in place of it. Results: There is a significant effect of maternal hemoglobin levels on neonatal TIBC and tranferrin saturations (p≤0.05) but not on other indices. Babies with deficient maternal stores had significantly low hemoglobin and ferritin concentrations at birth (p≤0.05), At birth neonatal hemoglobin concentrations (p≤0.05) and ferritin levels (p≤0.05) were significantly low in the preterm group as compared to the term group and in follow-up at four weeks preterms have significantly lower serum iron concentrations when compared to term babies (p≤0.05). Conclusion: The neonates with low cord blood iron stores are likely to have low iron stores at four weeks of gestational age. As the most significant adverse effects of iron deficiency are neurodevelopmental impairments every mother should be counselled about the importance of iron supplementation during pregnancy.

DOI: 10.5281/zenodo.

Background and Aim: Emotional Intelligence is a form of interpersonal intelligence. There’s evidence that high emotional intelligence (EQ) of a medical student is associated with better coping with the tedious medical training. Present study was planned to evaluate EI and its dimensions of first-year medical school students who are just starting out in their careers. Material and Methods: we carried out a survey that was based on a quantitative questionnaire in order to determine the level of emotional intelligence possessed by the students. In total, 290 individuals were included in the analysis. Questionnaire-based emotional intelligence test was given to the participants. There was a total of fifteen questions based on situations, five of which were pertaining to sensitivity, five to maturity, and five to competency. The EI and its three dimensions were analyzed. In order to conduct the analysis of the data for this study, both descriptive and inferential statistics were utilized. Results: A sensitivity score of 89 ± 7.07 was obtained from female subjects, while the sensitivity score for male subjects was 85.12 ± 13.12. The difference between males and females was found to be statistically significant (p=0.039). Mean sensitivity score for individuals aged 19 to 21 years was 87.65 ± 09.88, while the score for individuals aged 17 to 18 years was 85.06 ± 08.26. The comparison reveals a significant difference (p=0.032) between the two age groups. The score for emotional competency was significantly lower (p = 0.051) in the older age group compared to the younger age group where it was significantly higher. Conclusion: The findings of this study indicated that both male and female students at the college that was investigated possessed satisfactory levels of emotional intelligence. The importance of community-oriented medical education is highlighted by the fact that communitarian education settings have the potential to develop skills related to emotional intelligence.

DOI: 10.5281/zenodo.

Cancer is among the leading cause of death worldwide. The world health organisation has estimated that the number of cancer related deaths is going to increase up to 12.8 million peoples a year by 2030. Early diagnosis solves major of the cancer related problems on time. Conventional chemotherapy and radiation therapy is used to do so but they have some evil effects which include damaging of healthy cells, immune system and other organs with rapidly increasing cells due to imprecise targeting and incapability to enter the centre of the tumor cells concluding in improper treatment with decreased dose and this also decreases the possibility of staying alive. To overcome the obstruction of cancer therapy nanoscience has given special importance. The nanoscience deals with the particles and structures ranging less than 100 nm in size and the technology that uses it in practical life i.e., the nanotechnology. The nanotechnology provides remarkable opportunity to build prominent progression in cancer diagnosis and treatment. The nanoparticles are used as nanomedicine whose objective is to carry the drug cautiously to tumor cells without harming the healthy cells. Nanoparticles easily estimates disease and provides medication at micro level. The special property of nanoparticles empowers them to attach, absorb and deliver small biomolecules like medicaments, proteins and other molecules to desired sites and thus increases the success rate of curative agents. The purpose of this review article is to explain the diagnosis and treatment of cancer using different nanotechnology platforms like liposomes, carbon nanotubes, polymeric nanoparticles, dendrimers, quantum dots, gold nanoparticles.

DOI: 10.5281/zenodo.

Introduction: Stroke is the 5th leading cause of death and the 1st leading cause of disability worldwide Stroke is a leading cause of disability and death worldwide, necessitating prompt and accurate diagnosis for effective management. NCCT is the preferred initial imaging technique for suspected acute stroke due to its wide availability, rapid acquisition, and ability to exclude hemorrhage, which is critical for treatment planning. Methods: This was hospital based observational study of 100 patients done in the department of radiodiagnosis, bhavsinhji general hospital, Porbandar with use of computed tomography scan. Results: NCCT is the first-line imaging modality in most centers as the patient admitted and stabilized in the emergency room. It is performing to exclude hemorrhagic stroke and intracranial haemorrhage. Imaging in stroke patients is an early and essential evaluation which should be done as soon as possible to confirm the diagnosis and start the appropriate therapy. Conclusion: It is easily available, safe, and fast which is critical in acute stroke management. CT has high sensitivity for the detection of intracerebral hemorrhage. However, apart from hyperdense arteries that may indicate acute thrombus, the brain parenchyma is often normal on CT in the early few hours after AIS.

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.

Background: Cancer being a dreadful disease can cause substantial psychological & social distress to the patient and to relatives. Chemotherapy is the mainline treatment along with Radiotherapy & Surgery. Availability of different chemotherapeutic regimen, intolerability of combination regimens & variation of individual response to anticancer agents necessitate for continuous observation & evaluation of cancer chemotherapy by studying drug prescription pattern in these patients. Moreover, there is scarcity of reports and systematically analyzed data in Northeastern region of India regarding the pattern of drug use in cancer patients. Hence this study was conducted to evaluate the drug prescription pattern of cancer chemotherapy in the Oncology Dept in Northeast India. Methods: Present study was conducted with the aim to evaluate the drug prescription pattern of cancer chemotherapy in the Oncology Dept of a Tertiary care teaching hospital in Northeast India. This cross-sectional study was conducted for the period of two months (02.05.2017-30.06.2017) in the Oncology Dept of a Tertiary care teaching hospital in Northeast India after obtaining approval from institutional ethics committee. All admitted patients in Oncology Dept during this two-month study period and who fulfilled the inclusion criteria were included in this study. Relevant data regarding the prescription pattern were collected from the medical records of the patients & was recorded in Case Record Form. Results: Out of 254 diagnosed cancer patient’s majorities were male (139, 54.73%) and in the age group of 41-60 years. Head & neck cancer was most commonly reported [n=75(29.52%)] followed by Lung cancer [n=46(18.11%)]. Cisplatin was the most commonly prescribed anticancer drug at a frequency of 141 (55.51) % followed by 5-FU [118(46.45%]), Carboplatin [81 (31.88%)], paclitaxel [66 (25.98%)], Etoposide 50(19.6%), Docetaxel [28 (11%), Methotrexate [26 (10.23%)]. Conclusions: Most of the patients were treated with two anticancer drugs combination therapy. 5-FU and platinum-based combination therapy was preferred in majority of cases except in carcinoma of breast and stomach. In breast carcinoma, Taxol, Cyclophosphamide and Anthracycline combination therapy was preferred while in Gastric carcinoma, Taxanes was prescribed. Most of the drugs were used by their generic name.

DOI: 10.5281/zenodo.

Background: Pharmacovigilance plays a pivotal role in health care by monitoring and managing adverse drug reactions thereby safeguarding heath of individuals receiving medical treatments. Aims and Objective: to assess the prevalence, nature of adverse drug reactions, enhance early detection, and investigate causality. By delving into these aspects, we can enhance pharmacovigilance practices and   improve patient care and safety in healthcare setting and improve reporting systems. Material and Methods: This was observational study carried out from April 2018 to July 2020. All suspected adverse drug reactions submitted to adverse drug monitoring centre included. The data were analysis for type of adverse drug reactions, severity, organ system involvement and causality. Results: A total 524 ADR were observed.  ADR were reported more in male (53%) compared to female (47%) and majority of ADR were reported (73%) in age group of 17 to 64 years. 72.0% patients had no serious reaction, and 14.5% patients were required hospitalization/prolonged treatment of ADR, and 3.5% patients had permanent disability.  Suspected drugs were withdrawn in 51.0% patients. Most commonly affected organ system in ADR was GIT (43.89%) and frequently observed ADR were vomiting followed by anorexia and nausea. Causality assessment 76% patients ADR were categorized as probable and 3.5% were certain and 51% patients had mild ADR and 46% moderate, and 3% patients had severe ADR. Conclusions: This study suggests that there is greater need for reporting of ADR and monitoring system to generate the awareness and promote the reporting of ADR among health care professionals which can help in improving patients care by ensuring safe use of drug.

DOI: 10.5281/zenodo.

Aims and Objectives: To find out frequency and spectrum of fundal changes in patient with pregnancy induced hypertension &to find out relationship between degree of hypertension hypertensive retinopathy and severity of pregnancy induced hypertension. Material and Method: In this study hundred patients were taken with pregnancy induced hypertension who are admitted in department of obstetrics and gynecology in Government Medical College Kota from May 2022 to April 2023, in formed concerned was obtained and study followed by guidelines. Patients who had positive history of hypertension Diabetes mellitus cardiovascular disease and collision vascular disease prior to pregnancy were excluded from this study. Patience with ocular media opacity in both higher also excluded in this study. Results: There was significant Association of prevalence of retinopathy with primary gravida but Association of CBSE in return of the with primary gravita was not statistically significant, occurrence of retinopathy was most strongly associated with presence with both systolic and diastolic hypertension in an individual followed by pure systolic hypertension and pure diastolic hypertension, most frequent funder abnormality was arterial narrowing(68%cases). Mild generalized article in a rowing was most common subtype. The percentage of patience developing retinopathy due to pregnancy induced hypertension increased as we move from mild preeclampsia group (57.58% patients) to severe pre-eclampsia. 75.47% patients) to eclampsia group. (85.71% patients). A statistically significant positive correlation was present between occurrence and security of retinopathy with cbrt of pregnancy induced hypertension.

DOI: 10.5281/zenodo.

Thalidomide (TD) is the drug in clinical use since north of 50 years for variable signs like Sickness. In the 1960s, the use of TD led to the birth of around 10,000 youngsters with phocomelia. Later on, TD was taken out of the market. Dismissing Thalidomide Embryopathy (TE), this medicine has actually been upheld for the treatment of various myeloma for unequivocal signs. Species insurance from cultivate member distortions was an essential clarification of its inconspicuous teratogenicity during preclinical noxiousness testing. The inspiration driving this overview is to look at the succinct history of this prescription and the continuous revelation of a possible instrument of creature type’s expressness of TE, including SALL4 degradation by the Thalidomide-Cereblon (TD-CRBN) complex.

DOI: 10.5281/zenodo.

Background: Upper gastrointestinal bleeding is a common medical emergency with significant morbidity and mortality. The present study is to evaluate the clinical profile of patients with upper GI bleeding and to identify etiological factors by endoscopic findings in predicting the outcome of patients and application of Rockall scoring in assessing the prognosis. Materials and Methods: Subjects of this study include all patients who come with upper gastrointestinal bleeding (hematemesis/melena) are subjected to upper gastrointestinal endoscopy as a part of their workup. After obtaining approval and clearance from the institutional ethics committee, the patients who are fulfilling the inclusion criteria will be enrolled for the study after obtaining informed consent. Patients either on outpatient department or inpatient department with consent are subjected to upper gastrointestinal endoscopy after necessary investigations/resuscitation if patient presents with shock. Rockall’s score was calculated. It is a hospital-based case series study. Sample size: 70. Results: In this study of 70 cases of UGI bleed 65 were Male, 5 were Female with majority of patients with age group of 41-50 years coming with 37 cases of hematemesis, 23 cases of melena and 10 cases of both Hematemesis & melena. Most common risk factor was found to be Alcoholism. Most common clinical diagnosis was Chronic Liver disease with portal hypertension with prevalence of endoscopic lesion of Esophageal varices 62.8% and Rockall score was calculated and 10 cases showed rebleeding with score of 4-7. Mortality was seen in 10 patients. Conclusion: The study of endoscopic findings in UGI bleed concludes that: Esophageal varices is the most common cause of UGI bleed in this study accounting for 62.8%. Risk of rebleed was absent with rockall score of 0-3. Prognosis was poor in patients with comorbities and higher score in Rockall’s scoring system.

DOI: 10.5281/zenodo.

Background and Objectives: Stroke is a leading cause of morbidity and mortality worldwide, with significant implications for public health. Understanding the risk factors and clinical profile of acute stroke is essential for the development of preventive strategies and effective management protocols. This study aims to analyze the risk factors, clinical characteristics, and outcomes of patients presenting with acute stroke in a tertiary care hospital. Methods: A retrospective analysis was conducted in Department of Medicine, Government Medical College. Bettiah, West Champaran, Bihar, India for two years involving 100 patients diagnosed with acute stroke. Data on demographics, risk factors (e.g., hypertension, diabetes, smoking), clinical presentation, imaging findings, and outcomes were collected from medical records. The study sought to identify the most common risk factors associated with stroke and assess the relationship between these factors and clinical outcomes. Results: Hypertension was the most prevalent risk factor (65%), followed by diabetes mellitus (40%), and smoking (35%). Ischemic stroke accounted for 80% of cases, while 20% were hemorrhagic strokes. The mean time from symptom onset to hospital presentation was 4.5 ± 2.3 hours. The in-hospital mortality rate was 15%, with higher mortality observed in patients with hemorrhagic stroke and those presenting with severe neurological deficits. Conclusion: Hypertension, diabetes, and smoking are significant risk factors for acute stroke in this population. Early recognition and management of these risk factors are crucial for reducing the incidence and improving the outcomes of stroke patients.

DOI: 10.5281/zenodo.

Background: The most complex and largest artery network in the brain is the MCA (middle cerebral artery). The branches of the aortic arch can vary in shape because of embryonic changes that affect the development of some branchial arch arteries. It is essential to comprehend these differences when doing procedures on the neck, thoracic cavity, and aorta. Aim: The study examines the micro-surgical anatomy of the MCA (middle cerebral artery) varies within our population, comparing the variables and discussing their significance in relation to anatomical and surgical considerations. Methodology: A total of 40 cadavers were used in this study. After a coronal skin incision and removal of the skull vault, the brains were carefully extracted and preserved in 5% formalin. To examine the middle cerebral artery (MCA), dissection involved exposing the origin of the MCA and the internal carotid artery. The M1 section was meticulously analyzed, and branching patterns were recorded for analysis. Results: The study examined the anatomical characteristics of the middle cerebral artery (MCA). The majority of M1 segment lengths measured between 14-16 mm (37.68%), while most outer diameters ranged from 3-5 mm (69.60%). Bifurcation was the most typical branching pattern, observed in 71.01% of cases, followed by trifurcation (18.84%) and ramification (10.14%). These findings provide detailed insights into the variations of the MCA’s structure. Conclusions: The study on the middle cerebral artery reveals that the M1 segment predominantly falls within the 14-16 mm length range and 3-5 mm diameter. The most common branching pattern is bifurcation (71.01%), followed by trifurcation (18.84%) and ramification (10.14%). These findings highlight the prevalence of bifurcation and provide insights into the variability in segment length and diameter.

DOI: 10.5281/zenodo.

Background and Objectives: Intrauterine fetal growth restriction (IUGR) is a significant obstetric complication associated with increased perinatal morbidity and mortality. Early identification of pregnancies at risk for IUGR is critical for timely intervention and improved outcomes. Serum ferritin, an iron storage protein, has been studied as a potential predictor of IUGR, but its role remains under investigation. This study aims to evaluate the relationship between maternal serum ferritin levels during pregnancy and the risk of IUGR, with a focus on determining the predictive value of first-trimester ferritin levels. Methods: This prospective cohort study was conducted in Department of Obstetrics and Gynaecology, Jagannath Gupta Institute of Medical Sciences and Hospital (JIMSH) Budge Budge, Kolkata, West Bengal, India for one year   involving 300 pregnant women. Maternal serum ferritin levels were measured at two key points: during the first trimester (10-14 weeks) and the third trimester (28-32 weeks). Participants were monitored throughout pregnancy, and fetal growth was assessed using ultrasound biometry. IUGR was diagnosed based on fetal weight below the 10th percentile for gestational age. Multivariate logistic regression was used to analyze the relationship between serum ferritin levels and IUGR, adjusting for potential confounding factors. Results: The study found that women who developed IUGR had significantly higher mean serum ferritin levels during the first trimester (45.2 ± 10.8 ng/mL) compared to those with normal fetal growth (32.6 ± 9.5 ng/mL; p < 0.001). Although third-trimester ferritin levels were also higher in the IUGR group, the difference was less pronounced. Elevated first-trimester ferritin levels emerged as an independent predictor of IUGR (adjusted OR: 2.8; 95% CI: 1.6-4.8). No significant association was found between third-trimester ferritin levels and IUGR. Conclusion: Elevated maternal serum ferritin levels during the first trimester are significantly associated with an increased risk of IUGR. This finding suggests that serum ferritin could serve as an early biomarker for identifying pregnancies at risk, allowing for closer monitoring and timely intervention to improve perinatal outcomes.

DOI: 10.5281/zenodo.

Aim: Comparative analysis of catheter drainage versus needle aspiration for the treatment of liver abscess. Material and Methods: This comparative study was conducted in the department of Surgery, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India from December 2019 to November 2020. Fifty subjects for liver abscess drainage were randomly divided into two groups. Group (I) was assigned for percutaneous needle aspiration (n=52) and (II) was assigned for pigtail catheter drainage (n=69). The patients were selected from outpatient department and emergency department of hospital. All the patients were diagnosed to have liver abscess by clinically and ultrasonography (USG) or CT scan. The age groups of patients were 16 to 60 years were included in the study. The patients having abscess cavity smaller than 5 cm, ruptured liver abscess, biliary tract malignancy and uncorrectable coagulopathy were excluded from the study. Results: A total of 121 patients randomized into two groups of 52 for needle aspiration and 69 for catheterized drainage were included in the study. The following observations were made: The age of the patients varied from 20 years to 60 years with most of the patients falling within the age range from 31-40 years (96 patients). The second most common age group was 21-30 years (25 patients) and the number of patients was less in extremes of age. There were 110 male and 11 female patients with liver abscess involved in the study. The male to female ratio was 10:1. It was observed that out of 121 patients 117 (97%) patients have fever, 113 (93%) anorexia; nausea/vomiting 108 (89%), pain in the right upper quadrant of the abdomen was found in 102 (84%) cases. Weakness 99 (82%), 69 (57%) weight loss 29 (58%), night sweats 58 (48%), dyspnea 52 (43%), diarrhea 48 (40%), rigors 30 (25%), cough 24 (20%) and pain in the right shoulder region was observed in 21 (17%) cases. Mixed type of liver abscesses 103 (85%) were predominant over amebic 12 (10%) and indeterminate 6 (5%). Conclusion: Our study concludes that the percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration in respect to clinical improvement, resolution of cavity, success rate but there was no significant difference in hospital stay time.

DOI: 10.5281/zenodo.

Background and Objectives: Wound coverage in patients with large skin defects remains a significant challenge in reconstructive surgery. Split thickness skin grafts (STSG) are commonly used, and when combined with meshing, they cover larger areas with less donor skin. The application of collagen over meshed STSGs may enhance wound healing and graft take. This study introduces a novel technique of collagen application over meshed STSGs and evaluates its efficacy in wound coverage and healing outcomes. Methods: A prospective study was conducted in Department of General Surgery, Shaheed Nirmal Mahto medical College and hospital Dhanbad, Jharkhand, India for one year involving 50 patients with large skin defects requiring wound coverage. Patients were treated with meshed STSGs, with collagen applied over the grafts. The primary outcomes assessed were graft take, wound healing time, and incidence of complications such as infection or graft failure. The results were compared to a control group of 50 patients treated with meshed STSGs without collagen application. Results: The application of collagen over meshed STSGs significantly improved graft take (95% vs. 85%, p = 0.03) and reduced wound healing time (18 ± 3 days vs. 22 ± 4 days, p = 0.01) compared to the control group. The incidence of complications was lower in the collagen group, with fewer cases of graft infection and failure (p < 0.05). Conclusion: Collagen application over meshed STSGs enhances wound healing and graft take, offering a promising technique for improving outcomes in patients requiring extensive wound coverage.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to evaluate the etiopathogenesis of Morbidly Adherent Placenta, its clinical mode of presentation and maternal and fetal outcome with the aim to reduce maternal morbidity and mortality. Methods: This observational study was done in Obst/Gynae Department  for the period of 26 months. There were 42048 deliveries; among these 20 women met the diagnostic criteria of MAP making an incidence of 0.047% over 26 months’ study period. Results: 90% women had history of previous caesarean sections. Placenta Praevia was associated with 60% women.  The mean age was 31.4 years and mean parity 2.8. 40% were booked and 60% were unbooked. 60% 0f women with adherent placenta had accreta; 30% percreta and 10% had increta. Due to massive blood loss 80% cases were given Blood transfusion i.e. 1-5 units of whole blood and 50% were given i.e. 2-6 units of fresh frozen plasma (FFP). 60% women were shifted to ICU with an average stay of 3 days. The main newborn complication was prematurity and the average gestational age in our study was 32.4 weeks. 50% of the newborns were preterm with an average birth weight low birth weight <2500 gm, i.e. 2.2 kg. The perinatal mortality was 10%. Conclusion: Early antenatal diagnosis of morbidly adherent placenta, proper counselling of patients regarding associated risks followed by well-planned caesarean hysterectomy with non-separation of placenta adopting multidisciplinary approach is the management option to reduce maternal morbidity and mortality.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to assess the serum beta-HCG in second trimester as predictor of preeclampsia. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology from December 2023 to May 2024. Study population was Patient attending antenatal clinic of the department of obstetrics and gynaecology. 50 patients were included in the study as pregnancy induced hypertension and 50 as controls. Results: SBP, DBP and serum HCG showed statistical significant results in both the groups. There were statistical significant result in terms of SBP, DBP and serum HCG. Conclusion: Measuring serum beta hCG in early second trimester (12- 18weeks) is a useful indicator to identify women who are likely to develop PE in the same pregnancy. Serum beta hCG value >82500mIU/ml can be considered as marker for predicting preeclampsia in second trimester of pregnancy. Also, high levels are associated with increased severity of preeclampsia.

DOI: 10.5281/zenodo.

Aim: Utilizing diffusion tensor imaging to accurately map the white matter tracts in relation to brain malignancies. Materials and Methods: This hospital‑based study was conducted in the Department of Radiology, Mahavir Cancer Sansthan and research Centre, Phulwari sharif Patna, Bihar, India. A total of 50 patients with brain tumours were evaluated. Results: The mean FA value for displaced WMFT was 0.462 with standard deviation of 0.049 and the mean ADC value was 0.721 with 0.112. Mean FA was 0.414 with standard deviation of 0.044 and mean ADC was 1.339 with standard variation of 0.118 for edematous fibres. The mean FA of infiltrated fibres was 0.382 with a standard deviation of 0.045. Infiltrated fibres had 1.026 mean ADC and 0.088 standard deviation. Disrupted fibres caused a substantial FA reduction compared to the contralateral side. Disrupted fibres had a mean FA of 0.290 and an SD of 0.055. Disrupted and infiltrated fibres had similar ADC values. The mean ADC for disturbed fibres was 1.025 with 0.085 standard deviation. Conclusion: The FA and ADC values of white matter fibre tracts damaged by tumour and peritumoural oedema may help assess the tumour’s malignant potential, size, and operability, even if they cannot be linked to its histology.

DOI: 10.5281/zenodo.

Background: Menstrual dysfunction includes amenorrhea, menorrhagia, oligomenorrhea, and dysmenorrhea. These may be caused by hormone imbalances, PCOS, thyroid issues, lifestyle, uterine abnormalities, blood coagulation issues, or drugs. Hormonal and lifestyle adjustments are typically needed to treat these problems. Hysteroscopy has supplanted curettage in diagnosing endometrial illnesses and abnormalities. Aim: This study evaluated the diagnostic reliability of hysteroscopy for abnormal uterine bleeding (AUB) and correlated hysteroscopic observations via histopathological results. Method: AUB was examined in 84 patients their age was 20–60-year-olds in this descriptive cross-sectional research. This research excluded individuals with fibroids, current infections, or hormonal medication. All patients had hysteroscopy with dilatation and curettage under intravenous anesthesia, and endometrial tissue was histopathological examined. Result: Of the 84 patients, 56% were aged 31-40 years. Menorrhagia was the most common symptom (28.6%), followed by post-menopausal bleeding (16.7%) and polymenorrhagia (14.3%). Histopathological examinations revealed proliferative endometrium in 29.8%, secretory endometrium in 21.4%, and simple hyperplasia without atypia in 17.9%. Incidence of endometrial carcinoma was seen in 3.6% cases. Conclusion: Hysteroscopy significantly increases the accuracy of diagnosis in cases of AUB compared to the conventional curettage methods. Early and accurate diagnosis through hysteroscopy allow for further management of menstrual disorders, except for the prevention of complications associated with anemia and infertility.

DOI: 10.5281/zenodo.

Background: The incidence rate of surgical site infections (SSIs) varies between 14% and 16%, positioning them as the 3rd most frequently reported nosocomial infection. The incidence of surgical site infections in elective operations in India varied between 3.83% and 39%, whereas in emergency procedures, it ranged from 12.41% to 26.4%. Aim: The aim of this research was to assess the risk factors and incidence of surgical site infection in patients who are undergoing abdominal surgeries. Methods: A retrospective study was conducted at the ‘Department of General Surgery, Patna Medical College and Hospital, Patna, Bihar, India’, to include all patients who underwent abdominal surgery. Thorough investigations were conducted, and patient demographics and pertinent risk factors were recorded. Results: The research included 80 subjects, with an infection frequency of 38.75%. This rate is almost equivalent to that seen in prior studies conducted in India. The study conducted in the Western world has shown a decreased infection rate. Conclusions: SSIs seem to be a prevalent cause of perioperative morbidity and death, resulting in prolonged hospital stays and elevated treatment costs. Effective planning and management of case-by-case situations may reduce the occurrence of SSIs and alleviate the strain on the healthcare system.

DOI: 10.5281/zenodo.

Background: Pneumonia is a leading cause of under-five mortality, accounting for approximately 0.8 million deaths annually, predominantly in lower- and middle-income countries. Concurrently, anemia affects 47% of children globally, exacerbating pneumonia outcomes. This study investigates the impact of anemia on pneumonia treatment outcomes in children under ten. Aim: To evaluate the association between anemia severity and pneumonia outcomes in pediatric patients admitted to a Pediatric Intensive Care Unit (PICU). Materials and Methods: This retrospective observational study was conducted over eight months at a PICU. Eighty children under ten with pneumonia were included, and demographic, clinical, and laboratory data were collected. Anemia was classified according to WHO criteria, and associations between anemia and pneumonia severity were analyzed using SPSS. Results: The majority of patients were aged 1 to 5 years (48.75%), with a male predominance (60%). Moderate anemia was prevalent in younger age groups, correlating with increased pneumonia severity. In children aged 1 to 5 years, moderate anemia led to severe pneumonia in 56% of cases. Older children (6 to 10 years) with severe anemia had a 66.66% incidence of severe pneumonia. Conclusion: Anemia severity significantly influences pneumonia outcomes, particularly in children aged 1 to 5 years. Routine anemia screening in pediatric pneumonia cases is crucial for improving clinical outcomes. Future studies should focus on the causal mechanisms linking anemia to respiratory distress and evaluate the effectiveness of targeted interventions.

DOI: 10.5281/zenodo.

Background: Preterm neonates face a higher risk of mortality compared to full-term infants, with respiratory distress syndrome (RDS) being a significant cause. The prevalence of neonatal respiratory distress varies across countries, with India reporting higher rates compared to Western nations. RDS can result from several medical and surgical conditions and is influenced by factors like gestational age, body weight, and maternal health. Aim: This study aims to assess the incidence, causes, and outcomes of respiratory distress in newborns admitted to the Neonatal Intensive Care Unit at a medical college in Bihar, India. Methodology: A prospective study involving 80 neonates admitted to the Neonatal Intensive Care Unit within 24 hours of birth was conducted. Diagnoses were made based on clinical symptoms and supported by laboratory investigations, with statistical analysis performed using SPSS software. Variables such as gender, delivery mode, gestational age, and birth weight were analyzed. Results:  Out of 80 neonates, 45% presented with RDS, with a higher incidence in preterm infants (61.25%) compared to full-term neonates. Males represented 60% of cases. Vaginally delivered babies showed a higher incidence of RDS (63.75%) compared to those delivered via caesarean section. The study found that preterm delivery and low birth weight are important risk factors for RDS, which raises death rates and lengthens NICU stays. Conclusion: Respiratory distress is a leading cause of mortality and neonatal morbidity in India, especially among preterm infants. Early identification, timely interventions, and advanced therapies such as surfactant replacement and ventilatory support are crucial to improving outcomes. Further research in India is needed to better understand the factors influencing neonatal respiratory distress.

DOI: 10.5281/zenodo.

Background: Patients diagnosed with schizophrenia have increased medical comorbidity and heightened cardiovascular risk factors. The presence of 3 or more particular components signifies metabolic syndrome, which substantially impacts future morbidity and mortality. Aim: This research aim to clarify the prevalence and risk factors of metabolic syndrome among people with schizophrenia and related disorders, taking into account subgroup differences. Methods: A comprehensive review analyzed the relationship among hypertension, hyperglycemia, hyperlipidemia, and antipsychotic polypharmacy in schizophrenia. Among 5 databases were meticulously examined from their beginnings, in addition to Google Scholar and reference lists for unpublished reviews or publishing status. Two reviewers independently evaluated references and extracted data, addressing inconsistencies via discussion or consultation with a third expert. Results: A total of nine systematic reviews were included with varying conclusions, most of which were syntheses. In comparison to other combinations and/or monotherapy, research shows that aripiprazole-containing pharmacological combinations may offer protection against hyperlipidemia and diabetes. Hypertension has been associated with APP in only one review. The most frequently reported prescription combination was clozapine, which may have suggested that a patient group was experiencing issues that were resistant to therapy. Independently reported results by setting were absent from all reviews. Conclusion: More study is required to determine aripiprazole’s potential protective effect. Long-term prospective studies are necessary to accurately identify the risk of diabetes, hypertension, and hyperlipidemia in individuals taking antipsychotic polypharmacy.

DOI: 10.5281/zenodo.

Background: The treatment of fractures has evolved from external splints in the Hippocratic era to advanced fixation techniques. Distal femur fractures occur in 37 per 100,000 people, commonly caused by low-energy trauma in the elderly or high-energy injuries in the young. These fractures can lead to malunion, nonunion, and infection due to their proximity to the knee joint. Aim: This study aimed to evaluate the functional outcomes of distal femur fractures managed by open reduction and internal fixation using a locking compression plate, assessing clinical and radiological union. Methodology: A total of 60 patients aged 18 or older with C1-C3 fractures according to the AO classification underwent ORIF. The procedure involved anatomical alignment of fractures, stabilization with LCP, and post-operative knee range of motion (ROM) exercises. Patients were followed up monthly until fracture union was confirmed. Results: Most fractures (33.33%) achieved union within 16-20 weeks, with 73.33% of patients attaining excellent knee scores. Road traffic accidents were the leading cause of injury (76.67%). Men constituted 66.67% of the cases, with the right side more commonly affected. Conclusion: The use of LCP in managing distal femur fractures shows promising results, with faster healing and improved functional outcomes. This approach is effective in providing stability, reducing infection rates, and ensuring secure fixation, making it a valuable method in modern orthopedic practice.

DOI: 10.5281/zenodo.

Background: Liver abscess, a significant cause of morbidity in tropical regions, may arise from pyogenic, amoebic, or mixed infections, with amoebic liver abscess (ALA) often treated medically. In resistant cases, the treatments used are usually more invasive. Initially considered the sole treatment, surgical drainage has gradually been replaced by percutaneous needle aspiration and even by percutaneous catheter drainage, and there is an ongoing debate on which is the best. Objective: To assess the effectiveness and safety of PCD with PNA for the treatment of pyogenic liver abscess in terms of clinical outcomes, complication rates, and success in the overall procedure. Materials and Methods: This was a retrospective cohort study where 78 patients were diagnosed with a pyogenic liver abscess. Those patients were divided into PNA or PCD groups, and clinical and demographic details were documented appropriately. Both procedures were performed with ultrasonic guidance, and standard antibiotic treatment was given to the patients involved. The process was then followed by follow-ups, and data analysis used independent t-tests, which resulted in a p < 0.05 significance level. Results: These patients in the PCD group had clinical improvement faster (3.5 ± 0.9 days vs. 4.8 ± 1.2 days, p = 0.021), and they had a shorter time spent in the hospital (7.4 ± 2.1 days vs. 10.1 ± 2.8 days, p = 0.043) compared to those in the PNA group. The resolution of the abscess was much faster in the PCD group than that was observed in the PNA group, and fewer required repeat procedures at 12.8% vs. 30.8%, p = 0.045. Conclusion: Although PCD is more effective than PNA in the treatment of pyogenic liver abscesses, patients recover faster and there are fewer complications related to the procedure.

DOI: 10.5281/zenodo.

Background: Kidney infections, or pyelonephritis, are often caused by bacteria from the urinary tract and primarily affect females and pregnant individuals. Advances in imaging and treatment have improved diagnosis and reduced complications, yet managing upper urinary tract infections remains challenging. Aim: This study investigates the incidence of renal and perirenal infections and evaluates medical and surgical strategies to reduce morbidity and mortality. Methodology: A retrospective, observational study was conducted at Department of General Surgery,  Jannayak Karpoori Thakur Medical College and Hospital, Bihar, India, involving 70 patients with suspected infections. Patients with terminal illnesses or chronic kidney diseases were excluded. Data was collected through clinical assessments, laboratory tests, and imaging, with analyses performed using SPSS. Results: Most patients were males aged 20 to 60, with urinary tract infections as the leading risk factor. Fever was common, and perirenal abscesses were found in 47.14% of cases. E. coli was the most frequently identified pathogen (40%). DJ stenting was the most common treatment (25.71%), followed by PCNL and open drainage. A notable link was observed between diabetes mellitus and perirenal abscesses. Conclusion: The study highlights key demographics and risk factors for renal infections, emphasizing the importance of targeted management strategies. Findings suggest that specific antibiotics should be used against prevalent pathogens like E. coli to improve patient outcomes.

DOI: 10.5281/zenodo.

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, particularly following cesarean sections. Oxytocin has long been the standard uterotonic agent for preventing PPH, but its stability at room temperature is limited, making its use challenging in resource-limited settings. Carbetocin, a longer-acting oxytocin analog stable at room temperature, has emerged as a potential alternative. This study compares the efficacy and safety of room-temperature stable carbetocin with oxytocin for the prevention of PPH in women undergoing cesarean sections. Methods: A randomized controlled trial was conducted over 12 months at Department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India . A total of 100 women undergoing elective or emergency cesarean sections were randomly assigned to receive either 100 µg of carbetocin (n=50) or 10 IU of oxytocin (n=50) immediately after the delivery of the baby. The primary outcome was the incidence of PPH, defined as blood loss ≥1000 mL. Secondary outcomes included the need for additional uterotonic agents, the incidence of side effects, and the length of hospital stay. Results: The incidence of PPH was significantly lower in the carbetocin group (6.0%) compared to the oxytocin group (14.0%) (p<0.05). The need for additional uterotonics was also lower in the carbetocin group (8.0% vs. 22.0%, p<0.05). Both groups had similar side effect profiles, with no significant differences in the incidence of nausea, vomiting, or hypotension. The length of hospital stay was slightly shorter in the carbetocin group, but this difference was not statistically significant. Conclusion: Room temperature stable carbetocin is more effective than oxytocin in preventing postpartum hemorrhage in women undergoing cesarean sections, with a comparable safety profile. Its stability at room temperature makes it a valuable option, particularly in resource-limited settings where cold chain maintenance is challenging.

DOI: 10.5281/zenodo.

Aim: The aim of the present study was to compare different cord clamping timing (immediate cord clamping, delayed cord clamping and umbilical cord milking) in preterm infants delivered by caesarean section (CS). Material & Methods: The randomized controlled clinical trial was conducted at Department of Obstetrics and Gynaecology, Jannayak Karpoori Thakur Medical, College and Hospital, Madhepura Bihar, India for the duration of 1 year. Pregnant women at less than 32 weeks’ gestation admitted for caesarean section were enrolled in the study. A total of 150 patients with gestation age 32 weeks or less delivered by cesarean section that met inclusion criteria were enrolled in this study. Results: Each group (immediate cord clamping, delayed cord clamping and umbilical cord milking) consisted of 50 neonates.   The mean gestation age of studied infants was 32.78±1.58 weeks, 31.77±1.07 weeks and 30.42±1.48 in all the three groups, respectively.  Their birth weight was 1218±44 grams, 1152±136 grams and 1166±192 grams respectively. There was girls’ predominance. The infants in three groups were similar with respect to baseline characteristics. The mean hemoglobin was significantly higher in UCM group at admission and 30 days after birth (P<0.05). 66%, 56% and 72% patients needed surfactant therapy in all the three groups respectively. 22%, 20% and 6% needed mechanical ventilation in all the three groups respectively. Conclusion: UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.

DOI: 10.5281/zenodo.

Aim: Revealing the prognosis of the foetus by analysing the cerebral-placental ratio using Doppler ultrasonography in cases of hypertension pregnancy to get predictive knowledge. Materials and Methods: A retrospective study was conducted in conducted in the Department of obstetrics and Gynaecology, Bhagwan Mahavir institute of medical Science, Pawapuri, Nalanda, Bihar, India for July 2023 to December 2023. 200 Antenatal women of 18-35 years old, with singleton, cephalic presentation having Gestational age 36 weeks to 40 weeks diagnosed as hypertensive disorder of pregnancy were included. An ultrasound scan for fetal presentation, placental localization, fetal heart rate, approximate period of gestation, pulsatility index (PI) of Umbilical artery (UA) and Middle cerebral artery was calculated. Cerebroplacental ratio was calculated from Middle cerebral artery pulsatility index and Umbilical artery pulsatility index. Patients were divided into two groups depending on Cerebroplacental ratio. To test the validity of CPR sensitivity, specificity and Positive Predictive Value, Negative Predictive Value for Adverse Fetal and Neonatal Outcome was calculated. The statistical significance was kept at p<0.05. Results: Out of 200 patients, 76 women had no antenatal complication in which 1 women had CPR ratio <1. Out of 104 women with FGR, 49 (89.09%) women had CPR <1. 6 women had FGR with oligo in which 4(7.27%) women had CPR <1. 8 patients had oligohydramnios, 2 patients had abruption and one women had FGR with abruption, all these 17 women had CPR >1. Out of 2 women with eclampsia, one women had CPR <1. One women with eclampsia with FGR with oligo had CPR >1. While studying the diagnostic accuracy of CPR for prediction of neonatal complications, it was observed that sensitivity, specificity, PPV, NPV and accuracy for LBW was 51.04%, 94.23%, 89.09%, 67.59% and 73.50% respectively, for RDS was 57.14%, 75.98%, 21.82%, 93.79% and 74.0%, respectively. In the same order, for neonatal death, the recordings were, 81.82%, 79.21%, 32.73%, 97.24% and 79.50%, respectively. For MAS, the order of the parameters was, 57.14%, 73.58%, 7.27%, 93.97% and 73.0% (Table 6 & Figure 1). CPR (MCA PI/UA PI) was found to be most specific (94.23%) and positive predictive value (89.09%) in predicting low birth weight. Conclusion: In conclusion, CPR emerges as an important tool in assessing fetal well-being and predicting adverse outcomes in hypertensive pregnancies, offering insights that can guide clinical management and improve neonatal outcomes.

DOI: 10.5281/zenodo.

Aim: To investigate the maternal and perinatal outcomes in women with pregnancy-induced hypertension based on their blood LDH levels, comparing those with normal levels to those with high levels. Material and methods: A retrospective study, conducted in the Department of obstetrics and Gynaecology, Bhagwan Mahavir institute of medical Science, Pawapuri, Nalanda, Bihar, India from August 2023 to Feb 2024.  Pregnant women between 18-35 years, singleton pregnancy, ≥20weeks of gestation with pregnancy induced hypertension were included in this study. All women eligible for the study were explained about the study. An informed consent was taken from all the patients for inclusion in the study. Blood was collected for analysis along with routine blood investigations. LDH levels was estimated in Erba biochemical fully automated analyzer by using Kinetic UV test. Results: In our study with serum LDH <600 with urine albumin 2+ was 16%, 1+ in 15%, nil in 11%, traces in 5% and 3+ in 4%. Serum LDH between 600 to 800 with urine albumin 1+ in 23%, 2+ and nil with 3% each. Serum LDH >800 with urine albumin 1+ and 2+ is 9% each, with 3+ and nil in 1% each. p value is 0.001 which is statistically significant. In our study serum LDH <600 had abruption with PPH, DIC, eclampsia and PPH in 2% each, with serum LDH 600-800 had PPH in 6.9% and with serum LDH >800 had PPH in 5% cases. p value is 0.85 which is statistically not significant. In our study serum LDH<600 underwent elective LSCS in 47.1%, NVD in 47.1%, emergency LSCS in 3.9% and forceps assisted vaginal delivery in 2%. Serum LDH 600-800 underwent NVD in 72.4%, elective LSCS in 24.1% and emergency LSCS in 3.4%. serum LDH >800 underwent elective LSCS in 55%, NVD in 40% and emergency LSCS in 5%. p value is 0.286 which is statistically not significant. Conclusion: Higher LDH levels are indicative of maternal and fetal complications. higher serum LDH levels more than 500 IU/L to 600 to 800 IU/L have closer association with severe preeclampsia. Pre-eclampsia patients with raised LDH levels should be closely monitored.

DOI: 10.5281/zenodo.