Background: Pharmacotherapy is an integral part of combating a disease or its symptoms. Drug therapy for a disease has two sides: one is beneficial and the other is harmful. For this, there is a branch for monitoring these types of adverse drug reactions known as Pharmacovigilance. Every healthcare professional should actively participate in pharmacovigilance programs by reporting Adverse Drug Reactions (ADRs) properly instead of only managing the patients. Worldwide reports of ADRs are kept up to date in an international database maintained by the Uppsala Monitoring Centre (UMC, WHO), located in Sweden. Pharmacovigilance programs require attention and evaluation regularly for ADR reporting among new-comer healthcare Personnel in the medical field. Objective: To assess the knowledge, attitude, and practice (KAP) regarding pharmacovigilance among healthcare Personnel working at a teaching institute’s hospital. Materials and Methods: Across-sectional study was conducted using a pre-designed, semi-structured pre-tested questionnaire based KAP study was carried out among healthcare Personnel after approval from Institutional Ethics Committee. Result: A total of 560 participants participated and filled up questionnaires. 97.10% of participants knew about pharmacovigilance and 94.50% of participants knew how to fill out the ADR form. Resident doctors’ knowledge was found higher compared to nursing staff while undergraduate students’ knowledge was found higher compared to intern doctors. Significant difference in attitude was observed between different sub-groups of health care Personnel. 69.64% of participants reported the ADR to their superior or any authority and 95.40% encouraged patients to report any unusual symptoms or reactions they experienced with medications. However, there was a gap between identifying and reporting ADRs. Conclusion: Most healthcare Personnel knew about the concept of pharmacovigilance, the role of pharmacovigilance in post-marketing surveillance, the national pharmacovigilance centre or authority in a country, and also knew how to fill out the Suspected ADR form, but the practice of reporting ADR was relatively poor.

DOI: 10.5281/zenodo.

Introduction: Uveitis, a leading cause of blindness, often causes complications like cataracts and glaucoma due to recurrent episodes. This prospective study aims to compare the efficacy of corticosteroids, immunosuppressants, and biologics in preventing uveitis recurrence, focusing on recurrence rates, visual acuity, and treatment-related complications to optimize therapeutic strategies. Methods: This prospective observational study, approved by the ethics committee, assessed the efficacy of systemic corticosteroids, immunosuppressive agents, and biologics in preventing uveitis recurrence. Patients aged 18-65 with non-infectious uveitis were included. Outcomes measured included recurrence rate, time to recurrence, visual acuity, and adverse effects over 12 months. Results: Biologic therapy demonstrated the lowest recurrence rate (20%) and longest time to recurrence (10.5 months), with significant visual acuity improvement (0.20 LogMAR; p = 0.03). Corticosteroids had the highest adverse effects (50%), particularly cataracts (20%). Biologics were the most effective and safest treatment for preventing uveitis recurrence. Conclusion: Biologic therapy is the most effective treatment for preventing uveitis recurrence, offering the lowest recurrence rates, the longest time to recurrence, and the greatest improvement in visual acuity. Additionally, it has the fewest adverse effects, making it a safer option compared to corticosteroids.

DOI: 10.5281/zenodo.

Background: The sacral hiatus, an essential anatomical structure located at the caudal end of the sacral canal, exhibits significant morphological and morphometric variability. These variations are crucial for clinical procedures such as caudal epidural anaesthesia. Understanding the anatomical variability of the sacral hiatus can help improve the success rate of regional anaesthesia and minimize procedural complications. Methods: A cross-sectional study was conducted on 40 dry human sacra obtained from medical colleges in the surrounding region. The shape, apex, and base location of the sacral hiatus were analysed, along with morphometric measurements including length, breadth, and anteroposterior diameter. All measurements were performed using Vernier calipers (accuracy 0.1 mm). The data were statistically analysed to determine mean, standard deviation, and frequency distribution. Results: The inverted U shape (50%) was the most common sacral hiatus shape, followed by inverted V (32.5%), irregular (15%), and dumbbell (2.5%). The apex of the hiatus was predominantly located at the 4th sacral vertebra (50%), with the base most commonly at the 5th sacral vertebra (60%). The mean length of the hiatus was 32.5 mm ± 9.8 mm, the breadth ranged from 8 mm to 22 mm (mean 15.4 mm ± 3.1 mm), and the anteroposterior diameter at the apex averaged 6.4 mm ± 1.3 mm. Conclusion: The study confirms significant anatomical variability in the sacral hiatus, which is clinically relevant for anesthesiologists and surgeons performing caudal epidural blocks and other sacral procedures. The findings highlight the need for careful pre-procedural anatomical assessment to improve procedural success rates and minimize complications.

DOI: 10.5281/zenodo.

Background: Acute diarrhea is widespread in children from rural populations. It is one of the leading causes of morbidity and mortality in children below five years of age. The current study aimed to determine the factors associated with acute diarrhea in children under five years presenting to our tertiary care teaching hospital. Methods: 150 cases of acute diarrhea were selected based on the inclusion and exclusion criteria. Acute diarrhea was defined as having three or more episodes of loose stools in 24 hours within the past week. A similar number of control cases were included who attended the OPD because of other issues unrelated to gastrointestinal diseases. Results: This study examined risk factors for childhood diarrhea, comparing 120 cases and 120 controls. Cases were slightly younger (mean 2.8 years vs. 3.5 years). Rural residence was significantly associated with diarrhea (AOR 1.6, 95% CI 1.1–3.2, p=0.012). Unsafe water sources (AOR 1.7, 95% CI 1.2–3.3, p=0.021), lack of sanitation (AOR 1.5, 95% CI 1.1–2.5, p=0.030), and inadequate garbage disposal (AOR 1.2, 95% CI 1.0–2.2, p=0.023) also emerged as independent risk factors in multivariate analysis. While univariate analysis suggested associations with male sex (OR 1.9, 95% CI 1.2–4.1, p=0.02), this was not significant after adjusting for other factors. These findings highlight the importance of environmental and sanitation interventions in diarrhea prevention. Conclusion: This study identified key risk factors associated with acute childhood diarrhea in a middle-income country. Multivariate analysis revealed that rural residents, unsafe water sources, lack of sanitation facilities, and inadequate garbage disposal were independently associated with an increased risk of diarrhea. These findings underscore the critical role of environmental factors and sanitation in the transmission of diarrheal disease.

DOI: 10.5281/zenodo.

Introduction: Organophosphorus (OP) poisoning is a critical public health issue, particularly in agricultural regions like Gujarat, where pesticide exposure is prevalent. The easy availability of OP compounds has led to widespread misuse for both intentional and accidental poisoning, contributing significantly to toxicological emergencies worldwide. Materials and Methods: This hospital-based descriptive study was conducted over 12 months in the Department of Internal Medicine at a tertiary care center in Western Gujarat to evaluate the incidence, clinical presentation, management, and outcomes of OP poisoning in patients over 13 years old. Patients with confirmed OP exposure and serum cholinesterase levels below 8 U/ml were included, while those with mixed poisoning, chronic diseases, or pregnancy were excluded. Data collection included demographics, exposure history, clinical and lab findings, treatment, and outcomes. Statistical analysis used descriptive methods (p<0.05) to summarize findings. Results: Our study found a mean patient age of 35.72 ± 11.4 years, with 63.46% in the 21-40 age group. Males slightly predominated (53.85%, M: F = 1.17:1). Housewives (29.81%) and laborers (27.88%) were the most affected occupational groups. Suicidal intent was the leading cause (79.81%), with 20.39% of cases being accidental. 42.31% of patients sought care within 4-6 hours, while 34.61% had delayed presentation (>6 hours). Phorate (18.27%) and Malathion (16.35%) were the most common OP compounds. Nausea/vomiting and excessive salivation (24.46% each) were frequent symptoms. 63.46% required ventilatory support, with 42.31% presenting a GCS <8, indicating severe impairment. Serum cholinesterase levels were mostly 2001-5000 IU/L (47.12%), with 8.57% in the severe poisoning category (<1000 IU/L). Conclusion: Our study highlights the significant burden of organophosphorus poisoning, predominantly affecting young adults with suicidal ingestion as the leading cause. Early hospital presentation and timely intervention are crucial in reducing morbidity, especially in cases requiring ventilatory support. Strengthening mental health awareness and regulating pesticide use can help mitigate the risks associated with OP poisoning.

DOI: 10.5281/zenodo.

Introduction: Speech problems in children aged 6 months to 5 years arise from genetic, neurological, environmental, and psychosocial factors. Early diagnosis and intervention are crucial for improving speech, cognitive, and social development. Material and Methods: This observational study was conducted in the Pediatric OPD of a tertiary care center in Western Gujarat to analyze the clinico-etiological profile of speech problems in children aged 6 months to 5 years. Children with speech delays or disorders were included, while those with syndromic, neurological, or uncorrected hearing impairments were excluded. Data collection involved developmental history, audiological assessments (OAE, BERA), speech evaluations, and physical examinations. Ethical approval was obtained, and informed consent was secured from parents. Data were statistically analyzed using appropriate tests, with significance set at p < 0.05. Results: The study findings revealed that developmental delay (51.7%) was the most common outcome among children with speech problems, followed by speech language disorder (22.7%) and speech sound disorder (8.7%). The majority of children belonged to the 1–3 years age group (57.3%), with a slight male predominance (54.7%). Maternal education and socioeconomic status were significant factors, with most mothers having middle school education (44.7%) and 47% of families belonging to the lower-middle class. Nutritional assessment showed 25.3% had moderate acute malnutrition, and 8.3% of children required further evaluation for hearing defects. The DDST screening identified delays in 61.3% of cases, reinforcing the link between speech problems and developmental delays. Conclusion: Early identification and intervention are essential for addressing speech problems in young children, as multiple intrinsic and extrinsic factors contribute to delays. Timely diagnosis and targeted therapy can significantly enhance speech, cognitive, and social development.

DOI: 10.5281/zenodo.

Introduction: Idiopathic membranous nephropathy (IMN) is a common cause of proteinuria and nephrotic syndrome (NS) in adults. In a large multicentric retrospective study, 32% of patients with IMN were found to achieve spontaneous remission 14 months after diagnosis. Aims:To calculate the remission rates (partial and complete) in patients of resistant or relapsing primary membranous nephropathy presenting to the Department of Nephrology, Sri Rama Chandra Bhanja Medical College, Cuttack. Materials and Method: The present study was a hospital based prospective study. This Study was conducted from December 2019- January 2021 at Nephrology, SCB Medical College, Cuttack. Total 21 patients were included in this study. Result: The mean age of patients was 33+/-12.3 years and 33.3% were females. Two patients had associated diabetes and eight had hypertension. Mean proteinuria before RTX therapy was 6.2 +/-2.2 g/day. Two patients had less than nephrotic range proteinuria (3.4 g/day) but were symptomatic with edema and responded to treatment subsequently. Conclusion: In conclusion, the use of anti-CD20 antibodies in patients with resistant or relapsing primary membranous glomerulopathy (PMG) shows promising potential as a therapeutic strategy. Early evidence suggests that these antibodies may help in reducing proteinuria and stabilizing renal function, particularly in cases where conventional treatments have failed.

DOI: 10.5281/zenodo.

Background: Ovarian tumors encompass a diverse spectrum of neoplasms arising from the histological complexity of the ovary. While the majority are benign, their malignant counterparts pose significant diagnostic and therapeutic challenges. This case series highlights six unusual ovarian tumors, underscoring the critical role of histopathological evaluation in unraveling their complex nature. Methods: This case series involves six patients presenting with varied symptoms, including abnormal uterine bleeding and abdominal pain. Comprehensive clinical evaluation and histopathological examination were performed to establish definitive diagnoses. Results: The cases included: Granulosa Cell Tumor (GCT), Benign Brenner Tumor, Collision Tumor ( Leydig Cell Tumor with Benign Cystic Teratoma), Seromucinous Cystadenoma with Brenner Tumor, Seromucinous Cystadenoma with Osseous Metaplasia, Ovarian Fibroma. Discussion: These cases emphasize the unpredictable nature of ovarian tumors, including rare histological patterns, mixed tumor types, and unusual features like osseous metaplasia. GCTs, Brenner tumors, and ovarian fibromas highlight the importance of recognizing specific histopathological hallmarks. Rare combinations, such as collision tumors and associated neoplasms, offer insights into ovarian tumor biology and shared origins. Conclusion: Histopathological examination remains the cornerstone of ovarian tumor diagnosis, offering insights into tumor biology and guiding management. The unpredictable coexistence of tumor types and rare features underscores the need for vigilance and a multidisciplinary approach in ovarian pathology.

DOI: 10.5281/zenodo.

Psychological stress, duty overload, and social isolation are just a few of the ways in which alcoholic spouses bear the weight of their families. Living with an alcoholic spouse presents these ladies with significant emotional difficulties. Their stress and anxiety levels are already high from juggling all these responsibilities, including being an earner and carer. Loneliness is exacerbated by social stigma and the absence of networks of support. In order to create treatments and support systems that help these women and promote healthy family relations, it is crucial to understand these complexities. The impact of alcoholism on loved ones is the focus of this research article.

DOI: 10.5281/zenodo.

Background: Thyroid function tests (TFT) and markers of oxidative stress are crucial for understanding how the body works, evaluating the thyroid gland’s functionality, and diagnosing main thyroid issues such hypothyroidism. Objective: The purpose of this research was to evaluate oxidative stress markers and thyroid function tests in hypothyroidism patients. Materials and Methods: The Department of Biochemistry recruited 200 adults (ranging in age from 25 to 55) to take part in the study. One hundred healthy individuals and one hundred patients diagnosed with hypothyroidism made up the initial set of participants. The purpose of this study was to identify persons with a clinical diagnosis of hypothyroidism and who were treated with medication during the last five years. The participants should have been between the ages of 25 and 55. The research did not accept participants who were either under the age of 25 or above the age of 55, or who were pregnant, had just undergone surgery, had a chronic disease, or had a pre-existing medical condition. Results: The findings indicated that the levels of every thyroid profile evaluation differed statistically substantially between the hypothyroid group and the control group. The following variants were present: T3, T4, fT3, fT4, and TSH. People in the control group exhibited far lower malondialdehyde (MDA) levels than those in the hypothyroid group. The TAC group is hypothyroid when compared to the healthy control group. However, when comparing NO levels in hypothyroid and control individuals, we did not find any statistically significant changes. Conclusion: One kind of thyroid malfunction that significantly affects oxidative stress markers and overall health is hypothyroidism. It alters cardiac function, antioxidant metabolism, and hormone metabolism. To reduce the chance of cardiovascular problems, cardiac risk factors must be identified and managed as soon as possible.

DOI: 10.5281/zenodo.

Background: Thyroid lesions are among the most prevalent endocrine disorders, often presenting as goiter. Their etiology spans a spectrum from physiological hypertrophy to neoplastic processes, necessitating precise histopathological differentiation to guide therapeutic interventions. Objectives: This study evaluates the histomorphological characteristics of various thyroid lesions and investigates the diagnostic efficacy of CD56 immunohistochemical expression in distinguishing benign from malignant thyroid pathologies. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology, MAPIMS, Melmaruvathur, over a two-year period. Thirty-five thyroidectomy specimens were analyzed, comprising 18 benign and 17 malignant lesions. Histopathological evaluation was performed alongside CD56 immunohistochemical staining. Statistical analysis assessed the discriminative value of CD56 in thyroid lesion classification. Results: A female predominance (85.7%) was observed, with the highest incidence in the 31-40-year age group. CD56 was strongly expressed in 94.4% of benign lesions, except for a single follicular adenoma (5.5%) that was negative. In contrast, all cases of classic papillary thyroid carcinoma (PTC) (100%) and 57.1% of follicular variant PTC (FVPTC) lacked CD56 expression, demonstrating statistical significance (P=0.02). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CD56 in differentiating benign from malignant lesions were 82.3%, 94.4%, 93.3%, 85.0%, and 88.6%, respectively. Conclusion: CD56 is a robust negative marker for PTC and provides a valuable adjunct in differentiating malignancies from benign thyroid lesions, thereby enhancing diagnostic precision and mitigating the risk of over diagnosis.

DOI: 10.5281/zenodo.

Objectives: The present study aims to assess the antibacterial activity of raw and commercially available Jambul honey on MBL producing Pseudomonas aeruginosa from wound infection. Honey was selected as it possesses antibacterial activity. Methods: The isolated organisms were identified and the screened for MBL production which was confirmed by Imipenem (IMP)-EDTA combined disc test. The antibacterial activity of varying concentration of honey was tested against the isolated Pseudomonas aeruginosa by Agar Well Diffusion method. Results: 18 MBL producing Pseudomonas aeruginosa were isolated. Raw and commercially available honey both were tested on the 18 isolates, all of which showed inhibition at a concentration of 20% of honey. Conclusion: The study showed that both Raw and Commercially available Jambul honey were effective against Imipenem resistant MBL producing Pseudomonas aeruginosa which were isolated from wound infections. Raw honey showed slightly better results as compared to commercially available honey.

DOI: 10.5281/zenodo.

Background: Delayed postpartum hemorrhage is a less often encountered entity with an incidence of 0.2- 2 %. Choriocarcinoma following term pregnancy is a malignant and highly aggressive form of gestational trophoblastic neoplasia that presents as bleeding and can very often be misdiagnosed leading to inappropriate treatment causing serious morbidity in the mother. Case: A 37-year-old parity 4 living 4, post cesarean delivery presenting with secondary PPH underwent curettage followed by persistent bouts of bleeding. Diagnosis of Gestational Trophoblastic Neoplasia was made based on clinical examination, imaging and rising trend of β-hCG. She later underwent hysterectomy with bilateral salpingectomy, and histopathology reports were consistent with Choriocarcinoma. β-HCG, however, showed an increasing trend following week 8 of follow-up, and the patient was subsequently managed with 5 cycles of single-agent chemotherapy with Methotrexate. Conclusion: Choriocarcinoma presenting as postpartum hemorrhage is a rare entity that should be kept in mind as an important differential with prompt recognition and initiation of treatment at the earliest after risk assessment with standard and individualized protocols.

DOI: 10.5281/zenodo.

Gentamicin is an aminoglycoside antibiotic used to treat a variety of bacterial infections, but have adverse effects on the kidneys. When administered, it is excreted in the urine, which means that kidney cells are almost constantly exposed to it. Prolonged use or high doses of gentamicin can lead to progressive kidney failure. Variety of herbal plants can be used for the prevention and treatment of kidney damage. Therefore, the nephroprotective activity of alcoholic extract of Cichorium intybus (200 and 400 mg/kg) was evaluated on gentamicin (80 mg/kg) induced nephrotoxicity in albino rats. The study period was from 0- 10 days and blood samples were collected at 10th day. Serum urea and creatinine are the reliable markers to access the renal function. The results were analysed by ANOVA. The gentamicin caused a significant (p ≤ 0.01) increase in levels of serum urea, creatinine and blood urea nitrogen. Statistically significant decrease in levels of serum urea, creatinine and blood urea nitrogen was observed in the Chicorium intybus extract treated group as compared to gentamicin treated. Results revealed significantly improved renal cortical histopathology and kidney weight. The findings suggested that ethyl acetate fraction of alcoholic extract of Cichorium intybus root have marked nephroprotective activity in dose dependent manner.

DOI: 10.5281/zenodo.

Background: Road traffic injuries (RTIs) are a leading cause of morbidity and mortality, particularly in developing countries. Non-poly-traumatized RTI cases, involving isolated injuries, are often studied less. Objective: This study aimed to assess the characteristics, outcomes, and exit patterns of non-poly-traumatized RTI patients in the emergency department of a tertiary healthcare facility in South Gujarat. Material and Methods: A retrospective analysis was conducted on 790 RTI patients presenting to the emergency department from February 2023 to January 2024. Demographic details, injury types, and exit patterns were assessed. Results: The study found that the majority of RTI patients were young adults, with a higher incidence of injuries in males. Head injuries and fractures were the most common. A considerable proportion of patients were admitted to the ward, with a low mortality rate. Conclusion: Timely medical intervention plays a crucial role in improving patient outcomes. Understanding exit patterns can help optimize trauma care protocols in emergency departments.

DOI: 10.5281/zenodo.

Background and Aim: Diabetic foot ulcers (DFUs) represent a prevalent and significant complication associated with diabetes, especially in India. This research focuses on assessing the clinical and bacteriological characteristics, as well as the treatment results, of diabetic foot ulcers in patients receiving care at a tertiary hospital in Gujarat. Material and Methods: A cross-sectional study took place between February 2023 and May 2024, involving 155 patients with diabetes who were experiencing foot ulcers. Information regarding demographics, microbiological results, and treatment outcomes was gathered and examined. Results: The findings indicate that most patients experienced positive outcomes, although a significant number still needed debridement procedures. The most frequently identified pathogens were gram-negative bacteria. A troubling mortality rate of 15.5% was noted, with 5.8% of patients opting to leave against medical advice. Conclusion:  The importance of timely intervention and effective management of infections cannot be overstated when it comes to enhancing outcomes for diabetic foot ulcers. Addressing the challenges of rural healthcare is essential for improving access to care and ensuring treatment adherence.

DOI: 10.5281/zenodo.

Background: Myocardial infarction (MI) remains a leading cause of mortality and morbidity worldwide, with multiple risk factors contributing to the development of ischemic heart disease. Although diabetes mellitus and hypertension are well-known risk factors, there is growing evidence that microalbuminuria—an indicator of early renal dysfunction and endothelial injury—may also be associated with cardiovascular events. Dyslipidemia further contributes to atherosclerotic plaque formation, but data remain limited regarding the combined role of microalbuminuria and serum lipid profile in nondiabetic, nonhypertensive patients with MI in the Alwar District. Methods: This cross-sectional observational study enrolled 100 patients diagnosed with acute MI at a tertiary care hospital in Alwar District. Only patients who were confirmed to be nondiabetic and nonhypertensive were included. Urinary albumin excretion was measured using the immunoturbidimetric method to assess microalbuminuria. Fasting lipid profiles were evaluated to determine serum total cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Data were analyzed to assess the relationship between microalbuminuria, lipid parameters, and the occurrence of MI. Results: Microalbuminuria was detected in a significant proportion of patients (42%), even in the absence of diabetes or hypertension. Patients with microalbuminuria demonstrated higher serum LDL levels, lower HDL levels, and more frequent dyslipidemia. Furthermore, microalbuminuria correlated positively with increased triglycerides and total cholesterol levels. Statistical analysis revealed that microalbuminuria independently predicted adverse lipid profiles, suggesting an underlying endothelial dysfunction pathway. Conclusion: Microalbuminuria appears to be an important marker of cardiovascular risk in nondiabetic, nonhypertensive MI patients. The coexistence of microalbuminuria and dyslipidemia underscores the need for routine screening and vigilant management of these parameters to optimize cardiovascular outcomes.

DOI: 10.5281/zenodo.

Background: Budd-Chiari syndrome (BCS) is a rare and complex condition caused by hepatic vein obstruction, leading to liver dysfunction. The diagnosis is often challenging due to its nonspecific symptoms. Objective: This study aims to evaluate the role of non-invasive imaging techniques in diagnosing and managing BCS, focusing on Doppler ultrasound, MRI, and CT angiography. Material and Methods: A systematic review of the available literature on the diagnostic capabilities of imaging modalities in BCS was conducted. Various imaging techniques were compared for their effectiveness in detecting hepatic vein thrombosis and related complications. Results: Non-invasive imaging techniques, including Doppler ultrasound, MRI, and CT angiography, significantly enhance the diagnostic accuracy of BCS. MRI and CT angiography provide detailed anatomical information, while Doppler ultrasound is effective for initial screening. Conclusion: Non-invasive imaging is essential for the timely diagnosis, monitoring, and management of BCS. Accurate imaging techniques help in detecting abnormalities and guiding treatment strategies.

DOI: 10.5281/zenodo.

Introduction: Total hip arthroplasty (THA) is a common orthopedic procedure with high success rates; however, complications leading to revision THA (rTHA) vary significantly with patient characteristics, particularly Body Mass Index (BMI). Aim: This study aims to explore the disparate modes of failure in THA across different BMI categories to understand how underweight and obese patients are differently affected. Methods: Conducted at Jawahar Lal Nehru Medical College & Hospital from February 2021 to January 2022, this retrospective observational study included 180 patients who underwent THA. Patients were classified into BMI categories (underweight, normal, overweight, obese) to compare postoperative complications and rTHA causes. Results: Obese patients were more likely to undergo rTHA due to infections (16%), whereas underweight patients primarily experienced rTHA due to aseptic loosening (10%). Normal-weight patients showed the lowest complication rates. Statistical analysis revealed significant correlations between BMI categories and specific THA complications. Conclusion: BMI significantly influences THA outcomes, with obese and underweight patients showing increased risks for specific complications. Recommendation: Tailored preoperative and perioperative management strategies based on BMI can potentially improve patient outcomes and reduce the incidence of rTHA.

DOI: 10.5281/zenodo.

Introduction: Total Hip Arthroplasty (THA) has revolutionized the treatment of degenerative hip conditions, particularly arthritis, significantly enhancing patient mobility and quality of life. Accurate placement of the acetabular cup is crucial for the success of THA, as improper positioning can lead to complications. This study evaluates conventional techniques for acetabular cup positioning and their clinical outcomes. Methods: This prospective observational study involved 120 adult patients with degenerative hip diseases at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, from September 2021 to August 2022. Data on demographics, preoperative hip function, intraoperative techniques, and postoperative complications were collected and analyzed. Results: The study found that 90% of cups were positioned within the optimal anteversion range, and 83.3% within the inclination safe zone. Significant functional improvement was observed, with Harris Hip Scores increasing from 50.6 preoperatively to 91.3 at 12 months. Minimal complications were reported, including a 3.3% dislocation rate. Conclusion: The study demonstrates that conventional acetabular cup positioning techniques can achieve excellent outcomes in THA, highlighting their effectiveness and reliability in routine clinical practice.

DOI: 10.5281/zenodo.

Introduction: Patient satisfaction in total hip arthroplasty (THA) is a critical metric reflecting the quality and effectiveness of orthopedic care. This study explores various factors contributing to satisfaction, emphasizing the role of pain management, recovery outcomes, and service quality. Aim: The objective of this research was to analyze the factors that significantly impact patient satisfaction following THA at Jawahar Lal Nehru Medical College & Hospital. Methods: A prospective observational study was conducted, enrolling 204 patients over a year, from January to December 2022. Patients were assessed using a standardized questionnaire one month postoperatively to evaluate aspects such as pain management, staff interaction, and overall hospital experience. Results: The study recorded high satisfaction rates, particularly in pain management, with an average score of 4.3 out of 5. Age, length of hospital stays, and comorbidities were significant predictors of satisfaction. Younger patients and those without comorbid conditions reported higher satisfaction, while extended hospital stays correlated with lower satisfaction levels. Conclusion: Effective pain management and expedited recovery are pivotal in enhancing patient satisfaction post-THA. The study underscores the need for tailored patient care strategies to accommodate demographic and medical variabilities. Recommendation: Future research should optimize recovery protocols and reduce hospital stays to improve patient satisfaction.

DOI: 10.5281/zenodo.

Introduction: Tuberculosis of the spine, or Pott’s disease, poses significant challenges in determining the optimal duration of antitubercular therapy. Current treatment guidelines, primarily extrapolated from pulmonary TB protocols, do not adequately address the unique aspects of spinal tuberculosis. Methodology: This retrospective study analyzed 110 patients with spinal tuberculosis treated at Jawahar Lal Nehru Medical College & Hospital from August 2022 to July 2023. We evaluated clinical presentations, treatment durations, and outcomes, focusing on the effectiveness of therapy periods and the role of inflammatory markers (ESR, CRP) as indicators of treatment success. Results: The majority of patients achieved clinical resolution with treatment durations between 6 to 12 months. Extended treatment durations did not significantly enhance outcome efficacy but were associated with higher relapse rates. Significant reductions in ESR and CRP were noted, correlating with successful treatment outcomes. Conclusion: Shorter treatment regimens are effective in managing spinal tuberculosis, suggesting potential modifications to current prolonged therapy approaches. The study supports using ESR and CRP levels as reliable biomarkers to guide treatment duration. Recommendation: It is recommended that treatment guidelines be revised to consider shorter, evidence-based therapy durations for spinal tuberculosis, with regular monitoring of inflammatory markers to tailor individual treatment plans.

DOI: 10.5281/zenodo.

Background: Chronic low back pain (CLBP) reduces quality of life and costs money. For persistent instances, spinal fusion surgery is considered after conservative therapy. Clinical outcomes of spinal fusion in CLBP patients at Jawaharlal Nehru Medical College & Hospital were examined in this study. Methods: This prospective observational study included 150 people with CLBP for over six months who had failed conservative therapy. At baseline, 3, 6, and 9 months after spinal fusion surgery, the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) assessed pain and function. Results: VAS and ODI scores improved significantly during the research. The mean VAS score dropped from 8.2 to 2.8 at 9 months, and the mean ODI score dropped from 62 to 22. 85% of patients were satisfied with surgery results. Conclusion: VAS and ODI scores improved significantly during the research. The mean VAS score dropped from 8.2 to 2.8 at 9 months, and the mean ODI score dropped from 62 to 22. 85% of patients were satisfied with surgery results.

DOI: 10.5281/zenodo.

Background: Blueprint in curriculum is specification of assessment items based on educational outcome. It helps to make assessment clear, explicit and transparent to everyone involved in the process of learning. Aim: The aim of the study was to prepare a blueprint of assessment for Biochemistry subject of I year MBBS students and to test its utility. Methodology: The study was carried out with 750 students in the biochemistry department of PIMS, Udaipur. Standard blueprint involves calculation of impact by multiplying frequency and importance of the diseases to be asked in the examination. Modified method was adopted to suit preclinical subjects. In place of frequency and importance biochemical and clinical importance were used. Feedback of 8 reviewers and students on 5 points Likert scale was obtained. Results: Final Blueprint for paper I and paper II of biochemistry subjects were prepared. The blueprint prepared was well perceived and rated high by faculties as well as students. Conclusion: Blueprint should be executed as it establishes balance between teaching learning and improves validity, reliability and acceptability of assessments.

DOI: 10.5281/zenodo.

Aims: To compare the additive effect of Intrathecal Dexmedetomidine to levobupivacaine in spinal blockade characteristics, sedation score, hemodynamic parameters, postoperative analgesia and complications. Settings and Design: Tertiary care hospital. Double blind randomized control study. Methods and Material: A  prospective   randomized  study  was  carried  out  in  60  ASA I  and  II  patients  undergoing  tibia orthopaedic surgery  under  subarachnoid  block.  Patients were randomly allocated into two groups of 30 each.  In  Group L, patients  received  Levobupivacaine 0.5% 3ml with normal saline 0.5ml and Group LD  received Levobupivacaine 0.5% 3 ml with Dexmedetomidine 0.5 ml(10 μg). Statistical analysis used: Software used- Medcalc statistical software. Data presented in mean ±SD form. Parametric data was analysed by student ‘t’ test. Non parametric data by Chi square test for two groups. Significance of ANOVA was judged as follows- p> 0.05 not significant, p< 0.05 significant, p< 0.01 highly significant. Results: Both groups were demographically comparable and all blocks were adequate for the proposed surgery. Sensory and motor block times were significantly prolonged in group LD. The mean duration of sensory block at L1 (169.83±25.67 minutes in Group L, 218.62 ±36.20 minutes in Group LD; P<0.001). The Duration of motor block was taken, when bromage grade became 0. It was 224.16 ± 25.93 minutes in Group L, while it was 345.86 ± 34.98 minutes in Group LD. In both the groups, number of dermatomes blocked were similar T6-8. The duration of absolute analgesia in Group L was 239.83±13.29 minutes, while in group LD, it was 363.16±19.89minutes (P<0.001) and the duration of effective analgesia in Group L was 289.83±21.79 minutes, while in group LD, it was 501.16±17.63minutes (P< 0.001). The no. of rescue analgesics given were 2.53±0.77 in Group L as compared to 1.6±0.49 in Group LD (p<0.001) during 24hr period. All patients were hemodynamically stable and no difference in adverse effects were noted. Conclusions: The addition of Dexmedetomidine 10µg to Isobaric Levobupivacaine 0.5% intrathecally modifies the sensory and motor block by shortening the onset time and prolonging the duration of block. It prolongs the duration of post-operative analgesia, decreases the need for rescue analgesics with desired sedation and stable haemodynamics.

DOI: 10.5281/zenodo.

Introduction: The understanding of AMI (Acute Myocardial Infarction) manifestations in young and elder patients is evolving, but there remains a significant need for better strategies to rapidly diagnose, risk stratify, and manage such patients. AMI in young carries higher mortality and lower morbidity as compared with elderly patients who have less mortality but higher morbidity, probably owing to the development of collaterals. However, since elderly patients have more comorbidities like heart failure, cerebrovascular accident, diabetes mellitus and hypertension the management becomes more complicated, and outcome may be adversely affected. This blanket review explores the various etiologies for acute myocardial infarction in elderly and the young adults and outlines the approach to efficient diagnosis and management for these patients in Haryana. Aims and Objectives: To explore the age-related differences in the risk factors, clinical features, management and outcome in patients having acute myocardial infarction. Objectives: 1. To determine the age-related risk factors in patients having AMI. 2. To explore the clinical features in patients having AMI. 3. To assess the management and outcome in patients having AMI. Materials & Methods: The study was an observational study to be carried out over 18 months. All consecutive patients of acute myocardial infarction attending the medicine out-patient department (OPD) / Inpatient department (IPD) admitted in different wards of medicine were recruited for the study (100 subjects were ensured). Conclusion: We found that the clinical presentation of MI differs in the two groups with the > 50 years age group having more atypical presentation than the < 50 years age group. Our study observed that smoking is a more widespread risk factor in the younger age group, followed by dyslipidemia, 2D Echocardiography had more pronounced RWMA and global hypokinesia in the > 50 years age group, The>50yeas age group patients had more incidence of complications than the < 50 years age group with more mortality.

DOI: 10.5281/zenodo.

Background: Dysfunctional Uterine Bleeding (DUB) is a common gynecological disorder with a significant impact on women’s health. Conventional treatments include medical therapy and surgical interventions such as hysterectomy and endometrial ablation. Trichloroacetic acid (TCA), a known chemical cauterizing agent, has shown potential as an alternative to existing ablative techniques. This study aims to evaluate the safety, feasibility, and efficacy of TCA as a chemical ablative agent in DUB. Methods: A cross-sectional study was conducted on 40 patients with DUB scheduled for hysterectomy. The study was divided into two parts: in vitro application on hysterectomy specimens (n=20) and in vivo application prior to hysterectomy (n=20). In vitro applications included single (n=10) and double (n=10) applications of 100% TCA, while in vivo applications involved double TCA application in all cases. Cytomorphologic and histopathologic evaluations were performed to assess endometrial destruction. Results: The procedure was feasible in all patients with no observed complications. In vitro applications showed partial endometrial destruction, with better results in the double application group. In vivo applications resulted in significant cytomorphologic changes, including cell disruption, inflammatory reaction, and hemorrhagic background. Histopathologic findings confirmed complete ablation of the superficial endometrium in 65% of in vivo cases, with tissue destruction in the basal layer observed in 35% of patients. No adverse effects on the cervix or fallopian tubes were noted. Conclusion: TCA demonstrates promise as a safe, feasible, and effective chemical ablative agent for endometrial ablation in DUB. Further clinical trials are warranted to establish its long-term efficacy and patient outcomes.

DOI: 10.5281/zenodo.

Background: Rapid urbanization is causing growth of slums in urban areas in India. People live in slums with seriously compromised health and sanitary conditions putting them at a much higher morbidity and mortality risk than non-slum population. Objectives: To estimate the availability of safe drinking water and sanitary latrine in slums of Guwahati city, Assam. Materials and Methods: A Cross Sectional Study was carried out in slums of Guwahati during August 2017 to July 2018. From 99 notified slums in Guwahati, 25% i.e. 25 slums were selected randomly. From each slum 30 households were taken. So the total sample size was 750 households. Statistical analysis was performed using Microsoft Excel 2016 software. Results: In this study, out of the 750 households, majority (82.7%) used drinking water from shared tap. Most (35%) households used filtration for purification of drinking water, most (52%) used community latrine. majority (41.3%) shared toilet with 1-10 persons. Conclusion: Most of the households in the slums had poor access to safe drinking water and sanitation facilities. Slum dwellers should be made aware of the adverse effects of poor water, poor sanitation and also about proper methods of excreta and waste disposal through health education and Behavioural Change Communication methods.

DOI: 10.5281/zenodo.

Background and Objectives: The present study evaluated the direct cost of active epilepsy and looked at the pattern of drug prescription and utilization in epileptic patients with monotherapy and polytherapy visiting in the medicine OPD of National Capital Region Institute of Medical Sciences, Meerut. Materials and Methods: A total 170 epileptic patients were studied over a period of one year (April 2023- March 2024). Patients demography, commonly prescribed antiepileptic drugs (ADEs), socioeconomic status, direct cost, response ratio for newer drugs and quality of life was evaluated. Inclusion criteria: All patients who were treated with anti-epileptic drugs admitted in different units of Medicine department. Exclusion criteria: All pregnant women were excluded. Result and discussion: We found a higher percentage of female patients (57.64%) as compared with males. Most of the patients were in the age group 31-40 years. A higher percentage (30%) of drug was prescribed in polytherapy. Conclusion: The study indicate and increasing the clinical usage of polytherapy with significant escalation in the cost of therapy.

DOI: 10.5281/zenodo.

Introduction: Anaemia is a public health challenge in India with prevalence of anaemia among under five children higher (67.1%) compared to other age groups (NFHS-5). Under Anaemia Mukt Bharat, children aged 6 to 59 months are provided with prophylactic Iron and Folic Acid (IFA) supplementation. In background of this, we aimed to estimate the coverage and compliance with prophylactic IFA supplementation among children aged 6 to 59 months and to assess the reasons for noncompliance. Methodology: A community-based cross-sectional study was conducted among 6-59 months children residing in area of a rural Primary Health Centre, Tamil Nadu. Data was collected from primary caregivers using semi-structured questionnaire. Coverage and compliance with prophylactic IFA were expressed as proportions with 95% confidence interval and their association with sociodemographic characteristics was analysed using chi-square test. Results: Among the 267 participants, mean age of children and their primary caregivers was 30.39± 14.7 months and 26.56 ± 4.01years respectively. Coverage of prophylactic IFA was 39.3% (95% CI: 33.4, 45.5) and the compliance among the children who received IFA was 74.3% (95% CI: 64.8, 82.3). The main reasons for non-compliance among covered children were smell and taste (48.1%) and non-availability of IFA syrup (29.6%). Children utilising ICDS services had higher coverage of prophylactic IFA (OR 2.22 (95% CI: 1.25,3.91), p< 0.05) than children not utilising ICDS services. Children of homemakers were more compliant with IFA intake (OR 6.48 (95% CI: 1.72, 24.33), p < 0.05) than children of employed caregivers. Conclusion: Coverage of prophylactic IFA supplementation was low among 6 to 59 months old children. Adopting a life cycle approach beginning in early childhood and continuing through adolescence and adulthood by ensuring high coverage of prophylactic IFA supplements is essential to combat anaemia.

DOI: 10.5281/zenodo.

Background: Persistent pulmonary hypertension of the newborn (PPHN) is caused by the inability of the pulmonary arteries to dilate at birth, which leads to severe hypoxemia. Several risk factors have been identified in association with its occurrence and prognosis. The present study aimed to determine the incidence of PPHN, describe neonatal characteristics, and evaluate the etiology, as well as mortality risk factors in newborns hospitalized due to PPHN at Tata main hospital, Jamshedpur from 1st July 2022 to 30th June 2023. Methods: A total of 55 neonates were included in the present prospective observational study. The diagnosis of PPHN was based on clinical criteria and echocardiogram provided by in-house Pediatric cardiologist. Thereafter, a complete history, physical examination, and laboratory data were gathered. Finally, PPHN incidence was calculated and probable risk factors and its complications were investigated by using logistic regression analysis. Results: In the center under study Tata main hospital, Jamshedpur; incidence of PPHN was about 0.16%. Male gender (74.55%) more affected, significant relationship between PPHN and mode of delivery was reported (more in cesarean section, compared to VD P-value=0.035, 95% CI: 8.44-46.55). The OSI evaluated from study (Mean±SD=4.64±3.41) and P value is <0.001 which was statistically significant. Mortality rate in 55 neonates enrolled under the study was 10.91% and 61.82% neonates were discharged. Conclusion: The incidence of PPHN was about 0.16% in the center under study, which was relatively high. Male gender, abnormal APGAR SCORE at birth and delivery via cesarean section were high in PPHN neonate. Adequate lung recruitment and alveolar ventilation is the mainstay of management in neonates with PPHN.

DOI: 10.5281/zenodo.

Breastmilk is the complete nutrient for newborn and is essential for the sustenance of growth and maturity during the neonatal period and infancy. However, a significant proportion of neonates, owing to maternal reasons and disease conditions, are deprived of breast milk along with the benefits that it provides. Pasteurised human milk from donor mothers has been proven as an excellent replacement for breast milk in terms of survival of vulnerable babies. This study highlights the role of human milk bank in reducing the disease burden of high risk newborn, while achieving low mortality rates. Introduction: Breastmilk provides optimal nutrition for growing infants and is considered the cornerstone for child survival.The primary objective of the study is to assess the impact of human milk bank on Neonatal mortality and incidence of Necrotising Enterocolitis (NEC) in babies admitted in Neonatal Intensive Care Unit, Government Vellore Medical College and Hospital. Material and Methods: A retrospective cohort study was conducted at Neonatal Intensive Care Unit of Government Vellore Medical College and Hospital by comparing two groups. One group from January 2016 to December 2016 (Pre human milk bank establishment) and another group from January 2021 to December 2021(Post human milk bank establishment). Neonatal mortality percentage is defined as the average number of neonatal deaths over the period of one year to the total number cases admitted in the particular year in percentage. Necrotising enterocolitis is diagnosed based on modified Bell’s staging applied on any baby fitting in the criteria. Sick term and preterm babies who need level 3 and level 2 care, babies developing NEC as per modified Bell’s staging, babies born to mothers with postpartum illness or died in postpartum period, babies of mothers with lactation failure and abandoned babies are included in this study. All breastfed babies in NICU, babies with lethal congenital anomaly, severe birth asphyxia, post cardiac arrest babies, babies those who were not given expressed human milk from milk bank were excluded. Statistical Methods: Data obtained regarding deliveries, live births and neonatal mortality during pre and post HMB period were compared by using standard error of difference between 2 proportions which is <0.5.Number of variables influencing NICU admission during pre and post HMB period were depicted and were compared by means of standard error of difference between two proportions which is <0.5.Study population were grouped into Group A and group B. New-borns in group A were not given donor milk and given formulas were considered as unexposed. New-born in group B were given pasteurised human milk and considered as exposed. Results: Around 10.39% of the babies died among unexposed and only 9.25% of the babies died among exposed with the relative risk (<0.9) showing positive association between the exposure (pasteurised donor human milk fed babies) and the neonatal mortality. In the unexposed group, the incidence of NEC was higher 103 (10.7%) compared to group B where it is 60 (1.7%) with the relative risk (<0.7) showing positive association between the exposure (pasteurised donor human milk fed babies) and the incidence of NEC. Conclusion: The inference from our study is that, after the establishment of an HMB, there is a trend toward a decrease in the incidence of NEC as well as neonatal death. Relative risk for mortality among the exposed group (i.e.) those given pasteurised donor milk have 0.9 times less chance of dying when compared to those babies who are formula fed in Group B. Relative risk for the incidence among exposed were 0.7 times less chance of developing NEC than those who were unexposed i.e., Group B.

DOI: 10.5281/zenodo.

Background: Polypharmacy, the concurrent use of multiple medications, is a growing concern in patients with diabetes and hypertension due to the high prevalence of comorbidities. Excessive medication use can lead to adverse drug interactions, medication non-adherence, and increased healthcare costs. Objective: This study aims to evaluate the prevalence and risk factors of polypharmacy among diabetic and hypertensive patients, identifying key contributors to excessive medication use. Methods: A cross-sectional study was conducted on 250 patients aged ≥40 years diagnosed with diabetes, hypertension, or both. Data on demographics, comorbidities, medication burden, and socioeconomic factors were collected through structured interviews and medical record reviews. Polypharmacy was defined as the use of five or more medications. Logistic regression analysis was used to identify significant predictors. Results: Polypharmacy was observed in 66% of diabetic and 50% of hypertensive patients, with 18% experiencing excessive polypharmacy (≥10 medications). Key risk factors included age >65 years (OR: 1.9, p<0.05), multiple comorbidities (OR: 4.5, p<0.001), and obesity (OR: 2.7, p<0.01). Conclusion: Polypharmacy is prevalent among diabetic and hypertensive patients, requiring targeted deprescribing strategies and medication reviews to improve treatment safety and adherence.

DOI: 10.5281/zenodo.

Erector spinae plane block (ESPB) has been reported to provide analgesia in open abdominal surgeries in case reports or case series. We aimed to compare the effectiveness of ESPB and anterior Quadratus Lumborum block (QLB III) as a postoperative analgesic for open nephrectomy. Materials and Methods: This randomised controlled study was conducted on 48 patients undergoing open nephrectomy. Results: There were no significant differences found between the two groups in terms of age (p-value=0.999) and ASA grade (p-value=0.336). The total morphine consumption was lower in the ESP group (11 versus 17.58 mg, p-value <0.0001) compared to the control group. Conclusion: Ultrasound-guided ESPB was more effective in reducing postoperative pain, facilitating enhanced recovery, and significantly reducing the requirement for opioids in the postoperative period after abdominal surgery such as open nephrectomy.

DOI: 10.5281/zenodo.

Background: Eyelid tumors form an important part of ophthalmology practice representing more than 90% of ophthalmic tumors in people of both sexes and all age groups. Swift histopathological diagnosis of eyelid lesions is crucial because many malignancies can mimic a host of benign neoplasms that escalate the risk of misdiagnosis. Aim: To assess the various spectrum of eyelid tumors and their management. Materials& Methods:  This was a prospective observational study of 2 years duration (from October 2020 to September 2022). 38 patients with eyelid tumors were included in the study. Detailed patient history was taken and detailed ocular examination was done and recorded. All laboratory investigations were done. After surgical excision, defect in the eyelid was reconstructed using appropriate reconstruction procedure. The tissue was sent for histopathological evaluation. Results: Out of 38 patients, 18 patients (47.4%) were males and 20 patients (52.6%) were females. Among 38 cases maximum number of cases (44.7%) presented to us in age range of 40- 59 years, followed by more than 60 years (29%). Upper eyelid was involved in 16 cases (61.5%) with benign lesions and in 2 cases (16.7%) with malignant lesions. Lower eyelid was involved in 10 cases (38.5%) with benign lesions and in 10 cases (83.1%) with malignant lesions. Wide local excision including normal skin of 5-10 mm was performed with primary closure in 4 cases of basal cell carcinoma and 1 each from squamous cell carcinoma. Conclusion: Eyelid lesions were equally prevalent in both genders, with malignancy more common in males. Age significantly predicted malignancy, especially in older patients. Lower eyelid malignancies were frequent. Surgical excision was effective, emphasizing the importance of histopathological and clinical diagnoses.

DOI: 10.5281/zenodo.

Background: Microalbuminuria, a marker of early kidney damage, is well-established as a predictor of cardiovascular complications in diabetic patients. Recent studies have explored its predictive value for ischemic heart disease (IHD) in diabetic populations, yielding promising results. However, the relationship between microalbuminuria and IHD in non-diabetic individuals remains understudied. Moreover, identifying microalbuminuria as a potential risk factor for IHD in non-diabetic individuals could enable early detection, prevention, and treatment strategies. This could ultimately contribute to reduced morbidity and mortality associated with IHD. By exploring the relationship between microalbuminuria and IHD in non-diabetic populations, researchers can expand our understanding of IHD pathogenesis and improve patient outcomes. Aims and Objectives: This study will quantify microalbuminuria prevalence among non-diabetic patients with ischemic heart disease and assess the correlation between microalbuminuria and ischemic heart disease within this patient group. Methods: A 12-month cross-sectional case-control study (October 2023-September 2024) was conducted at Amala Institute of Medical Sciences, Thrissur, India.  Non-diabetic patients undergoing ischemic heart disease (IHD) evaluation were categorized into cases (IHD present) and controls (IHD absent), with 75 subjects in each group, matched by age, sex, smoking status, hypertension, and body mass index.  Fasting blood glucose, lipid profiles, and urine albumin were recorded.  Chi-square analysis compared microalbuminuria prevalence between cases and controls. Results: Microalbuminuria prevalence is significantly greater in cases (72%) than in controls (15%) (p<0.001). Conclusion: A significant correlation exists between microalbuminuria and IHD, independent of diabetic status.

DOI: 10.5281/zenodo.

The rational use of medicines is essential for optimizing healthcare outcomes, especially in rural settings. This study evaluates prescribing patterns using World Health Organization (WHO) prescribing indicators in a rural teaching hospital in Indore, India. A total of 600 prescriptions were analyzed, revealing high rates of polypharmacy, low generic prescribing, antibiotic overuse, and excessive injectable use, all of which deviate from WHO standards. Statistical analysis using the Chi-square test (p < 0.05) showed significant differences in prescribing patterns. The study highlights the need for prescriber education, antimicrobial stewardship programs, and policy interventions to improve prescribing practices and ensure patient safety.

DOI: 10.5281/zenodo.

Introduction: Surgical site infections (SSIs) in obstetric surgeries increase morbidity, hospital stays, and costs. Risk factors include postoperative hospitalization, comorbidities, surgery type, wound classification, and antimicrobial resistance pattern. Obstetric patients are particularly vulnerable due to physiological changes during pregnancy. Caesarean section carries a 5–20 fold times’ increase in maternal infections as compared to vaginal delivery. The study examines SSI incidence, risk factors, microbial trends, and antibiotic resistance at a tertiary care hospital in western India. Materials and Methods: This prospective observation study conducted at Civil Hospital, Ahmedabad from June 2017 to August 2018 analyzed 351 Lower Segment Caesarean Sections for SSIs using active surveillance. Patient demographics, surgery details, and microbiological findings were recorded. Antibiotic susceptibility was assessed using the Kirby-Bauer method, and statistical analysis was done via SPSS 25.0, with p<0.05 considered significant. Results: The overall surgical site infection (SSI) rate in Lower Segment Caesarean Sections was 5.12 % (18/351 cases). Prolonged postoperative hospitalization was a significant risk factor (p<0.0001), with SSI rates increasing from 2.59% (3 to 5 days) to 32.2% (>6 days) however no infection was recorded in 0 to 2 days of hospitalization. E. coli (27.7%), and Staphylococcus aureus (27.7%) were the most frequently isolated pathogen, followed by Klebsiella pneumoniae (22.2%), Acinetobacter spp. (16.6%), and Pseudomonas aeruginosa (5.5%). SSI rates were highest in patients aged 36 to 45 years (10%), those with ASA scores > 3 (75%), and those undergoing emergency surgeries (19.35%). General anesthesia (16.6%) was associated with a higher infection rate than spinal anesthesia (4.92%, p<0.0001). Dirty wounds (100%) had the highest SSI rates, followed by contaminated (85.71%), clean-contaminated (17.85%), and clean wounds (0.34%). Antibiotic resistance was alarmingly high for Ampicillin and 3rd generation cephalosporins (100%), and Cefepime showed (77%) resistance, while Imipenem (44%) showed the lowest resistance among gram-negative bacteria. These findings highlight prolonged hospital stays, emergency procedures, and multidrug-resistant pathogens as key contributors to SSIs. Conclusion: Strict infection control measures, targeted antimicrobial therapy, and optimized perioperative care are essential to reducing surgical site infections (SSIs) in lower-segment cesarean Sections. Early discharge, judicious antibiotic use, and surveillance of multidrug-resistant pathogens can help improve patient outcomes.

DOI: 10.5281/zenodo.

The supratrochlear foramen (STF) of the humerus, an anatomical variation, presents clinical and surgical implications, especially in orthopaedic procedures like intramedullary nailing. This study aimed to analyze the prevalence, morphology, and morphometry of the STF in a South Indian population using 140 dry humeri from the Anatomy Department of Dr. B.R. Ambedkar Medical College, Bangalore. The specimens comprised 82 right-sided and 58 left-sided humeri. The STF’s prevalence was 30.71%, with a higher incidence in left-sided humeri (39.65%) compared to right-sided (24.39%). Morphologically, the STF was most frequently oval-shaped (34.88%), followed by round (27.91%), triangular (23.26%), reniform (6.98%), and sieve-like (6.98%). Morphometric analysis revealed larger transverse and vertical diameters on the left side, with significant differences in distances from anatomical landmarks between sides. The STF’s degree of perforation categorized specimens into opaque, translucent, and complete foramen, with translucent and perforated septa more common on the left. These findings align with previous studies suggesting genetic and biomechanical influences. The clinical relevance of STF includes its potential to narrow the medullary canal, complicate radiological interpretation, and affect surgical planning. This research enhances our understanding of STF variability and its implications for anatomy, orthopaedics, and anthropological studies.

DOI: 10.5281/zenodo.

This study aims to demonstrate that hyperuricemia is a significant etiological role in the onset of liver dysfunction, hypertension, kidney disease, metabolic syndrome, and cardiovascular disease. This study was performed in a tertiary care facility in northern India from March 2021 to September 2024. A total of 250 patients are involved in the study with USG (Ultrasonography) proven non-alcoholic fatty liver disease. Of 250 patients, 184 (73.60%) were males and 66 (26.40%) were females. Ultrasonography revealed that 67 (26.80%) patients had normal liver on ultrasonography, 89 (35.60%) patients grade I, 49 (19.60%) patients grade II, and 45 (18.00%) showed grade III fatty liver disease. Their serum uric acid levels varied from normal to high.  A correlation between high serum uric acid and fatty liver disease exists but it may not be linear. This clinically significant correlation implies that patients should control high serum uric acid and take measures to manage fatty liver disease.

DOI: 10.5281/zenodo.

Introduction: Lateral Epicondylitis is the angiofibroblastic tendinosis of the common extensor origin. Overall prevalence of this condition is of 1% to 3% affecting day to day life events. Aims and Objectives: To find out the efficacy of autologous platelet rich plasma injection versus local steroids in the management of lateral epicondylitis. Material and Methods: Prospective interventional study was conducted amongst 40 study participants. Participants were randomly divided into 2 equal groups and treatment allocation was done by block randomization.  Outcome was measured using VAS (Visual Analogue Score) score and functional assessment of elbow was done by using with Mayo Elbow Performance Score (MEPS) after the procedure. Statistical Analysis: Data was entered and analyzed with Epi Info software. Means and frequencies were computed to confirm completeness of the data. Mann Whitney test was used for comparing means among interventional groups with p< 0.05 considered to be statistically significant. Results: Mean age of the study Participants was 39.2 Years (±8.8) and majority were in the age group of 31-40 Years 17(42.5%). Right side involvement was more compared to left. Conclusion: Participants in PRP group had both pain relief and favourable functional outcome for longer duration of time without any major side effect.

DOI: 10.5281/zenodo.

Introduction: Diabetes Mellitus (DM) is a global epidemic. Diabetes and its related complications are leading cause of morbidity and mortality worldwide. Microalbuminuria in patients with Diabetes Mellitus is a significant risk factor for progressive renal disease and cardiovascular morbidity. Glycemic status of the diabetes patients with microalbuminuria is crucial, as poor glycemic control may worsen microalbuminuria and thereby renal and cardiovascular outcome. Method: This is a cross sectional study, done at Dept of Medicine, AGMC & GBP Hospital from July 2022 to december2023 with 290 patients. Aim of the study is to-1) to check microalbuminuria in diabetes mellitus patients 2) to determine the association between microalbuminuria and glycemic status. Results: Among 290 participants, 70 number of patients have microalbuminuria, so proportion of microalbuminuria is 24.1%. In patients with microalbuminuria the level of postprandial blood glucose is 220.0 ± 37.9 mg/dl and in patients without microalbuminuria the level of postprandial blood glucose is 206.8 ± 17.53 mg/dl. The level of HbA1C is 8.01 ± 0.91 in microalbuminuria group and 6.9± 0.67 in non-microalbuminuria group. Conclusion: 1/4th of the diabetic cases are tends to develop microalbuminuria as complication which was associated with risk factor like uncontrolled blood glucose level and this factor showed significant association statistically.

DOI: 10.5281/zenodo.

Introduction: Thrombocytopenia is the most common hematological abnormality encountered in patients with chronic liver disease (CLD), occurring in 64%–84% of patients with cirrhosis or fibrosis. In addition to being an indicator of advanced disease, thrombocytopenia is associated with a poorer prognosis. It is crucial to conduct more studies specifically studying the clinical significance of hematological abnormalities in cirrhosis, such as anemia. Material & Methods: This is an observational cross-sectional study done at General Medicine ward of AGMC & GBP Hospital of 120 patients admitted with decompensated chronic liver disease (DCLD). Aim of the study is to evaluate the haematological abnormalities in decompensated chronic liver disease patients. Result: Out of 120 patients, in this study 118 patients having anemia, and most of them have hemoglobin between 7-9 g/dl (47.5%). Most of the patients have normocytic anemia (56.6%), followed by microcytic anemia (29.2%) and least number of macrocytic anemia (12.5%). Out of 120 patients, 85(70.8%) of them having low platelet count. 33.33% patients having platelet count between 50 thousand and 1 lakh. 65.8% having elevated prothrombin time (PT) and 76.6% having raised INR value. Discussion: Based on the previous study it was evident that, most of the patients with with decompensated chronic liver disease patients having maximum number of normocytic anemia and with low platelet count & those patients having increased risk of bleeding which is reflected in our study. Conclusion: 30% of the cases are found to be suffering from severe anaemia with a higher proportion of normochromic picture. These subgroups of patients are associated with low platelet count and active GI bleeding. More than 70% of the DCLD cases were found with abnormal prothrombin time (PT) (>16 seconds).

DOI: 10.5281/zenodo.

Introduction: Airway management is crucial in general anaesthesia, especially for breast surgeries, where maintaining oxygenation and minimizing complications is essential. While the cuffed endotracheal tube (ETT) remains the standard, its use can lead to significant hemodynamic responses. The i-gel supraglottic airway device offers a less invasive alternative with reduced airway irritation and postoperative complications, making it a promising option for surgical airway management. Materials and Methods: This randomized clinical study included 64 ASA I-II patients undergoing elective breast surgery, divided into two groups: Group A (ETT) and Group B (i-gel). Airway devices were inserted post-induction, and hemodynamic parameters were recorded at multiple intervals. Ease of insertion, time taken, and complications such as sore throat and blood staining were assessed. Statistical analysis was performed using SPSS, with a p-value <0.05 considered significant. Results: Our study found no significant differences in demographic parameters, airway insertion characteristics, or baseline hemodynamic measures between the ETT (Group A) and I-Gel (Group B) groups. However, post-induction, Group A exhibited consistently higher systolic, diastolic, and mean blood pressure levels at multiple time points (p<0.05), indicating greater hemodynamic stress. Heart rate was also significantly higher in Group A at key intervals. SPO2 levels remained stable in both groups (p=1.000), and ETCO2 variations were minimal, suggesting comparable ventilation efficacy. The number of insertion attempts was similar between groups. Postoperative complaints were more frequent in Group A, with a higher incidence of sore throat (21.9% vs. 9.4%), dysphonia (15.6% vs. 0%), and blood stains (3.1% vs. 9.4%), while nausea was reported equally (6.3%). Conclusion: Our study suggests that while both the ETT and I-Gel effectively maintain oxygenation and ventilation, the I-Gel offers advantages in reducing hemodynamic stress and postoperative complications, making it a preferable alternative for airway management in elective breast surgeries.

DOI: 10.5281/zenodo.

Background: Platelet parameters are one of the most common hematological changes observed in preeclampsia. The aim of this study is to study the correlation of platelet count, mean platelet volume and platelet distribution width in preeclampsia and normal pregnant females and to study the association of MPV and PDW in assessing the severity of preeclampsia. Materials and Methods: A case control study was conducted on normal pregnant females and preeclamptic patients at department of Pathology. Random samples were taken of 50 normotensive women and 50 pregnant women. Study variables include Age, BP proteinuria, platelet count, MPV, PDW. Platelet count, mean platelet volume and platelet distribution were measured by automated hematology analyser. Data is collected in MS Excel and then analysed by using SPSS software V.21 and correlation done by Pearson correlation coefficient. Results: PDW increased in preeclampsia when compared to normal pregnant women. PDW in fl-16.386±2.3576, 12.877±1.5206, p<0.0001. Platelet count decreased with the increase in severity of preeclampsia. MPV was higher in preeclampsia group than control group. Conclusion: Platelet count and PDW help in predicting the severity if preeclampsia. MPV is also a good marker in predicting the severity of preeclampsia.

DOI: 10.5281/zenodo.

Background: Necrotising fasciitis (NF) is an inflammatory progressive disease, spreads quickly to depth of subcutaneous tissue. For disease prognosis, LRINAC scoring system, comprising 6 blood parameters. Except CRP, all other blood parameters can be determined in low cost at rural set ups. Objectives:  The present study was to compare Modified LRINEC Scoring System without CRP with standardized LRINEC Scoring System and its predictive value in Necrotising Fasciitis. Methods: A cross sectional observation on 60 consecutive hospitalized skin and soft tissue infection confirmed as NF was conducted. Patients aged 15-75 years of either sex hospitalized with skin and soft tissue infection with suspected   progression to Necrotising Fasciitis within 15 days of onset were included. Cases who had received antibiotic treatment in the last 48 hours and other comorbidities were excluded. Blood investigations such as CRP, TLC, Hb, Serum Creatinine, Blood Glucose and Serum sodium were determined for LRINEC score. Modified LRINEC without CRP was evaluated against clinical outcome of Necrotising Fasciitis. Results: Mean age of SSTI patient was 54.2 ±10.1 and 63.33 % were from the age group of 46-60 years. Male and female ratio was 1.4. 56.6% patients were diabetic and in blood parameter investigation, blood glucose was widely distributed. Correlation matrix revealed Blood glucose is positively correlated to CRP. M-LRINEC without CRP is significantly comparable with LRINAC. Conclusion: A modified LRINEC scoring system demonstrated that by considering only five low-cost parameters (Haemoglobin, Serum Sodium, Serum Creatinine, TLC, Blood Glucose) and removing CRP for prediction of NF is equally significant to Standard LRINEC scoring system.

DOI: 10.5281/zenodo.

Background: Right ventricular free wall longitudinal strain may be associated with angiographic characteristics and serve as a predictor of adverse cardiac events in patients with acute inferior wall ST-elevation myocardial infarction (STEMI). Objective: To evaluate the correlation between right ventricular free wall strain (RV-FW strain) and angiographic findings in patients presenting with acute inferior-wall STEMI. Methods: This study included 100 patients with acute inferior wall STEMI. Baseline demographics and echocardiographic parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), left ventricular ejection fraction (LVEF), and RV-FW strain were recorded. Coronary angiography identified lesions in the proximal or distal right coronary artery (RCA), and the predictive value of RV-FW strain for proximal RCA lesions was assessed. Results: The mean age of the patients was 58.41 ± 14.5 years, with 67% male. Common comorbidities included hypertension (40%) and diabetes mellitus (36%). The lipid profile showed total cholesterol 188.1 ± 29.4 mg/dL, triglycerides 242.7 ± 44.2 mg/dL, LDL 94.5 ± 15.2 mg/dL, and HDL 38.7 ± 3.2 mg/dL. Echocardiographic findings included TAPSE 14.24 ± 2.54 mm, FAC 38.53 ± 3.18%, TDI 11.6 ± 1.9 cm/s, LVEF 48.1 ± 7.5%, and RV-FW strain −14.1 ± 3.97%. The RV-FW strain was significantly lower in proximal RCA lesions (-14.78 ± 3.85%) than in distal lesions (-17.98 ± 1.54%, p < 0.0001). An RV-FW strain cutoff of -16.93 predicted proximal RCA lesions with 78.95% sensitivity, 74.42% specificity, and 77% accuracy (AUC = 0.814, p < 0.0001). Conclusion: The RV-FW strain is a sensitive and specific echocardiographic parameter that correlates with proximal RCA lesions in acute inferior wall STEMI, providing critical prognostic information.

DOI: 10.5281/zenodo.

Background: Tobacco use remains a significant public health concern, contributing to cardiovascular diseases (CVD) and metabolic disturbances. Smoking has been linked to alterations in lipid profiles, oxidative stress, and disruptions in essential mineral levels. Despite extensive research on smoking and lipid metabolism, limited data exist on its impact on non-HDL cholesterol, uric acid, magnesium, and phosphorus levels in healthy adults, particularly in India. Objective: This study aimed to compare serum non-HDL cholesterol, uric acid, magnesium, and phosphorus levels between smokers and non-smokers, assessing the impact of smoking intensity on these biochemical parameters. Materials and Methods: A comparative cross-sectional study was conducted among healthy adults aged 18-45 years in the Ahmedabad region, Gujarat. The study was carried out in the Department of Biochemistry at a tertiary care hospital over six months (March-August 2024). A total of 200 participants (100 smokers and 100 non-smokers) were recruited using a convenience sampling technique. Smokers were categorized into mild (1-10 cigarettes/day), moderate (11-20 cigarettes/day), and heavy smokers (>20 cigarettes/day). Fasting blood samples were analyzed for total cholesterol, HDL cholesterol, non-HDL cholesterol, uric acid, magnesium, phosphorus, and creatinine using standard laboratory methods. Data were analyzed using SPSS v25, applying independent t-tests, ANOVA, and Pearson’s correlation, with a significance threshold of p < 0.05. Results: Smokers had significantly higher total cholesterol (218.2±21.5 mg/dL vs. 173.5±18.4 mg/dL, p < 0.001) and non-HDL cholesterol (179.5±17.4 mg/dL vs. 126.5±14.7 mg/dL, p < 0.001), with lower HDL cholesterol (33.9±6.9 mg/dL vs. 52.7±7.1 mg/dL, p < 0.001). Serum uric acid, magnesium, and phosphorus levels were significantly lower in smokers (p < 0.05), while serum creatinine was elevated (p < 0.001). A dose-dependent deterioration in biochemical parameters was observed with increasing smoking intensity. Conclusion: Smoking adversely impacts lipid metabolism and essential mineral homeostasis, increasing the risk of CVD and metabolic disorders. The findings highlight the need for targeted smoking cessation programs to mitigate associated health risks.

DOI: 10.5281/zenodo.

A thirteen year old girl presented with painful swelling of right ankle since 1 month duration. No significant trauma, family history or past history. Local examination revealed hard, immobile swelling over anterolateral aspect of right ankle with painful restriction of movements. Imaging evaluation showed two osteocartilaginous masses adjacent to the distal tibial and fibular epiphyses. Surgical excision of the masses done and histopathologically proved as osteochondromas.

DOI: 10.5281/zenodo.

Background: Super vasmol poisoning is an emerging alternative to Organophosphorous poisoning because of its easier availability and low cost. There is no specific antidote for super vasmol poisoning and treatment is supportive. Aim: To study the clinical profile, complications of super vasmol poisoned patients. Patients and Methods: A hospital based Prospective Observational study was carried for 89 patients. Results: Among 89 cases, 51 were female and 38 were male. The overall median age is 21-25years and the average amount of vasmol consumed was 50ml. About 5 patients undergone with tracheotomy and 2 patients were died. Conclusion: Recommending introduction of less than 25ml sachets in place of currently available 25/50ml sachets. Clinical outcome relies on early recognition and admission to the hospital.

DOI: 10.5281/zenodo.

Introduction: Numerous ocular problems are significantly influenced by diabetes mellitus (DM) linked to vascular and neural abnormalities. The optic nerve head (ONH) and retinal nerve fiber layer (RNFL) of diabetic eyes may reveal the impact of DM on neurovascular components. Few published studies have examined the ONH parameters in individuals with diabetes and inconclusive results were found. Considering this, the purpose of our study was to compare the alterations in the optic nerve and disc in individuals with diabetes. Material and Method: The present study was a cross sectional observational study. Detailed clinical and personal history of all the subjects was noted. General, systemic, ocular, slit lamp and stereoscopic fundus examination along with objective assessment of refraction was done. Visual acuity and intraocular pressure (IOP) in both eyes was recorded. Careful examination of the disc parameters and optical coherance tomography (OCT) was also performed. All the data were entered on a preformed proforma and were statistically analyzed using SPSS version 20. Result: In present study, there was no statistically significant difference in mean cup to disc ratio (CDR), mean cup volume and mean ocular perfusion pressure (MOPP) of both eyes in DM cases & controls. However difference was statistically significant in mean disc area, mean rim area, and mean RNFL thickness. Among ONH parameters on OCT, average RNFL thickness was significantly lower in diabetics. Parameters like rim area, disc area, cup volume, average CDR and vertical CDR showed statistically non-significant difference in both the groups. Correlation of HbA1c levels and duration of DM with all OCT parameters was non-significant. Conclusion: Our study parameters reflect that DM can cause retinal ganglion cell apoptosis which exacerbates cupping and visual field changes. OCT parameters of ONH found that DM leads to reduced viability of RNFL, increased optic disc pallor as increase in CDR and parapapillary atrophy. Neuroretinal rim can be the important OCT parameter that can differentiate diabetes and other pathologies induced optic nerve damage.

DOI: 10.5281/zenodo.

Sound stimulation in embryonic phase plays an important role in birds for preferential response to maternal sound. In present study, morphological effect of sound stimulation on Hippocampus of chick brain has been evaluated quantitatively. Hippocampal region in birds is involved in memory and recall. Changes in neuronal number in hippocampal region of chick brain have been determined by histo-morphometric method on 21-day old chick embryo, exposed to sound during 9^th day to 21 days of development. There was a significant increase in number and size of neurons in response to sound stimulation given during critical period of development.

DOI: 10.5281/zenodo.

Introduction:  The thyroid is a highly vascular, brownish-red gland located anteriorly in the lower neck. The term “thyroid nodule” refers to a distinct lesion within the thyroid gland that is palpably or radiologically distinct from the surrounding thyroid parenchyma. Ultrasound elastography has been developed to provide tissue elasticity information in addition to gray-scale or color flow information on conventional US. US strain elastography has been found to be helpful in the differential diagnosis of thyroid nodules, considering that malignant nodules tend to be harder than benign nodules. Aim: 1.  To evaluate the role of shear wave elastography in distinguishing benign from malignant thyroid nodules. Objectives: 1) To determine the sensitivity, specificity, positive predictive value and negative predictive value of shear wave elastography taking histopathology/FNAC diagnosis as gold standard diagnostic technique. 2) To compare shear wave elastography findings to the conventional ultrasound appearance of thyroid nodules. Material and Methods: The present study was Hospital based Cross sectional Descriptive study at Agartala Government Medical College & G.B. Pant Hospital for a period of One and half years. The diagnostic accuracy of the test will be determined after calculating sensitivity, specificity, PPV and NPV of the test against a gold standard test (either FNAC or histopathological examination). Results obtained will be discussed and Compared. Results: The study consisted of total 80 patients in maximum number of cases (48), right lobe of thyroid was involved. Lesions having multiple nodules are mostly benign in nature. Wider than taller shape is associated with benign nodules, whereas taller than wider shape is a feature of malignancy. Malignant nodules have high VTI score as compared to benign thyroid nodules. In the present study, out of 17 malignant thyroid nodules, 13 (76.4%) nodules have VTI score of 4 & 5. Out of 63 benign nodules, 42 (66.7%) nodules have VTI score of 1 & 2. Conclusion: It is a non-invasive method that gives information about all nodules. Thyroid nodule stiffness measured by ARFI generated shear wave elastography is an independent predictor of thyroid carcinoma. Shear wave elastography can enhance the B-mode findings and potentially improve our cancer detection rate and selection of patients for FNAC.

DOI: 10.5281/zenodo.

Background: Inappropriate use of antibiotics leads to antimicrobial resistance (AMR), a major global health issue.  This study evaluates antibiotic prescribing patterns and AMR in a district hospital in North-East India. Methodology: A Point Prevalence Survey (PPS) was conducted over three months (April, May, June) involving 133 admitted patients.  Data were collected from case sheets and treatment charts across various wards (Emergency, Male & Female wards, OBG).  Observations were made on specific days of each month. Results: The percentage of patients prescribed antibiotics was 80.55% in April, 75.4% in May, and 75% in June. Ceftriaxone was the most prescribed antibiotic, often without adherence to standard treatment guidelines or consideration of microbiological data.  The majority of antibiotics were administered intravenously, with a significant portion used for therapeutic purposes prophylactically. Discussion: The study highlights a high rate of antibiotic use, with a notable lack of adherence to standard guidelines and minimal use of microbiological data in prescribing decisions.  This practice contributes to the growing problem of AMR. Conclusion: There is an urgent need to sensitize prescribers about the rational use of antimicrobial agents.  Developing an antibiotic policy and implementing antimicrobial stewardship is crucial to improve prescribing practices and combat AMR.

DOI: 10.5281/zenodo.

Background: Parkinson Disease (PD) is one of the major causes of disability in elderly people. The biological plausibility and epidemiological data suggested that vitamin D deficiency contributes to development of PD. The major resources of vitamin D are diet and photo-synthesized in skin from solar ultra violate-B radiation. A typical finding in cobalamin deficiency or poor cyanocobalamin status is linked to an increased risk of Parkinson disease. Therefore, it would seem that neurodegenerative illnesses are influenced by deficits in both vitamin D and vitamin B-12. Aim: The study has aimed to analyze serum vitamin B12, vitamin–D3 and sodium estimation in subjects of Parkinson in tertiary care centre. Method: This study was carried out in PMCH, Udaipur from February 2024 to January 2025. A total of 50 patients were selected for analysis having Parkinson disease attending the Neurology OPD and admitted indoor. The analysis of collected data was carried out using SPSS 30.0. The demographical; data was provided using the measures of central location that involve the mean and median range. Moreover, the analysis of discrete variables was done by Chi-square test and continues variables were compared using non-parametric tests. Results: As per the analysis outcome of current study MMSE level of participants was found normal, mild and moderate for 28% for each and 16% participants had server level.  Moreover, the DSRA level of participant and found that 64% had mild, 20% participants have moderate and 16% had severe. According to analysis, p value was <0.005 which show there was statistically significant association of MMSE level with vitamin D and Parkinson disease. Conclusion: From the outcome of above analysis, it has been found that low levels of vitamin D and vitamin B12 as well as sodium were clearly linked to cognitive impairment in Parkinson’s diseases and this relationship was linearly correlated with the degree of dementia.

DOI: 10.5281/zenodo.

Meningiomas are the most common extra-axial tumours of Central Nervous System (CNS) and most commonly observed in females. They arise from the meningothelial cells of the arachnoid membrane. The clinical symptoms develop due to mass effect on brain structures. They can be diagnosed radiologically by Computed Tomography (CT) and Magnetic Resonance Imaging scans (MRI). The characteristic features include extra-axial location, hyperdense lesion, calcification, hyperostosis of overlying bony calvaria and usually show homogenous enhancement after contrast administration. The perilesional oedema is usually seen with grade II and III lesions, however can be extensive with secretory type. The MRI scan gives better soft tissue detail and is useful in grade II and III lesions for better depiction of invasion of brain parenchyma. This study presents seven cases of tumour on non-contrast CT scan with different locations of tumour with characteristics ranging from typical to complex and atypical features.

DOI: 10.5281/zenodo.

Introduction: The central nervous system (CNS) comprises the brain and spinal cord, which play fundamental roles in controlling and coordinating bodily functions, cognition, and behaviour. Lesions within the CNS can arise from number of reasons, including but not limited to traumatic injuries, infections, neoplasms, vascular abnormalities, autoimmune disorders, and degenerative diseases. Different types of brain tumors have their special pattern based on age, sex, complaints on admission, radiological signs and sometimes, their family history and seem these patterns are changing according to the geographic region over time. Material and Methods: The material studied consists of 60 CNS biopsy specimens received in histopathology section, department of pathology, C.U Shah medical college, Surendranagar. The specimens were collected from the indoor patients admitted in the department of neurosurgery at tertiary care teaching hospital during November 2022 to MAY 2024. Results: The histopathological study of 60 CNS lesions at our tertiary care centre highlights the diversity of lesions encountered, with a predominance of meningiomas and astrocytoma among neoplastic lesions, and intervertebral disc degeneration among non-neoplastic lesions. The age and gender distribution patterns observed in this study align with existing literature, with a higher incidence in the middle-aged group and a slight female predominance. Conclusion: WHO grading further provides insights into the prognostic implications and guides the clinical management of these lesions. Understanding the pathological basis of CNS lesions is an important for accurate diagnosis, prognosis, and management. Histopathology, the microscopic examination of tissue specimens, serves as an important in understanding the underlying cellular and molecular alterations associated with CNS lesions.

DOI: 10.5281/zenodo.

Background: Liver abscess remains a common clinical problem, particularly in developing countries. It is often associated with significant morbidity and mortality if not diagnosed early. This study evaluates the risk factors, clinic etiological profile, and biochemical markers of liver abscess patients admitted to a tertiary care centre in Central India. Methods: A case control study was conducted over 18 months at Gandhi Medical College, Bhopal. Fifty patients diagnosed with liver abscess were compared to fifty control subjects. Detailed clinical history, biochemical profiles, and imaging findings were analyzed using statistical methods to identify significant associations. Results: The mean age of liver abscess patients was 42 ± 16 years, with a significant male predominance (78%) majority belonging to lower class (40%).  Pyogenic liver abscess (PLA) was more frequent (58%), followed by amoebic liver abscess (ALA) (42%). Key risk factors included alcohol use disorder (66%) and poor hygiene (54%). Elevated liver enzymes (SGOT/SGPT) and bilirubin were found in most patients. The majority of patients responded well to percutaneous drainage and antibiotic therapy, with an average hospital stay of 14 days. Conclusion: Liver abscess predominantly affects middle-aged males with alcohol abuse and poor hygiene. Early diagnosis and appropriate management, including drainage and antibiotic therapy, can significantly improve outcomes.

DOI: 10.5281/zenodo.

The metabolic pregnancy complication Gestational diabetes mellitus (GDM) produces elevated blood glucose levels which start during the pregnancy period. The condition elevates the possibility of dangerous health complications for maternal individuals and newborn infants. The diagnostic criteria of GDM include oral glucose tolerance tests but they present restrictions because testing processes take a long time and some patients fail to adhere to test requirements. Glycated hemoglobin (HbA1c) demonstrates value as an indicator that helps determine the possibility of developing GDM. The research aims to determine how pregnancy HbA1c measurements relate to the future diagnosis of GDM. Three hundred pregnant women were tracked through the pregnancy to establish how their HbA1c levels related to developing GDM. High HbA1c levels from the beginning of pregnancy directly resulted in elevated risks of gestational diabetes mellitus. HbA1c demonstrates its ability to function as a basic and dependable assessment method that assists in the detection of pregnant women likely to develop GDM thus enabling prompt interventions and enhanced management plans.

DOI: 10.5281/zenodo.

Background: Emergency peripartum hysterectomy (EPH) is a critical procedure reserved for life-threatening conditions during childbirth. While rare, the need for EPH is often associated with severe maternal morbidity and mortality, driven by complications such as placenta accreta, uterine atony, uterine rupture, and massive postpartum hemorrhage. The global variance in EPH rates reflects differing regional healthcare standards and prenatal care practices. Aim: This study aims to evaluate the frequency, indications, and maternal outcomes associated with EPH at a tertiary care center, providing updated insights into the management and consequences of this extreme obstetric intervention. Methods: A retrospective review was conducted on 104 women who underwent EPH at Anugrah Narayan Magadh Medical College & Hospital from December 2023 to November 2024. Data on demographic characteristics, surgical indications, and postoperative outcomes were analyzed using descriptive statistics and chi-square tests for association, utilizing SPSS version 23.0. Results: The most common indications for EPH were placenta accreta (38.5%) and uterine atony (30.8%). Most women (75%) recovered completely, whereas 17.3% experienced minor complications, and 7.7% faced major complications. The statistical analysis confirmed a significant association between surgical indications and major complications (p < 0.05). Conclusion: EPH remains a vital, albeit high-risk, intervention for managing severe obstetric complications. The high recovery rate post-EPH indicates effective surgical and medical management at the tertiary care level. Recommendations: Enhanced prenatal screening for placental abnormalities and improved management protocols for high-risk pregnancies are recommended. Additionally, further training in the medical and surgical management of obstetric hemorrhage could reduce the frequency and improve the outcomes of EPH.

DOI: 10.5281/zenodo.

Background: Blood transfusion is a critical intervention in obstetric care, primarily used in cases of postpartum hemorrhage, severe anemia, and other maternal emergencies. Obstetric hemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low-resource settings where timely access to blood products is limited. Optimizing blood transfusion practices through evidence-based guidelines is essential to improving maternal outcomes and reducing transfusion-related complications. Aim: This study aims to analyze the indications, transfusion practices, outcomes, and complications associated with blood transfusion in obstetric patients at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar. The study also evaluates the effectiveness of transfusion in improving maternal health and identifies areas for optimizing blood utilization. Methods: A retrospective study was conducted on 100 obstetric patients who received blood transfusions between August 2023 and August 2024. Data were collected from medical records, including patient demographics, indications for transfusion, blood components used, transfusion reactions, and maternal outcomes. Statistical analysis was performed using SPSS version 23.0, with descriptive statistics and chi-square tests used to assess associations between transfusion parameters and maternal outcomes. Results: Postpartum hemorrhage was the most common indication for transfusion (40%), followed by severe anemia (35%) and antepartum hemorrhage (15%). Packed red blood cells were the most frequently used blood component (68%), with an average of 1.8 units per patient. Adverse reactions occurred in 8% of cases, with febrile non-hemolytic reactions being the most common (4%). Maternal outcomes were favorable in 92% of cases, but 5% required intensive care, and 3% resulted in maternal mortality due to excessive hemorrhage and multi-organ failure. A significant association (p < 0.05) was observed between high-volume transfusion (>3 units) and maternal mortality. Conclusion: Blood transfusion remains an essential component of obstetric care, particularly in managing hemorrhagic and anemic conditions. While transfusion effectively stabilizes critical patients, inappropriate or delayed transfusions can impact maternal health outcomes. Recommendations: Efforts should focus on strengthening antenatal screening for anemia, optimizing patient blood management strategies, and ensuring the availability of blood products in obstetric emergencies. Standardized transfusion protocols and training for healthcare providers can further enhance safe transfusion practices and reduce adverse events.

DOI: 10.5281/zenodo.

Background: Gestational diabetes mellitus, often known as GDM, is a condition that arises as a consequence of improper metabolism of glucose during pregnancy. As a result of the significant increase in its incidence, gestational diabetes mellitus (GDM) has emerged as one of the primary causes of death and morbidity among mothers and children all over the world. Aim: The current study intended to investigate the risk variables associated with GDM in order to facilitate early intervention. Materials and Methods: The study included participation from a total of five hundred pregnant women. In accordance with the diagnostic criteria for gestational diabetes mellitus (GDM), the individuals were divided into two groups: the group with GDM (n = 96) and the group without GDM (n = 404). Both the clinical data and the biochemical markers were compared between the group with GDM and the group without GDM. Additionally, logistic regression analysis was carried out in order to investigate the factors that contribute to the development of GDM. Results: In terms of age, pre pregnancy body mass index (BMI), pregnancy times, low-density lipoprotein (LDL) level, history of diabetes mellitus in first-degree relatives, incidence of subclinical hypothyroidism (SCH) and the positive rate of thyroid peroxidase antibody (TPOAb), the group with gestational diabetes mellitus (GDM) was significantly higher than the non-GDM group. The findings from the Logistic regression analysis indicated that the risk factors for GDM were the following: age (odds ratios (OR) = 1.119, 95% CI = 1.018-1.240, P = 0.019), pre-pregnancy body mass index (BMI) (OR =1.279, 95%CI = 1.120-1.470, P < 0.001), a history of diabetes mellitus in first-degree relatives (OR =4.940, 95%CI = 1.420-17.200, P = 0.011), and TPO Ab (OR = 4.850, 95% CI =1.739-13.499, P = 0.0029). Conclusions: There is a correlation between an elevated risk of gestational diabetes mellitus (GDM) and advanced age, excess body mass index (BMI) prior to pregnancy, diabetes mellitus history in first-degree relatives and the presence of positive TPOAb.

DOI: 10.5281/zenodo.

Background: Septic shock is a severe form of sepsis that endures despite advancements in therapy and is a leading cause of death in intensive care units. Poor outcomes, heart dysfunction, and tachycardia are all caused by excessive sympathetic activation in septic shock. Although norepinephrine is the first-line vasopressor for maintaining mean arterial pressure (MAP), using it may make tachycardia worse. Esmolol, a β1-selective adrenergic blocker, has shown promise as an adjuvant to enhance results by regulating heart rate without causing chronic hypotension. Aim: The study’s objective is to evaluate the clinical effects and prognostic significance of esmolol and norepinephrine in septic shock patients. Materials and Methods: Two hundred patients who had been diagnosed with septic shock participated in the trial. The intervention group of patients received both norepinephrine and esmolol, whereas the control group received norepinephrine alone. A number of significant metrics were analysed, such as adverse events, length of stay in the intensive care unit, heart rate, MAP, lactate clearance, and 28-day mortality. Statistical analysis was performed using SPSS version 23.0. Results: Significantly superior lactate clearance (64.3% vs. 47.1%; p = 0.019), greater heart rate management (87.4±6.3 bpm vs. 104.7±8.41 bpm; p < 0.001), and a lower 28-day mortality rate (30% vs. 42%; p = 0.039) were all shown by the intervention group. Organ dysfunction incidence was lower, and the length of stay in the intensive care unit was shorter (9.3±2.7days vs. 11.6±5.1days; p < 0.001). The intervention group experienced bradycardia more frequently (15 vs. 5%; p = 0.019), but it was treatable and did not result in long-term problems. Conclusion: When esmolol was added to norepinephrine therapy for septic shock, it improved haemodynamic stability, heart rate control, and clinical outcomes, such as a decrease in mortality and intensive care unit stay. The combination’s safety and effectiveness were supported by the few and controllable adverse events. Recommendation: More thorough randomised controlled trials are recommended in order to confirm these findings, create uniform guidelines for the administration of esmolol in septic shock, and evaluate long-term results.

DOI: 10.5281/zenodo.

Background: There has been an increase in the prevalence of cardiovascular risk factors for Acute Coronary Syndrome (ACS) among individuals of Indian descent, and ACS has become one of the most prevalent primary causes of mortality. The current lifestyle of people, which can be commonly characterised by smoking, drinking alcohol, using drugs like cocaine and amphetamine, eating a high-fat diet, eating fast food, and experiencing high levels of work-related stress, contributes to the increasing incidence of ACS. Aim: The purpose of this study was to investigate the risk factors that are most prevalent in the patients and the outcomes that they experienced while they were in the hospital. Materials and Methods: For the purpose of this prospective study, 60 patients under the age of forty who were admitted to our hospital and had clinical and electrocardiographic signs of acute coronary syndrome were studied over the course of eight months, and risk factors were evaluated. Results: Among the most common risk factors, male sex was found as the most prevalent (77%), followed by a sedentary lifestyle (73%). The following are the other risk factors: diabetes mellitus (37 %), dyslipidaemia (50 %), oral tobacco addiction (37 %), diet (40 %), smoking (30 %), hypertension (33 %), family history (13 %) alcohol (17 %), obesity (13 %) and family history (13 %).The majority of the patients, including 83%, had three or more risk factors. 2 of the patients in our study passed away. Conclusion: After doing our research, we came to the conclusion that the incidence of ACS was significantly higher in males, and that a sedentary lifestyle was the most significant modifiable risk factor in our sample. The consumption of Oral Contraceptive (OC) pills does not pose a significant threat to our health, despite the fact that other conventional risk factors are similarly prevalent. There was an increase in both morbidity and mortality when a number of risk variables were combined.

DOI: 10.5281/zenodo.

Background: Mitral valve disease (MVD) frequently coexists with atrial fibrillation (AF), exacerbating hemodynamic compromise and increasing the risk of adverse outcomes. Pulmonary hypertension, indicated by elevated pulmonary arterial systolic pressure (PASP), further complicates the clinical scenario and is an independent predictor of mortality and morbidity in this population. Aim: To evaluate the impact of PASP on clinical outcomes in patients with MVD and AF and to identify potential strategies to improve management and prognosis. Methods: A prospective observational study was conducted involving 100 patients with MVD and AF. Patients were stratified into two groups based on PASP levels (≤50 mmHg and >50 mmHg). Clinical data, echocardiographic parameters, and outcomes, including hospitalization, mortality, and functional improvement, were analyzed using SPSS version 23.0. Statistical significance was set at p < 0.05. Results: The mean age of participants was 58.3 years, with 60% males. Elevated PASP (>50 mmHg) was observed in 45% of participants. Patients with PASP >50 mmHg had higher rates of hospitalization (40% vs. 25%, p = 0.03) and mortality (10% vs. 5%, p = 0.04) compared to those with PASP ≤50 mmHg. Functional improvement was significantly lower in the PASP >50 mmHg group (50% vs. 75%, p = 0.01). Multivariate analysis identified PASP as an independent predictor of adverse outcomes. Conclusion: Elevated PASP is strongly associated with worse clinical outcomes in patients with MVD and AF, emphasizing the need for early identification and targeted management. Regular monitoring and interventions to reduce pulmonary pressures may improve survival and quality of life. Recommendations: Future studies should explore the efficacy of advanced therapeutic options, including pulmonary vasodilators and minimally invasive mitral valve interventions, in reducing PASP and improving outcomes. Multidisciplinary care involving cardiologists, pulmonologists, and surgeons is essential for optimizing management.

DOI: 10.5281/zenodo.

Introduction: β-thalassemia, a hereditary blood disorder, often leads to iron overload due to repeated transfusions, increasing the risk of oxidative stress and organ damage. While serum ferritin levels are commonly used for monitoring iron status, Perl’s Prussian blue staining of exfoliated buccal cells offers a non-invasive alternative for assessing iron deposits, particularly useful for pediatric patients requiring frequent monitoring. Materials and Methods: This cross-sectional study was conducted at a tertiary care center in Western Gujarat over one year, enrolling 200 β-thalassemia patients diagnosed via HPLC or hemoglobin electrophoresis, who had received at least three blood transfusions. CBC, serum ferritin levels, and peripheral blood smears were analyzed, while buccal smears were fixed, stained with Perl’s Prussian blue, and graded from 0 (no granules) to V (coarse granules in ≥3 HPFs). Data were analyzed using IBM SPSS v25. Results: Among 200 patients, 54% were aged 1-10 years, with a male predominance (64.5%). Weakness (43%), global developmental delay (23%), and inability to gain weight (13.5%) were common symptoms. 99% had Thalassemia major, with 37% receiving >150 transfusions. Ferritin levels varied significantly across Perl Prussian grades (P = 0.024), confirming its role in iron assessment, while chelation therapy showed no significant difference in ferritin levels (P = 0.984). A weak negative correlation (r = -0.038, P = 0.589) between serum ferritin and transfusions suggests individualized monitoring is essential. Conclusion: Perl Prussian staining is a valuable non-invasive tool for assessing iron overload in β-thalassemia, correlating significantly with serum ferritin levels, reinforcing its clinical utility in iron monitoring.

DOI: 10.5281/zenodo.

Background and Aim: The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal dosage. In this study, we aimed to determine properties of dexmedetomidine intrathecally and various doses to evaluate safe and least dose requirement combination of bupivacaine heavy. Material and Methods: 100 parturients with the statue of American Society of Anaesthesiologists’ physical class I or II, scheduled for elective lower abdominal and lower limb surgeries were selected, Patients were divided into 5 groups. The hemodynamic parameters, postoperative analgesia, other adverse effects and neonatal outcomes were monitored. Results: There were no significant differences in preoperative discomfort, sedation levels, or hemodynamics between the groups. Dexmedetomidine seems to have a dose-dependent decreasing tendency for the times required for sensory and motor block onset and for the block to reach T10, or the greatest degree. The highest sensory intensity achieved was not significantly different across groups in terms of median or range. Conclusion: Dexmedetomidine has been shown to dramatically increase the onset, duration, and analgesia of sensory and motor block. Therefore, it can be used as an alternative to epidural anaesthesia for long-term surgical procedures. However, increased caution is warranted when using 15mcg or 20mcg because of the elevated risk of hypotension and bradycardia at those doses.

DOI: 10.5281/zenodo.

Difficulty in breathing may occur because of abnormalities starting from the tip of the nose to the terminal bronchioles and even beyond. Nasal obstruction is a very common complaint in the clinical practice of otorhinolaryngology. It can happen due to abnormalities of the nasal septum hyper trophy of the turbinates or abnormalities of various structures of the roof of the nose. Among all these abnormalities diseases of the involving the septum are the most commonly seen. The silver lining here is that these can be corrected by surgery. While previous trauma is expected to be one of the leading causes of septum deformities, no such medical history has been found to be present in numerous cases. Developmentally, microfractures of the septum may form depending on the position of the head and nose, particularly during the last stage and time of birth.

DOI: 10.5281/zenodo.

To estimate the postoperative astigmatism after small‑incision cataract surgery (SICS) done  at the end of 1 and 3 months. Methods: This study was conducted at the Department of Ophthalmology of a tertiary eye care hospital at KBN Hopsital,Kalaburagi. 204 patients enrolled in the study underwent manual small incision cataract surgery. Preoperative detailed ocular examination was done, which included keratometric estimation using autokeratometer (GR‑3300K). Incision length, distance of incision from the limbus, and type of suturing technique were noted. Postoperatively, keratometric readings were noted at 1 and 3 months. Astigmatism (surgically induced astigmatism [SIA]) was estimated using Hill’s SIA calculator version 2.0. All the analyses were performed using Statistical Package for the Social Sciences (SPSS) ver. 26.0 (IBM Corp., USA) software, and the statistical significance was tested at a 5% level. Results: The observations achieved showed a maximum of 90 (44.11%) patients with matured cataract, followed by 56 (27.45%) with NS-2-3, 24(11.76%) NS-2-4. keratometric readings pre-post of K1 was 44.03 ±1.77 and 45.19 ± 1.74 there was a significant difference in the pre and post of keratometric readings for the K1 and similarly keratometric readings pre-post of K2 was 44.02 ± 1.66 & 46.18 ± 1.61. The axis and pre and post keratometric k1 were 81.35± 37.93 & 91.92 ± 43.90 and pre and post for k2 was 88.71 ± 60.73 and 113.3±52.64. Conclusion: Thus, the aim of the study was fulfilled. From our study, we conclude that SIA is directly related to the length of incision, distance from the limbus, and suturing techniques. The SIA estimated in resident‑operated SICS cases was found to be between 1.75 and 2.5 D at the end of 1 and 3 months.

DOI: 10.5281/zenodo.

Background: Neonatal seizures (NS) are a common neurological problem and they are sometimes very difficult to treat. Neonatal seizure has a high risk of mortality as well as neurological impairment/epilepsy disorders in later life. Common causes includes hypoxic-ischemic encephalopathy, intra ventricular hemorrhage, meningitis, metabolic causes like hypoglycemia, hypocalcemia, congenital anomalies etc. Methodology: We conducted this hospital based observational study in NICU of NMCH, Patna over a 1 year period from Jan 2024 to Dec 2024 including consecutively admitted term babies of less than 1 month age with neonatal seizure who stayed for >48 hours. Parameters studied were etiological profile, clinical type of seizure, time of onset of seizure and outcome of these neonates. Results: Incidence of NS was 17.3% in term neonates admitted in our NICU. . Out of the 101 neonates in the study, 46 (45.5%) were female and 55(54.5 %) were male. In our study most common risk factor for neonatal seizure was perinatal asphyxia (47.5% neonates), followed by meningitis in 31.7% neonates. Metabolic disturbances (hypoglycemia, hyponatremia, hypocalcemia) were also seen in 17.7 % neonate’s subtle seizures was the commonest seizure type (45.1%) followed closely by clonic seizures (32.8%) while tonic seizures were the least common (14.7%). In neonates with seizure, mortality was 35 (34.6%), mean duration of hospital stay was 9.4 days (SD= 2.4 days). Conclusion: Hypoxic ischemic encephalopathy was the commonest etiology in our study, followed by sepsis-meningitis. Together, these two problems are accountable for approximately 79 % of total neonatal seizure cases. Subtle seizures were the commonest clinical type of seizure which can be easily missed by untrained eyes .Most of the neonates developed seizure within 72 hours of life. Occurrence of neonatal seizure in term neonate seems to significantly increase duration of hospital stay and delay the commencement of enteral feeds without increasing mortality.

DOI: 10.5281/zenodo.

Introduction: Rhinosporidium seeberi causes Rhinosporidiosis, a chronic granulomatous infective disorder that manifests as a soft mass in the nasal mucosa. Common sites include the nasal cavity and nasopharynx, conjunctiva, larynx, and maxillary sinuses. Diseases affect all age groups and both sexes and require detailed history and examination by otorhinolaryngologists. Different types of space-occupying lesions can cause a wide range of clinical symptoms. Objective: The study aims to assess the epidemiology, clinical profile, and pathological conditions of sinonasal masses by examining their clinical behaviour and distribution among different age and sex groups in tertiary care centres. Materials and Methods: A cross-sectional study was conducted in the outpatient department of ENT at MGM Medical College and Hospital, Jamshedpur, for a period of 2 years. The study included a total of 26 cases. Clinical, demographic, and histopathological details were noted in each case. The study group included all cases diagnosed as rhinosporidiosis by histopathology during the study period. Results: The majority of patients in our study were young male adults of low socioeconomic status, some tribals, and from rural areas. The most common symptom in our study was 53.8% nasal masses and mucoid nasal discharge in 57.7% of cases. Conclusion: Rhinosporidiosis is an infectious disease that affects individuals who use surfaces water. It requires careful clinical evaluation and surgical excision in high-risk groups and continuous follow-up for an early diagnosis, a treatment plan, and the goal is to prevent nasal cavity patency and recurrence.

DOI: 10.5281/zenodo.

Aims and Objectives: Aim is to study the cases of hollow viscus perforation with and without x ray showing air under diaphragm preoperatively. Also to study the cases of pneumoperitoneum with negative intraoperative findings. Methods: This is a retrospective study performed at Department of General Surgery in Andhra Medical College, Vizag. All patients included are suspected hollow viscus perforation cases, aged 14 years and over, and underwent laparotomy between Jan 2023 to Jan 2024. Results: Based on the study, 3 patients were found to have pneumoperitoneum preoperatively, but no hollow viscus perforation was found intraoperatively. 3 patients had no abnormality on x ray, but perforation was confirmed with further investigations or laparotomy. The results obtained in the study shows male predominance, duodenal perforation being the commonest. Conclusion: It is important to note that, not all the cases of pneumoperitoneum indicate perforated abdominal viscus or vice versa. This study highlights the difficulty in preoperative diagnosing pneumoperitoneum with upright chest and abdominal x rays provided its sensitivity varied from 50-98%.

DOI: 10.5281/zenodo.

Background: Cerebrovascular accident (CVA), is a major cause of morbidity and mortality worldwide. D-dimer, a fibrin degradation product, is a key marker of thrombotic activity and has been proposed as a potential biomarker for stroke severity and prognosis. However, data on its correlation with ischemic stroke severity, particularly in the Indian population, remain limited. This study aimed to evaluate the relationship between plasma D-dimer levels and the severity of ischemic cerebrovascular accidents. Methods: This hospital-based observational cross-sectional study was conducted at the Department of Medicine, Tripura Medical College, and Dr. B.R. Ambedkar Memorial Teaching Hospital. A total of 102 ischemic stroke patients, aged 18 to 70 years, were included based on predefined inclusion and exclusion criteria. Plasma D-dimer levels were measured within 24 hours of admission using nephelometry immunoassay. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Pearson’s correlation coefficient was used to evaluate the association between D-dimer levels and stroke severity. Results: The mean age of the participants was 61.2 ± 5.8 years, with a male predominance (64.7%). Hypertension (74.5%) and type 2 diabetes mellitus (46.1%) were the most prevalent comorbidities. The majority of patients (70.5%) had moderate stroke severity (NIHSS score 6–13), followed by mild cases (27.5%) and severe cases (2%). Elevated D-dimer levels were observed in 99 patients, with a mean level of 0.97 ± 0.51 mcg/ml. A significant positive correlation was found between D-dimer levels and NIHSS scores (r = 0.826, p < 0.001), indicating that higher D-dimer levels were associated with greater stroke severity. Conclusion: Elevated plasma D-dimer levels are strongly correlated with the severity of ischemic stroke, suggesting their potential role as a biomarker for stroke assessment. These findings highlight the need for further studies to explore D-dimer’s prognostic value and its utility in guiding clinical management strategies.

DOI: 10.5281/zenodo.

Background: Congenital anomalies are structural or functional abnormalities including metabolic abnormalities present at birth. 6% of babies worldwide are born with congenital disorders. In India, reported incidence is 2.5%. Congenital anomalies are a diverse group of disorders of prenatal origin that can be caused by single gene defects, chromosomal disorders, multi-factorial inheritance, malnutrition or environmental teratogens. In India, congenital malformations are known to be third common cause of perinatal mortality. Aim: To correlate the fetal anomalies with maternal risk factors. Objective: To correlate the fetal anomalies with maternal comorbidities, social and environmental factors. To assess the hospital prevalence and types of congenital anomalies in fetuses. Methodology: This was a cross sectional retrospective hospital based study of 90 patients who delivered or aborted congenital anomalous babies during a period from January 2014 to September 2023. Relevant information like maternal age, consanguinity, Folic acid intake, comorbidities, habits, teratogenic drug exposure, antenatal USG, fetal sex, weight and gross anomalies were documented and analysed. Results: The prevalence of congenital anomaly was mostly involving Central nervous system followed by cardio vascular system. The major maternal risk identified was non intake of folic acid supplements (14%) and consanguinity (17%). Conclusions: Regular ANC visits, early diagnosis, antenatal screening, comorbidities control, appropriate counselling for current and subsequent pregnancies are needed for proper management.

DOI: 10.5281/zenodo.

Introduction: Neonatal health is a critical area of medical care that demands meticulous attention and specialized interventions. The Neonatal Intensive Care Unit (NICU) is a pivotal environment designed to support the survival and recovery of newborns who face serious health challenges. The aim of the study was to investigate the various morbidities affecting neonates in the NICU and evaluate the outcomes of their care. Methodology: This study is a retrospective, single-centre study conducted in the NICU of LAM Government Medical College in Raigarh, Chhattisgarh, from January to December 2024. It was designed as a retrospective cohort study, examining the medical records of neonates admitted over a one-year period. This retrospective design enabled the assessment of historical data to identify trends and outcomes related to various morbidities and mortalities. Results: In the present study, 502 neonates were admitted to the NICU from January to December 2024. The male-to-female ratio was 1.3:1. Of these neonates, 398 (79.4%) were discharged, while 73 (14.6%) died. The majority, 268 (53.4%), were delivered via normal vaginal delivery. Among the neonates, 251 (50%) were full-term, 249 (49.6%) were preterm, and 2 (0.4%) were post-term. Additionally, 167 (33.2%) were categorized as low birth weight (LBW), 69 (13.7%) as very low birth weight (VLBW), and 28 (5.6%) as extremely low birth weight (ELBW). A substantial number, 241 (48%), were hospitalized for 4-7 days, while 35 (7%) required more than 14 days of hospitalization. The most common morbidity observed was birth asphyxia, affecting 135 (26.9%) neonates, followed by Prematurity in 96 (19.1%) and neonatal hyperbilirubinemia in 82 (16.3%). The leading causes of neonatal mortality were birth asphyxia (31 cases, 42.5%), respiratory distress syndrome (18 cases, 24.7%), and septicaemia (16 cases, 21.9%). Neonatal mortality was directly related to birth weight and gestational age, with no observed correlation to gender. At our institution, there were a total of 6,095 live births, and the neonatal mortality rate was 11.98 per 1,000 live births. This rate is markedly lower than the average Neonatal Mortality Rate (NMR) for Chhattisgarh, which is 32.4 per 1,000 live births, and the national average for India, which stands at 24.9 per 1,000 live births according to the National Family Health Survey (NFHS-5) 2019-21. Conclusions: This study highlights the crucial role of the NICU in protecting neonatal health. Preventing many of the morbidities and mortalities hinges on the improvement and effective implementation of essential preventive services. Furthermore, ongoing research in neonatal care, the establishment of standardized protocols, and comprehensive training for healthcare providers, alongside the effective execution of maternal and essential newborn care, are indispensable for further reducing neonatal morbidity and achieving optimal outcomes.

DOI: 10.5281/zenodo.

Introduction: High levels of air pollutants, including PM2.5, PM10, NO₂, SO₂, and O₃, pose a significant hazard to human health, especially in cities. These pollutants can cause respiratory diseases including asthma and COPD. Objective: This research seeks to discover if polluted urban air exposure affects breathing. We measured pulmonary function using spirometric parameters like FVC, FEV1, and FEV1/FVC ratio, as well as exposure to pollutants like PM2.5 and NO₂. Materials & Methods: Researchers examined 215 city residents aged 18–65 using a cross-sectional approach. Researchers tested lung function and collected air pollution data from environmental monitoring stations. We used regression and correlation to find patterns and determine how pollution influenced lung function. Results: This indicated a negative connection between particulate matter (PM2.5 and PM10) levels and FEV1 and FVC values, indicating lung function deterioration. While NO₂ had a slight negative correlation with lung measurements, ozone did not have a significant impact. Conclusion: Due to air pollution, especially fine particulate matter, city dwellers have worse lung function. Results emphasise the need for public health measures and stricter air quality laws to reduce these harms.

DOI: 10.5281/zenodo.

Background: In regional anaesthesia, adjuvants improve block and prolong analgesia, according to research. This study examines 0.5% ropivacaine + dexmedetomidine + dexamethasone as adjuvants in ultrasound-guided supraclavicular brachial plexus blocks for upper limb orthopaedic procedures. Methods: 50 people scheduled for orthopaedic surgery on their upper limbs between January and December 2024 were divided into two groups in this prospective, randomised trial at Nalanda Medical College & Hospital in Patna, Bihar. 0.5% ropivacaine with dexmedetomidine (1 mcg/kg) was given to DEX, while dexamethasone (8 mg) was given to DXS. Crucial findings included the beginning and length of sensory and motor blockage. Additional outcomes included the amount of time patients needed analgesia after surgery, changes in haemodynamics, and adverse effects. An examination of statistical significance was carried out using SPSS software, with a p-value less than 0.05. Results: Compared to dexamethasone, dexmedetomidine significantly accelerated sensory and motor blockage (p < 0.05). Dexamethasone was more effective in prolonging postoperative analgesia (p < 0.05). Haemodynamic tests showed that dexmedetomidine caused bradycardia and hypotension, while dexamethasone stabilised it. Both groups reported minor adverse occurrences and no severe concerns. Conclusion: While dexamethasone offers longer analgesia with less haemodynamic side effects, dexmedetomidine speeds up the start of SCBPB. Surgical needs and patient conditions should guide adjuvant selection. This study’s results and the optimisation of adjuvant selection in regional anaesthesia require further large-scale, multi-center research.

DOI: 10.5281/zenodo.

Background: Osteoarthritis, rheumatoid arthritis, and other significant joint issues can be addressed with Total Joint Arthroplasty (TJA). Preoperative planning and precise surgical execution make optimal outcomes challenging, notwithstanding its efficacy. Preoperative planning could be improved by AI implant selection and alignment precision, which could improve surgical results and reduce complications. Methods: The study examined 75 TJA patients from November 2022 to April 2024 at Katihar Medical College. The study focused on how AI affects preoperative planning, surgical accuracy, and patient outcomes. Three-dimensional anatomical models were developed utilising AI technology like imaging analysis and predictive modelling to decide implant placement and size. Analysis included preoperative imaging, operation reports, and postoperative follow-ups. Alignment precision, intraoperative changes, complication rates, recovery times, patient-reported outcomes, and implant size forecast accuracy were evaluated. Regression models and descriptive statistics were employed to assess AI’s surgical precision and outcomes. Results: AI preoperative planning was accurate. Predicted implant sizes were within ±1 size in 92% of cases, and component alignments were precise in 88%. AI required 12% fewer intraoperative corrections than traditional planning methods. No significant complications like deep infections or prosthesis dislocation occurred at 8%. About 85% of patients were very delighted with their surgery results. Functional performance and pain management increased dramatically, and recovery averaged 4.3 weeks. Conclusion: Preoperative AI planning for TJA can improve surgical precision, reduce operation revisions, and improve patient outcomes. The results suggest that AI can increase surgical precision and efficiency, improving clinical outcomes and patient satisfaction. This study supports the use of AI in orthopaedic surgery, although larger samples and prospective designs are needed to validate these findings and examine the long-term implications of AI on surgical outcomes. Artificial intelligence could improve preoperative planning and orthopaedic therapy.

DOI: 10.5281/zenodo.

Introduction: Medication errors pose a significant challenge in tertiary care hospitals due to complex treatment regimens, high patient loads, and multidisciplinary involvement. These errors can occur at any stage, including prescribing, dispensing, administration, and monitoring, often resulting from miscommunication, human errors, and system inefficiencies. Aim: To assess the prevalence, types, and contributing factors of medication errors in a tertiary care hospital and evaluate prescription rationality to identify areas for improvement in medication safety. Materials and Methods: This prospective observational study was conducted in a tertiary care hospital to analyze medication errors across various stages of medication management. Errors were identified through direct observation, medical record reviews, and healthcare provider reports. Drug-drug interactions were assessed using Medscape Drug Interaction Checker, and prescription rationality was evaluated using Phadke’s criteria. Data were analyzed statistically to identify trends, risk factors, and significant correlations, with a p-value <0.05 considered significant. Results: A total of 869 patients were included in the study, with 330 medication errors (MEs) detected, predominantly in the Pediatric (53%) and Medicine (47%) wards. Intravenous (IV) administration errors (89%) were the most common, followed by oral administration errors (7%). Prescription errors (76%) were the leading cause, mainly due to inappropriate drug selection (74%), with ceftriaxone, co-amoxiclav, and metronidazole being the most frequently misprescribed drugs. Administration errors involved inaccurate dosing (16%), dose interval errors (10%), and wrong route of administration (5%). Prescription rationality assessment showed that 55% of prescriptions were semi-rational, 30% irrational, and only 15% rational, highlighting a need for better prescribing practices. Conclusion: Medication errors, particularly prescription and intravenous administration errors, remain a significant challenge in tertiary care hospitals. Strengthening prescribing practices, enhancing pharmacist involvement, and implementing digital interventions can improve medication safety and patient outcomes.

DOI: 10.5281/zenodo.

Background: Dengue fever is a major public health issue in tropical regions, with complex clinical manifestations that can include severe complications. Recent studies suggest an association between dengue infection and cholecystitis, but this relationship remains underexplored. Objective: This study aimed to determine the prevalence and clinical characteristics of cholecystitis in patients with dengue fever, focusing on the potential impact of severe dengue on the incidence of gallbladder inflammation. Methods: We conducted a descriptive, observational study involving 75 patients diagnosed with dengue fever at Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, over 12 months. Data on clinical symptoms, laboratory findings, and ultrasound results were collected to identify cases of cholecystitis. Results: Of the 75 dengue patients, 12 (16%) were diagnosed with cholecystitis. These cases were predominantly observed in patients with severe dengue (83.3%), featuring symptoms such as significant abdominal pain, nausea, and vomiting. Patients with cholecystitis also showed elevated liver enzymes and required longer hospital stays compared to those without cholecystitis. Conclusion: Serious dengue is associated with cholecystitis, suggesting that dengue virus infection may directly or indirectly cause gallbladder disease. This study emphasises the need of clinical awareness of cholecystitis in severe dengue patients and quick diagnosis to enhance patient outcomes.

DOI: 10.5281/zenodo.

Background: Albuminuria commonly indicates nephropathy in type 2 diabetes mellitus (T2DM). T2DM patients’ acute phase reactants and albuminuria are examined in this study. Methods: At Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, we conducted a cross-sectional observational study on 75 T2DM patients. We examined the association between albuminuria and acute phase reactants such as CRP, serum amyloid A, and ferritin using Pearson’s correlation coefficient. Results: A substantial positive connection was seen between CRP (r = 0.62, p < 0.01) and ferritin (r = 0.53, p < 0.05) levels and albuminuria. However, serum amyloid A was not associated with albuminuria (r = 0.19, p = 0.14). Conclusion: In T2DM patients, higher CRP and ferritin levels are related to albuminuria, highlighting the involvement of inflammation in diabetic nephropathy formation and progression.

DOI: 10.5281/zenodo.

Fibrous dysplasia is a rare, benign bone disorder characterized by the replacement of normal bone with fibro-osseous tissue due to defective osteogenesis; primarily affects the skull and facial bones, leading to cosmetic deformities and functional impairments. The present case series describes seven patients with craniofacial fibrous dysplasia, highlighting their clinical presentation, imaging findings, and diagnostic considerations. Non contrast CT scans were performed to assess the characteristic “ground glass” bone matrix appearance. The study cohort consisted of five females and two males, aged 05 to 46 years. The most commonly affected sites were the frontal, sphenoid, and parietal bones. Patients presented with symptoms such as headache, focal bony prominence, visual disturbances, and incidental findings during imaging for unrelated complaints. None of the patients exhibited endocrinological abnormalities or cutaneous manifestations of McCune-Albright syndrome. Imaging findings were consistent with fibrous dysplasia, characterized by well-defined, expansile lesions with a homogenous ground glass matrix.

DOI: 10.5281/zenodo.

Background: Breast cancer typically originates in the milk-producing ducts, known as invasive ductal carcinoma. Breast cancer can originate in the glandular tissue known as lobules (invasive lobular carcinoma) or in other cells or tissues within the breast. Breast cancer is the most prevalent malignancy among women overall. Breast cancer now accounts for one in four malignancies among women worldwide. This study evaluates the clinical and treatment outcomes of breast cancer based on patient characteristics, illness attributes, management strategies, and follow-up results. Objectives: The aim of this study is a retrospective examination of all patients with breast cancer registered in the Radiation Oncology Department at GMC, Bhopal, over the past ten years. Methods: This retrospective analytical investigation encompassed 1,061 breast cancer patients registered at the Department of Radiation Oncology, Gandhi Medical College and Hamidia Hospital Bhopal, over the past decade from 2010 to 2019. The data will encompass the total number of registered breast carcinoma patients and the percentage of breast cancer cases treated with chemotherapy and radiotherapy. Patient information: Name, age, sex, hormonal receptor status, histopathological data, and TNM staging with stage grouping. Menstrual condition 5) Familial history, Treatment strategy, treatment specifics, and adherence to treatment. Evaluation of therapy response utilizing RECIST criteria. Follow-up details at 3 months, 6 months, and 1 year. Treatment outcomes regarding the absence of abnormalities, relapse, recurrence, or residual disease. Results: The mean age was recorded at 47.36 years, with a standard deviation of 11.66. The highest proportion of patients exhibited IIIA stage (44.2%), with the majority diagnosed with IDC (infiltrating ductal carcinoma) or IVC (invasive ductal carcinoma) (84.07%). The estrogen receptors were detected in the majority of patients at 38.54%, with just 3.01% of patients having a substantial family history; the majority, 56.83%, were in the pre-menopausal category. Out of about 154 individuals with metastases at diverse sites, 62.9% exhibited bone metastasis, while 24.6% had lung metastasis. The highest proportion of patients received chemotherapy (84.8%), followed by surgery, which was administered to around 76.3% of patients. Patients received hormonal therapy, predominantly Letrozole at 27.5%, followed by Anastrozole at 7.06%. The average is 699.3 with a standard deviation of 169.99; patients have been monitored for an average duration of 6 months, and approximately 18.57% of patients exhibited a negative response during follow-up. The majority of patients were observed in PR, comprising 46.5% of the volume. Conclusion: Breast cancer is the most prevalent malignancy among females in India and constitutes a significant public health burden. The incidence of breast cancer is rising due to a lack of awareness and advancing age. The majority of patients come with locally advanced disease; hence, neoadjuvant treatment is crucial for tumor down staging. The standard follow-up for individuals treated for breast cancer involves regular visits, with the frequency diminishing in subsequent years.

DOI: 10.5281/zenodo.

Introduction: Tracheostomy is one of the common surgical procedures performed in patients with airway obstruction or respiratory failure. The presence of multidrug-resistant organisms in tracheostoma secretions pose a significant challenge in antibiotic management. This results in burdening economical and financial issues. There is a high chance of respiratory tract infection and ventilator associated pneumonia in patients who are intubated or tracheostomized. The main reason being leakage of secretions around the tracheostomy or endotracheal cuffed tube, reducing the clearance of bacteria by disabling the ciliary beat. A study over a period of time about the pattern of growth will help us to identify the most commonly involved microbes and thereby help in selecting proper empirical treatment in post-operative tracheostomy patients. Materials and Methodology: A descriptive type of observational study was conducted in Burdwan Medical College and hospital from November 2022 to March 2023 on a sample size of 50 patients. Study population was chosen from the patients above the age of 12 undergoing tracheostomy at the institution.after taking written informed consent the sample for study that was the secretions collected from the tip of the tracheostomy tube during tube change after 72 hours of tracheostomy procedure. The sample containing tracheal secretions was then sent to microbiology laboratory for isolation of the organisms and to obtain their antimicrobial susceptibility pattern. Results: The majority of samples (30) i.e. 60% reported no growth (NG). Pseudomonas aeruginosa was isolated from 11 patients, and Methicillin Sensitive Staphylococcus aureus (MSSA) was isolated from 8 samples. Generalized drug susceptibility showed maximum susceptibility to Vancomycin, Linezolid, and Colistin, Meropenem and resistance to Azithromycin, Ceftriaxone, Levofloxacin. Conclusion: By effectively managing the microbiological profile of tracheostoma secretions, healthcare providers can make significant strides in ensuring the well-being of patients undergoing tracheostomy procedures. Regular surveillance and antimicrobial susceptibility testing are essential in monitoring the emergence of multidrug-resistant organisms and tailoring treatment strategies.

DOI: 10.5281/zenodo.

Background: Breast carcinoma is a major health concern, with its prognosis significantly influenced by factors such as lymphovascular emboli (LVE), perineural invasion (PNI), and lymph node metastasis (LNM). This study aims to evaluate their association in modified radical mastectomy (MRM) specimens from the Konkan region. Methods: A record based observational cross-sectional study was conducted over three years (2021-2024) at a tertiary care hospital. A total of 101 breast carcinoma cases were analyzed using hematoxylin and eosin (H&E)-stained slides from paraffin-embedded tissue sections. Results: The most affected age group was 41–60 years. Poorly differentiated tumours (Grade III) were the most prevalent (76.23%), followed by moderately differentiated (Grade II, 19.8%) and well-differentiated (Grade I, 3.96%) tumours. LNM was observed in 49 cases (48.51%), LVE in 80 cases (79.2%), and PNI in 31 cases (30.69%). The highest association of LVE (55%) and PNI (25%) with LNM was found in moderately differentiated (Grade II) tumours. Conclusion: LVE and PNI, identifiable on routine H&E slides, serve as critical markers for predicting metastasis and overall prognosis in breast carcinoma patients. Their assessment can aid in early intervention and better clinical management.

DOI: 10.5281/zenodo.

Background: Ultrasonography (USG) is a cost-effective and widely available imaging modality used to evaluate hepatic lesions. This study aims to assess the diagnostic role of USG in characterizing liver space-occupying lesions (SOLs) as benign or malignant. Additionally, it investigates the utility of color Doppler imaging and the correlation between ultrasound findings and histopathology. Methods: A prospective observational study included 50 patients who underwent USG evaluation using grey scale and color Doppler techniques. SOLs were assessed for various characteristics, including composition, echogenicity, shape, and margins. Blood flow patterns within the lesions were analyzed using color Doppler imaging. Pathological diagnosis through FNAC/biopsy served as the reference standard. Statistical analysis was performed to evaluate the correlation between USG diagnosis and histopathology. This study provides a concise analysis of the effectiveness of USG in evaluating and diagnosing liver SOLs, emphasizing the use of color Doppler imaging for improved diagnostic accuracy. Results: In the present series 50 patients with focal hepatic SOL who were identified during sonological evaluation of abdomen with various clinical conditions, were included in my study. USG and colour Doppler flow imaging (CDFI) were studied meticulously. Then an attempt was made to correlate clinical, sonological (Both grey scale & colour Doppler) and histopathological diagnosis of these lesions. Therapeutic aspiration was also performed during the procedure whenever indicated. In the present series metastases was found to be the most common focal hepatic SOL and it is followed by amoebic liver abscess. Overall focal hepatic SOL are more common in the age group of 30-60 yrs. Male was found to be more affected irrespective of disease. Most common echo pattern of liver metastases found in this series was heterogeneous and hyperechoic masses. Hypo echoic & bull’s eye metastatic deposit were also found. On colour Doppler flow imaging most of the lesion showed no intra or peritumoral blood flow. Among the liver abscesses, amoebic liver abscess was found much more common than the pyogenic abscess, this may be due to improper hygienic condition in our country. USG was quite accurate in diagnosing all the cases & was also helpful in locating the abscess prior to therapeutic aspiration. Among the hepatic cysts hydatid cyst was most common. In this series also USG was competent enough in successfully diagnosing the condition. Colour Doppler flow imaging of inflammatory conditions of liver is not of any significant role. Among the hepatocellular carcinoma older age group was mainly affected. It was found that USG findings were not confirmatory but were sufficient enough in suggesting the condition. CDFI showed increased intra and peritumoral blood flow in majority of the cases thus enhancing the diagnostic specificity of the condition but confirmation was done by histopathological examination. Haemangioma of liver were encountered incidentally during scanning of hepatobilliary system with various clinician conditions. No significant blood flow was detected (intra or peritumoral) in this study. Conclusion: USG is an accurate, safe, non-invasive, sensitive and cost effective imaging modality for diagnosis of focal hepatic SOL. The presence or absence of flow on colour Doppler flow imaging is not a reliable feature for differential diagnosis of focal hepatic lesions when it is used alone. The flow pattern as assessed on CDFI may point to the nature of the lesion and when used along with other morphological imaging features can assist in diagnosis or in narrowing the list of differential diagnosis in a particular clinical situation. The guided FNAC procedure is very useful in establishing a final histopathological diagnosis. Therefore widespread use of ultrasonography should be strongly recommended for diagnosing focal hepatic SOL and colour Doppler flow imaging (CDFI) should be used as an adjunct whenever indicated and histopathological correlation should be done by guided FNAC.

DOI: 10.5281/zenodo.

Background: Pancreatitis is a condition of inflammation of pancreas with high rate of morbidity and mortality. USG provides the initial radiological assessment of the organ, clue of the extent of involvement and an opportunity to evaluate other abdominal organs. CT scan provides a cross-sectional anatomy of the organ, its internal structure, focal or diffuse involvement and involvement of adjacent structures. Aim of this study was to diagnose pancreatitis by ultrasound and computed tomography and to define limitations and advantages of one modality over other. Methods: This study was done in department of radio-diagnosis at Darbhanga Medical College and Hospital, Laheriasarai, Bihar from January 2019 to December 2019. Patients were confirmed to have pancreatitis based on imaging findings on eithermodality and a combination of clinical features suggestive of pancreatitis and biochemical values to support a diagnosis of the same.  In acute pancreatitis, CT severity index also taken into consideration. The index focuses on the presence and degree of pancreatic inflammation and necrosis on a 10 point severity scale, points are awarded for the presence or absence of fluid collections. Patients in whom the diagnosis of pancreatitis was made purely on clinical grounds without any imaging (ultrasound or CT) and patients in whom no imaging was done prior to surgery where a diagnosis of pancreatitis was made was excluded from the study. Results: Ultrasound by non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is first investigation of choice in pancreatitis. However, USG fails imaging in conditions with excess of bowel gas or fatty patient. It lacks in detailed characterization of the inflammatory process and does not delineate extent of necrosis of the gland. CT is superior to ultrasound for precise detection of size, parenchyma, MPD, calcification, pseudocyst, ascites, and pleural effusion, and necrosis and peri pancreatic region and hence helps to determine exact extent of inflammation of the organ, multi-system involvement and prognosis.  Conclusion: Ultrasound by non-invasiveness, easy availability, cost parameters, lack of radiation hazard and by ability to demonstrate structural changes in organ is first investigation of choice in pancreatitis. However, ultrasonography lacks in detailed characterization of the extent of involvement of the organ and adjacent structures. CT is superior to ultrasound for precise detection and extension of the pancreatitis and it has better sensitivity and specificity than ultrasonography.

DOI: 10.5281/zenodo.

Background: Pregnancy-related glucose intolerance is one of the early indicators of gestational diabetes, which can harm both the mother and the fetus. The current study focused on a number of maternal and perinatal outcomes associated with pregnancies affected by gestational diabetes. Methods: From December 2023 to November 2024, 296 women who had been given a gestational diabetes diagnosis in the Obstetrics and Gynaecology department at TMMC and RC, TMU in Moradabad, Uttar Pradesh, participated in this retrospective study. Maternal and perinatal data has been obtained from patient medical records in the hospital database. The data included maternal and neonatal morbidity and death, age, gestational age, parity, delivery method, BMI, infant birth weight, and prenatal issues. Every woman with numerous pregnancies who showed breech in the delivery room was excluded. To evaluate the outcomes for the mother and the fetus, a kidney function test and platelet count estimation were performed in addition to blood glucose measurements and routine tests. Results: 84 (28.4%) of the 296 women with a gestational diabetes diagnosis were between the ages of 30 and 40, whereas 194 (65.5%) were between the ages of 20 and 30. Pregnancy-induced hypertension was more common in 36 cases (12.2%), caesarean sections in 174 cases (58.8%), Polyhydramnios in 116 cases (39.2%), macrosomia in 8 cases (2.7%), and premature delivery in 10 cases (3.4%), even though gestational diabetes was identified and treated early. There were 86 (29.1%) perinatal morbidities and 10 (3.4%) deaths. Neonatal hypoglycemia caused 98 (33.1%) of the cases, meconium aspiration syndrome for 24 (8.1%), hyperbilirubinemia for 38 (12.8%), and the necessity for neonatal unit hospitalization for 74 (25%) of the cases, which were common causes of perinatal morbidity. Reports of 6 (2%) and 4 (1.4%) neonatal and intrauterine deaths were made. Conclusion: The prevalence of maternal and neonatal morbidity and mortality increased in women with gestational diabetes. A 75 g oral glucose tolerance test was used to assess pregnant women for gestational diabetes throughout the 24–28 week gestation period. An early diagnosis and timely treatment resulted in fewer issues. Proper management of gestational diabetes can improve pregnancy outcomes.

DOI: 10.5281/zenodo.

Background: Alternative analgesic techniques for post-operative pain in laparoscopic cholecystectomy have been spurred by growing concerns about opioid-related adverse effects and complications. By comparing the two groups’ post-operative VAS scores, hemodynamic parameters, recovery profiles, the total number of rescue analgesics needed, and any adverse drug reactions, this study sought to compare the effectiveness of lidocaine and dexmedetomidine intraoperative infusions. Methods: 66 ASA I/II class patients, both male and female, between the ages of 18 and 60, participated in an interventional, double-blind, randomized trial. These patients were assigned at random to Group D (Dexmedetomidine) and Group L (Lidocaine). At predetermined intervals during and after surgery, hemodynamic parameters were recorded. Richmond Agitation Sedation Score and Post-Operative Visual Analogue Scale Score were monitored. Results: Since there were no notable hemodynamic events during the trial, lidocaine and dexmedetomidine are both safe. Additionally, both medications were found to be efficient in controlling postoperative pain; however, during a 120-minute follow-up, the mean VAS for Group D was substantially lower than that of Group L (p<0.05). Conclusion: With comparable recovery characteristics, it can be concluded that both lidocaine and dexmedetomidine perioperative infusions successfully postponed the post-operative rescue analgesic demand. However, when it came to the analgesic efficacy and recovery profile, dexmedetomidine slightly outperformed lidocaine.

DOI: 10.5281/zenodo.

Background: The diagnosis of tubercular (TB) pleural effusion is still challenging in clinical practice because standard diagnostic methods are useful but not sensitive enough or specific enough. Methods: From February 2024 to October 2024, 76 patients participated in this prospective observational study, which was conducted at the Department of General Medicine, Adesh Medical College and Hospital, Mohri, Shahbad, Kurukshetra, Haryana. The clinical history, radiographic imaging, biochemical analysis, and cytological analysis of the pleural fluid were used to make the etiological diagnosis. A biomarker for tubercular pleural effusion was found in pleural fluid ADA. Results: Of the 76 patients in the study, 30.3% (n=23) were female and 69.7% (n=53) were male. The patients were 48.97±17.03 years old on average. Out of 76 pleural effusion cases, 14 were transudates and 62 were exudates. The most frequent cause of exudates, which caused 51.3% (n=39) of cases, was tuberculosis. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), Accuracy of pleural fluid ADA in diagnosing tubercular pleural effusion was 92.3%, 97.3%, 97%, 92% and 94.7% respectively. Conclusion: Pleural fluid Because of its remarkable sensitivity and specificity, ADA may be among the most reliable biomarkers for the detection of TB pleural effusion.

DOI: 10.5281/zenodo.

Background: The prevalence of heart failure (HF), a common cardiovascular condition, has increased recently. Its genesis involves several risk factors, making prevention and management more difficult. Assessing the clinical profile of patients with heart failure was the aim of this study. Methods: From March 2024 to August 2024, patients admitted to the medicine department of Adesh Medical College and Hospital in Mohri, Shahbad, Kurukshetra, and Haryana, participated in this prospective observational study. The study comprised patients who met the European Society of Cardiology’s (ESC) criteria for heart failure. Congestive heart failure prevalence was calculated using data from hospital outpatient departments and community studies. Results: The main risk factors for HF were ischemic heart disease, hypertension, drinking, and smoking. The most prevalent symptoms among the patients were palpitations (50%) and coughing (57.7%), foot edema (92.3%), and dyspnea (100%). The patients’ primary symptoms were elevated Jugular Venous Distention (JVD) (57.7%), S3 (57.7%), oedema foot (100%), and basal crepitations (80.3%). According to the results of the chest X-ray (CXR), 76.9% of the patients had an elevated cardiothoracic ratio. Left Ventricular Hypertrophy (LVH) and arrhythmias (mostly AF-19.2%) each contributed 26.9%.According to estimates, the prevalence of HF ranged from 0.51 to 27.27. Conclusion: Ischemic heart disease and hypertension were the leading risk factors apart from smoking and alcoholism and the management of comorbid conditions may have sizeable effect in the clinical management.

DOI: 10.5281/zenodo.

Background: The quality and duration of spinal anesthesia are frequently improved by intrathecal adjuvants. The anesthetic and analgesic effects of alpha-2 adrenergic agonists, such as clonidine and dexmedetomidine, have been extensively researched. In this study, the effects of clonidine and intrathecal dexmedetomidine as adjuvants to hyperbaric ropivacaine 0.75% in lower abdomen operations are compared. Materials and Methods: 80 scheduled for lower abdomen procedures under spinal anesthesia were involved in this prospective, randomized, double-blind trial. Group RC (3 ml of 0.75% hyperbaric ropivacaine + 30 µg clonidine in 0.5 ml normal saline) or Group RD (3 ml of 0.75% hyperbaric ropivacaine + 5 µg dexmedetomidine in 0.5 ml normal saline) were given intrathecally to patients at random. Sedation levels, side effects, sensory and motor block features, and hemodynamic parameters were evaluated both during and after surgery. Results: Group RD had sensory block much more quickly than Group RC (p < 0.05). Additionally, Group RD had longer postoperative analgesia and a longer duration of sensory and motor blockage. Compared to the clonidine group, the dexmedetomidine group experienced fewer bouts of bradycardia and hypotension and greater hemodynamic stability. Although Group RD experienced higher degrees of sedation, these levels were nonetheless within reasonable therapeutic bounds. In both groups, adverse effects were negligible. Conclusion: Both clonidine and dexmedetomidine successfully increased intrathecal ropivacaine’s analgesic and anesthetic effects. Nonetheless, dexmedetomidine was a better option for lower abdomen procedures because to its longer postoperative analgesia, improved hemodynamic stability, and superior sensory and motor blocking duration. These results might be supported by more research with bigger sample numbers.

DOI: 10.5281/zenodo.

Aim: To compare the morphological and histological changes in placenta with gestational diabetes mellitus and normal placenta. Materials and Methods: In this study 40 placenta were taken in them 20 placentas were normal and 20 placentas were gestational diabetes mellitus. Here the morphological parameters like age, weight, size, diameter, thickness, baby weight and histological parameters like chorangiosis, syncytial knots, stromal fibrosis, fibrin degeneration were taken for both the type of placenta and comparative study was done. Results: In this study there are significant changes in size, weight, baby weight, chorangiosis, fibrin degeneration have increased in the diabetes placenta compared with normal placenta. Conclusion: Gestational diabetes mellitus causes morphological and histological changes in placenta and neonatal outcome.

DOI: 10.5281/zenodo.

Background: Discovery of classical ABO system of blood group by Karl Landsteiner in the year 1901 and Rh system by Karl Landsteiner and Weiner in 1941 had started a new era in blood transfusion. Later on several other blood group systems were discovered. Blood grouping is made on the basis of presence or absence of a specific agglutinogen on the surface of red cell membrane. Aim: To determine the blood groups of the 1^st MBBS students studying in Lakhimpur Medical College and Kokrajhar Medical College of Assam and to determine their ethnic variation. Material and Method: Blood grouping was done by using slide agglutination method using commercially available antisera. Results: Among the 200 medical students selected for study, 54 were found to belong to various ethnic groups of Assam and 146 belonged to general caste that also included students from other states of India. Blood group ‘B’ was found to be the commonest (37.03%) and group ‘AB’ was found to be the least common (7.40%) among the ethnic groups of Assam. Among the general category, Blood group ‘O’ was found to be the commonest (41.78%) and group ‘AB’ was found to be the least common (7.53%). Rh positive blood group was found in most of the subjects (97.5%). Among Mising community, blood group ‘A’ and ‘O’ was most common, whereas among Ahom, Chutia , Bodo, Rabha and Karbi community, blood group ‘B’ was found to be most common. Conclusion: Determination of blood groups in relation to ethnicity of the population help generating database to keep records for future use.

DOI: 10.5281/zenodo.

Background: Healthcare-associated infections (HCAIs) are a significant public health concern, particularly in hospitals and other healthcare settings. Surgical Site Infections (SSIs), a critical subset of HCAIs, occur at or near the surgical incision within a specified time frame post-operation (30 days for non-implanted procedures and up to 90 days for procedures involving prosthetic materials). SSIs are particularly concerning in orthopedic surgeries due to their impact on patient recovery and healthcare costs. They not only increase morbidity but also lead to extended hospital stays and higher healthcare costs, placing a substantial economic burden on both patients and healthcare systems. Aims: Primary Aim: To determine the prevalence and characteristics of surgical wound infections among orthopedic patients at our hospital. Secondary Aim: To analyze the microbiological profile and drug resistance patterns of bacterial isolates, thus gaining insight into the prevalence of multi-drug resistant (MDR) strains in our setup. Materials & Methods: The present study was carried out in the Departments of Microbiology & Orthopedics at a tertiary care Referral Centre for a period of four years from June 2021 to June 2024. A total of 831 clinically diagnosed case of post-operative wound infections were studied in all age groups and both genders irrespective of their preoperative administration of antibiotics. All the specimens from clinically diagnosed cases of post-operative wound infections were processed in the laboratory using Standard Microbiological techniques. Results: Of the 4011 post-operative orthopedic patients, SSIs was diagnosed in 831 patients. Out of 831 samples cultured, 361 samples yielded growth and 470 samples yielded no growth. The percentage of infections was found to be higher in the age group of 21-40 years. Methicillin Resistant Staphylococcus aureus (MRSA) was the most common gram-positive organism isolated and Escherichia. Coli was the most common gram-negative organism isolated from cultures. Most of the gram-negative organisms were sensitive to polymyxin-B and colistin. All the gram-positive organisms were 100% sensitive to linezolid, vancomycin, Amikacin & Gentamicin. Conclusions & Recommendations: Due to antibiotic resistance and improper drug administration, the treatments of SSIs is challenging for the Orthopedician. The treatment should be instituted as per the Sensitivity report. There should be a proper antibiotic policy in place for each health care setting. The infection rates can be reduced by strictly adhering to aseptic precautions and antiseptic measures during all procedures. Further the infection control measures must be imposed and supervised regularly in each hospital in order to prevent the emergence of antibiotic-resistant strains, which is an emerging global challenge.

DOI: 10.5281/zenodo.

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is a growing concern in patients with Type 2 Diabetes Mellitus (T2DM), often linked to obesity and insulin resistance. This study investigates the prevalence of NAFLD in T2DM patients and its association with microvascular complications such as retinopathy, neuropathy, and nephropathy. Methodology: A cross-sectional study was conducted at the Department of Internal Medicine, MBS Hospital Kota, between December 2022 and December 2023. One hundred T2DM patients were included, with data analyzed using SPSS software. Investigations included fasting and postprandial glucose, urea, creatinine, lipid profile, liver function tests, HbA1c, fundus examination, urine spot ACR and ultrasonography. Diagnosis of NAFLD, retinopathy, neuropathy, and nephropathy followed standard criteria. Results: The mean age of participants was 51.13 years, with a male predominance (69%). The prevalence of NAFLD was high, with significant associations found between NAFLD and retinopathy (46.9% vs. 25% without NAFLD). No significant associations were observed for neuropathy or nephropathy. The study also noted that 39% of participants had retinopathy, 12% had neuropathy, and 9.0% had nephropathy. Conclusion: NAFLD is prevalent among T2DM patients and significantly associated with retinopathy. Early screening and intervention are crucial to reduce severe vascular complications in these patients. The study highlights the need for further research with long-term follow-up to better understand the progression of NAFLD and its complications in T2DM patients.

DOI: 10.5281/zenodo.

Introduction: Sepsis, a life-threatening condition resulting from a dysregulated host response to infection, often leads to significant morbidity and mortality. Platelets play a crucial role in sepsis pathophysiology, with changes in platelet parameters correlating with disease severity. This study investigates the relationship between platelet indices—platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW)—and the Sequential Organ Failure Assessment (SOFA) score in sepsis patients. Methods: This cross-sectional study was conducted at Government Medical College, Kota, India, from December 2022 to December 2023, after Institutional Ethical Committee approval. A total of 100 adult sepsis patients meeting Sepsis-3 criteria were included. Platelet indices and SOFA scores were measured on days 1, 3, and 7 after admission. Hematological parameters were analyzed using the Beckman Coulter Unicell DxH 800 Hematology Analyzer. Data were statistically analyzed using IBM SPSS Statistics (version 23), with p-values < 0.05 considered significant. Results: Among 100 participants (mean age: 50 ± 11.81 years, 55% male), 62% had thrombocytopenia, and 36% had positive culture growth, predominantly urinary. Improved participants exhibited higher platelet counts (Day 1: 131,204 ± 121,729/mm³ vs. 127,162 ± 135,271/mm³; p=0.001) and lower MPV (Day 7: 10.18 ± 1.03 fL vs. 12.64 ± 1.20 fL; p=0.001) and PDW (Day 7: 12.84 ± 1.94 fL vs. 17.04 ± 1.58 fL; p=0.006) compared to those who worsened or died. Higher SOFA scores correlated with lower platelet counts (SOFA 16: 49,919 ± 43,133/mm³) and elevated MPV (13.09 ± 0.87 fL) and PDW (18.32 ± 1.04 fL). Conclusion: This study highlights the potential use of platelet indices in assessing the prognostic utility of sepsis. Elevated MPV and PDW, alongside decreased platelet counts, correlate with higher SOFA scores and poorer outcomes. Integrating platelet indices into routine assessments could improve early diagnosis, risk stratification, and management of sepsis patients. Further multicenter studies are warranted to validate these findings.

DOI: 10.5281/zenodo.

Background: Delayed union and nonunion of long bones are significant challenges in fracture management, leading to prolonged recovery, functional impairment, and increased healthcare costs. Conventional treatments, such as revision surgery and bone grafting, are often invasive, costly, and have variable outcomes. Platelet-rich plasma (PRP), an autologous concentrate rich in growth factors, has shown potential to accelerate bone healing by enhancing osteogenesis and angiogenesis. Despite its growing use, evidence supporting PRP’s efficacy in treating delayed union and nonunion remains limited. This study aimed to evaluate the effectiveness of PRP in promoting bone healing and functional recovery in patients with delayed union and nonunion of long bones. Objectives: This study aimed to evaluate the efficacy of platelet-rich plasma (PRP) in promoting bone healing in patients with delayed union and nonunion of long bones. Secondary objectives included assessing functional recovery, determining the average time to radiological union, and evaluating the safety profile and patient satisfaction with PRP therapy. Methods: A prospective study was conducted at AGMC & GBP Hospital, Tripura, India, from 2022 to 2024, involving 55 patients with delayed union or nonunion of long bones. PRP was prepared using a standardized two-step centrifugation method and injected at the site of delayed or nonunion under aseptic conditions. Functional outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) score for upper limb fractures or the Lower Extremity Functional Scale (LEFS) for lower limb fractures. Radiological evaluation to confirm bone union was performed at 4-week intervals up to 6 months. Outcome measures included time to radiological union, functional recovery based on validated scoring systems, and the occurrence of adverse events. Data were analyzed using descriptive and inferential statistics to evaluate the efficacy of PRP therapy. Results: A total of 55 patients with delayed union or nonunion of long bones were included in the study. Radiological union was achieved in 87.3% (48/55) of patients within an average of 4.5 months (range: 3–6 months) after PRP therapy. Functional recovery scores, assessed using the VAS for pain and LEFS/DASH scales, showed significant improvement compared to baseline (p < 0.05). Complications were minimal, with only mild local reactions reported in 3.6% of cases. Overall, patients reported high satisfaction with the treatment. Conclusion: PRP is a safe, effective, and minimally invasive adjunct for the management of delayed union and nonunion of long bones. It significantly enhances radiological and functional outcomes, offering a promising alternative to conventional invasive interventions. Further studies are recommended to validate these findings in larger cohorts.

DOI: 10.5281/zenodo.

Background: Thoracic spine tuberculosis (TB) poses significant challenges due to its potential to cause neurological deficits, pain, and progressive kyphotic deformity. While anterior approaches have traditionally been used for surgical management, standalone posterior surgeries have emerged as a promising alternative offering advantages such as reduced operative time, lower blood loss, and effective kyphotic correction. Methods: In this descriptive panel study conducted from March 2022 to April 2024 at Agartala Government Medical College and GB Pant Hospital, 30 patients with thoracic spinal TB meeting defined inclusion criteria (presence of neurological deficit or unresponsiveness to conservative treatment, intractable pain, and minimal vertebral destruction) underwent posterior decompression, instrumentation, and interbody fusion via a transpedicular approach. Pre- and postoperative evaluations included clinical assessments using the American Spinal Injury Association (ASIA) grading system, Visual Analogue Scale (VAS) for pain, and Oswestry Disability Index (ODI). Radiological parameters such as the kyphotic Cobb angle were measured, while laboratory investigations (including ESR) were used to monitor inflammation. Data were analyzed using SPSS (v27.0) and GraphPad Prism (v5), with p-values ≤ 0.05 considered statistically significant. Results: The cohort, predominantly in the fourth and fifth decades (66.6%) with a male-to-female ratio of 60:40, had a mean follow-up of 9.3 months (range 4–18 months). The mean hospital stay was 13.5 days, with an average operative duration of 140 minutes and intraoperative blood loss of 709 mL. Significant improvements were observed postoperatively: ESR reduced from 95.8 to 25.4 mm/hr, VAS scores decreased from 7.4 to 2.9, and ODI improved from 73.12 to 17. Additionally, the mean kyphotic Cobb angle improved from 29.6° preoperatively to 17.6° at final follow-up (with a mean correction of 12° and a minimal loss of correction of 1.8°). Neurological deficits decreased from 80% preoperatively to 43.33% at last follow-up, with notable improvements in ASIA scores. Complications were minimal, including one case of ATT-induced (Ethambutol) toxicity and two wound healing issues managed with debridement and resuturing. Conclusion: Standalone posterior surgeries for thoracic spinal TB offer a safe and effective treatment modality, achieving significant improvements in pain, neurological function, and kyphotic correction with lower complication rates. These findings support the posterior approach as a viable alternative in managing thoracic spine TB, particularly in resource-limited settings. Further large-scale prospective studies are warranted to corroborate these outcomes.

DOI: 10.5281/zenodo.

Background: Much emphasis has been focused to the issue of infertility linked to the impact of food additives and enhancers on testicular toxicity. Because of the natural chemical components found in plants, herbal medications are becoming a viable option to alleviate these detrimental effects on the testes. Aim: The purpose of this study was to assess how well Hemidesmus indicus ethanolic extract safeguard rat testicular structure from the damage brought about by Monosodium glutamate (MSG) and how antioxidant markers were altered. Methodology: The study involved Twenty-four (12-week old) male wistar rats were divided into four groups at random: six animals each for the Control group (C), MSG group (MSG), Hemidesmus indicus ethanolic extract (HIE) group, and paired Hemidesmus indicus ethanolic extract and MSG (HIE+MSG) group. The study was conducted over 30 days. Results: The left testis was evaluated for antioxidant enzyme activity at the end of the study, and the right testis was subjected to a histological examination. The rats that were subjected to MSG showed significant cyto-architectural changes, including diminished growth of germ cells (including spermatids), disruption of the basal lamina, cytoplasmic vacuolation, and abnormalities in the levels of antioxidants in the testicles. Positively, there was a remarkable and steady alleviation in these effects in the group that received MSG and HIE treatment. Conclusion: The present study highlights the potential of ethanolic extract from Hemidesmus indicus as protective measure against testicular alterations caused by MSG, indicating the necessity for additional research on the effects of this extract on reproductive health and male fertility.

DOI: 10.5281/zenodo.

Background: Indirect inguinal hernia remains a common surgical challenge, particularly in young adults, where the choice of surgical technique can significantly impact the recurrence rates and postoperative recovery. This study compares the efficacy and outcomes of Modified Bassini’s Repair versus Lichtenstein’s Mesh Repair in treating indirect inguinal hernia in a young adult population. Methods: A comparative, observational study was conducted at the Department of General Surgery, Jagannath Gupta Institute of Medical Sciences & Hospital, Budge Budge, Kolkata, West Bengal, India. A total of 150 male patients aged 18-30 years, diagnosed with indirect inguinal hernia, were randomly assigned to undergo either Modified Bassini’s Repair (n=75) or Lichtenstein’s Mesh Repair (n=75). The primary outcomes measured were recurrence rates, postoperative pain, and recovery time, monitored over a one-year follow-up period. Secondary outcomes included complication rates and patient satisfaction scores. Results: The study is expected to demonstrate differences in the effectiveness of the two surgical techniques with potential variations in recurrence rates, postoperative pain, and overall recovery timelines. Early indications suggest that Lichtenstein’s Mesh Repair may provide lower recurrence rates and faster recovery times compared to the Modified Bassini’s Repair, aligning with global trends towards the use of mesh in hernia repairs. Conclusion: This study aims to provide evidence-based guidance on the optimal surgical technique for treating indirect inguinal hernia in young adults, contributing to improved surgical outcomes and patient quality of life.

DOI: 10.5281/zenodo.

Introduction: To minimize the stress response during intubation, various pharmacological agents are used, including clonidine and dexmedetomidine, both of which are α2-adrenergic agonists. This study aimed to compare the effectiveness of clonidine and dexmedetomidine in reducing the pressor response during laparoscopic cholecystectomy surgeries. Materials and Methods: This prospective, randomized controlled trial included 60 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned to two groups: Group C received clonidine 1 mcg/kg and Group D received dexmedetomidine 1 mcg/kg. Results: After Drug Administration Group D showed significantly lower HR, SBP, DBP, and MAP compared to the Group C while after Intubation, HR, SBP, DBP, and MAP were significantly lower in Group D compared to Group C at this stage as well. The Ramsay sedation score was significantly higher in Group D (2.7 ± 0.7) compared to Group C (0.6 ± 0.7), indicating deeper sedation in the dexmedetomidine group. Conclusion: Dexmedetomidine is more effective than clonidine in attenuating the pressor response during laryngoscopy and intubation, and it also provides superior sedation and pain relief. Therefore, dexmedetomidine may be preferred for premedication in patients undergoing surgeries like laparoscopic cholecystectomy where attenuation of hemodynamic stress is crucial.

DOI: 10.5281/zenodo.

Background: Neonatal jaundice is a prevalent clinical condition contributing significantly to neonatal morbidity and intensive care admissions. Cord blood albumin (CBA) plays a crucial role in bilirubin metabolism, and its low levels have been associated with an increased risk of severe hyperbilirubinemia. This study aims to evaluate the association between CBA levels and neonatal jaundice requiring interventions such as phototherapy or exchange transfusion. Methods: A prospective study was conducted at a tertiary care center in Central India from August 2017 to July 2018, involving 222 term neonates. CBA levels were measured at birth and classified into three categories: <2.8 g/dL, 2.8–3.3 g/dL, and >3.3 g/dL. Total serum bilirubin (TSB) was assessed between 48–72 hours of life. The predictive efficacy of CBA for neonatal jaundice was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Results: Significant neonatal jaundice developed in 31 (14%) neonates. The mean CBA level was significantly lower in jaundiced neonates (2.24±0.52 g/dL) compared to non-jaundiced neonates (3.58±0.47 g/dL). Neonates with CBA <2.8 g/dL had an 81.5% risk of developing jaundice requiring phototherapy, while none with CBA >3.3 g/dL required intervention (p<0.001). The ROC curve demonstrated high predictive accuracy (AUC=0.972), with study-specific CBA cut-offs optimizing sensitivity and specificity. Conclusion: CBA serves as an effective early biomarker for predicting neonatal jaundice, allowing timely risk stratification and intervention. Routine CBA assessment at birth may aid in reducing the severity and complications of neonatal hyperbilirubinemia.

DOI: 10.5281/zenodo.

Objective: To Evaluate Anti-A and Anti-B antibodies titers in ‘O’ blood group donors for safe transfusion practices. Methods: This is a cross sectional research done over a period of one year. The sample size for this study was 552 ‘O’ blood group donors. Titers of Anti-A and Anti-B antibodies in their plasma was recorded and compared with parameters like type of donor, gender, age, ethnicity, dietary habits and rhesus factor. This research was carried out at the Department of Immunohematology and Blood Transfusion, Govt Medical College, Jammu. Results: 10.32% of all blood donors had both Anti-A and Anti-B titer levels larger than 1:64; in contrast, 9.24% of donors had only Anti-A antibody titers greater than 1:64, and 9.24% of donors had just Anti-B antibody titers greater than 1:64. Anti-B titers were on the high side; the maximum titer recorded was 1:512 in 6 donors (1.09%). Donors who were younger than 27 years old had the largest percentage of high titer O’ donors (13.25%) (P=0.04). Conclusion: In summary, our study reveals a noteworthy age-related difference in hemagglutinin titers among blood donors. The higher titers observed in younger donors suggest a preference for utilizing blood products from older donors in non-ABO transfusions. Titrating ABO antibodies proves essential in mitigating the risk of immune hemolytic transfusion reactions, underscoring the importance of informed donor selection for enhanced transfusion safety.

DOI: 10.5281/zenodo.

Introduction: Antimicrobial drug resistance (AMR) is largely caused by the overuse of antibiotics, among many other causes. The usage of broadspectrum empirical antibiotic therapy rises when there is widespread resistance, which reduces the availability of treatment options and degrades patient outcomes. Methods: A Prospective observational study was carried out in the government tertiary care hospital Hyderabad, Department of Microbiology. The hospital information system was used to gather data on antibacterial usage from 2019 to 2021 in accordance with the WHO’s Guidelines. Data on antibacterial consumption were expressed as DDDs/1000 patient-days. Results: The total antibiotic consumption shows a gradual increase in all the three years. The average rate of Watch group of antibiotics consumption was higher in comparison to Access group of antibiotics. There is a strong correlation between increased consumption of antibiotics and increased resistance. Conclusion: Our study has shown a significant rise in antibiotic consumption over the three years. Antibiotic consumption and the emergence of antibiotic resistance are strongly correlated.

DOI: 10.5281/zenodo.

Pure tone audiometry (PTA) is a standard preoperative evaluation used to quantitatively assess hearing in patients with chronic suppurative otitis media (CSOM). Preoperative assessment of the ossicular chain is crucial for determining the appropriate surgical approach, predicting prognosis and hearing outcomes, assessing the need for postoperative hearing rehabilitation or ossiculoplasty, and counseling patients regarding expected hearing improvement. This study aims to evaluate the correlation between preoperative hearing loss and the intraoperative status of the ossicular chain in CSOM cases. This prospective study was conducted in the Department of Otorhinolaryngology, Bangalore Medical College and Research Institute, between May 2020 and November 2021, on 110 patients with mucosal and squamosal types of chronic suppurative otitis media (CSOM) undergoing tympanoplasty. Preoperative pure tone audiometry (PTA) was performed to assess hearing loss by measuring air conduction threshold, bone conduction threshold, and air-bone gap at 0.5–2 kHz. Intraoperatively, ossicular chain status was evaluated and documented. The presence of a round window reflex indicated intact ossicular continuity, while partial or complete ossicular loss was classified as ossicular discontinuity. This study aimed to correlate preoperative hearing loss with intraoperative ossicular findings. A total of 110 patients underwent tympanoplasty with or without mastoidectomy for mucosal and squamosal type of COM in this study. The mean age group being 35.2±11.1. Analysis revealed that patients with ossicular erosion exhibited statistically significant differences in pure tone average (PTA) and air-bone gap (ABG). Specifically, a PTA of 56.96 ± 13.37 dBHL and an ABG of 38.25 ± 4.30 dB or higher were strong indicators of ossicular discontinuity.

DOI: 10.5281/zenodo.

Objectives: The present study was to evaluate the the clinical outcome of postoperative visual acuity and complications of surgical procedure on posterior polar cataract patients at tertiary care center, Haldwani, Uttarakhand. Methods: All the ophthalmic assessment including the gender, age, pre and postoperative visual acuity with Snellen’s card in decimal notation and operative report were performed. Cataract types were examined when the pupils are dilated and then assessed according to the Lens Opacities Classification System (LOCS) III operative report data the type of cataract extraction (phacoemulsification / SICE), complications during surgery and treatment of complications. We recorded visual acuity data preoperative and one month after surgery. The visual acuity category of preoperative and postoperative follows, Category 1 if the best corrected visual acuity (BCVA) 6/6 – 6/18, Category 2 if BCVA <6/18 – 6/60, Category 3 is BCVA <6/60 – 3/60 and Category 4 is BCVA <3/60. Results: A total of 68 eyes were considered among 50 posterior polar cataract patients. Among 50 patients, most of the patients 58% were males and females were 42%. Most of the patients 21(42%) were in age group of 51-60 years. 12(24%) patients were in age group of 41-50 years. The type of surgery is consisted of 68 eyes (94.12%) with phacoemulsification and 4 eyes (5.88%) with SICE (Small Incision Cataract Extraction). Posterior lens opacity based on the Lens Opacities Classification System (LOCS III) of the patient’s medical record showed the most area opacity level is P3 for 26(38.24%) eyes. This was followed by P4 for 20(29.41%) eyes, P2 for 16(23.53%) eyes and P5 for 6(8.82%) eyes. Conclusions: Middle to old aged population were the preponderance to posterior polar cataract.  Visual acuity of most of the patients was 6/6-6/18. Posterior capsular rupture was the most common complication of posterior polar cataract patients. Hence, Early diagnosis and prompt treatment are required for the prevention of amblyopia and blindness. We should organise health check-up camp to community for awareness and early identification of posterior polar cataract patients.

DOI: 10.5281/zenodo.

Intravenous anesthetics are used widely for induction and maintenance of general anaesthesia. Various anesthetic drugs are available, each with unique attributes that dictate suitability for specific applications.

DOI: 10.5281/zenodo.

Introduction: The word ‘coronary’ is derived from the Latin word co-ro-ne. “Corona” meaning “Crown”. The coronary arteries are the main blood supply to the heart and are known for its variations in both its origin as well as its branching pattern. The right coronary artery most commonly arises from the right aortic sinus and the left coronary artery arises from the left posterior aortic sinus. Anomalous origin of the coronaries and its branching pattern have been associated with increased incidence of coronary vascular events. This study is a cross-sectional study done in 60 cadaveric hearts to study the origin and variations in the coronary arteries. Materials and Methods: Randomly selected 60 formalin   fixed hearts (preserved heart specimens and hearts from cadavers which were used for dissection teaching) were obtained from the Department of Anatomy. Meticulous dissection was done and the origin along with the course and branching of both the right and left coronary arteries and the coronary dominance were noted. Conclusion: The coronary artery disease is one of the major  cause of death. Both sedentary and stressful type of lifestyle is a risk factor. Coronary dominance is important because inferior wall myocardial infarctions are common. The knowledge of the origin, branching pattern and the coronary dominance gives an insight to the cardiologists while performing angiography for more comprehensive treatment of the patients with coronary artery disease.

DOI: 10.5281/zenodo.

Background and Objective: There is an increasing interest in methods for monitoring the depth of anaesthesia and especially an emphasis on detecting intraoperative awareness. The use of entropy to track the level of consciousness in patients receiving general anaesthesia or sedation is a relatively new monitoring approach. Entropy measures the degree of disorder or the lack of synchrony or consistency in a system. Cricoid pressure is a simple method to protect the subjects from regurgitation of gastric contents during the time of intubation in full stomach patients. Since it is the first step of clinical practice of anaesthesia, cricoid pressure has been considered for its efficacy, safety and its hemodynamic effects. No previous studies have been specifically performed to evaluate the anaesthetic depth by entropy monitoring when applying cricoid pressure. This study has been undertaken to assess the entropy and haemodynamic responses after application of cricoid pressure. Methods: After obtaining approval from institutional ethical committee, patients who consented were randomly allocated into two groups. Group CP received bi-manual cricoid pressure of 44N two minutes after the induction of anaesthesia lasting 1 minute. Group nCP had hands placed simply without exerting pressure. Entropy, NIBP, heart rate was recorded at baseline, after induction, before and after application of cricoid pressure, before laryngoscopy and intubation and every one minute after intubation until 2 minutes, every 2 minutes till 10 minutes and every 15 minutes till end of surgery. Results: The entropy values of RE & SE during induction were higher in the group CP (RE 68±3; SE 67±3) compared to group nCP (RE 58±2; SE 58±2) and was statistically significant. The haemodynamic parameters during induction like heart rate (CP 84±8; nCP 72±7), SBP (CP 132±8; nCP 123±8), DBP (CP 86±5; nCP 75±4) and MAP (CP 101±7; nCP 93±6) were higher in the group receiving cricoid pressure. Conclusion: Entropy values of response and state entropy were higher in patients receiving bimanual cricoid pressure during induction of general anaesthesia.

DOI: 10.5281/zenodo.

Background: Sperm motility, one of the key parameters of semen analysis, is essential for successful fertilization and is influenced by various lifestyle factors, including physical activity. There is still a need for comprehensive research to determine the optimal duration and intensity of isotonic exercise for improving sperm motility. Objectives: To study of effect of duration of isotonic exercise on sperm motility in healthy young adults. Material and Methods: This study was conducted in the Department of Physiology of Medical College & Hospital situated in an urban city of Maharashtra. Study was conducted on 90 healthy males for a duration of 1 year. Semen examination of the sedentary healthy individuals (Group A) and those healthy individuals who were involved in regular isotonic exercises (weight lifting exercises for upper limbs, lower limbs and torso) for 1 year (Group B) and 5 years (Group C) respectively was done in accordance with the standardized method of the World Health Organization. Results: There was no significant difference (p>0.05) between control group A, study group B & study group C with respect to age, weight, height and body mass index. There was highly significant difference (p less than 0.001) in mean values of sperm motility among the 3 groups. Sperm motility was significantly higher in group B as compared to other 2 groups. Conclusion: Regular Isotonic exercises over a one year exerts a positive effect on the sperm motility.

DOI: 10.5281/zenodo.

Background: Obesity is a public health issue, especially among adolescent people, due to its link to metabolic illnesses including insulin resistance. Insulin resistance speeds up type 2 diabetes and cardiovascular disease. Understanding the relationship between adolescent obesity and insulin resistance is crucial to developing effective interventions and preventative measures. Methods: Katihar Medical College researchers collected data for this review over a year. The study included 100 overweight and insulin-resistant 12–18-year-olds. From patients’ medical data, weight, height, glucose, insulin, and HOMA-IR were measured. To examine insulin resistance and obesity, descriptive and comparative statistical analyses were performed. Results: Obese adolescents had higher BMI (32.1 ± 3.8 vs. 24.7 ± 1.9 kg/m², p < 0.001), fasting glucose (102.3 ± 9.8 vs. 92.4 ± 8.7 mg/dL, p < 0.001), fasting insulin (18.6 ± 4.9 vs. 11.4 ± 3.2 µU/mL, p < 0.001), and HOMA-IR (4.66 ± 1.24 vs. These findings show a strong link between adolescents’ obesity and insulin resistance. Conclusion: This study established that adolescent obesity is linked to insulin resistance. The findings emphasise the importance of early obesity detection and treatment to prevent insulin resistance and metabolic disorders. Lifestyle treatments and other public health activities can reduce the metabolic impacts of adolescent obesity.

DOI: 10.5281/zenodo.

Background: Gastrointestinal infections, which include vomiting, diarrhea, and stomach pain, are a leading cause of childhood disease worldwide. Bacteria, viruses, and parasites can cause these diseases, which can cause dehydration, malnutrition, and greater healthcare costs. Some say consuming probiotics—live bacteria that can boost health in larger doses—may prevent stomach ailments. Probiotics may reduce certain disorders in children, however this is unknown. Objective: The objective of this study was to evaluate the effectiveness of probiotics in preventing pediatric gastrointestinal infections. Methods: As part of their standard medical treatment, 100 kids between the ages of 1 and 12 were given probiotics to take. This study looked at their data retrospectively. Half of the kids got probiotics and half didn’t. From the medical records, data was retrieved regarding gastrointestinal infections, including the kind, frequency, and duration of the infections. The frequency and length of infections in the probiotic and control groups were compared using statistical analysis. Results: The study found that the incidence of gastrointestinal infections was significantly lower in the probiotic group compared to the control group (30% vs. 60%, p=0.002). Infections in the probiotic group were also of shorter duration (mean duration 3.4 days vs. 5.1 days in the control group, p=0.007). These findings suggest that probiotics are effective in reducing both the incidence and duration of pediatric gastrointestinal infections. Conclusion: Probiotics reduce the frequency and duration of gastrointestinal illnesses in children. These findings support the incorporation of probiotics into clinical practice as a preventive measure, though further research is needed to confirm the optimal strains and dosages for widespread use.

DOI: 10.5281/zenodo.

Background: Neonatal sepsis remains a leading cause of morbidity and mortality in newborns, particularly in low- and middle-income countries. It is associated with significant short- and long-term complications, necessitating early diagnosis and prompt management. Understanding the incidence and risk factors of neonatal sepsis is crucial for improving neonatal outcomes. Objective: This study aims to determine the incidence and risk factors of neonatal sepsis and evaluate the clinical presentation, laboratory findings, and outcomes among affected neonates. Method: A retrospective cohort study was conducted among 100 neonates diagnosed with suspected or confirmed sepsis in a hospital setting. Data were collected from medical records, including demographic characteristics, maternal and neonatal risk factors, clinical features, laboratory findings, and outcomes. The incidence rate was determined using descriptive statistics, while associations between risk factors and sepsis were analyzed using logistic regression and chi-square tests (significance level: p < 0.05). Results: The incidence of neonatal sepsis in the study cohort was 35%. Preterm birth (p = 0.02), low birth weight (p = 0.01), prolonged rupture of membranes (p = 0.03), and maternal infections (p = 0.04) were significantly associated with neonatal sepsis. The most common clinical presentations were respiratory distress (60%), lethargy (50%), and feeding intolerance (40%). Blood cultures were positive in 20% of cases, with Klebsiellapneumoniae (10%) and Staphylococcus aureus (8%) as the most frequently isolated pathogens. The mortality rate was 20%, while 80% of neonates recovered following appropriate management.

Conclusion: The study highlights a high incidence of neonatal sepsis and underscores the importance of early identification of high-risk neonates, maternal infection control, and targeted antibiotic therapy. Improved neonatal care strategies and infection prevention measures can help reduce the burden of neonatal sepsis and associated mortality. Further multicenter studies with larger sample sizes are recommended to validate these findings.

DOI: 10.5281/zenodo.

Background: Hypoxic-ischemic encephalopathy (HIE), a serious neonatal condition caused by oxygen deprivation and insufficient cerebral blood flow, often causes death. It can cause seizures, developmental delays, and cognitive impairments in neonates. Comparing newborns with and without HIE can reveal a lot about the disease and how to improve treatment. Objective: This study will compare the clinical features and short-term outcomes of HIE-diagnosed and undiagnosed neonates. The results will improve early risk assessment and neonatal care interventions. Methods: A retrospective cohort study included 50 Sarnat-staged HIE neonates and 50 healthy controls. Premature babies, those with congenital disabilities or neurological infections, and those born at 36 weeks or later were not eligible. Data collected included seizures, respiratory Distress, NICU stay, mortality rates, APGAR scores, birth weight, need for resuscitation, and neurodevelopmental evaluations at discharge or six months after birth. A significance level of p < 0.05 was used for statistical analyses, including t-tests and chi-square tests. Results: Resuscitation was more frequent for HIE neonates compared to the control group, and their APGAR scores at 1 and 5 minutes were significantly lower (p < 0.001). In the HIE group, respiratory Distress (68% vs. 10%) and seizures (72% vs. 4%) were significantly higher (p < 0.05). Newborns with HIE had a longer average stay in the NICU (14.6 ± 4.2 days vs. 4.3 ± 1.5 days, p < 0.01). The HIE group had 18% mortality, while the control group had zero. At six months, HIE survivors had more motor and cognitive impairments, according to neurodevelopmental evaluations. Conclusion: HIE-affected neonates have more seizures, respiratory Distress, and mortality and stay longer in the NICU. Early diagnosis, CPR, and therapeutic hypothermia improve neurological outcomes and survival. More research with larger, multicenter studies and long-term follow-up is needed to enhance HIE neonatal care and treatment protocols.

DOI: 10.5281/zenodo.

Background: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (CKD) in Type 2 Diabetes Mellitus (T2DM) patients. Early detection is critical to prevent progression to end-stage renal disease (ESRD). Traditional markers such as serum creatinine and albumin-to-creatinine ratio (ACR) have limitations in identifying early renal impairment. Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C (CC) have emerged as promising biomarkers for early DN detection. Objective: This study evaluates the levels of plasma NGAL and serum CC in T2DM patients and assesses their diagnostic performance in detecting early DN compared to conventional renal markers. Methods: This cross-sectional study included 100 T2DM patients with a diabetes duration of ≥5 years. Participants were categorized into normoalbuminuria (n = 60) and microalbuminuria (n = 40) groups based on ACR. Plasma NGAL and serum CC levels were measured, and their correlations with eGFR, ACR, and serum creatinine were analyzed. ROC curve analysis was conducted to determine their sensitivity and specificity for early DN detection. Results: Patients with microalbuminuria had significantly higher plasma NGAL (162.7 ± 31.8 ng/mL) and serum CC (1.37 ± 0.32 mg/L) levels than those with normoalbuminuria (108.3 ± 22.5 ng/mL and 0.85 ± 0.21 mg/L, respectively; p < 0.001). NGAL and CC showed strong negative correlations with eGFR (r = -0.72 and -0.78, respectively) and positive correlations with ACR (r = 0.68 and 0.74, respectively; p < 0.001). ROC analysis showed that CC (AUC = 0.88, sensitivity = 85.4%, specificity = 82.3%) had superior diagnostic accuracy compared to NGAL (AUC = 0.85, sensitivity = 81.2%, specificity = 78.6%), indicating their potential in detecting early DN. Conclusion: Plasma NGAL and serum CC are reliable early biomarkers for diabetic nephropathy and may enhance screening protocols for T2DM patients. Routine integration of these biomarkers could facilitate early intervention, reducing CKD progression. Further studies with larger cohorts and longitudinal follow-up are recommended.

DOI: 10.5281/zenodo.

Background: Minimally invasive spinal decompression surgery (MIS) has emerged as a transformative approach for managing spinal disorders, including herniated discs, spinal stenosis, and degenerative disc disease. This study evaluates the efficacy and outcomes of MIS compared to traditional open surgery (OS) at AIIMS Patna over three years. Objectives: To assess the effectiveness of MIS in spinal decompression by analyzing surgical outcomes such as recovery time, complication rates, postoperative pain, and patient satisfaction. Methods: A Retrospective study was conducted on 100 patients diagnosed with spinal conditions requiring decompression surgery from August 2021 to August 2024. Fifty patients underwent MIS, while 50 underwent OS. Data collection included pre- and postoperative assessments, with outcomes analysed using statistical tools. Key measures included surgical duration, postoperative pain (VAS), hospital stay, complications, return-to-work duration, and patient satisfaction. Results: MIS demonstrated significant advantages over OS in all evaluated parameters. The average surgery duration for MIS was 75 minutes compared to 120 minutes for OS (p < 0.01). Postoperative pain was lower in MIS (4.2 vs. 6.1, p < 0.05), and hospital stay was significantly reduced (2.3 vs. 6.4 days, p < 0.01). Complication rates were 6% in the MIS group compared to 18% in the OS group (p < 0.05). Additionally, MIS patients returned to work faster (22 vs. 34 days, p < 0.01) and reported higher satisfaction (8.7 vs. 7.3, p < 0.01). Conclusion: The findings highlight the clinical advantages of minimally invasive spinal decompression surgery, including shorter recovery times, fewer complications, and improved patient satisfaction. These results advocate for adopting MIS as a standard practice in spinal surgery.

DOI: 10.5281/zenodo.

Background: COPD and heart failure (HF) are leading causes of death and disability worldwide. The co-occurrence of both diseases and similar risk factors makes clinical management difficult. There is little research comparing HF and COPD patients’ functional status, hospitalization rates, and ICU admissions. Its main objective is to thoroughly compare HF and COPD patients’ clinical outcomes. Objective: To compare the hospitalization rates, ICU admissions, mortality, and functional status outcomes between patients with HF and COPD. Methods: 50 of the 100 patients admitted between July 2024 and December 2024in Nalanda Medical College and Hospital Patna, had heart failure and fifty had COPD. Clinic data included demographics, clinical parameters hospitalization and intensive care unit admission rates, and functional status (as classified by the NYHA for heart failure and the Global Initiative for COPD. Statistical analysis used multivariate regression models, t-tests, chi-square tests, and descriptive statistics to identify adverse outcome risk factors. Results: COPD patients had a significantly higher mean number of hospitalizations (2.3 per patient) compared to HF patients (1.8 per patient, p = 0.042). ICU admission rates were slightly higher in COPD patients (32%) than in HF patients (28%), but this difference was not statistically significant (p = 0.658). Mechanical ventilation was required more frequently in COPD patients (22%) than HF patients (14%). Mortality rates were also higher in COPD patients (18%) compared to HF patients (12%), but these differences did not reach statistical significance. Functional impairment was common in both groups, with 42% of HF patients classified as NYHA Class III-IV and 50% of COPD patients in GOLD Stage III-IV. Multivariate analysis identified age ≥ 70 years (OR: 1.52, p = 0.034), smoking history (OR: 1.88, p = 0.017), and ICU admission (OR: 2.11, p = 0.009) as significant predictors of poor outcomes. Conclusion: COPD patients required more respiratory support and were hospitalized more often than HF patients. However, both groups had similar mortality and ICU admissions. Smoking history, advanced age, and ICU admission predicted worse outcomes. High-risk patients need closer monitoring and personalized management to improve clinical outcomes in both conditions.

DOI: 10.5281/zenodo.

Urovaginal fistula is a condition which affects females and it require vast attention of urologist. Urovaginal fistula repair has known recurrence rates thus its auditing is important. We did this study in between 2010- 2023 in NSCB medical college and ASHA kiran clinic. We included 94 patients out of which 11 patients recurrence occurred, major cause we find is absence of interpositional flap in 3 patients. Results of fistula repair surgery improves with time and learning curve. One should learn from their failures and always try to provide the best care to these needy females.

DOI: 10.5281/zenodo.

Background: Functional Endoscopic Sinus Surgery (FESS) has emerged as a cornerstone in the management of sinonasal pathologies, providing minimally invasive solutions with improved outcomes. However, its proximity to critical orbital structures poses a risk of complications that, though rare, can result in significant morbidity. This study evaluates the incidence, risk factors, management, and outcomes of orbital complications associated with FESS. Methods: This is a retrospective observational study of 250 patients undergoing FESS over a three-year period. The imaging done before surgery, surgical techniques, and the management protocols are discussed. The orbital complications are categorized according to their severity, and outcomes were analyzed after specific interventions. The statistical analysis was performed for the risk factors and the rate of recovery. Results: Orbital complications occurred in 18 patients (7.2%), ranging from minor periorbital ecchymosis (4.8%) to severe retrobulbar hematoma and vision impairment (2%). Anatomical variations, including dehiscence of the lamina papyracea and Onodi cells, were significant predictors of complications (p < 0.01). Conservative management achieved complete recovery in 83.3% of cases, while severe complications required surgical decompression, leading to partial recovery in some instances. Advanced imaging and intraoperative navigation were instrumental in reducing risks. Conclusion: Orbital complications in FESS, though uncommon, require early recognition and prompt management to prevent long-term sequelae. Preoperative planning, meticulous surgical technique, and multidisciplinary approaches are essential to enhance surgical safety and patient outcomes.

DOI: 10.5281/zenodo.

Background and Objective: The skin is the largest organ of the body and provides key immune protection. Susceptible to many diseases, granulomatous skin lesions are a major category of cutaneous diseases that involve the formation of granulomas. It is caused by various factors such as infections and autoimmune reactions. The present study aimed to investigate the histopathological spectrum of cutaneous granulomatous lesions in a tertiary care facility based in Devanahalli, with special reference to their aetiology and demographics. Methods: This retrospective study was conducted at the Akash Institute of Medical Science and Research Centre, a tertiary healthcare facility located in Devanahalli, Bangalore. A total of 220 skin biopsies were analyzed, out of which 55 granulomatous lesions were subjected to histopathological examination. The causative agents were established through histopathological examination with Hematoxylin and Eosin staining, further the  lesions were classified using various special staining techniques, such as Ziehl-Neelsen, PAS, Fite-Faraco, Gimesa. Results: The majority of cases (44%) were in the 21-30 age group, with a male predominance (62%). Leprosy was the most common diagnosis (29%) followed by borderline tuberculoid leprosy (25.4%). Foreign body granuloma and xanthoma were also observed. Tuberculosis-related lesions, such as lupus vulgaris accounted for 3.63%. Conclusion: Gross regional differences exist in granulomatous skin disorders, mainly leprosy and tuberculosis. For proper identification, it is necessary to perform detailed histopathological examination. Based on these findings, we recommend that histopathological studies be the gold standard for the identification and classification of the disease.

DOI: 10.5281/zenodo.

Background: Teenage pregnancy is a significant public health issue with adverse implications for maternal and neonatal health. Despite global declines in adolescent birth rates, teenage pregnancy remains prevalent, particularly in low- and middle-income countries, where it poses challenges related to biological immaturity, inadequate healthcare access, and socioeconomic disadvantages. Aim: The study aimed to compare the sociodemographic profile, antenatal care utilization, fetal outcomes, and modes of delivery between teenage and adult mothers at Jawaharlal Nehru Medical College, Ajmer. Methods: With 100 participants, a comparative cross-sectional study was carried out (50 adult mothers aged ≥20 years and 50 teenage mothers aged ≤19 years). Structured questionnaires and medical records were used to gather information on sociodemographic traits, prenatal care use, fetal outcomes, and delivery methods. SPSS version 23.0 was used for the statistical analysis, which included independent t-tests for continuous variables and chi-square tests for categorical data. Results: Teenage mothers had lower educational levels and were more likely to belong to lower socioeconomic backgrounds compared to adult mothers. Antenatal care utilization was significantly lower among teenage mothers, with 40% attending four or more visits compared to 78% of adult mothers (p < 0.001). Fetal outcomes were worse in teenage mothers, with a lower mean birth weight (2.5 kg vs. 2.9 kg, p < 0.001), higher rates of low birth weight (42% vs. 18%, p = 0.01), and more neonatal complications (28% vs. 10%, p = 0.02). Normal vaginal delivery was more common in teenage mothers (70% vs. 50%, p = 0.04), while cesarean section rates were higher in adult mothers (40% vs. 20%, p = 0.04). Conclusion: Teenage mothers face significant challenges, including lower socioeconomic status, limited access to antenatal care, and poorer fetal outcomes. In order to enhance maternal and newborn health outcomes in adolescent pregnancies, our data highlight the necessity of focused interventions. Recommendations: Interventions should focus on enhancing antenatal care access, improving health education, and addressing the socioeconomic determinants of teenage pregnancy. Additionally, community-based programs should be implemented to raise awareness about the risks associated with early motherhood.

DOI: 10.5281/zenodo.

Aim: This study investigates the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) and identifies associated risk factors. Material and Methods: A sample of 100 T2DM patients was assessed for clinical and biochemical parameters. Results: The results show a high prevalence of NAFLD, with key risk factors including insulin resistance, obesity, and dyslipidemia. Conclusion: Early detection of NAFLD in T2DM patients is crucial to prevent progression to more severe liver diseases such as nonalcoholic steatohepatitis (NASH). The findings underscore the need for early screening and targeted interventions in this population.

DOI: 10.5281/zenodo.

Background and Aim:  Erectile dysfunction (ED) is a common but often underdiagnosed complication in men with type 2 diabetes mellitus (T2DM), significantly affecting their quality of life. Understanding its prevalence and associated risk factors is essential for early intervention and management. Material and Methods:  A cross-sectional study was conducted at a tertiary care center in Gujarat over eight months, including 200 male T2DM patients. Data were collected on socio-demographic, lifestyle, and diabetes-related variables. The International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess ED severity. Statistical analysis was performed using chi-square and logistic regression tests, with P < 0.05 considered significant. Results:  The prevalence of ED was high, with significant associations observed with age, smoking (P = 0.001), hypertension (P = 0.001), and longer diabetes duration (P = 0.001). Retinopathy was also significantly linked to ED (P = 0.001), while obesity and physical activity did not show strong associations. Conclusion:  ED is a prevalent complication in men with T2DM, influenced by both modifiable and non-modifiable risk factors. Early screening, lifestyle modifications, and better glycemic control are essential for reducing ED risk in diabetic patients.

DOI: 10.5281/zenodo.

Background: Laparoscopic cholecystectomy is a common surgical procedure that requires effective anesthetic management. Total intravenous anesthesia (TIVA) is often used for its precise control over anesthetic depth and rapid recovery. The efficacy of three opioids—butorphanol, fentanyl, and nalbuphine—used as adjuncts in TIVA with propofol induction has not been extensively compared in this context. Aim: This study aims to compare the effects of butorphanol, fentanyl, and nalbuphine on hemodynamic stability, analgesia, and recovery characteristics in patients undergoing laparoscopic cholecystectomy with TIVA. Material and Methods: A randomized, double-blind, controlled trial was conducted at a tertiary care center in Gujarat. Patients were assigned to one of three groups: Group A (butorphanol), Group B (fentanyl), and Group C (nalbuphine). Hemodynamic parameters, pain scores (VAS), and recovery characteristics (time to extubate, time to first rescue analgesic, and PACU stay) were evaluated. Results: Fentanyl provided superior analgesia, as indicated by lower VAS scores at 30 minutes and 1 hour postoperatively. Recovery times were also faster in the fentanyl group, with a significantly shorter time to first rescue analgesic and reduced PACU stay duration. Hemodynamic stability was similar across all groups, and the incidence of adverse events was low and comparable. Conclusion: Fentanyl offers better analgesia and faster recovery compared to butorphanol and nalbuphine in TIVA protocols for laparoscopic cholecystectomy. All three opioids maintain stable hemodynamics and are well-tolerated.

DOI: 10.5281/zenodo.

Background and Aim: Sarcoidosis is a multisystem granulomatous disease with a varied clinical presentation. Diagnosis is established on the basis of clinicoradiological features supported by histopathological evidence of non-caseating granulomas. Transbronchial lung biopsy (TBLB) has a high diagnostic yield because the lesions of sarcoidosis are distributed along the bronchovascular bundle. We wanted to determine the clinical, laboratory and imaging profile of sarcoidosis patients. Material and Methods: This study included all 60 new (20) and old (40) cases of sarcoidosis presented in the inpatient and outpatient Department of Medicine and Chest & TB, Tertiary Care Teaching Institute of India. Lab evaluation done wherever possible, including baseline haemogram, ESR, serum creatinine, Na+, K+, Ca+2, uric acid, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphate and angiotensin converting enzymes levels, EKG, CXR-PA view, CECT/HRCT chest, pulmonary function test (PFT). Results: Predominant symptoms were cough and fever followed by breathlessness, chest pain. Pulmonary function testing showed restriction with impaired diffusion in 80% patients. The most common radiological feature was bilaterally symmetrical hilar lymphadenopathy. Conclusion: Sarcoidosis has clinical, laboratory and radiological manifestations which vary worldwide according to race. In a developing country with high prevalence of TB like India, sarcoidosis is often misdiagnosed as TB. Hence, patients having hilar lymphadenopathy with or without pulmonary infiltrates should be investigated for sarcoidosis.

DOI: 10.5281/zenodo.

Introduction: Chronic renal failure (CRF) is a progressive disease necessitating hemodialysis, with native vessel arteriovenous fistulae (AVFs) being the preferred vascular access. However, AVF maturation failure remains a significant concern, particularly in elderly and diabetic patients. Predicting AVF maturation is challenging, and failed maturation limits future vascular access. Doppler ultrasonography is a promising tool for assessing AVF maturation and detecting early hemodynamic abnormalities. Materials and Methodology: This prospective interventional study was conducted at Parul Sevashram Hospital and Parul Institute of Medical Sciences & Research, Vadodara, Gujarat, India, from September 2023 to April 2024. After obtaining ethical approval and informed consent, patients with chronic kidney disease (CKD) undergoing hemodialysis with upper limb AVFs were enrolled. Doppler ultrasonography was performed on 48 patients at postoperative days 7–14 and at 4–6 months to assess vascular parameters, including peak systolic velocity (PSV) and blood flow volume. The study excluded patients with previous AVFs in the same limb, poor vascularity, or loss to follow-up. Data were analyzed using GraphPad version 3.0, with comparisons made between mature and failed fistulas using chi-squared and t-tests. Results: Among 48 enrolled patients, 66.67% were male, and 39.58% had diabetes. The mean age was 60.10 ± 6.05 years. AVF maturation was successful in 79.17% of cases, while 20.83% failed. The mean PSV at baseline was significantly higher in mature fistulas (291.78 ± 105.95 cm/s) than in failed ones (126.1 ± 57.48 cm/s) (P < 0.0001). At 4–6 months, PSV increased to 449.68 ± 133.91 cm/s in mature fistulas, compared to 259.23 ± 27.58 cm/s in failed ones (P < 0.0001). Diabetes and advanced age were significantly associated with AVF failure (P = 0.02 and P < 0.0001, respectively). Conclusion: Doppler ultrasonography is an effective tool for early prediction of AVF maturation failure. Higher baseline PSV and favorable vascular characteristics were associated with successful maturation, while diabetes and advanced age were linked to failure. Routine ultrasonographic monitoring may facilitate timely interventions, improving long-term dialysis outcomes.

DOI: 10.5281/zenodo.

Background: The relationship of the various positions of appendix to its clinical picture and course in the patient. The objective is to study the correlation between anatomical position of appendix and its varied clinical presentation and also to determine the frequency of different positions of appendix in operated cases of acute appendicitis. Materials and Methods: This study was conducted from October 2023 to December 2024 for a period of 14 months in Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. There were 150 cases in the study, which were histopathologically positive for appendicitis. Results: There were total of 150 cases. The commonest position of the appendix is retrocaecal (67.3%) followed by pelvic (16%), preileal (7.3%), post-ileal (4.6%), paracaecal (2.6%), subcaecal (1.3%) and subhepatic (0.6%). Certain positions like fixed retrocaecal, pelvic and post-ileal presented more often atypically. Conclusion: There is no increased predisposition for any of the position of the appendix to get inflamed. Complications were more common in cases fixed retrocaecal, post-ileal and pelvic appendix. The patients with the above positions presented more often atypically than typically and with subtle signs and symptoms leading to delayed diagnosis and increased complications.

DOI: 10.5281/zenodo.

Introduction: The perception of public understanding on COVID vaccinations would help healthcare professionals advise the public on vaccination and guide policy decisions. The aim of the study was to discover knowledge gaps related to various aspects of COVID vaccination among the general population and enhance awareness that improves the vaccination practice. Methodology: A cross-sectional study was conducted at the COVID vaccination clinic of a tertiary care institute of Bihar during February to June 2021. Data was collected from 90 participants using a semi structured questionnaire applying convenience sampling technique. Collected data was analysed using SPSS (IBM version 23.0) software. Result: 83% participants were aware that COVID-19 vaccination is used to combat virus. Also, 85% were aware of the minor side effects. 93% and 94% responded respectively were aware of the number of doses and site of vaccination. 55% and 15% participants were aware that patients with underlying disease and pregnant female can take the vaccine respectively. Conclusion: Conducting studies on vaccine awareness can help identify gaps in knowledge, attitudes, and practices related to vaccination, thereby guiding policymakers in formulating more effective strategies to promote vaccine acceptance and combat vaccine hesitancy. The study highlights a strong awareness of the vaccine’s purpose, a recognition of the need to sustain preventive measures, and a preference for consistency in vaccine administration among the surveyed participants.

DOI: 10.5281/zenodo.

Background: Coronary artery ectasia (CAE) has been widely recognized as not so infrequent form of coronary artery disease (CAD). This study aims to investigate the clinical characteristics, risk factors, and outcomes of patients with isolated CAE, mixed CAE with CAD, and CAD alone. Materials and Methods: This observational study was conducted on 1,966 patients undergoing coronary angiography, with 136 patients categorized into two groups: isolated CAE (n=24), and mixed CAE+CAD (n=112), other1830 patients were group as CAD alone. Patients were evaluated using the Markis classification system, and clinical, demographic, and inflammatory parameters were analysed. Chi square test was used to assess the significance. The p-values <0.05 were considered as statistically significant. Results: The overall CAE incidence was 6.9%, with a predominance of males in all three groups. Diabetes showed an inverse association with ectasia, with lower prevalence in isolated CAE (25.0%) compared to mixed CAE+CAD (42.9%) and CAD (47.4%) groups. Inflammatory markers, particularly neutrophil-to-lymphocyte ratio, were significantly elevated in CAE groups. Markis type IV was most common overall, with type I predominant in isolated CAE. Right coronary artery (RCA) was most frequently involved in isolated CAE, while left anterior descending (LAD) artery was most affected in mixed CAE+CAD. In-hospital mortality was zero in isolated CAE, compared to 6.3% in mixed CAE+CAD and 5.7% in CAD groups. Follow-up revealed higher unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI) rates in the isolated CAE group. Conclusion: The CAE was predominantly characterized by mixed CAE along with CAD, where the RCA was most common in isolated CAE and the LAD predominant in mixed CAE. During follow-up UA and NSTEMI were more frequent in patients with CAE.

DOI: 10.5281/zenodo.

Background: Kidney Disease Improving Global Outcomes guidelines recommended estimation of glomerular filtration rate based on cystatin C level (eGFRcys) testing for confirmation of chronic kidney disease (CKD) in the absence of other markers of kidney damage and in circumstances when estimated glomerular filtration rate is based on serum creatinine (eGFRcr) level may be less accurate. Material and Methods: The present Observational Cross-sectional study was conducted on 300 subjects and it was divided into 2 groups. Group A consists of 150 chronic kidney disease with end-stage renal disease patients and Group B consists of healthy subjects. (n=150) from both genders, who aged more than 18 years. The marker dialysis adequacy measurement in a single HD treatment at pre-dialysis and post-dialysis on consecutive. Detailed personal and clinical history of all the subjects was taken and recorded in the Proforma. Basic anthropometric measurements were recorded on all the subjects. Biochemical investigations like Cystatin, creatinine, Uric acid and Thyroid function tests were performed from all participant’s Blood samples and analysed statistically. Results: The mean Cystatin C of the case group was 6.52 mg/l and that of the control group was 0.66 mg/l with a p-value < 0.001, showing that it is statistically significant. The average value for post-dialysis case cystatin C is 5.70 mg/l. The p-value is less than 0.001 which indicates that there is a significant difference between them. The mean CRP of the case group was 29.37 mg/L and that of the control group was 1.87 mg/L. The average value for post-dialysis CRP was 21.48 mg/l. The p-value was less than 0.001 which shows that there is a significant difference between control CRP and case CRP post dialysis. The mean TSH of the case group was 3.18 mIU/mL and that of the control group was 1.61 mIU/mL with a p-value < 0.001, showing that there is a statistically significant difference in mean TSH (mIU/mL) between the groups. Post dialysis it was 2.78 mIU/mL. From the p value, it can be stated that there is a significant difference between post-dialysis and control TSH. It was higher for cases. Conclusion: All things considered, this study emphasizes how important biomarker monitoring is to the treatment of CKD. Important information on the physiological effects of CKD and dialysis can be gained from the reported changes in thyroid, CRP, and Cystatin C profiles before and after dialysis. These results can guide individualized therapy plans that target endocrine dysfunction, systemic inflammation management, and dialysis efficacy optimization. Future studies should examine how these biomarkers affect patient outcomes over time and look into cutting-edge treatments to lessen the problems associated with CKD.

DOI: 10.5281/zenodo.

Background: Sun exposure is essential for Vitamin D synthesis but is also a major contributor to skin aging, leading to photo aging through the degradation of collagen, loss of skin elasticity, and the formation of wrinkles, pigmentation, and sagging. Understanding sun exposure habits and their relationship with visible signs of skin aging is crucial for developing effective preventive measures. Objectives: This study aims to evaluate the sun exposure habits of individuals and their correlation with visible signs of skin aging, specifically focusing on wrinkles, pigmentation, and sagging. The goal is to understand the impact of daily sun exposure and protective behaviors on skin health. Methods: A cross-sectional study was conducted with 100 participants. Data were collected using Electronic Medical Records (EMR) to assess participants’ sun exposure habits (including duration, time of day, and use of protective measures). A clinical dermatological assessment was performed to identify visible signs of aging, such as wrinkles, pigmentation, and sagging. Results: The study revealed a significant correlation between sun exposure duration and the presence of visible aging signs. Among participants with <30 minutes of daily sun exposure, the prevalence of wrinkles, pigmentation, and sagging was 10%, 15%, and 5%, respectively. However, those with >2 hours of daily sun exposure exhibited 80% wrinkles, 85% pigmentation, and 75% sagging. Regular sunscreens use significantly reduced the prevalence of pigmentation (p = 0.03) and wrinkles (p = 0.04), while protective clothing was associated with reduced aging signs (p = 0.02). Midday exposure (10 AM – 3 PM) was strongly linked to severe skin aging. Conclusion: The findings confirm that excessive sun exposure contributes to visible skin aging, while protective measures can help mitigate these effects. These results underscore the importance of sun safety in preventing premature skin aging.

DOI: 10.5281/zenodo.

Background: Herpes Zoster ophthalmicus (HZO) is a rare but serious complication of Varicella Zoster Virus (VZV) reactivation, which can lead to significant ocular morbidity. This study aimed to investigate the incidence rate and associated risk factors of HZO at Burdwan Medical College over six years from 2018 to 2024, providing important insights into the epidemiology of the disease in this region. Methods: A retrospective cohort study was conducted with sample of 200 patients who have been diagnosed with HZO. The inclusion criteria encompassed individuals with confirmed HZO and clinical and laboratory confirmation of VZV infection. Data were collected from patient charts, including demographics, clinical presentation, risk factors, and follow-up records. Statistical analysis was performed using SPSS software, with incidence rates calculated and risk factors assessed through regression analysis. Results: The overall incidence rate of HZO was 6.6 per 100,000 individuals. The highest incidence was observed in individuals over 60 years, with a strong association between HZO and diabetes as well as immunocompromised status. Prior VZV infection was reported in 90% of cases. Statistically significant correlations were found between HZO incidence and both age and comorbid conditions (p < 0.05). Discussion: The findings align with previous studies on HZO, supporting age and comorbidities like diabetes and immunocompromised conditions as major risk factors. This study underscores the importance of vaccination and early intervention in high-risk populations. The clinical implications of these findings suggest that preventive strategies, particularly vaccination for older adults and those with diabetes, could significantly reduce the burden of HZO. The limitations of the study, including its retrospective nature and reliance on medical records, are acknowledged, and recommendations for future prospective studies are provided. Conclusion: This study highlights the significant incidence of Herpes Zoster Ophthalmicus at Burdwan Medical College, with age, diabetes, and immunocompromised status identified as key risk factors. Early diagnosis and vaccination in high-risk populations are essential to reducing the incidence and preventing complications of HZO. The findings contribute valuable data to the global understanding of HZO epidemiology and emphasize the need for public health strategies aimed at prevention and early intervention.

DOI: 10.5281/zenodo.

Introduction: This study evaluates the impact of early nutritional interventions on the neurodevelopment of preterm infants. Preterm births often result in insufficient nutrient delivery, heightening the risk of developmental delays. By optimizing feeding strategies, researchers aimed to determine whether targeted nutrition could enhance cognitive, language, and motor outcomes over time. Methods: A longitudinal study enrolled infants born before 32 weeks’ gestation. Participants received either an enhanced feeding regimen as Intervention Group (IG) or standard care as Control Group (CG). Nutritional intake was systematically recorded, and baseline characteristics were documented. Neurodevelopment was assessed at 12 and 24 months using validated scales, including the Bayley assessments. Results: Infants in the IG consistently scored higher in cognitive, language, and motor domains at both 12 and 24 months. Baseline variables—gestational age, birth weight, maternal age, and steroid use—were comparable, reducing confounding. These findings suggest that targeted nutritional strategies may significantly influence and improve early neurodevelopmental trajectories in preterm infants. Conclusion: This study underscores the critical importance of early nutritional interventions for preterm infants. Enhanced feeding strategies significantly improved cognitive, language, and motor outcomes at 12 and 24 months, highlighting a durable, long-term advantage. By optimizing early nutrition, NICU practices can further strengthen developmental trajectories and ultimately improve vulnerable infants’ well-being.

DOI: 10.5281/zenodo.

Introduction: Neurodegenerative disorders (NDs) like Alzheimer’s and Parkinson’s involve cognitive and motor decline linked to oxidative stress, which arises from an imbalance between reactive oxygen species (ROS) and antioxidants. Elevated oxidative markers (MDA, AOPP) and reduced antioxidant enzymes (SOD, GPx) exacerbate neuronal damage, highlighting the potential for therapies targeting oxidative stress. Methods: This prospective observational study included individuals aged 18-75 with confirmed neurodegenerative disorders (NDs), excluding those with acute illnesses, malignancies, or antioxidant supplementation. Participants underwent clinical assessments, neuropsychological evaluations (MMSE/MoCA), and physical examinations. Fasting blood samples were collected to measure oxidative stress markers (MDA, AOPP, SOD, GPx). MRI/PET scans were analyzed, and periodic re-evaluation was conducted at 5 and 10 months. Results: This study included 23 participants with NDs, aged 62.5 ± 8.3 years, with 57% diagnosed with Alzheimer’s and 43% with Parkinson’s. Significant increases in MDA and AOPP levels were observed, while SOD and GPx decreased. Correlations showed MDA and AOPP were linked to cognitive and motor decline, respectively. Conclusion: This study highlights the significant role of oxidative stress in Alzheimer’s and Parkinson’s progression. Correlations between oxidative markers (MDA, AOPP, SOD, GPx) and cognitive/motor decline emphasize their potential as biomarkers. Targeted antioxidant therapies could mitigate oxidative damage, preserve neuronal function, and slow disease progression, warranting further research.

DOI: 10.5281/zenodo.

Introduction: Laryngoscopy and endotracheal intubation (EI) often trigger adverse hemodynamic responses like tachycardia and hypertension, posing risks during surgery, especially in high-risk patients. This study compares oral Ivabradine and Gabapentin, evaluating their effectiveness in mitigating perioperative hemodynamic changes during laryngoscopy and EI to enhance patient safety and outcomes. Methods: This prospective, double-blind, randomized study from May 2021 to Nov 2023.  Ivabradine 5 mg was given to group I members and Gabapentin 800 mg to group G and compared hemodynamic response attenuation during laryngoscopy and intubation. Parameters were monitored perioperatively, using a standardized anesthetic regimen. Ethical clearance, informed consent, and postoperative adverse effect monitoring were ensured. Results: The study included 100 participants, equally divided between groups. Demographics (age, weight, gender, and ASA grading) showed no significant differences. Group I had higher SBP preoperatively but lower DBP and MAP post-induction, with statistically significant differences. Conclusion: The study concludes that Ivabradine offers superior hemodynamic stability compared to Gabapentin during laryngoscopy and intubation, significantly reducing heart rate, SBP, DBP, and MAP. By selectively inhibiting sinoatrial If current, Ivabradine effectively minimizes stress-induced hemodynamic changes, reducing perioperative risks, and improving safety and outcomes, especially in high-risk surgical patients.

DOI: 10.5281/zenodo.

Background: The HIV/AIDS pandemic has become a serious public health problem. Objectives: 1. To study the source of information about HIV/AIDS 2. To assess the knowledge of medical students regarding transmission & diagnosis of HIV/AIDS. Materials and Methods: A cross sectional study has been done on medical students. Self-administered questionnaire was used to collect data. Results: The results were obtained from 121 respondents. Most of the students are from 19-23 of age group. All students (100%) heard about HIV/AIDS. Conclusion: The overall knowledge about the diseases was considered to be good among the study participants. Based on present study findings students had good level of positive and favourable attitude regarding HIV/AIDS prevention.

DOI: 10.5281/zenodo.

Peripheral nerve blocks have certain advantages over central neuraxial anaesthesia and general anaesthesia, hence they have become increasingly popular for the  management of pain during surgery. The development of ultrasonography in regional anaesthesia made it possible to confirm precise needle placement and appropriate local anaesthetic administration. Furthermore, it is possible to prevent     problems such as intravascular and intraneuronal injections. Real-time ultrasound  not only lowers the amount of local anaesthetic needed for a successful nerve block  but also enhances the quality of the block. Ultrasonographic guidance is beneficial in reducing intra neural injection and targets the neural sheath where drug can be deposited and block can be achieved with minimum possible volume. This study attempts to determine minimum possible volume of bupivacaine 0.5% to achieve adequate motor and sensory blockade by using ultrasound guided brachial plexus block. Methodology: The study was conducted in Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal during August 2022 to December 2023 after approval from institutional ethics committee. It was an Observational hospital-based study. The study was an observational study comprising of 75 patients between age group 18-60 years of either sex belonging to ASA grade I or II, scheduled for elective upper limb surgery. Patients with neurologic deficit in upper limb, Diaphragm palsy, Respiratory distress and Allergy to the local anaesthetics were excluded. Under all aseptic precautions ultrasonography was done at the level of supraclavicular region and structures traced from cephalic to caudal direction. the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. Once the needle penetrated the brachial plexus, the bupivacaine 0.5% was injected after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery. Twenty five patients received 10 ml Drug (group A), next 25 patients received 15 ml Drug (group B) and next 25 patients received 20 ml Drug (group C) each. Result: Based on our findings, we determined that a volume of 15 ml of bupivacaine 0.5% reliably achieves effective sensory and motor blockade in the patients undergoing upper limb surgeries. This volume provides adequate anaesthesia while potentially reducing the risk of systemic toxicity associated with higher volume.

DOI: 10.5281/zenodo.

Peripheral nerve blocks have certain advantages over central neuraxial anaesthesia and general anaesthesia, hence they have become increasingly popular for the  management of pain during surgery. The development of ultrasonography in regional anaesthesia made it possible to confirm precise needle placement and appropriate local anaesthetic administration. Furthermore, it is possible to prevent     problems such as intravascular and intraneuronal injections. Real-time ultrasound  not only lowers the amount of local anaesthetic needed for a successful nerve block  but also enhances the quality of the block. Ultrasonographic guidance is beneficial in reducing intra neural injection and targets the neural sheath where drug can be deposited and block can be achieved with minimum possible volume. This study attempts to determine minimum possible volume of bupivacaine 0.5% to achieve adequate motor and sensory blockade by using ultrasound guided brachial plexus block. Methodology: The study was conducted in Department of Anaesthesiology, Gandhi Medical College and associated Hamidia Hospital, Bhopal during August 2022 to December 2023 after approval from institutional ethics committee. It was an Observational hospital-based study. The study was an observational study comprising of 75 patients between age group 18-60 years of either sex belonging to ASA grade I or II, scheduled for elective upper limb surgery. Patients with neurologic deficit in upper limb, Diaphragm palsy, Respiratory distress and Allergy to the local anaesthetics were excluded. Under all aseptic precautions ultrasonography was done at the level of supraclavicular region and structures traced from cephalic to caudal direction. the probe was placed in the coronal plane to visualize the subclavian artery and the brachial plexus in a transverse sectional view. Once the needle penetrated the brachial plexus, the bupivacaine 0.5% was injected after negative aspiration for blood or air just next to the artery, then the needle was repositioned to inject on the upper pole of the artery. Twenty five patients received 10 ml Drug (group A), next 25 patients received 15 ml Drug (group B) and next 25 patients received 20 ml Drug (group C) each. Result: Based on our findings, we determined that a volume of 15 ml of bupivacaine 0.5% reliably achieves effective sensory and motor blockade in the patients undergoing upper limb surgeries. This volume provides adequate anaesthesia while potentially reducing the risk of systemic toxicity associated with higher volume.

DOI: 10.5281/zenodo.

Introduction: Evidence suggests that in brain, iron deficiency may disrupt metabolic processes, causes hypoxia and subsequently changes cognitive functions. Women of reproductive age are most vulnerable to iron deficiency and may be at high risk for cognitive alterations. Aim & Objectives: To examine the relation between iron status and cognitive functions in young women. Materials & Methods: A cross-sectional observational study was conducted on 60 women aged 18-30 years, of whom 30 had iron deficiency anemia (Hb level <12 g/dL, ferritin level <15 mcg/L), while another 30 were randomly selected from the obstetrics and gynecology department and did not have anemia. Cognitive function test – MMSE (Mini Mental State Examination) is performed. Descriptive statistics are used (mean & standard deviation) and results are compared using unpaired t test. Results: There is a significant difference between the two groups. (p< 0.001) . Mild (score = 20-23) to moderate (score = 10-19) cognitive function impairment is more seen with iron deficiency anemia group women than with non-anemic group women.

Discussion: According to this study, iron deficiency anemia has negative effect on cognitive functions of brain.  Further studies are needed to see whether these changes are reversible with iron therapy or not.

Conclusion: Iron deficiency anemia negatively affects cognitive functions of young females.

DOI: 10.5281/zenodo.

Introduction: Pranayama makes efficient use of abdominal & diaphragmatic muscles and plays major role in strengthening the respiratory muscle & improve respiratory endurance. Some studies on long-term yogic practices have proved improvements in respiratory functions. Methods: A Comparative study is conducted among 60 Healthy subjects of both the gender from age group of 25 to 35 years with normal BMI. One group of 30 subjects are practicing pranayama on regular basis for more than 6 month and another group of 30 Healthy subjects who never practiced pranayama. After written consent from all the subjects, parameters like Vital Capacity, Expiratory pressure, Breath holding time, 40 mm Endurance test were assessed, the parameters were analyzed by ‘t’ test. Results: There was significant difference in vital capacity, Expiratory pressure, Breath holding time, 40 mm Endurance test between both groups & to know the association ‘t’ test was used, (p value <0.05) was considered significant for analysis. Conclusion: Our study shows that regular practice of pranayama is beneficial in improving the respiratory functions even in healthy individual.

DOI: 10.5281/zenodo.

Introduction: Hypothyroidism has effect on heart by impairing cardiac function by increasing cardiac out by increase peripheral resistance and this changes we can detect by heart rate variability. Heart rate variability (HRV) is a vital indicator of autonomic nervous system function, reflecting the balance between sympathetic and parasympathetic activity. In hypothyroidism, changes in HRV patterns may signal cardiovascular risk, prompting a deeper investigation into the relationship between thyroid function and HRV. Aim and Objectives: This study aimed to evaluate the impact of hypothyroidism on HRV. Methods and Materials: A cross-sectional study was conducted with a sample of 60 participants devided in two groups group (A) comprising 30 patients with hypothyroidism from medicine department with irregular thyroid medication use civil hospital Rajkot and group (B) 30 healthy controls from civil hospital campus Rajkot after obtaining written consent from all participants. Heart rate variability was measured and statistical analyses of unpaired t test were performed to determine association between HRV and hypothyroidism. Results: The analysis revealed significant reductions in HRV among hypothyroid patients.( p<0.05 ). Discussion: These findings suggest that hypothyroidism is associated with decreased HRV. Elevated levels of catecholamines and thyroid-stimulating hormone (TSH) likely contribute to alter heart function by increasing peripheral resistance and impairment of cardiac function. Conclusion: Hypothyroidism significantly impacts heart rate variability; these changes highlight potential cardiovascular risks in hypothyroid patients and we can assess the cardiovascular changes and likely cause early detection of cardiovascular risk among hypothyroid patients.

DOI: 10.5281/zenodo.

Introduction: Epidural anesthesia for caesarean sections has advanced, with a shift towards neuraxial techniques over general anesthesia. This study compares 0.5% Bupivacaine and 0.75% Ropivacaine, focusing on their sensory block efficacy, motor blockade, and clinical outcomes. By evaluating these anesthetics, the research aims to enhance obstetric anesthesia practices for better maternal and fetal outcomes. Methods: Sixty patients were randomly divided into two groups receiving either drug via epidural catheter. Vital signs were monitored, and sensory and motor blocks were assessed using pinprick tests and modified Bromage scores, respectively. Onset and duration of blocks were recorded. Postoperative monitoring continued for 24 hours. Data were analyzed using unpaired t-tests with P<0.05 considered statistically significant. Results: In our study, sensory block onset was faster with Bupivacaine (9.33 ± 2.55 min) than Ropivacaine (11.33 ± 2.60 min), while Ropivacaine showed longer motor block duration (369.67 ± 42.51 min vs. Bupivacaine- 306.17 ± 47.83 min). No difference was noted in duration of sensory block and onset of motor block between two groups. Both groups had comparable intraoperative and postoperative hemodynamics. However, in the postoperative period, statistically significant differences were observed in systolic blood pressure at the 2nd, 3rd, and 4th hours as well as in diastolic blood pressure at the 2nd and 3rd hours (p < 0.05). Conclusion: Epidural 0.5% Bupivacaine and 0.75% Ropivacaine showed similar sensory and motor block efficacy for caesarean sections, with Ropivacaine offering a slightly longer motor block duration. Its lower cardiotoxicity and neurotoxicity make Ropivacaine a safer choice for epidural anesthesia in obstetric care.

DOI: 10.5281/zenodo.

Introduction: Obesity is a major public health problem in developing countries. Irrespective of aetiology, obesity is associated with cardiovascular diseases, Dyslipidaemia and insulin resistance. Aims and Objectives: This study was planned to demonstrate obesity is a risk factor for cardiovascular diseases. Material & Methods: A comparative study was conducted in thirty obese males based on BMI (>30kg/m2) who was selected as group-1 and equal number of non-obese (BMI<25 kg/m2) males serves as group-2. We measured their basal heart rate and blood pressure and HRV. After that different non-invasive tests (deep breathing test, Valsalva manoeuvre) were performed by all subjects and after tests heart rate and blood pressure were measured to evaluate their autonomic nervous function response. Results: There was higher basal heart rate and blood pressure in group-1 as compared to group-2. There was a significant difference in heart rate ratio before and after performing deep breathing test and Valsalva manoeuvre in both the groups and also reduced heart rate variability (HRV)in group-1 compared to group-2.To know the association test was used for statistical analysis (p value <0.05). There was not any statistically significant change in blood pressure in both the groups after performing tests. Discussion: Study showed that there was higher risk for developing cardiovascular disease in obese individuals. Elevated sympathetic activity appears to be the main pathological factor in developing cardiovascular diseases in obese individuals. Conclusion: Risk for developing cardiovascular diseases in later life increases more in obese individuals than in non-obese individuals.

DOI: 10.5281/zenodo.

Background: Post-partum hemorrhage is the leading cause of maternal mortality worldwide. Use of uterotonic drugs in active management of third stage of labour has been found to be most effective in prevention of PPH. Aims and objectives were to compare the efficacy and safety of carbitocin and oxytocin for prophylaxis of post-partum hemorrhage after singleton, term vaginal deliveries. Methods: Prospective randomized interventional study of 100 women with singleton term pregnancies undergoing vaginal delivery at Govt. Medical College, Bettiah, W. Champaran, Bihar from July 2023 to December 2023. Participants randomized into 2 groups, group A and B receiving carbitocin and oxytocin respectively. Post-delivery uterine tone, vaginal bleeding, change in Hb and PCV, occurrence of adverse effects used to assess efficacy and safety of both drugs. Results: Carbetocin was statistically equal to oxytocin in preventing uterine atony and hence PPH, with similar duration of uterotonic action and lesser requirement of other uterotonic drugs. There was no incidence of adverse effects in either group. Conclusion: Since carbetocin is an effective, room temperature stable uterotonic drug with minimal side effects, it can be beneficial for use in prevention of PPH in rural settings.

DOI: 10.5281/zenodo.

Background: Premature birth remains the leading cause of premature death. Preterm infants, known as labor before 37 weeks of gestation, often suffer from a large immediate morbidity and need prolonged stay in neonatal intensive care units with a high risk of long-term neurological disease in a proportion of survivors. The aim of this study was to investigate and compare the effects of nifedipine and ritodrine treatment on fetomaternal blood flow parameters in women with preterm labor. Methods: Sixty women with gestational age between 24 and 36 weeks admitted to the Govt. Medical College, Bettiah, and Bihar from January 2023 to June 2023 for preterm labor were enrolled in this study. Patients were randomly assigned to receive either nifedipine (n=30) or ritodrine (n=30) treatment. Demographic features, clinic and laboratory parameters, fetal and maternal side effects, and Doppler ultrasound indices of the umbilical artery (UA), uterine arteries (UtA), and middle cerebral artery (MCA) before, 2 hours after, and 48 hours after the initiation of tocolytic treatments were compared between the two groups. Results: In both the groups, early- and late-onset changes in the pulsatility index (PI) and other Doppler indices for UA, UtA, and MCA were similar. In addition, time elapsed till delivery, fetal mortality, and maternal morbidity in both the groups were not statistically significant (p>0.05). However, maternal side effects such as tachycardia was more frequent (p<0.05) in the ritodrine group. Besides, in the ritodrine group, anxiety was only minimally observed. Conclusion: Nifedipine and ritodrine used as tocolytic agents did not significantly alter early- and late-onset changes in Doppler ultrasonography parameters in fetal and fetomaternal circulation.

DOI: 10.5281/zenodo.

Background: One of the most frequent acute digestive conditions seen in emergency rooms across the globe is acute appendicitis. Despite improvements in surgical and diagnostic methods, detecting acute appendicitis is still difficult, and delaying treatment can make a seemingly straightforward surgical condition more complicated. In females, the diagnosis is even more difficult. A quick and inexpensive diagnostic method that doesn’t require expensive equipment, the Modified Alvarado Scoring System (MASS) can be used in emergency situations and even at strange hours of the night. Aim of this study to test the efficacy and diagnostic accuracy of MASS in the diagnosis of acute appendicitis. Methods: This prospective cross–sectional study was conducted from March 2024 to November 2024 in the Department of General Surgery, SKMCH, Muzaffarpur, and Bihar. A total of ninety-three adult patients (fifty-five males and thirty-eight females) were enrolled in the study. Sensitivity, specificity, Positive predictive value and Negative predictive value of MASS were found separately in males and compared with those of females to see the efficacy of MASS in the diagnosis of acute appendicitis. Results: Most of the patients having a MASS of 7 or higher were found to have acute appendicitis in comparison to those having score <7. The sensitivity and specificity of MASS were 93.24%, 84.21%, with acceptable Positive and Negative predictive values 5.91 and 0.08 respectively. Conclusion: The Modified Alvarado Scoring System is a simple and efficient diagnostic tool for the diagnosis of acute appendicitis with acceptable sensitivity and specificity and can be used with good degree of accuracy.

DOI: 10.5281/zenodo.

Background: Obstructive jaundice is a surgical condition that occurs when there is an obstruction to the passage of conjugated bilirubin from the liver cells to the intestine. This study has studied five clinical and nine laboratory parameters in patients presenting with malignant obstructive jaundice along with their radiological findings. By studying these parameters, the prognosis of patients with malignant obstructive jaundice and the best possible intervention could be predicted. Aim of this study to co-relate clinical, biochemical, radiological parameters in obstructive jaundice. Methods: From May 2024 to November 2024 present study was conducted at Department of General Surgery in SKMCH, Muzaffarpur, Bihar. Total 100 adult patients were divided into two groups benign obstructive jaundice (50) and malignant obstructive jaundice (50) who were diagnosed as cases of obstructive jaundice based on clinical, radiological and pathological criteria. Result: Benign Obstructive Jaundice, 6(12.0%) patients had fever, in malignant obstructive jaundice, 2(4.0%) patients had fever. Association of Fever vs Final diagnosis was not statistically significant (p=0.1403). In benign obstructive jaundice, 4(8.0%) patients had pruritis. In malignant obstructive jaundice, 37(74.0%) patients had pruritis. Association of pruritis vs final diagnosis was statistically significant (p<0.0001). Conclusion: AST and ALP were higher in malignant obstructive jaundice compared to benign obstructive jaundice which were statistically significant. Mean GGT was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically significant. It was found that mean CA 19.9 was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically significant.

DOI: 10.5281/zenodo.

Background: Over 300 million people worldwide have diabetes, according to a recent World Health Organization report. This number is expected to rise by another 60–70% by 2030, meaning that 100 million people in India alone would have the disease by then. In diabetic people, wound healing is challenging. Positive outcomes have demonstrated that PDGF administration is superior to simple wound care. However, there is little data to support the safety and effectiveness of PDGF in treating diabetic ulcers. Methods: The present study was carried out at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from July 2024 to December 2024, where 50 patients with diabetic foot ulcers were included in the prospective randomized controlled trial was designed for the study. 50 patients with diabetic foot ulcers admitted in surgery wards at SKMCH, Muzaffarpur, and Bihar. 25 patients were in the study/treatment group and 25 patients were in the control group. Results: Out of 50, patients, 25 took treatment in the form of conventional normal saline dressings and 25 took treatment with rh – PDGF dressing once a day. Glycaemic control and adequate control of infection was maintained in both the groups. X-ray foot was taken for all patients and bony involvement was excluded. The initial area measurement was taken on day 01 and final area measurement on day 15 was taken on transparent sheet. Plannimetry was used to measure the outcome that is the target ulcer area using a transparent graph sheet. Results were calculated by using student ‘t’ test. Conclusion: The wounds in the study group treated with rh-PDGF dressing contracted more than the wounds in the control group (38.55% Vs 12.79%; P≤ 0.001- statistically significant) which indicates rh-PDGF dressing is an effective modality to facilitate wound contraction in patients suffering from diabetes. Rh-PDGF dressing is found to be more effective, safe promoter of wound healing and can be used as an adjunct to saline dressing for healing of diabetic wounds and healing of ulcers receiving PDGF was significantly faster as compared to ulcers receiving placebo.

DOI: 10.5281/zenodo.

Background: Diabetes mellitus is a chronic disorder which is associated with significant morbidity & mortality and requires long term treatment. The conventional medical treatment alone may not meet the needs of these patients and often leads people to use complementary and alternative medicine (CAM). This study was conducted to determine the knowledge, attitude and practice of complementary and alternative medicine among type 2 diabetes mellitus patients and also to establish the prevalence and factors influencing the use of CAM. Materials and Methods: A cross- sectional questionnaire based study was performed in 200 type 2 diabetes mellitus patients aged 18 years and above of either gender attending the OPD of department of medicine in Govt. medical college, Kota, Rajasthan for a period of 6 months ( between –August 2022 and January 2023). Before initiation of the study, approval from the Institutional Ethics Committee and written consent was obtained from all the patients. Results: Among 200 diabetic patients, 165 were aware of CAM and 115 (57.5%) used it. Among the 5 main categories of CAM, alternative medical system (Ayurveda) and biologically based practices (herbal remedies) were found to be widely used. Dissatisfaction with conventional therapy was the most common reason stated. Most of the CAM users were females and belonged to rural background. Relatives/Friends (39%) were found to be the main source of CAM information. Majority of the CAM users (57%) were non-revealers and only (43%) patients disclosed regarding their CAM usage. Fear of disapproval by the physician (65%) was the most common reason stated for not revealing CAM usage. Conclusion: Physicians need to enquire about CAM use which might help in reducing complications due to concomitant use of two different modalities of treatment. The patients should be encouraged to reveal to their physician regarding CAM, which may reduce drug interactions due to use of CAM.

DOI: 10.5281/zenodo.

Background: Child enteric fever, mostly caused by Salmonella typhi and Salmonella paratyphi, is a major public health issue, especially in underdeveloped nations. Resistance to conventional antibiotics requires rethinking treatment protocols. Methods: New Delhi’s Batra Hospital and Medical Research Centre conducted this hospital-based prospective observational study from September 2019 to June 2020. In children aged 6 months to 13 years, 100 probable enteric fever cases were reported. Blood cultures and Kirby-Bauer disc diffusion antibiotic susceptibility tests determined resistance. Results: Blood cultures were positive in 30% of cases, with ampicillin (65%), cotrimoxazole (50%), and chloramphenicol (20%) resistance. Third-generation cephalosporins and azithromycin showed lower resistance, suggesting they could be useful treatments. Widal’s 60% connection with culture positive suggests its use in resource-limited contexts. Conclusion: The study highlights a critical shift in antibiotic resistance patterns among pediatric enteric fever cases, underscoring the need for revising treatment guidelines and reinforcing typhoid vaccination efforts.

DOI: 10.5281/zenodo.

Background: Pregnancy thyroid dysfunction is a frequent endocrine condition that can have a negative impact on the health of the mother and fetus. Low birth weight, developmental delays, premature delivery, and neurocognitive impairments are among the issues that can arise from disturbances in thyroid hormone levels. Research on the degree to which thyroid diseases affect pregnancy outcomes is still ongoing, despite their frequency. Aim: The purpose of this study is to assess the effects of maternal thyroid dysfunction on fetal outcomes in a cohort of pregnant women, including low birth weight, preterm birth, APGAR ratings, and neonatal intensive care unit admissions. Methods: 200 pregnant women were included in a prospective cohort research at JLN Medical College in Ajmer, India. The women were divided into five groups according to thyroid function: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. TSH, free T3, and free T4 levels in the serum were used to measure thyroid function. Neonatal ICU hospitalizations, birth weight, APGAR scores, and preterm delivery were among the fetal outcomes that were tracked. Version 23.0 of SPSS was used for statistical analysis. Results: The study found that maternal thyroid dysfunction significantly affected fetal outcomes. Preterm delivery rates were highest in the overt hyperthyroidism group (40%) and overt hypothyroidism group (35%), with the euthyroid group showing the lowest rate (10%). Low birth weight was most prevalent in the overt hyperthyroid group (45%), followed by overt hypothyroidism (40%). APGAR scores <7 were observed in 20% of neonates born to mothers with overt thyroid dysfunction. NICU admission rates were also higher among neonates of mothers with thyroid dysfunction, particularly in the overt hyperthyroidism (30%) and overt hypothyroidism (25%) groups. Conclusion: Preterm delivery, low birth weight, low APGAR scores, and increased neonatal intensive care unit hospitalizations are among the negative fetal outcomes that are substantially linked to maternal thyroid dysfunction, particularly overt hypothyroidism and hyperthyroidism. Improving mother and fetal health outcomes during pregnancy requires early identification and appropriate treatment of thyroid problems. Recommendations: It is recommended that thyroid function screening should be an integral part of prenatal care, particularly for women at risk of thyroid disorders. Regular monitoring and timely interventions can help prevent the adverse effects of thyroid dysfunction on pregnancy and fetal health.

DOI: 10.5281/zenodo.

Background: Although the liver has a definitive morphology but occasionally major morphological variations of lobes and fissures has been also reported by some authors. The knowledge of these variations has a great role in liver surgeries. Aim: The present study was conducted to see the morphological variations of lobes and fissures of the cadaveric human livers available after dissection. Methods: A cross-sectional observational study was carried out in the Department of Anatomy of leading Government College of Jaipur, Rajasthan (India) from March 2022 to January 2023. After approval from institutional ethics committee, a list of the cadaveric livers available in the department was made, assigning a unique number. The livers which were in good condition and having complete morphological features were included in the study and studied for morphological variations. Results: Elongated left lobe/ Beaver’s lobe was observed in 4.92% liver specimens. Quadrate lobe was absent in 4.92% and was bilobed in 9.84% specimens. Caudate lobe was absent in 1.64% of the liver specimens while an accessory lobe was found in 16.39% livers. Accessory fissures were more common on the anteroinferior surface of the right lobe and least common in posterosuperior margin of caudate lobe. Conclusion: In this study, several morphological variations in lobes and fissures of the human liver were observed. The knowledge of these variations will help the surgeons and radiologists to make more exact analysis of the surgical performance and radiological images.

DOI: 10.5281/zenodo.

Background: Hypogonadism is a widespread comorbidity in men with Type 2 Diabetes Mellitus (T2DM), significantly impacting their metabolic health and quality of life. Understanding the clinical and metabolic associates of hypogonadism in T2DM individuals is crucial for improving management and outcomes. The study aims to examine the associations among hypogonadism and various clinical and metabolic parameters in male individuals with T2DM. Methods: The study comprised 173 male T2DM individuals aged 35-65 years. Data were gathered on demographic details, BMI, waist circumference, duration of diabetes, FBS, PPBS, HbA1C, lipid profiles, and testosterone levels. Hypogonadism was termed by low total testosterone levels (<300 ng/dl) and a positive ADAM questionnaire. Statistical analysis involved correlation and regression analyses to explore associations between hypogonadism and clinical/metabolic parameters. Results: The incidence of hypogonadism was 27.2%. Participants with hypogonadism had higher mean age (53.79 ± 7.37 years vs. 49.11 ± 8.01 years, p < 0.001), BMI (26.55 ± 2.27 kg/m² vs. 24.81 ± 2.20 kg/m², p < 0.001), and waist circumference (94.05 ± 4.21 cm vs. 90.88 ± 4.07 cm, p < 0.001). They also had longer diabetes duration (9.53 ± 4.44 years vs. 6.15 ± 4.31 years, p < 0.001), higher FBS (151.81 ± 23.05 mg/dl vs. 136.97 ± 22.67 mg/dl, p < 0.001), PPBS (231.74 ± 67.55 mg/dl vs. 203.25 ± 57.26 mg/dl, p = 0.008), and HbA1C (8.74 ± 2.18% vs. 7.88 ± 1.74%, p = 0.005). Substantial negative correlations were seen among testosterone levels and age, waist circumference, BMI, diabetes duration, FBS, PPBS, and HbA1C. Conclusion: Hypogonadism is prevalent among male T2DM patients and is significantly associated with adverse clinical and metabolic parameters. Aging, obesity, central obesity, and poor glycemic control are key factors linked to reduced testosterone levels. Recommendations: Regular screening for hypogonadism in men with T2DM is recommended. Addressing hypogonadism through lifestyle modifications, weight management, and possibly testosterone replacement therapy could improve metabolic health and quality of life in these patients.

DOI: 10.5281/zenodo.

Background: Hypogonadism is prevalent among men with type 2 diabetes mellitus (T2DM), adversely affecting their clinical and metabolic health. Testosterone replacement therapy (TRT) has been proposed as a treatment to alleviate these conditions. The aim of the study was to evaluate the impact of testosterone replacement therapy on clinical symptoms and metabolic parameters in diabetic men with hypogonadism. Methods: The study comprised 173 male T2DM patients aged 35-65 years. Participants were screened for hypogonadism using the ADAM questionnaire and serum total testosterone (TT) levels. Patients diagnosed with hypogonadism received TRT. Clinical symptoms and metabolic parameters were assessed before and after TRT, including BMI, waist circumference, HbA1c, fasting blood sugar (FBS), postprandial blood sugar (PPBS), and lipid profiles. Statistical analysis was accomplished using IBM SPSS Statistics v23.0. Results: The prevalence of hypogonadism in the study population was 27.2%. TRT significantly improved clinical symptoms, with the prevalence of erectile dysfunction decreasing from 81.3% pre-TRT to 45.7% post-TRT and decreased libido from 70.2% to 40.4%. Metabolic parameters showed significant improvements post-TRT: BMI decreased from 26.55 ± 2.27 kg/m² to 25.78 ± 2.20 kg/m², waist circumference from 94.05 ± 4.21 cm to 91.74 ± 4.33 cm, HbA1c from 8.74 ± 2.18% to 7.88 ± 1.74%, FBS from 151.81 ± 23.05 mg/dl to 136.97 ± 22.67 mg/dl, and PPBS from 231.74 ± 67.55 mg/dl to 203.25 ± 57.26 mg/dl. Lipid profiles also improved, with reductions in total cholesterol, triglycerides, and LDL levels, and an increase in HDL levels. Conclusion: TRT significantly improves clinical symptoms and metabolic control in diabetic men with hypogonadism, suggesting its potential as an effective treatment option for this population. Recommendation: Further longitudinal studies with larger sample sizes are recommended to confirm these findings and establish standardized treatment protocols for the effective management of hypogonadism in diabetic men.

DOI: 10.5281/zenodo.

Background: Electrocution-related fatalities are a significant public health concern, particularly in developing countries where occupational hazards, poor electrical infrastructure, and lack of safety regulations contribute to increased mortality. This study aims to analyse the demographic patterns, circumstances, autopsy findings, and seasonal variations of electrocution deaths at a tertiary care centre over a one-year period. Methods: A retrospective observational study was conducted on 57 cases of electrocution-related deaths reported for postmortem examination at the Department of Forensic Medicine, Government Medical College, Ratlam, from November 2023 to October 2024. Data were collected from autopsy reports and investigating authorities, focusing on demographic distribution, circumstances of electrocution, injury patterns, and forensic findings. Results: Males accounted for 86.0% of cases, with the highest incidence in the 21–40 years age group (54.4%). Occupational electrocutions were most common (63.2%), followed by domestic incidents (24.6%). The highest fatalities occurred during the monsoon season (45.6%). Autopsy findings revealed electrical burns in 89.4% of cases, with 47.4% exhibiting both entry and exit wounds. The majority (96.5%) were accidental, while 3.5% were suicidal. Conclusion: Electrocution remains a preventable cause of unnatural deaths, particularly in occupational settings. Implementing workplace safety measures, electrical infrastructure upgrades, and public awareness campaigns can help reduce fatalities. Enhanced forensic evaluation and stricter enforcement of electrical safety regulations are crucial for prevention and accurate classification of cases.

DOI: 10.5281/zenodo.

Background: A frequent glomerular condition in children, idiopathic nephrotic syndrome (INS) is typified by edema, hypoalbuminemia, and proteinuria. Although the most common histological finding is Minimal Change Disease (MCD), other conditions like Membranous Nephropathy (MN) and Focal Segmental Glomerulosclerosis (FSGS) are frequently seen, especially in older children or those with more severe types of nephrotic syndrome. For these illnesses to be effectively managed and to improve long-term results, early and correct diagnosis is essential. Aim: The aim of this study was to evaluate the spectrum of renal biopsy findings in children diagnosed with idiopathic nephrotic syndrome and to investigate any potential correlations between age, gender, and histopathological patterns. Methods: This study included 100 children with idiopathic nephrotic syndrome who had renal biopsies performed at a tertiary care facility. The results of the biopsy were examined, and clinical and demographic information was gathered. In order to measure age-related differences in histopathological patterns, participants were divided into three age groups: 1–5 years, 6–10 years, and 11–16 years. To evaluate correlations between age, gender, and biopsy results, descriptive statistics and chi-square tests were used in the statistical analysis, which was carried out using SPSS version 23.0. Results: Membranous Nephropathy (15%), IgA Nephropathy (5%), Diabetic Nephropathy (5%), Focal Segmental Glomerulosclerosis (25%), and MCD (50%) were the most frequent biopsy findings. Children ages 1–5 were more likely to have MCD, but children ages 6–16 were more likely to have FSGS and MN. Age and the type of histopathological finding were significantly correlated (p<0.05), although gender and biopsy results were not significantly correlate. Conclusion: The study demonstrated that MCD is the most prevalent histopathological finding in children with idiopathic nephrotic syndrome, especially in younger children. As children age, the spectrum of renal pathology broadens, with FSGS and MN becoming more prominent. Early and accurate renal biopsy is essential for determining the appropriate treatment and preventing long-term renal damage in children. Recommendations: Early renal biopsy should be considered in pediatric nephrotic syndrome to guide treatment, particularly in cases with atypical presentations or in older children. To investigate the long-term consequences of these kids and the part that genetics plays in the development of nephrotic syndrome, more research with bigger sample sizes and longer follow-up times is advised.

DOI: 10.5281/zenodo.

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, often leading to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Acute kidney injury (AKI) is a common complication of IgAN that can accelerate renal dysfunction. Understanding the clinicopathological features and risk factors for AKI in IgAN patients is essential for improving prognosis and management strategies. Aim: The aim of this study was to investigate the clinicopathological features, risk factors, and renal outcomes in patients with IgA nephropathy complicated by (AKI). Methods: This retrospective observational study included 300 patients diagnosed with IgAN and presenting with AKI. Data were collected from medical records over a two-year period. Clinical and demographic information, laboratory results, histological findings, and renal outcomes were analyzed. Statistical analysis was performed using SPSS version 23.0, including descriptive statistics, chi-square tests, independent t-tests, and multivariate regression analysis. Results: The study cohort consisted of 60% male participants with a mean age of 52.3 years. Hypertension (63.3%) and diabetes mellitus (45%) were the most common comorbidities. Severe glomerular damage was significantly correlated with AKI progression (p=0.001). Other independent risk factors for AKI progression included older age (>60 years), hypertension, and diabetes mellitus. Renal outcomes revealed that 60% of patients had renal recovery, while 30% progressed to CKD, and 10% developed ESRD. Multivariate regression analysis identified age >60 years, hypertension, severe glomerular damage, and diabetes mellitus as independent predictors of AKI progression. Conclusion: AKI in IgA nephropathy is strongly associated with comorbidities such as hypertension and diabetes mellitus, as well as severe glomerular damage. Early identification of high-risk patients and timely interventions are crucial in preventing the progression to CKD and ESRD. Recommendations: Clinicians should prioritize early screening for AKI in IgAN patients, particularly in those with hypertension, diabetes, or severe glomerular damage. Further research is needed to identify biomarkers for early detection and to explore more targeted therapeutic options for these high-risk patients.

DOI: 10.5281/zenodo.

Premenstrual syndrome (PMS) is a common condition affecting women of reproductive age, characterized by physical and psychological symptoms. The autonomic nervous system plays a critical role in stress modulation, and relaxation techniques have been increasingly explored as non-pharmacological interventions to mitigate stress responses. This study investigates the effect of age on the physiological response to the 61-Point Relaxation Technique (Shavasana) in PMS patients exposed to cold pressor-induced stress. The study aims to determine whether younger and older PMS patients exhibit different levels of autonomic regulation following relaxation training.
Results indicate a significant reduction in heart rate, systolic blood pressure, and diastolic blood pressure, along with an increase in heart rate variability (HRV) post-intervention in both age groups. However, younger individuals exhibited a more pronounced autonomic shift toward parasympathetic dominance compared to the older group. These findings suggest that the 61-Point Relaxation Technique effectively reduces stress responses in PMS patients and may be particularly beneficial for younger individuals in modulating autonomic function.

DOI: 10.5281/zenodo.

Background: APH is considered a frightening obstetrical condition. Bleeding from or into the genital tract after 28 weeks of gestation but prior and before the delivery of the baby. APH is still regarded in our country as a serious obstetric emergency that causes considerable morbidity and mortality in both the mother and the foetus. In 30% of cases, haemorrhage is the direct cause of maternal death. Material & Methods: The present prospective and observational study was carried out at department of obstetrics and gynaecology at Ananta Institute of Medical Sciences And Research Centre, Rajsamand, Rajasthan. In this prospective we enrolled all on 75 patients, who were diagnosed with antepartum haemorrhage with gestational age >28 weeks froom ANC and emergency till sample size was reached. Results: In the present study, on the basis of the gestational age wise distribution. In our study group, 10.66% between 28 & 30 weeks, 16% between 31-32, 22.6% between 33-34 weeks. 29.33% between 35 & 36 weeks. 21.33 % between 37 and 38 weeks On the basis of fetal presentation it was found that the most common fetal presentation was (76%) cephalic presentation followed by 20% had Breech and 4% cases were of transverse lie. On the basis of mode of delivery in mothers, 98.66% mothers had LSCS delivery while only 1.33 % mothers had VD. On the basis of fetal condition of the patients. 85.33% fetus was alive while 14.66% fetus was dead. On the basis of term and preterm condition, 21.33 % fetus delivered term whereas, 78.66% fetus delivered pre term. Conclusion: Majority of the patients in this study appointments at other facilities and had complications. Study reported higher incidence of maternal morbidity, preterm births and fetal morbidity. Informing patients about routine ANC and ultrasonography can reduce morbidity and mortality, expectant management and timely intervention improves maternal and fetal outcome.

DOI: 10.5281/zenodo.

Background: Anemia is a common comorbidity in patients with acute myocardial infarction (AMI) and has been associated with worse clinical outcomes. Its impact on mortality, particularly in diabetic and non-diabetic populations, remains an area of clinical interest. Objective: This study aimed to evaluate anemia as an independent risk factor for mortality in patients with AMI, stratified by diabetes status. Methods: A retrospective cohort study was conducted on 180 patients with AMI, including 90 diabetic and 90 non-diabetic patients. Anaemia was defined using WHO criteria. One-year mortality and major adverse cardiac events (MACE) were analyzed using logistic regression and Kaplan-Meier survival analysis. Results: Anaemic patients had a significantly higher one-year mortality rate compared to non-anemic patients (28% vs. 12%, p=0.014). Among diabetic patients, mortality was 33% in anemic individuals versus 15% in non-anemic individuals. Anemia was identified as an independent risk factor for mortality (OR 2.8, 95% CI 1.3-5.9, p=0.007). Conclusion: Anemia is an independent predictor of increased mortality and adverse outcomes in AMI patients, irrespective of diabetes status. Early diagnosis and management of anemia could improve survival rates in this high-risk population.

DOI: 10.5281/zenodo.

Background: Petroclival meningiomas (PCMs) are rare intracranial tumors arising at the petroclival junction, often posing significant surgical challenges due to their proximity to critical neurovascular structures. Despite advancements in microsurgical techniques, achieving optimal outcomes while minimizing complications remains a complex task. Aim: This study aimed to evaluate the surgical management of PCMs and identify factors influencing early postoperative outcomes, thereby contributing to improved clinical strategies. Methods: A prospective observational study was conducted on 100 patients undergoing surgical resection of PCMs at a tertiary care center. Data were collected on patient demographics, tumor characteristics, surgical approaches, and postoperative outcomes. Statistical analysis was performed using SPSS version 23.0, employing logistic regression to identify predictors of complications. Results: The mean age of participants was 45.2 ± 12.3 years, with 75% female and 25% male. Gross total resection was achieved in 75% of cases, while subtotal resection was performed in 25%. Postoperative complications occurred in 40% of patients, with cranial nerve deficits (20%) and CSF leaks (10%) being the most common. Predictors of complications included age >50 years (OR = 2.5, p = 0.01), tumor size >4 cm (OR = 3.7, p <0.001), preoperative neurological deficits (OR = 3.1, p = 0.004), and subtotal resection (OR = 4.5, p <0.001). Conclusion: Surgical management of PCMs remains a challenging yet effective treatment. Factors such as patient age, tumor size, and extent of resection significantly influence postoperative outcomes. While gross total resection should be prioritized, subtotal resection with adjuvant therapies may be appropriate in select cases to minimize morbidity. Recommendations: Future research should focus on refining surgical techniques, developing advanced intraoperative tools, and establishing standardized guidelines for managing PCMs. Multidisciplinary approaches combining surgery and adjuvant therapies are recommended to optimize patient outcomes.

DOI: 10.5281/zenodo.

Background: Acute appendicitis (AA)is the most prevalent emergency necessitating general surgery. The most prevalent emergency abdominal procedure is an appendicectomy, which is the recommended intervention for acute appendicitis. A proficient option for managing appendicitis is laparoscopic appendicectomy (LA) as open appendicectomy (OA) is related with complications such as wound infection, intestinal blockage, and post-operative discomfort. Objective: To evaluate the operative characteristics of LA in a standard surgical environment. Materials and Methods: This prospective investigation comprised 186 individuals who had undergone LA for clinically confirmed AA from 1^st January 2024 to 31^st December 2024 at GMCH Purnea. Results: This study’s findings indicate that 65.6% of the cases were males, while 34.4% of the patients were females. The maximum number of male patients (40.9%) were between the ages of 19 and 29, while female patients’ percentage was 22.6%. A total of 186 cases of AA which were clinically diagnosed. The prevalence rates of open conversion and negative laparoscopy were 9.7% and 6.5%, respectively. The complication that was most frequently observed in this study was bleeding from the port site, which constituted 4.3% of the instances. Additionally, the rate of prevalence for infection of port site was 2.1%. Around 87.1% of subjects were discharged from the hospital within seventy-two hours of undergoing LA. Conclusion: LA is a comparatively safe and robust surgery for AA concerning operating complications, postoperative pain, conversion rate, and length of hospital stay. Recommendation: It is advisable to concentrate on decreasing open conversion rates, enhancing pain management, and mitigating complications such as haemorrhage and infections through improved surgical methods. Longitudinal follow-up studies must be undertaken to evaluate delayed problems, and enhanced laparoscopic training for surgeons may facilitate improved outcomes and diminish conversion rates.

DOI: 10.5281/zenodo.

Background: Identification of submucosal invasive carcinoma (SMIC) in large (≥20mm) nonpedunculated colonic polyps (LNPCPs) guides the determination of the most effective approach for resection. The size, morphology and location of LNPCP affect the submucosal invasive carcinoma risk; nonetheless, there is presently no significant use of this knowledge that has streamlined the process for accessibility and widespread use. We created a decision-making system to facilitate the identification of LNPCP subtypes with heightened risk of possible submucosal invasive carcinoma. Methodology: Individuals referred for resection of large nonpedunculated colonic polyps between one year were included in the study. Large nonpedunculated colonic polyps having submucosal invasive carcinoma were discovered from surgical results, biopsies of lesion or endoscopic resection specimens. A decision tree analysis of lesion features obtained through multivariate analysis was employed to provide a hierarchical classification of prevalence of submucosal invasive carcinoma. Results: A total of 245 LNPCPs were examined: 12 (4.8%) were depressed ,104 (42.6%) were nodular, and 129 (52.6%) were flat. Submucosal invasive carcinoma was verified in 27 of the large nonpedunculated colonic polyps (11.1%). It was correlated with proximal versus rectosigmoid location (OR 3.20 [95%CI 2.46–4.12]; P<0.001); granular versus nongranular appearance (OR 2.39 [95%CI 1.86–3.11]; P<0.001); flat versus depressed and nodular morphology OR 3.49 [95%CI 2.55–4.85] and (OR 35.69 [95%CI 22.5–56.4] respectively; P<0.001). Analysis using decision tree focused on submucosal invasive carcinoma revealed 8 terminal nodes: prevalence of SMIC was 20% in nodular proximal colon nongranular large nonpedunculated colonic polyps, 19% in nodular and rectosigmoid large nonpedunculated colonic polyps and 62% in depressed large nonpedunculated colonic polyps. Conclusion: This decision making method streamlines the identification of large nonpedunculated colonic polyps with an elevated risk of possible submucosal invasive carcinoma. When integrated with optical assessment of surface, it enables precise lesion characterisation and resection decisions.

DOI: 10.5281/zenodo.

Background: Postoperative pain treatment in laparoscopic cholecystectomy improves recovery and patient satisfaction. Long-acting local anaesthetic ropivacaine is extensively used to relieve pain. Ropivacaine with and without an absorbable surgical gelatine sponge (AbGel) is tested for postoperative analgesia after laparoscopic cholecystectomy. Methods: Postoperative pain treatment in laparoscopic cholecystectomy improves recovery and patient satisfaction. Long-acting local anaesthetic ropivacaine is extensively used to relieve pain. Ropivacaine with and without an absorbable surgical gelatine sponge (AbGel) is tested for postoperative analgesia after laparoscopic cholecystectomy. Results: The use of AbGel significantly prolonged the time to the first analgesic request from 12 hours in the control group to 24 hours in the intervention group. Patients in the AbGel group reported lower pain scores and required fewer rescue analgesics, demonstrating a prolonged analgesic effect. Furthermore, these patients achieved earlier ambulation compared to the control group. Conclusion: Adding an absorbable surgical gelatine sponge enhances the analgesic efficacy of Ropivacaine in laparoscopic cholecystectomy. This approach may provide a valuable method for improving postoperative pain management and expediting recovery.

DOI: 10.5281/zenodo.

Background: SLAP (superior labrum, anterior and posterior) lesions significantly contribute to shoulder pain and instability, particularly in athletes. Accurate diagnosis is crucial for effective management, with traditional physical examinations and imaging modalities aiming to identify these injuries. This study evaluates the correlation between clinical tests, particularly the O’Brien test, MRI findings, and arthroscopic confirmation of SLAP II lesions. Methods: A prospective study involving 90 patients was conducted, with 45 diagnosed with SLAP II lesions undergoing arthroscopy and compared to a control group of 45 patients with different shoulder pathologies. Preoperative assessments included the O’Brien test and MRI, specifically analyzing T1 and T2-weighted coronal oblique views. Results: Of 90 patients, 45 were diagnosed with SLAP II lesions, and 45 with other conditions. The study found that MRI had a sensitivity of 80% and specificity of 70% for detecting SLAP lesions. The O’Brien test showed a sensitivity of 83% and specificity of 34%. Notably, 80% patients with SLAP II lesions exhibited positive O’Brien test results alongside MRI evidence of their condition. Conclusion: MRI and arthroscopy are essential tools for diagnosing SLAP lesions, with arthroscopy providing greater accuracy. The enhancement of clinical assessments can improve MRI diagnostic performance, ultimately guiding better treatment decisions.

DOI: 10.5281/zenodo.

Background: Optic neuritis is an inflammatory demyelinating disorder affecting the optic nerve, often associated with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). It leads to varying degrees of visual impairment and progressive retinal nerve fiber layer (RNFL) thinning. Optical coherence tomography (OCT) is a non-invasive imaging modality that allows for the quantification of RNFL thickness, serving as a valuable biomarker for disease monitoring and prognosis. Despite visual recovery in many cases, structural damage to the optic nerve may persist, necessitating long-term follow-up and advanced diagnostic approaches. Aim: This study aims to analyze changes in RNFL thickness in patients with optic neuritis and correlate these findings with visual function recovery over a three-month period using spectral-domain optical coherence tomography (SD-OCT). Methods: A prospective observational study was conducted on 251 eyes diagnosed with optic neuritis. Patients underwent comprehensive ophthalmic evaluations, including best corrected visual acuity testing, pupillary reaction, automated perimetry, color vision assessment, and SD-OCT imaging at baseline, 1 week, 1 month, and 3 months . The primary outcome measures included changes in RNFL thickness, visual acuity improvement, and correlations between structural and functional recovery. Statistical analysis was performed using paired t-tests and Spearman’s correlation, with a significance level of p < 0.05. Results: At presentation, the mean RNFL thickness in the affected eye was significantly lower than in the fellow eye (105.16 ± 6.05 µm vs. 109.65 ± 6.16 µm, p = 0.032). RNFL thinning progressed over time, with a mean reduction to 102.78 ± 4.64 µm at 3 months (p < 0.001). Visual acuity improved in 80.48% of eyes to better than 6/18 at 3 months after treatment with IV Methylprednisolone according to ONTT when compared to 32.27% at baseline. A significant positive correlation was found between RNFL thickness at 3 months and visual acuity recovery (r = 0.152, p = 0.016). MRI findings revealed demyelinating lesions in 3.58% of cases and signal enhancement in 11.15%. Conclusion: The study confirms that optic neuritis patients with RNFL thinning at the time of presentation had a poor visual recovery.

DOI: 10.5281/zenodo.

Background: Childhood, as defined by the Children’s Bill of Rights, encompasses the period from birth to 18 years, marking a critical developmental phase from infancy through adolescence. The death of a child during this stage is a profound tragedy, highlighting deficiencies in essential healthcare and societal support systems. Childhood mortality represents not only a devastating loss but also serves as a significant indicator of a country’s healthcare standards and overall development. Aims & Objectives: To observe the patterns of unnatural deaths, socio demographic and medicolegal profile in the paediatric age group (up to 18 years) brought for medicolegal autopsy at SMS Medical College Jaipur. Materials & Methodology: This retrospective study applied specific inclusion and exclusion criteria. Total 4,774 autopsies were conducted during the study period, out of which 487 were paediatric cases (<18year). The study was conducted at the Mortuary, SMS Medical college, Jaipur, from January 1, 2024, to December 31, 2024. Results: The study observe 487 paediatric cases, of which 61.54% (306 cases) were male and 37.2% (181 cases) were female. The manner of death was accidental in 76% of cases, suicidal in 7.6%, homicidal in 1.6% and unknown in 14.8% at the time of autopsy. Road Traffic Accidents accounted for the majority of deaths (200 cases, 41.1%), burn in 76 cases (15.6%), followed by falls from height (73 cases, 15%) and most of subjects belonged to rural area. Conclusion: The study underscores the critical role of parents and caregivers in supervising children to prevent incidents leading to unnatural deaths. Additionally, prompt and adequate medical care following an incident is crucial for improving survival outcomes.

DOI: 10.5281/zenodo.

Background: Gastric cancer remains a major global health concern with high morbidity and mortality. HER2 and p53 have been studied as potential prognostic biomarkers in gastric carcinoma. This study aimed to evaluate the expression of HER2 and p53 and their correlation with clinicopathological parameters. Methods: A prospective study was conducted at SCB Medical College, including 50 gastric carcinoma cases. Immunohistochemistry was performed to assess HER2 and p53 expressions. Statistical analysis was conducted to determine their associations with tumor characteristics and prognosis. Results: HER2 positivity was observed in 34% of cases, with a higher prevalence in the intestinal subtype. p53 positivity was noted in 40% of cases and was significantly associated with advanced tumor stages, nodal involvement, and metastasis. Both markers were linked to poorer differentiation and aggressive tumor behavior. Conclusion: HER2 and p53 expressions correlate with adverse prognostic features in gastric carcinoma, emphasizing their potential role as biomarkers for risk stratification and targeted therapy. Further research is required to validate these findings and explore novel therapeutic interventions.

DOI: 10.5281/zenodo.

Background: Vaginal discharge is a prevalent issue among women of reproductive age, often signalling underlying gynecological disorders, including potentially serious cervical conditions. This study aims to compare the diagnostic effectiveness of Pap smear and colposcopy for patients presenting with vaginal discharge in an outpatient setting. Methods: This comparative analysis involved women presenting with vaginal discharge who underwent both Pap smear and colposcopy. We evaluated and compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each diagnostic method across different age groups. Results: The study highlights a significant difference in the sensitivity of the Pap smear between younger (28%) and older (10%) age groups, despite high specificity. Colposcopy demonstrated consistently high sensitivity (80%) and specificity (97.7%) across all age groups, making it a more reliable diagnostic tool. These findings emphasize the need for age-specific diagnostic strategies for cervical pathology detection. Conclusion: Colposcopy demonstrates superior diagnostic accuracy over Pap smear in evaluating women with vaginal discharge, suggesting its higher reliability and effectiveness as a primary diagnostic tool in outpatient settings.

DOI: 10.5281/zenodo.

Background: Cesarean scar defects (CSD) are increasingly recognized as a significant cause of abnormal uterine bleeding (AUB) in women with a history of cesarean deliveries. However, the relationship between these scar defects and AUB has not been thoroughly investigated. Methods: From October 2018 to May 2020, IMS,BHU, enrolled 100 women with previous caesarean sections in this prospective study. Participants were screened for CSD by transvaginal ultrasound. The effects of hormonal and surgical therapies on CSD and AUB symptoms were examined. Results: CSD was identified in 48% of participants, with 85% of these women experiencing AUB symptoms. Logistic regression analysis revealed a strong association between CSD and AUB (odds ratio = 3.5, p < 0.001). Treatment with hormonal therapy showed improvement in 80% of cases, while surgical intervention led to symptom resolution in 92% of cases requiring surgery. Conclusion: Cesarean scar defects are a prevalent and significant contributor to abnormal uterine bleeding. Effective management can be achieved with appropriate hormonal and surgical treatments, highlighting the importance of targeted interventions in this population.

DOI: 10.5281/zenodo.

Background: Ventral hernias are a common surgical challenge, especially when they reach large sizes, necessitating advanced repair techniques to reduce morbidity and recurrence rates. Methods: This study examines the outcomes of the anterior component separation technique in large ventral hernia repairs among 32 patients at a single institution in Eastern India. Patients ranged in age from 29 to 68 years and were observed over years, evaluating metrics such as operative time, wound complications, recurrence rates, and postoperative recovery. Results: The mean operative time was 119.21 minutes, significantly less than reported in previous studies. The study recorded no instances of seroma or flap necrosis, and a low complication rate with only 18.75% of patients developing wound infections, which were managed conservatively. There were no recurrences reported during the follow-up period. Conclusion: The anterior component separation technique, enhanced with mesh reinforcement, demonstrated efficacy in managing large ventral hernias with minimal complications and no recurrence in the short-term follow-up. This supports its use as a viable option for large hernia repairs, although longer-term studies are needed for further validation.

DOI: 10.5281/zenodo.

Background: Cardiac autonomic neuropathy (CAN) is a prevalent complication of diabetes mellitus (DM), which impacts cardiovascular function and is frequently associated with inadequate glycaemic management, as indicated by haemoglobin A1c (HbA1c) levels. This study examines the correlation between HbA1c fluctuation and CAN, forecasts the onset and advancement of CAN on the basis of levels of HbA1c, and evaluates the influence of glycaemic control on autonomic dysfunction (AD) in individuals with DM. Methods: A retrospective analysis was conducted including 120 patients with Type 2 diabetes mellitus(T2DM). Inclusion criteria comprised individuals aged ≥18 years, with a duration of T2DM of ≥10 years, and a minimum of 4 HbA1c readings. Using the Cardiovascular Autonomic Score Scale (CASS), cardiac autonomic neuropathy (CAN) was evaluated. Multiple linear regression, descriptive statistics, logistic regression, and correlation analysis were used to analyse the data. Results: The individuals in this study had an average age of 57 years, comprising 40% female and 60% male individuals. The cardiovascular autonomic parameters of individuals having and not having CAN differed significantly (p < 0.001). Composite autonomic rating showed a strong connection with BMI, mean HbA1c, hypertension (HTN), adjusted HbA1c standard deviation, coronary artery disease (CAD), diabetic retinopathy, and duration of diabetes mellitus (OR 1.29, p < 0.001). The development and progression of CAN were also indicated by elevated HbA1c variability. Improved glycaemic management reduced autonomic dysfunction. Conclusion: The research indicates that glycaemic management and cardiovascular risk factors are essential to the occurrence and advancement of CAN in patients with T2DM. Duration of diabetes mellitus, age, HTN,  body mass index and CAD were significantly associated with elevated composite autonomic scores(CAS), signifying more severe CAN. Intensive glycaemic management is necessary to mitigate the advancement of CAN in this cohort. Recommendations: Intensive glycaemic control and focused therapy on cardiovascular risk factors are advised to reduce risks of CAN and enhance outcomes in individuals with T2DM.

DOI: 10.5281/zenodo.