Microalbuminuria is an important predictor of renal and cardiovascular complications1 in patients with type 2 diabetes mellitus (T2DM). Early detection of microalbuminuria in recent-onset T2DM provides an opportunity to delay or prevent the progression to diabetic nephropathy and cardiovascular morbidity2. This study aims to determine the incidence of microalbuminuria in patients with recent-onset T2DM using spot urinary albumin-to-creatinine ratio (ACR) testing.

Background/Introduction: Adverse drug reactions (ADRs) are a significant challenge in pharmacovigilance, often underreported due to reliance on spontaneous reporting systems. Active surveillance provides a systematic approach to monitor and report ADRs, enhancing detection and reporting quality. This study assesses the impact of active surveillance on COVID-19 vaccine-related ADR reporting at a designated monitoring center. Aim/Objective: To analyze the impact of active surveillance on the reporting of COVID-19 vaccine-related adverse drug reactions compared to passive surveillance. Methodology: This retrospective observational study was conducted at the ADR monitoring center of Pt. JNM Medical College and Associated Dr. BRAM Hospital, Raipur, Chhattisgarh, under the Pharmacovigilance Program of India. The study included all adverse events following immunization (AEFIs) related to COVID-19 vaccination reported from January 10, 2021, to December 31, 2022. Data were collected through both passive and active surveillance methods. Active surveillance involved contacting beneficiaries via telephone within 7±3 days post-vaccination. All identified AEFIs were documented, analyzed, and compared for completeness and accuracy. Statistical analysis was performed using descriptive statistics, and results were presented in graphs and tables. Results: During the study period, 94,294 doses of COVID-19 vaccines were administered, and 4,480 telephone calls were made to beneficiaries. A total of 685 ADRs were reported, with 353 (51.5%) related to COVID-19 vaccines. Of these, 334 (94.6%) were reported in 2021 and 19 (5.4%) in 2022. Active surveillance identified 312 (93.4%) AEFIs in 2021 and 8 (42.1%) in 2022, while passive surveillance accounted for 22 (6.6%) AEFIs in 2021 and 11 (57.9%) in 2022. Most AEFIs were associated with the first dose (91.5%), followed by the second dose (6.5%) and the third dose (2.0%). Gender distribution showed a higher reporting rate among females (53.75%) compared to males (44.31%). Conclusion: Active surveillance significantly improved the detection and reporting of COVID-19 vaccine-related AEFIs compared to passive surveillance. The proactive approach facilitated timely identification of ADRs, contributing to enhanced patient safety and informed decision-making in pharmacovigilance.

Anal fissures are a common yet distressing condition characterized by a painful linear tear in the anoderm, often leading to severe discomfort, bleeding, and altered bowel habits. Although acute fissures can resolve with conservative treatment, chronic fissures frequently require targeted intervention to break the cycle of pain, sphincter spasm, and ischemia.
The management of anal fissures primarily revolves around two approaches: pharmaceutical therapy aimed at reducing sphincter spasm and promoting healing, and surgical intervention, which remains the definitive treatment for refractory cases. Pharmaceutical options such as topical nitrates, calcium channel blockers, and botulinum toxin aim to relax the internal anal sphincter and enhance perfusion, whereas surgical options, particularly lateral internal sphincterotomy (LIS), directly relieve sphincter pressure, often providing long-term relief. However, concerns about postoperative complications, particularly fecal incontinence, continue to fuel debate over the ideal management strategy.
This systematic review critically evaluates and compares pharmaceutical and surgical management of anal fissures by analyzing their efficacy, recurrence rates, side effects, and patient satisfaction. By examining the latest evidence, we aim to provide clarity on the optimal treatment approach, balancing effectiveness with safety to guide clinical decision-making. Anal fissures are small tears in the lining of the anal canal, often causing significant pain and bleeding during defecation. Management strategies for chronic anal fissures primarily include pharmaceutical interventions and surgical procedures, notably lateral internal sphincterotomy (LIS). This systematic review aims to compare the efficacy and safety of pharmaceutical treatments versus LIS in the management of chronic anal fissures.

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is closely linked to insulin resistance, obesity, and Type-2 Diabetes Mellitus. The progression of NAFLD from steatosis to Non-Alcoholic Steatohepatitis (NASH), and cirrhosis is a significant health concern. Prediabetes, characterized by elevated blood sugar levels, is often associated with an increased risk of developing NAFLD. Objective: To assess the effect of Saroglitazar, a dual-activity PPAR-α/γ agent, on the Fibrosis-4 (FIB-4) score and safety in prediabetic patients with NAFLD, highlighting the score’s cost-effectiveness and accessibility compared to invasive diagnostic methods. Methods: This six-month prospective, single-center, observational study was conducted at the Department of Pharmacology, MGM Medical College, Aurangabad. It included 65 prediabetic individuals with NAFLD, confirmed by ultrasonography. Patients were administered 4 mg of Saroglitazar once daily. The FIB-4 score was calculated at baseline, 3 months, and 6 months to assess the effectiveness of the treatment. Results: The study included 65 participants (41 males, 24 females) with a mean age of 54.4±7.83 years. The baseline FIB-4 score was 2.132 ± 0.34. A statistically significant reduction in FIB-4 scores was observed at 3 months (1.723 ± 0.27) and 6 months (1.514 ± 0.24). Adverse events were minimal, with only two patients reporting nausea and gastrointestinal upset. Conclusion: Saroglitazar significantly reduced the FIB-4 score in prediabetic patients with NAFLD over a 6-month period, indicating an improvement in liver health. The treatment was well-tolerated with minimal adverse events. This study supports the potential of Saroglitazar as a non-invasive, effective treatment option for NAFLD in prediabetic individuals, particularly in resource-constrained settings like India.

Introduction: Intrauterine growth restriction (IUGR) is a major obstetric concern, contributing to increased perinatal morbidity, mortality, and long-term neurodevelopmental impairment. Identifying growth-restricted fetuses and implementing timely interventions is a critical aspect of antenatal care. While ultrasonography is useful for fetal growth assessment, Doppler velocimetry provides a non-invasive means of evaluating feto-placental circulation, offering crucial insights into fetal hemodynamic status. This study evaluates the utility of umbilical artery and middle cerebral artery (MCA) Doppler indices in predicting IUGR and adverse perinatal outcomes. Materials and Methodology: A prospective observational study was conducted over eight months on 120 antenatal women with clinically suspected IUGR in the second and third trimesters. Doppler ultrasonography was performed to assess umbilical artery pulsatility index (PI), MCA PI, and cerebroplacental ratio (CPR). The correlation between these Doppler parameters and perinatal outcomes, including birth weight and NICU admission, was analyzed. Statistical significance was determined using chi-square tests. Results: Umbilical artery PI exhibited the highest sensitivity (81%) for predicting IUGR, while CPR demonstrated the highest specificity (79%). Abnormal umbilical artery and MCA PI were significantly associated with low birth weight (p = 0.009, p = 0.017) and NICU admission (p = 0.021, p = 0.028). A reduced CPR was also strongly correlated with adverse perinatal outcomes (p = 0.006). Conclusion: Doppler ultrasonography is a valuable tool for assessing fetal well-being in IUGR cases. Umbilical artery PI serves as a sensitive predictor, while CPR is highly specific for adverse outcomes. Integrating Doppler assessments into routine antenatal care can aid in timely interventions and improved perinatal outcomes.

Objectives: To study the outcome and risk factors in neonates of premature rupture of membranes delivery and to study the mortality and morbidity in neonates caused by premature rupture of membranes due to such causes as early onset sepsis, asphyxia, respiratory distress, preterm born, lbw. Methods: The methodology for this study was conducted at the Index Medical College and Hospital in Indore, Madhya Pradesh, from January 2018 to June 2019. From January 2018 to June 2019, all 105 newborns who were admitted to the hospital with symptoms of respiratory distress syndrome, early onset sepsis, pneumonia, and low birth weight were included in the study. A comprehensive checklist was utilized to gather demographic information about both the neonates and their mothers during the data collection process. Neonatal information included preterm, rds, birth asphyxia, neonatal sepsis, pneumonia, neonatal jaundice, seizure, hospitalization in Nicu. Results: most of the babies that were delivered were girls (57.1%), while 42.9% were boys. The ratio of males to females in the study was approximately 2:1. 33. Most common illness associated with mother was iron deficiency anemia (15. 2%) followed by megaloblastic anemia (7.6%), oligohydramnios in (5.7%), diabetes oligohydramnios in 4.8%. Among the 105 newborns, 60 (60%) tested positive for sepsis, while among the 105 mothers, 38. 1% tested positive. Conclusion: PROM is a significant factor contributing to neonatal mortality. Maternal health conditions linked to prom were iron deficiency anemia, megaloblastic anemia, diabetes, and oligohydramnios. A substantial number of mothers and newborns tested positive for sepsis. Neonatal morbidities and mortality, including jaundice, seizures, fever, and pneumonia, were significant issues, with one-third of neonates experiencing these complications.

Background: Thrombocytopenia is a commonly encountered hematologic condition necessitating a comprehensive assessment to ascertain its underlying etiology. The aim was to study platelet parameters and their correlation with clinical findings, other laboratory tests, and causes of thrombocytopenia. Material and Method: This was a descriptive cross-sectional study conducted in the Department of Pathology at GITAM Institute of Medical Sciences and Research, Visakhapatnam for a period of one and a half years from September 29, 2022, to March 28, 2024. Patients with a platelet count of less than 150,000/µL were included in the study. Results: A total of 308 thrombocytopenia cases were analyzed in this study. The most common age group with thrombocytopenia was between 20 and 40 years (51.6%). The male-to-female ratio is 1.6:1. Most patients (37%) had platelet counts ranging from >75,000-150,000/cu mm (Grade 1). Of the 308 cases, 62% had high Mean Platelet Volume, and 64% had high Platelet Distribution Width. We encountered 98% of cases with fever. Dengue was the most common cause of thrombocytopenia (64.5%), followed by viral fever (25%), malaria (6.1%), chronic liver disease (CLD) (3.5%), idiopathic thrombocytopenic purpura (ITP) (0.6%), and acute leukemia (0.3%). Conclusion: Infectious diseases are the leading cause of thrombocytopenia, with dengue being the most common, followed by viral fever and malaria. Evaluating platelet counts and related indices is essential for the early diagnosis and treatment of medical conditions.

Endometrial sampling is a crucial diagnostic procedure for women with suspected endometrial pathology presenting with abnormal uterine bleeding (AUB). Conventional uterine curettage (CUC) and manual vacuum aspiration (MVA) are two common methods used for endometrial sampling. This study aimed to compare the efficacy, safety, and patient satisfaction of CUC and MVA for endometrial sampling in women with suspected endometrial pathology presenting with AUB. A prospective, randomized controlled trial was conducted at a tertiary care hospital, involving 100 women with suspected endometrial pathology. The results showed that MVA was superior to CUC in terms of efficacy, safety, and patient satisfaction. MVA had a higher success rate (96% vs. 82%), lower complication rate (4% vs. 18%), and higher patient satisfaction rate (92% vs. 76%) compared to CUC.

Background: Inguinal hernioplasty is a frequently performed surgical procedure associated with moderate to severe postoperative pain. Effective postoperative analgesia is essential to prevent adverse outcomes. The ultrasound-guided transversus abdominis plane (TAP) block targets the anterolateral abdominal wall’s innervation from T6-L1, which can enhance analgesia duration, delay the first analgesic request, lower overall analgesic consumption, and reduce opioid-related side effects. Adjuvants like dexmedetomidine, clonidine, dexamethasone, and fentanyl are often used to prolong the effects of bupivacaine. This study evaluated the addition of two doses of dexmedetomidine (0.5 mcg/kg and 1 mcg/kg) to bupivacaine for the TAP block, with the objective of determining which dose provides optimal postoperative analgesia. Aims and Objectives: Aim of the study is to evaluate two doses of dexmedetomidine(0.5mcg/kg and 1 mcg/kg) in ultrasound guided transversus abdominis plane block for postoperative analgesia in patients undergoing unilateral inguinal hernioplasty. Primary objective was to identify optimal doses of dexmedetomidine added to bupivacaine for postoperative analgesia in unilateral inguinal hernioplasty while secondary objectives were to observe the time and average dose of rescue analgesics , level of sedation and other adverse effects related to drugs and technique, if any. Materials and Methods: A prospective hospital based study was conducted at Gandhi Medical College , Bhopal comprising of 80 patients between age group 18-60 years , male,  belonging to ASA grade I to II, scheduled for elective unilateral inguinal hernioplasty under the subarachnoid block (SAB) after informed consent. GROUP 1- 40  patients received a unilateral TAP block using 22 ml solution— consisting of 20 ml 0.25% bupivacaine and 0.5 mcg/kg dexmedetomidine dissolved in 2 ml normal saline. GROUP  2 – 40 patients received a unilateral TAP block using 22 ml solution— consisting of 20 ml 0.25% bupivacaine and 1 mcg/kg dexmedetomidine dissolved in 2 ml normal saline. Diclofenac 75mg was used as rescue analgesia. Post operative pain is evaluated by VAS score for pain at 0,2,4,8,12 and 24 hrs postoperatively, time to 1st request of analgesia ,total analgesia sedation by ramsay sedation score and any complications were noted. Result: There was no statistical significant difference between the two groups in demographic characteristics (age, weight, side of surgery, duration of surgery, ASA), Group A consistently exhibited higher mean pulse rates and systolic blood pressure compared to Group B at various postoperative intervals especially at 1 and 2 hrs, with statistically significant differences. However, diastolic blood pressure and mean arterial pressure showed significant differences only at specific time points(1 and 2 hrs) postoperatively, with no significant variances at other intervals. Group A had lower VAS scores at rest and during coughing compared to Group B postoperatively at all time points, indicating better analgesia quality in Group B. Group B showed a longer mean time to first rescue analgesic (11.45 hours)compared to Group A (6.53 hours), indicating more effective pain management in Group B. Additionally, Group B had significantly lower total analgesic consumption in 24 hours (159.38 mg) compared to Group A (270 mg), suggesting better pain management efficacy or patient response in Group B. all 80 patients exhibited a Ramsay Sedation Score of 2. Only 5.0% of patients in Group B experienced bradycardia, which was successfully managed with atropine. Notably, neither group reported any instances of nausea, vomiting, or hypotension. Conclusion: This study elucidated that addition of 1 mcg/kg Dexmedetomidine to Bupivacaine in ultrasound guided TAP block for postoperative analgesia in unilateral inguinal hernioplasty gives better quality and longer duration of post- operative analgesia than 0.5 mcg/kg Dexmedetomidine. It provides longer first analgesia request time and lesser total analgesia consumption in 24 hours with minimal side effects like sedation, bradycardia, nausea and vomiting.

Background: Hepatitis C virus (HCV) remains a critical public health issue, especially among haemodialysis patients who are at higher risk of infection due to prolonged vascular access. The virus, a positive-sense RNA virus from the Flaviviridae family, can lead to chronic liver disease and complications if not detected and treated promptly. Aim: This study aimed to determine the seroprevalence of HCV among haemodialysis patients at a tertiary care center, analyze liver function parameters, and evaluate the correlation between HCV infection and patient demographics using statistical analysis. Methods: A prospective study was conducted between June and August 2021 at Department of Microbiology, Saveetha Medical College and Hospital, Chennai, India. A total of 86 haemodialysis patients were screened for anti-HCV antibodies using Chemiluminescence Immunoassay (CLIA). Positive samples were further confirmed using Real-Time Polymerase Chain Reaction (RT-PCR) to detect viral RNA and determine genotype distribution. Liver function tests (SGOT, SGPT, total bilirubin, and direct bilirubin) were assessed, and statistical significance was determined using appropriate tests (p-value <0.05). Results: Among the 86 patients, 11 (12.8%) were seropositive for HCV antibodies, of which 9 (81.8%) were confirmed positive by RT-PCR. Additionally, 16 (21.3%) seronegative patients tested positive for HCV RNA, emphasizing the limitation of antibody screening. The overall prevalence of HCV among haemodialysis patients was 29.1%. Elevated liver markers were observed in HCV-positive patients compared to seronegative individuals: SGOT (mean 68.4 ± 12.5 IU/L vs. 42.7 ± 8.9 IU/L, p = 0.002), SGPT (mean 72.3 ± 14.2 IU/L vs. 45.6 ± 9.3 IU/L, p = 0.001), total bilirubin (mean 1.8 ± 0.4 mg/dL vs. 1.0 ± 0.2 mg/dL, p = 0.003), and direct bilirubin (mean 0.9 ± 0.2 mg/dL vs. 0.5 ± 0.1 mg/dL, p = 0.004). Genotype analysis revealed genotype 3 as the most prevalent (62%), followed by genotype 1 (38%). Conclusion: The study highlights a high burden of HCV among haemodialysis patients, emphasizing the urgent need for routine screening using more sensitive methods such as RT-PCR. Infection control measures, including stringent sterilization protocols, staff education, and patient awareness programs, are critical in reducing the nosocomial transmission of HCV in dialysis centers. The findings call for policymakers to strengthen healthcare policies to ensure better diagnostic facilities and treatment options for high-risk groups.

Background: The COVID-19 pandemic has highlighted the significance of inflammatory markers in assessing disease severity and guiding clinical management. Among these, serum ferritin and interleukin-6 (IL-6) have emerged as key indicators of hyper inflammation and disease progression. This study evaluates the role of these markers in COVID-19 patients at a tertiary care centre. Objectives: This study aims to study the role of inflammatory markers with special reference to Serum Ferritin and IL-6 in COVID 19 patients in a tertiary care centre and to determine whether the associated factors correlate with the severity of COVID-19 disease. Materials and Methods: An observational cross-sectional study was conducted at a tertiary care centre, analysing 135 COVID-19 patients admitted. Patients were categorized into mild, moderate, and severe cases based on clinical and laboratory parameters as per ICMR guidelines. Serum ferritin, IL-6, CRP, D-dimer levels and LDH were measured at admission and correlated with disease severity, inflammatory response, and patient outcomes. Statistical analysis was performed using SPSS software, with significance set at p<0.05. To evaluate the diagnostic accuracy of IL-6 and ferritin in predicting disease severity, receiver operating characteristic (ROC) curves were generated. Results: Serum ferritin levels were significantly higher in moderate to severe cases compared to mild cases (p<0.01). IL-6 levels strongly correlated with disease severity (p<0.001). Ferritin demonstrated a higher AUC compared to IL-6, suggesting it may be a more reliable biomarker for disease severity in COVID-19 patients. However, both markers exhibited significant potential in distinguishing severe cases from mild/moderate ones. Conclusion: Serum ferritin and IL-6 levels serve as important biomarkers for assessing COVID-19 severity. Routine measurement of these markers in clinical settings can facilitate early risk stratification and guide therapeutic decisions. Future research should focus on targeted interventions to modulate these inflammatory responses and improve patient outcomes.

Introduction: The young cricket players who have ambitions of playing at the national or international level or various leagues need to maintain high fitness levels regarding the Yo-Yo intermittent recovery (IR) test scores. Sprint interval training which consists of short duration high-intensity exercise for few sessions per week is a time-efficient protocol for improving the aerobic capacity and repeated sprint ability. Present study was undertaken to assess the effect of sprint interval training on the Yo-Yo intermittent recovery (IR) test scores in club level cricket players and also to compare the YYIT scores with VO2max scores. Material and Method: The present study is a Randomised Controlled Trial was conducted on male cricket players aged 18 to 30 years playing more than 5 years of club level cricket. Study was conducted at a tertiary care hospital during year 2018-2020. Results:  In this study 18 subjects (9 in each group) were enrolled to take care of loss to follow up. In the sprint interval training group, the YYIT score improved from 14.73 ±0.71 level to 15.61±0.48 level. There was a statistical significant difference (p= 0.0005) after the intervention period of 8 weeks in the YYIT score in this group. Similarly, the VO2max values (ml/kg/min) improved from 46.0±4.48 level to 51.41±3.25 level. This was a statistical significant difference (p= 0.0018) after the intervention period of 8 weeks in the VO2max in this group. The YYIT score was 0.1±0.22 in the regular training group, and 0.88±0.46 in the sprint interval training group. This difference was also statistically significant with p value of 0.0003. Thus, sprint interval training improved the YYIT score significantly as compared to the regular training. Conclusion: There was a significant improvement in YoYo intermittent test scores and aerobic capacity with the addition of sprint interval training of 10 minutes thrice a week. So, the study results are encouraging and we recommend that the protocol should be used for all the players at the cricket academies.

Introduction: Epilepsy is a neurological condition characterized by recurrent seizures, impacting a considerable number of individuals and leading to substantial morbidity, mortality, as well as economic and social challenges. Objective: To evaluate the efficacy and safety of valproate and lamotrigine combination therapy in patients with resistant epilepsy. Method: A Prospective observational study was conducted during January 2022 to December 2023 at Department of General Medicine, Government Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India of 43 patients of resist any epilepsy with a mean age of 28.44 years. Results: Male 65.1% patients were predominant than female patients 34.9%. Out of 43 epilepsy patients, majority of patients i.e. 32.6% of patient’s observed excellent outcome, followed by 30.2% of patients were observed good outcome and fair outcome in 23.2% of patients and 13.9% of patient’s outcome was poor. None of our patient reported any adverse effect. Conclusion: This study extends previous evidence that Valproate and lamotrigine can be safely combined show a favorable therapeutic interaction in patients with resistant epilepsy.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. In that posterior canal BPPV is the most common compared to horizontal canal BPPV and superior canal BPPV respectively.  Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful canalith repositioning maneuvers for BPPV. This study evaluated the role of labyrinthine sedative, Meclizine hydrochloride in treating residual dizziness after successful canalith repositioning by Epley maneuver in posterior canal BPPV. Objectives: Role of Meclizine hydrochloride, a labyrinthine sedative in treating residual dizziness after successful canalith repositioning by Epley maneuver in posterior canal BPPV. Material and Methods: A total of 60 patients were included in the study. They were divided into two groups: 30 to group A which received Epleymaneuver with Meclizine and 30 to group B who received only Epleymanuever. Results: Of the 60 patients, on Day 1, Day 2, Day 3 for both the groups, in group A, by the 3^rd day 25 patients had no symptoms and 2 had a mild handicap, 3 had severe handicap. In group B, by 3^rd day, 24 patients had no symptoms, 3 patients had a mild handicap, 2 patients had a moderate handicap, and 1 patient had a severe handicap. The p value between the two groups was more than 0.05 and it was statistically not significant. Conclusion: Addition of labyrinthine sedative like meclizine after successful Epley maneuver does not seem to significantly improve the residual dizziness so it is advisable not to prescribe unnecessary medications after successful Epley maneuver.

Background: Type-II Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance, hyperglycemia, and β-cell dysfunction. Oxidative stress plays a significant role in diabetes pathogenesis and complications by promoting lipid peroxidation, DNA damage, and chronic inflammation. This study aims to investigate the correlation between biochemical markers and oxidative stress in T2DM patients compared to healthy individuals. Methods: A case-control study was conducted at Index Medical College, Hospital, and Research Center, Indore, under Malwanchal University (2022–2024). The study included 100 T2DM patients (cases) and 100 age- and sex-matched healthy individuals (controls). Oxidative stress markers (Malondialdehyde [MDA], Superoxide Dismutase [SOD], Catalase [CAT], and Glutathione Peroxidase [GPx]) were measured using spectrophotometric assays. Glycemic and lipid parameters were assessed, and statistical analysis was performed using SPSS v25.0 (p < 0.05 considered significant). Results: T2DM patients exhibited significantly higher MDA levels (4.5 ± 0.6 nmol/L) compared to controls (2.3 ± 0.4 nmol/L, p < 0.001). Antioxidant enzyme levels (SOD, CAT, GPx) were significantly reduced in cases (p < 0.001). MDA positively correlated with HbA1c (r = 0.62, p < 0.001), while SOD and CAT negatively correlated with fasting glucose (r = -0.58, p < 0.001). Conclusion: Oxidative stress is significantly elevated in T2DM, as indicated by increased lipid peroxidation and decreased antioxidant defenses. Strong correlations between oxidative stress markers and glycemic control suggest that antioxidant-based interventions could mitigate diabetes complications. Further research should explore personalized antioxidant therapies for improved diabetes management.

Aim of the Study: To study the clinical profile of patients with new onset seizures after 40 years of age. Material & Methods: A 100 cases of Clinical Etiological and radiological profile in late onset seizures patients admitted in the Department of General Medicine, Government Tertiary Care Hospital. Results: In present study majority of the patients were lying in the age group of 50 – 60 Years of age which was 40%, followed by 40-50 years (34%) and  26% of the patients were found in the age group of more than 60 years of age. Conclusion: Out of 100 cases, 56 patients (56%) had significant imaging findings pointing towards the diagnosis. So every patient with new onset seizures should undergo some form of imaging, CT- Plain/ contrast or MRI- Brain depending on the situation as part of evaluation. Smoking and Hypertension are most common risk factors for seizures. From the study, it is clear that most of the seizures in late adulthood are symptomatic (86%). So every care must be taken to evaluate the cause of new onset seizures in adults.

Background: Laparoscopic abdominal surgery, also known as minimally invasive surgery (MIS), has revolutionized the management of various abdominal conditions, offering benefits such as smaller incisions, reduced postoperative pain, shorter hospital stays, and faster recovery compared to traditional open surgeries. The widespread adoption of laparoscopic techniques for procedures like cholecystectomy, appendectomy, and hernia repair has significantly advanced surgical practice. Despite these advantages, laparoscopic surgery is not without risks, and port site complications are among the most common issues encountered postoperatively. Aim of the Study: To study the incidence and clinical outcome of port site complications following elective laparoscopic abdominal surgeries. Material & Methods:  This study was a prospective observational study conducted to evaluate the incidence, types, and management of port site complications in patients undergoing laparoscopic abdominal surgeries. Total No. of 50 cases was done and the study was conducted at Osmania General Hospital, Hyderabad from January 2022 to June 2023 and was approved by the institutional ethics committee. Results: The results of a prospective study conducted on 50 subjects undergoing various types of laparoscopic abdominal surgeries. The analysis focuses on the distribution of complications based on the type of surgery, the influence of port size and access technique, and the role of patient-specific factors such as age and BMI. By identifying and understanding the determinants of port site complications, this research aims to contribute valuable insights into the field of minimally invasive surgery and guide future surgical practices to achieve better patient outcomes. Conclusion: Laparoscopic abdominal surgeries offer numerous advantages, the management of port site complications remains a significant challenge. Continued research efforts aimed at refining techniques, identifying risk factors, and developing effective prevention and management protocols are crucial to advancing patient care and enhancing outcomes in this evolving field of surgery.

Introduction: Diabetes is a chronic condition with long-term complications and multisystem involvement. The prevalence of diabetes is increasing globally, posing a significant public health challenge. The coexistence of other comorbidities not only complicates disease management but also increases financial burdens and negatively impacts the quality of life. This study aims to evaluate the impact of musculoskeletal conditions on individuals with diabetes compared to those without the disease. Materials and Methods: A comparative study was conducted in community medicine and medicine department at Swaminarayan Institute of Medical Sciences and Research, a tertiary-level hospital located in Kalol, Ahmedabad among patients visiting tertiary care hospital.  The objective was to assess the prevalence of musculoskeletal disorders in individuals with and without diabetes. A total of 100 patients with diabetes and an equal number of non-diabetic individuals were sequentially enrolled. Results: The prevalence of musculoskeletal comorbidities was significantly higher in individuals with diabetes (46.2%) compared to the non-diabetic group (25.1%). The overall odds ratio (OR) for musculoskeletal disorders was 2.5 times higher in diabetes patients than in those without diabetes. Specifically, the OR for rheumatoid arthritis, chronic back pain, and osteoarthritis was 3.6, 2.9, and 1.7, respectively. Additionally, diabetic patients with musculoskeletal comorbidities experienced a poorer quality of life and higher direct treatment costs compared to those without such conditions. Conclusion: Musculoskeletal comorbidities are highly prevalent among individuals with diabetes, significantly affecting their quality of life and increasing treatment costs. Integrating musculoskeletal screening into routine diabetes complication assessments could facilitate early detection and timely intervention, ultimately improving patient outcomes.

Objectives: This mixed-methods study aimed to explore the experiences of 62 participants diagnosed with tuberculosis (TB), 57 individuals with direct contact with TB patients, and 61 members of the general public regarding TB-related stigma. Materials and Methods: The study used both qualitative and quantitative methods to understand TB stigma. A representative sample of 62 TB patients, 57 contacts, and 61 individuals from the general public was selected. Data were collected through structured questionnaires and in-depth interviews. Trends and patterns were analyzed using descriptive statistics and the Chi-Squared test. Results: Over half of the TB patients reported internalized stigma, including feelings of shame and fear of being perceived as contagious or different. 68% expressed anticipated stigma, fearing discrimination and avoiding open discussion of their illness. 10% reported enacted stigma, citing a lack of respect from medical staff. Females were more likely than males to experience both anticipated stigma and avoidance of discussing the disease (p-value). There was no significant association between gender and respect from medical professionals (p-value = 0.172). Among contacts, 30% believed poverty caused TB, and 79% feared community infection risks. Most contacts viewed TB patients with compassion (63%) and were willing to associate with them (82%). Male contacts were more likely to fear infection risks (p-value < 0.001). Among the general public, 72% feared infection, and 28% believed poverty caused TB. Education levels and sociodemographic characteristics, including gender and economic status, were linked to stigmatization, with significant differences in the perception of TB patients. Conclusion: The study highlights the persistent stigma surrounding TB, underlining the need for programs that reduce stigma, enhance public awareness of TB, and educate medical professionals to treat patients with respect. Public education on TB causes is essential to reduce stigma, and targeted interventions to support TB patients’ social integration are necessary.

Introduction: Neuromuscular blocking agents (NMBAs) optimize intubation, reduce tissue trauma, and aid surgical relaxation. Rocuronium, a non-depolarizing aminosteroidal NMBA, provides rapid onset without histamine release. Cisatracurium, a potent benzylisoquinolinium, offers slower onset with Hoffman elimination. This study compares rocuronium and cisatracurium’s effects on hemodynamic stress during intubation. Methods: This prospective, randomized, double-blind study compared rocuronium and cisatracurium in elective surgeries under general anesthesia. Patients were randomized into two groups and administered the respective muscle relaxants. Hemodynamic parameters and neuromuscular monitoring guided dosing and intubation. Post-surgery, residual blockade was reversed, and patients were transferred to recovery. Results: The study included 60 participants, evenly divided between groups. Most (36.7%) were aged 31–40 years, with a male-to-female ratio of 0.93. Pre-intubation HR, SBP, DBP, and MAP showed no significant intergroup differences. Intubation duration was significantly shorter in group R. Post-intubation hemodynamic parameters showed no significant differences between groups. Conclusion: Rocuronium and cisatracurium demonstrated comparable hemodynamic stability during intubation and surgery. Rocuronium provided a significantly shorter intubation duration, making it advantageous in situations requiring rapid airway management. Both agents are effective and safe for elective surgeries, with choice depending on clinical context and individual patient considerations.

One of the most common causes of morbidity and mortality in ICU patients is the condition of Sepsis, that possesses a constant challenge to the treating and/ or the critical care physician. In that scenario, use of a basic blood investigation such as Complete Blood Count (that includes the Platelet Indices) may play a pivotal role in early prediction of the course of sepsis. Thus, in this study we have studied the role that Platelet Indices have in predicting the severity of sepsis patients in ICU, so as to use them as a marker of sepsis in peripheral as well as tertiary centres.
Total 102 patients of both sexes were included in the study, out of which 32 patients (31.4%) succumbed to sepsis, whereas a larger portion of the cohort, comprising 70 patients (68.6%), demonstrated clinical improvement during their stay in the ICU. It was found that Platelet Count (PLT), Platelet to Large Cell Ratio (PLCR) and Platelecrit (PCT) tend to increase in patients who recover from sepsis and have a decreasing trend in those who ultimately succumb. Whereas, Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV) behaved in the opposite way, as both of these indices increased in patients who ultimately died due to sepsis and decreased in cases of improved ones. Thus, it can be concluded that Platelet Indices do have a role in predicting sepsis and its severity and hence, these indices from a routine Complete Blood Count (CBC) may be used as markers for predicting the progression of Sepsis.

Objective: Effective communication is a cornerstone of quality healthcare, with significant implications for patient satisfaction, diagnostic accuracy, and clinical outcomes. This study assesses the knowledge, attitudes, and practices (KAP) of final-year medical students regarding communication skills, aiming to identify areas for improvement in medical education. Methods: A cross-sectional questionnaire-based survey was conducted at GMERS Medical College, Junagadh, involving 163 final-year MBBS students. The questionnaire, which was pre-validated and pilot-tested, assessed students’ knowledge of communication principles, attitudes towards patient-centered communication, and self-reported practices in clinical settings. Results: The results show that students possess strong theoretical knowledge, particularly in active listening (96.9%) and the importance of clear communication (95.7%), with some gaps in understanding the role of empathy (84.4%) and trust in patient care (88%). Most students expressed confidence in their communication abilities (52.8% very confident), and a majority recognized the importance of empathy (75.5%) and active listening (87.1%) in patient care. However, self-reported practices revealed variability in applying these skills, with only 46.6% consistently engaging in small talk with patients and 60.1% practicing active listening frequently. Conclusion: The study underscores the need for targeted interventions to bridge the gap between knowledge and practice, such as role-playing, feedback mechanisms, and simulation-based training. The findings suggest that enhancing communication skills training can better prepare students for patient-centered care, thereby improving healthcare outcomes.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by complement-mediated intravascular hemolysis, thrombosis, and bone marrow failure. It results from a somatic mutation in the PIG-A gene, leading to deficient synthesis of glycosylphosphatidylinositol (GPI) anchors and subsequent absence of GPI-linked proteins on hematopoietic cells. Clinically, PNH presents with hemolytic anemia, hemoglobinuria, and a heightened risk of thromboembolic complications. Diagnosis involves flow cytometry to detect populations of GPI-deficient blood cells, particularly CD55- and CD59-negative cells. Eculizumab, a monoclonal antibody targeting terminal complement activation, has transformed treatment outcomes by reducing hemolysis and preventing thrombosis. Despite these advancements, challenges persist in managing bone marrow failure and minimizing long-term complications.

Background: Uterine fibroids are the most common benign smooth muscle tumors of the female reproductive system. It accounts for one-third of all gynecological hospital admissions and is the most common indication (making up approximately 40%) for hysterectomy in premenopausal women. Mifepristone (RU 486) effectively reduces menorrhagia and other fibroid-related symptoms, and its size. Objectives: To study the effect of low dose Mifepristone for 3 months on improvement of fibroid related symptoms and its size. Materials and Methods: This was a hospital-based prospective cross-sectional study which was conducted in the Department of Obstetrics and Gynecology in Silchar Medical College and Hospital, Assam. 246 women were enrolled and divided into two groups. Patients in Group 1 received Tab Tranexamic acid (500 mg) and Tab Mefenamic acid (500 mg) thrice daily during menstrual bleeding for a period of 3 months. Patients in Group 2 received Tab Mifepristone 25 mg daily for 3 months. Results: Mean PBAC score reduced by 96.03%, Mean Numeric Pain Rating Scale Score for dysmenorrhea reduced by 82.87%, fibroid area reduced by 34% and hemoglobin concentration increased by 10% at 3 months in Group 2. These changes in Group 2 were found to be statistically significant (p<0.001) compared to Group 1. Conclusion: Mifepristone has proven to be safe and effective as compared to treatment with tranexamic acid and mefenamic acid for management of uterine fibroids.

Hypertension, or elevated blood pressure, is a significant global health burden affecting over 1.28 billion individuals. It is a major risk factor for cardiovascular diseases such as heart failure, stroke, and coronary artery disease. While its hemodynamic effects, such as increased arterial stiffness and left ventricular hypertrophy, are widely studied, the impact of hypertension on heart metabolism is less understood but equally critical. Hypertension, a prevalent cardiovascular disorder, significantly impacts cardiac structure, function, and metabolism. The chronic elevation of blood pressure imposes a sustained increase in cardiac workload, leading to pathological changes such as left ventricular hypertrophy (LVH), myocardial fibrosis, and capillary rarefaction. These structural adaptations disrupt the heart’s ability to maintain metabolic efficiency and flexibility. This manuscript provides a comprehensive review of the mechanisms by which hypertension alters cardiac metabolism, highlighting its profound effects on substrate utilization, mitochondrial function, and energy homeostasis. A key metabolic hallmark of hypertensive hearts is a shift in substrate utilization from glucose oxidation to an overreliance on fatty acid oxidation (FAO). While FAO typically serves as the primary energy source for the heart, its upregulation in hypertensive conditions is inefficient, oxygen-intensive, and associated with the accumulation of toxic lipid intermediates, leading to lipotoxicity. Concurrently, glucose uptake and oxidation are impaired due to reduced activity of glucose transporters, insulin resistance, and dysregulated signaling pathways. This metabolic inflexibility exacerbates energy deficits and compromises cardiac performance. Mitochondrial dysfunction emerges as a central feature in hypertension-induced metabolic derangements. The overproduction of reactive oxygen species (ROS), mitochondrial DNA damage, and impaired oxidative phosphorylation disrupt ATP generation, creating a state of energy starvation. Dysregulation of key molecular pathways, including the AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptors (PPARs), and mammalian target of rapamycin (mTOR), further impairs energy sensing, substrate utilization, and mitochondrial biogenesis. Additionally, neurohormonal activation—particularly the renin-angiotensin-aldosterone system (RAAS) and sympathetic overdrive—drives oxidative stress, inflammation, and maladaptive remodelling, further compounding the metabolic burden on the heart.

Aim of the Study: To evaluate the role of interventional radiology in post-living donor liver transplant complication management. Material and Methods: This prospective study was undertaken in Interventional Radiology Department Of Mahatma Gandhi Medical College & Hospital, Jaipur from January 2023 to December 2024. Total 20 patients referred from Liver transplant department for management of post LDLT complications. All patients evaluated for complications on 128 slice optima GE CT scan and on Allura clarity XperFD Philips medical system. Results: In our study complications of total 20 cases of post living donor transplant liver were managed, 18 male & 2 females with age range from 20 yrs. to 70 yrs. Complications including biliary stenosis 35%, hepatic vein stenosis 15%, portal vein stenosis 5%, hepatic artery stenosis 10%, hepatic artery thrombosis10%, biliary leakage 10%, cholangiolar abscess 10% and lymphatic leak 5%. We had seven cases of biliary stenosis, six were successfully treated with insertion of internal-external drain and stenting. We had three cases of hepatic venous occlusion, successfully treated with venoplasty and stenting, two cases of hepatic artery stenosis treated with angioplasty and stenting and two cases of hepatic artery thrombosis treated with catheter directed thrombolysis. One case of portal vein stenosis treated with portal venoplasty and stenting. Two cases of cholangiolar abscess with aspiration. Two cases of biliary leakage and one case of lymphatic leak treated with percutaneous pigtail insertion. Finally, in our study, we had 100% success rate in hepatic artery stenosis, portal vein stenosis and hepatic vein stenosis, 85% in biliary complications and 50% in hepatic artery thrombosis. Conclusion: Interventional radiology plays a crucial role in management of post-LDLT complications. It offers a safe and effective alternative to surgery in terms of minimal invasiveness with faster recovery, targeted treatment for specific area without damaging surrounding tissues and lower morbidity with improved outcomes.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder requiring effective glycaemic control to prevent complications. Among newer pharmacological agents, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated efficacy. Empagliflozin, an SGLT-2 inhibitor, promotes urinary glucose excretion and offers cardiovascular benefits, whereas linagliptin, a DPP-4 inhibitor, enhances incretin-mediated insulin secretion. This study compares the efficacy and safety of empagliflozin and linagliptin in T2DM management. Materials and Methods: This prospective, open-label, randomized controlled trial was conducted at Chirayu Medical College and Hospital, Bhopal, over 12 weeks. A total of 150 patients with T2DM were randomly assigned to receive empagliflozin (10 mg daily; n=75) or linagliptin (5 mg daily; n=75). Primary outcomes included changes in HbA1c, fasting plasma glucose (FPG), and postprandial glucose (PPG). Secondary outcomes included weight change, hypoglycemia incidence, urinary tract infections (UTIs), gastrointestinal side effects, and lipid profile changes. Statistical analysis was performed using SPSS version 26.0. Results: Empagliflozin resulted in a significantly greater reduction in HbA1c (-1.2% vs. -0.9%, p=0.002), FPG (130.5 ± 18.7 mg/dL vs. 140.3 ± 20.2 mg/dL, p=0.01), and PPG (190.2 ± 25.6 mg/dL vs. 200.8 ± 28.4 mg/dL, p=0.03) compared to linagliptin. More patients in the empagliflozin group achieved HbA1c <7% (77.3% vs. 61.3%, p=0.04). Weight reduction was greater with empagliflozin (-2.1 ± 1.5 kg vs. -0.3 ± 1.1 kg, p<0.001). The incidence of hypoglycemia (6.7% vs. 10.7%, p=0.41) and UTIs (9.3% vs. 4.0%, p=0.21) were comparable. Conclusion: Empagliflozin demonstrated superior glycaemic control and weight reduction compared to linagliptin without significantly increasing adverse events. These findings support the preferential use of empagliflozin in T2DM patients, particularly those requiring weight management.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a progressive metabolic disorder requiring effective glycaemic control to prevent complications. While long-acting basal insulins such as insulin glargine and insulin degludec are widely used, their comparative efficacy and safety in patients with uncontrolled T2DM warrant further investigation. The objective of the study is to compare the glycaemic control, insulin requirements, incidence of hypoglycemia, weight changes, and quality of life outcomes between insulin glargine and insulin degludec in patients with uncontrolled T2DM over a 12-week period. Materials and Methods: This prospective, randomized, comparative study was conducted at Chirayu Medical College and Hospital, Bhopal, from September 2023 to October 2024. A total of 150 patients with uncontrolled T2DM were randomized into two groups: insulin glargine (n=75) and insulin degludec (n=75). Primary outcome measured was the reduction in HbA1c levels after 12 weeks. Secondary outcomes included changes in fasting plasma glucose (FPG), daily insulin dose requirements, hypoglycaemic episodes, weight changes, and quality of life scores. Data were analyzed using SPSS version 26. Results: Both groups showed significant HbA1c reduction, with insulin degludec (-1.45±0.9%) demonstrating a greater decline compared to insulin glargine (-1.09±0.8%), though not statistically significant (p=0.124). More patients in the insulin degludec group (69%) achieved HbA1c ≤7% compared to insulin glargine (41%) (p<0.05). Insulin degludec required a lower daily insulin dose (18.6±4.8 vs. 25.7±5.4 units, p=0.002) and had fewer hypoglycaemic episodes (12 vs. 40, p<0.05). Weight gain was lower in the insulin degludec group (0.85±0.4 kg vs. 1.65±0.5 kg, p=0.082), and quality of life scores improved significantly (p<0.05). Conclusion: Insulin degludec demonstrated superior glycaemic target achievement, lower insulin requirements, and a significantly reduced risk of hypoglycemia compared to insulin glargine. These findings suggest insulin degludec as a favourable option for optimizing diabetes management in uncontrolled T2DM patients.

Background: The DV plays a crucial role in maintaining optimal oxygenation and nutrient delivery during early fetal development. Doppler ultrasound studies have demonstrated that the velocity and volume of blood flow through the DV change with gestational age. During the course of pregnancy, the DV undergoes significant structural changes. Our study aims to establish normogram of RI and PI of ductus venosus between 11–14 weeks of gestation in North Indian population. Methods: A cross sectional study of 210 antenatal women using observation cross sectional study was carried out at Era’s Lucknow medical college and hospital, Lucknow. RI and PI of ductus venosus was obtained in pregnant females of gestation age 11 – 14 weeks having singleton pregnancy and no structural abnormalities on ultrasound examination. Results: Mean DV PI values for 11-12, 12-13- and 13–14-week gestational ages were found to be 0.946±0.132, 0.946±0.112 and 0.951±0.117 respectively. Statistically, there was no significant difference among different gestational ages for DV PI values. Mean DV RI values for 11-12, 12-13 and 13-14 week gestational ages were found to be 0.717±0.100, 0.717±0.094 and 0.717±0.094 respectively. Statistically, there was no significant difference among different gestational ages for DV RI values. Conclusion: Normative range for DV PI or RI for 11 to 14 weeks gestational age can be used effectively with single representation for the entire span of this gestational age. Non-dependency of DV PI and RI on age, anthropometry and gravida status was reflective of its universal applicability for different ages, anthropometric and gravida strata.

Background: The term “asthma” originates from Greek, describing breathlessness. Bronchial asthma has been since time immemorial and is defined as paroxysmal dyspnoea with intervals of healthy breathing. In India, asthma prevalence ranges from 2-17%. It’s a leading chronic respiratory illness in childhood, escalating globally due to pollution and industrialization. Diagnosis relies on methods like FEV1 and peak expiratory flow. Early detection is crucial to prevent complications. Peak expiratory flow rate (PEFR) is a vital diagnostic tool, especially in children, reflecting airway obstruction severity and treatment response. Aim: (1) To study the peak expiratory flow rate in healthy school going children between 6-12   years. (2) To study the correlation between PEFR and age, sex, weight, height and maximum chest circumference and to construct a Nomogram. Materials and Methods: This cross sectional study was done on 350 subjects between 6 to 12 years of age who attended a school in urban area of Patna over a period of six months from October 2023 to March 2024. All patients who fulfilled the inclusion criteria were examined and their weight, height, chest circumference and PEFR were measured. For the determination of PEFR we used Mini Wright Peak Flow Meter. Results: A total of 350 patients were included in the study of which 175 (50%) were males and 175 were females. Prediction equations were derived for PEFR with height in boys and girls. Normograms were plotted based on the observed values of PEFR in the study population. Conclusion: Significant correlations were found between PEFR and biological variables like age, sex, weight, height and maximum chest circumference. Maximum positive correlation was seen for height, followed by age, weight and the least positive correlation was found for maximum chest circumference.

Aim: The Incidence and pattern of mandibular fractures may vary according to the geographical area, religion, and socioeconomic status. The aim of this cross-sectional retrospective study is to evaluate the cause, risk factors, characteristics and clinical epidemiology of mandibular fractures in eastern part of Uttar Pradesh. Materials and methods: The data collected included age, gender, mode of injury, mandible fracture location and associated fracture and treatment. In this study, various statistical techniques were employed to analyse the distribution and characteristics of cases across multiple variables. Descriptive statistics were utilized to summarize demographic data and percentages and proportions were calculated to provide a clear understanding of the relative prevalence of each category. Results: Total 181 mandibular fractures were found in 132 patients. Majority of participants were male and belonged to the 20–30 years age group, comprising 54 individuals (40.9%). most common mode of injury was road traffic accidents (RTA) involving drivers, accounting for 47.7% cases with 68.3 % not wearing helmet and 31.7% wearing open face helmet. Parasymphysis fractures were the most prevalent, accounting for 37.6% of cases. This was followed by condyle fractures with 17.7% cases, angle fractures of 16.0% cases, and symphysis fractures of 15.5% cases. Less frequent were body fractures at 8.8%, ramus fractures 2.2%, and both coronoid and dento-alveolar fractures, each occurring 1.1% cases respectively. Conclusion: The study provides important epidemiological data to formulate better future plans for preventing and treating mandibular injuries. The major populations at risk are young men and those driving two-wheelers with an open faced helmet or without one. Prevention is the key to reducing the incidence of maxillofacial fractures and it involves multiple strategies. This include the consistent use of protective gears like helmets and mouthguards, adherence to traffic rules, workplace and sports safety protocols.

Introduction: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated airway obstruction during sleep, leading to fragmented sleep and increased cardiometabolic risks. This study examines the association of lifestyle, dietary habits, and metabolic factors with OSA prevalence in a tertiary care center in Western Gujarat. Materials and Methods: A cross-sectional study was conducted on 50 adult participants, assessing OSA risk using the Modified Berlin Questionnaire. Demographic data, anthropometric measurements, comorbid conditions, dietary patterns, and lifestyle habits were analyzed. Polysomnography and metabolic markers were evaluated in high-risk individuals. Results: Among the 50 participants, 64% were classified as high risk for OSA, with a significant association observed with obesity (100%), hypertension (100%), dyslipidemia (66%), and abnormal 2D echocardiography findings (91%) (p < 0.05). High-risk individuals had a mean age of 60.81 years, with significantly higher BMI (36.18±2.99), neck circumference (43.94±6.01 cm), and waist-hip ratio (1.41±0.31) compared to lower-risk groups. Stored food consumption (87.5%) was significantly associated with higher OSA risk, while processed food intake showed a trend toward increased risk but was not statistically significant. Frequent fried food consumption (>2 times/week) was linked to increased OSA prevalence, while meal frequency, meal timing, and dinner-to-sleep intervals showed no direct correlation. Smoking and alcohol intake did not exhibit significant associations with OSA risk, though moderate-risk individuals reported higher addiction rates. Additionally, Grade 1 fatty liver (75.8%) and elevated triglyceride levels (159.56±26.84 mg/dL) were significantly prevalent among high-risk OSA participants. Conclusion: OSA risk is significantly influenced by obesity, metabolic disorders, and dietary habits, emphasizing the need for early screening and lifestyle modifications to reduce associated health risks.

Acute intestinal obstruction is one of common abdominal emergency and is associated with significant morbidity and mortality especially if it progresses to bowel ischemia. The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergencies that a general surgeon can come across. The study was conducted in the department of general surgery with symptoms and signs of acute intestinal obstruction admitted in the surgical ward. Fifty cases of intestinal obstruction have been studied. Patients belonged to above 20  age groups are included in present study. Our study shows causes of intestinal obstruction,  Post operative Adhesions 36%, Obstructed Hernia 12%, Peritonitis 16%, Kochs Abdomen 12%, Volvulus 08%, Intussception 04%, Stricture 04%. In our study  Out of 18 Post operative Adhesions 14 cases managed by Conservative methods, 4 by surgery. 4 cases of volvulus by surgery. 06 cases of Obstructed Hernia by surgery. 4 malignancy cases by surgery. Out of  8 Peritonitis cases 1 case by surgery and 7 by Conservative methods. Acute intestinal obstruction remains an important surgical emergency in the surgical field. Success in the treatment of acute intestinal obstruction depends largely upon its early diagnosis, skilful management and treating the pathological effects of the obstruction just as much as the cause itself.

Right iliac fossa mass is one of the most common clinical scenarios a surgeon encounters during their surgical practice. It poses a critical diagnostic dilemma for surgeons and requires considerable diagnostic skills. The mass arises from different anatomical structures with varied aetiologies that require a high clinical suspicion in its management. The reason being that the mass may range from being benign to most aggressively malignant lesion which encompasses various specialities of surgery like genitourinary, vascular, gynaecological and colorectal surgery. A total of 50 cases with mass in the right iliac fossa (RIF) were included in this observational study. Most common causes of mass in RIF were Appendicular mass (40%), Appendicular Abscess (18%), Ileocecal Tuberculosis (18%). Most common presenting symptoms were Pain (100%), fever (54%), Vomiting (48%). RIF mass is a challenging clinical scenario for the surgeons. Keeping in mind the various differential diagnosis with good clinical acumen supported by appropriate investigations, patients with RIF mass can be managed appropriately either by conservative or surgical management.

Background: Adductor canal block (ACB) is commonly used for postoperative analgesia in lower limb surgeries. Adjuvants such as midazolam and dexmedetomidine are added to local anesthetics to prolong analgesia and improve block characteristics. Aim and Objectives: This study compares the efficacy and safety of midazolam versus dexmedetomidine as adjuvants in ACB. Materials and Methods: A randomized controlled trial was conducted on 100 patients undergoing lower limb surgery under spinal anesthesia. Patients were randomly allocated into two groups: Group M (n=50) received midazolam as an adjuvant to local anesthetic, and Group D (n=50) received dexmedetomidine. The primary outcomes were the duration of sensory and motor block, time to first analgesic request, and total analgesic consumption in 24 hours. Secondary outcomes included hemodynamic parameters and adverse events. Results: The sensory block duration was significantly longer in Group D (9.01±2.64 hours) compared to Group M (6.31±2.34 hours) (p<0.001). The motor block duration was also prolonged in Group D (7.05±1.14 hours) versus Group M (4.47±1.62 hours) (p<0.001). Group D had a delayed time to first analgesic request (10.47±2.24 hours vs. 7.13±2.36 hours; p<0.001) and reduced total analgesic consumption (61.45±7.26 mg vs. 90.32±8.61 mg; p<0.001). However, Group D experienced more bradycardia, hypotension, and sedation. Conclusion: Dexmedetomidine as an adjuvant in ACB provides prolonged sensory and motor block, superior analgesia, and reduced analgesic consumption compared to midazolam but is associated with higher hemodynamic alterations. Careful monitoring is recommended when using dexmedetomidine in regional anesthesia.

Background: Supraclavicular brachial plexus block is widely used for upper limb surgeries, providing effective anesthesia and postoperative analgesia. This study aimed to compare the duration of analgesia between Ropivacaine and Bupivacaine in supraclavicular brachial plexus block. Methods: A randomized, controlled study was conducted on patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were divided into two groups: one receiving 0.5% Ropivacaine and the other 0.5% Bupivacaine. The primary outcome was the duration of analgesia, and secondary outcomes included sensory and motor block durations, hemodynamic stability, and total analgesic consumption. Data were analyzed using appropriate statistical tests. Results: The duration of analgesia was slightly prolonged in the Bupivacaine group (9.34±1.65 min) compared to the Ropivacaine group (8.97±1.80 min), though the difference was not statistically significant (p=0.236). Sensory and motor block durations were also comparable between the two groups (p>0.05). Hemodynamic parameters remained stable throughout the study, with minor fluctuations observed in both groups. The total analgesic consumption did not differ significantly between groups. Conclusion: Both Ropivacaine and Bupivacaine provided effective analgesia for supraclavicular brachial plexus block, with no significant difference in duration of analgesia. Ropivacaine demonstrated better hemodynamic stability, suggesting its potential as a safer alternative. Further large-scale studies are warranted to confirm these findings.

Background: Effective postoperative pain management is crucial for patient satisfaction and recovery. Aim and Objectives: This study evaluates the impact of adjuvant fentanyl on postoperative analgesia and patient satisfaction in nerve blocks. Materials and Methods: A comparative study was conducted on 120 patients undergoing surgery under nerve block anesthesia. Patients were divided into two groups: Group A (n=60) received a nerve block without fentanyl, while Group B (n=60) received a nerve block with fentanyl as an adjuvant. The duration of postoperative analgesia, total analgesic consumption, pain scores, patient satisfaction, and adverse events were assessed. Results: The mean duration of postoperative analgesia was significantly longer in Group B (8.85 ± 1.63 hours) than in Group A (6.11 ± 1.14 hours) (p<0.001). Total analgesic consumption was lower in Group B (98.97 ± 25.27 mg) compared to Group A (149.44 ± 30.0 mg) (p<0.001). VAS scores were comparable at different time intervals; however, patient satisfaction was significantly higher in Group B (p=0.049). Adverse events, including nausea, pruritus, and respiratory depression, were slightly more frequent in Group B but were clinically manageable. Conclusion: The addition of fentanyl to nerve blocks significantly prolongs analgesia duration, reduces analgesic consumption, and enhances patient satisfaction. While adverse events were slightly more common, they did not outweigh the benefits. These findings support the use of fentanyl as an adjuvant in regional anesthesia for improved postoperative pain management and patient comfort.

Background: Effective postoperative analgesia is essential for early rehabilitation following total knee arthroplasty (TKA). This study compares the efficacy of ultrasound-guided adductor canal block (ACB) and femoral nerve block (FNB) in postoperative pain management. Methods: A randomized comparative study was conducted on patients undergoing TKA, divided into ACB and FNB groups. Pain scores were assessed using the Visual Analog Scale (VAS) at multiple time points postoperatively. Total opioid consumption, time to ambulation, quadriceps strength, and patient satisfaction were also evaluated. Results: Both techniques provided effective analgesia, but ACB demonstrated superior outcomes in key parameters. The ACB group had significantly lower VAS scores at 12 hours (p = 0.027) and reduced opioid consumption (p = 0.041) compared to the FNB group. ACB also facilitated earlier ambulation (p = 0.008) without significant compromise in quadriceps strength (p = 0.253). Additionally, patient satisfaction scores were significantly higher in the ACB group (p = 0.031). Conclusion: ACB is an effective alternative to FNB for postoperative analgesia in TKA, offering better pain control, lower opioid requirements, earlier mobilization, and improved patient satisfaction without impairing quadriceps strength. These findings support ACB as a preferred analgesic technique for enhanced recovery following TKA.

Background: Neonatal small bowel obstruction (SBO) is a critical surgical emergency requiring timely diagnosis and intervention to prevent morbidity and mortality. This study aimed to evaluate the etiology, clinical presentation, and diagnostic approaches for neonatal SBO in a tertiary care centre. Methods: A prospective study was conducted in a neonatal surgical unit, enrolling neonates presenting with features of SBO such as bilious vomiting, abdominal distension, and failure to pass meconium. Clinical examination, laboratory investigations, and imaging modalities, including abdominal radiographs, ultrasonography, and contrast studies, were utilized for diagnosis. Surgical findings and histopathological reports were documented. Results: Among 290  neonates, Intestinal atresias accounted for 152 (52.41%) of the 290 neonates, making it the most common cause of SBO. With 48 cases (16.55%), malrotation was the second most common cause. 144 cases (49.66%) had a combination of vomiting and abdominal distension, which was the most frequent symptom. Abdominal x-ray suggested the most common finding was the multiple bubble sign, seen in 113 neonates (38.97%), indicative of distal small bowel obstruction. Conclusion: Congenital intestinal atresia and malrotation are the leading causes of neonatal SBO. Imaging plays a crucial role in preoperative diagnosis, enabling timely surgical management. Early recognition and comprehensive evaluation in a tertiary care setting improve outcomes.

Background: Road traffic accidents (RTAs) are a major global public health issue, with head injuries being the leading cause of death. Despite the protective role of the skull, high-impact trauma in RTAs often results in severe or fatal traumatic brain injuries (TBIs). This study aims to analyse the patterns of fatal head injuries sustained in RTAs at a tertiary care center, providing insights into their severity, distribution, and associated risk factors. Methods: This retrospective, cross-sectional study examined 100 cases of fatal head injuries due to RTAs between June 2024 and September 2024 at the Department of Forensic Medicine and Toxicology, Ratlam. Data were obtained from autopsy reports and investigating authorities, analysing demographic distribution, injury patterns, and contributing factors using Microsoft Excel. Results: Males accounted for 87% of cases, with the highest fatalities in the 21–30 age group (36%). Most accidents occurred between 6 PM and 12 AM (38%). The majority of skull fractures involved both the cranial vault and base (63%). Subdural and subarachnoid hemorrhages were the most frequent intracranial hemorrhages (78.57%). Two-wheeler accidents were the most common (71%), with low helmet usage (2.81%). Conclusion: The findings underscore the urgent need for improved road safety regulations, stricter helmet enforcement, and enhanced emergency trauma care to reduce the incidence and severity of fatal head injuries in RTAs.

Background: The Bispectral Index (BIS) is a valuable tool for monitoring the depth of anesthesia. Isoflurane and halothane are inhalational agents with distinct pharmacological profiles. This study compares BIS values produced by isoflurane and halothane at equal end-tidal minimum alveolar concentrations (MAC) to enhance anesthetic management during surgery. Methods: In a double-blinded, randomized comparative study, 50 patients were divided into two groups: Group I (isoflurane) and Group H (halothane), each with 25 patients. BIS and hemodynamic parameters were recorded at end-tidal MAC values of 0.5, 1.0, and 1.5 after stabilization periods of 10 minutes at each concentration. Results: BIS values decreased with increasing MAC in both groups. At equivalent MAC levels, isoflurane produced significantly lower BIS values than halothane (p < 0.05). Hemodynamic parameters remained stable and comparable between groups. Recovery times were slightly shorter in the isoflurane group, but differences were not statistically significant. Conclusion: Isoflurane results in lower BIS values compared to halothane at equal MAC concentrations, indicating a deeper hypnotic effect. BIS monitoring should be interpreted cautiously, considering the specific anesthetic agent used.

Background: Hip fractures are a significant cause of morbidity and disability among older adults, often requiring surgical intervention. THA and Hemiarthroplasty are the two primary surgical options, each with distinct advantages and limitations. This study retrospectively analyses and compares the outcomes of THA and Hemiarthroplasty in hip fracture patients to determine the most effective approach based on functional recovery, complications, and overall patient outcomes. Methods: A retrospective observational study was conducted at PMCH from March 2023 to September 2024, including 50 patients who underwent either THA or Hemiarthroplasty. Patients were selected based on inclusion and exclusion criteria, with data collected from medical records, radiographic findings, and post-operative assessments. Outcome measures included functional recovery (Harris Hip Score, mobility status), postoperative complications (dislocation, infection, mortality), length of hospital stay, reoperation rates, pain levels, and patient satisfaction. Statistical analysis was performed to compare the results between the two groups. Results: THA demonstrated superior functional recovery, with significantly higher Harris Hip Scores and better mobility at six months. However, it was associated with a higher risk of dislocation and longer hospital stay compared to Hemiarthroplasty. Patients who underwent Hemiarthroplasty had a lower incidence of dislocation but experienced higher residual pain and an increased need for revision surgery due to acetabular cartilage wear. Mortality rates were similar in both groups, indicating that preoperative health status played a crucial role in survival outcomes. Conclusion: THA provides better functional outcomes and lower long-term pain, making it the preferred choice for younger, active patients. Conversely, Hemiarthroplasty remains suitable for older, frail patients with limited mobility due to its lower surgical complexity and reduced risk of dislocation. A patient-centered approach is essential in surgical decision-making to optimize clinical outcomes.

Background: Due to their intricacy, distal femur fractures are difficult to treat. Surgery is typically needed to improve mobility, joint stability, and limb alignment. External Fixators, Retrograde Intramedullary Nails (RIN), and Locking Compression Plates are employed according on the fracture, patient, and surgeon. Choosing the optimal fixing method requires more clinical and radiological investigation. Objective: This study aims to compare the effectiveness of different fixation techniques for distal femur fractures in terms of functional recovery, radiological healing, complication rates, and rehabilitation outcomes. Methods: A retrospective cohort study at Patna Medical College and Hospital (PMCH) from March 2023 to September 2024 included 50 surgically treated distal femur fracture patients. Participants had to be 18 years old and follow up for six months after surgery. Polytrauma, pathological fractures, and poor medical records were excluded. Demographics, fracture classification (AO/OTA), fixation method (LCP, RIN, External Fixator), functional outcomes (knee range of motion, pain score, weight-bearing status), and complications were collected and analysed. Statistical comparisons were made using t-tests and chi-square tests with a significance level of p<0.05. Results: Among 50 patients with distal femur fractures, LCP fixation showed superior outcomes, with a mean knee ROM of 110° ± 15 (p=0.012) and lower pain scores (VAS: 2.5 ± 1.2, p=0.021). Full weight-bearing was achieved faster in LCP (80%) than RIN (65%) and External Fixators (40%) (p=0.018). LCP had the shortest healing time (14.2 ± 3.1 weeks, p=0.026), lower complications, and shorter hospital stay (7.5 ± 1.8 days, p=0.029). These findings indicate LCP as the most effective fixation method, promoting faster recovery and better functional outcomes. Conclusion: The study suggests LCP is the best distal femur fracture repair method due to its lower complications and faster recovery. RIN can still treat non-articular fractures, although external fixation should only be utilized in extreme cases for temporary stabilisation or soft tissue damage. These findings require more prospective trials to establish that customized treatment selection improves patient outcomes.

Background: Benign Breast Disease (BBD) such fibroadenomas, breast cysts, and fibrocystic changes cause most breast pathology. Up to 30% of women will get these diseases. Rural healthcare access, health literacy, and diagnostic resources might delay diagnosis and treatment, lowering quality of life. Methods: An observational study was conducted at Safdarjung Hospital, affiliated with Vardhman Mahavir Medical College, in New Delhi from October 5, 2017, to October 4, 2020. In the sample were 75 women with noncancerous breast problems. Data collection covered demographics, clinical presentation, diagnosis, and treatment. All women with BBD were included, but those with malignancies or poor medical records were excluded. Data analysis used descriptive statistics to synthesise clinical findings and patient characteristics, and chi-square testing to uncover statistically significant relationships. Results: Fibroadenomas led the study’s benign breast disorders with 40% frequency. The cases had 20% fibrocystic changes and 33.3% breast cysts. The majority of women experienced breast lumps (73.3%), discomfort (40%) and nipple discharge (6.7%). Mammography was used by 60% of patients, second to ultrasound (93.3%). Fibroadenomas were usually surgically removed, while cysts were drained or treated conservatively. The study found that mammography supplemented ultrasonography for initial evaluation and surveillance in elderly patients. Conclusion: This study on Benign Breast Diseases in rural areas emphasises the importance of readily available diagnostic and treatment options. The results suggest rural communities should focus breast health education and awareness campaigns and improve healthcare systems to diagnose and treat breast cancer faster. These methods may improve benign breast disease outcomes and reduce anxiety. Future research should include a larger sample size and additional factors affecting benign breast disease appearance and therapy.

Objectives: To access variation in serum ferritin levels and correlational analysis of serum ferritin level and dengue NS1 antigen level in dengue virus infected paediatric population. Materials and Methods: An institution based analytical case control study was conducted in the department of Biochemistry in collaboration with departments of Microbiology, Pathology and Paediatrics. Paediatric patients were divided in three groups, one with clinically diagnosed dengue fever, other with fever of other etiologies and another consisting of individuals without any fever taken as controls. As far as possible age and sex matched control subjects were recruited for the study. 20 patients with clinically diagnosed dengue fever were taken as a cohort, 20 patients with fever of other etiologies were taken as a separate cohort and 20 subjects as control. Result: In our study we found a significant variation in serum ferritin level amongst the paediatric patients included in our study with the mean serum ferritin level in paediatric patients infected with dengue virus being 903.25 ng/ml and that in paediatric patients with fever of other etiologies being 458.35 ng/ml and the mean serum ferritin level in control group being 223.25 ng/ml. Conclusion: There exists significant difference in serum ferritin level among dengue virus infected group and other febrile illnesses group with serum ferritin being significantly higher in the dengue virus infected group as compared to the fever of other etiologies group. Thus serum ferritin could serve an effective biomarker in diagnosis and monitoring prognosis of dengue fever in the paediatric age group.

Background: Diagnosing the diseases of the small intestine has been challenging because of its anatomical complexity limited accessibility and non-specific clinical presentation. CT enterography (CTE) is a non-invasive modality that is commonly used for the evaluation of small bowel diseases. This current study aimed to evaluate the diagnostic utility of CTE by analyzing its accuracy, sensitivity, and specificity in detecting various small bowel pathologies. Methods: A prospective observational study was conducted among 25 cases aged 16 – 65 years, including 14 males and 11 females presenting with clinical suspicion of small bowel diseases based on clinical, laboratory, or other imaging investigations. They were subjected to CT enterography on a 128-slice CT scanner using iso-osmotic mannitol as neutral enteral contrast. Results: Among 25 cases, the most common clinical diagnosis was small bowel obstruction (40%), followed by Crohn’s disease and tumors (16% each). CTE findings included bowel thickening (76%), lymphadenopathy (40%), and bowel dilation (32%). Adequate bowel distension was achieved in 76% of cases. CTE showed 95.24% sensitivity, 100% specificity, and 96% overall accuracy. However, it missed some cases, including Crohn’s disease and tuberculosis. Despite minor discrepancies, CTE proved to be a valuable diagnostic tool for small bowel pathologies, aiding in early detection and management. Conclusion: CTE is a highly accurate and non-invasive diagnostic tool for small bowel diseases, particularly in identifying inflammatory and obstructive conditions. However, its limitations in detecting certain malignancies and differentiating overlapping pathologies highlight the need for other diagnostic methods such as histopathology.

Background: Needlestick injuries, or NSIs, present a grave danger to healthcare workers (HCWs), constituting significant occupational hazards due to the potential transmission of various bloodborne diseases. Among the pathogens that can be transmitted through NSIs are hepatitis B and C viruses, as well as the human immunodeficiency virus (HIV/AIDS), posing a serious threat to the health of healthcare workers. Aim: To assess the knowledge, attitude and practice of nursing students towards needle stick injuries. Materials& Methods: An institutional based cross-sectional study was conducted on 186 nursing students selected by simple random sampling. Initially, a pre-test was conducted .Then an intervention in form of lecture and simplified videos pertaining to the need of study was done following which post-test was conducted. Results: On comparing the results of pre-test and post-test, the calculated mean post-test knowledge score of 17.35 was higher than calculated mean pre-test knowledge score of 15.20, which meant that the intervention of lecture and video-based teaching programme was effective and the result was statistically significant. Comparison of KAP score with pretest and post-test was found to be statistically significant (p<0.05). On comparison of socio demographic variables with post-test knowledge, there was no statistical significance. Conclusions: The intervention proved successful in enhancing nursing students’ understanding and implementation of safety measures to prevent needlestick injuries.

Background: Several Middle Ear Surgeries can be done under either Local anaesthesia with sedation or General Anaesthesia. However, patients sometimes are unable to tolerate constant supine, frequent head and neck positionings, noise of suction, manipulation of instruments, pain of local anaesthetic drug infiltration etc. Monitored Anaesthesia care is a planned procedure for 10-30% of all surgeries. MAC typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during Tympanoplasty. Methodology: The present study was designed to compare α-2 agonist Dexmedetomidine and iv sedative midazolam with intravenous Propofol and Fentanyl using ramsay sedation score in tympanoplasty. 50 patients were registered in this study; patients were randomly allocated into 2 groups (group DM and group PF). Group DM received IV Midazolam 0.05mg/kg and Dexmedetomidine at a loading dose of 1mcg/kg over 10 minutes followed by continuous infusion 0.5 mcg/kg/hr till surgery was over. Other group PF received iv 1 mg/kg propofol and 1 mcg/kg fentanyl in titrated doses. Degree of sedation and pain intensity was assessed by using Ramsay Sedation Score (RSS). P-value was used for statistical analysis. Results: Higher repeated doses of midazolam were required for group DM patients (6.25±4.574) as compared to Group DF participants injected with Fentanyl (6±8.289). Patient and  surgeon satisfaction score was more satisfactory in Group PF (Propofol and Fentanyl) than Group DM( dexmedetomidine and midazolam). Post operative Visual Analogue Score (VAS) was higher in group DM (2.18±1.19) than group PF (0.593±0.2391). No post-operative complications were seen in both groups. Conclusion: We found that propofol-Fentanyl is a better combination in Tympanoplasty surgeries under monitored anesthesia care. It not only improves the intra-operative analgesia but also gives better post-operative analgesia.

Background: Delirium is a common and serious condition causing great impact on patients at the time of hospitalization, often more in Intensive Care Units. It is essential to understand the phenomenology and severity of delirium for patient outcomes. Methods: This is a cross-sectional, hospital-based study conducted at SCB Medical College, Cuttack, on 50 patients aged between 16 to 60 years referred from the Central ICU and general inpatient units. The level of delirium was assessed using the Delirium Rating Scale Revised 98 (DRS-R98). Details were gathered through a semi-structured proforma and laboratory investigations that included analyses of liver and renal function tests, complete blood counts, serum electrolytes, and CT imaging. Results: The total number of patients who fulfilled the DSM-5 criteria for delirium was 54, and 92% presented acutely. Hyperactive delirium presented in 68%, and among the biochemical abnormalities, deranged liver and renal functions were found in 34%. A high mean DRS-R98 score revealed severity of delirium to be more pronounced among ICU patients. Cognition impairment correlated positively with delirium severity. Conclusion: High prevalence and severity of delirium in hospitalized patients, particularly in the ICU. There is a clear association between delirium and cognitive impairment, with the underlying cause being medical diseases, thereby establishing that early detection with targeted interventions is warranted. Managed care of patients should be anchored around delirium management protocols to improve outcomes.

Background: Although RTI/STI affect both women and men but women are more susceptible to infection and are less likely to seek treatment than men. It is the second cause of healthy life lost among women of reproductive age after maternal morbidity and mortality in developing countries. Objectives: To find and compare the prevalence of RTI/STI and its association with sociodemographic variable and to identify the treatment seeking behaviour of reproductive age group married women in Rural and Urban Slum areas. Methodology: A community based Cross-sectional study was done in rural area of RHTC and urban slum area of UHTC under Department of Community Medicine, Jhalawar Medical College, and Rajasthan. Multistage Stratified Random Sampling technique was used. Total 750 subjects were selected, 375 from rural area and 375 from urban slum area. Results: Out of 750 participants maximum were belonging to 25-34 year age group. Point-prevalence of RTI/STI in Urban slum area (22.4%) was more than rural area (17.9%). Per vaginal discharge was the most common symptom in women of both Rural (92.2%) and Urban slum area (90.0%). 70% of the study participant sought treatment out of which 96% were compliant. Majority of women took treatment at government hospital (62%). Conclusion: Prevalence of RTI/STI in this study was found less but and treatment seeking behaviour was good but it was not as per NACO guideline of syndromic management.

Introduction: Sepsis is a life-threatening condition characterized by a dysregulated immune response to infection, leading to organ dysfunction and high mortality. Thrombocytopenia, a common hematological abnormality in sepsis, is associated with increased ICU stay, bleeding risk, and poor clinical outcomes. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital over 12 months, including adult ICU patients diagnosed with sepsis, severe sepsis, or septic shock. Patients with pre-existing platelet disorders, chronic liver disease, recent chemotherapy, or antiplatelet therapy were excluded. Clinical and laboratory data, including platelet counts, coagulation profile, inflammatory markers, and sepsis severity scores (SOFA, APACHE II), were analyzed. Primary outcomes included 28-day mortality, while secondary outcomes assessed ICU stay duration, major bleeding events, and transfusion needs. Results: Out of 115 ICU patients with severe sepsis or septic shock, 80 met the inclusion criteria, with 60% male and a mean age of 71.5 years. Septic shock was present in 90% of cases, and pneumonia (40%) was the most common infection source. Thrombocytopenia developed in 38 patients (47.5%), with 52.6% present at admission and 47.4% occurring during hospitalization. Thrombocytopenic patients had higher APACHE III scores (p=0.002), increased ICU stay (p=0.002), and higher rates of acute kidney injury (p=0.03). Severe thrombocytopenia was seen in 21%, and major bleeding was significantly more frequent (p=0.02). Patients with thrombocytopenia required more PRBC transfusions (p=0.04) and platelet transfusions (p<0.0001). Lactate levels (p=0.01) and prolonged vasopressor duration (p=0.03) were independent predictors of thrombocytopenia. 28-day mortality was higher in thrombocytopenic patients (36.8% vs. 23.8%), though not statistically significant (p=0.14).  Conclusion: Thrombocytopenia in sepsis is associated with increased ICU stay, organ dysfunction, and a higher need for transfusions. Early identification and monitoring of platelet trends can aid in risk stratification and improve patient management.

Introduction: Post-anesthesia shivering is a common yet significant concern in laparoscopic cholecystectomy, leading to discomfort and increased oxygen consumption. Tramadol, an opioid analgesic, and Dexmedetomidine, and α2-adrenergic agonist, are both used to prevent shivering through different mechanisms. This study compares their efficacy in reducing post-anesthesia shivering, focusing on onset, severity, and associated complications to determine the more effective agent for perioperative management. Materials and Methods: This randomized, prospective study included ASA I–II patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients were assigned to receive either intravenous Tramadol (1 mg/kg) or Dexmedetomidine (0.5 µg/kg) before extubation. Shivering incidence and severity were assessed at 1 and 2 hours postoperatively, along with hemodynamic parameters and adverse effects over 24 hours. Statistical analysis was performed using SPSS version 23, with a p-value of <0.05 considered significant. Results: Both Dexmedetomidine and Tramadol groups had comparable baseline characteristics, including age, sex distribution, ASA grade, and surgical duration (p > 0.05). However, the incidence of shivering was significantly higher in the Tramadol group (26 out of 33) compared to the Dexmedetomidine group (7 out of 33) (p < 0.001). While Tramadol led to earlier shivering cessation, recurrence was significantly lower in the Dexmedetomidine group, indicating better long-term control. Hemodynamic parameters such as SBP, DBP, pulse rate, SPO₂, and temperature remained stable across both groups, with no significant differences (p > 0.05), except for a slightly higher SBP after extubation in the Tramadol group (p = 0.029). Notably, nausea was significantly more frequent in the Tramadol group (14 out of 20 cases) compared to Dexmedetomidine (6 out of 20) (p = 0.039), highlighting Dexmedetomidine’s better tolerability. Conclusion: Dexmedetomidine was more effective than Tramadol in preventing post-anesthesia shivering, with lower incidence, longer duration of action, and fewer complications. Both drugs maintained stable hemodynamics, but Tramadol had a higher incidence of nausea.

Background: Helicobacter pylori (H. pylori) is a globally prevalent Gram-negative, spiral-shaped bacterium known to colonize the human gastric mucosa. Its role in various gastrointestinal diseases, including gastritis, peptic ulcer disease (PUD), gastric carcinoma, and, to a lesser extent, cholelithiasis, has been extensively studied. The prevalence of H. pylori infection varies geographically, influenced by socioeconomic status, hygiene, sanitation, and dietary factors. Southern Odisha over the years witnessed major changes in its food habits, migration and Environment and the majority of the Population are below the poverty line and most of the people are migrant laborers. Incidence of gastrointestinal diseases including Gastritis, PUD, Cholelithiasis and Gastric Carcinoma are on a rise. This study aims to investigate the prevalence and association of H. pylori with gastritis, peptic ulcer disease, cholelithiasis and carcinoma stomach, using rapid urease test (RUT) and histopathology as diagnostic modalities. This study analyzes the prevalence of H. pylori in Southern Odisha, incorporating age, sex, food habits, and socioeconomic status to better understand the disease burden and risk factors.Methods: A prospective case control study was conducted on 325 patients in the Post Graduate Department of General Surgery, MKCG Medical College, Berhampur, Odisha presenting with dyspeptic symptoms undergoing upper gastrointestinal endoscopy and Cholecystectomy. 100 normal asymptomatic individuals were taken as control group. Biopsy specimens were obtained for RUT and histopathological examination. Patients were categorized into four groups based on diagnosis: gastritis (n=120), peptic ulcer disease (n=80), carcinoma stomach (n=55), and cholelithiasis (n=70). Data regarding demographic factors, socioeconomic status, and rural-urban distribution were collected and analyzed. Statistical analyses included prevalence estimation, chi-square tests for categorical variables, odds ratio calculations, and logistic regression modeling to assess the association between H. pylori and the studied gastrointestinal diseases. Results: The overall prevalence of H. pylori in symptomatic upper gastrointestinal diseases was 64.92%, and that of control group was 30%. The highest prevalence of H. pylori was observed in peptic ulcer disease (75%), followed by carcinoma stomach (72.7%) and gastritis (65%). Cholelithiasis had a prevalence of H. pylori (47.14%). Age distribution analysis revealed that infection was most prevalent in the 51-60 years age group, with a male predominance (60% male vs. 40% female). Rural populations exhibited a higher prevalence (58.5%) compared to urban populations (41.5%). Socioeconomic analysis demonstrated a significant correlation, with higher prevalence observed in low (43.1%) and middle (36.9%) socioeconomic groups compared to high socioeconomic status (20.0%). Histopathological examination confirmed H. pylori in Peptic Ulcer (OR = 7.00, p < 0.0001) has the strongest association with H. pylori. Carcinoma Stomach (OR = 6.22, p < 0.0001) also shows a strong association. Gastritis (OR = 4.33, p < 0.0001) is significantly associated. Cholelithiasis (OR = 2.08, p = 0.025) is significant, suggesting H. pylori may be a risk factor. Conclusion: Among 325 patients, 211 (64.92%) were H. pylori positive, detected through RUT and histopathology. The highest prevalence of H. pylori was observed in peptic ulcer diseases as 75% then in carcinoma stomach 72%, H. pylori was found in 33 cases of cholelithiasis, shows an association which is statistically significant. In 40 biopsy-proven gastric carcinoma cases, H. pylori was present in a significant proportion, reinforcing its role in gastric malignancy.

Background and Objective: Fine needle aspiration cytology and core needle biopsy are reliable procedures for breast cancer detection. Core needle biopsy is an established alternative to surgical biopsy for diagnosis and prognostication.The objective of the study was to compare between Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) in the diagnosis of breast lesions. Materials and Methods: A prospective study was done on 50 cases at Department of Pathology; KVG Medical College and Hospital. Sullia, DK. Patients undergoing all three procedures (Fine Needle Aspiration Cytology, Core Needle Biopsy and subsequent excision surgeries were selected. May Grunwald Giemsa (MGG) and Papaniculou (PAP) staining were performed on cytology smears. Haematoxylin and Eosin (H&E) staining was done on both the CNB and tissue specimens obtained from subsequent excision surgeries to see the histological features. Result: The majority of the patients in the study were in the age group of 31-50 years. In our study, FNAC showed a sensitivity, specificity, PPV, NPV of 87%, 92.59%,90.94%,89.28%.CNB had a sensitivity, specificity, PPV, NPV 95.65%,96.22%,95.68% and 96.30%. It was also observed that the combination of both FNAC and CNB results have more improved sensitivity (98.55%) and specificity (99.99%) for diagnosis of breast lesions. Conclusion: The diagnostic accuracy of the combined assessment of FNAC and CNB against final histopathologic diagnosis for breast lesions was better than that of FNAC or CNB alone. This finding shows that both the techniques complement each other. FNAC and CNB are used as the first- and second-line methods of pathological diagnosis respectively.

Background: Worldwide, head injuries, particularly those that result in intracranial hemorrhages, are frequent causes of death and disease. This study aims to analyze the autopsy findings of individuals who succumbed to head injuries, with a focus on the nature and distribution of intracranial hemorrhages. Methods: This retrospective cross-sectional study included one-year cases of head injuries that were autopsied at our institution. The presence, location, and type of intracranial hemorrhages were recorded.  The relationship between the type of hemorrhage and demographic information like age and gender was looked at in the data. Results: Of the 100 autopsy cases reviewed, 65% showed the presence of intracranial hemorrhages.  Subdural hematoma was the most common type of hemorrhage, followed by epidural hematoma. Intracerebral hemorrhage was also frequently observed, particularly in older patients.  Statistical analysis revealed a significant correlation between the severity of hemorrhages and the age of the patient. Conclusion: Intracranial hemorrhages are a major cause of death in patients with head injuries.  The results show that early detection and treatment of these hemorrhages are crucial to lowering mortality rates. In these cases, the most common type of hemorrhage is still subdural hematomas.

Superior mesenteric artery (SMA) occlusion is a rare but life-threatening vascular emergency that can lead to ischemia and gangrene of the small intestine. Here, we report a unique case of an elderly male patient presenting with acute abdominal pain and shock, later diagnosed with SMA thrombosis resulting in extensive small bowel gangrene. This case emphasizes the importance of early recognition, prompt imaging, and urgent surgical intervention in SMA occlusion to prevent fatal outcomes.

Introduction: Sinonasal masses encompass a wide range of benign, malignant, and non-neoplastic conditions, presenting diagnostic and therapeutic challenges. Their prevalence, etiological factors, and management strategies vary significantly across different populations. This study investigates the clinicopathological patterns of sinonasal masses in a rural tertiary care setting in North Bengal. Objectives: The study aimed to analyze the demographic characteristics, identify the pathological variants, and evaluate the clinical presentations and management strategies of sinonasal masses in a rural population. Methodology: An observational study was conducted on 86 patients aged >5 years presenting with sinonasal masses at North Bengal Medical College over 16 months. Data were collected through clinical evaluation, imaging, and histopathological examination. Treatment approaches included surgical and conservative methods. Results: The majority of patients (56.9%) were aged 31–60 years, with a male predominance (62.8%). Nasal polyps were the most common diagnoses (59.3%), followed by mucormycosis (9.3%) and other malignancies (11.6%). Benign lesions accounted for 88.4% of cases. Endoscopic sinus surgery was the most frequently employed management method (64%). Conclusion: This study highlights the predominance of benign sinonasal masses, particularly nasal polyps, and underscores the importance of early diagnosis and minimally invasive surgical interventions. Future research should explore risk factors and long-term outcomes.

Background: Liver cirrhosis is a chronic disease that leads to multiple complications, including thrombocytopenia and upper gastrointestinal (GI) bleeding. Thrombocytopenia, characterized by a low platelet count, is commonly observed in cirrhotic patients due to hypersplenism and impaired platelet production. Upper GI bleeding, particularly from esophageal varices, is a major cause of morbidity and mortality in these patients. Objective: This study aims to analyze the correlation between thrombocytopenia and the incidence of upper GI bleeding in patients with liver cirrhosis. Methods: A cross-sectional study was conducted involving 50 cirrhotic patients admitted to a tertiary care hospital. Platelet counts and clinical parameters were recorded, and upper GI endoscopy was performed to assess the presence of varices and active bleeding. Results: Statistical analysis revealed a significant association between the severity of thrombocytopenia and the occurrence of upper GI bleeding (p < 0.05). Patients with severe thrombocytopenia (<50,000/µL) exhibited the highest incidence of GI bleeding. Conclusion: The findings suggest that thrombocytopenia is a strong predictor of upper GI bleeding in cirrhotic patients. Early detection and management of thrombocytopenia may help reduce bleeding-related complications and improve clinical outcomes in this population.

Potts spine, also known as tuberculous spondylitis, is a form of extrapulmonary tuberculosis which affects musculoskeletal system. One or more vertebral or intervertebral disc spaces are inflamed due to mycobacterium tuberculosis consequently leading to severe kyphotic deformity and neurologic deficit if there is delay in diagnosis and management. This is a case of 24 years old young male presented with weakness of both lower limbs for 5 days. He had pain in the lower back for last 7 months with difficulty in walking. No history of trauma to the back in the past. This was eventually diagnosed to be potts spine. For diagnosis of potts disease, CEMRI whole spine, IGRA was done. Patient was treated with antitubercular therapy.

Introduction: Ischemic stroke (IS) is a major cause of death and disability globally, with acute kidney injury (AKI) being a significant complication in hospitalized stroke patients. The correlation between stroke severity, assessed by the National Institutes of Health Stroke Scale (NIHSS), and the development of AKI remains a critical area of investigation. Objective: This study aims to explore the relationship between NIHSS scores and AKI in patients with ischemic stroke. Methods: An observational cross-sectional study was conducted at M.B.S. Hospital, Kota, from December 2022 to December 2023. A total of 67 ischemic stroke patients, confirmed by clinical presentation and CT scan, were enrolled. Renal function tests were performed on admission, at 72 hours, on the 5th day, and at discharge. The NIHSS score was used to assess stroke severity. AKI was defined according to KDIGO criteria and was evaluated in relation to NIHSS scores. Results: The study population had a mean age of 56.65 ± 8.63 years. Of the participants, 59% were male and 41% were female. The incidence of AKI increased with the severity of the stroke: 16.66% in minor stroke (NIHSS 1-4), 22.72% in moderate stroke (NIHSS 5-15), 61.53% in moderate to severe stroke (NIHSS 16-20), and 100% in severe stroke (NIHSS 21-42). Serum urea and creatinine levels, along with estimated glomerular filtration rate (eGFR), demonstrated significant changes over time, reflecting the progression of AKI. Conclusion: The study identifies a significant correlation between higher NIHSS scores and increased incidence of AKI in ischemic stroke patients. Higher NIHSS scores, indicative of more severe strokes, are associated with a greater likelihood of developing AKI. These findings emphasize the importance of renal function monitoring in stroke patients, particularly those with higher NIHSS scores, to potentially improve patient outcomes and reduce associated mortality.

Background: Changes in blood cell morphology occur easily, even after short periods of time in storage. Microscopic evaluation of a peripheral blood smear is one of the most beneficial tests to identify morphological changes. But anticoagulant-induced artefacts could lead to misinterpretation of the smears. by 24 hours changes become striking. In our study, we will discuss how long EDTA can preserve morphology and determine the best time to preserve blood samples. Aim: The current study was undertaken to identify the anticoagulant EDTA induced artefacts and thus avoid misinterpretation of peripheral blood smears. Methods: This study was carried out in haematology laboratory of BMCH, Chitradurga. A total of 80 blood samples were collected from patients who had come to the OPD as a part of routine medical checkup. The blood samples were collected into commercially prepared Tripotassium Ethylene Diamine Tetra Acetic acid [K3 EDTA] vacutainer tubes and were thoroughly mixed and smears were prepared immediately and at 1hr, 2hr, 4hr and 6hr respectively after storing the blood samples at room temperature. Morphological artefacts were studied. Results: Smears made immediately after addition of anticoagulant did not show any artefactual changes. Smears from EDTA stored blood show significant morphological artefacts on storage. Conclusion: EDTA has been recommended as the anticoagulant of choice for peripheral smear but should be examined within 1hr of collection to avoid misinterpretation as pathological findings leading to wrong diagnosis.

Background: Soft tissue can be defined as non-epithelial, extra skeletal tissue of the body exclusive of reticuloendothelial system, glial and supporting tissue of various parenchymal organs.^[1] Soft tissue tumors are defined as mesenchymal proliferation which occur in the extra skeletal non epithelial tissue of the body, excluding the viscera, coverings of brain and lymphoreticular system. Soft tissue tumors are a highly heterogenous group of tumors that are classified on a basis according to the adult tissue they resemble. Aim: To study the histopathological pattern for understanding the classification and type of soft tissue tumors. To find out the relative incidence of benign and malignant soft tissue tumors and to classify the soft tissue tumors on the basis of benign and malignant behaviour. Methods: The test population comprised of patients with soft tissue lesions between May 2018 to December 2019, evaluated by light microscopy and immunohistochemistry. Results: In the study majority of subjects were in the age group 31 to 40 years (28.4%), has female (59.9%) predominance. First most common soft tissue tumors are lipomatous tumor among all the soft tissue tumors. Most common site is extremities. Lipoma (65.3%) is the most common tumor followed by capillary Haemangioma (6.8%), 88 % were benign lesion, 3.1% were intermediate lesion and 8.5% were malignant lesion. IHC markers were applied to 11 cases to arrive at definite diagnosis. Conclusion: A good clinical acumen, through description and grossing specimen, and microscopic evaluation of Hematoxylin and eosin stained sections are fundamental aspects in diagnosis of soft tissue tumors. majority of tumors diagnosed by Hematoxylin and eosin stained sections. Immunohistochemistry was done wherever light microscopy was inconclusive.

Objective: The objective of the study was to evaluate the Heart rate variability parameters in offspring of Hypertensive and Normotensive parents, so as to detect early impairment of autonomic functions leading to future development of hypertension in offspring of hypertensive parents. Methods: Cross-sectional observational study. Two groups of  offspring of Hypertensive parents and offspring of Normotensive parents (n=60 each) were made. Short-term HRV was measured using 5-minute electrocardiogram (ECG). Unpaired t test was applied to analyze the data with p-value < 0.05  considered as significant and <0.001 as highly significant. Results: The offsprings of hypertensive parents showed significantly lower values of  HF power  and SDNN in females. There was significant rise in the values of LFnu and LF/HF ratio in both male and female offsprings of hypertensive parents. Significant fall in values of HFnu, RMSSD, pNN50%, SD1 and SD1/SD2 ratio were observed in both male and female offsprings of hypertensive parents. Conclusion: There is early dysfunction of vagal modulation in normotensive offsprings of hypertensive parents leading to sympathovagal imbalance and predisposition of future development of hypertension in these persons.

Background: Cervical cancer is one of the major causes of mortality among women worldwide. It has taken fourth place among malignancies that affect women, the first leading is breast cancer. In developing countries including India, it is the leading cause of morbidity and mortality. It is readily preventable and can be diagnosed at the pre invasive stage with adequate and repetitive cytological screening and Papanicolaou smears. Methods: This is a retrospective study was aimed to screen the patients attending OPD of BMCH, Chitradurga. The main purpose was to study the incidence of premalignant and malignant lesions in population. A total of 564 patients attending OPD of BMCH, Chitradurga were screened during a period of one year from January 2024 to December 2024. Pap smears are taken from women visiting gynaecological OPD between ages of 25 to 70 with different gynaecological complaints using Ayer’s spatula. Smears were reported according to Bethesda system 2014. Results: A total of 564 pap smears were examined. There were 229 patients with NILM, and 216 patients with inflammatory smear. ASCUS was found in 24 patients, LSIL in 20 patients, HSIL in 10 and squamous cell carcinoma in 01 patient. This study concluded that a simple pap smear test could be offered to vast populations for diagnosing premalignant conditions of the survey this has and will in future continue to aid us with the early diagnosis of survival cancer. Conclusions: PAP smear is useful in diagnosing malignant and premalignant lesions of the cervix. In developing countries such as India this screening method is cheap and can be widely used. It can be used by trainers and para medical staffs.

Background: Anganwadi Centers (AWCs) under Integrated Child Development Service (ICDS) need safe water, sanitation, storage, and child-friendly spaces. Urban infrastructure gaps hinder service delivery, impacting maternal and child health. Strengthening facilities is key to improving ICDS effectiveness and well-being. Objective: To evaluate facilities of Anganwadis centers delivered under ICDS scheme in urban Jaipur. Methods: A cross-sectional study of 85 randomly selected AWCs in urban Jaipur used structured interviews and direct observations. Sampling followed the probability proportionate to size method. Only functional AWCs were included; those without available workers were excluded. Data collection covered infrastructure, services, and resources. Statistical analysis, including Chi-square tests, was conducted using Microsoft Excel and SPSS v26 to assess associations and trends. Results: Among 85 AWCs, 78% operated from pucca structures, 75.3% were privately owned, and 71.8% had functional toilets. Electricity access was high(91.8%), but water supply varied(71.8%). Immunization and nutrition records were well-maintained(95–98%), while health check-up compliance was lower(73–88%). Essential medicines were widely available, staffing was adequate(93%), and 96% of workers reported skill enhancement. Jaipur-3 and Sanganer City had better infrastructure, with over 90% of AWCs having water and toilets. Water supply(p=0.047) was lowest in Jaipur 2(54.5%) and highest in Sanganer City(90.9%). Toilet availability (p=0.039) was lowest in Jaipur 1(61.1%) and highest in Sanganer City(90.9%), averaging 72.9%. Conclusions: Study highlights disparities in infrastructure, sanitation, and resource availability among Anganwadi Centers in Jaipur. While electricity access and record maintenance were adequate, gaps in water supply, sanitation, and storage persist.

Background: Magnesium is a crucial intracellular cation involved in numerous physiological processes, including cardiac electrophysiology and cellular bioenergetics. Hypomagnesemia, characterized by a serum magnesium level below 1.8 mEq/L, is common in hospitalized patients, particularly those with heart failure. Hyponatremia, the most frequent electrolyte disturbance in hospitalized patients, is associated with increased morbidity and mortality in heart failure. The interplay between hypomagnesemia and hyponatremia in heart failure patients is not well understood. This study aims to determine the prevalence of hypomagnesemia in heart failure patients with hyponatremia and evaluate its impact on patient outcomes, including mortality, hospital stay, readmissions, and complications. Methods: This observational study was conducted at Malabar Institute of Medical Sciences, Calicut, Kerala, from March 2019 to March 2020. A total of 150 patients admitted with heart failure and hyponatremia were enrolled. Patients were categorized into two groups based on their serum magnesium levels: Group A (hypomagnesemia, Mg <1.8 mg/dL) and Group B (normomagnesemia, Mg ≥1.8 mg/dL). Data on demographic characteristics, comorbidities, electrolyte levels, length of hospital stay, readmissions, mortality, and complications were analyzed using SPSS 17.0. Results: Hypomagnesemia was prevalent in 44.67% of heart failure patients with hyponatremia. The mean age was comparable between the two groups (68.35 ± 10.72 years in Group A vs. 67.28 ± 11.70 years in Group B). A significant male predominance was observed in hypomagnesemic patients (63.5% vs. 36.5%, p=0.020). The length of hospital stay was significantly longer in the hypomagnesemic group (8.03 ± 6.436 days vs. 6.27 ± 4.518 days, p=0.046). Mortality rates were not significantly different between the groups (12.7% in Group A vs. 16.09% in Group B, p=0.562). The incidence of readmissions was similar (36.51% vs. 39.08%, p=0.749). Common complications included acute kidney injury (34.72% in Group A vs. 48.91% in Group B), cardiac arrhythmias (29.16% vs. 25%), infections (8.33% vs. 5.43%), and thrombotic events (6.94% vs. 3.26%). Conclusion: Hypomagnesemia is common among heart failure patients with hyponatremia, affecting nearly 45% of cases. While hypomagnesemia was associated with prolonged hospital stays, it did not significantly impact mortality, readmissions, or complication rates. Further large-scale studies are required to assess the prognostic significance of hypomagnesemia in heart failure patients.

Objectives: The present study was to evaluate the prevalence of myopia in children and adolescents in Kumaon region of Uttarakhand, India. Methods: General data regarding the age, sex, address, history related to refractive error was collected by interviewing the child and parent, followed by entering the information taken in the pre-tested semi- structured questionnaire by the investigator, followed by the screening of vision of the child. A short counselling supported by charts, posters and audio-visual tapes regarding eye health education was given to children after general and ophthalmic examinations. Results: A total of 200 children with age group 5 to 15 years were visited to Ophthalmology OPD for eye related problem. Among them, most of the cases (58%) were in age group of 5 to 8 years. 29.5 % cases were in age group of 9 to 11 years. Most of the children 124(62%) were boys. 76(38%) were girls. Hence, rate of prevalence of myopia in male child was 21.77% and female child was 22.37%. And it was not statistically significant (p=0.921). Among myopic children, mild myopia was seen in 23(52.27%) children. Moderate myopia was seen in 16(36.36%)  children and severe myopia was seen in 5(11.36%) children. Conclusions: Overall, rate of prevalence of myopia is 22%. Myopia is greatly seen in primary and secondary school children. Mild myopia is commonly seen in more than half population of myopic children. Many factors such as increased indoor activities, lack of daylight exposure, particularly in view of increased use of digital media refractive error should be considered at early ages so that the Myopia can be timely diagnosed and treated. Hence, we should organise ophthalmology check-up camp in school time to time for awareness and early detection of myopia.

Introduction: Lymphomas are heterogeneous group of malignancies prevalent in developed countries. They arise from clonal proliferation of B cell, T cell and Natural Killer (NK cell) subtypes of lymphoid population at different stages of maturation. Lymphomas are broadly classified into non-Hodgkin lymphoma ( NHL) and Hodgkin lymphoma (HL) by WHO. Aims and Objectives: (1) To analyse the frequency of various lymphoma satatertiary care hospital in India. (2) To correlate clinical and radiological data with pathological features according to latest WHO classification of lymphoid neoplasms. Materials and Methods: Overall cases of lymphoma as were retrospectively assessed over a period of two years and categorised according to latest WHO classification of lymphoid neoplasms based on historical morphology and immunohistochemistry (IHC) results. Clinical and radiological data were correlated with pathological findings. Results: Total 43 proven cases of lymphomas were recorded in the present study, out of which 33 cases (77%) were reported as Non-Hodgkin’s lymphoma and 10 cases (23%) we’re reported as Hodgkin’s Lymphoma. Among Non-Hodgkin’s lymphoma, DLBCL was found to be most common subtype accounting for 42% followed by follicular lymphoma (12%), Marginal zone lymphoma including MALT lymphoma (9%), T cell lymphoma (7%), mantle cell lymphoma (5%) and Small lymphocytic lymphoma accounting for 2%. Among Hodgkin’s lymphoma, Mixed cellularity was the most common subtype accounting for 14% followed by lymphocyte rich type (7%) and 2% of nodular sclerosis variant were reported. Conclusion: Incidence of NHL is higher compared to HL. Follicular lymphomas are lower compared to western studies with DLBCL being the most common subtype of NHL. Mixed cellularity is the most common subtype of HL unlike nodular sclerosis subtype in Western world.

Background: Laboratory environments are potential reservoirs of bacterial contamination, posing risks of cross-contamination and laboratory-acquired infections. This study aimed to determine the prevalence of Pseudomonas spp., Bacillus spp., Escherichia coli, Klebsiella spp., Staphylococcus aureus, and Coagulase-Negative Staphylococci (CoNS) in Microbiology and Biochemistry laboratories after daily work sessions and to assess the effectiveness of routine disinfection. Methods: A total of 50 surface swabs were collected from laboratory workstations before and one hour after disinfection with 1% sodium hypochlorite and 70% ethanol. Bacterial isolation was performed using standard microbiological techniques, and statistical significance was analyzed using the Chi-square test. Results: Among 50 swabs collected post-session, bacterial contamination was as follows: Pseudomonas spp. (18%), Bacillus spp. (22%), E. coli (12%), Klebsiella spp. (10%), S. aureus (16%), and CoNS (22%). However, no bacterial growth was observed one hour after disinfection (p < 0.001, statistically significant). Conclusion: A significant bacterial load was detected after daily work sessions, with Bacillus spp. and CoNS being the most frequently isolated. The absence of bacterial growth after disinfection confirms the efficacy of routine cleaning protocols. Maintaining rigorous disinfection practices is crucial in minimizing laboratory contamination and ensuring biosafety.

Bronchiolitis affects a vast number of young children less than 2 years of age, mandating hospitalisation of a significant percentage of affected children. Oxygen therapy has been a cornerstone in the management of such children, and the oxygen delivery devices have undergone a revolution. This Open labelled randomized control study was conducted in GVMCH on 150 children to determine the outcome in terms of clinical improvement and the need for escalation and de-escalation of Oxygen therapy. Early initiation of HFNC Oxygen therapy in children with bronchiolitis proved to be more effective than standard Oxygen therapy in reducing the duration of Oxygen treatment, hospital stay and the need for invasive Mechanical Ventilation with minimal side effects.

Background: Carbapenem-resistant Pseudomonas spp. are a major concern in hospital-acquired infections, particularly in intensive care units (ICUs). Plasmid-mediated resistance contributes significantly to their multidrug-resistant nature, limiting therapeutic options. Plasmid curing, which involves eliminating resistance-carrying plasmids, is a potential strategy to restore antibiotic susceptibility. This study investigates the effectiveness of Lugol’s iodine in plasmid curing and the subsequent phenotypic reversal of carbapenem resistance. Methods: This experimental study was conducted over two months in a tertiary care hospital in West Bengal. A total of 20 carbapenem-resistant Pseudomonas spp. isolates were obtained from ICU (n=15), Medicine ward (n=3), and Surgery ward (n=2). Specimens included urine (n=9), lower respiratory tract samples (n=8), and wound swabs (n=3). Plasmid curing was attempted using Lugol’s iodine, and phenotypic restoration of carbapenem susceptibility was assessed. Results: Successful plasmid curing was observed in 11 out of 20 isolates (55%). The highest number of isolates was from urine (45%), followed by lower respiratory tract samples (40%) and wound swabs (15%). Conclusion: Lugol’s iodine demonstrated promising plasmid-curing activity, reversing carbapenem resistance in over half of the isolates. Further molecular studies are needed to confirm its potential clinical application.

Introduction: In India carcinoma cervix is 2^nd most common cancer among women, most common among rural population and major cause of cancer death in this population. Prevalence of cervical cancer in rural and socioeconomic weaker section is attributed to lack awareness and less access to screening programme. In this retrospective study we have analysed different treatment modality for early and locally advanced carcinoma cervix, pattern of recurrence, 5 year the disease free and overall survival from our institute. Materials and Methods: Histologically proven carcinoma cervix with FIGO stage (2009) I A to IVA treated between the year January 2014 to December 2014 in Government Royapettah hospital Chennai were retrospectively analysed with respect to initial workup, primary modalities of treatment, like surgery, concurrent chemoradiation, disease outcomes, follow up, disease recurrence patterns, secondary interventions and treatment modalities and followed up till January 2024. Results: A total of 265 patients with carcinoma cervix were registered in January 2014 to December 2014, of which 230 were non-metastatic disease and analysed for the study.  Median age at diagnosis was 50 years. 81.4% were above the age of 40 years, majority of the patients 174(75.4%) were in locally advanced stage (stage IIB-IVA). Among stage of disease IIB (37.4%)>IIIB (22.6%)>IVA (12.6%). Squamous cell carcinoma was the common histology (64.8%). Pattern of recurrence for early stage was loco regional on vaginal stump. DFS at 5 years was 64.3% and OS at 5 years was 73.2%. Pattern of recurrence in locally advanced disease was local in 30.4%, nodal in 12.7% and progression during treatment in 13.7%. Among distant recurrence lung (14.9%), left supraclavicular in (13.2%). DFS at 5 years for 32.6% and OS at 5 years was 34.1%. Conclusion: From this study we conclude early stage carcinoma cervix had better disease free survival and overall survival compared to locally advanced disease. Addition of neoadjuvant chemotherapy in locally advanced disease did not improve DFS or OS.

Objective: To investigate the prevalence, antimicrobial resistance patterns, and the influence of menopausal status on urinary tract infections (UTIs) in postmenopausal women aged 45 years and older. Method: A prospective cohort study was conducted on 127 postmenopausal women with confirmed UTIs. Urine samples were collected and processed following the Clinical Laboratory Standards Institute (CLSI) guidelines. Bacterial isolates were identified, and antibiotic susceptibility testing was performed using the VITEK-2 automated system. Resistance patterns were classified into multidrug-resistant (MDR), extensively drug-resistant (XDR), pan-drug-resistant (PDR), monodrug-resistant (MoDR), and MultiS (susceptible to all antibiotic classes). Data were analyzed statistically to assess the relationship between menopausal status and antimicrobial resistance trends. Result: Among the female participants, 53% were postmenopausal women. E. coli was the predominant uropathogen, isolated in 69% of the cases, followed by Klebsiella (12%) and Enterococcus (7%). Resistance to ampicillin (83%), amoxicillin/clavulanic acid (82%), and cefazolin (71%) was notably high. Nitrofurantoin demonstrated the lowest resistance rate (10%), followed by colistin (5%) and fosfomycin (8%). MDR, XDR, and PDR rates among all isolates were 33%, 9%, and 2%, respectively, with E. coli and Klebsiella showing the highest resistance. Conclusion: This study highlights the high prevalence of UTIs and antimicrobial resistance among postmenopausal women, particularly against commonly used antibiotics. The findings underscore the urgent need for targeted antibiotic stewardship programs and the development of tailored treatment guidelines. Further research is essential to explore the interplay between menopausal hormonal changes and resistance patterns.

Background: The fractures of the proximal femur, fracture of the neck of femur, intertrochanteric and subtrochanteric fractures, are the most common orthopaedic emergency among geriatric population. Pain associated with these injuries makes appropriate positioning difficult for the regional anaesthesia, various nerve blocks have been tried to reduce preoperative pain to facilitate proper positioning and to reduce postoperative pain. The present study aimed to compare pain relief in proximal femur fracture patients between USG guided fascia iliaca compartment block versus USG guided femoral nerve block at tertiary care hospital. Material and Methods: The present randomized control study was conducted in Department of Anaesthesiology at Government Medical College and Hospital. The sample size for the study was of 90 adult posted for elective surgery for fracture proximal femur randomly allocated into two groups, 1st with USG guided FICB and 2nd with USG guided FNB. Study was started only after approval of the ethics committee. USG guided peripheral nerve block given and data collection was done. Baseline vitals (HR, BP, SpO2) and VAS Score for pain assessment before the block in patients resting position (supine) and sitting position was assessed.  The software used in the analysis was SPSS 24.0 version. Results: The mean VAS score in supine and sitting position among group-1 and among group-2 were not statistically significant. After block administration in participants [supine position] with respect to VAS score there was significant difference at 5, 10, 15 and 20 min between both groups (i.e., p < 0.05). At the time of spinal anaesthesia administration in sitting position, mean heart rate, Mean Systolic blood pressure, mean VAS score of participants in group-2 was significantly better than group-1 (i.e., p = 0.003, p = 0.010 & p=0.006) respectively. Conclusion: The present study concludes that FNB holds considerable promise as an effective analgesia for positioning during spinal anaesthesia administration compared to FICB.

Background: Urinary bladder diseases, encompassing both neoplastic and non-neoplastic lesions, are commonly encountered in clinical practice. With bladder cancer now recognized as the seventh most prevalent cancer globally and its incidence on the rise, the need for effective diagnosis and management is crucial. This study focuses on examining the clinicopathological features of various bladder lesions, with a particular emphasis on grading. The goal is to mitigate the morbidity and mortality associated with urinary bladder cancers through improved understanding and early intervention. Aim: To study the histopathological spectrum of bladder lesions, highlighting their frequency and distribution across age and gender groups. Materials and Methods: The present study was two year analysis of biopsies of urinary bladder received in Department of pathology, Mysore medical college and research institute, Mysore from July 2022 to June 2024. A detailed clinical history was taken from the patient. A total of 128 cases were included who has undergone transurethral resection of bladder tumour/ cystoscopic biopsies were included in the study. Biopsy specimens with autolysis or inadequate tissue for histopathological evaluation were excluded. Results: In the study group, the majority of patients belonged to the 61–70 years age group. The most commonly reported symptoms included lower urinary tract issues, with haematuria being the most frequent, followed by increased frequency of micturition, burning micturition, dysuria, and abdominal pain. Out of 128 cases, 122 were neoplastic and 6 were non neoplastic lesions. Conclusion: Bladder tumours are well-known for their high recurrence rates, rapid advancement to high grade, and the challenge posed by their non-specific symptoms. This makes precise diagnosis essential, with cystoscopy and histopathological analysis of biopsy material being pivotal in guiding treatment.

Introduction: Medical students have greater academic load that can contribute to poor sleep quality. It is significant to know whether they have sleep problem, extent of problem and whether sleep disturbances have any effect on academic performance or quality of life. Yoga Nidra is a branch of Yoga; meaning psychic sleep, that is, sleep with full sense of awareness. Main principle behind Yoga Nidra is deep relaxation of mind. Material and Method: The study was conducted in Physiology department, WCMSRH, Jhajjar, Haryana. Study group comprised of 30 medical students who practiced Yoga Nidra for 02 months for 45 minutes daily at evening time. Sleep quality was assessed by Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale, before and after Yoga Nidra practice. Observation: Pittsburgh Sleep Quality Index: There was improvement in time of going to bed, minutes taken to fall asleep, morning getting up time and sleep hours per night after Yoga Nidra. Bad dreams and snoring during sleep got improved after Yoga Nidra. Epworth Sleepiness Scale: After Yoga Nidra, chances of dozing while sitting and reading, sitting and talking to someone and watching TV while sitting as passenger in a car for an hour or more without stopping for a break were reduced and they would never doze in these situations. Discussion: Medical students appear to be vulnerable to poor sleep, due to long duration, high intensity studies and clinical duties that can be emotionally challenging.  In Yoga Nidra, body sleeps but mind remains awake. One month practice helped in improvement of sleep quality as evident by outcomes of parameters in sleep scales. Conclusion: Our study revealed that overall psychological and physical outcome associated with health of medical students got improved after Yoga Nidra. Yogic intervention improves academic performance by reducing stress. Long term follow-ups are needed to optimize health safety and efficiency of our budding medical practitioners.

Background: Undernutrition is a leading cause of morbidity and mortality among children worldwide. Its health effects include stunted physical growth, impaired motor and cognitive development, lower IQ, poor social skills, increased behavioral issues, and heightened susceptibility to infections. Objectives: To determine the prevalence of Undernutrition in Anganwadi children among Ernakulam district during the study period and to identify the various sociodemographic factors associated with undernutrition in study groups. Methods: A descriptive cross – sectional study was conducted among 300 children between 3 to 6 years of age attending anganwadis in Ernakulam district selected by multistage cluster sampling. Anthropometric measurements were recorded after obtaining informed consent and completing a predesigned questionnaire. Data were analyzed using Anthrocal and SPSS software. Quantitative variables were expressed as mean and standard deviation (SD), while categorical variables were presented as frequency and percentage. ANOVA was used to test the statistical significance of difference between means of variables among different independent groups. Pearson Chi-square test was used to compare categorical variables between groups. Results: In our study, wasting was present among 14.7%, underweight 19.7% and stunting among 33% of the study population. The factors associated with underweight were mother’s occupation, vaccination status of child, birth weight of child and poor nutrition. Conclusion: The prevalence of underweight, stunting and wasting was notably high among the population under study. While mother’s occupation, vaccination status of child, birth weight of child, 24-hour calorie and protein intake, were factors associated with underweight, vaccination status of child, 24-hour calorie and protein intake were associated with wasting and stunting in children.

Background: Perimenopause and menopause often involve vasomotor symptoms (VMS), notably hot flashes and night sweats, which arise from shifting hormonal levels—especially estrogen. Current evidence proposes that VMS may also signal an elevated risk of cardiovascular disease (CVD). Since cardiovascular conditions are a principal cause of death in post-reproductive women, understanding the link between VMS and cardiovascular risk is of great clinical importance. Methods: A cross-sectional investigation was carried out with women aged 45–60 years in perimenopausal or postmenopausal stages. Each participant completed a questionnaire on the presence and intensity of VMS. Standardized measurements, including blood pressure, lipid profiles, fasting glucose, and body mass index (BMI), and were compiled to gauge cardiovascular risk. Statistical analyses such as correlation and regression were performed to explore the relationship between VMS severity and cardiovascular markers, adjusting for variables like age and smoking. Results: Women experiencing moderate-to-severe VMS presented with higher systolic blood pressure, low-density lipoprotein (LDL) cholesterol, and fasting glucose than those reporting mild or no VMS. The observed correlations persisted after controlling for lifestyle parameters, indicating a potential direct link. Night sweats occurring multiple times per week were associated with increased likelihood of developing metabolic syndrome. Conclusion: These findings imply that VMS might serve not just as a menopausal quality-of-life issue but also as a potential indicator for heightened cardiovascular risk. Prompt recognition and integrated management of VMS and associated risk factors could decrease long-term cardiovascular complications for women in midlife and beyond.

Background: Adenomyosis involves the migration of endometrial tissue into the myometrium, commonly resulting in menorrhagia, pelvic discomfort, and an enlarged uterus. In clinical practice, conservative strategies target symptom control, fertility preservation, and avoidance of surgical intervention. Low-dose mifepristone and the levonorgestrel intrauterine system (LNG-IUS) are two prominent non-surgical modalities. Methods: In this prospective, parallel-group trial, 80 premenopausal women (ages 30–50) diagnosed with adenomyosis via clinical assessment and ultrasound were randomly allocated to receive either oral mifepristone (5 mg/day) or LNG-IUS placement over six months. Primary outcomes included changes in uterine dimensions, dysmenorrhea severity (rated by a visual analog scale), and menstrual blood loss. Secondary measures comprised hemoglobin levels, quality of life indices, and adverse effect profiles. Results: Seventy-four participants finalized the study, with 37 in each group. Both treatments effectively reduced uterine volume by the six-month endpoint (p<0.05) without any significant difference between the two cohorts. Menstrual pain scores showed substantial reductions across both groups (p<0.01), and final pain ratings did not differ significantly between them at six months. Although LNG-IUS use led to a quicker initial reduction in menstrual flow, final bleeding patterns after six months were comparable in both arms. Each group also exhibited improved hemoglobin levels and enhanced quality of life. Adverse events were generally mild, with one case of device expulsion reported. Conclusion: Low-dose mifepristone and LNG-IUS demonstrated parallel effectiveness in managing adenomyosis symptomatology—reducing uterine bulk, alleviating pain, and mitigating heavy menstrual bleeding. While the LNG-IUS group achieved an earlier reduction in bleeding volumes, both methods produced comparable outcomes at the study’s conclusion. These findings suggest that either approach is a reasonable conservative option for individuals desiring non-surgical management of adenomyosis.

Background: Mean cord hemoglobin concentration is approximately 17gm/dl and values below 14gm/dl are considered abnormal, after 35 week of gestation. Amount of iron diverted to foetus is similar in a normal and in iron deficient mother. The new-born iron stores are related to maternal iron status and timing of cord clamping. Whether a maternal dietary iron transfer to the foetus is related to maternal iron status is still debated. Previous studies on the relationship between maternal and neonatal iron status using multiple parameters showed contrasting results. Estimation of hemoglobin of neonates from cord blood is useful in diagnosing neonatal anemia. Aim: (1) To study the impact of maternal hemoglobin on cord blood hemoglobin of newborn. (2) Observe correlation between maternal and new-born iron levels and to correlate the effect of maternal hemoglobin levels with birth weight of newborns. Study Site: Study was carried out at Nalanda Medical College & Hospital, Patna. Study Population: Pregnant mothers attending the labour room at Nalanda Medical College & Hospital, Patna and their babies delivered were included in the study. Study Design: Cross sectional study. Study Period: One year (January 2024 to December 2024). Results: The cross sectional study was conducted on 200 mother newborn pairs. Cord blood hemoglobin and maternal hemoglobin was compared. The mean maternal hemoglobin level was 10.52±1.74, for anemic mother it was 9.18±1.34, and for non anemic mothers it was 11.89±0.76. 31.68% mothers had mild anemia, 58.42% mothers had moderate anemia whereas only 9.90% study mothers had severe anemia. The mean serum iron in mothers was 108.06±37.19. The mean cord blood hemoglobin were 15.55±1.35 and mean cord blood iron level was 148.69, SD- 36.00. Mean cord hemoglobin between anemic and non-anemic mothers were compared and the difference between them was statistically significant with p<0.01. The mean cord hemoglobin among the three groups (mild, moderate, severe) were compared with mean cord hemoglobin of the non-anemic group. The difference between the groups were statistically significant with P values <0.01, <0.01 and <0.01 respectively. Conclusion: Maternal anemia has a significant impact on the hemoglobin status of the newborn. There was significant difference found between mean cord hemoglobin of newborns from anemic mothers that with newborns from non-anemic mothers.

While there are regional and distant methods for reconstructing acquired scalp defects, the use of local flaps consistently preserves the scalp’s topography. The selection of a local flap for scalp wound covering, similar to the treatment of any other defect, is determined by the defect’s location, size, depth, and the availability of neighboring tissue for rebuilding. The flexible triangular hatchet flap with a partial skin and subcutaneous bridging pedicle exhibits significant adaptability. When used alone or in pairs to address tiny and medium-sized faults, using both rotational and translational movements, it preserves the visual look. Double hatchet flaps are often used in an opposing fashion to transform a circular incision into a ‘S’ shaped suture line. In this case series, the authors describe four representative cases and present a modification of the double hatchet flap in an unopposing configuration, rather than an opposing pattern, to address scalp defects when the type and extent of injury precludes the use of flaps positioned 180 degrees apart. Authors assert that this approach enhances the developing repertoire of reconstructive surgeons and may be used in the specified scenarios when conventional methods are inadequate for covering moderate-sized scalp deformities.

82. Evaluating Risk Factors, Clinical Presentation and Angiographic Outcomes in Left Main Coronary Artery Stenosis
Jain Pramesh, Goel Ankur, Namdev Hemant, Gupta Piyush, Kurmi Pradeep
Background: Patients with left main coronary artery (LMCA) disease often present with variable angiographic findings, posing significant challenges in diagnosis and treatment.  Therefore, we aimed to evaluate the risk factors, clinical presentation, and angiographic outcomes in patients with LMCA stenosis. Methods: This prospective, observational study included 36 patients who underwent coronary angiography between January 2023 to December 2023 at a Tertiary care centre in central India and were diagnosed with LMCA disease. Patients were categorized into obstructive (>50% stenosis) and non-obstructive (≤50% stenosis) LMCA disease groups. Comprehensive clinical evaluations, including coronary angiography, were performed among the patients. Results: Of the 36 patients, 12 (33.3%) had obstructive LMCA disease and 24 (66.7%) had non-obstructive LMCA disease. Elderly patients (50-60 years) had more prevalence (58.3%) of LMCA stenosis. Diabetes (61.1%), hypertension (52.7%), and smoking (47.2%) were the most prevalent risk factors. Unstable angina was the most common clinical presentation (72.2%) followed by stable angina (22.2) and ST-elevation myocardial infarction (STEMI) (5.5). Triple vessel disease was observed in 72.2% of patients, and distal bifurcation lesions were most common (66.6%). All patients with obstructive LMCA disease showed ST-segment elevation in lead aVR on electrocardiogram. In-hospital outcomes for obstructive LMCA disease patients included cardiogenic shock and heart failure (41.6% each), with no death or post-procedure complications. Non-obstructive LMCA patients experienced no adverse events. Conclusion: This study identified smoking, hypertension, and diabetes as key risk factors for LMCA disease. Unstable angina was frequently associated with LMCA disease. Triple vessel involvement and distal bifurcation lesions were common. Obstructive LMCA disease was linked to severe complications such as cardiogenic shock and heart failure.

DOI: 10.5281/zenodo.

Introduction: Propofol is widely used in general anesthesia, though its administration is often associated with pain at the injection site. This discomfort can hinder the overall patient experience and recovery. Various methods have been explored to mitigate this pain, with pre-injection treatment using local anesthetics such as lignocaine being particularly notable. Understanding the optimal duration for venous occlusion during this pretreatment can aid in clinical practice. Aim: To study the effect of two different durations of venous occlusion under a tourniquet in preventing propofol injection pain with pretreatment using lignocaine. Objectives: 1. To determine the incidence of propofol injection pain with pre-treatment using lignocaine. 2. To assess the severity and grading of pain using the McCririck and Hunter pain scale. Materials and Methods: This prospective, randomized controlled study involved 100 patients of both genders, scheduled for elective surgeries under general anaesthesia. Participants were divided into two groups (Group L30 and Group L60), each consisting of 50 patients. Group L30 received Injection Lignocaine 40 mg intravenously with venous occlusion for 30 seconds, while Group L60 received the same dose under occlusion for 60 seconds. Pain was assessed after administering 25% of the total calculated dose of propofol. Preoperative assessments included checking for lignocaine sensitivity and investigating general fitness for anesthesia, followed by appropriate premedication and monitoring during the procedure. Results: The study revealed that significantly more patients in Group L30 (70%) reported pain compared to Group L60 (36%), with a statistically significant p-value of < 0.05. Among those who experienced pain in Group L30, 60% reported mild pain and 10% moderate pain. In contrast, Group L60 revealed that 34% experienced mild pain and 2% reported moderate pain. Conclusion: The findings indicate that pretreatment with Injection Lignocaine 40 mg under venous occlusion for 60 seconds leads to a significantly lower incidence.

Background: In clinical practice, we often encounter head and neck lesions requiring careful consideration and management. Fine needle aspiration cytology serves a crucial part in diagnosing these conditions due to the convenient accessibility of aspiration. When distinguishing between neoplastic and non- neoplastic etiologies, FNAC is essential, enabling clinicians to make informed decisions regarding patient management. Aim: The study aims to assess the role and usefulness of FNAC in diagnosing lesions of the head and neck. Materials and Methods: This is a prospective descriptive cross-sectional study conducted over eighteen months, utilizing FNAC at GITAM Institute of Medical Sciences and Research, Visakhapatnam. Results: A total number of 234 cases of head and neck lesions were evaluated. The most common age group encountered was 31-40 years with 38% of cases. Predominant cases were females 65.3% when compared to males 34.7%. The thyroid gland was the predominant site observed in 104 cases (44.4%) followed by the lymph node in 93 cases (41%). Thirteen cases (5%) were observed in the salivary gland. Skin and soft tissue cases were fifteen (6%) and nine cases (3.6%) were seen in the oral cavity. In a total of 234 cases there were 112 (47.9%) cases of non-neoplastic etiology, 117 (50%) cases pertaining to neoplastic etiology and five cases (2.1%) were indeterminate. Out of 117 neoplastic lesions, 102 (87.1%) were benign and 15 (12.9%) were malignant. Conclusion: FNAC serves as a straightforward, quick economical and minimally invasive technique. This study has determined that it can distinguish between non-neoplastic and neoplastic etiologies which contributes to the avoidance of unnecessary surgery and aids in the selection, guidance and adaptation of surgical planning for patients who need surgical procedures.

Background: US Food and Drug Administration (FDA) defines generic drug as “a drug product that should have the same active ingredient, strength, dosage form, route of administration, quality, performance characteristics, and intended use as the brand-name drug”. Prescription of generic drugs when clinically appropriate can reduce costs without reducing quality. Aim and Objectives: Aim of this study was to assess knowledge, Attitude and Practices of Generic Medicine among medical practitioners of tertiary care teaching hospital. Materials and Methods: A prospective observational questionnaire-based study was conducted after approval by Institutional Ethics Committee. Pre-validated Questionnaires based online google form about Generic Medicines was sent to 80 medical practitioners. Among them 78 Medical Practitioners voluntarily participated in the study. Data collected through Medical Practitioner’s responses in the google form and analyzed by using Microsoft Excel sheet. Results: 80% Medical Practitioner believed that Brand name medicines are copy of Generic name medicine. 82% Medical Practitioner believed that Generic Medicines are therapeutically equivalent than Brand name medicines. 45% Medical Practitioner believed that Brand name medicines produce lesser side effects than generic medicines. 56% Medical Practitioner prescribed Brand name medicine when Generic Medicine are available. 30% Medical Practitioner think that there should be a generic medicine store at every government hospital. Conclusion: However, Medical Practitioner had good knowledge and perception towards Generic medicine but there is a need to conduct Awareness Programs, Continuing Medical Education (CME), Workshops and Conferences to improve knowledge about the Generic Medicine. So that would increase the use of generic drugs which ultimately would reduce healthcare expenditure.

Background: Fixed-Dose Combinations (FDCs) of medications are increasingly prevalent in the Indian pharmaceutical market. However, the irrational prescribing of FDCs poses a significant public health concern. To address this issue, it is essential for healthcare professionals to promote awareness, ensure they remain up-to-date with the latest developments and adhere to rational prescribing practices. The possessing comprehensive knowledge, adopting appropriate attitudes, and engaging in prudent practices are crucial for optimal daily clinical practice across all health care settings. Aim: Aim of this study was to assess the knowledge attitude, and practices of Fixed Dose Combinations (FDCs) among medical practitioners in Gujarat. Methods: This prospective observational study (IEC approved) surveyed 219 medical practitioners across Gujarat using a pre-validated online questionnaire (Google Forms). The survey was completed by 218 respondents, and data were analysed as frequencies and percentages. Results: Out of 218 participants, only 17% believed that there is sufficient regulation and oversight of FDCs in India. 16.5% believed that prescription is necessary to avail FDCs from pharmacies. 50.9% never checked rationality before prescribing any FDCs. Participants gained knowledge about FDCs mainly through random internet surfing (60.1%) and from medical representatives (53.7%). More than 50% of respondents were unaware of recently banned or approved FDCs. Conclusion: Most medical practitioners are unaware of FDCs, their rationality, and recently approved and banned FDCs. This limited knowledge leads to suboptimal attitudes and inadequate practices regarding FDCs. A multi-step approach involving all stakeholders, including consumers, medical practitioners, regulatory authorities, industry leaders, and academicians, is necessary to decrease the irrational use of FDCs in India.

Background:  Rheumatoid arthritis (RA) is a Chronic systemic autoimmune disease characterized by inflammatory arthritis especially involving the small joints with irreversible joint damage and extra-articular involvement. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (Anti CCP antibodies) are currently used as biomarkers for diagnostics.in this study, we aimed to investigate the value of combined anti- CCP antibody and RF assays in the clinical diagnosis of patients with RA. Materials & Methods: A total of 111 new consecutive  patients above the age of 16 years who are clinically diagnosed to have  Rheumatoid arthritis were tested for the presence of Rheumatoid factor & Anti CCP antibodies. Result: The sensitivity of RF by Latex agglutination test is 42%, Specificity  88% &  Positive Predictive Value (PPV)  90%. The sensitivity of Anti CCP antibody detection by ELISA is 70%, Specificity  93% and PPV 96%. There is a  significant increase  in the sensitivity of the combined assay when compared to the assays done separately. The specificity & PPV of the combined assay also shows improvement. Conclusion: The combination assay outperformed any single  assay in terms of sensitivity, specificity & PPV.

Background: Acute pancreatitis is a catastrophic condition with many complications and poses a great challenge to the treating surgeon. 10-20% of the patients who develop complications will not recover with simple supportive therapy. Hence, an accurate prediction of severity and prognostic monitoring are necessary to anticipate the early and late complications so as to consider aggressive treatment. The present study was aimed at predicting the prognosis in patients with acute pancreatitis by using the Serum Amylase, Serum Lipase, APACHE II scoring system and at determining the utility of these scores in further management. Methods and Material: 84 patients, who were admitted to the PES Institute of Medical sciences with the clinical and radiological evidence of acute pancreatitis with an elevation in the serum amylase levels, were the subjects of this study. Results: Among 84 patients, 50 had severe disease and 34 had mild disease based on serum CRP (P<0.05). On the first day of hospitalization Serum Amylase and APACHE II scoring system were analyzed. Serum CRP was taken at 48 hours of admission. The age of incidence was between 31 to 40 years. Males were more commonly affected than females. Alcohol was the main factor in both mild and severe disease related deaths. The percentile of patients for mild and severe pancreatitis for Serum Amylase, APACHE II score and serum CRP includes 83.3%, 45.2%, 40.5% and 16.7%, 54.8%, 59.5%. The Standard Deviation of Serum Amylase, APACHE II score and serum CRP includes 347.1, 3.0, 24.1.The statistical inference of all the three parameters comparing one value with other parameters shows serum CRP has significant value of P<0.05. Conclusion: Serum CRP plays a significant role in stratifying individuals for early, aggressive treatment in order to reduce morbidity and mortality from Acute Pancreatitis. To define characteristics that allow for the establishment of multifactorial scores or biomarkers to predict acute pancreatitis severity and track disease progression, large population-based multi centre studies must be designed and conducted.

Background: Thyroid cancer is one of the most prevalent cancers of the endocrine system. TSH is involved in the regulation of thyroid function such as secretion of thyroid hormones, maintenance of thyroid-specific gene expression and gland growth. Higher TSH levels have also been associated with advanced stage thyroid cancer and it has been suggested that TSH may play a central role in its development and progression. Early detection and treatment are beneficial to prolonged survival. Higher thyroid stimulating hormone (TSH) level in a patient with a thyroid nodule is associated with a greater risk of differentiated thyroid carcinoma. Aim of the study is to evaluate utility of serum TSH levels as a predictor of malignancy in thyroid nodules. Methodology: Prospective observational study done in 60 cases of Thyroid nodules by Purposive sampling method in patients attended to OPD of Department of General Surgery PES Medical College and Hospital during October 2022 to November 2023. Results: The results of the study are as follows: Most of the patients were females with an average age of 57.69 ± 11.71 years. The mean age of malignancy was 59 years, with a higher mean age in males (67 years) compared to females (57 years). The majority of malignancy patients presented with a suspicious nodular thyroid (SNT). About 60% of malignancy patients presented with SNT. About 60% of malignancy patients had cervical lymphadenopathy. The mean preoperative TSH value was 1.87 ± 1.23 mU/L. The mean TSH value in malignancy was higher (3.41 ± 0.83mU/L) compared to those with benign disease (1.36 ± 0.86mU/L). The incidence of malignancy increased with higher TSH values. Conclusion: This study showed that serum TSH estimation can be a useful predictor of malignancy in suspicious thyroid nodules.

Background: Episiotomy, a surgical procedure that involves giving a perineal incision to widen the vaginal opening during childbirth, has been commonly practiced. In managing episiotomy pain and promoting wound healing, two commonly utilized interventions are infrared lamp therapy and sitz bath. This study aims to compare the effectiveness of infrared lamp therapy versus sitz bath in reducing pain perception at episiotomy site in postnatal mothers who have undergone vaginal delivery. By assessing the efficacy of these interventions, healthcare providers can optimize care practices and improve outcomes for women during this critical phase of recovery. Materials and Methods: This was a randomized control study conducted among 600 Post-natal mothers who delivered by vaginal delivery with mediolateral episiotomy in the Department of Obstetrics and Gynaecology, GMH, Tirupati, Andhra Pradesh, India for a period of 12 months from March 2023 to February 2024. Results: Majority (72.3%) were aged 21-30 years. Mean age: 23.36±3.57 years. 61.3% were Primipara, 30.7% were Multipara, and 8.0% were Grand multipara. Majority (51.8%) belonged to Low SES. 17.2% held a degree. Majority had normal vaginal deliveries with RMLE (64.8%). 17.7% had forceps delivery with episiotomy, 15.2% had vacuum delivery with episiotomy, 1.3% had preterm vaginal delivery with episiotomy while 1% had twin vaginal delivery (0.2% of this was preterm twin vaginal delivery). Majority experienced moderate pain (66.7%). In the study we observed no significant difference in age between Infra-Red and Sitz Bath groups (p = 0.065), type of delivery (p = 0.520) and significant difference was noted in parity status (p = 0.050), SES (p < 0.001) and education (p < 0.05), pain intensity (p < 0.001) and mean pain score (p < 0.001) between groups. Conclusion: This suggests that while sitz bath remains a viable option for pain management in the postpartum period, it needs to be supplemented with additional interventions, such as infrared therapy, to optimize wound healing outcomes. Further research exploring the long-term effects and cost-effectiveness of these interventions is warranted to guide evidence-based clinical practice and enhance the quality of care for postnatal mothers.

Background: Gestational diabetes (GDM) being defined as carbohydrate intolerance of variable severity first diagnosed in pregnancy and is one of the most common metabolic disorders complicating pregnancy. The higher prevalence is due to changes in lifestyle, dietary habits and Indian ethnicity. Aim of the study is to determine the maternal & perinatal outcome in patients diagnosed with GDM by IADPSG criteria. Patients and Methods: A Prospective study was conducted in the department of Obstetrics and Gynaecology, ESICMC and PGIMSR, Bangalore from January 2020 to June 2021. 206 pregnant women with singleton pregnancy with GDM diagnosed by IADPSG criteria pregnancy were included in the study. The maternal outcome for development of complications like pre-eclampsia, polyhydramnios, preterm labor and post-partum haemorrhage and mode of delivery was determined. Perinatal outcome for birth weight, APGAR score at 5 minutes and NICU admission was measured. Results: Out of 206 patients included in the study, 64% of patients were multiparous. 62.1% had BMI between 25 – 29.9. Preeclampsia in 24.2%, preterm delivery in 15%. 46.6% delivered vaginally, LSCS in 49% and instrumental delivery in 4.4%. The mean APGAR score at 1 and 5 minute was 7.7 and 8.6 respectively. There was Post-Partum Hemorrhage in 18%, shoulder dystocia in 4.9%. Perinatal complications – IUD – 2.9%, neonatal hyperbilirubinemia – 15.1%, hypoglycemia – 9.7%, and Respiratory Distress Syndrome – 8.7%. NICU admission in 24.8% babies. Conclusion: GDM is associated with higher morbidity and mortality. This includes maternal complications like preeclampsia, preterm labor, post-partum hemorrhage and shoulder dystocia. Perinatal complications include IUD, macrosomia, neonatal hypoglycemia, hyperbilirubinemia and RDS. By screening, early detection and timely management of GDM, we can achieve the best maternal and perinatal outcome.

Introduction: Infraumbilical surgeries, including lower abdominal, perineal, and lower limb procedures are frequently performed under regional anesthesia due to its efficacy in providing adequate sensory and motor blockade. Hyperbaric bupivacaine is a commonly used local anesthetic for spinal anesthesia. However, its limitations include hemodynamic fluctuations and insufficient postoperative analgesia. The addition of opioid adjuvants enhances intraoperative analgesia and prolongs postoperative pain relief. Fentanyl, a µ-receptor agonist, is widely used but is associated with side effects such as pruritus, nausea and respiratory depression. Butorphanol, a kappa-agonist and partial µ-antagonist, offers analgesia with fewer opioid-related adverse effects. This study aims to compare the efficacy and safety of intrathecal fentanyl versus butorphanol in combination with bupivacaine for infraumbilical surgeries. Aims and Objectives: The study aims to evaluate and compare the efficacy of fentanyl and butorphanol as adjuvants to intrathecal bupivacaine by assessing:
Onset and duration of sensory and motor block
Hemodynamic stability.
Postoperative analgesic efficacy using the Visual Analog Scale (VAS).
Incidence of side effects.
Material and Methods: A prospective, randomized study was conducted on 100 patients (ASA Grade I-II, aged 18-75 years) undergoing elective infraumbilical surgeries. Patients were randomized into two groups: Group F (fentanyl 25 mcg with 3 ml 0.5% hyperbaric bupivacaine) and Group B (butorphanol 25 mcg with 3 ml 0.5% hyperbaric bupivacaine). Hemodynamic parameters, sensory and motor blockade characteristics, sedation scores and VAS scores were recorded at regular intervals. Statistical analysis was performed using the unpaired t-test and chi-square test. Results: Both groups were comparable in demographic characteristics. The onset of sensory block was slower in Group B but had a significantly longer duration. The onset of motor block was similar between groups, but the duration was shorter in Group F. VAS scores were lower in Group B, and the time to first rescue analgesia was significantly prolonged compared to Group F. Hemodynamic parameters remained stable in both groups. Side effects such as hypotension, pruritus and shivering were more common in Group F, whereas sedation scores were higher in Group B. Conclusion: Both fentanyl and butorphanol are effective as intrathecal adjuvants to bupivacaine for infraumbilical surgeries. However, butorphanol demonstrated superior postoperative analgesia with prolonged sensory and motor blockade, reduced analgesic requirements and fewer side effects, making it a preferable alternative to fentanyl.

Background: Neonatal sepsis is a clinical syndrome in infants’ up to 28 days of life manifested by systemic sign of infection and isolation of a bacterial pathogen from the blood stream. A consensus on definition for neonatal sepsis is lacking1 and one of the four leading causes of neonatal mortality and morbidity in India. The aim of present study was to isolate and identify the bacterial isolates which are responsible for neonatal septicemia and determine their antibiotics resistance pattern in a tertiary care centre in North India. Methods: A total 226 blood samples of septicemic neonate were collected and processed in accordance with standard protocols. Antibiotics susceptibility testing was done by Kirby Bauer disc diffusion method in accordance to Clinical laboratory Standards Institutes (CLSI) 2022 guidelines. Results: A 21.68% (49 out of 226) case of septic neonate’s blood culture was positive. Staphylococcus aureus was the most common isolates (73.4%) encountered followed by E.coli (16%), Acinetobacter spp (4%), Enterococcus spp (4%) and Klebsiella spp (2%) Gram-positive isolates shows excellent sensitivity to Linazolid and Vancomycin. Gram-Negative organisms E coli is 100% resistant to Ceftazidime ,87.3%, to Ampicillin-Sulbactum and Klebsiella spp are resistant to all drugs. Conclusion: This study concludes that the isolates organism exhibited higher resistance towards commonly drug used antimicrobials. Health care personal and common population should be aware of the antibiotics resistance to frequently used antibiotics.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by ovarian dysfunction, hyperandrogenism, and metabolic disturbances. Advances in ultrasonography, particularly color Doppler, have provided new insights into the vascular alterations associated with PCOS. Objective: To evaluate vascular changes in the uterine and ovarian arteries using color Doppler ultrasonography in patients with PCOS and establish correlations between clinical, biochemical, and Doppler parameters. Methods: This observational study included 120 women diagnosed with PCOS based on clinical, biochemical, and ultrasound criteria. Patients underwent transabdominal and transvaginal ultrasonography, with color Doppler assessment of ovarian and uterine artery parameters, including pulsatile index (PI) and resistance index (RI). Correlations between Doppler indices, hormonal levels, and metabolic parameters were analyzed. Results: The mean age of participants was 24.37 ± 4.08 years, with 65% from urban areas. The most common presenting symptoms were oligomenorrhea (49.2%) and infertility (33.3%). The mean BMI was 27.26 ± 1.77 kg/m², with 89.2% of patients classified as overweight. The mean ovarian volume was significantly increased (Right: 15.79 ± 3.57 ml; Left: 15.71 ± 3.41 ml). The mean ovarian artery PI was 1.02 ± 0.19 and RI was 0.59 ± 0.06, while the mean uterine artery PI and RI were 0.78 ± 0.12 and 2.05 ± 0.69, respectively. Statistically significant correlations were observed between LH, LH/FSH ratio, and uterine artery PI (p<0.05). Conclusion: Color Doppler ultrasonography demonstrates significant vascular alterations in PCOS, supporting its role as a valuable diagnostic and prognostic tool. These findings may aid in early diagnosis and targeted management strategies for affected women.

Venolymphatic malformation (VLM) is a rare vascular anomaly, with fewer than 50 reported cases in the knee joint. We present a case of a 12 year-old Asian girl with no pre-existing illnesses presented with pain over right knee and difficulty in walking over the past few years. The patient had limited mobility and a flexion deformity at her right knee joint and was walking on her toes. The time duration from the onset of symptoms to the diagnosis was approximately of 3 – 3.5 years. She had no history of trauma. Physical examination revealed mild swelling over right knee with marked atrophy of the surrounding muscles at and below the knee joint. Clinical examination revealed fixed flexion deformity of approximately 30 degree. A few conservative management led to reduction of joint swelling for a short duration but did not resolve completely and recurrent exacerbation of swelling was noted. After a conventional radiography, we performed Knee ultrasound followed by 3 Tesla MRI which revealed cluster like venous malformation with associated surrounding muscle atrophy. The diagnosis was further confirmed with histopathologic assessment in this patient. Open surgery was performed which enabled complete excision of the mass and follow up was done.

Background: The cervical lymph node pathology spectrum exhibits considerable diversity, encompassing benign reactive changes and malignant transformations. A comprehensive understanding of the etiology, clinical manifestations, and diagnostic nuances is essential for effective patient management. Combined use of ultrasonography and elastography improves diagnostic efficacy in differentiating benign from malignant cervical lymph nodes, thereby helping in treatment planning and reducing unnecessary fine needle aspiration cytology/ biopsy. Our aim of this study is to prospectively differentiate benign and malignant cervical lymph nodes based on B-mode ultrasonography and sonoelastography pattern and correlating them with histological findings. Material and Methods: Patients underwent ultrasonography (B-mode) followed by elastography. Lymph node morphology on B-mode was assessed based on short axis diameter, short-to-long axis ratio, fatty hilum, echogenicity, and margin. Color Doppler assessment was also done to assess the vascularity pattern. On elastography, lymph nodes were defined based on elastography pattern and strain index and were characterized as benign or malignant using a five-pattern classification to define relative distribution and ratio of soft or hard regions of the LN. The final diagnosis was confirmed using fine-needle aspiration cytology (FNAC), core biopsy, and excisional biopsy according to each patient’s condition, followed by histopathological examination. B mode Ultrasonography and Elastography findings were correlated with FNAC/Histopathological diagnosis for malignant and benign lesions. Results: The sensitivity and specificity of B-mode USG for diagnosis of malignant lesions was 76.2% and 85.0%. Its positive and negative predictive values were 72.7% and 87.2% respectively. Accuracy of B mode USG was 82%. FNAC/Histopathology diagnosed a total of 21 cases as Malignant while Elastography diagnosed 21 cases as Malignant, 18 true positive, 3 false positive, 3 false negative and 37 true negative. Correspondingly, Elastography had sensitivity, specificity, negative predictive, positive predictive and accuracy values of 85.7%, 92.5%, 85.7%, 92.5% and 90.2% respectively for diagnosis of Malignancy. Conclusion: Compared with B-mode USG, elastography had a better sensitivity as well as specificity. Elastography can be a useful adjunct to ultrasonography for the accurate diagnosis of cervical lymphadenopathy. Elastography pattern and cut-off strain index of two can effectively differentiate benign from malignant cervical lymph nodes. With such high sensitivity and specificity, elastography had a high diagnostic yield which places it as the diagnostic modality of choice.

Background: Pregnancy is a physiological condition that can bring changes in ECG pattern and cardiovascular events. It was also found that cardiovascular changes during pregnancy can produce severe complications. It is very important to know the cardiovascular changes & ECG during pregnancy to manage the complications. Methodology: Total 300 study subjects were enrolled in the study. 150 were non-pregnant as controls and 150 were pregnant as cases. Subjects were investigated for ECG, blood pressure, heart rate, pulse rate, mean systolic blood pressure, mean diastolic blood pressure, and mean arterial pressure. All the readings were recorded. Results : This was observed that pulse rate , mean systolic blood pressure and mean arterial blood pressure was significantly raised in pregnant women when compared with non-pregnant(p<0.05). In ECG findings short PR interval was significantly more in pregnant women than non- pregnant women (p<0.05). Conclusion: This can be concluded that in pregnancy both cardiovascular changes as well as changes in ECG pattern can be recorded that can help to manage the complications during pregnancy.

Introduction: The most prevalent condition affecting the gallbladder is gallstones. It can lead to acute or chronic inflammation to metaplasias and even cancers. The measurement of argyrophilic nucleolar organizer regions (AgNORs) is a valuable diagnostic tool to determine the malignant potential of gallbladder lesions and is a good sign of cellular proliferation activity. Aims and Objectives: The study’s main objectives were understanding the morphologic variety of gall bladder lesions and their link to cholelithiasis and AgNOR counts. Materials and Methods: It was a prospective study done on 100 cholecystectomy samples received from August 2017 to December 2019 for histological evaluation at the department of Pathology. Hematoxylin and eosin staining was done, and slides were examined histopathologically. In 100 cells, the number of AgNOR staining’s, appearing as black dots inside the nucleus, were counted. Results: In 100 cases included in the study 89% were female and 11% were male, with a female to male ratio of 8.1.1. Out of these 93 (93%) had calculi, including the seven premalignant and three malignant cases. Mean AgNOR counts ranged from 2.57 ± 0.53 in benign cases to 4.53 ± 0.12 in premalignant cases to 8.56 ± 0.57 in malignant cases. A statistically significant increase in AgNOR counts was observed (p 0.001). Conclusions: Cholecystectomy specimens can reveal a wide range of histological abnormalities, from chronic cholecystitis to cancer. The AgNOR technique is a simple, affordable, and accurate way to determine whether gallbladder lesions have malignant potential.

Introduction: The wide and free availability of organophosphate and carbamate compound has resulted in gradual increase in accidental and suicidal attempts. Diazinon, Tik 20, Darf, Ragar, Temik, Baygon and several others have been introduced into the market and the new compounds continue to appear periodically. These compounds have different chemical structures, different effects and different metabolic pathways in human body and on consumption produce various acute as well as delayed toxic effects with various metabolic complications. Objective: The present study was undertaken to evaluate the biochemical and metabolic parameters in patients of organophosphate and carbamate compound poisoning. Method: A Prospective observational study was conducted at Department of Medicine, MGM Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India. The study included all patients of organophosphate and carbamate poisoning admitted during the study interval. Results: Out of 45 cases, 62.2% were male and 37.8% cases were females. Ingestion of poison was seen in 97.8% of cases and 2.2% inhalation of poison was observed. Oragnophosphate poisoning was most commonly used i.e. 84.4% cases and Rogar was consumed by 40.0% cases followed by Tick 20 in 22.2% cases. The cause of consumption of poison was suicidal attempt i.e. 91.1% cases followed by accidental in 8.9% cases. Conclusion: The clinical features found were miosis, sweating, fasciculations, paralytic signs. The acute biochemical and metabolic abnormalities are not rare in organophosphate and carbamate poisoning. Patient with these poisonings should be admitted to an intensive care unit where appropriate biochemical and hematological monitoring facilities are available in order that these serious metabolic and biochemical abnormalities can be treated at an early stage and to rescue the patient from death.

Introduction: Dengue is one of the most serious and viral infection most commonly caused by mosquito bite in man. Dengue is most frequently febrile arthropod borne arboviral disease affecting tropical and sub-tropical regions of the world. Dengue is endemic in India. Objective: The present study had undertaken the utility of immunochromatographic test for detection of NS1 antigen and to know the prevalence of serological markers of dengue infection in a tertiary care hospital. Method: A Prospective observational study was conducted during October 2015 to September 2017 at Department of Microbiology, MGM Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India All the samples received in microbiology department from suspected cases of dengue infection attending OPD and IPD of tertiary care hospital during study period had been included. Results: Out of 243 serum samples 99.17% were positive for either NS1 antigen and/or IgM and or IgG antibodies. 81.48%, 12.34%, 1.23% were positive for only NS1 Ag, IgMAb, & IgGAb, respectively. Out of 241 dengue seropositive patients 41.15% had platelet count <10⁵/cmm. ELISA test is more sensitive for detection of NS1 Ag as compared to ICT. Conclusion: NS1 Ag is an early marker for diagnosis of dengue infection as it can be detected from day one of onset of fever. ICT test detected primary dengue infections and secondary dengue infection on the basis of IgMAb positivity. As secondary dengue infection are associated with higher mortality. ICT test is easy to perform which gives the results within 15-20 minutes without involving any specific laboratory Equipments. For early diagnosis of dengue infection by detection of NS1 Ag gives promising results. Microlisa increases the diagnostic efficiency without the requirement of paired sera.

Introduction: Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hrs after patients have been intubated and received mechanical ventilation. It is characterized by the presence of a new or progressive infiltrate, signs of systemic infection, changes in sputum characteristics, and detection of a causative agent. VAP pneumonia which contributes to approximately half of all cases of hospital-acquired pneumonia and is the second most common nosocomial infection in the intensive care unit (ICU). Aims: Primary Aim: To detect the common pathogens causing Ventilator Associated Pneumonia (VAP) and their sensitivity pattern. Secondary Aim: To improve the specificity of the diagnosis of VAP and avoid the consequent unnecessary antibiotic usage and its associated problems. Results: A total of 230 people suspected of VAP were enrolled in this study. These included 138 60%) males and 92(40%) were females. Endotracheal Aspirate Semi-quantitative culture and blood cultures were done. 40.4% of patients with positive Endotracheal aspirate cultures were considered as VAP cases of which 60.2% were males and 39.8% were females. The most common age group of VAP patients in our study were from 60-74years.The mean age was 65 years. 49.5% of VAP patients were given broad spectrum antibiotics in preceding week. In non-VAP patients only 43% were given broad spectrum antibiotics, showing that prior antibiotic intake is significant risk for development of VAP. 67.7% 0f VAP patients were put on mechanical ventilation for more than 10 days. P value is 0.09 which is significant. Majority of patients in our study (66.6%) had late onset VAP and 34.4% had early onset. Conclusions: The incidence of ventilator associated pneumonia was around 40 percent among suspected mechanically ventilated patients in intensive care units , being predominantly late ventilator associated pneumonia and caused mainly by multidrug resistant gram negative bacteria, Acinetobacter spp and klebsiella spp. Nearly half the patients who developed ventilator associated pneumonia have taken prior antibiotics. The microbiological profile generated by this study will certainly help in giving guidance for formulating empirical therapy for suspected ventilator associated pneumonia patients. Moreover it will also provide guidance for the development of effective hospital infection control policy and measures which will help in preventing and controlling ventilator associated pneumonia.

Background: Vitamin D deficiency is associated with insulin resistance and type 2 diabetes through several mechanisms. Vitamin D also influences insulin receptor expression, enhancing glucose transport responsiveness. Aims & Objectives: To estimate serum vitamin D level and its relation to glycemic control in newly diagnosed type 2 diabetes mellitus, as assessed by HbA1c percentage with the objectives to estimate the serum vitamin D level in newly diagnosed type 2 diabetes mellitus patients and to find out relationship between serum vitamin D level and glycemic control in newly diagnosed type 2 diabetes mellitus. Materials and Method: This hospital based cross sectional study was conducted in the Department of Medicine, Jorhat Medical College and Hospital, Jorhat, Assam. Total of 70 newly diagnosed type 2 diabetes patients were enrolled in this study. Results: Mean age of patients was 53.4 years. 40(57.1%) were males & 30(42.9%) were females. Mean HbA1c of newly diagnosed diabetic patients was 9.31%. 52.9% (n=37) had HbA1c in range of 6.5 to 9%; 31.4% (n=22) had HbA1c in range of ≥ 9 to12%; 15.7% (n=11) had HbA1c in range of ≥12%. Total of 29(41.4%) patients were found to be having insufficient levels of Vit D and 16(22.9%) other patients were deficient of Vit D. 25(35.7%) patients had sufficient levels of Vit D. Individuals with Vit D levels <20ng/ml had significantly higher HbA1c levels (11.55%) with regard to those who have levels of Vit D in 20-30ng/ml category (9.26%) & above 30ng/ml (7.94%). Conclusion: From this study it can be concluded that most of the newly diagnosed type 2 diabetes patients were found to be having either deficient or insufficient levels of circulating vitamin D level. It is also found that with increasing level of HbA1c, there is increased frequency of serum vitamin D deficiency.

Background: In pregnancy, deficiency of micronutrients like vitamins and minerals has been documented in previous studies. The possible deleterious effects of the deficiency on fetal outcomes and feto-maternal health are shown to be associated in some studies. However, data are scarce from Eastern India. Objective: To determine the health institute-based point prevalence of selected micronutrients in pregnant mothers and their association with adverse fetal and maternal outcomes. Methodology: In this community-based prospective observational study, complete blood count, vitamin B12, vitamin D, folic acid, iron profile, zinc and calcium are measured from pregnant mothers who attended 4 primary health centers in Jamuhar, Sasaram (Rohtas district) of Bihar during February 2024 to January 2025. ELISA and RIA were used to estimate serum ferritin and folate with minimum cut-off 15 and 3 ng/mL respectively. By food frequency questionnaire, pattern of food consumption was assessed. ECLIA was used to estimate vitamins B12 and D with minimum cut-off 197 pg/mL and 50 mmol/L. All mothers were followed up (physically and/or telephonically) to observe fetal and maternal outcomes till at least 1 month after delivery. Results: Out of 251 pregnant women, 156 (62%) had Vitamin B12 deficiency, 148 (59%) had Vit D deficiency; 126 mothers (50%) had Zinc deficiency and 73 (29%) had Ferritin deficiency. 112 participants (45%) had anaemia. Most mothers (54%) were in the second trimester. 123 mothers (49%) were suffering from multiple micronutrient deficiency. Significantly higher incidence of adverse fetal and maternal outcomes was associated with multiple micronutrient deficiency (Odds Ratio 2.656, 95% CI 1.246 – 5.657; P = 0.011). Conclusion: Pregnant women were suffering from deficiency of multiple micronutrients of which Vitamin B12 and Vitamin D deficiency were high. The incidence of adverse fetal and maternal outcomes was significantly high in mothers with multiple micronutrient deficiency.

Background: Gestation, or pregnancy, is a critical period characterized by various physiological changes, including the development of the embryo into a fetus across three trimesters. Nutritional deficiencies, particularly iron, folic acid, and vitamin B12, significantly impact maternal and fetal health, leading to conditions such as anemia. Anemia, especially iron deficiency anemia (IDA), is prevalent in developing regions like Madhya Pradesh, India, where approximately 60% of pregnant women are affected, posing risks of premature birth and low birth weight. Understanding the roles of these nutrients and the regulatory peptide hepcidin is essential for improving maternal and fetal health outcomes. Aim & Objective: To study serum hepcidin, vitamin B12, Folic acid and Iron in anemic pregnant women in Indore region. Compare all these parameters between cases and controls. Materials and Method: Total 300 subjects were studied which were divided into two groups of 150 of anemic pregnant women as cases and 150 non-anemic pregnant women as controls. Healthy controls after defining proper inclusion and exclusion criteria. Hepcidin was estimated by ELISA, vitamin B12 & Folic acid was estimated by C.L.I.A. while Iron was estimated by Ferrozine method without deproteinization. Results: Anemic pregnant women exhibited significantly lower levels of serum Hepcidin, serum folic acid, serum Vitamin B12 and serum Iron compared to non-anemic pregnant women as controls. The differences were statistically significant (p < 0.05), indicating the need for monitoring and nutritional support for anemic pregnant women. Conclusion: This study highlights the significant nutritional deficiencies in anemic pregnant women as compared to non-anemic pregnant women. Regular screening and targeted interventions, including dietary counseling and supplementation, are essential to prevent anemia and promote maternal-fetal health during pregnancy.

Background: Abnormal uterine bleeding is a problematic condition affecting women of all ages, with Indian women showing a high prevalence rate. Endometrial pathology is a major cause of AUB, which the pathologist can discern via light microscopy. Objectives: To study the histopathological spectrum of endometrium in cases of abnormal uterine bleeding in correlation with clinical features such as age, parity, and pattern of menstrual bleeding in a tertiary care hospital. Materials and Methods: This is a descriptive cross-sectional study conducted in the Department of Pathology at GITAM Institute of Medical Sciences and Research, Visakhapatnam for one and a half years, from September 2022 to March 2024. We have included 319 patients who underwent dilatation and curettage, hysterectomy, or both, in the study. Results: Heavy menstrual bleeding was the most common symptom, with proliferative and secretory phases of the endometrium being the most common endometrial morphology. We encountered cases of endometrial polyps, endometrial hyperplasia and endometrial carcinoma among others. Leiomyoma was the most common finding in patients who underwent hysterectomy, with some women showing no structural cause. Conclusion: Evaluating the endometrium is an essential diagnostic tool for assessing AUB, which can be influenced by many factors. Women should be educated about recognizing the changes in menstrual bleeding patterns for safer outcomes.

Introduction: Chronic liver disease (CLD) is a major global health concern, leading to progressive liver dysfunction, cirrhosis, and increased morbidity and mortality. The etiological factors of CLD vary across populations, with viral hepatitis, alcohol-related liver disease, and non-alcoholic fatty liver disease (NAFLD) being the most common causes. Materials and Methods: This prospective observational study was conducted at a tertiary care center in Western Gujarat over one year. Patients diagnosed with CLD based on clinical, biochemical, radiological, and histopathological findings were included, while those with acute liver disease or incomplete records were excluded. Data collection involved demographic details, medical history, lifestyle factors, laboratory investigations, and imaging studies. The severity of CLD was assessed using standard scoring systems. Statistical analysis was performed to determine the prevalence of different etiological factors and their association with clinical presentations. Results: Our study on chronic liver disease (CLD) revealed that the majority of patients were aged 51-60 years (29.2%), with a male predominance (70.0%). Laborers (41.7%) and individuals from lower-income groups (60.0%) were most affected. The most common causes of CLD were Hepatitis B (33.3%), alcoholic liver disease (30.0%), and NAFLD (18.3%), while Hepatitis C, autoimmune hepatitis, and metabolic disorders contributed to a smaller proportion of cases. Fatigue (70.8%), jaundice (58.3%), and ascites (54.2%) were the most common presenting symptoms. Ascites (56.7%), portal hypertension (45.8%), hepatic encephalopathy (33.3%), and variceal bleeding (25.0%) were the predominant complications, reflecting the advanced disease stage at presentation. Laboratory findings showed elevated bilirubin, AST, ALT, and alkaline phosphatase, alongside low serum albumin and platelet counts, indicating significant liver dysfunction. Conclusion: Chronic liver disease remains a significant health concern, with Hepatitis B, alcohol-related liver disease, and NAFLD being the leading causes. Early diagnosis and targeted interventions are essential to reduce complications and improve patient outcomes.

Background: AMR is a present day universal healthcare challenge especially in the tertiary health care centres in which MDR organisms are evident. In pursuing the aim of this cross-sectional study, the following objectives were set: To assess the current trends of AMR in the selected bacterial pathogens in a tertiary care hospital and To determine the practicing clinicians knowledge, attitude [KA] towards AMR. Methods: A cross-sectional study was carried out on bacterial isolates derived from clinical samples from January 2020- December 2023 in a tertiary health facility. The data of resistance patterns were obtained from the microbial report forms and included the prevalent hospital-associated pathogens, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Trends in the resistance profiles to antibiotics under study were determined using beta-lactams, fluoroquinolones, carbapenems and aminoglycosides. Results: In the present investigation, a total of 2,346 bacterial isolates were used in the study. E. coli had resistance rates to fluoroquinolones 45.3%, to third generation cephalosporins 30.1%, and to carbapenems 18.5%. K. pneumoniae had resistance rate of 41.8% to beta-lactams and 28.9% to carbapenems. Aminoglycoside resistance of P. aeruginosa was 35.6% and methicillin resistance of S. aureus was 22.3%. Of interest, resistance to more than one antibiotic class was identified in 12.4% of the isolates, and extensive drug resistance in 3.5% of the isolates. Discussion: The results highlight concerning trends in AMR among hospital-associated pathogens. The high resistance rates to essential antibiotics, particularly carbapenems and fluoroquinolones, pose significant challenges to treatment options. The increasing prevalence of multidrug-resistant organisms necessitates enhanced antibiotic stewardship programs (ASPs) and infection control strategies. Diagnostic stewardship should be prioritized to ensure timely and accurate identification of pathogens, minimizing unnecessary antibiotic use. Conclusion: The findings reveal some worrying tendencies in the development of AMR in hospital-associated pathogens. The overall resistance rates to these core antibiotics, carbapenems and fluoroquinolones are high and limit the treatment options. Multidrug-resistant organisms are becoming more common, which means that ASPs and infection control measures must be improved. Diagnostic stewardship should be given a priority in order to identify pathogens on time and reduce the prescription of unnecessary antibiotics.

Background: DDIs are a major issue in hospitalized patients as they result in ADEs, longer hospitalization, and higher costs. DDIs are more likely to occur in patients with multiple co morbidities and on multiple medications. The knowledge of the risk factors for DDIs is important in enhancing patient safety and enhancing the desired therapeutic effects in the hospital. Objective: The purpose of this study is to identify the incidence of DDIs in the patients admitted in the hospital and to understand the factors that put the patients at risk such as polypharmacy, elderly patients and patients admitted in ICU. The purpose is to recognize these factors in order to design preventive measures for managing DDIs. Methods: A retrospective cohort study was carried out and data from patients admitted in the hospital were used. Polypharmacy defined as the use of five or more medications, age greater than or equal to 65 years, and admission to the ICU were evaluated with regard to the presence of DDIs. The ORs and 95% CIs were used to assess the magnitude of these risk factors in relation to the development of DDIs. Significance of the results was analyzed using p-values. Results: The study found that polypharmacy increased the risk of DDIs by 3.5 fold (95% CI 1.8-6.9, p = 0.001). Age above 65 years was also a significant risk factor, showing an odds ratio of 2.8 (95% CI: 1.4-5.6, p = 0.005). ICU admission was found to be the strongest risk factor for DDIs, with an odds ratio of 4.2 (95% CI: 2.1-8.4, p = 0.0001). These results show the importance of these factors in the development of DDIs in hospitalized patients. Conclusion: The study underscores the significant burden of DDIs in hospitalized patients, particularly among those with polypharmacy, advanced age, and ICU admission. Addressing these risk factors through vigilant monitoring, tailored interventions, and collaborative care models can help mitigate the adverse effects of DDIs, enhance patient safety, and improve clinical outcomes. Healthcare providers should be aware of these risk factors to optimize drug regimens and reduce the likelihood of harmful drug interactions.

Perforation peritonitis is amongst the most frequently encountered surgical emergency in general surgery. Incidence of perforation of hollow viscus, the site of perforation, and age at which it occurs are all variable in the developing world, and the trends are ever changing. The spectrum of etiologies leading to peritonitis as a result of perforation differs in the developing world, from that in the developed parts of the world.
The present study was conducted as a prospective observational study on patients who underwent Emergency surgery for Perforation peritonitis in the Department of General Surgery, at a tertiary care center of Madhya Pradesh during the period 2022 to 2024. This is a hospital based comparative study.
The sample size of this study was 100. Majority of these patients were Males (84%) while the remaining were Females (16%). 61% patients (61 out of 100 patients enrolled) were found to have no co-morbidities. While 39% patients had different kinds pre-existing co-morbid conditions showing variable degree of overlap i.e. a single patient showing multiple co-morbidities. In our study, it was observed that majority (56%) of the patients were found to have Gastric perforation who underwent either Grahams’s patch repair (36%) or Modified Graham’s patch repair (20%) patients were managed with primary repair of the perforation with or without stoma formation.
In India perforation peritonitis presents as an entirely different spectrum as compared to the western countries. An early diagnosis with adequate pre- operative resuscitation focusing on correction of fluid and electrolyte imbalance followed by an early surgical intervention to provide source control under the cover of appropriate antimicrobials/antibiotics is key to achieve good outcome with minimal morbidity and mortality. Hence this study could be a stepping stone towards easier diagnosis and management of emergency abdominal surgeries. Such studies should be performed on a larger scale to calibrate and demarcate the need of time for repairing perforated abdomen which is beyond scope and limitations of present study.

Background: Thyroid disorders are one of the most prevalent endocrine conditions worldwide, with a significant burden in India. Thyroid swellings require a systematic approach for diagnosis and management, including medical, minimally invasive, and surgical interventions. Objectives: This study aimed to determine the incidence, clinical characteristics, and outcomes of thyroid swellings, assess the correlation between fine-needle aspiration cytology (FNAC) and histopathological examination (HPE), and evaluate different treatment modalities. Methods: A prospective observational study was conducted at a tertiary care center from May 2022 to February 2024. A total of 100 patients presenting with thyroid swelling were evaluated through clinical examination, ultrasonography (USG), FNAC, and thyroid function tests (TFTs). Patients were managed based on their diagnosis, either conservatively, with medical therapy, microwave ablation, or surgery. Histopathological examination was performed on excised specimens to confirm the diagnosis. Results: The most commonly affected age group was 18–39 years (59%), with a female-to-male ratio of 8:1. 82% were euthyroid, 15% hypothyroid, and 3% hyperthyroid. FNAC had a diagnostic accuracy of 97.5%. Hemithyroidectomy was performed in 78.75% of cases, while microwave ablation had a 66.67% success rate in reducing nodule size. Postoperative hypocalcemia (8.75%) was the most common complication. Conclusion: Thyroid swellings are predominantly benign and more common in females. FNAC is a highly accurate diagnostic tool, while hemithyroidectomy remains the preferred surgical approach. Early diagnosis and appropriate treatment improve patient outcomes.

Objective: Major depressive disorder has been linked with inflammatory processes, but it is unclear whether individual differences in levels of inflammatory biomarkers could help in predicting the response to treatment. The authors tested the hypothesis that C-reactive protein (CRP), a commonly available marker of systemic inflammation, predicts differential response to treatment in depression. Method: The hypothesis was tested in patients admitted at a tertiary care centre. CRP was measured with a high-sensitivity method in serum samples from 50 adult men and women with major depressive disorder randomly allocated to this study. The primary outcome measure was the score on the Becks Depression Inventory, Hamilton depression rating scale along with the Clinical Global Impression scale administered on day 1, day 14, and day 28. Results: CRP level at baseline differentially predicted treatment outcome within the two groups. For patients who were tested CRP Negative(level ≤6mg/l), an improvement on the HAM-D and BDI score was greater as compared to the CRP Positive group(level ≥6mg/l). This study showed that the response rate is affected by a high level of baseline inflammation measured by the serum C- Reactive protein levels. Conclusions: An easily accessible peripheral blood biomarker may contribute to improvement in outcomes of major depressive disorder.

The primary contributors to the stability of DRUJ are the dorsal and palmar radioulnar ligaments, while the bony structure only provides around 20% of the overall stability. Chronic DRUJ instability often results from untreated or improperly treated injuries, such as fractures or triangular fibrocartilage complex (TFCC) ligament insufficiency. If DRUJ instability is not properly managed, it can disrupt the normal kinematics of the wrist and forearm, leading to discomfort, weakness, and degenerative osteoarthritis. DRUJ instability is diagnosed when there is excessive ulnar translation in relation to the radius compared to the unaffected wrist on the opposite side. If left untreated, these issues can progressively worsen, leading to further degeneration of the TFCC, joint arthritis, and functional impairments of the wrist and forearm.

Brachial plexus block is a reliable method to provide analgesia and anaesthesia to upper limb surgeries. Supra clavicular brachial plexus block is one of the most common types of brachial plexus blocks performed for upper limb surgeries. Adjuncts such as buperinorphine, fentanyl, tramadol, neostigmine, dexamethasone, dexmedetomidine have been used with local anaesthetic for supraclavicular block.

Introduction: Pancytopenia is not a disease entity but a triad of findings that may result from several disease processes. The differential diagnosis of pancytopenia in elderly can be exhaustive ranging from nutritional anaemia to malignancy. A detailed history with physical examination and a review of the blood film remains fundamental to the diagnosis of pancytopenia. Aim: To study the aetiological profile of pancytopenia in the elderly. Materials and Methods: 36 patients who were more than 60 years of age were clinically evaluated, with complete blood count, peripheral smears, and bone morrow aspiration-biopsy whenever possible, in Akash Hospital, Devanahalli, Bengaluru from May 2023 to October 2024. Patients with haemoglobin <10g/dL, total leukocyte count <4000/µL, and platelet count <1 lakh/µL were included in the study; while those diagnosed with leukaemia on chemotherapy, abnormal bleeding parameters, or had received blood transfusion were excluded. Results: Of the 36 patients, majority of the cases were seen in the age group of 60-70 years of age, with predominance of males. Most common cause of pancytopenia in this study was Megaloblastic anaemia (22.2%), followed by Alcoholic liver disease (19.4%) and Myelodysplastic syndrome (13.9%). 3 cases of liver cirrhosis following non-alcoholic fatty liver disease were also noted. Conclusion: Pancytopenia in elderly indicates significant underlying pathology that can be attributed to the nutritional, personal habits and infective causes. In this study, the most common aetiology was megaloblastic anaemia. An increase in incidence of liver disease is probably due to increasing trend of alcoholism in our society. Identification of cause can help the clinician in initiation of appropriate therapy.

Background: Chronic liver disease (CLD) is associated with complex hemostatic alterations that can lead to both bleeding and thrombotic complications. This study aimed to investigate coagulopathy in CLD patients and understand its clinical implications. Methods: This prospective observational study enrolled 43 adult patients with CLD of varying severity. Coagulation parameters (PT, INR, aPTT, platelet count) were assessed at baseline and during follow-up. Patients were monitored for bleeding and thrombotic events. Correlations between coagulation parameters and disease severity (Child-Pugh and MELD scores) were analyzed, and predictors of clinical events were identified using multivariate regression. Results: The study population (mean age 54.3 ± 11.7 years, 74.4% male) comprised 34.9% Child-Pugh A, 41.9% Child-Pugh B, and 23.2% Child-Pugh C patients. Coagulation parameters showed significant deterioration with increasing Child-Pugh class (p<0.001 for all parameters) and strong correlations with disease severity scores (r=0.756 for INR and Child-Pugh score, p<0.001). During the study period, 32.6% of patients experienced bleeding events and 14.0% developed thrombotic complications. Patients with bleeding events had significantly worse baseline coagulation parameters compared to non-bleeders (INR: 2.1 ± 0.6 vs. 1.5 ± 0.4, p=0.001; platelet count: 93.4 ± 32.6 vs. 134.7 ± 45.8 × 10³/µL, p=0.004). Multivariate analysis identified INR > 1.8 (adjusted OR=4.28, p=0.012), platelet count < 100 × 10³/µL (adjusted OR=3.74, p=0.020), and Child-Pugh Class C (adjusted OR=3.95, p=0.017) as independent predictors of bleeding. Dynamic worsening of coagulation parameters was significantly associated with bleeding risk in Cox regression analysis. Conclusion: Coagulopathy in CLD correlates significantly with disease severity and has important clinical implications. Conventional coagulation tests retain value in bleeding risk stratification, while their limitations in predicting thrombotic complications highlight the complex “rebalanced hemostasis” in CLD. Regular monitoring of coagulation parameters and individualized management approaches are essential in these patients.

Metacarpophalangeal dislocations are rare they are subdivided as simple and complex dislocations, complex dislocations are also called as Kaplan Dislocation.
While simple volar dislocations can often be reduced through closed maneuvers, complex dislocations are complete and require surgical intervention as they are irreducible through closed maneuvers.
We present a case of a complex  2nd MCP joint dislocation in a 28 year -old female patient who sustained a hyperextension injury to his index finger. The patient underwent open reduction surgery using a volar approach due to the buttonholing of the phalangeal head through the volar plate and blockage between the flexor tendons and lumbrical muscle. Following the procedure, the joint was immobilized in a palmar slab at 30°-40° flexion for 2-3 weeks before being allowed unrestricted mobilization. At the 6-week follow-up, the patient reported being pain-free and had nearly full range of motion in the index finger MCP joint.

Background: Microbial contamination of air and environment in operation theatres (OTs) has continued to increase the prevalence of surgical site and hospital-associated infections. Control of these infections in operation theatres is of utmost importance as it can increase patient’s morbidity and mortality. Aims and Objectives: Aim of the present study was to identify bacterial colonization of surfaces and to determine the microbial contamination of air by estimating the bacterial colony forming unit (CFU) rate in the OT’s of a tertiary care hospital. Material and Method: This was the tertiary care hospital based retrospective cross-sectional study done for a period of 18 months. Data was collected from routine microbiological surveillance of OT’s done in between February 2023 to July 2024. Two sampling procedures were considered in this study. For air quality surveillance, settle plate method whereas for surface sampling, soaked swabs from different sites in peptone water were included. Collected samples were transported to Microbiology Laboratory of the institution in sterile condition and careful observation was done of bacterial species, which were isolated and further identified by conventional methods. Results: A total of 463 samples were collected from different surfaces of various OT’s. Out of these 43 samples showed bacterial growth. The predominant species isolated was coagulase-negative Staphylococcus 31/43, Klebsiella species 8/43, E.coli 2/43, Staphylococcus aureus 1/43 & Pseudomonas aeruginosa 1/43. OT’s air samples showed highest colony forming unit (cfu) rate in Labor room (123cfu/m³) and least cfu rate in Radiotherapy (37cfu/m³). Conclusion: OTs of our hospital showed highest bacterial contamination in Labor room where the patient load was high and among all the surfaces, OT tables and floor were mostly contaminated with microorganisms.

Aim and objective: To study the incidence, risk factors and outcome of ROP in high risk infants. Material and Methods: All neonates of birth weight < 1500 g and/or with a gestation < 34 weeks admitted to NICU were routinely screened for ROP. Preterm Infants who underwent screening for ROP and infants who are diagnosed as having retinopathy are taken into the study. Data is analysed using MS Excel software &SPSS software (version 16). Results: Incidence of ROP is 28.5%, Gestational age and birth weight are the important significant risk factors for ROP in the study. Gestational age and birth weight are reciprocally related to the incidence of ROP. Oxygen exposure, neonatal sepsis, thrombocytopenia, surfactant, and mechanical ventilation are the other significant risk factors in the study. Laser photocoagulation was found to be effective in the treatment of ROP in the present study. Conclusion: Early diagnosis and prompt treatment of antenatal and natal risk factors prevent the incidence of ROP. Infants with risk factors should be screened regularly for ROP development. Usage of recent technology like retinal imaging with RETCAM can aid in the early diagnosis and prompt referral.

Background: Sepsis is the leading cause of death in Pediatrics Intensive Care Unit (PICU). Vitamin D deficiency is associated with an increased risk and progression of the disease, especially sepsis. A low level of serum Vitamin D when patients admitted in Pediatric Intensive Care Unit (PICU) is at higher risk of death. Therefore, the study was conducted to evaluate the impact of Vitamin D levels in treatment outcome in patients admitted in Paediatrics, Intensive care Unit (PICU). Material and Methods: This observational prospective cross sectional study carried out in the paediatric intensive care unit of U.P.U.M.S. Saifai, Etawah on all patients admitted in PICU more than 1 year to < 14 years age. Vitamin D was measured by ELISA method. PRISM III scoring on admission, at 24 hour and at 48 hour were recorded. Disease Severity and outcome was evaluated by correlating the vitamin D level with the change in pattern of PRISM III value. Results: This study was carried out on 358 patients with sepsis whose outcome was known and admitted to the PICU, Saifai, and Etawah. Out of them 79 cases were expired. Mean Vitamin D levels were significantly higher in those who were discharged (29.08±20.85 nmol/L) as compared to those who expired (22.35±15.94nmol/L) (p = 0.0083). Mean values of PRISM score in cases of sufficient vitamin D level at 0 hr, 24 hr and 48 hrs are 42.18±9.99, 38.20±10.94 and 34.47±13.13 respectively, while these values were 45.24±8.88, 44.53±10.94, 43.71±14.89 at 0 hr, 24 hr and 48 hr. Conclusion: The prevalence of vitamin D deficiency in sepsis patients in PICU was estimated as 61.6%. A significant and indirect correlation was found between the serum level of vitamin D and mortality. 25(OH)D deficiency is prevalent in critically ill children at PICU admission and seems to be associated with higher PRISM-III score.

Antimicrobial resistance is a significant global issue causing millions of deaths, long-term impairments, and increased medical expenditures. The investigation reveals a direct relationship between the widespread use of antimicrobials in human and veterinary medicine and the proliferation of resistant bacteria strains. Methicillin-resistant Staphylococcus aureus (MRSA) is an enormous pathogen that causes a wide range of infections, from minor skin infections to life-threatening conditions like sepsis, pneumonia, and endocarditis. In this study total 700 samples were included, out of which 358 samples were found positive for Staph aureus, after that antibiotic sensitivity testing was done for 358 Staph aureus isolates. Accurate treatment will help to improve the better patient’s outcome and reduces the morbidity rate. An antibiotic policy and screening of susceptibility patterns of MRSA may also help in reduces the prevalence rate of MRSA and antibiotic resistance.

Objectives: The present study was to evaluate the clinical correlation between rapid urease test and histopathology in H. pylori induced gastritis. Methods: 50 patients participated and underwent OGD scopy guided gastric mucosal sampling, 5 gastric mucosal bits were taken from all quadrants of stomach. Among those one bit was used for RUT test and rest were fixed in formalin in paraffin embedded blocks and sent to lab for histopathology for H&E staining and examined for H. Pylori in mucosa and gastric crypts. The enzyme Urease in H.pylori react with urea of test bed producing ammonia reacts with the phenol red indicator in the test changing the colour to pink a positive rut dry test indicates the load of bacteria of around 10⁵ H. pylori in the specimen. Based on laboratory and histopathology reports, the true positives, true negative, and sensitivity and specificities of RUT test and Histopathology were calculated and compared. Results: Out of the 50 cases 92% of patients belonged to lower socio economic status. P  was less than  0.000 and it was statistically significant. H&E detected H. pylori in 36 cases and majority of them had grade 1 gastritis(34%). RUT test showing 33 cases positive among 50 samples, RUT was negative in 17 samples. H&E staining detected H.pylori in 36 samples out of 50 and 14 samples were free of H.pylori. The true positives of RUT were 33 and true negatives were 14. Conclusions: Accuracy of Histopathology (H&E) is better but it is the cost effective and the time consuming. RUT should be used as an informal assessment of the accuracy of the pathology laboratory and discrepancies between the RUT and histology especially a positive RUT and negative histology should lead to prompt review of the histopathology. The positive tests, should be correlated with endoscopy findings and histological assessment of gastric mucosa. Therefore, to maintain high sensitivity and specificity and accurately diagnose the pathogen, it is important to use at least two diagnostic tests depending on the clinical situation.

Background & Objectives: This study was conducted to assess the functional and radiological outcomes of neck of femur fracture treated with cannulated cancellous screws. Study also assessed the associations of functional outcome, fracture union rates and complications. Materials & Methods: This analytical cross-sectional study was conducted on 80 patients with neck of femur fracture who had undergone internal fixation with 3 cannulated cancellous screws. AP and lateral X-rays of the hip were taken for radiological evaluation. The functional status of the patients was assessed by Harris hip score. The data was collected and analysed statistically to draw conclusions. Results: The study included 80 patients with femoral neck fractures, comprising 58.8% males and 41.3% females, aged 18 to over 50 years. Fracture types were predominantly Garden type II (42.4%) and type III (32.5%), with fewer cases of type I (13.8%) and type IV (11.3%). Outcomes were excellent in 42.4% of patients, good in 33.8%, fair in 18.8%, and poor in 5%. Harris Hip Scores were highest for type I fractures (93.45), followed by type II (86.76), type III (83.31), and type IV (81.44). Conclusion: Garden’s classification system provided prognostic insights, showing that non-displaced or minimally displaced fractures (Types I and II) generally had better outcomes, lower complication rates, and higher Harris Hip Scores (HHS). Conversely, displaced fractures (Types III and IV) had higher complication rates, including non-union and avascular necrosis, indicating their increased severity and treatment challenges. Overall, the study confirms that early, appropriate surgical intervention with CC screws is effective, especially for less severe femoral neck fractures.

Introduction: Adverse drug reactions (ADRs) to oral anti-diabetic drugs are a growing concern due to lifelong therapy and widespread use. This study aimed to evaluate the pattern, causality, preventability, and severity of ADRs in diabetic patients attending a tertiary care hospital in Western Gujarat. Materials and Methods: This was a 6-month observational study conducted on 640 diabetic patients. All suspected ADRs associated with oral anti-diabetic drugs were collected, assessed using WHO-UMC causality categories, Modified Schumock and Thornton scale for preventability, and Hartwig and Siegel scale for severity. Results: Out of 640 patients, 258 ADRs were reported. The most common ADRs were hypoglycemia (24.03%), nausea (20.93%), and weight gain (16.27%). Causality assessment revealed 84.88% of ADRs as probable, 12.40% possible, and 2.71% certain. Around 31.78% of ADRs were definitely preventable, while 57.75% were non-preventable. Severity analysis showed that 51.94% of ADRs were moderate, 41.86% mild, and 6.20% severe. Conclusion: In conclusion, careful monitoring, rational prescribing, and patient-specific therapy are crucial to minimize adverse drug reactions and ensure the safe use of oral anti-diabetic drugs in routine clinical practice.

Aim: This study aims to check for any association between sleep quality, mindful attention awareness, and cognitive performance of medical students with a yoga intervention of 4 weeks. Materials and Methods: The study was a two-armed, prospective interventional study. The intervention group had 35 students, and the Non-Intervention group had 35 students from the same university. Participants were selected based on inclusion criteria. The participants were chosen in intervention and non-intervention groups to minimise confounding factors and make the study reproducible. Informed written consent was obtained from all participants before testing. Participants received a thorough explanation of the yoga intervention, questionnaires, and assessments they would complete, ensuring they fully understood the process. Result: Yoga intervention (4 weeks) slightly improved sleep quality (PSQI, p = 0.063), significantly enhanced mindfulness (MAAS, p < 0.001) and cognitive function (MoCA, p < 0.001) in the Intervention group (n=35), with no changes in the Non-Intervention group (n=35). Conclusion: Yoga boosts mindfulness and cognition significantly, with modest sleep benefits, suggesting potential for student wellness programs.

Introduction: Cadaveric dissection plays a crucial role in anatomy education for first-year MBBS students, offering hands-on learning that enhances spatial understanding and manual dexterity. However, students often face challenges due to unfamiliarity with dissection tools, safety protocols, and proper handling techniques, which can lead to anxiety, hesitation, and inefficient dissection. Objectives: This study aimed to evaluate the effectiveness of structured dissection skills training in improving the knowledge, confidence, and preparedness of first-year MBBS students for cadaveric dissection. Methodology: A prospective qualitative study was conducted among 90 first-year MBBS students at GMC, Bettiah, Bihar, from November 2024 to December 2024. Students underwent a structured dissection skills training program covering instrument handling, safety protocols, and basic dissection techniques. Pre- and post-training knowledge assessments were conducted using a validated questionnaire. Additionally, students’ perceptions of the training were collected through a 5-point Likert scale questionnaire. Data were analyzed using SPSS v27.0, with chi-square tests applied to assess knowledge improvement. Results: Significant improvement (p<0.001) was observed in students’ knowledge and confidence across all questionnaire items after training. Knowledge of scalpel handling improved from 24% to 88%, and awareness of dissection tool usage rose from 57% to 90%. Perception analysis revealed that 78% of students supported incorporating structured dissection skills training into the curriculum, highlighting the session’s positive impact. Conclusion: Structured dissection skills training significantly enhances first-year MBBS students’ confidence, efficiency, and engagement during cadaveric dissection, emphasizing the importance of integrating such training into undergraduate anatomy curricula.

Background: Dementia is a common syndrome, especially among the elderly, and[1] represents a major public health issue. Therefore, the objective of the present study is to assess the levels of serum folic acid and vitamin B₁₂ among patients with dementia. Methods: This cross-sectional analytical study was carried out in the Department of Biochemistry in collaboration with the Department of Neurology at S.P. Medical College and its associated hospitals in Bikaner. The study involved a sample size of 50 patients in each group. Results: The mean folic acid level is 3.65 in the Case Group and 7.95 in the Control Group. The mean Vitamin B₁₂ level is 215.27 in the Case Group and 391.13 in the Control Group. Conclusion: This hospital-based study highlights the significant association between folic acid and vitamin B₁₂ deficiencies and the prevalence of dementia among patients. Our findings indicate that reduced levels of these essential nutrients are common in dementia patients and may contribute to cognitive decline. Specifically, deficiencies in folic acid and vitamin B₁₂ were observed in a substantial proportion of participants, suggesting that these deficiencies could be a modifiable risk factor for dementia or potentially exacerbate existing cognitive impairment.

Background: Vitamin D is linked with various physiological processes involving multiple organ systems and its deficiency is associated with pregnancy complication like pre-eclampsia, gestational diabetes mellitus, preterm delivery and low birth weight babies. If correlation is found in vitamin D deficiency and medical complications associated with pregnancy vitamin D supplementation can be optimized for better feto-maternal outcome. Methods: This was a Cross-sectional observational study at Department of Obstetrics and Gynecology, and Biochemistry, SPMC, Bikaner. 150 Antenatal women attending Department of Obstetrics and Gynecology after 28 weeks of gestation (singleton pregnancy) with medical complications like Anemia, gestational diabetes mellitus, hypertensive disease of pregnancy and intrauterine growth retardation were included. Enzyme-linked immunosorbent assay (ELISA) method was used for quantitative determination of 25 hydroxy vitamin D in serum of all pregnant women. Results: We found that 142 (94.66%) women with high-risk pregnancy were vitamin D deficient. Out of that 107 (71.33%) were deficient (serum vitamin D <20 ng/ml) and 35 (23.33%) were insufficient (serum vitamin D < 30ng/ml). Only 8 (5.33%) women with high-risk pregnancy were vitamin D sufficient. Conclusions: Vitamin D deficiency or insufficiency in pregnancy can lead to complications in both mother and fetus. Estimation of vitamin D levels in pregnancy and supplementation can lead to healthy baby and healthy mother.

Laboratory investigations play an important role in the diagnosis of diseases, as treatment and monitoring of patient is dependent on it. So, it is the prime responsibility of laboratory to give correct results. Quality of lab results is dependent on pre-analytical, analytical and post-analytical phases. Pre-analytical phase begins with the clinician’s request and end with the preparation of sample for testing. This phase consists of multiple levels, where errors can be detected. The aim of our study was to assess the various pre-analytical errors in Biochemistry Department in a tertiary care hospital; and find out the corrective measures to minimise the same.
We conducted a prospective study in the tertiary care hospital in Maharashtra, India. It was a pilot study. Total 12,159 samples were observed which involved samples in Outward patient Department (OPD), Inward Patient Department (IPD) and Emergency Section. Maximum number of errors were observed in IPD. Out of the total samples observed, 409 samples were found to have pre-analytical errors which constituted 5.4%. Total errors were further divided into various types of errors. Maximum percentage i.e., 44% samples were found haemolysed,21% samples were insufficient in quantity, 19% samples not received, 9% samples were without requisition forms, 3.2% samples were sent in inappropriate containers and 1.4% samples were found clotted. Pre-analytical errors form important link for maintaining quality of laboratory. So, proper technical education should be provided in the clinical areas during collection and transportation of biological samples to be investigated; which will minimise the pre-analytical errors and improve the quality of results from laboratory.

Lateral ventricle diverticulum is an out pouching from the wall of lateral ventricle which could be congenital or acquired associated with symptoms like visual disturbances, headache, vomiting, gait abnormalities. Long standing hydrocephalus which increases the ventricular wall pressure leading to the formation of diverticulum. We presented a 35-year-old male with headache and blurring of vision, on CT revealed ventriculomegaly with right lateral ventricular diverticulum extending to supra cerebellar cistern. On MRI the same findings are seen which confirmed right lateral ventricle diverticulum.

Introduction: Tuberculosis (TB), a global pandemic caused by Mycobacterium tuberculosis, is particularly deadly in its tuberculous meningitis (TBM) form. This study evaluates the efficacy of Ziehl-Neelsen (ZN) and fluorescent staining (FS) techniques in detecting TBM. Methods: Research was conducted in Konaseema Institute of Medical Sciences and Research Foundation. Both genders, >18 years, suspected TBM were included. CSF was collected by lumbar puncture. Immediately, specimen centrifuged at 3000 rpm for 15 minutes, 2 smears were prepared with sediment, stained by ZN FS. Smears preparation, staining and screening under microscope were carried as per the standard guidelines. Results: Total 32 (100%) TBM cases were detected in the study, 20 (62.5%) were male and the male female ratio was 1.67. The mean age was 41.2 + 4.8 years. With ZN, the positivity was 19 (59.3%) and it was 22 (68.8%) with FS; statistically there was no significant difference. Conclusion: This study emphasizes the critical need for prompt and accurate TBM diagnosis. Although FS showed a slight detection advantage, both FS and ZN methods are valuable, given ZN speed and cost-effectiveness. Reliable diagnoses were supported by specialist-handled CSF collections, aligning with global demographic trends.

Background: Magnetic Resonance Imaging (MRI), particularly diffusion-weighted imaging (DWI), plays a crucial role in the early diagnosis and monitoring of ischemic stroke. The Apparent Diffusion Coefficient (ADC) serves as a key biomarker in stroke evolution, reflecting pathophysiological changes over time. Objective: This study aims to evaluate the temporal variation of ADC values in ischemic stroke patients over a 12-month period, assessing their correlation with infarct duration and stroke progression. Methods: A retrospective analysis was conducted on 100 ischemic stroke patients at MVJMC and RH, Bangalore, using a 1.5T Siemens Magnetom Essenza MRI system. ADC values were obtained from diffusion-weighted imaging with a b-value of 1000, and relative ADC (rADC) values were calculated across predefined infarct duration groups. Statistical analyses, including ANOVA, Pearson’s correlation, and regression modeling, were performed to assess trends in ADC evolution. Results: A significant increase in ADC values was observed across stroke phases, ranging from 41% in the hyperacute phase (0–6 hours) to 221% in the chronic phase (>21 days) (p < 0.001). Pearson’s correlation analysis demonstrated a strong positive correlation between ADC values and infarct duration (r = 0.89, p < 0.001). Regression analysis revealed that infarct duration explained 79% of ADC variability (R² = 0.79). ROC curve analysis confirmed high diagnostic accuracy (AUC = 0.94, sensitivity = 91.2%, specificity = 88.7%). Conclusion: ADC values exhibit predictable temporal changes, providing valuable insights into stroke pathophysiology. The observed trends reinforce the role of DWI in early diagnosis and long-term monitoring, underscoring its potential in guiding therapeutic decisions and prognostic modeling.

Background: Peripheral nerve blocks (PNBs) are essential for anesthesia and pain management, with ultrasound-guided (USG) and peripheral nerve stimulator (PNS)-guided techniques being the most utilized methods. While USG ensures greater precision and success, its cost and training requirements pose challenges, particularly in resource-constrained environments. PNS-guided blocks, although cost-effective, are less precise and require greater operator expertise. Methodology: This prospective comparative study involved 50 patients randomized into two groups: USG (n=25) and PNS (n=25). Outcomes evaluated included procedural success rates, complication rates, and patient satisfaction using validated scoring systems. Results: The USG group showed higher success rates (96% vs. 84%), shorter procedure times, longer analgesia duration (14.5 vs. 11.8 hours), and better patient satisfaction scores (4.8 vs. 4.3 on a Likert scale). Complication rates were lower in the USG group (4% vs. 12%), though not statistically significant. Conclusion: USG-guided PNBs demonstrated superior outcomes, including, greater efficacy, extended pain relief, and higher patient satisfaction, compared to PNS-guided blocks. These findings support USG as the preferred method, with further studies needed to validate these results across broader clinical settings.

Aim: The aim of this study was to evaluate the accuracy and utility of fine needle aspiration cytology (FNAC) in diagnosing head and neck lesions in a tertiary care hospital, focusing on patients from rural areas. Material and Methods: A total of 240 patients with palpable head and neck lesions were included in the study. FNAC was performed on the lesions, and the cytological results were compared with the final histopathological diagnoses. The demographic data and lesion characteristics were recorded for each patient. Results: The majority of cases were non-neoplastic lesions, with lymphadenitis being the most common. Malignant lesions were less frequent, but FNAC provided accurate diagnoses, including non-Hodgkin’s lymphoma and papillary carcinoma. Inadequate samples were identified in a small proportion of cases. Conclusion: FNAC remains a dependable, cost-effective, and minimally invasive tool for diagnosing head and neck lesions, particularly in resource-limited settings. Challenges such as inadequate samples should be addressed to improve diagnostic accuracy.

Aim: The purpose of this research was to determine the prevalence of anxious depression in patients diagnosed with type 2 diabetes mellitus by utilizing the Diabetes Anxiety Depression Scale (DADS), as well as to investigate the association between anxious depression and glycemic control and the length of time the patient has had diabetes. Material and Methods: Methods included the evaluation of a total of one hundred diabetes in-patients, as well as the collection of pertinent clinical and psychological data. Results: higher DADS scores were associated with poorer glycemic control and longer illness duration. This suggests that there is a clear connection between psychological distress and metabolic outcomes. Conclusion: The evaluation and treatment of anxiety and depression in diabetic patients at an early stage may have the potential to improve clinical results and general well-being.

Background: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease among patients with type 2 diabetes mellitus (T2DM). Early detection is crucial to prevent progression to end-stage renal disease (ESRD). Aim: This study aimed to evaluate the association between serum homocysteine levels and DN in T2DM patients and explore its potential as a diagnostic and predictive biomarker for renal dysfunction. Material and Methods: A cross-sectional study was conducted on 100 T2DM patients in a tertiary care hospital for 12 months. Demographic and clinical data were recorded, and statistical analyses were performed to assess the relationship between serum homocysteine and renal function. Results: Elevated homocysteine levels were significantly associated with reduced eGFR. The ROC curve analysis demonstrated an AUC of 0.73, indicating fair diagnostic utility. Conclusion: Serum homocysteine may serve as a useful early marker for diabetic nephropathy in T2DM patients, supporting its potential inclusion in routine screening protocols.

Background and Aim: Open musculoskeletal wounds of the extremities present significant treatment challenges. This study aimed to compare the clinical outcomes and cost implications of Negative Pressure Wound Therapy (NPWT) with Standard Wound Therapy (SWT) in managing such wounds. Material and Methods: A total of 24 patients were divided into two groups: 12 received NPWT and 12 received SWT. Outcomes assessed included wound size reduction, bacterial clearance, and cost-effectiveness over a 9-day period. Results: NPWT demonstrated significantly greater wound size reduction (9.8 ± 3.45 cm vs. 3.2 ± 1.12 cm) and more effective bacterial clearance by day 9 compared to SWT. NPWT also required fewer dressing changes, contributing to reduced long-term care demands. Conclusion: NPWT is more effective than conventional methods in promoting wound healing and reducing infection in extremity wounds, making it a valuable option in tertiary care settings.

Aim: This study compares the functional and radiological outcomes of plate osteosynthesis and interlocking nailing fixation in patients with humeral shaft fractures. Material and Methods: A total of 100 patients were included, divided into two groups: Group A (plate osteosynthesis) and Group B (interlocking nailing). Functional outcomes were evaluated using the Constant shoulder score and the Mayo elbow performance score, while radiological outcomes focused on fracture union. Results: The results demonstrated superior shoulder function recovery with plate osteosynthesis, while both techniques showed similar elbow function outcomes. Radiologically, fracture healing was comparable between the two methods. Complications such as shoulder stiffness and hardware-related issues were observed in both groups. Conclusion: This study provides valuable insights into the efficacy and safety profiles of both fixation techniques.

Introduction: Prevalence of occupational health diseases is high in India and Occupational lung disease are commonest in occurrence. In comparison to developed countries, developing countries like India doesn’t take much precautionary measures with respect to health of employees. In order to preserve hospital hygiene and health, sweepers are essential. On the one hand, their role is significant, but on the other, they fail to take the necessary safety precautions when sweeping. Present study was undertaken with objective to assess pulmonary functions of hospital sweepers & to compare them with healthy individuals. Materials and Methods: Present study is a cross-sectional prospective study conducted from duration2013 to2015. 50 sweepers & 50 non sweeper between age group 30 to 60 years of both genders were enrolled. After Routine general & clinical examination in each case pulmonary function test was performed in two groups. Parameters recorded were forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), FEV1/ FVC% ratio, Peak Expiratory Flow Rate (PEFR), Forced Expiratory Flow at 25%-75% of volume as percentage of Vital Capacity (FEF25%-75%). Data compiled &Statistical analysis was performed using SPSS software, version 20. Observations and Results: Majority participants were males. No significant differences were found in age, height, weight and BMI between Group A & Group B. Amongst Group B participants 11 (22 %) had cough, 7 (14 %) had phlegm, 1 (2 %) had dyspnea and 1 (2 %) had wheeze at the time of recording the history. Amongst Group B participants 11 (22 %) had occupation exposure of about >10 years with 9 (18 %) having one of the symptoms. Amongst participants with symptoms, 10 (20 %) had working hours of >5. Statistically significant correlation was found between duration of occupation & duration of exposure with occurrence of symptom. result showed statistically significant difference for FVC (L), FEV1 (L), PEFR (L/s) and FEFR 25-75 % (L/s) between Group A & Group B except for FEV1/FVC (%). Conclusion: In conclusion, FVC (L), FEV1 (L), PEFR (L/s) and FEFR 25-75 % (L/s) values found statistically less significant in sweeper group compared to non-sweeper. Duration of occupation & duration of exposure to dust showed significant correlation with occurrence of symptom.

Background: Tracheal intubation with a cuffed ETT (Endotracheal Tube) ensures a safe and patent airway during general anesthesia. N₂O (Nitrous Oxide), widely used for its analgesic and anesthetic properties, can diffuse into the ETT cuff, leading to an increase in intracuff pressure. This pressure rise can result in complications such as tracheal mucosal ischemia, POST (Post-Operative Sore Throat) and PONV (Post-Operative Nausea and Vomiting). Regular monitoring of cuff pressure is recommended to minimize these risks. Materials and Methods: This prospective, observational study included 100 adult patients undergoing general anesthesia. Patients were divided into two groups: Group A received oxygen-air (40:60), and Group B received oxygen-nitrous oxide (40:60). Endotracheal tube cuff pressure was measured at baseline and at 15-minute intervals for 90 minutes. Adjustments were made if the pressure exceeded 34 cm H₂O. The incidence of POST and PONV was assessed at 1 and 6 hours postoperatively. Statistical analysis was performed using SPSS software. Results: Cuff pressure in Group B increased significantly over time compared to Group A (p < 0.001). 50% of patients in Group B required cuff pressure readjustment, whereas none in Group A required adjustments (p < 0.001). The incidence of PONV was higher in Group B (26%) compared to Group A (12%), but the difference was not statistically significant (p = 0.15). The incidence of POST was also slightly higher in Group B (16% vs. 10%), though not significant. Conclusion: Nitrous oxide significantly increases ETT cuff pressure, necessitating frequent monitoring to prevent tracheal mucosal injury. While there was a trend toward higher POST and PONV in the nitrous oxide group, the differences were not statistically significant. Regular cuff pressure adjustments may mitigate these adverse effects.

Background: Paraquat, a widely used non-selective herbicide, is associated with high mortality due to multi-organ toxicity. Limited data exists from South India regarding clinical presentations and outcomes of paraquat poisoning. Objective: To analyze the incidence, clinical profile, and outcomes of paraquat poisoning cases admitted to a tertiary care hospital in South India. Methods: This retrospective study examined medical records of adult patients admitted with paraquat poisoning to Government General Hospital, Vizianagaram, between June and December 2024. Demographics, poison characteristics, clinical presentations, laboratory parameters, treatment modalities, and outcomes were analyzed. Results: Of the 49 case records reviewed in the study the mortality rate was 84%. Acute Kidney injury was the most common manifestation. Use of steroids and antioxidants did not affect the outcome. Cyclophosphamide and hemoperfusion were not initiated for any patient. Pulmonary oedema and acute tubular necrosis were the most common histopathological findings. Conclusion: Paraquat poisoning presents a significant clinical challenge with high mortality despite intervention. These findings highlight the need for stricter regulations on paraquat availability and enhanced public awareness of its dangers.

Perforation peritonitis is one of the most common surgical emergencies of the field of general surgery. The incidence of hollow viscus perforation, the site of the perforation, and the age of onset in developing nations have a wide range of variability, with the trends evolving progressively. The etiologies responsible for peritonitis secondary to perforation differ between developing and developed nations. The present study was conducted as a prospective observational study on patients who underwent Emergency surgery for Perforation peritonitis in the Department of General Surgery, at a tertiary care center of Madhya Pradesh during the period 2023 to 2025. This is a hospital based comparative study. Sample size in present research was 100. Patients were predominantly Males (84%) and the remaining were Females (16%). 61% patients (61 out of total 100 enrolled patients) had no co-morbid conditions. While 39% patients had diverse kind pre-existing co-morbid conditions with different degree of overlapping i.e. one patient having multiple co-morbid conditions along with that modalities of surgery also observed for diverse types of surgeries. Patients were initially allowed fluid intake and eventually were allowed solid diet. 27% patients were allowed fluid intake within the first 3 days post-operatively 28% patients enrolled in the study were allowed solid meals before fifth post- operative day Out of the 100 patients enrolled in the study, 30% had their Nasogastric tube/Ryle’s tube removed within the first 3 days. 21% patients needed extra analgesia while 79% patients had no need for any sort of extra analgesia apart from the analgesic care given as per the adapted ERAS protocol. Perforation peritonitis in India is quite different from what it is in Western countries. Early diagnosis, effective pre-operative resuscitation, and early operation with adequate antibiotics are the cornerstones to decreasing morbidity and mortality. The ERAS protocol is an inexpensive and feasible strategy for patients who undergo an emergency laparotomy for perforation peritonitis. It reduces stress responses, which improves post-operative results like quicker return of bowel function and early mobilization. Application of ERAS can reduce recovery time, reduce the need for analgesia, and reduce hospital stays.

Background: Peritonitis following perforation of the intestine is quite commonly encountered in surgery emergency. The important causes of perforation in our country are typhoid, peptic ulcers, tuberculosis, penetrating abdominal trauma, etc. It requires urgent surgical intervention to reduce the morbidity and mortality of the patient. The current study was conducted to study the etiological patterns, assess the outcome of early surgical intervention of gastro-intestinal perforations, and evaluate mortality and morbidity. Methods: This prospective study was conducted after approval from the institutional ethical committee and informed consent of the patient. It included 30 patients presenting in the surgery department of Rajindra Hospital, Patiala from August 2006 to October 2008 with suspected diagnosis of gastrointestinal perforations. Conclusion: In our study, the most common cause of gastro-intestinal perforation was typhoid, in 43.13% (13/30) cases followed by peptic ulcer disease, in 33.3% (10/30) cases. All the patients operated on within 24 hours of admission had fewer post-operative complications. Post-operative complications were seen in 56.6% of cases (17/30). The mortality rate in our study was 6.66%. From this study, it is concluded that good resuscitation, early and energetic surgical intervention, and combination antibiotics are the factors that reduce the morbidity and mortality of gastrointestinal perforations.

Introduction: Acute Appendicitis is quite commonly encountered in surgical emergencies and if diagnosed and managed early, it improves the outcome of the patient. Hence, various clinical scoring systems have been designed to aid diagnosis. Aim & Objective: The present study was carried out to compare the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of RIPASA score & Modified Alvarado Score. Material & Methods: This prospective study was conducted after approval from the institutional ethical committee and informed consent of the patient. The study included 90 patients presented in the surgery department of Rajindra Hospital, Patiala from October 2022 to August 2024 with a suspected diagnosis of acute appendicitis. Result: RIPASA score had a Sensitivity of 89.33%, Specificity of 86.66%, Positive Predictive Value 97.10%, Negative Predictive Value of 61.9% and Diagnostic Accuracy of 88.88% whereas Modified Alvarado score had a Sensitivity of 74.66%, Specificity of 66.66%, Positive Predictive Value 91.80%, Negative Predictive Value of 34.48% and Diagnostic Accuracy of 73.33%. Conclusion: The results of the RIPASA scoring system, in comparison to Modified Alvarado Scoring System in terms of Sensitivity, Specificity, PPV, NPV, and Diagnostic accuracy were better in our study. So, the RIPASA score is a better diagnostic tool for the diagnosis of Acute Appendicitis.

Background and Objectives: Cirrhotic cardiomyopathy (CCM) is a condition characterized by subclinical cardiac dysfunction in patients with cirrhosis. Despite its significant impact on clinical outcomes, CCM remains underdiagnosed due to its subtle presentation at rest. This study aimed to determine the prevalence of CCM using stress echocardiography and assess its association with liver disease etiology and severity. Methodology: This prospective observational study included 121 patients with cirrhosis and no preexisting cardiovascular risk factors. Patients were recruited from July 2018 to December 2019. Clinical and laboratory data, including Child-Pugh and MELD-Na scores, ascites severity, gastroesophageal varices, and cardiac biomarkers such as pro-BNP and QTc interval, were collected. Left ventricular function was evaluated using transthoracic echocardiography at rest and during dobutamine stress echocardiography (DSE) to detect diastolic and systolic dysfunction. Results: The mean age of study participants was 52.5 years, with HBV (25.6%) and alcoholic cirrhosis (21%) as the leading etiologies. CCM was identified in 28.1% of patients. Diastolic dysfunction was present in 60.3% of patients at rest, while systolic dysfunction was unmasked in 28.1% post-DSE. Prolonged QTc intervals were observed in 40.4% of cases, and elevated pro-BNP levels were detected in 23.9% of patients. CCM prevalence correlated significantly with cirrhosis severity, as assessed by the Child-Pugh and MELD-Na scores (p<0.05), but was independent of age and cirrhosis etiology. Conclusions: CCM is a frequent yet often overlooked complication of cirrhosis, strongly associated with advanced liver disease. Resting cardiac evaluations may fail to identify systolic dysfunction, highlighting the importance of stress echocardiography in CCM diagnosis. Early detection and comprehensive cardiac assessment in cirrhosis patients, particularly those undergoing liver transplantation or TIPS, are crucial for improving clinical outcomes.

Introduction: Multi-drug tuberculosis is a significant health problem in India and the adverse drug reactions are divided into common side effects and uncommon side effects. Common side effects include gastrointestinal side effects like nausea, vomiting and others include fatigue, giddiness, headache, peripheral neuropathy and vertigo whereas uncommon side effects include cardiovascular side effects like QT prolongation, optic neuritis, hearing loss and hypothyroidism etc included in uncommon or less often adverse side effects associated with MDR-TB medications. Aim: The main aim of the study is to calculate the percentage of uncommon side effects present in patients taking MDR-TB drugs. Material and Method: The following is a cross-sectional analysis observational study done in 100 patients presenting with adverse drug reactions with both common and uncommon adverse side effects among the patients taking MDR-TB drugs and further calculating the percentage of the uncommon side effects among these patients. Results: Otological adverse effects in the form of sensory neural deafness were noticed highest among 6% of the patients, cardiotoxicity namely QT prolongation and arrhythmias were noticed in 5% of the patients, endocrine adverse effects namely hypothyroidism is noticed in 4% of patients, ocular toxicity namely optic neuritis was noticed in 4% of the patients. Conclusion: Most of the patients complains of the common side effects of the MDR-TB drugs and significant percentage (19%) of people present with uncommon side effects.

Background and Objectives: Bacterial vaginosis (BV) is a common vaginal infection that has been linked to various adverse pregnancy outcomes, including spontaneous abortion. However, the relationship between BV and recurrent spontaneous abortion remains unclear. (1). To evaluate the association between BV and history of spontaneous abortion. (2). To investigate the relationship between BV and recurrent spontaneous abortion. Bacterial Vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of reproductive age, accounting for 40 to 50 per cent of all cases of vaginal discharge. BV is a polymicrobial disorder. Methods: Hospital based observational study. The Department of Obstetrics and Gynaecology at JNKTMCH Madhepura. Study duration is Two years. Results: In the present study 75.30% women had history of previous one abortion. Among them 25% women had BV. Women who had prior history of two or three and more than three abortions had BV in 40% and 40% proportion subsequently. Conclusion: In the present study, the author also studied the association between previous reproductive outcome and BV. No statistically significant association between history of previous one abortion and the presence of BV was found.

Background and Objective: Postmenopausal bleeding (PMB) is a common gynecological symptom that affects women after menopause. It can be a sign of various underlying conditions, including malignancy. To evaluated the prevalence of post-menopausal bleeding. (1). To evaluate the clinical characteristics of women presenting with PMB at a tertiary care hospital. (2). To determine the underlying causes of PMB in this population. Methods: This is a descriptive type of observational study conducted among women with Postmenopausal Bleeding who attended the Gynaecology OPD JNKTMCH, Madhepura. Study duration is Two and half years.  60 Postmenopausal patients were included in this study. After fulfilling the inclusion crtieria a detailed history and clinical examination was done as per Proforma, followed by investigations. Results: On the basis of histopathological examination most of the patients was having atrophic endometrium followed by simple hyperplasia. Majority of patients had atropic endometrium i.e. 38.3% cases, followed by endometrial hyperplasia was detected in 14 patients i.e 23.3% cases out of which 11 had simple hyperplasia while 3 patients had atypical hyperplasia. Endometrial cancer was detected in 8 patients i.e. 13.3% cases. Out of 8 patients one case was confirmed as adenocarcinoma on histopathology after polypectomy through hysteroscope. Conclusion: The statistical probability of one of those postmenopausal bleeding episodes being due to gynecologic cancer is extremely low.

Background and Objectives: Fetal growth restriction (FGR) or intrauterine growth restriction (IUGR) is a significant concern in prenatal care, affecting 5-10% of pregnancies. Amniotic fluid index (AFI) is a commonly used marker to assess fetal well-being. Method: The present study was conducted in the Department of Obstetrics and Gynaecology, at JNKTMCH, Madhepura. Study duration is Two years. Each patient was told about her inclusion and participation in this study and her informed consent was taken. This is a case control prospective comparative study performed on 200 randomly selected low risk pregnant patients at term (37-40 weeks of gestation) admitted. Result: The live babies with congenital anomalies were admitted to NICU. Unpaired t-test is applied. The P value is 0.109 (insignificant). The mean value of weight of baby born to case group is 2.449±0.4190. The mean value of weight of baby born to control group is 2.554±0.5036. Study almost doubles the no. of babies in cases where IUGR or FGR. Though, statistically it came out to be insignificant. Conclusion: Increased rates of LSCS and congenital anomalies in babies, in rest all parameters no significant statistical difference found in cases and control groups. It is not that IUGR is necessarily associated with low AFI and normal AFI ensures normal birth weight. Among cases only 12% were booked and 88% were unbooked. In control 32% were booked and 68% were unbooked.

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease that can affect various systems, including the endocrine system. Thyroid dysfunction has been reported in patients with RA, but the relationship between thyroid function and seropositive RA remains unclear. The thyroid dysfunction in rheumatoid arthritis is well-known but unfortunately there are only few studies available in our country to assess the thyroid function in RA patients. To evaluate the thyroid function in patients with seropositive rheumatoid arthritis. investigate the relationship between thyroid function and disease activity in seropositive RA. To assess the prevalence of thyroid autoantibodies in patients with seropositive RA. Methods: It was a Hospital based observational, descriptive study. Upgraded department of General Medicine, AIIMS Patna. Study duration is Two and Half years. Results: Maximum patients 208(80.00%) are euthyroid followed by 28(10.77%) are overt – hypothyroidism, 22(8.46%) subclinical hypothyroidism and 2 patients (0.77%) are subclinical hyperthyroidism patients Conclusion: Prevalence of thyroid dysfunctions in rheumatoid arthritis is high and associated with thyroid autoimmunity and suggested that all rheumatoid arthritis patients should go for thyroid functions. Hence, it is advisable to screen the patients of rheumatoid arthritis for thyroid dysfunction so that early identification and treatment can provide a healthier life ahead.

Background and Objectives: Diabetes mellitus is a common condition in the geriatric population, and it is associated with various hematological abnormalities, including changes in platelet count. However, the relationship between diabetes and platelet count in the geriatric population remains unclear. Geriatric population (> 60 years) is rapidly increasing in India, To compare the platelet count in diabetic and non-diabetic geriatric population. To investigate the association between platelet, count and inflammatory markers (e.g., CRP, IL-6) in diabetic and non-diabetic geriatric population. It has been increased upto 8.6% in 2011. Diabetes Mellitus (DM) is a metabolic disorder and a major health problem, affecting a large section of the Indian population, especially as its incidence increases with advancing age. Host of complications are associated with this disease, one of which is the effect on platelet count. This study compares platelet count between diabetic and non-diabetic elderly. It is observed that Hyperglycaemia in diabetic persons is responsible for increased Thrombopoietin production at the cellular level, which leads to raised platelet count -Reticulated Thrombocytosis – when compared to non-diabetics. Platelets, especially reticulated thrombocytes are associated with uncontrolled blood sugar levels in the body and are well known for their role in artherosclerotic cardiovascular disease (CVD).

Background and Objectives: Organophosphorus poisoning (OPP) is a significant public health concern, particularly in rural areas. Lactate dehydrogenase (LDH) is a biomarker that has been studied in various poisonings, but its role in OPP remains unclear. Organophosphorus compounds have been widely used for a few decades in agriculture for crop protection and pest control. In India Organophosphorus poisoning is the most common. The objective of our study was to measure the LDH Level in acute organophosphorus poisoning. To evaluate the relationship between LDH levels and the severity of acute OPP. To investigate the prognostic value of LDH in predicting mortality in patients with acute OPP. Methods: This study was conducted among minimum 100 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending medical ward, at AIIMS Patna. Study duration is Two years. Serum lactate dehydrogenase estimation by spectrophotometric analysis using Beckman Coalter AU 680. Results: These were significantly higher among deaths on day 1 and 3(810±372.99 and 1027.09±458.26, respectively) in comparison to survivors on day 1 and 3 (538.18±300.42 and 365.19±175.49, respectively). Significant difference was found between mean values of different levels of severity of LDH on day 1 and 3. Conclusion: In this study found that Serum LDH can be used as biomarker in diagnosis or stratifying severity of acute OP poisoning, as it is cheap and easily available, especially in developing countries. Serial measurements of serum LDH levels in acute OP poisoning can predict the prognosis.

Background and Objectives: Beta-thalassemia is a genetic disorder that affects hemoglobin production, leading to anemia. Carrier patients, who are asymptomatic or mildly symptomatic, may still experience anemia due to impaired hemoglobin production. This study was conducted at AIIMS Patna. To determine the prevalence of anemia in beta-thalassemia carrier patients at AIIMS Patna. To characterize the severity and types of anemia in beta-thalassemia carrier patients. Material and Methods: Patients attending the department of haematology and referred from other periphery area after written consent (below and above 18 years patients of both gender) were included in the study. There haemogram and blood group, blood urea , serum creatinine, serum iron and vitamin B – 12 level, urine R/M and stool test for worm infestation and liver function were done bedside all relevant investigations. There blood sample for electrophoresis was done HbA1 and HbA2 and HbS who had criteria that showed thalassemia with a peripheral blood picture and electrophoresis with Hb less than 10 gm/dl were noticed and analysis done . Exclusion Criteria: Patient who had more than 10 gm haemoglobin, pregnant women, patients who refused for written consent with other haematological disorder such as sickle cell anemia, patients who had undergone blood transfusion within 4 months, patients suffering from HIV and HBV – HCV infection , patients of tropical splenomegaly and cancer patients. Conclusion: Most of the carriers are asymptomatic but few of them had symptoms and may need blood transfusion also. Pre-marital counseling for genetic disorder through genetic counseling is good tool to lesson the burden of genetic transmitted disease and recurrent transfusion and iron – overloaded.

Background and Objectives: Non-insulin-dependent diabetes mellitus (NIDDM) is a significant risk factor for cardiac dysfunction, including coronary artery disease, heart failure, and cardiac arrhythmias.  Globally Diabetes is a major Non communicable disease which is seen associated with cardiac dysfunctions. To find the prevalence of cardiac dysfunction in patients with NIDDM and to study associated factors (addiction, HBAIC, Serum Cholesterol) among diabetes mellitus patients. To determine the prevalence of cardiac dysfunction in patients with NIDDM at a tertiary care hospital in Bihar. To identify the factors associated with cardiac dysfunction in patients with NIDDM. Methods: Cross sectional study was carried out with convenient sampling. A semi structured questionnaire was used in patients coming to a tertiary medical college in Bihar. Physical examination, Blood examination, resting ECG were done. 2D- Echo was done to evaluate cardiac dysfunction. Test of significance to test association for various independent variables with dependent variable was done using Chi-square. Results: Study done in 50 patients showed prevalence of cardiac dysfunction in 67% patients with normal ECG findings. 50%of the patients had diastolic dysfunction and 34% was found to have left ventricular hypertrophy. Conclusion: Most of the patients had abnormal echocardiographic findings with diastolic dysfunction while few with left ventricular hypertrophy. The results were significant for association between duration of diabetes with diastolic dysfunction. More studies with increase sample size and various study designs is recommended for strong evidence.

Background and Objective: Abnormal uterine bleeding (AUB) is a common gynecological complaint, affecting millions of women worldwide. The FIGO PALM-COEIN classification system provides a standardized framework for diagnosing and managing AUB.
(1) To correlate clinical and histopathological findings of AUB using the FIGO PALM-COEIN classification system.
(2). To evaluate the diagnostic accuracy of the PALM-COEIN classification system in identifying underlying causes of AUB Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs.
AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological findings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based final diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons.

Background: Glaucoma is known to be the second most common cause of blindness globally, next to cataract. In primary open-angle glaucoma, the efficacy of 0.5% timolol and 2% dorzolamide was compared to reduce IOP and stabilize the membrane. Method: 100 adult patients with open-angle glaucoma were studied. 50 patients were randomly selected as group I (IOP between 20 to 30 mm Hg) and 50 as group II (IOP between 31 to 40) according to their IOP. Further, both groups were divided into IA (25), IB (25), IIA (25), IIB (25), Groups IA and IIA were administered Dorzolamide 2% and one drop thrice daily in both eyes. Groups IB and IIB were administered 0.5% Timolol; one drop was administered twice daily in both eyes. General examination includes examination by torchlight. Slit-lamp, distant visual acuity tested by illuminated Snellen’s chart, applanationtonometry, gonioscopy, fundus examination, and field analysis by the octopus auto-field analyzer. Ophthalmoscopy and slit-light biomicroscopy were used. Results: Comparison of IOP has significant p values (p<0.001). In a comparison of IOP reduction by different drugs, Dorzolamide 2% had a significant p-value (p<0.001). In a comparison of IOP reduction by the same drug in different groups, Dorzolamide has a significant p-value. But the effects of both drugs on blood pressure and heart rate had a significant p-value (p<0.001). Conclusion: It is noted that Dorzolamide 2% is well tolerated, efficiently reduces the IOP, and has a low allergic response as compared to Timolol 0.5%.

Background: Cardiomyopathies are characterized by dilated, hypertrophic and restrictive forms, having vivid clinical features that lead to unpredicted sudden death if not diagnosed and treated in due course of time. Aim: To study the clinical profile of patients with cardiomyopathy at tertiary care hospital.  Method: Present study was carried out on patients admitted with signs and symptoms of heart failure. Apart from detailed clinical history and physical examination, all the patients were subjected to ECG, echocardiography and CXR. Results: Out of 85 patients, 77 had DCM, 5 had HCM and 3 had RCM respectively. CAD is the main risk factor in 26(30.5%) patients. Dyspnea was the predominant symptom across all types of cardiomyopathy, with the following frequencies: 77 (100%) in DCM; 5(100%) in HCM; 3(100%) in RCM respectively. Chest x-ray findings revealed cardiomegaly in 82 (96.4%) patients, pulmonary congestion in 70 (82.3%) patients and pleural effusion in 14(16.4%) patients. ECG changes differed significantly (p < 0.001) among DCM, HCM and RCM patients. Bundle Branch Block was significantly associated with DCM (p<0.001). Echocardiography demonstrated 33 (38.8%) with diastolic dysfunction, 73 (85.8%) with MR, 60 (70.5%) with TR, 4 (4.7%) with clots, 4 (4.7%) with AR, 16 (18%) with pericardial effusion, 16 (18%) with Pulmonary hypertension, and 77 (90%) with global hypokinesia. Conclusion: Most common type of cardiomyopathy is Dilated cardiomyopathy (DCM) followed by Hypertrophic cardiomyopathy (HCM) and Restrictive cardiomyopathy (RCM). Biventricular failure was the most common clinical presentation followed by left heart failure and then right heart failure.

Introduction: Herpes zoster, also known as shingles, occurs due to the reactivation of varicella-zoster virus (VZV). Adults more than 50 years are at an increased risk of developing herpes zoster, probably due to the age-related decline in CMI associated with advancing age. Aim: To compare the clinical manifestations of HZ between immunocompetent and immunocompromised patients. Material & Methods: Cross sectional study of 100 HZ patients. Detailed history, general physical examination, dermatological examination was performed, tzanck smears and Biochemical parameters were done. Results: Among 100 patients of HZ out of which 60 patients were immunocompetent, and 40 were immunocompromised patients. Dermatomal pain is the most common prodromal symptom, prodromal symptoms are most common in immunocompromised patients. Unidermatome involvement was most commonly observed in the immunocompetent group (81.7%) compared to the immunocompromised group (27.5%) with a statistically significant difference between two groups, P- value=0.001. Multiple dermatomes involvement were most commonly observed in the immunocompromised group (65%) compared the immunocompetent group (16.7%) with P-value=0.001 (P-value<0.005), which was statistically significant. PHN was the most common complication observed in the immunocompromised group (35%) compared to the immunocompetent group (5%) with P-value=0.001 which was statistically significant. Scarring was the most common complication observed in the immunocompromised group (17.5%) compared to the immunocompetent group(3.3%) with P-value=0.015(<0.005), which was statistically significant. 42.5% in the immunocompromised group had complications as compared to only 6.7% in immunocompetent group. This difference was found to be statistically significant on the Chi-square test (P-value =0.001). Conclusion: Burning sensation, systemic symptoms like fever, bullous lesions, multiple dermatome involvement and complications of HZ are more observed in immunocompromised group compared to immunocompetent group.

Introduction: Alopecia areata is an autoimmune disorder of patchy non-scarring hair loss. Alopecia areata remains one of the most challenging afflictions encountered in dermatology clinics. With the ongoing search for optical treatment strategies, the potentially positive role of triamcinolone acetonide as well as PRP has been reported in various studies; however, the comparison of the two treatment modalities is largely underexplored. Aim: To evaluate and compare the therapeutic efficacy of intralesional injection of triamcinolone acetonide and platelet-rich plasma (PRP) in alopecia areata. Materials and Methods: A total of 40 patients with alopecia areata are subjects of this study. Group A: 20 patients administered triamcinolone acetonide (10mg/ml) Group B: 20 patients administered PRP Using Insulin syringe in multiple 0.1mL injections 1cm apart given. Procedure was done every 4weeks for 16weeks and evaluated by “severity of alopecia tool” [SALT] scoring system. Side effects were noted and results are compared. Results: The reduction in SALT score at each visit with respect to baseline was greater in the triamcinolone group as compared to PRP group. This signifies greater effect of triamcinolone in alopecia areata. Around 80% patients in triamcinolone group and 60% patients in PRP group showed improvement. Pain during intralesional injection was higher in the PRP group. Conclusion: ILS shows superior efficacy over PRP in treating Alopecia Areata, but PRP remains a safe and effective alternative.

Background: In this study, we aimed to evaluate and compare the effectiveness of an anterior quadratus lumborum plane block versus an abdominal wall block in postoperative pain after laparoscopic hysterectomy. Methods: This was a prospective, randomized controlled study, which randomly assigned patients undergoing elective laparoscopic hysterectomy into groups receiving either the quadratus lumborum plane block or the abdominal wall block. The NRS was used to score the pain scores at 6, 12, and 24 hours postoperatively and also opioid consumption and patient satisfaction scores. Results: Overall, 100 patients were involved in the study with 50 in each group. Results showed that patients in the anterior quadratus lumborum plane block had significantly less NRS pain scores at 6, 12, and 24 hours with less opioid analgesia needed compared to the abdominal wall block group (p < 0.05). Moreover, patient satisfaction scores were higher among the anterior quadratus lumborum plane block cohort. Conclusion: The anterior quadratus lumborum plane block is an effective method of postoperative pain management and hence should be adopted in clinical settings to further improve patient outcomes related to laparoscopic surgeries.

Background: Cirrhosis of the liver complicated by sepsis is associated with a high risk of morbidity and mortality. The AIMS65 score, a simple five-variable tool originally developed for risk stratification in upper gastrointestinal bleeding (UGIB), incorporates clinical and biochemical parameters that may also be relevant in septic cirrhotic patients. However, its prognostic utility in this specific population remains underexplored. Objective: To evaluate the prognostic value of the AIMS65 score in predicting in-hospital mortality in patients of cirrhosis of liver complicated by sepsis. Methods: This prospective observational study included 90 patients admitted with a diagnosis of liver cirrhosis and clinical sepsis. The AIMS65 score was calculated for each patient based on five variables: age ≥65 years, systolic blood pressure ≤90 mmHg, altered mental status, INR >1.5, and serum albumin <3.0 g/dL. The primary outcome measured was in-hospital mortality. Statistical analyses included independent t-test, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Out of 90 patients, 45 (50.0%) expired during hospitalization. The mean AIMS65 score was significantly higher among non-survivors (2.82) compared to survivors (2.16), with a p-value of 0.0016. Logistic regression showed the AIMS65 score to be a statistically significant predictor of mortality (Odds Ratio = 0.7192, p = 0.003). The ROC curve analysis yielded an area under the curve (AUC) of 0.6812, indicating moderate prognostic accuracy. Conclusion: The AIMS65 score shows moderate predictive power in assessing in-hospital mortality in patients of cirrhosis with sepsis. It is simple and easy to use. This makes it a potentially valuable bedside tool in emergency settings and when limited resources are available. However, further validation through more prospective studies is warranted.

Beta-thalassemia is a major genetic disorder in India affecting approximately 40 million carriers nationwide, significantly burdening rural populations where healthcare resources are limited. This case of 5 years old male emphases the need of timely intervention and applying diagnostic tools to rule out such conditions in underserved parts of India. This case report highlights the successful application of telemedicine, specifically through Jiyyo Healthcare, in the early detection and management of beta-thalassemia in a paediatric patient from rural Punjab. By bridging the gap between underserved regions and specialized healthcare, telemedicine ensured timely diagnosis, appropriate interventions, and better health outcomes.

Background: Growing research links early-life stress (ELS) to poor physical and mental health later in life. ELS involves abuse, neglect, parental death, and poverty. Immune system effects are a big concern. Long-term childhood stress candysregulate the immune system, increasing the risk of inflammatory and autoimmune disorders. Unfortunately, little is known about how ELS influences immune health and its long-term repercussions. Objective: This study aims to investigate the impact of ELS on adult immune function by assessing inflammatory biomarkers and stress-related immune alterations in individuals with a history of childhood adversity. Methods: A retrospective cohort research compared 100 18–50-year-olds with ELS to a control group without early-life suffering. Medical histories, psychological evaluations, and adverse childhood experience surveys were employed to collect data. CRP, IL-6, cortisol, and WBC counts are used to measure immunological function. Regression models, ANOVA, and t-tests were used to examine the relationship between immunological dysfunction and ELS severity. Results: 50 of 100 participants were in a control group and 50 were subjected to early-life stress. Both groups had similar gender and age distributions, but the ELS-exposed group had a higher frequency of lower socioeconomic status (68% vs. 32%), chronic diseases like hypertension (18% vs 8%, p = 0.03), and anxiety disorders (30% vs 12%, p = 0.02). The ELS-exposed group had higher levels of CRP (3.8 ± 1.5 vs. 2.1 ± 1.1 mg/L, p < 0.01), IL-6 (4.5 ± 1.2 vs. 3.1 ± 0.9 pg/mL, p < 0.01), and cortisol (16.5 ± 4.3 vs. 11.8 ± 3.5 µg/dL, p < 0.01), indicating increased systemic inflammation and HPA-axis dysregulation. A dose-response relationship exists between ELS severity and elevated CRP, IL-6, and cortisol levels (r = 0.48, p < 0.01, r = 0.52, p < 0.01, r = 0.55, p < 0.001). Despite correcting for relevant confounders, regression analysis showed that ELS exposure remains a significant predictor of immunological dysfunction (p < 0.05). The findings suggest that childhood stress can affect the immune system into old age. Conclusion: These findings underscore the lasting impact of early adversity on immune health, emphasizing the need for early intervention strategies. Future longitudinal studies are essential to elucidate causal mechanisms and develop targeted preventative measures.

Background: The rise in outpatient treatments, often known as day care surgeries, is partly due to progress in medical technology and changes in the financing method, which has made day care surgeries more appealing in recent years. The growing burden on providing health care to the public necessitates the priority establishment and taking up of day care surgeries when possible. Outpatient surgery and anesthesia, which began as a cost-cutting measure, has gained traction in India over the last decade as a result of developments in surgeries and anesthesia. Aim: The objectives of the study are to analyze the outcomes of day care surgery and to analyze the patients’ view on the process and its acceptance. Materials and Methods: This study was prospectively conducted in the Department of General Surgery at Narayana medical college, Nellore, Andhra Pradesh, from June 2019 to December 2021. Over the course of two years, 584 procedures were performed at the Department of General Surgery. Out of these only 88 patients were eligible based on inclusion criteria. Results: A total of 584 surgeries were done in the department of General Surgery from the period of December 2019 to December 2021 out of which 88 patients were satisfying the inclusion criteria. In the study 35(39.77%) were male patients and 53 (60.23%) were female patients. The age range of the patients in this study was between 18-72 years with the mean age being 45.841 ±15.918 years. The age distribution was divided into 3- 23.9% patients were between the age of 18-34 years, 37.5% patients were between the age of 35-54 years and 38.6% patients were of age >55 years. All patients were given the option of a day surgery or inpatient treatment. Conclusion: Day care results indicate quicker and faster recovery. Patients can readily return to their typical surroundings, such as their homes and everyday activities. The main benefit is a lower chance of cross-infection or hospital-acquired illness, as well as a lower risk of anesthesia related complications. India is a vast country with limited health-care resources serving a massive population. More devoted day care centres are needed immediately to deal with the growing patient load. Patients were only rated as satisfied if they answered yes to all 3 of these questions. 77 (87.5%) patients responded positively with good acceptance of day care surgery suggesting that they were satisfied with the day care surgery, whereas 11 (12.5%) patients responded that they were not satisfied with day care surgery.

Background: Umbilical (UH) and Para-umbilical hernias (PUH) are common in surgical practice. In the recent years, the laparoscopic repair of primary umbilical and par umbilical hernia gained attention with the reporting of lesser postoperative complications, shorter hospital stay, early return to work, recurrence and better cosmetic outcome than open approach. The objective of this study was to compare the outcomes between the open and laparoscopic hernioplasty in umbilical / paraumbilical hernia in adults. Patients & Methods: This was a descriptive, prospective, comparative study carried out in Department of General Surgery at Narayana medical college and General and Super speciality hospital, Nellore, Andhra Pradesh in 40 cases divided into two groups from December 2019 to December 2021. Results: In the present study, 57% were umbilical hernia and 43% were paraumbilical hernia. 33% were male and 67% were female. Minimum duration of surgery in open group was 40-60 minutes in 15% patients and maximum duration was >120 minutes in 5% patients. Minimum duration of surgery in laparoscopic group was 40-60 minutes in 10% patients and maximum duration was >120 minutes in 5% patients. Overall rate of intra operative complications in both groups was 20%. In open group, 35% of patients had mild, 55% had moderate, 10% had severe pain in postoperative period. In laparoscopic group, 95% of patients had mild, 5% had moderate, and no patients had severe pain in postoperative period. In open group, overall post-operative complications were 70% and in laparoscopic group 35% (Seroma, wound infection, paralytic ileus, chronic pain). In open group, minimum length of hospital stay was 6 to 10 days in 65% of patients while in laparoscopic group it was 1-5 days in 85% of patients. In open group, minimum length of hospital stay was 6 to 10 days in 65% of patients while in laparoscopic group it was 1-5 days in 85% of patients. In open group, minimum period to return to normal activity was 1 to 5 days in 5% of patients while in laparoscopic group it was 90 % of patients. Maximum post-operative follow up was 20 months in group, 25% in open group and 15% in laparoscopic group. Minimum PSAS score was 1-5 in 60% in open group while in laparoscopic group it was 100%. According to SSQ-6, patient’s satisfaction was better in laparoscopic group than open group. Work related symptoms like eye pain, neck pain, back pain, arm pain, hand pain, leg pain, and fatigue among surgeons felt more in laparoscopic group as compared to open group. Conclusion: Most common age group who underwent umbilical/paraumbilical hernia repair was 44±10 years in either group. Most of the patients who underwent surgery were female sex. From our study it was observed that laparoscopic hernioplasty for umbilical /paraumbilical hernia offers advantages like less post-operative pain, lesser post-operative stay, lesser post-operative stay, less post-operative complications, early return to normal activities, better patient satisfaction and cosmoses compared to open repair. Hence, laparoscopic umbilical and paraumbilical hernia repair is safe and feasible alternative to open hernia repair.

Background and Objectives: A number of foot ulcer classification systems have been devised in an attempt to categorize ulcers more effectively and allow effective comparison of the outcome of routine management. DUSS (Diabetic Ulcer Severity Score) is one of the latest wound based system of classification which needs to be validated. Our aim was Validation of the score with patient outcomes including healing and amputation. Methods: Total of 150 Diabetic patients attending surgical outpatient clinic or admitted into Hospital with foot ulcers irrespective of duration of ulcer were studies for two years. Results: Most common age group affected with Diabetic foot was between 36-50 years. Males accounted for 58 % of patients, most commonly ulcers were of DUSS Score of 3 followed by Score 2. Overall 76 (50.66%) of 150 people had amputations in our study. Major Amputation was done for 20 % of patients. Minor Amputation was done in 30.66% of patients in our study. 6.3% with score 0 had amputations, 7.1% with score 1 had amputations, 25 % with score 2 had amputations, 85 % with score 3 had amputations, 100 % with score 4 had amputations. Total 5.6% with score 2, 22.5% with score 3, 63.3% with score 4 had major amputations in our study. None of the patients with score 0 & 1 had major amputation. 6.3% patients with score 0, 7.1% with score 1, 19.4% with score 2, 62.5% with score 3, 36.7% patients with score 4 had minor amputations. Minor Amputations were more common in patients with DUSS Score of 3 in our study. The probability of healing with score 0 was 93.75%, 92.86% with score 1, 75% with score 2, 15% with score 3 and 0% with score 4. Conclusion: DUSS scoring system provides an easy diagnostic tool for anticipating probability of healing /amputation and need for surgery by combining four clinically assessable wound based parameters. It can be very helpful for the stratification of study groups depending on severity of ulcers and it provides a simple, streamlined approach in a clinical setting that requires no investigative equipment although subsequent adequate Wound care is an indispensable prerequisite to the DUSS being a valid diagnostic tool.

Introduction: The integration of online teaching in medical education has gained significant momentum, particularly in the post-COVID-19 era, as institutions adapted to digital platforms. This study aimed to compare student’s perceptions of online and traditional teaching methods and analyze gender-based differences in learning experiences. Materials and Methods: A cross-sectional study was conducted among 90 first-year MBBS students at Karpagam Faculty of Medical Sciences, using a structured questionnaire assessing various aspects of online learning on a five-point Likert scale. Results: Results indicated that 72% of students preferred traditional classroom teaching, citing better interaction, engagement, and comprehension, while 20% favoured online learning, appreciating its flexibility and accessibility. A blended learning approach was preferred by 8% of students. Although online teaching provided convenience, students reported several challenges, including fatigue (68%), distractions (56%), difficulty maintaining focus (49%), and technical issues (38%). Gender-wise analysis showed that females reported higher levels of fatigue (71%) and distractions (60%) compared to males, but statistical analysis using the chi-square test revealed no significant gender-based differences in most parameters. Discussion and Conclusion: While online education has transformed medical learning, its limitations highlight the continued relevance of traditional teaching. A blended learning model, integrating the advantages of both approaches, emerged as the most effective strategy. Future research should focus on optimizing digital teaching methodologies, addressing students’ concerns, and enhancing engagement to improve learning outcomes in medical education.

Introduction: Adverse Drug Reactions (ADRs) are a major public health concern contributing to increased morbidity, prolonged hospital stays, and healthcare costs. Pharmacovigilance programs rely on spontaneous ADR reporting by healthcare professionals; however, underreporting remains a significant barrier. Understanding the knowledge, attitude, and practice (KAP) levels of healthcare professionals regarding ADR reporting is essential to improve pharmacovigilance systems. The objective of the study is to assess and compare the knowledge, attitude, and practices related to ADR reporting among undergraduate (UG) students, interns, residents, and faculty members in a tertiary care teaching hospital. Materials and Methods: This cross-sectional study included 228 participants—55 UG students, 75 interns, 50 residents, and 48 faculty. A pre-validated, structured questionnaire based on WHO pharmacovigilance guidelines was administered. The questionnaire assessed demographic data, knowledge, attitude, and practice related to ADR reporting. Data were analyzed using SPSS version 26, and the chi-square test was applied to assess statistical significance. Results: Faculty demonstrated the highest knowledge (78.75%) and practice (67.36%) scores, while UG students scored the lowest (knowledge 45.82%, practice 32.72%). Although the majority across all groups recognized the importance of ADR reporting, practical implementation was lacking, especially among students and interns. Only 3.6% of UG students reported an ADR compared to 60.4% of faculty. Significant gaps were noted in causality assessment knowledge and usage of the Naranjo scale (p < 0.001). Conclusion: The study emphasizes the need for structured pharmacovigilance training, especially at the undergraduate level, to enhance ADR reporting practices and ensure patient safety.

Background: Neonatal mortality remains a major global health concern, particularly in low- and middle-income countries. Despite advancements in perinatal care, neonatal intensive care unit (NICU) admissions continue to be a significant challenge. Understanding the maternal risk factors associated with NICU admissions can aid in developing preventive strategies and improving neonatal outcomes. Aims/Objectives: To identify and analyze the maternal antenatal, intrapartum, and postpartum risk factors leading to neonatal NICU admissions in a tertiary care hospital. Methods: This hospital-based, prospective observational study was conducted at Bangalore Medical College and Research Institute from January 2024 to March 2024. A total of 1,454 deliveries were recorded, of which 245 neonate’s required NICU admission. Data on maternal demographics, medical history, antenatal care, and delivery outcomes were collected. Statistical analysis was performed using SPSS version 20.0, with univariate and multivariate logistic regression to assess risk factors. Results: The NICU admission rate was 16.83%. Significant maternal risk factors included preterm birth (41.87%), previous LSCS (17.88%), preeclampsia (17.07%), and gestational diabetes mellitus (17.07%). Intrapartum risk factors included induction of labor (50%) and PROM (29.54%). Postpartum factors included inadequate breastfeeding knowledge (56.88%). Primigravida mothers and rural residence were significantly associated with NICU admissions (p < 0.001). Conclusion: Identifying high-risk pregnancies and ensuring adequate antenatal care, along with educating mothers on breastfeeding, can help reduce NICU admissions. Strengthening perinatal health interventions is essential for better neonatal outcomes.

Bullous pemphigoid (BP) is a rare autoimmune blistering disorder commonly affecting the elderly, triggered by autoantibodies targeting hemidesmosomal proteins, namely BP180 and BP230. Drug-induced bullous pemphigoid (DIBP) is a variant often linked to medications such as diuretics, immunotherapies, and antibiotics. We report a 22-year-old male diagnosed with DIBP following anti-tubercular therapy (ATT) comprising isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient developed pruritic bullae on the trunk and extremities shortly after initiating ATT. Diagnosis was confirmed via histopathology and direct immunofluorescence, revealing subepidermal blistering with eosinophilic infiltration and IgG/C3 deposition. Immediate discontinuation of ATT, coupled with systemic corticosteroids and antihistamines, led to significant improvement. Careful reintroduction of ATT under close monitoring prevented recurrence. This case underscores the importance of recognizing DIBP in younger populations, emphasizing the need for prompt diagnosis, cessation of the offending drug, and an interdisciplinary approach to management for optimal outcomes.

Background: Preterm birth, defined as delivery before 37 weeks of gestation, remains a major cause of neonatal morbidity and mortality worldwide. Identifying maternal risk factors and understanding perinatal outcomes is crucial for improving antenatal care and neonatal management. Aim and Objectives: To analyze the maternal risk factors contributing to preterm birth and assess the associated perinatal outcomes in a tertiary care hospital. Materials and Methods: A retrospective analysis was conducted at the Department of Obstetrics and Gynaecology, GMERS Medical College and General Hospital, Junagadh. Medical records of 200 preterm birth cases over 6 months period were reviewed. Data on maternal risk factors, gestational age at delivery, mode of delivery, neonatal outcomes, and perinatal mortality were analyzed using descriptive statistics. Results: The study identified several common risk factors for preterm birth, including hypertensive disorders (28%), premature rupture of membranes (30%), gestational diabetes (14%), and infections (10%). The distribution of preterm births was as follows: 40% occurred between 34–36 weeks, 29% between 32–34 weeks, and 18% between 28–32 weeks. Regarding the mode of delivery, 58% were vaginal births, while 42% were cesarean sections. Additionally, 70% of the newborns required admission to the NICU, with the most prevalent complications being respiratory distress syndrome (45%), neonatal jaundice (36%), and neonatal sepsis (18%). The overall perinatal mortality rate was 12%, with the highest mortality rate (64%) observed in extremely preterm neonates (<28 weeks). Conclusion: Hypertensive disorders, premature rupture of membranes, and gestational diabetes are significant contributors to preterm birth. Neonatal morbidity, particularly respiratory distress syndrome and jaundice, remains high. Strengthening antenatal care, improving infection control, and enhancing neonatal intensive care services can help reduce preterm birth-related complications and mortality.

Biofilms are group of microorganisms encased in a matrix of extracellular polysaccharide (slime), called polysaccharide intercellular adhesion (PIA). They have been associated with a variety of chronic and persistent infections. Microorganisms associated with biofilm formation have tendency to delay healing and show increased resistance to antimicrobial drugs resulting in chronic infection. In this study, detection of biofilm production by using three different methods: Tube method (TM), Congo red agar method (CRA) and Tissue culture plate method (TCP). From 155 Central venous catheters tips analysed, 70 (45.16%) showed microbial colonization. Among the total organisms isolated 42(60%) showed Biofilm producer (BP), while 28 (40%) Non Biofilm producer (NBP). We can conclude from our study that TCP was better method for biofilm detection and quantification as compared to TM and CRA methods.

Benign cystic teratomas are frequently encountered ovarian neoplasms. Teratomas are common tumours of germ cell origin accounting to 69% incidence among young females. Only < 2% teratomas present as solid mass, while majority grossly appear as cystic lesions. This tumour shares the common clinical and radiological features and it is commonly seen in young adolescents. Epithelial neoplasms are common in the old age. Here we present a case of 56year old female who had a mobile mass extending from the midline to the left side. USG showed a multiloculated cyst measuring 13.4×12.3×3.3cm with fine internal echoes.

Introduction : Acute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Which in turn denotes the associated cerebral edema associated. Aims & Objectives: Prognostic accuracy of the difference between midline shift (MLS) and hematoma thickness (HT) for acute outcomes in patients with acute subdural hematoma (ASDH). To find out the Zumkeller index and review its importance. Materials & Methods: It is a Retrospective descriptive study with purposive convenient sampling of 154 Patients, Studied at Department of Neurosurgery, KAPV Govt Medical College & MGM GH, and Trichy. Studied from 1 January 2023 – 31^th December 2024. The results were tabulated in MS Excel sheet and processed using SPSS software, Chi Square test was test of significance with p value <0.5 significant. Results: 154 cases of unilateral acute SDH were analysed for general character of patient and HT and MLS was measures and compared to mortality individually. The difference values between MLS and HT (Zumkeller index, ZI) were also analysed. Analyses also considered Glasgow Coma Scale (GCS) score at admission, age, and associated traumatic injuries. ZI Prognostically was more favourable among all. Positive ZI is associated with positive Prognosis and vice versa. Conclusion: To conclude ZI needs to be revived to help the primary referring physician to know the prognosis. Also, it serves as more important in a set up where now CT Brain is available, but Neurosurgeon is missing and Person to tell clinical condition also missing, so need of surgery can be assessed based on ZI only.

Background: Posterior cervical spine fixation for sub axial cervical spine is one of stabilising procedure for various cervical spine pathologies. Modern fusion techniques like lateral mass screws (LMS), transfacetal screws (TFS), pedicle and interlaminar screw are proven to be safe, inexpensive, offer better biomechanical stability and neurological outcome. Transfacetal screw is an evolving technique which is better or equivalent biomechanical stability in terms of safety, cost effectiveness and ease of doing. Aim: Comparing the clinico-radiological outcomes and cost effectiveness of transfacetal screw with lateral mass screw fixation in cervical compressive myeloradiculopathy of various aetiologies. Methodology: It was a Retrospective observational study, with Purposive Convenient sampling and sample size of 40, n=20 in each group. The Study was conducted at Department of Neurosurgery, KAPV Govt. Medical College and MGM GH Trichy from Period: 1 Jun 2022 – 31st July 2024. [2 YEARS]. A pre designed proforma was used to collect the data and Chi Square test was test of significance. Results: Neurological improvement in group I and II were 90 % and 80% respectively. On follow up after 3 months, both groups showed a recovery rate of 90 %. When comparing other parameters, group I showed better results when compared to group II. In our series all the cases had bicortical purchase and most of the cases [85%] had good bony fusion which was evident by radiological images. The average direct cost of instrumentation for lateral mass screws and rod constructs would be more than 80% (84.9%) of the cost incurred for transfacetal screws. Conclusion: With TFS fixation, we could achieve similar neurological and radiological outcomes as with LMS. In addition, TFS is significantly cost effective in comparison with LMS. In other words, TFS is safe, cost effective and equally effective to LMS in achieving neurological and radiological betterment.

Introduction: CRS is a prevalent inflammatory disorder affecting the nose and PNS. Recent studies suggest a possible relation linking vit D3 deficiency and CRS. Aim: To investigate the association between vit D3 and CRS, including its subtypes—CRSwNP and CRSsNP. Methods: It is a cross-sectional, correlative study included 156 patients with CRS. Vit D3 levels were estimated using a chemiluminescent immunoassay. Results: Patients with CRSsNP had notablyly greater mean vit D3 levels in contrast to those with CRSwNP. Vit D3 deficiency was more usual in patients with CRSwNP. Receiver operating characteristic (ROC) curve analysis revealed that vit D3 levels had a moderate ability to discriminate between CRSwNP and CRSsNP patients. Conclusion: Vit D3 deficiency is frequent in patients with CRS, particularly those with CRSwNP. Vitamin D3 levels could serve as a potential marker to help distinguish between patients with CRSwNP and CRSsNP. Additional research is necessary to evaluate the potential therapeutic benefits of vitamin D3 supplementation for patients with CRS.

Background: Worldwide, bupivacaine is the most popular local anaesthetic for spinal anaesthesia in parturients undergoing elective Caesarean delivery. However, compared to other local anaesthetics, it has considerable adverse effects on the cardiovascular and central nervous system. Levobupivacaine has a lower risk of cardiovascular and CNS toxicity than bupivacaine. This study was taken up in order to compare the effects of both these agents used during spinal anaesthesia in caesarean section. Methodology: Seventy parturients meeting the inclusion criteria, scheduled for elective caesarean section were divided into Group A (n=35; patients receiving 0.5% hyperbaric bupivacaine with buprenorphine) and Group B (n=35; patients receiving 0.5% hyperbaric levobupivacaine with buprenorphine) by a computer-generated random selection using block randomization. Results: Group A had a longer duration of sensory block than Group B (262.29±12.39 mins vs 224.86±12.22 mins) and also a longer duration of motor block compared to Group B (205.29±13.717 mins vs 165.86±6.001 mins) which was statistically significant (p- value < 0.001). There was no significant difference in the onset of sensory and motor block and the intraoperative hemodynamics in Group A and Group B. The duration of analgesia observed in our study in Group A was 394±47.663 minutes and in Group B was 408.57±49.417 minutes. Conclusion: 0.5% hyperbaric levobupivacaine produced less duration of sensory and motor blockade compared to 0.5% hyperbaric bupivacaine. Both groups are comparable in terms of onset of sensory block, motor block, duration of analgesia, and duration of postoperative analgesia.

Aims: Regional anaesthesia is preferred for many surgeries, more so for surgeries on the limbs. Surgeries below the umbilicus are usually done under spinal anaesthesia as it provides adequate intraoperative analgesia, muscle relaxation and reflex suppression. To understand the current status and magnitude of this problem in our set up, we conducted this descriptive observational study to see the occurrence of PDPH in patients of who had undergone lower limb surgery under spinal anaesthesia. Methods and Material: The study was conducted in the department of anaesthesia, Department of orthopedic at S.M.S. hospital and trauma centre, attached to S.M.S. Medical College, Jaipur. A Hospital based descriptive observational study. Sample size was calculated 729 cases and required at 95% confidence and 2% absolute error to verify the expected 9.5% PDPH in case of spinal anaesthesia. Statistical Analysis: Data has been entered in excel and statistical analysis was performed with the SPSS, version 21 for Windows statistical software package (SPSS inc., Chicago, IL, USA). The Categorical data was presented as numbers (percent) and were compared among groups using Chi square test. The quantitative data was presented as mean and standard deviation. Probability was considered to be significant if less than 0.05. Conclusion: PDPH occurs more frequently when the number of prick are more than one other factor like age, sex, waist hip ratio, time to ambulation do not contribute substantially.25G Quincke’s needle is a good choice for successful, uneventful spinal anaesthesia in adequately trained hands (PDPH 1.2%) Also 25 G needles with Quincke type bevel are comfortable for training new post-graduates whereas finer needle may require introducer.

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) represents a significant and growing public health concern globally, associated with metabolic syndrome and insulin resistance. The condition ranges from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH), potentially progressing to cirrhosis and hepatocellular carcinoma. Objectives: The primary aim is to clinically characterize NAFLD patients and correlate liver fibrosis with subclinical atherosclerosis. Specific objectives include studying clinical and biochemical parameters in lean and non-lean NAFLD patients, estimating liver fibrosis using Fibroelastography, and determining correlations between liver fibrosis and markers of subclinical atherosclerosis. Methods: The study employed a clinical observational design, enrolling patients diagnosed with NAFLD. Clinical and biochemical parameters were assessed, and Fibroelastography was used to estimate liver fibrosis. Markers of subclinical atherosclerosis, such as carotid intima-media thickness and flow-mediated dilation, were also evaluated. Results: The results indicated significant differences in clinical and biochemical parameters between lean and non-lean NAFLD patients. Fibroelastography revealed varying degrees of liver fibrosis, with a notable correlation between the severity of fibrosis and markers of subclinical atherosclerosis. Lean NAFLD patients also exhibited a higher prevalence of subclinical atherosclerosis compared to their non-lean counterparts. Conclusion: The study underscores the complex interplay between liver fibrosis and subclinical atherosclerosis in NAFLD patients. It highlights the importance of thorough metabolic assessment and the potential for personalized diagnostic and therapeutic strategies to enhance patient outcomes. Early detection and management of liver fibrosis and subclinical atherosclerosis are crucial in mitigating the systemic impacts of NAFLD.

Background: Anaemia typically occurs with non-communicable diseases (NCDs), which might worsen clinical outcomes and disease management. This investigation focuses on the prevalence and impact of anaemia in tertiary care NCD patients. Methods: This year-long descriptive cross-sectional study at Nalanda Medical College Hospital, Jamuhar, involved 80 NCD patients. Anaemia prevalence was assessed using haemoglobin and demographic data. World Health Organisation criteria specified anaemia. Results: This year-long descriptive cross-sectional study at Nalanda Medical College Hospital, Jamuhar, involved 80 NCD patients. Anaemia prevalence was assessed using haemoglobin and demographic data. World Health Organisation criteria specified anaemia. Conclusion: The high prevalence of anemia observed in patients with NCDs highlights the need for integrated management approaches in tertiary care settings. Early detection and treatment of anemia can potentially improve the clinical management of NCDs and enhance patient outcomes.

Background: Breastmilk is the ideal source of nutrition for neonates. But various practical difficulties arise while providing breast milk exclusively in preterm and term small for gestational age(SGA) low birth weight(LBW)babies. This study was undertaken to evaluate the growth pattern of both preterm and term SGA-LBW infants nursed on exclusive breast milk from birth to six months of age. Methods:  This was a prospective, longitudinal study carried out in  the Department of Pediatrics, Madha Medical College and Research Institute, Chennai, where exclusive breast- feeding is practiced in all neonates. All consecutive low birth weight neonates irrespective of gestational age, born during the study period were included in the study. Assessment of growth parameters included recording of weight (daily when in the hospital and later weekly), length (weekly) and head circumference (weekly) till the age of six months. Result:  Low birth weight infants, both the preterm and the term small for gestational age, on being exclusively breastfed by their own mothers, gained weight and had an increase in their head circumference and length to the levels almost comparable to the standard fetal-infant growth norms. Conclusion:  Exclusive breast-feeding results in adequate growth in low birth weight babies including preterm.

Severe acute respiratory corona virus 2 (SARS-CoV-2) [1] is a type of virus that causes covid -19 infection which is dreadful virus of this century. Invasive fungal infections like pulmonary aspergillosis and pulmonary mucomycosis most common infections in the post covid era. Like aspergillosis, mucomycosis classically been observed in patients already suffered with covid -19 patients. In the present case series mucomycosis is the most common fungal infection seen in these patients. These fungal is most common in post covid-19 patients because of the impaired mucosal membrane barrier and impaired immune response in these viral infections and because of the highest dose of immunosuppressive medicine like high dose steroids and interleukin-6 inhibitors like toclizumab. The following the 4 cases of post covid-19 fungal infections which are present in unusual centres like mediastinum etc which are diagnosed in our centre.

Introduction: Cardiac arrhythmias are a common and serious cause of emergency department (ED) visits, associated with significant morbidity and mortality. Prompt recognition and management are essential to prevent complications such as stroke, heart failure, and sudden cardiac death. Materials and Methods: This prospective observational study was conducted over 12 months in the emergency department of a tertiary care hospital. A total of 130 adult patients diagnosed with cardiac arrhythmias were included. Detailed clinical profiles, laboratory parameters, ECG findings, comorbidities, management interventions, and outcomes were recorded and analyzed. Results: The mean age of patients was 43.52 ± 13.60 years, with a predominance of males (75.4%). Hypertension (28.5%) and diabetes (19.2%) were the most common comorbidities. The majority of patients presented with tachycardia (71.5%), and atrial fibrillation was the most frequent ECG finding (32.3%), followed by complete heart block and SVT. Common presenting symptoms included shortness of breath (44.6%), cough (44.6%), and chest pain (28.5%). Shock was the primary indication for urgent management in 30% of patients, and 32.3% received electrical therapy. The mean ED stay was 55.4 hours, and the average hospital stay was 6.45 days. Complications such as hypotension (11.5%) and death (15.4%) were noted, with refractory ventricular fibrillation being the leading cause of mortality. Conclusion: Cardiac arrhythmias in the emergency setting are common, complex, and often life-threatening. Early recognition, aggressive intervention, and comprehensive care are essential to improve outcomes in this high-risk population.

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common metabolic liver diseases round the world. NAFLD ranges from simple steatosis to progressive nonalcoholic steatohepatitis ultimately leading to cirrhosis of liver. Objective: This study estimates the serum creatinine body weight ratio of nonalcoholic fatty liver disease with respect to healthy control in adult population. Design: A observational cross sectional study conducted in outpatient department of medicine of tertiary care centre in northern India for a period of 1 year. Participants: 364 patients were included in study coming in medicine OPD of Dr. RMLIMS Lucknow out of which 185 were of nonalcoholic fatty liver disease and 179 of healthy controls. Main Measures: Estimation of serum creatinine body weight ratio was done in nonalcoholic fatty liver disease group and healthy control groups and then comparison was done. Key Results: On comparing both groups it is found that there is statistically significant difference in SCBWR in both groups. On dividing the serum creatinine body weight ratio in different range it is found that in NAFLD group 55% were in 0.008-0.01range and 25% in 0.01-0.012. On the other hand, in healthy control group 32% in 0.014-0.016 range, 28% in 0.012-0.014 and 19% in 0.01-0.012 range. On subgroup analysis of NAFLD group there is no significant difference between male and female group. Conclusions: The study suggested that serum creatinine body weight ratio of NAFLD patients is lower than healthy control irrespective of gender. It may be predicted that low SCBWR is associated with increased risk of NAFLD.

Introduction: The vermiform appendix exhibits significant anatomical variability in its position, influencing the clinical presentation and diagnosis of appendicitis. Understanding these variations is crucial for accurate diagnosis and surgical management. This study aimed to determine the distribution of different anatomical positions of the appendix in patients undergoing appendectomy at a single center. Materials and Methods: This prospective observational study was conducted at Government Medical College, Akola, Maharashtra, from January 2023 to December 2024. A total of 100 patients who underwent appendectomy were included. The anatomical position of the appendix was recorded intraoperatively and categorized into seven types: retrocecal, pelvic, pre-ileal, post-ileal, subcecal, paracecal, and other (ectopic). Data on appendix length and diameter were also collected. Descriptive statistics were used for analysis. Results: The most common anatomical position of the appendix was pelvic (42%), followed by retrocecal (31%), paracecal (9%), subcecal (7%), post-ileal (6%), subhepatic (3%), and pre-ileal (2%). The mean appendix length was 87 mm, with the majority (49%) falling within the 81–120 mm range. The average appendix diameter was 8.5 mm, with most patients (58%) having a diameter in the 5–8 mm range. Conclusion: The pelvic position was the most common anatomical location of the appendix in this study. Variability in appendix position can lead to differences in clinical presentation, impacting the timely diagnosis and management of appendicitis. Recognizing these anatomical variations is essential for improving surgical outcomes.

Background: This study aims to compare the recovery times and postoperative outcomes of Sevoflurane, Propofol, and Isoflurane. The demand for outpatient surgeries has increased significantly over the last few decades. Rapid recovery is an essential need for maximum efficiency and patient satisfaction. The selection of anesthetic agents is most important for patient outcomes. Method: The study involved 96 patients and was carried out for a randomized controlled trial. The patients were grouped into three categories depending on the types of anesthetic agents they have received. Both primary and secondary parameters were as follows: time till discharge, awakening, and incidence of PONV. Results: The patients receiving Sevoflurane and Propofol had a shorter time to discharge and were more alert than the patients who were given Isoflurane. The frequency of PONV was also the lowest in the Sevoflurane group. Faster recovery time in Sevoflurane and Propofol group led to optimization of time in the operating room and resource efficiency. Conclusion: Sevoflurane and Propofol are more effective for faster recovery and higher patient satisfaction in outpatient surgeries. Isoflurane was associated with longer recovery times and higher postoperative complications. These findings recommend Sevoflurane and Propofol and for enhanced surgical efficiency.

Background: Type II DM patients with micro albuminuria is an indication of chronic renal failure and cardiovascular diseases. It leads to fatal consequences if not treated efficiently. Method: 100 (one hundred) adult patients with type II DM with MA are compared with 100 type II DM patients; having normal MA, BP was recorded. The blood examination included HbA1C, GFR, lipid profile, fasting plasma glucose, serum creatinine, and urine analysis. A calorimetric semi-quantitative urine test strip, pH, and specific gravity were also carried out. Results: Clinical and biometric manifestations, BMI, BP, fasting plasma glucose, serum creatinine, and GFR have significant p-values (p < 0.001). Conclusion: The prevalence of micro albuminuria in type-2 DM patients confirms a longer duration of undiagnosed diabetes and prognosis of type-II DM complications. It will help the clinician to treat such patients efficiently to avoid morbidity and mortality.

Background: Menopause is associated with various biochemical and physiological changes, which lead to osteoporosis due to variations in various hormones, including PTH. Hence, causes of osteoporosis have to be ruled out. Method: 80 premenopausal and 80 postmenopausal women were studied. Apart from their anthropological parameters, their biochemical profile was studied. 5 ml of venous blood from each patient was collected. Serum calcium was measured by the colorimetric method (Erba kit). Calcitonin and PTH were estimated by ELISA, and results were compared. Results: In anthropological parameters, the age group of premenstrual and postmenstrual women had a significant p-value (p<0.001). In the comparative study of serum calcium and serum calcitonin, PTH had a significant p-value (p<0.001). Conclusion: It is confirmed that postmenopausal women have low calcium along with higher PTH, which results in osteoporosis. More study is required to increase calcium levels in post-menopausal women to lead healthy, socio-economically independent lives.

Background: Among the most frequent diseases linked to healthcare, surgical site infections (SSIs) greatly concern with patient morbidity, lengthen hospital stays, and raise medical expenses. The frequency, risk factors, and results of SSIs in patients having elective procedures are assessed in this study. The purpose of this study is to evaluate the influence of SSIs on postoperative recovery by analyzing their incidence, risk factors, and trends after elective surgical operations. Methods: At Department of General Surgery Government Medical College Firozabad, this prospective observational research was carried out over 6 months. Using conventional CDC standards, patients undergoing elective procedures were recruited one after the other and tracked for the development of SSI. Information was gathered on surgery specifics, postoperative results, comorbidities, and patient demographics. To find correlations between risk variables and the incidence of SSI, statistical analysis was conducted. Result: 28 patients accounting for 14% of the 200 patients who were recruited experienced SSIs. All routine operations pertaining to elective general surgery performed. Most commons risk factors related to SSI are diabetes mellitus, hypertension, smoking and obesity. In relations to duration of developing SSI most patients developed SSI after 21 days of surgery even after routine antibiotic prophylaxis. Conclusions: With a number of modifiable and non-modifiable risk factors, the frequency of SSIs after elective procedures is still a concern. To lessen the burden of SSIs, focused preventative measures must be implemented, and infection control procedures must be followed.

Aim: This study compares the hemodynamic responses to laryngoscopic endotracheal intubation and classic laryngeal mask airway (cLMA) insertion in adult patients undergoing elective surgery under general anesthesia. Material and Methods: Fifty ASA I & II patients aged 20–60 were randomly assigned to two groups (n=25 each): Group L (cLMA) and Group E (ETT). Devices were inserted as per standard techniques. Hemodynamic parameters including heart rate, systolic and diastolic blood pressure, mean arterial pressure, rate pressure product (RPP), and SpO₂ were monitored and compared. Results: The cLMA group exhibited significantly lower and shorter-lasting increases in hemodynamic parameters compared to the ETT group. RPP, an indicator of myocardial oxygen demand, was also more favorable in the cLMA group. Conclusion: Classic LMA is a safer and more stable alternative to endotracheal intubation for airway management under general anesthesia.

Background: Antimicrobial resistance is the biggest danger to global health. It is challenging to cure illnesses brought on by pathogens, including bacteria, fungi, and viruses. The overuse or abuse of antibiotics by the pharmaceutical industry and a dearth of research into the development of new medications are two factors that contribute to antibiotic resistance. Aim: Thus, the objective is to evaluate the ability of the specifically designed hydrogel beads to eliminate biofilms and eradicate both benign and dangerous strains of P. aeruginosa and S. aureus. Materials & Methods: Calcium alginate hydrogel beads and copper sulfate hydrogel beads in different concentrations are two biocompatible adsorbents that are made in this work using sodium alginate as a basis. Because of their mechanical performance, biocompatibility, swelling capacity, and porous structure, hydrogels are excellent platforms for the creation of antimicrobial materials. The study was split into two phases, the first of which concentrated on making beads and the second on the hydrogels’ antibacterial, swelling, and biofilm-forming properties for possible drug development applications. Alginate solutions in different ratios with calcium chloride (CaC1₂) and copper sulfate (CuSO₄) were easily combined to generate the hydrogel beads. Results & Conclusion: Alginate beads and hydrogels that are encapsulated in different substances and microbes may be used as biosorbents in the environment. CuSO₄ alginate beads and other crosslinked alginate beads are antibacterial. Sodium alginate decomposes and is biocompatible.

Background and Aim: Endotracheal intubation for general anaesthesia produces airway mucosal injury leading to post-operative sore throat (POST). Though this complication is mild but it causes dissatisfaction and agony to the patients after surgery. This study was conducted to compare the role of pre-operative ketamine and dexmedetomidine intra oral spray in attenuating post-operative sore throat in patients undergoing tonsillectomy. Methods: This study was designed as a randomized clinical study. After obtaining institutional ethical committee clearance, 60 patients were randomly allocated into two groups Group D and Group K scheduled to undergo Elective Tonsillectomy. Group D received Dexmedetomidine intraoral spray and Group K received Ketamine intraoral spray just before intubation under direct laryngoscopy. POST monitoring was done at 0,2,6,12, 18 and 24h after extubation. POST was graded on a four-point scale (0-3). Results: The overall incidence of POST in this study was 18.33%. POST was experienced by 5 patients (16.66%) in Dexmedetomidine group and 6 patients (20%) in Ketamine group (P = 0.74). There was no statistically significant difference in the incidence of POST between the two groups at 0,2,6,12,18 and 24h post-operatively. It was observed that the severity of sore throat was lower in both the groups at all times. Conclusion: Pre-induction intraoral spray of Dexmedetomidine or Ketamine can decrease the incidence and severity of post-operative sore throat in patients undergoing tonsillectomy.

Background: Acne vulgaris in adults is increasingly recognized as having significant endocrine underpinnings, particularly related to androgen excess. This study aimed to characterize the hormonal profiles of adult acne patients and evaluate their correlation with acne severity. Methods: A cross-sectional study was conducted at a tertiary care center involving 150 consecutive adult acne patients (18-45 years) and 50 age-matched controls. Serum levels of total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin were measured. Acne severity was assessed using the Global Acne Grading System (GAGS). Polycystic ovary syndrome (PCOS) was diagnosed using Rotterdam criteria. Results: Acne patients demonstrated significantly higher mean TT (2.8±1.1 vs 1.5±0.6 nmol/L, p<0.001) and FT (15.2±6.8 vs 6.4±2.3 pg/mL, p<0.001) compared to controls. Among acne patients, 72/150 (48%) had biochemical hyperandrogenism, with 32/108 females (29.6%) meeting PCOS criteria. A strong positive correlation existed between FT levels and GAGS scores (r=0.48, p<0.001). PCOS patients had more severe acne (mean GAGS 28.4±6.2 vs 18.7±5.1, p<0.001) and higher androgen levels than non-PCOS patients. Conclusion: Hyperandrogenism, particularly in PCOS patients, is strongly associated with acne severity in adults. These findings support routine hormonal evaluation in adult acne patients, especially women with persistent or treatment-resistant acne, to guide targeted therapy.

Background: Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous units that causes comedones, inflammatory follicular papules, and pustules and the nodular cystic lesions in the sebaceous areas of the face and trunk. It is a psychosomatic disorder affecting both the body and psyche. AV can significantly affect an individual’s self-esteem and self-image. The present study aimed to determine body image concerns and self-esteem among patients with AV. Methodology: A cross-sectional study was conducted on 66 patients with AV, who were attending OPD or were admitted as IP in the Department of Dermatology of a tertiary care centre. Sociodemographic and related clinical variables were recorded using a semi structured proforma. Severity of AV was assessed using Global acne grading scale. Body Image Concern were assessed using Body Image Concern Inventory while Rosenberg Self Esteem Scale was used to assess self-esteem among the participants. Results: The results revealed that the mean age of the participants was 22.21 years, mean duration of AV in the participants was 12.37 months, two third participants were having mild AV, Median of BICI score for the participants was 33.5 (Interquartile range ±12) and RSES score for the participants was 26 (Interquartile range ± 3). The severity of AV and the duration of AV had positive association with both body image concern and self-esteem. Conclusion: This study highlights the importance of routine comprehensive clinical assessments in patients with Acne vulgaris. Consultation – liaison between dermatologist and psychiatrist is warranted to improve the treatment outcome.

Background: Endometriosis is a common gynecologic disorder linked to infertility, which frequently affects the efficacy of assisted reproductive technologies (ART), such as in vitro fertilization (IVF). The present research seeks to evaluate the impact of endometriosis on IVF results, with an emphasis on fertilization rates, implantation success, and oocyte quality. Methods: A retrospective study was carried out to assess IVF success in women with endometriosis versus a control group free of the disease. Parameters including oocyte recovery, fertilization rate, embryo quality, and clinical pregnancy rate were compared. Statistical analysis of data was carried out to establish the effect of endometriosis on fertility. Results: The results show that the women with endometriosis had significantly lower implantation and fertilization rates compared to those without endometriosis. Furthermore, the quality of oocytes was compromised and oxidative stress markers were elevated in the study group. All these findings concur with the existing literature, emphasizing the negative impact of endometriosis on ART outcomes. Discussion: The findings highlight the multifaceted pathophysiological processes of endometriosis-associated infertility, such as oxidative stress, immune dysregulation, and hormonal imbalance. Comparison with previous research supports the importance of tailored treatment strategies, including hormonal therapy and antioxidant supplementation, to improve IVF outcomes among affected patients. Conclusion: Endometriosis has a substantial negative impact on IVF success rates, requiring appropriate treatment regimens to enhance reproductive outcome. Further studies are necessary to formulate specific interventions that could counteract its detrimental effects on fertility.

Aim and Objective: To study the cytomorphological spectrum of lymph node lesion for early diagnosis and treatment. Methodology: Current study was retrospective study of one year duration from April 2021 to June 2022 conducted in Department of Pathology Govt. Medical College Mahasamund (C.G). Total 100 sample were taken and analyzed and correlated for their etiology. FNAC was conducted with 22-Gauge disposable needles attached to 10cc syringes. Smears were fixed in 95% ethyl alcohol and stained with papanicolau stain. Giemsa stain was done on air dried smears. Ziehl-Neelsen (ZN) staining was done wherever required. Result: Total 100 sample were included in the study, age ranges from 1year to 90 years most common age group affected are of 11 to 20 yrs followed by 21 to 30 yrs. Female patient outnumbered male patient. Male female ratio was 3:3.6. Most commonly affected lymph node is of cervical group followed by axillary group. Out of 100 cases, 35% case reactive lymphadenitis, 30% case granulomatous lymphadenitis 15% case tuberculosis confirmed by AFB staining and CBNaat, 13%metastasis 4% suppurative lymphadenitis, 3% case of lymphoma were noted. Conclusion: LN-FNAC can be performed in most cases, even when more invasive techniques are not feasible. FNAC is very useful, minimal invasive, cost effective and accurate approach in diagnosing various lymph node lesions. With the help of FNAC unnecessary biopsy can be avoided.

Background: DDIs, which are more common in multi-drug users like the elderly and those with long-term health conditions, pose a serious risk to patient safety. DDIs can cause hospitalizations, DDIs, and ADEs. Preventing DDIs requires proactive technology, clinical knowledge, and patient-centered approaches from healthcare systems. Clinical Decision Support Systems (CDSS), pharmacist-led medication reviews, prescriber education programs, patient counseling, and medication reconciliation have reduced DDI risks. The relative efficacy of these interventions in different healthcare contexts has received little attention. Objective: This study aimed to evaluate the effectiveness of different strategies for preventing DDIs through a retrospective analysis of medical records from inpatient, outpatient, and specialty care settings, with a focus on quantifying reductions in potential DDIs (pDDIs). Method: One hundred hospital and specialty and outpatient clinic patients’ medical records were reviewed. Children and incomplete records were excluded, but patients taking five or more medications were included. Prescription records, medication error reports, and intervention logs provided data from 2020 to 2024. Prevention measures included prescription education, patient counseling, CDSS alerts, and pharmacist reviews. Possible DDI frequency, intervention rates, severity categorizations, and intervention time were measured. The effectiveness of each tactic was assessed using t-tests and chi-square analyses. Results: Overall, 42% reduction in pDDIs was observed across all settings, with CDSS contributing to a 24% reduction, pharmacist reviews to 19%, prescriber education programs to 14%, and patient counseling and reconciliation efforts to 12%. Inpatient settings saw the highest reduction (47%), followed by outpatient clinics (38%) and specialty care settings (30%). Combined approaches, particularly CDSS alerts coupled with pharmacist reviews, were most effective, demonstrating synergistic benefits. Conclusion: Results show the need for comprehensive approaches that combine technology, clinical expertise, and ongoing training. Pharmacist-led reviews and CDSS, two of the most effective interventions, worked even better together. Healthcare systems should implement continuous prescriber training, increase pharmacist participation in medication reviews, and integrate CDSS into EHRs to reduce DDIs. Prospective studies are recommended to improve these strategies and assess their long-term effects on clinical outcomes and patient safety.

Background: Medication adherence and errors affect clinical outcomes, patient safety, and healthcare costs. Medication errors can cause serious adverse events, morbidity, and mortality, and non-adherence to prescribed therapies contributes to poor disease control, more hospitalizations, and avoidable consequences. There are several ways to improve adherence and reduce errors, but clinical data is scarce. Objectives: This retrospective study aimed to evaluate the effectiveness of different strategies used to improve medication adherence and reduce medication errors among patients on long-term therapy. The study also sought to identify the most effective combinations of interventions and explore factors influencing their success. Methods: Patient records, pharmacy records, adherence monitoring systems, and hospital incident reports from 2020–2023 were used for this retrospective observational study. One hundred long-term drug patients provided data. Strategies included medication reconciliation, pharmacist counselling, reminder systems (texts, mobile apps), and caregiver participation. Medication errors (per 100 prescriptions) and adherence (days covered) were the main outcomes. Result: This study analyzed 100 patients (mean age 56.4 years, 54% male) with chronic conditions (58% hypertension, 49% diabetes). Polypharmacy was present in 41%. The most effective strategies were pharmacist counselling (PDC 85.7%, 52.1% error reduction) and medication reconciliation (PDC 82.4%, 56.6% error reduction). SMS reminders showed lower adherence (PDC 68.4%) and smaller error reduction (22.6%). Patients aged 41-60 years had the highest adherence (78.2%) and lowest error rate (4.5 per 100 prescriptions), while older adults (>60 years) and psychiatric patients had the lowest adherence (72.0%, 69.4%) and highest error rates (5.7, 6.1 per 100). Targeted strategies are needed for high-risk groups. Conclusion: This study emphasizes the importance of integrating technology-based adherence tools with proactive healthcare provider involvement, such as pharmacist counselling and medication reconciliation, to improve medication adherence and reduce medication errors in long-term therapy patients. Comprehensive, multi-faceted approaches tailored to patient needs and health literacy improve medication safety and clinical outcomes.

Background: Neonatal hypoglycemia is a common metabolic disorder that can lead to significant neurodevelopmental impairments if left undetected. Asymptomatic hypoglycemia often remains unnoticed during the early neonatal period, necessitating routine screening for timely intervention. Objective: This study aims to determine the incidence and identify risk factors associated with asymptomatic hypoglycemia in neonates undergoing routine screening. Methods: A hospital-based prospective observational study was conducted in the Department of Pediatrics at Travancore Medical College, Kollam, over one year. A total of 100 neonates admitted to the neonatal unit within the first 48 hours of life were included. Routine blood glucose screening was performed at 1, 3, 6, 12, and 24 hours using a bedside glucometer, with confirmation by the glucose oxidase-peroxidase (GOD-POD) method for values <47 mg/dL. Data on gestational age, birth weight, mode of delivery, maternal history (diabetes, hypertension, preeclampsia), and feeding patterns were recorded. Statistical analysis was performed using SPSS (version 19), with chi-square tests and logistic regression used to identify significant risk factors. Results: The incidence of asymptomatic hypoglycemia was 30% (30/100 neonates). Significant risk factors included preterm birth (p = 0.02), low birth weight (<2.5 kg, p = 0.03), small for gestational age (SGA, p = 0.05), intrauterine growth restriction (IUGR, p = 0.01), and maternal diabetes (p = 0.02). Logistic regression analysis indicated that preterm neonates (OR = 2.5, p = 0.02), low birth weight neonates (OR = 2.1, p = 0.03), and infants of diabetic mothers (OR = 3.0, p = 0.01) had significantly higher odds of developing asymptomatic hypoglycemia. Conclusion: Asymptomatic neonatal hypoglycemia is common, particularly among preterm, low birth weight, and small-for-gestational-age neonates, as well as those born to diabetic mothers. Routine screening and early intervention strategies are essential to prevent potential complications. Strict monitoring protocols and early feeding support can help mitigate risks and improve neonatal outcomes.

Background: Early-onset hypocalcemia (EOH) is a common metabolic disorder in preterm neonates, often associated with immature parathyroid function, maternal metabolic disorders, and neonatal complications. This study aims to evaluate the incidence, risk factors, and biochemical profiles of hypocalcemia in preterm neonates. Methods: A prospective observational study was conducted over one year, including 100 preterm neonates admitted to the neonatal intensive care unit (NICU). Serum total and ionized calcium levels were measured within the first 72 hours of life. Maternal and neonatal risk factors, including gestational age, birth weight, maternal diabetes, vitamin D deficiency, neonatal sepsis, and respiratory distress syndrome (RDS), were analyzed. Results: The incidence of EOH was 38%. Hypocalcemic neonates had a significantly lower gestational age (33.1 ± 2.5 weeks) and birth weight (1,740 ± 430 g) compared to normocalcemic neonates (p < 0.05). Maternal risk factors such as gestational diabetes (42%), vitamin D deficiency (55%), and preeclampsia (26%) were significantly associated with hypocalcemia. Neonatal factors including sepsis (30%) and RDS (45%) were also significant contributors. Hypocalcemic neonates had lower mean serum calcium levels (6.5 ± 0.7 mg/dL vs. 8.2 ± 0.6 mg/dL, p < 0.001) and ionized calcium levels (0.98 ± 0.12 mmol/L vs. 1.25 ± 0.15 mmol/L, p < 0.001). Logistic regression identified gestational diabetes (OR: 4.2), neonatal sepsis (OR: 2.8), RDS (OR: 2.6), and maternal vitamin D deficiency (OR: 3.1) as independent predictors of EOH. Conclusion: EOH is prevalent in preterm neonates and is significantly associated with maternal diabetes, vitamin D deficiency, neonatal sepsis, and RDS. Early identification of high-risk neonates and targeted calcium supplementation strategies may reduce the incidence of hypocalcemia and improve neonatal outcomes. Further multicentric studies are recommended to establish standardized screening and management protocols.

Introduction: Radiation-induced hypothyroidism (HT) is one of the significant side effects of external beam radiation to the neck region. Subclinical hypothyroidism usually develops (elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (T4) levels) and is stable for years and then progresses to a clinical form (elevated TSH levels with decreased T4 levels). Radiation-induced hypothyroidism mechanism is not well known, but thyroid cell fibrosis, vascular proliferation, and the immune response may be considered. Aims: To assess thyroid function status in head and neck malignancy patients undergoing radiotherapy with or without concurrent chemoradiation from the initiation of treatment till six months following completion of treatment. Method: This hospital-based observational study was conducted in the Otorhinolaryngology and Radiation Oncology department of Assam Medical College and Hospital (AMCH), Dibrugarh, Assam, from 1st June 2023 to 31st July 2024 done. All the biopsy-proven head and neck malignancy patients fulfilling the inclusion criteria during the study period were observed. A total of 50 cases were studied. After obtaining written informed consent, patients included in the study were evaluated for TSH, free T3 and free T4 before the start of radiation therapy/ chemoradiotherapy, immediately after completion of treatment, at 2 months and 6 months. Results: Our prospective study of 50 head and neck cancer patients including 32 males and 18 females with median age 54 undergoing radiotherapy found a 18% incidence of subclinical hypothyroidism after 6 months. Hypothyroidism was diagnosed in 27.77% of females and 12.50% of males. The condition was most prevalent among hypo pharyngeal malignancy cases (50%), followed by laryngeal (26.31%) and oropharyngeal (25%) cases. Patients receiving chemoradiation (80%) had a higher incidence (20%) compared to those receiving radiotherapy alone (10%). Age-wise, 25% of patients aged 10-44years developed hypothyroidism, while 15.78% of those above 44 years did. Conclusion: The study emphasises the importance of thyroid function monitoring in head and neck cancer patients undergoing radiotherapy, especially those with hypopharyngeal malignancies or receiving chemoradiation.

Introduction: Laparoscopic cholecystectomy, a minimally invasive surgical technique, provides numerous benefits, including reduced morbidity, shorter recovery times, and lower healthcare costs. However, the induction of pneumoperitoneum leads to significant hemodynamic alterations, requiring optimal anesthetic management. Postoperative pain remains a concern, necessitating effective analgesic strategies. This study compares the efficacy of Butorphanol and Nalbuphine in attenuating the hemodynamic response and providing postoperative analgesia in laparoscopic cholecystectomy. Aim: To compare the effects of premedication with Nalbuphine and Butorphanol on hemodynamic cardiovascular responses and postoperative analgesia in laparoscopic cholecystectomy. Objectives: (1) Evaluate changes in hemodynamic parameters (HR, NIBP, EtCO₂) before, during, and after pneumoperitoneum. (2) Assess duration of postoperative analgesia. (3) Compare postoperative sedation. (4) Identify side effects and complications. Materials and Methods: A randomized, double-blind study was conducted on 60 ASA grade I-II patients undergoing elective laparoscopic cholecystectomy. Patients were allocated into two groups: Group B (Butorphanol 25 µg/kg IV) and Group N (Nalbuphine 0.2 mg/kg IV). Hemodynamic parameters were recorded at various time intervals. Postoperative analgesia was assessed using the Visual Analog Scale (VAS), and sedation was measured using the University of Michigan Sedation Scale (UMSS). Results: Butorphanol provided superior hemodynamic stability, with significantly lower HR and BP variations post-intubation and during pneumoperitoneum compared to Nalbuphine. Postoperative analgesia duration was longer in the Butorphanol group (122.83 ± 15.96 min) than in the Nalbuphine group (100.33 ± 13.89 min, p < 0.001). However, Nalbuphine caused prolonged sedation (109 ± 53.71 min) compared to Butorphanol (43 ± 42.92 min, p < 0.001). No significant respiratory depression was observed in either group. Conclusion: Both Butorphanol and Nalbuphine are safe premedication options for laparoscopic cholecystectomy. However, Butorphanol demonstrated better hemodynamic stability and longer postoperative analgesia, making it a preferable alternative.

Introduction: Of all vascular anomalies, Venous Malformations (VM’s) are the most common with a propensity for the head and neck. Due to limitations of surgical intervention and laser therapy in the craniofacial region, minimally invasive procedure of percutaneous sclerotherapy is the first line of management. Common agents include foam sclerosing agents, polidocanol, sodium tetradecyl sulfate, anhydrous ethanol and bleomycin. As it produces only minimal swelling after sclerotherapy (as opposed to ethanol-based agents), bleomycin is especially recommended for treatment of vulnerable areas such as the periorbit or regions related to the airway (i.e., tongue and parapharyngeal spaces). Aim of the Study: Treat facial venous malformations by percutaneous sclerotherapy with Bleomycin as the sclerosant and compare the outcome by clinical, subjective and objective methods using MR imaging with patients rendered Sodium Tetradecyl Sulphate (STS) as sclerosant. Materials and Method: This is a prospective study conducted in the Department of Radiology and Imageology, Nizam’s Institute of Medical Sciences, Hyderabad (India) over a period of 3 years from May 2013 to May 2016, with approval of Institutional Ethics Committee. Thirty patients with Cranio-facial VM were treated by ‘percutaneous foam sclerotherapy’ with Bleomycin or Sodium Tetradecyl Sulphate as sclerosing agents. Multiple sessions when required were performed with a minimum interval of three weeks. Treatment response was assessed and compared clinico-radiologically (USG/MRI) and subjectively based on response of the patient as unchanged, improved or disappeared at the end of treatment sessions. Result: Fluoroscopy-guided foam sclerotherapy using Belomycin and Sodium Tetradecyl Sulphate (STS) is a safe and equally effective method for treatment of venous malformations. However, due to limitations of dose of the drug, treatment sessions are increased to achieve the needed result in Bleomycin group. The number of patients with minor complications with STS outnumbered those with Bleomycin. However no major complication was encountered in our study during or post sclerotherapy. Conclusion: Choice of sclerosant in craniofacial VM’s is patient dependent. Bleomycin is preferred in patients with relatively small lesion involving critical areas such as periorbit or regions related to the airway (i.e., tongue and parapharyngeal spaces) and Sodium Tetradecyl Sulphate (STS) in patients having VM involving soft tissues of craniofacial region other than the above.

Introduction: Maxillo-facial injuries vary from soft tissue lacerations to complex fractures of maxilla-facial skeleton. Oral, nasal, submental, retromolar intubations, tracheostomy is established techniques for airway management. Blind nasal intubation is a recognized technique of intubation in panfacial fractures. Study Setting & Design: A Randomized Prospective Study in plastic surgery operation theatre in a tertiary care hospital. Method: A randomized prospective study of a group of 60 patients with Maxillo-facial trauma were divided into 2 groups, patients with Inter Maxillary Fixation intact (Group IMF, n =30) and patients without IMF (Group NIMF, n = 30) and were successfully intubated with blind nasal technique with minimal complications. The aim of the study was to find out the success rate and compare the number of attempts and complications of Blind Nasal intubation (BNI) after induction of General Anaesthesia in Cases of Maxillo-facial fractures in Group IMF and Group NIMF. Result: The number of patients being intubated in the first attempt were more in the Group IMF as compared to Group NIMF (19 Vs 11). The data is statistically significant. (p < 0.005). The average duration of intubation in the first attempt was noted to be lesser in Group IMF (29.7 secs) as compared to Group NIMF (34.72 secs.(p < 0.005). Conclusion: Blind nasal intubation in patients with IMF was better compared to patients without IMF. Probably IMF facilitated the ease of intubation by maintaining the airway without causing much tongue fall and allowing easy passage of endotracheal tube as the jaw does not fall due to fixation.

Objective: The objective of the study was to assess  the Autonomic Nervous System functions (ANS functions) in Normotensive young offspring of Hypertensive parents and Normotensive parents using Cold Pressor test so as to find the existence of sympathetic overactivity in normotensive young offsprings of Hypertensive parents. Methods: Two groups of offspring of Hypertensive parents and offspring of Normotensive parents (n=60 each)  were made. The study was a cross-sectional observational comparative study. Cold pressor test was used to assess autonomic functions in the subjects. Unpaired t test was applied to analyze the data with p-value < 0.05 considered as significant and <0.001 as highly significant. Results: Significant increase in diastolic and systolic blood pressure at 3 minutes following cold pressor test was found in male and female offspring of hypertensive parents as compared to offspring of normotensive parents. Diastolic blood pressure at 1 minute was significantly increased in only male off spring of hypertensive parents. Conclusion: Early detection of sympathetic overactivity was found in offspring of hypertensive parents by use of cold pressor test.

Background: Spinal anaesthesia requires a low dosage to achieve effective anaesthesia, thereby reducing the likelihood of complications and rendering it a safer option for orthopedic surgeries involving the lower limbs. Aims: This study evaluated the effects of administering 3ml (15mg) of bupivacaine in bolus versus fractionated dose in patients undergoing upper limb surgeries in terms of sensory and motor blockade as well as haemodynamic parameters. Methods: The study recruited 70 patients, of the American Society of Anesthesiologists physical status I-II, age 18-55 years, BMI 18.5-22.9 kg/m2. Group B: Patients were administered a single bolus dose of 3 mg (15 mg) of the anaesthetist. Group F: Patients were treated with a fractionated injection of 3 ml (15 mg) in a dose-dependent manner. Sensory and motor blocks were evaluated. Results: Group B patients had lower baseline mean arterial pressure at 2, 4, 6, 8, 10,16, 33, 25, 28, 30, 35, 40, 45, 50, 60 minutes (p<0.05). Sensory block regression took longer time in Group F as compared with Group B (189.53±14.21 vs 169.93±21.20) (p< 0.05). Motor block onset was comparable in both groups (p>0.05). Time for rescue analgesia was delayed in both Groups (515.24±29.83 vs 336.12±24.51)(p<0.001). The occurrence of bradycardia was statistically significantly greater in the Bolus group than in the Fractionated group. The administration of atropine was more in the Group B than in Groups F. Conclusion: This study concludes with the findings that, fractionated administration of bupivacaine in spinal anaesthesia provides better aesthetic outcomes in terms of prolonged duration of sensory and motor block.

Antepartum hemorrhage (APH refers to any bleeding from the genital tract after the 20th week of pregnancy but before labor. APH is implicated globally as one of the causes for 15.1% of fetal demise and 7.1% of early newborn deaths. APH can lead to significant complications, such as preterm birth, fetal distress, and stillbirth. Aims and Objectives: This study aimed to study fetal outcome in antepartum haemorrhage. Results: The fetal complication in our study was (67.98%) had low birth weight, (49.33%) had RDS, (22.66%) neonatal hypoglycemia, (13.33%) with neonatal jaundice and (14.66%) IUD. This study observed 78.66% Preterm delivery and 21.33% term delivery. In 53.34% neonates the APGAR score was <7 in 1min. Conclusion: Pregnancies of multiparous women with abruptio placenta are more likely complicated with SGA infant. Better antenatal services, increased awareness, improved transportation, improved nutritional status can help to address some of the complications associated with antepartum haemorrhage.

Introduction: Pituitary adenoma is a benign tumour that originates from the adenohypophyseal cells of the anterior lobe of pituitary gland. It accounts for 12% to 15% of all intracranial tumours. Pituitary adenomas are of 2 types according to the size microadenomas (≤10 mm) and macroadenomas (& gt; 10mm). A spectrum of visual manifestations are seen with these tumours, ranging from the absence of any visual symptoms to severe visual field defects and loss of vision. In comparison to male, female have a 2-fold increased risk of developing pituitary adenomas. Pituitary adenoma are benign tumour, however, it has a tendency of recurrence. Clinical features of adenomas are either due to hypersecretion or hyposecretion of hormones or compression of pituitary adenoma to the surrounding structures. Objective: The primary goal of the study is to study the various ophthalmic manifestations in cases of pituitary tumours and analyse the proportion of cases presenting with ophthalmic manifestations in cases diagnosed as pituitary adenoma on radiological imaging. Materials and Methods: It is a prospective study which was conducted in the department of Neurosurgery, CN Centre, Gauhati Medical College &amp; Hospital from June 2023 and May 2024. In our study we included 50 patients with pituitary tumours (male female ratio 1:1.27), age group from 21 to 60 years (mean age for male 52±9.46 years and female 44±8.2 years) with range of duration of visual field decline was 1 month to 36 months (mean 9±5.01 months). Headache (76%) was the most common associated symptom. Bitemporal hemianopia (65.9%) was the most common visual field defect. All patients were managed surgically. Results: Pituitary tumours are most common in the age group from 31 to 50 years (88%) and the least in the 21–30 age group (6%). Headache was the most common presenting symptom (76%) followed by blurring of vision (44%), diplopia (8%), loss of depth perception (8%) and photophobia (6%) of patients. 57% had visual acuity between 6/6 to 6/12 on presentation. 23% of patients had a visual acuity between 6/18 to 6/36 and only 20% had an acuity below 6/60. Bitemporal hemianopia (65.9%) was the most common visual field defect. Disc pallor was found in 20% eyes, optic atrophy in 15% eyes on fundoscopy. Duration of visual field decline was ranged from 1 month to 36 months (mean 9±5.01 months). 68% patients underwent Tran’s sphenoidal decompression and 32% patients underwent transcranial decompression. Postoperative complications eg, CSF leak in 16% patients, DI in 8%, meningitis in 4%, SSI in 4%, seizure and DVT in 2% each. Conclusion: A neuro-ophthalmic examination is crucial for early diagnosis, treatment planning, and follow-up because the main objective of pituitary adenoma management is to restore visual loss. The Bitemporal visual field defect is a pathognomonic ophthalmic finding in individuals with pituitary adenomas, but our analysis also revealed a number of other clinical features, such as headache, ophthalmoplegia, sensory visual abnormalities, and other field defects. In order to diagnose pituitary adenomas, a thorough clinical evaluation is required.

A patient aged 68 year old male came to the emergency for the complain of fever high grade fever, loose motion, headache and right side eye swelling which was sudden in onset. Incidentally on further investigations he was diagnosed metastasis to orbit. A case is presented where an old patient was diagnosed of thyroid malignancy where symptoms were negligent and absence of any thyroid swelling.

Background: The bronchiolitis is a common disease in children affecting the respiratory system. The most common electrolyte abnormality is hyponatremia. Bronchiolitis is caused mainly by Respiratory Syncytial Virus (RSV) which causes inflammation of small bronchioles; consequently, there is increase of wide range of inflammatory markers. Methods: An observational cross-sectional study, was conducted in 76 patients aged 1-24 months old and born after a full-term pregnancy (POG>/37weeks) with normal birth weight and hospitalized with clinical diagnosis of bronchiolitis. The objective of the study was to determine correlation of hyponatremia and inflammatory markers (C-reactive Protein, Neutrophil/Lymphocyte ratio, Procalcitonin, Interleukin-6, Ferritin,) with clinical severity of bronchiolitis. Results: There was significant association between serum sodium levels and severity of bronchiolitis. However, there was no significant association observed between the various inflammatory markers and severity of bronchiolitis. None of the inflammatory markers had significantly discriminatory power to predict severe bronchiolitis. PCT (ng/mL) had sensitivity of 100.00% followed by CRP (mg/L) (85.71%) and Ferritin (ng/mL) (76.19%). In prediction of severe bronchiolitis, Sodium (mmol/L) had lowest sensitivity of 9.52%. On the other hand, IL-6 (pg/mL) had specificity of 92.73% followed by Sodium (mmol/L) (70.91%), neutrophil-lymphocyte ratio (20.00%), Ferritin (ng/mL) had lowest specificity of 12.73%. Highest positive predictive value was found in IL-6 (pg/mL) (50.00%) and highest negative predictive value was found in PCT (ng/mL) (100.00%). Conclusion: Serum sodium levels can be used to assess the severity of bronchiolitis however inflammatory markers to predict severity of bronchiolitis is discriminatory as PCT, CRP, Ferritin and platelet count have high sensitivity. However, IL-6, platelet count, neutrophil lymphocyte ratio has variable specificity. So, these inflammatory markers are recommended to be studied in more detail further to establish correlation with severity of bronchiolitis.

Introduction: Hip fractures, caused by trauma or frailty, require emergency surgery in younger and older patients, respectively. Effective pain management is crucial to avoid complications and improve patient outcomes. Multimodal analgesia protocols, including regional anesthesia like the femoral nerve block, SIFI, and PENG blocks, have been recommended for proper positioning during spinal anaesthesia. This study compares the analgesic efficacy of two regional blocks: supra-inguinal fascia iliaca (SIFI) and pericapsular nerve (PENG) blocks, in improving spinal anesthesia positioning and patient comfort. Aim: To compare the efficacy of PENG and SIFI blocks in facilitating spinal anesthesia positioning and managing pain in hip surgery patients. Objective: To assess and compare Visual Analog Scale (VAS) scores at rest and during passive limb movement, ease of spinal positioning, and patient satisfaction in both groups. Materials and Methods: This randomized, controlled trial was conducted at Parul Sevashram Hospital with 70 patients (aged >40, ASA I-IV) undergoing hip fracture surgery under spinal anesthesia. Patients were divided into two groups (35 per group), receiving either a PENG block or a SIFI block. The primary outcome was pain relief, assessed using VAS scores before and after the block. Secondary outcomes included ease of spinal positioning, patient satisfaction. Results: Both groups showed significant pain reduction post-block, with VAS scores at rest and during limb movement significantly lower in the PENG group (p < 0.05). Ease of spinal positioning was better in the PENG group (p = 0.009). Patient satisfaction was higher in the PENG group, with 28 patients reporting good satisfaction compared to 25 in the SIFI group. The duration of analgesia was comparable between the groups. Conclusion: Both PENG and SIFI blocks effectively relieve pain in hip fracture patients, but the PENG block provides superior analgesia and better comfort during spinal positioning. Postoperative analgesia was similar between the groups, indicating that both blocks are effective, but PENG may be preferred for better perioperative management.

This hospital-based observational study aims to examine the results of laparoscopic cholecystectomy (LC) in patients with cholelithiasis at the Department of Surgery, Muzaffarnagar Medical College & Hospital, over an 18-month period. A total of 60 patients, aged 18 and up, who were diagnosed with cholelithiasis via USG or radiographic tests were included. Patients experiencing problems such as empyema, a perforated gallbladder, or choledocholithiasis were excluded. The study assessed anesthesia time, surgical difficulties, comorbidities, intraoperative problems, and postoperative recovery. The bulk of the patients were between the ages of 41 and 50 (31.7%), with a higher number of female patients (65.0%). Intraoperative data revealed that 73.3% of spillages occurred during gallbladder extraction and 18.3% during gallbladder dissection. The study also discovered that 71.7% of patients had a constricted gallbladder, and 56.7% required a difficult cholecystectomy due to factors such as gallbladder wall thickness and the presence of many big stones. The procedure lasted an average of 36.5±15.0 minutes. Our findings revealed that the presence of many big stones and gallbladder inflammation strongly contributed to longer operational periods and more difficult procedures. Overall, laparoscopic cholecystectomy in this cohort was rated successful and safe, with a low complication rate. However, issues such as gallbladder wall thickness, inflammation, and stone size must be considered when planning complicated treatments. The findings are consistent with previous study, further supporting the challenges faced by inflammatory alterations and the presence of big stones in the gallbladder.