Introduction: Nonalcoholic fatty liver disease (NAFLD) is one of the most important causes of liver disease worldwide and will probably emerge as the leading cause of end-stage liver disease in the coming decades, with the disease affecting both adults and children. Objective: The present study had undertaken to study the Prevalence of Non-Alcoholic Fatty Liver Disease in Hypertensive Patients. Method: A Prospective observational study was conducted during October 2020 to October 2022 at Department of Medicine, Government Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India Patient with history of Hypertension and age more than 18 years were enrolled in this study. Results:  In present study, out of 600 cases screened only 350 cases of HTN came for follow-up and among them 90 patients were diagnosed as NAFLD. This prevalence of NAFLD among hypertensive patient was 25.71%. The Mean age of patients was found to be 42.70 ± 7.34 years. Maximum numbers of cases were females 52.22% and males 47.78%. Male to female ratio was 1.09:1. Most of patient 56.67% residing in rural area followed by 43.33% were from urban area. Majority of 56.0% patients were having NAFLD Grade II followed by 40.0% of grade I and 4% of grade III NAFLD. Conclusion: The prevalence of NAFLD among hypertensive patient was 25.71%. Most of patients had history of hypertension of 5-10 years. Majority of patients under study were obese and overweight BMI was found to be significantly associated NAFLD.  It can be inferred that a clinician should have a high index of suspicion in order to detect NAFLD early in the course of the disease as symptoms and signs of NAFLD are non-specific duration and occur later in the course of the disease. Early detection would help not only in modifying the disease course and delaying its complications but would also play a major role in preventive of disease.

Introduction: Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of clinic-pathologic entities that have in common the presence of fat accumulation in the liver in the absence of significant alcohol consumption. The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. The present study is conducted to study the clinical profile of non-alcoholic fatty liver disease in hypertensive patients. Method: A Prospective observational study was conducted during October 2020 to October 2022 at Department of Medicine, Government Medical College and Hospital, Chh. Sambhajinagar, Maharashtra, India. Patient diagnosed NAFLD with hypertension and age more than 18 years were enrolled in this study. Results: In present study, 90 patients of NAFLD with HTN were enrolled. Most of the patients 46.67% had 2nd degree of NAFLD followed by 43.33% had 1st degree and 10% had 3rd degree of non-alcoholic fatty liver disease. There was statistical significance relation between diastolic BP and degree of NAFLD (p=0.035). No mortality was seen among study patients. In multivariate analysis non-alcoholic fatty liver disease grading was significantly related with BMI (p=0.0001), W/H ratio (p=0.0001) & triglyceride (p=0.004). Conclusion: There was statistical significance relation between diastolic BP and degree of NAFLD. In multivariate analysis non-alcoholic fatty liver disease grading was significantly related with BMI, W/H ratio & triglyceride. Early detection would help not only in modifying the disease course and delaying its complications but would also play a major role in preventive cardiology as its association with metabolic syndrome is frequent and its components are well documented cardiovascular risk factors.

Background: Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, often leading to prolonged morbidity, increased healthcare costs, and reduced quality of life. Conventional wound dressings may not adequately address the underlying pathophysiology of DFUs. This study evaluates the efficacy of a papain urea-based preparation in comparison to conventional saline dressing in promoting wound healing. Methods: A randomized controlled trial was conducted at a tertiary care hospital in Tamil Nadu, enrolling 100 patients with Wagner grade II-IV DFUs. Patients were randomly assigned to either the papain urea-based preparation group (n=50) or the normal saline dressing group (n=50). The primary outcomes measured were the rate of granulation tissue formation and the duration of hospital stay. Wound area measurements were taken at baseline and on day 14 post-treatment. Statistical analyses, including t-tests and chi-square tests, were performed to assess significant differences between the groups. Results: Patients treated with papain urea-based preparation demonstrated a statistically significant acceleration in healthy granulation tissue formation (p < 0.001) and a shorter duration of hospital stay compared to the normal saline group. The intervention was well-tolerated, with no observed systemic adverse effects. Conclusion: The findings indicate that papain urea-based preparation is a superior alternative to conventional saline dressings for DFU management, promoting faster healing and potentially reducing healthcare costs. Incorporating papain urea-based formulations into wound care protocols may enhance clinical outcomes for DFU patients.

Background: Breast carcinoma remains the most common cancer among women globally, with varying subtypes, clinical presentations, and responses to treatment. Estrogen receptor (ER), progesterone receptor (PR), and HER2neu are crucial biomarkers that influence prognosis and treatment strategies. This study evaluates the expression of these receptors in breast cancer patients, correlating their status with clinicopathological parameters. Methods: A cohort of 50 adult patients diagnosed with breast cancer was analyzed at Government Erode Medical College from January 2022 to December 2024. All patients underwent a triple assessment, including clinical, pathological, and radiological evaluations. Immunohistochemistry (IHC) was used to assess ER, PR, and HER2neu expression. Clinical parameters, such as age, tumor size, lymph node status, and histological grade, were correlated with receptor status. The follow-up period was six months. Results: Among the 50 patients, 66% were ER-positive and PR-positive, and 54% were HER2-positive. Tumor size varied, with 46% of tumors between 2-5 cm. A significant association was found between receptor expression and age (p=0.03), lymphovascular invasion (p=0.01), and cancer type (p=0.02). Histopathological diagnosis revealed that 98% had invasive ductal carcinoma (IDC), and 66% showed lymph node metastasis. Surgical intervention was predominantly modified radical mastectomy (86%). Immunohistochemical subtyping showed 44% of patients were ER/PR+HER2-, 22% were ER/PR+HER2+, 32% were ER/PR-HER2+, and 2% were ER/PR-HER2-. Conclusion: Hormone receptor status, particularly ER and PR expression, significantly influences treatment decisions and patient prognosis. This study highlights the critical role of immunohistochemistry in breast cancer diagnosis, offering valuable insights into tumor biology and therapeutic planning. Accurate receptor profiling, alongside clinicopathological parameters, can enhance the precision of treatment strategies and improve patient outcomes.

Aim: This study evaluates the outcomes of intertrochanteric femur fractures treated with long and short proximal femoral nails (PFN). Material and Methods: Fifty patients were included, with fractures classified according to the AO system. Surgical outcomes, including union time, complication rates, and functional recovery, were compared between the long and short PFN groups. Results: The study found that the short PFN group had a significantly shorter surgical time, lower blood loss, and better functional outcomes, as measured by the Harris Hip Score, compared to the long PFN group. No significant differences were observed in the union time between the two groups. Conclusion: The findings suggest that the short PFN offers advantages in terms of quicker recovery and fewer complications.

Introduction: Obstetric referrals are a vital component of maternal healthcare, especially in resource-limited settings, where timely transfer of high-risk cases can significantly reduce maternal and neonatal complications. This study was undertaken to analyze the spectrum, causes, and outcomes of obstetric referrals at a tertiary care center in Western Gujarat. Materials and Methods: This was a prospective observational study conducted over a period of six months in the Department of Obstetrics and Gynecology at a tertiary care hospital. All obstetric patients referred from peripheral health facilities with gestational age ≥28 weeks were included. Detailed data on socio-demographic profile, referral source, causes of referral, delays, transport mode, and maternal outcomes were collected using a structured proforma and analyzed descriptively. Results: Among 150 referred obstetric patients, the majority were aged 21–30 years, primigravida, from low socioeconomic backgrounds, and residing in rural areas. Educational status was poor, with 36.7% being illiterate. Most referrals were made after 36 weeks of gestation. Hypertensive disorders (18.7%), previous cesarean section (14.7%), and severe anemia (12%) were the most common indications for referral. Referrals predominantly came from district hospitals (32%) and private clinics (32.7%), and 63.3% of patients were transported via government ambulances. Delay in referral was observed in 44.7% of cases, mainly due to delayed decision-making and lack of transport. Maternal outcomes were favorable in most cases, with no maternal deaths reported. Conclusion: Effective referral systems, timely transportation, and strengthening of peripheral healthcare services are essential to ensure positive maternal outcomes in high-risk pregnancies.

Background: WHO core prescribing pattern indicators are widely used to analyze medicine prescribing patterns. The elderly’s involvement in multiple co-morbidities has been crucial in terms of polydrug use while being treated in the hospital. The present study aims to evaluate the prescribing pattern of drugs among hospitalized patients in the geriatric ward. Materials and Methods: A cross-sectional study was conducted among randomly selected geriatric patients at AGMC & GBP Hospital, Tripura, during 2023-24. Data were collected in a case record form which included WHO core prescribing indicators. Data were analysed using IBM SPSS 21.0. Both descriptive and inferential statistics were applied to express the data. Results: A total of 35 new cases from the Geriatric ward and their records of medical prescriptions were included in the study. The majority of cases were CVA (74.3%) followed by heart diseases (60.0%), diabetic complications (48.5%), respiratory diseases (45.7%) etc. As per WHO core prescribing indicator’s analysis, the average number per prescription was 9.74, the number of injections used per prescription was 2.11, the average number of antibiotics used was 3.45, and the average number of drugs not from the NLEM list was 3.02. Only 1.02 prescriptions were found with fixed-dose combinations. Conclusion: The study concludes the need of intellect prescribing practice, to install more rational therapy among geriatric patients including antimicrobials.

Background: Vitamin B12 deficiency has been implicated in various neurological disorders, with emerging evidence suggesting its association with auditory dysfunctions such as chronic tinnitus and noise-induced hearing loss (NIHL). Methods: A descriptive, cross-sectional study was conducted at Madhubani Medical College & Hospital, North Bihar, involving 110 patients diagnosed with chronic tinnitus or NIHL. Serum Vitamin B12 levels were measured, and the severity of auditory symptoms was assessed through audiometric testing. Results: Out of 110 participants, 36.4% exhibited Vitamin B12 deficiency. A significant negative correlation was found between Vitamin B12 levels and the severity of auditory symptoms, particularly in patients with severe symptoms (r = -0.45, p < 0.05). Conclusion: The study highlights a notable prevalence of Vitamin B12 deficiency among patients with chronic tinnitus and NIHL, with lower Vitamin B12 levels associated with greater severity of symptoms. These findings suggest the potential role of Vitamin B12 in managing auditory health, emphasizing the need for further research into therapeutic interventions.

Background: The fetus, mother and placenta constitute the triad of dynamic equilibrium in reproduction. Placenta is a readily evaluable and easily accessible component of triad. Placental study gives information of both infant and mother. Any disturbances in maternal health affects placenta, leading to decreased placental perfusion and causing fetal mortality and morbidity. Anaemia in the mother is associated with decrease in volume and weight of placenta. This study was planned to evaluate the histomorphological features of placenta in anemia of pregnancy, also to analyze and correlate the morphology of placenta with fetal parameters and to use Immunohistochemistry (CD34) for demonstrating features of anemia in pregnancy. Materials and Methods: The relevant clinical data regarding the mother and fetus was recorded. The gross features of the specimens are noted along with the relevant physical parameters. With the above details, the fetoplacental ratio and coefficient were calculated. The specimens are examined microscopically along with the CD34 marker. Results: In anemia, the fetoplacental ratio was 5.34:1, both average placental weight (435 ±41gm) and birth weight of the baby (2317 ±316 gm) was decreased. There is a positive correlation between baby weight and placental weight. The average number of cotyledons (19 + 3) was increased. Discussion and Conclusion: Anemia in pregnancy alters the morphology of placenta if left untreated. Hence, morphometrical and morphological examination of placenta plays a crucial role in perinatal and maternal care.

Background: Vitamin B12 deficiency has been implicated in various neurological disorders, with emerging evidence suggesting its association with auditory dysfunctions such as chronic tinnitus and noise-induced hearing loss (NIHL). Methods: A descriptive, cross-sectional study was conducted at Madhubani Medical College & Hospital, North Bihar, involving 110 patients diagnosed with chronic tinnitus or NIHL. Serum Vitamin B12 levels were measured, and the severity of auditory symptoms was assessed through audiometric testing. Results: Out of 110 participants, 36.4% exhibited Vitamin B12 deficiency. A significant negative correlation was found between Vitamin B12 levels and the severity of auditory symptoms, particularly in patients with severe symptoms (r = -0.45, p < 0.05). Conclusion: The study highlights a notable prevalence of Vitamin B12 deficiency among patients with chronic tinnitus and NIHL, with lower Vitamin B12 levels associated with greater severity of symptoms. These findings suggest the potential role of Vitamin B12 in managing auditory health, emphasizing the need for further research into therapeutic interventions.

Introduction: In early 90s, concept of regional analgesia existed & propagated by various workers. In recent years it has gained momentum, and now a days role of regional analgesia for postoperative pain relief is a current tradition. With advent of opioid receptors, variety of opioid agents are used for this purpose. Present study was undertaken to compare Butorphanol plus local aesthetics Vs local anaesthetic agents alone via Brachial Plexus block. Material and Methods: A double-blind prospective hospital-based study was carried out in 100 patients of either sex undergoing supraclavicular brachial plexus block, using local aesthetic agents with or without injection Butorphanol at tertiary care centre of Baroda Gujrat. Various parameters were recorded for obtaining results. Results and Discussion: Sensory onset was 225.5\pm32.01 (Sec) in group A and 217.7\pm26.8 (Sec) in group B. Motor onset was 236.6\pm41.85(Sec) in group A and 250.6\pm 32.01 (Sec) in group B. Comparison of onset of both sensory & motor blockade showed statistically insignificant difference. The hemodynamic parameters were comparable in both the groups. Respiratory rate was comparable in both the groups. Though Butorphanol being opioid respiratory depression was not observed in group B. In group A patients, VAS score was 6.28 ± 0.85 at the end of 6 hrs while in group B patients, VAS score was 7.18 ± 1.13 at the end of 12 hrs so the duration of analgesia was up to 3-4 hrs in group A, whereas it was up to 6-8 hrs in group B. Thus, postoperative duration of analgesia was significantly higher in group B than in group. Conclusion: Hence, we can conclude from our study that addition of Butorphanol (an opioid) to the mixture of local anesthetic agents (lignocaine + Bupivacaine) in supraclavicular Brachial plexus block produces longer duration of postoperative analgesia. Good intraoperative sedation without respiratory depression. Hemodynamic stability. No other side effects apart from vomiting which occurred in both the groups.

Neuromuscular blocking drugs play a crucial role in modern anesthesia, providing a relaxed surgical field and minimal cardio-respiratory disturbance when combined with mild anesthetics like nitrous oxide. Anticholinesterase drugs like neostigmine, pyridostigmine, physostigmine, edrophonium are commonly used to reverse the action of non-depolarizing neuromuscular blocking agents. Despite clinically effective reversal of neuromuscular block, there’s a considerable incidence of residual muscle paralysis, though patients confined to bed post-surgery may not face immediate harm. This study aims to address the issue of residual paralysis post-reversal and determine the additional neostigmine dose required, contributing to improved patient safety and post-operative outcomes. Sixty patients were selected for this work from the routine operation lists of a tertiary care center of Kanpur city. The selection of patients was made during the preanesthetic visits in the wards, one day prior to the operation. Patients of both sexes between the age of 14 years to 65 years (Mean 34.9 years) were selected. Their weight varied from 35 kg. to 70 kg. (Mean 49.5 kg.). Out of the total 60 patients, 44 showed inadequate reversal of neuromuscular block (residual paralysis), when tested with the Maddow wing. Of these, 19 patients belonged to the “gallamine group” 18 to the “Pancuronium group” and 7 to the “Tubocurarine group”. Out of the 44 patients who showed inadequate reversal of neuromuscular block when tested with the Maddox wing, 30 patients complained of diplopia and 10 patients showed Nystagmus while trying to focus their eyes on the scale of the Maddox wing. The incidence of diplopia and nystagmus in the three groups of patients. D-tubocurarine results in significantly lower and less severe residual paralysis compared to gallamine and pancuronium. The neostigmine dosage necessary for adequate tubocurarine block reversal is notably less than that required for gallamine or pancuronium blocks.

This study compares postoperative outcomes of stapler versus open haemorrhoidectomy. It found that stapler haemorrhoidectomy resulted in less pain, shorter hospital stays, and quicker recovery, though it had a higher rate of postoperative bleeding. Both techniques showed similar infection and wound healing rates. The findings suggest stapler haemorrhoidectomy offers recovery benefits, but bleeding risks should be managed carefully.

Hernia repair is one of the most common surgical procedures performed worldwide. Among the various techniques, the use of mesh in hernia repair is considered the gold standard. This review aims to compare two widely used approaches in hernia repair—Open Intraperitoneal Onlay Mesh (IPOM) Repair and Laparoscopic Intraperitoneal Onlay Mesh (IPOM) Repair. By analyzing the outcomes, benefits, risks, and complications associated with both methods, this paper aims to offer a comprehensive understanding of the two techniques.

Background: Patients with Schizophrenia have a wide range of symptoms involving multiple domains like positive symptoms, negative symptoms, and affective symptoms, psychomotor and cognitive symptoms. Studies have shown that among the different domains of schizophrenia, cognitive impairment appears to contribute more to the illness burden. Our study focuses on assessing the cognitive impairments in different domains and its association with various demographic and illness variables. Methodology: This is a hospital based cross sectional study done in 196 patients with schizophrenia under remission. Remission was confirmed using Positive and Negative Syndrome Scale (PANSS) and all of them were assessed for cognition using Addenbrooke’s cognitive examination –ACE-III. Results: All the participants scored low in the ACE – III significantly even in remission phase irrespective of the variables. Participants with older age, lower level of education, unmarried or separated, higher doses of anti-psychotic medication and longer duration of illness performed poorer in the ACE – III. Conclusion: Our study showed that cognitive impairment continues to be present in patients with schizophrenia even in a remission state, affecting their attention, memory, problem solving abilities, fluency and visuospatial abilities. It highlights the association of cognitive impairment with various socio-demographic and illness variables.

Background: Surgical intervention is often required for patients with third or fourth-degree hemorrhoids. This study aims to compare the outcomes of hemorrhoidopexy and open hemorrhoidectomy, focusing on postoperative pain, wound healing, and associated morbidities. Methods: With approval from the institutional ethics committee, a prospective study was initiated. This research involves 60 patients who sought treatment at the outpatient and emergency surgery departments of PIMS. Between June 2023 and January 2025, these patients, all diagnosed with grade III hemorrhoids, were randomly assigned to undergo either transanal suture rectopexy/hemorrhoidopexy (n=30) or the Milligan-Morgan procedure (n=30). The outcomes were assessed at multiple intervals—24 hours, 3 weeks, 6 weeks, and 3 months post-surgery—evaluating postoperative complications and symptom resolution. Results: Each group consisted of 30 patients. No significant differences were observed between the two surgical methods concerning complications, pain levels, or length of hospital stay. Four cases required reoperation due to bleeding, all of which occurred after open hemorrhoidectomy. At the three-week follow-up, 78% of patients who underwent hemorrhoidopexy had completely healed wounds with no signs of infection, compared to 26% in the open hemorrhoidectomy group, who exhibited delayed wound healing symptoms. Conclusions: Both hemorrhoidopexy and open hemorrhoidectomy are effective treatments for advanced hemorrhoids. While postoperative pain levels were similar, hemorrhoidopexy demonstrated a significant advantage in terms of faster wound healing.

Background: Fever in pregnancy is a common clinical problem worldwide. The effect of fever during pregnancy depends on the level of temperature rise, duration and the stage of fetal development. Maternal complications associated with fever during the antenatal period include postoperative wound infection, post-partum hemorrhage, pneumonia, septicemia, jaundice, hypoglycemia, and other complications specific to the infectious agent or cause. Adverse fetal outcomes associated with fever during pregnancy include low birth weight, intrauterine growth retardation, preterm delivery, neonatal sepsis, perinatal mortality, neonatal seizures, poor APGAR score at birth, need for resuscitation after delivery, intra ventricular hemorrhage, periventricular leukomalacia, and cerebral palsy. Aim: To evaluate febrile pregnant women of term gestation and its effect on maternal and fetal outcome. Objectives: To determine incidence of fever in term pregnancy, causes of fever, the impact of fever on maternal and fetal outcomes. Methodology: A Prospective Observational Study done for one year period in 70 cases at the Department of Obstetrics and Gynaecology, Government Maternal Hospital, Tirupati. Results: In the study 69% of the cases were between 21 – 30 years. 67% were Primi and 33% were Multigravida. 4% cases had fever at 37 weeks of gestation. UTI was the commonest cause seen in 21% of cases. Oligohydramnios was seen in17% of cases. 52% had C Section delivery. Conclusion: The most common cause of Fever was UTI and Dengue. The maternal mortality rate was zero and neonatal mortality rate was 1%, this was because all the cases were in full term pregnancy when the onset of fever was observed. There was a significant large positive relationship between low fever, high fever, and maternal outcome. There was a non- significant large positive relationship between low fever, high fever, and fetal outcome.

Background: Facility Based Newborn Care program is one of the key initiatives launched by the Government of India under the National Rural Health Mission and RMNCH, a strategic program to improve the status of newborn health in the country. Newborn period is the most vulnerable phase of life. In India, deaths during first 28 days of life account for 70% of all infant deaths and 56% of all deaths. It is worth to note that two thirds of the newborns die in the first week of life and among them, two thirds die on day 1. (1) The advance in neonatal care services over the past few decades has significantly improved the survival rate of newborns particularly premature neonates. To improve neonatal survival with better overall outcomes and less severe morbidities, early identification of the risk factors is paramount so that appropriate interventions can be directed towards the most prevalent and treatable neonatal illnesses.  The aim of the study is to analyze the conditions causing admissions of newborns in special new born care unit and their outcome. Objectives were to enlist the antenatal maternal and fetal factors influencing the newborn outcome and to document the intrapartum issues leading to newborn admissions in special newborn care unit and their outcome. Methodology: Prospective Observational study done in 389 newborns who were admitted to special new born care unit of Government Maternity Hospital, Tirupati in two months period. Results: over 389 neonates studied, 98.4% had less than 7 days of admission and 1.5% had 7 – 28 days of admission. Out of 389 newborns, 42.4% were born by normal vaginal delivery and 57.5% were delivered by C Section. Outlet forceps were used in 27 cases, Vacuum was used in 24 cases and VBAC was done in 3 cases. Neonatal Jaundice was the leading cause for newborn admissions ie., 42.1% (164/389) with 100% survival rate. Respiratory Distress Syndrome was the reason in 25.9 %( 101/389) of cases with a death rate of 14.9%. Asphyxia was seen in 8.2% of cases and deaths were noted in 21.9% of them. Meconium Aspiration and sepsis were seen in 1.1% and 2.3% and deaths were noted as 50% and 22.2% respectively. Conclusion: This study shows that most common cause of new born admissions was neonatal jaundice, followed by respiratory distress syndrome and birth asphyxia with the leading antepartum causes being PROM, Preterm births, Oligohydramnios with associated medical disorders. Neonatal sepsis, Neonatal respiratory distress syndrome, perinatal asphyxia and preterm low birth weight are leading grounds of morbidities in new borns. Most common organisms isolated are Candida, E. coli, and Klebsiella in sepsis cases.

Background and Objectives of the Study: Fetal death gives traumatic experience for the mother in particular and for the family as a whole and remains a challenge for obstetrician. There are nearly 2 million intrauterine fetal deaths every year – one every 16 seconds. This study was conducted to study of maternal causes of intrauterine fetal death in pregnant women in a tertiary care centre. Materials and Methods: This was a cross-sectional study done at a tertiary care hospital Government Maternity Hospital (GMH), Tirupati, Andhra Pradesh, India for a period of one year from December 2022 to November 2023 in 70 cases diagnosed of IUFD of more than 28 weeks attending institute for pregnant women who gave consent. All cases of IUFD with congenital anomalies and Single fetal demise in a twin gestation were excluded from the study. Results: In this study, nearly half of the participants were in the age group 21-25 years. More than 2/3^rd of the participants were housewives and few of them were daily wage labourer. All participants were from the lower socio-economic group and as expected 4/5thof them were unbooked and so poor antenatal care. In this study, IUFD was common among the primi gravida which constituted nearly half of them. Nearly 2/3^rd of the IUFD were preterm in this study and the majority of them were delivered vaginally. Past obstetrics history was seen in 1/3rdof the participants and the majority had past history of miscarriage. Few had a previous history of IUFD. Under nutrition was seen in nearly one-fifth and overweight and obesity in more than one-fifth of the participants. As expected nearly 4/5thof babies had low birth weight. Male predominance was seen in this study. Blood group O positive was common in nearly half of the participants. Among the co-morbidity associated with IUFD, anemia was common in this study which constituted more than half of them. The second most commonly associated co-morbidity was severe PE and eclampsia. Placental abruption was also seen in 10%in this study. APLA positive/ indeterminate was observed in more than one fifth of the cases. 13 of them had transfused blood, PPH, Post-partum eclampsia, shoulder dystocia and retained placenta was seen in one case each in this study. Conclusion: This study revealed that low SES, multigravidas with poor antenatal care with past history of pregnancy losses and associated co-morbidities like anemia, severe pre-eclampsia might lead to IUFD. The incidence of intrauterine fetal death in our study is comparable to that of the majority of previous Indian studies. Health education, proper screening, preconception counseling and regular antenatal check-up in pregnancy are advised. Any co morbidities should also be diagnosed as early as possible and treat the condition.

Background and Objectives: The Body Mass Index and Waist Circumference are widely recognized parameters used in the assessment of nutritional status and prediction of health outcome. These anthropometric measures are particularly significant in pregnancy, where maternal obesity can have profound implications for both maternal and fetal health. However, the validity and applicability of BMI and WC cut-offs across different populations remain a subject of continuous scrutiny. Aim of the study: To compare the Asian Indian body mass index (BMI) and waist circumference (WC) with the World Health Organization (WHO) BMI and WC in predicting the adverse maternal and perinatal outcomes in overweight and obese women. Material and Methods: A comparative study done in Government Maternity Hospital, Tirupati, 110 pregnant women booked within 10 weeks of pregnancy attending OPD at GMH, SVMC, and Tirupati. Summary and Conclusion: Maternal obesity in the study was associated with multiple feto-maternal adverse outcomes, especially increased prevalence of PIH, GDM, need for labour induction, cesarean sections and post-operative wound infection among the obese mothers. The WHO classification of BMI was more accurate in predicting both Gestational diabetes and PIH whereas ASIAN classification of BMI was found to have relatively low predictability. ASIAN classification of Waist circumference was more accurate in predicting Gestational diabetes but has relatively low predictability for PIH and preeclampsia, WHO classification of Waist circumference being more accurate in predicting PIH. Both classifications WHO and ASIAN, showed the variable results and predictability of fetomaternal outcomes in high-risk pregnancies. Further research is required to establish the evidence.

Background: India is an area with a high incidence for gall bladder cancer is 9-11% of the burden of bladder cancer around the world. Cancer gallbladder (GBC) is one of the most common gastrointestinal cancer in India, which has been seen more in northern and central India. However, data from East India are modest, especially from Madhya Pradesh, where a recent increase in the number of GBC. Rewa division of Madhya Pradesh population shows female superiority for bladder cancer. Advanced disease is symptoms of symptoms of pain of the right upper quadrant and has a poor prognosis. Material and Methods: In the case setting of a case control of 18 months. All newly diagnosed patients’ lesions of the bolt bladder in Shyam Shah Medical College and Sanjay Gandhi Memorial Hospital, Rewa, Madhya Pradesh were included for histopathological examination with observational findings. Results: A total of 133 cases of bladder lesions were included in the study on the basis of histological diagnosis. Demographic information about all subjections has been obtained and laboratory investigations were carried out, which was recorded in a separate. In all patients, the common age of patients was 51 to 60 years 44 (33.08%). 72 (54.14%) were women and 61 (45.86%) of men. The most common symptom was abdominal pain 108 (81.20%), lump in the abdomen 85 (63.91%), jaundice 65 (48.87%), nausea and vomiting 51 (38.34%) and GB Stones 43 (32.33%). Conclusion: Early diagnosis of bile bladder lesion or polyp radiological and histopathological research will help reduce mortality related to bladder cancer. Most patients subjected to palliative treatment in the form of chemotherapy.

Background: The nose and paranasal sinuses (PNS) play significant aesthetic and functional roles as part of the upper respiratory system. Malignant lesions of the sinonasal tract are rare, accounting for less than 3% of head and neck malignancies. Due to their overlapping clinical and radiological features with inflammatory conditions, histopathology remains crucial for accurate diagnosis. This study aims to classify epithelial malignant neoplastic lesions in the sinonasal region, assess their relative incidence, and analyze their clinicopathological features. Methods: A retrospective and prospective study was conducted over 8 years at a teaching institute in Western India. Of 47,621 pathology samples, 654 sinonasal mass lesions were analysed. Clinical details, presenting symptoms, and radiological findings, were reviewed. The specimens were processed using hematoxylin and eosin staining and classified based on the World Health Organization (WHO) classification. Results: Among 654 cases, non-neoplastic lesions were most prevalent (67.74%). Neoplastic lesions comprised 211 cases (32.26%), including 132 benign (20.18%) and 79 malignant (12.08%). Of 50 epithelial malignancies, squamous cell carcinoma (14 cases) was most common, followed by sinonasal undifferentiated carcinoma (9 cases) and nasopharyngeal carcinoma (9 cases). Squamous cell carcinoma predominantly affected males (2.5:1), with peak incidence in the sixth decade. The maxillary sinus and nasal cavity were most common sites, with nasal obstruction as the leading symptom. Conclusion: Epithelial malignancies of the sinonasal tract are rare but varied. Accurate histopathological classification aids in early diagnosis and management. Squamous cell carcinoma remains the most frequent malignancy, necessitating thorough clinical and radiological correlation for effective treatment planning.

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder that increases the risk of cardiovascular complications, often accompanied by dyslipidemia, including elevated total cholesterol, triglycerides, LDL, and reduced HDL-C. Ischemia-modified albumin (IMA) and homocysteine (Hcy) are emerging biomarkers associated with oxidative stress and endothelial dysfunction in T2DM. This study explores the relationship between lipid profile abnormalities, IMA, and serum Hcy levels in T2DM, and their potential role in disease progression and cardiovascular risk. Material and Methods: This case-control study, conducted in collaboration with Sai Tirupati University, Udaipur, and the World College of Medical Sciences, Jhajjar, included 40 Type 2 diabetes patients and 40 healthy controls. Ethical approval was granted and informed consent was obtained. After a 12-14 hour fast, blood samples were collected for lipid profile, homocysteine (Hcy), and Ischemia Modified Albumin (IMA) analysis, using commercially available kits. Results: The results of this study showed significantly elevated levels of homocysteine (Hcy) and ischemia-modified albumin (IMA) in patients with type 2 diabetes mellitus (T2DM). Additionally, all lipid profile indicators, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) cholesterol, were significantly higher (p<0.0001), while high-density lipoprotein (HDL) levels were notably lower in T2DM patients. A positive correlation was observed between homocysteine and IMA levels, highlighting their potential role in the disease’s progression and cardiovascular risk. Conclusion: This study highlights significant alterations in lipid profile, homocysteine (Hcy), and ischemia-modified albumin (IMA) levels in type 2 diabetes mellitus (T2DM). Elevated total cholesterol, triglycerides, LDL, and VLDL, along with reduced HDL, indicate increased cardiovascular risk. Positive correlations between Hcy and IMA suggest their role in oxidative stress and endothelial dysfunction. These biomarkers may aid in monitoring disease progression and cardiovascular risk, emphasizing the need for early intervention in dyslipidemia management.

Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion, resulting in hyperglycemia. Key biomarkers such as Tumor Necrosis Factor-alpha (TNF-α), oxidized low-density lipoprotein (OxLDL), and glycated hemoglobin (HbA1c) are involved in the pathophysiology of T2DM. TNF-α contributes to insulin resistance, OxLDL is linked to vascular complications, and HbA1c is a critical indicator of long-term glycemic control and diabetic risk. Material and Methods: This hospital-based case-control study was conducted at Sai Tirupati University in Udaipur, Rajasthan, and the World College of Medical Sciences and Research Hospital in Jhajjar, Haryana. It included 200 Type 2 diabetic patients (cases) aged 35 to 60 years with fasting blood glucose levels >126 mg/dL, and 200 age- and gender-matched healthy controls. Serum TNF-α and OxLDL levels were measured using commercially available ELISA kits, while HbA1c was determined through the immunoturbidimetry method in whole blood. Results: The study found significantly higher fasting blood glucose levels in Type 2 diabetic patients (206.23 ± 57.34 mg/dL) compared to controls (90.21 ± 10.48 mg/dL), with a statistically significant difference (p < 0.05). Serum TNF-α levels were also significantly elevated in diabetic patients (14.50 ± 7.51) compared to controls (7.52 ± 3.04) with a p-value < 0.05. OxLDL levels were notably higher in diabetic patients (6.65 ± 3.08) than in controls (1.14 ± 0.66), showing a significant difference (p < 0.05). HbA1c levels in diabetic patients (9.59 ± 2.15%) were significantly higher than in controls (5.13 ± 0.38%) with a p-value < 0.05. A negative correlation was observed between serum TNF-α and HbA1c levels in the diabetic group (r = -0.01, p < 0.05). Conclusion: This study emphasizes the critical role of biomarkers such as HbA1c, TNF-α, and OxLDL in both the diagnosis and prognosis of T2DM. The findings further underscore the need for early intervention and comprehensive management strategies targeting hyperglycemia, inflammation, and oxidative stress to mitigate the risk of complications and improve patient outcomes.

Background: Middle ear surgeries are generally carried out under local anaesthesia with or without conscious sedation. A majority of anxious patients requires general anaesthesia for middle ear surgeries. However, these surgeries may be carried without muscle relaxation therefore, in suitable patients  a supraglottic airway devices (SAD) can  be used as a safe alternative method to secure the airway. Methods: Total 100 patients, 18-65 years of age, either sex, of American Society of Anaesthesiologist(ASA) grades I and II were randomly allocated into two groups of 50 patients each. Half patient’s airway was manged with endotracheal tube and in other 50 patients I-gel was inserted and devices were assessed for hemodynamic response in terms of heart rate and mean arterial pressure and other characteristics like requirement of muscle relaxant and opioids, time required for insertion, number of attempts required and post operative complications like post-operative sore throat and nausea and vomiting. Results: Significantly less hemodynamic response was observed with I-gel (p<0.01) as compared to ET-Tube. Significantly lesser time (p<0.01) and lesser number of attempts (p<0.01) were required for I-Gel to insert successfully. Muscle relaxant was not required when I-Gel was use whereas it was used in all patient managed with ET-tube. Opioid requirement was lesser in patient managed with I-Gel. Incidence of postoperative sore throat was more with endotracheal tube as compared to I-gel(p<0.027). No significant difference in incidence of post-op nausea and vomiting was observed among group(p=0.461). Conclusion: I-gel can be safely used in middle ear surgeries where it has advantages of lesser hemodynamic response, easy and faster insertion, lesser requirement of opioids, no use of muscle relaxant and lesser postoperative side effects.

Objective: This study was done to compare Etomidate and Propofol as inducing agent in general anaesthesia for laryngeal mask airway and to evaluate and compare haemodynamic parameters between the two groups and compare the ease of insertion of laryngeal mask airway. Methods: Prospective randomized single blind controlled study was conducted in 90 patients of either sex in the age group of 20-60 years of ASA grade I or II scheduled for short surgical procedures with proseal LMA insertion under general anaesthesia. Patients were randomly divided into two groups of 45 patients each. Group P Propofol n=45 Group E: Etomidate n=45.Total sample size-90. Pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation and end tidal carbon dioxide (ETCO2;) baseline and then every minute after the induction until ten minutes. Duration and number of attempts for LMA proseal insertion, side were noted. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusion: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

Purpose: Optic atrophy is the end stage of a disease process affecting the retinogeniculate portion of the visual pathway. This study aimed to describe the various etiology and clinical features of optic atrophy seen in tertiary care centre from Central India. Methods: This is a single center, hospital based retrospective observational study. All cases of optic atrophy who presented to outpatient department from March 2023 to December 2024 were enrolled in the study. Detailed evaluation was done which included assessment of visual acuity, colour vision, contrast sensitivity, anterior and posterior segment, and extraocular motility. Additional visual field, neuroimaging, and tailored blood test were done when clinically indicated to establish the underlying etiological cause. Statistical analyses were performed using Microsoft excel, Version 2019 and IBM SPSS Statistics for window, version 22.0 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered significant. Results: A total of 212 patients were evaluated of which 114 (54%) males and 98 (46%) females. Bilateral involvement was seen in 58 (27%) patients and unilateral in 154 (73%) patients. The most common affected age group was 51–60 years in 61 (29%) patients. The most common presenting complaint was diminution of vision in 95 (45%). The most common cause of optic atrophy was glaucoma 57 (27%). Among the non-glaucomatous optic atrophy, the most common cause was ischemic causes 30 (14%). 41 (19%) were below 20 years old and the most common cause of optic atrophy was hypoxic ischemic encephalopathy in this age group. Conclusion: In this study, glaucoma and ischemic causes were the commonest etiology responsible for optic atrophy except in children where the hypoxic ischemic encephalopathy (HIE) appears to be the most common cause. Its potential association with various neurological and systemic diseases makes it an important clinical entity for the ophthalmologist. Knowledge of the prevalent causes with systemic approach and tailored investigation can aid timely intervention for these patients.

Objective: This study aimed to compare the efficacy of intravenous Magnesium Sulphate and Dexmedetomidine in reducing the hemodynamic stress response during laryngoscopy and endotracheal intubation. Methods: The present study included a total of 60 patients of either sex aged between 18 to 60 years who underwent surgery under general anaesthesia. The patients were randomly allocated into two groups, Group M (Magnesium Sulphate) and Group D (Dexmedetomidine) of 30 patients each. Group M patients were administered intravenous 25 mg/kg of 50% Magnesium Sulphate in normal saline (10ml total) and Group D patients were received intravenous Dexmedetomidine 1 mcg/kg in normal saline (10ml total), 10 minutes before intubation. In the present study demographic variables, anthropometric variables, ASA physical status and duration of surgery was comparable between two groups. Results: Mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean MAP in Magnesium Sulphate (M) group was significantly higher as compared to that of Dexmedetomidine (D) group throughout the study period except at baseline. Hence Dexmedetomidine (D) group is better than Magnesium Sulphate (M) group Both the drugs had minimal side effects with no significant difference between the groups. Overall, Dexmedetomidine provided a better Hemodynamic study and was found to be superior when compared to Magnesium sulphate. Conclusion: The sympathetic reactions to laryngoscopy and intubation have been suppressed using a variety of medication combinations with varying degrees of efficacy. Overall, Dexmedetomidine provided a better Hemodynamic study and was found to be superior when compared to Magnesium sulphate.

Background: Peptic Ulcer Disease (PUD) remains a prevalent health issue worldwide, affecting an estimated 4 million people annually. The condition results due to imbalance between defensive and aggressive factors on the gastric and duodenal mucosa resulting in ulcer formation. The global prevalence of PUD varies significantly, influenced by genetic, environmental, and socioeconomic factors, as well as the prevalence of Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs). While many individuals with PUD may be asymptomatic, the disease can lead to several severe complications, the most life-threatening being perforation. This acute medical emergency occurs when an ulcer erodes through the full thickness of the stomach or duodenum, leading to the spillage of gastric contents into the peritoneal cavity, causing chemical peritonitis and, potentially, severe sepsis or septic shock. Our hospital being a referral tertiary hospital in Southern Odisha, with patients referred from several Districts takes the load of treating and managing complications of PUD. The population is predominantly rural, uneducated daily wage workers and tribal’s with changing food habits which is unhygienic and not having access to clean drinking water, use of tobacco and alcohol, and dependence on unauthorized health care facilities make the population vulnerable to PUD and its complications. Perforation being a major complication, needs timely surgical intervention is denied because of inadequate healthcare infrastructure, and limited access to specialized medical care. Patients are referred to our centers from far-off places with late diagnosis and improper management. These factors collectively contribute to high mortality rates as the majority of the patients reach our facilities late with sepsis and other co-morbidities making the management difficult. Aims: This study aims to find out the association between various preoperative and intra operative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. The management of perforated peptic ulcers typically requires urgent surgical intervention. The mainstay of treatment has been the omental patch repair technique, though there has been an increase in the adoption of laparoscopic approaches in suitable facilities. Despite advancements in surgical techniques, the outcomes in perforated ulcer cases vary significantly due to factors like the patient’s age, overall health, time of presentation, and the presence of co morbid conditions. Given the substantial burden of PUD and its complications in Southern Odisha, there is a critical need for detailed research into the clinical profiles and outcomes of these conditions within this specific geographic and demographic context. This study aims to fill the existing knowledge gap by providing comprehensive data on the epidemiology, presentation, treatment, and outcomes of PUD and perforated peptic ulcers in this region. This study is expected to yield crucial insights that will inform the optimization of treatment protocols and healthcare policies in Southern Odisha and similar regions. Enhanced understanding of the local disease burden and treatment outcomes will aid in the development of targeted interventions, improve clinical outcomes, and potentially reduce the healthcare costs associated with the management of PUD and its complications. Methods: This is a prospective observational study designed to evaluate the clinical profiles, management strategies, and outcomes of 140 patients presented and treated for perforated peptic ulcers in the Post Graduate Department of General Surgery, MKCG Medical College and Hospital, Berhampur, Odisha from May 2023 to February2025. A detailed data collection form was used to gather information on demographics, medical history, clinical presentation, diagnostic data, treatment information, and patient outcomes. The data were meticulously recorded at multiple points: at admission, pre-operation, post-operation, at discharge, and during follow-up visits up to 30 days post-discharge. Each patient’s clinical journey from admission through treatment to follow-up was documented to ensure comprehensive data capture. The collected data were analyzed using Jamovi software with the help of the Dept of Community Medicine, MKCG Medical College, and Berhampur. Descriptive statistics provided a summary of patient demographics and clinical profiles. Inferential statistics, including Chi-square tests for categorical variables and independent t-tests for continuous variables, were applied to identify significant differences in outcomes across different treatment groups. Results: This prospective study on collected data and analysis showed a mean age of 49.1 years ranging from 26 – 72 yrs, highest prevalence of perforation in PUD cases were in the 40-49 age group [78.1%], the female sex were more affected, and 47.1% were from the upper lower class who were predominantly semi-skilled workers, significant use of tobacco and alcohol was seen, use of NSAIDs was Linked to 61.4% of duodenal and 56.7% of gastric ulcers. Symptomatically Abdominal pain was seen in 100%, fever in 85.71% patients on presentation, Majority of patients came or were referred within 48 hours (39.3% within 24 hours, 42.9% within 24-48 hours). Most common site of perforation was seen in the 1st part of the duodenum (71.4%), with size between 0.6 and 1.0 cm (68.7%). Pre-Operative Sepsis was absent in 64.3% of cases. 37.9% cases were H.pylori positive. 93.13% of cases underwent Modified Graham Omentopexy, with no complications in 58.6% of cases. Average stay in the hospital was 9.56 days and earlier presentation was associated with better survival rates. 10.7% mortality was seen following Modified Graham Omentoplexy associated with type 2 DM (P = 0.015). And with elevated leukocytosis (28.0% for >20000). Conclusion: The study found that the majority of patients (89.3%) undergoing Modified Graham Omentopexy survived, while Gastrojejunostomy showed a higher mortality rate (22.2%). Conservative treatment had the best outcomes with a 100% survival rate, although it was used less frequently. Larger perforations were associated with higher mortality rates, [over 10mm having a 60% mortality rate]. This emphasizes the importance of early detection and management of perforations to improve survival outcomes. There was a significant correlation between elevated preoperative leukocytosis levels and increased mortality, suggesting that a higher white blood cell count could be indicative of more severe infections or complications leading to poorer outcomes. Post-operative complications were high in pre-existing conditions like Type 2 Diabetes Mellitus (T2DM) and anemia. Use of NSAIDs had a significant correlation with the occurrence of peptic ulcers, underscoring the need for careful prescription practices and patient education on the risks associated with these medications. The study also found notable percentages of patients with addiction habits, particularly tobacco and alcohol use, which were prevalent among those with ulcer complications.

Aim: This study compares the efficacy, safety, and tolerability of iron isomaltoside (also Known as Ferric Derisomaltose) and iron sucrose in pregnant women with iron deficiency anaemia (IDA). Material and Methods: A total of 320 participants were randomly assigned to receive either iron isomaltoside (Group A) or iron sucrose (Group B). Results: The results showed that iron isomaltoside led to a significantly rapid and greater rise in hemoglobin levels and serum ferritin levels compared to iron sucrose. Both treatments were well tolerated, with similar rates of adverse drug reactions. Conclusion: These findings suggest that iron isomaltoside may be more effective in rapidly improving iron status in pregnant women, although both formulations are safe alternatives for managing IDA during pregnancy.

Background and Aim: Spontaneous pneumothorax is defined as presence of air in pleural cavity.  Spontaneous pneumothorax can be classified as primary or secondary. Primary spontaneous arise in otherwise healthy person without any visible underlying lung disease and secondary spontaneous arise in subject with Underlying TB and COPD etc. Material and Methods: The present study carried out in department of Pulmonary Medicine, C U. Shah medical college and hospital, Surendranagar, Gujarat, India. In this study, total 50 patients of adult aged with either sex was included in department of pulmonary medicine ward or attended OPD during period of October 2022 to September 2023. Results: In this study, we observed that secondary spontaneous pneumothorax is more common than primary spontaneous pneumothorax. COPD and Pulmonary Tuberculosis are two main causes for secondary pneumothorax. Majority of secondary spontaneous pneumothorax require surgical interventions as thoracostomy management. Conclusion: Males are more affected than females. Secondary spontaneous pneumothorax is more common than primary spontaneous pneumothorax. Smoking is one of independent risk factor for pneumothorax. Majority of patients with secondary spontaneous pneumothorax required tube thoracostomy management.

Aim: This study compares the effectiveness of supraclavicular brachial plexus block (SBPB) using two techniques: the traditional landmark technique and the ultrasound-guided technique. Material and Methods: A total of 50 patients were enrolled and randomly assigned to either the landmark or ultrasound-guided group. Key parameters such as procedure time, onset and duration of sensory and motor blockade, block completeness, and complication rates were assessed. Results: The ultrasound-guided technique had a faster onset of both sensory and motor blockade, a longer duration of block, and a higher success rate in achieving complete blocks with fewer complications compared to the landmark technique. Conclusion: Despite a longer procedure time, ultrasound guidance proved to be superior in terms of efficacy and safety. These findings suggest that ultrasound-guided SBPB is a more effective and reliable technique for regional anesthesia in upper extremity surgeries.

Background: Menarche is the onset of the first menstrual cycle, which is a crucial milestone in female reproductive development. The timing of menarche is influenced by a complex interplay of genetic, environmental, and socioeconomic factors. Body mass index (BMI) has been associated with early menarche, as body fat plays a significant role in hormone regulation, mainly leptin, which influences the hypothalamic-pituitary-gonadal axis. Socioeconomic status (SES) also plays a pivotal role in shaping health outcomes, nutritional status, including pubertal development. Understanding the association between BMI, SES, and the age of onset of menarche is essential for identifying at-risk populations and implementing early interventions. Objectives: The primary objective of the study was to determine the mean age of onset of menarche and to assess the association of onset of Menarche to BMI and Socio economic status among adolescent girls who have attained menarche between 8 to 16 years of age in rural area. The secondary objective was to determine the prevalence of obesity, overweight and underweight in rural school going girls aged between 8 to 16 years. Methodology: A cross-sectional observational was conducted among school going adolescent girls aged between 8 – 16 years from Nagamangala taluk, Mandya district over a period of eighteen months. A total of 433 girls who have attained menarche between 8 to 16 years were included in the study using convenience sampling. Girls with endocrine and metabolic disorders were excluded. After obtaining the ethical committee clearance and permission from school authority, self-formulated questionnaire regarding age of onset of menarche and socio-economic status was obtained. Height and weight was recorded, BMI was calculated and classified using IAP- growth charts. Socioeconomic status was graded according to modified BG Prasad classification. Collected Data was analysed using licensed version of SPSS 30 statistical analysis was performed to determine the association between age of onset of menarche to BMI and Socio-economic status. Results: The study conducted on 433 school going girls aged between 8 to 16 years determined the mean age of onset of menarche was 12.3±1.1 years with less than 30% girls attaining menarche before 11 years. There was statistically significant association between ages of onset of menarche to BMI. The study also showed a significant association between age of onset of menarche to socio economic status. As BMI and socio economic status increased age of onset of menarche decreased, which showed negative correlation. The prevalence of obesity, overweight and underweight was 2.8%, 18.2% and 8.5% respectively. Conclusion: The study highlights a significant association between body mass index, socioeconomic status, and the age of onset of menarche. The mean age of menarche among the study population is 12 ± 1.1 years, aligning with global trends of declining menarcheal age. Statistical analysis revealed a significant correlation between BMI and the timing of menarche, suggesting that higher BMI is associated with earlier onset. Similarly, socioeconomic status was found to be significantly linked to menarcheal age, with higher SES groups experiencing earlier menarche, likely due to better nutrition. These findings emphasize the role of both BMI and socioeconomic factors in early pubertal development. Further studies are recommended to assess the underlining importance of public health initiatives to promote balanced nutrition and physical activity to maintain optimal BMI.

Background and Objectives: Dry eye syndrome (DES) is a common complication associated with soft contact lens wear. Tear osmolality is a sensitive indicator of dry eye status. (1) To evaluate the tear osmolality in soft contact lens wearers in Bihar. (2) To assess the dry eye status in soft contact lens wearers using the Ocular Surface Disease Index (OSDI) and the Schirmer’s test.
Prospective two years study of the dry eye status following use of soft contact lens. At the end of 1 year of soft contact lens use, 20% soft contact lens wearers developed mild dry eye. No patients had moderate or severe dry eye. Two years after use of soft contact lens, 33% wearers developed mild dry eye and 2% had moderately severe dry eye. Tear Osmolarity values were used to assess dry eye status.

Background and Objectives: Dry eye syndrome (DES) is a common complication in patients with diabetes mellitus (DM). Diabetic retinopathy (DR) is a microvascular complication of DM that can also affect the ocular surface. The present study was done to assess dry eye syndrome in patients with and without diabetic retinopathy. We compared symptoms and signs of dry eye syndrome in patients with and without retinopathy.  compare the prevalence and severity of dry eye syndrome in patients with diabetes mellitus, with and without diabetic retinopathy. To evaluate the relationship between dry eye syndrome and diabetic retinopathy in patients with diabetes mellitus. Methods: The study was conducted on cases of Type 2 diabetes mellitus with age ≥35 years. The study participants were divided into two distinct groups. First group consists of diabetic patients with clinical evidence of diabetic retinopathy and second group with no evidence of diabetic retinopathy. 50 patients were enrolled in each of the above two groups after written informed consent. Results: All Signs of dry eye disorder were found more commonly in patients with diabetic retinopathy (42.00%) as compared to those without diabetic retinopathy (18.00%). Conclusion: Dry eye syndrome was positively correlated with the presence of diabetic retinopathy in this study. Any diabetic patient complaining of dry eye symptoms should be screened for diabetic retinopathy.

Introduction: Forearm fractures are a common cause of upper extremity injury, and nerve blocks are preferred for anesthesia due to their safety and clinical advantages. The supraclavicular and infraclavicular brachial plexus blocks have a similar distribution of anaesthesia, and both can be used effectively for surgeries of the upper limb. Ultrasound guidance (USG) has enhanced the safety and efficacy of these blocks. This study aimed to compare the supraclavicular and infraclavicular approaches of brachial plexus blocks, guided by ultrasound Aim: To compare the efficacy of ultrasound-guided supraclavicular and infraclavicular approach to block the brachial plexus in forearm surgeries. Objectives: To compare two approaches with respect to Scanning time, Block performance time, Onset of sensory and motor block and complications. Materials and Methods: A prospective, double blinded study was conducted in 90 patients of ASA grade 1 and 2, aged 18-60 years undergoing elective forearm surgeries. Patients were randomly assigned to receive either ultrasound-guided supraclavicular (Group SC) or infraclavicular (Group IC) blocks. Both the groups received total 30 ml anaesthetic solution consisting of 10 ml of 2 % Lignocaine plus 19 ml of 0.5 % Bupivacaine and 1 ml of Dexamethasone. The primary outcomes included scanning time, block performance time, onset of sensory and motor blocks, and complications. Results: The results showed a statistically significant shorter scanning time and block performance time in Group SC compared to Group IC. However, the onset of both sensory and motor blocks were significantly earlier in Group IC. The incidence of vascular puncture was higher in the supraclavicular group. No major complications such as pneumothorax or diaphragmatic paralysis, were observed. Conclusion: The ultrasound-guided infraclavicular block offers faster onset of sensory and motor blocks but requires a longer scanning and execution time compared to the supraclavicular approach. Both techniques are safe and effective for forearm surgeries, with the infraclavicular approach providing more consistent block.

Introduction: The main purpose of nerve conduction studies (NCS) is to detect issues with the peripheral nervous system. Nerve conduction velocity is influenced by a variety of physiological and anthropological factors. False positive and false negative results are thought to result from setting absolute criteria without taking these considerations into consideration. The current study set out to assess the relationship between height and nerve conduction velocity, specifically with regard to median nerve fibres in the Indian population. Materials and Methods: The current study is a cross-sectional prospective study that included 60 willing participants of all ages and sexes. Following the collection of each participant’s personal and anthropometric information, the median motor and sensory nerve conduction velocities in both hands were measured. Observations and Results: There were 13 (22%) females and 47 (78%) males. The mean ± SD ages of the male and female were 40.61±12.04 and 41.12±8.79, respectively. Motor fibre NCV values in both hands showed a decreasing trend with increasing height, while sensory fibre NCV values showed an ascending trend. Conclusion: As anthropometric factors influence baseline nerve conduction measures, it is crucial to comprehend how these different parameters affect the normal values for nerve conduction measurements in order to help identify abnormal nerve conduction study results.

Background: Nasal polyposis is a chronic inflammatory condition of the nasal mucosa characterized by benign, edematous, pedunculated growths that originate primarily from the mucosa of the ethmoidal labyrinth. It often results in significant nasal obstruction, anosmia, and impaired quality of life, particularly in patients with underlying allergic or infective etiologies. Objective: To evaluate the clinical profile, associated risk factors, and surgical outcomes in patients with nasal polyposis. Methods: This prospective study was conducted at the Department of ENT, Rajiv Gandhi Institute of Medical Sciences, Kadapa, from 2017 to 2019. A total of 100 patients diagnosed with nasal polyps were included. Detailed clinical history, anterior and posterior rhinoscopy, diagnostic nasal endoscopy, CT scan of paranasal sinuses, and histopathological examination were performed. Patients underwent appropriate medical therapy followed by surgical intervention where indicated. Outcomes were assessed clinically and endoscopically during follow-up. Results: The majority of patients were in the 31–50 year age group, with a higher incidence in males. Nasal obstruction was the most common presenting complaint (92%), followed by anosmia and nasal discharge. Bilateral ethmoidal polyps were more prevalent than antrochoanal polyps. Allergic rhinitis was the most common associated factor. Functional endoscopic sinus surgery (FESS) was the preferred surgical approach, with significant symptomatic improvement noted postoperatively. Recurrence occurred in a small subset, predominantly in patients with underlying allergy. Conclusion: Nasal polyposis is a common and recurrent condition predominantly affecting adults with a male predilection. Accurate diagnosis using endoscopy and CT imaging, combined with appropriate surgical management, particularly FESS, offers excellent symptom relief. Long-term control requires addressing associated allergic and infectious components.

Background: Hypothyroidism is a clinical entity known to affect electrolytes, fat, protein, and carbohydrate metabolism in hypothyroidism. Method: Out of 150 subjects, 75 were known hypothyroid patients, and the remaining 75 were healthy volunteers. 3 ml of venous blood from these 150 people was studied. TSH levels were studied by the Monobind Acculite Thyroid TSH Kit. Serum calcium level was estimated by the Arsenozo III method, and serum electrolytes were measured by Easylytes ion-selective electrodes. Results: Except for chloride (Cl+), all electrolytes and calcium had significant decrease levels, and the chloride level was highly increased to 105.42 (± 7.48); the t-test was 5.10, and p<0.001. All parameters had a significant p-value, but regression and negative correlation only calcium level (0.78) had a significant p-value (p<0.001). Conclusion: It is confirmed that there is a profound influence of thyroid hormones on serum electrolytes; serum calcium, sodium, and potassium levels were decreased, and chloride levels were significantly elevated in hypothyroidism patients when compared to the normal (controlled) group.

Head neck reconstruction surgery has considerably evolved over the past decade mostly by using the free flaps. With the advent of microvascular surgery in 1970 harvesting free flap become popular in the head neck surgery. This study is about, how to achieve good outcomes in head neck free flap onco-plastic surgeries in resource limited settings. This is a retrospective study was conducted in 2020-22 from central India, Jabalpur Madhya Pradesh. We have collected the data from electronic records of 56 consecutive patients. Our study showed that with necessary basic prerequisite, free flap surgery can be performed safely with good outcome even in resource limited settings. Starting free flap surgery is the need of modern medicine to achieve better functional, cosmetic outcome and get advantage of pliability of free flap with less morbidity. Free flap surgeries ask a surgeon’s passion, dedication, optimal preoperative planning with risk taking behavior to achieve excellence for good outcomes.

Background: Speech and language development is one of the most useful pointers fora child’s development and intellectual functioning. In Anganwadi children come for vaccination, health checkups, and Nutrition, where they can be accessed at early stages and appropriate intervention can be done. Aim and Objectives: Primary objective was the assessment of speech and language in 0-3 years of children attending anganwadi using LEST. Secondary Objectives were to determine hearing impairment using BERA in children with language Delay and to determine the delay in other domains using DDST-II. Material and Methods: This study was undertaken in anganwadis in the urban area of Bhopal.403 children of 0-3 years were selected using cluster random sampling and assessed for Speech and Language Delay using LEST and developmental delay using DDST II. Then Children with Speech and language delays were assessed for hearing defects using BERA. Results: Prevalence of Speech and language delay was 6.45%. Developmental delay among children with language delay was 15.3%. Among children with Speech and language delay, 11% of children had a hearing defect. Among various risk factors studied inadequate calorie intake (p-value 0.02) and microcephaly (p-value 0.01) showed significant association in multivariate analysis. Conclusion: 6.5% prevalence of language delay in the children indicates the need for language screening in all children attending anganwadi. All children with Speech and Language Delay should be screened for Hearing defects and Delay in other domains as well to facilitate early and timely intervention.

Introduction: Congenital anomalies are the fifth major cause of neonatal mortality in India. Studies regarding prevalence of congenital anomalies are essential for early detection, multidisciplinary approach and maternal-fetal interventions for improved outcomes. Materials and Methods: This study was conducted in the Department of obstetrics and gynaecology in Rajiv Gandhi Institute of Medical sciences, Adilabad from January 2024 to July 2024 on structural fetal anomalies and maternal risk factors associated with them. Results: The prevalence of fetal anomalies was 1.8% of all deliveries. The maternal age of study population was 23+/- 3 years among which 75.47% were primigravidas. In the given study population , precious pregnancies were 49.05% and 62.26% were detected in the second trimester. Most common system involved was genitourinary system where 35.85% of total cases among which major fetal anomaly was hydroureteronephrosis followed by central nervous system which involved 26.42% of all cases. Conclusion: The study on prevalence and types of fetal anomalies helps identify potential risk factors like young maternal age and long marital life. This emphasizes the importance of early detection, routine folic acid supplementation and second trimester anomaly scan for all mothers.

Introduction: Obesity, a rising epidemic, is a disorder characterized by an accumulation of excessive body fat, associated with a cluster of metabolic abnormalities like hyperglycemia, insulin resistance, dyslipidemia and hypertension collectively often referred to as metabolic syndrome. Ferritin, the storage form of iron, is essential for regulation of iron homeostasis and is widely used as a clinical biomarker to estimate body iron status. It is also an acute positive phase reactant protein that is elevated in inflammatory conditions. Thus, ferritin can serve as a marker of inflammation rather than iron deficiency in case of over-weight patients. Objectives: The objectives of the study are to find out whether there is any correlation between serum Ferritin, CRP, Lipid Parameters and the anthropometric data of the apparently healthy but over-weight patients. Materials and Methods: The study was conducted in the Department of Biochemistry and Medicine of KPC Medical College and Hospital.  Equal number (forty) in each group of apparently healthy normal weight, overweight and obese individuals were chosen for study Body mass index (BMI) was recorded as described in the Asia-Pacific classification. Standardized kits were used to assay all the serum parameters. Results: Significant positive correlation (R=0.999, p <0.01) was found between serum total cholesterol and BMI. Significant positive correlation (R=0.973, p <0.01) wasalso observed between serum ferritin and BMI. There was again a significant positive correlation (R=0.999, p <0.01) found between serum Triglyceride and BMI. (In all the cases of over-weight and obese individuals). Conclusion: This study indicates a positive correlation between serum ferritin with BMI and WHR in overweight and obese individuals, suggesting potential underlying inflammatory changes associated with obesity. However, the lack of correlation with CRP with BMI highlights the need for further research using more sensitive inflammatory markers.

Background: Hemoglobinopathies, including beta thalassemia, sickle cell disease, sickle cell trait, and hemoglobin E (HbE) disorders, are significant public health concerns in Eastern India. Aim: This study aims to evaluate the differences in red blood cell (RBC) indices among patients with common hemoglobinopathies in Eastern India to aid in accurate diagnosis and management. Methods: A cross-sectional study was conducted on 600 patients diagnosed with various hemoglobinopathies from 2021 to 2023 at Hitech Medical College and Hospital, Rourkela. Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were analyzed. Results: Sickle cell trait (HbAS) was most prevalent (40%), followed by beta thalassemia (30%), sickle cell disease (20%), and HbE disorders (10%). RBC indices were significantly lower in beta thalassemia, intermediate in HbSS and HbE, and nearly normal in HbAS. Conclusion: RBC indices offer valuable diagnostic insights for differentiating hemoglobinopathies. The higher prevalence of HbAS highlights the need for enhanced screening and genetic counseling in Eastern India.

This cross-sectional study examined the viral causes and clinical features of acute keratoconjunctivitis in West Bengal, India. Conducted over one year at the Viral Research and Diagnostic Laboratory (VRDL) of Burdwan Medical College, the research analyzed 110 patient samples using multiplex RT-PCR and quantitative PCR. Adenovirus emerged as the predominant pathogen, detected in 19.09% of cases, followed by Herpes Simplex Virus 1 (HSV-1) at 2.72%. No instances of SARS-CoV-2, Varicella-Zoster Virus (VZV), or H1N1 were identified. Common clinical symptoms included red eyes (89.09%), itching (79.09%), and foreign body sensation (73.63%), and discharge (57.27%). Petechial haemorrhages were strongly associated with the condition. Seasonal analysis revealed higher incidence rates during winter and monsoon months. Adenovirus infections exhibited lower cycle threshold (CT) values compared to HSV-1, indicating higher viral loads. Genetic analysis identified a G95C substitution in the adenoviral genome, resulting in a proline-to-proline alteration, which may influence protein function and contribute to keratoconjunctivitis. These findings underscore adenovirus as the primary cause of viral keratoconjunctivitis in the region and emphasize the need for improved clinical protocols and public health measures during peak seasons.

Aims: Aim was to study the pregnancy outcomes and incidence of postpartum diabetes in women with Gestational diabetes mellitus (GDM) with and without insulin. Methods: This prospective cohort observational study was done on women with GDM diagnosed after the first trimester, attending the tertiary care hospitals for 2 years. Comparison of clinical variables and maternal and neonatal outcomes were recorded in women with GDM with and without insulin. The postpartum glycemic status was determined at 1 and 6 months. Results: There were 54(30.3%) women with GDM in insulin group and 124(69.7%) women with GDM in non-insulin group. Women with GDM in insulin group had a higher baseline risk (older, obesity, higher baseline blood glucose). The frequency of polyhydramnios and need for caesarian section was higher in GDM women in insulin group. Large for gestational age (LGA) neonates, macrosomia and neonatal hypoglycemia were significantly higher in women with GDM in insulin group. Postpartum diabetes at 1 and 6 months was significantly higher in GDM women in insulin group than in those with GDM in non-insulin group (15.6% vs 3.8% and 26.8% vs 5.3% at 1 and 6 month respectively). Conclusion: GDM women treated with insulin have a higher baseline risk profile. Insulin did not prevent adverse maternal and neonatal outcomes. GDM women with insulin are at rapid progression to postpartum diabetes.

Nutraceuticals and Dietary supplements have demonstrated high health benefits and reducing risks of diseases. Parkinson’s disease (PD) is the most prevalent neurological condition worldwide behind Alzheimer`s disease. A simple balanced diet will be able to provide the brain with the necessary nutrients, such as bioactive substances, to support proper brain function and shield it from oxidative stress and inflammation. Grape Seed (GS) once such dietary supplement, which is a valuable ingredient to the culinary, cosmetics, and pharmaceutical industries. High in polyphenolic components GS may be beneficial for treating neurological illnesses since they have antioxidant and neuroprotective properties. GS is also rich in fatty acids, and vitamins. Its potential use as an edible oil has also been raised, particularly in light of its pleasing sensory qualities. Several medicinal effects like anti-inflammatory, cardioprotective, antibacterial, and anticancer effects of GS have been mostly identified through in-vitro research. Several components of GS, including tocopherol, linolenic acid, resveratrol, quercetin, procyanidins, carotenoids, and phytosterols, have been linked to these therapeutics effects. Even though it is critical to shed light on GS as a potential natural therapy for PD, there is currently no evaluation summarizing the neuroprotective impact of GS. In this article we have summarized the preventive properties of grape seeds against neurological disorders. The ability of these grape seeds to protect against neurological diseases is the main emphasis. The selection of grape seeds was made in light of the numerous published pharmacological research on their neuroprotective efficacies. Therefore, based on the biological and pharmaceutical data gathered from the previously mentioned laboratory, epidemiological, and intervention studies, the relevant understanding and limits are explored.

Background: Diabetes is characterized by chronic inflammation and oxidative stress, which can lead to endothelial dysfunction and increased carotid intima media thickness (CIMT). Hypertension causes structural changes in the intima and medial layers of the large vessels and results in development of atherosclerotic changes in the arteries. There is a paucity of data regarding the correlation between CIMT among diabetic patients with and without hypertension. Aim: To assess the CIMT in patients with type 2 diabetes mellitus with hypertension (DMHT group) and without hypertension (DM group). Methodology: This study included 30 patients with known type-2 diabetes mellitus and hypertension (Group 1) and 30 participants with only type 2 diabetes (Group 2). All patients were subjected to carotid artery scanning for carotid intima medial thickness (CIMT) using a high resolution B-mode ultrasonogram. Result & Conclusion: Carotid intima-media thickness (CIMT) was significantly elevated and positively correlated with each other in patients with type 2 diabetes mellitus and hypertension and hence can be used as a marker for cardiovascular risk among diabetic patients especially with concomitant hypertension.

Introduction: Physical activity is related with the memory and thinking ability. Aerobic exercise which helps in increase the neurotrophins – BDNF, IGF -1 leads to increase the neurogenesis, which in turn improves the memory after moderate intensity of exercise. Insufficient studies on the effect of exercise on short term memory as a result this study is taken up to evaluate the effect of single bout of aerobic exercise on short term memory performance in adolescent and middle age group. Methodology: The study was conducted in the college students and 35 – 45 years adults in general population. 120 samples and data were collected. The subjects were participated in pre-exercise task, which consists of Rey auditory verbal learning test followed by 30 mins engaging in aerobic exercise. The exercise should be discontinued after 60 – 70% of increase in heart rate.  The intensity of the exercise is scored using Rate of Perceived Exertion. Allow the subject to take 5 mins rest. Post-exercise task was conducted. Results: Majority of outcome shows positive effect on short term memory after exercise in young adolescents. Acute exercise has minimal positive effect on memory in the middle age group when compared with young age group. Acute exercise improves the immediate recall without considering sequential order in both age groups.  Statistical Analysis: The data was entered using Microsoft Xcel sheet. Statistical analysis was conducted in SPSS 23. Paired t test was used to analyse the data for immediate recall, delayed recall and forgetting pre and post exercise effects. Conclusion: Various factors such as age, gender, differences in memory function, trick used to memorise, intensity of activity and genes are the major influential factors that affect memory. Acute exercise has minimal positive effect on memory in the middle age group.

Background: Prostatic diseases are chronic progressive diseases, baseline parameters like age; prostate specific antigen and prostate volume (PV) have been linked to the progression of BPH like acute urinary retention. PV has been included as a useful tool in treatment guidelines. Obtaining S. PSA levels can be used as rough estimate for PV, risk and extent of progression of disease and lower urinary tract symptoms. The aim of the study was to assess the correlation of serum PSA levels with bladder outlet obstruction secondary to enlarged prostate and Prediction of progression of Bladder outlet obstruction in patients with enlarged prostate using serum PSA levels as a marker. Materials and Methods:  This was an Observational study done in 40 cases aged 50 years or more are included in the study, from 10/10/2011 to 10/10/2013, who had lower urinary tract symptoms and having objective evidence of enlarged prostate, who visited Karnataka Institute of Medical Science, Hubli. Results: Maximum number of patients was in 7^th decade, constituting about 67.5%. 35% of patients had moderate and 65% of patients had severe symptoms according to IPSS. Most common symptom was incomplete emptying (82.5%), acute retention of urine (70%), week stream (42.5%) and straining (32.5%). Significant correlation was observed between S.PSA levels and Bladder Outlet obstruction secondary to enlarged prostate (p=0.001). Significant Correlation was observed between age and prostate volume (p=0.004) and Prostate volume and IPSS. Significant correlation was noted between age and IPSS (p<0.001). On analysis S.PSA levels and Acute Retention of Urine, Prostate volume and AUR, was not statistically significant. Prostate volume >64.4cc, S.PSA levels >4.9 and age >66.9 years are predictors of Acute retention of urine.

Introduction: Dental practitioners frequently prescribe medications like antibiotics for infections and analgesics for pain relief where prescriptions are often based on clinical and epidemiological data rather than culturing. This prospective descriptive analytical study was planned to analyse the antimicrobial and analgesic prescription patterns in the dental outpatient department at a tertiary care hospital with the concern of irrational use of medications in day-to-day practice. Methods: This was a prospective analytical study conducted on a total of 1161 prescriptions of the patients visiting the dental outpatient department at Hamdard Institute of Medical Sciences & Research and associated HAH Centenary Hospital, New Delhi, over a period of 6 months. Patients of both gender and all ages receiving antimicrobial agents and analgesics consenting to participate in the study were included. The exclusion criteria of this study were the use of topical / inhaled antibiotics, anti-tubercular / antiretroviral agents and antimicrobials which were prescribed for non-dental conditions. Topical anti-inflammatory / analgesic agents were also excluded from the study. Data mining and analysis of various aspects of prescriptions such as patient characteristics, details of antimicrobial and analgesic agents prescribed including route, dose, duration and respective dental indications were done. Results: Out of 1161 patients who visited Dental OPD, (55.5%) were females and (44.5%) were males (with a mean age-of 43 ± 3.8 years). Antimicrobials were prescribed to 41.3% patients whereas 83.7% received analgesics with a higher number of both antibiotics (59.4%) and analgesics (57.4%) being prescribed to the female patients in comparison to male patients. It was noted that in (99.4%) of cases, antibiotics were prescribed in view of treatment of infections, on the contrary in (98.1%) it was given for the empirical therapy, of which 99% antibiotics were given orally whereas only 1% was given by parenteral route. A key concern developed where it was seen that in only 1% of cases culture and sensitivity testing was done. On analysis, the most common conditions for which the antibiotics were prescribed were Irreversible pulpitis (51%) followed by Periapical abscess (10.8%) and Exodontia (7.7%). Among all, B-lactam was the commonest prescribed antibiotic class (95.9%) out of which (Amoxicillin + Clavulanic acid) dominated at (91.9%). Single antibiotic was prescribed to (96.04%) whereas in (3.96%) patients two antibiotics were prescribed against the diagnosis. On the other hand, recorded data on analgesics stated that (94.1%) of the patients received oral analgesics and (5.9%) of them received via the parenteral route. Common indications included Irreversible pulpitis (45.3%), Periapical abscess (13.4%), Periodontitis (10.9%) for which the most common analgesics prescribed were the NSAIDs (84.3%), primarily Ketorolac (48.3%), Ibuprofen (8.2%) and Diclofenac + Paracetamol (25%). Surprisingly it was noted that newer analgesics like Bromelain + Trypsin + Rutoside were prescribed in (13.2%) of patients which are mostly the enzyme-based preparations. Conclusion: In our study, we found that the dental infections among the population were the most frequently reported conditions followed by the dental caries for which antimicrobials were prescribed while Amoxicillin +Clavulanic acid were the most commonly used antimicrobials agents for the management of various acute and chronic dental conditions but were prescribed without culture and sensitivity in most of the cases. For pain management the most common class of drugs prescribed were the NSAIDs followed by the enzyme preparations. To conclude, it was observed that appropriate measures are needed to be promoted for rational use of prescribing antimicrobials along with their culture and sensitivity.

Blood transfusion safety is paramount to prevent the spread of transfusion-transmitted infections (TTIs), including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and syphilis. This study assesses the seroprevalence of TTIs and explores the association between these infections and ABO and Rh blood groups among voluntary blood donors at a tertiary care hospital. These findings aim to enhance the understanding of blood type susceptibility to TTIs and hence, guide strategies for safer blood transfusion practices.

Introduction: Anal fissure ranks among the most prevalent anorectal issues, characterized by a tear in the anoderm located distally to the dentate line. This condition constitutes a frequent proctologic concern, comprising approximately 10-15% of proctological consultations. It is notably prevalent among individuals in the young and middle-aged demographics. Aim and Objective: The aim of our study is to evaluate the effects of administering lignocaine for acute anal fissures, focusing on its efficacy and effectiveness. Material and Methods: This prospective study was conducted at the Department of Surgery, Pacific Institute of Medical Science, and Udaipur. We included a total of 150 patients presenting with acute anal fissures in the surgery department. We excluded patients who were under 20 years of age and those who were unwilling to participate. Results: In the study group, the mean age of patients was 41.12 years, with the majority falling within the 31-40 years age bracket, followed by the 21-30 years age group. Among the patients, 73% were male and 27% were female. Regarding occupation, 78% were classified as hard workers, while 15% were moderate workers. Pain relief was observed in all patients by the end of the first week. The healing of fissures progressed as follows: 35% of patients showed healing by the end of the first week, 60% by the 15th day, 85% by the end of the first month, and 100% by the 6-month mark. Conclusion: Lignocaine is effective in providing pain relief for patients with acute anal fissures. Although it may contribute to dietary modifications and the use of stool softeners can help achieve faster results.

Aim:  The aim of the present study was to calculate the overall caesarean section rate, to identify groups of women (distributed according to Robson’s Ten Group classification system) that contributed most to the overall caesarean section rate and to analyse caesarean section rates within groups in our institute. Materials and Methods: An Observational cross-sectional study was conducted for a period of 1year from July 2023 to July 2024 at Narendra Modi medical college and hospital. All pregnant women with gestational age of more than 28 weeks, delivered during the study period were classified according to Robson’s ten-group classification system. Caesarean section rate, group size, group caesarean section rate and absolute and relative contribution of each group to caesarean section (CS) rate were calculated and analysis was done. Results: The overall caesarean section rate was 49.63%. During this study period, we had 6376 deliveries, out of which 3165 pregnant women (49.63%) were delivered by CS compared to 3211 vaginal deliveries. Women with previous CS (term with single cephalic pregnancy) were included in Robson group 5. Group 5 had the highest CS rate (20.38%). Robson group 5, 1 and 10 were the largest contributors to the high CS rate at our institute. Conclusion: Women with previous caesarean section constitute the most important determinant of overall caesarean section rates. Decreasing the primary caesarean section rates is the key to reducing overall caesarean section rates.

Background: Anemia continues to be a major public health problem globally and Iron-deficiency anemia is among the top three major causes of disability in the world. About 61% of children of age 6 months to 59 months are anaemic in our part of  Tamilnadu. It leads to impaired physical and cognitive development, increased risk of morbidity in children, poor pregnancy outcome and reduced work productivity. Any intervention to treat anemia is largely based on the level of  haemoglobin(Hb) and  the  estimation of Hb is the most effective way to diagnose and classify severity of anemia. Point of care testing (POCT) has been recommended as one of the key interventions of Anemia Mukht Bharat program since 2018(1). POCT plays a pivotal screening role in areas where sophisticated instruments are not available. However, their reliability needs to be established. Aim: To establish the role of digital hemoglobinometer in detecting anemia against automated analyzer (gold standard for screening and diagnostic purpose) and estimate the prevalence of anemia in children aged between 6 to 59 months in a rural coastal district of Tamilnadu. Methods: A cross-sectional study of 367 In-Patients of age 6-59 months was conducted over a period of 1 year in a rural tertiary care hospital, Nagapattinam. Prevalence of anemia was estimated, and severity was classified as mild, moderate and severe based on WHO classification. This included 200 male children and 167 female children. Statistical analysis was done using Bland Altman analysis. Results: The overall prevalence of anemia was 70.8% (n=260), estimated using digital hemoglobinometer [mild anemia = 35% (n=91); moderate anemia = 54.6%, (n=142); and severe anemia = 10.4% (n = 27)]. 66.2% (n=243) was estimated to have anaemia using automated cell count analyser [mild anemia = 39.12% (n=95); moderate anemia = 53.5%, (n=130); and severe anemia = 7.4% (n = 18)]. There was a statistically significant difference in the diagnostic utility of both equipments in terms of specificity; however, the pattern prevalence of anemia estimated by the digital hemoglobinometer was comparable with the automated cell count analyser (McNemar’s test: p < 0.001).Digital hemoglobinometer had 80.7% sensitivity, 48.4% specificity, 75.4% positive predictive value, 56.1% negative predictive value and 69.8% accuracy for detection of anemia as compared with the automated cell count analyser. Conclusion: As a non-invasive screening tool, diagnostic role of digital hemoglobinometer is satisfactory and comparable with the automated cell count analyzer.

Aims and Objectives: To determine the maternal and fetal outcomes by studying the cardiotocographic changes during labour in term pregnancies. To assess the fetal wellbeing during labour in normal and selected high risk pregnancies. To predict the mode of delivery by using cardiotocographic monitoring during labour. Methods: This study investigates the cardiotocographic (CTG) changes in term pregnancies and their correlation with neonatal outcomes at Karwar Institute of Medical Sciences. Utilizing a prospective observational design, the study enrolled 195 term pregnant women between August 2022 and January 2024. The CTG parameters, including baseline fetal heart rate (FHR), variability, accelerations, and decelerations, were continuously monitored and analyzed according to FIGO criteria. Key outcomes assessed were the mode of delivery, presence of meconium-stained liquor, Apgar scores at 1 and 5 minutes, and the need for neonatal intensive care unit (NICU) admission. Results: Results indicated a mean maternal age of 28.04 years, with 55.38% being multigravida. The study found significant associations between CTG findings and several key outcomes. Specifically, abnormal CTG patterns were correlated with higher rates of cesarean sections, lower Apgar scores, and increased NICU admissions. Among the study population, 67.69% underwent full-term normal vaginal delivery, while 32.31% had cesarean sections. Additionally, 33.33% of the cases had meconium-stained liquor. Notably, 25.13% of newborns required NICU admission, with significant variations observed across different CTG categories. Conclusion: The findings underscore the importance of CTG as a predictive tool for fetal distress, guiding timely and appropriate interventions to improve neonatal outcomes. The study highlights the need for precise interpretation of CTG patterns to optimize labor management and reduce unnecessary interventions. Continued research and refinement of CTG interpretation protocols are essential to enhance its clinical utility in obstetric care, ultimately contributing to better maternal and neonatal health outcomes. This research provides valuable insights into the application of CTG in monitoring term pregnancies and emphasizes its role in ensuring favorable birth outcomes through vigilant fetal monitoring and timely clinical decision-making.

Introduction: Meningocele is a common congenital open neural tube defect that causes cystic dilation of the leptomeninges, resulting in cerebrospinal fluid without neural tissue and an immediate neurological impairment. Meningocele is a developmental aberration that occurs in the dura and non-fusion arches of the vertebrae during embryogenesis, usually around the fourth week of gestation, with a protruding meningeal sac covered by a single layer of skin. Meningocele occurs in approximately 1.0 to 2.0 per 1,000 live births. This study focusses on the importance of embryology in evaluation, diagnosis, and management. Material & Methods: A series of prenatal cases were screened from 2023 to 2024, with 20 cases analysed using TIFFA images. In one of these cases, a meningocele was discovered, which appeared as a cystic bulge on the lower back in the lumbar region. The diagnosis led to a medical termination of pregnancy (MTP) at 20 weeks, and the aborted foetus was later taken for further examination at the Department of Anatomy, Government Medical College Siddipet, Telangana. Results: A lumbar meningocele typically manifests as a lemon-shaped round mass on the lower back. Cystic oedema is caused by the meninges (protective coverings of the spinal cord) and cerebrospinal fluid (CSF) emerging through a vertebral defect. The cyst’s shape and location (in the lumbar area) match the characteristics of a meningocele. . CT Brain – No Neurological Deficit: Despite a structural abnormalities in the lumbar spine, the brain and central nervous system appear to operate normally. This is a favourable sign since it shows that there was no significant hydrocephalus or other serious spina bifida issues, which can sometimes impair brain development. Discussion: Neural tube defects (NTD’S) are the consequences of failure to close anterior and posterior neuropore during neurulation process around 3rd or 4th week of intra uterine life due to some genetic and environmental factors. NTD’S often associated with risk factors like maternal diabetes, maternal febrile illness, inadequate folic acid intake, maternal use of antiepileptic medications like valproic acid and carbamazepine and family history of NTD’s. The index case during dissection had a dysraphic L2 to L4 lumbar vertebrae with an intact spinal cord within the vertebral canal and abdomen showed normal abdominal situs. Meningocele are often diagnosed following ultrasonography during pregnancy. Conclusion: Lumbar meningocele is a congenital deformity caused by the unfused vertebral arches of the L2 to L4 vertebrae that arises during the third to fourth week of intrauterine life.

Kidney anomalies can arise in quantity, position, form, or rotation. The term dysmorphic refers to the kidney’s aberrant size and shape, whereas malrotation refers to its incorrect orientation. Ectopic kidney is a birth condition in which the kidney is placed in an incorrect position. All of these congenital abnormalities are strongly related to development. Urinary system congenital abnormalities are uncommon, accounting for just around 0.3% of all live births. Normally, the kidneys are retroperitoneally positioned in the lumbar diaphragmatic fossa. The left kidney’s upper extremity extends to T11 vertebrae, whereas the right kidney’s upper extremity only reaches T11-T12. There are numerous questions about the development of the kidney that remain unanswered. Anatomical variations in kidney morphology and ureter branching patterns have been extensively studied, contributing to a better understanding of surgical anatomy and treatments in the abdomen. The most common kidney anomalies are those that differ in structure and position, however variable anatomical involvement of all of them is significantly rarer. Materials and Methods: Ten embalmed cadavers were dissected to explore the internal organs and structures of the urinary system. The morphological variance of the kidney and the branching pattern of the ureter were noted, and detailed photographs were taken on the dissection table. Results: The present example demonstrates morphological abnormalities in kidney size, shape, and position, as well as an aberrant branching pattern of the ureter. The concurrent participation of variable anatomy in the entire system appears to be rare. Discussion: The development of the urinary system, including the kidney, begins in the 4th week of pregnancy as a bud in the pelvis. The most obvious discovery in the index case was an unascending right kidney located just above the pelvic brim at L4 to L5 lumbar level, where the abdominal aorta was bifurcated. Dysmorphic right kidneys are smaller in size than anatomically positioned left kidneys. A malrotated, laterally orientated hilum with a duplication of the proximal section of the right ureter was observed. The literature describes two types of embryogenesis for the kidney. The renal vascular variability, location, position, and size were carefully examined and compared to the contralateral side. Urineal patterning and variants are not as widespread as in the vascular system, although data suggest an approximate prevalence of 1%. The combined participation of variant anatomy in the current study appears to be rare, with a frequency of less than 0.3%. This study reflects the developmental morphology of kidney and underlying embryological principles, as well as the educational consequences. Conclusion: The malrotated ectopic kidney with proximal ureter duplication is clinically significant. The congenital abnormality may always be considered accidental. Knowledge of diverse abnormalities is vital not just for anatomists, but also for urologists doing kidney transplants. It is also important for interventional radiologists who do invasive procedures.

Introduction: Gastroschisis is a congenital abdominal wall defect that causes the intestinal loops, stomach, liver, and occasionally other abdominal organs to protrude through a gap in the abdominal wall, which is usually placed on the right side of the umbilical cord. Unlike omphalocele, gastroschisis lacks a protective sac. The specific cause of gastroschisis is unknown, but it is thought to be the result of vascular disruption or a failure to close the lateral body folds during embryonic development. The incidence of gastroschisis is about 2 to 3 per 10,000 pregnancies. It is particularly common in teen pregnancies and those under the age of 20, and is recognised to be increasing globally. Understanding its embryological basis is crucial for effective prenatal diagnosis, postnatal management, and surgical intervention. Material and Methods: We screened 20 prenatal cases from 2023 to 2024 using ultrasound images. One of these Gastroschisis was seen in a foetus between 16 and 20 weeks gestation, offering a direct view of the front abdominal wall defect and the amount of numerous organ herniation. Results: Before dissection, we found herniated abdominal organs in the foetus, including the liver, pancreas, stomach, duodenum, and undifferentiated intestinal loops protruding through the umbilical cord. The heart and lungs remained in place within the thoracic cavity. Adrenal glands are present in the kidneys, but the right kidney did not climb to its proper position. The bladder, uterus, and rectum are all in place, and there is a visible imperforated anus. Additionally, the right foot exhibited syndactyly. This disorder is characterised by widespread organ herniation in the absence of a protective sac, which results in amniotic fluid exposure, inflammation, and oedema. Discussion: Gastroschisis is an anterior abdominal wall deformity whose cause is not fully known. Gastroschisis occurs in one out of every 4000 live births. The most obvious index finding was caused by the failure of the formation and development of the ventral body wall during embryogenesis, which is classically characterised by abdominal organ herniation, including the major organs, liver, pancreas, stomach, and duodenum, with intestine loops protruding through the umbilical area. There was a visible imperforated anus and syndactyly on the right foot. The incidence of gastroschisis is rising worldwide. Prenatal diagnosis using ultrasound as early as possible can reduce the frequency to some extent. Conclusion: Gastroschisis causes varying organ herniation, emphasising the significance of prenatal detection and meticulous surgical therapy to improve results and reduce complications.  This syndrome entails severe herniation of organs without a protective sac, resulting in exposure to amniotic fluid, irritation, and swelling.
Early detection through good prenatal imaging and better care tactics can lead to substantial changes in the disease. Surgical therapy aids in the decrease of herniated viscera into the peritoneal cavity and the closure of abdominal wall defects.

Background: Urinary tract infections (UTIs) are common worldwide, with adolescents being especially vulnerable due to hormonal, anatomical, and behavioral factors like puberty, sexual activity, and hygiene habits. Females face higher risk, while UTIs in males may signal underlying issues. Poor hydration, infrequent urination, and inadequate sanitation also contribute. Despite their impact, adolescent UTIs are understudied, especially in low-resource settings. This hospital-based observational study investigates the prevalence and risk factors of UTIs in adolescents to inform better prevention and care. Objectives: The primary objective of the study was to identify the associated risk factors of UTI in Adolescence, and also to estimate the prevalence of UTI in Adolescence admitted in pediatric ward. Methodology: Hospital based observational study was conducted on 300 adolescents of age 10-18 years, admitted in the pediatric wards. Patients with congenital renal anomalies, Patients with a recent history of urinary catheterization or intervention and Patients requiring ICU admission were excluded from the study. Adolescents admitted in wards were sent routine laboratory investigations along with Urine microscopy, Urine Culture and Sensitivity. Data was collected through self-formulated questionnaire was taken by face-to-face interview analysis. Socioeconomic history was taken during the by questionnaire considering the per capita income of the family they were categorized using modified Prasad classification. Results: The present study included with adolescence age between 10-18 years admitted in pediatric wards, there was statistically significant (P<0.05) association between sex, rural population, socioeconomic status, mothers education, poor menstrual and general hygiene and low fluid intake. The present study also estimated the prevalence of UTI in adolescence admitted in pediatric wards was 30%. Conclusion: Our study found that poor hygiene, infrequent urination, and low fluid intake are modifiable risk factors for UTIs in adolescents, while female sex and low socioeconomic status are non-modifiable factors. Improving hygiene, hydration, and clothing choices may help reduce UTI incidence. Further research with larger samples is needed to confirm these findings and explore preventive strategies.

Objectives: To determine the differences between demographic, clinical and histopathologic features of oral squamous cell carcinoma in users and nonusers of tobacco. Materials and Methods: The Archival records of patients who were histologically diagnosed with Oral Squamous cell carcinoma at the Department of Oral Pathology and Microbiology, Govt Dental College, Kottayam from January 1^st 2009 to 31^st December 2018 were identified. Records of patients who satisfy inclusion and exclusion criteria were studied. The cases were categorized into two groups – tobacco users and tobacco non users. Results were statistically analysed using SPSS software. Results: A total of 1084 oral cancer cases studied retrospectively during a ten year period (2009-2018). Among this 961 were tobacco users and 123 were nontobacco users. Male predominance with mean age group of 64yrs and female predominance with mean age group of 54yrs was noted in tobacco and nontobacco users respectively. Tobacco users more belongs to lower socioeconomic class while nontobacco users more concentrated in lower middle class. Most frequent site of oral cancer in both groups were tongue. In addition, tumor occurrence in the posterolateral border of tongue was twice as common in nontobacco users compared to tobacco users. Small tumor size (5sq.cm) with ulcerative type in nontobacco users and large tumor size (8sq.cm) with ulcer proliferative type in tobacco users were the common findings with respect to comparison of site and type of the lesion. Both the groups showed oral cancer with more of moderate level of differentiation (according to Broder’s criteria). In nontobacco users well differentiation is noted almost equal as moderate level of differentiation. Conclusion: The attributed risk factor of oral squamous cell carcinoma is mainly by tobacco products, there appears to be a rising proportion of oral squamous cell carcinoma in non-tobacco users. Comparison studies between tobacco and nontobacco users focusing on molecular aspects are the future perceptive to evaluate the risk and prevention of oral cancer in these groups.

Objectives: The present study was to evaluate the prevalence of transfusion transmitted infections amongst various age group blood donors in the blood bank at tertiary care center. Methods: Information regarding age, sex, previous history of surgery, chronic illness, hospitalisation, blood transfusion, jaundice, high-risk behaviour, history of vaccination, etc., was recorded. After satisfaction with the answers from donors and medical examination, donors were allowed to donate blood. The serum of all donors was tested for HBsAg, HCV antibodies (anti-HCV), HIV p24 antigen, antibodies 1, 2 (anti-HIV-1,2), Rapid Plasma Reagin (RPR) for syphilis antibodies, and malaria parasite antigen. Results: Out of 3405 total donors, 354 were voluntary and 3051 were replacement donors. Among the total 3405 donors, 3321(97.53%) were males and 84(2.47%) were females. Most of the donors 1771(52.01%) was found in the age group of 31-40 years.  33.95% were in age group of 18-30 years.  10.11% and 3.94% donors were in age group of 41-50 and 51-60 years respectively.  The overall seroprevalence of HBV, HCV, HIV, Syphilis, and malaria in amongst all donors was 0.73%, 0.15%, 0.12%, 2.06%, and 0% respectively. And overall rate of prevalence of transfusion transmitted infection was 3.05%. Conclusions: Most of the blood donors are in adult aged populations. Transfusion transmitted infections (TTIs) are also mostly seen in adult age population. Syphilis and Hepatitis B Virus (HBV) are the most common transfusion transmitted infections in blood donors. Therefore, we recommend that a heavy emphasis should be given to maximize voluntary blood donations so as to minimize the risk of TTIs. And awareness programs should  be organised for general public to promote voluntary blood donations, frequent organization of blood donation camps, better donor recruitment and retention strategies and reducing the replacement donations to minimum.

Introduction: Chronic kidney disease (CKD) is a global health issue affecting millions of world population and has emerged as a common complication of several chronic diseases like diabetes mellitus, hypertension, collagen vascular diseases etc. Chronic inflammation and enhanced oxidative stress are the hallmarks of CKD. Studies have reported CKD to be associated with hyperuricemia, mostly due to decreased renal clearance. Researchers have also pointed out that uric acid, in spite of being a natural antioxidant, does not help in reducing the oxidative stress in CKD patients rather it forms urate crystals and promotes inflammation further worsening the condition. But there are studies that have reported that elevated total serum bilirubin levels, but within the physiological range, may have a protective role on the kidneys. Aim of the study: To determine whether there is any correlation between the levels of total serum bilirubin [TSB] and serum uric acid and renal function [mainly serum creatinine] in CKD patients. Methods: 70 cases and 70 age-sex matched controls, in the age group of 30-80years, attending Medicine OPD of KPC Medical College and Hospital were recruited for this study, obeying inclusion and exclusion criteria. The biochemical assays were done in the biochemistry department of KPC Medical College and Hospital. Results: The mean serum urea (92.6 ± 43.67) and creatinine (3.48 ± 0.65) for the cases were significantly higher than that of controls (urea: 22.84 ± 9.32, creatinine: 0.92 ± 0.25) with p values of <0.0001. The mean TSB for cases (0.35 ± 0.16) was significantly lower than that of controls (0.82 ± 0.11) (p<0.0001) and the mean serum uric acid was higher for cases (6.07 ± 0.50) than that of controls (3.54 ± 0.61) (p<0.0001). There was a significantly negative correlation between TSB and creatinine among the cases (R= -0.35, p=0.003) and a significant positive correlation between serum uric acid and creatinine (R=0.97, p=0.00) among the cases. Conclusion: Increase in total serum bilirubin levels may play a protective role in CKD patients, while increased serum uric acid levels may have a role in disease progression of CKD.

Osteochondromas are the most common benign bone tumors (accounting for 30–50% of all benign bone tumors). This benign tumor characterized by a bony protuberance surrounded by cartilaginous surface, most commonly in proximal tibia, distal femur, proximal humerus. Our case was presented in a very unusual site, i.e., left second metatarsal head. They are developmental malformations rather than true neoplasms and are thought to originate within the periosteum. W present a case report of unusual manifestation of a osteochondroma, a common benign tumor but in a rare site, i.e., left second metatarsal head. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2-3% if complete resection is achieved.

Background: Children face the highest risk of dying in their first month of life. The acute neonatal physiology is significantly affected based on temperature, oxygenation, perfusion, and blood sugar (TOPS). This study was conducted to investigate the role of TOPS in predicting mortality in transported neonates in our institute. Materials and Method: This is a prospective observational study was conducted on 373 out-born neonates, admitted in Special New-born Care Unit (SNCU)/ Neonatal Intensive Care Unit (NICU) of tertiary care hospital. Complete history, examination, and including Temperature, oxygenation, Perfusion by Capillary Refill Time (CRT), and blood sugar were recorded in predesigned proforma at the time of admission, and they were followed till discharge or death. Data thus collected was entered in a Microsoft Excel sheet and was subjected to statistical analysis. Results: Out of 373 neonates, 74.3% of neonates were discharged, while 25.7% neonates were expired. 89% of neonates were referred during the early neonatal period. Derangements in TOPS variables had a significant correlation with mortality, as shown by the univariate odds ratio. Prolonged capillary refill time was the strongest predictor of mortality with the highest Odds ratio (18.7%). Among all parameters, hypothermia had the highest sensitivity (71.8), prolonged CRT had highest specificity (97.7%) and positive predictive value (82.2%), hypoxia had highest negative predictive value (89%). We found that there is a 100% mortality in neonates with alteration in all four TOPS variables. Conclusion: The TOPS score remains a valuable tool for assessing neonatal mortality, particularly in resource-limited settings.

Background: Inguinal hernia repair is a common surgical procedure often associated with moderate postoperative pain. Effective pain management is crucial for optimizing patient recovery and minimizing opioid-related side effects. Aim: To assess analgesic effect between patients receiving ultrasound-guided TAP block and those receiving conventional analgesia. Document the opioid consumption in both groups, time to administer post-operative analgesics for 24 hours and any adverse event. Methods: After ethical approval a prospective observational study was conducted on 90 patients aged 18-60 years, in ASA I-III, undergoing elective unilateral open inguinal hernia repair under spinal anaesthesia. In Group T lateral TAP block was administered by USG using a combination of 30ml of 0.25% bupivacaine with 2 ml (8 mg) dexamethasone, total 32 ml volume. And for the conventional analgesia technique Group C, 100 mg of tramadol in 100 ml of normal saline was administered after the regression of the T10-T12 level of spinal anaesthesia. Pain scores were assessed at 2, 6, 12, and 24 hours postoperatively using the Visual Analog Scale (VAS). Results: Mean VAS score at rest in Group T was 0.6 ± 0.91, while in Group C it was significantly higher at 2.77±1.11 (P <0.0001) at 6 hours. Within the first 6 hours postoperatively, only 1 patient in Group T required tramadol compared to 28 patients in Group C (p- <0.0001).  Additionally, total postoperative opioid consumption was lower in the TAP block group (37.77±67.62 mg) compared to Group C (95.56±55.59 mg) (p <0.0001). No major complications were observed in either group. Conclusion: Ultrasound-guided TAP block is an effective postoperative analgesia technique for inguinal hernia repair, providing superior pain relief, reducing opioid consumption, and minimizing adverse effects compared to conventional intravenous analgesia. These findings support the use of TAP block as part of a multimodal analgesic approach in postoperative pain management.

Introduction: Frozen-thawed embryo transfer (FET) enhances synchronization between embryo and endometrium, increasing pregnancy rates while reducing IVF complications and risks like low birth weight. This study aims to compare pregnancy outcomes in artificial endometrial preparation (AEP) with hormone replacement treatment (HRT), with or without GnRHa pre-treatment. Methods: This prospective study at CIMAR Fertility Centre compared two groups receiving different endometrial preparation protocols for FET. Participants underwent rigorous inclusion and exclusion criteria, with treatment tailored by hormonal and ultrasound assessments. Outcomes measured included pregnancy rates and losses, revealing no significant differences between the groups. Results: The study involved 116 participants, split into two groups with 51 and 65 members. Despite varying rates of biochemical pregnancies, ongoing pregnancies, and miscarriages, no significant statistical differences were found between the groups concerning previous failed ETs, β-HCG levels, or outcomes linked to the Obstetric formula. Conclusion: The study reveals that while Obstetric formula and β-HCG levels offer insights, they alone don’t predict pregnancy outcomes due to the significant impact of factors like endometrial receptivity and embryo quality. Variability in results, likely from small sample sizes, highlights the need for broader, integrated future research.

Introduction: Acute kidney injury (AKI) in pregnancy, marked by sudden renal decline and high morbidity, is influenced by factors like preeclampsia and sepsis. This study evaluates AKI’s clinical profile and predictive factors for maternal outcomes, aiming to enhance prognosis and healthcare approaches through a multidisciplinary strategy. Methods: This retrospective study at Tantia Medical College involved pregnant women diagnosed with AKI, defined by specific renal criteria. Excluding pre-existing renal conditions, the study monitored clinical parameters, conducted extensive lab tests, and followed rigorous treatment protocols including dialysis. Maternal outcomes were meticulously categorized and recorded. Results: The study of 282 pregnant women showed a mean age of 28.4 years and high incidences of preeclampsia (29%), sepsis (16%), and hemorrhages. Most recovered fully (69%), but some had partial recovery (25%), renal failure (4%), or died (2%). Severe AKI stages and abnormal renal tests were common. Conclusion: The study highlights the severe impact of AKI in pregnancy, driven by complications like preeclampsia, sepsis, and hemorrhage. Despite notable recoveries, the presence of severe outcomes emphasizes the need for robust prenatal care, preventive strategies, and specialized healthcare, especially in developing regions to enhance maternal and fetal outcomes.

Mandibular reconstruction is necessitated by various conditions that compromise the integrity and function of the mandible. These include traumatic injuries, surgical resections due to benign or malignant tumors, chronic infections, and pathological fractures resulting from osteonecrosis. Rehabilitation of patients following mandibular resection and reconstruction using microvascular fibular grafts presents numerous challenges. These challenges include low bone height, excessive soft tissue volume, lack of attached gingiva, difficulties in implant maintenance, poor abutment-to-implant ratio, risk of pathological fibular fractures, and unfavorable bone composition with a predominance of cancellous over cortical bone. Additionally, osteoradionecrosis and prosthetic complications further complicate the rehabilitation process. Various solutions have been proposed to address these issues, including the double-barrel fibula technique to enhance bone volume, pre-resection implant placement to ensure uninterrupted vascular supply, and a structured algorithmic approach to patient-specific rehabilitation planning. This review aims to discuss the key challenges and potential solutions for optimizing functional and aesthetic outcomes in patients undergoing mandibular reconstruction with fibular grafts.

Background: Acute uncomplicated appendicitis in children remains a diagnostic challenge due to overlapping symptoms with other abdominal conditions. Early and accurate diagnosis is crucial to prevent complications and avoid unnecessary surgeries. Calprotectin and Lactoferrin, inflammatory biomarkers released by activated neutrophils, have shown promise in detecting infections and inflammation. This study aims to evaluate the levels of Calprotectin and Lactoferrin in children presenting with suspected appendicitis to assess their utility as early, non-invasive markers for diagnosing acute uncomplicated appendicitis. Methods: Children aged 5 to 15 years presenting with right lower quadrant abdominal pain and clinical suspicion of acute appendicitis were considered for inclusion. After clinical, laboratory, and radiological evaluation, patients were categorized as having acute uncomplicated appendicitis, complicated appendicitis (perforated/gangrenous), or non-appendicitis abdominal pain. Serum calprotectin and lactoferrin levels were measured using commercially available quantitative enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer’s instructions. All samples were analyzed in duplicate to ensure accuracy. Laboratory personnel were blinded to the clinical diagnosis to minimize bias. Results: The study included 40 children with acute uncomplicated appendicitis and 40 healthy controls. Age distribution was comparable, with no significant differences. Abdominal pain was the most consistent symptom (100%), followed by diarrhea (60%) and vomiting (50%). Mean Calprotectin and Lactoferrin levels were significantly elevated in cases compared to controls (19.55 ng/ml vs 10.28 ng/ml and 12.27 ng/ml vs 2.19 ng/ml, respectively). A weak positive correlation existed between the two markers. Calprotectin levels varied with symptoms, while Lactoferrin levels remained consistent, highlighting their potential in early diagnosis. Conclusion: Our study highlights the potential utility of Calprotectin and Lactoferrin as early diagnostic biomarkers for acute uncomplicated appendicitis in children. Significantly elevated levels of both markers in cases compared to controls suggest their diagnostic relevance. Calprotectin showed a variable association with specific symptoms, while Lactoferrin levels remained consistently elevated, indicating its stability as a marker.

Introduction: Postoperative sore throat is a common complication after general anesthesia in  both adult and pediatric patients. The incidence of postoperative sore throat is lower with I-gel  insertion compared to tracheal intubation using a cuffed oral endotracheal tube. Objectives: The primary objective was to compare the incidence of postoperative sore throat  following I-gel insertion versus cuffed oral endotracheal tube insertion in pediatric patients  undergoing surgery under general anesthesia at Government Medical College,  Thiruvananthapuram. The secondary objective was to compare these airway management  techniques in terms of inspired and expired tidal volumes, air leak during ventilation, and  intraoperative hemodynamic stability. Methodology: This hospital-based prospective observational study included 72 pediatric  patients aged 6–12 years undergoing elective surgery under general anesthesia. Patients were  divided into two groups: Group 1 (n=36) received a cuffed oral endotracheal tube, and Group  2 (n=36) received an I-gel. Study variables included the incidence of postoperative sore throat,  Harding and McVey Score (HMS) at 4 hours postoperatively, and hemodynamic parameters. Results: The incidence of postoperative sore throat was significantly lower in the I-gel group  (13.9%) compared to the cuffed endotracheal tube group (41.7%) (p=0.007). The mean HMS. Score at 4 hours postoperatively was also lower in the I-gel group (1.2 ± 0.6) compared to the  cuffed endotracheal tube group (2.4 ± 0.8) (p<0.001). Conclusion: I-gel is a safe and effective alternative to a cuffed oral endotracheal tube in  pediatric patients undergoing short-duration procedures. The severity of postoperative sore  throat, as assessed by the HMS score, was significantly lower in the I-gel group.

Background:  Electromagnetic radiations from mobile phone deranges inner ear, cochlea and outer hair cells of inner ear and auditory tract. Materials and Methods: Case control study. Group 1, N=30 subjects, mobile smart phones exposure for about 1-7 years and exposure time more than 3 hours per day. Group II, N=30 subjects, mobile smart phones exposure for more than 7 years and exposure time more than 3 hours per day. Headache, tinnitus, burning sensations around phone-using area around ear were excluded. Brainstem auditory evoked potential (BAEP) done. Student Unpaired t test for analysis. Results: BERA waves III, V and all interpeak latencies at 80 dB and 2 KHz in Group 2 were delayed and significant as compared to Group 1. Conclusion: Brain stem evoked response audiometry (BERA) detects hearing derangement in smart mobile phone users at 2 KHz and 80dB.

Background: Varicose veins are the most common chronic vascular disorder leading to surgical treatment. Many treatment options are currently available for the disease. Aim: The aim is to analyze the incidence, distribution and clinical manifestations of varicose veins of lower limbs. Methods: All the patients admitted with varicose veins of lower limbs in the Department of Surgery in tertiary hospital, Andhra Pradesh, for 1 year period were studied. Results: About 30 patients with primary varicose veins who met the inclusion and exclusion criteria were studied and the incidence, distribution and clinical manifestation were analyzed. Conclusion: Varicose veins are most prevalent in younger age group, 21 to 40 years with Male: Female ratio of around 2: 1. The long saphenous system is more commonly involved particularly in the left lower limb with above knee perforator involvement being most common. Dragging pain is the most common presenting symptom. The incidence of venous ulcer in higher in the present study compared with other studies i.e. 21%. Varicose veins are more prevalent in occupations involving prolonged standing.

Background: Hypertensive disorders are present in 3–10% of all pregnancies. They are among the main causes of maternal and perinatal morbidity and mortality. The present study was conducted to assess prevalence of pregnancy induced hypertension and to assess neonatal outcomes. Materials & Methods: The present retrospective study was done using data from the patient record of pregnant women with hypertension and neonates admitted to the Neonatal Intensive Care Unit of the Hospital. An analysis was performed on 1200 birth records. Of the women, 120 were diagnosed with hypertension in their pregnancies. The data was collected from the medical record and statistical analysis was done using statistical software SPSS version 22. P-value less than 0.05 was considered statically significant. Results: The prevalence of hypertension among the pregnant women hospitalized was 10% (120/1200). Maximum women of age group 20-36 years had diastolic blood pressure ≥110mmHg (32.5%) and diastolic blood pressure ≤110mmHg (33.33%). Maximum women had cesarean had diastolic blood pressure ≥110mmHg (30.83%) and diastolic blood pressure ≤110mmHg (31.66%). Maximum women had term pregnancy had diastolic blood pressure ≥110mmHg (39.16%) and diastolic blood pressure ≤110mmHg (49.16%).95.83% newborns were live born. Maximum newborns had weight ≥2500grams (73.33%). APGAR at the Ist minute was ≥7 in 83.47% newborns. APGAR at the 5^th minute ≥7 in 98.26% newborns. There was a statistical association between DBP and newborn weight. The group of women with DBP ≥110 mmHg presented a smaller mean newborn weight compared to the group with DBP ≤110 mmHg. Conclusion: The study concluded that the prevalence of hypertension among the pregnant women hospitalized was 10% (120/1200). Maximum newborns were live born with weight ≥2500grams. There was a statistical association between DBP and newborn weight. The group of women with DBP ≥110 mmHg presented a smaller mean newborn weight compared to the group with DBP ≤110 mmHg.

Aim: The present study aimed to compare pre-labour transvaginal cervical length with modified Bishop Score in predicting successful labour induction. Materials & Methods: This prospective observational study evaluated 200 term primigravidae (37-42 weeks gestation) undergoing labor induction at INHS Asvini.  Modified Bishop score was evaluated by digital examination, and the cervical length was measured by Transvaginal sonography (TVS). A vaginal delivery within 24 hours after the start of induction was deemed a successful labor induction. Result: Cervical length was significantly shorter (24.04 ± 5.95 mm) in women with induction phase intervals ≤6h (n=148) compared to those with intervals >6h (28.19 ± 5.84 mm, n=52; p<0.0001). Women with induction phase intervals <24h (n=154) had significantly shorter mean cervical lengths (24.91 ± 5.89 mm) than those with intervals ≥24h (n=44, 29.7 ± 5.98 mm; p<0.0001). Among women undergoing induction, those with Bishop Scores ≥4 (n=121) had a significantly shorter mean active phase (6.14 ± 4.98 hours) compared to those with transvaginal cervical lengths >25 mm (n=111, 9.04 ± 5.37 hours; p<0.0001). Women with Bishop Scores ≥4 (n=154) had a significantly shorter mean interval (9.78 ± 4.82 hours) than those with transvaginal cervical lengths >25 mm (n=106, 12.08 ± 5.84 hours; p<0.0001). Conclusion: Present study concluded that the Bishop score is superior in predicting the response to induction as compared to the cervical length measured by transvaginal ultrasonography.

Background: Scrub typhus, which is due to Orientia tsutsugamushi, is a newly emerging under-recognized cause of acute febrile illness (AFI) in much of India. Although data are stronger from the southern and northeastern regions, epidemiology in eastern India, including Jharkhand, remains inadequately investigated. This research sought to evaluate the prevalence, demographic pattern, and time trends of scrub typhus in a tertiary care center in eastern Jharkhand. Methods: A cross-sectional study was carried out between January and December 2024 in patients with AFI. Scrub typhus and dengue were tested through blood samples by IgM ELISA. Demographic, geographic, and clinical information was examined for epidemiological patterns and correlations. Results: Of more than 1000 suspected cases, 5% were positive for scrub typhus. Among a clinically suspected subgroup (n=38), all were positive, and 5.26% were co-infected with dengue. Most cases occurred in adults with ages between 21–60 years, with a mild male predominance. The majority of the patients were rural or semi-urban dwellers of Jamshedpur and contributed to 70–80% of cases. There was a seasonal peak in November 2024, which reflects post-monsoon transmission. There was a moderate correlation between age and scrub typhus positivity, while location had a poor association. Conclusion: Scrub typhus is an emerging health risk in eastern Jharkhand with specific demographic and seasonal trends. Improved surveillance, early diagnosis, and rural public health interventions are critical for successful disease control.

Background: Understanding sacral anatomy is essential for procedures such as spinal anesthesia, sacral fixation, and sacroiliac joint interventions. However, population-specific morphometric data remain limited, especially in Central India. Objective: To evaluate sacral morphometry using MRI and CT-based imaging in adults from Madhya Pradesh and assess its clinical implications. Methods: Eighty adult sacra (40 male, 40 female) were analyzed via dry bone and imaging data. Key parameters—including sacral index, auricular surface width, curvature, and canal dimensions—were measured. Statistical comparisons and reference intervals were established. Results: Significant sex-based differences were observed in sacral index, curvature, and auricular surface width (p < 0.001). MRI provided highly reproducible measurements (ICC > 0.90). Conclusion: MRI-based sacral morphometry reveals clinically relevant sex differences and regional anatomical patterns. These findings can improve procedural accuracy and support anatomy education through population-specific reference standards.

Aim: To evaluate the effectiveness and safety of conservative antibiotic therapy compared to surgical appendicectomy in the management of uncomplicated acute appendicitis. Background: Acute appendicitis is a common surgical emergency, typically treated with appendicectomy. However, conservative treatment using antibiotics alone has emerged as a potential alternative for uncomplicated cases. This study compares outcomes between conservative and operative management. Methods: A randomized interventional study was conducted in the Department of General Surgery at the Pacific Institute of Medical Science, Udaipur, from January to March 2025. A total of 208 patients diagnosed with uncomplicated acute appendicitis were randomly divided into two groups: 104 managed conservatively with antibiotics, and 104 treated surgically. Patients were assessed for Alvarado score, pain using Visual Analog Scale (VAS), leukocyte count, hospital stay duration, time to resume normal activities, and complication rates. Results: The mean patient age was 24.8 years, with males comprising 80.76% of participants. The operative group had a higher mean Alvarado score (6.7 vs. 6.1, p=0.001). At admission, VAS was significantly higher in the operative group (8.4 vs. 7.3, p<0.001). The conservative group had a shorter hospital stay (2.6 vs. 3.1 days) and quicker return to normal life (12.6 vs. 13.2 days, p=0.04). Complications were lower in the conservative group (6.6%) compared to the operative group (13.3%). Conclusion: Conservative treatment with antibiotics can be a safe and effective alternative for uncomplicated acute appendicitis. Further large-scale randomized controlled trials are recommended to establish this approach as standard care.

Introduction: Caesarean section is an important operative procedure to reduce the morbidity and mortality of the pregnant women. However, it comes with its own pros and cons. various intra-operative as well as post-operative complications are seen which increases with increasing number of repeat caesarean section. Some of the intraoperative complications are- extension of the uterine incision, PPH, adhesions, bowel injury etc. Some common post-operative complications are- abdominal distension, prolonged catheterization, fever etc. In this study we aim to compare the intra-operative as well as post-operative complications encountered during primary and repeat caesarean section. Materials and Methods: A total of 100 women were selected who met the inclusion and exclusion criteria and who underwent caesarean section in Assam Medical College who had complications during or after the surgery. They were then divided into two groups Group 1 (50 women undergoing primary CS) and Group 2 (50 women undergoing repeat cs). Results: Out of 100 participants, majority belonged to the age group of 21-30 years. Most common indication of caesarean section in group 1 was fetal distress 24% followed by oligohydramnios 14% whereas the most common indication of group 2 was post-caesarean in labor 44%, followed by elective caesarean section 16%. The mean time taken for surgery in group 1 was 33.50(+/-13.3) mins whereas in group 2 was 54.34(+/-21.35) mins. Most common intra-operative complication was blood transfusion 12% followed by extension of uterine angle incision 10% in Group 1. Adhesion 30% followed by scar dehiscence 14% and placenta previa 14% were most common intra-operative complications in group 2. Prolonged hospitalization 10%, followed by fever 6% was most common post-operative complication in group 1. Prolonged hospitalization 6%, delayed return of bowel movements 4% and prolonged catheterization 4% were most common in group 2. Conclusion: Repeat caesarean section has more complications than primary caesarean section and complications increases with increasing number of repeat caesarean section. Hence, rate of caesarean section has to be monitored.

Background: Syndrome Z represents the coexistence of obstructive sleep apnea (OSA) and metabolic syndrome (MetS), a condition characterized by abdominal obesity, hypertension, dyslipidemia, insulin resistance, and hyperglycemia. Despite its clinical importance, limited data exist on the prevalence of Syndrome Z and its associated risk factors in the general population. OSA has been strongly linked to increased cardiovascular morbidity and mortality, including coronary heart disease and stroke. However, it remains unclear whether these risks are mediated by traditional cardiovascular risk factors or specific effects of OSA itself. Objective: This review explores the potential role of OSA as an independent cardiovascular risk factor. It also examines the interaction between OSA and vascular risk factors, which may account for unexplained variance in the incidence and severity of cardiovascular disease (CVD). Key Findings: OSA is commonly associated with systemic hypertension, yet the causal relationship between these conditions remains debated due to confounding factors such as obesity and aging. Evidence suggests that OSA contributes to vascular dysfunction through mechanisms including intermittent hypoxia, oxidative stress, systemic inflammation, and metabolic dysregulation. These processes may exacerbate components of MetS, promoting a synergistic increase in CVD risk. Furthermore, OSA is prevalent in individuals with hypertension and MetS, highlighting its potential role in amplifying cardiometabolic burden. Conclusion: Syndrome Z underscores the complex interplay between OSA and MetS in driving cardiovascular risk. Identifying and managing OSA in patients with MetS could mitigate its impact on CVD outcomes. Further research is warranted to clarify causal pathways and inform targeted therapeutic strategies.

Objective: Self-medication has become one of the most common practices nowadays. It involves obtaining medicines using old prescriptions to purchase medicines or without a prescription, sharing of medicines amongst each other or using leftover medicines from previous illness. The present study was conducted to assess self-administration of drugs use and misuse among MBBS professional medical students. Material and Methods: The study was conducted among 160 students from first, second and final year MBBS. All selected students were asked to fill the details of questionnaire. The questionnaire was divided in two parts. The first part contained questions on demographic information, Socio-economic variables in second part of questionnaire.MS excel was used to record the data and were analyzed using Graph pad prism version 6 Results: In the present study total participants were 160 in which, 53.75% were male and 46.25% were female. In first year 55.38% were male and 44.61% were female, while in second 65.38% were male and 34.61% were female. In final year 53.48% and 46.51% were male and female respectively. Maximum participants were of age group 21-23 yrs (45%). In first- and second-year maximum participants were of age group 18-20yrs. In final year maximum participants were of age group 24-26yrs. Maximum students takes self-medication for headache all groups. Maximum students take Tablet paracetamol as self-medication. Conclusion: The present study concluded that Self-medication had been widely practiced among medical students.

Serum creatinine levels are widely recognized as the primary clinical marker for estimating renal function, specifically the glomerular filtration rate (GFR), due to their simplicity, rapidity, and cost-effectiveness. However, the use of creatinine as a sole indicator has notable limitations, as its levels can be significantly influenced by various factors including advanced age, physical activity, protein-rich diets, male gender, certain medications, and ethnicity. As an alternative, serum cystatin C has emerged as a potential adjunct to serum creatinine measurements, as it is less affected by these confounding variables. Creatinine is predominantly synthesized in muscle tissue, making it a useful biomarker for assessing lean body mass within body composition. This aspect is particularly important for evaluating and monitoring nutritional status in patients with chronic kidney disease (CKD), where maintaining an appropriate body composition is crucial for overall health outcomes. This review aims to synthesize existing literature on creatinine metabolism and its application in clinical practice, highlighting both its advantages and disadvantages in assessing renal function. Furthermore, it emphasizes the importance of considering individual variability in creatinine generation rates when evaluating GFR. By providing a comprehensive overview of the role of creatinine in renal assessment and its utility in measuring lean body mass, this article seeks to enhance understanding and inform clinical decision-making regarding kidney health and nutritional status in patients with CKD.

Background: Bowel anastomosis, a surgical technique that re-establishes bowel continuity after resection of a diseased segment, relies on meticulous surgical technique and adherence to fundamental principles for successful outcomes. Gastrointestinal surgery safety hinges on factors influencing anastomotic healing. Objective: This study aimed to identify risk factors for anastomotic leakage following bowel anastomosis, determine the incidence of early complications, and evaluate mortality rates associated with the procedure. Methods: A prospective, hospital-based study was conducted at VIMSAR, Burla, from November 2018 to October 2024, encompassing all patients undergoing intestinal resection and anastomosis. Data were collected through detailed patient history, clinical examination, and haematological and radiological investigations. A total of 300 patients undergoing resection and anastomosis for various diseases were included. Results: The study cohort included 12 patients under 20 years, 234 between 20 and 60 years, and 54 over 60 years of age. Anastomotic leak rates were higher in the elderly (over 60 years) at 33.3%, compared to 7.7% in the 20-60 year age group. The study population consisted of 228 males (76%) and 72 females (24%). 36 patients developed anastomotic leaks, with 66.7% of these presenting more than one day post-surgery. Small bowel to small bowel anastomosis was performed in 174 patients (58%), while 78 patients (26%) underwent small to large bowel anastomosis. Conclusion: The type of anastomosis performed did not significantly affect the anastomotic leak rate. Malnourished patients (indicated by low serum albumin levels) demonstrated a higher risk of anastomotic leak, surgical site infection (SSI), morbidity, and mortality following bowel anastomosis. In emergency situations, creating a temporary stoma in malnourished patients (after addressing the primary pathology) should be considered to stabilize the patient, with delayed stoma closure planned. If anastomosis is unavoidable, these patients should receive close postoperative monitoring for leak signs and prompt intervention. Optimizing enteral nutrition before elective surgery may reduce morbidity and mortality rates.

Background: Respiratory infections contribute significantly to global morbidity and mortality, with bacterial infections playing a crucial role in disease burden. Cefpodoxime is used in combination with clavulanic acid to enhance its efficacy against beta-lactamase-producing bacteria. Despite their common usage, data on clinicians’ perspectives regarding the clinical utilization is limited. The study aimed to explore prescribing pattern, perceived benefits and clinicians’ attitude and opinion towards utilization of cefpodoxime-clavulanate. Methods: A descriptive, questionnaire-based cross-sectional survey was conducted among 709 clinicians from varied specialties who were attending national conferences throughout the country. This survey utilized a pre-validated questionnaire comprising of 8 multiple choice questions. Data was collected on Microsoft excel and analyzed using descriptive statistics. Results: The survey participants consisted of ENT surgeons (37.79%), Pediatricians (29.47%), and Consulting Physicians (29.33%), and General Physicians (3.41%) comprising the rest. More than half of the respondents (54.18%) prescribe cefpodoxime-clavulanate routinely (Always/frequently) on their clinical practice. Among the RTIs, cefpodoxime-clavulanate is most commonly used in acute otitis media (36.81%) and acute bacterial sinusitis (31.59%) followed by acute tonsillopharyngitis (18.47%), community-acquired pneumonia (12.83%) and, other undefined URTIs (0.28%).  Almost all (92.52%) clinicians rated the effectiveness of cefpodoxime-clavulanate as good or excellent. As per their experience, patient adherence was also high, with 67.41% demonstrating excellent compliance. Conclusion: The study highlights cefpodoxime-clavulanate as a widely used first-line therapy for RTIs, preferred in severe, resistant, and recurrent cases. While its use in clinical setting is well-supported, further clinical research is needed.

Background: Lower lumbar radiculopathy significantly contributes to the global burden of chronic pain and disability. This prospective study evaluates the efficacy of selective nerve root blocks (SNRBs) in patients presenting with symptoms of lower lumbar radiculopathy at a tertiary care hospital in Gujarat, India, from January to December 2024. Fifty patients were assessed pre- and post-SNRB using pain scales and disability indices. The results suggest that SNRBs provide substantial pain relief, confirming their role in the therapeutic management of lower lumbar radiculopathy. Low back pain (LBP) is a pervasive issue, with its lifetime prevalence reported as high as 60-80% in the general population. Among the various manifestations of LBP, lower lumbar radiculopathy is particularly prevalent, leading to significant disability and work absenteeism. Selective nerve root blocks (SNRBs) are increasingly utilized as both diagnostic and therapeutic procedures to alleviate radicular pain associated with lumbar disc herniation and spinal stenosis. This study aims to investigate the short-term outcomes following SNRBs in a cohort of patients with lower lumbar radiculopathy. Materials and Methods: After receiving approval from the Institutional Ethics Committee, the study was initiated. The study design is a randomized, prospective trial carried out at a tertiary hospital in Gujarat from January to December 2024. A total of 50 patients, aged 20 to 60 years, diagnosed with lower lumbar radiculopathy, were included. We assessed baseline characteristics and primary outcomes including pain levels measured by the Visual Analog Scale (VAS) and disability measured using the Oswestry Disability Index (ODI). The SNRB was performed under fluoroscopic guidance, where corticosteroid and local anesthetic were injected around the affected nerve root. Pain and disability assessments were repeated at one week, four weeks, and twelve weeks post-procedure. Results: Data analysis revealed a significant reduction in VAS scores, with pre-procedure scores averaging 6.51 ± 1.17, decreasing to 3.96 ± 1.44 after SNRB (p<0.001), representing an improvement of approximately 40 %.VAS scores improved by 45% (1week), 54%(4 weeks) and 65%(12 weeks) while ODI Index improved by 31% (1 week), 62% (4 weeks), and 67%(12 weeks) as compared to values on admission. These outcomes corroborate findings from existing literature supporting the efficacy of SNRBs in managing radicular symptoms. Conclusion: In conclusion, selective nerve root blocks are a safe and effective treatment option for managing lower lumbar radiculopathy, producing significant improvements in pain and disability outcomes. This study supports the continued use of SNRBs in clinical practice as a means of providing symptomatic relief for patients suffering from this condition.

Point-of-care ultrasound (POCUS) has become an invaluable diagnostic tool in the emergency department (ED), offering rapid, bedside imaging that can significantly influence clinical decision-making. This case series aims to explore the role of POCUS in the ED by presenting various clinical scenarios where it was utilized to guide patient management. Over a period of six months, a series of cases were collected from a high-volume urban ED at a tertiary care centre ( Dr. R.M.L.I.M.S, Lucknow) encompassing diverse conditions such as trauma, cardiology, respiratory, and abdominal emergencies. The use of POCUS provided critical insights in diagnosing conditions such as cardiac tamponade, DVT, hemoperitoneum and pneumothorax. The case series highlights not only the diagnostic accuracy of POCUS but also its capacity to enhance workflow efficiency, reduce the need for further imaging studies, and aid in the early identification of life-threatening conditions. Additionally, the study underscores the importance of ongoing training as the effectiveness of the procedure is closely relates to the skill of the operator. This case series contributes to the growing body of evidence supporting the integration of POCUS as a standard practice in emergency care for improving patient outcomes.

Background/Aims: Vancomycin-resistant Staphylococcus aureus (VRSA) is an emerging global health concern, particularly in hospital settings, where it poses significant challenges to infection control and treatment. S. aureus is a major pathogen responsible for a wide range of infections, from minor skin infections to life-threatening conditions such as bacteraemia, pneumonia, and endocarditis. The widespread use of vancomycin to treat methicillin-resistant S. aureus (MRSA) has led to the emergence of VRSA, which exhibits reduced susceptibility or complete resistance to this last-line antibiotic. In India, particularly in tertiary care hospitals, the prevalence of VRSA remains a crucial area of study due to the high burden of nosocomial infections. Phenotypic methods, including minimum inhibitory concentration (MIC) testing and disc diffusion assays, play a vital role in detecting VRSA isolates and guiding appropriate therapeutic interventions. Aim: Phenotypic Determination of Vancomycin Resistant Staphylococcus Aureus Isolated from Tertiary care Hospital, from Central India Objectives: (1). Isolation of Staphylococcus aureus from various clinical samples of the patients attending a tertiary care Hospital, from Central India. (2). Phenotypic characterization and antibiotic susceptibility pattern of Staphylococcus aureus using Vitek-2 automated methods and microbroth dilution method. (3). Molecular characterization of vancomycin resistance in Staphylococcus aureus for detection of genes like Van A, B, D, E, and G by using multiplex polymerase chain reaction. Sample Collection and Bacterial Isolation: A total of 150 clinical samples, including pus, blood, urine, and sputum, were collected from patients with suspected MRSA, infections. Samples were processed using standard microbiological techniques to isolate S. aureus. Result: A total of 150 clinical specimens were processed for this study, including 6 urine samples, 13 diabetic foot swabs, 17 blood samples, 7 bronchoalveolar lavage (BAL) samples, 9 pleural fluid samples, 5 bronchial aspirates, 21 throat swabs, 12 biopsy samples, 3 CSF samples, 4 stool samples, 25 sputum samples, and 7 catheter tips. Conclusion: The results of the current study illustrate the emergence of vancomycin resistance among methicillin-resistant S. aureus isolated from children with healthcare-associated infections. The majority revealed the occurrence of vanA and vanB as an accountable mechanism for this resistance.

Background: Tuberculosis (TB) remains a major public health challenge in India, with a significant burden of morbidity and mortality. While conventional diagnostic tools like sputum smear microscopy are widely used, limitations in sensitivity—especially in smear-negative cases—necessitate alternative diagnostic biomarkers. Serum adenosine deaminase (ADA) has emerged as a potential tool for differentiating pulmonary TB from other respiratory illnesses. Aim: To evaluate the diagnostic significance of serum adenosine deaminase (ADA) levels in pulmonary tuberculosis. Methods: This cross-sectional observational study was conducted over one year at Tirunelveli Medical College Government Hospital. A total of 160 participants were included and categorized into four groups: pulmonary tuberculosis (n=40), lung carcinoma (n=40), non-TB respiratory diseases (n=40), and healthy controls (n=40). Serum ADA levels were measured using an enzymatic assay, and statistical analysis was performed using one-way ANOVA to compare ADA levels across groups. Results: Mean ADA levels were significantly elevated in the pulmonary TB group (57.04 ± 10.72 U/L) compared to non-TB respiratory diseases (33.20 ± 7.78 U/L), carcinoma lung (29.11 ± 5.21 U/L), and healthy controls (20.63 ± 5.57 U/L), with a statistically significant difference (p = 0.001). Demographic analysis revealed that pulmonary TB patients were predominantly male (70%), with 63% reporting alcohol use and 50% being smokers. Conclusion: Serum ADA levels were markedly elevated in patients with pulmonary tuberculosis compared to other respiratory conditions, supporting its role as a reliable, cost-effective biomarker in the differential diagnosis of TB. Incorporating ADA estimation in routine diagnostic workup, particularly in smear-negative or diagnostically ambiguous cases, could enhance early detection and improve patient outcomes.

Introduction: Supracondylar fractures are the most common type of elbow injury in children under the age of eight, accounting for approximately 64% of all pediatric elbow fractures. These injuries are associated with a range of complications, which can be classified as either pre-existing at the time of injury or arising after treatment. Pre-treatment complications often include neurological involvement, such as injury to the median, radial, or ulnar nerves, as well as vascular compromise due to brachial artery damage. In some cases, compartment syndrome may also develop early due to increased pressure within the forearm compartments. Following treatment, complications can be observed in both the early and late phases of recovery. Early post-treatment issues may include loss of fracture alignment, persistent or new neurological deficits, vascular disturbances, recurrence of compartment syndrome, and infections, particularly those related to Kirschner wire fixation. Over time, children may also experience late complications such as angular deformities like cubitus varus or valgus, limited joint mobility, the formation of myositis ossificans, avascular necrosis of the trochlea, and other long-term structural or functional impairments. Prompt diagnosis, appropriate management, and careful follow-up are essential to minimize these risks and ensure optimal recovery. Objectives: To investigate the incidence and spectrum of complications associated with supracondylar fractures of the humerus in the pediatric population. Material and Methods: This study involved a cohort of fifty children, aged between three and fourteen years, diagnosed with supracondylar fractures of the humerus. Outcomes were assessed by evaluating the carrying angle and elbow joint range of motion, with any observed complications systematically recorded. Results: Among the fifty patients included in the study, the majority (58%) sustained displaced supracondylar fractures classified as Gartland type III, while the remaining 42% presented with either type I or type II fractures. Vascular injuries were observed in 4% of the cases, compartment syndrome developed in 6% of the patients, and nerve injuries were identified in two individuals. Long-term complications documented during follow-up included cubitus varus, cubitus valgus, elbow joint stiffness, and myositis ossificans. Conclusion: One of the most critical complications following a supracondylar fracture of the humerus is compartment syndrome, a potentially limb-threatening condition. Despite its severity, timely intervention often leads to favorable outcomes in pediatric patients. Brachial artery injury, although less common, constitutes a surgical emergency necessitating immediate evaluation and management to prevent ischemic damage. Nerve injuries, particularly those affecting the median nerve, occur infrequently but should not be overlooked. Delayed complications may include malunion, which can manifest as cubitus varus (commonly known as gunstock deformity) or cubitus valgus, along with elbow stiffness and the development of myositis ossificans. These sequelae can significantly impair functional recovery. Therefore, prompt and appropriate management of supracondylar humerus fractures in children is essential to minimize both early and late complications.

Background: Upper gastrointestinal (GI) bleeding causes significant morbidity, mortality and use of health care resources. Despite newer endoscopic strategies, radiological and surgical advances, clinical outcomes have not changed significantly & mortality remains around 10%. Endoscopy is the primary diagnostic test for evaluation of upper gastrointestinal bleeding. Aim: To evaluate the cause and risk factors of upper gastrointestinal bleeding. Study design: A hospital based observational study of 250 patients presenting with upper gastrointestinal bleeding from July 2021 to June 2022 to Assam Medical College & Hospital was done. Results: In this study, the mean age was 53.39 +10.91 years and 75.2% were male & 24.8% were females. The most common lesion found was duodenal ulcer (36.8%) followed by esophageal varices (28%) and gastric ulcer (18.8%). Stomach growth was found in 2% patients. The most common risk factor found was alcohol intake (55.6%) followed by smoking (17.6%). In 45.71% patients H. pylori rapid kit test was positive. Conclusion: The study showed that gastrointestinal bleeding commonly occurred in males aged 51-60 yrs, with peptic ulcer disease as the leading cause, followed by esophageal varices. Alcohol use was the main risk factor and 45.71% had H. pylori infection.

Background: Fever is one of the commonest symptoms in pediatric age group, for which the children come in contact with health care system. However, a prolonged fever creates anxiety among parents and sometimes a diagnostic challenge for the treating physician. Our study aims to find the etiological spectrum in children presenting with prolonged fever. Methods: This hospital based prospective observational study was conducted in a tertiary care center in Northeast India for a period of 1 year from 1^st August 2023 to 31^st July 2024. Total 226 children were enrolled in the study and each child was evaluated,  both clinically and through necessary investigations as per clinical clues. All children were followed up on a regular basis till their discharge, at which final diagnosis was made. Results: Out of 226 enrolled cases, in 10.2% of cases the diagnosis could not be established. Infectious diseases are the most common causes (53.00%) followed by Neoplastic (15.9%), Inflammatory (15.1%) conditions. Among infectious conditions tuberculosis (20.3%) is the most common followed by enteric fever (9.2%). Among non-infectious conditions malignancies are the commonest cause (15.9%) followed by Kawasaki Disease (4.8%). Conclusion: Infections are the commonest cause of prolonged fever in pediatric age group. Apart from malignancies Kawasaki Disease was found to be one of the commonest causes of prolonged fever of non-infectious etiologies.

Renal tumours are most frequently encountered in patients of 4^th-6^th decade of life with mean age of 52 years and are less common in children and young adults with the exception of Wilms tumour. Relatively rare tumors occurs in younger adults 18-45 years. Benign tumors are less common than malignant tumors. Of the malignant tumors renal cell carcinoma constitutes the maximum number of cases. The present study is carried out to find out the incidence and spectrum of renal neoplasms in a tertiary care hospital.

Background: Asphyxia is one of the common conditions observed in the neonatal period which has long term effects on the baby. The “Expanded Apgar Score” by the American Academy of Pediatrics (Fetus and Newborn Committee) was proposed to reflect resuscitative interventions, but does not propose specific scores for resuscitative interventions leaving room for subjectivity, especially with the respiratory score component during resuscitation. Present study was intended to assess the predictive ability of the Apgar score and Neonatal Resuscitation Adaptation Score in high risk newborns for predicting birth asphyxia and neonatal mortality. Methodology: After obtaining informed consent from the parents the study was conducted on 240 babies. All the high risk deliveries were attended and each baby was assessed simultaneously by 2 investigators for APGAR and NRAS score at 1^st and 5^th minute. Cord pH was done in babies who did not cry immediately after birth. Results: When it comes to predicting mortality, APGAR scores at the first minute with a cut-off value of 3.50 have a 75% sensitivity and an 87.1% specificity. When it comes to predicting mortality, APGAR scores at the fifth minute with a cut-off value of 5.50 have a 75% sensitivity and an 84.9% specificity. Mortality can be predicted by NRAS scores at the first minute with a cut-off value of 4.50 with a 75% sensitivity and 92.2% specificity. In terms of predicting mortality, NRAS scores at the fifth minute for the cut-off value of 4.50 demonstrated a 94.4% specificity and a 75% sensitivity. In our study it was found that the mean NRAS scores in discriminating birth asphyxia was found to be statistically significant at the 1^st minute and 5^th minute. (p value <0.05) The mean APGAR scores in discriminating birth asphyxia was not found to be statistically significant at the 1^st minute and 5^th minute. (p value > 0.05). The cord blood pH that were determined in our study 88% of the neonates had cord pH more than 7 and 12% has less than 7. Conclusion: The study has shown a positive correlation between APGAR and NRAS score of 1^st minute and 5^th minute. There was no significant difference observed between APGAR and NRAS in predicting the Asphyxia and mortality. However NRAS at 1^st minute and 5^th minute has shown high specificity compared to APGAR score and there was no difference in sensitivity observed in 1^st and 5^th minute.

Background: Medication adherence is crucial to chronic disease treatment. Non-adherence raises morbidity, hospitalizations, and healthcare costs. Pharmaceutical errors still cause harmful drug reactions and reduce treatment efficacy, threatening patient safety. To optimize healthcare delivery, effective medication adherence and error reduction strategies must be identified and implemented. Objective: This study will examine how different interventions improve medication adherence and reduce medication errors in Shri Krishna Medical College and Hospital patients. The study assesses healthcare settings and patient characteristics to determine the best strategies. Methods: Over 22 months, 200 patients participated in a prospective observational study. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), prescription refill records, and patient self-reports. Medication errors were assessed by prescription and hospital incident report audits. Drug reconciliation, electronic prescribing, patient education, SMS alerts, pill organizers, and chemist-led counselling were tested. We used logistic regression, chi-square tests, and paired t-tests to compare outcomes before and after the intervention. Results: Pharmacist-led interventions and electronic prescription systems were the most effective strategies, improving adherence rates by 55% and 50%, respectively, and reducing medication errors by 60% and 55%, respectively. Patient education and medication reconciliation also showed significant benefits, while reminder systems had a moderate impact. Older adults and patients with chronic diseases exhibited the most improvement with structured interventions. Conclusion: Chemist participation, electronic prescribing, and instructional frameworks are needed to improve medication adherence and reduce errors. These interventions should be prioritized by healthcare systems to improve treatment outcomes and patient safety. The strategies’ long-term viability and cost-effectiveness need more study.

Background: Adverse Drug Reactions (ADRs) are a significant concern in hospitalized patients, contributing to increased morbidity, prolonged hospital stays, and healthcare costs. Identifying the incidence, risk factors, and severity of ADRs can help improve patient safety and pharmacovigilance. Objective: This study aimed to determine the incidence of ADRs among hospitalized patients, analyze demographic and drug-related risk factors, and assess the severity and outcomes of ADRs. Methods: A retrospective observational study was conducted on 100 hospitalized patients at Shri Krishna Medical College and Hospital. Data were collected from hospital records and Electronic Medical Records (EMRs) on patient demographics, comorbidities, drug exposure, and ADR characteristics. Statistical analysis was performed using SPSS/Stata software. Logistic regression identified risk factors, and ADR severity was classified using the WHO-UMC and Naranjo probability scales. Results: 24% of adverse drug reactions (ADRs) were gastrointestinal (33.3%), skin (25%), and neurological (20.8%). Older patients (35% of total) and those 41–60 had the highest incidence rates. Men had a slightly higher ADR rate (55% vs. 45%). In 45% of cases, polypharmacy (five or more drugs) occurred. Antibiotics (37.5%) and nonsteroidal anti-inflammatory drugs (20.8%) were most often implicated. Age over 60 (50%), female (58.3%), comorbidities (75%), and drug interactions (45.8%) were risk factors. ADR severity was 41.7% mild, 37.5% moderate, and 20.8% severe. In 41.7% of cases, drug discontinuation required treatment changes, and 29.2% required long hospital stays. 4.2% of cases died from ADRs. Conclusion: ADRs remain a major challenge in hospitalized patients, with polypharmacy and comorbidities being significant risk factors. Enhanced pharmacovigilance, individualized drug therapy, and close monitoring of high-risk patients are essential to reduce ADR incidence. Further research is needed to develop predictive models for ADR prevention.

Background: Uterine fibroids (leiomyomas) are the most common benign tumors of the uterus, affecting up to 30% of women of reproductive age. While many pregnancies in women with fibroids progress without complications, studies suggest an increased risk of adverse outcomes, including miscarriage, preterm labor, fetal malpresentation, and cesarean delivery. However, data on these associations remain inconsistent. This study aims to retrospectively assess the impact of uterine fibroids on pregnancy outcomes among women treated at Nalanda Medical College & Hospital, Patna, Bihar, over a one-year period (March 2022 – March 2023). Methods: A retrospective observational study was conducted on 100 pregnant women diagnosed with uterine fibroids via ultrasound. Patient records were reviewed for demographic characteristics, fibroid features (size, number, and location), pregnancy complications, mode of delivery, and neonatal outcomes. Statistical analysis was performed using SPSS software, with categorical variables analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant. Results: The mean age of participants was 29.8 ± 4.2 years. Among them, 60% were multiparous, and 40% were primigravida. The distribution of fibroid sizes was as follows: 55% had small fibroids (<5 cm), 30% had medium-sized fibroids (5–10 cm), and 15% had large fibroids (>10 cm). Pregnancy complications included miscarriage (12%), preterm labor (18%), antepartum hemorrhage (10%), and fetal malpresentation (20%). The cesarean section rate was high (65%), while 35% had vaginal deliveries. Neonatal complications included low birth weight (22%), NICU admissions (15%), and an Apgar score <7 at 5 minutes in 8% of cases. Conclusion: Uterine fibroids are associated with increased risks of adverse pregnancy outcomes, including higher rates of cesarean delivery and neonatal complications. Early diagnosis, careful antenatal monitoring, and individualized management plans are crucial for optimizing maternal and fetal health. Future research with larger prospective cohorts is necessary to refine clinical guidelines for managing fibroid-affected pregnancies.

Background: Maternal Near Miss (MNM) and Maternal Mortality (MM) are key indicators of the quality of maternal healthcare. MNM refers to cases where a woman survives a life-threatening obstetric complication, while MM represents fatal outcomes. Assessing MNM and MM provides valuable insights into the strengths and weaknesses of the healthcare system. This study aims to determine the prevalence, causes, and healthcare response to MNM and MM at Patna Medical College and Hospital (PMCH), Bihar, from January 2022 to December 2023. Methods: A retrospective observational study was conducted using hospital records of 100 cases of MNM and MM. Data on patient demographics, obstetric history, causes of MNM/MM, and interventions received were collected. Descriptive statistics were used to analyze the frequency and distribution of cases, and chi-square tests were applied to assess associations between risk factors and outcomes. Results: The study found a high prevalence of MNM cases compared to MM, indicating the effectiveness of emergency obstetric interventions. The leading causes of MNM included postpartum hemorrhage, hypertensive disorders, and sepsis, while MM was primarily associated with delayed medical attention and inadequate emergency response. A significant proportion of MNM cases required ICU admission, blood transfusion, and surgical interventions. The study also identified gaps in emergency obstetric care, such as referral delays, lack of critical care infrastructure, and insufficient healthcare personnel. Conclusion: The findings emphasize the need for enhanced maternal healthcare strategies, including improving referral systems, timely interventions, and strengthening emergency obstetric care. Addressing these gaps through policy reforms, better resource allocation, and healthcare training programs can help reduce maternal mortality and improve maternal health outcomes in Bihar.

Background: One to two percent of pregnant women experience recurrent miscarriage, which is defined as the sequence of two or more spontaneous abortion as documented by either sonography or histopathology, before 20th week of gestation. Research on the possible involvement of progesterone in avoiding miscarriage has been conducted. This hormone is important for maintaining a pregnancy. Nevertheless, there is contradictory information about its effectiveness. This study looks back at how well progesterone treatment worked to lower miscarriage rates for women who had miscarriages before. Methods: Two hundred women who had experienced several miscarriages between Sept 22 to Sept 2024 were part of a retrospective cohort research that took place at Nalanda Medical College & Hospital in Patna, Bihar. The study included two groups of participants: one group that got progesterone medication (oral, vaginal, or intramuscular) and another group that did not. Details about progesterone medication, demographic information, obstetric history, and pregnancy outcomes were collected from medical records. Miscarriage rates, live birth rates, and neonatal outcomes were compared between the groups using chi-square testing and logistic regression analysis. Results: The rate of miscarriage was noticeably lower in the group that received progesterone treatment (28% vs. 46% in the control group) (p < 0.05). The progesterone group had a greater live birth rate (72% vs. 54%) than the control group. There were no notable variations in terms of maternal problems, neonatal birth weights, or rates of preterm birth. Conclusion: This study suggests that progesterone therapy is effective in reducing miscarriage rates among women with recurrent pregnancy loss. Given its low cost and favorable safety profile, progesterone may be a beneficial treatment. However, further prospective randomized controlled trials are needed to establish definitive guidelines for its routine use in clinical practice.

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treating symptomatic gallstones. While titanium clips (MC) are conventionally used for ligating the cystic duct and artery, suture ligation (SL) with silk offers a potentially secure and cost-effective alternative. This prospective study aimed to evaluate and compare the safety, efficacy, and cost-effectiveness of suture ligation versus metal clip ligation in LC. Aim: To compare intraoperative and postoperative outcomes of suture ligation versus metal clip application of the cystic duct and artery in laparoscopic cholecystectomy. Methods: This hospital-based prospective study was conducted in the Department of Surgery, Pacific Institute of Medical Science, Udaipur, Rajasthan, from January to March 2024. A total of 200 patients undergoing LC were randomized into two equal groups: Group A (clip ligation) and Group B (suture ligation using silk 2-0). Key outcomes measured included duration of duct ligation, intraoperative complications, drain output, postoperative recovery, and cost analysis. Results: No significant differences were observed in age or sex distribution between the two groups. The mean ligation time was significantly shorter in the clip group (1.63 min) compared to the suture group (2.5 min). Bile spillage was slightly higher in the clip group, but without statistical significance. All patients were discharged on the first postoperative day. No bile leak, clip migration, or CBD injury was reported. Suture ligation proved to be significantly more cost-effective than clip application. Conclusion: Suture ligation is a safe, practical, and economical alternative to clip ligation in LC, especially suitable for low-resource settings. Proper technique and training can mitigate complications.

Introduction: Speech and language development during early childhood is crucial for cognitive and social growth. Delays or disorders during this period can stem from nutritional, developmental, auditory, or socioeconomic factors and require early identification for effective intervention. Material and Methods: This was a cross-sectional observational study conducted at the pediatric OPD of a tertiary care center, involving 90 children aged 6 months to 5 years with speech-related concerns. Detailed demographic, nutritional, and developmental data were collected. Hearing was assessed using OAE, and developmental status was screened using the DDST tool. Data were analyzed using descriptive statistics. Results: In our study of 90 children, most were aged 1–3 years (58.9%), and 55.6% were male. The majority of mothers had primary (23.3%) or middle school (41.1%) education, and 82.2% of children were from lower socioeconomic classes. Nutritional assessment showed 23.3% with MAM and 15.6% with SAM. Speech delay was the most common issue (81.1%), followed by stuttering, misarticulation, and tongue tie (4.4% each). OAE testing revealed 75.6% passed, 10% were referred, and 13.3% were not assessed. DDST results showed developmental delay in 61.1% of children. Final outcomes included developmental delay (50%), speech language disorder (21.1%), and speech sound disorder (8.9%). Conclusion: Speech delay was the most common disorder, often coexisting with developmental delay and nutritional deficits. Early screening and multidisciplinary intervention are essential.

Introduction: Adverse drug reactions (ADRs) are a significant concern in the elderly due to age-related physiological changes and the high prevalence of polypharmacy. Early detection and evaluation of ADRs are essential for improving drug safety in this vulnerable group. Material and Methods: A hospital-based, cross-sectional study was conducted over six months among patients aged 60 years and above who experienced ADRs. Data were collected using a structured form and analyzed for drug class, severity, causality, and preventability. Causality was evaluated using the WHO-UMC scale, severity by the Modified Hartwig and Siegel scale, and preventability using the Schumock and Thornton criteria. Drug classification followed the ATC system. All ADRs were reviewed for type (A or B), affected organ systems, and management. Statistical analysis was performed using SPSS version 25.0, with significance set at p < 0.05. Results:  In this study involving 56 elderly patients over six months, adverse drug reactions (ADRs) were slightly more prevalent in males (57.1%) than females (42.9%), with the 60–69 years age group accounting for the majority of cases (64.3%). Oral medications were the most common route associated with ADRs (55.4%), followed by parenteral (32.1%) and topical agents (12.5%). The most frequently implicated drug classes were antimicrobials (25%), cardiovascular agents (21.4%), and NSAIDs (17.9%), with ciprofloxacin (8.9%), enalapril (14.3%), and diclofenac (12.5%) being the leading individual drugs. Organ systems most affected included the skin and mucosa (32.1%), gastrointestinal tract (26.8%), and central nervous system (14.3%). Regarding severity, 35.7% of ADRs were mild, 50.0% moderate, and 14.3% severe; the majority (89.3%) were classified as Type A (predictable). Causality assessment revealed 75.0% of ADRs as probable and 25.0% as possible, with none categorized as certain. Most ADRs (85.7%) were deemed preventable, and 26.8% were linked to potentially inappropriate medications per Beers criteria, predominantly involving NSAIDs and sedatives. Conclusion: The study highlights the need for vigilant prescribing and active pharmacovigilance to reduce preventable ADRs in the elderly. Rational drug use and routine screening can significantly improve patient safety in geriatric care.

Background: The multiplicity of CT scans required for management of COVID-19 pandemic patients necessitates to review our standard CT protocols and reduce the radiation dose exposure. Therefore, we aimed to investigate the diagnostic accuracy of low dose CT with Model Based Iterative reconstruction (LD-MBIR) in comparison with standard dose CT protocol. Methods: In our study, total 100 patients aged 18years or older referred for chest CT scans indicated for COVID-19 pneumonia by Medicine Department were enrolled and scheduled for CT scan. Out of 100 patients, 50 cases and 50 controls were scanned using low dose CT with MBIR reconstruction and standard dose CT with HIR reconstruction respectively and diagnostic accuracy was compared. Results: The quality of images as per 3 point Likert scale seen in standard dose CT with HIR, iDose 4 (84%; 42 out of 50 patients) was good as compared to patients in low dose MBIR CT images (68%; 34 out of 50). There was excellent intra-reader agreement in detecting typical findings of COVID-19 pneumonia. The CTDI_vol and DLP were significantly lower in low dose MBIR CT than standard dose CT with HIR (mean CTDI_vol : 1.6mGy vs 18.56 ± 2.75 mGy respectively. P value <0.001 ; mean DLP was 46.87 ± 3.2 mGycmvs 720.1 ± 129.6 mGycm, p value < 0.001), corresponds to 93.6% reduction in mean effective dose. Mean effective dose in MBIR CT was 0.64mSv and in HIR CT was 10mSv. Conclusion: The results of our study indicated that low dose MBIR CT chest protocol can be reliably used in routine patients for detecting COVID-19 pneumonia with significant reduction in radiation dose, without sacrificing the distribution, appearance and severity of disease.

Introduction: Histopathological examination of autopsy specimens is an indispensable tool for determining and correlating the cause and manner of death, and allows detailed study of a wide range of conditions, including infections, inflammations, tumors, and infrequent or unnoticed lesions. Recent advances in diagnostic medical technology have increased the use of non-invasive modalities, histopathological examination of autopsies remains the gold standard for obtaining direct morphological and histological diagnoses, and this study was therefore undertaken to investigate the gamut of histopathological findings in autopsy specimens at our institution. Objectives: The primary objective was to determine the range of histopathological lesions and identify any incidental findings. Materials and Methods: This retrospective study included 1146 autopsy organs of which 760 organs showed significant changes archived over six years, from 2016 to 2021.Following ethical clearance, autopsy specimens sent for histopathological examination and diagnosis, irrespective of cause of death, were retrieved from the records. Hematoxylin and eosin-stained slides were retrieved and studied for histopathological details; inclusion criteria were all archived histopathological examination slides and records of autopsy specimens, and exclusion criteria were any records or slides that were not archived due to unavailability or loss; all data collected were analyzed using descriptive statistics. Results: The study reveals that the heart was the most frequently examined organ (42.14%), with atherosclerosis being the most common pathology (25.98%). Incidental findings such as myxoma of the heart, fungal abscess and SCC metastatic deposits of the lung were also noted. Conclusion: The findings underscore the continued importance of autopsy histopathology in elucidating disease processes and identifying unexpected pathologies, which have significant implications for understanding disease mechanisms and improving clinical practice.

Introduction: Transient tachypnea of newborn is the most common etiology for respiratory distress in a newborn. It occurs due to delayed clearance of foetal lung fluid. It is characterised by early onset tachypnea(>60 breaths/min), sometimes with retractions, grunting, minimal cyanosis that is usually relieved by oxygen supplementation within 48-72 hrs. It occurs in preterm and term infants(between 34 to 42 weeks of gestation). Aim: To study the incidence, risk factors and outcome of transient tachypnea of newborn (TTN). Objectives: To study and analyse the incidence and risk factors associated with TTN and analyse the outcomes of babies suffering from TTN. Materials and Methods: A prospective observational study to assess incidence, risk factors and outcome of neonates diagnosed with TTN(born between 34 to 42 weeks of gestation) admitted in department of Pediatrics over a period of 18 months(01 November 2022-31 April 2023). Results: In this study 102 neonates diagnosed with TTN were admitted in NICU. Common risk factors were studied.TTN was present in 79 neonates (77.5%) delivered via cesarean section, 53 neonates (52%) were late preterm, 66 neonates (64.7%) were male. Maternal diseases like diabetes was present in mothers of 11 neonates (10.8%), maternal PIH in 17 neonates (16.7%) and maternal asthma in 15 neonates (14.7%). Multiple gestation was seen in 55 (53.9%).  Most of the neonates were discharged in clinically stable condition, 96 neonates (94.1%) were discharged and no mortality was observed. Conclusion: From this study it can be inferred that TTN is a common respiratory disorder and  risk factors like cesarean section, preterm delivery, male gender and maternal comorbidities have its role. TTN  has an excellent prognosis.

Background: Chronic diarrhoea in children aged 1 to 10 years is a common clinical concern, particularly in developing regions where it contributes significantly to morbidity and nutritional deficiencies. The causes are multifactorial and age-specific, including infectious, allergic, malabsorptive, and inflammatory conditions. Early identification of the underlying etiology is essential for prompt and effective treatment. This study aimed to assess the spectrum and frequency of chronic diarrhoeal diseases in children aged 1 to 10 years. Materials and Methods: This cross-sectional study was conducted over one year in the pediatric department of a tertiary care hospital. Children aged 1 to 10 years presenting with chronic diarrhoea (defined as diarrhoea lasting four weeks or more) were enrolled. Detailed clinical history, nutritional status, physical examination findings, and investigations such as stool microscopy, culture, ova and parasite screening, and endoscopic evaluation with biopsies (where indicated) were recorded. Data analysis was performed using SPSS version 25, and descriptive statistics were used to present the results. Results: A total of 150 children were included, with 86 males (57.3%) and 64 females (42.7%), and a mean age of 5.2 ± 2.6 years. The leading causes identified were infectious diarrhoea (30.7%), cow’s milk protein allergy and food intolerances (21.3%), celiac disease (16.0%), inflammatory bowel disease (10.7%), and immunodeficiency-related diarrhoea (6.7%). In 14.6% of the cases, the cause remained undiagnosed despite comprehensive evaluation. Conclusion: In children aged 1 to 10 years, chronic diarrhoea is most frequently due to infectious and allergic causes, followed by celiac disease and inflammatory conditions. A thorough and age-specific diagnostic workup is vital for accurate diagnosis and effective management to reduce the burden of chronic gastrointestinal morbidity in the pediatric population.

Aim: This study aimed to analyze the penetrability and adaptability of three different fluoride-releasing sealants in different fissure types. Materials and Methods: Extracted human premolars (n = 45) were randomly divided into three groups of 15 each and randomly allotted to receive the sealants Fisseal (FS), Helioseal F Plus (HS), and Beautisealant (BS). The sealed samples were sectioned in the buccolingual plane, and the deepest fissures were examined under a scanning electron microscope (SEM). The samples were also observed for the fissure types (I, IK, U, V, and inverted Y). The percentage of penetration (POP) and overall gap (OG) between the sealant and fissure wall were measured from the SEM images using ImageJ software. Results: Group FS exhibited the highest POP (68 ± 29.3%) and the smallest OG (1.0 ± 0.9 μm). The least POP was observed for group BS (52.3 ± 20.3%). The I-type fissure was seen in most of the teeth (33%), and the V-type fissure was the least (18%). The mean OG was significantly less in group FS (one-way analysis of variance; p = 0.046). The mean POP was the highest in group FS, followed by groups HS and BS. Conclusion: This SEM study revealed that FS had relatively superior penetrability and adaptability into the fissures, whereas BS was the least-performing material.

Aim: The purpose of this study was to evaluate and compare the efficiency of two obturation techniques in filling artificially designed lateral canals using three different endodontic sealers. Materials and Methods: Twenty-four resin blocks were used, each containing four main canals and eight lateral canals, with four located in the apical region and four in the coronal region. The primary canals were instrumented, and the blocks were divided into two groups (n = 12 per group) based on the obturation technique: Group I utilized the single-cone technique, while group II used the lateral condensation technique. Each group was further divided into three subgroups (n = 4 per subgroup) according to the type of sealer: subgroup A used AH Plus, subgroup B used BioRoot RCS, and subgroup C used GuttaFlow 2. After canals obturation, the lateral canals were examined under a stereomicroscope to measure penetration depths of sealers and fill percentages, with data subjected to statistical analysis. Results: The lateral condensation technique achieved significantly better lateral canal filling compared with the single-cone technique (p < 0.05). The lateral canals in the apical region showed better filling compared with the coronal lateral canals in both obturation methods. For the lateral condensation technique, AH Plus (99.51%) and GuttaFlow 2 (99.26%) provided the highest filling performance of apical lateral canals, while BioRoot RCS (83.05%) outperformed others in filling coronal lateral canals. In the single-cone technique, BioRoot RCS (80.13%) was the most effective in the filling of the apical lateral canals, while all sealers exhibited similar performance in the filling of the coronal lateral canals. Conclusion: The efficiency of filling the lateral canals was influenced by the obturation technique, the location of lateral canals, and the type of sealer. BioRoot RCS demonstrated versatility in filling apical and coronal lateral canals, while AH Plus and GuttaFlow 2 excelled primarily in filling the apical lateral canals.

Aim: To compare the removal torque loss (RTL) percentage of screw-retained, cement-retained, and combined screw- and cement-retained implant-supported crowns after cyclic loading and measure the impact of cyclic loading on removal torque. Materials and Methods: Thirty-two dental implants (4.0 × 10 mm) in resin blocks and abutments were divided into four groups (n = 8) based on restoration design: combined screw- and cement-retained group (SC), two cement-retained groups: cemented with adhesive resin cement (AR) (Panavia V5) or provisional cement (PR) (RelyX Temp NE), and screw-retained one-piece titanium group (TI). Removal torques were measured in Newton-centimeter (Ncm) before and after 500,000-cycle cyclic loading with forces ranging from 20 to 200 N at 15 Hz. The RTL percentage in each group was calculated. The paired t-test was used to detect the difference between pre-loading (RT1) and post-loading removal torque (RT2) in each group and 1-way ANOVA was used to detect the difference of RTL percentage between groups. Results: The post-loading removal torques in all groups were significantly lower than their pre-loading removal torques (p < 0.001). The 1-way ANOVA test found no significant difference in the RTL% between the study groups. The PR group exhibited the lower RTL% (30.74 ± 7.3%), followed by the TI (30.78 ± 5.6%), AR (32.12 ± 2.5%), and SC (35.71 ± 5.1%) groups. Conclusion: Combined screw- and cement-retained restorations exhibited similar RTL compared with other restoration designs, and cyclic loading significantly affected the removal torque. Clinical Significance: Combined screw- and cement-retained restorations can be utilized in single-tooth situations, offering a comparable impact on screw joint stability while providing benefit of retrievability. Cyclic loading significantly influences joint stability, periodic checkup for screw loosening is recommended.

Background: Mean Platelet Volume (MPV) is an easily accessible hematological parameter that reflects platelet size and activity. Elevated MPV has been associated with increased platelet reactivity and thrombogenesis, suggesting its potential role in predicting cardiovascular events. This study aimed to assess the relationship between MPV and cardiovascular risk factors, and to evaluate its predictive value in patients with Acute Coronary Syndrome (ACS). Methods: A cross-sectional observational study was conducted at the Department of Medicine in a tertiary care hospital over a period of six months (January to June 2023). A total of 86 patients diagnosed with ACS—including STEMI, NSTEMI, and unstable angina—were enrolled. MPV was measured at admission before initiation of antiplatelet therapy. Patients were evaluated for the presence of major cardiovascular risk factors such as hypertension, diabetes, smoking, dyslipidemia, and family history of coronary artery disease. MPV values were analyzed across different ACS subtypes and compared based on risk factor profiles using appropriate statistical tests. Results: The mean age of the study population was 58.4 ± 10.3 years, with 65.1% males. MPV was significantly higher in patients with STEMI (10.45 ± 0.89 fL) compared to those with NSTEMI (9.92 ± 0.76 fL) and unstable angina (9.34 ± 0.68 fL; p = 0.003). Patients with hypertension, diabetes, smoking history, dyslipidemia, and positive family history of CAD also exhibited significantly elevated MPV values (all p < 0.05). A positive correlation was observed between the number of risk factors and MPV levels. Conclusion: MPV is significantly elevated in patients with more severe forms of ACS and in those with a greater burden of cardiovascular risk factors. It may serve as a simple, cost-effective, and adjunctive tool for early risk stratification in ACS, particularly in resource-limited settings.

Background: Oxidative stress is a major contributor to the development and progression of Type 2 Diabetes Mellitus (T2DM) and its vascular complications. Biomarkers such as Ischemia-Modified Albumin (IMA) and Protein Carbonyl content have emerged as potential indicators of oxidative damage. This study aims to evaluate the association between these oxidative stress markers and glycemic control, as measured by glycated hemoglobin (HbA1c), in T2DM patients. Methods: A cross-sectional analytical study was conducted on 146 patients with confirmed T2DM at a tertiary care hospital. Participants were divided into two groups based on HbA1c levels: good control (<7%) and poor control (≥7%). Fasting venous blood samples were collected to estimate HbA1c, IMA (via cobalt-albumin binding assay), and Protein Carbonyl content (via DNPH spectrophotometric method). Comparative and correlation analyses were performed to evaluate the relationships between oxidative stress markers, glycemic status, BMI, and diabetes duration. Multivariate regression and ROC curve analyses were conducted to identify predictors and diagnostic performance. Results: IMA and Protein Carbonyl levels were higher in patients with poor glycemic control (IMA: 0.83 ABSU, Carbonyl: 3.56 nmol/mg) compared to those with good control (IMA: 0.81 ABSU, Carbonyl: 3.44 nmol/mg). Duration of diabetes and BMI were also associated with elevated oxidative stress markers. HbA1c showed a weak, non-significant correlation with IMA (r = 0.042) and Protein Carbonyl (r = 0.075). However, multivariate analysis identified HbA1c, BMI, and disease duration as significant predictors of protein carbonyl levels (p < 0.05). ROC analysis revealed moderate diagnostic performance of Protein Carbonyl (AUC = 0.67) in identifying poor glycemic control, compared to IMA (AUC = 0.61). Conclusion: Protein Carbonyl content is a more reliable indicator of chronic oxidative stress and glycemic dysregulation in T2DM than IMA. Its association with HbA1c, BMI, and disease duration supports its use as an adjunct biomarker in diabetic risk profiling. IMA, while relevant, may be more reflective of acute ischemic episodes and less sensitive to long-term glycemic status.

Background: Proximal fractures of the humerus are common fractures. Females are more prone to such fractures, and treatment of this type of fracture still remains controversial. Method: Out of 50 adult patients, 25 were treated conservatively and 25 with surgical treatment. Apart from routine blood examination and RBS, serum calcium was also studied. X-rays were taken before and soon after treatment and at the 4th week after treatment, and results were noted. Results: Abduction (114^O), adduction (32^O), and flexion (128^O) were significantly more in conservative method after 4 weeks of treatment, but patients surgical treatment had higher excellent (24%) and satisfactory (32%) rates, but unsatisfactory and failure rates were in patients treated with conservative methods. Conclusion: It is confirmed that surgical Neer type-3 and type-4 had better results than conservative treatment.

Introduction: Corticosteroids are widely used in dermatology for their anti-inflammatory and immunosuppressive effects, especially in chronic conditions like psoriasis and eczema. Despite their therapeutic benefits, inappropriate or prolonged use can lead to significant cutaneous and systemic adverse effects. Over-the-counter misuse is a growing concern, especially in dermatology OPDs, highlighting the need for awareness and monitoring. Material and Methods: This prospective observational study was conducted over six months in the dermatology OPD of a tertiary care hospital. Patients using corticosteroids (topical, oral, or injectable) for dermatological conditions were included. Data were collected on demographics, corticosteroid use patterns, adverse effects, and laboratory parameters. ADRs were clinically assessed and categorized; statistical analysis was done using SPSS v25.0 with significance set at p<0.05. Results: Out of 375 patients, most were above 60 years (28.5%) and female (51.5%). Workers (26.9%) and students (18.4%) were commonly affected. Psoriasis and scabies were the top indications (14.7% each), with topical creams (41.9%) being the most used form. Alarmingly, 92% of corticosteroids were used over-the-counter, often on non-medical advice. ADRs were reported in 70.1% of patients, predominantly cutaneous (62.9%), with late-onset reactions (63.2%) being more frequent. Clobetasol 0.05% and betamethasone 0.1% were commonly used strengths. Lab findings showed raised WBCs, RBS, and mild liver enzyme elevations, indicating systemic involvement in some cases. Conclusion: Our study highlights widespread misuse of corticosteroids and a high burden of adverse effects, particularly cutaneous and late-onset reactions. There is an urgent need for improved regulation, documentation, and public education.

Background: Diseases of the female genital tract are extremely common in clinical and pathology practice, encompassing complications of pregnancy, inflammations, tumors, and hormonally induced effects. Female genital tract lesions rank among the most frequent conditions prompting females to seek medical care, and they are associated with significant gynecological and reproductive morbidity. Materials and Methods: The prospective studies of 1014 patients having female genital tract lesions were included in this study over a period of one year from October 2019 to September 2021. Specimens were formalin fixed and tissue was adequately processed. The sections were stained routinely with hematoxylin and eosin stain. Results: Majority of specimens were from age-group 40-49 years i.e. 34.61%. The Endometrial bits (Dilatation and curettage) constituted 267(26.33%) of all specimens followed by simple hysterectomy 236(23.27%), Hysterectomy with bilateral salpingo-oophorectomy 210(20.71%). most common symptom was abnormal uterine bleeding 436(44.85%) followed by abdominal pain 231(23.17%), Dysmenorrhoea 150(14.79%), Retention of urine 78(7.69%). Leiomyoma was diagnosed in 212 (77.94%) cases and adenomyosis in 60(22.05%) cases. Conclusion: Histopathological examination of lesions of female genital tract is important in evaluation of endometrial, uterine, cervical, tubal and ovarian lesions for further management regarding risk factors and screening programmes in order to decrease morbidity and mortality.

Introduction: The postpartum period is marked by significant physiological and psychological changes, with pelvic girdle pain (PGP) and pelvic floor disorders (PFDs) being prevalent issues that can severely impact a woman’s quality of life. Despite their frequent co-occurrence, the relationship between PGP and PFDs remains underexplored. This study aims to evaluate the impact of PFDs on the incidence, severity, and persistence of PGP in postpartum women, providing a comprehensive understanding of postpartum pelvic health. Methods: This research utilized a one-to-one matched case-control design, pairing each woman with PGP to a control without PGP based on age, postpartum period, delivery type, and parity. Participants included women aged 18-45, 6-24 weeks postpartum. Pelvic floor muscle (PFM) function was assessed using vaginal manometry, and diastasis recti was evaluated through palpation. Statistical analyses included t-tests, Mann-Whitney U tests, chi-square tests, and conditional logistic regression. Results: Sixteen women with clinically confirmed PGP were matched with sixteen controls. Women with PGP exhibited significantly lower vaginal resting pressure, impaired voluntary PFM activation, and increased PFM tenderness compared to controls. They also showed a wider inter-recti distance and more abdominal wall distortion. No significant differences were found in PFM strength, endurance, or urinary incontinence severity between the groups. Conclusion: This study highlights significant differences in PFM function and abdominal muscle integrity between postpartum women with and without PGP. The results suggest that comprehensive postpartum care should include assessments of both pelvic and abdominal muscles to better manage and mitigate the impacts of PGP and PFDs on women’s health.

Background: The postpartum period is a critical phase characterized by significant physiological changes that impact maternal health, particularly bone status. Despite extensive research on bone health in various populations, there is limited data on Indian mothers, who face unique dietary, cultural, and socioeconomic challenges. This study aims to assess postpartum bone health among Indian mothers and identify key determinants influencing bone status. Methods: A cross-sectional study was conducted involving 150 urban postpartum mothers, divided into three groups: Group A (1 week postpartum), Group B (1–2 years postpartum), and Group C (3–4 years postpartum). Bone mineral density (BMD), bone mineral content (BMC), and related parameters were measured using a Lunar DPX-PRO densitometer. Data on weight, dietary intake, physical activity, sunlight exposure, and socio-demographic factors were collected. Statistical analyses were performed to identify variations in bone health and potential predictors. Results: Participants in Group A had the highest postpartum weight and calcium intake, but also exhibited the highest prevalence of vitamin D deficiency. By 3 years postpartum, Group C showed improved lumbar spine BMD compared to Group A. Total body BMD and bone mass showed minimal variation across groups, while Group C demonstrated better bone metrics at lumbar spine sites. Nutrient deficiencies, including calcium, iron, and zinc, were prevalent across all groups. Low physical activity and minimal sunlight exposure were noted, with significant variations in these factors among the groups. Conclusion: Indian postpartum mothers experience significant bone health changes, with improvements in lumbar spine BMD over time. However, deficiencies in essential nutrients and vitamin D deficiency persist.

Background: Chronic diarrhoea in children aged 1 to 10 years is a common clinical concern, particularly in developing regions where it contributes significantly to morbidity and nutritional deficiencies. The causes are multifactorial and age-specific, including infectious, allergic, malabsorptive, and inflammatory conditions. Early identification of the underlying etiology is essential for prompt and effective treatment. This study aimed to assess the spectrum and frequency of chronic diarrhoeal diseases in children aged 1 to 10 years. Materials and Methods: This cross-sectional study was conducted over one year in the pediatric department of a tertiary care hospital. Children aged 1 to 10 years presenting with chronic diarrhoea (defined as diarrhoea lasting four weeks or more) were enrolled. Detailed clinical history, nutritional status, physical examination findings, and investigations such as stool microscopy, culture, ova and parasite screening, and endoscopic evaluation with biopsies (where indicated) were recorded. Data analysis was performed using SPSS version 25, and descriptive statistics were used to present the results. Results: A total of 150 children were included, with 86 males (57.3%) and 64 females (42.7%), and a mean age of 5.2 ± 2.6 years. The leading causes identified were infectious diarrhoea (30.7%), cow’s milk protein allergy and food intolerances (21.3%), celiac disease (16.0%), inflammatory bowel disease (10.7%), and immunodeficiency-related diarrhoea (6.7%). In 14.6% of the cases, the cause remained undiagnosed despite comprehensive evaluation. Conclusion: In children aged 1 to 10 years, chronic diarrhoea is most frequently due to infectious and allergic causes, followed by celiac disease and inflammatory conditions. A thorough and age-specific diagnostic workup is vital for accurate diagnosis and effective management to reduce the burden of chronic gastrointestinal morbidity in the pediatric population.

Introduction: Electrolyte disturbances are frequently associated with severe pneumonia. Therefore, it is crucial for healthcare providers to focus on stabilizing electrolyte levels alongside initial pneumonia management to prevent potential complications. Aims and Objectives: This study aims to examine the relationship between dyselectrolytemia and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) in children aged 2 months to 5 years with radiologically confirmed severe pneumonia. Materials and Methods: cross-sectional, observational study was conducted on 67 children (aged 2 months to 5 years, both genders) diagnosed with severe pneumonia. Comprehensive clinical and radiological evaluations were performed. Laboratory investigations included complete blood count (CBC), serum electrolytes (sodium and potassium), renal function tests (urea and creatinine), urine sodium, serum osmolality, and urine osmolality. These tests were conducted on the day of admission and repeated daily for the next three days. Statistical analysis was performed using Epi Info™ 7.2.2.2. Results: Severe pneumonia was most common among children aged 1 to 5 years (67.2%). Among the 67 participants, 44 (65.67%) had electrolyte imbalances, with 4 (9.09%) exhibiting mixed imbalances. The most prevalent imbalances were hyponatremia (46.2%, n=31), hypokalemia (10.4%, n=7), hypernatremia (5.9%, n=4), and hyperkalemia (2.9%, n=2). Potassium levels were normal in 86.57% (n=58) of children, while 13.43% (n=9) had abnormal levels—7 with hypokalemia (77.78%) and 2 with hyperkalemia (22.22%). Notably, 57% (4 out of 7) of children with hypokalemia also presented with hyponatremia. Among hyponatremia cases, the incidence of SIADH was 64.5%, a statistically significant finding (Z=4.10; p<0.001). SIADH was more frequently observed in children aged 1 to 5 years (28.9%) compared to those aged 2 months to 1 year (31.8%), though this difference was not statistically significant (Z=0.44; p>0.05). Additionally, SIADH was present in 33.3% of male and 26.5% of female children, with no statistically significant difference (Z=1.05; p>0.05).

Conclusions: These findings highlight the importance of routine monitoring of serum electrolyte levels, as well as plasma and urine osmolality, to ensure optimal fluid and electrolyte management in hospitalized children with severe pneumonia.

Background and Objectives: Understanding the clinical anatomy of the elbow joint is essential for diagnosis and treatment of elbow-related injuries and conditions. To assess the relationships between various structures in the elbow joint. To identify potential variations and their clinical implications. The elbow is a complex joint synovial hinge joint comprising of three articulations. humeroulnar, humeroradial and proximal radioulnar during certain activities t can be subjected to significant loads, Satisfactory function and stability are provided by bony and soft tissue stabilising structures. Injuries around the elbow joint are common. Methods: Conduct a detailed morphometric analysis of the elbow joint structures. Cadaveric study design. Results: The article discusses the osseous and ligamentous anatomy around the elbow joint and their relevance when assessing and managing elbow injuries. Conclusion: Knowledge of the intricate anatomy around the elbow joint is essential to successfully assessing and managing elbow injuries and restoring good function.

Background and Objectives: understanding the anatomical relationship between the phrenic nerve and subclavian vein is crucial for various medical procedures, including central venous catheterization and thoracic surgery. Deep knowledge of anatomy is an essential part of surgical practice. Students of medical sciences gain knowledge and theoretical data through actual visualization of anatomic structures of the cadavers also anatomic relations can be studied more efficiently by practicing on cadavers. As phrenic nerve may be damaged during subclavian vein catheterization the relationship between the phrenic nerve and the subclavian vein is of clinical interest. During the subclavian vein catheterization analogous variable relationships are helpful to explain and prevent damage to the phrenic nerve. To investigate the anatomical relationship between the phrenic nerve and subclavian vein. To evaluate the course and proximity of the phrenic nerve to the subclavian vein. Material and Methods: Dissection was started from the root of the neck. No surgical scars, gross anatomical and morphological abnormalities was noted on the cadaver. Measurements were taken during the anatomical dissections. Results: Of the 36 cadavers dissected in 34 (94.44%) cases phrenic nerve was found posterior to the subclavian vein and in 2(5.56%) cases found anterior to the subclavian vein of which one case was male and the other was female. In the male case in which phrenic nerve was passing anterior to the subclavian vein, it was adherent to the anterior wall of the subclavian vein and was nor piercing the vein wall. Conclusion: The cannulating needle may damage the phrenic nerve which is adherent to the subclavian vein. So, the puncture site should be more laterally at the outermost portion of the subclavian vein. Anatomical variants during invasive practical procedures should be always kept in mind.

Background and Objectives: The axillary artery is a vital blood vessel in the upper limb, and understanding its branching pattern is essential for surgical and clinical procedures. Deviations from the normal arterial pattern of the axillary artery is of immense in the medical science. Therefore, study is an attempt to know the normal and abnormal anatomy of the axillary artery. To investigate the branching pattern of the axillary artery. To identify variations in the branching pattern. To evaluate the clinical implications of these variations. Materials and Methods: The present study was conducted in the department of Anatomy, SKMCH, Muzaffarpur. The limbs were dissected retaining continuity with the trunk. Exposure of axillary artery and its branches were achieved as per standard procedures. The axillary artery was identified; the observations such as length of the artery, midpoint of the width of the artery were measured by keeping a thread along whole of its length, marked with India ink. Results: Total 50 cadavers were dissected. The average length of axillary artery was found to be 10.17 cm, range 7 – 11 cm, number of branches ranged 2 – 9. In 38% of dissections, number of branches encountered was 5, followed by 6 branches in 36% and 4 branches in 10%. In 28% of cases (14 out of 50) the 6 name branches were found arising independently from axillary artery. Conclusion: The knowledge of axially artery variations is of anatomical and surgical interest. This information is useful for the surgeons dealing with the axillary region especially in the case of reconstructive surgery.

Background and Objectives: The greater sciatic notch is a reliable feature for sex determination in hip bones. Metric analysis of this feature can provide valuable insights for forensic and anthropological applications. The distinctive morphology of human skeleton and its clear sexual dimorphism make it of interests from anatomical, forensic, obstetrical, radiological and anthropological point of view. The hip bone is considered as an ideal bone for sex determination as it provides the highest accuracy levels. Many workers have studied various metric parameters for sexing of hip bone. To evaluate the efficacy of metric analysis of the greater sciatic notch for sex determination. To identify the most reliable measurements for sex determination. Methods: The present study was done with an aim to find out the sex of hip bone using various parameters of greater sciatic notch. For this purpose, 100 dry hip bones were collected from the Department of Anatomy. Seven different parameters of the greater sciatic notch were used for the study: Maximum width, Maximum depth, Posterior segment, Index I, Index II, Total angle and Posterior angle. Results: All the parameters (especially posterior segment, posterior angle and index II) were found to be highly indicative of sex hip bone by t- test (p<0.005) except the depth. Conclusion: By the present study it was concluded that the width and depth of the greater sciatic notch were a less useful criteria for sexing purposes while the posterior angle was found to be the best parameter, which identified 75 % of left and 88 % of right male hip bones and 92 % of left and 100 % of right female bones. Length of the posterior segment and Index II also assigned sex to a high percentage of hip bones, specially to the female ones (95-97 %), these results suggests that the widening of the greater sciatic notch found in females has occurred mainly in its posterior part.

Background: Effective postoperative pain management is crucial for enhanced recovery following major abdominal surgeries like laparotomy. Epidural analgesia with adjuvants has gained popularity to improve analgesic efficacy and minimize opioid-related side effects. Aim and Objective: To compare the effectiveness and safety of epidural bupivacaine with butorphanol versus bupivacaine with neostigmine for postoperative pain relief in patients undergoing laparotomy. Materials and Methods: A prospective, randomized, double-blinded study was conducted on 60 ASA grade I and II patients aged 18–60 years undergoing elective laparotomy at the Department of Anaesthesiology, Gandhi Medical College, Bhopal. Patients were randomly assigned to two groups: Group A received epidural 0.125% bupivacaine with 1 mg butorphanol, and Group B received 0.125% bupivacaine with 150 µg neostigmine. The primary outcomes measured were onset and duration of analgesia. Secondary outcomes included pain scores using the Visual Analogue Scale (VAS) and incidence of adverse effects. Data were analyzed using appropriate statistical methods, with p < 0.05 considered significant. Results: Group A (bupivacaine + butorphanol) showed a significantly faster onset of analgesia (mean 8.4 ± 1.2 minutes) compared to Group B (bupivacaine + neostigmine) (mean 12.3 ± 1.5 minutes, p < 0.001). However, the duration of analgesia was significantly longer in Group B (mean 381.4 ± 25.8 minutes) versus Group A (mean 308.6 ± 21.3 minutes, p < 0.001). VAS scores were comparable between groups at most time points. Mild sedation and nausea were more common in Group A, while hypotension and bradycardia were more frequent in Group B. Conclusion: Both drug combinations provided effective postoperative analgesia with acceptable safety profiles. Bupivacaine with butorphanol is preferable for faster pain relief, while bupivacaine with neostigmine offers a longer duration of analgesia. Selection should be individualized based on clinical needs.

Background and Aim: Neonatal respiratory distress (RD) is a common and significant cause of morbidity and mortality in neonates. Identifying the factors that predict poor outcomes in neonates with RD is crucial for improving management strategies.  This study aimed to assess the prognostic factors associated with poor outcomes in neonates with RD. Material and Methods: A cohort of neonates diagnosed with RD was analyzed for risk factors, including antenatal visits, gestational age, need for resuscitation, and the onset of RD. Multivariate logistic regression was used to assess the association of these factors with poor outcomes. Results: Severe RD was identified as a significant predictor of poor outcomes. Irregular antenatal visits, delayed crying, and need for resuscitation were not significantly associated with poor outcomes. Early intervention and management of severe RD were crucial for improving survival and long-term health. Conclusion: Severe RD remains the most significant factor in predicting poor neonatal outcomes. Early detection and appropriate management of severe RD are essential for improving neonatal survival.

Background: With the rapid global rise in mobile phone usage, concerns have emerged regarding potential health impacts, particularly on auditory function. Mobile phones emit electromagnetic radiation, which may affect the cochlea, especially the outer hair cells, leading to sensorineural hearing loss. Methods: This cross-sectional analytical study was conducted over 12 months at a tertiary healthcare center. A total of 100 participants aged 20–40 years with over 4 years of mobile phone use were enrolled and divided into two groups: Group A (cases, >60 min/day phone use) and Group B (controls, <60 min/day use). Air and bone conduction thresholds were measured for both ears across 250–8000 Hz frequencies using calibrated pure tone audiometer. Data were analyzed using SPSS v22. Results: Group A exhibited significantly elevated hearing thresholds, particularly at higher frequencies (4,000–8,000 Hz), in both air and bone conduction tests. Hearing loss prevalence was 22% in Group A versus 9% in Group B, with a statistically significant difference (p = 0.019). Conclusion: Prolonged daily mobile phone use is associated with increased hearing thresholds, especially at higher frequencies and in the dominant ear. These findings suggest early cochlear changes linked to long-term electromagnetic radiation exposure. Public health education on safe phone use habits, including limiting call duration and alternating ears, is recommended.

Introduction: Obesity is a major risk factor for most of cardiovascular diseases. There are various methods of screening overweight – obesity like body mass index (BMI), waist circumference (WC), waist hip ratio (WHR). These may be difficult or less acceptable in community and outpatient settings. Neck circumference measurement appears to offer a more consistent alternative for assessing overweight and obesity. Objectives: To demonstrate neck circumference’s reliability as an indicator for measuring obesity compared to BMI and to determine the optimal cut-off values for overweight and obesity in young adults using neck circumference. Methodology: This is a cross-sectional study conducted from Feb to Aug 2024 among medical students aged over 18 years from all batches (1^st, 2^nd, 3^rd, and final MBBS) at a tertiary care teaching hospital in Central Karnataka, South India. Anthropometric measurements like height, weight and neck circumference (NC) were done following standard guidelines. Data was analysed using Statistical Package for the Social Sciences (SPSS) Version 10.0. Sex stratified receiver operating curves (ROC) were plotted for NC to identify the best cut-offs for overweight-obesity with respect to the Asian Pacific WHO classification for BMI. The area under the curves (AUC) with 95% confidence intervals along with cut-offs points with sensitivity and specificity were determined. Results: The mean BMI for males and females was 22.334 ± 4.59 and 24.24 ± 4.12 kg/ m2. The mean neck circumference was 31.85 ± 4.7 and 36.17 ± 2.34 cm for males and females respectively. The Area under the Curve for males and females was 0.775 and 0.848 indicating a high predictive value of neck circumference for identifying overweight/obesity. The NC cut-off was 36.25 cm (sensitivity: 85%; specificity: 73%) and 31.55 cm for females (sensitivity: 82.7%; specificity: 70.1%) to detect overweight/obesity. Conclusion: Neck circumference can be considered as the most preferred anthropometric measurement for screening overweight – obesity with good sensitivity and specificity.

Objective: The primary objective of the study was to evaluate the clinical effectiveness and safety profile of cefotaxime in the treatment of respiratory tract infections (RTIs) and urinary tract infections (UTIs). Methods: The study was a single-arm, multicentre retrospective study that analysed the data of 5264 patients. The study included all patients diagnosed with RTIs and UTIs, who have been treated with cefotaxime therapy. Existing medical records were used to collect data on efficacy endpoints (clinical cure rate, duration of treatment and hospitalisation, isolation of bacterial isolates) and safety endpoints (adverse events reported). Descriptive statistics were used for continuous and categorical variables. Results: A total of 5,264 patients were included for analysis. Out of which 1580 patients were of UTI and 3684 patients were of RTI. Majority of the patients of RTI and UTI had received 1000 mg twice daily (78.26% and 66.30%, respectively). The mean duration of cefotaxime prescription was 5.43 ± 1.72 days. E. coli was the most prevalent pathogen among the 464 samples assessed, initially detected in 170 (36.64%). Its prevalence significantly declined to 68 during treatment and further to 3 (5.17%) in the post-therapy follow-up. Symptoms were cured for 84% and 97% of the population at the end of therapy and post-therapy follow up respectively. The mean duration of hospital stay was 6.02 days. Adverse effects were reported in 107 patients at the end of therapy and in 88 patients at follow up visit. Conclusion: Cefotaxime demonstrated clinical effectiveness, with the majority of the patients achieving symptom resolution and reduction in microbial infection following treatment. Cefotaxime was well-tolerated, with a low incidence of adverse events reported, ranging from mild to moderate. This indicates that cefotaxime demonstrated a safe and effective drug profile in Indian patients with RTI and UTI.

Introduction: Metabolic syndrome (MetS) is a multifactorial disorder characterized by central obesity, dyslipidemia, hypertension, insulin resistance, and a pro-inflammatory state. Recent studies have identified serum alkaline phosphatase (ALP) as a potential biomarker associated with chronic low-grade inflammation and cardiometabolic risk. However, limited data is available on the correlation between ALP and metabolic syndrome in the Indian population. This study aims to investigate the association between serum ALP levels and metabolic syndrome, and its relationship with anthropometric and biochemical parameters. Methods: This comparative cross-sectional study was conducted at a tertiary healthcare center over a two-month period. A total of 120 adult participants were enrolled 60 with metabolic syndrome (cases) and 60 healthy individuals (controls). Anthropometric measurements including BMI and waist circumference, along with blood pressure, lipid profile, CRP, and serum ALP levels were recorded. Blood samples were collected after a 12-hour fast and analysed using standard laboratory techniques. Results: Patients with metabolic syndrome exhibited significantly higher ALP levels (111.0 IU/L) compared to controls (79.8 IU/L, p<0.001). CRP levels were markedly elevated in cases (median: 12.6 mg/L) versus controls (1.4 mg/L, p<0.001). Significant differences were also observed in waist circumference (102.25 cm vs. 84.27 cm), BMI (28.3 vs. 22.0), total cholesterol (174.6 mg/dl vs. 148.1 mg/dl), triglycerides (129.5 mg/dl vs. 97 mg/dl), LDL (113.5 mg/dl vs. 80.2 mg/dl), and HDL (41.2 mg/dl vs. 46.2 mg/dl). Glycaemic parameters were elevated in cases, with FBS and PPBS averaging 165.4 mg/dl and 198.7 mg/dl, respectively. Discussion: The study establishes a significant association between elevated serum ALP levels and metabolic syndrome, supporting its role as a marker of low-grade inflammation, insulin resistance, and visceral obesity. Findings align with existing literature indicating a link between ALP, dyslipidaemia, and inflammation. Given its accessibility and cost-effectiveness, ALP could serve as a practical biomarker for early identification of individuals at risk for metabolic syndrome, especially in primary care settings.

Aim: To investigate the incidence of chronic groin pain (CGP) in mesh fixation techniques, specifically comparing Polyglactin (Vicryl) with Polypropylene (Prolene) in open inguinal hernia repair. Methods: A randomised controlled study was conducted in the surgical ward of SVBP Hospital, affiliated with Llrm Medical College Meerut, from December 2022 to December 2023. The study included 30 patients in each group: Group A underwent mesh fixation via Polyglactin (Vicryl), while Group B underwent mesh fixation via Polypropylene (Prolene). Postoperative pain scores (Visual Analog Scale – VAS) were assessed at 12 hours, 24 hours, 72 hours, 1 month, and 6 months. Results: The incidence of CGP/inguinodynia was significantly higher in the fixation group using Polypropylene (Prolene) compared to the fixation group using Polyglactin (Vicryl). This difference was statistically significant (p < 0.05). Postoperative pain on the first and third days was comparable with both Vicryl and Prolene sutures. However, after 7 days, 1, 3, 6, and 12 months, the postoperative pain was significantly higher in the polypropylene group. Conclusion: Based on the findings of this study, it is concluded that the use of Polyglactin sutures for mesh fixation offers a safe, simple, and effective alternative to the conventional use of Polypropylene sutures in Lichtenstein hernia repair. This approach may help reduce the incidence of chronic groin pain in the postoperative period.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major global health burden. Pre-COPD and Preserved Ratio Impaired Spirometry (PRISm) are early respiratory conditions that may progress to COPD. Objective: This study aimed to assess the prevalence and characteristics of PRISm among smokers and non-smokers aged 18 and above years at The Oxford Medical College Hospital and Research Centre. Methods: A descriptive study was conducted over six months. Spirometry was used to identify PRISm (FEV1/FVC ≥ 0.7 with FEV1 < 80%). Demographic, BMI, and smoking data were analyzed. Results: The study encompassed 100 participants, with 56% male and 44% female. With a majority of males are non-smokers. Majority PRISm subjects were overweight (BMI 25-29.9). The mean age group of study population was 48.01±17.29 with the majority of the population was ≥45 years old. PRISm subjects showed moderate obstruction (FEV1 50-79%) and prevalent small airway disease. Conclusion: PRISm is associated with small airway disease and may transition between normal and obstructive spirometry. Early identification and intervention are crucial to mitigating COPD progression. Further research is needed on long-term outcomes and treatment strategies.

Background: Micronutrient deficiencies, particularly in vitamin D, iron, iodine, and B-complex vitamins, are a major public health concern among children in India. Limited dietary sources, inadequate sun exposure, and changing food habits contribute to these deficiencies, impacting growth, immunity, and development. Objective: This study examines pediatricians’ prescribing practices for vitamin and mineral supplements, focusing on prescription frequency, preferred formulations, targeted age groups, and key influencing factors. Methods: A structured questionnaire was administered to 104 pediatricians to assess their supplementation practices, including prescription patterns, assessment methods, and reasons for supplementation. Results: The survey involved 104 participants, with a majority being male (72%). Most participants practiced privately (52.88%), while others worked in government (34.62%) and corporate hospital settings (11.53%). Over half (50.97%) had more than 10 years of pediatric experience, reflecting a broad range of expertise. Daily prescription of vitamins and minerals was reported by 74.04% of pediatricians, mainly for toddlers and preschoolers (41.35%), highlighting a focus on younger age groups. Vitamin D (45%) and Iron (40%) were the most common deficiencies. Nearly all (95.19%) agreed on Vitamin D supplementation from birth, with 63.46% preferring it with other vitamins and minerals. Supplements were prescribed for growth and development (39.42%) and preventive health (39.42%), based primarily on clinical assessment (50.96%). Syrup or liquid formulations were favoured by 77.88%, and most prescriptions (56.73%) were for over 30 days, indicating a long-term therapeutic approach. Conclusion: Pediatricians play a crucial role in mitigating micronutrient deficiencies through supplementation. Given widespread dietary inadequacies, a combined approach—including supplementation, dietary improvements, and public health initiatives—is essential for ensuring optimal child health outcomes.

Background: Cognitive decline and dementia constitute leading causes of disability worldwide. Mounting evidence suggests that vascular risk factors (VRFs)—including hypertension, diabetes mellitus, dyslipidaemia and smoking—are key, modifiable drivers of neuro degeneration. Yet their combined contribution and relative weight across late midlife remain incompletely quantified. Methods: We followed 1,502 community dwelling adults aged 60–80 years (55 % women) without dementia at baseline in the Brain & Vessels Study, a population based prospective cohort (2016–2022). VRFs were ascertained by clinical examination and laboratory testing; a Framingham General Cardiovascular Risk Score (FGCRS) was calculated. Global cognition was assessed annually with the Montreal Cognitive Assessment (MoCA). Primary outcomes were (i) annualised change in MoCA and (ii) incident all cause dementia adjudicated by DSM 5 criteria. Mixed effects models and multivariable Cox regressions examined associations, adjusting for age, sex and education. Results: Over a median 5.2 years (IQR 4.9–5.5), 400 participants (26.6 %) experienced significant cognitive decline (>3 point MoCA drop) and 145 developed dementia. In fully adjusted models, hypertension (β = −0.21 points/year), diabetes (β = −0.19), current smoking (β = −0.15) and each SD increase in FGCRS (β = −0.24) independently accelerated decline (all p < 0.01). Participants in the highest FGCRS quartile had more than double the dementia risk versus the lowest (HR = 2.12,95 % CI 1.45–3.11). VRFs jointly explained 32 % of the variance in cognitive trajectories. Conclusion: In this population based cohort, common, modifiable VRFs—especially aggregated cardiovascular risk—substantially hastened cognitive deterioration and dementia onset. Aggressive midlife vascular risk management may therefore represent an effective strategy for preserving late life cognitive health.

A prospective study was done to know the etiological and clinical spectrum of cervical lymphadenopathy among 100 cases aged 1-90 years, who attended the department of ENT in this tertiary hospital from Oct 2020- March 2022 (18 months). Detailed history was taken regarding mode of onset, duration, progression, associated symptoms, history of smoking or tobacco chewing, history of alcohol intake, history of contact with tuberculosis and also about their socio- economic status. Material And Method: The study was conducted on 100 cases, attending the outpatient department or admitted for inpatient care in the department of ENT with cervical lymphadenopathy at Government General Hospital, Nizamabad, Telangana over a period of 18 months (October 2020 – March 2022). Result: A total of 100 cases with enlarged cervical lymph nodes were studied for a period of 18 months (OCT 2020 to MARCH 2022). Conclusion: Detailed investigations including CBC, ESR, CXR, USG neck, FNAC of enlarged cervical node, Mantoux test and other serological tests for the diagnosis of viral infections are needed. CECT neck to know the benign or malignant nature of involved group of lymph nodes. Excision biopsy, Pan endoscopy, CECT chest, USG abdomen, PET- CT has to be done in cases of metastatic deposits in cervical lymph nodes to know the primary site of tumour(reports collected from higher center).

Background: Pseudoexfoliation (PEX) syndrome is an age-related condition characterized by the accumulation of fibrillar, amyloid-like material on various ocular structures. This can lead to complications during cataract surgery and increase the risk of glaucoma. While diabetes mellitus is a known risk factor for senile cataracts, its relationship with PEX is not well-established. Methods: A hospital-based observational study was conducted at the Department of Ophthalmology, Adichunchanagiri Institute of Medical Sciences. A total of 314 patients with senile cataract were enrolled over six months, consisting of 160 diabetic and 154 non-diabetic individuals. Comprehensive ocular examinations-including slit-lamp biomicroscopy, applanation tonometry, and gonioscopy-were performed to detect PEX and assess other clinical parameters. Data were analyzed using Chi-square tests, ANOVA, and logistic regression. Results: The overall prevalence of PEX was 15.3%, with significantly lower rates in diabetic patients (6.3%) compared to non-diabetics (24.7%, p<0.001). PEX-positive patients showed higher mean intraocular pressures (19.5 ± 3.2 mmHg vs. 17.2 ± 3.4 mmHg, p=0.01) and slightly poorer visual acuity (LogMAR 0.9 vs. 0.8, p=0.05). Logistic regression indicated that diabetes was associated with a protective effect against PEX (OR = 0.25, p = 0.004), while increasing age significantly raised the risk (OR = 1.08 per year, p = 0.002). Conclusion: This study found that diabetic patients with senile cataract had a significantly lower prevalence of PEX than non-diabetic patients. Higher intraocular pressure and reduced visual acuity in PEX-positive patients highlight the clinical implications of the syndrome. These findings suggest that diabetes may offer some protective effect against PEX, warranting further investigation into the underlying mechanisms.

Background: Primary angle closure disease (PACD) remains a major cause of preventable blindness in Asia. This study aims to evaluate whether uncomplicated phacoemulsification surgery offers protective anatomical and functional benefits in patients with primary narrow angle (PNA). Methods: In a prospective observational study, 50 patients aged 40–70 years undergoing cataract surgery were enrolled and divided into two groups: Group A (open angle) and Group B (primary narrow angle), based on gonioscopic grading. Parameters including intraocular pressure (IOP), anterior chamber depth (ACD), angle opening distance (AOD), trabecular iris angle (TIA), iris thickness (IT), and iris-lens contact distance (ILCD) were measured pre- and post-operatively using applanation tonometry and ultrasound biomicroscopy (UBM). Results: Both groups showed a significant reduction in IOP postoperatively. Narrow-angle patients showed greater improvement (mean IOP reduction of 4.72 mmHg, p<0.001) compared to the open-angle group (mean reduction 2.16 mmHg, p<0.001). Significant increases in ACD and AOD were observed, particularly in the narrow-angle group (ACD: +1.09 mm; AOD: +121.36 µm, p<0.001). Conclusion: Phacoemulsification significantly widens the angle and lowers IOP in PNA patients, suggesting its dual role in visual rehabilitation and disease prevention.

Background: The Indian Medical Graduate as envisioned by The National Medical Commission ought to be a  life-long learner. Competency based medical education thus focuses on Self Directed Learning (SDL) as one of the teaching learning methods. SDL would enable the graduate to pursue and acquire necessary skills in this fast-changing profession. SDL is often passed off as exercises after routine teaching hours. There are variations in perception among students and faculty. We intended to study the perceptions among both the faculties and students. This would help us to develop SDL in a better way and incorporate it in the said curriculum. Aim: To study the perceptions of students and faculty towards self-directed learning and factors modifying them. Primary Objective: To study the perceptions of faculty and students towards SDL. Secondary Objective: To assess the factors that modify and overcome the challenges. Method: The study was conducted in the medical college among the first and second phase of students over a period of 6 months. The study was also conducted among faculties of all the three phases. An SDL Assessment Scale, a prevalidated tool SDLI by Shen et al. (2014) was used. A google form with twenty questions was circulated. The questionnaire consisted of 20 items, which explored their learning motivation, planning, and implementation abilities, and lastly the interpersonal communication skills. The participants were asked to select from a Likert scale 5-point rating of “strongly disagree,” “disagree,” “neutral,” “agree,” and “strongly agree. The responses were analysed. Conclusion: Didactic lectures are the commonest method for imparting knowledge but SDL is another effective teaching learning method. Our study has pointed out several barriers or challenges on the part of students. These are mainly the vastness of topics, difficulty in strategizing their learning methods and time. Having access to the right resources may allow them to broaden their knowledge and lead to better analysis and integration. The perceptions of faculty that SDL be done independently after scheduled teaching hours is a challenge. This change of perception may be done by faculty training. The time devoted by faculty is another challenge. They have to provide the right resources and guide the students to utilise these. They also have to take time out for formative assessment of the students. SDL should be tried for various domains of learning. With understanding of the knowledge gaps of students they may assist the educators in choosing relevant and suitable resources. SDL will be the right direction to help students learn actively and pave their way for lifelong learners.

Background: Diffusion-weighted imaging ,based on alterations in the microscopic motion of water molecules, promises improved specificity for breast MR imaging .The purpose of our study was to evaluate the role of Diffusion weighted imaging and apparent diffusion coefficient (ADC) values in differentiating benign and malignant breast lesions, which would help the surgeon to decide further management and outcome. Aim: To study the role of Diffusion Weighted MR Imaging of breast and apparent diffusion coefficient (ADC) values in differentiating benign from malignant breast lesions. Objective: To determine usefulness of DWI combined with ADC values in distinguishing breast lesions into benign and malignant lesions, distinguishing their histological subtypes and establishing correlation between ADC values and structure of breast tissue on the basis of ACR classification. Methods: The retrospective observation cohort-study included 120 female patients referred from general surgery department with palpable breast lump or a suspected breast lesion detected on Mammography / sonography or diagnosed cases of carcinoma breast with suspected recurrence. The patients underwent history taking, clinical examination, contrast enhanced MRI evaluation using a 3 Tesla MRI machine and histopathological examination. Result: Quantitative analysis of Diffusion weighted images was done and their ADC values were recorded. Mean ADC values were significantly lower in malignant lesions compared to benign lesions (0.71 Å~ 10−3mm2/s vs. 1.05 Å~ 10−3mm2/s,p < 0.001). The cut off value of ADC for malignant lesions was 0.787 Å~ 10−3mm2/s (sensitivity 98.4%, specificity 65.9%), and for benign lesions 1.111 Å~ 10−3mm2/s (sensitivity 98.3, specificity 80.8%). There was no significant correlation between malignant lesion subtypes and ADC values. Conclusion: DWI and ADC were highly sensitive as well as specific in differentiating malignant from benign breast lesions. They could be used together in order to obtain highly specific and accurate results.

Cerebellar disruptions, as opposed to malformation, have not garnered much attention in the literature. We present a case of 26 year old male with no history of any antenatal-perinatal insult presenting with intermittent headache and vertigo for 6 months. Contrast enhanced MRI brain was done on 3 Tesla machine and a cleft was found in right cerebellar hemisphere extending to fourth ventricle.

Background: An important impact of estrogen on auditory tract has been studied. Few research has been done on different menstrual cycle phases and menopause. Here, comparison of the Brainstem Auditory Evoked Potential (BAEP) between menstruating females during follicular phase and menopausal group has been done. Materials and Methods: Case control study. Group 1, N=25 menstruating females in follicular phase group between 19-26 years. Group II, N=30 menopausal female group, between 42-50 years. Student unpaired t test for analysis. Brainstem auditory evoked potential (BAEP) mean wave latencies I, III, V, and Interpeak Latencies (IPL) I‑III, III‑V and I‑V were recorded. Results: BERA waves III, V and all interpeak latencies at 80 dB and 2 KHz in Group 2 menopausal females were delayed and significant as compared to Group 1 menstruating females. Conclusion: Brain stem evoked response audiometry (BERA) detects hearing derangement early in menopausal females at 2 KHz and 80 dB.

Objective: This literature review aims to highlight the dangers of microbial contamination in non-sterile medications, such as tablets and capsules, and to showcase methods for maintaining quality, safety, and effectiveness. Methods: The review synthesizes information on contamination sources (including raw materials, equipment, personnel, and environmental factors), exacerbating conditions (such as poor hygiene and inadequate maintenance), and mechanisms of microbial degradation. It also discusses the complexities of using preservatives, innovations like barrier technology and bacteriocins, and the effects of moisture, temperature, and nutrients on microbial growth. Effective microbial control strategies are explored, including rigorous material testing, adherence to Good Manufacturing Practices (GMP), environmental monitoring, and rapid detection techniques. Results: Evidence indicates that microbial contamination can severely compromise the integrity of non-sterile medications due to substandard materials and flawed manufacturing processes. Often, these medications degrade without visible signs, and preservatives can inadvertently support microbial growth. Factors such as moisture content, ambient temperature, and nutrient availability facilitate microbial spread. Strong controls emphasizing rigorous testing, compliance with GMP, and the application of advanced preservation techniques are essential to mitigate these risks. Conclusion: To ensure that everyday medications are safe and effective, a multifaceted approach to microbial control is essential. This includes a focus on GMP, innovative technologies, thorough monitoring, and comprehensive staff training to enhance the safety and quality of pharmaceutical products.