European Journal of Cardiovascular Medicine

Background:  Supratrochlear foramen (STF) is an important variation in the lower end of humerus which has been neglected and the knowledge of the presence of Supratrochlear foramen in a humerus may be important for preoperative planning for treatment of supracondylar fractures. Anatomical knowledge of STF is important for discerning normal from various pathological conditions of lower end of humerus in various disciplines of medicine like orthopaedics, radiology and paediatrics etc. The present study was done on a total of 400 dried adult humerii (200 right &200 left) from the bone bank of department of anatomy, rangaraya medical college, Kakinada, East Godavari.The presence of supra trochlear foramen and its various shapes was observed.Out of 400 humeriisupra trochlear foramen was seen in 124 humerii (63right & 61 left).Incidence of STF wasmore on right side. Oval shape was most common

Background and objective: Anthropometric research has revealed significant differences in physical attributes between various racial groups. Consequently, while performing a total knee arthroplasty, implants particular to a patient's gender and race must be used.. The study specifically examined the breadth of the intercondylar notch, bicondylar width, and condyle measurements of the femur. Method: A total of 130 femur bones—70 from the right side and 60 from the left—were used in the investigation. A sliding calliper was used to measure the intercondylar notch width, bicondylar width, and anteroposterior dimensions of the femur's condyles. Result: The study found that the average Bicondylar width was 70.65±5.48 mm on the left side and 67.54±4.4 mm on the right. On the right side, the intercondylar breadth measures 20.95±5.54 mm, while on the left side, it is 21.68 ±3.25 mm. Conclusion: The study's findings can be used in the field of biomedical engineering to create knee implants tailored to the needs of the South Indian population because the values of the medial and lateral condyles' anteroposterior length, bicondylar width, and intercondylar width between the right and left sides did not differ statistically significantly

Background:  Identification and age determination are becoming more and more crucial in today's world due to a number of causes, including contested birth records, premature delivery, legal issues, and the necessity to validate a birth certificate for a variety of reasons (including marriage, employment, immigration, adoption, or school admission). When evaluating growth, different groups have had varying degrees of success utilising dental age, bone age, or a mix of the two. Methods: Only 40 subjects between the ages of 6 and 14 years old were chosen for the study out of a total of 400 screened children. A total of 400 patients aged 6 to 14 years who visited the Outpatient Department of Forensic Medicine, Guntur Medical College Guntur, Andhra Pradesh, India from June 2021 to May 2022 were screened for this cross-sectional study. The Demirjian method was used to calculate dental age. Pearson's and Spearman's correlation tests were used to determine the association between chronological and dental in the study population. Result: In the male group, there was a significant positive association between age, dental age, and all MP3 development stages. With the exception of a substantial but not statistically significant association between dental age and chronological age in the H stage of the MP3 region, the same was true for females. Conclusion: According to the study's findings, all individuals' chronological age, dental age, and skeletal age correlated statistically significantly, with females ageing before males.

Background: Coronary artery disease (CAD) imposes a substantial global burden, with millions affected. It remains a leading cause of morbidity and mortality, straining healthcare systems and necessitating proactive prevention and management efforts. Aims and Objectives: The present study aimed to study the prevalence OF Coronary Artery Disease among young Indian adults. Materials and Methods: The present study included 100 non cardiac patients attending the General Medicine OPD of Osmania General Hospital, Hyderabad. After obtaining consent, all the patients underwent detailed history taking, thorough clinical examination and necessary investigations. Data was collected in MS Excel, analyzed and presented as tables and figures. Results: Equal numbers of male and female patients were present in the study. The patients considered for the study fell into two (2) age groups, 20 – 30 years and 30 – 40 years. Both the age groups had almost equal no. of patients. Dyslipidemia was the most common risk factor in our study with 38% of the study population being dyslipidemic, followed by Hypertension (23%), Diabetes (21%), Sedentary Lifestyle (18%), Smoking (13%) and Obesity (9%). Family History of CAD was noted in 6% of study population. Conclusion: The current research highlights a notable occurrence of coronary artery disease (CAD) risk factors among the urban population in India. Consequently, urgent action is necessary to promote awareness about these risk factors, enabling proactive management of individuals at heightened risk for CAD in the future.

Background: Evaluation of retinal nerve fiber layer and ganglion cell complex thickness in diabetes mellitus using SD-OCT Methods: This cross-sectional study was carried out on 183 eyes of 100 patients of type 2 diabetes and 80 age and gender matched healthy control. Diabetic patients were further grouped into Group 1(no diabetic retinopathy) and Group 2 (mild diabetic retinopathy) as per ICDRDSS classification. Patients with evidence of macular oedema were excluded.  Demographic data and relevant medical details were documented and all study subjects underwent a comprehensive ophthalmic evaluation. Peripapillary RNFL thickness and macular GCC thickness were assessed for all study participants by SD-OCT (Carl Zeiss Cirrus HD-OCT) and their mean values were compared between both groups of diabetic patients and healthy controls. Results: Significantly (p<0.0001) reduced RNFL thickness was demonstrated in both diabetic patients’ groups (81.73µm in no DR and 76.99 µm in DR) compared with controls (96.86 µm). For GCC values also, significant (p<0.0001) reduction was observed in no DR (71.99 µm) and DR (71.0 µm) groups compared to controls (84.81 µm).  Conclusion: The statistically significant reduction in RNFL and GCC thickness in diabetic patients (with and without retinopathy) compared to healthy controls indicates that retinal neuronal degeneration occurs in early stages of DR.

Objective: Malnutrition is a major problem in India as well as Madhya Pradesh. TB and HIV are the leading causes of morbidity and mortality in SAM children along with diarrhea and pneumonia. This study conducted to know the prevalence of pulmonary tuberculosis in SAM children. Study Design: A prospective observational study.  Setting: The present study was conducted in the NRC, Department of Pediatrics, M.G.M. Medical College, Indore, over a period of 18 months.  Participants/Patients: 429 SAM children of age 6-59 months were enrolled and screened for tuberculosis. Demographic, anthropometric, clinical history and investigation were done as per updated national guideline for pediatric tuberculosis and were analysed. Results: Out of 429 SAM children,53 diagnosed as PTB(prevalence= 12.3 %), prevalence of PTB were 11.2% in < 24 months then 8.8 % 25-60 months,12.7% were female then males(8.3%).Prevalence of PTB was found 11.6% in  W/H < -3SD, and 18.8% in group with MUAC < 11.5 cm, Malnutrition was found to be strongly associated with tuberculosis. The prevalence of PTB in BCG unvaccinated children was 57.7% while in vaccinated was 9.4% .85.7% had history of contact with tuberculosis then without history of contact 6.6%,31.82% TST were positive and 4.99% TST negative , 82 %  cases had positive chest x ray finding and only 1.1% had normal chest x ray,all found to be statistically significant.Total 16.9 % PTB cases were bacteriologically confirmed in our study. Conclusion: Every SAM child should be screened for tuberculosis, good quality X-ray,history of contact with TB, and TST should be available as an important tool and every effort should be made to diagnose tuberculosis by microscopy and culture, so that sensitivity of mycobacteria could be known.

Introduction: Burst abdomen is considered to be there when intestine or other viscera are seen through the abdominal wound after surgery (general and obstetric surgeries).It can increase the length of hospital stay and result in significant social and economic costs for the patient and health care system. The present study aims at analyzing the incidence, etiological factors and management of this severe post-operative complication experienced by gynaecologists.  Materials and Methods: The present study comprises 25 cases of burst abdomen in the Department of Obstetrics and Gynaecology, MKCG Medical College Hospital, Berhampur, Odisha from August 2020 to July 2022. Using a check-list and a questionnaire, the patient’s demographic data, medical history, physical examination findings, laboratory investigation results, surgical procedures, and outcome of the repaired burst abdomen were collected.  Results: In our study period the incidence of burst abdomen was 0.19%. Majority of the cases, both caesarean delivery cases (100%) and gynaecological cases (60%), were emergency cases. The indication of laparotomy being ectopic pregnancy (40%) was the most common in gynaecological cases and the most frequent indication for caesarean delivery leading to burst abdomen was obstructed labor (40%). Obesity was the the most frequent (24%) comorbidity encountered in our setup. Majority of the cases (84%) had transverse incision and only 16% cases had sub-umbilical midline incisions. Layer closure was used in majority (92%) of the cases which led to burst abdomen as compared to mass closure which was seen in 8% of the burst abdomen cases. The majority (72%) of burst abdomen occurred between 6th and 7th post-operative day in our study, with the average mean of 6.72 days.  The post-operatively anemia was seen in 72% of the cases that led to burst abdomen. Operative area infection also seemed to pre-dispose patients to burst abdomen and was seen post-operatively in 36% of the patients.  Conservative treatment (daily saline dressings) was done in no case in our study. Immediate re-suturing of the wound in the operation theatre was done in 22 cases. In majority of cases (56%), secondary closure of burst abdomen was done with non absorbable polypopylene. In present study the range of stay for majority was within 21-35 days and mean duration of stay was 24.52 days. Two cases had burst abdomen recurrence, i.e. 8%. Conclusion: Burst abdomen is one of the serious postoperative complications faced by surgeons and is of greatest concern because of risk of evisceration, the need for immediate intervention and the possibility of repeat dehiscence. It poses tremendous impact on quality of life, health care cost for patients, their families and hospitals by requiring re-operations, need for antibiotics and prolonging hospital stay. Knowledge of the more common mechanisms and how to avoid or overcome these hazards should help to reduce the incidence of this dangerous complication such as maintaining asepsis, avoiding preoperative, intraoperative and postoperative precipitating factors of burst abdomen and providing good antibiotic coverage.

Introduction: A pleural effusion is accumulation of excessive fluid in the pleural space due to an imbalance between the production and absorption of pleural fluid by pleurae (visceral as well as parietal). Pleural effusion is a common clinical manifestation and about 3000 per Million people in the world suffers from pleural disease. Aims: To assess usefulness of ratio of serum LDH to Pleural Fluid ADA in differentiating Malignant Pleural Effusion and Tubercular Pleural Effusion.  Materials and Methods: The study was a Descriptive Observational Cross-sectional study was conducted in Department of Respiratory Medicine, Kamala Nehru Chest Hospital, Dr S N Medical College Jodhpur (Rajasthan), and a tertiary care centre for Respiratory Disease in Rajasthan, India after getting clearance from the Ethical committee. Result: found that most patients with tubercular pleural effusion (n=20) had Pleural Fluid ADA levels >35 and majority of the patients had Biopsy proven Malignant pleural effusion [22 (44.0%)] and it was statistically significant (p< .00001), (z=4.1036). Conclusion: We found that, most number of patients had Tubercular Pleural Effusion. It was statistically significant and majority of the patients had Biopsy proven malignant pleural effusion and it was statistically significant.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnoea, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. Aim: To study RCI as a marker for severity of COPD. Material and Methods: An observational study was conducted in Department of Pulmonary Medicine, K. N. Chest hospital, after approval from institution ethical committee, Dr. S. N. Medical College, Jodhpur. Result: In our study, 58 (58.0%) patients were Cigarettes, 36 (36.0%) patients were Ex-smoker and 6 (6.0%) patients were Non-Smoker. Conclusion: We conclude that, majority numbers of patients were Cigarettes in Stage 1 compared to Stage 2, Stage 3 and Stage 4 though it was not statistically significant.

Introduction: Acute kidney injury frequently occurs secondary to diuretics, intravenous radio contrast agents, paracentesis, gastrointestinal bleeding or infection and the development of Hepatorenal Syndrome (HRS) secondary to the progression of Liver Cirrhosis and elevation of portal pressure is not uncommon in the patients with Liver Cirrhosis. In several studies of AKI in such patients, those with serum Creatinine (Cr) levels of more than 1.3 to 1.5mg/mL have a poor prognosis. In early stages of HRS its possible to recover or delay deterioration of renal function with aggressive treatment . Though  Serum Creatinine is most widely used for measurement of GFR in clinical practice, it is greatly influenced by non renal factors, such as muscle atrophy and protein intake, especially in patients with Liver Cirrhosis. This study focusses on such scenarios where Cystatin C as a Novel Biomarker is superior to serum creatinine in predicting the incidence of Hepatorenal Syndrome in liver cirrhosis patients. Material and Methods: This is a Descriptive study was included about 100 patients diagnosed with Liver Cirrhosis in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute from July 2021 to December 2022. Detailed history, detailed clinical examination, complete blood count, liver function test, serum Cystatin C, Serum Urea, Creatinine, USG Abdomen, CT Abdomen if necessary, Endoscopy, Portal Venous Doppler. Results: Most of the patients in this study belong to the age group between 41 to 50 years (29 out of 100 patients). Patients belonging to age group between 31-40 are equally high. In this study, Males were more commonly affected when compared to female patients (88% were males & 12 % female patients.).  Out of the 100 patients in the study population, 24 patients developed Hepatorenal syndrome ( 19 belonged to Type 1 HRS & 5 belonged to  type 2 HRS). The Novel Biomarker Serum Cystatin C was Elevated in 92 % of the patients and was in the high normal limit in the remaining . On the other hand almost 97 % of patients had Normal serum Creatinine levels when it was done initially, only 3 % had  raised Creatinine level.  24 patients had increased Serum Creatinine levels only when followed up. Comparison between Cystatin C and Serum Creatinine in HRS patients showed a statistical significant P Value of < 0.001. The Sensitivity of Cystatin was 92 % and specificity was 80% in the Hepatorenal Syndrome Patients. Conclusion: Serum Cystatin C as a novel biomarker is a good predictor of Hepatorenal Syndrome (in early stages) in Liver Cirrhosis patients. It is superior to serum Creatinine in prediciting renal injury earlier in Liver Cirrhosis patients than serum Creatinine which varies with age, sex and with body mass etc. This study shows Cystatin C is more specific and sensitive marker of renal function in Liver Cirrhosis patients.

Background: Postpartum haemorrhage (PPH) is the most common complication following childbirth. Postpartum haemorrhage remains a significant contributor to maternal mortality and morbidity throughout the world. PPH is often classified as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, occurring from more than 24 hours post birth to up to 12 weeks postpartum. Aims: The aim of this study was to determine the percentage of patients requiring medical therapy for PPH management and to determine the percentage of patient requiring surgical therapy for PPH management. Methods:  The present study was a population and hospital based observational study conducted in the Dept of Gynae and Obstetrics, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. All the patients presenting with postpartum haemorrhage following delivery during my study period and meeting my inclusion criteria which is 304. Template was generated and analysis was done on STATA11 software. Results: In the present study the overall incidence of PPH is 1.4%(304 out of 22,182 deliveries). higher prevalence is seen between 24-27yrs and >=27yrs. Prevalence of PPH is more in women with no schooling (31.9%) The PPH occurred mostly at the gestational age 37-40wks (60%). Atonic PPH has higher prevalence (50.6%) than other types of PPH. In instrumental delivery traumatic PPH has higher prevalence (50%). In caesarean section Atonic PPH (80.64%) had higher prevalence than any other types. Atonic type of PPH is responsible for most maternal death (75%). Uterine tamponade was mostly done and successful in PPH following vaginal delivery (86.66%). Conclusions: To conclude, majority of deaths following PPH is preventable if timely and prompt intervention is made. Antenatal anaemic status contributed a significant role in PPH occurrence which should be corrected to decrease the prevalence of PPH.

Objective: To analyse Non-Stress Test as a Predictor for High-Risk Pregnancy-In Background of Fetal Color Doppler in Umbilical and Middle Cerebral Artery  by  means  of categorization intofour groups and comparing the prediction of perinatal outcome in high -risk pregnancies. Material and Method : This was  a  Prospective Observational study conducted on all ‘High Risk  Pregnancies’  in  Department  of  Obstetrics  &  Gynaecology,   Ruxmaniben  Deepchand   Gardi Medical  College,  Ujjainfrom  Oct 2020 to Nov 2021. A  total  of  182  antenatal  women  with ‘High  Risk’patients were  recruited.  They  were examined clinically,  and  Doppler  velocimetry  andnon- stress  test  were  performed.  The  main   vessels   studied   by  Doppler  were   umbilical   artery and   middle  cerebral  artery, to study and analyse the indices.   The  results  of   Non-Stress testwere  interpreted as  Reactive and Non-Reactive.  Based   on  the  results  of  Doppler  and   Non- Stress,  the  182 cases  were  categorized  into  four  groups  and  interpretation  of  results  was  done.Fetal outcome was considered on the basis of.APGAR score and NICU admissions Results: Among the182  cases of high-risk pregnancies, those with a normal Doppler study and a  reactive non-stress test had good perinatal outcome. When both were abnormal, there was a higher percentage of adverse out-come as compared to that of either Doppler or NST alone being abnormal or non-reactive. It was observed in this study that Abnornal Doppler  study  with Reactive  non-stress  test  had relatively  bad perinatal  outcome as compared  to  Normal  Doppler study  with  non reactive non stress test.In this study sensitivity and specificity of Doppler was 71%  and 73% while that of NST was 69%   and  54%  respectively  for  NICU  admissions. Conclusion: Color Doppler is comparatively a better in  predicting adverse  perinatal  outcome. However,  when  both test  are abnormal  perinatal  outcome  is  definitely  poor.NST can be used as an alternative in absence of colour doppler at rural PHCs and CHCs to identify adverse perinatal outcome and timely referral.

Background: The number of adolescents in India are 250 million and are a significant proportion to the Indian population. Increase in the addictions, both in terms of behavioral and non-behavioral addictions leading to lot of changes in the attitudes of the adolescents resulting in aggressive and some times violent behaviour which is detrimental to the future of the individual and also to the societies as a whole. Methodology: It is an institution-based study in southern part of India, conducted among 500 adolescents in the schools and colleges of Rajahmundry city, East Godavari district, Andhra Pradesh. The Aggression scale and socio demographic details and other factors are obtained from the adolescents Results: 26 (5.2%) members showed aggression and factors like gender, type of school or college, residential status and Socio-economic status were significantly associated with Aggressive behaviour

Background: Lack of physical activity (PA) was one of the most important cardiovascular risk factors causing higher morbidity and mortality rate worldwide. Thus, early health promotion activity like physical activity is needed for healthy life. As future physicians the health of the medical students is even more important as they personally ignore adopting healthy lifestyle. So, the study was conducted with an aim to estimate the level of physical activity and to find the factors associated with low physical activity among medical students. Methodology: An institute based cross-sectional study was conducted among 200 medical students in a medical college in Rajahmundry, Andhra Pradesh. Global Physical Activity Questionnaire (GPAQ) by WHO was used to estimate the level of physical activity and Metabolic Equivalents (METs) were used to express the intensity of physical activities. The collected data was entered into Microsoft excel and analysed using SPSS version 21. Results: The mean age of the study population was 19.61 ± 1.94 years and 62% of the study subjects were female. Based on WHO recommendation of minimum 600 MET min/week in the present study 64.5% had adequate physical activity and 35.5% had low physical activity. Low physical activity was high in female students when compared to male students (41.1% vs 26.3%, p-value=0.034). There was low level of physical activity in first professional year (46%) when compared to other professional years. Conclusion: There was need of promoting physical activity among medical students. Medical colleges need to increase the proportion of students adopting and maintaining regular physical activity habits

Background: Injuries are the leading cause of death and hospitalization among young people aged 15–24 years in India. While progress has been made in preventing injury deaths and disability in both older and younger age groups, young people remain at increased risk of injuries. The purpose of the study is to raise awareness and provide the national authorities and stakeholders with an insight into the size and impact of risk-taking behavior in accidents. The study was conducted with an aim to estimate the prevalence of risk-taking behavior and road traffic accidents and its association between them. Methodology: A cross-sectional study was conducted among 300 students aged 15-25 years of a medical and engineering colleges in Rajahmundry. A predetermined, semi-structured questionnaire was used to collect data. Data collected was entered and analyzed using Microsoft excels 2011 and Chi-square test was used to find the association between risk taking behaviour and road traffic accidents. Results: The prevalence of road traffic accidents in the study population was 46.7 per 1000 students/per year. Not taking personal safety measures (89%), over speeding (44%), using of mobile (46%) and thinking about something else (37%) were found to be the major factors causing road traffic accidents. There was a statistical significant association found between risk-taking behavior and a history of road traffic accidents (P<0.0001)

Introduction: non-communicable diseases (NCDs) present an imminent threat to people worldwide. Globalization delivers the uniform cause for the spread of chronic diseases to every corner of the World. AIM: To determine prevalence of Major risk factors of Non Communicable Diseases among study population. Material and methods: This was a Cross sectional study including 325 Doctors with minimum qualification of MBBS/BDS, working in Govt. health care facilities of Bikaner district, from Dec. 2019 to dec 2021 at Department of Medicine, S.P. Medical College, Bikaner, Rajasthan. Results: Mean age of study population was 40.58 ± 10.21yr. we found that 9.85% were current smoker, 1/3rd had used at least a standard drink in last 12 month, 68.92% consumed >5gm salt per day, 45.85% were active physically. 48.62% were overweight and obese, 12.92% had systolic BP ≥140 mmHg, prevalence of diabetes mellitus was 14.46%. Conclusion: The prevalence of risk factors for lifestyle diseases was high among the health professionals

Background: Hypertension and dyslipidemia are associated with oxidative stress and are major causes of cardiovascular disease amounting to 30% of global death rate.  Objective: To study the pathogenic role of Serum Uric Acid Levels  in  essential hypertension. Material and Methods:  This study was conducted at Department of General Medicine in a Medical College. Results: Mean age of the cases with hypertension was 55.02 years with 28.9% cases being above 60 years of age. Out of the total 235 cases, 57.9% were males while 42.1% were females. Out of the total 235 cases with hypertension, 83.8% were in stage I hypertension while 16.2% were in stage II hypertension. Prevalence of hyperuricemia was seen as 27.7% among cases with hypertension. Mean age was comparable among cases with and without hyperuricemia (54.85 vs 55.09 years; p-0.84. Conclusion: Mean serum uric acid levels were significantly associated with increase in systolic and diastolic blood pressure

Background: Grades of malnutrition can be classified and diagnosed by various available methods like IAP, WHO-Z score, Waterlow, Gomez and various parameters like anthropometric measurements. All these methods are also used to compare incidence and prevalence of malnutrition between different age groups. This study was done to compare the IAP vs WHO-Z score classification in precisely assessing the malnutrition status of children aged 0 to 5 years. Methods: This multicentric prospective comparative study was conducted at twenty-five ICDS centers in Karaikal, Puducherry between 2017-2019. Eligible study population included 0-5 years old children whose parents were willing to give consent at the time of enrollment. A thorough clinical examination was done to diagnose various nutritional deficiencies. Comparison was done between IAP and WHO classification of degrees of malnutrition. The comparison groups were analyzed using chi-square test. Results: A total of seven-hundred children were assessed for malnutrition, classified into various grades using IAP and WHO-Z score. Comparative analysis was done between two groups from each grade of malnutrition and it was observed that WHO-Z score classification and IAP classification didn’t have significant difference in identifying moderate malnutrition but WHO-Z score was significantly better (P=0.0001) in precisely identifying severe malnutrition. Conclusion: This study indicates that severe malnutrition which is still prevalent as assessed by IAP and WHO-Z score can be more precisely diagnosed using WHO-Z score [WAZ-7.8%, WHZ-3.8%, Grade III & IV-3.5%]. IAP grading is a time-tested method, which is easy to use and all categories of health workers were already accustomed to use it. A new tool incorporating WHO-Z scores in the existing IAP grading can be evolved for an accurate assessment of severe malnutrition

Objective: To evaluate the utility of narrow band imaging with magnifying endoscopy for the diagnosis of oesophageal lesions in north Indian population. Methods: The study was an observational study. Patients with various clinical symptoms were included in the study.  Patient on chemotherapy for carcinoma oesophagus, patients with sepsis and not willing for Endoscopy were excluded from the study. All cases were evaluated using endoscopic findings with respect to socio-demographic history, past history, a thorough clinical examination and details of the investigations done. Results: More than one third of patients were between 61-70 years of age (38.8%). More than half of patients were males (65.7%). Both WLE and NBI detected visible submucosal vessels among 56.7% and 52.2% patients respectively. Tanned columnar mucosa was detected among 49.3% by WLE and 31.3% patients by NBI. However,  low-grade adenoma was detected in 43.3% by WLE and 46.3% patients by NBI.  Polypoidal lesions were detected among 28.6% by WLE and 47.8% patients by NBI. NBI correctly detected oesophageal lesions among majority of patients (77.6%) with sensitivity and specificity of 89.7% (95%CI=81.8-97.5) and 33.3% (95%CI=2.5-64.1). A high positive predictive value was also observed (89.7%; 95%CI=81.8-97.5). Conclusion: The NBI endoscopes are clearer compared with ordinary stained endoscopes, it has a higher levels of diagnostic value and diagnostic coincidence rate for early diagnosis of Oesophageal lesions. Also it has a more accurate detection rate of lesions and less occurrence of adverse reactions. It can effectively detect and screen early Oesophageal lesions and benign lesions, it is worth promoting clinically

Background: Diabetes mellitus (DM) is a common endocrine disorder with around 415 million affected people worldwide. It is expected that DM will affect more than an estimated 700 million persons, 10.9% of the global adult population, by 2045. Objective: to find the prevalence of LVDD in type 2 diabetics and assess its correlation with HbA1c levels as measure of glycemic control. Methods: The present study was conducted in a tertiary care hospital in Central India from July 2020 to October 2022. Results: In our study majority study subjects were males.  The mean age for this study group was 46.3±8.3 years. Most of the study subjects (48.9%) had HbA1c within intermediate control range (7.1- 9%). 42 (45.6%) subjects were shown to have Left Ventricular Diastolic Dysfunction on 2D ECHO.  The mean HbA1c value for subjects having LVDD is 7.84 ± 1.34 and for those not having LVDD is 7.24 ± 1.35. Therefore, in our study it was concluded that LVDD was significantly associated with higher HbA1c values. Conclusions: The prevalence of left ventricular diastolic dysfunction was more in type 2 diabetic patients with high HbA1c levels

Purpose: The purpose of the study was to develop a new scoring system for predicting difficult intubation based on the ratio of the patient’s height to thyromental distance, upper lip bite test(ULBT), head and neck movements, modified Mallampati test(MMT), and neck circumference and compare it with Wilson score. Methodology: This prospective observational study was conducted on 300 ASA I, II, and III patients, who underwent elective surgeries under general anesthesia with endotracheal intubation as per inclusion and exclusion criteria. Results: In this study, among the individual parameters, MMT had the highest sensitivity (61%), while head and neck movements had the highest specificity (95.5%). ULBT had the best positive predictive value (42.9%), negative predictive value (94%), and positive likelihood ratio (5.5). Taking the cutoff for the new score as >=2, it predicted 34 out of 36 difficult intubations. Sensitivity was high at 94.4%. But specificity was low (41.7%). Kappa was 0.13. Wilson score with a cutoff of >=2 predicted only 16 difficult intubations out of 36. Sensitivity was low (44.4%), and specificity was 70.8%. Kappa was 0.09. On comparing the two scores, the sensitivity was very high for the new score >=2 compared with the Wilson score and was statistically significant (94.4% vs. 44.4%, p < 0.01). Specificity was less for the new score than the Wilson score and was statistically significant (41.7% vs. 70.8%, p <0.01). Accuracy was poor for the new score compared to the Wilson score and was significant (48% vs 67.7%, p<0.01).  Positive (PPV) and negative (NPV) predictive values were comparable for both. Using a cut off for New score >=3 resulted in higher sensitivity and specificity (88.9% and 82.6%, respectively) and accuracy of 83.3%. The new score with a cut off of >=3 yielded significantly higher sensitivity (88.9% vs. 44.4%, p <0.01), specificity (82.6% vs 70.8%, p <  0.01), and accuracy (83.3% vs. 67.7%, p <0.01) than Wilson score. PPV (41% vs. 17.2%, p <0.01) and NPV (98.2% vs. 90.3%, p <0.01) were also significantly higher for a new score >=3 than Wilson score. Conclusion: The modified Mallampatti test, the upper lip bite test, the ratio of height to thyromental distance, neck circumference, and, head and neck movements failed to meet the criteria for an ideal predictive test, when used as an independent predictor. When these parameters were combined to derive a new score, the predictive accuracy was much better. We had hypothesized that a new score with a cutoff of >=2 would accurately predict difficult intubation. It was inferior to Wilson score in predicting difficult intubation. By increasing the cutoff to >=3, sensitivity and specificity were equally good, and positive and negative predictive values were also high. On comparing it with the Wilson score, the predictive accuracy of the former was better. A combination of predictors is always better than a single predictor in identifying difficult intubation, and the new score with a cutoff score >=3 predicts difficult intubation better than Wilson score

Introduction: Acute intestinal obstruction is one of the commonest and potentially dangerous surgical emergencies with a high frequency of morbidity and mortality if managed inappropriately. Although the mortality is decreasing with a better understanding of pathophysiology, improvement in radiological diagnostic techniques, fluid and electrolyte correction, potent antimicrobials, surgical management, and improvement in anaesthesia. The present prospective study was conducted to find out various etiological factors of mechanical intestinal obstruction and to evaluate morbidity and mortality in adult patients. Material Methods: The present prospective observational study of 290 patients with adult intestinal obstruction was carried out from December 2016 to October 2018 in the Department of Surgery at a Tertiary Care Hospital. The study included a total of 290 patients out of which 218 underwent surgical management and 72 underwent management conservatively, hence aetiology of intestinal obstruction was studied in the operative patients. Results:The peak age incidence was seen between 31-60 years in small bowel obstruction. Abdominal pain 283(98%) and distension 278(96%) were the most common presenting complaints. Out of 290 patients 218 (75.17%) patients underwent a surgical procedure in whom the most common intraoperative findings were adhesions and bands seen in 84 cases (38.53%) which were post-operative. Malignancy was seen in 6 cases (9.17%) involving small bowel. Adhesiolysis was the most common procedure done in 94 cases, with 78 cases of postoperative adhesive intestinal obstruction. Surgical site infection was the most common complication 109(50%). Conclusion: Clinical, radiological, and operative findings put together can bring about the best and most accurate diagnosis of intestinal obstruction. Among the factors influencing mortality and morbidity are age, state of hydration, the viability of the bowel, aetiology of obstruction, site of obstruction, delay in diagnosis and surgical intervention and associated medical illness

Aims and Objective- To study the prevalence of coagulation abnormalities associated with Intrauterine fetal death. Materials and Method-The study was conducted in Obst &gynec Dept, Tertiary care hospital, Southern Odisha in a study period Aug-2020 to Oct 2022. A detailed clinical history, demographic parameters, causes of IUFD, associated complications and examination findings will be recorded as per the proforma and the following investigations will be done in each case: CBC to ascertain thrombocytopenia, Prothrombin time(PT), Activated partial thromboplastin time(aPTT),D-Dimer ,Fibrinogen assay,Modified ISTH score taken consisting of  platelet count, PT and fibrinogen level. Results - Out of the total 116 cases of IUFD, 18 cases were clinically diagnosed with DIC; Prevalence is 15.5% in our study. The mean age of study participants was 25.10 ±6.30 years which ranged from 18 to 37 years. Majority of the cases were primigravida and presented at preterm. Apart from the undiagnosed cases, which was the major part ,from the rest of the cases PIH and Abruptio constituted the major proportion of identifiable causes of IUFD. PIH, Abruptio and HELLP syndrome were the major obstetrical complications contributing to clinical DIC as well as those at risk of developing subsequent DIC which was found to be statistically significant. The sensitivity was found to be more in pregnancy modified ISTH score --(83.3%) compare to ISTH overt score (50%). The specificity was found to be more in ISTH overt score (96.9%) compare to pregnancy modified ISTH score (78.5%) Conclusion- in obstetrics is a life-threatening complication that is secondary to obstetrical and non-obstetrical related complications of pregnancy. It is associated with high maternal and perinatal morbidity and mortality. The present study was conducted to determine the risk of DIC in the cases of IUFD.It is recommended that coagulation studies should be considered in IUFD specially when complicated by PIH. abruption or severe complications such as HELLP syndrome. However, our study is of small sample size (116) requires large studies meta analysis

Objective: The primary goal of the intraoperative Frozen Section biopsy in a clinically suspected Central Nervous System (CNS) neoplasm is to evaluate the submitted tissue for rapid diagnosis, which helps in proper management during open craniotomy. In this study, the accuracy of frozen section in the diagnosis of CNS neoplasms and discrepancies in diagnosis were analyzed. Material & Methods: Ninety cases of CNS neoplasms were examined over a period of one year. All the cases were open biopsies performed at Neurosurgery Department &intra-operative frozen section (by cryostat) was performed & reported in the Histopathology section of a referral center in Eastern Odisha. The diagnoses given on FS were compared with the final diagnosis given on permanent paraffin embedded tissue sections. Results: In all cases, cryostat sections were prepared and a provisional diagnosis was given. Final histopathological diagnosis was given by studying the Hematoxylin & Eosin (H&E) section. Out of these 90 cases, 81 cases (90.0 %) were concordant, 9 cases (10.0 %) were discrepant. The discrepancies occur in mainly differentiating astrocytomas from oligodendrogliomas & schwannoma from meningioma along with few over-grading of glioma cases. Conclusion: Our results showed a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, freezing artifact, obscuring cytological detail, heterogenous features of gliomas and lack of proper clinical inputs were the major causes for discrepancies

Background: Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people’s quality of life. There are several treatment methods such as medical and surgical procedures. Objective: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment in terms of pain, healing, complications, recurrences and patients satisfaction Methods: This study includes retrospective analysis of 100 patients (male 71 and female 29) who underwent lateral internal sphinceterotomy for the treatment of chronic anal fissure between september 2020 to october 2022 for a period of about two years. All these patients were operated under general or spinal anesthesia after obtaining consent and routine examinations. We analysed the patients clinical features, complications and outcomes of Lateral internal sphincterotomy Results: As a result the final analysis included 70 were male patients and 29 were female patients with mean age of 38 years, age ranged between 18-56 years, 89% presented with pain, 45% bleeding per rectum ,37%  constipation , 32% complain of hard stool, 26% had  sentinel pile and 54% were having an increase anal tone. Bleeding per rectum was common problem in 34% patients in early post operative period followed by 3% perianal abscess, 2% perianal hematoma, 7% had incontinence of flatus followed by 2% liquid stool incontinence and 1% solid stool incontinence all patients with flatus and liquid stool incontinence regressed with conservative management. Recurrence occurred in 4% patients, nearly complete healing occur in 95% patients and  91% patients had no complain regarding pain: Conclusion Lateral internal sphincterotomy is a safe, effective, and inexpensive procedure that leads to quick symptomatic improvement and healing in chronic anal fissure with minimal complications

Introduction: Peptic ulcer disease is a disease of gastric and duodenal ulcers. This ulcer is a major threat worldwide over the past two centuries with a high morbidity and mortality. There are also some studies suggested that there is a complications that is seen after post operative peptic ulcer. Objective: To study postoperative complication in peptic ulcer disease patients in tertiary care hospital. Material:  A prospective study conducted on 180 post operative peptic ulcer patients. This study was conducted in department of surgery and patient ready to give inform consent form. This study was carried out after taking approval from institute ethical committee permission. Results: The present study was carried out on 186 pre operative peptic ulcer patients among them majority of the patients were males with a age group under 41 to 50 years. Out of 186 patients, 45.16% patients having ulcers among them multiples ulcer was observed in 61.90% .symptoms such as epigastric pain (90.32%) and gastritis (74.19%) was observed in most of the patients. 83.33% not taken any  drugs 16.66% has taken drugs like NSAIDs taken by 74.19%. surgery 34.40% having no complication and 65.59% having complications, majority of the patients having surgical site infection (26.22%) followed by pleural effusion and diarrhea respectively. Conclusion: Mostly this peptic ulcer is seen in employs and students, patients taking NSAIDs, mostly seen in diabetes patients, symptoms like epigastric pain and post-operative complication like infection at the surgical site is mostly seen

Although there are innumerable studies on vitamin D deficiency in India, there is limited data in Mizoram. Keeping this in view the aim of our study is to find out the deficiency of Vitamin D in our region, Mizoram (NE India). Our study population included patients attending Genesis Laboratory, Aizawl, Mizoram (November 2021 – November 2022) for various ailments who were advised serum Vitamin D level estimation. The study population was grouped according to gender and age in decades. Blood was collected in plain vials and serum obtained was used for vitamin D estimation. Out of 480 patients, 180 were male and 300 were female. Age of the study population ranged from 11 – 79 years. 17% of the total study population had normal values, 62.7% was vitamin D Deficient and 20.3 % showed Vitamin D insufficiency. The prevalence of Vitamin D Deficiency was high in all age groups, there were a higher percentage of females in the vitamin D insufficient and deficient groups. Maximum numbers of patients with vitamin D deficiency were in the age group of 60-69 years with a female predominance. Prevalence of Vitamin D deficiency is very high in our region that is in Mizoram, as is reflected from our study. This pattern is seen in other parts of our country too. Also, the deficiency is high in the age groups N – N years and females outnumbered male

Background:  Breast abscess continues to be a major cause of morbidity in developing countries. The treatment of breast abscess continues to be a challenge. In era of technical advances management of breast abscess has shifted to minimally invasive and painless techniques which are more patient friendly. Aims: to compare outcomes in management of breast abscess by incision and drainage versus ultrasound guided needle aspiration. Methods: The present study was carried out in the department of surgery in a tertiary care hospital central India.  A total of 100 female patients with acute lactational breast abscess between 18 and 45 years of age were enrolled in our study. The patients were randomized into group A (incision and surgical drainage) and group B (ultrasound-guided needle aspiration). Results: In our study total 100 patients were analysed, majority of the cases (53% in group A & 54% in group B) belong to 21-25 years age group. Post operative pain, high recurrence rate, fistula formation, cessation of breast feeding, ugly scar formation and longer duration of hospital stay were observed in incision & drainage procedure as compared to USG aspiration. Conclusions: USG guided aspiration is the safest, painless, day care and widely accepted procedure for treatment of breast abscess as compared to the incision and drainage, it reduced the post-procedure hospital stay and minimum scar formation

There is little information available about neurological manifestations in paediatric COVID-19 patients from around the world, including India. This study aimed to identify characteristics of paediatric COVID-19 cases with neurologic involvement who were hospitalized in IMS & SUM Hospital,  Odisha. This retrospective cross-sectional study included hospitalized patients with confirmed SARS-CoV-2 from January 2020 to December 2022 aged 0 to 14 years.The necessary information was obtained from the patients' medical records. There were 21 cases in total. The studied group's median ages, those with neurological manifestations and those without, were 6.5, 11.0, and 5.0 years, respectively. Five COVID-19 patients experienced neurological manifestations, with headache and decreased consciousness being the most common recorded manifestations. The majority of patients, both with and without neurological manifestations, survived. In hospitalized paediatric COVID-19 cases, neurological manifestations were common. However, most of the neurological manifestations were mild and nonspecific, with headache being the most common. Although specific neurological manifestations were uncommon, paediatric COVID-19 patients, especially young infants, were at risk of developing severe encephalopathy with a fatal outcome

Background: Fissure in ano is a common anorectal condition associated with high sphincter pressure and a reduction in mucosal blood flow, with secondary local ischemia and a poor healing tendency. The principle of treatment is breaking the cycle of pain, spasm, and ischemia thought to be responsible for the development of fissure in ano. Objective: The objective of our study is to compare the outcome of lateral internal sphinctereotomy and application of topical 0.2%  glyceryl trinitrate for the treatment of anal fissure. Methods: This prospective comparative study was conducted at department of surgery bundelkhand medical college and associated hospital sagar (MP) from september 2021 to october 2022. Total 60 patients with anal fissure were included in the study. After the diagnosis of anal fissure and before  starting treatment, a detailed scenario of its treatment, process, side effects, and healing and complication were explained to patients then consent was signed by the individual patients. Patients were divided into two groups to compare the outcomes of both lateral internal sphincterotomy and application of 0.2% glyceryl trinitrate ointment. Group A had 30 patients and Group B had 30 patients as well. Both group were followed up to six weeks. Results: In this study, males were commonly affected than females. The most common age group were 41-50yrs. Majority of the patients presented with pain during defecation. Constipation was the major predisposing factor among all cases. Most of the anal fissure were located in the posterior midline. The final comparison after six weeks of treatment shows the 83.3% of patients healed with the lateral sphincterotomy and 46.6% of patients healed with application of topical ointment of 0.2% glyceryl trinitrate. Complication of glyceryl trinitrate is headache which occurred in majority of patients. Pain is the most common post operative complication of lateral internal sphincterotomy. Conclusion:  We concluded that lateral internal sphincterotomy has an effective response to treat the anal fissure as compare to application of 0.2% glyceryl trinitrate ointment with advantages of good symptomatic relief, high rate of healing

Introduction: Diabetes mellitus a group of metabolic disorder leading to chronic hyperglycemia. The most common symptoms are polyuria, Polydipsia and polyphagia. There are different classes of antidiabetic drugs that can be prescribed in T2DM. the main aim is to study is to observe the suitable antidiabetic drug for the treatment of T2DM. Aim:  The aim is to study the prescription pattern, comorbidities and complications in type 2 diabetes mellitus in tertiary care hospital. Material and methods: Patients under inclusion criteria was selected for the study. A total of 100 T2DM patients were selected for the study. the patients were divided into two groups, group A – newly diagnosed T2DM and group B – Already diagnosed T2DM. the information was taken from the based on risk factors, ranges of HbA1c, FBS & PPBS, BMI, Duration of diabetes and comorbidities. Results: The study was conducted on 100 T2DM patients. the majority of the patient were male with a age group of 51 – 60 years. In group A patients majority of the patients were prescribe with metformin as monodrug therapy and in group A & B, metformin + glimepride as combination therapy. As per our study most of the patients having hypertension, smokers, and overweight respectively. Conclusion: Metformin and combination of metformin with glimepiride are most commonly prescribed drugs in treatment of type 2 diabetes mellitus

Omicron, a new variant of Covid-19 has hit the India in the third wave during 2022. The outbreak of this new variant has increased globally. At this time, there is an urgent need of fast, reliable and effective detection method. The real time RT-PCR is the most used technique for the detection of viral DNA. In the present study ‘OmiSure’ kit developed by Mumbai-based Tata Medical and Diagnostics Ltd (TATA MD) in partnership with The Indian Council of Medical Research (ICMR) was used for direct detection of Omicron variant in the SARS-CoV-2 positive samples via multiplex real time RT-PCR as a diagnostic tool. The reaction was tested targeting viral RNA and human target mRNA sequence using S gene target failure and S- gene mutation amplification strategy. In the present study 532 samples were tested for the presence of Omicronin the SARS-CoV-2 positive samples. The study found that a total of 501 individuals were positive for Omicron variant while 31 individuals were detected to be of other variants. Further these 31 SARS-CoV-2 positive samples were processed by nanopore whole genome sequencing and identified as Delta and its sub variants of SARS-CoV-2. These sequences were submitted in Indian SARS-CoV-2 Genomic Consortium (INSACOG) and Global Initiative on Sharing Avian Influenza Data (GISAID). The study showed that OmiSure kit is an accurate, fast and easy to use rRT-PCR Omicron diagnostic assay

Background: To treat coronary artery disease, PCI is a well-established method. Its efficacy in treating symptoms is widely known. In patients with baseline intact left ventricular function, the impact of PCI on systolic and diastolic function is uncertain. We postulated that individuals with chronic stable angina may have impaired regional contractile performance and that PCI would have the potential to enhance ventricular systolic and diastolic function following successful coronary angioplasty. Methods: The diagnosis of CSA was made based on the history of exertional substernal chest discomfort suggestive of typical angina, physical examination, ECG changes, and 2D Echo features. Coronary angiography was performed after taking consent and PCI was performed based on the results of coronary angiography if deemed appropriate based on the existing guidelines. Patients with a SYNTAX score >22 on CAG were referred to undergo CABG. All patients were kept under follow-up and assessed for symptomatic improvement of chest pain and echocardiography along with tissue Doppler analysis was performed on day 1 and 6 weeks after PCI. Results: In this study, overall there is an insignificant improvement in trans-mitral E wave velocity compared to baseline value and 6 weeks after PCI with a p-value of 0.8. Trans-tricuspid E wave velocity also showed an insignificant (p=0.5) improvement 6 weeks after PCI. Trans mitral and trans-tricuspid late diastolic filling velocities also showed an insignificant improvement 6 weeks after PCI with a p-value of 0.4 and 0.6 respectively. Deceleration times of the E waves across mitral and tricuspid valves did not improve significantly after PCI. Conclusion: The study showed conventional echocardiographic parameters of mitral and tricuspid diastolic flow patterns failed to show significantly, the impact of PCI on myocardial function. Tissue Doppler parameters of myocardial systolic and diastolic function across the mitral and tricuspid valves were able to show a significant improvement in myocardial function soon after PCI and this persisted till 6 weeks after PCI

Background: High grade fever (103-106°F), headaches, backaches, sharp painful joints, pain behind the eyes, nausea, vomiting, and a generalized erythematous rash are among the common symptoms of dengue. The febrile, critical, and recovery stages can be used to describe the disease's clinical course. WHO published a recommendation in November 2009 that categorizes symptomatic patients as severe dengue or dengue (with or without warning signs). Method: The present study was conducted under the Department of General Medicine, Rajshree Medical Research Institute, Bareilli. It was a Prospective cohort study conducted between February 2021 to July  2022. Study population comprised of those admitted in IPD in RMRI of 18-59 years of age, having fever more than 38.5oC with NS1 antigen positive or IgM dengue positive or both.  Result : Out of 90 patients, studied that Vomiting are present in 51(56.7%) patients whereas 43.3% subjects do not had vomiting. Out of 90 patients, studied 54.4% study subjects had headache whereas it is absent in 45.6% patients. Out of 90 patients, studied that URI are present in 12(13.3%) patients.86.7% study subjects do not had URI. Abdominal pain are present in 8(8.9%) patients.,91.1% study subjects do not had abdominal pain.  Conclusion: In this study, dengue infection affected a large portion of the young population and was more prevalent in men than in women. The bulk of the patients had fever. In addition to the typical headache, body aching, and fatigue, many patients also presented with gastrointestinal and respiratory symptoms such stomach discomfort, nausea, vomiting, diarrhea, and dry cough

Introduction-Chronic kidney disease (CKD) is one of the multifactorial diseases. CKD outcomes are based on many factors and once developed disease tends to progress to end stage renal disease. Many studies have proven relationship of bone minerals and non-protein nitrogenous (NPN) substances with CKD but data showing an association of these parameters with progression of disease is inadequate. Material and method- The study consisted of 88 CKD patients enrolled from kidney hospitals of Lucknow in the period between November 2020 to April 2021. Same number of control was also taken for comparison. Calcium, phosphorus and uric acid was analysed from the blood sample taken from both the groups. GFR was estimated and patients were classified into different stages of CKD. Chi-square test was applied to see the association and ANOVA & Post-hoc Tukey test were used to find the mean difference of parameters among different stages of CKD patients and the control group. For these tests, P-value less than 0.05 was considered statistically significant. Result- Females were found to be affected more by advance stage of CKD than their male counterparts. Hypocalcemia, hyperphosphatemia and hyperuricemia was the general finding in all the CKD stages when compared to control. Mean Ca of stage4 or 5 was significantly lower than stage3 and control group. Mean level of P of stage5 was higher than that of stage3 or 4 of CKD. Similarly, difference in mean uric acid between all the pairs was significant except between control and CKD stage 3. Conclusion- Our study found deranged Ca, P and uric acid levels along with advancement of CKD stages. Correcting these parameters may be of value in the management of CKD to stop its progression

Background: Despite advances in diagnosis, management and critical care of patients with peritonitis due to hollow viscus perforation, prognosis remains poor. Early assessment by scoring systems will influence the management and prognosis. Aim: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis. Materials and Methods: Prospective study of 60 patients admitted and operated for peritonitis in. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software. Results: The overall mortality was20%. MPI scores of <21, 21-29, and ≥ 30 had a mortality of 6.67%, 13.4%, and 0% respectively. In our study ACCURACY of  Mannheim peritonitis index (MPI) to grade the severity of acute peritonitis is 72.9%, SENSITIVITY is16.7%, SPECIFICITY is 79.2% Conclusion: MPI is disease specific, easy scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice

Introduction: One of the most frequent causes of acute abdomen in nearly all age groups is acute appendicitis and emergency appendectomy is one of the most common surgeries being performed worldwide.This classic presentation occurs in only 50%– 60% of patients and the diagnosis may be missed or delayed when atypical patterns of disease are encountered.Material and Methods. This study was conducted study at Government Medical College Srinagar J&K India over a period of 2 years.117 patients above the age of 14 years who underwent emergency appendectomy for suspected acute appendicitis were enrolled as study subjects. This study aims to study the diagnostic accuracy of ultrasonography, total leucocyte count and neutrophil percentage in diagnosing acute appendicitis. Results Ultrasonography, Neutrophil Percentage andLeucocyte count had a sensitivity of 81%, 74% and 70% respectively for acute appendicitis.  Sensitivity decreased (53%) when raised TLC, NP and USG were used together to predict appendicitis but specificity increased markedly (94.1%) pointing to the fact appendicitis was highly unlikely if all these tests were simultaneously negative.Conclusion.The results showed that normal blood parameters (total leucocyte count and neutrophil percentage) along with normal ultrasonography have a high combined diagnostic accuracy for acute appendicitis

Introduction: Sigmoid volvulus is an obstructive bowel disease caused by abnormal twisting of sigmoid colon about its mesentery. It commonly affects the middle aged and elderly adults. It is the third most common cause of acute large-bowel obstruction, it accounts for 75% of all patients with volvulus. Many different parameters have been used for the classification of SV. These include clinical timing, classified as acute (fulminant), subacute (indolent) or chronic (recurrent); severity (complete or incomplete), prevalence (sporadic or endemic) and axis of rotation (mesenterio -axial and organ axial organ axial types). Materials And Methods: This is a prospective study was conducted among patients suspected to have sigmoid volvulus by clinical feature and abdominal X-ray. A total of 144 patients were selected from Emergency department, VSSIMSAR, Burla over the 2 years study period. After evaluation and assessment, patients were categorized into 3 groups according to the angle between the mesenteric axis of sigmoid colon and the horizontal line on abdominal X-ray anteroposterior view (coffee bean sign) a per axis classification. All the studied cases underwent emergency exploratory laparotomy. Resection of the volvulus segment was done. Result: In our study, Patients of study had 2.49 gm/dL mean value of Serum albumin. 107 (74.3%) out of 144 patients were in shock at the time of presentation. In Group A, Group B and Group C 58.7%, 90.9% and 92.8% patients were in shock at the time of presentation respectively.  49 (34%) out of 144patients had Gangrenous sigmoid colon at laparotomy. Gangrene in colon was evident in 92.9%, 49.1% and 12 % in Group c, Group B and Group C respectively. The difference between 3 Groups were statistically significant, P value was less than 0.001. Conclusion: With increased axis, the AXIS C having poor prognostic factors leading to increased 30 days mortality rate. Therefore, increased axis is associated with increased 30 days mortality rate of patients. Preoperative serum albumin level also decreased with the progression of the AXIS leading to increased postoperatively complications like wound dehiscence, SSI, chest complications, anastomosis leak etc. The AXIS classification system enables the prediction of the severity of sigmoid volvulus and facilitates treatment decision-making at an early stage of the disease. With the AXIS classification system, a simple abdominal X-ray performed in the emergency room used to predict the severity of sigmoid volvulus

Introduction: Subtrochanteric fractures are femoral fractures that involve the lesser trochanter and extend distally up to 5 cm. These fractures account for 10% to 34% of all fractures. Civilization and modernization has brought certain problems along with its own benefits to the citizens of the world over. Aims: To evaluate the outcome of subtrochanteric fractures in adults managed by Proximal Femoral Nail; Materials and Methods: The Observation and Cross sectional study. This Study was conducted from October 2019 – September 2021 at Department of Orthopaedics. Agartala Government Medical College & GB Pant hospital and west Tripura. Total 30 patients were included in this study. Result: In our study, out of 30 patients, higher number of patients had full in Hip ROM at 9 months [26 (86.7%)] though it was statistically significant (p<0.0001) (z=6.2106). We found that, most of the patients had Excellent Functional Outcome at 6 months [25 (83.3%)] and Excellent Functional Outcome at 9 months [26 (86.7%)] which were statistically significant (p<0.0001). Conclusion: In our study, PFN is biomechanically sound and has advantages on collapse at fracture site as it is done mostly in closed method. PFN prevents excess collapse at fracture site and maintain the neck length and Most of the complications are seen due to surgeon and instruments related. They can be cut down by good pre-operative planning

Silicosis is an occupational hazard for those working in mines & in construction works. These patients are exposed to long term complications and chronic morbidity. In patients with silicosis, the involvement of pleura in the form of pneumothorax is uncommon. In our study, we have made an attempt to study the risk factors, pathophysiology & clinical profile of patients with silicosis presenting with pneumothorax,its treatment outsome and recurrence rate of pneumothorax . Silicosis has no definitive treatment. An awareness of safety & preventive measures to reduce the incidence of the disease, morbidity & mortality are needed to improve the health of people working in such places

Background: The Degenerative lumbar disc disease requires a multimodal therapeutic approach. Lumbar radiculopathy is a prevalent symptom that results from (a) mechanical pressure on nerve roots caused by a herniated disc (b) chemical irritation from inflammatory mediators1 and (c) compression of arteries supplying and veins draining the nerve roots. Given the complex pathophysiology of the degenerative cascade, an initial non-surgical management approach is necessary. Objectives: to determine the efficacy of Selective Nerve Root Block (SNRB) for pain relief. SNRB is an effective and less invasive intervention that is easy to administer and serves as an adjunct to non-operative treatment. Materials & Methods: A total of 46 patients who fulfilled these inclusion criteria were enrolled in the study. The duration of symptoms ranged from 4 to 24 weeks, and all patients were initially treated with analgesics, drugs for neuropathic pain, and physiotherapy, which failed to result in the resolution of radiculopathy. The nerve root block was performed in the operating theater with fluoroscopic guidance, using the technique described by Bogduk et al. under aseptic precautions. Pain Relief was measured periodically using Visual Analogue Scale. Results: Our study included a total of 46 patients with radiculopathy, consisting of 23 male and 23 female patients, with 1 patient having L3 radiculopathy, 36 patients having L5 radiculopathy, and nine patients having S1 radiculopathy. Immediate pain relief was observed in all 46 patients after the nerve root block procedure. Conclusion: Transforaminal epidural steroid injections may be used as part of a multimodal treatment regimen to provide pain relief in selected patients with radicular pain. Short-term (3 months) pain relief was very good, indicating that SNRB can be used to postpone surgery. However, long-term results require further follow-up. SNRB is therapeutically effective in relieving lumbar radiculopathy pain, easy to administer, cost- effective, and has minimal complications. Therefore, it is recommended for initial non-surgical management

Aim & Objectives of the study: The aim of this present study is to compare between laparoscopic and open hernioplasty in noncomplicated ventral hernia regarding operative data, postoperative pain and recurrence rate, intra and postoperative complications, and return to normal activity Materials And Methods Source of data: Patients admitted with ventral hernia during January 2021 to October 2022 at Rama Medical College and Research Institute, Hapur were taken up for study with the help of relevant history, clinical examination and appropriate investigations. Study design: Prospective Study Data Collection: Clinical features, symptomatology, investigations, operative findings, post operative wound complications, and length of hospital stay were analysed using the performa. Conclusion: No one technique is the “best” procedure for all patients. Knowledge of the wide variety of surgical options will be of benefit to all patients. In our study the laparoscopic approach appears to be as effective as open repairs in the treatment of ventral hernias. Advanced surgical skill, laparoscopic experience and high technology are the major factors for successful ventral hernia repair

Background: Peptic ulcers are the defects found in the gastric or duodenal mucosa and extend through the muscularis mucosa. Approximately 4 million people are affected by peptic ulcer disease every year.Material andMethods. This prospective observational study was conducted at the Postgraduate Department of General Surgery, Government Medical College, Srinagar (a tertiary care center) over a period of two years from October 2020 to October 2022.The aim of this study was to evaluate the accuracy of PULP (Peptic Ulcer Perforation) scoring system in predicting postoperative morbidity and mortality in patients operated for peptic ulcer perforation in our hospital.Results. 40 patients formed our study group. Maximum number of patients affected were in the younger age group, with median age of 25 years with male predominance (97.5%). Smoking was present in 67.5%. Serum creatinine was raised (>1.47mg/dl) in 22.5% patients. 90% patients were categorized as low risk according to PULP Score. Mortality was 5%, with PULP score of 11 each.  Conclusions.The prognostic predictors present in the PULP score are readily identified before surgery. The PULP score helps in accurate and early identification of high - risk patients with perforated peptic ulcer, and therefore assist in risk stratification and triage

Introduction: The current feasibility study is to be analysed for the possibility of establishing a podiatry unit in PMR hospital Hyderabad. This study focuses on the better performance  in means to facilitate the service to the diabetic foot patients. This study is performed with the way of framing close ended questionnaires stating the goal of the study.  Aims: Study also aims to gather opinion of health care staff and patients about need for podiatry services.  Materials and methods: The data gathered with questionnaire is from various participants of sample size approximately 100. Qualitative and quantitative form of analysis are being used in this study. Qualitative analysis is used for purposive sampling and quantitative analysis is used for convenience sampling.  Results: There is statistical significance impact of opinion of patients in the overall experience on foot ulcer treatment towards the overall ease of podiatric equipment availability for the patients for the treatment. Overall experience in management varies high then there is a variation occurring in the other two variables, the seeking support and the availability of podiatry equipment’s.  The significance value in the above regression test, explains about the significance correlation among those variables the preparedness of patients to acquire surgery from same tertiary care centre and overall experience of the patients in management for foot ulcers. Nearly 37% of probability of predictor variable is prevailing to have specific relation on the dependent variable Ease of availability of Prescribed podiatry equipment including removable cast walkers and dressings. Conclusion: The podiatry consists of delivery of services associated to the issues in foot health. The prominent challenge to provide the podiatry-services seems complex and it necessitates on-going variation of role flexibility, knowledge, skills and working practices

Background: Every year, 60% to 80% of all newborn deaths are caused by low birth weight (LBW). Low birth weight is a significant public health issue in developing nations like India. The objective of this study was to assess the magnitude and associated factors of low birth weight in a tertiary care hospital of northern India.  Methods: This was across-sectional study conducted at tertiary care Hospital. A total of 650 individuals in the study were chosen via systematic sampling. Data were gathered using a standardised questionnaire that had been pre-tested. Epi Info V7 was used to analyse the data. To find related factors, bivariate and multiple logistic regression were utilised. An association was deemed statistically significant at a 0.05 p-value. Results: In this study, the magnitude of low birth weight was 14.2%. A low birth weight was three times more frequent in women with a history of chronic disease than in those without such a history [AOR=3.04(1.04,9.02)]. Pregnant women with haemoglobin levels below 11 g/dl had a higher risk of having babies with low birth weights than those with haemoglobin levels above 11 g/dl [AOR=3.06(1.08,8.96)]. Contrary to those who did, women who did not take iron/folic acid supplements during their pregnancies had a higher risk of having babies with low birth weights [AOR=0.28(0.12,0.78)]. The odds of having a low birth weight were higher for pregnant women who did not eat extra food or meals during their pregnancy than for those who did [AOR=0.26(0.11, 0.73)]. Conclusions: Hemoglobin level, iron/folic acid supplementation, extra meals during pregnancy, and a history of chronic medical conditions were all found to be significant predictors of low birth weight. To lower the risk of low birth weight, it is crucial to encourage pregnant women to take iron together with folic acid and extra meals

Introduction: Cataract affects nearly 9–12 million Indians annually after the age of 50 years. and, this exceeds glaucoma, macular degeneration, and diabetic retinopathy numbers combined. Cataract surgery is the most frequently performed surgery in India, with a success rate of nearly 98% and excellent visual rehabilitation. More than a million intraocular lenses (IOL) are implanted every year. Aims: A Comparative analysis of Recent Generation intraocular lens power calculation formulae to achieve emmetropia following Cataract surgery by phacoemulsification. Materials and methods: The present study was a prospective comparative study. This Study was conducted from October 2022 – February 2023 at Department of Ophthalmology, Venkateshwara Institute of Medical Sciences, Amroha (U.P). 120 patients were included in this study. Result: In our study for small eyes (< 20mm) Haigis group, the mean residual spherical refractive error was 0.68 ± 0.26 and in Holladay group, the mean residual refractive error was 0.83 ± 0.14 which was statistically significant (p=0.0008). In our study for normal eyes of Axial Length 20 to 24mm of in Haigis group the mean residual spherical refraction of the patients was -0.36 ± 0.80 and in Holladay group, the mean residual spherical refraction of the patients was 0.31 ± .63 which was statistically significant (p<0.0001).  In our study for long eyes > 24mm of Axial length, In Haigis group the mean residual refractive error of large eye was -0.50 ± 0.00 and in Holladay group the mean residual error in large eye was 0.12 ± 0.64 which was not statistically significant (p=0.1189). Conclusion: we concluded that, prospective analysis of results showed that Comparing all four IOL formula we had found that in SMALL eyes, NORMAL eyes as well as in LARGE eyes The HOLLADAY IOL formula is having better result followed by HAIGIS

Introduction: Cardiovascular disease is the most commonly diagnosed medical condition among patients aged 65 years and above and is a major global problem with an estimated worldwide prevalence of 38 million. The high morbidity and mortality rate associated with heart failure (HF) make it a challenging public concern with significant financial burden on healthcare. Patients with HF frequently present with multiple electrolyte abnormalities, hyponatremia, hypokalemia, and hypochloremia being the most common.  Aims: To assess the effect of admission serum chloride levels on the duration of hospital stay in decompensated heart failure patients and their correlation with serum sodium levels. Materials and Methods: The present study was a prospective observational single center carried out at tertiary care center in Ahmedabad, India. Patient’s demographic, clinical and laboratory data was collected from June 2020 till May 2021.  Result: In the present study, 60 patients were included. It was observed that serum chloride level was less than 96 mEq/L in 40%, 96 to 101 mEq/L in 35% and more than 101 mEq/L in 25% Conclusion: Our findings highlight the clinical significance of chloride, a routinely measured electrolyte. Given the critical role of chloride in a number of regulatory pathways central to heart failure, it is possible that serum chloride may represent a therapeutic target rather than simply a marker of disease severity

Background: Asthma is a heterogeneous disease, usually represented by chronic airway inflammation leading to variable respiratory symptoms and variable expiratory airflow limitation. Vitamin D has been shown to have several effects on the innate and adaptive immune systems that might modulate the severity of asthma exacerbations. Vitamin D deficiency and insufficiency is common in asthma patient, which causes frequent asthma attacks, respiratory tract infections, reduced lung function, poor asthma control, poor steroid responsiveness and severe asthma exacerbations. Objective: To determine serum vitamin D levels among asthmatic patients and to correlate them with the severity of bronchial asthma. Methods: A total of 50 patients with stable bronchial asthma between 18 to 60 years ages groups were included in the study. This Observational Study was conducted from April 2022 to December 2022 in Department of Respiratory medicine, Kamla Nehru Chest Hospital, Jodhpur. After taking proper clinical history and system examination, spirometry was done in each patient to obtain forced expiratory volume (FEV1), FVC and FEV1/FVC ratio for determination of the severity of asthma. Asthma control was assessed by using of asthma control questionnaire. Serum vitamin D level and absolute eosinophils count were measured in all participants. Results: In our study out of 50 cases, male patients (n=24) and female (n=26) which Association of Allergic history in Group with Severity of asthma was statistically significant (p=0.0240) and mean Vitamin-D Levels (ng/ml) was significantly higher in Mild [29.2182± 6.0880] compared to Moderate [23.3583± 5.2467] and Severe [14.9067± 5.1568] (p<0.0001). The mean Vitamin D Levels was significantly higher in “well controlled” [27.9071 ± 6.3191] compared to “partly controlled” [22.8706 ± 6.8941] and “uncontrolled” [17.2158 ± 7.0243] (p=0.0002). Conclusion: Vitamin D deficiency and insufficiency are highly prevalent in asthma patients in which prolonged duration of illness, frequently asthma exacerbation and poor asthma control. Hence, vitamin D is a useful for prevention and treatment of bronchial asthma

Background: -Brain abscess is defined as a focal infection within the brain parenchyma which starts as a localised area of cerebritis which is subsequently converted into a collection of pus within a well vascularised capsule.Intracranial abscesses are life-threatening infection that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Case report: -A 17-year-oldboy presented to Trauma and emergency Department AIIMS Raipur in a drowsy state with complaints of severe headache and right sided ear discharge for 15 days,fever on and off and weakness over all limbs for 1 day.Patient had a history of chronic suppurative otitis media (CSOM) of right ear discharge without any evidence of recent trauma or neurological procedure.Contrast enhanced CT brain showed cerebellar abscess with compressed fourth ventricle. Patient underwent emergency craniotomy, drainage of abscess and extra ventricular drain. Pus sample on gram stain showed gram positive cocci in chains and pairs and few gram-negative bacilli.Aerobic bacterial culture revealed pinpoint beta-haemolyticcolonies along with few translucentnonhaemolytic colonies which failed to grow in MacConkey agar.The two isolates were identified asStreptococcus constellates and.Spingobacterium multivorumby VITEK II system.Antibiotic susceptibility pattern was performed by Kirby Bauer Disk diffusion and VITEK II system compact automated ID/ AST system.Initial empirical antibiotics were replaced withIV vancomycin as both the organisms were found sensitive to it. Patient responded with improved Glasgow comma Score and gradual resolution of abscess size which was evident on successive postoperative CECT Scan findings. Conclusion: Streptococcus constellatus and Spingobacterium multivorumboth are ubiquitous.Haematogenous spread from ear could have resulted in brain abscess.Appropriate sampling and use of automated instruments may increase isolation of new and unusualpathogensand result in early and appropriate management of brain abscess

Allergic diseases are developed through complex interaction between exposure to environmental substances and genetic susceptibility. The prevalence of allergic diseases has increased during last decade globally. The present cross sectional study was designed to evaluate the skin prick test reactivity in children with allergic diseases. A total of 400 children between age group 1-12 years were recruited. The Skin prick tests (SPT) using 14 standardized allergen extracts were conducted in the volar surface of forearm. Majority children had asthma (52.5%), followed by atopic dermatitis (22.75%) and allergic rhinitis (15.75%). Food habits triggering allergic conditions in 76% children, environmental factors in 4.75% children, pets in 8.25% and indoor conditions in 11% children. Skin prick test was positive to egg (13.5%), milk (22%), wheat (9.75%), apple (4.5%), cereals (6.5%), cat (18%), dog (6%), blatella (9.5%), aspergillus fumigatus (9.5%), fungi (12.75%), Dermatophytes farina (24.75%), Dermatophytes pteromyssinus (23.75%), Blomia tropicalis (9.5%) and Bermuda grass (13.75%). Determination of allergen sensitization patterns in children with atopic disease is crucial for selecting proper preventive and therapeutic strategies which helps to improve quality of life of in children

Face, limb, and oral abnormalities are hallmarks of Papillon-Léage-Psaume Syndrome. It is inherited in a prenatally lethal manner that is X linked dominant (XLD). We reported a case of 13-year-old male who was prima facie diagnosed with aforementioned syndrome .Early diagnosis from an odontogenic perspective can lessen the physical and dental abnormalities that may develop as a result of this condition, so it deserves the attention of paediatric dentists

Background: Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in the world mainly because of the obesity pandemic. Objective: to assess the prevalence and association of NAFLD in Type II Diabetics with one or more components of the metabolic syndrome. Methods: The present observational cross sectional study was carried out at tertiary care center of central India from November 2020 to October 2022.  Results: There were 46(59.7%) males and 31(40.3%) females. The mean age of cases with NAFLD was found to be 52.89±10.61 years. There is an increased risk of 1.667 times was observed for those with high BMI in association to with NAFLD which is statistically not significant. The mean HbA1C was higher in cases with NAFLD than in cases without NAFLD which is not statistically significant. Among the cases, 34 were diabetics with no other component of metabolic syndrome and 38.23% (13/34) of them had NAFLD; Conclusions: There is high period prevalence of NAFLD in type 2 Diabetic males. Study did not observe significant association between NAFLD and components of metabolic syndrome

The purpose of the current study is to evaluate the impact of low dose isotretinoin therapy on the changes of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in acne vulgaris patients. Methodology: Fifty patients with moderate to severe acne who were attending the dermatology department and were between the ages of 15 and 45 were treated with 20 mg of isotretinoin every day for four months. Blood samples were taken on day 0, the second week, the first, second, third, and fourth months. Results: The measured baseline cholesterol levels in the continuous therapy group were 116.86 ± 23.55, and they grew above the baseline levels at each subsequent interval of 4 weeks, 8 weeks, 12 weeks, 16 weeks, and at the end of the treatment. The P-value is significant when compared to the baseline. At all time points, compared to baseline and above the normal limit, there was a statistically significant increase in cholesterol, triglycerides, and LDL. There was also a statistically significant decline in HDL levels. Conclusion: Increase in cholesterol, triglycerides, and LDL over the usual range was brought on by low dosage continuous isotretinoin therapy. HDL values fluctuate with grade 1 (increase and decrease). Mild, well-tolerated side effects did not need therapy discontinuation. So it's crucial to raise awareness of the implications. We tell our expert that using low dose isotretinoin for moderate to severe acne can be done with little worry, although close monitoring is crucial

Background World Health Organization declared COVID 19 as pandemic in March 11,2020. SARS-CoV-2 is different from other known viruses due to multiple mutations on the sites of nonstructural proteins. Since the healthcare workers (HCWs) are at high risk for COVID 19 infection, Government of India gives priority for HCWs for vaccination against COVID 19. Aims and objectives: The present study aims and objectives are to estimate the prevalence and severity of COVID 19 infection in vaccinated HCWs and to determine the severity, course and outcome of COVID 19 infection in vaccinated HCW and to determine the effectiveness of vaccines among HCWs Materials and Methods: Cross-sectional questionnaire-based study conducted between October 2021 and December 2021 among 262 Health CareWorkers (Doctors, CRRIs, Nurses, Paramedical staff) in Government and Private hospitals in South Tamilnadu. Results: Prevalence of covid-19 in vaccinated HCWs was 12.9%. ADR was seen in 19.2% HCWs, mostly mild ADRs like fever, myalgia, headache, etc. SpO2 was more than 93 in 94% HCWs infected with covid, 6% had in between 90-93. Chest CT was taken in 17 HCWs infected with covid, 10 persons had a normal study, 3 persons showed 8% lung involvement, 1person had 32% lung involvement based on CT study. Conclusion: Covid-19 infection was found in 12.9% of the vaccinated people. Vaccination is effective in preventing Covid infection

Background and Objective: It is well established that intact parathyroid hormone (iPTH) and blood 25(OH) D levels have an impact on bone mineral density (BMD). There are few Indian statistics relevant to the aforementioned finding. In this study, we looked at the correlations between intact parathyroid hormone (iPTH), serum 25(OH)D levels, and bone mineral density (BMD) in a group of patients from India. Methodology: Individuals with low BMD at the hip or lumbar spine, whether or not they had fragility fractures, underwent clinical evaluations and laboratory tests. From BMD-DEXA, hip and spine T-scores were generated (dual-energy X-ray absorptiometry). The associations between serum 25(OH) D, iPTH, and BMD were examined using multivariate regression models. Results: A total of 102 patients were enrolled in the study, with a male to female ratio of 38:64 and a mean age of 62.5 6.4 years. Osteopenia affected 44 people. There was osteoporosis in 58 individuals. Serum 25(OH)D and iPTH levels were, respectively, mean values of 21.3 0.5 ng/ml and 53.1 22.3 pg/ml. Vitamin D deficiency was confirmed in 84.3% of patients by blood 25(OH)D levels that were below 30 ng/ml (normal range: 30-74 ng/ml). 25(OH) D levels and BMD at the hip or lumbar spine did not correlate (P = 0.473 and 0.353, respectively). iPTH levels, male gender, body mass index (BMI), and age were discovered to be significant predictors of BMD at both the hip and lumbar spine. BMD and T-score were considerably decreased in patients with increased BMI. Conclusion: There was no correlation between serum 25(OH) D levels and BMD among our group of patients with poor BMD. However, at serum 25(OH) D concentrations below 30 ng/ml, there is a negative connection between iPTH and 25(OH) D. A substantial inverse relationship between BMD at the hip and lumbar spine and serum iPTH levels was observed. Our results highlight the crucial part that parathyroid hormone plays in the health and metabolism of bones

Objectives: Sigma metrics is a emerging tool in internal quality assurance and it helps in determining accuracy and precision. It is not new to quality assurancebut its applicability in hematology laboratory is still in its developing stages. The study aimed to theutility of sigma metrics as an additional toolin the Haematology laboratory against the current quality tools of Internal Quality assurance. Methods: In the present study, IQC data was analysed from January 2022 to November 2022. Control material included second-party controls. Sigma was calculated for five key haematological parameters run in HORIBA PENTRA ES60. Sigma metrics were calculated using the formula Sigma = (TEa – Bias) / CV(coefficient of variation) .TEa(Total allowable error) was taken from CLIA(Clinical Laboratory Improvement Amendments) haematology guidelines. Bias was calculated using the formula Bias = [(ourlaboratorymean–target mean)/targetmean] ×100. Results: Average sigma metrics achieved for parameters were, RBC: 3.95, HB: 7.06, HCT 3.67, PLT: 5.42, and WBC: 7.1. The laboratory has achieved marginal to world-class performance in all analytes. Conclusion: Labs must use six sigma to design their IQC protocols, for individual parameters. This would help to achieve better quality in the haematology laboratory.

Introduction: In recent years, scrub typhus has rapidly emerged to become the major cause of acute febrile illness (AFI) in India. The commonest tests used for diagnosis are serology and PCR. Therefore, the present study was planned to compare these two techniques in the diagnosis of scrub typhus. Aim of the study: To compare IgM ELISA and PCR for diagnosis of scrub typhus as a causative agent of AFI. Material and Methods: Patients with acute undiagnosed febrile illness presenting to the outpatient (OPD) or inpatient services of PGIMER Chandigarh between August 2013 and March 2014 were included in this study. Blood was collected for further analysis by IgM ELISA and nested PCR followed by Sanger sequencing. Result: Of 176 patients, 29 (16.4%) were positive for scrub typhus by nested PCR while 162 (92%) were positive by IgM ELISA. There was 59 % concordance between the two tests. Conclusion: This study report shows that the concordance between PCR and ELISA for the diagnosis of scrub typhus is less than 60%. Ideally, both tests should be performed to diagnose scrub typhus depending on the day of presentation to hospital

Introduction: Mental foramen (MTF) is an opening in lateral surface of mandible with clinical importance in local anesthesia and surgical procedures in terms of achieving effective mental nerve blocks and avoiding injuries to the neurovascular bundles. Aims: To determine morphology and morphometry of mental foramen of central Indian population, hitherto unreported. Material and methods: 80 mandibles, 40 male and 40 female dry dentulus, without deformities were examined for position, shape, and number of mental foramen on right and left sides. Results: Various parameters investigated are( 1) the horizontal distance between the symphysis menti and MTF was 25.54 mm, on left side and 24.80 mm on right side in males, 24.72 on left side and 24.67 in females.(2) MTF and posterior border of ramus was 66.85 mm on left side and 67.68 mm on right side in male,62.71 mm on left side and 65.62 on right side in females.(3) MTF and mandibular base was 13.18 mm on left side and 13.32 mm on right side in males and 13.03 on left side and 12.97 mm on right side in females. (4) MTF and alveolar crest was 14.33 mm on left side and 14.3 mm on right side in males, 12.60 mm on left side and 13.13 on right side in females. (4) Occurrence of MTF below the second premolar tooth was found to be highest. Average size of MTF was larger on right side and it's way of exit was in postero-superior direction. Shape of MTF round in 81.8%, and oval in 18.2 % of male and female on left side. 82.5% round and 17.5% oval in male and 92.5% round and 7.5% oval in female on right side. Conclusion: In the present study, most common position of MTF was found below the apex of second premolar in 73.9% of males and 67.5% of females on both sides. Shape of MTF is round in majority of mandibles. During surgical procedures on mandible this information is helpful to the surgeon

Purpose: Acute undifferentiated febrile illness (AUFI) is a great challenge and burdenin the tropics with respect to diagnosis and clinical practice.Patients presenting with fever alone in Covid-19positive cases is very difficult to distinguish them from other AUFIs in the tropics like Malaria, Scrub Typhus, Dengue and Typhoid. Rapid sero-diagnostic tests of these infectionshad frequently shown sero-positivity for two or more infections leading to difficulty in clinical diagnosis and treatment in endemic zones. This study was performed to determine the false-positive serological test in Covid-19 patients for Typhoid Materials and Methods: The present study was observational prospective study conducted from April 2020 to November 2020. A total of 574 febrile patients which were positive in Real time PCR for Covid-19, were included in the study. Results: Widal test was found positive in 263samples (45.8%). Conclusion: Our experience suggests that cross reactivity in the serological test should be interpreted with caution andcontinuous follow-up of these patients along with surveillance should be done during Covid-19 pandemic in the resource-constrained tropical settings

Congenital birth abnormalities are a major factor in infants' poor health, which affects their likelihood of surviving. Even though these visual anomalies are rare, they have a substantial influence on people's quality of life.This study aimed to describe the clinical profile of congenital ocular anomalies with different epidemiological parameters in a tertiary health center in western Orissa. The study examined 3674 patients in the age group from 0 to 14 years who were admitted to the V.S.S. Medical College, Burla, Odisha and included 151 eyes from 99 cases of various types of congenital anomalies. A detailed history and other necessarydata were collected by trained ophthalmologists and descriptive analyses were carried out. The incidence of congenital ocular anomalies was 2.69%. Nasolacrimal duct anomalies (47 eyes) were the most common congenital ocular anomaly (31.1%); followed by congenital cataract (41 cases; 27.3%) and colobomy eye (18 cases; 11.9%). There was a slight male preponderance that accounted for 56.57% of all cases.The majority ofpatients were younger than 5 years (68%) and theincidence of congenital ocular anomalies was highest in the 0-5 year age group (68.69%). Single ocular involvement was observed in 47 cases (47.47%) while bilateral involvement was observed in 52 cases (52.53%). Consanguinity was identified in 13.13% of cases, with an increased risk of bilateral involvement (84.6% of cases). The most common symptom was ametropia (38.4%), followed by tearing (32.3%) and a white pupillary reflex (14.1%). A total of 60 eyes (39.7%) required surgery. Congenital ocular anomalies are a common cause of ocular morbidity, accounting for 2.7% of all cases in the pediatric age group. Early diagnosis, referral, and appropriate intervention would help prevent most permanent sequelae in congenital ocular abnormalities

Introduction: Diabetes mellitus is one of the most common diseases whose prevalence is on the rise. It is believed that within the next 30 years, the number of diabetic patients will double in comparison to the year 2000.Aims: To Study the effect of impaired blood glucose level on cognitive functions. Materials and Methods: The present study was a Prospective cross-sectional study. This Study was conducted from Dec 2019 to June 2021 at Department of Physiology in association with department of Medicine at tertiary care hospital  Result: In the present study, it was also seen that reduction in mean MMSE score in type2 DM subjects having duration above 5 years was significant when compared to those with duration less than 5 years. It shows that longer duration has an effect over cognitive function. Correlation coefficient between MMSE score and HbA1c was negative in this study, from which it is inferred that increase in HbA1c levels is associated with decrease in MMSE scores. Conclusion: We found that, Effective control needs proper diet, regular exercise, monitoring blood glucose by self and management of medications. A person’s cognitive skill to bring about the above mentioned needs is thus crucial for self-management of diabetes

There is debate regarding whether septoplasty in youngsters will have a negative impact on nasal and facial growth. Current research has demonstrated that in carefully chosen young patients, septoplasty can be safely performed without impairing nasofacial development. The goal of this article is to determine how paediatric septoplasty affects nasal and facial growth while also reviewing the clinical indications and supporting data on when to schedule surgery based on the most recent research. Using the terms paediatric, childhood, septoplasty, nasal septum, indications, nasal growth, and face growth, a structured review of the PubMed, Ovid Medline, and Cochrane Collaboration databases (Cochrane Central Registry of Controlled Trials, Cochrane Database of Systemic Reviews) was conducted. Another similar study came to the conclusion that most aspects of nasal function are unaffected by external septoplasty. Conclusions: There is proof that paediatric septoplasty can be done almost entirely without having an impact on the development of the nose and face. However, postponing or refusing to have a septoplasty when it is necessary may negatively impact nasal and facial growth, compounding negative outcomes in terms of deformity and asymmetry. Despite the fact that the majority support having septal surgery when a patient is 6 years old or older, further clinical trials are needed to gather greater support for correcting septal abnormalities in infants and young children. a function for septoplasty is thus supported by ached controls

Background: The ability of sonography to depict the subtle changes in the myometrium and endometrium makes it the diagnostic modality of choice for evaluation of many uterine disorders. The transvaginal sonography (TVS) has a pivotal role for assessment of gynecological patients and the vaginosonographic examination allows visualization of phasic variation of endometrial thickness, endometrial infiltration in endometrial cancer. Aims and Objectives: Validation of ultrasonographic measurement of endometrial thickness (ET), histopathological study and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause. Materials and Methods: The current study was a prospective observational study carried out in the department of Obstetrics and Gynecology, MKCG Medical College; Berhampur; Odisha from November-2017 to October-2019 over 120 cases. Cases were selected according to following inclusion and exclusion criteria after informed consent. After selection cases were subjected for detailed history taking with special attention to oral contraceptive use, use of HRT, antihypertensive medications, history of diabetes followed by thorough clinical examinations and baseline investigations including hemogram, FBS, urine routine and microscopic, chest X-ray and Pap smear. Then all the cases were subjected for ultrasound examination for ET followed by endometrial biopsy. Results: Majority of 52 cases (43.33%) had menarche at age of 13-15 yrs, of them 44 cases (84.61%) had ET ≥ 4 mm, 41 cases (34.16%) had menarche at age of 16-18 yrs, of them 30 cases (73.17%) had ET ≥ 4 mm. Most of cases i.e. 41 cases (34.16%) were of P4, of them 38 cases (92.7%) had ET ≥ 4 mm followed by 36 cases (30%) were of P5, of them 22 cases (61.11%) had ET ≥ 4 mm, 17 cases (14.16%) were of P3, of them 15 cases (88.2%) had ET≥ 4 mm, 8 cases (6.66%) were of P2, of them 6 cases (75%) had ET≥4mm,4cases(3.33%)wereofP1, ofthem3cases(75%)hadET≥4mmand2cases (1.66%) were of P0, of them one case had ET ≥ 4 mm. Among the cases, 26 cases (21.66%) who give history of OCP use, of them 16 cases (61.53%) had ET ≥ 4 mm whereas 94 cases (78.33%) who had never used OCP, of them 78 cases (82.9%) had ET ≥ 4 mm . Among the 108 cases (90%) who never taken HRT, 84 cases (77.77%) had ET ≥ 4 mm whereas among the 12 cases (10%) who had taken HRT, 10 cases (83.33%) had ET ≥ 4 mm(p value is 0.94). Conclusion: Transvaginal ultrasound is a measurement tool, justify subsequent study of the relationship between endometrial thickness and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause in cases of postmenopausal bleeding.

Background: Major cause of death/Adult fungal meningitis in HIV/AIDS patients is Cryptococcus neoformans. Fungal meningitis precedes serum/plasma cryptococcal antigen (CrAg) by several weeks. Cryptococcal Antigen (CrAg) screening and presumptive treatment can prevent fungal meningitis in HIV/AIDS patients significantly. Method: The descriptive cross-sectional study included 100 ART Naive patients ( 65  males &35   females) from both ART clinic and Medicine Indoor. Serum/CSF cryptococcal positivity detected by Latex agglutination test (Pastorex TM Cryptoplus, BIO-RAD,France) and  Lateral flow assay by IMMY Kit(US FDA approved).  CD4 Counts were measured using flow cytometer (Becton-Dickinson FACS count flow cytometer) Result: Prevalence of CrAg positivity in our study is 7 %(7/100), out of which 4%(4/100) had features of meningitis. Comparison of Antigenemia with Demographic features like Age, Inpatients; Symptomatic groups were having statistically significant association (p value0.0≤5).  Low CD4 count (<50) is associated with more seropositivity 33.3 %(5/100). Clinical features like Headache,Vomiting,Fever were having statistically significant association  with cryptococcal Antigenemia. Conclusion: Prevalence of cryptococcal Antigenemia  is higher in ART Naive  HIV patients with lower CD4 count which needs urgent attention for screening and substitution of Antifungal treatment to reduce morbidity / mortality from cryptococcal meningitis

Osteoporosis is a common metabolic disorder that causes decreased bone strength and is the leading cause of bone fracture, particularly in the elderly. There is no synthesis of evidence to inform policy regarding its prevalence and distribution in India. As a result, the goal of this systematic review and meta-analysis is to estimate and summarise the prevalence of osteoporosis among Indian adults. The PRISMA criteria were used to conduct the systematic review and meta-analysis. A thorough systematic search was conducted in the following electronic databases until May 23, 2022: Medline (via PubMed), Embase, and ProQuest. Following screening, twelve eligible studies were included in the study, which reported the prevalence of osteoporosis among adults aged 18 years, as well as for subsequent methodological quality assessment and data extraction using predefined standardised tools. To generate summary estimates for prevalence with 95 percent confidence intervals, random and fixed effects meta-analysis models were used. Data from 5261 study participants were used in the included studies. In India, the prevalence of osteoporosis is 22.9 percent (95 percent CI: 14.9-32.0 percent), and that of osteopenia is 44.8 percent (95 percent CI: 38.9-50.7 percent ). Females had a significantly higher prevalence of osteoporosis (26.3 percent (95 percent CI: 16.9-37.0 percent) than males (10.9 percent) (95 percent CI: 4.5-19.7). A robust and comprehensive prevalence estimate will aid in health policy decision-making and will aid in the planning and provision of necessary facilities for people suffering from osteoporosis. This is the first study to compile data on the prevalence of osteoporosis and osteopenia in India. Improved access to health services, other health systems, and policy research are required to initiate and increase the uptake of osteoporosis screening and treatment in India

Background: The most significant cause of infant fatalities in the neighborhood is neonatal sepsis. Objective: To identify the typical bacterial infections linked to neonatal sepsis, as well as their pattern of antibiotic sensitivity. Materials and Methods: A total of 100 newborns admitted to the neonatology unit during the study period had their physical examinations and clinical characteristics. All infants were observed using conventional methods and the Kirby-Bauer disc diffusion method. Samples were also tested for standard antibiotic sensitivity.  Results: The present study showed that out of 100 clinically suspected neonatal sepsis cases. 44% newborn sepsis patients with clinical suspicion and positive screening test results were confirmed by culture. The majority pathogen in the culture-positive cases was discovered to be Gram Negative 66% (n= 29); among them 62.06% (n=18) belonged to EONS and 37.93% (n=11) belonged to LONS. Klebsiella pneumoniae 46.15 % (n=12) was the most common isolate followed by Escherichia coli  23.06 %(n=6) whereas 34 % (n=15) were Gram Positive isolates. Out of 15 Gram-Positive isolates, 53.33% (n=8) were of EONS and 46.7 % (n=7) were of LONS. Staphylococcus aureus 19.23% (n=5) was the most common isolate followed by CoNS 7.69 %(n=2) and Enterococcus faecalis 3.85% (n=1).  Conclusion: The timely diagnosis and prompt use of antibiotics according to standard policy is warranted to save newborns from septicemia. Knowing the bacterial infections that are widespread in NICUs and their antimicrobial susceptibility pattern can assist the doctor choose the right drugs for treating cases of suspected newborn sepsis in light of the developing bacterial resistance to commonly used antibiotics

Acute & Transient Psychotic Disorders(ATPD) are a heterogeneous group of disorders and they need to be differentiated from Schziphrenia and organic psychotic disorders.Previous studies have observed significant association of Acute & Transient Psychotic Disorder (ATPD) with summer onset, fever, and viral & protozoal infections, suggesting contribution of biological factors in occurrence of ATPD. Methods: This study was undertaken using Magnetic Resonance Imaging (MRI) of brain in patients with ATPD in a hospital setting. 20 consecutive in-patients of ATPD were subjected to MRI of brain during active psychotic phase and they were subsequently followed up for their course for next six month to see their diagnostic stability. Results: Twenty percent of patients showed significant MRI changes in the brain. Significantly more patients of ATPD associated with schizophrenic symptoms had MRI brain change like hyperintensity foci and temporal sclerosis. Conclusion: Findings indicate that the subgroup of ATPD with schizophrenia like symptoms exhibiting more MRI changes may be closure to schizophrenia than other subgroups of ATPD

The Nottingham prognostic index (NPI) is a tool that takes into account the histological features of the tumor, which helps in the prediction of outcomes and supports clinical decision making while managing breast cancer patients. Hormonal receptors particularly estrogen, progesterone and HER2NEU receptors are present in the tumor tissue, considered as an important advancement in the evaluation of breast cancer. Objective: To calculate Nottingham Prognostic Index in newly diagnosed patients of breast carcinoma and to compare prognostic efficacy of molecular markers ER, PR, HER2NEU expression with Nottingham prognostic index. Material and Methods: A total 125 diagnosed cases of breast cancer were enrolled. Nottingham Prognostic Index was calculated from the histopathology report and molecular markers. Prognostic efficacy of molecular markers was compared with Nottingham prognostic index. Results:  After statistical analysis, ER expression was positive in 66 (53%) patients, PR expression in 55 (44%) patients and HER-2-neu expression was positive in 22 (18%) cases. Mean Nottingham Prognostic Index was found to be 4.99±1.23 SD. Molecular Markers were found to have an excellent prognosis in majority of group and Nottingham Prognostic Index show majority group has moderate prognosis value. No significant difference was observed between the Nottingham Prognostic Index and molecular markers receptors cases (p>0.05). Conclusion: The Nottingham Prognostic index is a better tool for prognosis determination than Immunohistochemistry markers in diagnosed cases of carcinoma breast

Background: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behaviorBackground: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behavior

Galactocele is a benign breast lesion that occurs commonly during lactating period. It can occur either in normal breast tissue or in accessory breast tissue. We report a galactocele in the left accessory breast tissue. The patient is a 23-year-old female, a mother of two children, who presented with a considerable painful swelling in the left axilla, which is clinically diagnosed as lipoma; however, subsequent investigation revealed it to be a galactocele. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes in normal breast tissue, such as mastitis, galactocele, fibrocystic disease, and carcinoma. Galactocele can sometimes also present as suspicious tumoral lesions in axillary accessory breast tissue

Introduction; Increased oxidative burden plays an important role in the pathogenesis of Chronic obstructive pulmonary disease (COPD).GGT (gamma-glutamyl-transferase) has been regarded as a novel marker of oxidative stress and CRP as inflammatory marker over the last few years. There exists a delicate balance between the toxicity of oxidants and protective function of antioxidant defence systems which is critical for the maintenance of normal pulmonary functions. Aims and objectives; This study aimed to compare the serum levels of GGT & CRP during stable and acute exacerba¬tions of COPD and its relationship with inflammation. Material and Methods; The study involved 120 patients with exacerbated COPD and normal function of the liver and biliary tract (mean age, 65.8 ±9.6 years;) and 120 patients with stable COPD (mean age, 64.5 ±7.9 years;).  Serum GGT and C‑reactive protein (CRP) levels were measured and compared between the groups. Result ; Serum GGT levels in patients with exacerbated COPD (AECOPD )were significantly higher than in those with stable COPD ( 25.3 vs. 18.6 U/l; P <0.001]. Serum CRP levels were significantly higher in patients with exacerbated COPD compared with those with stable COPD (59.6 vs. 17.4mg/l;  P<0.001). Conclusions; Our study indicates that serum GGT levels as the marker of oxidative stress increase significantly during exacerbated COPD and have a positive correlation with CRP levels as compared to stable COPD

Introduction: Blood is essential part of life saving treatment options in medical sciences. Various blood group systems have been identified till now but different human populations express to have different frequencies of blood types. The prevalence of blood groups differs distinctly in different parts and groups of populations around the globe.The information about distribution of blood groups in an area is of great value for better inventory management. Aim and Objective:To determinethe prevalence of ABO-Rh(D) blood types in apparently healthy population in Kota (Hadoti region). Material and Method: This blood centre based cross sectional study was carried out during the period of one year, i.e., from 1st January, 2021 to 31st December, 2021.During that period,5,657 blood donors donated whole blood at our blood centre and among the outdoor camps. ABO and Rh (D) typing was done by saline agglutination method done manually using commercially prepared antisera (for forward/cell grouping) and in house prepared reagent cells (for reverse/serum grouping).Descriptive analysisof sex and blood groups was done by using Microsoft Office Excel 2007. Results: Male donors 97.83% were more than female donors2.17%with M:F ratio being 45:1. 4.68% were detected to be having Rh (D) negative blood group while 95.32% were Rh (D) positive. Distribution of ABO-Rh(D) blood typesamong was found to be B+(36.70%)>O+(30.63%)>A+(19.32%)>AB+ (8.66%) > B- (1.75%) >O- (1.61%) > A-(0.92%) > AB-(0.41%). Conclusion: Present study concludes B+ being the most common blood group and Rh (D) negativity being 4.68% in the Hadoti region of Rajasthan. We recommend multicentricstudies with larger sample size to be conducted and comparative analysis to be done to more precisely understand the distribution pattern of blood groups in this region

Background: COVID 19 positive pregnantwomen form a very vulnerable group.  It adversely affects their physical and psychological health. These women are likely to develop new health problems or aggravation of existing problems during pregnancy and in the post-partum period. Materials and Methods: This was a prospective observational study of 100 consecutive Covid positive pregnant women who were admitted in the isolation wards of Government Medical College, Thrissur and delivered during the study period from 1st may 2021. These women were followed up till 6 months postpartum. Data was collected from recordsand bypersonal interview or telephonic call using astructuredquestionnaire. Demographic profile, Covid symptoms and their severity, obstetric details, breast feeding practices, neonatal outcomes and post Covid symptoms were studied. The association between breastfeeding, hygiene practices and neonatal positivity was also looked into/. Results: 51% of Covid positive pregnant women were asymptomatic. Nine women had severe Covid pneumonia with 2 of them requiring ventilatory support. There were no cases of vertical transmission or transmission through breastfeeding among the newborns studied. There was a strong association between strict adherence to hygienic practices and neonatal positivity. 24% of women had persistent symptoms at 6 months postpartum. Post exertion malaise was most commonly observed. Conclusion: Women with COVID-19 infection during pregnancy may continue to have health problems and hence need a close follow up

Background and objectives: The ankle is the most distal weight-bearing joint and the stability of the ankle mortise is crucial to the capacity to move. Distal fibula fracture management is uncertain because of the wide diversity of implants and fracture types. The purpose of this research was to compare the efficacy of closed reduction internal fixation with open reduction internal fixation in treating fractures of the lower fibula (at the syndesmotic level, Weber type B) in conjunction with breaks of the lower tibia or medial malleolus. This randomized controlled trial assessed different functional modalities and complications associated with fibula fixation. Methods: During January 2022 to January 2023, 75 patients with a lower fibula fracture (Weber type B) were enrolled in a randomized prospective and comparative study at Department of Orthopaedics, Ayaan Institute of Medical Sciences, Kanakamamidi, Moinabad, Telangana, India. The CRIF method was used on 45 individuals, whereas the ORIF method was used on 30 others. Results: Although the union rate was higher with plating, the functional score was higher and there were fewer difficulties with nailing. Conclusion: The nailing in the lower fibula fractures is preferable to the plating of comminuted ankle fractures. Crif and orif are equivalent for post-weight-bearing syndesmotic failure. The syndesmotic ankle becomes more rigid after receiving an Orif

Background: Preeclampsia is a multi-system disorder of pregnancy that manifests after 20 weeks of pregnancy in previously normotensive women. It is characterised by new-onset hypertension (systolic and diastolic blood pressure of 140 and 90 mm Hg, respectively, on two occasions, at least 6 hours apart) and proteinuria (protein excretion of 300 mg in a 24 hr urine collection, or a dipstick of ≥ 2+). AIM: To evaluate the utility of placental laterality and uterine artery doppler in the prediction of preeclampsia. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Anil Neerukonda Hospital.  Study Period: 1st January 2020 to June 2021. Study population: All Antenatal cases referred to the department of Radio-Diagnosis for clinically suspected Pre-eclampsia.  Sample size: study consisted of 86 subjects.  Sampling method: Simple random technique. EQUIPMENT: The study will be performed using Philips AFFINITY 50G ultrasound machine using a 3-7C curvilinear probe. SCANNING TECHNIQUE: A written informed consent was taken before performing the scan. The scan was performed with patient in supine position and moderately distended bladder. Data Collection: Basic demographic details, clinical data obtained from study subjects were recorded in a pre-designed proforma. Location of the placenta and uterine artery doppler velocimetry was performed by using convex probe. During the first and second trimesters of pregnancy, ultrasound was used to identify uterine arteries on each side of the uterocervical junction. In third trimester it was seen at the crossover of external iliac vessels. Sample box was 2mm. Insonation angle was less than 60 degrees. Angle dependent Doppler indices are obtained during each examination. Results: In our study 63 (74%) subjects had central placenta and 23(26%) subjects had laterally located placenta. Fourteen of the 86 patients developed preeclampsia; eight (57%) had unilaterally located placentas while only six had centrally located placentas. According to our study, 8 (34%) out of 23 women bearing lateral placentas alone developed preeclampsia whereas 6 (85%) out of 7 women bearing lateral placentas with Doppler abnormalities developed preeclampsia. Conclusion: A lateral placenta puts a pregnant woman at significant risk of developing preeclampsia. In lateral placentas co-occurring with uterine artery Doppler abnormalities, preeclampsia risk significantly increases as compared to those of lateral placentas alone

Background and objectives: Shoulder dislocations from automobile accidents are on the rise, making shoulder instability a widespread problem among young people today. to examine the association between these clinical and radiological results and arthroscopic findings, to compare the clinical outcome of arthroscopic treatment to open repair of anterior shoulder instability, and to treat these injuries arthroscopically. The essay aims to achieve these ends. Method: This study intends to investigate 25 cases of anterior shoulder instability by clinical, radiological, and arthroscopic methods in order to compare open repair versus arthroscopic therapy of these injuries. Result: We performed diagnostic shoulder arthroscopes on 25 people who had been diagnosed with anterior shoulder instability. According to the results of the procedure, all 25 patients had Bankart's lesions, and 16 additionally had Hillsach's lesions. Although bone loss in 14 of the 16 patients with Hillsach's lesion was less than 10%, they were candidates for arthroscopic Bankart's repair. The other two patients had bone loss of 13%-15%, making them surgical ineligible. In this procedure, the coracoid process was moved to the front of the glenoid using the Tasaki method and then set in place. Conclusion: "Arthroscopic Evaluation and Management of Anterior Shoulder Instability" is the best way to assess instability because of its higher specificity and sensitivity in recognising pathology compared to an MRI, its outstanding results when fixed with suture anchor points, and its outstanding range of motion

Background: The most frequent cause of morbidity among newborns is respiratory issues. That is the most frequent reason for admission to a NICU. In order to manage newborn distress and improve clinical outcomes, early detection of the aetiology of respiratory distress is crucial [3]. A combination of symptoms called respiratory distress results from illness processes that impair gas exchange. Objectives: To identify the etiological factors of respiratory distress in the early neonatal period and its immediate outcome. MATERIAL & METHODS: Study Design: Prospective Hospital based descriptive study. Study area: SNCU, Department of Pediatrics, Siddhartha Medical College, Vijayawada. Study Period: January 2020- December 2020. Study population: Full-term neonates with respiratory distress GA (≥37 weeks). Sample size: study consisted 207 study subjects. Sampling method: Simple random technique. Study tools and Data collection procedure: Full-term (gestational age 37 weeks and above) neonates (only inborn) admitted in SNCU Ward of Government Siddartha Medical College & Hospital, with respiratory distress, were consecutively recruited into this descriptive study after getting informed consent from the parents. The early neonatal period (full-term neonates admitted to the NICU with respiratory distress that started within 7 days of birth) was the focus of the study. Instances that were unfollowed were not included in the analysis. Results: Out of the 89 TTN cases, 47 were born early term & 42 were late-term, out of 33 birth asphyxia cases, 19 were born early term and 14 were born late-term, out of 19 CHD cases, 5 were born at early term and 14 were late-term, out of 22 sepsis cases 9 were early term and 13 were late-term, out of 7 surgical cases, 5 were born at early term and 2 were born late-term. 1 case of RDS was born late-term. Out of 2 cases due to other causes, 1 was early term and 1 was late-term. Thus TTN, surgical causes, and Birth asphyxia were common in the early term. CHD, MAS, and Sepsis were common in late term. CONCLUSION: From our study it can be concluded that the most prevalent reason for neonatal admission to the NICU was respiratory distress. TTN was the commonest cause of RD in term neonates, followed by Meconium aspiration, Perinatal asphyxia, Sepsis and pneumonia, and Congenital Heart Disease. Males are more likely than females to experience respiratory distress. Pneumonia are the most common causes of mortality

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. Methods: This is a prospective, descriptive and observational study conducted at Department of Microbiology, Ayaan institute of medical sciences over a period of 1 year included 410 patients. Patients of either sex of any age who have been admitted inward and on antibiotic therapy were included. Outdoor patients were excluded in our study. Conducted from various clinical Departments such as Medicine wards, Surgical wards, Paediatric wards and Orthopaedics wards. All data was be documented and reviewed periodically. Any deviations from the agreed criteria were communicated, discussed, and documented. Results: On the basis of gender, frequency of Male patients were recorded little bit higher (62.6%) than female (37.4%). So, the hospital attendance rate of this study was male predominant. Majority of subjects belonged to 21-40 years (32.1%) followed by 1-20 years (29.5%) of age range. When it is categorized according to ward, in Medicine ward was recorded 34.8%, and for Orthopaedics it was 20.0%, while 30.9% for surgery and 14.1% paediatrics wards. For this study, subjects were categorised in eighteen groups on the basis of their diagnosis. Out of which, majority of the population (20.50%) were found with diagnosis of carcinoma followed by orthopaedic diseases (19.90%), while least number of patients (0.9%) were diagnosed with ophthalmological as well as thyroid diseases. Beta lactam and Cephalosporin were found the most frequent used first antibiotic even after surgery. Even for the each wards, Beta lactam and Cephalosporin were recorded highly significant and most desirable choices among all the antibiotics. Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits

Introduction: Chronic kidney disease (CKD) is characterized by a progressive loss of renal function that often leads to end-stage renal disease (ESRD), high risk for cardiovascular disease, and high mortality. Diabetes mellitus is a growing epidemic and is the most common cause of chronic kidney disease (CKD) and kidney failure. Diabetic nephropathy affects approximately 20–40 % of individuals who have diabetes, making it one of the most common complications related to diabetes. Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. The kidneys play a vital role in the excretion of waste products and toxins such as urea, creatinine and uric acid, regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations, as well as the production of hormones like erythropoietin and 1,25 dihydroxy vitamin D and renin. Material and Methods: This is a prospective and observational study was conducted in the Department of Biochemistry at Tertiary care Teaching Hospital over a period of 1 year. Either Gender aged between 18 and 70 years. The study participants were signed written informed consent before the start of data collection. The study participants were selected based on a convenient sampling technique and total of 120 study participants were included.  Subjects suffered from an acute infection and critically sick individuals were excluded from the study.  Results: There was a significant difference  between case when compared to  Control in Male and female.  There was a significant difference in case group in FBS, HbA1c, Urea and S. Creatinine when  compared to control group and no significant difference between both groups in SBP and DBP. Conclusion: The present study it can be inferred that serum urea and creatinine levels were significantly higher in CKD subjects then control subjects. Increased amount of urea and creatinine levels were seen only in CKD subjects and no difference was seen in controls. Thus, it can be recommend that urea and creatinine values can be used for screening of renal status in CKD subjects

BACKGROUND- Brachial plexus blockade provides superior pain control with excellent intraoperative anaesthesia as well as post-operative analgesia in upper limb surgeries, eliminating the need for intra-operative opioids and minimizing the need for post- operative opioids. Local anaesthetics, singularly, for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia. Magnesium Sulphate( MgSO4) has been shown to circumvent the nociceptive effects by blocking the N-Methyl D -Aspartate receptors and associated Ca+ channels, thus preventing the central sensitization caused by peripheral nociceptive stimulation, thus MgSO4 was selected as an adjuvant to local anaesthetics in this study, as it prolongs the duration of analgesia in the post-operative period. This study tends to focus on the advantage of using magnesium sulphate as an adjuvant to bupivacaine on the post operative analgesia as well on the duration of sensory and motor blockade in the patients undergoing upper limb surgeries. MATERIAL AND METHODS  The study was carried out after obtaining Ethical clearance with 90 patients of ASA I -II group scheduled to have arm & forearm surgeries. The patients were randomly divided into two groups. Group BM (n=45) receiving 0.5% Bupivacaine (1.5 mg/kg ) + Magnesium sulphate 2 ml of a 10 % solution diluted to make a net volume of 30ml  and  Group B (n=45) receiving 0.5% Bupivacaine (1.5 mg/kg )+ 2 ml of normal saline, diluted to make a net volume of 30 ml. Sensory & motor block characteristics  were assessed with pinprick & Modified Bromage Scale. Haemodynamic changes & side effects were also  observed & recorded . These were compared with the same stimulation in the contralateral hand. Statistical analysis was performed using Student t test and Chi square test. RESULTS.  In our study, we found that the onset of sensory block was 13.70 ± 2.22 min in Group BM and 19.42 ± 2.49 min in Group B showing highly significant difference (p < 0.01) between the study groups & the mean time for onset of motor block for group BM to be 18.67 ± 2.35 min and 25.37 ± 2.81 for group B showing highly statistical significant difference (p < 0.01) in between the two groups. The mean time duration of motor block for group BM was 332.95 ± 87.85 min and that for group B was 229.08 ± 45.38 min showing statistical significant difference (p < 0.01) in between the two groups. The mean duration of analgesia for group BM was 473.44 ± 88.05 min and that for group B was 278.11 ± 65.10 min. There is a highly statistical significant difference (p < 0.01) in between the two groups. In our study, systolic BP, diastolic BP, MAP, heart rate, SpO2 and respiratory rate were comparable in both the groups and the p value was found to be insignificant. No side effect was noticed in both the groups. CONCLUSION Group BM (0.5 % Bupivacaine + 2 ml of 10 % magnesium sulphate) showed a shorter onset for both sensory and motor blockade with a significantly increased duration of post operative analgesia.

BACKGROUND: Motor vehicle accidents are one of the major causes of facial injuries. Midface is the common site to get involved. Midface fractures are frequently involved with head injury or associated with other facial fractures or in isolation.Mid face fracture patterns were first published by a French surgeon Rene Lefort in 1901.At present midfacefractures rarely fit into Lefort classification patterns.The changes in the lifestyle led to increased use of advanced motor vehicles which increased the road traffic accidents.The fractures are deviated from the Lefort patterns due to changes in the velocity,forces direction of impact on the skull. To emphasize the need for more comprehensive classificationto include variations in midface fractures patterns such as unilateral fractures, asymetricalLefort fractures,associated fractures etc., OBJECTIVE:A prospectiveobservational  cross sectional  study to assess various patterns of maxilla fractures in relation to age,sex and mode of injury. MATERIALS AND METHODS:Study includes patients presented to Plastic Surgery department in King George Hospital,Andhra Medical College from  June 2014  to May 2021.Patients were examined clinically and reviewed  with 3D CT facial bones .Injuries were classified using Lefort system and those fractures deviated from Leforts are noted. RESULTS: Evaluation of midfacial fractures done among facial bone fractures.Total number of patients in the study are 685 with 9.5 :1 male to female ratio.The peak incidence is in the age group of 21-30 years.The most common cause beingroad traffic accidents.Mid face fractures which are deviated fromlefort fractures aridentifie and evaluated.Different patterns in midface are observed with the help of radiological imaging.Among midface fractures majority doesnot fit into classical Leforts .Only 8.5%  constitutesLeforts patterns.

Incisional hernias are a very common problem encountered by a surgeon and has followed abdominal surgery like a shadow for more than a century now. Incisional hernia is a truly iatrogenic hernia. In this prospective study, all patients (50 cases) presenting to the opd of general surgery in Katuri medical college & hospital over a 2 year period, have been selected ensuring there was no obstructed or strangulated incisional hernias/ intra abdominal malignancies / patients with severe co-morbid conditions (severe cardio-pulmonary disease, uncontrolled ascites)/ pregnant women with incisional hernias/ recurrent incisional hernias. The aim was to  evaluate the outcome of anatomical and mesh repair of incisional hernia with reference to technical difficulty, convalescence, wound infection and recurrence. A majority of patients were in the age group of 31-40 years and was more common in females than males with a female to male ratio 7.2 : 2.8 It was found that 36% of patients had an onset of symptoms within one year of previous surgery, whereas, 22% of patients had an onset between 1-5 years,14% had onset between 5-10 years and 28% after 10 years. Meanwhile, 88% of patients had hernial defect size of less than 5 cm in diameter, 8% had a defect size in between 5-10 cm, however, only 4% had a defect size of more than 10 cm in diameter.The study had found 3 patients in the anatomical repair group and 11 patients in the mesh group had developed post operative complications; most common of which were: 1. Wound infection in the anatomical repair group (8%). 2. Seroma was seen in the mesh group (24%). 3. All the 25 cases in each group were followed up for a period of 1 year and no recurrence was noted.

Lower urinary tract infections are accountable for a huge number of presentations in general practice and were treated with regular antibiotic prescriptions. But, they cause a significant financial burden while seeking treatment services. In our prospective study, that took place over 18 months at Katuri Medical College and Hospital, was done to determine the etiology and treatment modalities of lower urinary tract symptoms. Our Objectives were- 1. To assess various etiological factors causing lower urinary tract symptoms among patients attending the outpatient department at Katuri Medical College and Hospital. 2. To investigate the etiological factor causing lower urinary tract symptoms among the patients. 3. To evaluate various treatment options available for management of lower urinary tract symptoms. Results: A total of 87 patients who were screened and a sample size of 30 cases had been selected with objective evidence of LUTS on whom an surgical intervention is needed. It was found that the highest incidence of LUTS in males was in 7th decade, and then sixth and eight decade, meanwhile, the lowest incidence was seen in ninth decade. In this present study, major proportion i.e., 73.33% (22cases) were men and the remaining 2 6.67% (8 cases) are females. Patients presented with the following complaints. 1. Frequency and nocturia were found in highest number of cases i.e., 28 (76.67%). 2. Weak Stream was in the least number of patients i.e.,11 (36.67%). 3. Intermittency and Urgency were found to be suffered by 60% and the later was observed to be present in 70% of the study subjects. The most common cause was BPH which was observed in 53.33% followed by bladder stones (23.33%), carcinoma prostate (10%), Urethral stricture (10%) and bladder carcinoma (3.37%). Out of 30 cases of LUTS, 14 underwent TURP, 5 cases underwent cystolithotripsy, 1 underwent radical cystectomy and ileal conduit, 1 underwent VIU, 2 underwent urethroplasty, 5 underwent open prostatectomy, 2 underwent cystolithotomy.

Background: Fungal keratitis is one of the most devastating microbial keratitis with the worst visual prognosis, potentially leading to blindness. The clinical characteristics of Fungal keratitis are mild pain, the insidious growth of fungal pathogens in the deep cornea, and difficult to differentiate it from other kinds of microbial keratitis early on. Therefore, the early and accurate diagnosis of Fungal keratitis by means of clinical features is sometimes impossible due to patients’ delayed visits or the great similarities of Fungal keratitis with other types of microbial keratitis in early stages of the disease. [3] Materials and methods: This is a prospective and observational study was conducted in the Department of Microbiology, SIMS over a period of 6 months. This includes 35 patients with clinically suspected fungal corneal ulcer within an age group of 15–60 years. Sociodemographic data, chief complain, history of present illness like onset, duration, associated features, aggravating or relieving factors were noted. Corneal scraping of the affected eye was collected under slit lamp illumination. The direct microscopy of 10% potassium hydroxide (KOH) wet mount and gram staining of the materials directly smeared on the slides were performed. The samples were also inoculated onto Sabouraud Dextrose Agar (SDA) plates for fungal culture at 27°C for 21 days. Result: Among the positive cases of fungal keratitis, males (65.7%) outnumbered females (34.3%) with the ratio of 1.67:1 (Table 1). The maximum number of positive cases were seen in age group of 21-30 years, followed by the age groups of 31-40 years and 11-20 years. The most common cause of Aspergillus fumigatus (28.6 %), Fusarium solani (20%), Cladophialophora bantiana and Candida tropicalis (14.3 % each), and Mucor and Candida albicans (5.7 % each), Curvularia (11.4%). Aspergillus species were found to be isolated from 50% of cases of keratomycosis.  Filamentous fungi were predominantly associated with mycotic keratitis, accounting for 71.4% of cases, as compared to yeasts which had caused keratitis in 28.6% of cases. Amongst the cases of keratomycosis (n=35), all were positive for fungal growth on culture, out of which 85.7% cases were also positive for the presence of fungal elements on direct microscopy. Conclusion: Fungal keratitis is often a severe disease in which diagnosis can be challenging, the response to medical treatment is slow, and the clinical outcome is poor. Corneal perforation is 5 to 6 times more likely with fungal keratitis than it is with bacterial keratitis. Because of serious consequences of infectious keratitis, it is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time

Introduction: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation it affects more than 5% of the population and is associated with high morbidity and mortality. It is the third common cause of death worldwide, killing around 1.2 Lakh, individuals each year. As a consequence of its high prevalence and chronicity, COPD causes high healthcare expenditure with frequent hospitalizations due to acute exacerbations and the need for long term therapy (eg, supplemental oxygen therapy, medication). Aims: The aim of this study is to evaluate right ventricular function in patients with COPD by echocardiography. Materials and methods: The present study was a Descriptive and cross-sectional case control study. This Study was conducted from April, 2021to November, 2022 at Indoor and outdoor patients of medicine, chest medicine, cardiology department of NRS Medical College, Kolkata. Total 100 patients were included in this study. Result: RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (P = 0.018). All the six patients who died had three or more abnormal RV systolic function parameters

Background: "Hypertrophic scars" are excessive scars in which the dense fibrous tissue does not extend beyond the borders of the original wound or incision. They tend to be wider than necessary for normal wound healing to occur. Histologically, hypertrophic scars have more organized collagen fibers than keloids, and scant mucoid matrix. Hypertrophic lesions are characterized by randomly distributed tissue bundles consisting of uni-axially oriented extracellular matrix and cells. Materials and methods: This is a prospective and single centre study conducted in the Department of Plastic Surgery, Tertiary Care Teaching Hospital from November 2021 to October 2022. Males and females in the age group between 18 and 60 years were included in this study. The split thickness skin graft was harvested from a normal thigh where no skin graft had been harvested earlier. Indications for skin grafting were both elective and emergency. Result: Better Aesthetic and symptomatic outcome in Triamcinolone injected skin graft donar areas. Conclusion: Injection of Triamcinolone into skin graft donar areas will reduce hypertrophic scarring significantly

Aim and objective -To compare with different site of infection & comorbidities among study group Study of various clinical features to rule out accurate diagnosis. To use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. Material and method- The present study was conducted in department of general surgery  Rajshree medical research institute , BareillyThis is an observation and comparative type of study. Result and conclusion- Healing of chronic leg ulcer is a complex process attributed to several elements. Although various parameters earlier proved to positively affect the healing of ulcers but the present study recommends that V.A.C. therapy should be considered as the treatment of choice for chronic leg ulcers owing to its significant advantages in the time to complete healing compared with conventional wound care. In this present study V.A.C. therapy overall appears to be superior to other wound care techniques

Background: No single modality of treatment for breast cancer can be the mainstay of therapy. One of them is breast conservation treatment (BCT) comprises BCS and whole breast radiotherapy. BCT is not popular among the surgeons in India (11-23% vs. > 60-70% in west). The advantages of BCS over MRM include, better body image, sexual functioning and better psychological adjustment. In view of this, the present study was undertaken to highlight the importance of BCT and comparison of post-operative events with MRM. Aim And Objective: To evaluate the possibility of BCT in cases of LABC after neo-adjuvant chemotherapy. To compare BCT with MRM in terms of quality of life and postoperative complications. Patients And Methods: The study was carried out in the PG department of General Surgery and Oncosurgery Wing of M.K.C.G. Medical College & Hospital from August 2018 to June 2021 (including 12 months of follow up period).Total no of cases included in this study are 20. We have selected stage I & II and few cases of stage III A for our study. Results: In our study, as the study period is only 2 years and follow-up period was only 12 month, so overall survival is 100% for both BCT & MRM. Recurrence rate for BCT is 15% and for MRM is 5%. Out of Several studies maximum show that overall survival rate for both BCT and MRM group are almost same and comparable. Recurrence rate in case of BCT is high as compared to MRM except in study of Fisher et al and Blichert-Toft et al where recurrence rate in MRM is high. Conclusion: It is a challenge for a surgeon to do BCS in early breast cancer case, as till now both the patients and the surgeons are in favour of MRM for reasons of safety and due to fear of recurrences. We felt that both the surgeons in the periphery and the women folks need to be made aware about the huge benefits of BCT in comparison to MRM. While selecting the patients, proper criteria must be adhered to. Radiation is a must after BCT but failing, for which the incidence of local recurrences goes up

Background: The incidence of autonomic dysfunction has increased in the presence of type 2 diabetes mellitus and various tools have been developed for assessing it. Classical autonomic function tests are one among them. Autonomic nervous system (ANS) innervates almost all organ systems and is primarily involved with homeostatic regulatory mechanisms. The important functions of ANS are maintenance of homeostatic conditions of the body; regulation of visceral activities; smoothening body’s responses to environmental changes, stress, and exercise; and assisting endocrine system to regulate various functions.  Materials and methods: This cross-sectional study was conducted in the Department of Physiology, Tertiary Care teaching Hospital over a period of 1 year. Involves participants with T2DM (n = 70) and healthy volunteers (n = 70) with an age range of 30-60 years of both genders. Subjects ranging from 30 to 60 years of both genders who were diagnosed with type 2 diabetes mellitus for 3 years duration were recruited for the study. The controls were normal healthy volunteers in the same age group. The cases were selected from diabetology OPD and endocrinology OPD according to the inclusion criteria. The controls were selected from medical OPD who were non diabetic healthy volunteers. Details of present history, treatment history were obtained. Result: There was no significance in age between cases and controls as the p value was 0.2789. The mean SDNN of cases was 29.88 ± 3.99 and for controls was 37.65 ± 4.69. The difference in SDNN between cases and controls were significant as the p value was < 0.05. The mean RMSSD of cases was 20.61± 16.81 and for controls was 22.65 ± 3.85. The difference in RMSSD between diabetics and non - diabetics were significant as the p value was < 0.05. The mean VLF % of cases was 88.75 ± 12.75 and for controls was 80.35 ± 8.59. The difference in VLF % between cases and controls was significant as the p value was < 0.05. The mean rise in DBP after hand grip in cases was 5.25 ± 0.58 and for controls was 12.18 ± 3.94. Conclusion: Results of this study concluded that cardiac autonomic dysfunction was present in LT2DM patients without CAN (based on conventional autonomic test) characterized by predominant parasympathetic nerve function impairment and sympathetic overactivity.

Introduction: Prostate cancer is a disease of men. An early observation reports that more than 65% of all prostate cancers are diagnosed in men over the age of 65. Current advances in molecular techniques have provided new tools facilitating the discovery of new biomarkers for prostate cancer. High levels of leptin have been significantly correlated with testosterone and Prostate specific antigen values in subjects with Prostate Cancer compared with subjects in the control group. Adiponectin is the most abundant circulating adipokine and accounts for 0.05% of the total plasma proteins. As a consequence of these observations, and its inhibitory role on the growth of breast and endometrial Cancer cells ,it can be labelled as an Anti-Cancer Adipokine. Interleukin (IL)-6 is a pro-inflammatory cytokine that is expressed in prostate tumors and in the stromal tumor micro-environment. It is known to regulate proliferation, apoptosis, angiogenesis, and differentiation. Material and Methods: This Observational study was conducted among 120 Males, aged above 50 years, out of which 60 were prostate cancer patients and 60 were Healthy controls, who attended the O.P at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre. Men were excluded at baseline, if they had a history of myocardial infarction, stroke, transient ischemic attack, unstable angina, cancer or current renal or liver disease, peptic ulcer, gout, or use of platelet-active agents, vitamin A, or β-carotene supplements. Serum samples of men with prostate cancer based on high prostate specific antigen (PSA),biopsy and/or abnormal DRE  and those of healthy controls were collected after an overnight fast and analysed on the same day. Serum PSA and IL-6 levels were estimated using ELISA. Plasma adiponectin and leptin concentrations were measured by competitive RIA.  Results: In our study, 60 Males were Cases of Prostate Cancer and 60 were Healthy Control group. The age of the patients was almost similar in both Cases of Prostate Cancer (66.23±7.25) and Control group (61.01 ± 7.81). The PSA (ng/ml) level was significantly (<0.001) higher in PCa patients (7.12±0.80) as compared to control group (0.93±0.84). Similarly, the Interleukin-6 level was significantly (<0.001) higher in PCa patients (9.71±0.75) as compared to control group (5.9±0.61). In our study, Leptin (ng/mL) level of Prostate cancer group was 13.31±0.84 which was higher when compared to control group where it was 7.52±0.74. Adiponectin (µg/mL) Levels of Prostate cancer group were 11.72±2.34 which was lower compared to control group where it was 16.25 ±2.73. Conclusion These data further support a relationship between elevated IL-6 and prostate cancer disease prognosis. IL-6 correlates with rising PSA levels and extent of disease, and thus can be used in conjunction with other disease indicators. The multifaceted role of adiponectin in regulating several hallmark pathways that drive cancer growth suppression has been proposed in various studies. Adiponectin is an adipose tissue-derived polypeptide hormone, that in addition, to its anti-diabetic and anti-atherogenic effects also exerts anti-angiogenic properties and therefore it can be used as a target for anti Cancer therapy. On the other hand, leptin would affect PCa growth by means of factors related with obesity such as testosterone and could influence cell differentiation and Prostate Cancer progession.

Introduction: The laparoscopic cholecystectomy treatment is technically more difficult than the traditional open cholecystectomy, yet it has revitalized general surgery and quickly become the gold standard procedure for benign gallbladder disease. Even though the introduction of laparoscopic cholecystectomy has significantly changed how patients with biliary illness are managed, there are still many difficulties and unresolved problems about using laparoscopic procedures for this prevalent medical disease. There are higher odds of harm to the viscera surrounding the common bile duct. Methodology: In order to evaluate and correlate the clinical, biochemical, and ultrasonographic findings with the operative findings for anticipating challenging laparoscopic cholecystectomy, a prospective study was conducted on 60 patients undergoing laparoscopic cholecystectomy in the Department of Surgery, SCB, Cuttack, between November 2018 and October 2020. Result: The conversion rate in this study was 8.3%, and the male-to-female ratio was 1:4.4. The majority of the patients were between the ages of 41 and 50. The standard deviation was 9.9, and the average age was 41.9. The age range of 51 to 60 years has the highest conversion rate. Clinical criteria predicted that 12 out of 60 patients would be challenging cases, of which 08 were challenging surgically and 05 were converted. Out of 60 patients 05 patients were predicted to be difficult based on biochemical parameters of which 04 were difficult on surgery. Out of 04 difficult cases 2 got converted to open procedure. Out of 60 patients 07 were predicted to be difficult of which 05 were found to be difficult on ultrasonographic parameters. Out of these 05 difficult cases 03 got converted to open procedure. Conclusion: We may infer from this study that preoperative clinical, biochemical, and ultrasonographic characteristics should be used as screening techniques because they are generally good indicators of how difficult laparoscopic cholecystectomy will be. It can assist surgeons in gaining insight into any potential challenges that may arise with a specific patient.

Background: Low blood platelet counts are a defining characteristic of the illness known as thrombocytopenia. It is the most typical haematological aberration observed in people with chronic liver disease.1 It has been documented in 64%–84% of individuals with various aetiologies of liver cirrhosis or fibrosis.2 Thrombocytopenia has been regarded as one of the key signs of advanced liver disorders as a result. OBJECTIVES: 1. Identifying the correlation of platelet count, spleen size, and their ratio with the presence of esophageal varices in patients with liver cirrhosis without any previous evidence of GI bleeding. 2. Assessing the ability of these parameters as non-invasive tools to predict the presence of esophageal varices. MATERIAL & METHODS:  Study Design: Prospective Observational study. Study area: Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatient. Study Period: January 2019 to December 2020. Study population: Liver cirrhotic Patients attending Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatients. Sample size: Study consisted a total of 50 subjects. Sampling Technique: Simple random technique. Study tools and Data collection procedure: In this prospective observational study of 50 patients, newly diagnosed patients with liver cirrhosis without a history of gastrointestinal bleeding were included. Relevant clinical parameters were assessed, which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of spleen long axis diameter. Platelet count/ spleen diameter ratio were calculated for all patients. Results: Patients were grouped according to Child-Pugh Classification of Cirrhosis. Majority of study group patients belonged to Child-Pugh class C (66.00%) followed with class B (30.00%). Majority of patients belonged to the category of ratio between 501-1000 (48.00%) followed with<500 (24.00%), 1001-2000 (20.00%) and >2000 (8.00%). CONCLUSION: we conclude that the incidence of thrombocytopenia and lower PC/SD ratio can be used to establish higher grades of varices. It can be used to identify the subset of patients requiring endoscopy for prophylactic management of esophageal varices. It may further reduce the burden on the endoscopy units, avoid unnecessary screening endoscopies and management costs for bleeding varices.

Background: Elevated Lp (a) and heart disease & indicates that Lp (a) is an important, independent predictor of cardiovascular disease. Objective: To evaluate the level and effect of lipoprotein (a) in CKD patients. Methods: The present study was conducted at the PG Department of Medicine of S.N. Medical College, Agra. The tests used for the determination of left ventricular hypertrophy were done by echocardiography (quantitatively) and by ECG (qualitatively). Results: Maximum number of subjects were male (60%). Maximum number of patients were between the age of 41-50 yrs (43%). The level of lipoprotein (a) was significantly increased in hemodialysis group. Lp (a) level was measured at the baseline, 3 month and  6 month in both groups and when analyzed statistically the P value was (0.7668), (0.0413) and (0.0495) respectively.This data is suggestive that P value is significant at 3 month and 6 month which means increase in Lp (a) level at 3 month and 6 month was positively correlated with hemodialysis. LVH had a positive correlation with hemodialysis group Conclusions: Lipoprotein (a) level is more in hemodialysis patients.

Background: HIV is predominantly lymphotropic to CD4 (T-helper) lymphocytes Other cells bearing CD4 receptors are also infected (e.g, macrophages, B cells, Langerhans cells, NK cells  etc.). Objective: To  find  out  the  various  patterns and presentations of  dermatological  conditions occurring  in  HIV Patients and their association with CD4count. Methods: In this study we included 100  patients above age of 15 years who were infected with HIV Virus. Results: The most prevalent infection was candidiasisseen in 25 patients it was a definite maker for HIV disease progression and was seen in early as well as late stages of HIV infection. Dermatophytosis was the second most common fungal infection seen in 11patients. Among viral infections, herpes simplex virus(HSV) wasthemost common infection found in 12patients, Herpes zoster was seen in 8 patients. The most common non – infectious dermatosis seen in our study was seborrhoeic dermatitis in 12patients. Conclusions: Dermatological manifestations occur throughout the course of HIV infection some of the manifestations can be considered as the predictors of advanced immunosuppression.

Background: Understanding the underlying causes and risk factors of child malnutrition is essential for developing effective solutions. This study was conducted to identify the contributing factors to undernutrition in children between the ages of 6 months and 5 in Bareilly, Uttar Pradesh. Material & Methods: This cross-sectional observational study was carried out among Children between age group 6 month to 5 year visiting Pediatric department in Rajshree medical research institute and hospital (RMRI), Bareilly. All of the patients were given a thorough medical history, in-depth physical examinations, and investigations that were both routine and appropriate. Results: There were 103 (23.5 percent) subjects older than three years old, 59 (13.5 %) subjects aged 0-1 year, and 276 (63.0 %) subjects aged 1-3 years with the mean age of 33.28 years and 16.89 months. There were 254 males (58.0%), which made up 58.0 percent of the total, and 184 females (42.0%). Stunting was present in 161 (38.6%), underweight was present in 151 (34.5%), and wasting was present in 86 (19.6%). Overall malnutrition was found to be prevalent in 50.7% of the population. Both stunting and malnutrition were much more prevalent in age groups older than three years. The stunting, underweight, wasting and malnutrition were all considerably higher among those with a Class I or Class II socioeconomic status. It was shown that those with birth orders 4 and 5 had considerably higher rates of stunting, underweight, wasting and malnutrition. There was not a significant difference between males and girls in terms of stunting, underweight, wasting and malnutrition. Conclusion: The prevalence of malnutrition in children under the age of five is rather high and highlight the importance of good newborn and child feeding practises, suitable maternal care, and female literacy in the prevention of childhood undernutrition

Objective: Several new or repositioned drugs have been tried in covid19, but none have been shown to be efficacious. This observational study was carried out because previous data showing effect of remdesivir in treatment of moderate to severe covid19 patients were controversial. Method: A retrospective analysis was carried out of moderate to severe covid19 patients with SpO2 level<94% admitted in hospital after approval of the ethics committee. Patients were divided in 2 groups according to treatment received, standard treatment (Group A) or standard treatment + remdesivir (group B). Purpose of the study was to determine the difference in term of final outcome (death or recovered), change in SpO2 level, average hospitalization duration and change in laboratory values between both group. Results: There were total 1193 covid19 patients (group A: 1044 patients; group B: 149 patients). No significant difference observed in final outcome [death in group A(43.29%), group B(42.28%), P=0.88]. Adding remdesivir to standard treatment significantly reduced hospitalization duration in those recovered (P=0.0025) and improved SpO2 level significantly between day 1-5(P=0.0002), 1-10(P<0.0001) and 1-14(P=0.0001). Conclusions: We concluded that adding remdesivir in the standard treatment of the patients did not improve the final outcome (prevention of death) of the disease

Background- Given the strong correlation between cardiac disease and chronic kidney disease (CKD), it is possible that even a slight drop in glomerular filtration rate (GFR) can act as a risk factor for developing cardiovascular abnormalities. Cardiovascular disease (CVD) patients with CKD had mortality risks that were three to thirty times higher than those of the general population. Methods- This cross-sectional study was conducted in the Medicine unit of Postgraduate Medical Center of Central India within 6 months duration. The analysis included a total of 140 patients who had been receiving maintenance for more than a year. Two-dimensional transthoracic echocardiography was done in each patient for the determination of cardiac structural and functional parameters such as LV hypertrophy, LV systolic dysfunction, and LV diastolic dysfunction. Results- Out of 140 patients, there were 75.7% males and 24.3% females. Maximum number of patients belonged to age group of 51-60 years. Mean age of ESRD patients was 53.3 ± 12.8. Hypertension (37.1%) was leading cause of ESRD, other causes included diabetes (21.4), diabetes with hypertension (10%), chronic glomerulonephritis (8.6%), polycystic kidney disease (7.1%), obstructive uropathy (5.7%), analgesic nephropathy (2.9%) and aetiology remained unknown in 7.1% cases. Conclusion- Left ventricular dysfunction was most common in ESRD patients. LVH was the most common ESRD echocardiographic abnormality. More ESRD patients had diastolic dysfunction than systolic dysfunction. Left ventricular hypertrophy and diastolic dysfunction were mostly caused by anaemia and hypertension. Systolic dysfunction was caused by ischaemic heart disease-related RWMA. Echocardiography detected LVH and minimal pericardial effusion before clinical diagnosis

Introduction: Induction of labor is the nonspontaneous initiation of uterine contraction to accomplish delivery prior to the onset of spontaneous labor. Induction of labor at term is a common obstetric intervention and cervical ripening in these cases is considered to be of importance. Aims: The  aim  of  the  present  study  was  to  compare  efficacy  and safety  of  two dinoprostone preparations and Laminaria tent in induction of labor. Materials and Methods: One fifty pregnant women were randomized and assigned for induction with Dinoprostone intracervical gel, Dinoprostone sustain release vaginal pessary and Laminaria tent according to inclusion and exclusion criteria. The study was carried out at Agartala Government Medical College & GBP Hospital, in the department of Obstetrics & Gynaecology from 1st January 2020 to 30th June 2021. Result: It has been observed that in our study Dinoprostone gel had shorter mean induction to delivery interval In comparison to Dinoprostone pessary and Laminaria tent which is statistically significant. The mean induction to delivery interval in D.gel group is 16.33±2.16 hours whereas D.pessary and Laminaria tent had 18.38±2.14 hours and 24.22±2.21 hours mean induction to delivery interval respectively. Though Dinoprostone gel had shorter mean induction to delivery interval in comparison to Dinoprostone pessary but that is not statistically significant that means they are alike. Conclusion: Though sometimes inconvenience might be encountered with the repeated application of Dinoprostone gel in comparison to Dinoprostone pessary and Laminaria tent, with the potential risk of infection which could be prevented by taking all precautions, yet outcome of Dinoprostone gel outweigh these disadvantages

Introduction: Fetal movement tracking may be used to identify worsening in the fetus condition. It is described as any kick, flutter, swish, or roll perceived by the pregnant women and is considered evidence of the musculoskeletal and central nervous systems' integrity. Decreased fetal movement has been linked to poor pregnancy outcomes such as intrauterine growth restriction, fetal death and preterm deliveries. Clinical data on the association between decreased fetal movements and perinatal outcome is insufficient. Methodology: Ethical clearance was obtained from SRIMANTA SANKARDEVA UNIVERSITY of HEALTH SCIENCE for study of decreased fetal movements in Gauhati medical college and hospital. A doppler study was conducted using 3 dimensional ultrasound machines in ANOPD, departmental indoor USG room, and 2 dimensional ultrasound machine in observation room in the Department of Obstetrics & Gynaecology, Gauhati Medical College& Hospital. Patients were placed in supine position with left lateral tilt and umbilical artery Wave forms were recorded in the mid position from the free floating loops. Indices noted were S(systolic)/D(diastolic) ratio, resistance index (RI), plasticity index (PI), and reversal of blood flow in diastole. CTG monitoring was done in Departmental Observation Room using a CTG machine (labelled as FETAL MONITOR, SN-EATB8L1732, manufacturer-BPL, model no. FM 9854). Each selected patient was monitored for a period of 20minutes with a paper speed of 3cm/minutes during antepartum or intrapartum status. Noted following information were: base line FHR, beat to beat variability, FHR accelerations, presence of deceleration, and reactive. Results: A prospective observational study was conducted in Gauhati Medical College & Hospital, Guwahati, Assam during a time period of one year. 150 antenatal women at term gestation with decreased fetal movements without any other high risk conditions were monitored for fetal wellbeing by CTG and Doppler. Four groups were categorised into four groups: Group I-CTG reactive and Umbilical Artery Doppler normal, Group IIA, Group IIB, and Group III. The findings of each group were compared with different modes of delivery and different parameters of perinatal outcomes. Conclusion: Maternal perception of fetal movements is the most widely used technique to evaluate fetal wellbeing. Low-risk pregnancies with decreased fetal movements should be monitored for close antenatal fetal monitoring, appropriate and prompt interventions. Non-reactive CTG alone or with combination of abnormal Doppler results are better predictors of poor perinatal outcome and can indicate if neonatal resuscitation is required. These two tools can be used together for fetal monitoring and appropriate intervention at the correct time to improve the perinatal outcomes

Introduction: Hyperbaric bupivacaine (0.5 %) has been the gold standard drug for the safe conduct of spinal anaesthesia in recent times. Various additives have been used along with hyperbaric bupivacaine to prolong the duration of analgesia. Out of these, fentanyl and midazolam have been two of the most commonly used. Here a clinical study was undertaken to compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal bupivacaine for spinal anaesthesia. Aims: To compare the effects of intrathecal midazolam 1mg and fentanyl 25 μg as additives to 3ml of 0.5% hyperbaric bupivacaine (15mg) for spinal anaesthesia with respect to the onset and duration of sensory and motor blockade, duration of effective analgesia, perioperative hemodynamic changes and any side effects of these drugs. Methodology: This is a prospective randomized study studied in 100 patients posted for various elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. They were randomly divided into two groups, Group A (Midazolam) and Group B (Fentanyl) each consisting of 50 patients in the age group of 18 years to 60 years posted for elective surgeries under spinal anesthesia. Subarachnoid block was administered in L3-L4 intervertebral space. The data collected were statistically analyzed. Results: Addition of 25 μg intrathecal fentanyl to hyperbaric bupivacaine resulted in a statistically significant duration of sensory blockade (Group A ; 206.56 min; Group B ; 230.06 min) and motor blockade (Group A ; 225.56 min; Group B ; 251.88 min).  The duration of effective analgesia was also significantly longer in group B (Group A ; 246.2 min; Group B ; 264.32 min). Incidence of hypotension and bradycardia is found to be similar in both groups. There was no significant difference between the two groups with respect to the occurrence of nausea. 4% of people in fentanyl group developed pruritus where as none in midazolam group developed it. None of them had urinary retention, respiratory depression, lower limb weakness or any other neurological deficits. There were no statistical differences in the sedation scores between the two groups. Conclusion: The results suggest that the use of 25 μg intrathecal fentanyl provides longer surgical analgesia, prolongs the duration of sensory and motor blockade, and offers relative hemodynamic stability with minimal side effects. Hence fentanyl is an excellent additive to Bupivacaine for prolangation of spinal anaesthesia

Background: Caesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period. Aims: To study the maternal and fetal outcome of emergency caesarean delivery between unbooked rural referrals and booked cases. Materials and methods: This is a Comparative cross sectional study was conducted in the Department of Obstetrics and Gynaecology in Gestational age > 37 weeks, Unbooked cases handled outside and referred, who underwent caesarean delivery on emergency, Booked cases admitted in our hospital and underwent emergency caesarean delivery and Singleton pregnancy. Results: This study included 980 antenatal patients who underwent emergency caesarean section, among them 420 were booked cases and 560 were unbooked cases. The incidence of emergency caesarean section was more in unbooked group compared to booked group.  This comparison of age, Teenage pregnancy, parity, socioeconomic status had  statistical significance with p value < 0.05. The major indication of emergency caesarean section in booked cases was previous caesarean section (29.26%), where as it was fetal distress (22.6%) in unbooked group. Septicaemia in unbooked group (4.6%) was more than booked group(1%).66 cases (11.8%) of unbooked group and only 21 cases (4.9%) of booked group had wound infection. Postpartum haemorrhage, Perinatal mortality, NICU admission rate statistically significant among the two groups. Maternal intrinsic factors such as nutrition socioeconomic status and lack of antenatal care have been suggested as the causative factors in the unbooked patients. Conclusion: Poor utilization of antenatal care is associated with adverse feto-maternal outcome. Most maternal deaths are preventable if complications are diagnosed early and managed effectively in time .Early admission and management of critical obstetric patients decreases maternal morbidity and mortality

Background: ß-thalassemia is one of the most common autosomal recessive disorder ranging from clinically silent heterogenous thalassemia minor to severe transfusion dependent thalassemia major. Blood transfusion is the primary way of treating thalassemia, but it leads to iron overload and results in serious damage to various organs by depositing in the liver, heart, and various other endocrine glands along with endocrine organ failure. Iron induced liver injury leads to high serum ferritin levels and thus in turn, accounts for the abnormal lipid profile. The purpose of this study is to investigate the lipid profile in ß- thalassemia major patients and their correlation with serum ferritin levels. Methods: 75 ß-thalassemia patients of both sexes ranging from 1-18 years, receiving multiple blood transfusions were included in the present study. Blood samples were withdrawn, analysed for serum ferritin levels and lipid profile and their correlation were assessed. Results: Out of 75 ß-thalassemia major patients, 64% were male and 72% were Sikh by religion. The mean no. of blood transfusions was 128.26±52.89 with average dose and duration of iron chelation was 1177.63±438.47 mg/day and 7.9±3.7 years respectively. The mean value of serum ferritin was 2788.05±1799.22 ng/ml. Mean HDL levels were on the lower side with an average of 21.73±8.56 mg/dl and its correlation with serum ferritin was negative (r=-0.635). The average value of serum total cholesterol and LDL were 116.1±46.15 mg/dl and 59.95±16.72 mg/dl respectively. The mean triglyceride level (TG) was on the higher side with an average of 202.87±91.57 mg/dl and its correlation with serum ferritin was positive (r=+0.845). Conclusion: Raised serum ferritin levels showed low levels of HDL and high levels of total cholesterol, LDL and serum triglycerides. Dyslipidemia in these children can lead to increased risk of atherosclerotic cardiovascular disease

Background: Breast cancer is the most common cancer in women, affecting 2.1 million women per year and accounting for the majority of cancer-related deaths among women. The use of neoadjuvant chemotherapy in the treatment of breast cancer has been shown to be effective in down staging primary tumors, clear surgical  margins and improve patient’s overall outcome. The aim of this study is to look at various factors affecting the clinical and pathological response in patients with locally advanced breast cancer after of neoadjuvant chemotherapy. Study Design: A prospective cohort study Patients and methods: This was a prospective cohort study on patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma. A total of 58 patients who presented with locally advanced breast cancer (LABC) were treated with neoadjuvant chemotherapy for 3 cycles and then were assessed for response,patients with adequate response to chemotherapy were continued further for 3 more cycles of NACT . Patients not responding to NACT after 3 cycles underwent Modified radical mastectomy. The clinical response was assessed with RECIST criteria before the start of NACT and then after 3 cycles or at end of therapy. The pathological response was checked with Chevallier’s criteria before the start of NACT and then after completion of 3 cycles or at the end of NACT. Results: A total of 58 female patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma from February 2021 to July 2022 were studied. The median age of the patients at the time of diagnosis was 53.5 years (28 – 84 years). In terms of menopausal status, 10 patients (17.3%) were pre-menopausal and 48 patients (82.7%) were post-menopausal. Histological classification showed infiltrating ductal carcinoma in 54 patients (93.2%), infiltrating lobular carcinoma in 2 patients (3.4%) patients and squamous cell carcinoma in 2 patients (3.4%). Among 58 patients, 15 patients (25.9%) had clinically complete remission (cCR), 23 patients (39.7%) had partial remission, 14 patients (24.1%) had stable disease and 6 patients (10.3%) had progressive disease. Also among 58 patients, 17 patients(29.3%) had pathological complete response (pCR) followed by 2 patients who had near to complete pathological response. Our study showed downstaging of tumor in 37 patients (63.7%) with T3 and T4 stage. Conclusion: Preoperative chemotherapy downstages the primary tumors and axillary metastasis in patients with locally advanced breast carcinomathus, it help in achieving surgically clear margins and elimination of micrometastases which may further decrease the recurrence rates and morbidity/mortality in patients

Background: Diabetes mellitus is a metabolic syndrome associated to a number of vascular and non-vascular problems. Hyperglycemia is the main presenting symptom of the metabolic syndrome. Oxidative stress caused on by hyperglycemia induced vascular damage, generation of proinflammatory cytokines, and growth factors. Chemerin was identified as an adipokine and its role in regulating adipogenesis and adipocyte metabolism was connected to metabolic syndrome. The goal of the current analysis was to assess the levels of serum chemerin in T2DM patients. Methods: The outcomes of 24 published studies that examined at serum chemerin levels in T2DM patients were exposed to meta-analysis. An estimation of the serum chemerin pooled mean was made using a random-effects model. Results: According to our meta-analysis research, the pooled mean of serum chemerin in diabetes mellitus patients was 169.82 ng/ml, which is higher than the healthy control (131.94 ng/ml).Conclusion: The meta-analyses revealed a significant relationship between diabetes mellitus and serum chemerin concentrations. These findings also suggest that routine measurement and evaluation of serum chemerin will contribute in the management of diabetes mellitus

Background: Portal hypertension is a major consequence of cirrhosis and is responsible for its most severe complications, including ascites, bleeding from gastro-oesophageal varices and encephalopathy. Measuring HVPG is very ideal to diagnosis and to grade severity. But the drawback of this procedure is its invasiveness leading to complications. So, a simple, routinely available, cost effective method for severity assessment of portal hypertension would be attractive. Methodology: It was a cross sectional study which included patients diagnosed as Chronic liver disease attending to the OPD as well as in-patients. Results: This study included a total of 100 subjects who had esophageal varices secondary to liver cirrhosis with portal hypertension. Majority of the patients were in the age group of 36 to 45 years (31%) with mean age of study subjects being 47.43 with male preponderance (87%). A statistically significant association was found for splenic size and esophageal variceal grading. 57% of the patients had splenomegaly between 13-15cm size of which 22 % had grade 3 esophageal varices followed grade 1 varices who constituted 17%. 20% of the patients had spleen size >15cm. Conclusion: Ultrasonographic measurement of spleen size > 13 cm can be considered as non-invasive predictor of presence of esophageal varices and grading in patients with Cirrhosis with portal hypertension along with other measurements like portal vein diameter and platelet count

Background: It is difficult to ascertain reliably the overall incidence and prevalence of the various cutaneous infections in different parts of the world because studies of one region of the country may not be a true representation of the overall disease pattern of that country; furthermore, incidence and prevalence figures may only will be representative of the population sampling, which may have associated risk factors for infection. Most of the studies done in this field are dealt with adults or with a specific clinical form of dermatophytosis. Only few surveys were performed in pediatric age group. Aim: To study clinical presentation of superficial dermatophytic infection in paediatric patients in tertiary health care centre. Methods: It is an observational type of study.  The present study was conducted in Department of Dermatology, Rajshree Medical & Research Institute, Bareilly, from 1st march 2021 to 28th February 2022. Results: Majority of the study population belonged to 11-15 years (48.7%) followed by 15-18 years (24.1%), 0-5 years (16.6%) and 5-10 years (10.6%). The mean age of the study population was 9.16±4.241 (0-18) years. There were 47.7% males and 52.3% females. Itching was present among most of the patients that is 226 patients had this complaint (95.3%). The most commonly affected sites was Groin (47.2%) followed by Trunk (29.9%), buttocks (29.1%), upper limbs (24.0%), Face (6.7%), Scalp (4.6%), lower limbs (4.6%) and Nails (0.4%). The predominant lesion type was Plaque (43.5%) followed by Others like  Pustules, erosions, excoriation, crusting (29.5%), Plaque with papules (16.5%), Plaque, Others (4.6%), Papules, Others (4.6%) and Macule being the least lesion type (1.3%). The most common lesion feature found in most of the study group was discoloration (94.1%). The most common diagnosis was T. corporis (29.1%) followed by T. corporis+ T. cruris (28.3%), T. cruris (22.4%). Limitations: The study was an observational study done at the first visit of the patient in OPD with no follow-up. This was major limitation of the study, since the further change of course of presentation was not noted. Also the patients undergoing any other treatment with dermatophytosis were not studied. Conclusion: Total 237 patients of superficial dermatophytosis were included in the study, out of which mean age was 9.16 ± 4.241 with female predominance (52.3%). Maximum patients were from middle school (48.9%) corresponding to age and belonged to middle class (70.5%) socioeconomic status. Common presenting complaints were itching (95.3%), affected site was groin (47.2%) and annular plaque was predominant type of lesion. The most common made in our study was T. Cruris (47.2%). More studies should be carried out in future on large scale so that this study can be corroborated to evidence. Along with that, alternation in dosage for pediatric age group should be studied

Introduction: One of the most common lower-extremity impediments in people suffering with diabetes-mellitus is foot ulceration. There is an increased risk of amputation and increased mortality rate in patients with foot ulcer. The neutrophil-to-lymphocyte-ratio (NLR) has lately been shown to forecast chemotherapy response in cancer patients, associated with peripheral arterial disease, systemic endothelial dysfunction and cardiovascular diseases. NLR is an useful measure in predicting overall mortality and disease-specific mortality.

Objectives: To evaluate the role of Neutrophil- Lymphocyte Ratio NLR in prognosis of Diabetic-Foot-Ulcer (DFU)

Methodology: The outcomes of diabetic foot ulcers in 100 patients admitted to surgical wards were assessed. Demographic, patient-specific, and wound specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing and chronic ulcer. The data was entered in Microsoft excel and analyzed using SPSS version 16.

Results: The mean (SD) age was 57.1(11.29) years. 58% of subjects were females and 42% were males. The mean (SD) duration of Hypertension was 10.3(3.50) years and that of Diabetes Mellitus was 9.49(3.03) years. 53% had history of trauma, 48(48%) of subjects had pain, 51(51%) had gangrene of foot. The mean (SD) CBP, Neutrophils, Lymphocytes and Neutrophil-Lymphocyte Ratio was 20.24(2.89) per thousand, 94.73(3.21) %, 14.97(3.23) % and 6.65(1.52) respectively. 58% had healing ulcers and 42 had non healing ulcers. 44% of study subjects were having NLR <6 which is normal and 56% had NLR>6 which is abnormal. Among 58 subjects with healing ulcers, 44(75.9%) had NLR<6 and among 42of non-healing ulcers, 42(100%) had NLR >6. This was statistically significant (p value <0.001). The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was 75% and negative predictive value was 100%. The mean (SD) NLR in healing group was 5.15(0.65) and in non-healing group was 8.205(0.84) and this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with poor prognosis.

Conclusion: NLR is a good prognostic variable in predicting the outcome of Diabetic foot ulcer. The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was75% and negative predictive value was 100%.

Prospective observational study, to formulate a risk scoring system that can predict the risk of amputation in a patient with an infected diabetic foot in patients presenting to the OPD and IPD of Katuri medical college &hospital, Chinakondrupadu, Guntur. Atotalof203patients in the duration from December 1st, 2020, to June 1st, 2022 presented with infected diabetic foot ulcerto our hospital, of which150 were enrolled in the study.

Using the specificity and sensitivity of our 11 risk factors, we constructed a ROC curve according to which our new Risk score had a high prognostic accuracy based on the area under the curve of 0.903, which was higher  than  the International Working Group on the Diabetic Foot (IWGDF) system which was 0.67. The Resultant ROC curve yielded a cut off score of 16.5.

Our study found the risk of amputation increases with the severity of the infection reflected in our study, with the highest incidence rate of 44.7%ofamputations belonged to IDSA grade4. An association between HbA1c levels and Lower extremity amputation can be drawn, with the maximum number of amputations identified in patients with HbA1c≥9.5. A strong correlation between the previous history of diabetic Lower extremity amputation and present amputation. 77.8% of patients who had a history of lower extremity amputation due to diabetes underwent amputations. 68.1 % of patients who underwent amputations had sensory neuropathy in ≥3sites.

A total of 9 patients required re amputation and 26 patients who were our previous amputee subjects required re debridement within a period of 18 months. All the patients who underwent re amputation had a score of>16.5.

Thus our score predicted the need for future amputation in those patients who had a Score of > 16.5.

Limitations of our study are:

1. The effect of our risk factors on major and minor amputations separately were not assessed.
2. The history of the previous lower extremity revascularization procedure was not taken into account while calculating the score.
3. The effects of venous insufficiency on diabetic foot ulcers in this study were not accounted for.
4. The motor neuropathy was not segregated into subsequent grades based on the muscle power

The effects of type 1 and type 2 diabetes was not studied independently

The second covid wave caused unprecedented havoc, morbidity and mortality all over India. This retrospective study delves into the disastrous impact of Covid 19 second wave in the pregnant population at our tertiary care center. This retrospective study was done to bring insight into demographical factors, associated comorbidities, mode of delivery, role of inflammatory markers, treatment administered, complications in pregnant women who were severely affected by COVID -19. Material and Methods: This retrospective observational study collected data from 1 April 2021 to 30 June 2021. A total of 40 pregnant COVID-19 patients admitted during the second wave of COVID-19 infections were included in the study. All demographic characteristics like age, parity, type of conception, BMI, associated comorbidities, symptoms and their duration, type of oxygen support, the inflammatory markers (IL6, serum ferritin, N/L ratio, LDH), mode of recovery and outcomes were analyzed. Statistics: Data was collected, summarized, tabulated using Microsoft Excel and expressed as percentage. Results: Of the 40 COVID- 19 cases, 10 pregnant women succumbed to COVID- 19. Age above 30 years and higher BMI was associated with all mortalities. Fever and Breathlessness was a common symptom in all. All women who succumbed had falling SPO2 levels and all were on higher oxygen support. CRP, D- dimers and IL-6 levels are markedly increased in all the fatalities who were infected by COVID-19. Conclusion: The second COVID-19 wave affected the pregnant population the most. The outcomes of women who were on higher oxygen support was worser. Serum Ferritin and IL-6 was raised in all patients with worse prognosis

Introduction: Haemorrhoids of grade 3-4 and prolapsed haemorrhoids need surgery. Previously, surgeons used to perform Milligan-Morgan open technique, but after the introduction of stapler haemorrhoidopexy, most surgeons prefer this technique. It involves the removal of rectal mucosa and haemorrhoidal tissue 4 centimetres above the dentate line. Stapler haemorrhoidopexy in the recent past has been accepted as the preferred modality of surgery for grade 3 and 4 haemorrhoids, though traditional method of open haemorrhoidectomy is still performed. Various previous studies have proved that stapler and open technique have the same results in efficacy but the complications are lesser with stapler haemorrhoidopexy.

Aim: To correlate the presence of muscle fibres in the doughnut of stapler haemorrhoidopexy with post-operative complications.

Results: This is an observational study conducted in 80 patients who underwent stapler haemorrhoidopexy for internal haemorrhoids. Most of the patients are between 20 to 40 years (42.5%) with mean age of 36 years. Early post-operative complications in patients with muscle fibres in donut of stapler haemorrhoidopexy specimen were mainly post-operative pain. All 7 patients (100%) suffered from severe pain at operative site i.e. VAS score > 6 (p- < 0.001**). 5 out 7 patients (71.4%) patients had post- operative urinary retention (p-0.009**) and post-operative bleeding per rectum is seen in all 7 cases (p- < 0.001**). All the early post-operative complications are strongly clinically and statistically significant. And in late post-operative complications proctalgia was seen in 3 (42.9%) patients (p- < 0.001**) which was also strongly clinically and statistically significant.

Conclusion: Early complications like post-operative pain, urinary retention and post-operative haemorrhage in patients with muscle fibre in donut are clinically and statistically significant. (P- < 0.001**). Late complications like proctalgia is clinically and statistically significant. (P- <0.001**).

An experienced surgeon and proper stapler haemorrhoidopexy technique is required to avoid such complications

Background: IThis hospital-based prevalence study was carried out to evaluate the clinical and epidemiological profile of anaemia in central India. Methods: In this study, 200 patients with anaemia from medical outpatient departments and indoor wards were randomly selected without regard to gender, occupation, socioeconomic status, or disease duration. Results: According to the findings of this study, the majority of patients (40%) were between the ages of 21 and 30. Females had a higher prevalence of anaemia than males between the ages of 15 and 30. The study population has moderate anaemia in 57% of cases, and severe anaemia in 41% of cases. Weakness and easy fatigability were the most common (100%) presenting symptoms, and pallor was the most common (98%) clinical sign. The most common laboratory findings were microcytic and hypochromic type peripheral smears (59 percent cases). The most common type of anaemia was nutritional anaemia (84 percent). Conclusions: Lack of nutrition The most common cause of anaemia in the population is anaemia, and iron deficiency is the most common nutritional deficiency in the population.

Background: Epicardial adipose tissue (EAT) thickness reflects visceral adiposity. Association between visceral obesity and cardiovascular risk was well-established in previous studies. EAT is also associated with coronary artery disease(CAD). Measurement of epicardial adipose tissue (EAT) thickness by echocardiography can be a novel parameter that is inexpensive and easy to obtain and may be helpful not only in cardiovascular risk stratification but also in predicting the severity of CAD. Objective: In this study,we aim to assess the correlation of echocardiographic EAT thickness with the severity& complexity of CAD as denoted by SYNTAX score. Methods: EAT was measured by 2-D echocardiography in 324 patients undergoing coronary angiogram, those who presented with acute coronary syndrome and chronic stable angina. The severity & complexity of CAD was assessed by SYNTAX score from angiography. Results: Epicardial adipose tissue thickness is independently related to coronary artery disease complexity as denoted by SYNTAX scores, and EAT thickness was higher in the high SYNTAX score group. Mean EAT thickness was 10.8± 1.07 mm, 7.8± .87 mm& 3.77± 1.52 mm in the high, intermediate and low Syntax score groups (p<0.0001).At progressivethicknesses (<6, 6–8, and >8 mm), mean Syntax scores were 8.76± 5.45,22.08±4.76,and 31.28±3.22,respectively.EAT thickness had strong and positive correlations with SYNTAXscore(ρ =0.937; p=<0.001)

Diabetes is a public health problem; prevalence of diabetes is progressively on the rise. International diabetes federation estimates a doubling prevalence of diabetes mellitus by 2035 from that of 541 million in 2022. Objectives: To find out the prevalence of peripheral neuropathy among known type 2 diabetics and to correlate peripheral neuropathy with select socio – demographic variables. Materials and Methods: A Descriptive cross -sectional community-based study was done among Known type 2 diabetes mellitus individuals of age group 30 years and above. The study was carried out for a period of 10 months after getting approval from the institutional ethical committee. Peripheral neuropathy was classified using the Toronto clinical scoring system of peripheral neuropathy. Data collected was entered in Microsoft 2010 excel spread sheet, compiled and analyzed using IBM SPSS Version 22 statistical package. Results: The prevalence of peripheral neuropathy was found to be 12.6% among the study subjects. Frequency of Peripheral neuropathy was increasing as the duration of diabetes increases. A significant association was found between duration of diabetes and peripheral neuropathy. A significant association was found between increased RBS value and peripheral neuropathy. Conclusion: Maintaining a proper blood-glucose control is the key to primary prevention of diabetes related complications. Regular monitoring of blood-glucose level must be done for the management of Diabetic peripheral neuropathy.

CONCLUSION: The overall prevalence of overweight and obesity were found to be 25.62% & 14.9% respectively in the present study. The overall prevalence rates of systolic elevated BP & hypertension were found to be 11.64% & 5.4% respectively. The overall prevalence rates of diastolic elevated BP & hypertension were found to be 16.30% & 5% respectively

Objective: The role of drains in uncomplicated acute cholecystitis is a topic of debate. In this study, we aimed to prospectively evaluate the benefits and complications of prophylactic drains in both open and laparoscopic cholecystectomy following a case of uncomplicated acute cholecystitis. Materials and Methods: A total of 100 cases, under unit 1 of the department of Surgery at Nimra Institute of Medical Sciences over a period of 12 months were observed in this study. Demographic details of the patients were compared. Patients were followed for up to 1 week after the surgery to assess different complaints such as nausea/vomiting, postoperative pain, shoulder tip pain, rise in temperature, mean duration of operation and the amount of fluid collected in the drain bag. Incidence of surgical site infections were also compared. The sample consisted of both open and laparoscopic cholecystectomy cases. Results: Drains were placed in 50 patients. The overall complication rate was higher in the group of patients who underwent open cholecystectomy followed by a placement of prophylactic drain. Pain score on the NRS scale was highest for the group of patients who underwent open cholecystectomy followed by placement of a prophylactic drain. There was more incidence of surgical site infection in the drain group than in the no drain group. The mean duration of drain placement was 2.76 ±0.77 following open cholecystectomy and 1.84 ±0.37 following laparoscopic cholecystectomy. The mean duration of hospital stay was higher in the drain group than in the no drain  group. Patients in no drain group who underwent laparoscopic cholecystectomy complained of shoulder tip pain and nausea/vomiting more in comparison to other groups. Conclusion: There is no role of prophylactic drains following cholecystectomy in cases of uncomplicated acute cholecystitis in draining of abdominal fluids. Abdominal drains lead to increased hospital stay and the incidence of surgical site infections. Thus, routine use of abdominal drains is not advised

Introduction: Type-2 diabetes mellitus are reported to have a 2 to 3-fold increase in the incidence of cholesterol gallstones. Gallstone disease in patients with diabetes mellitus is largely due to dyslipidemia, leading to the alteration in the composition of bile. Impairment of gallbladder motility and contraction, as a result of hyperglycemia and diabetic autonomic neuropathy. Hence the study is undertaken to determine prevalence of gall-bladder disorders in diabetic patients with autonomic neuropathy and association of different parmaetrs with Cases and without autonomic neuropathy. Material & Methods: This was a hospital based case-control study carried out during the period of October 2010 to October 2012. Institutional ethics committee approved the study.The study comprised of known or newly diagnosed 101 patients of type-2 diabetes mellitus and 101 age and sex matched controls. Observation & Results: Out of 101 cases studied 67(66.33%) had autonomic neuropathy and out of 101 controls 9(8.91%) had autonomic neuropathy. Thus prevalence of autonomic neuropathy was significantly more in cases than controls.  Out of 67 cases with autonomic neuropathy 32 (47.76%) had gallbladder disorders and out of 34 cases without autonomic neuropathy 4(11.76%) had gallbladder disorders. Thus prevalence of gallbladder disorders in cases with autonomic neuropathy was significantly more than in cases without autonomic neuropathy. Conclusion: Present study concluded that Gallbladder disorders are significantly associated with metabolic syndrome in type-2 diabetics.Type-2 diabetics with autonomic neuropathy have larger gall bladders with poor contraction in response to fatty meals, thus predisposing these patients to various forms of gall bladder disease

Background: Preterm birth is defined as a delivery occurring at less than 37 weeks of gestation. It is divided into three categories: extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to <37 weeks). Similarly, preterm birth can be classified based on birth weight. Neonates weighing less than 2500 g at birth are considered low birth weight (LBW), <1500 g are considered very low birth weight (VLBW), and <1000 g are considered extremely low birth weight (ELBW). Preterm birth can also occur spontaneously or as a result of a provider's intervention (induced). Aim: The purpose of this study was to compare the neonatal outcomes of spontaneous and induced/indicated preterm births that occurred less than 37 weeks of gestation. Material & Methods: Study Design: Prospective Hospital based Comparative study. Study area: Department of Pediatrics & Department of Obstetrics, Government General Hospital, Vijayawada. Study Period: 1 year.  Study population: Singleton live preterm births <37 wk of gestational age born during the study period. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Study tools and Data collection procedure: The collected data includes A) Maternal characteristics: (i) age, (ii) parity, (iii) mode of delivery, (iv) Type of diabetes, (v) mode of control. B) Neonatal characteristics: (i) sex, (ii) gestational age, (iii) birth weight C) Physical examination was performed D) Laboratory investigations done: blood sugar, calcium and bilirubin levels, X-ray chest and abdomen, sepsis screen. Results: The mean birth weight of Spontaneous Preterm was lower than Indicated Preterm (2.036±0.3716 kg and 2.497±0.5878 kg). There was a statistically significant difference in infant birth weight between Spontaneous Preterm and Indicated Preterm. With statistical significance, the birth weight of late preterm infants was higher than that of early preterm infants. Conclusion: From our study it can be concluded that, Preterm births account for 5% of all deliveries during the study period. There were 200 (66.66%) spontaneous preterm births and 100 (33.34%) indicated preterm births among them. The mean birthweight of Spontaneous Preterm was lower than Indicated Preterm with statistically significant difference (p< 0.0001).

Introduction: Even before the culture reports are obtained, hematological alterations in sepsis can help in the early diagnosis of sepsis. One of the most common issues with neonatal sepsis is thrombocytopenia, which is also one of the most reliable independent risk factors for sepsis-related mortality. The purpose of the current study was to figure out the incidence of thrombocytopenia in newborn sepsis and to assess if it might be used as a screening test for the condition. Materials and methods: The Neonatal Intensive Care Unit at a tertiary care hospital hosted this hospital-based prospective observational cross sectional study from July 2022 to December 2022. In total, 220 neonates who were hospitalized to the NICU with suspected sepsis before turning 28 days old were included in the study. Results:  A total of 220 newborns with clinical sepsis were admitted during the research period. There included 73 (33.18%) female neonates and 147 (66.82%) male neonates. In 56 (25.4%) patients, the blood culture proved positive. The most prevalent Gram positive and Gram negative organisms were Kleibsella species 13 (23.21%) and coagulase negative Staphylococci (CONS) 23 (41.07%). 101 births (45.91%) by caesarean section and 119 (54.09%) by normal vaginal delivery were recorded. 43 neonates (19.55%) had low birth weights, while 177 had normal birth weights (>2.5 kg). SGA made up 33 (15%), AGA made up 183 (83.18%), while LGA made up 4 (1.82%). Preterm births made up 42 (19.09%), term births made up 168 (76.36%), while postterm births made up 10 (4.55%) cases. CRP was positive in 123 instances (55.91%) and negative in 97 cases (44.09%). Among the total cases, 89 (40. 45%) had thrombocytopenia, in which mild was 53 (24.09%), moderate was 28 (12.73%), severe was 8 (3.64%). Thrombocytopenia was significantly associated with Blood culture positivity, LSCS, SGA and CRP positivity. (P<0.05) Conclusion: Thrombocytopenia acts as an early predictor of neonatal sepsis and also the outcome of the neonates. Platelet counts and clinical correlation can be used in conjunction to detect early sepsis and administer prompt, effective care

Background: The ECG remains the most immediately accessible and widely used diagnostic tool for guiding emergent treatment strategies. Coronary angiography is a widely used invasive examination which is considered the reference standard for assessing presence of stenosis in the coronary arteries. Objectives: To correlate findings of ECG and Coronary Angiography in identifying culprit artery among patients with acute ST Elevation Myocardial Infarction. Methods and Material: The study was undertaken among 100 Patients aged 18years and above presenting with symptoms suggestive of Acute Myocardial Infarction as a diagnostic accuracy study. Convenient sampling technique was used to include patients in the study. Results: Most of the study participants were in the age group of 46-60 years (44%) and males (75.0%). Hypertension (44%), Obesity (28%) and Diabetes (26%) were found to be the three most common comorbidities among the study participants. Chest pain (71%), profuse sweating (57%) and chest discomfort (44%) were the most common complaints. The mean duration of symptoms among all the patients was 75.65±45.0 mins. The sensitivity and specificity of ECG  in detecting LAD involvement is 71.8% and 72% respectively. The sensitivity and specificity of ECG in detecting RCA involvement is 71% and 94.2% respectively. Conclusion: ECG was found to have good accuracy in predicting the culprit artery involved in patient with ST elevation MI. The sensitivity of ECG was good in predicting all the three main arteries and an even higher specificity was noted in case of RCA

Background: One of the most typical illnesses seen in clinical practise is urinary tract infection (UTI). 50% to 60% of adult women may encounter a urinary tract infection at some point in their lives, making it one of the most prevalent bacterial illnesses in women. Due to their anatomical characteristics, such as a narrow urethra, as well as other variables like pregnancy, the use of diaphragms, and sexual activity, women are more likely to acquire UTI. Objectives: 1. To isolate and identify the uropathogens from the urine samples. 2. To detect the antimicrobial resistance of uropathogens to fluoroquinolones. Material & Methods: Study Design: Descriptive Cross-sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Berhampore, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Urine culture sensitivity reports were analyzed of patients who were suspected to be having urinary tract infection. Sample size: Study consisted a total of 300 subjects. Sampling Technique: Simple Random technique. Results: The resistant pattern of E.coli and Klebsiella to the 4 fluroquinolones, highest resistance is seen to ciprofloxacin followed by norfloxacin. In this study the most sensitive drug was Amikacin, followed by Pippericillin/Tazobactum and imipenem. In this study the drug with maximum resistance was cotrimoxazole. Amoxycillin and quinolones followed the list. Conclusion: We need to take a number of steps to address the significant worldwide opposition issue we are facing. These include (i) using fewer antibiotics to lessen the pressure for resistance to develop. (ii) increasing our understanding of the mechanisms by which bacteria acquire resistance and how they reduce the ensuing fitness costs.

Tibial plateau fractures are one of the most common intraarticular fractures. Open reduction and internal fixation procedures is the common technique used to treat it however, it jeopardises the soft tissue. So, the use of a minimally invasive approach to fix plates has been recommended. As a result, the so-called internal fixators were created. So, the present study was conducted with an aim to study the functional outcome of tibial plateau fractures with locking compression plates by using modified Hohl and luck evaluation. A prospective observational study was conducted among 30 patients with fractures of tibial plateau (Schatzker classification Type I,II,III). 73.3% cases had excellent and 16.6% had good outcomes in the study. 6% had stiffness of knee, 3.3% had instability, 3.3% had infection and 3.3% had implant failure. We conclude that better preoperative surgical planning and correct application of principles of LCP (Locking Compression Plate) and MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) technique will yield excellent biological fixation for tibial plateau fractures

Preeclampsia is a multi organ disorder which is significantly associated with maternal and neonatal morbidity, affecting around 5-8% of pregnant women. Acute or chronic intrapartum insufficiency results in antepartum or intrapartum anoxia that may lead to foetal death, Intrauterine growth restriction and or preterm delivery. Neonatal complications occurring in these babies are closely related to the severity of hypertension and proteinuria and the duration of the disease. This was a retrospective observational study. Out of 77 preeclampsia mothers, 74 (96.2%) had live births and 3 (3.8%) had Intra uterine deaths. Out of 74 neonates, 33 neonates (42.8%) were term, 28 neonates (36.3%) were late preterm, 5 neonates (6.4%) were moderate preterm and 11 neonates (14.2%) were early preterm. With increasing maternal complications in preeclampsia there is an increase in neonatal morbidity and mortality. So, the aim of the study is to evaluate neonatal morbidity in mothers with preeclampsia

Background: Prematurity is a burden on any country for being the leading cause of infant mortality in the world. APGAR score, being a component of the degree of birth asphyxia,  is an important tool to assess the quality of  care used for observing neonatal outcome in the delivery room itself. Vitamin D has important role in decreasing the mortality and morbidity in the neonatal period as it helps in prevention of sepsis and respiratory complications .

Aim of the study: To determine the relationship between serum vitamin D level and APGAR score in premature infants.

Patients and methods: This cohort study was done in Sri Guru Ram Das Hospital, Vallah, Sri Amritsar from April 2021 to July 2022on 82 preterm (< 37 weeks ) neonates admitted to the NICU. Patients were divided into 3 groups based on their serum vitamin D levels : deficient , insufficient and sufficient. APGAR score of these preterm neonates at 1 minute and 5 minute was recorded. Later these were analyzed and relationship between serum vitamin D level and APGAR score at 1 minute and 5 minutes was noted.

Results: The lowest APGAR score at 1 minute (between 0-3 ) belonged to the neonates in the deficient group whereas majority of neonates in the insufficient group and in sufficient group had good APGAR scores (>6) at 1 minute. At 5 minutes, all neonates in the insufficient and sufficient group improved their APGAR scores to >6 and in the deficient group, 23.1 % neonates still had low score (4 to 6 ). Therefore, the relationship between APGAR score and serum vitamin D levels in the neonates was statistically significant with p value of 0.006 for APGAR at 1 minute and p value of <0.001 for APGAR at 5 minutes.

Conclusion: In this study, lower vitamin D levels were associated with lowerAPGAR score at 1 minute and 5 minutes

Background: Programmed labour protocol was developed with principles asensuring adequate uterine contractions , providing optimum pain relief & close clinical monitoring of labor events. Present study was conducted to evaluate the safety and efficacy of Programmed Labour protocol in a study group as against Spontaneous progression of labour in primigravida patients. Material and Methods: The present study was a hospital based randomized prospective clinical study, conducted in primigravidae at term with cephalic presentation, adequate liquor and no high risk factors and in active phase of first stage of labour or Cervical dilatation ≥ 3cm, ≥ 80% effacement and intact membranes, Reactive stress Test. 200 primigravidas were alternately allocated into 2 groups. as study group (100 women received programmed labour protocol) & control Group (100 women were observed expectantly and underwent spontaneous labour). Results: Mean age of patients in the study group was 23.13 ± 2.46 years and 23.74 ± 2.58 years in the control group. Among patients of the study group; period of gestation was 38.87 ±1.00 weeks and 38.74 ± 1.12 weeks in the control group. We compared various labour related parameters such as duration of active phase of labour (hours), rate of cervical dilatation (cm/hr), duration of 2nd stage of labour (mins), duration of 3rdstage of labour (mins), total duration of labour (min) & average blood loss (ml) between study & control group. All above parameters were favourable in study group & difference was highly significant statistically (p<0.001). Perception in degree of pain relief among patients of the study and control group was found be highly significant statistically. (p<0.001) i.e. pain relief was significantly much higher among patients of the study group than pain relief in control group patients. The difference in degree of maternal satisfaction in the study and control group was found be statistically significant (p<0.001). Conclusion: Programmed labour is safe, effective providing labour analgesia; facilitating cervical dilation and shortening duration of labour with good maternal and fetal outcomes

This study is a Prospective cross sectional observational study. The study was conducted from December 1st, 2020, to June 1st, 2022 in which 100 patients who had presented to the Surgery OPD and Emergency Department of Katuri medical college &hospital, Chinakondrupadu, Guntur with history suggestive of urolithiasis were enrolled for the purpose of studying the incidence of urolithiasis at different levels of the urinary tract and to assess different modalities of treatment and compare outcome of those results with that of the world literature. Our Study had found that the incidence of urolithiasis at our center was 3.74%. The age group of people between 21-30 years were the most commonly affected. However, the mean age for developing urolithiasis was 40.4 years. Males appear to be predisposed to the formation of calculi with M: F ratio being 1.77:1. Pain was the most common symptom which was seen in 91 % of the patients followed by nausea/vomiting seen in 58% followed by burning micturition (43.84%), fever (16.44%) and haematuria (15.08 %) of the study group. Right kidneys were affected more commonly than the left. Diabetes mellitus   was   the   most   commonly   associated   comorbidity   followed   by hypertension. Renal pelvis was the most commonly affected site (35%) followed by lower 1/3rd, urinary bladder (17%) upper ureter (14%) and lower ureter (11%) respectively. E. coli was the most commonly isolated organism in the urine cultures followed by Klebsiella. Serum calcium was normal in 96% of the study group while serum uric acid was raised in 25% of the subjects. Plain X ray KUB and ultrasound were the initial imaging modalities used. IVP was preferred over CT in diagnosis as CT was costlier and could not be afforded by the poor. Patients consuming mixed diet seemed to be more predisposed to the formation of urolithiasis. Open Pyelolithotomy was the operative modality for renal pelvic calculi, Open Ureterolithotomy for upper and mid ureters and URS for lower ureter. Open Cystolithotomy was used for bladder calculi. Stone free rates for Open Pyelolithotomy was 91.4%, 96% for Open Ureterolithotomy, 91.3% for URS and 100% for Open Cystolithotomy. The average size of stone extracted in Open Pyelolithotomy was 2.78 cm, 1.34 cm for Open Ureterolithotomy, 3.92 cm for Open Cystolithotomy and 1.1 cm for URS. Mean duration of hospital stay was 7.42 days for Open Pyelolithotomy, 6.16 days for Open Ureterolithotomy, 5.35 days for Open Cystolithotomy and 1.34 days for URS. Thus we can conclude that, the incidence of urolithiasis was 3.74% in our study. The patients underwent open procedure for removal of stones at our cente.r However, as seen in our study, open procedures have good success rates and also have less post- operative complications. It can thus be concluded that it does not hamper patient care. This is in accordance with the other studies over open urological procedures

Introduction: Ventilator associated pneumonia is defined as pneumonia occurring more than 48hours after the initiation of endotracheal intubation and the most common nosocomial infection in intensive care unit.VAP is second most common health care associated pneumonia in spite of wide range of preventive measures. Aim: To isolate the bacterial pathogens and their antibiogram of organisms causing VAP. Materials and Methods: Cross sectional descriptive study conducted for a period of 6 months i.e January 2022 - June 2022 in patients admitted in ICUs of King George hospital on ventilator for more than 48 hours. Endotracheal aspirates are collected and transported to department of Microbiology, AMC, Visakhapatnam. Results: From 50 endotracheal samples studied ,15(30%) were culture positive. Among them the most predominant organism is Pseudomonas aeruginosa 5(33.3%) followed by Methicillin resistant Staphylococcus aureus 4 (26.6%), Klebsiella species 3 (20%) and Acinetobacter species 3(20%).Gram negative bacilli were sensitive to Piperacillin – Tazobactam, fluoroquinolones, macrolides, Polymyxin whereas resistant to beta lactams.Gram positive cocci were 100% resistant to Cefoxitin, Oxacillin and sensitive to Linezolid and Vancomycin. Conclusion: Knowledge of incidence of VAP, their causative microbial flora along with their susceptibility pattern help in selection of appropriate antibiotics for therapeutic use and better outcome

Introduction: Nephrotic syndrome, characterized by presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population and is most common in Asian child.

Aims & Objectives: To know the bacterial etiologies and their antibiogram in urinary samples of Pediatricnephrotic syndrome.

Materials And Methods:   This was a Cross sectional, Descriptive study conducted for a period of 6 months i.e., January 2022 – June 2022 in pediatric patients admitted in PICU’s of KING GEORGE HOSPITAL, VISAKHAPATNAM.  Urine samples are collected and transported to Department of Microbiology, ANDHRA MEDICAL COLLEGE, VISAKHAPATNAM.

Results: Out of 70 urine samples studied, 21(30%) have urinary tract infection, 13(62%) were asymptomatic and 8(38%) are symptomatic.  Majority of UTI caused by E.coli 8(38%) followed by klebsiella 6(29%), Proteus 4(19%), Staphylococcus aureus 2(10%), Acinetobacter 1(4%).

Gram negative bacilli were sensitive to Amikacin, Cefixime, Piperacillin plus Tazobactum, Nirofurantoin, Meropenem.

Gram positive cocci were sensitive to Amoxicillin, Vancomycin, Linezolid.

Conclusion: Children with nephrotic syndrome are frequently predisposed to UTI and in most cases, it is asymptomatic.  It is necessary to examine the patient and prevent the risk of complications by initiating appropriate antibiotic therapy

Aim:  To determine the bacteriological profile and antibiogram of burn wound patients in teritiary care hospital.

Materials And Methods : A cross sectional descriptive study conducted  from January 2022- June 2022 and collected  50 specimens ( swabs ) from burn wound patients admitted in Burns ward  and processed in Microbiology Department ,Andhra Medical college, Visakhapatnam.  Drug susceptibility tests were performed using Kirby Bauer method   according to CLSI guidelines.

Results: Out of 50 samples , 42 samples  shown bacterial growth in which 34 bacterial isolates were GNB and 8 were GPC. Out 0f 42 , most frequently isolated was Pseudomonas aeurginosa ( 24 )(57.14% )of which 8 were ESBL producing , followed by Staph aureus ( 7) (16.66%), Klebsiella species (4)(9.52%), Acinetobacter species (4)(9.52% ) ,Escherischia coli (2)( 4.76%) ,Proteus species (1)(2.38% ). GNB were mostly sensitive to Piperacillin- Tazobactam, Fluoroquinolones, Macrolides and were  resistant to Beta lactams. GPC were sensitive to Vancomycin , Linezolid and were resistant to Cefoxitin .

Conclusion: Due to increased morbidity and mortality associated with burn wound infections, early detection and intervention are a prerequisite for better clinical outcomes of burn patients

Background: Psychosocial disturbance can have its effect on all organ systems of our body including cardiovascular system and at the same time prolonged cardiovascular diseases may also lead to worsening of mental health in people. Objective: Present study is carried out to find the effect of certain common psychiatric diseases and social stresses along with the effect of different levels of social support on the incidence and prevalence of cardiovascular diseases. Material and Method: The present cross-sectional analytical study was conducted in cardiac ward and on new and follow up cases in outpatient unit, Andhra Medical College, Visakhapatnam. 100 participants male and female of all age groups were taken as cases along with 100 participants as control after obtaining written informed consent by purposive sampling.

Data was analyzed using SPSS 21.0. The statistical tests used were student’s t-test and chi square test.

DSM-5 criteria, M.I.N.I, Perceived social stress scale, Oslo’s social support system and Modified Kuppuswamy criteria were used to carry out study. Results: Out of the total population under study, 15% of all the CVD cases were found to have psychiatric illness prior to cardiovascular disease where as 21% of CVD patients developed psychiatric illness after having diagnosed for cardiovascular disease. Among these cases 82% were having low social support. Gender predilection for psychiatric diseases in CVD patients was found to be more in females (12%) compared to males (9%) with (p-value = 0.042) and chi square value of 4.13. Conclusion: This research indicates that psychiatric illnesses and low social support can act as an independent risk factor for CVD while CVD patients are susceptible to develop psychiatric illnesses over the course of disease. We recommend multi centre detailed study with higher sample size in this area to generalize the results and use them for the benefit of society

Background: Anterior Cruciate Ligament (ACL) rupture is one of the major knee injuries throughout the world. Number of patients with ACL tear undergoing reconstruction had risen recently and more favourable results have been obtained with the advances in Arthroscopic surgery .Objective: The study was done to evaluate the functional outcome of arthroscopic ACL reconstruction using Semitendinosus and Gracilis graft. Materials And Methods: This study was conducted in department of orthopaedics of Katuri Medical college and hospital. 47 cases with anterior cruciate ligament tear were treated with arthroscopic reconstruction with semitendinosus and gracilis graft. Patients were assessed for the functional outcome using Knee IKDC score. Results: All 47 cases had good to excellent functional outcomes. Conclusion: Arthroscopic anterior cruciate ligament reconstruction “using semitendinosus and gracilis graft” is an effective method and gives stable fixation with excellent results

Objectives: To determine the clinical and functional outcome of open modified Bankart repair in cases of recurrent anterior shoulder instability.

Methods: This is a prospective study conducted in Department of orthopaedics Katuri Medical College and Hospital, Guntur. There were 25 patients included in our study who were followed up for an average of 12 months duration with minimum follow up of 6 months and maximum follow up of 24 months. All young and middle age patients with recurrent anterior shoulder instability presented were evaluated by thorough general and clinical local examination of the shoulder.

Results: This study included 25 patients , 20 out of 25 patients showed excellent functional outcome(80%) , 4 showed good functional outcome(16%) and 1 showed fair functional outcome(4%) according to ROWE score.

Conclusion: Arthroscopic Bankart repair is the management of choice for recurrent anterior glenohumeral instability but open Bankart repair still remains the gold standard in institutes where there are limited resources

Objectives: The aim of this study was to assess the fracture union with percutaneous autologous bone marrow injection in delayed union and non-union of long bone fractures.

Methods: Patients who were admitted in department of orthopaedics in Katuri medical college and hospital, Chinnakondrupadu, Guntur, with delayed union and non-union of long bone fractures, were included in this prospective study. Study span is about 2 years and sample size of 34 patients. Preoperatively patients were examined clinically and radiologically. Post operatively patients were followed up through serial post operative x-rays.

Results: This study included 34 patients, out of which one case was lost in follow up. 24 out of 33 cases good bone union was achieved (72.7%). Radiographically the healing   was seen on an average of 14 weeks.

Conclusion: Percutaneous bone marrow injection is a minimally invasive procedure. It is a simple, quick, safe procedure providing cellular reactivation of osteogenesis with no related complications that may occur with bone grafting

Aim and Objectives: This study was done to investigate the relationship between essential hypertension and blood uric acid levels. Materials and Method: This cross-sectional observational study was done after getting the permission from Board of Studies Department of General Medicine, Rajshree Medical Research Institute, Bareilly

Background: Back pain is regarded as one of the unrewarding problems that were dealt with in orthopedics. Of the various forms of low back pain, only those syndromes associated with neurologic compression of the cauda equina or nerve roots have a reasonably well-understood clinical presentation.

Objectives: The present study aims to study Micro lumbar Discectomy's functional outcome using a magnifying loop for lumbar intervertebral disc prolapse.

Materials and methods: Patients admitted in department of ortgopaedics in katuri medical college with a clinical diagnosis of lumbar disc herniation at either L4-L5, or L5-S1 levels and undergone lumbar microdiscectomy following the inclusion criteria specified in our protocol. Explained all the patients about the procedure, the necessity for follow up, and written consent was taken.

Results:48% of patients are between 41 to 50 years. 64% of the participants are males. The average pre-operative ODI (Oswerty disability index) score was 54.56. The ODI score at the most recent follow-up (3m) was 9.36. The result was excellent in all cases improving from severe disability to minimal disability. Mean ODI at each follow-up visit was compared with pre- operative using Paired T-test, and p-values were calculated. P-value was found to be significant with each comparison.(41-60%)Severe disability was present pre-operatively about 54.56 (21-40%)Moderate disability was present at 1st month about 24.24 and (0-20%)Minimum disability was present at 3rd month about 9.36.

Conclusion: Micro lumbar discectomy with loupe magnification is an excellent cheap procedure, which can be done on an daycare basis. The operated patients had less post-operative pain due to the minimal soft tissue exposure, minimal handling of paraspinal muscles on one side only, less or no damage to the lamina, and no damage to facet joints. All the patients required less dose of postoperative analgesics. Post-operative mobilization is very earlier compared to standard laminectomy and discectomy. All the patients had less postoperative morbidity avoiding complications. Functional outcomes are better compared to standard procedures

To analyze the occurrence of diabetic foot storm in hospitalized patients with foot complications. Methods and Materials: A retrospective analysis was done from July 2021 to December 2021 at Amit Jain’s Institute of Diabetic foot and wound care, Brindhavvan Areion Hospital, Bengaluru, India

Attitude Ethics and Communication (AETCOM) is incorporated as a part of Graduate Medical Revision 2019 with an aim of improved patient care in par with the needs of the society. The aim is to create doctors who are empathetic, ethical and effective communicators

Background: Pandemic module is introduced as a part of Graduate Medical Revision, as per National Medical Council, with the aim of sensitizing undergraduates towards handling pandemics. It is a longitudinal programme, incorporating student-directed teaching learning methods. Aims and objectives: To assess the student’s perception on pandemic module in the subject of Microbiology

Pain is defined as "an unpleasant sensory and emotional experience associated with existing or potential tissue damage or described in terms of such damage" by the updated taxonomy committee of the International Association for the Study of Pain (IASP).

Acute leukemias are a heterogeneous group of hematopoietic cell neoplasms characterized by clonal expansion and maturative block, with predominance of immature cells constituting more than 20% of the nucleated elements of the bone marrow

Introduction: Community-acquired pneumonia (CAP) refers to an acute infection of the pulmonary parenchyma acquired outside of the hospital. Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. The clinical presentation of CAP varies, ranging from mild pneumonia characterized by fever and productive cough to severe pneumonia characterized by respiratory distress and sepsis. Because of the wide spectrum of associated clinical features, CAP is a part of the differential diagnosis of nearly all respiratory illnesses

Introduction: Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. Early cervical epithelial changes can be identified by a Pap smear test, which is the primary screening test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer. Due to widespread screening programs, there has been a significant reduction in mortality from cervical cancer in developed countries

Introduction: Coronal plane fractures of femoral condyle, commonly known as HOFFA fracture, first described by Busch in 1869, latter by Hoffa in 1904. Coronal plane fractures of femoral condyle are rarer than saggital plane fractures. Unilateral bicondylar coronal plane fractures are even rarer than unicondylar coronal plane fractures

Background: Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses

Introduction: With the availability of better health care services and decrease in mortality rates the elderly population has increased significantly over the last couple of decades.1 Psychiatric illness in the elderly is compounded by mental morbidities due to ageing of the brain, problems associated with physical health, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence. The presence of comorbidities and the attendant polypharmacy makes management of these diseases a complex issue

Background: Meningiomas are the commonest primary, non-glial intracranial tumors. The diagnosis is often correctly predicted from characteristic imaging appearances. Some meningiomas have atypical imaging appearance that may cause diagnostic confusion. Aim: To differentiate typical from atypical and malignant meningiomas by using advanced MR imaging techniques

Background: The term "asymptomatic bacteriuria" (ASB) refers to persistent, aggressive bacterial growth in asymptomatic females' urinary tracts. The quantitative diagnosis is a clear catch mid urine sample with more than 100,000 organisms/ml.1 The incidence is often population-dependent geographical variance, ranging from 2 to 7%. The incidence is between 25 and 35 percent in emerging nations like India

Background: The long-term complications of DM have a variety of severe effects on people's quality of life as well as their prospective life, harming both individuals and civilizations. In order to reduce the microvascular and macrovascular complications, glycated haemoglobin (HbA1c), should be maintained below 7% in DMT2 patients. It is possible to predict complications in type 2 DM using the simple, reliable, and affoGlycosylated Haemoglobin and Microvascular, Type 2 Diabetes Mellitus Patientsrdable tests like Mean Platelet Volume (MPV)

Introduction: Obesity is a global public health challenge. Recent trends in life style among young college students resulted in an increasing prevalence of obesity. Students are also exposed to daily stress due to increased work load and high expectations .This makes them susceptible to various health problems such as cardiovascular, metabolic, pulmonary and psychosocial disorders. Stress and obesity are interrelated cardiovascular comorbid conditions which burden the person further. This leads to sympathetic over activity, autonomic dysfunction and psychological disturbances in these young individuals. Thus there is a need of timely reduction of sympathetic over activity to overcome autonomic imbalance and stress among them .This can be done by introducing a simple easy technique of breathing, the diaphragmatic breathing which has proven effects. Objectives: This study aimed at to know the effect of diaphragmatic breathing on cardiovascular and psychological parameters in obese undergraduate students

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action

Introduction: In December 2019 , COVID 19 had put unprecedented load over healthcare-systems across the world. The key to good surveillance and prognosis for COVID 19 cases lies in early diagnosis and appropriate management

Context : Graves’ disease is the commonest cause of hyperthyroidism. Other common causes include toxic multinodular goiter, thyroiditis etc. Clinical manifestations of thyrotoxicosis in cases of thyroiditis and early or mild Graves' disease may be difficult to differentiate. Although persistence of symptoms and signs in Graves' disease can distinguish it from other etiologies, it is prudent to distinguish between various etiologies of hyperthyroidism because of disease- specific management

Introduction: Type 2 Diabetes Mellitus (T2DM) is one of the most common metabolic disorders worldwide and its development is primarily caused by a combination of two main factors

Background: Lack of micronutrients like zinc and copper has been linked to a poor prognosis and high mortality in HIV infection. The purpose of this study was to look at the availability and deficit of a few trace elements in HIV-positive subjects undergoing HAART. Methods: A cross-sectional study was done on 150 persons who had been chosen at random and were receiving HAART at the clinic and had received a confirming diagnosis of HIV. Subjects signed written informed permission forms before receiving questionnaires. Following sample collection, the concentration of blood levels of zinc and copper was assessed using the spectrometric method, and the CD4+T-cell count was assessed using a flow cytometer. Simple percentages were used to calculate prevalence. The association between zinc, copper, CD4 and viral load deficiencies was investigated using the Mann Whitney U nonparametric test and the Chi-square test of independence. Results: The frequency of copper and zinc insufficiency was 59% and 16.7%, respectively, among the participants. A significant difference in median CD4 count and viral load was seen across zinc levels, with a p-value of 0.05, although CD4 count and viral load did not change by copper level among patients. Furthermore, p-value 0.05 indicated a link between subjects' zinc levels and immunological suppression. Conclusions: This study demonstrated that the CD4+T-cell count levels rather than the nutritional status do not complement HAART therapy. While the focus of HAART therapy is strengthening the immune system, patients may still be lacking in some micronutrients while having an increased CD4+T-cell count.

Background: The internet, mobile phones, and other similar tools are indispensable for the current functioning of both private life and business. In these two years of Covid 19 pandemic (2019 2021), internet use, especially for different games as well as social networking, were indispensable for the global population, allowing engagement and interaction among many people online in a virtual world. The term ‘Internet Addiction Disorder’ was first coined and described by Dr. Kimberly Young. There are various models for diagnostic criteria which contain some commonalities

Background Acute appendicitis is defined as a sudden inflammation of vermiform appendix causing pain in right side of abdomen and may be associated with fever and vomiting. Appendicitis is always in the top three differential diagnosis of acute abdominal pain It’s most common and an emergency general surgical operation performed. It’s estimated that around 6-7% population will encounter in their lifetime. Previously appendix was considered as a vestigial organ with no known function. It is now well recognized that appendix is an immunologic organ that actively participates in the secretions of immunoglobulins particularly immunoglobulin A.In case of emergency it may be managed conservatively or by operative procedure as per the clinical presentation

Abstract: Background and objectives: To investigate the effect of green human resource management practises on environmental sustainability in the healthcare sector in KSA. To estimate impact of green recruitment, green training and selection, development, and green performance management practices on environmental sustainability in the KSA healthcare industry. Method: A survey of healthcare facilities in KSA was undertaken as part of the research using a quantitative research approach and a descriptive research design. Data was collected via a questionnaire, which was distributed to 414 respondents and garnered 404 responses. The study's target group was the top management, middle management, and lower management levels of healthcare professionals in leadership and management roles

Introduction: hemodynamic changes during tracheal intubation it is more challenging in head injury patients.

Aim and objective: To Examine the effect of addition of dexamethasone and clonidine to local anaesthetic drug in (0.5% Bupivacaine+ 2% lignocaine with adrenaline) in PNS guided Supraclavicular brachial plexus block. Methodology: 90 patients presenting for upper limb surgery were divided into three groups. Group D receive Dexamethasone 8 mg as an adjuvant to Bupivacaine+ lignocaine whereas Group C receive Clonidine 75 mcg as an adjuvant to bupivacaine+ lignocaine and Group S is control group receiving saline as an adjuvant to bupivacaine+ lignocaine with adrenaline in Supraclavicular Brachial Plexus block

Introduction: Meningitis is a clinical syndrome characterized by inflammation of the meninges; it is one of the most common infectious diseases of the central nervous system (CNS). Infection with the human immunodeficiency virus (HIV) is emerging as a major risk factor for meningitis in adults. Meningitis causes significant morbidity and mortality globally. Long term sequelae of bacterial meningitis in adults include hearing and visual loss, seizures, and cognitive impairment

Background: The platelet count declines and petechiae appear in widespread distribution with spontaneous ecchymoses. Bleeding occurs at mucosal surfaces from the gastrointestinal tract and at venipuncture sites. Objective: to study Correlation between the laboratory features – thrombocytopenia, elevated hepatic enzymes, hyponatremia, high hematocrit and severity of dengue infection. Methods: It is an observational study conducted at a multispeciality teaching Hospital. The study population (cohort) was selected from the hospital inpatients who are admitted in paediatric intensive care unit as well as paediatric ward

Background and Aims: The success of labour analgesia is significantly influenced by the patient's position during the insertion of the epidural catheter. In this study, we contrasted how simple it was to implant the epidural catheter in the crossed-legged sitting position (CLP) against the traditional sitting position (TSP) (CLSP). The main goal was to compare how many of the groups' initial epidural placement attempts were successful. The patient's comfort, the simplicity of landmark palpation, and the quantity of needle-to-bone contacts were secondary goals

Background: The purpose of the current study is to evaluate asthma patients' health-related quality of life (HRQoL) using an HRQoL questionnaire (SF 36 v2). Methods: A 6-month prospective observational study on 108 patients with persistent asthma of either sex. Through a face-to-face interview and the use of an HRQoL questionnaire, asthma patients' HRQoL was assessed (SF 36v2)

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases

Introduction: Preeclampsia is a pregnancy-specific multi-systemic disorder characterized by proteinuria and the onset of hypertension during pregnancy (1, 2) Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity3. Calcium has an important role in the pathogenesis of pre- eclampsia. The present study was aimed to compare the level of serum calcium in normal pregnant women and in preeclampsia and determine the association of serum calcium with severity of the disease

Background: Breastfeeding is an ancient social custom, an unparalleled and most determinant way of giving ideal and safest food for the optimum development of vulnerable infants which fulfills all nutritional needs. WHO proposes exclusive breastfeeding during the 1st six months and introduction of safe complimentary feeds from 6 months onwards with continuation of breastfeeding till 2years of life. This study intends to give a better understanding of not only breastfeeding behaviors, but also of practices regarding formula feeding in 'upper middle class' population. Aims and Objective: To assess the knowledge, and practices of breastfeeding mothers with Children less than 2 years

Background: Dengue is known to cause multi-organ dysfunction including cardiac involvement, In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis not reported as a common complication we present a case series of dengue fever with cardiac involvement observed during a period of month August to December 2021 at PBM & Associated Group of Hospital, Bikaner Rajasthan. Case presentation: We have been reported 9 cases of dengue complicated with cardiac involvement admitted to Wards and ICU at PBM & Associated Group of Hospital. Age group ranging from 15 to 65 years. In our case series out of 9 cases comparising 2 females and 7 males. The group had 5 cases of Dengue hemorrhagic fever with dengue shock syndrome, 2 cases had Dengue hemorrhagic fever, 2 cases had dengue shock syndrome. There is co-infection of dengue with malaria in 2 cases. All cases had acute dengue hepatitis. Blood transfusion and other empirical therapeutic methods used apart from meticulous fluid management to suit issue of each patient. Bed side USG, digital chest x-ray PA view & 2D ECHO scanning help in early detection of critical phase of dengue. Out of 9 cases with complicated dengue 7 patients recovered and 2 patients expired. Data were collected during hospital admission, stay and follow up visits. Methods: A prospective observational study was conducted on patients with age group more than 15 years and having confirmed dengue fever. Patient on medication affecting heart Rate, Rhythms, pre-existing heart disease and electrolytes abnormalities excluded. A base line ECG, Troponin I NT Pro BNP were done for all patients. The biomarkers were measured using Enzyme linked immune fluorescent assay and recommended cut off were used. Patients with increased biomarkers gone for 2D ECHO (As per criteria of European society of cardiology 2019). Conclusion: Myocarditis and cardiac involvement in dengue may be overlooked due to Nonspecific clinical finding and co-existing multi organ dysfunction. Atypical presentation of this case series may be due to micro-geographical variation and unusual out break of dengue. Co-infection of malaria should be considered in managing patients especially in endemic area

Introduction: Cadaveric dissection remains the most powerful tool to teach and learn anatomy in clinical and surgical specialities. It helps to visualize the structures and their relations in a three dimensional view. This knowledge collected will bring about innovations and strengthen the anatomical basis for clinical and surgical module. Objective: To modify steps of dissection in region of axilla that allows exposure of other contents of axilla more clearly. Material and method: dissection technique was performed on the embalmed cadaver given to first year MBBS students. Result: The students were able to visualize the relations and identify the structures in the axilla better. Conclusion: The application of modified technique helped the students to learn anatomy with more clear understanding and also provides an opportunity to innovate clinical or surgical modules

Power point assisted spotter Examination (PASE): A digital tool in assessment of gross anatomy spotters Background: Power pointbased spotter assessment is a tool wherein the spotter questions were prepared using digital images of specimens in a power point format. Digital spotter assessment can be customized according to institutional resource and need without having to go through recreation of specimen or infrastructure. The objective of the study is to compare the Power point based spotter assessment with the traditional method of spotter examination. Methodology: Fifty, first year MBBS students Participated in this study. The students were randomly divided into two batches of 25 students each. Each batch of students were assessed by the two method of examination in sequential cross over manner. A survey was also administered asking faulty & students’ perception on the two different methods of assessment. Result: In the present study 83 % of faculty felt that the Power Point spotter assessment was easy to administrate, wide variety of questions can be implemented and less time consuming. 100% of the faculty agreed that this method can be included with the traditional method but cannot replace it. 42 % of students preferred the traditional format, 38% of students preferred the digital method of assessment and 20 % of students were comfortable with both the method of assessment. Conclusion: Digital spotter assessment method can be implemented in places where continuous availability of human cadaver is not possible. Medical educators can explore the concept and feasibility of integration of digital technology in evaluation of medical students

Background: Miscarriage is considered the most common adverse outcome in early pregnancy. Thyroid autoantibodies have a role in these regions and have been linked to substantial changes in the path of pregnancy that affect the mother, foetus, & newborn. Aim: To estimate the prevalence of TPO antibodies in recurrent pregnancy losses, first trimester abortions and preterm deliveries. Material & Methods: Study Design: Descriptive Cross sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Baharampur, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Pregnant women who had preterm deliveries, miscarriages attending outpatient as well as admitted in the antenatal & postnatal ward in the department of Obstetrics & Gynecology Sample size: Study consisted a total of 100 subjects. Study tools and Data collection procedure: The study group was comprised of all the pregnant women who had preterm deliveries and miscarriages regardless of the gestational age, that were fulfilling inclusion & exclusion criteria. Written informed consent was taken from all the patients participating in the study. They were subjected to a detailed history & thorough general & clinical examination, lab investigations, thyroid profile, thyroid peroxidase antibody testing (Normal range: TPO AB <9 IU/ML), ultra-sonic examination & other clinical work up was done. The study showed that the contribution of thyroid peroxidase antibody testing & its sensitivity determining risk of preterm deliveries and recurrent pregnancy loss. Results: The association between TPOAB and T3 category, among the high TPOAB (+ve) cases (n=11), 8 (72.7%) cases had normal level of T3, and, 3 (27.3%) cases had low level of T3. Whereas in the normal TPOAB (-ve) group (n=89), 5 (5.6%) cases had high level of T3, 84 (94.4%) cases had normal level of T3. The association between TPOAB and T3 category was shown statistically significant (P<0.0001). Conclusion: We concluded that, there was a statistically significant association of TPOAb with T3, T4, and, TSH (P<0.05) and it leads to developing hypothyroidism during pregnancy. The presence of TPO-Ab in pregnant women significantly increases the risk of preterm delivery. The screening of TSH and TPOAb was essential during pregnancy to avoid complications related pregnancy

Introduction: Yoga is an art in all its aspects, from the most practical to the highest. It is a spiritual art, in the sense that it transforms the seer and brings him into contact with his inner soul. It is a fine art, since it is aesthetic, expressive, visual art, since the body is made to form geometrical designs, lines architectural shapes and the like which are beautiful to behold. It is essentially a useful art for the doer and is presented as a performing art for viewer. Objective: To assess the effect of 45 minute yogic kriya (Surya Namaskar and Kapalbhati) for for 30 days on various physiological and biochemical parameters. Materials and Methods: This is a prospective and observational study conducted in the Department of Physiology and Biochemistry at Tertiary Care Teaching Hospital over a period of 6 months. All subjects volunteering for participation in the study had given their written informed consent. The study protocol was approved by our college ethical committee. Only healthy volunteers with daily regular lifestyle and are not involved in any sport regularly, were chosen to be part of the study between the age group 17-21 were taken into study. Subjects having any pathological condition and those who are on any pharmacological treatment from 3 months prior to the study were excluded from the study. Results: In the present study it was found that the pulse rate was decreased significantly (p<0.05) at 30 days in Group I and II. RR decreased significantly at 30 days in group I, and II with p<0.05. This significant decrease continued at 30 days with group I and II. In our study it was found that significant decrease in SBP at 30 days. At 30 days two groups had highly significant decrease in SBP (p<0.05). In addition, it was also found that significant decrease in DBP at 30 days. At 30 days two groups had highly significant decrease in DBP (p<0.05). After yoga, at 30 days, the reduction in the Serum Total cholesterol, serum triglycerides levels were found in two groups in the present study. The decrease was significant (p<0.05) in Group I and II (p<0.01). In addition, after 30 days of yogic practices significant (p<0.05) increase in the HDL level was found in Group I and II. Conclusion: It was concluded that in hypertensive subjects whether newly diagnosed subjects were restoration of the altered parameters towards normal

Background: Ambulatory assessment of the heart rate–corrected QT interval (QTc) within arrhythmia patients can be of diagnostic value where these patients are on QTc-prolonging medication. Repeating sequential 12-lead electrocardiograms (ECGs) to monitor the QTc is cumbersome, but Spandan Smartphone ECG devices can potentially solve this problem. Objective: Objective of this prospective and retrospective, cross-sectional, within patient diagnostic validation study was to validate the measurement of QTc interval in Spandan 12 lead ECG and to assess the accuracy of the 12 lead Spandan Smartphone ECG device in measuring the QTc intervals in the general cardiology outpatient population with normal ECG and arrhythmias. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from August 2022 to October 2022. All patients (n=1168) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Mean (SD) age was 54.36±4.9 years. The male gender (n=783,67.03%) shows the maximum frequency than female gender. Primary Coronary Intervention was noted in 426 (36.4%) of the study population. All the four parameters showed positive Pearson correlation between 12 Lead Standard ECG and Spandan Smartphone ECG. The maximum mean difference between 12 Lead Standard ECG and Spandan Smartphone ECG was noted for QTc parameter in overall participants. Conclusion: 12-lead Spandan Smartphone ECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs

Background: Interval duration measurements (IDMs) were compared between standard 12-lead electrocardiograms (ECGs) and 12 lead mobile ECG recorded with Spadnan ECG based ECG device, a single channel, hand-held mobile device designed for use by patients at home. Objective: Objective of this prospective, cross-sectional, within patient diagnostic validation study was to compare the interval durations between standard 12 lead ECG and 12 lead mobile ECG recorded with Spadnan ECG based single channel ECG device. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from January 2019 to August 2022. All patients (n=2308) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Smartphone-operated 12 lead ECGs showed good diagnostic accuracy for QT, PR, QRS, QTc and Heart rate measurement in comparison to the standard 12 lead ECG machine. The PR interval, QRS duration and Heart rate were under the clinical agreement levels. Whereas, the QT and QTc showed the variability of more than 20 ms. hence, the detection of the Arrhythmias associated with shorten PR intervals, prolonged PR intervals can be detected by the Smartphone ECG with accuracy, the conduction blockages like LBBB involving the QRS duration can be precisely be detected by the smartphone ECG. Conclusion: Our research evidence proved the equivalency of device in measuring the morphological parameters like PR intervals and QRS duration. Our study observed variation in detection of the QT and QTc intervals at above 25 ms, which might make it difficult to be used in diagnosis but for general purpose where no medical facility is available, our device can be used for primary care. Hence, the Smartphone ECGs can be used in the primary care and for general use

Introduction: Although communicable diseases are more common in developing countries, recently an upsurge in non-communicable diseases has been noticed. Among these non communicable diseases neurological and musculoskeletal disorders constitute a significant proportion affecting morbidity, mortality, disability and quality of life. The annual incidence of musculoskeletal disorders accounts for 31% of all occupational diseases estimated in the world in 1994. This means that the musculoskeletal disorders are the most frequent occupational disease affecting workers throughout the world. Aim: to identify the epidemiological factors that contribute in developing neurological and musculoskeletal disorders. Method: This was a hospital based cross sectional study conducted at Geetanjali College of Physiotherapy located in Geetanjali Medicity with institute of Geetanjali Hospital and College, Udaipur. Consisted cases of ND & MSD attending GCP and the referral calls for ND & MSD from GMCH to GCP. Results: In the index study male subjects constituted (60.7%) while the rest (39.3%) were female. There was a significant association of studied patients of neurological and Musculoskeletal disorder reporting to physiotherapy hospitals with gender p=0.011. There was a significant association of studied patients with BMI. Conclusion: Out of 300 studied patients 60.7% were male and 39.3% were female. The male to female ratio was 1.4 : 0.92. Most of our patients belonged to age group 50-59 years

Purpose: The study's primary objective is to compare the conventional dose of bupivacaine and a low dose of bupivacaine-fentanyl spinal anaesthesia in maintaining hemodynamic stability in patients undergoing TURP with a satisfactory sensory blockade. Methodology: Patients posted for elective TURP surgery were divided into two groups of 47 each. Group F (n=47) consisted of patients who received low-dose bupivacaine–fentanyl spinal anaesthesia[bupivacaine 5 mg with fentanyl 25mcg+ normal saline 0.5 ml]. And group B (n=47) consisted of patients who received a conventional dose of bupivacaine[bupivacaine 75 mg + normal saline 0.5 ml]. A combined spinal epidural technique was used. The peak dermatomal level of sensory block, the time to reach this level, motor blockade at the time of reaching peak sensory level, time to two-segment regression, and time to S2 sensory regression were recorded. Motor blockade was assessed with a Bromage scale(0=no motor block,1=hip blocked,2=hip and knee blocked,3=hip, knee, and foot blocked). Duration of motor block was considered as the time when Bromage score returned to zero. The pain was assessed every 10 minutes from the beginning of surgery using a 10-cm visual analogue pain scale. Adverse effects if any were recorded. Outcome variables were the level of segmental spinal block and any adverse events like a decrease in BP or decrease in Heart rate. Results: The peak sensory level attained in both groups was similar and adequate for surgery but the time to reach peak level was found to be significantly faster with the conventional dose. Two-segment regression difference and duration between the groups were not found to be statistically significant though the S2 regression was found to be faster in the conventional dose group and statistically significant. This was even though a lower dose was used in group B. The occurrence of hemodynamic instability (hypotension, bradycardia) was more in group B compared to group F, in which patients received low-dose bupivacaine(1mg) combined with 25mcg fentanyl. The occurrence of hypotension was 42.6% in group A compared with 29.8% in group B. The occurrence of bradycardia was 23.4% in group B compared with 12.8% in group F.Sensory block was adequate for all surgery in both groups. Conclusion: Low-dose bupivacaine with fentanyl spinal anaesthesia used in TURP cases decreases the occurrence of hemodynamic instability (hypotension and bradycardia) in elderly patients while providing adequate sensory block for the procedure

Background: Distal Peripheral Neuropathy (DPNP) is a frequent micro-vascular complication of long-term diabetes and one of the main causes of morbidity and disability due to ulceration and amputation. Our aim is Correlation Study of Peripheral Neuropathy in Impaired Glucose Tolerance and newly diagnosed Type-2 Diabetes Mellitus Methods: A prospective Cohort study was taken among 160 patients. From patients with diagnosis of Impaired Glucose Tolerance& Newly diagnosed case of Type -2 Diabetes Mellitus (DM) attending the OPD and IPD in Department of Medicine at our Medical Hospital. During study period from 1st of Feburary 2021 to 31st August 2022. Results: In the current study, the mean NDS for newly diagnosed diabetic participants was.43, whereas it was.30 for IGT subjects, and it was determined to be non-significant. In the current study, it was determined to be highly significant that the mean Sensory Nerve Conduction Velocity in newly diagnosed diabetes participants was 56.44± 9.85 and in IGT subjects it was 50.35± 10.94. Out of the total 160 study respondents, 32 subjects were having any kind of sensory abnormality in their body. out of these 32 subjects, 23 belongs to new diabetic group while nearly only 9 subjects belong to IGT group. This association was found to be significant with a p value 0.006 Conclusions: The mean Sensory Nerve Conduction Velocity in new diabetic subjects were 56.44± 9.85 and in IGT subjects were 50.35 ± 10.94which was found to be highly significant with a p value<0.001.However, The mean Sensory Nerve Action potential in new diabetic subjects were 7.64± 3.13 and in IGT subjects were 7.52 ± 3.24which was found to be non-significant with a p value 0.79.Patients with DM and pre diabetes are at elevated risk for PN, and PN patients are at increased risk for dm and pre diabetes

Background: Deep vein thrombosis (DVT) usually occurs when a blood clot (thrombus) forms in one or more of the deep veins. It can causes pain in leg or swelling. Sometimes there are subtle symptoms. Aim: This study was conducted to perform investigation of etiological variables, management strategies, and consequences among individuals presenting with DVT at a tertiary centre. Materials and Methods: The current study which was carried out over the course of three years at a tertiary care government hospital at Kurnool and it was prospective observational in design. Total 100 cases showed signs of deep vein thrombosis, and met the criteria for selection. Results: In present study average age was 40.2±17.9 years, with 26% of them falling between 30 and 40 years. The majority (21%) of individuals presented with discomfort and edoema but had no clear predisposing factors. Duplex venous ultrasound revealed that 57 (57%) had involvement of both proximal and distal veins, 40 (40%) cases had involvement of only proximal veins whereas only 3 (3%) had restricted involvement of distal veins. After 3 months, 81% of the patients had complete recovery. Recovery was observed in 62%, improvement in 18% and chronic changes were observed in 20% of the patients at end of 3 months in duplex venous ultrasonography. Conclusion: Young patients without any clear risk factors may develop and present with DVT, therefore factors that cause deep vein thrombosis in them are advised to be carefully assessed. A trustworthy non-invasive diagnostic tool is Duplex venous ultrasonography and is advised for clinically diagnosing and confirming DVT

Background and Aims: One of the most common illnesses with high morbidity and death is urinary tract infections (UTIs). Even though a broad variety of medicines are available for the care of UTI, uropathogens have developed resistance, leading to a major treatment failure. In order to assess the rate of pathogen isolation as well as the pattern of antibiotic susceptibility of microorganisms causing UTI, the current investigation was conducted. Materials and Methods: 350 urine samples from individuals who had a UTI that was clinically suspected were processed between January and March 2019. The susceptibility of various antibiotics and UTI isolates were studied using the Kirby-Bauer disc diffusion method. Results: In this study, among the 350 samples, 195 (55.7%) samples showed microbial growth. Out of 195 isolates, 33 were Candida spp., and 162 were bacteria. E. coli (46.29%) was the predominant isolate, followed by E. faecalis (23.45%) as well as Klebsiella spp. (19.75%). E. coli was most susceptible to nitrofurantoin (96.29%), and Candida spp was most susceptible to Fluconazole (90.90%). Conclusion: The study outcome showed that E. coli is the major uropathogen responsible for UTI, and Nitrofurantoin is the superior antibiotic with a high susceptibly rate

Object: This study aimed to investigate the status of Malondialdehyde (MDA) concentration and the activity of antioxidative enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in both gastric cancer patients and healthy controls. The role of enzymatic antioxidant activity in cell protection from the damages caused by oxidative stress was also examined. The differences between the lipid peroxidation levels and defense mechanisms of the two groups were analyzed and compared. Materials and Methods: This study was conducted on 50 patients diagnosed with gastric cancer and 50 healthy control subjects of the same age and gender. Spectrophotometric techniques were used to measure the activity of malondialdehyde, glutathione peroxidase, and superoxide dismutase. Results: The results of this study revealed that there was a significant increase in MDA and a highly significant alteration in antioxidants. Conclusion: The diagnosis of human gastric cancer or recurrence could be aided by studying the lipid peroxidation and antioxidant defense mechanisms, in addition to using biopsy, biochemical, and pathological investigations. This combination of methods may be a more effective tool

Background: OBJECTIVE The present study was aimed at evaluating the maternofetal outcome of pregnancies with nuchal cord. Material and Methods: A retrospective case control study, conducted over a period of 1year, 1000 ANC patient were enrolled, STUDYGROUP comprised of 200 ANC patients in which nuchal cord was found incidentally at the time of delivery (NVD /LSCS).CONTROL -800 matched controls were selected in which nuchal cord was not found at delivery. Data was analyzed for-Presenting complaints at admission, association with other complicating factors ,progress of labor, intrapartum events, fetal heart rate variation by electrocardiotocography, clinical peripartum management, mode of delivery, and neonatal outcom

Introduction: Diabetic retinopathy is a vascular condition of the retina that develops as a result of diabetes mellitus (DM). This study aimed to compare intravitreal bevacizumab, pan-retinal photocoagulation or a combination of both in proliferative diabetic retinopathy. Method: In this prospective, randomized interventional study, 180 patients with PDR were enrolled and divided into three equal groups, i.e., Group A-patients treated with laser alone and Group B- patients treated with Anti-VEGF alone and Group C- patients treated with Anti-VEGF and laser. A detailed history, clinical and demographical data of all the patients were recorded and compared.The examination was done, including visual acuity assessment with Snellen’s chart, Slit-lamp biomicroscopic examination, intraocular pressure and pupillary assessment for optic nerve dysfunction.

Background: Transversus abdominis plane block is a regional anaesthesia technique. It provides analgesia after abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anaesthetic deposition above transverses abdominus muscle. We evaluated the efficacy of TAP block with Ropivacaine and Bupivacaine for post operative analgesia in abdominal surgery, a double blind, prospective randomized controlled trial

Introduction: Mandibular third molar is the tooth that suffers from uneruption most frequently. A third molar that is impacted can eventually result in acute pain, an infection, tumours, cysts, caries, periodontal disease, and the loss of nearby teeth. For the third molar extraction, local anaesthesia is used. In this study, surgical extraction of bilaterally impacted mandibular third molars was tested using 2% lidocaine with 1:80,000 or 1:200,000 adrenaline

Background: Multifoetal gestation means the simultaneous development of more than one fetus in the uterus. The most common type is of two fetuses (twins), though the development of three (triplets), four (quadruplets), five (quintuplets), or six fetuses (sextuplets) may also occur, which is a rare phenomenon1. Objectives: To study incidence and the maternal and fetal outcome in multifetal gestation. Material & Methods: Study Design: Descriptive Cross sectional study. Study area: Akash Institute of Medical Sciences Research center, Bangalore.

Introduction: Thyroid disease is more common in women than in men, because most thyroid diseases are autoimmune in nature and increased susceptibility to autoimmune diseases, perhaps secondary to the female endocrine environment is likely contributing factor. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. Pregnancy is associated with significant and reversible changes in thyroid function and failure to adapt to these changes result in thyroid dysfunction. Material and Methods: This is a Prospective study done among 1000 pregnant women. Antenatal women attending the outpatient department of tertiary care centre from August 2021 October 2022. Detailed history was taken, regarding the symptoms of thyroid disorders, menstrual history, obstetric history, past medical history, family history and personal history

Introduction: Skin and soft tissue infection contribute to a substantial proportion of infective disease pool in OPD attendees, in both urban and rural set up across the globe and staphylococcus aureus is one of the common causative agent of cutaneous bacterial infections involving skin & soft tissue. MRSA can cause severe problems , if not detected early, resulting in complications like septicaemia, pneumonia, sepsis and death. Community acquired MRSA(CA-MRSA) infections are common among skin & soft tissue infections (SSTIs), making their management quite difficult. One simple method to reach the diagnosis is the culture and sensitivity pattern. As sensitivity and distribution pattern vary according to different geographical area as observed in other bacterial infections, it has become imperative to know the extent of MRSA distribution and it’s sensitivity pattern in a particular community

Background: Depression is associated with a 60% increased risk of type 2 diabetes mellitus, and diabetes doubles the likelihood of depression. This study was conducted to estimate the prevalence of depression and assess the association between glycemic control and depression in diabetic patients. Methods: A total of 100 patients with type 2 diabetes mellitus were included in this cross-sectional hospital study.

Introduction: Placenta is a functional unit between the mother and the foetus. Human placenta is discoid, deciduate, haemochorial, chorioallantoic, labyrinthine and endocrine gland which connects developing embryo by umbilical cord to the endometrium of mother’s uterus. The placenta responds to cues in the pregnancy environment through morphological and functional changes in an effort to maintain proper fetal growth and development. For example, delayed maturation of the placenta has been observed in response to increasing maternal BMI. This altered placental maturity may result in poor gas and nutrient exchange at the maternal-fetal interface and, subsequently, suboptimal infant outcomes. Material and Method: This is a prospective study conducted in the Department of Anatomy at Index Medical College over a period of 2 year.

Introduction:Lower end of the esophagus portosystemic anastomosis formed by Left gastric vein and Esophageal tributaries of accessory hemizygous vein. Although all these vessels contribute to the shunting of esophageal collaterals or varices, are the most important clinically, because of their predilection to bleeding. Sclerotherapy is associated with a wide range of complications ranging from transient pyrexia to esophageal perforation resulting in death. Complications following sclerotherapy depends on a number of factors namely nature of sclerosant used, amount of sclerosant, injection site, concentration of the drug and the time interval between the sessions. Material And Methods: A prospective and observation study on management of esophageal varices by endoscopic injection sclerotherapy using absolute alcohol as sclerosant has been done in Endoscopy Unit.

Background: H. pylori is the most common human bacterial pathogen that colonizes the gastric epithelium especially in those habitual Qat chewers; it influence can absorption of glucose which is also abnormal in DM patients, its common infection in diabetic patients who have inadequate metabolic control, this study was conducted to reveal the prevalence of H. pylori among T2DM and non-DM patients and potential risk factors. Methods: A cross-sectional study was conducted in the department of medicine, a tertiary care hospital in India, and there were 250 patients who included in this study. Data were collected through structural intervals questionnaire and sampling information. Results: The overall prevalence of H. pylori among diabetics was 29.2%. There was no significant association between H. pylori infections and diabetes (P> 0.05), most of the patients were 46-60 year age group, with male predominance (76.7%) H. pylori infections were not significantly associated with the smoking, hypertension, dyslipidemia and obesity. H. pylori infection increased in longer duration of diabetes and the increase in HbA1c level. Conclusion: Positive H. pylori DM patients should update their sugar level values and control the disease. Further research is highly recommended on relationship between H. pylori infections and diabetes

Adequate depth of anaesthesia is very important during a surgical procedure. A light plane of anaesthesia results in awareness and a depth above the desired level causes cardiovascular depression. 100 ASA-PS 1,2 patients undergoing elective surgeries under general anaesthesia were grouped into two. In first group, the depth of anaesthesia was assessed using clinical parameters (PRST Score) and in second group, along with clinical parameters, BIS was also used. After analysis of data, it was found that along with the PRST score, BIS helps in decision making, facilitates titration of anaesthetics and achieve the best possible outcome for the patient

Introduction: In the year 2020 World has seen a calamity known as COVID 19 a perilous respiratory and multi-systemic disease suing millions of deaths all around the Globe. This disease also supposed to have many post COVID complications which range from respiratory illnesses like COPD and asthma to cardiovascular diseases like cardiac arrest leading to be one of the most predominant cause deaths. Performing pulmonary function tests timely may opine about the picture of disease development in the pulmonary tree which may pick up the disease progression early leading to avoidance of critical terminal illness which will lead to a disease free life.

Background: The area near opening of pulmonary veins into the left atrium act as triggering focus of the electrical activity in atrial fibrillation. Selective radiofrequency ablations of these foci are being performed to treat patients with drug resistant atrial fibrillation. So the accurate knowledge about variations of pulmonary veins and their drainage pattern is very important for diagnostic and therapeutic intervention in atrial fibrillation. Materials and Method: Fifty formalin fixed adult cadaveric hearts were included in the present cross sectional observational study. The heart were examined for the variations in the number of pulmonary veins (and pulmonary ostia) opens into left atrium through pulmonary ostium and their drainage pattern.

Background- Wuhan, Hubei's capital, reported severe pneumonia in December 2019. China reported the epidemic to the WHO on December 31, 2019, based on respiratory sample aetiology. SARS CoV2 caused COVID19. Confusion, depression, anxiety, memory loss, and insomnia are more common in COVID19 patients. SARS (severe acute respiratory syndrome) infection has been linked to acute psychiatric symptoms, elevated inflammatory markers, and many neurologic manifestations in critically ill COVID 19 patients with comorbidities

Background: Patients with diabetes mellitus (DM), have poor long term glycaemic control, even when fasting glucose concentrations are normal.3,4, Glycosylated haemoglobin (HbA1c) is a useful index of glucose intolerance and hyperglycaemia. HbA1c is an established marker of long-term glycaemic control. HbA1c can be assessed in the non-fasted state and has higher reproducibility than fasting glucose. Aim of the Study: To study the blood levels of HbA1C in patients of Acute Coronary Syndrome at the time of admission and to find out the correlation with the angiographic pattern.

Background: Oral Submucosal fibrosis (OSMF) is one of the most prevalent premalignant conditions in India which is easy to diagnose but difficult to manage. At present it is considered as irreversible and incurable. Aims: Assessment of risk factors and the role of habit variables such as duration and frequency in the severity of OSMF and to ascertain the association of gender predilection for different habits and severity of OSMF. Material and Methods: Patient personal history was recorded with chewing habits, including frequency and duration of chewing. This descriptive retrospective study of 179 OSMF patients was carried out at the tertiary level hospital in the central India. The clinico-demographic data including details of habits was collected. Clinical staging was done on the basis of palpable fibrous bands. Functional staging was accomplished by measuring mouth opening.

Introduction: Coronavirus disease 2019 (COVID 19) infection has rapidly spread across the world, currently affecting more than 39 million people, leading to major societal, economical and health care system distruptions. Aim of the study: The study aimed to identify and explore the concerns of the long-term mishap of respiratory diseases regarding the impact of the COVID-19 pandemic and how these concerns were affecting them. Methods: A retrospective observational study was performed on consecutive patients admitted to the Shaheed Monsur Ali Medical College, Dhaka, Bangladesh. This study was carried out from January 2020 to December 2020 with 62 patients.

Introduction: Long since the dispute regarding the time duration of umbilical cord clamping after birth in a neonate, there have been several recommendations for the same. The delayed cord clamping improves the cerebral blood volume in term and preterm neonates and it also decreases the risk of anemia in neonates, apart from multiple other maternal and neonatal benefits. Objectives: The purpose of this prospective study is to determine the effect of differential duration of cord clamping (at30seconds, 1min and 2min) on cerebral blood flow (middle cerebral artery flow dynamics) in normal term neonates. Methods: 390 deliveries, which fulfilled inclusion and exclusion criteria, in tertiary care centre were attended and the cord was clamped using aseptic precautions at 30 seconds, 1 minute and at 2 minutes exactly using random number table and the data were entered into master chart and then analysed using IBM SPSS statistical software. Results: The results showed no significant difference in cerebral blood flow hemodynamics, with different duration of cord clamping. Conclusion: Our hypothesis was that longer duration of cord clamping would lead to greater middle cerebral artery (MCA) blood flow velocity, but there was no significant change in hemodynamic parameters in middle cerebral artery blood flow with increasing duration of cord clamping. This implies that the known maternal and neonatal benefits of delayed cord clamping beyond 30 seconds were independent of cerebral circulation and hemodynamic parameters

Background: Megaloblastic anaemia during metformin therapy can be treated by administrating vitamin B12. 10-30% of diabetic patients on long term treatment with metformin had vitamin B12 deficiency. Objective: To determine VitaminB12 deficiency in type2 diabetes patients on long term metformin therapy for >2years. Materials & Methods: This prospective study carried out in Department of Medicine in Dr DY Patil Medical College and Hospital, Pune. It was comparison between 50 cases and 50 controls to find Vitamin B12 Deficiency In Type 2 Diabetes Patients On Long Term Metformin Therapy For >2years. Results: Mean age was for cases was 47.12 + 12.54 years and for controls was 41.64 + 9.74 years with majority in the age group of 41 to 60 years among both groups. Among cases males 52% were more than females 48%. Mean weight was for cases was 70.72 + 11.6 kg and controls was 58.02 + 6.80 kg. Mean BMI was for cases was 27.36 + 4.88 and controls was 23.93 + 2.71 and majority were in range of 25 to 30. Common symptoms seen were Polyuria and polydipsia. 50% had HTN. Majority were smokers followed by alcoholic. Mean duration of DM among cases was 6.18 + 2.64years. Mean serum vitamin B12 of cases was 271.75 + 184.21 and controls were 410.45 + 154.34, showed statistical significance. Majority among cases had Vit B12 levels lower than 200 and controls were more than 301. P value was highly significant. Conclusion: Routine supplementation of vitamin B12 given to patients on long-term high dose metformin therapy seems to be clinically more prudent and a cost-effective approach

Background: The present study was undertaken to determine the role of the stainless steel locking compression plates in the treatment of the comminuted metaphyseal and diaphyseal fractures of femur and tibia using Bridging plate technique. Material & Methods: This study was done both retrospectively and prospectively in the Department of Orthopaedics and Trauma Centre in J. A. Group of Hospitals, Gwalior (M. P.) from September 2013 to September 2015 among the cases who had comminuted fractures of metaphysis and diaphysis of femur and tibia, were operated with stainless steel bridging plate

Background: The most frequent injuries are lower limb fractures because road traffic accidents, which are the main cause of trauma, are occurring more frequently worldwide. Recent developments and the creation of newer fixation techniques have produced promising results in the treatment of complex lower limb fractures thanks to a better understanding of fracture healing. In our study, we treat lower limb fractures with a novel plate fixation method known as biological plate fixation-bridge plating. The two major fracture fragments are fixed by using the plate as an internal fixator. Without affecting the intricate fracture zone, length, alignment, and rotation are restored. In this case, as opposed to the traditional plating method, the fracture is healed by callus formation

Introduction: Day care procedures has now becoming a popular modality of treatment throughout the world. Day care procedures means that patient gets admitted, undergoes interventional procedure and gets discharged from the hospital on the same day of the procedure.[1] Anaesthetic agents available now-a-days play an important role in achieving specific criteria for ambulatory anaesthesia. Anaesthestic agents like, propofol and sevoflurane favors the anaesthesiologist to perform successful day case surgeries.Propofol has become the drug of choice for induction of anesthesia in the day care procedures due to its favorable recovery profile and low incidence of side effects.[2] Newer inhaled anaesthetics like desflurane and sevoflurane with low blood gas partition coefficient facilitates rapid induction of anaesthesia and rapid recovery and less adverse effect at the end of anaesthesia, leading to their use in day care surgery

The goal of this study was to determine the risk of thrombosis in patients with severe SARSCoV2 infection. Methodology: All patients referred to intensive care units (ICUs) from two centres of an Indian tertiary hospital for acute respiratory distress syndrome (ARDS) owing to COVID19 were included. Medical history, symptoms, biochemical data, and imaging data were all gathered prospectively. To compare the occurrence of thromboembolic events in non-COVID19 ARDS versus COVID19 ARDS patients, propensity score matching was used

Background- Patients on chemotherapy frequently presented with signs and symptoms of autonomic dysfunction. Cardiac autonomic dysfunction (CAD) is a significant cause of morbidity, mortality and affects the quality of life with progressive advancing disease and is associated with short survival of cancer patients. Therefore a thorough assessment of cardiovascular autonomic functions is crucial to monitor the disease prognosis and chemotherapy side effects on these patients. The present study was done to evaluate baseline Heart Rate Variability (HRV) and Ewings battery of Cardiac autonomic reactivity tests in cancer patients on chemotherapy to evaluate CAD

Dermoscopy is an easy, quick, non-invasive diagnostic tool that enables the visualization of submacroscopical structures invisible to the naked eye. The diagnosis of pediatric dermatosis can be challenging sometimes especially when there are atypical presentations, incomplete history. We present six cases of pediatric dermatosis which presented with such challenges and the usefulness of dermoscopy in confirming the diagnosis and initiating early treatment

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children. Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), After obtaining approval from the Institutional Ethical Committee and informed consent from the parents, all children (aged one month to 14 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included.

Background: The use of digital gadgets like smartphones, tablets, and laptops has grown along with time and technology advancements as well as during the COVID-19 epidemic. These digital devices have a propensity to produce a variety of systemic, visual, and ocular problems.