European Journal of Cardiovascular Medicine

Introduction: Hypertension, characterized by persistently elevated blood pressure levels, presents a substantial global health challenge. Defined as having a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher, hypertension is a leading risk factor for cardiovascular diseases and other non-communicable diseases. It contributes significantly to premature mortality and represents a major public health concern. In this study, we aimed to assess the prevalence of hypertension and identify associated risk factors within the rural field practice area of RIMS (Raichur Institute of Medical Sciences) in Raichur, India. This investigation is critical in shedding light on the burden of hypertension in rural communities and informing targeted interventions. Method: This cross-sectional study was conducted over a three-month period, commencing in December 2021 and concluding in February 2022. A multistage proportional sampling method was employed to select a representative sample of approximately 409 participants from the rural field practice area. Data collection included blood pressure measurements following Joint National Committee 8 (JNC 8) guidelines, participant interviews using semi-structured questionnaires, and obtaining written informed consent. Participants meeting specific inclusion criteria, aged 30 years and above, and residing in the study area for at least one year, were enrolled. Pregnant women were excluded due to unique health considerations. Key risk factors, including age, gender, education level, occupation, BMI, physical activity, alcohol consumption, tobacco smoking, and diabetic status, were assessed. Results: Our study revealed a significant prevalence of hypertension within the rural population of RIMS Raichur, with notable variations across demographic groups. Age, gender, education level, and lifestyle factors exhibited significant associations with hypertension. For instance, individuals aged 51-60 demonstrated the highest prevalence (37.91%), while males exhibited a higher prevalence (58.68%) compared to females (41.32%). Illiterate individuals displayed a higher hypertension prevalence (62.33%), emphasizing the role of education. Furthermore, BMI emerged as a critical risk factor, with overweight and obese individuals at greater risk. Lifestyle choices, such as physical inactivity, tobacco smoking, and alcohol consumption, also exhibited notable associations with hypertension, as did diabetic status. Conclusion: This study underscores the substantial burden of hypertension in the rural field practice area. The identified risk factors, including age, gender, education, BMI, and lifestyle choices, emphasize the need for targeted interventions to address this public health concern. Tailored healthcare strategies, education initiatives, and lifestyle modification programs are essential to mitigate the impact of hypertension in rural communities. These findings contribute to our understanding of hypertension epidemiology and offer valuable insights for the development of effective prevention and management strategies in this specific context.

Background: Pain and duration of convalescence are the two substantial concerns after laparoscopic cholecystectomy.  Subcostal transversus abdominis plane (STAP) block is a newer block which produces reliable supraumbilical analgesia.  Our aim was to evaluate the efficacy of Subcostal transverse abdominis plane(STAP) block in reducing postoperative pain and opioid consumption. Materials and Method: Eighty patients undergoing elective laparoscopic cholecystectomy were randomly allocated to receive either USG guided STAP block (n=40) with 0.25% Ropivacaine or standard postoperative analgesia (n=40) with Tramadol. All the patients were assessed for post operative pain and rescue analgesia consumption at regular intervals for first 24 hours.  Results: VAS score was significantly higher in control group as compared to the study group at all the time. Total dose of TRAMADOL consumption in study group was 107.5± 61.55 mg and in control group was 225±66.96 mg, which was statistically significant. First dose of rescue analgesia required in study group was at 426.66 ± 331.36 min and in control group was 130.5 ±  240.6min which was statistically significant.  Conclusion: STAP block is a promising modality for pain management when used as apart of multimodal analgesia.

Background: Operative laparoscopy has become the standard approach for most common surgeries nowadays for several reasons. Periumbilical and intraumbilical incision have been used to create pneumoperitoneum in laparoscopy. As Laparoscopic surgery has its own bundle of complexities including postoperative infection and ultimately cosmetic aspect but there no definite data regarding these aspects of Periumbilical and intraumbilical incision.  So, we aimed to compare the wound complication rates, easier and safer method of port entry and post surgical cosmesis in laparoscopy patients according to the initial laparoscopic incision. Methods: 30-50year aged 100 individuals were selected from patients who were admitted in surgery wards for laparoscopic cholecystectomy, appendectomy and diagnostic laparoscopy by simple random sampling. Informed consent was obtained from individuals after details of the procedure were explained.  Then these patients were divided in two groups with 50 patients in each group according to type of incision made for laparoscopic procedures. 50 patients received periumbilical incision and 50 patients received intraumbilical incision. Thereafter, in all of the patients postoperative major and minor complications, wound complication rate, duration of hospital stay, Results: The result showed that after intraumbulical incision wound complication rates do not differ from the cases with periumbilical incision. The cosmetic survey score was significantly higher in the intraumbulical group compared to periumbilical group. Though no significant difference was observed between both procedures regarding operation time, wound infection, nausea and vomiting however, intraumbilical incision had fewer complications as compared to periumbilical incision. Conclusion: Intraumbilical incision is superior to periumbilical incision for laparoscopy in early postoperative recovery and cosmetic point of view.

This study scrutinizes the prevalence and demographic determinants of rhino-orbito-cerebral mucormycosis (ROCM) in the context of various factors including age, gender, and diabetic conditions, delineating clear patterns and potential risk factors that may contribute to the onset and exacerbation of ROCM. Methods This cross-sectional study was conducted to investigate the cerebrovascular involvements in patients diagnosed with COVID-19 associated mucormycosis (CAM) at hospitals affiliated with BMCRI. The study spanned from May 2021 to August 2021, during which time pertinent data from 49 patients were meticulously recorded and analyzed. Results The results underscored a significant gender disparity in ROCM prevalence, with males being more predominantly affected (p <0.05)[13]. Furthermore, the age group of 50-60 showed a heightened vulnerability to ROCM, especially amongst individuals with pre-existing diabetic conditions (p <0.001)[15,17,19]. Noteworthy was the exacerbation of symptoms and complications in patients with a history of steroid usage (p <0.01)[20]. A considerable portion of the cases also delineated a discernible difference in clinical outcomes between Mucor and Aspergillus infections in ROCM, paving the path for focused clinical strategies[21]. Conclusion: The study furnishes critical insights into the demographic precursors of ROCM, spotlighting age and diabetic conditions as potent risk factors. The findings beckon an immediate need to tailor medical interventions and community health programs that address these specific demographics, thereby potentially curtailing the incidence and severity of ROCM. Further research is advocated to establish a more intricate understanding of the disease dynamics.

Background and Aim: Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). Cardiac autonomic neuropathy is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with diabetes mellitus, but despite these significant consequences cardiac autonomic neuropathy often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. Aim of the is to assess the autonomic nerve functions in diabetic patients and its manifestations.  Methods: The present study include 40 subjects in which 30 were diabetics and 10 were taken as controls from the medical wards of MNR Medical College Sangareddy, Telangana. Results & Conclusion: The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of cardiac autonomic neuropathy is complex, likely multifactorial, and not completely understood.Valsalva ratio test has lower values, both parasympathetic and sympathetic components of ANS has shown evidence of dysfunction.

Aim and Objectives: To study perioperative morbidity and mortality in patients who underwent Modified Bentall’s procedure. Materials and Methods: This is a retrospective observational study of 3 years from December 2018. Sample size of 25 members who underwent Modified Bentall’s procedure, who fulfilling inclusion criteria were taken for study and analyzed. The age, Gender, Indications of surgery, modification of operative steps viz., Cannulation techniques, cerebro-protective techniques, coronary buttons, post-op complications, post- op ICU stay and their impact on the outcomes i.e., morbidity and mortality were assessed.  Results: No significant association between sex , comorbidities, risk factors, presenting symptoms , duration, etiology , diagnosis, postoperative bleeding and mortality . there is significant association was noted between number of blood transfusions , inotropic support and mortality. Of 25 cases in the current study, 10 cases (40%) underwent surgery on an emergency basis and 15 patients (60%) were operated on electively. Mortality was noted in 05 cases (20%) of which all 05 cases (20%) underwent emergency modified Bentall are. a significant association was noted between the type of surgery and mortality. Mortality was noted in 05 cases (20%) of 25 cases in the present study. The commonest cause of death was low cardiac output seen in 05 cases, ARF on CKD requiring dialysis seen in 3 cases. Postoperative complications were noted in 04 cases (16%) cases in the current study. Postoperatively 04 patients (16%) had renal dysfunction, 03 patients (12%) had hepatic and renal dysfunction and poor neurological status was seen in 02 patients (08%). No patient developed infection/sepsis.  Conclusions: Immediate presentation following onset of symptoms and operating on emergency basis with appropriate cerebro protective techniques and meticulous haemostasis with sound surgical technique and usage of local haemostatic agents are the key factors in significantly reducing the mortality and morbidity following modified Bentall’s procedure.

Introduction: Left main coronary artery (LMCA) disease is an important risk factor for increased mortality and morbidity at all stages of diagnosis and treatment of coronary artery disease. It is often silent, with an unpredictable presentation and has diagnostic and management challenges. Myocardial protection in CABG with cardioplegic heart arrest is effective in improving surgical outcomes. CABG is recommended over PCI for any patient with stable angina, unstable angina, or in asymptomatic disease and significant left main or left main equivalent coronary stenosis. The left main coronary artery (LMCA) is still one of the most challenging areas of disease for both cardiovascular surgeons and interventional cardiologists. Aim of the study: To study the clinical presentation, clinical profile, risk factors and surgical outcomes associated with Left main coronary artery disease. Materials and Methods: This was a retrospective observational study. The study subjects were all the patients with cardioplegic arrested heart who underwent Coronary Artery Bypass Graft (CABG) over a three-year period. All such patients were assessed based on age, gender, presentation, comorbidities, ejection fractions, various vascular factors, post operative complications, mortality and morbidity. The information was obtained from case records, discharge records and death summaries. Results: A total of 100 cases were studied with 80 males and 20 females with age ranging from 21 to 70 years.  A significant association was noted between age, gender, weight, mode of presentation, comorbidities, preoperative ejection fraction, LMCA stenosis, number of vessels involved; and mortality. Conclusion: LMCA disease is an independent predictor of increased morbidity and mortality rates among patients with coronary artery disease. CABG is the traditional gold standard therapy for revascularization of LMCA disease, offering greater survival benefits. Understanding factors that predispose patients with LMCA disease to perioperative mortality is essential to formulate strategies to improve patient outcomes.

Background: The paediatricians in the private sector in India can play an important role in providing vaccine service delivery and immunization coverage. Standards and systems for service quality of private providers should be estab-lished by countries.Standards should include practices in all facilities delivering vaccines, including proper storage and handling, appropriate use of injections, proper recording and adherence to safety measures, and waste management and disposal. [1]There is also a need to have co-partnership and communication with private providers to improve the per-formance of health system in long term. Methodology: A cross sectional study was conducted in urban area of Bhopal city. Knowledge and adherence to standard guidelines related to vaccination practices were assessed. Total 110 paedia-tricians were found eligible for the present study.After excluding 10 paediatricians who refused to participate, finally, 100 paediatricians were involved(responded) giving response rate of 90.9%. Pre-designed;pretested questionnaire was used for data collection. Results: In this study, the study population were paediatricians providing vaccination in private clinics and private hospital. Most of the private providers 50% were in between 41 to 60 age group, 81% paediatricians were trained and 82% immunization clinics were registered to Government sector. Out of total respondents (76/100) 76% answered correctly on all knowledge item questions. Most respondents 76% had complete knowledge score on cold chain vaccine. Mean (SD) for knowledge score was 96.3(±7.61) ranging from 70 to100.  Conclusion: Knowledge of ma-jority of paediatricians were good,for success of NIP (National Immunization Program),it is necessary toincrease the private sector involvement in the area of immunization delivery.

Background: In the Emergency Department, COPD patients are assessed clinically and categorized with different grades of severity of the disease. Aim: To analyze the factors predicting failure of non invasive ventilation in Emergency Department among the patients with acute exacerbation of chronic obstructive pulmonary disease. Methodology: It was a prospective cohort study carried out during the period from July 2022 to August 2023. A total of 82 patients with acute exacerbation of chronic obstructive pulmonary disease requiring NIV attending Department of Emergency Medicine Results: In the present study 71.95% of the patients were males and 28.05% of the patients were females. The male female to ratio was 2.56:1. In this study 52.44% of the patients had hypertension, 42.68% of the patients had diabetes mellitus. The other comorbid conditions are as shown in table 5.3 and graph 5.3. In this study all the patients had shortness of breath and cough (100.00%) while fever was noted in 70.73% of the patients. In the present study failure of NIV and requirement of intubation was noted in 4.88% of the patients. In this study NIV failure was significantly associated with patients having pre existing or pulmonale (p=0.017) and hypothyroidism (p=0.025). In this study with regard to temperature (p=0.042), PO2 pertaining to second ABG analysis (p=0.023), NIV tidal volume (p=0.031) and hospital stay (p=0.001) differed significantly in patients with and without NIV failure. Conclusion: Based on the findings of this study it may be concluded that, the rate of NIV failure was low (4.88%) in a carefully selected patient population with timely intervention and strict monitoring.

Introduction: Diabetic foot ulcer is characterized by several pathological complications such as neuropathy, peripheral vascular disease, foot ulceration and infection with or without osteomyelitis, leading to the development of gangrene and even necessitating limb amputation. The study aims to study the prescription pattern and effect of antidiabetic drugs on diabetic foot ulcer patients.  Material and methods: A prospective observational study was conducted at the Department of General Medicine for one year the data was collected from 112 patients using a data collection form. The patients were selected based on inclusion and exclusion criteria and after permission from the institutional ethical committee.  Results: As per the study majority of the patients were male (76.78%) under the age group of 61 – 70 years (52.67%).  as per demographic status, 70.53% were non-smokers, 59.82% were alcohol drinkers and 82.14% of patients were both smokers and alcohol drinkers and  63.39% of patients were having a family history of diabetes. Based on the location of ulcers on foot were graded as 1, 2,3,4 & 5 grades, as per our study 41.96% had grade 4 ulcers. The majority of the patients were prescribed with dural drug combination therapy of antibiotics 47.32% followed by triple drug combination of antibiotics 27.67%, multiple drug combination therapy 19.64% and 05.35% monodrug therapy respectively, as per the prescription pattern of antibiotics Metronidazole 30.35% followed by Piperacillin + Tazobactam 23.23%, ciprofloxacin 16.96%, Vancomycin 11.60%, Ceftazidime 06.25%, Ampicillin and Doxycyline 04.46% and Gentamycin 02.67%. As per our study majority of the patients were prescribed metformin + glimepride + insulin 56.25% followed by metformin + glimepride 24.10%, metformin + tenegliptine 11.60% and metformin + pioglitazone 08.03% respectively. A higher significant mean reduction was observed in metformin + glimepride + insulin-treated groups (p<0.005).  Conclusion: As per our study Metronidazole antibiotic and a combination of metformin + glimepride + insulin show better control over blood glucose levels in patients suffering from diabetes.

Introduction: The incidence of high-velocity injuries leading to open fractures has been increasing, results in more cases of nonunion and osteomyelitis. Antibiotic-impregnated polymethyl methacrylate (PMMA) coated nails or beads delivers a higher concentration of local antibiotics to treat bone infections. Our study is to assess the outcome of dual antibiotic impregnated bone cement coated nails in infected nonunions and chronic osteomyelitis of the tibia and femur. Methods: The study was conducted in two different hospitals. Cases selected based on the proposed inclusion and exclusion criteria. A combination antibiotic of 500 milligrams of Gentamicin impregnated in 40 grams of PMMA mixed with 3 grams of Vancomycin is used to coat nails with a custom-made mould. In every case, medullary canal was reamed and irrigated with saline. The antibiotic nail was placed within the medullary canal. After six weeks nail was removed and a secondary procedure was done. Time taken for wound healing /sinus tract healing, bone healing and secondary procedure were noted. Results were evaluated using the ASAMI (Association for the Study and Application of Methods of Ilizarov) scoring system. Results: the study was conducted in 27 cases with 19 males and 8 females. 16 tibias and 11 femurs are treated with excellent and good results in 20, fair and poor in six as per the ASAMI scoring system. One case with poor result required multiple procedures to eradicate the infection. Conclusion: This study shows dual antibiotic bone cement-impregnated nails are effective in treating nonunion of long bones and the use of a mould will produce nails of consistent diameters with a smooth surface that facilitates easy introduction and extraction. These nails provide relative stability to nonunion and are a substitute for expensive imported beads and nails.

Background: Cardiac lesions are responsible for approximately 60-70% of sudden death. Histopathological examination of  heart on autopsy plays an essential role in determining the cause of death.  Aims and Objectives : To study the frequency of  heart diseases along with histomorphological changes in heart autopsy specimens. Materials and Methods: This retrospective study of  149 heart autopsy specimens, which was carried out in the Department of  Pathology, Raichur Institute of Medical sciences, Raichur, over a period of  five years from January 2017 to December 2021.   Results: A total of 198 autopsies were analysed, irrespective of cause of death. Among them specimen of  heart was included in 149 autopsies. Males were affected more frequently in (73%) than  females in (27%). Among cardiac lesions the most common finding was atherosclerosis in (78.02%)  followed by (15.38%) of myocardial hypertrophy, (13.18%) of myocardial infarction, (7.69%) of cardiomyopathy, (4.3%) of myocarditis and (1.09%) of atrial rupture. Normal histological findings were seen in  (39%). Conclusion: Ischemic heart disease with coronary artery atherosclerosis was found to be the leading cause of death with triple vessel disease as the most common pattern of involvement. Therefore, a thorough examination of cardiovascular system is necessary in case of autopsy to reach the cause of death.

Background This study was conducted to evaluate the association of the syntax score with predicting short-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).  Methods This was a hospital-based cross sectional observational study, conducted among 100 patients with left main or multi-vessel disease undergoing primary PCI and is validated to predict the outcomes of patients aged more than 18 years in the Department of Cardiology, Apollo Hospital, Bangalore Road, Bangalore, from July 2018 to June 2019, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results Out of 100 patients on follow-up after one month, 83% improved symptomatically and were in NYHA functional class I, 8% in class II and < 5% in class III/IV. Follow-up echocardiography showed that all patients in the high syntax group had persistent RWMA. About 30% of the low-syntax group and 19% of the mid-syntax group showed no RWMA with a p-value of 0.185. However, there was no significant improvement in mean ejection fraction (EF) after PCI in all syntax groups with a p-value of 0.491. Five patients died within 30 days of the procedure (during 2nd- 3rd week after discharge) and 15 MACCE were recorded during this period. Out of which 4% each had ACS-NSTEMI and UA, 3% had ADHF, 1% each had CVA infarct and IC bleed, and 1% had stent thrombosis requiring revascularization with a p-value of < 0.001 which was statistically significant. Conclusion The syntax score has risk predictive value both in patients undergoing elective PCI and in those undergoing primary PCI for STEMI.

Background: Acute pancreatitis is an inflammation of the pancreas that can have fatal repercussions and include other organs. 10% of people with serious illnesses die before diagnosis and different degrees of the disease can go undiagnosed [1]. Typically, 70% of instances of acute pancreatitis are caused by gallstones and alcohol consumption. Between 35 and 40 percent of instances of acute pancreatitis are caused by gallstones, including microlithiasis [2].

Objectives:

1. To study the age and sex prevalence of acute pancreatitis.

2. To study the various etiological factors of pancreatitis.

3. To study the clinical presentation and outcome of pancreatitis.

Background- Cervical cancer is a preventable disease and it is the second most common malignancy world wide and major cause of mortality in developing countries1.In developing countries it accounts for 15% of all new female cancer with an estimated 5,00000 new cases and 2,75000 death 1.In developing countries it account for 15% of all new female cancer with an estimated 5,00000 new cases and 2,75000 death 1 In India every year 122,844 women are diagnosed with cervical carcinoma and 67,477 dies from the disease 1 Objectives  - The present study intends to see expression of EGFR-1 in Squamous cell carcinoma of cervix and correlate it with histological grade and patient’s age. This study will help in planning the  therapeutic approach in patients with cervical carcinoma and also prognosis. Method-In present study  52 cases of Squamous cell carcinoma of cervix  were studied  in  Department of pathology ,MR.Medical college attached to BTGH hospital KALABURAGI and in various   private labs of kalaburagi  from September 2015 to August 2017. Membrane Positivity will be scored according to DAKO criteria   and   cyto plasmic and nuclear positivity will be scored according to percentage and intensity score  Results–  Fifteen cases of well differentiated Squamous cell carcinoma of cervix showed weak expression & thirty cases of moderately differentiated Squamous cell carcinoma of cervix showed moderate to strong expression,Seven patients of  poorly differentiated squamous cell carcinoma of cervix patients showed Strong expression of EGFR- 1 in patients  aged group of 45 to 60 years. Conclusion –  This study showed strong expression of EGFR-1 in poorly differentiated  squamous cell carcinoma of cervix in patient  aged from  fourth to sixth decade of life .And need for  aggressive management and treatment of cervical carcinoma patients.

Traditionally, the diagnosis of appendicitis used to make solely based on clinical signs and symptoms. Later diagnosis included results of inflammatory laboratory investigations such as leukocyte counts, neutrophil counts and CRP. This practice in diagnostics led to a false positive diagnosis (negative appendectomy) rates many times in the range of 15-30%. So, it requires more data & correlation of investigations to diagnose acute appendicitis in time. Out of the total 100 patients, who were diagnosed clinically as to have acute appendicitis, 86% of them were found to be having elevated HsCRP level and 58% presented with acute suppurative appendicitis. HsCRP test sensitivity against histopathological findings was computed to be 97.67%, specificity 85.71%, positive predictive value 97.67%, negative predictive value 85.71% and diagnostic accuracy to be 96.0%. Appendix wall thickness and HsCRP both test sensitivity was 81.40%, specificity was 42.86%, positive predictive value was 89.74%, negative predictive value was 27.27% and diagnostic accuracy was 76.0% so both HsCRP and appendix wall thickness were found to be very useful test to detect acute appendicitis. 14.0% negative appendectomies were done. Therefore, HsCRP and appendix wall thickness can be considered as a reliable diagnosis of acute appendicitis. A normal serum HsCRP level after 12 hours of onset of symptoms should be used as a basis for the decision to defer surgery to reduce the rate of negative appendicectomies, and also to reduce burden on patient as well as on health system.

Purpose: The purpose of this study was to determine the demographic and clinical characteristics of patients who had pancreaticoduodenectomy as an indication of pancreatic cancer. Methodology: This prospective observational study aimed to investigate the demographic and clinical characteristics of individuals who presented with pancreatic cancer and underwent pancreaticoduodenectomy. A cohort of 50 adult patients who were hospitalized in the Department of General Surgery Medical College Trivandrum and diagnosed with pancreatic or peri-ampullary cancer and subsequently received curative resection within the study period were included in the study. Results: Out of the total 50 study subjects, the majority of them were females, 27 (54% females), with a male-to-female ratio of 1.1:1. The majority of the participants were between the ages of 46 and 59 (44%) and 60 and older (34%). The majority of the study participants exhibit jaundice, accounting for 29 (58%). Diabetes mellitus was the most prevalent, being present in 12 patients (24%). The majority of the study participants were diagnosed with carcinoma of the head of the pancreas; 52% had periampullary carcinoma detected in 48%. A total of 25 patients had pylorus-preserving pancreaticoduodenectomy (PPPD), while another 25 study subjects underwent Classical Whipple's Resection. Conclusion: The study revealed that the incidence of pancreatic cancer was higher in females than males. The incidence is higher in the elderly population.

Background: Acute Pancreatitis is associated with nearly 20% of the morbidity and mortality and the need for a critical care bed, nutritional support, urgent ERCP and antibiotic usage to combat the severity even then about 25% of patients with acute pancreatitis will develop severe acute pancreatitis (SAP) and is strongly associated with organ failure and local complications such as peripancreatic fluid collections, pancreatic or peripancreatic necrosis (sterile or necrotic), formation of walled-off necrosis (sterile or infected) or pseudocyst etc.  the present study was chosen to observe and understand the clinical course and the outcome of Acute Pancreatitis induced either by alcohol or gallstones comparatively so that it will help the patients for better management and to reduce the severity, morbidity and mortality associated with Acute Pancreatitis. Research Question: What is the clinical course and outcome of Acute Pancreatitis induced either by alcohol or gallstones comparatively in our setup?  The setting of the study was at department of Gastroenterology, Government General Hospital, Guntur Medical College, Guntur, Andhra Pradesh. A one year observational study was conducted during the period from January 2022 to December 2022 on about 100 Acute Pancreatitis cases admitted during the above period in the department of Gastroenterology  by studying their socio-demographic profiles, associated comorbidities, assessing the degree of severity, clinical course and outcome, and complications etc. Results: It was observed that maximum males (88.23%) were observed in Alcoholic AP whereas maximum (81.25%) females were observed in Gallstone AP which was statistically highly significant and among the patients with alcoholic AP about 48.52 % patients were in the age group of 36 – 45 years when compared to 15.62 % in gallstone AP whereas 31.25 % patients were in the age group of 26-35 years in gall stone AP when compared to 16.17 % in alcoholic AP which was statistically significant. And also it was observed that the percentage of patients with more than 56 years age group were more in gallstone AP group when compared to other group which was  statistically not significant. There was no significant difference in mean age between the two groups but male patients were higher among alcohol AP than gallstone AP significantly. It was understood that regarding total hospital stay and number of days in ICU after surgery Alcohol induced AP is significantly better than Gallstone induced AP but in other parameter NPO days (nothing per oral) both were same. Related to distribution of comorbid conditions and local complications no significant difference was observed (P>0.05) and regarding intervention procedures ERCP was more in Gallstone AP & Cystogastrostomy was more in Alcoholic AP significantly. With reference to Lab findings serum creatinine levels was equal in both the groups but significantly serum amylase levels were high among Gallstone group comparatively. And also mortality was observed significantly high among Alcoholic AP group (6%).

Background The frequency of open fractures is rising as high velocity injuries are on the rise in the current situation. Approximately 60–65% of all open fractures involve the tibia. The administration is challenging, time-consuming, and some people think it's raising morbidity. The current standard of care for open tibia fractures is wound debridement, external fixator placement, and delayed wound closure followed by internal fixation. Although the use of an external fixator is rapid, the patient's mobilisation and wound healing will be delayed as a result. Primary nailing is advantageous for open fractures Type I and Type II because there is less wound than in Type III. External fixation is the most common form of treatment for Type III a, b, and c. Materials and Methods A prospective study was done in department of Orthopedics, SVRR Government General Hospital, Tirupati from June 2022 to May 2023. The study was done in 25 patients who volunteered for the study with Gustilo Anderson Type IIIa open fracture of tibia who were treated with primary intramedullary interlocking nail fixation after wound debridement and skin grafting and skin release whenever needed. All the patients were surgically treated with in 24 hours from the time of fracture. Functional assessment is done by the Johner and Wruh criteria1. Radiological union assessment is done by RUST score (Radiological Union Scale in Tibia)2. All the patients were studied for the rate of infection. Results Of the 25 patients treated with primary nailing following debridement for Type IIIa tibia fractures, Johner and Wruh score of excellent in 12 patients(48%), good in 6 patients(24%), fair in 3 patients(12%) and poor in 4 patients(16%). RUST score of 9-12 is in 10 patients (40%), 5-8 in 12 patients (48%) and 4 in 3 patients (12%). Of all the 25 patients infection is seen in 4 patients (16%). Conclusion Primary nailing for Type IIIa tibia fractures gives good biomechanical stability and better wound coverage, and is advisable for early mobilization with good functional and radiological outcome and minimal complications.

Aim and Background: In every region of the world, alcoholic liver disease can be attributed to alcoholism, which is one of the most prevalent risk factors. The goals of this study were to determine whether or not Kallistatin is a helpful non-invasive diagnostic for the diagnosis of alcoholic liver disease; whether or not its utility correlates with disease severity.

Methods: This case control research included a total of 75 human participants. This study was conducted at the Department of Biochemistry, Government Medical College, Sircilla, Telangana, India between June 202 to May 2023. During their visit for non-hepatic causes, controls were enlisted from the outpatient department. We chose 25 people who appeared to be in good health, had a history of abstaining completely from alcohol, and had a normal USG of the abdomen. Based on compensated and decompensated features, 50 cases were chosen and split into two groups. Serum Kallistatin concentrations were determined using a regular automated analyzer and Kallistatin levels were analyzed using an Enzyme Linked Immunosorbent Assay.

Results: Serum kallistatin levels were found to be inversely proportional to the severity of liver injury. Thirty patients with compensated aspects of alcoholic liver disease make up Group 1, and thirty patients with decompensated features of alcoholic liver disease make up Group 2.

Conclusion: Serum kallistatin can be used to detect early liver damage caused by alcohol intake. Serum kallistatin levels may be an important and protective factor in the prevention of alcoholic liver damage. This study paves the way for therapeutic intervention to begin earlier based on blood kallistatin levels.

Background: The rising incidence of Chronic Obstructive Pulmonary Disease (COPD) has made it a significant public health concern, particularly in India where it ranks as the second leading cause of mortality. This study aims to explore the cardiovascular autonomic reactivity in COPD patients compared to normal subjects. Previous research has shown autonomic imbalance in COPD patients, making this a critical area for investigation to enhance management strategies and mitigate cardiovascular complications. Material & Methods: This prospective observational study was conducted over 18 months at a tertiary care center with 78 participants, comprising both normal subjects and individuals diagnosed with COPD. Various tests, such as deep breathing, isometric handgrip, postural change, and the Valsalva maneuvre, were administered to assess cardiovascular autonomic reactivity. Statistical analyses including t-tests, were utilized to interpret the data. Results: The study revealed significant differences in BMI, resting heart rate, and blood pressure between normal subjects (Group A) and COPD patients (Group B), with p-values of 0.00004, 0.002, and <0.0001 respectively. Cardiovascular autonomic reactivity tests, including E:I Ratio (P=0.001) and ΔSBP (P<0.0001), also showed marked disparities. Conclusion: The study highlights significant differences in cardiovascular autonomic reactivity between normal individuals and COPD patients, particularly in parameters like BMI, heart rate, and blood pressure. These disparities suggest compromised autonomic flexibility in COPD patients, underlining the need for a multi-system approach in their clinical management.

Background: Cholecystectomy, the surgical removal of the gallbladder, has evolved from open to laparoscopic approaches. This study compares the complications and outcomes of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for gallstone disease management. Methods: A retrospective analysis of electronic medical records was conducted, including patient demographics, surgical details, complications, recovery times, hospital stays, and patient satisfaction in Department of General Surgery ANMMCH,GAYA .Multivariate analysis explored associations between variables. Results: Among 300 patients (LC=150, OC=150), LC showed lower bile duct injury (1.3% vs. 3.3%), wound infection (4.7% vs. 8.0%), and postoperative pain (3.8 vs. 4.2) rates. LC patients had faster recovery (3.8 days vs. 5.2 days) and shorter hospital stays (2.6 days vs. 4.1 days). Patient satisfaction was higher with LC (80.0% "Excellent" vs. 63.3%, p=0.002). Subgroup analysis showed consistent benefits of LC across complex gallstone disease and comorbidity subgroups. Multivariate analysis indicated the laparoscopic approach as an independent predictor of lower complications (OR=2.18, p=0.007). Conclusion: This study highlights the advantages of laparoscopic cholecystectomy, demonstrating lower complication rates, faster recovery, shorter hospital stays, and higher patient satisfaction compared to open cholecystectomy. These findings underscore the continued relevance of the laparoscopic approach for gallstone disease management.

Background: Appendectomy is a commonly performed emergency procedure for acute appendicitis. Surgical approaches have evolved from traditional open surgery to minimally invasive techniques, including laparoscopic appendectomy and single-incision laparoscopic appendectomy (SILA). This study aimed to comprehensively compare these approaches in terms of operative time, hospital stay, postoperative pain, complications, and patient satisfaction. Methods: A retrospective observational analysis of medical records was conducted by Department of General Surgery at Magadh Medical College and Hospital, Gaya (Bihar) between period October 2016 to October 2019. Patients who underwent appendectomy for acute appendicitis were included. Baseline characteristics, operative time, hospital stay, postoperative pain, complications, and patient satisfaction were analyzed. Statistical tests were used to compare continuous and categorical variables. Results: Laparoscopic appendectomy demonstrated significantly shorter mean operative time (48.7 minutes) compared to open appendectomy (65.4 minutes) and single-incision laparoscopic appendectomy (52.3 minutes) (p < 0.001). Laparoscopic appendectomy also resulted in shorter hospital stays (1.9 days) compared to single-incision laparoscopic appendectomy (2.1 days) and open appendectomy (2.7 days) (p < 0.001). Postoperative pain scores were significantly lower in laparoscopic and single-incision laparoscopic appendectomy (3.8 and 4.1, respectively) compared to open appendectomy (6.2) (p < 0.001). Complications were fewer in the minimally invasive groups, with laparoscopic appendectomy reporting the highest patient satisfaction (90.9%) compared to single-incision laparoscopic appendectomy (80.9%) and open appendectomy (75.8%) (p < 0.001). Conclusion: Minimally invasive techniques, specifically laparoscopic and single-incision laparoscopic appendectomy, offer superior outcomes in terms of operative time, hospital stay, postoperative pain, and patient satisfaction compared to traditional open appendectomy. These findings support the adoption of minimally invasive approaches in the management of acute appendicitis, potentially guiding clinical guidelines and optimizing patient care.

Background and Objectives: Type 2 diabetes mellitus (T2DM) constitutes a pressing modern pandemic, with emerging evidence highlighting the pivotal role of glycemic control, alongside blood pressure and lipid management, in mitigating the onset and severity of T2DM-related complications. Particularly, T2DM often precipitates dyslipidemia, notably in cases of inadequate glycemic control, escalating the risk of atherosclerosis and coronary heart disease. Notably, glycosylated hemoglobin (HbA1c) stands out as a superior indicator of blood glucose levels compared to fasting and postprandial measurements. Materials and Methods: The study enrolled 78 patients aged over 40 years, diagnosed with Type 2 DM without clinical evidence of coronary artery disease. Thorough medical histories and systemic examinations were conducted. The evaluation included hemogram analysis, urinalysis, fasting and postprandial blood sugar assessments, HbA1c measurements, lipid profile analysis, chest X-rays, electrocardiograms, and echocardiograms. Results: Among the participants, approximately 29.51% of male patients and 48.15 % of female patients exhibited HbA1c levels ≤8%, while the remainder had HbA1c levels >8%. In terms of low-density lipoprotein cholesterol (LDL-C) levels, 53.85% of patients had LDL-C <100 mg/dl, 17.95% had LDL-C levels between 100 and 129 mg/dl, and 28.21% had LDL-C levels ≥130 mg/dl. As for HDL, approximately 52.56% of patients had levels below 40 mg/dl, 33.33% registered HDL levels between 40 and 50 mg/dl, while 14.10% recorded HDL levels exceeding 50 mg/dl. Conclusion: There is a direct correlation between HbA1c levels and LDL-C, triglyceride (TG), and total cholesterol (TC) levels, while a negative correlation exists with high-density lipoprotein (HDL) levels. Patients with HbA1c levels >8% exhibited a higher frequency of elevated LDL-C, TC, TG, and low HDL-C compared to those with HbA1c levels ≤8%.

Background: Diabetes mellitus is a recognized risk factor for coronary artery disease (CAD), increasing the vulnerability to adverse outcomes in patients with acute coronary syndrome (ACS). Stress-induced hyperglycemia further complicates the clinical course of ACS. This study aimed to explore the prevalence and outcomes of stress hyperglycemia and diabetes mellitus among ACS patients.

Methods: A prospective observational study was conducted at Indira Gandhi Medical College, Shimla. A total of 301 ACS patients were enrolled, categorized into known diabetics, newly diagnosed diabetics, and stress-induced hyperglycemia. Clinical parameters, risk factors, and complications were analyzed using descriptive statistics, chi-square tests, and t-tests.

Results: Among the ACS patients, the prevalence of diabetes mellitus was 21.26%, comprising 12.96% known diabetics and 8.6% newly diagnosed cases. Stress-induced hyperglycemia was observed in 20.26% of the patients. Male predominance was noted among diabetic patients. The mean age of ACS presentation was around 58-59 years. Smoking was the most prevalent risk factor (61.5%), followed by hypertension. Diabetic patients exhibited a higher prevalence of complications, particularly heart failure (29.7%). Uncontrolled diabetes was associated with a higher incidence of complications (48.5%). Stress hyperglycemia correlated with impaired fasting glucose at discharge.

Conclusion: Diabetes mellitus and stress-induced hyperglycemia contribute to adverse outcomes in ACS patients. Complications were more frequent in diabetic patients, and stress hyperglycemia was associated with impaired glucose tolerance. Effective management and follow-up of hyperglycemic patients are crucial for improved outcomes.

Introduction: Acute pancreatitis (AP) is an inflammatory disease of the pancreas leading to pancreatic edema, bleeding, and necrosis. Acute pancreatitis is the leading cause of gastrointestinal-related hospitalization in most of the developing countries. A growing number of studies have focused on the association between blood glucose levels and AP outcomes of acute pancreatitis. The main aim of our study is to detect the ranges of blood glucose levels in pancreatitis disease.  Material & Methods: This study was carried out after obtaining approval from the institutional ethics committee. A patient under inclusion criteria was selected for the study they were divided into three groups based on the severity of pancreatitis. In Group A 50 patients with mild pancreatitis, Group B 50 patients with moderate pancreatitis and Group C 50 patients with severe pancreatitis. All the patient's sign and symptoms, fasting blood glucose (FBS), postprandial blood glucose (PPBS), hemoglobin (Hb), neutrophils, and lymphocyte count was done. Then the patients were prescribed selective doses Insulin based on the Glycemic index and after 3 months of treatment, all the biochemical parameter investigation were repeated after 3 months. Results: As per the study majority of the patients were male under the age group 51 – 60 years (58.00%) in group A and in groups B & C majority of the patients were under the age group of 61 – 70 years there were 48.00% & 64.00% showing statistical insignificance (p<0.05) respectively. In this study, majority of the patients had Ascites (fluid buildup in the belly) - 148 (98.66%) followed by severe abdominal pain 146 (97.33%) as major symptoms. In group A patients, significant mean reduction was observed in FBS & PPBS 30.10±1.00 & 25.88 ± 0.30 (p<0.05) respectively and no significant was observed in group B & C of FBS and PPBS (p>0.05 respectively. There is no change in Hb, neutrophils, and leukocyte counts in all three groups.  Conclusion: Patients with mild pancreatitis have shown statistically significant reduction in FBS & PPBS levels, as compared to patients with moderate and severe pancreatitis.

Preoxygenation is the administration of oxygen former to the induction of anesthesia, it permits a safety shield during stages of apnoea and hypoventilation and it also prolongs the time period of safe apnoea. During anesthesia, oxygenation chiefly depends on alveolar ventilation, distribution of ventilation/perfusion ratio, and consumption of O2. The highest preoxygenation is attained when the alveolar and arterial tissues and venous compartments are all occupied with oxygen. During induction of general anesthesia in patients, the usage of 100% oxygen has become standard practice, although preoxygenation was primarily proposed as an optional precautionary measure. Oxygenation techniques is a safe intubation technique for the majority of the surgical patients.  Materials And Methods: The study was randomized control study with duration of 11 months. The study was conducted by the Department of Anesthesiology at Shadan Institute of Medical Sciences (SIMS), Hyderabad. The patients were explained regarding the study, the procedure and complications of arterial cannulation and the informed consent form was collected from all participating patients before the commencement of the study. 60 patients in the age group between 20-60 years of age and of either gender, belonging to ASA grade I-II scheduled for elective surgeries under general anesthesia, were included in the study and divided into two equal groups (Group a and Group b) of 30 each.  ABG samples were obtained before and after preoxygenation. All patients were instructed regarding the procedure of preoxygenation and procedure for obtaining an arterial blood sample. Results: In group A (100% oxygen) the mean value for age (20-60yrs) is 1.50±0.82, and in group B (60% oxygen) it is found to be 1.52±0.80. In group A (100% oxygen) the mean value for gender is 1.45±0.45, and in group B (60% oxygen) it is found to be 1.43±0.50. BMI (mg/m2) was measured and in group A (100% oxygen) the mean value is 1.43±0.77 and in group B (60% oxygen), it is 1.37±0.76. Comparison of partial pressure of oxygen (PaO2) in the study groups was done, group A (100% oxygen) showed 99.03±6.10 at PaO2 (0 mins) and 100±0.00 at PaO2 (3 mins). Group B (60% oxygen) showed 99.05±5.67 at PaO2 (0 mins) and 100±0.00 at PaO2 (3 mins). Statistical significance (p<0.001*) was found between group A (100% oxygen) and group B (60% oxygen). Comparison of level of oxygen saturation (SpO2) in the study groups was done, group A (100% oxygen) showed 98.50±0.60 at SpO2 (0 mins) and 100±0.00 at SpO2 (3 mins). Group B (60% oxygen) showed 98.50±0.51 at SpO2 (0 mins) and 100±0.00 at SpO2 (3 mins).  Conclusion: To be more apt, currently there is no clinical evidence claiming the increase in incidence of hypoxia and its complications with a lower FiO2. The findings of this current study performed over 60 patients could be reliable fundamental evidence for future references. Furthermore, the conclusions of our study could widen up the horizon for the anesthesiologists during times of oxygen scarcity.

Introduction: Atrial fibrillation (AF) is a prevalent and clinically significant cardiac arrhythmia, particularly in the elderly population. This study aimed to investigate the clinical presentation, predisposing factors, etiology, and complications of AF.  Materials and Methodology: We conducted a prospective observational study involving 123 atrial fibrillation cases admitted to the Government Medical College and Hospital in Bhavnagar, Gujarat, India, from August 2019 to January 2020. Comprehensive patient histories and clinical examinations were conducted following a predefined proforma, and all necessary investigations were gathered and subsequently analyzed. Results: Among the 123 cases, 65 were male, and 58 were female. The mean age was 51.05 ± 13.19 years, with the majority falling in the 40-59 age group (50.40%). Dyspnea was the predominant symptom in 82.11% of cases, followed by palpitations in 77.23%. Rheumatic heart disease (RHD) was the most common etiology of atrial fibrillation (AF) at 48.78% in our study, followed by ischemic heart disease (IHD) with hypertension (20%). Among RHD cases, mitral stenosis (MS) was the most prevalent valvular lesion, accounting for 26.83%. Complications included congestive cardiac failure in 67.48% of cases and congestive cardiac failure with cerebrovascular accident in 13.01%. Our study reported a mortality rate of 6.50% Conclusion: In our investigation, a higher proportion of male participants were observed compared to females. The predominant age group among the subjects was 41-59 years. The primary cause of cases in our study was rheumatic heart disease (RHD), with ischemic heart disease (IHD) in conjunction with hypertension comprising the second most common etiology at 20%.

Background: Post operative nausea and vomiting is one of the commonest complication following General Anaesthesia resulting in delayed discharge, pathological and physiological distress for the patients.

Materials And Methods: Patients were subjected to a thorough PAE, and routine investigations were done. After obtaining approval and clearance from institutional ethical committee, patients fulfilling criteria and willing to give informed written consent were included in the study and were divided into 2 groups with 30 patients in each group –

1. Group A – patients receive Tab Pregabalin 150 mg orally 1 hour before surgery as premedication with 1 spoon of water.

2. Group B – patients receive a placebo drug.

In preoperative area, baseline vitals were recorded and Patients received 150 mg of tab pregabalin as premedication 1 hour before the surgery. Patients were given premedication with Inj Midazolam 0.05mg/kg body weight, Inj Glyclopyrolate 60mcg/kg body weight. Patients were induced with Propofol 2mg/kg body weight and fentanyl 3mcg/kg body weight. Preoxygenated with 100% O2 for 3–4 mins and vecuronium at 0.1mg/kg body weight was used as muscle relaxant. Patients were intubated with appropriate size E.T Tube and fixed and connected to ventilator and maintained with O2 (60%)+ Nitrous oxide (40%) + Isoflurane (0.8 – 1%) + Vecuronium 0.08mg/kg body weight.

30 mins before extubation 5 HT 3 antagonist Ondensetron 0.15mg/kg body weight was given.

Number of post operative nausea vomiting episodes were recorded by Nausea as primary aim and pain score, hemodynamic stability with Heart rate, blood pressure were recorded as secondary aim.

Results: The comparative study between the two groups showed statistically significant results favoring the primary objective. The oral pregabilin dose of 150 mg produced significant reduction in post-operative nausea and vomiting (PONV). [Chi square 11.29, P value: 0.001 table 11]. The statistical analysis also significantly showed that the pregabilin group had less post operative pain, complications of vomiting and other symptoms. [chi square 1.429, P value <0.00, table 12]. The additional benefit of post operative pain relief determined via VAS score was also statistically in the oral pregabilin group. [chi square 60.0, P value <0.001, table 13]. However, the demographic composition of two groups were insignificant on (age, sex, weight) on statistical analysis. The heart rate response and the response on blood pressure (SBP and DBP) during the intubation process in the oral pregabilin group was significantly less and hence better in obtundation of the response to intubation [Table 7,8,9,10]. The sedative effect of pregabalin group assessed post operatively showed significant sedation and hence the additional benefit of post-operative analgesic effect too.  Conclusion: We conclude that pre-operative pregabalin is associated with significant reduction of post operative nausea and vomiting, and it can be considered as a part of multimodal approach to post operative nausea and vomiting and also for post operative analgesia.

Background Negative symptoms in schizophrenia are integral to the prodromal stage; are less evident when positive symptoms dominate and contribute immensely to the outcome. Both Blunted Affect-Alogia cluster and Anhedonia-Avolition-Asociality cluster are observed in nearly two-thirds of the patients. The present study compares the schizophrenic patient’s psychosocial disability and his family’s experienced burden with those suffering from Bipolar illness. Materials and Method  Sixty patients in each group were studied using the novel Schedule for Assessment of Psychiatric Disability (SAPD) and the Family Burden Interview Schedule (FBIS). Schizophrenics suffered significantly more in all domains of disability and caused more burden to their families in all considered parameters. The negative symptoms in schizophrenics were assessed using the Scale for Assessment of Negative Symptoms (SANS). The clinical necessity of defining them in individual patients and researching newer pharmacological and psychosocial innovations to manage them are emphasized. Results  The symptoms showed significant contribution to both the individual’s disability level and to the family’s burden. Results in the study showed that disability resulted directly from the negative symptoms whereas family burden derived from factors other than negative symptoms alone. Conclusion  In schizophrenia, positive symptoms can cause acute exacerbations and interpersonal disturbances, but they are mostly amenable to pharmacotherapy. On the other hand, negative symptoms presented early and relentlessly progressed to residual stages.  They were pervasive and treatment-resistant. The clinical necessity of defining them in individual patients and researching newer pharmacological and psychosocial innovations to manage them are emphasized.

Background: Smartphone has become an integral part of our daily living. The issue of smartphone addiction is increasing worldwide, particularly among students. The study was done to assess the chronotype pattern in medical students and the association of smartphone addiction with sleep quality according to their circadian typology. Material and Methods: A cross-sectional study was conducted on a sample comprising 525 medical students. Data was collected by circulating Google forms. Morningness-Eveningness Questionnaire Self-assessment version (MEQ-SA), Smartphone addiction scale - Short version (SAS -SV), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Score (ESS) were administered to assess the chronotype, smartphone addiction, sleep quality, daytime sleepiness respectively. Results: Almost a quarter of students involved in the study could be classified as being "smartphone-addicted" (135, 25.7%) and 29.5% (n=155) had poor sleep quality. Study subjects were divided into evening chronotype  (57, 10.9%) intermediate chronotype (374, 71.2 %), and morning chronotype (94, 17.9%). Smartphone addiction was associated with eveningness chronotype (p=0.001) and poor sleep quality (p=0.001). The study did not find statistical significance between chronotype and poor sleep quality. Conclusion: The results of the study showed that a significant number of medical students had smartphone addiction and suffered from poor sleep quality. Circadian typology demonstrated a significant association with smartphone addiction.

Key Message

• There is a high prevalence of smartphone addiction among medical college students
• Smartphone addiction is associated with poor sleep quality
• Smartphone addiction is associated with evening chronotype

Introduction:Vitamin B12 is chemically most complex vitamin. Dietary sources of vitamin B12 are meat, liver, fish, eggs and dairy products.It is a micronutrient essential for cardiac,neurological and hematopoetic functions.Wide range of manifestations are there due to deficiency of vitamin B12 like megaloblastic anemia,pancytopenia,dementia, delirium,peripheral neuropathy, sub acute combine degeneration of spinal cord etc.Vitamin B12 deficiency leads to hyperhomocysteinemia and methylmalonic acidemia. These biochemical abnormalities atributed to peripheral neuropathy with impaired nerve conduction parameters like nerve conduction velocity, amplitude, latency.Aim:The present study aimed to correlate the deficiency of vitamin B12 with peripheral nerve conduction parameters like nerve conduction velocity, Amplitude, latency.Materials And Methods:The present study was a cross sectional study conducted at Neurophysiology laboratory attached to Jawaharlal Nehru Medical College and Hospital Ajmer.The study period was one year,started in October 2021 and completed by October 2022. A total of 400 subjects of all age groups with vitamin B12 deficiency who underwent nerve conduction study tests during study period Included in the study.Estimation of Serum Vitamin B12 done. Nerve conduction study tests for Peroneal and Sural nerves performed on Vitamin B12 deficient subjects.Parameters recorded for data analysis were serum vitamin B12 level,Nerve conduction velocity, Amplitude, and Latency.Descriptive statistics used for data analysis and correlation analysis of serum vitamin B12 level with nerve conduction parameters done using pearson’s correlation test. p value < 0.05 Considered statistical significant.Results:Out of 400 subjects 240 were female,160 were male. 58(14.50%) subjects had borderline vitamin B12 deficiency, 142(35.50%) had vitamin B12 deficiency, 200(50%) had severe vitamin B12 deficiency. With the deficiency of vitamin B12 there was significant decrease in nerve conduction velocities (r= 0.16, p = 0.00169 ); amplitude(r= 0.14, p =0.00369) and significant increase in latency(r = - 0.11, p = 0.02493 ) of peroneal nerve. With the deficiency of serum vitamin B12 there was significant decrease in nerve conduction velocities (r = 0.12,p = 0.01182 ); amplitude(r= 0.14, p =0.00369) and significant increase in latency(r = - 0.17, p = 0.00065) of sural nerve. Conclusion:Present study showed that the nerve conduction velocities,amplitude of peroneal and sural nerves decreases and latencies of those increases  with decrease in serum vitamin B12 level.Early detection and appropriate interventions for vitamin B12 deficiency can prevent its progression to nerve functions impairements

Introduction: Injecting Drug Users (IDUs) raise a significant public health concern because of the associated risk of spread of infections like HIV, Hepatitis B and C. Andhra Pradesh has been ranked fourth in the entire country with regard to prevalence of injecting drugs like heroin and opioids, as well as having high prevalence of HIV and Hepatitis C cases. Practices that lead to transmission of Sexually transmitted diseases are termed risk behaviours. Objectives: Study of factors associated with risk behaviours among IDUs which led to spread of parenterally transmitted infections for understanding and planning of better management. Methodology: Observational descriptive study carried out among IDUs attending a Targeted Intervention Centre at Visakhapatnam from November 2020 to February 2021. Sociodemographic details were recorded using a pretested semi structured interview schedule and interview was done for assessing prevalence of risk behaviours. Results: The median age of participants in the study was 31.7 years. 2% participant reported as being attracted to both men and women (bisexual) while 98% of the participants reported heterosexuality. Out of the 65 study participants registered at the targeted intervention center for OST, 26 (40%) participants had reported using injecting drugs in the last one month with almost three-fourth of them admitted to injecting either once or multiple times a day. Conclusions: Socio-demographic factors like lower age, lower education, employment and marital status are statistically significant in prevalence of unsafe injection and sexual practices. The findings suggest that IDUs in the study area have tendency to engage in risk behaviours, but TIC has been effective in its reduction.

Background and Objectives-

Diabetes mellitus is a slowly growing epidemic of the global world; with the morbidity and mortality associated with it, the knowledge of the disease is ever evolving. Handgrip strength is a simple non-invasive technique for detection of muscle strength. Association of handgrip strength with glycaemic levels and other anthropometric parameters provides an early pavement for detection of individuals at risk of diabetes mellitus. The current study aims at comparing handgrip strength among impaired glucose tolerance individuals as compared to healthy individuals.

Materials and Methods

The current study is a hospital based cross-sectional study conducted at Chigateri government hospital and Bapuji hospital attached to JJM Medical College, Davangere. Study was conducted from February 2023 to July 2023 after taking written informed consent from all participants.  A total of 94 subjects; 48 individuals having impaired glucose tolerance and 48 individuals with normal blood glucose were taken as study population. Handgrip strength was measured in both hands with Digital Hand Dynamometer. Average of 3 readings was taken. All individuals aged above 18 years and who fall in category of IGT according to American Diabetes Association (ADA) guidelines.

Results

A total of 96 individuals were in the study population, 48 were in IGT group and 48 were normal controls. The mean age in IGT group was 55.89 years with ± 8.92 years. Handgrip strength was weak in 25 individuals in right hand and 33 individuals in left hand among IGT group. Blood sugar level had an inverse relationship with handgrip strength amongst IGT group and was statistical significant (p-value – 0.000).

Conclusion

Background: In view of recent guidelines in the management of obstructive airway disease advocate the early use of oral and inhaled steroids which intern responsible for many side effects extending up to many organ systems including eye also by developing rise of intra ocular pressure ranging from 15 to 30 mm of Hg after daily topical steroid use for 4-5 weeks. So basing on this, the present study was planned to estimate the risk of ocular hypertension among the patient under inhaled corticosteroids. Research Question: What is the incidence of ocular hypertension among the patients under inhaled corticosteroids? The setting of the study was at department of ophthalmology, “Government Medical College”, Machilipatnam, Andhra Pradesh. A twelve months observational follow-up study was conducted during the period from July 2022 to June 2023 on 100 patients of COPD under inhaled corticosteroids attending the hospital by targeting their socio-demographic profiles and periodical measurement of their IOP etc. Results: All the study subjects were heterosexuals among which 56% males & 44% were females and majority of the study group (54%) belongs to between 50-55 years of age  with the mean age 55.2 yrs [M ± 2SE = 55.2 ± 1.16]. About 7% of the study group developed ocular hypertension at the end of 6 months with the rise of female contribution 63% when compared to males 37%. And also it was observed that there was significant rise of ocular hypertension proportionate to age, dosage and duration in this study with the P<0.001.

Introduction:-The aspiration of successful induction of labour is to reduce the risk of expectant pregnancy. Application of Dinoprostone gel for induction of labour is the gold standard practice in obstetrics. Induction of labour should be safe, effective as well as convenient for both patient and medical staff. Therefor induction to delivery time interval has a determinable effect in its success.

Aim:-To observe induction to delivery time interval in labour induced with Dinoprostone gel and factors associated with it.

Material and methods:-This is a retrospective observational study conducted from December 2020 to May 2021 in GMERS hospital sola. Labour induction with Dinoprostone gel in 210 women was studied. Pregnant women fulfilling the inclusion criteria were induced with 0.5 mg Dinoprostone gel intracervicaly after recording baseline bishop score and assessing fetal wellbeing with NST.

Vigilant labour monitoring was done and second gel instillation and labour augmentation with oxytocin was done as and when required.

Induction was considered to be failed when there was no progressive cervical dilatation &/or inefficient uterine activity. Primary and secondary outcomes were observed and then analysed.

Results:-Out of total 210 pregnant women induced with Dinoprostone gel 83.80% women delivered vaginally with mean induction to delivery interval 13.6+/- 1.1 hours in primi gravida and 8.9+/-0.9 hours in multi gravida.

Only 7.61% maternal complication rate and 0.9% NICU admission suggests good maternal and perinatal outcome of this study.

Conclusion:-Intra cervical Dinoprostone gel application is associated with successful outcome and relatively shortens duration of labour improving its acceptance worldwide.

Clinical Significance:-Induction of labour with cervical prostaglandin application such as Dinoprostone is a common & Routine Procedure

Not only induction of labour but timely delivery also plays an important role in successful labour. Shorter the duration of labour better and more acceptable is the outcome both for women as well as doctor.

In this study we assess the duration of time required by Dinoprostone gel application for successful induction and delivery, and factors associated with it.

INTRODUCTION: Covid-19 has proved to be one of the most traumatic pandemics worldwide. Though it affected people of all ages and gender, pregnant ladies were the ones who suffered the bad consequences. Strongly occupied hospitals created a typical fear of the spread of infection among pregnant ladies. Due to all these factors, pregnant women could not even go out for a routine check-up, affecting the ANC care.

OBJECTIVES: To study pregnant patients during the covid-19 pandemic and also to find out complications during the pandemic

METHODS: Pregnant women who were admitted during the second wave of the covid-19 pandemic were included after a signed written informed consent was provided. At the Dept. of Obstetrics and Gynaecology of Dr. D.Y. Patil Hospital and Research Institute, Kolhapur, Maharashtra.

RESULTS: The majority were from the age group between 26 to 30 years followed by the age group 21 to 25 years. Regarding mode of delivery, Emergency LSCS was needed in 818 (68%) patients, normal vaginal delivery was performed in 354 (29.3%) patients and there were 32 (2.7%) cases of intra-uterine death. The most common maternal complication was the occurrence of anemia seen in almost half of the patients. The most common fetal complication was low birth weight in neonates, IUGR, and fetal distress.

CONCLUSION: It was found that complications like abortions, preterm birth, intrauterine deaths, and intrapartum complications. During a pandemic, psychological stress among patients was increased, because of the scarcity of ANC services and intrapartum services

Background: This study embarked on a critical analysis of the morphological and biochemical characteristics of the gall bladder in individuals diagnosed with gallstones, aiming to extend the understanding of gallstone pathogenesis.

Methods: A prospective study was conducted at the Dr. B. S. Kushwah Institute of Medical Sciences, where participants were recruited to undergo detailed analyses, including histopathological examinations, biochemical analysis of bile, microbial analysis, and imaging analysis.

Results: The study identified a significant presence of cholesterol gallstones (70%) in the population, with a high incidence of gallbladder inflammation (75%) and chronic cholecystitis (70%). The biochemical analysis revealed elevated levels of cholesterol (mean 5.2 mmol/L) and bilirubin (mean 17.3 µmol/L) in the bile. Furthermore, a notable presence of Firmicutes (90%) and Bacteroidetes (75%) was observed in the microbial analysis, indicating a potential correlation with gallstone formation.

Conclusion: Our study underscores the chronic nature of gallstone disease, highlighting the role of bile composition and microbiota diversity in its pathogenesis. The findings present avenues for future research, potentially focusing on preventive strategies based on bile composition alterations and microbial diversity.

Purpose: Developmental anomalies of the Atlas vertebrae are often encountered during the investigation of cervical pain. So this study was designed to find the variation of the Atlas vertebra.

Methods: A total of hundred dried Atlas vertebrae of unknown age and sex of the Northern population of India were examined to find the congenital defect of the Atlas vertebra in the Department of Anatomy.

Results: The presence of incomplete foramen transversarium was found in 6 % vertebrae. The Retroarticular canal was found in 9 %vertebrae. The bony spur originated from the posterior aspect of the superior articular facet was seen in 5% vertebrae. No anomaly was found in the anterior arch whereas aplasia of the posterior arch was found in 3% vertebrae.

Conclusion: The first cervical vertebra often presence the development anomaly. Such developmental abnormalities in different parts of Atlas vertebrae produce various clinical symptoms. The knowledge of such variation helps clinicians to distinguish it from the fracture and to find an accurate clinical diagnosis.

Introduction: The study of the dimensions of the head of femur is important for hip replacement surgery as for the use of appropriate prosthesis. The dimensions differ according to age, race, heredity, and geographical area.

Objective: To evaluate the morphometric parameters of the head of femur and analyze them statistically.

Material and Methods: 114 human adults’ dry Femur bones were used for study. The measurement was done to know the average transverse and vertical diameter of the head of Femur. All measurements were done with the help of Vernier calipers.

Results: The following are the mean values of transverse and vertical diameters of head of femur for114 bones. Mean transverse diameter of the head of Femur was 4.250.29 cm on the left side and 4.220.28 cm on right side. The mean vertical diameter of the head of Femur was 4.210.30 cm on the left side and 4.220.29 cm on right side.

Background: Orphan children are vulnerable group in the society due to lack of affection, care love, emotional attachment and phycological support from parents which leads depression, malnutrition. There is decreased immunity due to malnutrition which leads to infections. Hence the present study was done with an objective to assess morbidity profile and to estimate the prevalence of depression among the children residing in the orphanages Methods: A community based cross‑sectional study was carried out in 5 selected Orphanages and 210 children residing in those orphanages selected by the simple random sampling method. Data was collected by interview method using pretested semi structured schedule. Results:   Prevalence of Depression was 38.6 % and it was more among girls compared to boys and the difference is statistically significant. The major morbidities observed were dental caries 55.2 %, underweight 55.2 %, stunting 53.2 %, and pallor   20.5 %Conclusion: Depression, malnutrition and dental caries were the major health problems among the children in the orphanages and needs to be addressed and regular monitoring of nutritional status and improving the oral hygiene by health education and regular counselling will help to cope up with depression and other health problems.

Purpose: Anatomic variations of left atrium that are commonly observed and reported are the occurrence of a common Right or Left pulmonary venous ostia though a solitary ostium for a common pulmonary vein on the left atrial wall in an adult cadaveric heart has hardly been reported before. Method: A heart with a single ostium for PV was observed in the specimen collection of the gross anatomy lab. The organ was studied for identifying all external and internal features. Results: A very rare case of a Solitary Pulmonary ostium on the posterior aspect of Left Atrium in an otherwise normal heart was observed. Conclusion: This abnormal situation occurs when the solitary pulmonary vein which develops from an out-pouching of the primitive atrial chamber develops and its primary divisions fail to get incorporated into the left atrial wall as expected during development. Variant pulmonary veins have been reported as ectopic trigger spots for atrial fibrillation. This knowledge would benefit the radiologists and cardiovascular surgeons in this regard.

Background: The most frequent electrolyte imbalance seen in clinical practise is hyponatremia, which is characterised by a serum sodium concentration ([Na+]) 135 mEq/L. Mild hyponatremia—serum [Na+] 130–135 mEq/L—occurs in up to 30% of hospitalised patients. [1,2] Acute severe hyponatremia is known to produce cerebral oedema, which can have serious neurological effects. If it is not properly detected and treated, it can be fatal. [3]

Objectives:

1. To study the incidence of hyponatremia in hospitalized adult patients in medical wards.

2. To determine the etiology of clinically significant hyponatremia in 100 patients in medical wards.

3. To determine the clinical presentation of hyponatremia in these patients.

Material & Methods: Study Design:  Hospital based prospective observational study. Study area: Bapuji Hospital & Chigateri Hospital. Study Period: April 2022 to March 2023. Study population:  Patients admitted in  Hospital medical wards with serum sodium less than 130 mmol/L. Sample size: Study consisted a total of 100 subjects. In the hospital, all the patients, as routine, blood samples were taken and serum electrolytes were done in central biochemistry laboratory. The records were followed up for patients with hyponatremia and values repeated once for confirmation. A standard proforma was used to record to detailed history of present complaints, past history including diabetes mellitus, systemic hypertension, Ischemic heart disease, dyslipidemia, neurological, chronic kidney disease / renal disease, regulatory and endocrine problems. A detailed drug history was also recorded.

Results: 67 patients had some neurological symptoms of hyponatremia due to cerebral edema like nausea, vomiting, giddiness and altered sensorium. 14 patients presented with seizures. The lower the sodium value, the higher the incidence of symptomatic hyponatremia. The incidence of symptomatic hyponatremia is more with lowering sodium levels which is statistically significant. All patients with severe hyponatremia had symptoms.

Conclusion: Symptomatic hyponatremia is common among the hospitalized patients. Neurological symptoms are common in hyponatremia patients. SIADH and euvolemic hyponatremia formed the largest subgroup in the study. Drugs, especially diuretics, are a common cause of hyponatremia. A relatively large number of patients had endocrine abnormalities (thyroid, adrenal and pituitary). The mortality was about 10%. It was mainly due to underlying primary diseases. Older age groups had more incidence of hyponatremia. Symptoms of hyponatremia increased with severity of hyponatremia.

Introduction: In today's contemporary obstetrics, each surgery performed on a pregnant woman is entirely reliant on the gestational age or estimated date of confinement. This predicted date of delivery is crucial in controlling obstetric high-risk births. Any events such as medication administration, interpreting blood results, estimating foetal development or any planned surgical treatment, any cause for termination, foetal and  mother morbidity and death during birth are all reliant on gestational age. As a result, effective methods for providing a more precise and accurate gestational age are required, because care in particular high-risk pregnancies depend on the gestational age.

Material & Method: This is a hospital based cross sectional study conducted at the Dept of Obstetrics and Gynaecology, Medical College Kolkata from 1st August 2022 to 31st July 2023. Randomly selected pregnant women meeting the inclusion and exclusion criteria, the study includes, 100 pregnant women admitted in hospital at  more than 28 weeks to 40 weeks. The study group comprises of 100 pregnant women fulfilling the inclusion and exclusion criteria. This cross-sectional study was conducted after obtaining institutional ethics committee clearance. Written and informed consent were taken from all the pregnant women participating in the study. The pregnant women in the study was   subjected to a detailed history and thorough general and clinical examination.

Results: Total of 100 pregnant women fulfilling inclusion criteria are include in present study after obtaining informed consent. The mean age of participants was 25.95±2.59yrs of  age, with minimum age of 21yrs and maximum age of 32 years pregnant women. On assessment of the mean of placental thickness of all the study participants, we found it be 38.66±2.05 in multipara pregnancy and 38.60±1.65 in primipara pregnancy with no statistical difference between the both. Overall mean of placental thickness was found to be 38.64±1.93. The mean gestational age of the pregnancy was found to be 33.90±3.09, and the estimated gestational age by FL was 34.17±3.04, GA estimated by BPD was 34.14±3.02 and GA estimated by AC was 34.56±3.02weeks, with no significant difference in the gestational age.

Background: Chronic venous Insufficiency (CVI) is a commonest condition encountered in clinical practice that occurs due to venous valvular dysfunction in the superficial, deep, and/or perforating veins. The spectrum may vary from common varicose veins to more severe deep vein thrombosis and resulting local and systemic complications. Duplex ultrasonography plays vital role in understanding the spectrum of CVI.  Objectives: To evaluate the spectrum of colour duplex ultrasound findings in patients with chronic venous insufficiency clinical symptoms and signs.  Material & Methods: A prospective observational study was conducted in the department of Radio diagnosis of a tertiary care hospital. for a period two years. The study included 50 participants presenting with symptoms of pain, swelling, pedal oedema varicosities, erythema, and venous ulcer were included. In addition to detailed clinical assessment and review of past medical records,  Doppler ultrasonography of lower extremities was done. Results:  Age of the participants ranged from  11-70 years and 70% of participants were males. Among 50 participants 44 (88%) were positive on Doppler. In our study primary varicosities were seen in 29 cases ( 65.91%). Varicosities secondary to DVT were seen in 13 cases ( 29.55%), congenital causes were rare as noted in 2 cases (4.54%) of the total positive Doppler study cases. Swelling (36%) was the most common presenting symptom, followed by varicosity (20%). Prolonged hospitalization 5 (38.46%) is the major predisposing factor in patients with DVT. At least one perforator incompetence was seen in 42 (95.45%) cases. Below knee perforators seen in 30 (68.2%) cases, mid-calf perforators were involved in  26 (59.09%) cases and above ankle perforator incompetence was observed in 27(61.36%) cases. There was no statistically significant difference in the pattern of veins affected between male and female participants (P= 0.580). Conclusion: The colour duplex sonography is a safe, non-invasive, accurate, easily repeatable, economical, and widely available modality in the diagnosis of venous insufficiency and excludes underlying DVT, thus helping in providing valuable insights for the treatment of the patient.

Background: Numerous unfavourable outcomes for newborns are linked to foetal and neonatal acidemia.1–7 Low Apgar scores, respiratory distress syndrome, hypoxic-ischemic encephalopathy, convulsions, intraventricular haemorrhage, sepsis, and death are some of these outcomes.1–7 Understanding the mechanisms underlying these results and the period of the injury can have significant medico-legal repercussions.

Objectives:

1. To assess the relationship between umbilical cord blood (arterial andvenous) analyses and perinatal risk factors in pregnancy.

2. To assess the relationship between umbilical cord blood pH and Apgar score in high risk group of pregnancy.

Material & Methods:  Study Design: Hospital based prospective observational study. Study area: Department of Obstetrics & Gynecology, in a tertiary care teaching hospital.  Study Period: Jan 2022 – Dec. 2022. Study population:  All pregnant ladies who presented in labor to maternity ward, in a tertiary care teaching hospital. Sample size: Study consisted a total of 192 subjects. 192 pregnant ladies who presented to labor ward, in a tertiary care teaching hospital. At the time of admission, they were assigned to high or low risk group according to whether or not they had any perinatal risk factors. High risk pregnancy is defined as the mother who is at risk to deliver a neonate with birth asphyxia according to the definition by American Academy of Pediatrics. All normal vaginal and cesarean section deliveries included in this study were chosen in accordance with this definition. Sampling Technique:  Simple Random technique.

Results: Apart from the study proving the statistical difference in the high risk and low risk groups in various cord blood parameters; it also compared the cord blood pH with the Apgar score to find any correlation between them. Pearson correlation was used to define the correlation. In the low risk group, neither arterial nor venous pH was statistically related to Apgar score. In high risk group, a statistically significant correlation was established between Apgar at 1 minute and the arterial and venous pH.

Conclusion: The results of this study indicate that umbilical cord blood analysis might be useful predictors of fetal asphyxia at delivery. Our study highlights a correlation between the presence of perinatal risk factors and umbilical cord pH in high-risk mothers. So we recommend assessing the umbilical cord pH in any mother who has a perinatal risk factor in her history or physical examination. Their potential role as a tool for predicting the prenatal outcomes should be evaluated in subsequent studies.

In addition to inadequate illness control, medication nonadherence significantly increases the cost of healthcare[1]. However, there is a severe lack of formal adherence counseling as a focus of care. For patients with HIV and AIDS, we have employed a modified adherence measure that takes into account social background, treatment preparation, adherence behaviors, declaration of illness, usage of treatment partners, and assessment of potential adherence hurdles. Ninety-five (52.5%) of the one hundred and eighty-one were female, while 86 (47.5%) were men. Age was 50.83 years on average (SD: 12.54). Most of the patients (81.8%) were married and had completed at least their first year of school. 65% of the patients we spoke with had high blood pressure. One hundred and twelve (61.88%) people took drugs while going about their normal lives, such eating. The majority of the patients, 116(64.10%), were aware of their disease and the names of the medications they were taking. The majority of patients (72.4%) have told their spouses about their disease. Many patients claim that they stick to their regimen well. 72.4 percent of people had told their spouses about their sickness. Many patients say they adhere to their regimen well on their own.

Introduction: Hypertension is the major health problem observed throughout the world. Hypertension, along with pre-hypertension and other hazardously high blood pressure, is responsible for 8•5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. If untreated it may cause stroke, end stage renal failure and heart attack. For the treatment of hypertension, there are different classes of antihypertensive drugs that control blood pressure by acting through different mechanisms. The main aim of the study to determine a suitable monodrug therapy for the treatment of hypertension.  Material and methods: Present study was carried out on 186 hypertensive patients. Based on the inclusion criteria patients were divided into five groups and prescribed Atenolol, Azilsartan, Chlorthalidone, Diltiazem, and Enalapril as mono-drug therapy. All the parameters like systolic, diastolic blood pressure, heart rate, total cholesterol, and triglycerides were estimated and noted at baseline and after 3 months of treatment, all the parameters were estimated and noted as after 3 months of treatment respectively.  Results: The majority of the patients were male with the age group of 51 to 60 years. 15.05% were not having complications and 84.94% had complications. Based on the complication majority were having Hyperlipidemia followed by diabetes mellitus. Based On the treatment in groups A, B, C, D & E showed a significant mean reduction in systolic and diastolic blood pressure. A significant mean reduction in heart rate was observed in groups A, B & D whereas no significant mean reduction in heart rate was observed in groups C and E. No significant change was observed in total cholesterol and triglycerides in all five groups respectively.  Conclusion: Monodrug therapy with antihypertensive drugs shows better improvement in systolic and diastolic blood pressure, with few groups showing significant reduction in heart rate and whereas no effect on lipid profile.

Interstitial ectopic pregnancy also known as intramural ectopic pregnancy occurs in proximal portion of fallopian tube that lies within uterine myometrium. This is associated with higher risk of rupture and hemorrhage compared to usual ectopic pregnancies. We present an interesting case of interstitial ectopic pregnancy who presented to radiology department with clinical suspicion of bowel perforation and surprisingly negative urinary pregnancy test.

Background: Diabetes mellitus is a systemic disorder associated with inflammation and oxidative stress which target many organs such as the kidney, retina, and the vascular system. The pathophysiology, mechanisms, and consequences of diabetes on these organs have been studied widely. However, no work has been done on the concept of the lung as a target organ for diabetes and its implications for lung diseases. Aim: In this study, we aimed to investigate the effects of diabetes on lung diseases Results: One hundred cases of established diabetes mellitus with respiratory complications were analyzed. Respiratory complications included pulmonary tuberculosis in 52, chronic bronchitis in 27, 8 of bronchiectasis, 7 of lung abscess, 4 of pneumothorax and 2 cases of upper respiratory tract infection respectively.  Forty percent of cases pulmonary tuberculosis had moderately advanced lesion and in the forty percent advanced lesions were found radiologically.  Thirty percent of cases of chronic bronchitis were non-smokers, staphylococcal lung abscess was found in maximum number of cases (28 percent). Bronchiectasis was found commonly in lower lobes. Clinical and radiological profile of respiratory diseases and correlation with the severity of diabetes mellitus have been presented. Conclusions: Our results suggest that diabetes can affect the severity and clinical course of several lung diseases.

Background: Cholecystectomy is a common surgical intervention, with both early laparoscopic cholecystectomy (ELC) and late laparoscopic cholecystectomy (LLC) approaches being employed. This study aims to discern the differences in age distribution, symptom presentation, and surgical outcomes between ELC and LLC. Methods: A total of 100 subjects (50 ELC and 50 LLC) were retrospectively analyzed for age, gender, symptoms such as fever, vomiting, and jaundice, presence of gallbladder calculi, peri cystic fluid, and complications like gallbladder perforation and bile duct injury. The duration of surgery for both groups was also compared. Results: Age distribution showed a higher prevalence of individuals aged 20-30 undergoing ELC (60% vs. 50%, p=0.05). The ELC group reported slightly higher prevalence of fever (50% vs. 40%, p=0.25) and vomiting (40% vs. 30%, p=0.45). Jaundice was present in 20% of the ELC group and 10% of the LLC group (p=0.35). Multiple gallbladder calculi were observed in 80% of ELC and 76% of LLC subjects (p=0.65). The average duration of surgery was significantly shorter for ELC (76.16 minutes vs. 116.48 minutes, p<0.001). Conclusion: This study elucidates notable differences in age distribution and symptom presentation between ELC and LLC. Notably, ELC was associated with a significantly shorter duration of surgery. The choice between ELC and LLC should consider patient demographics, symptomatology, and potential surgical outcomes.

Background: Ventral wall hernias are a common surgical concern with evolving management strategies. This study aims to explore the outcomes and patient demographics of ventral wall hernia repairs at Government Medical College, Thiruvananthapuram. Methods: A retrospective cohort study was conducted from January 2022 to June 2023, encompassing 100 cases. Patient demographic data, hernia types, surgical outcomes, and complications were analyzed. Statistical analyses were employed to interpret the results. Results: Incisional hernias (50%) were the most prevalent, followed by paraumbilical (30%) and supraumbilical hernias (10%). The success rate was 90%, with 10% recurrence. Patient satisfaction stood at 80%. Post-operative complications included surgical site infections (20%), seroma formation (15%), and mesh infections (5%). Notably, 77% of cases reported no complications. Conclusion: The study provides insights into the outcomes and demographics of ventral wall hernia repairs. The results highlight the significance of regional variations in hernia demographics and outcomes, necessitating tailored approaches to management.

Background: The frequency of healthcare-associated infections (HAIs), which can affect up to 15% of hospitalized patients and 9%-37% of patients referred to intensive care units (ICUs), is a significant issue for the healthcare system.1 Healthcare organizations must prioritize HAI prevention.2-5 Effective infection prevention and control (IPC) depends on healthcare workers knowledge of infection control (IC) practices, and poor knowledge and awareness among HCWs have been associated to deteriorating healthcare delivery results. Objectives: To assess the knowledge, attitude and practices of infection control practices followed by nurses in their day to day procedures in Government General Hospital Vijayawada. Material & Methods: Study Design: A prospective hospital based descriptional study. Study area:  Government general Hospital Vijayawada. Study Period: February 2023 – July 2023. (6 months) Study population:  Staff nurses who are working in all wards of Government General Hospital Vijayawada. Sample size:  The study consisted of 91 subjects. Sampling method: Simple random technique. Study tools and Data collection procedure: A direct method approach was employed, consisting of a cross-sectional survey through questionnaire in Google sheets. The survey questionnaire was distributed among a representative sample of nurses across various departments within the hospital. The survey encompassed questions related to knowledge of IPC guidelines, hand hygiene practices, personal protective equipment (PPE) utilization, environmental cleaning routines, and perceptions of organizational support for IPC. Results: With regard to indications for hand rub, 51.6 % staff nurses opted and agreed that when your hands are not visibly soiled which is the correct answer and 27.5 % answered instead of traditional handwashing (20 sec) ,16.5% answered that instead of surgical hand washing (3min), remaining 4.4% answered when your hands are visibly soiled. Overall KAP status of the study population was excellent in 53.8%. 46.2% of the study population were having good KAP status. No subjects were in the group of average or poor KAP status. Conclusion: The largest difficulty in any hospital is infection prevention and control, and nurses' knowledge and understanding of this topic must be improved if it is to be successful. To increase understanding and compliance with IC practices, a multimodal strategy should be used, including training, feedback, and ongoing education programmes.

This case series study aims to evaluate the efficacy and safety of Segmental Spinal Anaesthesia (SSA) in ASA 1 & 2 patients undergoing a variety of routine surgeries. A total of 115 cases were analyzed, with patients ranging in age from 18 to 80 years, and a male-to-female ratio of 37:63. The study assessed the intervertebral space used and the drugs administered for each surgery, along with monitoring sensory anesthesia, motor block, postoperative nausea and vomiting (PONV), urinary retention, respiratory depression, hemodynamic changes, shoulder tip pain, abdominal discomfort, conversion to general anesthesia (GA),time to mobilization  and postoperative analgesia requirements.

Background: Hypertension is known to be accompanied by various renal and metabolic anomalies. The exact relationship between serum uric acid (SUA) levels and kidney function, especially in hypertensive patients, requires elucidation.Objective: To understand the correlation between SUA levels and kidney function, gauged by the estimated glomerular filtration rate (eGFR), in a sample size of 342 hypertensive individuals.Methods: Employed a cross-sectional design involving 342 hypertensive participants. SUA was determined using the enzymatic colorimetric technique, while the CKD-EPI equation was utilized to evaluate eGFR. Statistical methodologies were used to identify correlations.Results: A notable inverse correlation between SUA and eGFR was established (r = -0.67, p < 0.001). After accounting for confounding factors, increased SUA was identified as an independent predictor of diminished eGFR.Conclusion: In a sample of 342 hypertensive patients, elevated SUA levels were significantly related to a decline in kidney function. Regular monitoring of SUA may be integral for the management of hypertensive patients, but additional research is required to validate these outcomes and understand potential therapeutic directions.

Background: Distal femur fractures are commonly seen in elderly people owing to osteoporosis, while in young people, fractures are due to road traffic accidents or assaults. Whatever the mode of injury, distal femur fractures have always been problematic to surgeons despite many treatment options. In this study, we compare two of the many procedures available, i.e., retrograde nailing and locking compression plate. Materials and methods: - 46 patients with supracondylar fracture of the femur who were admitted to the Department of Orthopaedics, NRI Medical College and General Hospital, Guntur over 2 years, were divided into 2 groups. One group was treated with retrograde nailing and the other group was treated with locking plates.  Results: The locking plate procedure had a higher incidence of infection as a late complication, but had more number of excellent outcomes. Retrograde nailing has a significantly lesser operative period, lesser blood loss during surgery, and less time required for fracture union. Conclusion: Both procedures are good treatment options for supracondylar fracture treatment with LCP having relatively better outcomes than SCN.

Background: Psoriasis vulgaris (PV) is a chronic recurrent inflammatory skin disease that occurs in genetically predisposed individuals, influenced by various endogenous and exogenous transducing factors. Objectives: The present study was aimed to assess the relationship between cardiovascular risk factors such as, the pattern of dyslipidaemia and body fat deposition with insulin resistance in Psoriatic patients. Methods: Body mass index (BMI) and waist circumference (WC) were measured in 40 psoriaitic patients against matched controls. Fasting Blood Glucose (FBG), Triglyceride (TG), Cholesterol(CHOL), Low density lipoprotein(LDL), Very low density lipoprotein(VLDL), High density lipoprotein(HDL), hsCRP were measured by spectrophotometry. Homocysteine was measured by immune fluroscene technology. Insulin resistance was assessed by measuring the HOMA-IR values. Results: FBG, HDL and WC between this two groups were statistically not significant (p value=0.271, 0.21 and 0.72 respectively). On the other hand, BMI, HOMA-IR, TG, CHOL, LDL, VLDL, hsCRP and Homocysteine levels were significantly higher in the case group (p<0.05). Bivariate correlation analysis showed HOMA-IR to be significantly associated with FBG, BMI, WC, Total CHOL and LDL (but not with VLDL, TG and HDL, hsCRP and Homocysteine values). Conclusions: Mainly an increased insulin resistance that is directly related to significantly elevated levels of abdominal obesity and LDL cholesterol levels reflects metabolic derangements in psoriatic patients in this region. We suggest regular monitoring of psoriatic patients for these parameters to avoid the impending cardiovascular risks in them.

Instrumental vaginal births are performed to speed up the second stage of labour when there are maternal or foetal indications. Trends around the world point to declining instrumental delivery rates. Worldwide, the rate of caesarean sections has increased recently, while instrumental vaginal deliveries have decreased. These patterns might be brought about by worries about maternal and neonatal safety as well as a lack of clinical forceps delivery expertise. A decrease in training hours, a lack of senior supervision, and a fear of lawsuits are a few of the factors contributing to instrumental vaginal delivery being a lost art. Due to these circumstances, it has become more challenging to gain the level of expertise needed for proficiency in this method, which could be dangerous in the hands of an inexperienced or hasty obstetrician. These issues have long been an issue. With an emergency caesarean section, there is a dramatically increased risk of severe obstetric morbidity. Therefore, the right use of instrumental delivery could lower the expenses of obstetric care as well as the hazards related to caesarean sections. A following pregnancy's chances of having a successful spontaneous vaginal delivery are similarly more likely to increase after an instrumental vaginal delivery.

Objective:  The main aim of this study was to determine the level of knowledge, attitudes, and practises about eye health among the Indian community. Methodology: The objective of this cross-sectional survey study was to assess the knowledge, attitudes, and practises (KAP) of persons residing in rural areas of Bihar with visual impairment (VI) regarding their utilisation of medical eye-care services. The collection of KAP data occurred between the months of May and June 2023, facilitated by a group of proficient researchers. The survey consisted of a total of 16 Yes/No questions pertaining to the participant's knowledge of low vision and their behaviours regarding seeking eye care. Additionally, there was one question that required a single-choice response regarding the participant's attitudes towards eye care. Furthermore, four single-choice questions were included to assess the participant's tendencies in seeking eye care services. Results: There was no statistically significant disparity observed in the proportion of participants who had sought professional eye care prior to the survey, based on various demographic factors including gender, age, education, income level, family history of eye disease, visual acuity of the better-seeing eye, and personal history of diabetes or hypertension. There were notable disparities observed among individuals who self-identified their vision as poor, got an old-age pension, or had a personal history of eye disease. Specifically, approximately 36.4%, 66.7%, and 55.6% of these respective groups reported seeking medical care. The level of accurate understanding of visual acuity and eye disease exhibited significant variation throughout the sample. The highest proportion, 77.4% of participants, correctly recognised that individuals with myopia have the ability to see objects nearby but struggle with distant vision. Conversely, only a small percentage, 17.1%, were aware that the loss of far vision is not an inherent consequence of the ageing process. Conclusion: In summary, the visually impaired individuals in Bihar shown a lack of awareness regarding the importance of consistently accessing eye care services. Developing ways to enhance public awareness of the correlation between deteriorating vision and preventable blindness resulting from diagnosable and treatable illnesses within eye clinics situated in local hospitals is of utmost significance.

Introduction: Laparoscopy offers a simple, rapid and safe method to evaluate and diagnose intra-abdominal diseases. Aim: To evaluate the role of diagnostic laparoscopy in patients presenting with non specific abdominal pain and its correlation with clinical and radiographic findings in Bikaner region. Method: Study conducted on 50 patients aged between 15-50 years at S P Medical College & hospital, Bikaner from 1st Nov. 2019 to 31st Jan. 2021 by Simple Random Sampling. Patients with chronic pain abdomen of uncertain etiology and conditions which are unexplained by other investigation and clinical symptom were taken into study. Detail history has been taken followed by general and physical examination. Radiological investigations including ultrasonography, CT and MRI and also expert surgical management including laparoscopy will be performed. First follow up after 1 week, second follow up after 1 month and third follow up after three month will be performed. Result: 62% cases were female, 50% cases duration of pain was less than 6 months, 12% cases were pain site was upper abdomen. In 60% cases laparoscopy provide diagnostic & therapeutic or both. 92% cases pain were resolve. Conclusion: Diagnostic laparoscopy can identify abnormal findings and improve the outcome in patients with chronic abdominal pain. It allows the effective surgical treatment of many conditions encountered at the time of diagnostic laparoscopy.

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. The aim of the present study was to examine the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion. Patients and methods: This study was carried out at the Department of pulmonary medicine, SVRRGGH, TIRUPATI in the period from June 2022 to June 2023. It included 50 patients with undiagnosed pleural effusion. The included patients were subjected to full history taking, clinical examination, plain chest radiograph, ultrasonography, computed tomography of the chest, and tuberculosis assessment. Diagnostic aspiration of pleural fluid was performed by using chemical, cytological, and bacteriological analyses. Lastly, if the etiology remained unknown, a thoracoscopy was carried out. Results:  The present study included 25 men and 25 women patients, with a mean age of 54.4±16.1 years. Dyspnea was the most common presenting symptom among the studied patients. 36 (72.2%) patients had moderate right-sided pleural effusion. The diagnostic yield of medical thoracoscopy among the studied patients was 80.6%. The histopathological yield of thoracoscopic pleural biopsies was as follows: 40 (80%) malignant cases, (20%) patients with tuberculous pleuritis. The post-thoracoscopic complications in this study occurred only in nine (25%) patients, which were minor complications in the form of surgical emphysema and prolonged air leak, wound infection, dislodged drain, trapped lung, and pain during the procedure. Conclusion: Medical thoracoscopy is a good diagnostic procedure for pulmonologists to evaluate undiagnosed pleural effusions.

Background: Several studies have well established the pathogenic role of low density lipoprotein  (LDL) in coronary artery disease(CAD). Few studies have also been done to show that non- HDL levels , calculated using formula Total cholesterol minus  HDL , could be  a better predictor of coronary artery disease. Greater risk of cardiovascular and cerebrovascular disease have been found to be associated with increased homocysteine levels. But studies are inadequate with Indian population to identify these risk factors in acute coronary syndrome (ACS).

Objectives: The aim of this study is to correlate the LDL, non- HDL and Homocysteine levels in acute coronary syndrome patients(cases) matched with controls in Indian population.

Methods: In this retrospective study,80 cases, aged between 30-60 years, with diagnosis of  acute  coronary syndrome (ACS) admitted to Bharath Superspeciality hospitals and age, gender matched 80 controls , admitted as inpatients for illness other than ACS were selected . Detailed clinical  history and laboratory investigations such as lipid function tests, homocysteine levels were obtained . Quantitative data compared using unpaired t- test and Chi - square test used to compare qualitative data.

Results: Mean values of total cholesterol, LDL , non-HDL cholesterols and serum homocysteine were significantly increased in cases than controls. Odds ratio was highest for Non -HDL cholesterol than all the other parameters measured.

Conclusions: Non-HDL cholesterol proved to a better risk predictor of cardiovascular events compared to LDL, HDL or total cholesterol

Background: Serum uric acid has been linked to the development of hypertension. It has been known that uric acid has a positive association with blood pressure. Objective: The study aimed to assess the relationship between serum uric acid and blood pressure among patients in a specialized center. Method: This cross-sectional study was conducted from January 2020 to June 2021 at the National Center for Control of Rheumatic Fever & Heart Diseases, Dhaka, Bangladesh. A total of 250 patients were enrolled in this study as study subjects. Data were processed, analyzed and disseminated by using MS Office and SPSS version 23.0 programs as per need Results: The mean age was 39.2±13.7 and 38.3±13.5 years in males and females respectively. The mean systolic blood pressure was higher (132.3±15.6 mmHg) in males whereas the mean diastolic blood pressure was higher (129.4±16.5 mmHg) in females. The mean serum uric acid (288.7±74.44 μmol/l) was higher in males and the presence of hyperuricemia was 5.5% in males and 3.1% in female patients. There was a higher proportion of hypertension (32.1%), general obesity (18.2%), and central obesity (76.73%) in females. The mean systolic (137.1±14.6 mmHg), diastolic (82.4±13.9 mmHg) blood pressure and BMI (28.6±5.6) was higher in patients who have serum uric acid level above 357μmol/l. A significant correlation between uric acid and baseline parameters was observed in both male and female patients. Conclusion: In our study sample, serum uric acid level was an independent predictor of hypertension incidence and longitudinal hypertension development. Non-elderly, in contrast to the elderly had a substantial correlation between uric acid and hypertension. Early detection of elevated serum uric acid levels may play a role in the management of hypertension.the intricacies and establish a comprehensive comprehension of their interaction.

Anemia, characterized by diminished red blood cells or hemoglobin levels, is a global health challenge with significant implications for health outcomes. Ischemic stroke, a major type of stroke caused by cerebral blood supply disruptions, presents a substantial public health concern. The intricate relationship between anemia, iron status, and ischemic stroke risk remains complex and controversial, with varying observational studies reporting conflicting associations. This review aims to navigate this complex interplay and shed light on the relationship between anemia, iron status, and stroke severity. Materials and Methods:  A cross-sectional study was conducted among 130 acute ischemic stroke patients admitted to a tertiary care setup. Patients meeting specific inclusion criteria were selected, and a subset of 65 patients with anemia was analyzed. Hemoglobin levels, anemia severity, peripheral smear classification, and NIHSS scores were assessed. Statistical analysis using SPSS 27 software included descriptive statistics and chi-square tests to determine associations. Results: Among stroke patients with anemia, 55.4% were males, and 44.6% were females. Anemia severity was categorized as mild (18.5%), moderate (66.1%), and severe (18.5%). Peripheral smear analysis revealed microcytic hypochromic (55.4%), macrocytic (21.5%), and dimorphic (23.1%) anemia. NIHSS scoring classified patients into minor (5%), moderate (46.2%), moderate to severe (30.8%), and severe (15.4%) stroke categories. Analysis indicated no significant association between NIHSS scores and anemia severity or peripheral smear classification. Conclusion: This study contributes to understanding the intricate relationship between anemia and ischemic stroke. The complex interplay between anemia severity, peripheral smear classification, and stroke severity underscores the need for further investigation. While proposed mechanisms connecting anemia and stroke risk exist, additional research is essential to unravel the intricacies and establish a comprehensive comprehension of their interaction.

Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Aims and objectives: Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers in a tertiary health care hospital in West Bengal, India. Methods: Our study was a retrospective record study. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at Dept of G&O, N.R.S. Medical College and Hospital, Kolkata, West Bengal, India from November 2018 to November 2022. Statistical data were analysed by using SPSS V.20 software. Results: Most common age group of the mother found to 19-25 years 10 (43.5%). Gravida 1 was 11 (47.8%), followed by gravida 2 was 8 (34.83%). IUFD was 1 (4.3%), preterm was 7 (30.4%), SA was 2 (8.7%), term was 12 (52.2%) and neonatal death was 2 (8.7%). Associated Haematological Disorder of B Thal Trait and HbE Carrier was 3 (10.3%) each. Platelet Count during AN Period as <49000 was 13 (56.5%) and 50000-99,999 was 10 (43.5%). Myasthenia gravis during pregnancy was 7 (30.4%), Methylprednisolone was 3 (13.0%), thyroid disorder was among 5 (21.7%). Conclusion: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in foetus.

Background:  The diagnosis of immune thrombocytopenia (ITP) is one of exclusion. Immune-mediated rapid platelet breakdown and decreased platelet production are its hallmarks. ITP can appear as a main (separate) condition or as a secondary condition in the context of other illnesses such autoimmune conditions and infections. Material & Methods: Study Design: A prospective and retrospective hospital based observational study. Study area: Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh. Study Period: 1 year.  Study population:  The samples for the present study were collected from various clinical departments and wards like Medicine, Pediatrics, MICU and PICU. Sample size:  The study consisted of 60 cases. Study tools and Data collection procedure: Clinical history was collected from the patients and medical record files. Physical examination of the patients was done to see the clinical manifestations of the disease and to exclude other possible causes of present symptoms. Laboratory studies were conducted to diagnose Idiopathic Thrombocytopenic purpura. Blood was collected using standard phlebotomy procedures. Blood sample was processed in9 automated Hematology cell counter. Platelet count, Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) values were taken from the counter reading. Peripheral blood smear examination was done for all cases to look for thrombocytopenia lymphocytosis, eosinophilia and presence of blasts. Bone marrow aspiration/biopsy studies were done on selected patients to exclude other known causes of thrombocytopenia like those associated with leukemia, myelodysplasia etc. Indirect Immunofluorescence evaluation of presence of antiplatelet antibodies was performed in selective cases. Results: The most common presentation was with petechiae observed in 23 cases (39%) followed by ecchymoses (11cases,18%), epistaxis (09 cases,15%), hematuria (07 cases,12%) melena (05 cases,8%) and menorrhagia (05 cases,8%). Major serious hemorrhage like intracranial bleeding or hemopericardium was not seen. Conclusion: The majority of youngsters present with an abrupt onset of symptoms and a history of an earlier infection. Women who are childbearing age are the majority of those with chronic ITP. Isolated thrombocytopenia is the defining feature of ITP, and the presence of anaemia or neutropenia should raise the possibility that another illness may be the origin of the low platelet count.

Introduction: The acetabulum, a component of the hip joint, plays a pivotal role in maintaining stability and facilitating a wide range of motion. Total hip arthroplasty is a widely accepted surgical intervention for patients suffering from various hip pathologies, including osteoarthritis, avascular necrosis, and fractures. The successful outcome of total hip arthroplasty is heavily reliant on accurate implant positioning within the acetabulum, as improper placement can lead to postoperative complications such as dislocation, impingement, and accelerated wear of the prosthetic components. Morphometric analysis of the acetabulum involves the quantitative assessment of its anatomical features, which can greatly influence the surgical approach, implant selection, and overall postoperative function of the hip joint. The aim of this study is to conduct a morphometric analysis of the acetabulum that belonged to the North Indian population and investigate its clinical significance in total hip arthroplasty. Materials and Methods: In this cross-sectional study, 110 adult dry hip bones (among which 55 belong to the right side and 55 belong to the left side) of unknown gender and age were studied in the Department of Anatomy, Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar. We measured the diameter of the acetabulum, depth of the acetabulum, and width of the acetabular notch with the help of a digital vernier caliper which had a sensitivity of 0.01 mm and the least count observed was 0.01 mm. The obtained data is expressed in terms of Mean and standard deviation. A p-value less than 0.05 was considered significant in this study for analysis. The findings were tabulated and analyzed statistically by using the Graph Pad Prism version 9 software.  Results: We observed that the measurements of the diameter of the acetabulum on the right side were 47.94 ± 2.53 mm and on the left side was 46.87 ± 3.52 mm. The depth of the acetabulum on the right side was 25.05 ± 1.32 mm and on the left side was 26.16 ± 2.15 mm. While the width of the acetabular notch was 23.26 ± 3.55 mm on the right side and 23.97 ± 4.13 mm on the left side. In the present study, there were no significant differences found between the right and left side parameters of the acetabulum. Conclusion: The biomedical engineers will be able to create acceptable prostheses with the help of a complete understanding of the acetabulum's dimensions. The present study identified a number of acetabulum metrics that can be employed in total hip replacement to assess the acetabulum as part of preoperative planning.

Background: Patient Satisfaction, which is viewed as a significant indicator of quality of care, can be defined as fulfillment or meeting of expectation of a person from a service or product and has been receiving greater attention as a result of rise in pay for performance. It is an important and commonly used indicator to measure the quality of care that can contribute evaluation of structure, process and outcome of services. Patient satisfaction is a subjective phenomenon. It is also a multidimensional aspect as, many factors contribute directly or indirectly to patient satisfaction including accessibility and convenience of services, institutional structure, interpersonal relationships, the competence of health professionals and patient expectations and preferences. Patient satisfaction is an important and commonly used indicator to measure the quality of care that can contribute to a balanced evaluation of structure, process and outcome of services. So patient satisfaction has become a high priority to hospitals and health plans across the country, because of its impact on patient loyalty, the hospital’s reputation, perception of quality of care, employees’ dissatisfaction and retention of a hospital’s bottom line. Materials And Methods: It is a hospital based prospective study; the research was carried among 120 randomly selected patients who were admitted in the department of General Medicine, GGH, Srikakulam, a tertiary care teaching hospital. The study is conducted through the collection of primary and secondary data. Results: A total of 120  patients were included in the study of which 68 (56%) were males, 52 (44%) were females.56% in 15-45 years age group, 26% in 45-60 years, 18% in more than 60 years, and the level of patient satisfaction of various factors like time taken for admission is good as 45%, excellent staff friendliness 17%’ excellent timely discharge process as 20%, excellent doctor care as 46%, excellent dietary services 26% etc. Conclusion: Feedback of patients is one of the key parameters in assessing the quality of hospitals. The feedback results showed that most of the patients were satisfied with most of the services in Hospital under study and the doctor’s care and nursing services have the highest satisfaction level, which is very satisfactory and encouraging but there is always a scope for improvement. More than 85% of the patients rated most of the parameters as good or excellent.

Introduction: Diabetes mellitus (DM) is one of the most common metabolic diseases with a complex, multi- factorial etiology and has varied clinical and biochemical manifestations. The impact of the disease and of treatment on all chronic patients, quality of life (QOL) and lifestyle is a key concern for both the patients themselves and their physicians. Aims: To assess the quality of life (QOL) and the associated risk factors among adult diabetics attending the lifestyle clinic of a teaching hospital, West Bengal. Materials and Methods: This hospital- based, cross- sectional study recruited 152 patients with diabetes to assess the QOL in the lifestyle clinic of a tertiary healthcare facility. The QOL was assessed with the help of the World Health Organization (WHO) QOL BREF instrument. The socio demographic and diabetes- related attributes were collected by a pre-designed and pre-tested structured questionnaire. Clinical and anthropometric examinations were also conducted. All the available data were initially coded and then analyzed using the SPSS, 22.0 licensed software. Result: Association of QOL found with the respondents those were on OHA, on diet modification, on recommended physical activity, having family h/o DM and duration of diabetes. Patients those were using only OHA among them nearly 57% had good quality of life. More than 60% of the participants those who were not on diet modification and 56.13% of participants those were not doing recommended physical activity had poor QOL. It is found that 59.73% of participants those having family h/o DM had poor quality of life. Similarly, 62.86% respondents had poor QOL among those having diabetes of more than equal to 5 years duration. Conclusion: This study concludes that poor QOL was highest in social domain whereas half of the diabetics had an overall good score. Poor QOL was associated with ongoing treatment, patients not following any life style modification, family h/o diabetes, distance from home to hospital along with long waiting period for getting services and also with patients having other known co-morbidities, overweight/obesity and presence of pallor.

Advanced Glycation End Products (AGEs) are formed in the lungs either spontaneously or as a result of the insult due to cigarette smokes. These AGEs have deleterious effects due to their pro oxidant and inflammatory actions. The AGEs can interact with the receptor for AGE, called RAGE, triggering various kinase pathways that activate transcription factor NF-κB (nuclear factor kappa B). This, in turn, leads to the production of several inflammatory substances and promoters. Impeding the formation of AGEs and inhibiting the AGE-RAGE axis can prove beneficial in down regulating the inflammatory process, leading to favourable outcomes. Asafoetida and liquorice are two such herbs that can significantly impede the AGE-RAGE-NF-κBaxis, which plays a key role in the pathogenesis of chronic obstructive pulmonary disease (COPD). These herbs have the potential to improve symptoms and lung function in patients suffering from this condition.

Introduction and Background: Since it is the second most frequent cancer in males, and the second leading cause of cancer-related death, prostate cancer is a key focus of healthcare research and development. Traditional methods of assessing prostate cancer relied on digital rectal examinations and PSA levels because of the prostate's inconvenient position. Material and Methods: 20 patients with high PSA levels and aberrant DRE results who were sent to our clinic were analyzed. From December 2021 to November 2022, at Mahavir institute of Medical Sciences, Vikarabad, Telangana, researchers gathered data. All patients provided informed consent after having potential biopsy consequences outlined to them. Antibiotics were provided as a preventative measure before the operation.  Results: In our prospective study, 20 patients with abnormal digital rectal examination and elevated PSA levels underwent transrectal real-time strain elastography, transrectal ultrasonography, a systematic 12-core biopsy, and additional targeted biopsies from abnormal areas found by transrectal real-time strain elastography and transrectal ultrasound. The interpretations from each of these techniques were contrasted with the histopathological diagnosis. Conclusion: This research shows that compared to ultrasonography, elastography is more sensitive to the presence of malignancies and has a strong negative predictive value, both of which aid in avoiding unnecessary biopsies. Elastography and ultrasonography together improve cancer detection by pinpointing malignant tumors and facilitating guided biopsies.  

Background: Acute decompensated heart failure (ADHF) is one of the common cause for admission in emergency medical units. Patients admitted with Acute decompensated heart failure (ADHF) have high in-hospital mortality. This study aims at evaluating the prognostic significance of hepatic dysfunction in patients admitted with Acute decompensated heart failure (ADHF ). Methods: 84 patients admitted with Acute decompensated heart failure (ADHF) were evaluated for hepatic dysfunction using MELD ( Model for Endstage Liver Disease ) score and MELD-Na (MELD Sodium) score. They where followed up during their course in hospital and the outcome in terms of mortality was measured. Results: 57 patients survived and 27 patients died during hospitalisation. The MELD and MELD-Na scores of those patients who died during hospitalization were significantly high when compared to those who survived.

Introduction: Thyroid hormones are not essential for maintenance of vital functions of life, their deficiency causes severe deficit in mental and physical growth and extreme decrease in body metabolism. Aim: To study nerve conduction parameters in primary hypothyroidism patients. Method: study conducted on 84 patients( 42 patients in each  case group and control group) aged between 20 to 45 years at Department of Medicine, S.M.S. Medical Collage, Jaipur, Rajasthan from May 2020 onwards for one year or till the sample size was achieved and two months for data compilation and analysis. Cases and control fulfilling inclusion and exclusion criteria were taken into study. The study access nerve conduction parameters in primary hypothyroidism patients. Result: mean age for case group was 38.09 years and for control group it was 34.9 years( p >0.05). There was significant difference seen inFT3, FT4, TSH and anti TPO test. Significant difference in FT3 in abnormal nerve conduction and normal nerve conduction patients, FT4, TSH and anti TPO was found non-significant in abnormal nerve conduction and normal nerve conduction patients. Conclusion: Performing electrophysiological studies early in the course of the disease in hypothyroid patients is suggested, in order to detect nervous system involvement.

Background: Lesions of Lymph Nodes are very common and important manifestations of many systemic diseases. Especially, in developing country like India, most of the lesions are of infectious etiology. FNAC can be used as a triage to distinguish between various cases of lymphadenopathies, as it is a simple and economical procedure. Materials & Methods: This study was carried out in the Department of Pathology, in the newly established Government Medical College and Hospital, Rajamahendravaram, Andhra Pradesh, India. A total of 93 patients presenting with complaint of enlarged lymph nodes were subjected to FNAC procedure after taking history and doing general and local examinations. Smears were prepared, stained and Cytological Diagnosis was made. Results: Most of the patients presenting with lymphdenopathy were in age group of 11-20 years. The most common lesion diagnosed was Reactive Lymphadenitis, followed by Tuberculous Lymphadenitis. Malignancies formed 7.53% of all cases. Conclusion: FNAC is a rapid & economic technique to diagnose the etiology of various types of Lymphadenopathies and also to classify the lesions as Non Neoplastic and Neoplastic. It also reduces the need for excision biopsy in most cases of Lymphedenopathies as diagnosis can easily be done by Cytomorphological examination.

Introduction: Every element of human existence has been impacted by the COVID-19 pandemic, leaving people more susceptible to the illness. Aim: To investigate the KAP towards COVID-19 among COVID-19 patients admitted during April 2021 to Oct 2021 and its correlation with mortality and severity of disease. Methods: This cross-sectional descriptive survey was conducted among consecutive COVID-19 adult patients (>18 years) admitted to Dedicated COVID Hospital, at tertiary health care center, SP Medical College, Bikaner (Rajasthan). All covid positive patients, giving informed verbal consent, reporting to our COVID dedicated hospital within study duration, were included in our study by consecutive sampling. A pretested preformed questionnaire was used, which comprised of two parts to collect demographic details of the participants along with KAP towards COVID-19. The collected data was entered in Microsoft Excel and then was analysed and statistically evaluated using Epi info software. Results: Age of patients ranged between 18 to 85 years with mean age of 50.9±15.4 yr. A composite analysis of the KAP score revealed that 24.6% had a poor KAP score, 65.6% had an average KAP score while the remaining 9.8% had a good KAP score. We found a significant association between low disease severity or good disease outcome with all 3 parameters of KAP score (p value <0.05). Patients with low levels of KAP (knowledge, attitude, and practices) showed a higher likelihood of being infected with COVID-19. Conclusion: the knowledge, attitudes, and practices (KAP) regarding COVID-19 among patients with COVID-19 were average, and were lower among patients with low education levels, low socioeconomic status, and occupations not related to healthcare.

Objective: To compare the levels of microRNA (miRNA) 24 levels in diabetic patients with acute coronary syndrome (ACS)with non-diabetics suffering from ACS. Methodology: A prospective case-control study was carried out among 40 patients with ACS residing in Belagavi, Karnataka, South India. Patient characteristics based on demographics, ACS related information and treatment, biochemical parameters, and miRNA-24 levels were compared between diabetics and non-diabetics. Finally, miRNA-24 was evaluated for effectiveness as a clinical biomarker for CAD severity in ACS pateints in both the groups. Results: The majority of patients were males between the age group of 18 and 77 years living in urban areas with physical activities restricted to NHYA class 2.  A significant level of differences was found between the cases and controls inpatient characteristics such as duration of diabetes diagnosis, treatment of diabetes, family history of diabetes, comorbidities, random blood sugar and HbA1c. Within the levels of miR-24 also, significant variation was observed between the diabetics and non-diabetics. The ROC analysis for evaluating the efficiency of miR-24 as a clinical biomarker for diabetic patients with ACS was established.  Conclusions: The control (non-diabetic) group showed significant CT values of miRNA-24 compared to diabetics, suggesting an up-regulation of mi-RNA and thereby may play a protective role of miRNA-24 in these patients. Moreover, the ROC analysis for fold change in miRNA-24 level in diabetic patients with ACS was found to be significant, suggestive of a possible link between expression of miRNA-24 and glucose levels. Therefore, the current study supports the use of miRNA-24 as a prognostic marker inACS outcome.

Background- Anatomical variations in the hepatobiliary system are usually asymptomatic. However, it is very important to know the anatomy to avoid unwanted complications during surgery and in the postoperative period Materials and methods:- 80 patients with cholecystitis who presented to the department of surgery, KIMS, Narketpally, who underwent laparoscopic cholecystectomy, were included in this prospective study. Results: - Out of the 80 patients, variable anatomy of the biliary system and vascular system was found in 20 patients, of whom, 15 had variations in the biliary system and 5 patients had variations in the vascular system. 3 patients with variable anatomy developed complications. 6 patients had to be re-explored by conversion into open cholecystectomy due to frozen Calot’s triangle. Conclusion:- Variations in biliary anatomy and vascular system are diverse. Few such variations were confirmed with this study, thereby implying the need for in-depth knowledge about congenital anomalies of the biliary system.

Introduction: Lung cancer is the leading cause of cancer related death worldwide and accounts for 28% of all cancer mortality and around 1.8 million new cases were diagnosed in 2012. The morphological distinction between pulmonary adenocarcinoma (ADC) and squamous cell carcinomas (SCC) is sometimes difficult, mainly in cases of poorly differentiated tumors or when degenerative changes, necrosis and crushing may obscure the cell characteristics. p63 is a homologue of the p53 tumour suppressor gene that is responsible for proliferation and differentiation of epithelial progenitor cells. p40 is consistently the predominant isoform expressed in squamous cell carcinoma; thus, it offers improved specificity for diagnosing squamous cell carcinoma.  Materials And Methods: This is a prospective and observational study conducted in the Department of Pathology, Tertiary care Teaching Hospital over a period of 1 year. Primary lung carcinoma cases included with unequivocal morphological diagnosis irrespective of age, gender and nature of biopsy material (endoscopic biopsy/ needle core biopsy / resected specimen). Cases diagnosed as Small cell carcinoma of lung, as metastatic lung cancers, poorly differentiated NSCLC-NOS and with inadequate material for IHC study were excluded from present study.  Results: In the present study, a total of 150 patients were included out of which 112 (74.6%) were males and 38 (25.4%) were females. In our study, most of the patients were >61 years i.e., 63 out of 150 (42%), followed by 51-60 years, i.e., 40 out of 150 (26.7%). All 8 cases of well differentiated Adenocarcinoma were positive for P40 and 5 cases showed P63 expression. Out of 13 cases of moderately differentiated Adenocarcinoma, 3 cases were positive for P40 and 10 cases were positive for p63 marker.  Out of 30 cases of well differentiated Squamous cell carcinoma 15 cases were P40 positive and 15 cases were P63 positive.  All 53 cases of moderately differentiated Squamous cell carcinoma showed positive P40 and P63 expression.  Conclusion: We conclude that strong and diffuse p40 expression is seen in majority of lung squamous cell carcinomas and absence of p40 expression in most of the lung adenocarcinomas. Expression of p63 is similar to that of p40 in lung squamous cell carcinoma, but there was variable p63 immunoreactivity in lung adenocarcinoma. In Moderately differentiated cases, a two-panel approach of p63 and p40 help to distinguish adenocarcinoma from squamous cell carcinoma. Thus, p40 is an excellent marker for distinguishing lung squamous cell carcinoma from adenocarcinoma and that its expression is equivalent to that of p63 in lung squamous cell carcinoma.

Background and Objectives: The purpose of this study is to use contrast-enhanced computed tomography to categorize individuals with acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis according to the updated Atlanta classification, and to describe the kind of collections in these patients. After that, we'll determine how severe it is using the new Atlanta categorization. And using the BISAP clinical rating system, discuss the disease's clinical progression and severity. Ultimately, we hope to link these observations to improved patient care. Materials and Methods: The study period began June 2022 to May 2023, conducted at the Department of Radiodiagnosis, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Hyderabad, India. This prospective observational study took place in a hospital setting.  The sample size for this study was 200 patients. Primary data was obtained by the investigator from patients diagnosed with acute pancreatitis and admitted to the surgery or medicine wards at our hospital for CT scans.  Results: Patients in our study group tended to be male, and alcoholism was the leading cause of their condition. In addition, interstitial edematous pancreatitis and mild acute pancreatitis accounted for the vast majority of cases. They achieved favorable clinical outcomes with a BISAP score of less than 3. Acute necrotizing pancreatitis and interstitial edema were both classified as moderately severe. Necrotizing pancreatitis was the most common kind of the severe acute form. Clinical outcomes were unsatisfactory for the majority of these individuals. Grades in the moderately severe range lie between the mild and severe varieties. Clinical result was found to correlate positively with BISAP rating, and the updated Atlanta categorization. Conclusion: Acute pancreatitis imaging results can now be more uniformly described and recorded in clinical practice according to the new Atlanta classification system. Acute pancreatitis patients can now be more accurately triaged, predicted, and treated thanks to the integration of the new Atlanta classification and BISAP clinical grading.

Upper limb neurovascular injuries are uncommon in paediatric population [1]in the age group less than 5-year-old. The vascular injuries requiring surgical intervention pose technical difficulties in view of vasospasm and small calibre of the vessels in the paediatric population [2]. The purpose of this study is to present the technique of End to Side anastomosis of brachial artery proving beneficial in vascular repair in children with small calibre vessels with vasospasm than the conventional reverse vein end to end anastomosis.

Introduction: Acute pancreatitis is an acute inflammatory process ranging clinically from mild discomfort with localized inflammation to severe disease involving remote organ systems. Aim: Study of procalcitonin as an early predictor of severity in acute pancreatitis. Methods: This study was a Hospital based observational study conducted on 56 cases aged between 18 to 80 years at acute pancreatitis patients presenting in OPD and IPD of medicine and gastroenterology department at SMS Medical College and Hospital, Jaipur, Rajasthan, India. Data collection was started after approval from institutional research review board. Results: majority 46.4% patients were of 20-40 years age group, mean age was 43.69 years, 71.4% patients were male, 44.6% patients were alcoholic. Majority 37.5% patients were of Ranson score 2, as per Atlanta criteria, 66.07% patients were of mild acute pancreatitis, 10.7% patients died. Conclusion: We have observed that Procalcitonin has shown promising results as an early marker of development of complications.

Background: Rheumatoid arthritis (RA) is a prevalent chronic autoimmune illness that does not target specific organs. In contrast, autoimmune thyroid disease (AITD) is the most often occurring autoimmune disease that specifically affects the thyroid gland, potentially resulting in either hypo- or hyperthyroidism. The aetiology of both diseases is multifaceted, involving a combination of genetic and environmental variables. Furthermore, there are shared genetic elements that contribute to the development of both diseases. Methods: This observational study was conducted at the rheumatology OPD/Medicine OPD at Tertiary Care Hospital. The study included patients of rheumatoid arthritis, aged >18 years, who fulfilled European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) - 2010 criteria for rheumatoid arthritis and was screened for: free T3 (free triidothyronine), free T4 (free thyroxine) and TSH ( thyroid stimulating hormone). Results: Among a cohort of 100 patients, it was revealed that 41% of the patients exhibited thyroid abnormalities. Specifically, the study revealed that 59% of the participants exhibited normal thyroid function, while 6% were diagnosed with hypothyroidism, 10% with hyperthyroidism, 24% with subclinical hypothyroidism, and 1% with subclinical hyperthyroidism. Patients with thyroid abnormality had significantly lower levels of hemoglobin (p-value <0.001), mean corpuscular volume (p-value 0.011), total leucocyte count (p-value 0.004), and platelet counts (p-value 0.040) compared to individuals without thyroid problem. In addition, a statistically significant decrease in urea (p-value <0.001) and creatinine levels (p-value <0.001) was seen in patients with thyroid abnormalities compared to those without thyroid abnormalities. Conclusion: Thyroid dysfunction has been observed to exhibit a significant prevalence among individuals diagnosed with rheumatoid arthritis (RA). The study detected cases of subclinical hypothyroidism, which is the most prevalent thyroid condition, as well as cases of overt hyperthyroidism.

Introduction: Diabetes mellitus is the most common endocrine disorder. It is a state of persistent hyperglycemia secondary to defects in insulin secretion, insulin action, or both. The development of Diabetes involves several pathogenic processes ranging from autoimmune destruction of the β cells of the pancreas resulting in absolute insulin deficiency, to other abnormalities that result in insulin resistance. Thyroid hormones and Insulin have both agonist and antagonist action in glucose homeostasis. The most common endocrine disorder after diabetes mellitus is thyroid disorder. Hence, it is common to be affected by both thyroid disease and diabetes. This study also helps in recognition of the interdependent relationship between thyroid disease and diabetes and guides clinicians on the optimal management of both these conditions. Materials And Methods: 100 Type 2 Diabetic patients were analyzed in this study. A structured questionnaire designed for the study was used to collect the demographic details and the history related to their illnesses. A complete physical and systemic examination was conducted on all patients, and the findings were recorded. The following investigations were carried out on the study subjects like fasting and postprandial blood sugars, HbA1C levels, thyroid profile which includes t3, t4, TSH levels as needed. Results:  The mean age (years) of the study group was 54.57. Males were outnumbered by females in the study. Thyroid dysfunction was present in 23% patients. Of this 16.0% of the patients had subclinical hypothyroidism,6.0%of the patients had Hypothyroidism,1.0%of the patients had Hyperthyroidism. None of them had subclinical hyperthyroidism. Of these 91 patients, 48.3% had subclinical hypothyroidism, 24.2% had subclinical hyperthyroidism and 23.1% had hypothyroidism, females had more prevalence of thyroid disorders compared to males Conclusion: After having reviewed the results and significant findings of the above study, it can be concluded that Thyroid dysfunctions are prevalent in the diabetic population, and this further emphasises the need to screen for thyroid dysfunctions routinely to improve the quality of life and reduce morbidity.

Background: Ambulatory blood pressure (BP) measurement, compared to office blood pressure measurement, provides for better risk stratification in essential hypertension, but its prognostic role in non-dialysis chronic kidney disease has not been well studied. Methods: In 436 consecutive individuals with chronic kidney disease, the prognostic value of daytime and nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP) in contrast with office measurements was assessed. Time to renal mortality (end-stage renal disease or death) and time to fatal and nonfatal cardiovascular events were the primary end points. Patients were categorised using BP quintiles. Results: The patients had a mean (SD) age of 65.1 (13.6) years and a glomerular filtration rate of 42.9 (19.7) mL/min/1.73 m2. Of the participants, 41.7% were female, 36.5% had diabetes, and 30.5% had cardiovascular disease. SBP/DBP values measured in the office were 146 (19)/82(12)mmHg; midday values were 131(17)/75 (11)mmHg, and nighttime values were 122(20)/66 (10)mmHg. 155 and 103 patients, respectively, achieved the renal and cardiovascular end points during follow-up (median, 4.2 years).Patients with an SBP of 136 to 146 mmHg and those with an SBP greater than 146 mmHg had an increased adjusted risk of cardiovascular endpoint (hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.13-4.41and3.07;1.54-6.09) and renal death compared with those with a daytime SBP of 126 to 135 mmHg (1.72;1.022.89and1.85;1.11-3.08). In comparison to the reference SBP value of 106-114 mmHg, night time SBPs of 125 to 137 mmHg and higher than 137 mmHg also raised the risk of the cardiovascular endpoint (HR, 2.52;95%CI, 1.11-5.71and4.00;1.77-9.02) and renal endpoint (1.87; 1.03-3.43and2.54;1.41-4.57). The risk of the kidney or cardiovascular endpoints was not predicted by office blood pressure monitoring. Patients who didn't dip or did it backwards were more likely to experience both outcomes. Conclusion: When dealing with chronic kidney disease, ambulatory blood pressure monitoring, particularly at night, provides for a more precise prognosis of renal and cardiovascular risk however office blood pressure monitoring makes no prognoses.

Introduction: Carcinoembryonic antigen (CEA), one of the most widely used tumor markers, has been recently associated with carotid atherosclerosis. Aims: To assess the level of carcinoembryonic antigen in patients with unstable angina and its relation with quantitative troponin-I.  Materials and methods: An observational study was conducted for a period of two years among 120 patients with unstable angina in the department of general medicine, aim to assess the level of carcinoembryonic antigen in patients with unstable angina and its relation with quantitative troponin-I.  Results: The mean age of the study population was 51.9 ± 7.9 years. The gender ration male to female in the present study was 2.9:1 with male dominance (74.2%). Out of 120 cases, 15.8% had family history of myocardial infarction. The mean body mass index (BMI) of the study population was 25.8 ± 3.6 kg/sq.mt. Among 120 cases, 14.2% were overweight, 41.6% were pre-obese and 14.2% were obese. In the present study, 28.3% had diabetes mellitus, 22.5% had hypertension and 20.8% had hyperlipidaemia. All the cases had chest pain at the time presentation. 12.5% had shortness of breath, 17.5% had chest discomfort, 20.8% had sweating and 36.7% had tachycardia. Among 120 cases, ECG findings shows that 44.2% had ST elevation, 39.2% had t-wave changes and 28.3% had other ECG changes. The mean Left ventricular ejection fraction (LVEF) in the study population was 44.9 ± 7.91%. The mean Troponin-I (ng/ml) in the study population was 0.12 ± 0.04 ng/ml with 95% Confidence Interval of 0.10 – 0.12 ng/ml. The mean CEA (ng/ml) in the study population was 3.63 ± 0.88 ng/ml with 95% Confidence Interval of 3.47 – 3.79 ng/ml. There was a positive correlation  between CEA and Troponin-I, but there was no statistical significant association found between CEA and Troponin-I .  Conclusions: A biomarker such as CEA can give physician a window period to act and prevent myocardial necrosis from occurring in the first place. This can be helpful in future to bring down ACS related mortality and morbidity significantly.

Introduction: Stroke is one of the leading causes of mortality and long-term disability in both developed and developing countries. Aim: To establish relationship of Homocysteine level in patients of acute brain stroke event. Methods: This study was a Observational–comparative study on 30 cases and 30 controls aged above 18 years conducted at the General Medicine department of Sawai Maan Singh Hospital and attached group of Hospitals from Feb 2020 to jan 2021. Blood samples would be drawn for serum homocysteine, vitamin B12 and folate level. Compare the different outcome of brainstroke with different values of homocysteine. Results: Difference in age, sex and residence of cases and controls was found to be statistically insignificant. mean homocysteine level in cases was 18.55±7.99 which was higher compared to mean homocysteine level of controls 12.17±4.86(p value<0.05). Conclusion: Homocysteine level in blood was higher among cases of acute brain stroke in absence of traditional risk factors. It should be considered as independent risk factor for stroke.

Background- Additionally, the prevalence of prediabetes in India ranged from 10% to 14%, which is higher than the global prevalence of 8%. Dyslipidemia, characterized by elevated levels of low-density lipoprotein cholesterol (LDLc), elevated tri-acylglycerol (TG), and decreased levels of high-density lipoprotein cholesterol (HDLc), is linked to an augmented risk of cardiovascular disease (CVD). Consequently, the timely identification and management of dyslipidemia can significantly contribute to the prevention of cardiovascular morbidity and mortality. Methods- This is a Prospective observational cohort study, A total of 240 patients from Outpatient department (OPD) and Indoor patient (IPD) department of Medicine, Dr. Baba Saheb Ambedkar Medical college and Hospital, New Delhi, were taken for study considering the inclusion and exclusion criteria. The data was collected in a pre test proforma which includes various socio-economic parameters like age, sex, occupation, religion, etc Results - The mean age of participants was 53.020+-16.5 years, and mean BMI of 24.555±12.8 kg/m2. All patients, exhibited total cholesterol levels that fell within the range considered to be normal following the administration of the prescribed therapy. The mean total cholesterol level recorded was 141.2mg/dl. In the study, it was observed that 75% of the participants experienced a reduction in their cholesterol levels. On the other hand, a small percentage of 1.25% showed an increase in their cholesterol levels. Additionally, 23% of the participants demonstrated no significant change in their cholesterol levels, with a margin of error of plus or minus 10mg/dl, when compared to their baseline measurements. Conclusion- There was a notable enhancement in the average values (moving closer to the normal distribution) of each lipid profile parameter over time. The findings of the study indicate that the utilization of metformin resulted in improvements in lipid parameters.

Background: Fractures of the clavicle are common usually following trauma. Surgical fixation of clavicular fractures has been traditionally performed under General Anaesthesia (GA). Although GA has several benefits but also carries associated risks. Ultrasound-guided techniques have enabled the anaesthetists to reduce doses of local anaesthetic drugs and perform more successful blocks. In this case report we have explored use of only interscalene approach to brachial plexus block as surgical anaesthesia and analgesia in clavicle fracture. Case Description: A 39-year-old male patient, had a closed complete displaced fracture in the middle third shaft of the left clavicle due to a history of trauma. The interscalene block was performed under ultrasound guidance. A local anaesthetic drug was administered for interscalene block. Distribution of the local anaesthetic drug was visualized during the procedure. Motor blockade and sensory blockade was assessed. The patient underwent open reduction and internal fixation (ORIF) of the left clavicle. During intraoperative and postoperative period no intravenous analgesics were used. Patient was monitored for few hours in post-operative room and was sent home the day after the surgery, with oral medications (non-steroidal anti-inflammatory drug with an opioid). Conclusion: Our limited experience suggests that the interscalene block is possible as a sole anaesthesia method in patients who undergo clavicular fracture surgery. In this case study, regional anaesthesia was successful.

Objective: To study the incidence and outcome of cardiac manifestation in Acute febrile illness(AFI) with Dengue/ Leptospirosis/ Malaria/ Swine flu and to correlate organ dysfunction and mortality. Methods: This was a prospective observational study that included 187 AFI patients with laboratory confirmed Dengue/ Leptospirosis/ Malaria/ Swine flu admitted in tertiary care center. Demographic data, clinical presentation, investigations and outcomes were collected and analyzed. SOFA(Sequential organ failure assessment) score was used to assess outcome in patients with cardiac manifestation. Results: Total of 187 patients were included in this study. Mean age of patients was 26.5 years(SD8.4), 143(76.4%) were males and 44(23.5%) were females. 122 patients(65.2%) had ECG changes, out of which 86 patients(45.9%) had sinus tachycardia and rest 36 patients(19.2%) had ST-T changes or rhythm abnormalities. Of these 36 patients, 11 patients(5.88%) had 2D-Echo changes of hypokinesia and 27 patients(14.4%) had raised CPK-MB levels. 1 patient(0.5%) had LV hypokinesia without ECG manifestation. Mortality was higher among sinus tachycardia and additional ECG changes compared to sinus tachycardia alone(25% vs 3.4%,p<0.001). SOFA score >6 at zero hour and its increasing trends compared to decreasing or same trend predicted mortality(55.5% vs 1.85%,p<0.001). Conclusion: Incidence of cardiac manifestation in our study was 65.7% with 6.42% mortality. Sinus tachycardia is most common ECG manifestation. Mortality correlates better when Sinus tachycardia co-manifests with additional ECG changes. SOFA score >6 at zero hour has good mortality prediction as determined by the ROC (Receiver operative characteristic) curve. Increasing trends of SOFA score predicts mortality better than single initial score.

Introduction: Musculoskeletal disorders (MSDs) are prevalent across the globe and one of the commonest causes of long-term pain and disability, affecting million of the peoples.1 These disorders cause pain and discomfort which interfere with day to day activities. According to WHO Quality of life is defined as individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. This definition reflects the view that quality of life refers to a subjective evaluation which is embedded in a cultural, social and environmental context.6-9 Materials And Methods:The study was conducted in adults (aged 18 years or more) living in rural part of  Jaipur. The study was a descriptive, cross sectional, community-based study; and data was collected from each patient at only one point of time in the area covered under 3 subcentres viz. Kanth, Achrol and Dhand. Results: The study was conducted amongst 200 adult participants, 103 (51.5%) were female and 97 (48.5%) were male. Out of 70 study participants who had MSD at the time of interview, 35 (50%) perceived their quality of life as good, while 100 (76.9%) of the participants not suffering from MSD (n=130) perceived their quality of life as good and this association was found to be statistically significant. (p-value-0.001). Conclusion: According to our study, individuals with musculoskeletal disorders had considerably worse quality of life in the physical, psychological, and environmental domains.

Introduction: Oral health is an integral component of overall health and well-being, with a profound interplay between the health of the mouth and its impact on the rest of the body. The human body is a complex and interconnected system, where each part influences and interacts with others to maintain optimal functioning. In this intricate web of health, oral health plays a vital role, extending beyond the confines of the mouth to impact various aspects of general health. Many diseases of the oral cavity often are neglected and not attended for. To address this concern, we conducted a study aimed at identifying the common oral health conditions for children during the mixed dentition stage attending a tertiary care hospital in western Tamil Nadu, India. Objective: The objective of this study was to identify the common oral health conditions among children of mixed dentition stage. Materials And Methods: This cross-sectional study was done among 246 children of mixed dentition stage attending Paediatric Outpatient Department (OPD) of KMCH IHSR, Coimbatore, Western Tamil Nadu, India, between June 2023 to July 2023. A structured questionnaire was used to collect data Results: When assessed for common oral health conditions 64.2% of the study population had Dental carries. 35.8% had periodontal disease. 9.3% had oral mucosal lesions. 15% had malocclusion, 9.3% had unerupted teeth and 6.1% had deleterious oral habits.  Conclusion: The data presented in the current study highlights the prevalence of various dental conditions in the study population, emphasizing the need for comprehensive oral health care and preventive measures. Addressing these dental issues through regular dental check-ups, proper oral hygiene practices, and early intervention is essential in promoting optimal oral health and overall well-being for the children. Incorporating all these measures through the school dental health program will help in effective implementation and improving the dental status of the children.

Neonatal hypothermia in very low birth weight (VLBW) is a common issue worldwide, especially preterm infants. Even when caregivers follow routine thermal care guidelines, keeping preterm infants sufficiently warm immediately after birth is challenging.Along with various short-term outcome like hypoglycemia, hypoxia, acidosis, long-term neuro-developmental outcomes of VLBW infants with admission hypothermia have very limited studied.Globally, the incidence of hypothermia upon admission in VLBW preterm infants is 31%–78%.In recent years, improvement in pregnancy care, upgraded obstetric techniques and better neonatal nursing in India have influenced the over-all incidence and prevalence of neuro-developmental outcomes among preterm VLBW infants with hypothermia.Odisha being a low-resourced state faces a high prevalence of hypothermia among VLBW infants. So, this study has been planned with the primary focus to prevent the hypothermia among preterm VLBW infants which in future will improve their short-term and long-term consequences. Total of 329 infants were included in this study from department of Paediatrics between April 2022 to March 2023.All infants with a birth weight < 1500g and GA less than 34weeks admitted to the NICU / SNCU with admission hypothermia were included during this study period .Infants having major congenital abnormalities and infants with missing or incomplete temperature data were excluded from this study. Routine investigations were done in all study participants as per protocol. In result, we observed the maternal variables and found that thyroid disorder were significantly more in mothers i.e. 62.31% (205) as compared to other factors. Mortality (40.93%) and RDS (87.13%) was high in moderate hypothermic VLBW infants as short term outcome whereas delay in mean developmental age (p=0.003) was observed in same group as long term outcome after one year of age. Early diagnosis and careful management will prevent the hypothermia among the preterm VLBW infants which in futures improves their short-term and long-term consequences.

Introduction: Urinary tract infections are commonly encountered and managed worldwide, and emphysematous pyelonephritis (EPN) is among the most serious types of urinary tract infections. EPN is an acute necrotizing infection of the kidney, often associated with high rates of renal loss and mortality. Aims: This retrospective study aimed to study on clinical information, management strategies and predictors of outcome Emphysematous pyelonephritis. Materials and methods: 90 consecutive patients were diagnosed with EPN with there demographic characteristics, clinical presentations, management strategies, and final outcomes were analyzed retrospectively. Results: There are 36 men and 54 women among the 90 patients. The average patient age is 58 years old. 96% of patients have diabetes, and 22% of those patients also have renal calculi. 4% of patients do not have diabetes. The majority of patients (91%) present with a fever, followed by flank pain (75%), decreased urine output, lower urinary symptoms, shock, and altered sensorium. The most typical organism found in urine (71% of the time) is E. coli. 37 percent of patients had class 2 EPN, 35 percent had class 3, and 14 percent had class 4 EPN. In 46% of patients, left sided EPN, right sided EPN, and bilateral EPN were all present. Shock, thrombocytopenia, altered sensorium, serum creatinine, and symptoms that had only been present for seven days or less at the time of presentation were. The majority of people who have experienced an episode of EPN have advanced to CKD. The majority of patients are treated with minimally invasive procedures such PCD/PCN insertion and DJ stenting together with antibiotics. Only 2 patients underwent nephrectomy. Six patients died before invasive therapy was attempted, and eight of the 14 patients died within 48 hours. Conclusions: Serum creatinine level is the most reliable predictor of outcome in patients with emphysematous pyelonephritis. Most of the patients are treated by minimal invasive surgery like DJ stenting, PCD/PCN insertion in combination with antibiotics.

Background:  Changes  in  blood  pressure  and  heart  rate  in  smokers  have  been  investigated  in  previous  studies  but  far  less  is  known  about  the  cardiac  autonomic  response  in  smokers  and  according  to  best  of  our  knowledge  there  is  insufficient  data  especially  in  Northern  India  on  effect  of  smoking  on  HRV  (Heart Rate Variability).     Therefore,  we  have  taken  up  this  study  to  assess  HRV  including  the  non  linear  HRV  indices  and  HbA1c  in  non-diabetic,  smokers  and  non-smokers.  Methods:  A  total  of  sixty-two  participants  (including  30  male,  non-diabetic,  smokers  of  20  to  40  years  and  32  age  matched,  male,  healthy  non-smokers)  were  studied.  Anthropometric  variables  were  recorded.  HRV  was  recorded  and  blood  sample  was  sent  for  HbA1c  and  average  blood  glucose  level. Results:  We  found  a  significant  decrease  in  SBP  (p=0.0001),  DBP  (p=0.0002),  PR  (p=0.0072),  time  domain parameters -  mean  RR  (p=0.0001),  SDNN  (p=0.0001),  RMSSD  (p=0.0001)  &  pNN50  (p=0.0061),  frequency  domain  parameters  -  TP  (p=0.0002),  LF  (p=0.001)  and  HF  (p=0.0002)  and  non-linear  parameters -  SD1  (p=0.0015)  &  SD2  (p=0.0023)  in  the  study  group.  Cardiovascular  and  HRV  parameters  were  negatively  correlated  with  smoking  index. Conclusions:  Cigarette  smoking  impairs  cardiac  autonomic  activity.  We  found  a  significant decrease  in  the  time  and  frequency  domain  parameters  of  HRV  which   may  be  responsible  for  suppression  of  vagal  tone  and  increased  sympathetic  activity.  The  pack  years  and  smoking  index  were  significantly  associated  with  impaired  cardiac  autonomic  activity  and  decreased  HRV  which  may  predispose  to  cardiac  arrhythmias  including  sudden  cardiac  death. 

Introduction: The aim of this study was to demonstrate the quicker onset of sensory and motor blockade, increased duration of postoperative analgesia and lesser incidence of tourniquet pain following addition of dexmedetomidine to lignocaine compared to lignocaine alone in IVRA for upper limb surgeries. Methods: A randomized prospective study conducted in 60 ASA grade I and II patients, of either sex, between 20-60 years, scheduled for either elective or emergency surgeries of upper limb were included in the study. All patients were divided into two groups by computer generated randomization of 30 each, into group A and group B. Group A received 3mg/kg lignocaine diluted with saline to a total volume of 40ml with dexmedetomidine 0.5 microgram/kg added as an adjunct. Group B received 3mg/kg lignocaine diluted with saline to a total volume of 40 ml.  Pain score was evaluated using visual analog scale (VAS) of 0 to 10. Sensory and motor block onset and recovery times, onset of tourniquet pain, time to first analgesic requirement was noted. Result: Both groups are comparable with demographic details ie age, gender are weight. type and duration of surgery are insignificant  in between groups. Sensory, motor  blockade onset time are significantly less in lignocaine and Dexmedetomidine added groups. Sensory blockade recovery time and motor recovery time after the release of tourniquet was significantly longer Group A than for Group B (2.53 ± 0.51 minutes) which is statistically significant with a ‘p’ value of 0.0001. VAS reached a score of 3 at 416.2 ± 45.73 minutes in Group A and at 33 ±  0.96 minutes in Group B. This difference was statistically significant with a ‘p’ value of 0.0001. In group A, 7 cases had a sedation score of 1 and 23 had a score of  2. In group B, 30 cases had sedation score of 1.  Conclusions: Dexmedetomidine 0.5micrograms/kg   is   added   to   lignocaine   for Intravenous regional anesthesia, it provided   quicker onset of sensory and motor blockade, lesser   incidence of tourniquet pain, increased   duration of post operative analgesia and better haemodynamic stability.

Introduction: Spontaneous preterm delivery, a composite perinatal and obstetric condition is the main source of perinatal morbidity and mortality. Regardless of latest management of neonates in the last centuries, a couple of trials recognized high-probability category who might have premature delivery and also to concentrate on perinatal results, yet premature delivery not decreased. Early detection of premature labour has been pursued as a means of reducing prematurity-related perinatal morbidity. Preterm labor is triggered by a number of mechanisms, similar to how parturition at term is triggered by a number of mechanisms. Asymptomatic bacteriuria, cervical incompetence, cervico-vaginal infections, uterine overdistension, uteroplacental insufficiency, decidual hemorrhage and other factors might cause them.  Materials And Methods: This is Hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynaecology in a tertiary care teaching hospital for a period of one year. The pregnant mothers coming under inclusion criteria are explained about the study and the ultrasound procedure. Consent for the procedure is obtained. Using ultrasonography, cervical length is measured and they are asked to come for follow-up after 3-4 weeks. These patients are subjected to follow-up till delivery and their gestation age at delivery and mode of delivery are noted. Transvaginal ultrasonography of cervix is the reference standard technique for accurate determination of dimensions and characteristics of the cervix. USG Machine - Mind Ray 2D Ultrasound with Transvaginal probe (Frequency - 7.5MHZ). Results: In the present study 47% were in 18 weeks of gestational age. About 21% were in 19 weeks of gestational age. About 15% were in 20 weeks of gestational age. About 13% were in 21 weeks of gestational age. Only 4% were in 22 weeks of gestational age. Mean gestational age is 20.56 and standard deviation is 2.24. About 47% had cervical length equal to or less than 2.5 cm. About 53% had more than 2.5 cm cervical length. About 72% were Normal vaginal deliveries. About 22% were LSCS deliveries. About 65% of the mother delivered Preterm, less than 37 weeks of gestational age. About 35% of the mother delivered at and more than 37 weeks of gestational age. About 36% were between 2.1 - 2.5 Kgs followed by 22% between 2.6 - 3.0 Kgs. 17% were <2 kgs. 16% were between 3.1-3.5Kgs. 9% were between 3.6 - 4.0 Kgs. Conclusion: Even if using predictors may not diminish the pace of premature birth, it does help us identify patients who are at risk and choose better treatment options. It likewise assists us to avoid overseeing preterm labor and treating it too aggressively. The use of Transvaginal ultrasonography to determine the cervix has the potential to help forecast the probability of preterm labor. Considering the severity of premature labor, the expense of managing premature babies, and the associated morbidity and mortality, the utilisation of cervical sonological estimation at 18 to 24 weeks as a standard screening strategy is practical and has great legitimacy as a successful screening test, and should be offered to all pregnant women.

Background: Postoperative nausea and vomiting (PONV) is a common complication following surgical procedures, impacting patient recovery and satisfaction. This clinical trial aimed to compare the efficacy of palonosetron and ondansetron for PONV prevention, considering their safety profiles, patient satisfaction, and perioperative outcomes. Methods: A prospective, randomized, double-blind, controlled clinical trial enrolled patients undergoing elective surgery under general anesthesia. Patients were assigned to receive either palonosetron or ondansetron. The primary outcome was the incidence of PONV within 24 hours postoperatively. Secondary outcomes included time to first nausea and vomiting, adverse events, patient satisfaction, postoperative pain scores, and time to ambulation. Statistical analyses were employed to assess the differences between treatment groups. Results: Among the 300 patients (150 per group), palonosetron demonstrated a significantly lower incidence of PONV within 24 hours compared to ondansetron (10.7% vs. 24.0%, p < 0.001). The palonosetron group exhibited a prolonged time to first nausea and vomiting (p < 0.001 for both). Adverse events were comparable between groups, and patient satisfaction scores trended higher with palonosetron. Postoperative pain scores were lower (p = 0.013) and time to ambulation was shorter (p = 0.029) in the palonosetron group. Conclusion: This clinical trial highlights the superior efficacy of palonosetron over ondansetron in preventing PONV during the immediate postoperative period. Palonosetron's extended antiemetic effect, coupled with favorable safety and patient-centered outcomes, underscores its potential as a preferred antiemetic choice. These findings contribute to evidence-based perioperative practices, enhancing patient care and recovery.

Background and objective:  Incidence of twin pregnancy has grown from the past 20 years due to early detection by USG and increased use of ovulation inducing drugs and ART. There is significant risk of maternal and perinatal morbidity due to associated complications like re-eclampsia, anemia, premature delivery, malpresentations, PPROM in twin gestation. Active and timely intervention and strict vigilance helps in improving the maternal and perinatal outcome.  Methods: A prospective study was carried out from March 2021-December 2022 in the Obstetrics and Gynaecology Department at Siddhartha Medical College, Vijayawada, Andhra Pradesh, India. The study was approved by Institute Ethics Committee. 90 antenatal women with twin pregnancy more than 28 weeks attending antenatalop, labour ward were included. Results: Maternal complications most common is pre-eclampsia in 35.5% cases, anemia is seen in 30% cases, antepartum eclampsia seen in 3% cases, premature delivery in 70% cases, malpresentations in 53.6%, pph in 30%, postpartum eclampsia in 8.8%cases. Low birth weight is 62.2%, perinatal mortality rate is 6.32% and neonatal mortality rate is 4.87.Most common cause of neonatal death is prematurity with RDS. Conclusion: Early identification of twin gestation Chorionicity, is important to identify the twins at risk for complications. Good antenatal care, early detection of complications, timely intervention, and prevention of pre term labour, strict intrapartum care and good neonatal intensive care services reduces the maternal and prenatal morbidity and mortality to a significant extent.

Background and objective: Analysis of electrical burns to the upper extremities. Upper limb deformities caused by electrical burns are resurfaced using flaps that are tailored to the individual patient's situation. Methods: During the time period of March 2022 to January 2023, at the Department of Plastic Surgery, ASRAM Medical College and Hospital, Eluru, Andhra Pradesh, India, performed prospective research on a total of 25 patients with post electrical burn defects in upperlimbs with flaps. Result: When compared to electrical burns produced by lightning or higher voltages (>1000 volts), those caused by low-tension (1000 volts), mostly caused by domestic appliances, account for a disproportionately large number of visits to the emergency room. In all, 42 people have only had symptoms in their upper extremities, 22 in their lower extremities, and 16 in other parts of their bodies (scalp, face, neck, trunk, genitalia). One hundred and one people have been diagnosed with the condition affecting their upper limbs (42+22+16+21). Conclusion: The wrist and fingers are the most common places where soft tissues are injured. According to our findings, the groyne flap is the most often used flap, followed by the abdominal flap and the louvre flap. No unrestricted tissue swaps were done. The study population did not have any life-threatening complications, such flap failure.

Background: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes before the completion of 37 weeks of pregnancy. PPROM is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. PPROM occurs in 3% of pregnancies. Aims and objectives: The present study was done to identify risk factors associated with PPROM and feto-maternal outcome in PPROM. Methods: The present study was single centered prospective comparative study. A total of 100 patients in each group that is GROUP A - 28 to less than 34 weeks of gestation and GROUP B- 34 to 37 weeks of gestation were selected for the study. Study was conducted from April 2019 to March 2020 in the Department of obstetrics and Gynecology, Nil Ratan Sircar medical college and hospitals, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: PPROM is mainly seen is in primigravida patients compared to multigravida. My study had 60% primigravida in Group A and 52% in Group B. There were no risk factors found in 74% patient in 28 to less than 34 weeks of gestation and 76% in 34-37 weeks of gestation. Most common risk factors in both groups was history of PPROM in previous pregnancy followed by malpresentation like Breech. Perinatal mortality includes stillbirth and early neonatal death which was 12% in Group A and 2% in Group B. Maternal morbidity was less in both groups. There was no maternal mortality. Chorioamnionitis was seen in 3 patients in Group A. Conclusion: Perinatal morbidity was mainly due to respiratory distress syndrome and prematurity in less than 34 weeks of gestation. Maternal morbidity was also increased mainly in lower gestational age group.  

Aim and Objectives: The aim of the study is to assess the role of altered lipid profile, lipoprotein (a) and serum magnesium levels in young patients with acute myocardial infarction (AMI). To evaluate the lipid profile in young adult patients with AMI and compare it with matched healthy adults; To determine the level of Lipoprotein (a) in young adult patients with acute MI and compare it with matched healthy control group; To estimate the level of serum magnesium in patients with acute MI and compare with healthy group. Methodology: The present study was a case-control study carried out at Owaisi hospital and research center and princess Esra hospital to detect the role of altered lipid profile, lipoprotein (a) and serum magnesium levels in young patients with acute myocardial infarction (AMI) and compared it with normal healthy controls of same age group. In the study, the most common risk factors found in young acute MI patients were smoking followed by psychosocial stress and family history of CHD. Results: This study revealed a male predominance in young adult cases with acute MI and maximum incidence of acute myocardial infarction was seen in the 4th decade of life. Serum lipid profile in this study revealed some significant alterations, there was a marginal increase in serum total cholesterol, serum triglycerides and serum LDL-c in young adult patients with acute MI. However, serum HDL-c levels were slightly lower in cases of acute MI compared to healthy controls. Serum Lp (a) levels were significantly increased in young AMI patients when compared to controls. This suggests that an elevated Lp (a) concentration is associated with AMI and a risk factor for acute MI in young adults Serum Magnesium levels in cases with acute MI were significantly decreased compared to controls. Magnesium is known to have an influence in the causation of acute myocardial infarction in young adults also. Conclusion: The present study concluded that  lipid fractions like total cholesterol, serum triglycerides (TG) low density lipoprotein (LDL) high density lipoprotein(HDL) cholesterol and lipoprotein (a) along with serum magnesium may be important for the pathogenesis of atherosclerosis. and could be considered as risk markers for acute MI in young adult population. But to prove this, it needs further large scale studies with large number of patients.

Introducation: In the years between 1958 and 1993, the number of people diagnosed with Diabetes multiplied five – fold.1 In 1994, 135 million patients world – wide were living with Diabetes Mellitus. By the year 2025, it is estimated that this figure would increase to more than 300 million .2  Currently 25 million Indians have diabetes. The loss of a limb or foot is one of the most feared complications of diabetes and yet foot problems remain the commonest reason for diabetic patients to be hospitalized. Diabetic foot ulcers precede almost 85% of amputations.

Background: Irregular menstrual cycles are a prevalent concern affecting women worldwide, with a diverse range of underlying causes including hormonal imbalances and anatomical irregularities. Sonography has emerged as a powerful tool to investigate gynecological conditions, while hormonal imbalances and dermatological manifestations have been linked to menstrual irregularities. However, the correlation between these factors in women with irregular periods requires further exploration. Present study aimed to evaluate sonographic findings in patients presenting with irregular periods and subsequent correlation with hormonal levels and significant dermatological manifestations. Methods: This prospective observational study conducted at the Department of Radiology, Rajendra Institute of Medical Sciences(RIMS), Ranchi, Jharkhand. A sample of 200 women with irregular menstrual cycles in the age group of 18 to 45 years were recruited. Sonographic imaging focused on identifying anatomical irregularities, and hormonal assays measured estrogen, progesterone, FSH, and LH and TSH levels. Dermatological assessments examined acne, hirsutism, and abnormal pigmentation,  rashes and alopecia. Descriptive statistics, correlation analyses, and logistic regression were used for data analysis. Results: Sonographic findings revealed no abnormality in 24%, polycystic ovaries(PCOD) in 42%, uterine fibroids in 18% and endometriosis in 16% of participants. Hormonal analysis demonstrated positive correlations between LH/FSH ratio  and PCOD (r = 0.56, p = 0.011), positive correlation between estrogen and uterine fibroid(r=0.45,p=0.14), positive correlation between estrogen and endometriosis(r=0.24,p=0.12) and negative correlation between progesterone and endometriosis(r=-0.31,p=0.04). 31% of normal patients on sonography had elevated TSH levels. Dermatological manifestations of PCOD included acne (35%), hirsutism (47%), abnormal pigmentation (22%) and alopecia (11%) with some overlapping of findings. In endometriosis patients 20% had acne and 16% had rashes. No specific dermatological finding was seen in fibroid patients.  Significant correlations were observed between PCOD and dermatological conditions. Conclusion: The study underscores the importance of sonographic imaging in diagnosing irregular menstrual cycles and identifies potential associations between hormonal imbalances and dermatological manifestations. This integrated approach enhances understanding of irregular menstrual cycles, facilitating targeted treatment plans and improved patient outcomes.

Background: Diabetes mellitus is the most common metabolic disorder affecting the people all over the world. Diabetes mellitus has been known to be associated with lipid disorders and cardiovascular complications. This study is planned to assess the lipaemic changes in diabetes mellitus patients. Method: A total number of 50 control who were healthy non smokers non alcoholics and at the time of study all of them were keeping good health and 50 diabetics who were on treatment were studied. Results: In our study the lipid profile parameters difference between the control and the study (Diabetic) groups was Statistically highly significant. Conclusion: This study revealed that dyslipidaemia was observed in the diabetic population. The diabetic patients had a higher prevalence of high serum cholesterol, high triacylglycerol and high LDL-C than the controls, indicating that diabetic patients were more prone to cardiovascular diseases.

Background: Exposure to secondhand smoke has no safe limit. Secondhand smoking contributes to significant health problems in India. Apart from cancer, exposure to secondhand smoke has been reported to be associated with several respiratory diseases (including asthma, respiratory infections such as bronchitis and pneumonia, wheezing, coughing), ear infections, sudden infant death syndrome, and slow fetal growth and lung development. However, the overall rates for smoking, including consumption of different tobacco products, including smokeless tobacco, are still high. Smoking is a common practice among many adults in Indian people generally have very low concerns regarding the adverse health effects of secondhand smoking.  This study aimed to determine the factors associated with exposure to secondhand smoke among subjects in households of rural India. Materials and methods: We used two measures of SHS: exposure to SHS at home and exposure to SHS in the workplace. SHS exposure at home is estimated for non-smokers who reported anyone smoking inside his/her home. Exposure to SHS in the workplace is estimated for non-smokers who reported anyone smoking in the workplace in the past 30days before the survey. Statistical techniques such as χ2 test, logistic regression and discriminant function analysis were used. Result: The prevalence of SHS exposure at home was 55.8%, where 13.3% of children lived with one smoker, while 50% of children lived with ≥2 smokers. There was a significant difference in the mean score of the combined cognitive tests between SHS-exposed and non-exposed children after adjustment for sex, parental educational level, family income and academic performance [Pillai’s Trace=0.084, F statistic (df)=6.803 (4302), p<0.001]. Conclusion: Current smoking and exposure to second-hand smoke among internal migrants in India is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors, such as focusing on divorced/widowed women.

Background: Pregnancy has a profound impact on the thyroid gland and its functions.  During pregnancy, the thyroid gland increases in size by 10% in iodine replete countries but by 20% to 40% in areas of iodine deficiency. Production of thyroid hormones and iodine requirement each increases by approximately 50% during pregnancy. Hypothyroidism in pregnancy is associated with significant obstetrical and fetal complications such as spontaneous or threatened miscarriage, anaemia, preeclampsia, preterm delivery, low birth weight, fetal growth restriction, placental abruption, postpartum haemorrhage, high perinatal mortality etc. This study is designed to evaluate the prevalence of thyroid dysfunction and its impact on maternal and fetal outcome in antenatal women attending antenatal clinic at a tertiary healthcare centre in Raipur, Chhattisgarh.  Objectives: To study the prevalence of thyroid dysfunction in antenatal women and the impact of thyroid dysfunction on maternal and fetal outcome. Material And Methods: This was a prospective observational study with 113 healthy pregnant women attending the ante natal clinic of the Department of Obstetrics and Gynaecology between 8 to 26 weeks of gestation during the time period of 1st November 2018 to 31st October 2019. Statistical analysis was done using descriptive and inferential analysis. To establish association tests namely chi square test, ANOVA test and odds ratio were used. Level of significance P value <0.05 that is 5% was considered as statistically significant.  Results: Out of 113 subjects 74.34% were euthyroid and 25.66 % had thyroid dysfunction in which 18.58% were subclinical hypothyroid, 6.19% were overt hypothyroid and 0.88 % were hyperthyroid. Abnormal maternal outcome was significantly higher (p=0.003) among subjects with thyroid dysfunction (58.62%) as compared to euthyroid subjects (30.95%). Abnormal fetal outcome was significantly higher (p=0.002) among anti-TPO positive hypothyroid subjects as compared to anti TPO negative hypothyroid subjects. NICU admission was needed by neonates of 47.05%   and 75% of subjects with subclinical hypothyroidism and overt hypothyroidism respectively (p=0.0013). APGAR score <7 at 1 min after birth was significantly higher (p =0.0322) in neonates of subjects with thyroid dysfunction (36.36%) as compared to euthyroid subjects (15.58%). Conclusion:  In India prevalence of hypothyroidism in antenatal women is much higher as compared to western countries.  Prevalence also varies widely through different regions in India. Our study revealed a high prevalence of hypothyroidism in Mowa, Raipur, Chhattisgarh state in India. With our study we would like to conclude that both overt and subclinical hypothyroidism in antenatal women is significantly associated with adverse maternal  and  fetal  outcomes and  therefore  needs to  be  monitored vigilantly  for  development  of  complications  and  timely  interference  to  improve  maternal  and fetal  outcome

Background: One of the main causes of maternal and perinatal death is pregnancy-induced hypertension (PIH), a stigmatising condition in the field of obstetrics that requires challenging stigma removal. In order to evaluate ocular symptoms in individuals with pregnancy-induced hypertension, the current investigation was carried out. Materials & Methods: 200 patients with pregnancy-related hypertension in total were enrolled. Patients with persistent hypertension, underlying renal diseases, diabetes, haematological problems, infectious infections, and any past ocular diseases were disqualified. Torch light was used to examine the anterior portion. With the help of tropicamide, the eyes were dilated, and an indirect ophthalmoscope was used to examine the fundus. SPSS software was used to record and analyse each outcome. Results: 19% of the patients experienced eyesight problems. 11 percent of the patients had macular oedema. In 2% and 3% of the patients, respectively, lid oedema and choroidal infarcts were found. 14 percent of the patients had a narrowing of the arteries. Conclusion: Of the cases of preeclampsia, 32% involved ocular symptoms. In PIH patients, routine retinal screening is recommended.

Background: STEMI is a significant cause of morbidity and mortality in patients with CAD. All STEMI patients should undergo risk stratification at the earliest as these patients are at highest risk for developing complications. TIMI risk score is used to predict both early and one year mortality. MHR has emerged a prognostic marker and has been related to cardiovascular outcomes in various CVDs. Methods: 103 acute STEMI cases admitted to KIMS Hospital, Hubballi meeting the inclusion criteria were considered in 2year time period. Of these, 75 patients with a diagnosis of STEMI who underwent PCI with significant CAG findings were selected as the STEMI group and the remaining 28 patients, who had normal coronary arteries, were selected as the control group. The STEMI patients were then divided into two subgroups based on TIMI scores. Results: Among 103 study participants ,75.73 % were males and 24.27 % were females Mean age of STEMI group is 60.8 years.DM was found in 26.21 % and HTN was found in 45.63 % of participants. Mean HDL of the STEMI group is 41.6 mg/dl. Mean monocyte count of the STEMI group is 0.9 ×103 /µL. Mean MHR of STEMI group is 3 and mean TIMI score of STEMI group is 3.3. MHR is significantly higher in STEMI group. Conclusion: In this study it has been observed that MHR is associated with TIMI score in patients with STEMI. MHR can be used as a novel prognostic marker for risk stratification and may be as an predictor of future cardiovascular events in STEMI patients.

Background: Thyroid gland is unique in having a wide spectrum of lesions and these thyroid lesions are common worldwide. However, the thyroid gland lesions vary in their incidence and histopathological patterns. Hence the present study was undertaken to determine the histopathological pattern of thyroid lesions in tertiary care centre.  Material and methods: Total 250 thyroidectomy specimens received in the Pathology Department during a period from July 2021 to June2023 were included in the study. Detailed information regarding age, gender, clinical status, and relevant investigations like fine needle aspiration cytology, thyroid scan, ultrasound reports and operation findings were obtained from histopathology request forms and register. Percentages and simple frequency tables were used for data analysis. Results: Out of 250 thyroidectomy specimens, 215(86%) were females and 35(14%) were males. The age of patients ranged from 3-75 years, with a mean age of 37.56 years. 195cases (78%) were non-neoplastic and 55 cases (22%) were neoplastic. The most common non-neoplastic lesions were multi-nodular goiter (95cases; 38%) followed by colloid goiter (65 cases; 26%) whereas most common neoplastic lesions were follicular adenoma (20cases;12%) and papillary carcinoma(14cases;5.6%). Conclusion: In our study, majority of thyroid lesions showed a female predominance with most of them occurring in the age group of 31-40 years and most common thyroid lesions were non-neoplastic. Proper diagnostic tools, including clinical history, ultrasonography and proper pathological examination are required for the identification of thyroid malignancy. Diagnosis by histopathological examination is important for the prompt diagnosis and treatment of Neoplastic lesions.

Introduction: The knee joint trauma is a significant cause of morbidity at young and active persons. An early and accurate diagnosis of the severity of injuries is essential for early conservative as well as for surgical management. It needs a precise history of trauma, a thorough clinical examination and diagnostic imaging. MRI and arthroscopy were the most widely used diagnostic modalities to assess the joint injury. Arthroscopy is invasive and may cause complications. Magnetic resonance imaging has now accepted as the best non-invasive imaging modality for evaluation of traumatic knee joint. Aim: Arthroscopy in conjunction with MRI evaluation of patients with knee trauma. Materials and Methods: A prospective cross-sectional study done over a period of 1 year 7 months between March 2018 to October 2019. 50 consecutive patients with suspicion of knee trauma were selected for the study referred with clinically suspected internal derangement of knee following trauma to the knee from the orthopedic department of KGH, Visakhapatnam for evaluation of traumatic knee. Results: The study population's average age is 36.5±14.2 years, with a minimum age of 18 and a maximum age of 60 years. MRI has sensitivity, specificity, PPV and NPV with respective to ACL is 95.35%,85.71%,97.62%,75% , for  PCL has all 4 100%, MM it is 96.30%,95.65%,96.30%,95.65%, LM it is 92.86%,97.22%,92.86%,97.22%.Overall stating a very good diagnostic tool in comparison with Arthroscopy. Conclusion: In the present studyMRI proved to be an excellent, non-invasive, radiation-free imaging modality with multiplane capabilities and excellent tissue delineation in comparison with invasive Arthroscopy. Thus, helping in arriving at a correct anatomical diagnosis thereby guiding further management of the patient.

Objectives: Coronavirus disease2019 (COVID-19) has created an extraordinary health crisis worldwide.Given the infancy of the pandemic and limited data available for managing it in susceptible populations like pregnant women and neonates, there arises a need to understand the implications of this disease to formulate appropriate guidelines. Hence, this study assessed the clinical features, maternal and neonatal outcomes of COVID-19. Methods: This retrospective cross-sectional research study collected data from101COVID-19positive pregnant women using their case records. Variables analyzed included gestational age, symptoms, maternal investigations, period between test positivity and delivery, mode of delivery, maternal ICU admission/need for respiratory support, maternal mortality rate, and neonatal outcome. Results: Mean gestational age for becoming COVID positive was 36.03 ± 6.66 weeks (3rd trimester). Most cases (69%) were asymptomatic, while some had fever (15.84%), cough (12.87%), and elevated serum ferritin levels (32.67%). Obstetric complications were observed in 61.39% of the cases and 70.3% had cesarean deliveries, most likely due to oligohydramnios (15.49%). No case required ICU admission, but some required heparin (87.13%), steroids (9.9%), remdesivir medication (4.95%), and respiratory support (3.96%). Owing to 2 twin pregnancies, 83 mothers gave birth to 85 babies with a mean neonatal birthweightof2.97 ± 0.47 Kg. No babies were COVID positive and only 4.71% were admitted to NICU. Conclusion: No worsening of maternal and neonatal outcomes due to COVID 19 infection were seen.  Obstetrical complications like gestational diabetes mellitus (GDM)&pregnancy induced hypertension (PIH)were existing conditions in pregnant women.

Background: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. The objective of this study was to compare the efficacy of intravenous tramadol and ketamine with placebo in the treatment of intraoperative shivering in patients undergoing cesarean section under spinal anesthesia. Methods: This randomized, double-blind clinical trial was conducted at a tertiary care hospital in Uttar Pradesh. A total of 120 patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated into three groups: Group T (tramadol), Group K (ketamine), and Group P (placebo). Patients in Group T received intravenous tramadol 1 mg/kg, Group K received intravenous ketamine 0.5 mg/kg, and Group P received normal saline as a placebo. The occurrence and severity of shivering were assessed using a standardized shivering scale. Hemodynamic parameters, adverse effects, and patient satisfaction were also recorded. Results: The occurrence of intraoperative shivering was significantly lower in Group T (15%) and Group K (20%) compared to Group P (70%) (p < 0.001). Both tramadol and ketamine effectively reduced the severity of shivering compared to placebo (p < 0.001). Hemodynamic parameters remained stable in all groups. Adverse effects, such as nausea and sedation, were more prevalent in the tramadol group compared to the ketamine and placebo groups. Patient satisfaction was higher in Group T and Group K compared to Group P. Conclusion: Intravenous tramadol and ketamine are effective in reducing the occurrence and severity of intraoperative shivering in patients undergoing cesarean section under spinal anesthesia. However, tramadol is associated with a higher incidence of adverse effects compared to ketamine. Therefore, ketamine may be considered as a safer alternative in the management of intraoperative shivering during cesarean section under spinal anesthesia.

Background: For an infant's growth, development, health, and nutrition, it is crucial to start breastfeeding as soon as possible and to introduce safe, suitable supplementary meals at the right time. The aim of the present study was to assess mothers’ knowledge of IYFC is one of the objectives and to understand the breadth of IYFC usage among moms. Materials and Methods: At the PRM Medical College, Baripada, UHTC, Debendrapur vaccination session, cross-sectional research was done. Every mother who attended the vaccination session with a child aged 0 to 23 months was used as a research participant. The study took place between August 2022 and January 2023. The study participants' verbal consent was obtained after describing the study's goal. Data was gathered using pre-tested, pre-designed questionnaires, and MS Excel was used for analysis. Results: Of the 167 mothers, 163 (97.6%) were aware of the benefits of colostrum feeding, and 167 (100%) were aware of the benefits of pre-lacteal feeding. Only 163 mothers (97.6%) agreed that breastfeeding should begin within an hour of delivery. 167 moms (100%) agreed that exclusive breastfeeding should continue for another six months. 157 moms (94.1%) had sufficient understanding of supplementary feeding. 136 women (81.4%) were advised to continue breastfeeding for up to a year, and 21 (12.5%) were advised to do so for two years. 131 women (78.4%) were determined to be adequately knowledgeable about feeding the infant when they were experiencing diarrhea. All 167 (100%) moms provided their infants colostrum, and none of them had supplied pre-lacteal milk. 167 women practiced exclusive breastfeeding (100%) of the time. 90 (97.8%) of the moms provided complementary feeding. Conclusion: To enhance mothers' understanding of and use of IYFC, ongoing health education is crucial.

Background and objectives: To evaluate the effectiveness of an analgesic cock tail injection into the periarticular space in encouraging quick functional recovery. To evaluate the efficacy of the periarticular injection of an analgesic cocktail of medications in the immediate post-operative period and compare the results to the current treatment regimens currently being used to control pain in our institution, i.e. epidural infusion of Bupivacaine. Method: A randomised control trial was used in the investigation. The study included patients having a unilateral complete knee replacement. Following preoperative evaluation, patients were randomly divided into two groups, one of which received an epidural bupivacaine infusion for pain management and the other of which received a periarticular injection of a combination of analgesic medications. Range of motion and postoperative pain scores were recorded on days 1, 2, 3, and 10. Using a repeated measure ANOVA, consumption of morphine and functional rehabilitation were also measured and statistically analysed. Result: In the first few days following surgery, patients who got pericapsular injections of medication experienced pain reduction that was noticeably superior than that of the epidural group. The pericapsular injection group saw faster functional recovery, but by day 10 after surgery, there had been no change in functional ability or pain reduction. The method of pain control had no discernible impact on range of motion. Those who got pericapsular injections experienced less anesthesia-related adverse effects like nausea, pruritis, vomiting, and urine retention. Conclusion: Patients who underwent peri capsular injections experienced significantly less postoperative pain than those who used epidural injections on the first day following surgery (day 1). Even though the difference was not statistically significant, patients who got peri capsular injections for pain management reported less pain during the remaining days (days 2-10) after knee replacement. On the first day after surgery, patients who received peri capsular injections for pain treatment performed straight leg raises with braces far better than those who were receiving epidural infusions. From the second day on, this difference was no longer statistically significant.

Background and objectives: The accepted method for preventing surgical site infections during orthopedic surgery, including arthroplasty, is prophylactic systemic antibiotics. There is sufficient data to support its effectiveness in avoiding or decreasing surgical site infection. Controversial issues with this method include the timing of administration, the appropriate antibiotics to utilize, and the appropriate antibiotic duration. Methods: The study compared the effects of three intravenous doses of Ceftriaxone 1 g over three days (group 2 n = 65) vs three hours (group 1 n = 65), was conducted on patients who were scheduled for orthopaedic operations with a particular exclusion and was followed up for a year. Results: In groups 1 and 2, 65 patients each received antibiotics for one day and three days, respectively. There were 45 men and 15 women in group 2, compared to 40 men and 20 women in group 1. The patients' ages ranged from five to seventy. The patients in groups 1 and 2 were, on average, 32.5 and 36 years old, respectively. Both groups reported regional edema, redness, and soreness at the surgical site for the first 48 hours after the procedure. These side effects eventually disappeared on their own. Both groups exhibited no signs of localized inflammation, infection, or pus production at a subsequent check-up.  Conclusion: In neither group did any of the cases experience any infection. The study is a step in developing policies about the use of antibiotics in our nation and shows the value of antibiotic prophylaxis.

Introduction: Treatment of bacterial infections has become complicated due to the emergence of multidrug resistant strains of gram negative bacilli. The multidrug resistant strains of gram negative bacilli causes multiple clinical infections and has become a rising problem globally. The metallo beta lactamases encoding genes are very sever in gram negative bacteria such as E.coli. Metallo beta lactamases are beta lactamase enzymes produced by pathogenic bacteria and gradually found in gram negative organisms Materials And Methods: This is a prospective, descriptive, Cross sectional, In-vitro laboratory based , single center study in the Department of Microbiology, Index Medical College, Hospital and Research center Indore. The isolates will be obtained from clinical specimens such as blood, urine, exudative specimens which included pus, wound swabs, eye swab, ear swabs, conjunctival swabs, cerebrospinal fluid, pleural fluid, peritoneal fluid, drain fluids and cerebrospinal fluid (CSF) and lower respiratory secretions (bronchial wash, endotracheal aspirates and sputum) and other relevant clinical material submitted to Microbiology Laboratory for Culture and Sensitivity testing.  Result: Among 210 isolates, 81 isolates were Acinetobacter baumanni, 30 isolates were Acinetobacter lwofii, 23 isolates were of other Acinetobacter sp. and 76 isolates were Pseudomonas aeruginosa. Among 210 isolates, majority were collected from male patient (160). In case of Acinetobacterbaumanni isolates, 50 were collected from male patients whereas 26 isolates were collected from female patients.In case of Acinetobacter lwoffi, 27 isolates were from male and only 03 isolates were from female. AmongAcinetobacter sp.08 isolates were from male patients and only 05 were from female patient. Similarly in case of Pseudomonas aeruginosa isolates, 65 were from male and 16 isolates from female patient. Conclusion: All the MBL positive isolates showed resistance towards aminoglycosides. In case of Pseudomonas aeruginosa Colistin was 100% sensitive and the next effective drug was Amikacin.In Acinetobacter the most effective drug was Tigecyclin(100% sensitivity) and the next effective drug was found to be Tobramycin and Gentamycin. In most of the MBL positive isolates Aztreonam was resistant. This can be attributed to the co presence of multiple mechanism of resistance in MBL positive isolates.

Background: Atherosclerosis is diagnosed, treated, and predicted using lipid profile testing. An increase in the fasting serum cholesterol, triglyceride, or both values is referred to as hyperlipidaemia. Diet, exercise, smoking, and some medications can all have an impact on lipid levels. A sedentary lifestyle is one that is prevalent in modern civilisations and is distinguished by spending the most of the day sitting either at work or at home.  It is thought to contribute to obesity and other illnesses. Objectives: To study and compare the TC, TG, LDL-C, VLDL-C and HDL-C in the sedentary adult females and active adult females. Material & Methods:  100 healthy individuals who worked at various banks, schools, colleges, government and non-government organisations, as well as housewives, made up the study's subjects. All of the participants were female and between the ages of 25 and 45. 50 randomly chosen volunteers with sedentary lifestyles and 50 subjects with non-sedentary/active lifestyles. During individual interviews, a validated, structured questionnaire was utilised to gather information on demographic, socioeconomic, lifestyle, and physical activity patterns. Results: In our study when compared to the normal, healthy lipid profile patterns in active adult females, the evaluation of lipid profile patterns in the sedentary subjects revealed hypercholesterolemia, hypertriglyceridemia as well as decreased HDL-C levels in them. Less active adult females had statistically significantly higher lipid profiles (P-value 0.001) than active adult females. Compared to active adult females who have normal, healthy HDL-C levels, sedentary adult females have lower HDL-C levels. Conclusion: As a sedentary lifestyle increases the risk of hyperlipidaemia, regular lengthier training sessions at a greater working intensity and a low-fat diet should be promoted to significantly lower blood lipid levels and other heart disease risk factors including hypertension and obesity.

Background: Atherosclerosis is diagnosed, treated, and predicted using lipid profile testing. An increase in the fasting serum cholesterol, triglyceride, or both values is referred to as hyperlipidaemia. Diet, exercise, smoking, and some medications can all have an impact on lipid levels. A sedentary lifestyle is one that is prevalent in modern civilisations and is distinguished by spending the most of the day sitting either at work or at home.  It is thought to contribute to obesity and other illnesses. Objectives: To study and compare the TC, TG, LDL-C, VLDL-C and HDL-C in the sedentary adult females and active adult females. Material & Methods:  100 healthy individuals who worked at various banks, schools, colleges, government and non-government organisations, as well as housewives, made up the study's subjects. All of the participants were female and between the ages of 25 and 45. 50 randomly chosen volunteers with sedentary lifestyles and 50 subjects with non-sedentary/active lifestyles. During individual interviews, a validated, structured questionnaire was utilised to gather information on demographic, socioeconomic, lifestyle, and physical activity patterns. Results: In our study when compared to the normal, healthy lipid profile patterns in active adult females, the evaluation of lipid profile patterns in the sedentary subjects revealed hypercholesterolemia, hypertriglyceridemia as well as decreased HDL-C levels in them. Less active adult females had statistically significantly higher lipid profiles (P-value 0.001) than active adult females. Compared to active adult females who have normal, healthy HDL-C levels, sedentary adult females have lower HDL-C levels. Conclusion: As a sedentary lifestyle increases the risk of hyperlipidaemia, regular lengthier training sessions at a greater working intensity and a low-fat diet should be promoted to significantly lower blood lipid levels and other heart disease risk factors including hypertension and obesity.

Background and Objectives: he objective of this current study was to assess the ultrasonographic characteristics of pelvic masses and establish correlations with histopathological diagnoses in patients who underwent surgical intervention. Materials and Methods: A cross-sectional prospective study was conducted in the Department of Obstetrics and Gynaecology, and Radiology The study cohort comprised 113 female patients who presented with symptoms indicative of pelvic masses. The final diagnoses were subsequently correlated with histopathological findings, with the cytohistopathology diagnosis considered definitive. Results: A total of 113 female patients underwent ultrasonography (USG) scans, in concurrence with a clinical history and examination of pelvic masses. The predominant age group was 40-50 years. The most frequently reported chief complaint among the female patients in our study was pelvic pain followed by a combination of pain and palpable mass. Menstrual irregularities, menorrhagia, post-menopausal bleeding, infertility, and amenorrhea were among the less common complaints presented by female patients in our study. Conclusion: Ultrasonography emerges as the foremost imaging modality for evaluating gynaecological masses. Proper differentiation between gynaecological and non-gynaecological masses on sonographic assessment is vital for precise patient management.

Background: One of the biggest clinical problems in paediatric treatment is still bronchiolitis. Young children (under 2 years old) are more susceptible to the lower respiratory ailment bronchiolitis, which is brought on by seasonal viruses such as RSV, Rhinovirus, Influenza, Adenovirus and others. It is the most common reason for young children to be admitted to the hospital and is associated with a high level of morbidity but a low fatality rate (1%). Each year, bronchiolitis affects 20% of newborns in the US and about 3% of those need to be hospitalised.

Objectives:

1. To study the clinico-epidemiological andmicrobiological profile of bronchiolitis in children.profile of bronchiolitis in children.

2. To assess the clinical outcome in hospitalised infants with bronchiolitis.

Background: If you're looking for a reliable and adaptable approach of pain management during labor, look no further than central neuraxial analgesia. There have been a number of promising technical advancements in the realm of neuraxial analgesia. The purpose of this research is to examine the relative benefits of dural puncture epidural vs conventional epidural for delivering babies in pain-free conditions. Methods: Studying how well dural puncture epidurals work compared to more traditional epidurals for pain relief during labor. The Department of Anaesthesia, MNR Medical College and Hospital, Fasalwadi, Telangana, India, was the site of this clinical trial, which took place at the hospital's labor and delivery unit. From the month of February 2022 to January 2023. Forty participants are included in this analysis. Results: Adequate analgesia was reached on average 11.60 minutes into treatment in group A, and 10.04 minutes into treatment in group B. After 10 minutes after receiving an epidural bolus, 52% of women in Group A and 60% of women in Group B reported a VAS score of 10 or below for pain. Conclusion: In terms of pain relief during labor, dural puncture epidural method is preferable to classic epidural technique since it takes less time to reach therapeutic levels of analgesia. There are no harmful consequences on the mother or the baby from a dural puncture epidural, and the epidural enhances the sacral spread, the start of analgesia, and the bilateral pain alleviation for laboring women.

Background: India has now become the diabetic capital of the world, with over 30 million diabetic individuals. Cardiac involvement in diabetes commonly manifest as coronary artery disease. Invasive diagnostic modality like Coronary Angiography serves as a diagnostic as well as therapeutic aid in the management of coronary artery disease and it remains the gold standard technique. Objectives: Present study is an attempt to find out how coronary artery involvement in diabetics differs from that of non-diabetics with special interest in their electro-cardiography and angiographic profile.  Methodology: 50 patients having acute coronary syndrome undergoing coronary angiography, aged 18-60 years, were included in present study, and grouped into 2; group A having diabetes (n=25) and group B without diabetes (n=25). Angiographic extent, type of vessel, number of vessels, severity involving coronary artery and its branches in patients with acute coronary syndrome (ACS) were studied and compared in both groups. RESULTS: Significantly higher differences in age, sedentary lifestyle, and hypertension were seen among diabetics than non-diabetics. Significantly higher diabetic cases had ST-T changes. Diabetic patients had more multivessel, multi-lesion, extensive and small vessel disease than nondiabetic patients.  Conclusion: According to the present study, severe forms of coronary artery lesions were found common among diabetic patients as compared to non-diabetic patients.

Background: Psoriasis is an immune-mediated inflammatory disease, where a sustained inflammatory state causes comorbidities such as, metabolic syndrome (MS), psoriatic arthritis and cardiovascular disease. Aims: 1) To find out the prevalence of metabolic syndrome in patients of chronic plaque psoriasis. 2) To study the association of metabolic syndrome with severity of psoriasis and duration of psoriasis. Methods: It was an observational cross-sectional study for a period of one year (February 2021 to January 2022) in the Department of Dermatology, Tripura Medical College & Dr BRAM Teaching Hospital, Agartala. All diagnosed cases of psoriasis patients attending the Dermatology department enrolled after obtaining informed consent and prior Institutional Ethics Committee (IEC) permission. Total 90 patients were included using purposive sampling technique. Results: Present study found; 30 patients (40%) were having metabolic syndrome with mean age of study participants was 38.28 ± 10.29 years. Prevalence of metabolic syndrome was higher in severe psoriasis (59.5%) group compared to moderate (27.9%) and mild psoriasis (20%) group which was statistically significant (p value < 0.05). We also found that prevalence of metabolic syndrome was higher in patients who have psoriasis for longer duration (>3 years) which was statistically significant (p value < 0.05). Metabolic syndrome is seen frequently in patients of psoriasis specially those who has a longer disease course with higher PASI score. Conclusion: Prevalence of metabolic syndrome was higher in severe psoriasis patients. Patients with psoriasis should be regularly screened and advised lifestyle modification such as healthy diet, physical exercise, and stress reduction to reduce the incidence of metabolic syndrome.

Acute liver disease (ALD) or chronic liver diseases (CLD) are the two major comorbidities observed in patients with diabetes mellitus (DM) and metabolic syndrome (MS). It is well known that, aetiology of liver disease such as hemochromatosis, nonalcoholic fatty liver disease (NAFLD), hepatitis C virus (HCV) and non-alcoholic steatohepatitis (NASH) are frequently associated with DM. However, in many studies there is no direct relationships between MS and cirrhosis, acute hepatic failure, end-stage liver disease, hence, we tried to investigate the association between diabetes mellitus and metabolic syndrome (DM/MS) group Vs. non-diabetes and non-metabolic syndrome having ALD and CLD, which might further explore the feasibility of using DM and MS as a prognostic indicator in such patients. Consecutive, age and sex matched ALD (n=31) and CLD (n=62) patients of above 18 years age were included in this study. Patients were categorized into two groups of having diabetes and metabolic syndrome; whose anthropometric, clinical and biochemical details were documented. Further, clinical reports were analyzed to assess the immediate and short-term consequences. Among ALD patients, FBG, HbAlc, ALT values were found significantly higher in DM/MS group (P<0.05). Time to resolution of injury (bilirubin normalization) was found to be significantly higher in DM/MS group (p<0.05). Among CLD patients, high PPBG, HbAlc, TG, LDL, VLDL values were observed in DM/MS group (p<0.05) compared to the nonDM/nonMS group. Higher number of deaths occurred in DM/MS group (n= 6; 28%) in comparison to non DM / non MS group (n=3; 7%)(P>0..05). Overall, patients having DM/MS had high risk of liver disease, mortality and more length of stay in hospital. Patients with DM/MS are at a higher risk of developing severe hepatitis. There is a great impact of DM/MS on development and prognosis of acute as well as chronic liver disease, so, every DM patient must be screened and evaluated for liver injury and its complications.

Introduction: The Covid 19 pandemic has moved the world with devastating outcomes in the first wave (2019-20) and the second wave (2020-21). Additionally, in the second wave descending phase, mucormycosis, which is almost the rarest disease, has come rampant, again creating panic for the human race. Materials and Methods: 200 consecutive Mucormycosis cases were admitted, managed both medically and surgical by a multidisciplinary team approach over a period of 6 months. Results: Data is analyzed statistically in a Microsoft Excel sheet, represented pictorially by bar diagrams. Conclusion: Post Covid Mucormycosis differs from the mucormycosis seen in immunodeficient patients by pathophysiology, and the management protocols also differ. It has high mortality and morbidity with repeated complex surgical procedures. It requires a team approach and prolonged, repeated reconstructive, and rehabilitative procedures.

Aims: To study the morphological changes in the placenta in Hypertensive disorders of  pregnancy. To correlate the pathological changes in placenta with severity of disease  and fetal outcome.  Materials and methods:  The placentae for the study were obtained from the in  patients of Obstetrics and Gynaecology department from Government Maternity Hospital, Hanamkonda.53 placentae of clinically diagnosed cases of Preeclampsia and Eclampsia were included in study. Results: Out of 53 placenta 40 placentae were from Preeclampsia mothers and 13 placentae were from mothers with Eclampsia. The morphometric parameters viz. placental weight, placental diameter, placental thickness umbilical cord length were reduced in placentae of the mothers with Preeclampsia and Eclampsia . The mean birth weight and APGAR score of the babies born to mothers with Preeclampsia and Eclampsia  was significantly reduced.  Increased incidence of eccentric cord insertion, round placentae, calcification and infarction was noted in placentae of study group.  Significant microscopic changes were observed in placentae of study group viz. increased syncytial knots, fibrinoid necrosis and villous stromal fibrosis (p<0.001).  Conclusions: Early detection and early management, thus ensuring better outcomes for both mother and child.Our study of the histopathology involved in the placenta due to Hypertensive disorders can be beneficial.

Introduction: Gallstone disease or Cholelithiasis is the most common disorder affecting the gallbladder and biliary system. In western countries, 10-12% of adult population develops gallstone disease. The incidence of gallstone is 5-15% in Indian population while the prevalence of gallstone varies widely in different regions in India with North Indians having 2 – 4 fold higher prevalence as compared with the South Indians. Aims: To study the hypothyroidism among cholelithiasis, choledocholithiasis and also the factor associated with it. Materials and Methods: The present study was a Hospital Based Cross Sectional Study and Observational study. This Study was conducted from one and half years w.e.f Jan 2021 to June 2022 at Department of General Surgery, A.G.M.C & G.B.P HOSPITAL. Result: In our study we found that there were (4.0%) with high TSH level, with newly diagnosed hypothyroid patients. 86(31.5%) patients with normal level (under medication for hypothyroidism). out of which, 15 patients (5.5%) were found to have clinical hypothyroidism and 71(26%) were found to have subclinical hypothyroidism and rest 65% were euthyroid. Conclusion: A significant prevalence of previously undiagnosed hypothyroid patients were not found in this study, but it was evident that subclinical hypothyroidism was significantly more common, compared to the clinical hypothyroidism. Hypothyroidism was found to have a higher prevalence in females than in males which corresponds to other previous studies.

Introduction: Preterm birth is defined as babies born alive before 37 completed weeks of pregnancy. Preterm birth (PTB) is associated with short- and long-term adverse outcomes for the neonate. In addition, it is the leading cause of neonatal death and also a contributor to the under-five mortality rate. Aims: To study the perinatal outcome in terms of morbidity and mortality among early, intermediate and late preterm birth, in AGMC & GBPH. Materials and methods: The present study was a hospital based observational study with a cross sectional design. This Study was conducted for one and half years between January 2020 and June 2021 at department of Obstetrics & gynecology at AGMC & GBP Hospital during the study period. Total 216 patients were included in this study. Result: The association between lengths of maternal post-partum hospitalization with gestational age of the infants. It can be inferred that the mothers who gave birth to early preterm infants had a significantly higher proportion of post-partum hospitalization of 7 days or more the relation between interventions for neonatal jaundice and gestational age of the infants. The proportion of exchange transfusion was significantly more in the early preterm births in comparison, among the late preterm births, majority needed no treatment for neonatal jaundice. Conclusion: Preterm birth remains a significant risk factor for excess neonatal morbidity, hospitalization, and morbidity and associated costs, in addition to the psychological distress to the families. It is evident from this study that complications in both mothers and infants tend to increase with increasing prematurity associated with lower weeks of gestation. Developing a deeper understanding of the factors significantly associated with preterm birth especially identifying those factors that are modifiable, could help develop new approaches to antenatal, intranasal and post-natal care to prevent adverse pregnancy and neonatal outcomes. This study is the first of its kind in North East India that looks extensively into these predictors and helps identify areas of intervention for lower neonatal and pregnancy related adverse outcomes.

Background: The solitary node in thyroid is a palpably discrete swelling within an apparently normal thyroid gland. It is usually a benign lesion but from clinical standpoint the possibility of neoplastic disease is of major concern for surgeon and patient. As there is variability in the conclusion of various authors and there is no work about clinicopathology of solitary nodules of thyroid in our region, present study has been designed to evaluate the epidemiology, fine needle aspiration cytology and incidence of malignancy in solitary nodule. Aims: To review data regarding incidence of the solitary nodular goitre, analyse & discuss the various clinical presentation, percentage of malignancy and importance of histopathological examination. Methods: As per exclusion and inclusion criteria 80 patients with solitary nodule of thyroid were included in this study. Various data like age, sex, family history, duration of nodule, site and size of nodule were recorded. Thyroid function test, fine needle aspiration cytology and ultrasonographic finding were recorded from case record. Results: Out of all histopathological finding of nodules follicular adenoma was most common followed by multinodular goitre (25%) and Adenomatous goitre (7.5%). Carcinoma was present in (17.5 %) and thyroiditis is 7.5% patients. Conclusions: Most of the patients were Euthyroid and benign condition was more common than malignancy. Follicular adenoma was most common among benign lesion and papillary carcinoma was more common neoplasm. Most of the patients required hemithyroidectomy.

Background: This study was conducted to investigate the role of probiotics as an adjunct to phototherapy in the treatment of neonatal hyperbilirubinemia, with regard to reducing phototherapy's duration and accelerating the rate at which TSB (fading of jaundice) falls when used as an adjunct. Methods: This was a hospital-based prospective case control study conducted among 110 inborn neonates with unconjugated hyperbilirubinemia admitted to the NICU, Department of Paediatrics, Gandhi Medical College, and Hospital, Secunderabad, from December 2019 to May 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean TSB at inclusion was 19.14 ± 0.89 mg/dL vs. 16.89 ± 0.92 mg/dL in the case and control groups respectively (p<0.001). The mean duration of phototherapy was 3.93±0.85 days’ vs. 5.58±1.62   days in the case and control groups respectively (p<0.001). Hence, it was statistically significant. The mean TSB at 24 hours (17.88±1.15 vs. 16.17±1.11) (p value <0.001), 48 hours (15.36±1.90 vs. 14.74±1.67) (p-value 0.069) and at discharge (10.20 ± 1.84 vs 9.86 ±1.54) (p-value 0.308) in case and control group respectively. The rate of change of TSB among two groups at different time intervals (24 hours: 1.26±0.98 vs. 0.72±0.83 (p-value 0.002), 48 hours: 7.68±1.89 vs. 6.30±1.56 (p-value <0.001), and at discharge 8.94±1.82 vs. 7.03±1.53) was statistically significant. Conclusion: Hyperbilirubinemia is a common problem in neonates. An advantage was observed in the use of probiotic (Bacillus clausii) as an adjunct to phototherapy in the management of hyperbilirubinemia.

Background- The induction of hyperalgesia is a well-documented consequence of surgical trauma, and inadequate pain management has been identified as a contributing factor to the development of persistent pain during the postoperative phase. The primary objectives of this study were to assess and compare the impact of pregabalin and duloxetine on post-operative pain scores. Methods: In this observational study, a total of 120 patients with American Society of Anesthesiologists physical status I-II who were scheduled for lower limb trauma surgery were randomly assigned to two groups. One group received oral pregabalin at a dosage of 150 mg per day, while the other group received duloxetine at a dosage of 60 mg per day. The medications were administered 2 hours prior to surgery and continued once daily for the following 2 days after the surgery. The surgical procedure was conducted utilizing a standardized technique for spinal anesthesia. The investigator was unaware of the treatment allocation, which consisted of oral paracetamol at a dosage of 1 g every 6 hours, and intravenous diclofenac at a dosage of 75 mg as a rescue analgesic. The main objective of the study was to assess the response rate in relation to the need for rescue analgesia. The secondary outcomes encompassed various measures, such as the total amount of rescue analgesia administered, the visual analogue scale scores obtained at rest and during movement, the assessment of haemodynamics, the evaluation of anxiety and depression levels, the assessment of patient satisfaction, and the monitoring of any adverse effects. Results: In the pregabalin group, 60% of patients necessitated the initial administration of rescue analgesia within the first 72 hours following the surgical procedure, while the corresponding figure in the duloxetine group was 50%. Within the pregabalin group, it was observed that 6.6% of patients necessitated a second dose of rescue analgesia, with an average duration of 24 hours. Conversely, in the duloxetine group, 10% of patients required a second dose after an average duration of 40 hours. The scores on the visual analogue scale, the time until the first rescue intervention, and the cumulative use of rescue analgesics were found to be similar in both groups. Conclusion: Equivalent rate-responsive rescue analgesia was required in patients receiving pregabalin or duloxetine following lower limb trauma surgery.

Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients. Methods: This is a prospective hospital-based study conducted in the Department of General Medicine of tertiary care hospital of central India. During study period 200 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India. Results: The mean value of total bilirubin was found to be 0.8 mg/dl in patients with dengue fever (DF), 0.96 mg/dl in patients with dengue hemorrhagic fever (DHF), and 1.08 mg/dl in patients with dengue shock syndrome (DSS). The mean value of aspartate aminotransferase (AST) was 77.44 IU/L in the dengue fever (DF) group, 112.32 IU/L in the dengue hemorrhagic fever (DHF) group, and 486.28 IU/L in the dengue shock syndrome (DSS) group. The average alanine aminotransferase (ALT) level in the DF group was 94.36 IU/L, while in the DHF group it was 386.42 IU/L. The average serum albumin levels were found to be 3.97 gm/dl in the DF group, 3.65 gm/dl in the DHF group, and 3.49 gm/dl in the DSS group. The average serum globulin levels were 2.98 mg/dl in the DF group, 2.86 gm/dl in the DHF group, and 2.69 gm/dl in the DSS group. The serum alkaline phosphate level exhibited an elevation in all groups under investigation. The mean value of ALP was found to be 118.46 IU/L in the DF group, 164.32 IU/L in the DHF group, and 342.42 IU/L in the DSS group. Conclusion: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.

Traumatic brain injury is one of the major causes of morbidity and mortality in children.The anatomical features, physiological response to injury, neuronal development, and low myelination in children cause different clinical features compared to adult TBI. The aim is to study the incidence, predisposing factors, clinical presentations, and outcomes of paediatric head injuries. The patients included in this retrospective study are under the age of 14 years and admitted to the neurosurgery department of Siddhartha Medical College, Vijayawada and a tertiary care center.  The study period is one year duration from 1.1.2019 to 31.12.2019. Data was collected on the basis of history, physical examination, baseline investigations, and the plain CT scan in all cases. The paediatric patients were 226 in total, with 743 head injury cases.There were 64.6 % (n= 146) males and 35.4%% (n=80) females. The age ranged from 12 days to 14 years. Fall from height was the commonest cause of head injury found in 48.6% (n=110) cases, road traffic accidents (RTA) in 34.5 % (n =78), and other causes in 16.8 % (n=38). 49(21.68 %) patients had associated injuries. In 55.75% (n=126) cases, mild head injury with GCS 13-15 was present, and severe head injury with GCS less than 8 in 29 (12.8%) patients. The 188 patients are treated conservatively. Thirty-eight patients underwent different neurosurgical procedures, of which five patients died. Conclusion: Head injury in the paediatric age group carries a high risk of morbidity and mortality.Good outcomes are achieved by early diagnosis and referral from primary care centers to tertiary care centers.

Introduction: Renal Cell Carcinoma (RCC) is one of the most common cancers in this world. Partial nephrectomy (PN) leads to better preservation of renal function after surgery. The main purpose of PN is to preserve as much renal function as possible while still achieving negative surgical margins, all withinthe context of a low perioperative complication rate. Material & Methods: It is a Prospective observational study conducted in the urology department at the Medanta - The Medicity, Gurgaon, Haryana, over 24 months. Results: The average age of the patients was 44.86±13.23 years, ranging from 24 to 73 years. There was a slight male preponderance in the study (60%). HTN (28%) and T2DM (26%) were the most common comorbidities in the study.A correlation of the Ipsilateral PPPM in terms of actual and predicted levels (using the Renal score-based method) was done. It was seen that there was a strong positive correlation between the two parameters (r=0.6202) with a p-value of <0.0001. Conclusion: Our study is one of the first to explore the prediction of renal function in partial nephrectomy patients in the Indian subset of patients. We observed that the predicted preserved parenchymal mass (PPPM) levels correlated positively with the actual levels.

Background: Renal artery stenosis (RAS) is a vascular condition associated with hypertension and renal impairment, necessitating early and accurate diagnosis for optimal patient management. While Doppler ultrasonography has been the conventional imaging technique for assessing RAS, its limitations have led to the exploration of alternative modalities like Computed Tomography Angiography (CTA). This study aimed to evaluate the role of CTA in diagnosing RAS and its correlation with Doppler ultrasonography findings.

Methods: A prospective observational study was conducted at the Department of Radiology, Rajendra Institute of Medical Sciences(RIMS), Ranchi, Jharkhand, from December 2021 to December 2022. The study included 100 consecutive hypertensive adult patients referred for suspected RAS. CTA and Doppler ultrasonography were performed on all patients, and the results were interpreted. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both modalities. Correlation between CTA and Doppler findings was analyzed using Pearson correlation coefficient.

Results: The study involved 100 participants (mean age: 58.5 ± 10.2 years, male: 58%, hypertension: 72%, diabetes: 35%). CTA demonstrated higher sensitivity (85.4%) and specificity (91.7%) compared to Doppler ultrasonography (sensitivity: 72.8%, specificity: 81.3%). The correlation coefficient between CTA and Doppler findings was 0.836 (p < 0.001), indicating a strong positive correlation.

Background: Meibomian gland dysfunction (MGD) is a chronic disease of the meibomian glands that is frequently characterised by terminal duct obstruction and/or qualitative/quantitative abnormalities in glandular secretion. Aims and objectives: To evaluate the association between meibomian gland dysfunction and dyslipidemia and also severity of MGD associated with it. Materials and Methods: A Case control study was conducted in the Department of Ophthalmology in a Tertiary Care Centre after Institutional Ethical Committee approval. Total of 72 cases in each group were enrolled.Detailed history including drug usage was taken and ocular examination was recorded including grading of MGD on expressibility and secretions. Fasting Lipid Profile was done and levels of HDL, LDL, Triglycerides and total cholesterol were compared in cases and age matched controls . Prevalence of dyslipidemia was significantly higher among cases of MGD as compared to controls (56.9% vs 18.1%; p<0.01). Mean total cholesterol (186.89 vs 171.54 mg%; p<0.01), triglycerides (193.35 vs 102.58; p<0.01) and LDL levels (111.36 vs 98.50; p<0.01) were significantly higher in cases with MGD as compared to controls while HDL levels were significantly lower (37.99 vs 45.33; p<0.01).  Conclusion: cases with meibomian gland dysfunction (MGD) has significantly higher prevalence of dyslipidemia and higher grades of severity of MGD.

Background: The emissary foramina are the small foramina that transmit the valveless emissary veins connecting the extracranial veins with the intracranial veins. Occipital emissary foramina usually transmit the occipital emissary vein; this vein connects the suboccipital venous plexus with the occipital sinus. There are variations in the number and location of these foramina which deserves special importance during surgical procedures. Objectives: To evaluate the number and location of the occipital emissary foramen in dry adult skulls. Materials And Methods: The study was performed on 150 adult dry human skulls of unknown sex available at the department of Anatomy, Adichunchanagiri Institute of Medical Sciences. The occipital bones were observed with the magnifying lens for the presence, number, and location of occipital emissary foramina. The skulls with broken occipital bone were excluded from the study. The presence of foramen was confirmed by passing the probe through it. Results: The occipital emissary foramen was present in 45/150 (30%) skulls. In 2 skulls the foramen was located on the external occipital protuberance. In 2 it was located on the right side of the external occipital protuberance. In 4 it was located on the left side of the external occipital protuberance, in 8 it was bilateral and in 6 it was on the external occipital crest. Rest 23 solitary foramina were near the foramen magnum. Conclusion: The dura mater of the posterior cranial fossa is tightly adherent to the periosteum of the skull and cannot be stripped easily. Due to this reason, there might be a chance of massive intermittent bleeding from the bone or from the dura or from the dural sinus during the surgical procedures of the posterior cranial fossa which has to be taken care of. The knowledge of the presence, number, and location of occipital emissary foramina becomes very essential to avoid unexpected massive intracranial bleeding during neurosurgical procedures.

Background: Neurofibromatosis type-1 (NF-1) is an inherited neuro-ectodermal disorder primarily defined by the presence of six or more café‐au-lait macules, intertriginous freckles, two or more neurofibromas, plexiform neurofibroma, lisch nodules, bony defects like sphenoid dysplasia, and optic gliomas. Due to gross cosmetic disfigurement and multisystem involvement, it can have heavy psychological and physical burdens, especially in countries like India, wherein skin disease is significantly stigmatized. Aim: The aim of the study was to understand various clinical and epidemiological patterns and complications of NF-1. Material and methods: We conducted a cross-sectional study on 47 clinically diagnosed patients with NF-1 at a tertiary care center in Bihar to understand various presentations and life-threatening complications in patients with Neurofibromatosis type-1. A detailed history was taken regarding onset, symptoms, family history, and associated co-morbidities. A comprehensive cutaneous, ophthalmological, neurological, and psychiatric evaluation was done. Ophthalmological screening via slit-lamp examination was done in all patients. Magnetic resonance imaging (MRI) was done in patients having neurological complaints and findings were subsequently analyzed. Results: A total of 47 newly diagnosed patients were enrolled in the study out of which 36 (76.6%) were males and 11 (23.4%) were females. The majority of patients belonged to the 40 to 49 years age group (29.78%) followed by the 30 to 39 years age group (27.65%). The mean age of total patients was 31.68 ± 13 years ranging from seven years to sixty-eight years. A family history of NF1 was positive in 22 patients (46.8%), with six (12.76%) patients reporting consanguineous marriage of their parents. All the cases of NF-1 presented with one consistent finding, that is, the prerequisite number and size of café au lait macules. The next most common presenting lesions were cutaneous neurofibromas and axillary freckling present in 38 (80.8%) and 26(55.31%) patients respectively. Plexiform neurofibroma was present in twelve (25.5%) patients. Clinical severity was assessed by DNB (dermatological, neurological, and bone manifestations) classification of Japan and the majority of patients (38.29%) were classified as Stage 3 followed by Stage 4 (23.4%). The most common ocular finding was lisch nodules, present in 28 patients. The most common neurological abnormality present was cognitive dysfunction (12.7%) followed by seizures (4.2%). Conclusion: Neurofibromatosis type-1 is a life-long neurocutaneous disorder with an extremely unpredictable clinical course. Although the majority of patients have a benign course, there’s a small subset of patients who develop debilitating and life-threatening complications. To provide optimal care, treating physicians must be aware of its diverse presentations and rare complications, so as to prevent them at comparatively earlier stages and prevent chronic disabilities.

Background: Acute  pancreatitis  is  a  common  cause  of  acute  abdomen  in  pregnant  women Acute pancreatitis in pregnancy (APIP) is rare and occurs in  approximately 1 in 1000 to 1 in 4000  births. The most common symptom of acute pancreatitis is epigastric pain radiating to the back which is accompanied by nausea, vomiting and fever. Aims and objectives: The present study was done to evaluate the maternal and perinatal outcome of acute pancreatitis during pregnancy. Methods: The present study was hospital based retrospective observational study. A total of thirty-eight patients were admitted with acute pancreatitis complicating pregnancy between January 2020 to December 2020 in the department of Obstetrics and Gynaecology in IPGMER and SSKM Hospital, West Bengal, India and were followed up until after delivery. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: Incidence of acute pancreatitis in our study was 38 in 11,899. Maximum gestational age was 36 weeks i.e. 10 (26.3%) followed by 30 weeks 6 (15.8%). Among causes of acute pancreatitis Idiopathic was 12 (31.6%) followed by gallbladder stone 8 (21.1%), fatty lever and obesity were 4 (10.5%) each, trauma was 3 (7.9%). Raised S Amylase level was 33 (86.38%) and raised S Lipase level was 17 (44.7%), which is statistically significant. HELLP syndrome was present in 3 (7.9%) cases. In maternal complications Jaundice and loss off weight was observed in 5 (13.2%) cases each. Sepsis was present in 3 (7.9%) cases. Term deliveries were observed in 21 (55.2%) cases, miscarriage and still born was seen in 4 (10.5%) cases each. Babies delivered at 34 weeks, 36 weeks and IUFD was present in 2 (5.3%) cases each. Conclusion: The course of acute pancreatitis in pregnancy is usually mild and self-limiting. But, it can be rapidly progressive and fulminant with complications like electrolyte imbalance, ARDS and DIC. Most patients delivered preterm. Conservative management till delivery by multidisciplinary team lead to good maternal and perinatal outcome.

Background: The Covid pandemic has caused major disaster globally. It has been established, that the sinonasal-tract involvement plays a significant role in Covid-19 infection. Anosmia is one of the commonest symptoms of covid-19, ranging from 20-70%. But very few studies have shown the relationship between anosmia and Covid-19 related morbidity and mortality. The basic aim of this study is to describe the prevalence of anosmia in Covid-19 patients and the correlation of anosmia to the disease severity. Methodology:  This is a retrospective observational study. Patients >18 years of age with Covid disease (RTPCR proven), without any cardiac/respiratory comorbidities were included. The prevalence of anosmia, the incidence of hospitalizations, requirement of oxygen, disease severity and mortality were noted. The association of anosmia with the severity of covid-19 disease has been calculated and analyzed. Results: The prevalence of anosmia in hospitalized patients is 41.67%. Out of 112 covid patients with anosmia, 87 (77.68%) patients did not require hospitalization, but out of 98 patients without anosmia, 35 patients (35.71%) were hospitalised. 102(91.07%) patients with anosmia did not require any kind of oxygen support but 32 patients among 98 patients with no anosmia(32.65%) required oxygen support during the course of the disease. The mean of lowest recorded saturation in anosmic patients is 95.14 and the non-anosmic patients is 91.89. Among the anosmic patients 96 patients (85.71%) did not record the saturation below 94% in room air throughout the course of the disease. Contrary to that, in non-anosmic group 46 patients (46.94%) had a drop in saturation below 94 %. Conclusion: Presence of Anosmia is associated with improved outcome as evidenced by low hospitalization rates, less fall in Spo2 and less oxygen requirement during the course of the disease. So, anosmia can be used as a tool in future to predict the overall outcome in covid-19 disease.

Background: Sacralization of Fifth lumbar (L5) is a congenital abnormality in which the lumbar vertebra, specifically its transverse process, becomes fused or semi-fused with the sacrum, ilium, or both. This fusion can happen on either one or both sides of the body. The purpose of this study was to determine the prevalence of sacralisation of the transverse process of the fifth lumbar vertebrae. Methods: 40 adult human sacra were evaluated in the current study at the Department of Anatomy, Shree Shankaracharya Institute of Medical Sciences, Bhilai, C.G. Each sacra was examined for sacralisation and lumbarisation, the number of ventral and dorsal sacral foramen, the number of vertebral bodies, the sacral hiatus, and the sacral cornua. Results:In the present study out of forty sacral bones, there were 25 (62.5%) male sacral bones and 15 (37.5%) female sacral bones. Sacralization was found in 22.5% of cases. Among 9 sacralised bones, 66.67% were male bones and the remaining 33.33% were female bones. 6 bones showed bilateral sacralization and only 3 bones showed unilateral sacralization. Conclusion:Sacralisation knowledge is not only useful for orthopaedic surgeons, but also for Clinical Anatomists, Radiologists, Forensic specialists, Morphologists, Architects, and Anthropologists.

Background: Elderly in-patients are most usually affected by hyponatremia, a relatively prevalent electrolyte problem in clinical medicine [1-3]. It is recognised as occurring in 15–30% of hospitalised patients and is indicated by an s. Na+ level of less than 135 mEq/L. However, it has been noted that the occurrence rate in older people might reach 50% [3-5]. OBJECTIVES:

1. To classify severity of hyponatremia in hospitalized elderly and to correlate with outcome following treatment.

2. To study clinical feature and etiology of hyponatremia in elderly hospitalized patients.

Material & Methods: Study Design:  Hospital based prospective observational study. Study area: Department of General Medicine, Subbaiah Institute of Medical Sciences, Shivamogga. Study Period:  July 2022 – June 2023. Study population: Elderly patients (60 yrs and older) admitted in medical ICU Sample size: Study consisted a total of 100 subjects. Sampling Technique:   Simple Random sampling. All elderly patients admitted to medical ICU, 3-5 ml of venous blood was collected in a yellow top vaccutainer, and 5-10ml of urine (spontaneous void or catheter specimen) is collected in clean bottle. Routine blood and urine investigations as appropriate the diagnosis like, Complete blood count, renal function tests, electrolytes, liver function tests, urine routine, chest radiograph and other imaging studies as needed are done. When the electrolytes reports are available, patients are enrolled in the study if they are having serum sodium less than 125mmol/L and the plasma and urine sample are sent for measurement of serum osmolality and urine osmolality by freezing point depression osmometer. Serum electrolytes and urine spot Sodium are measured by ion sensitive electrode method. Results: Among the 80 patients who improved 50 were female and 30 were male. And among the 20 patients, who expired, 15 were male and 5 were female. This indicates that among the 45 male patients admitted 30 (66.67%) patients improved and 15 (33.33%) patients expired, and among 55 female patients 50 (90.91%) improved and 5 (9.09%) expired. Which shows though the severe hyponatremia is high among females the response to treatment and survival is better among females than compared to males (p=0.0026). Conclusion: Clinicians need to be aware about the common occurrence of hyponatremia in acutely sick elderly and early identification and adherence to standardized correction protocol is essential to avoid complications and to reduce mortality. Meticulous monitoring for dosing of multiple drugs in elderly population would help in preventing hyponatremia.

Coronary artery bypass grafting (CABG) is the most commonly performed procedure in most of the  cardiac centres. Patients with ischemic heart disease often suffer from other co-morbidities like  hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), chronic kidney disease  or cerebrovascular disease. Hence, optimising the patient pre-operatively is essential to decrease the  intra-operative risk factors and increase the chances of faster recovery in the post operative days. Based  on the associated co-morbidities, surgical and anaesthetic techniques have to be modified to suit  individual patient’s needs. Severe restrictive airway disease, pulmonary fibrosis and chronic pulmonary  infections will benefit with the use of high thoracic epidural anaesthesia (TEA) instead of endotracheal  general anesthesia which is the norm for any CABG procedure. In order to overcome post operative  lung complications and a possible ventilatory dependency in such cases, awake CABG is performed as  a suitable alternative to the conventional procedure.

Background: Papillary carcinoma of the thyroid(PTC) is the most common malignant thyroid carcinoma. Histological diagnosisof PTC is generally easy in majority of cases, because of its diagnostic clue that is presence of its characteristic nuclear feature. Due to its tumourheterogeneity, it is difficult to distinguish papillary carcinoma thyroid from thyroid papillary hyperplasia, solitary nodules with papillary transformation and follicular variant from other follicular thyroid lesions. As a result, immunohistochemistry(IHC) plays a supplementary role in the effort to resolve such dilemma. The study aims to evaluate the role of CK19 and CD 56 as supplementary diagnostic markers in diagnosis of papillary carcinoma thyroid. Methodology: Observational study was conducted by light microscopy and immunohistochemical examination of 150 thyroidectomy specimens at department of pathology studied in teritiary care hospital over a period of 2years Oct 2019 to Sept 2021. Results: Out of the 150 patients, 138(92%) were females and 12(8%) were males. In present study, majority of the thyroid lesions occurred between the age groups 31-40 years (31.33%) followed by 41-50 years (26%). 30 cases are subjected for CK19 and CD56 IHC.  CK 19 staining reveals strong positive expression in 9 cases,which include Classic variant of PTC(2cases),follicular variant of PTC(3cases),undifferentiated thyroid carcinoma(1 case) and multinodular goitre with suspicious papillary carcinoma like areas(2 cases).Lack of CD56 expression (negative) is seen in 10 cases. out of which 8 cases of malignant thyroid lesions - PTC- classic variant(2cases), PTC-follicular variant(3cases), multinodular goiter with microcarcinoma (2cases), undifferentiated thyroid carcinoma(1case) show negative CD56 expression.Conclusion: Classical papillary thyroid carcinoma has typical features on histopathology and does not need any additional Immunohistochemistry markers.  IHC helps to differentiate PTC and its variants from other mimicking thyroid lesions to sub classify them accurately.

Background: This study was conducted to evaluate the diagnostic accuracy of transabdominal ultrasound in preoperative staging of carcinoma of the stomach with postoperative histopathological findings, which is the reference standard. Methods: This was a hospital-based cross-sectional study conducted among 70 patients with endoscopic biopsy proven carcinoma stomach cases, referred to the department of Radio diagnosis at the Government Medical College Hospital, Thrissur, over a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: No T1 cases were detected in this study. The sensitivity for T2, T3 and T4 stages was 92%, 91.7% and 37.5% respectively. Specificity for T2, T3 and T4 stages was 91%, 79.4% and 100% respectively. The sensitivity for N1, N2 and N3 stages was 76.9%, 94.3% and 59.1% respectively. Specificity for N1, N2 and N3 stages was 98.2%, 74.3% and 100% respectively. Cases with metastasis were not included in this study as HPR was unavailable. Conclusion: Transabdominal ultrasound is accurate in the preoperative T staging of carcinoma of the stomach in advanced cases. In this study, the sensitivity for T4 was lower compared to T2 and T3 because most of the cases underwent only palliative procedures and hence were excluded from this study. On the other hand, sensitivity for N3 is lower compared to N1 and N2 because of the limited acoustic window; however, it has high specificity.

Background: Alpha-2-adrenergic agonists have synergistic action on local anesthetics used in spinal anaesthesia. The objectives of this study was to compare the efficacy of intravenous dexmedetomidine with clonidine and placebo on sensory and motor blockade duration, and analgesia duration in patients undergoing lower limb surgeries under bupivacaine spinal anaesthesia. Methodology: A total of 90 ASA physical status 1 and 2 patients undergoing lower limb surgeries under spinal anaesthesia were randomized into three groups of 30 each in this prospective randomized controlled study. Group N (placebo group) received 10 ml of intravenous normal saline, group C (clonidine group) received 1μg/kg intravenous clonidine, whereas group D (dexmedetomidine group) received 0.5μg/kg of intravenous dexmedetomidine, all given 10min after administration of spinal anaesthesia with 15mg of 0.5% hyperbaric bupivacaine. Onset time and regression of sensory and motor blockade and duration of analgesia were recorded. Data was analyzed using analysis of variance or Chi-square test, with value of p<0.05 considered statistically significant. Result: Onset of sensory and motor blocks were similar across the groups, p>0.05. Duration of sensory and motor blocks were longer in dexmedetomidine group (295.7 + 37.3min and 307 + 29min), than clonidine group (187 + 13min and 229 + 31min) or placebo group (123 + 16.4min and 168 +20min), p<0.05. Duration to first postoperative rescue analgesia was longer in dexmedetomidine group (336.3 + 29.3min) as compared to clonidine (252.7 + 33.4min) and placebo(183.7 + 15.2min), p<0.05. Hypotension was significantly more in group D and group C as compared to group N, whereas other side effects were not significant and comparable among the groups.  Conclusion: Intravenous dexmedetomidine is superior to intravenous clonidine as an adjuvant to bupivacaine spinal anaesthesia for lower limb surgeries to prolong duration of sensory and motor blockade and duration of analgesia with similar side effects.

Background: This study was conducted to evaluate and compare the effects of bupivacaine 0.5% and levobupivacaine 0.5%, ropivacaine 0.5% in subarachnoid block for elective lower abdominal surgeries with regard to onset and duration of sensory blockade, onset and duration of motor blockade, maximum height of sensory block, time for two segment regression from the highest sensory level and duration of analgesia. Methods: This was a randomized controlled trial carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, conducted among three groups of 40 subjects each from December 2015 to September 2017. Results: It was found that bupivacaine has a faster onset of action and a longer duration of action, with intense motor block associated with a small amount of hypotension. Levobupivacaine did not have any complications and had similar characteristics like that of bupivacaine except for a slightly slower onset of action and a less intense motor blockade. Though ropivacaine has a slower set of actions, less intensity of motor blockade compared to bupivacaine, it has a shorter duration of action for both sensory and motor blocks, which is more beneficial in day-care procedures without much complications. In our study, bupivacaine, levobupivacaine and ropivacaine showed excellent surgical block, resulting in sensory block that ensures the patient’s wellbeing, while motor block facilitated the surgeon’s work.  Conclusion: Levobupivacaine and ropivacaine can be used in parallel to bupivacaine for elective lower abdominal surgeries.

Introduction: Bacterial infections are one of the most devastating complications in the field of orthopaedicsurgery.Increasing incidence of open fractures leading to higher infection rates. Infection control can be achieved by meticulous surgical debridement and microbial specific antibiotic administration. Local antibiotic delivery is a way to deliver high concentration of drug locally even to avascular areas that are inaccessible by systemic antibiotics. AIM:The present study was designed to evaluate clinical outcome of orthopaedic infections which are managed by local antibiotic delivery system. Material and methods:This is a prospective study, for a period of 16 months, carried out in 32 patients posted for surgical debridement for bone & joint infections.  For evaluation of outcome we used Asepsis wound score, radiological, hematological and microbiological investigations. Results: In the 32 patients analyzed, 21.8%  were in age group of 18-30 years ,of which 71.4% had satisfactory outcome. 50 % were in age group of 30-50, of which 81.25% had satisfactory outcome and 28% were > 50 years , of which only 44% had satisfactory outcome. Overall infection was controlled satisfactorily in 68.75 % of patients by usinglocal antibiotic delivery system. In our study most common organism isolated was MRSA (37.5%), Followed by MSSA (31.25%). Conclusion: Systemic antibiotic therapy may not provide a minimum inhibitory concentration for prolonged period and which is further worsened due to decreased blood supply, secondary  to scarring. By using local antibiotic delivery system ,we can control infection effectively by delivering high concentration of drug locally. And also, this system decreases the risk of complications due to systemic antibiotics such as end organ failure and GIT side effects.

The cranio-vertebral junction (CVJ) is a complex transition region between base of skull and upper cervical spine. This study aimed to evaluate clinical features, radiological findings and various causes of CVJ disorders. It was a hospital-based prospective observational study from November 2021 to November 2022 in the Department of Radiology, RIMS, Ranchi, a tertiary care hospital of Jharkhand, India. A total of 62 cases were studied. Cranio-vertebral junction anomalies are more common in males than females with a ratio of approximately 1.7:1. Second and third decades are most common ages of presentation making up 19 cases in our study. 16 patients were above the age of 60 years. Most common presenting symptom was neck pain which 26 patients were having as their predominant complaint followed by limb weakness. Developmental anomalies were most common accounting for 51% followed by traumatic (15%) and then degenerative (13.33%). History of trauma was present in 15 patients of which 6 had developmental anomalies which were precipitated by trauma and 9 had history of pure trauma without any underlying developmental anomaly. Atlato-axial dislocation (AAD) was the most common CVJ anomaly seen in almost 60% of patients followed by basilar invagination seen in 36.66%. Os odontoideum is more common in males than females. In all 4 patients of CVJ tuberculosis, one had history of active pulmonary tuberculosis while in rest three there  was past history of pulmonary tuberculosis. Rheumatoid arthritis was present in all patients for a duration of more than 5 yrs. AAD was found in all whereas basilar invagination was seen in 2 patients. Radiographs of the cervical spine should be performed 2 years after diagnosis of  Rhematoid arthritis(RA) and periodically thereafter. Degenerative changes affecting the cervical spine may mimic CVJ anomalies

Background: Cervical cerclage reduces the risk of preterm birth in women at high‐risk of preterm birth and probably reduces risk of perinatal deaths.  Objectives: To study obstetric and neonatal  outcomes in antenatal patients with transvaginal cervical cerclage. Methods:  This is an ambidirectional cohort study conducted in Government Medical college, Thrissur for  2 years  on 42 antenatal women who underwent transvaginal  cervical cerclage,. After written informed consent, data was collected using a semi structured questionnaire at first visit or at time of cerclage and followed up until removal and delivery, all antepartum,intrapartum and neonatal events until discharge were listed. Results: Cervical cerclage in total had a fetalsalvage rate of 73.8%.Elective cerclage had 95.3% take home  baby rate, while emergency cerclage  had only 50% fetal salvage  rate.Comparing Mc Donald and Modified Shirodkar technique, though the latter is associated with more  prolongation of gestational age, the difference was not statistically significant. Cerclage was not found to have any maternal complications in this study. Conclusion: Overall cervical cerclage in indicated cases offers good obstetric outcomes in terms of mean prolongation of gestational age at delivery and improved take home baby rates. It is advisable to screen pregnancies at risk of cervical insufficiency and to offer elective cerclage as it gives better results when compared to emergency cerclage.

Introduction: Self-directed learning (SDL) is the practice of learning on one's own initiative and is characterised by the learner's main ownership of the planning, carrying out, and evaluation of the endeavour. To assess whether undergraduate medical students at North Bengal Medical College in Darjeeling district, West Bengal, are ready for self-directed learning, and because medical professionals need to be self-directed learners to maintain lifelong learning in the field of medicine. Methods: This descriptive epidemiological study with cross sectional design was conducted in North Bengal Medical College, located in Siliguri, Darjeeling district. Total 300 undergraduate medical students of North Bengal Medical College from 1st prof to final prof were included in the study after getting consent to participate in the study. The duration of the study was 6 months (August 2019- January 2020). The data was tabulated in Microsoft Excel software and analysed with SPSS V.20    software. Results: In the present study male were 192 (64%) and female were 108 (36%). Total day scholars were 55 (18.3%) and hostellers were 245 (81.7%). Median SDLRS score was 140.63. The mean sores in the three domains of self-management, desire for learning and self- control were 42.76±6.236, 44.67±6.257, and 52.52±7.563 respectively. Females scored higher in all three domains than males. Day scholars scored higher in all the three domains (self- management, desire for self-learning, self-control) when compared with Hostellers. Conclusions: There is need to modify medical education innovation programmes, such as problem-based learning and to emphasize more on self-directed learning rather than on traditional teacher centered learning.

Eisenmenger Syndrome is a rare constellation of symptoms due to untreated congenital heart disease with right to left shunt and increased pulmonary arterial hypertension. A female of 58 years old came to ER with respiratory failure and upon evaluation found to have Eisenmenger syndrome. Intensive work up concluded in medical management with patient. Eisenmenger syndrome patients’ need to be closely monitored once diagnosed owing to decreased life expectancy.

Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations  in cardiovascular physiology. Present study was designed to follow up  gradual adaptations in cardiovascular  hemodynamics  during the course of pregnancy using Doppler  echocardiography which is reproducible and noninvasive technique Method: In present  prospective study of 120 women, were divided into 2 groups of 60 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester).  They were  non invasively  analysed for cardiovascular function and systemic hemodynamics using  echocardiography  and compared  with control group. The data was  analysed using ANOVA for comparison within the group and student’s t- test  for comparison between the groups. ‘p’- value < 0.05 was considered to be significant. Results:  Mean age and height  in control and study  groups  were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with  peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05). Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II  trimesters and then  increased in III  trimester. The difference in DBP between control group and I , II  trimesters of pregnancy was  significant (p<0.05). Systemic vascular resistance progressively  decreased  with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily  increased in all trimesters of pregnancy with peak at 36 weeks  and was statistically significant (p<0.05). It was due to increase in  both heart rate and Stroke volume. Ejection fraction also increased in all trimesters .Conclusions: Present  study shows  significant  functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be  introduced into the antenatal management protocol, which will help to identify women at high risk to developing  cardiovascular complications and there by  early intervention.

Background:  In this study, our objective is to investigate the predictive factors influencing the anatomical and functional success of macular hole surgery in the Kashmir population. By analyzing a cohort of patients who underwent macular hole surgery, we aim to explore the preoperative characteristics, surgical techniques employed, and postoperative outcomes that contribute to the success rates in this specific population. Methods: This retrospective observational study was conducted at the Department of Ophthalmology, GMC Srinagar over a period of one year. A total of 70 patients, ranging in age from 45 to 76 years, were included in the analysis. We reviewed their preoperative characteristics, surgical techniques utilized, and postoperative outcomes. Results: Our findings revealed a prominent age group between 51-60 years, comprising 44.3% of the sample, followed by individuals aged 61-70 years, accounting for 31.4% of the cohort. Notably, female patients exhibited a higher representation, constituting 61.4% of the total sample. The duration of symptoms varied widely, ranging from 1 to 15 months, with the majority of patients (67.1%) reporting symptom duration of 1-6 months. Anatomically, Type 1 closure predominated, with an overwhelming majority of cases at 85.7%. Significantly, despite the absence of notable age and gender differences between the Type 1 and Type 2 closures, substantial variations were observed in critical parameters such as hole height, hole form factor (HFF), macular hole index (MHI), tractional hole index (THI), and postoperative best-corrected visual acuity (BCVA) between the two closure types. Conclusion: Our study highlights the utmost importance of a comprehensive evaluation that takes into account age, gender, and anatomical characteristics when assessing macular hole patients. These findings provide crucial insights for refining treatment strategies and tailoring interventions to optimize surgical outcomes in this specific population.

Introduction: With the rising mortality rate, worldwide liver cirrhosis has been ranked as the 13th leading cause of mortality. Portal hypertension is one of the common consequences of liver cirrhosis. Further, portal hypertension has its own complications and the most serious among them is the risk of development of esophageal varices (EV) caused by increased hepatic vascular resistance related to hepatic fibrosis and regenerative nodules. Methodology: A prospective study was carried out at the tertiary care hospital of, MKCG Hospital between September 2019 To November 2021. All patients of cirrhosis of liver without history of gastrointestinal bleed, irrespective of etiology, admitted in the hospital were included in this prospective study. Result: Among the patients studied males predominate the study population with 86% with females accounting for only 14%. Among the study population majority presented with abdominal distension constituting 86% followed by pedal oedema constituting 70%. Among 50 patients studied, cause of cirrhosis was found to be alcoholism in 78% and Non-alcoholic in 22%. Discussion: The platelet count and the spleen size showed the difference among the patients belonging to small varices and larger varices group, respectively. presence of thrombocytopenia and lower PC/SD ratio determine the presence of higher grades of varices and can hence identify the subset of patients who require high priority endoscopy for the prophylactic management of esophageal varices helping in better patient selection.

Background: Acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances. Some of the signs and symptoms can be subtle to both clinician and the patient. also may not present in all instances. Arriving at the correct diagnosis is essential, however, a delay may allow progression to perforation and significantly increases morbidity and mortality. Incorrectly diagnosing a patient with appendicitis although not catastrophic, often subject the patient to an unnecessary operation. It has been claimed that diagnostic aids can dramatically reduce the number of appendectomies' in patients without appendicitis, the number of perforations, and the time spent in hospital. The methods advocated includes laparoscopy, scoring system, computer programs, ultrasonography, computed tomography and magnetic resonance imaging. Aims: To compare the diagnostic accuracy of RIPASA and MODIFIED ALVARADO SCORING SYSTEM in the diagnosis of acute appendicitis. Materials and Methods: We compared prospectively Ripasa and Modified Alvarado Scoring Systemby applyingb them to 94 patients. Bpth scores were calculated for patients who presented with right illiac fossa pain during the study period Depending of radiological evidence, appendicectomy was done. Post-operative hiztopathology report was correlated with the scores. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Modified Alvarado Scoring system. The diagnostic accuracy of both the scoring system are compared. Results:-The RIPASA scoring system accurately diagnose 97.8% patients of high probability group (score greater than 7.5), whereas Modified Alvarado Scoring System accurately diagnose 91.4% patients of high probability group(score greater than 7). Conclusion:- RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population then Modified Alvarado Scoring System.

Introduction: The nephrotic syndrome is one of the best known clinical presentations of adult or pediatric nephropathy. Nephrotic syndrome is characterized by the association of heavy proteinuria with pedal edema, hypoalbuminemia, and hypercholesterolemia. Aims: To compare and correlate bone mineral density with biochemical parameters like serum calcium, phosphorus, vitamin-D, alkaline phosphatase, albumin and parathyroid hormone, in adults with nephrotic syndrome. Methodology: The study was Cross sectional observational study. The conducted in adult patients with nephrotic syndrome above 18 years of age with no primary bone pathology or metastatic disease. Biochemical parameters were assessed and correlated with bone mineral density by DXA scan of lumbar spine and neck of femur. Fifty patients of command hospital Kolkata (EC) were selected and compared with equal number of age and sex matched controls. All patients were selected from a period of 01 Jan 18 to 31 May 19. All underwent detailed clinical examination and investigations were done at the time of recruitment. Results: DXA scan results in cases of nephrotic syndrome show significantly low BMD for both lumbar spine and neck of femur with mean Z-scores less than -1.0 (P<0.001). Lumbar spine (L1-L4): Low BMD was found in 88 percent cases and 32 percent of controls (P < 0.001). Neck of femur: Low BMD was found in 44 percent cases and 10 percent controls (P<0.001). Cases with normal BMD had statistically significant lower levels of blood urea with mean 23 ± 4.53 mg/dl. Cases with osteopenia and osteoporosis had higher levels of blood urea with mean 54.13 ± 32.4 mg/dl and 66.85 ± 29.64 mg/dl respectively. Cases with normal BMD had higher levels of serum calcium with mean 7.67 ± 1.01 mg/dl. Cases with osteopenia and osteoporosis had serum calcium with mean 7.22 ± 0.88mg/dl and 7.26 ± 0.68 mg/dl respectively. However this comparison did not reach any statistical significance. Conclusion: Adults with nephrotic syndrome are at risk for low bone mineral density. These patients should undergo regular evaluations for mineral bone diseases and appropriate therapeutic interventions should be planned.

Introduction: Regional anaesthesia is the method chosen for surgeries involving the lower abdomen and lower limb in children. It provides a good alternative to general anaesthesia. This technique is safe and cost effective in day care surgeries.  Aims: The aim of this study is to evaluate the efficacy of Ropivacaine and Bupivacaine in spinal anaesthesia in children posted for infraumblical surgeries. Materials and Methods: The present study was a prospective randomized study. This Study was conducted January 2022 to December 2022 at department of Anesthesiology, Iqcty medical College nd hospital, Durgapur. Total 30 patients were included in this study. Result: Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block. Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block. Conclusion: Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block.

Introduction: Bupivacaine and ropivacaine have identical PKA values, however ropivacaine is less fat soluble, implying that ropivacaine will block A-alpha fibers more slowly than bupivacaine. Isobaric solution has the extra benefit of not affecting the intrathecal dissemination of local anaesthetic during and after injection. The purpose of this study was to compare the anaesthetic efficacy of intrathecal isobaric ropivacaine 0.5% to isobaric bupivacaine 0.5% in lower abdominal procedures in terms of: 1. Onset and duration of sensory block, 2. Onset, quality, and duration of motor block, and 3. Hemodynamic alterations. Material and Methods: The present study was a Prospective randomized comparative Study. This Study was conducted January 2021 to December 2022 at department of Anesthesiology, Iqcty medical College nd hospital, Durgapur. Total 100 patients were included in this study. Results: Intrathecal isobaric 0.5% ropivacaine causes a delayed onset but identical length of sensory block and a statistically significant shorter duration of motor block. Both groups have identical haemodynamics and block height (highest sensory level). Conclusion: Because of the shorter length of motor blockade and comparable duration of sensory blockade, haemodynamics, and blockade height, 0.5% isobaric ropivacaine is a superior choice for ambulatory anaesthesia.

Background: The standard cardioplegia solution for adult cardiac surgery, Saint Thomas Hospital solution, has been used for a long time. However, the prolonged cardiac arrest period offered by delNido cardioplegia has generated significant interest. This study aims to compare outcomes and variables in isolated valvular heart surgery using delNido and Saint Thomas cardioplegia solutions. Methods: This randomized controlled study was conducted in the Department of Cardiothoracic and Vascular Surgery at IGMC&H, Shimla, Himachal Pradesh. Patients requiring heart valve surgery between November 2017 and December 2018 were included. Randomization was computer-generated, and allocation concealment was achieved using opaque sequentially numbered sealed envelopes. Appropriate statistical tests were used to assess associations between variables. Results: The study included 25 patients in each group. Group 1 (control) used Saint Thomas solution, while Group 2 (intervention) used delNido solution. Baseline parameters were similar between the groups. CPB and ACC times were slightly lower in the delNido group (114.48±37.73, 83.56±24.71) compared to the Saint Thomas group (132.64±37.73, 89.20±41.02), but the difference was not statistically significant. Cardioplegia volume was significantly lower in the delNido group. The delNido group required fewer inotropes, had a shorter ICU stay, fewer blood transfusions, and fewer defibrillations post aortic clamp removal, but these differences were not statistically significant. Mean duration of ventilation was higher in the delNido group, but not statistically significant. The delNido group had a significantly lower percentage of patients requiring defibrillation. Cardiac output values showed a significant difference at 72 hours post CPB, with a slight decrease in the delNido group. The interaction and main effect for CKMB levels were not statistically significant, but there was a significant main effect for CKMB values at 24 hours post CPB. Conclusion: Intraoperative and postoperative safety profiles of delNidocardioplegia were found to be similar to those of Saint Thomas cardioplegia in adult MVR/AVR± TV repair procedures.

Background: Coronary artery disease(CAD) is a leading cause of morbidity and mortality in India. We have done this work to study prevalence of symptomatic and asymptomatic PVD in CAD patients undergoing CABG and to study whether low ankle brachial pressure index (ABPI) can be used as predictor of morbidity and mortality in CABG. Methods: Descriptive study was done enrolling continuous 80 patients who were referred for coronary artery bypass grafting. On bases of ABPI they were divided into 2 groups, group I included patients of CAD with PAD and group II included patients of CAD without PVD. Syntax score was calculated. Cardiovascular risk factors, intraoperative mortality and myocardial infarction, postoperative complications were studied.  Study was performed from March 2013 up to December 2014. Results:  88.75% of patients were males and 11.25% patients were females. Mean age was 55.94±8.42. Smoking and hypertension encountered in 85% and 45.6% of all patients respectively. BMI of >30 was present in 8.75% patients. 36% patients of group I and 35 % patients of group were diabetic. Left anterior descending artery was most commonly involved vessel in 97%. Deranged RFT's were found in 29% and 8% patients in group I and II respectively.  Conclusion: ABPI can be useful in assessing both the atherosclerotic risk factors and the degree of coronary involvement.  ABPI is a simple and easy tool to diagnose symptomatic and asymptomatic PVD.

Introduction: Biliary atresia is a rare disease characterized by an obstructive cholangiopathy of intrahepatic and/or extrahepatic bile ducts. Etiology is unknown. The reported two-year survival rate without any intervention is less than 5%. Early intervention is an important predictive factor for successful patient outcome. Aims: The goal of the present study is to examine the clinical use of serum gamma glutamyl transferase (GGT) for early diagnosis and prognostication in biliary atresia following Kasai Hepatoportoenterostomy (KHPE). Materials and methods: This is a retrospective study which was conducted at a large tertiary care pediatric referral center. A total of eighty cases were reviewed from March 2020 to April 2022. The GGT levels were obtained pre-operatively. Baseline parameters like age at surgery, outcome and prognosis were evaluated. Results: 80 infants underwent Kasai Hepatoportoenterostomy. The age of the infants ranged from 31days to 116 days (median age of 62 days). Out of all the cases, 60% (48/80) had GGT value of <400 IU/L, 40% (32/80) had GGT value of >400IU/L. Low GGT(<400IU/L) group had shorter time to liver transplant and a poorer outcome. Conclusions: A low GGT level in biliary atresia might be associated with early onset of severe liver illness, and poor postoperative course after Kasai Hepatoportoenterostomy. Recent advances in non-invasive test like GGT has shown promise as an effective diagnostic and prognostic marker in biliary atresia.

Background: The management strategy of patients with significant intraoperative high pRV/LV ratio in Tetralogy of Fallot with PS remains a considerable debate. The traditional thinking is that an intraoperative pRV/LV in excess of 0.70 is not acceptable and revision of RVOT repair with TAP is advised -as post op RVOTO is undesirable and not well tolerated. Postoperative pulmonary insufficiency is well tolerated and that only very significant RV dilation is problematic is also a debatable concept. In the current era with evolving concepts, efforts are made to avoid ventriculotomy and or TAP in order to preserve biventricular function. Preserving pulmonary valve integrity offers a better long-term prognosis, despite a risk of residual stenosis. Objectives: We sought to analyse the need for revision of RVOT repair (Dynamic / Fixed RVOTO), early survival and perioperative complications, and morphologic risk factors to determine their effects on outcomes in patients with significant intraoperative high pRV/LV pressure ratio. Methods: ToF with pulmonary stenosis operated between October 2013 to December 2015 with high pRV/LV ratio intraoperatively >/=0.70 were chosen for the study. Results: Out of a total of 178 patients of TOF with PS, 62 patients had pRv/Lv>/= 0.70. Mean pRv/Lv was 0.82 with 4 patients having ratio >1. 6 patients underwent re RVOT resection and post revision pRv/Lv was mean 0.60. 16 patients continued to have high pRv/Lv and unstable hemodynamics. Revision surgery was performed with Trans annular patch insertion. 40 patients did not undergo revision and high ratio was accepted. Mean RvOT gradient of these patients intra op was 48.2+/-12.6. The mean RVOT gradient showed significant decrease at 12 hour and 24 hour post surgery interval. Mean RVOT gradient at 12 hours post surgery was 34 .6 +/- 8.2 and 23.5 +/-6.3 at 24 hours after surgery in patients who didn’t undergo TAP. So 40 patients did not undergo revision and high ratio was accepted. 65 % of such patients could be managed with RA / RA-PA approach without performing a Trans annular patch. Conclusions: Pulmonary valve annulus sparing procedure in ToF with PS patients with pRV / LV ratio >/= 0.70 can be accepted with less morbidity and mortality if Pulmonary annulus > -2, tricuspid Pulmonary valve, RVOT resection is adequate, RVEDP is not high, less ionotropic support and no residual lesions. It may be due to Dynamic RVOTO.

Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period.  Results:  APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S).    Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S).  Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester.  PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:

Introduction: Bone lesions may present a diagnostic challenge to the histopathologists. Proper evaluation requires correlation of age, clinical presentation, site and imaging. In this study we aimed to evaluate the osteolytic lesions of the bone reported at the department of pathology in a tertiary care hospital. Material and Methods: We performed a retrospective study over a period of 5 years from 2018 to 2023. Osteosclerotic lesions were excluded from our study. The lesions were classified as non-neoplastic lesions, tumour like lesions, benign lesions and malignant lesions. Results: Over 5 years, 100 cases of osteolytic lesions of bone were reported. Of these, 37% were non-neoplastic lesions. The most common sites of osteolytic lesions were the femur, tibia and humerus. The most frequent histological diagnosis was giant cell tumour followed by chronic osteomyelitis and osteosarcoma. The most common benign neoplasm was giant cell tumour, and osteosarcoma was the predominant malignant lesion. Conclusion: Benign neoplasms are the most common osteolytic lesions. Bones of the extremities are the most frequent sites of involvement by both benign and malignant tumours. In addition to radiological correlation, a thorough knowledge of the age, sex and site of the common bone lesions were required for a correct histopathological diagnosis, so that proper treatment can be instituted. Most of these lesions do not require IHC for the diagnosis.

Background:  To identify the different unidentified causes of chronic stomach pain. To evaluate the diagnostic laparoscopy's efficacy in cases of persistent abdominal pain. To assess the effectiveness of laparoscopy in the treatment of persistent abdominal pain. Method: This prospective descriptive cross-sectional study enrolled 40 consecutive chronic abdominal pain patients between May 2022 to April 2022. They were chosen from the Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India, general surgery outpatients for the research. Result: Appendicectomy 30%, adhesiolysis 20%, and hernioplasty 10% were performed in 54% of patients. 18% of patients exhibited enlarged mesenteric nodes in the terminal ileum that were biopsied and revealed nonspecific adenitis. Study found 8% of patients with negative laparoscopy. Conclusion: Diagnostic laparoscopy is beneficial in chronic stomach pain, revealing underlying problems. Chronic abdominal discomfort sufferers benefit from diagnostic laparoscopy. After a full diagnostic evaluation, it should be considered. Diagnostic laparoscopy can treat several problems surgically. It is safe and useful for diagnosing chronic stomach discomfort and guiding treatment.

Background: Cardiomyopathies are conditions that affect the heart muscle and can be caused by genetic flaws, damage to the heart's myocytes, or infiltration of myocardial tissues. The most prevalent phenotype and frequently the last common pathway of many cardiac injuries is dilated cardiomyopathy. In the lack of echocardiography, histology, and genetic testing, it is mostly unknown. Material and Methods:  This was an analytical cross-sectional study of hospital data on Echocardiographic findings in 60 DCM patients who visited the cardiology unit for Echocardiographic evaluation between the May 2022 to April 2023 in Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India. Patients under the age of 18 and those who refused to give consent were excluded. Results: Among the 60 patients enrolled, 40 were male and 20 were female, resulting in a male to female ratio of 1.6:1. Elderly persons (61-75 years old) with an average age of 60 were frequently involved, and the majority of them had congestive heart failure, 32. An echocardiogram revealed that 28 had a slightly dilated Left Ventricle. With an average Ejection fraction of 39.6%, the majority showed impaired Left Ventricular Systolic Function. There was no significant difference in average EF% between male and female, and there was no significant relationship between age and average EF%. Conclusion: The most prevalent cardiomyopathy phenotype is dilated cardiomyopathy, which is characterized by congestive heart failure. It is frequently misdiagnosed in our part of the world, but echocardiography can easily detect it.

Introduction: Airway management is a basic aspect of anesthesia practice and critical care medicine. The relationship between airway indices and BMI mostly seen in terms of obesity, there is also conflicting evidence regarding this. So this study will try to resolve the disagreement in result associating obesity with difficult airway and also envisage the broader aspect by finding association between BMI and airway indices. Material and Methods:Two hundred adult participants aged between 20 to 55 yrs. of age of both sexes going through pre-anaesthtic check-up (PAC) for variety of surgeries at MIMS, Barabanki, were enrolled in this quantitative prospective observational study after meeting inclusion and exclusion criteria.Consecutive sampling method was used and sample size calculated using Taro-Yamane formula.During the PAC, data regarding various parameters such as demographic detail, BMI and airway indices were collected. BMI, Age and Sex were the independent variables and all airway indiceswere the dependent variables. The data collected for the study was continuous and categorical.Subsequently data was coded. The BMI and airway association was analyzed by using STATA version 12. Continuous data were presented as mean ± SD and ordered data were presented as percentage and analyzed by ordered logistic regression (‘p’ value, ‘z’ value and co-efficient). Results: The mean of age, height, TMD, HMD and SMD were comparable in all the four BMI categories. The mean of weight, BMI, NC and HLM were increasing from underweight to obese. BMI association with NC,MPG, HLM, WSand H and N movementwere statistically significant and having ‘p’ value = 0.000 (for all indices) and ‘z’ value = 9.94,8.18, 7.53, 6.29 and 6.2respectively. BMI weakly associated with SM, SMD and ULBT. BMI association with IIG, TMD and HMD were statistically not significant and having ‘p’ value > 0.05 (for all indices). All airway indices have positive co-efficient except SMD, which have negative co-efficient. Conclusion: The findings confirm that there were association between BMI with NC,MPG, HLM, WS and H and N movementat p value = 0.000 which is significant and z value > 6 and hence corroborates that difficult airway could be anticipated with these variables. Among all individual airway indicators Neck circumference was strongly associated with BMI followed by MPG.

Background: Hemophilia is a hereditary X-linked recessive disorder that occurs due to either deficiency or absence of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B). Hemophilia A is the commonest and is more likely to cause severe bleeding which occurs repetitively. These occult and apparent bleeding can predispose these patients to iron deficiency and iron deficiency anemia. These patients suffer from frequent joint bleeds which results iniron accumulation in the synovium of their joints and causes local inflammatory changes. Aim and objectives: This study aims to assess the frequency of iron deficiency and iron deficiency anemia among pediatric patients with hemophilia A. The frequency has also been correlated with severity of hemophilia A in these patients, severity being classified on the basis of factor level as mild (6-40%), moderate (1-5%) and severe (<1%). Material and methods: This is a cross-sectional study conducted for six months from January 2023 to June 2023 at our centre on 130 patients of hemophilia A. Data including demographic profile, complete blood counts and serum ferritin were collected and analysed. The correlation of serum ferritin with the disease severity was established. Results: Outof 130patients with hemophilia A all were male. Of these, 11% were cases of mild, 23% were cases of moderate and 66% were cases of severe hemophilia A. 53.84% patients had hemoglobin <11g% and 46.16% patients had hemoglobin ≥11g%. Out of 130 patients, there were 32 (24.6%) patients with serum ferritin <7ng/ml but Hb above 11g%, meaning they had iron deficiency (ID). While, 70 (53.84%) patients had low serum ferritin with low Hb, meaning they had iron deficiency anemia (IDA). 28 (21.56%) patients had normal Hb and serum ferritin levels. Conclusion:  Iron deficiency and iron deficiency anemia are usual problems among hemophilia patients and their frequency increases with the disease severity.

Aim: This study aims to assess clinical and microbiological profile of diabetic foot patients. Material & Methods: We conducted descriptive type of study on patients with type 2 Diabetes mellitus of duration more than 10 years having diabetic foot infections, visiting OPD/IPD of SGRD hospital, Vallah, Sri Amritsar from April 2021 to July 2022. All the patients were assessed through detailed history, comprising of clinical features of diabetes, its duration, risk factors associated with it, detailed foot examination. Diabetic foot ulcer was classified according to University of Texas foot ulcer classification and microbiological profile was studied. Results: We recruited 100 patients, out of which71 % were males and 29 % constituted female population. Predominant symptom with which the patients presented was foot ulcer(88%) but the  less frequent symptom was gangrene (12%). As per University Of Texas Foot Ulcer Classification, 45% patients were in grade 3D followed  by 24% in grade 2B & only 1 % in grade 3C. Out of 100 patients, 46% swab culture showed growth of organism whereas 54% patients swab culture were sterile. The most commonly cultured organismis E.coli. On antimicrobial culture susceptibility, all Gram-positive organisms were sensitive to Linezolid and resistant to Erythromycin. All gram negative organisms were sensitive to Gentamicin except Pseudomonas which was  sensitive to Tigecycline only. Among gram negative organisms, only E.aerogenes, E.coli, Klebsiella and M.morganii shows resistance to ciprofloxacin. Conclusion: Poor control of Diabetes Milletus puts a patient at higher risk of skininfections as being in a state of hyperglycaemia impairs the efficiency of the body’s immune or defence mechanism. . Poor healing status is a major cause of lower extremity amputations in diabetics. Early microbiological diagnosisand accurate treatment can decrease morbidity significantly.

Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period.  Results:  APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S).    Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S).  Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester.  PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:

Background: Immunohistochemistry is the definitive diagnosis in cases where a definite diagnosis cannot be made morphologically and histologically. IHC helps classify tumors. It also helps to solve the diagnosis problem of benign and malignant tumors. Material And Methods:  We studied 100 different ovarian epithelial tumors over a 2 year period. Three immune markers were included in the study. Result: Out of 100 case 70% are benign and 30%  aremalignant.Serous cystadenoma was most common benign lesion(60%)& among malignant lesions Serous cystadenocarcinoma was most common(60%).83.33% cases of serous carcinoma showed positivity for CK7 & 100% negativity for CK20 & CEA Conclusion: IHC helps to classify and confirm the histological diagnosis. IHC is particularly useful in solving the diagnostic problem of ovarian cancer and is poorly differentiated.

Background: Preoperative prediction of risk factors helps in assessing the intraoperative difficulties. Various scoring systems are available to predict the intraoperative difficulties in laparoscopic cholecystectomy. However, there is the need to find a consistent and reliable scoring and predictive system. The present study was undertaken to assess preoperative scoring system in determination of intraoperative difficult laparoscopic cholecystectomy (LC). Material and methods: The prospective observational study performed on 50 patients undergoing elective LC. All the patients were assessed and data regarding the previous history, clinical examinations, and USG findings were recorded. Preoperatively patients were assessed according to Randhawa and Pujahari scoring system. Whereas, intraoperatively, based on duration of surgery.m Results: Preoperative score suggested difficult and very difficult LC in 36% and 2% of patients respectively while intraoperatively 8% of patients had difficult and very difficult LC respectively. The sensitivity, specificity, and predictive value at the preoperative score of 5 was found to be 90%, 72.7%, and 96.7% respectively. Intraoperative difficult LC was found to be significantly associated with the previous history of hospitalization (P=0.021), palpable GB (P=0.003), wall thickness >4mm (P=0.000), pericholecystic collection (P=0.000), contracted GB (P=0.000), post ERCP (P=0.000), deranged LFT (P=0.000), and WBCs >11000 (P=0.000). Conclusion: Study finds the evaluated scoring system, reliable and useful for predicting difficulty in laparoscopic cholecystectomy.

Background: This study was conducted to test early resuscitation, targeting lactate levels as the marker of adequacy of oxygen delivery, compare the return of normal ScvO2 in predicting 7th day mortality, and compare the clearance of serum lactate (at least 10%) in predicting 7th day mortality. Methods: This was a hospital-based randomized prospective study conducted among 120 adult patients admitted to the medical ICU with septic shock at Rajarajeswari Medical College and Hospital from November 2015 to August 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: 7th day mortality was 21.7% in group L and 33.3% in group S, the p-value was 0.152 which was not clinically significant between both groups. But lactate clearance in group L at 24 hours was 57.50±25.82 and at 72 hours was 76.87±14.80 which was clinically strongly significant and ScvO2 at mortality was around 70.6% but still there was a mortality of 33.3% on 7th day, which is higher compared to the lactate group. Conclusion: Goal-directed therapy provided at the initial stages of severe sepsis and septic shock has significant short term and long-term benefits. We can also say that using lactate as an indicator of sepsis will help in early diagnosis with risk stratification and repeated measurements at regular intervals can assist in the progress of treatment.

Introduction: A stroke is defined by an abrupt onset of neurologic deficit that is attributable to a focal vascular cause. Thus, the definition of stroke is clinical; and laboratory studies including brain imaging are used to support the diagnosis. The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature. Fibrinogen plays a key role in blood clotting. Fibrinogen plays a role in the process of aggregation of platelets. It crosslinks the platelets by the process of binding the glycoprotein IIb-IIIa receptor on the surface of platelets. Hence, Measurement of plasma fibrinogen levels could be more useful than other acute phase reactants such as C-reactive protein, as fibrinogen is more specific to vascular disease. Material and Methods: A Cross sectional study was conducted in the Department of Medicine. Patients with age>18yrs, in both genders, who met the clinical and radiological diagnostic criteria of stroke within 24 hours along with non-stroke controls with matched age, sex and risk factors. Patients with age>18yrs, in both genders, who met the clinical and radiological diagnostic criteria of stroke within 24 hours. All patients older than 18 years present with features of stroke like Hemiplegia, hemiparesis, hemianaesthesia, speech abnormality, with or without cranial nerve palsy were enrolled in the study. Results: In our study, 150 no of people were enrolled in our study after exercising inclusion and exclusion criteria. Among them 61-80 years of age groups were mostly affected by stroke followed by age group 46-60 years. Mean age of presentation was 69.89±12.75 in ischemic stroke group and 64±12.99 in hemorrhagic stroke group. Mean age among control is 66±13.10. The mean fibrinogen level among 50 ischemic stroke cases was 396.6±116, 50 cases of hemorrhagic stroke was 310.9±78.21 & among controls was 209.2±117.5. The p-value for mean fibrinogen between cases and controls was 0.001. There was statistically significant difference between mean fibrinogen level between cases and controls. Conclusion: Fibrinogen is found to be an independent risk factor for stroke; more specifically for ischemic stroke. It can be used in predicting stroke. The mean fibrinogen level increases with age and higher in females, hypertensives, diabetics, smokers, alcoholics, obese & hypercholesterolemia. Fibrinogen levels were higher in patients with acute stroke with very severe impairment; hence, can be useful in accessing stroke severity. Further study is required for a thorough understanding of its risk for stroke and its prognostic significance. Thus early detection of fibrinogen level and treatment with drugs along with dietary modifications and lifestyle changes can reduce the risk of stroke and can also decrease morbidity and mortality in stroke patients.

Background and Objectives Hepatic Hydatid Cysts (HHCs) represent a significant and unaddressed public health concern in Indian population. The aim of this study was to evaluate the sociodemographic characteristics, clinical manifestations, and treatment approaches for individuals affected by HHCs in India. Materials & methods This retrospective study was conducted at an Indian tertiary care hospital. The study focused on 35 individuals who were diagnosed with an HHC based on clinical symptoms, imaging tests, or serology. A retrospective and descriptive analysis was performed on the collected data. Statistical analysis was carried out using Epi Info® to derive the results of the study. Results: 25 to 40 years was the most commonly affected group. Females were affected more than males. The most frequently reported symptoms among the patients was abdominal pain. For the diagnosis of HHC, computerised tomography (CT) and abdominal ultrasonography(USG) were the two main imaging tests utilized. The most common type of cystic lesion observed in these tests was unilocular and anechoic. Majority of patients had cysts in the right hepatic lobe. Surgical excision of hydatid cysts was performed in 47% of the patients included in the study. The most frequently performed surgical procedure for hydatid cyst removal was pericystectomy. Conclusion: HHC is a prevalent cause of morbidity in India. Despite advancements in medical treatments, surgery remains the preferred treatment approach for the majority of patients. Accurate diagnosis relies on a combination of clinical examination and imaging studies.

Background and Objectives There exists a limited body of research investigating the correlation between gestational diabetes mellitus (GDM) with fetal epicardial fat thickness (FEFT). The primary objective of this study was to assess the potential of FEFT as an indicator for screening GDM in pregnant women. The study was designed as a cross-sectional analytical investigation. Materials & methods The study incorporated pregnant women who were scheduled to undergo a 75g oral glucose tolerance test (OGTT). Antenatal ultrasonography (USG) were conducted in all patients. Among the total of 200 patients, a subset of 70 patients was selected for further analysis. This subset included 35 patients with elevated results in the 75g OGTT (indicating cases of GDM) and 35 patients with normal results. Results: There was a significant increase in FEFT among pregnant women with GDM. Furthermore, the elevated FEFT demonstrated a positive correlation with 2-hour OGTT serum glucose values. The mean FEFT in mothers with GDM was found to be significantly larger compared to mothers without GDM. To assess the predictive capability of FEFT for GDM, an ROC curve was constructed which demonstrated a high sensitivity of 95.57% and specificity of 91% for FEFT as a predictor of GDM. Conclusion: Assessing the FEFT in fetuses could serve as a novel marker for diagnosing GDM.

Background: Despite ongoing disagreement regarding its indications, interest in operating to treat paediatric fractures has grown during the past 20 years. There is some debate over the best way to repair long bone fractures in kids under the age of six (POP cast) and teenagers over the age of sixteen (locked intramedullary nailing, plating). OBJECTIVES:  To analyze the results of fixation of long bone fracture with TITANIUM ELASTIC NAILING SYSTEM (TENS) in the treatment of fracture shaft of long bones in children aged between 5 to 16 years with special emphasis on complications. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Orthopaedics, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Telangana. Study Period: 3 months. Study population:  All children and adolescent patients between 5-16 years of age with diaphyseal fractures of long bones admitted in the department of Orthopaedics. Sample size: Study consisted of 20 subjects. Sampling method:  convenient sampling. Study tools and Data collection procedure: As soon as the patient was brought to casualty, patient’s airway, breathing and circulation were assessed. Then a complete survey was carried out to rule out other significant injuries. Plain radiographs of AP and lateral views of long bone including one joint above and one joint below .to assess the extent of fracture comminution, the geometry and the dimensions of the fracture. Results: The duration of stay in the hospital ≤ 7 days for 3 (15%) patients, 8-10 days for 7 (35%), 11-15 days for 11 (50%). One case was operated within 6 days of injury, developed superficial infection which had to be dressed regularly, so stayed for 11 days. Another cases were who had multiple soft tissue injury had to stay 14 days. The average duration of hospital stay in the present study is 10.25 days. Conclusion: We draw the conclusion that the ELASTIC STABLE INTRAMEDULLARLY NAILING approach is the best course of action for treating paediatric long bone diaphyseal fractures. It provides elastic mobility that encourages quick union at the site of the fracture and stability that is perfect for early mobilisation. When compared to other forms of treatment, it has a reduced rate of complications and produces positive results.

Background: Urinary tract infection (UTI) is due to infection of microorganism involved urinary tract. Recently, antibiotics resistance rate is continually increase in UTI isolates. So, choice of antimicrobial drug becomes limited. Fosfomycin may be a promising alternative antimicrobial drug in that resistance cases in current scenario. Objective: Study focused on detects vitro sensitivity of fosfomycin against gram negative UTI isolates. Method: A study conducted at Microbiology Department of Smt. B. K. Shah Medical Institute and Research Centre, Piparia from January 2022 to October 2022. During study period total 256 patient’s urine culture found positive for microorganisms. Out of 256 bacterial isolates, 199 (77.8%) gram-negative bacteria, isolates which were included in our study. Bacterial isolates identified by standard laboratory procedure and antibiotic sensitivity was done by VITEK 2 compact system of bioMerieux. Results: Sensitivity of fosfomycin against isolated bacteria revealed that, 96%, 72.4%, 75%, 100%, 75% & 61.9% isolates were sensitive to Escherichia coli, Kebsiella pneumoniae, Proteus mirabilis, Enterobacter sp., Citrobacter sp. & Pseudomonas areuginosa respectively. Against Extended spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae, fosfomycin was given good result which were 91.4%, 76.9%, 60% and 100% sensitive for Escherichia coli, Kebsiella pneumoniae, Proteus mirabilis and Enterobacter sp. respectively Conclusion: Fosfomycin showed better drug of option in most of the common Enterobacteriaceae  and non fermented bacteria as well as in ESBL-producing Enterobacteriaceae

Background: The development of the foetal kidneys can be monitored during the entire pregnancy by measuring their length and comparing them to typical charts. The ultrasonogram is thought to be a useful tool for assessing kidney growth and anomalies in foetuses, and it can help with the early detection and treatment of some kidney-related disorders.

Objectives:

1. To perform obstetric USG in healthy women with uncomplicated pregnancy between 20 weeks and term gestation to determine correlation between fetal kidney length and gestational age.

2. To derive nomogram for estimating the gestational age of fetus from ultrasonographically measured fetal kidney length.

3. To assess the accuracy of fetal kidney length                                                                                                                      measurement in determining the gestational age of the fetus and its accuracy with other fetal biometric indices.

Material & Methods: Study Design: Hospital based observational study. Study area: Department of Obstetrics & Gynecology, Narayana medical college and hospital, tertiary care center at Nellore, Andhra Pradesh. Study Period: April 2022 – March 2023. Study population: Pregnant women with uncomplicated pregnancy more than 20 weeks Attending Antenatal Outpatient department. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Simple Random technique. Study tools and Data collection procedure: All the statutory requirements under PNDT act were followed and form F was obtained from all the patients. All the relevant clinical history was obtained and the correct LMP was confirmed. Transabdominal ultrasonography was performed with patient in supine position. Good acoustics coupling was obtained using synthetic ultrasound gel. Ultrasonography is done using Siemens Sonoline or Philips HD 7 ultra sound scanner using a 3.5- 12MHz transducers, images were recorded in the thermal films using the digital camera Results: The association between the fetal measurements and FK GA. The correlation was best for FK GA versus AC (r: 0.876) and least for BPD (r: 0.808). All the correlation was statistically significant. Conclusion: FKL is reasonably a precise parameter for estimating GA. Measurement of FKL will prove significant when other biometric parameters failed to be measured in certain situations like engaged/fixed head and when head is not in correct plane. Hence, FKL can be used as a reliable parameter for determination of gestational age.

Background:  To assess the association between vitamin D deficiency and hypothyroidism in a tertiary care center. Methods: Eighty- four subjects of both genders were divided into 2 groups of 42 each. Group I was healthy subjects (control) and group II was hypothyroid group. All were subjected to measurement of serum T3, T4, TSH, serum calcium and serum 25 (OH) D levels. Results: Group I had 22 males and 20 females and group II had 15 males and 27 females. The mean serum calcium level was 10.4 mg/dl and 7.1 mg/dl in group I and group II respectively. The serum 25(OH) vit D was 45.8 ng/dl and 15.3 ng/dl in group I and group II respectively. The mean serum TSH was 3.4 mU/L in group I and 6.2 mU/L in group II. The mean serum T3 was 2.8 pg/ml in group I and 1.5 pg/ml in group II. The mean serum T4 was 1.9 ng/dl in group I and 0.6 ng/dl in group II. The difference was significant (P< 0.05). Conclusions: Patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia. All hypothyroid individuals should undergo tests to check their serum calcium levels and check for vitamin D inadequacy.

Background:  To assess knowledge and attitude regarding self- reported adherence among individuals at high risk of metabolic syndrome in Kanyakumari district. Methods: One hundred ten of both genders were enrolled and parameters such as sociodemographic characteristics; compliance with prescribed treatments and dietary adjustments; awareness of metabolic syndrome; and attitude toward health, education, smoking, alcoholism, exercise and family history of CVD was recorded. For direct inquiries, the response was graded on a five-point scale: 0% for never, 25% for seldom, 50% for sometimes, 75% for often, and 100% for always. Results: Out of 110 patients, males were 62 (56.3%) and females were 48 (43.7%). Education was primary in 50, high in 42 and above in 18. Smoking was seen in 34, alcoholism in 15, family history of premature CVD was seen in 40, 32 perform exercise and 78 not. The difference was significant (P< 0.05). 14% heard about metabolic syndrome, 15% had understanding of metabolic syndrome, 27% had knowledge of MS as risk for cardiovascular diseases, 61% sedentary lifestyle as a risk factor, 30% as central obesity as a component, 26% considered hypertension as a component for MS, 25% ha knowledge of diabetes as a component of MS, 28% knew that high triglyceride level is a component and 22% knew that low HDL-C level is a component of MS. Age, the presence of hypertension, and attitude toward health were positively associated with the adherence to medications score and income level had a negative association. Conclusions: The people with high-risk metabolic syndrome frequently had low adherence rates to medications and lifestyle adjustments. The two most significant variables affecting adherence rates were patients' knowledge of metabolic syndrome and attitudes toward health.

Non-alcoholic fatty liver disease (NAFLD) is a prevalent and progressive liver condition with significant health implications. This study aimed to investigate the sonographic evaluation of NAFLD and its correlation with the non-HDL cholesterol to HDL cholesterol ratio, a marker of dyslipidemia. A total of 200 participants with suspected or known NAFLD were included in the study. Sonographic evaluations were performed to assess the severity of NAFLD in terms of increase in liver echogenicity, liver to kidney contrast, blurring of intrahepatic vessel borders and diaphragm. Non-HDL cholesterol to HDL cholesterol ratio was calculated from lipid profile results. The study found a positive correlation between the non-HDL cholesterol to HDL cholesterol ratio and the severity of sonographic features of NAFLD. Participants with a higher ratio exhibited more severe grade of NAFLD. Furthermore, the non-HDL cholesterol to HDL cholesterol ratio was higher in participants who showed NAFLD progression compared to those who did not progress, suggesting its potential as a predictive marker for disease progression. These findings contribute to our understanding of NAFLD and highlight the association between dyslipidemia and disease severity. The non-HDL cholesterol to HDL cholesterol ratio may serve as a non-invasive marker for disease severity and progression, aiding in risk stratification and therapeutic interventions. Further research is needed to validate these results and explore the clinical implications of this association.

Introduction: The treatment of childhood TB is based on the same principles as the treatment of adult TB. The standard treatment regimen for childhood TB consists of a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampicin for four months. Children with TB are treated with weight-based dosages of anti-TB drugs. Aims: To investigate delays and barriers in treatment initiation in children with TB. Material and Methods: The Department of Pulmonary Medicine and Pediatrics at the Govt. Medical College in Patiala carried out this cross-sectional investigation. In the current investigation, 126 participants in total were included. The study comprised children who had been diagnosed with T.B. (Pulmonary or Extra Pulmonary TB) during the course of a year and were patients at the department of Pulmonary Medicine and Paediatrics, Govt. Medical College, Patiala. Result: Delay was seen in 48.41 percent of the patients. Reasons for delay in treatment initiation as per parents/caregivers was denial diagnosis, economic constraints, lack of understanding and transportation challenges found to be present in 10.32 percent, 7.14 percent, 15.08 percent and 15.08 percent of the patients respectively. Conclusion: Strengthening HCP awareness regarding the importance of TB symptom screening and encouraging early referrals are crucial for rapidly scaling up early treatment initiation in childhood TB.

Background: Salivary gland tumors (SGTs) are relatively less common, and they exhibit a wide variety of morphological features, even within one particular lesion. This has caused considerable problems in categorization and diagnosis. The epidemiologic factors are also variable across the world.  Objectives: To study the site of occurrence, age, and gender-wise distribution with histopathologic features of various SGTs and their comparison with other studies.  Material and Methods: This eight year cross-sectional study was conducted in a tertiary care teaching hospital of central India and included all diagnosed cases of SGTs. Results: A total of 100 cases of SGTs were retrieved during the seven-and-a-half-year study period. Out of which 61% were benign and 39% were malignant. The age range was 5–83 years. The most frequently encountered benign tumor was pleomorphic adenoma (86.8%), followed by Warthin’s tumor (8.2%). Mucoepidermoid carcinoma (MEC) was the commonest malignant tumor (33.3%). The parotid gland was the commonest site for both types of SGTs.  Conclusion: SGTs had a wider age range of presentation. Benign tumors were more common and well-demarcated from surrounding tissue as compared to malignant tumors. They were more common in the major salivary glands, as the parotid was the commonest gland involved in both benign and malignant SGTs.

Background: Thyroid physiology is perceptibly modified during normal pregnancy. These alterations take place throughout gestation, help to prepare the maternal thyroid gland to cope with the metabolic demands of pregnancy, are reversible post-partum and the interpretation of these changes can pose a challenge to the treating physician. Material and Methods: This is a prospective, descriptive and observational study conducted among hypothyroid pregnant women from their preconception to complete gestational phase (with whatever outcome), conducting to Index institute of Medical sciences and Hospital over a period of 2 years. The hypothyroid pregnant females visiting to Endocrine and Obstetric Department at the Index institute of Medical sciences and Hospital. All pregnant women who will be diagnosed hypothyroidism defined as either overt (elevated TSH and low FT4) or subclinical (elevated TSH and normal FT4) hypothyroidism and those labelled only ‘hypothyroidism’ (uncategorized) by the clinician either before or during pregnancy. Results: In my study most of the patients who were started on treatment responded well to it so that by 16 weeks 53% of them had their TSH restored to normal range. In my study of 266 patients started on Levothyroxine 140 of them (53%) had normal TSH by 20 weeks but 110 of them (41%) still had relatively higher levels of TSH which necessitated an increase in dose of Levothyroxine. In this table NA denotes those who abort spontaneously before 20 wks of gestation. In my study at 32 weeks period of gestation except for a single patient all the other patients attained normal TSH levels. one patient needed further increase in dose of Levothyroxine.Those who have been diagnosed before 10 weeks and on treatment, if their repeat TSH values become normal they were grouped under adequately treated group. Conclusion:
Isolated Low free T4 followed by SCH have the highest rate of occurrence in the study sample. Though the occurrence of any low thyroid status, low isolated free T4 are more common in women with recurrent miscarriage, but the difference was not significant statistically. Anaemia in pregnancy was a mild public health problem in ours study. Ongoing interventions to target anaemia during pregnancy seem to be working in this setting and they should reach universal coverage.

Background: One of the most prevalent and deadly disorders is cerebrovascular illness. The second most prevalent cause of mortality worldwide is stroke.1 It is one of the most prevalent neurologic diseases that can be fatal and devastating. Approximately 6.15 million fatalities worldwide occur each year as a result of cerebrovascular disease. According to several Indian research, the prevalence rate of stroke varies depending on the region and the time of study from 40 to 470/100000 people. In India, stroke is a significant cause of mortality and morbidity.2

Objectives:

1. To observe plasma CRP levels in acute ischemic stroke.

2. To evaluate the role of CRP as a prognostic and diagnostic aid in acute ischaemic stroke.

3. To evaluate CRP levels as a risk factor in acute ischemic stroke.

Material & Methods: Study Design: Hospital-based prospective observational study. Study area: Department of General Medicine, in a tertiary care hospital in south India. Study Period: April 2021 – March 2022. Study population:  Patients admitted with a clinically first attack of the stroke to the medical intensive care unit or acute medical ward. Sample size: The study consisted of a total of 60 cases and 60 controls. Sampling Technique:  Simple random method. Clinical history was taken from either the patient or his/ her relatives or attender, while taking history importance was given regarding the presence or absence of vomiting, headache, and convulsions. Known history of hypertension, diabetes, CAD, RHD, TIA, collagen diseases, meningitis, tuberculosis, endocrine disorders, and congenital disorders was taken. Personal history regarding dietary habits, smoking alcohol consumption, and tobacco chewing were noted. The NIH stroke scale was assessed in all patients to assess the neurological disability and its prognosis. A detailed neurological examination was done based on proforma. Results: CRP values of CT evaluated ischemic stroke patients after admission, > 12 hours < 72 hours after the symptoms onset 54 of the 60 thrombotic stroke patients had CRP >6 mg/dl only 6 patients had CRP<6mg/dl (P <0.001). The Chi-square test value was 73.65, which is statistically very significant. Only 7 patients in the control group had CRP>6mg/dl. Conclusion: In this study mean C-Reactive protein levels were significantly higher in patients with ischemic stroke when compared to controls. It is also observed that elevated C-Reactive protein in ischemic stroke can be diagnosed positively and is an indicator of a worse prognosis, but subtypes (cortical, subcortical) of cerebral infarction cannot be differentiated at the time of early diagnosis. C-Reactive protein levels were raised in all cases that expired.

Background: Laryngoscopy and endotracheal intubation is the commonest method of securing a definitive airway for administering anaesthesia. However, it is associated with tachycardia and hypertension and an increase in intraocular pressure. Various pharmacologic and non-pharmacologic methods have been tried to limit the pressure responses and intraocular pressure changes following the insertion of endotracheal tube. One such attempt is the use of laryngeal mask airway, which has been shown to be an effective means of securing a clear airway in fasting patients for elective surgery. Its insertion requires neither the visualization of cords nor the penetration of larynx, making the placement less stimulating than tracheal tube insertion and it may provoke less sympathetic response and catecholamine release Methodology: Sixty patients, of 18-60 years of age, of either sex undergoing elective surgical procedures at Kidwai Memorial Institute of Oncology, Bangalore requiring general  anaesthesia were selected randomly. The study was conducted in our institute from December 2019 to February 2021. Patients were randomly divided into 2 groups. In Group 1, appropriate size of LMA was inserted blindly without laryngoscopy using standard technique whereas in Group 2, appropriate size of endotracheal tube was used to intubate trachea under direct laryngoscopy using macintosh laryngoscope. Results: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. Conclusion: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. There was statistically significant rise in hemodynamic parameters and IOP following laryngoscopy and intubation.

Background: Subarachnoid block is one of the commonest local anesthetic technique and would probably maintain its place in the developing countries because of simplicity minimal skill requirement, onset, economy and minimum post-operative complications. The use of neuraxial opioids has increased dramatically in recent years augmenting the analgesia produced by local anesthetics like bupivacaine by binding directly to the opioid receptors. The aim of the current study is to compare the efficacy of opioids Buprenorphine and Fentanyl as adjuvants to 0.5% hyperbaric bupivacaine in spinal anaesthesia for lower limb and lower abdominal surgeries. Materials and methods: This study comprised of 70 patients, of ASA grades I– II, between the age group 18 and 60 years, planned for lower limb and lower abdominal surgeries who were randomly divided into B group(n=35) & F group(n=35). Group B received intrathecal 60μg of buprenorphine with 3.5cc (15mg) of 0.5% hyperbaric Bupivacaine. Group F received intrathecal 25μg of fentanyl with 3.5cc (15mg) of 0.5% hyperbaric Bupivacaine. Onset of sensory block and motor block, two segment regression, duration of sensory & motor block, duration of analgesia, haemodynamic changes and side effects were recorded. Result: Time of onset of sensory (4.2±1.3 vs 4.5±1.07 in mins) & motor blockade (7.4±1.3 vs 7.8±2.5 in mins) were similar and comparable in both buprenorphine and fentanyl groups. Duration of 2 segment regression time of sensory block was comparatively longer in buprenorphine group (125±8.8 in mins) compared to fentanyl group (100±10.9 in mins). Duration of sensory blockade was longer in buprenorphine group compared to fentanyl group (280±17.5 vs 195±21.12in mins). Duration of motor blockade too was longer in buprenorphine group compared to fentanyl group(165±10.8vs155±9.5 in mins).Duration of perioperative analgesia was significantly higher in buprenorphine group(355±30.5 vs 254±27.7 in mins).Hemodynamic parameters were comparable between the two groups. The mean Vas pain score in the first 12 hours postoperatively were comparable between both the groups and statistically insignificant. Time of first voiding was longer in buprenorphine group compared to fentanyl group (282±25.35 vs 273±30.20 in mins). Adverse effects between both the groups were comparable. Conclusion: The duration of sensory block, motor block,2 segment sensory regression time and perioperative analgesia was longer in buprenorphine group compared to fentanyl group. Hence Buprenorphine was considered as superior opioid adjuvant to local anesthetic for spinal anaesthesia with better efficacy and potency compared to fentanyl.

Physical fitness implies not only the absence of disabling deformity of disease and the capacity to perform a sedentary task efficiently but also a sense of physical well being and the capacity to deal with emergencies demanding unaccustomed physical effort. There is a need to know the physical fitness levels of our future doctors. They can be sensitised to pursue a healthy life style right from the begining of their medical career. The present study was undertaken to assess the physical fitness index using modified Harvard Step Test. Present Cross Sectional Observational Study was conducted in Department of physiology, MGM Medical College and Hospital, Aurangabad [MH], India in Medical Students of 1st MBBS. The physical fitness of 192 male and 173 female medical students was evaluted using modified Harvard Step method 25.2% of study subject had excellent physical fitness. It was found that females had better fitness when compared to males. It was found that BMI had a statistically significant negative correlation with physical fitness, which means as BMI increases physical fitness decreases. Physical activity scores had a statistically significant positive correlation with physical fitness. Gender was also found to be correlated with physical fitness. In the present study, females had higher physical fitness than their male counterparts and this difference was statistically highly significant. Pulse rate was found to have a negative correlation with physical fitness. Systolic and diastolic blood pressure had statistically significant positive correlation with physical fitness.

Background: This study was conducted to study the clinical profile of acute kidney injury in haematotoxic snake bites. Methods: This was a hospital-based prospective observational study conducted among 120 patients who were admitted in ward and ICU with haematotoxic snake bites in the Departments of General Medicine in Government Medical College, Trivandrum, over a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age group was 49.8+/-17.8. Among them, 76.7% showed local reactions, and 23.3% showed systemic manifestations. 35.8% developed AKI and 16.7% needed haemodialysis. Associated neurological manifestations were seen in 2.5%. 42.5% developed sepsis, 9.2% developed DIC, and 14.2% developed a capillary leak. 33.3% had cellulitis of which 3.3% developed functional disabilities. 8.3% required ventilatory support and 4.2% succumbed to death. Conclusion: A cascade of events tends to occur in severe haematotoxic envenomation such as bleeding disorders, hypotension or circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory distress syndrome (ARDS). Early hospitalization, quick anti-snake venom administration and adequate supporting care provided promising results.

Gallstone’s status was based on information from self-reports, imaging procedures, surgical notes, and medical records. Among controls, a transabdominal ultrasound was performed to detect asymptomatic gallstones. Gallstones were removed from cancer cases and gallstone patients were classified by size, weight,color, pattern, and content of cholesterol, bilirubin, and bile acids. cancers of the gallbladder, extrahepatic bile ducts, and ampulla of Vater, respectively, persisting when restricted to those with gallstones at least 10 years prior to cancer. Biliary cancer risks were higher among subjects with both gallstones and self-reported cholecystitis, particularly for gallbladder cancergallbladder, bile duct, and ampulla of Vater cancers, respectively, could be attributed to gallstones. Cancers of the biliary tract encompass those arising from the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Biliary cancer is relatively uncommon in most parts of the world, although high-risk populations and upward incidence trends have been reported in certain areas (Hsing et al, 1998, 2006). Although gallstones are a well-documented risk factor for gallbladder cancer (Diehl, 1983, 1991; Zatonski et al, 1997; Lazcano-Ponce et al, 2001; Hsing et al, 2006), their role in cancers of the extrahepatic bile duct and ampulla of Vater is less established. Material and Methods: A prospectivestudy was conducted on patients admitted in various Departments of the J.A. Group of Hospitalsfrom Jan. 2021 to Aug. 2022. 75 patients will be selected for the study with gallstone disease and 75 patients as controls for conducting this study. Result: Females are mostcommonly affected with gallbladder cancer than males. Patients in the age group of 45-59 years were found to have the highest risk of gall bladder cancer. The mean age of the patients affected was 52 years. Patients having gallstone disease were more prone to developing gallbladder cancer.The size of the stone also has a significant risk factor for gallbladder cancer  ,No of stone also a significant role in developing gall bladder cancer. that gallstones were a strong risk factor for all three subsites of biliary cancer.cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation. Conclusion: That cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation (Cetta, 1991). Cholesterol stones are associated with lithogenic bile supersaturated with cholesterol, due to increased hepatic secretion of cholesterol or diminished secretion of bile salts and phospholipids that maintain the solubility of cholesterol (el Zayadi et al, 1991). In contrast, pigment stones have a high biliary concentration and are closely linked to cirrhosis, chronic infection, and blood disorders (Swidsinski and Lee, 2001). past few decades, there has been an increase in cholesterol stones and a decrease in pigment stones, probably related to increasing obesity and a more westernised diet and lifestyle. In our study, the magnitude of the biliary cancer risks associated with gallstones was higher than in most previous studies (Lowenfels et al, 1985; Vitetta et al, 2000), possibly due to our more comprehensive assessment of gallstone status and only assessment of gall stones in relation to gall bladder cancers.

Background: Decreased fetal movements perceived by the mother in pregnancy can cause apprehension and  increased incidence of unscheduled antenatal check-up and labour room admission. Decreased fetal movements  are  associated with a wide variety of intra-partum and postpartum complications.Aims And  Objectives: To identify the demographic and pregnancy characteristics, obstetric and neonatal outcome among women presenting to hospital with reduced fetal movements.Materials And Methods: A prospective observational study conducted among 150 term antenatal women who attended the labour room of Obstetrics department, Government Medical College, Thrissur with complaints of DFM from January 2020 to December 2020.These women were categorized into 2 groups after evaluation-immediate termination group and conservatively managed group (reassured and delivered later).Obstetric and neonatal outcomes were studied.Results:. 5 women had intrauterine demise at the time of presentation.58.6% of women with DFM  required immediate termination of pregnancy out of which 57.2% of cases were induced. A highly significant  association between intra-partum CTG and perinatal complications were noted.Caesarean sections and  instrumental deliveries were more in immediate termination group when compared to latter group. Perinatal complications(RDS at birth, APGAR scores, resuscitation and HIE) were more in immediately terminated group compared to latter group which was statistically  significant. There was increased risk of RDS at birth as the number of DFM increases which was statistically significant.Conclusion: Maternal perception of DFM should receive adequate medical attention and can be used as a predictor of adverse obstetric and neonatal outcome. DFM result in increased rate of planned early delivery, induction of labour and caesarean sections. Unless intervened, these cases of DFM would have ended up in still births. Universally accepted evidence based guideline needs to be developed enabling optimal management of cases of DFM

Postoperative pain management is one of the main challenges for anaesthesiologists. The addition of different adjuvants intrathecally is an attractive analgesic strategy due to simple and quick technique with low risk of failure and infection. Intrathecal opioids are the gold standard for the treatment of postoperative pain with morphine as the most effective due its potent and prolonged effects. However, over the years it is losing popularity due to dose dependent side effects such as pruritus, nausea, vomiting and the most feared risk of delayed respiratory depression. Dexmedetomidine is a highly selective alpha 2 agonist which possesses sedative, analgesic and sympatholytic properties and gives prolonged analgesia when used intrathecally without respiratory depression.

Introduction: Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting men and constitutes a major factor impacting male health. Clinical evaluation to assess the presence and degree of voiding dysfunction and/or the role of BPH in its presence has an increasingly broad spectrum of treatment goals. The goals of the evaluation of such men are to identify the patient’s voiding or, more appropriately, urinary tract problems, both symptomatic and physiologic; to establish the etiologic role of BPH in these problems; to evaluate the necessity for and probability of success and risks of various therapeutic approaches; and to present the results of these assessments to the patient so he can make an informed decision about management recommendations and available alternatives. Aims and Objectives:  This study aims to evaluate the role of Bulbocavernosus Reflex, Anal Tone, Perianal Sensation reflex, and Uroflowmetry assessment in establishing the prognosis after surgical management in patients of benign prostate hyperplasia. Materials and Methods: Operated Cases of BPHin the Department of General Surgery, Mahatma Gandhi Medical College. Pre- and post-operative reflexes status and uroflowmetry parameters analysis were recorded. Results:  A total of 400 patients were included with a study period of 2 years. The follow-up period was 6 months. Out of these, 352 patients had good pre-operative reflexes and 48 patients had weak/absent reflexes. All the patients had poor uroflowmetry parametersOut of 48 patients with absent reflexes or decreased anal tone, 46 patients (95.83%) showed no improvement in the uroflowmetry parameters and LUTS still persisted among them. Conclusion: There was no significant improvement in the lower urinary tract symptoms after surgery in patients whose clinical reflexes were weak/absent pre-operatively in different age groups ie. 40-60, 60-80 &>80 years and also there was no improvement in uroflowmetry study parameters. These clinical reflexes give an idea about detrusor activity. Patients with weak/absent reflexes give an idea about detrusor underactivity which may be due to various underlying neurological conditions. The majority of the patients who are having weak/absent clinical reflexes do not improve even after surgery since they have underlying detrusor underactivity. This study concludes that there is no benefit of surgery in patients having weak/absent clinical reflexes pre-operativelyie. in patients having detrusor underactivity. Also, not all the patients having preoperative poor uroflowmetry parameters will improve after surgery. The improvement depends on the pre-operative clinical reflexes.

Aim: To determine the KAP of Medical Students towards Hepatitis B and Hepatitis C. Material and Methods: The medical students participated in a research that consisted of filling out questionnaires. The questions sought information on the respondent's knowledge and attitude towards diseases caused by hepatitis B and C. 100 students enrolled in the MBBS programme took part in the research. Knowledge, attitudes, and practises with regard to hepatitis B and hepatitis C were evaluated with the use of a pretested proforma that included a questionnaire. Results: Respondents' awareness of hepatitis B risk factors included the following: 98% knew about infected blood transfusions, 97% knew about sharing needles, 88% knew about infected mother to child transmission, 91% knew about unsafe sexual contact, and 94% knew about body piercing and/or tooing. Responders were aware of the risk factors for Hepatitis C, including the transmission of the virus via blood transfusions. 88%, 81% knew about sharing needles; 6% knew about transmitting infection from mother to kid; 63% knew about risky sexual contact; and 64% knew less about tattooing and piercing, which was demonstrated to be the case. 79% of students were aware that nausea and vomiting are symptoms of hepatitis C, and 75% were aware that a yellowish tint is one of those symptoms. 78% of students were aware of anorexia as a sign and symptom of hepatitis C, whereas 63% were aware of stomach discomfort, and 58% were aware of joint pain. Conclusion: The medical students have a strong understanding of both Hepatitis B and C, as well as a positive attitude towards the topic. It is very necessary, in order to prevent the further spread of Hepatitis B and Hepatitis C, to educate medical students about the many facets of the illness and the need of vaccination as part of an active health education programme.

Background: Epidural anaesthesia has several benefits over general anaesthesia like reduced stress after surgery, maximum postoperative analgesia and less respiratory depression. The neuraxial dexmedetomidine, by promoting analgesic effects can reduce the dosage of local anaesthetics requiredfor epiduralanaesthesia. Our present study was designed to compare dexmedetomidine as an adjunct to bupivacaine along with plain bupivacaine in lumber epiduralanaesthesia in lower limb orthopaedic surgery for perioperative analgesia and anaesthesia. Methods: Eightypatients were assigned into group B (Bupivacaine plain) and group D (Dexmedetomidine with bupivacaine). The efficacy in terms of onset and duration of anaesthesia and analgesia were assessed along with the sedation score, heart rate, blood pressure (mean arterial pressure) at regular intervals throughout the perioperative period. Data was collected and then analyzed with appropriate statistical tools. Result: In present study patients who received lumber epidural bupivacaine plain (0.5%)(Group B) experienced significantly late onset effective anaesthesia and less longer duration of sensory and motor block and analgesia in comparison to the patients received lumber epidural bupivacaine (0.5%) plus dexmedetomidine 1 µg/kg (Group D) as an adjuvant. The patients of dexmedetomidine group had significant sedation than the patients of plain bupivacaine group. Around 12.5% of total patients experienced shivering and very few noticed urinary retention.  Conclusion: Dexmedetomidine as adjuvant with 0.5% bupivacaine in epidural anaesthesia produced faster onset of sensory and motor block, excellent surgical anaesthesia and extended analgesia in postoperative period with increase in the duration of sensory and motor blockade. Dexmedetomidine can be a good adjuvant to bupivacaine for epidural blockade in lower limb orthopaedic surgeries.

Background: This study was conducted to compare the efficacy of oral clonidine 200 mcg with oral gabapentin 900 mg in attenuating haemodynamic response to endotracheal intubation with regard to heart rate, blood pressure (systolic and diastolic), mean arterial pressure, and rate pressure product. We also wanted to ascertain the effectiveness of oral clonidine 200 mcg with oral gabapentin 900 mg or vice versa in attenuating haemodynamic response to laryngoscopy and endotracheal intubation. Methods: This was a hospital-based study conducted among 100 ASA1 and ASA2 patients posted for surgeries under general anaesthesia in KIMS, IEC/D/-49/2017, from 16th November 2017 to 23rd October 2018, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: Both groups showed attenuation of stress response. In gabapentin group, there was an increase in SBP, DBP and MBP up to 3 minutes, RPP up to 4 minutes HR up to 10 minutes after that, it was maintained below the baseline. In clonidine group, there was no rise in systolic and diastolic blood pressure, mean arterial blood pressure or rate pressure product compared to the baseline from the 1st minute of intubation which was statistically significant (p<0.0001). Post extubation, clonidine group patients were more sedated than those in gabapentin group. Conclusion: Both clonidine and gabapentin attenuate the stress response to laryngoscopy and intubation. When both of these drugs were compared, clonidine attenuated the stress response to laryngoscopy and intubation better than gabapentin and afforded good haemodynamic stability. Post extubation, clonidine group patients were more sedated than those in gabapentin group.

Background: Shivering is a frequent side effect in cesarean section (CS) after spinal anesthesia (SA). Pethidine has been considered as the gold standard for post – SA shivering control, but it is contraindicated in breastfeeding women. Methods: This randomized double-blind study was conducted at SDH Hospital Nowshera Rajouri (J&K), from June 2022 to Dec 2022. A total of 160 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K) tramadol (T), ondansetron (O) and placebo (P). The incidence and severity of shivering and patients’ complication were recorded and compared among the groups. Results: The demographic data of the patients in all the groups was comparable. Shivering was seen in 21 (52.50%) ,8 (20.0%), 24 (60.0), 26 (65.0) in K, T, O and P groups respectively (P<0.0001) Regarding shivering severity that was significant difference among the four groups (P<0.0001) Conclusion – As there was high incidence of shivering in the placebo group prophylactic intervention is CS under SA seems to be necessary. Among the studied groups tramadol was the most effective one followed by a low dose of ketamine and ondansetron.

Introduction: Menopause is defined as the cessation of menstrual cycles for 12 consecutive months, although many women seek medical advice before this time because of the onset of menopausal symptoms. The prevalence of hypertension in postmen opausal women is higher than in men. The aim of the present study was to identify the adherence to antihypertensive therapy based on the prescribing pattern in postmenopausal women. Methodology: Aprospective observational study was conducted in 116 post-menopausal patients visiting General Medicine OPD for the treatment of hypertensionin a tertiary care centre in South India, for a period of 6 months.  Results: Prescribing pattern of drug sin post-men opausal women is more complicated than in pre-menopausal women. The commonly prescribed anti-hypertensive agent is Calcium channel blocker (CCB) (45.16%), followed by Diuretics (19.35%), An giotensin receptor blockers (ARB)(14.51%), Beta blockers (9.67%) and An giotensinconverting enzyme inhibitors (58%). In monotherapy, ARB and CCB women achieved significant reduction fB Pandin combination therapy ARB with Diuretics gaves ignificant reduction. Conclusion: Inpost-menopausal women most commonly prescribedoral anti-hypertensive drugs are calcium channel blockers & diuretics. It is evident that good adherence to therapy and regular checkups will protect the post-menopausal women with HT from other major complications.

Background: Psychiatric morbidity is on the rise among patients having STI’s in India.  Little data is available on the prevalence of depression in patients having STI’s.  Aims And Objectives : The present study aims to assess the prevalence of depression in patients with Sexually transmitted infections. Materials And Methods : This cross sectional study was conducted in the STI clinic of Mahavir Institute of Medical Sciences & General Hospital. A total of 100 participants of both the genders who met inclusion and exclusion criteria were considered for the study after  taking informed consent. Participants were those patients who were diagnosed with STI. The study was conducted from August 2019 to March 2020.The study was carried out in single phase, screening for depression was done for all the patients using the " HAMILTON DEPRESSION RATING [HAM-D] SCALE, which is designed to grade the severity of depression.SPSS-23 was used for statistical analysis of data. Results : Majority of individuals who had STI’s were in the age group of 20-30 years followed by age group of 31- 40 years. Since patients of 20 – 30yrs had risk taking behavior & also were sexually active, they are more prone to develop STI’S. Overall prevalence of depression was found be 35% out of which 24 % had mild depression & 10% had moderate depression. Depression was more prevalent in age group of 20-30 years, 35.3% of this age group were found to have Mild depression. Among the age group of 31-40 years, 18.7% had mild depression and 6.3% had Moderate depression. When compared with the distribution of sex and gender, 42.2% females had depression among which 31.1% suffered with Mild depression and 8.9%, with Moderate depression. Prevalence of depression was high in females when compared with males (29.1%). The prevalence of depression was high among unmarried patients (77.45) when compared to married individuals (16%). It was found that less number of educated people suffered from depression (23.9%) when compared with illiterates (57.6%). Depression was more prominent among HIV +ve patients (76.5%), majority of them had Mild depression & few had Moderate and Severe depression. Subjects who had multiple sexual partners (72.2%)  were found to have depression when compared to other individuals. Conclusion : This study suggested that there is strong need to screen the patients visiting the STI clinic for depression. The sexual behavior in the study population put them at a high risk of developing STI’S.

Background: Chronic Myeloid Leukemia (CML) is clonal hematopoietic disease characterized by proliferation and expansion of myeloid cell lineages in bone marrow. It is a malignancy of considerable duration consisting of chronic phase followed by accelerated, and blast crisis phase.  Objective: To study the clinical, hematological, cytogenetic and molecular profile of CML.  Methods: This cross-sectional study was conducted in the department of Medicine and Oncology, KR hospital, Mysore Medical College and Research Institute, Mysore during the study period of one and half year from January 2020 to July 2021.  Results: The mean age of presentation was 44.5. There was slight male preponderance with Male: female ratio of 1.41:1. Cigarette smoking was seen in 31% patients which was statistically insignificant. An incidental diagnosis was made in 1 person. Anemia, thrombocytosis, leukocytosis and massive splenomegaly were striking features. The peripheral blood smear showed shift to left with spectrum of myeloid cells with varying degree of differentiation. Basophilia was striking in all the cases (100%). The bone marrow showed marked hypercellularity with increased M:E ratio. Majority of the patients were in CML-CP phase followed by 1 patient in AP phase and none in blast phase. Majority of the patients had standard Ph positive CML. Conclusions: The present study highlights that cytogenetics play a vital role in diagnosing and prognosticating CML and also the importance of routine health check-up.

Aim: To describe the presentation and outcome of secondary Methicillin-resistant Staphylococcal aureus (MRSA) infections in a cohort of confirmed dengue fever patients over a 5-year period, a rare but severe complication.  Methods: There were 18 patients with culture-confirmed Methicillin Resistant Staphylococcal infection of the 1170 patients admitted with Dengue fever over five years at Calicut Medical College, Kerala. Their mode of presentation, complications and outcome were studied.   Results: The Average age of the subjects were 45.8 years (range 22 -71 years) and the male-female ratio was 3:2. Most patients with MRSA complicating Dengue fever had a relapse of fever after 11-18 afebrile days (78%). Four patients had continued fever for more than one week, which is unusual for uncomplicated Dengue fever. Mortality in MRSA patients was 22% (4/18). The site of MRSA infection was most often skin and soft tissue, followed by lungs. Characteristic laboratory markers of leukocytosis following initial leucopenia and raised Erythrocyte sedimentation rate (ESR) were seen in all patients. Conclusions: MRSA secondary infection in Dengue fever occurred in 1.5% of the cohort and carried a mortality of 22%. It usually manifests about one week after the initial onset of fever with varying manifestations dependent on the infection site. Leukocytosis and raised ESR occurred in all patients. Preventing MRSA in patients admitted with dengue is of utmost importance. Early detection and treatment are essential for a better outcome.

Introduction -Vitamin D plays a role in optimization of the skeletal function. Vitamin D helps in calcium homeostasis which further helps in bone mineralization and preventing osteomalacia, hence older individuals with low vitamin D levels (<30ng/ml) must be prone to fragility fractures of the hip. Methodology 

● Study design – Prospective observational study.

● Study population Patients at Justice K. S. Hegde Charitable Hospital with closed fractures of the hip involving the proximal femur diagnosed by a physical examination and plain radiography in the pelvis with both hips Anteroposterior View (AP) and lateral view of the involved hip.

Study setting - Justice K. S. Hegde Charitable Hospital attached to K. S. Hegde Medical Academy, a unit of Nitte (Deemed to be University), Deralakatte, Mangaluru – 575018 (Hospital-based study).

● Study Duration - Study was  conducted from February 2021 till October 2022.

● Sample size – Sample size was calculated using nMaster software (version 2.0). Based on the alpha level of 5% SD of vitamin D in hip fragility fractures is 8.05(12), for the estimation error of 1.5, sample size was decided as 111. This was calculated using master version 2 software.

Methods: All patients over 45 with hip fractures from minor trauma, such as a slip and fall while standing or walking, were clinically and radiologically assessed. A patient history and injury information were documented using a predesigned proforma. The history consists of accidents/trauma, fractures in the past, surgeries, drug/supplement use history, and co-morbid conditions. The pelvis and affected limb were radiographed. Boyd and Griffin for intertrochanteric fractures and Garden for neck of femur fractures, Russel-Taylor classification for Subtrochanteric fracture to classify  the kind, comminution pattern, and grade of fracture. A biochemist evaluated 25-hydroxyvitamin D (25-OH Vit.D) levels in venous blood samples taken after admission. Our laboratory tested serum vitamin D levels using electrohemiluminescence Immuno Assay (ECLIA) on an automated analyzer.  Vitamin D values <20ng/ml were judged inadequate, while 20–20ng/ml were considered insufficient. 30-100mg/ml vitamin D was typical. Finally, vitamin-D levels correlated with fracture comminution. Data Analysis: On statistical analysis, the data was expressed in mean SD, frequency & percentage. Chi-square test was used for the analysis of the data. Results In the present study, 111 patients were evaluated with X-ray radiographs to investigate the comminution pattern of hip fractures and the presence of hypovitaminosis D in patients diagnosed with hip fractures. The mean age of patients was 70.40 ± 11.29 years. Out of 111 patients, 19 patients (17%) belonged to the age group of 46 to 60 years, 60 patients (53.6%) belonged to the age 61 to 75 years. 33 patients (29.5%) belonged to the age group of >75 years. Out of 111 patients, patients (71.4%) were females and 32 patients (28.6%) were males. Based on symptoms, 45 patients (40.17%) presented with left Hip/Groin pain with inability to bear weight and 66 patients (59.82%) presented with right Hip/Groin pain with inability to bear weight. Based on comminution, 59 patients (52.7%) had comminution. The mean vitamin D levels was 20.98 ± 13.11. 46 (41.1%) of the 111 patients had deficiency 20ng/dL, 4 (3.6%) had insufficient 21-29ng/dL, 6 (5.4%) had optimal 40-60ng/dL, and 3 (2.7%) had sufficient 30-39ng/dL. The correlation between comminution and Holick's classification was statistically significant. (p=0.001). The findings of the study conclude that Vitamin D have a significant effect on the presence of comminution and fracture site pattern. Conclusion -According to our study, osteoporosis, vitamin D deficiency, and fracture site comminution are all coexisting conditions. Early identification and treatment with vitamin D for osteomalacia and anti-osteoporotic regimens for osteoporosis will enhance bone, muscle, and general health, reducing falls and the associated fractures. Incorporating findings from bigger research into Indian hip fracture prevention recommendations is necessary.

Background: The range of the normal magnesium concentration is 1.7–2.2 meq/L. Usually, a serum level of less than 1.7 meq/L is used as a benchmark. When there is a low level of magnesium in the blood, there is an electrolyte disruption called hypomagnesemia. Numerous factors, such as insufficient magnesium intake, persistent diarrhoea, malabsorption, ongoing stress, drunkenness, and medications like diuretics, can cause hypomagnesemia. Objectives:

1. To know whether there is any change in the serum magnesium level in patients with acute phase of myocardial infarction.

2. Changes in the serum magnesium level, and its relation with the occurrence of complications of acute myocardial infarction like ventricular arrhythmias, supraventricular arrhythmias, left ventricular failure, cardiogenic shock, bundle branch block, hemi block, atrio ventricular block, mortality.

3. To compare the patients with altered serum magnesium levels with normal serum magnesium levels in A.M.I.

Background and objectives: This research has been carried out on all the autopsies performed at a teaching hospital, satisfying the inclusion criteria with an objective to ascertain the presence or absence of atherosclerotic disease of the coronary blood vessels. Method: This is a histological study done on 445 heart specimens in the department of forensic medicine for a period of one year, irrespective of cause of death, age and sex to evaluate the presence of coronary atherosclerosis. Results: Out of the 445 specimens of hearts examined, the most commonly affected coronary blood vessel was the LAD. No atherosclerotic changes were noted in 32 heart specimens examined which belonged to individuals between 18 years to 45 years. Triple vessel disease was also encountered in many cases that were asymptomatic. Out of 31 cases of natural death, coronary artery disease was found in all the cases, in varying grades and death due to coronary insufficiency due to CAD was found in 9 cases. The higher grades of coronary artery atherosclerosis were found more towards advanced age group.  Males were more commonly affected than the females.

Background: Hyperuricaemia is defined as an elevation of the uric acid level in the blood to more than 0.38 mmol/l. This increased uric acid gets deposited in the form of monosodium urate crystals in joint tissue to form a micro trophi complex. An increased uric acid level is associated with increased gouty risk. Antigout drugs such as allopurinol, Colchicine, probenecid, and Benzbromarone. The main action of these drugs is to decrease uric acid levels and symptoms of gouty arthritis. The main aim of our study is to detect a suitable mono-drug therapy for the treatment of gouty arthritis.  Aim: To study the effect of allopurinol, probenecid, and Benzbromarone mono-drug therapy in gouty arthritis patients in tertiary care hospitals. Material and method: The present study was conducted on 150 gout patients. All the patients were equally divided into three groups; group -1, 50 patients were treated with allopurinol, group 2, 50 patients treated with probenecid, and group -3, 50 patients were treated with Benzbromarone. All these patients were monitored with symptoms and also tested with blood pressure, serum creatinine, blood urea, and blood uric acid.  Results: In our study majority of the patients were male followed by female (p 0.342). With the age group of 61 – 65 years in all the groups (groups – 1, 2 & 3) respectively. On the basic characteristics of the gouty patients, 45.33% were alcoholic abuse, 35.33% were smokers, 52.66% were hypertensive, 80.66% were diabetic patients, 17.33% were Hypertriglyceridaemia, 45.33% were obesity, 21.33% positive family history and 58.66 % chronic tophaceous gout respectively. Based on the location of gouty arthritis and symptoms toes and swelling was observed in the majority of patients in all group – 1, 2 & 3. Based on biochemical parameters after 3 months of treatment, no significance was observed in serum creatinine in groups -1, 2 & 3 (p. >0.05) On blood urea no significance was observed in group -1(p>0.05), and significance was observed in blood urea in group 2 & 3 (p<0.05). Based on uric acid levels significance (p< 0.05) was observed in all three groups (group – 1, 2 & 3) respectively.  Conclusion:  Benzbromarone followed by is the better drug of choice in lower urea and uric acid levels compared with Probenecid and allopurinol group

Background and Objectives: The aim of this was to present our firsthand observations and findings pertaining to the occurrence of acute kidney injury (AKI) subsequent to exposure to toxic substances. Methods: This retrospective study involved the collection of data from patient case records at a prominent nephrology hospital situated in central India. Patient records were carefully examined to obtain information regarding the ingested substance, symptoms observed upon presentation, basic laboratory test results obtained upon admission, the treatment modality employed, and the ultimate outcome. It is important to note that patients who developed AKI following snake envenomation or scorpion stings were specifically excluded from this study. Results: A total of 200 cases involving AKI resulting from poisoning were identified. The largest group within this cohort consisted of patients who were affected by paraphenyline diamine poisoning. Additionally, there were cases of methanol poisoning, organophosphorus compounds, paraquat, and copper sulphate poisoning, tartaric acid poisoning, phenobarbitone poisoning. Notably, 9 patients had ingested a combination of multiple substances. Among the affected patients, 95% required renal replacement therapy. Overall, 70% of patients achieved complete recovery, while 30% succumbed to the acute phase of the illness. Conclusion: The reporting of toxic substances that lead to the failure of vital organs is of utmost importance in order to enhance awareness among the general population and healthcare providers. By providing comprehensive documentation and dissemination of information regarding these substances, the understanding of the potential hazards associated with them can be improved.

Background:  Hypertension is one of the most important risk factors for cardiovascular diseases particularly Ischemic Heart Disease & stroke. According to a nationally representative study on burden of high blood pressure in India, 70% of the people suffering from hypertension are not aware of it. Deaths due to hypertension are largely preventable. In comparison to other evidence-based interventions for non-communicable diseases, control of hypertension has the largest potential to save lives. Objective: 1.To estimate the magnitude of hypertension in a rural community. 2. To determine the significance of factors associated with hypertension   Design and Methodology: A Community based cross sectional study was conducted in two pre-selected villages near Kakaramanahalli, rural field practice area of RajaRajeswari Medical College for a duration of six months among the people aged 18 years and above. A person was considered to be a hypertensive if he/ she were already diagnosed case of hypertension and / or on treatment or with a current SBP of ≥ 140 mm Hg or DBP ≥ 90 mm Hg and a person was considered as pre hypertensive if he/ she were with a current SBP of 120 – 139 mm Hg or DBP 80 – 89 mm Hg. Results: Out of 101 participants, the mean age was 52.13±16 years. Majority of the people were in the age group of 60 years & above accounting for 44 (43%). Females outnumbered the males accounting for 66 (65%). Illiterates were more among the study participants accounting for 54 (53.5%). Majority of the people in the study were agriculturists accounting for 51 (50.5%) . Overall, the magnitude of Hypertension among the study population was found to be 33.7% and 32.7% were falling under the category of pre-hypertensive. There was no statistically significant association between blood pressure and age, gender, type of family, BMI and waist circumference. Conclusion: Our study concluded that more screening activities to be implemented at rural levels for the population who are above the age of 40 years. There is a need for frequent monitoring of Blood pressure irrespective of BMI, waist circumference in the population above the age of 40 years.

Objectives: The percentage of patients with difficult and prolonged healing of the wound is still high, while immediate complications such as wound dehiscence occur in up to 3 % of all treated patients in abdominal surgery. The aim of the study was to analyze the risk factors and comorbidities in the group of patients undergoing laparotomy and associated with early postoperative wound dehiscence. Methods: The prospective study included all patients treated surgically undergoing laparotomy at the Department of General Surgery,JA Group of Hospitals and GR Medical College, Gwalior (MP) Results: The results showed a statistical proportion of male patients102 (85%) compared to females18 (15%). The largest number of respondents were in the age group 21 to 40yrs. Surgical wound infection was evident in(103)85.3% of patients, hypoproteinemia was found in(86)71.76% of patients, anemia in(99)82.5%, peritonitis in 36% and diabetes in (34)28.33% of respondents. Of the total respondents with surgical wound dehiscence, 78 (65%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2 =4.399; p=0.036), wound infection (X2 =4.112; p=0.043. The frequency of the anemia, peritonitis, and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05) Conclusions: The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, tuberculosis, anemia, and active infection. The highest incidence of dehiscence was in patients operated on in medical emergencies and in patients with malignant disease.

INTRODUCTION: Obstructive jaundice is a common surgical problem. Occurs due to both benign and malignant conditions.Evaluation in patients with obstructive jaundice was a challenging problem. Presentation of obstructive jaundice patients is late and mostly present after the disease becomes advanced or uncurable Aims And Objectives: To assess age and sex patterns, clinical presentation, and radiological and biochemical patterns in obstructive jaundice patients. Materials And Method: 100 patients with obstructive jaundice were studied. Proformas form was filled an assessment of demographic and clinical patterns in benign and malignant obstructive were observed and radiological findings in benign and malignant obstructive were carried out to assess the operability. Result: we enrolled 100 patients, 18 were male and 82 were female having mean age was 52.58 yr. All patients have icterus, 60% lumping women, and 31% have pruritus. Gallbladder was palpable in 40% of patients which were due to pancreatic and Periampullary malignancy. Our study reveals the most common overall and benign cause of biliary tract obstruction was CBD stone(33%) and the most common malignant is gall bladder carcinoma(31%) followed by Periampullary carcinoma(17%). CBD stonesare treated by CBD exploration(85%) and palliative treatment by ERCP(15%) and the rest of the benign conditions are completely treatable. Among malignant causes of gallbladder carcinoma treated by radical cholecystectomy (16%), cholangiocarcinoma was mostly inoperable, and Periampullary carcinoma by Whipple's procedure (25%). Conclusion Malignant causes of obstructive jaundice outnumbered benign causes. The most common overall and benign cause was Choledocholithiasis and the malignant was gallbladder carcinoma followed by Periampullary carcinoma. Benign causes were prevalent in younger age groups (31-40 yr) and malignant in older age groups (61-70 yr). A common presentation of obstructive jaundice was icterus and palpable gallbladder was indicative of malignant etiology. Ultrasound followed by MRCP/ERCP and CT scan was the investigation of choice. Benign conditions have better outcomes and cure rates while malignant conditions were inoperable (83%).

Introduction: Pre-emptive analgesia provides some short-term (reduction in perioperative pain and acceleration of recovery) and long-term (prevention of chronic pain syndrome) benefits. Therapies that have been tested in pre-emptive trials include NSAIDS, intravenous opioids, IV Ketamine, peripheral local anesthetics, caudal and epidural analgesia, dextromethorphan, gabapentin, magnesium and dexmedetomidine. Aim & Objectives: As dexmedetomidine and magnesium seem to be new weapons in the armamentarium of anaesthesiologists to combat post-operative pain to reduce the requirement of anesthetics intra operatively; we planned this study to compare these two agents in our set up to know exactly their effectiveness in terms of intensity of pain relief and it’s duration, side effects and effect on haemodynamics. Material & Method: This was a double-blinded prospective study in which patients were randomly divided into 2 groups, 55 patients in each group. Group A (n=55) patients were administered intravenous dose of 1.0µg/kg dexmedetomidine for 10 minutes in 100 ml saline followed by a continuous infusion of 0.7µg/kg /hr till completion of the surgery. Group B (n=55) patients were administered intravenous dose of 50mg/kg magnesium sulphate for 10 minutes in 100 ml saline followed by a continuous infusion of 15mg/kg/hr till completion of surgery. Complaints of pruritus, nausea, vomiting, respiratory depression and shivering among all patients were carefully observed, recorded and managed symptomatically. Results: During the intraoperative and postoperative periods, Dexmedetomidine found to show better haemodyamic profile when compared to Magnesium sulphate. The postoperative analgesic scores and the requirement of rescue analgesics, both in terms of frequency and dosage were found significantly lower in Dexmedetomidine group (p=<0.001), compared to Magnesium group. The patient satisfaction scores were significantly higher (P = 0.011) in patients administered Dexmedetomidine, compared to Magnesium. Hypotension and bradycardia were more frequently observed in magnesium group, though no statistical significance could be attributed to this finding. Side effects like vomiting and nausea were more frequent in patients administered Magnesium. Conclusion: Dexmedetomidine as a preemptive analgesic provides better postoperative analgesia with a better haemodynamic profile as well as better patient and surgeon satisfaction with minimal side effects.

Introduction: Deep Vein Thrombosis (DVT) is the third most common vascular disease after myocardial infarction and ischemic stroke. DVT is a multi-factorial disorder with many inherited and acquired risk factors playing in its etiopathogenesis. Homocysteine (Hcy) is a sulphur-containing amino acid which plays a vital role for development of the tissues. Hyperhomocysteinemia is a disorder of methionine metabolism and a modifiable risk factor of myocardial infarction, peripheral arterial thrombosis as well as deep vein thrombosis and pulmonary embolism. Increasing prevalence of DVT worldwide causes increased morbidity & mortality & have increased economic burden in the community. Pathogenesis of DVT may be associated with the destruction of vascular endothelial cells resulting from immune and inflammatory mediators.mStudies about the role of Homocysteine in the pathogenesis of vascular thrombo embolism, shown conflicting results hence any reliable clue will be considered valuable. Aims & Objective: To estimate serum Homocysteine in female DVT patients and to assess the relation between hyperhomocysteinemia and deep vein thrombosis. Materials and Methods: This cross-sectional study included 60 female patients of DVT. Venous blood sample was collected in heparinized vial and analyzed for homocysteine levels. Results: In our study we found significantly raised serum homocysteine levels (p value <0.05) in females belonging to more than 40 yrs. of age as compared to the other age group. Conclusion: In our study we found that women are more susceptible to the pathological effects of elevated homocysteine levels in age group more than 40 yrs. which may be a risk factor for DVT

Background: Inflammation plays an important role in development and progression of the COVID 19 disease. Among all inflammatory markers, IL6 is a good predictor for symptomatic cases. But it is time-consuming, less cost-effective that cannot be done in low resource constraint setting.  So, we want to search another equally effective inflammatory biomarker that can be done in low resource setting. NLR and d-NLR are inflammatory parameters, we estimate association of NLR and d-NLR with disease severity and mortality. Methods: 150 COVID-19 patients aging between 18 and 45 years and 150 age and sex matched apparently healthy people were included. Then case group participants are subdivided into three sub-groups according to disease severity. Thereafter, all of the patients and healthy persons were subjected to the estimation of serum IL-6 and find out NLR and d-NLR. Results: It was found that the mean NLR d-NLR and IL6 were increased with disease severity. Then Pairwise multiple comparison in the post hoc ANOVA analysis with Bonferroni correction within the case group was performed and it became evident that IL6 concentration and NLR were significantly increased. It also found that IL6 and NLR were well correlated with disease severity. Then Pearson correlation was done and it was shown that IL6 with NLR and d-NLR are well correlated with disease severity. Then to determine the diagnostic value of the NLR for COVID 19 ROC curve and logistic regression analysis were performed and found that NLR of 5.89 and d-NLR 2.78 were demonstrated as the optimal cut-off value as a predictor of disease severity and 9.48 was disease mortality. Conclusion: NLR and d-NLR equally effective like IL6 for disease severity, prognosis and mortality from COVID-19.  They can be done in primary health care level as they are cheap, easily available.

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. The anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. Introduction: It is a granulomatous tract, single, or multiple external openings, which connects perianal skin to the epithelium of the anal canal or rectum.  Aims and Objective: The objective of the study was to assess the role and benefits of the fistula plug technique (modified seton placement) using absorbable sutures in the treatment of fistula-in-ano. Materials and Methods: This prospective clinical study was carried out on 50 patients between March 2019 and February 2021 Results: most of the patients were in the age group of 20–40 years (52.0%) with male preponderance (82%). The majority of the patients 37 (74.0%) showed recurrence at 1-year follow-up. Post-operative wound infection was seen in 24.0% of patients. Intersphincteric fistula was seen in 60.0%. No complications such as anal stenosis or incontinence were seen in our study subject. Conclusion: It is a very good alternative in cases of anal fistula. However, this technique has the vast disadvantage of a high incidence of recurrence and it cannot be used as a permanent alternative to surgery.

Background: Varicose veins could be a complicated condition, which may lead to limb swelling, pain, and venous ulcer. Conservative hemodynamic correction of venous insufficiency (CHIVA) has been developed over the past two decades and is currently the second most common surgical procedure for the operative treatment of varicose veins. Endovenous laser treatment of great saphenous vein was approved by FDA in 2002 and short saphenous vein (SSV) was approved in 2003. Endovenous laser ablation (EVLA) is a clinically safe, feasible, and well-tolerated technique without scar and allows people to return to their normal daily activities rapidly. Aims And Objectives:  To study the surgical management (great saphenous vein [GSV] stripping and perforator ligation) and its outcome and compare the outcome of GSV stripping in case of saphenofemoral junction incompetence and perforator ligation in case of perforator incompetence with the results of endoscopic and endovenous procedurespublished in the literature. Results: The patients with varicose veins were treated with high ligation with stripping followed by foam sclerotherapy and RFA. None of the patients undergoing high ligation with stripping had DVT and recurrence which favors the procedure selection for management. However, high ligation with stripping was associated with tenderness followed by infection. complications were less prevalent and only two patients had tenderness. Similarly, in radiofrequency ablation (RFA), one patient each had recurrences, skin color changes, and tenderness. None of the patients undergoing HL/S and foam sclerotherapy had recurrences. It was found that the duration of hospital days was more with HL/S; the majority had 6 to 8 days duration of hospital days whereas 13 patients had it for 4 days. In RFA, the majority had a duration of hospital days of 2 to 3 days only. Conclusion: open surgical management remains important in the treatment of varicose veins and is usually preferable to endovenous procedures and associated with less morbidity if carried out correctly.