European Journal of Cardiovascular Medicine

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: In gynecology, abnormal uterine bleeding (AUB) is a common symptom. AUB has been shown to affect 10-35% of women at some point in their lives (1). The prevalence of abnormal uterine bleeding in the United States is 53 per 1000 between the ages of 18 and 50, with a mean menarche age of 12 years and a mean menopause age of 51 years (2,3).

Objectives:

1. To study the various etiopathological factors responsible for abnormal uterine bleeding in women ages 20-55 years.

2. To evaluate the contributing aetiologies, common presentations, diagnosis, evaluation and management of abnormal uterine bleeding (AUB) on PALMCOEIN approach.

Background: Liver abscess is a global health concern with diverse etiologies, including bacterial, parasitic, fungal, or mixed infections. This study aimed to comprehensively investigate the clinicopathological and radiological aspects of various types of liver abscesses in a tertiary hospital center. Material & Methods: A retrospective analysis of 60 patients with liver abscesses was conducted from August 2022 to July 2023. Clinical presentations, laboratory findings, imaging characteristics, microbiological profiles, and abscess volumes were assessed. Liver abscesses were categorized based on ultrasound findings. Data were analyzed descriptively. Results: Fever (76.67%) and upper abdominal pain (66.67%) were the predominant symptoms. Leucocytosis (>11000/mm³) was observed in 63.33% of cases. Escherichia coli (15%) and Klebsiella (10%) were common isolates. Most abscesses (55%) presented with right upper quadrant tenderness. Ultrasound-guided aspiration facilitated diagnosis, revealing amoebic, pyogenic, and fungal abscesses. Abscess volumes ranged from 100-600 cc. Conclusion: Liver abscesses present with diverse clinical features and microbiological profiles. Diagnostic imaging, especially ultrasound, plays a crucial role in characterizing abscesses. The study underscores the importance of a multidisciplinary approach for accurate diagnosis and management.

Among the top 10 causes of death globally is tuberculosis. Chest radiography and sputum microscopy are the 2 basic investigations that are done to diagnose a case of pulmonary tuberculosis. Sputum CBNAAT is next diagnostic method of choice in sputum smear negative cases. The purpose of this study was to assess the link between chest radiography findings with method of microbiological detection. This study included 200 microbiologically confirmed cases of pulmonary tuberculosis that were diagnosed with either sputum microscopy (spontaneously produced or induced sputum) or sputum CBNAAT. Chest radiography findings were categorised based on type and location of lesions and extent of disease. Most common radiographic abnormality was consolidation, 61% of these were diagnosed on microscopy of spontaneously produced sputum. 70% patients of cavitary lesions and 80% with abscess were diagnosed on microscopy. Diagnostic yield of microscopy was less in lymphadenopathy and those with minimal lesions on chest radiography. All cases of miliary pattern (n=4) were detected on sputum CBNAAT. Sputum microscopy is fairly easy and sensitive method of diagnosis of pulmonary tuberculosis. With microscopy, patient can be diagnosed and started on treatment in single visit to healthcare facility. Sputum CBNAAT is more sensitive technique but due to requirement of higher expertise and specialized equipment, it’s not available at most of the peripheral centres. Sputum CBNAAT is the next diagnostic method of choice for sputum smear negative cases but due to unavailability, either sample or patient is to be transferred to higher centre which further delays the diagnosis and initiation of treatment. Apart from paediatric and HIV/AIDS patients, we suggest that sputum CBNAAT should be used for diagnosis of cases with miliary pattern and minimal involvement to shorten the time to diagnosis and initiation of treatment.

Background: A number of clinical and radiological indicators can reliably detect the prognosis of a stroke. Improved biomarkers for predicting prognosis in acute ischemic and hemorrhagic stroke are still elusive. Aims and Objective: The present study was aimed to observe whether serum cortisol acts a biomarker in predicting the severity of stroke. Materials and Methods: A prospective study performed among 50 patients with ischemic in Group A and 50 patients with hemorrhagic stroke in Group B. The random serum cortisol of these patients was compared with the NIHHS score. Results: Incidence of hypertension was significantly higher in group B than group A (72% vs. 38%; P<0.0001). Both systolic and diastolic BP were significantly higher in group B in comparison to group A (P<0.001). Severity of stroke was significantly higher in group B in comparison to group A (P<0.001). Mean cortisol levels were significantly more in group B in comparison to group A (P<0.001). Also, a statistically significant correlation with raised serum cortisol levels and the severity of stroke irrespective of type of stroke was observed. Conclusion: The study revealed that serum cortisol can be used as a biomarker for the prediction of severity of stroke.

Background: This study was conducted to evaluate the effects of intrathecal vs. intravenous dexmedetomidine on the duration of sensory and motor blockage and analgesia in patients having lower limb procedures while under bupivacaine spinal anaesthesia. Methods: This was a hospital based prospective comparative randomized study conducted among 90 patients who were scheduled to undergo lower limb surgeries under sub-arachnoid block at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore, from February 2021 to September 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean time for onset of sensory blockade was 1.24 ± 0.44 min and motor block was 1.38 ± 0.39 min in group IT, 1.40 ± 0.54 min and 1.49 ± 0.51 min respectively in group IV. The onset of motor blockade was significantly faster in the intrathecal group compared to the intravenous group (p < 0.001). The mean duration of sensory blockade was 295.11 ± 38.88 min in group IT and 251.78 ± 46.19 min in group IV. The mean duration of the motor block was 307.78 ± 30.74 min in group IT and 263.11 ± 47.62 min in group IV. The duration of sensory and motor blocks was significantly higher in the intrathecal group when compared to the intravenous group (p<0.001). The mean duration of analgesia was significantly longer in group IV (p<0.001). Conclusion: Intrathecal dexmedetomidine is a better alternative to intravenous dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine intrathecally, as it provides good quality intraoperative and post-operative analgesia under stable hemodynamic conditions with minimal adverse effects.

Background: Numerous studies have been conducted to deduce the association of serum lipid abnormality and BMI with diabetic retinopathy with inconsistent results. With a high prevalence rate of diabetes mellitus in India, diabetic retinopathy is emerging as a frequent cause of acquired blindness. Hence, the present study was conducted to assess the association of serum lipid level and BMI with different grades and severity of Diabetic Retinopathy, to facilitate future research towards preventive measures. Methods: 150 diabetic patients with retinopathy (Group I) were compared with age and sex matched 150 diabetic patients without retinopathy (Group II). All patients were assessed for serum lipid profile & BMI. Detailed fundus examination was done by indirect ophthalmoscope and 90D lenses after mydriasis with 0.8% tropicamide and 5% phenylephrine eye drops and the findings were documented by photography. Statistical analyses were performed using statistical software R version 3.5.1. The results were expressed as mean ± standard deviation for quantitative data and Pearson’s Chi-square test and t-test were used for qualitative data. P value < 0.05 was considered significant. Results: Patients with DR (Group I) were associated with higher TCL, LDL and TG than without DR (Group II). Significant positive correlation was observed between total cholesterol, LDL cholesterol and severity of DR. No significant association was seen between TG and severity of DR. A significant negative correlation was observed between HDL and severity of DR. There was no significant association between BMI and severity of DR. Conclusion: Increased levels of total cholesterol, LDL, triglycerides, and decreased level of HDL are associated with higher incidence and increased severity of DR as well as CSME, with the exception of high TG level. However, no significant association between higher BMI and severity of DR was observed. Further studies are required to strengthen the establishment of the causal relationship of these factors with diabetic retinopathy, so that appropriate treatment guidelines can be formulated to mitigate the risk of development of DR.

Aim Of Study : Clinical study over a period of 2 years, to analyze the demographics such as age, sex, occupation, site of lesion, symptomatology and prognosis of the most frequent benign lesions of larynx. Material & Methods : The present study “clinical study of benign lesions of larynx” has been carried out in the department of ENT, NRI medical college, Chinakakani over a period of 2 years. During this period patients who presented with hoarseness of voice were evaluated and 52 patients with benign lesions of larynx were included in the present study after taking their consent. Conclusion: Human voice is an extraordinary attainment, which is capable of conveying not only complex thoughts but also subtle emotions. In our present study, it is seen that benign lesions of larynx were more common in males, maximum incidence between 41-50 years. Teachers among males and housewives among females most effected. Right vocal cord polyp was the most common lesion apart from vocal cord polyp (bilateral and unilateral), Reinke’s edema as least. Vocal abuse was a strong predisposing factor in all the cases included in the study others being upper respiratory tract infection, smoking and alcohol consumption. Hoarseness of voice was the most common clinical presentation, foreign body sensation in the throat, vocal fatigue, difficulty in breathing were the other clinical presentations. Definitive treatment of microlaryngeal surgery and voice rest was advised to the patients with vocal cord nodules and vocal cord polyp and the same was executed in those patients were consent for surgery was given.

IBackground: The prime challenge of physicians in 21st century is cardiovascular disease (CVD). Cardiovasculardisease principally ischemic heart disease and stroke are the leading cause of mortality and majordisability in the world. The most important modifiable risk factors of CVDs are dyslipidemia, obesity and hypertension. The effects of unhealthy diet and physical inactivity include abnormal blood lipids, obesity and hypertension. Objective: To evaluate & correlate the pattern of lipid profile & blood pressure in obese & non-obese patients. Materials and methods: This is a cross-sectional study based on a database of 180 adults who received routine health screening. Subjects (n=180) include both male and female age between 20- 50 years who were willing to participate in the study, having body mass index (BMI) > 18.5 kg/m2,were considered. Subjects who are known case of obesity secondary to hypothyroidism, Cushing’s syndrome, hypothalamic disease, pregnant, congestive cardiac failure, renal failure, cirrhosis withascites and those on lipid lowering drugs or any drugs affecting lipid metabolism were also excluded. Subjects who are on antihypertensive drugs were also excluded. Statistical analysis: The data are expressed in numbers as means ± SD. The t test was used to compare continuous variables, such as obesity indicators and biochemical parameters, between the two groups. Statistical analyses were performed using SPSS version 26.0 (SPSS Inc.,). A p value < 0.05 was considered statistically significant. Result: Blood pressure was elevated in Gr-III as compared to Gr-I+II (p<0.001). Serum Cholesterol, triglycerides, LDL, VLDL were elevated in Gr-III as compared to Gr-I+II (p<0.001).HDL was decreased in Gr-III compared Gr-I+II (P<0.001). In our study shows comparison of lipidprofile parameters and blood pressure parameters between nonobese (Gr-I+II) and obese subjects(Gr-III). Elevated cholesterol, triglycerides, LDL, VLDL in Gr-III as compared to Gr-I+II. It also shows elevated blood pressure parameters in Gr-III compared to Gr-I+II. Conclusion: Obese persons are prone to develop elevated serum cholesterol, triglyceride, LDL and VLDL cholesterol as compare to non-obese. There is a positive correlation of serum cholesterol, triglyceride, LDL and VLDL level with body mass index in this study, and there is negative correlation of serum HDL level with body mass index. The mean values of blood pressure parameters are more in obese subjects as compared to non-obese subjects.

Introduction: Psoriasis is a common, chronic auto- immune disorder affecting a significant proportion of the population. It frequently affects the skin, musculoskeletal system, the gastrointestinal system and the eye, and is characterized by itchy red patches with scales which tend to flare in a cyclical manner. Due to the inexistence of a standardized cure for the disease, and the unsatisfactory results with the conventional drugs and treatments in use owing to the side effects and the development of drug resistance, 95% ethanolic extract of Nigella sativa was evaluated for its antipsoriatic activity.  Aim: To evaluate the Antipsoriatic Activity of Ethanolic Extract of Nigella Sativa in Propranolol Induced Psoriasis in Guinea Pigs. Materials and methods Study was conducted in the central animal house in Government Thoothukudi Medical College, Thoothukudi between December 2021 and March 2022 after receiving approval by Institutional Animal Ethical Committee of Government Thoothukudi Medical College, Thoothukudi, dated – 07/06/2019. 12 guinea pigs were divided into 3 groups, with 4 animals in each group. All the three groups received 0.1mg of 1% propranolol orally on a daily basis, for 14 days. In addition to it, they also received intradermal injections 2mL of Complete Freund’s Adjuvant(CFA) once a week for two weeks. After the induction of psoriasis, Group 1 was used as positive control. Group 2 was given standard drug 0.1% Tazarotene topically for 14 days, and Group 3 was given 95% ethanolic extract of Nigella sativa applied topically for 14 days. The psoriasis severity was calculated using the Psoriasis Area and Severity Index (PASI) before and after the use of the drugs, and the antipsoriatic action of the ethanolic extract of Nigella sativa was assessed by using Mann Whitney U and Kruskal Wallis test to analyse the association between the variables with p value less than 0.05 was taken as significant. Results: Considering day 14 to be the cut off for assessing the changes in the lesion, Group 1 animals did not show any reduction in the area or severity of lesions. The group 2 animals which were treated with Tazarotene showed a rapid decline in the psoriasiform lesions with an average PASI score reduction from (5.5 to 1.5). Considering day 14 to be the cut off for assessing the changes in the lesion, Group 3 animals after being treated with topical ethanolic extract of Nigella sativa showed an appreciable reduction in the severity of the lesion with an average PASI score reduction from 5.5 to 3.25. The erythema, induration, desquamation and the surface area of the lesions were considerably diminished. Conclusion The ethanolic extract of Nigella sativa was found to have a significant antipsoriatic effect on the induced lesion, when compared with control group.

Several emerging evidences have documented cardiovascular disease arise due to multifactorial causes with elevated diagnostic serum levels such as Lactate dehydrogenase (LDH).  LDH could be a useful marker of systemic inflammation, as it is a cytoplasmic enzyme that is widely expressed in tissues. As elevated LDH levels reflect cardiac damage and is used to diagnose acute myocardial infarction, valve heart disease, heart failure, and coronary heart disease, therefore, present study was aimed to evaluate the serum LDH levels in the pathogenesis of CAD. Present study was carried out at Manva kheda, Udaipur, Rajasthan, from 2013 to 2014on 100 patients suffering from myocardial infarction and for comparative study 50 controls were included after check-up at our hospital and after explaining about the examination, a signed informed consent was obtained. So from all the participants 5ml of blood was obtained and serum was extracted for further LDH analysis. It was observed that, total mean age of controls and patients is 54.64 ± 7.75 and 57.36 ± 11.96 years respectively. LDH level was 157.74 ± 23.11. Males had 158.08 ± 23.37 and females had 156.40 ± 23.16 U/L. With biochemical parameters done on MI Patients, the value of LDH was 317.25+36.91 U/L. The males had 316.71+41.53 and females had 318.88+17.21. The t and p value of patients (male) and control (male) was statistically highly significant with 26.20; P<0.001 and t and p value of patients (female) and control (female) was also statistically highly significant 20.08; P<0.001.Hence, concluded that, LDH in myocardial infarction revealed increased serum levels for all patients with myocardial infarction and remained to be a significant marker in predicting MI.

Background: Extra Y chromosome was found to cause more aggression with a ratio 1:28 in case of violent and aggressive males. The present study was done to see the level of aggression and number of Y chromosomes in the taller male prisoners of Ambala Central Jail. Material &Methods: The Buss and Perry questionnaire along with certain demographic factors was used to estimate the level of aggression in the male prisoners. Buccal smear staining and conventional karyotyping method was used to see the presence of extra Y chromosome. Results:  The aggression score was found highest in the tallest group of males and no extra Y chromosome was found in the prisoners. Conclusions: The aggression score was found increasing with the height. So, a correlation was found between height and aggression.

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results: The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%, 18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively. The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion: Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care.

Cardiovascular diseases (CVD) are major contributors to global burden of chronic diseases with 29.3% of global deaths and 9.9% of total disease burden. The diagnosis of the Myocardial infarction (MI) was based upon the electrocardiogram (ECG) and even if not indicated then different cardiac marker for example Serum Aspartate Transaminase (AST)was done for the confirmation of MI. Therefore, the present study was conducted on 50 normal and 100 patients suffering from myocardial infarction attending /admitted to various wards of Manva kheda, Udaipur. Patients with known cases of Diabetes mellitus and obese person were also included in study. The diagnosis of MI was confirmed by ECG changes and cardiac biomarkers. Controls were 50 normal healthy age and sex matched individuals without any major illness and not on any medications. 5 ml blood sample was obtained from both the groups and was subjected to centrifugation for serum separation and appropriate test analysis was performed. The total mean age of controls and patients is 54.64 ± 7.75 and 57.36 ± 11.96 years respectively. The value of serum AST was 25.76 ± 5.82, in which males had 26.08 ± 5.28 and females had 24.5 ± 7.82 IU/L. With biochemical parameters done on MI Patients, AST was 79.51+23.06. The males had 81.57+23.89 and females had 73.32+19.51 IU/L. The t and p value of patients (male) and control (male) was statistically highly significant with 19.25; P<0.001 and t and p value of patients (female) and control (female) was also statistically highly significant 10.57; P<0.001. Hence, concluded that, ASTin myocardial infarction revealed increased serum levels for all patients with myocardial infarction and remained to be a significant marker in predicting MI.

Background This prospective observational study was undertaken to look into the factors that affect the outcome of total knee arthroplasty and the short-term results of total knee replacements in complex knee pathologies. Methods  This prospective observational study was conducted between 2021 and 2023 at Owaisi Hospital and Research Centre, Hyderabad. A consecutive series of 12 total knee arthroplasties was performed on 12 patients at our institute using PFC Sigma endoprosthesis. The patients were assessed clinically and radiologically using the INSALL scoring system.  Results The average pre-operative range of motion (flexion) was 45˚, with a highest of 120˚ and a lowest of 0˚. The average post-operative flexion was 102˚, with a highest of 130˚ and a lowest of 90˚. The average extension lag preoperatively was 18˚, and the average postoperative extension lag was less than 10˚. The average pre-operative knee score was 64.84, with the highest score of 91 and the lowest score of 40. The majority of the patients had a score in the range of 51–100. The average post-operative knee score was 136.84, with the highest score of 160 and the lowest score of 120. A majority of the patients had an improvement in score in the range of 101–150. At 6 months, follow-up relief was excellent in most patients; only 10 patients had anterior knee pain, and all the patients were able to walk more than 50 blocks post-operatively without any walking aid. Conclusion  Determining the factors resulting in a difficult knee helps in formulating an appropriate surgical approach, which results in a better functional outcome following total knee arthroplasty.

Introduction: Cardiovascular diseases (CVDs) include coronary heart disease, cerebrovascular disorders, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism among other conditions affecting the heart and blood vessels. The primary objective of this study was to examine the correlation between anxiety and depression and the risk of experiencing cardiovascular events and mortality after a myocardial infarction. Methods: The Cochrane review and preferred reporting item for systemic review (PRISMA) guidelines served as the basis for this systematic review. The systematic search was conducted from different database like Embase, Scopus, Medline, PubMed, PsycINFO, Google Scholar and Copernicus from inception to May 2023. Data on the number of patients, the country they were from, the age of diagnosis, anxiety, depression, cardiovascular events, myocardial infarction and death was collected. Result: 448 references were taken out because there were fewer of them. After the first round of evaluation, 286 out of the 323 citations were found to be unnecessary. The full texts of 37 publications were looked at to see if they could be included. Ten of them met the minimum requirements. This systematic review analysis on anxiety and depression with risk of subsequent cardiovascular events and death after myocardial infarction included a total of 3560 patients from 10 studies. Conclusion: A significant part of deaths and disabilities globally are caused by cardiovascular diseases, and the number of deaths related to these conditions has increased in India along with the country's population growth. Anxiety was discovered to be a distinct risk factor for the occurrence of CVD and cardiac death in those who were initially in good health. Future studies on the biobehavioral mechanisms relating the physiological and psychological conditions that exist prior to myocardial infraction and long-term mortality could improve risk classification, long-term surveillance, and the creation of specialized therapies for myocardial infraction patients.

Purpose: The purpose of this prospective observational study was to assess the effect of the nutritional status of pregnant mothers on the birth weight of their new-borns. Material and methods: This study was a prospective observational study of 500 pregnant women registering at an antenatal clinic in GMH Rewa from January 2021 to June 2022. The study participants were followed up at their 2nd visit between 24th and 28th weeks and at their 3rd visit at the time of delivery. Anthropometric, dietary, and haematological parameters were obtained at each visit. Results: Among the 203 women, 140 (68.93%) gave birth to babies whose weight was appropriate for gestational age (AGA) babies, and 63 (31.03%) gave birth to babies whose weight was less than expected for gestational age (SGA) babies. The present study has shown an association between low maternal BMI, low weight gain, inadequate IFA intake, inadequate nutrient intake, inadequate protein intake, inadequate calorie intake, low haemoglobin count during pregnancy, and low birth weight babies. Conclusion: This study emphasizes the significance of a healthy diet and nutrition throughout pregnancy because they directly and favourably affect the new-born’s weight and overall health. Birth weight is statistically significant and positively correlated with maternal iron and folic acid supplementation, particularly blood iron levels. The potential benefits of nutrition and iron-folic acid supplementation, as well as the identification of their inadequacies, can support low-cost treatments intended to lower the incidence of SGA. The study suggests providing proper awareness and health education about pregnancy, timely ANC visits, nutrition, and institutional delivery for a better foetal outcome.

This study examines the influence on heart rate variability (HRV) indices in trained individuals as compared to untrained individuals presented in a prospective and cross-sectional study. The predictability of HRV in athletic performance is also included. Finally, some recommendations concerning the application of HRV methods in athletes are made. The cardiovascular system is mostly controlled by autonomic regulation through the activity of sympathetic and parasympathetic pathways of the autonomic nervous system. Analysis of HRV permits insight in this control mechanism. It can easily be determined from ECG recordings, resulting in time series (RR-intervals) that are usually analysed in time and frequency domains. As a first approach, it can be assumed that power in different frequency bands corresponds to activity of sympathetic (0.04-0.15 Hz) and parasympathetic (0.15-0.4 Hz) nerves. However, other mechanisms (and feedback loops) are also at work, especially in the low frequency band. During dynamic exercise, it is generally assumed that heart rate increases due to both a parasympathetic withdrawal and an augmented sympathetic activity. Most studies concern relatively small numbers of study participants, diminishing the power of statistics. In order to further develop this fascinating research field, we advocate randomised, controlled, long-term studies using validated measurement methods. There is a strong need for basic research on the nature of the control and regulating mechanism exerted by the autonomic nervous system on cardiovascular function in athletes, preferably with a multidisciplinary approach between cardiologists, exercise physiologists, pulmonary physiologists, coaches and biomedical engineers. In this study,  we determine the effect of long term endurance training (minimum period of one year) on heart rate variability in trained individuals  as  compared to the sedentary population, so that long term endurance exercise could be used for cardiac wellbeing.

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results:The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%,  18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively.The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion:Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care.

Background: This prospective observational study was undertaken to look into the factors that affect the outcome of total knee arthroplasty and the short-term results of total knee replacements in complex knee pathologies. Methods: This prospective observational study was conducted between 2021 and 2023 at Owaisi Hospital and Research Centre, Hyderabad. A consecutive series of 12 total knee arthroplasties was performed on 12 patients at our institute using PFC Sigma endoprosthesis. The patients were assessed clinically and radiologically using the INSALL scoring system.  Results: The average pre-operative range of motion (flexion) was 45˚, with a highest of 120˚ and a lowest of 0˚. The average post-operative flexion was 102˚, with a highest of 130˚ and a lowest of 90˚. The average extension lag preoperatively was 18˚, and the average postoperative extension lag was less than 10˚. The average pre-operative knee score was 64.84, with the highest score of 91 and the lowest score of 40. The majority of the patients had a score in the range of 51–100. The average post-operative knee score was 136.84, with the highest score of 160 and the lowest score of 120. A majority of the patients had an improvement in score in the range of 101–150. At 6 months, follow-up relief was excellent in most patients; only 10 patients had anterior knee pain, and all the patients were able to walk more than 50 blocks post-operatively without any walking aid. Conclusion: Determining the factors resulting in a difficult knee helps in formulating an appropriate surgical approach, which results in a better functional outcome following total knee arthroplasty.

Introduction Diabetes mellitus affects > 530 million individuals across the globe and is responsible for most of the world’s burden of preventable blindness, end-stage renal disease, and non-traumatic lower limb extremity amputation. Diabetic kidney disease was traditionally considered to be caused by adverse effects of increased levels of glucose (metabolic theory). However multiple studies have found a low-grade inflammation in patients with diabetic kidney disease. Materials And Methods 119 Diabetic patients were selected for this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. The diagnosis of T2DM was made according to the American Diabetes Association guidelines. The complete renal examination was applied to all participants, and the diagnosis of nephropathy was made by microalbuminuria and kidney size. Results Out of the 119 patients selected mean age of the study population was 56.65 +/- 9.67, 86 patients were diabetics without kidney disease and 33 were patients with diabetic kidney disease. The median neutrophil count in our study is 4545 in patients without DKD and in patients with DKD, it is 4862 which is statistically significant as the p-value is < 0.5. Conclusionour study sheds light on the association between the development of diabetic nephropathy. The neutrophil count is a good indicator of the risk of diabetic nephropathy and can be used as a predictor of diabetic nephropathy.

Background: Examining music therapy's influence on heart rate variability (HRV), measured by RMSSD, to elucidate its potential therapeutic effects. Objectives: This study explores the impact of music therapy on heart rate variability (HRV), specifically examining RMSSD as an indicator of autonomic nervous system activity. Methods: Initially, participants exhibited an average RMSSD of 49.80 milliseconds, serving as a baseline. Therapeutic interventions involved distinct musical genres, each with varying durations of exposure. Results: Exposure to calming music for an average of 30 minutes induced a significant increase in RMSSD, averaging 54.78 milliseconds (T-value = -3.13, P-value = 0.0020), suggesting its potential to enhance parasympathetic activity and promote relaxation.Conversely, stimulating music led to a modest decrease in RMSSD to 47.31 milliseconds after 20 minutes, although statistical insignificance (T-value = 1.69, P-value = 0.0934) highlighted individualized responses. Some participants, particularly those favoring stimulating music, reported improved mood, emphasizing the intricate interplay of emotional and physiological responses.Neutral music maintained an RMSSD akin to the baseline after 25 minutes, affirming its non-intrusive impact on HRV.Intriguingly, the control group, undergoing relaxation exercises without musical intervention, exhibited near-unchanged RMSSD at 49.73 milliseconds (T-value = 0.042, P-value = 0.9662), raising questions about the comparative efficacy of music therapy versus other techniques. Conclusion: This study reveals the multifaceted effects of music on HRV, with calming music enhancing parasympathetic activity, while responses to stimulating music vary. The contrast with neutral music underscores music's differential impact. The inclusion of a control group highlights potential avenues for therapeutic innovation and warrants further exploration. These findings have implications for tailoring music therapy interventions to individual preferences and optimizing their effectiveness.

Introduction: Acute MI is one of leading causes of death and majority of deaths are due to arrhythmias. The aim of this study was to evaluate the incidence and risk factors and outcomes of fatal arrhythmias. Early revascularization reduces the risk of fatal arrhythmias.  Most arrhythmias causes deaths within 48 hours and it includes bradyarrhythmias, heart blocks, atrial fibrillation and ventricular tachycardia and fibrillation. Aims and objectives: This study examines arrhythmias in acute coronary syndrome patients in the first 24 hours following presentation. Method: We collected hospital data from June 2022 to june 2023 with a 3 months follow-up after discharge. The study assessed clinical presentation, ECG monitoring of 900 ACS patients. Data was rigorously collected, including demographics, clinical information, and follow-up outcomes. Inclusion criteria: includes adults over 18 years with Acute MI. Exclusion criteria:  contraindications for monitoring, severe arrhythmias, communication issues. Result: Patients with acute myocardial infarction (AMI) were 2.21 times more likely to have >50 PVCs per hour. Those over 65 had a 2.41 times higher risk. The model fit well (chi-square value 14.79, p = 0.0004). Length of stay strongly correlated with AMI diagnosis (F value 35.41, p < 0.0001). Various arrhythmias were found, including PVCs (44.44%), non-sustained VT (20.44%), supraventricular (11.33%), and atrial fibrillation (6.55%). Sustained VT (2.44%), asystole (2.22%), torsade de pointes (1.11%), and ventricular fibrillation (1.11%) were less common but serious. Right bundle branch block was the most frequent conduction deficit (5.77%), followed by 2nd degree (2.66%) AV block, left anterior fascicular block (2.88%), left bundle branch block (1.77%), and left posterior fascicular block (0.88%). These findings emphasize the range of arrhythmias and conduction issues, highlighting the need for tailored therapeutic and monitoring approaches. Conclusion: This study concluded that life-threatening arrhythmias were less common compared to benign ventricular ectopics and supraventricular tachycardia in ACS patients in PCI era. Patient had favourable outcome if they received timely PCI.Isolated PVCs affected approximately 25% of the sample. It independently increased hospital stay but did not affect other outcomes.

Aim of the study to know main trunks of right and left coronary arteries with respect to diameter and branching pattern in central India population. Coronary arteries show wide variations among different populations. The present study was undertaken on 70 adult human heart specimens from embalmed cadavers. Hearts were dissected and studied. Length and external diameter of main trunks noted. Branching pattern of main trunk of right coronary artery and left coronary artery studied. Out of seventy hearts, trunk length of right coronary artery ranged from 0.1-5.9 cm. with mean of 2.59±1.45 cm. The range of trunk length of left coronary artery is 0.2-2 cm. with the mean of 0.60±0.37 cm. The range of external diameter of main trunk of right coronary artery is from 2.34-6.5 mm. The external diameter of left coronary artery main trunk ranges from 4.34-6.6 mm. Thus it is seen that the external diameter of left coronary artery main trunk was larger than right coronary artery. Right coronary artery is found to terminate at the right border in 6 hearts (8.57%), between the right border and crux in 5 hearts (7.14%), at the crux in 20 hearts (28.57%), between crux and left border in 38 hearts (54.28%) and at the left border in 1 heart (1.42%). Mode of termination of left coronary artery shows bifurcation and trifurcation. Bifurcation of left coronary artery observed in 65.71% of cases. In 34.28% of hearts trifurcation is observed. Here  main trunk of left coronary artery divided into left anterior descending, left diagonal and  circumflex arteries.

Introduction- Chronic thyroiditis embraces a heterogenous group of thyroiditis. Hashimoto’s thyroiditis forms the largest and clinically most significant cause of chronic thyroiditis. FNAC of thyroid provides a safe and accurate method of diagnosis of this condition. As there is paucity of literature on Hashimoto’s thyroiditis and the input of patients presenting with features of Hashimoto’s thyroiditis is on the rise, this study is under taken to correlate the cytomorphological features of Hashimoto’s thyroiditis

with clinical, biochemical and with antithyroid antibodies where ever feasible.

Objectives

1. Analysis of cytomorphological features on FNAC in Hashimito’s thyroiditis.

2. To determine the correlation between various cytomorphological features and biochemical & serological parameters in cases diagnosed as HT.

3. To correlate cytological diagnosis with histopathology wherever possible.

Materials and Methods This prospective study was conducted on 100 patients attending the cytopathology department of Adichunchanagiri Institute Of Medical Sciences, B.G. Nagara. Cytologically proven, cases of Hashimoto’s thyroiditis over a period of two years, from November 2017 to May 2019 formed the study material. The various parameters like patients clinical presentation, antithyroid antibodies & hormonal profiles, were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. RESULTS: Most of the patients were females (97%) who presented with a diffuse goiter (91.%). Hypothyroid features were present in 62.7% of cases. Anti TPO antibody showed positivity in.93.4% of patients. Cytomorphologic spectrum of Hashimoto’s thyroiditis was analysed and graded. Most of them had grade II disease by cytology.No correlation was observed between grades of cytomorphology and biochemical &

serologic parameters. Conclusion Despite the availability of several tests for diagnosis of Hashimoto’s thyroiditis, ‘FNAC’ remains the gold standard.

Background: The World Health Organization advised bedaquiline for the treatment of extensively drug-resistant (XDR), pre-XDR and multidrug-resistant (MDR) tuberculosis (TB). Bedaquiline is now recommended for usage for at least six months throughout therapy, it is used to treat drug-resistant tuberculosis when other treatment modalities cannot be used. This drug shows good result in clinically relevant patient associated with drug resistant tuberculosis. Objective: Present study was aim to analyseeffectiveness of bedaquiline treatment in patients with MDR, pre-XDR and XDR tuberculosis. We also aim to analyse the early culture conversion rate after starting bedaquiline treatment. Methods: Total 248 patients of which representing 160 patients with MDR and 88 patients with pre-XDR were included in the study. Sociodemographic data, outcome, HIV status, drug sensitivity, diagnosis and culture conversion rate were analysed. Results: There were 58.5% male and 41.5% female patients with mean age of 34.23 ± 15.42 years. Among total patients, 68.14% patients were cured whereas mortality observed in 21.4% patients. Total 46.4% patients exhibit resistance against isoniazid, 100% patients exhibit resistance against rifampicin and 43.5% patients exhibit resistance against fluoroquinolones.We found a significant linear declining trend in the positivity rate of sputum culture over a period of 24 months follow up which started declining from 3rd month & a significant drop after 8 months of treatment. Conclusion: Findings of present study are in consistent with the recommendations as per PMDT GUIDELINES 2021(Programmatic Management of Drug resistant Tuberculosis in India.)for the bedaquiline based drug resistant tuberculosis,which suggest a treatment of bedaquiline for6 months or longer showing the positive effect in sputum culture conversion & favourable effect on success rate as shown by pmdt guidelines.

Background: Iodine deficiency during pregnancy has substantial consequences; one such is fetal brain damage. Data on the potential effects of mild-to-moderate iodine deficiency on the thyroid function of pregnant women and their newborns are scarce and divergent. Henceforth we tried to find out an association between iodine intake in pregnancy with maternal and neonatal thyroid function. Methods: 350 full term (> 36 week of gestation) pregnant women within their reproductive age group aged 15 to 45 years were selected from attending the Labor room of the Department of Gynecology and Obstetrics at the Medical College and Hospital of Kolkata. Spot urine samples with venous blood samples were collected to select hypothyroid cases. Cord blood from newborn of these hypothyroid mothers for TSH estimation. Cord blood TSH value >20 µIU/ml were selected. Such families were asked to bring their house hold salt in a tight container or sealed packet. Salt iodine content was estimated by the iodometric titration method. Results: Approximately 10% of mother in were iodine deficient, with most of them falling into the “mild iodine deficiency” category. Only 5 babies of these mothers have cord blood TSH >20 µIU/ml.  Among these 5, only 1 (20%) of the households to have less than 15 ppm of iodine content and 4 (80%) households to have greater than 15 ppm of iodine content in their consumed salt. Conclusion: Pregnant women of the study area have iodine repleted. The neonatal thyroid function was also within normal range. The findings of the present study indicate that the iodine supplementation of the salt should be maintained in the area with periodical surveillance, especially about its preservation.

Introduction: Biochemistry is a very important subject in MBBS curriculum. because it teaches mechanisms of life at the molecular level Most students still have more difficulties in learning this subject and hate Biochemistry subject and what they do is mug up the topics before the unit tests. We though that there should be any supportive and alternative method to make the learning of Biochemistry interesting and increase curiosity of learning in the students’ minds. So, we decided to take poster preparation and presentation competition thinking that it will help in learning subject with interest along with traditional approach of learning biochemistry. Aim and Objective: To find out supportive or alternative method to learn biochemistry with interest by the student of first year MBBS Materials and Methods: 50 students participated then we grouped 3-5 student in each group into 10 groups. Topic was given to them related to medical biochemistry and asked them to prepare topic for poster preparation by giving proper instruction to prepare poster. 10 days’ time given to student to prepare topic by using standard textbook Results: Evaluation of poster done by expert teachers from department of anatomy physiology and biochemistry. Evaluation done based on 5 points that is content, originality creativity, presentation, interaction. Marks were given based on these 5 points and winner was decided. Prises given to first three groups. Conclusion: We started this alternative method to make the teaching of Biochemistry interesting and increase curiosity of learning in the students’ minds so, we as faculty along with majority of student found that Poster presentation exercise were beneficial activity to understand topic in depth and will increase interest of the student in subject biochemistry and all student participated enthusiastically So, we come to conclusion that this method can be supportive and alternative method to our traditional method of study biochemistry.

Aims & Objectives: To compare the incidence of placenta previa in current pregnancy in women with previously scarred and unscarred uterus. To compare the differences in incidence of placenta previa in current pregnancy in women with previously scarred and unscarred uterus; To compare the difference in maternal complications in current pregnancy in women with previously scarred and unscarred uterus; To compare the difference in fetal complications in current pregnancy in women with previously scarred and unscarred uterus. Methods: This was a Prospective cohort study conducted at Department. of Obstetrics and Gynecology, Kurnool Medical College and associated hospital, Kurnool from March 2021 to March 2022. Results: There were a total 1000 participants in the trial, of which 500 had a history of vaginal delivery in the past (Control Group PVD) and 500 had a history of uterine scarring in the past (Study Group PSU). In this current study, there were no significant differences in this patient distribution between the two groups based on presenting complaints like APH, and mean age, parity, GA, and foetal complications not appearance were comparable between the two groups. In this present study, in the women group PSU the number of previous cesarean sections were 1 in 69.2%, 2 in 27.6%, 3 in and above is 1.2% of the women, 2% of the women have history of D&C. With their history of one, two, three, or more cesarean sections or history of DC, placenta previa was observed in 3.1%, 12.3%, 33.3%, and 10% of instances, and the difference was determined to be statistically significant, indicating that scarring is a substantial risk factor for previa. Placenta prevalence was 2.4% in the PVD group and 6.8% in the PSU group, indicating a higher prevalence in the PSU group. The Placenta Previa group of PSU had more postpartum hemorrhage cases and interventions than the PVD group. Low birth weight (LBW), preterm, low APGAR scores, and NICU admissions were comparable in both groups with a modest increase in the PSU group. Conclusion: The current study's findings showed that uterine scarring in the past had a substantial impact on the chance of placenta previa in a subsequent pregnancy. Therefore, it's critical to encourage vaginal birth as much as possible. Regular prenatal checks, early diagnosis, and skillful management of previa are the keys to optimal maternal care.

Background: The mental foramen is a significant anatomical landmark that plays a crucial role in performing various types of surgical procedures and administering local anesthetics for oral and maxillofacial surgeries. Having a thorough understanding of the anatomy of this area is essential for performing effective nerve blocks and avoiding any damage to the neurovascular bundles. Hence, we aim to study the anatomical location, size, and shape of the mental foramen of the mandible in the population of Bihar and compare it with the findings of other studies. The mental foramen is a significant anatomical landmark that plays a crucial role in performing various types of surgical procedures and administering local anesthetics for oral and maxillofacial surgeries. Having a thorough understanding of the anatomy of this area is essential for performing effective nerve blocks and avoiding any damage to the neurovascular bundles. Hence, we aim to study the anatomical location, size, and shape of the mental foramen of the mandible in the population of Bihar and compare it with the findings of other studies. Materials and Methods:  The 120 dried fully ossified dentulous adult human mandibles (240 sides), of unknown gender and age, were used in the current cross-sectional investigation. Only those well-preserved mandibles that belonged to adults, were complete in all respects, and allowed for precise morphological observations were included in the study.  Results: Our study found that the mental foramen is most commonly round (60.42%) and exits in the postero-superior direction on both sides with a frequency of 92.92%. The mean transverse diameter is 3.22 mm on the right side and 3.74 mm on the left side, with a statistically significant difference (p-value ≤0.05). The mean vertical diameter is 3.37 mm on the right side and 3.48 mm on the left side. Our findings show that the most common position of the mental foramen in relation to the lower teeth is below the apex of the second premolar, accounting for 37.08% on the right side and 36.67% on the left side. The second most frequent position is between the first and second premolar, representing 7.92% on the right side and 7.08% on the left side. Additionally, a position between the second premolar and first molar teeth was observed, accounting for 5% on the right side and 6.25% on the left side. On the right side, the distance between the mental foramen and the symphysis menti was found to be 28.71±1.36 mm, while on the left side, it was 28.94±1.19 mm. Similarly, the distance between the mental foramen and the posterior border of the ramus was 73.83±1.12 mm on the right side and 78.91±1.86 mm on the left side. The distance between the mental foramen and the alveolar crest was 17.87±1.73 mm on the right side and 18.69±1.63 mm on the left side. Finally, the distance between the mental foramen and the inferior border of the body of the mandible was found to be 16.91±1.23 mm on both sides. Conclusion: This study provides data on the location and morphometry of the mental foramen, aiding dental surgeons in avoiding nerve damage during surgeries in this region.

Background:  Respiratory distress is the commonest morbidity responsible for majority of neonatal admissions to neonatal intensive care unit. It is a symptom complex arising from disease process that cause failure to maintain gaseous exchange.  Respiratory distress in new born can be due to a wide variety of conditions. The frequency of a given condition depends on various factors of which gestation is an important one. In preterm neonates, respiratory distress syndrome (RDS) is the most common cause while in the late preterm and term neonates’ transient tachypnoea of new born (TTN) is the predominant cause. Methods:  This is a prospective and observational study conducted among Neonates admitted with signs of respiratory distress to new born care unit, Dept. Of Paediatrics MKCG Berhampur (SNCU and NICU). Both inborn and out born babies admitted to new born care unit with respiratory distress were included. Neonates from birth to 28 days presenting with respiratory distress were selected through consecutive sampling. New born developing distress post admission were excluded from the study. Written informed consent were taken from parents concerned. Results: 110 respiratory distress cases were sampled consecutively for our study. The total admissions in the time period was 645 thereby making respiratory distress 15% of total admissions. When babies having respiratory distress were compared with place of delivery there were more number of out born cases 63 (57.3%) than inborn cases 47 (42.7%). Conclusion:  Survival of babies with hyaline membrane disease who were given exogenous surfactant therapy improved with increasing gestational maturity and birth weight. Sepsis is the major entity complicating outcome of babies who received surfactant. Proper antenatal care, early diagnosis of antenatal complications and avoiding preterm deliveries will aid in better outcome of newborn babies with respiratory distress.

Massive transfusion in obstetric catastrophes is to achieve surgical hemostasis while reducing the hypoperfusion complications.Aprospective observational study was conducted on subjects with obstetric hemorrhage requiring blood/blood product transfusions for 405 subjects out of 10063 subjects required transfusion (4.02% incidence).Association between massive transfusion and age ≥35 years was assessed using chi square test P value was <0.001 significant, similarly, irregular antenatal check-up was also found to be significant with P value 0.004. Association between previous LSCS and massive transfusion was found to be P value 0.017 significant and a significant association was found between platelet count & massive transfusion,blood loss & massive transfusion andshock and DIC with a P value of <0.001.

Background: Competency based medical curriculum  recommends self- directed learning skill to be developed in undergraduate medical students forlifelong learning .Hence the knowledge of learning styles isvery important to encourages students to use particular learning style in their self- directed learning. Aim-To assess the learning style of first phase and final phase MBBS studentsfor facilitation of  self- directed learning. Methodology: The VARK questionnaire  7.8 was  used to assess  the learning styles of MBBS students. Result: The predominant mode was kinesthetic, 37.37% and 31.63 % in first phase and final phase students respectively. The visual and auditory mode of learning was statistically significantly p>.05  more in final phase student The reading mode of learning in  first phase students was more in in final phase students although the difference was not statistically significant p <0.2.Conclusion: The preferred learning styles of medical students in the present studywas kinesthetic.Thelearning style in MBBS students need to assessed regularly forthe appropriate facilitation of Self- directed learning

Introduction- Chronic Kidney Failure (CKF)causes various problems over a period of time which includes cardiovascular diseases. Cardiovascular complications are major cause of deaths inpatients of CKF thanvarious other cause. In this complication’s dyslipidemia is commonly observed  features of CKF.Since various study shows that their relation between CRF and cardiovascular disease and dyslipidemia is constant feature we decided to study to understand the risk involved in cardiovascular morbidity in patients of CRF  by studying lipid profile Aim and Objective-To assess cardiovascular risk in cases of chronic renal failure by studying Lipid profile Materialand Methodology: This study was done in Medical College, Hospital and research Centre STUDY POPULATION: Total 100 subjects participated in this study 50 Chronic kidney failure (CRF) cases and 50 Controls. Collection of Blood SAMPLES: 8-10 ml of blood samples after fasting was collected before and after hemodialysis in a plain bulb taking all aseptic precautions. Serum was used after centrifugation.

Parameters

Lipid profile which includes

1.Serum Total Cholesterol-Dynamic extended stability CHOD-PAP Method (With LCF-Lipid Clearing Factor), End Point by Roeshlaus

2.Serum HDL-Cholesterol-Liquid stable reagent by Trinder reaction.

3.Serum LDL- Cholesterol-Liquid stable reagent by Trinder reaction.

4.Serum Triglyceride-Dynamic extended stability (With LCF)GPO-Trinder Method End Point

Observations and Results

In our studyLow Density Lipoprotein-Cholesterol, Total Cholesterol and Triglyceride levels increased in cases of chronic kidney failure patients in comparisonwith control whereasHDL-Cholesteroldecreased in casesof chronic kidney failure patients in comparisonwith control. Conclusion: In our study there is altered lipid profile found in our study in CRF there is increased cardio-vascular risk patients. Alteration in concentration of lipoproteins which causes acceleration of process of atherosclerosis in cases of CRF patients. These complications can be prevented by lipid lowering diet and drugs such as the HMG-CoA reductase inhibitors (statins). So, to prevent these cardiovascular complication proper diet advice and drug treatment should be given to the CRF patients.

Background: Dengue, is an arthropod-borne viral disease of significant public health importance. In the context of the rising burden of Dengue in South Odisha, this hospital-based cross-sectional study conducted at MKCG Medical College Hospital, Berhampur, aims to evaluate liver function tests in 100 Dengue patients. Recognizing the significance of hepatic involvement in Dengue, the study seeks to contribute valuable insights into the hepatic manifestations of the disease, potentially enhancing diagnostic and management strategies in this region. Methodology: Utilizing a systematic approach, this study employed a cross-sectional design at MKCG Medical College Hospital, Berhampur, enrolling 100 Dengue patients. Standardized liver function tests were conducted, including serum bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase. Data analysis involved descriptive statistics, providing a comprehensive overview of hepatic parameters in Dengue patients within the specified tertiary care setting Results: Among 100 Dengue patients, 40% exhibited less than a 2-fold increase in AST levels, while 28% showed a 2-10-fold rise, and 10% demonstrated more than a 10-fold increase. Overall, 22% maintained normal SGOT values, with 78% displaying elevated levels. Regarding SGPT, 20% had normal values, 35% presented with less than a 2-fold increase, 25% displayed a 2-10-fold rise, and 20% had more than a 10-fold increase from normal levels. Early-stage symptoms like vomiting and abdominal pain correlated with hepatic involvement, with statistically higher AST and ALT levels in patients developing complications such as DHF, DSS, hepatic failure, ARDS, AKI, and encephalopathy Conclusion: In summary, our study reveals a notable prevalence of hepatic involvement in Dengue patients, emphasizing the significance of vigilant monitoring, particularly in cases with early symptoms and those at risk of complications. These findings offer crucial insights for tailored interventions and enhanced patient care within the tertiary care context of South Odisha.

Introduction: Regional anesthesia is preferred for cesarean section as it allows a parturient to remain awake and participate in the birth of her baby while avoiding the risks of general anesthesia. The combined spinal-epidural (CSE) technique is frequently used to provide anesthesia and analgesia for labor and delivery. To improve the quality of intraoperative anesthesia, postoperative analgesia and aid early ambulation and recovery of motor block, several agents have been employed such as opioids and α-2 adrenergic agonist. Some recent placebo-controlled studies suggested that α-2 adrenergic agonist have both analgesic and sedative properties when used as an adjuvant in regional anesthesia.  Materials and Methods: After obtaining written consent from the 180 patients, they were randomly divided into three groups of thirty each. All the patients were pre-operatively assessed and the technique for study was explained to them. Patient’s age ranging from 25 to 60 years, of either sex, belonging to ASA I and II and no contra-indications to epidural analgesia or the drugs were taken into consideration. The three groups were comparable in terms of baseline demographic parameters like age, sex, and weight. Basal haemodynamic parameters were comparable. Patients of ASA III and above, allergic to study drugs were excluded from the study. Results: 180 patients were enrolled in the study. In group A, 60 patients, in group B 60 patients, in Group C 60 patients. In group A, 34 patients were male, 26 patients were females, In group B, 32 patients were male, 28 patients were females. In group C, 30 patients were male, 30 patients were females. Analgesia and sedation was more in Group C than the other two groups. Cardiovascular stability was good in groups A and B. Conclusion: Since sensitivity to a drug depends on numerous factors, the search for an ideal dose in endless. We found that epidural dexmeditomidine 50 mcg dose gave satisfactory analgesia and sedation with minimal side effects. 

Background: As we are aware that chronic liver disease frequently associated with haematological abnormalities which presents Anaemia of diverse etiology occurs in about 75% of patients and also this condition may be exacerbated by deficiency of folic acid and/or vitamin B12 that can occur secondary to inadequate dietary intake or malabsorption. So In this study we want to evaluate chronic liver disease patients having anaemia without overt bleeding in the past 3 months to know the severity and type of anaemia in these patients so as to enable us better management and decrease associated morbidity and mortality. Research Question: What is the scenario of anaemia in the spectrum of chronic liver disease 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 April 2022 to May 2023 on about 100 chronic liver disease patients having anaemia whose Hb levels <10 g/dl without overt bleeding in the past 3 months  admitted during the above period in the department of Gastroenterology by studying their socio-demographic profiles, type of chronic liver disease and anaemia with related laboratory investigations etc. Results: It was observed that in ALC the most common anaemia is folic acid deficiency (39.7%) followed by Iron deficiency (37.2%), in HBV most common anaemia was Iron deficiency (54.5%) followed by Folic acid deficiency (36.4%), in HCV both Iron and Folic acid deficiency were equally distributed (42.9%) and in NAFLD Iron and B12 deficiency were equally distributed (25%). Regarding severity, about 14% were severely anaemic flowed by 63% moderately anaemic and 23% were mild anaemic as noticed. In this study among the ALC cases maximum 35.9% were belong to the age group 41-50 years followed by 45.5% belong to 51-60 among HBV,42.9% belong to 41-50 years among HCV and  about 50% of cases belong to 41-50 years among NAFLD. Totally it was observed that the majority age group suffering from chronic liver disease was between 41 -60 years. Mean age of study subjects was 46.7 years. And the lowest mean values of serum iron (29.29mcg/dl) and folic acid (4.59ng/ml) was observed among HCV cases and serum vit-B12 (221.3pg/ml) seen in ALC cases in this study. 

Introduction:  Mitral valve (MV) replacement with preservation of subvalvular apparatus aids in maintaining left ventricular (LV) function, but this can be particularly difficult in rheumatic mitral stenosis (MS). The main evidence of this benefit is based on mitral regurgitation (MR), and it is unclear in rheumatic patients with fibrosis and calcification. This study is going to update experience with the Total chordal Preservation in mitral valve replacement in rheumatic mitral valve disease  at our institution.  Methods: This is a single centre retrospective cohort study. To evaluate and compare the risk factors like Clinical and Echocardiographic parameters, and  adverse events who underwent total chordal preservation during  mitral valve replacement in Rheumatic heart disease and follow up till 1 year after surgery (at 6 weeks, at 6 months and at the end of 1 year). Clinical parameters like NYHA class, chronic renal failure, atrial fibrillation. Echocardiographic parameters like left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction, left atrial diameter, pulmonary artery systolic pressure. Adverse events like Low cardiac syndrome, stroke, atrial fibrillation, , sepsis will be compared. All the variables were analyzed with statistical methods. All of them were evaluated for their clinical significance. p<0.05 was considered as statistically significant. Results: Total chordal preservation increases the cross clamp time and CPB time. No chordal preservation increases the chances of low cardiac out put syndrome. LV dimensions like LVESD, LVEDD were increased in no chordal preservation group and decreased in total chordal preservation group during follow up. Significant decrease of LVEF is noted in no preservation group. Significant decrease in LA size is noted in partial and total chordal preservation groups. PASP started decreasing in all the three groups in follow up irrespective of whether chordae is preserved or not.  Conclusion: Total chordal preservation patients have better LV dimensions and EF than partial chordal preservation and no preservation patients in the post operative and follow up period. Partial chordal preservation patients also have better LV dimensions and EF than no preservation patients. It is best to preserve total chordae in mitral valve replacement patients if not possible it is better to do partial preservation (PML preservation).

Introduction: Sickle cell disease (SCD) is a hemoglobinopathy with varied manifestations from an asymptomatic state to crisis and may be fatal. Hypercoagulable state in sickle cell diseaseis not uncommon but there is a paucity of data on Indian patients, especially in the Pediatric age group.   Aims and Objectives: To determine the coagulation parameters (PT, APTT), platelet count and MPV of children (<18 years) with SCD and to compare these parameters with controls(children with normal hemoglobin pattern). Material and Methods: This was a hospital based prospective observational study. 62 cases of homozygous sickle cell anemia (HbSS), 43 cases of sickle cell trait (HbAS) were included. 84 children with normal hemoglobin pattern (HbAA) of the age group 0-18 years were taken to serve as control in the study. Blood samples of all participants were collected in EDTA and Citrate vials. Hemoglobin, Platelet count, MPV, PT, and aPTT values were obtained. Result: The mean hemoglobin level of patients with HbSS was significantly lower as compared to HbAS and controls. (P<0.001) The mean value of PT, APTT, Platelet count, and MPV in HbSS cases was significantly higher as compared to HbAS and controls (P<0.001). There was no significant difference between hemoglobin PT, aPTT, platelet count, and MPV inHbAS and controls (P >0.05). There was a significant negative correlation between Hb levels and PT (r, -0.706;P,<0.0001), APTT (r,-0.467; P,0.0001), platelet count (r,-0.453; P, 0.0002)and MPV (r,-0.6952;P,<0.0001)for patients of HbSS.  Conclusion:Children with SCD have prolonged coagulation profile and marked variation in platelet count which may increase the risk of thrombosis and bleeding.So it needs to be investigated further for better patient management.

Objective: Patients diagnosed with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) with implantation of coronary stent are often prescribed with two different antiplatelet agents.The objective of our study was to find out the incidence of major and minor bleeding and their associated risk factors. Method: A cohort of 183 patients receiving Dual Antiplatelet Therapy (DAPT) was investigated. Demographic data, bleeding patterns, prevalent risk factors, and interventions were analysed. To categorise and evaluate the severity of the bleeding, The Global Use of Strategies to Open  Occluded Arteries (GUSTO) and Bleeding Academic Research Consortium (BARC)bleeding classifications were used. Results: Among the patients, 66.6% were males. Bleeding occurred in 32.14% of those on Aspirin-Clopidogrel and 30.23% on Aspirin-Ticagrelor combinations. Hypertension (71.5%), diabetes (39.3%), and dyslipidaemia (57.3%) were common risk factors. Upper GI Bleed (13.7%) and Hematuria (13.7%) were primary bleeding patterns, while Intracerebral Hemorrhage (ICH) was seen in 3 cases. Hospitalization was required for 21 patients. According to BARC, 38 had type 1 bleeding, and 21 had other formof bleeding; 124 had no bleeding. According to GUSTO, 6 had severe and 7 had moderate bleeding. Eight patients transitioned to Single Antiplatelet Therapy due to severe bleeding. Conclusion: Our study underscores the complexity of bleeding risks in DAPT patients, emphasizing the need for tailored treatment strategies. Future research should explore underlying mechanisms of bleeding events and the long-term impact on patient outcomes. Developing standardized protocols for risk assessment and management is crucial for optimizing clinical practice and patient safety.

Introduction- Acute symptomatic seizures(ASS) are commonly encountered in clinical practice. ASS are defined as seizures occurring in close temporal relationship with an acute medical or neurological injury which can be metabolic, toxic, vascular, structural, infectious or inflammatory. This study was done with the aim to determine  the clinical and etiological profile of new onset, non traumatic ASS. Materials & Methods- This is a hospital based cross- sectional study done for a period of 1 year, with a sample size of 86 patients. We included adult patients who were admitted with first episode of seizure or for other medical conditions who developed seizure during hospital stay and excluded hyperventilation, TIA, pseudo seizures, movement disorders, eclampsia, known epileptic disorder taking antiepileptic drugs and head injury. Data was collected using preformed porforma. Study participants were evaluated by thorough history taking, clinical examination, laboratory investigations, EEG, CT brain and MRI brain wherever indicated. Results- Our study enrolled a total of 86 patients with majority of cases in the age group of 21- 40 years, with a overall male:female ratio being 1.6:1. GTCS was the most common seizure type (60.4%), focal seizure was present in 10.4%. Status epilepticus was seen in 12.79%. Majority were due to metabolic and toxic causes (39.5%), followed by CNS infections (24.4%), CVA (22.1%), tumours (5.8%) and CVT (2.3%). CNS infections accounted for majority of cases of ASS in young and  metabolic causes predominated in middle aged and elderly populations. Among metabolic, majority (32.3%) patients presented with alcohol withdrawal/ intoxication induced seizures. Conclusion ASS is found to have a male preponderance occuring more commonly in 21-40 years with majority presenting with GTCS with most commonly metabolic etiology followed by CNS infections.

Background: Pre-existing hypertension, renal disease, diabetes mellitus, Obstructive Sleep Apnea, thrombophilia, and autoimmune disease all enhance the chance of developing hypertensive disease during pregnancy by decreasing uteroplacental blood flow. Women with a history of preeclampsia, HELLP syndrome, twin pregnancies or other multiple pregnancies, a BMI >30, autoimmune disease, being over 35 years old, being first-time mothers, or having a sister or mother who had hypertension during pregnancy are at an increased risk of developing hypertensive disorder of pregnancy and pre-eclampsia. Objectives: To evaluate the screening efficacy of urinary calcium creatinine ratio versus Doppler study in predicting pre-eclampsia. To study that low urinary calcium creatinine ratio (UCCR) of < 0.04 in asymptomatic pregnant women association with subsequent development of pre-eclampsia. To study the usefulness of uterine artery Doppler velocimetry as a predictor for pre-eclampsia before 20 weeks in asymptomatic pregnant women. Material & Methods:  Study Design: Hospital based observational study. Study area: Department of Obstetrics & Gynecology, in a tertiary care teaching hospital. Study Period: April 2022 – March 2023. Study population:  Normotensive nonproteinuric pregnant women less than 20 weeks attending the outpatient as well as antenatal ward. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Simple Random technique. Study tools and Data collection procedure: A hospital based prospective comparative study was conducted among a group of 100 normotensive nonproteinuric women 11 to 14 weeks attending the outpatient as soon as antenatal ward in tertiary care teaching hospital over a period of one years. They are subjected to a detail history and general examination. Results: Out of 100 women, 33 had abnormal PI at 11-14 weeks and out of which 24 developed Pre-Eclampsia. The sensitivity is 100% and specificity are 88.2% positive predictive value is 72.7%and NPV is 100% and its association between preeclampsia was statistically significant (p value<0.0001). Out of 100 women, 58 had abnormal PI at 16-20 weeks and out of which 23 developed Pre-Eclampsia. The sensitivity is 95.8%and specificity are53.9%, positive predictive value is 39.7 %and negative predictive value is 97.6% and its association between preeclampsia was statistically significant (p value<0.001). Conclusion:  We conclude that PI at 11-14 weeks and 16 – 20 weeks was found to be the better predictor of Preeclampsia compared to UCCR with better sensitivity, specificity and diagnostic efficacy. We recommend using PI at 11-14 weeks as the predictive tool to predict the development of preeclampsia.

Introduction- Heart failure is a major healthcare problem with significant morbidity and mortality. Half of these patients have a preserved ejection fraction. Early identification of this entity and its risk factors can help decrease the progression and prevent its complications. There is however a dirth of studies on this in North East India. We thus conducted this study to evaluate the clinical profile of patients with HFpEF. Materials & Methods- This is a hospital based cross-sectional study done over a period of 1 year from June, 2019 to May 2020. 105 patients presenting with heart failure with a normal ejection fraction on 2D-Echo were selected by convenience  sampling and data was collected using preformed porforma.  Results-  Out of 105 patients, mean age was 63 years, mostly females(66.6%). Hypertension is the most common risk factor(64.76%)  followed by diabetes mellitus(33.33%) and obesity(28.35%). On ECG,  68.57% had left ventricular hypertrophy & 66.6% sinus tachycardia. Most common chamber enlargement seen in 2D echo was left ventricular hypertrophy(68.57%). 61.90% had grade1, 28.57% had grade 2 and 9.52% had grade 3 diastolic dysfunction. Conclusion- More than half of the patients of heart failure have a normal ejection fraction. Early screening of those with risk factors and the elderly is key in decreasing the morbidity and mortality associated with it.

Background:

Siddha system of medical has developed a rich and unique treasure of drug knowledge in which use of plants, metals and minerals is very much advocated, which plays an important role in medicinal properties for both preventive and curative. These medicinal values of plants are in some chemically active substance they produce a definite physiological action on the human body. Kanda aviltham is a classic siddha medicine used in the treatment of suram, mukkutranoigal, naavaratchi. Vaanthi, malapantham, malapokku, neerkatti, etc.

Objective:

1. Anti-coagulant activity

2. Safety profile of kandha aviltham on mammalian cell A, Erythrocytes

B, Fibroblasts

Method:

1. Anti-coagulant activity

•Platelet aggregration assay [Human]

•Dose dependent assay/ 3hrs treatment

2. Safety profile

•MTT assay on NIH3T3 fibroblast, dose dependent assay/ 24 hrs treatment

•Hemolytic assay on human erythrocyte, dose dependent assay/ 1hrs treatment

Conclusion: The Anti-coagulant study, Fibroblastic toxicity and hemolytic study for kanda aviltham shows the drug is non- cytotoxic and it contains anti-coagulant and hemolytic activity.This evidence based data provides valuable information is helful to standardization of kandha aviltham. 

Background: Nurses are at risk of poor sleep due to their shift duties which has serious implications on their health. Hence this study was carried out to study the sleep quality of nurses working in a tertiary hospital and to identify the factors associated with it. Methods: A cross-sectional study was conducted on 375 nurses working in shifts for more than a year in a tertiary care centre of central India. Socio-demographic and work-related details were collected with the help of a pre-designed pre-tested questionnaire. Sleep quality was measured by Pittsburgh Sleep Quality Index. Clinical characteristics were also assessed which included hypertension, diabetes, BMI and psychological well being. Psychological well-being was assessed by GHQ-12. Association of sleep quality with sociodemographic, work-related and clinical characteristics was determined. Chi square test was used to test for significance and logistic regression analysis was done using IBM SPSS V23. Results: Out of total 375 nurses, 50.40% had poor sleep quality. Mean age of the participants was 38.36±8.69 years. Extended family, working in emergency departments, work experience of ≤5 years, hypertension, and poor psychological well-being were the factors demonstrated to be independently associated with poor sleep quality. Conclusions: Poor sleep quality among nurses is a matter of concern and warrants further investigation. 

Objective- Creatinine, the anhydride of creatine is formed largely in muscle by irreversible non-enzymatic dehydration of creatine phosphate. The 24 hours excretion of creatinine in the urine of a given subject is constant from day to day and proportionate to muscle mass. Materials and Methods- A total of 396 healthy subjects of whom 286 were male and 110 females and age ranges from 20 – 60 years were included in the study are compared with established interval. Estimation of serum creatinine level of all received samples was detected by enzymatic methods in fully automated analyser machine. Result-The calculated reference interval for serum creatinine level was 0.4 - 1.3 mg/dl and 0.6 to 1.3 mg/dl in the age groups of 21- 40 and 41- 60 years respectively.Conclusion-The present study has shown a variation in mean values of normal serum creatinine level. The difference between the mean serum creatinine value in total males and total females was statistically significant.

Introduction: Opportunistic infections of gram negative non fermenters cause significant increase in morbidity and mortality of critically ill patients. Materials And Methods: All the samples were collected by following aseptic precautions, among which 200 pathogenic isolates were obtained which formed the study group. All the samples were processed for microscopic examination, culture and sensitivity testing according to CLSI protocols. Results:Out of 200 clinical isolates, 42 different non-fermenters were studied .Among these the predominant non-fermenter was Pseudomonas. aeruginosa 30(71.4%), followed by Acinetobacter baumannii 8(19%), Alcaligenes faecalis 2(4.7%) and Acinetobacter lwoffii 2(4.7%). Modified hodge test detected 6(66%) of Carbapenemase production by imipenem resistant isolates .E-Test detected more number of positive isolates that produced MBLs i.e.,5(55.5%), followed by Combined disk potentiation test 4(44%), and double disk synergy test 3(33%). Conclusion: The future of prevention in ICUs will likely be based on our ability to adapt policies and emerging technologies to specific risk profiles.

Background: Operative procedure in chronic cases of Acromioclavicular joint dislocation remains controversial. The modified weaver-dunn method is one of the most popular methods but it is a non anatomic technique that presents approx 30:/: loss of reduction and horizontal instability. Anatomic Coracoclavicular ligament reconstruction using autogenous tendon graft reportedly diminishes pain, eliminates sequelae, and improves function as well as strengthstrength, still it also having some complications like clavicle fracture, coracoid fracture or hyperaesthsia due to infrapatellar branch of sapheneous nerve ( while taking hamstring tendon graft)  Objective: To compare functional outcomes between modified weaver –Dunn procedure and anatomic coracoclavicular ligament reconstruction technique using semitendinosus tendon graft. Method Fifty six patients (mean age, 31 years) with painful, chronic Rockwood type 3, 4, and 5 acromioclavicular joint dislocation were subjected to surgical intervention. All patients randomly divided in 2 groups, group A for anatomic coracoclavicular reconstruction using semitendinosus tendon (ST) graft and group B for modified weaver-dunn procedure. Clinical evaluation was performed using American shoulder and elbow surgeons shoulder score (ASES) and the constant score after follow up of 6 months  Results In the ST group (group A), the mean ASES shoulder score improved from  76.92+/-5.73 preoperatively to 95.14+/-3.85 postoperatively and mean constant score from 69.96 +/-6.70 preoperatively to 94.21+/-2.79 postoperatively. In the weaver-dunn group (group B), the mean ASES shoulder score improved from 76.78+/-5.76 preoperatively to 88.82+/-2.29 postoperatively and mean constant score improved from 69.50+/-5.87 preoperatively to 85.50+/-3.34 postoperatively. The results in the semitendinosus tendon graft grouwere significantly better than in the weaver–dunn group (p<0.05). Conclusion Semitendinosus tendon graft for coracoclavicular ligament reconstruction resulted in significantly superior functional outcomes compared to the modified Weaver-Dunn procedure.