Research Article
Open Access
Retrospective study of surgical outcome of decompressive craniectomy for cerebral venous sinus thrombosis: An Institutional experience of 45 cases Introduction
Pages 278 - 285

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Abstract
Objective: To evaluate the surgical outcomes of decompressive craniectomy in patients with cerebral venous sinus thrombosis (CSVT) at our institution. Methods: We conducted a retrospective analysis of 396 CSVT cases admitted to our institution. Among these, 45 (11.3%) underwent decompressive craniectomy. We assessed demographic data, clinical presentation, risk factors, Glasgow Coma Scale (GCS) scores upon presentation, and radiologic findings in relation to venous sinus and cerebral lobe involvement. Results: Of the 45 patients who underwent decompressive craniectomy, 26 (57.7%) were female and 19 (42.3%) were male. The mean age of incidence was 34 years, with a notable predominance in patients below 40 years (69%). The predominant presenting symptoms were headache (93.3%), altered sensorium (88.8%), focal motor deficit (60%), and convulsion (48%). Identified risk factors included chronic alcohol intake (31%), smoking (37%), postpartum status (30%), dehydration (51%), anemia (26%), homocystinemia (17.7%), and oral contraceptive pill usage (15%). In terms of GCS, 57.7% presented with scores between 8-12, while 22.2% had scores below 8. Radiologic findings revealed involvement of two or more sinuses in 21 patients. Specific sinus involvements were: superior sagittal (11 patients), sigmoid (7 patients), and transverse (6 patients). Regarding lobe involvement, the distribution was: parietooccipital (13 patients), frontal (10 patients), frontoparietal (14 patients), and temporoparietal (8 patients). Conclusion: Decompressive craniectomy serves as a crucial intervention in selected CSVT cases. Our study presents an institutional experience emphasizing demographics, clinical presentations, risk factors, and radiologic findings in patients undergoing this surgical intervention for CSVT.
Research Article
Open Access
The study of main trunks of right and left coronary arteries
Pages 272 - 277

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Abstract
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.
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Research Article
Open Access
Cytomorphological Study of Hashimoto’s Thyroiditis in Correlation with Biochemical & Serological Parameters
Pages 266 - 271

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Abstract
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.
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Research Article
Open Access
Clinical Profile and Outcome of Patients with Cardiorenal Syndrome Type 1: A Cross Sectional Observational Study
Pages 258 - 265

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Background: Cardiorenal syndrome type 1 (CRS1) represents a critical medical condition characterized by the rapid deterioration of cardiac function leading to acute kidney injury (AKI), posing significant healthcare challenges. Understanding this complex syndrome is crucial for improving patient care. Material and Methods: We conducted a one-year cross-sectional observational study at the Department of Medicine, Indira Gandhi Medical College, Shimla, enrolling consecutive patients with acute heart failure (AHF). We defined CRS1 as the rapid worsening of cardiac function leading to AKI and employed the Framingham Criteria for HF diagnosis. AKI was assessed using the AKIN classification. Various clinical, laboratory, and echocardiographic parameters were examined, and statistical analysis was performed. Results: Among the 92 AHF patients, 15 (16.3%) met the criteria for CRS1, while 77 (83.7%) did not experience kidney injury (NCRS1). Shortness of breath was the most common presenting symptom (93.47%). Patients with CRS1 had significantly lower total leukocyte counts (TLC) but no significant differences in other hematological or biochemical parameters. Dilated cardiomyopathy (DCMP) was a significant predisposing factor for CRS1, while other factors, including smoking, diabetes, and hypertension, did not contribute significantly. Medications for AHF management showed no significant impact on CRS1 development. Patients with CRS1 had higher mortality rates and longer hospital stays, with DCMP and Rheumatic Heart Disease (RHD) being major contributors to mortality. Conclusion: CRS1 is more prevalent in females and the elderly, presenting with shortness of breath and often triggered by infections. Lower TLC and DCMP are associated with CRS1 development. Smoking, diabetes, and hypertension appear unrelated to CRS1. Medications for AHF management showed no significant influence. DCMP emerges as a key underlying etiology, with CRS1 patients experiencing higher mortality rates and extended hospital stays, highlighting the need for tailored management strategies.
Research Article
Open Access
Correlation between mixed venous oxygen saturation, central venous oxygen saturation and cerebral oxygen saturation measured by near-infrared spectroscopy during off pump coronary artery bypass grafting
Pages 246 - 257

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Abstract
Introduction: OPCAB was designed to reduce complications resulting from cardiopulmonary bypass like stroke, renal complications and myocardial ischemia and to reduce hospital stay, reduce morbidity and mortality. It includes various anatomical distortions of heart using stabilizers and suspensions which needs extensive monitoring techniques. To improve its efficiency neurological monitoring like NIRS and PA cannulation could play a significant role in further reducing such complications. Mixed venous oxygen saturation (SvO2) remains the accepted standard during anesthesia to evaluate the balance of oxygen delivery and consumption, especially during cardiac surgery. Monitoring the ScvO2-SvO2 with conventional PAC gives indirect evidence of myocardial ischemia, after excluding other causes of ischemia in lower body. Materials and Methods: In this single centred prospective interventional study, 60 patients undergoing elective off pump CABG between March 2018 to March 2020 were taken. Institutional ethical and scientific committee approval was taken (UNMICRC/ANESTH/2017/09) and written informed consent from patients was obtained. Results: Total 360 patients were enrolled in the study for comparative analysis of regional cerebral oxygen saturation (rScO2), central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) in off pump CABG. Table 1 shows general characteristics of patients. Mean ejection fraction was 45.92 ± 9.23%. Fifty patients had triple vessel disease and 10 had double vessel disease for which 60, 53 and 49 patients had undergone Left anterior descending (LAD), Obtuse marginal (OM) or Diagonal (DG) and Posterior descending artery (PDA) or Right coronary artery (RCA) grafting respectively. Conclusion: Positioning of the heart for distal anastomoses at lateral and posterior wall was associated with more hemodynamic alteration and increased in inotropic and vasopressor requirement and significant decreased in rScO2, ScvO2 and SvO2. There was significant positive correlation on measured gradient between ScvO2 & SvO2 and rScO2 & SvO2 and rScO2 & ScvO2. ΔrScO2 was found to be highest as compared to ΔSvO2 followed by ΔScvO2.
Research Article
Open Access
Efficacy of bedaquiline inpatients with drug-resistant tuberculosis fortreatment outcome &early sputum culture conversion
Pages 241 - 245

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Abstract
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.
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Research Article
Open Access
Correlation of maternal iodine status with neonatal thyroid function in a tertiary care hospital of kolkata: A Unicenter Pilot study
Pages 233 - 240

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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.
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Research Article
Open Access
Supportive and Alternative Method to Learn Biochemistry -Poster Preparation and Presentation
Pages 227 - 232

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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.
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Research Article
Open Access
Scarred Uterus – A Risk Factor for Placenta Previa
Pages 218 - 226

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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.
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Research Article
Open Access
Microvascular Structures in Brain Tissue: A Cross-Sectional Histological Study
Pages 211 - 217

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Background: The intricate microvascular structures of the brain play a critical role in maintaining cerebral homeostasis and ensuring adequate delivery of oxygen and nutrients to neuronal tissues. Understanding their architecture can provide insights into various neurological disorders and conditions. Objective: To elucidate the morphology and distribution of microvascular structures in various regions of the brain using cross-sectional histological analysis. Methods: Post-mortem human brain tissues from ten donors were acquired, with appropriate ethical considerations. Tissues were sectioned and stained using standard hematoxylin and eosin, as well as immunohistochemical markers specific to endothelial cells. Regions of interest, including the cortex, basal ganglia, and hippocampus, were examined under high-resolution microscopy. Results: Preliminary observations revealed a dense network of capillaries uniformly distributed in the cortical regions. The basal ganglia demonstrated larger vessels with increased branching, while the hippocampus exhibited a unique vascular pattern consistent with its layered structure. Immunohistochemical staining confirmed the presence of intact endothelial cells and tight junctions, suggesting well-preserved microvascular integrity. Conclusion: This study underscores the diverse microvascular architecture across different brain regions. Understanding these differences may aid in predicting region-specific susceptibilities in various cerebrovascular disorders and facilitate targeted therapeutic interventions.
Research Article
Open Access
A Study of Incidence of Vascular Malformations Along With its Clinical Presentation and Treatment at Tertiary Care Centre
Pages 206 - 210

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Background: Vascular malformation are congenital lesions with complex clinical presentations and management. Their classification and treatment options have considerably changed throughout the years, with conflicting evidence in the literature. Vascular malformations occur due to errors during vasculogenesis. They are present since birth, though they may not be apparent until later in life. These malformations are most frequently found in the head and neck, but can occur in any part of the body. Methodology- The study was carried out in the department of General Surgery of Tertiary care center teaching hospital from September 2018 to September 2020. The sample size taken for this study was 30 patients who were diagnosed as having vascular malformations and undergoing treatment. Patients were examined thoroughly and baseline findings were recorded. All the patients were subjected to either injection sclerotherapy, surgery or wait and watch treatment depending upon the vascular malformation and condition of patient. Sodium tetradecyl sulfate was used as sclerosing agent. Follow up of each patient was scheduled every 2 weeks, and therapy was repeated after 4 weeks, if there was no response or only a partial response. Result- The most commonly affected age group was 0-10 years. Cosmetic problems (63.33%)was the commonest symptom of presentation. Most common type of malformation was venous malformation (83.33%)/ truncular malformation (70%). The most common location of vascular malformation was lower extremity (36.66%). A good response was achieved in majority of the patients (50%) treated with sclerotherapy in our study. Conclusion- Injection sclerotherapy is a relatively cost-effective procedure with low complications. Embolization is another treatment useful in cases of large AVMs where sclerotherapy and surgery are not possible
Research Article
Open Access
Pattern of ulcer healing with DUSS score: A follow up study at tertiary care hospital
Pages 202 - 205

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Background: The outcome of foot ulcers is affected by wound depth, infection, ischaemia and glycaemic control. Diabetic ulcer severity score (DUSS) is one of the latest wound based scoring system. Aim: To study the pattern of ulcer healing with DUSS score. Material and Methods: a total of 104 diabetic patients attending surgical outpatient clinic or admitted into the surgical department were included. The DUSS was calculated by these separate grading to a theoretical maximum of 4. DUSS score obtained was then correlated with the pattern of ulcer healing. Results: Majority of ulcers i.e. 14 (60.87%) healed by 3rd follow up, 6 (26.09%) got healed by 4th follow up, 2 (8.70%) healed by 5th follow up and 1 (4.35%) underwent amputation during 4th follow up. Conclusion: DUSS scoring system provides an easy diagnostic tool for anticipating probability of healing /amputation and need for surgery by combining four clinically assessable wound based parameters.
Research Article
Open Access
Study of diabetic foot ulcer outcomes using diabetic ulcer severity score
Pages 198 - 201

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Background: DUSS (Diabetic Ulcer Severity Score) is one of the wound based system of classification which is useful tool to measure outcomes of diabetic foot ulcers. It is a simple and easily producible scoring system. Aim: To evaluate diabetic foot ulcer outcomes using diabetic ulcer severity score. Material and Methods: A total of 104 diabetic patients attending surgical outpatient clinic or admitted into the surgical department wereassessed on the basis of DUSS score.This score obtained was then compared with the final outcome to validate the prediction of DUSS score. Results: Majority of foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intention or skin grafting. However, among those with score 3 and score 4 majority required amputation i.e., 18(60%) and 16 (76.19%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P<0.05). Conclusion: DUSS scoring system can predictprobability of healing or amputation by combining four clinically assessable wound based parameters.
Research Article
Open Access
An Ambispective Study of Empirical Antimicrobial Therapy and Spectrum of Microorganisms in Breast Abscess
Pages 191 - 197

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Introduction: Breast abscess is a painful condition that usually appears as a lump and is brought on by infection. Since it's one of the most prevalent medical conditions affecting women, it's critical to understand the most recent developments in isolated bacteria and antibiotics that can be applied empirically. The aim of present study is to evaluate the role of different antibiotics in breast abscess, efficacy of empirical antibiotic therapy and to find out the microbiology of the disease. Material and methods: The present ambispective study was conducted at E.S.I.C. Medical College and Hospital among females presented with breast abscess for a period of 2 years. Total cases selected were 160 based on inclusion and exclusion criteria. Statistical analysis was done using SPSS version 25.0. Level of significance was kept at p<0.05. Results: Maximum were in age group of <30 years (47.5%). Most common symptoms were pain (100%) and redness (85%). Examining subjects revealed that maximum 85% of subjects had Mastitis. The most common mycobacteria in abscess was MRSA (30%), followed by E.coli (15%). Linzolid was mostly susceptible with MRSA, Amikacin with E.coli and S.typhi, Gentamycinmycin/tetra with S.aureus. Conclusion: The majority of breast abscess cases involved the isolation of methillin-resistant Staphylococcus aureus. When choosing an empirical treatment for a breast abscess, understanding the microbiological profile and antibiogram of the bacteria is crucial.
Research Article
Open Access
Effectiveness of Hand and Foot Massage Therapy on Post-Operative Pain and Anxiety among Patients Undergoing Cardiothoracic Surgery
Pages 185 - 190

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Abstract
Background: This study was conducted to evaluate the effectiveness of hand and foot massage therapy on post-operative pain among patients undergoing cardiothoracic surgery and evaluate the effectiveness of hand and foot massage therapy on anxiety among patients undergoing cardiothoracic surgery. Methods: This was a hospital-based study conducted among 60 patients who underwent cardiothoracic surgery in the cardiothoracic ICU of Medical College Hospital, Thiruvananthapuram, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: It is evident that the mean age of participants in the experimental group was 50.43 and the standard deviation was 11.61 and the mean age of the control group was 54.53 and the standard deviation was 8.25. Hence, the difference was not statistically significant because both groups were not comparable with respect to age. 80% of participants in the experimental group and 60% in the control group were males whereas 40% of participants in the experimental group and 20% in the control group were females. Hence, the difference was not statistically significant, both groups were comparable with respect to gender. In the distribution of participants based on type of analgesic, effectiveness of hand and foot massage therapy on postoperative pain among patients undergoing cardiothoracic surgery, the effectiveness of hand and foot massage therapy on postoperative anxiety among patients undergoing cardiothoracic surgery were found to be statistically significant. Conclusion: Hand and foot massage therapy has been found to be effective in reducing postoperative anxiety among cardiothoracic surgery patients.
Research Article
Open Access
Difficulties Faced by Covid Health Care Workers Wearing Ppe Kit During Menstruation
Pages 181 - 184

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Abstract
Background: Females constitute a significant proportion of the healthcare community. An integral component that forms a part of the difficult work environment of health workers is both the long hours that they have to put in donning and doffing PPE kits. This also affects female workers, who also have to endure the psychophysiological changes and difficulties associated with menstruation while continuing to perform their clinical duties. Aims and objectives: The purpose of this study was to shed light on the difficulties faced by the female frontline workers who had to don PPE suits while menstruating. This study also focused on assessing if there has been any impact of the usage of PPE kits on their menstrual habits during this pandemic. Methodology: The study's methodology involved using a self-made questionnaire that five experts validated. The final sample size was calculated to be 264. A total of 309 individuals participated in our study. a total of 21 questions to evaluate the difficulties faced by female health care workers wearing PPE kits during the time of menstruation using inclusion and exclusion criteria. The collected data was entered into Microsoft Excel and analyzed by chi-square testing. Results: The study found that a significant number of female frontline health workers experienced fatigue (94.5%), sweating (88.9%), discomfort (85.4%), staining of undergarments (61.7%), pain (59.3%), itching in the genital area (50.6%), fainting or giddiness (50.6%), and chafing in the groin region (50%) while menstruating in PPE. It was also observed that a significant change had occurred in the menstrual hygiene habits concerning frequency of bathing (79.1%), number of sanitary pads, tampons, and menstrual cups used (68.4%), use of painkillers (47.8%), use of home remedies to alleviate pain (37.5%), and administration of medicines to delay menstruation (24.5%). Conclusion: This study found that difficulties like sweating, fatigue, discomfort when wearing pads, tampons, or cups, staining of undergarments, pain, itching in the genital area, fainting or giddiness, and chafing in the groin region were extremely common. Hence, it is recommended that appropriate measures be taken by the hospital administration to allay the difficulties faced by the female frontline health workers.
Research Article
Open Access
Mental Foramen Morphometry in Adult Human Mandibles: An Anatomical Analysis
Pages 176 - 180

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Abstract
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.
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Research Article
Open Access
Clinical Spectrum of Respiratory Distress in Newborn Babies with Special Reference to Surfactant Therapy
Pages 160 - 175

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Abstract
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.
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Research Article
Open Access
Prevalence of sleep related symptoms along with polysomnographic profile of patients with chronic obstructive pulmonary disease
Pages 155 - 159

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Background: COPD is among the most common lung diseases, becoming a major health problem around the world. It is characterized by a persistent and commonly progressive airflow limitation consequent to an abnormal inflammatory response of the airway and lung tissue a persistent and commonly progressive airflow limitation consequent to an abnormal inflammatory response of the airway and lung tissue. Sleep disorders are frequently present in COPD patients, particularly obstructive sleep apnoea syndrome (OSAS) and the coexistence of this two is termed as overlap syndrome. Methodology- The study was conducted in the Department of respiratory Medicine of a tertiary health care teaching hospital. The duration of the study was from December 2017 to November 2019. 105 cases of chronic obstructive pulmonary disease visiting outpatient / Inpatient section of Pulmonary Medicine department for diagnosis and fulfilling the inclusion and exclusion criteria were included. All the patients were evaluated with spirometry and polysomnography for detection of obstructive sleep apnea. Data was collected using predesigned, pre-tested, semi-structured questionnaire. Results- The prevalence of OSA in COPD (i.e. overlap syndrome) amongst study group was 27.62%. Sleep related symptoms were more prevalent in overlap group of patients as compared to patients without overlap and the difference is statistically significant between two groups for every symptom. Conclusion- Polysomnography in COPD patients is useful for early detection of OSA and to prevent them from further complications of OSA.
Research Article
Open Access
To Study the Effect of Covid-19 Pandemic on the Clinical Practice in Orthopaedics in A Tertiary Care Hospital in Jammu: A Retrospective Study
Pankaj Spolia,
Abdul Ghani,
Vivek Sharma
Pages 148 - 154

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Abstract
Background: COVID -19 pandemic had great impact on the day to day life of people and healthcare, including orthopaedic clinical practice. The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Due to this, not only in India but also in the western countries a lot of confusion in patient management and decision making was noted. Aims: In this study we intend to aware the orthopaedicians and healthcare staff about the pandemic situation in future by learning the experiences of the COVID-19 pandemic through literature for better patient management. Methods: This was a retrospective study aimed to see the impact of COVID-19 pandemic 2020 on orthopaedic practice with previous year 2019. The effects of COVID -19 pandemic on various clinical parameters like outpatient numbers, indoor patient admissions, management options conservative and surgery were revealed. Results: Total OPD cases in 2019 were 29700 and in 2020 were 6500. Total admissions in 2019 were 2690 and in 2020 were 855. The number of orthopaedic surgeries done in the time period of 2019 and 2020 were 1660 and 483 respectively. The surgical procedures were reduced in the year 2020 by 70.90%. Maximum reduction seen in the lockdown period was 87.7%. Conclusion: The study concluded that in Pandemic and disaster like situation decision making is an important step. Conservative treatment should be done as much as possible. Elective surgeries postponed and emergency surgeries to be continued by keeping all safety measures.
Research Article
Open Access
Evaluate The Risk Factors Associated with Massive Transfusion in Obstetric Hemorrhage at A Tertiary Care Centre
Pages 140 - 147

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Abstract
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.
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Research Article
Open Access
Improving facilitation of Self-directed learningwith knowledge of learning styles of MBBS Students-Institutional study
Pages 134 - 139

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Abstract
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
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Research Article
Open Access
Study of Lipid Profile in Chronic Renal Failure Patients
Pages 128 - 133

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Abstract
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.
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Research Article
Open Access
Liver Function Tests in Dengue Patients in A Tertiary Care Hospital of South Odisha: A Hospital Based Cross Sectional Study
Pages 123 - 127

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Abstract
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.
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Research Article
Open Access
Clinical Effects of Spinal Bupivacaine Versus Sciatic Femoral Nerve Block in High Risk Geriatric Patient for Lower Limb Orthopedic Surgeries
Pages 118 - 122

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Abstract
Introduction: Since the introduction of technology such as ultrasonography and Peripheral Nerve Stimulator (PNS), Peripheral Nerve Blockade (PNB) has become an appropriate outpatient anaesthetic. When compared to central neuraxial blockade, it has the advantage of providing surgical anaesthetic with superior cardiorespiratory stability. PNBs reduce the need for postoperative analgesics, reduce the incidence of nausea, shorten the time spent in the post anesthesia care unit, and boost patient and surgeon satisfaction. Materials and Methods: 120 patients undergoing lower limb orthopaedic procedure were allocated randomly into two groups. The study was single-blinded, randomised clinical trial. Group A (n=60) received spinal anaesthesia and Group B (n=60) received sciatic-femoral nerve block (Anterior approach). Both Genders (Male/Female), Age- 65 yrs.-75 yrs, Body weight- 40 kg -70 kg, ASA Physical status- II, III, Patients with controlled co-morbid conditions were included in the study. Results: Study result showed no statistically significant differences in demographic parameters and duration of operation in between the groups (Table 1). Mean time of onset of sensory block was later in Group - B (Mean 11.40 mins.) than in Group A (Mean 4.65 mins.) and this was statistically significant (P <0.005, Table 2). Mean time of onset of motor block was later in Group B (Mean 16.30) than in Group A and this was statistically significant (P < 0.005, Table 2). Mean time of duration of sensory block was greater in Group B (518.5) than in Group A (165.24) and this was statistically significant (P < 0.005, Table 2). Conclusion: we observed that duration of sensory block, motor block and post-operative analgesia were more prolonged in case of sciatic-femoral nerve block than spinal anaesthesia. Sciatic-femoral block (Anterior approach) was associated with stable haemodynamic, lesser complications and is better tolerated by patient with good satisfaction scale compared to spinal anaesthesia. So, we can conclude that sciatic-femoral nerve block (Anterior approach) is a better alternative than spinal anaesthesia in case of high risk geriatric patients undergoing lower limb orthopaedic procedure.
Research Article
Open Access
Effect of Different Concentrations of Epidural Dexmeditomidine for Post-Operative Analgesia
Pages 114 - 117

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Abstract
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.
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Research Article
Open Access
The Scenario of Anaemia in the Spectrum of Chronic Liver Disease an Observational Descriptive Study
Pages 107 - 113

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Abstract
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.
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Research Article
Open Access
A Retrospective study on role of Chordal Preservation during Mitral Valve replacement for Rheumatic Mitral valve disease in our institution
Pages 97 - 106

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Abstract
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).
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Research Article
Open Access
Coagulation alteration in children with sickle cell disease: A study from Southern Odisha
Pages 92 - 96

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Abstract
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.
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Research Article
Open Access
Estimation of lipoproteins levels & related risk of cardiovascular diseases in psoriasis patients
Pages 89 - 91

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Abstract
Introduction: Psoriasis is a systemic inflammatory disorder that involves complex pathogenic interactions between the innate and adaptive immune systems. Individuals with psoriasis have an increased risk of developing other chronic health diseases such cardiovascular disorders. The high incidence of cardiovascular events in the population with psoriasis could be explained by several mechanism. The high prevalence of traditional cardiovascular risk factors and metabolic abnormalities contributes to the high cardiovascular burden in patients with psoriasis. The most prevalent and chronically inflammatory dermatologic condition is psoriasis. Although it is connected to several illnesses, cardiovascular disease is the most prevalent. There is a critical need to analyze lipid abnormalities in psoriatic patients to determine the level of risk that individuals may experience for developing atherosclerosis, vascular obstructive disorders, associated morbidity and mortality. Aim: To estimate lipoproteins levels & related risk of cardiovascular diseases in psoriasis patients. Materials and Methods:This cross-sectional analytical study was carried out at Dr. D. Y. Patil Medical College & Hospital in Pimpri, Pune. 40 psoriatic patients with a mean age of 50.68 ± 8.86 years made up the study group, and 40 healthy people of either sex with a mean age of 50.15 ± 9.6 years made up the control group. Enzymatic End Point Method was used to estimate the levels of serum total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol on the same day. By computing the mean, standard deviation, p-value, and Chi-square test, the data was analyzed. Results: Findings of this study showed that, compared to the control, total cholesterol and VLDL was considerably higher in people with psoriasis(p<0.05).Difference between psoriasis cases(6.8 ± 1.49) and control (3.08 ± 1.3) in findings of serum TGs were highly significant(p<0.001).However, difference betweenserum LDLlevelin psoriasis cases and control was not significant.Serum HDL levels in both psoriasis cases and control were unchanged . LDL/HDL ration has not shown any significant changes in both psoriasis case and control, while in TC/HDL ratio, statistically significant difference(p<0.05) was observed. Conclusion: Patients with psoriasis have high risk of developing cardiovascular diseases. We propose that serum lipid profile screening in psoriatic patients will aid in identifying risk at an early stage. In these patients, impromptu treatment will lower the risk of cardiovascular illnesses.
Research Article
Open Access
Incidence of bleeding among Dual Antiplatelet Therapy Users in a tertiary care hospital: A 12 months’ prospective study
Pages 82 - 88

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Abstract
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.
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Case Report
Open Access
Early Repolarisation Pattern Masking Unstable Angina- A Case Report
Pages 77 - 81

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Abstract
Early Repolarisation Pattern (ERP) is an umbrella term that refers to ST-Segment elevation in the absence of chest pain, terminal QRS slurring, or terminal QRS notch. In patients with angina or anginal equivalents with ERP pattern on ECG(Electrocardiograph), the diagnostic dilemma of ERP masking ischemia vs. non-cardiac chest pain cause can falter further workup. We present a case of a 40-year-old male with risk factors of smoking and dyslipidemia presented with complaints of typical anginal chest pain followed by CCS III(Chronic Coronary syndrome III) symptoms of angina and dyspnoea. On primary evaluation he was found to have an Early repolarisation pattern in ECG, despite having a normal 2D Echo and negative cardiac biomarkers, His CAG revealed single vessel disease in the Left Circumflex coronaries. After revascularisation, the patient showed both angiographic and symptomatic improvement.
Research Article
Open Access
Outcome of Antenatally Detected Pediatric Surgical Congenital Anomalies - An Observational Study Done in a Tertiary Care Setting
Pages 70 - 76

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Abstract
Background: Congenital anomalies affect approximately 1 in 33 infants leading to 6.6% of deaths in infants and causing significant morbidity in children. There is a need for a study aimed to investigate the diagnosis, prognostication, follow-up and outcomes of antenatally diagnosed surgical anomalies. Aim & Objectives: To identify cases of antenatally detected congenital anomalies within the purview of a surgical perspective, serially monitor them and assess their outcomes over the given period of study. Methods: A total of 60 patients were selected from those pregnant mothers who were referred for antenatal counseling after the fetus was diagnosed to have congenital anomalies during routine gestational scanning in the tertiary care hospital, Ramaiah Medical College and Memorial Hospital over a period of July 1, 2015 to July 1, 2017. All relevant data of the patients was entered into a Proforma and all the quantitative variables were analyzed and presented using descriptive statistics such as mean, mode, median, and standard deviation. All the qualitative variables were presented using frequency and percentage. The association between the various abnormalities and the outcomes was tested using Chi Square Test. Results 41.9% of mothers less than 25 years of age showed fetuses with renal involvement, 29% involved multiple systems, 25.8% involved GIT and 3.2% involved the respiratory system. In mothers older than 25 years of age, 41.4% involved the renal system, 24.1% involved the GIT, 27.6% multiple systems and 6.9% involved the respiratory system. The highest incidence in this study was found to be of renal system involvement. 60.9% of renal anomalies, 21.7% of GIT anomalies, and 8.7% of multiple system and respiratory system anomalies did not require surgical intervention. 35.3% of multiple system anomalies, 29% of renal anomalies, 32.3% of GIT anomalies, and 3.2% of respiratory anomalies required surgical intervention. The study showed that multiple system anomalies were more likely to require surgical intervention. The percentage of need for intervention was least in renal anomalies. Conclusion: Pediatric Surgeons have a very important role in discouraging terminations for correctable anomalies. The time of presentation of various anomalies had no bearing on any particular system involvement. Renal anomalies were the most commonly detected and multiple system anomalies proportionately were more likely to require surgical intervention.
Research Article
Open Access
Clinicoetiological Profile of Patients with Acute Symptomatic Seizures
Pages 64 - 69

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Abstract
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.
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Research Article
Open Access
A Prospective Study on Comparison of the Urine Calcium Creatinine Ratio and the Doppler Test in Predicting Preeclampsia
Pages 56 - 63

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Abstract
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.
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Research Article
Open Access
Laboratory profile in serologically proven dengue in children
Pages 50 - 55

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Abstract
Background: Dengue fever is a significant global health concern, particularly affecting children in tropical regions. This study aimed to comprehensively analyze the laboratory profiles of serologically proven dengue cases in children and their associations with clinical outcomes. Materials and Methods: A prospective observational study was conducted on 300 pediatric patients with suspected dengue fever. Demographic data, clinical symptoms, serological markers (IgM and IgG antibodies, NS1 ELISA), and laboratory parameters were analyzed. Associations with disease severity and clinical outcomes were explored. Results: High prevalence of dengue-specific IgM antibodies (91.7%) and IgG antibodies (63.3%) was observed, with 50% of cases indicating secondary infections. NS 1 antigen ELISA was positive in 40% of cases. Clinical symptoms included fever (91.7%), headache (80%), myalgia (60%), and bleeding manifestations (16.7%). Severe forms of dengue (DHF/DSS) accounted for 30% of cases. Hemoglobin levels were lower in DHF/DSS cases (10.5 g/dL) than in non-severe cases (9.8 g/dL). Platelet counts were significantly lower in DHF/DSS cases (110 × 10^3/µL) compared to ICU admissions (85 × 10^3/µL). Serum creatinine levels were slightly elevated in ICU admission cases (1.1 mg/dL) compared to DHF/DSS cases (0.9 mg/dL). Conclusion: This study highlights the importance of serological markers and laboratory parameters in diagnosing dengue and assessing disease severity in pediatric cases. Early diagnosis and monitoring of these markers are crucial for timely clinical intervention. Further research is needed to validate these findings and enhance our understanding of pediatric dengue pathophysiology.
Review Article
Open Access
A New Classification for Wound Dressings
Pages 46 - 49

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Abstract
Wounds are extremely common in clinical practice and they include diabetic foot wounds, venous ulcers, burns, traumatic wounds, etc. These wounds occur frequently in daily life and needs to be managed appropriately otherwise they can lead to complications. Numerous wound dressings/products are available in Industry with each having merits and demerits. Often, it is also difficult to understand their usage and mechanisms of action. The primary author extended his ‘SCC’ classification series to wound dressings wherein one can categorize them into 3 type’s namely simple, complex, and complicated wound dressings. This article aims to discuss this new classification of wound dressings.
Research Article
Open Access
Clinical Profile of Heart Failure with Preserved Ejection Fraction in A Tertiary Care Hospital of North East Region
Pages 40 - 45

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Abstract
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.
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Research Article
Open Access
Determination of Anticoagulant, Hemolytic, and Fibroblast Toxicity Assay on Kandha Aviltham – A Unique Medicine of Siddha
Pages 30 - 39

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Abstract
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.
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Research Article
Open Access
Sleep quality and the associated factors among nurses working in shifts in a tertiary care centre of central India: A cross-sectional study
Pages 22 - 29

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Abstract
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.
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Research Article
Open Access
Study of serum creatinine levels in healthy male and females of different age groups attending at Nalanda Medical College and Hospital, Patna, Bihar
Pages 19 - 21

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Abstract
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.
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Research Article
Open Access
A Study of Vitamin D Levels, Immunological and Virological Outcomes in Hiv-Infected Adults
Pages 13 - 18

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Abstract
Background : HIV continues to be a major global public health issue, having claimed 36.3 million [27.2–47.8 million] lives so far. The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense against many infections and some types of cancer that people with healthy immune systems can fight off. Low vitamin D levels have been associated with HIV disease progression and HIV-related complications. Materials and Methods: Cases will be selected from patients presenting to KIMS hospital, IPD section with history Of HIV infection considering the inclusion and exclusion criteria. A total of 110 consecutive patients presenting with HIV positive status, whose inclusion and exclusion criteria are fulfilled are considered for study. It’s a single centered, time- bound prospective study carried out for a period of 2 years. Each patient was evaluated with History, clinical examination, and lab investigations. Results : In the present study involving 110 HIV patients. The mean CD4+ Count (/cu.mm) was 186.86 ± 104.35 and the mean Viral Load (x103) was 55.20 ± 68.61. vitamin D deficiency was present in 96.4% of population. There was a strong positive correlation between CD4+ Count (/cu.mm) and S. Vitamin D (ng/mL). There was a strong negative correlation between Viral Load (x103) and S. Vitamin D (ng/mL). Conclusion: In this study, with deficiency of Vitamin D level there was positive corelation with CD4 Count causing reduction in CD4 Count and negative correlation with viral load causing increased viral load with reduction in vitamin D levels in HIV affected individuals.
Research Article
Open Access
Prevalence of gram negative non fermenters in critically ill patients: A special focus on MBL producers
Pages 7 - 12

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Abstract
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.
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Research Article
Open Access
Reconstruction of Chronic Acromioclavicular Joint Dislocation: Modified Weaver-Dunn Procedure Versus Autogenous Semitendinosus Graft
Pages 1 - 6

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Abstract
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.
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Research Article
Open Access
Evaluation of Morning Symptoms Using Capacity of Daily Living During Morning (Cdlm) Questionnaire and Its Correlation with Chronic Obstructive Pulmonary Disease Severity Related Variables

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Abstract
Abstract:Introduction: COPD is a leading global cause of mortality, expected to rise in prevalence over the next four decades. Patients often find the early hours of the day troublesome, impacting their health-related quality of life (HRQoL). This study aims to address the commonly overlooked issue of morning symptoms in COPD patients, focusing on their severity and correlation with the CAT score and BODE index. The research underscores the significance of understanding and managing morning symptoms to improve the overall well-being of individuals with COPD. Materials and methods: A cross-sectional study involving 128 COPD patients meeting inclusion/exclusion criteria was conducted in hospitals affiliated with Bangalore Medical College & Research Institute. Comprehensive investigations were carried out, and morning symptoms were evaluated using the CDLM questionnaire. Patients were clinically classified into GesEPOC phenotypes and GOLD stages based on FEV1 (%). The severity of COPD was assessed through the BODE index and CAT score, with correlations examined against the CDLM questionnaire. Results: In this study of 128 COPD patients, predominantly males with a mean age of 63 years, the first tertile demonstrated lower CDLM scores, indicating a higher morning impact and more respiratory symptoms. These patients also had lower FEV1%, higher CAT and BODEx scores, and increased exacerbations. Higher CDLM scores were associated with the Non-Exacerbator clinical phenotype of GesEPOC Spanish Classification. Multivariate analysis revealed that lower CDLM scores were independently linked to higher CAT and BODEx scores, lower FEV1%, and increased exacerbations. Conclusion: Evaluation of morning symptoms using capacity of daily living during morning (CDLM) questionnaire revealed there was a strong association with markers of COPD severity. The significant association was found with CAT and BODE index score and GesEPOC phenotypes. The strong negative correlation was learned for CDLM with CAT score and BODE Index score independently. However, the CDLM questionnaire exhibits a ceiling effect, limiting its ability to effectively differentiate between low and high impacts of morning symptoms.