European Journal of Cardiovascular Medicine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Objectives:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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