Background: Benign breast disorders are prevalent among young ladies.   The most prevalent manifestation is an asymptomatic mass in the breast.   It is crucial to establish a connection between clinical and pathological findings.   Fibroadenoma is the most prevalent of all benign breast conditions.   The objective was to examine the age distribution of benign breast conditions.   The objective is to investigate various benign breast diseases, analyze their clinical manifestations, and establish correlations with radiological examination, cytology, and histology of breast disorders.Methods: The study conducted in the Department of General Surgery at Sri Aurobindo Medical College and Post Graduate Institute in Indore (M.P.) is a Randomized Observational Prospective study.A study was conducted on patients who were diagnosed as having benign breast disease on clinical examination who sought treatment at the surgery outpatient department or were admitted to the surgical wards at Sri Aurobindo Medical College and Post Graduate Institute in Indore, Madhya Pradesh. From January 1st, 2020 to June 30th, 2021.Results-Majority of the patients were in the age group of 21-30 years (51.28%). The average age of these patients was 28.56 years with range of 14 years to 57 years. Majority of the patients (65.4%) were from urban inhabitance. Most of the cases belonged to Middle (37.17%) and High (32.05%) socio economic status. 60.26% cases were educated upto high school and beyond. The commonest presenting symptom was pain in breast 64.1%.commonest lesion found was fibroadenosis 27.7%. Breast pain was found in 85.18% cases and was the commonest presentation. Sensation of lumpiness was there in 74.07% cases. 81.48% patients had tenderness in their breasts. 74.07% cases had nodularity and 18.51% had a lump in the breast. There were 74.07% cases of cyclical mastalgia and 25.93% cases of acyclicalmastalgia in 50 cases of fibroadenosis. In this study of 49 cases of fibroadenoma, all (100%) presented with lump in breast. Only 2 case (4.76%) presented with pain and tenderness. Conclusion- Fibroadenosis was the most common lesion at 27.7%. Fibroids (26.72%) and mastitis (31.3%) followed. Breast soreness (64.1%) and lump (42.3%) were the most common symptoms. The most common sign was a breast bulge or enlargement (67.79%), followed by soreness (58.97%). Most fibroadenosis patients (59.25%) were in their 30s. Cyclical mastalgia was the most common, at 74.07%.

breast cancer accounts for 14% of cancers in Indian women. It is reported that in every four minutes, an Indian woman is diagnosed with breast cancer. Vitamin D deficiency is assumed to be one of the risk factor for breast cancer. Objective: To study the association between vitamin D and risk of breast cancer among postmenopausal women.  Methodology: This was an observational cross sectional study.About 74 females of known breast cancer and 74 healthy females were evaluated. Appropriate statistical analysis was done to find association between vitamin D deficiency and risk of Breast Cancer. Our study demonstrated that number of subjects with Vitamin D level below 20 ng /dl i.e Vitamin D deficiency from the cases, in age group 41 to 50 years are 11, in the age group of 51 to 60 years were 39, in the age group of 61 to 70 years are 19, and in the age group of more than 70 years were 5 in number. The statistical difference between vitamin D levels, in patients having breast cancer and patients not having breast cancer was highly significant (p value 0.0001), showing the strong association between decreased vitamin D level and breast cancer in postmenopausal women. Conclusion: Our study showed that vitamin D and levels were inversely associated with risk of developing breast cancer. Vitamin D helps in prevention of cancer by reducing inflammation, anti-apoptotic, and anti-proliferative property. Vitamin D supplementation are needed in premenopausal women in order to reduce the risk of breast cancer in peri and post menopausal women

Introduction: Acute stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause which may be either ischemic or hemorrhagic in nature. Acute ischemic stroke, most common of the two types, results from prolonged cerebral ischemia leading to cerebral neuronal death. Ischemia Modified Albumin (IMA) is the only ischemic marker which has been approved by Food and Drug Administration(FDA) of United States(US) for early diagnosis of myocardial ischemia. Serum IMA levels and IMA to Albumin ratio(IMAR) were shown to increase in several diseases such as myocardial ischemia, acute stroke, muscle ischemia and bowel ischemia. Aim and Objectives: The aim of the study is to know whether Ischemia Modified Albumin (IMA) level is elevated in acute stroke patients and to compare the IMA levels and IMA to albumin ratio (IMAR) in acute stroke patients with healthy controls. Materials and Methods: Data required for the study were extracted from confirmed cases of Acute stroke (Diagnosed clinically and radiologically) patients attending Emergency and Intensive Care Unit of Neurology Department, GGH, Guntur and age matched normal healthy persons taken as controls. Biochemical parameters for the study were Ischemia Modified Albumin (IMA) estimated by Albumin Cobalt binding method and serum Albumin estimated by Bromo Cresol Green Dye binding method done on Beckman Coulter, Au 480 fully automated biochemistry analyzer. Ischemia Modified Albumin to Albumin Ratio(IMAR) was calculated from the results of both test and control groups. Results: IMA values of acute stroke patients were significantly higher than the control group (P Value <0.001). Mean serum albumin value of control group was higher than that of acute stroke patients. Negative Correlation was seen in Stroke patients between Serum Albumin and IMA (r = - 0.876). Mean IMA to Albumin Ratio(IMAR) of acute stroke patients were significantly higher than the control group (P Value <0.001). Conclusion: Ischemia Modified Albumin(IMA)would be a novel biomarker to support the clinical diagnosis of acute stroke. n this study mean IMA values of Acute Stroke patients were significantly higher than the control group. An arbitrary cut-off of 105.17 U/ml of IMA was chosen based on the ROC Curve analysis in the diagnosis of Acute Stroke patients. Further large scale studies are needed to choose clinically appropriate cut–off for serum IMA levels.

Trace elements are modulators of inflammatory cascades acting as antioxidants and co-factors to numerous enzymes required for physiological processes such as protein metabolism, RNA configuration, and membrane stabilization. The trace elements deficiencies may augment oxidative stress in critical illness, hence their supplementation may be beneficial in these patients. Methods: We measured serum concentrations of trace elements and evaluated their clinical significance in relation to treatment outcomes of critically ill patients. A total of 96 participants with age 18-65 years were enrolled. Patients were randomized into two groups (interventional group received intravenous multi-trace and control group received intravenous normal saline) The blood concentrations of the trace elements zinc, copper, selenium, chromium and manganese were measured at baseline and every 7 days. Results: Significant difference was observed 28 day and 90-day mortality between the interventional and control group (18 vs 32 and 20 vs 35 respectively). The mean days of stay in ICU was lower for interventional group (10.604±3.420) than that of controls (16.833±2.995) (p<0.0001). The hospital length of stay in the hospital was also significantly lower in the interventional (12.63 ±4.39) than control group (14.72 ±4.32). No significant difference was observed in number of ventilation days between both the group (7.167±4.570 vs 8.458±6.825) (p=0.2791). Conclusion: This study showed that intravenous supplementation of multi-trace elements improves the outcome in critically ill patients. 

The escalating prevalence of Type 2 Diabetes Mellitus (T2DM) globally necessitates a deeper understanding of its complex metabolic interactions, particularly concerning homocysteine, a known cardiovascular risk marker. This study aims to elucidate the role of homocysteine in the management of hyperglycemia in T2DM patients. Conducted as a cross-sectional study at Osmania Hospital, Hyderabad, India, it involved 30 T2DM patients without prior cardiovascular disease (CVD) complications and 30 age and sex-matched controls. Participants were subjected to comprehensive blood analyses to measure homocysteine, HbA1C, fasting, and post-lunch blood sugar levels. The study employed an independent sample t-test to determine significant differences in these biochemical parameters between T2DM patients and controls, with a significance threshold set at <0.05 and <0.001. Additionally, Pearson Correlation tests were applied to assess the relationship between homocysteine levels and the glycemic profile of the participants. The findings of this study are pivotal in understanding the interplay between homocysteine and hyperglycemia in T2DM. They offer insights into the potential role of homocysteine in T2DM management and its implications for cardiovascular risk in these patients. The results are expected to contribute to the evolving landscape of T2DM management, highlighting the importance of considering homocysteine levels in the holistic care and treatment strategies for T2DM patients. This study not only adds to the existing body of knowledge but also opens avenues for future research in this domain, particularly in developing targeted interventions for better management of T2DM and associated risks.

Background: Transcatheter Aortic Valve Implantation (TAVI) in a nonagenarian is a challenge and is usually performed under Monitored Anesthesia Care (MAC). Combining TAVI and Percutaneous Coronary Intervention (PCI) is associated with an increased risk of mortality. In this case report, we explore the challenges and strategies involved in successfully performing concomitant TAVI and PCI in a nonagenarian patient with Acute Decompensated Heart Failure (ADHF) and concurrent delirium under General Anaesthesia (GA). Notably, there are no documented cases in the existing literature that mirror the intricacies of this case, making it the first reported instance under GA in India.

Introduction: Brachial plexus block is the cornerstone of anaesthesia and analgesia in the management of upper limb surgeries. Different approaches to this block can be used and compared for efficacy and safety using the same volume of local anaesthetics. AIM: To compare the efficacy of supraclavicular block, interscalene block and combination of supraclavicular and low interscalene block in upper limb orthopaedic surgeries. Materials and Methods: 60 patients of ASA Grade I, II & III of age group 18-65 years of either sex undergoing orthopaedic upper limb surgeries under regional anaesthesia were randomly divided into 3 groups of 20 patients each. In Group SR, supraclavicular block was given using 20ml of Ropivacaine 0.5% with 0.05mg of Dexmedetomidine, In Group IR, Interscalene block was given using 20ml of Ropivacaine 0.5% + 0.05mg of Dexmedetomidine and in Group ISR, a combination of low interscalene and supraclavicular block using 20 ml of Ropivacaine 0.5% + 0.05 mg Dexmedetomidine (10 ml in low interscalene and 10 ml in supraclavicular block) was administered. Results: The demographic profile was comparable in the three groups. The mean time of onset of sensory block was earlier in group ISR (5.77± 1.51 mins) than in SR group (12.77± 2.55 mins) and IR group (7.52 ± 1.50 mins). The mean time of onset of motor block was also significantly shorter in the combination group ISR (7.91± 1.45 mins) than in SR (16.94 ± 3.03 mins) and IR group (11.82 ± 2.81 mins). The mean duration of sensory block (893.56±20.10 mins), as well as motor block (782.50±33.17 mins) in group ISR, was significantly prolonged than the other two groups. Conclusion: The combination of supraclavicular and low interscalene block is more efficacious than supraclavicular and interscalene blocks alone in terms of onset and duration of block without any significant side effects.

Introduction: Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide.This disease most often affects the lungs, although other organs are involved in up to one-third of cases.Tuberculous meningitis (TBM) is a non-suppurative inflammatory disease of the dura mater and spinal cord meninges caused by tubercle bacillus. About 5-15% of extrapulmonary tuberculosis involves the nervous system.TBM is a major one of extrapulmonary tuberculosis with involvement of the nervous system and accounts for about 70% of nervous system tuberculosis.Materials and Methods: This is a single centre prospective studywas conducted including the patients who were admitted in Department of General Medicine at Siddhartha Medical College, Vijayawada from November 2022 to October 2023. Patients selected for the study, satisfied all the inclusion and exclusion criteria.Patients attending Medicine OPD, Acute Medical Care are included after satisfying the inclusion criteria and written consent is taken.Initial history was directed towards obtaining the details of duration of the symptoms, night sweats, contact with tuberculosis, seizures, weakness, bowel and bladder disturbances, ear discharge, loss of weight etc.Results:Majority of the patients are in the age group (16-35 yrs) 2nd, 3rd & 4th decades (30 out of 50). Half (50%) of the patients have Glasgow coma scale < 9.25 patients (50%) 16 males, 9 females are in stage III.(Deeply comatose with decerebrate or decorticate posturing, irregular pulse and respiration).Hydrocephalus is the most common finding seen in 56% of cases (All are of communicating variety).Poor functional outcome is seen in 8.33%, 38.46%, 88% of stage I, II & III meningitis respectively.Out of 50 patients CT brain evidence of Hydrocephalus is found in 28 patients.Conclusion:In Tuberculous meningitis duration of illness 3 weeks or more at diagnosis, stage-III meningitis, GCS score less than 9 at admission, presence of focal deficit, and hydrocephalus on neuroimaging are the predictors of poor outcome.Patients can be categorized into high risk and low risk groups depending on the presence or absence of poor prognostic factors.Early diagnosis and prompt initiation of treatment reduces the mortality and morbidity.

Background:The goal of the current study was to evaluate the effectiveness, safety, acceptability, and degree of satisfaction of medical method vs manual vacuum aspiration (MVA) in first-trimester pregnancies with clinically confirmed missed miscarriages.Methods: From January 2021 to December 2022, a comparative interventional study on 100 clinically diagnosed first trimester missed miscarriages of gestational ages less than 12 weeks pog was undertaken at the Department of Obstetrics & Gynecology, Guntur Medical College, Guntur. Group A consisted of 50 patients who chose the medical procedure, and group B consisted of 50 patients who chose manual vacuum aspiration.Results:The mean age of the patients in MVA group was 23.6 and in the medical management group was 24.6. The mean gestational age was 67.5 days for the MVA group and 70.1 days for the MM group. The median value differences of Gravida, Para, Live and abortions between both the groups is not significant. The difference in pallor before intervention in both the groups is not significant at p>0.05. The difference in blood loss between both the groups is significant at p value <0.05. There is a significant amount of blood loss in medical management group compared to MVA group. The difference in both the groups for efficacy in terms of retained products of contraception during TVS/TAS scan is significant at p <0.05. MVA is better than medical management in terms of efficacy in managing missed abortions. The difference between the duration of hospital stay between both the groups is significant at p-value <0.05. The duration of hospital stay with MVA is shorter than with medical methods. The difference in pain by VAS is statistically significant between both the groups at p<0.0001. Pain according to Visual Analogue Score is more in medical management compared to MVA group. Patient satisfaction is more in MVA group compared to medical management group.Conclusions: Comparing the medical approach to MVA method, there is more bleeding per vaginum; this implies safety. Less patients left AMA/absconded, which led to a high satisfaction percentage in the MVA group. Because there were more cases of complete evacuation in the MVA group, the MVA mode of abortion in the current study was more effective. Due to shorter hospital stay, the MVA group had a higher patient acceptability rate than the medical group. The MVA is thereby demonstrated to be a more effective, safe, acceptable, and satisfying method than medical management.

Introduction: Breast cancer is second most common cancer all over the world and is one of the leading cancers among women. It has high prevalence rate in developed as well as developing nations. In 2018, there were estimated over 2million breast cancer cases. Its incidence is rising rapidly in developing world due to change in lifestyle, urbanization, increased life expectancy and influence of western lifestyles. The accumulated evidence suggests that breast cancers are preventable and highly suitable for secondary prevention. But in rural areas and small towns, there is still lack of awareness of breast cancer as well as health care services. The aim of present study was to know the epidemiology and clinical presentation of breast cancer among the women from rural area of Karnataka. Materials And Methods: A hospital based cross-sectional study was carried out among newly diagnosed cases of breast cancer. Present study was conducted at tertiary care hospital which provides the diagnostic as well as the therapeutic cancer services and referral services to many private and public health care institutions from neighboring regions. All newly diagnosed cases of breast cancer i.e. within study period, irrespective of age and stage of breast cancer. The Study was conducted over a period of 1st January 2018 to 31st December 2019. The sample size included total 150 newly diagnosed cases of breast cancer during study period. Results: In the present study the age of the patients ranged from 11-70 years. The meanage was 35.09 years. The youngest patient’s age was 11 and the oldest patient’s agewas 70 years. The mean age of the patients was 26.89 years for benign lesions and50.27 years for malignant lesions(Table1). Two Patients in age group 31-40 and two patients in age group 61-70presented with lesions in bilateral breast. Hence total 150 patients with 154 breastlumps(lesions) are included in present study.The maximum number of patients in our study were in the age group of 21-30years (30.5%) followed by 31-40 years (22.7%). The socio demographic parameters of the study population. There was association between clinical stage of at 1st hospital visit and patient's educational status. Proportion of patients having localized tumour was more in literate patients than illiterate Conclusion: Rural residence, poverty, ignorance, traditional practices, low women literacy and lack of health care services can affect stage at diagnosis and treatment of breast cancer. The increasing burden of breast cancer in Indian women warrants rigorous epidemiological actions in the form of arranging screening programme in rural area for early detection of breast cancer and prompt treatment to reduce the mortality due to breast cancer.

Objective: To analyze the group of elderly patients diagnosed with COVID-19 with a retrospective cohort study. Methods: The study was conducted in a health institution in Kayseri province in Turkey. In the study, 151 COVID-19 patients were retrospectively analyzed. Chisquare analysis was performed when both independent and dependent variables were categorical. Results: The mean age of the patients was 85.87 years. 61.59% of the patients were female. The most common symptom was fatigue with 73.5%. The most common chronic disease was hypertension. The most common radiologic classification was CO-RADS-1 with 47.6%. The mean incubation period of the disease was 10.25 days. The most common complication was acute renal failure. The mortality rate was 19.21%. Conclusion: We suggested that clinical status at presentation, age, serum CRP, LDH, AST, troponin I and hemoglobin levels are important predictors of the risk of death from COVID-19 and may help identify high-risk COVID-19 cases. 

Introduction: Urinary   bladder lesions   including both non-neoplastic and neoplastic lesions are disabling. Neoplastic lesions of the bladder are responsible for significant morbidity and mortality throughout the world. Urinary bladder cancer is 2nd most common cancer after prostate cancer in genitourinary system.  Histopathological analysis of cystoscopic bladder biopsy and Transurethral resection of the bladder tumor (TURBT) material are the mainstay for cancer diagnosis. Aim: The aim is to analyze the relative incidence, clinical presentation and spectrum of lesions in the urinary bladder at our institute which is tertiary referral Hospital. Material and Methods: A retrospective study of all urinary bladder specimens which were received in the department of pathology, Osmania General Hospital during a four-year period from Jan 2019 to Feb 2023 was conducted. Clinical data like age, sex, clinical presentation was recorded. Tissues were grossed, bits processed sections stained with Hematoxylin &Eosin, and examined microscopically. Immunohistochemistry was done to confirm the diagnosis. 118 Cases recorded during the 4-year period were analysed. Results: 118 cases were studied during period of 4 years.  Of them    13 cases were benign and 105 cases were malignant. Commonest symptom was hematuria. Most of the benign lesions occurred in the 4th decade, malignant tumors were common in 6th decade. Commonest benign lesion was chronic nonspecific cystitis. Among the neoplastic lesions, urothelial carcinoma was most common tumor seen in 6th decade   predominantly in males, with male to female ratio of 2.5:1. Malignant tumors are more common than benign tumors in the urinary bladder. High grade urothelial carcinoma was the most common malignant tumor encountered which occurred predominantly in males in our study. Tumors are invasive and best evaluated with imaging study’s Conclusion: Urinary bladder lesions are heterogenous and awareness about the risk factors, their various histological features and subtype, risk of recurrence and possible pitfalls can help in accurate and early diagnosis. IHC patterns of molecular subtypes of invasive urothelial carcinoma will enable the identification of case with poor outcome and development of novel biomarker-directed therapies. Therefore, a method to sub type the tumors that is applicable to routine clinical use is necessary.

Objective: Electrical storm (ES) carries a high mortality rate even with current advancements in care. There are limited data about clinical characteristics, risk factors and etiologies of ES from India.  We aim to report the clinical profile and risk factors related to ES from a tertiary care hospital in southern state of India. Methods: This is a retrospective, single center observational study done in the Department of Cardiology & Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research (SJICSR), a tertiary care medical center in Bengaluru, Karnataka. The data collected from medical records of patients presenting with ES from year October 1, 2022-September 1, 2023. Hospital medical chart of all patients who had received ES diagnosis were reviewed for demographic data (age, gender), clinical data (comorbidities, presenting symptoms), lab (complete blood counts and inflammatory markers), Electrocardiogram (ECG), echocardiography data and treatment options (medical and / or surgical). Other parameters assessed included type of procedure patient underwent. Results: A total of 29 ES were identified with mean age of 55.4±14.6 years, predominantly male population. The most common risk factor seen in this patient sample was prior history of MI (58. 6%).Post MI scar VT was the predominant etiology found in 18(72%) patients in our study. MMVT was the predominant form seen in 24 (82.7%) patients with RBBB morphology the dominant pattern on ECG. Cardiac imaging was done in 8 (27.5%) patients. The majority of patients were on amiodarone as the anti-arrhythmic drug of choice, while propranolol and ramipril were the most common beta blockers and RAAS inhibitors prescribed in our study population. In addition to standard care, radiofrequency ablation was performed in 5 patients and cardiac sympathetic denervation (CSD) was done in 2 patients only.  Overall 17 (58.6%) patients died. When compared with patients who survived, presence of severe LV systolic dysfunction had trend towards higher mortality. Conclusion: The study population of ES of southern state of Karnataka is characterized by middle age population with hypertension, tobacco consumption and diabetes as the prominent risk factors. ES portends a high mortality in acute settings particularly in patients with severe LVSD.  There is a considerable scope of taking initiatives to improve patient outcomes in ES.

Background: Cannabis is the generic word for all psychoactive preparations of the Cannabis sativa plant. Delta-9 tetrahydrocannabinol (THC) is the main psychoactive component in cannabis. Cannabis is one of the most often used illegal substances in the world. Cannabis is the fourth most prevalent psychoactive substance in the world, behind coffee, nicotine, and alcohol, with an estimated 200 to 300 million regular users. Objectives: 1. To evaluate sociodemographic profile among persons abusing cannabis. 2. To evaluate problematic domains among persons abusing cannabis. 3. To evaluate withdrawal symptoms among persons who abstain from cannabis. 4. To estimate the distribution of psychiatric comorbidity among persons abusing cannabis. 5. To estimate sociodemographic variables and psychosocial attributes between adolescent and adult-onset of cannabis use. Material & Methods:Study Design:  Hospital based prospective cross-sectional study. Study area:Manasa Psychiatry Hospital, Secunderbad, Telangana. Study Period: August 2022 – August 2023. Study population:  Participants were patients diagnosed with cannabis use disorders who came to the Psychiatry Department. Sample size: Study consisted a total of 40 subjects.  Sampling Technique: Convenience sampling. Study tools and Data collection procedure: After obtaining the written consent from the participants as required by the international ethics committee the following questionnaire was given to all subjects 1. Semi-structured proforma 2. Marijuana problem scale 3. The Cannabis withdrawal scale 4. MINI PLUS structured clinical interview. Results: In our study, those who seek cannabis-related problems were predominantly male i.e. 100%. No females registered for cannabis-related problems during our study period. 75% of people were below 10th standard. 80% of individuals with CUDs were unmarried. 30% were unemployed among persons who presented with CUDs. 92.5% of patients belong to low socioeconomic status. 90% of patients belong to Hinduism. 72.5% of patients belong to urban areas. In our study statistically significant difference in marital status and religion i.e., most of the adolescent-onset cannabis users were unmarried and Hindus. But occupation, place, SES there was no significant difference between these 2 groups. Conclusion: Psychiatric comorbidity is widespread in people who are addicted to cannabis, especially those who seek treatment. Cannabis withdrawal symptoms worsen as the length of cannabis addiction grows. The most common associations with cannabis abusers are comorbid other substance use and a family history of substance use. Adolescents who start using cannabis have lower levels of psychosocial characteristics such as impulsivity, drug-using peer relationships, drug availability in the neighbourhood, and skipping school or job than those who start using cannabis in early adulthood.

Introduction: Palpable breast swelling, whether benign or malignant, results from hormonal influences. Most cases are benign. Triple assessment—clinical, histological, and radiological—enables accurate detection and evaluation, guiding effective interventions. The research aimed to compare the patterns of breast swelling in premenopausal and postmenopausal women and identify the most common breast lumps in each group. Methods: One hundred female patients with palpable breast lumps were evenly divided into premenopausal (50 patients) and postmenopausal groups (50 patients). Each patient underwent clinical examination, fine-needle aspiration cytology (FNAC), and core needle biopsy if necessary. Ultrasonography (USG) of the breast was conducted for all patients, and mammograms were performed for selected cases. All postoperative specimens underwent histopathological examination. Results: Among the total 100 patients, 60 were diagnosed with benign breast disease, and 40 had malignant breast disease. In premenopausal women, 82% were diagnosed with benign disease, while in postmenopausal women, 38% had a benign diagnosis. Conversely, premenopausal women showed an 18% incidence of malignant breast disease, while postmenopausal women exhibited a 62% incidence. Among malignant breast diseases, 60% were invasive ductal carcinoma, 32.5% were invasive lobular carcinoma, 5% were invasive medullary carcinoma, and 2.5% were inflammatory carcinoma. Conclusion: The study finds a higher prevalence of malignant breast disease in postmenopausal women, while premenopausal women commonly experience benign breast disease, notably fibrocystic cystic disease. Premenopausal women exhibit a higher percentage of invasive lobular carcinoma than the general population, while postmenopausal women predominantly face invasive ductal carcinoma breast NST/NOS with increased invasive lobular carcinoma.

Introduction: When a baby has polycythemia, it is indicated by a central venous Hct more than 65% or a haemoglobin level greater than 22 g/dl. Increased viscosity leads to a reduction in tissue oxygenation and perfusion as well as a propensity for micro thrombi to develop. If these things happen to the kidneys, adrenal glands, or cerebral cortex, serious harm might result. Therefore, this problem has to be diagnosed and treated very away, although the best replacement fluid is still up for debate. to measure the haematocrit at 0, 6, and 24 hours following a partial exchange transfusion using fresh frozen plasma and normal saline, and to compare the outcomes in the two groups. Material & Method: From October 2016 to September 2018, the study was conducted at the newborn care unit of the Department of Paediatrics at VIMSAR Burla. For this andomised controlled experiment, which included two arms—the NS arm (neonates in whom NS was used as replacement fluid for PET) and the FFP arm (neonates in whom FFP was used as replacement fluid)—29 newborns who met the inclusion criteria were enrolled. After six and twenty-four hours after exchange transfusion, the different parameters were examined and compared between the groups. Result: The hematocrit and haemoglobin levels assessed six and twenty-four hours after PET did not, on the whole, differ significantly between the two groups. As with other criteria, there was no discernible difference between the two groups. In contrast to the FFP group, the NS group experienced a shorter time between diagnosis and treatment, which was shown to be significant (p value<0.00). The costs associated with utilising FFP were higher than those of NS, which was also statistically significant. Conclusion: There was no statistically or clinically significant difference seen between fresh frozen plasma and PET with normal saline, indicating that both are equally safe and effective. In comparison to FFP, normal saline was less expensive, more accessible, and more useful in the treatment of newborns with polycythemia; as such, it ought to be regarded as the perfect alternative fluid for PET.

Background: High sensitive C reactive protein levels (hs-CRP), a classical sensitive systemic inflammatory marker, are associated with short term and long term mortality in patient with acute coronary syndrome (ACS). Aim: The aim of this study was to find out the correlation of hs-CRP with coronary artery disease severity assessed by SYNTAX score (SX score) in patients with acute myocardial infarction (AMI). Methods: This cross sectional study was conducted in the Department of Cardiology, National Heart Foundation Hospital & Research institute, Dhaka, over a period of one year from 01/01/22 to 31/12/22. A total of 165 patients with AMI who underwent coronary angiography (CAG) selected purposively were included after considering inclusion and exclusion criteria. Study population were categorized equally into 3 tertiles according to available hs-CRP values. 33% (n=55) patients were in group A and their hs-CRP level was ≤25.3 mg/L; 33%(n=55) patients were in group B and their hs-CRP range was 25.4-70.6 mg/L; 33% (n=55) were in group C and their hs-CRP level was ≥70.7 mg/L. Baseline characteristics, biochemical variables, left ventricular ejection fraction(LVEF) and coronary artery disease severity by SYNTAX score were then compared among three groups. Results: Patients with raised level of           lllhs-CRP (Group C tertile) had significantly higher SYNTAX score compared with other    two tertiles [mean (±SD) SYNTAX score was 9.0 ± 4.3; 16.2 ± 5.6; 29.7 ± 8.3 respectively; (p <0.05)]. Strong positive correlation (r=0.885) was found between hs-CRP and SYNTAX score, which was statistically significant (p ˂0.05). Logistic regression analysis showed that hs-CRP was independently associated with severity of coronary artery disease assessed by SYNTAX score (OR= 54.883, p ˂0.001). Conclusion:  hs-CRP was a significant independent predictor of coronary artery disease severity  assessed by SYNTAX score in patients presenting with AMI.

Background: Metabolic causes of neonatal seizures which have good prognosis are hypoglycemia, hypocalcemia, andhypomagnesemia. Some of the cases of hypocalcemic seizures are accompanied by hypomagnesemia. However, the magnesium levels are rarely investigated in resource-restricted hospitals.  Aims and Objective: To evaluate the prevalence of hypocalcemia and the rate of association of hypomagnesemia with hypocalcemia within the study group.Materials and Methods: A group  of 150 neonates with seizures were studied. Analysis of serum Calcium, Magnesium, and Sodium were done on the samples using conventional methods. The prevalence of hypomagnesemia and hypocalcemia, and their association with the study group was estimated. Results: Among the 150 study population hypoxic ischemic encephalopathy (HIE) was the most common cause of seizures. The mean age of the neonates, at the time of admission included in the study was 3.98 ± 4.27 days. Among the metabolic abnormalities the commonest abnormality seen is hypoglycemia in 55 (36.6%) followed by hypocalcemia in about 45 (30%) of the neonates included in this study. Hyponatremia is seen in 12 (8%) of the neonates with seizures in this study. Hypomagnesemia is seen in 9 (6%) of all neonates with seizures in this study. Hypocalcaemia and hypomagnesemia were seen in 7(4.6%) of the neonates with seizures in the study. Conclusion: Hypomagnesemia was a significant cause of neonatal seizures. Most of the neonates with hypomagnesemia had an associated hypocalcemia. It is necessary to estimate levels of magnesium in addition to calcium in all neonates with seizures.

Background: The placenta is arguably one of the most important organs in the body. It influences not just the health of a woman and her foetus during pregnancy, but also the lifelong health of both mother and child. Despite its importance, we know little about this critical but temporary organ. The placenta has evolved to support the development of the embryo and foetus during the different intrauterine periods of life. By necessity, its development must precede that of the embryo. There is now evidence that during embryogenesis and organogenesis, the development of the human placenta is supported by histotrophic nutrition secreted from endometrial glands rather than maternal blood. These secretions provide a plentiful supply of glucose, lipids, glycoproteins, and growth factors that stimulate rapid proliferation and differentiation of the villous trophoblast. The present study conducted to observe any gross morphological change in placenta of normal individuals in North Karnataka region. Materials & Methods: 50 placentas were carried in multiple medical institutions in Karnataka, which were collected from labor room and operation theaters of connected Hospitals, washed under tap water and blot dried. Weight of placenta was recorded by weighing machine. Maximum diameter was measured, radius of placenta was obtained, and surface area was calculated using the formula. Cord attachments were also observed. Results: Out of 50 placentas 86% of placenta were circular and 14% were oval. Diameter was <15cms in 12%, 16- 20 cms in 68%, > 21cms in 20%. Surface area was 100- 200 cms2 in 16%, 201- 300 cms2 in 60%, 301- 400 cms2 in 20%, > 401 cms2 in 4%. Placental weight was between 300- 400gms in 14%, 401- 500gms in 58% and > 501gms in 28%. Umbilical cord insertion on fetal surface was found to be central - 60%, Paracentral -18% and Peripheral- 22%. The average diameter was 22.86+4.2, the average surface 316.52+76.42 and the average placental weight was 512.86+42.36. Conclusion: The present study parameters and an adequate knowledge of the morphometric analysis of the placenta with its clinical relevance proves to be useful in the early assessment of placental sufficiency and also the state of the fetal wellbeing. In mothers who have had no previous antenatal checkup, a thorough examination of the placenta helps in the early diagnosis of the fetal complications, soon after parturition and thus helps in the early treatment of the baby by neonatologists.

Background: The relationship between alteration of serum lipids and vascular complications is more significant in diabetic population. Present study was aimed to study lipid pattern (Serum cholesterol, Triglycerides, HDL & LDL) in Type 2 Diabetes Mellitus subjects. Material and Methods: Present study was single-center, cross sectional study, conducted in patients with duration of Diabetes mellitus of at least 6 months {BSL (Random) ≥200 mg/dl OR BSL (Fasting) ≥126 mg/dl OR HbA1c > 7}, underwent lipid profile estimation. Results: In present study, majority cases were 51-60 years (46 %), were male (64 %), were Obese (More than 25) (42 %) & mean age of the patients was 54.32 ± 7.12 years. Mean weight of cases was 67.38 ± 8.99 kg, mean height of cases was 161.34 ± 8.81 cms, mean BMI of cases was 26.08 ± 3.13 and mean WHR of cases was 1.02 ± 0.11. 19 (38.0) cases had History of Hypertension. It was observed that 16 (32.0) cases were having Normal Cardiac Risk and 34 (68.0) cases were having Increased Cardiac Risk. The BMI is significantly correlated with WHR. The BMI is significantly correlated with HbA1c. The BMI is insignificantly correlated with HDL. The BMI is significantly correlated with LDL. The BMI is significantly correlated with Triglycerides. The BMI is significantly correlated with cholesterol. The WHR is significantly correlated with HbA1c. The WHR is insignificantly correlated with HDL. The WHR is significantly correlated with LDL. The WHR is significantly correlated with Triglycerides. The WHR is significantly correlated with cholesterol. Conclusion: There was a significant association between type of Obesity and Waist hip ratio (WHR), HbA1c, HDL, LDL, triglycerides and Cholesterol.

Introduction: Vulvovaginal candidiasis (VVC) is a common cause of vaginal discharge in women of reproductive age-group.It affects 75% of women at least once during their lifetime and 10% of them have recurrent episodes.Most common offending organism is Candida albicans, and Candida glabrata being the most common non albicans species.Based on clinical presentation, microbiology, host factor like immunosuppression and recurrence, VVC is classified into complicated and uncomplicated VVC. The treatment of VVC is reasonably effective with a range of oral and intravaginal agents with Azoles being the predominant antifungals used. Aim And Objective: To compare the safety and efficacy of oral tablet fluconazole 150 mg single dose with intravaginal sertaconazole 500mg in the treatment of vulvovaginal candidiasis. MATERIALS AND METHODS: After obtaining informed consent, 100 patients who were clinically and mycologically confirmed to have vulvovaginal candidiasis were included in the study. They were randomly assigned into 2 groups, containing 50 patients each. Group A was treated with single dose of oral tablet fluconazole 150mg and group B was treated with sertaconazole 500mg vaginal pessary.The patients were reviewed at day 7 and 14 after the treatment. At each visit, symptomatic and mycological improvements were assessed and recorded. Results: A total of 97 patients completed the study.The symptomatic cure rate in both the groups at day 7 was 64.58% and 81.63% and in day 14 was 95.8% and 91.8% respectively in each group.The mycological cure rate in both groups at day 7 was 54.1%and 65.3% and day 14 was 75.1% and 85.7% respectively.  Conclusion: Treatment of VVC with single dose Sertaconazole 500mg vaginal pessary results in rapid symptom clearance and lesser recurrence rate than oral Fluconazole 150mg tablet in the treatment of uncomplicated VVC, in women with personal preference of vaginal route of drug administration without significant drug interactions and adverse effects. This can also be beneficial in the era of emerging fluconazole resistance.

Background: The prevalence of asthma has been rising over the past few decades, making it one of the most prevalent chronic diseases in the world. Although the precise cause of asthma is still unknown, it most likely results from intricate interactions between a number of hereditary and environmental factors. According to the World Health Organisation (WHO), 300 million people worldwide suffer from asthma. The effects of vitamin D as a hormone have drawn more attention recently. Every component of the immune system seems to be regulated by vitamin D, with a lack of the vitamin being associated with a number of immunologically based illnesses, including asthma. Therefore, it is beneficial to check serum vitamin D levels in bronchial asthma patients. Aim and objectives: To identify any correlations between vitamin D deficiency and the severity of asthma and the objective of the study is to evaluate the serum 25(OH) D level in patients with mild, moderate, and severe asthma. Material and Methods: This is a cross-sectional observational study, which involved 100 participants between the ages of 15 and 50, of both genders with a mean age of 37.40±9.46 years. They were divided into two groups: Group A (control) consisting of 40 healthy individuals (22 males and 18 females) and Group B consisting of 60 asthmatic patients (34 males and 26 females). Group B was further subdivided into three subgroups (A, B, C), based on FEV1% and symptom severity as per the Global Initiative for Asthma (GINA) guidelines. An assay of serum vitamin D levels by ELISA was performed in both groups. Results: The results of the study demonstrated that asthmatic patients had considerably lower serum vitamin D levels than the control group. Conclusions: There is a significant inverse association between serum vitamin D levels and the severity of asthma symptoms, and vitamin D deficiency is rather common in people with asthma. As a result, when routinely evaluating individuals with asthma, serum vitamin D levels should be taken into account. It could be used to indicate the severity of asthma.

Objective: To evaluate the outcome of Left Artrial Reduction by Auto Transplant technique in Giant LA with Mitral valve disease. Methods: This prospective study conducted in the Department of Cardio Thoracic and Vascular Surgery MGM Super Specialty Hospital Indore from 1"September 2022 to 30" August 2023.The aortic and bicaval cannulation was done and CPB instituted followed by cardioplegic arrest of heart. First the root, then the coronary ostia, provided cardioplegia. Transection of the Aorta, PA, SVC, and IVC followed by giant LA mobilization. An excised strip of LA wall and LAA (3-4cm width) was re-sutured with 5-0 prolene. Sutures repaired the SVC, IVC, PA, and aorta. Bleeding from Coseal-secured sutures. Interrupted stiches mobilized and sutured the mediastinal pleura and pericardium to reduce pulmonary vein suture line tension. Patient elective ventilation lasted 48 hours. Results: 10 patients underwent LA reduction. In 6 patients, concomitant Mitral valve replacement was done while in 4 patients concomitant Double valve replacement was done., 60% were in the age group between 33-35 years, and this was followed by the patients in the age group between 25-30 years of age (40%).Out of 5 patients who were included in the study, 8 patients had Atrial Fibrillation and 8 patients had Dysphagia. This was followed by previous history of thromboembolism seen in 4patients. LAA clot was seen in 4 patients. The mean LA size on Pre-Operative ECHO was 74 mm +/- 10 mm ranging from 64mm to 84mm. There was reduction in LA size (from 74+/- 10mm to 48 +/- 6mm) ranging from 42mm to 54mm. Conclusion: Giant LA associated with extra cardiac compressive symptoms should be reduced in size by Auto transplant technique which is safe in expert hands. Giant LA is typically found in patients with rheumatic mitral valve disease with severe regurgitation, Diagnosis is at times possible by routine chest x ray, Echocardiography is an excellent modality to establish its diagnosis, assess and direct correct management.

Introduction: UTI is a prevalent condition that affects approximately 40% of the adult population. Clinical Syndrome may be characterized as Asymptomatic Bacteriuria, Uncomplicated Cystitis, Pyelonephritis, Prostatitis, or complicated UTI. The goals of treatment of urinary tract infection are to eliminate the pathogen, to prevent Urosepsis, and to reduce the risk of renal scarring. Objective: To study the culture and sensitivity patterns of urinary tract infections in asymptomatic patients in a tertiary care hospital. Methods: A total of 120 samples were collected from January to June 2023. Identification was conducted by conventional biochemical tests. Antibiotic sensitivity test was analysed by disc diffusion method using different antibiotics and their zone of inhibition was measured. Results: Out of 120 subjects enrolled, 67 were males and 53 females The most common urinary pathogen isolated was E. Coli (64%) sensitive most often (82% sensitivity) to Amikacin. Overall sensitivity of different urinary isolates to amikacin was highest (82%).  Conclusion: Epidemiology and resistance patterns of bacterial pathogens in pediatrics urinary tract infection show large interregional variability, and rates of bacterial resistances are changing due to different antibiotic treatment. Knowledge of spectrum of pathogens and their patterns of drug resistance is indispensable for the empirical section of an effective therapeutic agent prior to availability of culture result.

Background: As we all know that Stroke is becoming an important cause of disability and premature death in low-income and middle-income countries like India, affecting largely the poorer sections of the society driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors which impoverish their families further. Therefore, our study was planned to evaluate the risk factors and their prognostic value in patients of ischemic stroke in our setup? Research Question: What are the risk factors and their prognostic value in the patients of ischemic stroke?The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one-year observational study was conducted during the period from October 2022 to September 2023 on about 100 Ischemic Stroke cases admitted during the above period in the department of General Medicineby studying their socio-demographic profiles, associated risk factors, assessment of the degree of severity in association with risk factors, clinical course and outcome, etc. Results: Among the total study subjects 61% were male and 39% were female and it was observed that the distribution of the disease was more as age advances and it was also noticed that the severity of the disease was more among males when compared to females. Among all the study subjects 55% had hypertension followed by 45% had diabetes mellitus, 34% had history of smoking, 26% had history of regular alcohol intake, 23% had dyslipidemia, 13% had heart disease, 6% had hypercoagulable states,10% had history of TIA, 6% had history of migraine, 3% had history of OC pills usage and 2% had family history of stroke. Hypertension, Diabetes and smoking were the common risk factors present in the majority of the study subjects. Regarding the outcome of the disease the disability and mortality was more among the study subjects who had hypertension and diabetes when compared to non-hypertensive and non-diabetic study subjects significantly(P<0.001).

Background: Tuberculosis (TB) remains a global health challenge, particularly with the emergence of drug-resistant strains. This study examines TB case detection and rifampicin resistance across different demographic categories in two healthcare institutions over two consecutive years. Methods: A retrospective analysis of TB cases reported by AIMS for 2023 and 2022, and MIMS for 2022, was conducted. Data included MTB detection and rifampicin resistance among PLHIV, pediatric populations, and private sector cases. Results: AIMS reported low rates of MTB detection (5.26% for PLHIV, 1.52% for pediatric cases in 2023) and no rifampicin resistance in 2023. MIMS reported higher overall TB cases with a 0.9% MTB detection rate among PLHIV and a 0.48% rate in pediatric cases, with a 10% rifampicin resistance among detected cases in 2022. No significant seasonal trends were observed at AIMS (p > 0.05), while MIMS showed a non-significant increase in detection during the monsoon months (p = 0.06). Newly diagnosed DRTB patients had higher detection rates (p < 0.01), and pulmonary TB was more frequently detected than extrapulmonary TB (p < 0.001). Conclusions: The low prevalence of rifampicin resistance suggests effective treatment and management strategies. However, the continued presence of MTB cases, especially in vulnerable populations, emphasizes the need for ongoing surveillance and improved diagnostic methods. Reinforced TB control programs and integrated healthcare strategies for high-risk groups are essential.

Background: Scorpion envenomation is a potentially fatal public health risk in tropical and subtropical places around the world. [1] However, morbidity and mortality from venomous animal bites or stings have received little attention in poor nations, including India. This is evident in the absence of a system for reporting venomous bites or stings. Objectives: 1. To study the clinical presentation, course, complications and outcome of scorpion sting envenomation. 2. To study the epidemiology and circumstances leading to scorpion sting in the community. Material & Methods: Study Design:  Hospital based prospective cross-sectional study. Study area: The study was conducted in the Department of Paediatrics. Study Period: 1 year. Study population: All the children admitted for scorpion sting into hospital.  Sample size: Study consisted a total of 54 subjects. Sampling Technique:  Simple Random technique.Study tools and Data collection procedure: On admission, a detailed clinical history, including the time of sting, symptomatology, details of treatment received before admission was taken. Further a description of the scorpion and details about the circumstances leading up to the sting were obtained. All the patients were subjected to a detailed clinical examination at admission and at frequent intervals thereafter, as was necessary in each case. Hourly monitoring of heart rate, respiratory rate, blood pressure, urine output, cardiovascular and respiratory status was done. Results: Commonest complications were, peripheral circulatory failure, pulmonary edema, Myocarditis and Congestive cardiac failure (15% of cases). One child developed popliteal artery thrombosis 76 hours after admission to hospital. Three patients presented with Encephalopathy, two of whom had massive pulmonary edema and succumbed within 5 hour of admission. One child had left sided hemiparesis and encephalopathy, secondary to Left MCA territory infarct with mild pulmonary edema. Conclusion: In India, cardiovascular complications are most common and life threatening. However, anticipation and close monitoring for other uncommon complications is critical for effective management. Prazosin has revolutionized the management of scorpion sting envenomation. Administration of prazosin, as early as possible, is probably the single most effective intervention for preventing complications following scorpion sting.

Background: Diabetes mellitus (DM) is a chronic endocrine metabolic condition that is mainly avoidable and non-communicable, resulting in millions of deaths, crippling complications, and incalculable human anguish each year. It constantly exhibits three key abnormalities: resistance to insulin action in peripheral tissues, particularly muscle and adipose tissue, reduced insulin secretion, and increased glucose synthesis by the liver. Objectives: 1. To estimate the value of serum adenosine deaminase (ADA) in patients with uncomplicated type 2 diabetes mellitus through a Cross sectional study. 2. To determine any correlation exists between serum ADA and blood glucose values. Material & Methods: Study Design:  Hospital-based, cross sectional study. Study area: The study was conducted in the Department of General Medicine, Siddhartha medical college, Vijayawada. Study Period: September 2022 to August 2023. Study population: Individuals with uncomplicated type 2 diabetes mellitus including both male and female, of age group 30-70 years attending to the hospital. Sample size: Study consisted a total of 100 subjects. (50 cases and 50 controls). Study tools and Data collection procedure: A pre-structured and pre-tested proforma was used to collect the data. Informed consent was taken from all cases and control subjects. A detailed clinical history and physical examination was an integral part of the methodology. Relevant investigations (blood urea, serum creatinine, lipid profile, urine protein, ECG, Fundoscopy etc.) were done before selection of subjects for the study. For all the subjects standing height and weight were measured. BMI was calculated as per the formula: Weight (Kg)/Height(meters)2. Results: In the present study the mean ADA in study group is 40.60±8.65 and in the control group is 19.75±2.65. In the present study the mean FBS in study group is 172.24±76.47 and in the control group is 82.34±10.77. Conclusion: Serum levels of ADA were found to be significantly higher in type 2 diabetics when compared to controls. A very large correlation was found to exist between serum ADA and blood glucose values. Statistical association was found between serum ADA and the long term index of glycemic control, HbA1c. Body Mass Index, Age, Sex, duration of diabetes was not found to significantly influence the ADA level.

INTRODUCTION: Paravertebral block is a regional technique involving peripheral nerve stimulator guided injection of local anaesthetic 0.5% bupivacaine (isobaric) at T10 level and L1 level immediately lateral to vertebral column, into the space where spinal cord emerges from the intervertebral foramina and bifurcates into dorsal and ventral rami. This technique provides unilateral motor, sympathetic and prolonged sensory blockade. Spinal anaesthesia for inguinal hernioplasty is widely used which provides intense sensory and motor blockade. It suppresses the stress response to surgical intervention, decreases morbidity in high risk patients and enabling maintenance of analgesia in postoperative period, cardiovascular system specific adverse events such as arterial vasodilation. MATERIAL AND METHODS: This was a prospective, randomized, single blind, comparative study. Adult patients belonging to ASA Grade I and II between ages 18 to 65 years of both sexes undergoing elective unilateral inguinal hernia repair were enrolled in the study.Total 60 subjects were recruited & divided into two groups i.e. 30 subjects in each group. Group P- Peripheral nerve stimulator guided paravertebral block in unilateral inguinal hernia repair using 0.5% Bupivacaine (Isobaric). Group S-Spinal anaesthesia in unilateral inguinal hernia repair using 0.5% Bupivacaine (hyperbaric). RESULTS: In our study we found that mean time of onset of sensory block was significantly longer in Group P (5.80 ± 1.21min) as compared to Group S (3.00 ±00 min). The mean time to achieve maximum sensory level was longer in Group P (16.33±2.01min) as compared to Group S (4.00±0.00min). The mean time for onset of motor block in Group P(9.73±1.01min) was significantly longer than Group S (5.00±00 min). The mean duration of motor block was longer in Group S (210.53±14.0min) compared to Group P (196.67±16.31min). The mean time to achieve maximum motor level was longer in Group P (19.73±2.08min) compared to Group S (5.00±0.00min). Mean duration of surgery in Group P (82.33±10.40min) and in Group S (84.17±10.99min).  CONCLUSION: After comparison of Peripheral nerve stimulator guided paravertebral block with spinal anaesthesia in unilateral inguinal hernia repair following conclusions were drawn: Two segment paravertebral block provides an excellent anaesthesia with unilateral motor, sympathetic and prolonged sensory blockade. Paravertebral block provides prolonged post-operative analgesia, better haemodynamic control and lesser incidence of side effects like urinary retention.

Background: Electroconvulsive treatment (ECT) is a procedure that creates a generalized cerebral seizure by using an electric current and electrodes inserted in the cranial vault under anesthesia. Electrical charges are delivered through these electrodes to cause seizures. For the past sixty years, it has been employed as a therapeutic therapy for the treatment of psychiatric disorder. ECT has been reported to be useful for pharmacologically resistant mental illnesses1, but at the immediate cost of a loss in emotional processing speed.2Objectives: 1. To study the cognitive functions before, immediately after the first electroconvulsive therapy, and at the end of one week of last electroconvulsive therapy. 2. To compare the cognitive functions before and after electroconvulsive therapy administration. 3. To correlate the cognitive functions and illness variable with electroconvulsive therapy. Material & Methods:Study Design:  Hospital based prospective observational study. Study area: Manasa Psychiatry Hospital, Secunderbad, Telangana. Study Period: August 2022 – August 2023. Study population: Patients suffering from psychiatric illness and planned for electroconvulsive therapy as recommended treatment option. Sample size: Study consisted a total of 50 subjects.  Sampling Technique:   Simple Random sampling.Study tools and Data collection procedure: TOOLS USED: 1) Semi-structured Proforma 2) PGI memory test 3) Digit symbol substitution test 4) Color Trail test-1 5) Color Trail test-2 6) Controlled Oral Word Association Test (COWA) 7) Addenbrooke’s Cognitive rating scale (ACE-R). After obtaining consent, patients who meet the exclusion and inclusion criteria were enrolled in the study design. Patients who took up for the study were able to understand the nature and purpose of the study. Uncooperative patients and patients with acute psychosis were ruled out from the study. Semi-structured proforma was administered for the patients taken up for the study. Socio-demographic profile as per the proforma was collected. Complete general physical examination and also detailed neurological evaluation were done before the study. All the subjects underwent cognitive assessment which lasted around 90 minutes. All the tests were carried out in a fixed order according to standardized administration procedures in a quiet room. Results:the mean COWA scores at baseline showed significantly higher scores as compared to 24 hrs at P<0.001. These results infer that the mean COWA scores show a difference between first ECT and 1-week post ECT which was highly significant statistically and further the difference between baseline and 1-week post-ECT was highly significant as it shows a significant increase in the scores at a 1-week time interval. P<0.001. Conclusion:From our study it can be concluded that, the ECT course causes rapid cognitive changes, both in the form of impairment as well as improvement. ECT treatment has effects on memory as well as other non-memory cognitive functions. ECT has acute effects on cognitive functions which are evident by changes in the cognitive profile of participating patients seen immediately after the first ECT.

Background: Hematological and inflammatory markers play a crucial role in assessing and differentiating between granulomatous and non-granulomatous lymphadenitis. Lymphadenitis refers to the inflammation of lymph nodes, and it can be categorized based on the presence or absence of granulomas. Granulomatous lymphadenitis is characterized by the formation of granulomas, which are aggregates of immune cells, particularly macrophages, that are surrounded by lymphocytes. Non-granulomatous lymphadenitis, on the other hand, lacks the formation of granulomas. Inflammatory markers play a crucial role in assessing and distinguishing between granulomatous and non-granulomatous lymphadenitis. These markers are substances in the blood that are elevated in response to inflammation. Here's an overview of the role of inflammatory markers in these two types of lymphadenitis. Materials and methods: This is a prospective study was conducted in the Department of Pathology, Tertiary Care Teaching Hospital over a period of 1 year. The study included 160 patients sample neck mass cases. Research participants were categorized as granulomatous and reactive lymphadenitis according to their cytological report. Samples were collected in tubes containing ethylenediaminetetraacetic acid and analyzed by automated blood count according to hospital procedures. An automated hematological analyzer was used to measure hematological parameters. We studied parameters such as TLC(Total leucocyte count), DLC(Differential Leucocyte Count), NLR(Neutrophil Lymphocyte Ratio), PLR(Platelet Lymphocyte Ratio). CRP was measured on a semi-automated analyzer 300, and ESR by the Westergren method. Result: In our study, out of a total of 160 cases, 80 were classified as granulomatous and 80 cases as reactive lymphadenitis. In the studied population, there were 64.5% females and 35.5% males. In our study found a female preponderance in both study groups as indicated. The average age of the study group was 29.59±0.95 in granulomatous lymphadenitis and 28.36±18.65 in non-granulomatous. All laboratory parameters in the two groups of lymphadenitis are shown in Table 4 indicating differences in their mean values. Hematological parameters such as NLR, PLR and CRP were significantly increased in patients of granulomatous disease and showed statistical significance with disease severity (P<0.001) where as other parameters such as TLC, ESR was not significant. Conclusion: Hematological and biochemical parameters like NLR, PLR, and CRP can give us some indication before FNAC for the presence of granulomatous and non-granulomatous lymphadenitis. It will help the treating doctor think methodically about early case identification and avoid diagnostic delays in situations like tuberculosis, especially at the primary care level.

Background: Acute pancreatitis (AP) is an inflammatory condition of the pancreas with a clinical course that varies from mild to severe, leading to activation of pancreatic enzyme and causing self-digestion of the pancreas. it is important to assess the disease severity in a timely and accurate manner to provide comprehensive treatment to AP patients, which will allow the clinician to consider more aggressive interventions to prevent adverse outcomes and decrease the high mortality of SAP. Methodology: The study was conducted at the Department of general surgery, Karnataka Institute of Medical Sciences, from November 2018 to December 2020. A total of 123 patients diagnosed with acute pancreatitis and undergoing treatment were included in the study. Detailed history taking, clinical examination and relevant investigations were done. Data was analyzed and entered using SPSS package. Results: Among 123 patients around 15 patients (12.2%) of the acute pancreatitis who were enrolled in to the study was found to have increased RDW. Around 2.2% patients had death who were enrolled in to the study was found to have increased RDW. Conclusion: RDW being a simple parameter which is easily available in a simple routine CBC thus, can be used as a novel predictor of acute pancreatitis.

Background: Hypokalemia, a common electrolyte disorder, poses substantial risks to various organ systems, necessitating effective identification of its underlying causes. The association between hypokalemia and hypomagnesemia, prevalent in clinical studies, underscores the need for comprehensive exploration in diverse populations, including limited Indian data. Methodology: A cross-sectional descriptive study was conducted at MKCG Medical College and Hospital, Berhampur, involving 154 participants aged 18 and above with hypokalemia (serum potassium <3.5 meq). Serum magnesium levels were analyzed (defining hypomagnesemia as <1.7 mg/dl) from August 2021 to November 2022. Statistical analysis employed R software, encompassing t-test, chi-square, and Pearson correlation. Results: Among 154 subjects (78 females, 76 males, mean age 45 +/- 09 years), the mean magnesium and potassium levels were 1.5825 and 2.8265, respectively. Hypomagnesemia occurred in 61.7% of hypokalemic patients. The mean magnesium levels for hypomagnesemia and normal magnesium groups were 3.1158 and 2.77, respectively. No significant correlation (p = 0.102) was observed between hypokalemia and hypomagnesemia. Discussion: Our findings indicated a higher frequency of hypomagnesemia in hypokalemic patients. Variations in reported associations between magnesium and potassium levels among studies highlight population heterogeneity. The discussion emphasizes the role of magnesium deficiency in exacerbating hypokalemia and underscores the importance of timely recognition and treatment. Conclusions: Hypomagnesemia is prevalent in hospitalized patients with hypokalemia, emphasizing the necessity for increased clinical awareness. Larger-scale investigations are recommended to explore the interconnected occurrence of these disturbances and evaluate the clinical utility of routine magnesium measurement in hypokalemic patients. Further research with expanded cohorts is encouraged for a comprehensive understanding of electrolyte imbalances.

Background: Coronary artery disease (CAD) poses a significant global health challenge, particularly affecting the elderly population. This study aims to investigate the socio-demographic aspects of acute coronary syndrome (ACS) in elderly patients aged 75 years and above in the eastern region of India, specifically in Odisha. Methodology: The prospective observational study was conducted at the Outpatient Department (OPD) of VIMSAR Medical College and Hospital, Sambalpur, Odisha. A total of 182 consecutive patients aged over 75 years and diagnosed with ACS underwent routine coronary angiography/percutaneous coronary intervention. The study focused on documenting demographic and angiographic profiles, as well as the distribution of various coronary artery disease risk factors. Results: Male patients constituted the majority of the population, comprising more than two-thirds of the total. The average age of enrolled patients was 81.02 ± 3.35 years. Geographically, the majority of patients were from the district of Sambalpur (41.2%), followed by Sundargarh (26.9%), Debagarh (17.6%), and Bargarh (11.5%). The incidence of CAD was higher in urban/semiurban areas compared to rural areas. Smoking showed a significant association with the diagnosis of ST-elevation myocardial infarction (STEMI). Discussion: The study sheds light on regional variations in the socio-demographic profile of elderly patients with ACS in Odisha. The observed higher incidence in urban/semiurban areas emphasizes the impact of lifestyle on cardiovascular health. The significant association of smoking with STEMI aligns with broader literature, emphasizing the need for targeted interventions. Conclusion: The study provides essential insights into the socio-demographic factors associated with ACS in the elderly population of Odisha. Tailored interventions and public health strategies informed by these findings have the potential to reduce the burden of CAD in this vulnerable demographic. The study addresses a critical knowledge gap, contributing to the holistic management of CAD in the specific context of Odisha.

Introduction: In conjunction with the Millennium Development Goals, the under-5 mortality rate had a remarkable global decline of 53% between 1990 and 2015 [1]. Currently, the first month of life accounts for 45% of under-5 mortality. Infections rank among the main causes of newborn mortality, along with intrapartum issues and problems from premature delivery [2]. Together, neonatal sepsis and meningitis account for 6.8% of all under-5 fatalities worldwide [3]. Material and Method: The limitations of the study are those characteristics of design or methodology that impacted or influenced the interpretation of the findings from your research. Study limitations are the constraints placed on the ability to generalize from the results, to further describe applications to practice, and/or related to the utility of findings that are the result of the ways in which you initially chose to design the study or the method used to establish internal and external validity or the result of unanticipated challenges that emerged during the study. Result: In the present study ,100 cases of neonatal bacterial meningitis have been taken from SVPPGIP and SNCU OF SCBMCH, Cuttack and their results were statistically analysed and compared. Conclusion: One of the leading causes of morbidity and death in neonates is still bacterial meningitis. Since LP is so widely used for diagnosis, an increasing number of cases have been diagnosed in the last ten years. Although the morbidity has not changed, the mortality has decreased dramatically as a result. Our study examined the relationship between greater complications and delayed hospital presentations.

Background: This study was conducted to evaluate the serum vitamin D levels in patients with type 2 diabetes mellitus with and without nephropathy. Methods: This was a hospital-based cross-sectional case control study conducted among 100 patients who attended OPD and IPD at the Department of Medicine, Dr. B.R. Ambedkar Medical College and Hospital, Bangalore, over a period of 18 months from December 2020 to May 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In comparison between diabetic nephropathy and non-diabetic nephropathy between both groups, a statistically significant difference (p<0.001) was noted between them with regard to serum creatinine, eGFR, UACR and vitamin D levels, suggesting that the diabetic nephropathic group has increased creatinine levels, highly reduced eGFR, highly elevated UACR and significantly decreased vitamin D levels, which are not present in the non-diabetic nephropathy patients. The eGFR and vitamin D levels were compared among the diabetic nephropathic subjects. The eGFR was split into three groups and by the ANOVA test measure, a significant association was obtained between them suggesting decreased eGFR also decreases vitamin D levels. On correlating vitamin D levels with serum creatinine and UACR a statistically significant (p<0.001) strong negative correlation was obtained (0.85 and 0.91) respectively. Conclusion: The study found that individuals with diabetic nephropathy had a higher prevalence of vitamin D insufficiency. However, at more advanced stages of diabetic kidney disease, their severity is more prevalent. Patients with CKD (Chronic Kidney Disease) should get information from health care providers on vitamin D monitoring and its dietary sources.

Introduction: Soft tissue defects in the middle and upper leg, knee and lower thigh are often encountered by reconstructive surgeons. Although perforator flaps and vascularized free flaps have been reported to reconstruct these defects more frequently, gastrocnemius muscular and myocutaneous flaps remain good alternatives for repairing these defects due to their relatively easy and quick procedure, large dimension, and reliable survival. The medial gastrocnemius myocutaneous flap with a larger dimension and wider reach was applied more frequently to cover these defects, while the lateral gastrocnemius myocutaneous (LGM) flap was used to resurface the defects when the defects were predominantly located in the lateral aspect of the regions mentioned above or when the medial gastrocnemius myocutaneous flap was unsuitable because its integrity was destroyed. Materials and methods: This is a prospective and observational study was conducted in the Department of Anatomy at Department of Anatomy at Kannur Medical College, Anjarakandy over a period of 1 year consist of 20 sample. In prior anatomic dissections almost all limbs had at least 1 large musculocutaneous perforator to the overlying calf skin that exited via the medial head of the gastrocnemius muscle, so that a true muscle perforator flap could be raised from that territory. The majority of these perforators were clustered in the distal half of the muscle and emanated near the raphe separating the 2 heads of the gastrocnemius. The mean distance of these perforators from the origin of the medial sural artery at the popliteal artery was 15.3 cm. (range, 10–20.5 cm.), which represents the maximum pedicle length for this as a local flap. Result: In the area defined as the medial flap we found an average of 3.7 perforators arising from the medial sural artery and 2.9 arising from the posterior tibial artery. In the medial flap the distal most perforator was the posterior tibial septocutaneous perforator, which was at an average 25.5cm from the intercondylar line, around 7.9 cm farther away from the distal most medial sural perforator. In the lateral flap region we found an average of 2.9 lateral sural perforators along with 2.7 peroneal perforators. In this flap the distal most perforator was the peroneal septocutaneous, at an average distance of 24.2cm distal to the intercondylar line and at an average of 7.3cm further away from the distal most lateral sural perforator. Conclusion: On analysis of the data we found that it could be possible to raise combined flaps which include both the sural perforators emerging through the gastrocnemius muscle and the posterior tibial or the peroneal septocutaneous perforators.

Aim and objective – present study was done to compare newly introduced gel card technique and conventional tube method. Methodology -  Present study was retrospective study of one-year duration from April 2021 to June 2022 conducted in department of Pathology Govt Medical College Mahasamund (C.G). Total 2000 sample were taken. Blood grouping and Cross match of both recipient blood sample and donor blood sample were done using Both tube and gel technique and their results were compared and analyzed. Result – In our study 0.5% samples showed incompatibility with Gel card method but by test tube method 100% samples showed compatibility until subjected to IAT using AHG after incubation at 37°C for 60 minutes, where 0.5% samples incompatible with gel card method were also found to be incompatible. The sensitivity and specificity of both methods is 100% if use of AHG is included in all tests performed by tube method, otherwise the specificity of tube method is 99.5%. Conclusion – The gel technique has definite advantages over the conventional tube technique because of being able to detect more positive samples than tube and its shorter duration for the cross matching procedure.

Introduction: The World Health Organization (WHO) definition of stroke is: “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”. The pathological background for stroke may either be Thrombotic or hemorrhagic disturbances of the cerebral blood circulation. Thrombotic cerebral infarction results from the atherosclerotic obstruction of large cervical and cerebral arteries, with ischemia in all or part of the territory of the occluded artery. Hyperhomocysteinemia has been emerging as an independent risk factor for atherosclerosis. Several workers opined that moderately elevated plasma Homocysteine (Hcy) concentration might be an independent risk factor for cerebrovascular disease including stroke and transient ischaemic attack. Material and Methods: The study is a hospital based observational study was conducted in the Department of General Medicine at ACSR Government Medical College, Nellore from Dec 2022 to October 2023. 31 patients with thrombotic stroke(cases) and 31 subjects without thrombotic stroke (controls) and other comorbid conditions that affect serum homocysteine were included in the study. Venous blood samples were collected in tubes containing disodium EDTA. Homocysteine assay is based on the measurement of co-substrate conversion product. Results: In the present study, the mean age ± SD of cases was 55.03±14.51. The mean age of males was 51.68±13.45 and the mean age of females was 60.33±15.11. The mean age in control group was 51.22±13.77. The mean serum homocysteine level in the present study, in cases was 25.98±11.95. The mean homocysteine level in males was 7.83±14.29. The mean in females was 23.05±5.67. The mean homocysteine level in control group was 7.19±3.51. Mean homocysteine level of cerebral ischemic stroke females was 14.86 ± 5.34. The mean homocysteine level in controls was 7.428 ± 4.091. The mean homocysteine level in controls was 12.30± 4.68. The mean cholesterol of the cases was167.67±40.68. The mean LDL in the study was 89.74±27.38. The mean HDL was 38.48±10.92. Conclusions: Serum homocysteine levels were significantly higher in those paients with stroke when compared to those without stroke. Apparently, Serum homocysteine level is an independent risk factor for thrombotic stroke.

Introduction: As of 2011, India has a population of 1.21 billion people. It is the second most populous country in the world, next only to China. In absolute numbers the population of persons above 60 years was around 76.62 million in 2001, will rise to nearly 179 million by 2031 and 324 million by 2050. In addition, as people age there are increased chances of becoming disabled, and once disabled, there are increased chances of deterioration with decreased likelihood of recovering from disability. AIM: To assess the Geriatric Morbidity pattern, Activities of daily Living (ADL) and Mini Mental Scale Evaluation (MMSE). Methodology: A Cross sectional study with multistage random sampling technique was used to select the requisite number of elderly for a sample size of 600. Results: Mean age of the study population is 66.9 with SD ± 5.73 years ranging from 60 to 88 year. Multi-morbidity was seen early in nearly 70% the study population, this seems to increase with increasing age which ranged from 57.4% to 85.3% and this association was statistically significant (p value = 0.002). The total morbidity in the study population was found to be 96.3%. Conclusion: Curative medicine has a very limited role to deal with the problems of elderly in terms of impairments and diseases. Palliative care is needed to tackle impairments and complications of NCDs.

Introduction: Amniotic fluid embolism (AFE) is remarkably infrequent yet carries a high mortality rate when it occurs. Here we report a case of AFE which was complicated by cardiac arrest, severe acute respiratory distress syndrome, and disseminated intravascular coagulopathy that was treated via our Mobile ECMO program. Case presentation: A 29-year-old gravid female at 40.5 weeks of gestation who experienced sudden hemodynamic instability secondary to AFE during labor. The patient exhibited a generalized tonic-clonic seizure, which was followed by pulseless electrical activity, necessitating emergent delivery via cesarean section of a healthy neonate. The patient’s condition continued to worsen and she suffered multiple cardiac arrest events, hypoxemia, and massive uterine bleeding. Due to hemodynamic compromise, the mobile extracorporeal membrane oxygenation (ECMO) team was activated and the patient was placed on a veno-arterial (VA ECMO) circuit. Subsequently, the patient developed abdominal compartment syndrome and required a bedside exploratory laparotomy. Following this intervention, the patient's hemodynamics stabilized, her cardiac and respiratory function improved, and VA ECMO was able to be removed on the fourth day. The patient remained neurologically intact and eventually was transferred to a rehabilitation facility. Discussion: Despite recent advances in prenatal care, AFE remains a significant and potentially fatal complication of parturition. Early recognition and prompt treatment are important, and refractory cardiopulmonary collapse can be supported with VA ECMO. The mobile ECMO program increases access to this life saving technology. Conclusion: Our report underscores the efficacy of ECMO as a therapeutic modality for AFE and the benefit of mobile ECMO in expanding access for this life saving technology.

Introduction: Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease, mainly affecting elderly people. It is caused by degeneration of dopaminergic neurons in the striatum. Metformin, by activating AMP-activated protein kinase (AMPK), induces autophagy and reduces reactive oxygen species (ROS) production, leading to a reduction in neuroinflammation. Thus, the study was designed to assess the neuroprotective effect of Metformin in the rotenone-induced Parkinson's model of Drosophila melanogaster. Materials and Method: Drosophila flies were cultured in cornmeal agar medium. Seven-day-old flies were divided into five groups with approximately 30 flies in each group: normal control, disease control, Levodopa (1 mM), and Metformin low dose (20 mM) and high dose (40 mM). Rotenone (125 μM) was used to induce the disease. All drugs were administered through the cornmeal agar medium for seven days, and on the eighth day, a climbing assay was performed. Effect on biochemical variables like Malondialdehyde (MDA) and Dopamine levels in the Drosophila brain were also assessed. Result: There was a significant improvement in the flying and climbing ability of Drosophila flies in the metformin (high and low doses) and L-dopa groups compared to the disease control group. Also, there was a significant increase in levels of Dopamine and a decrease in levels of MDA in the Drosophila brain in the metformin-treated groups and the L-dopa group. All these effects were most pronounced in the group receiving a high dose of metformin. Conclusion: Metformin was found to be neuroprotective as it improved the locomotor activity of Drosophila flies, probably by reducing oxidative stress and degeneration of dopaminergic neurons.

Introduction: Diabetes mellitus is one of the common non-communicable diseases in India. Dyslipidemia is also associated with diabetes mellitus. Role of vitamin D is described in diabetes mellitus in multiple studies owing to its facilitation/inhibition of transcription factor and immune-modulator property. Aim: to evaluate association of vitamin D level with parameters of fasting lipid profile. Methods: It was an analytical observational case study. Patients of type 2 diabetes mellitus were included in the study. All routine lab parameters were done. Statistical analysis was done by pearson correlation test, fisher’s exact test and ANOVA. Linear regression analysis was also done. Results: 119 patients were included in the study. Vitamin D deficiency was found in 77 patients (64.71%). Negative correlation was present between vitamin D level and HbA1c. Vitamin D deficiency was found to be significantly associated with high HbA1c (p = 0.024). Furthermore, Negative correlation was found between vitamin D level and total cholesterol (r = -0.0134, p = 0.8987), serum triglyceride (r = -0.0310, p = 0.7690) and serum LDL (r = -0.0149, p = 0.8873). Positive correlation was present between vitamin D level and serum HDL (r = 0.0296, p = 0.7782). On ANOVA test, mean values of serum triglyceride in vitamin D deficient, vitamin D insufficient and vitamin D sufficient groups were 206 ± 147.3 mg/dl, 152.78 ± 64 mg/dl and 147.84 ± 72.6 mg/dl respectively. (p = 0.0510), near significant association was found between vitamin D deficiency and increased serum triglyceride level. Conclusion: Vitamin D deficiency in type 2 diabetes mellitus is associated with poor glycemic control. Vitamin D deficiency in type 2 diabetes mellitus may be a risk factor for dyslipidemia.

Background: Cardiovascular disease (CVD) has become a major public health problem and leading cause of mortality in developing countries. Cardiovascular risk assessment approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs. so that immediate preventive measures or action can be taken to reduce the risk. Aim: The present study was conducted to assess the CVD (myocardial infarction or stroke) risk by utilizing the WHO/ISH risk charts (non-cholesterol based/ noninvasive chart) in a tribal population of Nasik, India. Methods: This was a cross-sectional community-based study conducted in the rural health training center of the tertiary Healthcare Institute Nashik on 110 participants. The WHO/ISH risk prediction chart for South-East Asia Region D (SEAR D) was used for calculating the 10-year cardiovascular risk. Results: Among total 110 study participants, 83 (75.5%) were in the mild-risk (<10%) category. The 10-year risk of myocardial infarction and stroke is comparable among both sexes (Male- 24.4%, female – 25%), type of occupation (Farmer 24.4%, Non-farmer group – 24.6%), and educational status (Up to secondary level – 25%, above secondary education – 23.3%). Risk factors such as advancing age, three generation family, Tobacco addiction, Family History of Diabetes, Stress, high blood pressure (Both SBP & DBP) and raised random blood sugar level were found to be significantly associated with increased risk of the major cardiovascular event. Conclusion: WHO/ISH chart is a best useful tool in identifying CVD risk. This can further help in planning and implementing targeted interventions amongst identified high risk population in tribal population.

Background: Skull base (SB) injuries happens mostly either in the thinnest or the least resistant part of skull base. The lateral lamella of cribriform plate is one of the common sites of injury during endoscopic anterior skull base surgeries. The anterior ethmoidartery (AEA) visualization is considered as a significant anatomical landmark in such surgeries. Studies correlating their positional relation with morphology of olfactory fossa remain limited. This study aims to look into the relation of AEA to that of SB in different types of olfactory fossa morphology. Materials and methods: A surveying radiological study was conducted on 90 coronal CT images from patients who were exposed to paranasal CT imaging in a tertiary care teaching hospital. The examination included all CT images as well as an indication of sinusitis. The exclusion being changed skull base anatomy as a result of previous surgical intervention, injury, or tumour, and age less than 18 years. RadiAnt Dicom viewer was used to inspect the images. [8] The position of AEA in relation to SB was identified in the bone window of coronal CT scans. On each side, it was divided as at SB or below SB. the longitudinal distance from AEA to SB was evaluated separately. Depending up on the distance of AEA from SB, 3 groups were sectioned as follows: set A - < 2.5 mm, set B – 2.5 to 5 mm and set C - > 5 mm. Result: In our present study of 90 patients, number of male patient was 58 (64.4%) whereas number of female patient was 32 (35.6%) [Table 1]. Age of patient was from 18 years to 80years. anterior ethmoidal artery canal was seen in 30% (27) scan. Most of those were complete type.  Anterior ethmoidal foramen was seen in 90% (81) of CT scan. Supraorbital pneumatisation was seen in 40% (36) scan [Table 2]. Conclusion: It was concluded that notch which was present in the medial wall of orbit was a very good landmark to locate anterior ethmoidal artery and it was found in 98% of cases and in 28% of CT scan supraorbital pneumatisation was found which has a very close relationship with visualization of anterior ethmoidal artery canal.

Squamous cell carcinoma (SCC) is the most prevalent malignant neoplasm of the oral cavity. Cervical lymph node metastasis is a prognostic factor of paramount importance in patients with oral squamous cell carcinoma. We retrospectively analyzed the clinicopathologic features and the association of these features including degree of differentiation, tumor size, T stage, lymphovascular invasion, perineural invasion, and depth of invasion—on the risk of neck node metastasis in 25 adult patients who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Depth of invasion and other pathologic features were determined by reviewing the pathology specimens. The association between the prevalence of neck node metastasis and the depth of invasion was observed to be statistically significant, but there was no significant association between neck node metastasis and tumor T stage or degree of differentiation. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases, as has been shown in previous studies. It is interesting that tumor size, which is the most important component in the TNM system for staging oral squamous cell carcinoma was not significantly associated with neck node involvement.

Pharmacogenetics: Pharmacogenetics studies how genetic and non-genetic factors influence drug response. Genetic variants can affect drug metabolism. Cytochrome P450 enzymes play a crucial role in drug metabolism. Personalized medicine utilizes patient-specific information, including genetic factors. Pharmacogenetics is being increasingly implemented in clinical practice. However, challenges exist in implementing genetic testing. Genomics and pharmacogenomics have the potential to improve drug discovery and personalized medicine. Genetic biomarkers are essential in drug development. Pharmacogenetic testing guides personalized medicine. Ethical and regulatory considerations surround the use of genetic information. This paper delves into the intricate relationship between genetic variations and an individual's response to drugs, examining how these variations profoundly influence drug metabolism, efficacy, and susceptibility to adverse reactions. The emerging field of pharmacogenomics, which resides at the crossroads of genetics and pharmacology, seeks to revolutionize clinical practice by tailoring drug treatments according to an individual's unique genetic profile. By seamlessly integrating pharmacogenomics into routine clinical care, the healthcare industry stands to benefit from the promise of delivering highly personalized and effective medical interventions, thereby elevating patient outcomes and the overall quality of healthcare services. As research advances and technology evolves, the full potential of pharmacogenomics continues to expand, offering a glimpse into a future where healthcare becomes increasingly precise and patient-centric. These advancements have the potential to not only optimize drug therapies but also reduce healthcare costs and enhance the overall healthcare experience. Ultimately, the integration of pharmacogenomics holds the potential to make medicine safer, more effective, and more patient-centered, marking a significant milestone in the evolution of healthcare practices.

Background: Type I Diabetes Mellitus is the most common endocrine-metabolic disorder of childhood and adolescent. Diabetic ketoacidosis is a potentially life-threatening complication among children, characterized by triad of hyperglycemia, ketosis and academia, accounting for majority of hospital admissions and deaths related to Diabetes in children.  Early diagnosis and prompt management substantially reduces the mortality. Objectives: This study was done to evaluate clinical profile, severity, complications and immediate outcome of patients admitted in PICU with Diabetic Ketoacidosis. Results: Out of 30 children included in our study, 70% were females(n21) and 30% were males(n9). Newly diagnosed diabetics accounted for 17 (56.5%) of the patients. The common presenting complaints of DKA in our study was altered sensorium (100%), rapid breathing (93%), vomiting (80%) and abdominal pain (73%) followed by polyuria (63%), polydipsia (60%), weight loss (50%) and fever (40%). Amongst all 30 cases, 20 patients (66%)had moderate dehydration meanwhile 10(33.3%) had severe dehydration. Complications like Hypokalaemia (20%), other electrolyte imbalance (16%) like hypocalcaemia, hyponatremia, superadded infection (26%) like upper and lower respiratory tract infection, acute febrile illnesses were commonly encountered in our study and 11(36%) cases of DKA were not associated with any complications. Out of 30, 5 (16%) children had mild DKA, 13(43%) children had moderate DKA and 12 (40%) children have severe DKA. In our study, all patients recovered and were shifted to ward with mortality of 0%. Conclusion: DKA was most prevalent in newly diagnosed IDDM cases. Infections was the most common precipitating factor. No lethal complications were recorded in our study.

Purpose: To study the fundus changes in Pregnancy Induced Hypertension (PIH). Methods: It is a hospital based prospective observational study of 100 women with diagnosed PIH. Fundus was examined by direct and indirect ophthalmoscope at bedside. Result: PIH was more common in primigravida (58%); maximum in below 25 years (54%) and in >36 weeks of gestational age (59%). Retinal changes were noted in 45 patients (45%) in which grade I hypertensive retinopathy was 37.7% and grade IV was 24.44%.  Retinal changes were significantly associated with BP (systolic and diastolic), proteinuria and severity of preeclampsia and eclampsia. Most of the changes in the fundus resolved within one week of delivery. Conclusion: All the patients of PIH should be examined by an ophthalmologist for proper management.

Background: Endotracheal intubation is a common procedure during general anesthesia, often associated with post-operative complications such as sore throat and emergence cough. This study aimed to investigate the efficacy of three intra-cuff solutions—air, normal saline, and 2% lignocaine—in mitigating these complications and their impact on intubation attempts and hemodynamic parameters. Methods: A randomized clinical trial was conducted involving 114 patients undergoing elective surgeries. Participants were divided into three groups based on the intra-cuff solution used. Intubation attempts, post-operative sore throat, emergence cough, and physiological parameters were assessed and statistically analysed. Results: The use of 2% lignocaine significantly reduced the number of intubation attempts (p < 0.001*) compared to air and normal saline. Additionally, lignocaine was associated with a significantly lower incidence of post-operative sore throat (p = 0.011*) and emergence cough (p = 0.010*) compared to the other solutions. However, there were no significant differences in hemodynamic parameters between the groups. Conclusion: This study suggests that 2% lignocaine may be a preferable intra-cuff solution for endotracheal intubation, as it reduces intubation attempts and the incidence of post-operative complications. Further research and clinical trials are needed to validate these findings and refine the selection criteria for intra-cuff solutions.

Brucellosis, a major health problem in developing countries, is a zoonotic disease with multisystem infection with a broad spectrum of clinical manifestations. We present a 48-year-old man diagnosed to have brucellosis in our hospital who was admitted through the emergency department with the chief complaint of fever for 25 days, generalized myalgia for 3 weeks, and decreased appetite associated with weight loss of 4-5 kg in a month. Fever was mild to moderate with the intermittent spikes and that subsided with paracetamol. There was no history of chronic cough or cold, joint pains, rashes, nausea or vomiting, urinary symptoms or bleeding manifestations. The blood culture grew out Brucella melitensis. He responded well to combination therapy consisting of doxycycline and beta lactam antibiotics. He recovered fully without relapse during the one-month follow-up.

Background: Circadian rhythm is a biological and behavioral process that regulates sleep. The quantity and quality of our sleep significantly impact our day-to-day life and various health outcomes that help the body in cellular repair and fight diseases. In the modern era, sleep has become another casualty of modern life thereby making it very essential to assess and keep track of sleep quality. Sleep quality is assessed commonly using the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The comparison of concordance and discordance of ESS and PSQI is not done earlier and a thorough evaluation of their measurement results and degree of agreement is essential. Thus, the study aims to do a comparative analysis of ESS and PSQI scales and analyses their concordance in measuring sleep-related parameters. Methods: Healthcare employees working in the Parent Institute were included in this study. Subjects were given the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index questionnaire to assess sleep quality and a comparative analysis of both scales was done. Results: The study compares both the scales – ESS (Adequate & inadequate sleep) & PSQI (Good & poor sleep) using Kappa statistics showing an overall agreement of 74.6% with a simple kappa value of 0.49 (Fair agreement) which was statistically significant (P < 0.001). Conclusion: The study shows significantly fair concordance between the ESS and PSQI in determining sleep parameters demonstrating that they each effectively assess different facets of sleep.

Introduction: Adverse drug reactions (ADR) are an important aspect of drug therapy and can be a major setback in clinical practice. An ADR is defined by the World Health Organization (WHO) as ‘a response to a medicine which is noxious and unintended, and which occurs at doses normally used in man. The safety of drugs used in patients of an adult age group cannot be extrapolated to a pediatric age group. The pharmacokinetics and pharmacodynamics of many commonly used drugs vary significantly between these two age groups of patients2.  Adverse drug reactions (ADRs) in children can have a relatively more severe effect when compared to adults. Thus, the ADRs can lead to significant morbidity among children.3 An increase in the number of drugs and self-medication with various medications have enhanced the occurrence of adverse drug reactions in recent times, especially in pediatric population. Material & Methods: This was a prospective, observation based, non-interventional study was Conducted in Dept. of Pediatrics, SCB Medical college and SVPPGIP, Cuttack which are two institutions under one department. This Department is a tertiary care center for pediatric patients in our state. Our institution is an approved ADR Monitoring Center (AMC) under Pharmacovigilance programme of India (Pvpi). ADRs were confirmed by the clinicians based on temporal relationship between start of drug and reaction, withdrawal of drug leading to decrease severity or abolition of reaction (dechallenge), exclusion of other causes etc. Sensitization of doctors in various seminar were done for spontaneous ADR reporting in Suspected Adverse Drug Reaction Reporting Forms by health care professionals. Results: Out of total 350 cases, dermatological system was most commonly involved i.e. 207 cases (59. 14%).This is followed by involvement of central nervous system 46 number of cases (13.14%). The GI system was involved in 34 cases i.e. (9.71%). Most of the ADRs were due to Antibiotics, these drugs are involved in 198 (56.57%) cases. Commonest antibiotics causing ADRs were Ofloxacin involving 26 cases (13.13%) of antibiotics followed by Ceftriaxone and cefixime comprising 22 cases (11.11%) and 14 cases (7.07%) respectively of total antibiotics used. A single drug as a possible causative agent of ADR,177 such cases were reported which constituted 50.57% of the total ADRs. Sometimes these agents were used with other drugs but Dechallenge test ruled out the probability of other drugs involvement. Out of 177, 110 drugs caused ADRs when used alone i.e. 31.4 % drug reactions were caused by monotherapy. Conclusion: Our study showed varied range of ADRs with higher reports in male children compared to females and maximum reports of ADRs obtained in age group 5-10 Years. Dermatological ADRs have highest incidence out of all the ADRs and FDE is most frequent among dermatological ADRs. Antibiotics were the commonest suspected agent in the reported ADRs. This study also exposed high occurrence of over-the-counter prescription to the pediatric age group causing ADRs (20.87%) of total ADRs and 12% of total serious ADRs. Incidence of serious ADRSs were more where multiple drugs were the suspected causative agents of ADRs. Various atypical ADRs were also observed due to active monitoring. Hence this study further emphasizes the need of proactive Pharmacovigilance, restriction of over-the-counter medications and increasing awareness among health care professionals, patients and public, for rational use of antibiotics, avoiding multidrug therapy and FDCs to reduce the incidence of ADRs especially in pediatric age groups.

Introduction: In today's demanding academic landscape, childhood leisure takes a backseat, impacting values and societal characteristics. Leisure, encompassing relaxation, enjoyment, and intrinsic motivation, plays a vital role in positive development, humanization, and interpersonal relationships. Its utilization varies based on location, parental education, and socioeconomic factors, involving physical activities, media engagement, and arts participation. Methodology: This cross-sectional study, conducted over a two-year period in Berhampur, Ganjam, aimed to explore the relationship between leisure activities and childhood obesity in both government and private schools. A total of 400 students participated, and the study assessed the quantity and quality of leisure time, correlating these factors with Body Mass Index (BMI). Result: The study identified an alarming prevalence of obesity (11.5%) and overweight (13%) among students, with private schools exhibiting a higher prevalence of obesity (22.3%) than government schools (8.3%). Males showed a higher prevalence of overweight and obesity compared to females, possibly influenced by cultural expectations. Discussion: A significant relationship between physical inactivity and BMI was observed, underscoring the crucial role of physical activity in obesity prevention. The findings emphasize the urgent need for interventions promoting physical activity to combat the rising prevalence of obesity among school children. Encouraging structured play and discouraging excessive screen time are vital components of fostering a healthy lifestyle. Conclusion: Prevention remains paramount, with the adoption of a healthy lifestyle, reduced sedentary time, regular exercise, and a nutritious diet being key strategies. Routine screening for overweight individuals is essential for timely interventions. Schools, parents, and pediatricians play pivotal roles in addressing this emerging health issue, highlighting the importance of a collaborative approach to promote and maintain a healthy lifestyle among school children.

Background and Aim: Diastolic heart failure is a common yet difficult to identify condition. The study's goal was to investigate and link NT-proBNP levels with four classes (grade I to grade IV) of diastolic dysfunction as measured by echocardiography. All patients underwent a thorough clinical examination, blood biochemistry, electrocardiography, chest X-ray, echocardiography, and plasma NT-proBNP testing. Material and Methods: The current study was carried out on 50 DHF patients enrolled from outdoor and indoor patients in the Department of Medicine, Tertiary Care Teaching Institute of India over a one-year period. Clinical assessment and echocardiography were performed on the patients. The autoanalyzer was used to estimate NT-proBNP utilising the electrochemiluminisense method. Echocardiography was used to classify patients into different levels of diastolic dysfunction. Results: The mean levels of NTproBNP in individuals with systemic hypertension were statistically significant (p0.05) higher than in non-hypertensive patients in the current investigation. NT-proBNP levels were observed to be statistically greater in LVH participants compared to those without LVH. (p≤0.05) In the current study of 50 patients with diastolic heart failure, 36 patients (72%) had grade I diastolic dysfunction, 9 patients (18%) had grade II diastolic dysfunction, 3 patients (6%) had a grade III diastolic dysfunction, and 2 patients (3%) had a grade IV diastolic dysfunction. Conclusion: Serum NT-proBNP levels give reliable diagnostic accuracy for detecting diastolic heart failure, and they correlate well with increasing degree of diastolic dysfunction as measured by a well-established modality of echocardiography. In symptomatic individuals, NT-proBNP can accurately detect the presence of isolated diastolic dysfunction and is a valuable diagnostic for ruling out patients with impaired exercise tolerance of non-cardiac origin.

Background: In the West, coronary heart disease, or CHD, is the main cause of mortality. Young people experiencing an acute myocardial infarction (AMI) is comparatively rare. Nevertheless, it remains a significant issue for both the patient and the attending physician. There are few studies of risk factors of coronary artery involvement in AMI in young adults, so the purpose of the present study is to identify the risk factors for acute myocardial infarction in rural India. Methods: This was an institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from May 2020 to July 2021. Total 100 patients admitted with AMI during this period meeting the inclusion and exclusion criteria were included in this study. A Microsoft Excel spreadsheet containing the data was used for data entry, and SPSS (version 2710; SPSS Inc., Chicago, IL, USA) was used for analysis. Result: In the present study mean age of patients was 35.21 ±4.39 years, majority of patients belonged to age group of 36-40 years (56%). The mean BMI was 27.23 ±3.34 kg/m2. The most common presentation was chest pain (90%) followed by profuse sweating (65%), radiation to left shoulder/arm (45%), nausea/vomiting (40%), anxiety (38%), breathlessness (28%). Most common risk factor was smoking (85%) followed by hyperlipidemia (82%), family history of premature coronary artery disease (72%), hypertension (52%), sedentary lifestyle (42%), psychosocial stress (38%), obesity (16%) and diabetes mellitus (14%). Majority of the study subjects had more than 3 risk factors (64%), while 21% had 3 risk factors, 13% had two risk factors. Mean level of cardiac enzyme marker CKMB was 38.42 ±5.67 IU/L. Conclusion: Acute MI in young patients is becoming a rising problem in Indian subcontinent which is more common in men. Smoking was the most common risk factor of MI in them indicating atherosclerosis could be the commonest cause followed by dyslipidemia.

Background:Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world.Evidence regarding its risk factors can guide clinical practice and prevention strategies. Aims and Objectives:To assess the prevalence of Sepsis and to identify the Risk factors for the Neonatal Sepsis in the unit. Patient and Methods:  A prospective observational study was planned in Neonatology Unit including Neonatal Intensive Care Unit [NICU] and Special Newborn Care Unit [SNCU] of Sri Venkateswara  Ramnarain Ruia Government General Hospital [SVRRGGH], Tirupati for a period of 1 year from the time of approval of Institutional Scientific and Ethics Committees of Sri Venkateswara Medical College, Tirupati i.e., April 2021 to March 2022. All neonates were screened and followed up. A predesigned proforma was utilised to record the observations during the study. Results: Out of 2265 admissions during study period, 471(20.72%) neonatal sepsis and 25.26% mortality has been observed. 43.9% were with Probable Sepsis. Sepsis was more seen in Male patients (56%), premature babies (64.3%), outborn (57.8%), early onset (55.6%), low birth weight babies(61.3%), CRP positive(60%), average hospital stay of 11-20 days(69.6%) and mostly discharged (74.8%). Conclusion: The neonatal sepsis and its mortality are more in the present study. Male, premature babies, low birth weight, outborn , multiple vaginal examinations, premature rupture of membranes are the predominant risk factors of Sepsis. Robustly designed Surveillance and research are the key to reduce the burden of Sepsis.

Introduction: Kidney disease is defined as an abnormality of kidney structure or function with implications for the health of an individual, which can occur abruptly, and either resolve or become chronic. Chronic kidney disease (CKD) is a general term for heterogeneous disorders affecting kidney structure and function with variable clinical presentation, in part related to cause, severity, and the rate of progression. Aims: To study carotid intimal thickness in different stages of chronic kidney disease. To study the correlation between the carotid artery intimal-medial thickness with lipid profile in Chronic Kidney disease. Materials and Methods: The present study was a cross sectional single centre, observational study. This Study was conducted from Jan 2015 to August 2016 at Department of Medicine of a tertiary care hospital. Result: There was negative correlation of CIMT with eGFR on both sides but statistical significance was not reached. There was no significant correlation with creatinine levels. That majority cases had serum creatinine above 4 mg/dL. Raised and normal CIMT were evident in nearly equal proportions in both right (p=0.839) and left (p=0.939) carotids.  That there was no association of raised CIMT with CKD stage in either right (p=0.932) or left (p=0.886). Association of CIMT with patient management. Patients who were managed by hemodialysis had raised CIMT in higher number of patients (63% on right and 56.4% on left) than those managed conservatively (37% on right and 43.6% on, left).  Conclusion: Raised CIMT is substantially linked with lipid markers in CKD patients. No correlation between elevated CIMT and either CKD stage or renal function measures was found, indicating that CKD stage has little to no effect on elevated CIMT. The CIMT of patients receiving haemodialysis, however, was elevated, indicating a higher risk in this population than in patients receiving conservative therapy.

Introduction: The likelihood of survival for patients receiving coronary artery bypass surgery with graft surgery is decreased by incomplete myocardial revascularization. The results of doing several grafts to each significant sick artery region are still unknown. They wanted to see how inserting numerous grafts in each myocardial area (supra-complete revascularization) affected survival and outcomes following coronary artery bypass grafting compared to regular territorial grafting (full revascularization). Aims: To investigate and compare the outcomes of total vs. supra complete territorial grafting in terms of intraoperative advantages and drawbacks, post-operative clinical status, 2 D Echocardiography parameters, incidence of any post-operative significant adverse cardiac event, and overall survival. Materials and Methods: The current study was a prospective, non-randomized study. From July 2021 to January 2023, the study was carried out in Cardiothoracic OT, Postcardiac Surgery Recovery Unit, and CTVS OPD I.P.G.M.E&R (University affiliated tertiary care hospital and teaching institution). There were 40 patients in all in this study. Result: ECG findings were found in 19 (95.0%) more individuals in the Complete group than in 18 (90.0%) in the Supra-complete group. Despite the fact that (p=0.5483) it was not statistically significant. The number of re-examinations and the group had a statistically significant link (p <0.0001). Conclusion: We demonstrated a statistically significant distinction between the mean Number of Re Explorations in the complete group and the supra-complete group. The difference between the mean ICU stay in the Supra-complete group and the complete group was statistically significant, as were the differences between the mean 2D echo findings in the Supra-complete group and the complete group.

Background: It has recently been demonstrated that vitamin D, long thought to be a hormone that regulates calcium and phosphate, is essential for the treatment of a number of non-skeletal illnesses, including cardiovascular disease. Numerous research have been conducted on the connection and potential causal involvement of vitamin D in cardiovascular diseases and the well-known risk factors associated with them. There aren't many research conducted in this region of the world, though. This study's primary goal was to measure the 25-hydroxyvitamin D levels in heart failure patients. Methods: This was a institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from March 2021 to May 2022. Total 100 patients with heart failure and fulfilled the inclusion criteria were included in this study data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism version 5. Result: In present study maximum participants 57 (57%) were from the age group of 61-80 years. Mean age of the participants was 65.38±13.7656l. In our study, 46 (46.0%) patients were Normal BMI, 14 (14.0%) patients were Obese BMI and 40 (40.0%) patients were Overweight BMI. In the present study 100 (100%) of the participants had Exertional Dyspnoea followed by PND and fine crepts 79 (79%) each. Vitamin D ≤30 was present in 88 (88%) off study population and >30 was present in 12 (12%) of study population.  Conclusion: In our study we found that 88 out of 100 study participants were Vit D deficient. It was also found that, 25(OH) Vit D levels had negative correlation with LVEF

Introduction: The diagnosis of pure neural leprosy (PNL) remains difficult due to absence of characteristic skin lesions. Prior to the advent of invasive nerve biopsy, patients with pure neural leprosy were mainly diagnosed based on clinical judgement. Nerve biopsy and polymerase chain reaction (PCR) based tests are increasingly being done to diagnose PNL. Aim: To assess and compare the diagnostic value of nerve biopsy and RLEP3 gene detection using polymerase chain reaction tests in suspected cases of pure neural leprosy. Material and methodology: The study is a prospective non-randomised analytical study done for a period of 12 months in a tertiary care hospital in Chennai. Clinically suspected patients having pure neural leprosy with a sample size of 30 patients were included in the study. After clinical evaluation, basic investigations, nerve conduction study and slit skin smear for AFB, nerve biopsy and polymerase chain reaction assay were performed. Results: Specific histopathological findings were obtained in 3 out of 30 cases with 66.67% sensitivity, 40.74% specificity and 53.7% accuracy rate. PCR was positive in 7 out of 30 cases with 100% sensitivity, 52.17% specificity and 76.08% accuracy rate. In this study PCR was positive in additional 4 cases in which nerve biopsy was negative. This affirms PCR as an indispensable tool & necessity of using PCR in AFB negative cases. Conclusion: PCR based assay is more sensitive than nerve histopathology in the diagnosis of pure neural leprosy. A multimodal approach comprising clinical evaluation, nerve biopsy and PCR based assay gives the maximal diagnostic yield in suspected cases of pure neural leprosy.

Background: Diabetes mellitus, characterized by elevated blood glucose levels, poses a significant global health challenge. Type 2 diabetes accounts for the majority of cases and is associated with factors such as obesity, physical inactivity, and poor dietary habits. The global burden of diabetes is substantial, contributing to major complications like blindness, kidney failure, heart attacks, stroke, and lower limb amputation.  Methodology: This study investigates cardiovascular complications in 209 adult diabetic cases with a disease duration exceeding 5 years. The research, conducted at a tertiary care teaching hospital, includes a detailed clinical examination, relevant investigations, and categorization based on disease severity, control status, and treatment type. Various parameters, including fasting blood sugar, postprandial blood sugar, urine examinations, serum cholesterol levels, and hypertension classification, were assessed. Results: The study reveals that 112 cases (53.6%) exhibited cardiovascular complications, with ischemic heart disease (IHD) being the most prevalent (39.7%). The majority of patients were in the 51-60 age group, and 75.6% were male. Poor glycemic control was evident in 79.9% of cases, while 23.9% had severe diabetes. Hypertension and retinopathy were present in 30.1% and 35.8% of cases, respectively. IHD was more prevalent in males (56.6%) and the 51-60 age group. Discussion: The study establishes associations between different complications, emphasizing the frequent coexistence of various cardiovascular issues in diabetes. It explores the distribution of IHD among diabetics, with a peak in the 51-60 age group and a higher incidence in males. The severity of diabetes did not significantly influence IHD incidence. Good glycemic control demonstrated a protective effect against complications. Conclusion: This comprehensive study underscores the substantial impact of cardiovascular complications in diabetes mellitus. It highlights the importance of glycemic control, lifestyle modifications, and weight management in reducing the incidence and severity of complications.

Background: This study was conducted to correlate, inflammatory markers with mechanical ventilation and mortality in Covid- 19 patients, IL-6 levels with mechanical ventilation and mortality in Covid-19, and CRP levels with mechanical ventilation and mortality in Covid- 19. Methods: This was a hospital-based descriptive cross-sectional study conducted among 200 cases, considering a 13-point difference in the IL-6 or CRP levels among the patients who needed mechanical ventilation, at the Department of Medicine, Tertiary Care Hospital, Mumbai, over a period of three years, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The CRP levels were significantly higher among the patients with mechanical ventilation when compared to the patients who were not ventilated [103.22 ± 99.04 mg/dl (present) vs. 78.70 ± 75.90 mg/dl (absent) mg/dl]. The IL-6 levels were significantly higher among the patients with mechanical ventilation when   compared to the patients who were not ventilated [432.09 ± 509.95 IU/L (present) vs. 81.79 ± 195.44 IU/L (absent) mg/dl]. The CRP levels were significantly higher among the patients who died when compared to the patients who were alive [137.49 ± 117.35 mg/dl (dead) vs. 74.73 ± 70.61 mg/dl (alive)]. The IL-6 levels were significantly higher among the patients who died when compared to the patients who were alive [491.95 ± 541.59 IU/l (dead) vs. 69.70 ± 156.54 IU/l (alive)]. Conclusion: CRP acts as a fair predictor for mortality in the present study, implying that elevated CRP levels may indicate an increased mortality risk.

Introduction: Surgical site infections (SSIs) continue to be one of the most common complications in conventional surgery. Various risk factors for the development of poor wound healing have been identified. An SSI is defined as an infection occurring within 30 days of surgery that meets the following criteria: (1) the diagnosis consists of the infection of an anatomic plane by one of the following manifestations: collection, inflammatory signs (pain, edema, tenderness, redness), dehiscence, or positive culture; and (2) classification according to the anatomic plane as follows: superficial incisional SSI, infection of the skin and subcutaneous tissue; deep incisional SSI, infection of the deep soft tissue (fascia and muscles); and organ/space SSI, infection of the organ/space. Objectives: A) To compare the incidence of superficial SSI in surgical incisions closed with coated polyglactin 910 suture with triclosan versus incisions closed with coated polyglactin 910 suture without triclosan. B) To study the time frame between surgery and development of SSI. C) To determine which bacteria is commonly associated with SSI after surgical closure. Material and Methods: This is a Randomized, prospective, open, single centre controlled study was conducted in the Department of General surgery, B.J Government Medical College and Sassoon general Hospital, Pune over a period of 1 year. Institutional Ethical Committee permission was obtained prior to commencement of the study. Intra-operative data was collected. It included the method of painting and draping, duration of the surgery, antibiotics received during surgery. intra-operative findings, wound class and subcutaneous tissue sutured with coated Polyglactin 910 suture with/without triclosan. Results: Mean age of case in Non-TCS group was 37.9 years, whereas mean age of TCS group was 36.8 years. P value of 'Student's t test for comparison of age distribution in Non-TCS and TCS groups was not significant. This assured the age matching of the two groups. 40 males and 33 females were included in Non-TCS group: 34 males and 30 females were included in TCS group. The Chi-square test was applied to observe the sex matching in two groups. P value was not significant, assuring the sex matching of two groups. Maximum number of case (40%) operated in Non-TCS group were Class II wounds, whereas maximum number of case (42%) operated in TCS group were Class I wounds. Least number of case, i.e., 9% in Non-TCS group and 8% in TCS group belonged to Class IV wounds. Conclusion: In our study, the incidence of Superficial SSI rate after surgery has been observed to be reduced with the use of triclosan coated suture (coated Polyglactin 910 suture with triclosan), but it was not totally eliminated. The pathogens cannot be completely eliminated from the site of surgery, but they can be minimized. Antimicrobial coated suture is a promising novel method to achieve the goal of least Surgical Site Infection (Superficial SSI) rates. Large scale trials are needed to further demonstrate the evidence of efficacy of antimicrobial (triclosan) coated suture material (coated Polyglactin 910 suture with triclosan) in reducing SSIS. More research is needed together with improved compliance with already established measures.701-706701-706

Near miss maternal mortality cases generally occur more frequently than maternal deaths and therefore a more reliable quantitative analysis can be carried out, which can provide a more comprehensive profile of health system functioning. Present study was aimed to study clinical profile of maternal near miss cases at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women who were pregnant or in labor or delivered or aborted; up to 42 days from termination of pregnancy, admitted and labelled as Maternal Near Miss. Results: In present hospital-based study, 220 near-missed cases were studied. Most of the patients are from the age group of 20-24 years (45.9 %), followed by 25-29 years (29.09 %) & 30-34 years (9.54 %). Majority of near-miss cases belonged to rural area (59.09%), were housewives (41.81 %), belonged to class III of socioeconomic class (29.09 %), were illiterate (55.90 %). Of 220 cases, 197 were registered (89.54 %), 95% of patients were immunized. Majority cases were referred from other hospitals (53.63 %) & were admitted in the antepartum period (87%). Majority cases were primigravida (40.9 %) followed by gravida two (20.45 %) & gravida three cases (19.09 %). 202 cases (91%) were delivered at a tertiary centre of which many were referred in antenatal period for high-risk management. 128 cases (58.18%) underwent LSCS, 88 cases (40%) delivered vaginally. Hypertensive disorders of pregnancy (53.18 %) contributed to the majority of near-miss cases, followed by anemia (19.09 %), heart disease (9.09 %), abruptio placentae (6.36 %) & respiratory disease (5.45 %). In 52% of near-miss cases, vascular and hematological dysfunction. Conclusion: Present study noted pregnant women from rural area, from lower socioeconomic class, low literacy were common among near miss cases.

Introduction: For centuries, alcohol use has been a significant social and health issue globally. based on a January 2015 WHO report.Each year, alcohol abuse leads to 3.3 million fatalities. Economic position, cultural background, educational attainment, physical and psychological health, geography, religion, and other environmental conditions are just a few of the elements that have been found to have an impact on alcohol consumption patterns. India’s alcohol consumption varies greatly by area. Alcoholic liver disease (ALD) can present with steatosis, liver cirrhosis, or any combination of these symptoms. Cirrhosis or hepatitis only affect 15–25% of long-term heavy alcohol users. Materials and Methodology: The Inpatients Department of General Medicine at PGIMER & CH, Bhubaneswar, Odisha, India, is the site of this hospital-based observational questionnaire study. Every hospitalised patient with liver illness at our facility who has ever used alcohol was tested. After obtaining their informed consent, the patients were questioned. Patients and their families were requested to provide a thorough personal and family history. Every patient's use of alcohol, including native alcoholic beverages, was recorded and converted to an average weekly gram intake. To confirm the diagnosis, every standard examination as well as supplementary research were conducted. The patient's data was gathered using a pre-made proforma. Including the specifics such age, gender, marital status, employment, yearly income, eating habits, drinking pattern, age at which drinking began, and amount of time spent drinking. The modified Kuppuswamy Scale was used to assess socioeconomic class. Results: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group.  Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week. Conclusions: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group.  Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week

Background: Hyperlipidemia is a widely observed medical condition that exhibits a strong correlation with the occurrence of coronary heart disease. Certain patients exhibit hesitancy or choose to abstain from the use of lipid-lowering prescription drugs due to concerns over potential adverse pharmacological responses. Objective: The goal of the treatment was to reduce the level Total cholesterol and Triglycerides. Method: This article presents the case report of a 30-year-old male who was diagnosed with Hyperlipidemia and Total cholesterol 207mg/dl Triglycerides 525 mg/dl. He wanted to be treated by Acupuncture with Traditional Chinese Method and following Suoxi Healthy Life Style controlled cholesterol level. Outcomes: For 3 months, electro acupuncture was done once a week   patient’s level of Total cholesterol and Triglycerides. Conclusion: This case showed that electro acupuncture combined   not only effectively reduces Triglycerides, but it also significantly improves cholesterol level of the patient.

Background: Surgical site infections (SSIs) are a common nosocomial infection, leading to increased costs, morbidity, and mortality in surgical patients. Surveillance and feedback to medical staff are vital in reducing SSI rates. This study aims to investigate the prevalence of SSIs in the Department of Surgery at Andhra Medical College, Visakhapatnam. Aims and Objectives: To determine the incidence and types of SSIs following abdominal surgeries. Materials and Methods: This retrospective study included patients admitted to the general surgery units at the Department of General Surgery, Andhra Medical College, King George Hospital, Visakhapatnam, for over one year. A total of 553 elective surgical patients and 314 emergency surgical patients were part of the study. Results: The study revealed a 11% prevalence of SSIs in the Department of General Surgery at Fakir Mohan Medical College and Hospital, Balasore, Odisha. Superficial incisional SSIs were the most common, followed by deep incisional SSIs, and organ/space SSIs. Exploratory laparotomy was the surgical procedure most commonly associated with SSIs. Alarmingly, 20% of SSIs were linked to emergency surgeries compared to 7% in elective surgeries. Conclusion: SSIs have significant implications for patients and healthcare systems. Preventing SSIs requires a comprehensive approach, addressing pre-, intra-, and postoperative factors. It is essential for healthcare facilities to foster a culture of patient safety, with support from management teams, regulatory agencies, and medical associations.

Background: Central variant of posterior reversible encephalopathy syndrome is clinico-radiological entity associated with hypertension,renal disease, cytotoxic immunosuppressive medications and autoimmune disease. We present a case of adult presented with uncontrolled hypertension and severe headache, unsteadiness of gait. Initial CT was done to rule of intracranial bleed showed hypodense area in pons. MRI finding showed vasogenic edema of brain stem leading to wide range of differential diagnosis. Follow up imaging within week shows marked resolution of MRI finding along with clinical improvement. This case represent importance of clinical and radiological corelation to diagnose central variant of posterior reversible encephalopathy syndrome, to avoid invasive investigation and treatment.It also emphasise the importance of awareness of this atypical central variant of PRES along with typical posterior cerebral variant.

Introduction: "Dilated Cardiomyopathy (DCMP)" is characterized by enlargement of one or both Ventricles and is accompanied by impaired LV function.. The causes can be primary (idiopathic) or secondary. Heart failure (HF) is a complex clinical syndrome resulting from the inability of the heart to pump resulting in inadequate metabolic demands of the tissues, or do so only with elevated filling pressures. Common symptoms are Dyspnea, fatigue, edema, syncope, and dysrhythmias. Heart Failure (HF) is predominantly a disorder of the elderly with rates increasing exponentially with time.  Aims and objectives: The objective of this study is to examine and record the clinical characteristics of individuals diagnosed with “Dilated Cardiomyopathy (DCMP”). Method: This retrospective observational study was conducted from September 2022 to August 2023 and involved 400 consecutive dilated cardiomyopathy patients. Patient examinations included clinical, ECG, radiography, and echocardiographic. Echocardiography criteria for impaired left ventricular systolic performance were ejection fraction below 45%, regional wall motion abnormalities, global hypokinesia of LV, heart chamber dilatation without valvular or congenital heart problems, and end-diastolic dimension above 3 cm per body surface area. Result: Smoking, alcoholism, Diabetes and hypertension were the leading risk factors in developing HF. Breathlessness(82.25%), swelling of the feet (50%) and palpitation (48%) were the most common symptoms observed in the patients. Edema of feet (50%), basal crepts (50.5%), raised and Jugular Venous Distention (JVD) (44.75%) were the leading signs in the patients. Chest X-ray (CXR) findings indicate that 62.75%  to 70% of the patients reported with increased Cardiothoracic ratio. ECG findings were : 59.5% had normal QRS axes, 25.5% had LAD, 15.00% had RAD. Common arrhythmias included sinus tachycardia (30.00%), ectopic beats (30.5%), AFib (21.75%), VT (8.00%), SVT (9.25%). LBBB was at 6.75%, RBBB at 3.00%. LA enlargement was 45.75%, RA 19.5%. LVH was present in 12.5% (left), 8.00% (right), and 3.00% (both). Patients with impaired cardiac function had an average EF% of 34.4 ± 6.03 (range: 20-45). LVDD and LVSD measures were 5.53 ± 0.74 cm and 4.46 ± 0.75 cm. Mitral regurgitation (MR) was present in 82%, TR in 14.00%. Wall motion abnormalities were widespread (97.25%). Pericardial effusion was found in 5.7% of patients. Moderate to severe Pulmonary artery hypertension was found in 19.5% Conclusion: The study has concluded that “dilated cardiomyopathy (DCM)” is mainly a disease of middle and elderly people with a higher prevalence among males. Pulmonary hypertension and very low ejection fraction was associated with adverse outcome.

Hereditary angioedema (HAE) is an autosomal dominant disease due to C1 esterase inhibitor deficiency (C1-INH). Patients present with non-pruritic subcutaneous and sub mucosal edema in the absence of urticaria in the first or second decade of life. Even though the disease causes significant morbidity and mortality, the diagnosis is often late or even completely missed. Diagnosis of HAE is made by assessing C1-INH levels in blood. In a populated country like India, the disease prevalence would be high. This case series emphasizes the importance of early diagnosis and prompt treatment of a potentially fatal disease.

Background: Perforated hollow viscus is characterized by loss of gastrointestinal wall integrity with subsequent leakage of enteric contents. Aim: The aim was to conduct diagnosis and treatment of non-traumatic hollow viscus perforation and the principles of management that have evolved through years will be addressed. Materials and Methods: This study was done in the Department of General Surgery. A total number of 50 cases were included in this study, which satisfied the inclusion and exclusion criteria. Results: Most common age group involved is in 3rd  to 4th  decade in the present study. Male preponderance (82%) was seen, with a male to female ratio was 4.6:1. The time lapse between onset of symptoms and presentation at the hospital was more than 24 hours in 24% of the study population. Abdominal pain was the most consistent symptom and was seen in 100% of the study population in the present study followed by  vomiting (52%) and fever (46%). Distended abdomen was seen in 46% of study population in the present study. Tenderness was seen in all the cases and is more prominent at the site of perforation. Guarding/rigidity and absent bowel sounds were seen in 92% of the study population. Sensitivity of imaging in detecting gas under diaphragm was 72% by USG abdomen and 80% by plain radiography. Benign  causes  of  gastrointestinal  perforation  constituted  majority  of  non- traumatic gastrointestinal perforations. Perforated peptic ulcers were responsible for 68% of non-traumatic gastrointestinal perforations. Peptic   ulcer   perforation   (68%)   is   the   major   cause   of   gastrointestinal perforation in the present study followed by appendicular (24%) and typhoid (4%) perforations. Most  common  site  for  non-traumatic  gastrointestinal  perforations  in  the present study was duodenum (48%) followed by appendix (24%) and pre- pyloric region of stomach (20%). Simple closure with omental patch was the operative procedure done for all cases of peptic ulcer perforation and appendicectomy for appendicular perforation. Ileal perforations secondary to typhoid perforation were treated with resection and end-to-end anastomosis in the present study. Colonic perforation was managed with Hartmann’s procedure. Most  common  complication  in  this  study  was  SSI  (34%),  followed  by respiratory  infection  (22%).  Burst  abdomen  was  seen  in  2%  of  cases. Mortality in the present study was 8% and was due to septicaemia. Conclusion: There were many risk factors for increased morbidity and mortality which includes older age group, delayed presentation and features of shock, so, aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscus perforation cases.

Background: Anaemia is a reduction in the oxygen carrying capacity of the blood resulting in tissue hypoxia.1 Cardiac output at rest is not usually increased in most chronic anaemia until haemoglobin levels fall below 7 g/dL, but abnormal rise in output with exercise may occur with levels as high as 10 g/dL.2 Anaemia is a major public health problem worldwide especially in developing countries like India. Nutritional cause of anaemia continues to predominate as the most common cause of anaemia. Objective of this study is to determine the clinical and laboratory profile of anaemia among patients admitted to our hospital. Methods: Our study was a prospective study in which 50 patients of anemia admitted to Medicine ward at tertiary care Teaching hospital, KRIMS, Karwar were studied for their clinical and laboratory characteristics. Duration of the study was 6 months from July 2021 to december 2021. Results: Anaemia was more common among females (68 % of total patients). Patients in age group 18- 30 years were involved in 46% of subjects. Pallor was the universal finding present in 100% of patients. On systemic examination haemic murmurs on auscultation was the most common finding present in 28% followed by hepatomegaly (18%). Microcytic and dimorphic anaemia constitute the bulk of anaemia. Conclusions: Nutritional anaemia particularly iron deficiency anaemia is the most common cause of anaemia. It tends to affect the working age group and females predominantly. Patients continue to present with severe anaemia to the hospital.

Cardio pulmonary resuscitation has been one of the most performed life-saving interventions in any acute care setting across the globe. However, CPR (cardiopulmonary resuscitation) itself has been known to cause serious thoracic and intra-abdominal complications. The aim of this manuscriptis to describe the clinical presentation, diagnostic challenge we faced, highlight the potential of missing the diagnosis if not looked in to specifically, and outcome of a patient who developed intra-abdominal bleeding after CPR. We performed a literature search and found only scanty number of cases of intra-abdominal haemorrhage after CPR reported and none from India to our knowledge. There is no study found on this especially in the kyphoscoliosis patient.

Our main finding was that we noticed severe pallor, increasing perihepatic ascites on USG after return of spontaneous circulation with noticeable fall in Haemoglobin trend in a previously normal USG scan of the abdomen.

Our manuscript highlights the importance of recognizing intra-abdominal bleeding as a potential complication of CPR. Our case illustrates the need for a high index of suspicion, prompt imaging, and aggressive management of this life-threatening condition.

Introduction: World Health Organization clinically defines a stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’. Hypomagnesaemia leads to neuromuscular hyperirritability, tremors, increased vascular resistance, coronary vasospasm and hypertension. Hypomagnesaemia triggers vasoconstriction enhancing vascular endothelial injury and hence leads to atherosclerosis. Subjects and Methods: It was a case control study, undertaken in the Department of Medicine in S Nijalingappa medical college and HSK Hospital during the period of July 2021–December 2022. 30 patients with acute ischemic cerebral stroke fulfilling the inclusion criteria were selected. 2 ml venous sample for serum magnesium level was taken within 24 hours. Magnesium levels in patients after acute cerebral ischemic stroke were documented in patients, receiving standard management protocol of ischemic stroke. The correlation co-efficient of Hypomagnesaemia with modified Rankin Scale Score was calculated. Results: The mean age of patients was 45-80 years, 36 (60 %) patients were male and 24 (40 %) were females and there was male preponderance. The mean serum magnesium levels were measured. The present study observed a statistically significant correlation between modified Rankin Scale score measured at three months and serum magnesium level. Conclusion: It was concluded through the results of this study that Hypomagnesaemia in the body can cause more severe ischemic stroke.

Background -Children and young people are most often killed and disabled by accidents. Blunt trauma accounts for more than 90% of traumatic mechanisms of injury in children. Blunt abdominal trauma accounts for between 10 and 15% of all blunt mechanisms. The establishment of the present non- operative treatment for the majority of blunt solid organ injuries in the pediatric age group was prompted by observations that most blunt solid organ injuries will heal on their own and that surgical intervention would thwart this mechanism Aim: this is a prospective observational study done in department of pediatrics surgery in north india institute from January 2022 to July 2023. The aim of this study is to determine the management of solid organ injuries in blunt trauma abdomen (BTA) in children how to diagnose radiologically whether to conserve or operate at tertiary health care center in high patient load hospital in India.  Methodology: 116 patients with blunt abdominal trauma due to any cause, the medical records of all patients with trauma of any kind age up to 13 years were carefully reviewed. The injured organ, patient age, sex, injury grade, imaging findings, intervention, length of hospital stay, and complications were prospectively reviewed using medical records. Initial resuscitation was done according to ATLS protocol. Ultimate management decision was based on stability of patients after resuscitation. Data was entered and analyzed through SPSS-26. Chi- square test and student's t-test were applied and P value <0.05 was considered statistically significant. Results: The mean age was 5.34 years. Most of the patients suffered from road traffic accident, 50(86.2%). 104 (89.65%) patients showed free fluid in the abdomen. CT abdomen with intravenous contrast confirmed findings of ultra sonography. Despite resuscitation, 12 (10.6%) patients remained unstable and were operated. 104 [89.4%] patients were kept on conservative treatment. Hospital stays ranged from 5-19 days. Pancreatic injury patient has more hospital stay. Conclusion: BTA is common in boys under age of 10 years. Although non-operative management is the treatment of choice in blunt trauma abdomen with solid organ injury but stability of the injured child is the central pivot around which the whole management revolves. Delay in presentation and failure of timely resuscitation results into high operative intervention.

Material & Methods: Study Design: Prospective hospital based observational study. Study area:  The study was carried out in the Department of General surgery, B.J Government Medical College and Sassoon general Hospital, Pune. Study Period:  1 year. Sample size: study consisted of 55 subjects. Sampling method: Simple random Sampling Technique. Study tools and Data collection procedure: The following protocol was followed • Clinically and radiologically (by Mammography) suspected cases of locally advanced Ca breast were enrolled for the study after informed written consent. • Histopathological diagnosis was made by FNAC. • In the cases where FNAC was not conclusive, tru-cut biopsy was done • Once histopathological diagnosis was confirmed estrogen and progesterone receptor status was found out by immunohistochemistry. • Clinical stage IIIa and IIIb i.e locally advanced breast cancer (LABC) patients were considered for the further study (total number of patients was 55). Results: A total of 18 (29%) patients had clinical complete response (CCR) of these 16 patients, only 10 patients (62.5%) had a correlating pathological complete response (pCR). In our study. 53 (90-4%) patients had an infiltrating ductal carcinoma while 2 had infiltrating lobular carcinoma. Majority (94 29%) of the patients had an infiltrating ductal carcinoma. Conclusion: The current study reveals that clinical assessment of response to NACT has higher sensitivity than radiological assessment, but the overall poor sensitivity and specificity rates of clinical assessment need the search for a better way of evaluation.