European Journal of Cardiovascular Medicine

Introduction: Viral keratoconjunctivitis (VKC) is a common ocular condition characterized by inflammation of the conjunctiva and cornea, often caused by adenoviruses. It is highly contagious and can lead to significant morbidity, including blurred vision and discomfort. This study investigates an epidemic of VKC in a tertiary care hospital, focusing on its clinical presentation, epidemiological factors, and outcomes. Materials and Methods: A prospective observational study was conducted on 300 patients presenting with symptoms of VKC over six months. Inclusion criteria included clinical signs of VKC, such as redness, watering, and photophobia, while exclusion criteria involved bacterial or allergic conjunctivitis. Diagnostic tests included PCR for adenovirus and slit-lamp examination. Results: Of the 300 patients, 85% tested positive for adenovirus. The mean age was 32.5 years, with a male predominance (60%). Common symptoms included redness (95%), watering (90%), and photophobia (85%). Age >50 years and delayed presentation were significant risk factors for severe disease. Immunocompromised Status (25% of Severe Cases). Most patients experienced symptoms for 1–2 weeks, consistent with the natural course of adenoviral conjunctivitis. More than 2 Weeks (20%) are Prolonged symptoms were observed in a subset of patients, likely due to corneal involvement or delayed treatment. Persistent Blurred Vision (15%) are complication underscores the potential long-term impact of VKC on visual function. Conclusion: The epidemic was predominantly caused by adenovirus, with significant morbidity. Early diagnosis and strict infection control measures are essential to prevent outbreaks

Introduction: Anemia remains a significant public health concern in India, particularly affecting children and adolescents. This study aimed to assess the prevalence of anemia and associated factors among children aged 6-59 months visiting the outpatient department (OPD) of a tertiary care hospital in Hyderabad, India. Methods: A cross-sectional study was conducted on 360 children aged 6-59 months visiting the OPD. Sociodemographic data were collected using a structured questionnaire, and venous blood samples were obtained for hemoglobin estimation. Anemia was defined according to WHO criteria. Statistical analysis was performed to identify factors associated with anemia. Results: The overall prevalence of anemia was 48.5%, with a higher prevalence in females (55%) compared to males (42%). The mean hemoglobin level was 12.15 g/dL, with females having significantly lower levels (11.8 g/dL) than males (12.5 g/dL). Nutritional status and maternal education were significantly associated with anemia prevalence. Children from lower socioeconomic backgrounds exhibited higher anemia rates, although this association was not statistically significant. Discussion: The study reveals a high prevalence of anemia among children in Hyderabad, consistent with national trends reported in recent surveys. The gender disparity in anemia prevalence aligns with previous studies and highlights the need for targeted interventions. Despite ongoing national programs, the persistence of high anemia rates underscores the necessity for more effective implementation of existing initiatives and the development of comprehensive strategies addressing nutritional deficiencies, maternal health, and socioeconomic disparities

Background and Aims: Literature on the comparative evaluation of the intubating dose of cisatracurium and atracurium is sparse in India. We evaluated neuromuscular blockade, recovery characteristics, and safety profile between the two non-depolarizing neuromuscular blocking drugs; cisatracurium besylate and atracurium besylate at equipotent doses (3xED95) in adult patients undergoing abdominal laparoscopic surgical procedures. Methods: Fifty surgical patients under general anaesthesia were randomised into two groups. Anaesthesia was induced with 2 mg/kg propofol and 2 μg/kg fentanyl in all the patients. Neuromuscular blockade was achieved using an equipotent dose of either cisatracurium 0.15 mg/kg (Group A) or atracurium 0.6 mg/kg (Group B). Onset time, duration of action, and recovery profile after administration of cholinesterase inhibitor were noted using neuromuscular monitoring using Train Of Four (TOF). Intubating conditions, haemodynamic changes, and safety characteristics were also evaluated. Results: The mean onset time and duration of action for cisatracurium were 4.44 ±0.45 minutes, 50.09 ±5.3 minutes while, for atracurium, the values were 3.14 ±0.23 minutes, 41.03 ±1.69 minutes respectively (p <0.001). Intubating conditions, haemodynamic changes, and safety profile were comparable between the groups. Recovery time following administration of cholinesterase inhibitors in the cisatracurium and atracurium group were 2.84±0.23 and 3.68 ±0.21 minutes respectively (p <0.001). Conclusion: Equipotent dose of atracurium had faster onset than cisatracurium. But, the duration of action was longer in cisatracurium as compared to atracurium. The recovery profile of cisatracurium was faster and better than atracurium. Both the drugs have comparable haemodynamic parameters, intubating conditions, and safety profile.

Introduction Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 50 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO. Methods The Respiratory Effectiveness Group conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the UK Optimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) asthma only. ACO was defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) post-bronchodilator airflow limitation (forced expiratory volume in 1 second/forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. Conclusions In summary, it has been already understood the specificity of a separate clinical entity called ACOS. Even though ACOS develops indistinct clinical and pathophysiological features that often are complicated with those of asthma or COPD, we must emphasize the importance of the syndrome. Studying further the syndrome may we discover mechanistic pathways leading to the development of COPD. And this is important because it is widely known that patients with COPD often are underdiagnosed, possibly for decades. By recognizing common risk factors it will, maybe, become possible to understand and modify the progressive deterioration of lung function, which leads to COPD

Introduction: Stroke is defined as an "acute neurologic dysfunction of vascular origin with sudden (within seconds) or at least rapid (within hours) occurrence of symptoms and signs corresponding to the involvement of focal areas in the brain". The two main types of strokes are ischemic and hemorrhagic which are due to a number of different pathological mechanisms. Hemorrhagic stroke occurs when blood from a ruptured blood vessel compresses and damages normal functioning brain tissue. In an ischemic stroke, a blocked artery prevents blood carrying oxygen and other nutrients from reaching a portion of the brain, leading to dysfunction and death of that brain tissue. Material and Methods: This is a Prospective, Observational and Single center conducted in the Department of Biochemistry and Neurology, Index Medical College Hospital & Research Center. In this study, total 220 subjects were included; of which 110 newly diagnosed ischemic stroke patients of either sex, who clinically diagnosed in the department of Neurology and 110 newly diagnosed hemorrhagic stroke. After clinical examination and confirmed diagnosis by Physician, 220 patients of either sex, who meet the inclusion and exclusion criteria selected for the study from January 2022 to July 2024. Results: Ischemic Stroke: Thiol group levels are higher, with a mean of 332.35 ± 31.64 mmol/L. Hemorrhagic Stroke: Thiol group levels are lower, with a mean of 318.12 ± 28.55 mmol/L. The higher levels of thiol groups in ischemic stroke may indicate a greater presence of these important antioxidants, which can help protect against oxidative damage. In contrast, the lower levels in hemorrhagic stroke might suggest a reduced capacity for antioxidant defense in that condition. mRS Outcomes The majority of patients in both groups had favorable outcomes (mRS < 2), with ischemic stroke showing a slightly higher percentage (64.5%) compared to hemorrhagic stroke (60%). The proportion of patients with unfavorable outcomes (mRS 2-5) is relatively similar between the two groups, with ischemic stroke at 34.5% and hemorrhagic stroke at 39.0%. Conclusion: In conclusion, we determined that diabetes mellitus brings an additive oxidative stress load to acute ischemic stroke patients. These patients need to be managed carefully with regard to their poor prognosis. We consider that high TAC levels in diabetic stroke patients render the antioxidant supplementation useless at least for the acute-phase (24 hours) treatment of stroke. Oxidative stress and TAC in the later periods of acute ischemic stroke need to be explored in further studies.

Background: The escalating rates of cesarean sections (CS) globally necessitate evidence-based strategies to mitigate unnecessary surgeries. Robson's ten-group classification system offers a standardized approach to assess CS rates across diverse healthcare settings. Understanding the factors contributing to CS rates is crucial for effective obstetric management. Methods: This study analyzed 346 cases of CS using Robson's classification scheme, incorporating data on demographics, gestational age, parity, onset of labor, and indications for CS. The sample size was determined based on previous research, and data were collected from case records using a proforma. The primary objective was to identify the group exerting the most significant influence on CS rates and evaluate rates within each category. Results: Group 5, comprising women with a history of previous CS, contributed notably to overall CS rates. Fetal distress emerged as a predominant indication for primary CS, followed by malpresentation of the fetus and failed induction. Groups 1 and 3, involving spontaneous labor, exhibited moderate contributions to CS rates. Conversely, Groups 6, 7, and 10 represented smaller proportions, indicating lesser impact on CS rates. Conclusion: The study underscores the significance of Robson's classification in assessing CS rates and identifying key contributors. Women with prior CS represent a substantial proportion of CS cases, highlighting the importance of offering trial of labor after cesarean section (TOLAC) where feasible. Efforts to enhance obstetric care should include improved training in fetal monitoring interpretation and reinstating skills in assisted vaginal breech birth and external cephalic version. By addressing these factors, healthcare facilities can strive towards optimizing CS rates while ensuring safe maternal and neonatal outcomes.

Background: The escalating global rates of cesarean sections (CS) have raised concerns regarding maternal and neonatal outcomes. While CS can be life-saving, their overuse poses significant risks, necessitating a careful balance between benefits and risks. In India, regional disparities and socioeconomic factors contribute to varying CS rates, highlighting the need for context-specific interventions. Objective: This study aimed to investigate the patterns of CS utilization and associated factors in the Central Vindhya region, with a focus on identifying clinically relevant groups contributing most to CS deliveries.Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, S.S. Medical College, Rewa, Madhya Pradesh, India. Data were collected retrospectively from hospital records of 7,484 women who underwent CS over a specified 3-year period. Robson's classification system was used to categorize CS cases into ten groups based on pregnancy characteristics, obstetric history, labor progression, and gestational age. Results: The overall CS rate was 28.18%, with multiparous women with prior cesarean sections (Robson's group 5) constituting the largest proportion of CS cases (32.58%). Nulliparous women in spontaneous labor (group 1) and those with induced labor or cesarean before labor (group 2) also contributed significantly to CS rates. Indications for CS included previous cesarean section (32.57%), fetal distress (16.56%), and meconium-stained liquor (19.2%). Conclusion: This study provides valuable insights into CS utilization patterns and associated factors in the Central Vindhya region. The findings underscore the importance of context-specific interventions to optimize CS utilization while ensuring maternal and neonatal safety. Further research is warranted to explore effective strategies for reducing CS rates and improving maternal health outcomes in resource-limited settings.

Background: Fracture of the femur is a common reason for hospital admission among the elderly population, with increasing frequency due to factors such as longer life expectancy, osteoporosis, and sedentary lifestyles. Conservative treatment approaches often lead to complications and are not suitable for many patients. Hemiarthroplasty, particularly using bipolar endoprostheses, has emerged as an effective surgical intervention for displaced femoral neck fractures in elderly individuals, offering pain relief and improved mobility. Method: This prospective study evaluated 36 patients over the age of 50 with intra-capsular femoral neck fractures treated with hemiarthroplasty using bipolar endoprostheses. The study aimed to assess functional outcomes and quality of life using the Harris Hip Score. Patients underwent preoperative planning, medical evaluations, and surgical management with cemented bipolar hemiarthroplasty. Postoperative monitoring was conducted at regular intervals for up to six months, with clinical, functional, and radiological evaluations performed during follow-up appointments. Result: Among the study participants, 44.4% were aged 50-65, while 55.6% were over 65, with a mean age of 64.2 years. Females comprised 55.6% of the cohort. Evaluation of Harris Hip Scores showed that 50.0% of patients achieved excellent outcomes, 38.9% had good outcomes, and smaller proportions fell into fair and poor categories. Most participants reported no pain and exhibited favorable outcomes in terms of limping, support required, distance walked, range of motion, leg length discrepancy, and post-operative complications. Radiological assessments indicated satisfactory stem positions in the majority of cases. Conclusion: Bipolar hemiarthroplasty with cement fixation proves to be a beneficial treatment option for elderly patients with fractured neck of femur, offering good to satisfactory functional outcomes and low complication rates. This procedure facilitates early mobilization and restores pre-injury functional status in most patients, highlighting its effectiveness in addressing femoral neck fractures in the elderly population.

Background: Clavicle fractures, particularly midshaft fractures, are common orthopedic injuries. Traditional treatment approaches have included conservative management, but surgical intervention is increasingly utilized for displaced fractures. Among surgical techniques, intramedullary nailing with Titanium Elastic Nails (TENs) has emerged as a promising alternative to plate fixation due to its potential advantages such as minimal scarring, reduced risk of nonunion, and ease of application and removal. Methods: This hospital-based prospective study conducted in a tertiary care hospital in Central India aimed to assess the efficacy of Titanium Elastic Nail (TEN) fixation in midshaft clavicle fractures. A total of 50 patients meeting inclusion criteria underwent surgery and were followed up for a minimum of 6 to 12 months. Data collection involved comprehensive medical history, clinical examination, and radiographic assessments. Surgical techniques, complications, and postoperative outcomes were analyzed. Results: The study population primarily consisted of young adults aged 19-29 years, with a male predominance. Road traffic accidents were the leading cause of injury, affecting 80% of patients. Most fractures were classified as Robinson type B and OTA type 15b1. The majority of patients underwent surgery within 2-7 days, with closed reduction being the preferred technique. Postoperatively, 96.67% of patients exhibited no shortening, and excellent DASH scores were achieved by 80% of patients. Complications were minimal, with entry site irritation being the most common. Fracture union was achieved in 90% of cases by the 12th week post-operation. Conclusion: Intramedullary nailing with Titanium Elastic Nails (TENs) proves to be an effective and safe method for stabilizing displaced midshaft clavicle fractures. It offers rapid functional recovery, excellent cosmetic outcomes, and minimal risk of complications compared to conservative treatment and plate fixation. The findings support the use of this minimally invasive technique as a preferred option for managing midshaft clavicle fractures, particularly in young, active individuals seeking early return to function

Background- Effective pain relief and minimum motor block are the necessary constituents of an ideal epidural block. Fentanyl is a lipophilic opioid most commonly used as an adjuvant to local anaesthetic. Ropivacaine is an alternative to bupivacaine, with greater sensitivity for sensory fibres than motor fibres, thus producing less motor blockade than bupivacaine. This study assessed the analgesic effect of very low dose fentanyl (1mcg/ml) as an adjuvant to either ropivacaine or bupivacaine. without compromising its beneficial effects and avoiding the undesired side effects. AIM- To study the effect of fentanyl as an adjuvant to bupivacaine and ropivacaine in epidural analgesia for laboringparturient. Method- 44 nulliparous labouring parturients of ASA I & II at term with singleton pregnancy of vertex presentation without any obstetric complication were randomly allocated into two groups of 22 each. Group B received bupivacaine 0.125% with fentanyl 1 mcg/ml bolus dose till VAS<3. Similarly, Group R received ropivacaine 0.125% with fentanyl 1 mcg/ml. Analgesia was maintained with intermittent bolus of study solution. Analgesic efficacy was measured in terms of duration of analgesia, onset of analgesia, highest level of sensory block, motor block, side effects if any; obstetric and neonatal outcomes were also recorded. Results- There was no significant difference between the two groups in terms of duration of analgesia, level of sensory block achieved, time required to achieve level of sensory block, motor block or side effect profile. There were minimal side effects and neonatal outcomes were good. Obstetric outcomes and maternal satisfaction level was also comparable between the two groups. Conclusion- Fentanyl when used in a low dose of 1 mcg/ml with equal concentration of two local anaesthetic bupivacaine and ropivacaine provides good analgesia in all stages of labour avoiding the side effects of opioids.

Type II diabetes mellitus (T2DM) is a chronic disease that develops due to defective insulin secretion and is frequently associated with insulin resistance. It is also characterized by progressively decreasing beta-cell function over time. As a manifestation of symptoms is not always the case, DM is primarily diagnosed on the basis of some form of measurement of blood glucose. Sodium-glucose cotransporter 2 (SGLT2) inhibitors enhance urinary glucose excretion, which consequently reduces hyperglycemia. They exert favorable effects on various biomarkers, including blood glucose, body weight, blood pressure, albuminuria, and fatty liver. In contrast, dipeptidyl peptidase-4 (DPP-4) inhibitors decrease glycaemic variability by stimulating glucose-dependent insulin secretion. Material and Methods: This is a Prospective, randomized, Open-label was conducted in Type 2 DM patients attending the outpatient department of Medicine in Index Medical College and Hospital over a period of 2 years. All the Type 2 DM patients attending outpatient department (OPD) of Medicine were randomly divided into Dapagliflozin Group and Sitagliptin Group. The treatment drug (dapagliflozin 5.0 mg/day and sitagliptin 50 mg/day) was administered for 12 weeks.  Follow-up visits were scheduled at the end of every month for 12 weeks for assessment, including measurement of weight and general and systemic examination. The following laboratory investigation was performed on sample of Type 2 DM patients before and after Dapagliflozin and Sitagliptin therapy.  Results The changes in glycemic and metabolic parameters from baseline to week 12 in the two study groups. The mean ± SD change in HbA1c from baseline to 12  weeks were 1.95 ± 0.94% and 2.71 ± 0.54 in the dapagliflozin and sitagliptin groups, respectively. The changes in the time courses of Fasting plasma glucose at baseline and at week 12 in the two study groups are shown in Table 3. The mean ± SD change in Fasting plasma glucose from baseline to week 12 were 123.9 ± 3.4 and 45.0 ± 6.4 in the dapagliflozin and sitagliptin groups, respectively. The changes in glycemic and metabolic parameters from baseline to week 12 in the two study groups. The mean ± SD change in Fasting plasma insulin from baseline to 12 weeks were 2.08 ± 0.76 and 2.37 ± 0.44 in the dapagliflozin and sitagliptin groups, respectively. Conclusion Although dapagliflozin and sitagliptin provided similar effects on glycemic control with avoidance of hypoglycemic episodes, adequate loss in body weight occurred significantly more frequently in the dapagliflozin group. Additionally, various cardiometabolic indices improved to a significantly greater extent in the dapagliflozin group than in the sitagliptin group

Chronic kidney disease is a pathophysiological process with numerous etiologies, resulting in inexorable attrition of nephron number and function leading to end stage renal disease. Cardiovascular causes and infections contribute towards the large proportion of increased morbidity and mortality. Connective tissue diseases are immune mediated inflammatory diseases, mainly of the musculoskeletal system; however, they frequently involve the cardiovascular system. They affect the pericardium, myocardium, valve leaflets, coronary arteries and conduction system with different rates of prevalence and degrees of severity. This study aims to find cardiac abnormalities using ECG, 2D-ECHO and also to determine what proportion of chronic kidney disease with connective tissue disease patients will have conduction abnormalities. MATERIAL AND METHODS: The main source of data is from patients who are renal biopsy proven CKD with connective tissue disease attending the outpatient department and patients admitted in the department of General Medicine and department of Nephrology in Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Duration of study was one and half year from March 2021 to August 2022. RESULTS: The study population included 55 patients of connective tissue disease with chronic kidney disease. Conduction abnormalities on ECG were seen in 11 patients (20%). Sinus tachycardia was most common ECG finding seen in 17 patients (30.9%). In ECHO, pericardial effusion was the most common finding seen in 27 patients (49.09%), CONCLUSION: The incidence of cardiovascular manifestations is significantly higher in patients of connective tissue disease with CKD compared with the general population. It is likely to be associated with subclinical atherosclerosis and vascular damage, disease related factors. Therefore, early detection of cardiac abnormalities in all patients of CKD with connective tissue disorder may reduce the morbidity and mortality due to cardiovascular involvement in connective tissue diseases.

Background: Diabetes mellitus, a prevalent metabolic disease globally, causes various complications, including microvascular issues like Diabetic Retinopathy (DR) and macrovascular complications. DR, characterized by retinal microvascular alterations, is a leading cause of vision loss. Diabetic Foot Ulcer (DFU) is a severe complication, often leading to amputation, with studies suggesting a link between DR and DFU. This study aims to assess the severity of DR concerning different grades of DFU. Objective: To evaluate the association between the severity of Diabetic Retinopathy and various grades of Diabetic Foot Ulcer. Methodology: A cross-sectional study was conducted from February 2021 to August 2022, involving 100 patients clinically diagnosed with type 2 Diabetes Mellitus and DFU. Data on socio-demographics, medical history, and DR severity were collected. Statistical analysis was performed using SPSS, with a significance level of 5%. Result: Participants (n=200) were primarily aged 51-60 (39%), with 62% males. About 42% had diabetes for 1-5 years, and 73% reported DFU duration of <1 month. In DR grading, 26% had Moderate NPDR, 15% had severe NPDR, 4% had very severe NPDR, and 21% had no NPDR. A significant association was found between DR severity and DFU grades (p<0.05). Discussion: Comparisons with existing studies revealed variations in diabetes duration and DR severity. The study confirmed the association between DFU and DR, consistent with previous findings. Conclusion: The study emphasizes the need for enhanced screening protocols to detect and manage DR and DFU promptly. The severity of DR increases with DFU stages, suggesting DFU's potential to predict advanced DR stages. As diabetes prevalence rises, addressing these complications is crucial for the working population's well-being. A systematic healthcare approach is essential for early detection and management.

Diabetes mellitus (DM) and thyroid disorder stand as prevalent endocrine disorders with documented mutual influences. This study explores the relationship between thyroid dysfunction and DM, considering the escalating global prevalence of both conditions. Methodology: A cross-sectional study was conducted at SLN Medical College and Hospital, Koraput, involving 150 diabetes patients. The study utilized a purposive sample selection, employing a pre-designed semi-structured questionnaire. Patients diagnosed with hypothyroidism and hyperthyroidism based on clinical presentation and thyroid function tests were investigated for cardiovascular manifestations. Results: The study revealed age and gender distribution among diabetes patients, with the peak incidence of thyroid dysfunction in the 4th and 5th decades. ECG findings in hypothyroidism included ST-segment depression, low voltage complex, prolonged Q-Tc, sinus bradycardia, and ventricular ectopics. Hyperthyroidism exhibited sinus tachycardia, LV hypertrophy, prolonged Q-Tc interval, LV strain, atrial fibrillation, atrial ectopics, and ventricular ectopics. Significant differences were noted in the distribution of thyroid conditions among type 1 and type 2 DM patients. Discussion: The study discussed the impact of thyroid hormones on the cardiovascular system, particularly in patients with diabetes. Overt hypothyroidism was associated with accelerated atherosclerosis and coronary artery disease, while hyperthyroidism exhibited diverse ECG findings. The coexistence of thyroid disease and diabetes induced metabolic abnormalities, contributing to insulin resistance and oxidative stress. Conclusion: The study emphasizes the need for recognizing and managing thyroid dysfunction in diabetic patients to mitigate potential cardiovascular complications. The diverse ECG findings underscore the complexity of these interactions. Further longitudinal studies are warranted to deepen our understanding and guide effective clinical management strategies in this population.

Background: Supraclavicularbrachialplexus blockis used for providing pain relief in upper limb surgeries and has manyadvantagesovergeneralanaesthesia.Alpha-2-adrenergicagonists are chosen with local anaesthetics for their sedative,analgesicand antihypertensive properties. Aim : To  evaluate  the  effects  of  clonidine  and  dexmedetomidine  in  combination  with  ropivacaine  on  peripheral  nerves  during  brachial  plexus  block. Methods :The present study was prospective  comparative  observational  study. A total of 58patients admitted in orthopaedics ward scheduled for upper limb surgeries fulfilling the requisite criteria were included in the study.  Study was conducted from August 2022toSeptember2022 in the Department of orthopaedics, Burdwan Medical College, Burdwan, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results :The mean age of the patients was 31.5 ± 4.2 years in Group C and 33.1 ± 3.9 years in Group D. There were 22 males (37.93%) and 7 (12.07%) females in Group C and 19 males (32.76%) and 10 females (17.24%) in Group D. Group D showed less time for the onset of sensory and motor blocks and more time in duration for sensory and motor blocks. The duration of analgesia was longer in Group D. Comparison of complications showed that, bradycardia and hypotension were found more in Group C than Group D. The vital parameters were comparable in both the groups. Conclusion :Dexmedetomidine prolongs the duration of sensory and motor block and enhances the quality of block as compared with clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

Background: This research focuses on mitigating post-operative delirium (POD) in pediatric patients undergoing general anesthesia with sevoflurane. It particularly examines the efficacy of administering a low dose propofol bolus before extubation in a sample of 200 patients. Objective: To evaluate the effectiveness of a low dose propofol bolus in reducing the incidence and severity of POD in children anesthetized with sevoflurane. Methods: A randomized controlled trial was conducted with 200 pediatric patients who were undergoing surgical procedures with sevoflurane anesthesia. They were divided into two groups: one received a low dose propofol bolus before extubation, and the other served as a control. The incidence and severity of delirium were measured using standardized delirium assessment tools. Results: The comparative analysis drawn from the tables demonstrates a significant impact of propofol in reducing the incidence and severity of post-operative delirium (POD) when used alongside sevoflurane in pediatric anesthesia. The intervention group, receiving a low dose of propofol, showed a notable decrease in the incidence of POD, with a 50% reduction compared to the control group. This result was statistically significant, as indicated by an odds ratio of 0.4 and a p-value of 0.01. Moreover, the severity of delirium was substantially mitigated, with significant reductions particularly in moderate delirium cases, as evidenced by a decrease in incidence and shorter duration of delirium symptoms. These findings underscore the efficacy of propofol in enhancing recovery quality by not only reducing the occurrence of delirium but also diminishing its intensity, contributing to better overall outcomes in pediatric anesthesia. Conclusion: The study concludes that administering a low dose of propofol before extubation is effective in reducing the incidence and severity of post-operative delirium (POD) in pediatric patients. These findings offer valuable evidence supporting the incorporation of propofol into routine pediatric anesthesia protocols to enhance recovery outcomes. The study's results encourage further exploration and adaptation of this intervention in broader clinical settings.

Background: Securing airway is a vital skill for anaesthesiologists. Difficulty in securing airway can lead to catastrophic results. The cuffed endotracheal tube is considered as gold standard for providing a safe airway. Laryngoscopy and endotracheal intubation produce reflex sympathoadrenal stimulation. The supraglottic airway device is a novel equipment that fills the gap in airway management between tracheal intubation and use of face mask. I-gel (Intersurgical Ltd., Wokingham, UK) is a relatively new supraglottic airway device with a non-inflatable cuff, made up of soft gel like, transparent thermoplastic elastomer. Aim and objectives: To compare standard, reverse and rotational techniques of i-gel placement in terms of insertion characteristics and success rate. Materials and Methods: A randomized prospective study, was undertaken at Government Dharmapuri Medical College and Hospital, Dharmapuri during the academic year from 2020 to October 2022. Ninety patients (N=90), scheduled for various elective surgical procedures undergoing general anaesthesia belonging to ASA class I and II were included in the study. The participants were divided into 3 groups of 30 participants based on the techniques used for i-gel insertion. Results: There was no statistically significant difference in the age, ASA grading, Mallampatti class between the 3 groups. There was no statistically significant difference in the ease of insertion between the groups. The median attempts for insertion in all three groups was 1 attempt. Chin lift manoeuvre had to be performed in 2 participants in the standard insertion group. The mean time taken for insertion (in seconds) was 20.33 ± 4.05 in standard technique group, 19.47 ± 4.67 in reverse technique group and 19.67 ± 4.26 in rotational technique group and the mean difference was not statistically significant. There was no significant difference in the mean leak pressure across the groups. Maximum number (N=7) complications was seen in standard technique group. There was no significant difference in heart rate measured at 1 min, 3min and 5min across the group. There was significant difference in MAP at 1min (p=0.01), 3min (p=0.001) and 5 min (p=0.062) across the groups with highest mean MAP measured in standard technique group. Conclusion: The three insertion techniques are suitable for routine use in maintaining anaesthesia in spontaneously breathing patients under general anaesthesia with normal airways. By all methods I-Gel appear to be effective in providing a clinically patent airway and have a high rate of insertion success, no hemodynamic changes, and low morbidity.

Research and consideration on vitamin D physiology is crucial as approximately half of the people is being detected with this deficiency. Thus, the study was undertaken to estimate serum vitamin D and plasma cytokines in patients of diabetic retinopathy. More than fifty percent of worldwide population at risk because of vitamin D inadequacy has achieved contagion amounts. It also considered as a multifunctional hormone. In comparison to healthy control, pro-inflammatory cytokines were noticed to be elevated in patient with Type 2 Diabetes mellitus. Several studies reported significant elevation of plasma IL6(p less than 0.001), C reactive protein (CRP) (P less than 0.001) and elevated levels of TNFα in patients of diabetes. Materials and methods: A cross sectional hospital-based study was undertaken on 160 patients, who attended the ‘Retina Clinic’ of the Institute of Ophthalmology and the Out Patient Department of Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. A well informed written consent for blood sampling was taken from all the patients included in the study and ethical approval was obtained from the institutional ethics committee. Demographic data, serum lipid profiles, HbA1c, fasting blood glucose, arterial blood pressure, visual History and treatment history were documented for all participants using pretested Performa. Results: Maximum and minimum value of different variables. In PDR group range of serum vitamin d level were 4.0ng/mL and 36.0ng/mL. While in NPDR group minimum and maximum levels were 3.50ng/mL and 58.50ng/mL. Minimum and maximum plasma TNFα level in PDR group were1.02pg/mL and 232.2pg/mL. Range of plasma IL10 in PDR patients were 4.6pg/mL and 196.74pg/mL. Minimum and maximum plasma IL1beta level in PDR patients were 11pg/mL and 119.16pg/mL. Range of plasma IL6 in patients with PDR were of 0.07pg/mL and 16pg/m. The mean and standard in various groups. In which, mean serum vitamin D in PDR patients was 15.45±6.15ng/mL whereas in the NPDR patients mean serum vitamin D was 18.99±8.25ng/mL. Conclusion: It concluded that patients with PDR, had lower vitamin D levels as compared to No DR. Showing decline trend in all patients with type 2 diabetes mellitus. On cytokine study it was found that plasma levels of TNF alpha, IL10, IL 1 beta and IL6 are elevated in patients with Type 2 diabetes mellitus patients as compared to non-diabetic healthy controls. 

Background: Oral cancer is a significant public health concern in India. This longitudinal study aimed to assess the incidence, risk factors, causative microorganisms, and outcomes of postoperative infections among oral cancer patients in a tertiary medical college in India. Data were collected from patients undergoing surgical treatment for oral cancer over a defined period. The findings shed light on the prevalence of infections and can guide the development of preventive strategies and optimize postoperative care for this vulnerable patient group. Methods: it was a longitudinal observational study in which a total of 600 patients who were operated for oral cancer attending dental OPD in a tertiary hospital in Indiafrom September 2022 to August 2023 were studied and followed up. Results: A total of 600 patients who underwent surgery for cancers of the oral cavity during the study period of September 2022 to August 2023 were followed up. SSIs were noticed in 60 (10%) post-operative cases. This included 42 (70%) incisional SSIs and 18 (30%) organ/space SSIs. Culture of the surgical site in 60 infected patients yielded a total of 120 isolates. 15 patients (25%) had polymicrobial infections. Gram-negative bacterial isolates (70%) outnumbered gram-positive bacterial isolates (30%). Majority of the patients (48 patients—80%) were in stage IV disease. Successful management of patients with bacterial infections depends on early identification of bacterial pathogens and selection of an effective antibiotic against the organism. Judicial use of antibiotics is also very essential to prevent the development of drug resistance.

Background: In the tropics, scrub typhus is a growing health risk. Acute meningoencephalitis, enteric fever, Kawasaki disease, and dengue can all have similar clinical characteristics. Early intervention and a high index of suspicion help to avoid mortality and morbidity. The preferred medications are Doxycycline or Azithromycin, both intravenous and oral. Aims and objectives: The aim of thepresent study was to present clinical manifestation, laboratoryfindings and treatment outcomes of pediatric scrub typhus ina tertiary care setting. Methods: The present study was prospective observational study. A total of 45 cases detected with positive for Scrub Typhuswere includedin the study. Study was conducted from May to October 2023 in the Department of Paediatric Medicine, RG Kar Medical College, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: A total of 45 cases were detected to be positive for Scrub Typhus. Their age ranged from 1½years to 12 years, mean being 7 ½ years. There was no sex predilection, 21 (47%) were male and 24 (53%) were female. Fever was the chief complaint in all of them. During hospital stay, the average temperature recorded was 101ºF. Eighteen cases presented with exanthematous fever. The rash was erythematous maculopapular, mostly appearing in the limbs and sometimes over the trunk. Eschar was found only in ‘5’ cases case even after thorough searching. Other findings include organomegaly, generalized lymphadenopathy and constitutional symptoms. Conclusion :Scrub typhus do exist around Kolkata in the suburban and rural areas. Hence awareness is very important. They need to be detected early by high index of clinical suspicion and screening test followed by rapid onset of treatment by Azithromycin and Doxycycline.

Cryptococcus neoformans is a leading cause of adult fungal meningitis and mortality in HIV/AIDS patients. The onset of fungal meningitis typically precedes the detection of serum/plasma cryptococcal antigen (CrAg) by several weeks. Screening for Cryptococcal Antigen (CrAg) and early treatment can significantly prevent the development of fungal meningitis in HIV/AIDS patients. Method: This descriptive cross-sectional study involved 100 antiretroviral therapy (ART) naive patients, comprising 65 males and 35 females, from both ART clinics and Medicine Indoor facilities. Serum/CSF cryptococcal positivity was determined using the Latex agglutination test (Pastorex TM Cryptoplus, BIO-RAD, France) and the Lateral flow assay by IMMY Kit (US FDA approved). CD4 counts were measured using a flow cytometer (Becton-Dickinson FACS count flow cytometer). Results: The prevalence of CrAg positivity in the study was 7% (7/100), with 4% (4/100) exhibiting features of meningitis. Statistical analysis revealed a significant association of antigenemia with demographic features such as age, inpatient status, and symptomatic groups (p-value ≤ 0.05). A low CD4 count (<50) was correlated with a higher seropositivity rate of 33.3% (5/100). Clinical symptoms like headache, vomiting, and fever showed a statistically significant association with cryptococcal antigenemia. Conclusion: The study concludes that cryptococcal antigenemia is more prevalent in ART-naive HIV patients with lower CD4 counts, emphasizing the need for urgent screening and the substitution of antifungal treatment to reduce morbidity and mortality associated with cryptococcal meningitis.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Respiratory diseases impose a big global health burden. Around 65 million people have moderate to severe chronic obstructive pulmonary disease (COPD), from which about 3 million die each year. Chest diagnostic imaging is vital in managing a critically ill patient. Right now, direct visualization of the lung parenchyma is done using a chest x-ray (CXR) and computed tomography (CT), with the patient in the supine position in the Intensive Care Unit (ICU). Aims & Objectives: To assess the efficacy of BLUE protocol in diagnosing patients with respiratory failure in intensive care unit. To evaluate the USG findings among study participants and to compare the USG Diagnosis and CT Diagnosis of Patients. Methodology: This was a hospital based cross-sectional, descriptive, prospective study conducted among 150 patients who were admitted into ICU at NRI Medical College suspected with Acute Respiratory Failure in a period of 18 months. Patients admitted to the ICU with respiratory failure were tested initially using LUS and BLUE protocol without interrupting other management. Final diagnosis was done based on history, clinical examination, CT scan, CXR, clinical progression under treatment, and evaluation of cardiac function using echocardiography, functional tests. Data was entered on a Case record form and was represented as frequency and simple percentages. Data analysis was done using Microsoft excel 2019 and IBM SPSS software version 23.0. Sensitivity, specificity, NPV and PPV were calculated for BLUE Protocol using CT diagnosis. Results: A total of 150 patients who were admitted into ICU with various respiratory disorders were evaluated in this study. The age of patients involved in this study ranged from 21-70 years with mean age of 52.27 years. The most common organism isolated was E Coli. Most of the patients had Pneumothorax in the current study. Accuracy was 90.48% in diagnosing pulmonary edema using USG in ICU. Conclusions: LUS is a multifaceted option with low radiation doses for ARF management in critical care settings. LUS is an accurate method for diagnosing pneumothorax, alveolar- interstitial syndromes, parenchymal consolidations, pleural effusion.

Background: Two subtypes of vulvar squamous cell carcinomas (VSCC) have previously been defined. The more common keratinising type typically occurs in older women (50-70 years), is generally associated with lichen sclerosis and/or differentiated vulvar intraepithelial neoplasia (dVIN), and is often associated with p53 tumor suppressor gene mutations. The other subtype is more common in younger women and primarily associated with human papilloma virus (HPV) infection, and a common precursor is usual-type vulvar intraepithelial neoplasia (uVIN) of the basaloid or warty type. To investigate the prognostic significance of HPV status in vulvar squamous cell carcinomas (VSCC) and to determine whether preoperative determination of p16 or p53 status would have clinical relevance. Materials and methods: This is prospective and descriptive study conducted in the Department of Pathology, Government Medical College, Siddipet over a period of 1 year. Immunohistochemistry was performed by using 5 μm paraffin sections which were deparaffinized in xylene (three times for five minutes) and rehydrated in decreasing concentrations of ethanol (100%, 96%; two times each for ten minutes) followed by washing in deionised H2O for one minute. To unmask the p16 antigen the slides were covered with 0.01 M sodium citrate buffer (pH 6.0) and placed on a hot plate (950C) for 10 minutes. After cooling down the specimens were rinsed briefly in deionised H2O (three times). The specific primary (mouse monoclonal) antibody (p16, clone E6H4) was applied in a dilution of 1:50 overnight at 40C. Result: HPV types and status in correlation with clinical parameters and expression of p16. 70 out of 70 patients with PCV could be evaluated for HPV status. 25 were positive for high-risk HPV and 45 were HPV negative. The majority (16 out of 26, 64%) of HPV-positive patients were positive for HPV16. The others were positive for HPV45 (4 patients, 16%), HPV18 (2 patient, 8%), HPV35 (1 patient), HPV56 (1 patient), and HPV68 (1 patient). Human papillomavirus positivity was significantly correlated with strong p16 expression (p= 0.045). In all, 7 out of the 59 HPV-negative patients were negative for p16 immunostaining, while the remaining 83% showed varying expression: 31 out of 45 (68.9%) showed moderate or strong p16 expression. Conclusion: The vast majority of HPV positive vaginal cancers showed p16 overexpression, suggesting active involvement of HPV in the malignant transformation process. HPV vaccines will help prevent some of the primary female genital cancers associated with HPV type 16. More in-depth studies are needed to understand the molecular carcinogenesis pathway in these p16- negative tumors and to improve outcomes for this population.

Introduction: Men, especially as they age, are more prone to specific genitourinary conditions compared to women. This study aimed to estimate the prevalence and identify correlates of chronic renal failure, incontinence, and kidney stones among men aged ≥45 years in India. Methods: Data from the first wave of the Longitudinal Ageing Study in India (LASI) wave-1, 2017-2018, were utilized. The sample included 33,097 men aged ≥45 years. Descriptive statistics reported prevalence with a 95% confidence interval. Multivariable regression analysis assessed associations between socio-demographic and behavioral factors with chronic renal failure, incontinence, and kidney stones. Results: The overall prevalence was 0.82% (95% CI: 0.71-0.93) for chronic renal failure, 3.02% (95% CI: 2.82-3.23) for incontinence, and 3.0% (95% CI: 2.79-3.20) for kidney stones. Multivariable regression analysis revealed that participants aged ≥75 years had higher odds [AOR: 1.91 (95% CI: 1.34-2.44)] of experiencing incontinence. Kidney stones were significantly associated [AOR: 1.88 (95% CI: 1.53-2.55)] with obesity. Conclusion: A noteworthy prevalence of chronic genitourinary conditions among aging men was observed, emphasizing the need for attention. The recently established Health and Wellness Centres (HWCs) offer a potential avenue for timely care, warranting further strengthening.

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Background: People face numerous hazards at work which may result in injuries, cancer,hearing loss, respiratory, musculoskeletal, cardiovascular, reproductive, neurological,skin and mental disorders. Objectives: To assess the Association of sociodemographicprofile and healthof traffic policemen in Kalaburagi. Method: The present cross sectional study studywascarriedoutamong all the traffic police men working in Kalaburagi city. Results: The association between ageand Waist Hip ratios was found to be highly significant. Majority of study subjects 27(55.10%) pre obese and 4(8-16%) obese belonged to more than 40 years of agegroup whereas 28(51.85%) pre obese and 2(3.70%) obese belonged to less than 40yearsofagegroup. Conclusion: There is a significant association between age and morbidities (like musculoskeletal disorders psychological problems and varicose vein) and found statistically highly significant.

Aim and Objectives: To study various methods to identify and localise, ease or difficulty in grafting, complications , morbidity and mortality in Intramyocardial coronaries Materials and methods: This is a retrospective observational study for a period of 5 years, at Department of Cardiothoracic Surgery, in patients who are undergoing CABG and have been found to have an intramyocardial coronary vessel. The study protocol was approved by the Hospital Ethics committee. Various techniques to localize the intramyocardial LAD and outcomes of the procedure were studied in 50 cases. Results: In the present study, most patients were in the range of 51-55 years (30%) and 61-65 years (22%) and were male(76%). Majority of cases had the Left Anterior Descending Artery (LAD) which was intramyocardial in nature (88%) while Ramus Intermedius was intramyocardial in the rest (12%).The intramyocardial coronary was identified by Vein sign (n=23, 46%) and Tracing (n= 19, 38%) in majority of the cases. The Groove sign was employed in (n=6, 12%) cases whereas Probe method was used in (n=2, 4%) cases. The time taken by Groove, tracing & Vein methods compared to the Probe method was statistically significant (0.002, 0.00, 0.00). The cross-clamp time and pump time for all methods were comparable. The prevalence of intramyocardial coronaries in this study was 13%. Conclusion: It maybe concluded that, intramyocardial coronaries can be grafted like any other epicardial coronary once localisation is achieved. Our proposed algorithm can serve as a guide as any one technique for LAD exposure is not ideal as every case requires an individual approach.

Vasculitis is a clinico – pathological entity involving all organs. Despite being reported widely, the triggering etiology for the disease appears to be broadly unknown. Emerging evidence linking immunological, infectious, environmental and genetic causes are being increasingly studied with focus on Infectious agents including viruses, bacteria, fungi and parasites. Case series: Here in we assessed three autopsies demonstrating histopathological evidence of vasculitis seen in various organ systems. Relevant clinicopathological details such as demography, course in hospital, gross and microscopic reports were retrieved from the hospital medical records, reviewed and analysed. In two cases vasculitis was observed against a backdrop of fungal infection with the organs affected being the cerebrum in one and lungs of both cases. The third case demonstrated vasculitis of the coronary arteries in a patient with a known history of tuberculosis. Conclusion: The aim of the cases series was to highlight the importance of infections in causing vasculitis in the demographic set up of India along with the need to consider infection – related vasculitis when faced with diagnostic conundrums. Early stage vasculitis are often clinically silent. Hence, early signs of infections should make one vary of vasculitis as a potential complication, thus direct the investigation panel and therapeutic modalities accordingly to prevent fatal outcomes of the disease.

Introduction: Community acquired pneumonia (CAP) is defined as pneumonia that is acquired outside the hospital i.e., acquiring a pathogen from the community and is a public health concern accounting for nearly 1% of all medical admissions. Identification of pathogen and its susceptibility pattern by processing appropriate samples will help to start prompt and effective treatment. The aim of the present study is to present the microbiological data of community acquired pneumonia in this region. Materials and Methods: In the present study 535 patients with clinical symptoms and suspected of community acquired pneumonia were included in this study. All patients were requested to collect good quality sputum and those samples were processed in the Microbiology department on recommended culture media. Bacteria; isolation was done by biochemical tests. Antibiotic susceptibility testing was performed by conventional methods. Results: Predominant pathogen was Klebsiella pneumoniae isolated as 33.6% followed by Streptococcus pneumoniae (24.7%), Staphylococcus aureus (18.5%), Pseudomonas aeruginosa (15.04%), Enterobacter species (5.3%), and Acinetobacter species (2.65%). Gram negative isolates antibiotic susceptibility pattern shows around 50% were sensitive to ceftriaxone, amoxyclav, about 70 % isolates were sensitive to Ceftazidime-clavulanic acid, Piperacillin-tazobactum, Levofloxacin, and 90% isolates were sensitive to Amikacin, Meropenem, Ertapenem, Tigecycline. In this study  23.8% were Methicillin Resistant Staphylococcus aureus isolates. Conclusion: Health education  measures such as cessation of smoking, wearing a mask to avoid occupational hazards, following public health measures during epidemics, flu and anti-pneumococcal vaccination may help to reduce the incidence of community acquired pneumonia.

Introduction: The consequences of CSOM varies from hearing loss, persistent otorrhoea, mastoditis, labrynthitis, facial palsy and also leads to dangerous complications such as intracranial abscess and thrombosis. Chronic suppurative otitis media (CSOM) is persistent inflammation of the middle ear or mastoid cavity. The treatment of CSOM is also controversial as the microbiotia and susceptibility patterns keep changing from time to time and vary from region to region. So here we tried to project a data of cross sectional study which gives the epidemiology of CSOM and its microbiological study.  Materials and Methods: This is a cross sectional study on CSOM Patients from whom clinical details were collected.  All pus swabs were collected under aseptic precautions and processed for gram stain, culture, biochemical reactions and sensitivity testing as per recommendations. All the data entered in to Spread excel sheet for analysis. All descriptive quantitative variables were expressed as numbers and percentages. Results:  Unilateral CSOM is the most common complaint observed i.e, 63.1%. On audiometric examination 64.8% of patients had <40dB of hearing loss and the majority CSOM patients had conductive hearing loss (69.7%). Predominant pathogen isolated was Pseudomonas aeruginosa (33%) followed by Klebsiella pneumoniae (22%) and Staphylococcus aureus (19%). Pseudomonas aeruginosa which were isolated showed 96.9% susceptibility to amikacin, 81.8% to levofloxacin, 81.8% to Ceftazidime-clavulanic acid, 81.8% to piperacillin+tazobactum, 75.7% to ceftazidime, and 87.8% sensitive to meropenem. Conclusion: Complications of CSOM can be prevented by appropriate antibiotic usage according to the microbiological report, irrational use of antibiotics cause the increase in multidrug resistant pathogens so it is strongly recommended to test for microbiological culture and sensitivity prior to usage of antibiotics. Early microbiological ensues prompt and effective treatment to avoid such complications.

Background: Dyke-Davidoff-Masson syndrome is a rare condition resulting from brain injury due to a multitude of causes; especially in early life. Characteristics include cerebral hemiatrophy/hypoplasia, contralateral hemiparesis, seizures, and compensatory osseous hypertrophy. Case presentation: We present a case of a 14-year-old girl who initially presented with left sided hemiparesis. Computed tomography (CT) showed evidence of right cerebral atrophy. Workup for paediatric stroke was negative. Upon further evaluation by Neuroradiology, features suggesting Dyke-Davidoff-Masson syndrome were confirmed. Patient has been under Neurology follow up since. Conclusions: Due to its rarity, Dyke-Davidoff-Masson syndrome may easily be missed by the majority of treating clinicians. Knowledge of its features on imaging enables timely and accurate diagnosis – allowing appropriate management.

Background: The skin acts as an external reflection of renal diseases. The dermatologic disorders in chronic kidney disease (CKD) can be attributed to the etiology, the disease, or the treatment and can markedly affect a patient’s quality of life.  Aim: The aim is to study the pattern and proportion of cutaneous manifestations in CKD patients on dialysis, on conservative management and in post transplant patients.  Materials and Methods: A hospital-based study was done using a cross-sectional design. The study comprised 60 patients with chronic kidney disease (CKD) on hemodialysis, 13 patients with CKD receiving conservative therapy, and 10 patients who had undergone a kidney transplant. Following written consent, all patients underwent a comprehensive clinical examination. Results: Each patient included in the study exhibited at least one dermatological manifestation. Diabetes mellitus is the predominant underlying illness that causes chronic kidney disease (CKD). The predominant presentation was xerosis observed in 60% of patients, followed by pruritus observed in 43%, pallor observed in 41%, and pigmentary alterations observed in 28% of patients. 43% of patients had cutaneous infections, 82% had nail alterations, 40% experienced hair changes, and 38% showed oral mucosa changes. Posttransplant patients had drug-induced skin symptoms, including acneiform eruptions in 32% of patients, hirsutism in 8% of patients, striae in 8% of patients, and hypertrichosis in 4% of patients.  Conclusion: The prevalence of xerosis, pruritus, pigmentation, and pallor is higher in the dialytic group compared to the nondialytic group. Timely identification and certain preventive interventions can avert or reduce some of the detrimental alterations.

Background: To evaluate the role of non-enhanced computed tomography (NECT) brain in diagnosis of acute cerebral venous sinus thrombosis (CVST). Methods: This cross sectional study was done in the Department of Radiodiagnosis among 32 patients referred to Radiology Department with symptoms & signs of acute cerebral venous sinus thrombosis (ACVST). The attenuation values of different dural venous sinuses & major cerebral veins/ large cortical veins were recorded in the proforma. The sensitivity, specificity & accuracy of using attenuation value of 70 HU as predicted in previous article was calculated. Also the cut off attenuation value suggestive of thrombosis was calculated retrospectively in our study keeping   sensitivity, specificity and accuracy to the maximum. Results: The majority of subjects are of 21-30 years age group (31.25%) and maximum were males(62.5%). 10(31.2%) subjects reported positive MR venography findings.Analysis of ROC curve of HU shows a zone under the curve of 0.966 with cut-off of 70 as well, sensitivity of 96%, specificity of 91% and accuracy of 98% was reported. And with cut-off of 68 as well, sensitivity of 92%, specificity of 84% and accuracy of 93% was reported. Conclusion: In case of acute neurologic symptoms, NECT is the most commonly requested modality. Plain CT is definite for the analysis of acute CVST in an acute context, however, the density of venous sinuses decreases as the age of the clot increases. According to our findings, the cut-off value for CVST diagnosis should be 70 HU (sensitivity 96 percent, specificity 91 percent), with no need for additional confirmatory procedures like as venography.

Background: There has been an alarming increase in recalcitrant dermatophytosis in recent years. The standard treatment guidelines no longer seem effective in achieving clearance and results in high failure rates. Methods: The present study was Prospective comparative study conducted in department of dermatology and venereology and leprology, Patna Medical College and Hospital, Patna, among patients attending in outpatients department. The study was conducted from august 2020 to august 2021. After getting institutional ethical committees’ approval for the use of oral itraconazole and oral terbinafine in patients of  dermatophytosis. The patients were allocated into two groups: GROUP I: Daily dose of terbinafine 250mg BD daily for 4 weeks and continue with treatment during follow for 8wk  if not cured. GROUP II: Daily dose  of itraconazole 100mg BDdaily for 4 weeks and continue with treatment during follow up  for 8wk if not cured. Results: This was prospective comparative study of oral Itraconazole and oral terbinafine in patients of Dermatophytosis. The  most commonly affected age group was  highly productive and working population that was 21-30yrs . By taking 9 point assessment score the severity of lesions were assessed and  graded accordingly. On 4 wks of follow up there was reduction of dermoscopic evidence , 34 % and 42%  in Group I  and group II respectively. At the end of study(8weeks) dermoscopic features of dermatophytosis reduced by 87 % and 91% n group I and group II respectively. Conclusions: It was found that Itraconazole was more efficacious than Terbinafine Although Terbinafine is fungicidal drug with more chances of drug resistance and Itraconazoleis fungistatic with less chances of drug resistance.However,with both drugs the clinical,mycological  and dermoscopic cure took more time from the conventional dosage and treatment duration because  the patient was treated with only oral therapy without any topical antifungal drugs.

Background: Accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. Multiple disciplinary approach is usually required for complete healing of chronic ulcers. Methods: A prospective study of 18 months duration was conducted on 50 consecutively admitted cases of chronic leg and foot ulcers in age group of 5-80 years of both genders. A through detailed history and clinical examination was undertaken. Local Symptoms, trophic skin changes and venous insufficiency if any was recorded. Both general and specific treatments were provided. Results: The majority of occurrences occurred in individuals aged 31-50 years, with a male to female ratio of 1.9 to 1 and a rural to urban ratio of 2.57 to 1. The majority of patients, including 76%, were illiterate. Additionally, 56% of the patients were from the lower socioeconomic level. A majority of patients (54%) had habits of smoking, tobacco consumption, or alcoholism. The most common location of the ulcer was the foot, accounting for 52% of instances, followed by the leg at 18%. The majority of ulcers (72%) were caused by trauma, whereas just a small percentage (2%) were due to ischemia. Regarding symptoms, 32% of the cases exhibited wound, pain, and discharge, while 26% showed wound and discharge. 66% of ulcers were found to have secondary infections, whereas the highest percentage of patients, 68%, required a hospital stay of approximately 2 weeks. Complete recovery occurred within around three months in 68% of instances. Conclusions: A correct diagnosis, multidisciplinary approach, optimal treatment and assessment of vascular status can facilitate healing of chronic leg ulcers in nondiabetic cases.

Introduction: The most common cancer among women in the last 20 years has been cervical cancer. In India, the age range of 55 to 59 is when the incidence of cervical cancer peaks.Every eight minutes, a woman in India loses her life to cervical cancer. Concurrent chemotherapy and radical radiation therapy are the accepted standards of care for advanced cervical carcinoma.Combining teletherapy and brachytherapy is a common practice.One form of teletherapy is whole-pelvic radiotherapy, which uses external beam therapy to treat the primary tumor and then uses brachytherapy and regional lymphatics to increase the gross tumor in the cervix. However, in the event that this treatment is successful, there is a possibility that the bladder, rectum, and small intestine will inadvertently be exposed to normal tissue radiation. Aims:The purpose of this study is to determine whether less toxicity results from lowering the dose in small bowl, prone-positioned urine bladders during pelvic radiotherapy. Materials and methods: Prospective randomizedly allocated control study from January 2017 to January 2018 Patients visiting at Radiotherapy department Out door of Nilratan Sirkar Medical College and Hospital,Kolkata-700014. Result:V20, V30, and V40 for the urinary bladder (UB) did not significantly differ between the two positions, according to our findings (p > 0.05). However, UB V45 demonstrated a notable difference (p = 0.9), while UB V50.4 indicated a statistically significant variance (p = 0.021), indicating higher radiation exposure in the supine position. UB Dmean and total volume did not exhibit substantial differences (p > 0.05) and Regarding the rectum, V20, V30, V40, and V45 showed no significant variation between positions (p > 0.05). However, rectum V50.4 indicated a significant difference (p = 0.004), implying higher radiation exposure in the prone position. Rectum Dmean and total volume did not display substantial differences (p > 0.05). Conclusion:In conclusion, our study revealed varied radiation exposure in prone versus supine positions. The urinary bladder indicated higher exposure in supine (V50.4 p = 0.021), while the rectum exhibited increased exposure in prone (V50.4 p = 0.004). Overall, patient positioning significantly influences organ-specific radiation doses.

Menstrual hygiene is a topic that has long been shrouded in silence and stigma, but in India, it has emerged as an urgent public health concern that demands our immediate attention. The lack of access to proper menstrual hygiene management not only affects the well-being of millions of Indian women and girls but also has far-reaching consequences for their health, education, and overall quality of life.¹Menstruation is a naturally unfolding biological process that takes place in adolescent girls and women of reproductive age.²

In a country as diverse as India, where cultural norms, traditions, and socioeconomic disparities vary widely,³ addressing menstrual hygiene requires a multifaceted, integrated approach. Here, we shed light on the critical aspects of this issue and the imperative need for a unified strategy to combat the menstrual hygiene crisis in India.

Hypertensive disorders in pregnancy, encompassing conditions like gestational hypertension and preeclampsia, significantly impact maternal and fetal health. Understanding their incidence and associated risk factors is vital for improving prenatal care. Objectives: This study aims to determine the incidence of hypertensive disorders among pregnant women and identify key demographic and health-related factors associated with these conditions. Methods: Design: Cross-sectional study. Setting: Obstetric outpatient Department. Participants: 250 pregnant women, ranging from 18 to 45 years, at various stages of gestation. Data Collection: Medical histories, blood pressure measurements, and relevant biochemical markers were collected. Statistical Analysis: Descriptive statistics, chi-square tests, and logistic regression were used to analyze the data. Results: Incidence: The incidence of hypertensive disorders was found in a specific percentage of the participants. Risk Factors: Key risk factors such as age, BMI, and medical history were significantly associated with the development of hypertensive disorders. Demographics: The study also revealed demographic trends, such as a higher incidence in certain age groups or pre-existing conditions. Conclusion: This study highlights a significant incidence of hypertensive disorders in pregnant women, underscoring the need for targeted prenatal screening and management strategies. The identification of key risk factors can aid healthcare providers in developing personalized care plans.

Introduction: Corneal ulcers, characterized by epithelial loss, stromal infiltration, suppuration, and inflammation, pose a global health concern, especially in the context of corneal blindness. Infectious keratitis, attributed to microbial agents, is a leading cause of corneal ulcers. This study focuses on the incidence, microbial etiology, and management strategies for corneal perforations arising from infectious keratitis. Objective: To investigate the incidence of corneal perforation in cases of infective keratitis, identify specific microorganism groups associated with corneal perforations, determine appropriate treatment modalities, and assess the prognosis of various interventions in perforated corneal ulcer management. Materials and Methods: A total of 150 patients with infectious perforated corneal ulcers were enrolled. Inclusion criteria covered patients aged 18 to 60 years, irrespective of gender, with infectious etiology. A comprehensive clinical examination, microbiological analysis, and various treatment modalities, including Bandage Contact Lens, Cyanoacrylate Glue, Amniotic Membrane Transplantation, and Corneal Transplantation, were employed. Results: Prevalence is observed in the age group of 25-50 years (70 patients), followed by 50-60 years (53 patients), and 18-25 years (27 patients). There is a significant male preponderance (117 cases) compared to females (33 cases). There is a higher incidence among farmers (44 cases) and laborers (27 cases), suggesting potential occupational risk factors. Paracentral perforations are the most prevalent (71 cases), followed by central (45 cases), and peripheral perforations (34 cases). A total of 132 positive cases indicate a predominantly infectious etiology. There is a higher prevalence of bacterial infections (75 cases), followed by fungal (29 cases), and mixed infections (28 cases). Micro perforations (<1mm) are the most common (68 cases), followed by small (59 cases), and large perforations (23 cases). Bandage Contact Lens (67 cases), Amniotic Membrane Transplantation (45 cases), and Penetrating Keratoplasty (38 cases) are frequently employed. Discussion:   Infectious keratitis, if not promptly managed, poses severe complications. Factors such as occupation, accessibility to medications, and gender influence delayed presentations. Corneal perforation, a consequence of various corneal disorders, requires timely recognition and intervention to prevent vision loss. Treatment modalities include medical approaches, tissue adhesives, and various surgical interventions. Conclusion:  The study underscores the multifaceted approach required for infectious keratitis management. Prompt intervention, gender-specific prevalence, and the efficacy of diverse treatments based on perforation characteristics are highlighted. The findings contribute valuable insights for the effective management of corneal perforations arising from infective keratitis.

Background: This study was conducted to find out CD10 expression in premalignant and epithelial malignant lesions of the colon and rectum with clinicopathological correlation. Methods: This was a hospital-based cross-sectional study conducted 50 biopsy/resected specimens of adenomas (20 cases) and adenocarcinomas (30 cases) who were selected randomly. They underwent H&E staining and IHC for CD10, with the exclusion of non-epithelial tumor samples and submitted to the Department of Surgical Gastroenterology, Department of Surgery, Hi-Tech Medical College and Hospital, from August 2020 to August 2023, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: Among the 50 cases, 35 (70%) >50 years and 15 (30%) <50 years, 28 (56%) were males, and 22 (44%) were females. Location-wise tumours comprise rectum 16 (32%), followed by descending colon 13 (26%), ascending colon 10 (20%), rectosigmoid junction 7 (14%), and transverse colon 4 (8%). The level of CD10 expression slowly rose from adenomas (<10%) to well-differentiated (G1)-adenocarcinomas (10–25%), with the highest level of expression seen in poorly differentiated (G3)-adenocarcinomas (>50%). Conclusion: At every step of the adenoma-carcinoma cascade, CD10 is crucial. Association of CD10 expression with malignant behaviour of colorectal adenocarcinomas and CD10 could be a new biomarker for aggressiveness and prognostic information. When used as a therapeutic target, CD10 will allow for the greatest possible targeting of malignant areas.

Background: Menstrual hygiene is a crucial aspect of adolescent health, impacting the well-being and dignity of school girls. In central Haryana, where a significant population of adolescent girls resides, there is a need to understand the knowledge, attitudes, and practices of school girls regarding menstrual hygiene. This study, conducted among 200 adolescent school girls, aims to fill this gap by assessing these factors and providing insights for targeted interventions. Methods: A cross-sectional study was conducted among 200 adolescent school girls aged 10-18 in central Haryana from 2020 to 2021. A self-designed questionnaire was administered to collect data on socio-demographic characteristics, knowledge, attitudes, and practices related to menstrual hygiene. SPSS version 24 was used for data analysis, employing the Chi-square test to identify associations between variables. Results: The study revealed that, among the 200 adolescent school girls in central Haryana, 68.3% considered menstruation a normal process, while 46.7% had good knowledge scores. However, concerning percentages, 30.8% were uncertain about menstrual blood hygiene, and 53.3% were categorized as having poor knowledge. Addressing these knowledge gaps is crucial for promoting menstrual hygiene and the well-being of school girls in the region. Conclusions: The findings emphasize the importance of addressing the knowledge gaps and misconceptions surrounding menstrual hygiene among school girls in central Haryana, where this study involved 200 adolescent participants. Targeted educational programs involving mothers and teachers as key influencers are essential to improving girls understanding and promoting better menstrual hygiene practices. This research serves as a foundation for empowering school girls with knowledge and promoting their overall well-being.

Background: Chronic stress is increasingly recognized as a significant risk factor for cardiovascular disease (CVD), particularly in the high-pressure environment of modern professional workspaces. This study investigates the correlation between chronic stress levels and the prevalence of cardiovascular disease among working professionals. Objectives: The primary objective is to examine the association between chronic stress and the incidence of cardiovascular disease in a sample of 200 working professionals. The study aims to provide empirical evidence to support or refute the hypothesis that chronic stress is a significant contributor to cardiovascular health risks in this demographic. Methods: We conducted a cross-sectional study involving 200 working professionals from diverse industries. Participants were selected based on specific inclusion criteria and represented a broad range of ages and job roles. Stress levels were quantified using standardized psychological assessment tools, and cardiovascular health was evaluated through medical examinations and health history analysis. Data were analyzed using statistical methods to identify any significant relationships between stress levels and cardiovascular health indicators. Results: The study found a statistically significant correlation between high levels of chronic stress and the prevalence of cardiovascular disease symptoms and diagnoses among the participants. A higher incidence of CVD-related health issues was observed in individuals reporting higher stress levels, even after controlling for other risk factors like age, gender, and lifestyle habits. Conclusions: The findings suggest that chronic stress is a significant risk factor for cardiovascular disease among working professionals. This underscores the need for stress management interventions and policies in professional settings to mitigate this risk. Further longitudinal studies are recommended to explore the causal relationships and the long-term impact of chronic stress on cardiovascular health.

Introduction: Recent research on Omentin-I and its associations with type II diabetes, the degree of insulin resistance, and obesity is intriguing and has potential for treatment.Adipose tissue is an active endocrine organ that generates many hormones and cytokines called adipokines, such as visfatin, TNF-α, IL-6, and adiponectin[11,12]. These findings are accumulating.These adipokines appear to be key players in the pathophysiology of insulin resistance, diabetes, atherosclerosis, vascular endothelial dysfunction, and inflammation. They also have broad impacts on the metabolism of fats and carbohydrates.Material and method: In partnership with the Department of Endocrinology at the M.K.C.G Medical College Hospital in Berhampur, Odisha, the Department of Biochemistry carried out this clinical investigation. Participants in the study included both inpatient and outpatient visits to the endocrinology department. The period of the clinical investigation was from January 1, 2013, to May 1, 2014.Results: the age distribution of cases and controls. Thirty-four out of fifty cases, or 68% of the cases in the current research, are in the 40–54 age range. whereas 56% of the control group consisted of 28 out of 50 individuals. The two groups' mean ages did not differ significantly (p>0.05).As a result, it was shown that the patient group had considerably greater levels of total cholesterol, triglycerides, and LDC-cholesterol than the control group (p<0.001), and that the patient group had much lower HDL cholesterol.Conclusion: All of the patients had higher fasting insulin levels.The patients were found to have high scores on the HOMA-IR assessment of insulin resistance.In TYPE 2 DM subjects, serum omentin levels were lowered. Blood sugar levels while fasting showed a negative correlation with serum omentin.Omentin serum levels and insulin fasting showed a negative correlation.A negative correlation was found between serum omentin and HOMA-IR.

Introduction: Body mass index (BMI) is the most widely used statistic to determine the prevalence of obesity. BMI is defined by the World Health Organisation as "a simple index of weight-for-height that is commonly used to classify adults as underweight, overweight, or obese." It is calculated as follows: kg/m2, which is the weight in kilogrammes divided by the height in metres squared. For instance, a 70 kg adult who stands 1.75 metres tall will have a BMI of22.9.Material and method: Type 2 diabetes, hypertension, elevated blood cholesterol, and triglycerides, which can result in atherosclerosis, are all made more likely by obesity. Previously thought to be a reservoir of excess energy, adipose tissue is now understood to be a functional, autonomous endocrine organ. Adipokines, a group of bioactive mediators that are expressed by adipose tissue and other biological systems, facilitate communication between the two.The adipokineadiponectin is only released by adipocytes. It is widely distributed in the bloodstream as a 360 kDa high molecular weight multimer and a 180 kDa low molecular weight hexamer.Results: This table shows age and sex distribution of cases and controls. Both cases and controls were divided into two groups according to age i.e. 20-35 years and 36-45 years. Maximum cases are within the range of 20-35 years. Percentage of male is more in comparison to controls.Conclusion: Adipokines are substances released by adipose tissue that regulate a variety of physiological processes throughout the human body by way of systemic circulation. Numerous organs and systems experience a disturbance in homeostasis as a result of adipokinedys regulation in obesity. These include insulin resistance, oxidative stress, endoplasmic reticulum stress, synaptic dysfunction, and cognitive decline.

Background: Hypotension is the most prevalent adverse effect of spinal anaesthesia for caesarean section, which demands specific prevention and treatment interventions. Present study was aimed to study correlation of symphysio-fundal height and abdominal girth with incidence of hypotension in caesarean section following spinal anesthesia.Material and Methods:Present study was single-center, Cross sectional study, conducted in pregnant women of age 19-35 years, height 151-170 cms, full term gestation, undergoing elective and emergency caesarean section under spinal anaesthesia. Results: In present study, total of 87 patients were included. Hypotension was present in 70.1% of the patients. 52.3% of patients with SFH of 32-35cms and 88.4% of patients with SFH of 36-39cms were hypotensive. The p-value was statistically significant (p=0.001). 55.1% of patients with AG of 86-95cms and 89.5% of patients with AG of 96-105cms were found to be hypotensive. Mean total dosage of rescue ephedrine in SFH 32-35cms was 7.91±2.86. Mean total dosage of rescue ephedrine in SFH 36-39cms was 11.05±5.13. Mean total dosage of rescue ephedrine in AG 86-95cms is 8.54±3.86. Mean total dosage of rescue ephedrine in AG 96-105cms is 10.94±5.13. We found negative correlation between SFH and SBP with ‘r’ = -0.389 which is found to be statistically significant and 13.11% patients required atropine. Conclusion: In patients undergoing elective and emergency caesarean section under spinal anaesthesia the symphysiofundal height and abdominal girth showed significant negative correlation with systolic blood pressure.

Introduction: Thyroid disorders, affecting approximately 42 million individuals in India, pose significant public health concerns. This study focuses on determining the prevalence of undetected hypothyroidism and associated risk factors among adults in Odisha, India. Methods: A cross-sectional study at SLN Medical College, Odisha, involved 970 participants aged 20-70 years. Demographic data, symptoms, and TSH levels were recorded. Regression analysis assessed risk factors, and Anti-TPO antibodies were tested in a subset. Results: Undetected hypothyroidism prevalence was 16.8%, higher than previous studies. Females exhibited a higher prevalence (19.1%) than males (10.2%). Regression analysis identified gender and symptoms as significant correlates. Anti-TPO positivity was 94.8% in subjects with elevated TSH. Discussion: The prevalence increase suggests a growing health concern. Regional variations and environmental factors, including thyroid disruptors, demand further investigation. The impact on reproductive health emphasizes the need for early detection. Conclusion: Undetected hypothyroidism remains a prevalent issue in Odisha, with autoimmune factors playing a substantial role. Addressing this condition is crucial for enhancing population health and productivity.

Background & Objectives: Hip pain has different etiologies in adults and children. MRI is the method of choice in characterizing the various disorders and assessing the full extent of osseous, chondral and soft tissue abnormality of the hip joint. This study was aimed to evaluate the diagnostic value of MRI in assessment of painful hip joint. Methodology: This prospective study included 60 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 & STIR WIs, axial T1&T2WIs, axial T1WI and sagittal T1WI after contrast injection. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: The most common pathology for which MRI hip advised was avascular necrosis (AVN) (40%), followed by septic arthritis (20%). Male to female ratio was 2.3:1, their ages ranged from 10 months to 76 years with a mean age of 40 years. In this study most common presentation was pain in hip joint (97%) followed by restricted movement (92%). In the study most common MRI finding of AVN was bone marrow edema (78%) of the lesions followed by joint effusion 63% and Double line sign (58%). In present study, stage 4 with secondary osteoarthritis was the most common stage of AVN present in 43% of the lesions followed by stage 3 31%. The frequency of MRI findings in septic joints was synovial enhancement (91%), joint effusions (91%), erosive bone destruction (67%). In the study most common changes of osteoarthritis is joint space reduction noted in 38% of hips studied. Conclusion: MRI of the hip joint is an informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.

Introduction: Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including the metabolic syndrome. Materials and Methods: A Cross-Sectional Study of a total of 100 patients visiting the Outpatient Department of Dermatology and Venereology of at Nalanda Medical College and Hospital in Patna, for psoriasis was done. The parameters included were age at onset of disease, current age, sex, type of disease, and distribution of lesions. Data and statistical analysis were done. Results: most common age of presentation between 18-43 years, there was a predominance of males, with a male-to-female ratio of 2.41:1, service class affected most followed by business people and house wifes respectively. addiction present in 80% cases and family history positive in 28% subjects. Majority cases were of moderate to severe PASI in our study. Metabolic syndrome was diagnosed in 21 out of 100 cases and 20 out of 100 controls (p-value: 1.000). We did not find any association of psoriasis with metabolic syndrome in our study. Conclusion: Our study refuted any association of psoriasis with metabolic syndrome at the onset of disease activity in Indian patients. The plenty of reports from west approving such an association can be explained by increased risk factors like smoking, alcohol consumption, obesity and stress levels. Further, most such studies have been conducted with patients on treatment, while ours is the study on newly diagnosed patients prior to the initiation of any therapy.

Objective: A common genito-urinary infection known as Balanoposthitis presents with mild symptoms like itching or severe complications such as phimosis, ulceration of glans, and foreskin. It can result in four types of sexual dysfunction including Disorder of sexual desire, Disorder of erectile dysfunction, Disorder of satisfaction/premature ejaculation, and Disorder of orgasm. Materials and methods: An observational clinic study including 65 patients diagnosed with Candidal Balanoposthitis based on KOH and clinical findings were recruited and evaluated for sexual function using a standardised questionnaire. Results: The results demonstrated that sexual dysfunction in patients with Candidal Balanoposthitis is a common entity encountered in STI clinics and should be addressed properly as any deficiency in any aspect of sexual health of a patient can lead to emotional and psychological disability impacting the overall quality of the life. The factors like advanced age, Diabetes Mellitus ,and poor hygiene measures of genitalia can increase the incidence of candidal Balanoposthitis as well as sexual dysfunction. Conclusion: Candidal Balanoposthitis ,a common cause of sexual dysfunction in elderly population takes a toll on emotional and psychological health and certain modifiable factors like diabetic control and hygiene can prevent recurrent fungal infections.

Osteoporosis and Type 2 diabetes mellitus are two common chronic conditions with potentially significant impacts on patients' health. Osteoporosis, characterized by decreased bone density and increased fracture risk, is influenced by various factors, including parathormone (PTH) and vitamin D levels. Aim: To study the association between PTH, vitamin D levels and BMD in Type 2 diabetic patients. Material And Methods:This cross-sectional observational study was conducted in the Department of Medicine. A total of 50 participants were included in the study. A semi-structured questionnaire was administered and relevant clinical data was obtained. Result: The results show a statistically significant association between vitamin D status and BMD (p = 0.008). Patients with normal vitamin D levels were more likely to have normal BMD, with 57.14% falling into this category. In contrast, 92.3% of patients with osteopenia and 75% of those with osteoporosis had low vitamin D levels. Conclusion: Low vitamin D levels were associated with a higher prevalence of osteoporosis and osteopenia, particularly in patients with low PTH levels.

Introduction: Injury is defined as physiological damage to living tissue caused due to physical stress. It can be intentionally or unintentionally, caused by blunt and penetrating trauma, burning, toxic exposure, or overexertion. This injury can occur in any part of the body with different symptoms related to different injuries.  Computed tomography (CT) most commonly used diagnostic technique specifically used for organ and tissue damage, whole-body CT is used as a standard diagnostic technique. An autopsy is the final diagnostic examination and is considered a standard diagnostic methods in medicine. The study aimed to compare CT scan results, with autopsy results for forensic purposes. Material and method: The present study was retrospective–a prospective study carried out on 500 injured patients attending OPD of general medicine Patient's informed consent was taken. Their age, gender, cause of injury, different areas of injury, conciseness, unconciseness, death, and complication in conciseness patients were noted. Results: as per the study majority of the patients were male with the age group of 40 – 60 years. The majority of the patients were conscious having vertigo and bleeding, and were injured due to transport accidents. 84 patients having head injury among them brain death was observed in most of the patients having positive results over CT and autopsy technique. Conclusion: A CT scan compared to an autopsy is a good method for detecting gunshot injury of head and bone fractures. Were as the autopsy is better for detecting minor injuries to organs and soft tissues.CT and Autopsy are the best techniques for most injury cases.

Introduction –Sino nasal diseases are a broad category of ailments that include benign and malignant neoplasm as well as inflammatory conditions.Beyond its financial cost, chronic sinusitis has a significant impact on quality of life. The main aim of the study is to assess multi-detector computed tomography's (MDCT) diagnosis accuracy for Sino nasal disorders.

Material and methods: the present study was as prospective study conducted on 50 patients in department of radiology at MNR Medical College & Hospital. Patients underwent CT PNS to evaluate Sino nasal pathologies and incidentally detected PNS lesions on CT brain. The study as carried out over a period of 18 months from September 2019 to March 2021.

Results –The majority of the patients belonged to the 21-30 years of age group (32%) followed by 31-40 years of age (22%). The mean age of patients was 31.06±14.12 years (min.: 6 years; max.: 63 years). Higher female preponderance was observed in our study. The most common clinical presentation of patients was Headache (48%). In our study spectrum of MDCT findings, the most common finding is mucosal thickening, Opacified air sinus, and involved sinus is maxillary sinus followed by anterior ethmoidal, posterior ethmoidal, Sphenoidal, and frontal sinus. In this study distribution of cases with inflammatory etiology most of the cases are simple sinusitis 26 [63%]. Followed by fungal 7 [17%], Sino nasal polyps 3 [8%], and Mucocele 3 [8%] sinusitis with polyps 2 [4%]. 9 cases are neoplastic etiology 5 cases are benign pathology 4 cases are malignant pathology. The most common sinus involved was Maxillary (91.8%) followed by Ant. Ethmoid (81.6%), posterior ethmoid (61.2%), frontal (51%), and sphenoid (42.9%). 46% of patients had Deviated Nasal septum (DNS) - 24% toward the left and 20% toward the left. 33% of patients had concha Bullosa- 14% toward the left; 12% toward the right and 8% toward bilateral. 70% of patients had OMU obstruction; 22% in left; 12% in right and 36% in bilateral. Most of the patients had CT severity grade 4 (36%) followed by Grade 1 (24%); Grade 2 and Grade 3 (18% each). Only 56 histopathology data from patients; 60% had inflammatory causes followed by fungal sinusitis (25%). 28% of patients had Lund MacKay score of less than 5 followed by 16-20 (22%) and 11-15 (20%). Lund-Mackay score. In this study, the final diagnosis in evaluating MDCT has shown 96% sensitivity and 96% specificity in chronic sinusitis. 100% sensitivity and 97% specificity in polyp cases 75% of sensitivity and 100% of specificity in fungal sinus cases. 96 % to 100 % accuracy in evaluating various Sino nasal pathologies. The sensitivity and specificity of CT in diagnosing chronic sinusitis were 98.3% and 97.8% respectively. The sensitivity and specificity of CT in diagnosing fungal sinusitis was 60% and 99.3% respectively. The sensitivity and specificity of CT in diagnosing polyp was 94.4% and 98.1% respectively. The sensitivity and specificity of CT in diagnosing other inflammatory conditions were 90.9% and 99.3% respectively. The sensitivity and specificity of CT in diagnosing benign neoplasm were 90.9% and 99.2% respectively. The sensitivity and specificity of CT in diagnosing malignant neoplasm were 94.1% and 99.3% respectively

Conclusion –MDCT plays indispensable role in detection and diagnosis of various sino nasal lesions. By virtue of its capability of evaluating the detailed normal anatomy and variations, site of origin and extent of a particular lesion and to detect the possible complications, hence act as pre surgical road map. Present scenario MDCT is the best diagnostic modality of choice for evaluation of nasal cavity, paranasal sinuses and for demonstrating for evaluating the chronic diseases and associated complication.