Background:  Lumber puncture is routinely performed by anaesthesiologists for administering spinal anaesthesia. Apart from knowledge of anatomy and technical skill, a pre-puncture estimate of skin to subarachnoid space depth (SSD) may guide spinal needle placement. Present study was aimed to study skin to subarachnoid space depth in various conditions (between males, females, full term parturient, bed ridden for more than 7 days) at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in 200 adult patients of either gender (50 male,50 female,50 parturient,50 bedridden for more than 7 days). Before starting the procedure, the predicted value of SSD was measured and after selection of patient observed SSD measured. Results: There was no statistically significant (p value>0.05) correlation between age, Height, BMI, BSA, Weight between group M, group F, group PF & group B. There was statistically significant difference (p value<0.001) between group M (4.95 ± 0.98 cm) and group F (4.61 ± 1.1 cm) in observed SSD (p value <0.001). There is no statistical significance in predicted SSD in between group M and group F using Abe, Bonadio, Craig, Modified Chong’s Formula (p value>0.05) Predicted SSD by using Modified Chong’s formula showed nearer value (4.96 ± 0.88 cm) to group M (4.95 ± 0.98 cm) and by using Craig’s formula (4.92 ± 0.37 cm) showed nearer value to group F (4.61 ± 1.1 cm). Conclusion: In the overall population skin to subarachnoid space distance depended on BMI as the only variable. Amongst the various formula such as Abe’s, Bonadio’s, Craig’s, Stocker’s and Chong’s modified formulae, Modified Chong’s formula most accurately predicted the SSD when applied to our population.

Background: The patients who are of age 35 or more at the time of delivery are termed as elderly gravida patients. The topic is related to concern as in previous 2-3 decades there is a shift towards advanced maternal age due to multiple reasons and it can result in adverse maternal as well as perinatal outcomes. Also reduced fertility with increasing maternal age is evidenced by decline in ovarian reserve and quality. Materials & Methods: An observational retrospective study participated by 500 pregnant women. These 500 patients are divided into a group of cases consisting of 250 elderly gravida patients who are compared with 250 patients of control group of non-elderly gravida group. Results: A significant difference can be noticed in associated morbidities and mortalities in maternal as well as perinatal context with increasing maternal age. Along with elderly gravida patients are at higher risk of undergoing operative delivery as well. Conclusions: The elderly gravida patients should be considered in high risk group due to possibility of antecedent complications and should be counseled and managed accordingly. For this purpose preconceptional counseling, prenatal diagnosis along with management of labor can play a vital role.

Background: Head and facial trauma constitute a significant portion of emergency medical services (EMS) responses, with the efficacy of pre-hospital interventions playing a critical role in patient outcomes. This study aimed to compare the efficacy of various pre-hospital interventions on mortality rates, hospital length of stay (LOS), and neurological outcomes in patients with head and facial trauma. Methods: A prospective study was conducted involving 100 patients with head and facial trauma, who received pre-hospital interventions such as airway management, hemorrhage control, spinal immobilization, and pain management. Data on mortality rates, hospital LOS, and neurological outcomes were collected and analyzed. Results: The mortality rates varied by intervention type, with airway management (10%), hemorrhage control (9%), spinal immobilization (8%), and pain management (7%). The average hospital LOS was shortest for patients receiving pain management (6 days). Notably, 85% of patients in the pain management group exhibited good neurological outcomes. Multivariate analysis identified specific interventions as independent predictors of improved outcomes. Conclusion: The study highlights the differential impact of pre-hospital interventions on the outcomes of patients with head and facial trauma. Pain management emerged as a particularly effective intervention, associated with lower mortality rates, shorter hospital LOS, and better neurological outcomes. These findings advocate for a tailored approach to pre-hospital trauma care to enhance patient recovery and outcomes.

Background: Surgical site infections (SSIs) remain a significant concern in complex surgeries, leading to increased morbidity and healthcare costs. The effectiveness of prophylactic antibiotic regimens in reducing SSIs incidence in such procedures requires further investigation.Methods: This prospective randomized controlled trial involved 100 participants undergoing complex surgeries, divided into groups receiving either broad-spectrum or targeted prophylactic antibiotics. The study evaluated SSI incidence, the impact of surgical complexity, procedure duration, patient comorbidities, and hospital stay durations. Results: The incidence of SSIs did not significantly differ between the broad-spectrum (16%) and targeted antibiotic (10%) groups (p=0.45). Complex surgeries had a higher SSI rate (20%) compared to less complex (6%) procedures (p=0.03). Significant risk factors for SSIs included age over 60 years (OR=2.3, p=0.03), diabetes (OR=3.5, p<0.001), and surgeries lasting longer than 3 hours (OR=4.0, p<0.001). Patients with SSIs had longer hospital stays (12.4 days) compared to those without infections (6.9 days, p<0.001). Conclusion: The choice between broad-spectrum and targeted prophylactic antibiotics did not significantly influence SSI rates in complex surgeries. The study emphasizes the importance of considering surgical complexity, patient age, comorbidities, and procedure duration as factors in SSI risk management.

Background: Hoarseness affects a significant portion of the population, impacting communication and quality of life. While systemic hydration and dietary modifications have been suggested as management strategies, empirical evidence supporting their efficacy remains sparse. Methods: This prospective study at the District Hospital in Sheopur involved 100 participants with hoarseness, assessing the impact of hydration and dietary interventions over six months. Voice quality was measured using the Voice Handicap Index (VHI) and acoustic parameters pre- and post-intervention. Adherence to interventions was monitored and correlated with outcomes. Results: Post-intervention, significant improvements were observed in VHI scores (from 30 ± 10 to 20 ± 8, p < 0.001) and acoustic measures. A strong correlation was found between high adherence to the prescribed interventions and improvement in voice quality (Spearman's rho for VHI improvement = 0.70, p < 0.001). Despite overall positive outcomes, 10% of participants experienced worsened symptoms, indicating variability in individual responses. Conclusion: The study provides empirical support for the efficacy of hydration and dietary modifications in improving voice quality among individuals with hoarseness. High adherence to the intervention was a key factor in achieving significant voice improvement, emphasizing the importance of patient engagement and tailored support in treatment plans.

Introduction: Head and neck cancer represents a prevalent global health issue, with its incidence varying across different regions and correlating with the presence of risk factors associated with these cancers. This study aimed to assess the prognostic significance of key pre-treatment variables utilized in the evaluation and management of head and neck carcinomas. Materials and Methods: A prospective study was conducted on patients attending the outpatient department. Inclusion criteria comprised biopsy-confirmed non-metastatic carcinomas of the oral cavity, pharynx, and larynx, specifically squamous cell carcinoma histology. Treatment protocols encompassed primary chemoradiotherapy for pharyngeal cancers, followed by salvage surgery. Early oral cavity cancers underwent either surgery alone or surgery followed by adjuvant chemoradiotherapy, while locally advanced disease received surgery followed by chemoradiotherapy. Results: Oral cavity cancers constituted the most common site, followed by hypopharynx, oropharynx, and larynx. The majority of patients presented with locally advanced stage IV and stage III disease. Early-stage head and neck cancers accounted for about 28% of cases. Most lesions exhibited moderately differentiated carcinomas. Conclusion: Stratifying head and neck cancer patients based on specific patient, tumor, and treatment-related variables is feasible. Tumor stage, degree of differentiation, ECOG performance status, treatment-related weight loss, and treatment interruption are identified as prognostic factors influencing survival outcomes.

Background: Acute appendicitis is a common surgical emergency with significant morbidity and mortality rates worldwide. Accurate diagnosis remains challenging, often leading to unnecessary surgeries. This study aimed to assess the presentation and management of acute appendicitis in a tertiary care hospital in Central India. Method: A prospective observational study was conducted in a tertiary care center, involving adult patients aged 18 years and above who underwent appendectomy for suspected acute appendicitis. Clinical parameters, imaging findings, intraoperative assessments, and postoperative outcomes were recorded and analyzed. Results: A total of 300 patients were evaluated, with acute appendicitis being the most frequent emergency surgical procedure. Males predominated, and the mean age was 27.62 years. Abdominal pain was the predominant symptom, and right lower quadrant tenderness was the most common physical finding. Ultrasound was the primary imaging modality, revealing definite acute appendicitis in the majority of cases. Intraoperatively, uncomplicated appendicitis was prevalent. Post-appendectomy complications occurred in 3.8% of cases, with superficial surgical site infection being the most common. Conclusion: Acute appendicitis constitutes a significant burden on emergency surgical services in Central India. Despite challenges in diagnosis, the majority of patients undergo successful appendectomy. Improved utilization of imaging modalities and careful intraoperative assessment contribute to favorable outcomes.

Background:  Because to hypoproteinemia, malnutrition, and inadequate obstetric facilities, the incidence of hypertensive diseases during pregnancy, such as PE and eclampsia, is high in developing nations. MgSO4 is the mainstay of preeclampsia and eclampsia treatment, and the Pritchard regimen is the most often used. Aims: To compare statistically the efficacy of two different preventive Magnesium Sulphate regimes in avoiding eclampsia when administered to 150 severely preeclamptic women at random. The major goal is to compare the two regimes in terms of their safety profile by comparing the adverse feto-maternal consequences when utilized in severe preeclampsia. This should be regarded as the study's secondary goal. Materials and methods: The present study was a hospital-based Retro-spective comparative study. This Study was conducted from 1 year at Department of Obstetrics and gynaecology; Midnapore Medical College and Hospital. Total 100 patients were included in this study. Result: In Group – A, Delivery mode of 16 (32%) patients were vaginal, Delivery mode of 11 (22%) patients were LSCS and Delivery mode of 15 (30%) patients were Live. In Group – B, Delivery mode of  20 (40%) patients were vaginal, Delivery mode of  15 (30%) patients were LSCS and Delivery mode of  6 (12%) patients were Live. In Group – A, 12 (24%) patients had taken time of recurrent convulsion within 5 min, 22 (44%) patients had taken time of recurrent convulsion within 15 min, 9 (18%) patients had taken Time of recurrent convulsion within 1 hour and 7 (14%) patients had taken Time of recurrent convulsion within 4 hour. In Group – A, 21 (42%) patients had taken time of recurrent convulsion within 5 min, 15 (30%) patients had taken time of recurrent convulsion within 15 min, 6 (12%) patients had taken Time of recurrent convulsion within 1 hour and 8 (16%) patients had taken Time of recurrent convulsion within 4 hour. Association of Time of recurrent convulsion (interval after loading dose) with Group was not statistically significant (p=0.2172). In Group – A, 33 (66%) patients were in control group and 17 (34%) patients were in study group. In Group – B, 22 (44%) patients were in control group and 28 (56%) patients were in study group. Association of Recurrence of convulsions with Group was statistically significant (p=0.027). Conclusion: We conclude that efficacy of reduced loading dose regimen (omitting IV loading dose) and 12 hour maintenance dose of MgSo4 is similar to standard Pritchard regimen (which employs full loading dose and 24 hour maintenance dose) in both prophylaxis of convulsion in severe preeclampsia and controlling convulsion and preventing recurrent convulsion in eclampsia with the obvious lower propensity for MgSo4 toxicity.

Background:  The rising incidence of stroke in young individuals has garnered attention, yet data disparities persist. This study aims to investigate stroke cases among communities in the Ganjam district of Odisha, considering the unique ethnic composition of the region.   Methods:  A retrospective hospital-based study was conducted at MKCG Medical College and Hospital, spanning February 2019 to February 2020. Inclusion criteria encompassed patients meeting the WHO stroke definition. Demographic, clinical, and diagnostic data were collected, including neuroimaging and comprehensive risk factor assessments.  Results:   Of 370 stroke cases, 32.4% were young individuals (n=120), with a mean onset age of 33 years and a male preponderance (1.5:1). Cerebral infarction was predominant (50.8%), primarily atherosclerotic (52.4%). Alcohol abuse (68.8%) and smoking (44.3%) were significant risk factors. Intracerebral hemorrhage constituted 41.6%, predominantly affecting the basal ganglia (71.4%), with alcohol abuse as a major risk factor. Subarachnoid hemorrhage and cerebral venous thrombosis occurred in 4.2% and 3.1%, respectively, with distinct gender patterns and risk factors. Conclusion:   Stroke in individuals necessitates tailored investigative approaches, considering the diversity in etiology and risk factors. Beyond traditional risks, the study underscores the importance of addressing modifiable factors, especially alcohol consumption. Comprehensive population-based studies are essential to understand stroke patterns in diverse populations.

Background:   Traumatic brain injury is still and will be a major cause of mortality and morbidity in India. Day by day there is an increase in motor vehicles and road traffic accidents in India. Epidemiological studies that are conducted regularly shall be useful for policy making, deployment of roadside assistance, and formulating preventive measures for traumatic brain injuries. Methods:  In this retrospective study, all the traumatic brain injuries admitted to Department of Neurosurgery, Guntur medical college during January 2023 to December 2023 are studied.  Results: Among 924 patients admitted with traumatic brain injury, the most susceptible age group was found to be the 31–40-year group. 2.The male gender is a susceptible gender group with a ratio of 6.22: 1 compared to females. 3.Road traffic accidents [RTA] is the most common mode of traumatic brain injury. Conclusion:  This is a study conducted at a district headquarters medical college level with radial population habitation and highway proximity. It has both urban and rural populations in its catering area. Regular and multicentric studies will provide comprehensive and distinctive data about the epidemiology of traumatic brain injuries in this vast subcontinent of India.

Background:   This study seeks to evaluate the accuracy and reliability of bronchoscopy in confirming the correct positioning of double-lumen endotracheal tubes (DLTs) in patients undergoing thoracic surgery. Accurate DLT placement is crucial for lung isolation. This research employs bronchoscopy as a diagnostic tool to validate DLT positioning and assess its effectiveness in clinical practice. Methods:  Our study included 30 adult patients undergoing thoracic surgery, which required the use of left-sided double-lumen endobronchial tubes. Anesthesia was induced with propofol, fentanyl, and midazolam as per body weight. Neuromuscular blockade was achieved with vecuronium and patients were ventilated with oxygen for 3mins. The adequate size of the left-sided double-lumen endobronchial tube (Portex sizes 35, 37, 39, and 41) was introduced. Confirmation of DLT placement was assessed initially by auscultation of the desired side of the lung by isolating it, capnography, and movement of the chest wall. Also, moisture during exhalation in the transparent proximal limb of DLT and on the catheter mount was noted. Results:   Among 30 patients studied 9 were females and 21 were males. Surgery performed included 10 Lobectomy, 2 Pneumonectomies, 1 Tumor excision, 14 Decortication (in Tubercular Cases), 1 Diaphragmatic Plication, 1 hydatid Cyst Excision, 1 Fungal Ball Removal. Among all the above patients Right Thoracotomy was performed in 19 patients and 11 had left thoracotomy. In all the patients studied left left-sided double-lumen tubes (DLT) (Sizes- 35, 37, 39, 41 fr) were used. Of the sample studied (30 Patients), 9 were female and 21 were males. Out of 30 cases studied desired lung isolation was achieved in 26 cases on clinical evaluation (auscultation and chest expansion), in 4 cases DLT was not giving satisfactory results on clinical evaluation and DLT was repositioned properly using the bronchoscope. Conclusion:   Bronchoscopy emerged as an invaluable tool in our study, enabling visualization of key anatomical landmarks and identification of complications such as bronchial cuff herniation and deep tube placement. Prompt intervention under direct vision allowed for the correction of these issues, ensuring proper tube placement and minimizing the risk of complications such as inadequate lung isolation or airway trauma.

Background:   Macrocytosis, characterized by abnormally large red blood cells (RBCs), often indicated by elevated Mean Corpuscular Volume (MCV) in complete blood count (CBC), is a significant hematological finding. Diverse underlying pathologies, including megaloblastic and non-megaloblastic etiologies, contribute to macrocytosis. Understanding these causes is crucial for tailored management strategies. Aim:  This study aimed to delineate macrocytic anemia into megaloblastic and non-megaloblastic subtypes through comprehensive hematological and biochemical analyses. Additionally, it sought to evaluate distinctive hematological features among different etiologies in macrocytic patients.  Methods:  A prospective observational study was conducted from January 2021 to November 2021 at MKCG Medical College and Hospital, Odisha, India. 350 adult patients with MCV ≥ 100 fl were enrolled, and comprehensive hematological and biochemical analyses were performed. Patients were categorized into megaloblastic and non-megaloblastic groups based on identified etiological factors.  Results:   Of the enrolled patients, 162 (46.29%) were diagnosed with megaloblastic anemia, while 188 (53.71%) presented with non-megaloblastic macrocytosis. Significant differences were observed in various hematological and biochemical parameters between the two groups. Excessive alcohol intake was the most prevalent etiology among non-megaloblastic macrocytosis cases. Discussion:  The study highlights the importance of evaluating macrocytosis, even in the absence of anemia, emphasizing thorough assessment for accurate diagnosis. Megaloblastic anemia was primarily associated with deficiencies in vitamin B12 and folate, while non-megaloblastic macrocytosis had diverse underlying pathologies, including liver diseases and alcohol consumption. Conclusion:   Comprehensive evaluation of macrocytosis is essential for accurate diagnosis and management. Further research is warranted to optimize diagnostic strategies for this clinically significant condition.

Background:  Constipation is a common problem after surgery for anorectal malformations (ARMs), especially in patients having preserved rectosigmoid after pull-down surgery. Here, we present our experience with patients having constipation after surgery for ARMs and briefly discuss its management.  Methods:  This was a retrospective observational study done in the department of General Surgery in a tertiary medical college from 2018 to 2022 on patients of anorectal malformations.  Results:  A total of 154 patients were included in the study. The median age was 5 years, and 60 were male. Primary diagnoses were rectourethral fistula (52; 33.77%), vestibular fistula (50; 32.47%), perineal fistula/ectopic anus (36; 23.38%), rectovaginal fistula (8; 5.19%) and imperforate anus without fistula (8; 5.19%). Anal stenosis was found in 40 (25.97%) patients, posterior ledge with an adequate anal opening in 10 (6.49%), displaced anus in 8 (5.19%) but no obvious problem found in 96 (62.34%) patients. Non-operative management was successful in 75.44% (86 out of 57) of patients. Surgery was performed in 64 out of 154 patients (41.56%) with no mortality. 86 (72.88%) patients are continent, stayed clean, but 32 (27.19%) patients still need some sort of laxative/bowel wash/enema intermittently (Grade I/II constipation). Incidence of constipation was higher in patients operated through anterior sagittal route (27.58%) than posterior sagittal route (23.94%), but it was not statistically significant (P = 0.5). Follow-up ranged from 3 months to 5 years. Conclusion:   Constipation is a common problem after ARMs surgery, especially in patients having preserved rectosigmoid after pull-down surgery. It is advisable to create relatively larger neoanus after pull through with early practice of neoanus dilatation, especially in redo cases. Repeated counselling, laxatives and dietary manipulations should begin at the first sign of constipation.

Background:   Out of 108 paediatric traumatic brain injuries admitted from January 2023 to December 2023, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Aim:  To find out the prevalence of early post traumatic seizure in pediatric traumatic brain injuries despite phenytoin prophylaxis. Methods:  In this prospective study all the paediatric traumatic brain injuries admitted to department of neurosurgery, Guntur medical college during 1st January 2023 to 31 st December 2023 are studied.  Results:   Among 108 patients admitted with traumatic brain injuries, only 3 patients have early post traumatic seizures who had received phenytoin prophylaxis. Conclusion:   This is a study conducted at a district headquarter medical college level with radial population habitation and having highway proximity. Its having both urban and rural population in its catering area. Regular and multicentric studies will provide comprehensive and distinctive data about the usefulness of prophylactic phenytoin in prevention of early post traumatic seizures in traumatic brain injuries in this vast subcontinent of India.

Background:  Acute pancreatitis (AP) is a condition with variable outcomes, necessitating reliable markers for early severity assessment. This study aimed to evaluate the concordance of serum C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels with the CT Severity Index (CTSI) in assessing AP severity.   Methods: In a prospective longitudinal study, 55 patients diagnosed with AP were enrolled. Serum CRP and LDH levels were measured upon admission and 48 hours later, and CTSI scores were calculated based on CT findings. Statistical analyses included correlation coefficients, predictive value assessments, and multivariate logistic regression.  Results:  The mean age of participants was 45 ± 14 years, with severe AP observed more frequently in older patients (50 ± 12 years, p=0.045). Serum CRP and LDH levels showed strong positive correlations with CTSI (r=0.72, p<0.001, and r=0.68, p<0.001, respectively). CRP ≥150 mg/L and LDH ≥500 U/L had high sensitivity (85% and 80%, respectively) and specificity (80% and 75%, respectively) for predicting severe AP. Multivariate analysis identified age >50 years, CRP >150 mg/L, and LDH >500 U/L as significant predictors of severity. Elevated biomarkers were associated with longer hospital stays, higher ICU admissions, and increased mortality rates. Conclusion:  Serum CRP and LDH levels are valuable in assessing the severity of AP, demonstrating significant concordance with CTSI. These biomarkers, alongside clinical assessments, can enhance early severity prediction and guide management strategies.

Mondor's disease of the breast is a rare superficial thrombophlebitis, which manifests as an indurated, tender cord in the breast, often after trauma or breast surgery. The diagnosis is mainly clinical, but imaging can be useful to confirm it, clarify it and look for a possible underlying cause, including breast cancer. We report the case of a 73-year-old woman, who presented with Mondor's disease of the right breast, which occurred suddenly. Ultrasound showed a thrombosed vein, with no evidence of associated breast neoplasia. The mammogram was subnormal. Treatment was symptomatic, with analgesics and anti-inflammatories. The evolution was favourable, with the cord disappearing within three months. This case illustrates the value of imaging in the management of Mondor's disease of the breast, which should suggest the differential diagnosis of breast cancer, especially in women at risk.

The care associated with the therapeutic course of the cancer patient must imperatively meet the rules of safety and above all comfort, for a patient population that is particularly fragile on a physical and psychological level. Our work will highlight the benefit of combining ultrasound guidance and ambulatory sedation, for the establishment of an implantable port for patients with active neoplasia. A series of 23 patients was collected in the Intensive Care Department of Bejaia University Hospital. The patients are referred by the medical oncology team for the installation of an implantable port for IV chemotherapy. The protocol consists, after verifying its feasibility, of preparing the patient. Simplified explanation of the procedure, Installation of equipment with monitoring, Titrated ambulatory sedation, based on ketamine associated or not with midazolam, Local anesthesia based on injectable lidocaine, placement of the implant after ultrasound-guided catheterization. End of the procedure, dressing and resumption of contact of the patient with his companion. This protocol made it possible to optimize the use of awake sedation drugs, putting the patient in comfort and making the procedure safer by ultrasound guidance. The initiation of this new protocol in adults with very satisfactory results for permanent implantable venous access, will open the door for the care of the pediatric population, for the establishment of implantable catheter ports in complete safety.

Background:   Ultrasound-guided costoclavicular block (CC-approach), an alternative approach to the supraclavicular approach (SC-approach), is a recently described brachial plexus block (BPB). Successful brachial plexus blocks always rely on proper techniques of nerve localization, needle placement and local anesthetic injection.  The relevant Sono anatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In the present study, we aimed at comparing the efficacy of supraclavicular brachial plexus block versus costoclavicular brachial plexus block for forearm and hand surgeries for providing surgical anesthesia by evaluating the time of onset of sensory and motor blockade, nerve sparing effect and duration of analgesia in both the groups.   Methods:  Sixty patients with ASA physical status 1, 2 and 3 undergoing forearm and hand surgeries were taken up for the study. Sixty patients in Group SC (n=30) and Group CC(n=30) received 20 ml 0.5% levobupivacaine by ultrasound guided supraclavicular and costoclavicular BPB respectively. The primary outcome of the study was the time of onset of sensory and motor blockade. Secondary outcome included nerve sparing effect, duration of analgesia and rescue analgesia if used any.  Statistical analysis was done with student-t test, unpaired t-test and Fisher exact test. Results:  In our study, onset of sensory blockade (9.33 ± 2.41 mins vs11.4 ± 2.989 mins) and onset of motor blockade (11.1± 2.35 mins vs 13.3± 2.87mins) were significantly shorter in group CC when compared to group SC. We did not find any nerve sparing effect in both the groups unlike other studies. Duration of analgesia (10.23±3.013 hours vs 10.56±2.35 hours) and requirement of rescue analgesics were comparable in both the groups. Conclusion:  We conclude that ultrasound guided costoclavicular brachial plexus block has shorter procedural time and rapid onset of sensory-motor blockade when compared to supraclavicular brachial plexus block. In addition, it (costoclavicular approach) may provide a promising alternative technique when considering the use of multipoint injection.

Diabetes Mellitus is fast gaining the status of a potential epidemic in India with more than 65.1 million diabetic individuals currently diagnosed with the disease.

The relationship between dyslipidemia and vascular complication of diabetes has long been of interest because both tend to occur with greater frequency in Type 2 DM. Apolipoprotein B is the principal moeity of LDL, IDL, VLDL and Lpa. Its concentration is thus a good estimate of total mass of atherogenic particles.ApoB has been associated with increased risk of microvascular disease in Type 2 Diabetes patients. Hence, present study is undertaken to study Apolipoprotein B and dyslipidemia in diabetic patients and its relation with proteinuria.

Objectives:

a.      To estimate the fasting lipid profile and ApoB levels in Type 2 Diabetes Mellitus.

b.     To correlate between ApoB levels and dyslipidemia in Type 2Diabetes Mellitus patients with proteinuria

Methods: The Study is a Hospital based cross sectional age-sex matched study conducted between November 2019 to December 2021 in hospitals attached to BMCRI.Patient’s history, vital parameters were obtained. Serum fasting lipid profile with Apolipoprotein values, renal parameters, urine ACR and blood sugars were determined. Microvascular complications of diabetes mellitus were studied and nephropathy was correlated with dyslipidemia and ApoB values. Results: In this study, 80 diabetic patients were enrolled, their serum Apolipoprotein levels and fasting lipid profile were correlated with Urine Albumin Creatinine ratio and Diabetic Retinopathy. The age distribution varied from 25 years to 78 years and majority of patients fell between 43-67 years of age. Majority of the patients were females (53.75%). The mean value of HbA1c was recorded to be 10.23±3.20. Average values of TC, TG, LDL, VLDL, HDL of the study population were 166.70±53.51mg/dl, 185.50±88.77 mg/dl, 94.72±35.78 mg/dl,  48.11±27.10 mg/dl, and 37.62±19.38 mg/dl respectively. In our study, the increasing trend of TC, TG, LDL and VLDL with increasing severity of proteinuria was observed. Further correlation test revealed a positive association of ApoB with ACR(r=0.32;p value=0.004).Correlation test between lipid profile parameters and ApoB showed a significant correlation of ApoB with all the parameters. Positive linear correlation of TG and LDL as well as negative correlation of HDL with ApoB was reported. It was found that there was a significant increase of HbA1c and ACR as the DR progressed from normal to severe proliferative form. Interpretation and Conclusion: This study demonstrates the direct association between ACR levels with lipid profile parameters TC, TG, LDL and VDL. ACR values were also found to positively correlate with ApoB and negatively correlate with HDL. Our study demonstrated a direct correlation of ApoB and dyslipidemia (increased TC and decreased HDL) with proteinuria. It was also evaluated that ACR and HbA1c levels directly impacted the fundoscopy outcome of patients with T2DM.  From our study we conclude that in type 2 diabetes patients, dyslipidemia and increased ApoB levels have an impact on predicting the likelihood of developing and progressing Diabetic nephropathy.

Background: Analgesics and antimicrobial agents are commonly prescribed drugs in dental patients. Therefore, monitoring their use and adverse reactions is very important. Aims and Objectives- To evaluate the prescription patterns and associated adverse drug reactions of analgesics and antimicrobial agents in dental patients. Materials and Methods: This is an observational study conducted in a tertiary care centre in northern India from July 2022 to September 2022. The study assessed a total of 100 prescriptions from dental practitioners. The majorities of patients visiting were in the age group of 21-30 years. The standard ADR reporting forms of CDSCO were used to record all adverse events experienced by the patients. Adverse drug reaction’s causality assessment was done using Naranjo’s Scale and the severity assessment by Modified Hartwig & Siegel scale. Results: The majorities of patients visiting the dental practitioners were males (53%) and the most common dental infections for which antimicrobials and analgesics prescribed were acute/chronic Caries (33%), acute/chronic Periodontitis (30%), Pericoronitis (19%), Periapical abscess (4%), Post RCT (5%), Trismus (2%), Sialadenitis (1%), Post operative TMJ ankylosis (1%), Oral Cancer (1%), Oroantral Fistula (1%), Ameloblastoma of jaw (1%), Cellulitis (2%) .  The antimicrobials most frequently used for management of the observed conditions were Amoxycillin + potassium clavulanate(67%), Cefixime (27%), cefixime + clavulanic acid (2%), Ceftriaxone (inj.) (1%), Amikacin sulphate (1%), Metronidazole (2%) and the most common Analgesics prescribed were Aceclofenac + paracetamol (71%), Paracetamol (5%), Diclofenac sodium(23%), Dynapar AQ (1%) Out of 100 patients, 19 reported adverse drug reactions (ADRs), and out of 19 patients with ADRs, 52 different types of adverse drug reactions were reported. Conclusion: Our findings suggested caries as the most frequently reported conditions for which Antimicrobials and Analgesics were prescribed. Amoxicillin+ Potassium Clavulanate followed by cefixime was the most commonly used antimicrobials. 19% patients reported ADRs of which nausea and diarrhea were most frequent.

Background: The perforating artery aneurysm arising from stem of perforating artery away from parent artery should be considered separate entity from those arising from parent artery in the adjacent to their origin or incorporating their origin.  Case report: A 34 years old, right-handed gentleman, presented to with multiple episodes of right sided facial and extremity tingling numbness and minimal weakness of extremities, episodes lasted for few minutes to maximum of 30 minutes. On examination there was no neuro deficit with all other vital parameters within normal limits. CT scan & MRI examination showed perimesencephalic cisren and suprasellar cistern SAH. Digital Substraction Angiography showed Aneurysm on the basilar top perforator. Very tiny perforator artery arising from basilar top is harbouring the aneurysm distally. It was decided to conserve this patient. Patient fully recovered over a period of 2 weeks. Repeat angiogram after 6 weeks showed complete resolution of the aneurysm. Conclusion: A conservative approach may be considered for selected cases where potential atherosclerosis is not present and where consecutive imaging shows a decrease in size and flow of the aneurysm. The surgical approach can be considered the next best mode of management Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.

Background:  Human coronaviruses can be divided based on their pathogenicity. The types with high pathogenicity including SARS-CoV, MERS-CoV, and the current novel SARS-CoV2. SARS COV2 has led to possibly the worst pandemic of this century in the form of Coronavirus disease 2019 (COVID-19). Initially recognized as a respiratory system disease, COVID-19 has been found to interact with functions of other organ systems like cardiovascular, GIT, CNS  Peripheral nervous system, during the course of the disease and postcovid syndromic manifestations including Endocrinal and psychological. The acute manifestations primarily lung will be involved that leads to ARDS, in severe disease all the organs will be effected that may lead to multiorgan dysfunction (MODS), and death. AIM: Evaluation of various endocrinal manifestations secondary to endocrinal gland dysfunction, in COVID 19 peak of the pandemic causing morbidity and mortality. In this COVID 19 pandemic everywhere the mortality was very high, the researchers and all over the globe thought that this is not only viral invasion or host’s immune mediated of it’s not due to viral virulence and postulated the actual pathogenesis of the disease and its manifestations causing morbidity and mortality. Some patients with coronavirus disease 2019 (COVID-19) develop a life-threatening hyper-inflammatory state that is commonly referred to as cytokine storm. This is the prime cause of all the syndromes presenting in this SARS COV2. The mortality has been increasing and new biochemical parameters are increasing in moderate to severe disease.

Introduction and Aim: Sub-arachnoid blockade with addition of adjuvants such as Dexmedetomidine and Fentanyl is needed in arthroscopic knee procedures for prolongation of intraoperative and postoperative analgesia and improvement of block characteristics. The purpose of this study was to compare the time of onset of sensory and motor block, duration of spinal anaesthesia and hemodynamic effects between Group BD (Bupivacaine+Dexmedetomidine) and Group BF (Bupivacaine+Fentanyl) in adult patients undergoing elective arthroscopic knee procedures for sports injuries. Methods: Sixty patients of ASA I & II of either sex and age between 18-50 years of age were randomly allocated into two groups (30 patients each). Group BD received 12.5mg Bupivacaine plus 5µg prediluted Dexmedetomidine and Group BF received 12.5mg Bupivacaine plus 25µg Fentanyl. Time of onset of sensory and motor block, duration of spinal anaesthesia and hemodynamic effects were compared between two groups. Results: Patients in two groups were similar in terms of demographic profiles & ASA classification. The onset of sensory and motor blockade was faster in Group BD than Group BF & was statistically insignificant. (Sensory:4.62±1.52 vs 4.82±1.03 minutes and Motor: 5.52±1.4 vs 5.62±1.01 minutes; p>0.05) Duration of spinal anaesthesia was significantly longer in Group BD than Group BF (301 ± 18.4 vs 230.6 ± 11.2 minutes; p< 0.0001). The mean values of mean arterial pressure (MAP) and heart rate (HR) were comparable between two groups throughout intraoperative period. Both adjuvants are clinically relevant in regional anaesthetic practice with minimal adverse effects after careful selection of patients. Conclusions: In our study, Intrathecal Dexmedetomidine is associated with faster onset of sensory and motor blockade, prolonged duration of spinal anaesthesia and comparable hemodynamic stability as compared to Intrathecal Fentanyl.

Aims: To assess whether the expression of ER/PR/HER 2 status changes between the pre-operative biopsy specimen and post operated specimen in response to neoadjuvant chemotherapy in breast cancer patients. Materials and Methods: It is Comparative prospective study in 50 patients of breast cancer who visited to out patients department for treatment with neo adjuvant chemotherapy from one year were taken up.  Patients of age 18 -80years of age, ECOG less than I-III, Pathologically proven breast cancer (infiltrative ductal cell carcinoma) (IDCC) were included in study. A Structured form with the details like Age, tumour size, grade, nodal status, Stage and other details like oestrogen receptor, progesterone receptor status were noted. Results: Only 41 patients were available with residual tumour tissue in their post-operative histo-pathological reports which are assessed for ER/PR/HER 2 status. In this study total 36.6% patients were hormone receptor positive (either ER+VE or PR+VE), 63.4% patients were hormone receptor negative before neo adjuvant chemotherapy and after chemotherapy 31.7% patients were hormone receptor positive and 68.3% hormone receptor negative in which 17% patients have changed from HR+VE to HR-VE and 12% have changed from HR-VE to HR+VE with hormone receptor conversion rate of 29.26%. Before taking neo adjuvant chemotherapy 22% patients were progesterone receptor positive,78% patients were progesterone receptor negative and after chemotherapy 17.1% patients were progesterone receptor positive, 82.9% were progesterone receptor negative of which 9.76% patients change from PR+VE to PR-VE and 4.88% patients change from PR-VE to PR+VE with a concordance rate of 85.37% and discordance rate of 14.63%. Conclusions: There is high chances of change is receptor status before and after neoadjuvant chemotherapy so it advisable to check ER/PR/HER status in post neoadjuvant resected specimen. It is better to do re biopsy from the metastatic site and repeat IHC with ER/PR and HER-2 assay.

BACKGROUND This study was conducted to assess the contribution of MDCT (Multi-Detector Computed Tomography) contrast-enhanced coronary angiography to the clinical classification of benign and malignant coronary artery variations and abnormalities.  METHODS This was a descriptive observational cross-sectional study carried out in a hospital setting among 200 patients who underwent MDCT coronary angiography at Fortis Hospital, Noida, between August 2016 and March 2018. The institutional ethics committee approved the study, and participants' signed informed consent was acquired. RESULTS Of the 200 patients in our investigation, 76 had variants, accounting for 38% of the cohort. These variants included variations in the dominance pattern (20%), conus branch variants (3%), SA nodal branch variants (0.5%), and ramus intermedius variants (14.5%). In terms of origin and course anomalies, LAD (Left Anterior Descending) and LCX (Left Circumflex Artery) have different origins and there is no LMCA (Left Main Coronary Artery). Two individuals in our sample had ectopic LMCA at the level of the sino-tubular junction and above the junction with the retroarterial and interarterial courses, while one patient had missing LMCA. Two percent of the population had an anomalous origin from the opposite coronary sinus (n = 1). CONCLUSION With MDCT coronary angiography, coronary artery variations and anomalies are most accurately detected. With MDCT angiography, a number of malignant anomalies that are challenging to diagnose by ICA can be quickly found. When a patient is having interventional procedures like cardiac catheterization, coronary angioplasty, and stenting, having prior knowledge of various defects is helpful.

Introduction:  Yoga is a spiritual discipline based on an extremely subtle science, which focuses on bringing harmony between the mind and the body. Aim: To study effect of nadisuddhi pranayama on heart rate and blood pressure. Methods: conducted on 25 Male volunteer of 18 to 25 years in the Department of Physiology, Dr. S.N. Medical College and Hospital, Jodhpur. The procedure of each and every test was explained to the cases before conducting the tests. Detailed history including personal history, drug history and past medical history was taken and recorded in a prefixed questionnaire. Results: 50 subjects with mean age of 32.12 ± 1.94 yr,  there is a decrease in resting heart rate, SDNN, RR, and increase in RMSSD, NN50, pNN50, after the practice of Nadisuddhi pranayama, decrease in LF/HF after the practice of Nadisuddhi pranayama and this decrease is statistically significant.  there is a decrease in SBP and DBP after the practice of Nadisuddhi pranayama and this decrease is statistically highly significant. Conclusion: Long term practice of yoga shows beneficial effects and prevents the occurrence of cardiovascular diseases.

Aim:To estimate prevalence of Diabetic retinopathy in patients with Diabetic nephropathy in Type 2 Diabetes Mellitus patients in a tertiary care centre. Material and Methods: Our study, conducted from January 1, 2020, to June 30, 2021, at Sri Guru Ram Das Institute of Medical Sciences, Sri Amritsar, was designed to assess the prevalence and grading of diabetic retinopathy among patients with Type 2 diabetes mellitus diagnosed with nephropathy. This study included patients from both inpatient and outpatient departments. Fundus photography and the grading of diabetic retinopathy were conducted as per the Early Treatment Diabetic Retinopathy Study classification. Individuals with Type 1 diabetes, nephrotic syndrome, those on glucocorticoids, with urinary tract infections, chronic kidney disease stages 4 and 5, and hypertensive patients were excluded. Results: Out of 139 patients 6.47%(n=9) patients were  having mild Non Proliferative diabetic Retinopathy, 11.51%(n=16) were having moderate Non proliferative diabetic retinopathy, 12.23%(n=17) were having severe Non proliferative diabetic retinopathy and 3.5%(n=5) were  having proliferative diabetic retinopathy. In 9 patients having mild non proliferative diabetic retinopathy,  mean duration of diabetes  was 9.6+3.2 years, 16 patients were having moderate non proliferative diabetic retinopathy , mean duration of diabetes was 10.5+2.3 years, 17 patients having mean duration of diabetes between 13.9+2.2 years were having severe non proliferative diabetic retinopathy and 5 patients having mean duration of diabetes between 15.2+2.7 were having proliferative diabetic retinopathy and  correlation between duration of diabetes and retinopathy was statistically significant.(p=0.001)  Conclusion: The analysis revealed a statistically significant correlation between the duration of diabetes and the presence and severity of retinopathy (p=0.001) .

The primary objective is to compare the efficacy of oral Melatonin and Oral Zolpidem on perioperative anxiety in surgeries done under regional anaesthesia. Secondary objectives of the study were to compare the effects of the two drugs on intraoperative and postoperative sedation. Materials and Methods:  A randomized double blinded study performed in department of Anesthesiology in Chettinad hospital and Research Institute from July 2022 to October 2022 on sixty patients undergoing surgeries under spinal or epidural anesthesia where they were allocated into two groups by computer generated randomization, Group Z – Tab. Zolpidem 10 mg and Group M – Tab. Melatonin 6 mg per oral. Approximately an hour after the administration of the study drugs were given, VAS A score and the Amsterdam Preoperative Anxiety Scale (APAIS) was used to measure preoperative anxiety. Intraoperative and postoperative sedation was measured using Ramsay sedation score. Results: The pre-operative APAIS score were comparable between the two groups (p value 0.979). There were no statistical significance found between the two groups in the pre- operative and post-operative Ramsay sedation scores. Conclusion: Our study concludes that the effects of oral Zolpidem and Oral Melatonin on anxiolysis and sedation were comparable.

Arch of aorta is the continuation of ascending thoracic aorta which lies in the superior mediastinum. It normally gives off three branches they are brachiocephalic trunk, left common carotid artery & left subclavian artery. Abnormal branching patterns are common in arch of aorta. The knowledge about it is very important since there is a recent increase in cardiac & vascular surgeries around the arch of aorta. It is important for us to study the various branching pattern of arch of aorta to give useful details to radiologists,  surgeons & anatomists. AIM & OBJECTIVES: To study the variations in the branching pattern of Arch of aorta and to correlate it with the embryological basis of development of aortic arch arteries. MATERIALS & METHOD: A cross-sectional cadaveric study involved 50 cadavers both male & female, which were used for routine dissection for 1^styear MBBS students in the department of anatomy, Kanyakumari Government Medical college, Asaripallam. RESULT: The arch of aorta was normal in 43 of 50 cadavers. In 7 cadavers it showed variations in branching pattern. 3 types of variations were noted, among that one type is very rare. Variations and incidence were discussed clearly in detail. CONCLUSION: Knowledge about the different branching pattern of Arch of aorta is essential during angiography, aortic, thoracic & neck surgeries.

Background: Tuberculous pleural effusion represents a significant manifestation of extrapulmonary tuberculosis, with pleuritic chest pain being a common symptom that affects patient quality of life and treatment outcomes. Methods: This retrospective study analyzed 100 patients with tuberculous pleural effusion undergoing antitubercular treatment at a tertiary care teaching hospital. Data on demographic and clinical characteristics, treatment outcomes, and the prevalence of pleuritic chest pain were collected and analyzed. Results: The study found that 82% of patients presented with pleuritic chest pain, which significantly reduced to 8% by the end of treatment. The majority of patients were males (57%), with a mean age of 37.46 ± 14.2 years. Malnutrition was prevalent, with 44% of patients having a BMI of less than 18.5 kg/m^2. Fever (93%) and cough (72%) were the most common symptoms at presentation. Treatment outcomes were positive, with 94% of patients completing treatment.Conclusion: The significant reduction in pleuritic chest pain highlights the efficacy of antitubercular treatment. The study underscores the importance of addressing nutritional needs and monitoring for potential drug resistance, especially in patients with persistent symptoms. Future research should focus on the comprehensive care approach, including the role of adjunct therapies in managing TB pleural effusion.

Objectives: Tuberculosis of the prostate is an extremely rare disease. Even most of the urologists are not familiar with it. But in backdrop of covid pandemic, we have encountered 5 such cases in last 3 years which are reported here and the literature reviewed in this context. Methods: This was a retrospective study carried out in a tertiary care centre from December 2021 to December 2023. Results: All the patients were in their fourth or fifth decade of life. Irritative voiding (100%) followed by haematospermia (50%) were the common presenting symptoms. A history of pulmonary tuberculosis was absent in 4 cases. All patients had positive history of Covid 19 infection in last 6 months. 80% (4 out 5) had a suspicious prostate on the digital rectal examination. PSA assays were slightly elevated with a mean of 8.35 ng/ml. Urine analysis revealed sterile pyuria in all patients, and the urine culture was negative. The urine and seminal fluid positivity rate was 40% for the microscopy of AFB , 80% for the M. tuberculosis culture test, and 100% for PCR. The transrectal ultrasonogram showed hypoechoic areas with irregular outlines in 3 cases (60%) and calcification in 3 cases (60%). All patients were scheduled to receive 6 months of chemotherapy with Isoniazid, Rifampicin, and Ethambutol or Pyrazinamide. Conclusion: A high index of suspicion of Tuberculosis of prostate is required in patients presenting with haematospermia. An upsurge in cases may been seen after covid pandemic and therefore a wide range of investigations may be required to achieve a complete diagnosis of prostatic tuberculosis. Although short-term multi-drug chemotherapy is the mainstay of treatment and it has excellent outcome.

Background: Allergic rhinitis (AR) is a recurrent, chronic condition with a substantial impact on health and quality of life. The debate persists on whether antihistamines or intranasal corticosteroids constitute the first-line treatment for AR. This study aims to compare the efficacy of fluticasone + azelastine nasal spray and levocetirizine tablets in AR treatment. Objectives: The study clinically evaluates the effectiveness of the two regimens in relieving symptoms and compares their overall efficacy in treating allergic rhinitis. Materials and Methods: Patients at a tertiary care hospital were included, with 100 individuals aged 12 to 65 randomized into two groups receiving either fluticasone + azelastine nasal spray or oral levocetirizine for four weeks. Symptom assessment, clinical examination, and laboratory investigations were conducted, with patients maintaining a daily symptom journal. Results: The fluticasone + azelastine group showed a significant reduction in individual symptom severity compared to the levocetirizine group (p<0.01). Symptom scores in the fluticasone + azelastine group decreased by 99-100%, exceeding the 90-91% reduction observed in the levocetirizine group. Except for nasal itching, other symptoms were significantly reduced in the fluticasone + azelastine group. Levocetirizine demonstrated a faster onset of effect compared to fluticasone + azelastine. Conclusion: Fluticasone + azelastine nasal spray is more effective than oral levocetirizine in treating AR. This finding supports the consideration of intranasal corticosteroids as a primary therapeutic approach for allergic rhinitis.

Background This study was conducted to determine the serum magnesium concentration in people with diabetes mellitus and evaluate as to how it relates to both micro and macrovascular problems. Methods After receiving approval from the institutional ethics committee and signed informed consent from study participants, a hospital-based prospective study was carried out among 100 consecutive patients with a documented history of diabetes mellitus who were admitted to the General Medical Ward of Kilpauk medical College hospital between November 2021 and June 2023. Results The prevalence of hypomagnesemia was higher in older patients. For age distribution and magnesium levels, the chi-square test of the relationship was significant (x2 = 16.11, p = .001). Hypomagnesemia was 100% prevalent in neuropathy patients. The correlation was significant according to the chi-square test (x2 = 6.25, p = 0.12). By using the chi-square test for statistical analysis, it was discovered that there was a substantial (p = 0.001) correlation between hypomagnesemia and retinal degeneration in patients with diabetes. The statistical significance of the relationship between hypomagnesemia and nephropathy in diabetic patients was determined by a p-value of 0.001. With a 'p' value of 0.019, the relationship between hypomagnesemia and IHD in diabetic patients was shown to be statistically significant. Conclusion Patients with hypomagnesemia were more likely to experience side effects, including nephropathy, retinopathy, and neuropathy. Compared to patients with non-proliferative diabetic retinopathy (62.9%), those with proliferative diabetic retinopathy have a prevalence of hypomagnesemia of 83.3%. Individuals with macroalbuminuria had a 100% frequency of hypomagnesemia, compared to 80% for individuals with microalbuminuria.

Background The diagnosis of strangulation is determined when there are signs of intestinal blockage, an irreducible hernia, no coughing impulse, and acute tension and tenderness. Early detection and repair of a hernia may prevent strangulation, the most dangerous situation that jeopardises both life and intestinal integrity. Therefore, the goal of the current study was to examine the clinical characteristics and results of surgically treated patients with strangulated inguinal hernias. Methods From June 2018 to May 2019, 373 patients, regardless of gender and older than 12 years, were scheduled for an emergency surgical procedure at Medical College Hospital in Trivandrum due to a preoperative diagnosis of an obstructed inguinal hernia. This was a prospective study. A comprehensive clinical examination and history were taken. The patients' postoperative status and operational results were documented. SPSS software was used to analyse the data after it was entered into an Excel spreadsheet. Results 25% (94) of the patients were under the age of 40, 21.4 % (80) were under the age of 40, and 30% (112) of the patients were under the age of 50–60. Just 3 patients were older than 70 years, while 11% (41 patients) were younger than 30. Of the 328 patients, or 87.9%, the majority were men. Of those who had hernias, 51.5% (192) had left-sided ones, while 48.5% (181) had right-sided ones. We did not encounter cases that were bilateral. Three hundred sixty-five patients, or 96.5%, arrived on the first day. On the second or third day, there were just 3 patients, or 3.5%. 362 patients, or 97.1%, had pain when they first had irreducible hernias. 22 patients (5.9%) reported vomiting. Conclusion To lower the related morbidity and death, it is crucial to repair inguinal hernias and identify strangulations as soon as possible. The primary prognostic factor determining morbidity and death is the amount of time that passes between the onset of symptoms and the time of surgery.

Gastrointestinal tract duplications are rare congenital abnormalities. Majority are diagnosed in pediatric age group of less than two years. Lesions can be seen anywhere from the oral cavity to the anus, but  the most commonly affected site is ileum (long and tubular) which is usually in the form of cystic masses. The clinical manifestation of Gastrointestinal duplicationin adults is variable, and they are rarely considered as part of differential diagnosis. In this case report, we presented a 30-year-oldmale patient with ileal duplication. ⁽¹⁾

Background: Hypospadias is a common congenital anomaly affecting male infants, with varied presentations and management strategies. This study aims to evaluate the types, surgical interventions, and outcomes of hypospadias repair in a pediatric population. Methods: A prospective analysis was conducted on 50 pediatric patients undergoing hypospadias repair over 18 months. Data on demographics, clinical findings, operative procedures, and postoperative outcomes were collected and analyzed. Results: The cohort predominantly consisted of toddlers (52%), with a majority presenting with distal penile (48%) and proximal penile (46%) forms of hypospadias. The TIP repair was the most common surgical technique employed (40%). The overall complication rate was 32%, with urethrocutaneous fistula (20%) being the most frequent. Parental satisfaction was high (60%), though a proportion reported dissatisfaction or uncertainty regarding the outcomes (40%). Conclusion: Early detection and intervention are crucial in managing hypospadias, with TIP repair being a reliable surgical option. However, the considerable complication rate calls for enhanced surgical precision and postoperative care. Further, effective communication with parents is essential to manage expectations and improve satisfaction.

BACKGROUND: Sepsis is one of the major causes of neonatal mortality. Clinical manifestations of sepsis vary from asymptomatic to severe manifestations. Hypoxaemia is closely associated with sepsis.Aim: To identify early onset sepsis using pulse oximeter as a screening tool in asymptomatic newborns. METHODS: This study group included 240 asymptomatic newborns, and was carried out for a period of 6 months during the period of 01 January 2021 to 30 June 2021 in the Department of Paediatrics of District Hospital, Tumakuru, Karnataka State, India. The collection and processing was started after obtaining clearance from the Institutional Ethics Committee. All asymptomatic newborns in the postnatal ward of District hospital, Tumakuruborn after 35weeks of gestation were screened on two occasions using pulse oximeter. Babies whose saturation was below predefined threshold of 90% or whose repeat readings remained between 90% and 94% were considered test positives babies. They were subjected to septic work up in the form of complete blood count, C reactive protein, blood cultures and chest X-ray. All test negative babies were followed up at one week to know if they were diagnosed with sepsis in the first week of life. RESULTS:240 asymptomatic newborns were screened. Six newborns (6/240,2.5%) were tested positive and were diagnosed to have early onset sepsis. All test negative babies were followed up and none had evidence of sepsis at follow up. CONCLUSION: This study demonstrates that it is feasible to use pulse oximeter as a screening tool for early onset sepsis in asymptomatic newborns. Thus, pulse oximetry can serve as useful tool for screening neonates especially in low/ middle income countries.

Introduction:Gestational diabetes is a condition that affects many pregnant women and can have negative impacts on both the mother and the baby. To manage this condition, it is essential to keep track of blood glucose levels and lipid profiles. This study aims to compare the changes in glycosylated hemoglobin (HbA1c) and lipid profile parameters between women with gestational diabetes and those without, to improve diagnostic and management strategies for this condition. The study found that HbA1c is an independent marker of dyslipidemia among women with gestational diabetes, highlighting the connection between these parameters in pregnant women in Bihar. Materials and Methods: We conducted a comparative study including fifty pregnant women diagnosed with gestational diabetes during their third trimester, and another fifty pregnant women who did not have gestational diabetes or any pregnancy complications during their third trimester, chosen at random from the age group of 20 to 45 years. We measured the serum lipid profile parameters, oral glucose tolerance test blood glucose levels, and glycosylated haemoglobin levels in patients with gestational diabetes, and compared them with those of healthy pregnant women. Results: In this study, 50 pregnant women with GDM had a mean age of 31.2 years, while 50 pregnant women in the healthy control group had a mean age of 29.3 years. In the present study, serum triglycerides were observed at 191.7±9.10 mg/dL in GDM cases and 149.9±7.89mg/dL in the control group, while serum total cholesterol was observed at 212.7±15.26 mg/dL in GDM cases and 170.2±18.92 mg/dL in the control group. The levels of serum triglycerides and serum cholesterol in GDM cases were statistically significantly higher as compared to the controls. In the present study, the serum HDL cholesterol was observed at 57.75±4.9 mg/dL in GDM cases and 55.53±6.60 mg/dL in the control group, while serum LDL cholesterol was observed at 90.2±13.23 mg/dL in GDM cases and 82.19±9.14 mg/dL in the control group. There was no statistically significant difference in their HDL Cholesterol in the cases and control group, while the difference between LDL cholesterol was statistically significant. The differences of fasting blood glucose, and blood glucose at 1 hour and 2 hours in cases and controls were statistically significant. The mean value of the HbA1c of cases and control groups was 8.19±1.09 mg/dL and 6.01±0.18 mg/dL respectively. This difference between healthy pregnant women and women with GDM was statistically significant. Conclusion: The findings of the study have provided conclusive evidence that the levels of triglyceride, high-density lipoprotein, glycated haemoglobin, and glucose in the blood significantly contribute to the development of dyslipidemia in gestational diabetes mellitus (GDM). Even though it is common knowledge that lipid parameters increase during a healthy pregnancy, the way they increase in GDM differs.

Background: Preterm birth (PTB) remains a significant challenge in perinatal healthcare, contributing to a substantial portion of neonatal mortality and long-term disabilities. Various risk factors contribute to PTB, necessitating effective preventive measures. Progesterone supplementation has emerged as a promising intervention to reduce the risk of PTB, but the route of administration and its efficacy remain under investigation. Methods: This prospective, randomized comparative study enrolled 600 pregnant patients divided into two groups receiving either oral micronized progesterone (OMP) or vaginal micronized progesterone (VMP). Patients were followed up fortnightly for signs of preterm labor (PTL) and perinatal outcomes. Statistical analyses were performed using unpaired t-tests, Fisher tests, and chi-square tests. Results: The study found significant differences in perinatal outcomes between the OMP and VMP groups. While both groups had similar rates of neonatal sepsis and hypoxemic ischemic encephalopathy, the VMP group demonstrated a higher proportion of asymptomatic births and a lower incidence of birth asphyxia compared to the OMP group. Additionally, the mean APGAR score at 1 minute was significantly lower in the OMP group, while birth weight distribution differed significantly between the two groups. Neonates in the VMP group had higher birth weights and lower rates of NICU admission, with a shorter NICU stay compared to the OMP group. Conclusion: Vaginal micronized progesterone appears to be more effective than oral micronized progesterone in preventing PTL and improving perinatal outcomes, including reducing neonatal morbidity and NICU admissions. These findings underscore the importance of route-specific progesterone administration in mitigating the risks associated with PTB. Further research is warranted to elucidate the mechanisms underlying the differential efficacy of progesterone administration routes and optimize preventive strategies for PTB.

Background: Buffered crystalloid solutions are often recommended as the first choice for intravenous resuscitation. Sepsis-related morbidity and mortality are lower when patients with septic shock are resuscitated early. Purpose: To compare the efficacy and potency of lactate clearance, resolution of metabolic acidosis, improvement in hemodynamic status, and resolution of shock after resuscitation with lactate- and acetate-buffered solutions in septic shock. Methods: Of the 60 patients with septic shock and sepsis, 30 were recruited for lactate solution and 30 for acetate solution. After admission of these patients to the ICU, we perform ABG of the patient to determine baseline PH, PCO2, PO2, bicarbonate, and lactate. After 12 hours of resuscitation, we repeat the ABG to determine the improvement in sepsis/septic lactate clearance and resolution of metabolic acidosis in both groups. Results:The mean change in pH and pO2 was significantly increased and pCO2 significantly decreased in the acetate group from admission to 12 hours after admission, whereas only pO2 was significantly increased in the lactate group. Mean lactate values at admission and after 12 hours were 6.20±2.67 and 4.60±2.13, respectively, in the acetate group and 5.24±1.44 and 2.98±0.53, respectively, in the lactate group. Mean SBP (mmHg) and DBP (mmHg) were significantly increased, and HR (beats/min) and RR (/min) were significantly decreased from admission to 12 hours after admission in the acetate group and the lactate group. Conclusion: Mean lactate was significantly decreased more in the lactate group (2.26) than in the acetate group. In addition, SBP (mmHg) and DBP (mmHg) were increased more and HR (beats/min) decreased more in the acetate group than in the lactate group.

Background: Numerous studies have highlighted the association between impaired lung function and ischemic heart disease, suggesting a potential link mediated by systemic inflammation. However, the extent of pulmonary functional abnormalities in elderly patients with ischemic heart disease remains inadequately explored, especially in the Indian context. Methodology: This prospective study aimed to evaluate pulmonary function among elderly patients with ischemic heart disease visiting SLN Medical College and Hospital, Koraput, Odisha, between January 2020 and March 2021. Spirometry and Doppler echocardiography were performed on 56 subjects aged 60 years and above with confirmed coronary heart disease. Data analysis employed descriptive statistics, ANOVA, t-tests, and Pearson correlation analysis. Results: The majority of participants (58.9%) were aged 60–69 years, with a mean age of 69.29 ± 5.66 years. Notable proportions of subjects exhibited impaired lung function, with restrictive-type defects predominant, particularly among older age groups. Associations were observed between impaired lung function, elevated inflammatory markers, and ischemic heart disease. Peak expiratory flow rates were below predicted values, suggesting potential mortality predictors. Discussion: The observed decline in lung function with age aligns with previous research, indicating a complex interplay between pulmonary and cardiac physiology. Systemic inflammation may contribute to impaired lung function and the development of coronary artery disease, emphasizing the need for multidisciplinary management approaches. Conclusion: Our study underscores the intricate relationship between impaired lung function, ischemic heart disease, and systemic inflammation in the elderly. Further research is warranted to elucidate underlying mechanisms and optimize management strategies, emphasizing the importance of early identification and intervention in this vulnerable population.

Aim of the study: determine the pattern of prescription of Anti Diabetic Drugs in a cohort of patients at a tertiary care centre of East Nimar region of Central India. Methods: The study was a Prospective observational study and was conducted in the Outpatient department of Medicine conducted for a period of 6 Months. Demographic and clinical data of total 82 patients were collected and Prescription of these Diabetic patients were analysed. Result: Out of Total 82 Patients, the maximum percentage of Diabetic patients, including both males and females belonged to the age group of 51 to 60 years (36.58%). Majority of Patients received Two Drug Anti-diabetic Drug combination (i.e. Metformin and Glimepiride combination) which were the most prescribed drugs (65.85%, 54 Patients out of total 82 Patients) followed by Mono-therapy with Metformin (13.41%, 11 Patients out of total 82 Patients). Among the three drugs combination therapy prescribed in 15 patients (18.29%), often Metformin + Glimepiride + Pioglitazone combination were prescribed (6 patients, 7.31%),  followed by Metformin + Glimepiride+ Vildagliptin /Tenegliptin/ Sitagliptin (DPPIV Inhibitors) (5 patients, 6.09 %). As far as comorbid conditions are concerned 62 Patients (75.60 %) had no comorbid disease along with Diabetes, 20 patients (24.39 %) had Hypertension and 3 patients (3.65 %) had Hyperlipidaemia along with Hypertension and Diabetes and received concomitant medications for the same. Conclusions: The present study represents the current prescribing pattern of Anti-Diabetic Drugs in our Hospital. Our findings showed that Metformin and Glimepiride combination dominated thescenario followed by Monotherapy with Metformin among the elderly populations of Diabetes. The use of Anti-Diabetic drugs largely confirms the guidelines as most of the patients belonged to the category of elderly populations, but still there is a significant room of improvement in terms of rational prescribing.

Background: Diabetic retinopathy (DR) poses a significant threat to individuals with diabetes globally, particularly in India where diabetes prevalence is high. Despite its severity, awareness and understanding of DR remain crucially low among affected populations. Aim: This study aimed to evaluate the level of awareness regarding diabetic retinopathy among patients attending the ophthalmology outpatient department at SLN Medical College and Hospital in Koraput, Odisha, India. Methodology: A prospective population-based study was conducted, enrolling 400 known diabetic patients aged 30 years and above. Participants completed a questionnaire gathering demographic data, diabetes duration, awareness of ophthalmological risks, and ocular health information. Results: Among the participants, 38% demonstrated awareness of diabetic retinopathy, while 62% were unaware. Type II diabetes mellitus was prevalent in 72% of subjects. Despite recommendations for regular eye examinations, only 38% complied. Notably, fundoscopic examination revealed DR in 45.5% of participants. Incidence rates of DR were notably higher among those with diabetes for over 5 years (66.11%) compared to recently diagnosed cases (13.91%). Discussion: The study highlights a moderate awareness rate of DR among patients, significantly lower than reported in other regions. Lack of awareness may contribute to the higher incidence of DR, emphasizing the importance of education and regular screenings. Hospital staff emerged as the primary source of information, suggesting a need for broader awareness campaigns.Conclusion: The study underscores the pressing need to improve awareness of diabetic retinopathy among diabetic populations in Odisha, India. Effective education and regular screenings are imperative to mitigate the risks and consequences associated with DR, emphasizing the role of healthcare providers and community support in combating this debilitating condition.

Background objectives: Laryngo Pharyngeal Reflux Disease is a very common condition in otorhinolaryngology characterised by reflux of gastric contents into the laryngo pharynx and larynx thus creating all the symptoms like heart burn, lump in the throat sensation, Cough, frequent throat clearing etc. It is very essential to diagnose this condition properly and find out an effective method to treat and prevent it as this condition creates major discomfort to the patients. Due to the presence of similar symptoms like heart burn and chest discomfort it often mimics an angina. And by this study we are trying to assess the efficacy of Diaphragmatic Breathing (DB)techniques in addition to the conventional treatment in LPRD patients. Methods: This is a prospective observational comparative hospitalbased study of 160 patients over 2 years with LPRD symptoms divided into Group A and Group B (80 patients each) randomly, which was conducted in department of ENT in our institution (SGMC Thiruvananthapuram). The data was collected using proforma. Pre treatment RSI and RFS scores were recorded also after 2 months of treatment RSI and RFS scores were obtained with the help of video Laryngoscopic examination. Results and Discussion : In our study total of 160 patients the mean age was 44. Majority were 18 to 30 years of age. Male to female ratio was 2:3. The commonest presenting symptoms among the patients were frequent throat clearing, heartburn, excess throat mucus and lump in the throat sensation. There was significant improvement in the post treatment RSI and RFS scores in the group in which diaphragmatic breathing was given as an add on treatment (Group B). Conclusion: Long term and consistent practice of Diaphragmatic breathing techniques are one of the noninvasive treatment modalities that can be combined with the normal pharmacological treatment of LPRD which improves the treatment outcomes to a greater extend. It decreases the reflux episodes, improves patient compliance and comfort. It gives both symptomatic relief and decrease in signs

Aims: to compare the effectiveness of epidural Ropivacaine with epidural Levobupivacaine for anaesthesia in lower abdominal and lower limb surgeries. Materials and Methods: It is a Hospital based prospective study in 100 patients admitted between age 18-60 years, ASA grade 1 and 2 in Patients undergoing Lower abdominal and Lower limb surgeries  Results: In  the  present  study,  the  mean  age, gender, weight, height, ASA-1 and 2, onset of sensory block, onset of motor block of  the  Levobupivacaine  group  and ropivacaine group was not statistically significant. No  significant  difference observed between the two groups with relation to Highest level of sensory block  achieved. There is significant difference between the two groups, with group L producing a deeper motor blockade (0.02). Mean Duration of Motor block in Group R was 282.98 ± 11.23 and in Group L was 280.54 ± 4.61. This observation was not statistically significant (p=0.64). Mean duration of sensory  analgesia in Group R was significantly prolonged than Group L. This observation was statistically significant (p=0.02).  Both the study groups were hemodynamically stable with relation to pulse rate at 0, 5, 15, 30,  60mins,  2, 6, 12 hours. Higher sedation score was observed in Ropivacaine group compared to Levobupivacaine group. Conclusion: Levobupivacaine can be used as a better alternative to Ropivacaine for epidural anaesthesia in lower abdominal and lower limb surgeries.

Background:  Lumbar spinal canal stenosis is one of the most common cause of chronic back pain in middle aged and elderly patients. The incidence of acquired lumbar stenosis is approximately 1 per 1000 in individuals older than 65 years. Aim: to find the functional outcome following posterior decompression for lumbar canal stenosis using spinaplasty technique. Material and methods: Present study was a observational study done in department of orthopaedics in tertiary care hospital. Totally 22 patients were included in the study out of which 2 patients were excluded due to loss of follow up. All patients underwent wide posterior decompression surgery at respective levels using spinaplasty technique. Wound was inspected every 3 days and IV antibiotics (cefoperazone+ sulbactam) was given for the first 3 days which were then changed to oral antibitotics(ceftriaxone) following surgery. No patient had surgical site infections/ dural leak/ post operative fresh neurological deficits. Surgical staples were removed on post operative day12 patient were mobilized using lumbar brace. Results: The mean intensity of back pain pre operatively was 5.05, post operatively it was reduced to 3.00 at 1 month,2.35 at 3months and 1.95 at 6months follow up. Conclusion: The described technique wide posterior decompression using Spinaplasty technique for lumbar canal stenosis preserves the posterior ligamentous complex by repairing the median structures i.e spinous process, interspinous ligament and supraspinous ligament by lifting them as a single piece and repairing after decompression.

Introduction: Medical undergraduates in India are being selected to learn medicine by putting them to vigorous training in schools to clear highly competitive exams that requires hard work, dedication and knowledge. Such students after joining MBBS, most of them don’t fair well in internal examinations being conducted in their respective departments, both in theory and practicals. Among those who pass the subjects are not expected to have a thorough understanding of the subject. This study aims to assess the perspective of first year MBBS students on learning their syllabus. Methodology: Students who had just finished first year MBBS from different medical colleges were asked to fill a feedback form comprised of questions regarding their perspective of learning first MBBS syllabus. Results: 15.9% of students opined that they studied the syllabus only to pass the examination whereas 84% of students studied the subjects to lay strong foundation of medicine. Conclusion: Through this study we concluded that there are students who study MBBS for the sake of only passing the exam instead of acquiring sound knowledge in the field. It also addresses the factors that dampen their quality of education.

Background: Enterococci are relatively avirulent in healthy individuals but pathogenic in hospitalized patients. Because of their resistance to multiple drugs resulted in serious super infections among hospitalized patients. The present study was undertaken for isolation, identification & speciation of enterococci and determines antibiotic susceptibility patterns in various clinical specimens. Methods: Identification & Speciation of 100 isolates were done by standard conventional methods from various clinical samples like urine, pus, blood, wound swab etc & Antibacterial susceptibility pattern determined by Kirby-Bauer disc diffusion method. Results: Among 100 isolates, enterococcus spp isolated more from female patients(21-40yrs). E. faecalis, isolated in 60% of cases followed by E. faecium (36%), E. durans (3%), E. avium (1%). Enterococcal spp. isolated from Urine (59%), followed by blood (18%), pus (13%), wound swab (8%) & CSF (2%). Enterococcus shows resistance to antibiotics like penicillin, ampicillin followed by ciprofloxacin, erythromycin, tetracycline, high level gentamicin & 100% sensitive to Linezolid followed by teichoplanin & vancomycin. The resistance pattern of enterococci in urinary isolates is only 33.89%. Conclusion: The most common isolate in our study is E. faecalis. There is an increase in isolation rate of E. faecium and other non faecalis species of enterococci. The study revealed the prevalence of multidrug resistant HLAR strains of E. faecalis & E. faecium. Therefore, a periodic surveillance is required to monitor these rapid changing patterns of Enterococcal infections for effective treatment.

Background: Chest pain is the most common symptom in patients who get admitted to the emergency department. Those patients must be assessed for having or developing Acute Coronary Syndrome (ACS). Early diagnosis of ACS is associated with a good prognosis of the patient if they receive targeted treatment. But, about 80 % of patients have no characteristic presentation to conclude the diagnosis of ACS. This leads to time delay due to the duration of clinical observation and unnecessary treatment. Materials and Methods: This hospital based observational study was done between Jan 2020 and September 2021 at a tertiary care institute of South India. About 101 patients who presented to the emergency department of the institute with chest pain have been enrolled into the study. Patients who presented to the emergency OPD with the symptom of chest pain and were above the age of 40 years of any gender were included in the study. Results: Around 39 percent of the study participants have significant ST elevation on ECG. 56 percent of the study participants have one or two risk factors and only 4 percent have more than or equal to 3 risk factors according to the HEART score. 26 percent of study participants have low risk; 47 percent have moderate risk and 27 percent have a high risk for getting Acute Coronary Syndrome according to the Heart Score. Conclusion: Thus, HEART score is an efficient and time-consuming tool that can be used in the emergency Out-patient department to stratify the patients for management

Background: Chronic Kidney Disease of Uncertain Etiology (CKDu) is a significant health concern affecting specific regions, particularly agricultural communities. This prospective study, conducted over one year at a tertiary care center, aimed to comprehensively investigate CKDu by evaluating demographic, clinical, laboratory, and environmental factors. Methods: A total of 150 CKDu patients and 150 control group participants were enrolled to explore this enigmatic disease. Demographic analysis highlighted the prevalence of CKDu in rural, agriculturally engaged individuals. Clinical characteristics revealed distinct symptoms and clinical markers, while laboratory results unveiled key biochemical differences. Occupational history and environmental exposures were assessed to identify potential risk factors. Results: CKDu patients exhibited elevated proteinuria levels, reduced eGFR, and heightened blood pressure, emphasizing the clinical impact. Laboratory findings confirmed renal dysfunction with elevated serum creatinine, BUN, and albuminuria. Occupational and environmental factors highlighted longer agricultural work durations, pesticide/herbicide exposure, and variations in water sources among CKDu patients. Conclusion: This study underscores the multifaceted nature of CKDu, where demographic, clinical, and environmental factors intersect to contribute to its pathogenesis. A strong association between proteinuria and CKDu was observed, emphasizing its diagnostic relevance. These findings call for targeted interventions and preventive measures in high-risk regions, acknowledging the need for a comprehensive approach to manage and mitigate the impact of CKDu on affected communities.

:  Introduction: Thrombocytopenia is often a dreaded complication of dengue requiring platelet transfusion. The etiology of thrombocytopenia in dengue is multifactorial IPF, a parameter recorded in newer hematology analyzer measures the immature reticulated platelets and it helps in predicting the rate of thrombopoesis and platelet recovery in dengue patients. Aims and Objectives- The study aimed at evaluating role of IPF in predicting platelet recovery in dengue patients. Material and Methods-The present study was a hospital based cross-sectional study done in Pathology department of PGIMER and Capital Hospital Bhubaneswar in the month of October 2023. Platelet count, IPF and platelet parameters were noted for patients of dengue (NS-1 positive) on day 1, 3, 5 and 7. RESULTS- 60% of patients with thrombocytopenia lacked platelet parameters MPV, PDW, PLCR in CBC while all the patients expressed IPF. Patients with high IPF (>10%) demonstrated a faster recovery compared to those with low IPF (<10%). Those with IPF greater than 10% had a gradual decline in IPF with improvement of platelet count. Conclusion: IPF is a consistent and reliable parameter to predict platelet recovery in patients of dengue with thrombocytopenia. It can help in guiding decision making regarding platelet transfusion.

INTRODUCTION Rheumatoid Arthritis (RA) is the most common form of chronic symmetrical inflammatory arthritis and often results in joint damage and physical disability. RA may result in a variety of extra-articular manifestations, including fatigue, subcutaneous nodules, lung involvement pericarditis, peripheral neuropathy, vasculitis, and hematologic abnormalities. Anti-CCP antibodies are auto antibodies which contains citrulline appears early phase of RA patients. During the course of the disease RA patients need to be diagnosed very early, possibly before diagnostic criteria are fulfilled or may be even before clinical symptoms are apparent. Materials and methods: The study was conducted in the department of Microbiology in a tertiary care hospital after obtaining approval from Institutional Ethical Committee. Samples were collected under aseptic precautions from the patients attending orthopaedic department and general medicine department. The total serum samples were 186 and were tested and interpreted by LA method (SPAN DIAGNOSTICS, SACHIN SURAT) for Rheumatoid factor and anti-CCP antibodies by IMUNOSCAN CCPLUS ELISA (EURODIAGNOSTICA, AB, SWEDEN). Results Among 48 anti-CCP positives in suspected RA cases, females were 33 (68.75%), males were 15 (31.25%). And among 7 ACCP positive in controls, females were 5 (71.43 %) and males were 2 (28.57 %). Based on the cut off value >10 IU/ml among 80 clinically suspected cases of RA, 50 sera were positive for RF by LA. In 106 participants who are controls, only 23 (21.7%) samples were positive. The prevalence is 43% .The sensitivity was 62.50%. The specificity was 78.3 %. Among 50 rheumatoid factor positives in case group, 48 sera were positive for anti-CCP test. Among 23 rheumatoid factor positives in control group, 7 were positive for anti-CCP test (as shown in table 2). Rheumatoid factor test could showed false positive result and those were observed as negative by anti-CCP test which is specific test.  CONCLUSION: The anti-CCP antibody assay is a valuable tool for the classification criteria of RA as they may predict the eventual development into RA when found in undifferentiated arthritis patients. Because of its low sensitivity it does not allow its use as a screening test, but because of its high specificity when compared to Rheumatoid factor, it is one of the most useful specific serological test for the diagnosis of RA. Combined use of RF and anti- CCP is a better tool for the diagnosis of RA.

Background: Falls are the major cause of dependence in older age and can result in long-term disability, loss of mobility, reduced the quality of life and even death. Among many health issues that are faced by the elderly, falls are an important concern. Methodology: A community-based cross-sectional study conducted in the urban field practice area of the Department of Community Medicine, Kurnool Medical College, and Kurnool during the period from November 2016 to October 2018. By using Consecutive sampling method, door to door survey was done by using predesigned semi structured questionnaire after approval from institutional ethical committee and by taking informed consent from participants. Data was analyzed by using SPSS Software. Results: Out of 1028 study participants majority were (62.84%) in the age group of 60-69 years. 49.90% of study participants were males and 50.10% were females. Among the 1028 elderly persons 282 (27.43%) had a fall within a period of 12months. Among determinants significantly higher fall rate was seen elderly with lower socioeconomic status, Hypertension, diabetes and smoking. Conclusions:  Prevalence of fall was higher with increasing age. Significantly higher falls were found among elderly persons with lower socioeconomic status increasing age, lower socioeconomic status and illiterates and elderly who are living alone and elderly with hypertension, Diabetes, visual problems and vertigo.

Background: 

Background: Assessing a patient with Type 2 Diabetes (T2DM) involves a comprehensive evaluation of their medical history, current symptoms, physical examination, and laboratory tests. Here's a structured approach to assessing a patient with T2DM. Evaluate the patient's current diabetes management plan, including diet, exercise, medication adherence, self-monitoring of blood glucose, and insulin administration if applicable. Assess barriers to effective diabetes management, such as socioeconomic factors, access to healthcare, health literacy, and psychosocial support. Collaborate with the patient to set individualized goals for glycemic control, blood pressure, lipid levels, weight management, and prevention of diabetes-related complications. Materials and methods: A six-month longitudinal study was conducted at a tertiary care facility. Those with type 2 diabetes who were receiving insulin and oral hypoglycemics were included in the trial. Laboratory investigations and a sociodemographic profile were gathered using a pretested, structured questionnaire. EPI Info, Open EPI, and SPSS 22 version software were used for the statistical analysis. The statistical tests were the Students t-test and the Chi-square test. Result: There were ninety-nine diabetic individuals in the oral group. Oral hypoglycemics were 46.8±7.6 years old on average. Our research indicates that type II diabetes can be treated with both monotherapy and combination medications. According to the results of this study, the majority of doctors first prescribed monotherapy (25%) consisting of Metformin, Glipizide, Glimepiride, and Gliclazide to control hyperglycemia. Then came triple treatment (40%) including Metformin + Glimepiride + Pioglitazone and dual therapy (35%) comprising FDC of Metformin + Pioglitazone, Metformin + Glipizide, Metformin + Glimepiride, Metformin + Saxagliptin, and Metformin + Voglibose. Conclusion: The most often given medications in our research were biguanide, metformin, and sulfonylureas, such as glimepiride, glibenclamide, glipizide, and gliclazide.

Abstract Background and Objectives: Unusual thyroid function tests are frequent in chronic kidney disease patients. The kidneys play an important role in thyroid hormone metabolism by converting T4 to T3 (the active metabolite). Low plasma free T3 in ESRD is a marker of inflammation and endothelial activation, and it has been linked to an increased risk of death from any cause. The present study has been conducted to look for biochemical abnormalities in thyroid function tests in chronic kidney disease, as well as to correlate the severity of CKD and changes in thyroid indices. Materials and methods: We performed a cross-sectional analysis based on the database of the laboratory information system of the clinical chemistry laboratory at security forces hospital to retrieve results of serum creatinine, thyroid-stimulating hormone TSH, free T4, and parathyroid hormone PTH, which have been performed. Outpatient adults (over 18 years of age) followed in Medicine department. Serum TSH and free T4 concentration were quantified. The value of TSH is 0.27–4.20 mIU/L and free T4 is 12–20 pmol/L, which were calculated from the estimated GFR. Result: In present study one third of subjects (34.4%) belonged to 50-60 years of age group. Majority of study subjects were males (74.4%). Among 46.0% subjects the TSH was raised above normal value and 24.4% of subjects were having subclinical hypothyroidism. During ANOVA analysis, the levels of serum creatinine were significantly raised (p=0.01) in subjects with overt, subclinical hypothyroidism and Low T3 when compared to euthyroid subjects. Conclusion: Incidence of hypothyroidism is increased in patients with chronic renal failure. Both clinical and biochemical parameters are essential to diagnose hypothyroidism in patients with CRF. Number of patients with low T3 and T4 syndrome progressively increase with severity of renal failure. Serum level of T3 and T4, has no correlation with the severity of renal failure. 

BACKGROUND Ondansetron is currently one of the commonly used drug for prevention of postoperative nausea and vomiting in adults. New drugs such as Palonosetron have emerged as alternative for postoperative nausea and vomiting in adults. Both have been tried for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic  gynaecological  surgeries. We, therefore conducted a prospective, randomized, double blind comparative study to compare the efficacy of injection ondansetron 4 mg with palonosetron 75µg to prevent postoperative nausea and vomiting in female patients undergoing general anaesthesia for elective laparoscopic non gynaecological surgeries. MATERIALS AND METHODS This was a prospective, randomized, double blinded, comparative study. All thepatients were well informed about study & each one of them gave written in formed  & valid consent to participate in the study. Total number of patients in the study was 100, with 50 patients in each of the two groups.Grouping done as follows Group I Injection  Ondansetron 4 mg Group II Injection  Palonosetron 75 mcg RESULTS The demographic data were comparable in both the groups. The incidence of nausea in ondansetron  group at 0 hrs, 1hrs, 2hrs, 3hrs, 12hrs, 24hrs, 48hrs are 12%, 12%, 08%, 04%, 0%, and 0% and in palonosetron group  is 2%, 12%, 0%, 2%, 2%, 0% and 0% respectively. The incidence palonosetron and ondansetron  groups though look clinically significant did not reach statistical significance .The incidence of vomiting in ondansetron was 0%, 6%, 10%, 10%, 2%, 0% and  0% and in palonosetron was  0% , 8% ,8%, 2%, 0% ,0% and 0% at 0 hrs ,1hrs , 2hrs , 3 hrs , 12hrs ,24hrs  and 48hrs respectively.  The incidence of  requirement of rescue antiemetic in ondansetron   group at  0hrs,1hrs, 2hrs, 3hrs,12hrs, 24hrs and 48 hrs   are  0(0%),5 (10%),5(10%), 6(12%),  1(2%)  ,0(0%),0(0%) and in  palonosetron   group 0(0%),4(08%),4(08%),02(04%), 0(0%), 0(0%), 0(0%)  respectively. CONCLUSION We found no statistical significance in terms of nausea, vomiting and the administration of rescue antiemetic between the two groups in the 48hour observation period. As per the study, both drugs are equally effective in the 48  hour observation period.

Introduction: In the pediatric population, laryngeal mask airways are often used during general anesthesia as a substitute for tracheal intubation. They need fewer hemodynamic adjustments, are simpler to introduce, and are more tolerated. Since propofol suppresses cough and gag reflexes so well, it is the agent of choice for its injection. A significant hypotension and apnea may result from the dosage of propofol needed for the seamless insertion of an LMA. As a result of its centrally acting skeletal muscle relaxant action, midazolam lessens patient movements and facilitates the airway insertion of the laryngeal mask. Objectives: The objective of this study is to assess the efficacy of midazolam in facilitating the placement of a laryngeal mask airway during propofol anesthesia in children undergoing daycare procedure. Methodology: A prospective cross-sectional study was conducted on 38 children between ages of 3-12 yrs undergoing pediatric day care surgeries under general anaesthesia not required tracheal intubation who are allocated to one of the 2 groups (19 in each group). Group A received propofol alone and Group B received Midazolam as supplementary dose (0.04mg/kg). Results: Midazolam along with propofol provides a better condition for placement of LMA in 72.7% of children (P: 0.01). Group B patient had a better hemodynamic profile in the study with a P value <0.01. Conclusion: The study demonstrated that the combination of Midazolam and propofol provides better conditions for laryngeal mask installation compared to the use of propofol alone.

Background: The impact of thyroid hormones on the human brain and behavior is well-established, with documented correlations between thyroid dysfunction and psychiatric disturbances. Non-thyroidal illness, often termed euthyroid sick syndrome, is characterized by altered thyroid function parameters in response to systemic or acute psychiatric illness. Limited data exist on thyroid dysfunction rates in major psychiatric disorders in the Indian population. Objective: This study aimed to assess thyroid dysfunction prevalence in depressive disorders among psychiatric outpatients, examining the correlation between endocrinopathy and depression. Methodology:A prospective study was conducted at SLN Medical College and Hospital in 2019-2020. Patients were diagnosed using ICD-10 criteria, and thyroid function tests were performed using the Chemiluminescence method. Samples were collected from newly diagnosed, non-medicated patients over 18 years, excluding those with pre-existing thyroid disorders or medications affecting thyroid function. Results: Out of 138 patients, 37.7% with depression exhibited abnormal thyroid function tests. Hypothyroidism was observed in 30.8%, hyperthyroidism in 15.2%, and nonspecific alterations in 53.9% of cases. Abnormalities were more common in females (43.8%) than males (32.3%). Elevated serum triiodothyronine (T3) levels were significantly associated with depressive patients. Discussion: The study revealed a higher prevalence of thyroid dysfunction in depressive disorders than reported in previous studies. Abnormalities were more prevalent in females, aligning with the higher prevalence of mood disorders in women. Non-specific alterations in iodothyronine concentrations were often associated with euthyroid sick syndrome in patients with depression. Conclusion: This study emphasizes the association between thyroid dysfunction and depressive disorders, showcasing the complexity of the hypothalamic-pituitary-thyroid system's role in mood regulation. Routine thyroid screening is recommended in psychiatric evaluations, considering the potential manifestation of psychiatric disturbances in thyroid disease.

Introduction: The rising incidence of stroke in young individuals has garnered attention, yet data disparities persist. This study aims to investigate stroke cases among young individuals in the Koraput district of Odisha, considering the unique ethnic composition of the region. Methodology: A retrospective hospital-based study was conducted at SLN Medical College and Hospital, spanning February 2019 to February 2020. Inclusion criteria encompassed patients aged 15–45 years meeting the WHO stroke definition. Demographic, clinical, and diagnostic data were collected, including neuroimaging and comprehensive risk factor assessments. Results: Of 370 stroke cases, 32.4% were young individuals (n=120), with a mean onset age of 33 years and a male preponderance (1.5:1). Cerebral infarction was predominant (50.8%), primarily atherosclerotic (52.4%). Alcohol abuse (68.8%) and smoking (44.3%) were significant risk factors. Intracerebral hemorrhage constituted 41.6%, predominantly affecting the basal ganglia (71.4%), with alcohol abuse as a major risk factor. Subarachnoid hemorrhage and cerebral venous thrombosis occurred in 4.2% and 3.1%, respectively, with distinct gender patterns and risk factors. Discussion: The study aligns with global trends, emphasizing the prevalence of ischemic strokes, particularly atherosclerotic, among young individuals. Traditional risk factors, such as hypertension, were associated with ischemic strokes, while alcohol consumption emerged as a significant modifiable risk factor. Hemorrhagic strokes exhibited a higher proportion among the young, with alcohol and hypertension synergy as significant risk contributors. Conclusion: Stroke in young individuals necessitates tailored investigative approaches, considering the diversity in etiology and risk factors. Beyond traditional risks, the study underscores the importance of addressing modifiable factors, especially alcohol consumption. Comprehensive population-based studies are essential to understand stroke patterns in diverse populations.

Background: Acne vulgaris, a prevalent skin condition, significantly impacts the quality of life, especially during adolescence. This study aimed to investigate the clinical profile of acne vulgaris, including its prevalence, severity, scarring, relationship with androgenicity, seasonal variation, and association with smoking in a South Indian population. Methodology: The study, conducted from July 2019 to May 2020, included 300 acne vulgaris patients attending the dermatology outpatient department. Patient demographics, lesion characteristics, and associated factors were assessed. Acne vulgaris severity was graded, and statistical analyses were performed using SPSS 15 software. Results: The study revealed a prevalence of 1.068% among new dermatology patients. Male predominance (57%) and an increased likelihood of severe acne in patients aged 20 years or older were noted. Closed comedones were the most common lesion type, and post-acne scarring was observed in 39.4% of patients. No significant correlation was found between acne severity and markers of androgenicity. Seborrheic dermatitis was the most common comorbidity, and seasonal variation was observed in 25.8% of patients. Discussion: The study's findings align with global acne epidemiology, with unique insights into the South Indian population. Notably, post-acne scarring incidence was relatively high, suggesting population-specific characteristics. The study provides valuable data on lesion types, severity distribution, and associated factors, contributing to the understanding of acne vulgaris in this region.Conclusion: This hospital-based study contributes to the limited literature on acne vulgaris in South India, emphasizing the need for larger, population-based studies. Understanding regional variations in acne presentation and associated factors is crucial for tailored management strategies. Further research should explore hormonal abnormalities in female patients exhibiting androgenic markers.

ABSTRACT: Background: Malnutrition refers to undernutrition as well as obesity. Anthropometric measurements are commonly used to assess nutritional status. According to estimates, 36% of Indian children are stunted and 32% are underweight ^[1]. Severe malnutrition raises the risk of illnesses, particularly in severely ill children.

OBJECTIVES:

1. To study the incidence of Protein Energy Malnutrition in age groups of 6 months – 5 years, admitted to this hospital.

2. To find out the major etiological factors causing Protein Energy Malnutrition in children aged 6 months to 5 years.

3. To study the clinico - investigative profile associated with Protein Energy Malnutrition in children.

Material & Methods: Study Design:  Hospital based Prospective Observational study. Study area:  Department of Paediatrics, Government Medical College, Kadapa, Andhra Pradesh. Study Period:  1 year.  Sample size: Study consisted of 137 cases. Sampling Technique: systematic random sampling method.  Study tools and Data collection procedure: Procedure - All the admitted cases with Protein Energy Malnutrition as per Wellcome-Trust classification were enrolled in the study. Out of these, every fifth case was selected as per systematic random sampling method. Etiology and Clinico-investigative profile of these cases were studied. Patients were admitted, detailed history was taken and examination done. Relevant investigations were sent; data was collected and statistically analyzed. Method: Every fifth case out of enrolled cases was selected. After admission detailed history including age, sex, socioeconomic status, presenting symptoms, past illnesses including gastrointestinal and respiratory tract infections, family history including parent child relationship, detailed dietary history, birth and immunization history and developmental history was taken. Thorough clinical examination was done to assess the nutritional status of patients which includes weight, height, mid arm circumference and head circumference.Results: Most of the malnourished children were weaned at the ages of 6 months to one year. Only 25% of the children were weaned between the ages of 1 to 11/2 year and it was statistically significant. (p<0.05). Most of the children suffering from SCU were from families having children four or more than four and statistically significant. (p<0.05). CONCLUSION: According to the findings of this study, malnutrition was quite common among children in low- and middle-income nations. India has a substantial number of stunted and wasted youngsters. SAM was more common in infants and children from rural communities. It was strongly connected with poor feeding practices, including a lack of breast feeding and the existence of mixed and incorrect feeding.

Background: Cardiovascular health is a fundamental determinant of overall well-being, and understanding how it varies between genders is of paramount importance in the field of exercise physiology and public health.This comparative cross-sectional study aimed to investigate gender differences in cardiovascular responses to exercise, focusing on resting heart rate (RHR), heart rate during exercise, blood pressure responses, recovery time, and maximal oxygen uptake (VO2max). Methods: Male and female participants underwent a standardized exercise protocol, during which RHR and heart rate during exercise were monitored. Systolic and diastolic blood pressure (SBP and DBP) at rest and during exercise were recorded. Recovery time for heart rate to return to baseline was measured post-exercise. VO2max was assessed using established methods. Results: The study included male (n=100) and female (n=100) participants. While RHR showed a modest gender difference (-4.7 bpm, p=0.12), heart rate during exercise revealed a significant gap between genders (10.3 bpm, p<0.05). Males exhibited higher SBP at rest (+1.6 mm Hg, p<0.05) and a more pronounced increase during exercise (+6.4 mm Hg, p<0.05). DBP response during exercise did not differ significantly (p=0.18). Recovery time for males was faster by 5.4 minutes (p<0.05). Importantly, males demonstrated a significantly higher VO2max compared to females (+7.8 ml/kg/min, p<0.01). Conclusion: Gender differences in cardiovascular responses to exercise were evident in this study. While RHR showed no statistical disparity, males exhibited a greater increase in heart rate during exercise, higher SBP at rest, faster recovery time, and superior aerobic capacity (VO2max). These findings underscore the importance of tailoring exercise interventions and cardiovascular assessments to gender-specific characteristics.

Background: Arteriosclerosis and its sequelae are the most common cause of death in diabetic patients and one of the reasons why diabetes has entered the top 10 causes of death worldwide, fatalities having doubled since 2000. The literature in the field claims almost unanimously that arteriosclerosis is more frequent or develops more rapidly in diabetic than non-diabetic subjects, and that the disease is caused by arterial inflammation, the control of which should therefore be the goal of therapeutic efforts. Methodology: A Cross sectional Observational study conducted in the Dept. of General Medicine. All newly diagnosed patients of Diabetes mellitus, attending diabetes OPD, AGMC & GBPH, subjected to inclusion and exclusion criteria. By census method, all the newly diagnosed type 2 diabetes mellitus patients visiting Diabetes OPD, AGMC & GBPH are considered for the study till the sample size is reached. Results: Multivariable logistic regression analysis was done to find the Variables influencing the Atherosclerosis, after adjusting the risk for other variables, with CIMT-high risk as dependent variable. In the present study population Triglycerides, HbA1c are found to be strongest predictors of atherosclerosis (p<0.001). VLDL are also affecting CIMT. After adjustment, S Ch, LDL not significance (p=0.21, p=0.61 respectively) in relation to CIMT and HDL (p=0.30 influence on CIMT is not significant. Conclusion: HbA1c is found to be the strongest predictor along with triglycerides, VLDL, but not the S.cholesterol, LDL & HDL. So, whenever newly diagnosed type 2 diabetes is presented, patient should be evaluated for the atherosclerosis, even in the absence of dyslipidemia and obesity, especially in a patient with poor glycemic control and older age males. It is justified to subject such patients for CIMT analysis. If found to be high risk it can be considered risk marker if not risk factor.

Background: Stroke in the young is particularly tragic because of its potential to create a long- term burden on the victims, their families, and the community. Stroke is one of the most important causes of high morbidity and mortality allover the world. Stroke was defined by World Health Organization criteria as rapidly developing clinical signs of focal, at times, global disturbance of cerebral function lasting for more than 24 hours or leading to death with no apparent cause other than vascular origin. Materials and Methods: 50 patients (29 males and 21 females) were included in the study. Detailed history taking and clinical examination were done and neurological deficits were identified. Other than routine investigations lumbar puncture for CSF analysis, electrocardiography, lipid profile, homocysteine levels and CT scan were done for all the patients. Other investigations such as echocardiography, Doppler etc were done as clinically indicated. Results: Smoking 40% [90%CI (28.6-51.4%)], hypertension 56% [90%CI (47.24-69.76%)], alcohol consumption 26% [90%CI (15.8-36.2%)], Dyslipidemia was present in 40% (90% CI(28.6-51.4%)of the patients. These were the risk factors associated with stroke in young. Conclusion: The major risk factors for stroke in young patients were smoking, alcohol consumption, hypertension and dyslipidemia, homocysteinemia. Migraine, OCP use were uncommon associated risk factors. Atherosclerosis was the most common cause of stroke in young. Cortical vein thrombosis was quite common among females.

Background:  Nonalcoholic fatty liver disease (NAFLD) is frequently linked to metabolic aberrant disorders including diabetes and elevated triglycerides (TGs). As of now, nonalcoholic fatty liver disease has no authorized pharmacotherapy. The treatment of diabetic dyslipidemia with saroglitazar, the first licensed dual PPAR α and γ agonist in the world, was approved in India. This study's goal was to determine whether saroglitazar, 4 mg once daily, is safe and effective in lowering glycemic markers and liver fibrosis in individuals with type 2 diabetic mellitus (T2DM) who also had nonalcoholic fatty liver disease (NAFLD). Objective:  To evaluate the efficacy of saroglitazar therapy in patients with non-alcoholic fatty liver disease. Materials and methods: The study was carried out at IGIMS, Patna. A total of 122 patients with raised liver enzymes and non-alcoholic fatty liver disease coming to IGIMS Hospital, Patna were enrolled in the study. This was a prospective, cross-sectional observational real-world study. all the participants took saroglitazar 4 mg daily once. liver enzymes were measured before and after 3 months of treatment with saroglitazar. Results: There was a significant improvement in serum triglyceride and liver enzymes at three months of treatment. Conclusion: Saroglitazar therapy is an effective therapy for non-alcoholic fatty liver disease.

To evaluate the efficacy of low-dose oral prednisolone therapy in patients with subacute thyroiditis. Materials and Methods: The study was carried out at IGIMS, Patna. A  total of 120 patients with features suggestive of subacute thyroiditis coming to IGIMS, Patna were enrolled in the study. This was a prospective, cross-sectional observational study. The patients were administered prednisolone in a starting dose of 15 mg tapered over 3-6 weeks. Results:120 patients with subacute thyroiditis were included in the study. The majority of patients comprise females with male to female ratio of 1:4 and a mean age of 35.4 years. Almost all (118) presented with severe neck pain whereas two presented with undiagnosed fever with moderate neck pain. Institution of steroid therapy produced immediate relief and pain and fever had completely resolved in 98 patients by three weeks and rest required treatment extending to six weeks or more.  Conclusion: 15 mg of prednisolone therapy is an effective treatment for relief of symptoms of subacute thyroiditis. whereas for some patients three weeks of therapy is good enough, others require extended therapy to six weeks or more.

Background:  Inguinal hernia, a common surgical problem, requires treatment to prevent complications and improve patient outcomes. The debate continues as to whether laparoscopic or open repair techniques are superior. This study assesses the success rates of laparoscopic and open inguinal hernia repairs in Vidarbha, Maharashtra. Methods: The 100 Vidarbha, Maharashtra  people who needed laparoscopic or open inguinal hernia repair were the subject of a retrospective study. Demographic information, recurrence rates, complications, postoperative pain scores, and duration of hospital stay were related between the two groups. Statistical study was used to determine the significance of the observed differences. Results: The laparoscopic (10%) and open (15%) repair groups had comparable recurrence rates. By comparing the two methods for hernia prevention yielded comparable less pain than open method results. The rate of complications in the laparoscopic group was 8%, while in the open repair group, it was 12% Laparoscopic procedures were associated with shorter hospital stays than open procedures. Statistical analysis demonstrated the importance of these results. Conclusion: This study demonstrates that both laparoscopic and open hernia repairs are equally effective at reducing the risk of recurrence and causing roughly the same level of postoperative discomfort. Laparoscopic surgery has the advantage of reducing the duration of hospital stays. Resources, surgeon experience, and patient characteristics should be considered when deciding between laparoscopic and open repair. It is suggested that additional research be conducted to substantiate and assess the long-term effects of these findings.

Background:  This study was conducted to investigate the presence of a-SMA (alpha-Smooth Muscle Actin) positive myofibroblasts in the stroma of invasive breast carcinoma with the help of immunohistochemistry (IHC) markers and investigate the correlation between a-SMA and known clinicopathological prognostic factors of breast tumors along with estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 neu (HER2/neu). Methods: This was a hospital-based study carried out from September 2019 to September 2021 in the Department of Pathology, Maharaja Krushna Chandra Gajapati (M.K.C.G) Medical College, Berhampur, among 75 patients undergoing surgery for palpable breast lesions. The study was approved by the institutional ethics committee (IEC), and written informed consent was obtained from the participants. Results: ER and PR status were negatively correlated with tumor grade and demonstrated statistical significance. HER2/neu receptor and a-SMA expressions were correlated with tumor grade and demonstrated statistical significance. In our study, 96% (n=72) had invasive breast carcinoma, followed by 2 cases of lobular carcinoma and 1 case of mucinous breast carcinoma. In the present study, 47% (n=35) of cases were of grade 3, followed by grade 2 (40%, n=30), and grade 1 (13%, n=10). In grade 3 cases, the majority were HER2-positive with strong SMA expression. Strong SMA activity was observed with an increase in HP grade (Histopathological grading is done as per MBR, i.e., Modified Bloom Richardson grading). Conclusion: a-SMA immunostaining does not correlate with age, size of the tumor, disease stage, or lymph node metastasis. a-SMA positivity shows no significant correlation with ER and PR receptor status. There is a significant correlation between a-SMA immunostaining and tumor grade and with HER2 receptor positivity.

Background:  Background: There is a need of universal hearing screening instead of focusing only on high-risk neonates. This study was done to study otoacoustic emissions (OAE) in neonates admitted in NICU at tertiary care hospital. Aims: To estimate the occurrence of abnormal hearing screening results in full term and preterm neonates admitted and screened at tertiary care hospital. To correlate maternal, intranatal and postnatal risk factors with OAE results. Methods: This is a cross sectional study done over a period of 1 year including 100 neonates admitted in NICU and level one care. Otoacoustic emissions (OAE) was used for primary screening upto 1 month of age. Presence of OAE response in both ear was considered as pass. Absence of OAE response in either ear was considered as ‘Refer’. The ‘Refer’ neonates underwent a 2nd screen within 4 weeks of 1 st screening. BERA was used to confirm the hearing loss if neonates failed 2nd screening. Various details of patient like age, gender, birth weight, gestational age, maternal, intranatal and postnatal risk factors for hearing loss were noted. Results: Out of 100 neonates 26 had ‘REFER’ on initial screening, out of which 19 were preterm and 7 were full term. In 2 nd screening 5 neonates failed, out of which 3 were preterm and 2 were full term neonates. They were advised BERA, out of which 1 neonate was diagnosed with hearing loss. High ‘REFER’ rate was observed in early preterm in comparison to late preterm (p value-0.015). Out of the 26 neonates which failed initial screening, the most common risk factor was prematurity (73%) followed by prolonged NICU stay (42%), followed by sepsis (31%), followed by hyperbilirubinemia and maternal diabetes (15%). Conclusion: There is a need to incorporate universal neonatal hearing screening in all health care facilities, for identification of all newborns with hearing loss before 6 months. Even Anganwadi workers can be trained to administer this test and refer to higher centre if required. Comparing the prevalence's of hearing loss in 2 groups of ‘At risk ‘and ‘not At risk ‘group, the difference was statistically insignificant. Thus applying only high risk strategy for neonatal hearing screening can miss significant number of children with hearing loss among ‘not At risk ‘group. BERA should be used to confirm hearing impairment.

Background: High velocity vehicular accidents are responsible for distal femoral fractures commonly observed in young and middle aged. Low energy mechanisms such as trivial fall at home may be responsible for producing fractures of distal femur in the elderly population, especially women. This study intends to obtain the functional outcome of extra articular fractures of distal femur in skeletally mature patients treated with distal femur locking plate using MIPO (Minimally Invasive Plate Osteosynthesis). Materials and Methods: This prospective study was carried out at Orthopaedics department of Rangaraya Medical College, Kakinada from December 2020 to December 2022. A total of 20 patients with extraarticular fractures of the distal femur treated were with distal femoral locking compression plates was included. The patients were aged between 20 years and 70 years with the mean age of 45.1 years. The time of operation ranges from the 1st day of injury to the 8th day of injury with the mean time of operation being 4.6 days. The clinical results of our study were based on the Neer’s criteria. Conclusion: In the treatment of distal femoral fractures, the LCP condylar plate is the preferred option, especially in Type A fractures where we have observed higher Neer scores. Additionally, LCP avoids periosteal vessels from being compressed.

Background:  Despite recent advances in heart failure (HF) management, mortality and morbidity remain high in patients with heart failure with reduced and preserved ejection fraction. HF is characterized by endothelial dysfunction, inflammation, and increased oxidative stress that results due to a reduction in the activity of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway. All these factors contribute to direct damage at the myocardial, vascular, and renal levels. At a fundamental level, it is known that this cardioprotective pathway of NO-sGC-cGMP is impaired in heart failure patients. Materials and Methods: Vericiguat is a soluble guanylate cyclase stimulator approved by various global regulatory bodies in January 2021 and recommended in recently updated clinical practice guidelines to reduce morbidity and mortality in patients with worsening chronic heart failure (HF) with reduced ejection fraction (HFrEF). It is a novel, orally used, small molecule, and direct stimulator of the soluble guanylate cyclase. It restores the deficiency in this signaling pathway, through stimulation and activation of sGC, aiming to increase cGMP levels, with a reduction in HF-related oxidative stress and endothelial dysfunction. For the present systematic review a Boolean search was carried out in Pubmed, Google Scholar and Embase. Conclusion: Overall, four main clinical trials have been carried out for vericiguat namely the SOCRATES-REDUCED, SOCRATES - PRESERVED, VICTORIA, and VITALITY. Vericiguat resulted in reduced CV death and HF hospitalization in patients with HFrEF and a recent episode of cardiac decompensation.

Heart failure remains a significant cause of global morbidity and mortality. The identification of accurate prognostic markers can be pivotal in patient management. Galectin-3 (Gal-3), a biomarker, has recently been studied for its potential in assessing heart failure prognosis.A comprehensive assessment of heart failure patients was conducted, focusing on demographics, clinical features, and biomarker evaluations. Galectin-3 levels were central to this analysis. Advanced statistical tools, including Pearson’s correlation and ROC analysis, were employed to analyze the data. A marked variability was observed in Galectin-3 levels based on clinical parameters. Notably, patients with three chambers dilated presented the highest average Gal-3 levels at 109.67 ± 96.111. The mean distribution of Galectin-3 levels on patients who died was 106.3 compared to patients who were alive was 55.46. The mean distribution of Galectin-3 levels of patients who were intubated was 84.04 as compared to non intubated patients , were 57.03. The mean galectin 3 levels in stage 3 of breathlessness was 61.06 ± 44.35  and in stage 4 of breathlessness was 82.73 ± 56.57 correlating the severity of breathlessness with high Galectin levels.Galectin-3 stands out as a crucial prognostic biomarker in heart failure patients, offering valuable insights into patient management and potential outcomes. death. In patients with deteriorating HF, measuring galectin-3 could be a key component in prognostic utility for in hospital mortality.

Background: Early-onset type 2 diabetes in adults is associated with more progressive cardiovascular disease than late-onset type 2 diabetes. The correlation between diabetes and cardiovascular disease (CVD) is well established, with CVD being the leading cause of death among individuals with diabetes. Young-onset diabetes is associated with an elevated risk of cardiovascular and microvascular complications. This study aimed to assess the prevalence of cardiovascular complications in individuals with early-onset type 2 diabetes. Methods: This observational study was conducted on 100 adult patients diagnosed with diabetes based on ADA criteria. Blood and urine investigations were performed, and cardiovascular abnormalities were evaluated using electrocardiography and echocardiography. Data were analyzed using Epi Info and descriptive statistics, including means and percentages, were calculated. Results: The mean duration of diabetes among the participants was 2.97 ± 1.64 years. Overweight status was observed in 49% of the patients, with 30% classified as having grade I obesity. Myocardial infarction was present in 15% of the patients with diabetes, while 9% had metabolic syndrome. Polycystic ovarian syndrome, gestational diabetes, hypothyroidism, smoking, and alcohol use were reported in 3%, 6%, 6%, 21%, and 3% of the patients, respectively. Electrocardiogram findings were normal in 82% of the patients, with 6% showing left ventricular hypertrophy along with ST depression and T inversion. Conclusion: The study concludes that myocardial infarction is a prevalent cardiac complication in early-onset diabetes mellitus. Male sex, metabolic syndrome, and elevated triglyceride and cholesterol levels are significant factors associated with myocardial infarction in early-onset type 2 diabetes. Screening and appropriate treatment are recommended for these patients.

Background: Diabetes is a chornic disease that affects 463 million people world wide over the age of 20 years and is expected to affect more than 570 million by 2030. Like other organs, lung is also affected in diabetes mellitus due to the presence of extensive microvasculature and abundant connective tissue. (1) The prevalence of defective pulmonary function in asymptomatic diabetic patients is more than generally thought, involving 60% of adult cases. Early detection of pulmonary changes in diabetic patients through routine Pulmonary function testing (PFT) check-up may help in planning strategies to delay the progression of cardio-respiratory complications Hence the present study was planned to assess the pulmonary functions in the Pre-diabetes. Aim: This study was conducted to determine the pulmonary function test parameters like FVC, FEV1 in Pre-diabetes. Materials and Methods: This study was conducted in the teaching hospital of Adichunchanagiri Institute of Medical Sciences (AIMS), B.G. Nagara, Mandya after the institutional ethical clearance and written consent from each participant. The present study was a case control study consisting of 30  cases and 30 controls in the age group of 20-40 years. FVC and FEV1was recorded. Results: The parameters thus recorded was analyzed for statistical significance using Students‘t’ test and p <0.05 was considered the level of significance. FVC and FEV1 were significantly decreased at (p < 0.001**) in the the Pre-diabetes. Conclusions:  The results of this study indicate that pulmonary function test is  decreased in the Pre-diabetes stage itself

Liver cirrhosis is a disease causing significant morbidity and mortality. Mortality in liver cirrhosis is mainly due to complications which are seen in decompensated stage. Incidence and prevalence of fungal infections are increasing especially as opportunistic infections in those with decompensated liver failure as a result of a pre-existing immunocompromised state. There is a low index of suspicion for infections in such patients due to lack of classical clinical features, hence it is being missed or diagnosed late. Hence, we performed this study to analyse the spectrum of infections in liver cirrhosis patients as well as the risk factors associated with it. Materials and Methods: This is a prospective observational study performed in a tertiary care centre. It included 125 known patients of liver cirrhosis with a clinical evidence of infection. In a semi-structured pro forma, presenting complaints, history of comorbid illnesses, past hospitalizations and medication intake were noted. Statistical analysis was done with SPSS v15. Results: We observed that 46 patients(36.8%) had bacterial growth, 4 patients (3.2%) had fungal growth and 12 patients(9.6%) had mixed growth (bacterial and fungal). Most common sources of infection was urinary tract (25.8%) and multisystem infection (25.8%) followed by respiratory tract infection-24.1%. The most common bacterial organisms isolated were Klebseilla (25%), and most common fungal was Candida albicans-8 (42%). 18 patients expired during hospital stay; decompensated liver disease with hepatic encephalopathy was the most common cause (33.3%). Conclusion: In patients diagnosed with CLD having underlying infections, factors like hypoalbuminemia and diabetes can further impair the immune status, worsening the decompensation. In this study we also identified certain specific risk factors like diabetes, hypoalbuminemia and other immunocompromised state. Hence, we recommend treating patients with culture-guided antibiotics/antifungals to improve outcomes.

Background:  Oral Sub Mucous Fibrosis (OSMF)   is a chronic, debilitating disease characterised by juxtaepithelial fibrosis of the oral cavity.  It is a precancerous condition-  a generalized pathological state of the oral mucosa associated  with a significantly increased risk of oral cancer . Lipids are major cell membrane components . The changes in  serum lipid levels have long been associated with cancerous and precancerous conditions .So this study is aimed to evaluate the plasma lipid profile in OSMF patients. Objectives. The present study aimed to evaluate the alteration in serum lipid profile in  OSMF and to compare them with healthy controls and to correlate the relationship between pathogenesis of OSMF and lipid profile. Materials and methods: It is a case control study. The study included 100 diagnosed  cases of OSMF and 100 matched healthy controls. Fasting venous blood of 3 ml was collected in both cases and controls and serum was separated . Fasting serum lipid profile including Total Cholesterol (TC), Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL) and Tri-Glycerides (TG) were measured using automated  analyser. Statistical analysis was done using student 't' test. Pearson's correlation  was performed to establish the relationship between study variables. Results : The plasma total cholesterol, TG, LDL, VLDL and HDL levels were significantly reduced  in patients with OSMF  as compared to the control group.(p<0.005). Conclusion : Our study  indicates that there is an inverse relationship between OSMF  and serum lipid profile. Decrease in the lipid levels may be considered as a valuable biochemical marker in the early diagnosis and prognosis of  oral malignancy.

In Algeria as at the global level, the incidence of cancers differs according to sex since the most common in men is colorectal cancer and in women breast cancer. All sexes combined, lung cancer, colorectal cancer, breast cancer and prostate cancer represent the four deadliest cancers with an overall cancer mortality estimated at 32,802,4116 (12.5%). Cardiovascular diseases represent the first cause of death. All these diseases have known risk factors and mortality can be reduced significantly by acting only on these risk factors Despite these very different clinical manifestations, the development of cancer and cardiovascular diseases, however, calls for a similar phenomenon: chronic inflammation. This was particularly well illustrated by the results of the CANTOS study, where it was shown that an antibody neutralizing the inflammatory protein interleukin-1b reduced both the risk of cardiovascular mortality and cancer. This common reliance of cancer and cardiovascular disease on chronic inflammation also explains why the set of lifestyle habits that promote the development of inflammatory conditions (smoking, physical inactivity, poor diet, obesity, diabetes) are so common risk factors for cancer and cardiovascular disease. Cancer and cardiovascular diseases are respectively the first and second cause of death in Algeria, being alone responsible for about 60% of all annual deaths, the aim of our study is to determine the common risk factors of colorectal cancer. and cardiovascular diseases in subjects over 50 years old in a representative sample of the population of Bejaia. During the study period, a total of 3002 citizens were included, 1735 (43.38%) people from the population of the daïra of Souk el Tenine, 375 (12.5%) people from the daïra of Adekar and 892 (29.7%) from the daïra of Amizour. The age group of the highest study population is between [50–54] years, then the age group between [60-64] years. The comorbidities found in our target population are: hypertension in 29.3%, diabetes in 22.2%, obesity in 32.35% and dysthyroidism. This survey made it possible to highlight the extent of risk factors for cardiovascular disease and diabetes, obesity, and colorectal cancer in the population studied. The results obtained will serve as baseline data for monitoring the most prevalent non-communicable disease prevention and control indicators in this region.

Background:  Neurotuberculosis, particularly tuberculous meningitis (TBM), poses a significant threat to pediatric populations, often leading to severe morbidity and mortality. Timely diagnosis and intervention are critical for improved outcomes. Neuroimaging, including CT and MRI, play a crucial role in identifying characteristic features of TBM, such as basal hyperdensities, hydrocephalus, and periventricular infarcts. Transcranial Doppler (TCD) is an emerging tool, offering real-time, non-invasive assessment of cerebral hemodynamics. Limited research has explored the role of TCD in TBM-related vasculopathy. Methodology: A prospective study conducted from August 2019 to July 2020 included 60 pediatric TBM patients. Diagnosis followed the Consensus clinical case definition. TCD was performed serially on days 1, 3, and 7, and findings were compared with CT. Disease severity was graded using the Modified British Medical Research Council (MRC). Statistical analysis was performed with a significance level set at p < 0.05. Results: The study identified a positive correlation between TCD findings and disease stage, with 52.5% of subjects exhibiting normal Doppler studies. Abnormal findings included stenosis in 37% of cases, primarily involving the middle cerebral artery (MCA). The correlation between TCD and CT angiography (CTA) was highly positive, with TCD demonstrating a sensitivity of 91.7%, specificity of 85.7%, and overall accuracy of 87.5%. Discussion: The findings underscore TCD's effectiveness in early diagnosis and monitoring of cerebral vasculopathy in pediatric TBM, particularly in identifying stenotic areas. The positive correlation between TCD and disease stage supports its utility as a reliable tool in assessing disease progression.

Background:  Childhood blindness, defined by the World Health Organization (WHO) as visual acuity less than 3/60 or corresponding visual field loss, poses a significant public health challenge globally, affecting not only individuals but also families and communities. This study aims to explore the prevalence, causes, and associated factors of childhood blindness, emphasizing the WHO's criteria for blindness in individuals below 16 years. Methodology: This prospective observational study focused on children below 16 years with visual acuity less than 6/60 in their better eye. Thorough examinations were conducted at SLN Medical College and Hospital, and data were analyzed to determine the clinical profile, including age and sex distribution, risk factors, and causes of childhood blindness. Results: Between 2019 and 2020, 50 cases of childhood blindness were examined, resulting in an institution-based prevalence of 1.11 per 1000 patients. Females constituted 54%, and 66% of cases were from rural areas. Malnutrition (30%) emerged as a significant risk factor, and corneal causes were predominantly associated with preventable factors (53.2%). Trauma accounted for 14% of cases, with a higher prevalence among males (71.42%). Discussion: Consistent with WHO criteria, this study found a prevalence of childhood blindness comparable to national surveys. The age-wise distribution reflected trends observed in previous studies, with a notable concentration in the 0-5 age group. Socioeconomic factors, including low income and illiteracy, were associated with a higher prevalence of childhood blindness. Preventable and treatable causes constituted 53.2%, emphasizing the potential for targeted interventions. Conclusion: Childhood blindness remains a significant public health concern, with a substantial portion being preventable or treatable. Efforts should focus on raising awareness, particularly in rural areas, and improving healthcare accessibility to reduce childhood blindness. Malnutrition and Vitamin A deficiency persist as major contributors, warranting targeted preventive measures. Public education on risk factors is essential for mitigating the impact of childhood blindness.

Background: To assess the effect of Magnesium sulphate on hemodynamic response and its analgesic effects in patients undergoing laparoscopic cholecystectomy. Methods: A prospective randomized single blinded study was carried out in 90 patients of ASA grade I and II, aged between 20 to 60 years weighing >50kgs scheduled for laparoscopic cholecystectomy. The patients were randomly allocated into three groups based on sealed envelope method as: Group B received Inj.Bupivacaine 0.25% 40 ml alone, Group BM received Inj.Bupivacaine 0.25% with Inj .Magnesium sulphate 15mg/kg total volume of 40ml, Group NS received Inj. Normal saline 0.9% 40ml at the conclusion of surgery.  Results: Time for first analgesic request was prolonged in Group BM (676 +/-29.55 min) when compared to Group B (406 +/- 26.6 min) and Group NS (46.67 +/- 9.32 min). Total number of tramadol doses consumed in 24hours were higher in Group NS compared to Group B and Group BM (p-value <0.001). Time duration in the ward was significantly reduced with Group BM when compared to Group NS and Group B (p-value <0.001).There were no significant haemodynamic adverse effects. Conclusions: Magnesium sulphate as an adjuvant to bupivacaine provided longer duration of analgesia when compared to bupivacaine alone and normal saline.

Background: Vitiligo is characterized by skin depigmentation as a result of destruction of melanocytes in the affected areas. Although the pathogenesis is not fully understood, it is considered as an autoimmune disease. Association with other autoimmune conditions such as pernicious anaemia, alopecia areata, systemic lupus, and thyroid disease has been established. Vitamin D3 is an essential vitamin for humans. The majority of its active form is obtained through activation of the pre-vitamin D3 formed in the skin after sun exposure particularly UVB (290–320nm). Diet is only a minor source for this vitamin. This vitamin has a significant role in immunity (innate and adaptive), calcium regulation, and melanin synthesis; in addition, many diseases have been associated with reduced vitamin D levels. Materials and methods: The study included 35 diagnosed vitiligo patients attending Dermatology OPD from 1st January 2023 to 31st December 2023. 50 healthy controls were also recruited after required matching was done based on demographics (age & sex) and skin phototype. Through clinical history and physical/woods lamp examination, the expert dermatologist established/ refuted the diagnosis of vitiligo. None of the patients required biopsy for confirmation. Patients data were recorded, which included (but was not limited to) age, sex of the patient, skin phototype and sunscreen usage. Detailed history about the disease and family history were obtained. Result: The majority of cases were that of vitiligo vulgaris (VV) subtype (54.3%), followed by acrofacial/ liptip vitiligo (42.9%) and focal vitiligo (2.8%). There was no statistically significant difference in vitamin D levels between the different types of vitiligo. There was no statistically significant difference in vitamin D levels within the case group with respect to age, gender, duration of illness or associated autoimmune condition. All patients had Fitzpatrick type V skin phototype. None of the recruited cases had any family history of vitiligo. Conclusion: Very low 25-hydroxyvitamin D levels (<15 ng/mL) appear to be a reasonable screening tool for the presence of comorbid autoimmunity. Furthermore, we demonstrate that Fitzpatrick phototype, rather than ethnicity, is specifically associated with 25-hydroxyvitamin D levels that are insufficient (<30 ng/mL).

Background:  To evaluate the efficacy and safety of the Tranexamic acid in hip fracture surgery patients. Method: Consecutive hip fracture 50 patients eligible for the study were randomised to TXA and Placebo group. TXA group received 1 gram of tranexamic acid in 100 ml NSIV and placebo group received 100 ml NS IV, given 10minutes before incision and same dose is repeated just before the skin closure. Primary outcome measures were: Total perioperative calculated blood loss, fall in haemoglobin at postoperative day two, blood transfusion rate, total drain output. Secondary outcome measures were: Analysis of Thromboembolic complications within 4 weeks after surgery. Results: Twenty-five patients each in TXA group and Placebo group are included in the study. Total perioperative blood loss was significantly lower in the TXA group than in the Placebo group (374±78.2 mL vs. 601.2±125.3 ml;P < 0.030). Postoperative PRBC transfusion rate was significantly lower in the TXA group than in the Placebo group (4/25,16 % vs. 10/25,40 %;P=0.025). Patients who received TXA had lesser fall in haemoglobin on Postoperative day 2 (0.5±0.8 vs. 2.1±2.7; P= 0.031) than the control group and this was statistically significant. Mean volume of blood in the drain was 35.43 ml as compared to 95.24 ml in placebo group showing a highly significant reduction in postoperative blood loss(P=0.02). None of the patients in both the groups were found to have any thromboembolic events after surgery. Conclusion: The present randomised study demonstrated that the administration of TXA reduces the total Perioperative blood loss, postoperative anaemia and need for transfusion in patients undergoing surgeries for hip and has no significant effect on the risk of symptomatic thromboembolic events. However further research is necessary to determine effectiveness, safety and usage of Tranexamic acid in high-risk patients.

Background:  Chronic liver disease (CLD) and its complications are becoming a major public health problem. The relation between trace elements and chronic liver disease has been studied in recent times. Objectives of the study: To study the levels of various trace elements like copper and zinc in cases of CLD and to compare and correlate them with healthy controls. Materials and methods: This was an observational case control study conducted in department of Medicine of KIMS Koppal for a duration of 18 months. A total of 100 subjects were prospectively included in the study (50 cases of CLD and 50 matched controls). The concentration of trace elements like serum zinc and copper were measured in all subjects and correlated. Results: There was significant reduction in the levels of zinc whereas copper levels were significantly increased in chronic liver disease. Conclusion: The functions of trace elements like coper and zinc  have a dual role. In normal levels, they are important for stabilization of the cellular structures, but in deficiency states may stimulate alternate pathways and cause diseases. These trace elements have clinical significant and these can be estimated using different analytical method.

Background:  This study was conducted to evaluate the diagnostic value of CT enterography using mannitol as a negative contrast agent for demonstrating and diagnosing bowel diseases and correlating it with the histopathological diagnosis. Methods: This was a hospital-based prospective cross-sectional observational study conducted among 60 patients with suspected bowel pathologies in the Department of Radiology, Mysore Medical College and Research Institute, attached to K. R. Hospital, Mysore, over a period of 18 months from January 2021 to June 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Of the 60 patients studied, 35 were males and 25 were females, with a slight male predominance. Most of the patients with benign lesions were in the age group of 30-39 years and those with malignant lesions were in the age group of 50-59 years. Most of the patients had bowel distension grade 3 (>80%) and grade 2 (50-80%), suggesting bowel distension was excellent in most of the patients. Sensitivity, specificity, positive predictive value and negative predictive value of CTE in the diagnosis of benign intestinal diseases were 97%, 93%, 97%, and 93% respectively and sensitivity, specificity, positive predictive value and negative predictive value of CTE in the diagnosis of malignant intestinal diseases were 93%, 97%, 93% and 97% respectively. Conclusion: CT enterography is an acceptable and applicable modality in routine practice in the diagnosis and differentiation of bowel pathologies and also in differentiating benign from malignant lesions. The taste of mannitol is good, acceptable, and tolerable, all of which helped in achieving adequate luminal distension and a good quality of image with the fewest artefacts.

Background:  This study was conducted to determine the clinico-etiological profile and outcome of hyponatremia in elderly hospitalised patients. Methods: This was a hospital-based observational study conducted among 50 patients aged more than 50 years who were admitted to the Department of General Medicine, Narayana Medical College, Nellore, with hyponatremia, over a period of 18 months from December 2019 to May 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Out of 50 subjects, the majority were from the age group of 71–80 years (62%), and males (64%) were comparatively more compared to females (36%). The most common co-morbidity was hypertension (46%), followed by f/b diabetes mellitus (34%). Among the CNS symptoms, altered sensorium is the most common (36%). Of the individuals, 58% had euvolemia, 24% had hypervolemia, and 18% had hypovolemia. SIADH was the most frequent cause (48%). Pneumonia was the second most common cause of SIADH after a cerebrovascular injury. In participants who did not exhibit any symptoms, hypervolemia was more evident than euvolemia and hypovolemia. Using the chi square test, the comparison of hydration status based on symptoms was determined to be statistically significant at p<0.05. In our study, 12% of the participants reported having died, with hypervolemic subjects reporting a higher percentage (25%). Using the chi square test, mortality was compared according to hydration status; p > 0.05 indicated an insignificant difference. Conclusion: Hyponatremia with symptoms is frequent among hospitalized patients. Patients with hyponatremia frequently experience neurological symptoms. The study's largest subgroup was SIADH with euvolemic hyponatremia.

Background:  Physical exercise provides multiple benefits to an individual. Previous studies shows that reaction time was significantly lower after performance of exercise. Aims and Objective -The aim of this study is to compare Reaction Time both ART+VRT between healthy adolescents, performing daily physical exercise and not performing any exercise. Material and Method: -100 healthy adolescent subjects of age group 18 – 25 years were participated in the study out which 18 subjects were excluded due to illness or some other reasons, so the sample size was 82 out of which 41 subjects were those who performs any kind of exercise daily for at least more than 30 mins/day and rest 41 subjects were not performing any exercise as their routine activity. Their reaction time {both ART+VRT} were taken with the help of reaction time apparatus and there mean reaction time was compared. Result –‘t test’ for equality of means was applied for VRT and ART which shows that result was significantwith p value < 0.05. Thus person who perform any kind of physical activities or exercise has better reaction time than those who have sedentary lifestyle. Conclusion: Present study suggests that exercise is beneficial to people in their daily lives because it influences reaction time abilities.A short course of any type of exercise has a beneficial effect on the reaction time and it can be used as a tool for improving the reaction time. Physical exercise affects brain plasticity, influencing cognition and wellbeing.

Background:  Many evidences have been suggested the psychiatric illness associated with the internet usage. As the internet and smart phone usage has been observe to be increased since few years, we had conducted the present study to analyse the severity of internet addiction and its correlation with the various psychiatric illness. Methods: A cross-sectional study, 400 medical students, 100 each from first, second, third and final year were included. Young Internet Addiction Test, Depression, Anxiety, and Stress Scale 2021 and Insomnia severity index were used as tool for analysis. Results: The average age of the study participants was 20.91±5.8 years with male predominance. 36 (9%) of the participants were alcoholics. Internet addiction was observed among 53% of the study population followed by Depression among 46%, insomnia among 40% and stress was observed among 33% of the students. 100 (25%) with moderate grade. 84 (21%) and 28 (7%) had mild and severe grade of internet addiction respectively. 23% had moderate depression followed by 13% with mild depression and 12 of them were extremely depressed. 23% of them had moderate anxiety, followed by 52 (13%) had mild anxiety. The rest 28 (7%) and 12 (3%) had severe and extremely severe anxiety. 76 (19%) had Sub-threshold insomnia followed by 68 (17%) with Moderate insomnia and 16 (4%) had Severe insomnia. All the psychiatric signs and symptoms had positive correlation with the internet addiction score.  Conclusion: Incidence of Internet addiction is more among the medical students and it has strong positive correlation with the depression anxiety stress and insomnia

Background:  This study was conducted to compare the lung ultrasound with the chest x-ray in the diagnosis of patients admitted to the critical care department with acute respiratory failure. Method: This was a hospital-based prospective observational study conducted among patients aged 18 years and older who presented with acute respiratory failure to the Department of Critical Care Medicine, Baby Memorial Hospital, Calicut, Kerala, over a period of 18 months, from April 2020 to September 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In USG diagnosing efficiency among CXR-diagnosed cases, 95.5% of CXR pathology found cases were identified by USG. But 72.7% of CXR pathology not found cases were also identified as pathology present. This association was statistically significant. (P<0.05). In CXR diagnosing efficiency among USG-diagnosed cases, 91.4% of USG pathology found cases were identified by CXR. But 72.7% of USG pathology not found cases were also identified as pathology present on CXR. This association was statistically significant. (P<0.05). Conclusion: Patients on mechanical ventilation have to get a chest ultrasound and x-ray as soon as possible. After that, chest ultrasonography can be performed to follow-up on imaging for patients who are clinically stable. Routine, regular chest x-rays can be replaced with USG follow-up to reduce unnecessary radiation exposure to the patient and ICU staff. When a patient's clinical state worsens, chest x-rays can be taken again and compared to fresh ultrasonographic results.

Migraine is a common cause of disability and loss of work. Migraine attacks are a complex brain event that unfolds over hours to days, in a recurrentmanner.A high frequency of migraine attacks can lead to frequent intake of acute medication, which may result in medication- overuse headache. Therefore, prophylaxis of migraine is justified as an important goal. Objective: To study and compare the clinical effectiveness and side effects of various migraine prophylactic drugs. Materials and methods: The patients fulfilling the inclusion and exclusion criteria were enrolled into this randomized, single blind study carried out in the patients visiting the Neurology OPD of Gauhati Medical College and Hospital, Guwahati from November 2022 to October 2023and were prescribed one of the following migraine prophylactic drugs-propranolol, amitriptyline, divalproex and desvenlafaxine .The initial four weeks were used for drug dose titration to minimum effective or maximum tolerable dosage and after optimal dose titration, the following 12 weeks were used to assess the efficacy of the drugs. MIDAS(Migraine Disability Assessment Score) questionnaire and Headache Impact Test- 6(HIT-6) along with drug diary were used to assess the pre and post drug intervention quality of life which will help in assessing the efficacy of the drugs being used. Results: The study had a total of 100 patients with a median age of 28 years, with most of the patients presenting in the third decade of life.  The male to female ratio was 1:2.3. The mean MIDAS scores at day 0 and at 3 months for the propranolol group were 18.9 and 7.20 ; for amitriptyline group it was 16.43 and 8.21, for divalproex it was 16.28 and 9.77, and for desvenlafaxine it was 17.5 and 8.5 respectively. The mean HIT-6 scores at day 0 and at 3 months for the propranolol group were 54.52 and 41.60 ; for theamitriptyline group it was 52.85 and 45.33, for divalproex it was 53.2 and 44.71, and for desvenlafaxine it was 52.18 and 42.26 respectively. All the 4 groups had comparable reduction in headache burden and number of headache days permonth based on mean MIDAS and HIT-6 scores. Conclusion: All the 4 groups had comparable reduction in headache burden and number of headache days per month based on mean MIDAS and HIT-6 scores and on t-test there was no significant difference in the mean scores between the groups indicating similar efficacy of the drugs used in the study. There were no adverse or side effects noted in any of the patients.

Background:  Anemia commonly aggravates the severity of respiratory diseases, whereas thus far, few studies have elucidated the impact of anemia on coronavirus disease. Anaemia can also occur as a protective mechanism in certain acute immune activation, to prevent the virus from invading the organs. Aim: The aim of this study was to evaluate the covid 19 patients with anemia, and to further explore the relationship between anemia and the severity of COVID‐19. Materials and Methods: In this single‐center, retrospective, observational study, a total of 972 confirmed patients admitted to Govt Medical College Ernakulkam, were grouped into 3 classes A, B, C according to their severity & Hb level was estimated & recorded. Data was analysed by descriptive statistics and results reported as mean and SD or median and interquartile range (IQR), depending on each variable value distribution, differences between groups. Results: Anaemia was significantly related to comorbidities present during admission, severity class  & complications.  Decrement in Hb level was seen in patients who had a  very serious disease & poor outcome. Conclusion: Anemia is an independent risk factor associated with the severe illness of COVID‐19, and healthcare professionals should be more sensitive to the hemoglobin levels of COVID‐19 patients on admission. Awareness of anemia as a risk factor for COVID‐19 is of great significance.

Background:  Chronic suppurative otitis media (CSOM) is one of the commonest illnesses which require urgent medical treatment especially in children’s of poor socio-economic status. The aim of present study was conducted to evaluate the different aerobic and anaerobic microorganisms causing csom in paediatric and adult patients and their antimicrobial sensitivity pattern as a guide to therapy. Materials and methods: A total of 106 clinically diagnosed cases of csom patients were included in the study, out of which 74 patients belong to paediatric csom and 32 cases were adult csom. From all the patients 106 samples were collected aseptically and processed according to standard CLSI Guidelines. Results: Out of 74 paediatric csom patients,68 patients (91.89%) were bacterial culture positive while out of 32 adult’s csom patients, 26 patients (81.25%) were culture positive. Bilateral csom was slightly more common in adults than paediatric age group. Polymicrobial nature of csom was noted in both paediatric and adult cases while number of organisms isolated per lesion was slightly higher in adults as compared to paediatrics cases. Staphyloccocus aureus was the commonest aerobic isolate in paediatric age groups csom, while in adult Pseudomonas aeruginosa was the commonest one. Among anaerobic culture Peptostreptococcus spp was commonest in paediatrics csom whereas Prevotella melaninogenica in adult csom. Sensitivity of S. aureus to Doxycycline, Clindamycin, Linezolid were 100%, piperacillin + Tazobacatum 94.59%, cefuroxime was 86.48% while that of gram negative bacilli was higher to cefuroxime, ceftriaxone, Azithromycin, Clindamycin, Doxycycline 90 to 100%. Among anaerobes higher sensitivity was seen to metronidazole (100%), clindamycin (100%) and ceftriaxone (100%). Conclusion: In view of the polymicrobial etiology of csom, prompt appropriate antimicrobial therapy can effectively reverse the disease process thereby preventing longterm sequelae.

Background:  ST-segment elevation myocardial infarction (STEMI) is a life-threatening emergency. Although primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy, a large proportion of patients from less developed areas in China are still unable to present or be transferred to a hospital with PCI capacity within the required time frame. A previous study reported that less than half of hospitalized patients with STEMI from military hospitals received primary PCI in China. Materials and Methods: This is a retrospective observational study. Case records of patients presenting to ICCU with chest pain, diagnosed as acute STEMI, in whom primary PCI was not feasible within 120 minutes of diagnostic ECG. Study was conducted on 50 patients in Department of Emergency Medicine, Sri Siddartha Medical College and Research Centre, B.H Road, Agalkote, Tumkur, Karnataka from January 2023 to December 2023. Protocol- Inj. Tenecteplase, Adjuvant Medication as per Physician’s instructions. Results: 50 patients of STEMI are studied in Department of Emergency Medicine, Sri Siddartha Medical College and Research Centre, B.H Road, Agalkote, Tumkur, Karnataka, India, with the above criteria. The rate of Clinically Successful Thrombolysis (CST) with tenecteplase was 92%. Those who received within 3 hours of symptoms was 94%. Those who received between 3-6 was 89% and those after 6 hours was 84%. STE resolution was observed in 94% of patients. Within 90 minutes, STE resolution was 91%. Mean time for resolution of STE was 70 minutes. 92% has relief of chest pain. Mean time of chest pain relief was 58 minutes. Within 30 minutes, 35% of patients had relief of chest pain. Reinfarction occurred in 2% of patients. 3 patients died before discharge. No incidence of Hypotension was observed. The incidence of bleeding excluding ICH is 2%. Incidence of stroke is 2%. Conclusion: Thrombolytic therapy is an evidence-based treatment for STEMI. Our study further reinforces the safety and efficacy of tenecteplase in Indian STEMI patients. Our study reconfirms the importance of early thrombolysis for successful thrombolysis, especially in Indian scenario where reaching PCI centre may not be immediately possible.

Background: This study was conducted to compare intrarenal arterial Doppler in patients with obstructed and non-obstructed kidneys and to assess the diagnostic value of this procedure in cases of renal obstruction. Methods: This was a hospital-based prospective study conducted among 50 patients with symptoms of acute renal obstruction who attended the Department of Radiodiagnosis at Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, over a period of 18 months from June 2021 to November 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age of the patients was 36.9 ± 14.2 years. The mean RI value of the right obstructed kidney was 0.74 and the non-obstructed kidney was 0.62, and the left obstructed kidney was 0.74 and the non-obstructed kidney was 0.62. The p-value showed statistical significance. The mean DELTA RI between obstructed and non-obstructed was 0.12. Sensitivity: 96.3%, specificity: 91.3%, positive predictive value: 92.86%, negative predictive value: 95.45%, and diagnostic accuracy: 94%. Conclusion: The Doppler USG has an overall 85% sensitivity and 96.3% specificity in identifying acute renal obstruction when the discriminating threshold value of RI≥0.70 is used. The accuracy of ultrasonography in the evaluation can be increased by using renal Doppler recordings, which can demonstrate altered renal perfusion prior to pelvicalyceal system dilatation. This makes Doppler studies a viable diagnostic tool in cases of suspected acute unilateral renal obstruction. For patients who report acute renal colic, Doppler US should thus be used as an adjuvant test in addition to gray-scale sonography.

Background:  Airway assessment is a vital part of pre-anesthetic evaluation. Amongst numerous existing methods for airway assessment, Modified Mallampati Score (MMS) is the most commonly used. The pitfall lies in the patient to actively perform a mandatory action, which is difficult in unconscious and moribund patients. Ultrasonography of upper airway requires less patient cooperation and might add to the value of traditional airway assessment. Aim: To evaluate whether the ultrasonographic measurement of maximal tongue thickness (MTT) and hyoid bone visualization predicted difficult laryngoscopy and intubation and to evaluate the correlation of MTT with other clinical parameters. Materials and Methods: This prospective observational study was conducted in 100 patients aged 18 to 70 years of ASA physical status 1 to 3. Ultrasonographic measurement of MTT and visualization of hyoid bone was done with patient lying supine in ‘sniffing position’ preoperatively. MTT was measured using a curvilinear probe in the median sagittal plane. Hyoid bone was visualized using a linear probe placed in the mid sagittal plane. After induction of anaesthesia and muscle relaxation, difficulty for laryngoscopy and intubation was assessed. Results: In our study, independent predictors for difficult laryngoscopy and for difficult intubation were MTT of ≥5.97cm and ≥6.54cm, respectively. Significant correlation between MMS and MTT was noted. Visualization of hyoid bone had no predictive value for difficult laryngoscopy and intubation. Conclusions: Our study concluded that MTT is an independent predictor of difficult laryngoscopy and intubation.There was a positive correlation between MTT and MMS.

Background:  Cutaneous tuberculosis is an important infectious public health problem in India. The incidence has dropped from 2% to 0.1%, making it a rare finding in clinical settings. Due to paucibacillary character of this illness and its resemblance to other dermatoses, making it challenging to diagnose. The present study was done to report the various clinical types of cutaneous tuberculosis. Material and Methods: All the clinically suspected cases of cutaneous tuberculosis attending the dermatology OPD of our tertiary care hospital during a period of one year (May 2022 to May 2023) were enrolled in the study. They were subjected to routine blood tests, Chest X- ray, HIV, Mantoux test and skin biopsy done for confirmation. Results: During a study period of 12 months, a total of 25 patients were diagnosed as cutaneous tuberculosis. Male to Female ratio was 1.3:1. Commonest type was Lupus vulgaris (48%) followed by Scrofuloderma (20%), Tuberculosis verrucosa cutis (8%), Erythema nodosum (8%),    Papulonecrotic tuberculid (8%), Erythema induratum of Bazin (4%), Lichen scrofulosorum (4%). In this study most cases are middle aged adults, the youngest was 13-year-old girl, oldest was 70-year-old male. Commonest site were limbs followed by trunk. One patient had pulmonary tuberculosis. All patients were responded to standard antitubercular treatment. Conclusion: Cutaneous tuberculosis remains an important medical problem despite the development of extremely potent anti-tuberculous medications. This case study demonstrates the importance of diagnosing a case of cutaneous tuberculosis in patients presenting with a suspicious skin lesion.