European Journal of Cardiovascular Medicine

Background: In prospective studies employing troponin assays in ACS, troponin-T and troponin-I have demonstrated to predict long-term risk for adverse cardiac events and to have diagnostic accuracy on par with, if not superior to, creatine kinase-MB. Recent prognostic studies have demonstrated that myocardial injury at initial presentation has a major role in determining both short- and long-term mortality as well as the probability of future reinfarction. Assays for cardiac-specific troponin-T (TnT) and troponin-I are very sensitive in identifying cardiac injury. Aims: To study the prognostic significance of troponin T in patients diagnosed to have unstable angina during their study in the hospital. Methods:A prospective longitudinal study was conducted in the medicine department of Vinayaka Missions Kirupananda Variyar Medical College Hospital, Salem, for a period of one year between May 2020 and April 2021. All patients over the age of 18 with chest pain or symptoms suggestive of unstable angina and a blood sample showing troponin positivity were included in the study. A total of 50 patients were included in the study. A semi-structured questionnaire was designed to collect information regarding socio-demographic details and symptoms related to their presenting illness at the time of admission. All the routine blood investigations were performed. An ECG was taken on all the study subjects to confirm the feature of unstable angina. Troponin T levels were measured in all the study subjects. The cut-off used in our study for a positive TnT assay was > 0.05 ng/ml. All the cardiac events that occurred during their hospital stay were recorded. Results:The majority of the study subjects had troponin T levels between 0.11 and 0.15 ng/ml, and only 6% of the subjects had troponin levels >0.2 ng/ml, and the mean troponin T level was 0.14 ng/ml. There was a statistically significant association between the troponin T levels and the occurrence of cardiac events; as the levels of troponin T increased, the incidence of infarction also increased. A statistically significant association was seen between death and high troponin T levels. This proves that troponin T levels predict the prognosis of patients with unstable angina. Conclusion: Our study concluded that an increased troponin T substantially increases the short-term risk of cardiac events, such as mortality and MI, in individuals with unstable angina or suspected myocardial ischemia.

Background: Alignment of the femoral and tibial components is a major independent indicator of implant survival. The placement of a lateralised tibial jig can increase the precision of the tibial cut. The aim of this study was to investigate whether lateralization of the lateral tibial plateau reference point influences proper coronal plane alignment of the complete knee prosthesis after surgery, based on the degree of tibia vara.

Methods:This observational prospective study included 19 patients with tibia vara who were receiving primary TKA (Total Knee Arthroplasty) for osteoarthritis of the knee. The main outcomes that were assessed were the tibia vara, the postoperative tibiofemoral angle, and the degree of lateralization of the tibial plateau reference point (and its relationship to the magnitude of the tibia vara). The AKSS (American Knee Society Score) was used to measure postoperative outcomes. Results: Pre-operative tibio-femoral angle mean (SD) in degree was 17.13 ± 6.04. Post-operative tibio-femoral angle mean (SD) in degree was 5.6 ± 1.38. The difference was statistically significant (p <0.001). The pre-operative tibia vara mean (SD) in degree was 9.89 ± 5.335. Post-operative tibia vara mean (SD) in degree was 0 ± 0. The difference was statistically significant (p <0.001). There was a significant, progressive improvement in the AKSS scores during the follow-ups compared to the preoperative scores. Linear regression analysis showed a very high degree of positive correlation between the amount of lateralization of the tibial reference point and the magnitude of the tibia vara (R2 = 0.526, p = 0.003) as well as the tibio femoral angle (R2 = -.440, p = 0.015). Conclusion: Reasonable accuracy can be achieved with the use of the extramedullary jig for tibial component alignment by lateralizing the proximal tibial reference point in patients with tibia vara, as evidenced by improvements in the AKSS score postoperatively and deformity correction.

Background: Psoriasis is a continuing, periodic, immune-mediated, fiery skin disease branded by hyper proliferation of epidermal keratinocytes and accompanying with inflammatory cellular infiltrate in both dermis and epidermis. Immunomodulation could be an important effect of vitamin D in Psoriasis. Vitamin D deficiency was found to be associated with psoriasis independently of gender, age, smoking status, family history, hypertension, chronic medication, nail changes, duration of symptoms and severity of disease. Vitamin D levels were seven times lower in patients with Psoriasis as compared to controls. Reduced vitamin D levels are related to duration and clinical severity of the disease. Early detection of vitamin D deficiency and timely intervention could lead to better clinical outcome and improved quality of life in psoriasis patients.  Materials and methods: This case–control study included thirty outpatients. Patients with psoriasis were selected consecutively from the dermatology outpatient department. The diagnosis of plaque psoriasis was made clinically. Inclusion criteria for patients were age between 18 to 60 years, not treated with oral and topical steroids, immunosuppressants and vitamin D supplements, not undergoing current phototherapy and presence of chronic inflammatory diseases like systemic lupus erythematosus, multiple sclerosis, inflammatory disease and malignancy. Result: The mean age of psoriasis in Group II was 38.95±3.95 years and 39.0±4.55 years in Group III. There is significant decrease in the level of serum vitamin D in moderate and severe patient groups compared with the control group whereas nonsignificant difference existed with group II. There is significant decrease in the level of serum vitamin D in severe cases than in each of mild and moderate cases. Also, there was no nonsignificant difference existed between mild and moderate cases. The mean vitamin D among Group II were 35.34±7.38 ng/ml followed by Group III  29.62±8.99 and in Group IV were 21.34±8.39 ng/ml. There is significant negative correlation between serum vitamin D and each of age, disease duration, and PASI score, whereas nonsignificant positive correlation existed with the age of onset of disease. Regarding sensitivity and specificity for vitamin D to diagnosis patients versus control: at a cutoff value of less than or equal to 41.28 ng/ml, the sensitivity was 95.5, specificity 82.0%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) was 82.0%. Conclusion: Decreased 25 OH vitamin D serum level was found in psoriatic patients. The 25 OH vitamin D serum level may be used as a marker of psoriasis severity and response to treatment. But PASI has higher sensitivity, specificity, PPV, and NPV for differentiation of psoriatic patients from controls, mild cases from moderate and severe cases, and severe cases from mild and moderate cases.

Introduction: Multifetal gestation is a high-risk pregnancy that leads to more maternal and fetal challenges because of the linked maternal and neonatal morbidity and mortality. The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). Aim and Objectives: To determine the maternal outcome in multifetal gestation. Material &Methods: The prospective observational study was carried in the department of obstetrics and gynaecology, Jorhat Medical College and Hospital, Assam from August 2023 to January 2024 included 50 women with multifetal gestation with gestational age of 28 weeks or more . All cases of multifetal gestation either admitted from antenatal clinics or from emergency labour room were included in the study. Results: These were recorded as per the proforma. Out of total 4744 births during this study period, 49 were twin pregnancies and 1 was triplet pregnancy. The incidence was 1.05%. In present study 62% of women are in the age group 21-29 years. Majority 80% were unbooked. 62% were primigravida. 12% women conceive after infertility treatment. Maximum 58% delivered between 29-36 weeks of gestation. Mostly 64% were dichorionic diamniotic twins.  Maternal complications observed were anaemia in 62%, preterm labour 58%, hypertensive disorders of pregnancy in 14% patients, PPROM and PROM in 14% and 12% respectively, APH in 6% and PPH in 10% patients. 38% cases were having both babies with cephalic presentation. Majority 62% delivered by LSCS and 38% delivered vaginally. Most common indication for LSCS is Malpresentation. No maternal mortality occurred. Conclusions: Our findings showed the importance of antenatal care playing a major role in the final outcome of multifetal pregnancy. Early detection of high-risk cases, timely referral, frequent antenatal visits and early hospitalization with optimum obstetrics care and intensive neonatal care set up are necessary to improve maternal and perinatal outcomes.

Background: Ectopic gestation is a gynaecological emergency. It causes significant maternal morbidity, mortality and hampers future conception. This study determines the incidence, risk factors, clinical features and management of ectopic pregnancy in a tertiary care centre. Methods: This was a cross-sectional observational study of 50 cases of ectopic pregnancies in a tertiary care centre from March 2023 to August 2023. A descriptive study was carried out after collecting information in a structured proforma. Results: The incidence of ectopic pregnancy found to be 1.394. 46% of patients belongs to more than 30 years of age. 36% were multiparous. Fallopian tube (82%) was found to the most common site. Previous history of abortion was most common risk factor accounting for 40%. A triad of amenorrhoea, pain abdomen and bleeding per vaginum was seen in 34% patients. Diagnosis was done clinically and by ultrasound, UPT, β-hCG estimation. Ruptured ectopic pregnancy accounted for 78%. 96% patient underwent surgical management, 2% underwent dilatation and evacuation and 2% were managed medically by 2 dose methotrexates. There was no associated maternal mortality. Conclusion: Ectopic pregnancy is a gynaecological emergency and is on rising trend. Women of reproductive age group should be educated about the risk factors and warning symptoms of ectopic pregnancy.

Background: Hematological parameters such as hemoglobin, white blood count (WBC), Mean Platelet volume, hematocrit (HCT), MCV, MCH, MCHC, RBC counts, neutrophil to lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) play significant role in progression of Diabetes mellitus. Aims: Purpose of this study is to evaluate hematological parameters in diabetic patients and compare it with the non diabetic healthy controls. Materials and Methods: One hundred twenty patients with type 2 diabetes mellitus and similar number of age matched healthy individuals served as the control group. Hematological parameters such as hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, NLR, platelets, platelet/lymphocyte ratio (PLR), and LMR were analysed in both the groups and compared. Results: One hundred twenty diabetic patients and same number of age matched healthy controls were enrolled. Majority of the cases (25%) and controls (26.3%) were 41-50 years age group, predominantly male 56.3% cases and 55% were control. BMI was significantly higher among diabetic cases as compared to control. Among hematological parameters: hemoglobin, RBCs count, MCV, MCH, MCHC and HCT were significantly lower whereas RDW, were significantly higher among diabetic patients as compared to control.  WBC count, lymphocytes, neutrophils counts and NLR were significantly higher in the diabetic patients, however, no significant differences were observed in platelet counts between patients and controls Conclusions: Hematologic parameters were significantly altered in diabetes mellitus patients can be utilized as cost-effective predictors of diabetic microvascular complications

Background: Hypernatremia is a significant concern in critical care settings due to its association with increased morbidity and mortality. However, there is a lack of detailed data regarding this issue specifically in Indian hospitals. This study aimed to assess the prevalence, associated factors, and outcomes related to intensive care unit (ICU) acquired hypernatremia in an academic hospital in India. Methods: The study involved a retrospective review of ICU charts of all patients during the study period were retrieved, excluding those with missing medical records. Patients were categorized into three groups: ICU-acquired hypernatremia (IAH), pre-admission hypernatremia (PAH), and normonatremia. Data from these groups were compared. Data collection included patient demographics, altered mental status, APACHE II score, serum Na levels, hypernatremia severity and duration, AKI, interventions such as hemodialysis and mechanical ventilation, length of ICU stay, and ICU mortality. Patient identities were protected, and data was stored securely. Results: Among the 235 patients enrolled, 88 (37.44%) had hypernatremia. Specifically, 41 (17.44%) had IAH, and 47 (20%) had PAH. Hypernatremia was significantly associated (p < 0.05) with altered mental status, higher Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores, increased rates and duration of mechanical ventilation, greater need for inotropic/vasopressor support, longer ICU stays, and higher ICU mortality rates. Conclusion: Hypernatremia in ICU patients remains a significant contributor to morbidity, mortality, and prolonged ICU stays. The prevalence of hypernatremia was notably higher than reported in higher-income countries, highlighting the importance of addressing this issue in critical care management.

Introduction: Cardiac arrhythmias are a prevalent issue following surgeries, with hypomagnesemia often associated with this complication. Prophylactic administration of intravenous magnesium has been a standard practice for patients admitted in ICU. This study aimed to compare the efficacy of oral versus intravenous magnesium in preventing hypomagnesemia and arrhythmias. Methods: In this interventional clinical study, 98 patients were randomly allocated into two groups. Baseline serum magnesium levels and arrhythmias were assessed for all patients. One group received 1.6 gm of oral magnesium hydroxide via nasogastric (NG) tube, while the other group was administered 2 g of magnesium sulfate at the induction of anesthesia. Serum magnesium levels were monitored for 48 hours postoperatively. Results: The preoperative hypomagnesemia difference between the groups was not statistically significant. During surgery, serum magnesium levels peaked at approximately 4 mg/dL, with no hypomagnesemia observed in any patient. Although the serum magnesium levels in the oral group decreased in parallel but remained below those in the intravenous (IV) group, no significant differences were observed during postoperative monitoring. Additionally, the prevalence of arrhythmias was 14.60% in the IV group and 6.83% in the oral group (OR=0.44). Conclusion: Administering 1.6 gm of oral magnesium hydroxide is as effective as 2 gm of intravenous magnesium sulfate in preventing hypomagnesemia and arrhythmias. This study suggests that oral magnesium supplementation is a promising, cost-effective alternative.

Background:  Among the elbow fractures, supracondylar fractures are the most common in paediatric age group of 4 to 9 years. Extension type supracondylar fractures are more common than the flexion type fractures. The lateral only pinning is relatively less stable than combined medial and lateral pinning but it does not possess an iatrogenic complication of ulnar nerve damage. The purpose of this study is to evaluate the outcome of supracondylar fracture treated by closed reduction and fixation with lateral only pinning.

Methods: This was a prospective study conducted from June 2023 to March 2024 in a tertiary care hospital in India. A total of 28 paediatric patients in the age group between 4 to 11 years, with modified Gartland classification type IIB and type III fractures having closed injury, with duration less than 10 days, without any associated trauma were included in the study. Functional outcome was assessed by the range of motion and carrying angle using the Flynn criteria. Anterior humeral line, Baumanns angle and Humer ocapitellar angle were noted in the postoperative X-Rays to check the radiological outcome. Result: Out of 28 patients, 12 patients had Gartland type IIB fractures and 16 patients had Gartland type III fractures. Mean age of the patients was 7.5 years (range, 4 to 11 years).As per Flynn grade, results were excellent in 21 (75%) cases, good in 6 (21.4%) cases, and fair in 1 (3.6%) case. Radiographic union was noted in the patients with a mean time of 4.2 weeks (range; 3.2 to 6.2 weeks).At final follow up, the mean Baumann angle in type IIB fracture was 73.2+/-4, and in type III fracture was 74.3+/-5.2. At final follow up, the humer ocapitellar angle in type IIB fracture was 34.4+/-3.9, and in type III fracture was 35.2+/-4.9. Conclusion: The lateral only pinning method of supracondylar fracture fixation is easier, safer, has no blood loss, healing is quicker, cosmetically good, and is cost effective method of surgical treatment with good functional results in paediatric patients.

Background: Blood lipid increases during gestation are considered a physiological adaption, and decrease after delivery. However, some adverse pregnancy outcomes are thought to be related to gestational lipid levels. Therefore, it is necessary to have a reference range for lipid changes during gestation. The present study aims to study trime ster specific changes insipid file and blood pressure and to study maternal and foetal outcome in relation to changes in lipid profile and blood pressure. Methodology: A Prospective study was carried out for a period of 24 months during January2021to December 2022 among1000 Singleton Pregnant mothers attending Government General Hospital, Guntur. Results: The mean Triglyceride level in first trimester is 144.99±37.30, in second trimester it is159.93±38.23, in third trimester itis 172.64±39.15. The mean Total cholesterol level in first trimester is 193.10 ± 22.35, in second trimester it is 212.40 ± 19.25, in third trimesteritis232.20±22.84. The mean SBP in first trimester is 109.7±1.31, in second trimester it is 107.8±1.41, in third trim ester it is 114.6 ±1.71mm of Hg respectively. In the study, 22.7% were Preterm births and 77.3% were Term deliveries. Conclusion: It is normal for blood triglycerides, LDL, VLDL, and total cholesterol to moderately rise throughout the third trimester. There is a natural drop in blood pressure during the middle trimester. It is easier to identify abnormal blood pressure readings and changes in lipid profiles when one is aware of the physiological changes and the reference values. This aids in the early diagnosis of pathological disorders that may have an impact on the result for both the mother and the foet us.  

Background: Vancomycin is the drug of choice for the treatment of Methicillin resistant Staphylococcus aureus. However, the emergence of vancomycin resistance among MRSA isolates has been perceived as a formidable threat in therapeutic management.This study investigates the antimicrobial sensitivity patterns among vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-intermediate Staphylococcus aureus (VISA), and vancomycin-sensitive Staphylococcus aureus (VSSA) isolated from various clinical specimens. Understanding these patterns is crucial for effective management and treatment of infections caused by these resistant strains. Aim and Objective: To study the antimicrobial sensitivity patterns of VRSA, VISA and VSSA isolates obtained from various clinical specimens among MRSA isolates. Materials and Methods:This was a Cross-sectional observational study carried out in the Department of Microbiology at Government Medical College, Kota, Rajasthan, India.  A total of 384 Staphylococcus aureusisolated from different clinical samples were analyzed.  Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to the CLSI guidelines. VRSA and VISA were confirmed by Minimum inhibitory concentration (MIC). MIC was measured by both Agar dilution method and E-test strip method. Results: In the present study out of the 2 VRSA strains, 2 (100%) were sensitive to both Teicoplanin and Linezolid, followed by Cefepime 1 (50%) and Tetracyclin 1 (50%). Out of 3 VISA strains, 3 (100%) were sensitive to Linezolid, followed by Teicoplanin 2 (66.67%), Cefepime 2 (66.67%), Tetracyclin 1 (33.33%), Amikacin 01 (33.33%), Levofloxacin 01 (33.33%), Clindamycin 01 (33.33%), Cefoperazone 01 (33.33%) and Quinopristin/Dalfopristin 01 (33.33%). Out of 180 VSSA strains, 180 (100%) were sensitive to Vancomycin followed by Linezolid 173 (96.11%), Teicoplanin 162 (90%), Cefepime 146 (81.11%), Amikacin 141 (78.33%), Tetracyclin 133 (73.89%), Levofloxacin 122 (67.78%), Clindamycin 117 (65%), Cefazolin 111 (61.67%), Erythromycin 104 (57.78%), Quinopristin/Dalfopristin 96 (53.33%), Cefoperazone 91 (50.56%), Cloxacillin 82 (45.56%), Cotrimoxazole 48 (26.67%) and Nitrofurantoin 24 (88.89%) out of 27 urine isolates. Statistical significance was obtained only in cases of Amikacin (p<0.01), Cefazolin (p<0.05), Cefepime (p<0.05), Erythromycin (p<0.01) and Nitrofurantoin (p<0.01). Conclusion: In our study linezolid and teicoplanin were found to be the most active against the VRSA strains as the VRSA isolates were sensitive to these antibiotics. Both antibiotics can be utilized as the alternative drugs against the VRSA, VISA and MRSA infections. The study highlights the significant antimicrobial resistance in VRSA and VISA isolates, emphasizing the need for continuous surveillance, stringent infection control measures, and effective antibiotic stewardship to manage and mitigate the spread of these resistant strains. VSSA isolates showed the highest antibiotic susceptibility, underscoring the varying resistance patterns among the different Staphylococcus aureus categories.

Background: Uterine fibroids are common benign tumors affecting women of reproductive age, causing significant morbidity. Accurate diagnosis and characterization are crucial for appropriate management. While ultrasound is the primary imaging modality, magnetic resonance imaging (MRI) is increasingly used. However, their comparative effectiveness in fibroid diagnosis remains debated. Objective: To compare the diagnostic accuracy of ultrasound and MRI in detecting and characterizing uterine fibroids and thereby its role in further management and facilitating to decide the mode of surgical managemet. Methods: This cross-sectional study involved 100 women (age range 25-55 years, mean 39.7 ± 7.3 years) with suspected uterine fibroids in Patna, Bihar, from February 2023 to January 2024. All participants underwent both ultrasound and MRI examinations. The number, size, location, and characteristics of fibroids were assessed, along with each modality's diagnostic accuracy. Results: MRI detected fibroids in 93% of patients versus 82% by ultrasound, identifying a higher mean number of fibroids per patient (3.1 vs. 2.3) and slightly larger mean fibroid diameter (4.7 cm vs. 4.2 cm). MRI showed superior diagnostic accuracy with higher sensitivity (98.9% vs. 88.2%), specificity (97.1% vs. 85.7%), and predictive values. MRI detected fibroids in 11% of cases missed by ultrasound, identified adenomyosis in 15% of patients not detected by ultrasound, and provided better characterization of fibroid degeneration in 23% of cases. The findings were correlated with intra-op findings in patients taken up for surgery. MRI gave a three dimensional picture of the disease entity and facilitated to identify the correct plane and plan the depth of incision especially in laparoscopy approaches. Conclusion: While both modalities effectively diagnose uterine fibroids, MRI demonstrates superior diagnostic accuracy and provides additional information on fibroid characteristics and associated uterine pathologies. These findings suggest MRI may be preferable for comprehensive evaluation of uterine fibroids, particularly in complex cases.

Background: Placental insufficiency is a significant cause of perinatal morbidity and mortality in high-risk pregnancies. Doppler ultrasound has emerged as a potential tool for early detection and management of this condition. Objective: To evaluate the role of Doppler ultrasound in assessing placental insufficiency and predicting adverse outcomes in high-risk pregnancies. Methods: In this study, we enrolled 100 high-risk pregnant women and performed Doppler ultrasound examinations of the umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA). Pregnancy outcomes and management changes were recorded. Results: Abnormal Doppler findings were observed in 35% of UA, 28% of MCA, and 32% of UtA examinations. UA Doppler showed high diagnostic accuracy for placental insufficiency (sensitivity 82.5%, specificity 96.7%). Abnormal UA Doppler was associated with increased odds of preterm delivery (OR 3.8, 95% CI: 2.1-6.9). Abnormal MCA Doppler correlated with low birth weight (OR 2.9, 95% CI: 1.7-5.2), while abnormal UtA Doppler was associated with pre-eclampsia (OR 4.2, 95% CI: 2.3-7.6). Doppler findings led to management changes in 45% of cases, including increased fetal monitoring (45%), antenatal corticosteroid administration (30%), and early delivery (22%).Conclusion:Doppler ultrasound is an effective tool for assessing placental insufficiency and predicting adverse outcomes in high-risk pregnancies, often guiding management decisions.  

Background: Cardiovascular disorders, especially Heart failure is increasingly becoming the most frequent reason for hospital admissions representing a major health problem. The current study was designed to identify clinic- etiological profile and echocardiographic variables of patients with heart failure (HF). Methods: A cross-sectional study on Clinical profile and Echocardiographic findings of 84 patients admitted in Department of Medicine at Tertiary care hospital from 2019-2021 were analyzed. A structured proforma was designed for recording the clinical, laboratory and echocardiographic data of patients. Results: Maximum patients of HF occurred in 5th and 6th decade. Male predominance was observed. Commonest clinical symptom was breathlessness (90%) and swelling over feet (77.38%). Hypertension (55.95%) and Diabetes mellitus (50%) were commonest comorbidities. Predominant signs of heart failure observed on our patients were elevated JVP (92.85%) and oedema feet (90.48%). Maximum patients reported abnormal ECG findings with Ischemic changes noted in 57.14% of the patients and atrial fibrillation in 23.8%. Echocardiography highlighted Heart failure with reduced ejection fraction (65.48%) as the most common type of HF seen followed by Heart failure with preserved ejection fraction (25%). Conclusion: So, we conclude in our study that incidence of heart failure increases with age. Dyspnea was the commonest symptom and Elevated JVP was the prevalent sign of HF observed in our patients. Coronary artery disease, Cardiomyopathy and Rheumatic heart disease were the major etiological diagnosis observed in our study. Heart Failure with Reduced ejection fraction (HFrEF) was the predominant type of HF observed.

Background: Pregnancy is a physiological situation characterized by significant hemodynamic changes that might cause symptoms and signs that resemble cardiovascular diseases. These hemodynamic adjustments often begin in the first trimester and progress to 50% or higher in the second and third trimesters. Objectives:1. To study the various electrocardiogram changes in normal pregnant women aged 18-35 years.2. To detect any deviation from the normal physiologic changes during pregnancy. Material & Methods: Study Design: Institutional-based cross-sectional study. Study area: The study was conducted in the Department of Physiology and OBG, Government Medical College, Kadapa, Andhra Pradesh.  Study Period: 15 months from January 2017 to June 2018. Study population: Subjects attending Antenatal clinics and Non-pregnant subjects attending to female medical O.P. Department in the age group of 18-35 years. Sample size: The study consisted of a total of 200 subjects. (pregnant – 150 and non–pregnant – 50) Sampling Technique:  Simple Random technique.Results: The distribution of QT interval duration among non-pregnant and three different trimesters of pregnant women, with a mean duration of 0.36 ± 0.03 sec in non-pregnant, 0.33± 0.02 sec in 1st trimester, 0.34 ± 0.02 sec in 2nd trimester and 0.33 ± 0.02 sec in 3rd trimester, with a p-value of less than 0.01.Conclusion: From our study, it can be concluded that ECG alterations found during pregnancy include sinus tachycardia, left axis deviation, ectopic beats, inverted or flattened T-waves, and Q-waves in lead ll. The QT interval may increase during pregnancy. A prolonged QT interval may result in serious cardiac arrhythmias that cause syncope or death.

Background: Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranolol and topical timolol, have emerged as promising and safer therapies. To minimize the systemic side events caused by oral administration of propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions.

Aims:treatment of Infantile hemangioma with topical timolol Vs oral propranolol. Methods:This is a prospective interventional study done in department of pediatrics medicine and pediatrics surgery in Gandhi medical college Bhopal from January 2022 to January 2024 in 200 patients We treated 200 children with superficial IHs using oral propranolol or topical timolol, and investigated the efficacy and safety of the two treatment patterns. Results: we treated 200 patients, The mean age at initiation of the treatment was 5.2 months. Age ranges from one months to 2 years. Most of the patients comes between 3-6 months of age. The ratio of female to male was 2.234:1, and males are 60 and females are 140 in study. 12.5% (25/200) of patients were born prematurely. 7.5% (15/200) of     patients had a history of progesterone use. 50% (100/200) of lesions were located in the head and neck region, 35% (70) at extremities and 15% (30) at trunk region. Tumor size ranged from 0.5 to 21.2 cm², with a mean size of 4.42 cm². The mean duration of treatment was 6.2 months, and the mean follow-up time was 6.2 months. Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 97 and 96.4%, respectively. No significant differences in visual analog scale (VAS) improvement between the two groups were observed. Occurrence rate of systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol (0%). Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, gestational age, and progesterone use during pregnancy, but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate.Conclusions: IHs are very common disease, so early and active intervention has become the first choice for proliferating infantile hemangiomas. We recommend that topical timolol instead of oral propranolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety.

Background:  Background: The role of Vitamin D in various metabolic disorders including Diabetes Mellitus has been explored. Vitamin D has sparked widespread interest in the pathogenesis and prevention of diabetes. Aim: This study evaluates the correlation between Vitamin D status and Glycated haemoglobin in Type 2 Diabetes Mellitus. Material and methods: A retrospective study, conducted on 150 Diabetes mellitus type II patients in the age group of 25-75 years. HbA1c levels were correlated with their Serum Vitamin D levels. Pearson correlation statistical test was chosen to see the relation between HbA1c levels and Serum Vitamin D levels. Results: Out of a total of 150 patients, 74.3% had deficiency, 21.3% insufficiency, and 5.3% had normal levels of Vitamin D. Similarly, 83.1% of the patients had HbA1c level more than and equal to 6.5% and 16.9% had HbA1c levels less than 6.5%. A negative correlation between Vitamin D and FBS levels and HbA1c and Vitamin D was seen. Conclusion: There is an inverse correlation between Vitamin D and HbA1C that is also statistically significant, seen in many studies, the present study also shown the inverse correlation between Vitamin D and HbA1C, but it didn’t came statistically significant, may be due to small sample size. Hence present study cannot establish the role of Vitamin D in preventing Diabetes Mellitus, but it is highly recommended for Vitamin D screening in diabetic patients on a regular basis

Background: Controlled hypotension is often induced during FESS to reduce intraoperative bleeding and improve the surgical field visibility. This study aims to compare the efficacy and safety of intraoperative infusions of Dexmedetomidine and Esmolol in achieving controlled hypotension during FESS.Methodology: The double blinded randomized prospective study was conducted on 60 patients posted for functional endoscopic sinus surgeries under general anaesthesia. 30 patients were allotted in each group i.e., group D with Dexmeditomidine (1 μg/Kg loading dosage within 10 min before intubation followed by 0.4 -0.8 μg/Kg/h infusion) and group E with Esmolol (loading dose 1 mg/kg being infused over 10 minutes before intubation followed by 0.3-0.5 mg/kg/h infusion). The infusion rates of the study drug were titrated to maintain MAP between 70-75 mm of Hg. The parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation were measured from onset of drug administration till the end of surgery. Ramsay sedation score, Surgical satisfaction score, and Bleeding score were also used to compare the efficacy of the intervention agents in producing controlled hypotension.Results: On comparing the variation in means of SBP, DBP, MAP, HR in both groups from baseline to 6 different occasions i.e., at 5, 10, 20, 30, 60 and 90 minutes, using repeated measures of ANOVA, there exists a statistically significant relation suggesting the upper hand of Dexmeditomidine. The mean duration for rescue analgesia in the Dexmeditomidine group was 619.87 minutes than that in the Esmolol group which was 356.60 minutes. The mean values of Ramsay Sedation Score and Surgical Satisfaction Score in the Dexmeditomidine group was 2.77 and 2.70 respectively, while that in the Esmolol group was 1.73 and 2.33 respectively. The mean values of Bleeding Score in the Dexmeditomidine group was 2.33 comparatively lesser than that in the Esmolol group which was 2.63. Conclusion: Dexmeditomidine was better than Esmolol in causing controlled hypotension along with postoperative sedation and in achieving higher surgeon satisfaction score and control bleeding.

Introduction: Breast carcinoma is a malignancy that forms in the cells of the breast. Breast carcinoma is one of the non-communicable diseases (NCDs) that has become a major public health issue. Globally, cancer is a feeding cause of death in which deaths due to breast cancer accounts for 15% of all cancer deaths among women Negative node breast carcinoma simply means breast cancer without lymph node involvement. Objectives: To study the association of tumour size, evaluated after histopathological studies with different clinicobiological parameters like age, histological grade, tumour markers such as p53, ki67 and bc1-2. Methods: This study was conducted from Jan 2021-June 2022 at department of pathology, Medical College, Kolkata, West Bengal, India. Total 30 patients were included in this study. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: In the study group analyzed, pathological tumor size ranged from 1.1 to 9cm. Tumors in 13cases exceeded 5cm while the rest was below 5cm.We showed that the pathological size was significantly associated with age greater than or equal to 50years than the one who were less than 50years of age(t=5,P<0.001),and histological grade III VS I(P<0.001). Also we found a significant difference for p53(P<0.001) positivity and ki-67(P<0.01). Conclusions: It was found that tumor size was significantly associated with age over 50years,histological grade 3 and increased immunohistochemical expression of ki-67 and p53,all of which support its prognostic value.  

Background: the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality.  Objective: To determine the frequency of placenta previa in non-scarred and scarred uterus groups.Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical and treatment, along with maternal and neonatal outcome parameters were noted in the proforma. Results: Incidence of placenta previa among scarred uterus was 1.32% and in unscarred uterus was 0.67%. Mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, prematurity at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position and adherent placenta were significantly associated with scarred uterus compared to unscarred uterus. Rate of caesarean hysterectomy was higher in scarred uterus, along with .statistical association with previous LSCS. Intraoperative procedures like uterine artery ligation, bakri ballon insertion and iliac artery ligation were higher in the scarred group. Maternal ICU admission rate was higher in the scarred group, and also showed its statistical association with previous LSCS Neonatal outcomes in terms of pre-term birth, still birth, NICU admission and neonatal death though higher in the scarred group, significant statistical differences were not observed between the groups. Conclusions: Advancing maternal age, multiparity, prior uterine surgeries and abortions are independent risk factors for placenta previa. Maternal and fetal morbidity is higher in the scarred uterus group compared to the unscarred group. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome in placenta previa patients.

:  Background & objectives: In May 2003, the Government of India had endorsed a comprehensive tobacco control law called the Cigarettes and other Tobacco Products Act 2003 (COTPA 2003) to reduce the use of tobacco by prohibiting the smoking of cigarettes and other tobacco products. The present study was undertaken to assess the Implementation and Compliance of anti-tobacco law in Visakhapatnam, South India. Methods: This is a community based descriptive, cross-sectional study conducted from 1^st July 2022 to 31st August 2022 at 60 Public places, 60 Educational institutions and among 60 Vendors present in shops selling tobacco and tobacco‐related products each located within 10 km radius from the centre of the selected zones in Visakhapatnam city. Results: Majority of the public places visited were found to be compliant with the section 4 of COTPA Law and no active smoking was noted in 83% of the places visited. People were found smoking tobacco products in 10% of the educational institutions. Only 25% places visited had displayed ‘No Smoking Signage’ in the institutes. At the points of sale visited, most of the shops were found to be have an advertising board/poster displayed openly mentioning about the sale of tobacco and tobacco‑related products (90%), violating the section 5 of COTPA Act. Interpretation & conclusions: Visakhapatnam city being the largest and most populous metropolitan city of Andhra Pradesh, showed disturbing results with poor compliance with COTPA. It is recommended that a fully efficient tobacco control cell is established along with sensitization of the administration and empowering administrative officers to take care of the offences and impound fine. 

Introduction: Antegrade selective cerebral perfusion (ASCP) through the right axillary artery has proved to be a safe and effective method for cerebral protection in aortic surgery. The right axillary artery is now preferred for complex ascending aortic operations. Aim: To assess the outcomes following direct right axillary artery cannulation for aortic surgeries. Materials And Methods: This is a retrospective study of 20 patients who underwent direct Right axillary artery cannulation for specific indications. We accessed medical records of these patients and assessed for post operative complications. Results: Twenty patients had undergone direct axillary artery cannulation during the study period for different aortic pathologies of which 14 (70%) were male and 6 (30%) female. 12 (60%) patients were operated for acute aortic dissection, 4(20%) for chronic aortic dissection and 4(20%) for aortic aneurysm. Patients were distributed among all age groups youngest being 29 years oldest being 70 years with most of the patients in their 3^rd and 4^th decade of life. 2 patients had transient neurological dysfunction of limb which settled with physiotherapy. 3 patients died during their ICU stay due to low cardiac output with mortality at 15%. Mean ICU stay was 3 days. Post operative recovery was satisfactory in these patients. The most common post operative complication is pain at wound site. Conclusion: Direct right axillary cannulation is a safe and effective procedure without limb ischemia, neurological complications and wound infection for aortic surgeries.

Background: Patients receiving a subarachnoid block (SAB) often experience hypotension and bradycardia which can lead to detrimental effect on the organ systems.Antihypertensive agents mitigate this effect by managing blood pressure. However, there are conflicting reports regarding whether antihypertensive medications should be continued on the day of surgery for patients undergoing spinal anesthesia. The aim of this study is to compare the Spinal anesthesia-induced hemodynamic changes in Normotensive and Hypertensive patients on antihypertensive Medications. Methods: This prospective & observational study included 60 patients of age group 20 years – 70 years, and they belong to ASA grade I and II who were elective cases posted for Inguinal Hernia and Hydrocoele surgery. Levo-bupivacaine 0.5% was administered to these patients. Baseline values of heart rate and Blood pressure was monitored preoperatively and the same were recorded intraoperatively and post operatively at specified time intervals. Results: The mean heart rate was more than the baseline values among both the groups till the end of surgery but later showed a slight decline and comparison this parameter among two groups were statistically insignificant. The mean systolic and diastolic BP among both the groups were statistically significant and the incidence of hypotension among hypertensive patients were comparatively high.Conclusion: Hypertensive participants on antihypertensive medications experienced a higher incidence of hypotension.

Objectives: Primary:1) To estimate prevalence of seropositive measles cases among children with fever with maculopapular rashes attending pediatric department of Dr.N.D. Desai hospital, Nadiad during 1^stJanuary to 31^stMay 2023.Secondary:To assess association between Immunization status along with nutritional status among seropositive measles cases diagnosed at pediatric department of Dr.N.D. Desai hospital, Nadiad during 1st January to 31^st May 2023.Study design: Retrospective Observational Cross-Sectional Study. Participants: Each and every patient from January to May attending pediatric OPD with fever with maculopapular rashes with seropositive results for measles. Methods: Retrospectively all OPD cases which were reported for fever with maculopapular rash, were studied from January to May 2023 in pediatric department and 30 seropositive cases were traced along with their IPD cases from MRD with permission of superintendent to fill preformed proforma for data collection which was then analyzed. Results: among 30 patients only 7(23.3%) patients were immunized for age.5(35.7%) patients were found severely acute malnourished while 3(21.4%) were MAM under 5 years of age(n=14).8(50%) patients were undernourished above 5 years of age(n=16).15(50%) patients had moderate to severe anemia. Conclusion: along with hampered immunization during covid, increased measles cases are attributed to malnutrition which contributed even more due to harmed health services in this pandemic.

Background: The alarming prevalence of noncommunicable diseases, particularly diabetes mellitus and coronary heart disease, in India accounts for approximately 5.8 million deaths annually. Insulin resistance is a key factor in the development of diabetes mellitus and metabolic syndrome (MS), which is characterized by four components: hyperinsulinemia, hypertension, hyperlipidemia, and hyperglycemia. Each of these components is an independent risk factor for CHD and can collaborate to aggravate the progression of atherosclerosis and atheroscleropathy associated with MS and T2DM. Materials & Methods: This is hospital based cross sectional observational study which was conducted in the  Department of general medicine of Private medical college with study period of 1 year. The total sample size of the study was 100 patients. The collected data was entered in Microsoft Excel. Coding of the variables was done. Analysis was done using SPSS software (Version 27, IBM). Results: The subjects had an average age of 57.56 years and a mean BMI of 25.63, with a standard deviation of 3.90. Additionally, the WHR ranged from 0.79 to 1.55, indicating variations in body fat distribution and potential health risks. Fasting Blood Sugar (FBS) levels varied from 102 to 208 mg/dL, while Postprandial Blood Sugar (PPBS) levels ranged from 167 to 307 mg/dL, reflecting the variability in glucose metabolism. Serum uric acid levels ranged from 3.2 to 8.4 mg/dL, which is important for evaluating metabolic health and potential gout risk. Duration of DM is 4.5± 1.17. The prevalence of the condition was 43%, with a highly significant P value of 0.0001. Conclusion: Elevated serum uric acid levels was found to be prevalent in individuals with diabetes, with a significant positive correlation observed between serum uric acid and dyslipidemia, high triglycerides, hypertension, elevated BMI, and increased WHR. Additionally, it was observed that serum uric acid levels rose with the duration of diabetes.

An approximate 60 to 70% of all decisions about the diagnosis, treatment, admission to the hospital and discharge of a patient are based on laboratory results. Medical laboratory plays a key role in the early detection, diagnosis and treatment of disease in patients. Implementation of Good Laboratory practices becomes at most important in improving the quality in the laboratory. Therefore this study is undertaken to assess the good laboratory practices among tertiary care hospitals in Bengaluru and managerial challenges experienced during the implementation of good laboratory practices. This questionnaire based experimental study was conducted in 26 laboratories attached to tertiary care Hospitals in central Bengaluru, India, from July 2023 to December 2023. An online questionnaire containing 34 questions was administered to all the participants after taking consent. Data were collected through validated questionnaires and analyzed using Fisher-exact test to test the statistical significance of cross-tabulation between categorical variables. P value < 0.05 was considered statistically significant. Descriptive analysis was carried out by frequency and proportion for categorical variables. Continuous variable was presented as median (IQR). Findings revealed common infrastructure challenges across laboratories, with notable disparities between NABL accredited and non-accredited facilities. Challenges in GLP implementation included staffing constraints, resistance to change, and financial limitations. The challenges were mitigated through strategies such as teamwork, continuous training, and management support.

Introduction: A rupture of the skin accompanied by erosion of the subcutaneous tissue beneath is called an ulcer. The adjacent muscle and bone may be further compromised by this breach. A full-thickness skin defect that has not significantly re-epithelialized for longer than four weeks is referred to be a chronic ulcer. Wounds with "full thickness depth" and a "slow healing tendency" are referred to as ulcerations. In general, the delayed healing tendency cannot be fully explained by depth and size alone. But brought on by a pathologic reality at the root that must be eliminated in order to promote recovery. Aims: To research the treatment of lower leg ulcers and their clinic pathological characteristics. Materials and methods: The present study was a Prospective observational study. This study was conducted from January 2023 to December 2023 at the Department of General Surgery, Private Medical Medical College & Hospital. Out of 80 patients, 65 patients were included in this study. Result: In our study, 8 patients presented with varicose veins the cause of ulcers is of venous etiology. The value of z is 1.002. The value of p is < .001. The result is significant at p < .05. In our study 5 patients had Raynaud’s phenomena and the cause of ulcers are of arterial etiology. The value of z is 0.899. The value of p is < .001. The result is significant at p < .05. In our study out of 21 patients with loss of sensation the causes of ulcers are diabetic followed by arterial and venous etiology. The value of z is 1.074. The value of p is < .001. Conclusion: We draw the conclusion that, in addition to adding to the expanding body of information on lower leg ulcers, our clinic pathological investigation emphasizes the significance of a thorough, multidisciplinary approach to diagnosis and treatment. Through the implementation of evidence-based treatment options and an attention to the intricate interaction of variables that lead to ulcer formation, our goal is to enhance patient quality of life while mitigating the prevalence of chronic wounds in our communities.

Background:  CVT is a kind of cerebrovascular illness characterized by localized cerebral oedema, venous cerebral infarction, seizures, and intracranial hypertension.^1,2 The condition primarily affects young people, women of reproductive age, and children. Previously, the incidence was estimated to be 0.2-0.5 per 100,000 person-years.^1,3 Objectives: To study the varied findings of CVT on CT Venography in clinically suspected cases. Material & Methods: Study Design: A prospective hospital-based observational study. Study area: Department of Radio Diagnosis, in a tertiary care teaching hospital. Study Period: 1 year. Study population: Patients with signs and symptoms of cerebral venous thrombosis were referred for CT Venography to the Department of Radio Diagnosis. Sample size: The study consisted of 50 subjects.  Sampling method: Simple random technique. Results: Transverse sinus was the next most common sinus involved at 33 pts, (isolated in 4 pts) followed by sigmoid sinus at 22 pts. The superficial venous system was involved in 5 pts (isolated in 2 pts) while the deep venous system was involved in 5 pts. The majority (39 pts) of patients had a combination of sinus and vein involvement, and 11 pts had only isolated sinus involvement. Conclusion: CSVT is an important and treatable cause of stroke, with risk factors such as OCP usage, alcoholism, and procoagulant condition becoming more well-recognized in addition to traditional risk factors such as postpartum status. In this study, the most common risk factors for cerebral venous thrombosis were procoagulant status and infections.

Background:  The placenta plays a vital role in the development and growth of fetus. The perinatal outcome of foetus is mainly depends on the placental measurements. Method: 208 placenta  from the uncomplicated pregnant women’s of age group between 20 and 35 years were collected from the obstetrics and gynaecology department .Number of Placental Cotyledons and Thickness were measured at delivery .The birth weight recorded from parturition register.  

Study Type: Cross sectional Study.

Conclusion: There was significant positive correlation between fetal weight and Number of Cotyledons, Thickness of placenta.

: Headache Is most common condition that needs medical attention. That may be acute or chronic. Most of them have recurrent headaches. some potential etiologies of headache may be life threatening or can affect neurological functions. So, it is important to diagnose the underlying cause of headache. Few serious brain pathologies present with recurrent headache. CT / MRI is best tool for diagnosis and treatment or follow up of cause of headache. It is also mandatory to exclude any serious intracranial pathology in patients with recurrent headache. MRI will diagnose any underlying cause of headache without radiation. It also excludes BIH, which is also the most common cause of headache. In this review we will discuss various intracranial pathologies, that are causing headache without neurological deficit.

Background: Tuberculosis (TB) is the leading infectious cause of death globally. ^[2] India, a country with a high TB burden, accounts for almost 2.7 million (27%) of the predicted 10 million global cases in 2017. Similarly, the country accounts for one-third of estimated TB mortality (excluding TB-human immunodeficiency virus [HIV]) globally. It is also one of the countries with the highest number of multidrug-resistant TB and TB-HIV cases. Objectives: 1. To determine the compliance rate in patients with microbiologically confirmed Tuberculosis registered under NTEP daily regimen.

2. To identify the determinants of ‘treatment after loss to follow up’ under NTEP daily regimen. Material & Methods: Study Design: Hospital-based, cross-sectional study. Study area: The study was conducted in the Department of General Medicine. Study period: 1 year. Study population: TB patients attending OP and IP at the Department of General Medicine and Pulmonology. Sample size: The study consisted of a total of 50 subjects. Sampling Technique:  Simple Random technique. Study tools and Data collection procedure: A validated questionnaire was developed. Consent was obtained from the Chief Health Officer and the District Tuberculosis Officer. The MO-TC conducts the weekly meeting in each TU. The investigator attended such meetings in all the TUs and briefed the STS and health visitors about the study, seeking their cooperationin tracking the defaulters. The ‘treatment after loss to follow up’ thus traced were visited at their residences through the address obtained from the designated microscopic centres, were interviewed at their residences and telephone using the standardized questionnaire. Results: It was observed that out of 677 patients registered in the designated centres for tuberculosis treatment, 90.98% of patients were compliant with the treatment and were following up regularly. 9.01% of patients were treated after loss to follow-up. Among this, 36% of the factors affecting this treatment after loss to follow-upwere due to therapy-related factors, 22% due to patient condition-related factors, 18% due to socio-economic factors, 16% due to disease-related factors, 2% due to health care related factors and 3 of them were loss to follow up due to the COVID 19 pandemic. Conclusion: Thus, based on the foregoing facts, it is possible to conclude that, while 90.98% adhered to the new treatment regimen, 9.01% did not. This 'treatment after loss to follow up' is a significant impediment to the NTEP program's success.

Background:  The study aimed to evaluate the radiological diagnostic accuracy of MRI imaging in sellar and juxtasellar lesions, a complex skull base region causing 15-20% of intracranial tumors. Methodology: MRI is used to diagnose sellar or parasellar mass in patients after a thorough clinical history, physical examination, and blood investigations. Results: The study found that P. macroadenoma accounts for 63% of all lesions in sellar pathology, with meningiomas, glial tumors, clival lesions, and P. microadenoma being the most common. The age distribution of cases is bimodal, with 52% females and 48% males. The texture distribution is homogenous, and the T1 and T2 signal distributions are varied. 93% of cases are correlated with HPE examination. Discussion: A study at Andhra Medical College examined the accuracy of MRI in diagnosing diseases in the sellar and juxtasellar regions. The majority of cases were Pmacroadenoma, followed by Meinigioma, P microadenoma, Clival, Craniopharyngioma, and Glial tumors. Pituitary adenoma was the most frequently reported lesion, accounting for over 90% of cases. The study found 100% sensitivity, specificity, and accuracy in diagnosing P.microadenoma, pilocytic astrocytoma, and diffuse astrocytoma. The majority of cases were female (86%), with a mean age of 39.3 years. The majority of cases were diagnosed as Pituitary macroadenoma, with the majority being extra axial. Conclusion: MRI is the preferred method for evaluating microadenomas, plasmacytoma, meningioma, and Pituitary macroadenoma, as it provides reliable signs of cavernous sinus invasion and invasive Pituitary macroadenoma.

Background and aim: Spinal anesthesia is commonly utilized in cesarean sections due to its efficacy and safety. Levobupivacaine, less cardiotoxic than bupivacaine, is frequently combined with fentanyl for enhanced effect. However, research on varying levobupivacaine doses with  fentanyl is lacking. This study aims to determine the optimal dosage of local anesthetic for fetomaternal outcome in cesarean section. Material & Methods : In this double-blind, randomized study, 105 patients undergoing elective caesarean section were divided into three groups receiving different doses of intrathecal levobupivacaine (7.5mg, 8.5mg, 10mg) with 25 µg fentanyl. Primary outcomes included haemodynamic parameters, Apgar score, and umbilical cord pH, while secondary outcomes encompassed sensory and motor block characteristics, satisfaction scores and side effects. Results : The study revealed comparable haemodynamic parameters across groups, with statistically significant differences (p<0.05) at specific time points. The 10 mg levobupivacaine group demonstrated the shortest onset time of sensory and motor block, while both 8.5 mg and 10 mg groups exhibited the longest effective analgesia duration (p=0.52). APGAR score and umbilical cord pH were consistent among groups (p=0.925), though Group C displayed heightened side effects. Conclusion : 8.5 mg levobupivacaine with 25 µg fentanyl demonstrated optimal hemodynamic stability , sensory and motor block characteristics, along with effective postoperative analgesia, comparable to the 10 mg group, thus potentially offering better fetomaternal outcomes. This dosage combination may be preferred for spinal anaesthesia in elective caesarean sections.

Background:  Rosacea is a chronic inflammatory skin condition that can be exacerbated by various environmental factors. This study aimed to investigate the impact of UV radiation, temperature, humidity, and air pollution on rosacea severity and quality of life over a one-year period.  Methods: A prospective observational study was conducted with 100 adult rosacea patients. Rosacea severity (assessed using the National Rosacea Society Expert Committee grading system) and quality of life (assessed using the Dermatology Life Quality Index) were evaluated at baseline and every three months for one year. Participants kept daily diaries of their exposure to environmental factors. Results: Significant associations were found between environmental factors and rosacea severity. UV radiation (coefficient 0.18, 95% CI 0.10-0.26, p<0.001), temperature (coefficient 0.14, 95% CI 0.08-0.20, p<0.001), humidity (coefficient 0.09, 95% CI 0.03-0.15, p=0.004), and air pollution (coefficient 0.12, 95% CI 0.06-0.18, p<0.001) were all significantly associated with increased rosacea severity. Rosacea severity scores decreased significantly from baseline to each follow-up visit (p<0.001), and quality of life scores improved significantly (p<0.001). Subgroup analyses revealed consistent findings across age groups, genders, and rosacea subtypes. Conclusion: Exposure to UV radiation, high temperatures, humidity, and air pollution were significantly associated with increased rosacea severity and reduced quality of life. These findings emphasize the importance of environmental factor management in the treatment and prevention of rosacea flare-ups.

Background: Osteoarthritis (OA),adegenerative disorder, becomes more prominent with advancing age. Various treatment modalities available,twononinvasive modalities to halt its progression are PRP and oral glucosamine. PRP therapy utilizes growth factors for tissue healing and cartilage regeneration, alleviating symptoms. Glucosamine, a natural compound, supports cartilage health by acting through cell mediators, retarding degradation, enhancing joint function. Materials and methods: Involving 30 patients per group, the study focused on elderly individuals diagnosed with symptomatic knee osteoarthritis (OA) grades 1, 2, or 3, who were randomly assigned to receive either intra-articular injection of autologous PRP or oral glucosamine. Clinical outcomes, VAS scores, and WOMAC scores were assessed and compared over a 4-month period. Data were collected and statistically analyzed to determine treatment efficacy.Results: In a comparison between Platelet-Rich Plasma (PRP) injection( group A) and oral glucosamine( group B) for knee osteoarthritis, significant WOMAC score reductions were observed in both groups over four months: Group A from 58.90 to 25.20 (p=0.001) and Group B from 59.43 to 42.90 (p=0.001). Regarding VAS scores, Group A demonstrated larger mean decreases (3.50±0.814, 3.17±0.980, 2.47±0.928) compared to Group B (0.36±0.973, 0.83±1.037, 1.53±1.208) (p=0.001). Conclusion: Our study highlights the effectiveness of intra-articular PRP and oral glucosamine for managing OA knee symptoms. Both treatments significantly reduced pain and improved function, with PRP showing superior efficacy, particularly in mild-to-moderate cases. PRP and glucosamine offer valuable options for symptom management and disease progression.

Traditionally, Malignant Small Round Cell Tumors (MSRCT) of the CNS are synonymous with Medulloblastomas. Histologically they are characterised by cellular blue tumor and pose diagnostic problems. There is no broad category of MSRCT in WHO classification. Though now we know many tumor of diverse histogenesis that can be included in this group. Overall, brain tumors amount to <2% of all malignant neoplasm’s and thus constitute a small fraction of the overall human cancer burden. As a clinical perspective, incidence of brain tumors is approximately 2.8/100000 children per year² of which about 2-4% are MSRCT. The need for studying and subcategorizing MSRCT is due to the fact that MSRCT includes a diverse group of tumors like Embryonal tumors, Pineal Parenchyma Tumors, Neuroblastic Tumors, Germ Cell Tumors, lymphomas, metastatic tumors and rare ones like Atypical teratoid/rhabdoid tumor, Medulloepitheliomas etc. Mimics of MSRCT diagnostic problems. This is a prospective study as well as retrospective study of MALIGNANT SMALL ROUND CELL TUMOR of the Central Nervous System at our Grant medical college over a period of 10 years. To evaluate the feasibility of sub-characterizing the broad category of Malignant Small Round Cell Tumors of the CNS by judicious use of histological parameters. To establish that to date routine histopathology still remains the gold standard for the diagnosis. To use stringent morphological criteria to diagnose, subcategorize and reduce the intra and inter observer variation in our cases. To categorize and study the mimics of MSRCT’S.

: Introduction: A neurotrophic joint, sometimes referred to as a Charcot joint, is a degenerative or destructive joint disorder that progresses over time in patients with abnormal pain and proprioception. Many neurotrophic joints are caused secondary to spinal lesions, often without any history of the patient indicating a lesion. Therefore, an MRI scan of the spine should be included in the investigation process in every case of neurotrophic joint. Aims and objectives: To investigate the prevalence of spinal lesions as the main cause of neurotrophic joints and the accuracy of MRI spine exams in detecting spinal lesions in patients who exhibit neurotrophic joint symptoms. Materials and methods: This study was conducted in the Radiology department of Dhiraj general Hospital. 30 patients presenting with neurotrophic joint/joints but giving no history suggestive of an underlying spinal pathology were evaluated byMRIspine. Results: Out of 30 patients presenting with neurotrophic joint whoweree valuated by MRI spine, only 18 scans revealed a spinal pathology secondary to which the patient had developed neuropathic change of the affected joint. Conclusion: Joint neuropathy typically manifests slowly at first. In the worst  case scenario, this pathological process may lead to amputation or death, joint deformity, ulceration and/or severe infection, and loss of function if left untreated. The greatest method to reduce morbidity is to identify joint changes as soon as possible, and early diagnosis of any underlying illness is crucial for this. An MRI of the spine is a sensitive tool for identifying any spinal lesions. It provides precise information about the size, extent, and severity of various spinal lesions, which aids in the proper diagnosis process and greatly aids in the management of neurotrophic joints.

Background:   Sternal fractures (SF) are a significant consequence of blunt chest trauma, with road traffic accidents being a leading cause. These fractures often involve associated injuries to surrounding structures, complicating management and impacting outcomes. While conservative management is common, surgical intervention, particularly sternal plating, has shown promise in stabilizing the chest wall and promoting healing. Cases: Five cases of SF are presented, each illustrating different presentations and management approaches. Patient 1 sustained a displaced mid-half sternum fracture with sterno-manubrial joint and bilateral rib fractures, managed surgically with titanium plates following a road traffic accident. Patient 2 presented with a displaced sternal fracture and rib fractures, also managed surgically using titanium plates after a similar accident. Patient 3 experienced traumatic paraparesis with a sensory deficit due to a fall, resulting in a manubrio-sternal joint dislocation and vertebral and calcaneal fractures, managed surgically with titanium plates. Patients 4  & 5 sustained a dislocated mid-half sternum fracture and bilateral rib fractures, managed surgically with titanium plates, following a road traffic accident. All the above patients except patient 3 had a paradoxical movement of the chest and were on ventilatory support. The plate prevents the movement of the sternal ends, as it provides strong support for the fractured sternum, with the screws anchored both above and below the fracture at the required distance. Conclusion: This case series underscores the complexity and potential severity of SF, highlighting the importance of associated injuries and diverse treatment modalities. While surgical intervention, particularly sternal plating, has shown efficacy in promoting stability and healing, the absence of standardized protocols necessitates further research to optimize management strategies for SF.

Background:   Infectious illnesses pose a significant health threat and are a leading cause of illness and death globally. The use of medicinal plants by traditional Siddha medical practitioners in their everyday practice contributes to the emergence of resistance to antifungal medicines and the occurrence of toxicity resulting from prolonged use of allopathic drugs. Throughout history, plants have served as an unparalleled reservoir of medicinal substances. In recent years, there has been an increasing prevalence of fungal infections caused by a rise in populations with weakened immune systems, such as individuals who have undergone organ transplants, cancer patients, and those with HIV/AIDS. The provided review presents information about the updated profile of Serankottai nei (Semecarpus anacardium), a traditional Siddha medicine having antifungal properties. It discusses the method of action, phytochemical constituents, and toxicity study of this medicine.

Background:   Nephrotic syndrome is characterized by the presence of proteinuria, more than 3.5 g per 24 h, hypoalbuminemia, edema and hyperlipidaemia. The spectrum of diseases causing nephrotic syndrome has changed globally over the last few decades. The current study aimed to investigate the clinicopathological characteristics of adults presenting with nephrotic syndrome. Methods: This study included patients aged 18 to >60 years who were diagnosed with nephrotic syndrome. All patients underwent renal biopsies and were examined using electron microscopy (EM), immunofluorescence (IF), and light microscopy.Results: Our study included 39 patients diagnosed with nephrotic syndrome who received treatment at hospitals affiliated with Bangalore Medical College and Research Institute. Among these patients, 61.5% were men, and 38.5% were women. The majority of cases (53.8%) occurred during the third decade of life. The most common initial symptom observed in these patients was pedal oedema. Systemic hypertension, hypercholesterolaemia, and hypothyroidism were found in 76.9 %, 87.2%, and 69.2% of patients, respectively. Elevated serum creatinine levels were detected in 25.6% of patients, predominantly in those with focal segmental glomerulosclerosis (FSGS) and IgA nephropathy. The 24-hour urine protein levels ranged from to 3.6-12.3g/day, with an average of 6.52g/day. The most prevalent histological variant is membranous glomerulonephritis (MGN), followed by IgA nephropathy and mesangiocapillary glomerulonephritis (MCGN). Conclusion: Membranous glomerulonephritis is the predominant aetiology of nephrotic syndrome in adults. Nephrotic syndrome typically manifests during the third decade of life and has a higher incidence in males. Most patients exhibit comorbidities such as hypertension, hypothyroidism, and hyperlipidaemia.

Background:  Geriatric surgical patients have unique complications due to age-related physiological changes and anesthesia-related issues. In this population, Total Intravenous Anaesthesia (TIVA) and inhalational anaesthesia are used, but their efficacy is questionable. Methods: A retrospective research was conducted at Dr. SNMC College in Jodhpur, focusing on eighty elderly patients undergoing surgery. The study aimed to compare the outcomes of TIVA and inhalational anaesthesia. Demographics, postoperative outcomes, and ASA classification were all factors that were examined. Comparative analyses and descriptive statistics were incorporated into the statistical study. Results: Comparable distributions of demographic variables and ASA scores were observed in the groups receiving TIVA and inhalational anaesthesia. Regarding the incidence of postoperative delirium, there was no statistically significant difference observed between the two groups: 20.0% in the inhalational group and 12.5% in the TIVA group (p=0.348). The median recovery time for the inhalational group was 35 minutes, whereas the TIVA group experienced a significantly shorter period of 30 minutes (p=0.041). There was no significant difference in total complication rates (p=0.426) or cognitive function scores following surgery (p=0.183). Conclusion: When geriatric patients undergoing surgery are weighing between TIVA and inhalational anaesthesia, it is vital to consider their unique characteristics and preferences regarding anaesthesia management. Critical as pre- and post-operative care is individualization, and the findings add to the expanding corpus of evidence that endorses the application of anaesthesia in geriatric surgery.

The prevalence of cardiovascular diseases (CVDs) has significantly increased in recent years due to changes in lifestyle, dietary habits, and environmental factors. Irudhaya noi, the encompassing term for cardiovascular diseases in Siddha, has witnessed a surge in prevalence. Cardiovascular diseases (CVDs) comprise several conditions affecting the heart and blood vessels, such as coronary heart disease, heart attacks, stroke, hypertension, peripheral artery disease, rheumatic heart disease, congenital heart disease, and heart failure. Siddha identifies imbalances in the three doshas as the main cause of heart-related ailments, and restoring their balance presents a challenging challenge in the treatment of cardiovascular diseases. Herbal treatments have been essential in human healthcare throughout history, as various traditional medical systems have used them to treat a wide range of maladies. Siddha is an ancient and internationally renowned traditional method of medicine. This review study examines the crucial role of Siddha in the prevention, management, and evaluation of cardiovascular diseases (CVDs) using interventions linked to diet (Unavu), lifestyle, seasonal routines (Kaala ozukkam), yoga, everyday routines (Naal ozukkam), and rejuvenation therapies (Kaaya kalpam). The research elucidates how Siddha's comprehensive methodology tackles the underlying factors of cardiovascular diseases (CVDs), providing significant perspectives on preventive measures, lifestyle adjustments, and herbal treatments. This review seeks to offer a complete viewpoint on the potential of Siddha in addressing the increasing prevalence of cardiovascular problems in modern society by combining traditional wisdom with contemporary scientific understanding.

Alzheimer's disease (AD) presents significant difficulties for those affected, often requiring substantial caregiving assistance from family members or other caregivers. The effectiveness of this care greatly depends on caregivers' understanding and perceptions of AD. This scoping review consolidates current literature on caregivers' knowledge and attitudes towards individuals with AD, with the goal of pinpointing areas for future research and uncovering any gaps in existing studies. A thorough search of electronic databases including PubMed, PsycINFO, CINAHL, and Google Scholar, uncovered 50 pertinent studies published between 2010 and 2024. The examination uncovered varying levels of knowledge among caregivers, spanning from well-rounded comprehension to misunderstandings, such as the notion that AD is a natural aspect of aging. Likewise, caregivers exhibited a diverse range of attitudes towards individuals with AD, shaped by cultural norms, personal encounters, and support systems. Favourable attitudes marked by compassion and understanding were linked to better care quality, whereas negative attitudes, such as stigma, impeded effective caregiving efforts. The practical implications involve developing customized interventions to rectify misunderstandings and foster favourable attitudes. Additionally, further research is necessary to delve into how caregivers' knowledge and attitudes influence caregiving outcomes. In essence, this review emphasizes the significance of comprehending caregivers' viewpoints to deliver effective assistance to individuals with AD, while also indicating directions for future investigations in this crucial domain.

The threat to human life posed by snakebite is a global health concern. Snake bites are a normal defense mechanism that can lead to medical issues. Snake venom contains proteins that can disrupt human bodily functions. Snake venom structure varies by species. Venoms contain numerous substances with varying biochemical and pharmacological properties. Cardiotoxins (CTXs), venom polypeptides with approximately 60 amino acid residues found in elapid snakes, have pharmacological functions such as hemolysis, cytotoxicity, and muscle depolarization. Snakebite also affects ions and electrolytes, such as potassium, which can have an impact on cardiac rhythm and contraction. One unusual consequence of a snakebite is myocarditis. Pericardial eosinophilia, nonspecific ST segment alterations, infarction patterns, fever, and an acute rash are just a few of the symptoms that can arise from an autoimmune reaction to a snake bite. Usually, hypereosinophilia coexists with this kind of myocarditis, also referred to as eosinophilic myocarditis (EM). A potential diagnosis may be suggested by clinical, electrocardiogram(ECG), and cardiac markers. In place of the invasive endomyocardial biopsy procedure, Cardiovascular magnetic resonance (CMR) is a noninvasive method for assessing myocardial inflammation, as a substitute for the invasive endomyocardial biopsy process. Refrain from using thrombolytic or antiplatelet drugs for treatment. Different mechanisms underlie cardiac injury. Supportive measures and anti-snake venom (ASV) are the mainstays of treatment.

Background: Human Immunodeficiency Virus (HIV) remains a significant public health challenge globally, with India being home to the third-largest HIV epidemic in the world. The advent of antiretroviral therapy (ART) has markedly improved the prognosis of HIV-infected individuals. However, the effectiveness of ART is often compromised due to the development of drug resistance, necessitating a switch to second-line therapy. This study aims to assess the effectiveness of second-line ART in HIV patients who experienced first-line drug failure at KIMS Teaching Hospital, Koppal, India. Methodology: This institutional-based observational study involved 36 HIV patients (11 males and 25 females) aged 15 years and above, who had been on a second-line ART regimen for at least one year. Data were collected retrospectively from patients' medical charts, including socio-demographic information, clinical characteristics, and laboratory parameters. First-line ART regimens consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI), while second-line ART included two NRTIs and one protease inhibitor (PI). Primary outcomes assessed were clinical, immunological, and virological responses. Statistical analyses were performed using SPSS software, with significance set at p<0.05. Results: The mean CD4 count increased from 150 cells/mm³ (±50) pre-treatment to 300 cells/mm³ (±100) post-treatment (p<0.001). The mean viral load decreased from 100,000 copies/mL (±50,000) to 10,000 copies/mL (±5,000) (p<0.001). Clinical failure occurred in 14% of patients, immunological failure in 17%, and virological failure in 11%. The loss to follow-up rate was 8%. No significant gender differences were observed in treatment outcomes. Conclusion: Second-line ART significantly improves immunological and virological outcomes in HIV patients who have failed first-line therapy. The findings support the continued use and expansion of second-line ART regimens to enhance health outcomes in similar settings. Further research is recommended to explore long-term outcomes and strategies to reduce treatment failure rates.

:  Background:  Chronic renal failure (CRF) is associated with a complex array of different cutaneous manifestations caused either by disease or treatment. CRF patients may exhibit various cutaneous abnormalities, including changes in skin colour, pruritus, xerosis, hair, nail and oral changes, metastatic calcinosis, and bullous dermatosis. The aim of the present study is to know about the dermatological manifestations of chronic renal failure patients undergoing hemodialysis.Materials and Methods: A Descriptive cross sectional study was conducted on 100 patients diagnosed to have chronic renal failure on haemodialysis. Details pertaining to patients such as history, presenting manifestations, relevant past history and examination findings were recorded in a pre-structured proforma. Clinical photographs were taken at the same sitting. All descriptive quantitative variables were expressed as numbers and percentages. Results: Out of the 100 patients, 63 were males and 37 were females. The age ranged from 18 years to 70 years with the majority of them in the age group of 41 to 60 years. The predominant cutaneous manifestations include xerosis (55%), nail changes (52%), pruritus (43%), pallor (32%), diffuse hyperpigmentation (40%), infections (23%), mucosal changes (15%), and perforating dermatosis (3%). The most common nail change was dystrophic nails (18%) followed by onychomycosis (12%), leuconychia (10%), onycholysis (3%), half and half  nails (3%). The cutaneous infections observed in the study include folliculitis (9%) dermatophytosis (8%), furunculosis (2%), intertrigo (2%), herpes zoster (1%), verruca vulgaris (1%). Conclusion: Early and accurate recognition and management of dermatological manifestations under the supervision of a nephrologist and dermatologist can help to reduce morbidity and mortality.

Background: Ultrasound-guided cannulation of the internal jugular vein is a critical procedure in critical care and anesthesia, with the Short Axis (SAX) and Oblique Axis (OAX) approaches being commonly employed. This study aimed to compare the efficacy and safety of these two approaches. Methods: In this prospective, randomized comparative study, 240 patients requiring central venous catheterization at Subbaiah Medical College Hospital and Research Centre Shimoga,Karnataka, were allocated to either the OAX or SAX group. Key outcomes measured included procedure time, first pass success rate, number of attempts, incidence of posterior vessel wall puncture (PVWP), and other complications. Results: The OAX approach significantly reduced procedure time (25.97 ± 6.53 vs. 29.92 ± 9.12 minutes, p < 0.001) and PVWP incidence (4.2% vs. 26.7%, p < 0.001) compared to the SAX approach. Carotid artery puncture was eliminated in the OAX group (0% vs. 8.3% in SAX, p = 0.001). No significant difference was found in the first pass success rate and incidence of pneumothorax between the two groups. Conclusion: The OAX approach for ultrasound-guided internal jugular vein cannulation demonstrates superior efficacy and safety compared to the SAX approach, particularly in reducing procedure time and minimizing complications such as PVWP and arterial puncture. These findings advocate for the preferential use of the OAX approach in clinical practice.

Introduction: Frozen shoulder which is a common condition which is characterized by painful limitation of active and passive range of motion. 2%-5% of general population are affected with this condition. Usually incidence is higher in females than males with age between 40 and 65 years. Main stay of treatment is symptomatic pain relief and followed by regaining normal range of movements. Aim: The purpose of the study is to evaluate effect of manipulation under anaesthesia of Frozen shoulder, objectives are to improve range of motion and pain and early return of individual to perform his daily activities of living. Material and methods: This is a prospective study, for a period of 15 months, carried out in 42 patients posted for manipulation under anaesthesia for Frozen shoulder. For evaluation of outcome we used VAS (Visual analog scale) for pain scoring, American Shoulder and Elbow surgeons Score (ASES) for evaluation of improvement in activities of daily living, Range of movements. Results: In the 42 patients analyzed, females were dominantly affected with 71.42% compared to males 28.57%. Of all 42 shoulders, dominant hand was more involved with 57.14%. Overall 40 patients achieved significant reduction of pain immediately after procedure and ASES score was improved from preoperatively 24.32 ± 9.36 to 88.52 ± 7.92 at 6 months after the procedure. There was significant improvement in range of movements.Conclusion: Frozen Shoulder treated with manipulation under anaesthesia followed by physiotherapy, results in good pain relief and also leading to good functional recovery, helps the patient for their early return to daily activities of living. 

Tracheal stenosis, which is the decrease in the size of the lumen of the windpipe, presents a set of complex challenges in medical care. The rising incidence and life-threatening complications of tracheal stenosis highlight the growing importance of tracheal reconstruction for its management. We describe a series of 5 cases of tracheal stenosis from a Thoracic Surgery centre in India. Each case required personalized treatment plans due to the specific nature of the traumatic injuries incurred by each of them. The intricacies and preoperative assessments are discussed. Further challenges like postoperative complications are acknowledged, prompting a call for continued research to refine treatments. Ultimately, these cases highlight the importance of an integrative approach, combining surgery and other therapies, to optimally manage tracheal stenosis.

Background: Knowledge of common etiological agents and the antibiotic resistance pattern of organisms causing urinary tract infections (UTI) is crucial in avoiding Catheter associated Urinary tract infections (CAUTI). The aim of the present study was to determine the clinico- microbiological profile & drug susceptibility pattern of bacterial pathogens causing UTI. The knowledge of the Etiological profile & local antibiogram acquired from the study help us in reducing the incidence of UTIs & their morbidity, especially the healthcare associated infection (CAUTI).Methods: Record based cross sectional study was conducted among 3000 clinically confirmed cases of urinary tract infection in tertiary care hospital during the period of November 2018 to October 2019. Urine culture yielded growth in 345 patient samples. The laboratory tests were done and results were analyzed using SPSS trial version 25.0. Results: The prevalence of UTI was 11.5% in our study. The mean age of patients was 52.34±4.7 years. Pediatric patients comprised of total 7.1% of total patients. Female patients (61.7%) were higher in number as compared to male patients (38.3%). The most common symptoms were Dysuria (33.5%), Fever (30.6%), Pollakiuria (16.5%), Pain in abdomen (8.9%). Extended spectrum beta lactamases (ESBL) -producing Escherichia coli (43.2%), Non ESBL-producing Escherichia coli (23.4%), ESBL-producing Klebsiella pneumoniae (9.5%), Non ESBL-producing Klebsiella pneumoniae (5.8%), and Pseudomonas aeruginosa (10.6%) were the most prevalent microorganisms. Meropenem showed the least resistance (3.4%), followed by Amikacin (25%), and Nitrofurantoin (27.9%).Conclusion: The increasing prevalence of ESBL producing organisms and their increasing resistance to commonly prescribed antibiotics raise concerns about the future treatment options for these conditions.

Background : The vascular endothelium is composed of a monolayer of specialized cells (endothelial cells), which form the interface between the underlying smooth muscle cells from the vascular lumen. Lipid ratios, atherogenic coefficient and atherogenic index of plasma have been found to indicate an atherogenic risk and are better predictors for the cardiovascular complication than lipids alone. Methodology: An analytical type of study was enrolled total of 60 subjects, of which 30 healthy controls and 30 diagnosed cases of endothelial complication. Lipid Parameters were analyzed by routine enzymatic methods. Atherogenic index of plasma was calculated by using formula log (TG/HDL-c). A p-value less than 0.05 was considered for the statistically significant. Results: Lipid parameters and lipid indices were significantly increased in cases compared to controls. Among this HDL-C is significantly reduced in cases than that of controls (P<0.001). There was a significant strong positive relation between TC, TAG with AIP and significant negative association between HDL & AIP (P<0.001). Conclusion: AIP has been shown to be more predictable when assessing cardiovascular risk.Lipid ratios, atherogenic coefficient and atherogenic index of plasma have been found to indicate an atherogenic risk and are better predictors for the cardiovascular complication than lipids alone. Methodology: An analytical type of study was enrolled total of 60 subjects, of which 30 healthy controls and 30 diagnosed cases of endothelial complication. Lipid Parameters were analyzed by routine enzymatic methods. Atherogenic index of plasma was calculated by using formula log (TG/HDL-c). A p-value less than 0.05 was considered for the statistically significant. Results: Lipid parameters and lipid indices were significantly increased in cases compared to controls. Among this HDL-C is significantly reduced in cases than that of controls (P<0.001). There was a significant strong positive relation between TC, TAG with AIP and significant negative association between HDL & AIP (P<0.001). Conclusion: AIP has been shown to be more predictable when assessing cardiovascular risk.

Background: Acute pancreatitis (AP) is a potentially severe complication in patients with type 2 diabetes mellitus (T2DM) presenting with diabetic ketoacidosis (DKA). This study aimed to investigate the incidence, risk factors, and clinical outcomes of AP in this population.Methods: A prospective observational study was conducted on 50 patients with T2DM presenting with DKA. The incidence of AP, risk factors, and clinical outcomes were analyzed using univariate and multivariate analyses. Results: The incidence of AP in patients with T2DM and DKA was 28% (95% CI: 16.2%-42.5%). Patients with AP+DKA had significantly higher levels of serum amylase, lipase, and triglycerides compared to those with DKA alone (p<0.001 for all). Univariate analysis identified a duration of diabetes ≥10 years (OR: 3.7, 95% CI: 1.1-12.9, p=0.040), HbA1c ≥9% (OR: 4.5, 95% CI: 1.2-17.1, p=0.028), and serum triglycerides ≥500 mg/dL (OR: 6.2, 95% CI: 1.4-27.9, p=0.017) as significant risk factors for AP. Patients with AP+DKA had significantly longer hospital stays (p<0.001), a higher need for ICU admission (p=0.007), and longer ICU stays (p=0.045) compared to those with DKA alone. Severe AP was associated with worse outcomes, including longer hospital stays (p=0.011), a higher need for ICU admission (p=0.026), longer ICU stays (p=0.036), and a higher mortality rate (p=0.029).

Conclusion: The incidence of AP in patients with T2DM presenting with DKA is high, and AP severity significantly impacts clinical outcomes. Early recognition and prompt management of AP in this high-risk population are essential to improve patient outcomes.

:  Introduction: Sexual differences in adults are divisible into metrical and non-metrical features, of which the metrical values of a bone are highly accurate.  Therefore with this study, an attempt was made to calculate a demarking point for the chilotic line that will be accurate for identification of sex from a hip bone in any given population. Aims and Objectives: To assess the reliability of the chilotic line of adult hip bone with respect to the chilotic line index and find a demarking point for the chilotic index that will be accurate for the identification of sex in the human hip bone.  Materials and Methods: A sample of 178 adult human hip bones of known sex available was used. Inclusion criteria: 1) Undamaged adult human hip bones. 2) Bones with no pathological deformity. Exclusion criteria: 1)Damaged bones. 2) Bones with artefacts. Results: The mean value of the chilotic line index in males is 120.22cm, and that of females is 97.58cm, with the value of males and females ranging between 83.07 – 151.1cm and 72.3 – 160.8cm respectively.  The standard deviation for males is 14.075 and for females is 15.525. The range of mean ± 3 S.D in males is 78 – 162.45 and in females is 51 – 144.15. Conclusion: Bones with a chilotic index above 115mm can be defined as male hip bones. Hence, the chilotic line index is one of the reliable parameters for the identification of the sex of hip bones.

Background:  Nephrotic syndrome is usually accompanied by retention of water and sodium. Nephrotic syndrome is a collection of clinical findings due to kidney damage. This includes protein in the urine, low blood albumin levels, high blood lipids, and significant edema. Objectives : This study aimed to observe the pattern of lipid profile in the children with idiopathic nephrotic syndrome and the effect of treatment on the same. Methods : The present observational, cross sectional of 40 cases of nephrotic syndrome children aged between 2-8 years was carried out from June 2022 to July 2023 in Department of Pediatrics of Medical College & Hospital, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: Number of nephrotic children presented during first episode (FE) was 10 (25%). Majority (65%) were under the category of infrequent relapser (I:R) and only 4 children (10%) were frequent relapse. It was observed that during relapse, 4 cases (10%) having their serum albumin level < 1.5 gm/dl showed a very high mean serum cholesterol value of 596 mg/dl. Among 40 nephrotic children during their relapse before treatment, majority of cases (60%) showed their serum LDL cholesterol value in between 200 – 300 mg /dl. Only few cases (8 %) showed very high LDL cholesterol level above 401 mg /dl. The mean + SD value (mg / dl of LDL- cholesterol among control children was 94.8 +30.39 Conclusions: This study suggests that serum lipid profile evaluation be done at regular intervals in children with nephrotic syndrome with follow up even during remission.  

Background: Anterior cruciate ligament (ACL) reconstruction is the current gold standard for treating ACL injuries. However, primary ACL repair has recently regained attention as a potential alternative in carefully selected patients.

Purpose: To evaluate the clinical, functional, and radiological outcomes of primary ACL repair in patients with proximal ACL tears and good tissue quality. Methods: Sixteen patients with proximal ACL tears (Sherman's type 1 and 2) and good tissue quality underwent arthroscopic primary ACL repair. Patients were divided into two groups based on follow-up duration: Group A (>12 months; n=4) and Group B (<12 months; n=12). Clinical stability tests, Lysholm scores, and postoperative MRI findings were assessed.

When a woman visits the gynaecological outpatient department, abnormal uterine bleeding (AUB) is the most often reported presenting issue. The initial diagnostic procedure in the assessment of AUB could involve endometrial sample. In order to distinguish between the many endometrial causes of AUB, this study examines the histology of the endometrium. The study included individuals who had endometrial sample and subsequently presented with AUB. This research has 180 patients in total. 35 instances out of 180 were eliminated because the sample size was insufficient. The age groups are divided into three categories: postmenopausal (over 50 years), perimenopausal (41–50 years), and reproductive (21–40 years). In our study, the perimenopausal group (44.13%) is the age group with the highest frequency of AUB presentations. Proliferative endometrium is the most prevalent pattern at this age (32.81%). The most typical reason

There is also proliferative endometrium in the reproductive age group (48.33%), whereas hyperplasia without atypia is seen in the post-menopausal age group (33.33%).In different age groups, endometrial polyps (2.7%), retained products of conception (1.37%), hyperplasia without atypia (17.93%), hyperplasia with atypia (2.06%), and endometrial cancer (6.89%) were the other reasons found.In order to determine the origin of AUB, a comprehensive histological analysis of endometrial samples might be utilised as a first diagnostic step, particularly in postmenopausal women who are more likely to develop cancer.

Introduction:        Multiple myeloma represents malignant proliferation of plasma cells derived from a single clone, forming a tumorpresenting as bone pain or fracture, renal failure, susceptibility to infection, anemia, hypercalcemia, clotting abnormalities, neurologic symptoms, and manifestations of hyper-viscosity. The purpose of this prospective study was to develop an algorithm-driven combination of laboratory parameters for detection of Multiple Myeloma without initial clinical inputs, to measure the diagnostic yield of such an algorithm over a period of 1 year and to assess their clinical, hematologic, immuno-histochemistry, bone marrow and protein electrophoresis findings along with case-specific observations. Materials & methods:In this study we reviewed routine biochemical and hematological reports in our hospital from January, 2022 to December, 2022. Patients suspected with hyperglobulinemia, hypercalcemia, renal insufficiency and anemia were selected and tests were done in standardized IQC maintained auto-analyzers along with serum protein electrophoresis in our department. Samples having clinico-biochemical correlations were further investigated in authorized laboratory for advanced biochemical tests and HPE along with IHC. Results: We found 6 confirmed cases of multiple myeloma out of 14 suspected patients in accordance with the above-mentioned tests. Conclusions: In our experience, laboratory medicine may provide a small but important contribution in diagnosis of multiple myeloma if sufficient resources and time are available and more specialists are aware of this algorithmic approach, even if detached from initial clinical care of the patient.

Introduction: The decline in estrogen levels post-menopause can elevate the risk of cardiovascular diseases in women. This study aimed to compare cardiovascular risk factors between premenopausal and postmenopausal women, providing insights into the protective period of estrogen and the onset of cardiovascular risk factor changes.

:  Introduction: Serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine is regarded as subclinical hypothyroidism (SCH). 3% to 8% of people without a documented thyroid condition have subclinical hypothyroidism, or mild thyroid insufficiency, which is a prevalent issue The frequency of SCH rises with age and is more common in women. It has long been questioned whether SCH is independently related with ischemic heart disease (IHD), as multiple observational studies comparing the outcomes of SCH individuals with euthyroid participants have yielded different results. In this study we tried to to look at the prevalence of SCH in individuals who had suffered an acute myocardial infarction. Material and Method: This cross-sectional prospective study was done on acute myocardial infarction (MI) patients attending or admitted in MLN Medical College and its associated S R N Hospital, Uttar Pradesh, from the period of August 2015 to August 2017. Study was done after obtaining ethical clearance from institutional ethics committee and consent from all the participants. After applying exclusion criteria, the study included 200 acute MI patients whether euthyroid or SCH based on TSH level between 6-10μIU/ml and normal T4 value 4.9-12.5 μg/dl. Medical history was taken, physical examination and anthropometric measurements was done. Serum T3, T4 and TSH levels were measured by the enzyme-linked immunosorbent assay (ELISA) method using commercial kits. Statistical analysis was done by SPSS software using descriptive analysis and chi-square test. A p-value<0.05 was considered to be statistically significant. Result: Out of 200 MI patients, 146(73%) were males and 54(27%) were females with male:female ratio of 2.703:1. Most common age group with MI was 51-60 years of age and Myocardial infarction was found significantly associated (p< 0.05) with age and gender of the patients. This study showed that the prevalence of SCH was 16% among the MI patients (including both STEMI, and NSTEMI), while prevalence of Euthyroid patients was 84%. Out of 200 patients with MI, number of SCH patients presenting with STEMI was 21while number of patients presenting with NSTEMI was 11. Proportions of males and females among STEMI patients were 66.6% and 33.3% respectively while among NSTEMI patients these proportions were 63.6% and 36.4%. The features of this study concluded that hypothyroidism may be associated with MI. So, thyroid hormone levels should be observed in all middle aged population for early diagnosis of cardiac involvement for better management.

Background: Thin tear film is the unique fluid layer, covers external mucosal surface of the eye. As such this layer is the interface between the ocular surface and the environment. This thin film is a transparent layer, has a mucin phase and a distinct lipid layer superficially. The lipid layer prevents evaporation of tears from outer ocular surface. Dry eye occurs due to insufficient lubrication of ocular surface and a potentially harmful condition which limits the activity as well as in extreme cases causes’ blindness. Objectives: To assess prevalence of dry eye in post menopausal women.Materials and Methods: This study was planned and conducted in a tertiary care health institute in eastern India. Total no of subjects recruited in this study was 183. Post menopausal women attending outpatient department (OPD) were included on the basis of inclusion and exclusion criteria. Diagnosis of dry was done by Schimmer’s test. Data analysis was done by Chi square test.

Results: Out of 183 subjects 97 postmenopausal women were suffering from dry eye which accounts 53% prevalence. Prevalence of dry eye in the age group 51-60, 61-70 and more than 70 years were 42.8%, 50.9% and 67.2% respectively. Also we found that, out of 97 dry eye, 54 (55.6%) were symptomatic and 43 (44.4%) were asymptomatic.  Mild, moderate and severe form of dry eyes was 50.5%, 38.1%, and 11.4% respectively.

Conclusion: It was found that prevalence of dry eye, high among postmenopausal women. There was significant association between dry eye and elder age group.

Background: Numerous medications have been researched in conjunction with local anesthetics to enhance anesthesia quality and offer deep analgesia. In a number of regional methods, clonidine has also been utilized as an adjuvant to local anesthetic drugs. Research on clonidine in brachial plexus block has shown contradictory findings. Aims: To evaluate how tramadol or clonidine affects things in a brachial plexus block: 1) Duration of analgesia (time from block administration to first request for rescue analgesia). 2) The beginning and length of sensory and motor blockade, 3) Pain scores at rest and with movement  4) Any concerns that may arise.

Materials and method: prospective, randomized, double-blinded, controlled trial  involving 60 patients aged 18-65 years, posted for upper limb surgery were randomly allocated into two groups. Group A received 100 mg of tramadol and group B received 100 µg of Clonidine added to bupivacaine (25 ml 0.5%) solution, in the supraclavicular block. The onset and duration of sensory and motor block was compared along with the duration of analgesia, sedation in both the groups. Patients’ pulse rate, blood pressure, saturation was also recorded. Result: In Group Tramadol, the mean Onset Sensory (min) block (mean± s.d.) of patients was 16.33±1.16. In Group Clonidine, the mean Onset Sensory (min) block (mean± s.d.) of patients was 13.10±2.03. Distribution of mean Onset Sensory (min) block with Onset was statistically significant (p<0.0001). In Group Tramadol, the mean Onset Motor (min) block (mean± s.d.) of patients was 22.70±1.60. In Group Clonidine, the mean Onset Motor (min) block (mean± s.d.) of patients was 16.86±1.94. Distribution of mean Onset Motor (min) block with Onset was statistically significant (p<0.0001). Conclusion: This study suggests that, in comparison to tramadol, the addition of clonidine to bupivacaine in supraclavicular brachial plexus block results in a faster onset and longer duration of sensory and motor blockage.

Heart failure (HF) is a progressive clinical syndrome characterized by the inability of the heart to efficiently perform its circulatory function. The burden of HF has been increasing globally, including in India, leading to higher mortality rates, hospitalizations, and diminished quality of life. The incidence of HF in India is expected to rise due to factors such as an aging population, increased cardiovascular risk factors, and the persistence of diseases like rheumatic heart disease. Despite advances in medical therapy, HF continues to impose a significant healthcare and economic burden.

To understand the underlying substrate of hypertension leading to HF, a group of 20 experts from various regions of India participated in a national-level expert panel meeting. The experts reviewed scientific literature and discussed the management of hypertension, dyslipidemia, and HF in the Indian context. Consensus statements were developed based on the discussions and approved by all participating experts.

Key findings include early onset of end-organ damage and microalbuminuria in Indian hypertensive patients, elevated sympathetic overactivity in certain subgroups, and the efficacy of combination therapies and calcium channel blockers. The management of dyslipidemias was found to be suboptimal, with physician inertia and concerns about side effects being barriers to guideline-directed therapy. Recommendations were made to improve physician education and patient awareness. In HF management, challenges were identified, and strategies were proposed to optimize guideline-directed medical therapy and implement newer therapies such as angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors. This consensus document provides valuable insights and recommendations for managing hypertension, dyslipidemia, and HF in the Indian population, with the potential to improve patient outcomes and reduce the burden of HF.

Background:  The autonomic nervous system (ANS) innervates nearly all organ systems, playing a crucial role in maintaining homeostasis. The prevalence of autonomic dysfunction has escalated in individuals with type 2 diabetes mellitus (T2DM), leading to the development of various assessment tools, including autonomic function tests (AFTs). The objective of this study was to compare AFTs between patients diagnosed with T2DM and healthy volunteers.Materials and Methods: This cross-sectional study included 89 participants with T2DM and 89 healthy volunteers aged between 30 and 60 years, encompassing both genders with a three-year history of type 2 diabetes mellitus meeting the inclusion criteria. Healthy controls were selected from the medical OPD as non-diabetic volunteers within the same age range. Detailed medical histories, including present and treatment histories, were obtained from all participants. Results: There was no statistically significant difference in age between the cases and controls. The difference in standard deviation of NN intervals (SDNN) between cases and controls was statistically significant. The mean root mean square of successive differences (RMSSD) had a significant difference between diabetics and non-diabetics. The mean very low-frequency power percentage (VLF %) also showed a significant difference between the two groups. The mean increase in diastolic blood pressure (DBP) after hand grip indicated a significant difference between cases and controls. Conclusion: This study's findings suggest the presence of cardiac autonomic dysfunction in type 2 diabetes mellitus patients without clinically detectable cardiac autonomic neuropathy (CAN) based on conventional autonomic tests. This dysfunction is characterized by predominant parasympathetic nerve function impairment and sympathetic overactivity.

Background:The role of oxidative stress in cardiovascular disease processes, such as atherogenesis, ischemic-reperfusion injury and cardiac remodeling, has been increasingly recognized in the past few decades. Currently, an increasing number of studies suggest that levels of oxidative stress markers in body fluids correlate with atherosclerotic disease activity. This finding may lead to novel clinical approaches in patients with coronary artery disease. Assessment of oxidative stress markers could modify risk stratification and treatment of patients with suspected coronary artery disease or myocardial infarction. Aim:To evaluate the patients of coronary artery disease proven by E.C.G, Coronary angiogram, and serum enzyme CK-MB.

Methods: A Case-Control study was conducted among patients aged <65 years presenting with history consistent with AMI with Ischaemic myocardial pain > 30min. duration but <24 hrs duration unrelieved by isosorbide dinitrate and ECG changes consistent with Tran mural infarction having 70% block in angiographic imaging for a period of 1 year from May -2021-June 2022.50 patients with AMI admitted in Acute coronary care unit and 30 matched controls. Serum level of Malondialdehyde (MDA) in patients and as well as the age and sex matched healthy controls. Serum Ascorbic Acid, lipid profile, serum ascorbic acid, serum calcium levels were correlated among the two groups. Results: Blood Malondialdehyde levels in study group is 6.0 + 0.63 nmol/ml and in controls are 3.0 + 0.53 nmol/ml. Serum ascorbic acid levels were decreased in study group. Serum Calcium level is increased in the study group with a mean value of 11.37 + 0.58 mg/dl. in control group it was 10 + 0.82mg/dl.   

Background: Vesiculobullous disorders (VBD) are heterogeneous group of dermatoses in which the primary lesion is a vesicle or a bulla.  These disorders can be extremely debilitating and even fatal. Histopathological evaluation of skin punch biopsy is the gold standard, widely available and cost effective test for the diagnosis of VBD.

Aims and objectives: To evaluate the clinico-demographic profiles of patients with vesiculobullous disorders of skin and to study their characteristic histopathological findings. Materials and methods: This is a descriptive study conducted in Department of pathology Government Siddhartha medical college, Vijayawada, Andhra Pradesh, India for 3 years period between March 2021 - February 2024. All the cases presenting with vesiculobullous lesions in the OPD  and  inpatient department during the study period were included after recording detailed history. Paraffin embedded, Haematoxylin & eosin stained tissue sections of skin punch biopsy were evaluated under light microscope. Results: During the study period a total of 745 skin punch biopsy specimens were received out of which 49 were vesiculobullous lesions which constituted 6.6 % of skin biopsy specimens. Bullous pemphigoid (BP) (14 cases; 28.6 %) was most frequently diagnosed VBD with male preponderance. Concordance between clinical and histopathological diagnosis was observed in 44 cases (89%). Conclusion: Histopathological evaluation of skin punch biopsy is a cost effective, widely available and reliable diagnostic modality in diagnosis of VBD of skin. Present study showed 89% concordance between clinical and histopathological diagnosis.

Introduction: Bacterial vaginosis is the most common outpatient clinical condition in gynecology department; globally Diagnosis of bacterial vaginosis is by amsel’s criteria during clinical examination, nugents criteria of gram stain and culture analysis can help to detect the exact pathogen and to start the accurate treatment. The aim of this study is to know the aerobic bacteriology of bacterial vaginosis and their antibiotic susceptibility pattern.Materials and Methods: A total of 363 patients participated in this descriptive cross sectional study was between the age group of 15 to 55 years. Their samples were collected and processed as per guidelines by performing gram stain and culture & sensitivity testing method. Patient details such as age, socioeconomic status, relapse of bacterial vaginosis, number of partners, type of discharge, associated symptoms and signs, and microbiological details were tabulated in an excel sheet to evaluate further. Results: Gram positive cocci are highly susceptible to gentamicin(100%), high level gentam icin(100%), vancomycin(82.8%) followed by linezolid(71.4%), clindamycin(60%), amoxiclav(48.6%) and least sensitive to azithromycin(28.6%). Gram negative bacilli are highly susceptible to amikacin(88.9%), meropenem(85.7%), cefipime(69.2%), followed by piperacillin tazobactam(60%), cotrimoxazole (53.5%), ciprofloxacin (50%), ofloxacin (44.4%), cefotaxime (40.7%), doxycycline (33.3%) and they were least sensitive to ceftriaxone (27.8%). Between the age group of 15 – 28 years, E.coli and Staphylococcus aureus were the most common organism isolated, followed by klebsiella pneumonia, Enterococci, CONS, Candida, Acinetobacter and Klebsiella oxytoca. Between the age group of 29 – 55 years, E.coli was the most common organism isolated, followed by Klebsiella pneumoniae , Enterococci and Staphylococci aureus. Conclusion: This study emphasizes the need to understand the aerobic pathogens associated with vaginitis especially in the reproductive age group to prevent adverse complications seen during pregnancy and labour.

Background: Tofacitinib is an oral Janus kinase inhibitor. Objective: This study assessed tofacitinib efficacy and safety vs placebo amongrural patients in Central India with moderate tosevere chronic plaque psoriasis. Methods: Patients were randomized 2:2:1:1 to tofacitinib 5 mg(N = 88), tofacitinib 10 mg (N = 90), placebo! 5 mg (N = 44), or placebo! 10 mg (N = 44), twice daily (BID)for 52 weeks. Results: At Week 16, more patients achieved PGA and PASI75 responses with tofacitinib 5 mg (52.3%;54.6%) and 10 mg (75.6%; 81.1%) BID vs placebo (19.3%; 12.5%; all p < 0.0001). Of patients with a Week 16response, 73.6% and 75.0% maintained PGA response, and 76.8% and 84.9% maintained PASI75 to Week 52 with tofacitinib 5 mg and 10 mg BID, respectively. Over 52 weeks, 2.2–4.5% of patients across treatmentgroups experienced serious adverse events, and 1.1–6.8% discontinued due to adverse events. Conclusion: Tofacitinib demonstrated efficacy vs placebo at Week 16 in Asian patients with moderate tosevere plaque psoriasis; efficacy was maintained through Week 52. No unexpected safety findings wereobserved.

Background: Foot and ankle surgeries often require effective postoperative pain management. Ultrasound-guided popliteal nerve blocks have emerged as a promising technique for providing anesthesia and analgesia in these procedures. This study aimed to investigate the efficacy and safety of ultrasound-guided popliteal nerve blocks for foot and ankle surgeries. Methods: A total of 40 patients aged 20-80 years, with ASA grades I-III, undergoing elective foot and ankle surgeries were included. Ultrasound-guided popliteal nerve blocks were performed, and the time taken to execute the block, onset and duration of sensory and motor blockade, quality of the block, duration of postoperative analgesia, and patient satisfaction were assessed. Results: The mean time taken to execute the block was 5.25 ± 1.24 minutes, with a mean onset of sensory and motor blockade of 4.25 ± 1.30 minutes and 7.10 ± 1.35 minutes, respectively. The mean duration of complete motor and sensory blockade was 247.00 ± 15.06 minutes and 300.25 ± 16.87 minutes, respectively. The mean duration of postoperative analgesia was 340.50 ± 13.77 minutes. The block was successful in 95% of the patients, and 95% were very satisfied with the procedure.

Conclusion: Ultrasound-guided popliteal nerve blocks are an effective and safe technique for providing anesthesia and analgesia in foot and ankle surgeries. The rapid execution, rapid onset, prolonged duration of the block, high success rate, and high patient satisfaction support the integration of this approach into perioperative pain management strategies.

Background: Febrile seizures are the most common seizure disorder in children of Age 6 months to 60months and it is important to differentiate febrile seizure from meningitis to start appropriate management.AIM- To find out Incidence of Culture Positive Bacterial Meningitis in children of Febrile Seizure. Methods: This was a prospective observational hospital based study conducted at Medical college, Hospital& Research, Tertiary health care Centre in Department of Paediatrics. A total of 55 patients of Febrile Seizure were studied.Informed verbal and written Consent was taken from the parents of the patient or the accompanying person before enrolmentinto the study.Results: In present study shows out 55 Children with febrile seizure, Simple febrile seizures were present in 34 (61.82%)children, complex febrile seizure in 4 (7.27%), meningitis in 17 (30.91%). Out of 17 (30.91%) meningitis cases, 2 cases hadculture positive bacterial meningitis and 15 had culture negative bacterial meningitis. Conclusion: Acute bacterial meningitis (ABM) should always be considered as a differential diagnosis in children betweenage 6 months to 60 months who present's with Febrile Seizure.

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has significantly impacted global health. COVID-19 primarily affects the respiratory system but also has notable cardiovascular implications. Patients with preexisting cardiovascular disease (CVD) or risk factors are at a heightened risk of severe complications and poor outcomes. This study aims to identify and evaluate the cardiovascular complications in symptomatic COVID-19 patients and assess the impact on disease outcomes. Methods: A retrospective, observational study was conducted on 100 COVID-19 patients confirmed via RT-PCR from June to December 2021. The patients were divided into two groups: Group A (n=25) for risk scoring and Group B (n=75) to analyze various risk factors. Exclusion criteria included patients under 18, pregnant women, and those with recent or known cardiovascular events. Data collected encompassed demographics, vital signs, symptoms, comorbidities, and laboratory results. Cardiovascular complications assessed included acute myocardial infarction, acute myocardial injury, new or worsening heart failure, de novo arrhythmias, and deep vein thrombosis. Statistical analyses were performed using online tools, with significance set at p<0.05. Results: Patients experiencing cardiovascular events in Group A had a significantly higher mean age (64.53 years) compared to those without events (53.1 years) (p<0.001), and a larger proportion were male (p<0.001). Symptoms like cough (p=0.002), fever (p=0.031), and shortness of breath (p=0.076) were more prevalent in the CV event group. Comorbidities such as diabetes mellitus (p=0.036) and coronary heart disease (CHD) (p<0.001) were also more common among those with cardiovascular complications. Multivariate analysis identified ten significant risk factors: male sex, age ≥60 years, cough, CHD, low lymphocyte count, high blood urea nitrogen, reduced eGFR, prolonged APTT, elevated D-dimer, and elevated procalcitonin levels.Conclusion: The study identified key risk factors for cardiovascular complications in COVID-19 patients, including male gender, older age, preexisting CHD, and specific laboratory markers. These findings underscore the importance of early identification and management of at-risk patients to improve outcomes. Further research is necessary to validate these risk factors and refine predictive models.

Background: Healing of skin graft depends on the site, size of the wound along with associated factors of the patient. Use of PRP (Platelet Rich Plasma) clusters platelet derived growth factors in skin graft, which has better healing properties for graft uptake. Graft also benefited from PRP due to its instant adhesion and hemostatic properties. Autologous PRP can be produced by centrifugation of patients own blood, which has great benefits and can be prepared at an affordable price. This study aims at comparing between conventional mechanical fixation and topical application of Autologous platelet rich plasma in wound bed during split skin grafting and to asses associated parameters in both groups i.e. instant adhesion, hematoma, discharge from graft site, graft edema, frequency of dressings, duration of hospital stays. Methods: This is a prospective comparative study conducted for a period of 15 months. Totally,100 patients undergoing skin grafting in the department of general surgery of a medical college, who met inclusion criteria were consented and included in this study. Results: Majority of the patients belong to the sixth and seventh decades of life with male: female ratio of 4:1. Patients in PRP group had 100% instant adhesion, and also significant reduction in graft edema (13%), discharge (4.3%), hematoma (2.1%), which led to decrease in number of dressings change (80.4% had 1-2 dressings) and hospital stay (86.9% stayed up to 10days) as compared to control group. Using PRP also reduced the significant time intra operatively compared to conventional fixation. No adverse reactions were reported with the use of Autologous PRP. Conclusion: Topical application of Autologous PRP prior to resurfacing of split skin graft is effective compared to conventional method as it provides instant adhesion of the graft, decreases the frequency of dressing change, reduces the chances of hematoma, graft loss and reduced hospital stay.

Aim: To evaluate the risk factor for difficult intubation in snorers and non- snorers. To compare difficulty of intubation in snorers and non- snorers.

Methodology: 145 subjects with age group 16-60 year undergoing elective surgery under general anaesthesia were selected. Demographic data such as age, sex, height, weight, and BMI were measured. ASA, Thyromental distance, Sterno-mental distance, Mandibulo-hyoid distance, Inter-incisor distance, Modified Mallampatti grade, intubation difficulty scale, Cormack and Lehane grading, LEMON score, anthropometric examination was performed by a single anesthesiologist to avoid inter-observer variability. Results: Out of 145 subjects, there were 40 (50.63%) male and 39 (49.37%) female non- snorers and 27 (40.91%) male and 39 (59.09%) female snorers. Among non- snorers, ASA grade 1 was seen in 60, and grade 2 in 19 subjects and among snorers, ASA grade 1 and 2 was seen in 33 subjects each. The mean MPG among non- snorers was 1.75 and in snorers was 1.94. Cormack & Lehane grade 1 was seen among 56 and 31, grade 2A in 21 and 31, grade 3A in 1 and 4 and grade 3B in 1 and 0 in non- snorers and snorers respectively. The mean IDS among non- snorers was 2.43 and among snorers was 3.06. The mean lemon score among non- snorers was 3.0 and among snorers was 3.18. Number of operator attempting intubation 1 was seen in 79 and 65 and 3 in 0 and 1 among non- snorers and snorers respectively. Number of attempts of intubation was 1 seen in 77 and 58 and 2 in 2 and 8 patients in non- snorers and snorers respectively. Conclusion: Snoring had an association with age, female gender, BMI and ASA grade. Snorers had a larger neck circumference, smaller thyromental and mandibulo hyoid distance as compared to non- snorers. It is important to consider these individual risk factors as help in predicting difficult intubation in snorers.

Background: The prevalence and adverse consequences of diabetes mellitus and coronary artery disease are alarmingly growing globally due to obesity. Currently, obesity is a global health problem and is associated with various disease processes particularly hypertension are the fundamental causes of mortality and morbidity. The main objective of the present study was designed to determine the prevalence of obesity in Northern coast region of Andhra Pradesh and association with body mass index (BMI) and hypertension. Methods: In the present cross-sectional study a total of 310 individuals were included between the age group 30-45 years of both the gender. Subjects were divided in to three groups based on BMI levels (Patients with BMI 18.0-22.9 Kg/m2 are considered as normal, 23.0-24.9 Kg/m2 as overweight and ≥25 Kg/m2 were as obese). Results: The mean age of males was 45.2±1.2 years and females were 42.8±1.6 years. We found that the prevalence of obesity and overweight was 60% and 20%, respectively. The prevalence of hypertension was 50%, and it was significantly higher in obese and overweight individuals (66.7% and 33.3%, respectively). The odds ratio for hypertension was 4.03 (95% CI: 2.13-7.64) for obese individuals and 2.23 (95% CI: 1.23-3.99) for overweight individuals, compared to those with normal weight. BMI and triglycerides are significantly associated with SBP and DBP in both males and females having a p-value <0.05. Conclusions: We concluded that a significant association between obesity and hypertension which underlines the need for comprehensive strategies to address them. These strategies should focus on promoting healthy lifestyles, early detection and management of overweight/obesity and hypertension, and further research to understand the factors contributing to these conditions.

Background: The validation of analytical methods and the calibration of equipment are of the essencial aspects of quality assurance programs in the laboratory.  All the methods used in an analytical chemistry laboratory must be evaluated and tested to ensure that they produce valid results suitable for their intended purpose i.e. they must be validated. The commonly used 3% sulphosalicylic acid method for the determination of total proteins in cerebro spinal fluid does not give satisfactory results. Hence the present study aims to study and evaluate the method for the estimation of proteins in CSF by 3% TCA.   Methodology: 3%Trichloroaceticacid (TCA) method was used for estimation of total proteins in cerebro spinal fluid by colorimeter and spectrophotometer. Results: Within run precision check revealed that the coefficient of variation was 1.57%. In the present study 4.76mg of protein was added and observed the recovery of the analyte. Recovery percentage was calculated by formula i.e concentration of recovered protein divided by concentration of protein was added multiplied with hundred.  We found percentage of recovery was 147%. Conclusion: We found that trichloroacetic acid method was linear up to 150mg/dL. Hence the observations of the present study concluded that 3% TCA method was simple precised and useful method to estimate total proteins in cerebrospinal fluid. Consideration of the financial constraints, this method can be very useful in resource limited centres.

Background:   In psychiatry, resilience stands for one's capacity to recover from extremes of trauma and stress. It is an attribute of some people who manage to endure and recover fully, despite suffering significant traumatic conditions of extreme deprivation, serious threat, and major stress. Schizophrenia is a complex, chronic mental health disorder characterised by an array of symptoms, including delusions, hallucinations, disorganised speech or behaviour, and impaired cognitive ability. Bipolar affective disorder is a chronic and complex disorder of mood that is characterised by a combination of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with substantial subsyndromal symptoms that commonly present between major mood episodes. Materials and Methods: This is an Observational, cross-sectional and a comparative study was conducted in the Department of Psychiatry in Government Medical College and Nizamabad, Telangana. With a sample size of 90, 30 caregivers of patients with Schizophrenia, 30 caregivers of patients with Bipolar Affective Disorder and 30 caregivers of patients with Alcohol Dependence Syndrome, i.e. a total of 90 caregivers were assessed during the study period. They were assessed for resilience using appropriate scales and compared. Results: The mean resilience score was 68 in the children (n=8/90) and was the highest. The mean Resilience scores are highest in the Upper middle SE strata (70.8) and nearly the same in the Lower middle (63.16) and Upper lower (65.16) groups. The resilience scores seem to be the lowest in the Lower SE strata (49.8). The difference showed a high statistical significance of (p value= 0.001). Conclusions: Caregiver resilience is an important aspect to be assessed and addressed, and the comparison of caregiver resilience between major psychiatric illnesses has often been under-studied. There was statistically significant difference between the resilience score of caregivers of Group 1 and Group 3. Caregivers who were children of the patients were more resilient than others. Sharing the burden of care of the patient showed better resilience for the caregivers.

Background:  Injections are preferred by patients because they believe they provide rapid relief and more effective than oral medications. Worldwide statistics suggested that unsafe injections account for 32% of new Hepatitis B, 40% new Hepatitis C and 5% of new HIV infections. The prevention of disease transmission through injection requires good knowledge and practice regarding safe injection practices. The present study was undertaken to determine awareness on safe injection practices among healthcare providers, to find out the current injection practices among healthcare providers and to compare the knowledge and practice regarding injection safety among various classes of healthcare providers in Chandragiri Mandal, Chittoor district. Methodology: A hospital based cross sectional study was conducted for 24 months i.e. November 2019 to October 2021 in Chandragiri mandal of Chittoor district among 203 healthcare providers in one area hospital, one community health centre, one primary health centre, one rural health training centre and 5 private clinics. Data collected was entered in MS Excel and analyzed using SPSS Version 16. Results: Among the 203 participants, mean age was found to be 33.65± 8.39 years with a range of 21-73. Majority of the subjects were females (83.7%). Differences were noted among knowledge and practice in preparing and administering injections. Conclusions: The present study shows that though the knowledge about safe injection practices is good among healthcare providers, the practice is poor. Unsafe practices like not washing hands, not wearing gloves and not following the correct steps in giving injections were observed in many.

A study was conducted at Suryapet government hospital between 2022 and 2023 in which the histological characteristics of osteosarcoma where evaluated using a new classification system. In this study we highlighted the importance of histological grade in determining the importance of the clinical outcome of Osteo sarcoma. A multivariate analysis was done for the prognostic variables. A total of 170 cases where analysed. Pleomorphism, mitotic count, amount of matrix, percentage of tumour cells and necrosis were the criteria we have taken into consideration at the time of diagnosis. All the 170 cases of osteosarcoma where classified into grade 1 (15), Grade 2(36) and grade 3(119). Elevated levels of Plasma alkaline phosphate were independent predictors of clinical outcome. Patients with high grade tumors and elevated alkaline Phosphorus should be carefully evaluated for the presence of metastatic disease before starting chemotherapy protocols.

Background: Super brain yoga is an ancient yogic exercise that uses subtle energy to improve cognitive functioning. It is mainly  based on principles of  pranic energy or bioplasmic energy and ear acupuncture. Aim:  The present study aims to study the impact of Super brain yoga on working memory among adolescent males. Materials & Method:  40  adolescent males in the age group of 14-16yrs, who were physically fit and unaware of this yoga were included in study population. Methodology: Digit span test and Digit cancellation test were used to assess working memory of students. These tests were done on students before the commencement of Super brain yoga and one month after doing the yoga. Results: There was highly significant improvement in both digit span and digit cancellation tests with p value <0.001 in paired ‘t’ test. Conclusion: Practicing Super brain yoga for one month has improved the working memory in adolescent males. Super brain yoga could be used by the students for academic improvement.

Background:  Super brain yoga is a simple squatting  exercise that claims to boost the holistic well being. It uses subtle energy to improve cognitive and academic performance. It is mainly  based on principles of  pranic energy or bioplasmic energy and ear acupuncture. Aim:  The present study aims to study the effect  of Super brain yoga on attention span of adolescent males. Materials & Method:  40  adolescent males in the age group of 14-16yrs, who were physically fit and unaware of this yoga were included in study population. Methodology: d2  test  was used to assess working memory of students. This test was done on students before the commencement of Super brain yoga and one month after doing the yoga. Results: There was highly significant improvement in all the parameters of  d2 test with p value <0.001 in paired ‘t’ test. Conclusion: Practicing Super brain yoga for one month has improved the attention span of adolescent males. Super brain yoga could be used by the students for improving academic performance.

Background: Diabetes mellitus is a common and a chronic disease with chronic complications and constitutes a substantial burden for both patient and health care system. According  to the International Diabetes Federation (IDF) Diabetes Atlas 2011, the number of people living with diabetes is expected to rise from 366 million in 2011 to 552 million by 2030 if preventive programmes are not put in place. Material and Methods:  It was a cross sectional study in patients with type-2 diabetes mellitus patients, who visited medicine outpatient department Hassan Institute of Medical Sciences and hospital, Hassan. The primary objective of this study was to examine LDL, HDL, and triglycerides. TG was tested by glycerol phosphate oxidase-peroxidase method; HDL and LDL were tested by direct enzymatic end point method. Results: A total of 300 patients were included in the study. Among which 176 (65.34%) were males, 124 (41.34%) were females. 178 (59.33%) patients were in the age group of 41-49years with mean age of 46 years. The youngest age was26 years and eldest being 81years. Socio-demographic and other parameters are given in table-1. 104 (34.66%) were of normal BMI, 88 (29.33%) were overweight and 108 (36%) are obese. Out of 300 patients, Lipid abnormality was seen in 200/300 (66.67%) of the patients. Increased LDL noted in 152 (50.67%), triglycerides in 112 (40.67%), decreased HDL in 130 (43.34%) of patients. Conclusion: From the above study it is clearly evident that dyslipidaemia is very common association of type 2 diabetes mellitus, and culprit of majority diabetic related cardiovascular mortality. Since it is reversible, early detection and treatment at the earliest will definitely reduce mortality and morbidity and improves the quality of life.

Background:  Aim: To study the prevalence of hypertension in type-2 diabetic patients. To study the association with hypertension and diabetic complications. Materials and Methods:  A cross sectional study consist of total 250 diabetic patients coming to Hassan Institute of Medical Sciences Hospital and College, Hassan were studied and evaluated for BP, and macro vascular and micro vascular complication. All type-2 diabetic patients who are on treatment for diabetes were included. Results: Prevalence of hypertension noted in 64 (25.6%) patients.  Blood pressure was normal in 55 (22%), 131 (52.4%) patients were prehypertensive, 45 (18%) patients were in stage-1 hypertension and 19(7.6%) had stage-2 hypertension. Conclusion: Macro vascular complications noted in 120 (48%) and micro vascular complications noted in 60 (24%) patients.

Background:  Vitamin B12 deficiency is a very common nutritional deficiency in developing countries and is known to cause neurologic manifestations.  However, relationship of Serum Vitamin B12 levels with appearance of neurologic manifestations remain unclear. Aim: To study the relationship of serum vitamin B12 levels with neurological manifestations in children 6 month to 5 years having vitamin B12 deficiency (using a cut-off 250 pg/dl). Methods: This observational analytical study included a single centre cohort of 80 children with Vitamin B12 deficiency (<250 picogram/dl) children aged between 6 months and 5 years in whom clinical manifestations were analysed. In all these children MRI brain was also performed. Results: Out of 80 cases enrolled, 49 (61.25%) were males and 31 (38.75%) were girls. 51(63.75%) cases were between 6 to 15 months. 38(47.50%) cases had severe vitamin B12 deficiency (<100 pg/dl) and remaining 42(52.50%) had mild to moderate vitamin B12 deficiency (100-250 pg/dl). 65% (52/80) cases presented with neurological manifestations and had significantly lower levels of serum vitamin B12 (90.86±58.78pg/dl) as compared to those not having Neurologic manifestations. Conclusion: Based on this study it is recommended that serum vitamin B12 levels between 160 to 250 pg/dl, between 90-160 pg/dl and <90 pg/dl should be categorised as mild, moderate and severe vitamin B12 deficiency states respectively. Early diagnosis and treatment is important to prevent neurological morbidity in these patients.

Background: This study explores the correlation between 24-hour urine protein levels and various clinical and biochemical parameters in patients with Type 2 Diabetes Mellitus (T2DM). Methods: A total of 100 T2DM patients were evaluated for 24-hour urine protein levels using the sulfosalicylic acid method. Clinical parameters such as serum creatinine, eGFR, HbA1c, lipid profile, and diabetic retinopathy were assessed. Statistical analyses were performed using SPSS software. Results: The mean age of the study population was 58.64 years (SD = 11.82). The mean 24-hour urine protein level was 187.88 mg/dL (SD = 116.65). A significant positive correlation was found between 24-hour urine protein and HbA1c levels (r = 0.869, p < 0.0001), serum creatinine (r = 0.602, p < 0.0001), and diabetic retinopathy (r = 0.797, p < 0.0001). Patients on combined OHA and insulin therapy had higher proteinuria levels compared to those on OHA alone (281.5 mg/dL vs. 155.0 mg/dL, p < 0.0001). Conclusion: Elevated 24-hour urine protein levels are significantly associated with poor glycemic control, impaired renal function, and diabetic retinopathy in T2DM patients. Proteinuria serves as a valuable marker for assessing the risk of target organ damage and guiding therapeutic interventions.

Background: We compared the effects of oral clonidine and gabapentin as premedicant in attenuation of hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. Methods: A total of 70 patients undergoing general anesthesia were enrolled in the study and were randomly allocated into two groups of 35 each. Group C patients received oral clonidine 0.3 mg and Group G patients received oral gabapentin 900 mg, 90 min prior to induction of anesthesia. Results: Both groups were matched for age, sex, weight and ASA grade. We observed that the difference in raise in SBP was lesser in group G as compared to group C at it was significant(p<0.05) at 3^rd,5^th and 10^th minute. The MAP was also lesser in group G than group C and was significant(p,0.05) at 3^rd minute. Heart rate increase was lesser in group G than group C and was significant at the first minute. (p<0.005). Conclusion: Oral gabapentin (900 mg) is better as compared to oral clonidine (0.3 mg) premedication, in attenuating the hemodynamic response to laryngoscopy and intubation.

Background:  Additives have been used with lignocaine for  improving analgesia and reducing tourniquet pain after IVRA. Inconsistent results have  been obtained with clonidine added to lignocaine bolus. Hence, effects of injecting  clonidine separately towards the end of surgery was assessed for the same study  parameters. Methods: Eighty patients undergoing below elbow surgeries were randomly allotted  to two groups to receive IVRA; group I received 40 ml lignocaine 0.5% at the beginning  of procedure with normal saline 15 ml at end; group II received same amount of  lignocaine and clonidine 150 µg made upto 15 ml with normal saline at the end. Duration  and quality of postoperative analgesia and tourniquet pain, haemodynamic parameters  and adverse effects if any were noted. Data was analyzed by using EPI INFO V-07 and  the results compared using Fisher’s exact test. Results: Almost all the patients in the group I required analgesic as compared to  group II where less than 50% of patients needed analgesic by 15 mins. Duration of  analgesia extended only upto a further 5 mins period in the group II. There was a small  & statistically insignificant difference in VAS scores at 11-15 min & 16-20 mins intervals between the groups. All the patients expressed feeling of discomfort after tourniquet release. There was no difference with respect to haemodynamic parameters, O₂ saturation or other effects during the study period between the groups. Conclusion: Addition of clonidine to lignocaine 0.5% at end of surgery under IVRA  did not significantly improve duration and quality of post operative analgesia or  tourniquet pain. 

Background:   COPD primarily affects the lungs and is characterized by weight loss and decline in exercise tolerance. We aimed to determine the nutritional status evaluated by BMI (Body Mass Index) and FFMI (Fat Free Mass Index) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) levels in stable subjects with COPD and the association between FFMIand exercise capacity with COPD severity. Method: Forty-eight patients of clinically stable COPD attending the outpatient department of pulmonary medicine, were recruited for the study. They were classified into the COPD GOLD stages and were evaluated for BMI, BFMI (Body Fat Mass Index), FFMI (measured by bioelectrical impedance analysis), airway obstruction and hyperinflation (FEV1, FEV1/FVC) and exercise capacity (6-min walk distance). Result: The mean values of FFMI (p=0.035) and BMI (p=0.008) were significantly lower in severe COPD cases (GOLD stage 3&4). The independent predictors for low fat free mass index with statistically significant difference were female gender (beta= -0.216 and p=0.034) and low BMI (beta=-0.678 and p=<0.001). Six- minute distance covered was less (p= 0.016) in severe COPD cases (GOLD stage 3&4) and with low FFMI patients. Conclusion: FFMI presented significant correlations with COPD severity and so may serve as useful predictor of COPD severity. Abnormal body composition is an important non-pulmonary impairment that modulates the risk of functional limitation in COPD. Body composition abnormalities may represent an important area for screening and preventive intervention in COPD and can be used for the long term health benefits in COPD patients.

Aims: This study has been taken up to establish the possible relationship of  Glycosylated Haemoglobin (HbA1c) which can be used as a marker to predict the extend of target organ damage that may have already taken place at the time of diagnosis in a case of newly detected type 2 diabetes mellitus. Materials and methods: This was a hospital-based, cross-sectional observational study. 84 cases of  newly diagnosed T2DM were studied over a period of  two years from May 2017 to April 2019, for the prevalence of Retinopathy and  Nephropathy and their relationship with HbA1C. Results: Out of  84 cases, 17(21.3%) cases were found to have Retinopathy out  of which 13 patient had Mild NPDR and  4 patient had moderate NPDR.  Most of the patients were with age between 41-60 years (77.4%) which was significantly higher (Z=7.74; p<0.0001).  Most of the patients were with over weight (88.1%) which was significantly higher (Z=11.11;p<0.0001). 9.5% of them were having Class-I obesity. Diabetic retinopathy was present in 20.3% of patients with Mild NPDR being the most common form of diabetic retinopathy and a significant positive correlation was observed between level of HbA1C and  prevalence of diabetic  retinopathy  in  the  newly  diagnosed  cases  of  T2DM. 3.6% cases had macroalbuminuria and  a  significant positive correlation was observed between HbA1C and prevalence of diabetic nephropathy in the newly diagnosed cases of  T2DM. Conclusions: Our study can suggest that  estimation of  HbA1C should be done in all newly diagnosed Type 2 diabetes mellitus cases so that we can easily assess the degree of chronic hypergycaemia and also to assess the presence of progression of these complications  as eye and renal changes by optimum glycaemic control.

Background:  PCOS is a complex genetic condition that is heterogeneous and multifactorial. It primarily affects females who are of reproductive age. One of the most common illnesses in the world, neglected treatment for this one can lead to infertility and possibly uterine cancer. Objectives: This study aimed to determine the prevalence and phenotypes of PCOS among women attending a teaching hospital of eastern India. Methods: The present cross sectional observation study of 50 PCOS patients was carried out from April 2023 to December 2023 in gynecology out-patient department of Gynae and Obstetrics, Calcutta National Medical College, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: The prevalence of PCOS was 5.42% in the gynecology out-patient visits and 38.46% among infertile women. The mean age group of the patients was 24.3±5.16 SD. The mean BMI was 23.2±5.32 SD. The mean duration of infertility was 5.68 years. In present study among 50 PCOS patients, hirsutism was present in 28 (56%). Androgenic features like acne were present in 20 (40%) of the patients, acanthosis nigricans in 10 (20%) of the patients and androgenic alopecia was present in 26 (52%) of patients. The prevalence of metabolic syndrome in our study was 18.0%. In this study menstrual irregularity was the most common complaint. Conclusions: According to the study, oligomenorrhea was evident in the majority of our participants with polycystic ovarian syndrome. Central obesity and hirsutism were also frequent presentations. Because of their more severe ovulatory dysfunction, obese women with PCOS require additional care to ensure proper management.

Background:  The classic™ laryngeal mask airway and I-gel  devices are both  supraglottic airway devices  which has become a standard fixture in securing airway in short surgical procedures. This  study aimed to compare LMA Classic™ and i-gel™ in terms of device related adverse effects, complications and hemodynamic changes in pediatric population undergoing General anesthesia for Ophthalmic surgeries. Methods: The present prospective observational study was conducted at Regional Institute of Ophthalmology, Trivandrum among pediatric patients admitted for ophthalmic surgery during the study period of one year. The patients were selected and divided into two groups with 54 patients in each group. Results were analyzed using SPSS version 20.0. Results: There was no statistical significance when comparing hemodynamic variables like blood pressure, heart rate and saturation between LMA classic and i-gel. When comparing post -op complications after removal of both airway devices, dysphagia  was found to be statistically significant in LMA group. Conclusion: i-gel™ serves as a marginally superior choice  for managing the airway of pediatric patients who are undergoing brief ophthalmic surgery while under general anesthesia.

Uretero-pelvic junction obstruction is being diagnosed more frequently than in the past largely secondary to improved prenatal detection. The, natural history of hydronephrosis secondary to pelvi-ureteric junction obstruction varies. High grade obstruction results in hydrostatic distension of renal pelvis, increased intrapelvic pressure and ultimately results in irreversible renal damage with increasing duration. In low grade obstruction, the developing kidney may remain in homeostatic state without much renal damage. Between the two extremes raises the debate and the question when to perform pyeloplasty for better renal functional outcome. In this study, we have collected the data of all children with case sheets. attempted to measure Differential renal function by renal scintigraphy and by renal USG. We have total 37 puj obstruction cases from January 21 to December 2023. There are 3 cases of Crossed lower pole vessels obstructing the pelvi ureteric junction, two cases of bilateral puj obstruction, one male child had malrotated kidney with hilum facing posteriorly and one case with mcd kidney.

Background:  The educational experience in medicine is distinct and varies greatly from other programs in higher education. Its curriculum is competitive, difficult, stressful, complicated, and lengthy compared to other undergraduate curricula. OBJECTIVES: 1. To identify the factors that influence the academic performance of the phase - I MBBS students in physiology. 2. To recommend measures to improve their academic performance by correcting the factors identified. Material & Methods: Study Design: Institutional-based cross-sectional study. Study area: The study was conducted in the Department of Physiology, Government Medical College, Kadapa, Andhra Pradesh.  Study Period:  August 2022 – July 2023 (1 year).  Study population: Phase I MBBS students of the 2022-2023 batch joined in the GMC, Kadapa.  Sample size: The study included a total of 142 subjects. Sampling Technique:  Simple Random technique. This is a cross-sectional observational study done on phase I MBBS students of the 2022-2023 Batch. Institutional Ethical Committee Clearance was obtained. At the end of the year, the student data about their academic performance i.e. the final aggregate of internal assessments and the final attendance percentage was collected from the departmental records. Data was collected from the phase I MBBS students of the 2022-2023 batch via Google Forms having the closed questionnaire with student data and the factors that influence academic performance by sending a link in a WhatsApp group. Results: Out of 175 students, 142 (81.1%) students gave their consent and filled out the questionnaire. Out of 142, males were 75 (52.8%) and females were 67 (47.2%). Most (85.2%) of the students had <75% attendance in our study. Only 14.8% of the students were having >75% attendance in our research. Most (93%) of the students were having <50% marks in our study. Only 7% were having >50% marks. Conclusion: After analyzing the data, we were able to determine that a few factors, such as language barriers, misuse of gadgets, and bad friendships, were significantly associated with students' poor academic performance and needed to be rectified (p-value less than 0.05).

Background: Neonatal sepsis is defined as an invasive bacterial infection which occurs in the first 4 weeks of life. During the last decades efforts have been made to improve the laboratory diagnosis of neonatal sepsis by studying a large variety of inflammatory markers with diverse success. Some of these markers, such as C-reactive protein (CRP) and, more recently, procalcitonin (PCT) have been implemented in diagnosis of neonatal sepsis. Objectives : to compare procalictonin and C-reactive protein (CRP) levels with blood culture as gold standard in early diagnosis of neonatal sepsis. Material & Methods: A cross-sectional study was conducted in a neonatal intensive care unit (NICU) of a tertiary institute from January 2020 to June 2021 including all term newborns with clinical features of sepsis. The specimen of blood was obtained from each neonate prior to commencement of the antibiotic with in first 24 hours of birth for the sepsis workup which included complete blood count, blood culture, C-reactive protein(CRP) and procalcitonin(PCT). Results: Among 143 newborns, male predominance was seen with 82 (57.3%) males and 61 (42.7%) females. Sensitivity, specificity, PPV, NPV, PLR and NLR of CRP was 56.25%, 69.62%, 60%, 75.95%, 1.85, 0.63 respectively which was lower than the Sensitivity, specificity, PPV, NPV, PLR and NLR of PCT i.e. 84.38%, 81.1%, 78.26% ,82.52%, 4.44 and 0.19 respectively. Conclusion : PCT shows higher sensitivity, specificity, PPV and NPV as compared to CRP in early diagnosis of neonatal sepsis.

Background: Gastric and duodenal perforations are severe complications of peptic ulcer disease, associated with significant morbidity and mortality. This study aimed to assess the etiological factors responsible for the higher incidence of gastric perforations and to evaluate the role of biopsy in the etiology and management of these perforations. Methods: A prospective, descriptive study was conducted on 50 patients with peritonitis due to gastric and duodenal perforations. The incidence of anatomical sites, age distribution, time of presentation, symptomatology, risk factors, and postoperative complications were analyzed. The diagnostic efficacy of X-ray erect abdomen and the role of edge biopsy were also evaluated. Results: The incidence of gastric perforation (96%) was significantly higher than duodenal perforation (4%) (p<0.00001). The 40-60 years age group had the highest incidence (42%). Abdominal pain was the most common symptom (100%), and alcohol consumption and smoking were the most common risk factors (72% each). The diagnostic efficacy of X-ray erect abdomen was high (98%). Respiratory failure (56%) and surgical site infection (44%) were the most common postoperative complications. The mortality rate was 4%. Edge biopsy revealed a significant association between induration and malignant histopathological examination. Conclusion: The high incidence of gastric perforation, the prevalence of alcohol consumption and smoking as risk factors, and the importance of edge biopsy in detecting underlying malignancy were notable findings. Early presentation, prompt diagnosis, and timely management could contribute to lower mortality rates.

Introduction: Chronic kidney diseases show’s high mortality and morbidity in the world as well as in India. Various treatment modalities are used for CKD patients which includes transplantation and hemodialysis, Transplantation is considered as very highly successful treatment modality. Transplantation helps in altering  quality of life  positively as well a negatively Maintenance haemodialysis is another  treatment which is commonly used for the CKD  patients who cannot undergo renal transplantation. Dialysis prolongs  the survival of patients and also help in improving  quality of life. Various studies showed that there is considerable alteration in RFTS after haemodialysis which has beneficial effect on CKD patients. So, we decided to study  renal function test (RFTs) in the pre and post haemodialysis to see the effect of haemodialysis on serum urea, creatinine and uric acid levels Methods: 1.Blood Urea-GLDH-Urease Method, Initial Rate by Talke and Schubert, Tiffany et al 2. Serum Creatinine-Modified jaffes reaction. 3. Serum Uric Acid- Dynamic extended stability (with lipid clearing factor) Modified Trinder method, End Point. All tests were done in CCL using semiautomatic/automatic analyser. Results: 100 subjects were selected for study which included 50 controls and 50 patients with C. Renal function tests which included Blood urea, Uric acid and Creatinine were assayed in all subjects. Blood urea and Serum Creatinine showed highly significant decreased level, and uric acid showed significant decreased level in post-hemodialysis when compared with pre hemodialysis in patients with CKD.  Conclusion: Haemodialysis  decreases serum levels of creatinine and  urea and uric acid in these CKD patients in post haemodialysis and that helps in decreasing load on kidney.

Introduction: Abnormal uterine bleeding is a routinely encountered gynecological problem, pointing out the magnitude of the disease. It is a major problem accounting for 33% of outpatient gynecological referrals1 and one of the leading indications of hysterectomy. This proportion rises to 70% in the perimenopausal and postmenopausal years. Several methods are utilized for assessing the endometrium, with histopathological interpretation of endometrial tissue being considered the gold standard investigation. However, studies have raised concerns regarding the diagnostic accuracy and adequacy of pipelle endometrial samples. Aim: To assess the diagnostic value of the pipelle endometrial sampling method against the conventional Dilatation and Curettage (D&C) procedure in diagnosing Abnormal Uterine Bleeding (AUB). Materials and Methods: A cross-sectional observational study was done at a teritiary hospital of Bangalore between January 2019 to January 2021. 70 cases of abnormal uterine bleeding attending the outpatient clinic in the department of Obstetrics and Gynecology were included in the study. The endometrial sample was obtained with Pipelle device followed by conventional D & C and sent for histopathology assessment. Samples were labeled as A and B and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared. Result: Pipelle had a high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for diagnosing proliferative phase, disordered proliferative endometrium. It showed a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 100% in diagnosing secretory endometrium, hyperplasia, hyperplasia with atypia, endometritis, irregular ripening and endometrial carcinoma. The histopathology results obtained by D & C and pipelle sampling were comparable. No opinion could be inferred in 5 cases in pipelle group and 3 cases in D&C group due to inadequate sample. Conclusion: Pipelle is a simple, safe and yet very efficient tool for endometrial assessment. It is very convenient and less painful to the patients and a cost-effective sampling procedure. Endometrial tissue obtained by pipelle has shown high sensitivity and specificity in patients with abnormal uterine bleeding even for hyperplasia and malignancy. Thus, pipelle can be considered as a first line investigation for getting adequate endometrial sample in patients with abnormal uterine bleeding.

Background:  Acute appendicitis was the second most common cause of acute abdominal pain (11-23%) after nonspecific abdominal pain (31-37%). It is not only the most common emergency abdominal surgery, with a lifetime appendicectomy risk of 23% for females and 12% for males, but also the most frequent cause of intra-abdominal infections, as confirmed by the WISS study. The prevalence of patients who underwent appendicectomy for appendicitis, as well as the proportion of uncomplicated cases, increased with age. Interestingly, the incidence of acute appendicitis is variable - it is stable in most Western countries but appears to be increasing rapidly in newly industrialized countries. Material & Methods:  This is a prospective study was conducted in the Department of Surgery, Tertiary Care Teaching Hospital over a period of 1 year. Inclusion criteria include patients diagnosed to have acute appendicitis which is complicated by appendicular mass (diagnosed by clinical examination, abdominal ultrasound examination or accidentally encountered during appendectomy). Patients either come to our hospital directly or referred from other hospitals. The symptoms of the patients were right lower abdominal pain and anorexia in all patients while vomiting, fever, abdominal distension and constipation were present but not in all patients. These symptoms ranged from 4 to 12 days in duration. Results: Acute appendicitis was the commonest presentation and open appendicectomy, even today, is the commonest surgery done in our unit and department. Around 47.83% of patient with appendicitis have some form of complications and 86.96% of the total patients required surgical intervention. Though there was no mortality, around 8.9% of the patients developed complications following surgery. 85.37% of the patients had undergone emergency surgeries. Conclusion:  For patients diagnosed with appendicitis who also have underlying hematologic conditions, careful preoperative laboratory adjustments and choosing a minimally invasive appendectomy seem to be safe options. These approaches do not increase the incidence of severe complications when compared to conservative treatments.

Aims of the Study

To evaluate Thyroid function in patients with Chronic Liver Disease (CLD).

To assess the severity of liver dysfunction in relation to interpretation of thyroid function.

Aims Of The Study

1. To assess whether serum brain natriuretic peptide (BNP) will increase in liver cirrhosis

2. To study the association of serum BNP levels as a biochemical marker of severity of cirrhosis

Aims of the Study

Background: The prevalence of chronic kidney disease is increasing worldwide. Most common cause being diabetic nephropathy secondary to type 2 diabetes mellitus The population of India is projected to become the major reservoir of chronic diseases like diabetes mellitus and hypertension also 25–40% of them are likely to develop CKD which increases the mortality and morbidity risks thereby raising the ESRD burden. An association has been found between hemodialysis and pulmonary hypertension (PH) which is estimated to be around 19-69% and also ESRD with PH (9-39%). Aim: To study the prevalence of pulmonary hypertension in CKD patients and compare prevalence of pulmonary hypertension in dialysis dependent and independent CKD patients Material and Methods: It is a prospective observational and cross-sectional study conducted on 120 (60 non dialysis and 60 hemodialysis dependent) CKD patients of age ≥18 years coming to Department of General Medicine & Nephrology of M.K.C.G. Medical College and Hospital, Berhampur between April 2021 to March 2023. Results: Maximum (43.3%) patients were more than 60 years and mean age was 58.8 years. There were 40 male and 20 female in dialysis dependent group and 38 male and 22 female in non-dialysis dependent groups. 41(34.2%) patients had diabetes and 69 (57.5%) had systemic hypertension and 33(27.5%) had PH. Mean eGFR was 17.68 with mean duration of dialysis 12.72 months. The mean Hb was 7.53 gm% in dialysis group and 10.1gm% in non-dialysis group. Mean urea level was 150 mg/dl and 80 mg/dl and mean creatinine level 7 and 2.4 mg/dl in dialysis and non-dialysis group respectively. 62 patients were in ESRD, 30.8% patients were in stage 4 and 17.5 % in stage 3 of CKD. LVH was found in 35.83% of dialysis group and 16.67% of non-dialysis group. Conclusion: Prevalence of PH is high among patients on dialysis owing to their AVFs and other factors rather than those on conservative management. It linearly increases with the duration of hemodialysis, so this complication should be anticipated and addressed early and alternate mode of dialysis must be considered.

:  Background: Cervical carcinoma can be diagnosed at an early stage with screening since cervical intraepithelial neoplasia has a long latency period. The nuclear anomalies suggestive of genotoxicity include budding, binucleation, micronucleation, broken eggs, karyorrhexis, and karyolysis. It also can be seen either as chromosomal breakage or chromatid fragments or a whole chromosome that could not get incorporated into the daughter cell during mitosis.In the present study an attempt was made for the early diagnosis of cervical carcinoma at an early stage in order to improve the prognosis and provide the patient a better quality of life. Material and methods: A prospective study was conducted among 500 females attending colposcopic clinic were studied for micronucleus and nuclear abnormalities in Department of Anatomy of World Medical College, Jhajjar.A standard Proforma was prepared and a proper recording of detailed menstrual, obstetrics, gynaecological and personal history was recorded. From all these cases cervical smearsamples were collected and examined for micronucleus and other nuclear abnormalities. The data thus collected was analysed using appropriate statistical tests. Results: About 500 samples were examined for presence of micronucleus of which 30.0% of the samples contained micronucleus. There was no statistically significant difference in number of micronucleus and age group of the patients. There was no significant association between the number of micronucleus and education. There was no significant difference in number of micronucleus and socio-economic status. About 27.0% of the cases with 1 binucleate nucleus were aged between 31 – 40 years and 30.0% of the cases with 2 binucleate nucleus were aged between 21 – 30 years. This difference in number of binucleate nucleus and age group was not statistically significant. There no statistically significant difference in age group with the Karyorhexis and Karyolysis. Conclusion: This study had shown that, frequencies of binucleate nucleus were higher in cases aged between 21 – 30 years. Karyorhexis and Karyolysis was higher in cases aged between 31 – 40 years.

Background: Pulse oximetry is widely used in the NICU and PICU to monitor oxygenation in newborns and children with respiratory distress. This study aimed to evaluate the relationship between arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2) values in this patient population. Methods: A total of 50 newborns and children with respiratory distress admitted to the NICU and PICU were included in this observational study. PaO2 and SpO2 values were obtained simultaneously, and their relationship was analyzed using correlation, linear regression, and agreement analyses. Results: A strong positive correlation was found between PaO2 and SpO2 (r = 0.78, p < 0.001). The linear regression equation was PaO2 = 21.5 + 0.46 × SpO2 (R-squared = 0.61, adjusted R-squared = 0.60, p < 0.001). The mean difference between PaO2 and SpO2 was 2.8 (SD = 8.2), with 95% limits of agreement ranging from -13.3 to 18.9. The sensitivity and specificity of SpO2 for detecting hypoxemia (PaO2 < 60 mmHg) were 85.7% and 91.2%, respectively. Conclusions: SpO2 is a reliable tool for monitoring oxygenation in newborns and children with respiratory distress, showing a strong correlation with PaO2. However, its accuracy may be influenced by factors such as the FiO2 level and the severity of hypoxemia. Clinicians should use SpO2 in conjunction with other clinical parameters and diagnostic tools when assessing and managing this patient population.

Introduction: Differentiating between Acute Coronary Syndrome (ACS) and Stable Coronary Artery Disease (SCAD) often requires advanced laboratory tools and electrocardiograms, which are limited in primary care facilities in developing nations. Given the common occurrence of hematologic alterations in ACS, these changes may serve as valuable cues for distinguishing ACS from SCAD. This investigation evaluates hematologic parameters in ACS and SCAD patients, exploring their potential as prognostic markers for ACS identification. Methods: 145 subjects, comprising 61 ACS and 84 SCAD patients, meeting inclusion criteria were included. Patient demographics, initial hematologic readings, and final diagnoses were extracted from medical records and analyzed using SPSS 23.0. Results: Our study found significantly higher values of Mean Corpuscular Hemoglobin Concentration (MCHC), White Blood Cell count (WBC), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) in ACS patients compared to SCAD. Conversely, Mean Platelet Volume (MPV) was significantly lower in ACS patients. Receiver Operating Characteristic (ROC) analysis indicated MPV as the most accurate marker for ACS diagnosis, with a threshold of ≤ 7.93fL, offering 92.2% sensitivity and 95.3% specificity. Conclusion: The investigation highlighted significant distinctions in hematologic parameters between patients with ACS and those with SCAD. Particularly noteworthy was MPV, which exhibited the highest Area Under the Curve (AUC). The optimal threshold for MPV was determined as 7.93 fL, yielding a sensitivity of 92.2% and specificity of 95.3%.

Background: ketamine is unique in the sense that it produces dissociative anaesthesia rather than generalized depression of the CNS.  Aim: The aim of this study was to evaluate the effect of administration of ketamine as the only anesthetic drug utilized to induce the patients, maintain intraoperative hemodynamics, postoperative analgesia, and analgesia during certain operations like appendectomy, Hernia, Hydrocele and circumcision at a district hospital in Assam. Settings and Design: This prospective, observational study was conducted from January 2023 to December 2023, over a period of 12 months in a District hospital in Assam. Materials and Methods: Fifty individuals aged 15 to 40 who were scheduled for various procedures were enlisted. Before surgery, ketamine was administered at a dose of 2 to 3 mg/kg. During the procedure, this dose was repeated every ten to fifteen minutes at a rate of .5 to 1 mg/kg. For the first five hours, hemodynamic parameters, the duration until the first rescue analgesia, and complications were noted.  Results: Within the first five hours following surgery, 90% of the patients did not require any postoperative rescue analgesics. 10% of the patients experienced mild postoperative problems, and none of the patients reported pain right away after finishing of procedure.  Conclusion: Ketamine with inducing doses have been shown to be effective analgesics, especially during procedures like conventional appendicectomy,operations for Hernia, Hydrocele and Circumcisions.

Background: The addition of dexmedetomidine to lignocaine for Intravenous regional anaesthesia may improve the quality of anaesthesia and peri-operative analgesia without causing side effects Aim: to study the Comparison of Lignocaine 3mg with Dexmedetomidine 1 mcg adding to lignocaine 3mg for Intravenous regional anaesthesia Materials and Methods: 50 patients of ASA grade I and II of 21 to 60 years age, undergoing elective forearm and hand surgeries were divided into two groups of 25 each. Group I: received lignocaine (3mg/kg) up to the volume of 40 ml dissolved in saline and Group II: received dexmedetomidine (1mcg/kg) with (3mg/kg) lignocaine up to the volume of 40 ml dissolved in normal saline. Results: The mean time for onset of sensory block was 3.61±0.92 minutes in Group-I patients compared to Group-II patients(1.94±1.13 minutes); the meantime for the onset of motor block was 5.69 ±1.29 minutes in Group-I patients compared to Group-II patients (3.84 ±1.49 minutes); The mean time for regression of sensory block was 4.24 ±0.82 minutes in Group-I patients compared to Group- II patients (6.47±1.43minutes); The mean time for regression of motor block was 3.92±1.51 minutes in Group-I patients compared to Group-II patients (5.78±1.33minutes) was observed. In Group-I patients, the mean time for post-operative analgesia was 25.10+6.56 minutes. Compared to Group-II patients (234+40.42 minutes) was noted in the present study. Conclusion: The addition of dexmedetomidine as an adjuvant to Lignocaine can be used for early onset and delayed regression of motor and sensory block with prolonged post-operative analgesic effect with minimal side effects and good haemodynamic stability was observed in our study.

Introduction:  Preterm birth is the leading factor behind perinatal morbidity and mortality in affluent nations. Over the recent years, there has been an upward trend in the occurrence of preterm births as well as an improvement in the survival rates of premature infants. The aims of this study were to provide a detailed account of the morbidity and mortality rates and to ascertain whether there are any disparities among individuals who were administered prenatal corticosteroids. Material and Methods: This study was a prospective observational study with the main purpose of investigating the impact of antenatal administration of corticosteroids on the outcomes of preterm infants. The patients for this study were chosen from Department of Obstetrics and Gynaecology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India. The study was done from May 2023 to April 2024. Result: The study found that 42.5% of the mothers were 35 years old or older, 46.6% were first-time mothers, 7.7% of pregnancies were the result of assisted reproduction, 24.1% of pregnancies involved multiple gestations, and 41.7% of deliveries were induced due to maternal or foetal indications that align with previous literature. Within our research, it was found that 29.6% of individuals with Late Preterm Infants had been administered prenatal corticosteroids. It was observed that the admission rates were notably greater in those who had not received this treatment, both for the neonatal unit and the Neonatal Intensive Care Unit. Conclusion: Conclusively, extending the administration of antenatal corticosteroids beyond 34 weeks of gestation can significantly decrease morbidity and mortality rates, length of hospital stays, NICU admissions, resource utilisation, and the socio-economic burden associated with this specific population.

Background and Objectives: To investigate the connection between early pregnancy BMI and maternal issues. To determine the connection between birth outcomes and BMI during the early stages of pregnancy. to investigate the effect of BMI during early pregnancy on the newborn's outcome. To evaluate the connection between early pregnancy BMI and gestational weight increase. To evaluate the risk of adverse outcomes for both the mother and the foetus in women with high BMIs. Method: A prospective observational study was conducted between May 2023 to April 2024, involving 150 pregnant women with singleton, uncomplicated pregnancies who were scheduled at the Rangaraya Medical College, Kakinada, Andhra Pradesh, India, between the first 12 weeks of gestation. Result: The table above displays the distribution of frequency and percentage. 54.9% of the people had BMIs that were normal. Of the participants, 28% were overweight.12.8% of people were obese. Women who were underweight made up 16.8% of the population. Obese patients (35.7%) and women with normal BMI (0.9%) had the highest prevalence of Preeclmpsia. chi-square analysis is used. There was a significant correlation (X 2 = 14.73, p 0.01) between preelampsia and BMI. Obesity women had a higher percentage of LGA children than women with a normal BMI. Babies with SGA were born into underweight mothers. Chi-square research was carried out. The BMI and birth weight had a significant correlation. (p<0.001, X2 = 38.598). Conclusion: In this study, there was a clear correlation between BMI and maternal outcomes. Maternities who were underweight experienced reduced fluid volume, anaemia, low Apgar scores, and an increased incidence of caesarean sections. Obese and overweight women were more likely to experience PPROM, increased liquor Volume, gestational diabetes, pregnancy-induced hypertension, instrumental births, caesarean sections, postpartum complications like haemorrhage and delayed wound healing, and low Apgar scores in their LGA babies. Women who were underweight gained the least weight, while those who were overweight or obese gained the most. Additionally, the relative risk of different pregnancy outcomes in patients with high and low BMIs was evaluated and supported.

Background: The study aims to study and classify various primary immunodeficiency diseases diagnosed in paediatric age group at a tertiary care hospital. Objectives: The primary objective is to describe the clinical profile, immunological profile and flow cytometry findings in different types of primary immunodeficiency diseases. The secondary objectives are to study the pattern of complete blood count values in various primary immunodeficiency diseases and to describe the bone marrow findings in whichever case possible especially in Bone marrow failure syndromes. Methods: This is a descriptive cross-sectional study with a duration of 13 months from June 2021 to July 2022. Children within 14 years of age presenting in the Paediatric out-patient department with the warning signs of primary immunodeficiency diseases were included in the study. Clinical details were collected from OP records, IP records and from patients. Samples were studied in the Department of Pathology for haematological and immunological findings. Descriptive statistics were used. Results: A total of 70 PID cases were studied. Males predominated with a frequency of n = 46. The most common age of onset was found to be 1 – 5 months of age (41%). Combined immunodeficiency with associated or syndromic features was the IUIS category with the greatest number of cases in the study (31%). The most common case encountered was Hyper IgE syndrome (HIES). Respiratory system was the most commonly affected system (73%), followed by skin (51%) and gastrointestinal system (36%). Haematological, immunological and flow cytometry findings in each subtype of PID were studied separately. Conclusion: The clinical presentations of PIDs can vary widely. Therefore, high degree of alertness is required in recurrent or unusual infections, along with a systematic diagnostic workup which includes CBC, peripheral smear, flow cytometry and immunoglobulin assay for the early diagnosis of primary immunodeficiency diseases.

BACKGROUND In this study, we wanted to evaluate the prevalence of genitourinary tract infection in diabetic patients and to know the clinical presentation, bacteriological profile and antibiotic sensitivity pattern of organism causing Genitourinary tract infection. METHODS This was a hospital based study conducted among 344 patients who were screened for genitourinary tract infection by culture of urine and discharge, in the Department of Medicine with the assistance of Department of Microbiology at VIMSAR, Burla, over a period of two years from December 2015 to November 2017, after obtaining clearance from institutional ethics committee and written informed consent from the study participants. RESULTS Nephropathy was found to in maximum no. of cases (64%) followed by retinopathy and neuropathy.

Background: Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in low-resource countries. The objective of this study was to assess knowledge and awareness of cervical cancer prevention among healthcare workers. Materials and Methods: This is a cross-sectional study design was conducted to assess the level of knowledge about cervical cancer screening and its practice among female health care workers at Tertiary Care Teaching Hospital. All female health workers comprising doctors, nurses, midwives, pharmacy technicians, pharmacists, and medical laboratory technicians and technologists, aged between 15 and 65 years, and employed in our zone were considered as the source population, while those who were employed in the selected health institution were considered as the study population. Result: Only 27.8% (n=25) of the participants regularly had gynecologic examination. While 94.4% (n=85) of the participants reported that they had already heard about pap smear test, 44.4% (n=40) had underwent this test. It was determined that the participants who had pap smear test had it for averagely 2.70±0.95 times (1-4) within the last five years. Some 55.6% (n=50) of the participants informed about Pap smear test (p<0.001) and 83.3% (n=75) of the participants who regularly had gynecological examinations (p<0.001) had this test. Conclusion: Through the findings of this study, it has been identified that the knowledge level of the clinical staff required to offer cervical cancer services in rural area requires adequate training. There was a lack of knowledge about HPV, the recommended screening method, the recommended age for screening, and the recommended frequency for screening. The most experienced clinicians obtained lower knowledge scores in the studied population. This study also identified that training for staff to provide these services was not adequate and required a broader and more comprehensive approach to ensure that quality service is offered to clients.

Background:  Functional Endoscopic Sinus Surgery, one of the less invasive procedures requires bloodless surgical field for proper visualisation. Intense bleeding is a major limitation of this procedure. Aim of this study was to compare induced controlled hypotension by Dexmedetomidine and Esmolol to provide better surgical field visibility. Methods:40 consenting individuals scheduled for elective FESS fulfilling the inclusion criteria participated in this randomised, double-blinded, prospective, comparative study. They were sorted into 2 groups of 20 each randomly. Group D was administered Dexmedetomidine 0.5mcg/kg diluted to 60ml and Group E received Esmolol 0.75mg/kg diluted to 60ml as an infusion started at induction at the rate of 1ml/min over 1 hour. Haemodynamic variables like mean arterial pressure, systolic and diastolic blood pressure, heart rate and average category score were recorded at every 10 minutes for 1 hour. Any adverse effects during the study were noted. Results: In Group D, Mean arterial pressure(MAP), Systolic blood pressure(SBP) and Diastolic blood pressure(DBP) were all significantly lower than those of Group E, particularly at 30mins, 40mins, 50mins and 60mins after study drugs were started. No patients exhibited severe bradycardia, resistive hypotension or hypertension. No serious side effects were noted. In Average category score for quality of surgical field, group D showed grade 1 in majority patients even at 30 mins, 40 mins, 50 mins after start of infusion. Conclusion: Dexmedetomidine & Esmolol both are safe to produce controlled hypotension & good surgical field during FESS, but Dexmedetomidine has superior haemodynamic profile and added effects of analgesia & sedation.

Introduction: Surgical site infections (SSIs) pose a significant risk to patients undergoing invasive surgical procedures, particularly in the case of class IV laparotomy wounds. Despite advancements in surgical techniques and medical care, SSIs remain a significant concern due to their association with delayed wound healing, increased morbidity, prolonged hospital stays, and heightened treatment costs. Subcutaneous drains have been proposed as a potential intervention to mitigate SSIs by removing collections and eliminating dead space, although their efficacy and impact on patient outcomes remain debated. Methods:This quasi-experimental study was conducted at the Department of General Surgery, Institute of Gastroenterology Sciences & Organ Transplant, Bengaluru & Rajarajeshwari Medical college & Hospital, Bengaluru over a one-year period from December 1, 2022, to November 31, 2023. The study enrolled 110 patients, with 55 patients allocated to each group: one with subcutaneous drains and the other without. Randomization was performed using computer-generated random numbers. Data collection involved detailed history-taking, physical examinations, and prospective audits in the post-operative period. Patients were followed up for the development of SSIs, and other nosocomial infections were also monitored. Statistical analysis was conducted using SPSS version 23, with significance set at P < 0.05. Results:Demographic analysis revealed no significant difference in age or gender distribution between the two groups. Clinical findings indicated that abdominal pain was the most common complaint in both groups, with significant associations observed for nausea. Intraoperative findings showed Peptic Perforation and Perforated Appendix as the most common, while post-operative complications were prevalent, with fever and local site pain being predominant. Hospital stay was longer in the group without drains, and a higher incidence of surgical site infection was observed in this group. Discussion: Our study findings align with previous research, indicating the predominance of males in both groups and the association of abdominal pain with nausea. Notably, the use of subcutaneous drains was associated with reduced wound discharge and a lower incidence of SSIs, highlighting their significant role in mitigating post-operative complications. Conclusion: In conclusion, our study suggests that subcutaneous drains play a significant role in reducing SSIs in class IV laparotomy wounds, leading to improved patient outcomes and reduced hospital stays. However, further large-scale clinical trials are warranted to validate these findings and establish the optimal use of subcutaneous drains in surgical practice.

Aim: To study the mode of delivery in breech presentation from 28 weeeks of gestation and its perinatal outome.

Methodology: This study was conducted in the Department of Obstetrics and Gynaecology, GMC Kadapa from February 2021 to July 2022.

Results: In the study 100 cases of breech presentation was taken and studied.42% belonged to the age group of 20-25 years. 54% belonged to multigravida in this study and the remaining were primigravida. 77% were in between gestational age of > 36 weeks of gestation. 58% of cases were booked and the remaining registered late in pregnancy. 9% cases had oligohydramnios as risk factor in this study population. 9% had PIH disorders and 6% had other medical disorders. Indications of caesarean section are FPD, which is 20%, followed by oligohydramnios, footling presentation and fetal distress. 51% cases were in frank breech followed by 33% in flexed and remaining were footling. 21 cases in this study had uterine anomaly in which most common was  unicornuate uterus followed by septate uterus. Caesarean section reduces risk of perinatal outcome at term during both labour and delivery for singleton breech presentation compared with vaginal delivery. Fetal morbidity was lower and APGAR scores are better in fetuses delivered by lower segment cesarean section. Perinatal mortality was more in fetuses delivered by vaginal route. Hence, it can be stated that vaginal mode of delivery is not always a completely safe option but may be considered as a safe mode for babies in breech as long as the selection criteria is fulfilled and delivery is done by a skilled and trained   obstetrician with continuous fetal monitoring.

Background: Poisoning in children is largely an accidental phenomenon. In various studies carried out in India mortality ranged upto 11.6%.

Aim & Objective: The study is to focus on poisoning problem in children with an objective to study the Clinical profile of children presenting with poisoning, to analyze the socio demographic factors in relation to motive, mode, pattern and types of poisoning in children and to determine the factors affecting outcome of poisoning in children.

Methodology: It is a prospective study conducted in children of 1-18 years who are admitted in Dept of Pediatrics, SVRR Govt General Hospital for various types of poisoning over a period of one year (February 2016 to February 2017). Analysis of subjects was done according to sociodemographic factors, clinical presentation and risk factors & outcome. 94 cases are taken in the study. There is equal sex distribution. Adolescents are more prone with 34%. In this study lower middle class contributed to 53% of the cases. Poisoning with kerosene oil with 36% topped the list among various agents followed by organophosphorus compounds with 17%. Most common type of poisoning is due to household products with 46% followed by agrochemicals with 29%. There are 70% cases with accidental motive and 30% with suicidal motive. In females among 47 cases 46% are with suicidal motive. The duration of hospital stay was more in children with suicidal motive. There was good Ventilation survival in our study with 87%. There are 2 deaths reported out of 94 cases admitted during the study period. Psychiatric evaluation was done for poisoning with suicidal motive. The most common factor behind suicidal intent was impulsive act. 29% of children with suicidal motive happened to be school dropouts, whereas 32% of females with suicidal motive reported gender inequality. Adolescents are the most common group affected, mostly females, with suicidal motive under impulsive act with underlying risk factors being low socioeconomic status, rural background, school dropouts, gender inequality and parental neglect. Most common agent in suicidal motive is organophosphate. Toddlers are most affected in accidental poisoning, commonly with household products due to parental neglect, improper storage and easy accessibility. Most common agent with accidental motive is kerosene Morbidity and mortality are high with poisoning due to suicidal motive, children brought to the hospital with more time lag and unconscious state. There is good survival associated with mechanical ventilation in poisoning cases

Conclusion: we recommend the establishment of multidisciplinary adolescent clinics in all the teaching hospitals and district hospitals and health education of parents with special reference to care of adolescent girls. Improving literacy, socioeconomic status and empowerment of girl child would reduce the poisoning rate in adolescents. In view of highest incidence of poisoning due to household products in the age group 1 to 5 years, the use of mass media campaigns and awareness programs regarding proper storage of the household products will help in reducing morbidity and mortality.

Background: Fever associated with thrombocytopenia is a common clinical issue in pediatric wards. Literature shows very minimal data on fever associated with thrombocytopenia in children , even though there are some studies on profile of individual diseases like dengue fever, typhoid fever, malaria in children. Aim &Objective: This study was conducted to analyze clinico-etiological profile in preference to infective etiology and outcome of children with febrile thrombocytopenia. This was a prospective observational study conducted in Pediatric Dept, Government Medical College, Anantapur from January 2021 to June 2022. 150 children in the age group of one month to twelve years of age who fulfilled the criteria of fever for 5 days or more with thrombocytopenia were taken into the study and children with known ITP and hematological malignancy, Pseudo thrombocytopenia were excluded. After informed written consent detailed history, clinical examination and necessary laboratory investigation were undertaken. Study parameters were documented in Excel spread sheet and analyzed using SPSS version 16 software. Results: This study demonstrated no gender difference. Analysis of different age group revealed two third study group comprised of children more than 5 years. Comparison of different age group and gender was done which showed in infants, toddlers and preschool children, males were more affected and in school going children females were more affected. Geographic and Seasonal analysis revealed more than 50 % children from Anantapur, Hindupur, Kalyandurg and 62% of the children were residing in Rural areas. 85 % of study group presented between months of August and November. Clinical features and Physiological status at admission were analyzed for frequency and occurrence in different age groups which revealed altered sensorium, GI bleeds, seizures and oliguria were common in infants. Hepatomegaly was seen in two third children, facial puffiness in half, pallor in one-third. Shock was seen in 26 % of children. Shock was frequent in infants. Positive Tourniquet testing was seen in 21 % children. Thrombocytopenia was graded as per WHO guidelines, of which 46 % had severe and 43 % had moderate thrombocytopenia. Severe type of thrombocytopenia was the common type associated with bleeding manifestations. Among bleeding manifestations GI bleeds was the commonest followed by petechiae and other bleeds, bleeding manifestations were common among infants, school going children. Bleeding manifestations were common in ALL followed by Dengue fever. Univariate analysis of clinical signs and lab parameters among the bleeding manifestations group and non- bleeding manifestations group was undertaken. Mortality in febrile thrombocytopenia is 3.3%. This was due to Multi-Organ Dysfunction Syndrome. Blood product transfusion was given in 8 patients of which 2 required Platelet Transfusion due to severe Thrombocytopenia, 3 required FFP Transfusion due to Coagulopathy, 3 required Fresh Whole Blood due to Falling Hematocrit. Conclusion: The analysis revealed significant association between bleeding manifestation and positive tourniquet test and low platelet count. Early rise in platelet count ( < 3 days) was seen in nonbleeding group compared to bleeding group. In this study Dengue Fever was the commonest etiology followed by Undifferentiated fever, Malaria, Scrub typhus and Enteric Fever.

Introduction: Staphylococcus comprises 53 recognised species and 28 subspecies, most of which are found in only lower mammals. There are other species of staphylococci which lack this enzyme and hence are called Coagulase-negative Staphylococci (CoNS). The CoNS species as a group constituted a major component of the normal microbial flora of humans. In the past, CoNS were generally considered contaminants with little significance. CoNS will continue to be an infective agent in the future, and studies on CoNS will be helpful in formulating and adapting specific antibiotic policies for treating CoNS infections and restricting further emergence of drug resistance strains in future. Aims and Objectives: Isolation of bacteria and their species from the clinical samples and evaluating antibiotic susceptibility. Results: 124 strains of CoNS isolated from various clinical samples were collected, isolated, identified and subjected to antimicrobial susceptibility tests. All strains were sensitive to vancomycin.  Most of the strains were resistant to Penicillin and Co-trimoxazole. 66.1% of strains were methicillin-resistant, and 33.9% were methicillin-sensitive. The majority of strains were sensitive to Amikacin and Ceftriaxone. In the case of Amoxyclav, 61 strains were sensitive, and 63 strains were resistant. Conclusion: Globally, it is found that CoNS strains are increasingly becoming drug-resistant. Hospital authorities will need to adapt antibiotic policy depending upon the culture and sensitivity report, as methicillin-resistant staphylococcal strains are difficult to treat. Preventive measures should be taken by the hospital authorities to eradicate the nasal carrier state of methicillin-resistant staphylococci. Clinicians will have to adopt restrictive antibiotic policies.

Background: This study was conducted to determine the baseline perfusion index value that can predict hypotension at 5 minutes post-induction. Methods:This was a hospital-based prospective observational study conducted among forty-two adults aged between 18 and 65 years belonging to the ASA (American Society of Anesthesiologists) physical status I and II undergoing elective surgery under general anaesthesia at the Department of Anaesthesiology, Government Medical College, Thrissur, Kerala, India, over a period of one year from January 2019-January 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results:Out of the 42 participants, 26 (62%) developed hypotension within 5 minutes and 13 (31%) developed hypotension after 15 minutes. ROC analysis was conducted to identify a cut off for predicting hypotension. The area under the ROC curve was 0.98, 95% CI [0.95 to 1.0]. Hypotension was predicted with a baseline PI < 1.86, showing 92.3% sensitivity and 93.75% specificity. There was a 96% positive predictive value and an 88.2% negative predictive value. The baseline perfusion index is an accurate predictor of hypotension within 5 minutes. Conclusion:The perfusion index was found to be a significant predictor of hypotension following propofol induction and a cut off value (baseline PI<1.86) was obtained to predict the same, from this study.

Introduction:Management of perioperative sedation and pain is the cornerstone of a good and well balanced anaesthesia technique in children. Many adjuvants are used with local anaesthetics for caudal block in paediatric patients in order to produce desirable effects like sedation, prolonged analgesia and to prevent adverse effects. The present study was undertaken to compare the effects of clonidine and dexmedetomidine as an adjuvant to ropivacaine in caudal epidural block. Methods: 60 patients of ASA physical status I and II in the age group of 1 to 12 years undergoing infraumbilical surgeries were enrolled for the study. They were randomised into two groups; Group C (n=30) received Ropivacaine 0.2% 0.5ml/kg + 1mcg/kg Clonidine and Group D received Ropivacaine 0.2% 0.5ml/kg + 1mcg/kg Dexmedetomidine. The following parameters were assessed and compared: duration of sedation, duration of postoperative analgesia, hemodynamic parameters and adverse effects. Results:Demographics were comparable. The duration of sedation was 93.5 minutes in Group C and 103 minutes in Group D (p 0.030) and was comparable in both the groups. Duration of analgesia in group C was 8.10 hours and 10.17 hours in Group D (p. <0.001) and was significant. Hemodynamic parameters were comparable in both the groups and no adverse effects were noted. Conclusion: Dexmedetomidine can be used as an effective adjuvant to ropivacaine for caudal block in paediatric patients to prolong the duration of analgesia when compared to clonidine.

Aim & Objective: The  aim of this study was designed to compare the effect on Intraocular Pressure of Rocuronium with that of Succinylcholine during Rapid Sequence Induction of anaesthesia using Propofol and Fentanyl. Methodology: This was a sequential controlled study. The study was conducted at Apollo Institute of Medical Sciences & Research, Hyderabad, Telangana.  Patients were allocated sequentially to one of two groups (n20 in each group) to receive Succinylcholine (group S) and Rocuronium (group R). All patients were medicated with Tab Alprazolam 0.5 mg orally night before surgery.  Preoxygenation was done for 3 min,  Anaesthesia was induced with Inj Fentanyl 2 mcg/kg and a sleep dose of Propofol given at a rate of 100 mg /min until loss of verbal response. Results: There was no significant difference between groups in Age, Sex, Weight, Propofol dose, Baseline IOP, Baseline MAP or Baseline HR. The difference in the changes in IOP between the Succinylcholine and Rocuronium groups was highly significant (P=0.001). Conclusion: To conclude Rocuronium bromide in a dose of 1 mg/kg  Provides Good to Excellent intubating conditions comparable to that of Succinylcholine.  It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable.

Background: Hernia surgeries, encompassing both inguinal and ventral/incisional types, rank among the most frequently performed surgical procedures globally. The inception of laparoscopic inguinal hernia repair closely followed the establishment of laparoscopic cholecystectomy as the standard treatment for cholelithiasis. Despite this, laparoscopic hernia repair has been a subject of ongoing debate within the surgical fraternity. Evidence-based medicine remains the most scientific approach to evaluating the superiority of one surgical method over another. This study is to compare the factors associated with Transabdominal Preperitoneal (TAPP) laparoscopic hernioplasty versus Lichtenstein tension-free open hernioplasty. Material and Methods: The study encompasses all cases of primary uncomplicated unilateral direct or indirect inguinal hernia operated in the elective theatre at the Upgraded Department of Surgery, Osmania Medical College over a 10-month period from July 2021 to May 2021. A total of 50 patients were included, with 25 cases each of open hernioplasty and TAPP. Results: A total of 50 patients were studied. In the present study, the mean operative time was (106.40 ±11.504) minutes for TAPP, (55.00 ±8.416) minute for open Lichtenstein repair. There was no patients with wound infection (0%), two patients with seroma (8%), no patients with hematoma (0%), for TAPP repair in contrast to 6 seroma cases (24%), two patients with hematoma (8%) and five patients with wound infection (20%); however, no marked differences were detected between both groups. And no substantial differences in terms of hernia recurrence. Conclusion: Our study showed that TAPP repair of inguinal hernia is safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time.

Background: Anterior mediastinal masses pose a significant challenge during the perioperative period due to their close vicinity to vital structures, causing airway compression, obstruction of venous return, or obstruction to the output of the heart. Herein, we report a known case of anterior mediastinal mature cystic teratoma that underwent excision of tumour along with right phrenic nerve transection ten years ago. The patient now presents with complaints of chest pain. Upon investigation, they were diagnosed with a recurrence of the tumour and were scheduled for redo-sternotomy with excision of the tumour under general anaesthesia.

Objective: Fine Needle Aspiration Cytology (FNAC) is a popular,cost effective and rapid method for diagnosing various lymphadenopathies and palapable swellings of body. The Sydney system for lymph node cytology classification and reporting has been developed for clear communication among cytopathologists and clinicians regarding diagnosis. The aim of this study is to determine the system’s applicability and accuracy along with limitations in the diagnosis of   lymph node cytology. Also this study tells about cytoradiological correlation of various lymphadenopathies. Patients and Methods: This was a retrospective cross sectional study of lymph node cytology conducted from 1 January 2020 to 30 July 2021 in Geetanjali Medical College and Hospital Udaipur Raj. and 1 January 2023 to 31 January 2024 in Ananta Institute Of Medical Sciences and Research Centre Rajsamand Rajasthan, and the results were reported using the Sydney System into 5 groups from L1 to L5. To measure diagnostic accuracy for each diagnostic category, the diagnoses were compared with the corresponding radiological diagnoses. The statistical tools used were calculation of sensitivity and specificity. Results: A total of 210 cases were chosen for the study from a total of 300 FNACs performed for lymphadenopathy since they had radiological correlation. The L1, L2, L3, L4, and L5 categories were assigned to all of them respectively. We found 95% concordance in benign diseases, 86% concordance (metastasis) and 50% concordance (lymphoma) with radiological findings. 70% cases which were diagnosed in L3 category were diagnosed radiologically correct. 100% inconclusive cases were diagnosed on radiological scans. This study proposed here revised version of Sydney classification by adding 1 more category L6 of Lymphoma to it based on radiological and microscopy findings. Conclusions: The proposed Sydney system of reporting and classification of lymph node cytology helps in achieving uniformity and accessibility. This appears to be the first time, the    Sydney system has been introduced in this region in routine patient care, and this has improved the clinicians understanding of the risk of malignancy and subsequent care.This System can be modified by adding Radiological diagnosis in defining it and adding 1 more final category L6 of Lymphoma diagnosis.

Background:   CKD is now considered as major public health importance worldwide because of the critical combination of an increased disease prevalence with remarkable harmful effects on prognosis and quality of life, and too on economic resources. Present study was aimed to study serum uromodulin as a biomarker of kidney function in patients with CKD and to identify early stages of chronic kidney disease. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients older than 18 years age, with chronic kidney disease. Estimation of serum levels of Uromodulin, Glucose, Urea, and Creatinine done in all patients. Estimated glomerular filtration rate (eGFR) was calculated using  the CKD-EPI formula Results: In present study, 150 cases with Chronic Kidney Disease and 30 healthy controls were studied. Serum Uromodulin concentrations were gradually decreased with progressive stages of CKD, ranging from a maximum of 107.1ng/ml in CKD I to a minimum of 7.8ng/ml in CKD V. When comparing Serum Uromodulin levels between healthy control & different stages of CKD, it shows a significant difference (p<0.0001). Comparing adjacent stages of CKD, a significant difference is detected for all pairs of CKD stages. (p<0.0001) by using One Way ANOVA with Bonferroni Post hoc test. Upon univariate analysis, Serum Uromodulin concentrations were significantly associated with all biomarkers and eGFR. eGFR, (r = 0.866); Urea (r = -0.783), creatinine (r = -0.686). There was a significant negative correlation between Serum Uromodulin with SBP, Serum creatinine, Blood urea, and a positive correlation with eGFR. Conclusion: Serum Uromodulin can be used as a biomarker to detect early stages of Chronic Kidney Disease.

Background: Thyreoides," which meaning shield. The left and right lobes of the thyroid gland are joined by a small isthmus. Each lobe has a pear-shaped base that is located at the level of the fourth and fifth tracheal rings, and an oblique line on the thyroid cartilage lamina at the top. Across the midline, in front of the second, third, and fourth tracheal rings, lies the isthmus. Frequently seen, a pyramidal lobe rises from the isthmus and is typically located to the left of the midline. An elongated The hyoid bone and pyramidal lobe are often connected by a fibrous or muscular band known as the levator glandulae thyroideae. Material and Method: After obtaining written informed consent, all patients with thyroid nodules who visited M. K. C. G. Medical College and Hospital were included in the study, provided that they agreed to attend for regular follow-up visits at least every six months to record any side effects or recurrence that may have resulted from the treatment used to treat the thyroid nodules. Patients with other major disabling disorders and those with thyroid nodules who could not be followed up for six months were excluded from the trial. The period of the study is September 2008–May 2010. Result: The present study has included 45 cases of Thyroid Nodules which includes both solitary and multi nodular goiter admitted to M. K. C.G. Medical College , Berhampur from September 2008 to May 2010. After FNAC study of each nodule, they were segregated into benign nodules, follicular neoplasms and malignant (which includes mainly papillary). Conclusion: It is acknowledged that papillary tumours less than 1 centimetre in size and free of lymphatic or systemic metastases are suitable candidates for lobectomy and isthmusectomy. Patients with papillary carcinoma that measure more than 1 cm may also be eligible for lobectomy with isthmusectomy if they are deemed to have a decreased risk of death or recurrence. For the treatment of papillary carcinoma with a higher risk, total thyroidectomy is universally recognised. Furthermore, because of the high frequency of carcinoma at locations other than nodules and the increased lifetime risk of thyroid cancer in the remaining thyroid gland, individuals who have had Head and Neck irradiation should undergo a complete thyroidectomy.

Precancerous and cancerous lesions and conditions with high incidence rates is occurring in many countries including in India, Pakistan, Bangladesh, Sri Lanka and Taiwan. So many causative factors like  Smoking, alcoholism, and betel nut chewing are considered to be the main risk factors for oral precancerous and cancerous lesions. Further, deaths from oral cancer have increased year by year. Although several oral cancer-associated biomarkers have been reported, very few useful biomarkers have been applied for early diagnosis. Therefore, the investigation of oral cancer-specific biomarkers is urgently needed. In this, to determine the role of serum fucose, HsCRP and lipid profile as a reliable biomarker for early detection of malignant transformation of potentially malignant lesions, conditions and prediction of biologic behavior of the malignant lesions. 200 samples collected and divided into four groups, OSMF, Oral Leukolplakia, Oral Cancer and healthy controls, each group has 50 samples for the analysis of reliable tests for biomarkers (Serum Fucose, Hs CRP and Lipid Profile). After completion of study we were found, these biomarkers reliable for early detection for precancerous and cancerous lesions and conditions.

Background:    Breast abscesses in the postpartum period usually occur within the first few weeks of breast feeding and present with point tenderness, erythema and hyperthermia. Present study was aimed to study etiology, clinical features and surgical management of breast abscess at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in female patients with age more than 18 years, with diagnosis of breast abscess confirmed by clinical or radiological method. Results: In the present study most commonly affected age group was 25-30 years, with 30 cases (73.3%) >25 years, with 10 cases less than 25 years (26.6%). 12 patients had breast abscesses of size less than 4cm and 16patients had breast abscess of size 4-5cm and 12 patients had breast abscesses of size greater than 5 cm. Mean duration of complete healing in patients who underwent incision and drainage was 21.6 + 6.8 days and patients who underwent percutaneous placement of suction drain was 18.5 + 5.7 days and for PCNA 17.8±4.4 days. S. aureus was the causative organism in 10 cases of I&D,11 cases of PCNA and 6 cases of PCND. 4 patients had recurrence of breast abscess.1 patient (6%) among I&D group,2 patients (13.3%) among PCNA group and S. aureus one patient (10%) among PCSD group. Patients who underwent PCNA had no scars. Patients among I &D groups 2 of them had scar of size 3 to 5 cm and 13 had scar size more than 5 cm. Patients among PCSD group 2 of them had scar of size1 to 3 cm and 8 had scar size between 3 to 5 cm. Conclusion: Staphylococcus aureus is the most common causative organism; most common symptoms of breast abscess were pain and swelling. Percutaneous needle aspiration is more suitable for small breast abscess <4 cm.

Introduction: Cardiovascular disease is a significant global health issue. Cardiovascular disease is a major contributor to mortality and morbidity in India. This study investigated the characteristics and risk factors of patients admitted for myocardial infarction (MI). Enhancing comprehension of the risk factors will enable us to plan more effective techniques for mitigating heart disease. Material and Methods: A total of 100 patients were included, with 65% being male and 35% female. The majority of patients (80%) within the middle-aged adult category (30-40 years old). This study involved the analysis of young patients suffering from myocardial infarction. The inclusion criterion includes the male and female in the age group of 20 years to 40 years. The exclusion criterion included the patients suffering from some other cardiac disease. The outcome consists of the analysis of the various factors involved in the occurrence of myocardial infarction in young patients. Results: Results showed significant differences in risk factors between genders. Hypertension was more prevalent in males (21.54%) compared to females (8.57%), while smoking was more common in females (65.71%) than males (44.62%) among studied patients. Both these differences were statistically significant (p-value < 0.05). Diabetes mellitus was also more common in males (15.38%) than females (8.57%), and this difference was statistically significant (p-value < 0.05). Tobacco chewing was less frequent than smoking but still showed a statistically significant difference between genders (p-value < 0.05), with a higher prevalence in males (10.77%) compared to females (2.86%). In terms of the type of myocardial infarction, the anterior wall was more affected compared to the lateral wall. STEMI (ST-segment elevation myocardial infarction) was less frequent than NSTEMI (Non-ST-segment elevation myocardial infarction) for both the anterior and lateral walls. Conclusion: A substantial portion of cases was classified as "Other or Unspecified" due to limitations in identifying the precise location of the infarction. This study highlights the importance of considering gender differences in risk factors for MI. While smoking was the most prevalent risk factor overall, it was significantly higher in females. Further research is warranted to understand the reasons behind these gender variations and improve preventative strategies.

This abstract discusses the revolutionary approach of biofabrication in healthcare and the rapidly progressive technology of nanotechnology. It highlights the green synthesis of nanoparticles, focusing on the microorganism-mediated synthesis method. The background and research problem concern the environmental impact of nanoparticle production and the need for sustainable and environmentally friendly synthesis methods. The aim is to explore the mechanisms, advantages, and applications of microorganism-mediated synthesis. The methodology involves a review of the literature on green synthesis methods and the mechanisms of microorganism-mediated nanoparticle synthesis. The results show that microorganism-mediated synthesis is environmentally friendly, cost-effective, and offers control over nanoparticle size and shape. The implications include diverse applications in drug delivery, catalysis, and environmental remediation, as well as the potential for large-scale production and biocompatibility.

Takayasu arteritis is a chronic vasculitis mainly involving the aorta and its main branches most commonly subclavian and carotid. It induces clinically varied ischemic symptoms due to stenotic lesions or thrombus formation, including blindness, retinal haemorrhage, pulselessness, aortic regurgitation and congestive heart failure due to dilatation of the ascending aorta. More acute progression causes destruction of arterial wall, leading to the formation of aneurysms and rupture of the involved arteries. Here we present a case of Takayasu’s arteritis in a 28-year-old male who presented with nonspecific symptoms of fever and neck pain with palpitations and feeling of pulsations in right side of neck since last 20 days and was eventually diagnosed as arteritis. This case shows that it can present with many nonspecific symptoms and can be diagnosed with proper examination and a high index of suspicion due to its nonspecific overlapping features with many diseases.

Background and objectives: Sepsis and septic shock are the major causes of mortality in critically ill patients. Sepsis on misdiagnosis or diagnosis results in indiscriminate use of antimicrobial agents leading to antimicrobial resistance (AMR). Studies have proven that immediate antimicrobial treatment of sepsis reduced mortality. Hence, early diagnosis of sepsis using biomarkers and prompt treatment with empirical therapy may reduce mortality rates and AMR burden. The aim is to study the role of biomarkers in the diagnosis of sepsis with objectives of detecting serum C-reactive protein, serum procalcitonin, serum presepsin in suspected patients of sepsis and correlate with blood culture and SOFA score. Materials and methods: It is a cross sectional study conducted in a tertiary care hospital. The patients with two or more features of fever or hypothermia, tachycardia, tachypnoea and leucocytosis or leucopoenia were included and patients on antibiotic therapy or immunocompromised were excluded. Blood samples were collected and tested for C-Reactive protein (CRP) by latex agglutination, procalcitonin (PCT) by automated CLIA and serum presepsin (PSP) by ELISA; further gold standard test blood culture was done by standard conventional methods and SOFA score was calculated by clinical history and investigations.  Results: The positive percentage of CRP, PCT and Presepsin were 83.9%, 69.6%, 82.1% respectively which correlated with 80.4% positive SOFA score (sepsis ≥2). The blood culture was positive in 16%. Staphylococcus aureus was the commonest isolate followed by Klebsiella pneumoniae, CONS. Based on the severity of sepsis, PCT range was higher, and it matched with higher SOFA score.  Conclusion: The management of sepsis requires diagnosis based on SOFA score, biomarkers, and blood culture. Procalcitonin is a promising marker for the diagnosis of sepsis as presepsin or CRP, and in regulating antibiotic usage to curb AMR. Sepsis is not yet a laboratory-based diagnosis, but a laboratory supported diagnosis.

Background: Spinal anaesthesia can cause hypotension and bradycardia which can reduce the perfusion of vital organs, causing increased morbidity and mortality. Aim: To assess the spinal anaesthesia induced hemodynamic variations, ECG changes and postoperative outcome of normotensive & hypertensive patients. Methods: This prospective & observational study was conducted in the Department of Anaesthesiology from January 2014 to October 2015, at Tertiary Care centre among 60 patients who were elective cases of Inguinal Hernia and Hydrocoele posted for surgery. The patients included in the study were between 20 and 70 years and they belong to ASA grade I and II. Spinal anaesthesia using Levo-bupivacaine 0.5% was administered to the patients. Baseline values for heart rate, Blood pressure and ECG pattern was recorded preoperatively and was monitored to assess any variation in the intra operative and post operative period. The patients were followed up for the postoperative outcome/ morbidity- mortality after one month and at 6 months post-surgery. Results: In the intraoperative assessment, bradycardia occurred in 30.8% (n=8) of hypertensive patients and 29.6% (n=7) of normotensive patients. Additionally, fall in blood pressure was reported by 34.6% (n=9) of hypertensive patients and 11.77% (n=4) of normotensive patients. In the postoperative assessment, variations in systolic blood pressure were statistically significant in both hypertensive and normotensive patients. No new ECG changes were noted during follow-up. Postoperatively, five patients reported experiencing either headaches or urinary retention. Conclusion: Spinal anaesthesia induced fall in blood pressure is more common in hypertensive patients than in normotensive patients.

Background: The SARS-CoV-2 Omicron variant was first recorded in South Africa on November 24th, 2021, and was assigned as a variant of concern (VOC) within two days by the World Health Organization (WHO). Despite vaccine development and vaccination programs underway around the globe severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) variant Omicron (B.1.1.529) has ushered panic responses around the world due to its contagious and vaccine escape mutations. The focus is the mutations on the S protein receptor-binding domain (RBD) for the potential impact on infectivity and antibody resistance caused by this new variant. This is due to the fact that the RBD located on the S protein facilitates the binding between the S protein and the host angiotensin-converting enzyme 2 (ACE2). Aim & Objectives: The present study aims to determine the variants of omicron by genomic sequence. Materials and Methods: A retrospective study was conducted at State level Viral Research Diagnostic Laboratory (VRDL) in Department of Microbiology, Guntur Medical College, Guntur for a period of 8 months. 519 RT-PCR positive RNA extracted samples were analyzed by Next clade and CT values of <30 was processed by Illumina COVID seq assay. Results: Out of 519 samples, Females were 52% and Males were 48 %. Hospitalized were 62% and quarantined were 38%. Mean age for females were 28 yrs and males were 31 yrs. CT value ranged from 10 to 30 processed of which CT value of 16-20 were 36.8% followed by 21-25 were 31.2%. All 519 samples were omicron positive and by Next Clade analyzes it showed in order of prevalence 21L omicron - 40.26%, 22 B omicron-24%, 22 D omicron – 20.2%, lowest prevalence is 21B Kappa, 21J Delta, 21K Omicron 22C omicron - 0.19%. Conclusion: Omicron variant (B.1.1.529) of SARS COV-2 is a global pandemic. By analyzing, the gene sequencing 40.26% were 21L omicron subvariant followed by 22 B omicron was 24% 22D Omicron was 20.2% in this region. Phylogenetic analysis suggest that omicron is related to gamma variant (P.1). It is atleast 3 times more infectious than the original SARS COV -2. Sequencing helps in determing the extact rate of transmission and severity of this VOC (including the symptoms) and the treatment available.

Introduction: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. The beneficial effects of breastfeeding depend on breastfeeding initiation, its duration, and the age at which the breast-fed child is weaned. Data from NFHS-4 suggest that in India 40% are breastfed within one hour of birth, in West Bengal 48% infants are initiated with breastfeeding within one hour of birth. Objectives:  This study aims to study socio-demographic features and breast-feeding profile of mothers of urban slum area of Kolkata. Methods: The present included cross sectional study was conducted in the Tangra area of Kolkata between June 2023 to December 2023. Total 200 mothers of infants aged 6-12 months were interviewed using pretested semi-structured questionnaire. Details about the socio-demographic characteristics and breast-feeding practices and knowledge about breast feeding were obtained. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Result: In the present study, out of 200 mothers, 44% mothers practice exclusive breast feeding. The knowledge of mothers about the breast feeding, among this knowledge regarding time of initiation of breast feeding after normal delivery and caesarean section was maximum i.e. 83%, followed by 64% mothers having knowledge regarding duration of exclusive breast feeding. The mothers having minimum knowledge was regarding continuation of breast feeding i.e. 46%. Conclusion: This study sheds light on the mothers' actual practices and level of awareness around breastfeeding. Exclusive breastfeeding and prelacteal feeding were less common than the national average.

Introduction: The incidence of portal vein thrombosis can vary depending on factors such as age, underlying liver condition, portal venous blood flow rate, and the patient's pro- or anticoagulant status. This study aimed to describe clinical profile and assess the correlation between portal vein thrombosis and color Doppler findings in patients with chronic liver disease. Materials & Methods: A total of 145 patients diagnosed with chronic liver disease, including both alcoholic and non-alcoholic etiologies and both genders, were included in the study. Detailed medical histories, clinical examinations, and laboratory evaluations were conducted for all patients. This included assessments of fasting glucose levels, liver function tests, and coagulation profiles (Prothrombin time, INR). Results: Among the 145 participants, the majority belonged to the 36-55 age group. The average age of participants was 44.78±12.51 years. Most participants had hemoglobin levels below 11 gm%. Serum bilirubin levels were above normal in 68 participants. Elevated SGPT/SGOT values were observed in 54 participants. 48 participants had below-normal serum albumin levels, and 44 had low platelet counts. Subjects with portal vein thrombosis exhibited a mean portal vein diameter which was significantly higher compared to those without portal vein thrombosis. Biochemical markers showed a significant association between Child Pugh score and platelet count, INR, and total bilirubin.  Conclusion: Portal vein thrombosis can exacerbate hepatic decompensation and affect the survival of patients with cirrhosis. The prognostic significance of portal vein thrombosis in cirrhosis remains uncertain. Early detection, appropriate treatment, and regular monitoring can help prevent portal vein thrombosis in liver cirrhosis, leading to improved liver function and survival.