European Journal of Cardiovascular Medicine

Spinal Anaesthesia is a procedure that is currently being used a lot because of its benefit to relieve temporary pain sensation in patients without affecting patients’ consciousness. However, this action can cause several complications. The present study was a descriptive observational study, conducted on 200 patients aged 12-65 in post operative unit undergone spinal anesthesia to find out the prevalence of complications on the bases of self-created questioner, in which included back pain, headache, urine retention, hypotension etc. Related to spinal complications recorded by medical record in the department of anesthesia and critical care of individual after the spinal anesthesia and performed statistical analysis on collected data. The results showed that the most prevalent complications in the recovery unit include shivering followed by hypotension, nausea, back pain, delirium, vomiting etc. The high prevalence of complications in the post-anesthetic care unit can be considered an alarm and also highlights the importance for skilled personnel and monitoring equipment in critical care unit.

The autonomic nervous system (ANS) is fundamental in maintaining blood pressure (BP) homeostasis through the dynamic interplay between the sympathetic and parasympathetic systems. This study aims to elucidate the mechanisms of ANS-mediated BP regulation, focusing on its responses under different physiological and pathological conditions. Experiments were conducted to assess the effects of autonomic stimulation and inhibition on BP in healthy subjects and patients with dysautonomia. Results demonstrate distinct roles of the sympathetic and parasympathetic systems in regulating cardiac output, vascular resistance, and hormonal pathways affecting BP.

Background: The laboratory hematological and inflammatory biochemical markers may help to predict COVID-19 prognosis. Many studies were pinpointed various prognostic markers, including D-dimer, C-reactive protein (CRP), lactate dehydrogenase (LDH), and high-sensitivity cardiac troponin, in serum of COVID-19 patients with poor outcomes. Deep analysis of abnormal levels of such factors and the interface between their functions in the organs of the body and mechanisms of viral infection can provide the basis for first-line diagnosis as an efficient screening tool to predict the severity of the disease. Thus our study was planned to evaluate the hematological and inflammatory biochemical parameters to rule out the severity of the SARS Covid-19 among the affected patients in our set up. Research Question: Is  there any difference of Hematological, biochemical and radiological abnormalities between survived and non survived patients affected with SARS - COVID 2 Pneumonia?  The setting of the study was at Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry.  A six months observational study was conducted during the period from January, 2021 to June, 2021 on about 240 SARS Covid-19 patients admitted during the above period in the department of General Medicine by studying their socio-demographic profiles, CBP, LFT, RFT, Serum electrolytes, Serum albumin, RBS & HbA1C, D-dimer and CT- Severity score etc; .Results: Majority (74%) of the study subjects were belong to 50 years and above age group with the mean age 58.5 years      and males (64%) were more when compared to females (36%) in this study. And also it was noticed that, the ratio of male & female was same among both the survivers and non survivors groups. Significantly (P<0.05) about 52.5% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (15.3%) basing on the NLR report. Also it was observed that significantly (P>0.05) about 70.8%% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (12.1%) basing on the PF ratio. Furthur with reference to Hematological and Biochemical inflammatory parameters significant results of differences were observed among Total count, Platelet count, Ferritin, LDH, D-dimer, Serum creatinine, Liver function tests of ALP,ALT & AST and Serum electrolytes (Sodium & Potassium) etc; between both the groups of Non survivors and Survivors.

Background: “irritable bowel syndrome (IBS)” is a established gastrointestinal disorder with substantial influence on patients' “Quality of Life (QoL)”. Dietary interventions have emerged as promising approaches for managing IBS symptoms. Objective: This prospective research aimed to measure the efficacy of dietary interventions in reducing IBS indicators and adjusting QoL in Subjects attending a tertiary care center. Methods: Adult Subjects identified with IBS based on Rome IV standards were registered in the research. Baseline demographic and clinical data were collected, and subjects underwent tailored dietary interventions, including gluten-free diet, low FODMAP diet, or elimination diet. Symptom severity and QoL were calculated at baseline and regular follow-up visits. Statistical analysis was conducted to estimate the influence of dietary involvements on IBS symptoms and QoL. Results: Preliminary results indicate significant improvements in IBS symptom severity and QoL after dietary interventions. Subgroup analysis revealed differential responses to specific dietary approaches. Conclusion: This prospective research gives valuable insights into the efficacy of dietary interventions for managing IBS symptoms and enhancing QoL. Further analysis and longstanding follow-up are ongoing to elucidate the sustainability and longstanding outcomes of dietary interventions in IBS management.

Background: Intra-vascular lithotripsy (IVL) has piezo-electric crystals embedded in them, which generates multiple ultrasonic shockwaves when attempting to pre-dilate a severely calcified coronary artery. The calcific coronaries have various patterns of calcium deposition including superficial calcium, deep calcium, and nodular calcium. The data about periprocedural complications and effectiveness of IVL in dealing with different types of calcific lesions are lacking. This study tries to answer these questions. Results: This retrospective study spanning for 24 months, included 52 patients who underwent IVL. 50 out of 52 patients had severe calcific CAD. The mean minimum lumen diameter (MLD) at stenotic lesion is 1.18 ± 0.67 mm and mean lesion length of 24.8 ± 8.5 mm. Successful plaque modification was achieved in 100% of the cases. The optimal stent expansion in superficial calcium is 87.5% and similarly in deep and nodular calcium it is 57.14% (p: 0.0016). 1 mortality was noted 48 hours post procedure, though unrelated to procedure. Other serious complications include atrial fibrillation, side branch MI, coronary edge dissection, and coronary perforation which contributed 7.8% (4 out of 51). Minor complications include edge dissection, IVL balloon burst, and transient bradycardia which contributes 9.8% (5 out of 51).  Conclusion: The superficial calcific lesions are more malleable than deep calcium and nodular calcium put together. IVL successfully modifies calcific plaques to achieve optimum stenting in overwhelming majority of the patients. The complications associated with IVL ballooning are manageable and pose minimal risk when compared to other modes of calcific plaque modification presently available.

Introduction: Thyroid Imaging Reporting and Data System (TIRADS) categorizes thyroid nodules based on ultrasound characteristics that are associated with malignancy, aiding in clinical decision-making and helping to determine when FNAC is necessary. Present study was aimed to study High-Frequency Ultrasound (HFU) in evaluating thyroid nodules. Material and Methods: Present study was Observational Cross-Sectional study, conducted in patients of any age and gender with primary thyroid-related complaints, underwent ultrasonography of the thyroid gland. Based on these ultrasound features, the thyroid nodules were stratified into the appropriate Thyroid Imaging Reporting and Data System (TIRADS) categories.  Results: The present study has been undertaken in 100 patients presented with primary thyroid related complaints. Sonographic features such as a taller-than-wide shape, irregular margins, microlobulated margins, microcalcification, and marked hypoechogenic city are associated with an increased risk of thyroid malignancy. TIRADS category 3 nodules present a 0% risk of malignancy, while TIRADS category 5 nodules have a 100% risk of malignancy, indicating an increasing risk from TIRADS category 3 to TIRADS category 5. By categorizing nodules according to TIRADS, highly suspicious nodules (categories 4 and 5) can be promptly sampled with FNAC or managed surgically, while category 3 nodules should be monitored with follow-ups. Lesions categorized as TIRADS 2 do not require further investigation.  Conclusion: High-Frequency ultrasound is a reliable method for assessing the morphology of thyroid nodules. Using a standardized lexicon and categorizing findings according to TIRADS, improves the accuracy of identifying malignant lesions.

Introduction: Hypoxic-ischemic encephalopathy (HIE), a consequence of perinatal asphyxia, is a major cause of pediatric mortality and morbidity, often leading to neurological conditions like cerebral palsy, mental retardation, and epilepsy. This study aimed to assess the presence or absence of a lactate peak on MR spectroscopy (MRS) in relation to HIE severity and neurodevelopmental outcomes in asphyxiated neonates. Objectives: To examine the trend of brain lactate peaks in asphyxiated neonates over the first 3 months and its relationship with neurodevelopmental outcomes at 6 months. The study also sought to determine the correlation between HIE severity at birth and brain lactate peaks observed on MRS. Methods: This prospective observational clinical study was conducted at Dr. S. N. Medical College, Jodhpur, India, in the Department of Pediatrics and Radiology, following IEC approval. The study spanned December 2020 to May 2021. A total of 89 full-term neonates with clinical HIE were stabilized and underwent MRI with MRS. Repeat MRI/MRS was performed after 4-6 weeks if a lactate peak was initially present. Neurodevelopmental outcomes were assessed using the Hammersmith Infant Neurological Examination (HINE) score at 6-7 months. Results: Of the 89 neonates, 49 (55.1%) showed a lactate peak on the first MRS. Follow-up MRS at a mean age of 67.41±7.91 days showed persistent lactate peaks in 12 (31.5%) of these neonates. In total, 79 neonates completed neurodevelopmental follow-up; 22 (53.65%) with an initial lactate peak exhibited developmental delays. Conclusion: Lactate detected on neonatal MRS often persists until 2-3 months in asphyxiated neonates, correlating with poor neurodevelopmental outcomes, growth, and head circumference. Routine MRS alongside MRI is recommended for all asphyxiated neonates to assess and monitor lactate levels.

Background-Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can involve multiple organs, causing widespread inflammation and tissue damage. One organ often affected is the thyroid gland, which plays a critical role in regulating metabolism. Thyroid dysfunction, such as hypothyroidism, hyperthyroidism, and autoimmune thyroiditis, is frequently observed in SLE patients. However, the exact mechanisms linking these disorders and their clinical significance are not well understood. This study seeks to investigate thyroid dysfunction's prevalence and clinical implications in SLE patients to improve patient management and outcomes. Method-This was a prospective observational study conducted at a tertiary care hospital over a 6-month period. Fifty-two newly diagnosed SLE patients meeting the SLICC criteria were included. Their clinical data, including age, gender, and presenting symptoms, were collected. Disease severity was measured using the SLE Disease Activity Index (SLEDAI) at admission, with follow-up assessments at 3 and 6 months. Thyroid function was evaluated by measuring T3, T4, and TSH levels at baseline, 3 months, and 6 months. Routine blood investigations were also conducted.  Results-Among the 52 patients, 94.2% were female, with the majority (40.4%) aged between 18-25 years. Thyroid dysfunction was observed in 23.1% of the participants—7.7% had subclinical hypothyroidism, and 15.4% had clinical hypothyroidism. The study revealed significant improvements in disease activity (SLEDAI scores) across all thyroid status groups after 6 months of treatment. Euthyroid patients had a 79.73% reduction in SLEDAI scores, while those with subclinical and clinical hypothyroidism showed reductions of 57.89% and 82.35%, respectively. Statistical analysis indicated no significant differences in treatment outcomes among the thyroid status groups. Conclusion- This study confirms that thyroid dysfunction is common in SLE patients and significantly affects disease activity. Regular thyroid function screening in SLE patients is essential for timely diagnosis and management of this comorbidity, which could improve disease prognosis and treatment outcomes. Further research is required to explore the shared pathophysiological mechanisms between SLE and thyroid disorders.

Background: Assessing fluid status in critically ill patients is challenging, and traditional methods may lack accuracy. IVC ultrasound offers a non-invasive alternative to guide fluid therapy and predict fluid responsiveness, which is crucial for managing intravascular volume. Aims and Objectives: To evaluate the effectiveness of dynamic IVC parameters in predicting fluid responsiveness and optimizing fluid management in critically ill patients. Materials and Methods: This 9-month prospective observational study included mechanically ventilated patients aged 18–70 who underwent exploratory laparotomy. Hemodynamic variables and IVC measurements were taken at baseline and 2-hour intervals. Fluid responsiveness was defined by a ≥15% increase in cardiac output post-fluid challenge. Data were analyzed using SPSS, with significance set at p < 0.05. Results: Hemodynamic stability improved over 6 hours, with significant decreases in heart rate (p < 0.001) and increases in IVC diameters (p < 0.001), correlating with fluid balance changes. IVC ultrasound effectively predicted fluid responsiveness in a significant number of patients. Conclusion: IVC ultrasound is a reliable, non-invasive tool for predicting fluid responsiveness and guiding fluid therapy, improving fluid management and patient outcomes in critical care.

Background: Direct laryngoscopy and tracheal intubation is associated with a rise in the hemodynamic responses as well as intraocular pressure.¹ Pediatric airway is different from adult and the complications associated with laryngoscopy and intubation is higher. The use of supraglottic airway devices to maintain airway have been very effective in reducing the pressor response associated with tracheal intubation.^2,3 I-gel is a second generation supraglottic airway device made of a soft gel-like thermoplastic elastomer with a non-inflatable cuff. I-gel has got a channel for gastric suction catheter placement and its design is compatible with the anatomical structures so that it causes minimal pharyngeal tissue compression.⁴. Methods: The study was a prospective randomized controll trial. It was a comparative study with 60 pediatric patients of age group 2-12 yrs, undergoing strabismus surgery. The study duration was six months. Inclusion criterias were ASA physical status I/ II, Age group 2- 12yrs, both males and females were included in the study. Exclusion criteria were Patients with difficult airway, Patients with a history of allergy to multiple drugs, Cases of intubation following failure of I-gel insertion, patients with history of raised ICP. Patients were randomized into groups A and B of 30 each by a sealed envelope method. Group A patient’s airway was managed by I-gel supraglottic device and group B by tracheal intubation. The variables assessed were Intraocular pressure (IOP) of both eyes, Heart rate, Systolic blood pressure (Non-invasive blood pressure), Mean arterial pressure (Non-invasive blood pressure), Breath holding on extubation. The instrument used fo the study was Perkins applanation tonometer for measuring IOP. Results: The demographics of the two groups were age comparable. The mean age of group A was 5.77±2.69 and group B was 6.30±2.67 (p = 0.443) and mean weight was 21.47±9.87 in group A and 22.53±8.68 in group B (p = 0.658). Two groups were also gender matched with 17(56.7%) males & 13(43.3%) females in group A and 12(40%) males & 18(60%) females in group B. The baseline haemodynamic parameters were comparable between the groups.  Baseline heart rate (HR) in group A was 83.30±12.96 and in group B was 83.83±8.74 (p = 0.852). HR increased in both groups immediately following airway intervention and was found to be higher at 5 minutes after intervention. The HR immediately after airway intervention was 94.50±12.66 in group A and 101.33±14.07 in group B which was statistically not significant (p=0.053). The HR at 5minutes following intervention in group A was 87.23±14.89 and in group B 89.23±13.40 (p = 0.587).. Conclusion: I-gel is a safe and effective airway management device which provides better haemodynamic stability and stable intra ocular pressure in general anaesthesia for pediatric strabismus surgeries

Background: Stillbirths constitute a major part of perinatal deaths. It is influenced by a wide range of maternal social and circumstantial factors. The study was done to find out the various factors associated with stillbirth in our hospital with the help of the existing ReCoDe System.  Materials And Methods: A cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur by collecting data from all pregnant women who had during the study period of 12 months, i.e., from 1^stJanuary 2022.Data was then collected using a semi-structured interview after obtaining informed and signed consent. The questionnaire included general information, detailed clinical history. The relevant investigations, ultrasonography (growth parameters, liquor, biophysical profile, doppler parameters) were noted. After delivery, the stillborn baby Placenta, Umbilical cord and Amniotic fluid examined for any abnormalities. Results: Out of the134 cases of stillbirths during the study period of 12 months majority (52, 38.8%) were in the age group of 20 – 25 years, and 25 patients were included in the high-risk group in which 10 (7.5%) were below 20 years and 15 (11.2%) were above 35 years. Among the study participants, 51 (38.1%) were overweight and 27 (20.1%) were obese, 10 (7.5%) women had a Bad Obstetric History. There were 58 (43.3%) primigravida women. There were 4 (3.0%) women who were unbooked, while 20(14.9%) women had irregular antenatal care. 15 of the participants had maternal infection in the antenatal period of which 5 (3.7%) had viral and 10 (7.5%) had bacterial infection. 47(35.1%) patients had anemia in our study. A significant number of pregnant women (60, 44.8%) had gestational hypertension which was the most common cause leading to intra uterine fetal death. Gestational diabetes accounted for 49 (36.6%) of stillbirth in our study, 47 (35.1%) had hypothyroidism. IUGR was present in 51 (38.1%) of the study participants, and this was the second most common cause identified, resulting in stillbirth. Conclusion: Hypertensive Disorders of pregnancy was seen as the most common cause associated with intra uterine foetal demise. Intra uterine growth restriction and Gestational diabetes were the other important associated factors identified that led to stillbirth.

Background: CTO PCI can provide significant clinical benefits, yet there is limited information on its safety in unselected patient populations. Objective:The aim of this study is to describe short term outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a tertiary care hospital in southern India. Methods: We analysed the frequency of short-term clinical outcomes of CTO PCI between Jan 1, 2023, and Dec 31, 2023. Results: During the study period, total of 212 patients (men 178(84%) were treated with PCI for CTO. Out of these, 159 patients (75%) had successful PCI and was unsuccessful in 53 patients (25%).In a total sample of 212 individuals, 26 (12.3%) experienced coronary dissection, while 13 (6.1%) had coronary perforation. Cardiac tamponade requiring urgent intervention occurred in 9 patients (4.2%), and 7 patients (3.3%) needed urgent revascularization. Additionally, 4 patients (1.9%) suffered a stroke after the procedure, and 2 patients (0.9%) died. Compared to successful procedures, unsuccessful ones showed significantly higher rates of coronary dissection (34% vs. 5%, p < 0.0001), perforation (17% vs. 2.5%, p < 0.0001), and tamponade (9.4% vs. 2.5%, p = 0.031). However, no significant differences between unsuccessful and successful PCI were observed in terms of death (0% vs. 1.3%, p = 0.412), peri-procedural MI (0% vs. 1.9%, p = 0.314), urgent revascularization (1.9% vs. 3.8%, p = 0.506), or stroke (3.8% vs. 1.8%, p = 0.244). Conclusion: In the present study, failed CTO interventions are associated with a higher incidence of complications such as coronary dissection, coronary perforation, and cardiac tamponade compared to successful CTO interventions. Although periprocedural MI, death, and urgent revascularization occurred more frequently in successful attempts, the differences are not statistically significant.

Introduction: Iron deficiency anemia (IDA) is a major public health issue, particularly in developing countries like India, where malnutrition and limited access to healthcare exacerbate the problem. In the Sub-Himalayan region, the coexistence of IDA with deficiencies in Vitamin B12 and folic acid poses an additional challenge to healthcare providers. This study focuses on the prevalence of these combined deficiencies and aims to shed light on the complex interplay between iron, Vitamin B12, and folic acid metabolism in anemia. Aims: To assess the prevalence of iron deficiency anemia among patients in a tertiary care hospital in the Sub-Himalayan region Materials and Methods: This is a cross-sectional observational study conducted at a tertiary care hospital in the Sub-Himalayan region of India. The study was carried out over a period of 1 year, focusing on patients diagnosed with anemia.100 Patients were included in this study.  Result: In our study, 5 (5.0%) patients had Normal Range, 13 (13.0%) patients had Mild Deficiency, 15 (15.0%) patients had Moderate Deficiency and 67 (67.0%) patients had Severe Deficiency. The value of z is 9.1335. The value of p is < .00001. The result is significant at p < .05. In our study, 1 (1.0%) patient had Alfa thalassemia trait, 1 (1.0%) patient had Beta thalassemia trait, 1 (1.0%) patient had HbE carrier, 7 (7.0%) patients had HbE disease, 14 (14.0%) patients had HbE trait and 76 (76.0%) patients had Normal Pattern in HPLC. Conclusion: This study demonstrates a strong correlation between iron deficiency anemia and deficiencies in Vitamin B12 and folic acid in the Sub-Himalayan region of India. The coexistence of these deficiencies complicates the management of anemia and necessitates a more comprehensive diagnostic approach. The findings underline the need for nutritional interventions and public health strategies to address these deficiencies in resource-limited settings.

Background: In India, poisoning is one of the common modalities for attempting suicide especially farmers. There is varied presentation among these patients. One such uncommon presentation is Methemoglobinemia. Methemoglobinemia is a rare but potentially life-threatening condition characterized by the oxidation of hemoglobin to methemoglobin (MetHb), rendering it incapable of effectively transporting oxygen, resulting in tissue hypoxia. This condition can be congenital or acquired, often due to exposure to certain chemicals, drugs, or toxins. Acquired methemoglobinemia is frequently seen in cases of poisoning, as highlighted in this case series of three patients admitted to a tertiary care hospital in central India following suicidal ingestion of toxic substances Material and Methods: This study was conducted in a tertiary care teaching hospital of central India where patients of Toxin induced Methemoglobinemia were recruited. It was an observational study of 6 months duration. Informed consent was obtained and duly signed by the patient or next of kin. History, Physical examination, Routine investigations, ABG, Co-Oximetry studies were done. Patients were managed as per established protocol with no additional out of protocol investigation or treatment was done pertaining to this study. Patient's confidentiality was maintained throughout this study.  Results: This case series involved three patients who developed toxic methemoglobinemia following ingestion of different toxic substances. - Effectiveness of Methylene Blue: In cases with moderate to severe methemoglobinemia (MetHb 33.5% to 41.4%), methylene blue proved effective in reducing MetHb levels and improving clinical outcomes. The initial treatment significantly improved MetHb levels and patient symptoms, with favorable outcomes observed in two of the three cases. - Severe Outcomes: The third case, with an exceptionally high MetHb level of 74%, demonstrated the limits of methylene blue treatment. Despite multiple doses, the patient’s condition deteriorated, indicating that extremely high MetHb levels and delayed treatment can lead to poor outcomes.Complications and Mortality: The case with the highest MetHb level resulted in mortality, underscoring the critical importance of early diagnosis and intervention. The other two cases, despite initial severe symptoms, responded well to timely methylene blue treatment and supportive care. Conclusion: This case series illustrates the clinical variability and challenges in managing toxin-induced methemoglobinemia. The condition should be suspected in cases of poisoning, particularly when there is a mismatch between oxygen saturation and arterial blood gas measurements. Early intervention with methylene blue, guided by co-oximetry, is essential for improving outcomes. Severe cases, especially those with MetHb levels exceeding 70%, carry a poor prognosis despite aggressive treatment, highlighting the need for early recognition, monitoring, and advanced supportive care

Background: Age-related cataracts are a leading cause of visual impairment worldwide, with multiple risk factors contributing to their development. Emerging evidence suggests a possible link between oxidative stress-related biomarkers, such as serum uric acid, and cataract formation. Elevated uric acid levels, often associated with systemic oxidative stress, may influence lens opacity, but this association remains underexplored. Objective: This observational study investigates the association between serum uric acid levels and age-related cataract formation, aiming to assess serum uric acid as a potential risk factor for cataracts. Methods: A sample of 100 participants (mean age: 65.3 ± 8.4 years; 45% male, 55% female) was recruited. Participants were grouped into four age categories (50-59, 60-69, 70-79, and 80+). Serum uric acid levels were measured, and cataract presence was documented. Correlation and logistic regression analyses assessed the association between serum uric acid levels, age, and cataract presence. Results: Cataract prevalence was 58%, increasing by age group: 32% (50-59 years), 60% (60-69 years), 72% (70-79 years), and 80% (80+ years). Participants with cataracts had higher mean serum uric acid levels (6.1 ± 1.3 mg/dL) compared to those without (5.4 ± 1.4 mg/dL, p < 0.05). Correlation analysis indicated a moderate positive association between serum uric acid and cataract formation (r = 0.42, p < 0.05). Logistic regression showed each 1 mg/dL increase in uric acid increased cataract risk by 1.2-fold (OR = 1.2, 95% CI: 1.1–1.5, p < 0.05). Conclusion: Elevated serum uric acid levels are significantly associated with age-related cataract formation, highlighting its potential role in cataract risk. Further studies are recommended to explore interventions targeting uric acid reduction

According to the present statistics, end of this decade the non-communicable disease will cause 70% of deaths in developing countries. The use of thrombolytic strategies like Streptokinase has been reason for reduction in mortality and Reperfusion arrhythmias have been considered successful markers of reperfusion. The prevalence of reperfusion arrhythmias during and within 48 hours of intravenous streptokinase therapy, to assess the prognosis of myocardial infarction (MI) secondary to thrombolytic therapy, and find if the reperfusion arrhythmias are non-invasive markers of successful thrombolysis using the electrocardiogram. Methodology: 100 Patients admitted to NRI Institute of Medical Sciences, Sangivalsa, tertiary care, teaching hospital in South India, with features suggestive of acute myocardial infarction who have undergone thrombolytic therapy are selected for the study. These 100 patients were divided into 5 age groups as 35-45,46-55, 56-65,66-75 and 76-85years. Each age group was further divided into male and female groups. Adult patients of both sexes and different age groups after obtaining formal consent from the patients or relatives were included. Reperfusion arrhythmias during and within 48 hours of thrombolytic therapy using electrocardiography (ECG) were assessed. Results: Among all types of myocardial infractions (MI), Reperfusion Arrhythmias are more prevalent in anterior wall MI (43%) and less observed in inferoposterior wall MI (7%). The prevalence of the age and sex has been depicted. Maximum incidence of reperfusion arrhythmias was present in age group of 46-55 years i.e 28% followed by 66-75 i.e 26%,56-65-16%,35-45 and 76-85-15%. Among males and females, 57% of males and 43% of females showed maximum incidence. Results showed that there was no significant relationship between age and gender with reperfusion arrhythmias.  There was a significant relationship observed between reperfusion arrhythmias and Diabetes (p=0.023). Incidence with hypertension (HTN) was 53%, and although hypertension was high in MI, the p-value was not significant between reperfusion arrhythmias and hypertension. Reperfusion arrhythmias incidence in risk factors such as alcoholics and smokers which was not significant, suggests that there was no statistical significance between these risk factors and arrhythmias. Observations drawn from results suggest that window period hospital presentation and types of myocardial infarction do not influence the occurrence of reperfusion arrhythmias (P=0.778) and there was a significant relation between reperfusion arrhythmias and survival of the effected patients of the study group (p=0.014).

Conclusion:

• Arrhythmias are most frequently seen during or following thrombolysis of Acute MI. Mortality and morbidity of Acute MI can be modified by early recognition and management of these arrhythmias.
• Acute MI is a major cause of hospitalization in the elderly and is associated with higher mortality and morbidity, most frequently seen between the 4^th to 7^th decades, with male preponderance.
• Mortality was high in Anterior wall MI, Ant Inf wall MI, which were associated with Ventricular Tachycardia, Ventricular Fibrillation, showing 100% mortality which must be intervened immediately.
• Reperfusion Arrhythmias are not an event of serious concern as they are usually well-tolerated and are amenable to treatment. Early streptokinase therapy has a favorable impact on mortality in MI and hence should be tried in all the Acute MI patients who do not have contraindications for streptokinase therapy.

Introduction: supra-trochlear foramen located near the lower end of the humerus is less prevalent in human being as compared to other primates like Dogs. Its prevalence rate is different in different ethnic groups. The supratrochlear foramen is important not only clinically but anthropologically. It is prevalent more in Female and more on left sided humerus. It is a rare anatomical variation and should not be misinterpreted as injury (1) Aim/objective: to study prevalence of supra-trochlear foramen in Gujarat population and its morphometric analysis Methodology: 100 dry humeri were studied for morphometric changes in supra-trochlear foramina in anatomy department of SMT.NHL Municipal Medical College of Gujarat Results : out of the right sided bones examined, in a proportion of 33.9% STF were present and for the left sided bones the proportion was 34.1%.more oval shaped foramina were found in the study. Conclusion: STF was significantly present on left sided humerus. Oval shaped foramen was common in our study. Study is evolutionary important because it is also found in dogs and hyenas (2)

Introduction: The hospitalization process has three main stages: an admission, an inpatient period and a final stage with the discharge process. An inefficient bed management in any of the three stages of the hospitalization can cause a mismatch between demand and capacity. It has been proved that when bed demand exceeds capacity, patient admissions and scheduled surgical procedures can be delayed or cancelled. Moreover, the discharge process should start at the point of admission in the case of planned admissions, as in some cases the estimated length of stay without a medical complication is known. Methodology: It is a prospective interventional study was carried out in Nizam’s Institute of Medical Science, a tertiary care teaching hospital located in Hyderabad, Telangana, India. Various elements of discharge process are studied using data collection forms which were developed suing Time Motion Study, enclosed in annexure 1 and 2 designed as per events in discharge process. Discharge time is calculated for study sample and steps contributing to delays are noted. Based on the steps contributing to delay, possible interventions are planned and implemented to reduce the delays at necessary steps of discharge flow. The difference of time taken in discharge process before and after intervening is analyzed. The intervention steps contributing to maximum benefit to reduce the total discharge time will be suggested for implementation by the institute. Results: The junior residents are usually entrusted with the task of writing the discharge summaries. The junior resident initiates the task of writing the discharge summary after the end of the morning rounds. Some of the discharge summaries are hand written and some are typed. The hand written summaries are sent to the personal secretary or assistant of the department concerned either by the junior resident or the class IV employee of the ward. Immediate availability of the class IV employee was observed as an issue since he/ she would be multitasking in the ward functions. Conclusions: The present study has been conducted in Nizams Institute of Medical Sciences, a super speciality teaching hospital with the aim of studying the current discharge practice, total time taken for the process and implementing few possible interventions to reduce the discharge process time.

Background: The myocardial performance index (MPI) can assist in the non-invasive diagnosis of coronary artery disease (CAD) in patients selected for further management. However, there is limited data on MPI in patients with Acute Coronary Syndrome (ACS), and its relationship with the severity of coronary atherosclerosis in this group remains unclear. This study aims to determine whether MPI can predict the angiographic severity of CAD and to evaluate its association with both systolic and diastolic dysfunction in patients with ACS. Methods: This Hospital Based Analytical Prospective cross-sectional study included a total 155 patients with acute coronary syndrome from December 2022 to May 2024 who underwent coronary angiography. Echocardiography evaluation of Myocardial Performance Index was done by using Pulse wave Doppler evaluation. Angiographic severity was done through Gensini scoring system. The ROC curves were constructed. It was deemed statistically significant when p< 0.001) between the Myocardial Performance Index (MPI) and the Gensini scoring system in the patients with Acute Coronary Syndrome.  Results: In this study, patients were categorized based on low, mid, and high Syntax and Gensini scores. The MPI (Tei Index) exhibited statistically significant positive correlation with the Gensini score. Conclusion: Echocardiographic assessment of the Myocardial Performance Index (MPI) in patients with acute coronary syndrome can serve as a valuable surrogate marker for the detection of severity of coronary artery disease. It also has the potential to predict the complexity of coronary artery disease and guide the necessary interventions.

Introduction: Acute myocardial infarction (MI) is the leading cause of death in globally. Electrocardiogram (ECG) is a pivotal tool for risk stratification due to its affordability, non-invasiveness, and rapid results. The Tpeak-Tend interval shows how repolarization propagates throughout the myocardium and has been linked to dangerous ventricular arrhythmias and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Objective: To study the role of Tpeak-Tend/QT interval ratio as a predicator of in-hospital MACE in patients with STEMI. Methodology: This cross-sectional study was conducted at a tertiary care hospital between September 2022 and February 2024. A total of 87 patients were enrolled, of which 79 patients with STEMI presentation who met the inclusion criteria were included. Further the Tpeak-Tend/QT ratio was calculated, those with Tpeak-Tend/QT ratio < 0.3 were grouped as Group A (n=32), and those with ratio > 0.3 were in group B (n=47) Results: Out of 79 patients in this study, male gender was predominant, in group A, 23 of 32 patients and in group B, 32 of 47 patients were male. The most common age group noted in Group A was 60-70 years and in group B it was 50-60 years. Chest discomfort was the most common presenting symptom in 27 out of 32 patients in group A and 44 out of 47 patients in group B. Further in these patients the occurrence of in-hospital MACE was analysed, it was observed that the commonest MACE was heart failure, seen in 4 of 32 patients in group A and 16 of 47 patients in group B. Conclusion: The study showed a statistically significant correlation (P value = 0.03) between the incidence of in-hospital MACE in STEMI patients and a high Tpeak-Tend/QT ratio (>0.3). Hence Tpeak-Tend/QT ratio > 0.3 on a 12-lead ECG is a non-invasive and dependable predictor of MACE.

Background- Levobupivacaine and ropivacaine, both relatively new amide local anesthetic agents, have been developed to overcome the problems associated with bupivacaine toxicity. This study was conducted to compare clinical efficacy and characteristics of 0.5% hyperbaric levobupivacaine with 0.75% hyperbaric ropivacaine for subarachnoid block in lower limb orthopaedic surgeries. Methods- This was a prospective randomized double-blind study conducted among 60 patients scheduled for elective lower limb orthopaedic surgeries under spinal anaesthesia. The patients were randomly allocated into two groups Group L and Group R. Group L (n = 30) received 3ml of 0.5% hyperbaric levobupivacaine and Group R received 3 ml of 0.75% hyperbaric ropivacaine. Onset and duration of sensory and motor blockade, hemodynamic parameters, patient satisfaction score and adverse effects were recorded. The data was analysed using SPSS version 24.0 with appropriate tests and a P<0.05 was considered significant. Results-The distribution of patients was comparable with respect to age, sex, ASA grades and duration of surgery (P>0.05). Mean time to reach highest sensory level was significantly higher in Group L (19.2±1.4 min) than Group-R (17.9±1.2 min) (P<0.05). The mean time of two segment regression from highest sensory level blockade was less in group R (Group R 65.7±3.3 min Group L 72.4±5.1 min; P<0.05). However, the time of regression from highest sensory level to S1 was significantly less in Group L (Group L 180.8±7.3 min; Group R 188.4±3.7 min; P<0.05). Mean time of onset of motor blockade (Bromage scale 3) was 19.2±1.3 min in group L and 19±1.2 in group R and the difference was not statistically significant (p = 0.484). Patients in hyperbaric ropivacaine group had a significantly faster recovery from motor blockade recorded as mean regression to motor blockade (Bromage scale 0) (Group R 119.5±6 min vs Group L 128.8±7 min; P< 0.05). Both drugs were also found to be safe and comparable in terms of impact on hemodynamic parameter and no complication was observed. Conclusion- Hyperbaric levobupivacaine and hyperbaric ropivacaine are reliable in term of efficacy and safety for subarachnoid block in lower limb surgery. However, hyperbaric ropivacaine is a better alternative than hyperbaric levobupivacaine in patients where early mobilisation is required as it offers a faster recovery from motor blockade.

Introduction: Hypoxic-ischemic encephalopathy (HIE), a consequence of perinatal asphyxia, is a major cause of pediatric mortality and morbidity, often leading to neurological conditions like cerebral palsy, mental retardation, and epilepsy. This study aimed to assess the presence or absence of a lactate peak on MR spectroscopy (MRS) in relation to HIE severity and neurodevelopmental outcomes in asphyxiated neonates. Objectives: To examine the trend of brain lactate peaks in asphyxiated neonates over the first 3 months and its relationship with neurodevelopmental outcomes at 6 months. The study also sought to determine the correlation between HIE severity at birth and brain lactate peaks observed on MRS. Methods: This prospective observational clinical study was conducted at Dr. S. N. Medical College, Jodhpur, India, in the Department of Pediatrics and Radiology, following IEC approval. The study spanned December 2020 to May 2021. A total of 89 full-term neonates with clinical HIE were stabilized and underwent MRI with MRS. Repeat MRI/MRS was performed after 4-6 weeks if a lactate peak was initially present. Neurodevelopmental outcomes were assessed using the Hammersmith Infant Neurological Examination (HINE) score at 6-7 months. Results: Of the 89 neonates, 49 (55.1%) showed a lactate peak on the first MRS. Follow-up MRS at a mean age of 67.41±7.91 days showed persistent lactate peaks in 12 (31.5%) of these neonates. In total, 79 neonates completed neurodevelopmental follow-up; 22 (53.65%) with an initial lactate peak exhibited developmental delays. Conclusion: Lactate detected on neonatal MRS often persists until 2-3 months in asphyxiated neonates, correlating with poor neurodevelopmental outcomes, growth, and head circumference. Routine MRS alongside MRI is recommended for all asphyxiated neonates to assess and monitor lactate levels.

Background: In tropical countries like India, thrombocytopenia is commonly encountered by clinicians in any speciality. Thrombocytopenia present as asymptomatic condition to sometimes becomes a life-threatening condition requiring blood transfusion in various etiological conditions. Infections like malaria and dengue are invariably associated to thrombocytopenia with changing trends in clinical features. Infection is the commonest cause of thrombocytopenia. The objective of study was to evaluate the different causes of thrombocytopenia along with study of clinical profile and laboratory parameters in patients with thrombocytopenia. Methods: A cross-sectional hospital based study was conducted in Department of Medicine at Tertiary Care Hospital from April 2019 to October 2019. This study comprises cases of thrombocytopenia of age more than 14 years admitted with platelet count <1 lack/mm3, whereas patients with already diagnosed with causes associated with thrombocytopenia such as malignancy and chemotherapy induced thrombocytopenia, idiopathic thrombocytopenic purpura, cirrhosis of liver were excluded. Results: Study shows almost 46.6 % of total patients were below age of 30 years and 53.4% patients were above 30 years of age. The highest incidence of thrombocytopenia was seen in the age group of 21-30 years (26.6%), followed by 31-40 (25.8%) and 12-20 years (20%). The most common diseases that causes thrombocytopenia were infections (65.80%) [i.e. Dengue (31.67%), Malaria (25.0%), Enteric fever (3.33%), HIV (0.8%), and DIC (5.0%)]. Megaloblastic anaemia (18.33%) were common in younger population. Conclusion: Study concluded that most common causes of thrombocytopenia were infections (65.8%) and megaloblastic anemia (18.33%). Bleeding manifestations were present in 28.33% of patients and the most common site of bleeding was skin and mucous membrane. The main etiological cause of bleeding in this study was dengue hemorrhagic fever followed by malaria and megaloblastic anaemia

Background: High Flow Nasal Cannula (HFNC) therapy is increasingly used in pediatric cardiac postoperative care, facilitating improved oxygenation and comfort, which may reduce the need for reintubation. Given the physiological complexities associated with pediatric cardiac surgeries such as Glenn and Senning operations or repairs for Tetralogy of Fallot (TOF) and Ventricular Septal Defect (VSD), this study aims to evaluate the efficacy of HFNC in such high-risk pediatric populations. Materials and Methods: This observational study was conducted at the GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India. It included seven pediatric patients aged 1.5 to 6 years, undergoing cardiac surgeries requiring postoperative respiratory support. HFNC therapy was initiated based on specific clinical criteria involving elevated PCO2 levels, increased respiratory rates, and decreased oxygen saturation. Respiratory and cardiac parameters were monitored pre and post-HFNC therapy, with statistical significance determined by paired t-tests. Results: HFNC therapy led to statistically significant improvements in respiratory and cardiac parameters among the patients. Post-treatment, there was a notable decrease in mean PCO2 levels from 47.33 ± 2.95 mmHg to 42.87 ± 1.45 mmHg (p=0.004) and respiratory rates from 48.14 ± 4.98 to 31.43 ± 3.95 breaths/min (p<0.001). Heart rates decreased from 134.00 ± 9.93 bpm to 115.71 ± 7.25 bpm (p=0.001). Oxygen saturation levels improved from 85.14% ± 10.95 pre-HFNC to 87.43% ± 11.00 post-HFNC (p<0.001), and lactate levels decreased from 2.80 ± 0.81 mmol/L before HFNC to 1.90 ± 0.40 mmol/L after (p=0.009), indicating reduced metabolic stress. Conclusion: HFNC therapy significantly enhances respiratory mechanics, reduces cardiac workload, stabilizes oxygen saturation, and alleviates metabolic stress, making it an effective non-invasive ventilation tool in the postoperative management of pediatric cardiac surgery patients. This study supports the broader application of HFNC, suggesting it may expedite recovery and reduce intensive care stays without compromising hemodynamic stability.

Background: Mechanical ventilation (MV) is a life-saving intervention for patients with respiratory failure, but it is associated with high morbidity and mortality, especially in critically ill patients. This study aimed to assess the clinical profile, complications, and outcomes of patients requiring invasive ventilatory support in a medical intensive care unit (MICU). Methods: This prospective observational study was conducted over a 12-month period at Northern Railway Central Hospital, New Delhi. A total of 99 patients who required invasive mechanical ventilation for more than 12 hours were included. The study evaluated patient demographics, clinical conditions, comorbidities, complications, duration of MV, and hospital stay. The APACHE II score was calculated to assess disease severity, and outcomes were compared based on mortality and survival. Results: The study population included 62.6% male and 37.4% female patients with a mean age of 64.35 years (SD = 11.23). Pneumonia (25.3%), neurological conditions (15.2%), and acute on chronic respiratory failure (15.2%) were the most common indications for MV. Complications included ARDS (27.3%), ventilator-associated pneumonia (32.3%), sepsis (50.5%), and acute renal failure (33.3%). Overall, 54.5% of patients died during the course of MV, with a significantly higher mortality rate among patients with APACHE II scores above 30 (p<0.05). Prolonged MV (>15 days) and longer hospital stays (>30 days) were associated with higher mortality (p<0.05). The highest mortality (92.6%) was observed in patients with ARDS. Conclusion: This study highlights the significant morbidity and mortality associated with invasive mechanical ventilation in critically ill patients. The APACHE II score, duration of MV, and the presence of complications like ARDS and sepsis were strong predictors of mortality. Early identification of these risk factors and prompt management may improve outcomes in these patients.

Background: Early-onset neonatal sepsis (EONS) remains a significant cause of neonatal morbidity and mortality, particularly in resource-limited settings. EONS is defined as sepsis occurring within 72 hours of birth, often associated with maternal risk factors such as premature rupture of membranes and intrapartum infections. Identifying risk factors and improving early diagnosis are critical to reducing adverse outcomes in neonates. Objective: This study aimed to assess the incidence, microbial profile, cutaneous manifestations, risk factors, and diagnostic accuracy of early-onset neonatal sepsis (EONS) in a large urban hospital. Methods: A retrospective cohort study was conducted at the Neonatal Intensive Care Unit (NICU) of a large urban hospital in Khammam. The study included 100 neonates admitted within 72 hours of birth between January and December 2023. EONS was diagnosed based on clinical suspicion and confirmed by blood cultures and laboratory markers. Data collection included demographic, clinical, and maternal risk factors. Multivariable logistic regression identified significant risk factors for EONS, while receiver operating characteristic (ROC) curve analysis assessed diagnostic accuracy. Results: Eighteen neonates (18%) were diagnosed with EONS, with Escherichia coli being the most common pathogen (44%). Significant risk factors included premature rupture of membranes (OR = 4.3, p = 0.001), maternal intrapartum fever (OR = 2.8, p = 0.03), and low Apgar scores. The ROC curve for the diagnostic model showed strong accuracy (AUC = 0.85, 95% CI: 0.78-0.92). Conclusion: EONS remains a prevalent issue in urban NICUs, with identifiable risk factors and microbial profiles. Early identification through clinical and maternal markers can significantly improve outcomes.

Background: Biomedical waste (BMW) management is critical to minimizing health risks and environmental pollution in healthcare settings. The knowledge, attitude, and practice (KAP) of healthcare workers are pivotal to successful BMW management. Objective: This study aimed to evaluate the knowledge, attitude, and practice of biomedical waste management among healthcare workers at Tezpur Medical College & Hospital, India. Method: A cross-sectional study was conducted from May 2021 to October 2021, involving 250 healthcare workers. A structured KAP questionnaire was administered, and data were analyzed using descriptive statistics and chi-square tests to identify associations. A p-value < 0.05 was considered statistically significant. Results: Out of 250 healthcare workers, 56% were male and 44% female. The majority (40%) were aged 20-30 years, with nurses making up the largest occupational group (40%). Regarding knowledge of biomedical waste (BMW) management, 48% were aware of BMW categories, but only 32% knew about color-coded segregation. Attitudes towards BMW management were generally positive, with 40% recognizing its importance for infection control. In terms of practices, 48% followed color-coded segregation, but only 4% regularly reported incidents. Key barriers included inadequate training (40%) and insufficient resources (32%), indicating the need for institutional improvements. Conclusions: There is a significant gap between knowledge and actual practices in biomedical waste management among healthcare workers. Targeted training and improved resource availability are essential to bridge this gap and enhance adherence to BMW guidelines.

Objective: Our study is to evaluate the association between body mass index (BMI), Body composition and pulmonary function tests among undergraduate medical students of Mahavir institute of medical sciences Methods: A cross-sectional study conducted among 80 MBBS students of Mahavir institute of medical sciences Basic information, body composition and pulmonary function tests such as FVC, FEV1, FEV1/FVC, PEFR were measured. We divided the subjects into two groups according to their BMI.18.5– 24.9 kg/m2 as normal weight, (n=40) and 25.0–29.9 kg/m2 is considered as overweight(n=40). Results:  There was a significant difference in BMI between the groups (P < 0.0001). Mean visceral fat % of the Normal weight individuals was 3.95 and mean of visceral fat% in Overweight individuals was 11.03 Showed significantly higher level (p<0.0001) The pulmonary function test parameter Mean of FEV1/FVC of the Normal weight individuals was 87.49 and Mean of FEV1/FVC of the overweight individuals was 66.86 Showed significantly higher level (p<0.0001) Conclusion: According to our research, those who are overweight likely have a considerable deterioration of their lung functioning

Background: Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Among them the spectrum of ischemic heart disease which encompass stable ischemic heart disease, unstable angina, NSTEMI & STEMI is the commonest cause. Coronary no-reflow is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction during reperfusion therapy. In this study, we focused on to assess the prevalence of coronary no reflow in STEMI patients undergoing primary PCI. Methodology: This study was conducted in patients in Cath lab, Coronary Care Unit and different wards of the department of Cardiology in Apollo Multispecialty Hospital Limited during the period of 18 months spanning from November 2021 to April 2023. Consecutive patients of STEMI who had undergone PPCI were enrolled in this study. The patients to be included are those with STEMI above age≥18 years. They were divided into no reflow and normal flow and their characteristics were studied. Results: The prevalence of no reflow was 9.93%. Majority of the patients had age more than 60 years (55%) whereas 45% of the patients were younger than 60 years with males (71%) and females (29%). Common associated condition with patients undergoing percutaneous coronary intervention in present study was hypertension (86%), dyslipidemia (80%) and diabetes mellitus (93%). TIMI thrombus scale and Myocardial blush grade (MBG) was significantly higher in patients with hypertension. There was a significant difference found in TIMI thrombus scale and MBG between diabetic and non-diabetic patients. There were significant differences found in mean LVEF in respect to myocardial blush grade (MBG). Conclusion: The TIMI thrombus scale and myocardial blush grade was found to be higher in patients with no reflow undergoing PCI. The prevalence of no reflow after primary PCI is 9.93%. The co morbidities like DM, hypertension and dyslipidemia were more common among these patients.

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease

Background: Accurate blood pressure (BP) measurement is crucial for hypertension management. Despite recommendations for back and feet support during BP measurements, adherence varies. The impact of unsupported back positions on BP readings remains controversial, necessitating further evaluation, particularly with oscillometric devices commonly used in clinical and home settings. Objective: To assess the impact of back and feet support on oscillometric blood pressure measurements. Methods: This study included 100 patients aged 18 and above of both genders visiting the outpatient department. BP was measured using an Oscillo metric device under two protocols: back and feet supported and unsupported. The SBP and DBP readings in the same position was recorded as the final BP. Differences between unsupported and supported conditions were calculated as delta BP and PV were calculated as (delta BP/BP with unsupported position) * 100. Paired sample t-test and ANOVA determined the significance of delta BP and PV across age, sex and hypertension history. Results: The study population had a mean age of 39.2±12.6 years, with 44 females and 56 males, 38 of whom had hypertension. BP readings were higher with unsupported back and feet (119.8±15.5/69.9±8.9 mmHg) than with support (119.2±16.4/68.2±8.8 mmHg), differing by 0.7±4.9/1.8±3.0 mmHg. SBP and DBP levels were consistently higher in the unsupported position across all subgroups, with no significant delta SBP/DBP differences between subgroups. The mean delta SBP and DBP were 5.5±1.56 mmHg and 4±1.52 mmHg, respectively. PV in SBP and DBP was 4.2±1.33% and 4.9±1.99%, with females and hypertensive patients showing larger PV. Conclusion: Proper back and feet support significantly affect the accuracy of oscillometric BP measurements, with unsupported positions leading to higher SBP and DBP. These findings emphasize the importance of standardizing patient placement during BP measurement to obtain accurate readings.

Introduction: Liver cirrhosis is often associated with altered thyroid function, which may reflect the severity of liver dysfunction. Understanding this relationship can help in predicting disease progression and prognosis in cirrhotic patients. The aim of this study was to demonstrate the relationship between thyroid function tests and the severity of liver function in cirrhosis of the liver. Method: A total of 73 patients diagnosed with cirrhosis of liver based on clinical, biochemical, and radiological findings were included. Results: Majority of the patients belonged to the age group of 41-59 years (63%) with male predominance (79.4%). Alcoholism (84.9%) emerged as the leading cause of liver cirrhosis. Fatigue (73.9%), body ache (57.5%), and dysphagia (54.7%) were the most common clinical symptoms linked to thyroid dysfunction. Using the Child-Pugh classification system, 15 patients were categorized as Child A, 37 as Child B, and 21 as Child C. Hypothyroidism (65.7%) was more prevalent than hyperthyroidism among the patients. Significant correlations were found between T3, FT3, and TSH levels and the severity of liver dysfunction, as classified by the Child-Pugh score (p<0.05). Hepatic encephalopathy (42.85%) was the main complication causing mortality, and all fatal cases (7) had abnormal thyroid profiles. Conclusion: In conclusion, altered T3, FT3, and TSH levels were associated with disease progression in cirrhosis and can serve as valuable indicators for prognosis. These findings suggest that thyroid function tests should be considered in evaluating the severity of liver disease progression and outcome of cirrhosis in affected patients.

Objective: Utilizing a confocal laser scanning microscope (CLSM) and a culture of bacteria test, the goal of this research was to determine the bactericidal impact of different doses of triple antibiotic paste (TAP) against Enterococcus faecalis (E. faecalis) in dentinal tubules. Techniques: E. faecalis (ATCC 29212) infected 90 human teeth, which were then divided into 5 groups at random: 1 mg/ml, 5 mg/ml, 7.5 mg/ml, and 10 mg/ml TAP (n = 18). The negative control group did not receive TAP. Samples were taken both the root canal space and root dentin at 100-μm and 200-μm depths following a three-week TAP treatment. Ten bacterial culture assays were performed on the gathered samples. A CLSM analysis was performed on eight roots from each group in order to identify the live and dead cells of bacteria. Results: The negative control samples were all culturable, according to the results of the bacterial culture assay. Following TAP treatment, there were less culture-positive samples at 1, 5, 7.5, and 10 mg/ml, with 2, 2, 1, and 0 culturable samples, in that order. Nonetheless, there were no appreciable variations between the TAP treatments. Remarkably, the CLSM investigation showed that all samples included live bacteria in the dentinal tubules. There were 52.36%±3.24 viable bacteria in the negative control. The smallest percentage of viable bacterial cells (40.58%±5.40) was observed with 10 mg/ml of TAP treatment. This was followed by 7.5 mg/ml (44.14%±6.03), 5 mg/ml (46.31%±5.32), and 1 mg/ml (52.55%±8.82). Conclusion: TAP treatment significantly decreased the percentage of viable E. faecalis cells in the dentinal tubules and its bactericidal effect was dose-dependent.

Background: Chronotherapy in hypertension control is considered to better control nocturnal blood pressure patterns. This study aimed at studying relation between diurnal blood pressure patterns and timing of antihypertensive medication. Method: Hypertensive patients of age group 19 years to 65 years who were on antihypertensives for a minimum period of one month and were free of any cardiovascular complication or chronic kidney disease were included in the study. After doing routine workup, they were subjected to 24-hour ambulatory blood pressure monitoring. Results: In this study of 105 patients (mean age 44±10.9), morning administration of antihypertensive medication resulted in significantly higher blood pressure surges and less nighttime BP decrease compared to nighttime administration, with a p-value of 0.001. No significant difference was found across medication classes for nocturnal dipping. Conclusion: Taking antihypertensive drugs in night appears to results in better control of hypertension.

Abstract Background: Postoperative sore throat (POST) is a common complication following general anesthesia with endotracheal intubation. This study compared the efficacy of ketamine, magnesium sulfate, and lignocaine gargles in preventing POST. Methods: In this randomized, double-blind, placebo-controlled study, 120 patients undergoing surgery under general anesthesia with endotracheal intubation were allocated to four groups: ketamine gargle, magnesium sulfate gargle, lignocaine gargle, and control. The incidence and severity of POST were assessed at 0, 2, 4, 8, 12, and 24 hours postoperatively. Patient satisfaction and willingness to undergo the same intervention in future surgeries were also recorded. Results: The incidence of POST was significantly lower in the magnesium sulfate group compared to the ketamine, lignocaine, and control groups at 0 hours (3.3% vs. 10%, 13.3%, and 26.7%, respectively; p=0.049), 2 hours (6.7% vs. 16.7%, 20%, and 40%, respectively; p=0.011), and 4 hours (3.3% vs. 13.3%, 16.7%, and 33.3%, respectively; p=0.015). The severity of POST was also significantly lower in the magnesium sulfate group at 0, 2, and 4 hours postoperatively (p<0.05). Patient satisfaction and willingness to undergo the same intervention were highest in the magnesium sulfate group (96.7% and 93.3%, respectively; p<0.05). The side effect profiles were comparable among the groups. Conclusion: Magnesium sulfate gargle is superior to ketamine and lignocaine gargles in reducing the incidence and severity of POST in the early postoperative period, with higher patient satisfaction and willingness to undergo the same intervention in future surgeries.

Background: Sexually transmitted infections (STIs) are the most often reported infectious disorders in the world.   Sexual intercourse with an infected partner is the most significant risk factor for STIs.¹Sexually transmitted infections (STIs) are a major global health concern, with serious co-morbidities and mortality rates.

Objectives:

1. To identify the aetiology of ulcerative STIs among hospital patients.
2. To study the HIV and GUD co-infection
3. To study the prevalence of contacts and partners
4. To Identify different factors influencing genital ulcer diseases

Material & Methods: Study Design:  Hospital-based, cross-sectional study.  Study area: The study was conducted in the Department of OBG & Microbiology of a Medical College, in Kolkata.  Study period: 1st July 2023 to 30th June 2024.  Study tools and Data collection procedure: The project was evaluated and approved by the ethics committee, of the institution. Written, informed consent was obtained from each participant at the time of enrolment in the study, and socio-demographic characteristics were recorded. Detailed sexual exposure history was taken of each individual including sexual partners, sexual behavior, and sexual practices. Only strongly suspected cases of ulcers of STD origin were studied after thorough clinical examination. Results: Out of 51 cases who used condoms, in 22 cases (18.3%) aetiology was identified. Whereas out of 69 cases who did not use condoms, in 62 cases (51.6%) aetiology was diagnosed. So, in condom used cases, the incidence of GUD was 43% whereas in condom not used cases, the incidence of GUD was 89.8%. This shows the impact of condom use in preventing genital ulcers. The present study included 4 cases from the high-risk group, Men having sex with men (MSM) 3 cases and female sex workers (FSW) 1 cases. These patients presented with genital ulcers and were diagnosed. Conclusion: This study concluded that eliminating bacterial GUDs caused an increase in cases of Viral GUDs (Genital Herpes). The presence of GUD increases HIV susceptibility, hence proper and regular use of latex condoms is required to avoid the transfer of STIs. Laboratory tests detected GUDs with numerous etiologies that had previously gone undetected clinically. This aids in the identification of cases and allows patients to obtain proper and appropriate care.

Introduction: Current evidence from individual studies shows that music primarily captures attention, can suppress various emotions, and alters or regulates mood. It enhances work performance, stimulates arousal, promotes higher cognitive functions, regulates inhibitions, and supports rhythmic movement, among other effects. Previous research has demonstrated that exposure to various types of music improves sustained attention when compared to a control group. Additionally, various types of music, such as those with high-frequency beats, have been found to enhance alertness and attentional focus. Music has also been shown to have positive effects on physiological responses. Aims & objectives: the present study was an attempt to assess the effect of different types of music on HRV. Material & Methods: This cross-sectional observational study was conducted in the Department of Physiology at Government Medical College, Patiala, from January to December 2023. A total of 120 subjects, aged 18 to 25, were enrolled based on specific inclusion and exclusion criteria. Results: The study enrolled a total of 120 study subjects, comprising of more than 50% female study subjects followed by males. The result showed that POP and Punjabi music had a more pronounced impact on increasing blood pressure, pulse rate, and HRV measures compared to Raag Darbari, which showed subtler effects. Conclusion: Raag Darbari caused minimal changes in blood pressure and heart rate, while POP and Punjabi music significantly increased systolic/diastolic pressure and heart rate. Faster-paced music stimulates the autonomic system more, while Raag Darbari has a calming effect. Music genre influences physiological parameters. 

Background: The term 'Non-Invasive Ventilation' (NIV) refers to the application of artificial ventilation without any conduit access to the airways, i.e., without an endotracheal or tracheostomy tube. Earlier negative pressure ventilation was used, but in the modern era, positive pressure ventilation has supplanted negative-pressure ventilation as the major mode of delivery of Non-Invasive Ventilation. The mention of Non-Invasive Ventilation will refer to Non-invasive Positive-Pressure Ventilation (NIPPV). It is used as an alternative conventional Mechanical Ventilation through an Endotracheal Tube (Endotracheal Tube Mechanical Ventilation or ETMV), in more severe patients deem to require ventilatory assistance. Materials and Methods: The study was conducted among 40 patients with COPD with Acute Respiratory Failure, who were admitted under The Department of Respiratory Medicine, Tertiary Care Teaching Hospital from January 2024 to June 2024. The patients included were those with COPD and hypercapnia acute respiratory failure, who worsened despite medical treatment in the ward and were deemed to require mechanical ventilation. The diagnosis of COPD was based on clinical history, physical examination, and prior Pulmonary Function Tests. A study of patients with COPD with Acute Respiratory Failure falling in the age group between 40 and 80 years were included, with the below mentioned inclusion and exclusion criteria. Results: The mean age of the study population in NIV group is 59.45 years and 62.75 years in the ETMV group. The majority of the subjects were in the age range of 60-69 years in both NIV and ETMV groups, consisting of 45% and 50% respectively. The most common symptom on presentation was dyspnea seen in the enrolled subjects. Cough was present in the about 55% of the subjects, fever in 15% and chest pain was present in 12.5% of the subjects. The mean respiratory rate in the NIV group is 35.95 ± 4.26 breaths per minute whereas the mean respiratory rate in the ETMV group is 37.20 ± 2.44 breaths per minute. Higher respiratory rate indicates the severity of dyspnea. Conclusion: In the patients with COPD-AE with severe acute respiratory failure, the modality of management is ETMV, however NIV provides a few advantages over conventional invasive ventilation. The use of NIV is not only a cost effective ventilatory modality, but also a treatment that is associated with significant improvements in clinical and biochemical outcomes. Usage of NIV in ventilator required patients had a high rate of NIV failure and got intubated. NIV trial did not produce any significant difference in the mortality rate or in the length of the ICU stay.

Introduction: Leprosy is a leading cause of physical disability due to weakness of muscles and loss of sensation. Due to the difference in immune response in the various forms of leprosy, Langerhans cells (antigen presenting cells) in the skin show a graded number in the various forms of leprosy patients. Materials and methods: a total of 44 cases were considered analysed by categorising according to Ridley and Joplin criteria. Paraffin blocks sections were stained with CD1A antibody using green coloured chromosen. Immuno - histochemistry studies where done using UltraVision LP detection system made by ThermoFisher Scientific. The number of epidermal, dermal and hair follicle Langerhans cells were counted. Result: There was no statistical significance between leprosy types on comparing with the dermal LC score. Whereas Mean value of epidermal LC score was significantly less in lepromatous leprosy (LL) (1.78) and was gradually increasing from borderline lepromatous type (BL) (2.44), borderline tuberculoid type(BT) (5.25) to tuberculoid leprosy (TT) (5.50). There was a statistically significant difference in number of Langerhan cells between BL and BT and between LL and TT (p=0.000). Conclusion: Progressive reduction in the number of Langerhans cells from tuberculoid subtype to lepromatous subtype was noted. Atrophy, epitheloid cells, giant cells, and nerve changes was seen more in tuberculoid pole than lepromatous pole. There is a statistically difference in the number of Langerhans cells between BL and BT and between LL and LT.

Introduction: This case series study evaluates the optimization of anesthesia protocols for concurrent carotid endarterectomy (CEA) and off-pump coronary artery bypass (OPCAB). The study aims to create awareness about the significance of optimizing anesthesia for these combined high-risk procedures. The case series included fifteen patients, aged 54 to 72 years, with body mass indices (BMI) ranging from 24.2 to 28.7. Hospital stays ranged from 7 to 10 days, with minimal anesthesia-related complications observed. Key findings highlight the importance of individualized anesthesia management and meticulous postoperative monitoring to ensure favourable outcomes in patients undergoing concurrent CEA and OPCAB. The results contribute to the existing body of knowledge by demonstrating that a multidisciplinary approach and tailored anaesthetic protocols can enhance patient safety and surgical success. Future research should focus on larger, prospective studies to validate these findings and further refine anesthesia protocols. These insights underscore the critical role of optimized anesthesia in managing complex cardiovascular and cerebrovascular pathologies, ultimately improving patient care and outcomes in this high-risk population.

Background: Anaesthetic medications are frequently used in psychiatric patients for various surgical procedures, but minimal is known about their long-term cognitive effects. This study examines the cognitive effects of anaesthetic exposure in psychiatric patients. Method: At MGM Medical College and LSK Hospital, Kishanganj, Bihar; researchers examined 100 Psychiatric patients between May 2023 to October 2024 who had undergone anaesthetic procedures. Patients' demographics, mental illness diagnosis, anaesthetic exposure, and cognitive outcomes were gathered from medical records. Anaesthetic-exposed and non-exposed individuals' cognitive function was evaluated using statistical analyses of standardised neuropsychological tests. Results: Memory, attention, processing speed, and executive function were all severely impaired in anaesthetic-exposed individuals compared to non-exposed patients. In comparison to patients who were not subjected to anaesthesia, patients who were exposed to it , showed significantly worse results on tests of verbal memory (p < 0.001), processing speed (p = 0.003), attention (p = 0.012), and executive function (p = 0.028). Conclusion: This study emphasises the need of detecting and controlling cognitive risks in perioperative therapy, as anaesthetic exposure in psychiatric patients has negative cognitive effects. These findings improve clinical treatment and underline the necessity for customised anaesthesia care by showing the long-term cognitive impact of anaesthetics on psychiatric patients . Reducing cognitive hazards and improving mental health requires interdisciplinary teamwork and personalised therapies.

Background Nowadays Laparoscopic Hernia repair is preferred over Open Hernia repair. The Laparoscopic approach has less chronic postoperative pain and decreased incidence of wound infection and hematoma, it could be considered an appropriate approach for inguinal hernia surgery. This study aims to compare TAPP and TEP procedures done for hernia repair. Objective To compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. Methods PubMed, Embase, and Cochrane library abstracts up to December 2023 were searched for randomized controlled trials comparing TAPP or TEP hernia repair. The hernia surgery duration, pain score, and hospital stay were recorded by the analysis of the hernia type. Results Twelve studies that randomized 905 patients with hernia into TAPP and TEP repair groups were analyzed in this study. The results revealed that TEP repair resulted in longer operating time, shorter hospital stay, and less postoperative time, but was associated with some cases of conversion to open.  Conclusion:  Each of TEP and TAPP has benefits of its own. Compared to TAPP repair, TEP repair lessens postoperative pain and shortens the hospital stay for primary cases. TAPP repair, on the other hand, is associated with reduced surgical time. These results proved that the need for joint decision- making with relation to the two laparoscopic hernia repair techniques.

Introduction: Coronary artery disease (CAD) remains a major global health concern, with left main coronary artery (LMCA) disease posing high risks due to the large myocardial area it supplies. Despite coronary artery bypass grafting (CABG) being the preferred revascularization strategy for unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as a viable alternative. However, data on ULMCA PCI outcomes in the Indian subcontinent are scarce. Materials and Methods: This single-center, retrospective study evaluated 253 patients who underwent ULMCA PCI using DES between January 2018 and June 2023 in Central India. Clinical, angiographic, and procedural data were analyzed with a median follow-up of 753.5 days. Comparative analyses were conducted based on SYNTAX scores and imaging-guided versus non-imaging-guided interventions. Results: The cohort's mean age was 61.3 years, with a predominantly male population (77.5%). Imaging guidance was employed in 30.4% of cases. The composite outcome (cardiovascular death, myocardial infarction, stroke) occurred in 11.6% of patients. Higher age and hypertension were identified as significant predictors of adverse outcomes. Conclusion: In this study, PCI for unprotected left main coronary artery (ULMCA) disease using drug-eluting stents (DES) demonstrated favorable short- and mid-term outcomes in an Indian cohort, even in a resource-limited setting. While procedural success was high, factors such as SYNTAX score and patient comorbidities such as age >60 yrs, hypertension significantly influenced outcomes. Imaging- guided interventions, though not altering mortality rates, appeared to enhance procedural safety. These findings support the feasibility of PCI as an alternative to surgery in select high-risk patients, emphasizing the need for further research to refine risk stratification and optimize intervention strategies.

Background: The incidence of surgical site infections (SSI) must be determined to help decision-makers better plan and execute surgical care by gauging the severity of the problem. OBJECTIVES: The meta-analysis aims to determine the risk factors for SSI in general surgical patients undergoing appendectomy and to estimate the incidence of SSI in the Indian subcontinent population. Materials And Methods: To find cross-sectional, cohort, Rct’s, and observational studies reporting SSI incidence or prevalence, a systematic review was conducted using PUBMED, MEDLINE, EMBASE, and the Cochrane Library. Excluded were studies with fewer than 40 participants. Two review authors worked independently to extract the data and evaluate its quality. The cumulative incidence of SSI occurring up to 30 days postoperatively was the main outcome. Random effects models were applied when there was a significant amount of heterogeneity. Subgroup and sensitivity analyses of meta-regression were employed to investigate the sources of heterogeneity. Results: 18 studies were included out of the 231 publications retrieved. The meta-analysis included 18 studies covering three countries and 4924 patients. The cumulative incidence of SSI was 5.25% (95% CI 0.4-16.2). There were no data on prevalence identified. SSI rates varied depending on a geographical location, surgical approach, and priority (planned or emergency). A multivariable meta-regression revealed a significant correlation between appendectomy and incidence of SSI (estimate 2.2, 95% CI 1.11-2.42, P =0.019). Conclusion: This systematic review and meta-analysis, which revealed a significant prevalence of SSI following appendectomy is 5.25 per 100 appendectomies. These findings imply that a lower incidence of SSI following appendectomy is linked to less invasive procedures. To reduce the harm caused by SSI, high-quality studies are needed to better understand the patient and associated risk factors.

Purpose: The surgical treatment of carpal tunnel syndrome (CTS) has been enriched, by different minimally invasive techniques to decompress the median nerve at the wrist as the endoscopic approaches or modified open technique. However, controversy remains about their safety and complication rate. We present the results of our minimally-invasive technique to median nerve release at the wrist. Methods: The study was conducted in the department of Plastic and Reconstructive surgery GMC Srinagar. The patients who underwent treatment for carpal tunnel syndrome from March -2018 to Feb -2022 were the subjects of study. Results:  The study included 63 patients, majority of patients were females (55 patients), and median age was 45 years. 16 patients had bilateral disease; right hand was predominantly involved. All the procedures were done under regional anesthesia under Tourniquet control. Average time taken was 15-20 minutes. Most patients returned to normal routine work in 2 to 3 weeks, with immediate and significant relief of symptoms. Complications were recorded in 3 patients, which included mild scar tenderness in two patients and minor hematoma in one patient. Follow up ranged from 6 months to 2 years. No patient required any repeat surgery for incomplete release of carpal tunnel. Conclusion: It is a simple, easy and effective technique, in a setup with limited resources, with all the advantages of an ECTR and having significantly reduced the complications of conventional open surgical techniques.

Background: This meta-analysis study was to evaluate the effectiveness of drain usage after thyroidectomy in preventing wound hematoma, post-operative pain, length of hospital stays, and wound infection. Objectives: Post-operative wound complications following thyroid surgery are not decreased by the use of drains. Materials AND METHODS: Following PRISMA guidelines, a systematic review and meta-analysis were carried out. After a search of the literature, RCTs comparing the use of drains versus not using any drains in patients undergoing thyroid surgery were found. Excluded from consideration were trials involving patients who had lateral neck dissections. Data extraction and methodological quality grading were carried out by impartial reviewers. Heterogeneity was evaluated and the risk ratio (RR) or mean difference (MD) with a 95% confidence interval was computed. Results: A total of 13 RCTs with 1100 patients were included in the meta-analysis. The rates of hematoma were found to be higher in the drain group (P value=0.24) as compared to no drain group (P value=0.015). The wound infection rates (P value=0.21), the length of hospital stay (P value=0.33), and the pain score (P value=0.37) on the first week of the postoperative day were all higher in the drain group as compared to no drain group. Conclusion: Overall, there was a higher incidence of hematoma, pain, length of hospital stays, and infection in the drain group. It indicates that patients do not benefit from using a drain following a thyroidectomy.

Introduction: The anatomical proximity of urinary and genital organs in females increases the risk of ureteral and bladder injuries during pelvic surgeries. Ureteral injuries occur in approximately 0.43% of gynaecological procedures, while bladder injuries range from 0.5% to 1%. Obstetric operations report incidences of 0.25% and 0.3%, respectively. Aims: This audit evaluates bladder and ureteric injuries in obstetric and gynaecological surgeries at Raipur Institute of Medical Sciences (RIMS) over two years, given its role as a tertiary referral centre with significant surgical workloads. The goal is to reduce iatrogenic injuries and enhance patient safety. Materials and Methods: A retrospective analysis of 1408 obstetric surgeries (LSCS, hysterotomies, laparotomies, etc.) and 464 gynaecological surgeries (387 open, 77 laparoscopic) performed from January 2022 to January 2024 was conducted. Documented urological injuries were further analysed, with cystograms performed for suspected bladder injuries. Results: The mean age for bladder injuries was 34.8 years, with a mean parity of 2.4, whereas the mean age for ureteric injuries was 35 years with a mean parity of 3. Among obstetric procedures, bladder injuries occurred in 0.7% (10 cases), while there were no ureteric injuries. In gynaecological procedures, bladder injuries were found in 7.5% (35 cases), ureteric injuries in 2.8% (13 cases), and concurrent injuries in 0.8% (2 cases). The overall bladder injury rate was 2.4% (45 cases), and ureteric injury was 0.7% (13 cases). Most bladder injuries were located at the dome (35 cases), posterior wall (7), and lateral wall (3); no injuries were reported at the bladder neck. Repair methods included triple-layer Vicryl with suprapubic catheter (SPC) insertion-20 cases, without SPC- 9 cases, and through catheterization alone- 13 cases; 3 patients were lost to follow-up. 5 Ureteral mucosal injuries were managed by Oversewing/conservative, 6 cases by DJ stent +/- repair, 1 fistula repair, while 3 were lost to follow up. Conclusion: The incidence of bladder injury was 2.4%, and ureteric injury was 0.7%, with concurrent bladder and ureteric injury noted in 0.1%. Timely detection and management can reduce associated morbidity. Surgeons should maintain awareness of potential urological injuries to improve outcomes during obstetric and gynaecological surgeries.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from insulin resistance and pancreatic beta-cell dysfunction. With the global rise of obesity and sedentary lifestyles, T2DM has become a major public health concern, requiring a combination of pharmacological and lifestyle interventions for effective management. This systematic review explores the roles of exercise, diet, and weight reduction in improving glycemic control, enhancing insulin sensitivity, and reducing the need for pharmacological interventions. By synthesizing evidence from various clinical trials and cohort studies, this review highlights the critical importance of lifestyle modifications in reducing the burden of T2DM and preventing associated complications. The findings underscore the synergistic benefits of combining exercise, diet, and weight reduction strategies in managing T2DM, offering valuable insights for clinical practice and patient care.

Background: Hypertension and dyslipidemia are major risk factors for cardiovascular diseases and may also impact retinal microvasculature. This study investigates the correlation between serum lipid profiles and retinal microvascular changes in hypertensive patients. Objective: To assess the association between serum lipid levels and retinal microvascular measurements, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR), in hypertensive patients. Methods: A cross-sectional study was conducted on 100 hypertensive patients. Baseline demographic data, blood pressure, and serum lipid profiles (total cholesterol, LDL, HDL, triglycerides, and VLDL) were recorded. Retinal microvascular measurements were assessed using fundus photography. Pearson correlation and multivariate regression analyses were performed to evaluate the relationship between lipid levels and retinal microvascular changes, adjusted for age, gender, BMI, and blood pressure. Results: Total and LDL cholesterol were negatively correlated with CRAE (r = -0.32, p = 0.002; r = -0.29, p = 0.005) and positively correlated with CRVE (r = 0.28, p = 0.006; r = 0.34, p = 0.001). HDL cholesterol was positively correlated with CRAE (r = 0.35, p = 0.001) and AVR (r = 0.29, p = 0.005). Multivariate analysis confirmed these findings, showing that total cholesterol, LDL, and triglycerides negatively impacted retinal microvasculature, while HDL had a protective effect. Conclusion: Dyslipidemia is associated with retinal microvascular changes in hypertensive patients, suggesting its potential role in hypertensive retinopathy development. Lipid management may help in preserving retinal microvasculature.

Aim and objective: Is to conduct a comparative analysis of Cord Blood and Whole Blood transfusions on clinical parameters and evaluate their effects on morbidity and mortality outcomes in neonatal sepsis, utilizing the Neonatal Sequential Organ Failure Assessment (N-SOFA) score as a clinical evaluation tool. Methodology: This prospective, comparative study was conducted at Gandhi Memorial Hospital, Rewa, from September 2022 to June 2024, involving 184 neonates with confirmed sepsis and hemoglobin < 7 g/dL requiring transfusion. Neonates were randomly assigned to two groups: Group 1 received umbilical cord blood transfusions, and Group 2 received adult human blood transfusions. The Neonatal Sequential Organ Failure Assessment (N-SOFA) score was utilized to evaluate organ dysfunction pre- and post-transfusion at 12 and 24 hours. Clinical assessments included blood indices and the need for inotropic support, with statistical analyses determining changes in N-SOFA scores and their significance. Results: The study included 184 neonates, equally divided into two groups: 92 receiving cord blood transfusions and 92 receiving whole blood transfusions. The demographic analysis showed no significant differences between groups in sex distribution (p = 0.880), mode of delivery (p = 0.673), or gestational age (p = 0.657). Notably, cord blood transfusions resulted in a significant reduction in the N-SOFA score > 4 from 67.3% pre-transfusion to 53.2% post-transfusion (p = 0.05), indicating an improvement in organ function. Additionally, cord blood transfusions significantly reduced the need for inotropic support (from 34.8% to 12.0%, p < 0.001), increased culture negativity (from 29.3% to 10.9%, p = 0.002), decreased procalcitonin levels (from 21.7% to 5.4%, p = 0.001), and reduced C-reactive protein levels (from 27.2% to 10.9%, p = 0.005). In contrast, the whole blood group did not demonstrate significant improvements in these parameters. Conclusion: This study demonstrates that cord blood transfusions significantly improve outcomes in neonatal sepsis compared to whole blood transfusions. Key findings include reduced N-SOFA scores, decreased inotropic support needs, and lower inflammatory markers in the cord blood group, indicating enhanced organ function and immune modulation. These results support the use of cord blood transfusions as a promising therapeutic option for critically ill neonates, warranting further exploration and clinical implementation. 

Menarche, the first event in a woman’s reproductive phase, It occurs between the age of 9- 16 years. This would differ with physical, hereditary and cultural base of an individual. The dietary customs emphasize the consumption of specific foods to support the hormonal balance, encourage regular menstruation and improve general well-being and the menarche has been celebrated through various cultural practices. The aim of the study is to compile the information of dietary customs and cultural practices followed at the time of menarche and its importance Method: A 6-month study was conducted in 7 districts of Kerala, involving 70 female participants aged 30-80, who were surveyed using a self-structured questionnaire. Results: In this study, 63% of them informed about special diet during menarche. 14% of them informed about certain cultural practices. Conclusion: Without being aware of the nutritional value and health advantages, the people have followed the specific diet as a custom. This study suggests that intake of a traditional diet rich in essential nutrients is paramount. A wholesome nutritious diet and practices play a crucial role in sustaining hormonal balance and support the reproductive health.

Purpose:  To compare cardiopulmonary exercise test (CPET) parameters, including VO2, VCO2, respiratory exchange ratio (RER), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), and blood pressure (BP), between COPD smokers and healthy smokers, and to assess their relationship with 6-minute walking distance (6MWD) and spirometric values. Methodology: The study employed an evaluative approach to compare CPET parameters between COPD smokers and healthy smokers. Ethical approval was obtained, and the sample included 50 participants from each group. Data collection involved spirometry, 6-minute walking tests, and CPET using a treadmill under the modified Bruce Protocol. Parameters such as VO2, VCO2, RER, heart rate, and oxygen saturation were measured pre- and post-exercise. Pulmonary function was assessed using spirometry, and the results were analyzed using statistical tests, including Chi-square, with significance determined at p < 0.05. Result: This evaluative study, conducted over 15 months, enrolled 100 participants equally divided between chronic obstructive pulmonary disease (COPD) smokers and healthy smokers, revealing a male predominance (96%). Key findings included significant differences in cardiopulmonary exercise testing (CPET) parameters: COPD smokers had a mean VO2 of 429.20 ± 158.88 ml/min compared to 1569.88 ± 356.74 ml/min in healthy smokers (P < 0.001). Correlation analysis demonstrated a strong relationship between FEV1 (%) and FEV1/FVC (%) (R = 0.906, P < 0.001), while lower oxygen saturation was associated with decreased exercise performance (R ranging from -0.719 to -0.805). Post-CPET assessments showed significantly higher respiratory rates (28.24 ± 1.64 vs. 25.52 ± 3.03, P < 0.01) and heart rates (158.96 ± 7.81 vs. 169.28 ± 7.06, P < 0.01) in COPD smokers, alongside elevated O2 desaturation (9.92 ± 2.23 vs. 1.28 ± 1.05, P < 0.01). Notably, the 6-Minute Walk Distance (6MWD) was significantly lower in COPD smokers with higher smoking indices, with a mean 6MWD of 308.75 ± 49.53 meters for those with a smoking index of 151-250 (P = 0.04), illustrating the adverse effects of smoking exposure on physical performance. Conclusion: Overall, these results highlight the utility of Cardiopulmonary Exercise Testing (CPET) in identifying the underlying causes of exercise limitation and assessing the maximal exercise capacity in COPD patients. In situations where CPET is unavailable, the 6MWD serves as a practical alternative exercise test that closely correlates with CPET parameters, making it a valuable tool for evaluating the functional status of COPD patients.

Congenital absence of the right coronary artery (RCA) is an extremely rare coronary anomaly, but can have significant clinical implications. Therefore, early detection, correct diagnosis, and appropriate treatment are important. We present a unique case of a 19-year-old female presenting with chief complaints of chest pain and breathlessness. CT coronary angiography findings typically demonstrate single common origin of coronary artery from the left coronary sinus with no separate origin of RCA with left circumflex artery being dominant and supplying the RCA territory.

Background: Acute Coronary Syndrome (ACS) is a predominant cause of mortality, particularly in the elderly population (>60 years). This study aimed to evaluate the correlation between thyroid hormone profiles and the severity of ACS  in old  patients, using Killip classification and TIMI flow grade. Material and Method: This hospital-based cross-sectional study involved 95 patients aged over 60 years, presenting with ACS at Shri B M Patil Medical College. Exclusion criteria included known coronary artery disease, thyroid disorders, use of medications affecting thyroid function, and other conditions impacting thyroid tests. Thyroid profiles were measured within 72 hours of admission using the Electrochemiluminescence method. ACS severity was assessed using the Killip classification and TIMI flow grade. Statistical analysis was performed using JMP SAS 16 Software, with significance set at p<0.05. Results: The mean age of patients was 66.2 years, with 64.2% being male. Chest pain (91.5%) was the most common symptom. Hypertension (50.5%) and diabetes (46.3%) were prevalent comorbidities. ECG indicated STEMI in 64.2% of patients, with positive Troponin I in 85.3%. Single, double, and triple vessel diseases were observed in 31.6%, 42.1%, and 26.3% of cases, respectively. TIMI flow grade 2 was most common (48.4%), and Killip class 2 was the most frequent clinical severity (32.6%). Lower T3 and T4 levels were significantly associated with higher Killip classes, indicating severe ACS, while higher T3 levels correlated with higher TIMI grades, indicating better perfusion. Conclusion: The study found a strong relationship between thyroid hormone levels and the severity of ACS in older people. Lower thyroid hormone levels are related with more severe ACS, implying that thyroid profiling might be an important tool in the risk assessment and treatment of older ACS patients. More study is needed to investigate the underlying processes and corroborate these findings across a variety of clinical contexts.

Background: Complications of hypertension are the third leading cause of pregnancy relaed deaths, superseded only by hemorrhage and embolism. Pre-eclampsia is associated with increased potential risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular complication and maternal death. Consequently, early diagnosis of pre-eclampsia and close observation and timely drug intervention is needed. Labetalol is generally considered to be more effective than methyldopa for treating pre-eclampsia and pregnancy-induced hypertension (PIH) and Labetalol is quicker and more effective at controlling blood pressure and causes fewer side effects than methyldopa. Drowsiness is a common side effect of methyldopa. And also, Labetalol has a beneficial effect on renal function, ripening effect on the uterine cervix, decreases proteinuria/preeclampsia and decreases fetal/newborn death compared with methyldopa.1 Methyldopa is the medicine of choice for hypertensive conditions in pregnancy in several countries. Despite this, there is little proof of its safety in early pregnancy. So far, most methyldopa safety studies have focused on therapy during the second and third trimesters2,3,4. Thus this study was planned to know the efficacy of the two commonly used drugs comparatively in our set up. Research Question: What is the efficacy of the drugs Labetalol Vs Methyldopa on obstetric outcome in women with pre-eclampsia? The setting of the study was at department of Obstetrics and Gynaecology, Government Medical College, Machilipatnam. A one year observational study was conducted during the period from March ,2023 to February, 2024 on about 200 Pre-eclampsia patients admitted during the above period in the department of Obstetrics and Gynaecology by studying their socio-demographic profiles, type of hypertensive disorders, mode of delivery & preterm or term delivery, maternal complications and evaluation of efficacy of the drugs Labetalol and Methyl Dopa comparatively etc ; Results: The disease was more among the pregnant women  between 21-25 years of age group (49.5%) and the Mean age was 52 years and very few about 3% was observed among >31 years of age group. And most of them are primigravidae. And also, majority of the study subjects were belonging to low socioeconomic group & early marriages (adolescent marriages) were also high in number. There was a significant reduction of Blood Pressure noticed by both the drugs but the more significant reduction was seen among those treated by Labetalol. And also, significantly (P<0.05), about 32% of spontaneous vaginal deliveries happened with Labetalol users when compared to 20% among Methyldopa users & 25% induced deliveries with Labetalol as against 21% with Methyldopa and also significantly 43% LSCS with Labetalol as against 59% LSCS with Methyldopa but totally among both the groups LSCS was little bit more happened among the study subjects. Further it was observed that Preterm deliveries were only 23% with Labetalol as against 40% with Methyldopa which was highly significant (P >0.001). With reference to Birth weight LBW babies were more among Methyldopa users (55%) when compared Labetalol users (50%).

Background: Antithrombin III (AT III) has a prime role in heparin induced anticoagulation required during cardiovascular and percutaneous coronary interventions. This anticoagulation adequacy is monitored by regular activated clotting time (ACT) estimation. If there is deficiency of AT III due to any reason the desired anticoagulation i.e. target ACT is not achieved after administrating standard dose of injection heparin. Hence, extra dose of injection heparin, fresh frozen plasma (FFP) transfusion or AT III concentrate are to be given to achieve target ACT. Aim and Objectives: The aim of this study was to find incidence of AT III deficiency in patients undergoing cardiovascular surgery and percutaneous coronary interventions. To evaluate the effect of inherent AT III levels on the ACT values to heparin over the physiologic range of AT III levels and co-relation of other factors (Factor V, Fibrinogen C, Protein C and Protein S) with AT III and their implications on CPB. Material and Methods: This was single center observational prospective study. The patients included in this study had cardiovascular diseases planned for surgical or percutaneous coronary interventions. All the patients were tested preoperatively for AT III and other anticoagulation factor levels. In all the patients ACT was monitored at regular intervals to keep a check on anticoagulation during procedure.  Results: In this study 267 patients underwent preoperative evaluation of AT III and other anticoagulation factor levels and incidence of AT III deficiency i.e. <80% was found in 59 (22%) patients. In open heart surgeries, 22 patients were treated with extra dose of injection heparin in addition to standard dose in whom mean ACT was prolonged from 471 seconds to 485 seconds and in 16 patients additional FFP transfusion was given and mean ACT was prolonged from 471 seconds to 544 seconds. In vascular procedures, 4 patients who required extra dose of injection heparin mean ACT was prolonged from 258 seconds to 434 seconds and in 16 patients additional FFP transfusion was given and mean ACT was prolonged from 258 seconds to 537 seconds. In 14 patients undergoing percutaneous coronary interventions mean ACT was prolonged from 217 seconds to 446 seconds after extra dose of injection heparin.  Conclusion: It is important to routinely measure the AT III and other associated coagulation factors before the patient undergoes any cardiovascular intervention as its incidence is significant in patients having cardiovascular disease.

Introduction: Study comparatively evaluated the effect of metoprolol (intravenous followed by oral) treatment along with control drug (isosorbide dinitrate and diazepam) in a prospective randomized control trial manner. Here, patients were stratified according to age, infarct size, infarction type and type of ventricular arrhythmias before administrations of drug intravenous and oral metoprolol and others for total 70 patients. All patients were studied up to 365 days here and no death recorded in metoprolol therapy while 37% death occurred in control drug group. Thus, sufficient improvement in reduction of cardiac deaths recorded via metoprolol as compared to (Control) isosorbide dinitrate and diazepam (37%). Not only is that improvement in the reduction of chest pain, better controlled heart rate with reduction in the incidence of post-infarction arrhythmias, controlled systolic blood pressure, better reduction and limitation of infarct size , better electrocardiographic findings and reduced serum CPK-MB value also been recorded. In conclusion early administration of metoprolol and treatment in AMI improves the health (cardiac) status of patients suffering from myocardial infarction and thereby, significant reduction in death rate, reinfarction did not occur in metoprolol treated group as compared to 17.1% cases had reinfarction in control group.

Background: Myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved. The loss of viable myocardium initiates a process of adverse left-ventricular remodeling leading to heart failure. Cardiac transfer of Bone marrow and human peripheral blood mononuclear cells (PBMNCs) -derived stem cells can have a favorable impact in patients with myocardial infarction. Objectives: To study transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) in patients with Myocardial infarction with its safety and feasibility. Methods: It is ist prospective pilot study from the region with six months of follow-up. 10 Patients of ST-elevation acute anterior wall Myocardial infarction with occlusion of left anterior descending were taken for Echocardiography (2 blind operators) before coronary intervention. Percutaneous coronary intervention of left anterior descending (LAD) by drug eluting stent followed by intracoronary infusion of PBMNCs was done. 10 patients of acute anterior wall myocardial infarction were taken as control in whom only LAD stenting was done. PBMNCs suspension was infused distally to the occluding balloon through the central port of the balloon catheter. This maneuver was repeated 4 times to accommodate infusion of the total 20-ml cell suspension, interrupted by 2-3 minutes of reflow by deflating the balloon to minimize extensive ischemia. Left ventricular functions were compared at base line and after six months of follow up by blinded operators. Results: Demographic variables, clinical variables and left ventricular systolic functions at base line were comparable. After Six months of follow up in both case and control group there was improvement in left ventricular functions. But there was more improvement in Left ventricular functions in cases where intracoronary stem cell therapy was given in addition to LAD stenting as compared to control group. Increase in Ejection fraction and wall motion score index was statistically significant (P-value <0.05) in stem cell therapy group. Conclusion: Intracoronary PBMNCs infusion is a less invasive, more feasible, safer and a novel therapy for acute myocardial infarction patients who have depressed cardiac function. It causes significant improvement in parameters of left ventricular functions especially Ejection fraction and wall motion score index which are most important prognostic factor in myocardial infarction patients.

Background: Nosocomial infections are a serious threat in healthcare settings, particularly in paediatric intensive care units (PICU), and understanding the microbiological landscape is crucial for effective infection control and improved patient outcomes. This study seeks to identify and characterize the microorganisms present in the PICU and their resistance to antibiotics. Methods: This study was prospective observational research in the PICU. Various samples (blood, urine, endotracheal aspirates, swabs etc) were collected and analysed. Antimicrobial susceptibility testing was performed using the vitek-2 compact system. Results were interpreted according to CLSI guidelines (2022). Positive isolates were categorized and their antimicrobial susceptibility and resistance patterns were documented and presented as the number of isolates and percentage of resistance to specific agents. Results: 111 out of 1116 culture samples were positive (9.94% positivity rate). Blood culture was most common (41.4%), followed by endotracheal (31.5%) and urine (12.6%) cultures. Most positive patients were children under 6 years old (76%). Coagulase negative staphylococcus aureus (CONS) and Acinetobacter species were the most frequent bacteria (18% and 18.9% respectively). Resistance rates were high for benzathine penicillin and quinolones whereas linezolid and daptomycin were most effective against gram-positive organisms. Carbapenems, Colistin, and tigecycline were most effective against gram-negative isolates. Extended spectrum beta-lactam (ESBL) resistance was high in Acinetobacter spp., klebsiella, E. coli, and pseudomonas spp. Conclusions: The study highlights the importance of understanding the microbiological landscape in paediatric intensive care unit to implement effective infection control measures and select appropriate antimicrobial therapies.

Space travel, particularly long-duration missions, poses unique physiological challenges due to microgravity, radiation exposure, confinement, and isolation. This systematic review aims to synthesize the current understanding of the physiological changes that occur in astronauts during space travel. Using the PRISMA methodology, a total of 50 studies were included, focusing on cardiovascular deconditioning, musculoskeletal degradation, neurocognitive impairments, immune system dysregulation, and sensory changes. Cardiovascular effects include fluid redistribution, reduced plasma volume, and orthostatic intolerance. Musculoskeletal degradation manifests as bone density loss and muscle atrophy, primarily in weight-bearing muscles and bones. Neurocognitive impairments, including decreased executive function, are often accompanied by psychological challenges such as mood changes and sleep disturbances. Immune dysregulation, characterized by altered cytokine profiles and reduced immune response, increases the risk of infection. Sensory changes, including altered proprioception and spatial disorientation, affect astronauts' ability to perform tasks effectively in space. Various countermeasures such as exercise protocols, nutritional supplementation, and pharmacological interventions have been explored, but gaps remain in fully mitigating these physiological challenges, particularly in the context of deep-space missions to Mars. This review highlights the need for further research to develop comprehensive strategies for long-term astronaut health maintenance.

Background: The data of lower quantitative hepatitis B surface antigen (HBsAg) level were associated with more severe liver fibrosis in HBeAg-positive chronic hepatitis B. This study aimed to analyze correlation between liver fibrosis based on transient elastography and quantitative HBsAg levels in HBeAg-positive chronic hepatitis B patients. Methods: We conducted a cross-sectional study of 52 treatment-naive HBeAg-positive chronic hepatitis B patients. Liver fibrosis was measured using transient elastography, and quantitative HBsAg level was measured using automated Chemiluminescence Enzyme Immunoassay. Results: Quantitative HBsAg levels were highest in the F1 group, followed by F2, F3 and lowest in the F4 group. A strong negative correlation between transient elastography and quantitative HBsAg level was revealed in HBeAg-positive chronic hepatitis B patients (r=-0.706, p=0.000). Quantitative HBsAg levels were found to be higher in the immune-tolerant phase which liver fibrosis was minimal compared to the immune clearance phase which liver fibrosis was more severe. Patients with more severe liver fibrosis showed lower quantitative HBsAg levels. Conclusion: We found a negative correlation between liver fibrosis based on transient elastography and quantitative HBsAg levels in HBeAg-positive chronic hepatitis B.

Laparoscopic surgery involves creating a pneumoperitoneum with insufflation of CO2 into the abdomen to visualise during the surgery. Insufflation with CO2 has advantages such as reduced risk of venous air embolism however few disadvantages like sudden tachycardia and hypertension and hypercarbia.  This study aimed at measuring the ETCO2 (End Tidal CO2) after intubation, after insufflation and 10 mins after pneumoperitoneum to analyse the rise of PaCo2 due to pneumoperitoneum with CO2 during laparoscopic surgeries.  This study included 113 patients between 18-65 years of age, both sexes with ASA 1 & 2 posted for laparoscopic surgeries. Patients with History of Cardiovascular disorders, neurological disorders and pregnant patients were excluded from the study.  After the start of the anaesthesia after intubation, the initial ETCO2 was noted and followed by wich the measurements were noted immediately after pneumoperitoneum and 10 mins after the pneumoperitoneum. Result was found that there was an immediate increase in ETCO2 value after pneumoperitoneum when compared to before and after 10 mins of pneumoperitoneum. This may be attributed to the absorption of co2 as a result of higher CO2 tension gradient between the pneumoperitoneum and the blood perfusing the peritoneum.

Conclusion: The P.I. is useful tool for predicting hypotension in parturient undergoing LSCS under spinal anesthesia .

Background: Sepsis is a critical condition resulting from a dysregulated immune response to infection, leading to severe organ dysfunction and increased healthcare costs. Early identification of sepsis severity is crucial for effective management. This study investigates the correlation between hypoalbuminemia, arterial blood gas (ABG) pH levels, and the severity of sepsis, as assessed by the Sequential Organ Failure Assessment (SOFA) score, in critically ill patients. Methods: A retrospective analysis was conducted on 100 adult patients admitted to the ICU of a tertiary care hospital in South India from June 2023 to December 2023. Data collected included demographic characteristics, comorbidities, SOFA scores, ABG results, and microbiological cultures. Statistical analyses were performed using descriptive statistics, Chi-square tests, ANOVA, and Pearson’s correlation coefficient, with a significance threshold set at p < 0.05. Results: The majority of patients exhibited acidemia, with a significant inverse correlation between pH levels and SOFA scores (p < 0.001), indicating that lower pH is associated with greater sepsis severity. However, no significant relationship was observed between hypoalbuminemia and SOFA scores (p = 0.566). The most frequently identified pathogens included Klebsiella and E. coli. Conclusion: The study demonstrates that ABG pH levels serve as a valuable early indicator of sepsis severity in critically ill patients. While hypoalbuminemia was prevalent, its correlation with sepsis severity was not statistically significant. These findings underscore the importance of prompt ABG analysis in managing sepsis and suggest the need for further research to elucidate the role of hypoalbuminemia in sepsis outcomes.

Background And Justifications: Pre-anesthetic checkup is a necessary tool to take the detailed history of the patient, conduct physical examination and investigations which is used to evaluate the peri-operative risk informing priorly about the surgical anesthetic complications and risk factors As aging causes decline in the progressive function of the organ system, it is important to detect the underlying diseases, dental loss,head and neck joint changes ,so it is very important to plan for the level of difficulty in the endotracheal intubation,as the delay in endotracheal intubation can causes fatal consequences. The current study is carried out to determine the causes of difficult endotracheal intubation in the patients of different age groups and to assess the airway. Objectives: The objective of the study is to assess the airway and difficulty of endotracheal intubation during pre-anaesthetic checkup in different age groups. Results: The total of 60 patients included in the study,29(43.30%) were male and 31(51.66%) were female.To assess predictive factor for endotracheal intubation according to the three age groups.Patients basic demographic profiles assessed according to the Wilson’s scoring of airway assessment was investigated.In this study 56 (93.33%) patients experienced easy intubation, 3(5%)patients were experienced moderate difficulty and 1(1.66%) patient experienced difficult tracheal intubation(P=0.21192) Conclusion: The study’s findings shows that the age is not a factor for difficult endotracheal intubation and its predictive factors are varying by different age groups..

This researchwas done to investigate the association between optic disc parameters analyzed by optical coherence tomography (OCT) and the occurrence of peripheral retinal tears in patients with symptomatic posterior vitreous detachment (PVD). Methodology:  This cross-sectional study enrolled 150 patients with symptoms of acute PVD, who were allocated into two groups based on whether a peripheral retinal tear occurred or not. Observation And Results: When comparing the average retinal nerve fiber layer (RNFL) thickness (μm) between retinal tear and control groups, it was shown that patients with a retinal tear have a significantly higher (87.2 [95% confidence interval (CI), 84.47 to 89.9] vs 81.1 [95% CI, 77.81 to 84.46], P = 0.005) average RNFL thickness. Furthermore, we observed a significant difference (0.13, 0.06 to 0.22 vs 0.07, 0.04 to 0.1, P = 0.036, Mann–Whitney U-test) in the size of cup volume (mm3) between the tear and control groups, respectively. Linear regression showed a significant decrease (P = 0.03) in average RNFL thickness with increasing age, but without a significant difference between the two groups. There was no statistically significant difference between the tear and control groups in terms of rim area, disc area, and average cup-to-disc ratio. Conclusion: Patients with a higher average RNFL thickness and larger cup volume measured by OCT were more prone to develop a peripheral retinal tear. Increased peripapillary average RNFL thickness due to trauma and subsequent inflammation, possibly related to the more adherent posterior hyaloid membrane to the retina, may also indicate strengthened adhesions in the areas of the peripheral retina where retinal tears occur. OCT analysis of the optic nerve head may be used in everyday clinical practice as a predictor of the development of peripheral retinal tears in patients with symptomatic PVD

Introduction: Acute poisoning poses a major health challenge, and understanding the patterns of death from such poisoning is crucial for developing effective preventive and remedial measures. This study aimed to assess the patterns of acute poisoning fatalities at a tertiary care center. Material and method: The study was carried out after taking permission from institutional ethical committee and patients ready to give inform consent form. This study was carried on 328 patients over 2 years of time. Poison patients was admitted in emergency department of tertiary care hospital. The patient sociodemographic status, physical examination and postmortem was done.  Results: The study found that most patients were male, with the majority aged 31-40 years (37.50%). Excessive intake of substances often leads to poisoning. According to the data, food poisoning was the most common cause, affecting 92 patients (28.04%). Among the 298 unintentional cases and 30 suicides, most suicides involved sleeping pills (17 cases, or 56.66%). Excessive intake of sleeping pills led to 6 deaths (20.00%), with 5 of these (83.33%) due to sleeping pills. Symptoms were present in 130 patients (39.63%), with nausea and vomiting being the most common (31 cases, or 23.84%). External examination revealed stains around the lips and nostrils in 173 patients (52.74%), while 155 patients (47.25%) had no observable signs. Postmortem examinations showed oral cavity perforation, stomach, and intestinal damage in all cases (100%), with oral cavity corrosion and stomach content damage observed in 5 patients (83.33%). Inflammation was noted in 142 patients (43.29%). Conclusion: The patient having poisoning due to sleeping pills, with the symptom of nausea and vomiting, stains around the lips and nostrils. After postmortem showing different set of inflammation and ulceration. 

Background: Morphometric parameters of human femora play a significant role in sex determination and to design the implants for replacement of hip and identification of unknown in forensic investigations Aim: to study the major sex determinative variables of human femora and their significance Materials and Methods: A total of 50 dry human femora of unknown sex were collected from Department of Anatomy, Kurnool Medical College, Kurnool and different Medical Institutions. The morphometric parameters like vertical and transverse diameters of head of femur and neck- shaft angle of femur was measured Results: The vertical diameter of head of femur ranges from a minimum 38.50 mm to maximum 54 mm with a mean value of 44.96 mm. The transverse diameter of head of femur varies from a minimum 32 mm to maximum 53mm with a mean value of 44mm and the Neck shaft angle ranges from a minimum of 1150 to maximum of 1500 with a mean value of 134.700 were noted in our study. Conclusion: The femora of unknown gender can be sexed to extend of 75- 80 % with parameters like vertical and transverse diameters of the head of the femur, Neck- shaft angle of femur and these parameters considered as significant variables in sex determination and also play a crucial role to help the orthopaedic surgeons while planning surgeries.

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder interrelated with hyperlipidaemia, abdominal obesity, hypertension which are report to be related to sympathetic hyperactivity. The main aim of this study is to determine and compare autonomic status in between PCOS cases and control on the basis of heart rate variability (HRV). This case control study was conducted in RNT Medical College and Attached Group of Hospital, Udaipur (Rajasthan). The sample size of 160 cases of PCOS   were included in this study with equal number of the control group. The mean outcomes were the values of HRV in the time (mean RR interval, SDNN, RMSSD, pNN50%) and frequency (Total Power, Low Frequency (LF), LF norm, High Frequency (HF), HF norm and LF/HF ratio) domains. There was significant difference in the values of the time domain (mean RR, SDNN, RMSSD, pNN50%) between the groups. In the frequency domain, women with PCOS showed significantly higher LF (P = <0.001), and LF/HF ratio (P=<0.001) than the control group. HF norm was significantly lower in the women with PCOS than in the controls. This low frequency (LF) indicates sympathetic activity, high frequency (HF) indicates vagal activity and LF/HF ratio indicates sympathovagal balance. The present study concluded sympathovagal imbalance with high sympathetic dominance in women with PCOS.

Background: Liver cirrhosis significantly affects health outcomes, with rising cases linked to nonalcoholic steatohepatitis (NASH) in addition to chronic alcohol abuse. "Cirrhotic cardiomyopathy" is defined by systolic and diastolic dysfunction along with electrophysiological abnormalities, absent other cardiac disease. Patients are at risk of heart failure under stress, diagnosed through electrocardiography, 2D echocardiography, and biomarkers such as BNP. Key diagnostic indicators include a resting ejection fraction < 55%, diminished cardiac output under stress, and an E/A ratio < 1.0, while additional supportive features like electrophysiological changes and elevated biomarkers may be helpful but are not required. Methods: This cross-sectional study at Dr. PSIMS & RF Hospital included 50 cirrhosis patients, assessed using Child-Pugh and MELD scores. Evaluations included QTc interval assessment, 2D echocardiography, and cirrhotic cardiomyopathy criteria from the 2005 World Congress of Gastroenterology, Montreal. Inclusion criteria were hospitalized patients with cirrhosis, while those under 18 years of age, with COPD, or with co-existing heart disease were excluded. Statistical analysis used SPSS version 21, with significance set at p < 0.05. Results: Patients with QTc intervals ≤ 440 ms generally exhibited better liver function, with 65.5% in Child-Pugh Class A and 37.9% with MELD scores ≤ 9. Conversely, those with QTc intervals > 440 ms often had more severe liver impairment, with 71.4% in Child-Pugh Class C and 42.9% with MELD scores ≥ 30, showing significant differences (p < 0.05). Ejection fractions > 55% were associated with better liver function, while ejection fractions ≤ 55% indicated more severe impairment, with significant differences (p < 0.05). Cardiac parameters, including right atrial size, left atrial size, and ejection fraction, differed significantly across Child-Pugh classes, with Class C patients having larger right and left atrial sizes and lower ejection fractions compared to Classes A and B (p < 0.05). Conclusion: In conclusion, the study reveals that in liver cirrhosis patients, prolonged QTc intervals are strongly correlated with Child-Pugh and MELD scores, while an ejection fraction ≤ 55% indicates more severe impairment, highlighting the critical need for continuous cardiac monitoring.

Background: Exchange transfusion (ET) is required in hyperbilirubinemia hospitalized neonates.  Objectives: 1) Neonate’s Rh factor wise grouped then the changes in hematological and biochemical parameters before and after exchange transfusion. 2) To study the effect of whole blood exchange transfusion to decrease serum bilirubin and raise hemoglobin in neonatal hyperbilirubinemia.3) To find out the underlying disease pattern of hemolytic jaundice among the study population.  Methods: The study center at SMS and associated hospitals. The blood bank was licensed and fully equipped. Fall in serum bilirubin minimum 40 cases were required as the sample size of the present study.  Results: Neonate’s Rh factor wise grouped was Rh+ve= 37 (92.5%) and Rh−ve= 03 (7.5%). When Neonate’s blood groups were Rh+ve and Rh-ve, then the Hb (g/dl) and Direct bilirubin (mg/dl) mean value before exchange transfusion was comparison revealed that the difference was non-significant. When Neonate’s blood group was Rh+ve, then the Hematocrit Total bilirubin (mg/dl) Indirect bilirubin (mg/dl) means value before exchange transfusion was revealed that the difference was significant in comparison Rh-ve, was non-significant.

Background: The COVID-19 pandemic had been uniquely challenging for the general as well as pregnant and postpartum women. Uncontrollable stress arising due to its high infectivity has exacerbated risk for maternal depression and anxiety, in turn leading to adverse mother and child outcomes. The aim of present study was therefore to assess the psychological responses of Covid 19 pandemic in pregnancy and post –partum women. Methods: The current study was a questionnaire based cross sectional study done for one year, in a tertiary care hospital of Northern India. After getting ethical clearance from university ethical committee a face-to-face interview using three scales namely Generalized Anxiety Disorder 7-Item Scale (GAD-7), Hamilton depression score (HAM-D), Fear ofcovid 19 scale was applied on 192 pregnant and and post –partum women who visited hospital and their response was assessed. Responses were calculated as scores as used in validated questionnaires and were categorized accordingly. Results: Responses of total 192 patients included in the study (cases/covid positive=96 and control/covi negative=96), it was found that overall anxiety was more prevalent in Covid positive group as compared to covid negative group with 53% of cases had severe anxiety. Hamilton depression scale used to assess depression showed that depression was also more prevalent in covid positive group as compared to covid negative group with distribution of Severe, and Very Severe depression in 26.04%, and 35.42% in case group respectively. Fear was more prevalent in case group as compared to covid negative group with the percentage distribution of mild and severe fear to be 20.83% and 79.17% in case and in control group the percentage distribution being 83.33% and 16.67%. This difference in the two groups was also found to be statistically significant. Conclusion: Anxiety, depression and fear was significantly more prevalent in the covid positive pregnant and post - partum women however control group was also not free from anxiety, depression and fear due to Covid 19.

Introduction: Any situation that necessitates adjustment can lead to stress. While a certain level of stress can be beneficial, excessive stress can negatively affect performance. Individuals vary in their perceptions, interpretations, and coping mechanisms regarding stress. The human body responds to stress with changes in biological functions, particularly in autonomic functions. 1st M.B.B.S. students likely experience significant stress during their first-term internal examinations. This study aims to investigate the effects of exam stress on cardiac autonomic functions in these students and to observe the differences in their individual responses to such stress. Methods: A total 33 students of 1st M.B.B.S included in the study. Written informed consent obtained. Detailed history, which included age, sleeping and reading habits of last 1 week. Depending on sleeping hours, students were divided into 2 groups, students in group I had no afternoon sleep and group II had afternoon sleep. Resting pulse rate (PR) & blood pressure (BP) were recorded after 5 min of rest in sitting position and with handgrip & Valsalva maneuver allowing at least 5 min gap between measurements. All the recordings were taken 1 hour before exam and immediately after the exam. Mean and SD values of age, sleeping time, pulse rate & blood pressure were determined. Statistical significance of the data was measured by applying paired & unpaired t test appropriately. p < 0.05 was considered statistically significant. Results: The data compares two groups of adolescents: Group I (n=14) with an average age of 17.71 years and Group II (n=19) with an average age of 17.73 years. Group I reported an average total sleep of 4.85 hours, significantly lower than Group II's average of 6.3 hours, indicating a notable difference in sleep duration between the two groups. Overall, the results indicate a notable cardiovascular stress response during exams, characterized by decreased heart rates and variations in blood pressure. Conclusion: Individuals exhibit varying responses to stress, as evidenced by their sleep patterns and autonomic responses. Students who demonstrate a sustained blood pressure response should be monitored regularly to assess their risk of developing hypertension in the future.

Background: In neuroimaging, Magnetic Resonance Imaging (MRI) is a cornerstone technique that allows clinicians to see fine aspects of brain architecture and pathology with unparalleled clarity. Ring-enhancing lesions (RELs) in the brain pose a particularly difficult diagnostic scenario among the many abnormalities found. Objectives: 1. To differentiate neoplastic from non-neoplastic brain lesions using conventional and advanced MR imaging techniques. 2. To study the characteristic imaging findings of various ring enhancing lesions on MRI.  Material & Methods: Study Design: A prospective hospital-based observational study. Study area: Department of Radio Diagnosis, Subbaiah Institute of medical sciences, Shivamogga, Karnataka. Study Period: 1 year. Study population: All patients referred to the Department of Radio diagnosis with clinically suspected cerebral ring-enhancing lesions. Sample size: The study consisted of 60 subjects. Sampling method: Simple random technique. Results: Out of 60 patients evaluated, Seizures were the most common presenting complaint in 70% of cases. Headache (18%), fever (6.6%), vomiting (15%), ataxia (5%) and motor weakness (6%) were the other presenting complaints. Our findings were compared with the study conducted by ps mahato8 in which headache (57.5%) was the most common symptom followed by seizures (52.5%).  CONCLUSION: From our study, it can be concluded thatMRI is the most sensitive modality in the characterization of intracranial ring-enhancing lesions. MRI being non-invasive and non-radiating is an ideal imaging modality.

Background: Spinal anaesthesia is the most commonly performed technique in parturients undergoing Lower Segment Caesarean section (LSCS). This randomized double-blinded study compared the hemodynamic effects of levobupivacaine and ropivacaine in parturient with pre-eclampsia undergoing emergency LSCS. AIM: The commonest side effect of subarachnoid block is hypotension and bradycardia and so to counter that, there has been developments of newer amide group of local anaesthetics. Both hyperbaric levobupivacaine and hyperbaric ropivacaine, have shown better hemodynamic effects as compared to conventional hyperbaric bupivacaine. So, in this study we shall further compare hyperbaric levobupivacaine and hyperbaric ropivacaine and consider its outcome in parturients with pre-eclampsia undergoing emergency Lower Segment Caesarean section (LSCS). Material And Methods: Eighty parturients with pre-eclampsia scheduled for emergency LSCS were randomized into Group L and Group R of 40 parturients each. Group L parturients received 1.4ml of 0.5% hyperbaric levobupivacaine while Group R parturients received 1.4 ml of 0.75% hyperbaric ropivacaine with fentanyl 0.4 ml (50 mcg/ml) as an adjuvant in both groups was injected intrathecally at L2-L3 interspinous space. Primary objective was to compare perioperative hemodynamic changes. Secondary aim was to compare onset and duration of sensory and motor block, duration of analgesia and quality of motor block. Results: Group L provides better hemodynamic stability and postoperative analgesia as compared to Group R. Conclusion: Ropivacaine and levobupivacaine are the newest drugs utilized for neuraxial blockade and they have demonstrated a superior pharmacological safety profile. Levobupivacaine emerges as the more favorable option when considering cardio stability and hemodynamic stability in parturients with deranged hemodynamics.

Introduction & Background: Alvarado score and the Appendicitis Inflammatory Response (AIR) score are two of the most commonly used scoring systems for diagnosing acute appendicitis. Accuracy of the scoring systems is essential for clinical diagnosis, early referral from primary health care facilities, and for deciding on surgical intervention especially when imaging is inconclusive or not available. Aims & Objectives: The aim of this Study is to compare the AIR score to the Alvarado Score to determine which is more accurate in the diagnosis of acute appendicitis. The objective of the present study is to evaluate the AIR score on a consecutive cohort of patients with suspicion of acute appendicitis and compare the AIR score’s performance to the Alvarado score. Materials & Methods: The study design is a single institution, prospective cohort study. Study period is 1 year (January 2023 to December 2023) and the Sample size is 50 patients. The Alvarado score and the AIR score is calculated for each patient. Patients then undergoes pre-operative computed tomography (CT) scan. The final diagnosis of acute appendicitis will be based on the post-operative histopathology report. Results & Discussion: CT finding & HPE finding correlate more closely with the AIR Scores when compared to the Alvarado Scores, with the P-value of AIR Score being more significant. Receiver Operating Characteristic (ROC) Curves indicate that the Empiric ROC Area of AIR Score is greater than Alvarado Score and also Sensitivity & Specificity being higher for the AIR Score when compared to the Alvarado Score. Conclusion & Recommendations: This study externally validates that the AIR score has a high discriminating power and outperforms the Alvarado score. A randomized control trial should be considered to study the AIR score as grounds for selective use of CT in those deemed with probability for appendicitis.

Background: In India, about 3-4% of people are carriers of beta thalassemia. Sickle cell occurs in about 1 in 100 Indians. As per WHO at least 5.2% of the world population with 7% prevalence in pregnant women carries a variant of hemoglobin disorder. HbE is the most common hemoglobinopathy in north eastern states of India, with carrier frequency of around 50% in a hospital based study27. Objective: To follow up the maternal and fetal outcome of pregnancy with hemoglobinopathies. Methodology: A prospective observational study to evaluate the maternal and fetal outcome in pregnancy with hemoglobinopathies. Results: 78% of the patients had moderate anaemia. HbE disease comprising of 44.8 % was the most common hemoglobinopathy. 53 % of the patients underwent LSCS. The most common indication being fetal distress in first stage of labour (19.56%). 43 % of the patients had associated obstetrics complications with 23 % preterm delivery, 7 % FGR pregnancy, 4.59% hyperbilirubinemia, 9.1% PROM. 26 (29.8%) of babies were born with low birth weight. 22.9% of the babies were admitted in NICU. Among the pregnant women, 19.5 % had severe anaemia which needed blood transfusion. There was one maternal death due to postpartum haemorrhage. Conclusion: HbE disease comprising of 46 % was the most common among the hemoglobinopathies. Since the incidence of hemoglobinopathy is high in our region, routine Hb typing has to be done for Hb of < 8 g/dl.

Objective: Present study was conducted to evaluate the trends of Microbial agent in patients with chronic Dacryocystitis and their drug resistance pattern. Material and method:  A total of 86 patients suffering from chronic Dacryocystitis were included in the study. From all the patients a total of 86 Swab samples were taken aseptically and send for culture and sensitivity testing. Result: A total of 74 pure cultures isolated from 86 swab samples, the most common organism found were Staphylococcus aureus in 33 cases (44.59%) followed by Coagulase Negative Staphylococcus (CONS) in 14 cases (18.91%). Amongst S. aureus isolates, aminoglycoside group of antibiotics i.e. Amikacin, and Tobramycin showed a good sensitivity of 66.66%, and 81.81%. Against beta lactam group of antibiotics like cefazolin (63.63%) and cefotaxime (66.66%) were sensitive. Moxifloxacin showed 100% sensitivity when compared to ciprofloxacin (87.8%). For S. pneumoniae moxifloxacin, cefotaxime and cefazolin gave a high sensitivity of 100% followed by Ciprofloxacin 87.8% and Chloramphenicol showed a sensitivity of 51.51%. Amongst Gram negative Bacilli (GNB) maximum isolates (100%) were sensitive to Ceftazidime which is a third generation Cephalosporin with a good antipseudomonal activity followed by Cefotaxime (82.35%). Sensitivity to Moxifloxacin was observed in 82.35% isolates as compared to 47.05% sensitivity against Ciprofloxacin. Amikacin and Tobramycin was equal effective in 64.70% of isolates. Conclusion: Staphylococcus is the major cause in pathogenesis of chronic dacryocystitis, and candida albicans in few cases which might to be due to reduced immunity.

The Tnnt2 gene encodes for the troponin T isoform that is predominantly expressed in the adult heart and plays a crucial role in regulating myocardial contractility. Mutations in the Tnnt2 gene have been associated with various cardiomyopathies, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Recent studies have also highlighted the potential involvement of Tnnt2 in certain syndromes, such as LEOPARD and Noonan syndrome LEOPARD syndrome is an autosomal dominant disorder characterized by occulur, cardiac, genital, developmental, and neurological manifestations similarly Noonan syndrome is another autosomal dominant disorder characterized by facial dysmorphism, short stature, cardiac abnormalities, and developmental delay. Gene modifier: are genes that alter the phenotypic and molecular expression of other genes Interestingly, recent studies have identified Tnnt2 as a potential modifier gene that can modulate the clinical features of LEOPARD syndrome and Noonan syndrome in individuals with TNNT 2 mutations Understanding the role of Tnnt2 in these syndromes may shed light on their underlying pathophysiology and contribute to the development of targeted therapies

Background: Psoriasis is a chronic inflammatory disease associated with an increased risk of cardiovascular diseases (CVD) due to systemic inflammation and metabolic dysregulation. Objective: This study investigates the association between psoriasis and cardiovascular diseases in patients attending Hamdard Institute of Medical Sciences and Research, New Delhi. Methods: A prospective observational study was conducted from January 2023 to May 2024. A sample of 65 psoriasis patients was assessed for cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and metabolic syndrome. Detailed clinical evaluations, blood tests, and ECG were performed. The prevalence of CVD risk factors and the correlation with psoriasis severity were statistically analyzed. Results: Out of the 65 patients (mean age 43.7 years, 60% male), 45 (69%) showed at least one cardiovascular risk factor. Hypertension was observed in 40% of the patients, dyslipidemia in 35%, and metabolic syndrome in 30%. Psoriasis severity (PASI score) was positively correlated with the presence of multiple CVD risk factors (p<0.05). Furthermore, 12% of the patients had a history of cardiovascular events such as myocardial infarction or stroke. The findings indicated a higher prevalence of cardiovascular risk factors in moderate-to-severe psoriasis cases than in mild cases. Conclusions: Psoriasis patients, especially those with severe forms, exhibit a significantly increased risk of cardiovascular diseases. Early cardiovascular screening and management should be integral to psoriasis care to mitigate this risk.

Introduction: Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. Patients undergoing emergency coronary artery bypass grafting represent a unique and high-risk population that remains challenging for cardiac surgeons. Aims: To analyse pre-operative risk factors along with intra operative, in hospital & shortterm clinical outcome in patients undergoing urgent CABG Materials and method: The present study was a Retrospective Observational Audit. This Study was conducted from December 2022 – March 2024 at department of general surgery &department of CTVS, Peerless Hospitex Hospitals and B K Roy Research Centre Limited, Kolkata. Total 33 patients were included in this study. Result: The mean age of the patients in the urgent group was 56.55 ± 12.44 (mean± s.d.). The mean age of the patients in the elective group was 61.06 ± 7.32 (mean± s.d.). The group's mean age distribution showed statistically significant differences (p=0.036). There were 14 (28) female patients and 36 (72) male patients in the urgent group. Twelve (24) and 39 (78) of the patients in the elective group were female. Sex and group associations were not statistically significant (p=0.22). Thirty-two (64) participants in the urgent group had diabetes mellitus. Conclusion: In conclusion, the outcomes of urgent coronary artery bypass grafting (CABG) can vary depending on several factors, including the patient's preoperative condition, the urgency of the surgery, and the presence of comorbidities. While urgent CABG is associated with higher risks compared to elective procedures, it often leads to significant improvements in cardiac function, symptom relief, and survival in patients with severe coronary artery disease. The success of the procedure largely depends on timely intervention, the expertise of the surgical team, and effective postoperative care. Despite the inherent risks, urgent CABG remains a crucial life-saving intervention for patients with acute coronary syndromes.

Background: HbA1c is recommended as the standard laboratory assessment of glycaemic control and efficacy of treatment of patients with type 1 and type 2 diabetes mellitus. However, HbA1c assays give incorrect values in patients with hemoglobinopathies. Hemoglobinopathies interfere with the detection of HbA1c by the HPLC method. HbE disorder is very common in North- Eastern part of India both in tribal and non-tribal populations. Serum fructosamine is estimated to find out the glycaemic status of HbE disease patients instead of HbA1c. Methods: This hospital-based cross-sectional study was conducted in the Department of Medicine, Assam Medical College & Hospital, Dibrugarh for a period of 12 months. A total of 90 diabetic patients were included. Serum Fructosamine and HbA1c were analysed. Results: The results showed that the mean age was 49.83 years with male preponderance (55 %) with male to female ratio of 1.2:1. In our study, in diabetic patients with adult hemoglobin there was a statistically significant correlation between serum fructosamine and HbA1C (r=0.93) and in diabetic patients with HbE trait also, there was a statistically significant strong correlation (r=0.522). Conclusion: It is seen that HbE disorder is prevalent in this part of the country, and the presence of Hemoglobin E causes significant interference in HbA1C measurement. In the presence of HbE disease, serum fructosamine can be used in place of HbA1c to know the glycaemic status of the patient.

Background: Patients with hepatocellular carcinoma (HCC) face a number of challenges for surgical resection or liver transplant including poor liver status, significant postoperative morbidity, a slight mortality risk and high costs. Radio-Frequency ablation (RFA) is an established effective and minimally invasive treatment method for the treatment of HCC. Aims and objectives: The aim of this study was to determine the relationship between preprocedural tumor morphology, or the size of the lesion on contrast imaging, the Child-Pugh score, and technical parameters, and the outcome of RFA whether successful ablation or local tumor progression. Materials and methods: Inclusion criteria were single nodular HCC ≤5cm in maximum diameter, 3 lesions, each ≤3 cm in diameter and Child-Pugh class A or B liver cirrhosis. Radio-frequency ablation was performed on patients under sedation. A repeat ablation session was carried out if persistent tumor was detected on the follow-up CT scan. The patients underwent imaging one month after the procedure. After then, an MRI or CT scan was done every three months. The mean follow-up period was 13 months. Results: A statistically significant association was observed in the size of the lesion with the outcome. Technical parameters and the patient's Child Pugh score did not statistically correlate with the outcome. The 1-year survival rate for Child-Pugh A and B patients was 61% and 50% respectively. Conclusion: Our study found out that size of the lesion has an impact on the outcome of RFA, with small HCC < 3cm in size showed higher rates of successful ablation than larger ones. Since the Child Pugh score of patients and technical parameters did not show any statistical association, further studies consisting of a larger number of patients and longer follow-up are necessary, as regular long-term surveillance is essential for early detection and eradication of local tumor progression and intrahepatic distant recurrence.

Background: Autopsy, being the precise and detailed study of a person's corpse following death is of different types. Medicolegal autopsy plays the pivotal role to the forensic pathologist. Regular weighing of different types of human viscera plays a significant role in medical sciences as any detection of dereliction in weight from the normal range is suggestive of some pathological changes in the organ. Recording of organ weights is regularly being done by the forensic pathologists during an autopsy. The findings are meant to be compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weight of spleen in particular has significant clinical value. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria.  Results: Total 570 cases had been selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and rest (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weight of spleen. Conclusion: A database may be deduced from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification.

Background: This study examines the correlation between thyroid function and obesity, an area of increasing clinical interest due to the rising prevalence of both thyroid disorders and obesity worldwide. Previous research has suggested potential links, but findings have been inconclusive, necessitating further investigation. Objectives: The primary objective was to explore the relationship between thyroid function tests and obesity indices in a cross-sectional population. The study aimed to contribute to the understanding of how thyroid function may influence or be influenced by obesity. Methods: We conducted a biochemical cross-sectional study involving 250 participants, selected based on predefined inclusion and exclusion criteria. Thyroid function was assessed using standard thyroid function tests (TFTs), including TSH, T3, and T4 levels. Obesity was evaluated using body mass index (BMI) and waist circumference measurements. Statistical analysis was performed to identify correlations between TFTs and obesity indices. Results: The study found significant correlations between certain thyroid function parameters and measures of obesity. Elevated TSH levels were notably associated with higher BMI and waist circumference. These associations persisted even after adjusting for potential confounders, such as age and gender. Conclusion: Our findings suggest a significant correlation between thyroid function tests and obesity, particularly an association between elevated TSH levels and increased obesity indices. This study enhances the understanding of the interplay between thyroid function and obesity, potentially guiding future clinical management and research.

Background: Even in this modern era of advanced knowledge in medical science, still the human skeleton holds its medicolegal importance in forensic anthropology as before. The forensic pathologists still face the dilemma to identify and opine whether the skeletal remains are of human or not along with estimation of the relatively correct age, sex, and height of the specimen available. Innumerable scientific literature is not unavailable in forensic anthropometry for the identification of human skeletons. The examination of the human skeleton is an integral part to serve medico-legal purpose. The pivotal step of forensic investigation usually starts with the sexual differentiation of the adult human bone. The whole skeleton helps to identify the sex of bone (male/ female) with almost 100% accuracy. This current pilot study is an attempt of finding morphometric relationship between sex and predefined transverse linear measurements of adult sternum. Materials And Methods: Following the approval of the institutional ethical committee, the research was carried out on 64 adult human sternums that were selected based on specific inclusion and exclusion criteria. Results: In the current study, the study population comprises 38 (59.4%) males and 26 (40.6%) females, selected through the complete enumeration method. Among total 64 cases of the present study 28(43.8%) cases are from 18-39 years age group and 22 (34.4%) cases are from 40-59years age group 14(21.9%) cases are from 60-90years. Predefined transverse linear parameters i.e. Manubrium Width and Mesothermal Width_ both found to be greater in Male sex. Independent t -test also suggested that the sex-wise differences also found to be statistically significant (<0.001) Conclusion: Transitioning from a morphological approach to a morphometric analysis for sex determination based on the sternum is expected to minimize subjective variability, allowing for subsequent refinement and enhancement through more detailed methodologies.

Introduction: Bullous keratopathy can be caused by various diseases and surgeries, including Fuchs corneal endothelial dystrophy, iridocorneal endothelial dystrophy, cataract surgery, and glaucoma surgery. Trabeculectomy is one of these possible causes for bullous keratopathy. Both intra-operative insult to the corneal endothelium by surgical manoeuvres and anti-metabolites, as well as intra- and post-operative flat anterior chamber (leading to iris–cornea touching) may induce corneal endothelial dysfunction after trabeculectomy. Intraocular lens implantation is recognized as a major advance in the field of ophthalmic surgery in recent years. The high success rate and the safety of this visual rehabilitative procedure has made it the most popular method for correction of aphakia. Materials and methods: This was a prospective interventional study done at department of ophthalmology, Tertiary Care Teaching Hospital. 32 patients with PBK presenting to us were studied. Patients with PBK irrespective of type of IOL were included. All eyes with posterior chamber IOL were retained after ensuring they are well centred. In 2 eyes IOL repositioning was done. Two eyes with anterior chamber IOL were explanted along with anterior vitrectomy and were left aphakic. Results: As per present study, out of 28 patients with bullous keratopathy had history of SICS in 10 patients (35.71 %), ECCE in 9 patients (32.15%), Phacoemulsification in 3 patients (10.71 %), ICCE in 2 patients (7.14%) and in 4 patients (14.29 %) type of cataract surgery was not known. As per the present study, out of 32 patients with bullous keratopathy, 11 patients ( 34.38% ) were having ACIOL, 9 patients ( 28.13% ) were having PCIOL and 1 patient ( 3.12% ) was having iris – fixated IOL,total 21 patients were pseudophakic bullous keratopathy. 7 patients (21.87% ) were aphakic and 4 patients ( 12.50% ) were phakic. As per present study, out of 32 patients with bullous keratopathy in 21 patients ( 65.63% ) best corrected visual acuity was worse than 3/60 and in 11 patients ( 34.37% ) BCVA was between 3/60 to 6/60. As per present study, IOP was high in 9 patients ( 28.12% ) and normal in 23 patients (71.87%) out of 32 patients with bullous keratopathy preoperatively. Conclusion: The outcomes for PK in bullous keratopathy are good for patients having previously undergone trabeculectomy surgery, but it may be desirable that surgical procedures such as needling of the bleb and re-trabeculectomy be performed before PK in eyes with non-functioning blebs, even when IOP is under control with medication

Background: One of the significant groups of pediatric illnesses and major cause of mortality and morbidity in childhood are congenital heart diseases. In the present study, we aimed to study the spectrum of congenital heart diseases in children at a tertiary care hospital of Western Maharashtra. Material and Methods: The present study is cross-sectional Descriptive Study, conducted in children diagnosed with congenital heart diseases. Results: Amongst 50 children, 28 (56%) children belong to the age group of 1 month to 12 months; Males were 26 (52%) and females were 24 (48%). On cardiovascular examination, 21 (42 %) children had ejection systolic murmur, 17 (34%) had pansystolic murmur and 6 (12%) had continuous machinery murmur. The other common cardiovascular examination findings in our study were thrill (40 %), S3 gallop (38 %), precordial bulge (26 %) and loud P2 (20 %). Amongst 50 children, 37 (74%) children were diagnosed as acyanotic congenital heart disease and rest of the 13 (26%) children were cyanotic heart disease. 18 (36%) children were found to have isolated atrial septal defect and 8 (16%) children had isolated ventricular septal defect on 2-D Echocardiography. The other frequently found congenital heart diseases were Tetralogy of fallot (8%), isolated patent ductus arteriosus (6 %), DORV (6%) and Pulmonary Atresia (4%). Few of the children with acyanotic congenital heart diseases had multiple defects with the combination of PDA with ASD (6 %) being the most frequent followed by pulmonary stenosis with VSD (4 %). Conclusion: Congenital heart diseases are one of the major congenital anomalies and a leading cause of mortality in paediatric age group and hence, early diagnosis plays a significant role in improving the quality of life in children with congenital heart diseases as well lessen the burden of congenital heart diseases on the society.

Background: Sepsis remains a critical challenge in intensive care units (ICUs), necessitating a comprehensive understanding of its epidemiology and the management strategies employed in critical care settings. Methods: This cross-sectional survey involved 200 critically ill patients diagnosed with sepsis across five major hospitals. Data were collected on the incidence of sepsis, management strategies, and outcomes, using structured questionnaires and review of medical records. Results: The study identified prevailing patterns in the occurrence of sepsis and elucidated the variety of management strategies adopted by healthcare professionals in the ICUs. Data analysis highlighted the impact of early intervention and protocol-driven care on patient outcomes. Conclusion: The epidemiological data and management strategies derived from this survey provide vital insights that can enhance sepsis care protocols, potentially improving patient outcomes in critical care environments.

Background & Objectives: Bowing in forearm is common because trauma to the forearm is common in children and also both the radius and ulna are of comparable diameter and are naturally curved bones. Present study was aimed to assess maximum ulnar bow and apex ratio in normal children 2-12 years of age at a tertiary care teaching hospital. Material and Methods: The present study was a prospective, descriptive study, conducted in patients with forearm injuries with normal contralateral forearm/normal bilateral forearm 2-12 years of age. The assessment of ulnar bow was performed by using standard true lateral x ray film and scale. Results: There were 122 limbs which had undergone X ray of forearms. X-ray was done for 54 left and 68 right forearms. The Maximum Ulnar Bow (MUB) was present in 10 children. The mean MUB was 0.20 (SD=0.05) cm. The MUB ranged from 0.12 cm to 0.29 cm. The mean total length of ulna (Measurement A) in our study was 17.04 (SD=2.38) cm, ranging from 13.14 cm to 19.75 cm. Also, the mean distance from the apex to the tip (Measurement B) was found to be 3.69 (SD=2.01) cm, ranging from 1.43 cm to 7.70 cm. The mean apex ratio was found to be 0.21 (SD=0.10). The range of apex ratio was between 0.10 and 0.44. 6 boys & 4 girls showed bowing in their ulna. The mean MUB in was more in boys (2.1±0.57 mm) as compared to that in girls (2±0.6 mm) in girls. But this was statistically comparable p=0.86. Kim elbow scores were found to be full in case of all 10 children with ulnar bow. Conclusion: Atraumatic Ulnar Bow found in our population was far less in magnitude than the ulnar bow found in the traumatic case reports and studies done in western population.

Background: Bloodstream infections (BSIs) are a major global health issue, leading to significant morbidity and mortality, especially in healthcare settings. They are associated with prolonged hospital stays, increased healthcare costs, and high mortality rates, with a substantial incidence reported globally and particularly in pediatric intensive care units (PICUs). Objective: This study aims to assess the antimicrobial resistance patterns among Gram-negative isolates and evaluate the distribution of genetic markers of drug resistance in a tertiary care hospital in Cuttack, Odisha. Methods: A prospective study was conducted from November 2023 to July 2024 in the Department of Microbiology at SCBMCH, Cuttack, Odisha. The study included 558 pediatric patients with suspected BSIs from the PICUs. Blood cultures were processed using the BacT/ALERT 3D system. Isolates were identified using standard microbiological methods, and antimicrobial susceptibility was tested using the broth microdilution method. Genetic analysis for resistance markers was performed using PCR targeting TEM, SHV, CTX, NDM-1, and AmpC genes. Results: Out of 558 suspected cases, 192 (34.4%) were culture positive. Among these, 97 (50.5%) were Gram-negative bacteria, with 75 (77.3%) being multidrug-resistant (MDR). Genotypic analysis revealed that all Gram-negative isolates carried the TEM gene, with 18 (24%) containing both SHV and CTX genes. None of the isolates were carbapenemase producers by phenotypic methods, but 29 (38.6%) were detected by genotypic methods targeting the NDM-1 gene. Additionally, 4 isolates (5.3%) were identified as AmpC producers phenotypically, while 9 (12%) were detected genotypically. Conclusion: The high prevalence of MDR Gram-negative bacteria, particularly with significant genetic markers for drug resistance, highlights the urgent need for continuous surveillance and judicious use of antibiotics to manage BSIs effectively. Genotypic methods proved more sensitive than phenotypic methods in detecting resistance, emphasizing the importance of advanced diagnostic tools in clinical settings.

Objective-   To compare the efficacy of our indigenous transporting device with current transporting systems to prevent neonatal hypothermia while transporting sick neonates from GLR to NICU. Design-   Prospective Interventional Study Setting-   GLR and NICU (Neonatal Intensive Care Unit) in a government hospital in central India. Participants- 317 participants Eligibility Criteria- All newborns with an indication for admission in NICU in a government hospital in central India. Selection Procedure- Random sample. Intervention- Simple indigenous transporting device for transportation of sick neonates from GLR to NICU. Results- 159 neonates were transported using cloth alone out of which 145 (91%) had hypothermia while only 14 (9%) were normothermic. 158 neonates were transported using cloth plus trolley combination out of which 107 (67%) had hypothermia while 51 (33%) were normothermic. 124 preterm neonates were transported using cloth alone out of which 112(90%) had hypothermia while only 12 (10%) had normothermia. 122 preterm neonates were transported via cloth plus trolley combination out of which 83 (68%) had hypothermia while 39 (32%) were normothermic. 135 LBW neonates were transported using cloth alone out of which 122 (90%) had hypothermia while only 13 (10%) were normothermic. 127 LBW neonates were transported via cloth plus trolley combination out of which 80 (62%) had hypothermia while 47 (38%) were normothermic.  Conclusion- In our study we have observed that our transporting device in conjunction with cloth was efficient in reducing hypothermia during intrahospital transport of neonates including high risk babies like preterm and LBW babies rather than transportation using cloth alone. Transporting incubators although efficacious in preventing hypothermia, but still are not readily available in peripheries and low resource settings, so to overcome these problems our trolley and cloth combination can be used.

Background: Autopsy is the precise and detailed study of a person's corpse following death. An autopsy is of different types. To the forensic expert, Medicolegal autopsy plays the pivotal role. Study of weight of different types of human body organs plays a significant role in almost all the branches of medical sciences as any dereliction in weight from the normal range is suggestive of some pathological changes in the organ. Recording of organ weights is mandatory by the forensic experts during an autopsy. The findings is to be compared to what is standard or average of a specific organ for a specific age range and particular sex. The determination of weights of kidneys of both sides in particular has significant clinical value.  Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 570 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria. Results: Total 570 cases had been selected after following the inclusion and exclusion criteria out of which 362 were males and 208 were females. Among the studied 570 cases, 362 (63.5 %) were male and rest (36.5 %) were female. In this study the discussion was mainly on relation of age, sex, body weight, and body length upon the weight of kidneys of both sides. Conclusion: A database may be deduced from this study regarding normal range of the weight of various organs and their relation with external parameters of the subjects which can be applicable on the population of this region for future reference. In severely mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give an idea about the stature, built and age of the victims helping in identification.

Background: Snakes have always managed to grab human attention and have been an object of fear and veneration since historic civilizations. Snakes are found almost all over the world. Snakebite is a common medical emergency and an occupational hazard, more so in Tropical India, where farming is a major source of employment. Venomous snakes prevalent in India usually belongs to 3 families. Snakebite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is an important cause of mortality in patients with vasculotoxic snake bite. In India, renal failure is mostly associated with Russell's Viper & E. Carinatus bites (13- 32%). Several mechanisms including hemorrhage, hypertension, haemolysis, haemoglobinuria rhabdomyolysis and DIC as well as the direct effect of the venom have been incriminated in the pathogenesis of snakebite-related nephropathy. Hemodynamic alterations induced by cytokines & vasoactive mediators leading to renal ischemia are important in ARF's pathogenesis, leading to cortical & tubular lesions. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 51 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria and following complete enumeration method.  Socio-Demography related data were gathered from the Police Inquest. After collection, data were analyzed by available statistical software. Results: Total 51 cases had been selected after following the inclusion and exclusion criteria out of which 29 were males and 22 were females. Incidence of snake bite was maximum during rainy season in the month of June, July, August with August having the highest number of victims (12, 23.6%). Maximum number of victims in the study group fall between the age range 41 to 50 years, Highest age is 73 years & the lowest being 08 years. Out of 51 cases, 30 patients were admitted in BMC&H, while the rest 21 were admitted in other health facilities. Most of the victims were treated at a primary centre before referral. No “Brought -Dead” cases due to venomous snake bite were encountered during study period. Highest number (20, 39.2%) of snakebite occurred between 6am to 12pm, more precisely between 6am to 6:30am, followed by those between 6pm to 12midnight (14, 27.5%). Least incident was in between midnight to 6am. Highest number of bite were in the lower limb (41, 80.5%), followed by upper limb (7, 13.7%). Conclusion: In spite of several limitations and time constraints, this current study tried to focus on some socio demographic profile of victims of fatal snake bite which later may be useful to deploy newer preventive measure.

Background: People undergoing Bariatric surgery have increased globally. Currently no clear anticoagulation prophylaxix protocol exists in bariatric surgical practice. Need to have standardized protocol regarding anticoagulation prophylaxis Aim: To suggest protocol regarding anticoagulation prophylaxis perioperatively including its duration and dose. Methods: Database searches were collected retrospectively from August 2018 to November 2021. Patient follow-up record collected till 6 months post-surgery. All patients underwent pre bariatric surgical profile – including coagulation profile, maintained good hydration 3 hrs prior to surgery by starting IV fluids including colloids, Mechanical and chemical prophylaxes were provided perioperatively for all patients as per institutional protocol. Results: Morbidity & mortality Incidence of DVT, incidence of pulmonary embolism and VTE related mortality found nil. Conclusion: Risk of VTE can be decreased significantly by use of proper protocol early mobilization immediately 2 hrs after surgery and use of mechanical compressive device during period of anesthesia and immobilization.

Background: Loop ileostomies are often used to protect a difficult coloanal or ileoanal anastomosis and dampen the clinical effects of an anastomotic leakage.  Ileostomy closure itself is associated with considerable morbidity and mortality and is not just a routine operation. Objective: The aim of this study was to audit the complications seen after ileostomy closure at Bhopal Memorial Hospital & Research Centre, Bhopal Madhya Pradesh from January 2022 to January 2023. The primary outcome was to determine the complication rate. The secondary      outcome was to determine if there was any association between the various perioperative, operative and patient factors and the complications observed. Method: All patients who underwent closure of ileostomy from January 2022 to December 2023 were included in the study. Individual patient records were used to   extract patient demographics, perioperative variables, operative variables and postoperative complications retrospectively. The complications were graded using the Clavien- Dindo classification system Results: A total of 80 patients were included in the study. There were 45 males and 35 females with a mean age of 50.6 years (18-81yrs). The median time to achieve bowel movement post closure was 3 days (range 2-16 days). The overall complication rate was 47.5%. Major complications were seen in 35% (28/80) of patients and these included bowel obstruction (14% 11/80), enterocutaneous fistula (6% 5/80), incisional hernia (4% 3/80) and stricture (1% 1/80). Minor complications accounted for 25% (18/80) of the total complications of which wound infection accounted for 21% (17/80). Medical complications made up 21% (17/80) of all complications of which the most common complication was pneumonia (6% 5/80). Two patients (2.5%) died after closure from medical complications. After using a stepwise logistic regression model and adjusting for confounders, renal dysfunction was found to be a statistically significant determinant for the development of complications (OR=3.31, p=0.022, 95% CI=1.186 to 9.242). The pathology (p=0.177), type of closure (p=0.285) and the surgeon (p=0.064) did not show any statistically significant association with development of complications. Conclusion: Ileostomy closure is associated with significant morbidity. Renal dysfunction is associated with a high complication rate. Abbreviations: TME=Total mesorectal excision, BMI =Body mass index, SBO= small bowel obstruction, DVT= Deep venous thrombosis, UTI=urinary tract infection, FAP=Familial adenomatous Polyposis, PJS=Peutz Jegher’s syndrome, RVF= rectovaginal fistula, ASA=American Society of Anaesthesiologists’ classification

Introduction: Acute Coronary Syndrome (ACS) is a significant cause of morbidity and mortality worldwide, characterized by a spectrum of conditions ranging from unstable angina to myocardial infarction. Traditionally perceived as a disease predominantly affecting older adults, ACS is increasingly being recognized in younger populations, raising concerns about its etiology, presentation, and management in this age group. Aims: The findings will highlight the distinctive characteristics and needs of the very young CAD patients, underlining the necessity for targeted interventions in this emerging subset. This study is especially essential for India, given its significant and growing young population vulnerable to CVD. Materials and Methods: his study was an investigator-initiated, single-center, retrospective observational study aimed at examining the clinico- demographic, risk factors, and angiographic profiles of Acute Coronary Syndrome (ACS) in young adults at a tertiary Cardiology Institute in Central India. Approved by the local ethical committee and conducted according to ICH Harmonized Guidelines for Good Clinical Practice, the study involved a review of medical records from 550 young adults (aged 18 to ≤ 45 years) diagnosed with ACS between January 2018 and July 2023. Result: The comparative analysis of coronary angiographic profiles by age group. Among the cases with single-vessel disease, 22 (8.9%) were under 30 years, while 226 (91.1%) were over 30 years. In cases of double-vessel disease, 1 (0.7%) was under 30 years, and 140 (99.3%) were over 30 years. Notably, no patients under 30 years had triple-vessel disease, whereas all 92 (100%) cases of triple-vessel disease occurred in patients over 30 years. Conclusion: Our study provides valuable insights into the clinico-demographic characteristics, risk factors, and angiographic profiles of ACS in young adults. Young ACS patients exhibit a strong male predominance. Although Obesity and hypertension emerged as the most common risk factor, affecting around 40% of participants, conventional risk factors, such as diabetes and hypertension, are significantly less prevalent in patients younger than 30 years compare to older young patients.

Background: In the second wave of Covid-19 structural involvement of the heart (isolated) especially in young adults became an established entity. Ante mortem templates for diagnosis based on echocardiography and strain imaging (which correlated with earlier post mortem findings and CMR slides) proved to be sensitive and specific. Paediatric referral of children with isolated unexplained pain chest prompted to study these patients. Because with each successive wave the age of incidence is lowered. In this study we aim to establish that children also can be diagnosed like young adults. In this study we aim to document similarities and differences in findings found in echocardiography and AFI compared to young adults. We also aim to highlight that it is as specific and sensitive as was found in adults Methods: 50 patients of the age group of 8± 2 years who presented with chest pain (unexplained by clinical and routine examination) and those patients who complained of recent onset of decreased effort tolerance were also included. All patients underwent clinical examination, ECG, echocardiography, strain imaging and estimation of inflammatory markers especially D Dimer. All patients underwent TTE and AFI by vivid T9 ultra (G.E healthcare Chicago USA). All the test were done at presentation and repeated after two months and six months Results: At the presentation ECG showed poor R wave progression in anteroseptal leads. D Dimers were significantly raised (3-4 folds). Echo showed thinned out septal endothelium with SEC in basal and mid cavity of left ventricle confirmed with another echo view of LV. SEC was absent in other chambers. No clots were seen. SEC was present in all patients and served as a mandatory diagnostic criterion. SEC was not seen in young adults. Thinning of septum produced an operculum like appearance in the SAX view. Apico-lateral, antero-septal and antero-lateral hypokinesis was observed. 4CH auto EF was reduced by 10% c.f 2CH AFI revealed mild reduced PGLS and reduced regional strain in apical-lateral segment. PSD PSI values near normal. Repeat echo and AFI after six months revealed resolution of SEC, repair of endothelium and recovery of hypo kinetic segment and improved EF of 4 CH Conclusion: Specific patterns of cardiac involvement can be detected on echocardiography and AFI. Documentation of SEC in LV is a mandatory criterion in diagnosis unlike young adults. Echocardiography and AFI can be used as a reliable tool for diagnosis of COVID Heart in the paediatric population also.

The autonomic nervous system (ANS) plays a critical role in regulating involuntary physiological processes such as heart rate, blood pressure, and digestion. This comparative study aims to evaluate the differences in ANS reactivity between vegetarians and non-vegetarians using various autonomic function tests, including heart rate variability (HRV), Valsalva ratio, cold pressor test, orthostatic test, and deep breathing test. A total of 200 healthy individuals were recruited for this study, divided equally into two groups: vegetarians and non-vegetarians. The results demonstrated that vegetarians exhibited better autonomic function, with significantly higher HRV, Valsalva ratio, and parasympathetic reactivity during the deep breathing test. Additionally, vegetarians experienced a lower increase in blood pressure during the cold pressor test and smaller drops in blood pressure during the orthostatic test compared to non-vegetarians. These findings suggest that vegetarian diets may contribute to improved autonomic balance and cardiovascular health.

Background: Understanding the correlation between lipid profile, glucose levels, and depression/dementia in post-menopausal women is crucial for developing effective prevention and treatment strategies. Aim: Hence, the aim of this study is to investigate the correlation between lipid profile, urea, creatinine, uric acid, and glucose levels, and depression/dementia in post-menopausal women. Materials & methods: At SMS Medical College and Attached Hospitals in Jaipur, India, researchers from the Departments of Biochemistry and Gynecology and Obstetrics performed a comparative cross-sectional study on one hundred postmenopausal women (PMWs) suffering from depression. The research evaluated cognitive functioning and the degree of depression using the Beck's depressive inventory, respectively. One hundred healthy postmenopausal women served as a control group, and the patients were split into two categories according to their scores.  Results: Depressed PMWs had lower HDL values and higher serum total and LDL cholesterol. They had higher uric acid levels and blood glucose levels. Beck's score showed a strong positive association with total cholesterol, inverse correlation with HDL and LDL, and positive correlation with VLDL. Conclusion: The research indicates a connection between menopause and depression, but additional investigation is necessary to comprehend its root causes. Treatment strategies should concentrate on dietary intake, estrogens, and social support systems.

Background: Chronic stable angina is a common symptom of ischemic heart disease and its management is a priority. Trimetazidine and Ranolazine are recommended as add-on drugs to relieve angina in patients who are not controlled on conventional anti-anginal drugs. There is lack of study comparing Trimetazidine or Ranolazine as add-on drugs in patients with stable angina. Aim and Objectives: The purpose of this study was to compare Trimetazidine versus Ranolazine as add-on therapy in patients with stable angina using TMT parameters and Seattle Angina Questionnaire-7 (SAQ-7) Methodology: It was a comparative, 2 group, observational study conducted over a period of 12 months from December 2022 to November 2023 after approval from IEC. Patients with stable angina between the age group of 18 to 70 years were recruited in the study who were prescribed either Trimetazidine or Ranolazine as add-on therapy. A baseline TMT using modified Bruce protocol and SAQ-7 evaluation was done at the time of recruitment. After 1 month of follow-up period, again a TMT using modified Bruce protocol and SAQ-7 evaluation was done for all the participants. Results: Trimetazidine group and Ranolazine group had 70 patients each. During 1 month of follow-up period, 6 patients of both Trimetazidine and Ranolazine group discontinued the treatment. Baseline exercise duration was 551.25 seconds in the Trimetazidine group while it was 540.72 seconds in the Ranolazine group (p=0.716). After 1 month of follow-up period, exercise duration was 611.41 seconds in the Trimetazidine group while it was 715.44 seconds in the Ranolazine group (p<0.001). Baseline SAQ7-QoL score was 53.18 in the Trimetazidine group while it was 49.38 in the Ranolazine group (p=0.073). After 1 month of follow-up period, SAQ7-QoL score was 70.31 in the Trimetazidine group while it was 81.88 in the Ranolazine group (p<0.001). There was a statistically significant difference in exercise duration and SAQ7-QoL score in Ranolazine group as compared to Trimetazidine group after 1 month of follow-up. Conclusion: Ranolazine may be superior to Trimetazidine in improving the exercise duration and quality of life as add-on therapy in patients with stable angina. Categories: Original research article

Background: This cross-sectional study aimed to assess the psychological profiles of patients presenting with alcohol-related disorders at a tertiary care hospital in India. Material and Methods: A sample of 30 patients underwent comprehensive evaluation using standardized instruments including the CAGE questionnaire, DSM-IV-TR criteria, General Health Questionnaire-28 (GHQ-28), Hamilton Depression Rating Scale (HAM-D), and Eysenck Personality Questionnaire (EPQ). Results: revealed high rates of psychological distress (90%, p=0.00002) as measured by the GHQ-28, though clinical depression was not statistically significant. Personality assessment showed significantly elevated levels of psychoticism (70%, p=0.04) and neuroticism (73.83%, p=0.01). The most common reason for psychiatric consultation was suicide attempts (53.3%), followed by withdrawal symptoms (26.6%). Conclusion: These findings highlight the complex interplay between alcohol use disorders, psychiatric comorbidities, and personality traits, emphasizing the need for comprehensive assessment and integrated treatment approaches in this population.

Background: Hypothyroidism is associated with cardiovascular and pulmonary complications. This study aimed to explore the relationship between Spirometric parameters and left ventricular diastolic dysfunction (LVDD) in hypothyroid patients.

Objective: To investigate the association between Spirometric parameters and left ventricular diastolic dysfunction (LVDD) in patients with hypothyroidism.

Methods: This cross-sectional hospital based study included 100 hypothyroid patients on treatment, divided into two groups: 50 with LVDD and 50 without diastolic dysfunction. Sociodemographic data, biochemical parameters, Spirometric measures, and echocardiographic findings were collected. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and maximal voluntary ventilation (MVV). Echocardiography evaluated left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), E/A ratio, deceleration time (DT), and is ovolumetric relaxation time (IVRT).

Results: Hypothyroid patients with LVDD showed significantly lower values for FVC, FEV1, and PEF compared to those without LVDD. The mean FVC was 2.5 ± 0.5 L in the LVDD group versus 3.2 ± 0.6 L in the non-LVDD group (p < 0.01). FEV1 was 1.9 ± 0.4 L versus 2.5 ± 0.5 L (p < 0.01). PEF was 250 ± 50 L/min versus 320 ± 60 L/min (p < 0.01). Correlation analyses revealed significant associations between spirometric parameters and echocardiographic measures of diastolic function. Multiple regression analysis indicated that reduced spirometric parameters were independently associated with LVDD after adjusting for potential confounders.

Conclusion: The study demonstrated that a significant association between spirometric patterns and LVDD in hypothyroid patients. Our findings reveal that hypothyroid patients with LVDD exhibit markedly reduced spirometric measures, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF), compared to those without diastolic dysfunction indicating restrictive pattern. Reduced lung volumes and airflow rates are indicative of impaired cardiac function, highlighting the importance of integrated evaluation of both pulmonary and cardiac health in this population. Regular spirometric assessment in hypothyroid patients may aid in early identification and management of diastolic dysfunction.

Background: Intrapartum hypoxia causes fetal suffocation, acidosis, newborn brain damage, long-term morbidity, and mortality.1 As a result, intrapartum fetal monitoring is performed to detect early indicators of fetal hypoxia and to take appropriate action as soon as possible to avoid fetal hypoxia complications. Objectives: 1. To study the correlation between fetal Doppler ultrasound and umbilical cord blood gas analysis in detecting fetal academia.  2.To identify the maternal and obstetric determinants associated with fetal acidemia. MATERIAL & METHODS:  Study Design: Hospital-based prospective observational study. Study area: The study was conducted in the Department of Obstetrics and Gynaecology.  Study Period:  1 year. Sample size:  Using a sample size calculator, expecting a correlation coefficient of r=0.300, the required sample size was calculated to be 85. Study population: During the study period, a total of 92 pregnant women with abnormal fetal Doppler ultrasound findings, meeting the below-mentioned inclusion and exclusion criteria were eventually recruited into this study. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: The institutional ethical committee clearance was obtained. The design and nature of the clinical study were explained to the patients and significant relatives of the patients. Informed consent was obtained from patients. The socio-demographic data was collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the Socio-Economic Status Schedule. The obstetric history data was gathered and recorded in the proforma. All the patients in the sample group (n=92) were subjected to thorough clinical examination which included general physical, systemic examination and pelvic examination. Maternal blood samples for routine laboratory investigations (including tests for acidosis) were sent. Results: There was a significant correlation between gestational age and fetal acidemia (p value=0.0096). A gestational age of 41 weeks or more has a lesser incidence of fetal acidemia. Middle cerebral artery pulsatility index (MCAPI) was significantly associated with fetal academia (p-value of <0.0001). The umbilical artery pulsatility index (UAPI) had a highly significant correlation (p <0.0001) with the umbilical cord blood gas analysis. Conclusion: Based on the statistical analysis of the data, it is safe to assume that fetal Doppler ultrasound can predict the development of fetal acidemia. Two indicators, the Middle cerebral artery pulsatility index and the Umbilical artery pulsatility index, are strong predictors of fetal acidemia. Similarly, determinants like obstetric score, medical comorbidity, general physical examination and status of labour per vaginal examination were also not found to be significantly associated with fetal acidemia.

Background: Lung cancer is one of the most frequent cancers and a major cause of cancer death worldwide. Lung cancer accounts for 11.6% of all new cancer cases identified each year and is quickly becoming the most prevalent fatal neoplastic disorder in the world, accounting for 18.4% of all cancer-related fatalities worldwide1. Objectives: 1. To study the clinical profile of newly diagnosed bronchogenic carcinoma patients. 2. To study the clinicopathological correlation among various histological types of bronchogenic carcinoma in the above patients. 3. To study the extrapulmonary manifestations and the prevalence of identifiable paraneoplastic syndromes (if present) in patients with bronchogenic carcinoma. MATERIAL & METHODS: Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Government Medical College, Kadapa.  Study Period:  June 2023 – December 2023. Sample size: The study consisted of 52 subjects. Sampling method: Simple random Sampling Technique. Inclusion criteria: Patients attending hospital, diagnosed with bronchogenic carcinoma in the specified period. Study tools and Data collection procedure: Patients included in the study were selected according to the inclusion and exclusion criteria. After obtaining informed consent, data was gathered from history, objective examination of the patients and lab investigations using a semi-structured questionnaire. The localisation of the tumors was done by chest x-ray, fibre optic bronchoscopy and/or CT scan as required. Tissue diagnosis was obtained by FNAC/ biopsy or other cytology and histopathological examination of the specimen was carried out. The type pattern of paraneoplastic syndromes was noted. Results: COPD (65.38%) and Diabetes (23%) were the common co-morbidities affecting the study population followed by HTN (19.2%). H/O old PTB was noted in 11.5% of the patients and 1 patient (1.9%) had h/o ILD. 2(3.8%) patients had past h/o malignancy. One patient had h/o squamous cell carcinoma of the right ear another patient had cervical cancer and 1 (3.8%) patient had a family history of malignancy (first-degree relative). Conclusion: Lung cancer is a rapidly progressive disease with a very high mortality rate but treatment in the early stage may give a good prognosis. High-risk patients with having smoking history should be evaluated clinic radiologically with high suspicion so that early diagnosis can be made and the quality of life of patients can be improved. Primary lung cancer should always be suspected in a person presenting with unexplained cough for several weeks with other symptoms such as weight loss, and fever with non-resolving collapse-consolidation on chest radiograph.

Background & Objectives: Hand hygiene (HH), a fundamental action which is simple, inexpensive and most effective tool in preventing healthcare- associated infections, is at the core of infection prevention and control (IPC) program, yet hand hygiene compliance (HHC) among health care workers (HCWs) is quite low in healthcare settings and remains a lasting cause of alarm.1,2 Previous studies have shown that a multifaceted approach is critical for HHC improvement, a fact endorsed by World Health Organization.2,3,4,5 In health research, the term ‘choice architecture’ and related term ‘nudging’ are broadly applied to a range of intervention types across multiple behavioral contexts, which in recent times, are increasingly being perceived as policy strategies. 6 Nudges are choice-preserving interventions that steer people’s behavior in specific directions, while still allowing them to go their own way and thus can be easily implementable, inexpensive measures as hand hygiene interventions.7,8 Multimodal strategies have been recognized as the most effective intervention, affecting three levels: individual, interpersonal, and organizational.9,10,11 These mini-nudges, however, will not displace the traditional tools like training, regulations etc, but instead, will combine with them as potential reinforcers, since behavior can be influenced by altering the microenvironments within which people make choices (choice architecture).12 This in turn, would provide a sustainable contribution towards improving HHC to a significant extent and in turn reduce healthcare– associated infections. Aim: To assess the outcome of multimodal nudge interventions on hand hygiene compliance in healthcare workers Objective: To bring about behavioral change using nudges as interventions and in turn contribute to long- term success of these strategies to improve HHC Methods & Results: A quasi-experimental study was conducted, including a pre-intervention phase and a post-intervention phase with 226 HCWs overall, from various wards and high-risk areas of our hospital. HHC was measured using both overt and covert observations by trained personnel in pre intervention and post intervention phases. Levels of hand hygiene compliance were low in the pre-intervention phase (40.9 %) with significant improvement seen (68.4 %) in the post intervention phase, the increase after nudging interventions being statistically significant (p<0.05). Interpretation & Conclusion: If properly devised, integrated multimodal interventions based on a multilevel socioecological approach has great potential in bringing about sustained improvement in hand hygiene compliance of healthcare workers.

Objectives-To determine the association between tobacco and peri-implant diseases in a sample of patients who had received implant-supported restorations in a university dental clinic Materials and Methods There were four hundred and fifty implants examined. Data pertaining to the individuals and the implant were assessed after a sample of patients was chosen from an electronic database. The development of smoking was thoroughly documented, including the amount of smoke smoked, the cumulative lifetime dose, the length of exposure, the intensity of the habit, and the decision to stop smoking. The main objective of the study was to determine the peri-implant status, which includes peri-implant mucositis (PM), peri-implantitis (PI), and health (H). Results: 49 patients (47.9%) did not smoke, 42 patients (35.9%) had smoked in the past, and 19 patients (16.2%) were smokers currently. Thirty-nine subjects (33.4%) showed H, while 37 subjects (31.6%) and 41 subjects (35%) showed PM and PI. Conclusions-Smoke intensity was associated with an increased risk of the development of peri-implantitis. Moreover, the risk of peri-implant diseases might be similar in those subjects who had stopped smoking for more than 21 years with respect to never-smokers.

Introduction: Depression is one of the leading causes of morbidity among psychiatric illness. Depression can be precipitate by some stressful life events such as the death of a loved one, divorce, financial difficulties or job loss, social isolation, chronic health issue. In chronic course of depression, impairment of an individual’s occupational potential and quality of life occurs. Aims and Objective: To study socio demographic variables in patients of major depressive disorder and in healthy controls. Material and Methods: The present study was conducted in the department of Biochemistry and department of Psychiatry of M.G.M. Medical College & M.Y. Hospital Indore, Madhya Pradesh. The present study included 50 newly diagnosed drug naive cases of depression of age group 18-50 years, attending Psychiatry OPD in M.Y. Hospital and 50 apparently healthy controls matched for same age and sex were taken. The subjects were enrolled for the study after obtaining written consent. Results: The age group 21-30 years (38%), followed by 31- 40 years (28%) had the maximum number of patients. Females constituted 62% of the total patients and the rest were males (38%).  26 % and 74 % patients were rural and urban dwellers, respectively. 68 % patients were married, while 28% patients were unmarried. Most of the patients (60%) belonged to lower socio-economic class. Conclusion: In our study we found that, academic and other socio demographic variables of the subjects are associated with the major depressive disorder.

Introduction: The conventional approach to treating aneurysmal bone cysts involves bone curettage and grafting, which is linked to a high rate of morbidity. As a result, sclerotherapy has emerged as a minimally invasive alternative, gaining popularity. This study aimed to evaluate the radiological outcomes of aneurysmal bone cysts treated with polidocanol sclerotherapy. Methods: This retrospective study included 56 patients with confirmed diagnoses of aneurysmal bone cysts, all of whom underwent treatment with polidocanol sclerotherapy. The patients were followed for a 24-month period. Key parameters evaluated included healing time, recurrence rates, and pain relief. Radiological outcomes were measured using modified Nere’s criteria. Complications, if any, were documented and categorized based on their severity and resolution. Results: At the final follow-up, all 56 patients (100%) demonstrated complete radiological and clinical healing of their aneurysmal bone cysts. No recurrences were observed during the follow-up period. Common complications included localized injection site necrosis, transient pain exacerbation post-injection, and skin hypopigmentation around the treatment area. Importantly, these adverse effects were mild and self-limiting, resolving without the need for additional medical intervention. Conclusions: Polidocanol sclerotherapy represents a safe and effective treatment option, offering reduced morbidity, favorable cosmetic outcomes, cost-efficiency, and the potential for outpatient care. Local complications related to extravasation typically resolved without intervention.

Background: One non-invasive method for measuring EtCO2 (End-Tidal Carbon Dioxide) is capnometry. Despite the creation of a portable colorimetric device for semiquantitative ETCO2 assessment, its primary applications are in emergency care, post-anesthetic recovery, and intensive care. Its accuracy and usefulness for nonincubated patients have not been thoroughly investigated. Methods This was a cross-sectional study carried out in the AIG Hospital, Hyderabad, between 2020 to 2022 involving 100 patients presenting to the emergency department with respiratory distress with a respiratory rate greater than 30/min, use of accessory group of muscles, Spo2%< 90% or abnormal pattern of breathing. PaCO2 was measured using an arterial blood gas analyzer and ETCO2 was measured using capnometry. The data was compiled on a Windows XL spread sheet and analyzed using SPSS version 19. Results: Out of 100 patients males were 74% and females were 26%, with the majority being >60 years old. The study revealed a strong correlation between ETCO2 and paCO2 in patients with respiratory distress in both respiratory and non-respiratory conditions of any age and sex (p=<0.05). The correlation coefficient between ETCO2 and PaCO2 was 0.90 (R2 = 0.81). Conclusion: End-tidal carbon dioxide concentration measurements show a strong correlation with Paco2 values in nonintubated patients who arrive at the emergency room for a range of ailments. In some cases, end-tidal carbon dioxide readings may be adequate indicators of PaCO2 and eliminate the requirement for repeated arterial blood gas analysis

Context: There are multiple treatment options available for Melasma without established efficacy and safety. This study is an attempt to fill that gap. Aims: To compare the efficacy and safety of Fluocinolone acetonide 0•01% Vs Mometasone Furoate 0.1 % used in triple combination (TC) topical cream therapy in the treatment of facial Melasma.  Settings and Design: This study is prospective Cohort study. Methods and Material: The Split Face, Interventional study was carried out on 20 clinically diagnosed patients of Melasma. All patients were instructed to apply the Fluocinolone acetonide 0.01% containing TC cream on the right side and Mometasone Furoate 0.1 % TC cream on the left side of the face. Melasma Area and Severity Index (MASI) score was noted. Statistical analysis used: Medclc 19.2 used. Results: There was a 79.40% improvement in MASI score when 0.01% Flucinolone acetonide TC was applied on right side of the cheek and 0.1% Mometasone Furoate TC, when applied on Left side of the cheek showed an improvement of 75.79% in MASI score at 0 week and 12 weeks. Similarly, there was a 30.82% percentage improvement in MASI score on the Right side of the cheek and 29.1% improvement in MASI score on the left side of the cheek at 0 week and 6 weeks. The side-effects are more with 0.1% Mometasone Furoate than with Fluocinolone acetonide 0.01%. Conclusions: TC cream containing Fluocinolone acetonide 0.01% was as effective as Mometasone furoate 0.1%  TC cream with fewer side effects.

Introduction- Mitral stenosis (MS) is the most common valve disease seen as a sequel of rheumatic fever and usually presents with exertional dyspnoea and right-side heart failure and pulmonary arterial hypertension. Normal Left Atrial function consists of reservoir, conduit and pump function. To assess the outcomes of successful BMV on LA functions in patients with isolated severe rheumatic MS in sinus rhythm over a period of one year follow up. Material & Methods: Prospective observation study done on patients with severe mitral stenosis with suitable valve morphology who are undergoing PTMC. Thorough history taking, full clinical examination, 12 lead ECG, full 2D, M mode & Doppler transthoracic echocardiographic and transesohageal echocardiography study in standard views. Observation & Results: Peak atrial longitudinal stain improved significantly over a period of 12 months. LA dimension also reduced immediately 24 hr after BMV from 42.4 ± 7.6mm to 41.1±5.4. LA volume also reduced significantly 24 hr post bmv (P value-< 0.033) and during 1 month (P value-< 0.021) and 12 months follow up (P value-< 0.011). MVA by planimetry increased significantly from pre BMV value of 0.89±0.11 cm2 to 1.83±0.3 cm2 at 24 hr post BMV. Conclusion: All Left atrial parameters in terms of mitral valve area, left atrial volume index, mean gradient across mitral valve, pulmonary artery systolic pressure has shown significant improvement. However larger study is needed to confirm our findings.

Introduction: Rheumatic Fever and Rheumatic Heart Disease is a significant cause of cardiovascular diseases in the world today. Impaired function of the Left Atrial Appendages (LAA), such as reduced flow velocity and reduced atrial strain, typically results in thrombus formation. Recovery of LAA velocity after PTMC depends directly upon improving the mitral valve hemodynamics and reducing the trans-mitral gradient. Material & Methods: Prospective observation study on 50 patients with severe mitral stenosis with suitable valve morphology undergoing PTMC. Transesophageal echocardiography (TEE) was performed for assessment of left atrial appendage functions as well as to rule out any clot. After PTMC, TEE was performed at least after1 month and then at 12 months follow up. Observation & Results: Youngest patient was 13-year female and eldest one was 51 years male. LAA end systolic volume was decreased significantly after PTMC. The LAA ejection fraction (LAAEF) increased significantly from pre BMV value of 42.82±1.572 % to 54.24±1.341%. LAA emptying velocity (LAAEV) increment upto 20% seen post BMV at 1 month follow up which remained consistent at 12 months follow up. Conclusion: LAA ejection fraction and LAA emptying velocity by transesophageal echocardiography at least one month post PTMC have also shown significant improvement. However large and detailed studies needed to establish our findings.

Introduction: In western countries, around 20% of surgical emergencies are related to acute small bowel obstruction. Over 60% of all cases of small bowel blockage are primarily caused by post-operative adhesions. Aims: Monitoring and contrasting the care style with the symptoms in the same group of individuals who have had prior surgery. Materials & Methods: This Cross Sectional (Observational) study was conducted on 60 patients, at Bapuji Hospital and Chigateri General Hospital, from the department of General Surgery, JJM Medical College, Davangere. The study period was from January 2021 to August 2022. Result: The abdominal pain is the most common symptom present in 96.6% cases (58 patients). 66.6% cases (40 patients) had Vomiting. 58.3% (35 patients) and 66.6% of cases (40 patients) had abdominal distension and Constipation or obstipation respectively. Fever was there in 36.66% cases (22 patients), but it is significant if this symptom is present the management is surgical approach. Conclusion: The most frequent reason for small bowel blockage is adhesion. The most typical signs of adhesive small intestinal obstruction are vomiting and abdominal discomfort. However, surgical intervention decision-making is less sensitive.

Background and Objective: Neoadjuvant chemotherapy (NACT) is currently a standard therapeutic approach to downstage the locally advanced breast cancer. This study aimed to 1) Evaluate the post NACT histopathological changes in the mastectomy specimens and lymph nodes, 2) Compare the immuno-histochemistry profiles of hormone receptor status ER, PR and HER2/NEU before and after NACT, 3) Categorize the patients according to the pathological response. Methods: Hospital based prospective study was conducted on 50 cases, diagnosed as carcinoma breast on trucut biopsies and assessed for ER, PR and HER2/NEU receptor status. Following NACT, modified radical mastectomy specimens were evaluated for histopathological changes, residual tumor and patients were categorized according to pathological response. The specimens with residual tumor were again subjected to ER, PR and HER2/NEU receptor status. Then comparison of ER, PR and HER2/NEU status was done between pre and post NACT specimens which showed residual tumor. Results: Histopathological changes observed were DCIS (14%), inflammation (88%), necrosis (74%), fibrosis (90%), calcification (12%) and LVI (20%). Among 50 cases, 14% showed pathological complete response, 48% showed pathological partial response and 38% showed pathological no response. Among 43 cases, comparison of ER, PR and HER2/NEU status between pre and post NACT cases documented a statistically significant loss of ER expression (p=0.020) and PR expression (p= 0.014) while no significant difference was observed in HER2/NEU expression. Conclusions: This study highlights the NACT induced histopathological, hormonal receptor- ER, PR and HER2/NEU changes along with assessment of pathological response to therapy which provides valuable prognostic information and helps in directing the effective hormonal/targeted treatment.

Hypopituitarism following snake bite-induced acute kidney injury (AKI) and dialysis is an uncommon complication. Often the presentation is delayed and can present with a myriad of features. We present a case of a 35-year-old male patient with a history of hemotoxic snake bite and AKI requiring dialysis, which subsequently resolved. The patient presented to us with fatigability, weakness, absence of secondary sexual characteristics, and poor academic performance 15 years post-envenomation. Clinical examination revealed pale, coarse skin, hoarseness of voice, proximal muscle weakness, and loss of body hair with low testicular volume. Hormonal profiling suggested central hypopituitarism, while neuroimaging revealed an empty sella indicative of pituitary apoplexy. This case highlights the importance of considering delayed hypopituitarism in snake bite survivors and emphasizes the need for long-term endocrine follow-up in these patients. 

Background- Atherosclerotic vascular diseases, major global health burden which comprises cerebrovascular disease and coronary heart disease. For coronary artery disease and cerebrovascular disease, diabetes is considered as an independent risk factor. Since more than 80% of diabetes cases occurs in developing countries so they pose the highest economic burden. HDL levels are low in diabetics then non diabetics. This Low level of HDL is strongly associated with elevated increase risk for CAD in diabetics. Hence it is very important to study the clinical way of presentation of the disease and in which pattern coronary arteries are involved in both patients with diabetes and without -diabetes. Methodology: The present study is a cross-sectional study. This study was conducted on 335 patients with ACS who subsequently underwent coronary angiogram admitted in Department of Cardiology. Patients who matched the inclusion and exclusion criteria were selected randomly during period of approximately one year formed the study group. The severity of involvement of coronary artery is quantitatively assessed by GENSINI score [Angiographic severity score].So in this study we analysed the comparison of coronary artery disease and its influence by change in glycaemic status quantitively .Result- CAD severity was higher in patients with diabetes with mean gensini score of 40.9 followed by pre-diabetics 33.7and non diabetics with 23.8 (p value .001) .The severity of CAD was higher in patients with diabetes for more than 6 years. There was Statistically significant correlation between duration of diabetes and severity of CAD in diabetes. Conclusions: The severity and extent of CAD in diabetics was more compared to non-diabetics. Involvement and occlusion of vessels were more commonly seen in diabetic patients. The incidence of triple vessel or multi-vessel disease was significantly higher in diabetics. Patients with poor glycemic control with elevated levels of HbA1c had diffuse pattern of atherosclerotic disease and high levels of HbA1c mildly correlated with gensini score.

Introduction: The present study evaluated the cardiovascular responses of moderate physical activity in a population, which is underreported from all over world literature and can provide unique insights for Indian population. The aim of this research was to assess the cardiovascular response to moderate physical exercise in a healthy Indian population, providing distinctive perspectives. Methods: Participants undertook a standardized submaximal exercise protocol and cardiac output was evaluated continuously using non-invasive methods like cardiography throughout the procedure in a hospital setting. Rather, these approaches were designed to capture the cardiovascular adjustments during moderate exercise and not put subjects under substantial stress. The sample size was n=100 in the resting stage group and n=100 for the exercise group and total n=200. The age group of the participants was in the range of 19-50 years.  Results: The results indicated that there was a significant rise in cardiac output following exercise, and the non-linear data aligned within which the work bout took place. This study showed that cardiovascular adjustment to physical stress is particularly efficacious in Indian population. Heart function was found to be generally healthy in this group. Moreover, there were no significant differences in the gender in the present study indicating that among this people group both sexes have similar cardiovascular response suggestions. There was a significant effect on cardiac vascular activity amongst the people engaged in exercise in comparison to the control group. Conclusion: In conclusion, the studies provide useful data regarding cardiovascular fitness of Indian youth people and strength in carrying out frequent cardiovascular testing if engaged into physical activity. The results indicate that this type of monitoring may become a valuable tool in identifying the cardiac risk populations better, and eventually they will lead to greater health effects over an available period of time.

Background: Basic Life Support (BLS) is an essential set of emergency procedures designed to stabilize individuals facing life-threatening conditions such as cardiac arrest, respiratory failure, and choking. This study aims to assess the level of awareness, understanding, and practical knowledge of BLS among adults in New Delhi, identifying key gaps and proposing strategies to enhance public preparedness for emergencies. Materials & Methods: A descriptive, cross-sectional survey was conducted over five months (January 2024 to May 2024) across various districts in New Delhi. The study targeted adults aged 18 and above who had resided in the city for at least 12 months. A sample size of 400 participants was selected using a 95% confidence level and a 5% margin of error. Data were collected using a structured questionnaire comprising 25 multiple-choice questions that assessed knowledge of CPR steps, AED usage, and scenario-based BLS interventions. Responses were gathered via both digital (Google Forms) and physical questionnaires, and the data were analyzed using Epi Info V7 software. Results: The study revealed that 76.8% of participants had heard of BLS, but only 54.8% knew the correct sequence of steps involved. Knowledge of specific CPR techniques varied, with 44.3% aware of the correct chest compression-to-breath ratio and 42.0% knowing the recommended compression depth. Only 40.3% had received training on AED usage, and scenario-specific knowledge, such as recognizing heart attack symptoms (49.5%) and performing BLS on a choking victim (45.5%), was also limited. Overall, 30.8% of participants demonstrated a "Fair" understanding of BLS, while 21.8% had "Poor" knowledge. Conclusion: The findings highlight significant gaps in the public's knowledge of BLS in New Delhi, particularly in areas critical for effective emergency response. The study underscores the need for targeted educational initiatives and practical training programs to improve BLS proficiency across the city's diverse socio-demographic groups. Enhancing BLS awareness and accessibility to training resources could substantially improve community-level preparedness and save lives in emergencies.

Background: Background: This study aimed to describe Correlation between Kawasaki disease & MIS-C in Indira Gandhi Medical College, Shimla. Material & Methods: We conducted a cross-sectional study for MIS-C from January to July 2021, in the pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh, in Western Himalayas. All children admitted with a diagnosis of MIS-C were included in the study. Data regarding sociodemographic factors and Kawasaki cases were extracted and analyzed using Epi Info V7 software. Results: In the present study, a total of 31 children diagnosed & admitted as a case of MIS-C were included. Mean age of these patients was 7.12±4.78 years. Among the total 16(51.6%) were males while 15(48.4%) were females. Of, 31 cases of MIS-C, 5 children presented KD. All of them were males. 3 children were less than5 years, while 2 were 6-10 years old. Echo was normal in 4 cases and 1 had low ejection fraction. IVIG was given to all, while LMWH was given to one child. Methylprednisolone in low doses to 4 children, while in 1recieved high dose. Aspirin was given to 4 patients. Oxygen therapy in 3 patients, ventilatory support was given to one child, while inotropic support was given to 2 patients. All 5 patients were discharged after full recovery. Conclusion: Given the frequent overlap of clinical manifestations between MIS-C and those of Kawasaki disease, the majority of patients with hyperinflammatory syndrome have generally been treated with the standard therapeutic protocols used in Kawasaki disease.

Background: Autopsies are done to know the identity, manner, cause of death and approximate time since death. The condition of internal organs can be revealed by Autopsy and is often followed by histopathological examination of tissues from various organs to relate the cause of death with associated pathology and the correlation between the two. The present study was taken to determine lung lesions in relation to age and sex and to identify the histopathological alterations spectrum in lung specimens, irrespective of cause of death and sex. Methods: This study was retrospective and done on 117cases of autopsies in last one year i.e August 2023 to July 2024. The tissue specimens were properly fixed and processed. Routine paraffin sectioning was done followed by staining with Hematoxylene and Eosin (H and E). Special stains were done whenever required. Clinical and postmortem findings, gross and histopathological examination findings were studied. Results: After thorough Histopathological examinations, of total 117 cases. Most commonly affected age group was 30-50 years, followed by age group of >60 years. Majority of diseased were males 83. The predominant finding was chronic venous congestion seen in 36 cases – 30.78% followed by pulmonary edema with 26 cases – 22.22% and changes in interstitium seen in 17 cases – 14.53%. Cause of death was known in 99 cases (84.62%) of pathological lesions. Poisoning, 41 cases (35.04%) was the most common followed by sudden death (11.11%) Conclusion: Autopsy is an important tool useful for identifying, recognizing pathology and pathogenesis of disease regardless of recent advances in diagnostic technology. Autopsy study reveals the true prevalence of infectious diseases and also suggests the need and emphasis of timely diagnosis and treatment of these diseases to reduce mortality due to these diseases.

Objectives: Open chest management and delayed sternal closure is a documented viable option for the management of pediatric complex congenital cardiac surgery. This helps improving outcomes by increasing the diastolic filling volume and cardiac output. This also helps ease access for cardiac inspection and open-heart massage, hemodynamic management and hemostasis control. It provides a survival advantage for patients who are hemodynamically unstable and don’t tolerate primary closure.  Materials and methods: This is a retrospective observational study from January 2016 tp December 2020. 100 patients were included in this study who fulfilled out inclusion and exclusion criteria. The data was collected form hospital records and analysed. We wanted to determine the indications for delayed sternal closure, the timing of closure, the duration of ventilation, post op morbidity and mortality and duration of hospital and icu stay amongst survivors. Results: the incidence of open chest is 3.38 %. The average age of our patients has been 50.04 ± 15.14 yrs. Male dominance of 68 % noted. Redo and emergency surgeries were 15% and 28 % respectively. Isolated cabg (33%), combined procedures (22%), valve replacements (17%) and surgeries on the aortic root (13%) formed bulk of our cases. The mian indication for keeping the patients open were multifactorial-bleeding (58%), cardiac odema (45%), hemodynamic instability (24%) and arrthymias(8%).The average duration of open chest was 21hrs 35 min ± 10 hrs 40 min. Total icu and hospital stay has been 5.76 ± 3.26 days and 9.59 ± 2.83 days. The in-hospital mortality was 13% Conclusion: open chest management and delayed sternal closure is a safe and viable option to be considered in patients with coagulation abnormalities and unstable hemodynamics with high inotropes. With advances in surgical techniques, aggressive icu management and planned interventions to avoid complications, delayed sternal closure is an effective tool to provide survival advantage for high-risk cases.

Background: Chronic Kidney Disease (CKD) is a progressive condition associated with significant morbidity, mortality, and healthcare utilization. This longitudinal study aimed to analyze disease progression, healthcare utilization patterns, and the impact of medication adherence and comorbidities in CKD patients. Methods: A total of 200 CKD patients were followed for 36 months. Data on demographic characteristics, CKD stage progression, healthcare utilization, medication adherence, comorbidities, mortality, complications, and quality of life were collected and analyzed. Disease progression was defined as advancement to a more severe CKD stage. Healthcare utilization metrics included hospitalizations, outpatient visits, and specialist consultations.Results: The mean age of the patients was 57.3 years, with a balanced gender distribution. At baseline, 70% of patients were in Stage 3 CKD, 20% in Stage 4, and 10% in Stage 5. During the study, 42% of patients experienced CKD progression. Hospitalizations and outpatient visits increased significantly as CKD advanced. High medication adherence was associated with a lower rate of progression (30% vs. 55%) and fewer cardiovascular events. The mortality rate was 9%, with the highest rates in Stage 5 CKD (55%). Comorbidities such as diabetes and hypertension were prevalent and associated with faster CKD progression. Quality of life declined significantly with advancing CKD.Conclusions: CKD progression leads to increased healthcare utilization, morbidity, and mortality. Effective management of medication adherence and comorbidities is crucial in improving outcomes. These findings emphasize the need for targeted interventions to reduce the burden of CKD.

Introduction: In addition to established risk factors such as smoking, diabetes mellitus, hypertension, homocysteine, C-reactive protein (CRP), fibrinogen, and albumin, coronary artery disease (CAD) is characterised by a chronic inflammatory state. Inflammation plays a significant role in the initiation and progression of atherosclerotic plaque rupture, thrombus formation, and endothelial dysfunction. Two indicators, the fibrinogen to albumin ratio, are altered, and this results in vascular endothelial dysfunction through a variety of mechanisms, including platelet aggregation, thromboxane affinity, and plaque erosion. As a result, FAR has been identified as a new inflammatory marker that is correlated with the severity of coronary artery disease. Materials And Methods: The study included 108 patients who had acute coronary syndrome (ACS) and were admitted to the IPD division of the ICCU at KIMS Hospital. The patients underwent coronary angiography (CAG) while taking into account inclusion and exclusion criteria. Serum fibrinogen and serum albumin were measured at the time of admission, and the fibrinogen to albumin ratio was computed. Written informed consent was obtained from each subject or relative in every case. A detailed clinical history, including complaints, past history, and family history, was also obtained. The angiographic severity of coronary artery disease was assessed using the Gensini risk scoring system. The Chi-square test was employed to evaluate the association between FAR and other risk variables, and the Pearson correlation coefficient was utilised to determine the linear link between Gensini score (GS) and FAR. Results:  108 patients participated in the research; 70 (64.8%) were men and 38 (35.2%) were women. The mean age was 57 years, and the patients' ages varied from 29 to 83 years. Of the 108 patients who had acute coronary syndrome, 51 (47.2%) had diabetes, 65 (60.2%) had hypertension, 7 (6.5%) had a family history of coronary artery disease, and 52 (48.2%) had smoked. 38 (35.2%) patients with coronary angiography (CAG) had single vessel disease (SVD), 63 (58.3%) with double vessel disease (DVD), and 7 (6.5%) with triple vessel disease. The 108 patients who were enrolled in the study were split into three FAR tertiles: low FAR (n = 36; <9), middle FAR (n = 36; <11.8), and high FAR (n = 36; >11.8). Of the 108 patients, ANOVA in one manner, the mean Gensini score for the low FAR group was 34.6, the mean Gensini score for the intermediate FAR group was 38.8 13.8, and the mean Gensini score for the high FAR group was 48.6 16.2 with a statistically significant p <0.001. The pearson correlation coefficient between FAR and Gensini for the 108 patients is 0.446, indicating statistical significance with a p-value of less than 0.001. Conclusion High FAR levels are strongly correlated with angiographic severity of coronary artery disease, as determined by the Gensini risk score method, in individuals with acute coronary syndrome.

Introduction: A significant contributor to morbidity and death is hypertension. In hypertension, microalbuminuria is thought to be a potent, early, and independent indicator of elevated cardiovascular risk. Micro-Albuminuria shows a strong correlation with left ventricular hypertrophy in hypertensive individuals. This investigation was carried out on both inpatients and outpatients in the Department of General Medicine. Material And Method: A total of 100 Cases admitted in medical wards and those attending medicine outpatient department in Al Ameen Medical College, Athani road, Vijayapura who were recently diagnosed of hypertension. Results: Study was conducted in 100 newly diagnosed hypertensive patients. Out of 100 patients, 70 % patients had Microalbuminuria and 41 % had Left Ventricular Hypertrophy. The relationship between Microalbuminuria and Left Ventricular Hypertrophy was found to be Statistically Significant. Conclusion: In the present study we evaluated the Prevalence of Microalbuminuria and Left ventricular hypertrophy in newly diagnosed hypertensive patients. We found that: 43% were between age group of 40-49 Among 100 patients, 41 patients had LVH and 59 had normal cardiac geometry Among 70 patients with microalbuminuria, 39 patients had Left ventricular hypertrophy showing a significant association between Microalbuminuria and Left ventricular hypertrophy. A significant association was found between Stage of Hypertension with Microalbuminuria and left ventricular hypertrophy. Microalbuminuria is an integrated marker of CV risk and has a statistically significant association with Left ventricular hypertrophy

Background: Supracondylar fractures are the most common elbow fracture recorded in children, accounting for approximately 60% of fractures around the elbow and 13-15% of all pediatric fractures [1]. These fractures are prevalent in the non-dominant hand between the ages of 5 and 8, with boys being more afflicted than girls Objectives: To evaluate the Functional outcome of type 3 supracondylar fracture of the humerus in children treated by open reduction and internal fixation by k-wires. Material & Methods: Study Design: Hospital-based prospective study. Study area: The study was conducted in the Department of Orthopaedics. Study Period: February 2024 to July 2024. Study population: All the children with Gartland type III fracture who presented to the orthopaedic outpatient or casualty. Sample size: The study consisted of a total of 20 subjects. Sampling Technique:  Simple Random technique. Results: Excellent result was obtained in 54% of the patients, good in 30% and fair in 10% and poor result in 6% of the patients. Complications such as nerve injuries, vascular injuries, infections were seen in the study which healed following short course of the treatment. 3 patients had cubitusvarus and 6 patients had flexion loss on follow-up study. Conclusion: Posterior open reduction of childhood supracondylar fractures does not result in significant loss of elbow mobility and should not be avoided on this basis. In a country with high hospitalization expenditures and congested wards, operational treatment of these fractures allows for rapid patient turnover. This has significant economic implications for a developing country like ours.

Roundup (41% glyphosate and 15% poly oxy ethylene amine, POEA surfactant) is a common herbicide used by famers in India. Its cause of poisoning is mostly suicidal, consumed by oral route. Acute poisoning involves gastro intestinal system, respiratory system, renal and cardiovascular system. Glyphosate and its surfactant (POEA) cause hyperkalaemia, metabolic acidosis and cardiac arrest which is the main cause of mortality associated with poisoning. Treatment involves supportive care in high dependency units as there is no specific antidote available.1,2. We report three cases of herbicide poisoning managed in critical care unit.

The p53 tumor suppressor protein and BCL-xL, an anti-apoptotic member of the BCL-2 protein family, play crucial roles in cellular regulation and apoptosis. Fusion proteins combining elements of p53 and BCL-xL have emerged as potential targets for cancer therapy. This paper explores the use of targeted next-generation sequencing (NGS) and computer-aided drug design (CADD) to investigate the structural and functional aspects of the p53/BCL-xL fusion complex. By leveraging high-throughput sequencing and advanced computational tools, we aim to identify potential active sites and design inhibitors that could modulate the activity of this fusion protein, offering new avenues for cancer treatment. We utilized computational tools, CB-Dock, COBALT, and Biopython to analyze the structure and interactions of the fusion protein, with Biological sample as the primary PDB ID,interpreting the accuracy of model similarity on the basis of structure or rmsd score to check higher of similarity.The need for new anticancer medications has arisen from the rising incidence of cancer worldwide, the shortcomings of current treatments, and the creation of drug-resistant cancer strains. The necessity for computational methodologies in anticancer drug discovery is further highlighted by the lengthy and complex nature of the traditional drug discovery process as well as the high failure rate of new medications in clinical trials. Molecular docking, molecular dynamics, NGS analysis, and machine learning are some of the tools used in computer-aided drug design (CADD) to forecast the effectiveness of candidate drug molecules and choose the most promising ones for further development and testing.

Background: Diabetes is a prevalent lifestyle ailment arising from insulin resistance and insufficient insulin, leading to persistent high blood sugar and related heart issues. Yogic practices could potentially assist in preventing and managing diabetes. Objective: The goal of the current study was to assess the impact of yoga therapy on physiological and biochemical parameters in individuals with diabetes. Method: The study recruited 100 diabetic outpatients divided into two groups: the experimental group, where yoga was introduced, and the control group. The examinations were conducted both before and after a comprehensive 24-week yoga therapy program, consisting of 30 minutes of practice per day. After the intervention period, blood samples were collected from all subjects and analyzed to assess the biochemical and physiological changes associated with the impact of yoga on diabetes management. Result: The results showed a significant improvement in both physiological and biochemical parameters of diabetes patients in group with yoga intervention (P<0.05) as compared to the control (P>0.05). A decrease in the BMI was observed in the experimental group (from 24.08 kg/m2 to 21.96 kg/m2). A significant decrease in fasting glucose levels (from 122.13 mg/dL to 108.11 mg/dL), blood pressure (Systolic, 130.32 mmHg to 119.84 mmHg and diastolic, 83.86 mmHg to 80.66 mmHg), postprandial sugar (226.76 mg/dL to 144.86 mg/dL) and Hb1Ac (7.27 mmol/mol to 6.69 mmol/mol) were observed in the present investigation. Conclusions: The study suggests that yoga shows promise in improving various health-related outcomes. However, further studies employing robust methodologies are required to thoroughly investigate and understand the specific health benefits associated with different types of yoga.