European Journal of Cardiovascular Medicine

Background: Polycystic Ovary Syndrome (PCOS) affects up to 20% of women of reproductive age globally, with chronic inflammation implicated in infertility and adverse pregnancy outcomes. Objective: To investigate the role of inflammatory pathways in PCOS-related infertility and pregnancy complications, highlighting their contribution to altered reproductive and metabolic health. Methods: A one-year observational study was conducted at Akash Institute of Medical Sciences and Research Center, Bangalore, involving 150 women diagnosed with PCOS. Participants underwent clinical assessments, hormonal profiling, and inflammatory marker evaluation, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Statistical analysis involved correlation coefficients and multivariate regression to explore associations between inflammatory markers and clinical outcomes. Results: Elevated levels of CRP (mean: 6.2 ± 1.3 mg/L), IL-6 (mean: 3.8 ± 0.9 pg/mL), and TNF-α (mean: 12.4 ± 2.1 pg/mL) were observed in 78% of participants. Among infertile women (56%), inflammatory markers were significantly higher (CRP: +18%; IL-6: +22%; TNF-α: +25%) compared to fertile counterparts (p < 0.01). Pregnancy complications, including gestational diabetes (34%) and preeclampsia (18%), showed positive associations with inflammatory marker levels (p < 0.05). Multivariate analysis revealed CRP as the strongest predictor of adverse outcomes (β = 0.42, p < 0.001). Conclusions: This study underscores the pivotal role of inflammatory pathways in PCOS-related infertility and pregnancy complications, advocating for targeted anti-inflammatory interventions to improve clinical outcomes.

Background: Polycystic ovary syndrome (PCOS) affects 5-20% of women globally, characterized by endocrine and metabolic dysfunctions that significantly impact fertility and overall health. Objective: This study investigates the endocrine and metabolic factors in PCOS, aiming to identify effective strategies for fertility restoration through a multidisciplinary and integrated approach. Method: A prospective study was conducted at Akaash Institute of Medical Sciences and Research Center, Bangalore, involving 150 PCOS patients over one year. Clinical, metabolic, and hormonal parameters were evaluated, focusing on ovulatory function, insulin resistance, and androgen levels. Results: Among 150 patients, 78% exhibited insulin resistance, and 65% showed elevated androgen levels. Lifestyle modifications improved ovulatory function in 52% of cases, while pharmacological interventions increased ovulation rates to 68%. In-vitro maturation of oocytes was successful in 80% of participants undergoing ART. Gut microbiota-targeted therapies reduced systemic inflammation by 40% and improved insulin sensitivity in 45% of cases. A combined approach achieved fertility restoration in 62% of patients. Conclusions: Integrating lifestyle, pharmacological, and innovative therapies addresses endocrine and metabolic dysfunctions in PCOS, offering effective strategies for fertility restoration and improved overall health outcomes

Introduction: A popular regional anesthetic method, spinal anesthesia has a number of benefits, such as a quick onset, low medication costs, and consistent operative analgesia. Its brief duration of action, however, is a typical disadvantage. Adding different adjuvant medications, such as opioids like butorphanol and alpha-2 agonists like clonidine, which also produce postoperative analgesia, might prolong the effects of intrathecal bupivacaine. The purpose of this study was to evaluate the effects of butorphanol (0.2 mg) and intrathecal clonidine (30 mcg) as additions to 3 ml of 0.5% hyperbaric bupivacaine for spinal anesthesia, with an emphasis on each drug's capacity to improve postoperative analgesia and extend its duration of action. Material and Method: This study comprised 100 patients in total who met the inclusion criteria. Two groups of patients were formed: Group BB got intrathecal butorphanol, while Group BC received intrathecal clonidine. Numerous factors were evaluated and compared between the two groups, including patient demographics, surgical length, sensory and motor block features, hemodynamic stability, and incidence of adverse effects. Results:  The study discovered that Group BC and Group BB had similar hemodynamic stability, surgical length, and demographic characteristics. In contrast to Group BB, Group BC had a longer duration of motor blockade, a delayed demand for the initial analgesia, and a much shorter time for sensory block regression to the S2 section. The two groups had side effects at comparable rates. Conclusion: When added to hyperbaric bupivacaine, intrathecal clonidine proved to be more effective than butorphanol at extending the duration of sensory and motor blockage and postponing the need for postoperative analgesia. These results demonstrate how clonidine may be used as an adjuvant in spinal anesthesia to enhance perioperative pain control.

Introduction: Sickle cell anaemia is a genetic abnormality involving the haemoglobin. Patients present with a wide spectrum of disorders because of a single-point mutation in which thymine substitutes for adenine, thereby encoding valine instead of glutamine in the sixth position of the beta-chain. The repeated sickling and unsickling damage the red cell membrane leading to irreversibly sickled red cell even when the oxygen pressure is increased. Methodology: Patients admitted in the Medicine department of tertiary care center from December 2020 to December 2022 with sickle cell anaemia were included in the study. Sample size taken for this study was 100 patients. Predesigned and pretested questionnaire was used to record the necessary information. Result: In this study, association of LVH and severe anemia in sickle cell patients was not statistically significant(P>0.05) Association between anaemia and pulmonary artery hypertension in sickle cell patients was found to be statistically significant. Conclusion: Most common electrocardiographic finding was sinus tachycardia followed by T- inversions. Most common echocardiographic changes were pulmonary hypertension.

The authors highlight Big Sugar's powerful and multidimensional influence in the obesity science and sports sector. The term Big Sugar encapsulates a group of major producers/manufacturers of sugar and related products. The authors investigate how companies like PepsiCo, Coca-Cola, Cadbury, and McDonald's provide massive and longstanding financial sponsorships to famous sports events such as the Olympic Games, Commonwealth Games, and Indian Premier League (IPL). Big Sugar aggressively promotes the notion that consuming sugary products is benign as long as the individual exercises to expend (burn) an equivalent number of calories consumed. However, the authors suggest that this calorie-burning notion is misleading and incorrect. The authors present scientific evidence suggesting that exercise cannot outrun the adverse effects of sugar calories. The human body metabolises different calories—from carbohydrates (sugars), proteins, and dietary fats—in different ways. Calories originating from carbohydrates/sugars promote insulin secretion, body-fat accumulation and appetite. Moreover, the authors discuss how Big Sugar has a massive financial influence on healthcare research, policies, and communication and how Big Sugar perpetuates misleading concepts to prioritise profit over public health. This urgent issue is evident in the pattern that even the physically active population is suffering from obesity, diabetes, and metabolic disorders, likely due to misleading concepts such as burning sugar calories by exercising.  Moreover, the authors suggest that public health policymakers should encourage manufacturers to reduce products' sweetness so consumers may reduce their pleasure threshold. Ultimately, the authors propose the Whole System Approach to mitigate Big Sugar's vested interest and conflicts of interest. Offering hope for India’s healthier future, the authors stress the importance of establishing robust collaboration between researchers/scientists, healthcare providers and councils, sports agencies, public health authorities/organisations, policymakers, non-governmental organisations, educational institutes, advocacy groups, and regulatory bodies.

Since posterior lumbosacral spine fixation surgeries are nowadays common spine procedures performed for various reasons and usually accompanied by moderate to severe postoperative pain, it is necessary to find effective postoperative analgesia in these patients. This study was aimed at monitoring the analgesic effect of dexmedetomidine in combination with bupivacaine versus bupivacaine alone on ESPB erector spinae plane blockade for postoperative pain relief in posterior lumbosacral spine fixation surgeries. Methodology: A study involving 75 patients who were randomly divided into 3 groups (25 patients each): Dexmedetomidine in combination with bupivacaine (group DB), bupivacaine (group B) and saline (control) (group S). Primary clinical outcomes were active (during mobilization) and passive (at rest) visual analog scale (VAS) pain scores in the first 24 hours measured every 2 hours, opioid consumption (number of PCA presses), and need for rescue analgesia. Other clinical outcomes included active and passive VAS pain scores at 24 hours, measured every 4 hours, opioid consumption, need for rescue analgesia, postoperative side effects of opioids, and intraoperative side effects of dexmedetomidine such as bradycardia and hypotension. Observation And Results: In our study we observed that Active and passive VAS pain scores, postoperative opioid consumption, need for rescue analgesia, and postoperative opioid side effects were significantly lower in DB group when compared to other groups (B and S groups). There were no additional intraoperative dexmedetomidine side effects as bradycardia and hypotension.

The aim of this study was to evaluate the effectiveness of intravenous dexmedetomidine (DEX) in the prevention of shivering after intrathecal anaesthesia in women undergoing C-sections. Methodology: This study was done in a tertiary medical college in central India from 1stOctober 2022 to September 2023 on 160 female patients, posted for elective C-sections under intrathecal anaesthesia. Patients were randomly divided into two groups of intravenous DEX (group D; 0.5 µg/kg) and normal saline (control, group C) and received the medications after umbilical cord clamping. All patients were evaluated during and after surgery for hemodynamic changes, the incidence and severity of shivering. Observation And Results: In our study we observed that the incidence of shivering in group C was significantly higher than in group D (P = 0.003). Moreover, the severity of shivering on minutes 20, 30, and 45 in group C was significantly higher than in group D (P < 0.05). The mean sedation score during minutes 10 - 30 in group D was significantly higher than in group C (P < 0.05). Heart rate was not significantly different between the two groups (P < 0.05). Systolic and diastolic blood pressure were higher in group D than in group C (P < 0.05).

This study was done to study the quality and efficacy of brachial plexus block through supraclavicular versus infraclavicular approach in upper limb orthopaedic surgeries. Methodology: This study was a prospective observational study done in a tertiary medical college in central India from 1stOctober 2023 to September 2024 on 120 patients, 60 patients in 2 groups (S and I) admitted for upper limb orthopaedic surgery. Observation And Results: In our study we observed that the time required for onset of sensory block in group S (6.13 ± 0.89 min) was not statistically significant (p value 0.222) when compared with onset of sensory block in group I (6.16±1.48min).The time required for onset of motor block in group S (13.16 ± 0.83 min) was not statistically significant (p value 0.908) when compared with onset of motor block in group I (13.26±1.5min).The quality of block in 2 groups, Group S and Group I as per scoring of 1, 2 and 3 were 1 and 1, 1 and 2, and 28 and 27 respectively. P value was 0.839 which is not significant.

Background: The COVID-19 pandemic has posed significant challenges, particularly for individuals with underlying health conditions such as Type 2 Diabetes Mellitus (T2DM). Understanding the interplay between T2DM and COVID-19 severity is crucial, given the contradictory findings regarding diabetes as a comorbidity affecting COVID-19 outcomes. This study aims to investigate the clinical relationship between T2DM and COVID-19 to fill the knowledge gap and inform better treatment strategies. Objective: To compare the clinical outcomes, laboratory parameters, and complications of COVID-19 between patients with and without T2DM.Methods: This retrospective cohort study was conducted at SCB Medical College and Hospital, Cuttack, including 180 COVID-19 patients (90 with T2DM and 90 non- diabetic) admitted between September 2020 and September 2021. Data on demographics, clinical presentations, laboratory findings, and outcomes were collected. Statistical analyses included the Chi-Square Test for categorical data and Spearman’s Correlation Coefficient for continuous data, using SPSS software version 26. Results: The mean age was slightly higher in diabetic patients (52.2 years) compared to non-diabetic patients (49.67 years), with a male predominance in both groups. Diabetic patients exhibited more severe disease (78.9%) compared to non-diabetics (64.4%) with a significant association between diabetes and COVID-19 severity (Χ² = 7.2053, p = 0.0273). Laboratory analysis showed higher Random Blood Sugar (RBS) and C-Reactive Protein (CRP) levels in diabetics. Significant differences were observed in SGPT and inflammatory markers (LDH, D-dimer, ferritin, and procalcitonin), indicating heightened inflammatory response in diabetics. Complications such as acute kidney injury (AKI), sepsis, and multiple organ dysfunction syndrome (MODS) were more prevalent in diabetic patients, with higher mortality rates (OR=2.55, 95% CI=1.27-5.09, p=0.007). Conclusion: T2DM significantly exacerbates the severity and complications of COVID-19, highlighting the need for tailored clinical management for diabetic patients during the pandemic. Further research is required to explore underlying mechanisms and improve therapeutic strategies for this high-risk group.

Introduction: Effective airway management in anesthesia relies on the optimal choice of laryngoscope blade, which can impact both the visibility during intubation and the patient's cardiovascular response, especially in elective surgeries where minimizing physiological stress is crucial. Objectives: This study aimed to evaluate the differences in laryngoscopic views and cardiovascular responses elicited by the use of Macintosh, Mc Coy, and Miller blades in adults undergoing elective orthopedic surgeries under general anesthesia. Methods: A total of 120 adult patients scheduled for elective orthopedic procedures under general anesthesia were included in this comparative retrospective study. Patients were grouped based on the laryngoscope blade used: Macintosh, Mc Coy, or Miller. The quality of the laryngoscopic view was assessed using the Cormack-Lehane grading system, and cardiovascular responses (changes in blood pressure and heart rate) were monitored and recorded during intubation. Results: The Mc Coy blade was found to provide the best laryngoscopic view, with 47.5% of cases achieving an excellent view, compared to 30% for Macintosh and 32.5% for Miller. In terms of cardiovascular response, the Miller blade was associated with the highest incidence of significant increases in blood pressure (40%), whereas the Mc Coy blade showed the lowest (10%). Statistical analyses confirmed significant differences across the blade types in both the quality of laryngoscopic views and the magnitude of cardiovascular responses (p < 0.05). Conclusion: The study underscores the importance of blade selection in optimizing laryngoscopic outcomes and minimizing cardiovascular risks. The Mc Coy blade may offer a favorable balance, providing superior visibility with less hemodynamic disturbance, suggesting its potential benefits in patients at risk of cardiovascular complications.

Introduction: Intestinal obstruction in paediatric age group differs from that in adults in presentation, etiology and management. Management of intestinal obstruction in children differs from that in adults in terms of fluid requirement, electrolytes and drugs dosage, mode of anesthesia, surgical technique & post-operative monitoring as well as complications. Present study was aimed to study of various causes, symptomatology & management of intestinal obstruction in paediatric age group at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted patients of both the genders and age less than 16 years of age, presented with intestinal obstruction & underwent surgical intervention. Results: During study period, 100 patients satisfied study criteria. Male cases were 75 (75.0%) and female were 25 (25.0%). Maximum number of cases were from the age groups of 1-12 months and 1years -5 years (27.0% each) followed by age group of < 1 month (26.0%) & age group 5-10 years (20 %). Common clinical features observed were distention (83 %), vomiting (66 %), constipation (44 %), pain abdomen and bleeding PR (24 % each). Intussusception (25 %) was most common diagnosis followed by imperforate anus (21 %), volvulus (10 %), CHPS (10 %), Hirschsprung's disease (8 %), Meckle’s band (6 %) & post operative adhesive (6 %). Study reveals that, there was statistically very highly significant difference of distribution of mortality of patients among outcome of complicated and uncomplicated surgeries (P < 0.001) & all deaths were occurred in complicated surgeries 11 (100.0%) Common post operative complications observed were septicemia (9 %), fever (8 %), wound infection (6 %) & respiratory distress (4 %). Conclusion: The most important conclusion drawn out of this study is that with early diagnosis and intervention, the outcome and the mortality rates of these children can be reduced accountable.

Introduction: The contemporary goal of providing maternal labour analgesia is the relief of the suffering and the pain of labour and delivery, while minimizing effects on maternal safety, awareness, motor functions, progress of labour and fontal wellbeing. This study is being undertaken to know the outcome of this epidural labour analgesia program me in a tertiary care hospital. Material and Methods: Present study was conducted in pregnant female, gestational age of 37- 42 weeks, Singleton fetus with engaged head & adequate pelvis, cervical dilatation ≥ 4cm, Bishop’s score >6, American Society of Anesthesiologists (ASA) Grade I or ASA Grade II, willing for epidural labour analgesia program me. Results: A total of 255 parturients were studied, mean age was 26.8 ± 2.6 years. 205 cases (80.4%) were done in Epidural and 50 patients (19.6%) in CSE. Out of the 255 parturients included in this study, 205 parturients underwent normal delivery, 29 (11%) parturients required instrumental assistance and 21 parturients i.e., 8.6% underwent caesarean section. Duration of the first stage of labour after institution of labour analgesia was 100.32 + 20.619 minutes & duration of 2nd stage was 88.53 + 15.67 minutes.  In our study mean Apgar at 1 min 6.26 ± 0.8 and at 5 min 9.8 ± 0.7. APGAR score at 5 min was > 7 in 97% neonate in present study, side effects noted were pyrexia (20.4 %) followed by nausea (20 %), shivering (20 %), pruritic (4 %), backache (13.7%), prolonged labour (11.8 %), fetal bradycardia (5.9 %) & hypotension (2 %). In our study 84.7% parturient graded labour analgesia was excellent 5.5% fair,8.2% good,1.6% poor. Conclusion: Programmed epidural labour analgesia protocol can be implemented as a safe and effective method of pain relief during labour in facilities where expertise for epidural analgesia is available. 

Background- Pseudomonas aeruginosa is an important opportunistic pathogen associated with chronic and recurrent infections, largely attributed to its ability to form biofilms. This study aimed to assess the biofilm-forming capacity of P. aeruginosa isolated from various clinical samples and evaluate the correlation between biofilm formation and antimicrobial susceptibility patterns (MTPM). Material and methods- The present study was conducted in the department of Microbiology, GMC, Kota (Rajasthan), India. 225 non-duplicate isolates of Pseudomonas aeruginosa from various clinical samples such as pus, urine, sputum, ET and body fluids were taken for the study. All isolates were subjected to routine antibiotic susceptibility testing by Kirby Bauer Disc Diffusion method. Biofilm production seen by Microtiter plate method. Result- Out of 225 sample, 155 (68.88%) were from males and 70 (31.11%) were from females. Ps. aeruginosa most commonly isolated from  59-69 age group. The maximum number of isolates was obtained from sputum 68 (30%), followed by urine 59 (26%), pus 57 (25%), body fluids 26 (12%), and endotracheal tube 15 (7%). In the present study, P. aeruginosa showed resistance against most of the commonly used antibiotics. Out of 225 isolates, 110 (48.88%) of P. aeruginosa isolates were identified as MDR and 115 (51.11%) of isolates were susceptible to most commonly used antibiotics. All 225 isolates were tested for biofilm production by MTPM. Among the MDR isolates, 53 (48.1%) were biofilm producers and 57 (51.8%) were non-biofilm producers. Biofilm producing isolates showed more resistance as compared to non-biofilm producers. The observed difference between biofilm formation for multidrug resistant and susceptible isolates was found to be statistically significant. Conclusion: The study found that biofilm-forming P. aeruginosa isolates exhibited higher resistance to commonly used antibiotics, particularly carbapenems and cephalosporins. These findings emphasize the need for effective biofilm-targeted therapeutic strategies in the management of P. aeruginosa infections in tertiary care settings.

The World Heart Report noted a notable rise in the mortality toll resulting from coronary heart disease (CHD)from 2.26 million in 1990 to 4.77 million in 2020, the World Health Organization’s 2023. [3,4]. The current study "A study of the association of serum lipid profile with body mass index (BMI) in young Indian adults," was carried out at G.S.V.M. Medical College in Kanpur, (U.P.) , India , on 120 healthy first-year professional M.B.B.S. students, ages 18 to 25 years. After being informed about the study, the subjects gave their informed consent. Random selection was used to select the subjects. “In below risk level (WC < 94 cm) males, mean Cholesterol was 143.67± 21.87 mg/dl and in at risk level (WC ≥ 94 cm) males it was 184.62± 31.71 mg/dl. Total cholesterol was increased in at risk level males as compared to below risk level. Whereas in below risk level (< 80 cm) females, mean Cholesterol was 172.13 ± 16.71 mg/dl and in at-risk level (WC ≥ 80 cm) females it was 193.16 ± 18.73 mg/dl. Total cholesterol was increased in at risk level females as compared to below risk level females”. The mean triglyceride was 137.74 ± 18.37 mg/dl in below risk level (WC < 94 cm) males and in at-risk level (WC ≥ 94 cm) males it was 184.8 ± 36.21 mg/dl. Mean triglyceride was increased in at risk level males as compared to below risk level males. Whereas in below risk level females, mean triglyceride was 140.3 ± 18.91 mg/dl in below risk level females and in at-risk level females it was 180.29 ± 27.32 mg/dl. Total cholesterol was increased in at risk level females as compared to below risk level females. In conclusion, the study suggests that overweight individuals may have higher levels of cholesterol, triglyceride, HDL, LDL, and VLDL compared to normal weight individuals. A positive correlation was found between BMI and Total Cholesterol and Triglycerides, but not with LDL and VLDL parameters in males.

Introduction: Hypertension is a significant health concern for pregnant women, potentially leading to adverse maternal and fetal outcomes. This study aims to investigate the maternal and fetal consequences in pregnancies complicated by preexisting hypertension. Objectives: To evaluate the maternal and fetal outcomes in pregnant women with preexisting hypertension. Methods: Study Design: Prospective cohort study. Setting: Two tertiary care hospitals. Participants: 200 pregnant women with a confirmed diagnosis of preexisting hypertension. Data Collection: Data were collected on maternal age, hypertension severity, medication use, prenatal care, and lifestyle factors. Fetal outcomes included gestational age at delivery, birth weight, and incidence of congenital anomalies or distress. Statistical Analysis: Descriptive statistics, chi-square tests for categorical variables, and t-tests or ANOVA for continuous variables. Results: The study found significant associations between the severity of hypertension and maternal complications such as preeclampsia, gestational diabetes, and preterm labor. There was a higher incidence of low birth weight, preterm birth, and neonatal intensive care unit (NICU) admissions in the hypertensive group compared to national averages. Results were statistically significant with p-values <0.05. Conclusions: Preexisting hypertension in pregnant women is strongly associated with adverse maternal and fetal outcomes. Early intervention and careful management of hypertension during pregnancy are crucial to improve health outcomes for both mother and child.

Background & Objective: Cold-induced acute pain is associated with significant autonomic cardiovascular responses and pulmonary function changes. The autonomic changes appear with weight gain and especially the metabolic syndrome. This study was done to establish Cold pressor test (CPT) as a diagnostic tool to see the responsiveness as a guide to future cardiovascular and pulmonary function disorders in the pre-disease phase. Methods: 105 healthy volunteers aged between 25 – 35 years were randomly distributed into normal, overweight, and obese groups, of 35 subjects in each. Their baseline cardiovascular parameters viz. heart rate (HR), Blood Pressure (BP), pulse pressure (PP), mean arterial pressure (MAP) were recorded. Dynamic lung response was recorded by measuring FEV1%. All the parameters were also recorded after immersing the hand of the subjects in cold water at 4ºC. Comparisons of cardiovascular and lung parameters were done before, during, and after the cold-induced pain in all the groups. The results were statistically analysed by ANOVA, Paired t-test and unpaired t- test on STATA 13.0 for statistical comparisons. Result: There was significant increase in cardiovascular parameters and significant decrease in FEV1% in overweight group. Conclusion: This study indicates that alteration in cardiovascular profile and dynamic lung response form a part of multidimensional autonomic responses secondary to sympathetic challenges during acute pain induced by the cold pressor test.

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, accounting for approximately 18 million deaths annually. Despite progress in treatment and management, the global burden of CVD continues to rise, fueled by aging populations, urbanization, and the growing prevalence of modifiable risk factors such as hypertension, diabetes, and obesity. Traditional prevention strategies have focused on controlling these risk factors through lifestyle modifications and pharmacological interventions. However, the persistence of high CVD-related morbidity and mortality rates highlights the limitations of conventional approaches, necessitating innovative solutions. This systematic review summarizes evidence for recent advances in cardiovascular disease prevention across 34 studies, emphasizing digital health technologies, precision medicine, therapeutic innovation of pharmacological agents, and public health initiatives. Wearable devices, artificial intelligence (AI)-powered data processing, and other digital tools are revolutionizing cardiovascular prevention through improved early detection, risk stratification, and personalized care. With recent pharmacologic breakthroughs like RNA-based remedies and PCSK9 inhibitors, we now have potent alternatives for treating lipid disorders and ameliorating cardiovascular events. Precision medicine approaches are also being employed to develop polygenic risk scores (PRS) and for biomarker-guided prevention of these at-risk individuals. It has been shown that public health approaches utilizing mobile health (mHealth) technologies and community-based interventions can effectively encourage healthy practices and increase access to preventive services. The results highlight the life-changing possibilities of introducing new technologies and therapies in conjunction with new prevention methods. Not only do these advances fill gaps in current strategies, but they also provide scalable approaches to closing global divides in cardiovascular health. This holistic approach, which takes lessons from old practices and combines them with the best modern innovations, marks an important step in reducing the global burden of CVD, ultimately improving patient outcomes.

Background: Over the past few decades there is an increase in the prevalence of diabetes mellitus (DM) and is associated with a number of complications. Glycosylated Hemoglobin (HbA1C) is used as the “gold standard” for measuring the glycemic control and is also used as predictor of diabetic complications. HbA1c levels is not only affected by the blood glucose levels alone. They are also changed in conditions like blood loss, hemolytic anaemia, pregnancy, chronic kidney diseases, vitamin B12 deficiency anaemia, splenectomy, hyperbilirubinemia, alcoholism and iron deficiency anaemia. As per WHO, iron deficiency is the commonest out of all deficiency diseases worldwide. Anemia is cited as a major confounding factor in the measurement of HbA1C. It was shown by few studies that patients with iron deficiency had higher HbA1C levels while few demonstrated that absolute HbA1c levels and mean HbA1c levels were lower in patients with iron deficiency anaemia. However, some studies showed no differences in HbA1c levels of patients with anaemia and healthy subjects. All these studies gave contradictory and inconsistent results. Thus, this study is conducted to know the effect of iron deficiency anaemia on glycosylated hemoglobin levels in non-diabetic individuals. Methods: 50 patients with iron deficiency anaemia and 50 healthy control subjects who were age and sex matched were registered in this study. Complete hemogram including peripheral smear, fasting and postprandial blood sugar levels, glycated hemoglobin and serum ferritin levels were measured in both the groups. Results: The prevalence of iron deficiency anaemia was more in females during the third and fourth decades of life. Mean HbA1c of iron deficiency anaemia patients (5.78 ± 1.08) was significantly higher than that of the control population (5.46 ± 0.26 ) that was statistically highly significant (p<0.001) Conclusion: Our study showed that HbA1c levels were affected by iron deficiency anemia. HbA1C values were higher in patients with iron deficiency anemia than control group. So iron deficiency anemia has to be taken into consideration before using the HbA1c in the diagnosis of diabetes.

Background: The present understanding of COVID-19 and its therapeutic management is limited.  Clinicians were looking for the best treatment options for COVID-19 patients to control this disease by using experimentally tested therapies and drug repurposing. Materials and methods: The present retrospective study comprises four treatment groups, G1 (Hydroxychloroquine (HCQS)), G2 (Ivermectin combination with Doxycycline), G3 (Favipiravir) and G4 (Ivermectin combination with HCQS).  120 patients were included with a median age of 40.53±11.35 years. Routine blood investigations and chest radiograph were done. Results: The median interval from illness onset to viral clearance was lower in G1 6.8 ± 1.47 and G4 7.23 ± 0.85 as compared to G2 8.67 ± 1.97 and G3 9.97±2.773 days. In study, G1 had taken less time in becoming asymptomatic with treatment as compared to G2, G3 and G4. ROC analysis was performed in comparison to G1 group against the G2, G3 & G4 the AUC, sensitivity and specificity showed better results in comparison to G2 group against the G3 & G4 and G3 group against G4 for all the three parameters. Conclusion: The study concluded that low-dose hydroxychloroquine drug helps in diminishing the viral load as well as cytokine storm in critically ill COVID-19 patients.

Introduction: Primary percutaneous intervention is the preferred treatment for ST-elevation myocardial infarction. Even after the restoration of epicardial flow graded as thrombolysis in myocardial infarction flow (TIMI) after percutaneous coronary intervention, microvascular obstruction can occur, which in turn leads to poor left ventricular function. The main cause of microvascular obstruction is atheromatous microparticle embolization within the culprit artery causing increased infarct size, mortality, and positive remodeling of the heart, which leads to overt heart failure and increased mortality. Objective: To determine the association between Myocardial Blush Grade (MBG) post-PCI and Left Ventricular Ejection Fraction in patients with ST-Elevation Myocardial Infarction. To investigate the relationship between Myocardial Blush Grade and adverse cardiovascular outcomes (e.g., heart failure, recurrent infarction, mortality) in STEMI patients.  To determine predictors of myocardial recovery: Identify factors associated with favourable myocardial recovery, including procedural characteristics, patient demographics, and comorbidities, to better understand the determinants of post-PCI left ventricular function. Methods: The data will be analysed using IBM SPSS software version 26.0. For analysis of groups in the study, MBG ≥2 was considered as ‘high’ grade whereas MBG <2 was considered as ‘low’ grade. Descriptive statistics will be used to describe variables such as gender.  Mean and standard deviation will be used for calculating variables such as age and ejection fraction. Chi-square test will be used to compare the clinical characteristics of the high and low MBG groups. Independent samples t-test will be used to determine if differences between TIMI score and MBG will be significant with respect to age.  Risk ratios will be calculated for adverse outcomes and improved LVEF with respect to MBG. Logistic regression analysis will be performed to determine the confounders of the study. Result: MBG may be considered as an additional angiographic parameter to define angiographic success and also better prognosticate patients and decide on management plans to improve long-term patient outcomes. The study findings may contribute to risk stratification models, helping clinicians tailor interventions and improve outcomes for STEMI patients. Conclusion: In the present study, we found a significant association between MBG and TIMI, suggesting that MBG can predict adverse events after thrombolysis/PTCA in those with ACS. However, we found no association between age, gender, co-morbidities or EF.

Background: Breastfeeding is vital for infant nutrition, offering essential nutrients and immunological benefits. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, yet only about 41% of infants globally meet this guideline. This study aims to assess breastfeeding awareness and practices among mothers of children aged 6 months to 2 years at a Taluk hospital in North Kerala and identify socio-demographic factors influencing these practices. Aims and Objectives: To study the awareness and practices of breast feeding among mothers of children between the age of 6 months and 2 years attending Taluk Hospital. Methodology: A cross-sectional study was conducted with 200 mothers attending the outpatient department of a Taluk hospital in Kannur district, Kerala. Data were collected using a pretested, semi-structured questionnaire covering breastfeeding awareness, practices, and socio-demographic details. Statistical analysis was performed using SPSS software. Results: The study found that while 95% of mothers had satisfactory knowledge about breastfeeding, only 55% practiced exclusive breastfeeding for six months. Reasons for introducing artificial feeds included perceived lack of breast milk, beliefs about child health, job-related issues, and cultural practices. Knowledge regarding topics such as expressed milk, storage, and lactational amenorrhea was found to be inadequate. Ragi emerged as the most common weaning food used after six months. Conclusion: The findings highlight a significant gap between breastfeeding awareness and actual practices among mothers in South India. Despite high awareness of breastfeeding's importance, the low rates of exclusive breastfeeding indicate an urgent need for targeted educational interventions to support improved breastfeeding practices.

Introduction: The International Diabetes Federation (IDF) estimated that the number of individuals living with Diabetes would increase from approximately 65 million in 2013 to 100 million by 2035. Despite the increasing burden of Non-Communicable Diseases, both research and the allocation of resources to combat Non-Communicable Diseases remain limited¹. The NCDs like Diabetes, Hypertension, Obesity, CVS etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years. Individuals with Non-Communicable Diseases also have a higher risk of increased health expenditure, and a substantial proportion of households face catastrophic health expenditure and subsequent impoverishment due to NCD related expenses.² Objectives of the study: 1. To assess the prevalence of Non-Communicable Diseases (Hypertension, Diabetes Mellitus and Obesity) among the adult population of Kokrajhar District. 2. To assess the prevalence of risk factors of common non-communicable diseases in adult population of Kokrajhar District. Methodology: Study Type: Community-based, Descriptive Cross-sectional study. Study Population: Adult Population of 18 –59 years of age. Study Area:  Villages under Titaguri area which is one of  the  field  practice  areas and Family adoption areas  of  the  Department  of Community    Medicine,   Kokrajhar Medical  College. Study Duration: July 2024 to September 2024.  Sample Size calculation: The sample size was calculated by the formula N = 4pq/l2, where p represents prevalence of diabetes which was 15.5% (Thakur J, Jeet G, et al. (2019) non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India. PLoS ONE 14(11): e0208872. https://doi.org/10.1371/journal.pone.0208872). ‘l’ is allowable error, taken as 5% of p. Therefore, a sample size of 210 was taken. Ethical Clearance: Ethical clearance had been obtained from the Institutional Ethical Committee of Kokrajhar Medical College and Hospital, Kokrajhar, Assam. Inclusion Criteria: Permanent residents of Kokrajhar District (residing for more than 6 months) Exclusion Criteria: 1) Pregnant lady, 2) Those with known psychiatric illness, 3) Individuals having serious morbidity, Consent: Informed consent was taken from all the participants before data collection and confidentiality was maintained. Data collection: Information regarding risk factors of NCDs were collected by using Pre tested per-designed questionnaire. Non-stretchable    measuring    tape, digital weighing scale, portable stadiometer, digital BP apparatus were   used to measure waist and hip circumference, weight, height, and blood pressure, respectively. Data analysis–Data has been entered in MS excel sheet. Qualitative data were expressed in proportions.  Mean and standard deviation were used for quantitative data.  Suitable tests    of    significance    has been      applied    wherever necessary.

Lumbar intervertebral disc degeneration is a major cause of back pain and imaging is crucial for early diagnosis. The main imaging technique utilized to evaluate degenerative conditions of the lumbar spine is MRI. This study’s aim was to correlate lumbar spine degenerative disc changes as seen on MRI with Oswestry disability index (ODI), which is a clinical parameter.

Introduction:  Systemic sclerosis is the family of auto-immune diseases most commonly considered in the connective tissue disease category. The annual incidence is approaching 20 per million populations and may be underestimated. Prevalence studies have not been undertaken, but 500 per million populations may be a reasonable estimate. Aims: To observe the prevalence of cardio-vascular diseases among systemic sclerosis patients and to correlate socio-demographic profile of patients with different cardio-vascular diseases: Materials and method: The present study was a Observational, cross sectional, non-interventional, hospital based study. This Study was conducted from 1st April 2021 to 31st March 2022 at Department of Medicine and the Critical Care Unit of North Bengal Medical College and Hospital, Darjeeling. Total 52 patients were included in this study. Result: Majority (78%) of the study population had duration of illness of 1-5 years followed by 12% and 10% having 6-10 years and more than 10 years respectively, 78% of the study subjects took medicines regularly after diagnosis where as 22% did not. Majority (88%) of the study population had diffuse skin involvement. A large group of patients had complained of Raynaud’ phenomenon (76%) and GERD (27%). 10% and 8% patients complained of shortness of breath and cough respectively. Conclusion: We conclude from the study that Age of onset of systemic sclerosis patients varies from 20-50 years. Assessing the cardio-vascular disease profile we have found PAH, Right and Left ventricular dysfunction, pericardial effusion, tricuspid regurgitation and atherosclerotic plaques leading to stenosis of both CCA.

Introduction: Being one of the most common fractures encountered by orthopedic surgeons today, tibial shaft fractures have increased incidence in both males and females. There is an equal bimodal distribution of tibial fractures with preponderance towards young male. In young people , the risk of these fractures increases upto 37.5 %. The intramedullary nail acts as an internal splint and permits early weight bearing. Several complications have been described during the postoperative care of intramedullary nailing including infection compartment syndrome, deep vein thrombosis, malunion, nonunion and anterior knee pain. Out of all, anterior knee pain carries special significance as it decides the daily activities of the individual.  Materials And Method: This is a Prospective- randomized control study. All cases satisfying the inclusion criteria will be chosen. Patients will be randomly assigned to the two study groups. Fifty percent of the patients will undergo intramedullary nailing of tibia using patellar tendon splitting approach (group1) with an incision of 1.5cm. Fifty percent of the patients will undergo intramedullary nailing of tibia using medial parapatellar approach (group2) without splitting patella tendon and postoperatively they will be assessed for clinical and functional outcomes at regular intervals namely1,3 and 6 months respectively and assessed with VAS score. Results: The majority of subjects were in the age group <30 and 41 to 50 years (35%) and in group 2, majority of subjects were in the age group 31 to 40 years (35%). In group 1, 80% were males and 20% were females and in group 2, 85% were male  and 15% were female. Duration of surgery in group 1 was 109.40 ± 10.53 mins and in group 2 was 94.85 ± 12.79 mins.  In group 1, 75%  of them were closed fracture, 15% were GA grade 1, 10% were GA grade 2. In group 2 85%  were closed fracture, 10% were GA grade 1 and 5% were GA grade 2. Mean VAS score at 1 month follow up in group 1 was 6.5 and in group 2 it was 6.2. At 3 months in group 1 it was 3.7 and in group 2 it was 3.3. At 6 months follow up it was 1.7 in group1 and 1.7 in group 2. Conclusion: Medial para patellar approach is better than patellar tendon splitting approach for intramedullary nailing of tibial fractures in terms of VAS score, Duration of surgery, length of incision and functional outcome.

Introduction: Cervical carcinoma is fourth most common cancer. It is an increasing health problem and an important cause of mortality in women worldwide. Pap smear test is primary screening test to detect early cervical epithelial changes for detection of precancerous cervical intraepithelial neoplasia and it is also important for several infectious diseases. Materials and Methods: This is a retrospective study conducted at the Tertiary care Centre over a period of 1 year. Women having age 18 – 65 years undergoing Pap smear examination were taken. Women having different complaints, including hypertrophied cervix, white discharge, foul smelling discharge, irregular menstrual bleeding, postmenopausal bleeding, abdominal pain, infertility and patients with history of healthy cervix were included in this study. Results: In our study we included 1107 women with mean age of 38yrs and majority of women were aged between 36-42 years. Patients presenting symptoms of cancer cervix patients included white discharge (21.4%), Cervix hypertrophied (31%), infertility (8.4%), irregular menstrual cycle (20%), abdominal pain (7.4%) % and cervical mass (1.2%). These all were diagnosed with following cervix diseases Bacterial vaginosis 15.1%, Trichomoniasis 7%, HSIL 1.09%, LSIL 1.09%, ASCUS 1.4%, Atrophic 7.25%, SCC 1.5%, Adenocarcinoma 0.4% and normal 68.67%. The sensitivity of pap smear screening test is 94.74%. Conclusion: It is evident that cervical screening programs can reduce cervical cancer mortality by 80% or more among screened women. Out of 1107 pap smears, 759 cases were healthy clinically and 6 of them were diagnosed as SCC. Introduction of new techniques and facilities had made screening and treatment of infectious cervical diseases, cervical precancerous lesions feasible and highly cost-effective for all set ups. Early detection and treatment of premalignant lesions by help of colposcopy admixed with pap smear can result in massive improvements of survival, and are especially important in developing countries and rural areas where resources are limited and non-affordable.

Background: Sucralfate serves as a cytoprotective medication that is predominantly used to treat ulcers of the gastrointestinal tract, such as duodenal, gastric, and gastritis ulcers. Recent studies suggest sucralfate can be implemented topically to open wounds and has positive effects for treating persistent ulcers. The study aims to investigate the efficacy of sucralfate in wound healing among patients with diabetic foot ulceration. A prospective study was over a period of six months (July 2023-December 2023) among 60 patients who were allocated into two equal groups. The conventional dressing (group-B) was compared with sucralfate (group-A) dressing through evaluation of wound condition at the time of admission, 4th and 8th week. The data was analyzed using Jamovi v 2.3.28 software. The results showed that wound size was reduced in group A in the 4th and 8th week of admission which is statistically significant and also healthy granulation tissue was noted in higher proportion among the patients in group A. Topical application of sucralfate can be proven to be more effective, safe, and facilitate wound healing than conventional dressings.

Background: Prone positioning during general anesthesia for spine surgery can induce significant hemodynamic changes. This study aimed to quantify these changes and their time course. Methods: Fifty-four patients undergoing elective spine surgery were included. Hemodynamic parameters were measured in supine position and at three time points after prone positioning: immediately, 5 minutes, and 10 minutes. Results: Significant decreases were observed in systolic blood pressure (mean difference 12.926 mmHg, p<0.001), diastolic blood pressure (mean difference 3.778 mmHg, p<0.001), and mean arterial pressure (mean difference 6.574 mmHg, p<0.001) immediately after prone positioning. Peak airway pressure increased significantly (mean difference 1.630 cmH2O, p<0.001). These changes persisted at 5 and 10 minutes, though some recovery was noted. Heart rate, end-tidal CO2, and oxygen saturation showed minimal changes. Conclusions: Prone positioning under general anesthesia leads to significant reductions in blood pressure and increases in airway pressure, with partial recovery over 10 minutes. These findings highlight the need for careful monitoring and management during prone positioning.

Background: Ossification of the ligamentum flavum also known as OYL (ossification of yellow ligament) is a rare condition, commonly observed in the thoracic region. Ossified yellow ligament (OYL) is one of the major reasons for thoracic myeloradiculopathy. 88.8% of the cases are seen in Japanese population followed by Caucasians (8.2%). A series of 18 cases of ossified yellow ligament who presented with compressive myelopathy over a period of 21 years in a south Indian state and the outcome of surgical treatment of the same are presented here. Methods: 18 operated cases of OYL with compressive myelopathy due to ossified yellow ligament are reviewed. All the patients presented with lower limb motor and sensory weakness and gait abnormalities. The neurological status was assessed using JOA scoring at admission and periodically thereafter. Results: All patients underwent laminectomy and instrumented fusion. Neither dural tear nor any neurological deterioration was noticed post operatively. The complete neurological improvement in our series were 77.77%. JOA scores 1 and above at admission recovered completely at 1 year (100%). This agrees with Joji Inamasu et al, who stated that preoperative neurological status is a predictor of neurological recovery after surgery. Conclusion: OYL predominantly affects the dorsal spine. 8 of the 18 patients were diabetic. Co-existing OPLL were found in 6 out of the 18 patients. The dural calcification/ossification was addressed with floating technique. All the operated patients had excellent neurological recovery.

Background: Ultrasonography is a non-invasive technique that provides reliable measurements of gallbladder dimensions, which are essential for assessing its structural integrity. Objective: To evaluate the normal dimensions of the gallbladder in healthy adults in Jalpaiguri, India, using ultrasonography, and to establish reference values based on age, sex, and body mass index (BMI). Method: A cross-sectional study was conducted from June 2023 to June 2024 at Jalpaiguri Government Medical College, Jalpaiguri. A total of 100 healthy adults (50 males and 50 females) were enrolled. Gallbladder length, width, and wall thickness were measured using ultrasonography. Correlations between gallbladder dimensions and demographic factors such as age, sex, and BMI were analyzed. Result: The average gallbladder length was 7.3 cm (±1.2 cm), width was 3.8 cm (±0.6 cm), and wall thickness was 2.3 mm (±0.4 mm). No significant difference was observed between males and females in terms of gallbladder dimensions. A positive correlation was found between BMI and gallbladder dimensions, with obese individuals presenting larger gallbladders. Gallbladder length was slightly higher in individuals aged 40 and above, constituting 35% of the study population. The largest gallbladder measurements were observed in the 35-45 age group, with an average length of 8.2 cm. Conclusion: This study provides normative data for gallbladder dimensions in the Indian population, emphasizing the need for population-specific reference ranges for accurate diagnosis of gallbladder-related conditions.

Background: Critical care environments are highly complex, characterized by immense data overload, clinician fatigue, and the need for rapid, precise decision-making. Artificial intelligence (AI) presents a promising solution to overcome these challenges, aiming to enhance clinical decision-making and improve patient outcomes. Objectives: This study explores the applications of AI in critical care, particularly in diagnostics, predictive analytics, workflow efficiency, and overall patient care. Methods: A comprehensive review of the literature was conducted, incorporating systematic reviews, meta-analyses, and case studies to evaluate AI's impact and effectiveness in critical care settings. Results: AI demonstrated a 20-40% improvement in early detection of critical conditions, such as sepsis and cardiac events, alongside reducing intensive care unit (ICU) stays by an average of three days. Furthermore, diagnostic accuracy improved significantly, with AI achieving a precision rate of 92%, compared to 78% for human clinicians. Conclusion: AI represents a transformative advancement in critical care, addressing key challenges such as diagnostic delays and workflow inefficiencies. However, its implementation raises ethical and operational considerations that must be carefully managed to maximize its potential.

Introduction: The gonial angle of the mandible is the angle formed between the ramus line and the mandibular line where the ramus line is a tangent to the posterior border of the mandible and the mandibular line is the lower border of the mandible through the gnathion. It is also known as the anatomical angle of the mandible. This angle should not be confused with the medico-legal angle of the mandible. Alterations in this angle have been noted when compared with age, sex, and dental status of a person. Aim: To derive the relation between the angle of the mandible and the sex, age, and dental status of an individual. Methodology: A total of 105 subjects have been included in the study and have been divided into five groups on the basis of chronological age. The data is analyzed by physico-forensic anthropometry. The gonial angle was measured by the scale of a protractor and the angle was recorded in degrees. Results: The gonial angle is found to be varying with the type of dentition and also with age and sex. The present study shows a significant decrease in the gonial angle (127.9375 to 113.8235 in females and 120.2222 to 115.8333 in males) with age but is found to be increasing in certain cases. Those certain cases include edentulous people (130). The average measure of the angle is more in females (121.3509) as compared to males (120.125). With the loss of teeth, the bone undergoes remodelling and consequently, an increase in size is seen. Conclusion: The present study concludes that the gonial angle of the mandible can serve as a forensic parameter and scientific growth scale, which guides for age, sex, and dental status assessment. Also, it is considered to be an important parameter while dealing with class 2 and class 3 malocclusion.

Background: Inadequate postoperative pain management remains a significant challenge, negatively impacting patient outcomes and satisfaction. Preoperative patient education has emerged as a potential strategy to improve postoperative pain management outcomes. Objective: To investigate the impact of a structured preoperative patient education program on postoperative pain intensity, analgesic consumption, patient satisfaction, and functional recovery in adult patients undergoing elective surgery. Methods: A prospective, single-center, randomized controlled trial was conducted with 120 adult patients undergoing elective surgery. Participants were randomly allocated to either the intervention group, receiving a structured preoperative patient education program, or the control group, receiving standard care. Outcomes were assessed at 24, 48, and 72 hours after surgery. Results: The intervention group had significantly lower postoperative pain intensity scores at 24 hours (3.8 ± 1.6 vs. 4.9 ± 1.8; p=0.001), 48 hours (2.5 ± 1.3 vs. 3.7 ± 1.5; p<0.001), and 72 hours (1.6 ± 1.0 vs. 2.8 ± 1.2; p<0.001) compared to the control group. Analgesic consumption was significantly lower in the intervention group at all time points (p<0.001). The proportion of patients "very satisfied" with pain management was significantly higher in the intervention group (46.7% vs. 25.0%; p=0.03). Functional recovery scores were significantly higher in the intervention group at all time points (p<0.001). Conclusion: A structured preoperative patient education program significantly reduces postoperative pain intensity and analgesic consumption while improving patient satisfaction and functional recovery compared to standard care in adult patients undergoing elective surgery.

Post-dural puncture headache is one of the common complications of spinal anesthesia. Although self-limiting, it is problematic for the patient. The aim of this study was to determine the prevalence of postdural puncture headache after spinal anesthesia in parturient women undergoing caesarean section at the Department of Anesthesiology in a tertiary care center. Methodology: This study was a prospective observational study done in a tertiary medical college in central India from 1stOctober 2023 to September 2024 on parturients who underwent cesarean section under spinal anaesthesia. The pregnant patients aged 18-45 years of the American Society of Anesthesiologists Physical Status II/IIE who underwent elective or emergency cesarean section under spinal anaesthesia were included. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Observation And Results: In our study we observed that the prevalence of post-dural puncture headache was 7% (4.53-9.67, 95% Confidence Interval). A total of (42.86%) cases experienced post-dural puncture headache in the first 24 hours followed by (32.14%) and (21.42%) cases in 48 and 72 hours respectively. Moderate pain was complained of by(11.11%) and  (7.41%) cases at 48 and 72 hours post-caesarean section respectively.

Background: Preoperative anxiety significantly impacts surgical outcomes and patient experience. This study evaluated the effectiveness of preoperative IV midazolam on surgical outcomes and patient satisfaction. Methods: A prospective, randomized, double-blind, placebo-controlled trial was conducted between September 2020 and September 2021 at Karpagam Faculty of Medical Sciences and Research, Coimbatore. One hundred and twenty adult patients undergoing elective surgery were randomized to receive either IV midazolam (n=60) or placebo (n=60). Primary outcomes included postoperative pain scores and anxiety levels. Results: The intervention group demonstrated significantly lower postoperative pain scores at all time points (mean difference at 2 hours: -1.6, 95% CI: -2.2 to -1.0, p<0.001) and reduced STAI scores (mean difference: -10.1, 95% CI: -12.7 to -7.5, p<0.001). PACU duration was shorter in the intervention group (42.6 ± 11.4 vs 49.8 ± 13.2 minutes, p<0.001), with higher patient satisfaction scores (8.2 ± 1.1 vs 7.1 ± 1.3, p<0.001). Complication rates were comparable between groups (26.7% vs 21.7%, p=0.516). Conclusions: Preoperative IV midazolam significantly improves postoperative outcomes and patient satisfaction without increasing complications, supporting its routine use in surgical patients.

Aim: To assess the effectiveness of a hybrid cardiac rehabilitation program on the quality of life and cardiovascular risk factors in heart failure subjects. Objectives: 1. To determine the effect of a cardiac rehabilitation program on cardiovascular risk factors and bio-physiological parameters in heart failure patients. 2.To determine the effectiveness of a cardiac rehabilitation program on health-related quality of life in heart failure subjects. 3.To assess the effect of a cardiac rehabilitation program on functional capacity in heart failure subjects. Need of the Study: While previous studies have largely focused on the effect of cardiac rehabilitation on morbidity, mortality, and re-hospitalization, there is limited research on its impact on quality of life, functional capacity, and independence in activities of daily living in heart failure patients. Furthermore, most data are derived from center-based programs, which pose practical limitations for rural populations. This study aims to develop a simple, easily implementable hybrid (canter- and home-based) cardiac rehabilitation program with tele-consultations and outpatient follow-ups. Methods: A total of 102 subjects were initially enrolled, with 100 completing the study. Descriptive statistics were used to evaluate variables such as age, SPO2, SBP, DBP, resting pulse, BMI, LDL, HDL, RBS, 6MWT, and various health-related quality of life parameters before and after the intervention. Results: Post-intervention results showed significant improvements in several key areas:SPO2: Increased from a mean of 88.60 ± 2.71 to 96.38 ± 1.95 (p=0.000).SBP: Decreased from 122.00 ± 16.58 to 114.80 ± 11.05 (p=0.000).6MWT: Improved from 502.95 ± 69.13 meters to 514.71 ± 66.31 meters (p=0.000).PCS: Increased from 23.83 ± 3.63 to 149.50 ± 3.49 (p=0.000).MCS: Improved from 29.40 ± 5.36 to 73.50 ± 5.44 (p=0.000).Statistically significant reductions were observed in smoking (p=0.001) and alcohol consumption (p=0.001) post-intervention. There were no significant changes in DBP, resting pulse, BMI, LDL, HDL, or RBS. Conclusion: The hybrid cardiac rehabilitation program significantly improved SPO2 levels, SBP, 6MWT performance, and health-related quality of life (both PCS and MCS). Additionally, there was a notable reduction in smoking and alcohol consumption among participants. These findings suggest that hybrid cardiac rehabilitation can effectively enhance the quality of life and reduce cardiovascular risk factors in heart failure patients, making it a viable option for both urban and rural populations.

Introduction: Non-alcoholic fatty liver disease is increasingly recognized as a major public health issue globally including India. Understanding its prevalence and associated factors in specific populations is crucial for effective prevention and management strategies. This study aimed to estimate the prevalence of NAFLD and to determine the factors associated with its presence among adults attending a tertiary care centre. Methods: An observational, cross-sectional study was conducted in a tertiary care hospital in Rajahmundry, Andhra Pradesh, from October 2022 to March 2022.  a sample size of 200 subjects was selected using simple random sampling. Demographic data, lifestyle risk factors, anthropometry, and ultrasound findings were collected using a pretested, predesigned, and validated case record form. Statistical analysis was carried out using SPSS software, employing a chi-square test to find associations between NAFLD and various variables. Results: Among 200 participants, the prevalence of NAFLD was found to be 38%. Factors such as BMI, waist-hip ratio, sedentary habits, and diabetes were significantly associated with NAFLD (P<0.05) and were identified as significant risk factors. Conclusions: This study highlights a notable prevalence of NAFLD of 38%. The findings emphasize the significant role of factors such as BMI, waist-hip ratio, sedentary lifestyle, and diabetes in increasing the risk of developing NAFLD. These factors can serve as key targets for prevention and intervention strategies aimed at reducing the burden of NAFLD in at-risk populations.

Introduction: Implantation of cardiac implantable electrophysiological devices (CIEDs), including permanent pacemakers and implantable cardioverter-defibrillators has been on the rise over the past years, largely due to the expanded indications for CIED implantation for primary prevention. Infection associated with implantable devices is a serious complication with high morbidity leading to mortality. The importance of appropriate empirical antibiotic coverage is illustrated by studies that document the association between inappropriate selection and increased mortality in patients with permanent pacemaker implantation. Increasing multi drug resistance problem could be due to mutations, over use of broad-spectrum antibiotics, across the counter availability of antibiotics and lack of infection control policy in the hospital settings. Methodology: A prospective observational study conducted at the major tertiary care centre of the State of Himachal Pradesh, for duration of one year. Patients who had undergone interventional cardiology procedure and developing any sign or symptom of general or systemic infection were included. Results: On direct Gram staining of clinical samples, microorganisms were seen in 12 (70.58%) samples and in 5 (29.41%) samples no microorganism seen. Out of 12 positive samples, Gram positive cocci were isolated from ten samples accounting for 83.33% of total isolates, while Gram negative bacilli were isolated from one sample (8.33%) and both Gram positive cocci and Gram-negative bacilli were isolated from single sample accounting for 8.33% of total isolates. Majority of the isolates were S.aureus (46%), followed by S.epidermidis (38%). Pseudomonas aeruginosa and Achromobacter spp. were 8% each. Out of 11 Staphylococcus isolates, 6 (54.54%) were identified as Staphylococcus aureus (S.aureus) and 5 (45.45%) were Staphylococcus epidermidis (S.epidermidis). There was 100% sensitivity to Vancomycin, Daptomycin and Linezolid. Almost 64% samples were resistant to Oxacillin, Cefoxitin, Cefazolin and Erythromycin; 45% were resistant to Co-trimoxazole and Clindamycin; 18% were resistant to Gentamicin and 9% were resistant to teicoplanin and Rifampicin. All the isolates were resistant to Ampicillin and Penicillin G. Out of 6 isolates of S.aureus, 3 (50%) were MRSA. Out of 5 isolates of S.epidermidis 4 (80%) were Methicillin resistant. All the MRSA isolates were sensitive to daptomycin, teicoplanin, vancomycin, linezolid and rifampicin but they were resistant to erythromycin, ampicillin and penicillin G. 67% isolates were sensitive to gentamicin, co-trimoxazole and clindamycin. All Methicillin resistant S.epidermidis were sensitive to daptomycin, vancomycin and linezolid. 75% were sensitive to gentamicin, teicoplanin and rifampicin and only 25% were sensitive to co-trimoxazole. However, all were resistant to erythromycin and clindamycin. In single isolate of Achromobacter spp resistance was observed for gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and tetracycline. The isolate was sensitive to ceftazidime, piperacillin-tazobactam and co-trimoxazole. Single isolate of Pseudomonas aeruginosa was sensitive to amikacin, gentamicin, imipenem, meropenem, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin and piperacillin-tazobactam. Conclusion: The present study indicated an infection rate of 8.1% following permanent pacemaker implantation. 84% of the causative organisms were Staphylococcus species and out of which 64% were methicillin resistant. Staphylococcus has been reported as a major cause of community and hospital acquired infections. Infections caused by Staphylococcus used to respond to β-lactam and related group of antibiotics. Vancomycin has been used as the drug of choice for treating MRSA infections. Further, the regular surveillance of hospital associated infections including monitoring antibiotic sensitivity pattern of MRSA and formulation of definite antibiotic policy may be useful for reducing the incidence of MRSA infection.

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as a significant public health concern, associated with conditions such as Type 2 diabetes, obesity, and metabolic syndrome. In India, prevalence estimates vary widely across regions. Objectives: This study aimed to determine the prevalence of NAFLD and its association with demographic, anthropometric, and lifestyle factors among patients attending a tertiary care hospital in Guntur, Andhra Pradesh. Methods: A cross-sectional analytical study was conducted on 457 patients aged 20–40 years undergoing abdominal imaging from October 2021 to November 2022. NAFLD was diagnosed using ultrasonography and graded from 0 to 3. Data on demographics, anthropometrics, and lifestyle were collected and analyzed using SPSS version 19.0. Statistical significance was set at p<0.05. Results: The prevalence of NAFLD was 46%, with grades 1, 2, and 3 observed in 33.9%, 19.8%, and 0.3% of participants, respectively. NAFLD prevalence increased significantly with age (p=0.022) but showed no gender difference (p=0.232). Patients with NAFLD had higher BMI (27.39 ± 5.41 vs. 21.84 ± 3.6), waist circumference (97.56 ± 10.05 cm vs. 79.25 ± 9.61 cm), and waist-to-hip ratio (0.95 ± 0.18 vs. 0.87 ± 0.08; p<0.001). Diabetes was more prevalent in NAFLD patients (24.3% vs. 7.1%; p<0.001), while hypertension showed no significant difference. Sedentary lifestyle (88.1% vs. 67.6%; p<0.001) and non-vegetarian diets (p=0.025) were significantly associated with NAFLD. Conclusion: NAFLD prevalence in Guntur was high (46%) higher than the global average of 25.24%. NAFLD patients had higher BMI, waist and hip circumferences, and were less physically active, with a higher prevalence of diabetes. The findings underscore the importance of weight management, routine screening, and lifestyle changes to mitigate NAFLD risk. These findings emphasize the need for early screening, lifestyle modifications, and targeted interventions to address NAFLD effectively.

Introduction: Endotracheal intubation is essential for airway management during anaesthesia. Conventional laryngoscopy can cause significant hemodynamic responses, like increased heart rate and blood pressure, which may be harmful to high-risk patients. Fibreoptic intubation offers a potential alternative by reducing airway trauma and hemodynamic instability. Objectives: The primary objective of the study was to compare hemodynamic responses and intubation times between conventional laryngoscopy and fibreoptic intubation. The secondary objective was to assess post-procedural complications associated with each method. Methods: This randomized controlled trial involved 200 ASA grade I and II patients aged 18-45 undergoing elective surgery. Patients were divided into two groups: Group A (Conventional laryngoscope [Romsons Scientific & Surgical Pvt. Ltd., Agra, Uttar Pradesh, India], n=100) and Group B (Fiberoptic bronchoscope [Karl Storz GmbH & Co. KG, Tuttlingen, Germany], n=100). Measurements included intubation time, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) at baseline, post-induction, and five minutes after intubation. Post-procedural complications (sore throat, soft tissue trauma, dental injury) were assessed over 24 hours. Statistical analysis used SPSS v23, with p<0.05 deemed significant. Results: Group B showed significantly lower hemodynamic responses compared to Group A. One minute after intubation, the average HR in Group A was 95.74 bpm, while in Group B it was 80.99 bpm (p < 0.05). Similarly, SBP was higher in Group A (135.52 mmHg) compared to Group B (114.57 mmHg) (p < 0.05). Intubation time was longer for Group B (30.83 seconds) than for Group A (24.69 seconds) (p < 0.01). Postoperative complications were lower in Group B, with 3 patients (3%) reporting a sore throat, compared to 11 patients (11%) in Group A (p = 0.024). Additionally, there were no cases of soft tissue trauma in Group B, whereas 11 patients (11%) in Group A experienced this complication (p < 0.01). Conclusion: Fiberoptic intubation offers better hemodynamic stability and fewer postoperative complications, although it requires more time for intubation. It is a safer option for airway management, particularly in patients prone to hemodynamic changes or airway injuries.

Sleep disorders, encompassing conditions such as obstructive sleep apnea (OSA), insomnia, restless leg syndrome (RLS), and circadian rhythm disturbances, have emerged as critical contributors to cardiovascular disease (CVD) risk, which remains a leading cause of global mortality and morbidity. These disorders disrupt the restorative functions of sleep, initiating a cascade of physiological changes including heightened sympathetic nervous system activation, systemic inflammation, oxidative stress, hormonal imbalances, and metabolic dysregulation. Such disruptions significantly exacerbate cardiovascular risk factors, including hypertension, atherosclerosis, arrhythmias, and heart failure. The bidirectional relationship between sleep disorders and cardiovascular health highlights the need for comprehensive management strategies that integrate sleep health into broader preventive care frameworks. This systematic review synthesizes findings from 29 studies to explore the underlying mechanisms linking sleep disorders to cardiovascular outcomes, evaluate the effectiveness of current therapeutic interventions, and identify challenges in diagnosing and managing these conditions. Using a PRISMA-based methodology, the review emphasizes the role of sleep disorders as both independent risk factors and contributors to the progression of existing cardiovascular conditions. Evidence suggests that interventions such as continuous positive airway pressure (CPAP) therapy for OSA and cognitive-behavioral therapy for insomnia (CBT-I) can mitigate cardiovascular risks, but challenges related to adherence, access, and awareness remain significant barriers. Sleep disorders such as insomnia, narcolepsy, RLS, and OSA significantly impair heart health by disrupting the sleep cycle, increasing cardiovascular stress, and promoting metabolic dysregulation. Despite advancements in understanding the relationship between sleep disorders and cardiovascular health, critical gaps in knowledge persist, particularly regarding the long-term impact of therapies, the role of emerging technologies, and the implications of genetic and environmental factors. By addressing these gaps and promoting multidisciplinary approaches to care, integrating sleep health into cardiovascular risk management can significantly reduce the burden of disease. The findings underscore the urgent need for public health initiatives, policy interventions, and innovative research to address the dual burden of sleep disorders and cardiovascular diseases, ultimately improving population health outcomes.

Background: Acute coronary syndromes (ACS) are the primary cause of death worldwide and includes Unstable angina (UA), Non-ST segment elevation (NSTEMI) and ST segment elevation myocardial infarction (STEMI). The standard diagnostic test for ACS is currently troponins. Increased levels of Gamma glutamyl transferase (GGT) may indicate the oxidative stress inside the coronaries which further increases the atherosclerotic plaque formation. Assessing GGT levels in relation to the severity of ACS and its association with major adverse cardiovascular events (MACE) is the current goal. Methodology: 80 participants with ACS who were more than 18 years old participated in the current cross-sectional study, which was conducted in a tertiary hospital between December 2023 and August 2024. Hepatobiliary diseases, drug consumption such as barbiturates, phenytoin, and anti-tubercular medications, and history of alcohol intake in less than 24 hours were the exclusion criteria. Physical examination along with electrocardiography (ECG), a complete blood count, renal and hepatic function tests, GGT, troponin-I were done. Additional testing was performed, including coronary angiography (CAG) and echocardiography. A two-tailed approach was used for all statistical tests, and a p-value of less than 0.05 was considered statistically significant.  Results: The study consisted of sample size of 80 with 52(65%) males and 28(35%) females. Majority (61.25%) of the people at presentation had at-least one of the comorbidities. Majority (56.25%) of the people had no risk factors at the time of presentation. The mean, median and standard deviation of GGT were 78.3IU/L, 68IU/L and 45.592IU/L respectively. The study consisted mainly of STEMI patients i.e., 49 (61.3%) followed by NSTEMI (25%) and UA (13.8%). Majority of the people with STEMI had serum GGT levels more than 70IU/L. The major adverse cardiovascular outcomes were found in 8 patients (10%). The majority of the people with MACE had serum GGT levels above 70IU/L. Death (37.5%) was the predominant MACE among them. The study showed significant correlation of GGT values with both CAG and troponin-I levels. Serum GGT and ACS were shown to be significantly correlated in the study with p-value of 0.005. A substantial correlation between serum GGT and MACE was also discovered in the current investigation, with a p-value of 0.02. Conclusion: We observed significant correlation with ACS severity and GGT levels along with the association between serum GGT and MACE. Increment of GGT levels in UA in this trial may also help with the early start of therapy and serve as a predictor for future difficulties. GGT is therefore a useful and affordable marker for ACS severity prediction, early therapy initiation and to predict MACE during the hospital stay.

Traumatic cataract is one of the common sequeal following ocular injury. It is one of the leading causes of uniocular visual loss. A need was therefore felt to study the clinical profile of traumatic cataract, postoperative complication, to analyze the visual prognosis following traumatic cataract extraction with intraocular lens implantation.  Objectives: 1. To study the demographic profile of traumatic cataract. 2. To study the visual outcome after traumatic cataract surgery. 3. To study post-operative complications in traumatic cataract. Methods: A prospective hospital-based study on Forty-five cases who developed traumatic cataract were prospectively analyzed. Age, sex, traumatic sequelae, surgical strategies and postoperative complications were reviewed for all eyes from the period of June 2023 to May 2024.  Results: Out of the 45 patients 20 patients (44.44%) were female and 25 cases were & male (55.55%). 31 patients (68.88%) belong to rural background. Wood injury came out to be most common cause with 57.77 % in our study. 21 patients (46.66%) had vision between 6/12-6/6 while 2 patients had vision PL+ PR accurate following surgery due to posterior segment involvement. Conclusion: cataract extraction with IOL implantation provides satisfactory results in traumatic cataract. The main cause for impaired vision was corneal scarring and opacity obstructing visual axis and posterior capsule opacification

Background: Cigarette smoking is a leading cause of preventable respiratory morbidity and mortality. Small airway obstruction is an early manifestation of smoking-related lung damage and often precedes overt airflow limitation detectable by spirometry. Impulse Oscillometry (IOS) is a noninvasive tool that measures respiratory mechanics and offers potential advantages in detecting early small airway dysfunction in smokers. Methods: A cross-sectional observational study was conducted in the Department of Respiratory Medicine, SAIMS PGI, involving 96 smokers aged 18–60 years with a smoking history of ≥10 pack-years. Participants underwent detailed clinical evaluation, spirometry, and IOS testing. IOS parameters, including resistance at 5 Hz (R5), resistance at 20 Hz (R20), reactance at 5 Hz (X5), and R5–R20, were analyzed and compared with spirometry parameters such as FEV₁ and FVC. Statistical analysis evaluated the correlation between smoking intensity (pack-years) and airway obstruction. Results: The study included 96 smokers (mean age 55.2 ± 10.4 years; 70 males, 26 females) with an average smoking history of 30.5 ± 15.6 pack-years. IOS detected significant increases in R5 (6.2 ± 1.5 cm H2O/L/s) and R20 (4.5 ± 1.0 cm H2O/L/s), along with a decrease in X5 (-0.5 ± 0.4 cm H2O/L/s) compared to normal ranges (p < 0.001). These abnormalities were observed even in smokers with normal spirometry. Correlation analysis revealed a significant association between pack-years and IOS parameters (p < 0.05). Conclusion: Impulse Oscillometry is a sensitive and noninvasive tool for early detection of small airway obstruction in smokers. By detecting changes undetectable by spirometry, IOS offers potential for earlier diagnosis and intervention, reducing the risk of progression to chronic obstructive pulmonary disease.

Background: Pulmonary tuberculosis (PTB) is a leading cause of mortality, particularly in developing countries, and its burden is exacerbated by HIV co-infection. Diagnosing sputum smear-negative cases poses a significant challenge due to their contribution to transmission and the limitations of conventional diagnostic methods. Fibreoptic bronchoscopy-guided bronchoalveolar lavage (BAL) has emerged as a promising diagnostic tool. Methods: This prospective study was conducted over 18 months (September 2022–February 2024) at a tertiary care hospital to evaluate the diagnostic utility of bronchoalveolar lavage (BAL) in sputum smear-negative pulmonary tuberculosis (PTB). Patients suspected of PTB, based on clinical history, physical findings, and chest X-ray lesions, were included if they had two sputum smear-negative samples for acid-fast bacilli (AFB) per RNTCP guidelines. Exclusions included smear-positive cases, extrapulmonary tuberculosis, ongoing anti-TB treatment, and contraindications to bronchoscopy. BAL samples underwent smear microscopy, culture, and CBNAAT for Mycobacterium tuberculosis detection and rifampicin resistance assessment. Data were analyzed using descriptive and inferential statistics, with p-values <0.05 considered significant. Results: The study population comprised 200 patients (154 males and 46 females) aged 11–70 years, with the majority aged 21–30 years. Common presenting symptoms included cough/expectoration (88.6%) and fever (85.7%). Chest X-rays revealed pulmonary infiltrates in 55.7% of cases, cavitary lesions in 30.0%, and nodular shadows in 8.6%. The right upper lung zone was most frequently involved (60.0%). The diagnostic yield of bronchoscopy for smear-negative PTB was significantly enhanced when BAL fluid analysis was combined with culture and radiological findings. Conclusion: Fibreoptic bronchoscopy-guided BAL is a safe, reliable, and effective diagnostic method for sputum smear-negative pulmonary tuberculosis. Incorporating BAL fluid analysis, transbronchial lung biopsy, and post-bronchoscopy sputum cultures significantly improves diagnostic accuracy, aiding timely treatment and reducing disease burden.

Background: The complications of Diabetes Mellitus are due to both microvascular and macrovascular involvement. The sexual dysfunction in diabetic males manifest as Erectile dysfunction (ED). This study aims at evaluating the prevalence of ED among diabetic males and the factors associated with it. Methods:  360 Diabetic males of age group between 25 - 65 years were included in the study.  Their Erectile function was assessed using the IIEF-5 score.  The influence of various factors like Age, BMI, Duration of DM, HbA1c, LDL cholesterol, HDL cholesterol, Triglycerides, Uric acid, HsCRP and Testosterone on ED were studied.  Results and conclusions: The prevalence of ED among diabetic males is 45 % and is associated with increasing age of the patients, duration of diabetics, high BMI, low HDL, high Triglycerides, high HsCRP and high uric acid levels.

Objective: This cross-sectional study was carried out to assess the awareness of role of diet in oral and systemic health and their inter-relationship amongst the general population of Jodhpur city, Rajasthan. Materials and Methods: A cross-sectional epidemiological survey was conducted 800 subjects of Bareilly city and a self-constructed questionnaire was used to collect the information. Here patient’s awareness for periodontal-systemic health inter-relationship was also assessed by questionnaire. Results: It was observed that majority knew about role of diet in oral and respiratory health whereas many of them were not much aware about association of periodontal and systemic conditions which was statistically significant. Conclusion: There is an imperative call for ample educational programs to promote good oral hygiene awareness and its impact on systemic health amongst the general population 

Background: Community-Acquired Pneumonia (CAP) is the leading cause of death in children under 5 years of age according to WHO. Platelets have been recognized as an important component of an immune response. Thrombocytopenia is a prognostic indicator of pneumonia according to different studies Methods: A Retrospective observational study was conducted in the Department of Paediatrics in the tertiary care teaching hospital in Karwar from April 2021 to April 2023 for a period of 24 months to determine the association of abnormal platelet count with complications, TLC, CRP and duration of hospital stay in under 5 children with CAP. Results: A total of 150 children were included in the study. Majority were between 3-5 years (58%) of age and males (58%). 24.7% were diagnosed to have severe pneumonia. Both thrombocytopenia and thrombocytosis showed significant association with development of systemic complications. Weak association was found between platelet count and TLC but no significant association observed between platelet count with CRP and duration of hospital stay.  Conclusion: Abnormal platelet count can be considered as a prognostic indicator in CAP among children of under 5 years age. 

Overall, machine learning is fundamentally one of the standard and evolving approach which has efficient algorithms for classification and reorganization through recursive learning. I argue that machine learning allows it’s possible to build and verify a classification system were, on a human level, can be called ‘intelligence’. In term of disease forecasting, it is machine learning which has done the greatest wonder provided one has the right training and testing case. This Study introduces a novel approach of predicting diabetes using Machine Learning Classification which is based on other factors that contributes to an individual’s diabetes risks. We have a dataset with a total of 768 instances and 9 attributes. It includes the usual risk factors such as age, glucose, and BMI. We were six method uses that is Logistic regression, Random Forest, KNN, Support Vector, Decision Tree and Naïve Bayes. The accuracy of the different algorithm of the training data set was obtained by 77 %, 100%, 81%, 81%, 100% and 74% respectively.

Background: Timely reperfusion is essential in STEMI patients, with the choice between primary percutaneous coronary intervention (pPCI) and fibrinolytic therapy depending on treatment availability, delivery time, and ischemic duration. The pharmacoinvasive strategy involves immediate fibrinolysis followed by coronary angiography within 3–24 hours. This study compares the efficacy and safety of the pharmacoinvasive strategy to pPCI in STEMI patients during hospitalization. Methods: This was a cross-sectional study conducted on 138 patients divided into two groups (group 1 - primary PCI) and group 2 (pharmacoinvasive therapy). The study was carried out Department of Cardiology, Tirunelveli Medical College Hospital, Tirunelveli over period of one year after obtaining ethical clearance. Results: The mean age in Group 1 (n=69) was 54.93 ± 10.247 years, while in Group 2 (n=69), it was 54.46 ± 9.393 years. In a comparison between Group 1 (primary PCI) and Group 2 (pharmacoinvasive PCI), significant differences were found in pre-PCI TIMI scores. Group 1 had 10.1% with a TIMI score of 0, compared to 2.9% in Group 2 (p = 0.039). Both groups had similar distributions for TIMI scores of 1 and 2. After PCI, Group 1 achieved 100% TIMI 3, while 97.1% of Group 2 patients reached TIMI 3, with 2.9% having TIMI 2 (p = 0.154). The results of our study indicated no statistically significant difference in mortality between primary PCI and pharmacoinvasive PCI (0% vs. 1.4%, p = 0.316). Conclusion: Pharmacoinvasive strategy is non inferior to primary PCI. The pharmacoinvasive strategy, when compared to primary PCI (PPCI), demonstrates similar rates for both primary and secondary endpoints. The pharmacoinvasive strategy leverages the availability of fibrinolysis alongside the effectiveness of PCI.

Background: Diabetic foot ulceration (DFU) is a devastating complication of diabetes that is associated with infection, amputation, and death. Dressing is mostly used in wound care for both the protection of the wound as well as its healing. Silver ions were identified as a highly efficient potent of antibiotics of different classes. The study aims to investigate the efficacy of silver nano gel in wound healing among patients with diabetic foot ulceration. A prospective study was over a period of six months (July 2023-December 2023) among 60 patients who were randomly allocated into two equal groups. The conventional dressing (group-B) was compared with silver nano gel (group-A) dressing through evaluation of wound condition at the time of admission, 4^th and 8^th week. The data was analyzed using Jamovi v 2.3.28 software. The results showed that wound size was reduced in group A in the 4^th and 8^th week of admission which is statistically significant with a p-value of 0.001 also healthy granulation tissue was noted in seventy percent of the patients in group A, whereas only fifty-five percent in group B. Employing nano-silver gel for the management of diabetic foot ulcers was much more effective than using conventional dressing techniques.

Introduction: Infective endocarditis (IE) is characterized by inflammation of the endocardium, primarily caused by infectious agents affecting cardiac valves and other extracardiac locations. Despite advancements in the management of IE, it remains an extremely difficult condition for clinicians to diagnose, resulting in significant morbidity and mortality 1. Predisposing factors for infective endocarditis include underlying anatomical cardiac conditions such as valvular and congenital heart diseases, as well as the presence of prosthetic valves and intravenous drug abuse. The spectrum of infective endocarditis (IE) in India has evolved over the past decade due to a decrease in rheumatic heart disease incidence, a rise in intravenous drug abuse, improved survival rates among congenital heart disease patients, and the availability of diagnostic tools such as echocardiography2-4. Gram-positive cocci, particularly Staphylococcus aureus, are the predominant infecting organisms, affecting each native and prosthetic valve infective endocarditis. Case Report: A 19-year-old man had intermittent fever for 4 months, NYHA class III shortness of breath for 3 weeks, and bilateral lower limb oedema for 2 weeks. Diabetes, high-risk conduct, or intravenous drug misuse were not present. Upon examination, the patient presented with fever (oral temperature 38.8°C), tachypnea (respiratory rate 30/min), and a heart rate of 118/min. Blood pressure was measured at 114/70 mm Hg, with elevated jugular venous pressure (JVP) at 10 cm above the sternal angle (v waves > waves). Conclusion: The double-chambered right ventricle is often associated with rare congenital abnormalities like pulmonary stenosis, VSD, and aortic obstruction. DCRV seldom causes infective endocarditis, which affects the pulmonary valves when the jet damages the endothelium. It is rare for DCRV to affect the distal RVOT, tricuspid, pulmonary, and aortic valves. Diagnosing significant involvement is difficult, and surgery is usually needed.

Background: Coronary artery disease is one of the major risk factor for myocardial infarction (MI) and associated death. It is very important to predetermine the coronary artery obstruction to reduce the mortality. Computed tomography angiography (CTA) can be used to determine the degree of blockage and Circulatory T-cadherin can be used for early screening of cardiovascular diseases. Aim: This study aims to evaluate the prognostic role of computed tomography angiography and circulatory T- cadherin for better prognosis and treatment. Methodology: This study is case-control and was done on 140 subjects. 70 healthy controls and 70 cases those were subjected for CTA, or advised to invasive coronary angiography (ICA) or referred for CTA having acute chest pain, difficulty in breathing, heaviness in chest with age in between 30-70 years were enrolled after informed consent. Chronic kidney disease (CKD), hyperthyroidism, Pregnant women were excluded from the study. Waist circumference, Blood pressure, fasting blood sugar and lipid profile was done to evaluate involved risk factors in all the enrolled subjects. Results: Maximum patients i.e. 25(35.7%) were of age in between 51-60 years. 25 patients were obese, 38 having T2DM, 32 with hyperlipidemia and 40 were having hypertension. When CTA was done 15(21.4%) have single vessel involvement, 20(28.5%) have two vessel and 35(50%) having three vessels involvement were recorded. Circulatory T-cadherin was estimated and the mean in cases (7.12±0.60) was significantly higher than controls (1.01±0.32) and when Circulatory T-cadherin was estimated among cases the mean was highest (7.79±0.73), in patients having three vessels involvement and was statistically significant (p<0.05). Conclusion: This can be concluded that estimation of circulatory T-cadherin can be used as prognostic tool in determining the degree and severity of coronary obstruction. This estimation can be used for early screening and preventing the patients from the risk of MI, hence reducing the mortality associated with coronary artery disease (CAD.

Objective: To evaluate and compare the hemodynamic effects of ketamine + propofol (ketofol) and Propofol during induction in adult elective surgeries. Parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SpO₂), and postoperative outcomes were analyzed. Methodology: This retrospective observational study was conducted at Gandhi Surgical Hospital, Tagore Road, Gandhidam, Gujarat, India. The study reviewed patient records from August 1, 2024, to October 31, 2024. The study aimed to compare hemodynamic stability and recovery characteristics between patients receiving ketamine + propofol (ketofol) and propofol alone during elective surgeries lasting more than 30 minutes. Result: Ketofol and Propofol demonstrated comparable hemodynamic stability, with no statistically significant differences in heart rate (Ketofol: 75.13 ± 7.61 bpm vs. Propofol: 77.13 ± 6.46 bpm, p = 0.444), systolic blood pressure (Ketofol: 130.47 ± 6.95 mmHg vs. Propofol: 134.47 ± 14.68 mmHg, p = 0.348), or diastolic blood pressure (Ketofol: 79.93 ± 4.76 mmHg vs. Propofol: 75.60 ± 7.72 mmHg, p = 0.075). Time to ambulation was significantly longer with Ketofol (78.67 ± 30.85 minutes) compared to Propofol (40.33 ± 9.90 minutes, p < 0.001). Gender distribution, ASA classification, postoperative nausea, and complications showed no significant differences, and both groups had high patient satisfaction scores, though Ketofol showed a slight edge (score 8 in 73.3% vs. 53.3%, p = 0.215). Conclusion: Ketofol provides effective Induction agent with stable hemodynamic parameters, making it suitable for procedures requiring enhanced analgesia. However, its longer recovery time may limit its utility in settings where rapid postoperative recovery is crucial. Propofol, with its quicker recovery profile, may be preferred when procedural Induction agent demands faster ambulation. Both agents demonstrate excellent safety profiles with minimal complications, allowing clinicians to tailor Induction agents based on procedural and patient needs.

Our study comparing two groups for elective surgery requiring anesthesia showed that a better view of the larynx was obtained in the McCoy group with respect to Cormack and Lehane grade compared to the Macintosh group and a significant HR of 3 and 2 minutes after laryngoscopy was increased in the McCoy group. . The hemodynamic response to laryngoscopy in the Macintosh group was characterized by an increase in HR, SBP, DBP and MAP compared to the McCoy group. Better visibility the hemodynamic response to laryngoscopy is less compared to the Macintosh blade.

Background-The aim of this study is to detect the possible reasons of abdominal pain in the patients aged 65 and older admitted to emergency department (ED) with complaint of abdominal pain which is not related to trauma, to determine the length of hospitalization of old (65-75 age) and elderly (aged 75 and older) patients, and to define the hospitalization and mortality rates. Methodology: In the study, 336 patients were included. Groups were compared in respect to gender, internal or surgical pre-diagnosis, complaints accompanying abdominal pain, vital findings, comorbidities, requested consultations, hospitalizing service, waiting time in the ED and in the hospital, and treatment methods. Results: Of the patients, 48.2% were male, and 51.8% were female. While 52.4% of the patients were in 65-74 age group, 47.6% of them were aged 75 years and above. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain. Most common pre-diagnosis were biliary diseases and diseases related to biliary tract followed by nonspecific abdominal pain, abdominal pain secondary to malignity, ileus, and acute gastroenteritis, respectively. The most frequent finding accompanying abdominal pain was vomiting. The most frequent chronic disease accompanying abdominal pain was hypertension in both age groups. We observed that 75.9% of the patient’s required consultation. We detected that 48.8% of the patients with abdominal pain were hospitalized and they were hospitalized mostly by gastroenterology ward (24.8%). Surgical treatments were applied to the 17.6% of the patients with abdominal pain. Conclusion: Clinical findings become indistinct by age, and differential diagnosis of abdominal pain gets more difficult in geriatric patients. Therefore, physicians should consider age related physiological changes in order to distinguish geriatric patients admitted to emergency service with abdominal pain from pathological cases requiring immediate surgical operation

Heart failure (HF) is a significant cardiovascular condition associated with high morbidity and mortality. Iron deficiency is prevalent among HF patients and has been linked to worsened outcomes. Recent studies suggest that correcting iron deficiency may enhance functional capacity and reduce hospitalizations. Additionally, red cell distribution width (RDW) has emerged as a cost-effective prognostic marker in HF. This study aims to explore the relationship between iron parameters—including serum ferritin, total iron-binding capacity (TIBC), and RDW—and the severity of heart failure in patients diagnosed with heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).  Material and Methods: A cross-sectional study was conducted at a tertiary care center, enrolling 180 adult patients diagnosed with heart failure through echocardiography. Data on demographics, clinical history, symptoms, and iron profiles (serum iron, ferritin, TIBC, and RDW) were collected. The severity of heart failure was classified using the New York Heart Association (NYHA) criteria. Statistical analysis was performed using SPSS version 21.0, with descriptive statistics, ANOVA, and Student’s ttests applied to assess significant differences.  Results: The cohort had a mean age of 58.36 years, with 62.8% diagnosed with HFrEF. Serum iron, ferritin, and TIBC levels significantly decreased with increasing severity of HF (p < 0.05). RDW exhibited a notable upward trend correlating with NYHA classification (p < 0.001). There were no significant differences in TIBC and unsaturated iron-binding capacity across severity levels. A significant negative correlation was observed between patient age and RDW (r = -0.316, p < 0.003).  Conclusion: The findings highlight that heart failure is associated with significant alterations in serum iron parameters, especially as HF severity increases. RDW serves as an effective and economical prognostic marker, suggesting that screening for iron deficiency in HF patients may improve clinical outcomes and reduce rehospitalization rates.

Background: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality worldwide. Risk stratification in acute coronary syndrome (ACS) plays a crucial role in predicting patient outcomes and guiding therapeutic decisions. The GRACE (Global Registry of Acute Coronary Events) and SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) scores are two well-established tools for evaluating risk in ACS patients, but their correlation has not been fully explored. Objective: This study aims to evaluate the correlation between the GRACE risk score and the SYNTAX score in patients with ACS, and to assess the predictive ability of these scores in guiding clinical decisions, particularly in revascularization strategies. Methods: A prospective observational study was conducted in the Cardiology Department of Jawaharlal Nehru Medical College, Belagavi, from January 2023 to June 2024. A total of 249 ACS patients were enrolled. The GRACE risk score was calculated for each patient based on clinical parameters, while the SYNTAX score was determined through coronary angiography. The correlation between the two scores was assessed, and their ability to predict the severity of CAD and guide treatment strategies was evaluated. Results: The mean age of the participants was 60.02 ± 10.99 years, with the majority of patients aged between 46 and 65 years. The study revealed a significant correlation between the GRACE risk score and the SYNTAX score. A higher GRACE score was associated with more severe coronary artery disease, as reflected by higher SYNTAX scores. The ROC analysis demonstrated that the GRACE score had a predictive capacity for severe CAD (SYNTAX score ≥32) with an area under the curve of 0.696 (p=0.001). Additionally, the study found that the combination of GRACE and SYNTAX scores provided a more accurate stratification of patients for revascularization procedures. Conclusion: The GRACE risk score and SYNTAX score are significantly correlated in patients with ACS and can complement each other in guiding clinical decision-making. This combined risk assessment approach is valuable for identifying high-risk patients and determining the most appropriate revascularization strategy. Further research is needed to refine these tools and explore their potential in personalized medicine for ACS patients.

Introduction: COPD is characterized by a poorly reversible airflow limitation resulting from chronic inflammation. Spillover of inflammatory mediators in systemic circulation may predispose to various co-morbid states like diabetes mellitus, ischemic heart disease, osteoporosis, metabolic syndrome etc. in COPD. We aimed to study the prevalence of metabolic syndrome in COPD patients and assess association between severity of COPD and metabolic syndrome Methods: Patients with confirmed COPD were included in the study. Patients having acute exacerbation in the last 6 weeks and on hypolipidemic drugs were excluded from the study. Symptoms, smoking status, co-morbidities and treatment history were recorded in all patients. Patients were subjected to proper clinical examination and routine blood investigations. Symptom of dysnea was recorded as per MMRC functional classification, Six minute walk test(6MWT) and Visual analog scale(VAS).All patients underwent pulmonary function test(PFT), transthoracic 2D echocardiography, CT scan for visceral fat accumulation and body composition analysis. Results:101 patients were studied with 75% males and 25% females. Sixty five(65%) of patients were smokers with median smoking of 15 pack years and 37% of them were current smokers. The mean age of study population was 60.8±8.8years. The mean BMI and waist circumference of the patients were  21.7+4.1 kg/m2 and 84.5±13.4 cm respectively.    Number of patients in stage I,II,III and IV of COPD were 6,45,36 and 14 respectively. The prevalence of metabolic syndrome in Stage I,II,III & IV of COPD were 33.3%, 42.2%, 36.1% and 35.7% respectively. Overall prevalence was 38.6%. No statistical significant difference was found among groups in the occurrence of metabolic syndrome (p:0.684). The fasting blood glucose level (≥ 100 mg/dL or known diabetic) was found to be abnormal among 37.6% subjects. There was significant difference in the presence of abnormal blood glucose level between stage I/II and stage III/IV of COPD (p:0.041).No significant difference in other metabolic parameters like HDL,LDL, Triglyceride and deranged blood pressure was found between different stages of COPD. On multivariate logistic regression analysis, total body fat was only found to be the independent predictor of metabolic syndrome in COPD. Conclusion: Metabolic syndrome is an important co-morbidity in patients of COPD. However, the prevalence of metabolic syndrome in COPD is not related to its severity, exercise capacity, severity of dyspnoea, duration of disease or exacerbation frequency.

Since the description of PRES in 1996 by Hinchey et al, its being increasingly recognized and reported. With increased facilities like neuroimaging, it is animportant differential in the spectrum ofhypertensive encephalopathy. We retrospectively analyzed 5 cases of PRES in our ICU over a period of 1 year. Demographic parameters, presentations, etiologies, radiological findings including outcome was studied. Most common aetiologies were pregnancy induced eclampsia and immunosuppressant’s. ICU admissions were for uncontrolled hypertension, seizures, and low level of consciousness. Two patients were ventilated for airway protection.  One patient had a complicated course and developed septicaemia and TTP. Two patients with renal involvement with PRES required hemodialysis. All patients recovered, none had residual neurological deficits. Given its diverse presentation from headache, blurring of vision to seizures and coma. Increased awareness with high degree of suspicion is the key for early identification and management of this nearly reversible condition.

Background- Glycated hemoglobin (HbA1c) is a key indicator for assessing long-term glycemic control in diabetes mellitus (DM) and is used for diagnosis. However, certain conditions, such as iron deficiency anemia (IDA), can affect HbA1c levels. This study aims to investigate the impact of IDA on HbA1c levels in non-diabetic patients. Methods- This study was conducted from July 2022 to July 2024 at the Sri Aurobindo Institute of Medical Sciences. A total of 100 non-diabetic participants diagnosed with IDA were included. Data collected included socio-demographic information, clinical history, and various blood tests including CBC, serum ferritin, iron profile, RBS, and HbA1c. Exclusion criteria were chronic diseases, known cases of diabetes, age below 18, and those on iron supplements or blood transfusion. Comparative analyses were performed between non-anaemic and IDA groups. Results- The study found significant differences in iron indices and HbA1c levels between non-anaemic and IDA groups. The mean HbA1c level was significantly higher in the IDA group (6.04 ± 0.74%) compared to the non-anaemic group (4.91 ± 0.65%). Severity of anemia correlated with higher HbA1c levels, with severe anemia showing the highest HbA1c values. Conclusion- The study concludes that IDA significantly elevates HbA1c levels in non-diabetic patients, suggesting that iron deficiency is an important factor influencing HbA1c measurements. This highlights the need for cautious interpretation of HbA1c levels in patients with anemia.

Introduction: Rheumatic mitral stenosis (MS) is a significant clinical condition resulting from rheumatic heart disease (RHD), a sequela of acute rheumatic fever that leads to chronic valve damage. It primarily affects the mitral valve, leading to narrowing and obstructed blood flow from the left atrium to the left ventricle, thus increasing atrial pressure and affecting cardiac function. Rheumatic Mitral stenosis leads to depressed left ventricular function which is frequently overlooked by conventional echocardiography. Speckle tracking echocardiography is a sensitive tool to detect this depressed left ventricular function and thus helps identifying early decline of left ventricular function. Rheumatic carditis  itself is responsible for decline in left ventricular function. Aims: To study speckle tracking echocardiography among patients of rheumatic mitral stenosis. Materials & Methods: The study design was Observational, Cross Sectional Study.Place of Study were Cardiology Department of ABVIMS and Dr RML Hospital, New Delhi-110001. Period of Study: from December 2022 to November 2023. Result: Progressive mitral stenosis has an average age of 25.8 years, age range for severe mitral stenosis is 20 to 36 years, with a mean age of 26.6 years in normal controls. BSA of individuals with Severe Mitral Stenosis a mean of 1.69. BSA for people with progressive mitral stenosis is 1.58 square meters, mean of 1.71 in the Normal group. In the Progressive Mitral Stenosis group, the mean GCS is -0.204%, the Severe Mitral Stenosis group, the mean GCS is -0.198%. In the Progressive Mitral Stenosis group, the mean strain rate is 1.05,  Severe Mitral Stenosis group has a mean strain rate of 1.06. Progressive Mitral Stenosis group, the mean EF is 57.8%, severe Mitral Stenosis group, the mean EF is slightly lower at 56.6%, The Normal group has a mean EF of 57.9%.For Progressive Mitral Stenosis, the mean GLS is -0.160%, in the Severe Mitral Stenosis group, the mean GLS is -0.152%. Conclusion: We came to the conclusion that in adult patients with rheumatic mitral stenosis (MS), Speckle Tracking Echocardiography (STE) is a sensitive and successful technique for identifying early changes in left ventricular (LV) strain. According to our research, LV strain metrics—in particular, global longitudinal strain, or GLS—can identify subclinical alterations in LV function that traditional echocardiography techniques frequently overlook.

The mind-body connection is a critical area in psychoneuroimmunology, examining how psychological factors, especially chronic stress, impact immune function. This systematic review synthesizes findings from 75 studies published between 2003 and 2023 to explore mechanisms linking stress with immunity and evaluates interventions like mindfulness, cognitive behavioural therapy (CBT), and yoga in mitigating these effects. Following PRISMA guidelines, studies were selected based on relevance to immune biomarkers, intervention efficacy, and health outcomes. Results indicate that chronic stress promotes a pro-inflammatory immune profile, increasing susceptibility to infections, inflammatory conditions, and autoimmune disorders. Conversely, mind-body interventions demonstrate the potential to counteract stress-induced immune dysfunction by reducing stress markers, enhancing immune resilience, and promoting immune stability. These findings support integrating mind-body practices as preventive and therapeutic tools in healthcare for managing stress-related immune dysregulation.

Background: An understanding of musculoskeletal anatomy is crucial for medical students as it underpins effective diagnosis and management of various clinical conditions. Despite its importance, many students lack sufficient knowledge, potentially leading to diagnostic errors. This study assesses the knowledge and awareness of musculoskeletal anatomy among medical students across multiple institutions to identify gaps and propose improvements. Materials and Methods: A multi-institutional, cross-sectional study involving 500 students from five institutions was conducted. A validated questionnaire, consisting of a 50-item multiple-choice test and a Likert scale survey, evaluated knowledge and self-perceived confidence across pre-clinical, clinical, and postgraduate levels. Data were analyzed using SPSS, including chi-square tests, ANOVA, and Pearson correlation. Results: The study demonstrated a progression in knowledge scores across academic levels, with mean scores increasing from 24.7 in pre-clinical students to 38.6 in postgraduate students. There were significant differences in performance between institutions, with variations linked to the use of different teaching methodologies. Mixed methods, combining cadaveric dissection, digital simulations, and clinical integration, yielded the highest mean score of 37.2. The correlation between self-perceived confidence and actual knowledge was moderate to strong (r = 0.54 overall), with confidence increasing alongside academic progression. Conclusion: The study highlights gaps in early anatomy education and inconsistencies across institutions. A multi-modal, integrated approach is recommended for enhancing student proficiency, providing essential insights for optimizing anatomy curricula.

Introduction: Laparoscopic cholecystectomy is one of the most commom surgeries done under general anaesthesia. Second generation supraglottic airways are used more frequently due to ease of insertion, less haemodynamic changes and good oropharyngeal pressures nowadays. Aim: To compare efficacy and safety of Baska mask, Ambu AuraGain and LMA Supreme in airway management of laparoscopic cholecystectomy Methodology: A randomized controlled, open label study was done on 150 patients of either sex, of age 20 to 70 years undergoing elective laparoscopic cholecystectomy under general anaesthesia. The patients were randomized in to one of the three groups, Group I (Baska mask), Group II (Ambu AuraGain) Group III (LMA Supreme) and airway secured. Time required for successful insertion, correct insertion of device ,OLP and leak fraction and ease of gastric tube placement noted. Postoperative morbidity, laryngopharyngeal morbidity and haemodynamic stability also noted. Results: Time required for successful insertion was least for AAG: median 7.8 sec, Baska mask :8.15sec, LMA Supreme (9.45 sec). Oropharyngeal leak pressure (OLP) significantly highest in Baska mask group (32.39 ± 1.65) than AAG group (28.33 ±1.17) and LMA Supreme (25.91 ±1.44) cm of H2O.Ease of insertionof gastric tube, incidence of postoperative complications, laryngopharyngeal morbidity and haemodynamic changes were same. Conclusion: All SADs were comparable and efficient in maintaining the hemodynamic stability. Higher first attempt success rate, less time required for adequate insertion and ventilation, ease of insertion, and gastric drainage, less intubation response of Baska mask, AAG and LMA Supreme make them an ideal choice for airway management of patients undergoing laparoscopic cholecystecomy.

Introduction: Early recognition of tissue perfusion inadequacies is critical, and key parameters include lactate clearance and the venous-arterial CO2 difference (PCO2 gap). This study evaluates these parameters and compares their outcomes with the APACHE-II scoring system. Materials And Methods: This single-center, prospective observational study included 66 critically ill adult patients. Blood lactate concentration, PCO2 gap, and APACHE-II score were measured at admission (H0) and after 12 hours of resuscitation (H12). Lactate clearance was calculated from H0 to H12. The PCO2 gap was defined as the difference between central venous and arterial CO2 partial pressures. Results: Of the 66 patients (40 males, 26 females), 28 (42.4%) survived and 38 (58.6%) did not. Ventilatory support was required by 80.3% of patients, and 62% required ionotropes. Lactate clearance was significantly higher among survivors (18.21 ± 7.09%) compared to non-survivors (-7.33 ± 9.27%, P < 0.001). While the PCO2 gap decreased over time in both groups, it remained higher in non-survivors. APACHE-II scores also remained elevated in non-survivors. Lactate clearance at 12 hours was the best predictor of ICU mortality (AUROC = 0.979). Conclusion: Blood lactate clearance is the strongest predictor of ICU mortality, but including the PCO2 gap at admission may enhance resuscitation and therapeutic strategies to improve outcomes in critically ill patients.

Background: Pre procurement study of impact of using CSTD on environmental drug contamination, while reconstituting chemotherapeutic agents in a chemotherapy facility at Cancer center in North India.  Methodology: A case control study conducted at two cubicles conducted over a period of one month for 50 reconstitutions of chemotherapeutic agents. A swipe study analysis of 17 areas was done to evaluate surface contamination. Data regarding perception of nursing staff was collected using two internally validated structured close ended questionnaires. Records of all the vials being used and drugs being dispensed were recorded and documented. The cost analysis was done after ascertaining the minimum expense incurred. The data was compiled, tabulated and analyzed using SPSS version 21.0.  Results: Chemotherapeutic drug preparation and administration was not as per ISOPP standards at the center. The swipe test results ascertained occurrence of environmental contamination at study site to as high as 4780 ng /cm2 in control phase, reduced in almost all areas in post intervention phase. An average of 3.5 hours/ day were spent by respondents in contact with chemotherapeutic agents where 75% respondents complained of experiencing acute symptoms after contact and all respondents found the system easy to use and useful in reducing drug spillage. Rs.65,862 /- INR could be saved by reducing wastage of drugs by the use of this device.  Conclusion: The use of the device may be expensive in a lower middle-income country like India but the device is useful in reducing health hazards to the healthcare personnel.

Background: Endothelial dysfunction marks the initial phase of atherosclerosis, a condition that leads to the thickening and stiffening of arterial walls, particularly in the aorta. This increased arterial wall thickness and stiffness result in higher arterial resistance, subsequently reducing the aortic propagation velocity (APV). This study aims to explore the relationship between APV, a relatively under-researched echocardiographic parameter, and the presence and severity of coronary artery disease (CAD) in patients experiencing acute coronary syndrome (ACS). The study is aimed.  Objective:  To assess the aortic propagation velocity and correlate it with the severity of cad using syntax score in patients presenting with acute coronary syndrome. Methods: A prospective observational study conducted in Department of Cardiology of Jawaharlal Nehru Medical College, KAHER, Belgaum between January 2O23 to December 2O23. Patients with confirmed ACS diagnosis according to fourth universal definition of acute myocardial infraction were eligible to participate in the study.  Result: A total of 292 study participants were included in this study. Among the 292 study participants, 49.7% (n=145) were in the CAD group and 5O.3% (n=147) were in the non-CAD group. The mean age of the study participants was 57.27 ± 13.4O years. Among study participants, 68.97% were male and 31.O3% were female. The mean ejection fraction in CAD and Non-CAD groups were 49 ±9.94 and 58.O6 ±6.86 respectively. The mean SYNTAX scores I of study participants in CAD group was 18.42 ±13.15. The mean SYNTAX score II PCI and SYNTAX score II CABG were 34.78 ±13.75 and 25.7 ±13.O2 respectively.  The mean AVP average in CAD group and non-CAD group were 44.32 ±33.93 and95.8 ±34.15 respectively. The prevalence of diabetes and hypertension among the study participants in CAD group were 6O.69% and 45.52% respectively. Prevalence of substance abuse like smoking, tobacco and alcohol were present in 41.38%, 46.21% and 33.1% respectively. Chest pain, dyspnoea, palpitations, and syncope were present in 89.66%, 49.66%, 1.38% and 1.38% of study participants respectively. Positive correlation of AVP was present in variables like SYNTAX Score I (p<O.O5), SYNTAX Score II CABG (p<O.O5), SYNTAX Score II PCI (p<O.O5), HbA1c (p<O.O5) and age (p<O.O5). The prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) among the study participants in CAD group were 4O.69%, 2O.69% and 38.62% respectively. The ROC curve shows 84.8% of sensitivity and 1OO% of specificity in predicting CAD by APV value. The area under the curve was O.912 (p<O.O5). Conclusion: The study showed that APV can significantly predict the CAD. This technique offers a practical, non-invasive, and cost-effective echocardiographic approach for detecting or screening coronary artery disease (CAD). It may also prove useful in assessing comorbidities associated with CAD, aiding in risk stratification, and identifying individuals at high risk for CAD. Given its predictive accuracy and potential clinical utility, APV could be integrated into routine cardiovascular assessments, particularly for patients presenting with symptoms like chest pain or those with significant risk factors. However, the study underscores the need for further large-scale, multicenter studies to validate APV’s effectiveness and confirm its applicability as a screening tool for CAD in broader populations. These future studies would help refine APV's role in clinical practice and enhance its value in preventing and managing coronary artery disease.

Background: Asthma and chronic obstructive pulmonary disease (ACO) were considered two different diseases, but recently it was found that some patients have features of both asthma and chronic obstructive pulmonary disease (COPD), and they were defined as having ACO. It has been suggested that patients with ACO may have special characteristics such as greater airway hyperresponsiveness, higher sputum and blood eosinophils and better response to inhaled corticosteroids (ICS) than patients with COPD. History of atopy, eosinophilic inflammation and serum IgE had been emphasized by Hattori to identify patients with ACO among those with COPD.  Materials and methods: This cross‑sectional study included outpatients who applied to our pulmonology outpatient clinic with the previous diagnosis of asthma and COPD. These participants were evaluated to determine whether they met criteria of ACO. The diagnostic criteria in Global Initiative for Asthma (GINA)‑Chronic Obstructive Lung Disease (GOLD), Spanish, and American Thoracic Society (ATS) Guidelines were used as the diagnostic assessment for ACO. Patients were divided into three groups following evaluation of ACO criteria such as the asthma group, the COPD group, and the ACO group. The characteristics and some parameters of these three groups were compared. Result: This study was conducted on 65 patients with chronic airway diseases (COPD, asthma and asthma COPD overlap) were selected. It included 72 (80%) males and 18 (20%) females. Among the studied participants, 36 (40%) patients were diagnosed as having ACO, 23 (25.6%) patients were diagnosed as having asthma and 31 (34.4%) patients as having COPD. Regarding the age difference between groups, it was found that patients who were diagnosed as having ACO were older than asthmatic patients with mean age of 53.48±8.38 and 41.58±6.28 years, respectively. The men age of patients with COPD was 56.29±8.32 which was older than both ACO and asthmatic patients.   Conclusion: Many patients who have asthma or COPD have symptoms from both diseases. The use of a syndromic approach to chronic airway diseases may result in the diagnosis of ACO in many patients who were previously treated for COPD or asthma. According to the findings of this study, patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. HRCT features may aid in distinguishing ACO patients from COPD and asthma patients and may be included in future ACO diagnostic guidelines.

BACKGROUND: Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. This double-blind, randomized controlled trial aimed to compare bilateral ultrasound-guided TAP block with bupivacaine and levobupivacaine for analgesia after cesarean delivery performed under spinal anesthesia. Aims: The aim of this study was to compare the duration of postoperative analgesia between levobupivacaine (0.25%) versus bupivacaine (0.25%) alone in the bilateral TAP block after lower segment cesarean section (LSCS). Materials and methods: In this prospective randomized double-blind interventional study, 100 parturients undergoing elective LSCS were included in the study. Patients were randomly divided to receive either 20-ml levobupivacaine 0.25% (Group A; n = 50) or 20-mL bupivacaine (0.25%) bilaterally (Group B; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction, total requirement of analgesics in the first 24 h, and the side effects sedation, hypotension, and bradycardia were observed. Statistical analysis: Statistical tests were conducted using SPSS. P < 0.05 was considered as statistically significant. Results: A total of 100 patients were analyzed. Duration of analgesia was significantly longer in Group B (10.94 ± 0.56 h) compared to Group A (6.16 ± 0.81 h) (P < 0.001). Mean consumption of tramadol was 134.77 ± 14.90 mg and 78.89 ± 28.77 mg in Groups A and B (P < 0.001), respectively. All patients in Group B were extremely satisfied while those in Group A were satisfied (P < 0.01). None of the patients experienced any side effect like hypotension or bradycardia. sedaion were comparable in both the groups. Conclusion: 0.25% bupivacaine in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative rescue analgesic requirement, and increases maternal comfort compared to 0.25% ml of levobupivacaine.

Background: This study employs Robson's 10 Group Classification System to analyze caesarean section rates at a tertiary care center in Jaipur, India. The global increase in caesarean section rates necessitates careful evaluation of this trend to optimize maternal and neonatal outcomes. Material and Methods: A retrospective analysis of 458 consecutive caesarean sections performed between March 2023 and February 2024 was conducted. Data was collected from the labour room birth register and analyzed using standard statistical methods. Results: The overall caesarean section rate was 40.42%. Groups 1-5 contributed 74% of the study population, with Group 5 (previous caesarean sections) being the largest contributor (35.31%) to the overall rate, followed by Group 1 (nulliparous, spontaneous labor) at 22.47%. Conclusion: The high caesarean section rate is attributed to the institution's status as a referral center for complex pregnancies. The study highlights the need for comprehensive VBAC counseling, implementation of trial of labor after caesarean for low-risk cases, and judicious use of caesarean sections based on strict clinical indications.

Background: Combined femoral and sciatic nerve blocks are crucial for lower limb orthopedic surgeries. This study compared the efficacy of 0.5% Bupivacaine and 0.5% Ropivacaine in these blocks, focusing on onset time, duration, hemodynamic stability, and postoperative analgesia. Methods: In this cross-sectional study, 60 ASA I-II patients undergoing elective lower limb below-knee orthopedic surgeries were randomized into two groups of 30 each. Group A received 0.5% Bupivacaine (3mg/kg), while Group B received 0.5% Ropivacaine (3mg/kg). Sensory and motor blockades were assessed using Modified Hollmen's and Bromage scales. Postoperative pain was evaluated using VAS scores for 24 hours. Hemodynamic parameters and time to first rescue analgesia were recorded. Results: The study found no significant difference in the onset of sensory block for both femoral and sciatic nerves between the two groups. However, the duration of sensory block was significantly longer in Group A (890.07±11.36 min) compared to Group B (834.50±10.20 min, p<0.001). Group A also demonstrated a significantly faster onset of motor block (21.43±0.77 min vs 22.60±0.69 min, p<0.001) and a longer duration of motor block (242.67±6.39 min vs 192.83±4.86 min, p<0.001). Hemodynamic parameters remained generally stable in both groups, with only minor differences at specific time points. VAS pain scores showed similar progression in both groups, with no significant differences. The time to first rescue analgesia was not significantly different between the groups (Group A: 14.08±1.95 hours, Group B: 13.49±1.71 hours, p=0.222). Conclusion: While both 0.5% Bupivacaine and 0.5% Ropivacaine provided effective anesthesia and postoperative analgesia, Bupivacaine demonstrated superior performance in terms of block duration for both sensory and motor components. Bupivacaine may be preferred for longer procedures or when extended postoperative analgesia is desired, while Ropivacaine could be favored when shorter duration of motor block is preferred. The choice between these agents should be tailored to specific surgical and patient requirements.

Background: The identification of prostate cancer by PET/CT imaging of the Prostate-Specific Membrane Antigen (PSMA) has achieved significant relevance in recent years. Hybrid PET-CT imaging with 68Ga-PSMA ligand can reveal lesions indicative of prostate cancer with superior contrast. The aim of present study was “to evaluate the role of 68Ga labelled Prostate-Specific Membrane Antigen (PSMA)ligand hybrid PET/CT in primary & recurrent carcinoma prostate for lesion characterisation, lymph node involvement & skeletal & liver metastases”. Methods: The prospective study was conducted at a large tertiary centre during the period of June 2015 to January 2016 among 100 male patients with a clinical suspicion or diagnosis of prostate cancer. Radiolabeling of PSMA ligand with 68Ga is done using on-site commercially available 68Ge/68Ga generator (itg). Image analysis was done & results were analyzed using SPSS version 25.0. Results: For the study, 100 male patients with a median age of 69 years (range: 37-90 years) were chosen.  All images showed good resolution and the lesions had great target-to-background ratio. Thirty-two patients were referred for clinical suspicion, twenty-four for initial staging, & forty-four for examination of recurrence. 16 patients (50%) out of 32 with a clinical suspicion of PCa had focused, strong uptake in the prostate gland that was indicative of the disease. Of the 24 individuals with PCa who were referred for first staging, 24 out of 24 (100%) had abnormal prostate gland uptake. Ninety-nine percent of the 44 PCa patients who had a clinical suspicion of recurrence displayed involvement of the disease site. The sensitivity, specificity, positive predictive value, negative predictive value, & overall accuracy of the 68Ga-labeled PSMA-ligand PET/CT were 95.6%, 100%, 100%, 50%, & 97.6%, respectively. Conclusion: 68Ga-PSMA hybrid PET/CT showed accurate detection of initial & recurrent prostate cancer lesions. Patients with suspected PCa, initial staging, restaging, & recurrence showed excellent contrast in primary lesion identification & lymph node, skeletal, & liver metastasis.

Introduction- A supraclavicular approach for blockade of the brachial plexus was first described by Kulenkampf in 1911. The sonographic image can be used in real time to guide the injection needle while minimizing the risk of contact with structures such as the pleural dome and subclavian artery. Ultrasound-guided supraclavicular blockade has been highly successful. Aims- The aim and objective of this study was to detect the minimal effective volume of local anaesthetic agents in ultrasound guided   supraclavicular brachial plexus block for achievement of surgical anaesthesia. Materials and methods- Single blinded observational cohort study in Tertiary Care Superspeciality Hospital. The study is to be completed within a span of 2 years. Subjects assigned to 3 groups as per choice of consultant anaesthesiologist. After approval by the institutional local ethical committee written informed consent was taken from each of the patients. Results- There was no statistically significant difference between the two groups in     respect to demographic parameters like age, sex, weight, height as the patients had in each group. Significant higher heart rate was observed at 30,60, 90, 120, 150, 180and 210 minutes in group c as compared to group A and B. There is a significant rise in MAP after 25 min in group C. there is no difference between MAP in group A and B. There is no difference in oxygen saturation during surgery in all groups. There is no difference between onset of sensory block and motor block onset in all groups. Quality of block in group A (4 ± 0), B (3.92 ± 0.28) and C (3.08 ± 0.28) observed, In comparison to group A, group B has no difference in quality of block, In compare to group c it has significant difference(p-0.001) with group A. There is a significant difference between group B and group C(p-0.001). There is no significant difference between group A, B and C in incidence of nausea and vomiting. Conclusion- From above finding we conclude that minimal effective volume of local anesthetic agents in ultrasound guided supraclavicular brachial plexus block for achievement of surgical anaesthesia using would be 20 ml of local anesthetics 50:50 mixture of Bupivacaine 0.5% (preservative free) and lignocaine 2% with adrenaline (1:200000).

Venous thrombosis is uncommon cause of stroke as compared to arterial occlusions, but it is an important consideration because of its potential morbidity and increasing incidence especially in current covid era. Historically comparatively low incidence of cerebral venous thrombosis {CVT} is approximately at 0.2 to 0.5 per 100000 per year while the mortality of CVT probably varied between 20%-50%. Standard medical management for CVT is hydration and systemic anticoagulation with heparin at therapeutic dosage, even in patients with an intracranial hemorrhage (ICH) i.e., Venous hemorrhagic infarct at baseline along with watchful monitoring for seizures & raised Intracranial Tension (ICT) and fundoscopy to monitor Papilledema. There are few cases that do not respond to standard of care with medical management & with progressive CVT leading to poor outcomes with resultant ischemic and hemorrhagic stroke, cerebral edema, mass effect and death.  Endovascular options has been in vogue in recent decade, including intra-venous application of thrombolytic agents and/or mechanical thrombectomy for patients with Major venous sinus thrombosis without large hematoma & significant  midline shift that necessitates emergency decompressive craniotomy  and those with Altered Sensorium (Glasgow Coma scale < 10)/ Refractory to anticoagulation with progressive disease or neurologic deterioration (deterioration on Glasgow Coma Scale ) refractory to anti- coagulation therapy or with new deterioration of symptoms or worsening of ICH or Haemorrage despite standard medical management. We present our unique experience of venous stroke patients in covid era that underwent endovascular salvage for major cortical venous sinus thrombosis & technical note on direct jugular vein accesses intervention utilizing peripheral hardware.

Introduction: Prolactin- oxytocin interplay is thought of as the key factor in lactogenesis and milk let down. Recent evidence suggests that glucose uptake in the phase 2 lactogenesis is mediated by insulin and its receptors. It is hypothesized that reduced glucose uptake due to insulin resistance is responsible for reduced lactogenesis and scanty milk production.  Aims: To observe if insulin resistance leads to reduced lactogenesis and delayed or non-lactation Methodology: 124 mothers (GrA 62mothers with delayed/non-lactation, GrB 62 patients with normal lactation) attending Lactation Clinic were included. Mothers with gross NAC abnormalities, infants with oral-anatomical problems, mother- child separation were excluded. Parameters checked to establish insulin-resistance are BMI, Waistline, BP, FBS-PPBS, HbA1c, Lipid profile, c-peptide, Prolactin. Delayed lactation and non-lactation are defined as non-initiation of lactation following 72hours or non-establishment respectively. Results: Non-lactation/delayed lactation is strongly associated with increased BMI (p<0.0001), increased waistline (p<0.0001), raised systolic-diastolic BP(p<0.0089, <0.0027), raised FBS-PPBS (p<0.0364,<0.0045), raised HbA1c(p<<0.0001), raised S-triglycerides (p<0.0035), but not associated with increased age, with S-cholesterol, S-LDL/S-VLDL/S-HDL, c-peptide, S-prolactin.  Discussion: The study confirms the role of insulin on lactogenesis function of mammary glands. Mothers with insulin-resistance are prone to lactation failure. To plan public health strategies to achieve “universal breast-feeding goal” as stated by WHO. All mothers must be evaluated in the first trimester of pregnancy and immediately post-partum with special reference to insulin resistance so that prediction of lactation failure can be made, and appropriate therapeutic strategy can be planned.

Background- Shivering is distressing for the patient’s undergoing surgery under both regional and after general anaesthesia. Shivering increases expenditure of cardiac and systemic energy, resulting in increased oxygen consumption and carbon dioxide production, lactic acidosis and raises the intraocular and intracranial pressure. It also interferes with haemodynamic monitoring intra operatively Aims- To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering in patient undergoing elective surgeries under spinal anaesthesia. Materials and methods- A Prospective, Randomized, Double Blind Comparative Study, done in Tertiary Care Superspeciality Hospital with in a span of 1 year. Adult patients posted for various elective surgeries under Spinal Anaesthesia. Patients scheduled for elective surgeries under spinal anaesthesia, Age group of 18-60 years of both sexes and ASA grades I or II included in study. The subjects were randomized in to 4 groups by using computer generated SPSS 16 software in to random numbers to receive ketamine, tramadol or clonidine. The patients were randomized into four groups of 42 patients each. Results- The age range was 18-60 years for all the groups.  There was no significant difference between the groups for age and sex distribution (p>0.05). There was no significant difference observed in the duration of surgery (p=0.46). There was no significant difference observed in the median level of spinal anaesthesia in the four groups (p=0.052). There was significant difference observed in the distribution of grade of shivering in normal saline group compared to tramadol, ketamine and clonidine group (p=0.0499). There was no significant surface temperature difference between the groups (p=0.67). There was statistically significant difference observed in ketamine group with respect to heart rate compared to tramadol, clonidine and normal saline groups till 40min after spinal anaesthesia with p-value of <0.001 except the baseline values (p=0.93). After 40 min, there was no statistically significant difference observed among the groups. There was statistically significant difference observed in ketamine group with respect to mean blood pressure compared to tramadol, clonidine and normal saline groups till 50 min after spinal anaesthesia with p-value of <0.001 except for baseline value (p=0.870) and value at 5 mins (p=0.0012).  After 50 min, there was no statistically significant difference observed in four groups. Conclusion- We conclude that giving either ketamine 0.5 mg/ kg, clonidine 75 mcg or tramadol 0.5 mg/kg i.v. prophylactically just before neuraxial blockade significantly decreases the incidence of shivering without causing any major side-effects. Using ketamine may be more beneficial as it improves the hemodynamic profile by its sympathomimetic effects and it sedates the patient effectively, which increases patient comfort during surgery, maintains cardiorespiratory stability and prevents recall of unpleasant events during the surgery.

Background- A number of patients living with uncontrolled blood pressure remains a challenging problem all over the world. Hypertension is responsible for 57% of all stroke deaths and 24% of coronary heart disease death in India. Therefore, it is important to know the prevalence of uncontrolled blood pressure in patients with hypertension. Aims- To Assess adequacy of blood pressure control in patients with hypertension attending medicine OPD & other medical clinics of hospital. Materials and methods- This was an observational prospective study which was conducted in the Department of Internal Medicine, Maulana Azad Medical College and Lok Nayak Hospital, located in New Delhi, India. A total of 100 diagnosed cases of hypertension fulfilling inclusion and exclusion criteria were evaluated in this study. Risk factors like adherence, no of antihypertensive medications, reduced salt intake, knowledge about hypertension, hyperlipidemia, diabetes mellitus, demographic and socioeconomic characteristics, cardiovascular disease, smoking, alcohol, physical activity and obesity were assessed. Results- The mean age of the patients was 50.48 (±12.01) years. As compared to patients with controlled BP, those with uncontrolled BP had significantly more number of females (77.4% vs. 52.2) then to males (22.6% vs. 47.8%) (P=0.01). age, Educational standard, residency, occupations, did not show a significant association with control of hypertension in our study. Socioeconomic status as a factor showed a significant association with control of hypertension. As compared to patients with controlled BP to those with in uncontrolled BP, uncontrolled BP was more common in patients with heart disease, diabetes mellitus and respiratory disease.  (12.9% vs 0.0%, P<0.01). 14% patients used tobacco in the form of smoking; 5% were current alcoholic. In the index study, 66% patients were on salt restricted diet and 73% of the patients were adhere to antihypertensive medications. Whereas patients on dual and single antihypertensive were more in controlled group 58.0% and 14.5 % respectively (P<0.01). In uncontrolled group, there were significantly more patients (77.4%) who had inadequate knowledge about HTN control vs.(23.2%) in controlled BP group, (P<0.001. Among the hypertensives, 40% subjects were physically active. BMI as a factor showed a significant association with control of BP in our study. Mean cholesterol level in uncontrolled BP group was significantly higher than controlled BP group (184.13 vs. 137.68, P≤0.01). Mean triglycerides level in uncontrolled BP group was significantly higher 157.68 (±55.98) vs. 126.29 (±38.47) in controlled group (P≤0.01). Conclusion- The present study compares parameters such salt restriction diet and adherence to antihypertensive medications in uncontrolled and controlled hypertension patients in India, which provides valuable information for researchers and authorities, who are responsible for the planning of health services. There are a limited number of researches on BP control status of hypertensive in India. So, this study will provide information about risk factors responsible for uncontrolled blood pressure in patients with hypertension. Our findings have significant public health implications that emphasize the urgency of increased awareness about blood pressure control

Background- chronic kidney disease (CKD) is a public health problem worldwide with a global prevalence of 11 to 13%¹. It is a pathophysiological process with multiple etiologies, resulting in inexorable attrition of nephron number and function leading to end stage renal disease. Cardiovascular diseases (CVD) are becoming the major cause of morbidity and mortality in most of the developing countries; including India in patients of chronic kidney disease³. Aim- To assess left ventricular functional status on echocardiography in chronic kidney disease patients. Methods and materials- This is a Observational Cross-sectional study, done in cases of chronic kidney disease admitted under medicine department & those attending the medical OPD of Deen Dayal Upadhyay Hospital, New Delhi, for a period of 2 years from November 2017 to November 2019. CKD patients were selected on basis of selection criteria as mentioned above. All patients were be clinically evaluated thoroughly. After taking informed consent, these individuals were subjected to the following investigations. GFR Estimation was be done using Modification of Diet in Renal Disease (MDRD) equation and staging of CKD was done on the basis of estimated GFR as per KDIGO guidelines. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results- Majority of the patients included were in stage 3 (44%) followed by stage 4 (35%) CKD. The mean blood urea was 89.14 ± 24.28 mg/dl, mean serum creatinine was 3.14±1.46mg/dl, mean eGFR was 26.96± 13.31, mean LVEF was 49.92± 9.23 & mean e/a ratio was 1.13 ± 0.53. Systolic dysfunction was present in 24% of CKD patients. Systolic dysfunction was present in 6% of mild/moderate CKD patients & in 42% of severe CKD patients. The association of systolic dysfunction between these two groups was statistically significant (p = <0.0001). In the mild/moderate CKD group out of 50 patients only 3 had systolic dysfunction & it was of the mild variety in all three of them. In the severe CKD group out of 50 Patients, 21 had systolic dysfunction of which maximum patients had moderate systolic dysfunction (41.67%) followed by mild and severe systolic dysfunction in 29.17% patients each. The association of severity of systolic dysfunction between these two groups was statistically significant. Diastolic dysfunction was present in 58% CKD patients, 46% of mild/moderate CKD patients & in 70% of severe CKD patients. The association of diastolic dysfunction between these two groups was statistically significant (p = 0.026). In this study E/A ratio < 0.8 was seen in 34% of mild/moderate CKD group patients & in 24% of severe CKD group patients and the association between these two groups was statistically not significant. E/A ratio of 0.8-2 with an E/e’ ratio >10 was seen in 30% of severe CKD group patients & in 10% of mild/moderate CKD group patients and the association between these two groups was statistically significant. E/A ratio > 2 was seen in 16% of severe CKD group patients & in 2% of mild/moderate CKD group patients and the association between these two groups was statistically significant. Conclusion- Echocardiography is a cost effective, noninvasive and easily reproducible diagnostic test which can detect early changes in the cardiac parameters. This is important for risk stratification and early preventive measures. Thus, echocardiographic screening of CKD patients has both therapeutic and prognostic implications. All asymptomatic CKD patients should undergo a routine echocardiographic evaluation.

Background: Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening condition requiring prompt medical intervention. This study investigates the clinical and etiological profile of UGIB patients presenting to an emergency department in Indore, Madhya Pradesh. Material and Methods: An observational study was conducted involving 100 adult patients aged over 18 years diagnosed with UGIB. Data collection included demographic information, clinical presentations, laboratory findings, and outcomes. Upper gastrointestinal endoscopy was performed for diagnostic and therapeutic purposes. Results: The mean age of participants was 45.78 ± 13.87 years, with males constituting 72% of the sample. Hematemesis (68%) and melena (54%) were the most frequent symptoms. The most common underlying cause was esophageal varices (51%), followed by gastric ulcers (12%). A total of 65% of patients required hospitalization, with a mortality rate of 14%. Septic shock was the leading cause of death (56.3%). Significant associations with mortality included high respiratory rate, low blood pressure, and abnormal laboratory values such as elevated lactate levels. Conclusion: The findings underscore the importance of early intervention and endoscopy in managing UGIB, particularly in patients with portal hypertension. Comprehensive assessment and proactive management can significantly improve patient outcomes.

Background: Diabetes is increasingly prevalent in India, with over 62 million diagnosed cases. Studies suggest a complex interaction between diabetes and thyroid disorders, impacting glucose tolerance and insulin sensitivity. This study aimed to investigate the prevalence and types of thyroid dysfunction among type 2 diabetes mellitus (T2DM) patients in India, given limited data on the subject. Methods: This cross-sectional study was conducted at the Sri Aurobindo Institute of Medical College over 18 months, from September 2022 to February 2024. A sample of 130 patients with T2DM was recruited, excluding individuals with a known history of thyroid dysfunction or those on medications affecting thyroid function. Patients underwent clinical assessments and laboratory investigations for fasting blood sugar, postprandial blood sugar, HbA1c, and thyroid profiles. Thyroid dysfunction was categorized as hypothyroidism, hyperthyroidism, subclinical hypothyroidism, or euthyroid. Results: Among the 130 T2DM patients, 85.4% exhibited normal thyroid function, while 14.6% displayed thyroid abnormalities. Subclinical hypothyroidism was the most common (7.7%), followed by hypothyroidism (5.4%) and hyperthyroidism (1.5%). Thyroid dysfunction was more prevalent among female patients, who constituted 70.8% of the sample. A significant correlation was observed between blood glucose levels (fasting and postprandial), HbA1c, and TSH levels (p<0.05), though perfect correlations indicated potential data inconsistencies. Conclusion: Thyroid disorders, especially subclinical hypothyroidism, are relatively common in individuals with T2DM, particularly among women. The presence of thyroid dysfunction correlates with poor glycemic control, suggesting a need for routine thyroid screening in diabetic patients to enable early intervention and improve metabolic outcomes.

Septic shock triggers an inflammatory response and the release of several mediators on a cellular level. There is vascular and ischemic damage leading to apoptosis of hypothalamic-pituitary- adrenal axis. This ultimately results in adrenal insufficiency further affecting T-cell response with uncontrolled systemic inflammation. Corticosteroids were said to enhance the vasoconstrictor response of vasopressor drugs and exogenous catecholamine with immune modulation. Aim The study investigated whether low-dose corticosteroid (hydrocortisone) infusion will decrease the need for vasopressors among patients with septic shock. This single-center study has aimed at observing the reduction in the dose of vasopressors, vasopressor-free days, mortality benefit among the patients with septic shock when low-dose hydrocortisone infusion is given in addition to vasopressors. Material And Methods: In a single-blind prospective randomised clinical trial, 90 patients were recruited in this study who got admitted in the Intensive Care Unit, Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi and randomly assigned to the control group 1 (n=45) and intervention group 2 (n=45) with septic shock for less than 24 hours fulfilling the criteria of SIRS. The control group 1 (n=45) were administered vasopressors and the intervention group 2 (n=45) was administered vasopressors with additional 50 mg hydrocortisone infusion every 6 hours. After that scoring was done with GCS, APACHE Ⅱ and SOFA scores, followed by the need for vasopressors, duration of mechanical ventilation, and length of ICU stay, hemodynamic stability and 7 days mortality among the patients. Results: Among the 90 patients without any dropouts, there was a significant difference in the length of ICU stay showing a shorter ICU stay of Group 2 (12.09±5.180) compared to Group 1 (14.71±5.983). There was a decrease in the total dose of noradrenaline required on daily basis in group 2 (P<0.05) as compared to group 1 but there was no difference in the dose of vasopressin requirement between the two groups. There was no significant difference in the duration of mechanical ventilation except on day 7 which was comparable: Conclusion: Our study shows beneficial effects of corticosteroid on decrease in length of ICU stay and a reduction in the dose of norepinephrine. However, there was not significant improvement in mortality and duration of mechanical ventilation in these 7 days.

In the first part of this study the Schneider (S), Weine (W), and Long-Axis (LA) techniques are used for comparing the measurement of canal curvature. One hundred mandibular first and second molar teeth were selected. Radiographs were taken after inserting size 10 K-files into the mesiobuccal root canals. The radiographic findings were digitized on a computer, and the three different curvature angles were measured from drawings of the same root canal and compared statistically. ANOVA showed that there were significant differences between the curvature angle values determined using each technique (p  0.001). In the second part of this study the term “canal access angle” (CAA) was introduced and it was defined by examining the morphology of canal curvature. Canal length, curvature distance (y), curvature height (x), Schneider angle, and the newly defined CAA were evaluated statistically. Using a multiple regression analysis, the CAA was significantly related to x (p  0.001) and y (p  0.005). There was a positive correlation (r 0.74) between the CAA and curvature height (x). The results indicated that the CAA is a more effective way of evaluating the root canal curvature

Objective: This study is aimed to assess the coronary sinus blood flow by transthoracic echocardiography in acute MI patients undergoing coronary angiography and comparing the coronary sinus flow pre and post percutaneous coronary intervention. Methods: The present hospital based prospective cross sectional descriptive study was conducted at KAHER University Hospital, Belgaum from January 2023 to June 2024 among 150 adult patients with acute coronary syndrome. Details on demographics, patient characteristics, laboratory parameters were recorded. Echocardiography parameters taken on admission were compared with the parameters post thrombolysis and post revascularization and was correlated with the severity of CAD and the success of revascularization Result: most of the patients were males. The patient population has a mean age of 60 years with a standard deviation of 11.29 years. The average Body Mass Index (BMI) is 27.61, suggesting that the population is, on average, slightly overweight, with a standard deviation of 4.68. The average diameter of the coronary sinus (CS) is 0.85 cm, with a standard deviation of 0.2 cm. Coronary Sinus Blood Flow (CSBF) per beat has a mean of 3.03 mL, with a standard deviation of 1.52 ml. On admission, the mean CSBF per minute is 218.63 mL, with a standard deviation of 93.64 mL. After Percutaneous Coronary Intervention (PCI), the mean CSBF significantly increases to 372.05 mL per minute, with a standard deviation of 126.15 ml, reflecting the effectiveness of PCI in improving coronary blood flow in this patient group. Overall, these results demonstrate that PCI significantly improves coronary blood flow in patients across all these categories, with the most substantial increases observed in those with STEMI-AWMI in the current study. Conclusion: Non-invasive evaluation of CSBF using transthoracic echocardiography is technically feasible in all patients undergoing PCI.It is a potentially simple, repeatable, cost-effective, non-cumbersome imaging modality for the assessment of CSBF in patients with CAD, and especially for those with AWMI. It can also be used to assess the effectiveness of treatment in patients with CAD. Results reflect hemodynamically significant changes in total coronary blood flow.

Background: Gastroesophageal reflux disease (GERD) is a chronic condition that affects many people worldwide, including a growing number in India. Laparoscopic surgery has emerged as a viable treatment option for patients with refractory GERD. Objective: This study aims to assess the efficacy and patient satisfaction of laparoscopic surgery in managing GERD among 30 patients at Rama Medical College Hospital, Kanpur, and NEO Hospital, Noida. Method: This prospective study included 30 patients with refractory GERD who underwent laparoscopic fundoplication between January 2023 and June 2024. Patients were evaluated based on pre- and post-surgical symptom relief, quality of life, and satisfaction levels using validated scoring systems. Data were collected through clinical assessments and patient surveys. Result: Of the 30 patients, 90% (n=27) reported significant symptom relief within three months post-surgery, with 85% (n=25) experiencing complete cessation of heartburn and regurgitation. The average post-operative hospital stay was 2.5 days, with minimal complications. Patient satisfaction was high, with 80% (n=24) of participants expressing satisfaction with the outcome, citing reduced reliance on medication and improved quality of life. Conclusions: Laparoscopic fundoplication is a highly effective surgical approach for managing GERD, with notable improvements in both symptom relief and patient satisfaction. This technique offers a promising alternative for patients in India, where GERD is increasingly prevalent.

Background: Drug-resistant Tuberculosis (TB) poses a significant threat to TB control efforts globally. In 2022, 7.5 million new TB cases and 1.3 million deaths were reported worldwide, with India bearing a substantial burden. India accounted for 27% of the global multidrug-resistant TB (MDR-TB) cases, with 124,000 new cases in 2019. This study aims to identify independent risk factors, including social determinants, for MDR-TB among TB patients in the Kanchipuram district, India. Methods: Age and Sex matched case-control study was conducted from January 2023 to November 2023, involving 40 MDR-TB patients (cases) and 120 drug-susceptible TB patients (controls). Data were collected using a semi-structured questionnaire covering demographic profiles, treatment history, clinical history, housing conditions, and co-morbid conditions. Statistical analysis included univariate and multinomial logistic regression to identify significant predictors of MDR-TB. Results: Among the 160 participants, significant differences were observed between cases and controls regarding income, overcrowding, ventilation, and behavioral factors such as smoking and passive smoking. Key independent predictors for MDR-TB included previous TB treatment (AOR=14.82, 95% CI: 9.699-36.117), low income (AOR=9.00, 95% CI: 2.372-28.099), passive smoking (AOR=9.649, 95% CI: 7.891-31.87), overcrowding (AOR=2.062, 95% CI: 2.004-5.005), and inadequate ventilation (AOR=4.743, 95% CI: 4.227-14.907). Discussion: The study highlights the significant role of socioeconomic factors in the prevalence of MDR-TB. Factors such as low income, inadequate housing, and poor ventilation are critical determinants, exacerbating the risk of MDR-TB. Behavioral factors like passive smoking and a history of previous TB treatment also significantly contribute to the risk. Conclusion: Addressing the socio-economic determinants and enhancing health education, sanitation, and housing conditions are crucial for controlling MDR-TB. These findings underscore the need for targeted interventions and robust health policies to mitigate the risk factors and reduce the burden of MDR-TB in India. The study's insights can guide policymakers and healthcare providers in designing effective strategies for TB elimination by 2025, in line with India's national strategic plan.

Background: To improve the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block will help to reduce many false activations of the protocols for emergent reperfusion and will help to provide timely reperfusion to those patients who are truly experiencing an acute myocardial infarction Methods: Adult patients referred for suspected myocardial infarction because of new or presumed new Left bundle branch block (LBBB) with available Electrocardiography (ECG) recorded at the first medical contact were included in this study.   Results: A total of 39 patients were included in this study. Mean age was 56.2 years, 23 were male (59%). The patients presented with symptoms of chest pain (48.7%), dyspnoea (17.9%) and palpitations (15.4%). The following commodities were noted, diabetes in 51.3 % and hypertension in 43.6%. Median troponin I was 2197 pg/mL. Barcelona criteria had a sensitivity of 73 % and modified Sgarbossa had a sensitivity of 64%. Both the criteria had specificity of 100%. Conclusions: Barcelona criteria significantly improved the diagnosis of Acute myocardial infarction (AMI) as compared with previous ECG rules, achieving a diagnostic performance for AMI similar to that of ECG in patients without LBBB. The high specificity of the algorithm was confirmed in a large and heterogeneous control group of patients without suspected AMI.

Background: Cassava or tapioca is one of the staple foods of the people of Kerala. Population with tapioca as staple food should be studied in detail due to the increased toxicity of tapioca yields due to the greenhouse effect. It is rich in hydrogen cyanide, which is metabolized by the liver to thiocyanate.  Objective:The objectives of the study are to observe the variation in physiology of the human body due to the effect of low dose cyanide in the diet and the effect of thiocyanate in blood on the blood pressure and thyroid function. Methods: A descriptive cross-sectional study design was conducted in the department of General Medicine out-patient department of a tertiary care hospital of central Kerala. This research was conducted after obtaining ethical clearance from the institutional ethical committee.  Results: The blood pressure of each subject was recorded. The thyroid function tests (fasting TSH values) of each subject were determined. The BMI for each subject was calculated. There were not much changes in the systolic blood pressure in hypothyroid group and hyperthyroid group. There were not much changes in diastolic blood pressure in hypothyroid group and in hyperthyroid group. The TSH values in the hypothyroid group and in the hyperthyroid group were significant compared to the matched controls. There is significant increase in BMI in the hypothyroid subjects. There is significant decrease in BMI in the hyperthyroid subjects. Conclusion: The above study did not show much changes in the systolic and diastolic blood pressure. These findings are unusual. Thyroid dysfunction cause increase in blood pressure. This means low dose dietary thiocyanate, in a population with tapioca as staple food might be protective to the cardiovascular system. TSH values are comparable with the values obtained in other studies. Kerala is a developed state compared to other states of India. This allows the people to have more proteins and iodine in the diet. These protect the population from many toxic effects of cyanide in diet.

Background: The timing of laparoscopic cholecystectomy (LC) performed for surgical management of acute calculous cholecystitis has always been a contentious topic. The rate of conversion from laparoscopic to open cholecystectomy is a significant factor contributing to the choice between acute versus delayed surgery for acute calculous cholecystitis. Methods: This was a prospective randomized study carried out between December 2022 and June 2024; 462 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 231 patients. Patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other patients were placed in the delayed group, first they were managed conservatively followed by LC 3 to 6 weeks later. Rate of conversion from laparoscopic to open cholecystectomy was compared between the 2 groups. Results: The conversion rates in both early and delayed groups were 7.36% and 11.26% respectively. The operating time was 40.38 ± 9.67 minutes in the early LC group and 48.52 ± 9.83 minutes in the delayed LC group. Early LC group, on the other hand, required a shorter postoperative hospital stay (4.90 ± 1.59 vs. 6.89 ± 1.70 days) compared to the delayed LC group. Conclusion: Early LC might have benefits over late LC when we consider shorter operative time and hospital stay without significant increase of open conversion rates.

Background In this study, we wanted to assess the diastolic dysfunction in type 2 diabetic patients using Doppler echocardiography. Methods: This was a hospital based cross-sectional study conducted among 100 patients with Type 2 Diabetes Mellitus (DM) who exhibited diastolic dysfunction, admitted to the Department of Medicine, of a tertiary care hospital, over a period of 2 years after obtaining clearance from institutional ethics committee and written informed consent from the study participants.

Results

In associations with Diastolic Dysfunction

Diastolic dysfunction was significantly associated with age (p=0.038). Older age groups (51-60 years and >60 years) had higher proportions of advanced diastolic dysfunction (Grades III and IV). Males were more likely to have milder forms of diastolic dysfunction, while females had     higher proportions in the severe grades (p=0.037). A significant association was observed between rural residency and severe diastolic dysfunction (p=0.034), with rural participants showing higher prevalence of Grade III and IV dysfunction. Higher triglyceride levels were associated with increasing diastolic dysfunction severity (p=0.006). Advanced diastolic dysfunction was significantly associated with microalbuminuria and macroalbuminuria (p=0.004), indicating kidney damage. Higher HbA1c levels were associated with more severe diastolic dysfunction (p=0.000), reflecting poor glycemic control. Longer duration of diabetes was significantly associated with worsening diastolic dysfunction (p=0.049). Overweight and obese individuals were more likely to have advanced diastolic dysfunction (p=0.000). Severe forms of neuropathy, particularly autonomic neuropathy, were associated with higher grades of diastolic dysfunction (p=0.000). Conclusion Age, sex, region, and duration of diabetes all showed a significant relationship with the severity of diastolic dysfunction. Older individuals, females, and urban residents were at higher risk for more advanced stages of diastolic dysfunction. Glycemic control (HbA1c) was a key factor, with poorer control being strongly associated with more severe dysfunction. This highlights the importance of achieving good glycemic control to prevent cardiac complications. Triglyceride levels and BMI were also significantly associated with diastolic dysfunction, pointing to the importance of managing dyslipidemia and obesity in diabetic patients. Diabetic nephropathy, retinopathy and neuropathy were more prevalent in those with advanced diastolic dysfunction, indicating that cardiovascular and renal complications often coexist in diabetic populations.

Aim and Objective: To describe the epidemiology, clinical-serological profile, and outcome of primary APS in a South Indian tertiary care center. Material and methods: This retrospective study, conducted in the Clinical Immunology and Rheumatology Department at SRMC/SRIHER Chennai from 2018 to 2024, included 40 patients with the primary anti-phospholipid syndrome (PAPS) as defined by the modified Sapporo criteria. Patients with conditions like protein C or S deficiency, hyperhomocysteinemia, Factor V Leiden mutation, or other autoimmune diseases were excluded. Data on demographics, clinical presentation, lab results, and treatment outcomes were gathered. Anticardiolipin (aCL) and anti-β-2 glycoprotein I (β-2GPI) antibodies (IgG and IgM) were measured by ELISA, with positivity cut-offs of 12 GPL-U/ml for aCL and 20 GPL-U/ml for β-2GPI. Lupus anticoagulant (LAC) was assessed using the diluted Russell Viper Venom Test (dRVVT), with a normalized ratio >1.2 indicating positivity. This approach ensured standardized PAPS diagnosis and characterization in the study cohort. Result: In this study of 40 primary anti-phospholipid syndrome (PAPS) patients, 82.5% were female, with an average diagnostic age of 35.9 years (range 16–65). Venous thrombosis was the most frequent presentation, seen in 60% of cases, followed by arterial thrombosis (37.5%) and mixed thrombosis (22.5%), while 12.5% had obstetric complications. Deep vein thrombosis (DVT) and ischemic stroke were the most prevalent venous and arterial events, at 47.5% and 27.5%, respectively. Diagnostic testing revealed lupus anticoagulant (LAC) in 55% of patients, anti-β-2 glycoprotein I (β-2GPI) in 47.5%, and anticardiolipin (aCL) antibodies in 37.5%; 20% were positive for all three antibodies. Non-thrombotic manifestations included thrombocytopenia (27.5%) and hemolytic anemia (22.5%). Catastrophic anti-phospholipid syndrome (CAPS) affected 12.5% of patients, with one fatality, while 12.5% experienced thrombosis recurrence. Conclusion: Data on primary anti-phospholipid syndrome (PAPS) alone is limited, as most studies combine primary and secondary APS cases. Our study uniquely focuses on PAPS, including cases with catastrophic APS (CAPS), where triple-positive APS antibodies were more prevalent. Venous thrombosis was the most common presentation, with LAC as the leading antibody, followed by β2GPI and aCL, while thrombotic microangiopathy (TMA), frequently observed in our study, is rarely reported elsewhere.

Introduction: Regional analgesic techniques such as fascia iliaca block (FIB) and pericapsular nerve group (PENG) block have been found to be effective in providing good pain relief in hip‑fracture patients. However, comparative studies between PENG and FIB are lacking. The aim of the study is to compare the analgesic effect of continuous FIB and PENG block in hip fixation surgery. Methods: Eighty adult patients with American Society of Anesthesiologists physical status I and II, undergoing hip fixation surgery were randomised to receive either FIB or PENG block, with 20ml of 0.25% bupivacaine. An epidural-style catheter was threaded, secured, and fixed at the site of the block to provide a continuous infusion of 0.125% bupivacaine in the perioperative period. The primary objective of the study was the assessment of postoperative analgesia using Numerical Rating Scale (NRS) at rest and in movement at different time periods. The secondary objectives studied were the calculation of the mean difference in NRS scores while positioning for spinal anesthesia and the estimation of postoperative analgesic requirement. Results: There was a significant reduction in NRS scores. The mean NRS for the PENG group was 1.2 ± 0.94 while for the FIB group was 3.02 ± 0.86 during positioning for spinal anesthesia (SA). Immediately after surgery (0 hours) mean NRS in the PENG group at rest was 0.48 ± 0.51 whereas in the FIB Group was 0.98 ± 0.7; while on movement it was 2.62 ± 0.74 in the PENG group and 6.38 ± 0.95 in FIB group. At 24-hour intervals post-operatively, the mean NRS score at rest in the PENG group was 0.08 ± 0.27 while for the FIB group was 0.8 ± 0.65. Similarly, on movement the mean NRS in the PENG group at 24-hour intervals post-operatively was 0.65 ± 0.66 while for the FIB Group was 2.38 ± 0.84. The total cumulative mean rescue opioid consumption was 9.75 ± 3.74 mg morphine equivalents in the PENG group and 18.25 ± 3.5 mg morphine equivalents in the FIB group.  Conclusion: PENG block provided better postoperative analgesia than FIB, in patients undergoing hip fixation surgery. It also leads to superior ease of positioning during spinal anesthesia and lesser opioid consumption in the postoperative period.

Background and Aims: Pure enantiomers of Bupivacaine such as Levobupivacaine and Ropivacaine (amides) have been established in routine practice due to their reduced detrimental impact on the cardiovascular and nervous systems. The effects of these drugs were compared in our study in patients undergoing surgeries under subarachnoid block. Materials and Methodology: Seventy patients assessed under American Society of Anaesthesiologists, Grade I and II of both genders between 18-65 years of age, scheduled for both elective and emergency surgeries under the subarachnoid block of duration more than or equal to one hour were included, randomized into two groups. Thirty-five people received 0.5% Isobaric Inj. Levobupivacaine 3.5 ml with Inj. Buprenorphine 0.2 ml (60µg) and thirty-five people received 0.75% Isobaric Inj. Ropivacaine 3.5ml with Inj. Buprenorphine 0.2 ml (60µg). Comparison between both groups with regards to age, sex, weight, onset of sensory and motor blockade, duration of sensory and motor blockade, hemodynamic responses, visual analog score ≥ 3, and the side effects were analyzed. Results: The sensory blockade onset was accelerated in the levobupivacaine subset (7.37 ± 3.59) than in the ropivacaine group (9.66 ± 3.56) and was significant statistically. The mean motor blockade onset was longer in the Ropivacaine subset at 8.49 ± 2.95 minutes compared to the Levobupivacaine group at 6.51 ± 2.36 minutes showed a P value of 0.003 and was significant statistically. The two-segment regression time and the motor blockade duration were longer in the levobupivacaine group (192.86 ± 49.5 and 141.43 ± 35.33) than in the ropivacaine group (163.71 ± 36.63 and 111.43 ± 31.36). The need for postoperative analgesia was faster in the Ropivacaine group than in the Levobupivacaine group. There was no remarkable statistical variation (P value > 0.05) in the hemodynamic parameters at different follow-up periods between both groups. Conclusion: Levobupivacaine has a faster onset and duration of the sensory blockade and motor blockade, and a delayed requirement of post-operative rescue analgesia compared to Ropivacaine without any significant differences in hemodynamic parameters and side effects.

Introduction: Acute myocardial infarction (AMI), commonly known as a heart attack is a leading cause of mortality in developed countries, posing a significant threat to public health. “Over a million sufferers may travel there every year, and the condition affects over three million people worldwide. Aims: The study to aim the prognostic significance of white blood cell count and plasma glucose level at admission in acute ST elevation myocardial infarction terms of in hospital mortality. Materials and method: The present study was a Cross-Sectional Study. This Study was conducted from July 2022 to December 2023 at Katihar Medical College and Hospital in Bihar. Total 80 patients were included in this study.  Result: In our study, 49 (61.3%) patients had Diabetics. The value of z is 2.846. The value of p is .00438. The result is significant at p < .05. In our study, 61 (76.2%) patients had Low RBS and 19 (23.7%) patients had High RBS of Random Blood sugar of patients in High RBS (>200) and Low RBS (<180). The value of z is 6.6408. The value of p is < .00001. The result is significant at p < .05. Conclusion: In conclusion, elevated plasma glucose and white blood cell (WBC) counts at the time of admission in patients with acute myocardial infarction (AMI) are significant prognostic indicators. Both hyperglycemia and leukocytosis are associated with increased in-hospital complications, higher mortality rates, and poorer long-term outcomes. These findings highlight the importance of early detection and management of these markers in AMI patients, as they can provide valuable insight into the severity of the condition and guide treatment strategies to improve patient outcomes.

Introduction: Acute myocardial infarction is one of the most common causes of hospitalization as well as one of the most common causes of death. Up to three million people worldwide are afflicted with the illness, which has an incidence of 64.37/1000 in India and a very high chance of passing away in the initial hours following the onset of symptoms. Aims: To study the prevalence and pattern of dyselectrolytemia in patients of acute MI (both STEMI and NSTEMI). To study effect of dyselectrolytemia towards clinical outcome in patients with Acute MI during early acute phase. Materials & Methods: The study design was prospective case control study, from July 2022 to December 2023, place of study was Katihar Medical College and total sample size was 60 Result: In our study, 6 (10.0%) patients had Accelerated Hypertension, 1 (1.7%) patient had Bradycardia, 3 (5.0%) patients had Bradycardia With Hypotension, 2 (3.3%) patients had Cardiogenic Shock, 2 (3.3%) patients had Heart Block, 7 (11.7%) patients had Hypotension 6 (10.0%) patients had Pulmonary Edema, 3 (5.0%) patients had Pulmonary Edema With VT and 5 (8.3%) patients had VT complications. The value of z is 5.318. The value of p is <.00001. The result is significant at p < .05. Conclusion: We concluded that AMI frequently have electrolyte abnormalities, especially those affecting potassium and sodium, which can have a negative impact on clinical outcomes. For patients to have a better prognosis, these abnormalities must be identified early and managed.

Introduction: Dyspnoea, coughing, and increased production and purulence of sputum are symptoms of chronic obstructive pulmonary disease (COPD), which can sometimes deteriorate rapidly. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes this extreme worsening of symptoms all at once. Aims: To study the level of serum electrolytes in patients with acute exacerbation of COPD. Assessment of acute exacerbation of COPD based on severity of dyspnea using modified medical research council dyspnoea scale, clinical examinations and pulmonary function tests. Materials and Methods: The present study was a prospective hospital-based study. This Study was conducted from July 2022 to December 2023, spanning 18 months at Katihar Medical College and Hospital in Bihar, India. Result: In our study, 63 (63%) of the patients had fever, 100 (100%) had cough, 73 (73%) had crepitations, and 90 (90%) had wheeze. In our study, 77 (77%) patients had SPO2 levels between 94-85, 22 (22%) had SPO2 levels between 84-75, and 1 (1%) had SPO2 levels below 75. In our study, 25 (25%) patients had one mMRC Scale, 35 (35%) had two mMRC Scales, 25 (25%) had three mMRC Scales, and 15 (15%) had four mMRC Scales. In our study, 44 (44%) patients had <135 (hyponatremia), while 56 (56%) had 135-145 (normal). In our study, 49 individuals (49.0%) had <3.5 (hypokalemia), while 51 (51.0%) had 3.5-5.0 (normal). Conclusion: The findings suggest that serum electrolyte imbalances are common in acute exacerbations of COPD and may exacerbate respiratory symptoms. Monitoring and managing electrolyte levels could be essential in improving patient outcomes during acute exacerbations. Further studies are recommended to explore the therapeutic implications of these findings.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver conditions characterized by excess fat accumulation in the liver, occurring in individuals with minimal or no alcohol consumption. It has become a major global health concern due to its increasing prevalence, particularly in conjunction with metabolic disorders like type 2 diabetes mellitus (T2DM). NAFLD encompasses a range of liver pathologies from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and hepatocellular carcinoma. Aims: To study nonalcoholic fatty liver disease in type 2 diabetes mellitus patients. To study the correlation between glycemic control (FBS) and duration of diabetes with ALT/SGPT levels. Materials & methods: For eighteen months beginning in July 2022 and ending in December 2023, researchers from Katihar Medical College and Hospital in Katihar carried out this cross-sectional study. Study population 100.v Result: Out of the 60 people who tested positive for NAFLD, 30 had cholesterol levels below 150 mg/dl, 17 had levels between 150 and 199 mg/dl, and 13 had values of 200 mg/dl or more. Among the 40 people who tested negative for NAFLD, 33 had levels below 150 mg/dl, 6 had levels between 150 and 199 mg/dl, and 1 had levels of 200 mg/dl or more. A statistically significant link between increased cholesterol levels and the existence of NAFLD was indicated by the Chi- square test, which generated a value of 12.17650 with a P value of 0.002. Conclusion: NAFLD affects 60% of diabetics, with the highest incidence in women aged 41-50. Obesity and elevated Alanine Aminotransferase levels significantly influence NAFLD risk. Regular testing and targeted therapies for weight and metabolism control are recommended to reduce NAFLD severity.

Introduction: Both community residents and hospitalized patients are impacted by the electrolyte imbalance known as hyponatraemia. Growing older is correlated with a higher risk of hyponatraemia, which is a potent independent risk factor for the condition. Aims: To investigate the clinical characteristics of hyponatremia in senior hospital patients. To investigate the cause of hyponatremia in senior hospital patients. To evaluate the hyponatremia correction response. Materials & Methods: The research took place at Katihar Medical College and Hospital from July 2022 to December 2023, spanning duration of 1.5 years. This study comprised 80 patients hospitalized to the medicine ward of the Department of Medicine at Katihar Medical College and Hospital in Katihar, Bihar, who were 60 years old or older and had serum sodium levels below 135 meq/litre. Result: Hyponatremia in patients can have several causes, but the most common one is inadequate intake (37.5%), followed by congestive heart failure (35.0%). About a quarter of cases involve vomiting, while about a third have SIADH, or syndrome of inappropriate antidiuretic hormone secretion. Hyperglycemia and diarrhea occur in 6.2% of cases. Hypothyroidism affects 5% of cases and chronic liver disease 2.5% of instances, dehydration 3.7% of cases, and idiopathic 5.0% of cases round out the total. Conclusion: According to the findings of my prospective study, elderly hospitalized patients frequently have hyponatremia, a common electrolyte imbalance.It affects all sexes, albeit males are more prone to suffer it. Those with symptoms had critically low salt levels, even though the majority of patients did not exhibit any. The most often reported symptoms were postural dizziness, abnormal behavior, and lethargy.

Purpose: To evaluate patient discomfort and tolerability during bronchoscopy using two sedation protocols: midazolam alone versus a combination of midazolam and fentanyl, assessed by the Richmond Agitation-Sedation Scale (RASS). Methods: In this prospective, randomized trial, 100 patients undergoing bronchoscopy were divided into two groups. Group M received midazolam alone, while Group MF received midazolam and fentanyl. Sedation levels were assessed using the RASS, while procedural tolerability was rated by observers. Adverse events were monitored. Results: Patients in Group MF achieved a more consistent sedation depth, indicated by RASS scores closer to the target range (0 to -3) compared to Group M (p<0.001). Procedural tolerability was rated as "good" or "excellent" in 92% of Group MF cases, versus 76% in Group M. Mild respiratory depression occurred in 6% of Group MF but resolved with supplemental oxygen. Conclusions: The combination of midazolam and fentanyl enhances procedural tolerability and sedation consistency during bronchoscopy, with minimal adverse effects. This sedation protocol may be preferred in settings where stable sedation is crucial.

Background: The study evaluates the renal function and coagulation abnormalities in patients with sickle cell disease and their association with clinical status. Objectives: To assess relative hypertension, renal function parameters, and coagulation abnormalities in sickle cell disease patients and the association of these parameters with clinical status. Materials And Methods: A descriptive cross-sectional study from June 2017 to June, 2018 including patients in Wayanad who come to sickle cell clinics under sickle cell project of Department of Pathology, GMC, Calicut, who are diagnosed as sickle cell anemia by simple random sampling. The patients coming were counseled regarding the testing for RFT and thromboembolic complications and informed consent was taken Personal data (age, gender, community), medical history (treatment, number of crises in preceding year) & blood pressure was recorded. Complete blood count, blood urea, creatinine, prothrombin time, activated partial thromboplastin time, HPLC were performed. Data was analyzed using SPSS software, association done by chi square test and 95% confidence interval was estimated. Results: Fifty-five cases had relative hypertension and 18 were hypertensive. Forty-two patients received blood transfusion and 56% required hospitalization in the past one year. Serum creatinine ranged from 0.1-9.1 mg/dl (mean=0.99mg/dl, SD=1.16. Serum urea ranged from 10-134 mg/dl (mean= 24.6mg/dl, SD=22.3). Fifteen and Nine cases had elevated creatinine & urea levels respectively. Prothrombin time ranged from 11.1-81sec (mean=17.55sec, SD=8.54). aPTT ranged from 20-102sec (mean=35.66sec,SD=0.86). Nine & Six cases had elevated PT & aPTT respectively. Better outcomes were notes with patients on hydroxyurea. Conclusion: Regular follow up of these patients can help to alleviate the general well-being of the sickle cell anemia patients

Background and Objectives: In general, laparoscopic surgeries are linked to a high likelihood of Postoperative Nausea and Vomiting (PONV) approximately 20 – 51% with gynecological laparoscopy having an evenhigher rate (50 – 80%). This study was conducted to determine the efficacy of ondansetron and dexamethasone administered alone or in combination for the prevention of postoperative nauseaandvomitingin patients undergoinglaparoscopicsurgery. Materials and Methods: One hundred and twenty patients of age 18-75, ASA PS I-II of both gender who underwent laparoscopic surgeries were included in the study and divided into three groups. Ondansetron 4mg, dexamethasone8mg, ondansetron4mg, anddexamethasone8mgweregivenI/Voneminutebefore induction in Group O, Group D, and Group OD respectively. Patients were observed forthe incidence of nausea and vomiting and the requirement of rescue anti-emetics for the first 6hours. Statistical Analysis: Continuous data were analyzed using ANOVA.Categorical data wereanalyzedusingChi-squareor Fischer Exact whichever is appropriate. Results: The incidence of nausea and vomiting was significantly lower in Group OD (12.5%) than GroupD (50%) and Group O (52.5%). The requirement for a rescue antiemetic was lower in Group OD (0%) than in GroupD (30%) orGroupO (27.5%). Conclusion:ThecombinationofOndansetronandDexamethasoneismoreeffectiveforprophylaxisagainstPONVthanondansetronandDexamethasonealoneinlaparoscopicsurgeries.

Fungi are ubiquitous organisms in our environment. Invasive fungal rhinosinusitis is characterized by mycotic infiltration of the mucosa of the nasal cavity and the paranasal sinuses. Invasive fungal rhinosinusitis is rapidly destructive. Medical advances, such as new chemotherapeutic agents and long-term use of immunosuppressive agents following bone marrow or solid organ transplantation, have resulted in an increase in the population at risk of developing AIFR. There are very few landmark studies on invasive fungal rhinosinusitis in our country, and there is insufficient data regarding the causative agents from the southern part of the country. Aim: To study multimodal diagnostic and therapeutic approaches for the management of invasive fungal rhinosinusitis. Objectives: 1. To study the underlying risk factors. 2. To study the isolated pathogens 3. To study the radiological features of invasive fungal sinusitis. 4. To study various treatment modalities.  Material And Methods This prospective and observational study was conducted in the Department of ENT, Subbaiah Institute of Medical Sciences, Shivamogga, over a period of two years. All cases of invasive fungal rhinosinusitis treated at the hospital were included. Results: Study of CT scans of 60 patients revealed unilateral pansinusitis in (74%) of cases with incidentally more on the left side with 47% of cases, bilateral pan sinusitis was seen in 27% of cases, with bony erosions of lamina papyracea in 57%, hard palate erosion in 47%, maxilla erosion was seen in 13% of cases and intracranial extension                           was seen in 23% of cases. On fungal culture of the nasal tissue 53.3% of cases were found to isolate mucor species and 10% of cases isolated to have aspergillous species where as in 36.6% of cases no fungus was grown. All cases that were diagnosed as invasive fungal sinusitis either clinically or based on histopathology were treated with IV Amphotericin in which 60% of cases were treated with amphotericin deoxycholate and 40% of cases were treated with lipid emulsion amphotericin purely based on the financial status of patient. 87 % of cases     underwent endoscopic sinus surgery and debridement of fungal debris was done other were excluded as they were not fit for the surgery. Conclusions: Invasive fungal rhinosinusitis is a relatively rare disease with high morbidity   and mortality. The most common risk factor is uncontrolled diabetes mellitus. Maintaining a high index of suspicion in at- risk patient populations, followed by prompt evaluation and management, is crucial in suspected AIFRS. Early diagnosis of IFR requires a high level of suspicion because of the non- specific initial symptoms and radiological signs.

Introduction: Intra cerebral hemorrhage (ICH) is the most devastating form of stroke, with high mortality and severe disability among survivors. Non contrast computed tomography (CT) is the most commonly available tool for the diagnosis of intracranial hemorrhage. he aim of the study is to document the location and volume of intra cerebral hemorrhage, presence of subarachnoid /ventricular extension various types of brain herniations. The relation of extent of damage to patient management and outcome was analyzed. Materials and Methods: This prospective study was carried out on 54 patients with spontaneous intracerebral hemorrhage (SICH) over a period of 18 months (April 2023 - September 2024). Non contrast CT was performed using sixteen slice Multidetector Computed Tomography scanner (GE Revolution ACT 50 slice CT scanner).Contrast CT, follow up CT and additional radiological tests were performed as and when required. Results: In our study out of 54 patients, SICH was higher among males, with hypertension as the most important risk factor and most of the patients are with volume of bleed less than 30mL (59%). Intraventricular extension was seen in 25 patients. Supratentorial location of hemorrhage (81%) was more common compared with infratentorial location (19%) with the most common site being basal ganglia (37%). 48 patients were treated medically and six patients underwent surgery. Of the 48 patients treated medically, 9 were in infratentorial location with 4 in cerebellum and 5 in brain stem and all these patients had fatal outcome, remaining 39 patients treated medically for the supratentorial ICH, 23 patients survived. Among these patients, 22 patients had ICH volume of less than 30 mL (95%). Of 16 patients with intracerebral hemorrhage volume of ≥ 60 mL, mortality was seen in 87.5% (14 of 16 patients). Of the six patients treated surgically for supratentorial bleeds, survival rate was 66.67% (4 of 6 patients) and all the survived patients had volume of bleed more than 30 mL. Interpretation and conclusion: Based on the findings we conclude that SICH volume involving more than 60 mL, infratentorial location and intraventricular extension are predictors for poor outcomes. Patients with ICH volume of less than 30 mL have a good prognosis and patients with ICH volume ofmore than 30 mL may be considered as patients suitable for surgery.

Introduction: Total knee replacement (TKR) is commonly performed surgeries associated with high degree postoperative pain, prolonged immobilization. Postoperative analgesia with Ultrasound guided (USG) Adductor canal block(ACB) using Ropivacaine with or without Nalbuphine is reported to give good analgesia without compromising on the motility of patients. Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. The combination of Ropivacaine with Nalbuphine for ACB may offer improved postoperative pain management compared to Ropivacaine alone. Materials and Methods: Thirty American Society of Anesthesiologists (ASA) class I and II patients, ranging in age from eighteen to sixty, were chosen as candidates for elective total knee replacement procedures in a randomized clinical trial. Once TKR surgery was done, Adductor canal block was performed using ultrasound guidance. 30 patients were randomly allocated into two groups of 15 each by computer generated randomized number. Group R recieved19ml of ropivacaine (0.375%) +1ml normal saline. Group RN received 19ml solution of Ropivacaine (0.375%) with 1ml (10mg) Nalbuphine. Results: it was observed that time of postoperative analgesia has 398.67 minutes in group RN and 306.67 minutes in group R. P value is 0.000 (‘p’ < 0.05). this is statistically significant. Conclusion: we concluded that the addition of Nalbuphine as an adjuvant to Ropivacaine after unilateral total knee replacement using ultrasound guided Adductor canal block prolongs the duration of postoperative analgesia.

Introduction: Subarachnoid block is the most commonly used anesthetic technique for infraumbilical surgeries.1 Intrathecal hyperbaric bupivacaine had relatively narrow cardiovascular safety1 which, led to discovery of Levobupivacaine with less cardiotoxicity. Isobaric levobupivacaine had an unpredictable spread, but hyperbaric preparations of Levobupivacaine produced effective and predictable block.2 Hence, the study was conducted to compare the block characteristics (the onset of sensory and motor block) with equivalent doses of intrathecal hyperbaric levobupivacaine and isobaric levobupivacaine in elective major lower limb orthopaedic surgeries. Methods: A prospective randomized double blinded study of 40 Patients with ASA grade 1 and 2 of either sex with age group between 18 to 60 years posted for elective major lower limb surgeries, were randomized into two groups, Group HL, received 3 ml of 0.5% hyperbaric Levobupivacaine (15 mg) and Group IL received 3 ml of 0.5% isobaric Levobupivacaine (15 mg) intrathecally. Block was given in sitting position at L3-L4 or L4-L5 interspace, using Quincke 25G spinal needle. The study drug was given according to group allocation and the patient was placed supine. The onset of block - time to achieve sensory block of T10 and motor block of M3 (modified Bromage scale) were compared between the two study groups. Results: The onset of sensory and motor block was earlier in group HL compared to group IL (3.40 ± 1.05 versus 7.30 ± 2.72) minutes with p-value of <0.001 and (3.80±2.78 versus 9.25±3.45) minutes with p-value of <0.001, both of which had statistical significance. Conclusion: Hence, we conclude that, Hyperbaric Levobupivacaine having early onset of sensory and motor block, was found to be a better option for intrathecal block in elective major lower limb orthopaedic surgeries.

Introduction: Etomidate is an imidazole derivative that is used to induce anesthesia, especially in elderly and individuals with poor cardio vascular reserve. With clinical data, it was found that etomidate lowers serum cortisol due to reversible adrenal suppression. Vitamin C (ascorbic acid) is a water-soluble vitamin that aids in the synthesis of cortisol by functioning as a co-factor in the terminal phase of the conversion of 11-deoxycortisol to cortisol. Research evaluating serum cortisol levels in etomidate-induced patients revealed that vitamin C might be involved in counteracting the drug's suppression of cortisol. Materials and Methods: Twenty American Society of Anesthesiologists (ASA) class I and II patients, ranging in age from eighteen to sixty years, were chosen as candidates for elective ENT surgery under general anesthetic procedures in a randomized clinical trial. The patients in the vitamin C group received one gram of intravenous vitamin C one hour before the start of the surgical procedure. Two blood samples are taken, an initial sample was obtained in pre- operative room while securing iv access one hour before induction, and the other four hours following induction with etomidate following surgery. Serum-free cortisol levels were assessed for each sample. Results: The length of the procedure, the pre-operative blood pressure, and the heart rate did not differ significantly between the two groups (p>0.05). Serum cortisol decreased considerably in the control group from 14.4±3.4 to 4.7±1.7 in the post-operative period (p=0.0005), but not in the vitamin C group from 11.26±6.1 μg/dl to 9.6±5. (p>0.05). Conclusion: with Inj Vitamin C 1g IV infusion as premedication 1hour before surgery helps in reducing Serum Cortisol suppression during induction of Anaesthesia with Inj Etomidate.

Hypertension, or high blood pressure, is a chronic health condition affecting over 1.13 billion individuals globally and a significant contributor to cardiovascular diseases, kidney failure, and strokes. Known as the “silent killer” due to its often-asymptomatic progression, hypertension poses extensive public health challenges worldwide. It results from a complex interaction of non-modifiable factors, such as age, sex, and genetic predisposition, alongside modifiable lifestyle factors, including diet, physical inactivity, obesity, stress, and socio-economic determinants. The prevalence of hypertension has notably increased in recent years, particularly in low- and middle-income countries (LMICs), where urbanization, dietary shifts, and sedentary behaviours exacerbate the risk. This systematic review provides a detailed analysis of these key risk factors, highlighting the genetic, environmental, lifestyle, and socio-economic factors that contribute to hypertension and emphasizing the necessity of multi-level interventions involving clinical care, public health policies, and lifestyle changes to effectively address this global health issue.

Background: Platelets are quintessential for primary hemostasis. Platelet counts are measured by automatic cell counters which work on the basis of electrical impedance, optical and fluorescent methods using the size, refractive index and nucleic acid stain. Ethylene diamine tetra acetic acid (EDTA) is commonest used anticoagulant for haematological investigations. This can very rarely lead to a spuriously low platelet count called EDTA induced pseudothrombocytopenia (PTCP). PTCP is an in-vitro problem and low platelet count can be alarming to the patient and clinician. It may lead to the use of unnecessary treatments and diagnostic procedures, such as platelet transfusions, bone marrow aspiration and biopsy, and sometimes long-term steroid therapy or even splenectomy. However, it is not associated with bleeding symptoms or platelet dysfunction. 1-3. This is a cross-sectional prospective study of 5600 cases related to platelet count in 3 years from 2021-2024 in a private diagnostic centre in Mandya, Karnataka. Among these, 12 cases of EDTA induced thrombocytopenia were observed. The female to male ratio was 3:1. The median age was 37 ± 14.08 years. All cases showed thrombocytopenia on cell -counters. There was no clinical suspicion of thrombocytopenia in these patients. PTCP leads to more pronounced thrombocytopenia even in mild cases of thrombocytopenia. History and clinical examination of the patients revealed no underlying clinical condition like common viral infections, steroid or chemotherapy that would have caused thrombocytopenia.  

Background: Subacute thyroiditis, also known as De-Quervain’s thyroiditis (DT), is a rare condition with an incidence of 4.9 cases per 100,000/ year. The usual work-up includes history-taking, neck examination, thyroid function test, ultrasonography (USG) of the thyroid gland, and a fine-needle aspiration cytology (FNAC). They often show nodules on examination which may appear neoplastic, thus warranting an intensive surgical treatment. This is a self-limiting condition, often with a preceding history of fever or infection.  Case Details A total of 656 cases of thyroid lesions were observed over a period of 24 months among which 14 cases of DT were diagnosed on FNAC. Females outnumbered the males with a ratio of 3.6:1. All the patients complained of painful thyromegaly. On USG, 10 cases (71.4%) showed hypoechoic nodules with ill-defined margins and 4 cases (28.6%) showed diffuse geographical areas. Six patients showed increased vascularity peripherally. Eleven patients were hyperthyroid, 2 patients were hypothyroid and 1 patient was euthyroid. Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated in 6 cases (42.8%). FNAC in all showed granulomatous inflammation along with multinucleated giant cells engulfing colloid. Ten patients were followed up over 6 months among which 8 patients had disappearance of pain and nodules while another 2 were hypothyroid after 6 months. Conclusion DT may appear dangerously neoplastic at presentation but resolves spontaneously or with anti-inflammatory medication. FNAC helps in precise diagnosis and prevent surgical intervention.  

Introduction- In India stroke stands as a threat, to life affect 1 in every 1000 individuals. Due to lack of awareness among the public, about the symptoms and risks of stroke prompt administration of rtPA treatment gets delayed frequently. Aim and Objectives- The aim is to assess how well the general public recognizes the signs of a stroke and its risk factors and treatment options based on age and gender differences and to provide education to those, with understanding to encourage intervention. Methodology- This was a cross-sectional survey; five hundred subjects aged 18-80 were recruited from patients attending health care in Ahmedabad city using stroke awareness questionnaire. Participants were educated about stroke warning signs, risk factors, and actions after inquiring the required responses and obtaining informed consent. Results- Of the sample 49% males and 51% females participated, and average age was 22 years. The knowledge of stroke warning signs and treatment response was better among females. However, age did not make any significant difference (p=0.06). Gender and age did not significantly regard awareness of risk factors. However, there were significant relationships between awareness of warning signs and treatment action, as well as between awareness of risk factors and treatment awareness. Discussion- Even though 95% of respondents understand the word "stroke," only 25% were able to identify warning signs; awareness was higher among females. This calls for directed education about the improvement of the ability to identify when the symptoms appear in an effort to eliminate the time that these patients wait before they receive treatment. This study proposes to evaluate the level of stroke signs, risk factors and methods available to treat heart stroke within the society targeting the existing gaps on educational needs.

Background: Over the past fifty years, significant lifestyle and environmental changes have led to an increase in metabolic syndrome (MetS), a cluster of metabolic risk factors including hypertension, central obesity, impaired glucose tolerance, low HDL, and elevated triglycerides. MetS has been shown to negatively impact reproductive health and fertility. Obesity, a common component of MetS, is associated with hormonal imbalances and ovulatory dysfunction, potentially leading to diminished ovarian reserve and reproductive challenges. This study investigates the prevalence of MetS among infertile women with diminished ovarian reserve and explores correlations between MetS components and reproductive outcomes. Method: A cross-sectional observational study was conducted from January to December 2023 in the Department of Medicine at MGM College and MY Hospital, Indore. The study involved 298 women aged 20–40 years with primary infertility, recruited through the endocrine and infertility OPDs. Data collection included demographic and clinical information, medical history, laboratory investigations, and sonographic ovarian reserve assessments. The modified Asian NCEP ATP III criteria were applied to define MetS, and statistical analysis was performed using SPSS-25, with a p-value < 0.05 considered significant. Results: Among the participants, 36.9% (n=110) had metabolic syndrome. Elevated waist circumference (≥80 cm) was found in 70.1%, while 64.1% had high fasting triglycerides (≥150 mg/dL). Obesity (BMI ≥ 25 kg/m²) was observed in 52.7% of women. A significant association was noted between MetS components, particularly BMI and waist circumference, and primary infertility in women with diminished ovarian reserve.  Conclusion: This study reveals a high prevalence of metabolic syndrome (36.9%) in women with primary infertility, highlighting the significant impact of obesity and metabolic risk factors on reproductive health. Lifestyle modifications targeting metabolic syndrome components could potentially enhance reproductive outcomes. Early identification and management of modifiable risk factors may improve fertility outcomes in women with MetS.