European Journal of Cardiovascular Medicine

Background: Effective pain management is a crucial aspect of postoperative care for minimally invasive surgeries, such as laparoscopic nephrectomy. Regional anesthesia techniques like the transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) have gained attention as part of multimodal analgesia strategies aimed at minimizing opioid use and enhancing recovery. While TPVB is a well-established technique, TMQLB has emerged as a promising alternative due to its ease of administration and potential for broader sensory coverage. This study aimed to compare the analgesic efficacy, opioid-sparing effects, and postoperative recovery outcomes of TMQLB and TPVB in patients undergoing laparoscopic nephrectomy through a prospective randomized controlled trial. Materials and Methods: This prospective, randomized, double-blind, single-center study was conducted to compare the analgesic efficacy and recovery outcomes of transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) in laparoscopic nephrectomy patients. A total of 68 participants, aged 17–80 years and classified as ASA I–III, were enrolled and randomized into two groups. All blocks were performed under ultrasound guidance using 0.5% ropivacaine at a dose of 0.4 ml/kg. The primary outcome was 48-hour postoperative cumulative morphine consumption, while secondary outcomes included sensory block dermatomes, intraoperative hemodynamic changes, Numerical Rating Scale (NRS) pain scores, postoperative recovery data, and quality of recovery scores. Data analysis was performed using GraphPad software, with a significance threshold of p < 0.05. Results: A total of 68 patients were randomized into two groups (n=34 each), with 30 patients per group included in the final analysis. Both groups had similar baseline characteristics. Postoperative cumulative morphine consumption was significantly lower in the TPVB group at all time points (p < 0.05), though pain scores were comparable. The postoperative pain NRS at rest and on movement, incidences of side effects, anesthesia-related satisfaction, and quality of recovery scores were similar between the two groups (all P > 0.05). The TMQLB group achieved a broader sensory block (p = 0.002). Intraoperative hemodynamics were stable, with no significant differences between groups. The TMQLB group required more sevoflurane and fentanyl. Postoperative recovery, including gas passing, urination, mobilization, and length of stay, showed no significant differences. Complication rates and quality of recovery were similar, with high patient satisfaction in both groups. Conclusion: The present study demonstrated that transmuscular quadratus lumborum block (TMQLB) provides a comparable postoperative analgesic effect to T10-level thoracic paravertebral block (TPVB), as reflected by similar 48-hour cumulative morphine consumption in patients undergoing laparoscopic partial nephrectomy. TMQLB shows promise as a viable alternative to TPVB in select surgical settings and patient populations, warranting further research to explore its potential applications and benefits.

Type 2 Diabetes Mellitus (T2DM) is a multifactorial metabolic disorder characterized by insulin resistance, impaired glucose regulation, and progressive beta-cell dysfunction. The global prevalence of T2DM has been rising at an alarming rate, influenced by genetic, lifestyle, environmental, and socio-economic factors. This systematic review examines the key risk factors associated with the development of T2DM, including obesity, physical inactivity, unhealthy diet, genetic predisposition, psychosocial stress, environmental toxins, and socioeconomic determinants. The review synthesizes evidence from epidemiological studies, clinical trials, and meta-analyses to provide a comprehensive understanding of the complex interplay of risk factors that contribute to T2DM onset. Identifying and addressing these risk factors through preventive strategies is crucial for reducing the burden of diabetes globally. Moreover, this review highlights the importance of personalized lifestyle interventions and early screening methods to mitigate risk and improve long-term health outcomes. Addressing disparities in healthcare access and developing targeted public health strategies are essential in reducing diabetes prevalence and improving patient quality of life. Future research should focus on innovative prevention programs, technological advancements in monitoring glucose levels, and community-based interventions that promote sustainable lifestyle changes

Introduction: Breast cancer (BC) proliferative activity is a significant predictive factor associated with treatment response and can be regarded as a proxy measure of tumor aggressiveness. Aims: The goal of research on atypical breast cancer is to comprehend, identify, and treat uncommon or uncommon breast cancers that differ from their conventional presentations, guaranteeing precise diagnosis and suitable therapy. Materials & Methods: The present study was a Case-Control Study. This Study was conducted from One year. Total 120 patients were included in this study. Result: There was a significant association between high atypical mitoses and high grade, larger tumor size, NST tumor type, the poor prognostic NPI group and TNBC phenotype. A significant association was confirmed between high overall mitotic count (>21 mitoses per 3 mm²) and other parameters characteristic of aggressive tumor behavior including high tumor grade, larger tumor size, NST histological type, the moderate and poor prognostic NPI groups and (TNBC) phenotype. Conclusion: We came to the conclusion that atypical breast tumors are a broad category of uncommon and uncommon cancers that differ from their usual appearances, which complicates diagnosis and treatment.

Introduction: Critically sick patients admitted to the Intensive Care Unit (ICU) frequently suffer from anemia. Anemia is defined by the World Health Organization (WHO) as hemoglobin (Hb) < 13g/dl in men and < 12g/dl in women. Aims: To evaluate the morbidity and mortality of adult transfused patients and to establish transfusion protocols for all components—PC, FFP, and PLTC—among critically sick patients. Materials & Methods: The present study was a hospital based observational descriptive study. This Study was conducted from eighteen months after ethical clearance from March 2021 to September 2022 at ICU, IQ CITY Medical College and Hospital, Durgapur. Total 218 patients were included in this study. Result: Out of 44 (80.0%) patients who died had received PRBC transfusion, 1 (1.8%) who died patient had received PRBC+FFP transfusion, 1 (1.8%) patient who died patient had CRBC+FFP+PC transfusion, 8 (14.5%) patients who died had FFP transfusion, and 1 (1.8%) patient who died had PC transfusion. Association of BLOOD COMPONENT with Mortality was not statistically significant (p=0.0634) as shown in table 25 and figure 22. Conclusion: We came to the conclusion that, even if blood transfusions are essential in intensive care units, it is crucial to use blood components with caution, evidence, and individualization. This would guarantee that blood products are utilized safely and effectively in critically ill patients, minimize possible dangers, and improve patient care.

Asymptomatic bacteriuria (ASB) is a prevalent condition in Type-2 Diabetes Mellitus (T2DM) patients, often exacerbated by the chronic inflammatory milieu associated with diabetes. This study aims to evaluate and compare the levels of key inflammatory biomarkers—Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), C-reactive protein (CRP), and Hemoglobin A1c (HbA1c)—in T2DM patients with and without ASB in Northern Andhra Pradesh. IL-6 and TNF-α are pivotal pro-inflammatory cytokines that contribute to both the pathogenesis of insulin resistance and the inflammatory response during bacterial infections. Elevated IL-6 and TNF-α levels are associated with poor glycemic control and increased susceptibility to infections, including urinary tract infections. CRP, an acute-phase reactant, is commonly elevated in systemic inflammation and serves as a reliable marker for infection and inflammation, which is critical in assessing the risk of ASB in diabetic patients. HbA1c, reflecting long-term blood glucose control, is also implicated in chronic inflammation, with poorly controlled diabetes being linked to higher inflammation and infection rates. By assessing these biomarkers, this study aims to elucidate the relationship between systemic inflammation, glycemic control, and the incidence of ASB in T2DM.

Background: High-risk patients, including those with cardiovascular conditions and geriatric individuals, present significant challenges in anesthetic management due to their increased susceptibility to perioperative complications. Cardiovascular diseases (CVDs) are a leading cause of perioperative morbidity, while the aging population experiences unique physiological changes that complicate surgical outcomes. Objective: This study aims to evaluate the outcomes and effectiveness of tailored anesthetic strategies for high-risk cardiovascular and geriatric patients undergoing surgical procedures. Methods: A prospective observational study was conducted involving 500 high-risk patients, comprising 250 cardiovascular and 250 geriatric individuals. Data on perioperative challenges, anesthetic techniques, intraoperative monitoring, and postoperative outcomes were collected and analyzed. Results: Cardiovascular patients demonstrated increased risks of hemodynamic instability, arrhythmias (12%), and myocardial ischemia (8%). Effective management included preoperative cardiac optimization and advanced intraoperative monitoring. Geriatric patients exhibited heightened incidences of postoperative cognitive dysfunction (14%) and delayed recovery (10%), with age-specific protocols such as regional anesthesia and multimodal analgesia showing positive outcomes. Conclusion: Tailored anesthetic approaches are crucial for high-risk patients to mitigate complications and improve surgical outcomes. Multidisciplinary collaboration and the integration of advanced monitoring technologies play pivotal roles in enhancing patient safety. This study provides evidence supporting the need for personalized anesthetic strategies to address the unique challenges faced by cardiovascular and geriatric patients

Objective: To evaluate the effectiveness of transthoracic echocardiography as a hemodynamic monitoring tool during induction of anesthesia and endotracheal intubation Design:  Prospective, single center, observational study Setting: Medical college teaching hospital Participants: Sixteen patients undergoing elective coronary artery bypass surgery Interventions: Patients were monitored with Transthoracic echocardiography and pulmonary artery catheter  Measurements and Main results: Baseline pre induction Transthoracic echocardiography was done to calculate fractional Shortening, fractional Area Change. Cardiac output and systemic vascular resistance were calculated by left ventricular outflow and mitral inflow Doppler. At the same time baseline pulmonary artery catheter measurements, cardiac output and calculated systemic vascular resistance were recorded. Measurements of Transthoracic echocardiography and pulmonary artery catheter were repeated during post induction and one minute after endotracheal intubation. Percent difference between baseline and post induction (Group A data) and percent difference between post induction and post intubation (Group B data) of all parameters were calculated. From group A and group B data estimated percent change in cardiac output and systemic vascular resistance correlated between two techniques. It also predicts the change in contractility during induction and endotracheal intubation. The change in cardiac output as estimated by the mitral inflow doppler and the left ventricular outflow doppler correlated well. Conclusion: Transthoracic echocardiography can be used as a replacement for pulmonary artery catheter to predict change in blood pressure, afterload and cardiac output during induction of anaesthesia in a non-invasive manner

Introduction The origin of radiology in 1895 is marked by discovery of the X-ray by Physicist Wilhelm Conrad Röntgen (Roentgen) on November 8^th  is highlighted in the history of radiology timeline. The International day of radiology (IDOR) marking the anniversary of discovery of X-rays is celebrated every year with the motive of spreading awareness and value of radiology in safe patient care. Objective Our research study was aimed to assess the awareness, perception and knowledge of interventional radiology (IR) among medical students & evaluate their understanding of its applications and scope via survey questionnaire which was conducted among 50 medical students in Bharati Vidyapeeth (Deemed To be University) medical college and hospital Sangli, Maharashtra, India. Results Our study found that 52 % of students were aware about the specialty of Interventional Radiology.  Conclusion Medical schools play a vital role in ensuring that medical students acquire sufficient knowledge about interventional radiology (IR) before completing their final licensing. Inclusion of research related to IR through intramural projects during UG, participation during internship postings, along with PG related IR postings can help in further awareness along with hospital management and panel consultants priming and sensitization and teamwork approach and thus aid in 360-degree (overall) patient care via IR clinical applications which can benefit the critical patients in long-term.            

Allergic Bronchopulmonary Aspergillosis (ABPA) is a pulmonary condition which is immune mediated and is most commonly seen in people with asthma or cystic fibrosis. This condition occurs as a result of hypersensitivity to the fungus Aspergillus. This report highlights a case of a 31-year-old female with poorly controlled bronchial asthma presenting with haemoptysis, shortness of breath, and characteristic radiological findings suggestive of ABPA. Her elevated total IgE levels, along with bronchoscopic findings of a fungal ball, were critical for diagnosis and management

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) poses a significant clinical challenge due to its complex pathophysiology and increasing prevalence, particularly among older adults. Despite normal or near-normal left ventricular ejection fraction, patients exhibit heart failure symptoms such as dyspnea and fatigue. HFpEF is commonly associated with comorbidities like hypertension, diabetes, and obesity, which complicate management and contribute to poor prognosis. Methods: A descriptive observational study was conducted over two years at a tertiary care hospital in Chhattisgarh. The study included 100 adult patients diagnosed with HFpEF, defined by symptoms of heart failure, left ventricular ejection fraction (LVEF) ≥ 50%, and without evidence of structural or cardiovascular heart disease. Clinical evaluation, laboratory tests, and imaging studies, including echocardiography, were performed to assess cardiac function. Statistical analysis was conducted using descriptive statistics, t-tests, and chi-square tests. Results: The study participants had a mean age of 56.72 years, with a balanced gender distribution. Fatigue (87%) and dyspnoea (82%) were the most common symptoms. Hypertension (88%) and diabetes (67%) were prevalent comorbidities. The mean ejection fraction was 54.53%, with mild diastolic dysfunction observed in 78% of patients. Conclusion: HFpEF primarily affects older adults with significant comorbidities, notably hypertension and diabetes. Although ejection fraction remains normal, mild diastolic dysfunction is common. These findings emphasize the need for comprehensive management strategies focusing on symptom relief and comorbidity control to improve patient outcomes.

Introduction Liver disease, particularly alcoholic liver disease (ALD), is a significant global health issue, contributing to high morbidity and mortality rates. With increasing cases of liver cirrhosis, there is a growing need for simpler, cost-effective, and non-invasive diagnostic tools. The Aspartate Aminotransferase to Platelet Ratio Index (APRI) score has shown promise in assessing liver fibrosis, especially in resource-limited settings. This study explores the APRI score's utility in diagnosing and staging liver fibrosis in alcoholic liver cirrhosis patients in India. Objective To assess the effectiveness of the APRI score as a non-invasive marker for liver fibrosis and to correlate APRI score with the Child-Turcotte-Pugh (CTP) score. Methodology This cross-sectional study was conducted at Sri Siddhartha Medical College and Hospital, Tumkur, over 24 months, involving 102 patients with ultrasound-confirmed alcoholic liver cirrhosis. Data were collected through clinical, laboratory, and radiological assessments. The severity of liver dysfunction was evaluated using APRI and CTP scores. Statistical analysis was conducted, with significance set at p<0.05. Results 69.6% of participants had APRI scores >1, indicating advanced fibrosis, with a mean score of 3.034. APRI scores were significantly associated with CTP classification (p=0.024).  Conclusion The APRI score is an effective, non-invasive tool for assessing liver fibrosis in alcoholic liver cirrhosis, particularly in resource-limited settings. Its correlation with CTP score further denotes its use as a prognosticating factor.  Further longitudinal studies are needed to validate its prognostic value

Background And Justification: Spinal Anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery, provided there is no contraindication. Pregnancy causes major physiological changes to the mother’s body. An understanding of the physiological changes in pregnancy is the key to safe obstetric anaesthesia. Spinal Anaesthesia is associated with hypotension which can have maternal and foetal side effects. Methods: This study was performed on 100 patients, after getting informed consent. In this study the baseline hemodynamic parameters of the patient was noted during intra operative period. After spinal anaesthesia is performed by the Anaesthesiologist, hemodynamics such as Heart Rate, Blood Pressure, Mean Arterial Pressure and SPO2 was noted for every 3 minutes for first 20 minutes after which it was noted for every 5 minutes, till end of the surgery.  Results: From the descriptive statistics and chi square test, after spinal anaesthesia performed there is a hypotension, p=0 which is <0.05, hence statistically significant, and there is fall in heart in rate, p=0.0029 which is <0.05, hence statistically significant.  Conclusion: 100 pregnant patients who underwent spinal anaesthesia for elective caesarean section were included in this study. Based on the result we concluded that hypotension and bradycardia are the frequent response after spinal anaesthesia due to arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardio inhibitory receptors. This study benefits to the anaesthesiologist in prediction of possible adverse effects and to overcome the same.

Background: AES is defined as an acute onset of fever and a change in mental status manifesting as confusion, disorientation, coma, inability to talk and or new onset seizures (except febrile seizure). It is a major public health problem in India, particularly in Assam, and is linked to significant morbidity and mortality. Viruses are the main causes of AES.  Objectives: To study the clinical and etiological profile of AES in hospitalized children of urban tertiary care centre. Methods: This prospective hospital based observational study, conducted among children between 1m to 12 yrs of age as per inclusion criteria admitted as AES in Pediatric ward and PICU, Gauhati Medical Cllege and hospital, Assam from July 2023 to June 2024. Data were collected and all relevant investigations like serum and CSF were analysed in search of the etiologic agent. Radio imaging of brain MRI and CT scan was done after stabilization whenever is indicated. All the cases were managed as per institutional treatment protocol.   The collected data was statistically analysed. Results: The most common age group was 6-10 years (43%), and maximum cases were males 68%. The mean age of presentation was 6.7 years. Majority of the cases were from rural area (81%). All the cases (100%) presented with fever and altered sensorium, 85% children presented with convulsion and 42% presented with vomiting. JE was the commonest cause of AES (22%), non-JE encephalitis (18%) and unknown etiology (60%). Out of 100 cases 49% cases recovered completely, 34 % recovered with neurological sequelae and 17% cases died. Conclusion: AES is a major public health problem of multiple and varying etiology with significant mortality and morbidity. Early diagnosis, appropriate investigation, prompt management and prevention by vaccination go a long way in reducing mortality and sequalae in AES.

Background:  Road traffic accidents have become a significant public health concern in the recent times. This issue has resulted in a rising rate of death and illness, largely due to changes in lifestyle and advancements in the automobile sector ^[1]. Trauma to eye remains a leading cause of visual morbidity and blindness, constituting approximately 75% of ocular emergencies, road traffic accidents (RTA) being one of the most common risk factors ^[2].

Objectives:

1. To study the incidence of ocular injuries in road traffic injuries.
2. To determine the pattern of clinical presentation of ocular injuries due to road traffic injuries.
3. Effective management and final visual prognosis in vehicular ocular injuries.

Material & Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Ophthalmology, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka.  Study Period: 1 year. Study population:  All patients with a history of ocular injuries following road traffic accidents presenting to the casualty and outpatient ophthalmology department. Sample size: The study consisted of 60 subjects.Results: The most common ocular manifestation of road traffic accidents was subconjunctival haemorrhage 32 (53.33%), followed by ecchymosis 29 (48. 33%). Majority of the ocular injuries (35%) occurred in the age group of 31- 40 years and the least number of cases (13.33%) were seen in patients over the age of 50 years. Ocular injuries were more common in males 43 (71.67%). Road traffic accidents with ocular injuries were more commonly seen with two wheelers 34 (56.67%).  Conclusion:  Ocular injuries resulting from road traffic accidents are among the primary contributors to eye-related health issues and loss of vision in developing nations such as India, where the number of two-wheeler vehicles is increasing and public awareness regarding eye protection gear is lacking. The most impacted demographic group consists of working-class male.

Introduction Bronchiectasis a chronic lung condition, defined as the abnormal, irreversible dilation of the bronchi and bronchioles, where the elastic and muscular tissue is destroyed by acute or chronic inflammation and infection.  This anatomical definition has been evolved from the original description of ectatic bronchi found in pathological specimens in the year 1819. Bronchi, mostly medium sized, are abnormally dilated and bronchial wall shows inflammatory changes. Such changes result from disordered anatomy of bronchial tree, bacterial colonization and chronic host inflammatory response. Materials and Methods This is a prospective study was conducted in the Department of Respiratory medicine at Tertiary Care Teaching Hospital. Data were collected from inpatients diagnosed with bronchiectasis with or without asthma over a period of 1 year. Patients who had not received a chest HRCT scan examination or who had indecipherable HRCT scan images were excluded. Patients with other diseases (e.g. chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis, α1-antitrypsin deficiency, significant immunodeficiencies and respiratory carcinomas) were also excluded. All aspects of the study were performed in accordance with relevant guidelines and regulations. Results In the present study, 618 BE were analyzed and divided into 2 groups into BE with asthma (n = 144, 23.3%) and those without asthma (n = 474, 76.6%). The characteristics of the patients are shown in Table 1. Among the 518 patients, 242 (53.3.%) were female and the median age of all patients was 65.6 years (IQR, 59.8–71.5 years). BE with asthma had higher BMI (23.8 vs. 100 Patients with asthma had more frequent hospitalizations, outpatient visits, and antibiotic usage compared to those without asthma. Conclusion The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

Background: A headache is one of the most prevalent conditions that individuals encounter frequently. Approximately 90% of individuals experience a headache at least once every year, while around 40% suffer from a severe headache at least once annually.¹

OBJECTIVES:

1) to determine the effectiveness of CT brain scans in identifying the underlying causes of headaches.

2) To evaluate the extra benefit of obtaining limited PNS pictures after evaluating the brain in individuals with headaches.

Material & Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Radio Diagnosis, Karuna Medical College, Chittor, Palakkad, Kerala. Study Period: 1 year. Study population: This cross-sectional study was conducted on 75 patients, who were presented with complaints of head-aches.  Sample size: The study consisted of 75 subjects. Sampling method: Simple random technique. Results: The study was conducted on 75 patients, including 38 females &37 males from the ages of 12 to 84. One-quarter (29.3%) of the subjects were between the ages of 20 and 29, while the average patient age was 35. Isolated headaches and headaches accompanied by vomiting were the two most common complaints that got a CT brain reference. There were 17 subjects with significant pathologies, 13 of whom had intra-cranial pathology & 4 of who had PNS disease. 6 of the 17 positive cases are SOLs, 2AISs, one SAH, four cortical vein thrombosis, &four cases of sinusitis. With a positive likelihood ratio of less than 1, the diagnostic conclusion for primary headache was low. Conclusion:  When assessing individuals with headaches, a CT scan of the brain serves as an effective screening tool that can either identify structural issues or eliminate them from consideration. The additional acquisition of limited PNS sections enhances the imaging yield, lowers the costs associated with dedicated PNS imaging, and aids in distinguishing between headaches originating in the PNS and those arising from other areas in the brain. Patients who experience severe headaches, those that onset suddenly, or headaches accompanied by symptoms such as vomiting, fever, a runny nose, or neurological deficits tend to have a higher diagnostic yield from CT scans.

Introduction: Exacerbations in COPD have a considerable impact on morbidity, mortality, and quality of life as it affects the health status of patients by accelerating the progression of the disease. It has been estimated that approximately 40%- 50% of acute exacerbation of COPD cases are due to bacterial infections and the cause of approximately one third of severe exacerbation cannot be identified.  Present study was aimed to study serum procalcitonin levels combined with CRP as a diagnostic marker in acute exacerbation of chronic obstructive pulmonary disease to differentiate cause for exacerbation from bacterial infections and other causes. Material and Methods: 120 patients presenting with symptoms and signs of AECOPD were included. Serum procalcitonin levels and CRP levels were correlated with growth in sputum culture. Results: Analysing the data statistically for the correlation between serum procalcitonin levels, CRP and sputum culture growth shows positive correlation between serum procalcitonin levels and CRP with Pearson Correlation coefficient of 0.73. Among patients having serum procalcitonin levels >0.5ng/dl 82.5% patients had positive sputum culture. (p<0.001) Among patients having CRP levels >6mg/L, 65.9% patients had positive sputum culture. (p=0.56). Among patients having both serum procalcitonin levels >0.5ng/dl and CRP levels >6mg/L, 87.5% patients had positive sputum culture. (p<0.001) Conclusion: Since there was good correlation between biomarkers and sputum culture growth in AECOPD, biomarkers like serum procalcitonin combined with CRP can be used as diagnostic markers in differentiating cause of acute exacerbation of COPD and to guide the antibiotics. 

Introduction: There are a number of causes for Vitamin D deficiency in chronic liver disease, including insufficient sun exposure, inadequate dietary intake, steroid use, deterioration of vitamin synthesis in the skin caused by jaundice, and decreased Vitamin D absorption brought on by intestinal edema secondary to portal hypertension. Present study was aimed to study vitamin D deficiency and its relationship with Child Pugh score in patients with chronic liver disease. Material and Methods: The present study was carried out in the patients who were clinically diagnosed with chronic liver disease. All necessary investigations were performed, and the severity of chronic liver disease (CLD) was defined as per Child Pugh Criteria and MELD scoring system. Results: In the study, the mean age of the subjects was 47.36 ± 10.56 years. Majority were males(80.7%), normal BMI (53.5%). The prevalence of Vitamin D deficiency among the subjects with chronic liver disease was 60.5%. About 28.9% of the subjects were deficient of Vitamin-D, while remaining 10.5% cases showed normal levels of Vitamin D. The mean Vitamin D levels among the subjects was 22.15 ± 5.72 ng/mL. On cross-analysis, the Vitamin D status found to deteriorate significantly with increase in the age group and BMI, more among males and increase in the severity of hepatic encephalopathy. The mortality rate was 2.9% and 30.3% among the subjects with insufficient and deficient levels of Vitamin D respectively. The study also found statistically significant difference in the levels of Vitamin D with respect to severity of liver disease, thereby suggesting that Vitamin D levels reduce significantly among the subjects with severe liver disease. Conclusion: Statistically significant difference was observed in the levels of Vitamin D with respect to the severity of chronic liver disease based on Child Pugh Score.

Background: Aortic valve replacement (AVR) with bioprosthetic valves is a widely accepted treatment for severe aortic stenosis, particularly in elderly patients or those unable to tolerate lifelong anticoagulation. Bioprosthetic valves offer distinct advantages, including improved hemodynamics and reduced risks of thromboembolism. Objective: To evaluate hemodynamic improvements and regression of left ventricular hypertrophy in patients undergoing AVR with bioprosthetic valves, using echocardiographic parameters over a one-year follow-up period. Methods: This hospital-based prospective study included 100 patients with isolated severe aortic stenosis undergoing AVR with bioprosthetic valves at Narayana Hrudayalaya, Bangalore, from June 2011 to May 2015. Parameters such as left ventricular mass (LVM), left ventricular internal diameter in diastole and systole (LVIDD, LVIDS), and ejection fraction (EF) were assessed preoperatively and one year postoperatively. Statistical analysis was performed using paired t-tests for pre- and post-comparison. Results: The study population comprised 70 male and 30 female patients, with a mean age of 60.5 ± 9.3 years. Significant improvements were observed in LVM (mean reduction: 19%), LVIDD (8.7%), LVIDS (10%), and EF (3.7%) postoperatively. Hemodynamic parameters, such as peak pressure gradient (PPG) and mean pressure gradient (MPG), demonstrated significant reductions of 75.5% and 79.6%, respectively. Conclusion: AVR with bioprosthetic valves significantly improves hemodynamic parameters and leads to left ventricular mass regression, enhancing patients' clinical outcomes. The absence of thromboembolic or hemorrhagic events during follow-up underscores the safety and efficacy of bioprosthetic valves.

Background: Postoperative nausea and vomiting (PONV) significantly affect patient recovery following general anesthesia, particularly in breast surgery patients. Objective: To compare the effects of sugammadex versus neostigmine–glycopyrrolate on PONV incidence and severity in patients undergoing breast surgery under general anesthesia. Method: In this double-blind randomized controlled trial at Indira Gandhi Institute of Medical Sciences, 84 eligible breast surgery patients were randomly assigned to two groups receiving either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg) with glycopyrrolate (0.01 mg/kg) for neuromuscular blockade reversal. PONV was assessed at defined intervals post-extubation using a 4-point scale over 12 hours. Data on PONV episodes, need for rescue antiemetics, and adverse events were collected and statistically analyzed using mean ± standard deviation (SD), percentages, and p-values. Result: The sugammadex group demonstrated a significantly lower PONV incidence of 15% ± 4.2 compared to 35% ± 5.1 in the neostigmine group. The mean PONV scores were 0.8 ± 0.4 for sugammadex versus 1.5 ± 0.6 for neostigmine. The requirement for rescue antiemetics was 10% in the sugammadex group versus 28% in the neostigmine group. Statistical analysis revealed this reduction was significant (p=0.03). Calculations showed a relative risk reduction of 57% with sugammadex, supported by a 95% confidence interval. The standard deviation values indicate consistent performance within each group, reinforcing the robustness of the findings. Conclusion: Sugammadex substantially reduces the incidence and severity of PONV compared to neostigmine–glycopyrrolate, suggesting its preferable use in breast surgery patients.

Background: Cholecystectomy remains the definitive treatment for complicated gallbladder disease, with laparoscopic (LC) and open cholecystectomy (OC) as primary surgical approaches. Objective: To compare recovery trajectories and complication rates between laparoscopic and open cholecystectomy in patients with complicated gallbladder disease. Method: A randomized controlled trial was conducted at Veer Surendra Sai Institute of Medical Sciences And Research (VIMSAR), Sambalpur, Odisha, from 2021 to 2024. A total of 300 patients diagnosed with complicated gallbladder disease were randomly assigned to undergo either LC (n=150) or OC (n=150). Recovery metrics, including time to ambulation, length of hospital stay, and return to normal activities, were assessed. Complication rates, such as bile duct injury, infection, and hemorrhage, were recorded. Statistical analyses involved chi-square tests for categorical variables and t-tests for continuous variables, with significance set at p<0.05. Additionally, multivariate regression was utilized to adjust for potential confounders, and cost-effectiveness was evaluated based on hospital expenses and patient recovery times. Result: Among the 300 patients, the LC group exhibited a significantly shorter hospital stay (mean 3.2 days vs. 6.8 days, p<0.001) and faster ambulation (mean 12 hours vs. 24 hours, p<0.001) compared to the OC group. Return to normal activities was expedited in the LC group (mean 7 days) versus the OC group (mean 14 days, p<0.001). Complication rates were markedly lower in LC (15%) compared to OC (30%, p=0.002). Specifically, bile duct injuries occurred in 2% of LC patients versus 5% of OC patients, infections in 5% versus 12%, and hemorrhages in 3% versus 13%. Multivariate analysis confirmed that LC was independently associated with reduced hospital stay (β=-3.6, p<0.001) and lower overall complications (OR=0.45, 95% CI: 0.28-0.72, p=0.001). Cost analysis revealed that LC incurred an average cost of INR 50,000 compared to INR 70,000 for OC, indicating a 28.5% cost reduction. Additionally, the conversion rate from LC to OC was 10%, primarily due to severe inflammation and anatomical variations. Conclusions: Laparoscopic cholecystectomy significantly enhances recovery times and reduces complication rates compared to open cholecystectomy in patients with complicated gallbladder disease. These findings support the preferential use of LC as the standard surgical approach in such clinical scenarios.

Introduction: Depression is a pervasive mood disorder significantly impacting mental health and quality of life, with global prevalence ranging from 3.2% to 4.7%. Nesfatin-1, a hypothalamus-derived anorexigenic peptide, is implicated in stress and emotional regulation via its effects on the hypothalamic-pituitary-adrenal (HPA) axis. This study investigates the relationship between plasma nesfatin-1 levels and the severity of major depressive disorder (MDD) in a sample population. Methods: A case-control study was conducted at Mahatma Gandhi Memorial Government Hospital, Tiruchirappalli, Tamil Nadu, India, involving 89 participants. Depression severity was assessed using the PHQ-9 scale, with scores ≥5 classified as cases and <4 as controls. Plasma nesfatin-1 levels were quantified using ELISA. Statistical analyses included ANOVA, Student’s *t*-test, Post-Hoc Bonferroni test, and ROC curve analysis for sensitivity and specificity. Results: A significant positive correlation was observed between PHQ-9 scores and plasma nesfatin-1 levels (*p*<0.001). Mean nesfatin-1 levels progressively increased across depression severity groups: normal (5.63 ng/mL), mild (11.38 ng/mL), moderate (21.97 ng/mL), moderately severe (27.85 ng/mL), and severe (36.46 ng/mL). ROC analysis demonstrated an area under the curve (AUC) of 0.92, indicating high diagnostic accuracy of nesfatin-1 for depression severity, with a sensitivity of ~80% and specificity of ~76-85% at a cutoff of ~15-16 ng/mL. Gender had no significant impact on nesfatin-1 levels or PHQ-9 scores. Conclusion: Elevated plasma nesfatin-1 levels are associated with higher depression severity, underscoring its potential utility as a biomarker for MDD diagnosis and stratification. Further multicentric studies are recommended to validate these findings.

Background: Effective fluid management is crucial in preventing progression to severe dengue, but evidence on optimal fluid strategies is limited. This study aimed to evaluate the association between intravenous fluid management strategies and the risk of progression to severe dengue in hospitalized adult patients without shock. Methods: A prospective observational cohort study was conducted in a tertiary care hospital in a dengue-endemic area. Adult patients with confirmed dengue infection, hospitalized within 3 days of illness onset, and without shock at admission were enrolled. Fluid management strategies were categorized based on the type and volume of intravenous fluids administered. The primary outcome was progression to severe dengue (WHO 2009 criteria). Multivariable logistic regression was used to identify predictors of severe dengue. Results: Among 155 patients (mean age: 35.6±12.4 years; 56.8% male), 37.5% receiving crystalloids at 2 times maintenance volume progressed to severe dengue, compared to 10.3% receiving maintenance volume (RR: 3.63, 95% CI: 1.43-9.20, p=0.007). Independent predictors of severe dengue were 2 times maintenance volume of crystalloids (OR: 5.18, 95% CI: 1.65-16.25, p=0.005), warning signs (OR: 3.64, 95% CI: 1.58-8.38, p=0.002), and higher hematocrit (OR: 1.56 per 5% increase, 95% CI: 1.12-2.17, p=0.009). The association was stronger in patients with warning signs (RR: 3.92, 95% CI: 1.74-8.85) and older age (≥40 years; RR: 3.74, 95% CI: 1.39-10.08). Conclusion: Higher volumes of intravenous fluids, particularly crystalloids at 2 times maintenance volume, were associated with an increased risk of progression to severe dengue in hospitalized adult patients without shock. Judicious fluid administration guided by clinical and laboratory parameters is crucial in managing dengue patients.

Background: Fluid resuscitation is a critical component of care for critically ill patients, with the choice of resuscitation fluids significantly impacting patient outcomes. Normal Saline (NS) and Multielectrolyte Solution (MES) are widely used crystalloid fluids, but their comparative efficacy in terms of renal function, acid-base balance, and hemodynamic stability remains controversial. Objectives: This study aimed to compare NS and MES in critically ill patients undergoing major surgery, focusing on primary outcomes such as blood gas levels and hemodynamic stability, and secondary outcomes including renal function and chloride balance. Methods: This prospective cohort study, conducted in a tertiary care ICU, included 100 patients randomized into two groups: Group A (NS) and Group B (MES). Preoperative, intraoperative, and postoperative data were recorded, and the primary outcome was renal function assessed via serum creatinine levels. Secondary outcomes included arterial blood gas (ABG) pH, serum chloride, and hemodynamic parameters over 7 days. Results: Both groups had similar baseline characteristics, with a median treatment duration of 6.5 days. The MES group showed significantly higher arterial blood pH and lower serum chloride levels compared to the NS group, suggesting superior acid-base and chloride balance. Both groups demonstrated comparable improvements in renal function and hemodynamic stability. Serum creatinine, hemoglobin, lactate, and potassium levels did not differ significantly between groups. Conclusion: Both NS and MES are effective in managing critically ill patients, but MES offers advantages in maintaining acid-base stability and a balanced chloride profile. These findings suggest MES may be the preferred option in cases where acidosis or hyperchloremia is a concern. Further research is warranted to explore the long-term clinical implications of these differences.

Objectives: The objectives of this study were to evaluate the clinical profile, the long -term complications, managements, prevention of various morbidity of forgotten double –J (DJ) stents. Materials and Methods: The study was conducted a retrospective analysis of patients with forgotten DJ stents from February 2020 to January 2025. The following parameters such as age, sex, literacy, socioeconomic status, indications for stent placement, indwelling time, presenting complaints, reason for non-removal, radiological investigations, managements given, complications and eventual outcome were recorded and analyzed. Results: A total of 48 patients were included in our study, of which 14 patients (29.2%) underwent previous procedures (for which DJ stent was inserted) in our institution and the remaining 34 patients (71.8%) were referred from other hospitals. The mean age of the patients was 37.28 years. Out of 48 patients, 35(72.9%) were male and 13(17.1%) patients were female. Most of the patients 31(64.6%) were illiterate and belongs to lower socioeconomic class group 25(52%). DJ stents were more commonly inserted on right side 29(60.4%) than left side 21(39.6%). The mean duration of indwelling stent in situ was 24.76 months ranging 6 months to 96 months. Most common indications for DJ stenting were URSL 18(37.5%), pre-stented ESWL 3(6.3%) cases, post PCNL 9((18.7%) cases, post open pyelolithotomy /ureterolithotomy 9(18.7%) cases, Pyeloplasty 5(10.4%) cases, ureteroneocystostomy and B/L DJ insertion 2(4.2%) cases in each. Presenting complaints were pain 38 (79.2%), dysuria 31(64.6%), storage LUTS 21(43.8%), recurrent UTI 19(39.6%) and hematuria 8(16.7%) cases. In our study who had DJ insertion, location of stones as follows ureteric stone 41(85.4%), bladder stone 38(63.3%), renal stone 24(50%) cases and combined stones are as follows renal stone +bladder stone +ureteric stone 17(35.4%), bladder stone + ureteric stone 14(29.2%), renal stone+ ureteric stone 7(14.6%), renal stone +bladder stone 6(12.5%) cases. The incidence of fragmented DJ stents was 5(10.4%) and migrated distally in 4(8.3%) cases. Reasons for forgotten DJ stent was known 27(56.3%) cases and did not know 21(43.7%) cases. DJ stents were removed in 48 patients. Single procedure was required in 33(68.8%) cases and multiple procedures were required in 15(31.2%) cases. 41(85.42%) patients were managed by endoscopic approaches with either single or multiple procedures (total 65 procedures) and 7 patients require open procedures. In our study thirteen 13(21.1%) patients were having mild encrustations and were removed through retrograde cystoscopic extraction, without any intraoperative complications. Five patients (10.4%) had spontaneous stent fragmentation, and four patients (8.3%) had migrated DJ stents. For proximal renal calculus, PCNL was done in 11(22.9%) patients while URSL was done in 17 (35.4%) cases. ESWL in 5 patients with encrusted stent followed by cystoscopic removal of those stent were done and in two patients ESWL along with cystolithotripsy were done. PCLT and TUCLT were done in 9(18.8%) and 8(16.7%) patients respectively. Open procedure like pyelolithotomy, ureterolithotomy, cystolithotomy and ureteric reimplantation were done in 7(14.6%) cases in those patients where endoscopic procedures failed, large bladder calculus or patients develop vesicoureteric reflux (VUR). Conclusions: Forgotten DJ stents may have severe consequences and morbidity which is not uncommon and usually seen after 6 months of indwelling. Management of forgotten DJ stents are judicious use of different endourological procedures like CPE, URSL, PCNL, PCLT, TUCLT or ESWL, open ureterolithotomy, pyelolithotomy or cystolithotomy. Patient should be informed about the complications of forgotten DJ stent. Proper education and counseling of patients and their relatives before and after procedure and strictly maintaining stent register is the cornerstone of preventing long standing indwelling of forgotten DJ stent and stent related complications and morbidity to the patients.

Introduction: Pleural effusion is the abnormal accumulation of fluid in the pleural space. Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption. Pleural effusion may develop when there is excess pleural fluid formation (from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity) or when there is decreased fluid removal by the lymphatics The pleural effusion is associated with the history of suffering of mankind. It is a common medical problem encountered by the doctors across the globe. It is a manifestation of respiratory as well as systemic diseases.Materials and Methods This is a Descriptive, observational single centre study was conducted in the department of General Medicine, Sri Siddartha medical college and hospital, Tumkur, Karnataka over a  period of one year. Cases of pleural effusion admitted under Medicine department. Patients of either sex above 12 years of age with pleural effusion supported by X ray chest with of tuberculous and nontuberculous origin were included. Patients meeting the diagnostic criteria of more than one categories, pleural effusions of undetectable or obscure origin, obvious haemothorax secondary to trauma were excluded. Results  In the study, among exudative pleural effusion, 10(20%) patients were tubercular,13(26%) had malignancy,4(8%) had empyema,4(8%) had connective tissue disorders,1(2%) had pancreatitis. Among transudative pleural effusion 6(12%) had congestive heart failure,6(12%) had chronic kidney disease,3(6%) had chronic liver disease, 3(%6) had nephrotic syndrome. In TB, 9 (90%) patients pleural fluid glucose >60mg/dl, 3 (30%) had <60mg/dl. In empyema all cases had glucose<60mg/dl and in malignancy 12 (93%) patients had PF glucose >60mg/dl and 1 (7%) had <60mg/dl. In CTD all cases had PF glucose >60mg/dl. In acute pancreatitis, 1(100%) had PF glucose <60mg/dl and 78% of all transudative pleural effusion were having PF glucose >60 mg/dl. Conclusion The study was single institutional, observational study. The study was focusing on efficacy of pleural fluid cholesterol and its ratio to serum level in distinguishing exudates from transudate

Introduction: Adenoid hypertrophy is one of the common causes of morbidity in children. Adenoidectomy is a common operation performed in otorhinolaryngology in children worldwide.  Aim:  Study is to determine remnant adenoid tissue performed using different surgical techniques.  Methods: A prospective observational study conducted on 50 children between 5-15years who underwent adenoidectomy at government ENT hospital between 2017 and 2019. 40% children underwent conventional curettage, the other 40% underwent endoscopic assisted surgery and remaining 20% underwent consecutive conventional and endoscopic approach. children were evaluated using clinical questionarre, endoscopic assessment, radiological imaging preoperatively. postoperatively clinical assessment is done at 1^st week and endoscopic and radiologic assessment at 6^th week.  Results: 18% of children showed adenoid tissue residual following surgery with significant symptoms, with greater incidence with conventional technique than endoscopic assistance, whereas almost negligible residual tissue with combined technique.  Conclusion: Endoscopic assisted adenoidectomy is an adjunct to perform a more complete adenoidectomy thereby improving the quality of life and avoiding complications such as chronic recurrent adenoiditis. The use of endoscopic equipments allows the adenoid to be removed piece by piece under vision. 

Background- Respiratory Distress is one of the commonest causes of NICU admissions. Certain risk factors increase the likelihood of neonatal respiratory disease. If not recognized and managed quickly, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. Aims- To study the clinico-etiological factors of respiratory distress in neonates admitted in NICU and its immediate outcome. Methods and materials- This is a prospective study done in NICU, Department of Pediatrics, Dr. B.R.A.M hospital, Raipur from Feb 2023 to Feb 2024 in 182 patients. Both in-born and out-born neonate admitted in NICU with respiratory distress within 72 hrs of birth. Neonates with all the information (neonate & maternal information) contained in proforma will be included. Newborn babies admitted in NICU of Dr B.R.A.M. Hospital, Raipur with Respiratory Distress, during a period of 12 months, will be assessed using standard scores such as DOWNE score for term neonates and Silverman Anderson score in preterm neonates and appropriate treatment according to the scoring will be provided to the concerned neonates. Results- In present study among neonates with respiratory distress majority 57.14% were male and 42.86% were females. Mean gestational age of was 34.71±3.72 weeks. Mean birth weight of was 1925.91±649.82 gms. Majority 49.45% were of parity-2, followed by 35.16% were of parity-1, 11.54% were of parity-3 and 2.75% were of parity-4. 26% of the had MSAF, 21% of the mother had PROM and 20% of the mother had prolong labor. Comorbid illness among mothers of showed that 19.23% had anemia, 8.24% had GDM, 4.40% had hypothyroidism, 3.85% had pre-eclampsia, 2.75% had eclampsia, 2.20% had GTHN, 1.10% had sickle cell anemia and 0.55% had APH. Majority 60% of the delivery were NVD and 40% were LSCS. The Silverman Anderson Score among preterm showed that majority 13.26% had SAS-7, followed by 8.29% each had SAS-5 and SAS-6. DOWNE Score among preterm showed that majority 13.74% had score-4, followed by 11.54% had score-3. In present study Blood culture sensitivity among showed that growth was seen in only 14% cases. Conclusion- In this study we concluded that males are more affected. Child from second parity of mother is more common affected and most common, and Meconium-stained amniotic fluid was present in most patients. Anemia and GDM is most common associated co-morbidity. Most of the patients have SAS Score 7 and DOWNE’S score-4 found. Proper antenatal care, early diagnosis of the antenatal complication and avoiding preterm deliveries will aid in the better outcome of the newborns. Early detection and appropriate management of the condition is essential to ensure better outcome in all newborns presenting with respiratory distress.

A 29-year-old young female presented in out-patient with complain of breathlessness on exertion, and bilateral lower limb swelling. Transthoracic echocardiography (TTE) showed severely dilated isolated right ventricle with dysfunction without pulmonary hypertension. Endomyocardial biopsy revealed lymphocytic myocarditis with fibrosis.

Background: Hypertension is a global health burden and a major risk factor for cardiovascular diseases. Emerging evidence highlights the role of metabolic disturbances, including hyperhomocysteinemia and dyslipidemia, particularly elevated serum Very Low-Density Lipoprotein (VLDL) levels, in the pathogenesis of hypertension. Understanding the relationship between these factors is crucial for effective management and prevention of cardiovascular complications. Aim To investigate the correlation between serum VLDL levels and hyperhomocysteinemia in hypertensive patients. Methods This retrospective cross-sectional observational study was conducted at the VSS Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, from February 1, 2023, to January 31, 2024. A total of 100 hypertensive patients aged 30–65 years were included. Participants were categorized into two groups: those with hyperhomocysteinemia (serum homocysteine >15 µmol/L) and those with normal homocysteine levels. Serum VLDL and homocysteine levels were measured using enzymatic and HPLC methods, respectively. Data were analyzed using SPSS version 23.0, with correlation and independent t-tests employed to assess associations. Results Among the 100 participants, 55% had hyperhomocysteinemia. The hyperhomocysteinemia group exhibited significantly higher serum VLDL levels (45 ± 8 mg/dL) compared to the normal homocysteine group (35 ± 7 mg/dL; p<0.001). A strong positive correlation was observed between serum VLDL and homocysteine levels (r=0.72, p<0.001). Additionally, systolic and diastolic blood pressures were significantly elevated in the hyperhomocysteinemia group (p<0.05). Conclusion The study demonstrated a significant association between elevated serum VLDL levels and hyperhomocysteinemia in hypertensive patients, highlighting the interplay between lipid metabolism and homocysteine levels in hypertension. These findings suggest that addressing both lipid abnormalities and hyperhomocysteinemia may improve clinical outcomes in hypertensive patients. Recommendations The fundamental mechanisms and causal link between serum VLDL and homocysteine levels require further longitudinal research. Incorporating lipid and homocysteine management into hypertensive care protocols may reduce cardiovascular risk and improve patient outcomes.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality globally. This study aimed to determine the prevalence, associated risk factors, severity, and management outcomes of PPH in a tertiary care hospital. Methods: An observational analysis was conducted on 100 postpartum cases. Data on demographics, obstetric history, labor characteristics, and management approaches were collected. The prevalence and risk factors of PPH were analyzed, and the severity of cases was categorized based on blood loss volume. Management strategies were evaluated for their effectiveness. Results: The prevalence of PPH was 23%. Significant risk factors included maternal age ≥35 years (65%), grand multiparity (48%), cesarean delivery (56%), prolonged labor (>12 hours, 60%), antepartum anemia (67%), placenta previa/placental abruption (30%), macrosomia (5%), and pre-eclampsia (70%). Mild PPH (500–1000 mL) accounted for 65% of cases, moderate PPH (1001–1500 mL) for 26%, and severe PPH (>1500 mL) for 9%. Management was primarily medical, effectively controlling 83% of cases, while surgical interventions were required in 17%. Conclusion: PPH remains a significant obstetric challenge, with multiple risk factors contributing to its occurrence and severity. Effective management, predominantly through medical interventions, is critical in reducing complications. Preventive measures focusing on high-risk groups, such as those with antepartum anemia or pre-eclampsia, may mitigate PPH prevalence and severity.

Non-communicable diseases (NCDs) are a leading cause of death globally, with rural populations in India being particularly vulnerable due to limited healthcare access. This study aims to evaluate the effectiveness and challenges of a Community-Based Assessment Checklist (CBAC)-based screening program for NCDs in underserved rural areas of Jaipur, Rajasthan. A mixed-methods approach was employed, combining quantitative analysis of NCD risk factors (blood pressure, blood sugar, BMI, chronic kidney disease) and qualitative data on community engagement and operational challenges. Screening camps were organized in 10 underserved villages, where 404 individuals were screened. Results revealed that 47% of participants were classified as high-risk for NCDs based on CBAC scores. Significant associations were found between high-risk CBAC scores and hypertension, diabetes, and obesity. However, qualitative findings highlighted critical barriers to participation, including lack of awareness, logistical challenges, and mistrust in the process. Despite these barriers, the study demonstrated the potential of CBAC as a valuable tool for early NCD detection, though addressing community engagement and operational challenges is essential for its broader implementation.

Introduction: Tuberculosis (TB) remains a significant public health challenge globally, particularly in densely populated urban slums where the disease burden is exacerbated by socio-economic and environmental factors. Methods: This cross-sectional study was conducted to investigate the prevalence of tuberculosis in urban slums, utilizing a pathological approach. The study involved a sample size of 100 individuals selected randomly from the slum areas. Results: The findings highlight the prevalence rate and identify key factors influencing TB spread in these settings. Conclusions: The results underscore the urgent need for targeted public health interventions and enhanced surveillance systems in urban slums to control the spread of tuberculosis effectively.

Effective learning strategies play a critical role in shaping academic success, particularly in rigorous programs like the Bachelor of Medicine and Bachelor of Surgery (MBBS). This study examines the impact of individual and group learning approaches on the academic performance of first-year MBBS students. The research employed a comparative study design, involving 200 students from a leading medical college. Participants were categorized into two groups based on their predominant learning styles: individual learners and group learners.

Quantitative data were collected through examination scores, while qualitative insights were obtained via questionnaires assessing study habits, motivation, and perceived benefits of their chosen learning style. Statistical analysis was conducted to identify correlations between learning approaches and academic outcomes.

The findings reveal that both individual and group learning strategies significantly influence academic performance, albeit differently. Individual learners demonstrated higher performance in subjects requiring self-paced critical thinking and in-depth analysis, such as anatomy. Conversely, group learners excelled in collaborative subjects like physiology, where peer discussion and teamwork were beneficial. The study highlights that a blended approach, integrating both individual and group learning strategies, can optimize academic outcomes by leveraging the strengths of each method.

This research underscores the importance of tailoring educational practices to suit diverse learning preferences in medical education. It recommends that educators encourage students to adopt flexible learning approaches and provide resources that foster both individual and group learning. The insights gained from this study have implications for enhancing teaching methodologies and academic support systems in medical colleges globally.

Background: Platelet indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), have been reported to be altered in various hematological and non-hematological disorders. This study aimed to analyze platelet indices in different hematological and non-hematological disorders in a tertiary care institute in northern India. Methods: A total of 1701 cases, including 1317 (77.4%) hematological disorders and 384 (22.6%) non-hematological disorders, were analyzed retrospectively. Platelet indices were compared between hematological and non-hematological disorders and among different hematological disorders using appropriate statistical tests. Correlations between platelet indices and age, hemoglobin, and white blood cell (WBC) count were also assessed. Results: Hematological disorders had significantly higher PC (268.4 ± 107.4 × 10⁹/L vs. 245.7 ± 98.3 × 10⁹/L, p = 0.001), MPV (10.5 ± 1.7 fL vs. 10.2 ± 1.6 fL, p = 0.003), PDW (15.5 ± 2.4% vs. 15.1 ± 2.4%, p = 0.007), and PCT (0.28 ± 0.11% vs. 0.25 ± 0.10%, p < 0.001) compared to non-hematological disorders. Among anemia subtypes, macrocytic anemia had the lowest PC and the highest MPV and PDW (p < 0.001). Thrombocytosis had a higher PC and PCT and lower MPV and PDW compared to thrombocytopenia (p < 0.001). Age, hemoglobin, and WBC count showed significant correlations with platelet indices (p < 0.05). Conclusion: Platelet indices differ significantly between hematological and non-hematological disorders and among various hematological disorders. The findings highlight the potential utility of platelet indices as diagnostic and prognostic markers in these disorders. Further studies are needed to validate their clinical significance and establish their role in disease management.

Background: Aphakia, characterized by the absence of the natural lens, can result from cataract surgery, trauma, or congenital conditions. Treatment options for aphakia primarily involve intraocular lens (IOL) implantation, but alternative IOL designs are required in cases with insufficient capsular support. The retro pupillary iris-claw IOL has emerged as a promising solution, but its safety profile requires further evaluation. Objective: To assess the safety and effectiveness of the retro pupillary iris-claw IOL as a viable option for aphakia in patients with compromised capsular support. Methods: A retrospective study was conducted on 120 aphakic patients who underwent retro pupillary iris-claw IOL implantation. Data on complications, visual acuity, intraocular pressure (IOP), and patient demographics were collected and analyzed over a 6-month follow-up period. Results: The study found that 75% of patients achieved a best-corrected visual acuity (BCVA) of 20/40 or better, with a low rate of complications. Complications included mild inflammation (12.5%), minor iris damage (5%), and IOL dislocation (2.5%). IOP remained stable throughout the follow-up period. These results suggest that the retro pupillary iris-claw IOL is a safe and effective solution for aphakic patients with minimal risk of severe complications. Conclusion: The retro pupillary iris-claw IOL can safely treat aphakia in patients with poor capsular support. This study supports its long-term use and lays the groundwork for safety and efficacy research.

Introduction: Educational micro learning environment is a small dynamic placement. A positive and inclusive environment helps in achieving learning objectives. Assessment of this is important for constructive modification. Methods: This is a prospective cross-sectional study done in tertiary care institute as end posting feedback in critical care units. Thirty-five second year post graduate trainees were enrolled and HEMLEM Questionnaire was circulated after valid consent. Data analysis was done using SPSS software version 22. Results: The study population consisted of 54.29% males and 45.71% females. Regarding staff attitude and behaviour, most of the students agreed that the environment was welcoming and they felt free to ask questions. Equal number of students strongly agreed (22.86%) and strongly disagreed (22.86%) to enthusiasm in faculty about teaching. Most students (54.13%) agreed to faculty’s interest in student’s learning. Most of the trainees agreed that student’s inputs were valued and 31.43% strongly agreed to that. Nearly fifty percent (54.29%) trainees felt neutral to providing with regular and supportive feedback during their postings. Regarding Quality of teaching, there was encouraging feedback and most of the students strongly agreed that the quality was well maintained. More than fifty percent (51.43%) strongly agreed that they had an opportunity to apply their previous knowledge in this posting. There was enhancement in knowledge and skills of more than fifty percent students. More than ninety percent found the posting helpful for practical application of theory. Hundred percent students achieved their learning objectives during this posting. Most of them had an opportunity to deal with patients under supervision. Conclusion: Healthcare Education Micro-Learning Environment Measure scale serves as important tool to assess learning environment in a small and dynamic placement. It is a handy and easy to use tool to obtain feedback and modify the learning environment constructively.

Background: The MPI is a composite measurement of systolic and diastolic dysfunction that has demonstrate the predict congestive heart failure. This study was correlated the myocardial performance (TEI) index and LV function by Simpsons method in EF <35% patients and to evaluate its efficiency by echocardiography. Method: The myocardial performance is obtained by measuring IVRT, IVCT, ET using pulse wave doppler and LV function is assessed using Simpsons method in apical 4 chamber view using GE VIVID S5 and ESAOTE. Result: The myocardial performance functional parameters were significantly correlating with LV function value of EF <35% patients. Conclusion: MPI is a sensitive indication of total cardiac dysfunction in patients with congestive heart failure.

Background and Aims: Literature is sparse comparing the intrathecal use of hyperbaric ropivacaine and levobupivacaine for lower limb procedures. To take advantage of stereoselectivity, ropivacaine and levo-(S)-bupivacaine were developed. Both are less cardiotoxic than bupivacaine. This study was undertaken with the aim of comparing the block characteristics following intra-thecal administration of hyperbaric levobupivacaine (0.5%) with hyperbaric ropivacaine (0.75%) for lower limb orthopedic surgeries under sub-arachnoid block. Material and Methods: This randomised, comparative study was undertaken in a tertiary care, teaching hospital after taking necessary approvals (IRB and IEC), in consenting adult patients fulfilling the inclusion and exclusion criteria, posted for elective lower limb orthopaedic surgeries under subarachnoid block. After standard sample size calculation, a total of 80 patients were enrolled and randomised into two groups (40 patients in each group). Group L received 3 ml of preservative-free, 0.5 percent hyperbaric Levobupivacaine with 20 microgram fentanyl; and Group R received 3 ml of 0.75% hyperbaric Ropivacaine (preservative free) with 20 mcg fentanyl, intra-thecally. The vital parameters, onset of motor and sensory blockade as well as duration of motor and sensory blockade were noted at regular intervals, tabulated and subjected to statistical analysis. Results: As regards to demographic variables, both the groups were comparable. In terms of onset of motor block (minutes), there was a significant difference between the two groups (p = 0.001), with onset of motor block (minutes) being higher for Levobupivacaine. Ropivacaine had a faster onset of motor block as compared to levobupivacaine. Between the two groups, there was a substantial variation in the number of hours that the motor block lasted (p = 0.001), with the duration of motor block (hours) being longer in the levobupivacaine group. Levobupivacaine produced longer lasting motor block than ropivacaine. In terms of onset of sensory block (minutes), there was a significant difference between the 2 groups (t = -8.746, p = 0.001). Ropivacaine had a faster onset of sensory block as compared with levobupivacaine. The duration of sensory block (hours) varied significantly across the 2 groups (p = 0.001), with the Group L (levobupivacainegroup) having longer duration of sensory block (hours). Ropivacaine had a lesser duration of sensory blockade as compared with levobupivacaine. Participants in the group Group L (levobupivacaine group) had a higher proportion of MAP fall >10% from baseline as compared to Group R (Ropivacaine). Conclusions: In demographically similar group of patients, intra-thecal ropivacaine showed earlier onset of both sensory and motor block than levobupivacaine. Duration of both sensory and motor blocks was longer with levobupivacaine than ropivacaine. Hemodynamic parameters (HR, SBP, DBP, ECG, SpO2) remained similar and stable with both the drugs, although the systolic BP fall was more with levobupivacaine than ropivacaine. Level of block achieved with both the drugs in the used doses were similar in our study.

Background: Vasectomy remains underutilized as a contraceptive method in many countries, including India. Healthcare providers, particularly nursing staff, play a crucial role in promoting family planning methods. This study aimed to assess the knowledge, attitudes, practices, and perceived barriers regarding vasectomy among male nursing staff in a medical college setting. Methods: A cross-sectional study was conducted among 215 male nursing staff at Raichur Institute of Medical Sciences, India. Data were collected using a pre-structured questionnaire and analyzed using descriptive statistics and chi-square tests. Results: The majority of participants (97.7%) rated their knowledge of vasectomy as average to good. While 91.7% were willing to recommend vasectomy, only 43.7% were willing to undergo the procedure themselves. The main perceived barriers were misconceptions about effects on sexual function (36.7%) and cultural and religious beliefs (18.6%). Conclusion: Despite generally positive knowledge and attitudes, significant barriers to vasectomy adoption persist among male nursing staff. Targeted education and culturally sensitive interventions are needed to address these barriers and promote vasectomy as a contraceptive option.

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Introduction A common anesthetic method for a range of lower limb orthopedic procedures is spinal anesthesia due to its ease of administration, robust sensory and motor blocking, and reliable surgical anesthesia. However, the length of spinal anesthesia caused by local anesthetics alone is often brief; for this reason, adjuvants are employed to prolong analgesia and improve block quality. The quality and duration of spinal anesthesia have been enhanced by intrathecal opioids such as morphine, fentanyl, and butorphanol used as adjuvants to local anesthetics. Material And Method Written informed permission was obtained from research participants. A computer-generated random number was used to divide the minimum number of patients who met the inclusion criteria into two groups. Group A patients got 3 milliliters of 0.5% hyperbaric bupivacaine along with 0.2 milliliters, butorphanol (200 micrograms). Group B patients got 0.15 ml of buprenorphine (150 micrograms) together with 3 ml of 0.5% hyperbaric bupivacaine. Result The gathered information was imported into Microsoft Excel 2016 and examined using IBM SPSS Statistics for Windows.Descriptive statistics were employed to characterize the data: for continuous variables, the mean and standard deviation were utilized, and for categorical variables, frequency analysis and percentage analysis. Using the Independent sample t-test, the bivariate samples in the independent groups were compared to see whether there was a significant difference. Conclusion According to our study onset of sensory blockade and faster with butorphanol and duration of sensory blockade was more in buprenorphine compared to butorphanol whereas motor blockade is comparable in both groups. Buprenorphine group required rescue analgesia at 4hrs postoperatively whereas butorphanol group required rescue analgesia at 2nd hr Hence we conclude that buprenorphine would be beneficial for lower limb orthopedic surgeries as it provides prolonged duration of analgesia although further studies need to be done in a greater number of patients and for prolonged duration of procedures..

Background Carotid body tumors (CBTs), also known as paragangliomas or chemodectomas, originate from paraganglion cells at the carotid bifurcation. They are predominantly benign, with 5% being bilateral and 10% malignant. The primary treatment modality is surgical excision, though larger tumors and higher Shamblin grades pose increased operative risks. Adequate preoperative biochemical, anatomical, and radiological evsaluation is critical for successful management. Materials and Methods A retrospective analysis of eight patients treated for CBTs from January 2020 to the present was conducted. The cohort included 3 males and 5 females, aged 23 to 57 years. Detailed clinical assessments, including imaging and surgical outcomes, were reviewed. Specialized training recommendations for neurosurgeons in microvascular anastomosis and bypass procedures were emphasized to ensure optimal patient care. Results Among the eight patients, no perioperative mortality was reported. Case highlights included a 28-year-old female presenting with painless progressive neck swelling and hoarseness without vocal cord palsy or other focal neurological deficits, and a 42-year-old male with hypertension presenting with painless neck swelling and Horner’s syndrome. Effective surgical excision with preservation of the carotid artery and surrounding structures was achieved in all cases, underscoring the importance of surgical expertise and interdisciplinary training. Conclusion Surgical management of CBTs requires a multidisciplinary approach and advanced neurosurgical skills, particularly in microvascular anastomosis and bypass procedures. Subspecialized training in cerebrovascular surgery is essential to improve operative outcomes. Thorough preoperative evaluation and skillful execution are pivotal in ensuring "happy surgeries" with minimized complications

Background: The combination of Ropivacaine and Dexmedetomidine has been suggested to enhance the efficacy of epidural anesthesia. This study aims to compare the effects of Ropivacaine alone with Ropivacaine and Dexmedetomidine for postoperative analgesia in lower abdominal surgeries. Methods: This randomized controlled trial included 122 adult patients scheduled for elective lower abdominal surgeries. Participants were randomly assigned into two groups: Group R (Ropivacaine 0.75%) and Group RD (Ropivacaine 0.75% with Dexmedetomidine). Onset and duration of sensory and motor blockades, sedation scores, and hemodynamic parameters were assessed. Statistical analyses were performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: The onset of sensory and motor blockades was significantly faster in Group RD compared to Group R (6.1±2.5 vs. 11.1±3.1 minutes, p=0.009; 10±2.5 vs. 17±3.1 minutes, p=0.005, respectively). The duration of sensory and motor blocks was significantly prolonged in Group RD (349±52 vs. 196±12.5 minutes, p=0.007; 240±12 vs. 150±34 minutes, p=0.002, respectively). Group RD exhibited more intense motor blockade (Bromage 4: 34.4% vs. 0%, p=0.002) and higher sedation scores (p=0.004). Hemodynamic parameters were comparable between the groups, with no significant side effects observed. Conclusion : Dexmedetomidine, when added to Ropivacaine for epidural anesthesia, enhances the onset, intensity, and duration of sensory and motor blockades and provides better sedation scores without compromising safety. This combination is effective and safe for lower abdominal and lower limb surgeries.

Background: Rh isoimmunization is a condition that occurs when a woman with Rh negative blood type becomes sensitized to Rh positive blood cells during childbirth, miscarriage, abortion, medical procedures like invasive prenatal testing (e.g., amniocentesis) trauma to the abdomen during pregnancy or transfusion with Rh positive blood. With each successive pregnancy, there is a cumulative effect of fetomaternal transfusions thus increasing the severity of the problem at hand. It can lead to hemolytic disease of the newborn which can range from mild to severe, including features such as anemia, jaundice, hepatospleenomegaly, and, in severe cases, hydrops fetalis.  Such newborns may require treatments such as phototherapy for jaundice, blood transfusions, IV immunoglobulins, and in severe cases, exchange transfusions. Aim: To study the role of cord bilirubin as a non invasive, early predictive marker of hemolysis in Rh positive neonates delivered to Rh negative mothers. Study Type and Design: Observational, descriptive, longitudinal study. Materials:  Rh positive neonates delivered in OT/labor room of our hospital to Rh negative mothers studied according to specific protocol. Study Setting: Neonatal and postnatal wards of a rural tertiary care hospital. Period of Study:  (Two years) From June 2022 to June 2024. Ethical Committee consent was taken at the start of the study. Data was entered in excel sheets and analyzed using IBM SSPS Statistics software. Results: Out of 277 neonates delivered at term to Rh negative mothers in the study duration, 158 were Rh positive and 119 were Rh negative mothers. A cord bilirubin cutoff of >1.9 mg/dL was found to have excellent specificity (97.8%) and positive predictive value (95.74%), making it a robust tool for identifying newborns at high risk of hyperbilirubinemia, with a sensitivity of 67.16% and a negative predictive value of 80.18%. For the phototherapy group, the average cord bilirubin level was found to be 2.13 ±0.51 mg/dL, as compared to the no phototherapy group, wherein the average cord bilirubin level is 0.80±0.58 mg/dL. Cord bilirubin values >1.9 mg/dl (seen in 29.7% of the study population) were found to have a statistically significant association with a need for interventions (phototheraphy and/or exchange transfusion) with a p value <0.05. Conclucion: Hemolysis due to Rh isoimmunization is more frequent and severe in neonates of multigravida mothers as Zompared to neonates of primigravida mothers, due to the cumulative effect of fetomaternal transfusions in each successive pregnancy. Cord sampling proves to be an essential predictive marker of the risk of hemolysis in the neonate earlier to allow for early initiation of therapeutic measures and reducing the risk of rapid hemolysis and further, long term complications such as bilirubin encephalopathy, emerging as a cornerstone of non invasive care.

Background: Dengue fever, caused by arthropod-borne viruses, presents as a mild illness with fever, muscle pain, rash, and swollen lymph nodes, while its severe form, dengue hemorrhagic fever, can be fatal due to capillary permeability and hemostasis issues. Infants aged 4-9 months face higher risks of severe dengue, with symptoms like convulsions and liver dysfunction being more common and fatal. Aim & Objectives: A Study on the Relationship Between Organomegaly, Dengue Severity, and Dengue Seropositivity in a Rural Tertiary Care Hospital in Western Maharashtra. Methodology: This descriptive longitudinal study was conducted over a period of two years, from June 2022 to May 2024, in the Department of Paediatrics at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. The inclusion criteria consisted of all male and female patients under one year of age with a laboratory-confirmed diagnosis of Dengue Fever, provided their parents gave written informed consent. The exclusion criteria included infants presenting with other viral exanthematous fevers or dengue-like illnesses with a negative laboratory test. Result: The study examined 79 infants admitted with dengue between June 2022 and May 2024, accounting for 12% of all infantile dengue cases. The average age of the infants was 7.5 months. Dengue fever without warning signs constituted 55.7% of the cases, while 26.6% had dengue with warning signs, and 17.7% were diagnosed with severe dengue. Severe outcomes were linked to hepatomegaly and splenomegaly. Conclusion: Infants with dengue frequently exhibit non-specific symptoms, making diagnosis challenging. While IgM positivity was commonly observed, NS1 positivity was associated with increased severity and mortality. Early detection of NS1 was vital for effective management. Hepatosplenomegaly were found to be linked to greater severity and higher mortality rates. Timely diagnosis, close monitoring, and proper supportive care are crucial for improving outcomes in the management of infantile dengue.

Background: Anemia poses a considerable global public health issue, leading to high rates of illness and death, increased hospitalizations, and setbacks in socio-economic progress. Iron deficiency anemia is recognized as the predominant cause of this burden worldwide. Infants and young children are especially vulnerable to anemia, particularly iron deficiency, which significantly impacts community health. Globally, iron deficiency is the most prevalent and widespread nutritional disorder affecting people of all ages, with notably high prevalence rates observed among children in developing countries, where it can affect up to half of infants aged 12 months in some areas. Aims and objectives:To study the association of Iron Deficiency Anemia among different age groups in paediatric population, with respect to severity of Anemia. Methods: This is a descriptive cross sectional study was conducted at the department of paediatrics, Dr. Vitthalrao Vikhe Patil Pravara Rural hospital Loni, Maharastra, India, performed on children aged 6 months to 12 years coming to Paediatrics department from June 2022 to June 2024. Results: Out of 112 cases of Iron Deficiency Anemia, 19 cases (17%) were of Mild Anemia, 53 cases(47%) were of Moderate Anemia and 40 cases(36%) were of Severe type of Anemia. And 99 cases(88.4%) are from 6 months to 59 months age group and 13 cases (11.6%) are from 5 years to 11 years. Conclusion: Iron Deficiency Anemia is common among the low socio-economic classes in the rural areas of Western Maharashtra, leading to a significant morbidity during early childhood in the form of poor growth rates, easy susceptibility to infections and illnesses, pica which may lead to accidental poisoning, seizures and long term motor, cognitive and socio-emotional behavioral deficits. Therefore it is necessory to screen the school aged children, regularly to avoid the complications realated to Iron Deficiency Anemia, by proper dietary councelling and early initiation of Iron supplements in susceptible groups.

Objective: To determine socio-demographic risk factors of Myocardial Infarction (MI). Study Design: Hospital based, case - control study. Result: 125 cases of MI were matched with 125 controls for age, sex and socioeconomic status. The mean age of MI in the present study was 55.63±9.473 years, with maximum number (n=29) in age group 60-64 years & minimum number of patients (n=02) were below 35 years. Distribution of cases according to place of residence revealed equal number of patients from urban (n=62) and rural areas. Maximum number of cases were from three generation family (n=68), while most of the controls were from nuclear (n=59). Unskilled workers contributed to more than 50 % of cases in current study in comparison to no cases amongst professionals. Similar trends were observed in as per literacy status where illiteracy contributed to more than 40 % of MI cases. Almost equal number of patients belonged to Kuccha & Pucca house. No statistically significant correlation was found between source of water and MI in this study. Conclusion: Associations of socio-demographic factors with MI i.e. area of residence, type of family, type of house, occupation, education status and source of water were found to be non-significant.

Introduction: In the developing world, peripheral arterial disease (PAD) is a major health issue that is becoming more prevalent as a result of rising risk factors. Minor impairments to limb loss are among its complications. The primary cause of PAD is atherosclerosis. Lower extremities artery disease affects more than 200 million people globally, with symptoms ranging from mild to severe. Materials And Methods: The study was a comparative study done on 40 patients with signs and symptoms of peripheral arterial occlusive disease referred for evaluation by imaging by colour doppler ultrasonography and MDCT angiography to the department of Radiodiagnosis at MNR Medical College Hospital were included in the study. Results

In comparison of colour doppler ultrasound versus MDCT, there is statistically extremely significant difference in the detection of the extent of segment involvement in ATA. Conclusion: MDCT is better than Doppler in detecting the length of stenosis in the arterial system.MDCT is better than Doppler in detecting the presence of thrombosis especially in the infra-popliteal segment.Even though MDCT is not statistically significant than Doppler in detecting the number of collateral segments , as the arterial tree is better delineated in MDCT , this modality is needed to be performed before any vascular intervention is planned.Doppler is also an effective tool which can detect the lesions to a comparable extent when no intervention is planned and only medical therapy is considered

Introduction: Preoperative anemia is known to influence outcomes in various surgical disciplines, yet its specific impact on vascular surgery patients remains underexplored. This cross-sectional study investigates the association between preoperative anemia and postoperative outcomes in a cohort of vascular surgery patients. Methods: We retrospectively reviewed medical records of 80 patients undergoing vascular surgeries at Vascular Surgery Unit of General Surgery Department of Medical College hospital. Patients were categorized based on their preoperative hemoglobin levels to assess the prevalence of anemia and its correlation with postoperative complications, length of hospital stay, and mortality. Statistical analysis was performed using chi-square tests and logistic regression to adjust for potential confounders. Results: Of the 80 patients studied, 45 (56.25%) were anemic. Anemic patients exhibited a significantly higher incidence of major complications (20% vs. 8.6%, P=0.045) and minor complications (28.9% vs. 17.1%, P=0.034) compared to non-anemic patients. Although not statistically significant, a trend towards increased reoperations (8.9% vs. 2.9%, P=0.087) and mortality (4.4% vs. 0%, P=0.158) was observed among anemic patients. Additionally, anemic patients were more likely to have extended hospital stays exceeding five days (55.6% vs. 28.6%, P=0.009). Conclusion: Preoperative anemia is associated with an increase in both major and minor postoperative complications in patients undergoing vascular surgeries. The findings suggest that addressing anemia preoperatively could potentially improve postoperative outcomes. Future studies should focus on longitudinal assessments to better understand the causal relationships and develop targeted interventions.

Background: Acute myocardial infarction has been reported to have poor long-term outcome in young adults. Hence, identifying the risk factors is necessary for primary and secondary prevention. This study was done to identify the risk factors for young myocardial infarction. Materials and Methods: 86 patients of myocardial infarction admitted at IGMC Shimla were included in the study and their demographic profile and risk factors were studied followed by coronary angiography. Observations: Out of 86 patients studied, maximum number of patients (53.48%) were in age group of 40-45 years with mean age of 38.4 years. 89.5% patients were male. ST segment elevation myocardial infarction (72%) was more commonly observed on ECG. Anterior wall and Anterolateral wall were the most common areas involved with prevalence of 35.4% and 30.6%, respectively. Smoking was the most common risk factor present in 93.02% cases. Hyperhomocysteinemia was present in 84.88% patients while 82.55% patients had ratio of ApoB/ApoA1 > 0.8. Diabetes mellitus and hypertension were present in 36.04% and 26.74% patients, respectively. Most common lipid abnormality observed was raised LDL followed by low HDL. Most common abnormality seen on coronary angiography was single vessel disease, seen in 62.71% patients. Conclusion: Acute myocardial infarction in young patients is more common in men in the Sub-Himalayan region. Smoking is the most common risk factor. ST elevated myocardial infarction with anterior wall involvement is the most common presentation. Single vessel disease is most commonly seen.

Background: Breast cancer is a heterogeneous disease, with molecular subtypes playing a critical role in determining prognosis and treatment strategies. The expression of Ki-67, a marker of cellular proliferation, has been widely used to assess the aggressiveness of breast cancer. This study aimed to analyze the distribution of molecular subtypes of invasive breast cancer and their association with clinicopathological features, with a focus on Ki-67 expression. Methods: A cross-sectional study was conducted on 400 breast cancer patients diagnosed at SCB Medical College, Cuttack, between January 2019 and December 2021. Tumors were classified into molecular subtypes using immunohistochemistry (IHC) for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67. Clinicopathological data, including age, tumor size, grade, lymph node involvement, and Ki-67 expression, were collected and analyzed. Results: The most common molecular subtype was Luminal B (38.3%), followed by Luminal A (20.8%), HER2-enriched (12.8%), and triple-negative breast cancer (TNBC) (12.8%). High Ki-67 expression was observed in 65% of tumors, with significantly higher rates in the Luminal B, HER2-enriched, and TNBC subtypes. High Ki-67 expression was significantly associated with younger age, higher tumor grade, and lymph node involvement (p < 0.05). Additionally, high Ki-67 expression was more common in premenopausal women, particularly in the HER2-enriched and TNBC subtypes. Conclusions: This study highlights the significant role of molecular subtypes and Ki-67 expression in determining the clinicopathological characteristics of breast cancer. The findings emphasize the need for personalized treatment strategies, with particular attention to the aggressive nature of Luminal B and TNBC subtypes. Ki-67 expression emerges as an important marker for assessing tumor aggressiveness and guiding therapeutic decisions, particularly in premenopausal women. Further multicenter studies are needed to validate these findings and establish Ki-67 as a standard marker in clinical practice.

Neuropathy is one of the most common complications of diabetes mellitus. Neuropathy can cause the sensory deficit, neurological disorder, limb ulcers, osteomyelitis, and amputation. Therefore, neurological examinations, determining the nerve conduction velocity and performing sensory and motor tests are important for timely diagnosis and treatment. The present study was undertaken for a period of   subjects, both males and females aged between 40-50 years , informed written consent was taken from the subjects. The study group consisted of 30 diabetic patients, with history of diabetes for 1-10 years and controls (Non Diabetics) were 30 age and sex matched healthy individuals.  Comparison of sensory nerve parameters in Control Group(non diabetics) and diabetics shows  there is highly significant slowing of sensory nerves median & ulnar (p<0.001) and decrease in amplitude of Median nerve(p<0.05) in diabetics compared to controls. The study proved neuronal involvement in the diabetese mellitus which is accelerated by poor glycaemic control. Therefore nerve conduction studies should be carried out for the early detection and management of neuropathy in the diabetic patients

Background: Paraquat poisoning poses a major clinical challenge due to its high mortality rate (60%-90%) and lack of an antidote. Its rapid systemic absorption triggers oxidative stress, resulting in multi-organ failure, especially in the lungs. Early interventions, such as CHP, have shown promise in mitigating oxidative stress and reducing Paraquat plasma levels. This study investigates effectiveness of early CHP compared to standard treatment protocols. Primary Objective: To evaluate the effectiveness of early extracorporeal clearance via CHP in enhancing survival rates in paraquat poisoning.Secondary Objectives: Toanalyse the impact of toxin dosage and time to presentation on survival outcomes. To assess complications associated with paraquat poisoning and its treatment.Methodology: This observational cross-sectional study included 12 patients presenting with Paraquat poisoning over one year. Data collected included demographics, ingestion details dose, time, clinical presentation, and treatment specifics. Patients received either CHP with standard care/ standard care alone. Survival outcomes and complications were analysed based on time to intervention and dosage consumed.Results: Among 12 patients, 42% were female and 58% male. Survival rates were 50% for those presenting within 12 hours and 25% for later presentations. Patients consuming <5 ml had a 100% survival rate; mortality was 80% for 5-15 ml, 50% for 16-30 ml, and 75% for >30 ml. CHP initiated within 6 hours resulted in a 75% survival rate, while delays reduced survival. Among 8 patients undergoing CHP, 3 survived (37.5%); among 4 receiving standard treatment alone, 1 survived (25%). Complications included ARDS (41.7%) and AKI (41.7%).Conclusion: Early initiation of CHP significantly improves survival in Paraquat poisoning. This study highlights the critical importance of timely diagnosis and advanced interventions to optimize outcomes.

Background and Objectives:Diabetes Mellitus(DM) and retinopathy are one of the main chronic health condition affecting millions of people worldwide in both developed and developing countries and leading to loss of vision. In India also it affects more than 77 millionindividuals. Oxidative stress and inflammation might play an important role in the pathogenesis of Diabetic Retinopathy (DR) but the available literature is inconclusive. Materials and Methods: This case–control study includes 50 type 2 DR patientsand 50 age –matched type 2 diabetic patients without retinopathy.Blood glucose, lipid profile, oxidative stress and inflammatory markers were estimated. Analysed results were summarized as mean ± standard deviation.. Unpaired t-test and Pearson’s correlation was performed using SPSS. Results: Data showed that inflammatory maker HsCRP and oxidative stress markers MDA and SOD were significantly elevated in DR patients. MDA and SOD showed positive association in both study group. Conclusion:This study confirms that elevated oxidative stress and inflammatory markers is associated with diabetic retinopathy and might be used as a biomarker for determining severity of DR

Background:  Tenecteplase has higher fibrin specificity and greater resistance to inactivation by its endogenous inhibitor (PAI-1) compared to native t-PA. The objective of this study was to assess the outcome of intravenous thrombolysis (IVT) with Tenecteplase (TNK) in patients with Middle Cerebral Artery (MCA) ischemic stroke. Methods: A prospective observational study was conducted in a South Indian multi-specialty tertiary care hospital from April 2019 to March 2020. We have observed that 42 MCA ischemic stroke patients underwent IVT with TNK (0.25 mg/kg) within four and half hours of onset of symptoms. All were followed up for 3 months, to assess the response to therapy and clinical outcomes. Results: Among the study population, the majority of the patients (71%) were from ≥55 years of age group and 33 (77%) were male; 62% had a history of hypertension and 52% were diabetics. Slurred speech was the most common (47.8%) presenting symptom and Right hemiparesis was the most common (54.8%) neurological sign. There is a significant reduction (P<0.001) in NIHSS score was observed with a mean score of 3.38 after 24 hours of IVT with TNK and in the modified Rankin Scale (mRS) score (mean score: 1.61; P<0.001) at 3 months follow up. Two (4.7%) patients have developed hemorrhagic transformation; among them, one (2.3%) had an NIHSS score of more than 13 at arrival. Conclusion: Intravenous thrombolysis (IVT) with Tenecteplase (TNK) 0.25 mg/kg is safe with less chance of symptomatic intracranial hemorrhage and has good functional outcomes.

Introduction: Focal liver lesions have a wide range of differential diagnoses to consider. HCC ranks sixth in over all incidence after lung, breast, prostate, colorectal and gastric cancer. It ranks 3 for both genders in terms of mortality Differentiating between different liver lesions is thought to be essential for choosing a course of treatment.. Both rates of incidence , mortality are 2–3 times more in men compared to women.. The chosen liver imaging approach should have good lesion characterisation skills and high specificity and sensitivity for lesion identification in order to differentiate between lesions those require additional diagnostic testing or treatment from those do not require. Material And Methods: A prospective and correlation study was conducted among 40 patients attending Department of Radio Diagnosis, Karuna Medical College, Chitoor Palakkad. Clinically suspected focal liver lesion, or previous investigations depicted focal hepatic lesion with a non specific appearance. They will be evaluated Siemens Somatom and findings are correlated with biopsy/surgical findings where ever applicable. The conspicuity, enhancement patterns of individual lesions after the CT examination were noted and these findings were further correlated with histopathology/surgical findings/USG/follow-up as applicable. Results: Triphasic CT enhancement patterns observed as 100% sensitive and specific in diagnosing all the cases of Abscess, Cysts, Intrahepatic CCA. Sensitivity of Triphasic CT enhancement patterns in diagnosing the following cases of focal liver lesions in HCC, Haemangioma, Metastases 95.2%,90.9%,84% respectively. 100% specificity in diagnosing most of the cases only when the individual lesion had typical enhancement pattern except for 97.5% Metastasis and 95.2% in HCC. 100% sensitivity and specificity for intrahepatic CCA observed in our study was due very small sample size and larger size (>3cm) of the lesion. Conclusion: Hepatic Arterial Phase images are helpful in detecting hyper vascular lesions and are essential for characterization of large proportions of lesions. Images in the equilibrium /delayed phase help further characterization of lesions

Background: Digital breast tomosynthesis (DBT) improves detection and characterization of breast lesions especially in women with non-fatty breasts hence if used along with full field digital mammography can yield better results.  Aim: To compare and evaluate the impact of Digital Breast Tomosynthesis (DBT) combined with Full Field Digital Mammography (FFDM) versus FFDM alone in the diagnosis and interpretation of benign and malignant breast lesions utilizing the BIRADS score Methodology: This was a prospective, longitudinal study with retrospective component conducted in the department of Radiodiagnosis in a tertiary hospital in Western India from January 2018 to December 2019. All patients presenting to the department with breast lesion or lump with suspicion of breast malignancy were evaluated with full field digital mammography (FFDM) using BIRADS score and digital breast tomosynthesis (DBT) with histological correlation. Observation and Results: In our study 141 patients were included, who were in range of 29 to 91 years with mean age of 55.8 years. Out of 141, 61 came for screening and 80 came for diagnostic purpose. According to breast density, patients were divided into four groups a, b, c and d. Improvement in sensitivity, specificity, false positive rates, and positive predictive values was seen with addition of DBT to FFDM in patients with breast density d. On addition of DBT to FFDM it was observer there is down gradation of the BIRADS score from 4A to 3 in 8 cases. And upgradation of BIRADS score from 4A to 4B in 1 case, 4A to 4C in 7 cases and to 5 in 2 cases.  Statistically significant increase in sensitivity was seen with the addition of DBT to FFDM in BIRADS ≥ 4B and ≥ 4C (P = 0.004). Statistically significant increase in positive predictive value was seen with the addition of DBT to FFDM in ≥ 4A. In both diagnostic and screening groups, significant increase in sensitivity, positive predictive value (P < 0.05) was seen with the addition of DBT to FFDM. Conclusion: Use of tomosynthesis is helpful in analysis and characterization of breast masses seen on mammography. Most of lesions can be classified either into overlapping normal breast parenchyma or densities with addition of tomosynthesis avoiding the need for unnecessary   follow   ups   or   delay   in   pathological   procedures   and   diagnosis.   So tomosynthesis should always be added while evaluating asymmetries on mammography.

Background: Type 2 diabetes mellitus (T2DM) is a rapidly growing global health concern, particularly in developing countries like India. This study aims to evaluate the sociodemographic, clinical, and biochemical profiles of newly diagnosed T2DM patients in Burla, Odisha, to inform targeted intervention strategies. Methods: A hospital-based observational study was conducted from September 2022 to February 2023, enrolling 783 newly diagnosed T2DM patients through random sampling. Sociodemographic and clinical data were collected using a semi-structured questionnaire. Anthropometric measurements and laboratory investigations, including glycosylated hemoglobin (HbA1c), lipid profiles, and renal function tests, were performed. Data were analyzed using R software, with significance set at p<0.05. Results: The mean age of participants was 47.70±10.94 years, with 60.3% being male. Most were literate (98.6%), with 68.1% classified as obese (BMI ≥25 kg/m²). Classic diabetic symptoms like weakness (59.3%), nocturia (44.4%), and weight loss (26.7%) were prevalent. Poor glycaemic control (HbA1c >9%) was observed in 41.4% of patients, while only 6.8% achieved good control (HbA1c <7%). Dyslipidaemia (78.2%), hypertension (51.2%), and sedentary lifestyles (84%) were common. Obesity was significantly associated with hypertension (p<0.001), and a positive family history of diabetes was linked to increased risk (p=0.049). Conclusion: The study highlights poor glycaemic control, high prevalence of obesity, and associated risk factors like hypertension and dyslipidaemia among newly diagnosed T2DM patients in Odisha. These findings underscore the urgent need for lifestyle modifications and effective management strategies tailored to the region's socio-cultural context to mitigate the growing diabetes burden.

Obesity is a growing global health crisis that significantly contributes to chronic diseases such as type 2 diabetes, cardiovascular disorders, hypertension, and certain cancers. It is recognized as a multifactorial condition influenced by genetic, environmental, behavioral, and psychological factors. Traditional obesity management approaches, which predominantly focus on dietary modifications and increased physical activity, often fail to produce sustainable long-term results. As a result, there is an increasing emphasis on multidisciplinary approaches that integrate dietary interventions, physical activity, behavioral therapy, pharmacological treatments, and bariatric surgery to address obesity more comprehensively.

Obesity Management in a Multidisciplinary Approach Multifaceted in nature, the management of obesity requires teamwork that involves different health professionals from diverse fields, such as dietitians, exercise physiologists, psychologists, endocrinologists, and bariatric surgeons. They work best at offering individualized and global approaches to overcome the lifestyle challenges and the psychosocial issues that impact weight loss success. This approach emphasizes behavioural and psychological strategies, including evidence-based methods such as cognitive-behavioural therapy (CBT), mindfulness-based stress reduction for managing stress and other triggers that lead to emotional eating, and achieving sustainable lifestyle changes.

Pharmacological interventions are a critical component in obesity management, especially in those patients who do not respond to lifestyle changes alone. GLP-1 receptor agonists and orlistat are two examples of medications shown to help with weight loss. Bariatric surgery is the most effective intervention for patients with severe obesity, resulting in durable and clinically meaningful weight loss, improved metabolic control, and resolution of obesity-related comorbidities. Nevertheless, surgical solutions demand complete support pre-operatively and post-operatively to be successful in the long run.

This systematic review synthesized evidence from 30 studies to assess the effectiveness of multidisciplinary approaches for managing obesity. The results show that combining different modalities yields superior and longer-lasting weight loss to those delivered by a single modality. Moreover, multidisciplinary care enhances patients' psychological well-being, quality of life, and metabolic health. While the results are encouraging, adherence, access, and long-term feasibility are challenges for widespread implementation.

It also discusses future directions in obesity management, including the potential for mobile health applications, telemedicine, and wearable technology to promote patient engagement and monitoring. Such multidisciplinary approaches can transform obesity care by tackling the underlying causes of the disease and delivering personalized, patient-centred interventions. These results highlight the need for multidisciplinary approaches that focus on preventive care and holistic treatment models as healthcare systems move to help alleviate the global burden of obesity and improve long-term health outcomes.

Introduction: Due to the fast growth of cities and economies, health risks at work have become a significant public health issue. Several segments of society face an increased likelihood of experiencing negative outcomes due to their work conditions. One such group is petrol pump workers, who are consistently exposed to harmful chemical compounds found in gasoline as a result of their vocation. Hence, this cross-sectional research was conducted to examine the influence of workplace exposure to petrol vapours, diesel, and automobile emission on tests for pulmonary function. Methods: The study group consisted of thirty male petrol pump personnel, while the control group consisted of thirty healthy males who were matched to the study group. The assessment of pulmonary functions was conducted using a handheld spirometer. The mean ± standard deviation (SD) values for each parameter were calculated for both the study as well as the control groups. These values were subsequently compared utilizing an unpaired 't' test. Results: The study group (Petrol pump operators) exhibited a noteworthy decrease (p <0.05) in Forced Vital Capacity (FVC) and Forced Expiratory Flow between 25-75% (FEF 25-75%) compared to the control group. Conclusions: This study determines that petrol pump workers face an increased risk of developing pulmonary impairment, specifically a restrictive pattern of lung disease, over time. It also highlights the importance of medical monitoring and the enforcement of occupational safety measures to prevent work-related illnesses.

Background Gestational Diabetes Mellitus (GDM) is a significant health concern during pregnancy, characterized by elevated blood glucose levels first identified during pregnancy. Pregnancy induces insulin resistance due to placental hormones, but excessive resistance can lead to GDM, which poses risks to both maternal and fetal health. In India, GDM prevalence varies widely, exacerbated by factors such as demographics, healthcare access, and diagnostic methods. The increasing prevalence of GDM, particularly in developing countries, necessitates a better understanding of contributing factors to improve maternal and neonatal health outcomes. Objective This study aims to determine the prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women attending the outpatient department of SCB Medical College and Hospital in Cuttack, Odisha, India, and to identify associated risk factors such as age, family history, obstetric history, diet, BMI, and physical activity. Methodology A cross-sectional study was conducted from July 2018 to June 2019, involving 483 pregnant women who were screened for GDM using the 75 g, 2-hour oral glucose tolerance test (OGTT), following WHO diagnostic criteria. Data on age, family history of diabetes, obstetric history, diet patterns, BMI, and physical activity were collected through structured interviews and questionnaires. Statistical analysis was performed using the Chi-square test with a significance threshold of p<0.05. Results The overall prevalence of GDM in the study population was 15.9%. The highest prevalence was observed in the 25-29 age group (23.7%), and no significant association was found between age and GDM (p=0.234). A family history of diabetes was linked to higher prevalence, with women having both parents diabetic showing a significantly higher rate of GDM (49.4%). Obstetric history showed a significant association with GDM, with women with a good obstetric history having a higher prevalence (21.0%) compared to those with a bad obstetric history (9.2%). Diet patterns, particularly a higher prevalence of GDM in non-vegetarian women (61.0%), were also significant (p=0.001). Women with higher BMI, especially those classified as obese (BMI ≥ 30 kg/m²), exhibited a significantly higher prevalence of GDM (45.7%) compared to those with normal BMI (5.7%) (p=0.001). Additionally, physical inactivity was associated with higher GDM prevalence (57.1% in sedentary women). Discussion The study confirms that GDM is a major concern during pregnancy, with significant associations identified between various risk factors such as obesity, family history of diabetes, diet, and physical inactivity. Women with a higher BMI, poor dietary habits, and lack of physical activity were more likely to develop GDM. The results align with global studies linking obesity and poor lifestyle choices with increased risk of GDM. Interestingly, a family history of diabetes was also found to increase the risk, underscoring the genetic predisposition in GDM development. Moreover, women with good obstetric histories showed a higher prevalence of GDM, suggesting that factors beyond the current pregnancy, such as pre-existing metabolic conditions, may contribute. Conclusion The prevalence of Gestational Diabetes Mellitus in Cuttack, Odisha, India is high, particularly among women with higher BMI, sedentary lifestyles, and poor dietary patterns. Early screening, lifestyle modifications such as maintaining a healthy weight, improving diet, and engaging in regular physical activity are essential strategies to reduce the risk of GDM and its complications. There is a pressing need for public health initiatives and further research to mitigate the growing burden of GDM and ensure better maternal and neonatal health outcomes in India.

Pulmonary embolism (PE) is a potentially life-threatening condition that can present with non- specific symptoms, including dyspnea and refractory hypoxemia, complicating diagnosis, especially in the absence of clinical signs of deep vein thrombosis (DVT). This study retrospectively evaluates the use of computed tomography pulmonary angiography (CTPA) in diagnosing PE in patients presenting with refractory hypoxemia and dyspnea but without clinical evidence of DVT. The relationship between D-dimer levels, DVT presence, and patient outcomes was also explored. Twenty patients admitted to a tertiary hospital between January 2022 and September 2024 were included in the study. CTPA confirmed PE in all cases, while Doppler ultrasound post-diagnosis revealed DVT in 55% of patients despite the absence of clinical symptoms. D-dimer levels varied from 700 to 2100 ng/mL, with higher levels correlating with a more significant embolic burden. ICU admission was required for 50% of patients, and 35% received thrombolysis due to massive PE or hemodynamic instability. The overall mortality rate was 35%, predominantly among patients with malignancy or those requiring thrombolysis. These findings underscore the importance of considering PE in patients with unexplained hypoxemia, regardless of the absence of DVT symptoms. CTPA remains critical for diagnosis, and D-dimer results should be interpreted cautiously, as normal or mildly elevated levels do not rule out PE. Doppler ultrasound is valuable for detecting subclinical DVT. Further studies are needed to develop non-invasive diagnostic protocols for atypical PE presentations.

Background: Brachial plexus block is most common peripheral nerve block technique for upper limb surgeries. Present study was aimed to know the efficacy of magnesium sulphate as an adjuvant to Ropivacaine in interscalene brachial plexus block using peripheral nerve stimulator. Material and Methods: Present study was hospital based, randomized, double blinded, clinical trial conducted in patients of age group 18-55 years, ASA grade I and II, posted for above elbow surgeries under peripheral nerve stimulator guided interscalene brachial plexus block. Patients were randomly allocated to Group A {Ropivacaine 0.5% (5mg/ml) with Normal saline} and group B {Injection Ropivacaine 0.5% (5mg/ml) with 0.3ml Magnesium sulphate (150mg)}.  Results: Mean onset time of sensory blockade was earlier in group A, mean onset time of motor blockade was earlier in group A, difference was statistically significant. Mean duration of sensory blockade was less in group A & Mean duration of motor blockade was less in group A, difference was statistically significant. The mean VAS score of Group A at 12hours is 3.95 ± 0.136 and group B is 2.00 ± 0.000, which was statistically significant. Mean VAS score of Group A at 24hours is 4.95 ± 0.316 and group B is 3.00 ± 0.000, which was statistically significant. In Group A, mean duration of postoperative analgesia was 345 ± 57.24 min i.e., 5.75± 0.954 hours and in Group B it was 457.8 ± 35.16 min i.e., 7.63 ± 0.586 hours.  In group A none of the patients had intraoperative complications whereas, two patients in group B suffered from vomiting, which was statistically significant (P value <0.001) Conclusion: Addition of 150 mg magnesium sulphate to 0.5% ropivacaine in interscalene brachial plexus block significantly prolongs the duration of sensory and motor blockade and significantly reduces the requirement of rescue analgesic.

An accumulating body of evidence has established that one of the clinical implications of vitamin D deficiency in diabetes mellitus (DM) is the contribution of cardiovascular disease (CVD) among different groups. Objectives: This study aims to investigate the correlation of Vitamin D levels with cardiovascular risk and their association in diabetic patients compared to healthy controls, along with the correlation with significant biomarkers. Materials and Methods: This cross-sectional study was conducted on 240 participants (120 diabetic patients and 120 control group). Standardized approaches were used to evaluate Serum Vitamin D concentrations, lipid profiles, glycaemic parameters, pro-oxidant biomarkers, and inflammatory biomarkers. T-tests and correlation analyses were performed to conduct statistical analyses of significant associations. Results: The diabetic group had significantly lower vitamin D status (13±5 ng/mL) compared to healthy subjects (28.2±8 ng/mL, p<0.001). Vitamin D was found to have strong inverse correlations with low-density lipoprotein (LDL) (r = -0.65, p < 0.001), high-sensitivity C-reactive protein (hs-CRP) (r = -0.58, p < 0.001), and systolic blood pressure (r = -0.52, p < 0.001). Based on sex, it was found that the prevalence of vitamin D deficiency was 65 % among women as compared to 45 % among men (p < 0.05).