European Journal of Cardiovascular Medicine

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 followingintra-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, 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;andGroup R received 3 ml of 0.75% hyperbaric Ropivacaine (preservative free) with 20 mcgfentanyl, 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. Levobupivacaineproduced 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 to levobupivacaine.The duration of sensory block (hours) varied significantly across the 2 groups (p = 0.001), with the Group L (levobupivacainegroup) having longerduration of sensory block (hours). Ropivacaine had a lesser duration of sensory blockade as compared to levobupivacaine. Participants in the group Group L (levobupivacainegroup) had ahigher 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).