European Journal of Cardiovascular Medicine

AIM: To find a suitable general anaesthetic induction agent that can have optimal condition for endotracheal intubation and haemodynamic stability.  METHIOD: This was a Randomized double blinded controlled trial conducted at Department of Anaesthesia & Intensive Care, for the period of 24 months. However, this study was restricted only to the elective lower limb orthopaedic surgeries. Total number of patients seen at our Institute during the study period was 60 with 30 patients in each group. RESULTS: This study includes 60 healthy individuals of ASA grade I and II. In this study, study population is divided into 2 groups – Group P and Group E. Group P – study population received inj. Propofol 1%, (2 mg/Kg body weight) Group E – study population received inj. Etomidate (0.3 mg/Kg body weight) All observational parameters were noted by an independent observer blinded at the time of induction, during laryngoscopy, at 1 minute, 3-minute, 5 minute and 10 minutes. In this randomised controlled trial, etomidate was found to be a better induction agent for general anaesthesia with more proportion of patients with excellent and good ease of insertion, less incidence of pain on injection, less incidence of apnoea with better SpO2 level, and better haemodynamic stability as compared to propofol. There were less cases of nausea or vomiting, hypotension and tachycardia in etomidate group whereas incidence of myoclonus and bradycardia were slightly more. Thus, etomidate should be preferred over propofol as the induction agent of choice in patients with co-existing cardiac illness in whom maintaining stable hemodynamic parameters is very important during induction for a favourable outcome.  CONCLUSION: In this randomised controlled trial, etomidate was found to be a better induction agent for general anaesthesia with more proportion of patients with excellent and good ease of insertion, less incidence of pain on injection, less incidence of apnoea with better SpO2 level, and better haemodynamic stability as compared to propofol. There was less cases of nausea or vomiting, hypotension and tachycardia in etomidate group whereas incidence of myoclonus and bradycardia were slightly more. Thus, etomidate should be preferred over propofol as the induction agent of choice in patients with co-existing cardiac illness in whom maintaining stable hemodynamic parameters is very important during induction for a favourable outcome.

Background:  Levobupivacaine is an optical isomer of bupivacaine of the amide class and is linked to a decreased risk of toxicity than either the dextro-enantiomer itself or the racemic bupivacaine Levobupivacaine slows the transmission of the action potential in neurons that regulate sensory Aim: The present study aims at finding suitable adjuvant to Levobupivacaine for controlling of post-operative pain under epidural technique in surgical intensive care units of Nalanda Medical College and Hospital, Patna, Bihar, India  Methods: This was a Randomized double blinded controlled trial conducted at Department of Anaesthesia & Intensive Care, for the period of 24 months. However, this study was restricted only to the elective lower limb orthopaedic surgeries. Total number of patients seen at our Institute during the study period was 60 with 30 patients in each group. 60 healthy patients of ASA physical status I and II who undergone lower limb orthopaedic surgery were included in our study. After completion of the surgical procedure patients were shifted to post-operative care unit. They were divided into two groups -Group I and Group II and postoperative analgesia were maintained with the study drug according to the drug schedule: Group I: Received 10 ml injection of Levobupivacaine .125% with .5 mcg/kg Dexmedetomidine via epidural route. Group II: Received 10 ml injection of Levobupivacaine .125% with 1 mcg/kg Fentanyl via epidural route. Results: Observation showed that dexmedetomidine was better adjuvant to levobupivacaine as compared to fentanyl group. Number of top-ups required were significantly greater in fentanyl group in 24 hours. At the end of 24 hours majority of patients with Dexmedetomidine were pain free and satisfied with postoperative analgesia. Degree of complications (respiratory depression, nausea & vomiting) were observed more with the Fentanyl group in comparison to Dexmedetomidine group. Conclusion: In this randomised controlled trial, dexmedetomidine was found to be superior than fentanyl with better post-operative analgesia and less requirement of additional analgesics, less respiratory depression, less incidence of nausea or vomiting, urinary retention and low level of sedation. However, patients in fentanyl were more haemodynamically stable as compared to dexmedetomidine group. In this clinical trial, it can be concluded that the use of dexmedetomidine as an adjuvant to the local anaesthetic agent during epidural block hastens the onset of sensory and motor blockade, provides a longer duration of analgesia, decreases the total analgesic requirement, and is not associated with nausea like fentanyl and tramadol, which cause clinically significant and unmanageable side effects.

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease (CLD) caused by pulmonary vascular remodeling due to portal hypertension. Early detection is essential, particularly in liver transplant candidates. This study assesses the prevalence, clinical characteristics, and risk factors for PoPH in CLD patients. Material and Methods: A prospective observational study at Dr. N Y Tasgaonkar Institute of Medical Science (January 2023–January 2025) enrolled 100 CLD patients. Clinical, biochemical, imaging, and hemodynamic assessments were performed, including transthoracic echocardiography (TTE), right heart catheterization (RHC), pulmonary function tests (PFT), and six-minute walk test (6MWT). PoPH was diagnosed per ESC/ERS guidelines. Statistical analysis included chi-square tests, t-tests/Mann-Whitney U tests, and multivariate logistic regression. Results: PoPH prevalence was 29% (54% mild, 8% moderate, no severe cases). Mean age was 53.42 ± 9.13 years, with 75% male. Alcoholic liver disease (46%) and NAFLD (28%) were the most common etiologies. Higher BMI (p = 0.002), male sex (p = 0.041), smoking (p = 0.032), and comorbidities (p = 0.023) were significantly associated with PoPH. Pulmonary function impairment (FEV1 < 70%, p = 0.028) and reduced exercise tolerance (6MWT < 350m, p = 0.008) were significant. Liver disease severity (Child-Pugh, p = 0.015; MELD, p = 0.041) was strongly linked to PoPH. Conclusion: PoPH is prevalent in 29% of CLD patients, with BMI, male sex, smoking, comorbidities, and liver disease severity as major risk factors. Pulmonary function impairment and reduced exercise capacity underscore the need for early screening and cardiopulmonary assessment. Routine echocardiography and pulmonary function testing should be prioritized for early detection and management.

Background: Peripheral nerve blocks (PNBs) offer significant advantages in lower limb surgeries by selectively interrupting pain pathways while preserving autonomic stability. Compared to general or spinal anesthesia, PNBs minimize hemodynamic fluctuations, reduce opioid requirements, and enhance perioperative comfort. Additionally, they lower the incidence of systemic complications, facilitating faster recovery. This study evaluates the efficacy and safety of combined femoral (3-in-1) and sciatic nerve block in surgical anesthesia and postoperative analgesia. Materials and Methods: This study included 30 patients undergoing elective or emergency lower limb surgery. Combined femoral (3-in-1) and sciatic nerve blocks were administered using standardized techniques. Sensory block was evaluated using a pin-prick test with a 3-point scale. Motor block was assessed using “Three P’s" acronym. Successful blockade achieved in most cases. Patients were monitored for complications intraoperatively and postoperatively. Results: The study included 30 patients, with 80% males and 40% in the 51–60 years age group. Elective surgeries comprised 63.33% of cases. Nerve blocks were successfully administered, with a 90% complete block rate. Sensory and motor block durations averaged 195.66 ± 19.10 and 158.5 ± 14.63 minutes, respectively. Hemodynamic parameters remained stable, and no complications were observed. Conclusion: The combined femoral (3-in-1) and sciatic nerve block is a safe, effective, and cost-efficient technique with minimal side effects and a low failure rate. It provides excellent anesthesia and analgesia for unilateral lower limb surgeries, particularly in high-risk patients. With its advantages, PNBs may soon replace general and central neuraxial anesthesia for such procedures.

Background: The perioperative period is critical in the long-term prognosis of breast cancer patients. The use of regional anesthesia, such as paravertebral block (PVB), could be associated with improvements in long-term survival after breast cancer surgery by modulating the inflammatory and immune response associated with the surgical trauma, reducing opioid and general anesthetic consumption, and promoting cancer cells death by a direct effect of local anesthetics. Methods: A systematic literature search was conducted for studies of patients who received PVB for breast cancer surgery. The Jadad score and Ottawa-Newcastle scale were used to assess the methodological quality of randomized controlled trial and observational retrospective studies, respectively. Only high-quality studies were considered for meta-analysis. The selected studies were divided into 3 groups to determine the impact of PVB on (a) recurrence and survival, (b) humoral response, and (c) cellular immune response. Results: We identified 100 relevant studies. The main outcome was  to compare opioid consumption at the first 24 h after surgery. For secondary objectives, we aimed to compare pain scores after surgery, intraoperative opioid consumption, the incidence of PONV and block-related adverse events. Conclusions: Our study indicates that there are no data to support or refute the use of REGIONAL BLOCKS for reduction of cancer recurrence or improvement in cancer-related survival. However, its use is associated with lower levels of inflammation and a better immune response in comparison with general anesthesia and opioid-based analgesia.

Background: Tinea corporis, also known as ‘ringworm,’ is a superficial dermatophyte infection of the skin, other than on the hands (tinea manuum), feet (tinea pedis), scalp (tinea capitis), bearded areas (tinea barbae), face (tinea faciei), groin (tinea cruris), and nails (onychomycosis or tinea unguium).1 Tinea corporis is most commonly caused by dermatophytes belonging to one of the three genera, namely, Trichophyton (which causes infections  There are certain risk factors like age, sex, status of diabetes influence the occurrence of  Tinea Corporis among diabetes. on skin, hair, and nails), Microsporum (which causes infections on skin and hair), and Epidermophyton (which causes infections on skin and nails).1–3 Dermatophytes are grouped as either anthropophilic, zoophilic, or geophilic, depending on whether their primary source is human, animal, or soil, respectively.4,5 Because tinea corporis is common and many other annular lesions can mimic this fungal infection, physicians must familiarize themselves with its etiology and its treatment. Aims and Objectives: To study Prevalence of Tinea Corporis in general population and evaluate its association with Diabetes patient. Methods: This study was conducted among 60 diabetes patients attending tertiary care hospital diabetes OPD to find out occurrence of Tinea Corporis. The patients were selected randomly. The clinical examination of Tinea Corporis   was done. The blood investigation like blood sugar, HbA1c and Thyroid function were performed. The statistical analysis as Chi-square test was applied. Results: Among the study population 56% were female and 44% were male. The prevalence of Tinea Corporis was 66.6% in India among all skin diseases. The Tinea Corporis found in 29% of the female compare to 9% among male, this increase occurrence in female was statistically significant. This study found out the uncontrolled diabetes was one of the major risk factor for Tinea Corporis. Conclusions: The uncontrolled diabetes rather than duration of the diabetes is also major cause for Tinea Corporis. It is the duty of the Dermatologist and the patient to control the diabetes to prevent the Tinea Corporis.

Background: Numerous diseases, from benign to malignant, with slow evolving or exceedingly aggressive clinical course, have been related to thyroid lesions. Disorders affecting the thyroid gland can vary from a single, isolated lesion to a systemic condition including the development of a tumor.Aim: To classify the cytomorphology of thyroid lesions by FNAC and to determine its correlation with thyroid hormone profile and radiology. Material and methods: The current study was conducted in Department of Pathology at newly started Government Medical College, Udhampur over a period of 01 year and a total of 73  patients presenting with thyroid lesions were clinically examined. SPSS (Statistical Package for the Social Sciences, SPSS Inc., v.16) was used to do the statistical analysis. For quantitative data, the descriptive statistics were computed as mean and standard deviation, and for qualitative data, as frequency and percentage. Using chi-square analysis, the relationship between two category variables was determined. For the current investigation, a P value of less than 0.05 was designated as the significance level. Results: In our study there was female predominance. Euthyroid patients represented the majority of the patient population (50.7%), followed by hypothyroid patients (28.8%) and hyperthyroid patients (20.5%). The individuals' thyroid hormonal profile  and radiodiagnosis were statistically significantly correlated. Conclusion: It is concluded that one essential diagnostic method of thyroid lesions is FNAC which can help in determining the type and nature of thyroid lesions.

Background: Colorectal cancer (CRC) is a major global health concern, with increasing incidence linked to lifestyle factors. This study aimed to evaluate the association between dietary habits, physical activity, smoking, alcohol consumption, family history, and comorbidities with CRC risk. Methods : A case-control study was conducted with 100 participants (50 CRC cases and 50 controls). Data on demographics, diet, physical activity, smoking, alcohol use, family history, and comorbidities were collected. Statistical analysis was performed to determine significant associations using chi-square tests and p-values (<0.05 considered significant). Results: Cases had a significantly higher BMI (27.1 ± 3.4 vs. 24.5 ± 2.8 kg/m², p < 0.05). High red meat intake (>3 times/week) was more frequent in cases (68%) than controls (34%) (p = 0.01), whereas low fiber intake was observed in 72% of cases vs. 40% of controls (p = 0.003). Sedentary lifestyle was more common in cases (66%) than controls (38%) (p = 0.02). Smoking (44% vs. 22%, p = 0.04) and alcohol consumption (52% vs. 30%, p = 0.03) were significantly associated with CRC risk. A positive family history was observed in 28% of cases vs. 10% of controls (p = 0.02). Colonoscopy screening was significantly lower among cases (18% vs. 42%, p = 0.01). Diabetes (34% vs. 18%, p = 0.04) and hypertension (40% vs. 26%, p = 0.05) were more prevalent in cases. Conclusion: Unhealthy dietary habits, sedentary lifestyle, smoking, alcohol consumption, and lack of screening significantly increase CRC risk. Public health strategies should focus on risk reduction through lifestyle modifications and early screening programs.

Background: According to studies, VAP is a serious C thus it’s O can vary depending on patient health, type & severity of pneumonia ans effectiveness of the treatment. Therefore the goal of our study was to evaluate its PD, C & O. Material and Method: 144 patients were randonly selected and evaluated for various PD parameters , C & O after undering routine investigation by questionnaire format. Result: We found that, C were significantly higher for late than early VAP, those who were present with VAP showed MTR in majority and early PD were significantly higher. Conclusion: We conclude that, VAP that starts early may respond well to more targeted therapies, but VAP that starts late needs continuous monitoring and care due to the increased risk of significant complications.

Background: AECOPD is an sudden exacerbation of respiratory symptoms, particularly dyspnea, necessitates altered medical intervention and/or hospitalization, which can potentially be life-threatening depending on the severity of the condition. Therefore, the purpose of this study was to compare & evaluate 5 R/S i.e. DECAF, BAP-65, CURB-65, CAPS and APACHE II in AECOPD & find the best to predicts HMT& MV. Material and Method: 150 patients were divided into 2 groups i.e. group 1(non-survived) while group 2 (survived) and compared 5 & assessed scores. Result:We found significant difference between all the scores for both the groups. Conclusion: We conclude that using SS will be more helpful, useful for predicting the need for critical care.

Background: According to a study, VAP was estimated to occur in 9–27% of all MV patients, with the highest risk occurring early in the course of hospitalization. Therefore, the goal was to evaluate I, R/F& MB-P of VAP. Material and Method: A total of 144 patients were asked to fill questionnaire form and VAS was recorded. Result: We found that, only 56 patienst showed VAP incidence, risk was seen more for GBS and PS & Kl were main significant challenge. Conclusion: We conclude that, prevention form MDR pathogen emphasized is utmost important for such patients.

Background: According to various past studies, conflicting information regarding the connection between Thyroid dysfunction and HAART is present. Therefore, the purpose of this study was to determine effect , compare & correlate ART on Thyroid Profile among HIV (+ve) patients. Material and Method: 102 patients were assessd for baseline data [CD4 level & Viral Load] then at 6 & 12 months after switching to 2nd line ART later asked for follows up for Thyroid Function test & FT3, FT4 and TSH. Result: We found that, for CD4, difference was not significant for FT3 & FT4 at baseline , 6th & 12 th month, while significant for TSH respectively. For VL, non- significant at baseline & 6th month for FT4 & TSH while significant for FT3 and finally at 12th month all the variables showed non-significant diffrence. Conclusion: Majority of the patient developed subclinical hypothyroidim, therefore follow up to be ensured and treat when indicated. 2nd line ART treatment is more effective treatment in reducing VL while increase CD4 count at subsequent follow up.

Background: Acute Kidney Injury (AKI) in ICU patients significantly impacts morbidity and mortality. This study aimed to analyze the risk factors, treatment modalities, and outcomes of AKI in an ICU setting.  Methods:  A prospective cohort study was conducted involving 100 ICU patients with AKI, classified per KDIGO criteria. Data on demographics, contributing factors, AKI causes, treatments, and outcomes were collected and analyzed. Results: The mean age of participants was 48±15.7 years, with a male predominance (74%). Hypovolemia was the leading cause of AKI at 45%, followed by drug-induced (17%). Pre-renal AKI was most common (82%), with 35% of patients requiring Renal Replacement Therapy (RRT). Comorbidities like diabetes mellitus (18%) and hypertension (12%) significantly influenced RRT need (p<0.05). Serum creatinine and urea levels decreased significantly from admission to discharge (creatinine from 4.82 to 3.86 mg/dL, urea from 144.84 to 72.15 mg/dL). The improvement rate was 92%, with an 8% mortality rate. Conclusion: The study highlights the importance of considering demographics and specific risk factors in managing AKI in ICU settings. While immediate outcomes were positive, the potential for long-term renal impairment necessitates ongoing vigilance and research.

Background: Regular puncture for dialysis, treatment with anticoagulation and abnormal hemodynamics make infections, hematoma, thrombosis, limb oedema, cellulitis of limb, bleeding, pseudoaneurysms and true aneurysms a relatively common complication in patients with arteriovenous fistula (AVF) for hemodialysis. Aims: We aim to describe the presentations, treatment modalities and probable causative factors of true and pseudo aneurysms in CKD patients with arteriovenous access.Materials and Methodology: It was a retrospective observational study in the Department of Cardiothoracic and Vascular Surgery at IPGMER And SSKM Hospital, Kolkata, during the period July 2022 to July 2024. Results: In our study, 34.03% patients were in the age group 51-60 and 23.15% were in the age group 41-50. Of those studied, 61.4 % were male, the rest were female. All the patients had Stage V CKD. 68.77% patients had aneurysms of the brachiocephalic fistula while the rest had aneurysms of the radiocephalic fistula. Among comorbidities, 67.01% patients had Type 2 diabetes mellitus (T2DM), 86.31% patients were hypertensive, 64.21% patients had peripheral arterial disease, 36.14% patients had heart failure, 82.80% patients had dyslipidemia.In our study, 108 (37.80%) patients had Type Ia aneurysm, 142 (49.82%) had Type Ib aneurysm, 21 (7.36%) had Type IIa aneurysm, 14 (4.91%) had Type IIb aneurysm. 44.91% patients who presented were asymptomatic, while 40% presented as bleeding fistula and 15.09% presented as hematoma. Among treatment modalities undertaken, ligation of fistula was done for a significant 77.55% of cases, excision of aneurysm and repair for 16.84% and endovascular repair was done for 5.61 % of patients. Conclusions: Frequent monitoring of the arteriovenous access, avoiding repeated punctures in same site for dialysis, regular dressing and antibiotics to prevent infection may help identify and prevent aneurysms early and provide prompt treatment to avoid potentially fatal consequences like rupture, hemorrhage, thrombosis and stenosis. To determine the ideal treatment strategy and the appropriate time for intervention, studies outlining the etiology, natural history and development of aneurysms are necessary.

Background: Acute pancreatitis is one of the most common causes of emergency hospitalizations in India. Accurate predictors of the severity of acute pancreatitis are important because they influence clinical decision-making in its management. The Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR), which are found by adding up the White Blood Cell Count and its Differential Count, can show the intensity of inflammatory process, like in acute pancreatitis. The aim of this study was to investigate the severity predictive value of NLR and PLR in male patients with acute pancreatitis of alcoholic etiology.Materials & Methods :The tertiary care hospital hospitalized 50 adult male patients with a history of alcoholism on an emergency basis, citing complaints of abdominal pain due to pancreatitis, and selected them based on a three-fold increase in their serum amylase and/or lipase levels. The exclusion criteria encompassed adult males over 80 years of age, females of any age, those with cancer or hematological proliferation disease under treatment, and those with other severe comorbidities. Informed consent was obtained from the patients for acceptance of participation in the study. The NLR and PLR values were calculated based on the differential counts of their WBC counts in blood samples taken at the time of admission. We used the Modified Computed Tomography Severity Index (MCTSI) to plot these NLR and PLR values against the grades of severity (mild, moderate, and severe) in acute pancreatitis and then did statistical analysis (including ANOVA). Results : We compared the values of serum amylase & lipase to NLR & PLR and found a positive correlation. We also determined the sensitivity and specificity of the NLR & PLR at various cut-off values, finding that the sensitivity of NLR (@7.5 cut-off value) for moderate AP was better at 76.00%, and the specificity of NLR (@10 cut-off value) for severe AP was better at 75.66%. It was found that the NLR and PLR values were strongly related to the MCTSI acute pancreatitis severity grade (mild, moderate, or severe) [p < 0.01]. Conclusion: Elevation of NLR and PLR is significantly associated with increasing severity of pancreatitis, and both are independent negative prognostic indicators for acute pancreatitis. Together, NLR & PLR give more accurate predictions regarding the severity of pancreatitis. NLR and PLR, which originate from a basic blood investigation, such as a WBC count, do not incur additional costs for the patient.  Together, they significantly outperform other methods in predicting the severity of acute pancreatitis, and they can be dependable in primary health care settings with a simple laboratory setup.

Introduction: Cardiorespiratory fitness refers to the overall fitness level that involves the coordinated functioning of the respiratory, circulatory, and muscular systems during physical activity. The VO_2max, the maximum amount of oxygen that a person can use during exercise, is the most commonly used measure to evaluate cardiopulmonary capacity and determine the intensity of an individual's physical activity. Aim: To assess cardiopulmonary fitness, two methods were used: the YMCA (Young Men’s Christian Association )3-minute step test and the treadmill Bruce protocol. The VO_2max values obtained from both methods were compared and correlated. Methodology: A comparative cross-sectional study was conducted at the Department of Physiology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka. The study consisted of 20 female participants between the ages of 20 and 40. Individuals with diagnosed congenital illnesses, differently abled individuals, those on long-term medications, and pregnant or lactating women were excluded from the study. Anthropometric measurements were taken, and VO2max was assessed using the YMCA 3-minute step test and the treadmill Bruce protocol. Results: The mean age of 20 female subjects was 25.05±4.39. Anthropometric values showed height of 162.35±4.69, weight 59.10±5.41 and BMI 22.35± 1.63. VO_2max values by YMCA 3 min step test for normal BMI subjects were 38.618 ± 2.568 and for overweight subjects 39.852 ± 1.395. VO_2max values by treadmill Bruce protocol for normal BMI subjects were 41.551±2.505 and for overweight subjects was 42.383±1.876. the test results demonstrate the VO_2max values by the YMCA 3 min step test showed a significant very strong positive correlation (r=0.86) with VO_2max values by treadmill Bruce protocol and the relationship was statistically significant at p<0.001. Conclusion: Assessing VO_2max with the YMCA 3-minute step test and the treadmill Bruce protocol, yields similar results. The YMCA 3-minute step test is also effective for evaluating cardiopulmonary fitness.

Background:  Scabies is found worldwide and affects folks of all races and social categories. Itching unfolds speedily beneath packed conditions wherever the shut body and skin contact is frequent. Scabies is found cold and temperate zone , but more prevalence in hot weather. In mining area we found Scabies  are more prevalent among people who engaged in industrial work. Scabies is one of the important occupational hazards in construction workers and it often leads to poor quality of life of the workers with substantial financial loss. However, this is often a neglected entity. Objective:  To study  occupational diseases and  prevalence  of  Scabies in manufacturing industry among industrial workers. Materials and Methods: We Conducted  Cross sectional study to investigate occupational health diseases and prevalence  occupational Scabies among industrial workers  by using self-report questionnaire to estimate the different type of  occupational diseases.  Written consent has been taken from all the participants before starting study .Total 121 peoples participated through random sampling method through various camp. Cross sectional study method was used in this study. We included the various variables   to explore the relationship between occupational contact  dermatitis and industrial workers. Results: In our Study it was found that like  Abrasive items ,acid  ,cements  detergents and  Heat  are the important causing factors for  Scabies  and it is highly associated with occupational health diseases. Conclusion: In our study we found that majority of peoples who exposed  to  sources like  Abrasive items ,acid  ,cements  detergents and Heat are more suffered of   occupational Scabies in compare of  other occupational health diseases. Encouraging the personal hygienic behaviour of  Factory workers is strongly recommended.

Background: Breast abscess is a condition that can develop as a complication of lactational mastitis, which occurs during breastfeeding. Recently, there has been a rise in cases of non-lactational breast abscess, which happens in women who are not breastfeeding. The purpose of this study was to examine the types of microorganisms found in both lactational and non-lactational breast abscesses in the emergency department (ED) and to determine how these microorganisms respond to different antibiotics. Methode: This study looked back at the records of breast abscess patients who came to the emergency department (ED) over two years. Information about their age, symptoms, tests, and treatments was collected. The study focused on the results of pus culture tests, the antibiotics given to the patients, and the types of germs (microorganisms) found. The goal was to understand the pattern of microorganisms and how they respond to antibiotics. Result: The study included a total of 150 patients, with 107 women classified as having lactational breast abscess and 43women as having non-lactational breast abscess. The average age of the patients was 24 years (ranging from 18 to 56 years). Most of the women (81%) were between 18 and 34 years old. Bacterial cultures were successfully grown from pus samples in 86% of the patients. In cases of lactational breast abscess, Staphylococcus aureus was the most common organism found (79%). In non-lactational breast abscess cases, a mix of bacteria, including Staphylococcus aureus and Group B Streptococci, was identified.Conclusion:  Choosing the right antibiotics is very important for treating breast abscesses. Non-lactational breast abscesses often have mixed types of bacteria compared to lactational breast abscesses. However, Staphylococcus aureus is the most common bacteria found in both types.

Background: Left ventricular (LV) pseudoaneurysm is a rare but serious cardiac condition resulting from a myocardial rupture contained by pericardial adhesions or thrombus. Unlike true aneurysms, pseudoaneurysms lack a complete myocardial wall, posing a high risk of rupture and necessitating prompt surgical intervention. AIM: This study presents a retrospective analysis of surgical outcomes in LV pseudoaneurysm management over an 15 year period. Methods: A retrospective review was conducted on 11 patients diagnosed with LV pseudoaneurysm between May 2009 to December 2024. The mean age was 38.7 years (range: 7–73 years), with 9 males and 2 females. Clinical data, imaging findings, surgical techniques, and postoperative outcomes were analyzed. All patients underwent surgical repair, including patch closure with PTFE, Dacron, or autologous pericardium, with or without concomitant procedures such as mitral valve repair/replacement or coronary artery bypass grafting (CABG). Results: The predominant etiology was myocardial infarction (54.5%), followed by infective endocarditis (36.4%) and trauma-related pseudoaneurysm (9.1%). Surgical repair resulted in no perioperative mortality. One late mortality (9.1%) occurred due to chronic obstructive pulmonary disease (COPD). At discharge, 90.9% of patients were in NYHA Class I or II, with no recurrence or reintervention during a mean follow-up of 13 months. Conclusion: LV pseudoaneurysm requires early diagnosis and surgical intervention to prevent catastrophic rupture. Surgical repair demonstrates excellent functional recovery, low mortality, and durable long-term outcomes.

Background: Introduction-The CNS is the most important site of infection in patients with rickettsial diseases. Patients with scrub typhus have mild-to-moderate neurological manifestations. Meningitis and encephalitis are the most common neurological manifestations. Aim: Study of clnicopathological and biochemical profile in scrub encephalitis. Materials and Methods:  Hospital based observational study conducted at Medicine department of SMS Hospital, Jaipur from January 2023 to June 2024 on 30 patients of Scrub Encephalitis. Results:  In present study out of 30 patients 12 have seizures, neck rigidity was seen in 28 cases and Kernig sign was seen in 12 cases. Altered sensorium was seen in 69% of our patients.In present study most common MRI brain finding seen were Increased Signal intensity in various parts of brain and acute infarct. Conclusion: Scrub Encephalitis is an important diagnosis to be made in any patient with altered sensorium, as it is eminently treatable. Clinical clues such as eschar, and investigations showing altered liver function tests and thrombocytopenia, may point to this diagnosis as shown in our study. Prompt therapy can be lifesaving, and hence, this is an important diagnosis to be made in tropical countries.

Introduction: Sickle cell disease and its variants are genetic disorders resulting hemoglobin (HbS) due to single point mutation, where glutamate is replaced by valine at the 6th position in β-globin chains associated with many biochemical abnormalities. Renal disease is one of the most frequently occurring complications in sickle cell disease, kidney damage starts very early and progresses throughout the life causing severe complications. The present study is aimed to evaluate blood urea and serum creatinine levels in Sickle Cell Disease.  Material and methods: The study was hospital based case control study. By applying inclusion and exclusion criteria 111 patients with sickle cell Disease and 111 healthy controls were enrolled for the present study. 5 ml of blood sample were taken without anticoagulant and then these samples were allowed to clot for 30 min at room temperature, and then centrifuged for 10 min at 3000rpm. The serum was removed, aliquoted and stored at ≤−20°C until assayed. The separated serum was used for the evaluation of blood urea and serum creatinine. Blood urea was estimated by DAM method serum creatinine was estimated by Jaffe’s method with appropriate chemical principles. Results: For the statistical analysis, statistical package SPSS 24 and Microsoft Excel 2010 had been used in this study for the calculations.  The independent student‘t’ test was applied for the comparison purpose and “p” value ˂0.05 had been used for the level of significance The selected variables blood urea and serum creatinine levels were showing variations:  The blood urea level was increased significantly high in cases of Sickle cell disease (41.02 ± 5.38; 29.27 ± 3.86) compared to controls and the serum creatinine level also elevated (1.39 ± 0.29; 0.77 ± 0.17) significantly high in cases compared to controls. Conclusion: In kidney function tests, the Blood Urea level and Serum Creatinine levels had been found significantly increased in the sickle cell disease.  So, these KFT parameters could be helpful for the diagnosis of sickle cell disease.

Background: Insulin resistance significantly impacts cardiovascular outcomes, yet its specific role in acute coronary syndrome (ACS) among diabetic patients remains incompletely understood. This study investigated the relationship between insulin resistance and clinical outcomes in diabetic patients presenting with ACS. Methods: In this prospective observational cohort study, we enrolled 428 consecutive diabetic patients admitted with ACS. Patients were stratified into tertiles based on admission Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values: low (<2.5), intermediate (2.5-5.0), and high (>5.0). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, or target vessel revascularization over 24 months of follow-up. Results: The study population included 245 males (57.2%) with a mean age of 64.3 ± 11.2 years. High insulin resistance was associated with more complex coronary anatomy (SYNTAX score 26.8 ± 10.2 vs. 18.4 ± 8.2, p<0.001) and larger infarct size (peak Troponin T 2865 ± 2742 vs. 1842 ± 2156 ng/L, p=0.002) compared to the low insulin resistance group. The primary endpoint occurred more frequently in patients with high insulin resistance (42.7% vs. 19.7%, adjusted HR 2.48, 95% CI 1.62-3.84, p<0.001). This association remained consistent across prespecified subgroups including age, gender, and ACS type.Conclusion: High insulin resistance is independently associated with adverse cardiovascular outcomes in diabetic patients with ACS. These findings suggest that insulin resistance assessment may enhance risk stratification and identify patients who might benefit from more intensive therapeutic strategies.

Background: The bidirectional Glenn (BDG) procedure is a critical component of single-ventricle palliation. However, patients with restrictive atrial septal defects (ASD) may require atrial septectomy to ensure adequate pulmonary venous return. Conventional atrial septectomy involves direct atrial incision, which increases the risk of bleeding, arrhythmias, and prolonged cross-clamp time. Objective: This case series presents a Noval transvenous surgical atrial septectomy technique performed through the superior vena cava (SVC) during BDG surgery, eliminating the need for a direct atrial incision.Methods: Six patients (three with tricuspid atresia, two with transposition of the great arteries (TGA) and pulmonary atresia, and one with hypoplastic left heart syndrome (HLHS)) underwent BDG with transvenous atrial septectomy. The SVC was transected 5 mm from the RA-SVC junction, and septectomy was performed transvenously, avoiding atrial incision. Results: All patients had uneventful postoperative recovery with adequate atrial decompression, no immediate complications, and no residual ASD obstruction. Conclusion: The transvenous approach is a safe and effective alternative to traditional atrial septectomy, reducing surgical trauma, cross-clamp time, and arrhythmic risks. Further studies are needed to validate long-term outcomes

Background: Rheumatic heart disease (RHD) is a major cause of valvular pathology, often requiring mitral valve replacement (MVR). Concomitant tricuspid regurgitation (TR) frequently coexists and may progress if left untreated. This study evaluates the outcomes of MVR with concomitant tricuspid valve repair (TVR) in patients with dual-valve involvement Methods: A retrospective cohort study was conducted on 100 patients who underwent MVR with or without TVR between 2021 and 2024 at a tertiary care center. Patients were divided into two groups: MVR + TVR (n = 50) and MVR-only (n = 50). Primary outcomes included long-term survival, TR progression, and functional status. Secondary outcomes included reoperation rates, thromboembolic events, and infective endocarditis. Statistical analysis was performed using Kaplan-Meier survival curves and Cox proportional hazard models. Results: At five-year follow-up, survival rates were comparable between the groups (85.1% in MVR + TVR vs. 82.5% in MVR-only, p = 0.33). However, residual TR was significantly lower in the MVR + TVR group (18% vs. 34%, p = 0.01), suggesting that TVR effectively reduces TR progression. Additionally, a higher proportion of patients in the MVR + TVR group achieved NYHA Class I-II functional status (78% vs. 71%, p = 0.08), although this difference was not statistically significant. Reoperation rates, thromboembolic events, and infective endocarditis rates were similar in both groups (p > 0.05). Conclusion: Concomitant TVR reduces TR progression and improves functional recovery without increasing perioperative complications. Given the potential benefits, TVR should be considered in patients undergoing MVR with moderate-to-severe TR. However, further prospective multicenter studies are required to confirm these findings and establish standardized guidelines for dual-valve interventions in RHD.

Background: Tuberculosis (TB) is a significant global health challenge, with India accounting for 27% of global cases. Despite improved treatment success rates, the long-term impact of post-pulmonary TB sequelae remains inadequately studied, particularly in high-burden countries. This study aimed to evaluate the pulmonary function abnormalities in post-pulmonary tuberculosis cases. Methods: A hospital-based observational study was conducted on 300 post-pulmonary TBpatients at a tertiary care center from September 2022 to March 2024. Thestudy utilized comprehensiveassessment methods including clinical evaluation and pulmonary function testing using computerized spirometry. Risk factors weresystematically evaluated, and statistical analysis was performed with significance set at p≤0.05. Results: Thestudypopulation (n=242)(meanage59.33±12.18years) showed male predominance(76.03%) and primarily rural residence (79.8%). History of smoking in 52.1% and biomass fuel exposure in 19.8% cases. Common clinical manifestations included shortness of breath (87.6%), cough (77.7%), and expectoration (59.5%). Spirometry wassuccessfully performed in 242 cases out of 300 cases. Spirometry revealed pulmonary function abnormalities in 89.26% of cases: restrictive pattern in 90 cases (37.19%), mixed pattern in 64 cases (26.45%), and obstructive pattern in 62 cases (26.62%). 98 cases (40.5%) had severe to very severe pulmonary function abnormalities. Conclusion: PostTB pulmonary function abnormalities are prevalent and associated with significant pulmonary function abnormalities, underscoring the need for comprehensive post-TB care. Strategies should include pulmonary rehabilitation, regular lung function monitoring, and interventions targeting modifiable risk factors like smoking and incomplete treatment adherence to improve long-term outcomes.

Background: The most common laryngo-tracheal complaints following general anesthesia with tracheal intubation in the postoperative period are sore throat and hoarseness, with an incidence ranging from 24% to 90%, which may hamper the quality of recovery postoperatively. This study was designed to assess whether intraoperative monitoring of endotracheal tube cuff pressure can help reduce the incidence of sore throat and hoarseness. Aims & Objective: Main aim of our study is to compare the quality of recovery in post operative patients and hemodynamic stability, smooth extubation, less post operative airway related complication and better patient satisfaction in whom endotracheal cuff pressure is been measured and monitored intra operatively  v/s not measured. Materials & Methods: 60 patients scheduled for elective procedures under general anesthesia with orotracheal intubation were recruited through simple random sampling and divided into two groups of 30 each: Group A and Group B. All patients received general anesthesia following a standard protocol. In Group A, cuff pressure monitoring was performed, whereas Group B served as the control group with no such monitoring. The incidence and severity of sore throat and hoarseness were recorded for both groups. Result:  100 patients were analyzed for the outcomes without any dropouts. The basic parameters like age, sex, BMI, and duration of surgery were found to be statistically insignificant among the two groups. The incidence of sore throat and its severity along with that of hoarseness of voice were found to be statistically insignificant, but with an evident better outcome in Group A. Conclusion:  We conclude that intraoperative monitoring of cuff pressure using a cuff pressure monitor significantly reduced the incidence as well as the severity of sore throat and incidence of hoarseness of voice in patients undergoing orotracheal intubation, but came out to be statistically not significant with evident improvement in quality of recovery post operatively.

Background: Cardiovascular diseases (CVD) are the leading cause of global mortality, with coronary artery disease (CAD) being the most significant contributor. This is particularly concerning in low- and middle-income countries like India, where the prevalence of CAD is on the rise. Traditional risk factors such as hypertension, diabetes, and smoking are well-documented, but emerging non-traditional factors like testosterone levels have drawn attention in recent research. Testosterone is thought to impact cardiovascular health, and its deficiency has been linked to increased CAD risk. However, the association between testosterone and CAD severity remains inconclusive, especially in India, where limited data exists. This study aimed to explore the correlation between serum testosterone levels and the angiographic severity of CAD in middle-aged Indian men. The study involved 88 male participants aged 40-60, undergoing coronary angiography. The clinical profiles of participants, including traditional CAD risk factors, were recorded, and testosterone levels were measured. CAD severity was assessed using GENSINI and SYNTAX scoring. Despite high levels of traditional risk factors, the study found no significant correlation between testosterone levels and CAD severity, as indicated by both Pearson and Spearman correlation coefficients. Moreover, multiple linear regression analysis revealed that traditional risk factors and testosterone levels did not independently predict CAD severity. In conclusion, while traditional risk factors remain crucial in CAD management, this study highlights that testosterone levels do not independently correlate with CAD severity. These findings suggest that the role of testosterone in CAD pathophysiology is complex and warrants further investigation, particularly in the Indian population, to better understand its contribution

Background: Bronchiectasis is a chronic respiratory disorder characterized by irreversible bronchial dilatation, recurrent infections, and progressive lung damage. While cystic fibrosis-associated bronchiectasis has been extensively studied, non-cystic fibrosis bronchiectasis (NCFB) remains under-recognized. Etiological factors and clinical presentations vary geographically, necessitating region-specific studies. This study aims to assess the microbiological profile and radiological patterns in patients with bronchiectasis at a tertiary care center in North India Methods: A cross-sectional study was conducted at the Department of Pulmonary and Critical Care Medicine, King George's Medical University (KGMU), Lucknow, between May 2024 and November 2024. A total of 70 patients diagnosed with bronchiectasis were enrolled. Clinical evaluation, high-resolution computed tomography (HRCT) of the thorax, and microbiological assessment, including sputum and bronchoalveolar lavage (BAL) cultures, were performed. The antimicrobial susceptibility of isolated pathogens was analyzed. Statistical analysis was conducted using descriptive methods, with a significance level set at p < 0.05. Results: Among 70 patients, 55.7% were female, and the majority (51.2%) were aged 61–70 years. The most common symptoms included cough (73.2%), sputum production (70.7%), and dyspnea (60.9%). HRCT findings revealed a predominance of cystic (46.3%) and cylindrical (39%) patterns, with 65.9% of cases showing bilateral lung involvement. Microbiological analysis identified Pseudomonas aeruginosa (44.3%) as the most frequently isolated pathogen, followed by Klebsiella pneumoniae (27.1%). Patients with Pseudomonas aeruginosa exhibited more severe radiological involvement, including multilobar and cystic patterns. Conclusion: This study highlights the significant burden of bronchiectasis in elderly patients, with post-tuberculosis sequelae being a predominant etiological factor. Pseudomonas aeruginosa colonization is associated with more extensive radiological involvement, underscoring the need for targeted antimicrobial strategies. Comprehensive management approaches should address both underlying etiologies and associated comorbidities to improve patient outcomes.

Background: Acute Myocardial infarction (AMI) causes reduction in cardiac function and is one of major cause of death world-wide. The degree of myocardial damage following myocardial infarction is the key predictor of immediate as well as long term reduction in cardiac function and other complications. The serum CK- MB (Creatine Kinase-MB) levels are useful for assessing prognosis after AMI, the validity of the test goes down after 36 hours due to sudden fall in levels.Serum C-Reactive Protein (CRP), an acute phase protein, also increases during myocardial infarction in proportion to the degree of inflammation. The inflammatory process following myocardial infarction is a key role in determining the real damage to the myocardium following infarction. In this study, we made an attempt to find the correlation between serum CRP levels with CK-MB and left ventricular ejection fraction (LVEF) to assess if serum CRP levels could be used as a proxy to CK-MB levels for the prediction of inflammation and infarct extent, thereby having a reliable prognostication marker after 48 hours. Methods: 55 Patients diagnosed with acute myocardial infarction in a tertiary care centre were enrolled in the study. Serum CRP levels were measured and its correlation with Serum CK-MB levels and left ventricular ejection fraction were studied. Results: The Serum CRP levels were showing significant positive correlation with serum CK-MB levels and significant negative correlation with Left ventricular ejection fraction. Conclusions: The magnitude of elevation of CRP, the marker of inflammation in circulation correlates with the extent of myocardial injury following infarction showed significant positive correlation with CK-MB levels and a significant negative correlation with LVEF. So it could be used to predict the functional status of myocardium following acute MI. So the serum CRP can be used as an independent and more comprehensiveprognostic marker, like CK-MB and LVEF

Background: Chronic Obstructive Pulmonary Disease (COPD) is currently among the leading three causes of death globally, with 90% of these fatalities occurring in low- and middle-income countries (LMICs).1 In 2012, over 3 million individuals lost their lives due to COPD, which accounted for 6% of all deaths worldwide. OBJECTIVES:  To compare the duration of smoking in pack years first-day values of pH PaCO2 in predicting the need for mechanical ventilation in Acute Exacerbation of COPD. To compare S. Albumin, Glasgow coma scale, APACHE II score and Premorbid functional status to predict the need for mechanical ventilation in Acute Exacerbation of COPD. MATERIAL & METHODS:  Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Katuri Medical College and Hospital, Guntur.  Study Period:  June 2022 to May 2023. (1 year).  Sample size: The study consisted of 100 subjects. Study population: The present study was conducted on 100 cases, including males and females, from Pulmonology OPD, Katuri Medical College and Hospital, Guntur.  Sampling method: Simple random Sampling Technique.Results: Of the 100 COPD patients, 39 had a GCS < 13, of whom 29 eventually needed mechanical ventilation, whereas only 20 of 61 patients with GCS >13 eventually needed mechanical ventilation. The p-value of <0.03 obtained by our study indicates that GCS< 13 is an independent predictor of the need for mechanical ventilation in COPD patients. CONCLUSION: In conclusion, COPD predominantly affects males and individuals over 50, with smoking being the leading cause. Key predictors for mechanical ventilation in acute exacerbations include long smoking history, low arterial pH (<7.2), altered mental state (GCS <13), high APACHE II score (>15), low serum albumin (<3.5 g/dl), elevated PaCO2 (>60 mm Hg), and poor pre-existing functional status (Menzies Grade III/IV). These factors help identify high-risk patients early, enabling timely intervention.

Background: Drug utilization studies (DUS) are an important resource for stakeholders in drug and health policies. DUS is the marketing, distribution, prescription and use of certain drugs in the society concerned, and the resulting medical, social and economic consequences therefore it covers prescribing, dispensing, administration or intake of medicine and related events. DUS is mainly aimed at analyzing drug therapy problem and monitoring its consequences in drug utilization, attempting to improve drug therapy quality.Drug utilization research promotes rational drug use by encouraging prescribers the correct drug, dose, and affordable price, Assessing whether drugs are prescribed and used appropriately, providing feedback to doctors on prescription rationality, evaluating the effectiveness of interventions aimed at improving rational drug use. Objective: To evaluate the drug utilization study in outpatient department (OPD) patients at a tertiary care teaching hospital in North India. Methods: An observational, prospective study was conducted in the OPD of a tertiary care hospital. The Patients' demographic data and prescription details were recorded.Results: A total of 650 patients were included in the study. The findings revealed that 89% drugs were prescribed by brand name, while 11% were by generic name, Antibiotics were prescribed in 6.50% of cases, Injections were prescribed in 6.30% of cases, Polypharmacy was observed in 20.6% of patients.Conclusion: This study highlights the need for rational use of drugs in OPD patients. The findings of this study can inform policy design, education, and awareness programs to motivate physicians to use drugs rationally.

Background: Spinal anaesthesia is widely used for lower limb surgeries, but its effectiveness is limited by the relatively short duration of postoperative analgesia. Nalbuphine, a mixed κ-agonist and μ-antagonist opioid, has been explored as an adjuvant to prolong analgesia and enhance patient outcomes. This study evaluates the efficacy and safety of intrathecal nalbuphine as an adjuvant to bupivacaine in lower limb surgeries. Methods: A randomized, double-blind, prospective study was conducted on 60 patients (ASA I-IV) undergoing lower limb surgeries. Patients were assigned into two groups:Group BN (n=30): Received 0.5% hyperbaric bupivacaine + 2 mg nalbuphine.Group B (n=30): Received 0.5% hyperbaric bupivacaine + normal saline.The primary outcomes included sensory and motor block characteristics, duration of analgesia, and postoperative pain scores (VAS). Hemodynamic parameters and adverse effects were also monitored.Results: The onset of sensory and motor blockade was comparable between the groups (p > 0.05). However, the duration of sensory and motor block was significantly prolonged in Group BN (p < 0.05). Time to first rescue analgesia was significantly longer in Group BN (284.4 ± 31.33 min) compared to Group B (162.56 ± 8.12 min, p < 0.001). Postoperative VAS scores were lower in Group BN at all intervals (p < 0.001). Hemodynamic parameters were stable, with minimal adverse effects in both groups.Conclusion: Intrathecal nalbuphine (2 mg) as an adjuvant to bupivacaine significantly prolongs sensory and motor blockade, enhances postoperative analgesia, and maintains stable hemodynamics with minimal adverse effects. These findings support its use as a safe and effective adjunct in spinal anaesthesia for lower limb surgeries.

Introduction: Acute respiratory distress (ARD) remains a critical challenge in emergency settings, presenting with varied causes and influencing patient outcomes differently. This study evaluates the clinical characteristics, treatment approaches, and outcomes of patients with ARD in an emergency department (ED). Methods: We analyzed data from 240 adult patients (aged ≥18 years) who presented with symptoms of ARD—defined as acute shortness of breath, low blood oxygen levels, or respiratory failure—to a tertiary ED over one year. Information on patient demographics, existing health conditions, clinical signs, diagnostic tests, treatments, and outcomes (hospitalization, ICU admission, death) was collected from electronic health records. Statistical analysis involved descriptive statistics, chi-square tests, and logistic regression. Results: Patients (average age 62.4 ± 15.2 years; 55% male) frequently had comorbidities such as hypertension (48%), chronic obstructive pulmonary disease (32%), and heart failure (25%). The leading causes of ARD were pneumonia (28%), acute exacerbations of asthma/COPD (24%), and pulmonary edema (19%). A significant portion (64%) exhibited hypoxemia (SpO₂ <90%), and 38% needed non-invasive or mechanical ventilation. The hospitalization rate was 82%, with 26% requiring ICU care. The in-hospital mortality rate was 12%, with higher risks associated with older age (OR 1.05, 95% CI 1.01–1.09), septic shock (OR 3.2, 95% CI 1.4–7.1), and multiorgan failure (OR 4.8, 95% CI 2.1–11.0). Delays in ED intervention over two hours were linked to increased ICU admissions (p=0.03). Conclusion: ARD results from diverse etiologies and is significantly affected by patient age, comorbidities, and the timeliness of medical interventions. Prioritizing early identification and standardized treatment protocols may enhance patient survival and decrease the demand for intensive care services.

Introduction: Aortic Stenosis (AS) represents a major cardiovascular concern, especially in the aging population. Traditional assessment tools like Left Ventricular Ejection Fraction (LVEF) are often insufficient for early detection of subclinical left ventricular (LV) dysfunction, which is pivotal for timely intervention. Methods: This observational, cross-sectional study conducted at SMS Hospital, Jaipur, included 100 patients with AS who had preserved LVEF (≥50%). The study utilized Speckle Tracking Echocardiography to measure Global Longitudinal Strain (GLS), aiming to correlate GLS with the severity of AS and explore its utility as an early diagnostic tool. Patients were followed up for a period of 18 months, during which clinical and echocardiographic data were collected and analyzed. Results: The study found a significant correlation between reduced GLS and higher severity of AS. Patients with severely reduced GLS showed a greater prevalence of subclinical LV dysfunction, independent of LVEF. GLS was also inversely related to traditional echocardiographic markers like aortic valve area and mean gradient, suggesting its effectiveness in identifying early myocardial changes before noticeable LVEF decline. Conclusion: GLS serves as a reliable and sensitive indicator of subclinical LV dysfunction in AS patients with preserved LVEF, offering a significant improvement over traditional metrics like LVEF alone. The inclusion of GLS in routine evaluations could enable earlier detection of cardiac involvement, potentially guiding more timely therapeutic interventions.

Background: Scrub typhus, caused by Orientia tsutsugamushi, is a vector-borne disease that presents a wide array of clinical manifestations, ranging from mild symptoms to severe, life-threatening complications. It remains a significant public health challenge in endemic regions across the Asia-Pacific area. As the disease expands geographically, understanding the predictors of severe outcomes becomes increasingly critical. Aim: This study aims to identify the clinical parameters and biochemical markers predictive of severe scrub typhus in patients to improve early diagnosis and management. Methods: A retrospective study was conducted at VSS Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, involving 100 patients diagnosed with scrub typhus between January 1, 2024, and December 31, 2024. Data on demographic information, clinical symptoms, laboratory values, and treatment outcomes were extracted from medical records. Logistic regression analysis was employed to identify predictors of severe disease using SPSS version 23.0. Results: The study found that age over 50 years, low platelet count, elevated liver enzymes, and high serum creatinine were significant predictors of severe scrub typhus. The presence of eschar was associated with better outcomes, whereas the absence of rash or eschar correlated with increased severity. Approximately 30% of the patients developed severe complications, underscoring the potential lethality of the disease. Conclusion: Older age, specific laboratory abnormalities, and absence of characteristic skin manifestations such as rash and eschar are important predictors of severe scrub typhus. These findings can guide clinicians in prioritizing resources and interventions for high-risk patients. Recommendations: It is recommended that healthcare providers in endemic areas maintain a high index of suspicion for scrub typhus in patients presenting with fever and atypical symptoms, especially in the absence of rash or eschar. Further research should focus on developing rapid diagnostic tests and exploring new treatment modalities to manage antibiotic resistance.

Introduction: Evidence from preclinical studies indicates that expression of the ER beta demonstrates an inverse relationship with the presence of colorectal polyps and stage of tumors, and can mediate a protective response. Studies have shown that targeted activation of ER beta may represent a novel clinical approach for management of colorectal adenomatous polyps and prevention of colorectal carcinoma in patients at risk for this condition. The present study aims to estimate the proportion of negative ER-beta expression in colorectal carcinoma specimens received in the south Indian population Materials and methods: 50 colectomy specimens with histopathological proven diagnosis of colorectal carcinoma were included in the present study. . H&E sections were studied and tumor characteristics like histopathological type, invasion, differentiation, metastatic node were recorded. Formalin fixed paraffin embedded blocks of tumor were used for IHC staining using primary antibody – ERb. Data was collected using structured proforma and analysis done using appropriate statistical software (SPSS) Results: IHC of 64 cases had been done and were statistically analyzed. Majority of patients were in the age group of 50 to 75 years. Female sex predominated with 57.6% cases. Maximum cases were confined to rectum at 39%. 89% cases were adenocarcinomas among the histological subtypes, which had no significant association with loss of ERb expression Conclusion: The study concludes that most of the CRC case occurs in the age group of 50 to 75 years, with rectum being the most common site and female preponderance. Moderately differentiated adenocarcinoma being the commonest subtype among the cases included in the present study. 71.9% cases had loss or decreased expression of ERb in their tumor tissue when compared to adjacent normal tissue and 28.1% cases had no loss of expression. There is no significant loss of ERb expression with histological subtype, degree of differentiation and advancing stage

Background: Introduction: Airway procedures involving direct manipulation can trigger powerful reflexes that cause significant cardiovascular changes, particularly dangerous for patients with pre-existing cardiac, hypertensive, or neurological conditions due to the risk of myocardial ischemia, heart failure, or elevated intracranial pressure. For optimal patient outcomes, laryngoscopy should provide clear glottic visualization, enable precise endotracheal tube placement, minimize physical trauma, and reduce procedure duration - objectives that research shows are increasingly achievable through video laryngoscopy technology, which has demonstrated superior visualization and higher success rates compared to conventional methods. Aim And Objectives: To compare the total time taken for endotracheal intubation (in seconds) in adult patients and the hemodynamic stability during and after insertion of endotracheal tube in adult patient. Materials and Methods: After taking the institutional approval for the study, age 18-60 year, posted for elective surgeries undergoing general anaesthesia were equally divided into 2 groups, 30 patients each after taking written informed consent from patient in their own vernacular language. Group M (n=30) - Conventional Macintosh laryngoscope group. Group G(n=30) – McGrath MAC video laryngoscope group. Results: Patients in all two groups were comparable with Intubation criteria, mean pulse rate, SBP, DBP, mean ABP by using unpaired t-test. The mean difference was found statistically significant with P<0.05. No major complication were reported in patients of any of the group. Conclusion: This study it is concluded that Mcgrath MAC Video laryngoscope provides easier intubation and provide better hemodynamic as compared with Macintosh laryngoscope. And total duration of intubation is less with Mcgrath MAC Video laryngoscope than with Macintosh laryngoscope.

Background:  Suprascapular notch is situated at of superior border of scapula,seperating the root of corocoid process from superior border of scapula.The notch is bridged by the superior transverse scapular ligament(STSL)  converting the notch into the foramen, transmits suprascapular nerve to supraspinous fossa, whereas the suprascapular vessels pass backwards above the ligament. Aims: The detailed morphological study of suprascapular notch in dry human  scapulae.objectives i)to study the shape  of suprascapular  notch ii) Degrees of ossification of STSL.iii)to take different parameters of each suprascapular notch –Superior transverse diameter(STD), maximum vertical diameter(MVD), and mid transverse diameter(MTD).iv)classification of notch based on the various parameters ,comparison with other studies and clinical correlation. Materials And Methods: The present study was conducted in about 120 dried randomly selected human scapulae from the stock of bones in the department of anatomy, Karwar Institute of medical sciences. Detailed morphological study of suprasapular notch was studied under various parameters with the use of digital vernier calipers. Based on observations suprascapular notch were classified (type I to Type VI).Result: In our study it was found that type III (71.7%) of Rengachery classification was the most common occurring notch and type VI (5.8%) was the least. Type V (8.3%) occurrence was found to be more compared to other studies.Conclusion: The above study will be helpful to deal with suprascapular nerve entrapment (an anomalous STSL or as a narrowed notch or both).

Background: Sickle cell anemia (SCA) is a severe hereditary blood disorder marked by vaso-occlusive crises (VOCs), which lead to pain, acute chest syndrome, and other serious complications. These crises are often accompanied by a hypercoagulable state, evidenced by elevated D-dimer levels. Understanding the relationship between these biomarkers and clinical outcomes is critical for managing acute episodes. Aim: This study aims to investigate the correlation between chest X-ray findings and serum D-dimer levels in patients with SCA during VOCs, to better predict complications and guide treatment. Methods: We conducted a retrospective study of 100 patients with SCA admitted for VOCs at VSS Institute of Medical Sciences and Research, analyzing serum D-dimer levels and chest X-ray findings. Data were collected for patients admitted between January 1, 2024, and December 31, 2024. Statistical analysis was performed using SPSS version 23.0, focusing on correlations between D-dimer levels, chest X-ray findings, and hospital stay durations. Results: The study found that patients with abnormal chest X-rays exhibited significantly higher D-dimer levels compared to those with normal X-rays. There was a strong negative correlation between D-dimer levels and oxygen saturation (r = -0.42, p = 0.001). Patients with findings such as consolidation and pleural effusions had longer hospital stays and higher D-dimer levels, indicating more severe crises. Conclusion: Elevated D-dimer levels are correlated with severe chest X-ray findings in SCA patients during VOCs, correlating with worse clinical outcomes. Recommendations: Routine measurement of D-dimer levels in SCA patients presenting with VOCs can be beneficial in predicting the severity of pulmonary complications. Early intervention strategies based on these findings may help in reducing hospital stay lengths and improving patient outcomes.

Background: Retinal Vein Occlusion (RVO) is a prevalent cause of vision impairment in the elderly population. Emerging evidence suggests a potential link between vitamin D deficiency and the incidence of RVO. This study aims to compare serum vitamin D levels in RVO patients with those in age-matched control groups to elucidate this association and highlight the significance of vitamin D as a potential risk factor for RVO. Materials and Methods: This hospital-based case-control study was conducted at the Department of Ophthalmology, Government Medical College and Hospital, Bettiah, Bihar, India, with 50 RVO patients and 50 age-matched controls. Participants were recruited consecutively, and written informed consent was obtained. Comprehensive ophthalmologic evaluations, including fundus photography and OCT, confirmed RVO diagnoses. Medical histories and systemic evaluations, including blood pressure, blood glucose, lipid profiles, and serum vitamin D levels, were recorded. Vitamin D was measured using tandem mass spectrometry, and statistical analysis was performed using GraphPad software. Results: In this study, 50 RVO patients and 50 age-matched controls were analyzed. No significant differences in age and gender distribution were found between the groups. Superotemporal BRVO was the most common RVO type (48%), followed by CRVO (34%) and inferotemporal BRVO (18%). Notably, all RVO patients had suboptimal vitamin D levels compared to controls, with a significant association (p < 0.05). The mean vitamin D level in RVO patients was 21.08 ± 5.08 ng/mL, with no significant differences among subtypes. The study also found a higher prevalence of hypertension and dyslipidaemia among RVO cases compared to controls, indicating these as additional risk factors. Statistical analysis confirmed significant differences in the prevalence of both conditions between cases and controls. Furthermore, the findings suggest that vitamin D deficiency may play a crucial role in the pathogenesis of RVO, underscoring the importance of screening and managing vitamin D levels in at-risk populations. Conclusion: Our study confirmed that low vitamin D levels are prevalent in RVO cases compared to age-matched controls. This suggests vitamin D deficiency is a significant risk factor in RVO development. Routine investigation of vitamin D levels in RVO patients, alongside other risk factors, is recommended. Additionally, patients with vitamin D deficiency should undergo ophthalmological examinations and vitamin D supplementation should be given as prophylaxis in cases of deficiency.

Background: Total Hip Arthroplasty (THA) is extensively utilized to address hip joint failures from various etiologies. The geometric analysis of the proximal femur is pivotal in preoperative planning and prosthetic design. This study aims to highlight the morphometric differences in the proximal femur of the Indian population compared to other demographic groups. Methods: This prospective study analyzed 94 dry human cadaveric femur bones from the Indian population, using digital Vernier calipers, goniometers, and osteometric boards for measurements. Demographic and morphological data from patients undergoing THA were also incorporated. Results: Significant differences were noted in the Femoral Neck Width and Neck-Shaft Angle between the Indian population and other groups. These variations underline the need for demographic-specific prosthetic designs to ensure better clinical outcomes and prosthetic alignment. Conclusion: The study identifies critical morphometric variations in the Indian proximal femur, suggesting a significant impact on the surgical outcomes of THA. Customized prosthetic implants tailored to these unique dimensions could potentially reduce complications and enhance the efficacy of the surgeries.

Background and Aim: ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event requiring prompt reperfusion therapy. Streptokinase, an affordable thrombolytic agent, has been widely used in resource-limited settings. This study aims to evaluate the clinical outcomes of STEMI patients treated with streptokinase and correlate these outcomes with 2D echocardiographic (2D echo) findings. Material and Methods:  The present study comprises of 50 cases of ST elevation myocardial infarction (STEMI) which were admitted in ICCU department during the period between April 2022 to September 2022. Results: Maximum patients (48%) presented between 6 to 12 hours from the symptom onset. Serum CKMB levels were found to be significantly raised (>100 U/L) in 74% patients of MI at the time of admission. The study showed that 38(76%) patients had resolution of ST segment elevation by 50% after thrombolysis with streptokinase and 35(70%) patients had pain relief by more than 50% after thrombolysis with streptokinase. This indicates Successful Clinical Reperfusion in around 70% patients. 66% patients who presented within 12 hours of symptom onset had successful thrombolysis. This shows that earlier the presentation more chances of successful thrombolysis. 2D ECHO findings showed that all the patients had RWMA and 45 was (90%) patients had LV dysfunction which seen maximum with anterior wall MI. Mitral regurgitation was the most common valvular dysfunction being present in 36(72%) patients. Conclusion: Among STEMI patients, 66% who presented within 12 hours of symptom onset achieved successful clinical reperfusion (SCR) following thrombolysis with Streptokinase.

Background: Diabetes mellitus requires effective management to prevent complications, with insulin therapy playing a crucial role in maintaining glycemic control. Premixed insulin formulations such as Human Mixtard 30 and Human Mixtard 50 are commonly used to simplify dosing regimens while addressing both basal and prandial insulin needs. Aim: This study aims to compare the effectiveness of Human Mixtard 30 and Human Mixtard 50 in improving glycemic control among poorly controlled insulin-requiring diabetics. Methods: A retrospective observational study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research, Burla, from November 1, 2023, to October 31, 2024. The study included 100 diabetic patients who were on either Human Mixtard 30 or Human Mixtard 50. Data on HbA1c levels, insulin dosage, and adverse events were collected from medical records, analyzed using SPSS version 23.0. Results: Both insulin regimens significantly reduced HbA1c levels from baseline (9.2% ± 1.5%) to study end (Human Mixtard 30: 7.8% ± 1.2%, Human Mixtard 50: 7.5% ± 1.1%; p < 0.001). No significant differences were found between the two groups in terms of efficacy (p = 0.202) or safety (p = 0.739). Conclusion: Human Mixtard 30 and Human Mixtard 50 are equally effective in managing poorly controlled insulin-requiring diabetes, with comparable safety profiles. Recommendations: Further research is recommended to explore the long-term impacts of different premixed insulin regimens on patient outcomes and to assess patient preferences and satisfaction with each regimen.

The long-term cardiovascular effects of COVID-19 have emerged as a significant concern in post-pandemic healthcare. COVID-19 affects multiple organ systems, but its impact on cardiovascular health extends beyond acute infection. Several studies suggest that SARS-CoV-2 induces direct myocardial injury, persistent inflammation, and endothelial dysfunction, leading to long-term cardiovascular complications. This systematic review evaluates recent studies on the impact of COVID-19 on cardiovascular health, including complications such as myocarditis, arrhythmias, thromboembolic events, and long-term vascular dysfunction. Using PRISMA guidelines, 50 peer-reviewed studies published between 2020 and 2024 were analyzed to assess the pathophysiological mechanisms, risk factors, clinical manifestations, and potential treatment strategies associated with post-COVID-19 cardiovascular complications. Findings indicate that SARS-CoV-2 infection leads to endothelial dysfunction, persistent inflammation, and myocardial injury, increasing the risk of long-term cardiovascular diseases. The presence of chronic inflammation and immune dysregulation even after recovery further complicates the disease trajectory. Identifying high-risk populations and implementing targeted interventions are crucial to mitigating adverse outcomes. Future research should focus on longitudinal studies to establish standardized protocols for cardiovascular risk assessment and management in COVID-19 survivors, with emphasis on prevention and early intervention strategies

Background: Diabetes mellitus, characterized by chronic hyper glycemia due to defects in insulin secretion or action, is a global health concern with significant systemic and ocular implications. Among its lesser-known yet impactful complications is its association with elevated intraocular pressure (IOP), a key risk factor for glaucoma, a leading cause of irreversible blindness worldwide. Chronic hyper glycemia in diabetes has been linked to increased IOP, highlighting a close relationship between diabetes and glaucoma, which is characterized by optic nerve damage and visual field loss. In India, where diabetes prevalence is rapidly rising, with projections estimating 80 million cases by 2030, the need for early diagnosis and intervention to prevent vision loss is critical. This study aims to compare IOP in diabetic and non-diabetic individuals, exploring the impact of Type 2 Diabetes Mellitus on ocular health to inform better prevention and management strategies for diabetes-related vision complications. Materials and Methods: This hospital-based case-control study included 100 participants, 50 diabetics and 50 non-diabetics, aged 20-80 years. Participants were excluded if they had glaucoma, ocular infections, inflammation, surgery history, or medications affecting intraocular pressure (IOP). Type 2 Diabetes Mellitus was confirmed through blood tests according to the American Diabetes Association guidelines. Ocular examinations, including visual acuity, color vision, slit-lamp assessment, tonometry, and dilated fundus examination, were performed. IOP was measured with a non-contact tonometer. Results: We observed that diabetic patients had a higher mean intraocular pressure (IOP) compared to non-diabetic controls. The mean IOP was 17.57±1.67 mm Hg for diabetics and 14.17±1.40 mm Hg for non-diabetics, with a significant difference (p < 0.0001). Elevated IOP was associated with poor glycaemic control and higher HbA1c levels. The duration of diabetes also influenced IOP, with both early and long-term diabetes showing higher IOP levels. This suggests that diabetes contributes to elevated IOP, increasing the risk of ocular complications like glaucoma. Conclusion: The study concluded that intra-ocular pressure (IOP) was higher in diabetic patients compared to controls, with a significant positive correlation between IOP and HbA1c levels in patients with diabetic retinopathy. It recommends regular screening for both diabetic retinopathy and IOP to detect early signs of ocular hypertension or glaucomatous changes

Background: Organophosphorus (OP) poisoning is a significant global health concern, particularly in agricultural regions where these compounds are widely used. The variability in clinical presentations and the potential for severe outcomes necessitate improved biomarkers for early diagnosis and prognosis. Serum creatine phosphokinase (CPK) has emerged as a promising prognostic marker, given its association with muscle damage and systemic toxicity in OP poisoning. Aim: This study aims to evaluate the correlation between serum CPK levels and clinical severity in patients with OP poisoning to establish CPK as a reliable prognostic tool. Methods: A retrospective analysis was conducted on 160 patient records from the VSS Institute of Medical Sciences and Research (VIMSAR) who were treated for OP poisoning between January 1, 2024, and December 31, 2024. Serum CPK levels were measured and correlated with clinical outcomes. Data analysis was performed using logistic regression to adjust for potential confounders, with SPSS version 23.0. Results: Patients with severe clinical outcomes had significantly higher median CPK levels (650 U/L) compared to those with mild to moderate outcomes (150 U/L). Statistical analysis confirmed that higher CPK levels were associated with an increased likelihood of severe clinical outcomes (Odds Ratio: 2.5; 95% CI: 1.8-3.5, p < 0.01). Conclusion: The findings support the hypothesis that serum CPK levels are significantly associated with the severity of clinical outcomes in OP poisoning, underscoring the potential of CPK as an effective prognostic marker. Recommendations: It is recommended that healthcare providers consider incorporating serum CPK measurements into the routine assessment of patients with suspected OP poisoning to better predict clinical severity and tailor treatment approaches accordingly. Further prospective studies are needed to validate these findings and potentially implement them in clinical practice.

The advance of medical technologies that enable the development of new modalities of treatment, the use of new medical procedures or the spread of the existing ones is also associated with an increased number of complications. Therefore, it is essential to reduce the chances of problems from arising and when they do arise, manage them as effectively as possible. For instance, permanent catheters have come to be increasingly used in dialysis-requiring patients, which means that sooner or later the catheter may need to be removed for various reasons in more and more people. Surgical removal of catheters through fibrous tissue ingrowth creates a larger wound and increases the risk of infection, therefore transvenous extraction of dialysis catheters under fluoroscopic guidance should be considered as the first-line option. The important factors that will affect the outcome of the procedure include lead removal experience, availability of necessary medical equipment and trained medical personnel.

Background: Diabetes mellitus (DM) and thyroid disorders are among the most common endocrine diseases, with a well-documented association. Thyroid dysfunction, particularly hypothyroidism, can impact glycemic control and metabolic outcomes in diabetic patients. The prevalence of hypothyroidism varies across populations, with studies indicating a higher incidence in individuals with diabetes. This study aims to determine the prevalence of thyroid disorders in diabetic patients and assess their clinical and metabolic implications in a rural South Indian population. Methods: This hospital-based, cross-sectional study was conducted in the Department of General Medicine, Jhalawar Medical College, Jhalawar (Raj.), from September 2023 to August 2024. A total of 200 Type 2 diabetic patients were included. Clinical history, laboratory investigations including thyroid function tests (TSH, Free T3, Free T4), fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, and lipid profile were assessed. Patients were categorized as euthyroid or having thyroid dysfunction based on standard diagnostic criteria. Statistical analysis was performed using SPSS version 25.0, with a p-value <0.05 considered statistically significant. Results: Among 200 diabetic patients, 48 (32%) had thyroid disorders. Hypothyroidism was found in 16 patients (10.67%), while 24 (16.00%) had subclinical hypothyroidism. The prevalence of thyroid dysfunction was significantly higher in females (44%) compared to males (20%) (p = 0.0027). Elderly individuals had a higher prevalence of hypothyroidism (15.52%) than middle-aged adults (7.61%). Patients with thyroid dysfunction had significantly higher TSH levels (p < 0.0001) and increased total cholesterol, LDL, and triglyceride levels compared to euthyroid diabetic patients. Additionally, a longer duration of diabetes was significantly associated with thyroid dysfunction (p = 0.0055). Conclusion: This study highlights a high prevalence (32%) of thyroid dysfunction in diabetic patients, with a greater burden on elderly individuals and females. Hypothyroid diabetic patients exhibited higher BMI, lipid abnormalities, and prolonged diabetes duration, emphasizing the need for routine thyroid screening in diabetic patients to prevent metabolic complications

Background: Every year millions of patients suffer from venous thromboembolism and its sequelae. Due to significant morbidity and mortality associated with Venous Thromboembolism (VTE), prevention is critical. Deep Vein Thrombosis (DVT) is an unfortunate and potentially life-threatening condition causing fatal pulmonary thromboembolism (PTE). Objective: To determine the incidence of VTE in acutely ill medical patients admitted to a tertiary care hospital. The role of VTE prophylaxis, in the outcome of the acutely ill medical patient, admitted to the same hospital and to evaluate the safety profile of LMWH (Enoxaparin or Dalteparin) administered for a period of 07-14 days or more if clinically indicated. Study Design: This study was conducted at the tertiary care hospital during the period 1 Jun 2021 to 30 Jun 2022 and included 314 consecutive patients admitted with acute medical illness. These patients were given thromboprophylaxis for 7-14 days or more if indicated. Results: Out of 314 patients with acute medical illness who underwent thromboprophylaxis in our study, VTE occurred in 1.27 % of those and sub-group analysis revealed higher frequency VTE in patients suffering from Acute Infection (Sepsis) as compared to various other co-morbid medical conditions. The incidence of VTE in patients of acute medical illness in the other group of patients in whom thromboprophylaxis was not given was 3.5 % (p-value= 0.018). Conclusion: Thromboprophylaxis with LMWH (Enoxaparin or Dalteparin) for acutely ill medical illnesses was safe and effective and significantly reduced the occurrence of VTE in patients suffering from acute medical illness.

Introduction: Cardiac tumors are rare neoplasms classified as primary or secondary, with secondary tumors being more prevalent. Primary tumors are mostly benign, such as myxomas, while malignant forms like sarcomas are less common but have a poorer prognosis. Methods: This retrospective study analyzed 25 patients diagnosed with cardiac tumors who underwent surgical intervention at a tertiary care centre between 2014 and 2024. Data on patients, tumor types, diagnostic modalities, surgical procedures, and outcomes were collected and reviewed. Results: Among the 25 patients, 23 had atrial myxomas, 1 had left atrial (LA) with left ventricle (LV) myxoma and one had liposarcoma. The most common symptoms were dyspnoea and palpitations. Transthoracic and transoesophageal echocardiography were pivotal for diagnosis, while surgical excision was the primary treatment modality. Postoperative follow-up showed no recurrence in our study. Conclusion: Cardiac tumors present diagnostic and therapeutic challenges due to their rarity and varied clinical manifestations. Early detection and prompt surgical intervention are key to favourable outcomes, particularly for benign tumors. Malignant tumors require multimodal treatment approaches, with prognosis remaining guarded.

Background: Staphylococcus aureus  is a leading cause of skin and soft-tissue infections (SSI), with methicillin-resistant strains (MRSA) posing major risks, especially in healthcare settings. Methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolates are increasingly being implicated in nosocomial infections; hence, understanding the resistance of both MRSA and MRCoNS is critical for effective infection control measures. Mupirocin, widely used for MRSA decolonization, is less effective due to the increasing number of mupirocin-resistant MRSA (MuRMRSA) strains, driven by the mupA gene. This study aimed to determine the prevalence of high-level mupirocin resistance (MuH) in methicillin-resistant Staphylococcus aureus  (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolated from wound infections in a West Bengal hospital, to fill local data gaps and inform targeted infection control strategies Materials and Methods: In this cross-sectional hospital-based study, clinical samples, including pus, tissues, and wound swabs, submitted to the bacteriology laboratory of the Department of Microbiology of Burdwan Medical College over a nine-month period, were screened for the growth of Staphylococcus species. These were identified as Staphylococcus aureus  and coagulase-negative Staphylococcus species using standard microbiological procedures. All isolates were tested for methicillin resistance using Cefoxitin 30 μg disc. Moreover, all isolates were tested for mupirocin susceptibility using 200 μg discs to detect high-level mupirocin resistance according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI) Results: Staphylococcus species were isolated from 130 of the 653 specimens collected from wound infections. Of these, 90 (69.2%) were identified as Staphylococcus aureus, while the remaining 40 (30.8%) were classified as coagulase-negative Staphylococcus species. Among them, 33 (36.7%) were MRSA and 15(37.5%) were MRCoNS. High-level mupirocin resistance (MuH) was observed in 25.3% of 130 Staphylococcus isolates, and among MRSA and MRCoNS isolates, the MuH prevalence was 21.2% and 33.3%, respectively. Both groups showed 100% susceptibility to vancomycin, linezolid, and teicoplanin Conclusions: This study revealed significant high-level mupirocin resistance in MRSA and MRCoNS isolates, emphasizing the need for judicious use and robust antimicrobial stewardship. Routine surveillance, molecular studies, and the optimization of mupirocin policies are critical. Future research should explore alternative decolonization strategies to curb resistance and enhance infection control in tertiary-care settings.

Background:  Diabetes mellitus (DM) is a metabolic disorder associated with impairment of insulin secretion or its receptor and post receptor signal cascade malfunctioning.  Microangiopathy, a long term complication of DM,   interferes with blood supply to the cochlea   either by reducing transport through the thickened capillary walls, by the reduction of flow in vascular pathways, or because of secondary degeneration of 8th cranial nerve. Aims: To analyze relationship of type 2 DM with severity of sensorineural hearing impairment (SN). Method: This case-control, observational study was done in Biochemistry CNMC&H, after getting clearance from hospital ethical committee in 150 patients with sensorineural hearing disorder and 150 controls selected from ENT OPD. Fasting blood glucose, Post prandial blood glucose (PPBS) and insulin resistance (HOMA IR) was estimated. Result: In  our  present  study  there  is  no  difference  between  males  and  females  between  the   case  and control   groups.   Significant   alteration   of   FBG, PPBS   among   mild (Group I) & severe   (Group II) sensorinural deafness from normal control were observed using independent t test. Conclusion: From this study it can be hypothesized that FBG and HOMA IR were significantly higher in severe SN Deafness in comparison to control. Although the mean values of FBG and HOMA IR were higher in both groups from the control group, but it was not significant statistically in the mild group. We conclude that SN hearing loss is more prone at the advanced stages of DM..

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder which affects the joints and is associated with swelling, stiffness and pain. As RA causes functional limitations in the joints, this might affect the movements or the movement patterns of the damaged and inflamed joints. The prevalence of rheumatoid arthritis in India is about 1 to 1.5 %. The primary targets of inflammation are synovial membranes and articular structures but other organs also affected. Nerve conduction studies are most commonly used test, it is the main laboratory technique for the study of peripheral nerve function and it involve the surface stimulation of motor & sensory nerves. The result of these motor & sensory nerve conduction studies is expressed as amplitudes, latencies & conduction velocities. Aim and Objective: Nerve conduction Studies of Lower Limbs in Rheumatoid Arthritis Patients. Material and Methods: 50 Rheumatoid Arthritis patients and 50 controlled subjects were randomly selected. Patients from the Rheumatology OPD. Age group of the subject from 25 to 65 years and it includes both male & female. A complete NCS was done by using a NEURO – MEP – NET (NEUROSOFT) Machine according to standard protocol and settings. Nerves are tested on major affected side in all rheumatoid arthritis patients and unilaterally in control subjects. The electrodes used were of 3 types, i.e. active, reference and ground. Result: Comparison of the results of RA patient with healthy controls subject, both Motor and sensory nerve conduction studies in deep peroneal and sural nerve was prolonged latency, low amplitude and decreased conduction velocities. Conclusion: Abnormal electrophysiologi­cal findings existed more in rheumatoid arthritis patient than control group. This could be due to peripheral neuropathy in RA patients.

Acute myocardial infarction (AMI) in young patients is less common entity, but the incidence has increased over years past at younger ages, likely due to the presence of multiple risk factors. We present a of ST-elevation AMI (STEMI) in a young female. A 38-year-old female was transferred to our hospital due to severe chest pain. An electrocardiogram revealed ST elevation in lead V1, V2, V3, V4, V5, V6 with reciprocal depression in lead III and aVF. An emergency coronary angiogram was performed, revealing a 100% occlusion of mid left anterior descending (LAD) and we established a diagnosis of STEMI. Thrombo-suction was done and stented with third generation drug eluting stent. Afterwards, the patient was discharged the next day. In this case, a combination of atherosclerotic plaque rupture and stress from surgical trauma might lead to this atypical event.

The worldwide health issue of hypertension affects millions of people especially those within middle age. Hypertension of long duration affects various organs including the auditory pathway. ABR testing represents an effective technique to assess how hypertension affects brainstem auditory processing. This study investigated the relation between hypertension levels with Auditory Brainstem Response parameters for male adults with hypertension between 40 and 60 years of age. Materials and Methods A case-control cross-sectional study was conducted at Lady Hardinge Medical College, New Delhi including two groups of participants with thirty male patients diagnosed with hypertension (HT) who were aged between 40–60 years as well as thirty age and sex matched normotensive participants (NT). Blood pressure measurement and ABR testing was done using standard procedures. Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), absolute wave latencies of waves I, III, and V, wave morphology as well as interpeak latencies between waves I-III, III-V, and I-V were evaluated. For comparing groups between one another and observing associations, unpaired Student’s t-test and Pearson’s correlation were used. Results Participants who maintained normal blood pressure (NT) averaged 48.83±6.44 years in age whereas those with high blood pressure (HT) measured 51.73±6.11 years. The measurement of wave I, III, V absolute latencies as well as IPL values I-III, III-V, I-V between hypertensive and normotensive groups revealed no significant statistical variance (p>0.05). The comparison between controlled and uncontrolled hypertensive patients yielded no statistically significant results (p>0.05). Systolic along with diastolic blood pressure failed to demonstrate a statistical relationship with ABR parameters through regression analysis. Mean wave amplitude measurements from wave I and V yielded similar results for both normotensive and hypertensive groups and also for patients with controlled and uncontrolled hypertensive conditions. Conclusion The research results revealed that hypertension level failed to produce any significant change to auditory brainstem response parameters in male subjects within the age bracket of 40–60 years. The research shows hypertension within the studied range does not produce noticeable changes in auditory brainstem response measures. More extensive longitudinal studies incorporating larger subject populations as well as patients with diverse range of hypertension should be conducted for systematic assessment of potential associations.

Background: India has reported a recent surge in Mucormycosis cases. Mucormycosis is a rare, life-threatening fungal infection having an increased incidence during this COVID-19 pandemic, especially in the second wave in India. Number of rhino-orbito-cerebral mucormycosis cases Post COVID-19 infection increased in Ahmednagar.  Aims and Objectives: To study the early contact of mucormycosis infection after covid positive test. To study the relation of D-Dimer, C-Reactive protein, Sr. Ferritin, blood group and HbA1c to mucormycosis infection. To study the incidence of death rate in mucormycosis patient. Materials and Methods: This retrospective clinical analysis includes data collection of 30 patients from tertiary care hospital located in Ahmednagar district of Maharashtra, India from 1st May, 2021 to 31st August, 2021. All these were post COVID-19 patients presented after varying number of days postinfection and had undergone indoor treatment at various hospitals. Results: We had majority of the patients with blood group O+ 13 cases (43.33%), followed by A+ 9 cases (30%) and B+ 6 cases (20%). KOH mount showed Zygomycetes fungus in all specimens. Debridement was done in 22 patients (73.33%). There were 10 deaths in our study participants (33.33%). We observed a significant difference in Serum ferritin levels (p = 0.048) and HbA1c levels (p = 0.017) in patients who had died of Mucormycosis as compared to those who survived. Conclusion: Close correlation was observed between rhino-orbito-cerebral mucormycosis, diabetes mellitus and Serum Ferritin level in COVID-19 positive patients. Possible follow up and larger sample size will be needed to justify these results more.

Background: Mupirocin (pseudomonic acid A)  is widely used to treat skin infections and eradicate nasal carriage of Methicillin-resistant Staphylococcus aureus  (MRSA). Its mechanism of action involves binding to leucine-specific tRNA aminoacyl synthetase, thereby inhibiting protein synthesis. However, prolonged and widespread use of mupirocin, particularly for decolonizing healthcare personnel and treating bedsores and skin lesions, has led to the emergence of resistance. This study aimed to determine the prevalence of high-level mupirocin resistance among clinical isolates of Staphylococcus species obtained from skin infections, and to explore the relationship between Mupirocin and Methicillin resistance. Materials and Methods: In this cross sectional hospital based study, clinical samples, including pus, tissues and wound swabs, submitted to the bacteriology laboratory of department of Microbiology of Burdwan Medical College, over a nine-month period, were screened for the growth of Staphylococcus species. These were identified as Staphylococcus aureus  using standard microbiological procedures. All isolates were tested for MRSA using cefoxitin 30 μg discs and confirmed by an automated system measuring the Minimum Inhibitory Concentration (MIC). Moreover, all of these isolates were tested for mupirocin susceptibility using 200 μg disc to detect high-level mupirocin resistance according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Results: Of the 653 samples, 130 yielded Staphylococcus species, of which 90 were identified as Staphylococcus aureus. Of these, 33 (37%) were MRSA. High level mupirocin resistance was detected in 21 Staphylococcus aureus  isolates (23.3%),and among all MRSA and MSSA isolates, 7 (21.2%) and 14 (24.6%)  isolates, respectively, showed high level mupirocin resistance. Conclusions: Overall, our results showed a significant increase in the prevalence of high-level mupirocin resistance in clinical S. aureus isolates.

Background: Improved neural connections with age reduce the risk of common neurodegenerative disorders like Alzheimer’s ⁽¹⁾. Neurological disorders make the patient dependent on others to perform even their day-to-day routine activities. It also creates tremendous work responsibility for caretakers of such people.  Hence it was of utmost importance to study the various factors (e.g., meditation, physical exercise, and playing a musical instrument) that can reduce or slow down cognitive decline in humans suffering from neurological conditions ^(2).  Music constitutes an integral part of the Indian culture and very few studies have been done on the Indian population about the neurocognitive benefits of music. This study intended to establish a relationship between the two and see if there is any improvement in memory and executive functioning in instrumental musicians. Material and Methods: Study participants meeting specific inclusion and exclusion criteria, were selected and divided into two groups, a study group (instrumental musicians) and a control group (non-musicians). The participants underwent tests for assessment of memory (MMSE) and executive functioning (TMT A and B). They were graded based on accuracy and time taken to complete the tests.  Results: Musicians exhibited higher scores on the MMSE compared to non-musicians. In contrast, non-musicians demonstrated longer completion times for both TMT A and TMT B in comparison to musicians. The Mann-Whitney U test was conducted to assess significant differences in the scores for MMSE, TMT A, and TMT B between musicians and non-musicians. The analysis revealed a significant difference in MMSE (p< 0.001),TMT A (p <0.001), and TMT B (p = 0.007) between musicians and non-musicians. Conclusion: Playing a musical instrument significantly improves the neuro-cognitive abilities of adult individuals helping them to have an improved memory and better executive functioning, thereby allowing them to have a better quality of life.

Introduction: Its widely known that sensory blockade of the brachial plexus with local anaesthetics for perioperative analgesia leads to stable haemodynamics intraoperatively, smoother emergence from general anaesthesia and decreased need for supplemental analgesics or suppositories in the Post-operative period. The current study aimed at determining the efficacy of dexamethasone as an adjuvant to bupivacaine for Post-operative analgesia following sensory blockade of the brachial plexus in children. Materials and Methods: The study was divided into two groups of 30 each, group BD receiving dexamethasone (0.1mg/kg) as an adjunct to bupivacaine 0.125% and group B receiving bupivacaine alone. The duration of analgesia was taken as time from completion of the block to the patient receiving rescue analgesia, the haemodynamics were measured until 180 minutes after surgery, the incidence of Post-operative Nausea and Vomiting (PONV) was measured. Results: The duration of analgesia in the group BD was 26.1±12.4 hours and was significantly higher as compared to the group B, in which it was 12.9±10.3 hours (p<0.05). The pulse rate measured Post-operatively between both groups at 20 minutes (p-value 0.534), 60 minutes (p-value 0.788), 120 minutes (p-value 0.804) and 180 minutes (p-value 0.428) showed no statistical significance. Likewise, the mean blood pressure measured between the two groups at 20 minutes, 60 minutes, 120 minutes and 180 minutes Post-operatively showed no significance. There was no significant difference in incidence of PONV in both groups with p-value of 0.524. Conclusion: Dexamethasone as an adjuvant to local anaesthetic in brachial plexus blocks significantly, prolongs duration of analgesia in children undergoing upper limb surgeries.

This article explores the interrelationship between Generalized Anxiety Disorder (GAD), Panic Disorder ( PS ) and Major Depression (MD), with emphasis on neurobiological mechanisms , genetic predispositions , environmental influences and therapeutic approaches . Through a review of the literature, the neurobiological pathways that lead from GAD to panic and depression , the morphological consequences in the brain , and the importance of early therapeutic intervention are discussed . Furthermore , it addresses how brain dysfunction can impair decision-making , leading to inertia and refusal to seek professional help, exacerbating anatomical and functional changes . Specific pharmacological and psychotherapeutic treatments are presented for each stage of the disorders, highlighting the need for personalized and continuous treatment.

Aim and Objective: To compare the Glottic view using Cormack Lehane grading in Sniffing Position (by Fixed Pillow) and Modified Ramped Position (by Customized Pillow) and to compare the number of attempts taken for endotracheal intubation in both groups Methodology: A cross-sectional study was conducted in the Department of Anaesthesiology at Government Medical College, Idukki, over six months to evaluate the effect of head and neck positioning on ease of intubation. The study included two groups: Group A (sniffing position: by Fixed Pillow) and Group B (Modified Ramped Position: by Customized Pillow), comprising ASA class 1, 2, and 3 patients aged above 18 years undergoing elective surgery under general anesthesia. Exclusion criteria included pregnancy, BMI >35, unstable cervical spine, or contraindications to conventional laryngoscopy or study drugs. Sample size was calculated 36 patients per group. Ethical approvals were obtained, and informed consent was secured. Result: The study included 72 participants (mean age: 41.08 ± 13.00 years), with 55.6% females and 44.4% males. BMI distribution showed 52.8% normal weight, 31.9% overweight, 6.9% obese, and 8.3% underweight, with a mean BMI of 24.20 ± 4.00 kg/m². ASA Class 1 comprised 73.6% of participants, followed by Class 2 (25.0%) and Class 3 (1.4%). Participants were evenly divided between Group A (sniffing position) and Group B (Modified Ramped Position). The Cormack-Lehane (CL) grade distribution was significantly better in Group B (p = 0.012), with higher proportions of Grade 1 and 2A, indicating superior airway visualization. Group B also required significantly less airway assistance (p = 0.032), with fewer cases needing bougie or BURP maneuvers and a higher proportion of successful intubations without assistance. Conclusion: Overall, the Customised Pillow (CP) group showed better airway visualisation, easier intubation, and required less assistance compared to the Fixed Pillow (FP) group. Significant differences were observed in MMPC scores, CL grades, and the use of assistance tools, with CP consistently showing superior outcomes. These findings confirm that Customised Pillow positioning provides a clinical advantage in airway management.

Background: The use of non-steroidal anti-inflammatory drugs (NSAIDs) has shown promising results in reducing the incidence of posterior capsule opacification (PCO) in animal models following cataract surgery. NSAIDs are believed to inhibit the proliferation, migration, and metaplasia of residual lens epithelial cells (LECs), which are key contributors to PCO formation. Building on these preclinical findings, this study aimed to evaluate the efficacy of a combined postoperative regimen of topical dexamethasone 0.1% and ketorolac tromethamine 0.5% eye drops versus dexamethasone 0.1% alone in preventing PCO in human patients undergoing cataract surgery with foldable “in the bag” posterior chamber intraocular lens (PC-IOL) implantation. By comparing these two treatment approaches, the study sought to determine whether the addition of ketorolac, an NSAID, to the standard corticosteroid regimen could provide a significant reduction in PCO rates, thereby improving long-term visual outcomes and reducing the need for Nd:YAG laser capsulotomy. Materials and Methods: This prospective, observational study was conducted over two years. A total of 100 patients undergoing elective cataract surgery with posterior chamber intraocular lens (PC-IOL) implantation were enrolled. Patients were divided into two groups: Group 1 received topical dexamethasone 0.1% and ketorolac 0.5%, while Group 2 (control) received only dexamethasone 0.1%. The incidence and severity of posterior capsule opacification (PCO) were assessed at regular follow-ups, and statistical analysis was performed using GraphPad 8.4.3, with P < 0.05 considered significant. Results: Both groups underwent identical surgical procedures, with no significant differences in demographic characteristics (p > 0.05). Group 1 (dexamethasone + ketorolac) had a mean age of 61.85 ± 2.76 years, while Group 2 (dexamethasone alone) had 58.97 ± 3.34 years. The incidence of posterior capsule opacification (PCO) requiring Nd:YAG capsulotomy was slightly lower in Group 1 (4%) than in Group 2 (6%), but this difference was not statistically significant (p > 0.05). The mean time to capsulotomy was also comparable between the groups (23.56 ± 1.45 vs. 24.18 ± 2.76 months, p > 0.05), indicating that ketorolac did not significantly reduce PCO incidence or delay capsulotomy. Conclusion: This study found that adding ketorolac to dexamethasone did not significantly reduce posterior capsule opacification (PCO) incidence or delay the need for Nd:YAG capsulotomy compared to dexamethasone alone, suggesting dexamethasone remains effective for postoperative management without additional benefit from ketorolac. Further research with longer treatment durations, extended follow-up, and advanced imaging techniques is needed to explore NSAIDs' potential in PCO prevention.

Background: Infertility is a multifactorial condition impacting women of reproductive age, often associated with psychological, socioeconomic, and comorbid health factors. Obesity has emerged as a key contributor to infertility, exacerbating its impact on quality of life.To investigate the association between obesity and infertility and assess the psychological and comorbid disturbances affecting the quality of life of infertile women. Methods: A qualitative content analysis study was conducted from October 2023 to March 2024 at the obstetrics and gynecology outpatient department of KIMS Amalapuram. Data were collected from 40 infertile women through in-depth interviews, using a semi-structured questionnaire. Demographic details, type of infertility, BMI, comorbidities, and psychological outcomes were recorded and analyzed. Results: Secondary infertility was more common (especially among women aged 31-35 years), while primary infertility was predominant among women with higher socioeconomic and educational backgrounds. Comorbidities such as PCOS (60%) and hypothyroidism (50%) were prevalent among women with primary infertility, while diabetes (35%) and hypertension (25%) were common in secondary infertility cases. Psychological disturbances, including depression (55%) and sexual dysfunction (50%), were highly prevalent among obese women with infertility. Central obesity affected 65% of women with secondary infertility and was linked to a higher prevalence of previous abortions. Conclusion: Obesity, particularly central obesity, significantly impacts infertility, comorbidities, and psychological well-being. Multidisciplinary interventions targeting weight loss, psychological support, and comorbidity management are critical to improving reproductive outcomes

Interstitial Lung Disease (ILD) refers to a heterogeneous group of more than one hundred distinct lung disorders that are grouped together because they share similar clinical, radiographic, and pathologic features. Diagnosing ILDs in India has proven to be a challenge as it is confounded by environmental and cultural factors in the midst of infections, especially Tuberculosis. The country has a lack of resources, standardized health care and guidelines for approach to ILD While approaching a patient suspected to have ILD one should use a combination of a detailed history, clinical examination, radiographic findings, pathological features and serological tests. Method: A descriptive study designed to evaluate 50 suspected ILD with multidisciplinary approach including clinical, radiological, serological and histopathological approaches. Results: We evaluated 50 patients (mean age 48.02 years; 54.0% females) of Interstitial Lung Diseases (ILD) with multidisciplinary approach. Connective tissue disease related ILD (26.0%) was the most common type of ILD, followed by Hypersensitivity pneumonitis (20.0%) and Idiopathic pulmonary fibrosis (18.0%). Sarcoidosis was diagnosed in a lesser proportion of patients (4.0%) as compared to other studies. Conclusions. TBLB appears to be an important diagnostic tool for the diagnosis of DPLDs. The use of a pattern-based approach to TBLB adds to its diagnostic yield and can be helpful in cases where open lung biopsy is not available.

Background: Burden of   breast   cancer   is increasing with change in lifestyle, so are the treatment modalities changing. Immunohistochemistry positivity can help in planning the management of cancers, similarly GATA3 labelling. Its role in breast cancers is less explored. Hence the study was planned. Objectives: This study aimed to know the GATA3 expression in invasive breast carcinoma and its correlation with modified bloom Richardson grading. Methods: A cross-sectional study was conducted for one year in a tertiary care government hospital in a south Indian city. All invasive breast cancers during the study setting was included in the study. Timeframe sampling was adopted; and Histopathological typing, grading and immunohistochemistry of the tumor was done. Immunostaining was also graded as per the strength of positivity. Results: One-third patients belong to the age group of 51-60 years. Also, one-third of the invasive breast cancers were of ductal type. Almost half the patients were of grade 2. 90% cancers expressed GATA3, of which 50% expressed strong positivity and 32.5% expressed moderate positivity.  Conclusions: Grade of breast cancer was significantly associated with GATA3 expression. Higher the grade of breast cancer, weaker was the GATA3 expression. GATA-3 is expressed by most invasive breast cancers and are strongly associated with histological grade 1 followed by grade 2.

Introduction: Urinary bladder cancer (UBC) is the ninth most common cancer of all cancer cases in men, with the male:female ratio of 8.6:1. Detection of grade as well as muscle invasion is of great consequence as it highly influences the management and overall prognosis. Hence, histopathology plays a crucial part in directing the therapy and gauging the prognosis in patients with urothelial cell tumors.  Objectives: To study the expression of GATA 3 in urothelial cell tumors and its correlation in histologic variants of urothelial cell tumors. Material and Methods: To study the expression of GATA 3 in urothelial cell tumors and its correlation  in histologic variants of urothelial cell tumors. Results: Most urothelial cancer patients, i.e., 37.5%, belonged to the age group of 61–70 years. The most common predominant symptom was hematuria (seen in 31 patients, i.e., 77.5%), followed by dysuria (seen in 6 patients, i.e., 15%), and urgency (seen in 3 patients, i.e., 7.5%). The most common site for urothelial cancers, as per the present study, was lateral wall, which grew cancers in 26 patients (65%). High-grade cancers were observed in 18% of patients, and invasive cancers were reported in 30% of patients. The most common pathological feature was nuclear pleomorphism. The proportion of tumors with an invasive nature gradually decreased as the IHC grade increased. Conclusion: Expression of GATA3 has a strong correlation with the pathological grading of urothelial cancers and hence may be used in diagnosis, assessment of severity and prediction of prognosis.

Background: Diabetes mellitus (DM) is a prevalent metabolic disorder that affects approximately 2-5% of the population in India and around 20% of the population in other parts of the world. The global incidence of diabetes mellitus is on the rise, with projections indicating a staggering increase to 366 million by 2030. Among the myriad complications that individuals with diabetes may face, those involving the foot are particularly devastating. It is estimated that 15% of all individuals with diabetes will develop a foot ulcer at some point in their lives. Neuropathy and foot ulcers are among the most significant complications associated with diabetes mellitus. Research indicates that the severity of diabetic foot ulcers is the primary risk factor for amputation in diabetic patients. These findings underscore the critical importance of early detection and management of foot ulcers in individuals with diabetes. By addressing these complications promptly and effectively, healthcare providers can help mitigate the risk of amputation and improve the overall quality of life for patients with diabetes. Materials and Methods: This prospective observational study was conducted in the Surgery Department of Basaweshwar Teaching and General Hospital (BTGH), affiliated with Mahadevappa Rampure Medical College, Kalaburagi. A total of 100 cases were included over a nine-month data collection period from March 2024 to December 2024. The inclusion criteria comprised all patients with diabetes mellitus presenting with diabetic foot-related ulcers, while patients with ulcers and foot gangrene of non-diabetic etiology or those unwilling to participate were excluded. After obtaining informed consent, detailed patient histories were recorded, and complaints were documented chronologically. Routine investigations, including complete blood count, liver and renal function tests, chest X-ray, ECG, random and fasting blood sugar levels, postprandial blood sugar, lipid profile, and lower limb arterial Doppler ultrasonography, were performed. Relevant special investigations were also conducted. Patients underwent conservative management with meticulous dressing, and major surgical interventions were carried out as required, with outcomes meticulously recorded. Results: The average age of participants in the study was 57.62 years, ranging from 29 to 87 years old. The majority of participants fell within the 60-69 age group, accounting for 37.5% of the total. In terms of gender distribution, 74% of participants were male, while females made up the remaining 26%. A significant portion of patients, 70%, had a history of diabetic foot ulcers, while the remaining 30% did not. Peripheral vascular disease (PVD) was present in 42.5% of patients, highlighting its prevalence in cases of diabetic foot ulcers. The primary cause of diabetic foot ulcers was swelling leading to skin breakdown, accounting for 32% of cases. Unknown causes and other factors contributed to 16% and 29% of cases, respectively. Gangrene emerged as a highly significant predictor of amputation, with 84.61% of amputees exhibiting gangrene compared to only 8.10% of non-amputees (p=0.0001). This underscores the importance of early detection and intervention in cases of diabetic foot ulcers to prevent severe complications such as amputation. Conclusions: Gangrene and PVD are the most critical predictors of amputation in diabetic foot patients.Early diagnosis and targeted management of these conditions are essential to reduce amputation rates.Other factors, including gender, hypertension, neuropathy, and nephropathy, showed no significant impact on amputation risk in this study.

Abstract: Introduction: Blood transfusion, a critical component of healthcare, faces challenges in ensuring judicious use to balance safety, availability, and appropriateness. Given the risks associated with transfusion-transmissible infections and the scarcity of blood, guidelines for its judicious use are paramount. This study evaluates the implementation of such guidelines in a teaching hospital, focusing on the rationale behind blood transfusion practices. Materials and Methods: A descriptive, observational, retrospective study was conducted on 755 whole blood units transfused in 2010 at a teaching hospital without a blood component separation facility. The study assessed the appropriateness of blood use across various departments, employing criteria based on acute blood loss, exchange transfusion cases, and the calculated percentage of blood loss versus patient vitals. Inclusion criteria encompassed all whole blood units transfused within the hospital, covering a wide demographic. Results: Of the 755 units analyzed, 45.56% were deemed appropriate, 47.94% inappropriate, and 6.49% indeterminate. The highest appropriateness was observed in Pediatrics (83.01%), and the lowest in Medicine (17.24%). The study revealed a significant proportion of transfusions (53.68%) consisted of single units, discouraged by WHO guidelines. The audit identified a need for improved documentation and adherence to transfusion guidelines. Conclusion: The study highlights a substantial gap between guidelines and practice in blood transfusion, with almost half of the transfusions categorized as inappropriate. It underscores the urgent need for rigorous implementation of guidelines, education on alternative transfusion strategies, and regular audits to enhance the appropriateness of blood transfusion practices.

Introduction: Pain relief in the postoperative period is to be considered a basic human right. Pain is the commonest reason for admission to the emergency department. Acute pain following surgery constitutes a major distress experienced by the patient. It is thought that pain is inadequately treated in half of all surgical procedures.1 Surgical trauma induces sensitization of both central and peripheral nociceptors and hyperalgesia.2 Inadequately treated acute postoperative pain has many negative consequences on patients both physiological and psychological life.  Materials and Method: All patients posted for elective laparoscopic cholecystectomy who fulfilled the inclusion criteria were taken for the study. Allocation of groups: 100 patients of either sex were randomly allocated into two study groups- Group I and Group II (50 in each group). Group I: Patients received 150 mg pregabalin capsule orally with sips of water 2 hrs before surgery. Group II: Patients received 15 mg/kg paracetamol tablet orally with sips of water 2 hrs before surgery. Results: The present study was a hospital based observational study comparing the effect of oral pre-emptive pregabalin and paracetamol on acute postoperative pain relief in patients undergoing laparoscopic cholecystectomy. In the present comparative study 100 patients of ASA grade I and II of either sex and age between 18-60 years were selected after obtaining written and informed consent and were divided into 2 groups. Group I received 150 mg pregabalin capsule and Group II received 15 mg/kg paracetamol tablet orally with sips of water 2 hrs before surgery. The parameters which were compared between the two groups included age, sex, weight, ASA status, duration of surgery, visual analogue scale, ramsay sedation score, hemodynamic variables, any adverse effects and time for the requirement of first rescue analgesic dose. The result and observation of all these different parameters are shown in the following tables and graphs. Conclusion: Based on the present comparative study, it has been observed that a pre-emptive oral dose of pregabalin 150 mg is an effective analgesic for the control of acute postoperative pain in patients undergoing laparoscopic cholecystectomy compared to oral paracetamol 15mg/kg in the early postoperative period.

Background: The mandible, along with the skull, forms the facial skeleton. The mandible is one of the strongest bones of the body, and it is formed by membrano-cartilaginous ossification. The mandible consists of two halves. Each half of the mandible has parts like a body and the ramus. The ramus of the mandible consists of two processes, namely the coronoid and the condylar processes. The coronoid process is anterior and gives attachment to the temporalis muscle. Morphological and morphometric variations of the coronoid process are common in relation to race, age, gender, and dietary habits. The coronoid process is commonly used as an autograft material in various reconstructive surgeries. Knowledge of the morphometric features of the coronoid process, like size and shape, is very important for various branches of medicine, like plastic surgery, oro-maxillofacial surgery, radiology, etc. Aim: To study the variations in shape of the coronoid processes in human adult dry mandibles. Methods: This study was conducted in the coronoid processes of 100 dry mandibles in the East Godavari district population. Out of 100 dry mandibles, 68 belong to males and 32 belong to females. Various shapes of the coronoid process and their morphometric measurements were observed and recorded. Results: Triangular shape is more predominant (55%), followed by hook shape (29%) and round in shape (16%). The incidence of triangular shape is more common in both males and females. Conclusion: The shape of the coronoid process is influenced by many factors like gender, race, chewing habits, and pull of the temporalis muscle, etc. Among the various shapes of coronoid processes, the triangle shape was predominant in both males and females in the East Godavari population.

Introduction: Type 2 diabetes mellitus (T2DM) is associated with significant cardiovascular complications, often progressing silently before clinical manifestations appear. Subclinical cardiac dysfunction can be detected early using echocardiographic parameters. This study aimed to evaluate the correlation between metabolic risk factors including BMI, lipid profile, and glycemic control—and subclinical cardiac changes in asymptomatic T2DM patients. Material and Methods: A cross-sectional study was conducted at the Department of Medicine, Mamata Academy of Medical Sciences, Hyderabad, enrolling 300 asymptomatic T2DM patients. Clinical and metabolic parameters, including BMI, HbA1c, fasting blood sugar (FBS), lipid profile, and renal function tests, were recorded. 2D echocardiography was performed to assess left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), E/A ratio, and global longitudinal strain (GLS). Correlations between metabolic risk factors and echocardiographic parameters were analyzed using Pearson’s correlation coefficient and multiple regression models. Results: The mean HbA1c level was 8.2 ± 1.0%, and the mean BMI was 28.5 ± 3.4 kg/m². Significant correlations were observed between HbA1c and E/A ratio (r = -0.88, p < 0.001), indicating that poor glycemic control is associated with diastolic dysfunction. Total cholesterol showed a strong correlation with LVMI (r = 0.60, p < 0.001), suggesting that dyslipidemia contributes to left ventricular remodeling. LVEF was mildly reduced (55.0 ± 4.4%), and GLS values (-17.8 ± 1.9%) confirmed early myocardial strain impairment. Conclusion: Metabolic risk factors, particularly poor glycemic control and dyslipidemia, are significantly associated with subclinical cardiac dysfunction in asymptomatic T2DM patients. The strongest correlation was observed between HbA1c and diastolic dysfunction (E/A ratio), emphasizing the need for strict glycemic control to prevent early cardiac impairment. The study highlights the importance of early cardiovascular screening using echocardiographic markers, even in the absence of symptoms, to mitigate the progression of diabetic cardiomyopathy.

Introduction: Pulmonary hypertension (PH) is a common and serious complication of chronic obstructive pulmonary disease (COPD), contributing to increased morbidity and mortality. Identifying the prevalence and associated risk factors of PH in COPD patients is crucial for early detection and management. Objectives: To estimate the prevalence of PH in patients with COPD and identify significant risk factors contributing to its development. Methods: This cross-sectional observational study included 200 COPD patients meeting the GOLD criteria. Clinical data, spirometry results, and echocardiographic measurements were collected to assess the presence of PH (defined as RVSP > 25 mmHg). Multivariate logistic regression was performed to identify independent risk factors for PH. Results: The prevalence of PH in the study population was X% (exact value derived from analysis). Key risk factors associated with PH included advanced GOLD stage, severe airflow limitation (FEV1 < 50%), prolonged smoking history (>20 pack-years), chronic hypoxemia (SpO2 < 90%), and elevated BMI (>30 kg/m²). Patients with PH had significantly worse clinical outcomes and quality-of-life scores compared to those without PH. Conclusions: PH is prevalent in COPD patients, particularly in those with advanced disease and specific risk profiles. Early identification of at-risk patients through regular echocardiographic screening and risk stratification could improve clinical outcomes and guide targeted therapeutic interventions

Background: Therapeutic Plasma Exchange (TPE) is a life-saving procedure used to treat various autoimmune, hematological, and neurological disorders. While effective, TPE is associated with a range of complications that can affect patient safety and treatment outcomes, especially in tertiary care settings managing critically ill patients. Objective: This study aimed to analyze the types, frequencies, severities, and timing of complications associated with TPE in a tertiary care hospital in Central India. Methods: A cross-sectional observational study was conducted at MGM Medical College and M.Y. Hospitals, Indore, from December 2020 to December 2024. Data were collected from 400 TPE sessions involving 160 patients. Complications were categorized as mild, moderate, or severe and recorded during the procedure and within 24 hours post-treatment. Statistical analyses, including chi-square tests, were used to assess associations between complications and patient or procedural characteristics. Results: Complications were observed in 37.75% of TPE sessions. Mild complications, such as hypotension, fever, and pruritus, accounted for the majority (69.5%) of the total complications and were primarily transient. Moderate complications included hypocalcemic symptoms (7.3%) and catheter-related issues (5.3%), while severe complications, such as deep vein thrombosis (3.3%) and sepsis, were rare but critical. Most complications occurred during the procedure (61.59%), followed by within one hour post-TPE (28.48%), and least after one hour (9.93%). A significant association was noted between the timing and severity of complications (p = 0.004).Conclusion: TPE is generally safe when performed with proper monitoring, but complications remain a concern, emphasizing the importance of individualized care and vigilance. Advanced technology, aseptic techniques, and adherence to evidence-based protocols are essential to minimizing risks. This study provides valuable insights into optimizing TPE protocols in tertiary care settings and improving patient outcomes

Background: Diabetes is a major cause of vision loss worldwide, with cataracts being a common complication. Cataract surgery in diabetic patients accounts for about 20% of total procedures and helps improve visual acuity while facilitating retinal examination. However, there is a potential risk of worsening diabetic retinopathy. This study aims to evaluate and compare visual outcomes and postoperative complications in diabetic and non-diabetic patients undergoing cataract surgery. Materials and Methods: This prospective observational study included 50 diabetic and 50 non-diabetic patients undergoing phacoemulsification or SICS with PCIOL implantation. Preoperative assessments included HbA1c levels, visual acuity, intraocular pressure, cataract grading, and fundus evaluation. Postoperative evaluations were conducted on days 1, 2, and 6 weeks, assessing BCVA, intraocular pressure, and fundus changes. Central foveal thickness (CFT) was measured using OCT preoperatively and six weeks postoperatively. Statistical analysis was performed using GraphPad version 8.4.3, with P-values < 0.05 considered significant. Results: This study compared visual outcomes, intraocular pressure, and retinal changes in diabetic and non-diabetic patients undergoing cataract surgery. Diabetic patients had a higher prevalence of cortical cataracts, while nuclear cataracts were slightly more common in non-diabetics. Preoperative glycaemic control, measured by HbA1c levels, significantly influenced postoperative visual recovery, with better-controlled diabetics (HbA1c <7%) achieving superior vision. Both groups showed significant improvement in visual acuity post-surgery, with no major differences between them. Postoperative complications, including iritis and Descemet’s membrane folds, were more frequent in diabetics but not statistically significant. A significant increase in central foveal thickness was observed in both groups, with a greater rise in diabetics, indicating a higher risk of subclinical macular edema. These findings highlight the importance of glycaemic control and close retinal monitoring in diabetic patients undergoing cataract surgery. Conclusion: Cataract surgery improves vision in diabetic patients, though outcomes are slightly better in non-diabetics. Complications like iritis and Descemet's membrane folds were more common in diabetics but not statistically significant. Poor glycaemic control and diabetic retinopathy affected recovery, with a greater increase in central foveal thickness post-surgery. Preoperative diabetic retinopathy remains a key factor in visual outcomes.

Background: Anastomotic leakage (AL) is a significant postoperative complication following small bowel anastomosis, contributing to increased morbidity and mortality. Identifying risk factors for AL can aid in improving surgical outcomes. This study evaluates demographic, clinical, biochemical, and intraoperative predictors of AL and their impact on patient prognosis. Methods: A prospective observational study was conducted at Burdwan Medical College & Hospital, enrolling 50 patients who underwent small bowel anastomosis. Patients were assessed for demographic variables, preoperative risk factors, biochemical markers, intraoperative parameters, and postoperative outcomes. Statistical analysis included chi-square tests, t-tests, and multivariate logistic regression. A Kaplan-Meier survival analysis was performed to evaluate postoperative survival outcomes.

Results

• Incidence of AL: 6 out of 50 patients (12%).
• Demographic Factors: AL was most prevalent in the 41–50 years age group (66.6%, p=0.613) with a male predominance (83.3%, p=0.927).
• Preoperative Risk Factors: ASA score III was significantly associated with AL (83.3% of cases, p=0.05). All AL patients were smokers (p=0.05) and 66.7% were alcohol consumers.
• Biochemical Markers: AL patients had significantly lower albumin levels (3.28±0.14 vs. 4.16±0.47, p=0.034) and hemoglobin (9.26±0.77 vs. 10.73±0.34, p<0.0001).
• Intraoperative Factors: Longer operative time was significantly associated with AL (182.50±4.18 vs. 150.97±13.06, p=0.05). Lack of mechanical bowel preparation (50%, p=0.006) and absence of prophylactic drainage (66.7%) were also linked to AL.
• Multivariate Analysis: ASA III status, low albumin, smoking, and prolonged operative time were independent predictors of AL.
• Survival Analysis: Kaplan-Meier analysis showed 100% survival at 2 months, despite AL cases experiencing longer postoperative recovery.

Conclusion: Anastomotic leakage remains a critical complication influenced by ASA III status, hypoalbuminemia, smoking, prolonged operative time, and lack of prophylactic drainage. Identifying high-risk patients and optimizing perioperative care can improve surgical outcomes. Further large-scale studies are recommended to validate these findings.

Keywords: Anastomotic Leakage, Small Bowel Anastomosis, Risk Factors, ASA Score, Hypoalbuminemia, Surgical Outcomes, Kaplan-Meier Analysis.

Background: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia, which can lead to serious microvascular complications such as diabetic retinopathy (DR). DR is one of the leading causes of vision impairment among individuals with diabetes and is closely linked to poor glycemic control. Studies have shown a strong association between elevated HbA1c levels and the severity of DR, highlighting the importance of maintaining optimal blood sugar levels. However, there is limited data exploring this relationship in specific populations, particularly in Bihar. This study aims to evaluate the association between HbA1c levels and DR severity to enhance early diagnosis and management strategies. Materials and Methods: This prospective observational study was conducted at the Department of Ophthalmology, Government Medical College and Hospital, Bettiah, Bihar, on one hundred patients with type II diabetes mellitus. Patients were selected through randomization, and written informed consent was obtained. A comprehensive ophthalmic evaluation, including best-corrected visual acuity, intraocular pressure measurement, and dilated fundus examination, was performed. Patients with type 2 diabetes who underwent fundus examinations and had HbA1c measurements were analyzed. Data on demographic and clinical parameters, including age, gender, duration of diabetes, glycaemic control, anti-diabetic medications, body mass index (BMI), and diabetes-related complications, were collected. The severity of DR was classified into mild, moderate, and severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Statistical analysis was performed using GraphPad version 8.4.3, which included chi-square tests, independent t-tests, and analysis of variance (ANOVA), with P-values < 0.05 considered significant. Results: The study assessed the relationship between HbA1c levels and diabetic retinopathy severity. The mean age of the study group was 52.23±11.34 years. Poor glycaemic control was common, with 48% having HbA1c between 7–9% and 35% above 9%. Obesity was prevalent (45%), and 48% of the patients used insulin therapy. Among diabetic complications, neuropathy and nephropathy were observed in 12% and 17% of cases, respectively, while 31% had macular edema. Retinopathy severity varied, with 40% having mild NPDR, 26% moderate NPDR, 6% severe NPDR, and 28% PDR. While age, gender, diabetes duration, HbA1c, and BMI were not significantly linked to retinopathy severity, insulin use was associated with higher PDR prevalence (p=0.044). Macular edema showed a strong correlation with retinopathy severity (p=0.002), while there were no significant associations were found between DR severity and neuropathy or nephropathy. Conclusion: Early detection and management of glycaemic control and diabetes duration are crucial in reducing diabetic retinopathy severity. Comprehensive care, including patient education and regular screenings, can help preserve vision. Raising awareness and further research on targeted interventions are essential for improving outcomes

Background: Rheumatic mitral stenosis remains an important clinical problem, especially in developing regions where rheumatic heart disease prevails. While the severe lesions present a strong indication of urgent intervention, the non-severe lesions that involve mildly symptomatic or asymptomatic subjects warrant closer long-term follow-up for understanding their clinical course and guiding management strategies. Methods: This was a longitudinal cohort study of 140 adult patients with non-severe rheumatic mitral stenosis and a mitral valve area ≥1.0 but <2.0 cm² at Heritage Hospitals Lanka. The baseline characteristics, symptom progression, echocardiographic parameters, and quality of life were assessed in this three-year follow-up study. The primary outcome measure was progression of mitral stenosis, defined as a reduction in the mitral valve area to less than 1.0 cm². The secondary outcomes were incident atrial fibrillation and changes in the quality of life as measured with the Kansas City Cardiomyopathy Questionnaire. Results: During the median follow-up period of 20 months, mitral stenosis had progressed in 35.7% of patients. The median time to progression was 18 months. The risk of progression was significantly greater in patients with NYHA Class III at baseline, p < 0.01. Also, 25% of the patients developed atrial fibrillation, mostly in those with a mitral valve area <1.5 cm² (p < 0.001). Quality-of-life scores showed a significant improvement from baseline in all patients with p < 0.001, reflecting effective symptom management despite disease progression in some patients. Conclusion: The study lays much emphasis on long-term follow-up in patients with nonsevere rheumatic mitral stenosis, whereby the identification of such patients will be at a higher risk for disease progression and complications like atrial fibrillation. Individualized care strategy and regular monitoring improve outcome and enhance quality of life in these patients.

Introduction: Hypertension can adversely affect renal function, and renal sonographic parameters provide a means to evaluate renal status. Ultrasound serves as a cost-effective and safe method for kidney evaluation. This study aimed to use sonography to assess renal parameters in patients with essential hypertension, identifying markers indicative of increased renal damage risk. Materials and Methods: The study included 178 hypertensive patients (114 females and 64 males) attending the outpatient department. An equal number of non-hypertensive volunteers (95 females and 83 males) were included as controls. Renal length, width, anteroposterior diameters, parenchymal volume, cortical thickness, and echogenicity were measured in both groups. Serum creatinine levels were also recorded. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS version 20.0). Results: The difference in renal cortical thickness between the hypertensive and control groups was statistically significant. No significant difference was observed in the renal parenchymal volume between the right and left kidneys in either group. A significantly higher proportion of hypertensive subjects had higher echogenicity grades compared to normotensive subjects on both the right and left kidneys. Serum creatinine levels were significantly elevated in the hypertensive group. Conclusion: Hypertensive individuals exhibited significantly higher cortical echogenicity compared to normotensive individuals, whereas renal parenchymal volume and cortical thickness were reduced in hypertensives. Hypertension appears to predominantly affect the renal cortex rather than the medulla

Background: Unstable intertrochanteric (I/T) fractures present significant treatment challenges, particularly in elderly populations, due to high morbidity and functional impairment. Objective: This study aims to evaluate the functional outcomes of unstable I/T fractures treated with Proximal Femoral Nail (PFN) using the Modified Harris Hip Score (mHHS) over a 6-month follow-up period. Method: A prospective observational study was conducted from October 2019 to April 2021 on 25 patients aged 22–80 years with unstable I/T fractures. Patients were treated with PFN at ESI-PGIMSR, New Delhi, and followed at 1, 3, and 6 months postoperatively. Data on demographic characteristics, operative time, nail dimensions, and complications were collected. Functional outcomes were assessed using mHHS, and statistical analysis included mean, standard deviation, and p-value determination to evaluate significance. Results: At 6 months, the mean mHHS was 88.84 ± 6.43, with scores classified as excellent in 64%, good in 24%, and fair in 12% of cases. At 1 month, all patients scored poorly (mean: 24.4 ± 2.64). The average operative time was 80.2 ± 20.5 minutes. Complication rates were low, with deep infection and screw migration observed in 4% each. The p-value for improvement in mHHS from 1 to 6 months was <0.00001, indicating significant functional recovery. The study suggests that PFN fixation results in reliable fracture union within 12–18 weeks, with substantial improvement in hip function over time. These results demonstrate a statistically significant recovery trajectory under standardized protocols. Conclusions: PFN fixation for unstable I/T fractures effectively improves hip function, with high rates of excellent outcomes and low complications at 6 months

Background: Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, with increasing prevalence in India, particularly in Punjab. Despite the rising burden of CVDs, public awareness of cardiovascular risk factors, early symptoms, and preventive strategies remains insufficient. Understanding the general population's knowledge can aid in designing effective awareness programs and interventions to mitigate the disease burden. Material and Methods: A descriptive, cross-sectional study was conducted among 400 residents of Punjab using an online questionnaire-based survey. The structured questionnaire collected socio-demographic data and assessed participants' knowledge regarding cardiovascular risk factors, symptoms, preventive measures, and the impact of lifestyle choices. Responses were categorized into four knowledge levels: Very Good (>80% correct responses), Good (60–79%), Fair (41–59%), and Poor (<40%). Data were analyzed using descriptive statistics, with frequencies and percentages used to summarize findings. Results: Of the 400 respondents, 52.3% were female and 47.7% male, with the highest representation from the 26–35 age group (36.5%). While 77.5% correctly identified regular exercise as a preventive measure, awareness of obesity and diabetes as risk factors was lower at 62.0% and 65.0%, respectively. Only 64.0% of participants recognized dizziness as a potential symptom of heart disease, highlighting significant gaps in knowledge. Regarding preventive healthcare, 80.0% acknowledged the importance of regular health check-ups, yet financial constraints were identified as a major barrier. Knowledge levels were classified as Very Good (25.5%), Good (35.0%), Fair (28.0%), and Poor (9.5%), emphasizing the need for targeted educational interventions. Conclusion: The study reveals a moderate level of awareness regarding cardiovascular health among the population of Punjab, with significant knowledge gaps in symptom recognition and preventive measures. Focused health education campaigns, leveraging digital platforms, and community-based initiatives are essential to enhance awareness and promote heart-healthy behaviors. Addressing socio-economic and cultural barriers will further facilitate better health-seeking practices and reduce the burden of cardiovascular diseases.

Background: Hypertension is a major cardiovascular risk factor, and beta-blockers are commonly used for its management. This observational study compares the efficacy and tolerability of Bisoprolol and Metoprolol in patients with Stage-1 Hypertension in an Indian population. Methods: A total of 100 patients with Stage-1 Hypertension were enrolled and evenly distributed into two groups: Bisoprolol (n=50) and Metoprolol (n=50). Baseline blood pressure (BP) and heart rate (HR) were recorded. Patients were followed for 12 weeks, and outcomes included reduction in systolic BP (SBP), diastolic BP (DBP), HR, target BP achievement (<130/80 mmHg), adverse events, and patient satisfaction scores. Statistical significance was evaluated using independent t-tests and chi-square tests, with p<0.05 considered significant. Results: The Bisoprolol group demonstrated significantly greater reductions in SBP (-19.3 ± 3.7 mmHg vs. -16.8 ± 4.1 mmHg, p=0.01) and DBP (-10.8 ± 2.6 mmHg vs. -8.9 ± 2.9 mmHg, p=0.02) compared to the Metoprolol group. HR reduction was not significantly different (-12.5 ± 3.4 bpm vs. -11.2 ± 3.7 bpm, p=0.13). Adverse events were comparable (18% vs. 22%, p=0.61), with fatigue and dizziness being most common. A higher proportion of patients in the Bisoprolol group achieved target BP (76% vs. 64%, p=0.04), and patient satisfaction was significantly higher (8.4 ± 1.1 vs. 7.9 ± 1.3, p=0.03). Conclusions: Bisoprolol demonstrated superior efficacy and comparable tolerability to Metoprolol in managing Stage-1 Hypertension, making it a preferred option for patients in this cohort.

Background: Varicose veins are a common vascular condition affecting a significant portion of the population, with symptoms ranging from mild discomfort to severe complications such as venous ulceration and thrombophlebitis. Traditional treatment with high ligation and stripping has been supplemented by minimally invasive techniques like Endovascular Laser Ablation (EVLA), which offers reduced postoperative discomfort and faster recovery. This study aimed to compare the effectiveness and outcomes of EVLA and conventional venous stripping in the treatment of varicose veins. Methods: A prospective case-control study was conducted in the Department of General Surgery, M.G.M. Medical College and M.Y. Hospital, Indore, over one year. Thirty patients were included, divided equally into two groups: Group 1 (EVLA) and Group 2 (conventional venous stripping). Patients were assessed for postoperative pain, bruising, recurrence, and complications at follow-up intervals of 1, 3, and 12 months. Data were analyzed using statistical software, with significance set at p<0.05. Results: Group 1 (EVLA) demonstrated significantly lower postoperative pain (p<0.0001) and minimal bruising (p<0.001) compared to Group 2. Recurrence rates were markedly lower in Group 1, with only 1 patient experiencing recurrence versus 25 in Group 2 (p<0.001). Long-term complications were also significantly reduced in Group 1 across all follow-up intervals (p<0.0001). These results highlight the superior efficacy and safety profile of EVLA compared to conventional venous stripping. Conclusion: The study findings underscore the advantages of the endovascular laser technique over conventional venous stripping for treating varicose veins. EVLA demonstrated reduced postoperative pain, minimal bruising, lower recurrence rates, and fewer long-term complications. Despite limitations such as a small sample size, the results strongly advocate for EVLA as the preferred treatment option. Further large-scale, randomized studies are recommended to validate these findings and assess long-term outcomes.

The purpose of this study is to explore the distribution and characteristics of nutrient foramina in the human clavicle, conducted at Jalpaiguri Government Medical College between November 2023 and November 2024. Nutrient foramina are critical openings that allow blood vessels to nourish bone tissue, and their characteristics are especially important for surgical procedures and bone fracture management. This research aimed to provide detailed anatomical insights into the clavicle’s vascular structure, which can assist in improving clinical practices related to clavicular injuries and surgeries.

Background: Trauma is a leading cause of morbidity and mortality among children worldwide. Understanding the patterns and outcomes of pediatric trauma is crucial for improving emergency care and preventive strategies. This study aims to describe the epidemiology, clinical characteristics, and outcomes of pediatric trauma cases presenting to the emergency department (ED) of a tertiary care hospital in East India. Methods: A retrospective observational study was conducted over a period of 12 months, from January to December 2022, in the ED of a tertiary care hospital in East India. Data were collected from medical records of 90 pediatric trauma patients aged 0-18 years. Variables included demographic details, mechanism of injury, injury severity, clinical management, and outcomes. Descriptive statistics were used to analyze the data. Results: The mean age of the patients was 8.5 years (SD ± 4.2), with a male predominance (65.6%). The most common mechanism of injury was falls (48.9%), followed by road traffic accidents (RTAs) (32.2%), and burns (10%). Head injuries were the most frequent (42.2%), followed by fractures (30%) and soft tissue injuries (20%). The majority of patients (75.6%) were discharged with full recovery, while 15.6% required hospitalization, and 8.8% were referred to higher centers for specialized care. Mortality was observed in 2.2% of cases, primarily due to severe head injuries. Conclusion: Pediatric trauma in East India predominantly results from falls and RTAs, with head injuries being the most common. Most patients achieve full recovery, but severe cases require specialized care and have higher mortality rates. Preventive measures and improved emergency care protocols are essential to reduce the burden of pediatric trauma.

Introduction: Sepsis is defined as a “life-threatening organ dysfunction due to a dysregulated host response to infection”. For early diagnosis and predict the outcome of sepsis many scoring systems are available. In present study we aimed to compare between quick sepsis-related organ failure assessment (qSOFA), modified shock index (MSI), and national early warning score2 (NEWS2) in sepsis and it's outcome in emergency department. Material and Methods: Present study was Observational, Prospective, Unicentric Study, conducted in patients of age ≥ 18yrs. both male and female, who met Suspected infection definition, qSOFA score, MSI, NEWS2 scores were calculated at time of admission. Results: Our study result shows qSOFA cut off value ≥ 2 significantly associated with patient morality and ICU stay > 3 days in sepsis. In our study qSOFA of value 2 predicting patients mortality, the sensitivity is 70%. From this study, MSI cut off value ≥ 1.88there is an increased probability of mortality in sepsis. Our results shows that in patients with an MSI≥ 1.585there is an increased probability of ICU admission. In our study NEWS2 cut of value 9 score for predicting patients’ mortality, the sensitivity is higher than qSOFA. Our results show that in patients with an NEWS2 cut of value 7.5there is an increased probability of ICU admission more than 3 days. In this observational study our findings suggest that for predicting mortality and ICU stay >3 days among all patients with suspected sepsis, NEWS2 score was more sensitive than qSOFA and MSI score. For predicting mortality, qSOFA has higher sensitivity than MSI but lower than NEWS2. No study compared MSI with other scores. Conclusion: NEWS2 is a better score than qSOFA and MSI in predicting sepsis mortality and ICU stay in emergency department.

Background: Pulmonary tuberculosis (PTB) remains a significant public health concern, with drug-resistant tuberculosis (DR-TB) complicating treatment and prognosis. Radiological imaging plays a crucial role in the early detection and differentiation of drug-sensitive tuberculosis (DS-TB) and DR-TB. Objective: This study aims to evaluate the radiological features of DS-TB and DR-TB and identify distinguishing characteristics to facilitate early diagnosis and improved clinical decision-making. Methods: A prospective observational study was conducted from December 2023 to November 2024 at the Department of Respiratory Medicine, RKDF Medical College, Bhopal, and Maharshi Devraha Baba Autonomous State Medical College, Deoria. Patients aged ≥18 years with microbiologically confirmed DS-TB or DR-TB were included. Extrapulmonary TB cases and those with comorbid pulmonary conditions affecting imaging interpretation were excluded. Chest X-rays (CXR) and high-resolution computed tomography (HRCT) scans were analyzed for imaging patterns such as cavitation, consolidation, nodular opacities, fibrosis, pleural effusion, and bronchiectasis. Statistical analysis included descriptive statistics, chi-square tests, and logistic regression to determine significant differences. Results: DR-TB cases demonstrated a higher prevalence of cavitation (75.0% vs. 29.2%, p<0.001), bronchiectasis (50.0% vs. 12.5%, p<0.001), fibrosis (68.8% vs. 25.0%, p<0.001), and pleural effusion (31.3% vs. 16.7%, p=0.021) compared to DS-TB. Additional findings such as tree-in-bud appearance (81.3% vs. 33.3%, p<0.001) and lymphadenopathy (62.5% vs. 20.8%, p<0.001) were more frequent in DR-TB. Conclusion: Imaging serves as a critical tool in differentiating DS-TB from DR-TB. The distinct radiological patterns observed in this study can aid clinicians in early diagnosis, treatment planning, and monitoring of TB cases, thereby improving patient outcomes..

Background: Nomophobia (NO-Mobile Phone-PHOBIA) is the fear of being without a mobile phone, a growing concern in the digital era. With increasing smartphone usage, nomophobia has become a significant psychological and behavioral issue, particularly among younger individuals. Objective: This study aimed to assess the prevalence of nomophobia among smartphone users attending the Urban Health Training Centre, Dharwad, and its association with sociodemographic factors. Methods: A cross-sectional study was conducted over two months (May–June 2018) among 188 smartphone users aged 15–55 years. Data were collected using a semi-structured questionnaire, including the Nomophobia Questionnaire (NMP-Q). Statistical analysis was performed using SPSS version 22.0, with the Chi-square test applied to assess associations. Results: The prevalence of nomophobia was high, with 47.87% of participants experiencing mild nomophobia, 46.28% moderate nomophobia, and 2.66% severe nomophobia. A significant association was observed between nomophobia and education level (p<0.01), occupation (p<0.01), socioeconomic status (p<0.01), type of family (p<0.01), hours of smartphone use per day (p<0.01), and social networking usage (p<0.01). However, no significant association was found between gender (p=0.612) and total expenditure on smartphone services (p=0.06). Conclusion: Nomophobia is highly prevalent among smartphone users, with a significant impact on daily life. Younger individuals, those with higher education, and those from higher socioeconomic backgrounds are more susceptible. Awareness programs and behavioral interventions are needed to mitigate the negative effects of excessive smartphone use.

Background: It is well documented that there is a significant relationship between aerobic capacity i.e. VO2max and the total distance covered, frequency of sprints made in a match, as well as the number of involvements with the ball by football players. Soccer includes high intensity, intermittent bouts of exercise, which stresses the anaerobic glycolysis metabolic pathway. The high intensity burst of football is fueled by anaerobic glycolytic system. Objectives: To determine and statistically analyze VO2 max and plasma lactate values in football players undergoing continuous training and HIIT. Materials and Methods: Ethical clearance was taken prior to the study. 60 football players were randomly allocated into two groups i.e. 30 players in continuous training group and 30 players in high intensity interval training group for 6 weeks training. VO2 max and plasma lactate values were assessed before and after training of these two groups. Results and Conclusion: There was marked improvement in VO2 max and plasma lactate in both continuous training and HIIT group and it was comparatively more in HIIT group.

Background: The outcome of cardiac arrest and CPR is dependent on critical interventions, particularly early defibrillation, effective chest compressions and assisted ventilation. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress towards resuscitation guidelines. Objective: To determine how well CPR is utilized at our institution and to identify key predictors of post CPR outcome by analyzing in-hospital cardiac arrest data collected using the Utstein template based form.  Methods: 150 patients of in-hospital cardiac arrest, from April 2015 up to 18 months, including patients with cardiac arrest announced through code blue were studied. Patients with cardiac arrest were resuscitated according to ACLS guidelines and data was recorded in the proforma according to utstein template. Those patients with return of spontaneous circulation (ROSC) were followed up at the time of discharge and after 6 months for survival. Result: Mean age of patients with cardiac arrest was Mean ±SD: 57.02±16.76. Out of 102 cardiac arrest cases on which defibrillation was attempted, for 80 patients defibrillation was attempted within 1-10secs, that is nearly 78.4%, which had an a significant impact on the outcome.  Out of 150 cases of cardiac arrest, 65 patients had initial rhythm of ventricular fibrillation of which 56 patients were alive at the time of discharge and 9 patients could not be revived. Nearly 30 patients had an initial rhythm of asystole of which only 10 patients that is 10.8% were alive and 20 patients that is 35.1% could not be revived. Only 2 patients that are 2.2% having PEA as initial rhythms were alive at the time of discharge and 18 patients that is 31.6% could not be revived. The survival at discharge was higher for patients with VF than asystole and PEA.  Out of total 104 cases in which defibrillation were attempted 84 patients were alive at discharge that is nearly 90.3% and 20 patients were not revived which is 35.1%. Survival status at discharge was significant in patients in whom chest compressions was started within 1-5seconds. Patients in whom defibrillation was attempted at the earliest had better survival. Hence proves the importance of early intervention, effective chest compression and rapid defibrillation.  Out of 150 patients, 94 patients achieved return of spontaneous circulation out of which 93 patients were alive up to discharge that is 127.4% and 1 patient did not survive up to discharge that is 5.3%. Out of 65 patients with VF, 56 patients achieved return of spontaneous circulation that is 59.6%. Out of total 30 patients with asystole, 10 patients achieved return of spontaneous circulation that is 10.6% and 20 patients did not achieve return of spontaneous circulation that is 35.7%.  Conclusion: The most common cardiac arrest rhythm with better outcome was ventricular fibrillation. Asystole and PEA had a poor outcome inspite of early and effective chest compressions. Patients with early defibrillation had a higher survival rate at discharge with a CPC-3 followed by CPC-2, hence proving the importance of rapid defibrillation being a critical intervention during resuscitation. Patients achieving ROSC had a better survival to discharge, which gradually declined after 6months of follow up. Patient with shockable rhythm, early chest compression and rapid defibrillation had higher incidence of achieving ROSC.

Background: Root canal therapy (RCT) is a vital procedure in endodontics, offering a definitive treatment for infected or damaged pulp tissue. The choice between single-visit and multi-visit RCT remains contentious, with debates focusing on success rates, postoperative pain, and complication profiles. This meta-analysis evaluates the outcomes of these two approaches to provide evidence-based insights. Methods: This study systematically reviewed and analyzed 15 studies with a combined sample size of 150 patients, comparing single-visit and multi-visit RCT. Primary outcomes included success rates based on clinical and radiographic assessments. Secondary outcomes examined postoperative pain, flare-ups, and patient satisfaction. Statistical analyses were performed using odds ratios (ORs) and confidence intervals (CIs) to compare outcomes. Results: Single-visit RCT demonstrated success rates comparable to multi-visit RCT (92% vs. 90%; OR = 1.05, 95% CI: 0.98–1.12). However, it showed a lower incidence of postoperative pain within 48 hours (20% vs. 35%) but a slightly higher rate of flare-ups (5% vs. 3%). Patient satisfaction was higher with single-visit RCT due to reduced time commitment and convenience. Conclusion: Both single-visit and multi-visit RCT achieve high success rates, with each approach offering distinct advantages. Single-visit RCT is associated with reduced postoperative pain and greater convenience, while multi-visit RCT may be better suited for managing complex cases. Clinicians should tailor their approach based on patient-specific factors and clinical presentations.

Background: In order to prevent adverse outcomes, proper referral at appropriate times is a fundamental process in maternal and neonatal care. This study assesses the effect of referral timeliness and appropriateness on the health outcomes of maternal and neonatal patients who were referred to a tertiary care center. Methods: This is a one year prospective observational study among 120 referral cases of maternal and neonatal patients. Data collected on time for referral, reasons for the referral, appropriateness based on clinical criteria, maternal and neonatal outcomes in relation to referral characteristics. Results: Delayed referral 40%, and inappropriate referrals 30% cases. Delayed referrals show significant maternal complications such as postpartum hemorrhage and eclampsia at a p-value of < 0.05. Similarly, inappropriate referrals depict bad neonatal outcomes like low birth weight and admissions to NICU at a p-value of < 0.01. Conclusion: The current study highlights the importance of timely and appropriate referrals in improving maternal and neonatal health outcomes. Strengthening referral systems and training of healthcare providers can help reduce delays and inaccuracies, thus reducing preventable morbidity and mortality.

Background: Diabetes mellitus (DM) is a multisystemic disorder associated with chronic dermatological manifestations, largely driven by metabolic dysfunction, impaired glycemic control, and systemic inflammation. Understanding the interplay between diabetes, inflammatory markers, and skin disease severity is critical for developing targeted interventions. This study evaluates the association between metabolic markers, glycemic regulation, and dermatological disease burden in diabetic patients. Objective: To investigate the relationship between glycemic control, inflammatory markers (CRP, IL-6, TNF-α), and dermatological disease severity in diabetic patients and assess the impact of metabolic regulation on skin disease progression over 24 months. Methods: A prospective observational study was conducted at HIMSR, New Delhi, including 100 diabetic patients over two years (up to 2025). Patients were stratified based on HbA1c quartiles, and dermatological disease burden was assessed using PASI scores and lesion severity indices. Multivariate regression analysis was used to identify independent predictors of severe dermatological disease. Repeated-measures ANOVA was employed to evaluate the impact of glycemic control on skin disease progression over time. Results: •Higher HbA1c levels correlated with increased PASI and lesion severity scores (p < 0.001), with patients in the highest quartile exhibiting the worst outcomes. •Elevated CRP, IL-6, and TNF-α levels were significantly associated with increased skin disease severity (p < 0.001), confirming the role of chronic systemic inflammation. •Multivariate regression analysis identified HbA1c (β = 1.32, p < 0.001), duration of diabetes (β = 0.94, p = 0.002), and inflammatory markers (CRP, IL-6, TNF-α) as independent predictors of severe skin disease. •Glycemic control interventions over 24 months led to significant improvements in PASI scores and lesion severity indices (p < 0.001), underscoring the therapeutic potential of metabolic regulation. Conclusion: Our findings underscore the interplay between glycemic control and systemic inflammation as key drivers of dermatological complications in diabetes. Tight glucose control and early intervention targeting inflammatory pathways may improve skin disease outcomes in diabetic patients. Future research should explore immunomodulatory treatments and AI-based dermatological screening tools to enhance clinical management.

Background: Pre-eclampsia significantly impacts maternal and neonatal health. Magnesium sulfate (MgSO₄) is established for seizure prophylaxis in severe cases, yet the optimal postpartum duration remains debated.Objective:To compare the incidence of eclampsia and maternal recovery metrics between immediate versus 24-hour postpartum MgSO₄ regimens in severe pre-eclampsia.Method:This observational, comparative study enrolled 138 postpartum women with severe pre-eclampsia at R.G. Kar Medical College & Hospital from July 2019 to June 2020. Participants were divided equally into Group A (MgSO₄ stopped immediately post-delivery) and Group B (MgSO₄ continued 24 hours postpartum). Demographic, clinical, laboratory data, and recovery parameters were collected. Statistical analysis involved t-tests, Chi-square tests, and ANOVA using SPSS v27.0 and GraphPad Prism 5. A p-value ≤0.05 was considered significant.Result:Baseline characteristics between groups were comparable (mean age: 20.88±3.35 vs. 21.01±3.52 years, p=0.8239). Incidence of convulsions was low (2.9% vs. 1.4%, p=0.5594). No significant differences were found in blood pressures, lab parameters (platelet count: 2.15±0.38 vs. 2.31±0.57 lakh/cmm, p=0.0537), or need for antihypertensives (14.5% vs. 11.6%, p=0.6131). Significant reductions were observed in Group A for catheter duration (8.62±5.11 vs. 23.65±2.03 hours, p<0.0001), time to ambulation (8.65±5.22 vs. 23.65±2.03 hours, p<0.0001), newborn contact (7.35±5.90 vs. 14.96±4.04 hours, p<0.0001), and initiation of breastfeeding (6.26±6.03 vs. 10.58±3.16 hours, p<0.0001).Conclusion:Immediate cessation of MgSO₄ postpartum is safe, reduces recovery times, and enhances early mother-infant bonding compared to the 24-hour regimen.

Chronic Kidney Disease (CKD) is a major global health issue, often leading to End-Stage Renal Disease (ESRD), which requires renal replacement therapy, particularly hemodialysis (HD). This study aimed to evaluate the cost incurred by CKD patients undergoing hemodialysis at Shri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad, and to explore the financial burden of treatment. A cross-sectional descriptive study was conducted over one year, with 130 CKD patients undergoing hemodialysis. Data were collected on demographic factors, comorbidities, frequency of dialysis, and cost components. The findings revealed that the majority of costs were direct medical expenses (78.54%), followed by direct non-medical costs (16.83%) and indirect costs (4.63%). Hemodialysis session costs were the highest contributor to direct medical expenses (37.68%). Additionally, the study showed a significant variation in costs based on the frequency of dialysis. These results highlight the substantial financial strain on CKD patients and emphasize the need for policy reforms to make CKD care more affordable and accessible, especially in low-resource settings.

Background: Caesarean deliveries are one of the most commonly performed surgeries in this world. However, the past decades have witnessed a gradual rise in the caesarean section rate in India as well as worldwide. The objective of this present study is to analyse the rate and indications of caesarean delivery over a five year period in 7 Air Force Hospital, Kanpur, Uttar Pradesh. Methods: This is a retrospective study that analysed the rate and indications of caesarean delivery that took place over five years from 01 Jan 2019 to 31 dec 2023. Data of the patients was obtained from the hospital records and statistical analysis was done. Results:  There was an overall rise in the rate of caesarean delivery from 21.3% in 2019 to 32.2% in 2023. Previous caesarean status was the most common indication. There was an increase in primary caesarean section as well from 10% in 2019 to 24% in 2023. At the same time, there was a reduction in the incidence of neonatal birth asphyxia from 1.28% in 2019 to 0.5% in 2023. Conclusion: Efforts should be made to ensure that every caesarean delivery is medically justified and that every patient who needs a caesarean delivery receives it on time, instead of trying to achieve a specific rate of caesarean delivery. At the same time, patient education, better intrapartum care, improved monitoring of labour and regular audits can help us minimize the rate of caesarean delivery over time.

Introduction: Tuberculosis (TB) remains a significant public health concern, particularly in pediatric populations, where diagnosis and treatment are often challenging. The emergence of drug-resistant Mycobacterium tuberculosis strains complicates TB management. This study aimed to investigate the drug resistance patterns of M. tuberculosis isolates in pediatric pulmonary TB patients at a tertiary care hospital. Material & Methods: The present study was a prospective, observational study undertaken in a tertiary care hospital, Jaipur among 150 clinically suspected cases of pulmonary tuberculosis in paediatrics age group. Clinically relevant samples were collected depending on history and clinical findings with all aseptic precautions. Results: Out of the 150 suspected pulmonary TB specimens, 7.33% were positive for acid-fast bacilli. On Lowenstein Jensen medium, mycobacterial growth was observed in 4% specimen. The Gene Xpert positivity was observed in (8.66% patients. Resistance to first-line anti TB drugs was observed in 03 (60%) of the MTB isolates. The overall prevalence of mono resistance was observed in 02 (40%) isolates  showing resistance to Isoniazid and prevalence of multidrug-resistant TB (MDR TB) was observed as 4%. 60% concordance was observed between Gene Xpert and DST for the detection of rifampicin. Discordance in the detection of rifampicin resistance by DST, Gene Xpert, and was observed in 40%. Discordance in the detection of isoniazid resistance by DST and Gene Xpert was observed 40%. Conclusion: Management of drug-resistant tuberculosis represents a potential challenge for clinicians. Antitubercular drugs act as a gold standard in this situation. the use of conventional DST along with Gene Xpert seems promising for the detection of drug resistance in pulmonary TB cases, particularly in the scenario of the rising number of MDR TB cases. Continuous surveillance system to be advocated for evaluation of drug resistance patterns in pediatric age group.

Cortisol is a “stress hormone” and has been used as an indicator in stress evaluation in various studies. There is good evidence of many studies where stress and anxiety are related to increase resting levels of cortisol. Anxiety and Depression are psychological behaviors associated with stress, as stress increases there is increase the anxiety and depression so increases the serum cortisol level. Hence the present study was aimed to assess and co-relate the anxiety, depression and serum cortisol levels in surgically treated and conservative treated patients compare with normal individuals. Total of 150 samples was included in the study that were divided into different groups, GROUP I (Surgical treated patients), GROUP II (conservative treated patients) and GROUP III (Control group). All the patients were assessed for serum cortisol level, severity of anxiety and depression by (HAM‑A) questionnaire and (HAM‑D) questionnaire respectively. A significant co-relation was seen between serum cortisol level, anxiety level and depression level in surgically treated patients, conservative treated patients and control group. Assessing anxiety and depression in patients with surgically and conservative treated patients, comparing with the serum cortisol level may reveal the level of stress. Proper psychological counseling should be given to patients so that they can cope with stress avoiding ill effects.

Laparoscopic Cholecystectomy is one of the widely performed elective surgeries worldwide and is the gold standard method for patients with symptomatic gallstones. It was a common practice earlier, to use prophylactic antibiotics before an operative procedure; but recent studies show evidence againsttheuseofprophylacticantibioticsinlow-riskpatientsundergoingelective laparoscopic cholecystectomy. In our study we included 200 patients diagnosed with symptomatic cholelithiasis and divided them into 2 groups of 100 patients each. All were planned for elective laparoscopic cholecystectomy, in which, group (A) underwent surgery without any prophylactic antibiotics and the other group (B) got the routine antibiotic prophylaxis preoperatively. At 95% confidence level, there is no significant difference in the fever, port site infection and raised TLC (Leucocytosis) during hospital stay, at the time of discharge and on1-weekfollow-upof the patients in both the study groups. We concluded that there is no need for routine antibiotic prophylaxis in patients undergoing an elective uncomplicated laparoscopic cholecystectomy for symptomatic gallstone disease.