Research Article
Open Access
Ease of intubation using the Sniffing Position versus the modified ramped laryngoscopy position: A comparative study
Noreena Xavier,
Tania James,
Anjusha N,
Irfana Hameed
Pages 265 - 270

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Abstract
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.
Research Article
Open Access
A Comparative Study of the Rate of Posterior Capsule Opacification Following Combined Treatment with Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone
Md. Obaidur Rahman,
Sudhir Kumar
Pages 259 - 263

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Abstract
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.
Research Article
Open Access
Psychological Disturbances and Quality of Life Among Obese Infertile Women in Amalapuram
Shaik Abdul Asiya Begum,
Varada A Hasamnis,
K Sai Anusha,
K Vasudha Bhargavi
Pages 252 - 258

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Abstract
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
Research Article
Open Access
A Multidisciplinary Approach for The Clinical, Radiological, Histopathological & Serological Profile in Patients with Interstitial Lung Disease
Sujeet Kumar Karn,
Vikash Kumar,
Akhilesh Singh
Pages 247 - 251

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Abstract
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.
Research Article
Open Access
GATA3 Expression in Invasive Breast Carcinoma
Ravi Teja CN,
Sharath Kumar HK,
K.T Athulya Krishna Kumar,
Priyanka Rajendran,
Nataraju G.
Pages 240 - 246

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Abstract
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.
Research Article
Open Access
Study of GATA3 Expression in Urothelial Cell Tumors
Ravi Teja CN,
Sharath Kumar HK,
K.T Athulya Krishna Kumar,
Tsering Lhamo,
Nataraju G.
Pages 233 - 239

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Abstract
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.
Research Article
Open Access
A Study on Clinical Profile of Patients with Diabetic Foot in North Karnataka.
Shreeja R Chapparbandi,
Sharanabasappa Karbhari,
Shweta R Chapparbandi,
Shivanand
Pages 226 - 232

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Abstract
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.
Research Article
Open Access
Evaluation of implementation of guidelines regarding judicious blood transfusion in hospital
Suyog Gurav,
Kishor Babaji Satras,
Anita Gaule
Pages 222 - 225

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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.
Research Article
Open Access
Comparative Study Between Oral Pregabalin and Paracetamol as Pre-emptive Analgesia on Postoperative Pain Relief in Laparoscopic Cholecystectomy
Raju Prasad Tayung,
Revathi ,
Madhuchanda Bora,
Pydimalla Venkata Gowtham,
Sarvesh Kumar Singh,
Raju Prasad Tayung,
Revathi ,
Madhuchandra Bora,
Pydimalla Venkata Gowtham,
Sarvesh Kumar Singh
Pages 215 - 221

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Abstract
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.
Research Article
Open Access
Morphometric Study of the Coronoid Process of the Mandible in Population of East Godavari District, Andhra Pradesh
Adabala N.V.V. Veerraju,
K. Deepika,
G. Sailaja
Pages 211 - 214

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Abstract
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.
Research Article
Open Access
Metabolic Risk Factors and Subclinical Cardiac Changes in Type 2 Diabetes: A Cross-Sectional Study
Keshav kumar kumar Majjari,
Muthkur Prathyusha,
Vijay Sagar Reddy
Pages 205 - 210

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Abstract
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.
Research Article
Open Access
Prevalence and Risk Factors for Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease
Ankit kumar Vakil,
Rakesh kumar Raval,
Robin kumar Patel
Pages 200 - 204

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Abstract
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
Research Article
Open Access
Study Of Automated Red Cell Exchange in The Management of Sickle Cell Disease in A Tertiary Care Hospital of Indore District
Tamil Priya L,
Amrita Tripathi,
Devesh Bulbake,
Imlimenba walling,
Ashok Yadav,
Ramu Thakur
Pages 195 - 199

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Research Article
Open Access
A Study on Complication During Therapeutic Plasma Exchange in A Tertiary Care Hospital of Central India
Devesh Kumar Bulbake,
Sachin Sharma,
Amrita Tripathi,
Ashok Yadav,
Ramu Thakur,
Tamil Priya L
Pages 190 - 194

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Abstract
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
Research Article
Open Access
A Study on the Visual Outcomes of Cataract Surgery in Diabetic Patients and Assessment of Post-operative Complications Compared to Non-Diabetic Patients.
Md. Obaidur Rahman,
Sudhir Kumar
Pages 183 - 189

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Abstract
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.
Research Article
Open Access
Influence Of Different Risk Factors on The Development of Complications in Case of Elective Small Bowel Anastomosis: An Institute Based Prospective Observational Study at Burdwan Medical College and Hospital
Chandranath Banerjee,
Sutapa Karmakar,
Susil Murmu,
Kajal Kumar Patra
Pages 170 - 182

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Abstract
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.
Research Article
Open Access
A Study on Association of HbA1c Levels and Severity of Diabetic Retinopathy in the Patients of Diabetes Mellitus
Md. Obaidur Rahman,
Sudhir Kumar
Pages 163 - 169

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Abstract
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
Research Article
Open Access
Rheumatic Mitral Stenosis: Long-Term Follow-Up of Adult Patients with Nonsevere Initial Disease
Sudhakar Singh,
Dheeraj Kela
Pages 157 - 162

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Abstract
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.
Research Article
Open Access
Correlation of Chronic Kidney Disease with USG Features like Cortical Echogenicity and Echotexture in Patients with Hypertension
Mythreesha ,
Shruti Kakaraddi,
. Divya G.A,
Panchami P
Pages 153 - 156

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Abstract
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
Research Article
Open Access
Evaluation Of Functional Outcomes of Unstable Intertrochanteric Fracture Treated with Proximal Femoral Nailing Using Modified Harris Hip Score
Dr. Rahul Sonkaria,
Dr. Amit kumar Singh,
Dr. Shashikant prakash,
Dr. Inder pawar
Pages 142 - 152

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Abstract
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
Research Article
Open Access
Carotid Doppler Intima Medical Plaque Correlation with Cerebrovascular Accident
Mythreesha ,
Shruti Kakaraddi,
Divya G.A,
Panchami P
Pages 137 - 141

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Research Article
Open Access
Clinico Radiological Correlation of Radiculopathy in Lower Back Ache Patient With MRI
Dr. Shivdayal Meena,
Dr. Amit Kumar Singh,
Dr. Inder Pawar,
Deepak Sharma
Pages 124 - 136

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Research Article
Open Access
Heart Health in Punjab: Assessing Public Awareness and Prevention Strategies for Cardiovascular Diseases in Punjab
Manvi Sagara,
Ritu ,
Naveen Sharma,
Rohit Batish
Pages 117 - 123

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Abstract
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.
Research Article
Open Access
Comparative Efficacy and Tolerability of Bisoprolol and Metoprolol in Patients with Stage-1 Hypertension: An Observational Study
A.N. Vijay Kumar,
Yakaiah Vangoori,
Sanjeeva Kumar Goud T
Pages 110 - 116

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Abstract
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.
Research Article
Open Access
A Study of Assessment of The Superiority of Endovascular Laser Technique Over Conventional Venous Stripping in Patients with Varicose Vein.
Priyansh Chauhan,
Varsha Dhakad,
Arvind Ghanghoria,
Kabang Modi,
Nayan Jain
Pages 106 - 109

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Abstract
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.
Research Article
Open Access
The study of nutrient foramina in human clavicle
Pages 103 - 105

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Abstract
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.
Research Article
Open Access
Patterns and Outcomes of Pediatric Trauma Cases in the Emergency Department of a Tertiary Care Hospital from East India
Santosh Kumar Pradhan,
Pradipta kishore Sahoo,
Alok Kumar Meher,
Chinmay Sahu
Pages 99 - 102

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Abstract
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.
Research Article
Open Access
Comparative Study 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
Dhileeban C M,
Hari Prasad S,
Sarat Kumar Naidu,
Ajay Jain,
Manish Gupta,
Rajarajeshwaran
Pages 89 - 98

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Abstract
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.
Research Article
Open Access
Evaluation of Imaging Features of Drug-Sensitive and Drug-Resistant Pulmonary Tuberculosis
Anurag Shukla,
Sarajuddin Ansari,
Vivek Arora
Pages 84 - 88

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Abstract
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..
Research Article
Open Access
Study Of Nomophobia Among Smartphone Users in Urban Health Training Centre
Ashwini V Rao,
Rakesh K. Nayak,
Krishna Agarkhed
Pages 80 - 83

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Abstract
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.
Research Article
Open Access
Effect Of Continuous Training and Interval Training on Vo2 Max and Plasma Lactate Values in Football Players
Yasir Askari,
Arifa Almas,
Mohammad Shoebuddin,
Jaya Muneshwar,
Badaam Khaled,
Yasir Askari,
Arifa Almas,
Mohammad Shoebuddin,
Jaya Muneshwar,
Badaam Khaled
Pages 75 - 79

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Abstract
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.
Research Article
Open Access
In-Hospital Cardiopulmonary Resuscitation Using Utstein Template- An Observational Study
Faranghees Yusuff Khan,
Harsha R
Pages 68 - 74

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Abstract
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.
Research Article
Open Access
Outcomes of Single-Visit Versus Multi-Visit Root Canal Therapy: A Meta-Analysis of Success Rates
Vinay Rao,
Ankur G Shah,
Ekta Chaudhari Desai,
Hemant Agrawal,
Kishan Patel,
Priyal Patel,
Anjali Kothari,
Deep Agrawal,
Riya Jain,
Ritu Bharti
Pages 62 - 67

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Abstract
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.
Research Article
Open Access
Evaluation of Referral Timeliness and Appropriateness in Maternal and Neonatal Health Outcomes
Mrudula Chelamkuri,
Jayachandra Reddy,
Sona Tejaswini,
Bala Tripura Sundari M,
Suvrathi Bhansal
Pages 57 - 61

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Abstract
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.
Research Article
Open Access
Exploring The Relationship Between Diabetes Mellitus and Chronic Skin Disease
Shafia Nisar kakroo,
Mohammad Ashraf Khan,
Mirza Aumir Beg,
Basit Kakroo
Pages 47 - 56

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Abstract
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.
Research Article
Open Access
A Comparative Study of Short Versus Twenty-Four Hours Post-Partum Magnesium Sulphate Regimen to Prevent Complications in Severe Pre-Eclampsia
Ritwick Priyam Das,
Bharat Chandra Mandi,
Chhandos Saha,
Tulika Jha
Pages 29 - 46

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Abstract
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.
Research Article
Open Access
Cost Analysis Among Chronic Kidney Disease Patients Undergoing Haemodialysis in Tertiary Care Hospital
Ashwini V Rao,
Pushpa S Patil,
Sanjay T Patil,
Krishna Agarkhed
Pages 24 - 28

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Abstract
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.
Research Article
Open Access
Indications and Rate of Caesarean Delivery in a Zonal Hospital in Kanpur, Uttar Pradesh: a Retrospective Study
Ritam Bhattacharya,
Roshni Abichandani,
Arunav Sharma
Pages 20 - 23

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Abstract
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.
Research Article
Open Access
Investigating Drug Resistance Patterns of Mycobacterium Tuberculosis Isolates in Pediatric Pulmonary Tuberculosis Patients
Kishori Shyamkant Bagul,
Babita Kumari Fageria,
Grace Darryl,
Anjali Swami
Pages 13 - 19

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Abstract
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.
Research Article
Open Access
Assessment Of Anxiety, Depression and Serum Cortisol Levels in Invasive and Non-Invasive Treated Patients- A Physiobiochemical Study
Lata Sachan,
Prabha Verma,
Afreena Nasir
Pages 6 - 12

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Abstract
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.
Research Article
Open Access
A Comparative Observational Study on The Incidence of Surgical Site of Infections in Low-Risk Patients, Undergoing the Elective Laparoscopic Cholecystectomy with And Without Prophylactic Antibiotics in A Rural Tertiary Health Facility
Jitendra Kumar,
Mohit Jain,
Rajesh Kumar
Pages 1 - 5

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Abstract
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.