European Journal of Cardiovascular Medicine

Introduction: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by altered bowel habits and recurrent abdominal pain. The Rome III criteria are the main mainstay for its diagnosis. The reliability on any biochemical markers is reduced provided all warning signs have been excluded. The aim of our study was to assess the prevalence of IBS among medical students in our region (Western Punjab) and to investigate the lifestyle, sociodemographic and clinical factors associated with IBS. Materials and Methods: A cross sectional study was conducted among Indian medical students. Participants (first- to fifth year medical students from different courses) were invited to complete an anonymous questionnaire addressing social, demographic and clinical characteristics. 456 medical students were recruited in this study. Rome III criteria were used to identify patients with IBS. This questionnaire was used to gather baseline information like the family history of irritable bowel syndrome, socio-demographic data, history of chronic disease, previous diagnosis of IBS, daily sleep hours, smoking, food habits etc. Results: This study included 268 male medical students and 188 were female medical students. Approximately two third of the (69.2%) were in the age group 21 to 24 years and 26.3% had the age between 18 and 20 year and very few among age group of 24-27 years. IBS was diagnosed among 276 out of 456 participants based on Rome III Criteria. The profiles for symptoms were characterized by constipation predominant (IBS-C) (45.6%), diarrhea predominant (IBS-D) (44.7%), and others as mixed type (9.7%). The prevalence of IBS was reported as 72.3% among the female medical students studying at various medical colleges in Punjab and 53.7% among male students. Conclusion: In conclusion, 60.5% of medical students, in this study, met the Rome III criteria for IBS diagnosis. Risk factors for IBS among them included depression, anxiety, low fruits and vegetables intake, taking caffeine and any chronic medication’s intake

Background- Wuhan, Hubei's capital, reported severe pneumonia in December 2019. China reported the epidemic to the WHO on December 31, 2019, based on respiratory sample aetiology. SARS CoV2 caused COVID19. Confusion, depression, anxiety, memory loss, and insomnia are more common in COVID19 patients. SARS (severe acute respiratory syndrome) infection has been linked to acute psychiatric symptoms, elevated inflammatory markers, and many neurologic manifestations in critically ill COVID 19 patients with comorbidities

Background: Women experience onset of labour in a variety of different ways & cervical anatomy at labour onset is also highly variable from women to women. During latent phase, women may experience painful uterine contractions and need a lot of support. High level of pain and anxiety in latent phase are linked with increased interventions in labour. Objectives: 1. To study maternal and fetal outcomes of low risk women admitted in latent phase as compared to those admitted in active phase of labour in primigravida. 2. To compare the mode of delivery and maternal and neonatal complications between two groups. 3. To compare the neonatal APGAR Scores and admission to NICU in both groups. Material & Methods: Study Design: Prospective Observational study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Berhampore, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Patients admitted in antenatal ward and labour room. Sample size: 300 (200 in latent phase and 100 in active phase). Sampling Technique: Simple Random sampling method. Study tools and Data collection procedure: Data collection tool was used to collect the different information. Face to face interviews were conducted using data collection tool by the investigator including detailed history taking and relevant physical examination. A detailed history was taken from the patient (if the patient was in shock the history was taken retrospectively). Results: Perineal tears, cervical tears needing exploration; prominent blood loss in the form of either atonic or traumatic PPH and cases of retained placenta requiring either manual removal with/without anaesthesia was more in LPA gp compared to APA gp. The p values are 0.02, 0.19, 0.15, 0.5 for perineal tears, cervical tears, PPH, retained placenta respectively which are insignificant except for perineal tears, that is 0.02 which is significant. Conclusion: The present study has shown that early admission to the hospital in low risk women may negatively affect the outcome of labour. There is a significantly increased risk of early initiation of augmentation, increased rate of caesarean section for dystocia, increased rate of instrumental delivery, increased third stage complications in latent phase admitted group compared to active phase admitted group.

Background: In this study, we wanted to compare the safety and efficacy of clear fluids until 3 hours as compared to 6 hours of starvation before and after minor surgical procedures. Materials And Methods: This was a hospital based prospective randomized comparative interventional study conducted among patients age group of 18 to 60 years of either sex who presented with minor surgeries to the Department of Surgery, ENT, Obstetrics & Gynaecology and Ophthalmology after obtaining clearance from institutional ethics committee and written informed consent from the study participants.  Results: The sense of wellbeing parameters in the starvation group that were not statistically significant were dizziness, anxiety, nausea or loss of appetite, headache and weakness than the clear fluid group at 3 and 6 hours of starvation post operatively. The difference was statistically significant with regard to thirst and dryness of mouth. Conclusion: Wellbeing parameters were significantly improved in patients who were given clear liquids before surgery and after surgery and significance reduced as fluids replaced over time.

Background: Postoperative pain is the major cause of fear and anxiety leading to prolonged hospital admission and delayed discharge rates in hospitalized patients. So, to make the patient pain free, multimodal analgesia has been used since long time. Opioids as an adjunct to epidural local anaesthetics by many people, but opioid free analgesia is a major concern in recent times to avoid its respiratory depressant and other adverse effects. Objective: studying non opioid drugs namely α2 agonist dexmedetomidine and magnesium sulphate as an adjunct to epidural bupivacaine and to compare their hemodynamic, sedative and analgesic effects. Methods: A randomized double blinded study was conducted in 60 patients of either sex belonging to ASA class I and II scheduled for elective lower abdominal and lower limb surgeries under epidural anaesthesia. They were divided randomly into two groups (n = 30). After epidural block, test dose was given with 3 ml 2% lignocaine with adrenaline. Both the groups received 15ml 0.5% bupivacaine, group MB received 50mg magnesium sulphate and group DB received 25µg dexmedetomidine. Onset and duration of sensory blockade, motor blockade; time required for first rescue analgesia; Ramsey sedation score; cardiorespiratory parameters and adverse events were recorded. Result:   Onset of sensory and motor blockade was rapid: duration of sensory and motor blockade; and the time for rescue analgesic was prolonged with higher sedation in group DB. Cardiorespiratory parameters and adverse effects were comparable between the two groups. Conclusion: Addition of dexmedetomidine to epidural bupivacaine can be advantageous with increased duration of sensory and motor blockade with arousable sedation, acceptable side effects and better patient comfort compared to addition of magnesium sulphate.

Background: Corona virus disease 19 (Covid-19) was declared as global pandemic by WHO in March 2020. India has witnessed two waves of Covid 19 in the month of March 2020 and March 2021. Due to improper use of steroids in the treatment of these patients post covid mucormycosis patients had increased drastically in the second wave. This has taken a toll on physical and mental health alike. There is equally rise in the psychiatric comorbidities in post covid mucormycosis patients. Various disorders like Post traumatic stress disorder (PTSD), anxiety, depression, sleep disorders have been reported in COVID-19 survivors. Current study aims to estimate the prevalence of psychiatric disorders and its associated correlation in patients with mucormycosis. Methods: The study population comprised the patients referred to the Psychiatry outpatient department (OPD) of tertiary health care center from the post covid OPD over 6 months i.e. July 2021 to december 2022. Patients were assessed using a semi structured proforma, sociodemographic profile, treatment facility ( institutional or home quarantined), duration of stay at treatment facility, medical and psychiatric diagnosis were recorded and analysed using descriptive statistics. Results: 83 patients were included and assessed of which 78.3% were male and 21.6% were female. Mean age was 52.19 years. The referral rate was found to be 12%. Most common psychiatric disorder was sleep disorder (24%), followed by stress and trauma related disorder (15.6%), depression (12.04%), anxiety disorder (9.6%). Conclusion: The study emphasize on vigilant approach and constant supervision of these patients so that an early diagnosis could be made and an add on burden to mental health care system could be reduced.

Background: This study was conducted to evaluate the effectiveness of hand and foot massage therapy on post-operative pain among patients undergoing cardiothoracic surgery and evaluate the effectiveness of hand and foot massage therapy on anxiety among patients undergoing cardiothoracic surgery. Methods: This was a hospital-based study conducted among 60 patients who underwent cardiothoracic surgery in the cardiothoracic ICU of Medical College Hospital, Thiruvananthapuram, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: It is evident that the mean age of participants in the experimental group was 50.43 and the standard deviation was 11.61 and the mean age of the control group was 54.53 and the standard deviation was 8.25. Hence, the difference was not statistically significant because both groups were not comparable with respect to age. 80% of participants in the experimental group and 60% in the control group were males whereas 40% of participants in the experimental group and 20% in the control group were females. Hence, the difference was not statistically significant, both groups were comparable with respect to gender. In the distribution of participants based on type of analgesic, effectiveness of hand and foot massage therapy on postoperative pain among patients undergoing cardiothoracic surgery, the effectiveness of hand and foot massage therapy on postoperative anxiety among patients undergoing cardiothoracic surgery were found to be statistically significant. Conclusion: Hand and foot massage therapy has been found to be effective in reducing postoperative anxiety among cardiothoracic surgery patients.

Background: In the West, coronary heart disease, or CHD, is the main cause of mortality. Young people experiencing an acute myocardial infarction (AMI) is comparatively rare. Nevertheless, it remains a significant issue for both the patient and the attending physician. There are few studies of risk factors of coronary artery involvement in AMI in young adults, so the purpose of the present study is to identify the risk factors for acute myocardial infarction in rural India. Methods: This was an institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from May 2020 to July 2021. Total 100 patients admitted with AMI during this period meeting the inclusion and exclusion criteria were included in this study. A Microsoft Excel spreadsheet containing the data was used for data entry, and SPSS (version 2710; SPSS Inc., Chicago, IL, USA) was used for analysis. Result: In the present study mean age of patients was 35.21 ±4.39 years, majority of patients belonged to age group of 36-40 years (56%). The mean BMI was 27.23 ±3.34 kg/m2. The most common presentation was chest pain (90%) followed by profuse sweating (65%), radiation to left shoulder/arm (45%), nausea/vomiting (40%), anxiety (38%), breathlessness (28%). Most common risk factor was smoking (85%) followed by hyperlipidemia (82%), family history of premature coronary artery disease (72%), hypertension (52%), sedentary lifestyle (42%), psychosocial stress (38%), obesity (16%) and diabetes mellitus (14%). Majority of the study subjects had more than 3 risk factors (64%), while 21% had 3 risk factors, 13% had two risk factors. Mean level of cardiac enzyme marker CKMB was 38.42 ±5.67 IU/L. Conclusion: Acute MI in young patients is becoming a rising problem in Indian subcontinent which is more common in men. Smoking was the most common risk factor of MI in them indicating atherosclerosis could be the commonest cause followed by dyslipidemia.

The prevalence of depression and anxiety disorders globally necessitates a multifaceted approach to treatment. This review paper delves into the beneficial impacts of exercise, yoga, and meditation as adjunctive therapies for these mental health conditions. Through a comprehensive analysis of recent studies, the paper elucidates the substantial contributions of these holistic practices to the treatment of depression and anxiety. It examines the underlying physiological and psychological mechanisms by which exercise, yoga, and meditation enhance mental well-being. Furthermore, the paper provides pragmatic guidelines for the integration of these practices into standard treatment protocols, considering the individual variability in response and the challenges associated with adherence and accessibility. The synthesis of current research presented in this paper aims to inform healthcare professionals and policymakers, fostering a more integrative approach to mental health care.

Introduction: Sexual dysfunction (SD) is a common adverse effect associated with the treatment of psychotropic drugs, particularly antidepressants (AD) and antipsychotics (APs). Clinicians increasingly recognize the importance of acknowledging and managing SD to ensure long-term adherence to medication. This adverse effect poses a significant challenge, as it can severely impact the quality of life and treatment compliance among patients. Materials and Methods: Patients must meet a diagnosis in ICD-10 that falls under psychotic spectrum disorders (cases generally include only first episode psychosis), depression, and anxiety. Remission of the disease is indicated by a decrease in scores on appropriate scales about that disease. Patients diagnosed with first-episode psychosis, depression, or anxiety are started on antipsychotics and antidepressants, respectively. Patients who achieve remission in 6-8 weeks of treatment are considered for the study. Selection will be through a random sampling method. Patients meeting the inclusion and exclusion criteria will be chosen for the study. The nature of the study will be explained to the patients. After obtaining informed consent, patients will be interviewed, and details will be collected per the 
socio-demographic proforma. Results: From the table, the vast majority of patients fall into the age group between 21-30 years (38.7%), followed by the 31-40 years age group (32.7%). Female patients (53.6%) constitute a higher proportion than male patients (46.4%). Most of the population is employed (73.2%) compared to the unemployed group (15.5%). Most of the patient group lies in class 3 socioeconomic class (lower middle class- 58.9%). The subset of patients belonging to the group ‘not applicable’ are males, excluding most female patients who have regular menstrual cycles (39.9%). Conclusion: The study notes a decline in sexual functioning after the use of antipsychotics and antidepressants, which mainly depends on the baseline sexual functioning, dose of the drug, and type of the drug. The decline in sexual functioning (drug-induced) is often less than 50% in sexual functioning domains. Individuals with higher baseline scores in sexual functioning domains experience less or no dysfunction with minimal effective doses. Patients with higher baseline sexual functioning report a decline in sexual satisfaction than before, but their scores do not correlate with sexual dysfunction. With maximum doses of an individual drug, sexual dysfunction becomes obvious

Introduction: The Human Immunodeficiency Virus (HIV) undermines the immune system, compromising the body's ability to fend off infections and certain cancers. This virus leads to the destruction and malfunction of immune cells, causing those infected to progressively suffer from immunodeficiency. Typically, the functioning of the immune system is assessed through the count of CD4 cells. Materials and Methods: A hospital-based observational cross-sectional study design was adopted. 150 patients were selected through systematic random sampling from January 2023 to December 2023. Patients who were known cases of HIV or recently diagnosed and presented in the Department of Medicine and all ART clients who attended the ART clinic in the Department of General Medicine at a Tertiary care Hospital in Hyderabad were included in the study considering the inclusion and exclusion criteria. Results: The majority of the study participants who were on ART and had anxiety and depression were females, 37.14%, compared to males, 27.7%. The majority of study participants having anxiety and depression were illiterate, 39.43%, followed by those with primary plus secondary schooling, 28.35%, graduates, 20.68%, and postgraduates, 11.6%. Conclusion: 30% of individuals reported clinical features of anxiety, depression, and mixed features of both. Female patients were more affected than male patients. Participants who were on less than 1 year of ART duration had the maximum depression, anxiety, and combined features of both. Highly depressed patients reported lower levels of CD4 count at the beginning. The treatment year of the patients was positively associated with a higher CD4 count at present; the duration of the ART regimen was associated with a high level of CD4 count at present. Therefore, early psychiatric intervention, psychological assessment, and treatment for depression or anxiety must be initiated to ensure better coping, treatment, and long-term compliance for ART in people living with HIV.

Background: Depression and anxiety are common psychiatric conditions that can significantly affect the quality of life. However, their prevalence among general medicine outpatients remains inadequately explored. Methods: This cross-sectional study involved 200 general medicine outpatients from a tertiary care hospital. Standardized tools, the Patient Health Questionnaire (PHQ-9) for depression and the Generalized Anxiety Disorder (GAD-7) scale for anxiety, were utilized to assess the prevalence rates. Results: Of the 200 outpatients studied, the prevalence of clinically significant depression was found to be 35%, while anxiety was detected in 30% of the patients. Comorbidity of both conditions was observed in 20% of the subjects. Conclusion: The study highlights a significant prevalence of depression and anxiety among general medicine outpatients, emphasizing the need for routine screening and integrated psychiatric care in general medical settings.

Introduction: Surgery and anaesthesia are uncomfortable experiences for patients, often causing stress and anxiety that can impede the intended therapeutic outcomes. Increased stress and anxiety may have a deleterious impact on post-operative analgesic use and pain perception. Advancements in anaesthesia extend anesthesiologists’ role beyond the surgery, allowing for an anaesthesia in diverse procedures, and raising patient expectations for comfortable treatment. (1) At least two days before the operation, anxiety affects a majority of patients scheduled for surgery. Materials And Methods: After obtaining institutional ethics committee approval (SGRD/IEC/2022-163 dated 13.12.2022) and the patient’s informed consent, this prospective semi-experimental randomised single-blind controlled study was conducted to investigate the effect of music (the independent variable) on cortisol levels, VAS-A scores and VAS pain scores (the dependent variables). The study was conducted in 100 patients of either sex in the age group between 18 to 60, with ASA classification I and II, undergoing Laparoscopic Cholecystectomy from January 2023 to December 2023.Results: The demographic characteristics of the study participants were analysed and there were no statistically significant differences in the mean values of all the characteristics. (Table 1) As shown in Table 2 on comparing mean VAS-A scores among the three groups, the difference at the baseline was statistically not significant (p-value 0.77) but when the three groups were compared after the respective interventions, the scores before surgery were significantly lower in group A than in groups B and C (p-value 0.037) additionally, scores of group B were significantly lower than group C. Similar findings were seen when the three groups were compared after surgery (p-value 0.02).Conclusion: Music therapy especially listening to music of choice is a safe and effective non-invasive non-pharmacological intervention with several benefits for surgical patients. It reduces the need for pain medication during the postoperative period without causing any side effects. It also hinders the increase of blood cortisol levels. Additionally, music therapy helps lower anxiety enhancing the overall surgical experience for patients.

Introduction: Pregnancy is an incredibly stressful period due to outcome of delivery, anxious about the well-being of the unborn child, added responsibilities once the child is born, financial obligations, adapting to her postpartum body, interpersonal relationships with her spouse and other family members. Aim & Objectives: 1. To determine whether higher anxiety levels in term patients has significant effects on the duration, progress and complications of labour, 2.To assess whether significant maternal anxiety can lead to an increase in caesarean sections or instrumental deliveries, 3.To assess the difference in anxiety levels between term primigravida and term multigravida. Methodology: The study was a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology in IGMC&RI.  Antenatal women in the low-risk group with gestational age more than or equal to 37 weeks, who gave consent for participation were included in the study. Antenatal women who refused to give consent or those with known co-morbidities complicating labour like gestational diabetes mellitus, pregnancy induced hypertension, multiple gestation, breech presentation, placental abnormalities like placenta previa or abruption, previous history of caesarean section and cephalo - pelvic disproportion were excluded. Results: The demographic details of the participants are shown in Table 1. Out of the 269 participants analysed for the study, Majority of them were housewives, belonged to the age group of 25-30 years (40%). Majority were graduates (49%) and pregnant for the first time (primi) (56.1%). Conclusion: The significance of this study is that maternal anxiety was found positive in about 105 patients, among which 19 participants had severe anxiety. These anxiety scores if known during the antenatal chechups can help in interventions for the betterment of maternal health including guidance and counselling

Background: The COVID-19 pandemic had been uniquely challenging for the general as well as pregnant and postpartum women. Uncontrollable stress arising due to its high infectivity has exacerbated risk for maternal depression and anxiety, in turn leading to adverse mother and child outcomes. The aim of present study was therefore to assess the psychological responses of Covid 19 pandemic in pregnancy and post –partum women. Methods: The current study was a questionnaire based cross sectional study done for one year, in a tertiary care hospital of Northern India. After getting ethical clearance from university ethical committee a face-to-face interview using three scales namely Generalized Anxiety Disorder 7-Item Scale (GAD-7), Hamilton depression score (HAM-D), Fear ofcovid 19 scale was applied on 192 pregnant and and post –partum women who visited hospital and their response was assessed. Responses were calculated as scores as used in validated questionnaires and were categorized accordingly. Results: Responses of total 192 patients included in the study (cases/covid positive=96 and control/covi negative=96), it was found that overall anxiety was more prevalent in Covid positive group as compared to covid negative group with 53% of cases had severe anxiety. Hamilton depression scale used to assess depression showed that depression was also more prevalent in covid positive group as compared to covid negative group with distribution of Severe, and Very Severe depression in 26.04%, and 35.42% in case group respectively. Fear was more prevalent in case group as compared to covid negative group with the percentage distribution of mild and severe fear to be 20.83% and 79.17% in case and in control group the percentage distribution being 83.33% and 16.67%. This difference in the two groups was also found to be statistically significant. Conclusion: Anxiety, depression and fear was significantly more prevalent in the covid positive pregnant and post - partum women however control group was also not free from anxiety, depression and fear due to Covid 19.

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

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.

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.

Background: Epilepsy is associated with significant psychiatric and cognitive comorbidities. This cross-sectional study evaluates the prevalence of cognitive impairment (CI) and psychiatric disorders in 100 individuals with epilepsy (PWE) attending a tertiary neurology clinic in India. Methods: Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination-III (ACE-III). Psychiatric morbidity was evaluated using the Mini-International Neuropsychiatric Interview (MINI). Results: CI was identified in 66% (MoCA <26) and 90% (ACE-III <83) of participants. Psychiatric comorbidities were present in 17%, with major depressive disorder (64.7%) and social anxiety disorder (35.3%) being most prevalent. CI correlated with lower education (p<0.001), unemployment (p=0.001), polytherapy (p=0.03), and longer epilepsy duration (p<0.001). No significant association was found between CI and psychiatric morbidity (p=0.12). Conclusion: High rates of CI and psychiatric disorders highlight the need for routine screening and multidisciplinary care in epilepsy management.

Background: Neonatal surgery is often performed to correct life-threatening conditions in newborns. However, little is known about its long-term impact on developmental and psychiatric outcomes in early childhood. This cohort study aimed to examine the association between neonatal surgery and the occurrence of developmental delays and psychiatric disorders in children. Methods: A cohort of children who underwent neonatal surgery was compared with a control group. Data on demographic characteristics, developmental delays at age 3, and psychiatric disorders at age 5 were collected. Statistical analyses included chi-square tests and multivariate regression models. Results: There were no significant differences between the two groups in terms of gender, gestational age, or birth weight. At age 3, 30% of children in the neonatal surgery group exhibited developmental delays, compared to 12% in the control group (p = 0.02). Specifically, motor delays were more prevalent in the neonatal surgery group (20% vs. 8%, p = 0.04). At age 5, 20% of children in the neonatal surgery group had psychiatric disorders, compared to 8% in the control group (p = 0.03). Anxiety disorders were more common in the surgery group (12% vs. 4%, p = 0.09). Multivariate analysis revealed that neonatal surgery was significantly associated with both developmental delays (OR = 2.8, p = 0.02) and psychiatric disorders (OR = 2.5, p = 0.03). Conclusion: Neonatal surgery is associated with a higher risk of developmental delays and psychiatric disorders in early childhood. These findings highlight the importance of early monitoring and intervention for children who undergo neonatal surgery

Background: Face being the most exposed, area of body ,present early to clinician for getting evaluated. As FNAC is a non-scarring simple, OPD based, sensitive technique for evaluating these easily assessable sites, is the first investigation of choice. Quick reporting help to relieve patient anxiety. This study is aimed to tell reliability and utility of FNAC in case of face lesions.  Material and Methods: FNAC was performed in face lesion presenting in one year duration along with clinical and radiological details. The cytology reports were correlated with histopathology and immunohistochemistry in difficult cases.  Result: Toal 15 face lesions including forehead, facial bones, eye, lacrimal gland, nose, cheek, lips and salivary gland were studied. Majority were female with peak age 45 years. Lesions varied from inflammatory cystic lesions, benign and malignant. Lesions included 4 epidermal cyst,1 sialoadenitis,5 pleomorphic adenoma, 2 squamous cell carcinoma,1 solitary fibrous tumor,1giant cell tumor of mandible and 1 case of metastasis of follicular carcinoma thyroid in facial bone and orbit.

Pulmonary arterial hypertension (PAH) is a rare and progressive condition characterized by elevated blood pressure in the pulmonary arteries, often presenting with symptoms such as dyspnea, fatigue, and chest pain, particularly during exertion. This case report details a 37-year-old male patient with a history of kyphoscoliosis, who was referred for evaluation due to worsening breathlessness, anxiety, and abdominal distention over the past year. Clinical examination revealed significant cyanosis and respiratory distress, with imaging studies confirming PAH indicated by dilated pulmonary arteries and an enlarged cardiac silhouette. The patient's complex presentation also included mild hepatic changes and the identification of Pseudomonas aeruginosa, suggesting possible infection. This case underscores the challenges in diagnosing PAH, particularly in patients with multifactorial health issues. It emphasizes the necessity for comprehensive evaluations, including imaging and hemodynamic assessments, to facilitate timely and accurate diagnosis. A multidisciplinary approach to management is crucial for improving patient outcomes, highlighting the importance of early recognition and individualized treatment strategies to enhance quality of life in PAH patients.

Background and Aim: Preoperative anxiety in children can complicate anesthetic induction. This study compares intranasal dexmedetomidine and intranasal ketamine as premedicants in pediatric surgical patients. Material and Methods: 66 pediatric patients (ASA I and II, aged 2–10) undergoing elective surgery were randomized to receive either intranasal dexmedetomidine (1 µg/kg) or intranasal ketamine (5 mg/kg). Sedation level, ease of parental separation, IV cannula acceptance, hemodynamic parameters, and side effects were recorded. Results: Dexmedetomidine showed better sedation scores and smoother parental separation, while ketamine had quicker onset but more side effects. Conclusion: Intranasal dexmedetomidine provides effective premedication with fewer side effects, while ketamine ensures faster onset.

Background: Generalized Anxiety Disorder (GAD) is a prevalent and debilitating psychiatric condition. Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed as first-line pharmacological treatments. This retrospective study evaluates the efficacy and tolerability of SSRIs in managing GAD. Objective: To assess the clinical outcomes and adverse effect profile of SSRIs in patients with GAD over a 12-week treatment period. Methods: This retrospective analysis included 100 adult patients diagnosed with GAD who were prescribed SSRIs and followed for 12 weeks. Data were extracted from electronic medical records over a one-year period. Efficacy was assessed using changes in Hamilton Anxiety Rating Scale (HAM-A) scores at baseline, week 6, and week 12. Tolerability was evaluated based on reported adverse events and treatment discontinuation rates. Results: The mean baseline HAM-A score was 25.4 ± 4.2, which significantly decreased to 11.8 ± 3.5 at week 12 (p < 0.001), representing a 53.5% reduction. Clinical response (≥50% reduction in HAM-A) was achieved in 68% of patients, and 34% reached remission (HAM-A ≤7). Escitalopram was the most prescribed SSRI and showed the highest efficacy. Adverse effects included nausea (20%), insomnia (14%), and sexual dysfunction (12%). Seven patients (7%) discontinued treatment due to side effects. No serious adverse events were reported. Conclusion: SSRIs demonstrated substantial efficacy and acceptable tolerability in the management of GAD. Escitalopram appeared to be the most effective among the SSRIs used. These findings support the continued use of SSRIs as a primary pharmacological treatment for GAD.

Background: Medical students face a unique set of academic and personal stressors that significantly impact their mental well-being and overall academic performance. This study aims to identify and analyse the key stress factors affecting medical students and their coping mechanisms. Methods: A cross-sectional survey-based study was conducted among 50 medical students using an anonymous Google Form questionnaire. The survey assessed academic stressors such as exam pressure, workload, and faculty support, as well as personal stressors including financial constraints, social isolation, and family expectations. Data were analysed using descriptive and inferential statistical methods. Results: The findings indicate that a majority of students reported experiencing moderate to high stress levels, with academic pressure being the most cited stressor. Examination-related anxiety, excessive workload, and lack of faculty support were identified as key contributors. Personal stressors such as financial difficulties, social isolation, and family expectations also played a significant role. Many students struggled to maintain a work-life balance and adopted various coping mechanisms, including exercise, peer support, and mindfulness practices. Statistical analysis revealed a strong correlation between academic stress and anxiety levels. Conclusion: The study highlights the significant impact of both academic and personal stressors on medical students. Institutions must prioritize mental health interventions, implement structured mentorship programs, and provide access to professional counselling services. Addressing these stress factors can improve student well-being and foster resilience among future medical professionals.

Background: Heart rate variability (HRV) is a recognized indicator of autonomic nervous system function, particularly cardiac vagal activity (CVA), which is regulated by the Central Autonomic Network (CAN). In females, hormonal fluctuations across the menstrual cycle influence CAN activity, potentially affecting both psychological states and cognitive performance. While emerging evidence suggests a connection between HRV, mood, and cognition, the differential impact of autonomic and psychological factors on specific cognitive domains in women remains underexplored. Material and Methods: This cross-sectional observational study was conducted over 18 months in the Department of Physiology, IGIMS, Patna and included 200 community-dwelling females aged 18–60 years with at least 12 years of formal education. HRV was measured using the AD Instruments PowerLab system, assessing total power (TP), low frequency (LF), high frequency (HF), and LF/HF ratio. Psychological profiles were evaluated using the Hamilton Anxiety Rating Scale (HAM-A) and the Beck Depression Inventory-II (BDI-II). Cognitive domains were assessed using a standardized neuropsychological battery, including the Rey Auditory Verbal Learning Test (RAVLT), Rey’s Complex Figure Test, Digit and Spatial Span tasks, and the Color-Word Stroop Test. Statistical analyses included Pearson’s correlations and multiple regression modeling. Results: Higher HF power was positively correlated with better verbal memory (r = 0.32, p = 0.001) and working memory (r = 0.28, p = 0.004), while a higher LF/HF ratio was negatively associated with executive function (r = -0.25, p = 0.008). Psychological distress was also linked to cognitive outcomes; anxiety scores (HAM-A) were negatively correlated with verbal memory (r = -0.30, p = 0.002) and executive function (r = -0.29, p = 0.003), and depression scores (BDI-II) were inversely related to visual memory (r = -0.27, p = 0.006). Regression analyses confirmed HF power and lower anxiety as significant predictors of improved verbal and working memory, while increased LF/HF ratio and anxiety predicted poorer executive function. Conclusion: The study demonstrates that both autonomic function and psychological profile significantly influence cognitive performance in females. Enhanced parasympathetic activity and reduced anxiety and depression levels were associated with superior performance across cognitive domains. These findings underscore the importance of integrating HRV and psychological assessments in understanding female cognitive health and contribute to the broader understanding of sex-specific neurovisceral integration.

Background: Chronic Pelvic Pain Syndrome (CPPS) is a multifactorial condition characterized by persistent non-cyclical pelvic pain in women, often accompanied by psychological and functional impairments. Emerging evidence suggests a potential link between chronic pain, and cognitive impairment. However, this interplay remains underexplored in women with CPP. This study aimed to assess cognitive dysfunction in women with chronic pelvic pain and explore their interrelationship. Materials and Methods: This cross-sectional observational study was conducted over 18 months at the Department of Physiology in collaboration with Gynecology Outpatient Department of IGIMS, Patna. A total of 200 female participants aged 18–60 years were enrolled, including 100 diagnosed with chronic pelvic pain and 100 age-matched healthy controls. Pain was assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ). Cognitive function was assessed using a neuropsychological battery including the Mini Mental State Examination (MMSE), RAVLT, CFT, and the Victoria Stroop Test. Psychological status was evaluated using the Perceived Stress Scale (PSS), Hamilton Anxiety Rating Scale (HAM-A), and Beck Depression Inventory-II (BDI-II). Statistical analyses included independent t-tests. Results: Cognitive testing revealed significant impairments in verbal memory, visual memory, and executive function (p < 0.001). Psychological assessments showed significantly higher stress, anxiety, and depression scores in the CPP group (p < 0.001).  Conclusion: Women with chronic pelvic pain demonstrated marked cognitive impairments, closely associated with increased psychological distress. The observed correlation between underscores a shared pathophysiological mechanism. These findings emphasize the importance of a holistic, multidisciplinary approach incorporating cognitive and psychological assessments into the management of CPP.

Background: Heart rate variability (HRV) serves as a non-invasive measure of autonomic nervous system (ANS) function and has garnered increasing interest in psychiatric research due to its association with mental health disorders. Bipolar disorder (BD) is known to be linked with increased cardiovascular morbidity and mortality, potentially mediated through autonomic dysregulation. However, studies assessing HRV in drug-naïve BD patients remain limited. This study aimed to evaluate HRV in non-medicated patients with bipolar disorder compared to healthy controls, using time-domain, frequency-domain, and non-linear analyses. Materials and Methods: This cross-sectional observational study included 60 drug-naïve patients diagnosed with bipolar disorder and 100 age- and sex-matched healthy controls, all aged 18–60 years. Participants underwent clinical assessment using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression-Severity (CGI-S) scale. HRV data were recorded using a validated system (AD Instruments, Australia) under resting conditions. HRV parameters were analyzed across time-domain (SDNN, RMSSD, NN50, pNN50), frequency-domain (LF, HF, LF/HF ratio), and non-linear indices (SD1, SD2, approximate entropy). Statistical analysis was performed using Student’s t-test and Pearson’s correlation, with p < 0.05 considered statistically significant. Results: BD patients exhibited significantly reduced HRV compared to controls across all time-domain, frequency-domain, and non-linear measures (p < 0.001). The LF/HF ratio was significantly elevated in the BD group, indicating heightened sympathetic dominance. Clinical scores were significantly higher in BD patients across all scales (p < 0.001). HRV parameters such as SDNN, RMSSD, HF power, and approximate entropy showed significant negative correlations with symptom severity, while LF/HF ratio showed a positive correlation. Subgroup analysis revealed that patients in manic episodes had a significantly higher LF/HF ratio than those in depressive episodes (p = 0.024), suggesting greater sympathetic activation during mania. Conclusion: The study demonstrates significant autonomic dysfunction in non-medicated individuals with bipolar disorder, independent of pharmacological influence. The consistent reduction in HRV and its association with symptom severity underscores autonomic imbalance as a potential physiological hallmark of BD. HRV may serve as a valuable biomarker for assessing emotional and physiological regulation in BD, with implications for early cardiovascular risk detection and personalized treatment approaches.

Background: Dizziness is a pretty common complaint, and while doctors often think about heart issues particularly in patients who are already diagnosed with cardiac conditions, but when patients with heart disease feel dizzy, there are plenty of other potential causes. This study looks into those other causes of dizziness in cardiac patients who came to hospitals in a rural part of Jammu and Kashmir (J&K), India. Methods: We reviewed medical records of cardiac patients who showed up at Govt. Medical College Doda in remote area of J&K, complaining of dizziness, between January 2019 and December 2023. We collected information like their age, sex, heart diagnoses, non-heart-related causes of dizziness, and what the doctors found. We used some basic statistical methods to analyze the data, and we also compared our findings with what other studies have reported. Results: Over those 5 years, 2476 cardiac patients came to the hospitals because of dizziness. Their average age was 47.5 years and about 53% were female. The most common heart problems were Hypertension, coronary artery disease, heart failure, and cardiac arrhythmias. In a pretty significant number of these patients—around 1039 (42%)—the dizziness wasn't due to their heart. The most frequent non-cardiac causes were:

• Vestibular disorders: 280 (26.94%) Benign Paroxysmal Positional Vertigo (BPPV): 145 (13.95%), Meniere's disease 83 (7.99%), Vestibular Neuritis: 52 (5%).
• Medication-related: 218 (20.98%) Diuretics: 135 (12.99%), Beta-blockers:83 (7.98%).
• Neurological disorders: 177 (17.03%) (Peripheral Neuropathy: 114 (10.97%), Migraine: 63 (6.06%).
• Psychogenic factors: 135 (12.99%) anxiety disorder 83 (7.98%), Depression 52 (5%).
• Metabolic disorders: 11 (10.87%) (Anemia: 73 (7.02%), Hypoglycemia: 41 (3.95%).
• Cervical spine issues: 116 (11.36%).

Conclusion: Non-cardiac causes of dizziness are quite common in cardiac patients in this rural part of J&K. Inner ear problems and medication side effects were particularly frequent. Neck issues also seem to be a factor. These results suggest that when cardiac patients have dizziness, doctors really need to consider all the possible reasons, not just their heart condition. More in-depth studies with larger numbers of patients would help to confirm these findings and figure out who might be more at risk

Background: The COVID-19 pandemic has posed unprecedented challenges, especially for individuals with underlying comorbidities. Among these, metabolic syndrome (MetS) — characterized by central obesity, dyslipidemia, hypertension, and insulin resistance — has emerged as a key determinant of adverse outcomes. This study aims to prospectively assess the long-term post-COVID complications in patients with pre-existing MetS, focusing on cardiometabolic, respiratory, and neuropsychiatric sequelae. Materials and Methods: A prospective cohort study was conducted across three tertiary healthcare centres in India. A total of 300 patients aged 30–65 years with laboratory-confirmed COVID-19 and pre-existing MetS (as per IDF criteria) were enrolled. Follow-up assessments were conducted at 3-, 6-, and 12-months post-recovery. Clinical outcomes including new-onset type 2 diabetes, exacerbation of hypertension, pulmonary fibrosis, persistent fatigue, and cognitive decline were evaluated using structured clinical assessments, laboratory tests, and imaging modalities. A control group of 200 COVID-19-recovered patients without MetS was also followed for comparison. Results: At 12 months follow-up, 42.3% of patients in the MetS group reported persistent fatigue compared to 18.5% in the control group (p<0.01). New-onset type 2 diabetes was observed in 26.7% of MetS patients versus 8.0% in controls (p<0.001). Pulmonary complications such as reduced DLCO and fibrotic changes were documented in 33.1% of MetS cases and 14.5% of controls (p<0.05). Neurocognitive issues, including memory deficits and anxiety, were more prevalent in the MetS group (38.5%) than in controls (21.0%) (p=0.02). Conclusion: Individuals with pre-existing metabolic syndrome are at significantly increased risk of developing long-term post-COVID complications, including cardiometabolic dysfunction, chronic respiratory impairment, and neuropsychiatric disturbances. These findings highlight the need for tailored post-COVID monitoring and management strategies in this high-risk population.

Background: Pruritus represents a distressing but often neglected comorbidity of type 2 diabetes mellitus (DM2) with possible impacts on quality of life (QoL), glycemic management, and psychological status. However, there is a dearth of Indian clinical data on this entity. The present study was designed to find out the prevalence, severity and clinical as well as psychological correlates of pruritus among adult DM2 patients in a tertiary care hospital in India. Methodology: This is a cross-sectional study that was performed from February 2023-22 at the College of Medicine, a tertiary care hospital, in which 354 adult DM2 patients were thpatient: 1). Itch was evaluated according to the Numerical Rating Scale (NRS) and Four-Item Itch Questionnaire (4IIQ). Diabetic neuropathy was evaluated by Katzenwadel scale. ItchyQoL, Hospital Anxiety and Depression Scale (HADS). Metabolic indicators including HbA1c and FPG were compared among patients with and without pruritus. Results: One hundred and thirty-nine (39.3%) of the patients reported pruritus. Mild, moderate and severe itch accounted for 27.3%, 48.2%, and 24.5% of them, respectively. Patients with pruritus had higher HbA1c levels (8.6 ± 1.2 vs. 7.9 ± 1.0; p = 0.003) and FPG (165.2 ± 28.6 vs. 151.8 ± 25.9 mg/dL; p = 0.012). Psychologic assessment demonstrated higher levels of anxiety (9.3 ± 2.1), depression (8.1 ± 1.9), and stigmatization scores (5.4 ± 1.6) in pruritic patients. Conclusion: Pruritus is a prevalent and burdensome symptom in Indian patients with DM2, significantly associated with poor glycemic control, and diabetic neuropathy. It also imposes substantial psychosocial stress, highlighting the need for integrated dermatologic and psychological evaluation in routine diabetes management.

Background: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms affecting multiple organ systems beyond the acute phase. These include respiratory dysfunction, neurological deficits, and psychological disturbances, severely impairing quality of life. The complexity of this syndrome necessitates a multidisciplinary approach for effective diagnosis and management. This study aimed to evaluate the clinical outcomes of an integrated care model involving pulmonology, neurology, and psychological assessment in patients with Long COVID. Materials and Methods: A total of 120 patients (aged 20–65 years) diagnosed with Long COVID (symptoms persisting >12 weeks post-infection) were enrolled. Participants underwent comprehensive evaluations: pulmonary function tests (spirometry, DLCO), neurological assessments (cognitive function via MoCA scale, neuropathy screening), and psychological evaluation (using GAD-7 and PHQ-9 scores). Patients were then managed with individualized multidisciplinary interventions for 12 weeks, including pulmonary rehabilitation, neurocognitive therapy, and psychological counseling. Clinical outcomes were assessed at baseline and after 12 weeks. Results: At baseline, 72% of patients had reduced DLCO values (<80%), 58% demonstrated mild cognitive impairment, and 66% showed moderate to severe anxiety/depression symptoms. After 12 weeks of integrated care, 80% of patients exhibited significant improvement in DLCO (>10% increase, p < 0.001), 67% showed improvement in MoCA scores by an average of 3 points (p = 0.002), and 74% reported reduced GAD-7 and PHQ-9 scores (p < 0.001). Patient-reported quality of life (measured via EQ-5D-5L) improved significantly in 82% of cases. Conclusion: Multidisciplinary management of Long COVID, incorporating pulmonary, neurological, and psychological interventions, significantly improves clinical and functional outcomes. This approach highlights the importance of integrative care in addressing the complex, multisystemic nature of post-COVID syndromes.

Background: Diabetic Peripheral Polyneuropathy (DPN) is a debilitating complication of diabetes mellitus characterized by progressive nerve damage, leading to sensory disturbances and neuropathic pain. Pharmacologic management includes anticonvulsants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). However, comparative data on combination therapies for DPN, particularly Pregabalin plus Nortriptyline (Preg-Nort) versus Pregabalin plus Duloxetine (Preg-Dul), remains limited. Methods: A double-blind, randomized controlled trial was conducted on 80 patients diagnosed with DPN. Participants were assigned to either the Preg-Nort (Pregabalin 75 mg + Nortriptyline 10 mg) or Preg-Dul (Pregabalin 75 mg + Duloxetine 20 mg) group for 12 weeks. Primary outcomes included pain reduction (VAS score), while secondary outcomes evaluated insomnia severity (ISI), anxiety (HADS-A), depression (HADS-D), and incidence of adverse effects. Data were analyzed using SPSS v24, with significance set at p < 0.05. Results: Both groups exhibited significant pain reduction, with Preg-Dul achieving faster pain relief at 4, 6, and 8 weeks (p < 0.05), though long-term efficacy converged. Preg-Nort improved insomnia scores earlier (4 weeks, p < 0.001), but differences diminished over time. Anxiety reduction was comparable between groups, whereas Preg-Dul demonstrated greater depression improvement by 8 and 12 weeks (p < 0.05). Adverse events differed: Preg-Dul had higher nausea and vomiting incidence, while Preg-Nort caused more dry mouth (p < 0.01). Conclusion: Pregabalin plus Duloxetine provided superior early pain relief and greater depression improvement, whereas Pregabalin plus Nortriptyline exhibited faster insomnia relief. Safety profiles varied, necessitating individualized treatment selection. These findings support the tailored use of combination therapy for DPN, factoring in symptom priorities and side effect tolerability.

Introduction: The coronavirus disease (COVID-19) pandemic has had a worldwide impact on the population and heath care systems. Coronavirus pandemic has seen the introduction of novel methods of delivering education to medical students using various platforms such as Zoom. The present study was conducted to assess the effectiveness of online learning among medical students during COVID-19. Materials and methods:  This cross-sectional study was conducted in Department of Physiology, Dr. B.R. Ambedkar Medical College & Hospital, Bengaluru, Karnataka, India. This was a questionnaire-based study and the questions were based on a pre-validated questionnaire from a study done in UK. The questions included general information of the student and related to advantages and disadvantages of online learning during COVID-19. There were 20 questions and were of various styles including 5-point Likert scale ranging from strongly disagree to strongly agree. Few questions had single answer and few had multiple answers. This study invited 300 undergraduate medical students belonging to 2nd year, 3rd and final year during 2022. In this study, a total of 270 undergraduate medical students were participated, among them, 2nd year students were 94, 3rd year students were 96 and final year students were 80. Informed consent was obtained from all the study participants. Data was downloaded from google form in Microsoft excel and was used for analysis.  Results: Out of 270 students, females were 159 (58.8%) and males were 111 (41.1%). Before COVID-19 pandemic, 95 (35.1%) of the students never used online platforms for learning whereas 86 (31.8%) were using to some extent and 87 (32.2%) were using to great extent. When students were asked about most effective method of online learning, their first priority was combined videos and tutorials then followed by you tube videos and live tutorials alone. When they were asked if teaching was stimulating, 46 (17%) of them disagreed, 148 (54.8%) were neutral and 76 (28%) students agreed to that. When asked if it was easy to concentrate on online lectures, 120 (44.4%) strongly disagreed, 81 (30%) were neutral and 69 (25.5%) agreed to that. Students felt 121 (44.8%) free to ask doubts during online lectures than offline. Majority of the students around 168 (62.2%) disagreed that online teaching was as effective as offline teaching and also around 151 (55.9%) of them preferred offline teaching. When students were asked to choose the advantageous aspects of online learning, most of them (82%) opted for no travel, 50% of them said that they were more comfortable and were able to learn at own pace. Some students also felt that it was more flexible and cost saving. Among various options provided for barriers to online learning, majority of them had problems with internet connection and many had family distractions. Lack of devices, lack of space and anxiety were other barriers faced by the students. Majority of the students (38.8%) felt that online learning cannot replace the clinical teaching by direct patient contact whereas 33% of them said it has replaced only to some extent, 15% agreed that it replaced to great extent and only 12% of them opined that online learning can completely replace offline clinical teaching.  In this, 41% of the students were not able to learn clinical skills through online demonstrations whereas 47% were able to learn only to some extent and 10% of them to great extent. Conclusion: The present study may conclude that majority of the students used online platform during COVID 19. Online teaching has enabled the continuation of medical education during these unprecedented times. Moving forward from this pandemic, in order to maximise the benefits of both face-to-face and online teaching and to improve the efficacy of medical education in the future.

Context: Alcoholism is a global concern affecting both developed and developing nations. Clinicians and researchers have long expressed alarm over its profound impact on children and family dynamics. Despite well-documented consequences—such as liver damage, depression, and cognitive impairment—many individuals persist in alcohol use, highlighting the complex and entrenched nature of the disorder.  Aim: The present study aims to assess the psychopathology in children of patients with alcohol dependence. Materials And Methods: The present study is a Cross-sectional study  conducted at Government Medical College and Hospital, Anantapur. Children of patients fulfilling the ICD-10 criteria for alcohol dependence syndrome both in patients and out patients  during the period September 2023 to March 2024. Result: The current study shows majority of patients were in the middle socio-economic status & the mean age group is 36.4 years. Mean age group of children showing psychopathology was 9.34 years. Anxiety and Depression was noted to be highest in Age group more than 10 years in CPMS factor-wise score. Conclusion: Alcohol dependence should be viewed as a disorder affecting the entire family. This study supports earlier findings linking parental alcoholism to childhood psychopathology and highlights the need to treat alcohol-dependent individuals within the context of their family.

Background: Local skin infiltration of 2% lignocaine is a standard procedure which is usually used prior to lumbar puncture. It is invasive and itself leads to fear and anxiety in patients before application and is also associated with pain during the procedure. EMLA cream provides surface analgesia, hence the fear, anxiety and pain of analgesic infiltration is prevented. Against this background, the present study aimed to find out the efficacy of topical EMLA cream in comparison to the standard infiltration technique in reducing pain of needle insertion during lumbar subarachnoid block and have better patient satisfaction level.Methods: This prospective, single blinded, randomized controlled study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak after obtaining approval from Institutional Ethical Committee. Patients aged 18-60 years, of either sex undergoing elective lower abdominal, pelvic and lower limb surgeries belonging to ASA grade I and II were selected. Sixty patients were divided into two groups of 30 each: Group1 EMLA- 2.5 gms of 5% EMLA cream per 10sq.cm was applied for a minimum of 60 minutes prior to lumbar puncture and covered with an occlusive dressing; Group 2 Lignocaine - skin and deeper structures were infiltrated with 2ml of 2% lignocaine just prior to lumbar puncture. Hemodynamic parameters, pain scores and patient satisfaction were recorded. Results: Demographic characteristics were comparable between the two groups. The heart rate and mean arterial pressure values before and after lumbar subarachnoid block were statistically similar between the two groups (p>0.05). VAS scores in both groups were comparable with no significant difference amongst the two groups. The 4-point pain scale was comparable with no statistical difference between the two groups (p=0.59). There was a significant difference in patient satisfaction score in the two groups (p=0.03). Conclusion: EMLA cream is an effective alternative to lignocaine infiltration for analgesia during administration of spinal anaesthesia when using a 25G spinal needle.

Introduction: Psychiatric comorbidity with type 2 diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the relationship between psychiatric comorbidities in individuals with type 2 diabetes mellitus and quality of life. Aim And Objectives: To study the relationship between psychiatric comorbidities in individuals with type 2 diabetes mellitus and quality of life and to study the association between psychiatric comorbidity, socio demographic and clinical variables in such patients. Material And Methods:  This is a hospital based observational study where 150 consecutive patients visiting the Department of Medicine OPD or admitted in ward for the treatment of Diabetes, at Rama Medical College, Hospital & Research Centre Hapur and fulfilling the inclusion and exclusion criteria were recruited. All the subject under study were interviewed and a detailed history and clinical examination was done by using a semi-Structured performa, General Health Questionnaire 12 (GHQ12), Hospital Anxiety and Depression Scale (HADS), Brief Psychiatric rating scale (BPRS), WHO Quality Of Life BREF (Brief Hindi Version) and KUPPUSAMY SOCIO ECONOMIC STATUS SCALE. The results were tabulated and analyzed using the Chi (χ2) square test. The correlation coefficient was measured between scores of all scales using Pearson’s formula. Results: 51(51.5%) patients with psychiatric comorbidity and 43(84.3%) patients without psychiatric comorbidity were males. While 48(48.5%) patients with psychiatric comorbidity and 8(15.7%) patients without psychiatric comorbidity were females. The P value was found to be significant (0.00). 48(32.0%) patients had generalized anxiety disorder, 30(20%) had depression, 13(8.6%) had mixed anxiety and depressive disorder, 6(4%) had specific phobia (needle phobia) and 2(1.2%) had adjustment disorder. In patients without Psychiatric Co-morbidity, the mean Overall quality of life (mean± s.d.) of patients was 3.00± 1. 732.In patients with Psychiatric Comorbidity, the mean Overall quality of life (mean± s.d.) of patients was 2.46±1.593. Distribution of mean Overall quality of life with Psychiatric Co-morbidity was statistically significant (p=0.032). Conclusion:  This study concludes that in patients with Type 2 Diabetes disorder socio demographic variables like marital status, family type, education, socioeconomic status occupation have a significant impact on patient of Type 2 Diabetes disorder with psychiatric comorbidity. Quality of life is poor in patients with Type 2 Diabetes disorder with comorbidpsychiatricillness.

Background: Benign breast diseases (BBD) represent a heterogeneous group of disorders affecting up to 30% of women, often mimicking malignant conditions and causing significant patient anxiety. The ANDI (Aberrations of Normal Development and Involution) classification system offers a standardized approach to categorize and manage these conditions.

Objective: This study aimed to assess the utility of the ANDI classification in diagnosing and guiding treatment for BBD. Methods: A prospective clinical study was conducted on 100 female patients presenting with BBD at a tertiary care center from October 2024 to February 2025. Patients were classified using ANDI criteria, and data were analyzed for clinical presentation, imaging (ultrasonography, mammography), cytology (FNAC), histopathology, and treatment outcomes. Inflammatory conditions and malignancies were excluded.

Results:

• Disease distribution: Fibroadenoma (60%, *n*=60) was the most common diagnosis, followed by cyclical mastalgia with nodularity (30%, *n*=30), incapacitating mastalgia (5%, *n*=5), duct ectasia (3%, *n*=3), and giant fibroadenoma (2%, *n*=2).
• Age correlation: Peak incidence occurred in women aged 21–30 years (56%), with fibroadenoma predominating in this group (42%). Cyclical mastalgia was most frequent in ages 31–40 (16%).
• Clinical features: 50% of fibroadenomas presented as painless lumps; mastalgia cases typically involved bilateral breast pain (35%).
• Management: Surgical excision was performed for fibroadenomas (55/60) and duct ectasia (3/3), while mastalgia cases (30 cyclical, 5 incapacitating) responded to medical therapy (analgesics, hormonal modulation).

Conclusion: The ANDI classification effectively stratifies BBD, enabling tailored management. Fibroadenoma and mastalgia are the most prevalent entities, with age and symptom patterns aiding diagnosis. Conservative therapy suffices for functional disorders, while surgery remains definitive for localized lesions.

Background: This study evaluated the quality of life (QOL), sleep quality, and mental health status of 619 undergraduate students from medical, paramedical, and arts and science disciplines at Nandha Medical College and Hospital, Erode, Tamil Nadu, India, from August 2023 to December 2023. Utilizing standardized tools—WHO Quality of Life-BREF (WHOQOL-BREF), Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety and Stress Scale (DASS-42), and Subjective Well-Being Inventory (SUBI)—we assessed QOL, sleep quality, mental health parameters, and subjective well-being. Results revealed a mean overall QOL score of 63.89, with 69.79% of students reporting moderate QOL. Poor sleep quality (PSQI > 5) was prevalent in 67.53% of students, with significant associations with gender, academic discipline, and place of living. Mental health outcomes indicated normal stress levels in 70.44% of students, while depression and anxiety were less prevalent but notable, particularly among arts and science students. Significant correlations were found between QOL and depression, and between QOL and sleep quality. These findings highlight the need for targeted mental health interventions, particularly for rural and paramedical students, to enhance well-being and academic performance

Background: Excessive electronic device and social media use among adolescents is a growing concern, often linked to physical, academic, social, and emotional disturbances. Understanding usage patterns and their multifaceted impacts is essential for designing preventive strategies. Objectives: To assess the patterns of electronic device and social media use among adolescents and examine their associated physical, academic, social, and emotional consequences. Methods: A descriptive cross-sectional study was conducted among 118 adolescents aged 11–19 years using a structured, self-administered questionnaire. The survey collected data on demographic characteristics, device and social media usage patterns, and related health, academic, and psychosocial effects. Descriptive statistics were applied for analysis. Results: Most participants were aged 17–19 years (66.1%) and male (54.2%). Daily device use exceeded 3 hours in over 78% of adolescents, and 43.2% reported using social media for 1–2 hours daily. A significant proportion (66.1%) checked social media first thing in the morning, and 70.3% had attempted to quit or reduce usage. Reported physical effects included eye strain (34.7%), sleep disturbances (24.6%), and headaches (16.1%). Academic decline (66.9%) and reduced family interaction (74.6%) were common. Emotional issues such as anxiety (21.2%), loneliness (20.3%), and social isolation (16.1%) were also prevalent. Conclusion: The findings highlight a high prevalence of excessive screen time and its broad-ranging impacts among adolescents. Targeted digital hygiene education, parental supervision, and mental health support are recommended to mitigate adverse outcomes

Background: Postpartum depression (PPD) and anxiety (PPA) are major public health concerns that can significantly affect maternal wellbeing and infant development. Despite growing awareness, these conditions often remain underdiagnosed, particularly in low- and middle-income countries like India. Objective: This study aimed to determine the prevalence of postpartum depression and anxiety and to identify psychosocial factors associated with these conditions among postpartum women attending a tertiary care hospital in India. Methods: A hospital-based cross-sectional study was conducted between January 2023 and June 2024 at a tertiary care center in India. A total of 600 women aged 18–40 years, between 4 weeks to 6 months postpartum, were systematically sampled. The Edinburgh Postnatal Depression Scale (EPDS) and the Zung Self-rating Anxiety Scale (SAS) were used to assess depression and anxiety, respectively. Statistical package for social sciences, version‑26 (SPSS‑26, IBM,Chicago, USA) was used for data analysis. P <0.05 was considered statistically significant. Results: The prevalence of postpartum depression (EPDS ≥10) was 28.0%, and postpartum anxiety (SAS ≥45) was 34.0%. Significant psychosocial correlates of both depression and anxiety included unplanned pregnancy, low education level, lack of partner support, unemployment, and the loss of a parent or sibling (p < 0.001 for all associations). Conclusion: A substantial proportion of postpartum women suffer from depression and anxiety, with distinct psychosocial determinants

Introduction: Hypopigmented skin lesions are a frequent dermatological concern in the pediatric population, often eliciting significant parental anxiety due to cosmetic implications and fears of underlying systemic illness. These lesions can represent a wide spectrum of conditions, ranging from benign developmental variants to manifestations of more serious dermatological or systemic disorders. Therefore, a comprehensive clinico-epidemiological evaluation is crucial for accurate diagnosis and appropriate management.  Objectives: To study the clinical patterns, epidemiological factors, and associated conditions of hypopigmented skin lesions in children attending dermatology outpatient departments. Methods: A hospital-based cross-sectional study was conducted over a period of one year in the Dermatology Department of a tertiary care center. A total of 150 pediatric patients (aged 0–18 years) presenting with hypopigmented skin lesions were enrolled. Detailed history taking and thorough clinical examinations were performed for each patient. Wood's lamp examination and relevant laboratory investigations were carried out as indicated. Diagnoses were primarily based on clinical criteria and confirmed by histopathological evaluation where necessary. Results: The most commonly affected age group was 6–10 years (45%), with a slight male preponderance (male:female ratio of 1.2:1). Pityriasis Alba was the most frequently observed lesion (40%), followed by vitiligo (25%), post-inflammatory hypopigmentation (15%), and nevus depigmentosus (10%). Less common conditions included tuberous sclerosis, leprosy, and idiopathic guttate hypomelanosis. A significant association was observed between pityriasis Alba and a history of atopy. Vitiligo exhibited familial aggregation in 18% of cases. Socioeconomic and nutritional factors were also found to influence the prevalence and distribution of certain hypopigmented lesions. Conclusion: Pityriasis Alba and vitiligo emerged as the leading causes of hypopigmented skin lesions in children. Early and accurate diagnosis through clinical evaluation is essential to avoid unnecessary investigations and to alleviate parental anxiety. Awareness of the diverse etiologies and epidemiological patterns is vital for dermatologists and pediatricians to ensure prompt recognition, appropriate management, and effective counseling.

Introduction and Background: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, leading to complications in reproduction, metabolism, and mental health. Comorbidities, including anxiety and depression, are increasingly recognized as critical variables in polycystic ovarian syndrome (PCOS), which subsequently lead to a diminished quality of life and reduced adherence to treatment.   Regrettably, there is an absence of case-control data from South Asian populations that could elucidate the prevalence and determinants linked with various mental diseases. Material and Methods: This case-control study recruited sixty women; thirty were diagnosed with PCOS according to the Rotterdam criteria, while thirty served as age-matched healthy controls. Clinical and sociodemographic information was recorded. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate anxiety and depression. Symptoms were considered clinically serious if the threshold score was 8 or above. Correlation analysis was employed to evaluate the relationships among biochemical indicators, menstrual irregularities, and body mass index (BMI). Results: At 26.8 ± 4.5 years old, the participants in the PCOS group were slightly younger than the controls at 27.3 ± 4.2 years old (p = 0.68).  In comparison to the controls, the PCOS group had a substantially higher mean body mass index (27.6 ± 3.4 kg/m²) (p < 0.001).  The mean HADS-Anxiety ratings for PCOS were 10.2 ± 3.1, while the mean HADS-Depression scores for controls were 6.1 ± 2.8 (p < 0.001).  Anxiety and sadness scores were substantially linked with a higher body mass index (r = 0.42, p = 0.02) and monthly abnormalities (r = 0.38, p = 0.03) in the PCOS group, according to correlation analysis. Conclusion: Anxiety and depression were significantly more prevalent in women with PCOS compared to healthy controls. Psychological morbidity was markedly correlated with obesity and menstrual abnormalities. Women diagnosed with PCOS might gain from regular testing for depression and anxiety within their professional healthcare regimen.