Background: Adult hypertension is more common as people get older, affecting 15% of young adults and 60% of people over 65. 1 It is crucial to identify kids and teenagers who have a higher risk of acquiring essential (primary) hypertension as adults since blood pressure in children is an excellent predictor of blood pressure in adults.

OBJECTIVES:

1. To study the prevalence of elevated blood pressure in children of age group 11-15 years.

2. To study the relation of blood pressure with age, weight, height, BMI & family history of hypertension.

MATERIAL & METHODS: Study Design: Prospective Observational Cross sectional study. Study Period: Jan 2022 – Dec. 2022. Study population: School going children of age group 11-15yrs. Sample size: Study consisted a total of 601 subjects. Sampling Technique:  Simple Random technique. Study tools and Data collection procedure: The study is a School based cross sectional study. A team of four members were formed to collect the data and prior training was given to record anthropometric data and to record blood pressure. The school authorities were informed prior and permission was taken from principal of every school. The message was given by school authorities to children to remain present during the visit of study team. Information regarding number of schools was obtained from Officer of Board of Secondary Education after explaining the importance of the study. 3 schools were selected randomly and selected schools were visited. The purpose of conducting the study was explained elaborately to the heads of all the schools before initiation of study.

Results: Out of 601 children ,119 children were having family history of HTN and 482 children were not having family history of HTN. Out of 119 children having family history of HTN,22 children (18.5%) were having elevated BP,35 children (29.4%)were hypertensive,62 children (52.1%) were normotensive. Out of 482 children without family history of HTN,78 children (16.2%)were having elevated BP,49 children (10.2%)were hypertensive,355 children (73.7%)were normotensive. This shows that family history of HTN is a risk factor for elevated BP & HTN in children.

Background: Lymph node enlargement is a normal age related physiological change, may also herald chronic infections and serious conditions like autoimmune disorders. Etiology varies from region to region. However few studies have emphasized on the clinico- pathological correlation. Material and Methods: This is a Prospective study in a tertiary care hospital setting. Seventy consecutive children reporting to the Department of Pediatrics, Dr. VRK Women College, Hyderabad, Telangana were studied. FNAC, Mantoux test and hematological parameters were performed in all the cases. Additional investigations like culture, serological test and roentgenogram were done wherever required. Results: Among 70 cases the common age group was 4year to 8 years in 41.4% children .The etiology was confirmed in 84.3% cases and could not be ascertained in 21.4 % cases even after relevant investigations. Cytological examination revealed reactive lymphadenitis in 74.3% cases, tubercular lymphadenitis in 14.3% cases and Suppurative lymphadenitis in 7.1% cases, 4.3% cases yielded inadequate aspirate . Commonest etiology diagnosed after detailed investigation was due to infections in areas of drainage like tonsils, ear and scalp, oral cavity in 38.5% cases followed by tuberculosis in 24.2% cases. In addition, there were 12.8% cases of HIV , 2.9% cases were measles . Sensitivity of FNAC in TB was 58.9%. Conclusion: Reactive lymphadenitis due to underlying infection caused by streptococcal and staphylococcal infections were the commonest treatable entity of significant pediatric cervical lymphadenopathy. Further studies and longer follow-up involving detection of antigen and antibodies against lesser known viruses, parasites and rarer causes of lymphadenopathy may decrease the fraction of undiagnosed reactive conditions .

Aims and Objectives: The aim of the present study was to determine various factors on clinical and radiological grounds to predict difficult laparoscopic cholecystectomy. The objective of this study was to correlate the pre operative clinical and ultrasonographic findings of the gall bladder with the intra operative difficulties encountered during the surgery and need for the conversion. Materials And Methods: Study population: Cases admitted during September 2020 to April 2022 in RMC, Hapur for cholelithiasis, who were clinically evaluated and confirmed by ultrasonography.  Study Design: Prospective observational study  Patients were considered from any socio-economic status, any religion, age limits between 18-60 years, and both gender were included. Conclusion: The term "difficult cholecystectomy" refers to many intraoperative technical challenges that greatly lengthen the procedure time and raise the risk of complications. Knowing the various clinical, radiological, and specific predictors that offer some prognosis of difficult LC is crucial since it not only aids in patient counseling but also aids the surgeon in better preparation for anticipated intra-operative challenges.

Introduction: Neck masses are a relatively common head and neck problem. There are usually no associated symptoms besides the recognition of a lump noticed incidentally on palpation and cosmetic appearance with increase in size of swelling over duration or noticed by another individual. Two most common methods of classifying neck masses are accordingly to site of lesion and according to its etiology. Neck masses may be benign or malignant. Aims: To do cytological study of non-reactive causes of neck swelling in patient attending in DMCH Material and methods: The present study was a Prospective study. This Study was conducted from 18 months at Dept. of Darbhanga Medical College and Hospital. Total 100 patients were included in this study. Result: In our study, 4 (4.0%) patients had Midline neck swelling x 10 years, 4 (4.0%) patients had Midline neck swelling x 1½ years, 9 (9.0%) patients had Midline neck swelling x 2 years and 9 (9.0%) patients had Midline neck swelling x 3 years Conclusion: In our study female population was higher than the male population but it was satistacally significant, we found that, most number of patients had Midline neck swelling x 3 years. It was statistically significant and we examined that, majority of the patients had 2x2cm, firm, mobile, tenderness present and it was statistically not significant.

Introduction: Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Monocytes are professional phagocytes that are highly skilled in defence against many pathogens, including MTB.4 They circulate in the blood and can differentiate into monocyte-derived macrophages and monocyte-derived dendritic cells that govern innate and adaptive immune responses and Lymphocytes (L) provide resistance to the spread of infection causing mycobacterial clearance. Aim & Objectives: To assess the monocyte lymphocyte ratio (M/L ratio) as a possible prognostic biomarker to see the outcome of Anti Tuberculous Therapy in terms of sputum status in active TB cases. Material & Methods: The present study was a Prospective observational study. This study was conducted from Feb 2021 and July 2022 at Department of respiratory medicine, Kamla Nehru Chest Hospital, Dr S N Medical College Jodhpur, a tertiary care Centre for respiratory diseases, Rajasthan, India. 130 patients were included in this study. Result: In our study, 7 (5.4%) patients had COPD, 23 (17.7%) patients had HTN and 18 (13.8%) patients had T2DM. The value of z is 9.8029. The value of p is < .00001. The result is significant at p <.05. In our study, 130 (100.0%) patients had Sputum Status at 0 month. In our study, 117 (90.0%) patients had Sputum conversion at 2nd month. The value of z is 12.8996. The value of p is < .00001. The result is significant at p <.05. The mean Monocytes at 0 Month of patients was [5.0769± 1.2519], mean Lymphocytes at 0 Month of patients was [17.7392± 4.3696], mean M/L ratio at 0 Month of patients was [.3057± .1206], mean Monocytes at 2nd Month of patients was [4.4862± 1.1302] and mean M/L ratio at 2nd Month of patients was [.2389± .0821]. Conclusion: Tuberculosis ss associated with Increased M/L Ratio, which Declines and Returns to Normal with Anti-Tuberculous Therapy.

Introduction: Coronary artery calcification (CAC)  occurs  in  small  amounts  in  the early lesions of atherosclerosis  that  appear  in the second  and  third  decades of life, but it is found more frequently in advanced lesions and in older age. A positive CT study (defined as presence of any CAC) is nearly 100% specific for atheromatous coronary plaque. Since both obstructive and non- obstructive lesions can have calcification present in the intima, CAC is not specific for obstructive coronary disease. Aims: To compare CAC (coronary artery calcium) score in patients with Obstructive and Non-obstructive CAD, to compare CAC score in patients with single and multivessel disease, to compare CAC score in males and females, to compare CAC score in those with and without HT, Smoking and Diabetes and to compare CAC score between IRA and other vessels in multivessel disease. Materials and Methods: This study was conducted in the Department of NRS medical college, during the year January 2022 to December 2022.The study is a prospective observational non-interventional study involving 100 patients. Result: Men and women in the highest CAC score category showed an adjusted odd ratio for myocardial infarction of 7.7 (95%cl:4.1-14.5) and 6.7( 95%cl:2.4-19.1 ), respectively, compared with the lowest score category (0-100). The predictive power of CAC was independent of FRS category (low, intermediate or high). Conclusion: CAC scores showed good correlation in patients with obstructive CAD especially in Elderly, Diabetics and in those with a family history of CAD. There is less correlation of CAC score with regards to other conventional risk factors like Gender, Hypertension and Smoking in both obstructive and non-obstructive CAD.

Background: SSI continues to account for 20% of all infections related to healthcare, making them the most frequent causes of postoperative morbidity and mortality. Several anecdotal investigations have found that the incidence in India is between 5% and 24%, or three to 10 times greater than in wealthy nations. The wide range in SSI rates across the world may be due to a number of patient-related factors (such as smoking, diabetes, and other comorbidities), operation-related factors (such as the length of the procedure, preoperative skin preparation), technical skills, the level of sterilisation of the surgical instruments, hospital environment, and climate. Aims and Objectives: Objective of the study was to observe prevalence of Surgical site infection (SSI) & its related Health care associated infections (HAI) in post-operative elective nurosurgery & elective laparotomy, to observe common pathogenic microorganisms causing it, to ascertain the risk factors associated with Surgical site infections, suggest measures to reduce surgical site infection (SSI) & healthcare associated infections in admitted patients, find out common etiological factors in Elective neurosurgery & Elective laparotomy cases causing surgical site infection and To suggest rationale “Antibiotic-Policy” for cases. Methods: This prospective observational study was conducted at Mahatma Gandhi Memorial Medical College & Maharaja Yeshwant Rao Hospital and allied hospitals of Indore, Madhya Pradesh under the infection control and prevention committee, Department of Microbiology, MGM Medical College, Indore (M.P.). The participants or the subjects of the study are the patients those who are admitted in the Neurosurgery and Elective laparotomy section in Department of Surgery, M.Y.H. Indore during the study period and undergone either elective Neurosurgery or elective Laparotomy. Results: The prevalence of SSI In present study is 15.53% and highest for the elective Neurosurgery. There is associated coinfection along with SSI most commonly BSI and UTIs. The investigation of 3 days from post surgery reveals 286 cases out of which 39% i.e. 87 were infected and 61% i.e. 199 were noninfected. Than 7 days suture line observation reveals that only 25 cases were indentified infected out of 174 i.e. 14%. Final outcome of the Prevalence of Surgical Site Infection is 15.53% in the study. Conclusion: Poor infrastructure of surveillance system and reduced average duration of stay causes problems in long follow-ups. Increase number of E. coli and S. aureus suggests improved hand hygiene practices during routine surgical care.

Background: Multiple pregnancies are associated with an increased risk of obstetric complications as well as perinatal morbidity and mortality especially in developing countries. The present study aims to identify socio-demographic, obstetric, and maternal complications associated with any adverse perinatal outcome in singleton and twin deliveries in the department of obstetrics and gynaecology at the R. D. Gardi Medical College in Ujjain between September 1, 2021 and December 31, 2022..  Methods: This comparative prospective study was conducted in the department of obstetrics and gynecology, R. D. Gardi Medical College in Ujjain between September 1, 2021 and December 31, 2022. Consecutive sampling was done till the sample size of 142 was reached for both twin and singleton pregnancies. It included all women admitted in antenatal ward and labor room with clinical or ultrasound diagnosis of twin pregnancy after 28 weeks of gestation. Results: The incidence of twins in this study was 1.85%. Mean maternal age was 24.08±2.73 years for twin pregnancies and 24.08±3.56 for singleton pregnancies. Twins were seen more in multigravida  as compared to primigravida. Preterm labor (40%), anemia (26.5%) and hypertensive disorders (14.3%) and PPH (6%) were the most common complication in twin pregnancies. Significantly higher rate of LSCS were seen in twin pregnancies (30.6%) as compared to singletons 17%. There was higher incidence of moderate to severe asphyxia, IUGR and higher rate of NICU admissions in twins as compared to singletons. Conclusions: Early diagnosis, good antenatal care with early recognition of complications and their timely referral and management at a tertiary care with level 3 neonatal care can help reduce maternal and perinatal mortality and morbidity. Prompt ANC care and timely intervention is required to avoid these complications.

Background: In this study we wanted to evaluate the maternal morbidity in women with moderate and severe anaemia and compare maternal and perinatal outcome in moderate and severe anaemic pregnant females with those of non-anaemic pregnant females delivering at or more than 28 weeks of gestation. Methods This was a hospital based prospective case control study conducted among 75 pregnant women who presented with severe anemia to the Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Ludhiana, over a period of 18 months, from November 2020 to May 2022 after obtaining clearance from institutional ethics committee and written informed consent from the study participants.  Results In distribution according to antenatal complications, past medical history, history of blood transfusion, anthropometric parameters, hemogram, mode of delivery, approximate intrapartum blood loss (mL), admission of neonates to NICU, in cases and controls were found to be statistically significant. Requirement of blood transfusion was significantly higher in cases as compared to controls. P value- <.0001 and was statistically significant. Postpartum complications were significantly higher in cases as compared to controls, with p value <.0001, which was statistically significant. Birth weight was significantly lower in cases as compared to controls and was statistically significant. APGAR score at 1 minute was significantly lower in cases as compared to controls. Conclusion Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy.

Introduction: Liver abscess are more prevalent due to pyogenic, amoebic or mixed infection. Sometimes these may be fungal in origin. The primary mode of treatment is medical, but 15% of these may be refractory to medical   treatment. Percutaneous drainage continues to be the basis of care in these situations. For the purpose of curing sepsis, liver abscesses greater than 5 cm in size must be promptly drained.  In contrast, surgical drainage enables the rupture of multiloculi and the draining of viscid pus from large abscesses that are multiloculated or contain thick viscid pus. Our aim is to assess the effectiveness, success rate, clinical improvement, time required for complete abscess resolution, and length of hospital stay for patients undergoing USG guided pigtail catheterization vs. open drainage in the management of liver abscess. Materials And Method: After obtaining approval from institutional ethical committee this prospective study was conducted in 32 patients with liver abscess who admitted in surgery department of M.K.CG. MCH, Berhampur. On the basis of the clinical history, serologic testing (IgM Elisa), and inspection, followed by USG, a liver abscess was diagnosed. Standard investigations were conducted.. The patients included in the study were having non complicated abscesses with no features of rupture, no feature of impending rupture (liver tissue rim >1cm), no compression effect and abscess size >5 cm diameter. Patients who had multiple abscess cavities, ruptured or threatened abscesses, peritonitis symptoms and signs, and abscesses larger than 5 cm in diameter were excluded from the study.  Results: Mean age in group PD was 36yr while in group SD it was 35.9yr. There is male predominance in both the groups. A commonest symptom in both the groups was abdominal pain. Next common symptom was fever which was present in all patients of group PD and 13 patients in group SD. In both the groups (table 1) Haemoglobin and Liver function test was in normal range. Leucocytosis was present in 85% of cases and raised ESR in 90% of cases in both the groups. Volume of abscess ranged from 114 to 1200 ml 9. In group PD, success rate was 94.4 % while in group SD success rate was 100%. Total clinical improvement was seen in 4-8 days and 4-7days in Group PD and Group SD respectively. Time needed for total reduction was 5- 17 weeks in Group PD and 7-24 weeks in group SD. Hospital stay was 5-18 days and 6-21 days in group PD and SD respectively. Morbidity is 27% in group PD and 50% in group SD. Conclusion The conventional treatment for liver abscess is percutaneous catheter drainage (PCD), which is both safe and efficient. It leads to early symptom alleviation and quicker abscess cavity clearance. Surgery is an option for liver abscess drainage with concurrent intraabdominal pathology, multiloculated abscess with biliary communication, and failure of percutaneous drainage. PCD also has low morbidity and a good success rate, allowing it to be used as first line management in liquefied moderate sized abscesses.

Introduction: Fournier’s gangrene is an extensive necrotizing soft tissue infection of the perineum affecting the skin, soft tissues, and muscles. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. Treatment of Fournier’s gangrene entails treating sepsis, stabilizing medical parameters, and urgent surgical debridement. The present study was conducted to study the surgical outcome in operated cases of Fournier’s gangrene in the department of general surgery at a tertiary care centre. Methods: The present prospective clinical observational study was carried out on 62 patients with gangrene of the genitalia and perineum who came to the Department of general surgery in a tertiary care centre from October 2019 to October 2021. The diagnosis of Fournier’s gangrene was established clinically based on presenting history and physical examination and supported by investigations.  Results: 40.32% of patients were in the age group above 60 years. There was a male preponderance with 24.59% morbidity. Scrotal swelling was the most common presenting complaint in 60 patients (96.77%). 45.16% of patients presented within 7 days and had a morbidity of 28.57% with no mortality. 77.41% etiological factor of FG was idiopathic.  Diabetes Mellitus (27.41%), chronic alcoholism (22.58%), and smoking 17.74%), were the commonly observed comorbid condition. Testicular repositioning with secondary suturing was done in 65.38% of patients. Conclusion: Early stabilization of hemodynamic status and immediate debridement of whole necrotic tissues with appropriate antibiotic cover will certainly reduce the risk of morbidity. The presence of diabetes, advanced age, delayed presentation, and systemic sepsis on admission are individual risk factors described to predict mortality.

Introduction:  Introduction: Nerve Conduction Study (NCS) are most commonly used in neurophysiological laboratories not only for the understanding of normal peripheral nerve function and structure but also in relation to various diseases. Peripheral neuropathies are unfavorable consequences of radiation treatment. Tissue changes due to Radiation Exposure result in inflammation and fibrosis that affect the peripheral nerve and lead to peripheral neuropathies. Hence we have undertaken this study to observe effect of radiation exposure on peripheral nerve conduction study parameters in Radiologic Technologists of our institutions and compared the nerve conduction study with healthy individuals. Material and methods: Present study is a case control cross-sectional analytic prospective hospital-based study. In present study a sum of 60 individuals were selected, of which 30 were Radio-logic Technologists (study group/cases) who had a history of occupational exposure to ionizing radiations and 30 were age and sex matched normal healthy individuals (controls). Motor Nerve conduction study (MNCS) parameters for sensory and motor were recorded in Median, Ulnar and Radial nerves on both right and left Upper extremities and data was recorded.We found that the nerve conduction velocities of all the motor and sensory nerves were significantly reduced in radiologic technologists compared to healthy subjects.  Results and discussion :We also found reduced CMAP amplitude (significant in Ulnar, and Radial) and SNAP amplitude (significant in Median, Ulnar and Radial nerves) along with prolonged motor distal latencies (significant in Median, Ulnar and Tibial nerves) and sensory distal latencies (significant in Median, Ulnar and Radial nerves) among radiological technologists compared to healthy individuals. Conclusion: Present study depicting that ionizing radiations are harmful to all the body tissues including the peripheral nerves. Radiations appear to cause both demyelination and axonal loss.

Purpose: The purpose of this study was to examine how the SARS-CoV-2 infection affects antenatal women and newborn babies in terms of symptoms, complications, and outcomes. Methods: A total of 128 antenatal women were included in this prospective single-center observational study. The present study was conducted in a tertiary-level public hospital in Kerala. The presence of SARS-CoV-2 was detected by running a real-time PCR using the extracted RNA using an appropriate PCR kit (SeegenAllplexTM 2019-nCoV Assay). Result: Out of 128 COVID-19-positive antenatal women, RT-PCR was positive for 57.8% of them, followed by antigen positive for 34.4% and TrueNat for 7.1%. The Mean ±SD duration of COVID positivity from delivery was 8.45±5.1 days and the Mean ±SD CRP was 3.15±6.2 mg/dl, Mean ±SD FERRITIN was 61.8±98.2 mg/l and the Mean ±SD D DIMER was 2.09±1.4 mg/l. Seven study subjects were transferred to the intensive care unit (ICU), 5 were given oxygen support, 3 were given NIV assistance with oxygen, and one was transferred on mechanical ventilation due to a severe complication. Out of 128 COVID-positive study subjects, the majority of them didn’t have any post-partum complications. 19 study subjects experienced complications such as PPH (10 study subjects), sepsis, and maternal near-miss (4 study subjects), and one study subject died due to thromboembolism. Conclusion: The study demonstrated that LSCS was more in COVID pregnant women. However, the majority of the COVID-positive pregnant women didn’t require ICU admission. Further, the study found that the majority of the neonates were COVID-negative and healthy.

Background: In this study, we wanted to evaluate intrathecal hyperbaric bupivacaine with different doses of buprenorphine for infraumbilical surgeries on concurrent administration, with regard to the onset of sensory and motor blockade, the duration of motor blockade and effectiveness of post-operative analgesia. Materials And Methods: This was a hospital based prospective randomized clinical study conducted among 70 patients who underwent infraumbilical surgeries, in Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, over a period of 18 months from December 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.  Results: The onset of sensory and motor blockade was comparable in both the groups. The duration of post-operative analgesia was longer in group 2 (60 mcg) when compared to group 1 (30 mcg) (p < 0.001). Side effects were noted with higher dose of 60 mcg than 30 mcg of buprenorphine.  Conclusion: The addition of buprenorphine 30 mcg and 60 mcg to intrathecal hyperbaric bupivacaine is safe as it does not produce excessive sedation or respiratory depression. Addition of 60 mcg buprenorphine to 0.5 % hyperbaric bupivacaine significantly prolongs the duration of post-operative analgesia better than 30 mcg buprenorphine (p value < 0.001) and the request for first analgesics without any significant motor blockade prolongation. Side effects like nausea and vomiting were noted to be seen significantly higher with dose 60 mcg than 30 mcg buprenorphine (p value 0.012). The patient’s well-being was satisfactory in both the groups.

Background: Component separation technique typically involves one or more fascial planes incision to form myofascial advancement flaps to assist fascial closure in large ventral hernia repair. Aim of the study was to compare the outcomes and quality of life post operatively with traditional preperitoneal mesh repair. Methods: A prospective study was done on 40 patients in MKCG Medical College with ethical clearance. IEC no1087.It was a comparative study between component separation technique and traditional preperitoneal repair for large midline ventral hernia. Observations: Mean age of patients operated for CS were 49.5+SD10.15 and for Preperitoneal repair mean age was 48.95+SD9.87. Wound complications were 16% with mean follow up12 months and recurrence rate was 5% with odds ratio 0.21(0.021-2.079) p=0.91 when compared to preperitoneal mesh repair. Conclusion: The component separation technique was better regarding the shape of abdominal contour than pre peritoneal mesh repair. The use of component separation technique results in an increased risk of wound complications but does not increase the hernia recurrence rate CS with myofascial advancement flaps reduces chance of recurrence but does not impact on quality of life.

Introduction: The central nervous system [CNS] is made up of the brain and the spinal cord. Cells within the CNS normally grow in an orderly and controlled way. If for some reason this disorder is disrupted the cells continue to divide and form a lump of tumour. CNS brain tumors is about equal in males and females – 51% for females and 49% for males (CBTRUS STUDY). The incidence of malignant CNS tumors is greater in males i.e. 7.2/1, 00,000. Brain tumor incidence tends to be higher in countries with more developed medical care. Aims: To evaluate the role of immunohistochemical markers in CNS tumours for confirmation and arriving at final diagnosis. Materials and Methods: In this prospective study of CNS neoplasms which covered 100 cases during January 2022 – January 2023, Darbhanga Medical College and Hospital, Bihar. The overall incidence of CNS neoplasms encountered by others was less than 9% (CBTRUS data) and in my observation it was 9.97%. Result: Of the 41 cases of the astrocytomas diagnosed there were 3 cases of grade I astrocytoma with an incidence of 7.3%. All the three cases, showed only an increase in cellularity. The three cases occurred in the middle age group with a slight increase in males (2:1). Conclusion: We conclude that, Primary CNS tumours are seen supratentorially in adults and in children it occurs infratentorially and Astrocytomas constitute the most common CNS tumor. Grading of astrocytomas by WHO norms reveal grade II pattern as the commonest.

Background: Globally, prematurity affects 15 million newborns every year with numbers increasing in most countries according to the latest trend of data.1 Respiratory distress is one of the most common reasons because of which a neonate is admitted to the neonatal intensive care unit. Respiratory distress syndrome (RDS), earlier known as hyaline membrane disease, is one of the causes of respiratory distress in a preterm baby and is a known complication of prematurity.2 Aims & objective : To study the clinical outcome of respiratory distress syndrome in preterm neonates. Material & Methods: This prospective study was conducted in NICU on all preterm neonates meeting the inclusion and exclusion criteria, after taking informed written consent from parents/guardians of the neonates providing all the necessary information about the study. All enrolled preterm neonates were observed for development of any complication such as intracranial hemorrhage, pneumothorax, ventilator associated pneumonia, sepsis, retinopathy of prematurity, bronchopulmonary dysplasia Results : In this study , males were 44 (53.65%) and females were 38 (46.34%). Sepsis was the most common clinical outcome seen in 52  (63%) neonates, followed by retinopathy of prematurity in 8 (9.7%), intraventricular hemorrhage in 2(2.4%), ventilator associated pneumonia in 2(2.4%),  and suspected broncho-pulmonary dysplasia in 2(2.4%). Conclusion: Respiratory distress syndrome is significant cause of mortality and morbidity in preterm neonates in any country

Background: Acute Coronary syndrome (ACS) in diabetic patients is associated with an increased overall risk of stent thrombosis compared to the general ACS population. In many centers worldwide the routinely used antiplatelet agent in most settings is still clopidogrel. It is generally recognized that many patients exhibit a diminished response to Clopidogrel. The study aimed to verify whether clopidogrel response measured by MEA in response to ADP, in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis and bleeding. Methods:  In this prospective observational study, consecutive diabetic patients admitted with ACS who were treated by successful PCI with stent implantation and started on Clopidogrel as a second antiplatelet agent were included. ADP-induced platelet reactivity assessment was performed directly before patient discharge using a Multiplate electrode analyzer with ADP as an inducer. The cutoff value for high platelet reactivity was considered as greater than 468 AU * min and less than 188 AU * min for very low platelet reactivity, based on the consensus of the Working Group On treatment platelet reactivity. Results:  Out of n=100 members included in the study most of the patients were having single vessel disease (62%) and 38% had double vessel disease. 30% of the study population showed high platelet reactivity and 14% were having low platelet reactivity. Stent thrombosis developed in 6% of patients, of which 4% had definite stent thrombosis and 2% had probable stent thrombosis. Out of n=6 patients with stent thrombosis, 4 cases showed high platelet reactivity with an odds ratio of 5.23 (0.90-30.29) and a P value of 0.0064. N=8 patients developed bleeding of which 2 were major and 6 minor. Out of n=8 patients with bleeding n=4 cases were having low platelet reactivity with an odds ratio of 6.538 (0.38-111.09) with a P value of 0.001 which was statistically significant for major bleeding Conclusion: This study shows that in a high-risk population of patients with ACS and diabetes treated with stent implantation and receiving clopidogrel, higher on-treatment platelet reactivity (HPR) is related to increased risk of stent thrombosis and low platelet reactivity (LPR) to increased risk of bleeding at 1-year follow-up.

Background: This study was conducted to evaluate the role of ultrasound elastography in differentiation of solid breast masses, to calculate the elasticity score and strain ratio of all solid breast masses, and to determine the sensitivity and specificity of ultrasound elastography in differentiating between benign and malignant breast masses. Methods: This was a hospital based prospective diagnostic analytical study, conducted among 50 female patients who presented with solid breast masses to the Department of Radiodiagnosis, VIREC, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, over a period of 2 years, from November 2019 to October 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: There was strong evidence of relationship, found between BI-RADS interpretation and histopathology interpretation (p<0.0001), radiological interpretation and histopathology interpretation (p<0.001), and interpretation of Tsukuba score and histopathology interpretation (p<0.0001). Diagnostic significance of ES in class 2 lesions was shown to have a significant association between histopathological interpretation and ES. (P<0.001). Diagnostic significance of Tsukuba score in lesion with largest diameter (mm) >20 mm was assessed. A significant association was noted between histopathological interpretation and Tsukuba score (p<0.0001). In association of Tsukuba score with histopathological diagnosis, significant difference in frequency distribution was observed (p<0.0001) indicating a higher frequency of malignant lesion in subjects with a higher Tsukuba score. Conclusion: B-mode sonography which is well known for its high sensitivity but poor specificity, in combination with qualitative sonoelastography with high specificity, may increase diagnostic performance when differentiating between benign and malignant breast masses. Sonoelastography works best in combination with B-mode sonography and thus represents a technologically advanced extension of the same.

Introduction: Second-hand smoke is formed from the burning of smoking products and the smoke exhaled by the smokers. Worldwide, a large proportion of children, male and female non-smokers are exposed to the second-hand smoke at home. Exposure to second-hand smoke resulted in the occurrence of several diseases such as ischaemic heart disease, lower respiratory infections, asthma and lung cancer, and even death. With the growing scientific evidences for the hazard of Second-hand smoke, many countries have taken stringent action to reduce Second-hand smoke exposure through legislation and health education, and have achieved significant improvements. Materials and methods: This is a prospective and cross-sectional study conducted in the Department of Community Medicine at Tertiary Care Teaching Hospital over a period of 1 year; we objectively assessed SHS exposure concentrations. A predesigned, pretested semi structured interview schedule was prepared and translated into the local language. We used two measures of SHS: exposure to SHS at home and exposure to SHS in the workplace. SHS exposure at home is estimated for non-smokers who reported anyone smoking inside his/her home. Exposure to SHS in the workplace is estimated for non-smokers who reported anyone smoking in the workplace in the past 30 days before the survey. Result: In this study shows the demographic predictors of SHS at home and workplace. At home and workplace, the SHS exposure was higher among male (89%) as compared to female (11%), whereas at home, the SHS exposure was higher among male (82.5%) as compared to female (17.5%) and at workplace, the SHS exposure was higher among male (90.9%) as compared to female (9.1%). Distribution of Age group of persons exposed to second‑hand smoke at home and workplace, the exposure was highest in 25–44 years old (52.7%) while lowest years old have exposure to SHS as compared to other age group categories. Distribution of Residence of persons exposed to second‑hand smoke at home and workplace at urban area (62.7%) as compared to rural settings (37.2%). The high-grade education category was (30.9%) had the highest exposure to SHS at the workplace in contrast to other categories. The Retired and unemployed occupation category (3.6%) had the highest exposure to SHS analogous to other occupation categories. Conclusion: Current smoking and exposure to second-hand smoke among internal migrants in India is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors.

Background: Second-generation supraglottic airway devices (SADs) are used in routine cases or when encountered with a difficult airways. This study was done to compare the ease of blind endotracheal intubation using I-Gel versus the Blockbuster Laryngeal Mask Airway (LMA) in female patients posted for laparoscopic cholecystectomy under general anesthesia. Materials and methods: This study was a randomized, prospective, double-blind and controlled in which included Ninety, American Society of Anaesthesiologists (ASA) I-II and Mallampatti class (MMC) 3-4, female patients aged between 18-60 years and were divided into two groups. Each Group A and B had 45 patients, in whom blind endotracheal intubation was attempted through the I-Gel and Blockbuster LMA respectively after induction of anaesthesia. The time required for insertion, ease of insertion, number of attempts, maneuvers applied, and time for intubation, intubation success rates, intraoperative hemodynamic parameters during the procedure along with postoperative complications thereafter were documented and compared. Results: Time required for placement was less and ease of insertion better with Blockbuster LMA as compared to I-Gel. Duration for tracheal intubation was reduced and the overall rate of successful intubation was higher (96.9%) with Blockbuster LMA than I-Gel (80%). Fewer hemodynamic changes with minimal post-operative complications were seen with the Blockbuster LMA. Conclusion: It was concluded by the study that both I-Gel and Blockbuster LMA can be used as a channel for conducting endotracheal intubation, the overall success rate was higher with the Blockbuster LMA with minimal complications.

Background- Vast majority of fractures of distal radius are articular injuries that result in disruption of both radiocarpal and radioulnar joints. This article presents a percutaneous pinning technique.The purpose of this study is Prospective study on outcome of distal radial fractures treated with closed reduction and percutaneous pinning. Material and method - after ethical approval from IEC, 34 patients with AO type C radius fractures were treated by percutaneous pinning (K-wire) between 27th Aug 2021 to 31st October 2022. The follow up studies include clinical and radiographic examinations. Results- All 34 patients were assessed by follow ups using modified mayo score. The majority of study participants, or 55.90% (n=19), received good scores, while 29.40% (n=10) received exceptional scores. Only 2.90% (n=1) of respondents received a low score. Conclusion- Primary treatment of distal radius fractures is necessary to improve function and prevent complications from immobility. Closed reduction and percutaneous fixation with Kirschner wires alone are effective for distal radius complete intra-articular fractures. Closed reduction and percutaneous pinning patients with distal radius fractures had good range of motion, normal Mayo wrist scores, and no radiographic changes between fracture fixation and fracture healing.

Introduction: Upper limb surgeries frequently use the brachial plexus blockade method. The conventional approach of treating paresthesia is a blind procedure that may have a higher failure rate and cause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to help with better localization of the nerve/plexus in order to avoid some of these issues. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus blocks. The purpose of this study was to contrast the effectiveness of a Peripheral nerve stimulator with an ultrasound-guided technique brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: Peripheral nerve stimulator (Group PNS) and ultrasound-guided technique (Group USG). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting PNS is less compared to USG, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was statistically significant. The success rate of the block is more in ultrasound group than PNSgroup which was not clinically significant. The incidence of complications was seen more in PNS group. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.

Introduction- Ovarian cancer is one of the ten most commonly diagnosed cancers in women and has the highest mortality rate and the worst prognosis of all gynecological cancers. In 2018, 295,414 cases of Ovarian cancer were detected worldwide, and 184,799 died, with the highest incidence in developed countries. The mortality rate has not changed in the past 30 years, and it is predicted that by 2040, this rate will be significantly increasing. Materials And Methods- Study based on proper clinical examination, radiological investigation, histopathological diagnosis and hematological investigations and Measurement of serum CA-125 and HE4 will be carried out by ELISA method. Results- out of 50 neoplastic lesions 31 cases are benign tumours, 02Borderline and 17 cases are malignant. Conclusion-We concluded High ROMA Index Value shows malignancy. Low value of ROMA index cases are benign so that ROMA Index is helpful to differentiate     in benign and malignant lesion preoperatively

Introduction- Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide, specially in developing nations with poor access to health facilities. An easy, cost effective and precise diagnostic algorithm needs to be developed for early detection of preeclampsia in order to reduce maternal and fetral mortality. There are also marked changes in the coagulation and fibrinolytic system occurs during normal pregnancy leading to hypercoagulable state. These changes are more magnified during eclampsia and preeclampsia. Coagulation activation probably represents a secondary event consequent upon endothelial activation and damage. Antithrombin which binds and inactivates thrombin correlates inversely with the level of proteinuria and subsequent renal dysfunction. aim And Objectives-To evaluate platelet parameters in prediction of preeclampsia, assess platelet indices namely platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (PLCR) in women with preeclampsia compared with healthy controls. Determine correlation between platelet count and platelet indices in preeclampsia patients and normal pregnancy,and assess coagulation parameters and LFT levels in women with preeclampsia and normal pregnancy. Materials And Methods- It is a Prospective Case Control study included women with pre-eclampsia and control study group included healthy normotensive pregnant women of age group between 18-35 years of more than 20 weeks gestation. Total 102 cases taken [51 preeclampsia patients and 51 healthy pregnant women] Results- The platelet count in preeclampsia was significantly lower than in normotensive control group. while all platelet indices were increased with preeclampsia with a statistically significant difference p value-0.00. Results also showed an increase in coagulation parameters and liver function variables in preeclampsia patients when compared with the control group. Conclusion-Pregnancy induced hypertension is a significant cause of maternal and fetal morbidity and mortality. The current study was undertaken to study about the platelet parameters and coagulation profile in early detection and prediction of severity of preeclampsia. We have compared multiple laboratory variables in women with preeclampsia with normotensive patients.

Introduction: Upper limb surgeries frequently use the brachial plexus block for anesthetizing the limb. The conventional approach by eliciting paresthesia is a blind procedure that may have a higher failure rate and  cancause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to aid in better localization of the nerve/plexus avoiding tissue damage. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus block. The purpose of this study was to compare the effectiveness of a Peripheral nerve stimulator with Ultrasound for giving Supraclavicular brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent,a total of 60 patients were enrolled in this prospective randomized study which were randomly divided into two groups in whom Supraclavicular brachial plexus block was given using either  Peripheral nerve stimulator (Group PNS) or Ultrasound (Group USG). Both groups received 15 ml  0.5% Bupivacaine and 10 ml Lignocaine with Adrenaline {2%}[1;200,000]. The  chiefparameters considered were time of onset of sensory and motor block, duration of analgesia ,block failure and complications following block. Results:Demographic data was comparable in both the groups. The mean time of onset of motor block and sensory blockwas  found to be more in Group PNS as compared to Group USG.The duration of sensory and motor blockade was more in group PNS ascompared to group USG . The success rate of the block was higher in ultrasound group than  inPNSgroup however it wasstatisticallyinsignificant. No complications occurred in either group. Conclusion:Ultrasound guidance  is a safe and effective method for giving supraclavicular brachial plexus block with faster onset and more lasting duration of motor and sensory blockade.

Background: To study the pattern and treatment outcome of secondary glaucoma in all age group of patients in a tertiary care hospital. Methods:This was a hospital-based prospective longitudinal study conducted on 70 patients of secondary glaucoma in a tertiary eye hospital of central India from January 2021 to June 2022. Demographic data was collected, detailed history was taken and a comprehensive ophthalmic examination was done in all patients. Results: The mean age at presentation was 61.08 ± 14.08 years with male to female ratio of 1.4:1. The most common cause was lens induced (LIG)in 45 (64.2%) followed by neo-vascular (NVG) in 7 (10%) and uveitic glaucoma in 6 (8.57%). Traumatic glaucoma was seen in 5(7.14%) cases while miscellaneous included 7 (10%). At presentation, the mean IOP was 37.87mmHg, being highest in NVG patients. Sixty four (91.4%) of patients had a presenting VA<6/60 in the affected eye. Forty nine (70%) patients regained VA better than 6/60 with maximum improvementbeing seen in LIG patients. Conclusion: Among different types of secondary glaucoma lens induced glaucoma was most common. Most patients were females, and majority presented with poor vision. NVG patients had the highest mean IOP. Best visual improvement after management was observed in LIG patients.

Background- The purpose of this study was to assess the effectiveness of oncoplastic surgical management for benign phyllodes tumour. Methods- Patients (n = 37) with eligible breast benign phyllodes tumour underwent oncoplastic surgical management. Primary outcome measures included, postoperative recurrence, and intra-operative and postoperative complications. Results-Thirty-seven patients who underwent surgical excision and oncoplastic breast surgery. The age range of the patients was 42 to 58 years. The majority of breast lesions were between 5 and 10 cm in size, ranging in size from 3.5 to 12.5 cm. On the seventh post-operative day, 56.8% of patients reported pain at the surgical site, 10.8% of patients had seroma, 5.4% had wound infections, 5.4% had flap necrosis, and 21.6% had lymphedema. Pain observed On Day 7 (56.8% of patients), there were 21 patients; on Day 21, there were 5 patients (13.5% of patients). There was a statistically significant difference in the proportion (P=0.001). Conclusions-Surgery and oncoplastic breast surgery are safe and effective for benign phyllodes tumours. Oncoplastic breast conservation surgery allows greater parenchymal resection without compromising oncology or aesthetics. Histopathological analysis pre-operatively reduces recurrences, reoperations, and oncologic outcomes. It can also prevent adjuvant therapy delays.

Background: Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim is to determine the accuracy with the benign and malignant lesions can be differentiated by fine needle aspiration cytology (FNAC) and to correlate the findings with histopathological diagnosis Material and Methods: It is a prospective study comprising of 105 patients of breast lumps who underwent FNAC followed by histopathological examination. All the breast lump aspirates were stained with Haematoxylin and Eosin (H and E) stain. Results: Among total majority of the patients (29.5%) belong to 31-40 years age group. Benign breast lesions were found in 65.8%, among which fibroadenoma (40.9%) was the commonest lesion which was observed. Malignancy was observed in 34.2%; among them, ductal carcinoma was the predominant lesion (18.1%) which was seen. Breast lump lesion was more in right side (54.3%) than left breast. Conclusion: The most common benign tumor in the present study was fibroadenoma and the most common malignant tumor was invasive ductal carcinoma.

Introduction: Vitiligo is an acquired pigmentary anomaly of the skin. It is manifested via de-pigmentary white patches on the skin with normal border or surrounding hyperpigmentation. Over the recent years, vitD (vitamin D) is implicated in a wide variety of medical conditions. It functions like a hormone and is produced in the skin where it plays an important role in skin pigmentation, increase enzyme action of tyrosinase and thus also affects melanin production. It also displays various immunoregulatory functions. VitD is found to be reduced in autoimmune diseases, like SLE, DM, alopecia areata, RA and multiple sclerosis.  Materials and methods: This is a prospective and case-control study was conducted. 120 vitiligo patients attending Department of Dermatology at R V M. Medical College, were included over a period of 6 months. Full history and examination were done, and the diagnosis was confirmed clinically and by using Wood’s light examination. In addition, 100 controls, age and sex matched, were included for comparison. Patients with vitiligo (generalized, focal, or segmental), normal thyroid function tests, and serum vitamin B12 were included in the study. In addition, clinical details of vitiligo were obtained including patient demographics, duration of vitiligo, and current and previous treatment.  Results: The demographic data of the 60 patients with vitiligo participating in this study. Comparison of mean VASI score calculated before and after treatment shows that the overall VASI score was significantly decreased relative to baseline (P<0.001).  Conclusion: Further studies are required to establish a causal relationship between vitiligo and vitD and likewise exploring the possibilities of use of vitD in treating vitiligo either alone or in combination with other therapies. The findings suggested there is no convincing evidence that vitamin D may help to prevent vitiligo.

Background: India, like many other developing nations has seen a steady decline in pulmonary tuberculosis over the past decades due to successful implementation of RNTCP-DOTS programme nationwide and improvement in social & economic condition of the general population. It is now seen that extra-pulmonary presentations form a major proportion of new cases. A majority of them present as head and neck tuberculosis (TB) - tubercular cervical lymphadenopathy. In spite of advent of newer diagnostic tools like nuclear ploidy, genetic analysis, nuclear scan and so on, Ultrasonography (USG) being the simplest, quickest and non-invasive diagnostic modality with high sensitivity has gained a very significant place in clenching early diagnosis of neck nodes. Aims & Objectives To calculate the Sensitivity, Specificity & Predictive Accuracy of USG in diagnosis of Extra Pulmonary Tuberculosis (EPTB) when presenting as cervical lymphadenopathy. Material &Methods A prospective, cross sectional study was conducted for 12 months in a Medical College and Hospital among the patients attending the ENT, Surgery, Paediatrics and Medicine OPD & IPD with cervical lymphadenopathy. After estimating the sample size,172 patients were included in this study. After obtaining approval from the IEC and informed consent of the participants, they were selected according to the inclusion and exclusion criteria. Result The Sensitivity and Specificity of USG in reference to TB cervical lymphadenopathy were 91.43% and 84.38% respectively with a positive predictive value of 96.24% and negative predictive value of 69.23%. 15.63% were false positive and false negative were 08.57%. Conclusion USG is an effective, non-invasive, inexpensive and safe tool with a high Sensitivity which can become an important and integral screening modality in the diagnosis of Extra Pulmonary Tuberculosis.

Background: Thyroid dysfunction is the second most prevalent medical disorder which has impact on reproductive health and pregnancy outcome. Because of the link of thyroid auto antibodies with various pregnancy related complications and antithyroid peroxidase antibody (TPO Ab) being most common of all of them, can be used as a surrogate marker for thyroid related adverse pregnancy outcomes. Hence, this present study is designed to further elucidate any association of TPO Ab and TSH levesl with adverse pregnancy outcomes. Aims: The present study was undertaken to determine pregnancy outcomes between TPO Ab positive and negative hypothyroid mothers. Methods: This hospital based observational study was conducted in the Department of Gynaecology and Obstetrics, Raiganj Government Medical College, Uttar Dinajpur, West Bengal, India. 305 hypothyroid pregnant women at 1st trimester were chosen randomly between 1st June 2021 to 31st May 2022. The data was tabulated in Microsoft Excel software and analysed with SPSSV.20 software. Results: Maximum participants belonged to age group 15-20 years i.e. 115 (37.7%), followed by 21-25 years’ age group, 92 (30.2%) Mean age of the participants was 23.30 years. Mothers with high TPO were 127 (41.6%). In our study 74 (24.3%) mothers required 25 mcg Levothyroxin followed by 12.5 mcg required for 58 (19%) mothers. GDM (27.78% vs 12.29%, p <0.001), were significantly higher in TPO Ab positive than TPO Ab negative hypothyroid mothers. Conclusions: Pregnant women with hypothyroidism and positive TPO Ab status were more predisposed to GDM than TPO Ab negative women.

Introduction: Hypernatremia is serum sodium less than 135 meq/L. Hypernatremia is the most common electrolyte disorder. Its homeostasis is vital to the normal physiologic function of cells. A disturbance in body water homeostasis is a common feature of advanced cirrhosis. Aims: To study the prevalence of hypernatremia (<130mMol/l) in cirrhosis of liver and the association between hypernatremia and complications in cirrhosis of liver and its prognostic significance. Materials and method: This prospective research included 100 patients hospitalized to the Department of Medicine at PMCH in Patna. The research was carried out at PMCH Department of Medicine in Patna. This research was carried out between April 2021 and November 2022. This research covered 100 patients. Result: There was significant difference in three groups of ≤130 meq/L, 131-135 meq/L and ≥136 meq/L with respect to the complications of liver cirrhosis namely portal hypertension, hepatic encephalopathy, hepatorenal syndrome (p value = 0.0111, <0.0001, 0.0140 respectively). However no statistical significant difference was found in three groups with respect to ascites, gastrointestinal bleeding and coagulopathy (p value= 0.0621, 0.6904, 0.7094 respectively). There was significant difference in three groups of ≤130 meq/L, 131-135 meq/L and  ≥136 meq/L with respect to the complications of liver cirrhosis namely portal hypertension,  hepatic  encephalopathy,  hepatorenal  syndrome  (p value= 0.0111,  < 0.0001, 0.0140 respectively). However no statistical significant difference was found in three groups with respect to ascites, gastrointestinal bleeding and coagulopathy (p value= 0.0621, 0.6904, 0.7094 respectively). Conclusion: Low serum sodium levels in cirrhosis are linked to serious consequences of liver cirrhosis such hepatic encephalopathy and hepatorenal syndrome, and causes high morbidity and mortality. Hyponatremia is common in cirrhotic individuals. Hyponatremia in cirrhosis patients leads to poor prognosis. To avoid potential liver cirrhosis consequences, hyponatremia must be treated.

Introduction: Perinatal asphyxia refers to a condition during the first and second stages of labour in which impaired gas exchange leads to fetal hypoxemia and hypercarbia which in turn can lead to cerebral edema and various circulatory disturbances. Aims: Role of cranial ultrasonography and colour doppler study of cerebral arteries in predicting neuromotor outcomes in newborns with perinatal asphyxia; A prospective/follow-up study. Material and methods: The study was conducted to assess the neuromotor outcomes in newborns with birth asphyxia by cranial ultrasonography and colour Doppler study of cerebral arteries. According to the inclusion and exclusion criteria, a total of 85 patients diagnosed with Birth asphyxia and complicated by hypoxic-ischemic encephalopathy (HIE) were selected for the study randomly from the SNCU & NICU, Department of Paediatrics, Murshidabad Medical College & Hospital, Murshidabad, West Bengal. Result: Majority of them (58, 68.2%) had poor outcome. Gross motor delay was most common complication (40, 47.1%), followed by Fine motor delay (26, 30.6%), Social delay (22, 25.9%), Language delay (18, 21.2%), Persistent seizure (18, 21.1%) and impaired vision and hearing (6, 7.1%). Some of them died (6, 7.1%) before the follow up. Conclusion: According to the present study, Transcranial ultrasonography and resistive index values of anterior and middle cerebral arteries showed high diagnostic accuracy, sensitivity, and specificity in predicting neuromotor outcomes in term newborns with birth asphyxia.

Background: Hypertension is the most common medical disorder in pregnancy, complicating 6-10% pregnancies1. Treatment of severely increased blood pressure is widely recommended to reduce the risk of maternal and fetal complications. Regimens for acute treatment of severe hypertension in pre-eclampsia include intravenous medications. Although effective, these drugs require venous access and careful fetal monitoring and might not be feasible in busy or low resource environments. Therefore, this study aimed to compare the efficacy of intravenous labetalol and oral nifedipine for control of hypertension in severe pre-eclampsia. Objective: To compare efficacy of intravenous labetelol and oral nifedipine when used rapidly to lower high blood pressure in severe pre-eclampsia mothers. Methodology: This is a hospital based prospective randomized interventional comparative trial conducted at Midnapore Medical College and Hospital from April ’21 to Sep ’22. The study has a sample size of 100 patients divided into two groups randomly, group A received intravenous labetelol injection (in escalating dose of 20,40, 80 and 80 mg every 30 mins, maximum dose of 220mg) and group B received oral nifedipine (10mg tablet orally upto 5 doses) every 30 mins2. Target BP is ≤ 150/ 90 mm of Hg. After target BP is reached further antihypertensive given as per choice. Results: In labetalol group 18 (32%) patients achieved target blood pressure with 1 dose, 10 patients (20%) with 2 doses, 14 (28%) with 3 doses and 8 (16%) with 4 doses while in nifedipine group 16 (32%) of patients achieved target blood pressure with 1 dose, 12 patients (24%) with 2 doses, 10 (20%) with 3 doses, 8 (16%) with 4 doses and 4 (8%) with 5 doses and P value is non significant (0.29).The mean average reduction in systolic blood pressure and diastolic blood Pressure after 30 minutes of drug administration was 6.04± 7.38mmHg and 6.88±4.8mmHg for labetalol and for nifedipine it was 4.32±4.22mmHg and 5.12±3.9mmHg with a non significant P value of 0.469. The mean time required to achieve target BP in Group A was 67.2±33.168 minutes and In Group B was 73.2±38.475 minutes with a P value of 0.405 which stands non significant. Conclusion: Oral nifedipine and intravenous labetalol regimens are almost equally effective in acute control of blood pressure in severe preeclampsia.

Introduction: Teenage pregnancy is defined as “pregnancy occurring between 10-19 completed years at the time of delivery”1. Early marriages are still a social problem in our society specially in developing countries like India where the adolescent individuals face a lot of issues involving changes in hormonal, emotional and psychological level. Teenage pregnancy implicates so many adverse outcomes both in maternal and fetal health. Objectives: To study the incidence of pregnancy in teenage group and to evaluate the maternal and fetal adverse outcome of teenage pregnancies for the sake of prevention. Materials and Methods: This observational prospective study was undertaken with 115 teenage pregnant mothers over a period of 12 months from 1st April 2021 to 31st March 2022 at Department of Obstetrics and Gynaecology, Midnapore Medical College and Hospital. Required details were collected on a pre designed proforma from admission to delivery and were analysed. Results: Incidence of teenage pregnancy in present study was 8.4%. Maternal complications like anaemia (72%), HDP (28%), preterm labour (30%), PROM (20%), post-dated pregnancy (23%), obstructed labour (16%), PPH (10%) and complications like IUGR (15.6%), LBW (58%), respiratory distress (14%), hyperbilirubinemia (14%), congenital anomalies (1.7%) among fetal complications were seen in teenage pregnancies. Conclusion: Maternal and fetal morbidity and mortality due to teenage pregnancy is still a common problem in our society.

Introduction: Chronic otitis media is relatively common and potentially dangerous disease of the ear. It is often characterized by cholesteatoma that causes local destruction and osseous erosion leading to complications. Its management is mainly surgical, mostly a canal wall up and down tympanomastoid surgery. High resolution computed tomography (HRCT) is the imaging modality of choice for evaluation of middle ear structures and pathology. The aim of this study is to identify causes of failure and its management with special reference to CT scan. Aims: Evaluation of different causes of revision tympanomastoid surgery, assessment of their outcome, and ascertaining the possible measures to prevent further recurrence. Materials and Methods: This Prospective descriptive study conducted at department of ENT, IPGMER & SSKM Hospital, Kolkata from 1year&6 months (April, 2020 to September, 2021). Result: 30 (60.0%) patients had Modified Radical Mastoidectomy Surgery and 20 (40.0%) patients had Radical Mastoidectomy Surgery. 41 (82.0%) patients had Cavity obliteration Palva flap. 23 (46.0%) patients had Cavity obliteration Bone dust. 26 (52.0%) patients had Cavity obliteration Cartilage. 41 (82.0%) patients had Adequate in Conchomeatoplasty Size Post-operative findings 1 Month. A significant improvement in mean air conduction level, mean bone conduction level, and mean air-bone gap (ABG) was found postoperatively (p < 0.05). For all types of ossicular chain reconstruction, a significant improvement in mean Pure Tone Average was observed (p < 0.05).Conclusion: A revision canal wall down surgery, if performed successfully following all the basic principles of tympanomastoid surgery, can help achieve a safe and dry ear and can significantly improve the subjective well-being of the patients.

Background: Breast cancer is the foremost cause of cancer related death in young females; hence early detection of breast cancer carries much importance. This study is done to determine the incidence of Malignancy in all breast lumps in patient admitted in Department of general Surgery, RAMA medical college and hospital,Hapur. Material & Methods: This Prospective study was conducted between January 2021 to September 2022. 50 consecutive patients admitted in Inpatient department with complaints of a palpable breast mass were included  . Each patient underwent a modified triple test which included a complete clinical examination, ultrasound examination and mammography of the breast mass and finally Fine Needle aspiration and histopathological test of specimen obtained from the breast lump was done.  Results: Out of the 50 patients,12 (24%) patients were between the age group of 10 to 20 years, 12(24%)  patients were in the age group of 21 to 30 years and 13(26%) patients were in the age group of 31to 40 years. 14(28%) patients were nulliparous while 36(72%) were multiparous.  Most of the patients 15 (30%) had symptoms for the duration of 4 to 6 months.Pain over lump was present in 26(52%) patients while nipple discharge was present in 9(18%) patients. Majority of the females (60%) had their onset of menarche between 12-15 years. Upper outer quadrant of the breast was found to be most commonly involved with tumor in 25 (50%). A lump size of 3 to 4 cm in maximal diameter was found in 17 (34%) patients. 35(70%) patients had lumps which were firm in consistency. 38 (76%) patients were subjected to Excision biopsy, 3 patients (6%) were treated with BCS  and 9 patients (18%) underwent Modified Radical Mastectomy. 41(82%) patients with lumps were diagnosed to have benign lesions on histopathology while 9 (18%) patients had malignant lesions. Fibroadenoma was the most common benign breast tumour, seen in 31 out of 41 patients (75%). Of the malignancies proven by histopathology (9 patients), 7 patients had invasive ductal carcinoma (77.8%). Conclusion: Age is important risk factor for malignant lesions. Majority of the females with benign diseases are premenopausal and majority of the patients with malignant lumps are post menopausal in our study. Fibroadenomas are among the most common benign lesions of the breast while invasive ductal carcinoma is the most common of the malignant lesions of the breast.

Background: Trauma is reported to be the leading cause of death, hospitalization and morbidity in young population. Road traffic accidents (RTAs), fall from height, occupational injuries, and assault are the usual etiologies, RTAs being the commonest. Material and Methods: All the patients presenting with traumatic injury to the thorax with or without other associated injuries, between February 2019 to January 2023   at our centre were included in the study. Patient data  collected  comprised of demographic information of the patient, characteristics of injury, primary diagnosis, associated thoracic and non-thoracic injuries, medical and surgical interventions, and outcome of the injury.Results and Observations: There were 549 (65.6%) male and 288 (34.4%) female patients whose ages ranged from 2 years to 92  years with  mean age of  35.72 ± 15.18 years. There were 688 (82.2%) patients with blunt traumas and 149(17.8%) patients with penetrating traumas. In blunt thoracic trauma the most common mechanism was road traffic accident (n= 424, 61.6%), followed by fall from height (n=183, 26.5%), occupational accident (n=44, 6.3%), and assault (n=37, 5.3%). Rib fractures were the most common type of injury in our series and  presented in 498( 59.5%) patients. After rib fractures pneumothorax was the second most common type of injury (n=399, 47.7%),  followed by hemothorax (n=289, 34.5%), lung contusion (n=223, 26.6%). Approximately two-third  of the patients were having concomitant associated  injuries  (n=502 ,59.9 %), the commonest being extremity fracture (n=214, 42.6%). Tube thoracostomy (n=432, 51.6%) was the most common surgical intervention in our patients, followed by thoracotomy (n=16, 1.9 and conservative management  (n=389,46.4%) . The mean hospital length of stay (LOS) was 4.1 ± 3.6 days. The mortality rate was 0.9 % (8 out of  837 ). Hemorrhagic shock (n=5) and respiratory failure (n= 3) were the most causes of death.Conclusion: Middle aged  males owing to more outdoor activities and vehicular accidents bear most of the brunt of blunt chest trauma thus affecting the most productive age group of population. Rib fracture followed pneumothorax and hemothorax were the commonest injuries. Often a combination of these injuries were present.Majority of patients with blunt chest injuries can be managed at the level II trauma centre like ours.

Background- 'Liver abscess' is a common medical condition in India and has a high mortality ratedue to delayed detection and treatment. Based on the available literature, ruptured liver abscess occurs in 2- 17% of patients and is associated with a mortalityrate of 12%-50%. Currently, these patients are treated with antibiotics along with percutaneous needleaspiration (PNA) or percutaneous catheter drainage (PCD) or surgical drainage, used only for patients who do not respond to these treatments. Therefore, this study aims to evaluate outcomes associated with different treatment strategies for liver abscess. Methods- In the present study, all patients of Ruptured Liver abscess were selected from MYH Hospital Department of Surgery Indore MP,during the period from September 2020 to September2021. Patient was treated conservatively if the size of abscess rupture into subphrenic space, perihepatic space, right paracolic gutter, and right pleural cavity. Percutaneous pigtail catheter was inserted in abscess cavity and collection space under USG guidance. Pus aspirated was then sent for culture and sensitivity. Result- In our study on the basis of outcomes among pigtail and laparotomy procedures-death rate was 13.3 % (higher) in laparotomy procedures than pigtail procedures 6.7 %. And successful rate higher in pigtail procedure (93.3%) than laparotomy procedures (86.7%) . Hence pigtail procedures were better than laparotomy procedures in ruptured liver abscess on the basis of outcome (death rate and success rate). Conclusion: Laparotomy procedures had a higher death rate than pigtail procedures (6.7%). Pigtail procedures (93.3% successful) outperform laparotomy procedures (86.7%). Pigtail procedures performed better than laparotomy in ruptured liver abscess in terms of mortality and success.

Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. Aim To perform hematological evaluation of anaemia in 200 geriatric patients.  Research Design and Methods This was a hospital-based prospective observational study, conducted in 200 patients aged 60 years and above at SIMS, Hapur, NCR, a tertiary care center of North India from July 2022 to Dec 2022.  The hemoglobin level below 13 g/dl in men and below 12 g/dl in women is taken as anaemia. Results A total of 200 patients of age 60 years and above with anemia were evaluated for various hematological parameters. Data analysis was done using laboratory parameters like hemoglobin, Packed cell volume, MCV, MCH, MCHC, ferritin, transferrin saturation, C-reactive protein, vitamin B12 and folic acid.  Medical history and demographics was taken into consideration. Out of 200 patients, the etiological distribution of anemia showed Anemia of chronic disease (ACD) in 76 patients (38%), to be the most common cause , especially  Chronic kidney disease (CKD) in 37 patients(18.5%). This was followed by iron deficiency anemia in 65 geriatric patients (32.5%), multifactorial cause in 10 (5%), vitamin B12 deficiency in 13 (6.5 %), Anaemia due to hematological cause in 13 patients( 6.5%) folate deficiency in 6 (3%). No etiology for anemia could be found in 17( 8.5%) patients . Conclusions In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.

Introduction: A morphometric study of the upper end of the dry tibia bone explores the anatomical features and measurements of the tibial plateau, which is vital in knee replacement surgeries. By analyzing these dimensions, this research aims to uncover valuable insights with clinical significance. Understanding the morphometry of the tibial plateau facilitates implant design, surgical technique refinement, and patient-specific considerations, ultimately enhancing the accuracy and success of knee replacement procedures. Materials and Methods: In this cross-sectional and prospective study, 60 adult tibias (among which 30 belong to the right side and 30 belong to the left side) of unknown gender and age were studied in the Department of Anatomy, Nalanda Medical College & Hospital, Patna, Bihar. Using a digital vernier caliper, various upper-end characteristics were measured on a fully osseous, dried, macerated, and carefully cleaned tibia. Results: We observed that the mean anteroposterior diameter of the medial condyle was more than the lateral condyle, while the transverse diameter was more in the case of the lateral condyle on both sides. It was observed that the anteroposterior diameter of the intercondylar area was more on the left side. The transverse diameter of the intercondylar area of the upper end of the tibia at the anterior end as well as the middle narrow part was found more on the left side, while that of the posterior end was more on the right side. But the difference between the right and the left side was statistically insignificant. Conclusion: This study and its clinical significance in knee replacements seek to enhance our understanding of the tibial plateau's anatomical variations and their impact on surgical outcomes. By shedding light on these crucial aspects, we aspire to improve surgical precision, implant selection, and patient outcomes in knee replacement surgery.

Introduction: Sodium levels should be between 135 and 145mEq/L. A cell's ability to maintain homeostasis is necessary for proper operation. An imbalance in the body's general water control may be the cause of abnormal sodium levels. High sodium levels caused by irregular water balance are present in chronic liver illness that is not yet fully reversible. Aims: To assess the correlation among serum sodium imbalance and prognosis in decompensated liver disease patients and its clinical relevance. Materials and Methods: It was a prospective hospital based observational study of 75 patients with biochemical and clinical evidence of chronic liver disease (CLD), who were admitted in the medical ward of Katihar Medical College, Katihar, since December 2020 to May 2022. Result: In present study, 69 (92%) patients were alcoholic, 1 (1.33%) had HCV, 5 (6.67%) had HBV, and none had primary biliary cirrhosis, cryptogenic cirrhosis, and autoimmune hepatitis. There was abdominal distension in 75 patients (100%), jaundice in 22 (29.33%), lower limb swelling in 75 (100%), GI bleed in 19 (25.33%), and altered sensorium in 15 patients (20%). Conclusion: It has been shown that low serum sodium is a poor prognostic marker and increases the risk of early mortality. The few available treatments for hyponatremia currently consist of appropriate free water restriction, stopping diuretics, and may be short-term vaptan (eg; Tolvaptan) usage.

Introduction: Pterygium, derived from Pterygion (ancient Greek word means wing) is a slow growing proliferation of wing shaped common ocular surface lesion originating in the limbal conjunctiva within the horizontal palpebral fissure with progressive involvement of the cornea. Aims: To observe refractive error changes following primary pterygium excision and autologous stem cell grafting placed by suture. Materials and methods: The present study was an Institution based, longitudinal, observational, prospective study. This Study was conducted 9 month, between January 2019 and September 2019 at Outdoor and indoor of Department of North Bengal Medical College and Hospital. Total 50 patients were included in this study. Result: Pre-operative, post-operative DAY1, DAY7 and DAY30 visual acuity distribution were analysed statistically. Mean pre-operative visual acuity of the study subjects were 11.04 (sd =3.98). Whereas mean post-operative visual acuity were 10.740 (sd =3.78), 9.600(sd=3.48) and 7.80 (sd=2.48) respectively for DAY1, DAY7 and DAY30. Visual acuity significantly improved DAY7 (P≤0.001, mean difference=1.44) and DAY30 (p≤0.001, mean difference =3.24). There was no statistically significant improvement of visual acuity on DAY1 post-operative period (p≤ 0.16) but post-operative DAY30 visual acuity improvement was highly significant. Conclusion: Pterygium has direct impact on visual acuity, horizontal and vertical keratometric reading. There was no improvement of visual acuity on DAY1 post-operative period but post- operative DAY30 visual acuity improvement was highly significant. Both K1 and K2 value changed following operation. Mostly values were changed after 7th post-operative day. K1 values were changed more in compare to K2 values. Though required spherical glass power changes were not observed but cylindrical glass power changes were noted.

This study was conducted to compare the efficacy and the best time for administration of ondansetron and dexamethasone in controlling PONV. Methods This was a hospital based prospective study conducted among 120 patients who presented with elective surgeries to the Department of Anaesthesiology and Critical Care, Sri Aurobindo Medical College and Post Graduate Institute, Indore, over a period of one year from September 2015 to September 2016 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results The association between postoperative nausea and vomiting at 1 hour, 2 hours, 3 hours, 4 hours, 5 hours, and 6 hours with groups was found to be highly significant. In comparison of mean VAS at 1 hour, 2 hour, 3 hour, 4 hour, 5 hour, and 6 hour was highly significant, whereas in Tukey pairwise comparisons was found  significant except ondansetron before induction to dexamethasone before extubation, ondansetron before induction to dexamethasone before extubation, Ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, Ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction, ondansetron before induction to dexamethasone before extubation, ondansetron before extubation to dexamethasone before induction was not significant. Conclusion Dexamethasone administration 20 minutes before induction proved to be the best drug for preventing PONV, especially during the first 6 hours postoperatively.

Introduction: Cardiopulmonary arrest (CPA) is the cessation of effective ventilation and circulation. It is also known as cardiac arrest or circulatory arrest. In adults, it is most likely to be caused by a primary cardiac event. The most common electrical mechanism which is responsible for 50 to 80% of cardiopulmonary arrest is ventricular fibrillation (VF). While, 20% to 30% which represents the less common causes of dysrhythmias involve Pulseless electrical activity (PEA), and asystole. Pulseless sustained ventricular tachycardia (VT) is a less common mechanism.   Objective:  To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital. Materials and Methods: This prospective observational study was conducted in the Department of Cardiology in a Tertiary care Teaching hospital over a period of 6 months among all patients above 18 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: After CPR, 10 (20%) of 50 patients were discharged fully conscious, whereas 40 (80%) patients died; 20 of them died immediately, whereas 20 patients developed hypoxic encephalopathy and died during hospitalization. There was no statistically significant association between age, sex, and associated comorbidities and the outcome of CPR. However, there was a significant inverse relation between the duration of CPR and its outcome. The duration of CPR was significantly lower in survivors (3.80 ±1.90 min) compared with non survivors (11.31 ± 3.41 min) (P<0.001). GCS was significantly higher in survivors group compared with non-survival groups (12.38±0.3 vs 3.68±1.20, P<0.001). Conclusion: These results suggest that out-of-hospital cardiac arrest among children has a very poor prognosis, especially when efforts at resuscitation continue for longer than 20 minutes and require more than two doses of epinephrine.

Background: Sepsis is an emergency state in response to an infectious process ultimately leading to multiorgan dysfunction and death. There is an urgent need for sepsis detection methods, especially in emergency settings. To fill this gap, monocyte distribution width (MDW) was studied as an early indicator of sepsis. MDW is a routinely reported component of the automated complete blood count (CBC) performed by hematology analyzers. Overwhelming patient load and scarcity of health resources are among the major challenges that are faced in resource-limited settings. Materials and methods: This is an observational prospective, monocentric cohort study to evaluate the possible association of population cell data parameters with ensuing sepsis at the intensive care unit of Tertiary Care Teaching Hospital. Patients were consecutively enrolled whenever hospitalized for suspected infection or sepsis. Clinical characteristics of patients at entry, including demographics (age and gender); vital signs (heart rate, respiratory rate, body temperature, blood pressure), past medical history and other laboratory examinations (white blood cell counts, blood gas analysis, blood biochemistry) were prospectively collected. Result: Exactly 30 patients (33.3% of total cases enrolled in the trial) belonged to the group that survived till the 28th day of hospitalization, among them were 12 women (40%) and 15 men (50%). The rest of the patients from the research, precisely 60 of them, were deceased (66.7%). Among non-survivors were 15 women (25%) and 45 men (75%). Descriptive statistics for selected variables (MDW, age, CRP, PCT, lactate, and ICU days) in certain groups are expressed as mean, standard deviation, minimum and maximum values, and interquartile range. Test of normality (Shapiro–Wilk) for all parameters p < 0.05 showed a nonparametric distribution of data. The Chi-square test was used to compare differences between groups (survived and deceased on the 28th day), with cut-off values for MDW 26.0 μm, CRP 100 mg/mL, PCT 1 ng/mL, lactate 2 mmol/L respectively. Conclusion: MDW is an inexpensive and readily available biomarker that will help emergency clinicians to promptly identify sepsis accurately and start appropriate treatment in a timely manner. MDW as an early sepsis indicator would be a strong addition to current sepsis protocols, especially in resource-limited settings.

Aim: The study was conducted to determine incidence, causes and management of small bowel obstruction following appendectomy. Methods: This was a prospective, observational study conducted at Government Medical College, Srinagar, India from June 2018 to October 2020.The study group consisted of 250 patients who underwent emergency appendectomy for acute appendicitis. Results: Amongst the study group of 250 patients, 14 (5.6%) developed intestinal obstruction post appendectomy. The frequency of readmission of patients was 1.29 times. Majority of these patients required surgical intervention for management, which led to an increase in morbidity among them. Conclusion: The risk factors for developing small bowel obstruction were reviewed and measures to avoid them were suggested.

Background: Anaemia is a medical condition in which the haemoglobin (Hb) concentration and erythrocyte count are lower than the normal range. The main causes of anaemia are a decrease in RBCs, insufficient Hb synthesis or increased RBCs destruction, and the primary cause is an iron deficiency. A useful method for diagnosis and classification of anaemias is based on the morphological appearance of RBCs on an ideal stained blood smear. Aim: In our prospective study we investigated about the morphological type and the etiological spectrum of anemia  Materials and Methods: A hospital based prospective was carried out in the Department of Pathology, tertiary care hospital, central India from October 2021 to September 2022. A total of 250 patients of 18-80 years age group were evaluated for morphological pattern of anaemia based on red cell indices, peripheral smear, and leukocyte and platelet parameters. Anaemia was defined according to WHO criteria as Hb concentration <13 g/dL in men and 12 g/dL in women.  Results: The results of CBC and PBP showed that 72 (29%), 138 (55%), and 40 (16%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anaemia respectively. The gender wise classification of the patterns revealed that 44 male patients and 28 female patients had normocytic normochromic patterns, while 105 female patients and 33 male patients had microcytic hypochromic patterns whereas 23 males’ patients and 17 cases of female patients showed macrocytic pattern. Pancytopenia was found in 12% cases while neutrophilia and lymphocytosis were in 10% cases. Conclusion: Morphological patterns of anemia reflect the underlying etiology, the study of which would ensure benefits in the early detection and appropriate treatment. Iron deficiency anemia being a nutritional anemia which can be prevented by improving nutritional status, creating awareness and educating people.

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of prospective risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. We try to establish the correlation between the fatty liver with diastolic dysfunction in normotensive young patients under 40 years of age. Method: This cross-sectional analytical study was conducted between April 2021 and March 2022 in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa. It included 214 normotensive cases under 40 years with fatty liver. Patient information, clinical examination, and various tests were conducted to assess diastolic dysfunction. The collected data was compared with previous studies for analysis. Results: Out of 214 cases 105 (49%) were male and 109 were female (51%). Mean age of the patients was 27.84 ± 8.27 years. Out of 214 patient’s normal diastolic dysfunction found in 167 (78.04%) cases followed by the 26 (12.15%) cases had grade- 1, 15 (7.0%) cases had grade 2 and 06 (2.81%) patients had grade 3 diastolic dysfunction.  Among all cases 180 (84.11%) of the patients had grade 1 fatty liver out of which 156 (86.66%) had no diastolic dysfunction, while the 17 (9.44%) cases had grade- 1, 6 (3.33%) had grade 2, and 1 (0.55%) patient had grade 3 diastolic dysfunction. 29 (13.55%) cases were found to have grade 2 fatty liver out of which 6 (20.68%) had no diastolic dysfunction, while the 9 (31.03%) cases had grade- 1, 9 (31.03%) had grade 2, and 5 (17.25%) patients had grade 3 diastolic dysfunction. 5 (2.33%) cases found to have grade 3 fatty liver all 5 (2.33%) were found to have no diastolic dysfunction.  Conclusion: The prevalence of diastolic abnormalities in adults under 40 years with fatty liver was 21.9%, indicating a significant correlation. Clinicians should consider cardiovascular risks and undertake early risk factor modification.

Introduction: Lymphadenopathy is defined as an abnormality in the size or character of the lymph node. It is caused by invasion or propagation of either inflammatory cells or neoplastic cells into the node. Cervical lymphadenopathy may be the sole clinical finding or may coexist with other non-specific findings and recognition of enlarged cervical lymphnodes will often unveil a spectrum of differential diagnosis. Aims: To evaluate sonographic features in cervical lymphadenopathy under different parameters, distribution of etiologies according to sonological parameters and sensitivity and specificity of different sonographic parameters in differentiating benign from malignant lymphadenopathy. Materials and Methods: The present study was an observational study with prospective component. This study was conducted for 18 months at department of Radiology, Murshidabad Medical College and Hospital, Berhampore, West Bengal. Result: In the present study among malignant nodes 44% showed peripheral vascularity and 56% showed mixed pattern of vascularity. Echogenic hilum showed  89% and 77% sensitivity and specificity in differentiating malignant nodes with PPV and NPV of 44% and 97% respectively.. Conclusion: Different sonographic parameters have high sensitivity and specificity in differentiating malignant from benign nodes

Introduction: PONV is defined as nausea and/or vomiting occurring within 24 h after surgery. Post-operative nausea and vomiting (PONV) is a common and distressing complication after anaesthesia and surgery, with an incidence of approximately 30%. PONV is usually self-limiting and nonfatal but it is unpleasant and leads to considerable post-operative discomfort and dissatisfaction. Objectives: Efficacy of dextrose infusion before induction to prevent post-operative nausea vomiting and whether it is influenced by plasma osmolarity.  Materials and Methods: The present study was a prospective randomized double blinded clinical study. This Study was conducted from January 2019 to January 2020 at Department of Anaesthesiology, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal. Result: Rapid infusion of 5%Dextrose may increase the blood sugar level to an unexpected level which was our concerned. But after completion of the study we found negligible amount of patients (13.3% at immediate post-operative period, 5.3% at 1st hour post-operative period, 2.6% at 2nd hour post-operative period) in Group D had capillary blood glucose level more than 180mg/dl which is the upper limit of target blood sugar level perioperatively.  Conclusion: From our study it was found that intra venous administration of Dextrose (5%) before induction of patient’s undergone laparoscopic cholecystectomy can reduce post-operative nausea and vomiting (PONV) significantly and even if PONV occurred the quantity of rescue antiemetic combat PONV also reduced significantly.

Introduction: Cerebrovascular accident (CVA) or stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. 1Cerebrovascular accidents (CVA) can be classified into two major categories: about 87% of strokes are ischemic, the rest being haemorrhagic. It is difficult to be sure clinically about the type of stroke (haemorrhagic or ischemic) in majority of cases as there is no absolute differentiating feature. Aim:Monitoring ECG changes in real time can help lessen the severity of the consequences of a cardiovascular event and the number of casualties.  Materials and Methods: The present study was a hospital based prospective observational study. This Study was conducted from December 2020 to May 2022 at Departmentof General Medicine, Katihar Medical College, Katihar. Result:In this study, ST segment changes, T wave changes, U waves, Q waves, LVH, Sinus arrhythmia, P Pulmonale, Normal were significantly associated with type of stroke. Conclusion:Patients with cerebrovascular accidents often have abnormal electrocardiogram in the absence of known organic heart disease or electrolyte imbalance. These ECG changes are more common in intracerebral hemorrhage and subarachnoid hemorrhage than in infarcts.

Introduction: Diabetes mellitus (DM) is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Aims: To determine the effects of ulcer size, ulcer age, duration of diabetes, glycaemic control, infection, lower limb ischemia and neuropathy on outcome of diabetic foot ulcer. Materials and Methods: The present study was a Prospective comparative study. This Study was conducted from December 2020 to May 2022 at Department of general Surgery, Katihar medical college and Hospital, katihar. Result: Regarding the duration of diabetes, their findings indicate that individuals with longer duration of diabetes were at higher risk of developing foot ulcers. Specifically, individuals with diabetes for more than 10 years had a higher prevalence of foot ulcers compared to those with diabetes for less than 10 years. This is consistent with your study's finding that the mean duration of diabetes in individuals with foot ulcers was 9.21±3.76 years. Conclusion: The study results suggest that a conservative approach may be a more cost- effective option for treating diabetic foot ulcers, and early diagnosis and treatment can lead to better outcomes. Further research could focus on developing more targeted and effective treatments for foot ulcers, as well as improving prevention measures for diabetic complications. In this study suggests that with targeted approach we have almost obviated the need for any amputation.

Many attempts have been made to attenuate the pressor response to laryngoscopy and endotracheal intubation e.g. deep anaesthesia, topical anaesthesia, use of ganglionic blockers, antihypertensive agents, calcium-channel blockers, fentanyl, lignocaine, magnesium sulphate etc.  Clonidine is mainly used as an anti-hypertensive agent, but has many properties of ideal premedicant and also has beneficial effects on haemodynamics during stressful conditions like laryngoscopy and endotracheal intubation. Different studies have shown that intravenous clonidine is effective in reducing the haemodynamic responses to laryngoscopy and endotracheal intubation on an average dose of 3-4µg/kg body weight. The present study is aimed to observe whether further reduction in dose of clonidine will be effective or not for the same. This study was designed to observe the effects of clonidine hydrochloride infusion on haemodynamic response to laryngoscopy and endotracheal intubation during general anaesthesia in comparison with placebo and to observe any side effect of the study drug. Methods: In this prospective randomized study two groups of 34 patients each were studied. The Group-A received normal saline as study solution and Group-B received 2μg/kg Clonidine as study solution, was infused with an infusion pump over 10 minutes as per randomization table. After completion of infusion General Anaesthesia was administered and haemodynamic variables were noted immediately, one, three and five minutes after intubation. There was rise in all the parameters (HR, SBP, DBP, and MAP) compared to baseline value in both the groups. Inter-group comparison was done with respect to all the above parameters and side effects in both groups were noted. Result: There was rise in mean heart rate which was statistically significant at immediately after LETI compared to baseline within the groups, but the rise was not statistically significant when compared between two groups. Inter-group comparison shows that there was statistically significant lower rise in the study group. Immediately and one minute after LETI the difference in mean systolic blood pressure from baseline was statistically significant but at three and five minute the rise was similar in both the groups. Inter- group comparison shows highly significant difference in rise of diastolic blood pressure between two groups. Mean arterial pressure showed statistically significant rise from baseline at all the point of measurement after LETI in both the group. This rise was significantly less in study group only immediately after LETI. Inter-group comparison at other points of measurement  showed no difference in changes of mean arterial pressure between the groups. Conclusion:  We conclude that pre-induction low dose Clonidine infusion is a reasonable option to attenuate haemodynamic surge following LETI compared to placebo.

Introduction: Parkinson‟s Disease has been known in India since ancient times. Parkinson‟s Disease is a progressive neurodegenerative disorder characterized by clinical features of bradykinesia, tremor and rigidity. Nearly all forms of PD results from a reduction of Dopaminergic transmission within the Basal ganglia. Aims: To study clinically around 50 patients of Idiopathic Parkinson‟s Disease having non- motor manifestations in and around Patna, Bihar, having a mixed population and the clinical correlation, if any, between non-motor symptoms with that of the severity of Parkinson‟s Disease in accordance with the stages 1 to 5 of the Modified Hoehn and Yahr Scale. Materials and method: This present study was Cross-sectional type of observational study. This study was conducted from April 2021 to October 2022of Patna Medical College and Hospital, Patna. Total 50 patients were included in this study. Result: Majority of the patients (58%), suffer from depression, followed by dementia (30%), followed by hallucination/illusion/ delusion (24%), followed by panic attacks (18%).Percentage of depression was found to be highest in Stage 4 with 71.4% (5 out of 7), followed by Stage 5 (66.67%), Stage 2.5 (57.14%), stage 3 (54.54%), stage 2 stage 1.5 (40%) and stage 1 with (28.57%).The percentage of patients with RBD was highest in Stage 1.5 with 60% (3 out of 5), followed by Stage 3 (45.45), stage 5 (33.33%) and stage 2.5 (28.57%) followed by stage 1 (14.28%) and 4 (14.28%).The percentage of patients with RLS was highest in Stage 2 with 40% (4 out of 10), followed by Stage 5 with 33.3%.The percentage of patients with EDS was highest in Stage 1.5 with 100%, followed by Stage 5 with 66.7%.The percentage of patients with Nocturia was highest in Stage 5 with 100%, followed by Stage 3 with 72.7%. Conclusion: This study helps in screening patients with Parkinson‟s disease (PD) of non- motor symptoms (NMS) and aims at providing holistic treatment improving the quality of life. There is a need for large and well-designed prospective, adequately powered, large community-based study on the prevalence, the symptom, the efficacy of treatment, and the progression over time, of NMS in PD. This will provide a basis for improving the quality of care of these patients by clinicians.

Aims and objectives: To assess effect of single chamber right ventricular pacing on function of atrio-ventricular valve at 1 year of prospective of follow up.  Methods and Results: A total of 135 patients having atrio-ventricular disease received single chamber pacemaker implantation were enrolled. Study outcomes were changes in the function of atrio- ventricular valve. During 1 year of follow up proportion of moderate MR was similar but proportion of severe MR was significantly reduced to 0.0% (p=0.03) and proportion of moderate and severe TR was not changed but proportion of mild TR was increased 35.7% from baseline to 53.1% at 12 month but statistically not significant (p=0.84) Conclusions:  Right ventricle apex pacing lead was not affect tricuspid regurgitation significantly. None of the patients were developed  right  side  heart failure.

Introduction: Gallstones are a major cause of morbidity throughout the world, necessitating hospitalization and cholecystectomy. Gallbladder is known to play crucial role in the formation of gallstones. Therefore, understanding the interaction between gallbladder mucosa and bile is an important step towards understanding the pathogenesis of gallstone disease. Aims: Qualitative and quantitative assessment of gallbladder mucins in chronic calculous cholecystitis and Correlating the mucin histochemistry and morphology of gall bladder in chroniccal culouschole cystitis with each otherand with the chemical composition of gallstones Materials and methods: The present study was a Prospective, Observational institutional based study. This Study was conducted for the duration of 18 monthsat DarbhangaMedical College and Hospital, Laheriasarai, Darbhanga.Total110 patients were included in this study. Result: In the present study, pigment stones were found more often in association with severe inflammation, gastric metaplasia and increased expression of sialomucins,as against cholesterol stones. Conclusion:The normal gallbladder epithelium contains sulphated acid mucins with traces of neutral and sialomucins .The sulphomucin content decreases in chronic calculus cholecystitis

Background: In the early neonatal period, respiratory distress affects up to 7% of new-born babies. (1) The respiratory distress syndrome and chronic lung disease of prematurity in preterm new-borns (gestational age 37 weeks) have received a lot of attention (2,3), but many term-born infants are brought to neonatal units each year for the care of their respiratory distress. OBJECTIVES: • To estimate the incidence of respiratory distress in term neonates. • To know the risk factors of respiratory distress in term neonates. • Evaluation of outcome of respiratory distress in term neonates during their hospital stay. Material & Methods: Study Design:  Hospital based prospective observational study Study area: The study was conducted in the Department of Paediatrics, Mallareddy institute of medical sciences, Hyderabad, Telangana. Study Period: Oct. 2022 – March 2023. Study population:  Term neonates admitted to Inborn and Out born NICU. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Simple Random technique. Results: In this study, out of 100 babies with respiratory distress, 30 babies (30%) had Downe’s score of 2; 30 babies (30%) had a score of 3; 11 babies (11%) had a score of 4 and 19 babies (19%) had a score of 5. Inference was that most of the babies with respiratory distress had a lower Downe’s score in the range of 2-4. It was found that, 84 babies (84%) had a perinatal risk score of 0 – 3.  Conclusion: From our study we conclude that there was a highly significant association between Caesarean extraction and RD. Frequency of RD is inversely related to gestational age and birth weight. 74 babies admitted with respiratory distress required only Oxygen, whereas 5 required mechanical ventilation and 32 required CPAP. 97% survived and 3% died in the present study. k score of 0-3.

Introduction- Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. Aims And Objectives- compares the efficacy accuracy of hysteroscopy and transvaginal sonography in diagnosing the  pathology of AUB. The hysteroscopic and sonographic findings are correlated with the histopathological diagnosis of endometrium obtained by curettage. Material And Methods- The present study “A comparative study of hysteroscopy and transvaginal ultra sonography in the evaluation of AUB in reproductive age group” is a prospective study which was done in the department obstetrics and gynecology, Indore. 100 patients with the complain of AUB were selected at random from the Gynecology Out Patient Department of the Institute of obstetrics and gynecology medical college and MY hospital Indore. The age group of the selected patients ranged from 20 to 40 years. All the patients underwent TVS, Hysteroscopy followed by curettage and removal of abnormal lesions like Polyps and Submucous fibroid and the material was sent for histopathological analysis. The period of study was from September 2018 to Aug-2019. Patients with age group in the range of 20 to above and parous woman with AUB and who do not have any other medical or surgical complications and who do not require any emergency management were selected for this study. Patients with severe anemia, pregnancy, nulliparous, pelvic inflammatory disease, systemic cause of bleeding, vaginal and cervical cause of bleeding, thyroid disorder and coagulation disorder, unmarried girls and medical complications like uncontrolled diabetes mellitus or hypertension were also excluded from  study to preclude any anesthetic or surgical risks during hysteroscopy. After informed written consent and counselling, detailed clinical history was taken. obstetric history included parity, mode of delivery, abortion, history of IUCD, history of D and C, contraception history, detailed menstrual cycle history past and present in term duration, frequency, flow amount and type of abnormal bleeding, and duration of complain, any relevant preceding event.  Results- Total number of patients selected: 100. Among the reproductive age group, patients in the age group of  26 – 30 constitute 40%. Patients having 1 – 2 children constitute the majority - 48% of cases; whereas multiparous women having more than 4 children constitute only 10%. Kumari m et al and Patil et al, 61% and 71% patient with aub were multiparous respectively. Mishra et al study 65% multiparous 30% primiparous. 80% of patients sought medical advice within 6 months of illness; whereas only 2% of patients sought the medical advice after 1 year of illness. Commonest pattern of bleeding is menorrhagia accounting for                          42% of cases. By Histopathology 74 patients (74%) had normal endometrium. Histopathology diagnosed 8 cases of hyperplasia and 14 cases of endometrial polyp, 4 cases of Submucous fibroid. In the present study there were no malignancies detected. 8 out of 100 patients had simple hyperplasia, whereas in 74 out of 100 patients, endometrium was normal. Conclusion- This study confirms that hysteroscopy is superior to transvaginal sonography in evaluating abnormal uterine bleeding. Most of the patient presenting with aub are in reproductive age group. Higher incidence of intrauterine pathologies in this age group.  Both tvs and hysteroscopy will diagnose the condition of uterus. but both have different accuracies. Compare to tvs, hysteroscopic is direct visualization   of endometrial cavity and also a safe reliable and fast procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value, negative predictive value with minimal complication. Additional opportunity of taking biopsy. Transvaginal sonography can be used as the first line diagnostic technique but hysteroscopy followed by histopathological examination should be considered as “Gold standard” for evaluation of abnormal uterine bleeding.

Introduction: Corona virus disease 2019 (COVID-19) is highly contagious and has great transmission rate. Growing amounts of research are showing how inflammation affects COVID-19 patients; illness development and mortality. An important aspect of COVID-19 pathogenesis is inflammation. Aim: To study the association of inflammatory markers in COVID-19 patients with and without comorbidity. Materials and Methods: The study was conducted in the Department of Physiology and Department of Respiratory Medicine, SGRRIMHS, Dehradun, prospectively in COVID-19 patients who were admitted to the Department of Respiratory Medicine, Shri Mahant Indiresh Hospital, SGRRIMHS, Dehradun, COVID ward with positive RT PCR (real-time reverse-transcriptase-polymerase-chain-reaction) test. Blood samples were taken at the time of admission for laboratory assessments of inflammatory markers i.e. CRP, Ferritin, LDH, D-Dimer, and Procalcitonin. Results: CRP, Ferritin, D-Dimer, and LDH levels were raised in all Covid patients whereas the levels of Procalcitonin were within the normal range. The levels of CRP, Ferritin, D-Dimer, and LDH levels were raised more among Covid patients with comorbidity as compared to Covid patients without comorbidity. Serum Ferritin and LDH levels were statistically significant among patients with comorbidity [p < 0.05]. Conclusion: CRP, Ferritin, D-Dimer and LDH were raised among Covid patients with comorbidity and the levels of Ferritin and LDH were statistically significant among Covid patients with comorbidity.

Introduction- PPH is most significant and common cause of maternal morbidity and mortality in developing and developed countries both due to uncontrolled bleeding. It is responsible for 30% of maternal death. Around, two-thirds of the obstetric morbidity is related to haemorrhage. From many studies, found that, PPH 50 times increases the risk of the morbidity and 5 times higher morbidity than mortality.  Methods- This is a prospective, single centre, cohort study, which is done in the Department of Obstetrics & Gynaecology of MGM Medical College and M.Y. Hospital, Indore over a period of one year in 60 patients. All the patients who developed PPH with failed medical management and give proper consent for application of clamp included. Patients with cervical cancer and Patients who do not give consent are excluded.  Statistical test -All the data analysis was performed using IBM SPSS ver. 20 software. Frequency tables and cross tabulation is used to prepare the tables. Categorical data was expressed as number and percentages whereas quantitative data was expressed as mean and standard deviation. Categorical data was compared using chi square test whereas means were compared using one-way Anova. Microsoft word and excel used to generate graph, table etc. P value of less than 0.05 was considered as significant. Results- In our study, more than half (56.7%) clamping were successful. Patients with lower parity had more chances of successful clamp as compared with those with higher parity. Blood loss was significantly less in those with successful clamp as compared to without successful clamp as revealed by the highly significant p value of <0.001. Conclusion-In the present study, we evaluated requirement of further surgical procedure and clamp success rate and results showed that majority of the patients who had successful clamp does not require further surgical procedure to undergo as compared to those without successful clamp. Blood loss was significantly less in those with successful clamp as compared to without successful clamp.

Introduction- Doppler is a noninvasive method for evaluation of fetoplacental circulation without any disturbance to human pregnancy. It gives valuable information about hemodynamic situation of the fetus and is an efficient diagnostic test of fetal jeopardy that helps in management of high-risk pregnancy. Doppler ultrasound technology evaluates umbilical artery (and other fetal arteries) waveforms to assess fetal well-being in the third trimester of pregnancy. Aims and objectives- To evaluate the usefulness of the pulsatility index (PI) of the umbilical artery (UA) and the pulsatility index of fetal middle cerebral artery (MCA). Also, emphasize on the importance of altered cerebroplacental ratio in predicting the adverse perinatal outcome in patients with abnormal cerebroplacental ratio and timely intervention in these fetus to prevent adverse perinatal outcome. Material and methods- This study, Prospective observational study, was conducted in the Department of Obstetrics & Gynecology at Tata Main Hospital, Jamshedpur, Jharkhand, periods of 1 Year and 6 Months, from January 2018 to June 2019. Patients those were attended OPD & got admitted as IPD to Tata Main Hospital at 30-36 weeks of gestation comprised the study population. Only those women who fulfilled the inclusion criteria and were willing to participate in the study voluntarily were included in the study after taking an informed consent.  Results and conclusion - In our study, 58% and 42% patients in control group were primigravida and multigravida respectively which was comparable to patients in Case group 56% and 44% respectively. Doppler flow velocity analysis can be valuable in antenatal assessment of SGA, FGR and even in AGA for prediction of late onset growth restriction and perinatal adverse outcome. By noninvasive hemodynamic monitoring of umbilical arteries (Feto-placental circulation) and middle cerebral arteries (fetal-circulation) has been a great help to improve perinatal outcome in pregnancy with comorbidities. For the prediction of adverse perinatal outcome in women with high-risk pregnancies, the best doppler index according to our study was cerebroplacental ratio (MCA/UA PI ratio). In cases with abnormal doppler, timely interventions lead to improved perinatal outcome. Hence, repeated doppler study in these pregnancies can help to reduce perinatal morbidity and mortality in high-risk cases. This study also suggested that CP ratio has the value for identifying those fetuses at risk for adverse perinatal outcome even their weights was greater than the 10th centile but are at risk for adverse outcome or late onset FGR because of an abnormal or lower CP ratio than 50th percentile value for age specific cutoff value.

Background- Currently, spinal anaesthesia is the preferred mode of regional anaesthesia for gynaecological surgeries as it is easy to administer and economical. Hyperbaric bupivacaine is the most common local anaesthetic in use, but it has short duration of action that may require early analgesic intervention postoperatively. Many additives have been used to increase the duration of action of local anaesthetic and currently dexmedetomidine is being used in different doses. Methods- This prospective, Randomized, comparative, single blinded study was carried out in the Department of Anaesthesiology, MGM Medical Collegeand MY Hospital, Indore, after approval from institutional ethics committee 60 patient qualifying inclusion criteria were included and randomly allocated in twoequal groups  • Group D3(n=30) patients received 3µg dexmedetomidine in combination with hyperbaric Bupivacaine (0.5%) to total volume of 3.5ml through intrathecal route. • Group D5(n=30) patients received 5µg dexmedetomidine in combination with hyperbaric Bupivacaine (0.5%) to total volume of 3.5ml through intrathecal route. Results- The mean duration of analgesia was significantly longer in Group D5 (474.33 ± 24.73 minutes) as compared to Group D3 (389.67 ± 26.97) (p=0.001).The onset of sensory block and motor block was significantly early in Group D5 than Group D3 (P<0.05). The mean duration of motor block was significantly longer in Group D5 (335.33 ± 20.13 minutes) than Group D3 (286.00 ± 21.59) (P=0.001).Analgesic use and intraoperative complications were similar in both the groups. (p > 0.05). Conclusions- Based on the findings and observations from our study, It can be concluded that Dexmedetomidine in a dose of 5µg seems to be a better adjuvant to hyperbaric bupivacaine in comparison to dexmedetomidine 3µg in terms of duration of post-operative analgesia and early onset of sensory and motor block.96

This study was conducted to evaluate the natural course of WMH (White Matter Hyperintensities) and lacunes over a period of one year, determine the main MRI representatives of small vessel diseases over time, and evaluate the possible predictors for the development of small vessel disease. Methods This was a hospital-based prospective study conducted among 132 patients who underwent CT/MRI in the Department of Radio-Diagnosis, S.C.B. Medical College, Cuttack, over a period of one year from September 2016 to September 2018 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results Baseline and 1 year follow-up white matter hyperintensity volume comparisons were found to be statistically significant. The correlation between age and WMH was significant; there was a significant difference in WMH progression among different age strata. The progression of WMH was significantly higher in the age group of 76-85 years as compared to the other two groups. There was a statistically significant correlation between hypertension and WMH progression, diabetes mellitus and incidence of new lacunar infarct, and stroke and incidence of new lacunar infarct. Conclusion The rapid increase in WMH in our subjects supports the potential use of WMH volume as a surrogate marker for small vessel disease progression in elderly individuals. Because WMHs are known to have functional consequences and the volumetric estimation of these lesions is now possible, they can provide an objective measure of outcome of the preventive trials.

Introduction: Liver is the largest solid organ of the body and constitutes 2% of its body weight, varying in adult from 1200-1500 gms. Its functions are remarkably diverse and anatomy correspondingly complex. Liver, probably as a consequence of its anatomic iodation, size, dual blood supply and favorable nutritional elements, is the site of neoplastic lesions, which are greater in number and diversity than. Aims: To study various ultrasonography, CT and MRI patterns of FOCAL liver SOL in arriving at a specific diagnosis before surgery or biopsy, the importance’s of image guided extraction of tissues and fluids for histopathological examination and correlate the radiological diagnosis by histopathological studies. Materials and Methods: It’s an Institution based, prospective, cross sectional, comparative study. This Study was conducted one and half years at the DEPT OF RADIODIAGNOSIS ,KATIHAR MEDICAL COLLEGE , KATIHAR , BIHAR. Total 62 patients were included in this study. Result: It was found that, higher number of the patients had Provisional USG Diagnosis in Hepatic Sol [11 (21.2%)] which was statistically significant (p=.00758) (z=2.6685). In our study, lower number of the patients had Associate Finding in USG in Dilated IHBR [3(5.8%)] which was statistically significant (p< .00001) (z=4.36) and Density & Morphology of Lesions in Ct (p=.13888) (z=1.4825) which was statistically significant. Conclusion: We found that, lower number of the patients had Associate Finding in MRI in Breast Mass but which statistically significant and Histopathological Diagnosis in Carolidisease It was not statistically significant and higher number of the patients had CT & MRI Corroborative (z=5.099) but which statistically significant.

Introduction: Left Ventricle being the primary pump of the heart. Left Ventricular Hypertrophy (LVH) has a significant role as a risk and prognostic factor in Cardiovascular and Hypertensive incidences. LVH is a marker of Target organ damage in Hypertension and helps stratifying cardiovascular risk. Electrocardiography and Echocardiography are two of the most important and primary investigations in quickly assessing Left Ventricular Hypertrophy. Although ECG being less sensitive for LVH it is still routinely used. Aim: to determine prevalence of Left Ventricular Hypertrophy  in Primary and Secondary Hypertensive Patients. Method: This was a prospective observational study carried out in the Department of General Medicine, Pacific Medical College and Hospital, Bhilon Ka Bedla, Udaipur, Rajasthan from August 2021 till August 2022. Result: The prevalence of LVH was found to be 54%. Conclusion: The study concluded that LVH development was in 54% of the total patients. The prevalence of LVH was very high and adequate blood pressure control along with regular medication is needed to avoid cardiac complications.

Background: Testicular lesions encompass a wide range of pathological conditions, including inflammatory, neoplastic, and developmental disorders. This study aims to provide an overview of the histopathological spectrum of testicular lesions observed at Amruth diagnostic laboratory. Methods: A retrospective analysis was conducted on testicular specimens received at Amruth diagnostic laboratory over a four-year period. Relevant clinical and pathological data were collected from the medical records, including age, presenting symptoms, and histopathological findings. The specimens were examined microscopically, and diagnosis was made based on established criteria. Results: A total of 200 testicular specimens were included in the study. The age of the patients ranged from 18 to 75 years, with a mean age of 42 years. The most common presenting symptom was testicular pain, reported in 65% of cases. The histopathological analysis revealed a diverse range of testicular lesions. Inflammatory conditions such as orchitis and epididymo-orchitis were observed in 20% of cases, followed by testicular tumors, including germ cell tumors (70%), sex cord-stromal tumors (12.5%), and metastatic tumors (7.5%). Additionally, non-neoplastic lesions like testicular atrophy, interstitial fibrosis, and vascular disorders were identified in 7.5% of cases. These findings provide important insights into the histopathological spectrum of testicular lesions in our study population. Conclusion: This study provides insights into the histopathological spectrum of testicular lesions encountered at Amruth diagnostic laboratory. The findings highlight the importance of a thorough histopathological evaluation in diagnosing and managing various testicular conditions. Understanding the diversity of testicular lesions can aid in appropriate treatment planning and counselling for patients with testicular pathologies. Further research and prospective studies are warranted to validate these findings and explore potential risk factors associated with specific testicular lesions.

Introduction: Brachial plexus block is a regional anaesthesia technique used for upper extremity surgery that is a safe alternative to GA for upper limb procedures.  Ropivacaine is a new long-acting local anaesthetic which produces less cardiac and central nervous system toxicity. Fentanyl and Tramadol, synthetic opioids are added to local anaesthetics to improve peripheral block quality in peripheral nerve blocks and to extend postoperative analgesia. Tramadol is a weak-opioid receptor agonist and has central analgesic effects and also has peripheral local anaesthetic properties that led to its use as an adjunct in peripheral nerve blocks. Tramadol is a relatively weak opioid with less respiratory depressant effects. With this background, we conducted a comparative study to study the effect of tramadol as an adjuvant to ropivacaine and ropivacaine plain in terms of quality, onset and duration of anaesthesia in supraclavicular brachial plexus block. Methods: The present clinical randomized comparative prospective controlled study was conducted amongst 70 patients undergoing surgery under supraclavicular brachial plexus block during the period of November 2020 – June 2022 amongst the patients between the ages of 18-60 years of age of ASA I and II who were scheduled for elective upper limb orthopaedics surgery. The patients were divided into groups, Group 1 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml normal saline and Group 2 (n=35) receiving 28 ml 0.5% ropivacaine + 2 ml tramadol (50mg/ml). Results: In the present study among the Ropivacaine group, the majority were of age 51-60 years 23(65.7%) and among the Ropivacaine + Tramadol group, of age 51-60 years 18(51.4%). The onset of sensory and motor block was earlier in Ropivacaine + Tramadol group. The duration of sensory and motor block was more in Ropivacaine + Tramadol group. Among Ropivacaine + Tramadol group According to VAS Score, at recovery, the Mean was 3.25 with an SD of 0.44. Among Ropivacaine group Nausea present among 10(28.6%), Vomiting among 6(17.1%), Bradycardia among 9(25.7. Among Ropivacaine + Tramadol group Nausea present among 6(17.1%), Vomiting among 7(20%), Bradycardia among 5(14.3%). Among the Ropivacaine + Tramadol group, according to the satisfaction of analgesia, was Present among 33(94.3%) and absent among 2(5.7%). Conclusion: We concluded that there was no significant difference between the two groups in terms of hemodynamic changes. The onset and duration of sensory and motor block were better in Ropivacaine + Tramadol group. Post-operative pain management with Ropivacaine + Tramadol was more acceptable by patients. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks.

Background: Haemorrhagic stroke is a major cause of mortality worldwide, however, patient outcomes rely heavily on available treatment modalities. There is an abject paucity of medical literature concerning determinants of patient outcome in Andaman & Nicobar Islands, which lie far removed from the Indian mainland, especially since surgical facilities available here are significantly less than those available in the Indian mainland. Aim: To examine clinical outcomes and course of treatment of patients with Haemorrhagic Stroke, within the acute-hospitalisation Department of Medicine, GB Pant Hospital, Port Blair, Andaman & Nicobar Islands.Methods:The study is prospective observational in nature, and follows patients admitted to the hospital in the months of July 2022 to September 2022.Results: Patients treated in GB Pant Hospital, Andaman & Nicobar Islands, were found to be at a statistically significant higher risk of mortality as compared to their counterparts in main-land India (p=0.01615). 85.72% patients, inspite of being advised Neurosurgical evaluation, could not avail it.Conclusion: The authors conclude that in-hospital mortality rate of Haemorrhagic stroke in Andaman & Nicobar Islands is higher than that in mainland India, and hypothesise that the cause for this is lack of Neurosurgical amenities in Andaman & Nicobar Islands.

Introduction: Dacryocystitis is the inflammation of the lacrimal drainage system which presents as acute dacryocystitis or much commonly as chronic dacryocystitis. The conventional treatment for watering eyes due to Naso Lacrimal Duct (NLD) obstruction is the procedure of external dacryocystorhinostomy (DCR) which has its own limitations and disadvantages. With the introduction of high resolution endoscopes for paranasal sinuses, endoscopic endonasal DCR (EnDCR) is gaining popularity.In EnDCR the most common cause for failure of surgery is closure of rhinostoma and to prevent this silicone tube insertion is the most preferred method.  It has also been claimed that silicone tubing would improve surgical results. But studies also indicate that silicone tubing itself results in certain problems like foreign body sensation, increased granulation tissue leading to failure, prolapse of tube leading to injury to cornea, nasal migration of tube, fistula formation, pharyngitis and associated sinusitis & recurrent nose bleed. The present study was undertaken to compare the surgical results of endoscopic endonasal DCR with and without silicone stent. Aims & Objectives: To compare the success rates of endonasal dacryocystorhinostomy and evaluate the presence of post-operative changes and their effect on the outcome of the surgery in endoscopic dacryocystorhinostomy with and without stenting. Material & Methods: This Prospective randomized comparative study was carried out amongst the patients attending ENT OPD for chronic nasolacrimal duct obstruction with complaint of chronic epiphora. After obtaining approval from the IEC and informed consent of the participants, 50 patients divided into two groups of 25 each fulfilling inclusion and exclusion criteria were included in this study. Group 1 includes patients undergoing EnDCR with stenting and Group 2 includes patients undergoing EnDCR without stenting. Patients were assessed for post-operative complications like granulations, size of the neo ostium and patency of the neo ostium. Data was entered in MS Excel work sheet. Data was analyzed using appropriate statistical methods. Result This study had Female predominance in both the groups. Neither any laterality nor any major intra operative complications were observed. Duration of surgery was more in Group I which was statistically significant. Post-operative complications are seen more in group without stenting (64.0%) than in group with stenting (56%) with no statistical difference between the two groups. Granulations had no effect on the outcome of the surgery. On subjective assessment of symptoms, 92% of patients in group I and 88% of patients in group II showed improvement of symptoms post operatively. No statistical difference had been found between the results of both the groups. On objective assessment of size of the neo ostium, no statistical difference was seen between the two groups. The size of the neo ostium had no effect on the outcome of the surgery. On objective assessment, patency of the neo ostium was observed in 92% of patients in group I and 88% patients in group II with no statistical difference between the two groups. Conclusion: As success rates of the surgery with stenting and without stenting are comparable and stenting leads to increased duration of surgery and additional cost to the patient, we conclude that EnDCR without stenting is the treatment of choice for nasolacrimal duct obstruction (NLDO).

Background: Stroke is the second leading cause of death worldwide and is defined as a sudden onset of neurological deficit that is attributable to a focal neurological cause. Several risk factors are attributable to the etiopathogenesis of stroke, among which hypertension, diabetes, dyslipidemia, lifestyle changes are modifiable. Hypertriglyceridemia is a risk factor for stroke because of its prothrombotic nature. Aim: The present study was to assess the correlation of serum triglycerides and TG/high-density lipoprotein ratio to the severity of stroke. Methodology: The present study is a prospective hospital-based study of 100 patients who attended the government general hospital between Dec 2017 to Oct 2019 and diagnosed as ischemic stroke based on clinical, imaging, and laboratory findings. Data included Age, Sex, HTN, DM, routine blood investigations, brain imaging, lipid profile, and others when required.TG/HDL-C ratio was categorized into two groups as <2 and >2 and correlated with the severity of stroke. Results: Out of 100 patients with ischemic stroke, majority of the patients (60%) were < 60 years of age, predominantly male (58%). Hypertension, DM, CAD, Smoking and alcoholism were the significantly associated with the severity of the stroke (p<0.05). Serum triglycerides level and highTG/HDL-C ratio (>2) were significantly associated with the severe stroke (p<0.05).  Conclusion: Hypertensions, Diabetes, dyslipidemia, smoking, alcohol, all are significantly associated with the severity of stroke. Serum triglycerides are raised in severe stroke patients than moderate stroke patients significantly.TG/HDL-C ratio is also related to the severity of stroke significantly.

Introduction: Patients of 65 years of age and older with Acute Myocardial Infarction(AMI) have a worse prognosis due to co-morbidities and poor treatment facilities This gap is made worse by the low proportion of the elderly in clinical research and the ignorance about the consequences of ageing.. It is yet unknown what external factors have a major impact on elderly   patients' long-term prognosis following myocardial infarction. Aims and objectives: The primary purpose of this research is to assess the possible connections between patient’s age and  its associated  risk factors in case of acute myocardial infarction. Methods: A prospective comparative and descriptive study was conducted on sixty patients who visited our hospital's outpatient clinic. Patients who were below 45 years of age were assigned to Group A and those who were above 45 years of age were assigned to Group B. The baseline characteristics were obtained and other variables were compared. Risk factors of both the groups were evaluated particularly related to hypertension and both the groups were receiving same treatment. Results: Patient related risk factors are presented in Table 1. Sex differences in the sample population were not statistically significant. Risk variables such as high cholesterol, hypertension, triglycerides, LDL- cholesterol, and family history were similar. The majority of smokers were younger than 45. Over 45-year-olds who were obese had diabetes. The prevalence of hypertension was similar across categories and subgroups. Diaphragmatic myocardial infarction was prevalent  in patients older than 45 years of age (Table 3). Conclusion: In conclusion, our research discovered important risk factors for AMI, However, because it was dependent on laboratory analysis, risk assessment methods could not be fully assessed.

Introduction: Anterior ischemic optic neuropathy (AION) is a sight-threatening condition characterized by the infarction of the optic nerve head. It is a major cause of acute visual loss, particularly in individuals over the age of 50. The exact incidence and prevalence of AION vary across populations due to differences in study methodologies and diagnostic criteria. However, AION is generally considered a relatively rare condition. The incidence has been estimated to range from 2 to 10 cases per 100,000 population per year, with the prevalence estimated at approximately 3 to 10 cases per 100,000 population (1,2). This study aims to provide an overview of the epidemiology of AION, including its incidence, risk factors, and associated comorbidities, to better understand the burden and implications of this condition. Materials and Methods: This prospective observational study was carried out in the Department of Ophthalmology, S.S. Medical College and associated GM Hospital, Rewa, over a period of 18 months among 31 consented patients presenting to the department with features suggestive of AION. Detailed history was recorded and thorough clinical and ophthalmic examination was carried out. Data was collected, compiled and analysed using SPSS 22.0 (trial version). Results were expressed as the means and standard deviation or as numbers and percentages, wherever required. Result:Mean age of patients was 53.34±9.10 years. Male preponderance (54.84%) was observed. Right eye (61.29%) was affected more than left eye. All patients presented with diminution of vision. Only 9.68% experienced jaw claudication, scalp tenderness and headache. History of similar complaints in the fellow eye was given by 29.03%. 78.12% presented within 10 days of onset of symptoms. The most common systemic disease associated with AION was diabetes mellitus (64.52%)followed by hypertension (48.39%). NAION patients had higher incidence of OSA.No patient had history of IHD, TIA or stroke. Mean VA in affected eye was 1.36±0.74 log MAR units.Colour vision of AION patient was defective in almost all patients where it was documentable. Mean number of Ishihara plates read was 5.41±1.55. Mean contrast sensitivity was 0.67±0.43 log units. 67.74% presented with grade 3 RAPD followed by grade 4(16.13%). The most common type of disc oedema was diffuse, and these had poor VA at presentation. Disc at risk was found in 38.71% patients. Fellow eye had a pale disc in 29.03%. Inferonasal field defect was the most common (25.81%) followed by superior altitudinal defect (19.35%). Peripapillary RNFL thickness, average as well as in all quadrants was found to be increased. Conclusion: The data for AION comes mainly from western literature as there have been only few studies in Indian population. Through this study, we aimed to provide an overview of AION, its clinical profile and to study various systemic risk factors associated with it.

Background: Exoscopes have emerged as a promising and reliable substitute or supplement to the conventional binocular surgical microscope in procedures such as brain tumour and skull base surgery, aneurysm clipping, as well as complex cervical and lumbar spine surgery. They offer a safe and efficient option, potentially paving the way for a groundbreaking era in the realm of innovative tools and techniques within the field of neurosurgery. Aims And Objectives: The study was conducted to find the practicality, advantages and disadvantages of exoscope assistance rather than use of conventional microscope in ICSOL surgeries. Material And Methods: This Prospective study included patients admitted with intracranial space occupying lesions under department of neurosurgery, GRMC and associated J.A. group of Hospitals from April 2023 to May 2023 who underwent surgery. No randomisation done.  Results: Out of a total of 9 patients, the male population accounted for 57%, while the female population comprised 43%. More than half of the patients, specifically 66.6%, were aged 40 years or older. The prevailing condition among most patients was glioma with a combination of solid and cystic components. During the utilisation of the exoscope, the overall rate of surgical complications was 11.1%. These complications exhibited a similar profile to those observed in patients who underwent the same procedures with the traditional operating microscope. Moreover, there was an overall incidence rate of 11% for switching from the exoscope to the operating microscope during the course of surgery. Conclusion-The utilisation of the exoscope has consistently yielded positive surgical outcomes, surpassing the results achieved with the operating microscope, particularly in surgeries for intracranial space-occupying lesions (ICSOL). The exoscope has emerged as a secure alternative to the traditional operative microscope for common brain procedures, offering several notable advantages. These include user-friendly simplicity, improved 3D visualisation, and enhanced magnification of the surgical field. These advancements have contributed to better surgical results and overall success in ICSOL surgeries.

The present study was a prospective study which was aimed to determine the incidence of age, sex, distribution, etiological factors &mode of head injuries in western UP. This was carried out in Subharti Medical College and associated CSSH hospital on patients of head injury who were admitted during September 2011 to December 2012 and were followed up to 6 months after discharge up to July 2013.There were 823 head injury patients which were admitted in the hospital, 119 were found suitable for study in this group.It was observed that males were more prone to head injuries than females in age groups above 16 years. Below 16 years incidence was same. Maximum number of head injury was caused due to road traffic accidents (67.2%). It was found that maximum number of head injury patients belonged to the age group of 21-40 years (54.6%). Fall from height was the common cause of injury (73.9%) in the age group of < 20 years and among them 52.1% were below 10 years .Road traffic accidents were the major cause of injury among 20-40 years of age group (67.5%). Majority of the accident victims of head injury were two-wheeler riders (56.2%) without helmets, followed by four-wheeler / auto-rickshaw travelers (27.6 %.). People should follow safety rules while driving. Wearing of helmets and seat belts will decrease chances of injury if an accident occurred. Driving and drinking should never be mixed.

Introduction: Hyperpigmentation is one of the most common reaction to inflammatory, benign and malignant lesions of the skin. These disorders comprise heterogeneous group of diseases of epidermal and dermal hyperpigmentation divided into various types according to etiology and pathology. Correct diagnosis of these hyperpigmented lesions is linked to histopathologic examination     of     skin     biopsies     with      clinical      correlation. Aim: To study the spectrum of hyperpigmented skin lesions with reference to age and sex distribution. To study the histopathology of hyperpigmented skin lesions in correlation with clinical features. Materials and Methods: This prospective cohort study was conducted at Department of Pathology, at Alluri Sitaramaraju Academy of Medical Sciences, Eluru,Andhra Pradesh, India, which included 80 patients who were clinically diagnosed with hyperpigmented skin lesions in all age groups from July 2014 to August 2016. Frequency and percentage statistics was used to present the results. Results: Out of 80 cases,34 cases of inflammatory lesions, 23 cases of benign lesions and 23 cases of malignant lesions were reported. Among the post inflammatory lesions the majority were classical Lichen planus. Conclusion: Most common lesion was lichen planus and its variants with highest incidence in females and age group greater than 60 years. Histopathological diagnosis with clinical correlation aids in effective management of the patients.

Background: Dermatophytosis is most common fungal skin infection observed in dermatology out- patient department. In recent years, the number of patients with dermatophytosis has increased considerably in alarming manner. Aim: To evaluate various socioeconomic factors and risk factors associated with dermatophytosis along with various clinical types and prevalence of dermatophytosis.  Methods: A prospective observational study was done on 899 patients with clinical diagnosis of dermatophytosis visiting outpatient department at JIIU’S IIMS&R Warudi Jalna during October 2020 to March 2021.Detailed history, clinical examination and KOH examination was done. Results: Dermatophytosis was most common in the third decade of life (21-30 years). Male: Female ratio was found to be 1.44:1. Farmers (33.25%) were commonly affected followed by housewives (29.69%). 55.83% patients were residing in a joint family. Family history was positive in 43.59% patients. Diabetes mellitus was the most common disorder associated with dermatophytosis with 187(20.80%).Itching was the most common symptom experienced by 689 (76.64%) patients and use of OTC medications was most common risk factor observed. In both males and females most common clinical type observed was tinea corporis with cruris with 313(59.50%) and 212(56.83%) cases respectively. Direct microscopic examination of KOH mount was positive for fungal elements in 547 (60.84%) cases Conclusion: Increase in awareness among the public to avoid use of OTC products, maintenance of proper hygiene and avoiding wearing occlusive synthetic clothing will help in reducing the burden of dermatophytosis in the community.

Introduction: Lung cancer has been the most common cancer in the world for several decades. There are estimated to be 2.38 million new cases in 2023 (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains as the 3rd most common cancer in men worldwide. Cancer of the lung has not received much attention in India so far, neither has the carcinogenic potential of tobacco smoke been adequately realized by the general public.11 The prevalence of Lung Cancer is increasing in India along with increase in tobacco smoking habit particularly in rural India.   Material And Methods This is a prospective study consisting of 50 Lung cancer  patients examining the clinical, radiological and Histopathological Profile. The present study comprises of 50 patients who are admitted in the Department of Respiratory Medicine, Kamineni academy of medical sciences and research centre, Hyderabad from April 2022 to March 2023. All the patients having symptoms and radiological features suggestive of primary or secondary malignancy of Lung and Pleura are included in the study. Detailed demographic and clinical parameters including age, sex, occupation, and habits like smoking and alcoholism were taken.  Results: Most common diagnostic modality used was FOB  guided  biopsy  (36%), followed by CT guided trans thoracic biopsy (32%).  Ultra sound guided biopsy was done in 18%. 6% of patients were diagnosed by pleural fluid analysis.  4% were diagnosed by lymph node biopsy and bronchial washings cytology. Squamous cell carcinoma was the commonest histopathological type noted accounting for 48% followed by adenocarcinoma. It was also observed that 10 patients presented with secondary lung malignancy, 3 of whom were presented with lung mass lesions and the remaining 7 patients were presented with pleural effusions. Conclusion: This study has shown smoking as the principal risk factor in the causation of lung cancer among men. Lung cancer should always be suspected in a person presenting with unexplained cough of several weeks with other symptoms such as weight loss and fever with non-resolving collapseconsolidation on chest radiograph, and further investigations should be carried out to rule out lung cancer. Majority of the cases were misdiagnosed as tuberculosis and treated, causing delay in diagnosis. This emphasized the need for more effective methods like FOB, CT for early detection of lung cancer.

Background: India has been experiencing significant demographic, economic and epidemiological transition during the past two decades. The young patients are increasingly affected by stroke, because of both the changing population exposures to risk factors and most tragically, not being able to afford the high cost for stroke care. Age specific incidence of stroke increases progressively with increasing age. Apart from the traditionally recognized risk factors for ischemic stroke (IS), several potential novel risk factors have emerged over the last two decades among which hyperhomocysteinemia (HHC) is one of them.  Methods: A hospital based prospective observational study was undertaken among the adult patients presented with stroke at Dr.Chandramma Dayananda Sagar Institute of Medical Education & Research, Harohalli, Ramanagara from April 2021 - March 2023. Patients with first episode of ischemic stroke in age group 15 years to 45 years of either sex were included. A predesigned, self-administered proforma was designed keeping the objectives of the study at the centre point. Carotid IMT was defined as the distance from the leading edge of the first echogenic line to the leading edge of the second echogenic line on the scans.  Results: Out of total 73 patients, about 78.1% of the study subjects were males and 21.9% were females with male:female ratio of 3.6:1. The maximum study population were between 40 – 45 Yrs (43.8%) with mean age 42.1 ± 2.0 years while total mean age of entire study population was 36.5 ± 6.5 years. 63.1% of the subjects had normal homocysteine with mean 12.5 ± 1.63 µmol/L while 36.9% of the subjects had hyperhomocysteinemia with mean 30.2 ± 11.6 µmol/L. 43.8% of the subjects had ≤0.8 mm of carotid intima-media thickness with mean 0.69 ± 0.07 mm while 56.2% had increased carotid intima-media thickness 1.09 ± 0.16 mm. Conclusion: Identification of newer individual risk factors have not only created a new challenge to the understanding of pathology of MI but have also opened up different approaches other than simply modifying the conventional risk factors in primary prevention of MI. Therefore, the role of newer risk factors has to be identified. In case of our study, serum homocysteine did not show any significant relation with age, sex, DM and diet pattern but goes significant with alcohol habit, hypertension and dyslipidemia.

Background: About 3% of all pregnancies are complicated by one of the many types of hepatic diseases. First, there are a variety of liver problems specific to pregnancy that affect people with previously healthy livers. These include intrahepatic cholestasis of pregnancy, which affects 60% of cases, acute fatty liver of pregnancy, and liver dysfunction linked to hyperemesis gravidum, which affects 50% of cases, and preeclampsia, which affects 12% of cases. Objectives:

1. To determine the maternal and fetal outcome in jaundice complicating pregnancy

2. Find out the measures to reduce maternal& fetal mortality & morbidity.

3. To analyse various maternal and fetal complications which can be prevented

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic disease that is characterized by impaired glucose metabolism and Insulin resistance. Leptin is a 16-kDa protein hormone, which is secreted by adipocytes. Plasma Leptin concentration increases in proportion to body fat mass and regulate food intake and energy expenditure to maintain body fat stores. Leptin binds with a Leptin receptor (LEPR) that is located on pancreatic beta cells to regulate Insulin secretion. Materials and Methods: This is a prospective and case-control study was conducted in the Department of Biochemistry at Great Eastern Medical School and Hospital over a period of 1 year. After the inclusion of participants in the study, their demographics such as age, BMI, gender, and smoking history were noted in self-structured questionnaires. Their blood was drawn and sent to the laboratory for Lipid profile levels, Insulin resistance and Leptin levels. The serum levels of Leptin were measured using a Enzyme linked immune sorbent assay (ELISA).  Results: The probable association between Leptin and Insulin resistance in type 2 diabetes mellitus. 60 recent onset (<5 years) diabetics and age-sex matched 60 non-diabetic controls were assessed for physical and chemical parameters. All the physical parameters showed positive correlation with Leptin and the HOMA-IR score, the strength of association being highest between Insulin resistance and abdominal circumference. Leptin and Insulin resistance showed no correlation. Findings were lower in controls.  Conclusion: In our study, significant higher level of Leptin was found in Insulin resistant subjects compared to the subjects without the condition in both genders. This finding provides an insight into the explanation why the metabolic risk was different among persons with same degree of adiposity and may help identify the people at risk for diabetes and/or cardiovascular diseases across adiposity level and thereby an important contribution in clinical and preventive measures.

Background: The goal is to reduce or eliminate perioperative pain with as few adverse effects as possible. The mode of anaesthesia that has been proven to be safe and effective in children is regional. In addition to extending analgesia to the postoperative period with minimal sedation (2), the use of inhalational and intravenous analgesics can be reduced. In childern caudal epidural is the regional block infra-umbilical procedures. Objectives:This study was aimed at comparing Bupivacaine 0.125 % (1ml/kg) alone against Bupivacaine 0.125 % (1ml/kg) plus Fentanyl 0.5 μg/kg as a caudal block administered via single bolus in infra-umbilical procedures in children aged 1 to 8 years.Hemodynamic alterations, ie heart rate and blood pressure., and Duration of post operative analgesia after and Adverse reactions are the parameters noted  Material & Methods:  Study Design: A prospective, randomized, comparative study. Study area: Department of Anaesthesia and Critical care, Government Medical college ,Srikakulam ,AP.Study Period: 1 year.  Study population: children, of both gender, posted for infraumbilical procedures of various types. Sample size: study consisted a total of 60 cases. Sampling method: Simple random method.A general, systemic examination, including the airway and spine, was done on the day of surgery also. Vital parameters such as systolic blood pressure, respiratory rate and pulse rate were noted. In addition, investigations such as blood and urine tests, bleeding and clotting times, a chest x- ray if necessary, and viral tests (HIV & HBsAg) were done. Informative and written consent was obtained from the parent. Prior to surgery, restriction was advised for solid foods for 6 hours, milk for 4-5 hours and clear fluids for 2-3 hours. All children were given 1 mg/kg of Promethazine syrup the night before the scheduled operation. Results: The mean duration of analgesia at various time intervals in both the groups was statistically significant. The mean duration of analgesia in the B group (0.125% Bupivacaine) is 5.2 ± 0.85 hrs, the mean duration of analgesia in the BF group (0.125 % Bupivacaine + 0.5 mc/kg Fenyanyl) is 10.8 ± 1.24 hrs. This duration of analgesia is statistically significant as detected by using t test (p = 0.03, <0.05) Conclusion: The present study demonstrated that caudal epidural block with Bupivacaine 0.125% (1ml/kg) plus Fentanyl (0.5 mcg/kg) resulted in analgesia of longer duration and postoperative analgesia when compared with 0.125% Bupivacaine (1ml/kg) alone, with no significant difference in the hemodynamic parameters and the occurrence of side effects.

Purpose: The purpose of this study was to evaluate children's cognitive and overall performance affected by admission to the pediatric critical care unit. Methods: It was a prospective observational study conducted over a 12-month period at the pediatric intensive care unit (PICU) of the Shyam Shah Medical College, Sanjay Gandhi Memorial Hospital, and Gandhi Memorial Hospital. 200 children (100 PICU admissions and 100 Ward admissions) between the ages of 28 days and 17 years who had been committed to the PICU for at least 24 hours were selected using a technique of purposive sampling. The indicators used to evaluate the child's performance were (i) The Glasgow Outcome Scale, (ii) the Functional Status Scale (FSS), (iii) The Pediatric Cerebral Performance Category Scale (PCPC), and (iv) The Pediatric Overall Performance Category Scale (POPC). Results: A total of 200 pediatric ICU study subjects were included in this study. The majority of them were females. Most of the study population was classified as Grade 1 on the PCPC Score and Grade 2 on the POPC Score. The mean (SD) PRISM-IV score was 4.07 (4.91), the PCPC score was 1.50 (0.98), and the POPC score was 2.30 (1.12) at the time of admission. The mean duration of stay for patients admitted to the PICU was 9.55 (5.82) days, while those admitted to the ward had a mean duration of 6.64 (3.92) days. Most of the study population was discharged in Grade 1 of PCPC and POPC. The mean (SD) PCPC score was 1.82 (1.53) and the POPC score was 2.25 (1.52) at discharge. Conclusion: Compared to patients confined to the Ward, patients admitted to the PICU showed inadequate cerebral and overall performance.

Background: Sonography has been considered an excellent diagnostic imaging technique for the detection of both opaque and nonopaque renal calculi. The sonographic diagnosis of a calculus is usually based on the demonstration of a highly echogenic focus with an associated acoustic shadow. To compare the detection of urinary stones using standard gray scale ultrasound for diagnostic accuracy using the color Doppler “twinkling sign”. Material and methods: In our study 90 consecutive patients with various abdominal pathologies (not directly linked to renal lithiasis) were included in our study. All patients then underwent US at our department. Color Doppler US was performed using a red-and-blue color map and power Doppler US using a pink color map with a standardized Doppler protocol to detect the twinkling artifact. For color Doppler, gain was set to the point just below the threshold for color noise and the pulse repetition frequency (= velocity scale) was set to 64 cm/sec to eliminate color flow signals from renal blood flow. The color window size was adjusted to cover the whole renal sinus. Doppler imaging began with continuous sweeps of the renal sinus in the longitudinal and transverse planes. Result: On abdominal CT scans, 81 selected patients showed 90 renal lithiasis equal to or smaller than 5 mm. The diameter of renal lithiasis ranged from 2.6 to 5.0 mm (average diameter 4.1 mm). Out of 90 CT positive lithiasis, 50 (55.6%) were absolutely positive on gray-scale. Out of the 50 lithiasis, 14 were hyperechogenic foci with posterior shadow cone, but with a slight echogenicity difference, 50 showed both posterior shadow cone and a marked echogenicity difference, and 24 showed a marked echogenicity difference without posterior shadow cone. So, the posterior shadow cone appeared 40 out of 50 times, while marked echogenicity difference was detected 84 times. Conclusion: The stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis.

Background:  Epilepsy is one of the common chronic conditions affecting women of reproductive age. The rates of maternal death are ten-fold higher in women with epilepsy than those without the condition. Care of women with epilepsy continues to be fragmented, with few units providing joint obstetric-epilepsy care. Objectives: To determine the obstetric and neonatal outcome of pregnancy in women with epilepsy. Material & Methods:  Study Design: Hospital based prospective observational study. Study area: Department of Obstetrics & Gynecology, Mayo institute of Medical Sciences, Barabanki, Uttar Pradesh. Study Period:  June 2022 to May 2023.  Study population:  Pregnant women with epilepsy attending the antenatal clinic at Mayo institute of Medical Sciences, Barabanki, Uttar Pradesh. Sample size:  The study included a target number of 200 subjects with 50 as cases and 150 as controls. Sampling Technique:  Simple Random technique. Results: The percentage of IUD was 6% in cases and 14% in controls, the difference is not statistically significant. The percentage of antepartum hemorrhage in cases was 4%, while it was 3.33% in controls. The difference is not significant statistically. The percentage of abortions in cases was 4% and in controls it was 4%. The difference is not significant statistically. Conclusion: The present study provides reassurance to women with epilepsy that, epilepsy in pregnancy in the majority of women is uneventful. AED use during pregnancy is generally not associated with adverse maternal and fetal or neonatal outcomes, although it is important to be aware that AEDs differ in their teratogenic potential.

Diagnosis of extrapulmonary tuberculosis is challenging due to pauci bacillary disease and is mostly multidimensional involving judgmental assessment of clinical features and disease-related structural radiological changes. The study was undertaken to assess the utility of CBNAAT in field conditions in evaluatingboth Pulmonary and extrapulmonary tuberculosis patients. Methodology: This study was a prospective Observational study conducted in a tertiary care hospital in Jamnagar, West Gujarat. Among 125 extra-pulmonary patients, 34.4% were 20-39 years and 68(54.4) were males, and 85(68) were newly diagnosed. In pulmonary 36.9% were 20-39 Years,51(78.4) were males and 45(69) were newly diagnosed. Results: Out of 125 extrapulmonary TB patients, CBNAAT detected MTB in 50%,44.44%,34.71%,15%,10%,10%,0.0%,and0.0% respectively in articular, pus, lymph node, CSF, pleuralfluids, gastric fluids, pericardialand urinary TB. CBNAATMTB detection was 66.67%, 50% ,50%,0.0%,33.33%, and 0.0%in pus aspirated from psoasabscess, breastabscess ,chest walls welling, splenic abscess, gluteal abscess, and occipitals welling respectively. Conclusion: The diagnostic efficacy of CBNAAT MTB was greater in pulmonary TB than in extrapulmonary TB. The highest diagnostic yield of CBNAAT was found in non-lymph nodalpurulentaspirate, most forpsoas abscessaspirate. The lowest diagnostic efficacy of CBNAAT inextrapulmonary TB was forurinary and peritoneal fluid samples. CBNAAT was found high diagnostic yield tool for cases of necrotic lymphadenopathy, psoasabscess, and articular disease with fusion

Context: A significant proportion of survivors from COVID-19 infection have shown residual pulmonary abnormalities including lung fibrosis which if not managed at appropriate time can cause disastrous effects, even requiring lung transplantation in few patients.  Aims: To evaluate the usefulness of Mean CT Severity Score of initial scans done during acute illness in predicting Post-COVID Syndrome. Settings and Design:  A prospective observational study was conducted in a tertiary care centre comprising of 2000 patients, among which 650 patients showed residual lung abnormalities. Methods and Material: HRCT Scan was performed to calculate Mean CT Severity Score during acute illness and after an interval period of 1 month, 3 months and 6 months respectively to detect residual lung abnormalities. Statistical analysis used: SPSS software used for calculation of mean and standard deviation. A chi-square test was used for the comparison of categorical variables. (P-value <0.05, significant) Results- At cut off score of 7 of Mean CT Severity Score calculated at initial scan, high sensitivity and specificity of Mean CT Severity Score was found in predicting Post Covid Syndrome. Moreover, the study found significant association between the lesions including ground-glass opacities, reticular opacities and consolidation separately with high initial CTSS score with their persistence in post COVID follow up scan. (P value- <0.001) Conclusion – Mean CT Severity Score can act as an effective parameter in predicting long term pulmonary outcome of COVID-19 illness and can guide towards appropriate management of the patient’s allowing intervention at an early stage in post-COVID syndrome.

Background: Breast cancer is the most common cancer in women worldwide and second most common after cervical cancer in India. Sonographic demonstration of suspicious findings appropriately leads to further evaluation with core needle biopsy, even when mammographic findings are negative. Present study was aimed to correlate ultrasound categorised breast lesions with FNAC findings in diagnosing benign & malignant breast lesions at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted female patients of age > 18 years had suspicious lesions on mammography. All patients underwent BIRAD score interpretation by USG & FNAC procedure. Results: In present study, 233 women were included. Majority were from 31-60 years age group, with mean age of 47.22 ± 11.43 years. Common radiological characteristics were microlobulated (35.6 %) & Circumscribed (29.6 %) margins of lesion, hypoechoic (60.9 %) & hyperechoic (17.6 %) echogenicity of lesion. Posterior features of lesion were Post acoustic Enhancement (27.9 %) & Shadowing (51.5 %). In present study common BIRAD grade were high suspicion of malignancy (IVc) (23.60 %) followed by benign (II) (19.74 %), highly suggestive of malignancy (V) (18.88 %), moderate suspicion of malignancy (IVb) (13.73 %), probably benign (III) (13.30 %), low suspicion of malignancy (IVa) (7.73 %) & negative (I) (3 %). USG-FNAC correlation was concordant in 222 patients (95.3 %). Sensitivity and Specificity of BIRAD ≥ IVb was highest (90.9 % & 89.1 % respectively) followed by BIRAD ≥ IVa (88.6 % & 75.3 % respectively) & BIRAD ≥ IVc (71.2 % & 95.1 % respectively). Conclusion: Combined ultrasonography (gray scale & colour Doppler) and FNAC offers the best approach in diagnosing a breast pathologies / lesion.

Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. The anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. Introduction: It is a granulomatous tract, single, or multiple external openings, which connects perianal skin to the epithelium of the anal canal or rectum.  Aims and Objective: The objective of the study was to assess the role and benefits of the fistula plug technique (modified seton placement) using absorbable sutures in the treatment of fistula-in-ano. Materials and Methods: This prospective clinical study was carried out on 50 patients between March 2019 and February 2021 Results: most of the patients were in the age group of 20–40 years (52.0%) with male preponderance (82%). The majority of the patients 37 (74.0%) showed recurrence at 1-year follow-up. Post-operative wound infection was seen in 24.0% of patients. Intersphincteric fistula was seen in 60.0%. No complications such as anal stenosis or incontinence were seen in our study subject. Conclusion: It is a very good alternative in cases of anal fistula. However, this technique has the vast disadvantage of a high incidence of recurrence and it cannot be used as a permanent alternative to surgery.

Introduction: Pre-emptive analgesia provides some short-term (reduction in perioperative pain and acceleration of recovery) and long-term (prevention of chronic pain syndrome) benefits. Therapies that have been tested in pre-emptive trials include NSAIDS, intravenous opioids, IV Ketamine, peripheral local anesthetics, caudal and epidural analgesia, dextromethorphan, gabapentin, magnesium and dexmedetomidine. Aim & Objectives: As dexmedetomidine and magnesium seem to be new weapons in the armamentarium of anaesthesiologists to combat post-operative pain to reduce the requirement of anesthetics intra operatively; we planned this study to compare these two agents in our set up to know exactly their effectiveness in terms of intensity of pain relief and it’s duration, side effects and effect on haemodynamics. Material & Method: This was a double-blinded prospective study in which patients were randomly divided into 2 groups, 55 patients in each group. Group A (n=55) patients were administered intravenous dose of 1.0µg/kg dexmedetomidine for 10 minutes in 100 ml saline followed by a continuous infusion of 0.7µg/kg /hr till completion of the surgery. Group B (n=55) patients were administered intravenous dose of 50mg/kg magnesium sulphate for 10 minutes in 100 ml saline followed by a continuous infusion of 15mg/kg/hr till completion of surgery. Complaints of pruritus, nausea, vomiting, respiratory depression and shivering among all patients were carefully observed, recorded and managed symptomatically. Results: During the intraoperative and postoperative periods, Dexmedetomidine found to show better haemodyamic profile when compared to Magnesium sulphate. The postoperative analgesic scores and the requirement of rescue analgesics, both in terms of frequency and dosage were found significantly lower in Dexmedetomidine group (p=<0.001), compared to Magnesium group. The patient satisfaction scores were significantly higher (P = 0.011) in patients administered Dexmedetomidine, compared to Magnesium. Hypotension and bradycardia were more frequently observed in magnesium group, though no statistical significance could be attributed to this finding. Side effects like vomiting and nausea were more frequent in patients administered Magnesium. Conclusion: Dexmedetomidine as a preemptive analgesic provides better postoperative analgesia with a better haemodynamic profile as well as better patient and surgeon satisfaction with minimal side effects.

INTRODUCTION: Obstructive jaundice is a common surgical problem. Occurs due to both benign and malignant conditions.Evaluation in patients with obstructive jaundice was a challenging problem. Presentation of obstructive jaundice patients is late and mostly present after the disease becomes advanced or uncurable Aims And Objectives: To assess age and sex patterns, clinical presentation, and radiological and biochemical patterns in obstructive jaundice patients. Materials And Method: 100 patients with obstructive jaundice were studied. Proformas form was filled an assessment of demographic and clinical patterns in benign and malignant obstructive were observed and radiological findings in benign and malignant obstructive were carried out to assess the operability. Result: we enrolled 100 patients, 18 were male and 82 were female having mean age was 52.58 yr. All patients have icterus, 60% lumping women, and 31% have pruritus. Gallbladder was palpable in 40% of patients which were due to pancreatic and Periampullary malignancy. Our study reveals the most common overall and benign cause of biliary tract obstruction was CBD stone(33%) and the most common malignant is gall bladder carcinoma(31%) followed by Periampullary carcinoma(17%). CBD stonesare treated by CBD exploration(85%) and palliative treatment by ERCP(15%) and the rest of the benign conditions are completely treatable. Among malignant causes of gallbladder carcinoma treated by radical cholecystectomy (16%), cholangiocarcinoma was mostly inoperable, and Periampullary carcinoma by Whipple's procedure (25%). Conclusion Malignant causes of obstructive jaundice outnumbered benign causes. The most common overall and benign cause was Choledocholithiasis and the malignant was gallbladder carcinoma followed by Periampullary carcinoma. Benign causes were prevalent in younger age groups (31-40 yr) and malignant in older age groups (61-70 yr). A common presentation of obstructive jaundice was icterus and palpable gallbladder was indicative of malignant etiology. Ultrasound followed by MRCP/ERCP and CT scan was the investigation of choice. Benign conditions have better outcomes and cure rates while malignant conditions were inoperable (83%).

Objectives: The percentage of patients with difficult and prolonged healing of the wound is still high, while immediate complications such as wound dehiscence occur in up to 3 % of all treated patients in abdominal surgery. The aim of the study was to analyze the risk factors and comorbidities in the group of patients undergoing laparotomy and associated with early postoperative wound dehiscence. Methods: The prospective study included all patients treated surgically undergoing laparotomy at the Department of General Surgery,JA Group of Hospitals and GR Medical College, Gwalior (MP) Results: The results showed a statistical proportion of male patients102 (85%) compared to females18 (15%). The largest number of respondents were in the age group 21 to 40yrs. Surgical wound infection was evident in(103)85.3% of patients, hypoproteinemia was found in(86)71.76% of patients, anemia in(99)82.5%, peritonitis in 36% and diabetes in (34)28.33% of respondents. Of the total respondents with surgical wound dehiscence, 78 (65%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2 =4.399; p=0.036), wound infection (X2 =4.112; p=0.043. The frequency of the anemia, peritonitis, and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05) Conclusions: The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, tuberculosis, anemia, and active infection. The highest incidence of dehiscence was in patients operated on in medical emergencies and in patients with malignant disease.

Introduction -Vitamin D plays a role in optimization of the skeletal function. Vitamin D helps in calcium homeostasis which further helps in bone mineralization and preventing osteomalacia, hence older individuals with low vitamin D levels (<30ng/ml) must be prone to fragility fractures of the hip. Methodology 

● Study design – Prospective observational study.

● Study population Patients at Justice K. S. Hegde Charitable Hospital with closed fractures of the hip involving the proximal femur diagnosed by a physical examination and plain radiography in the pelvis with both hips Anteroposterior View (AP) and lateral view of the involved hip.

Study setting - Justice K. S. Hegde Charitable Hospital attached to K. S. Hegde Medical Academy, a unit of Nitte (Deemed to be University), Deralakatte, Mangaluru – 575018 (Hospital-based study).

● Study Duration - Study was  conducted from February 2021 till October 2022.

● Sample size – Sample size was calculated using nMaster software (version 2.0). Based on the alpha level of 5% SD of vitamin D in hip fragility fractures is 8.05(12), for the estimation error of 1.5, sample size was decided as 111. This was calculated using master version 2 software.

Methods: All patients over 45 with hip fractures from minor trauma, such as a slip and fall while standing or walking, were clinically and radiologically assessed. A patient history and injury information were documented using a predesigned proforma. The history consists of accidents/trauma, fractures in the past, surgeries, drug/supplement use history, and co-morbid conditions. The pelvis and affected limb were radiographed. Boyd and Griffin for intertrochanteric fractures and Garden for neck of femur fractures, Russel-Taylor classification for Subtrochanteric fracture to classify  the kind, comminution pattern, and grade of fracture. A biochemist evaluated 25-hydroxyvitamin D (25-OH Vit.D) levels in venous blood samples taken after admission. Our laboratory tested serum vitamin D levels using electrohemiluminescence Immuno Assay (ECLIA) on an automated analyzer.  Vitamin D values <20ng/ml were judged inadequate, while 20–20ng/ml were considered insufficient. 30-100mg/ml vitamin D was typical. Finally, vitamin-D levels correlated with fracture comminution. Data Analysis: On statistical analysis, the data was expressed in mean SD, frequency & percentage. Chi-square test was used for the analysis of the data. Results In the present study, 111 patients were evaluated with X-ray radiographs to investigate the comminution pattern of hip fractures and the presence of hypovitaminosis D in patients diagnosed with hip fractures. The mean age of patients was 70.40 ± 11.29 years. Out of 111 patients, 19 patients (17%) belonged to the age group of 46 to 60 years, 60 patients (53.6%) belonged to the age 61 to 75 years. 33 patients (29.5%) belonged to the age group of >75 years. Out of 111 patients, patients (71.4%) were females and 32 patients (28.6%) were males. Based on symptoms, 45 patients (40.17%) presented with left Hip/Groin pain with inability to bear weight and 66 patients (59.82%) presented with right Hip/Groin pain with inability to bear weight. Based on comminution, 59 patients (52.7%) had comminution. The mean vitamin D levels was 20.98 ± 13.11. 46 (41.1%) of the 111 patients had deficiency 20ng/dL, 4 (3.6%) had insufficient 21-29ng/dL, 6 (5.4%) had optimal 40-60ng/dL, and 3 (2.7%) had sufficient 30-39ng/dL. The correlation between comminution and Holick's classification was statistically significant. (p=0.001). The findings of the study conclude that Vitamin D have a significant effect on the presence of comminution and fracture site pattern. Conclusion -According to our study, osteoporosis, vitamin D deficiency, and fracture site comminution are all coexisting conditions. Early identification and treatment with vitamin D for osteomalacia and anti-osteoporotic regimens for osteoporosis will enhance bone, muscle, and general health, reducing falls and the associated fractures. Incorporating findings from bigger research into Indian hip fracture prevention recommendations is necessary.

Introduction: Menopause is defined as the cessation of menstrual cycles for 12 consecutive months, although many women seek medical advice before this time because of the onset of menopausal symptoms. The prevalence of hypertension in postmen opausal women is higher than in men. The aim of the present study was to identify the adherence to antihypertensive therapy based on the prescribing pattern in postmenopausal women. Methodology: Aprospective observational study was conducted in 116 post-menopausal patients visiting General Medicine OPD for the treatment of hypertensionin a tertiary care centre in South India, for a period of 6 months.  Results: Prescribing pattern of drug sin post-men opausal women is more complicated than in pre-menopausal women. The commonly prescribed anti-hypertensive agent is Calcium channel blocker (CCB) (45.16%), followed by Diuretics (19.35%), An giotensin receptor blockers (ARB)(14.51%), Beta blockers (9.67%) and An giotensinconverting enzyme inhibitors (58%). In monotherapy, ARB and CCB women achieved significant reduction fB Pandin combination therapy ARB with Diuretics gaves ignificant reduction. Conclusion: Inpost-menopausal women most commonly prescribedoral anti-hypertensive drugs are calcium channel blockers & diuretics. It is evident that good adherence to therapy and regular checkups will protect the post-menopausal women with HT from other major complications.

Background: Decreased fetal movements perceived by the mother in pregnancy can cause apprehension and  increased incidence of unscheduled antenatal check-up and labour room admission. Decreased fetal movements  are  associated with a wide variety of intra-partum and postpartum complications.Aims And  Objectives: To identify the demographic and pregnancy characteristics, obstetric and neonatal outcome among women presenting to hospital with reduced fetal movements.Materials And Methods: A prospective observational study conducted among 150 term antenatal women who attended the labour room of Obstetrics department, Government Medical College, Thrissur with complaints of DFM from January 2020 to December 2020.These women were categorized into 2 groups after evaluation-immediate termination group and conservatively managed group (reassured and delivered later).Obstetric and neonatal outcomes were studied.Results:. 5 women had intrauterine demise at the time of presentation.58.6% of women with DFM  required immediate termination of pregnancy out of which 57.2% of cases were induced. A highly significant  association between intra-partum CTG and perinatal complications were noted.Caesarean sections and  instrumental deliveries were more in immediate termination group when compared to latter group. Perinatal complications(RDS at birth, APGAR scores, resuscitation and HIE) were more in immediately terminated group compared to latter group which was statistically  significant. There was increased risk of RDS at birth as the number of DFM increases which was statistically significant.Conclusion: Maternal perception of DFM should receive adequate medical attention and can be used as a predictor of adverse obstetric and neonatal outcome. DFM result in increased rate of planned early delivery, induction of labour and caesarean sections. Unless intervened, these cases of DFM would have ended up in still births. Universally accepted evidence based guideline needs to be developed enabling optimal management of cases of DFM

Gallstone’s status was based on information from self-reports, imaging procedures, surgical notes, and medical records. Among controls, a transabdominal ultrasound was performed to detect asymptomatic gallstones. Gallstones were removed from cancer cases and gallstone patients were classified by size, weight,color, pattern, and content of cholesterol, bilirubin, and bile acids. cancers of the gallbladder, extrahepatic bile ducts, and ampulla of Vater, respectively, persisting when restricted to those with gallstones at least 10 years prior to cancer. Biliary cancer risks were higher among subjects with both gallstones and self-reported cholecystitis, particularly for gallbladder cancergallbladder, bile duct, and ampulla of Vater cancers, respectively, could be attributed to gallstones. Cancers of the biliary tract encompass those arising from the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Biliary cancer is relatively uncommon in most parts of the world, although high-risk populations and upward incidence trends have been reported in certain areas (Hsing et al, 1998, 2006). Although gallstones are a well-documented risk factor for gallbladder cancer (Diehl, 1983, 1991; Zatonski et al, 1997; Lazcano-Ponce et al, 2001; Hsing et al, 2006), their role in cancers of the extrahepatic bile duct and ampulla of Vater is less established. Material and Methods: A prospectivestudy was conducted on patients admitted in various Departments of the J.A. Group of Hospitalsfrom Jan. 2021 to Aug. 2022. 75 patients will be selected for the study with gallstone disease and 75 patients as controls for conducting this study. Result: Females are mostcommonly affected with gallbladder cancer than males. Patients in the age group of 45-59 years were found to have the highest risk of gall bladder cancer. The mean age of the patients affected was 52 years. Patients having gallstone disease were more prone to developing gallbladder cancer.The size of the stone also has a significant risk factor for gallbladder cancer  ,No of stone also a significant role in developing gall bladder cancer. that gallstones were a strong risk factor for all three subsites of biliary cancer.cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation. Conclusion: That cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation (Cetta, 1991). Cholesterol stones are associated with lithogenic bile supersaturated with cholesterol, due to increased hepatic secretion of cholesterol or diminished secretion of bile salts and phospholipids that maintain the solubility of cholesterol (el Zayadi et al, 1991). In contrast, pigment stones have a high biliary concentration and are closely linked to cirrhosis, chronic infection, and blood disorders (Swidsinski and Lee, 2001). past few decades, there has been an increase in cholesterol stones and a decrease in pigment stones, probably related to increasing obesity and a more westernised diet and lifestyle. In our study, the magnitude of the biliary cancer risks associated with gallstones was higher than in most previous studies (Lowenfels et al, 1985; Vitetta et al, 2000), possibly due to our more comprehensive assessment of gallstone status and only assessment of gall stones in relation to gall bladder cancers.

Background: This study was conducted to study the clinical profile of acute kidney injury in haematotoxic snake bites. Methods: This was a hospital-based prospective observational study conducted among 120 patients who were admitted in ward and ICU with haematotoxic snake bites in the Departments of General Medicine in Government Medical College, Trivandrum, over a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age group was 49.8+/-17.8. Among them, 76.7% showed local reactions, and 23.3% showed systemic manifestations. 35.8% developed AKI and 16.7% needed haemodialysis. Associated neurological manifestations were seen in 2.5%. 42.5% developed sepsis, 9.2% developed DIC, and 14.2% developed a capillary leak. 33.3% had cellulitis of which 3.3% developed functional disabilities. 8.3% required ventilatory support and 4.2% succumbed to death. Conclusion: A cascade of events tends to occur in severe haematotoxic envenomation such as bleeding disorders, hypotension or circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory distress syndrome (ARDS). Early hospitalization, quick anti-snake venom administration and adequate supporting care provided promising results.

Background: One of the most prevalent and deadly disorders is cerebrovascular illness. The second most prevalent cause of mortality worldwide is stroke.1 It is one of the most prevalent neurologic diseases that can be fatal and devastating. Approximately 6.15 million fatalities worldwide occur each year as a result of cerebrovascular disease. According to several Indian research, the prevalence rate of stroke varies depending on the region and the time of study from 40 to 470/100000 people. In India, stroke is a significant cause of mortality and morbidity.2

Objectives:

1. To observe plasma CRP levels in acute ischemic stroke.

2. To evaluate the role of CRP as a prognostic and diagnostic aid in acute ischaemic stroke.

3. To evaluate CRP levels as a risk factor in acute ischemic stroke.

Material & Methods: Study Design: Hospital-based prospective observational study. Study area: Department of General Medicine, in a tertiary care hospital in south India. Study Period: April 2021 – March 2022. Study population:  Patients admitted with a clinically first attack of the stroke to the medical intensive care unit or acute medical ward. Sample size: The study consisted of a total of 60 cases and 60 controls. Sampling Technique:  Simple random method. Clinical history was taken from either the patient or his/ her relatives or attender, while taking history importance was given regarding the presence or absence of vomiting, headache, and convulsions. Known history of hypertension, diabetes, CAD, RHD, TIA, collagen diseases, meningitis, tuberculosis, endocrine disorders, and congenital disorders was taken. Personal history regarding dietary habits, smoking alcohol consumption, and tobacco chewing were noted. The NIH stroke scale was assessed in all patients to assess the neurological disability and its prognosis. A detailed neurological examination was done based on proforma. Results: CRP values of CT evaluated ischemic stroke patients after admission, > 12 hours < 72 hours after the symptoms onset 54 of the 60 thrombotic stroke patients had CRP >6 mg/dl only 6 patients had CRP<6mg/dl (P <0.001). The Chi-square test value was 73.65, which is statistically very significant. Only 7 patients in the control group had CRP>6mg/dl. Conclusion: In this study mean C-Reactive protein levels were significantly higher in patients with ischemic stroke when compared to controls. It is also observed that elevated C-Reactive protein in ischemic stroke can be diagnosed positively and is an indicator of a worse prognosis, but subtypes (cortical, subcortical) of cerebral infarction cannot be differentiated at the time of early diagnosis. C-Reactive protein levels were raised in all cases that expired.

Background: Thyroid physiology is perceptibly modified during normal pregnancy. These alterations take place throughout gestation, help to prepare the maternal thyroid gland to cope with the metabolic demands of pregnancy, are reversible post-partum and the interpretation of these changes can pose a challenge to the treating physician. Material and Methods: This is a prospective, descriptive and observational study conducted among hypothyroid pregnant women from their preconception to complete gestational phase (with whatever outcome), conducting to Index institute of Medical sciences and Hospital over a period of 2 years. The hypothyroid pregnant females visiting to Endocrine and Obstetric Department at the Index institute of Medical sciences and Hospital. All pregnant women who will be diagnosed hypothyroidism defined as either overt (elevated TSH and low FT4) or subclinical (elevated TSH and normal FT4) hypothyroidism and those labelled only ‘hypothyroidism’ (uncategorized) by the clinician either before or during pregnancy. Results: In my study most of the patients who were started on treatment responded well to it so that by 16 weeks 53% of them had their TSH restored to normal range. In my study of 266 patients started on Levothyroxine 140 of them (53%) had normal TSH by 20 weeks but 110 of them (41%) still had relatively higher levels of TSH which necessitated an increase in dose of Levothyroxine. In this table NA denotes those who abort spontaneously before 20 wks of gestation. In my study at 32 weeks period of gestation except for a single patient all the other patients attained normal TSH levels. one patient needed further increase in dose of Levothyroxine.Those who have been diagnosed before 10 weeks and on treatment, if their repeat TSH values become normal they were grouped under adequately treated group. Conclusion:
Isolated Low free T4 followed by SCH have the highest rate of occurrence in the study sample. Though the occurrence of any low thyroid status, low isolated free T4 are more common in women with recurrent miscarriage, but the difference was not significant statistically. Anaemia in pregnancy was a mild public health problem in ours study. Ongoing interventions to target anaemia during pregnancy seem to be working in this setting and they should reach universal coverage.

Background: Despite ongoing disagreement regarding its indications, interest in operating to treat paediatric fractures has grown during the past 20 years. There is some debate over the best way to repair long bone fractures in kids under the age of six (POP cast) and teenagers over the age of sixteen (locked intramedullary nailing, plating). OBJECTIVES:  To analyze the results of fixation of long bone fracture with TITANIUM ELASTIC NAILING SYSTEM (TENS) in the treatment of fracture shaft of long bones in children aged between 5 to 16 years with special emphasis on complications. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Orthopaedics, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Telangana. Study Period: 3 months. Study population:  All children and adolescent patients between 5-16 years of age with diaphyseal fractures of long bones admitted in the department of Orthopaedics. Sample size: Study consisted of 20 subjects. Sampling method:  convenient sampling. Study tools and Data collection procedure: As soon as the patient was brought to casualty, patient’s airway, breathing and circulation were assessed. Then a complete survey was carried out to rule out other significant injuries. Plain radiographs of AP and lateral views of long bone including one joint above and one joint below .to assess the extent of fracture comminution, the geometry and the dimensions of the fracture. Results: The duration of stay in the hospital ≤ 7 days for 3 (15%) patients, 8-10 days for 7 (35%), 11-15 days for 11 (50%). One case was operated within 6 days of injury, developed superficial infection which had to be dressed regularly, so stayed for 11 days. Another cases were who had multiple soft tissue injury had to stay 14 days. The average duration of hospital stay in the present study is 10.25 days. Conclusion: We draw the conclusion that the ELASTIC STABLE INTRAMEDULLARLY NAILING approach is the best course of action for treating paediatric long bone diaphyseal fractures. It provides elastic mobility that encourages quick union at the site of the fracture and stability that is perfect for early mobilisation. When compared to other forms of treatment, it has a reduced rate of complications and produces positive results.

Background: This study was conducted to test early resuscitation, targeting lactate levels as the marker of adequacy of oxygen delivery, compare the return of normal ScvO2 in predicting 7th day mortality, and compare the clearance of serum lactate (at least 10%) in predicting 7th day mortality. Methods: This was a hospital-based randomized prospective study conducted among 120 adult patients admitted to the medical ICU with septic shock at Rajarajeswari Medical College and Hospital from November 2015 to August 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: 7th day mortality was 21.7% in group L and 33.3% in group S, the p-value was 0.152 which was not clinically significant between both groups. But lactate clearance in group L at 24 hours was 57.50±25.82 and at 72 hours was 76.87±14.80 which was clinically strongly significant and ScvO2 at mortality was around 70.6% but still there was a mortality of 33.3% on 7th day, which is higher compared to the lactate group. Conclusion: Goal-directed therapy provided at the initial stages of severe sepsis and septic shock has significant short term and long-term benefits. We can also say that using lactate as an indicator of sepsis will help in early diagnosis with risk stratification and repeated measurements at regular intervals can assist in the progress of treatment.

Background: Preoperative prediction of risk factors helps in assessing the intraoperative difficulties. Various scoring systems are available to predict the intraoperative difficulties in laparoscopic cholecystectomy. However, there is the need to find a consistent and reliable scoring and predictive system. The present study was undertaken to assess preoperative scoring system in determination of intraoperative difficult laparoscopic cholecystectomy (LC). Material and methods: The prospective observational study performed on 50 patients undergoing elective LC. All the patients were assessed and data regarding the previous history, clinical examinations, and USG findings were recorded. Preoperatively patients were assessed according to Randhawa and Pujahari scoring system. Whereas, intraoperatively, based on duration of surgery.m Results: Preoperative score suggested difficult and very difficult LC in 36% and 2% of patients respectively while intraoperatively 8% of patients had difficult and very difficult LC respectively. The sensitivity, specificity, and predictive value at the preoperative score of 5 was found to be 90%, 72.7%, and 96.7% respectively. Intraoperative difficult LC was found to be significantly associated with the previous history of hospitalization (P=0.021), palpable GB (P=0.003), wall thickness >4mm (P=0.000), pericholecystic collection (P=0.000), contracted GB (P=0.000), post ERCP (P=0.000), deranged LFT (P=0.000), and WBCs >11000 (P=0.000). Conclusion: Study finds the evaluated scoring system, reliable and useful for predicting difficulty in laparoscopic cholecystectomy.

Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period.  Results:  APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S).    Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S).  Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester.  PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:

Introduction: Airway management is a basic aspect of anesthesia practice and critical care medicine. The relationship between airway indices and BMI mostly seen in terms of obesity, there is also conflicting evidence regarding this. So this study will try to resolve the disagreement in result associating obesity with difficult airway and also envisage the broader aspect by finding association between BMI and airway indices. Material and Methods:Two hundred adult participants aged between 20 to 55 yrs. of age of both sexes going through pre-anaesthtic check-up (PAC) for variety of surgeries at MIMS, Barabanki, were enrolled in this quantitative prospective observational study after meeting inclusion and exclusion criteria.Consecutive sampling method was used and sample size calculated using Taro-Yamane formula.During the PAC, data regarding various parameters such as demographic detail, BMI and airway indices were collected. BMI, Age and Sex were the independent variables and all airway indiceswere the dependent variables. The data collected for the study was continuous and categorical.Subsequently data was coded. The BMI and airway association was analyzed by using STATA version 12. Continuous data were presented as mean ± SD and ordered data were presented as percentage and analyzed by ordered logistic regression (‘p’ value, ‘z’ value and co-efficient). Results: The mean of age, height, TMD, HMD and SMD were comparable in all the four BMI categories. The mean of weight, BMI, NC and HLM were increasing from underweight to obese. BMI association with NC,MPG, HLM, WSand H and N movementwere statistically significant and having ‘p’ value = 0.000 (for all indices) and ‘z’ value = 9.94,8.18, 7.53, 6.29 and 6.2respectively. BMI weakly associated with SM, SMD and ULBT. BMI association with IIG, TMD and HMD were statistically not significant and having ‘p’ value > 0.05 (for all indices). All airway indices have positive co-efficient except SMD, which have negative co-efficient. Conclusion: The findings confirm that there were association between BMI with NC,MPG, HLM, WS and H and N movementat p value = 0.000 which is significant and z value > 6 and hence corroborates that difficult airway could be anticipated with these variables. Among all individual airway indicators Neck circumference was strongly associated with BMI followed by MPG.

Background: The goal of the study is to determine how frequently patients with cholelithiasis/ choledhocolithiasis also have hypothyroidism. To determine whether a thyroid profile is necessary for biliary lithiasis patients. Method: A prospective and observational investigation carried out at the Department of General Surgery, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India ethics committee granted permission for a study to be conducted on 75 subjects from April 2022 to March 2023. Result: The average age of gallstone sufferers is 47.14 years old. The ratio of men to women is 1: 2.2. Hypertension was the most common co-morbidity, affecting 21.3% of the patients. Four patients were converted from a laparoscopic to an open operation out of the 35 patients who received laparoscopic cholecystectomy. Hypothyroidism was present in 27% of patients with cholelithiasis/choledocolitiasis. The majority of the group was female and aged between 50 and 70. This category includes more than 72% of hypothyroidism patients. Conclusion: The study found that middle-aged females are at greater risk for hypothyroidism. Undiagnosed and untreated hypothyroidism in such persons will cause recurrence and consequences. Thus, early treatment of hypothyroidism-related gall stones will help patients.

Background:  To identify the different unidentified causes of chronic stomach pain. To evaluate the diagnostic laparoscopy's efficacy in cases of persistent abdominal pain. To assess the effectiveness of laparoscopy in the treatment of persistent abdominal pain. Method: This prospective descriptive cross-sectional study enrolled 40 consecutive chronic abdominal pain patients between May 2022 to April 2022. They were chosen from the Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India, general surgery outpatients for the research. Result: Appendicectomy 30%, adhesiolysis 20%, and hernioplasty 10% were performed in 54% of patients. 18% of patients exhibited enlarged mesenteric nodes in the terminal ileum that were biopsied and revealed nonspecific adenitis. Study found 8% of patients with negative laparoscopy. Conclusion: Diagnostic laparoscopy is beneficial in chronic stomach pain, revealing underlying problems. Chronic abdominal discomfort sufferers benefit from diagnostic laparoscopy. After a full diagnostic evaluation, it should be considered. Diagnostic laparoscopy can treat several problems surgically. It is safe and useful for diagnosing chronic stomach discomfort and guiding treatment.

Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period.  Results:  APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S).    Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S).  Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester.  PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:

Introduction: Bupivacaine and ropivacaine have identical PKA values, however ropivacaine is less fat soluble, implying that ropivacaine will block A-alpha fibers more slowly than bupivacaine. Isobaric solution has the extra benefit of not affecting the intrathecal dissemination of local anaesthetic during and after injection. The purpose of this study was to compare the anaesthetic efficacy of intrathecal isobaric ropivacaine 0.5% to isobaric bupivacaine 0.5% in lower abdominal procedures in terms of: 1. Onset and duration of sensory block, 2. Onset, quality, and duration of motor block, and 3. Hemodynamic alterations. Material and Methods: The present study was a Prospective randomized comparative Study. This Study was conducted January 2021 to December 2022 at department of Anesthesiology, Iqcty medical College nd hospital, Durgapur. Total 100 patients were included in this study. Results: Intrathecal isobaric 0.5% ropivacaine causes a delayed onset but identical length of sensory block and a statistically significant shorter duration of motor block. Both groups have identical haemodynamics and block height (highest sensory level). Conclusion: Because of the shorter length of motor blockade and comparable duration of sensory blockade, haemodynamics, and blockade height, 0.5% isobaric ropivacaine is a superior choice for ambulatory anaesthesia.

Introduction: Regional anaesthesia is the method chosen for surgeries involving the lower abdomen and lower limb in children. It provides a good alternative to general anaesthesia. This technique is safe and cost effective in day care surgeries.  Aims: The aim of this study is to evaluate the efficacy of Ropivacaine and Bupivacaine in spinal anaesthesia in children posted for infraumblical surgeries. Materials and Methods: The present study was a prospective randomized study. This Study was conducted January 2022 to December 2022 at department of Anesthesiology, Iqcty medical College nd hospital, Durgapur. Total 30 patients were included in this study. Result: Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block. Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block. Conclusion: Children who receive spinal anesthesia with ropivacaine have sensory and motor block later than adults. In comparison to bupivacaine, it also exhibits a faster offset of the sensory and motor block with a sufficient quality of block.

Background: Acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances. Some of the signs and symptoms can be subtle to both clinician and the patient. also may not present in all instances. Arriving at the correct diagnosis is essential, however, a delay may allow progression to perforation and significantly increases morbidity and mortality. Incorrectly diagnosing a patient with appendicitis although not catastrophic, often subject the patient to an unnecessary operation. It has been claimed that diagnostic aids can dramatically reduce the number of appendectomies' in patients without appendicitis, the number of perforations, and the time spent in hospital. The methods advocated includes laparoscopy, scoring system, computer programs, ultrasonography, computed tomography and magnetic resonance imaging. Aims: To compare the diagnostic accuracy of RIPASA and MODIFIED ALVARADO SCORING SYSTEM in the diagnosis of acute appendicitis. Materials and Methods: We compared prospectively Ripasa and Modified Alvarado Scoring Systemby applyingb them to 94 patients. Bpth scores were calculated for patients who presented with right illiac fossa pain during the study period Depending of radiological evidence, appendicectomy was done. Post-operative hiztopathology report was correlated with the scores. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Modified Alvarado Scoring system. The diagnostic accuracy of both the scoring system are compared. Results:-The RIPASA scoring system accurately diagnose 97.8% patients of high probability group (score greater than 7.5), whereas Modified Alvarado Scoring System accurately diagnose 91.4% patients of high probability group(score greater than 7). Conclusion:- RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population then Modified Alvarado Scoring System.

Introduction: With the rising mortality rate, worldwide liver cirrhosis has been ranked as the 13th leading cause of mortality. Portal hypertension is one of the common consequences of liver cirrhosis. Further, portal hypertension has its own complications and the most serious among them is the risk of development of esophageal varices (EV) caused by increased hepatic vascular resistance related to hepatic fibrosis and regenerative nodules. Methodology: A prospective study was carried out at the tertiary care hospital of, MKCG Hospital between September 2019 To November 2021. All patients of cirrhosis of liver without history of gastrointestinal bleed, irrespective of etiology, admitted in the hospital were included in this prospective study. Result: Among the patients studied males predominate the study population with 86% with females accounting for only 14%. Among the study population majority presented with abdominal distension constituting 86% followed by pedal oedema constituting 70%. Among 50 patients studied, cause of cirrhosis was found to be alcoholism in 78% and Non-alcoholic in 22%. Discussion: The platelet count and the spleen size showed the difference among the patients belonging to small varices and larger varices group, respectively. presence of thrombocytopenia and lower PC/SD ratio determine the presence of higher grades of varices and can hence identify the subset of patients who require high priority endoscopy for the prophylactic management of esophageal varices helping in better patient selection.

Background: Pregnancy is associated with volume overload producing significant vascular and hemodynamic adaptations  in cardiovascular physiology. Present study was designed to follow up  gradual adaptations in cardiovascular  hemodynamics  during the course of pregnancy using Doppler  echocardiography which is reproducible and noninvasive technique Method: In present  prospective study of 120 women, were divided into 2 groups of 60 each: control group & study group (pregnant patient in I trimester, II trimester & III trimester).  They were  non invasively  analysed for cardiovascular function and systemic hemodynamics using  echocardiography  and compared  with control group. The data was  analysed using ANOVA for comparison within the group and student’s t- test  for comparison between the groups. ‘p’- value < 0.05 was considered to be significant. Results:  Mean age and height  in control and study  groups  were comparable. Weight gain was within the expected range with advancement of pregnancy. Heart rate was increased in I and II trimesters with  peak rise in III trimester. The difference between control group and study groups was statistically significant (p < 0.05). Systolic blood pressure was slightly decreased in all the trimesters as compared to control group which was statistically not significant. There was gradual increase in SBP from I to III trimesters. Diastolic blood pressure progressively decreased in I and II  trimesters and then  increased in III  trimester. The difference in DBP between control group and I , II  trimesters of pregnancy was  significant (p<0.05). Systemic vascular resistance progressively  decreased  with advancement of pregnancy and difference was statistically significant (p <0.05) . Cardiac output is steadily  increased in all trimesters of pregnancy with peak at 36 weeks  and was statistically significant (p<0.05). It was due to increase in  both heart rate and Stroke volume. Ejection fraction also increased in all trimesters .Conclusions: Present  study shows  significant  functional changes in the cardiovascular dynamics during pregnancy. Doppler echocardiography provides an excellent noninvasive method for the evaluation and serial analysis of hemodynamic changes. These results will help in distinguishing abnormal echocardiographic changes from the normal physiologic changes of pregnancy. Therefore maternal echocardiography should be  introduced into the antenatal management protocol, which will help to identify women at high risk to developing  cardiovascular complications and there by  early intervention.

The cranio-vertebral junction (CVJ) is a complex transition region between base of skull and upper cervical spine. This study aimed to evaluate clinical features, radiological findings and various causes of CVJ disorders. It was a hospital-based prospective observational study from November 2021 to November 2022 in the Department of Radiology, RIMS, Ranchi, a tertiary care hospital of Jharkhand, India. A total of 62 cases were studied. Cranio-vertebral junction anomalies are more common in males than females with a ratio of approximately 1.7:1. Second and third decades are most common ages of presentation making up 19 cases in our study. 16 patients were above the age of 60 years. Most common presenting symptom was neck pain which 26 patients were having as their predominant complaint followed by limb weakness. Developmental anomalies were most common accounting for 51% followed by traumatic (15%) and then degenerative (13.33%). History of trauma was present in 15 patients of which 6 had developmental anomalies which were precipitated by trauma and 9 had history of pure trauma without any underlying developmental anomaly. Atlato-axial dislocation (AAD) was the most common CVJ anomaly seen in almost 60% of patients followed by basilar invagination seen in 36.66%. Os odontoideum is more common in males than females. In all 4 patients of CVJ tuberculosis, one had history of active pulmonary tuberculosis while in rest three there  was past history of pulmonary tuberculosis. Rheumatoid arthritis was present in all patients for a duration of more than 5 yrs. AAD was found in all whereas basilar invagination was seen in 2 patients. Radiographs of the cervical spine should be performed 2 years after diagnosis of  Rhematoid arthritis(RA) and periodically thereafter. Degenerative changes affecting the cervical spine may mimic CVJ anomalies

Introduction: Bacterial infections are one of the most devastating complications in the field of orthopaedicsurgery.Increasing incidence of open fractures leading to higher infection rates. Infection control can be achieved by meticulous surgical debridement and microbial specific antibiotic administration. Local antibiotic delivery is a way to deliver high concentration of drug locally even to avascular areas that are inaccessible by systemic antibiotics. AIM:The present study was designed to evaluate clinical outcome of orthopaedic infections which are managed by local antibiotic delivery system. Material and methods:This is a prospective study, for a period of 16 months, carried out in 32 patients posted for surgical debridement for bone & joint infections.  For evaluation of outcome we used Asepsis wound score, radiological, hematological and microbiological investigations. Results: In the 32 patients analyzed, 21.8%  were in age group of 18-30 years ,of which 71.4% had satisfactory outcome. 50 % were in age group of 30-50, of which 81.25% had satisfactory outcome and 28% were > 50 years , of which only 44% had satisfactory outcome. Overall infection was controlled satisfactorily in 68.75 % of patients by usinglocal antibiotic delivery system. In our study most common organism isolated was MRSA (37.5%), Followed by MSSA (31.25%). Conclusion: Systemic antibiotic therapy may not provide a minimum inhibitory concentration for prolonged period and which is further worsened due to decreased blood supply, secondary  to scarring. By using local antibiotic delivery system ,we can control infection effectively by delivering high concentration of drug locally. And also, this system decreases the risk of complications due to systemic antibiotics such as end organ failure and GIT side effects.

Background: Alpha-2-adrenergic agonists have synergistic action on local anesthetics used in spinal anaesthesia. The objectives of this study was to compare the efficacy of intravenous dexmedetomidine with clonidine and placebo on sensory and motor blockade duration, and analgesia duration in patients undergoing lower limb surgeries under bupivacaine spinal anaesthesia. Methodology: A total of 90 ASA physical status 1 and 2 patients undergoing lower limb surgeries under spinal anaesthesia were randomized into three groups of 30 each in this prospective randomized controlled study. Group N (placebo group) received 10 ml of intravenous normal saline, group C (clonidine group) received 1μg/kg intravenous clonidine, whereas group D (dexmedetomidine group) received 0.5μg/kg of intravenous dexmedetomidine, all given 10min after administration of spinal anaesthesia with 15mg of 0.5% hyperbaric bupivacaine. Onset time and regression of sensory and motor blockade and duration of analgesia were recorded. Data was analyzed using analysis of variance or Chi-square test, with value of p<0.05 considered statistically significant. Result: Onset of sensory and motor blocks were similar across the groups, p>0.05. Duration of sensory and motor blocks were longer in dexmedetomidine group (295.7 + 37.3min and 307 + 29min), than clonidine group (187 + 13min and 229 + 31min) or placebo group (123 + 16.4min and 168 +20min), p<0.05. Duration to first postoperative rescue analgesia was longer in dexmedetomidine group (336.3 + 29.3min) as compared to clonidine (252.7 + 33.4min) and placebo(183.7 + 15.2min), p<0.05. Hypotension was significantly more in group D and group C as compared to group N, whereas other side effects were not significant and comparable among the groups.  Conclusion: Intravenous dexmedetomidine is superior to intravenous clonidine as an adjuvant to bupivacaine spinal anaesthesia for lower limb surgeries to prolong duration of sensory and motor blockade and duration of analgesia with similar side effects.

Background: Elderly in-patients are most usually affected by hyponatremia, a relatively prevalent electrolyte problem in clinical medicine [1-3]. It is recognised as occurring in 15–30% of hospitalised patients and is indicated by an s. Na+ level of less than 135 mEq/L. However, it has been noted that the occurrence rate in older people might reach 50% [3-5]. OBJECTIVES:

1. To classify severity of hyponatremia in hospitalized elderly and to correlate with outcome following treatment.

2. To study clinical feature and etiology of hyponatremia in elderly hospitalized patients.

Material & Methods: Study Design:  Hospital based prospective observational study. Study area: Department of General Medicine, Subbaiah Institute of Medical Sciences, Shivamogga. Study Period:  July 2022 – June 2023. Study population: Elderly patients (60 yrs and older) admitted in medical ICU Sample size: Study consisted a total of 100 subjects. Sampling Technique:   Simple Random sampling. All elderly patients admitted to medical ICU, 3-5 ml of venous blood was collected in a yellow top vaccutainer, and 5-10ml of urine (spontaneous void or catheter specimen) is collected in clean bottle. Routine blood and urine investigations as appropriate the diagnosis like, Complete blood count, renal function tests, electrolytes, liver function tests, urine routine, chest radiograph and other imaging studies as needed are done. When the electrolytes reports are available, patients are enrolled in the study if they are having serum sodium less than 125mmol/L and the plasma and urine sample are sent for measurement of serum osmolality and urine osmolality by freezing point depression osmometer. Serum electrolytes and urine spot Sodium are measured by ion sensitive electrode method. Results: Among the 80 patients who improved 50 were female and 30 were male. And among the 20 patients, who expired, 15 were male and 5 were female. This indicates that among the 45 male patients admitted 30 (66.67%) patients improved and 15 (33.33%) patients expired, and among 55 female patients 50 (90.91%) improved and 5 (9.09%) expired. Which shows though the severe hyponatremia is high among females the response to treatment and survival is better among females than compared to males (p=0.0026). Conclusion: Clinicians need to be aware about the common occurrence of hyponatremia in acutely sick elderly and early identification and adherence to standardized correction protocol is essential to avoid complications and to reduce mortality. Meticulous monitoring for dosing of multiple drugs in elderly population would help in preventing hyponatremia.

Background: Snakebite envenomation represents a prevalent and acute medical emergency of significant mortality in the Indian context. Farmers and agricultural labourers are the individuals who face the highest level of risk. Individuals employed in occupations such as bush cleaners, construction workers, scientists, and entertainers who come into contact with snakes face an elevated level of risk. Snakebite primarily affects individuals in rural areas and is commonly encountered as an occupational hazard among farmers and land workers. The timely administration of treatment can effectively address snake bites. The objective of this study was to assess the impact of snake envenomation on the cardiovascular profile. Method: This prospective observational study included a total of 200 patients, all of whom were over the age of 14 and had been diagnosed with snake bite. Patients with pre-existing conditions such as ischemic heart disease, diabetes, valvular heart disease, known history of cardiomyopathy, and deep vein thrombosis were excluded from the study. All individuals were subjected to a comprehensive assessment, including a physical examination, electrocardiogram, echo-cardiography, arterio-venous colour doppler study, and analysis of cardiac enzymes. Result: Total 200 cases had envenomation. Most common ECG manifestation showed sinus tachycardia 65% followed by 25% patients have normal ECG finding, 12% ST-T changes due to myocardial injury, 7% had bradycardia only 2% patients have noted A-V block.8).7Most of the echocardiographic findings are normal. Only 9% patients have global hypokinesia. Increase CPK-MB level seen in 5% cases. Increased troponin-I level seen in 12% cases. Conclusion: Cardiac complications are not commonly observed manifestations of snake bites, as the clinical presentation is typically characterised by predominant neurological, haematological, and vascular impairments caused by the snake venom. The predominant cardiac manifestation observed in electrocardiograms (ECGs) was sinus tachycardia, which could potentially be attributed to anxiety. This was closely followed by sinus bradycardia. Several patients exhibited myocarditic changes that were identified through consecutive electrocardiograms (ECGs). The elevation of CPK-MB levels has been observed in approximately 5% of cases. A 12% incidence of elevated troponin-I levels was observed. The prevailing echocardiographic observation indicated the presence of global hypokinesia.

Background: Neurofibromatosis type-1 (NF-1) is an inherited neuro-ectodermal disorder primarily defined by the presence of six or more café‐au-lait macules, intertriginous freckles, two or more neurofibromas, plexiform neurofibroma, lisch nodules, bony defects like sphenoid dysplasia, and optic gliomas. Due to gross cosmetic disfigurement and multisystem involvement, it can have heavy psychological and physical burdens, especially in countries like India, wherein skin disease is significantly stigmatized. Aim: The aim of the study was to understand various clinical and epidemiological patterns and complications of NF-1. Material and methods: We conducted a cross-sectional study on 47 clinically diagnosed patients with NF-1 at a tertiary care center in Bihar to understand various presentations and life-threatening complications in patients with Neurofibromatosis type-1. A detailed history was taken regarding onset, symptoms, family history, and associated co-morbidities. A comprehensive cutaneous, ophthalmological, neurological, and psychiatric evaluation was done. Ophthalmological screening via slit-lamp examination was done in all patients. Magnetic resonance imaging (MRI) was done in patients having neurological complaints and findings were subsequently analyzed. Results: A total of 47 newly diagnosed patients were enrolled in the study out of which 36 (76.6%) were males and 11 (23.4%) were females. The majority of patients belonged to the 40 to 49 years age group (29.78%) followed by the 30 to 39 years age group (27.65%). The mean age of total patients was 31.68 ± 13 years ranging from seven years to sixty-eight years. A family history of NF1 was positive in 22 patients (46.8%), with six (12.76%) patients reporting consanguineous marriage of their parents. All the cases of NF-1 presented with one consistent finding, that is, the prerequisite number and size of café au lait macules. The next most common presenting lesions were cutaneous neurofibromas and axillary freckling present in 38 (80.8%) and 26(55.31%) patients respectively. Plexiform neurofibroma was present in twelve (25.5%) patients. Clinical severity was assessed by DNB (dermatological, neurological, and bone manifestations) classification of Japan and the majority of patients (38.29%) were classified as Stage 3 followed by Stage 4 (23.4%). The most common ocular finding was lisch nodules, present in 28 patients. The most common neurological abnormality present was cognitive dysfunction (12.7%) followed by seizures (4.2%). Conclusion: Neurofibromatosis type-1 is a life-long neurocutaneous disorder with an extremely unpredictable clinical course. Although the majority of patients have a benign course, there’s a small subset of patients who develop debilitating and life-threatening complications. To provide optimal care, treating physicians must be aware of its diverse presentations and rare complications, so as to prevent them at comparatively earlier stages and prevent chronic disabilities.

Background: Renal artery stenosis (RAS) is a vascular condition associated with hypertension and renal impairment, necessitating early and accurate diagnosis for optimal patient management. While Doppler ultrasonography has been the conventional imaging technique for assessing RAS, its limitations have led to the exploration of alternative modalities like Computed Tomography Angiography (CTA). This study aimed to evaluate the role of CTA in diagnosing RAS and its correlation with Doppler ultrasonography findings.

Methods: A prospective observational study was conducted at the Department of Radiology, Rajendra Institute of Medical Sciences(RIMS), Ranchi, Jharkhand, from December 2021 to December 2022. The study included 100 consecutive hypertensive adult patients referred for suspected RAS. CTA and Doppler ultrasonography were performed on all patients, and the results were interpreted. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both modalities. Correlation between CTA and Doppler findings was analyzed using Pearson correlation coefficient.

Results: The study involved 100 participants (mean age: 58.5 ± 10.2 years, male: 58%, hypertension: 72%, diabetes: 35%). CTA demonstrated higher sensitivity (85.4%) and specificity (91.7%) compared to Doppler ultrasonography (sensitivity: 72.8%, specificity: 81.3%). The correlation coefficient between CTA and Doppler findings was 0.836 (p < 0.001), indicating a strong positive correlation.

Introduction: Renal Cell Carcinoma (RCC) is one of the most common cancers in this world. Partial nephrectomy (PN) leads to better preservation of renal function after surgery. The main purpose of PN is to preserve as much renal function as possible while still achieving negative surgical margins, all withinthe context of a low perioperative complication rate. Material & Methods: It is a Prospective observational study conducted in the urology department at the Medanta - The Medicity, Gurgaon, Haryana, over 24 months. Results: The average age of the patients was 44.86±13.23 years, ranging from 24 to 73 years. There was a slight male preponderance in the study (60%). HTN (28%) and T2DM (26%) were the most common comorbidities in the study.A correlation of the Ipsilateral PPPM in terms of actual and predicted levels (using the Renal score-based method) was done. It was seen that there was a strong positive correlation between the two parameters (r=0.6202) with a p-value of <0.0001. Conclusion: Our study is one of the first to explore the prediction of renal function in partial nephrectomy patients in the Indian subset of patients. We observed that the predicted preserved parenchymal mass (PPPM) levels correlated positively with the actual levels.

Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients. Methods: This is a prospective hospital-based study conducted in the Department of General Medicine of tertiary care hospital of central India. During study period 200 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India. Results: The mean value of total bilirubin was found to be 0.8 mg/dl in patients with dengue fever (DF), 0.96 mg/dl in patients with dengue hemorrhagic fever (DHF), and 1.08 mg/dl in patients with dengue shock syndrome (DSS). The mean value of aspartate aminotransferase (AST) was 77.44 IU/L in the dengue fever (DF) group, 112.32 IU/L in the dengue hemorrhagic fever (DHF) group, and 486.28 IU/L in the dengue shock syndrome (DSS) group. The average alanine aminotransferase (ALT) level in the DF group was 94.36 IU/L, while in the DHF group it was 386.42 IU/L. The average serum albumin levels were found to be 3.97 gm/dl in the DF group, 3.65 gm/dl in the DHF group, and 3.49 gm/dl in the DSS group. The average serum globulin levels were 2.98 mg/dl in the DF group, 2.86 gm/dl in the DHF group, and 2.69 gm/dl in the DSS group. The serum alkaline phosphate level exhibited an elevation in all groups under investigation. The mean value of ALP was found to be 118.46 IU/L in the DF group, 164.32 IU/L in the DHF group, and 342.42 IU/L in the DSS group. Conclusion: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.

Background: This study was conducted to investigate the role of probiotics as an adjunct to phototherapy in the treatment of neonatal hyperbilirubinemia, with regard to reducing phototherapy's duration and accelerating the rate at which TSB (fading of jaundice) falls when used as an adjunct. Methods: This was a hospital-based prospective case control study conducted among 110 inborn neonates with unconjugated hyperbilirubinemia admitted to the NICU, Department of Paediatrics, Gandhi Medical College, and Hospital, Secunderabad, from December 2019 to May 2021 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean TSB at inclusion was 19.14 ± 0.89 mg/dL vs. 16.89 ± 0.92 mg/dL in the case and control groups respectively (p<0.001). The mean duration of phototherapy was 3.93±0.85 days’ vs. 5.58±1.62   days in the case and control groups respectively (p<0.001). Hence, it was statistically significant. The mean TSB at 24 hours (17.88±1.15 vs. 16.17±1.11) (p value <0.001), 48 hours (15.36±1.90 vs. 14.74±1.67) (p-value 0.069) and at discharge (10.20 ± 1.84 vs 9.86 ±1.54) (p-value 0.308) in case and control group respectively. The rate of change of TSB among two groups at different time intervals (24 hours: 1.26±0.98 vs. 0.72±0.83 (p-value 0.002), 48 hours: 7.68±1.89 vs. 6.30±1.56 (p-value <0.001), and at discharge 8.94±1.82 vs. 7.03±1.53) was statistically significant. Conclusion: Hyperbilirubinemia is a common problem in neonates. An advantage was observed in the use of probiotic (Bacillus clausii) as an adjunct to phototherapy in the management of hyperbilirubinemia.

Background: Chronic Venous ulcer (CVU) is an ulcer on gaiter area persisting for more than six weeks and difficult to heal even after three months of treatment. The prevalence of CVU ranges from 0.18% and 1% and Standard therapy for CVU is multilayered bandages and treatment of incompetent veins to prevent recurrence. All adult patients having CVU, due to primary varicose veins were randomly allocated to two intervention groups (Group A- comprising of use of compression bandages along with treatment of varicose veins by Endovenous Laser ablation and Group B- Non usage of compression bandages after the aforesaid surgical intervention). Out of 60, total 30 (50%) cases were in each group. Quality of life and therapeutic outcomes were noted, and patients were followed for 6 months. Quality of life outcomes compared based on SF-36 questionnaire showed more improvement in group A in all 8 domains. Other parameters like use of analgesics, itching, eczema, and increased leisure activities were better with use of compression bandages. Healing of ulcer was faster in Group A. Charing Cross varicose vein questionnaire also showed more improvement in group A (p value<0.001, <0.001, 0.003   at 1 month, 3 month and 6 month, respectively). In chronic venous ulcer, four-layer compressive bandaging after surgery enhances the healing rate of venous  Dengue is an endemic disease in tropical and subtropical regions of the world causing severe epidemic in India and is endemic in many parts of India, especially in metropolitan cities and towns. There are evidences which states that platelet parameters may have diagnostic and prognostic value in febrile thrombocytopenia including Platelet count, Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT). These parameters are obtained as a part of Complete Blood Count using Automated Hematology analyzers. Aim and Objectives: of this prospective study is 1) To evaluate the role platelet parameters in Dengue fever and also to determine the relationship of platelet parameters with platelet count and disease severity. 2) to assess the utility of platelet profile in patients with Dengue fever and understand its significance so that adverse outcomes of this rapidly spreading disease can be controlled to a greater extent. Material and Methods: This study was conducted on 133 confirmed cases of Dengue infected patients for a period of 9 months from April 2022 to December 2022. The Platelet parameters like Platelet count, MPV, PDW and Plateletcrit were measured by using BC 300 plus Mindray Automated Hematology Analyzer on venous samples collected in K3EDTA from 133 patients and was compared with disease severity (DF/DHF/DSS) . These 133 patients were grouped into three according to platelet count (100000). Results: Out of 133 patients, 17 patients who had platelet count ulcer with better quality of life outcomes.

Background: One of the biggest clinical problems in paediatric treatment is still bronchiolitis. Young children (under 2 years old) are more susceptible to the lower respiratory ailment bronchiolitis, which is brought on by seasonal viruses such as RSV, Rhinovirus, Influenza, Adenovirus and others. It is the most common reason for young children to be admitted to the hospital and is associated with a high level of morbidity but a low fatality rate (1%). Each year, bronchiolitis affects 20% of newborns in the US and about 3% of those need to be hospitalised.

Objectives:

1. To study the clinico-epidemiological andmicrobiological profile of bronchiolitis in children.profile of bronchiolitis in children.

2. To assess the clinical outcome in hospitalised infants with bronchiolitis.

Background and Objectives: he objective of this current study was to assess the ultrasonographic characteristics of pelvic masses and establish correlations with histopathological diagnoses in patients who underwent surgical intervention. Materials and Methods: A cross-sectional prospective study was conducted in the Department of Obstetrics and Gynaecology, and Radiology The study cohort comprised 113 female patients who presented with symptoms indicative of pelvic masses. The final diagnoses were subsequently correlated with histopathological findings, with the cytohistopathology diagnosis considered definitive. Results: A total of 113 female patients underwent ultrasonography (USG) scans, in concurrence with a clinical history and examination of pelvic masses. The predominant age group was 40-50 years. The most frequently reported chief complaint among the female patients in our study was pelvic pain followed by a combination of pain and palpable mass. Menstrual irregularities, menorrhagia, post-menopausal bleeding, infertility, and amenorrhea were among the less common complaints presented by female patients in our study. Conclusion: Ultrasonography emerges as the foremost imaging modality for evaluating gynaecological masses. Proper differentiation between gynaecological and non-gynaecological masses on sonographic assessment is vital for precise patient management.

Background: Atherosclerosis is diagnosed, treated, and predicted using lipid profile testing. An increase in the fasting serum cholesterol, triglyceride, or both values is referred to as hyperlipidaemia. Diet, exercise, smoking, and some medications can all have an impact on lipid levels. A sedentary lifestyle is one that is prevalent in modern civilisations and is distinguished by spending the most of the day sitting either at work or at home.  It is thought to contribute to obesity and other illnesses. Objectives: To study and compare the TC, TG, LDL-C, VLDL-C and HDL-C in the sedentary adult females and active adult females. Material & Methods:  100 healthy individuals who worked at various banks, schools, colleges, government and non-government organisations, as well as housewives, made up the study's subjects. All of the participants were female and between the ages of 25 and 45. 50 randomly chosen volunteers with sedentary lifestyles and 50 subjects with non-sedentary/active lifestyles. During individual interviews, a validated, structured questionnaire was utilised to gather information on demographic, socioeconomic, lifestyle, and physical activity patterns. Results: In our study when compared to the normal, healthy lipid profile patterns in active adult females, the evaluation of lipid profile patterns in the sedentary subjects revealed hypercholesterolemia, hypertriglyceridemia as well as decreased HDL-C levels in them. Less active adult females had statistically significantly higher lipid profiles (P-value 0.001) than active adult females. Compared to active adult females who have normal, healthy HDL-C levels, sedentary adult females have lower HDL-C levels. Conclusion: As a sedentary lifestyle increases the risk of hyperlipidaemia, regular lengthier training sessions at a greater working intensity and a low-fat diet should be promoted to significantly lower blood lipid levels and other heart disease risk factors including hypertension and obesity.

Introduction: Treatment of bacterial infections has become complicated due to the emergence of multidrug resistant strains of gram negative bacilli. The multidrug resistant strains of gram negative bacilli causes multiple clinical infections and has become a rising problem globally. The metallo beta lactamases encoding genes are very sever in gram negative bacteria such as E.coli. Metallo beta lactamases are beta lactamase enzymes produced by pathogenic bacteria and gradually found in gram negative organisms Materials And Methods: This is a prospective, descriptive, Cross sectional, In-vitro laboratory based , single center study in the Department of Microbiology, Index Medical College, Hospital and Research center Indore. The isolates will be obtained from clinical specimens such as blood, urine, exudative specimens which included pus, wound swabs, eye swab, ear swabs, conjunctival swabs, cerebrospinal fluid, pleural fluid, peritoneal fluid, drain fluids and cerebrospinal fluid (CSF) and lower respiratory secretions (bronchial wash, endotracheal aspirates and sputum) and other relevant clinical material submitted to Microbiology Laboratory for Culture and Sensitivity testing.  Result: Among 210 isolates, 81 isolates were Acinetobacter baumanni, 30 isolates were Acinetobacter lwofii, 23 isolates were of other Acinetobacter sp. and 76 isolates were Pseudomonas aeruginosa. Among 210 isolates, majority were collected from male patient (160). In case of Acinetobacterbaumanni isolates, 50 were collected from male patients whereas 26 isolates were collected from female patients.In case of Acinetobacter lwoffi, 27 isolates were from male and only 03 isolates were from female. AmongAcinetobacter sp.08 isolates were from male patients and only 05 were from female patient. Similarly in case of Pseudomonas aeruginosa isolates, 65 were from male and 16 isolates from female patient. Conclusion: All the MBL positive isolates showed resistance towards aminoglycosides. In case of Pseudomonas aeruginosa Colistin was 100% sensitive and the next effective drug was Amikacin.In Acinetobacter the most effective drug was Tigecyclin(100% sensitivity) and the next effective drug was found to be Tobramycin and Gentamycin. In most of the MBL positive isolates Aztreonam was resistant. This can be attributed to the co presence of multiple mechanism of resistance in MBL positive isolates.

Introduction: The knee joint trauma is a significant cause of morbidity at young and active persons. An early and accurate diagnosis of the severity of injuries is essential for early conservative as well as for surgical management. It needs a precise history of trauma, a thorough clinical examination and diagnostic imaging. MRI and arthroscopy were the most widely used diagnostic modalities to assess the joint injury. Arthroscopy is invasive and may cause complications. Magnetic resonance imaging has now accepted as the best non-invasive imaging modality for evaluation of traumatic knee joint. Aim: Arthroscopy in conjunction with MRI evaluation of patients with knee trauma. Materials and Methods: A prospective cross-sectional study done over a period of 1 year 7 months between March 2018 to October 2019. 50 consecutive patients with suspicion of knee trauma were selected for the study referred with clinically suspected internal derangement of knee following trauma to the knee from the orthopedic department of KGH, Visakhapatnam for evaluation of traumatic knee. Results: The study population's average age is 36.5±14.2 years, with a minimum age of 18 and a maximum age of 60 years. MRI has sensitivity, specificity, PPV and NPV with respective to ACL is 95.35%,85.71%,97.62%,75% , for  PCL has all 4 100%, MM it is 96.30%,95.65%,96.30%,95.65%, LM it is 92.86%,97.22%,92.86%,97.22%.Overall stating a very good diagnostic tool in comparison with Arthroscopy. Conclusion: In the present studyMRI proved to be an excellent, non-invasive, radiation-free imaging modality with multiplane capabilities and excellent tissue delineation in comparison with invasive Arthroscopy. Thus, helping in arriving at a correct anatomical diagnosis thereby guiding further management of the patient.

Background: Pregnancy has a profound impact on the thyroid gland and its functions.  During pregnancy, the thyroid gland increases in size by 10% in iodine replete countries but by 20% to 40% in areas of iodine deficiency. Production of thyroid hormones and iodine requirement each increases by approximately 50% during pregnancy. Hypothyroidism in pregnancy is associated with significant obstetrical and fetal complications such as spontaneous or threatened miscarriage, anaemia, preeclampsia, preterm delivery, low birth weight, fetal growth restriction, placental abruption, postpartum haemorrhage, high perinatal mortality etc. This study is designed to evaluate the prevalence of thyroid dysfunction and its impact on maternal and fetal outcome in antenatal women attending antenatal clinic at a tertiary healthcare centre in Raipur, Chhattisgarh.  Objectives: To study the prevalence of thyroid dysfunction in antenatal women and the impact of thyroid dysfunction on maternal and fetal outcome. Material And Methods: This was a prospective observational study with 113 healthy pregnant women attending the ante natal clinic of the Department of Obstetrics and Gynaecology between 8 to 26 weeks of gestation during the time period of 1st November 2018 to 31st October 2019. Statistical analysis was done using descriptive and inferential analysis. To establish association tests namely chi square test, ANOVA test and odds ratio were used. Level of significance P value <0.05 that is 5% was considered as statistically significant.  Results: Out of 113 subjects 74.34% were euthyroid and 25.66 % had thyroid dysfunction in which 18.58% were subclinical hypothyroid, 6.19% were overt hypothyroid and 0.88 % were hyperthyroid. Abnormal maternal outcome was significantly higher (p=0.003) among subjects with thyroid dysfunction (58.62%) as compared to euthyroid subjects (30.95%). Abnormal fetal outcome was significantly higher (p=0.002) among anti-TPO positive hypothyroid subjects as compared to anti TPO negative hypothyroid subjects. NICU admission was needed by neonates of 47.05%   and 75% of subjects with subclinical hypothyroidism and overt hypothyroidism respectively (p=0.0013). APGAR score <7 at 1 min after birth was significantly higher (p =0.0322) in neonates of subjects with thyroid dysfunction (36.36%) as compared to euthyroid subjects (15.58%). Conclusion:  In India prevalence of hypothyroidism in antenatal women is much higher as compared to western countries.  Prevalence also varies widely through different regions in India. Our study revealed a high prevalence of hypothyroidism in Mowa, Raipur, Chhattisgarh state in India. With our study we would like to conclude that both overt and subclinical hypothyroidism in antenatal women is significantly associated with adverse maternal  and  fetal  outcomes and  therefore  needs to  be  monitored vigilantly  for  development  of  complications  and  timely  interference  to  improve  maternal  and fetal  outcome

Background: Exposure to secondhand smoke has no safe limit. Secondhand smoking contributes to significant health problems in India. Apart from cancer, exposure to secondhand smoke has been reported to be associated with several respiratory diseases (including asthma, respiratory infections such as bronchitis and pneumonia, wheezing, coughing), ear infections, sudden infant death syndrome, and slow fetal growth and lung development. However, the overall rates for smoking, including consumption of different tobacco products, including smokeless tobacco, are still high. Smoking is a common practice among many adults in Indian people generally have very low concerns regarding the adverse health effects of secondhand smoking.  This study aimed to determine the factors associated with exposure to secondhand smoke among subjects in households of rural India. Materials and methods: We used two measures of SHS: exposure to SHS at home and exposure to SHS in the workplace. SHS exposure at home is estimated for non-smokers who reported anyone smoking inside his/her home. Exposure to SHS in the workplace is estimated for non-smokers who reported anyone smoking in the workplace in the past 30days before the survey. Statistical techniques such as χ2 test, logistic regression and discriminant function analysis were used. Result: The prevalence of SHS exposure at home was 55.8%, where 13.3% of children lived with one smoker, while 50% of children lived with ≥2 smokers. There was a significant difference in the mean score of the combined cognitive tests between SHS-exposed and non-exposed children after adjustment for sex, parental educational level, family income and academic performance [Pillai’s Trace=0.084, F statistic (df)=6.803 (4302), p<0.001]. Conclusion: Current smoking and exposure to second-hand smoke among internal migrants in India is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors, such as focusing on divorced/widowed women.

Background: Irregular menstrual cycles are a prevalent concern affecting women worldwide, with a diverse range of underlying causes including hormonal imbalances and anatomical irregularities. Sonography has emerged as a powerful tool to investigate gynecological conditions, while hormonal imbalances and dermatological manifestations have been linked to menstrual irregularities. However, the correlation between these factors in women with irregular periods requires further exploration. Present study aimed to evaluate sonographic findings in patients presenting with irregular periods and subsequent correlation with hormonal levels and significant dermatological manifestations. Methods: This prospective observational study conducted at the Department of Radiology, Rajendra Institute of Medical Sciences(RIMS), Ranchi, Jharkhand. A sample of 200 women with irregular menstrual cycles in the age group of 18 to 45 years were recruited. Sonographic imaging focused on identifying anatomical irregularities, and hormonal assays measured estrogen, progesterone, FSH, and LH and TSH levels. Dermatological assessments examined acne, hirsutism, and abnormal pigmentation,  rashes and alopecia. Descriptive statistics, correlation analyses, and logistic regression were used for data analysis. Results: Sonographic findings revealed no abnormality in 24%, polycystic ovaries(PCOD) in 42%, uterine fibroids in 18% and endometriosis in 16% of participants. Hormonal analysis demonstrated positive correlations between LH/FSH ratio  and PCOD (r = 0.56, p = 0.011), positive correlation between estrogen and uterine fibroid(r=0.45,p=0.14), positive correlation between estrogen and endometriosis(r=0.24,p=0.12) and negative correlation between progesterone and endometriosis(r=-0.31,p=0.04). 31% of normal patients on sonography had elevated TSH levels. Dermatological manifestations of PCOD included acne (35%), hirsutism (47%), abnormal pigmentation (22%) and alopecia (11%) with some overlapping of findings. In endometriosis patients 20% had acne and 16% had rashes. No specific dermatological finding was seen in fibroid patients.  Significant correlations were observed between PCOD and dermatological conditions. Conclusion: The study underscores the importance of sonographic imaging in diagnosing irregular menstrual cycles and identifies potential associations between hormonal imbalances and dermatological manifestations. This integrated approach enhances understanding of irregular menstrual cycles, facilitating targeted treatment plans and improved patient outcomes.

Introducation: In the years between 1958 and 1993, the number of people diagnosed with Diabetes multiplied five – fold.1 In 1994, 135 million patients world – wide were living with Diabetes Mellitus. By the year 2025, it is estimated that this figure would increase to more than 300 million .2  Currently 25 million Indians have diabetes. The loss of a limb or foot is one of the most feared complications of diabetes and yet foot problems remain the commonest reason for diabetic patients to be hospitalized. Diabetic foot ulcers precede almost 85% of amputations.

Background: Diabetes mellitus is the most common endocrine disorder. It is a state of persistent hyperglycemia secondary to defects in insulin secretion, insulin action, or both. The development of Diabetes involves several pathogenic processes ranging from autoimmune destruction of the β cells of the pancreas resulting in absolute insulin deficiency, to other abnormalities that result in insulin resistance. The purpose of this study helps in recognition of the interdependent relationship between thyroid disease and diabetes and guides clinicians on the optimal management of both these conditions. Methods: This is a hospital based prospective study of 100 patients with type 2 diabetes mellitus admitted in the Department of General Medicine, SVRR Govt. General Hospital S.V.Medical college, Tirupati. Fasting and postprandial blood sugars HbA1C thyroid profile which includes t3, t4, TSH levels were measured. Results: Out of 100 patients, 77.0% of patients had normal thyroid function (i.e. Euthyroid). 16.0% of patients had subclinical hypothyroidism. 6.0% of patients had Hypothyroidism and 1% of patients had Hyperthyroidism. The mean ofHbA1C (1%) in patients with thyroid dysfunction was 9.00 (i.e. 1.74). The mean(SD) of HbA1C(1%) in patients with normal thyroid function was 8.78 (i.e. 1.52). This was statistically insignificant (P value 0.441). Conclusion: There was no significant difference between Euthyroid patients and patients with thyroid dysfunction in terms of duration of Diabetes and HbA1Cin the present study.

Background: Preterm premature rupture of membranes (PPROM) is the spontaneous rupture of the fetal membranes before the completion of 37 weeks of pregnancy. PPROM is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality. PPROM occurs in 3% of pregnancies. Aims and objectives: The present study was done to identify risk factors associated with PPROM and feto-maternal outcome in PPROM. Methods: The present study was single centered prospective comparative study. A total of 100 patients in each group that is GROUP A - 28 to less than 34 weeks of gestation and GROUP B- 34 to 37 weeks of gestation were selected for the study. Study was conducted from April 2019 to March 2020 in the Department of obstetrics and Gynecology, Nil Ratan Sircar medical college and hospitals, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: PPROM is mainly seen is in primigravida patients compared to multigravida. My study had 60% primigravida in Group A and 52% in Group B. There were no risk factors found in 74% patient in 28 to less than 34 weeks of gestation and 76% in 34-37 weeks of gestation. Most common risk factors in both groups was history of PPROM in previous pregnancy followed by malpresentation like Breech. Perinatal mortality includes stillbirth and early neonatal death which was 12% in Group A and 2% in Group B. Maternal morbidity was less in both groups. There was no maternal mortality. Chorioamnionitis was seen in 3 patients in Group A. Conclusion: Perinatal morbidity was mainly due to respiratory distress syndrome and prematurity in less than 34 weeks of gestation. Maternal morbidity was also increased mainly in lower gestational age group.  

Background and objective: Analysis of electrical burns to the upper extremities. Upper limb deformities caused by electrical burns are resurfaced using flaps that are tailored to the individual patient's situation. Methods: During the time period of March 2022 to January 2023, at the Department of Plastic Surgery, ASRAM Medical College and Hospital, Eluru, Andhra Pradesh, India, performed prospective research on a total of 25 patients with post electrical burn defects in upperlimbs with flaps. Result: When compared to electrical burns produced by lightning or higher voltages (>1000 volts), those caused by low-tension (1000 volts), mostly caused by domestic appliances, account for a disproportionately large number of visits to the emergency room. In all, 42 people have only had symptoms in their upper extremities, 22 in their lower extremities, and 16 in other parts of their bodies (scalp, face, neck, trunk, genitalia). One hundred and one people have been diagnosed with the condition affecting their upper limbs (42+22+16+21). Conclusion: The wrist and fingers are the most common places where soft tissues are injured. According to our findings, the groyne flap is the most often used flap, followed by the abdominal flap and the louvre flap. No unrestricted tissue swaps were done. The study population did not have any life-threatening complications, such flap failure.

Background and objective:  Incidence of twin pregnancy has grown from the past 20 years due to early detection by USG and increased use of ovulation inducing drugs and ART. There is significant risk of maternal and perinatal morbidity due to associated complications like re-eclampsia, anemia, premature delivery, malpresentations, PPROM in twin gestation. Active and timely intervention and strict vigilance helps in improving the maternal and perinatal outcome.  Methods: A prospective study was carried out from March 2021-December 2022 in the Obstetrics and Gynaecology Department at Siddhartha Medical College, Vijayawada, Andhra Pradesh, India. The study was approved by Institute Ethics Committee. 90 antenatal women with twin pregnancy more than 28 weeks attending antenatalop, labour ward were included. Results: Maternal complications most common is pre-eclampsia in 35.5% cases, anemia is seen in 30% cases, antepartum eclampsia seen in 3% cases, premature delivery in 70% cases, malpresentations in 53.6%, pph in 30%, postpartum eclampsia in 8.8%cases. Low birth weight is 62.2%, perinatal mortality rate is 6.32% and neonatal mortality rate is 4.87.Most common cause of neonatal death is prematurity with RDS. Conclusion: Early identification of twin gestation Chorionicity, is important to identify the twins at risk for complications. Good antenatal care, early detection of complications, timely intervention, and prevention of pre term labour, strict intrapartum care and good neonatal intensive care services reduces the maternal and prenatal morbidity and mortality to a significant extent.

Background: Postoperative nausea and vomiting (PONV) is a common complication following surgical procedures, impacting patient recovery and satisfaction. This clinical trial aimed to compare the efficacy of palonosetron and ondansetron for PONV prevention, considering their safety profiles, patient satisfaction, and perioperative outcomes. Methods: A prospective, randomized, double-blind, controlled clinical trial enrolled patients undergoing elective surgery under general anesthesia. Patients were assigned to receive either palonosetron or ondansetron. The primary outcome was the incidence of PONV within 24 hours postoperatively. Secondary outcomes included time to first nausea and vomiting, adverse events, patient satisfaction, postoperative pain scores, and time to ambulation. Statistical analyses were employed to assess the differences between treatment groups. Results: Among the 300 patients (150 per group), palonosetron demonstrated a significantly lower incidence of PONV within 24 hours compared to ondansetron (10.7% vs. 24.0%, p < 0.001). The palonosetron group exhibited a prolonged time to first nausea and vomiting (p < 0.001 for both). Adverse events were comparable between groups, and patient satisfaction scores trended higher with palonosetron. Postoperative pain scores were lower (p = 0.013) and time to ambulation was shorter (p = 0.029) in the palonosetron group. Conclusion: This clinical trial highlights the superior efficacy of palonosetron over ondansetron in preventing PONV during the immediate postoperative period. Palonosetron's extended antiemetic effect, coupled with favorable safety and patient-centered outcomes, underscores its potential as a preferred antiemetic choice. These findings contribute to evidence-based perioperative practices, enhancing patient care and recovery.

Introduction: Spontaneous preterm delivery, a composite perinatal and obstetric condition is the main source of perinatal morbidity and mortality. Regardless of latest management of neonates in the last centuries, a couple of trials recognized high-probability category who might have premature delivery and also to concentrate on perinatal results, yet premature delivery not decreased. Early detection of premature labour has been pursued as a means of reducing prematurity-related perinatal morbidity. Preterm labor is triggered by a number of mechanisms, similar to how parturition at term is triggered by a number of mechanisms. Asymptomatic bacteriuria, cervical incompetence, cervico-vaginal infections, uterine overdistension, uteroplacental insufficiency, decidual hemorrhage and other factors might cause them.  Materials And Methods: This is Hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynaecology in a tertiary care teaching hospital for a period of one year. The pregnant mothers coming under inclusion criteria are explained about the study and the ultrasound procedure. Consent for the procedure is obtained. Using ultrasonography, cervical length is measured and they are asked to come for follow-up after 3-4 weeks. These patients are subjected to follow-up till delivery and their gestation age at delivery and mode of delivery are noted. Transvaginal ultrasonography of cervix is the reference standard technique for accurate determination of dimensions and characteristics of the cervix. USG Machine - Mind Ray 2D Ultrasound with Transvaginal probe (Frequency - 7.5MHZ). Results: In the present study 47% were in 18 weeks of gestational age. About 21% were in 19 weeks of gestational age. About 15% were in 20 weeks of gestational age. About 13% were in 21 weeks of gestational age. Only 4% were in 22 weeks of gestational age. Mean gestational age is 20.56 and standard deviation is 2.24. About 47% had cervical length equal to or less than 2.5 cm. About 53% had more than 2.5 cm cervical length. About 72% were Normal vaginal deliveries. About 22% were LSCS deliveries. About 65% of the mother delivered Preterm, less than 37 weeks of gestational age. About 35% of the mother delivered at and more than 37 weeks of gestational age. About 36% were between 2.1 - 2.5 Kgs followed by 22% between 2.6 - 3.0 Kgs. 17% were <2 kgs. 16% were between 3.1-3.5Kgs. 9% were between 3.6 - 4.0 Kgs. Conclusion: Even if using predictors may not diminish the pace of premature birth, it does help us identify patients who are at risk and choose better treatment options. It likewise assists us to avoid overseeing preterm labor and treating it too aggressively. The use of Transvaginal ultrasonography to determine the cervix has the potential to help forecast the probability of preterm labor. Considering the severity of premature labor, the expense of managing premature babies, and the associated morbidity and mortality, the utilisation of cervical sonological estimation at 18 to 24 weeks as a standard screening strategy is practical and has great legitimacy as a successful screening test, and should be offered to all pregnant women.

Introduction: The aim of this study was to demonstrate the quicker onset of sensory and motor blockade, increased duration of postoperative analgesia and lesser incidence of tourniquet pain following addition of dexmedetomidine to lignocaine compared to lignocaine alone in IVRA for upper limb surgeries. Methods: A randomized prospective study conducted in 60 ASA grade I and II patients, of either sex, between 20-60 years, scheduled for either elective or emergency surgeries of upper limb were included in the study. All patients were divided into two groups by computer generated randomization of 30 each, into group A and group B. Group A received 3mg/kg lignocaine diluted with saline to a total volume of 40ml with dexmedetomidine 0.5 microgram/kg added as an adjunct. Group B received 3mg/kg lignocaine diluted with saline to a total volume of 40 ml.  Pain score was evaluated using visual analog scale (VAS) of 0 to 10. Sensory and motor block onset and recovery times, onset of tourniquet pain, time to first analgesic requirement was noted. Result: Both groups are comparable with demographic details ie age, gender are weight. type and duration of surgery are insignificant  in between groups. Sensory, motor  blockade onset time are significantly less in lignocaine and Dexmedetomidine added groups. Sensory blockade recovery time and motor recovery time after the release of tourniquet was significantly longer Group A than for Group B (2.53 ± 0.51 minutes) which is statistically significant with a ‘p’ value of 0.0001. VAS reached a score of 3 at 416.2 ± 45.73 minutes in Group A and at 33 ±  0.96 minutes in Group B. This difference was statistically significant with a ‘p’ value of 0.0001. In group A, 7 cases had a sedation score of 1 and 23 had a score of  2. In group B, 30 cases had sedation score of 1.  Conclusions: Dexmedetomidine 0.5micrograms/kg   is   added   to   lignocaine   for Intravenous regional anesthesia, it provided   quicker onset of sensory and motor blockade, lesser   incidence of tourniquet pain, increased   duration of post operative analgesia and better haemodynamic stability.

Objective: To study the incidence and outcome of cardiac manifestation in Acute febrile illness(AFI) with Dengue/ Leptospirosis/ Malaria/ Swine flu and to correlate organ dysfunction and mortality. Methods: This was a prospective observational study that included 187 AFI patients with laboratory confirmed Dengue/ Leptospirosis/ Malaria/ Swine flu admitted in tertiary care center. Demographic data, clinical presentation, investigations and outcomes were collected and analyzed. SOFA(Sequential organ failure assessment) score was used to assess outcome in patients with cardiac manifestation. Results: Total of 187 patients were included in this study. Mean age of patients was 26.5 years(SD8.4), 143(76.4%) were males and 44(23.5%) were females. 122 patients(65.2%) had ECG changes, out of which 86 patients(45.9%) had sinus tachycardia and rest 36 patients(19.2%) had ST-T changes or rhythm abnormalities. Of these 36 patients, 11 patients(5.88%) had 2D-Echo changes of hypokinesia and 27 patients(14.4%) had raised CPK-MB levels. 1 patient(0.5%) had LV hypokinesia without ECG manifestation. Mortality was higher among sinus tachycardia and additional ECG changes compared to sinus tachycardia alone(25% vs 3.4%,p<0.001). SOFA score >6 at zero hour and its increasing trends compared to decreasing or same trend predicted mortality(55.5% vs 1.85%,p<0.001). Conclusion: Incidence of cardiac manifestation in our study was 65.7% with 6.42% mortality. Sinus tachycardia is most common ECG manifestation. Mortality correlates better when Sinus tachycardia co-manifests with additional ECG changes. SOFA score >6 at zero hour has good mortality prediction as determined by the ROC (Receiver operative characteristic) curve. Increasing trends of SOFA score predicts mortality better than single initial score.

Background- Additionally, the prevalence of prediabetes in India ranged from 10% to 14%, which is higher than the global prevalence of 8%. Dyslipidemia, characterized by elevated levels of low-density lipoprotein cholesterol (LDLc), elevated tri-acylglycerol (TG), and decreased levels of high-density lipoprotein cholesterol (HDLc), is linked to an augmented risk of cardiovascular disease (CVD). Consequently, the timely identification and management of dyslipidemia can significantly contribute to the prevention of cardiovascular morbidity and mortality. Methods- This is a Prospective observational cohort study, A total of 240 patients from Outpatient department (OPD) and Indoor patient (IPD) department of Medicine, Dr. Baba Saheb Ambedkar Medical college and Hospital, New Delhi, were taken for study considering the inclusion and exclusion criteria. The data was collected in a pre test proforma which includes various socio-economic parameters like age, sex, occupation, religion, etc Results - The mean age of participants was 53.020+-16.5 years, and mean BMI of 24.555±12.8 kg/m2. All patients, exhibited total cholesterol levels that fell within the range considered to be normal following the administration of the prescribed therapy. The mean total cholesterol level recorded was 141.2mg/dl. In the study, it was observed that 75% of the participants experienced a reduction in their cholesterol levels. On the other hand, a small percentage of 1.25% showed an increase in their cholesterol levels. Additionally, 23% of the participants demonstrated no significant change in their cholesterol levels, with a margin of error of plus or minus 10mg/dl, when compared to their baseline measurements. Conclusion- There was a notable enhancement in the average values (moving closer to the normal distribution) of each lipid profile parameter over time. The findings of the study indicate that the utilization of metformin resulted in improvements in lipid parameters.

Introduction: Early detection and treatment of dysglycemia including diabetes and pre- diabetes is demonstrated to improve disease outcomes and prevent complications. Material and Methods: This is a Prospective observational cohort study, A total of 240 patients from Outpatient department (OPD) and Indoor patient (IPD) department of Medicine, Dr. Baba Saheb Ambedkar Medical college and Hospital, New Delh. Anthropomorphic measurements, demographic and clinical information were taken, and blood pressure was measured. Fasting blood sample was obtained for the measurement of plasma glucose (FPG), glycated hemoglobin (HbA1C), and lipid profile. Plasma glucose was estimated 1 hr after the ingestion of 50 g glucose (1h-OGTT). Prediabetes and dyslipidemia were defined according to international guidelines.  Results: A total of 240 individuals were included with a mean age (±SD) of 53.020+-16.5 years, mean BMI of 24.555±12.8 kg/m2. The initial lipid parameters of the participants were analyzed. It was found that 77% of the individuals had baseline total cholesterol levels within the normal range, with a mean value of 170.8mg/dl. Additionally, 85% of the participants had baseline HDL levels within the normal range, with a mean value of 41.9mg/dl. At baseline, 50% of the participants had normal LDL levels, while the other 50% had abnormal LDL levels, with a mean value of 100.6mg/dl. Furthermore, 94% of the participants had baseline VLDL levels, with a mean value of 22.2mg/dl. Lastly, 89.5% of the participants had baseline TG levels within the normal range, with a mean value of 100.75mg/dl. Conclusion: Even though high LDL-C is associated with prediabetes, a recommendation for universal screening of prediabetes patients requires further cohort studies.

Background and Objectives: The purpose of this study is to use contrast-enhanced computed tomography to categorize individuals with acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis according to the updated Atlanta classification, and to describe the kind of collections in these patients. After that, we'll determine how severe it is using the new Atlanta categorization. And using the BISAP clinical rating system, discuss the disease's clinical progression and severity. Ultimately, we hope to link these observations to improved patient care. Materials and Methods: The study period began June 2022 to May 2023, conducted at the Department of Radiodiagnosis, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Hyderabad, India. This prospective observational study took place in a hospital setting.  The sample size for this study was 200 patients. Primary data was obtained by the investigator from patients diagnosed with acute pancreatitis and admitted to the surgery or medicine wards at our hospital for CT scans.  Results: Patients in our study group tended to be male, and alcoholism was the leading cause of their condition. In addition, interstitial edematous pancreatitis and mild acute pancreatitis accounted for the vast majority of cases. They achieved favorable clinical outcomes with a BISAP score of less than 3. Acute necrotizing pancreatitis and interstitial edema were both classified as moderately severe. Necrotizing pancreatitis was the most common kind of the severe acute form. Clinical outcomes were unsatisfactory for the majority of these individuals. Grades in the moderately severe range lie between the mild and severe varieties. Clinical result was found to correlate positively with BISAP rating, and the updated Atlanta categorization. Conclusion: Acute pancreatitis imaging results can now be more uniformly described and recorded in clinical practice according to the new Atlanta classification system. Acute pancreatitis patients can now be more accurately triaged, predicted, and treated thanks to the integration of the new Atlanta classification and BISAP clinical grading.

Introduction: Lung cancer is the leading cause of cancer related death worldwide and accounts for 28% of all cancer mortality and around 1.8 million new cases were diagnosed in 2012. The morphological distinction between pulmonary adenocarcinoma (ADC) and squamous cell carcinomas (SCC) is sometimes difficult, mainly in cases of poorly differentiated tumors or when degenerative changes, necrosis and crushing may obscure the cell characteristics. p63 is a homologue of the p53 tumour suppressor gene that is responsible for proliferation and differentiation of epithelial progenitor cells. p40 is consistently the predominant isoform expressed in squamous cell carcinoma; thus, it offers improved specificity for diagnosing squamous cell carcinoma.  Materials And Methods: This is a prospective and observational study conducted in the Department of Pathology, Tertiary care Teaching Hospital over a period of 1 year. Primary lung carcinoma cases included with unequivocal morphological diagnosis irrespective of age, gender and nature of biopsy material (endoscopic biopsy/ needle core biopsy / resected specimen). Cases diagnosed as Small cell carcinoma of lung, as metastatic lung cancers, poorly differentiated NSCLC-NOS and with inadequate material for IHC study were excluded from present study.  Results: In the present study, a total of 150 patients were included out of which 112 (74.6%) were males and 38 (25.4%) were females. In our study, most of the patients were >61 years i.e., 63 out of 150 (42%), followed by 51-60 years, i.e., 40 out of 150 (26.7%). All 8 cases of well differentiated Adenocarcinoma were positive for P40 and 5 cases showed P63 expression. Out of 13 cases of moderately differentiated Adenocarcinoma, 3 cases were positive for P40 and 10 cases were positive for p63 marker.  Out of 30 cases of well differentiated Squamous cell carcinoma 15 cases were P40 positive and 15 cases were P63 positive.  All 53 cases of moderately differentiated Squamous cell carcinoma showed positive P40 and P63 expression.  Conclusion: We conclude that strong and diffuse p40 expression is seen in majority of lung squamous cell carcinomas and absence of p40 expression in most of the lung adenocarcinomas. Expression of p63 is similar to that of p40 in lung squamous cell carcinoma, but there was variable p63 immunoreactivity in lung adenocarcinoma. In Moderately differentiated cases, a two-panel approach of p63 and p40 help to distinguish adenocarcinoma from squamous cell carcinoma. Thus, p40 is an excellent marker for distinguishing lung squamous cell carcinoma from adenocarcinoma and that its expression is equivalent to that of p63 in lung squamous cell carcinoma.

Background- Anatomical variations in the hepatobiliary system are usually asymptomatic. However, it is very important to know the anatomy to avoid unwanted complications during surgery and in the postoperative period Materials and methods:- 80 patients with cholecystitis who presented to the department of surgery, KIMS, Narketpally, who underwent laparoscopic cholecystectomy, were included in this prospective study. Results: - Out of the 80 patients, variable anatomy of the biliary system and vascular system was found in 20 patients, of whom, 15 had variations in the biliary system and 5 patients had variations in the vascular system. 3 patients with variable anatomy developed complications. 6 patients had to be re-explored by conversion into open cholecystectomy due to frozen Calot’s triangle. Conclusion:- Variations in biliary anatomy and vascular system are diverse. Few such variations were confirmed with this study, thereby implying the need for in-depth knowledge about congenital anomalies of the biliary system.

Objective: To compare the levels of microRNA (miRNA) 24 levels in diabetic patients with acute coronary syndrome (ACS)with non-diabetics suffering from ACS. Methodology: A prospective case-control study was carried out among 40 patients with ACS residing in Belagavi, Karnataka, South India. Patient characteristics based on demographics, ACS related information and treatment, biochemical parameters, and miRNA-24 levels were compared between diabetics and non-diabetics. Finally, miRNA-24 was evaluated for effectiveness as a clinical biomarker for CAD severity in ACS pateints in both the groups. Results: The majority of patients were males between the age group of 18 and 77 years living in urban areas with physical activities restricted to NHYA class 2.  A significant level of differences was found between the cases and controls inpatient characteristics such as duration of diabetes diagnosis, treatment of diabetes, family history of diabetes, comorbidities, random blood sugar and HbA1c. Within the levels of miR-24 also, significant variation was observed between the diabetics and non-diabetics. The ROC analysis for evaluating the efficiency of miR-24 as a clinical biomarker for diabetic patients with ACS was established.  Conclusions: The control (non-diabetic) group showed significant CT values of miRNA-24 compared to diabetics, suggesting an up-regulation of mi-RNA and thereby may play a protective role of miRNA-24 in these patients. Moreover, the ROC analysis for fold change in miRNA-24 level in diabetic patients with ACS was found to be significant, suggestive of a possible link between expression of miRNA-24 and glucose levels. Therefore, the current study supports the use of miRNA-24 as a prognostic marker inACS outcome.

Introduction and Background: Since it is the second most frequent cancer in males, and the second leading cause of cancer-related death, prostate cancer is a key focus of healthcare research and development. Traditional methods of assessing prostate cancer relied on digital rectal examinations and PSA levels because of the prostate's inconvenient position. Material and Methods: 20 patients with high PSA levels and aberrant DRE results who were sent to our clinic were analyzed. From December 2021 to November 2022, at Mahavir institute of Medical Sciences, Vikarabad, Telangana, researchers gathered data. All patients provided informed consent after having potential biopsy consequences outlined to them. Antibiotics were provided as a preventative measure before the operation.  Results: In our prospective study, 20 patients with abnormal digital rectal examination and elevated PSA levels underwent transrectal real-time strain elastography, transrectal ultrasonography, a systematic 12-core biopsy, and additional targeted biopsies from abnormal areas found by transrectal real-time strain elastography and transrectal ultrasound. The interpretations from each of these techniques were contrasted with the histopathological diagnosis. Conclusion: This research shows that compared to ultrasonography, elastography is more sensitive to the presence of malignancies and has a strong negative predictive value, both of which aid in avoiding unnecessary biopsies. Elastography and ultrasonography together improve cancer detection by pinpointing malignant tumors and facilitating guided biopsies.  

Background: Patient Satisfaction, which is viewed as a significant indicator of quality of care, can be defined as fulfillment or meeting of expectation of a person from a service or product and has been receiving greater attention as a result of rise in pay for performance. It is an important and commonly used indicator to measure the quality of care that can contribute evaluation of structure, process and outcome of services. Patient satisfaction is a subjective phenomenon. It is also a multidimensional aspect as, many factors contribute directly or indirectly to patient satisfaction including accessibility and convenience of services, institutional structure, interpersonal relationships, the competence of health professionals and patient expectations and preferences. Patient satisfaction is an important and commonly used indicator to measure the quality of care that can contribute to a balanced evaluation of structure, process and outcome of services. So patient satisfaction has become a high priority to hospitals and health plans across the country, because of its impact on patient loyalty, the hospital’s reputation, perception of quality of care, employees’ dissatisfaction and retention of a hospital’s bottom line. Materials And Methods: It is a hospital based prospective study; the research was carried among 120 randomly selected patients who were admitted in the department of General Medicine, GGH, Srikakulam, a tertiary care teaching hospital. The study is conducted through the collection of primary and secondary data. Results: A total of 120  patients were included in the study of which 68 (56%) were males, 52 (44%) were females.56% in 15-45 years age group, 26% in 45-60 years, 18% in more than 60 years, and the level of patient satisfaction of various factors like time taken for admission is good as 45%, excellent staff friendliness 17%’ excellent timely discharge process as 20%, excellent doctor care as 46%, excellent dietary services 26% etc. Conclusion: Feedback of patients is one of the key parameters in assessing the quality of hospitals. The feedback results showed that most of the patients were satisfied with most of the services in Hospital under study and the doctor’s care and nursing services have the highest satisfaction level, which is very satisfactory and encouraging but there is always a scope for improvement. More than 85% of the patients rated most of the parameters as good or excellent.

Background:  The diagnosis of immune thrombocytopenia (ITP) is one of exclusion. Immune-mediated rapid platelet breakdown and decreased platelet production are its hallmarks. ITP can appear as a main (separate) condition or as a secondary condition in the context of other illnesses such autoimmune conditions and infections. Material & Methods: Study Design: A prospective and retrospective hospital based observational study. Study area: Department of Pathology, Government Medical College, Kadapa, Andhra Pradesh. Study Period: 1 year.  Study population:  The samples for the present study were collected from various clinical departments and wards like Medicine, Pediatrics, MICU and PICU. Sample size:  The study consisted of 60 cases. Study tools and Data collection procedure: Clinical history was collected from the patients and medical record files. Physical examination of the patients was done to see the clinical manifestations of the disease and to exclude other possible causes of present symptoms. Laboratory studies were conducted to diagnose Idiopathic Thrombocytopenic purpura. Blood was collected using standard phlebotomy procedures. Blood sample was processed in9 automated Hematology cell counter. Platelet count, Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) values were taken from the counter reading. Peripheral blood smear examination was done for all cases to look for thrombocytopenia lymphocytosis, eosinophilia and presence of blasts. Bone marrow aspiration/biopsy studies were done on selected patients to exclude other known causes of thrombocytopenia like those associated with leukemia, myelodysplasia etc. Indirect Immunofluorescence evaluation of presence of antiplatelet antibodies was performed in selective cases. Results: The most common presentation was with petechiae observed in 23 cases (39%) followed by ecchymoses (11cases,18%), epistaxis (09 cases,15%), hematuria (07 cases,12%) melena (05 cases,8%) and menorrhagia (05 cases,8%). Major serious hemorrhage like intracranial bleeding or hemopericardium was not seen. Conclusion: The majority of youngsters present with an abrupt onset of symptoms and a history of an earlier infection. Women who are childbearing age are the majority of those with chronic ITP. Isolated thrombocytopenia is the defining feature of ITP, and the presence of anaemia or neutropenia should raise the possibility that another illness may be the origin of the low platelet count.

Background:  The shoulder is a ball and socket joint made up of the humeral head (ball) from the upper arm, and the glenoid (socket) from the shoulder blade (scapula). Dislocation occurs when the ball is wrenched out of its socket. The force required Present study was done to compare the effectiveness i.e. range of motion and incidence of failure rates, recurrence and pain of arthroscopic repair versus open surgical techniques for the management of recurrent anterior shoulder instability. Materials and methods: This is a prospective and comparative study was conducted in the Department of Orthopedics at Surabhi Instittute of Medical Sciences among 70 patients. Inclusion criteria were patient with soft tissue Bankart’s lesion, bony Bankart’s lesion, humeral avulsion of glenohumeral ligament (HAGL), anterior labral posterior sleeve avulsion (ALPSA), glenoidlabrum and articular disruption and capsular stretch and injury. Patients having associated rotator cuff tear, habitual dislocators, and high-risk groups (bone loss, contact athletes) were excluded. Result: in our study time of surgery was significantly longer in the arthroscopic surgery group than the open surgery group (P < 0.05). Intraoperative blood loss was significantly more in the open surgery group than the arthroscopic surgery group (P < 0.0001) and total time of hospital stay was significantly more in the open surgery than the arthroscopic surgery group (P < 0.05). Total 3 patients were seen in open surgery, complications such as wound infection and nerve injury. VAS pain scores after the surgery was significantly higher in the open surgery group than the arthroscopic surgery group (P > 0.05). Conclusion: The available evidence does not show a statistically significant difference in outcome measures between arthroscopic and open repair for the treatment of recurrent anterior shoulder instability. Given the similar results between the 2 groups, differences in length of hospital stay and cost to the patient and society point to arthroscopic repair as the more judicious treatment approach.

Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Aims and objectives: Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers in a tertiary health care hospital in West Bengal, India. Methods: Our study was a retrospective record study. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at Dept of G&O, N.R.S. Medical College and Hospital, Kolkata, West Bengal, India from November 2018 to November 2022. Statistical data were analysed by using SPSS V.20 software. Results: Most common age group of the mother found to 19-25 years 10 (43.5%). Gravida 1 was 11 (47.8%), followed by gravida 2 was 8 (34.83%). IUFD was 1 (4.3%), preterm was 7 (30.4%), SA was 2 (8.7%), term was 12 (52.2%) and neonatal death was 2 (8.7%). Associated Haematological Disorder of B Thal Trait and HbE Carrier was 3 (10.3%) each. Platelet Count during AN Period as <49000 was 13 (56.5%) and 50000-99,999 was 10 (43.5%). Myasthenia gravis during pregnancy was 7 (30.4%), Methylprednisolone was 3 (13.0%), thyroid disorder was among 5 (21.7%). Conclusion: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in foetus.

Background: The frequency of healthcare-associated infections (HAIs), which can affect up to 15% of hospitalized patients and 9%-37% of patients referred to intensive care units (ICUs), is a significant issue for the healthcare system.1 Healthcare organizations must prioritize HAI prevention.2-5 Effective infection prevention and control (IPC) depends on healthcare workers knowledge of infection control (IC) practices, and poor knowledge and awareness among HCWs have been associated to deteriorating healthcare delivery results. Objectives: To assess the knowledge, attitude and practices of infection control practices followed by nurses in their day to day procedures in Government General Hospital Vijayawada. Material & Methods: Study Design: A prospective hospital based descriptional study. Study area:  Government general Hospital Vijayawada. Study Period: February 2023 – July 2023. (6 months) Study population:  Staff nurses who are working in all wards of Government General Hospital Vijayawada. Sample size:  The study consisted of 91 subjects. Sampling method: Simple random technique. Study tools and Data collection procedure: A direct method approach was employed, consisting of a cross-sectional survey through questionnaire in Google sheets. The survey questionnaire was distributed among a representative sample of nurses across various departments within the hospital. The survey encompassed questions related to knowledge of IPC guidelines, hand hygiene practices, personal protective equipment (PPE) utilization, environmental cleaning routines, and perceptions of organizational support for IPC. Results: With regard to indications for hand rub, 51.6 % staff nurses opted and agreed that when your hands are not visibly soiled which is the correct answer and 27.5 % answered instead of traditional handwashing (20 sec) ,16.5% answered that instead of surgical hand washing (3min), remaining 4.4% answered when your hands are visibly soiled. Overall KAP status of the study population was excellent in 53.8%. 46.2% of the study population were having good KAP status. No subjects were in the group of average or poor KAP status. Conclusion: The largest difficulty in any hospital is infection prevention and control, and nurses' knowledge and understanding of this topic must be improved if it is to be successful. To increase understanding and compliance with IC practices, a multimodal strategy should be used, including training, feedback, and ongoing education programmes.

Background: Numerous unfavourable outcomes for newborns are linked to foetal and neonatal acidemia.1–7 Low Apgar scores, respiratory distress syndrome, hypoxic-ischemic encephalopathy, convulsions, intraventricular haemorrhage, sepsis, and death are some of these outcomes.1–7 Understanding the mechanisms underlying these results and the period of the injury can have significant medico-legal repercussions.

Objectives:

1. To assess the relationship between umbilical cord blood (arterial andvenous) analyses and perinatal risk factors in pregnancy.

2. To assess the relationship between umbilical cord blood pH and Apgar score in high risk group of pregnancy.

Material & Methods:  Study Design: Hospital based prospective observational study. Study area: Department of Obstetrics & Gynecology, in a tertiary care teaching hospital.  Study Period: Jan 2022 – Dec. 2022. Study population:  All pregnant ladies who presented in labor to maternity ward, in a tertiary care teaching hospital. Sample size: Study consisted a total of 192 subjects. 192 pregnant ladies who presented to labor ward, in a tertiary care teaching hospital. At the time of admission, they were assigned to high or low risk group according to whether or not they had any perinatal risk factors. High risk pregnancy is defined as the mother who is at risk to deliver a neonate with birth asphyxia according to the definition by American Academy of Pediatrics. All normal vaginal and cesarean section deliveries included in this study were chosen in accordance with this definition. Sampling Technique:  Simple Random technique.

Results: Apart from the study proving the statistical difference in the high risk and low risk groups in various cord blood parameters; it also compared the cord blood pH with the Apgar score to find any correlation between them. Pearson correlation was used to define the correlation. In the low risk group, neither arterial nor venous pH was statistically related to Apgar score. In high risk group, a statistically significant correlation was established between Apgar at 1 minute and the arterial and venous pH.

Conclusion: The results of this study indicate that umbilical cord blood analysis might be useful predictors of fetal asphyxia at delivery. Our study highlights a correlation between the presence of perinatal risk factors and umbilical cord pH in high-risk mothers. So we recommend assessing the umbilical cord pH in any mother who has a perinatal risk factor in her history or physical examination. Their potential role as a tool for predicting the prenatal outcomes should be evaluated in subsequent studies.

Background: Chronic venous Insufficiency (CVI) is a commonest condition encountered in clinical practice that occurs due to venous valvular dysfunction in the superficial, deep, and/or perforating veins. The spectrum may vary from common varicose veins to more severe deep vein thrombosis and resulting local and systemic complications. Duplex ultrasonography plays vital role in understanding the spectrum of CVI.  Objectives: To evaluate the spectrum of colour duplex ultrasound findings in patients with chronic venous insufficiency clinical symptoms and signs.  Material & Methods: A prospective observational study was conducted in the department of Radio diagnosis of a tertiary care hospital. for a period two years. The study included 50 participants presenting with symptoms of pain, swelling, pedal oedema varicosities, erythema, and venous ulcer were included. In addition to detailed clinical assessment and review of past medical records,  Doppler ultrasonography of lower extremities was done. Results:  Age of the participants ranged from  11-70 years and 70% of participants were males. Among 50 participants 44 (88%) were positive on Doppler. In our study primary varicosities were seen in 29 cases ( 65.91%). Varicosities secondary to DVT were seen in 13 cases ( 29.55%), congenital causes were rare as noted in 2 cases (4.54%) of the total positive Doppler study cases. Swelling (36%) was the most common presenting symptom, followed by varicosity (20%). Prolonged hospitalization 5 (38.46%) is the major predisposing factor in patients with DVT. At least one perforator incompetence was seen in 42 (95.45%) cases. Below knee perforators seen in 30 (68.2%) cases, mid-calf perforators were involved in  26 (59.09%) cases and above ankle perforator incompetence was observed in 27(61.36%) cases. There was no statistically significant difference in the pattern of veins affected between male and female participants (P= 0.580). Conclusion: The colour duplex sonography is a safe, non-invasive, accurate, easily repeatable, economical, and widely available modality in the diagnosis of venous insufficiency and excludes underlying DVT, thus helping in providing valuable insights for the treatment of the patient.

Background: The most frequent electrolyte imbalance seen in clinical practise is hyponatremia, which is characterised by a serum sodium concentration ([Na+]) 135 mEq/L. Mild hyponatremia—serum [Na+] 130–135 mEq/L—occurs in up to 30% of hospitalised patients. [1,2] Acute severe hyponatremia is known to produce cerebral oedema, which can have serious neurological effects. If it is not properly detected and treated, it can be fatal. [3]

Objectives:

1. To study the incidence of hyponatremia in hospitalized adult patients in medical wards.

2. To determine the etiology of clinically significant hyponatremia in 100 patients in medical wards.

3. To determine the clinical presentation of hyponatremia in these patients.

Material & Methods: Study Design:  Hospital based prospective observational study. Study area: Bapuji Hospital & Chigateri Hospital. Study Period: April 2022 to March 2023. Study population:  Patients admitted in  Hospital medical wards with serum sodium less than 130 mmol/L. Sample size: Study consisted a total of 100 subjects. In the hospital, all the patients, as routine, blood samples were taken and serum electrolytes were done in central biochemistry laboratory. The records were followed up for patients with hyponatremia and values repeated once for confirmation. A standard proforma was used to record to detailed history of present complaints, past history including diabetes mellitus, systemic hypertension, Ischemic heart disease, dyslipidemia, neurological, chronic kidney disease / renal disease, regulatory and endocrine problems. A detailed drug history was also recorded.

Results: 67 patients had some neurological symptoms of hyponatremia due to cerebral edema like nausea, vomiting, giddiness and altered sensorium. 14 patients presented with seizures. The lower the sodium value, the higher the incidence of symptomatic hyponatremia. The incidence of symptomatic hyponatremia is more with lowering sodium levels which is statistically significant. All patients with severe hyponatremia had symptoms.

Conclusion: Symptomatic hyponatremia is common among the hospitalized patients. Neurological symptoms are common in hyponatremia patients. SIADH and euvolemic hyponatremia formed the largest subgroup in the study. Drugs, especially diuretics, are a common cause of hyponatremia. A relatively large number of patients had endocrine abnormalities (thyroid, adrenal and pituitary). The mortality was about 10%. It was mainly due to underlying primary diseases. Older age groups had more incidence of hyponatremia. Symptoms of hyponatremia increased with severity of hyponatremia.

Background: This study embarked on a critical analysis of the morphological and biochemical characteristics of the gall bladder in individuals diagnosed with gallstones, aiming to extend the understanding of gallstone pathogenesis.

Methods: A prospective study was conducted at the Dr. B. S. Kushwah Institute of Medical Sciences, where participants were recruited to undergo detailed analyses, including histopathological examinations, biochemical analysis of bile, microbial analysis, and imaging analysis.

Results: The study identified a significant presence of cholesterol gallstones (70%) in the population, with a high incidence of gallbladder inflammation (75%) and chronic cholecystitis (70%). The biochemical analysis revealed elevated levels of cholesterol (mean 5.2 mmol/L) and bilirubin (mean 17.3 µmol/L) in the bile. Furthermore, a notable presence of Firmicutes (90%) and Bacteroidetes (75%) was observed in the microbial analysis, indicating a potential correlation with gallstone formation.

Conclusion: Our study underscores the chronic nature of gallstone disease, highlighting the role of bile composition and microbiota diversity in its pathogenesis. The findings present avenues for future research, potentially focusing on preventive strategies based on bile composition alterations and microbial diversity.

Aim: The aim of this study was to evaluate the prevalence of maternal and neonatal outcomes with respect to cervical length (CL), amniotic fluid volume, and latency in women with preterm premature rupture of membranes (PPROM). Methodology: The present study was conducted as a prospective observational investigation. All female admitted to the hospital got transabdominal ultrasonography to assess their amniotic fluid index. A minimum of three measurements were obtained, and the measurement with the shortest length was documented. The procedure of cervical measurement entails the insertion of callipers into the space between the external and internal cervical Os. Female admitted patients were given expectant management, which involves the provision of antibiotics and steroids. Resuls: The study population consisted of 90 women with singleton pregnancies at gestational ages ranging from 28 to 36 weeks. Patients in gestational duration of 24 to 28 weeks having cervical index of ≤ 2.5 cm reported the low mean latency duration of 8.95 ± 1.86 days as compared to the cases having >2.5 cm index among the same group. This low gestational group reported high incidence of Chorioamniionitis (10% and 63.3% in cervical index of  ≤ 2.5 cm and >2 cm respectively), 1 min APGAR <7 (26.6% and 73.3%), high incidence of NICU admission (23.3% and 63.3%) and early neonatal death (13.3% and 60%) than the other gestational age groups. Significant differences of <0.0001 was reported between groups (Table 1). Meanwhile, regarding amniotic fluid index the average latency rate in ≤5 cm was reported as 7.43 ± 1.83, 5.12 ± 1.06 and 1.33 ± 0.23 in gestational duration of 24 to 28, 28 to 32 and 32 to 36 weeks. Meanwhile the the high latency rate was observed in all three groups when comparing the amniotic fluid index of >5cm.  Conclusion: The latency period is negatively correlated with gestational duration, meaning that a shorter gestational duration is followed by a longer latency period. An raised amniotic fluid index, which is linked to a higher incidence of chorioamnionitis and neonatal difficulties and is probably caused by a prolonged period of latency, is positively correlated with an extended cervical length.

Background:  Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. According to the International Diabetes Federation (IDF), approximately 415 million adults between the ages of 20 to 79 years had diabetes mellitus in 2015. [1] DM is proving to be a global public health burden as this number is expected to rise to another 200 million by 2040. This is a Prospective, Cross sectional, Randomization, Observational study wa conducted in the Department of Biochemistry and Medicine, Index Medical College. Inclusion Criteria: Controls without family history of type 2 diabetes: Healthy subjects in the age group of 18 - 30 years of either Gender. Exclusion Criteria: Individuals who are using any medicines for any health condition to restrict in performing sub-maximal exercise. TAOS while comparing between control group (without family history of type 2 diabetes) and case group (with family history of type 2 diabetes), in our study found that in mean and standard deviation of TAOS in 18- 21 years in control group (1.45 + 0 .34 mM) and case group (0.71 + 0.46 mM) was statistically not significant difference between both groups (p=0.061), meanwhile TAOS in 22- 25 years in control group (1.37 + 0 .47 mM) and case group (0.45 + 0.14 mM) was statistically significant difference between both groups (p=0.003). MDA in 18-21 years in Case Group showed an increase in Mean 11.05 + 9.26 mM then control group 6.14 + 0.89m M (p<0.0001), MDA in 22-25 years in Case Group showed an increase in Mean 13.05 + 9.34 mM then control group 5.74 + 1.19m M.

Background: Post operative nausea and vomiting is one of the commonest complication following General Anaesthesia resulting in delayed discharge, pathological and physiological distress for the patients.

Materials And Methods: Patients were subjected to a thorough PAE, and routine investigations were done. After obtaining approval and clearance from institutional ethical committee, patients fulfilling criteria and willing to give informed written consent were included in the study and were divided into 2 groups with 30 patients in each group –

1. Group A – patients receive Tab Pregabalin 150 mg orally 1 hour before surgery as premedication with 1 spoon of water.

2. Group B – patients receive a placebo drug.

In preoperative area, baseline vitals were recorded and Patients received 150 mg of tab pregabalin as premedication 1 hour before the surgery. Patients were given premedication with Inj Midazolam 0.05mg/kg body weight, Inj Glyclopyrolate 60mcg/kg body weight. Patients were induced with Propofol 2mg/kg body weight and fentanyl 3mcg/kg body weight. Preoxygenated with 100% O2 for 3–4 mins and vecuronium at 0.1mg/kg body weight was used as muscle relaxant. Patients were intubated with appropriate size E.T Tube and fixed and connected to ventilator and maintained with O2 (60%)+ Nitrous oxide (40%) + Isoflurane (0.8 – 1%) + Vecuronium 0.08mg/kg body weight.

30 mins before extubation 5 HT 3 antagonist Ondensetron 0.15mg/kg body weight was given.

Number of post operative nausea vomiting episodes were recorded by Nausea as primary aim and pain score, hemodynamic stability with Heart rate, blood pressure were recorded as secondary aim.

Results: The comparative study between the two groups showed statistically significant results favoring the primary objective. The oral pregabilin dose of 150 mg produced significant reduction in post-operative nausea and vomiting (PONV). [Chi square 11.29, P value: 0.001 table 11]. The statistical analysis also significantly showed that the pregabilin group had less post operative pain, complications of vomiting and other symptoms. [chi square 1.429, P value <0.00, table 12]. The additional benefit of post operative pain relief determined via VAS score was also statistically in the oral pregabilin group. [chi square 60.0, P value <0.001, table 13]. However, the demographic composition of two groups were insignificant on (age, sex, weight) on statistical analysis. The heart rate response and the response on blood pressure (SBP and DBP) during the intubation process in the oral pregabilin group was significantly less and hence better in obtundation of the response to intubation [Table 7,8,9,10]. The sedative effect of pregabalin group assessed post operatively showed significant sedation and hence the additional benefit of post-operative analgesic effect too.  Conclusion: We conclude that pre-operative pregabalin is associated with significant reduction of post operative nausea and vomiting, and it can be considered as a part of multimodal approach to post operative nausea and vomiting and also for post operative analgesia.

Introduction: Atrial fibrillation (AF) is a prevalent and clinically significant cardiac arrhythmia, particularly in the elderly population. This study aimed to investigate the clinical presentation, predisposing factors, etiology, and complications of AF.  Materials and Methodology: We conducted a prospective observational study involving 123 atrial fibrillation cases admitted to the Government Medical College and Hospital in Bhavnagar, Gujarat, India, from August 2019 to January 2020. Comprehensive patient histories and clinical examinations were conducted following a predefined proforma, and all necessary investigations were gathered and subsequently analyzed. Results: Among the 123 cases, 65 were male, and 58 were female. The mean age was 51.05 ± 13.19 years, with the majority falling in the 40-59 age group (50.40%). Dyspnea was the predominant symptom in 82.11% of cases, followed by palpitations in 77.23%. Rheumatic heart disease (RHD) was the most common etiology of atrial fibrillation (AF) at 48.78% in our study, followed by ischemic heart disease (IHD) with hypertension (20%). Among RHD cases, mitral stenosis (MS) was the most prevalent valvular lesion, accounting for 26.83%. Complications included congestive cardiac failure in 67.48% of cases and congestive cardiac failure with cerebrovascular accident in 13.01%. Our study reported a mortality rate of 6.50% Conclusion: In our investigation, a higher proportion of male participants were observed compared to females. The predominant age group among the subjects was 41-59 years. The primary cause of cases in our study was rheumatic heart disease (RHD), with ischemic heart disease (IHD) in conjunction with hypertension comprising the second most common etiology at 20%.

Background: Diabetes mellitus is a recognized risk factor for coronary artery disease (CAD), increasing the vulnerability to adverse outcomes in patients with acute coronary syndrome (ACS). Stress-induced hyperglycemia further complicates the clinical course of ACS. This study aimed to explore the prevalence and outcomes of stress hyperglycemia and diabetes mellitus among ACS patients.

Methods: A prospective observational study was conducted at Indira Gandhi Medical College, Shimla. A total of 301 ACS patients were enrolled, categorized into known diabetics, newly diagnosed diabetics, and stress-induced hyperglycemia. Clinical parameters, risk factors, and complications were analyzed using descriptive statistics, chi-square tests, and t-tests.

Results: Among the ACS patients, the prevalence of diabetes mellitus was 21.26%, comprising 12.96% known diabetics and 8.6% newly diagnosed cases. Stress-induced hyperglycemia was observed in 20.26% of the patients. Male predominance was noted among diabetic patients. The mean age of ACS presentation was around 58-59 years. Smoking was the most prevalent risk factor (61.5%), followed by hypertension. Diabetic patients exhibited a higher prevalence of complications, particularly heart failure (29.7%). Uncontrolled diabetes was associated with a higher incidence of complications (48.5%). Stress hyperglycemia correlated with impaired fasting glucose at discharge.

Conclusion: Diabetes mellitus and stress-induced hyperglycemia contribute to adverse outcomes in ACS patients. Complications were more frequent in diabetic patients, and stress hyperglycemia was associated with impaired glucose tolerance. Effective management and follow-up of hyperglycemic patients are crucial for improved outcomes.

Background: The rising incidence of Chronic Obstructive Pulmonary Disease (COPD) has made it a significant public health concern, particularly in India where it ranks as the second leading cause of mortality. This study aims to explore the cardiovascular autonomic reactivity in COPD patients compared to normal subjects. Previous research has shown autonomic imbalance in COPD patients, making this a critical area for investigation to enhance management strategies and mitigate cardiovascular complications. Material & Methods: This prospective observational study was conducted over 18 months at a tertiary care center with 78 participants, comprising both normal subjects and individuals diagnosed with COPD. Various tests, such as deep breathing, isometric handgrip, postural change, and the Valsalva maneuvre, were administered to assess cardiovascular autonomic reactivity. Statistical analyses including t-tests, were utilized to interpret the data. Results: The study revealed significant differences in BMI, resting heart rate, and blood pressure between normal subjects (Group A) and COPD patients (Group B), with p-values of 0.00004, 0.002, and <0.0001 respectively. Cardiovascular autonomic reactivity tests, including E:I Ratio (P=0.001) and ΔSBP (P<0.0001), also showed marked disparities. Conclusion: The study highlights significant differences in cardiovascular autonomic reactivity between normal individuals and COPD patients, particularly in parameters like BMI, heart rate, and blood pressure. These disparities suggest compromised autonomic flexibility in COPD patients, underlining the need for a multi-system approach in their clinical management.

Background The frequency of open fractures is rising as high velocity injuries are on the rise in the current situation. Approximately 60–65% of all open fractures involve the tibia. The administration is challenging, time-consuming, and some people think it's raising morbidity. The current standard of care for open tibia fractures is wound debridement, external fixator placement, and delayed wound closure followed by internal fixation. Although the use of an external fixator is rapid, the patient's mobilisation and wound healing will be delayed as a result. Primary nailing is advantageous for open fractures Type I and Type II because there is less wound than in Type III. External fixation is the most common form of treatment for Type III a, b, and c. Materials and Methods A prospective study was done in department of Orthopedics, SVRR Government General Hospital, Tirupati from June 2022 to May 2023. The study was done in 25 patients who volunteered for the study with Gustilo Anderson Type IIIa open fracture of tibia who were treated with primary intramedullary interlocking nail fixation after wound debridement and skin grafting and skin release whenever needed. All the patients were surgically treated with in 24 hours from the time of fracture. Functional assessment is done by the Johner and Wruh criteria1. Radiological union assessment is done by RUST score (Radiological Union Scale in Tibia)2. All the patients were studied for the rate of infection. Results Of the 25 patients treated with primary nailing following debridement for Type IIIa tibia fractures, Johner and Wruh score of excellent in 12 patients(48%), good in 6 patients(24%), fair in 3 patients(12%) and poor in 4 patients(16%). RUST score of 9-12 is in 10 patients (40%), 5-8 in 12 patients (48%) and 4 in 3 patients (12%). Of all the 25 patients infection is seen in 4 patients (16%). Conclusion Primary nailing for Type IIIa tibia fractures gives good biomechanical stability and better wound coverage, and is advisable for early mobilization with good functional and radiological outcome and minimal complications.

Purpose: The purpose of this study was to determine the demographic and clinical characteristics of patients who had pancreaticoduodenectomy as an indication of pancreatic cancer. Methodology: This prospective observational study aimed to investigate the demographic and clinical characteristics of individuals who presented with pancreatic cancer and underwent pancreaticoduodenectomy. A cohort of 50 adult patients who were hospitalized in the Department of General Surgery Medical College Trivandrum and diagnosed with pancreatic or peri-ampullary cancer and subsequently received curative resection within the study period were included in the study. Results: Out of the total 50 study subjects, the majority of them were females, 27 (54% females), with a male-to-female ratio of 1.1:1. The majority of the participants were between the ages of 46 and 59 (44%) and 60 and older (34%). The majority of the study participants exhibit jaundice, accounting for 29 (58%). Diabetes mellitus was the most prevalent, being present in 12 patients (24%). The majority of the study participants were diagnosed with carcinoma of the head of the pancreas; 52% had periampullary carcinoma detected in 48%. A total of 25 patients had pylorus-preserving pancreaticoduodenectomy (PPPD), while another 25 study subjects underwent Classical Whipple's Resection. Conclusion: The study revealed that the incidence of pancreatic cancer was higher in females than males. The incidence is higher in the elderly population.

Background: Acute pancreatitis is an inflammation of the pancreas that can have fatal repercussions and include other organs. 10% of people with serious illnesses die before diagnosis and different degrees of the disease can go undiagnosed [1]. Typically, 70% of instances of acute pancreatitis are caused by gallstones and alcohol consumption. Between 35 and 40 percent of instances of acute pancreatitis are caused by gallstones, including microlithiasis [2].

Objectives:

1. To study the age and sex prevalence of acute pancreatitis.

2. To study the various etiological factors of pancreatitis.

3. To study the clinical presentation and outcome of pancreatitis.

Introduction: Diabetic foot ulcer is characterized by several pathological complications such as neuropathy, peripheral vascular disease, foot ulceration and infection with or without osteomyelitis, leading to the development of gangrene and even necessitating limb amputation. The study aims to study the prescription pattern and effect of antidiabetic drugs on diabetic foot ulcer patients.  Material and methods: A prospective observational study was conducted at the Department of General Medicine for one year the data was collected from 112 patients using a data collection form. The patients were selected based on inclusion and exclusion criteria and after permission from the institutional ethical committee.  Results: As per the study majority of the patients were male (76.78%) under the age group of 61 – 70 years (52.67%).  as per demographic status, 70.53% were non-smokers, 59.82% were alcohol drinkers and 82.14% of patients were both smokers and alcohol drinkers and  63.39% of patients were having a family history of diabetes. Based on the location of ulcers on foot were graded as 1, 2,3,4 & 5 grades, as per our study 41.96% had grade 4 ulcers. The majority of the patients were prescribed with dural drug combination therapy of antibiotics 47.32% followed by triple drug combination of antibiotics 27.67%, multiple drug combination therapy 19.64% and 05.35% monodrug therapy respectively, as per the prescription pattern of antibiotics Metronidazole 30.35% followed by Piperacillin + Tazobactam 23.23%, ciprofloxacin 16.96%, Vancomycin 11.60%, Ceftazidime 06.25%, Ampicillin and Doxycyline 04.46% and Gentamycin 02.67%. As per our study majority of the patients were prescribed metformin + glimepride + insulin 56.25% followed by metformin + glimepride 24.10%, metformin + tenegliptine 11.60% and metformin + pioglitazone 08.03% respectively. A higher significant mean reduction was observed in metformin + glimepride + insulin-treated groups (p<0.005).  Conclusion: As per our study Metronidazole antibiotic and a combination of metformin + glimepride + insulin show better control over blood glucose levels in patients suffering from diabetes.

Background: In the Emergency Department, COPD patients are assessed clinically and categorized with different grades of severity of the disease. Aim: To analyze the factors predicting failure of non invasive ventilation in Emergency Department among the patients with acute exacerbation of chronic obstructive pulmonary disease. Methodology: It was a prospective cohort study carried out during the period from July 2022 to August 2023. A total of 82 patients with acute exacerbation of chronic obstructive pulmonary disease requiring NIV attending Department of Emergency Medicine Results: In the present study 71.95% of the patients were males and 28.05% of the patients were females. The male female to ratio was 2.56:1. In this study 52.44% of the patients had hypertension, 42.68% of the patients had diabetes mellitus. The other comorbid conditions are as shown in table 5.3 and graph 5.3. In this study all the patients had shortness of breath and cough (100.00%) while fever was noted in 70.73% of the patients. In the present study failure of NIV and requirement of intubation was noted in 4.88% of the patients. In this study NIV failure was significantly associated with patients having pre existing or pulmonale (p=0.017) and hypothyroidism (p=0.025). In this study with regard to temperature (p=0.042), PO2 pertaining to second ABG analysis (p=0.023), NIV tidal volume (p=0.031) and hospital stay (p=0.001) differed significantly in patients with and without NIV failure. Conclusion: Based on the findings of this study it may be concluded that, the rate of NIV failure was low (4.88%) in a carefully selected patient population with timely intervention and strict monitoring.

Objective- To describe the association of Systolic Blood Pressure with outcomes in children with acute non traumatic neurological illnesses. Materials and Methods- the present prospective observational Study conducted in the PICU, Department of Pediatrics of central India over the period of 1 year 6 months, All patients admitted with acute non traumatic neurological illnesses. Children between the age group of 1-14 years of age, admitted with the provisional diagnosis of acute neurological illnesses -acute encephalitis syndrome, pediatric stroke, meningitis, hepatic encephalopathy and seizure were included while all cases of acute traumatic neurological illnesses and/or Patients with chronic illnesses of any system were excluded. Results- the study was conducted among 249 subjects, out of which 57.4% (n=143) belonged to the age group of 1-5 years, 30.9% (n=77) subjects were of 5-10 years, 11.6% (n=29) subjects were of more than 10 years of age. Out of which males 63.1% (n=157) were male and 36.9% (n=92) subjects were female. Among all subjects 50.6 % (n=126) had primary diagnosis of seizure disorder, 41.4% (103) had acute encephalitis syndrome, 5.2% (n=13) had bacterial meningitis. which death rate was reported in 11.2% . In present study systolic blood pressure was found to be a significant predictor of mortality across the time points. Across the time points death was more common in those with systolic blood pressure. Conclusion- Children with acute non-traumatic neurological illnesses have higher systolic blood pressure in the Pediatric Intensive Care Unit (PICU), which increases mortality and hospital stays. The relationship between systolic blood pressure and acute non-traumatic neurological illness in children needs further multi-institutional research. Timely and proactive blood pressure treatment improves mortality and hospitalization rates.

Background: Pre-existing hypertension, renal disease, diabetes mellitus, Obstructive Sleep Apnea, thrombophilia, and autoimmune disease all enhance the chance of developing hypertensive disease during pregnancy by decreasing uteroplacental blood flow. Women with a history of preeclampsia, HELLP syndrome, twin pregnancies or other multiple pregnancies, a BMI >30, autoimmune disease, being over 35 years old, being first-time mothers, or having a sister or mother who had hypertension during pregnancy are at an increased risk of developing hypertensive disorder of pregnancy and pre-eclampsia. Objectives: To evaluate the screening efficacy of urinary calcium creatinine ratio versus Doppler study in predicting pre-eclampsia. To study that low urinary calcium creatinine ratio (UCCR) of < 0.04 in asymptomatic pregnant women association with subsequent development of pre-eclampsia. To study the usefulness of uterine artery Doppler velocimetry as a predictor for pre-eclampsia before 20 weeks in asymptomatic pregnant women. Material & Methods:  Study Design: Hospital based observational study. Study area: Department of Obstetrics & Gynecology, in a tertiary care teaching hospital. Study Period: April 2022 – March 2023. Study population:  Normotensive nonproteinuric pregnant women less than 20 weeks attending the outpatient as well as antenatal ward. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Simple Random technique. Study tools and Data collection procedure: A hospital based prospective comparative study was conducted among a group of 100 normotensive nonproteinuric women 11 to 14 weeks attending the outpatient as soon as antenatal ward in tertiary care teaching hospital over a period of one years. They are subjected to a detail history and general examination. Results: Out of 100 women, 33 had abnormal PI at 11-14 weeks and out of which 24 developed Pre-Eclampsia. The sensitivity is 100% and specificity are 88.2% positive predictive value is 72.7%and NPV is 100% and its association between preeclampsia was statistically significant (p value<0.0001). Out of 100 women, 58 had abnormal PI at 16-20 weeks and out of which 23 developed Pre-Eclampsia. The sensitivity is 95.8%and specificity are53.9%, positive predictive value is 39.7 %and negative predictive value is 97.6% and its association between preeclampsia was statistically significant (p value<0.001). Conclusion:  We conclude that PI at 11-14 weeks and 16 – 20 weeks was found to be the better predictor of Preeclampsia compared to UCCR with better sensitivity, specificity and diagnostic efficacy. We recommend using PI at 11-14 weeks as the predictive tool to predict the development of preeclampsia.

Objective: Patients diagnosed with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) with implantation of coronary stent are often prescribed with two different antiplatelet agents.The objective of our study was to find out the incidence of major and minor bleeding and their associated risk factors. Method: A cohort of 183 patients receiving Dual Antiplatelet Therapy (DAPT) was investigated. Demographic data, bleeding patterns, prevalent risk factors, and interventions were analysed. To categorise and evaluate the severity of the bleeding, The Global Use of Strategies to Open  Occluded Arteries (GUSTO) and Bleeding Academic Research Consortium (BARC)bleeding classifications were used. Results: Among the patients, 66.6% were males. Bleeding occurred in 32.14% of those on Aspirin-Clopidogrel and 30.23% on Aspirin-Ticagrelor combinations. Hypertension (71.5%), diabetes (39.3%), and dyslipidaemia (57.3%) were common risk factors. Upper GI Bleed (13.7%) and Hematuria (13.7%) were primary bleeding patterns, while Intracerebral Hemorrhage (ICH) was seen in 3 cases. Hospitalization was required for 21 patients. According to BARC, 38 had type 1 bleeding, and 21 had other formof bleeding; 124 had no bleeding. According to GUSTO, 6 had severe and 7 had moderate bleeding. Eight patients transitioned to Single Antiplatelet Therapy due to severe bleeding. Conclusion: Our study underscores the complexity of bleeding risks in DAPT patients, emphasizing the need for tailored treatment strategies. Future research should explore underlying mechanisms of bleeding events and the long-term impact on patient outcomes. Developing standardized protocols for risk assessment and management is crucial for optimizing clinical practice and patient safety.

Introduction: Sickle cell disease (SCD) is a hemoglobinopathy with varied manifestations from an asymptomatic state to crisis and may be fatal. Hypercoagulable state in sickle cell diseaseis not uncommon but there is a paucity of data on Indian patients, especially in the Pediatric age group.   Aims and Objectives: To determine the coagulation parameters (PT, APTT), platelet count and MPV of children (<18 years) with SCD and to compare these parameters with controls(children with normal hemoglobin pattern). Material and Methods: This was a hospital based prospective observational study. 62 cases of homozygous sickle cell anemia (HbSS), 43 cases of sickle cell trait (HbAS) were included. 84 children with normal hemoglobin pattern (HbAA) of the age group 0-18 years were taken to serve as control in the study. Blood samples of all participants were collected in EDTA and Citrate vials. Hemoglobin, Platelet count, MPV, PT, and aPTT values were obtained. Result: The mean hemoglobin level of patients with HbSS was significantly lower as compared to HbAS and controls. (P<0.001) The mean value of PT, APTT, Platelet count, and MPV in HbSS cases was significantly higher as compared to HbAS and controls (P<0.001). There was no significant difference between hemoglobin PT, aPTT, platelet count, and MPV inHbAS and controls (P >0.05). There was a significant negative correlation between Hb levels and PT (r, -0.706;P,<0.0001), APTT (r,-0.467; P,0.0001), platelet count (r,-0.453; P, 0.0002)and MPV (r,-0.6952;P,<0.0001)for patients of HbSS.  Conclusion:Children with SCD have prolonged coagulation profile and marked variation in platelet count which may increase the risk of thrombosis and bleeding.So it needs to be investigated further for better patient management.

Background:  Respiratory distress is the commonest morbidity responsible for majority of neonatal admissions to neonatal intensive care unit. It is a symptom complex arising from disease process that cause failure to maintain gaseous exchange.  Respiratory distress in new born can be due to a wide variety of conditions. The frequency of a given condition depends on various factors of which gestation is an important one. In preterm neonates, respiratory distress syndrome (RDS) is the most common cause while in the late preterm and term neonates’ transient tachypnoea of new born (TTN) is the predominant cause. Methods:  This is a prospective and observational study conducted among Neonates admitted with signs of respiratory distress to new born care unit, Dept. Of Paediatrics MKCG Berhampur (SNCU and NICU). Both inborn and out born babies admitted to new born care unit with respiratory distress were included. Neonates from birth to 28 days presenting with respiratory distress were selected through consecutive sampling. New born developing distress post admission were excluded from the study. Written informed consent were taken from parents concerned. Results: 110 respiratory distress cases were sampled consecutively for our study. The total admissions in the time period was 645 thereby making respiratory distress 15% of total admissions. When babies having respiratory distress were compared with place of delivery there were more number of out born cases 63 (57.3%) than inborn cases 47 (42.7%). Conclusion:  Survival of babies with hyaline membrane disease who were given exogenous surfactant therapy improved with increasing gestational maturity and birth weight. Sepsis is the major entity complicating outcome of babies who received surfactant. Proper antenatal care, early diagnosis of antenatal complications and avoiding preterm deliveries will aid in better outcome of newborn babies with respiratory distress.

Aims & Objectives: To compare the incidence of placenta previa in current pregnancy in women with previously scarred and unscarred uterus. To compare the differences in incidence of placenta previa in current pregnancy in women with previously scarred and unscarred uterus; To compare the difference in maternal complications in current pregnancy in women with previously scarred and unscarred uterus; To compare the difference in fetal complications in current pregnancy in women with previously scarred and unscarred uterus. Methods: This was a Prospective cohort study conducted at Department. of Obstetrics and Gynecology, Kurnool Medical College and associated hospital, Kurnool from March 2021 to March 2022. Results: There were a total 1000 participants in the trial, of which 500 had a history of vaginal delivery in the past (Control Group PVD) and 500 had a history of uterine scarring in the past (Study Group PSU). In this current study, there were no significant differences in this patient distribution between the two groups based on presenting complaints like APH, and mean age, parity, GA, and foetal complications not appearance were comparable between the two groups. In this present study, in the women group PSU the number of previous cesarean sections were 1 in 69.2%, 2 in 27.6%, 3 in and above is 1.2% of the women, 2% of the women have history of D&C. With their history of one, two, three, or more cesarean sections or history of DC, placenta previa was observed in 3.1%, 12.3%, 33.3%, and 10% of instances, and the difference was determined to be statistically significant, indicating that scarring is a substantial risk factor for previa. Placenta prevalence was 2.4% in the PVD group and 6.8% in the PSU group, indicating a higher prevalence in the PSU group. The Placenta Previa group of PSU had more postpartum hemorrhage cases and interventions than the PVD group. Low birth weight (LBW), preterm, low APGAR scores, and NICU admissions were comparable in both groups with a modest increase in the PSU group. Conclusion: The current study's findings showed that uterine scarring in the past had a substantial impact on the chance of placenta previa in a subsequent pregnancy. Therefore, it's critical to encourage vaginal birth as much as possible. Regular prenatal checks, early diagnosis, and skillful management of previa are the keys to optimal maternal care.

Introduction- Chronic thyroiditis embraces a heterogenous group of thyroiditis. Hashimoto’s thyroiditis forms the largest and clinically most significant cause of chronic thyroiditis. FNAC of thyroid provides a safe and accurate method of diagnosis of this condition. As there is paucity of literature on Hashimoto’s thyroiditis and the input of patients presenting with features of Hashimoto’s thyroiditis is on the rise, this study is under taken to correlate the cytomorphological features of Hashimoto’s thyroiditis

with clinical, biochemical and with antithyroid antibodies where ever feasible.

Objectives

1. Analysis of cytomorphological features on FNAC in Hashimito’s thyroiditis.

2. To determine the correlation between various cytomorphological features and biochemical & serological parameters in cases diagnosed as HT.

3. To correlate cytological diagnosis with histopathology wherever possible.

Materials and Methods This prospective study was conducted on 100 patients attending the cytopathology department of Adichunchanagiri Institute Of Medical Sciences, B.G. Nagara. Cytologically proven, cases of Hashimoto’s thyroiditis over a period of two years, from November 2017 to May 2019 formed the study material. The various parameters like patients clinical presentation, antithyroid antibodies & hormonal profiles, were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. RESULTS: Most of the patients were females (97%) who presented with a diffuse goiter (91.%). Hypothyroid features were present in 62.7% of cases. Anti TPO antibody showed positivity in.93.4% of patients. Cytomorphologic spectrum of Hashimoto’s thyroiditis was analysed and graded. Most of them had grade II disease by cytology.No correlation was observed between grades of cytomorphology and biochemical &

serologic parameters. Conclusion Despite the availability of several tests for diagnosis of Hashimoto’s thyroiditis, ‘FNAC’ remains the gold standard.

Objective: The aim of this study was to examine the immediate effect of short duration of slow deep breathing on heart rate and blood pressure in healthy young adults. Methodology: This prospective study was conducted in ….. hospital from August 2022 to January 2023 after obtaining the ethical approval from the institutional committee. There were two sessions, each lasting five minutes, in which the participants were told to engage in deep breathing at a rate of six breaths per minute. These sessions were separated by a five-minute interval, after which a second five-minute deep breathing session at a rate of six breaths per minute was conducted. The individuals were divided into groups and instructed to practice consistently for 10 minutes daily, from 7 a.m. to 8 a.m., over 3 months. The investigator provided supervision throughout this period. Results: In the male population, the baseline systolic diastolic blood pressure population was observed as 121.5 ± 8.8 and 75.89 ± 3.18mmHg which was reduced to 69.56 ± 4.10 and 111.23 ± 4.64 mmHg after exercise. The baseline and outcomes of systolic blood pressure reported a significant statistical difference of 0.03; however, no significant difference was found for diastolic blood pressure. The finalobservations of pulse rate showed a reduction; however, no statistical significance was observed in baseline and post-exercise outcomes. A significant difference of 0.001 in respiratory rate was observed after exercise (15.99 ± 1.48 to 12.23 ± 1.56). However, in the female population, minimal changes in all outcomes were reported without showing any significant statistical difference. Conclusion: Given the limitations of the current study, it is possible to conclude that practising slow, deep breathing for a period of three months results in lower blood pressure and heart rates as well as improved autonomic functioning. Compared to their female counterparts in the same age group, the observed effects are more significant in the male individuals. It has been proven that extended durations of quiet, deep breathing improve parasympathetic tone.

Background: This prospective observational study was undertaken to look into the factors that affect the outcome of total knee arthroplasty and the short-term results of total knee replacements in complex knee pathologies. Methods: This prospective observational study was conducted between 2021 and 2023 at Owaisi Hospital and Research Centre, Hyderabad. A consecutive series of 12 total knee arthroplasties was performed on 12 patients at our institute using PFC Sigma endoprosthesis. The patients were assessed clinically and radiologically using the INSALL scoring system.  Results: The average pre-operative range of motion (flexion) was 45˚, with a highest of 120˚ and a lowest of 0˚. The average post-operative flexion was 102˚, with a highest of 130˚ and a lowest of 90˚. The average extension lag preoperatively was 18˚, and the average postoperative extension lag was less than 10˚. The average pre-operative knee score was 64.84, with the highest score of 91 and the lowest score of 40. The majority of the patients had a score in the range of 51–100. The average post-operative knee score was 136.84, with the highest score of 160 and the lowest score of 120. A majority of the patients had an improvement in score in the range of 101–150. At 6 months, follow-up relief was excellent in most patients; only 10 patients had anterior knee pain, and all the patients were able to walk more than 50 blocks post-operatively without any walking aid. Conclusion: Determining the factors resulting in a difficult knee helps in formulating an appropriate surgical approach, which results in a better functional outcome following total knee arthroplasty.

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results:The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%,  18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively.The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion:Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care.

This study examines the influence on heart rate variability (HRV) indices in trained individuals as compared to untrained individuals presented in a prospective and cross-sectional study. The predictability of HRV in athletic performance is also included. Finally, some recommendations concerning the application of HRV methods in athletes are made. The cardiovascular system is mostly controlled by autonomic regulation through the activity of sympathetic and parasympathetic pathways of the autonomic nervous system. Analysis of HRV permits insight in this control mechanism. It can easily be determined from ECG recordings, resulting in time series (RR-intervals) that are usually analysed in time and frequency domains. As a first approach, it can be assumed that power in different frequency bands corresponds to activity of sympathetic (0.04-0.15 Hz) and parasympathetic (0.15-0.4 Hz) nerves. However, other mechanisms (and feedback loops) are also at work, especially in the low frequency band. During dynamic exercise, it is generally assumed that heart rate increases due to both a parasympathetic withdrawal and an augmented sympathetic activity. Most studies concern relatively small numbers of study participants, diminishing the power of statistics. In order to further develop this fascinating research field, we advocate randomised, controlled, long-term studies using validated measurement methods. There is a strong need for basic research on the nature of the control and regulating mechanism exerted by the autonomic nervous system on cardiovascular function in athletes, preferably with a multidisciplinary approach between cardiologists, exercise physiologists, pulmonary physiologists, coaches and biomedical engineers. In this study,  we determine the effect of long term endurance training (minimum period of one year) on heart rate variability in trained individuals  as  compared to the sedentary population, so that long term endurance exercise could be used for cardiac wellbeing.

Purpose: The purpose of this prospective observational study was to assess the effect of the nutritional status of pregnant mothers on the birth weight of their new-borns. Material and methods: This study was a prospective observational study of 500 pregnant women registering at an antenatal clinic in GMH Rewa from January 2021 to June 2022. The study participants were followed up at their 2nd visit between 24th and 28th weeks and at their 3rd visit at the time of delivery. Anthropometric, dietary, and haematological parameters were obtained at each visit. Results: Among the 203 women, 140 (68.93%) gave birth to babies whose weight was appropriate for gestational age (AGA) babies, and 63 (31.03%) gave birth to babies whose weight was less than expected for gestational age (SGA) babies. The present study has shown an association between low maternal BMI, low weight gain, inadequate IFA intake, inadequate nutrient intake, inadequate protein intake, inadequate calorie intake, low haemoglobin count during pregnancy, and low birth weight babies. Conclusion: This study emphasizes the significance of a healthy diet and nutrition throughout pregnancy because they directly and favourably affect the new-born’s weight and overall health. Birth weight is statistically significant and positively correlated with maternal iron and folic acid supplementation, particularly blood iron levels. The potential benefits of nutrition and iron-folic acid supplementation, as well as the identification of their inadequacies, can support low-cost treatments intended to lower the incidence of SGA. The study suggests providing proper awareness and health education about pregnancy, timely ANC visits, nutrition, and institutional delivery for a better foetal outcome.

Background This prospective observational study was undertaken to look into the factors that affect the outcome of total knee arthroplasty and the short-term results of total knee replacements in complex knee pathologies. Methods  This prospective observational study was conducted between 2021 and 2023 at Owaisi Hospital and Research Centre, Hyderabad. A consecutive series of 12 total knee arthroplasties was performed on 12 patients at our institute using PFC Sigma endoprosthesis. The patients were assessed clinically and radiologically using the INSALL scoring system.  Results The average pre-operative range of motion (flexion) was 45˚, with a highest of 120˚ and a lowest of 0˚. The average post-operative flexion was 102˚, with a highest of 130˚ and a lowest of 90˚. The average extension lag preoperatively was 18˚, and the average postoperative extension lag was less than 10˚. The average pre-operative knee score was 64.84, with the highest score of 91 and the lowest score of 40. The majority of the patients had a score in the range of 51–100. The average post-operative knee score was 136.84, with the highest score of 160 and the lowest score of 120. A majority of the patients had an improvement in score in the range of 101–150. At 6 months, follow-up relief was excellent in most patients; only 10 patients had anterior knee pain, and all the patients were able to walk more than 50 blocks post-operatively without any walking aid. Conclusion  Determining the factors resulting in a difficult knee helps in formulating an appropriate surgical approach, which results in a better functional outcome following total knee arthroplasty.

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results: The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%, 18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively. The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion: Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care.

Background: Epididymoorchitis, a prevalent inflammatory condition that impacts both the epididymis and the testis, served as the basis for the current study. The primary aim of this investigation was to shed light on the various factors involved in the development of chronic epididymoorchitis. Methods: This prospective observational research involved a group of 50 patients who had been diagnosed with chronic epididymoorchitis. We designed a structured questionnaire and collected data systematically. The patients underwent comprehensive examinations, received accurate diagnoses, and were provided with suitable treatment. The gathered data were then analyzed utilizing SPSS version 20. Results: The most common age range for the occurrence of epididymo-orchitis is typically between 31 and 40 years. Among the cases, industrial workers accounted for a significant portion, with 15 individuals, representing 30% of the total cases. Pain served as the predominant clinical symptom, being present in all 50 patients, which constituted 100% of the total cases. Urinary tract infection (UTI) emerged as a relatively common predisposing factor, observed in 12 cases, making up 24% of the total cases. Staphylococcus aureus (S. aureus) was the most frequently encountered organism in urine cultures among the isolated organisms. Medical treatment was the chosen approach for managing the majority of cases, with 36 patients, equivalent to 72% of the total, undergoing this form of treatment. Conclusion: Finding a positive urine culture in 62% of cases could suggest an underlying genitourinary issue. Staphylococcus aureus (S. aureus) was the most commonly identified organism in urine cultures among those isolated. Notably, in our research, a substantial proportion of patients responded positively to empirically administered treatment.

Background: This study was conducted to evaluate the effects of intrathecal vs. intravenous dexmedetomidine on the duration of sensory and motor blockage and analgesia in patients having lower limb procedures while under bupivacaine spinal anaesthesia. Methods: This was a hospital based prospective comparative randomized study conducted among 90 patients who were scheduled to undergo lower limb surgeries under sub-arachnoid block at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore, from February 2021 to September 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean time for onset of sensory blockade was 1.24 ± 0.44 min and motor block was 1.38 ± 0.39 min in group IT, 1.40 ± 0.54 min and 1.49 ± 0.51 min respectively in group IV. The onset of motor blockade was significantly faster in the intrathecal group compared to the intravenous group (p < 0.001). The mean duration of sensory blockade was 295.11 ± 38.88 min in group IT and 251.78 ± 46.19 min in group IV. The mean duration of the motor block was 307.78 ± 30.74 min in group IT and 263.11 ± 47.62 min in group IV. The duration of sensory and motor blocks was significantly higher in the intrathecal group when compared to the intravenous group (p<0.001). The mean duration of analgesia was significantly longer in group IV (p<0.001). Conclusion: Intrathecal dexmedetomidine is a better alternative to intravenous dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine intrathecally, as it provides good quality intraoperative and post-operative analgesia under stable hemodynamic conditions with minimal adverse effects.

Background: A number of clinical and radiological indicators can reliably detect the prognosis of a stroke. Improved biomarkers for predicting prognosis in acute ischemic and hemorrhagic stroke are still elusive. Aims and Objective: The present study was aimed to observe whether serum cortisol acts a biomarker in predicting the severity of stroke. Materials and Methods: A prospective study performed among 50 patients with ischemic in Group A and 50 patients with hemorrhagic stroke in Group B. The random serum cortisol of these patients was compared with the NIHHS score. Results: Incidence of hypertension was significantly higher in group B than group A (72% vs. 38%; P<0.0001). Both systolic and diastolic BP were significantly higher in group B in comparison to group A (P<0.001). Severity of stroke was significantly higher in group B in comparison to group A (P<0.001). Mean cortisol levels were significantly more in group B in comparison to group A (P<0.001). Also, a statistically significant correlation with raised serum cortisol levels and the severity of stroke irrespective of type of stroke was observed. Conclusion: The study revealed that serum cortisol can be used as a biomarker for the prediction of severity of stroke.

Introduction: Dense adhesions may cause prolonged surgery, injury to bowel, or bladder, and also excessive bleeding , during adhesiolysis and entry to abdominal cavity, especially when these procedures are performed by inexperienced surgeons as assistant doctors at training hospital Aims: Aim to study preoperative detection of adhesions by sonographic sliding sign  and determines its accuracy rate which will highlight its effectiveness in prevention of the complications during C- section. Materials and methods: This was a prospective observational study conducted at the Department of Obstetrics and Gynaecology, Izmir Katip Celebi University, Ataturk Training and Research Hospital in 70 full term pregnant women with history of C- section, included in this study. All patients were admitted to our clinic for elective C-section and sonographic evaluation done preoperatively to assess the “sliding sign “for detection of adhesions between uterus and abdominal wall. Results: Our analysis shows that significant positive sliding sign in intraoperative adhesions, so the accuracy rate is 77.4%, which can be assumed as optimal. Other characteristics found to have no correlation with the adhesions and hgb drop level. Haemoglobin drop degree is also correlate with the sliding sign. The predictivity of hgb drop more than >2 g/dl has the highest correlation with the sliding sign. Accordingly, the sensitivity, specificity, PPV and NPV of sliding sign in predicting marked intra-operative adhesions were 87.5%, 62.5%, 77.7% and 76.9% respectively. The median of delivery time (time from skin incision till delivery of baby) was significantly longer in patients with negative sliding sign compared to those with positive sliding sign (18 minutes versus 8 minutes) Conclusion: The sliding sign by ultrasound has a sensitivity of 87.5%, specificity of 62.5%, a positive predictive value of 77.7%, a negative predictive value of 76.9%, and accuracy of 77.5%, considering it rapid, easy and reliable method for prediction of intraperitoneal adhesions.

Background: Coronavirus disease 2019 (COVID-19) continues to be a significant health problem worldwide. The unprecedented surge of mucormycosis in patients with COVID-19 is a new emerging challenge. Although a few studies documenting high incidence of mucormycosis in COVID -19 patients have recently emerged in literature, data pertaining to treatment outcomes in such cohorts is lacking. Here, we report our experience in management of mucormycosis in COVID-19 patients at our tertiary care centre. Materials and methods: We prospectively enrolled and analyzed 70 post-COVID-19 patients who presented with the invasive mucormycosis of the head and neck region. Clinical and histology details were noted in predesigned forms. Various histology variables were graded from I to III to propose a scoring system for the severity of the disease. Result: A male predominance (86%) was observed with a male to female ratio of 2.8:1 at an age range of 26–75 years (mean age 46.8 ± 11 years). All patients had a history of COVID-19 disease in the last 2 months. Maximum cases (94.3%) presented within 20 days of COVID-19 treatment/ recovery. All patients presented with one or other local or constitutional symptoms or signs. The most common complaint at the time of presentation was local facial pain (92.9%), swelling of the cheek (67.1%), and eye pain with periorbital swelling (35.7%). Conclusion: Mucormycosis is a rare but fatal fungal infection that should be kept in mind in covid 19 recovered patients especially those who have uncontrolled diabetes and treated with corticosteroids. Timely diagnosis by histomorphological assessment supported with special stains is the cornerstone to prevent an adverse clinical outcome.

Introduction: Arboviruses are growing concern for state and central health authorities in India. Prevention of arbovirus infections or to break the chain of infection valuable strategy is by vector control measures. However, it's not effective to control the country's mosquito population. The primary aim of this study was to analyse the epidemiology and demographic characteristics of dengue and chikungunya. Materials And Methods: In this prospective study patients presenting with clinical features suggestive of dengue and chikungunya data was collected. Specimens about 5 ml of blood from each patient were collected for serological testing. Results: The mean age of dengue and chikungunya positive patients was 34.8±2.34 and 43±4.21 respectively with a slight male predominance. Dengue confirmed cases count increased in August and September and more number of cases was noted from November to January. Whereas, Chikungunya confirmed cases didn’t show any much seasonal variation during the studied years. 49.7% positives were detected as IgM antibodies, 28.57% were tested as NS1 antigen positive and remaining 21.6% positives were detected as both NS1 and IgM antibodies. Conclusion: South India region is endemic for dengue & chikungunya, research studies on incidence, demographic parameters and transmission dynamics will be useful for central and state government authorities to implement protocols like vector control measures, early diagnostic testing and health education at higher level.

Introduction: Chronic Suppurative otitis media is one of the most commonly encountered diseases in the otolaryngeal practice, which is well known for its multiple etiology, persistence and recurrence. Reevaluation of aerobic bacterial and fungal study to know the microbiotia in this location and also for treatment purpose antibiotic susceptibility testing using current available antibiotics of predominant bacterial pathogens were depicted in this study. Materials and Methods: In this prospective study Patients with chronic suppurative otitis media (CSOM) presenting with more than 3 weeks of ear discharge and who did not receive any topical or systemic antibiotics in the past one week were included in this study. All swabs were processed for gram stain, KOH mount, culture, biochemical reactions and sensitivity testing according to CLSI guidelines. Results: Most common organism isolated from CSOM study population was Pseudomonas aeruginosa (42.1%), followed by Staphylococcus aureus (34.2%). Most common organism isolated from CSOM study population was Pseudomonas aeruginosa (42.1%), followed by Staphylococcus aureus (34.2%). Pseudomonas aeruginosa which were isolated showed 93.7% susceptibility to amikacin, 78.1% to levofloxacin, 81.2% to Ceftazidime-clavulanic acid, 81.2% to piperacillin+tazobactum, 75% to ceftazidime, and 87.5% sensitive to meropenem. Klebsiella pneumoniae showed 75% sensitivity to amikacin and levofloxacin, 100% sensitive to meropenem, ertapenem and tigecycline. Escherichia coli and Proteus mirabilis showed 100% sensitivity to amikacin, ciprofloxacin and meropenem. S.aureus showed 84.6% susceptibility to clindamycin, 76.9% to ciprofloxacin, 84.6% to amoxicillin+clavulanic acid, 96.1% to amikacin, and all were cefoxitin sensitive. Conclusion: Microbiological testing of specimen prior to start the antibiotic therapy in CSOM patients alleviate the emergence of drug resistant of pathogens and also helps clinicians to give accurate and prompt treatment.

Background: Breast cancer is the most prevalent malignancy diagnosed in women globally (22%), and it ranks second to cervical cancer (18.5%) in India. Breast cancer is becoming more prevalent in both developed and developing countries; the peak occurrence of breast cancer in developed countries occurs after the age of 50, whereas it occurs after the age of 40 in India.

Objectives:

1. To correlate clinical, radiological, and gold standard pathological parameters in assessing the tumor response to Neoadjuvant chemotherapy (NACT) in locally advance breast cancer (LABC).

2. To find out the rates of response after neoadjuvant chemotherapy in patients of locally advanced breast cancer under following categories a. Clinical, b. Pathological, c. Radiological

3. To study the various prognostic factors to determine the outcome of the disease related to mortality and morbidity.

Background: The pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has dramatically tested health services all over the world. Since being hit by the first wave of the epidemic in the spring of 2020 and the second wave in the autumn of the same year, Italy has been one of the countries most affected. For frontline healthcare workers the two waves posed different problems. In the first phase of the outbreak, the sudden overload of work, the lack of protective equipment, fear of infection, insufficient knowledge of safety procedures, and uncertainty about treatment criteria were among the major problems. Materials and methods: This is a prospective study was conducted at Department of Community Medicine, Prathima Institute of Medical Sciences, Karimnagar. With this broad perspective in mind, to grasp the complexity of the problem. Result: Most of the participants (31.1%) were non-smokers and nondrinkers. About 22 (24.4%) of the doctors modify their life style and 60 (66.7%) used home remedies as preventive methods against this viral infection. Despite decreased financials, a majority of healthcare workers 65 (72.2%) did not feel harassed and took pride in their work. Conclusion: In our study longitudinal study of weight changes, eating patterns, physical activity, and psychological factors among a specified group of FHWs. The findings contribute to the current body of growing evidence to best understand how pandemic-induced life style disruptions shape health behaviors and weight change among FHWs.

Introduction: Rectal cancer is a common malignancy in both men and women, with about 40,000 new cases in the United States and more than 14,000 cases in the United Kingdom in 2015. Despite the overall decrease in incidence and mortality from colorectal cancer, the incidence in young individuals is rising, with a 124% increase expected among 20-34-year-olds by 2030. In 2018, there were 56750 new cases of rectal cancer recorded in India. Despite efforts to implement screening programmes, the majority of individuals are diagnosed at a locally advanced stage of the disease (T3-T4, Nx, and Mx). Aims: Response evaluation after neo adjuvant CT and RT treatment for rectal carcinoma using MRI imaging. Materials and methods: The present study was a prospective observation cohort study. This Study conducted for one and half years from January 2019 to June 2020 at department of Radiotherapy, AGMC and GBP Hospital and Regional Cancer Institution, Agartala. Total 66 patients were included in this study. Result: Almost one third of the patients presented with a chief complaint of per rectal bleeding, which was the most common symptom. Significant unexplained weight loss was experienced by 24.2% of the participants, followed by recurrent abdominal pain (18.2%), constipation (16.7%) and diarrhoea (10.6%). As for co-morbidities, it was seen that around two-thirds (77.3%) of the patients had no comorbidity. Diabetes mellitus was seen in 15.2% of the patients while essential hypertension was marked in 12.1% of the patients. Chronic Hepatitis B infection was seen in 1 patient (1.5%). A large proportion of the participants reported suffering from addiction to betel nuts (34.8%), alcohol (28.8%) and tobacco (18.2%). It was seen that only one participant (1.5%) had a family history of rectal carcinoma. Conclusion: MRI is important not only in the initial staging of rectal cancer, but also in the context following neoadjuvant chemoradiation therapy. MRI provides superior soft-tissue characterization, enabling for both primary and nodal tumour staging, as well as examination of tumour morphologic alterations that have been demonstrated to correlate with treatment response. These MRI characteristics have been proven to correlate well with pathologic response and may be predictive of tumour recurrence and patient survival. More research into established and upcoming MRI techniques will help to refine the function of MRI in the care of patients with rectal cancer undergoing neoadjuvant therapy.

Introduction: Infections of respiratory tract are perhaps the most common human ailments. They are the source of discomfort, disability and loss of many work days for most adults. They lead to substantial morbidity and mortality in young children and elderly. Among the respiratory infections, pneumonia is a common cause of hospital admission, although a majority are treated in out-patient settings. Pneumonia presents as a challenge to physicians, have to decide on therapy without the benefit of definitive etiological diagnosis as the clinical features of pneumonia are neither sensitive nor reliable guide in permitting an etiological diagnosis. Diabetes mellitus is a very prevalent chronic metabolic disorder that is present in about 5-10% of elderly population. Several aspects of immunity such as polymorphonuclear leukocyte function i.e., leukocyte adherence, chemotaxis, phagocytosis and bacterial activity of serum are depressed in patients with diabetes. In this study we proposed to determine whether the clinical or radiological findings, the causative organisms or the out-come of pneumonia are modified by presence of diabetes mellitus as underlying disease. Material and Methods: This is a Prospective study conducted among 30 diabetic patients and 30 non-diabetic patients with bacterial pneumonia admitted at Prathima Institute of Medical Sciences. A diagnosis of diabetes mellitus was based on previous clinical and /or biochemical diagnosis and /or treatment with oral anti-diabetic agents or insulin. Sputum was collected for bacteriological examination after rinsing the mouth with saline before institution of antibiotic therapy and subjected to following tests. Sputum was examined macroscopically with respect to quantity, colour, odour and evidence of haemoptysis. All the sputum smears were stained with gram’s stain.Those smears which showed more than 25 polymorphs per low power field and less than 10 squamous epithelial cells per low power field was considered as appropriate sample and others as inappropriate. Sputum was also examined for AFB by Ziehl nelson (ZN) stain. The purulent portion of the sputum was inoculated on blood agar, Mac conkey’s medium and heat blood agar. These were read after overnight incubation. Results: The average age in SG was 46.43 ± 8.65 yrs and in CG were 44.3 ± 9.37 yrs. Most of the patients (80% in SG and 70% in CG) were between 40 to 60 years. Most of the patients in both groups were males (66.7% in CG and 80% in SG). There was no statistically significant difference regarding sex in both the groups. The commonly associated co morbidities in CG and SG were Asthma (3.3% vs 6.7%), COPD (16.7% vs 23.3%) and IHD (10% vs 20%). There was no statistically significance difference of associated co morbidities in between two groups (p = 0.207). The complications in diabetic group were Pleural effusion (13.3%), septic shock (16.7%), Renal failure (3.3%) & MODS (3.3%) in comparison with Non – Diabetic group were Pleural effusion (6.7%), septic shock (10%). Patients in diabetic group were predominantly among PSI class IV and V (53.3%), in comparison with non – diabetic group who were predominantly in PSI Class I (53.3%). Conclusion: In patients with pneumonia, Diabetes mellitus is a significant prognostic factor of mortality. Polymicrobial etiology, multilobe involvement and increased severity in the form of high PSI score are associated with poor prognosis. Comorbidities of the patients rather than microbiological findings attribute to adverse outcome. Associated comorbidities like CVA, IHD, COPD and asthma had poor outcome in both the groups. However, diabetics had worse outcome compared to non-diabetics. Thus emphasizing on the fact that more efforts are needed to increase awareness of impact of uncontrolled DM on the clinical outcome of CAP.

Introduction: Acute kidney injury is defined by a quick decline in renal function, and it is frequently linked to the emergence of serious complications as well as an independent mortality risk in patients who have been admitted. Methods: To evaluate the importance of urinary biomarkers tissue inhibitor metalloproteinase and IGFBP 7 (Insulin growth factor binding protein 7) in early detection and diagnosis of acute kidney damage in patients presenting to emergency room. Study site: emergency room and the ICU (medical, cardiac and surgical) at a tertiary health care centre. Study population: All patients attended the emergency room and admitted in medical and surgical units for 18 months were included in the study. It is a prospective, observational double blinded study. Study period:  January 2018 to June 2019. Sample size 120 patients.  Results: In our study population, serum creatinine (<1.1 and 1.1) and nephroncheck values were compared at admission and there was statistical correlation between nephrocheck and creatinine (P=.04565) and serum creatinine and urinary biomarkers values were correlated at 48 Hrs after admission, there was no statistical correlation between urinary biomarkers and creatinine(P=0.3463). Conclusion: Acute kidney injury was two times more common in above 50 years of age. High early mortality in AKI (Acute kidney injury) died within 48 hours of enrollment. Tachycardia and hypotension are associated with ATI (acute tubular injury) as manifested by high levels of biomarkers at 48 hours. Hypoxemia also contributes to acute kidney injury. Patients with initial normal nephrocheck values are unlikely to have serum creatinine>1.1 at 48 hours.

Introduction: In Thalassemia major there is decrease or total suppression of hemoglobin polypeptide chain synthesis occurs. Patient require regular blood transfusion to maintain normal Hb level greater than 10 gm% [17]. An inevitable, important and potentially lethal complication of administering repeated blood transfusion to a child with thalassemia is gradual overloading of body with iron. Iron deposition on various organ affects their function including lungs. Pulmonary deposition of iron ultimately leads to decease in function of lungs which can be assessed by spirometry and their correlation can be derived. From the above facts one can apprehend the problem of associated complication in thalassemia major children receiving regular blood transfusion. Aim &Objectives: To determine the pulmonary function status in beta-thalassemia major patients receiving regular blood transfusion. To study the pattern of respiratory impairment using spirometry. Also to estimate iron overload status by estimating serum ferritin level and with these values correlation of respiratory impairment with iron overload in thalassemia patients. Methodology: Hospital based observational cross-sectional prospective study, of sample size 81 having diagnosed as Thalassemia major of patients between age group of 6year to 14 years. Just before transfusion, venous sample collected from all participants and serum ferritin levels were assessed. Serum ferritin levels were recorded in the chart of patients every 6 months. Serum ferritin was derived by calculating the average measurement over a 2-year period for each patient. Further patients were categorized into population group A and population group B whom having serum ferritin level greater than or equal to 2500ng/ml and less than 2500ng/ml respectively. PFT was performed on the day scheduled for blood transfusion. Results were expressed as a percentage of normal. To compare the clinical parameter and biochemical parameters, chi-square test of association has been used. For comparison of study variable, independent student t test was used. For correlation of number of blood transfusion with serum ferritin, pearson correlation co-efficient has been used. The results were compared by using SPSS software version 17. Results: Patients with higher number of transfusion i.e. greater or equal to 140 showed increased chance of pulmonary abnormality as evidenced by mean FEV1(91.82±3.556) which was significantly higher compared to patients with less number of transfusion (i.e. less than 140) was (86.23±2.224). Pulmonary function test parameter FEV1 when compared to serum ferritin level. It was found that mean FEV1(91.06±3.564) level of population with serum ferritin level less than 2500 is significantly higher than mean FEV1(81.18±4.177) of population with serum ferritin level higher or equal to 2500, which is statistically significant as evidenced by p-value of 0.001 Conclusion: Patients with higher number of transfusion showed  increased chance of pulmonary abnormality. The severity of the restrictive disease increases in older age and with more transfusion iron burden, which is indicative of a central role of iron in the pathogenesis of pulmonary function abnormality, which is associated with thalassemia major. This study will emphasise, patients with Thalassemia major on regular blood transfusion need monitoring throughout treatment to avoid future Pulmonary complications.

Background: Fractures, stemming from trauma or medical conditions, pose significant challenges to global healthcare. Despite extensive research on biomechanical aspects, the systemic impact on mineral homeostasis, particularly urinary calcium dynamics, remains understudied in adults undergoing fractures and surgical interventions. Materials and Methods: A prospective observational study conducted at a tertiary medical college in Uttar Pradesh, India, aimed to scrutinize urinary calcium levels in adults with fractures and surgical intervention compared to a fracture-free control group. Participants included adult patients (n=150/group) with fractures requiring surgical intervention and age-matched controls. Serum and urinary calcium levels were assessed, and statistical analyses were performed using appropriate tests. Results: The "Fracture + Surgery" group exhibited lower mean serum calcium levels (9.3 mg/dL) compared to controls (9.7 mg/dL, p<0.001). Urinary calcium levels were significantly elevated in the "Fracture + Surgery" group (175 mg/24h) compared to controls (120 mg/24h, p<0.001). Subgroup analysis based on fracture types revealed nuanced variations in urinary calcium dynamics. Type 2 fractures exhibited the highest mean urinary calcium levels (180 mg/24h, p<0.001). Conclusion: Our study highlights disruptions in calcium metabolism following fractures and surgical interventions, emphasizing the need for comprehensive clinical management. The setting in Uttar Pradesh provides unique insights into diverse patient populations. Future research should explore molecular mechanisms underlying these changes and targeted interventions.

India is witnessing a demographic transition, leading to a rapid increase in the number of older people. Present study was aimed to study health problems and disability of elderly population at a tertiary hospital. Material and Methods: Present study was prospective, observational study, conducted in cases above 60 years, both gender, selected were from daily medicine OPD. Results: 100 elderly cases satisfying study criteria were studied. Majority of elderly were from age group of 66-70 years (31 %), were male (56 %), belongs to socioeconomic class IV (38 %). Common disabilities were visual (32.39 %) followed by locomotive (28.16 %), hearing (23.94 %), mental (8.45 %) & speech (7.04 %). Genderwise visual (12 males & 11 females) & locomotive (11 males & 9 females) disabilities were common. According to age groups, disabilities were common in 60-69 years (29 cases) followed by > 80 years (28 cases) & 70-79 years (18 cases). Majority adults showed good abilities of selfcare as bathing (92 %), self-feeding (92 %), dressing (90 %), ambulation (88 %), toileting (88 %) & transfer (86 %). Among male elderly 5.86% were able to Prepare meals for themselves, 89.28% were able to shopping, 85.71% were able to light homework, 82.14% were able to financial management, 78.57% were able to medical managements 85.71% able to use the transportation, 19.64% were able to use telephone. Among female elderly 95.45% were able to Prepare meals for themselves, 90.90% were able to shopping, 90.90% were able to light homework, 81.81% were able to financial management, 86.36% were able to medical managements 77.27% able to use the transportation, 20.45% were able to use telephone. Conclusion: The common health morbidities seen in elderly were anaemia, hypertension, diabetes, cataract, arthritis and neuropsychiatric.