Background: The Calcium Score (CS) is a pre clinical index of atherosclerosis and the prediction of cardiovascular risk is more accurate if CS is included. Current guidelines recommend the use of CS scoring for cardiovascular risk with intermediate-risk patients but there is not established the role of CS in patient with low risk factors.Objective: To define the prognostic significance of CS in smokers (SMO) or not smokers (NSMO)without symptoms. Diabetic patients were excluded in the first analysis.Methods: we’ve studied, in primary prevention, 32 not diabetic patients, 16 females and 16 males, range 60 ± 15 years old, with a metabolic syndrome based on the Third Adult Treatment Panel ATP III criteria of the National Cholesterol Education Program. Patients underwent to a heart coronary CT angiography (HCCT), a not invasive procedure. We have classified the patients into two groups: SMO (a pack of cigarettes for 10 years minimum) and NSMO (In NSMO category are included adults patients that have never smoked or have smoked not more than 100 cigarettes during their entire life). The SMO displayed have higher CS (94 (3;301.5) vs 0 (0;10.2); p<0.001), in comparison with NSMO. Accordingly, the associations between CS and cigarette smoking was still maintained after adjustment for age (rs 0.317; p<0.05). Finally, multiple regression analysis showed that smoke was the variable that best predicted the CST variance (R2 0.131; ®-standardised coefficient 0.362; p<0.05) . Results: CS gravity and extension have been elevated in smokers and the statistical correlation has been highly significant. CS is related to age, epicardial fat and smoke. Stepwise analysis demonstrated that smoke parameter is independent to age and epicardial fat. Conclusions: CS score offers a direct measurement of subclinical coronary pathology. Our study demonstrates that smokers have an elevated CS and the CS, in our opinion, is absolutely useful for the screening of coronary disease in asymptomatic smokers.

Objectives: The aim of current study is to evaluate relation between body mass index (BMI) and in-hospital outcome in patients undergoing percutaneous coronary intervention (PCI). Background: Relation between body mass indexes (BMI) with percutaneous coronary intervention (PCI) has shown in different studies. Recent studies suggested a paradox relation between different BMI values and outcome in certain patients. Methods: In this prospective study, 1134 patients (81.7% male, 18.3% female with mean age of58.18±11.16 years) whom undergone PCI between January 2011 and December 2011 were chosen and their BMI and disease outcome was studied. Classification of BMI was: healthy weight (18.5 to24.9 kg/m2), overweight (25 to 29.9 kg/m2), moderate obesity (30 to 34.9 kg/m2) and severe obesity (over 35 kg/m2). Baseline patient characteristics and in-hospital outcome were compared among BMI categories. Results: Major adverse cardiac events (MACE) were significantly higher in patients with overweight and moderate obesity than two other groups. There was no difference in mortality, reinfarction, revascularisation, stroke and bleeding events among the 4 groups. Being overweight is an independent factor associated to in-hospital MACE (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.17 to 0.73, p=0.01) and mortality rate (OR 0.20, 95%CI 0.04 to 0.85, p=0.03). Conclusion: BMI overall is not correlated to in-hospital MACE and mortality; however, overweight patients are at reduced risk for MACE and mortality.

Clopidogrel and Aspirin are widely used antiplatelet agents in the prevention and treatment of isch- emic heart disease (IHD). Many patients have been noticed with recurrence of major ischemic events, due to resistance of these drugs. Different platelet function tests can be used to evaluate the de- gree of achieved platelet inhibition in patients treated with clopidogrel. The objective of this study was to determine frequency of clopidogrel resistance in patients of ischemic heart disease. Seventy one patients of IHD were selected from out-patient department of Punjab Institute of Cardiology Lahore. Platelet aggregation studies were performed on Diamed Impact R. Clopidogrel response as- say was performed with DiaAdin(ADP 110µmol/L). Chi-square test was applied to measure statistical significance. Resistance to Clopidogrel was observed in 17% (12 out of 71). Clopidogrel resistance was significantly associated with female gender (p=0.046). In our study no statistically significant as- sociation was observed between clopidogrel resistance and risk factors like diabetes mellitus, family history ischemic heart disease, hypertension and smoking. We concluded that resistance to Clopido- grel therapy is seen in significant number of patients and female patients are at high risk of develop- ing the resistance to clopidogrel therapy. These patients can be identified by performing platelet aggregation studies on Impact R.

Addiction involves continuous use of a substance with neglect of other things in life. It essentially incorporatesconceptslikeCraving, Tolerance, Withdrawal, Abuse etc., developing a sense of Dependence in the person. With the increasing civilization and modernization, abuse of various substances has been rampant across all age groupsspecially youth. Recent National Crime Record Bureau (NCRB) dataindicates that maximum crime against society conducted by Youth were under drug or substance influence. With an overall increase in understanding, towards managingpersons with substance abuse, various treatment modalities were in place. However, review of existing literature indicates that, use ofbehavioraland/or pharmacologicaltreatment modalities, though targeting Craving issues are,at best yielding mixed outcomes.Relapses are commonly seen in person with addiction problems as the sense of Craving- meaning the urge to take a substance, is not well tolerated by the addict. Further, it also poses challengeseven with use of cognitive therapeutic techniques to induce a sense of comfort in the substance/drug addiction,for, craving is not for the intake of substance/drug, but for the pleasure(pleasurable sensations) that the person gets after intake of a particular substance/drug. So here Vipassana Meditation can be effective, for, it helps the person to understand the impermanence nature of all (bodily) sensations, be it unpleasurable or pleasurable ones. Thereby with practice of Vipassana, the person gradually develops a sense of perfect Equanimity of mind, so there will be no aversion for unpleasurable sensations and no Craving for pleasurable sensations. Thus, with practice of Vipassana the addict can come out of his addiction, permanently.

If tricuspid regurgitation (primary and secondary) is left untreated, it will be associated with significant complications and death, even if left ventricular dysfunctions are corrected, TR does not decrease in many cases. Since many studies have not been conducted in this area, we decided to evaluate the results of tricuspid repair. In this retrospective study conducted since 2006 to 2011, 448 patients undergoing tricuspid surgery with different methods with or without surgery were studied. Statistical analysis was performed by Friedman, Fisher exact and Pearson chi-square methods. In the Mod and Severe RV dysfunction section, the mean age of the patients was 52 years, 289 were female (64%), 343 (76%) had rheumatic pathology, 79 (17%) had myxomatous pathology, 12 (2%) had endocarditis pathology, and 14 had an unknown pathology. Before surgery, Mod and Severe dysfunction was seen in 226 patients (40%) and after surgery (follow up), it was seen in 85 patients (19%). Before surgery, Mod and Severe TR was seen in 356 patients (79%) and after surgery, it was seen in 91 patients (20%). The mean of PAP before surgery was 54 mmHg and after surgery, it was 37 mmHg, which was significant in all cases (P<0.05). Out of 282 people with Mod to Sever TR before the surgery by bicuspidization method, 37 people reached follow up and out of 156 people operated by devega method, 22 people reached follow up and out of 65 people operated by ring method, 9 people reached follow up. Based on the results obtained in this study, all the methods used for tricuspid repair are useful, but the results of ring use and bicuspidization were better than devega method and had less residual TR after surgery. Therefore, it is recommended to use the Ring method in cases of TR with or without involvement of other valves, since it showed better results and bicuspidization method and devega method are not recommended.

Infection with Helicobacter pylori (H. pylori) is a prevalent global infection that is a leading cause of peptic ulcer disease and stomach cancer. Determine the prevalence of H. Pylori in the province of Thi-Qar from 2017 to 2018. Data was collected utilizing a periscope on the second floor of Educationa Al Hussein Hospital's Gastroenterology Unit for patients with gastrointestinal ulcers on the basis of age, gender, housing area, and month. A survey of the therapies utilized throughout the world was performed to get information on ulcer therapy. The current study found that the number of people infected with H. pylori in 2017 was higher than the number of people infected in 2018, in both sexes, with the overall number of people infected in 2017 being higher than the total number of people infected in 2018. (250). Females between the ages of 15 and 35, living in the countryside during the month of May, had a significant frequency of H. pylori with gastric ulcer. The treatment of stomach ulcers employed in the gastrointestinal unit of the patients was positive tests for H.pylori infection, Treatments were pretty similar with the global sources, but were not categorized into standard or alternative therapy, and did not employ Levofloxacin in treatment. This demonstrates the doctor's ability in selecting proper treatment in Educational Al Hussein Hospital as an alternative therapy.

Abstract: Introduction: Lower urinary tract symptoms (LUTS) is a common condition, with Benign prostatic hyperplasia (BPH) being a frequent condition in men over 50 years of age. The natural history of BPH is characterized by an age-dependent increase in histological changes and an increase in prostate size. Cystoscopy is often used in the diagnosis and treatment. This study aims to assess the relative use of cystoscopy in patients with LUTS. Methods: The study design is a descriptive, prospective study design. The targeted group were male patients above the age of 50 years who presented with lower urinary tract infection in Yastabshiron, and Ibn Sina hospitals between the periods of (August 2015-January 2016). Primary data collected from sampling units using a questionnaire containing questions of the variables of interest. The data was analyzed by using Statistical Package for Social Science (SPSS) and chi square for analysis with alpha level of significance 95%. All appropriate permission and consents were taken.Results: BPH was diagnosed in 90% of cases. 60% of patients had complications. The most common complications was Orchitis/Epididymitis and found to be in 26% in study participants, followed by hematuria in 18%, dysuria in 12% and stricture in 4%. The mean reduction in IPSS score for those receiving medical treatment was 4.8, while in the cystoscopy group it was 3.8. Independent sample t test analysis shows that there is a statistical difference between the cystoscopy and medical treatment groups (p=0.016). Conclusion: A trial of medical treatment was found to be significantly better at treating the symptoms of patients with LUTS as compared to cystoscopy. Since cystoscopy is associated with a high rate of complications, a trial of medical treatment should be the first line treatment.

Appendicular mucocele is defined as an obstructive dilatation of the appendix caused by intraluminal accumulation of mucoid material. It has an incidence of 0.2-0.3%, commonly seen in females and individuals more than 50-years of age. A 25-year-old male was referred from a peripheral healthcare facility for an abdominal and pelvic ultrasound scan on account of recurrent episodes of lower right quadrant (iliac-region) pain and discomfort. The ultrasound scan demonstrated tenderness with sonographic probe pressure over the right iliac region, a blind ending tubular structure with dilated central lumen (dilated appendix), a linear echogenic structure casting posterior acoustic shadow and causing luminal obstruction within the appendix. An oval cystic area measuring about 18mm in widest diameter with echogenic walls, internal echoes and mixed echo material forming a circumferential rim in the innermost aspect of the cystic area, this is most likely the mucocele. A mixed echo material is also noted clogging the lumen of the appendix before the cystic mass. A diagnosis of acute appendicitis coexisting with features of a complex cystic mass most likely a mucocele. We present the ultrasonographic features of acute appendicitis coexisting with a complex cystic mass most likely a mucocele in a 25-year-old male patient.

The virus which has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (abbreviated “COVID-19”) is an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in Wuhan City, Hubei Province, China since December 2019 and which has now been detected in 37 locations internationally. Person-to-person spread has been reported both China and outside China. Reported illnesses have ranged from mild to severe, including illness resulting in death. Even though a large number of medical personnel have been mobilized from all over the country to help Hubei, there is still a lack of medical personnel, medical protective equipment and medical places. Mild patients are novel coronavirus pneumonia patients with mild symptoms. The mild cases in Wuhan account for 32%. The main treatment measures are isolation and oral medication. The proportion of severe patients in Wuhan is 4.7%, and the proportion of critically ill patients increases with age. Most of the patients with severe illness are old people, many of the work that need to be done by the nurses now because of lack of nursing workers, and the workload of nursing is heavy. In order to alleviate the above problems, it is suggested that mild cases (aged between 18 years and 60 years old, without basic diseases, persistent high fever, and mental disorders, with a PS score of 0) should take care of the self-rescue medical mode of the critical patients on the principle of voluntariness, implement the 4-h shift system, and return to the shelter hospital for isolation and oral drug treatment on the principle of proximity after the care. In addition, priority should be given to the patients who are transferred to the intensive care unit or their immediate family members. This method would firstly, greatly alleviate the shortage of medical staff and medical protective articles; secondly reduce the infection rate of medical staff; realize the sharing of care workers and the reasonable and fair distribution of medical resources which finally effectively shorten the time of epidemic control

Background: Left atrial enlargement (LAE) has been proven to be significantly related to stroke and cardiovascular diseases. Previous studies have shown a link between Left atrial enlargement (LAE) with the increase in the risk of stroke and cardiovascular diseases (CVD). Bangladeshi data is lacking on the exact prevalence of LAE. Aims and Objectives: To study the prevalence of LAE and its associated risk factors. Materials and Methods: Hundred patients having were studied in the Department of Vascular Surgery, Bangabandu Sheikh Mujib Medical University (BSMMU), and Dhaka, Bangladesh from January 2020 to December 2020. After a complete physical examination, echocardiogram was performed in all the patients. In present study LAE is defined if the LA diameter is more than 4.0 cm in men and 3.8 cm in women. We performed multivariable logistic regression analysis to identify risk factors for LAE. Results: Prevalence of LAE was 8%. The prevalence of LAE was higher in men (9.37%). On multivariable logistic regression analysis advancing age (OD;1.034), increased systolic blood pressure (SBP) (OR: 2.862), increased diastolic blood pressure (DBP) (OR: 1.32), abnormally high BMI (OR: 3.721), increased prevalence of diabetes (OR: 1.245), increased left ventricular myocardial index (LVMI) (OR: 1.023), and decreased left ventricular ejection fraction (LVEF), decreased heart rate (HR), and decreased estimated glomerular filtration rate (eGFR) were found to be the major risk factors of LAE. Conclusion: A significant number of patients had LAE. Among the risk factors advancing age, increased SBP, increased BMI, presence of diabetes mellitus, increased LVMI, decreased eGFR, decreased LVEF, and decreased HR were more common.

Allergic rhinitis is the most common atopic disorder seen in the outpatient clinic. Montelukast, is a novel medication, is an antagonist to the leukotriene receptor. The aim of this work was to identify the improvement in the severity of symptoms of child with AR treated with Montelukast. A cross-sectional study was conducted among fifty-patients with a chronic cough and (sneezing, nasal congestion, rhinorrhea, and postnasal drip) at least eight weeks using Montelukast between the periods of January 2019 to March 2019. By using the symptom severity score for AR, that calculated. Data including (age, gender, associated disease, exacerbation factors, and classical therapy). The dose of 10-mg Montelukast once daily was prescribed. On follow-up, after four-weeks, compliance was ensured and then the symptom severity score was recorded again. Most of patients aged above 40 years. Males to females ratio was 1:1.5. Most of patients (40, 80%) lived in urban regions. There was a reduction of the symptoms associated with RA after treatment with Montelukast. Exacerbation factors was as following, dust was found in 80%, food 40%, exercise 64%, psychological 50%, and smoking 48%. SSS was declined after therapy significantly (P=0.05). Patients using showed improvement of symptoms, pain was relieved from 82%, exhaustion 80%, vomiting 92%, sleep disturbance in 80%, affecting daily life in 88%, and syncope 96%. In conclusion, the common symptoms of AR are improvement in response to Montelukast. The improvement in the symptom severity score was maximum in sneezing-nasal congestion- rhinorrhea and least in postnasal drip

Background: Maternal nutritional status is important for health and quality of life in women and growing fetus. Maternal weight gain in pregnancy can offer a good means of assessing the wellbeing of the pregnant mother and her baby. Inadequate prenatal weight gain is a significant risk factor for intrauterine growth restriction, preterm delivery and low birth weight in infants. Obesity and excessive weight gain on the other hand can lead to adverse maternal and fetal outcomes. Interestingly, to get a good fetomaternal perinatal outcome mode of delivery decision is also changed with BMI. Objective: The aim of the study was to evaluate the effect of maternal BMI on the mode of delivery. Methods: This cross-sectional study was carried out department of obstetrics and gynaecology at Bangabandhu Sheikh Mujib Medical University. A total 100 population of purposive sampling was the methods of choice to select the sample from the hospital admitted patients during the period from August 2016 to December 2017. Results: The mean age of 100 mothers were 28.4 (± 6.2) years. The maximum mothers attended from 3rd trimester were overweight (55.36%) whereas 44.64% from the same trimester were normal BMI mothers. Maximum mothers (27%) were from 25-29 years age group and the minimum mothers (4%) were from >= 40 years. Forty Seven Percent mothers came as primigravida. Primigravid women and multigravida with LSCS and without LSCS showed different mode of deliveries. The more the gravida with history of caesarean section the more frequency of present occasion of CS (p=0.006). The higher BMI showed more frequency of caesarean section than NVD or assisted delivery (p=<0.00001) Multiparous women showed more BMI than the p nulliparous. (p=0.005). Multiparity, maternal age and pre-existing medical conditions revealed more complicated labor. Conclusion: The more BMI of mother showed more frequency of caesarean section, assisted delivery than the normal vaginal delivery.

Objective: The present study investigated the antioxidant activity of ethanol extract of leaves of Ageratum conyzoides. Methods: leaves of ethanol extract of Ageratum conyzoides were tested for in vitro free radical scavenging assays, nitric oxide, such as hydroxyl radical, inhibition of superoxide anion radical, 2, 2-diphenyl-1-picryl hydrazyl radical (DPPH), and hydroxyl radical. Results: leaves extract effectively scavenged free radicals at all different concentrations and showed its potent antioxidant activity. Further, these effects were in a dose dependent manner. Results were compared to standard antioxidants Conclusion: leaves of Ageratum conyzoides showed strong antioxidant potential.

Background: Diabetes is one of the most common chronic diseases. The development of albuminuria in Type 2 Diabetes (T2DM) increases the risk for renal disease. Methods: The study was retrospective conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 1583 Saudi with T2DM were randomly selected. Results: Total of 1583 patients with T2DM included in this study; 636 (40.2%) male and 8947 (59.8%) female with mean age 56.0

Since the first reports of a novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged from the province of Wuhan, China in December 2019 [1], it has brought the entire worldwide to a standstill and impacted every single individual on the planet. In this age of globalization, as expected, the eyes of the world have been vehemently focused on the medical fraternity in hopes of a so far elusive cure. In spite of hundreds of clinical trials, anecdotal reports and off-label attempts, no therapy has proven to be effective in improving outcomes nor provide effective prophylaxis. Intense social, political and media scrutiny, along with the sheer scale of the pandemic, have presented a unique challenge to the medical and scientific fraternity to be able to develop effective remedies in an extremely limited amount of time, and at times, with limited resources as well. Unfortunately, the discovery and licensing of a nascent molecule as an effective drug involves a prolonged gestational period, creating an unacceptable lag between therapeutic need and availability. Drug repurposing, a novel approach which involves identification of new indications for pre-existing drugs, is an economic and time saving endeavor [2], allowing a drug to directly enter phase III or IV clinical trials, thereby saving billions of dollars in production cost [3]. Much like the Middle East Respiratory Syndrome virus (MERS), the SARS-CoV-2 spreads through the respiratory route; however, unlike the former which utilizes Dipeptidyl Peptidase 4 (DPP4), it utilizes Angiotensin Converting Enzyme 2 (ACE 2) as a receptor to enter cells [4,5]. Fusion, is followed by endocytosis of the virion, which is facilitated by an acidic environment, wherein comes in to play diprotic bases such as hydroxychloroquine and chloroquine [6]. Activation of the main RNA Dependent RNA Polymerase (RDRP) enzyme requires proteolysis by a viral protease. Inhibition of the latter by anti-retroviral agents such as lopinavir, ritonavir and darunavir hold therapeutic promise [6]. Agents targeting RDRP such as remdesivir, favipiravir and arbidol have demonstrated some degree of in vitro and in vivo activity against SARS-CoV-2.

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 300 patients of low back pain between the age group of 31-70 years of both sexes who were admitted and treated at Dept. of Forensic Medicine, Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, Osteoarthritis and history of trauma. The provisional diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A neurological examination of the lower limbs was performed. Results: The author tabulated 300 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (124) is observed in the age group of 31-40 years (41%) and the lowest number of cases (45) is observed in the age group of 51-60 years (15%). All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a rigorous clinical examination and a battery of investigations. In 300 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively).The study found association between low back pain and various factors. Prevention is the best strategy for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large proportion of the population and is difficult to diagnose. Physicians must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of debilitating back pain.

Aim: To assess obstetric patients treated in anesthesiology intensive care unit. Methods: We retrospectively screened 269 patients. In all patients, gestational age, mode of delivery, parity, referring clinic, previous medical disease, diagnosis at admission, APACHE II Score and GCS score were recorded. Clinical course in intensive care unit and cause of death in non-survivors were recorded. Results: The percentage of obstetric patients treated in intensive care unit was 9.4% with a mortality rate of 3.7%. Preeclampsia, eclampsia and HELLP syndrome were leading causes for intensive care unit admission. Conclusion: Most common cause of death was postpartum bleeding and its complication.

Described as the most common cause of gastric outlet obstruction and the most common surgical cause of vomiting in infants, Hypertrophic Pyloric Stenosis (HPS) is defined as a hyperplasia of smooth muscle fibers of the pylorus that is responsible for the narrowing of the pyloric canal and obstruction of gastric emptying. It occurs at a rate of 1–4 per 1000 live births with a male to female ratio 4:1. The classic presentation of HPS is nonbilious, projectile vomiting in a full-term neonate with a classic presentation at 3 to 4 weeks of age. We report in here a delayed presentation of HPS in an infant aged 4 months who presented with projectile nonbilious recurrent episodes of post prandial vomiting, where history, examination and investigations supported the diagnosis of HPS and Ramstedt's pyloromyotomy was curative.

Hepatic tuberculosis is a rare form of extra-pulmonary tuberculosis The aim: to describe the clinical, morphological and evolutionary aspects of hepatic tuberculosis. Methods: The medical data of all cases of hepatic tuberculosis admitted to our department. Results: Among the 240 cases of abdominal tuberculosis, 6 patients had a hepatic location with a prevalence of 2.5%. They were 2 men and 4 women, with an average age of 38 years. The clinical and imaging manifestations were various. The diagnosis of tuberculosis was confirmed by the pathological study of the liver biopsies (4cases) or by the association of clinical, biologic and morphological arguments (2cases). The clinical and biological course was favorable in all patients under anti-tuberculosis protocol. Conclusion: Hepatic tuberculosis, although rare, should be considered in endemic countries. Its diagnosis is difficult to establish, because it simulates many pathologies.

Acute abdominal pain in children represent a diagnostic dilemma, generally although many causes of acute abdomen are benign, other require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common surgical cause is acute appendicitis. This study tries to evaluates the distribution of cases through the age and the fate of the management and complications that may occur during the course of the disease. This is a prospective study over a period of six months starting from March 15th to September 15th 2018. A total of 82 child were included in this study who are presented to our hospital complaining of acute appendicitis. The patients divided in to three groups according to their age, undergo careful clinical evaluation supplemented by laboratory and radiological investigations followed by surgical intervention and histopathological study. Eighty – two child suffering from acute appendicitis were included in this study, 44 male and 38 female , those 82 case undergone surgical line of appendectomy, no line of conservative treatment was applied and no any case of appendicular mass was included in this study, seven cases from those patients were presented with generalized peritonitis due to perforated appendices. From estimation of the cases we found that acute appendicitis in pediatrics age groups. during comparing the examination of child with adult patient has revealed that any child with abdominal pain should be carefully examined and the examination may be repeated more than one time to cover the area of examination in order to enhance good management through perfect diagnosis because the examination is more difficult than in older patients and need skills of communication between the surgeon and the child.

Introduction: Infertility is a public health problem associated with medical, emotional, social, and financial consequences. Recent study on infertility suggests that in India, approxi- mately 15 to 20% of married couples in the reproductive age group suffer from infertility and its incidence is on the rise. Artificial reproductive techniques (ARTs) including IVF/ICSI and ET have been a major development in the treatment of infertility. Objective: To compare reproductive outcomes of day 2 and day 3 embryo transfer (ET). Materials and methods: In this retrospective records study, all couples who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and ET cycles at International Fertility Center, Delhi, India over a period of 1 year were studied. Data were collected and analyzed by chi-square test and unpaired t-test by Statistical Package for the Social Sciences, version 19. Results: There was no statistically significant difference between the clinical and demographic parameters of group day 3 and day 2 ET. In our study, clinical pregnancy rate was 45% in day 3 ET and 36.5% in day 2 ET group [odds ratio (OR) 1.43, p-value 0.49]. The ongoing pregnancy rate was 39.2% in day 3 ET and 26.9% in day 2 ET group (OR 1.75, p-value 0.26). We observed that the miscarriage rate was 5.9% in day 3 ET and was 5.8% in day 2 ET group (p-value 0.69, OR 1.02). We observed one case each of multiple pregnancies, ectopic pregnancy, and fetal anomaly (anencephaly) in day 2 ET group, while in day 3 ET group, no such case was detected. Conclusion: There are chances that day 3 ET has better clinical and ongoing pregnancy rates than day 2 ET, but the difference is not statistically significant. Study showed similar miscarriage rates in both groups and very low incidence of complications like multiple pregnancy, ectopic pregnancy, and fetal anomaly. So, it is safe to schedule and transfer embryos either on day 2 or on day 3 for planning and programming cycles in coordination with patient and IVF team and for adjusting weekends (nonworking days).

Yam is a very essential tuber stem with relevance to nutrition, medicine and others. In this review, common cultivars of yam were discussed in respect to genetic indicators, modifications, development and evaluation of molecular markers, genetic improvement of yam, hybridization and selection of cultivars. Other important areas reviewed from different articles include genetic tools for yam improvement, properties of yam cultivars, phytochemicals of yam, phytochemicals interactions with edibility of yam as well as nutritional value of yam, processing methods and biological implications, effects of processing methods on the nutrient and anti-nutrient composition of yam; and the storage techniques practiced in yam farming. Information from this review will enable scientists, government agencies, policy makers amongst others to make quality decisions as it relates to yam and food availability towards achieving the United Nations sustainable development goals.

Quinolone antibiotics have potentially serious proarrhythmic effects. The effects on intracardiac potassium channels result in QT interval prolongation, leading to torsades de pointes. Evidence suggests fluoroquinolones cause QT-mediated proarrhythmia, and weak evidence links ciprofloxacin with QT-mediated arrhythmias. Ciprofloxacin may be given to select patients because the agent is believed to be safer than other drugs in its class. We report a case of ciprofloxacin-induced Q-T prolongation in a 33 year-old woman within 48 hours of its administration.

morbidity in the presence of persistent antiphospholipid antibodies. Current therapeutic recommendations for thrombosis prevention in patients with APS are limited to anticoagulation with Vitamin K Antagonists (VKA) or heparins and to anti-platelet aggregating agents. Maintaining optimized anticoagulation to prevent recurrent thrombosis or bleeding remains a therapeutic challenge. Direct Oral Anticoagulants (DOACs) DOACs have been approved to prevent recurrent thrombotic events in different prothrombotic conditions, such as non- valvular atrial fibrillation, deep vein thrombosis still aim the same target and thromboprophylaxis after elective orthopedic surgery.

Large wounds with heavy exudate are known to cause moisture related skin damages that can be distressing to the patient especially when he has pain that disturbs his sleep and other activities. Honey, known to be used to treat wound in ancient era, has antimicrobial properties, is anti- inflammatory and is known to promote wound healing. This case report demonstrates the efficacy of Indian medical grade honey in high exuding wound with peri wound skin damage.

Worldwide, one in eight deaths is due to cancer. Projections based on the GLOBOCAN 2012 estimates predict a substantive increase new cancer cases per year by 2035 in developing countries if preventive measures are not widely applied. According to the World Health Organization (WHO), millions of lives could be saved each year if countries made use of existing knowledge and the best cost-effective methods to prevent and treat cancer. Therefore, the aim of this study is to estimate a provisional budget against cancer in low and middle incomes countries, according the GNI-PPP, the cancer incidence and the number of population. Economically country classification is determining with the Gross national income (GNI), per capita, Purchasing power parity (PPP), according the administrations of the International Monetary Fund (IMF), the World Bank (WB) and the Central Intelligence Agency (CIA). Cancer incidence data presented are based on the most recent data available at IARC. However, population compares estimates from the US Bureau of the Census. The provisional budget is establishing among the guidelines developed by WHO for regional and national cancer control programs according to national economic development. Provisional budget against cancer is estimated to 42,148.788 (thousands of U.S $) for a population of 11,901,484 persons in Rwanda.

Aim: A clinical, demographic, biochemical and outcome profile of diabetic ketoacidosis in children with type 1 diabetes mellitus. Material and methods: This Prospective observational study was carried out in the Department of Paediatrics, Shantabaa Medical College and General Hospital, Amreli in Gujaratfor the period of 9 months, after taking the approval of the protocol review committee and institutional ethics committee. 50 DKA patients admitted during the study period. All those patients aged from 6 months to 14 years with Type 1 D.M. with DKA.

Background: Early detection of the disease in its latent phase through executive health checkup facilitates timely therapeutic interventions, thereby significantly reducing the associated morbidity, mortality and economic burden. Objectives: To evaluate the physiological determinants of health and disease in executive health checkup. Methods: In this hospital-based, cross-sectional study, a total of 768 individuals aged >20 years, irrespective of their gender, reporting for an executive health check-up were included. Demographic parameters, radiological examinations and psychological wellbeing score were evaluated and compared. Data were analyzed using statistical software R version 3.6.3

Background: Fine needle aspiration cytology is a simple, quick and inexpensive method that is used to sample palpable lymph nodes. Objective: To study the role of FNAC in the evaluation of lymphadenopathies. To categorize various lymph node lesions into neoplastic and non-neoplastic lesions. To study the various cytomorphological patterns in correlation with histopathology of various lymph node lesions. To evaluate the sensitivity and specificity of FNAC using histopathology as gold standard. Material and Methods: All patients referred to the Department of Pathology, Dr VRK Womens Medical College and Research centre. RR District, Telangana. for FNAC of palpable lymph node were included in our study. FNAC was done and the standard method for the procedure adopted. All the slides were reviewed and their diagnosis was made. FNAC diagnosis was compared with histopathology in cases which underwent surgical excision and thus it's diagnostic accuracy determined. This was two years prospective study from Jan-2015 to Dec-2016. Results: A total of 150 patients were included in our study, reported to various clinical departments with history of swelling. Lymph node biopsy was done in 55 cases. Statistical analysis was done in 55 cases, where FNAC diagnosis was correlated well with histopathological diagnosis. Maximum number of cases were in the age group of 21-40 years. Our study showed female preponderance of cases. Cervical group of nodes were most commonly involved. Benign lymphadenopathies were diagnosed in 72.67% of cases. Maximum number of cases being granulomatous lymphadenitis (50.46%). Metastatic deposit was diagnosed in 23.33% of cases. Most common subtype being adenocarcinoma (54.3%). Lymphoma were diagnosed in 06 cases (4%). The overall correlation between FNAC and histopathology was 98% (54 out of 55). Conclusion: FNAC is an accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathies

Introduction: Hypothyroidism is associated with decreased thermogenesis, decreased metabolic rate, and has also been shown to correlate with a higher body mass index (BMI) and a higher prevalence of obesity. There is clinical evidence suggesting that even mild thyroid dysfunction in the form of subclinical hypothyroidism is linked to significant changes in body weight and represents a risk factor for overweight and obesity. It has been further noted that small variations in serum TSH caused by minimal changes in Thyroxin dosage during replacement therapy are associated with significantly altered resting energy expenditure in hypothyroid patients. Methods: This is a prospective study conducted in the Department of General Medicine, Shadan Institute of Medical Sciences Teaching Hospital and Research Centre over a period of 1 year among 60 subjects. The variables collected were gender, age, thyroid dysfunction etiology, TSH levels, free levothyroxine (FT4) levels, presence of thyroid autoimmunity (considered as detection of anti-thyroperoxidase antibodies and/or TSH receptor antibodies), BMI and weight at the time of referral to the Department and after normalization of thyroid hormone levels after treatment. Result: T3 and TSH of control group (2.32±0.21, 83.54±8.35) respectively. In the mean of them in the second visit (1.35±0.11, 36.23±16.24) respectively in comparison with control group. The correlation between T3 and T4 in the first visit which revealed that there was strong positive correlation (r=0.432) with a highly significant difference (P=0.00). Correlation between T3 and TSH in this table showed that there was a weak negative relationship (r =-0.103) with a non-significant difference (P=0.325). In correlation between T4 and TSH there was a weak negative correlation (r= -0.024) with a highly significant difference (P= 0.542). Between T4 and BMI there was a weakly negative correlation (r = -0.019) with a non-significant difference (P=0.431). Conclusion: The number of patients with an elevated BMI (obese) differs significantly from the others. Thyroxin played a part in a lower BMI. Finding hypothyroid patients as soon as feasible is crucial

Introduction: The measurement of handgrip strength (HGS) is an indicator of an individual’s overall strength and can serve as a predictor of morbidity and mortality. Aims: To measure the relationship between Hand Grip Strength with anthropometric variables in healthy school going children between6-12 years. Materials & methods: The present cross-sectional study with 840 patients was based on 6 schools in the city of Hyderabad, from June 2020-Dec 2021 with School going children of age 6-12 years. Results: Males in all the 7 age groups were shown to have significantly higher hand grip strengths than the female children. There was gradual and significant increase in grip strength with age for both the genders (p <0.001). Height and weight were also positively correlated with hand grip strengths for both males as well as females (p<0.001). Conclusion: Hand grip strength measurements were shown to be positively and statistically correlating with age, height and weight

Background: Malnutrition is an important and major public health problem in a developing nation like India. Keeping this in mind, a study was conducted to determine the proportion of under-five children with malnutrition among hospitalised under-five-year children and to examine co-morbid diseases and epidemiological factors associated with malnutrition. Methods: This was a hospital-based cross-sectional study conducted in the paediatric ward of a tertiary care hospital in Koraput, Odisha. All children under the age of five years suffering from malnutrition were admitted in the hospital over a period of 1 month were included in the study. Results: The total number of children under the age of five diagnosed with malnutrition was 72 (40.4%). Moderate and severe/very severe malnutrition were statistically significantly higher in the girl child. The proportions of moderate and severe/very severe malnutrition were higher in low-birth-weight babies, i.e., children who were incompletely immunised due to age. Incorrect infant feeding practice was observed in 41 (56.9%) children. Some of the co-morbid conditions that contributed to the morbidity of the malnourished child were acute diarrhoea, acute respiratory infections, anaemia, and septicemia. Conclusion: A large proportion of the hospitalised children were malnourished. Girls suffered from moderate to severe malnutrition compared to male children, which was the only statistically significant association. This may be due to the negligence of a girl child

Introduction: VLDL stands for very low density lipoprotein. Lipoproteins are made up of cholesterol, triglycerides, and proteins. They move cholesterol, triglycerides, and other lipids (fats) to around the body. Methods: General information such as name, age, gender etc. was noted. Other parameters such as clinical examination, height, weight, biochemical analysis, pulse wave velocity and intima media thickness was done. Results: out of 130 patients, males were 60 and females were 70. The difference was non- significant (P> 0.05). Table I shows s. cholesterol 250 in males (16) and females (12). Males have higher Av C-F PWV and Av CIMT as compared to females. The difference was significant (P< 0.05). Conclusions: Increased level of LDL, VLDL and decrease level of HDL indicates increase in arterial stiffness and carotid intima media thickness. HDL levels are inversely associated with baPWV after adjustment for cardiovascular risks, and TG levels are positively related to baPWV independent of cardiovascular risksand liver function

Background: The most prevalent cause of hair loss in men is androgenetic alopecia (AGA), which has few available treatments. One of the more recent treatment options for the management of AGA that has produced encouraging outcomes is platelet-rich plasma (PRP) therapy. Aims and Objectives- the efficacy of PRP versus topical 10% minoxidil and microneedling in the treatment of androgenic alopecia and study the safety profile of these modalities. Materials and Methods: A prospective study was conducted in Department of Dermatology, Dr SN Medical College Jodhpur, 90 male patients with grade III to VI were randomly divided in three groups. Group 1: Platelet Rich Plasma. Group 2: 10% Minoxidil. Group 3: Microneedling. Results: The mean patient age in the current study was 36.03 years for PRP, 33.56 years for Minoxidil, and 35.9 years for the microneedling group. The mean hair thickness increased by 2.26 micron in PRP group, 8.76 micron in minoxidil group and 1.77 micron in micro needling group. The mean hair density of the patients in all groups increased statistically significantly. Conclusion- Overall, PRP can be considered an effective modality to begin treatment in patients to be supplemented with minoxidil if hair loss progresses. Microneedling can be used as a lone modality in patients or an additive therapy with PRP. In addition to its own action, it would help promote penetration of other therapeutic agents. Combining the following therapies can stimulate hair growth and halt hairloss for a while. These are effective before hair transplant surgery

Objective: (1) To define the role of ultrasonography and Paracentesis in deciding the treatment plan (conservative/operative) in blunt abdominal trauma. (2) To find out the specificity and sensitivity of ultrasonography and Paracentesis in blunt abdominal trauma. Design: Prospective study. Setting: VSSIMSAR. Period: From December 2012 — December 2014. Materials and methods: Seventy Five patients irrespective of age, sex and mode of blunt injury included in the study. All the patients presented in emergency ward with blunt trauma abdominal underwent ultrasonography & Paracentesis. Results: In 66 out of 75(88%) patients, the abdominal ultrasonography showed positive findings with the sensitivity of 82.7%, the specificity 89% and accuracy 90.9%. Paracentesis was positive in 55 patients out of 66 (83%) with 97% sensitivity, 73% specificity and 89%accuracy. Conclusion: Paracentesis is as effective as ultrasonography to pick up the intra-peritoneal fluid in the assessment of blunt abdominal trauma patient but with slightly less sensitivity, specificity and accuracy

Introduction: Type 2 Diabetes mellitus (Type 2DM) is chronic, lifelong progressive metabolic disease characterized by hyperglycaemia due to absolute or relative insulinopaenia. Monotherapy with Metformin, a biguanide agent acts primarily as an insulin sensitizer. Its primary clinical site of action is in the liver, improving hepatic insulin sensitivity and as a result, decreasing hepatic gluconeogenesis. Sitagliptin is an oral, highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of patients with Type 2 Diabetes Mellitus. Sitagliptin inhibits the enzymatic degradation and inactivation of glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic peptide (GIP) by DPP-4 the major incretins involved in glucose homeostasis, thereby increasing insulin release and lowering glucagon secretion in a glucosedependent manner. Material and Methods: This is an Open label, Randomized, Parallel group, Comparative and Prospective clinical study. Study was conducted in Type 2DM patients attending the outpatient department of Medicine in tertiary care center. Inclusion criteria: Patients of either sex having age group between 30 -60 years, Patients willing to participate and willing to give written informed consent prior to any study-related procedures and to comply with the requirements of the study protocol. Patients having newly diagnosed Type II DM with prandial blood glucose levels >180 mg% and <250 mg%. HbAlc in the range of 6.5 to 8.5 % at screening and BMI >27 kg/m2 Results: The mean fasting blood glucose level in Group I at baseline was 150.81±11.61 mg/dl, in Group II was 151.92±10.44 mg/dl and in Group III was 150.53±11.64. The mean fasting blood glucose level in Group I after 3 months was 99.73±9.91 mg/dl, in Group II was 92.72±9.82 mg/dl and in Group III was 85.72±9.82 mg/dl. These was statistically highly significant difference in mean Fasting Blood Glucose level at baseline versus after 3 months in Group I, Group II and Group III (p<0.0001). The mean of HbA1c level was 9.61±1.91% at baseline and 8.99±1.82% after 3rd month. In Group II the mean of HbA1c level was 9.61±1.83% at baseline, 8.65±1.73% after 3rd month. In Group III the mean of HbA1c level was 9.64±1.81% at baseline and 8.44±1.73% after 3rd month. Conclusion: Sitagliptin with Metformin causes efficient glycaemic control with less significant adverse reaction but the gylcaemic control of patients taking Sitagliptin with Metformin was slightly better as compared to patients taking alone. Thus, concluding Sitagliptin with Metformin to be more efficacious than alone

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

Introduction: Mandible also known as the largest and inferior, primary facial bone of the face giving a curved shape to it. It changes its shape and gives variations to the bony structure of the face from birth till older age. Mental foramen is known as the vintage of the mandible and is an important mark of the face for carrying out many diagnostics and surgical processes along with aesthetic procedures of the face. Thus, the present study is designed with an aim to get insight knowledge of position and shape of mental foramen in dry adult human mandible. Material and Method: Totally, 60 bones were studied in 2 years duration. The study was carried out in the Department of Anatomy Tertiary Care Teaching Hospital over a period of 1 year. The position of mental foramen was studied using an instrument known as digital Vernier Calliper (in mm) while shape was analysed visually. Position of mental foramen was calculated using Statistical package for social sciences (SPSS) software. Results: The present study showed that the position of mental foramen from symphysis menti and posterior border of ramus of mandible was more from right side than left side and found to be insignificant while position of mental foramen from inferior border of body of mandible was more from left side than right side and found to be insignificant for right side while significant for left side. The shape of mental foramen from right side was found to be (Oval shape- 68.33% and round shape – 31.66%) while for left side was found to be (Oval shape- 71.66% and round shape – 28.33%). Conclusion: Hence, mental foramen plays a pivotal role in performing major facial surgeries and is an important landmark for several facial procedures performed

Introduction: Magnitude of malnutrition problem among children under 5 years is high throughout India. Inadequate feeding practices, in combination with other factors such as infection, may account for 1/3 of all malnutrition cases. On other hand, low MUAC (<11.5cm) is not only suggestive of severe wasting or severe acute malnutrition but also indicative of morbidity and risk of mortality. The present study was carried out to determine the prevalence of malnutrition and its associated factors among 24 to 60 months aged children in urban field practice area of a medical college in Tirupati, Andhra Pradesh. Methods: This community based cross-sectional study was carried out among 282 children aged 24 to 60 months in UHTC area of a medical college in Tirupati city. Nutritional status was determined using MUAC. Water, sanitation and hygiene practices; child feeding practices and other associated factors were noted in the questionnaire. Data was entered and analyzed using IBM SPSS 26 version. Results: The total prevalence of malnutrition was 13.1%, of which mild to moderate malnutrition and severe malnutrition were 11.7% and 1.4% respectively. About 19% of the children were malnourished who were not utilizing anganwadi services and there was a significant association found between utilization of anganwadi services and malnutrition (p=0.05).Conclusion: Although prevalence of malnutrition was low compared to other studies, this should be addressed through appropriate community based strategies for halting long term sequel of malnutrition among pre-school children

Background : The dual forms of malnutrition is characterized by the coexistence in a population of underweight and overweight. In India evidence suggests presence of both forms of malnutrition not only in adults but also in adolescents. The present study was done in Ghaziabad with an aim to gauze the presence of both forms in adolescent going to schools. Methodology - The present cross-sectional survey was conducted among 1128 school-going adolescent students (10–19 years) in Ghaziabad district of Uttar Pradesh. Multistage sampling technique was used to study 1128 study population. Anthropometry and a structured questionnaire were used as study tool. Results- The most frequently reported dietary deficiency was underweight at 21.6 percent, followed by overweight at 10.7 percent and obese at 9.5 percent. (3.6 percent).We had 620 boys and 508 girls as participants in our study sample.We found 35% of adolescents as having both forms of malnutrition. Conclusion- Our study highlights the presence of both forms of malnutrition among adolescent school going population. Our study also reinforces the latest trend in adults in country which might be a continuation of the features of malnutrition in both forms found. Adolescence is the future also for coming adults in country and if we have more number of adolescents malnourished we will have more problems due to the number of health and other issues malnutrition poses at all ages

Background: Studies have demonstrated that red blood cell distribution width (RDW) is closely associated with the prognosis of patients with chronic obstructive pulmonary disease (COPD). In addition, the dynamic changes in RDW appear to play an important role. Thus, we aimed to investigate the relationship between dynamic changes in RDW and 30- day all-cause readmission of patients with acute exacerbation of COPD (AECOPD). Methods: This is a prospective and observational study was conducted in the Department of Pulmonary Medicine, J J M Medical college, Davangere Patients hospitalized for AECOPD between April 2020 to March 2021 were revised. Clinical and laboratory parameters were noted. Participants were followed to determine the incidence of readmission due to AECOPD, readmission from any cause and composite end point of readmission or death during 60 days after discharge. Result: Maximum patients in both groups were found in>60 years age group. The mean age in AECOPD group was 66.75±10.35 years and in Stable COPD was 65.31±11.25 years. Both groups were comparable. Maximum patients in both groups were presented with cough and breathlessness. Maximum patients in AECOPD group was from GOLD stage 4 and in stable COPD was also from GOLD stage 4. The difference in both group was foundstatically significant. Mean FEV1% significantly lower in AECOPD patients (43.87±14.26) as compare to stable COPD patients (50.15±22.22). The difference in both groups was found statistically significant. Mean RDW was significantly higher in AECOPD (19.65±7.75%) as compare to stable patients (15.85±5.55%). The difference in both groups was found statistically significant. Conclusion: Prolonged hospital stay was closely associated with increased RDW on admission in AECOPD patients. Elevated RDW may be an independent predictor for prolonged hospital stay in AECOPD patients

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder (5-10%) in women of reproductive age. It is characterized by clinical and biochemical hyperandrogenism, menstrual irregularities, infertility and metabolic syndrome. Hypothyroidism is more common in PCOS

Introduction: Since the first detection on 8th March 2020 in Bangladesh, the number of cases is rising alarmingly. The paediatric population is also getting infected in Bangladesh. So far there is very few studies of COVID in children in this country. Aim of the study: The aim of this study was to explore the demographic profile, clinical presentation, laboratory findings and outcomes of COVID-19 children patients. Methods: This is a retrospective hospital-based study; 149 Children were enrolled and analyzed in this study. The study was conducted from June 2020 to June 2021 at the Department of Pediatrics in Dhaka Shishu Hospital, Dhaka, Bangladesh. Result: Among 149 patients were included in the study over a period of 13months. Mean age was 59.96 ± 43.24 months, 48% were male and 52% were female. Out of 149 cases 7(4.6%) cases were associated with co-morbidities like congenital heart disease& bronchial asthma was 2(1.34%) followed by hereditary hemolytic anaemia, adenoid and ROP was 1(0.67%) (Table-4). Out of all 149 patients 125(83.89%) patients were improved and discharged, 12(8.05%) patients transferred to other hospitals and 5(3.36%) childs died in this study. Conclusion: During the pandemic of COVID19 Children were also affected due to household contact. Children present with flu like illness with or without other system involvement should be investigated for COVID19, as because early diagnosis will help to restrict the spread of the virus and will help to get a better outcome

Background: Burst Abdomen is a preventable condition in which many risk factors play their role and lead to life threatening complications. This study's goal was to evaluate the incidence and risk factors, of burst abdomen in patients receiving midline laparotomies. Patients and methods: 240 patients who underwent midline laparotomies at Government Medical College in CENTRAL INDIA between January 2021 and December 2021 were the subjects of a prospective cohort research. Online available Software was used to monitor and analyse factors including age, sex, BMI, substance abuse, previous laparotomy, malignancy, diabetes mellitus, ascites, albumin, renal functions, bilirubin, haemoglobin, intra-abdominal pathology, suture material, creation of stoma, postoperative chest infection, postoperative paralytic ileus, leakage, and wound infection. Results: Incidence of burst abdomen was 11.25% among patients who underwent laparotomy. The following statistically significant factors (P<0.001) were linked to burst abdomen: wound infections, anaemia, uncontrolled diabetes, hypoalbuminemia, previous laparotomy, development of stoma, chest issues, ascites, postoperative cough, postoperative leakage, and peritonitis. In this investigation, we did not find any statistically significant relationships between patient sex, age, concomitant morbidities including jaundice and uremia, past steroid use, suture material utilised in closure, and postoperative paralytic ileus. Conclusion: According to the results of our study, significant risk factors for burst abdomen included wound infection, anaemia, previous laparotomy, stoma creation, hypoalbuminemia, ascites, diabetes, type of intra-abdominal pathology, with maximum incidences in peritonitis, postoperative cough, and postoperative leakage

Introduction: Day care procedures has now becoming a popular modality of treatment throughout the world. Day care procedures means that patient gets admitted, undergoes interventional procedure and gets discharged from the hospital on the same day of the procedure.[1] Anaesthetic agents available now-a-days play an important role in achieving specific criteria for ambulatory anaesthesia. Anaesthestic agents like, propofol and sevoflurane favors the anaesthesiologist to perform successful day case surgeries.Propofol has become the drug of choice for induction of anesthesia in the day care procedures due to its favorable recovery profile and low incidence of side effects.[2] Newer inhaled anaesthetics like desflurane and sevoflurane with low blood gas partition coefficient facilitates rapid induction of anaesthesia and rapid recovery and less adverse effect at the end of anaesthesia, leading to their use in day care surgery

Background: Megaloblastic anaemia during metformin therapy can be treated by administrating vitamin B12. 10-30% of diabetic patients on long term treatment with metformin had vitamin B12 deficiency. Objective: To determine VitaminB12 deficiency in type2 diabetes patients on long term metformin therapy for >2years. Materials & Methods: This prospective study carried out in Department of Medicine in Dr DY Patil Medical College and Hospital, Pune. It was comparison between 50 cases and 50 controls to find Vitamin B12 Deficiency In Type 2 Diabetes Patients On Long Term Metformin Therapy For >2years. Results: Mean age was for cases was 47.12 + 12.54 years and for controls was 41.64 + 9.74 years with majority in the age group of 41 to 60 years among both groups. Among cases males 52% were more than females 48%. Mean weight was for cases was 70.72 + 11.6 kg and controls was 58.02 + 6.80 kg. Mean BMI was for cases was 27.36 + 4.88 and controls was 23.93 + 2.71 and majority were in range of 25 to 30. Common symptoms seen were Polyuria and polydipsia. 50% had HTN. Majority were smokers followed by alcoholic. Mean duration of DM among cases was 6.18 + 2.64years. Mean serum vitamin B12 of cases was 271.75 + 184.21 and controls were 410.45 + 154.34, showed statistical significance. Majority among cases had Vit B12 levels lower than 200 and controls were more than 301. P value was highly significant. Conclusion: Routine supplementation of vitamin B12 given to patients on long-term high dose metformin therapy seems to be clinically more prudent and a cost-effective approach

Introduction: Escherichia coli serogrouping is used as a conventional method for pathogen characterization and diagnosis. As diarrheal disease is generally self limiting, antidiarrheal agents are not usually recommended for treatment of diarrhea. Escherichia coli is enormously versatile bacterium which elaborates its commensal and pathogenic potential in human host. Diarrheagenic E. coli (DEC) is reported as one of the leading causes of gastrointestinal disorders worldwide and signified as an important issue to address in public health

Background: H. pylori is the most common human bacterial pathogen that colonizes the gastric epithelium especially in those habitual Qat chewers; it influence can absorption of glucose which is also abnormal in DM patients, its common infection in diabetic patients who have inadequate metabolic control, this study was conducted to reveal the prevalence of H. pylori among T2DM and non-DM patients and potential risk factors. Methods: A cross-sectional study was conducted in the department of medicine, a tertiary care hospital in India, and there were 250 patients who included in this study. Data were collected through structural intervals questionnaire and sampling information. Results: The overall prevalence of H. pylori among diabetics was 29.2%. There was no significant association between H. pylori infections and diabetes (P> 0.05), most of the patients were 46-60 year age group, with male predominance (76.7%) H. pylori infections were not significantly associated with the smoking, hypertension, dyslipidemia and obesity. H. pylori infection increased in longer duration of diabetes and the increase in HbA1c level. Conclusion: Positive H. pylori DM patients should update their sugar level values and control the disease. Further research is highly recommended on relationship between H. pylori infections and diabetes

Introduction: Skin and soft tissue infection contribute to a substantial proportion of infective disease pool in OPD attendees, in both urban and rural set up across the globe and staphylococcus aureus is one of the common causative agent of cutaneous bacterial infections involving skin & soft tissue. MRSA can cause severe problems , if not detected early, resulting in complications like septicaemia, pneumonia, sepsis and death. Community acquired MRSA(CA-MRSA) infections are common among skin & soft tissue infections (SSTIs), making their management quite difficult. One simple method to reach the diagnosis is the culture and sensitivity pattern. As sensitivity and distribution pattern vary according to different geographical area as observed in other bacterial infections, it has become imperative to know the extent of MRSA distribution and it’s sensitivity pattern in a particular community

Object: This study aimed to investigate the status of Malondialdehyde (MDA) concentration and the activity of antioxidative enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in both gastric cancer patients and healthy controls. The role of enzymatic antioxidant activity in cell protection from the damages caused by oxidative stress was also examined. The differences between the lipid peroxidation levels and defense mechanisms of the two groups were analyzed and compared. Materials and Methods: This study was conducted on 50 patients diagnosed with gastric cancer and 50 healthy control subjects of the same age and gender. Spectrophotometric techniques were used to measure the activity of malondialdehyde, glutathione peroxidase, and superoxide dismutase. Results: The results of this study revealed that there was a significant increase in MDA and a highly significant alteration in antioxidants. Conclusion: The diagnosis of human gastric cancer or recurrence could be aided by studying the lipid peroxidation and antioxidant defense mechanisms, in addition to using biopsy, biochemical, and pathological investigations. This combination of methods may be a more effective tool

Background: Deep vein thrombosis (DVT) usually occurs when a blood clot (thrombus) forms in one or more of the deep veins. It can causes pain in leg or swelling. Sometimes there are subtle symptoms. Aim: This study was conducted to perform investigation of etiological variables, management strategies, and consequences among individuals presenting with DVT at a tertiary centre. Materials and Methods: The current study which was carried out over the course of three years at a tertiary care government hospital at Kurnool and it was prospective observational in design. Total 100 cases showed signs of deep vein thrombosis, and met the criteria for selection. Results: In present study average age was 40.2±17.9 years, with 26% of them falling between 30 and 40 years. The majority (21%) of individuals presented with discomfort and edoema but had no clear predisposing factors. Duplex venous ultrasound revealed that 57 (57%) had involvement of both proximal and distal veins, 40 (40%) cases had involvement of only proximal veins whereas only 3 (3%) had restricted involvement of distal veins. After 3 months, 81% of the patients had complete recovery. Recovery was observed in 62%, improvement in 18% and chronic changes were observed in 20% of the patients at end of 3 months in duplex venous ultrasonography. Conclusion: Young patients without any clear risk factors may develop and present with DVT, therefore factors that cause deep vein thrombosis in them are advised to be carefully assessed. A trustworthy non-invasive diagnostic tool is Duplex venous ultrasonography and is advised for clinically diagnosing and confirming DVT

Introduction: Although communicable diseases are more common in developing countries, recently an upsurge in non-communicable diseases has been noticed. Among these non communicable diseases neurological and musculoskeletal disorders constitute a significant proportion affecting morbidity, mortality, disability and quality of life. The annual incidence of musculoskeletal disorders accounts for 31% of all occupational diseases estimated in the world in 1994. This means that the musculoskeletal disorders are the most frequent occupational disease affecting workers throughout the world. Aim: to identify the epidemiological factors that contribute in developing neurological and musculoskeletal disorders. Method: This was a hospital based cross sectional study conducted at Geetanjali College of Physiotherapy located in Geetanjali Medicity with institute of Geetanjali Hospital and College, Udaipur. Consisted cases of ND & MSD attending GCP and the referral calls for ND & MSD from GMCH to GCP. Results: In the index study male subjects constituted (60.7%) while the rest (39.3%) were female. There was a significant association of studied patients of neurological and Musculoskeletal disorder reporting to physiotherapy hospitals with gender p=0.011. There was a significant association of studied patients with BMI. Conclusion: Out of 300 studied patients 60.7% were male and 39.3% were female. The male to female ratio was 1.4 : 0.92. Most of our patients belonged to age group 50-59 years

Background: Ambulatory assessment of the heart rate–corrected QT interval (QTc) within arrhythmia patients can be of diagnostic value where these patients are on QTc-prolonging medication. Repeating sequential 12-lead electrocardiograms (ECGs) to monitor the QTc is cumbersome, but Spandan Smartphone ECG devices can potentially solve this problem. Objective: Objective of this prospective and retrospective, cross-sectional, within patient diagnostic validation study was to validate the measurement of QTc interval in Spandan 12 lead ECG and to assess the accuracy of the 12 lead Spandan Smartphone ECG device in measuring the QTc intervals in the general cardiology outpatient population with normal ECG and arrhythmias. Materials and Methods: This single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from August 2022 to October 2022. All patients (n=1168) visiting the electrocardiogram (ECG) room at the Department of Cardiology of the SMIH, Dehradun during the study period were enrolled in the study by taking their written consent and explaining the purpose of the study. Results: Mean (SD) age was 54.36±4.9 years. The male gender (n=783,67.03%) shows the maximum frequency than female gender. Primary Coronary Intervention was noted in 426 (36.4%) of the study population. All the four parameters showed positive Pearson correlation between 12 Lead Standard ECG and Spandan Smartphone ECG. The maximum mean difference between 12 Lead Standard ECG and Spandan Smartphone ECG was noted for QTc parameter in overall participants. Conclusion: 12-lead Spandan Smartphone ECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs

Introduction: Yoga is an art in all its aspects, from the most practical to the highest. It is a spiritual art, in the sense that it transforms the seer and brings him into contact with his inner soul. It is a fine art, since it is aesthetic, expressive, visual art, since the body is made to form geometrical designs, lines architectural shapes and the like which are beautiful to behold. It is essentially a useful art for the doer and is presented as a performing art for viewer. Objective: To assess the effect of 45 minute yogic kriya (Surya Namaskar and Kapalbhati) for for 30 days on various physiological and biochemical parameters. Materials and Methods: This is a prospective and observational study conducted in the Department of Physiology and Biochemistry at Tertiary Care Teaching Hospital over a period of 6 months. All subjects volunteering for participation in the study had given their written informed consent. The study protocol was approved by our college ethical committee. Only healthy volunteers with daily regular lifestyle and are not involved in any sport regularly, were chosen to be part of the study between the age group 17-21 were taken into study. Subjects having any pathological condition and those who are on any pharmacological treatment from 3 months prior to the study were excluded from the study. Results: In the present study it was found that the pulse rate was decreased significantly (p<0.05) at 30 days in Group I and II. RR decreased significantly at 30 days in group I, and II with p<0.05. This significant decrease continued at 30 days with group I and II. In our study it was found that significant decrease in SBP at 30 days. At 30 days two groups had highly significant decrease in SBP (p<0.05). In addition, it was also found that significant decrease in DBP at 30 days. At 30 days two groups had highly significant decrease in DBP (p<0.05). After yoga, at 30 days, the reduction in the Serum Total cholesterol, serum triglycerides levels were found in two groups in the present study. The decrease was significant (p<0.05) in Group I and II (p<0.01). In addition, after 30 days of yogic practices significant (p<0.05) increase in the HDL level was found in Group I and II. Conclusion: It was concluded that in hypertensive subjects whether newly diagnosed subjects were restoration of the altered parameters towards normal

Background: Miscarriage is considered the most common adverse outcome in early pregnancy. Thyroid autoantibodies have a role in these regions and have been linked to substantial changes in the path of pregnancy that affect the mother, foetus, & newborn. Aim: To estimate the prevalence of TPO antibodies in recurrent pregnancy losses, first trimester abortions and preterm deliveries. Material & Methods: Study Design: Descriptive Cross sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Baharampur, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Pregnant women who had preterm deliveries, miscarriages attending outpatient as well as admitted in the antenatal & postnatal ward in the department of Obstetrics & Gynecology Sample size: Study consisted a total of 100 subjects. Study tools and Data collection procedure: The study group was comprised of all the pregnant women who had preterm deliveries and miscarriages regardless of the gestational age, that were fulfilling inclusion & exclusion criteria. Written informed consent was taken from all the patients participating in the study. They were subjected to a detailed history & thorough general & clinical examination, lab investigations, thyroid profile, thyroid peroxidase antibody testing (Normal range: TPO AB <9 IU/ML), ultra-sonic examination & other clinical work up was done. The study showed that the contribution of thyroid peroxidase antibody testing & its sensitivity determining risk of preterm deliveries and recurrent pregnancy loss. Results: The association between TPOAB and T3 category, among the high TPOAB (+ve) cases (n=11), 8 (72.7%) cases had normal level of T3, and, 3 (27.3%) cases had low level of T3. Whereas in the normal TPOAB (-ve) group (n=89), 5 (5.6%) cases had high level of T3, 84 (94.4%) cases had normal level of T3. The association between TPOAB and T3 category was shown statistically significant (P<0.0001). Conclusion: We concluded that, there was a statistically significant association of TPOAb with T3, T4, and, TSH (P<0.05) and it leads to developing hypothyroidism during pregnancy. The presence of TPO-Ab in pregnant women significantly increases the risk of preterm delivery. The screening of TSH and TPOAb was essential during pregnancy to avoid complications related pregnancy

Background: Dengue is known to cause multi-organ dysfunction including cardiac involvement, In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis not reported as a common complication we present a case series of dengue fever with cardiac involvement observed during a period of month August to December 2021 at PBM & Associated Group of Hospital, Bikaner Rajasthan. Case presentation: We have been reported 9 cases of dengue complicated with cardiac involvement admitted to Wards and ICU at PBM & Associated Group of Hospital. Age group ranging from 15 to 65 years. In our case series out of 9 cases comparising 2 females and 7 males. The group had 5 cases of Dengue hemorrhagic fever with dengue shock syndrome, 2 cases had Dengue hemorrhagic fever, 2 cases had dengue shock syndrome. There is co-infection of dengue with malaria in 2 cases. All cases had acute dengue hepatitis. Blood transfusion and other empirical therapeutic methods used apart from meticulous fluid management to suit issue of each patient. Bed side USG, digital chest x-ray PA view & 2D ECHO scanning help in early detection of critical phase of dengue. Out of 9 cases with complicated dengue 7 patients recovered and 2 patients expired. Data were collected during hospital admission, stay and follow up visits. Methods: A prospective observational study was conducted on patients with age group more than 15 years and having confirmed dengue fever. Patient on medication affecting heart Rate, Rhythms, pre-existing heart disease and electrolytes abnormalities excluded. A base line ECG, Troponin I NT Pro BNP were done for all patients. The biomarkers were measured using Enzyme linked immune fluorescent assay and recommended cut off were used. Patients with increased biomarkers gone for 2D ECHO (As per criteria of European society of cardiology 2019). Conclusion: Myocarditis and cardiac involvement in dengue may be overlooked due to Nonspecific clinical finding and co-existing multi organ dysfunction. Atypical presentation of this case series may be due to micro-geographical variation and unusual out break of dengue. Co-infection of malaria should be considered in managing patients especially in endemic area

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases

Introduction: One of the most common types of fractures seen in orthopedic treatment is a crack or break in the shaft of the femur. In individuals who have sustained high intensity trauma, a fracture of the shaft of the femur is a major source of morbidity and mortality. Materials and methods: There were 20 people total who participated in the study. This study was a prospective research study that took place in Department of Orthopedics, Government Medical College, Ongole, Andhra Pradesh, India. There are roughly 8 men for every female. The time frame for the research was from May 2021 to April 2022. Results: The survey involved 20 people, with men making up 72% and women 28%. At least 88% of the population is under the age of 50. The majority of femur fractures occurred in the middle one-third of the thigh, and car accidents were the most prevalent cause of injury. Within 24 hours of injury, 76% of patients were seen. Fractures in most patients healed completely between 12–14 weeks clinically, and within 16–18 weeks radiologically. After 10 weeks, patients could begin light weight bearing, and by 16 weeks, they could handle their whole-body weight. Conclusion: In the fracture of the shaft of the femur that we saw, interlocking nailing had a very low complication rate and produced great results in terms of the patient's ability to function.

Background: Suxamethonium, a depolarizing neuromuscular agent, was introduced in 1952 and since then has been used for tracheal intubation. It was favoured for its rapid onset and ultra-short duration of action but has numerous side effects, especially cardiovascular. So agents with low potency and shorter duration of action were developed, and in 1995, Rocuronium was introduced, which is a non-depolarizing agent and has the fastest onset of action

Introduction: With the availability of better health care services and decrease in mortality rates the elderly population has increased significantly over the last couple of decades.1 Psychiatric illness in the elderly is compounded by mental morbidities due to ageing of the brain, problems associated with physical health, socio-economic factors such as breakdown of the family support systems, and decrease in economic independence. The presence of comorbidities and the attendant polypharmacy makes management of these diseases a complex issue

Objectives: To determine the clinical and functional outcome of open modified Bankart repair in cases of recurrent anterior shoulder instability.

Methods: This is a prospective study conducted in Department of orthopaedics Katuri Medical College and Hospital, Guntur. There were 25 patients included in our study who were followed up for an average of 12 months duration with minimum follow up of 6 months and maximum follow up of 24 months. All young and middle age patients with recurrent anterior shoulder instability presented were evaluated by thorough general and clinical local examination of the shoulder.

Results: This study included 25 patients , 20 out of 25 patients showed excellent functional outcome(80%) , 4 showed good functional outcome(16%) and 1 showed fair functional outcome(4%) according to ROWE score.

Conclusion: Arthroscopic Bankart repair is the management of choice for recurrent anterior glenohumeral instability but open Bankart repair still remains the gold standard in institutes where there are limited resources

Background: Psychosocial disturbance can have its effect on all organ systems of our body including cardiovascular system and at the same time prolonged cardiovascular diseases may also lead to worsening of mental health in people. Objective: Present study is carried out to find the effect of certain common psychiatric diseases and social stresses along with the effect of different levels of social support on the incidence and prevalence of cardiovascular diseases. Material and Method: The present cross-sectional analytical study was conducted in cardiac ward and on new and follow up cases in outpatient unit, Andhra Medical College, Visakhapatnam. 100 participants male and female of all age groups were taken as cases along with 100 participants as control after obtaining written informed consent by purposive sampling.

Data was analyzed using SPSS 21.0. The statistical tests used were student’s t-test and chi square test.

DSM-5 criteria, M.I.N.I, Perceived social stress scale, Oslo’s social support system and Modified Kuppuswamy criteria were used to carry out study. Results: Out of the total population under study, 15% of all the CVD cases were found to have psychiatric illness prior to cardiovascular disease where as 21% of CVD patients developed psychiatric illness after having diagnosed for cardiovascular disease. Among these cases 82% were having low social support. Gender predilection for psychiatric diseases in CVD patients was found to be more in females (12%) compared to males (9%) with (p-value = 0.042) and chi square value of 4.13. Conclusion: This research indicates that psychiatric illnesses and low social support can act as an independent risk factor for CVD while CVD patients are susceptible to develop psychiatric illnesses over the course of disease. We recommend multi centre detailed study with higher sample size in this area to generalize the results and use them for the benefit of society

This study is a Prospective cross sectional observational study. The study was conducted from December 1st, 2020, to June 1st, 2022 in which 100 patients who had presented to the Surgery OPD and Emergency Department of Katuri medical college &hospital, Chinakondrupadu, Guntur with history suggestive of urolithiasis were enrolled for the purpose of studying the incidence of urolithiasis at different levels of the urinary tract and to assess different modalities of treatment and compare outcome of those results with that of the world literature. Our Study had found that the incidence of urolithiasis at our center was 3.74%. The age group of people between 21-30 years were the most commonly affected. However, the mean age for developing urolithiasis was 40.4 years. Males appear to be predisposed to the formation of calculi with M: F ratio being 1.77:1. Pain was the most common symptom which was seen in 91 % of the patients followed by nausea/vomiting seen in 58% followed by burning micturition (43.84%), fever (16.44%) and haematuria (15.08 %) of the study group. Right kidneys were affected more commonly than the left. Diabetes mellitus   was   the   most   commonly   associated   comorbidity   followed   by hypertension. Renal pelvis was the most commonly affected site (35%) followed by lower 1/3rd, urinary bladder (17%) upper ureter (14%) and lower ureter (11%) respectively. E. coli was the most commonly isolated organism in the urine cultures followed by Klebsiella. Serum calcium was normal in 96% of the study group while serum uric acid was raised in 25% of the subjects. Plain X ray KUB and ultrasound were the initial imaging modalities used. IVP was preferred over CT in diagnosis as CT was costlier and could not be afforded by the poor. Patients consuming mixed diet seemed to be more predisposed to the formation of urolithiasis. Open Pyelolithotomy was the operative modality for renal pelvic calculi, Open Ureterolithotomy for upper and mid ureters and URS for lower ureter. Open Cystolithotomy was used for bladder calculi. Stone free rates for Open Pyelolithotomy was 91.4%, 96% for Open Ureterolithotomy, 91.3% for URS and 100% for Open Cystolithotomy. The average size of stone extracted in Open Pyelolithotomy was 2.78 cm, 1.34 cm for Open Ureterolithotomy, 3.92 cm for Open Cystolithotomy and 1.1 cm for URS. Mean duration of hospital stay was 7.42 days for Open Pyelolithotomy, 6.16 days for Open Ureterolithotomy, 5.35 days for Open Cystolithotomy and 1.34 days for URS. Thus we can conclude that, the incidence of urolithiasis was 3.74% in our study. The patients underwent open procedure for removal of stones at our cente.r However, as seen in our study, open procedures have good success rates and also have less post- operative complications. It can thus be concluded that it does not hamper patient care. This is in accordance with the other studies over open urological procedures

Background: Programmed labour protocol was developed with principles asensuring adequate uterine contractions , providing optimum pain relief & close clinical monitoring of labor events. Present study was conducted to evaluate the safety and efficacy of Programmed Labour protocol in a study group as against Spontaneous progression of labour in primigravida patients. Material and Methods: The present study was a hospital based randomized prospective clinical study, conducted in primigravidae at term with cephalic presentation, adequate liquor and no high risk factors and in active phase of first stage of labour or Cervical dilatation ≥ 3cm, ≥ 80% effacement and intact membranes, Reactive stress Test. 200 primigravidas were alternately allocated into 2 groups. as study group (100 women received programmed labour protocol) & control Group (100 women were observed expectantly and underwent spontaneous labour). Results: Mean age of patients in the study group was 23.13 ± 2.46 years and 23.74 ± 2.58 years in the control group. Among patients of the study group; period of gestation was 38.87 ±1.00 weeks and 38.74 ± 1.12 weeks in the control group. We compared various labour related parameters such as duration of active phase of labour (hours), rate of cervical dilatation (cm/hr), duration of 2nd stage of labour (mins), duration of 3rdstage of labour (mins), total duration of labour (min) & average blood loss (ml) between study & control group. All above parameters were favourable in study group & difference was highly significant statistically (p<0.001). Perception in degree of pain relief among patients of the study and control group was found be highly significant statistically. (p<0.001) i.e. pain relief was significantly much higher among patients of the study group than pain relief in control group patients. The difference in degree of maternal satisfaction in the study and control group was found be statistically significant (p<0.001). Conclusion: Programmed labour is safe, effective providing labour analgesia; facilitating cervical dilation and shortening duration of labour with good maternal and fetal outcomes

Background: The ECG remains the most immediately accessible and widely used diagnostic tool for guiding emergent treatment strategies. Coronary angiography is a widely used invasive examination which is considered the reference standard for assessing presence of stenosis in the coronary arteries. Objectives: To correlate findings of ECG and Coronary Angiography in identifying culprit artery among patients with acute ST Elevation Myocardial Infarction. Methods and Material: The study was undertaken among 100 Patients aged 18years and above presenting with symptoms suggestive of Acute Myocardial Infarction as a diagnostic accuracy study. Convenient sampling technique was used to include patients in the study. Results: Most of the study participants were in the age group of 46-60 years (44%) and males (75.0%). Hypertension (44%), Obesity (28%) and Diabetes (26%) were found to be the three most common comorbidities among the study participants. Chest pain (71%), profuse sweating (57%) and chest discomfort (44%) were the most common complaints. The mean duration of symptoms among all the patients was 75.65±45.0 mins. The sensitivity and specificity of ECG  in detecting LAD involvement is 71.8% and 72% respectively. The sensitivity and specificity of ECG in detecting RCA involvement is 71% and 94.2% respectively. Conclusion: ECG was found to have good accuracy in predicting the culprit artery involved in patient with ST elevation MI. The sensitivity of ECG was good in predicting all the three main arteries and an even higher specificity was noted in case of RCA

Background: Preterm birth is defined as a delivery occurring at less than 37 weeks of gestation. It is divided into three categories: extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to <37 weeks). Similarly, preterm birth can be classified based on birth weight. Neonates weighing less than 2500 g at birth are considered low birth weight (LBW), <1500 g are considered very low birth weight (VLBW), and <1000 g are considered extremely low birth weight (ELBW). Preterm birth can also occur spontaneously or as a result of a provider's intervention (induced). Aim: The purpose of this study was to compare the neonatal outcomes of spontaneous and induced/indicated preterm births that occurred less than 37 weeks of gestation. Material & Methods: Study Design: Prospective Hospital based Comparative study. Study area: Department of Pediatrics & Department of Obstetrics, Government General Hospital, Vijayawada. Study Period: 1 year.  Study population: Singleton live preterm births <37 wk of gestational age born during the study period. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Study tools and Data collection procedure: The collected data includes A) Maternal characteristics: (i) age, (ii) parity, (iii) mode of delivery, (iv) Type of diabetes, (v) mode of control. B) Neonatal characteristics: (i) sex, (ii) gestational age, (iii) birth weight C) Physical examination was performed D) Laboratory investigations done: blood sugar, calcium and bilirubin levels, X-ray chest and abdomen, sepsis screen. Results: The mean birth weight of Spontaneous Preterm was lower than Indicated Preterm (2.036±0.3716 kg and 2.497±0.5878 kg). There was a statistically significant difference in infant birth weight between Spontaneous Preterm and Indicated Preterm. With statistical significance, the birth weight of late preterm infants was higher than that of early preterm infants. Conclusion: From our study it can be concluded that, Preterm births account for 5% of all deliveries during the study period. There were 200 (66.66%) spontaneous preterm births and 100 (33.34%) indicated preterm births among them. The mean birthweight of Spontaneous Preterm was lower than Indicated Preterm with statistically significant difference (p< 0.0001).

Introduction: Type-2 diabetes mellitus are reported to have a 2 to 3-fold increase in the incidence of cholesterol gallstones. Gallstone disease in patients with diabetes mellitus is largely due to dyslipidemia, leading to the alteration in the composition of bile. Impairment of gallbladder motility and contraction, as a result of hyperglycemia and diabetic autonomic neuropathy. Hence the study is undertaken to determine prevalence of gall-bladder disorders in diabetic patients with autonomic neuropathy and association of different parmaetrs with Cases and without autonomic neuropathy. Material & Methods: This was a hospital based case-control study carried out during the period of October 2010 to October 2012. Institutional ethics committee approved the study.The study comprised of known or newly diagnosed 101 patients of type-2 diabetes mellitus and 101 age and sex matched controls. Observation & Results: Out of 101 cases studied 67(66.33%) had autonomic neuropathy and out of 101 controls 9(8.91%) had autonomic neuropathy. Thus prevalence of autonomic neuropathy was significantly more in cases than controls.  Out of 67 cases with autonomic neuropathy 32 (47.76%) had gallbladder disorders and out of 34 cases without autonomic neuropathy 4(11.76%) had gallbladder disorders. Thus prevalence of gallbladder disorders in cases with autonomic neuropathy was significantly more than in cases without autonomic neuropathy. Conclusion: Present study concluded that Gallbladder disorders are significantly associated with metabolic syndrome in type-2 diabetics.Type-2 diabetics with autonomic neuropathy have larger gall bladders with poor contraction in response to fatty meals, thus predisposing these patients to various forms of gall bladder disease

CONCLUSION: The overall prevalence of overweight and obesity were found to be 25.62% & 14.9% respectively in the present study. The overall prevalence rates of systolic elevated BP & hypertension were found to be 11.64% & 5.4% respectively. The overall prevalence rates of diastolic elevated BP & hypertension were found to be 16.30% & 5% respectively

Diabetes is a public health problem; prevalence of diabetes is progressively on the rise. International diabetes federation estimates a doubling prevalence of diabetes mellitus by 2035 from that of 541 million in 2022. Objectives: To find out the prevalence of peripheral neuropathy among known type 2 diabetics and to correlate peripheral neuropathy with select socio – demographic variables. Materials and Methods: A Descriptive cross -sectional community-based study was done among Known type 2 diabetes mellitus individuals of age group 30 years and above. The study was carried out for a period of 10 months after getting approval from the institutional ethical committee. Peripheral neuropathy was classified using the Toronto clinical scoring system of peripheral neuropathy. Data collected was entered in Microsoft 2010 excel spread sheet, compiled and analyzed using IBM SPSS Version 22 statistical package. Results: The prevalence of peripheral neuropathy was found to be 12.6% among the study subjects. Frequency of Peripheral neuropathy was increasing as the duration of diabetes increases. A significant association was found between duration of diabetes and peripheral neuropathy. A significant association was found between increased RBS value and peripheral neuropathy. Conclusion: Maintaining a proper blood-glucose control is the key to primary prevention of diabetes related complications. Regular monitoring of blood-glucose level must be done for the management of Diabetic peripheral neuropathy.

Background: IThis hospital-based prevalence study was carried out to evaluate the clinical and epidemiological profile of anaemia in central India. Methods: In this study, 200 patients with anaemia from medical outpatient departments and indoor wards were randomly selected without regard to gender, occupation, socioeconomic status, or disease duration. Results: According to the findings of this study, the majority of patients (40%) were between the ages of 21 and 30. Females had a higher prevalence of anaemia than males between the ages of 15 and 30. The study population has moderate anaemia in 57% of cases, and severe anaemia in 41% of cases. Weakness and easy fatigability were the most common (100%) presenting symptoms, and pallor was the most common (98%) clinical sign. The most common laboratory findings were microcytic and hypochromic type peripheral smears (59 percent cases). The most common type of anaemia was nutritional anaemia (84 percent). Conclusions: Lack of nutrition The most common cause of anaemia in the population is anaemia, and iron deficiency is the most common nutritional deficiency in the population.

Introduction: Haemorrhoids of grade 3-4 and prolapsed haemorrhoids need surgery. Previously, surgeons used to perform Milligan-Morgan open technique, but after the introduction of stapler haemorrhoidopexy, most surgeons prefer this technique. It involves the removal of rectal mucosa and haemorrhoidal tissue 4 centimetres above the dentate line. Stapler haemorrhoidopexy in the recent past has been accepted as the preferred modality of surgery for grade 3 and 4 haemorrhoids, though traditional method of open haemorrhoidectomy is still performed. Various previous studies have proved that stapler and open technique have the same results in efficacy but the complications are lesser with stapler haemorrhoidopexy.

Aim: To correlate the presence of muscle fibres in the doughnut of stapler haemorrhoidopexy with post-operative complications.

Results: This is an observational study conducted in 80 patients who underwent stapler haemorrhoidopexy for internal haemorrhoids. Most of the patients are between 20 to 40 years (42.5%) with mean age of 36 years. Early post-operative complications in patients with muscle fibres in donut of stapler haemorrhoidopexy specimen were mainly post-operative pain. All 7 patients (100%) suffered from severe pain at operative site i.e. VAS score > 6 (p- < 0.001**). 5 out 7 patients (71.4%) patients had post- operative urinary retention (p-0.009**) and post-operative bleeding per rectum is seen in all 7 cases (p- < 0.001**). All the early post-operative complications are strongly clinically and statistically significant. And in late post-operative complications proctalgia was seen in 3 (42.9%) patients (p- < 0.001**) which was also strongly clinically and statistically significant.

Conclusion: Early complications like post-operative pain, urinary retention and post-operative haemorrhage in patients with muscle fibre in donut are clinically and statistically significant. (P- < 0.001**). Late complications like proctalgia is clinically and statistically significant. (P- <0.001**).

An experienced surgeon and proper stapler haemorrhoidopexy technique is required to avoid such complications

The second covid wave caused unprecedented havoc, morbidity and mortality all over India. This retrospective study delves into the disastrous impact of Covid 19 second wave in the pregnant population at our tertiary care center. This retrospective study was done to bring insight into demographical factors, associated comorbidities, mode of delivery, role of inflammatory markers, treatment administered, complications in pregnant women who were severely affected by COVID -19. Material and Methods: This retrospective observational study collected data from 1 April 2021 to 30 June 2021. A total of 40 pregnant COVID-19 patients admitted during the second wave of COVID-19 infections were included in the study. All demographic characteristics like age, parity, type of conception, BMI, associated comorbidities, symptoms and their duration, type of oxygen support, the inflammatory markers (IL6, serum ferritin, N/L ratio, LDH), mode of recovery and outcomes were analyzed. Statistics: Data was collected, summarized, tabulated using Microsoft Excel and expressed as percentage. Results: Of the 40 COVID- 19 cases, 10 pregnant women succumbed to COVID- 19. Age above 30 years and higher BMI was associated with all mortalities. Fever and Breathlessness was a common symptom in all. All women who succumbed had falling SPO2 levels and all were on higher oxygen support. CRP, D- dimers and IL-6 levels are markedly increased in all the fatalities who were infected by COVID-19. Conclusion: The second COVID-19 wave affected the pregnant population the most. The outcomes of women who were on higher oxygen support was worser. Serum Ferritin and IL-6 was raised in all patients with worse prognosis

Introduction: One of the most common lower-extremity impediments in people suffering with diabetes-mellitus is foot ulceration. There is an increased risk of amputation and increased mortality rate in patients with foot ulcer. The neutrophil-to-lymphocyte-ratio (NLR) has lately been shown to forecast chemotherapy response in cancer patients, associated with peripheral arterial disease, systemic endothelial dysfunction and cardiovascular diseases. NLR is an useful measure in predicting overall mortality and disease-specific mortality.

Objectives: To evaluate the role of Neutrophil- Lymphocyte Ratio NLR in prognosis of Diabetic-Foot-Ulcer (DFU)

Methodology: The outcomes of diabetic foot ulcers in 100 patients admitted to surgical wards were assessed. Demographic, patient-specific, and wound specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing and chronic ulcer. The data was entered in Microsoft excel and analyzed using SPSS version 16.

Results: The mean (SD) age was 57.1(11.29) years. 58% of subjects were females and 42% were males. The mean (SD) duration of Hypertension was 10.3(3.50) years and that of Diabetes Mellitus was 9.49(3.03) years. 53% had history of trauma, 48(48%) of subjects had pain, 51(51%) had gangrene of foot. The mean (SD) CBP, Neutrophils, Lymphocytes and Neutrophil-Lymphocyte Ratio was 20.24(2.89) per thousand, 94.73(3.21) %, 14.97(3.23) % and 6.65(1.52) respectively. 58% had healing ulcers and 42 had non healing ulcers. 44% of study subjects were having NLR <6 which is normal and 56% had NLR>6 which is abnormal. Among 58 subjects with healing ulcers, 44(75.9%) had NLR<6 and among 42of non-healing ulcers, 42(100%) had NLR >6. This was statistically significant (p value <0.001). The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was 75% and negative predictive value was 100%. The mean (SD) NLR in healing group was 5.15(0.65) and in non-healing group was 8.205(0.84) and this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with poor prognosis.

Conclusion: NLR is a good prognostic variable in predicting the outcome of Diabetic foot ulcer. The sensitivity of NLR >6 in predicting non-healing ulcer was 100% with a specificity of 75.9%. The positive predictive value was75% and negative predictive value was 100%.

Background: It is difficult to ascertain reliably the overall incidence and prevalence of the various cutaneous infections in different parts of the world because studies of one region of the country may not be a true representation of the overall disease pattern of that country; furthermore, incidence and prevalence figures may only will be representative of the population sampling, which may have associated risk factors for infection. Most of the studies done in this field are dealt with adults or with a specific clinical form of dermatophytosis. Only few surveys were performed in pediatric age group. Aim: To study clinical presentation of superficial dermatophytic infection in paediatric patients in tertiary health care centre. Methods: It is an observational type of study.  The present study was conducted in Department of Dermatology, Rajshree Medical & Research Institute, Bareilly, from 1st march 2021 to 28th February 2022. Results: Majority of the study population belonged to 11-15 years (48.7%) followed by 15-18 years (24.1%), 0-5 years (16.6%) and 5-10 years (10.6%). The mean age of the study population was 9.16±4.241 (0-18) years. There were 47.7% males and 52.3% females. Itching was present among most of the patients that is 226 patients had this complaint (95.3%). The most commonly affected sites was Groin (47.2%) followed by Trunk (29.9%), buttocks (29.1%), upper limbs (24.0%), Face (6.7%), Scalp (4.6%), lower limbs (4.6%) and Nails (0.4%). The predominant lesion type was Plaque (43.5%) followed by Others like  Pustules, erosions, excoriation, crusting (29.5%), Plaque with papules (16.5%), Plaque, Others (4.6%), Papules, Others (4.6%) and Macule being the least lesion type (1.3%). The most common lesion feature found in most of the study group was discoloration (94.1%). The most common diagnosis was T. corporis (29.1%) followed by T. corporis+ T. cruris (28.3%), T. cruris (22.4%). Limitations: The study was an observational study done at the first visit of the patient in OPD with no follow-up. This was major limitation of the study, since the further change of course of presentation was not noted. Also the patients undergoing any other treatment with dermatophytosis were not studied. Conclusion: Total 237 patients of superficial dermatophytosis were included in the study, out of which mean age was 9.16 ± 4.241 with female predominance (52.3%). Maximum patients were from middle school (48.9%) corresponding to age and belonged to middle class (70.5%) socioeconomic status. Common presenting complaints were itching (95.3%), affected site was groin (47.2%) and annular plaque was predominant type of lesion. The most common made in our study was T. Cruris (47.2%). More studies should be carried out in future on large scale so that this study can be corroborated to evidence. Along with that, alternation in dosage for pediatric age group should be studied

Background: Portal hypertension is a major consequence of cirrhosis and is responsible for its most severe complications, including ascites, bleeding from gastro-oesophageal varices and encephalopathy. Measuring HVPG is very ideal to diagnosis and to grade severity. But the drawback of this procedure is its invasiveness leading to complications. So, a simple, routinely available, cost effective method for severity assessment of portal hypertension would be attractive. Methodology: It was a cross sectional study which included patients diagnosed as Chronic liver disease attending to the OPD as well as in-patients. Results: This study included a total of 100 subjects who had esophageal varices secondary to liver cirrhosis with portal hypertension. Majority of the patients were in the age group of 36 to 45 years (31%) with mean age of study subjects being 47.43 with male preponderance (87%). A statistically significant association was found for splenic size and esophageal variceal grading. 57% of the patients had splenomegaly between 13-15cm size of which 22 % had grade 3 esophageal varices followed grade 1 varices who constituted 17%. 20% of the patients had spleen size >15cm. Conclusion: Ultrasonographic measurement of spleen size > 13 cm can be considered as non-invasive predictor of presence of esophageal varices and grading in patients with Cirrhosis with portal hypertension along with other measurements like portal vein diameter and platelet count

Background: Breast cancer is the most common cancer in women, affecting 2.1 million women per year and accounting for the majority of cancer-related deaths among women. The use of neoadjuvant chemotherapy in the treatment of breast cancer has been shown to be effective in down staging primary tumors, clear surgical  margins and improve patient’s overall outcome. The aim of this study is to look at various factors affecting the clinical and pathological response in patients with locally advanced breast cancer after of neoadjuvant chemotherapy. Study Design: A prospective cohort study Patients and methods: This was a prospective cohort study on patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma. A total of 58 patients who presented with locally advanced breast cancer (LABC) were treated with neoadjuvant chemotherapy for 3 cycles and then were assessed for response,patients with adequate response to chemotherapy were continued further for 3 more cycles of NACT . Patients not responding to NACT after 3 cycles underwent Modified radical mastectomy. The clinical response was assessed with RECIST criteria before the start of NACT and then after 3 cycles or at end of therapy. The pathological response was checked with Chevallier’s criteria before the start of NACT and then after completion of 3 cycles or at the end of NACT. Results: A total of 58 female patients who received neoadjuvant chemotherapy for locally advanced breast carcinoma from February 2021 to July 2022 were studied. The median age of the patients at the time of diagnosis was 53.5 years (28 – 84 years). In terms of menopausal status, 10 patients (17.3%) were pre-menopausal and 48 patients (82.7%) were post-menopausal. Histological classification showed infiltrating ductal carcinoma in 54 patients (93.2%), infiltrating lobular carcinoma in 2 patients (3.4%) patients and squamous cell carcinoma in 2 patients (3.4%). Among 58 patients, 15 patients (25.9%) had clinically complete remission (cCR), 23 patients (39.7%) had partial remission, 14 patients (24.1%) had stable disease and 6 patients (10.3%) had progressive disease. Also among 58 patients, 17 patients(29.3%) had pathological complete response (pCR) followed by 2 patients who had near to complete pathological response. Our study showed downstaging of tumor in 37 patients (63.7%) with T3 and T4 stage. Conclusion: Preoperative chemotherapy downstages the primary tumors and axillary metastasis in patients with locally advanced breast carcinomathus, it help in achieving surgically clear margins and elimination of micrometastases which may further decrease the recurrence rates and morbidity/mortality in patients

Introduction: Emergence agitation is a common side-effect of Sevoflurane anaesthesia in children. Dexmedetomidine, a specific α2- receptor agonist, may be useful adjuvant during general anaesthesia by promoting hemodynamic stability and decreasing the doses of anaesthetics and analgesics. The purpose of our study was to test the effect of Dexmedetomidine in reducing emergence agitation in children undergoing Sevoflurane anaesthesia.

Material and Methods: 60 children aged 3 to 7 years scheduled to undergo superficial lower abdominal or genital surgeries were included in the study. Patients were randomly assigned to receive either Inj. Dexmedetomidine 0.3µg/kg (Group D) or Inj. Fentanyl 1µg/kg (Group F) i.v prior to induction. After induction with 8% Sevoflurane, a laryngeal mask airway was inserted. Anaesthesia was maintained with 1-2% Sevoflurane and 50% nitrous oxide on spontaneous ventilation. Postoperatively, caudal epidural block was given. At the end of anaesthesia, the time of response to verbal commands (TRVC) and characteristics of emergence were recorded.

Results: Mean postoperative behaviour score in Group D was 1.7 ± 0.79 while that in Group F was 2.96 ± 0.96. There was significant reduction in the VAS score from 5.7 ± 0.98 in Group F to 2.4 ± 0.89 in Group D. 13.33% patients in Group D and 43.33% in Group F showed agitation.

Conclusion: We conclude that Inj. Dexmedetomidine 0.3µg/kg i.v reduces postoperative emergence agitation after Sevoflurane anaesthesia in children

Background: Caesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period. Aims: To study the maternal and fetal outcome of emergency caesarean delivery between unbooked rural referrals and booked cases. Materials and methods: This is a Comparative cross sectional study was conducted in the Department of Obstetrics and Gynaecology in Gestational age > 37 weeks, Unbooked cases handled outside and referred, who underwent caesarean delivery on emergency, Booked cases admitted in our hospital and underwent emergency caesarean delivery and Singleton pregnancy. Results: This study included 980 antenatal patients who underwent emergency caesarean section, among them 420 were booked cases and 560 were unbooked cases. The incidence of emergency caesarean section was more in unbooked group compared to booked group.  This comparison of age, Teenage pregnancy, parity, socioeconomic status had  statistical significance with p value < 0.05. The major indication of emergency caesarean section in booked cases was previous caesarean section (29.26%), where as it was fetal distress (22.6%) in unbooked group. Septicaemia in unbooked group (4.6%) was more than booked group(1%).66 cases (11.8%) of unbooked group and only 21 cases (4.9%) of booked group had wound infection. Postpartum haemorrhage, Perinatal mortality, NICU admission rate statistically significant among the two groups. Maternal intrinsic factors such as nutrition socioeconomic status and lack of antenatal care have been suggested as the causative factors in the unbooked patients. Conclusion: Poor utilization of antenatal care is associated with adverse feto-maternal outcome. Most maternal deaths are preventable if complications are diagnosed early and managed effectively in time .Early admission and management of critical obstetric patients decreases maternal morbidity and mortality

Introduction: Hyperbaric bupivacaine (0.5 %) has been the gold standard drug for the safe conduct of spinal anaesthesia in recent times. Various additives have been used along with hyperbaric bupivacaine to prolong the duration of analgesia. Out of these, fentanyl and midazolam have been two of the most commonly used. Here a clinical study was undertaken to compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal bupivacaine for spinal anaesthesia. Aims: To compare the effects of intrathecal midazolam 1mg and fentanyl 25 μg as additives to 3ml of 0.5% hyperbaric bupivacaine (15mg) for spinal anaesthesia with respect to the onset and duration of sensory and motor blockade, duration of effective analgesia, perioperative hemodynamic changes and any side effects of these drugs. Methodology: This is a prospective randomized study studied in 100 patients posted for various elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. They were randomly divided into two groups, Group A (Midazolam) and Group B (Fentanyl) each consisting of 50 patients in the age group of 18 years to 60 years posted for elective surgeries under spinal anesthesia. Subarachnoid block was administered in L3-L4 intervertebral space. The data collected were statistically analyzed. Results: Addition of 25 μg intrathecal fentanyl to hyperbaric bupivacaine resulted in a statistically significant duration of sensory blockade (Group A ; 206.56 min; Group B ; 230.06 min) and motor blockade (Group A ; 225.56 min; Group B ; 251.88 min).  The duration of effective analgesia was also significantly longer in group B (Group A ; 246.2 min; Group B ; 264.32 min). Incidence of hypotension and bradycardia is found to be similar in both groups. There was no significant difference between the two groups with respect to the occurrence of nausea. 4% of people in fentanyl group developed pruritus where as none in midazolam group developed it. None of them had urinary retention, respiratory depression, lower limb weakness or any other neurological deficits. There were no statistical differences in the sedation scores between the two groups. Conclusion: The results suggest that the use of 25 μg intrathecal fentanyl provides longer surgical analgesia, prolongs the duration of sensory and motor blockade, and offers relative hemodynamic stability with minimal side effects. Hence fentanyl is an excellent additive to Bupivacaine for prolangation of spinal anaesthesia

Background- Given the strong correlation between cardiac disease and chronic kidney disease (CKD), it is possible that even a slight drop in glomerular filtration rate (GFR) can act as a risk factor for developing cardiovascular abnormalities. Cardiovascular disease (CVD) patients with CKD had mortality risks that were three to thirty times higher than those of the general population. Methods- This cross-sectional study was conducted in the Medicine unit of Postgraduate Medical Center of Central India within 6 months duration. The analysis included a total of 140 patients who had been receiving maintenance for more than a year. Two-dimensional transthoracic echocardiography was done in each patient for the determination of cardiac structural and functional parameters such as LV hypertrophy, LV systolic dysfunction, and LV diastolic dysfunction. Results- Out of 140 patients, there were 75.7% males and 24.3% females. Maximum number of patients belonged to age group of 51-60 years. Mean age of ESRD patients was 53.3 ± 12.8. Hypertension (37.1%) was leading cause of ESRD, other causes included diabetes (21.4), diabetes with hypertension (10%), chronic glomerulonephritis (8.6%), polycystic kidney disease (7.1%), obstructive uropathy (5.7%), analgesic nephropathy (2.9%) and aetiology remained unknown in 7.1% cases. Conclusion- Left ventricular dysfunction was most common in ESRD patients. LVH was the most common ESRD echocardiographic abnormality. More ESRD patients had diastolic dysfunction than systolic dysfunction. Left ventricular hypertrophy and diastolic dysfunction were mostly caused by anaemia and hypertension. Systolic dysfunction was caused by ischaemic heart disease-related RWMA. Echocardiography detected LVH and minimal pericardial effusion before clinical diagnosis

Background: Understanding the underlying causes and risk factors of child malnutrition is essential for developing effective solutions. This study was conducted to identify the contributing factors to undernutrition in children between the ages of 6 months and 5 in Bareilly, Uttar Pradesh. Material & Methods: This cross-sectional observational study was carried out among Children between age group 6 month to 5 year visiting Pediatric department in Rajshree medical research institute and hospital (RMRI), Bareilly. All of the patients were given a thorough medical history, in-depth physical examinations, and investigations that were both routine and appropriate. Results: There were 103 (23.5 percent) subjects older than three years old, 59 (13.5 %) subjects aged 0-1 year, and 276 (63.0 %) subjects aged 1-3 years with the mean age of 33.28 years and 16.89 months. There were 254 males (58.0%), which made up 58.0 percent of the total, and 184 females (42.0%). Stunting was present in 161 (38.6%), underweight was present in 151 (34.5%), and wasting was present in 86 (19.6%). Overall malnutrition was found to be prevalent in 50.7% of the population. Both stunting and malnutrition were much more prevalent in age groups older than three years. The stunting, underweight, wasting and malnutrition were all considerably higher among those with a Class I or Class II socioeconomic status. It was shown that those with birth orders 4 and 5 had considerably higher rates of stunting, underweight, wasting and malnutrition. There was not a significant difference between males and girls in terms of stunting, underweight, wasting and malnutrition. Conclusion: The prevalence of malnutrition in children under the age of five is rather high and highlight the importance of good newborn and child feeding practises, suitable maternal care, and female literacy in the prevention of childhood undernutrition

Background: HIV is predominantly lymphotropic to CD4 (T-helper) lymphocytes Other cells bearing CD4 receptors are also infected (e.g, macrophages, B cells, Langerhans cells, NK cells  etc.). Objective: To  find  out  the  various  patterns and presentations of  dermatological  conditions occurring  in  HIV Patients and their association with CD4count. Methods: In this study we included 100  patients above age of 15 years who were infected with HIV Virus. Results: The most prevalent infection was candidiasisseen in 25 patients it was a definite maker for HIV disease progression and was seen in early as well as late stages of HIV infection. Dermatophytosis was the second most common fungal infection seen in 11patients. Among viral infections, herpes simplex virus(HSV) wasthemost common infection found in 12patients, Herpes zoster was seen in 8 patients. The most common non – infectious dermatosis seen in our study was seborrhoeic dermatitis in 12patients. Conclusions: Dermatological manifestations occur throughout the course of HIV infection some of the manifestations can be considered as the predictors of advanced immunosuppression.

Background: Elevated Lp (a) and heart disease & indicates that Lp (a) is an important, independent predictor of cardiovascular disease. Objective: To evaluate the level and effect of lipoprotein (a) in CKD patients. Methods: The present study was conducted at the PG Department of Medicine of S.N. Medical College, Agra. The tests used for the determination of left ventricular hypertrophy were done by echocardiography (quantitatively) and by ECG (qualitatively). Results: Maximum number of subjects were male (60%). Maximum number of patients were between the age of 41-50 yrs (43%). The level of lipoprotein (a) was significantly increased in hemodialysis group. Lp (a) level was measured at the baseline, 3 month and  6 month in both groups and when analyzed statistically the P value was (0.7668), (0.0413) and (0.0495) respectively.This data is suggestive that P value is significant at 3 month and 6 month which means increase in Lp (a) level at 3 month and 6 month was positively correlated with hemodialysis. LVH had a positive correlation with hemodialysis group Conclusions: Lipoprotein (a) level is more in hemodialysis patients.

Introduction: The laparoscopic cholecystectomy treatment is technically more difficult than the traditional open cholecystectomy, yet it has revitalized general surgery and quickly become the gold standard procedure for benign gallbladder disease. Even though the introduction of laparoscopic cholecystectomy has significantly changed how patients with biliary illness are managed, there are still many difficulties and unresolved problems about using laparoscopic procedures for this prevalent medical disease. There are higher odds of harm to the viscera surrounding the common bile duct. Methodology: In order to evaluate and correlate the clinical, biochemical, and ultrasonographic findings with the operative findings for anticipating challenging laparoscopic cholecystectomy, a prospective study was conducted on 60 patients undergoing laparoscopic cholecystectomy in the Department of Surgery, SCB, Cuttack, between November 2018 and October 2020. Result: The conversion rate in this study was 8.3%, and the male-to-female ratio was 1:4.4. The majority of the patients were between the ages of 41 and 50. The standard deviation was 9.9, and the average age was 41.9. The age range of 51 to 60 years has the highest conversion rate. Clinical criteria predicted that 12 out of 60 patients would be challenging cases, of which 08 were challenging surgically and 05 were converted. Out of 60 patients 05 patients were predicted to be difficult based on biochemical parameters of which 04 were difficult on surgery. Out of 04 difficult cases 2 got converted to open procedure. Out of 60 patients 07 were predicted to be difficult of which 05 were found to be difficult on ultrasonographic parameters. Out of these 05 difficult cases 03 got converted to open procedure. Conclusion: We may infer from this study that preoperative clinical, biochemical, and ultrasonographic characteristics should be used as screening techniques because they are generally good indicators of how difficult laparoscopic cholecystectomy will be. It can assist surgeons in gaining insight into any potential challenges that may arise with a specific patient.

Introduction: Prostate cancer is a disease of men. An early observation reports that more than 65% of all prostate cancers are diagnosed in men over the age of 65. Current advances in molecular techniques have provided new tools facilitating the discovery of new biomarkers for prostate cancer. High levels of leptin have been significantly correlated with testosterone and Prostate specific antigen values in subjects with Prostate Cancer compared with subjects in the control group. Adiponectin is the most abundant circulating adipokine and accounts for 0.05% of the total plasma proteins. As a consequence of these observations, and its inhibitory role on the growth of breast and endometrial Cancer cells ,it can be labelled as an Anti-Cancer Adipokine. Interleukin (IL)-6 is a pro-inflammatory cytokine that is expressed in prostate tumors and in the stromal tumor micro-environment. It is known to regulate proliferation, apoptosis, angiogenesis, and differentiation. Material and Methods: This Observational study was conducted among 120 Males, aged above 50 years, out of which 60 were prostate cancer patients and 60 were Healthy controls, who attended the O.P at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre. Men were excluded at baseline, if they had a history of myocardial infarction, stroke, transient ischemic attack, unstable angina, cancer or current renal or liver disease, peptic ulcer, gout, or use of platelet-active agents, vitamin A, or β-carotene supplements. Serum samples of men with prostate cancer based on high prostate specific antigen (PSA),biopsy and/or abnormal DRE  and those of healthy controls were collected after an overnight fast and analysed on the same day. Serum PSA and IL-6 levels were estimated using ELISA. Plasma adiponectin and leptin concentrations were measured by competitive RIA.  Results: In our study, 60 Males were Cases of Prostate Cancer and 60 were Healthy Control group. The age of the patients was almost similar in both Cases of Prostate Cancer (66.23±7.25) and Control group (61.01 ± 7.81). The PSA (ng/ml) level was significantly (<0.001) higher in PCa patients (7.12±0.80) as compared to control group (0.93±0.84). Similarly, the Interleukin-6 level was significantly (<0.001) higher in PCa patients (9.71±0.75) as compared to control group (5.9±0.61). In our study, Leptin (ng/mL) level of Prostate cancer group was 13.31±0.84 which was higher when compared to control group where it was 7.52±0.74. Adiponectin (µg/mL) Levels of Prostate cancer group were 11.72±2.34 which was lower compared to control group where it was 16.25 ±2.73. Conclusion These data further support a relationship between elevated IL-6 and prostate cancer disease prognosis. IL-6 correlates with rising PSA levels and extent of disease, and thus can be used in conjunction with other disease indicators. The multifaceted role of adiponectin in regulating several hallmark pathways that drive cancer growth suppression has been proposed in various studies. Adiponectin is an adipose tissue-derived polypeptide hormone, that in addition, to its anti-diabetic and anti-atherogenic effects also exerts anti-angiogenic properties and therefore it can be used as a target for anti Cancer therapy. On the other hand, leptin would affect PCa growth by means of factors related with obesity such as testosterone and could influence cell differentiation and Prostate Cancer progession.

Background: The incidence of autonomic dysfunction has increased in the presence of type 2 diabetes mellitus and various tools have been developed for assessing it. Classical autonomic function tests are one among them. Autonomic nervous system (ANS) innervates almost all organ systems and is primarily involved with homeostatic regulatory mechanisms. The important functions of ANS are maintenance of homeostatic conditions of the body; regulation of visceral activities; smoothening body’s responses to environmental changes, stress, and exercise; and assisting endocrine system to regulate various functions.  Materials and methods: This cross-sectional study was conducted in the Department of Physiology, Tertiary Care teaching Hospital over a period of 1 year. Involves participants with T2DM (n = 70) and healthy volunteers (n = 70) with an age range of 30-60 years of both genders. Subjects ranging from 30 to 60 years of both genders who were diagnosed with type 2 diabetes mellitus for 3 years duration were recruited for the study. The controls were normal healthy volunteers in the same age group. The cases were selected from diabetology OPD and endocrinology OPD according to the inclusion criteria. The controls were selected from medical OPD who were non diabetic healthy volunteers. Details of present history, treatment history were obtained. Result: There was no significance in age between cases and controls as the p value was 0.2789. The mean SDNN of cases was 29.88 ± 3.99 and for controls was 37.65 ± 4.69. The difference in SDNN between cases and controls were significant as the p value was < 0.05. The mean RMSSD of cases was 20.61± 16.81 and for controls was 22.65 ± 3.85. The difference in RMSSD between diabetics and non - diabetics were significant as the p value was < 0.05. The mean VLF % of cases was 88.75 ± 12.75 and for controls was 80.35 ± 8.59. The difference in VLF % between cases and controls was significant as the p value was < 0.05. The mean rise in DBP after hand grip in cases was 5.25 ± 0.58 and for controls was 12.18 ± 3.94. Conclusion: Results of this study concluded that cardiac autonomic dysfunction was present in LT2DM patients without CAN (based on conventional autonomic test) characterized by predominant parasympathetic nerve function impairment and sympathetic overactivity.

Background: "Hypertrophic scars" are excessive scars in which the dense fibrous tissue does not extend beyond the borders of the original wound or incision. They tend to be wider than necessary for normal wound healing to occur. Histologically, hypertrophic scars have more organized collagen fibers than keloids, and scant mucoid matrix. Hypertrophic lesions are characterized by randomly distributed tissue bundles consisting of uni-axially oriented extracellular matrix and cells. Materials and methods: This is a prospective and single centre study conducted in the Department of Plastic Surgery, Tertiary Care Teaching Hospital from November 2021 to October 2022. Males and females in the age group between 18 and 60 years were included in this study. The split thickness skin graft was harvested from a normal thigh where no skin graft had been harvested earlier. Indications for skin grafting were both elective and emergency. Result: Better Aesthetic and symptomatic outcome in Triamcinolone injected skin graft donar areas. Conclusion: Injection of Triamcinolone into skin graft donar areas will reduce hypertrophic scarring significantly

Background: Fungal keratitis is one of the most devastating microbial keratitis with the worst visual prognosis, potentially leading to blindness. The clinical characteristics of Fungal keratitis are mild pain, the insidious growth of fungal pathogens in the deep cornea, and difficult to differentiate it from other kinds of microbial keratitis early on. Therefore, the early and accurate diagnosis of Fungal keratitis by means of clinical features is sometimes impossible due to patients’ delayed visits or the great similarities of Fungal keratitis with other types of microbial keratitis in early stages of the disease. [3] Materials and methods: This is a prospective and observational study was conducted in the Department of Microbiology, SIMS over a period of 6 months. This includes 35 patients with clinically suspected fungal corneal ulcer within an age group of 15–60 years. Sociodemographic data, chief complain, history of present illness like onset, duration, associated features, aggravating or relieving factors were noted. Corneal scraping of the affected eye was collected under slit lamp illumination. The direct microscopy of 10% potassium hydroxide (KOH) wet mount and gram staining of the materials directly smeared on the slides were performed. The samples were also inoculated onto Sabouraud Dextrose Agar (SDA) plates for fungal culture at 27°C for 21 days. Result: Among the positive cases of fungal keratitis, males (65.7%) outnumbered females (34.3%) with the ratio of 1.67:1 (Table 1). The maximum number of positive cases were seen in age group of 21-30 years, followed by the age groups of 31-40 years and 11-20 years. The most common cause of Aspergillus fumigatus (28.6 %), Fusarium solani (20%), Cladophialophora bantiana and Candida tropicalis (14.3 % each), and Mucor and Candida albicans (5.7 % each), Curvularia (11.4%). Aspergillus species were found to be isolated from 50% of cases of keratomycosis.  Filamentous fungi were predominantly associated with mycotic keratitis, accounting for 71.4% of cases, as compared to yeasts which had caused keratitis in 28.6% of cases. Amongst the cases of keratomycosis (n=35), all were positive for fungal growth on culture, out of which 85.7% cases were also positive for the presence of fungal elements on direct microscopy. Conclusion: Fungal keratitis is often a severe disease in which diagnosis can be challenging, the response to medical treatment is slow, and the clinical outcome is poor. Corneal perforation is 5 to 6 times more likely with fungal keratitis than it is with bacterial keratitis. Because of serious consequences of infectious keratitis, it is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time

Incisional hernias are a very common problem encountered by a surgeon and has followed abdominal surgery like a shadow for more than a century now. Incisional hernia is a truly iatrogenic hernia. In this prospective study, all patients (50 cases) presenting to the opd of general surgery in Katuri medical college & hospital over a 2 year period, have been selected ensuring there was no obstructed or strangulated incisional hernias/ intra abdominal malignancies / patients with severe co-morbid conditions (severe cardio-pulmonary disease, uncontrolled ascites)/ pregnant women with incisional hernias/ recurrent incisional hernias. The aim was to  evaluate the outcome of anatomical and mesh repair of incisional hernia with reference to technical difficulty, convalescence, wound infection and recurrence. A majority of patients were in the age group of 31-40 years and was more common in females than males with a female to male ratio 7.2 : 2.8 It was found that 36% of patients had an onset of symptoms within one year of previous surgery, whereas, 22% of patients had an onset between 1-5 years,14% had onset between 5-10 years and 28% after 10 years. Meanwhile, 88% of patients had hernial defect size of less than 5 cm in diameter, 8% had a defect size in between 5-10 cm, however, only 4% had a defect size of more than 10 cm in diameter.The study had found 3 patients in the anatomical repair group and 11 patients in the mesh group had developed post operative complications; most common of which were: 1. Wound infection in the anatomical repair group (8%). 2. Seroma was seen in the mesh group (24%). 3. All the 25 cases in each group were followed up for a period of 1 year and no recurrence was noted.

BACKGROUND: Motor vehicle accidents are one of the major causes of facial injuries. Midface is the common site to get involved. Midface fractures are frequently involved with head injury or associated with other facial fractures or in isolation.Mid face fracture patterns were first published by a French surgeon Rene Lefort in 1901.At present midfacefractures rarely fit into Lefort classification patterns.The changes in the lifestyle led to increased use of advanced motor vehicles which increased the road traffic accidents.The fractures are deviated from the Lefort patterns due to changes in the velocity,forces direction of impact on the skull. To emphasize the need for more comprehensive classificationto include variations in midface fractures patterns such as unilateral fractures, asymetricalLefort fractures,associated fractures etc., OBJECTIVE:A prospectiveobservational  cross sectional  study to assess various patterns of maxilla fractures in relation to age,sex and mode of injury. MATERIALS AND METHODS:Study includes patients presented to Plastic Surgery department in King George Hospital,Andhra Medical College from  June 2014  to May 2021.Patients were examined clinically and reviewed  with 3D CT facial bones .Injuries were classified using Lefort system and those fractures deviated from Leforts are noted. RESULTS: Evaluation of midfacial fractures done among facial bone fractures.Total number of patients in the study are 685 with 9.5 :1 male to female ratio.The peak incidence is in the age group of 21-30 years.The most common cause beingroad traffic accidents.Mid face fractures which are deviated fromlefort fractures aridentifie and evaluated.Different patterns in midface are observed with the help of radiological imaging.Among midface fractures majority doesnot fit into classical Leforts .Only 8.5%  constitutesLeforts patterns.

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined by GOLD as a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. [1] The most common respiratory symptoms include dyspnea, cough and/or sputum production. These symptoms may be under-reported by patients. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. The sample size for this research study was calculated on the basis of prevalence of abnormal left and right ventricular dysfunction of 25% in known patients of COPD at 95% confidence interval and an absolute precision of 10%. Right atrial Pressure (RAP) was estimated from the evaluation of the inferior vena cava during respiration. If the inferior vena cava diameter is normal and the segment adjacent to the right atrium collapses by at least 50% with respiration, then right atrial pressure is estimated as 5 mm Hg. Results: Number of males is slightly higher than females in the study group. But there was no significant difference in sex between the study group and the control group. There is no significant difference in age between COPD and control group. The minimum age of the patient was considered to be 35 because COPD is usually a disease of middle age and is less likely below 35 years. The mean difference in FEV1 in the study group is 1.03±0.31 and in control group is 4.23± 0.91. By applying student t test, p value was found to be significant between the two groups. The mean difference in FVC is 2.03±0.34 in COPD group and 4.61±0.88 in the control group. P value was significant between the two groups. The mean difference in the FEV1/FVC in COPD group was 53.15±9.99 and control group was 83.88±6.66. p value was significant. Conclusions: This study on clinically stable patients with COPD with a wide range of severity of airways disease provides evidence of subclinical RV dysfunction and suggests that cardiovascular comorbidities may begin early in COPD and are often occult. RIMP and RV basal strain showed largest difference between controls and COPD cases irrespective of the presence or absence of PH

Background:  In India smoking and tobacco dipping are major health problems and one of the largest preventable causes of disease and premature death. Nicotine has been reported to improve attention, learning, reaction time (RT), problem solving, and stimulus evaluation and discrimination. Previous research has established that cholinergic systems are important for cognitive functioning and nicotine is a potent cholinergic stimulant that affects many central nervous system (CNS) pathways, including the auditory pathway. It is a measure of function of sensory­ motor association and performance of an individual. It involves stimulus processing, decision making, and response programming. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. Audio-visual reaction time – Measurement of reaction time is a simple test which is measured by ‘audiovisual reaction time apparatus’ (Anand agency, Pune). Reaction time is a commonly used parameter for measuring implicit learning. In measurement of reaction time subject was asked to respond by pressing the button as soon as he had received the stimulus in the form of sound or light. The apparatus provides both auditory (low and high pitched sounds) and visual (red and green) stimuli. The arrangement consists of a source of stimulus, response key and the time recording device. The response is given by the subject by pressing a key with his index finger. Results: In the present study, in age groups ART values were significantly different (Graph-1) in all three groups, ART and VRT values increase in control, smokers and dipping tobacco users as age advances. As regards ART values, age group 31-40 years differs significantly from age group 11-20 years and 21-30 years (p<0.05), similarly age group 41-50 years differs significantly from age groups 11-20 years, 21-30 years and 31-40 years. As regards, VRT values age groups differ from each other but age group 41-50 years differ significantly from age group 11-20 years and age group 21-30 years.  Conclusion: Significant difference was also observed after smoking and after 12 hours of abstinence in study group subjects. This indicated increased reaction time required for integration process in CNS and delayed conduction in reflex arc after abstinence. Thus, the evidence presented in this article supports that temporary abstinence from nicotine has adverse effect on reaction time which may force them to smoke again. Health education and nicotine replacement therapy may help them to achieve the ultimate goal of complete cessation from smoking.

Background:  Asthma attack is the most common respiratory symptom observed and is of great concern. Throughout the world asthma cases are increasing during pregnancy. The major issue is that the control levels of asthma is changing during pregnancy so the management is a little difficult during pregnancy. Objective: The present study was undertaken to observe the prevalence of asthma and respiratory symptoms during pregnancy. Materials and methods: 40 pregnant women attending OPD in the hospital were part of the study after obtaining the written informed consent. Confidentiality of the data was maintained. Willing pregnant women were included in the study. Pregnant women with any other complications severe were excluded from the study. Respiratory symptoms were examined during the general physical examination by an expert physician. Results: The age group of the participants ranges from 22-30 years. 25% of individuals have asthma. 37.5% of individuals have wheeze without cold, 15% of individuals have nasal allergies. 27.5% have shortness of breath. 5% of individuals have a history of smoking. 15% of individuals are currently under the medication for asthma. Conclusion: The present study results explained that wheezing without cold and shortness of breath are the most common respiratory symptoms during pregnancy. Further detailed studies with a higher sample size are recommended to understand better the respiratory symptoms during pregnancy

Introduction: Chronic kidney disease (CKD) is characterized by a progressive loss of renal function that often leads to end-stage renal disease (ESRD), high risk for cardiovascular disease, and high mortality. Diabetes mellitus is a growing epidemic and is the most common cause of chronic kidney disease (CKD) and kidney failure. Diabetic nephropathy affects approximately 20–40 % of individuals who have diabetes, making it one of the most common complications related to diabetes. Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. The kidneys play a vital role in the excretion of waste products and toxins such as urea, creatinine and uric acid, regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations, as well as the production of hormones like erythropoietin and 1,25 dihydroxy vitamin D and renin. Material and Methods: This is a prospective and observational study was conducted in the Department of Biochemistry at Tertiary care Teaching Hospital over a period of 1 year. Either Gender aged between 18 and 70 years. The study participants were signed written informed consent before the start of data collection. The study participants were selected based on a convenient sampling technique and total of 120 study participants were included.  Subjects suffered from an acute infection and critically sick individuals were excluded from the study.  Results: There was a significant difference  between case when compared to  Control in Male and female.  There was a significant difference in case group in FBS, HbA1c, Urea and S. Creatinine when  compared to control group and no significant difference between both groups in SBP and DBP. Conclusion: The present study it can be inferred that serum urea and creatinine levels were significantly higher in CKD subjects then control subjects. Increased amount of urea and creatinine levels were seen only in CKD subjects and no difference was seen in controls. Thus, it can be recommend that urea and creatinine values can be used for screening of renal status in CKD subjects

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. Methods: This is a prospective, descriptive and observational study conducted at Department of Microbiology, Ayaan institute of medical sciences over a period of 1 year included 410 patients. Patients of either sex of any age who have been admitted inward and on antibiotic therapy were included. Outdoor patients were excluded in our study. Conducted from various clinical Departments such as Medicine wards, Surgical wards, Paediatric wards and Orthopaedics wards. All data was be documented and reviewed periodically. Any deviations from the agreed criteria were communicated, discussed, and documented. Results: On the basis of gender, frequency of Male patients were recorded little bit higher (62.6%) than female (37.4%). So, the hospital attendance rate of this study was male predominant. Majority of subjects belonged to 21-40 years (32.1%) followed by 1-20 years (29.5%) of age range. When it is categorized according to ward, in Medicine ward was recorded 34.8%, and for Orthopaedics it was 20.0%, while 30.9% for surgery and 14.1% paediatrics wards. For this study, subjects were categorised in eighteen groups on the basis of their diagnosis. Out of which, majority of the population (20.50%) were found with diagnosis of carcinoma followed by orthopaedic diseases (19.90%), while least number of patients (0.9%) were diagnosed with ophthalmological as well as thyroid diseases. Beta lactam and Cephalosporin were found the most frequent used first antibiotic even after surgery. Even for the each wards, Beta lactam and Cephalosporin were recorded highly significant and most desirable choices among all the antibiotics. Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits

Background: The most frequent cause of morbidity among newborns is respiratory issues. That is the most frequent reason for admission to a NICU. In order to manage newborn distress and improve clinical outcomes, early detection of the aetiology of respiratory distress is crucial [3]. A combination of symptoms called respiratory distress results from illness processes that impair gas exchange. Objectives: To identify the etiological factors of respiratory distress in the early neonatal period and its immediate outcome. MATERIAL & METHODS: Study Design: Prospective Hospital based descriptive study. Study area: SNCU, Department of Pediatrics, Siddhartha Medical College, Vijayawada. Study Period: January 2020- December 2020. Study population: Full-term neonates with respiratory distress GA (≥37 weeks). Sample size: study consisted 207 study subjects. Sampling method: Simple random technique. Study tools and Data collection procedure: Full-term (gestational age 37 weeks and above) neonates (only inborn) admitted in SNCU Ward of Government Siddartha Medical College & Hospital, with respiratory distress, were consecutively recruited into this descriptive study after getting informed consent from the parents. The early neonatal period (full-term neonates admitted to the NICU with respiratory distress that started within 7 days of birth) was the focus of the study. Instances that were unfollowed were not included in the analysis. Results: Out of the 89 TTN cases, 47 were born early term & 42 were late-term, out of 33 birth asphyxia cases, 19 were born early term and 14 were born late-term, out of 19 CHD cases, 5 were born at early term and 14 were late-term, out of 22 sepsis cases 9 were early term and 13 were late-term, out of 7 surgical cases, 5 were born at early term and 2 were born late-term. 1 case of RDS was born late-term. Out of 2 cases due to other causes, 1 was early term and 1 was late-term. Thus TTN, surgical causes, and Birth asphyxia were common in the early term. CHD, MAS, and Sepsis were common in late term. CONCLUSION: From our study it can be concluded that the most prevalent reason for neonatal admission to the NICU was respiratory distress. TTN was the commonest cause of RD in term neonates, followed by Meconium aspiration, Perinatal asphyxia, Sepsis and pneumonia, and Congenital Heart Disease. Males are more likely than females to experience respiratory distress. Pneumonia are the most common causes of mortality

Introduction: Seizures are one of the most common medical problems affecting children, and epilepsy is the most common chronic neurological condition in children. Materials and Methods: This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Tertiary Care Teaching Hospital over a period of 1 year. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results: The male–female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients. Conclusion: Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures

Introduction: Fever is one of the common reasons for OPD as well as in patient admission department. Due to improvements of laboratory facilities & imaging the incidence and etiological profile of fever have drastically changed. Proper history taking and systematic examination remains the gold standard for fever evading diagnosis. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Result: In this study typhoid fever was the most common cause of undifferentiated fever (28.9%) followed by malaria (17.8%), dengue fever (13.3%), Acute gastroenteritis (16.7%), Pneumonia (12.2%), Bronchiolitis (5.6%), Hepatitis  (3.3%) and Pharyngotonsillitis (2.2%). Treatment- Enteric fever was treated with Ceftriaxone. Chloroquine was used for treatment of Malaria. Dengue was treated symptomatically and with fluids according to Dengue protocol. If fever persisted even after 6 days of antibiotics, then Azithromycin was added. In the undiagnosed fever category, received empirical antibiotics. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians

Abstract   Introduction: Throughout ancient times, tuberculosis has posed a serious threat to humankind. Around 150 million years ago is when the Mycobacterium genus was first recognised. Egyptian mummies have been used to show the skeletal malformations caused by TB. Yet, the infectious agent behind this terrible sickness was not identified for quite some time. Material and Methods: Between January 2022 and October 2022, the epartment of Microbiology at the Ayaan Institute of Medical Sciences in Moinabad, Telangana conducted a prospective study. A total of one hundred people were included as part of this study's sample.  Results: Children who had expressed concerns were asked for and given permission to have a sample taken by their parents or legal guardians. Gastric aspirates, broncho-alveolar lavage, induced sputum, sputum, tracheal aspirate, ascitic fluid, lymph node aspirates, pleural fluid, and a synovial biopsy were all included in the collection of specimens. There was complete processing and analysis of all samples. Conclusion: This research was conducted to identify the most efficacious techniques for detecting TB in young people. CBNAAT has an advantage over other methods used to diagnose paediatric TB because it picked up more instances that were overlooked by those other approaches

Introduction: The brain is normally a sterile site that is protected from infection by specialized barriers, including the bony skull and the blood-brain barrier. Consequently, infections of the central nervous system are comparatively rare. Material and Methods: This study was starting from January of 2022 to the November 2022, researchers was collected data in a cross-sectional fashion. This research was conducted at the Department of Microbiology at the Ayaan Institute of Medical Sciences in Moinabad, Telangana. Results: This research shown that brain abscesses might manifest at any age. The most vulnerable age range was between 11 and 20. Nonetheless, the peak incidence rate was between the ages of 30 and 40. Incidence of this condition occurs between the ages of 30 and 50. According to Sinha et al., 74.89% of their patients were younger than 20. Conclusion: In addition, treating this cluster of risk factors would be more effective if more people knew about the devastating consequences of infections of the scalp, cheeks, ears, and paranasal sinuses. Cyanotic congenital heart disease patients who have not undergone surgery would benefit greatly from a high index of clinical suspicion coupled with prompt treatment

Introduction; Increased oxidative burden plays an important role in the pathogenesis of Chronic obstructive pulmonary disease (COPD).GGT (gamma-glutamyl-transferase) has been regarded as a novel marker of oxidative stress and CRP as inflammatory marker over the last few years. There exists a delicate balance between the toxicity of oxidants and protective function of antioxidant defence systems which is critical for the maintenance of normal pulmonary functions. Aims and objectives; This study aimed to compare the serum levels of GGT & CRP during stable and acute exacerba¬tions of COPD and its relationship with inflammation. Material and Methods; The study involved 120 patients with exacerbated COPD and normal function of the liver and biliary tract (mean age, 65.8 ±9.6 years;) and 120 patients with stable COPD (mean age, 64.5 ±7.9 years;).  Serum GGT and C‑reactive protein (CRP) levels were measured and compared between the groups. Result ; Serum GGT levels in patients with exacerbated COPD (AECOPD )were significantly higher than in those with stable COPD ( 25.3 vs. 18.6 U/l; P <0.001]. Serum CRP levels were significantly higher in patients with exacerbated COPD compared with those with stable COPD (59.6 vs. 17.4mg/l;  P<0.001). Conclusions; Our study indicates that serum GGT levels as the marker of oxidative stress increase significantly during exacerbated COPD and have a positive correlation with CRP levels as compared to stable COPD

Background: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behaviorBackground: Non Communicable Diseases (NCDs) are one of the important modern epidemics affecting the elderly and it also worsens with age.  Health seeking behavior among elderly plays an important role in managing NCDs properly and thereby reducing the morbidity and mortality from NCDs. And health seeking behavior in turn is influenced by various factors. Knowing more about the pattern of health seeking behavior and its determinants among elderly will help health care workers in taking proper measures to improve their health seeking behavior and thus improve the quality of living. Objectives: To assess the health seeking behavior among elderly living with NCDs in a rural area in Trivandrum district and to find out the determinants of health seeking behavior among them. Materials and methods: It is a qualitative study using Focus group discussion method. Done  within 3months during June 2022 to August 2022 in a rural grama  panchayath area in Trivandrum district, Kerala among elderly individuals  diagnosed with NCD like hypertension, diabetes, dyslipidemia,  heart diseases, residing in the that  panchayath area  in Trivandrum .Total of 2 FGDs were conducted with each one having minimum of 6 and maximum of 12 participants. Total of 18 participants were included. Details regarding socio-demographic details, details regarding pattern of health seeking behavior for NDCs, and factors influencing health seeking behavior were discussed. Results: In the current study it was found that half of the participants had good health seeking behavior. Less than half of the participants had self medication. Motivation from dear and near, fear of complication, good support from health care worker were found out to be the facilitating factors while Self medication, poor transportation availablty, poor attitude from health care workers, fear of Covid19, poor financial status were reported as reason for poor health seeking behavior in this study. Conclusion: Addressing these barriers by improving the awareness of public regarding NCDs and importance of early diagnosis and prompt treatment along with overall improvement of health related facilities and quality health care services along with integration and coordination of public and private health services and promoting the various motivational factors can improve the overall health seeking behavior

Osteoporosis is a common metabolic disorder that causes decreased bone strength and is the leading cause of bone fracture, particularly in the elderly. There is no synthesis of evidence to inform policy regarding its prevalence and distribution in India. As a result, the goal of this systematic review and meta-analysis is to estimate and summarise the prevalence of osteoporosis among Indian adults. The PRISMA criteria were used to conduct the systematic review and meta-analysis. A thorough systematic search was conducted in the following electronic databases until May 23, 2022: Medline (via PubMed), Embase, and ProQuest. Following screening, twelve eligible studies were included in the study, which reported the prevalence of osteoporosis among adults aged 18 years, as well as for subsequent methodological quality assessment and data extraction using predefined standardised tools. To generate summary estimates for prevalence with 95 percent confidence intervals, random and fixed effects meta-analysis models were used. Data from 5261 study participants were used in the included studies. In India, the prevalence of osteoporosis is 22.9 percent (95 percent CI: 14.9-32.0 percent), and that of osteopenia is 44.8 percent (95 percent CI: 38.9-50.7 percent ). Females had a significantly higher prevalence of osteoporosis (26.3 percent (95 percent CI: 16.9-37.0 percent) than males (10.9 percent) (95 percent CI: 4.5-19.7). A robust and comprehensive prevalence estimate will aid in health policy decision-making and will aid in the planning and provision of necessary facilities for people suffering from osteoporosis. This is the first study to compile data on the prevalence of osteoporosis and osteopenia in India. Improved access to health services, other health systems, and policy research are required to initiate and increase the uptake of osteoporosis screening and treatment in India

Background: Major cause of death/Adult fungal meningitis in HIV/AIDS patients is Cryptococcus neoformans. Fungal meningitis precedes serum/plasma cryptococcal antigen (CrAg) by several weeks. Cryptococcal Antigen (CrAg) screening and presumptive treatment can prevent fungal meningitis in HIV/AIDS patients significantly. Method: The descriptive cross-sectional study included 100 ART Naive patients ( 65  males &35   females) from both ART clinic and Medicine Indoor. Serum/CSF cryptococcal positivity detected by Latex agglutination test (Pastorex TM Cryptoplus, BIO-RAD,France) and  Lateral flow assay by IMMY Kit(US FDA approved).  CD4 Counts were measured using flow cytometer (Becton-Dickinson FACS count flow cytometer) Result: Prevalence of CrAg positivity in our study is 7 %(7/100), out of which 4%(4/100) had features of meningitis. Comparison of Antigenemia with Demographic features like Age, Inpatients; Symptomatic groups were having statistically significant association (p value0.0≤5).  Low CD4 count (<50) is associated with more seropositivity 33.3 %(5/100). Clinical features like Headache,Vomiting,Fever were having statistically significant association  with cryptococcal Antigenemia. Conclusion: Prevalence of cryptococcal Antigenemia  is higher in ART Naive  HIV patients with lower CD4 count which needs urgent attention for screening and substitution of Antifungal treatment to reduce morbidity / mortality from cryptococcal meningitis

Background: The ability of sonography to depict the subtle changes in the myometrium and endometrium makes it the diagnostic modality of choice for evaluation of many uterine disorders. The transvaginal sonography (TVS) has a pivotal role for assessment of gynecological patients and the vaginosonographic examination allows visualization of phasic variation of endometrial thickness, endometrial infiltration in endometrial cancer. Aims and Objectives: Validation of ultrasonographic measurement of endometrial thickness (ET), histopathological study and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause. Materials and Methods: The current study was a prospective observational study carried out in the department of Obstetrics and Gynecology, MKCG Medical College; Berhampur; Odisha from November-2017 to October-2019 over 120 cases. Cases were selected according to following inclusion and exclusion criteria after informed consent. After selection cases were subjected for detailed history taking with special attention to oral contraceptive use, use of HRT, antihypertensive medications, history of diabetes followed by thorough clinical examinations and baseline investigations including hemogram, FBS, urine routine and microscopic, chest X-ray and Pap smear. Then all the cases were subjected for ultrasound examination for ET followed by endometrial biopsy. Results: Majority of 52 cases (43.33%) had menarche at age of 13-15 yrs, of them 44 cases (84.61%) had ET ≥ 4 mm, 41 cases (34.16%) had menarche at age of 16-18 yrs, of them 30 cases (73.17%) had ET ≥ 4 mm. Most of cases i.e. 41 cases (34.16%) were of P4, of them 38 cases (92.7%) had ET ≥ 4 mm followed by 36 cases (30%) were of P5, of them 22 cases (61.11%) had ET ≥ 4 mm, 17 cases (14.16%) were of P3, of them 15 cases (88.2%) had ET≥ 4 mm, 8 cases (6.66%) were of P2, of them 6 cases (75%) had ET≥4mm,4cases(3.33%)wereofP1, ofthem3cases(75%)hadET≥4mmand2cases (1.66%) were of P0, of them one case had ET ≥ 4 mm. Among the cases, 26 cases (21.66%) who give history of OCP use, of them 16 cases (61.53%) had ET ≥ 4 mm whereas 94 cases (78.33%) who had never used OCP, of them 78 cases (82.9%) had ET ≥ 4 mm . Among the 108 cases (90%) who never taken HRT, 84 cases (77.77%) had ET ≥ 4 mm whereas among the 12 cases (10%) who had taken HRT, 10 cases (83.33%) had ET ≥ 4 mm(p value is 0.94). Conclusion: Transvaginal ultrasound is a measurement tool, justify subsequent study of the relationship between endometrial thickness and other risk factors like nulliparity, obesity, early menarche, antihypertensive drugs, hormone replacement therapy, hypertension and late menopause in cases of postmenopausal bleeding.

Congenital birth abnormalities are a major factor in infants' poor health, which affects their likelihood of surviving. Even though these visual anomalies are rare, they have a substantial influence on people's quality of life.This study aimed to describe the clinical profile of congenital ocular anomalies with different epidemiological parameters in a tertiary health center in western Orissa. The study examined 3674 patients in the age group from 0 to 14 years who were admitted to the V.S.S. Medical College, Burla, Odisha and included 151 eyes from 99 cases of various types of congenital anomalies. A detailed history and other necessarydata were collected by trained ophthalmologists and descriptive analyses were carried out. The incidence of congenital ocular anomalies was 2.69%. Nasolacrimal duct anomalies (47 eyes) were the most common congenital ocular anomaly (31.1%); followed by congenital cataract (41 cases; 27.3%) and colobomy eye (18 cases; 11.9%). There was a slight male preponderance that accounted for 56.57% of all cases.The majority ofpatients were younger than 5 years (68%) and theincidence of congenital ocular anomalies was highest in the 0-5 year age group (68.69%). Single ocular involvement was observed in 47 cases (47.47%) while bilateral involvement was observed in 52 cases (52.53%). Consanguinity was identified in 13.13% of cases, with an increased risk of bilateral involvement (84.6% of cases). The most common symptom was ametropia (38.4%), followed by tearing (32.3%) and a white pupillary reflex (14.1%). A total of 60 eyes (39.7%) required surgery. Congenital ocular anomalies are a common cause of ocular morbidity, accounting for 2.7% of all cases in the pediatric age group. Early diagnosis, referral, and appropriate intervention would help prevent most permanent sequelae in congenital ocular abnormalities

Introduction: In recent years, scrub typhus has rapidly emerged to become the major cause of acute febrile illness (AFI) in India. The commonest tests used for diagnosis are serology and PCR. Therefore, the present study was planned to compare these two techniques in the diagnosis of scrub typhus. Aim of the study: To compare IgM ELISA and PCR for diagnosis of scrub typhus as a causative agent of AFI. Material and Methods: Patients with acute undiagnosed febrile illness presenting to the outpatient (OPD) or inpatient services of PGIMER Chandigarh between August 2013 and March 2014 were included in this study. Blood was collected for further analysis by IgM ELISA and nested PCR followed by Sanger sequencing. Result: Of 176 patients, 29 (16.4%) were positive for scrub typhus by nested PCR while 162 (92%) were positive by IgM ELISA. There was 59 % concordance between the two tests. Conclusion: This study report shows that the concordance between PCR and ELISA for the diagnosis of scrub typhus is less than 60%. Ideally, both tests should be performed to diagnose scrub typhus depending on the day of presentation to hospital

Background and Objective: It is well established that intact parathyroid hormone (iPTH) and blood 25(OH) D levels have an impact on bone mineral density (BMD). There are few Indian statistics relevant to the aforementioned finding. In this study, we looked at the correlations between intact parathyroid hormone (iPTH), serum 25(OH)D levels, and bone mineral density (BMD) in a group of patients from India. Methodology: Individuals with low BMD at the hip or lumbar spine, whether or not they had fragility fractures, underwent clinical evaluations and laboratory tests. From BMD-DEXA, hip and spine T-scores were generated (dual-energy X-ray absorptiometry). The associations between serum 25(OH) D, iPTH, and BMD were examined using multivariate regression models. Results: A total of 102 patients were enrolled in the study, with a male to female ratio of 38:64 and a mean age of 62.5 6.4 years. Osteopenia affected 44 people. There was osteoporosis in 58 individuals. Serum 25(OH)D and iPTH levels were, respectively, mean values of 21.3 0.5 ng/ml and 53.1 22.3 pg/ml. Vitamin D deficiency was confirmed in 84.3% of patients by blood 25(OH)D levels that were below 30 ng/ml (normal range: 30-74 ng/ml). 25(OH) D levels and BMD at the hip or lumbar spine did not correlate (P = 0.473 and 0.353, respectively). iPTH levels, male gender, body mass index (BMI), and age were discovered to be significant predictors of BMD at both the hip and lumbar spine. BMD and T-score were considerably decreased in patients with increased BMI. Conclusion: There was no correlation between serum 25(OH) D levels and BMD among our group of patients with poor BMD. However, at serum 25(OH) D concentrations below 30 ng/ml, there is a negative connection between iPTH and 25(OH) D. A substantial inverse relationship between BMD at the hip and lumbar spine and serum iPTH levels was observed. Our results highlight the crucial part that parathyroid hormone plays in the health and metabolism of bones

The purpose of the current study is to evaluate the impact of low dose isotretinoin therapy on the changes of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol in acne vulgaris patients. Methodology: Fifty patients with moderate to severe acne who were attending the dermatology department and were between the ages of 15 and 45 were treated with 20 mg of isotretinoin every day for four months. Blood samples were taken on day 0, the second week, the first, second, third, and fourth months. Results: The measured baseline cholesterol levels in the continuous therapy group were 116.86 ± 23.55, and they grew above the baseline levels at each subsequent interval of 4 weeks, 8 weeks, 12 weeks, 16 weeks, and at the end of the treatment. The P-value is significant when compared to the baseline. At all time points, compared to baseline and above the normal limit, there was a statistically significant increase in cholesterol, triglycerides, and LDL. There was also a statistically significant decline in HDL levels. Conclusion: Increase in cholesterol, triglycerides, and LDL over the usual range was brought on by low dosage continuous isotretinoin therapy. HDL values fluctuate with grade 1 (increase and decrease). Mild, well-tolerated side effects did not need therapy discontinuation. So it's crucial to raise awareness of the implications. We tell our expert that using low dose isotretinoin for moderate to severe acne can be done with little worry, although close monitoring is crucial

Background: Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in the world mainly because of the obesity pandemic. Objective: to assess the prevalence and association of NAFLD in Type II Diabetics with one or more components of the metabolic syndrome. Methods: The present observational cross sectional study was carried out at tertiary care center of central India from November 2020 to October 2022.  Results: There were 46(59.7%) males and 31(40.3%) females. The mean age of cases with NAFLD was found to be 52.89±10.61 years. There is an increased risk of 1.667 times was observed for those with high BMI in association to with NAFLD which is statistically not significant. The mean HbA1C was higher in cases with NAFLD than in cases without NAFLD which is not statistically significant. Among the cases, 34 were diabetics with no other component of metabolic syndrome and 38.23% (13/34) of them had NAFLD; Conclusions: There is high period prevalence of NAFLD in type 2 Diabetic males. Study did not observe significant association between NAFLD and components of metabolic syndrome

Allergic diseases are developed through complex interaction between exposure to environmental substances and genetic susceptibility. The prevalence of allergic diseases has increased during last decade globally. The present cross sectional study was designed to evaluate the skin prick test reactivity in children with allergic diseases. A total of 400 children between age group 1-12 years were recruited. The Skin prick tests (SPT) using 14 standardized allergen extracts were conducted in the volar surface of forearm. Majority children had asthma (52.5%), followed by atopic dermatitis (22.75%) and allergic rhinitis (15.75%). Food habits triggering allergic conditions in 76% children, environmental factors in 4.75% children, pets in 8.25% and indoor conditions in 11% children. Skin prick test was positive to egg (13.5%), milk (22%), wheat (9.75%), apple (4.5%), cereals (6.5%), cat (18%), dog (6%), blatella (9.5%), aspergillus fumigatus (9.5%), fungi (12.75%), Dermatophytes farina (24.75%), Dermatophytes pteromyssinus (23.75%), Blomia tropicalis (9.5%) and Bermuda grass (13.75%). Determination of allergen sensitization patterns in children with atopic disease is crucial for selecting proper preventive and therapeutic strategies which helps to improve quality of life of in children

Background: Migraine headache are usually characterized by pain on one or both sides of the head1. Migraine headaches are often accompanied by photophobia, phonophobia and vomiting. Pharmacological treatment is traditionally divided into acute or symptomatic treatment, and preventive treatment or prophylaxis. Most studies have evaluated the efficacy of such drugs alone; however, there are some studies with propranolol and tricyclic agents in association with other drugs. The clinical experience with combination therapy for migraine seems to be a rational approach when monotherapy fails and when migraine is refractory. Several drugs are used individually for migraine prophylaxis. Objective: The purpose of the present study was to compare the propranolol and amitriptyline as monotherapy for the prophylaxis of migraine. Materials and methods: This is a prospective, double-blinded, randomized, comparative, with a parallel group design and single center study conducted at Department of General Medicine at Surabhi Institute of Medical Sciences.  Patients between 18 and 70 years of age, of either sex (male/female) with a diagnosis of Migraine either with or without aura as per The International Classification of Headache Disorders (ICHD) criteria were recruited in the study. Patients had more than two attacks of headache per month, each episode lasting for more than 2 days > 2 episodes/months. Result: In both the groups, maximum number of patients were in the age group of 5-25 years and least number of patients were 46-65 years of age. Mean age in group 1 patients were 29.25±9.75 and in Group 2 patients were 30.05±9.71. There was no statistically significant difference in mean age of patient from Group 1 and Group 2 patients with unpaired t test. the mean severity of Attack of migraine in Group 1 at period 1 was 4.95 with SD of 1.88 and period 2 was 4.15 with SD 1.68. In Group 2 during period 1 was 4.05 with SD of 1.75 and in period 2 mean 4.81 with SD 1.85. These was statistically significant difference in Group 1 and Group 2 (p=0.028) with Unpaired t test. Conclusion: Migraine is one of the most common disabling conditions in the world, which undermines quality of life; the mean number of migraine attacks in the Amitriptyline and the Propranolol group decreased as the duration of treatment increased

Background: -Brain abscess is defined as a focal infection within the brain parenchyma which starts as a localised area of cerebritis which is subsequently converted into a collection of pus within a well vascularised capsule.Intracranial abscesses are life-threatening infection that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Case report: -A 17-year-oldboy presented to Trauma and emergency Department AIIMS Raipur in a drowsy state with complaints of severe headache and right sided ear discharge for 15 days,fever on and off and weakness over all limbs for 1 day.Patient had a history of chronic suppurative otitis media (CSOM) of right ear discharge without any evidence of recent trauma or neurological procedure.Contrast enhanced CT brain showed cerebellar abscess with compressed fourth ventricle. Patient underwent emergency craniotomy, drainage of abscess and extra ventricular drain. Pus sample on gram stain showed gram positive cocci in chains and pairs and few gram-negative bacilli.Aerobic bacterial culture revealed pinpoint beta-haemolyticcolonies along with few translucentnonhaemolytic colonies which failed to grow in MacConkey agar.The two isolates were identified asStreptococcus constellates and.Spingobacterium multivorumby VITEK II system.Antibiotic susceptibility pattern was performed by Kirby Bauer Disk diffusion and VITEK II system compact automated ID/ AST system.Initial empirical antibiotics were replaced withIV vancomycin as both the organisms were found sensitive to it. Patient responded with improved Glasgow comma Score and gradual resolution of abscess size which was evident on successive postoperative CECT Scan findings. Conclusion: Streptococcus constellatus and Spingobacterium multivorumboth are ubiquitous.Haematogenous spread from ear could have resulted in brain abscess.Appropriate sampling and use of automated instruments may increase isolation of new and unusualpathogensand result in early and appropriate management of brain abscess

Background: Asthma is a heterogeneous disease, usually represented by chronic airway inflammation leading to variable respiratory symptoms and variable expiratory airflow limitation. Vitamin D has been shown to have several effects on the innate and adaptive immune systems that might modulate the severity of asthma exacerbations. Vitamin D deficiency and insufficiency is common in asthma patient, which causes frequent asthma attacks, respiratory tract infections, reduced lung function, poor asthma control, poor steroid responsiveness and severe asthma exacerbations. Objective: To determine serum vitamin D levels among asthmatic patients and to correlate them with the severity of bronchial asthma. Methods: A total of 50 patients with stable bronchial asthma between 18 to 60 years ages groups were included in the study. This Observational Study was conducted from April 2022 to December 2022 in Department of Respiratory medicine, Kamla Nehru Chest Hospital, Jodhpur. After taking proper clinical history and system examination, spirometry was done in each patient to obtain forced expiratory volume (FEV1), FVC and FEV1/FVC ratio for determination of the severity of asthma. Asthma control was assessed by using of asthma control questionnaire. Serum vitamin D level and absolute eosinophils count were measured in all participants. Results: In our study out of 50 cases, male patients (n=24) and female (n=26) which Association of Allergic history in Group with Severity of asthma was statistically significant (p=0.0240) and mean Vitamin-D Levels (ng/ml) was significantly higher in Mild [29.2182± 6.0880] compared to Moderate [23.3583± 5.2467] and Severe [14.9067± 5.1568] (p<0.0001). The mean Vitamin D Levels was significantly higher in “well controlled” [27.9071 ± 6.3191] compared to “partly controlled” [22.8706 ± 6.8941] and “uncontrolled” [17.2158 ± 7.0243] (p=0.0002). Conclusion: Vitamin D deficiency and insufficiency are highly prevalent in asthma patients in which prolonged duration of illness, frequently asthma exacerbation and poor asthma control. Hence, vitamin D is a useful for prevention and treatment of bronchial asthma

Introduction: Cardiovascular disease is the most commonly diagnosed medical condition among patients aged 65 years and above and is a major global problem with an estimated worldwide prevalence of 38 million. The high morbidity and mortality rate associated with heart failure (HF) make it a challenging public concern with significant financial burden on healthcare. Patients with HF frequently present with multiple electrolyte abnormalities, hyponatremia, hypokalemia, and hypochloremia being the most common.  Aims: To assess the effect of admission serum chloride levels on the duration of hospital stay in decompensated heart failure patients and their correlation with serum sodium levels. Materials and Methods: The present study was a prospective observational single center carried out at tertiary care center in Ahmedabad, India. Patient’s demographic, clinical and laboratory data was collected from June 2020 till May 2021.  Result: In the present study, 60 patients were included. It was observed that serum chloride level was less than 96 mEq/L in 40%, 96 to 101 mEq/L in 35% and more than 101 mEq/L in 25% Conclusion: Our findings highlight the clinical significance of chloride, a routinely measured electrolyte. Given the critical role of chloride in a number of regulatory pathways central to heart failure, it is possible that serum chloride may represent a therapeutic target rather than simply a marker of disease severity

Introduction: Cataract affects nearly 9–12 million Indians annually after the age of 50 years. and, this exceeds glaucoma, macular degeneration, and diabetic retinopathy numbers combined. Cataract surgery is the most frequently performed surgery in India, with a success rate of nearly 98% and excellent visual rehabilitation. More than a million intraocular lenses (IOL) are implanted every year. Aims: A Comparative analysis of Recent Generation intraocular lens power calculation formulae to achieve emmetropia following Cataract surgery by phacoemulsification. Materials and methods: The present study was a prospective comparative study. This Study was conducted from October 2022 – February 2023 at Department of Ophthalmology, Venkateshwara Institute of Medical Sciences, Amroha (U.P). 120 patients were included in this study. Result: In our study for small eyes (< 20mm) Haigis group, the mean residual spherical refractive error was 0.68 ± 0.26 and in Holladay group, the mean residual refractive error was 0.83 ± 0.14 which was statistically significant (p=0.0008). In our study for normal eyes of Axial Length 20 to 24mm of in Haigis group the mean residual spherical refraction of the patients was -0.36 ± 0.80 and in Holladay group, the mean residual spherical refraction of the patients was 0.31 ± .63 which was statistically significant (p<0.0001).  In our study for long eyes > 24mm of Axial length, In Haigis group the mean residual refractive error of large eye was -0.50 ± 0.00 and in Holladay group the mean residual error in large eye was 0.12 ± 0.64 which was not statistically significant (p=0.1189). Conclusion: we concluded that, prospective analysis of results showed that Comparing all four IOL formula we had found that in SMALL eyes, NORMAL eyes as well as in LARGE eyes The HOLLADAY IOL formula is having better result followed by HAIGIS

Background: Peptic ulcers are the defects found in the gastric or duodenal mucosa and extend through the muscularis mucosa. Approximately 4 million people are affected by peptic ulcer disease every year.Material andMethods. This prospective observational study was conducted at the Postgraduate Department of General Surgery, Government Medical College, Srinagar (a tertiary care center) over a period of two years from October 2020 to October 2022.The aim of this study was to evaluate the accuracy of PULP (Peptic Ulcer Perforation) scoring system in predicting postoperative morbidity and mortality in patients operated for peptic ulcer perforation in our hospital.Results. 40 patients formed our study group. Maximum number of patients affected were in the younger age group, with median age of 25 years with male predominance (97.5%). Smoking was present in 67.5%. Serum creatinine was raised (>1.47mg/dl) in 22.5% patients. 90% patients were categorized as low risk according to PULP Score. Mortality was 5%, with PULP score of 11 each.  Conclusions.The prognostic predictors present in the PULP score are readily identified before surgery. The PULP score helps in accurate and early identification of high - risk patients with perforated peptic ulcer, and therefore assist in risk stratification and triage

Introduction: Sigmoid volvulus is an obstructive bowel disease caused by abnormal twisting of sigmoid colon about its mesentery. It commonly affects the middle aged and elderly adults. It is the third most common cause of acute large-bowel obstruction, it accounts for 75% of all patients with volvulus. Many different parameters have been used for the classification of SV. These include clinical timing, classified as acute (fulminant), subacute (indolent) or chronic (recurrent); severity (complete or incomplete), prevalence (sporadic or endemic) and axis of rotation (mesenterio -axial and organ axial organ axial types). Materials And Methods: This is a prospective study was conducted among patients suspected to have sigmoid volvulus by clinical feature and abdominal X-ray. A total of 144 patients were selected from Emergency department, VSSIMSAR, Burla over the 2 years study period. After evaluation and assessment, patients were categorized into 3 groups according to the angle between the mesenteric axis of sigmoid colon and the horizontal line on abdominal X-ray anteroposterior view (coffee bean sign) a per axis classification. All the studied cases underwent emergency exploratory laparotomy. Resection of the volvulus segment was done. Result: In our study, Patients of study had 2.49 gm/dL mean value of Serum albumin. 107 (74.3%) out of 144 patients were in shock at the time of presentation. In Group A, Group B and Group C 58.7%, 90.9% and 92.8% patients were in shock at the time of presentation respectively.  49 (34%) out of 144patients had Gangrenous sigmoid colon at laparotomy. Gangrene in colon was evident in 92.9%, 49.1% and 12 % in Group c, Group B and Group C respectively. The difference between 3 Groups were statistically significant, P value was less than 0.001. Conclusion: With increased axis, the AXIS C having poor prognostic factors leading to increased 30 days mortality rate. Therefore, increased axis is associated with increased 30 days mortality rate of patients. Preoperative serum albumin level also decreased with the progression of the AXIS leading to increased postoperatively complications like wound dehiscence, SSI, chest complications, anastomosis leak etc. The AXIS classification system enables the prediction of the severity of sigmoid volvulus and facilitates treatment decision-making at an early stage of the disease. With the AXIS classification system, a simple abdominal X-ray performed in the emergency room used to predict the severity of sigmoid volvulus

Introduction: One of the most frequent causes of acute abdomen in nearly all age groups is acute appendicitis and emergency appendectomy is one of the most common surgeries being performed worldwide.This classic presentation occurs in only 50%– 60% of patients and the diagnosis may be missed or delayed when atypical patterns of disease are encountered.Material and Methods. This study was conducted study at Government Medical College Srinagar J&K India over a period of 2 years.117 patients above the age of 14 years who underwent emergency appendectomy for suspected acute appendicitis were enrolled as study subjects. This study aims to study the diagnostic accuracy of ultrasonography, total leucocyte count and neutrophil percentage in diagnosing acute appendicitis. Results Ultrasonography, Neutrophil Percentage andLeucocyte count had a sensitivity of 81%, 74% and 70% respectively for acute appendicitis.  Sensitivity decreased (53%) when raised TLC, NP and USG were used together to predict appendicitis but specificity increased markedly (94.1%) pointing to the fact appendicitis was highly unlikely if all these tests were simultaneously negative.Conclusion.The results showed that normal blood parameters (total leucocyte count and neutrophil percentage) along with normal ultrasonography have a high combined diagnostic accuracy for acute appendicitis

Background: High grade fever (103-106°F), headaches, backaches, sharp painful joints, pain behind the eyes, nausea, vomiting, and a generalized erythematous rash are among the common symptoms of dengue. The febrile, critical, and recovery stages can be used to describe the disease's clinical course. WHO published a recommendation in November 2009 that categorizes symptomatic patients as severe dengue or dengue (with or without warning signs). Method: The present study was conducted under the Department of General Medicine, Rajshree Medical Research Institute, Bareilli. It was a Prospective cohort study conducted between February 2021 to July  2022. Study population comprised of those admitted in IPD in RMRI of 18-59 years of age, having fever more than 38.5oC with NS1 antigen positive or IgM dengue positive or both.  Result : Out of 90 patients, studied that Vomiting are present in 51(56.7%) patients whereas 43.3% subjects do not had vomiting. Out of 90 patients, studied 54.4% study subjects had headache whereas it is absent in 45.6% patients. Out of 90 patients, studied that URI are present in 12(13.3%) patients.86.7% study subjects do not had URI. Abdominal pain are present in 8(8.9%) patients.,91.1% study subjects do not had abdominal pain.  Conclusion: In this study, dengue infection affected a large portion of the young population and was more prevalent in men than in women. The bulk of the patients had fever. In addition to the typical headache, body aching, and fatigue, many patients also presented with gastrointestinal and respiratory symptoms such stomach discomfort, nausea, vomiting, diarrhea, and dry cough

Introduction: Diabetes mellitus a group of metabolic disorder leading to chronic hyperglycemia. The most common symptoms are polyuria, Polydipsia and polyphagia. There are different classes of antidiabetic drugs that can be prescribed in T2DM. the main aim is to study is to observe the suitable antidiabetic drug for the treatment of T2DM. Aim:  The aim is to study the prescription pattern, comorbidities and complications in type 2 diabetes mellitus in tertiary care hospital. Material and methods: Patients under inclusion criteria was selected for the study. A total of 100 T2DM patients were selected for the study. the patients were divided into two groups, group A – newly diagnosed T2DM and group B – Already diagnosed T2DM. the information was taken from the based on risk factors, ranges of HbA1c, FBS & PPBS, BMI, Duration of diabetes and comorbidities. Results: The study was conducted on 100 T2DM patients. the majority of the patient were male with a age group of 51 – 60 years. In group A patients majority of the patients were prescribe with metformin as monodrug therapy and in group A & B, metformin + glimepride as combination therapy. As per our study most of the patients having hypertension, smokers, and overweight respectively. Conclusion: Metformin and combination of metformin with glimepiride are most commonly prescribed drugs in treatment of type 2 diabetes mellitus

Background: Fissure in ano is a common anorectal condition associated with high sphincter pressure and a reduction in mucosal blood flow, with secondary local ischemia and a poor healing tendency. The principle of treatment is breaking the cycle of pain, spasm, and ischemia thought to be responsible for the development of fissure in ano. Objective: The objective of our study is to compare the outcome of lateral internal sphinctereotomy and application of topical 0.2%  glyceryl trinitrate for the treatment of anal fissure. Methods: This prospective comparative study was conducted at department of surgery bundelkhand medical college and associated hospital sagar (MP) from september 2021 to october 2022. Total 60 patients with anal fissure were included in the study. After the diagnosis of anal fissure and before  starting treatment, a detailed scenario of its treatment, process, side effects, and healing and complication were explained to patients then consent was signed by the individual patients. Patients were divided into two groups to compare the outcomes of both lateral internal sphincterotomy and application of 0.2% glyceryl trinitrate ointment. Group A had 30 patients and Group B had 30 patients as well. Both group were followed up to six weeks. Results: In this study, males were commonly affected than females. The most common age group were 41-50yrs. Majority of the patients presented with pain during defecation. Constipation was the major predisposing factor among all cases. Most of the anal fissure were located in the posterior midline. The final comparison after six weeks of treatment shows the 83.3% of patients healed with the lateral sphincterotomy and 46.6% of patients healed with application of topical ointment of 0.2% glyceryl trinitrate. Complication of glyceryl trinitrate is headache which occurred in majority of patients. Pain is the most common post operative complication of lateral internal sphincterotomy. Conclusion:  We concluded that lateral internal sphincterotomy has an effective response to treat the anal fissure as compare to application of 0.2% glyceryl trinitrate ointment with advantages of good symptomatic relief, high rate of healing

There is little information available about neurological manifestations in paediatric COVID-19 patients from around the world, including India. This study aimed to identify characteristics of paediatric COVID-19 cases with neurologic involvement who were hospitalized in IMS & SUM Hospital,  Odisha. This retrospective cross-sectional study included hospitalized patients with confirmed SARS-CoV-2 from January 2020 to December 2022 aged 0 to 14 years.The necessary information was obtained from the patients' medical records. There were 21 cases in total. The studied group's median ages, those with neurological manifestations and those without, were 6.5, 11.0, and 5.0 years, respectively. Five COVID-19 patients experienced neurological manifestations, with headache and decreased consciousness being the most common recorded manifestations. The majority of patients, both with and without neurological manifestations, survived. In hospitalized paediatric COVID-19 cases, neurological manifestations were common. However, most of the neurological manifestations were mild and nonspecific, with headache being the most common. Although specific neurological manifestations were uncommon, paediatric COVID-19 patients, especially young infants, were at risk of developing severe encephalopathy with a fatal outcome

Background:  Breast abscess continues to be a major cause of morbidity in developing countries. The treatment of breast abscess continues to be a challenge. In era of technical advances management of breast abscess has shifted to minimally invasive and painless techniques which are more patient friendly. Aims: to compare outcomes in management of breast abscess by incision and drainage versus ultrasound guided needle aspiration. Methods: The present study was carried out in the department of surgery in a tertiary care hospital central India.  A total of 100 female patients with acute lactational breast abscess between 18 and 45 years of age were enrolled in our study. The patients were randomized into group A (incision and surgical drainage) and group B (ultrasound-guided needle aspiration). Results: In our study total 100 patients were analysed, majority of the cases (53% in group A & 54% in group B) belong to 21-25 years age group. Post operative pain, high recurrence rate, fistula formation, cessation of breast feeding, ugly scar formation and longer duration of hospital stay were observed in incision & drainage procedure as compared to USG aspiration. Conclusions: USG guided aspiration is the safest, painless, day care and widely accepted procedure for treatment of breast abscess as compared to the incision and drainage, it reduced the post-procedure hospital stay and minimum scar formation

Although there are innumerable studies on vitamin D deficiency in India, there is limited data in Mizoram. Keeping this in view the aim of our study is to find out the deficiency of Vitamin D in our region, Mizoram (NE India). Our study population included patients attending Genesis Laboratory, Aizawl, Mizoram (November 2021 – November 2022) for various ailments who were advised serum Vitamin D level estimation. The study population was grouped according to gender and age in decades. Blood was collected in plain vials and serum obtained was used for vitamin D estimation. Out of 480 patients, 180 were male and 300 were female. Age of the study population ranged from 11 – 79 years. 17% of the total study population had normal values, 62.7% was vitamin D Deficient and 20.3 % showed Vitamin D insufficiency. The prevalence of Vitamin D Deficiency was high in all age groups, there were a higher percentage of females in the vitamin D insufficient and deficient groups. Maximum numbers of patients with vitamin D deficiency were in the age group of 60-69 years with a female predominance. Prevalence of Vitamin D deficiency is very high in our region that is in Mizoram, as is reflected from our study. This pattern is seen in other parts of our country too. Also, the deficiency is high in the age groups N – N years and females outnumbered male

Introduction: Peptic ulcer disease is a disease of gastric and duodenal ulcers. This ulcer is a major threat worldwide over the past two centuries with a high morbidity and mortality. There are also some studies suggested that there is a complications that is seen after post operative peptic ulcer. Objective: To study postoperative complication in peptic ulcer disease patients in tertiary care hospital. Material:  A prospective study conducted on 180 post operative peptic ulcer patients. This study was conducted in department of surgery and patient ready to give inform consent form. This study was carried out after taking approval from institute ethical committee permission. Results: The present study was carried out on 186 pre operative peptic ulcer patients among them majority of the patients were males with a age group under 41 to 50 years. Out of 186 patients, 45.16% patients having ulcers among them multiples ulcer was observed in 61.90% .symptoms such as epigastric pain (90.32%) and gastritis (74.19%) was observed in most of the patients. 83.33% not taken any  drugs 16.66% has taken drugs like NSAIDs taken by 74.19%. surgery 34.40% having no complication and 65.59% having complications, majority of the patients having surgical site infection (26.22%) followed by pleural effusion and diarrhea respectively. Conclusion: Mostly this peptic ulcer is seen in employs and students, patients taking NSAIDs, mostly seen in diabetes patients, symptoms like epigastric pain and post-operative complication like infection at the surgical site is mostly seen

Background: Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people’s quality of life. There are several treatment methods such as medical and surgical procedures. Objective: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment in terms of pain, healing, complications, recurrences and patients satisfaction Methods: This study includes retrospective analysis of 100 patients (male 71 and female 29) who underwent lateral internal sphinceterotomy for the treatment of chronic anal fissure between september 2020 to october 2022 for a period of about two years. All these patients were operated under general or spinal anesthesia after obtaining consent and routine examinations. We analysed the patients clinical features, complications and outcomes of Lateral internal sphincterotomy Results: As a result the final analysis included 70 were male patients and 29 were female patients with mean age of 38 years, age ranged between 18-56 years, 89% presented with pain, 45% bleeding per rectum ,37%  constipation , 32% complain of hard stool, 26% had  sentinel pile and 54% were having an increase anal tone. Bleeding per rectum was common problem in 34% patients in early post operative period followed by 3% perianal abscess, 2% perianal hematoma, 7% had incontinence of flatus followed by 2% liquid stool incontinence and 1% solid stool incontinence all patients with flatus and liquid stool incontinence regressed with conservative management. Recurrence occurred in 4% patients, nearly complete healing occur in 95% patients and  91% patients had no complain regarding pain: Conclusion Lateral internal sphincterotomy is a safe, effective, and inexpensive procedure that leads to quick symptomatic improvement and healing in chronic anal fissure with minimal complications

Aims and Objective- To study the prevalence of coagulation abnormalities associated with Intrauterine fetal death. Materials and Method-The study was conducted in Obst &gynec Dept, Tertiary care hospital, Southern Odisha in a study period Aug-2020 to Oct 2022. A detailed clinical history, demographic parameters, causes of IUFD, associated complications and examination findings will be recorded as per the proforma and the following investigations will be done in each case: CBC to ascertain thrombocytopenia, Prothrombin time(PT), Activated partial thromboplastin time(aPTT),D-Dimer ,Fibrinogen assay,Modified ISTH score taken consisting of  platelet count, PT and fibrinogen level. Results - Out of the total 116 cases of IUFD, 18 cases were clinically diagnosed with DIC; Prevalence is 15.5% in our study. The mean age of study participants was 25.10 ±6.30 years which ranged from 18 to 37 years. Majority of the cases were primigravida and presented at preterm. Apart from the undiagnosed cases, which was the major part ,from the rest of the cases PIH and Abruptio constituted the major proportion of identifiable causes of IUFD. PIH, Abruptio and HELLP syndrome were the major obstetrical complications contributing to clinical DIC as well as those at risk of developing subsequent DIC which was found to be statistically significant. The sensitivity was found to be more in pregnancy modified ISTH score --(83.3%) compare to ISTH overt score (50%). The specificity was found to be more in ISTH overt score (96.9%) compare to pregnancy modified ISTH score (78.5%) Conclusion- in obstetrics is a life-threatening complication that is secondary to obstetrical and non-obstetrical related complications of pregnancy. It is associated with high maternal and perinatal morbidity and mortality. The present study was conducted to determine the risk of DIC in the cases of IUFD.It is recommended that coagulation studies should be considered in IUFD specially when complicated by PIH. abruption or severe complications such as HELLP syndrome. However, our study is of small sample size (116) requires large studies meta analysis

Introduction: Acute intestinal obstruction is one of the commonest and potentially dangerous surgical emergencies with a high frequency of morbidity and mortality if managed inappropriately. Although the mortality is decreasing with a better understanding of pathophysiology, improvement in radiological diagnostic techniques, fluid and electrolyte correction, potent antimicrobials, surgical management, and improvement in anaesthesia. The present prospective study was conducted to find out various etiological factors of mechanical intestinal obstruction and to evaluate morbidity and mortality in adult patients. Material Methods: The present prospective observational study of 290 patients with adult intestinal obstruction was carried out from December 2016 to October 2018 in the Department of Surgery at a Tertiary Care Hospital. The study included a total of 290 patients out of which 218 underwent surgical management and 72 underwent management conservatively, hence aetiology of intestinal obstruction was studied in the operative patients. Results:The peak age incidence was seen between 31-60 years in small bowel obstruction. Abdominal pain 283(98%) and distension 278(96%) were the most common presenting complaints. Out of 290 patients 218 (75.17%) patients underwent a surgical procedure in whom the most common intraoperative findings were adhesions and bands seen in 84 cases (38.53%) which were post-operative. Malignancy was seen in 6 cases (9.17%) involving small bowel. Adhesiolysis was the most common procedure done in 94 cases, with 78 cases of postoperative adhesive intestinal obstruction. Surgical site infection was the most common complication 109(50%). Conclusion: Clinical, radiological, and operative findings put together can bring about the best and most accurate diagnosis of intestinal obstruction. Among the factors influencing mortality and morbidity are age, state of hydration, the viability of the bowel, aetiology of obstruction, site of obstruction, delay in diagnosis and surgical intervention and associated medical illness

Background: Diabetes mellitus (DM) is a common endocrine disorder with around 415 million affected people worldwide. It is expected that DM will affect more than an estimated 700 million persons, 10.9% of the global adult population, by 2045. Objective: to find the prevalence of LVDD in type 2 diabetics and assess its correlation with HbA1c levels as measure of glycemic control. Methods: The present study was conducted in a tertiary care hospital in Central India from July 2020 to October 2022. Results: In our study majority study subjects were males.  The mean age for this study group was 46.3±8.3 years. Most of the study subjects (48.9%) had HbA1c within intermediate control range (7.1- 9%). 42 (45.6%) subjects were shown to have Left Ventricular Diastolic Dysfunction on 2D ECHO.  The mean HbA1c value for subjects having LVDD is 7.84 ± 1.34 and for those not having LVDD is 7.24 ± 1.35. Therefore, in our study it was concluded that LVDD was significantly associated with higher HbA1c values. Conclusions: The prevalence of left ventricular diastolic dysfunction was more in type 2 diabetic patients with high HbA1c levels

Objective: To evaluate the utility of narrow band imaging with magnifying endoscopy for the diagnosis of oesophageal lesions in north Indian population. Methods: The study was an observational study. Patients with various clinical symptoms were included in the study.  Patient on chemotherapy for carcinoma oesophagus, patients with sepsis and not willing for Endoscopy were excluded from the study. All cases were evaluated using endoscopic findings with respect to socio-demographic history, past history, a thorough clinical examination and details of the investigations done. Results: More than one third of patients were between 61-70 years of age (38.8%). More than half of patients were males (65.7%). Both WLE and NBI detected visible submucosal vessels among 56.7% and 52.2% patients respectively. Tanned columnar mucosa was detected among 49.3% by WLE and 31.3% patients by NBI. However,  low-grade adenoma was detected in 43.3% by WLE and 46.3% patients by NBI.  Polypoidal lesions were detected among 28.6% by WLE and 47.8% patients by NBI. NBI correctly detected oesophageal lesions among majority of patients (77.6%) with sensitivity and specificity of 89.7% (95%CI=81.8-97.5) and 33.3% (95%CI=2.5-64.1). A high positive predictive value was also observed (89.7%; 95%CI=81.8-97.5). Conclusion: The NBI endoscopes are clearer compared with ordinary stained endoscopes, it has a higher levels of diagnostic value and diagnostic coincidence rate for early diagnosis of Oesophageal lesions. Also it has a more accurate detection rate of lesions and less occurrence of adverse reactions. It can effectively detect and screen early Oesophageal lesions and benign lesions, it is worth promoting clinically

Background: pregnancy is one of the important times in a woman’s life. Women's bodies become more sensitive to dangerous substances and they may develop different complications, such complications might be to pregnant women or the fetus. Some women don’t have proper knowledge about pregnancy complications or nutritional food products to be taken during pregnancy the main aim of the study is to study ABO blood groups and sociodemographic status in anomalies and normal fetuses in pregnant women. The present study is a cohort study carried out on 180 pregnant women. Among them, group 1 136 were normal pregnant women (without any fetal complications) and group 2 44 were anomaly pregnant women (with fetal complications). In groups, -1 & 2 majorities of the pregnant women were under the age group of 31 – 35 years (45.58%) and 20 – 25 years (27.27%) after comparing both groups – 1& 2 significance was observed at 20 -25 years (p<0.05). in group 1 majority of pregnant women have 1 fetus but in group 2 majority of the pregnant women have 2 fetuses. In comparing the ABO blood group of both groups 1 & 2 there is a significant difference was observed in blood group A and no significance was observed in blood group B, AB & O. as per the education status of a pregnant women in group 1 in education status of a pregnant women majority were upto degree 43.38% and in group 2 majority of pregnant women were not educated (45.45%). Complications observed in group 2 in 44 pregnant women having Hematocolpos 29.54% followed by Hydramnios 22.72%, Oligohydramnios 18.18%, Microcephaly 13.63%, Cleft palate 9.09% and Hygroma colli 6.81 %. Early age Pregnancy, more than 1 fetus, A blood group, no education about taking care during pregnancy and there complications such pregnant women may develop complication in fetus and even death of the fetus can be seen

Background: Grades of malnutrition can be classified and diagnosed by various available methods like IAP, WHO-Z score, Waterlow, Gomez and various parameters like anthropometric measurements. All these methods are also used to compare incidence and prevalence of malnutrition between different age groups. This study was done to compare the IAP vs WHO-Z score classification in precisely assessing the malnutrition status of children aged 0 to 5 years. Methods: This multicentric prospective comparative study was conducted at twenty-five ICDS centers in Karaikal, Puducherry between 2017-2019. Eligible study population included 0-5 years old children whose parents were willing to give consent at the time of enrollment. A thorough clinical examination was done to diagnose various nutritional deficiencies. Comparison was done between IAP and WHO classification of degrees of malnutrition. The comparison groups were analyzed using chi-square test. Results: A total of seven-hundred children were assessed for malnutrition, classified into various grades using IAP and WHO-Z score. Comparative analysis was done between two groups from each grade of malnutrition and it was observed that WHO-Z score classification and IAP classification didn’t have significant difference in identifying moderate malnutrition but WHO-Z score was significantly better (P=0.0001) in precisely identifying severe malnutrition. Conclusion: This study indicates that severe malnutrition which is still prevalent as assessed by IAP and WHO-Z score can be more precisely diagnosed using WHO-Z score [WAZ-7.8%, WHZ-3.8%, Grade III & IV-3.5%]. IAP grading is a time-tested method, which is easy to use and all categories of health workers were already accustomed to use it. A new tool incorporating WHO-Z scores in the existing IAP grading can be evolved for an accurate assessment of severe malnutrition

Background: Hypertension and dyslipidemia are associated with oxidative stress and are major causes of cardiovascular disease amounting to 30% of global death rate.  Objective: To study the pathogenic role of Serum Uric Acid Levels  in  essential hypertension. Material and Methods:  This study was conducted at Department of General Medicine in a Medical College. Results: Mean age of the cases with hypertension was 55.02 years with 28.9% cases being above 60 years of age. Out of the total 235 cases, 57.9% were males while 42.1% were females. Out of the total 235 cases with hypertension, 83.8% were in stage I hypertension while 16.2% were in stage II hypertension. Prevalence of hyperuricemia was seen as 27.7% among cases with hypertension. Mean age was comparable among cases with and without hyperuricemia (54.85 vs 55.09 years; p-0.84. Conclusion: Mean serum uric acid levels were significantly associated with increase in systolic and diastolic blood pressure

Introduction: non-communicable diseases (NCDs) present an imminent threat to people worldwide. Globalization delivers the uniform cause for the spread of chronic diseases to every corner of the World. AIM: To determine prevalence of Major risk factors of Non Communicable Diseases among study population. Material and methods: This was a Cross sectional study including 325 Doctors with minimum qualification of MBBS/BDS, working in Govt. health care facilities of Bikaner district, from Dec. 2019 to dec 2021 at Department of Medicine, S.P. Medical College, Bikaner, Rajasthan. Results: Mean age of study population was 40.58 ± 10.21yr. we found that 9.85% were current smoker, 1/3rd had used at least a standard drink in last 12 month, 68.92% consumed >5gm salt per day, 45.85% were active physically. 48.62% were overweight and obese, 12.92% had systolic BP ≥140 mmHg, prevalence of diabetes mellitus was 14.46%. Conclusion: The prevalence of risk factors for lifestyle diseases was high among the health professionals

Background: Injuries are the leading cause of death and hospitalization among young people aged 15–24 years in India. While progress has been made in preventing injury deaths and disability in both older and younger age groups, young people remain at increased risk of injuries. The purpose of the study is to raise awareness and provide the national authorities and stakeholders with an insight into the size and impact of risk-taking behavior in accidents. The study was conducted with an aim to estimate the prevalence of risk-taking behavior and road traffic accidents and its association between them. Methodology: A cross-sectional study was conducted among 300 students aged 15-25 years of a medical and engineering colleges in Rajahmundry. A predetermined, semi-structured questionnaire was used to collect data. Data collected was entered and analyzed using Microsoft excels 2011 and Chi-square test was used to find the association between risk taking behaviour and road traffic accidents. Results: The prevalence of road traffic accidents in the study population was 46.7 per 1000 students/per year. Not taking personal safety measures (89%), over speeding (44%), using of mobile (46%) and thinking about something else (37%) were found to be the major factors causing road traffic accidents. There was a statistical significant association found between risk-taking behavior and a history of road traffic accidents (P<0.0001)

Background: Lack of physical activity (PA) was one of the most important cardiovascular risk factors causing higher morbidity and mortality rate worldwide. Thus, early health promotion activity like physical activity is needed for healthy life. As future physicians the health of the medical students is even more important as they personally ignore adopting healthy lifestyle. So, the study was conducted with an aim to estimate the level of physical activity and to find the factors associated with low physical activity among medical students. Methodology: An institute based cross-sectional study was conducted among 200 medical students in a medical college in Rajahmundry, Andhra Pradesh. Global Physical Activity Questionnaire (GPAQ) by WHO was used to estimate the level of physical activity and Metabolic Equivalents (METs) were used to express the intensity of physical activities. The collected data was entered into Microsoft excel and analysed using SPSS version 21. Results: The mean age of the study population was 19.61 ± 1.94 years and 62% of the study subjects were female. Based on WHO recommendation of minimum 600 MET min/week in the present study 64.5% had adequate physical activity and 35.5% had low physical activity. Low physical activity was high in female students when compared to male students (41.1% vs 26.3%, p-value=0.034). There was low level of physical activity in first professional year (46%) when compared to other professional years. Conclusion: There was need of promoting physical activity among medical students. Medical colleges need to increase the proportion of students adopting and maintaining regular physical activity habits

Background: Postpartum haemorrhage (PPH) is the most common complication following childbirth. Postpartum haemorrhage remains a significant contributor to maternal mortality and morbidity throughout the world. PPH is often classified as primary/immediate/early, occurring within 24 hours of birth, or secondary/delayed/late, occurring from more than 24 hours post birth to up to 12 weeks postpartum. Aims: The aim of this study was to determine the percentage of patients requiring medical therapy for PPH management and to determine the percentage of patient requiring surgical therapy for PPH management. Methods:  The present study was a population and hospital based observational study conducted in the Dept of Gynae and Obstetrics, R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India. All the patients presenting with postpartum haemorrhage following delivery during my study period and meeting my inclusion criteria which is 304. Template was generated and analysis was done on STATA11 software. Results: In the present study the overall incidence of PPH is 1.4%(304 out of 22,182 deliveries). higher prevalence is seen between 24-27yrs and >=27yrs. Prevalence of PPH is more in women with no schooling (31.9%) The PPH occurred mostly at the gestational age 37-40wks (60%). Atonic PPH has higher prevalence (50.6%) than other types of PPH. In instrumental delivery traumatic PPH has higher prevalence (50%). In caesarean section Atonic PPH (80.64%) had higher prevalence than any other types. Atonic type of PPH is responsible for most maternal death (75%). Uterine tamponade was mostly done and successful in PPH following vaginal delivery (86.66%). Conclusions: To conclude, majority of deaths following PPH is preventable if timely and prompt intervention is made. Antenatal anaemic status contributed a significant role in PPH occurrence which should be corrected to decrease the prevalence of PPH.

Introduction: Acute kidney injury frequently occurs secondary to diuretics, intravenous radio contrast agents, paracentesis, gastrointestinal bleeding or infection and the development of Hepatorenal Syndrome (HRS) secondary to the progression of Liver Cirrhosis and elevation of portal pressure is not uncommon in the patients with Liver Cirrhosis. In several studies of AKI in such patients, those with serum Creatinine (Cr) levels of more than 1.3 to 1.5mg/mL have a poor prognosis. In early stages of HRS its possible to recover or delay deterioration of renal function with aggressive treatment . Though  Serum Creatinine is most widely used for measurement of GFR in clinical practice, it is greatly influenced by non renal factors, such as muscle atrophy and protein intake, especially in patients with Liver Cirrhosis. This study focusses on such scenarios where Cystatin C as a Novel Biomarker is superior to serum creatinine in predicting the incidence of Hepatorenal Syndrome in liver cirrhosis patients. Material and Methods: This is a Descriptive study was included about 100 patients diagnosed with Liver Cirrhosis in the Department of General Medicine at Mahatma Gandhi Medical College and Research Institute from July 2021 to December 2022. Detailed history, detailed clinical examination, complete blood count, liver function test, serum Cystatin C, Serum Urea, Creatinine, USG Abdomen, CT Abdomen if necessary, Endoscopy, Portal Venous Doppler. Results: Most of the patients in this study belong to the age group between 41 to 50 years (29 out of 100 patients). Patients belonging to age group between 31-40 are equally high. In this study, Males were more commonly affected when compared to female patients (88% were males & 12 % female patients.).  Out of the 100 patients in the study population, 24 patients developed Hepatorenal syndrome ( 19 belonged to Type 1 HRS & 5 belonged to  type 2 HRS). The Novel Biomarker Serum Cystatin C was Elevated in 92 % of the patients and was in the high normal limit in the remaining . On the other hand almost 97 % of patients had Normal serum Creatinine levels when it was done initially, only 3 % had  raised Creatinine level.  24 patients had increased Serum Creatinine levels only when followed up. Comparison between Cystatin C and Serum Creatinine in HRS patients showed a statistical significant P Value of < 0.001. The Sensitivity of Cystatin was 92 % and specificity was 80% in the Hepatorenal Syndrome Patients. Conclusion: Serum Cystatin C as a novel biomarker is a good predictor of Hepatorenal Syndrome (in early stages) in Liver Cirrhosis patients. It is superior to serum Creatinine in prediciting renal injury earlier in Liver Cirrhosis patients than serum Creatinine which varies with age, sex and with body mass etc. This study shows Cystatin C is more specific and sensitive marker of renal function in Liver Cirrhosis patients.

Introduction: Improving maternal health is one of the fifteen Sustainable goals  adopted by world leader in September 2015 by  an historic  international community at the United Nations Summit, which aims  to reduce the global maternal mortality ration to less than 70 per 100,000 live births by the year 2030.The MMR in developing countries is more than developed countries. MMR in developed country is 12/1,00,000 live birth Maternal mortality ratio of India is 97/lakh live births. Preeclampsia is a new onset of hypertension and proteinuria after 20 weeks of gestation  in a previously normotensive women.Severe Preeclampsia  is a serious clinical type of preeclampsia by atleast one of the following – persistent increase in blood pressure [≥160/110 mmhg ],hepatic and renal failure,platelet count less than 1,00,000 / mm3 , hemolysiselevsted liver enzymes and low platelet count [HELLP] Syndrome, Cerebral or visual disturbances, persistant epigastric pain and pulmonary oedema. Eclampsia is a serious obstetric emergency with new onset grand mal seizure during pregnancy or postpartum in women having signs and symptoms of preeclampsia. The sequel of severe preeclampsia and eclampsia include organ failure, loss of consciousness and finally loss of lives of both mother and fetes. Aims and Objectives: To study clinical outcome of Preeclampsia and Eclampsia in a Tertiary Care Centre. Materials and Method: The study was conducted in department of Obstetrics and Gynaecology, MKCG Medical College, Berhampur, Odisha, India for a period of 18 months extending from November 2020 to September 2022.A total of 400 patients were studied. At the end of the study, collected data were tabulated and analysed. Results: Present study was conducted on 400 cases, during the study period.Mean age was 31.19 ± 5.7 years. Majority of patients (194 cases, 48.5%) belonged to lower class followed by 129 cases (32.3%) belonging to middle class. Fifty four patients (13.5%) were from lower middle class. Upper middle class had 16 (4%) patients. Only 7 cases (1.7%) were from upper class. In 127 patients (31.8%) diabetes mellitus and in 227 patients (56.8%) pre-existing hypertension was reported respectively. Among 400 patients studied, 114 patients (28.5%) were primigravida and 286 patients (71.5%) were multigravida.  Twenty eight (16.8%) patients died of complication. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.34, Paog=0.33). Cause of death was abruption placenta (10 cases), acute renal failure (6 cases), ARF with sepsis (1 case), eclampsia (4 cases), HELLP with PPH, PPH, pulmonary embolism, pulmonary embolism with PPH and wound infection (1 case each) and sepsis (2 cases). Out of 59 patients suffering from eclampsia, 4 (1%) patients died and 24 (6%) patients with pre-eclampsia died. Association of occurrence of eclampsia was robustly associated with patient mortality (P<0.0001).Two hundred and sixteen neonates (54%) had low birth weight while 279 (69.8%) were cases of intra uterine growth retardation. Preterm birth, birth asphyxia and NICU admission was seen in 175 (43.8%), 168 (42%) and 270 (67.5%) respectively. Eighty nine (22.3%) neonates died after birth while 52 (13%). Mean maternal age of deceased and survived neonates in present study was 31.51±5.6 years and 31.1±5.8 years respectively. Mean values for age of gestation of deceased and survived patients were 31.29±1.4 weeks and 31.59±2.2 weeks respectively. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.56, Paog=0.24).  Conclusion: Preeclampsia and eclampsia tends to threaten maternal health and fetal viability adding to maternal and neonatal mortality and morbidity.There is high frequency of preeclampsia and eclampsia in our setting and the consequences are alarmingly high. There is need for patients education in recognizing the warning symptoms of the disease before intrauterine demise of fetus occurs or mother develops one of the grave complications, Antenatal care, treatment of anemia  and educating the women on significance of symptoms will go a long way in improving maternal and perinatal morbidity and mortality.Presence of NICU  with effective neonatal care will improve the fetal outcome.

Introduction: Pain during and after surgery results in intense changes in hemodynamics, increased metabolic and endocrine stress hormone production, and increased myocardial oxygen demand and consumption. Some patients require bothopioid and non-opioid analgesics within the first 24 hours followingsurgery. Pre-emptive analgesia is theintroducing of analgesic management beforeonset of noxious stimuli, which helps to prevent pain potentiation. It provide spain relief priorto surgery and throughout the perioperative period. Bilateral superficial cervical plexus block (BSCPB) is a technique where local anaesthetic mixtureis injected based on anatomical landmarks. It reduces the intraoperative analgesic requirements when administered before surgery. By decreasing analgesic requirements, the block produces tableintra operative vital sin comparison to general anaesthesia alone [3] Therefore, this study involved administering bilateral superficial cervical plexus blocks for thyroid surgeries in addition to general anaesthesia, along with assessment of intra- and post-operative hemodynamics, evaluation of postoperative eanalgesia, and detection of adverse effects. Materials and Methods: This randomized study was carried out in the Department of Anaesthesia, MGM Medical College and MY Hospital, Indore, among 60 consented patients aged 18 – 60 years belonging to ASA grade I/II and posted for elective thyroid surgeries under general anaesthesia, allocated into 2 groups of 30 each: Group A (without SCPB) and Group B (with SCPB), using a proforma, pre-anaesthetic evaluation, investigations followed by induction of anaesthesia and performing of SCPB. Data was collected, compiled and analysed using SPSS 22.0 (trial version). Result: Majority Group A (36.67%) and Group B (40%) participants belonged to 31-40 years and 18-30 years age group, respectively and were females (Group A=90%; Group B=83.3%). Most were classified as ASA grade I (63.3%). The HR, SBP, DBP and MAP in Group A intra-operatively, was found to be significantly higher than Group B (p-value-0.000). Post-operatively, it was observed that the HR and SBP was significantly higher in Group A at all the time intervals till 24 hours after the procedure (p-value=0.000). The DBP was higher initially in the post-operative period in Group A (p-value=0.000), however, 24 hours later, it was found to be comparable with Group B(p-value>0.05). Similar was the case with MAP, which was higher in Group A in the initial post-operative period, decreased gradually and 24 hours later, was comparable with Group B(p-value>0.05). Statistically significant difference was also observed between both the groups (p-value<0.05) with respect to VAS score. Requirement of first rescue analgesia was earlier in Group A (p-value<0.000). Post-operative complication were experienced more in Group A. Conclusion: It was concluded that BSCB block with injection Ropivacaine 0.75% and injection Fentanyl 25 mcg was effective in blunting hemodynamic stress response to pain and provided stable hemodynamics throughout the surgery. It also reduced the dose and requirement of opioid analgesics after the surgery.

Background: Malignancy of Gastrointestinal tract starting from Oesophgus to Anus may cause acute or sub-acute obstruction which requires emergency relief from the symptoms. Surgery with diversion, colostomy or ileostomy, Nutritional Management with feeding gastrostomy/jejunostomy and further chemoradiotherapy were required according to the different pathological variants at different site of G.I. tract to reduce the mortality rate and prolonging the survival time. Previous studies have been compared for the outcome of success rate, hospital stay, mean long term survival for different palliative interventions. None of them had proved to be most efficient for prolonged survival as most of cases were in the advanced stage of cancer. Objective: To determine the best palliative procedures undergone surgery and non-surgical procedures such as Chemotherapy/Stenting. Method A retrospective study of Seventy patients of malignant bowel obstruction was done with statistical analysis. Observation Among the Seventy patients 49 were male and 21 were female and mean age of the patient was 49.57. The overall symptoms improve rate was 75.71%. Among them symptom improve rate 96% in surgical group,42.80% in stenting group and 15.38% are in chemotherapy group. Median survival time was 270 days in surgery group. Conclusion Malignant obstruction is an emergency condition in most of times needs urgent symptom relief by any mean of palliation. Complete and unresectable malignant obstruction needs diversion colostomy or any by-pass surgeries. Among all type of surgeries resection and anastomosis with or without diversion of loop is best palliation.

Introduction: An ectopic pregnancy occurs when the developing blastocyst implants either outside the uterus i.e fallopian tube (interstitial, ampullary, isthmic, fimbrial), Ovary and abdominal cavity or in an abnormal position within the uterus i.e cornual, cervical. Around 98.3% of ectopic pregnancies occur in the fallopian tubes. Visualization of an intrauterine sac, with or without fetal cardiac activity, is often adequate to exclude ectopic pregnancy. The treatment modality also has evolved from radical surgery, conservative surgery to medical and expectant management. Laparoscopy is now recommended approach in surgical management of ectopic pregnancy.Materials and Methods: This is a prospective observational study conducted in Department of Obstetrics and Gynaecology from 2020 to 2022 where 118 cases were studied. Detailed history was taken for all cases with special reference to risk factors like smoking, PID, abortions, previous ectopic, IUD use, sterilization, D & C, IVF and LSCS followed by clinical examination. Routine and other relevant investigations were done including (UPT, CBC, ICTC, HCV, HbSAg, USG (TVS) and serum β-HCG and managed according to the condition of patient either medical, surgical or both. Data regarding intraoperative finding confirming site of ectopic pregnancy, ruptured or unruptured, operative techniques including salpingectomy, salpingo ophorectomy, cornual repair or hysterectomy and blood product transfusion were collected. Patients were followed up till discharge or death and the outcome were analysed. Results: Maximum numbers of cases, 45 cases (38.1%) were in the age group between 26 to 30 years. Among all cases, 24 cases (20.3%) had history of previous abortions, 22 cases (18.6%) had history of PID, 14 cases (11.9%) had undergone D & C earlier, 8 cases (6.8%) had earlier tubal ligation, 5 cases (4.2%) had h/o IUCD insertion and 1 case (0.8%) had previous history of ectopic pregnancy. The classical triad of amenorrhea, abdomen pain and abnormal vaginal bleeding was seen in 52 cases (44.0%). The most common site of ectopic pregnancy site was fallopian tube, of which 96 cases (81.3%) were in amupulla, 14 cases (11.9%) were in isthmus and only 3 cases (2.5%) were in infundibulum. Only 2 cases (1.7%) had cornual pregnancy with gestational sac implanted in the non communicating horn of unicornuate uterus. Maximum number of ectopic pregnancy cases underwent surgery, with 98 cases (83.0%) had undergone  unilateral salpingectomy as the most common procedure whereas 15 cases (12.7 %) had undergone unilateral salpingophorectomy in cases with unhealthy ovary and ovarian pregnancy out of 113 cases of tubal ectopic pregnancy. Only 2 cases (1.7%) with cornual pregnancy had cornual resection and repair. Hysterectomy was adopted as surgical treatment in 2 cases (1.7%) only.Conclusion: Patients with risk of ectopic pregnancy like PID, IUCD implantation, previous ectopic pregnancy and patients with history of D & C should undergo routine USG in first trimester to locate the site of early pregnancy. We recommend follow up above cases of ectopic pregnancy and analyzing the effect of ectopic pregnancy on future fertility and pregnancy.

Backgroud: Pulmonary thromboembolism (PE) is a common and potentially lethal condition. Despite significant advancements in diagnosis and management, there is limited reporting of this condition from India. Objective: To study the clinical profile and outcomes in patients of pulmonary thromboembolism. Methodology: This was a prospective observational study, conducted at the Department of Medicine, which includes the Medicine wards and MICU, in a tertiary care hospital located in central India. The study period was from November 2020 to October 2022, with a sample size of 43 participants. Results: The mean age of the cases was 50.86 years. Hypertension was the most common risk factor and Diabetes was the most common comorbidity. Palpitation was the most common symptom seen in 100% of cases and most common sign at the time of presentation was Tachycardia. ECG finding was Sinus tachycardia in 69.8% of the cases, the chest x-ray finding was dilated MPA/R in 34.9% of the cases, Right Ventricular (RV) dysfunction was seen in 30.2% of the cases on Echocardiography, DVT was seen in 9.3% of the cases in doppler and Pulmonary thromboembolism was seen 100% of the cases on CT pulmonary angiography. Heparin was given in 32.6% of cases and LMW Heparin was seen in 37.2% of the cases. Oral anticoagulation was given in 18.6% of the cases. New-oral anticoagulants were given in 37.2% of the cases. Thrombolytic therapy, Streptokinase was given in 30.2% of the cases. The outcome was discharge in 72.1% of the cases and death in 27.9% of the cases. Conclusion: Pulmonary thromboembolism (PTE) remains a major cause of morbidity and mortality all over the world. Risk factors are present in a majority of patients with confirmed venous thromboembolic disease. This condition is unrecognized and underdiagnosed clinically despite its high mortality.

Background: Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs. Objectives: To assess theetiologies, clinical profile, and outcome of encephalopathy in elderly. Method: This was a prospective observational study conducted over a period of two year (November 2020 to October 2022) on all elderly patients presenting with encephalopathy.Their demographic profile along with clinical presentation, laboratory, imaging results and outcome were recorded and analysed.Results: Majority of patients belonging to age group of 60-70 years (41.5%), with males’ predominance (59.9%). Maximum 56(39.4%) patients had 7-12 hours of altered mental status, (p<0.00001).47.2% presented with fever. Most patients had raised blood pressure (45.07%), neurological abnormalities (motor weakness) (27.4%), GCS score of 6-10 (57.7%), respiratory findings(47.8%). 29.5%had hyponatremia, 22.5%hypocalcaemia and 22.5% hypokalaemia. Higher number ofpatients had CT/MRI brain findings suggestive of haemorrhage and infarction. Most of the patients had ECG abnormalities in form of atrial fibrillation (11.2%). Etiology of encephalopathy in elderly was most commonly due to neurological causes (37.3%). Out of 142 patients, 64.8% were survivors and 35.2% was non-survivors.Most common cause of death were neurological (cerebro-vascular episode) followed by infections (meningitis). Patients who presented late or with more duration of altered mental status has more mortality than patients who presented early signifying that early diagnosis and treatment can reduce mortality significantly. Patients who presented with low GCS has higher mortality then patients with higher GCS. Conclusion: Elderly patients present late with paucity of symptom and signs. Hence, early presentation, early diagnosis and treatment will facilitate better outcome.

Labour and delivery are focus and climax of the reproductive process. They are both physical and emotional challenge for the mother and a hazardous journey for the fetus. Labour is a dynamic phenomenon characterized by a progressive increase in the frequency, intensity and duration of uterine contractions with progressive dilatation and effacement of the cervix and the  fetal  descent  through  the  birth  canal.   This physiological process may lead to pathology and failure to recognize this would result in prolonged labour resulting in increased morbidity and mortality of mother and baby.2 Material And Methods A hospital-based prospective study of 100 pregnant women with high-risk pregnancy  attending  the  department  of  Obstetrics  and  Gynaecology, Gayatri vidyaparishad medical college, Vishakhapatnam, from December 2021- November 2022. The study groups randomly selected a hundred primigravida with high-risk pregnancy fulfilling the inclusion and exclusion criteria. Informed and written consent was taken from all the women participating in the study. The study's primi pregnant women fulfilling inclusion and exclusion criteria were divided into the PARTOGRAM GROUP (P) and the other NO PARTOGRAM (NP). Each group consists of 50 primi  pregnant  women.  In the partogram group,  the progress of labour was documented on MODIFIED  WHO PARTOGRAPH and the notes on the progress sheet of case record file while standard notes only in no partogram group. Results In our study, 80% of pregnant women gestational age was below 39 weeks. In the NP group, 34% of women at 38 weeks, followed by 32% at 39 weeks. In the P group, 54% were at 38weeks, followed by 18% at 39 weeks and 18% at 40 weeks. Oligohydramnios  was  predominantly  observed  in  women  presented  in  39 weeks  (48%)  gestational  age.  Gestational  hypertension  (38.6%)  and  gestational diabetes mellitus(18.1%) was commonly observed in women in 38 weeks of gestation as both conditions are delivered at 38 weeks. Hypothyroidism was predominantly observed in women at 37 weeks(36.3%) and 39 weeks(24%) of gestation.  In individuals' groups, among the NP group, most pregnant women were delivered by FTNVD (60%) followed by 30% cases by LSCS. In P group out of 50 deliveries, 78% of cases delivered by FTNVD, followed by 14% undergone LSCS.  Conclusion: Partogram is an excellent tool for reflecting quick and consistent review of labour events, handing over the patient in changing shift duties, especially in low resource settings. It leads to earlier decision making in labour management and shown to reduce cesarean section rates.

Diabetes Mellitus is a metabolic disorder of multiple aetiology characterized by presence of hyperglycaemia with disturbances of carbohydrate, protein and lipid metabolism due to defects in insulin secretion, action or both. The link of vitamin D with insulin insensitivity or abnormal glucose metabolism gained much more scientific attention in the last 10 years. Various observations or associations were cited. Exploring the possible role for either altered vitamin D status and its metabolites or altered Insulin sensitivity in the pathogenesis of the each disease. In view of increased prevalence of diabetes mellitus, vitamin D deficiency and association of vitamin D with diabetes mellitus the present study is undertaken to evaluate vitamin D levels in type 2 diabetes mellitus and its correlation with HbA1c levels Aim: To study vitamin D levels and its correlation with HbA1c level in type 2 diabetes mellitus. Methods: An observational study was carried out over a span of 1.5 years who were previously diagnosed case of type 2 Diabetes Mellitus attended Medicine department OPD and IPD between age group 30-70 years were included in study Serum vitamin D3, HbA1c, FBS, PPBS and other clinical features were noted based on history and clinical examination of these patients. Results:  25% had HbA1c of less than 7, 39 patients (39%) had HbA1c more than 9. The mean HbA1c level was 8.65 ± 1.93. We observed in 41 patients (41%) the level of Vitamin- D were deficient, in 17 patients (17%) the levels were inadequacy and in remaining 42 patients (42%) the levels were either normal or more than normal. In our study Vitamin D levels were found to be lower in the diabetic cases with >5 years of duration compared to recently diagnosed diabetic cases. The difference is statistically significant (P value 0.001) as compared with recently diagnosed (P value 0.63). It was found that patients with poor glycaemic control had maximum Vitamin D deficiency (12%) which was statistically significant with p value of  0.001 than those with good glycaemic control had sufficient Vitamin D levels (9%) with p value of 0.07. We compared the mean Vitamin D levels with duration of diabetes of mellitus and HbA1c and it was observed that the mean levels of Vitamin D were reduced with increasing duration of diabetes mellitus and increasing HbA1c levels. This difference was statistically significant. (P<0.05). Conclusion: There was an association between Vitamin D levels and HbA1c in patients with type 2 diabetes mellitus. In the present study of 100 patients with type 2 diabetes mellitus we found that lower vitamin D levels were associated with poor glycaemic control

Background: Persistent inflammation of the middle ear and mastoid cavity that manifests as recurrent ear discharge or otorrhoea due to a tympanic membrane perforation is known as chronic suppurative otitis media [1]. Objectives:  1) To categorize active chronic suppurative otitis media into tubotympanic and atticoantral disease. 2) To find out microbiological organisms responsible for both these categories (tubotympanic and atticoantral) and their sensitive drugs by culture and sensitivity report. Material & Methods: Study Design: Prospective Hospital based observational study. Study area: Department of E.N.T, Narayana Medical College and Hospital, Nellore, Andhra Pradesh. Study Period: June 2021 – May 2022.   Study population: Patients with CSOM of all age groups and both sexes attending the Narayana Medical College and Hospital, were selected randomly for the study. Sample size: study consisted a total of 50 cases. Sampling method: Simple random method. Results: Majority of pseudomonas infection showed mucopurulant type of discharge (50%) followed by S. aureus (33.33%). Purulent discharge was common in Pseudomonas (37.5%) and S. Aureus (37.5%). Mucoid discharge was common in Klebsiella (16.67%) followed by pseudomonas (27.78%) infection. It is interesting to know that 100% of no growth had mucoid discharge. Chi square was used to find the association between bacteria and discharge; and it was found not significant. Conclusion:  Out of 50 cases, 56 ears were examined, 51 pathogenic organisms were isolated. Only aerobic bacteria were isolated in the present series. P. aeruginosa was the most common organism isolated 23 (41.07%), followed by S. aureus 15 (26.79%), Klebsiella 5 (8.93%), E. coli 3 (5.36%), Proteus 3 (5.3%), Acinetobacter 1 (1.79%). No growth was found in 5 (8.93%) and commensal was found in 1 (1.8%) of discharge. Cf was the most effective antibiotic followed by Ak, G, Ce. In both TTD, AAD, no anaerobic organisms were cultured.

Introduction: Treatment for breast cancer is based on the expression of the immunomarkers such as ER, PR and HER2/neu. Cases which are negative to all the three immunomarkers, are called Triple Negative Breast Cancers (TNBC) and they have a poor prognosis. Recent studies have shown that some of the TNBCs express cytokeratins CK 5/6 (subcategorizing them as basal-like breast cancers) and these respond well to anthracycline-based chemotherapy. Aim and Objectives: The purpose of this study was to look at the expression of basal cytokeratins CK 5/6 in breast carcinomas from our centre and see how it correlated with histological type, grade, size, clinical characteristics, and ER, PR, and HER2/neu status. Methods: Our research is a retrospective one. Female breast carcinomas diagnosed between the January 2022 to January 2023 at Darbhanga Medical College and Hospital, Bihar. A few instances were excluded because there was insufficient clinical information or blocks were unavailable. Trucut biopsies were not considered. Results: 29 (29.0%) of the 100 patients tested positive for Cytokeratin. The number of Cytokeratin positive patients was greatest in the 41-50 age group, followed by the 51-60 age group. It is lowest at the extremes of age. In our investigation, no correlation was found between patient age and Cytokeratin 5/6 expression. Conclusion: We conclude that CK 5/6 should be used routinely in all cases of Triple Negative Breast Carcinomas because they aid in identifying the basal-like subtype without depending on expensive molecular genetics testing. Despite the dismal prognosis, this group responds well to platinum and anthracycline-based chemotherapy.

Background: The technique of intra-focal pinning described by Kapandji is used in the paediatric patients. We present the series of paediatric patients treated with Kapandji technique for unstable displaced distal radius fractures. Methods: We retrospectively reviewed medical records and radiographs of a consecutive series of 36 paediatric patients who underwent closed reduction and fixation with Kapandji technique for unstable displaced metaphyseal fractures from 2021 september to September 2022. percutaneous K-wires were inserted intra-focally to lever out, reduce and stabilize the distal fragment. The arm was immobilized with an above-elbow cast, and radiographic controls were scheduled at 1, 4, 8weeks, at least. Results: The mean age at the time of the trauma was 11.5 years. The K-wires were removed at a mean of 5.6 post-operative weeks. An above-elbow cast was used for the first 3 weeks, afterwards a below-elbow cast for 2 weeks and a short-arm brace until the full recovery of motion. The mean follow-up was 9 months (range 3.5-12 months). No pin-related complications were seen. All fractures showed good healing, and the full function of the wrist was achieved in all the cases. Conclusion: Kapandji pinning is a better technique in paediatric patients with unstable displaced distal radius fractures. It shows a lower complication rate and good outcome compared to other techniques.

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide, with hypertension being the leading risk factor. Ischemic heart disease and stroke are the leading causes of Disability Adjusted Life years (DALYs) in people aged 50 and older, and high systolic blood pressure is responsible for 19.2% of all deaths worldwide. The global NCD priority is to reduce hypertension prevalence by 25% by 2025. Strategies such as early detection, treatment, and control, cost sharing, and benefit designs can help reduce unfavourable health outcomes associated with hypertension. Objectives: The current study is a Community Interventional Trial for Hypertension Control in Rural Maharashtra, India to determine if a community-based intervention delivered to community and healthcare workers in a rural area can be effective in controlling hypertension and if any beneficial effects can be sustained in the long term. Materials & Methods: The study was conducted in the Coverage area of two Primary Health Centers in Palghar District of Maharashtra from Jan 2018 to Dec 2022. It was a Cluster randomized controlled trial with 1850 people in each Sub-center. Comprehensive community-based intervention was implemented in one Subcenter under Primary Health Centre of Kaman and second subcenter in the Primary Health Centre of Satpati in rural area of Maharashtraand its effect was assessed. Results: The baseline characteristics of the study population were similar in both sub-centres. Recommended Physical activity was less in both subcentres, with most of the participants consuming 2000-2499 Kcal/Day. Overweight was higher in Kaman, while central obesity was higher in both PHCs. The prevalence of known cases of both Diabetes Mellitus and Hypertension was 3.4% in Kaman, while Suspected Hypertension cases was higher in Kaman. In Kaman there were 27.5% of confirmed cases of hypertension and after intervention it has reduced to 17.5%. There was a decrease of 10%. In Satpati there were 25.2% of confirmed cases of hypertension and after intervention it has reduced to 21.6%. There was a decrease of 3.6%. Conclusion: A high number of cases of Hypertension is found in rural population. 27.5% of the participants were newly diagnosed with Hypertension. Screening and early detection and treatment of Hypertension is highly needed in rural areas. Community-based intervention is equally important to focus on prevention, promotion, and enable lifestyle changes to prevent and control Hypertension and avoid risk factors.

Introduction: Diabetes mellitus (DM) refers to a group of common metabolic disorder that shares phenotype of hyperglycemia. In India, the prevalence rates are estimated to be around 10% in cities, and recent figures showed surprising increasing rates in rural areas. To ascertain the true prevalence in any community, it is essential that there must be standardized methods for the diagnosis with proper acceptable criteria so that the results are comparable.  Aims: To determine the incidence of LV diastolic dysfunction in asymptomatic Type-II  DM patients and to compare it with normal subjects and To quantify the relation of LV diastolic dysfunction with age, duration of DM, HbA1c, obesity indices and other diabetic complications Materials and Methods: The present study was a case-control study. This Study was conducted from April 2021 to November 2022 at Department of Medicine at PMCH, Patna. Result:Transmitral velocity data showed the significant low E/A ratio (E<A), prolonged declaration time (>240ms) and isovolumetric relaxation time (>110ms) in patients with diastolic dysfunction both in study group and control group. Conclusion: The incidence of diastolic dysfunction was found significantly high in newly diagnosed type 2 diabetes mellitus patients as compared with non-diabetic subjects. Prevalence of diastolic diastolic dysfunction in new diabetic population has female preponderance in the ratio of 2:1.

Introduction: Acute kidney injury is a common clinical condition encountered in our hospital. This study is an attempt to evaluate the clinical profile and to investigate the risk factors for poor prognosis among critically ill patients with acute kidney injury. Materials & Methods: A hospital-based cross-sectional study was conducted after ethics committee approval in an ICU of a tertiary care hospital. Study included 70 cases admitted in ICU during the study period, and also having acute kidney injury. Etiology for development of AKI was identified using appropriate investigations. Outcome was studied in the form of recovery, death, or discharge on dialysis. Data was analyzed by SPSS ver 26.0. Results: Mean age of the study cases was 46.58 years with 61.4% males. Intrinsic etiologies for development of AKI were seen in majority of the cases (71.4%) followed by pre-renal etiologies (27.1%).  Mortality was observed among 28.6% cases. On univariate analysis, elderly age (>60 years), high APACHE II Score and co-morbidities like cirrhosis, sepsis, ARDS and IHD were observed to be significantly associated with mortality among AKI cases. On multi-variate analysis, only APACHE II score was observed as significant predictor of mortality in ICU cases developing AKI. Conclusion: Acute kidney injury is a serious problem in critically ill cases with over one fourth of the ICU cases developing AKI succumbed to death. Advancing age, high APACHE II score and presence of associated co-morbidities were associated with poor prognosis.

Background: From minor bursal or articular side irritation and tendonitis to severe degenerative rotator cuff arthropathy, rotator cuff illness includes a broad spectrum of pathology. Adults of all ages can develop rotator cuff disease, and other shoulder conditions must be checked out by a thorough medical history and physical examination1.  Objectives: 1. To identify significant predictors of the functional outcome of rotator cuff repair, such as age, sex, side, tear size, fixation techniques, smoking, and associated pathology. 2. To evaluated the functional outcome of arthroscopic repair of full-thickness rotator cuff tears. Material & Methods:  This prospective study done in the Department of Orthopaedics, MVJ Medical College and Research Hospital, Hoskote, from February 2022 to January 2023. We included the patients who have undergone Arthroscopic repair of Rotator cuff tear in the Department of Orthopaedics. The functional outcome was assessed by two scoring systems, UCLA and ASES. Results: The incidence of partial thickness tears was 11 out of 20 evaluated and full thickness tears noted in rest. Restriction of external rotation seen in 16 patients. Arm lift off was positive in 90% patients. Belly press was positive in 60 % patients. Jobes empty can test is positive in all the cases.   Conclusion: Arthroscopic rotator cuff repair offered good results and enabled the same reconstruction as with open technique and avoided its complications. Arthroscopic rotator cuff repair is technically demanding procedure that needs prerequisite skills as diagnostic shoulder arthroscopy, arthroscopic subacromial decompression, and arthroscopic knot tying. It has been observed adherence to strict post-operative physiotherapy is key for achieving full range of movement and pain free activities of daily living.

Background: Diabetes is characterized by a chronic hyperglycemic state and the development of alterations in the vascular structure. Nailfold capillaroscopy (NC) is a non-invasive, easy to perform, painless, and sensitive technique for evaluating microvascular involvement. With convenient use of dermatoscopes, we can detect and monitor the changes of the microvascular structure with reliability allowing an evaluation in the progression of the disease.  Materials and Methods: Observational and descriptive study was conducted in out-patient-department of dermatology and endocrinology at tertiary care centre. Total of 100 patients diagnosed with type 2 diabetes mellitus more than 18 years of age, and consenting to the study, were included. The capillary morphology was evaluated as bushy, tortuous, cross-linked, drop out, giant, meandering, micro-hemorrhagic areas, avascular areas, and areas of neo-angiogenesis. Results: Nailfold capillaroscopy was performed on 100 patients who visited the OPD of dermatology and endocrinology. The findings were: bushy (n = 52), tortuous (n = 84), cross-linked (n = 12), drop out (n = 36), giant (n = 52), meandering (n = 52), micro-hemorrhagic areas (n = 24), avascular areas (n = 12), and areas of neo – angiogenesis (n = 20). Morphological changes were more commonly seen in patients with poor glycemic control (HbA1c > 7.0). Thirty patients had HbA1c <7.0 and had changes such as tortuous (73.33%), crosslinked (3.33%), giant (33.33%), meandering (40%), micro – hemorrhages (20%), and neo – angiogenesis (13.33%). Seventy patients had HbA1c >7.0 and had changes such as bushy (34.28%), tortuous (88.57%), cross-linked (15.71%), drop out (51.42%), giant (60%), meandering (57.14%), micro-hemorrhagic areas (25.71%), avascular areas (17.14%), and areas of neo-angiogenesis (22.86%). Conclusion: Nail fold capillaroscopy (NFC) is a noninvasive, easy to perform, in vivo technique aiding detection of changes in the microvascular bed. Significant changes were visualized in patients with T2DM. Our results suggest NFC can be an indispensable tool to predict long term glycemic control and also helps in prognosticating microvascular complications in diabetics. Microvascular changes happening in pivotal organs are also producing significant changes in the capillaries.

Background: Prostate cancer (PCa) is a major cause of morbidity and mortality among men in the United States and globally. However, many men with prostate cancer have slow growing tumor and experience an indolent course even without curative therapy. The increasing incidence may be due to increased PSA-measurements and other diagnostic efforts. However, this review does not handle the associated differential diagnosis. Also, the biological heterogeneity that characterizes this disease causes decision issues unique to prostate cancer. Low-grade cancer diagnosed late in life may have no impact on the quality or length of life.  Materials and methods: A cross-sectional study was conducted to test the hypothesis of an association of IFN-γ, IL-6 and PSA with obesity parameters for the severity of prostate cancer. Total 90 participants included in study and Anthropometric examination and hormonal test were also performed simultaneously. Among 90 participants; Total 45 participants were grouped in Benign Prostatic Hyperplasia (BPH) and 45 in PCa groups respectively. Serum samples of men with suspicion of prostate cancer based on high prostate specific antigen (PSA) and/or abnormal DRE were withdrawn before biopsy between 8 a.m.  and 11 a.m. Serum PSA, IFN-gamma and IL-6 levels were estimated using ELISA on the same day. The serum was separated, aliquoted and kept frozen at -80ºC for analysis. Result: Waist hip ratio was significantly (p<0.0001) higher in the patients of PCa (2.9 ± 1.43) as compared to BPH (1.92 ± 1.20). Level of IFN-γ was significantly (p<0.0001) higher in PCa (144.6 ± 49.9) patients as compared to BPH patients (61.8 ± 11.9). Similarly, the Interleukin-6 level was significantly (p<0.0001) higher in PCa patients (36.95±11.37) as compared to BPH patients (13.7±9.47). The age of the patients was almost similar in both Lower (68.59±12.15) and Higher (67.70±12.70) grades.  The level of BMI was significantly (p=0.008) higher in the patients of Higher grade (28.35±7.99) as compared to Lower (26.85±5.89) grade.  The higher-grade patients had more risk of being overweight than the lower grade patients (Unadjusted OR=1.14, 95%CI=1.03-1.16). Similarly, the waist-hip ratio was also significantly (p=0.03) higher in the patients of Higher grade (2.33±1.53) as compared to Lower grade (2.09±1.38). Conclusion: The introduction of total PSA in clinical practice has resulted in early detection and reduced mortality from PCa. However, PCa screening remains controversial, because of the risk of over diagnosis reduced mortality and overtreatment and the inability to detect a significant proportion of dangerous tumors. A large concerted effort has been made to improve and/or monitoring the activity of PCa and to guide molecular targeted therapy and/or assess therapeutic response. An integrated approach with blood-based measurement of different molecular forms of PSA in combination with genetic and urine biomarkers hold the promise of improving screening for and diagnosis of PCa. Analysis of panels of blood-based biomarkers will be a significant step towards fingerprinting of the tumors biologic behavior.

Introduction: Breast carcinoma is found to be the leading cancer in women, both in developed and developing countries across the world. Though breast cancer is thought to be a disease of developed countries, 50% of the cases and 58% of the deaths occur in developing countries. It is found to have increased in developing countries due to lack of awareness and its later stages detection. Detection of cancer in early stage can improve the survival chances of the patient, and cancer control can be achieved. Aims: The objective of my study is to find accuracy of FNAC in diagnosis of breast malignant masses and to correlate the benign and malignant FNAC feathers with ultrasound diagnosis for early detection of Breast Carcinoma.  Screening of the breast lesion using ultrasonography followed by FNAC of the lesion will help early detection and treatment of the disease. Materials and Methods: The study was prospective, cross sectional and hospital-based on 100 female patients of age ranging between 15-85 years with history of palpable breast masses referred to Radiological Department of DMCH for USG scan independently and in combination with FNAC correlation in the Department of Pathology of DMCH. Result: Out of the total 62 breast lump examined, 42 (67.74%) breast lumps were reported as benign and 19 (30.65%) were reported as malignant. In one case the result was indeterminate as the cytopathologist reported as “papillary lesion”. The final histopathological result, however, turned out to be “ductal carcinoma in situ with solid, cribriform and micropapillary patterns”. Conclusion: A breast tumour must be evaluated to rule out cancer. FNAC is a tissue diagnostic method, while ultrasonography is an imaging approach. In our research, the specificity of both diagnostic instruments in identifying malignant breast lump was found to be 100%, implying that a positive (malignant) result of either test can exclusively determine the treatment choice without further diagnostic inquiry.

Background: Acute appendicitis is one of the commonest general surgical problems seen in pregnant females. Prompt evaluation and management is of utmost importance to avert maternal and fetal morbidity and mortality. The aims and objectives of this study were to study the presentation and management of acute appendicitis in pregnancy. Methods: This was a prospective cohort study of 50 pregnant patients presenting with acute appendicitis over a period of 4 years in a tertiary care hospital of a developing area.Results: The mean age of the patients was 29.31 ± 4.83 years with most of them being in the age group of 25 - 30 years. Thirty-one (62%) patients hailed from the rural areas. Twenty-eight (56%) patients were primigravida. Majority of patients presented in the 2ndtrimester [28 (56%) patients]. Ultrasonography was used as the diagnostic modality of choice in 48 (96%) patients. Majority of the patients [47(94%)] were managed conservatively on intravenous antibiotics, analgesics and fluids. The mean hospital stay was 4.26 ± 1.29 days. Simple open appendectomy was needed in two (4%) patients whereas one (2%) patient required laparotomy because of generalized peritonitis. No maternal or fetal loss was seen in our study.Conclusion:Acute appendicitis is a common surgical emergency encountered in the pregnant females and usually responds well to conservative therapy. However early surgical intervention is warranted in case of peritonitis to circumvent maternal and fetal complications.

Introduction: Intracranial metastases are most frequent in the brain and dura. 80% of the brain metastasis are located in the anterior border zones of the cerebral hemispheres, 3% are found in the basal ganglia and 15% in the cerebellum. In the cerebrum, metastasis occurs typically near the junction of cortex and white matter. Aims: To study the presenting symptoms in asymptomatic and known cases of malignancy and its correlation to the type of malignancy. Special emphasis will be on asymptomatic patients with their first presentation and correlation with age and sex, to estimate the incidence of metastatic lesions of CNS. Materials and Methods: The present study has been performed predominantly on CNS metastasis cases admitted in the department of Neurosurgery, SMS Medical College & Hospital Jaipur. 50 cases have been studied and cytological as well as histological diagnoses were compared. This diagnosis was then compared with diagnosis given on CT & MRI. Result: Backache was the symptom found in only spinal metastasis, not intracranial. 100% of spinal metastasis in our study complained of this symptom. In the Intracranial metastasis from unknown primary, moet were adenocarcinomas and surprisingly either from GIT or overy the patient remained asymptomatic for prolonged periods. This fact Is probably attributed to occull carcinoma. Conclusion: In the Intracranial metastasis from unknown primary, moet were adenocarcinomas and surprisingly either from GIT or overy the patient remained asymptomatic for prolonged periods. This fact Is probably attributed to occull carcinoma.

Background: This prospective study aimed to assess the clinical and demographic profile of adolescent poisoning cases admitted to the Department of Pediatrics at HIMS Hassan, India. Methods: A total of 105 patients aged between 10 and 17 years were included in the study, with data collected regarding their clinical-demographic profile and consumption details.  Results: The majority of cases were female (79%) and from a rural area (63.8%). In terms of socioeconomic status, the largest proportion of cases were from the upper lower class (32.3%). Insecticide (26.6%), rat paste (13.3%), acid (11.4%), and tablet consumption (24.7%) were the most common poisons consumed by the adolescents. Suicidal consumption accounted for 85.7% of cases, while 14.2% were accidental. Regarding treatment, 80% of patients received supportive and symptomatic management, while 20% received a specific antidote. Conclusion: The study provides valuable information about the clinical and demographic profile of adolescent poisoning cases in India, which can be used to inform prevention and management strategies.

Fluorosis, a condition caused by the excessive intake of fluoride, results in toxic effects on the human body. It is a collective term for the various manifestations of this condition. Recent estimates indicate that approximately 200 million people across 25 nations worldwide are affected by the alarming consequences of fluorosis. In India, 20 states are facing the challenge of high fluoride levels impacting their population. Objectives: To determine the effect of black tea drinking and use of toothpaste in the development of dental fluorosis among children in the age group of 10-15 years in Kerala.  Methodology: This study involved the selection of two districts with a high prevalence of fluorosis and two neighboring districts without fluorosis. A sample size of 980 school-going children werecalculated, and adequate sample size was selected. Data was collected using a pretested modified questionnaire. Dental specialists evaluated the fluorosis status, and information regarding the use of tooth paste and consumption of black tea along with other details.Subsequently, the collected data was entered and analyzed. The prevalence of fluorosis was calculated in percentage. Results: In the district of Alappuzha, the prevalence of dental fluorosis was found to be 38.9% among children who used toothpaste for dental cleaning and 30.6% among those who did not use tooth paste.However, in the other districts, no significant relationship was observed between the prevalence of dental fluorosis and the use of toothpaste. In the district of Alappuzha, the prevalence of dental fluorosis was 37.9% among individuals who consumed black tea, compared to 33.6% among those who did not consume black tea. Similarly, in Palakkad, the prevalence was 39.9% among black tea consumers and 35.2% among non-consumers. It was observed that a majority of students in both Alappuzha and Palakkad consumed black tea, and the prevalence of dental fluorosis was higher among students who consumed black tea in both districts. Conclusion: Dental fluorosis is a public health problem in the district of Alappuzha and Palakkad in Kerala, India. The main causative risk factor was the use of drinking water containing high fluoride level but the use of black tea and fluoridated toothpaste are the added risk factors in the development of fluorosis. Measures should be taken to avoid these added risk factors in these endemic areas in order to solve this public health problem.

Background: Occupational pulmonary diseases are more widespread and more disabling than any other group of occupational disease. The lung with its extensive surface area, high blood flow and thin alveolar epithelium is an important site of contact with substance in environment. The inhalation of dust over periods of time leads to proliferation and fibrotic changes in lungs. The workers working in industries suffer from various types of air way diseases like pneumoconiosis, farmer’s lung, chronic bronchitis, pulmonary fibrosis and asthma. So, the present study was undertaken to study the effects of wood dust on respiratory functions of exposed workers. Materials and methods: The present study was a cross-sectional comparative study. Subjects of experimental and control groups were selected by inclusion and exclusion criteria. There were two groups of experimental subjects (sawmill (n=50) and carpet workers (n=50)), who were non smokers and exposed to industrial dusts. And the subjects of control group were age matched, working in office set up, non smokers and not exposed to industrial dusts (n=100). Their height, weight, age, sex, presence of any respiratory symptoms/diseases, history of smoking and duration of exposure to dusts were documented using a standard case history sheet. Ambient temperature was also recorded. Weight was recorded in kg and height was measured in cm without shoes while standing erect. Pulmonary function parameters were recorded using an electronic spirometer. Result: In our study we found significantly lower PEFR values in their study as compare to healthy individuals in their study which is comparable PEFR (6.8±1.38 Versus 9.33±1.35) in our study. Moreover, we found significant lower FEV1/FVC ratio in their study in wood workers which also comparable with our study showing significant lower FEV1/FVC (89.99±5.70 Versus 77.91±6.6) ratio. Furthermore, MVV significantly lower among wood workers same interpretation was carried by our study with significant lower MVV (77.05±5.8) as compare to healthy individuals (112±4.6). Conclusion: We conclude from this study that workers exposed to pine and fibre wood dust have more respiratory symptoms than control subjects and that such exposure increases the risk of airflow obstruction. So, we recommend that workers should learn to use protective facemasks at sites and use other measures to reduce dust flow into the environment. It is important to take account not only of dust concentration, particle size, and exposure time, but also of a variety of background and individual factors (e.g., specific sort of wood, wood dust related biohazards, or disease history), since they may also contribute significantly to the decreased efficiency of lung function.

Introduction: Hyponatremia is serum sodium less than 135 meq/lit. Hyponatremia is the most common electrolyte disorder in hospitalised patients. In advanced cirrhosis a disturbance of body water homeostasis is a common feature. Hence there is higher rate of renal retention of water in relation to sodium due to a reduction in solute-free water clearance. Pathologic features consist of the development of fibrosis to the point that there is architectural distortion with the formation of regenerative nodules. This results in a decrease in hepatocellular mass, and thus function, and an alteration of blood flow. The induction of fibrosis occurs with activation of hepatic stellate cells, resulting in the formation of increased amounts of collagen and other components of the extracellular matrix.Material And Methods: This is cross-sectional study conducted in the Department of General Medicine at Mahalakshmi Multispeciality Hospital, Ambattur, Chennai from June 2021 to May 2023. Patients were selected based on clinical examination, biochemical tests and ultrasound abdomen. Informed consent was obtained from all patients enrolled for the study. The data of the patients like relevant clinical history, examination findings, laboratory investigations were recorded in a proforma sheet. All the patients enrolled in the study were examined at the time of admission in the hospital and their serum sodium levels were checked and the patients were followed during their stay in the hospital. The severity of cirrhosis was assessed according to Child-Pugh score. MELD score and MELD-Na score were also calculated at the time of admission. Results: The mean age of the patients was 48.15±13.79 and consisted of 85 (94.4%) men and 05 (5.6%) women. Causative factors for liver cirrhosis included alcoholism in 90% of patients, hepatitis B in 5.6% of patients and hepatitis C in 4.4% of the patients. Alcohol was the most common etiology in present study, seen in 94.4% patients.In the present study, alcohol is found to be cause of cirrhosis in 24 patients out of 25 (96%) in the group with serum sodium levels ≤ 130 meq/L, in 23 patients out of 28 (82%) in patients with serum sodium levels between 131-135 meq/L, in 33 out of 37 patients (89.2%) in the group with serum sodium levels ≥136 meq/L. In the present study, there is no significant statistical differencebetween the three groups with respect to alcohol as the cause of cirrhosis (p value 0.25). Conclusions: Dilutional hyponatremia is frequent in cirrhotic patients and low serum sodium levels are associated with severe complications of liver cirrhosis like hepatic encephalopathy, hepatorenal syndrome. Hyponatremia is also associated with high morbidity and mortality in cirrhotic patients. Hence hyponatremia is a valuable marker that can be used to assess the prognosis in patients with cirrhosis of liver. Incorporation of sodium levels in MELD score is much more useful than MELD score alone to assess the prognosis and to refer the patient for liver transplantation.

Background:   Bactibilia, or the presence of bacteria in bile from the gallbladder, may contribute to the development of septic complications. It has been related to increased rates of surgical site infection after cholecystectomy. Laparoscopic cholecystectomy is the definitive treatment for cholelithiasis and cholecystitis. Advanced age, acute cholecystitis, ERCP, and gallstones are important risk factors for the development of bactibilia. This study aims at showing the effect of bactibilia on the course of laparoscopic cholecystectomy. Materials and methods: This are a prospective case-control study to be conducted at Govt. General Hospital, Vijayawada at Dept. of General Surgery over 1 year on 50 patients. Patients with asymptomatic Cholelithiasis of age 18-60 are included in the study and patients with hemoglobin < 10 gm%, hypoalbuminemia < 2.5 gm/dL, patients in acute sepsis, patients with HbA1c >6.5%, hypertension (>139/89 mm of Hg) and BMI > 30 and patients in an emergency setting and patients who have not consented for the study were excluded from the study. None of the patients received pre-operative antibiotics. Intra-operatively, bile is collected from the gall bladder and sent for microbiological culture in aerobic and anaerobic media for 3-5 days. Patients are divided into: Group A - Microbiological culture positive for microbes and Group B - Microbiological culture sterile. Both groups will be analyzed for the duration of hospitalization after surgery, post-operative wound infection, and any other complications encountered. Results: Out of the 50 patients, 32 were males and 18 were females. The mean age of the patients was 43.5 ∓ 9.6 years. The mean BMI was 27.1 ∓ 4.7. Of the total 25 samples positive for bile culture, 11 were E.coli, 7 were Klebsiella, 3 were Enterobacter spp., 2 were Acinetobacter spp., and the remaining were 2 Viridans streptococci. All the bacteria were sensitive to Amikacin. All except Acinetobacter were sensitive to gentamycin and imipenem. All except one case of E.coli were susceptible to ciprofloxacin. The incidence of port site infection, prolonged fever, intra-abdominal abscess, pneumonia, wound healing duration, and hospital stay were significantly higher in group A compared to group b (p-value < 0.05). Conclusion: Bactibilia affects the outcomes of laparoscopic cholecystectomy in terms of prolonged hospital stay, increased incidence of wound infection, duration of wound healing, and fever.

Conclusion: Serum homocysteine, vitamin B12and folic acid are easily available investigations which may predict the severity and outcome of patient s    of acute ischemic stroke.

Background: Bupivacaine is a pipecoloxylidide derivative developed by Ekenstam in 1957 and first utilized in clinical practice in 1963. It is a racemic mixture of the D and L isomers. (2) (3) Bupivacaine is used for procedures that last 2 to 2.5 hours. For longer procedures it may be necessary to convert to general anaesthesia or augment with an intravenous anaesthetic drug. Objectives: The main aim of this study was to see how intravenous dexmedetomidine affected infraumbilical operations done under spinal anaesthesia with hyperbaric bupivacaine 0.5% to observe 1. duration of sensory block, 2. duration of two-segment regression, 3. duration of motor block, 4. intraoperative hemodynamic stability, 5. sedation score, 6. duration of postoperative analgesia and 7. side effects 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: Adult patients of either   sex, aged between 18-55 years belonging to ASA class I and II without any severe co morbid diseases scheduled for elective infra umbilical surgeries. Sample size: study consisted a total of 100 cases. Study tools and Data collection procedure: A hundred patients undergoing infraumbilical surgeries under spinal anaesthesia were randomly divided into two groups of fifty each using a computer-generated random list. Group D patients got dexmedetomidine infusions of 1 mcg/kg over 10 minutes and subsequently 0.5 mcg/kg/hr until the completion of the surgery, while Group C patients (placebo control) had a similar ratio of normal saline infusion. Results: The median sensory block duration of the dexmedetomidine group was 207.60 (+21.001) minutes, two-segment regression time was 126.10 (+17.65) minutes and median motor block duration was 164.10 (+27.732) minutes. Median sensory block duration was 177.10 (+15.587) minutes in the control group median two-segment regression was 110.80 (+10.418) minutes and motor block duration were 150.40 (+15.937) minutes.Dexmedetomidine group had significantly prolonged sensory block (p < 0.0001) and two-segment regression (P = 0.001) when evaluated to control group. Conclusion: It can be concluded from the present study that Intravenous dexmedetomidine exacerbates the motor and sensory blockage induced by spinal anaesthesia. The risk of bradycardia is considerably raised when IV dexmedetomidine is used as an adjuvant to bupivacaine in spinal anaesthesia.

Background: The ninth most prevalent cancer in women and the fourth most common cancer in men, respectively, is bladder cancer [1]. More than 95% of all bladder cancer cases are caused by transitional cell carcinoma (TCC), the most prevalent histological type [2, 3]. Only 5% of UCs occur in the upper urinary tract (UUT), compared to 95% in the bladder [1]. Renal pelvic tumours are 3–4 times more common than ureteral tumours among all urothelial carcinomas (UC) in the UUT [4]. OBJECTIVES:  1. To evaluate transabdominal USG findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors. 2. To evaluate cystoscopy findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors.  3. To evaluate Comparision of transabdominal USG findings with cystoscopy findings for detection of new cases and recurrence in the follow up of patients with bladder cancer or tumors. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Mamata Academy of Medical Sciences, Bachupally, Hyderabad.  Study Period: Dec. 2022 – May 2023. Study population:  Subjects attending the Department of Medicine and Urology Department all age group and diagnosed with urinary bladder tumors. Sample size: study consisted of 30 subjects. Study tools and Data collection procedure: The present study includes total of 30 subjects attending the Department of Medicine and Urology Department all age group and diagnosed with urinary bladder tumors. The patients were examined by transabdominal USG and cystoscopy. The demographic details, clinical history were taken as per the detailed prescribed proforma followed by well informed consent from all the study subjects. The present study was conducted after approval from ethical committee. 30 patients clinically suspected to have bladder tumors were investigated by transabdominal ultrasonography. The examination was performed with Siemens acuson X 300 premium edition CH5-2, VF10-5 ultra sound machine. Results: All tumors had a wide area of attachment. 70% of the tumors had irregular out line, 30% smooth out line and 73.33% had heterogenous echotexture, 26.67% uniformly homogenus, 63.33%, 20%, 16.67% frond shaped, flat, and small nodules were present respectively. Ultrasound and cystoscopy was correlated in the aspect of site of involvement 100% in 18 cases at Right postero- lateral, 100 trigones in 6 cases, 100% dome 2cases, 75% of the left postero lateral wall in 12 cases, 50% anterior wall in 2 was accurately demonstrated on ultrasonography. Conclusion: Sensitivity of transabdominal ultrasound for bladder tumors varies from 26% to more than 80% in the literature. Most studies show that transabdominal bladder ultrasound is especially poor in detection of tumors smaller than 5 mm. Another important point is bladder tumor site influences on the ultrasound detection rate. Anterior wall tumors have a lower detection rate because of reverberation artifacts.

Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge.  Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates.  Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.

Purpose: The aim of this study was to evaluate the therapeutic effects and safety of oral propranolol along with topical timolol maleate or oral propranolol alone for treatment. To study the increases in the success rate of propranolol when used along with timolol solution. Whether there is a decrease in the duration of therapy.To study the speed of improvement in haemangioma treatment with propranolol therapy when used along with timolol solution. Methods:  From March 2019 to June 2020, 40 cases of Surface Infantile Patients were treated. The experimental group (20 patients with 7 males and 13 females) was treated using oral propranolol combined with topical timolol maleate, whereas the control group (20 patients with 5 males and 15 females) was treated with oral propranolol alone. Vas scale is used to grade the improvements. Results:  In terms of the volume reduction of the lesion at the endof the study, the combination therapy (P+T) was found to be more efficacious than the monotherapy (only Propranolol),  volume reduction percentage was(67.28 ± 17.11 %) for the combined therapy group (P + T) and (55.547 ± 16.39 %) for the single therapy group i.e only Propranolol,  with P value (P=0.033), when the analysis was further carried on for the earlier age group, Reduction in terms on depth was found to be better in the Propranolol + Timolol group (Depth 0.765 ± 0.437 cm) thanthe propranolol alone, the combination therapy failed to show better results in terms of shortening of the duration of treatment and ameliorating the efficacy of propranolol However it was found that volumetric reduction was better in combination therapy than propranolol alone. Effects were seen better when the treatment was started in early age groups that is 0-6 months. Conclusions: In our study, we found out that the Propranolol 2-3mg per kg and Timolol solution of 0.5% applied thrice over the lesion were well tolerated by all the patients without any serious adverse events. The Propranolol and Timolol combination therapy fails to demonstrate a statistically approvable shorter period of treatment as well as efficacy when compared to Oral Propranolol alone. But clinically there is Volumetric reduction in terms of depth reduction and a decrease in duration of treatment. This was found to be better in the combination group than propranolol alone and was significant for early-age group patients. 0-12 months.

Background: Cardiovascular disease remains the leading cause of death globally, accounting for a significant burden of mortality and morbidity. It affects people of all ages and socio-economic backgrounds, with a particular impact on low- and middle-income countries. Risk factors such as high blood pressure, tobacco use, unhealthy diets, physical inactivity, and obesity contribute to the global prevalence of cardiovascular disease.  Aims and Objectives: The aim of this research was to study and compare the thyroid profile and serum uric acid levels in diabetic and non-diabetic cardiovascular disease patients. Materials and Methods: The present hospital based observational study was carried out Osmania General Hospital and included 44 cardiovascular disease patients. All the patients underwent detailed history taking, thorough clinical examination and relevant laboratory investigations. Thyroid profile and serum uric acid levels were compared between diabetic and non-diabetic cardiovascular patients. Data was collected in MS Excel and presented as numbers and percentages in the form of tables and figures. Results: More than 60% of the patients considered for the study were male. Majority of the patients, nearly two-third (65.91%), were non-diabetic. Of the 15 patients who were diabetic, almost all the patients (86.67%) fell into the Euthyroid category, while  Hypothyroidism and Hyperthyroidism were found in only one patient (6.67%) each. None of the non-diabetic patients from the study had Hyperthyroid. Majority of the non-diabetic patients (86.21%) exhibited Euthyroid state while only 4 non-diabetic patients (13.79%) had Hypothyroidism. Almost all the diabetic patients (93.33%) from the study had normal uric acid levels, while only one diabetic patient (6.67%) had a raised uric acid level. Among the non-diabetic patients, majority of them (89.66%) had normal uric acid levels. Only 3 of the 29 non-diabetic patients (10.34%) had raised uric acid level. Conclusion: There is a strong association between diabetes and cardiovascular disease. However, further research needs to be carried out to in view of thyroid profile and uric acid levels in diabetic and non-diabetic cardiovascular disease.

Background: This study was conducted to evaluate and compare the effect of adding two different doses (10 mg and 20 mg) of intrathecal meperidine with 0.5% hyperbaric bupivacaine on the onset, incidence and intensity of shivering during lower limb surgeries under spinal anaesthesia. Methods: This was a hospital-based randomized controlled trial study conducted among 60 patients aged between 18 and 60 years of physical status ASA grade 1 and ASA grade 2 of either sex undergoing elective lower limb surgeries at the Department of Anaesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, from December 2015 to September 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: The onset and intensity of shivering were greater in group 1 than in group 2 (p =0.007). The duration of shivering was significantly prolonged in group 1 compared to group 2 (p=0.004). There was a significant drop in temperature in both groups at 25 minutes (p<0.001) and 1 hour (p<0.001). The noted side effects were vomiting and pruritis. Conclusion: 0.5% hyperbaric bupivacaine with 20 mg of meperidine prevents shivering better with respect to incidence, intensity and duration of shivering when compared to 10 mg meperidine. Hence, we conclude that meperidine can be safely used at dosages of both 10 mg and 20 mg for the prevention of shivering with no significant difference with respect to complications.

Study Conducted: AT dept of generalsurgery, gajra raja medical college and JahGroup of Hospitals, Gwalior Madhya Pradesh Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: This study was conducted on 100patients of diabetic foot in the Department of Surgery, JA Group of Hospitals and GR Medical College, Gwalior (MP) from January 2020 to June 2021 Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21 Results: A total of 100 cases of diabetic foot wounds were studied from January 2020 to August 2021 in the Department of Surgery JAH Hospital and G.R. Medical College, Gwalior.In our study,most diabetic foot wound patients presented in the 50-69 years age group with a mean age of 52.23±14.92 years. Male to female ratio of 4.5:1 was shown in our study.Total of 56% of patients presented with a diabetic foot wound within <10 years of duration of diabetes mellitus.67(67%) out of 100 patients gave a positive family history of diabetes.The most common cause was trauma/injury (65%) and the most common presentation was an ulcer (70%).Out of 100 patients, 66(66%) patients belonged to rural areas and 75% were illiterate.The most commonly affected patients are farmers (47%) and labors (29%) by occupation. Most of the patients were using ill-fitted shoes or barefoot walking.Most of the patients developing complications had uncontrolled RBS with delayed presentation and longer duration of diabetes and not took proper precautions and treatment.50% of patients underwent surgical debridement and 15 % of patients underwent amputation.Mortality was 2% in our study. Conclusions: Several risk factors for LEA were identified. , PAD, hypertriglyceridemia, and hypertension have been recognized as predictors of LEA in this study. Good glycemic control, the active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation riskNot all diabetic foot complications can be prevented, but it is possible to reduce their incidence through appropriate management. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in high-risk diabetic patients.

Background: Identifying the women who are likely to miss receiving complete ANC care during their pregnancy and understanding the causal factors is essential towards the development of effective and targeted public health interventions. Objectives: To assess the sociodemographic profile and the factors influencing the utilisation of antenatal services among pregnant women in rural Coimbatore. Methods: A community based cross-sectional study was conducted among antenatal women residing in the field practice area of Rural Health Training Centre using multi-stage sampling method from June 2021 to May 2022 (one year) in the Rural Field Practice Area of a Medical College in Coimbatore district using pre-tested, validated, semi-structured questionnaire. Results: Majority (55.2%) of the participants were aged between 18-25 years. Only 10% of the women were currently employed. Tests of association showed that sociodemographic factors were significantly associated with ANC utilization (p<0.05). Among the study participants, 80.4% utilized the services completely (ANC visit to healthcare facility, consumption of IFA tablets, Td vaccination, basic blood, and urine investigations and ultrasonogram); 19.6% had incomplete ANC care and none had “No ANC”. Conclusion: The overall high ANC utilisation in the study area could be attributed to the favourable knowledge, attitude, and practice of the antenatal women towards maternal and child health as a result of high literacy rate, ongoing IEC and health promotional activities. Attention should be given to regular and sustained contact between healthcare workers and antenatal mothers especially through home visits to develop mutual confidence in preparing them for pregnancy, childbirth, and care beyond.

Background: Salivary gland tumors (SGTs) are relatively less common, and they exhibit a wide variety of morphological features, even within one particular lesion. This has caused considerable problems in categorization and diagnosis. The epidemiologic factors are also variable across the world.  Objectives: To study the site of occurrence, age, and gender-wise distribution with histopathologic features of various SGTs and their comparison with other studies.  Material and Methods: This eight year cross-sectional study was conducted in a tertiary care teaching hospital of central India and included all diagnosed cases of SGTs. Results: A total of 100 cases of SGTs were retrieved during the seven-and-a-half-year study period. Out of which 61% were benign and 39% were malignant. The age range was 5–83 years. The most frequently encountered benign tumor was pleomorphic adenoma (86.8%), followed by Warthin’s tumor (8.2%). Mucoepidermoid carcinoma (MEC) was the commonest malignant tumor (33.3%). The parotid gland was the commonest site for both types of SGTs.  Conclusion: SGTs had a wider age range of presentation. Benign tumors were more common and well-demarcated from surrounding tissue as compared to malignant tumors. They were more common in the major salivary glands, as the parotid was the commonest gland involved in both benign and malignant SGTs.

Introduction: Acute appendicitis is a common surgical emergency, with appendectomy being the gold standard treatment for this condition. Traditionally, early appendectomy has been advocated to prevent the potential complications associated with delayed intervention. However, recent studies have questioned the necessity of immediate surgical intervention and proposed a conservative approach with delayed appendectomy or even non-operative management. The debate between early versus delayed appendectomy in the treatment of acute appendicitis has gained significant attention among surgeons, researchers, and healthcare providers. This comparative study aims to provide a comprehensive analysis of the outcomes, efficacy, and safety of these two approaches. Aims and Objectives: This study aims to compare the morbidity, mortality, postoperative length of stay and 30 days readmission rate of acute appendicitis patients who had appendectomy within 8 hours of visiting the emergency room with those who had surgery after that period. Material and Methods: This study was conducted on 175 patients retrospectively who underwent appendectomy procedures from January 2021 to December 2021 at Adesh Medical College and Hospital, Shahabad, Kurukshetra, Haryana, India. The study population was divided into two groups based on the length of time before the intervention: early appendectomy (group 1), which included patients who underwent surgery within 8 hours, and delayed appendectomy (group 2), which included patients who underwent surgery after that time. The underlying characteristics of the two study groups were then compared, including demographic, clinical, radiological, and perioperative data. The 30 days readmission rate, postoperative length of stay, and mortality and morbidity were all regarded as outcome measures. Data were manually collected by reviewing patient charts in the electronic medical record. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for the statistical analysis. Statistical significance was evaluated at p<0.05.  Results: A total of 175 patients met the inclusion requirements for the study population over the course of the twelve months of the trial period. Within 8 hours of their arrival at the emergency department, 100 patients (57.1%) underwent early appendectomy, while 75 patients (42.8%) did so after that time. The age was 43.8±11.85 years on average. A total of 54.28% (n = 95) of the population were male patients and the rest were females. Twenty patients (11.43%) overall experienced postoperative problems, including two postoperative hemorrhages (1.1%), five surgical site infections (2.86%), eight pneumonia (4.57%), one urinary tract infections (0.5%) and four patients (2.28%) who experienced multiple organ system failure. Within 30 days of surgery, six patients (3.4%) were readmitted. The 30‐day readmission rate (2% vs. 4%, p = 0.569) did not differ significantly between the two groups. The postoperative duration of stay did not differ significantly between the two groups: Median (IQR) 24.8 (11.2‐38.4) vs. 26.9 (11.6‐26.9) hours (p = 0.692). Conclusions: Our results concluded that eight hours delay in the appendectomy did not lead to longer postoperative stays, an increase in mortality or morbidity, or a higher 30‐day readmission rate, of patients with acute appendicitis. This comparative study investigated that early versus delayed emergency appendectomy in the treatment of acute appendicitis holds significant importance in guiding clinical decision-making. By critically analyzing the available evidence, this research aims to provide evidence-based recommendations to enhance patient care and optimize outcomes.

The prevalence of Chronic Venous Disorder (CVD) and the socioeconomic impact of its symptoms are directly related to the importance of the disease. The most common symptom of CVD is varicose veins (VVs). 45-75% of VVs cases are related to insufficiency of the Great saphenous vein (GSV), and 15-25% are due to an incompetent Short Saphenous Vein (SSV).  Objective of this study was to study the anthropometric measurements and the anatomical variations of GSV, Anterior accessory saphenous vein (AASV), Posterior accessory saphenous vein (PASV) and intersaphenous vein (ISV), and the diameter of GSV and Short SaphenousVein (SSV) in Chronic venous disease patients Methods: Patients of primary varicose vein(diagnosed  clinically and on Duplex doppler USG )on 200 legs were enrolled. Age, sex, anthropometric data, and findings on duplex USG were noted. Venous reflux, GSV, SSV, AASV, PASV diameter was noted and its severity with Venous clinical severity (VCSS) score was also noted. Results: The mean age, weight (kg), height (cm), hip diameter(cm), waist diameter (cm), and BMI (kg/m2)of the patients were 35.65±9.91, 75.41±12.34, 63.48±5.06, 40.80±3.49, 40.09±4.35, and 29.37±6.97respectively. The percentages of male and female were 82.00% and 18.00%,. The mean VCSS, Diameter of GSVjust below SFJ (mm), at upper thigh (mm), mid-thigh (mm), above knee (mm), below knee (mm), at Mid leg (mm), at medial malleolus (mm), SSV diameter Just below knee (mm), SSV Diameter at mid-calf (mm) and SSV Diameter at Lat. Malleolus (mm) were 10.40±2.54, 9.09±2.04, 8.10±1.96, 7.13±1.93, 6.28±1.89, 6.81±1.77, 6.61±1.88, 4.79±4.13, 3.93±0.75, 4.47±5.84, and 3.85±2.86, respectively. Conclusion: Weight and BMI were significantly positively correlated with the diameter of competent perforators. . Moreover, the SFJ incompetent,SPJ-incompetent, AASV incompetency, perforator-incompetency, and GSV diameter  were  significantly positively correlated with VCSS.  Other anatomical changes such as diameter of GSV and SSV were not significantly correlated with age, weight and BMI. Also, the hip, waist circumference, and hip-to-waist ratio were not significantly associated with the different anatomic changes in varicosities whereas SSV diameter just below the knee was significantly negatively correlated with VCSS.

Background: The profile of cirrhosis may vary with different age and ethinic groups, geographical, social and etiological factors. So the present study will be undertaken  to study the  clinical profiles of patients with cirrhosis of liver in the form of demography, aetiology, clinical presentation, laboratory evaluation and  complications in this region of north Karnataka. Methodology: A two  years observational study after ethical committee approval was conducted at a tertiary care hospital among 200 cirrhotic patients in whom after explaining the purpose of the study,  detailed history, clinical and laboratory data was collected. The DATA was analyzed using  IBM SPSS Statistics for Windows, Version 25.0. Result. In our study the commonest age group was 31-50 years, mean age 44.10±13.08 years. Majority (88.5%) were males. Symptoms were abdominal distension (85.5%), lower limb edema(63.5%), jaundice (48%), gastrointestinal bleed(18.5%), altered sensorium in 14%. Aetiology were alcohol related (57.5%), HBV (13.5%), NAFLD(11.5%), viral and alcohol(5%), HCV (3%), Cryptogenic cirrhosis (4.5%) and Autoimmune Hepatitis (2.5%). Commonest   complications were hepatic encephalopathy (14%), Spontaneous bacterial peritonitis(14%), major renal impairment(12%) and Hepatocellular carcinoma (0.5%). 49% had CTP category B disease and 47.5% had CTP category C, 165 patients had MELD Na of >15. Conclusion: Cirrhosis is common among the most productive age group of society with change in lifestyle habits and increased alcohol use this has gained more importance. Recent advances in treating these patients may take a few more years in yielding new results and this article will act as a benchmark for comparison.

Background: General anaesthesia is associated with marked cardiovascular changes. Previous studies say that etomidate can be used in patients with limited hemodynamic reserve and propofol can lead to more hemodynamic instabilities. Hence, the present study was undertaken to compare the effects of propofol and etomidate on hemodynamicA changes during induction of general anaesthesia. Method: total 70 patients of ASA grade I & II, aged 18-60 years, weighs 40-80 kg, undergoing surgeries with general anesthesia were included and randomly divided into two equal groups.Induction of anaesthesia was carried out by using 0.3 mg/kg of etomidate in group A patients and 2.0 mg/kg of propofol in group B patients. Hemodynamic parameters such as: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and O2 saturation (SpO2) was measured and recorded at 1,3,5 and 10 minutes after intubation.Results: Both the groups were comparable and found no significant difference regarding demographic profile of patients, (p>0.05).At various time intervals i.e., T0 (before induction), T1 (after 1 min), T2 (after 3 mins), T3 (after 5 mins) and T4 (after 10 mins) the mean values of HR and SpO2 was comparable between two groups, (p>0.05) while the mean values of SBP, DBP and MAP were significantly lower in group B compared to group A, (p<0.05). Conclusion:Etomidate is haemodynamically more stable compared to propofol as the incidence and severity of hypotension are higher with propofol. Etomidate is a better option in patient’s particularly prone to hemodynamic instability at induction.

Background: Stroke rank high among the leading causes of death and permanent disability in India. Due to shifting demographics and rising rates of important modifiable risk factors. The purpose of this study was to compare the blood sugar levels of people with and without diabetes in the early stages of ischemic stroke. Material and Methods:  40 patients who had been admitted to the Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India for the diagnosis of acute ischemic stroke between the April 2022 to March 2023 were included in this study. The Patients were on the basis of the inclusion and exclusion criteria. Results: In our analysis of 40 patients, the majority of them were male, indicating a male preponderance, which is prevalent in most investigations. Twenty-eight of the forty patients had hypertension, 34 had diabetes, three had a history of myocardial infarction, and one female patient had atrial fibrillation. The majority of the patients (15) were between the ages of 51 and 60, with 11 between the ages of 27.5 and 12.5% between the ages of 40 and 50. Conclusion: Ischemic stroke severity, magnitude, and outcome are linearly related to admission day hyperglycemia. Diabetes and stress hyperglycemics have greater severe strokes and worse functional outcomes and higher death. Admission day glucose levels predict ischemic stroke outcomes.

Background: Plantar fasciitis is a degenerative condition, which is the most common cause of heel pain seen in nearly 10% of population. Though it is usually a self-limiting disease, symptoms may require treatment. Methods: 120 (n=60) adult patients with chronic plantar fasciitis, who met the inclusion criteria were evaluated from November 2020 to June 2021 in IGGGH & PGI, Puducherry. In this prospective comparative study, Group-A was given Platelet-Rich Plasma (PRP) and Group-B was given triamcinolone acetonide injections intra-lesionally. Follow-up was done at 4th, 8th and 12th week post-injection and improvement was assessed by Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AHFS) and Foot & Ankle Ability Measure - Activities of Daily Living (FAAM-ADL) subscale. Results: 63 males and 57 females in the age group between 23 and 81 years with a mean duration of symptoms of 6.74 ± 2.75 months were included. Right side was predominantly involved. There was a statistically significant improvement in VAS and FAAM-ADL at 4 weeks follow-up in group B, whereas there was no difference in effectiveness at 8th and 12th weeks. AOFAS-AHFS scores were similar in both with “excellent” results in 23 Group-A and 45 Group-B patients. Conclusion: Both PRP and corticosteroid injections are effective in treating chronic cases of plantar fasciitis with better immediate results with corticosteroid. As PRP is an autologous product it is a safer option. Further studies with longer follow-up period are needed to confirm our findings.and lignocaine alone.

Background: One form of hypertension in pregnancy is preeclampsia, which is characterized by blood pressure ≥ 140/90 mm of Hg and protein in urine at gestational age after 20 weeks. Preeclampsia is a global problem affecting 2-8% of pregnancies, and an estimated 8.3 million pregnant women experience preeclampsia every year.  In this review we will look at potential biomarkers and its correlation with uterine artery Doppler for early prediction and diagnosis of preeclampsia. Aim: To investigate the role of placental growth factor, and uterine artery diastolic notch to predict the early onset of preeclampsia. Materials And Methods: A hospital based prospective study conducted on 100 normotensive, non- proteinuric antenatal women less than 20 weeks of gestation were recruited. At 12-16 weeks, PLGF level was estimated from stored serum samples of all cases ad Doppler assessment of uterine circulation for uterine artery indices were done. These women were again rescanned at 24 weeks of gestation by transabdominal USG and further followed up clinically for development of preeclampsia. Methods used for the detection of PLGF is ELISA kit ad Uterine artery Doppler velocimetry was done by transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer Results: In this study,the median PLGF levels being significantly lower in pre-eclampsia cases (15 pg/ml) compared to normal (20.0pg/ml) with sensitivity being 90% and specificity being 23.4%, positive predictive value of 15.5% and negative predictive value of 93.8%. When Uterine arteries notch and RI >0.65 taken together increases sensitivity by 85.71%, 84.62% specificity and negative predictive value by 98.25%.  We found 52.3% sensitivity rate and 84.62% specificity with  70.51% of Negative predictive value regarding Uterine arteries PI  at >0.9573 with Optimal Cut off.  Conclusion: The combined measurement of maternal serum PlGF concentrations and The uterine artery notching, high Resistance Index and Pulsatility Index in uterine artery Doppler waveform at <20 weeks has shown as best screening test for early prediction of preeclampsia.

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

Background & Objectives: Postpartum depression (PPD) is defined as presence of depressive symptoms in the postpartum period. A seemingly innocuous disorder, if untreated can lead to foeticide or maternal suicide. Furthermore, there is currently no screening tool designated for use in clinical practice and no data are routinely collected on the proportion of perinatal women with postpartum depression. Hence the current study is taken to accurately estimate the burden of postpartum depression using valid tool. To assess the prevalence of postpartum depression among postnatal mothers in rural India Methods: A cross-sectional study was done among the 110 postnatal mothers attending immunization clinics and general OPD in the field practice area of department of Community Medicine, GMC, Srikakulam. Modified EPDS scale validated in local language was used to collect data. Results: The mean age of the mothers 23.7 ±2.6 ,most(42.7%) of them were intermediate educated and upper lower class(70%) of SES. The prevalence of possible depression (score ≥10) is 19.1% and the prevalence of Depression of varying severity (score >13) is 10%. Post partum depression is associated with age, SES, type of delivery, immediate outcome of delivery. Conclusion: EPDS tool can be effectively used to screen post partum depression at primary health care level.

Objective: The aim of this study was to evaluate the level of meniscal damage, including meniscal tears and degeneration, in all osteoarthritis patients.  Methodology:  This observational cohort study was conducted in a Hospital in Punjab. We included both symptomatic and asymptomatic participants in our research. Knee radiographs of the individuals were assessed using the Kellgren-Lawrence (K-L) grading by an experienced rheumatologist (JK) blinded to patient details, history, and clinical data. A 15-channel transmit/receive knee coil was used with a 3T system. The (painful) knee on the side with symptoms was imaged, and the knee on the side with no signs was imaged. Before having an MRI (mean time interval 3.4 days, range 0-41 days), the individuals had to fill out questionnaires that were used to assess their symptoms. A 100 mm visual analog scale (VAS) was used to measure the intensity of the pain. Results: This study recruited 137 participants (80 asymptomatic and 57 symptomatic). Among them, 81 (59.1) were female. Meniscus tears were more common in the symptomatic group, where they were 50.0%, respectively, than in the asymptomatic group, where they were 31.6%. Conclusion: The study results allow us to conclude that osteoarthritic individuals frequently suffer meniscal injuries. Additionally, the frequency of these injuries rises with patient age. Meniscal tears are also more likely in cases of severe osteoarthritis. In addition, meniscal tears increased as body mass index rose. Therefore, having an MRI performed on an osteoarthritis patient can help to detect meniscal tears early in the disease and allow for correct management.

Objective: Congenital heart disease (CHD) is the most common congenital anomaly in newborns and is a significant cause of mortality. The distribution pattern varies with different regions.   The aim of this study was to evaluate the pattern of CHD among referred pediatric population in south India. Methods: This was a single centre cross-sectional observational study done over a period of one year. A total of 616 infants and children referred with suspected CHD to a tertiary care centre in Kerala, from January to December 2019 were included. They underwent routine clinical examination, pulse oximetry and echocardiography. Results: Among the 616 enrolled subjects, 553 had CHD of which 526 (95%) had acyanotic lesions, 20 (3.6%) cyanotic lesions and 7 (1.2%) non-specified CHD.  Among acyanotic CHD, shunt lesions were much common (87%) than obstructive/ regurgitant lesions (13%). Atrial septal defect (ASD) accounted for 54.9% followed by Ventricular septal defect (14.5%) and patent ductus arteriosus (PDA) (13.9%). Pulmonary stenosis was the most common obstructive lesion (4.5%). Tetralogy of Fallot was the commonest among cyanotic CHD (2.1%). In 47 (8.4%) cases a combination of simple defects was seen, the commonest being ASD with PDA in 17 (3%) cases. Only consanguinity (2.6% vs. 0.3%, p 0.02) prematurity (16% vs. 4.4%, p 0.0001) and low birthweight (2.65 Kg vs. 2.89 Kg, p 0.001) were significantly associated with CHD. Conclusion: Among a referral pediatric population, ACHDs were far more common than CCHDs.  Shunt lesions formed the majority of ACHD. While prematurity, low birth weight and consanguinity were the risk factors associated with CHD, parity, birth order and parental age were not. Inclusion of neonates in the study is one probable reason for the large proportion of shunt lesions like ASD in the study.

Background: The fourth most common cause of death from malignancies, pancreatic cancer is a serious cause of morbidity and mortality. [1] This low survival rate is due to late presentation, vague indications and symptoms, and insufficient diagnostic and treatment options. The effectiveness of treatment approaches can be significantly increased by correctly diagnosing benign and malignant diseases of the pancreas. Objectives: To study diagnostic efficacy of EUS-FNA with importance of cytopathology and correlating with histopathology and biochemical markers. Material & Methods: Study Design: Retrospective Hospital based observational study. Study area: Department of Pathology (Histopathology laboratory), NIMS, Hyderabad. Study Period: January 2019 – December 2022. (3 years) Study population: Sample size: study consisted a total of 172 cases. Sampling method: Simple random method. Study tools and Data collection procedure: Clinical information, results from lab tests, and reports from cytopathology and imaging studies were all retrieved for each patient. To determine the location, size, and features of the pancreatic lesions, imaging reports from sonography, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasonography (USG) were analyzed. The location, size, and features of the pancreatic lesions were evaluated using computed tomography (CT) and magnetic resonance imaging (MRI). Atrained pathologist and a technician from the on-site pathology team assisted with the EUS instruction for each FNA. Results: The mean age of the study subjects was 53.7 ± 13.33 years. Most (52.9%) of the subjectswereintheagegroupof41-60years, followed by 30.8% were in 61–80 years group. Only2.3% were in < 20yearsagegroup.Ourstudyalsohadresultswithsensitivity, specificity, PPV, and NPV of 58.2%, 82.3%, 85%, and 53.5%, respectively. Conclusion: The results of this study demonstrated that EUS-FNA had good sensitivity, specificity, PPV, and NPV in the detection of solid and cystic pancreatic cancer. If necessary, a composite of the EUS-FNA cytology, cell block preparation, and immunohistochemistry results can be used to make the final diagnosis. This information may then be used to guide both surgeons' and oncologists' treatment strategies.

Introduction: Anemia is a prevalent disorder that impacts approximately one-third of the global population, with a majority of affected individuals residing in countries with limited resources. There are various new methods to find out the level of Hb in children which included both invasive and non invasive procedure. The present study was conducted among 5 to 10 year old school children for screening of anemia by Medela pulse oximeter with SpHb and to know its benefits over traditional methods. Material & Methods: A total of 500 subjects were enrolled from outpatient department of pediatrics, Mediciti institute of medical sciences. Children of the age group 5-10 years were considered in the study. Blood samples were collected from the subjects for Hb test-Complete blood Count (CBC) and simultaneously Hb is measured using Pulse oximeter with SpHb probe. Data was collected and result was analysed using SPSS software. Results: Out of total 500 children there were 48 % boys and 52% were girls. The maximum children were of age group 7 to 8 years (43%) and least were in the age group of 5 to 6 years (12%). Those Children examined with Medela pulse oximeter with SpHb probe shows 175 (35%) no anemia (Hb ≥11 mg/dL), 290 (58%) anemic (Hb<11 mg/dL) and 35 (7%) were severe anemia (<7 mg/dL). Children examined through CBC showed 157(31%) no anemia (Hb ≥11 mg/dL), 275(55%) anemic (Hb<11 mg/dL) and 68(14%) severe anemia (<7 mg/dL). Conclusion: All those children who found to have Hb less than 11 on SpHb correlated with CBC Hb by 95%. Those children whose SpHb is above 11 had CBC Hb correlation 90%. This shows that SpHb is effective tool for screening anemia in children and avoiding unnecessary blood pricks for knowing Anemia.

Anemia is a major health problem in developing countries like ours’. Although macrocytic anemia constitutes a minor portion among nutritional anemias, Vitamin B12 (Cobalamin) and Folate deficiency in Indian population is quite prevalent. As the of studies evaluating the relationships of these nutritional parameters with RBC indices in the same group of study participants are limited, we planned this study to study correlation of serum Ferritin, Vitamin B12, Folate with and RBC indices. A case-control study including 100 patients with anemia (Cases) and 100 age and sex-matched subjects without anemia (Controls) was conducted at UPUMS, Saifai, Etawah, Uttar Pradesh. Patients satisfying WHO criteria of anemia were included as cases, while those with history of any factors that are known to alter study parameters were excluded. Estimation of all study parameters was done following standard operating procedures of our laboratory and the results were analysed using appropriate statistical methods. In our study, serum Ferritin (p=0.0001), Vitamin B12 (p=0.0004) and Folate (p=0.0001) deficiency were found to be significantly higher in cases, compared to controls. There was a moderate positive significant (p-value<0.05) correlation of Hb with serum Ferritin in both cases and controls. We also observed a positive significant (p-value<0.05) correlation of MCV with serum Ferritin in both groups. There was also a mild negative correlation of MCV with serum Vitamin B12 and Folate, in both groups of cases and controls. Based on our findings, it may be concluded that Microcytic RBCs on microscopic examination does not necessarily mean serum Ferritin deficiency. It could be a concomitant deficiency of both serum Ferritin and Vitamin B12.

Background: In a clinical setting assessment of airway needs to be simple and convenient3. There is no single test with absolute accuracy to predict difficult airway2. In our study we assessed airway difficulty in elective surgeries for adults by comparing ULBT and MMS individually as well as in combination to that of Cormack-Lehane grading. Method: The single blinded prospective, comparative and observational study was conducted at SDMCMS& Hospital Dharwad. A total of 150 patients aged 18-60 years of either sex with ASA physical status 1,2&3 who underwent elective surgery under general anaesthesia were included. CL grade 3&4 deemed as difficult laryngoscopy. Diagnostic testing was carried out to compare MMS and ULBT with CL grade in predicting difficult intubation. McNemar test was used to compare difference between diagnostic parameters. P-value less than or equal to 0.05 was considered statistically significant. Results: Demographic data and ASA grades were same for participants. We observed that at 95% Confidence Interval (CI) for ULBT sensitivity (92%), specificity (68%), positive predictive value (93.5%) and negative predictive value (62.96%) was better compared to that of MMS whose sensitivity was 64.8 %, specificity 24%. Also, ULBT had a better accuracy 88% than that of MMS with 58%.  Conclusion: Our study and analysis concluded that the upper lip bite test is good option for predicting difficult intubation than Modified Mallampati Score.

Introduction: Diabetes mellitus is the most common endocrine disorder of humans characterized by metabolic abnormalities leading to long term complications involving kidneys, gastrointestinal tract, nerves and blood vessels, thereby causing morbidity and mortality. Human diabetic neuropathy is characterized by dysfunction of somatic and autonomic nervous system. A simple definition it Was recently agreed on at an international consensus meeting. “The presence of symptoms and/ or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes”. Vagal innervation of the heart is essential efferent pathway to sustain this variation which is decreased as age advantage due to lowered vagal tone. Asymptomatic but striking reduction or absence of this variation is observed in autonomic neuropathy.  Materials And Methods: Diabetes mellitus patients who have been attending Department of General Medicine, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka from January 2022 to December 2022 were taken for study considering the inclusion and exclusion criteria. This is a cross sectional study. All the Selected patients will be investigated with RBS, FBS, PPBS, HbAIc for glycemic control. Ultrasonography was done to study the fasting gall bladder volume in patients. Cardiac autonomic neuropathy will be assessed clinically by using simple non invasive bed side tests like heart rate variation during to standing, deep breathing.  Results: The youngest patients was 41 years old and the oldest was 76 years old. The maximum number of patients were in the age group of 41-50 ( 55%). Mean age in the present study was 52.6 years. In our study 60 (75%) were male and 20 (25%) were female. In the present study the mean gall bladder volume in diabetes with diabetic Severe autonomic neuropathy was 55.8 + 9.9ml and as a whole mean gall bladder volume in persons with autonomic neuropathy was 30.13 ± 18.73ml and the mean gall bladder volume in diabetes without diabetic autonomic neuropathy was 18.5 +5.01ml. P value is <0.05 there is statistically significant correlation between diabetic autonomic neuropathy and Gall bladder volume. Conclusion: The gall bladder volume was significantly higher in diabetic patients with autonomic neuropathy when compared to diabetics without autonomic neuropathy. Diabetic autonomic neuropathy was seen in diabetic patients who had poor glycemic control when compared to those who had good glycemic control. The gall bladder volume was more in diabetic patients with higher age group patients. A definite association of cardiac autonomic neuropathy with cholecystomegaly has been established by our study.

Background: The incidence of Central Nervous System tumors is low in India when compared to western countries. Now a days, the increase in incidence may be due to improved diagnosis with advancement of studies. They have a wide spectrum clinically and histopathologically.  Aims And Objectives: This study aims to provide the spectrum of CNS tumors histologically and clinically, along with radiological correlation,To analyse  various histological types of Cranial and spinal tumors ,to evaluate age and gender distribution and topography of tumors. Materials And Methods: A retrospective study was performed in the department of pathology, for a period of 18 months.The data and Hematoxylin and Eosin stainedslides were retrieved from the archives, the cases were analysed and graded according to 2021WHO grading system. Results And Conclusion: out of 76 CNS tumors, most common were Intracranialtumors 85.5% (65) cases and Spinal tumors were 14.4% (11) cases. There is male preponderance, 44 cases (57.8%)Majority were in 45 to 60 years. Tumors were more common on right side, 61% (47 cases) and most common location was cerebellopontine angle 13.1.% (10 cases) followed by frontal region 11.8% (9 cases). The most common histological type were Astrocytomas, followed by Meningiomas. WHO Grade I tumors are more common, 24.6% followed by Grade II, 21.7%. Most common tumors  inchildren were Medulloblastomas (Grade IV). Three cases ofsecondary deposit from epithelial malignancy were also included in the study.

Due to advent of technology and internet, teaching too is now largely utilizing these modern devices and internet to impart education to the children. When it was mandatory to keep social distancing and hence avoid regular classes for medical students during the dreadful COVID pandemic, it was decided to teach the 1st year MBBS students online using the technology and the internet. This study aimed at determining if the students found this novel online teaching to be helpful or not. Methodology: A total of 100 1st year MBBS students in a tertiary medical college in central India were included in the study from September 2020 to February 2021 for 6 months. It was an observational study and an informed consent from the students was taken prior to the study. Classes were conducted as usual as per the institutional guidelines and feedback forms were collected after that. Results: Out of total 100 students, 65 were girls and 35 were boys. Average age of the class was 19.2  1.1 years. 85% had used mobile phones and internet for education before and 15% had never used it for education purpose. 75% had a concentration time of 30 minutes. About 50% students faced internet issues and faced moderate disturbance during the classes. 85% used mobile phones for the classes. 60% students opined that such online classes are effective for teaching anatomy while 40% told that it was not effective. Conclusion: The study concludes that currently online classes for the subject like anatomy are not as effective as regular classroom teaching. The factors could be low motivation, technology and internet problems, low attention span etc.

Introduction: Squamous cell carcinomas comprise 90% of oral cancers, are usually preceded by premalignant lesion.  Oral cancers are approachable to visual inspection and there are chances for earlier detection in order to reduce morbidity and mortality. Screening asymptomatic individuals by systematic visual oral examinations to detect the disease has been shown to be feasible. Despite the ready accessibility of oral cavity, these malignancies are often detected at late stage due to ignorance in rural areas. Aims and objectives: The present study aimed to identify clinicopathological characteristics of patients with oral squamous cell carcinoma (OSCC) according to age, sex and risk factors, to analyse histological differentiation specific to tumour and grading [Broder’s grading]. Materials and methods: A total of 137 samples received in the department of pathology between July 2015- June2017, were studied. Clinical data including age, gender, site, size of tumour, risk factors like alcohol consumption, smoking, pan chewing had been recorded. Histopathological grading was determined using Broder’s grading system. Results: The mean age of incidence was 54.6 yrs. with male predominance. Out of 137samples the most common presentation was with fungating growth seen in 71(51.8%) patients. The most common site was tongue in 49 cases (35.7%) followed by buccal mucosa in 38 cases (27.7%).  Aetiology of smoking accounted for 131 cases (95.6%), alcohol consumption in 74 cases (54%), pan chewing among 69 cases (50.3%).  Moderately differentiated tumours were observed in 73 cases (53.3%), well differentiated carcinoma in 60 cases (43.8%), verrucous carcinoma identified in 4 cases (2.9%) patients. Conclusion: OSCC is frequently encountered in fourth to sixth decade of life with male predominance. Smoking and pan chewing were common risk factors. The most common histological subtype was moderately differentiated squamous cell carcinoma.

Introduction: Dialysis access procedures and complications represent a major cause of morbidity in CKD patients. Recent guidelines have encouraged a creation of AV fistula access in a CKD patient at least 6 months before first dialysis for proper maturation and to give time, if any secondary procedure is needed due to primary failure. Aggressive strategy should be taken for creation of AV Fistula to avoid sepsis and morbidity of temporary access. Objectives: To analysis various factors affecting the primary failure, secondary failure and primary patency of AV Fistula, complications of AV Fistula and its management. Methods: We evaluate the AV Fistula created in RGKMCH in Urology department in 5 years period from January 2017 to February 2022 (212 cases of AV Fistula, done by Radio- cephalic or Brachio- Cephalic end to side anastomosis). A fistula is adequate, if it provides a blood flow of at least 350 ml/min in 6 sessions of hemodialysis in one month. Various demographic factors (age, sex), clinical factors (diabetes, obesity, persistent low BP with Interstitial Nephritis, smoking), venous anatomy of upper limbs, arterial atherosclerosis are related with primary failure and complications. Results: Of 212 AV Fistulas, 178 fistulas developed for dialysis and 34 were primary failure. Primary failure rate was lower in patients aged less than 65 years, in 34 cases of primary failure 6 patients developed pseudoaneurysm and required emergency closure of AV fistula. In 178 cases, 38 patients had eventually secondary failure (mean time ~4 months after initiation of HD) and required a second procedure in upper arm (mainly Brachio- cephalic anastomosis and 12 cases required Permanent Dialysis Catheter insertion in IJV). Primary failure was higher in poorly controlled diabetics (random CBG > 200mg/ dl), in atherosclerotics, in low BP (SBP< 100) and in elderly females. Among 6 cases of pseudoaneurysm in the entire study, 4 were poorly controlled diabetics. The adequacy rate was not related with Serum albumin, Serum PTH, Surgeon, Serum Creatinine. Primary (28 out of 34) and secondary failure (22 out of 38) rate is significantly higher in forearm fistula than upper arm fistula, but complications like pseudoaneurysm (4 cases), serpentine aneurysm (4 cases), steal phenomenon (10 cases), gangrene of the limb (2 cases) are more common in upper arm fistula. The adequacy of forearm fistula is poorer in older women, diabetics and they need upper arm fistula to avoid primary failure, though complications are more common in upper arm fistula.  Conclusion: Success rate of AV Fistula is lower in certain subset of patients. To achieve best outcome, AV Fistula need to be constructed in upper arm in older, female, low BP, or in diabetics, though upper arm fistula has more complications like pseudoaneurysm, serpentine aneurysm, steal phenomenon, gangrene of limb.

Background and Objectives: Alterations in the QT interval represent a crucial electrocardiographic parameter that holds clinical significance not only among adults but also in the pediatric population. The prevalence of conditions leading to sudden fatalities in children has propelled researchers to explore the realm of electrocardiographic (ECG) investigations. The primary objective of study was to establish normative QT values for pediatric subjects across different age groups and genders. Methods: Employing a cross-sectional design, we enrolled 175 healthy children (100 males, 75 females) and recorded their electrocardiograms. To ensure the homogeneity of the study cohort, individuals with congenital or acquired cardiovascular disorders were excluded from participation. Result: Heart rate exhibited an inverse relationship with the QT and QTc interval, whereas the RR interval displayed direct proportional correlations with both the QT and QTc intervals. As age increased, heart rate declined, while other ECG parameters exhibited progressive increments. Despite the inverse correlation between heart rate and QT/QTc interval, a positive correlation was observed between QT/QTc and RR interval. Conclusion: The integration of ECG as a routine investigative tool for pediatric subjects is warranted, as it aids in the early diagnosis of congenital and acquired cardiac conditions and arrhythmias, discernible through QT interval assessments.

Background: Alopecia areata is a common cause of non-scarring alopecia of hair characterized by single or multiple patches of hair loss.  It is an autoimmune disease with an unpredictable course and has a profound impact on the psychosocial well-being of the patients. Aims: Our present study aimed to assess the demographic pattern, clinical patterns, and associations with diseases in a tertiary care teaching hospital in Bihar. Materials & methods: All patients diagnosed with alopecia areata visiting dermatology opd and fulfilling the inclusion criteria were included in the study. A detailed history-taking and clinical examination was conducted and recorded in a predefined performa. All routine blood and radiological investigations, dermoscopic and histopathological examination in doubtful cases. All data were recorded and analyzed with Descriptive statistics and Chi-Square Test. Analyses of collected data were done by SPSS software, version 18.0. Results: A total of 82 patients suffering from alopecia areata were included in our study. 53(64.6%) patients were male and 35(29%) were female. The male-female ratio was 1.5. Classical alopecia areata was the commonest (87.8%) variant noted. Alopecia totalis (6.1%), alopecia universalis (3.6%), and ophiasis pattern (2.4%) were also identified. Scalp (67.3%) was the commonest site involved. Majority of our patients presented to us within 6 months of disease onset. 23 patients (28%) had nail involvement. In our study, Atopy was the most common condition associated condition seen in 10.8 % of cases followed by vitiligo in 4(4.8%), leucotichia in 2(2.4%), lichen planus in 3(3.6%), androgenic alopecia in 4(4.8%) and verruca in 3 (3,4%) cases. Ocular changes were present in 11(13.4%) cases. Conclusion: Alopecia areata mainly affects young and adolescent age group patients. Poor prognostic factors are extensive involvement, early age of onset, and positive family history. The scalp region is most commonly involved. The most common associated condition noted was atopy.

Background: Over the past three decades, Transradial-Access (TRA) has revolutionized cardiac catheterization, demonstrating superior safety and outcomes compared to other access points. The European Society of Cardiology has now endorsed TRA as a viable alternative to traditional methods. Challenges during TRA can arise despite its success, making a comprehensive assessment of forearm artery anatomy essential. Forearm artery angiography (FA) has emerged as a valuable tool to improve procedural success and reduce complications. In this study, we retrospectively analyze the impact of FA on a diverse patient population, aiming to enhance TRA's effectiveness and safety in cardiac catheterization procedures in Bangladesh. Aim of the study: This study investigates the potential for enhanced success rates of Coronary Angiography and Percutaneous Coronary Intervention (PCI) by utilizing Standardized Forearm Angiography in a diverse patient population. Methods: This is a prospective comparative study, a total of 480 patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2022 to December 2022.  Result: In this prospective study, 480 patients were analyzed, and various characteristics of the study population were examined. The average age of patients was 71.4 years, 71% male and 29% female. The study focused on forearm artery access, with 54.17% having right forearm access and 45.83% left forearm access. The most common access type for left forearm artery access was the distal radial artery, while the proximal radial artery dominated right forearm access. Arterial hypertension was the most prevalent variable, followed by diabetes mellitus and active smoking. The most common clinical indication for medical procedures was "Suspected CAD or chronic coronary syndrome." Etiological factors leading to medical conditions were also analyzed, with "Failure to achieve arterial puncture or introduce arterial sheath" being the most common factor, followed by "Kinking" and "Atherosclerotic occlusion." Conclusion: The retrospective analysis showcased promising results, indicating that standardized forearm angiography may lead to enhanced success rates in coronary angiography and PCI among a diverse patient population. This non-invasive approach could offer improved diagnostic accuracy and procedural outcomes, warranting further investigation and consideration for broader clinical implementation.

Background and Objectives: Bacterial meningitis (BM) poses a considerable global public health concern. C-reactive protein (CRP) has emerged as a viable diagnostic marker, particularly in differentiating bacterial and aseptic meningitis, especially in cases where bacterial culture results are negative in both blood and cerebrospinal fluid (CSF) samples. The present study was done with the primary objective of estimating the serum CRP levels in pediatric meningitis cases caused by bacterial pathogens. Materials and Methods: A hospital-based descriptive cross-sectional study was undertaken at a renowned tertiary care hospital in India, involving the evaluation of 222 samples. Cerebrospinal fluid samples were collected following standard guidelines, and bacterial identification and antimicrobial susceptibility testing were carried out using an automated system. Quantitative estimation of CRP levels was performed using a solid-phase, sandwich-format immunometric assay employing a gold antibody conjugate. Results: The study cohort consisted of pediatric meningitis cases with a median age of 3.9 years, ranging from 1 to 4.6 years. Among the bacterial isolates, Escherichia coli was identified as the most prevalent pathogen, followed by Klebsiella pneumoniae. Notably, 31.32% of the participants exhibited elevated serum CRP levels. Moreover, a statistically significant association was observed between elevated serum CRP levels and cases with Gram-negative bacterial etiology. Conclusion: Elevated serum CRP can serve as a valuable diagnostic marker for identifying pediatric bacterial meningitis cases with a Gram-negative etiology. The utilization of CRP as a diagnostic adjunct can aid in timely and accurate differentiation between bacterial and aseptic meningitis, facilitating appropriate clinical management and improved patient outcomes.