European Journal of Cardiovascular Medicine

Dermoscopy is an easy, quick, non-invasive diagnostic tool that enables the visualization of submacroscopical structures invisible to the naked eye. The diagnosis of pediatric dermatosis can be challenging sometimes especially when there are atypical presentations, incomplete history. We present six cases of pediatric dermatosis which presented with such challenges and the usefulness of dermoscopy in confirming the diagnosis and initiating early treatment

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

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

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

Omicron, a new variant of Covid-19 has hit the India in the third wave during 2022. The outbreak of this new variant has increased globally. At this time, there is an urgent need of fast, reliable and effective detection method. The real time RT-PCR is the most used technique for the detection of viral DNA. In the present study ‘OmiSure’ kit developed by Mumbai-based Tata Medical and Diagnostics Ltd (TATA MD) in partnership with The Indian Council of Medical Research (ICMR) was used for direct detection of Omicron variant in the SARS-CoV-2 positive samples via multiplex real time RT-PCR as a diagnostic tool. The reaction was tested targeting viral RNA and human target mRNA sequence using S gene target failure and S- gene mutation amplification strategy. In the present study 532 samples were tested for the presence of Omicronin the SARS-CoV-2 positive samples. The study found that a total of 501 individuals were positive for Omicron variant while 31 individuals were detected to be of other variants. Further these 31 SARS-CoV-2 positive samples were processed by nanopore whole genome sequencing and identified as Delta and its sub variants of SARS-CoV-2. These sequences were submitted in Indian SARS-CoV-2 Genomic Consortium (INSACOG) and Global Initiative on Sharing Avian Influenza Data (GISAID). The study showed that OmiSure kit is an accurate, fast and easy to use rRT-PCR Omicron diagnostic assay

Background: Respiratory conditions are the most common cause for admission to a NICU in term and preterm infants and comprise around 33.3% of neonatal admissions at >28 weeks gestation. Chest radiography is considered the gold standard for diagnosing lung disease, but it unavoidably causes radiation damage to the neonate. Ultrasonography is non-invasive, non-ionizing, easily operable, and performed in real-time, making it an accurate, reliable technique for the diagnosis of neonatal lung diseases. Due to the lack of research on ultrasonography in Indian neonates with pulmonary diseases, this study was done to determine the role of ultrasound as a diagnostic tool in neonates with respiratory distress and decreasing radiation exposure. Objectives: 1) To determine the accuracy and effectiveness of lung ultrasonography as a diagnostic tool in neonates with pulmonary diseases. 2) To determine if Ultrasound based analysis can play an effective role in reducing radiation exposure in neonates with pulmonary diseases. Material & Methods: The study was conducted on neonates with respiratory distress in the Neonatal Intensive Care Unit of KLE’s Dr. Prabhakar Kore Hospital. (Respiratory distress in the neonate is diagnosed when one or more of the following is present; tachypnoea or respiratory rate of more than 60/ minute, retractions or increased chest in drawings on respirations (subcostal, intercostal, sternal, suprasternal) and noisy respiration in the form of a grunt, stridor or wheeze).  Neonates admitted in the NICU with any cardiac diseases and other non-pulmonary diseases and neonates with congenital anomalies such as congenital heart diseases, Congenital Diaphragmatic hernia, Tracheoesophageal Fistula, and Esophageal Atresia were excluded from the study. Institutional Ethical Clearance from the Institutional Ethics Committee for Human Subjects Research of Jawaharlal Nehru Medical College, Belagavi, Karnataka was obtained, and informed consent from the parents of all the study subjects. Results: Out of 51 neonates enrolled in the study, 23 neonates were diagnosed with respiratory distress syndrome, 11 neonates were diagnosed with transient tachypnea of the newborn, 5 neonates were diagnosed with meconium aspiration syndrome, 3 neonates were diagnosed with pneumonia and 2 neonates were diagnosed with pneumothorax. Lung ultrasound demonstrated a sensitivity of 92.7 % and specificity of 87.21 % as a diagnostic modality in our study. Conclusion: Lung ultrasonography serves as an alternative diagnostic imaging modality to chest radiographs in detecting neonatal pulmonary diseases.

Introduction: Acute appendicitis remains one of the most common surgical emergencies, accounting for 1% of all emergency operations. The diagnosis can at times be very difficult, so any test which can contribute towards the diagnosis is very valuable. Even though USG, MRI and CT scan of abdomen and blood tests can confirm the diagnosis but not its severity.  Aim: The aim of this study is to establish the role of deranged liver function tests as a new diagnostic tool and also to predict gangrenous and ruptured appendicitis which would serve the purpose of decreasing the mortality and morbidity in these patients.  Methods: Ninety patients of different age groups from 8 to 70 years of both sexes were included in this study over a span of 14 months. They were confirmed by USG, routine blood examination and clinical findings. LFT were performed, studied and compared with all patients of acute appendicitis.  Results: Out of 90 patients, hyperbilirubinemia was observed in 45 cases (50%). There was an increase in other liver enzymes like SGOT in 18 patients (20%), SGPT in 3 patients (2.7%), and Alkaline Phosphatase in 10 patients (9%). However, serum albumin was found to be normal in all patients. GGT increase is seen in 6 patients (9.23%). Specificity, sensitivity, positive predictive value and p value were highly significant (p<0.001) in complicated appendicitis. Conclusion: The elevated parameters of LFT in patients of complicated appendicitis (ruptured, gangrenous) carried considerable prognostic significance. Hence LFT can be used as a diagnostic and prognostic indicator in patients of acute appendicitis, thus avoiding unnecessary morbidity and mortality in these patients.

• Objectives To predict the  risk  of amputation .
• Prognosticate diabetic foot ulcer healing & complications
• Average length of Hospital stay(ALOS)

Material and Methods: This Is Prospective Study Conducted In Belgavi Institute Of Medical Sciences Belgavi From 2018 Till 2020. Total of 90 Diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the BELGAVI INSTITUTE OF MEDICAL SCIENCES BELGAVI were recruited into the study based on the inclusion and exclusion criteria. ulcers were followed up for a minimum period of 6 months. Once a patient’s ulcer had healed completely either by primary healing or skin grafting or a lower-limb amputation performed, the outcome was noted and the patient was deemed to have completed the study Results AND Interpretation: Most Of The Patients Were Male In Thr 5 N 6 Decade ,Scoring Done Using Duss Score 11% Requiring Major Ampuatation And 44 % Minor Ampuatation. With Increases In Duss Score Ampuatation Chances Are More. Conclusion: DUSS scoring system provides an easy diagnostic tool for predicting probability of healing or amputation by combining four clinically assessable wound based Parameters.

Background: Breast lesions are a significant global health concern, often requiring invasive procedures for definite diagnosis. Cytological and molecular markers present alternative, potentially less intrusive diagnostic methodologies. This study aims to compare the effectiveness of cytological and molecular markers for the diagnosis of breast lesions. Methods: A cross-sectional study was performed on a cohort of 500 patients presenting with breast lesions, undergoing cytological evaluation (Fine-Needle Aspiration Cytology) and molecular marker testing (HER2/neu, ER, PR, and Ki-67). Concordance between the two methods was evaluated. Results: Both cytological and molecular marker evaluations showed significant diagnostic potential. There was substantial concordance between the two modalities. However, molecular markers exhibited a slightly higher diagnostic sensitivity and specificity, especially in the detection of pre-malignant and malignant lesions. Conclusion: Cytological and molecular markers each offer valuable, complementary diagnostic approaches. While cytology provides rapid, cost-effective results, molecular markers offer increased sensitivity and specificity. Their combined usage can help minimize invasive procedures and improve patient outcomes. Further research is recommended to refine the usage of these diagnostic tools.

Background:  Liver diseases represent a significant global health concern, necessitating accurate detection and characterization of focal liver lesions (FLLs). Precise differentiation between benign and malignant lesions, as well as distinguishing primary liver lesions from metastases, is pivotal for effective clinical management. This study aims to compare the efficacy of respiratory-triggered diffusion-weighted single-shot echo planar imaging (RT DW-SS-EPI) and T2 weighted turbo spin echo imaging (T2W TSE) in detecting and characterizing FLLs. Additionally, the study aims to determine the apparent diffusion coefficients (ADCs) of FLLs and normal liver parenchyma. Methods: A total of 30 patients with suspected focal liver lesions and 10 healthy volunteers without FLLs were enrolled. Patients referred for MRI with clinical suspicion of FLLs were included. The study employed respiratory-triggered fat-suppressed single-shot echo-planar DW imaging in the transverse plane with tridirectional diffusion gradients and three b values (0, 500, and 1000 sec/mm²). ADC maps were generated, and routine MR sequences were obtained using a 1.5 Tesla MRI scanner. ADC values were calculated using operator-defined regions of interest (ROIs), and differences in ADC values were analyzed. Results: The study encompassed 85 lesions in 30 patients, including 23 hepatocellular carcinomas (HCCs), 4 cholangiocellular carcinomas, 36 metastatic lesions, and 22 benign lesions. Males comprised 63.3% of participants. DWI demonstrated significantly higher FLL detection rates than T2WI (p < 0.001), particularly for malignant lesions (98.4% with DWI vs. 76.5% with T2WI). No significant difference was observed in detecting HCCs alone. DWI exhibited superior detection capabilities for both liver lobes compared to T2WI. Mean ADC values for various lesion types showed significant differences, with malignant lesions displaying lower ADC values than benign lesions (p < 0.001). Conclusion: Respiratory-triggered diffusion-weighted MRI (RT DWI) emerges as a valuable and contrast-free diagnostic tool for detecting and characterizing focal liver lesions. DWI outperformed T2 weighted imaging in detecting malignant lesions and showed potential for accurate differentiation between benign and malignant lesions based on ADC values. The study highlights DWI's clinical utility for liver lesion evaluation in routine practice.

Background: The outcome of foot ulcers is affected by wound depth, infection, ischaemia and glycaemic control. Diabetic ulcer severity score (DUSS) is one of the latest wound based scoring system. Aim: To study the pattern of ulcer healing with DUSS score. Material and Methods: a total of 104 diabetic patients attending surgical outpatient clinic or admitted into the surgical department were included. The DUSS was calculated by these separate grading to a theoretical maximum of 4. DUSS score obtained was then correlated with the pattern of ulcer healing. Results: Majority of ulcers i.e. 14 (60.87%) healed by 3rd follow up, 6 (26.09%) got healed by 4th follow up, 2 (8.70%) healed by 5th follow up and 1 (4.35%) underwent amputation during 4th follow up. Conclusion: DUSS scoring system provides an easy diagnostic tool for anticipating probability of healing /amputation and need for surgery by combining four clinically assessable wound based parameters.

Introduction: The diagnosis of pure neural leprosy (PNL) remains difficult due to absence of characteristic skin lesions. Prior to the advent of invasive nerve biopsy, patients with pure neural leprosy were mainly diagnosed based on clinical judgement. Nerve biopsy and polymerase chain reaction (PCR) based tests are increasingly being done to diagnose PNL. Aim: To assess and compare the diagnostic value of nerve biopsy and RLEP3 gene detection using polymerase chain reaction tests in suspected cases of pure neural leprosy. Material and methodology: The study is a prospective non-randomised analytical study done for a period of 12 months in a tertiary care hospital in Chennai. Clinically suspected patients having pure neural leprosy with a sample size of 30 patients were included in the study. After clinical evaluation, basic investigations, nerve conduction study and slit skin smear for AFB, nerve biopsy and polymerase chain reaction assay were performed. Results: Specific histopathological findings were obtained in 3 out of 30 cases with 66.67% sensitivity, 40.74% specificity and 53.7% accuracy rate. PCR was positive in 7 out of 30 cases with 100% sensitivity, 52.17% specificity and 76.08% accuracy rate. In this study PCR was positive in additional 4 cases in which nerve biopsy was negative. This affirms PCR as an indispensable tool & necessity of using PCR in AFB negative cases. Conclusion: PCR based assay is more sensitive than nerve histopathology in the diagnosis of pure neural leprosy. A multimodal approach comprising clinical evaluation, nerve biopsy and PCR based assay gives the maximal diagnostic yield in suspected cases of pure neural leprosy.

Introduction: Gastritis is a prevalent clinical condition with a global incidence of over 50%. The primary cause of gastritis is Helicobacter pylori (H. pylori), a bacterium that infects about 50% of the world's population, especially in developing countries. The prevalence of H. pylori is influenced by geographic distribution, age, race, and socioeconomic status. It is a significant risk factor for gastric carcinoma and MALT lymphoma. Diagnosing H. pylori involves both endoscopic and non-endoscopic tests, with histological diagnosis and rapid urease tests being highly effective. Methodology: A prospective cross-sectional study was conducted at MKCG Medical College and Hospital in Berhampur from January to December 2017. Patients with symptoms of gastritis underwent upper GI endoscopy, and tissue samples were taken for histopathological examination and rapid urease tests. The study collected socio-demographic data and evaluated endoscopic findings using the modified Sydney system of grading. Statistical analysis was performed using SPSS software. Results: Out of 325 enrolled cases, 66.15% were male, and 33.85% were female, with the majority being over 60 years old. The most common symptoms were heartburn (75.38%), dysphagia (65.85%), and abdominal pain (60.92%). Endoscopy revealed gastritis in 81.54% of cases. The rapid urease test was positive in 83.69% of cases, and histopathological examination confirmed H. pylori in 81.53% of cases. Inflammatory cellular infiltrates were graded, with significant correlations between endoscopic findings and H. pylori colonization. Discussion: The study highlights the high prevalence of H. pylori-associated gastritis, with significant gender and age-related trends. The rapid urease test proved to be a sensitive diagnostic tool, and the modified Sydney system provided a comprehensive evaluation of histopathological changes. The findings emphasize the importance of accurate diagnosis and management to prevent complications such as mucosal atrophy and gastric carcinoma. Conclusion: The prevalence of H. pylori infection in gastritis cases necessitates effective diagnostic and management strategies. Rapid urease tests and histopathological examination are reliable methods for detecting H. pylori and grading gastritis. Continuous surveillance and appropriate treatment are crucial to mitigate the health burden associated with H. pylori infection.

Fetal cardiac screening through ultrasound, particularly fetal echocardiography, plays a critical role in the early detection and management of congenital heart disease (CHD), one of the most common congenital anomalies worldwide. This comprehensive review explores the role of ultrasound in fetal cardiac screening, focusing on the basics, techniques, and guidelines of fetal echocardiography. The review covers the principles of ultrasound in fetal imaging, the indications for fetal echocardiography, and the clinical implications of early diagnosis. It delves into the techniques employed, including basic and advanced imaging modalities, Doppler ultrasound, and the application of 3D/4D imaging in the assessment of fetal cardiac anatomy and function. The article also discusses the standard protocols for performing fetal echocardiography, highlighting guidelines from major professional bodies, including the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the Indian Radiological and Imaging Association (IRIA). The clinical applications of fetal echocardiography are illustrated through case studies that emphasize the impact of early diagnosis on perinatal management and outcomes. Additionally, the review addresses the challenges and limitations of fetal cardiac imaging, including technical difficulties and the influence of maternal and fetal factors on image quality. Looking forward, the review considers emerging trends in fetal cardiac screening, such as the integration of artificial intelligence and portable ultrasound devices, as well as the potential for early intervention through advanced surgical and therapeutic techniques. The conclusion underscores the importance of fetal echocardiography in improving outcomes for infants with CHD and calls for continued advancements in imaging technology and clinical practice to enhance the effectiveness of this critical diagnostic tool.

Background: Bloodstream infections (BSIs) are a major global health issue, leading to significant morbidity and mortality, especially in healthcare settings. They are associated with prolonged hospital stays, increased healthcare costs, and high mortality rates, with a substantial incidence reported globally and particularly in pediatric intensive care units (PICUs). Objective: This study aims to assess the antimicrobial resistance patterns among Gram-negative isolates and evaluate the distribution of genetic markers of drug resistance in a tertiary care hospital in Cuttack, Odisha. Methods: A prospective study was conducted from November 2023 to July 2024 in the Department of Microbiology at SCBMCH, Cuttack, Odisha. The study included 558 pediatric patients with suspected BSIs from the PICUs. Blood cultures were processed using the BacT/ALERT 3D system. Isolates were identified using standard microbiological methods, and antimicrobial susceptibility was tested using the broth microdilution method. Genetic analysis for resistance markers was performed using PCR targeting TEM, SHV, CTX, NDM-1, and AmpC genes. Results: Out of 558 suspected cases, 192 (34.4%) were culture positive. Among these, 97 (50.5%) were Gram-negative bacteria, with 75 (77.3%) being multidrug-resistant (MDR). Genotypic analysis revealed that all Gram-negative isolates carried the TEM gene, with 18 (24%) containing both SHV and CTX genes. None of the isolates were carbapenemase producers by phenotypic methods, but 29 (38.6%) were detected by genotypic methods targeting the NDM-1 gene. Additionally, 4 isolates (5.3%) were identified as AmpC producers phenotypically, while 9 (12%) were detected genotypically. Conclusion: The high prevalence of MDR Gram-negative bacteria, particularly with significant genetic markers for drug resistance, highlights the urgent need for continuous surveillance and judicious use of antibiotics to manage BSIs effectively. Genotypic methods proved more sensitive than phenotypic methods in detecting resistance, emphasizing the importance of advanced diagnostic tools in clinical settings.

Introduction: Infective endocarditis (IE) is characterized by inflammation of the endocardium, primarily caused by infectious agents affecting cardiac valves and other extracardiac locations. Despite advancements in the management of IE, it remains an extremely difficult condition for clinicians to diagnose, resulting in significant morbidity and mortality 1. Predisposing factors for infective endocarditis include underlying anatomical cardiac conditions such as valvular and congenital heart diseases, as well as the presence of prosthetic valves and intravenous drug abuse. The spectrum of infective endocarditis (IE) in India has evolved over the past decade due to a decrease in rheumatic heart disease incidence, a rise in intravenous drug abuse, improved survival rates among congenital heart disease patients, and the availability of diagnostic tools such as echocardiography2-4. Gram-positive cocci, particularly Staphylococcus aureus, are the predominant infecting organisms, affecting each native and prosthetic valve infective endocarditis. Case Report: A 19-year-old man had intermittent fever for 4 months, NYHA class III shortness of breath for 3 weeks, and bilateral lower limb oedema for 2 weeks. Diabetes, high-risk conduct, or intravenous drug misuse were not present. Upon examination, the patient presented with fever (oral temperature 38.8°C), tachypnea (respiratory rate 30/min), and a heart rate of 118/min. Blood pressure was measured at 114/70 mm Hg, with elevated jugular venous pressure (JVP) at 10 cm above the sternal angle (v waves > waves). Conclusion: The double-chambered right ventricle is often associated with rare congenital abnormalities like pulmonary stenosis, VSD, and aortic obstruction. DCRV seldom causes infective endocarditis, which affects the pulmonary valves when the jet damages the endothelium. It is rare for DCRV to affect the distal RVOT, tricuspid, pulmonary, and aortic valves. Diagnosing significant involvement is difficult, and surgery is usually needed.

Background: Pulmonary tuberculosis (PTB) is a leading cause of mortality, particularly in developing countries, and its burden is exacerbated by HIV co-infection. Diagnosing sputum smear-negative cases poses a significant challenge due to their contribution to transmission and the limitations of conventional diagnostic methods. Fibreoptic bronchoscopy-guided bronchoalveolar lavage (BAL) has emerged as a promising diagnostic tool. Methods: This prospective study was conducted over 18 months (September 2022–February 2024) at a tertiary care hospital to evaluate the diagnostic utility of bronchoalveolar lavage (BAL) in sputum smear-negative pulmonary tuberculosis (PTB). Patients suspected of PTB, based on clinical history, physical findings, and chest X-ray lesions, were included if they had two sputum smear-negative samples for acid-fast bacilli (AFB) per RNTCP guidelines. Exclusions included smear-positive cases, extrapulmonary tuberculosis, ongoing anti-TB treatment, and contraindications to bronchoscopy. BAL samples underwent smear microscopy, culture, and CBNAAT for Mycobacterium tuberculosis detection and rifampicin resistance assessment. Data were analyzed using descriptive and inferential statistics, with p-values <0.05 considered significant. Results: The study population comprised 200 patients (154 males and 46 females) aged 11–70 years, with the majority aged 21–30 years. Common presenting symptoms included cough/expectoration (88.6%) and fever (85.7%). Chest X-rays revealed pulmonary infiltrates in 55.7% of cases, cavitary lesions in 30.0%, and nodular shadows in 8.6%. The right upper lung zone was most frequently involved (60.0%). The diagnostic yield of bronchoscopy for smear-negative PTB was significantly enhanced when BAL fluid analysis was combined with culture and radiological findings. Conclusion: Fibreoptic bronchoscopy-guided BAL is a safe, reliable, and effective diagnostic method for sputum smear-negative pulmonary tuberculosis. Incorporating BAL fluid analysis, transbronchial lung biopsy, and post-bronchoscopy sputum cultures significantly improves diagnostic accuracy, aiding timely treatment and reducing disease burden.

Background & Objective: Cold-induced acute pain is associated with significant autonomic cardiovascular responses and pulmonary function changes. The autonomic changes appear with weight gain and especially the metabolic syndrome. This study was done to establish Cold pressor test (CPT) as a diagnostic tool to see the responsiveness as a guide to future cardiovascular and pulmonary function disorders in the pre-disease phase. Methods: 105 healthy volunteers aged between 25 – 35 years were randomly distributed into normal, overweight, and obese groups, of 35 subjects in each. Their baseline cardiovascular parameters viz. heart rate (HR), Blood Pressure (BP), pulse pressure (PP), mean arterial pressure (MAP) were recorded. Dynamic lung response was recorded by measuring FEV1%. All the parameters were also recorded after immersing the hand of the subjects in cold water at 4ºC. Comparisons of cardiovascular and lung parameters were done before, during, and after the cold-induced pain in all the groups. The results were statistically analysed by ANOVA, Paired t-test and unpaired t- test on STATA 13.0 for statistical comparisons. Result: There was significant increase in cardiovascular parameters and significant decrease in FEV1% in overweight group. Conclusion: This study indicates that alteration in cardiovascular profile and dynamic lung response form a part of multidimensional autonomic responses secondary to sympathetic challenges during acute pain induced by the cold pressor test.

Introduction Liver disease, particularly alcoholic liver disease (ALD), is a significant global health issue, contributing to high morbidity and mortality rates. With increasing cases of liver cirrhosis, there is a growing need for simpler, cost-effective, and non-invasive diagnostic tools. The Aspartate Aminotransferase to Platelet Ratio Index (APRI) score has shown promise in assessing liver fibrosis, especially in resource-limited settings. This study explores the APRI score's utility in diagnosing and staging liver fibrosis in alcoholic liver cirrhosis patients in India. Objective To assess the effectiveness of the APRI score as a non-invasive marker for liver fibrosis and to correlate APRI score with the Child-Turcotte-Pugh (CTP) score. Methodology This cross-sectional study was conducted at Sri Siddhartha Medical College and Hospital, Tumkur, over 24 months, involving 102 patients with ultrasound-confirmed alcoholic liver cirrhosis. Data were collected through clinical, laboratory, and radiological assessments. The severity of liver dysfunction was evaluated using APRI and CTP scores. Statistical analysis was conducted, with significance set at p<0.05. Results 69.6% of participants had APRI scores >1, indicating advanced fibrosis, with a mean score of 3.034. APRI scores were significantly associated with CTP classification (p=0.024).  Conclusion The APRI score is an effective, non-invasive tool for assessing liver fibrosis in alcoholic liver cirrhosis, particularly in resource-limited settings. Its correlation with CTP score further denotes its use as a prognosticating factor.  Further longitudinal studies are needed to validate its prognostic value

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

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

Background: A Complete Blood Count (CBC) and Peripheral Blood Picture (PBP) are essential diagnostic tools in assessing the severity and outcomes of dengue infection. Dengue, a mosquito-borne viral illness caused by the dengue virus (DENV), can range from mild dengue fever (DF) to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CBC and PBP provide critical information about hematological changes that correlate with disease progression and severity. The objective is to observe the trends of recovery of white blood cells (WBCs) and platelets in dengue fever  Materials and Methods: This is a prospective and cross-sectional study conducted in the Department of Pathology at Uma Nath Singh Autonomous State Medical College, Jaunpur, Uttar Pradesh over period of 1 year. Patients diagnosed with dengue fever, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS) based on WHO criteria were included. Cases confirmed by serological tests (NS1 antigen, IgM/IgG ELISA) or RT-PCR. Patients with recorded laboratory parameters, including hemoglobin, hematocrit, white blood cell count, platelet count, and peripheral blood smear findings were included. Results : A total of 560 patient data were analyzed in this study, comprising 280 males and 280 females. The mean age of the study population was 34.2 years, with a standard deviation of 13.7, and the age range was between 16 and 84 years. Among these patients, 245 did not develop DHF during hospitalization, while 315 progressed to DHF in the ward. During the acute febrile phase (Days 2–3) of the illness, leucopenia (WBC < 5000 cells/mm³) was observed in 72.4% of the patients. The average WBC counts for DF and DHF patients were 4.22 and 4.57, respectively. Neutrophil counts showed mean values of 2.85 in DF patients and 3.21 in DHF patients. Lymphocyte counts were lower in DHF patients, with a mean of 0.92 compared to 1.07 in DF patients.Conclusion: In conclusion, DF is an increasing, global problem with a growing footprint on millions of lives. At this time, monitoring decreases in hemoglobin and increases in WBC counts, particularly neutrophils, through routine CBC testing in hospitalized patients with suspected DF may identify those young children at higher risk of severe

Background: Benign breast diseases (BBDs) encompass a diverse range of lesions that can present with various clinical symptoms or remain asymptomatic. These conditions are more common in young women, particularly during the reproductive years, with a decreasing prevalence in older age groups. Accurate diagnosis requires clinical assessment, imaging, and cytological/histopathological correlation. Methods: This observational study was conducted over six months at a tertiary care center and included 100 female patients diagnosed with benign breast diseases. All patients underwent clinical examination, fine-needle aspiration cytology (FNAC), and, where necessary, histopathological examination (HPE) for confirmation. Data were analyzed using SPSS software to determine diagnostic accuracy and correlation between cytological and histopathological findings. Results: The majority of cases (60%) were in the 21-30 years age group, followed by 22% in the 31-40 years group. The most common clinical presentation was a painless, mobile breast lump (68%), followed by a lump with pain (24%). Fibroadenoma (58%) was the most frequently diagnosed lesion, followed by fibrocystic disease (13%) and proliferative breast disease (12%). Cytological diagnoses closely correlated with histopathological findings, with minimal discrepancies primarily in differentiating fibroadenoma from fibrocystic disease and intraductal papilloma. Conclusion: Benign breast diseases predominantly affect young women, with fibroadenoma being the most common lesion. The majority of cases present with a painless breast lump, and FNAC serves as a reliable diagnostic tool. However, histopathology remains essential for confirming certain cases. Early diagnosis and appropriate management can help alleviate patient concerns and improve clinical outcomes

Introduction: Heart failure (HF) remains a significant cause of morbidity and mortality worldwide. This study explores the association between proportional pulse pressure (PPP) and the severity of HF categorized by left ventricular ejection fraction (LVEF) using echocardiography. Material and Methods: The study included a sample size of 92 patients, with findings indicating a statistically significant relationship between lower PPP and reduced LVEF. PPP was found to be an effective non-invasive marker of arterial compliance and cardiovascular function, particularly in patients with heart failure with reduced ejection fraction (HFrEF). Patients with a lower PPP exhibited higher levels of cardiac dysfunction, indicating that PPP could be a useful tool for risk stratification and prognosis determination. Results: The study highlights that patient with reduced LVEF consistently demonstrated lower PPP values, with a significant inverse correlation between these two parameters (p < 0.001). The results suggest that proportional pulse pressure can serve as a cost-effective and reliable parameter in assessing heart failure severity, particularly in resource-limited settings where access to advanced diagnostic tools such as echocardiography is limited. Conclusion: Given its simplicity and ease of measurement, PPP could be incorporated into routine clinical practice to enhance early detection and improve treatment strategies for HF patients. Future research should explore the longitudinal impact of PPP measurements on HF management and outcomes.

Background: Congenital Heart Diseases (CHDs) are the most common congenital anomalies, contributing significantly to neonatal morbidity and mortality. Early detection of CHDs is crucial for timely intervention and improved clinical outcomes. Genetic markers have emerged as potential diagnostic tools for early identification of CHDs in neonates. This study aimed to evaluate the efficacy of specific genetic markers in the early detection of CHDs among neonates. Materials and Methods: A prospective case-control study was conducted over 24 months in a tertiary care hospital. A total of 150 neonates were enrolled, comprising 75 diagnosed with CHDs (case group) and 75 healthy neonates (control group). Blood samples were collected from all participants within 24 hours of birth. Genetic analysis focused on detecting mutations and polymorphisms in genes commonly associated with CHDs, including GATA4, NKX2-5, and TBX5, using Polymerase Chain Reaction (PCR) and sequencing techniques. Statistical analysis was performed using SPSS software, with a p-value of <0.05 considered significant. Results: The frequency of mutations in GATA4, NKX2-5, and TBX5 genes was significantly higher in the case group (45%, 40%, and 35%, respectively) compared to the control group (5%, 7%, and 4%, respectively) (p < 0.001). Sensitivity and specificity of GATA4 mutations in detecting CHDs were 90% and 85%, respectively. Combined analysis of all three genetic markers improved diagnostic accuracy to 92%. Conclusion: The findings suggest that genetic markers such as GATA4, NKX2-5, and TBX5 are effective in the early detection of congenital heart diseases in neonates. Incorporating genetic screening into neonatal screening protocols could enhance early diagnosis and facilitate timely interventions, potentially improving clinical outcomes. Further studies with larger sample sizes are warranted to validate these findings.

Background: Bone marrow examination is an important diagnostic tool to evaluate various disorders which includes neoplastic and non-neoplastic hematological disorders. The present study was conducted to analyze clinical details and bone marrow profile and to formulate rapid, effective method for diagnosing wide spectrum of hematological disorders. Materials and Methods: This is an Observational study done from May 2022 to July 2023. Detailed clinical history, clinical examination and hematological parameters along with peripheral smear, bone marrow aspiration and bone marrow biopsy, wherever indicated were done.  Results: Among 102 cases studied, 83 cases were non-neoplastic and 19 cases were neoplastic cases. The most common finding was pancytopenia on the peripheral smear. Nutritional anemia was the most common diagnosis on bone marrow examination. Conclusions: Bone marrow examination is an important diagnostic tool to evaluate various hematological disorders, particularly those presenting with cytopenias. In absence of relevant etiological investigations and in resource poor settings, bone marrow examination is done to evaluate hematological disorders.

Background: Anemia remains a major global health issue, particularly in developing countries like India, where nutritional deficiencies and chronic diseases are prevalent. Anemia affects not only systemic health but also has significant cardiovascular implications. Chronic hypoxia caused by anemia can lead to compensatory cardiac changes, many of which are detectable on electrocardiography (ECG).  Materials and Methods: A prospective observational study was conducted at Patna Medical College and Hospital, Patna over 20 months (February 2020 – September 2021), involving 100 patients with clinical and laboratory evidence of anemia (Hb ≤7 g/dL; RBC count ≤3 million/cu.mm). Patients were categorized as having severe, moderate, or mild anemia based on RBC count. Detailed clinical histories, laboratory investigations, chest radiographs, and 12-lead ECGs were performed. ECG parameters such as heart rate, QRS amplitude, ST segment changes, and T wave morphology were analyzed before and after anemia correction. Statistical analyses were performed to identify correlations between ECG findings and anemia severity. Results: Out of 100 anemic patients (54 males, 46 females), ECG abnormalities were observed in 83%, with the highest prevalence in the moderate anemia group. Sinus tachycardia (45%), low QRS voltage (60%), ST segment depression (45%), and T wave changes (26%) were the most common abnormalities. Notably, 98% of cases demonstrated left axis deviation. A significant number of ECG changes were reversible after raising hemoglobin above 7 g/dL; however, 3% exhibited persistent abnormalities such as bundle branch blocks or ventricular hypertrophy. No consistent linear relationship was observed between hemoglobin levels and ECG changes, but abnormalities were more common with cardiothoracic ratios (CTR) >55%, especially in females. Conclusion: The study confirms a high prevalence of ECG abnormalities in anemic patients, particularly in those with moderate-to-severe anemia. Most changes, including low QRS voltage, ST depression, and T wave alterations, were reversible, underscoring the functional nature of anemia-induced cardiac stress. ECG serves as a valuable, accessible diagnostic tool for detecting early myocardial involvement in anemia. Incorporating routine ECG analysis in anemia screening, especially in resource-limited settings, can enhance early cardiac risk stratification and guide timely management.

Background: A Purpose This study was designed to evaluate the reliability of preoperative ultrasonography (USG) to detect tractional retinal detachment (TRD) in vitreous hemorrhage (VH) due to proliferative diabetic retinopathy. Methods: This was a retrospective, descriptive study. The medical records of patients with VH who underwent A- and B-scan ultrasonography prior to a vitrectomy between January 2023 to December 2024 were reviewed in this retrospective study. All of the patients were assessed using USG before surgery with 4-quadrant transverse and 1-quadrant longitudinal scans whether to determine if the VH was accompanied by TRD. The USG results were compared with the vitrectomy findings. Results:  A total of 111 eyes of 106 patients with VH were evaluated. Twenty-three eyes were excluded from the study due to non-diabetic diagnoses, such as retinal vein-artery occlusion, trauma, intraocular mass, choroidal neovascular membrane, or macroaneurysm. The remaining 88 eyes with diabetic VH were included in the study. Preoperatively, VH alone was observed in 65 eyes (73.8%) and VH accompanied with TRD was determined in 23 eyes (26.2%) using USG. TRD was not found during the operation in 2 eyes (2.2%) diagnosed as VH with TRD by USG (false positive), and in 8 eyes (9.1%), TRD was detected during surgery though VH alone had been recorded based on the USG results (false negative). Conclusion:  USG is a reliable diagnostic tool that will provides accurate preoperative information about the presence of TRD in diabetic VH; however, in some cases TRD may go undetected, especially in eyes with peripherally localized or small TRD.

Background: Placenta Accreta Spectrum (PAS) represents a range of severe obstetric complications characterized by abnormal placental adherence, leading to significant maternal morbidity. Early and accurate prenatal detection is crucial for optimal management. A low-lying placenta (LLP) is a known risk factor for PAS. This study aimed to investigate the correlation between maternal serum alpha-fetoprotein (MS-AFP) levels and the presence of PAS in pregnant women with LLP, and to evaluate its potential as a predictive marker. Methods: This was conducted at Lalla Ded hospital, a tertiary care centre in Srinagar, J&K, between August 2023 and January 2025. Pregnant women with gestation >=28 weeks, diagnosed with LLP via ultrasound , who underwent MS-AFP screening were included. MS-AFP levels were measured using and expressed as Multiples of the Median (MoM). An MS-AFP level of >=2.5 MoM was considered elevated. The diagnosis of PAS was confirmed by intraoperative findings and/or histopathological examination. Statistical analysis included descriptive statistics,, correlation analysis, and calculation of diagnostic accuracy metrics. Results: A total of 250 women with LLP were included. PAS was confirmed in 38 (15.2%) participants. The mean MS-AFP level was significantly higher in women with PAS (>=2.5 MoM) compared to those without PAS ( <2.5 MoM) (P<0.05). A significant positive correlation was observed between MS-AFP levels and the presence of PAS (P<[0.05]). Elevated MS-AFP (>=[2.5] MoM) demonstrated a sensitivity of [86.8]%, specificity of [72.1]% for the detection of PAS in this observational study.  Conclusion: Elevated second-trimester MS-AFP levels are significantly correlated with an increased risk of PAS in women with LLP. While not a standalone diagnostic tool, MS-AFP may serve as a valuable, non-invasive adjunct for risk stratification, prompting enhanced surveillance and timely referral for specialized management in this high-risk population.

Introduction: Hydatid disease, caused by Echinococcus granulosus, remains a significant public health concern in endemic regions. This study aimed to evaluate the prevalence, organ involvement, clinical presentation, and diagnostic patterns of hydatid disease in a tertiary care setting in northern Chhattisgarh. Methods: A cross-sectional study was conducted over 18 months among 35 patients diagnosed with hydatid disease at a tertiary hospital. Data on demographics, exposure history, clinical presentation, organ involvement, diagnostic modalities, and statistical associations were recorded and analyzed. Results: The mean age of patients was 41.86 ± 18.17 years, with a slight female predominance (54.3%). Most patients (80%) were from rural areas and 51.4% reported contact with street dogs. The liver was the most commonly affected organ (74.29%), followed by the lungs (5.7%) and several rare sites (each ~2.9%). Abdominal pain and hepatomegaly were the most common symptoms. Ultrasonography was the primary diagnostic tool in 57.1% of cases, with CT used in 40%. No significant association was found between organ involvement and sex, or between dog contact and demographic variables. Conclusions: Hydatid disease remains prevalent in rural populations of India, with liver involvement predominating. Routine imaging, public education, and integrated control strategies remain essential for effective management and prevention.

Background: Dengue fever is typically a self-limited disease with a mortality rate of less than 1% when identify early and with access to proper medical care. The rising incidence of dengue fever in India can be contributed by the rapid urbanization with unplanned construction activities and poor sanitation facilities contributing fertile breeding grounds for mosquitoes. The present study is an attempt to describe the salient clinical as well as laboratory findings of serologically confirmed hospitalized cases of dengue fever and correlate bleeding severity with platelet count and platelet volume at the time of bleeding. Materials & Methods: A Descriptive type of study on 100 patients who are going to get admitted as in patients in Santosh Medical College & Hospital, Ghaziabad with symptoms suggestive of Dengue fever such as fever, severe headache, joints pain and bleeding manifestations, shock are investigated with Dengue ELISA test. Those patients found positive for the test are included in study and informed consent is taken from all patients. Results: Our study suggested that the majority of cases were seen in 26-35 years of age group which accounted for 45 patients. Overall male to female ratio was 2.84:1. The mean age was 40 years in males and compared to females was 39 years but statistically non-significant (p=0.7124). The mean platelet count was statistically significant (P < 0.0001***) in comparison between at time of admission (71300±36858) and at the time of discharge (162070±37000). Our study showed that the raised blood urea level, serum creatinine, serum bilirubin, MPV, SGOT & SGPT was associated with higher mortality due to dengue fever. Conclusion: Present study has disclosed a varied clinical profile of dengue fever which is of important diagnostic tool. In the recent few years, the world has seen varied clinical presentation of the dengue fever in different epidemics, even in the same regions and even with the period of time.

Background: Urinary tract obstruction is the most common cause of flank pain. Computed tomography is the investigation of choice for many urologic problems including urolithiasis, trauma, pelvi-ureteric junction (PUJ) obstruction and renal masses. Prompt diagnosis is crucial, as delayed treatment can result in renal complications, emphasizing the importance of accurate diagnosis for timely intervention and effective management. The purpose of this study is to evaluate the role of non-contrast computed tomography (NCCT) abdomen in patients presenting with symptoms of urinary tract obstruction and to determine the level and its cause. Materials and methods: A descriptive cross-sectional study of 80 subjects referred from various clinical departments to the department of Radiodiagnosis done at tertiary care hospital from April 2019 to October 2019. A NCCT abdomen scan was performed with Wipro GE Revolution ACTS (16-slice). Images were reconstructed at a slice thickness of 1.25 mm. After the identification of kidneys and urinary tract structures, urinary tract obstruction was assessed as either unilateral or bilateral. The site and cause of obstruction was identified using multiplanar reconstruction images. Any associated findings related and unrelated to urinary tract were also documented. Results: Amongst the 80 cases, 88.7% had causes for obstruction, with urolithiasis being the commonest cause, followed by PUJ obstruction, prostatomegaly, ureteral stricture, urinary bladder neoplasm, external compression and vesico-ureteric reflux. The ureter was the commonest site of obstruction accounting for 87.2% cases, followed by kidney (18%) cases and 1 case of bladder calculus (1.8%). Interpretation and conclusion: NCCT abdomen is the preferred diagnostic tool for urinary tract obstruction due to its availability, ease and high sensitivity. CT has become the standard of reference in detection of urolithiasis due to its high sensitivity, high specificity and ability to delineate alternative cause of flank pain. Contrast study is required to evaluate non-calculus causes, providing further diagnostic precision in selected cases.

Background: Varicose veins are the most common symptoms of chronic venous insufficiency, resulting from reverse blood flow through damaged valves, perforating veins, or post-thrombotic sequelae. Duplex colour Doppler imaging is the primary diagnostic tool for lower limb venous diseases, preferred by clinicians due to its non-invasive nature and high acceptability, making it an ideal choice for routine pre-operative evaluation. Materials and methods: A descriptive cross-sectional study of 100 subjects with symptomatic and asymptomatic visible varicose veins referred from other clinical departments to the department of Radiodiagnosis were imaged using Duplex color Doppler ultrasonography at a tertiary care hospital from April 2019 to October 2019 and were subjected to perform clinical manoeuvres for complete assessment of causes of chronic venous insufficiency. Patency of the sapheno-femoral junction (SFJ) and sapheno-popliteal junction (SPJ) along with duration of venous reflux at SFJ was assessed. Level of incompetent perforating veins and varicosities of the superficial venous system was evaluated using GE Voluson S10 Expert and GE Voluson P8 ultrasound machines. Results: Amongst the 100 patients studied, the observed mean age was 46.87±6.4 years with male preponderance (79%). The bilateral limb involvement with varicosities was 40% followed by 31% in left limb and 29% in right limb. Both great saphenous vein (GSV) and small saphenous vein (SSV) territories were affected in 50% of patients who had bilateral varicosities and predominantly SSV territory was affected in those having unilateral varicosity. Grade I & II incompetency at SFJ was most frequently observed in both bilateral and unilateral varicosities of lower limbs. Many patients had incompetent perforators at multiple sites with anterior thigh perforators were more common amongst the unilateral and posterior mid-calf perforator were incompetent in bilateral varicosity of lower limbs. SFJ reflux duration was more than 1001 msec in majority of the patients (74.7 % - 62 of 83 patients). Conclusion: Duplex ultrasound is a cost-effective and non-invasive modality for assessing venous insufficiency of lower limb. It helps in determining the type and level of vessel incompetence, venous reflux. The employment of various manoeuvres during the scan helps in determining the site and severity of vessel incompetence. Hence preoperative venous mapping of incompetent sites to target the sites of venous incompetence is essential to achieve increased post-operative success rate. 

Background: Sepsis progress rapidly and has high morbidity and mortality. So, it becomes necessary to have a valid diagnostic tool which can rapidly stratify the patients based on the risk they pose. MEDS score is such an evaluation tool which is computed from readily available parameters. This study is conducted to evaluate the MEDS score to predict mortality in 28 days of sepsis. Methods: This Prospective study was conducted at Government medical college and ESI hospital, coimbatore for one year duration after obtaining local ethical committee permission. Based on the incidence at this college the sample size was calculated as 178 patients presenting to emergency department with features of systemic inflammatory response syndrome. Nine clinical and laboratory parameters were noted at the time of admission and they were followed for 28 days with aim of recovery from illness or mortality and the variables noted.  Results: Data were analysed using SPSS V.16 software. The MEDS score had an area under receiver operating characteristic curve of 0.88(95% confidence interval, 0.83- 0.92) and has perfect discriminatory ability in all five risk categories. Conclusion: The MEDS score system predicts 28-days mortality with discriminative ability among patients presenting with features of systemic inflammatory response syndrome to emergency department, Government medical college and ESI hospital, coimbatore. All the nine risk factors included in computing MEDS score has cumulative effect in influencing mortality rate and none has independent risk.