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.

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.

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.

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

In this paper we studied the effect of tuber extract of nutgrass (Cyperus rotundus l.) on fetal weight and length of white rat (Rattus novergicus) Sprague Dawley. Pregnant female rats (n=24) are grouped into four consisted of six rats each. Group-1 (control) only received distilled water. Group-2, 3 and 4 consecutively received tuber extract of nut grass at the dose of 22.5, 45, and 90 mg/kg body weight. Extract was given orally using gavage needle on day 6th for 13 days until day 18th of pregnancy. On day 18th of pregnancy, female rats were lapartomized under deep anaesthesia. All fetuses were taken to measure their body weight and length. The results showed that both fetal weight and fetal length of the rats were significantly decreasing with increasing doses of the extract. In conclusion, tuber extract of nut grass (Cyperus rotundus l.) has inhibitory effects against fetal growth of rats during pregnancy

The risk of Gastrointestinal (GI) cancers in patients with Cystic Fibrosis (CF) is high, and such a risk is not always fully taken into consideration, as Yamada et al. [1]. CF is characterized by altered management of intracellular Chloride (Cl-), owing to altered sequences in the Cystic Fibrosis Transmembrane Regulator gene (CFTR). The heterozygous frequency of at least one of the over 1900 mutated sequences of this gene occurs in one of 13 and one of 24 people, respectively, of Ashkenazy and of European descent, a non- infrequent occurrence. Altered Cl- transport might occur also in heterozygous individuals, albeit at a somewhat non-dangerous level. Additional increased modification of Cl- transport can be caused by the Vacuolating Toxin (VacA) of Helicobacter pylori as its p33 subunit with the N-terminal part of the p55 subunit also acts as a chloride channel [2]. VacA is known to circulate in vescicles called exosomes; these are very stable, can enter any cell type, and, therefore, have been proposed as a vehicle for therapies that need to reach distant organs. We wish to report our experience of testing chloride (Cl-) concentration in the sweat of patients with liver cirrhosis, aiming at excluding a risk factor for liver cancer development. Cl- levels above 59 mmol/L were found in 13 adult female patients who accepted to perform the test at the Regional Centre for cystic fibrosis of Torino; this level is a bona fide positive for Cystic Fibrosis Transmembrane Regulator (CFTR) dysregulation. Seven of these patients had already been diagnosed with cancer (or subsequently were diagnosed) at varying sites (two in breast, one each lung, liver, endometrium, stomach, acoustic nerve).

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

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Background: Bile duct injury is severe and potentially life threatening complication of cholecystectomy. It ruins the patient physically, mentally, socially and financially. The incidence of bile duct injury is alarming in our country. Management of such patients needs to be explained. Methods: It is a cross- sectional descriptive study carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period January 2018 to July 2020. A total of 70 patients diagnosed as bile duct injury were included in the study. Bile duct injury that occurs during liver or pancreases surgery or accident was excluded. Data were collected using a predesigned data collection sheet and analyzed using computer software SPSS (Statistical Package for Social Sciences) version 22. Results: Young and female patients suffer more 44(62.9%) than male. Occurrence was common during laparoscopic cholecystectomy 42(60%). Most of bile duct injury occur when cholecystectomy done on acute condition of gall bladder 59(84.3%). Most of bile duct injury patient came to specialized center after several week of injury with billiary stricture 54 (77.14%) with jaundice, some patients presented with abdominal pain 48(68.6%), abdominal distension 18(25.7), biliary peritonitis 16(22.9) and biliary fistula 14(20%). Patients with bile duct injury were evaluated by USG, liver function test, ERCP and MRCP. Maximum BDI patients were Bismath Type II 32(45.7%) and Bismath Type III 18(25.7%). Out of 70 cases USG performed 68 cases (2 patients repair at the time of surgery) and these investigations provided valuable information about condition of biliary tree, hepatic parenchyma and ductal system also intra-abdominal collection. 14 patients were done ERCP. Billiary stricture in different level seen among most of the patients (10). Bile leakage seen among 4 patients and all were underwent ERCP stenting. Conclusion: The present study showed that bile duct injury occurs mostly in young female with acute cholecystitis. Common presentation was obstructive jaundice and biliary sepsis. Bismuth Type II and III were most common form of stricture. Biliary reconstruction (Roux-en-Y hepaticojejunostomy) was the treatment for biliary stricture. Peritoneal toileting, controlled fistula and later on biliary reconstruction was the treatment of biliary sepsis.

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.

Background: The danger of chronic kidney disease (CKD) is rising quickly worldwide and has become a main health crisis and most of these patients die from cardiovascular disease (CVD) prior to progression to end stage renal disease (ESRD), therefore, Poor cardiovascular outcomes in CKD patients have encouraged nephrologists to search for biomarkers that may improve risk stratification in this population. The aim of this study was to assess serum brain natriuretic peptide (BNP) hormone and cardiac troponin T (cTnT) levels in CKD patients and to determine their involvement with cardiovascular diseases. Methods: This analytical case control study was conducted at Ibn sina and Military hospitals in the period from February 2016 to March 2019, (n = 150) clinically diagnosed CKD patients (age range between 22 - 76 years, 105 males and 45 females), and (n = 150) healthy subjects were included as controls. Serum BNP hormone and cardiac troponin T (cTnT), were estimated by Cobas E-411® fully automated analyzer, serum creatinine by Cobas C-311® fully automated analyzer, hemoglobin by Sysmix, glomerular filtration rate (GFR) was calculated by Cocroft-Gault formula and blood pressure was measured by using mercuric sphygmomanometer. Results: Serum BNP, cTnT, creatinine, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) were significantly higher in CKD patients than in controls, while hemoglobin and GFR were significantly lower. Moreover, serum BNP, cTnT, SBP and DBP were significantly higher in CKD patients with cardiovascular disease (CVD) than CKD patients without CVD. In addition, serum BNP, at cutoff level of 240 pg/ml, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 87%, 90%, 52% and 92%, respectively in relation to CVD, while serum cTnT, at cutoff level of 0.1 ng/ml, the sensitivity, specificity, PPV and NPV were 80%, 57%, 46% and 74%, respectively. Furthermore, there was an association between elevated BNP levels and CVD outcomes in patients with CKD, since it is a strong risk factor for CVD (OR: 1.48, p. value 0.031). Conclusions: BNP levels are significantly associated with cardiovascular events (left ventricular hypertrophy and systolic dysfunction) in patients who have CKD and are on maintenance hemodialysis (HD)

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.

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: 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

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

Introduction: Heart failure (HF) is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy. UA is the final product of purine metabolism and hypoxic states cause an elevation of the serum UA level. Cell death, tissue hypoxia, and impaired metabolism in HF increase XO activity, leading to an overproduction of UA. Aim: To study correlation of uric acid levels with ejection fraction in heart failure patients (both acute & chronic). Materials and Methods: This is an observational study conducted at tertiary care Teaching Hospital over a period of 1 year. All patients who are admitted with symptoms and signs of Heart Failure in the wards like Intensive Care Unit, Acute Medical Care, Intensive Cardiac Care unit, Medical Wards, Cardiac Wards both paid and general rooms were recruited in the study. The sample size was 100 patients after evaluation by clinical and 2D echocardiography findings. Patients with signs and symptoms of Heart Failure and by satisfying inclusion and exclusion criteria were recruited. Results: A total of 100 patients with heart failure and ejection fraction less than 50 who presented to the department of general medicine. 26 male patients had ACS as the precipitating cause of heart failure compared to 29 female patients. In the present study the range of uric acid was observed between 7.1 – 10 mg/dl, the mean uric acid levels were observed to be 8.6 ± 0.67. In the present study, the range of Ejection fraction was observed between 28 – 48%, the mean ejection fraction was observed to be 34.8 ± 6.65. In the present study, it was observed that there was a significant and inverse correlation observed between uric acid levels and ejection fraction r = -0.808 p<0.001. Conclusions: The analysis of correlation conclusively proves that when serum uric acid is more than 7 mg / dl, then either RWMA or Global hypokinesia positive OR LVEF < 50 % in heart failure patients. The analysis also proves that serum uric acid levels are more in the severe functional disability patients (NYH III AND IV). This implies that Uric acid levels can be used as a marker for cardiac

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: 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: 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: Thyroid disease is more common in women than in men, because most thyroid diseases are autoimmune in nature and increased susceptibility to autoimmune diseases, perhaps secondary to the female endocrine environment is likely contributing factor. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. Pregnancy is associated with significant and reversible changes in thyroid function and failure to adapt to these changes result in thyroid dysfunction. Material and Methods: This is a Prospective study done among 1000 pregnant women. Antenatal women attending the outpatient department of tertiary care centre from August 2021 October 2022. Detailed history was taken, regarding the symptoms of thyroid disorders, menstrual history, obstetric history, past medical history, family history and personal history

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

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: The term "asymptomatic bacteriuria" (ASB) refers to persistent, aggressive bacterial growth in asymptomatic females' urinary tracts. The quantitative diagnosis is a clear catch mid urine sample with more than 100,000 organisms/ml.1 The incidence is often population-dependent geographical variance, ranging from 2 to 7%. The incidence is between 25 and 35 percent in emerging nations like India

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

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: 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: 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

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

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.

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

Lower urinary tract infections are accountable for a huge number of presentations in general practice and were treated with regular antibiotic prescriptions. But, they cause a significant financial burden while seeking treatment services. In our prospective study, that took place over 18 months at Katuri Medical College and Hospital, was done to determine the etiology and treatment modalities of lower urinary tract symptoms. Our Objectives were- 1. To assess various etiological factors causing lower urinary tract symptoms among patients attending the outpatient department at Katuri Medical College and Hospital. 2. To investigate the etiological factor causing lower urinary tract symptoms among the patients. 3. To evaluate various treatment options available for management of lower urinary tract symptoms. Results: A total of 87 patients who were screened and a sample size of 30 cases had been selected with objective evidence of LUTS on whom an surgical intervention is needed. It was found that the highest incidence of LUTS in males was in 7th decade, and then sixth and eight decade, meanwhile, the lowest incidence was seen in ninth decade. In this present study, major proportion i.e., 73.33% (22cases) were men and the remaining 2 6.67% (8 cases) are females. Patients presented with the following complaints. 1. Frequency and nocturia were found in highest number of cases i.e., 28 (76.67%). 2. Weak Stream was in the least number of patients i.e.,11 (36.67%). 3. Intermittency and Urgency were found to be suffered by 60% and the later was observed to be present in 70% of the study subjects. The most common cause was BPH which was observed in 53.33% followed by bladder stones (23.33%), carcinoma prostate (10%), Urethral stricture (10%) and bladder carcinoma (3.37%). Out of 30 cases of LUTS, 14 underwent TURP, 5 cases underwent cystolithotripsy, 1 underwent radical cystectomy and ileal conduit, 1 underwent VIU, 2 underwent urethroplasty, 5 underwent open prostatectomy, 2 underwent cystolithotomy.

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

Introduction: Even before the culture reports are obtained, hematological alterations in sepsis can help in the early diagnosis of sepsis. One of the most common issues with neonatal sepsis is thrombocytopenia, which is also one of the most reliable independent risk factors for sepsis-related mortality. The purpose of the current study was to figure out the incidence of thrombocytopenia in newborn sepsis and to assess if it might be used as a screening test for the condition. Materials and methods: The Neonatal Intensive Care Unit at a tertiary care hospital hosted this hospital-based prospective observational cross sectional study from July 2022 to December 2022. In total, 220 neonates who were hospitalized to the NICU with suspected sepsis before turning 28 days old were included in the study. Results:  A total of 220 newborns with clinical sepsis were admitted during the research period. There included 73 (33.18%) female neonates and 147 (66.82%) male neonates. In 56 (25.4%) patients, the blood culture proved positive. The most prevalent Gram positive and Gram negative organisms were Kleibsella species 13 (23.21%) and coagulase negative Staphylococci (CONS) 23 (41.07%). 101 births (45.91%) by caesarean section and 119 (54.09%) by normal vaginal delivery were recorded. 43 neonates (19.55%) had low birth weights, while 177 had normal birth weights (>2.5 kg). SGA made up 33 (15%), AGA made up 183 (83.18%), while LGA made up 4 (1.82%). Preterm births made up 42 (19.09%), term births made up 168 (76.36%), while postterm births made up 10 (4.55%) cases. CRP was positive in 123 instances (55.91%) and negative in 97 cases (44.09%). Among the total cases, 89 (40. 45%) had thrombocytopenia, in which mild was 53 (24.09%), moderate was 28 (12.73%), severe was 8 (3.64%). Thrombocytopenia was significantly associated with Blood culture positivity, LSCS, SGA and CRP positivity. (P<0.05) Conclusion: Thrombocytopenia acts as an early predictor of neonatal sepsis and also the outcome of the neonates. Platelet counts and clinical correlation can be used in conjunction to detect early sepsis and administer prompt, effective care

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 Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, and shortness of breath and chest tightness. It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. The assessment of asthma control has become pivotal in the management of asthma. However, several surveys in developed nations have shown that the majority of patients with asthma do not enjoy adequate asthma control. This is not because asthma control is unrealistic and not achievable; the multicentre, multinational study of asthma management, the Gaining Optimal Asthma control (GOAL) study, has shown that well-controlled asthma is achievable in the majority of patients.  Materials and Methods: This is a descriptive and cross-sectional study to assess the levels of asthma control among adult patients attending Tertiary Care Teaching Center. The study used those (physician-diagnosed asthma patients) participants who volunteered. There is a causality department where patients presenting with acute asthma attack are managed. Complicated cases of asthma including status asthmaticus are managed in the high dependency unit. Results: Prevalence of bronchial asthma in adolescents was 13.1% (n = 110) of which 10.2% had episodes in the past 1 year. Prevalence was higher among males (6.23%) compared to females (3.94%). About 79.1% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke producing fuel at home (firewood/cow dung/kerosene; P = 0.021), and with history of smoking among family members (P = 0.027). Among current asthmatics, 71.8% reported cold/rhinitis (51.3% in March–May duration), 59.1% nocturnal dry cough, 48.2% sleep disturbances, and 42.7% speech disturbances in the past 1 year. Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses

Introduction: Blood is essential part of life saving treatment options in medical sciences. Various blood group systems have been identified till now but different human populations express to have different frequencies of blood types. The prevalence of blood groups differs distinctly in different parts and groups of populations around the globe.The information about distribution of blood groups in an area is of great value for better inventory management. Aim and Objective:To determinethe prevalence of ABO-Rh(D) blood types in apparently healthy population in Kota (Hadoti region). Material and Method: This blood centre based cross sectional study was carried out during the period of one year, i.e., from 1st January, 2021 to 31st December, 2021.During that period,5,657 blood donors donated whole blood at our blood centre and among the outdoor camps. ABO and Rh (D) typing was done by saline agglutination method done manually using commercially prepared antisera (for forward/cell grouping) and in house prepared reagent cells (for reverse/serum grouping).Descriptive analysisof sex and blood groups was done by using Microsoft Office Excel 2007. Results: Male donors 97.83% were more than female donors2.17%with M:F ratio being 45:1. 4.68% were detected to be having Rh (D) negative blood group while 95.32% were Rh (D) positive. Distribution of ABO-Rh(D) blood typesamong was found to be B+(36.70%)>O+(30.63%)>A+(19.32%)>AB+ (8.66%) > B- (1.75%) >O- (1.61%) > A-(0.92%) > AB-(0.41%). Conclusion: Present study concludes B+ being the most common blood group and Rh (D) negativity being 4.68% in the Hadoti region of Rajasthan. We recommend multicentricstudies with larger sample size to be conducted and comparative analysis to be done to more precisely understand the distribution pattern of blood groups in this region

Galactocele is a benign breast lesion that occurs commonly during lactating period. It can occur either in normal breast tissue or in accessory breast tissue. We report a galactocele in the left accessory breast tissue. The patient is a 23-year-old female, a mother of two children, who presented with a considerable painful swelling in the left axilla, which is clinically diagnosed as lipoma; however, subsequent investigation revealed it to be a galactocele. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes in normal breast tissue, such as mastitis, galactocele, fibrocystic disease, and carcinoma. Galactocele can sometimes also present as suspicious tumoral lesions in axillary accessory breast tissue

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

Introduction: Mental foramen (MTF) is an opening in lateral surface of mandible with clinical importance in local anesthesia and surgical procedures in terms of achieving effective mental nerve blocks and avoiding injuries to the neurovascular bundles. Aims: To determine morphology and morphometry of mental foramen of central Indian population, hitherto unreported. Material and methods: 80 mandibles, 40 male and 40 female dry dentulus, without deformities were examined for position, shape, and number of mental foramen on right and left sides. Results: Various parameters investigated are( 1) the horizontal distance between the symphysis menti and MTF was 25.54 mm, on left side and 24.80 mm on right side in males, 24.72 on left side and 24.67 in females.(2) MTF and posterior border of ramus was 66.85 mm on left side and 67.68 mm on right side in male,62.71 mm on left side and 65.62 on right side in females.(3) MTF and mandibular base was 13.18 mm on left side and 13.32 mm on right side in males and 13.03 on left side and 12.97 mm on right side in females. (4) MTF and alveolar crest was 14.33 mm on left side and 14.3 mm on right side in males, 12.60 mm on left side and 13.13 on right side in females. (4) Occurrence of MTF below the second premolar tooth was found to be highest. Average size of MTF was larger on right side and it's way of exit was in postero-superior direction. Shape of MTF round in 81.8%, and oval in 18.2 % of male and female on left side. 82.5% round and 17.5% oval in male and 92.5% round and 7.5% oval in female on right side. Conclusion: In the present study, most common position of MTF was found below the apex of second premolar in 73.9% of males and 67.5% of females on both sides. Shape of MTF is round in majority of mandibles. During surgical procedures on mandible this information is helpful to the surgeon

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

Introduction: Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. Materials and methods: This is a prospective study was conducted in the Department of Radiology at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre Hyderabad, among 70 cases of acute pancreatitis. All the cases of acute pancreatitis referred under department of radiology in a tertiary healthcare institute, and fulfil the set inclusion criteria, who consented to participate in the study were included in the present study. It was carried out among 46 indoor cases of acute pancreatitis referred under department of radiology for further diagnostic evaluation, in a tertiary healthcare teaching institute in Maharashtra during study period. Ethical Approval was taken from the college ethics committee. Result: In our study, a total 70 patients were studied using CT scan, who was suspected to have acute pancreatitis. Among them, 50 (71.5%) were males and 20 (28.5) were females. Necrosis of the pancreatic gland parenchyma was seen in 17 (24.3%) patients. 12 patients (17.1%) showed <30% necrosis. 8 patients (11.4%) showed 30-50% necrosis, and 10 patients (14.3%) showed more than 50% necrosis. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures

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

Background: Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients. Materials and methods: Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively. Result: A total of 70 patients were studied which included 45 males and 25 females. Out of these mild AA was seen in 15 males and 10 females, moderate AA was found in 30 males and 15 females. We did not get any cases of alopecia totalis (AT), alopecia universalis (AU) or ophiasis. Conclusion: Women with hair loss can benefit from higher ferritin levels

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: 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

Background: The Degenerative lumbar disc disease requires a multimodal therapeutic approach. Lumbar radiculopathy is a prevalent symptom that results from (a) mechanical pressure on nerve roots caused by a herniated disc (b) chemical irritation from inflammatory mediators1 and (c) compression of arteries supplying and veins draining the nerve roots. Given the complex pathophysiology of the degenerative cascade, an initial non-surgical management approach is necessary. Objectives: to determine the efficacy of Selective Nerve Root Block (SNRB) for pain relief. SNRB is an effective and less invasive intervention that is easy to administer and serves as an adjunct to non-operative treatment. Materials & Methods: A total of 46 patients who fulfilled these inclusion criteria were enrolled in the study. The duration of symptoms ranged from 4 to 24 weeks, and all patients were initially treated with analgesics, drugs for neuropathic pain, and physiotherapy, which failed to result in the resolution of radiculopathy. The nerve root block was performed in the operating theater with fluoroscopic guidance, using the technique described by Bogduk et al. under aseptic precautions. Pain Relief was measured periodically using Visual Analogue Scale. Results: Our study included a total of 46 patients with radiculopathy, consisting of 23 male and 23 female patients, with 1 patient having L3 radiculopathy, 36 patients having L5 radiculopathy, and nine patients having S1 radiculopathy. Immediate pain relief was observed in all 46 patients after the nerve root block procedure. Conclusion: Transforaminal epidural steroid injections may be used as part of a multimodal treatment regimen to provide pain relief in selected patients with radicular pain. Short-term (3 months) pain relief was very good, indicating that SNRB can be used to postpone surgery. However, long-term results require further follow-up. SNRB is therapeutically effective in relieving lumbar radiculopathy pain, easy to administer, cost- effective, and has minimal complications. Therefore, it is recommended for initial non-surgical management

Introduction-Chronic kidney disease (CKD) is one of the multifactorial diseases. CKD outcomes are based on many factors and once developed disease tends to progress to end stage renal disease. Many studies have proven relationship of bone minerals and non-protein nitrogenous (NPN) substances with CKD but data showing an association of these parameters with progression of disease is inadequate. Material and method- The study consisted of 88 CKD patients enrolled from kidney hospitals of Lucknow in the period between November 2020 to April 2021. Same number of control was also taken for comparison. Calcium, phosphorus and uric acid was analysed from the blood sample taken from both the groups. GFR was estimated and patients were classified into different stages of CKD. Chi-square test was applied to see the association and ANOVA & Post-hoc Tukey test were used to find the mean difference of parameters among different stages of CKD patients and the control group. For these tests, P-value less than 0.05 was considered statistically significant. Result- Females were found to be affected more by advance stage of CKD than their male counterparts. Hypocalcemia, hyperphosphatemia and hyperuricemia was the general finding in all the CKD stages when compared to control. Mean Ca of stage4 or 5 was significantly lower than stage3 and control group. Mean level of P of stage5 was higher than that of stage3 or 4 of CKD. Similarly, difference in mean uric acid between all the pairs was significant except between control and CKD stage 3. Conclusion- Our study found deranged Ca, P and uric acid levels along with advancement of CKD stages. Correcting these parameters may be of value in the management of CKD to stop its progression

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

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

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

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

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

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: 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: Systemic lupus erythematosus (SLE), also known as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissues of the body. Symptoms vary among people and may be mild to severe.  Common symptoms include painful and swollen joints, fever, hair loss, mouth ulcers and skin rash most commonly seen on face. Aims: To determine the clinical profile of Systemic Lupus Erythematosus patients at presentation. Materials and Methods: This is a cross sectional, observational study of 60 cases of Inpatients and outpatients fulfilling the 2015 SLICC criteria for diagnosing SLE in Vivekananda Institute of Medical sciences (VIMS), Ramakrishna Mission Seva Pratishthan (RKMSP), Kolkata, during the period of Jan 2017- Jan 2018. Result: In our study, we found that 43(71.7%) patients had acute/ subacute cutaneous lupus rash. 30(50.0%) patients had discoid lupus erythematosus(dle)rash or hyertrophic lupus rash. 24(40.0%) patients had non scarring frank alopecia. 33(55.0%) patients had oral /nasal ulcer. 48(80.0%) patients had joint disease. 19(31.7%) patients had pleurisy and / or pericarditis. Conclusion: SLE is more common among young females in third decade. In our study, most common features were joint and hematological manifestations followed by skin rash, oral/ nasal ulcers and frank alopecia. All patients were ANA positive. SLE patients assessed their quality of life as rather low. Increased disease activity was seen among 80% of SLE patients.   Measurement of quality of life along with modified SLEDAI 2000 index will help in providing better therapeutic management to SLE patients.

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.

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: 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.

Introduction: Vitamin D plays a significant role in the functioning of the immune system and it influences many dermatological diseases such as psoriasis and atopic dermatitis. The prevalence of vitamin D deficiency is growing globally with around 30–50% of people are known to have low levels of vitamin D.  Acne vulgaris is a common inflammatory disorder of the pilosebaceous unit. Studies about the role of vitamin D in the pathogenesis of acne vulgaris have shown conflicting and nonconclusive results. Thus, the precise purpose of vitamin D has not yet been established.  Aims & Objective: To evaluate serum levels of vitamin D in sample of patients with acne vulgaris and compare it with matched healthy controls & to investigate if there is any relation between serum vitamin D level and the severity of acne vulgaris. Materials and Methods: This cross-sectional study included 40 patients with acne vulgaris and 40 matched healthy controls. Serum 25-hydroxyvitamin D [25 (OH) D] levels were measured for both patients and healthy controls.  Results: Patients with acne are younger than healthy controls and female preponderance was observed as compared with male patients.  The mean (± SD) concentrations of 25[OH]D in patient group and the control group were 21.3 ± 9.7 ng mL and 29.6 ± 11.2 ng/mL respectively. The difference was found to be statistically significant (P < 0.05). Thus our study yielded lower levels of serum 25-hydroxyvitamin D in patients with acne vulgaris than its level in healthy controls. Conclusion: This study has shown clearly that in patients with acne Vulgaris vitamin D deficiency is more evident with P-value P < 0.05. Moderate to severe vitamin deficiency was observed in 27 cases (67.5%) and in 20 controls (50%) (P < 0.05). Further clinical studies with larger sample size are required to address the importance of vitamin D in pathogenesis & grading of Acne vulgaris. Specifically, to determine the effects of treatment of acne with both topical vitamin D analogs and vitamin D supplementation.

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.

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.

Background: Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory disease of unknown etiology characterized by symmetric polyarthritis. It is the most common form of chronic inflammatory arthritis. It can also cause a variety of extra-articular manifestations, such as vasculitis, nodules, and accelerated atherosclerosis. RA affects 0.5–1% of the adult population worldwide. Females are more commonly affected than males, which can be attributed to the role of estrogen in enhancing immune response. Genetic and environmental factors play an important role in the pathogenesis of RA. Materials and Methods: This is a prospective study conducted in the Department of OBGY and Orthopaedics. Data about RA pregnancies were collected before conception and during each trimester and post- partum period. All the patients were prospectively followed at the multidisciplinary Pregnancy Clinic for Rheumatic Diseases. Data collection was performed at five time points: preconception visit (3–6 months before conception), during each trimester of pregnancy (first: 8–12 weeks of gestation, second: 18–24 weeks, third: 30–36 weeks), and up to 6 months after delivery. Results: Flare rates during pregnancy in patients with RA are associated with active disease in early pregnancy. A total of 65 pregnant patients were identified. No patient with RA experienced more than one episode of flare during pregnancy. Comparing patients with flares with those without them, the discontinuation of TNFi in early pregnancy correlated with the risk of flares. Conclusion: Elevated disease activity and TNFi discontinuation in early pregnancy may cause a relapse of disease activity in patients with RA. Restart of medication controls disease activity in pregnant patients with RA but shows insufficient effect in pregnant patients. The data indicate that tailored medication should be considered beyond conception to stabilize low disease activity and to prevent a flare during pregnancy.

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.

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.

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.

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: Wound Healing is the summation of a number of processes that follow injury. Despite immense advances in the technique of wound creation and closure, there continues to be an important percentage of patients undergoing abdominal operations, suffering from delayed wound healing and partial wound failure. The aim of this study is to assess the various factors influencing post laparotomy wound healing. To identify the pre-operative, operative and post operative risk factors in patients having poor wound healing. Material and Methods: All adult male and female patients undergoing laparotomy for various indications were included in the study. This descriptive, non-interventional case study was conducted in the Departments of General Surgery in Veer Surendra Sai institute of medical science and research burla sambalpur. (Minimum of 100 cases). Results: This prospective study was conducted in VIMSAR hospital, burla, sambalpur. A total of 100 patients undergoing laparotomies were studied .40 patients were found to have delayed wound healing. The strongest association for delayed healing was found to be wound infection, followed by smoking, chronic cough, poorly controlled diabetes and alcohol. Conclusions: The incidence of delayed healing was found to be higher in our study with increased incidence of wound infection. It was found that emergency laparotomies were associated with an increased incidence of wound infection and thereby delayed healing. Poor wound healing is also associated strongly with poor nutrition and uncontrolled diabetes. These factors should be taken into account and efforts have to be made to correct the risk factors pre or post-operatively.

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 and Objectives: Low back pain with radicular symptoms is a prevalent musculoskeletal disorder and a leading cause of disability. Radicular back pain affects multiple nerve roots, resulting in pain, sensory loss, and motor dysfunction. Assessing the quality of life (QOL) provides valuable insights into the impact of health conditions and treatment outcomes. Low back pain significantly interferes with QOL and work performance. This study aimed to analyze the QOL in female patients with low back pain and radiculopathy. Materials and Methods: An observational study was conducted on 404 patients and healthy individuals at a medical college in India. The SF-36 questionnaire, which measures eight scores representing physical and mental components, was used to assess QOL. Results: Results from 364 eligible patients revealed significantly lower mean PCS and MCS scores compared to the normative population, indicating poorer QOL among low back pain patients. Conclusion: In conclusion, patients with low back pain and radiculopathy experience a diminished QOL compared to individuals without this condition. Therefore, efforts should be made to enhance patient care, focusing on improving QOL, as this aspect remains relatively unexplored.

Background: In diabetic foot, in case of lacerated wound in lower leg or in case of non healing ulcers in distal part of lower extremity it is very difficult to fill the wound gap. It is because of the area around malleolus and foot, the skin is very tight. Moreover, in between the bones and the skin mainly we are getting muscle tendons without any proper fleshy muscle bulk. so muscular flaps are less available to cover the wound. So based on fascio cutaneous or cutaneous flap generally the repairs were done in the region of lower third of leg. Perforator branches from Posterior tibial artery are the preferred solution in these cases to construct a proper flap. so we have tried to find out details of the perforator arteries based on posterior tibial artery in a cadaveric study. Materials and method: In a dissection based study we have dissected both of the lower limbs of total 10 cadavers. So total samples were 20 posterior tibial artery and their perforators in lower third of leg. Among them 8 were male and 2 were female. All of them were adult cadavers which were properly embalmed. It is a cross sectional study, where we had dissected a cadaver once and collected all of the data once. Result: Out of 20 samples from 10 cadavers, we got among 16 samples, 80% of the fascio cutaneous perforators were Bilateral symmetrical regarding their number and position. Most of the perforators are present within 7-10 cm distance from medial malleolus. Number of perforators in each leg were 3-5. Conclusion: posterior tibial artery perforator based flaps are of high Success rate if we exclude the risk factors. So with proper knowledge of perforators from PTA would help the surgoens to properly care the wounds around ankle and foot. There is probability of racial variation on which more extensive researches are needed.

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.

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.

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:  Tuberculosis is a specific infectious disease caused by bacteria belonging to the "Mycobacterium tuberculosis complex". It presents a great social and economic problem and is one of the major factors responsible for high morbidity and mortality in India. The incidence of tuberculous cervical lymphadenopathy accounts for two third of extra pulmonary tuberculous lymphadenopathy. Higher proportion of tuberculous origin is because of greater incidence of pulmonary tuberculosis in our country. Perhaps there are many other causes of lymphadenopathy which are usually misdiagnosed as tuberculosis. Thus, it has been a common problem for both the clinicians as well as the pathologists to diagnose tuberculosis. Methods and Materials: The present work is carried out in 100 clinically suspected cases of tuberculous cervical lymphadenitis attending E.N.T., Surgery, Paediatrics and Medicine Department of central India institute as an outdoor/indoor patient during the period of one year. Patients with enlarged cervical lymph nodes with a history suggestive of tuberculosis were included after taking an informed consent. Results: Study was conducted on 100 clinically suspected cases of tuberculous cervical lymphadenitis, Tuberculosis was diagnosed in 57% cases by FNAC, smear and culture together, the maximum incidence of tuberculosis was observed in second and third decades, Females were more affected (64%) than males with the ratio of 1:2.3. FNAC showed accuracy of 42%, 30% cases were AFB smear positive in our study which nearly matches to other authors. The culture studies could diagnose 57 cases as tuberculous and 4 cases as non-tuberculous cervical lymphadenitis. Culture positive was higher in granulomatous necrotic lesions. Sensitivity, specificity and predictive values of culture study were significantly higher than FNAC and smear. These methods of investigation require considerable experience and confidence of the pathologist who perform the procedure for better results. When culture was taken as Gold Standard, cytology was found to be more sensitive than smear. Conclusions: From this study we concluded that Both FNAC and smear are quick, simple, less traumatic and cost-effective methods and are used as routine investigating procedures in OPDs of urban and semi-urban hospitals. Simplicity of these techniques (FNAC & Smear) combined with early availability of results and good diagnostic accuracy warrants their clinical application. Missed cytological diagnosis and isolation of non-tuberculous mycobacteria justify the use of culture studies in all suspected tuberculous lymphadenitis cases.

Background: Onychomycosis is the commonly encountered problem especially in  adults. Appears as a simple cosmetic  problem  infected  nails, but have significant effect on patients emotional, occupational and social aspects, also  serve  as  reservoir  of  mycotic  infection  and  can give rise to repeated skin infections. Dermatophytes are the principal pathogens.  Objectives: Isolation and identification of fungal agents causing onychomycosis and to study the predisposing factors with their clinical presentations. Methods:  Appropriate samples from 50 patients with a diagnosis of onychomycosis were included in study for a duration of one year, from July 2012 to August-2013. Nails were collected in sterile black craft paper envelopes of 5x5 cms after disinfection and nail borings from nail bed. These were subjected to 20 to 40% KOH mount, routine Culture on SDA with antibiotics and cycloheximide. Isolates were identified based on colony morphology and biochemical reactions. Results: In a sample size of 50, dermatophytes were predominant agents 70.58% compared to non-dermatophytes 29.4%, 78% were males and 22% were females. In these cases distal and lateral sububgual onychomycosis (60%) was the most common clinical presentation followed by proximal subungual onychomycosis (20%). Total positive culture cases were 17 (34%), among which Trichophyton rubrum 41.17% was predominant followed by T.mentagrophytes 17.6%. Conclusion:  Not all nail dystrophies are fungal in origin, an accurate laboratory diagnosis of onychomycosis is must, as been shows in this study.  Dermatophytes were predominant etiological agents among which T.rubrum was most common Changing. Systemic and local predisposing factors were diabetes, anemia, traumatic injury, hands submerged in water for prolonged time.

Aim: To find out risk factors of hypertension among hypertensive patients among the patient visiting a tertiary care center. Patients and methods: In this study, analysis and interpretation of data were based on data collected through a structured interview schedule, measurement of BMI and blood pressure of 100 study subjects. Results: A Chi-square test was applied to determine the association of dietary & behavioral risk factors with socio-demographic variables. Dietary risk factors with socio-demographic variables. The statistical test showed the level of significance with gender, religion, marital status and type of family (p-value is less than 0.05). Fruit and vegetable consumption with socio-demographic variables. The statistical test showed the level of significance with age, education level and occupation (p-value is less than 0.05). Coffee consumption with socio-demographic variables. The statistical test showed that all variables are non-significant (p-value is greater than 0.05). Fatty food intake with socio- demographic variables. Discussion: The study concludes that 51% of females were hypertensive. Hypertension was higher among subjects with risk factors like fatty food and desi ghee intake, frequency of meal 2 times a day, physically inactive and taking less than 6 hours sleep in a day. Although there was a significant association of dietary & behavioral risk factors with socio-demographic variables like gender, age, religion, marital status, education, occupation and family income (p is less than 0.05) as depicted by the Chi-square test.

Background: The issue of organophosphorus (OP) poisoning remains a significant global health concern, especially prevalent in developing nations. Aims and Objective: This current investigation endeavors to examine the clinic-demographic characteristics observed among patients exhibiting symptoms of OP poisoning. Methodology: A retrospective and prospective study spanning a duration of one and half year was carried out on patients with OP poisoning at a tertiary-level medical college. Results: Throughout the study duration, a total of 40 patients presented themselves. Instances of intentional self-poisoning (95%) outweighed those of accidental exposure (5%). The preponderance of patients were identified as housewives (32.5%), succeeded by individuals in occupations such as private job, farmers, studentship, sweepers and some were unemployed (5%). Among the toxins ingested by patients, Dichlorvas (42.5%) emerged as the predominant choice (35.74%), trailed by Chlorpyrifos, Dimethoate, Methyl parathion, Phorate , Thiomate and Monocrotophos. Manifestations of nausea and vomiting, observed in 85.02% of cases, while the predominant sign was miosis, noted in 91.94%. The mean duration of hospital stays varied among the different severity level. In terms of outcomes, 75% of patients survived without the need for mechanical ventilation and the mortality rate documented in our study stood at 10%. Conclusion: The current investigation revealed that a significant proportion of the patient cohort consisted of individuals in their youthful years, with males surpassing females in representation. Deliberate poisoning incidents exceeded accidental ones.

Tibial plateau fractures are one of the commonest periarticular fractures. These fractures include 1% of all fractures and 8% of fractures in elderly. Motor vehicle accidents account for the majority of these fractures in younger individuals with good bone stock, but in elderly individuals these fractures may result from simple fall due to osteopenic bone. These fractures are associated with high energy violence and extensive soft tissue injury. Each fracture type has its own morphology, treatment considerations and prognosis.  Materials And Methods: This is a prospective study was conducted in the Department of Orthopaedics, Surabhi Institute of Medical Sciences among 30 patients with displaced tibial plateau fractures with posterior column involvement were selected for the study. Patients with tibial plateau fractures with posterior column involvement, closed injury, and age >18 years were included in this study. Patients with fractures with zero columns (pure depression type), pure lateral or medial column involvement without posterior column involvement, open injury, and associated head/chest/abdomen/pelvis/spine injury, patient below 18 years of age, and patient not fit for surgery and not willing for surgery were excluded from the study. Results: In our study, the most of the patients were belongs to 21-30 years old 12 (40.0%). In our study, predominant were males 90% and females were of 10%. Single-column fractures (Schatzker Type IV and Hohl and Moore Type I coronal split fracture), Two-column fracture (Schatzker type IV and type V), Three-column fractures (Schatzker Type V).  In this study majority of patients were Three-column fractures, followed by Two-column fracture and Single-column fractures. Mean duration of surgery time of single column fractures were 61.49 minutes, two-column fracture 80.40 minutes and 103.38 minutes for Three-column fractures Conclusion: Based on this study, we would like to conclude that we were able to achieve acceptable clinical and radiological outcome while managing complex tibial plateau fractures with column specific approach.

Background and Objectives: Chronic lymphocytic thyroiditis is autoimmune thyroiditis; it is considered as second most common thyroid disorder diagnosed on FNAC following colloid goitre. FNAC is a reliable and efficient method for diagnosing these thyroid lesions. Chronic Lymphocytic thyroiditis frequently affects women, primarily compared to men and is commonly found with hypothyroidism, euthyroidism or every so often with hyperthyroidism. The incidence rate of Hashimoto’s thyroiditis is 1–4%, with an occurrence of 30–60/100000 population per year. Autoimmune thyroiditis can be categorized on the cytomorphological features of FNAC. Methods: To compare FNAC cytological findings with TFT in Chronic lymphocytic thyroiditis. One hundred ten patients with thyroid swellings were presented for FNAC examination, serology of TFT and Anti TPO antibodies and Ultrasonography during 2020–2021. In addition, fine needle aspiration cytology was performed using non-aspiration or aspiration techniques. TFT and Anti- TPO antibodies were performed on Avion CLX 120 auto analyser based on the Chemiluminescence method. Result: Out of 110 cases of midline neck swelling presented in our department, Autoimmune Thyroiditis was observed in 43 cases. The most affected age group of lymphocytic thyroiditis was 21–30 years, with the male: female ratio being 1:3. Most of the patients presented with diffuse swelling and few presented with nodular swelling. The Grading of the lymphocytic thyroiditis was done by the criteria used by Bhatia et al Anti-TPO antibody was elevated in 19 cases (26.2%), and TSH was elevated in 28 cases (40.81%). These cases were diagnosed as autoimmune thyroiditis on cytology, clinically and also correlating with radiological findings. Grade 3 lymphoid infiltrate was seen in 53.33% (16/30) cases, and Grade 2, lymphoid infiltrate was seen in eight cases (62.50%). Grade 1 lymphoid infiltrate was seen in five cases (11.63%). Among 43 cases, 28 cases (65.12%) show hypothyroidism, 7 cases (16.28%) show hyper, and 8 cases (18.60%) show Euthyroidism. Among these 43 cases, 26 cases showed diffuse thyroid swelling on ultrasonography, and 7 cases showed solitary nodule. Conclusion: Grade 3 lymphocytic infiltration statistically correlates with anti-TPO and TSH in conjunction with ultrasonography findings of diffuse enlargement of the thyroid gland. The presence of Hurthle cell change, giant cells, anisonucleosus, and granulomas do not find to be any statistical correlation with lymphocytic thyroiditis as these cases are primarily corresponding to Grade 1 and Grade 2. Through this study, we conclude that FNAC remains the gold standard method despite having different diagnostic modalities accessible for diagnosing thyroid lesions. Grading of FNAC Smears depends on lymphocytic infiltration of the thyroid follicles, along with positivity for antithyroid antibodies (anti-TPO antibody) and TSH. These findings are firmly associated with Chronic Lymphocytic Thyroiditis.

Background: Vitiligo is an acquired disorder of the melanocytes characterized by depigmented macules and patches. The chronic, unpredictable course of the disease and the visible cosmetic disfigurement leading to social discrimination lead to a decline in the quality of life (QoL) of patients suffering from Vitiligo. Aims and objectives: This study aims to assess the impact of Vitiligo on the quality of life of patients using two questionnaires – Dermatological Life Quality Index (DLQI) and Vitiligo Quality of Life (VitiQoL). Materials and methods: All patients above the age of fifteen years presenting with Vitiligo were included in the study after taking written informed consent. Patients with any other co-existing debilitating disease or disability, psychiatric problems, systemic or personal conditions which might have an impact on the Quality of life (QoL) as well as pregnant and lactating women were excluded from the study. Socio-demographic data and detailed history regarding the symptoms, duration of disease, and treatment history was recorded. A thorough general physical, systemic, and cutaneous examination was done. Patients were requested to answer the questions of the DLQI questionnaire and VitiQoL questionnaire after clearly explaining the meaning of the questions to them in their preferred language. The answers were noted by the same dermatologist in every case. The DLQI and VitiQoL score was then calculated. The scores were evaluated and compared at the end of the study. Results: A total of 78 patients were included in the study in the age group of 15-78 years and the mean age was 34.6 ± 4.4 years. There were 46 males and 32 females included in the study and the male-female ratio was 1.4:1. According to the DLQI scores, a moderate effect was seen in 27(34.6%) patients, followed by a very small effect in 24(30.7%) patients, very large effect in 18(23%) patients, no effect in 6(7.6%) patients and extremely large effect in 3(3.8%) patients. The mean DLQI score was 7.8 ± 5. There were 19(24.3%) new patients, and 59(75.6%) patients already under treatment for vitiligo. The commonest type was non-segmental (generalized vitiligo) seen in 38(48.7%) patients followed by acro-facial in 14(17.9%) patients. Segmental vitiligo was present in 8(10.2%). The duration of symptoms was greater than one year in 44(58.9%) patients and the mean duration was 1.8 years. Around 21(26.9%) patients had patches of overexposed parts of the body and a family history of vitiligo in first–degree relatives was positive in 3.8% of patients. The VitiQoL score in our study had a mean value of 37.8 with a standard deviation of 4.2. Higher mean values were seen in questions pertaining to frustration regarding the disease (3.8± 2.4), fear of progression (3.3±1.9), and worrying about what other people might think of them (3.1±2.7). Conclusion: Vitiligo is a disease that is still significantly associated with tremendous social stigma which greatly impacts the personal, professional, and social aspects of the patient’s life. Understanding the degree of impairment that Vitiligo can have on the quality of life (QoL) of patients will help us understand the magnitude of the problem and thereby take adequate steps like treatment with psychological support as well as counseling, along with community awareness programs to improve the QoL of patients.

Background and Objectives: Community-acquired pneumonia (CAP) is a prevalent infectious disease with significant implications for the elderly's health worldwide. This study explores the potential of the Neutrophil Lymphocyte Ratio (NLR) as a biomarker for CAP. Methods: This diagnostic comparative study involved patients aged 18 and above with community-acquired pneumonia under care at a tertiary care hospital in India. Detailed history, clinical assessments, and lab investigations were conducted after obtaining informed consent. NLR, CURB-65 score, and PSI score were computed and statistically analyzed. Result: The study included 246 patients (mean age: 56.8 ± 15.9 years; 60.3% male, 39.7% female). Comparing mild, moderate, and severe risk groups showed significantly higher mean NLR in the severe group. Pearson's correlation revealed positive links between NLR and CURB-65 score, and PSI score. ROC analysis resulted in AUCs of 0.902 (NLR), 0.922 (CURB-65), and 0.931 (PSI), all significant (p < 0.05). Conclusion: Neutrophil Lymphocyte Ratio emerges as a significant biomarker for community-acquired pneumonia. NLR also correlates positively with CURB-65 and PSI scores, offering a simple and effective tool for outcome assessment in CAP patients.

Objective: Malnutrition is a major problem in India as well as Madhya Pradesh. TB and HIV are the leading causes of morbidity and mortality in SAM children along with diarrhea and pneumonia. This study conducted to know the prevalence of pulmonary tuberculosis in SAM children. Study Design: A prospective observational study.  Setting: The present study was conducted in the NRC, Department of Pediatrics, M.G.M. Medical College, Indore, over a period of 18 months.  Participants/Patients: 429 SAM children of age 6-59 months were enrolled and screened for tuberculosis. Demographic, anthropometric, clinical history and investigation were done as per updated national guideline for pediatric tuberculosis and were analysed. Results: Out of 429 SAM children,53 diagnosed as PTB(prevalence= 12.3 %), prevalence of PTB were 11.2% in < 24 months then 8.8 % 25-60 months,12.7% were female then males(8.3%).Prevalence of PTB was found 11.6% in  W/H < -3SD, and 18.8% in group with MUAC < 11.5 cm, Malnutrition was found to be strongly associated with tuberculosis. The prevalence of PTB in BCG unvaccinated children was 57.7% while in vaccinated was 9.4% .85.7% had history of contact with tuberculosis then without history of contact 6.6%,31.82% TST were positive and 4.99% TST negative , 82 %  cases had positive chest x ray finding and only 1.1% had normal chest x ray,all found to be statistically significant.Total 16.9 % PTB cases were bacteriologically confirmed in our study. Conclusion: Every SAM child should be screened for tuberculosis, good quality X-ray,history of contact with TB, and TST should be available as an important tool and every effort should be made to diagnose tuberculosis by microscopy and culture, so that sensitivity of mycobacteria could be known.

Fine needle aspiration cytology (FNAC) has been established as the most preferable first line investigation for palpable breast lumps. Incidence of both benign and malignant breast lesions has been increasing in India in the recent times. Various predisposing factors have been attributed for the rapid surge of breast lesions. Materials & Methods: This study was carried out in the Department of Pathology, in the newly established Government Medical College and Hospital, Rajamahendravaram, Andhra Pradesh. A Total of 57 female patients presenting with palpable breast lump were subjected to FNAC procedure after taking history and doing general and local examination. Smears were prepared, stained and cytological diagnosis was made and reporting done by IAC (International Academy of Cytology), categories C1 to C5. Results: Most of the female patients presenting with palpable breast lump were in the age group of 31-40 years. The most common lesion diagnosed was Fibroadenoma. Malignancies formed 19.29% of all cases. Most of the lesions (71.95%) were in C2 category of IAC. Conclusion: FNAC is a fast and easily available technique to diagnose and differentiate between various benign and malignant breast lesions. It also guides the clinician for proper preoperative evaluation of patients.

Background: Birth asphyxia is defined by the occurrence of hypoxia, hypercapnia, and acidosis, resulting in systemic disruptions, potentially including electrolyte imbalances, in newborn infants. The acquisition of knowledge pertaining to electrolyte disturbances is of significant worth, as it serves as a crucial determinant impacting perinatal morbidity, mortality, and the subsequent course of treatment. Material and Methods: The study described herein is a one-year prospective case-control investigation that took place within the Department of Pediatrics located in central India. A total of 80 newborns, consisting of 40 in the study group and 40 in the control group, were included in the study.The diagnosis of birth asphyxia was determined through the utilization of the APGAR score, while the diagnosis of hypoxic ischemic encephalopathy was established by employing the SARNAT staging system.The renal parameters, including serum creatinine, blood urea nitrogen (BUN), serum electrolytes from blood samples, and urine sodium and urine potassium from urine samples, were assessed in all the newborns. Results: Total 80 newborns out of which 40 were included in study group and 40 were included in control group. Out of 40 asphyxiated newborn 25(62.5%) were males and 15(37.5%) female. So there was higher incidence seen in the male babies. The BUN levels were 28+8.98 in the asphyxiated newborns as compared to controls who had BUN level was 20.3+2.65 and it was statistically significant. BUN level was higher among cases as compared to control and it was statistically significant.The mean serum creatinine levels were 1.7+0.29 in case group and 1.12+0.4 in control and it was statistically significant difference between both the groups. Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of blood levels of urea, serum creatinine, serum calcium and urine output helps in the early diagnosis and management of renal failure in birth asphyxia. Serum electrolytes levels and renal parameters had a linear correlation with severity of birth asphyxia.

Background: Obstructive Sleep Apnea (OSA) is characterized by the partial or complete narrowing of the pharyngeal airway during sleep.The purpose of the study is to find out the prevalence of Obstructive sleep apnea among obese individuals by using STOP BANG Questionnaire. Material and Methods: The present study examined the prevalence of obstructive sleep apnea among patients who were obese. The method that was used was an observational approach. The research was carried out at the ACS Medical College and Hospital in Velappanchavadi, which is located in the city of Chennai. The duration of the study was for a period of six months, during which time data was collected from a total of 204 different participants. The research would need to include 204 people as its sample size if it were to be conducted on the basis of the assumption that was drawn from an earlier study, which said that 15 percent of the people who make up the population possess the particular factor that is of interest. Results: The mean age of the participants were 45.0414.94 years. Around 64.7% were females and 35.3% were males. Around 47.1% were overweight, 37.35 obese class I, 10.3% obese class II and 5.4% obese class III. As age increases the risk of sleep apnoea increases. According to StopBang sleep apnoea scores low risk and moderate risk more commonly seen among females. Correlation ofStop Bang score with BMI shows as the obesity increases the Stop Bang sleep apnoea scores increases. Conclusion: The study showed prevalence of obstructive sleep apnea among obese individuals to be 69%. This study delved into the prevalent yet underdiagnosed realm of obstructive sleep apnea (OSA) among obese individuals.

Background: Acne affects an increasing number of adult females, impairing quality of life, with significant negative psychological effect and social impact. Adult female acne (AFA) is defined as one that affects women over the age of 25 and may persist continuously or intermittently from adolescence or manifest for the first time in this period. It is believed that genetic and hormonal factors contribute to the pathogenesis of AFA, characterized by chronic evolution, requiring maintenance treatment, in some cases for years. The etiopathogenesis of acne vulgaris involves a complex interaction between the main factors such as: genetic predisposition; androgenic hormone stimulation leading to an increase in sebaceous secretion; alteration of the lipid composition; follicular hyperkeratinization; bacterial colonization mainly by Propionibacterium acnes (P. acnes) and periglandular dermal inflammation. Materials and methods: Patients having acne of age ≥25 years were analyzed using a pre devised proforma to elicit trigger factors while the severity was graded using the Global Acne Grading System (GAGS). A detailed hormonal assessment was undertaken that assessed total testosterone (TT), sex hormone‑binding globulin (SHBG), free androgen index (FAI), AMH, 17‑hydroxyprogesterone (17‑OHP), dehydroepiandrosterone sulfate (DHEAS), follicle‑stimulating hormone (FSH), luteinizing hormone (LH), thyroid‑stimulating hormone (TSH), and prolactin. Result: This research involves 90 students as the sample. The profile of the samples that contain average age, gender, degree of acne vulgaris, father genetic history, and mother genetic history. Statistical analysis of the father’s genetic history resultsin a p-valuel3t of 0.001, which means that the father’s genetic history was significantly related (p0.05) to the degree of acne vulgaris. Topical steroid use was found to be an important factor responsible for aggravation of acne in our study population. The objective assessment implicated the role of diet in 14.4% of patients with the common foods being ―oily ―and dairy products. Conclusion: Adult female acne may be triggered by diet, stress, and cosmetics and there is a distinct hormonal milieu that accounts for hyperandrogenemia. We noted high levels of adrenal androgens which have been known to be associated with stress and sleep deprivation. Our study shows the value of counseling adult female acne patients about various acne triggers.

Background: Infections attributable to Streptococcus are protean. These range from mild skin and soft tissue infections to life-threatening conditions like meningitis, endocarditis and toxic shock syndrome. There appears to be a recent surge of invasive infections due to these organisms. Penicillin is drug of choice for majority of Streptococcal species. Objectives: Isolation, identification and antibiotic susceptibility of Streptococcus species from various samples to revise hospital empirical therapy with regards to penicillin allergic patients in whom Streptococcus species is isolated. Methods: This is a prospective study over the past 2 ½ years (January 2020-August 2022) that includes all the Streptococcal species, isolated from clinical specimen. These were identified using ID GP card, Vitek-Compact 2. Antibiotic susceptibility was performed using AST 628 and ST03 cards. Results: There were 50 Streptococcal isolates from 50 patients. The ages ranged between 21 to 80 years; Males (61%) & Females(39%). The isolation of Streptococci from skin and soft tissue samples was high (55.3%) followed by respiratory samples (17%). Str.pyogenes (31.9%) and Str. agalactiae (25.5%) were predominantly isolated from skin and soft tissues, especially with lower limb cellulitis and necrotizing fasciitis. Str.pneumoniae (27.6%) were isolated mainly from lower respiratory infections in elderly patients. Other isolates included Str.mitis (6.3%), Str.viridians (2.1%) , Str.mutans (2.1%), Str.sanguis (2.1%) and Str.uberis (2.1%). Most of the isolates were susceptible to Penicillin & Ampicillin. Interestingly, susceptibility to macrolide and lincosamide was low. Conclusion: Str.pyogenes has emerged as an important cause of life-threatening skin and soft-tissue infections, especially necrotizing fasciitis. Using erythromycin or Clindamycin as empirical therapy in penicillin allergic patients should be cautioned due to low susceptibility at our hospital

Early diagnosis followed by prudent dietary supplementation and drug therapy in these high-risk neonates may provide an opportunity for long-range primary amelioration of risk factors that contribute to the development of CVD in adult life. Present study was aimed to evaluate the cord blood lipid profile level in term neonates and late preterm neonates and its correlation with gestational age. Material and Methods: Present study was single-center, cross-sectional study, conducted in neonates (late preterm and term) were born by vaginal delivery/LSCS with one minute Apgar score > 7. Total cholesterol level TC, triglycerides, high-density lipoprotein HDL, low-density lipoprotein LDL, very low-density lipoprotein VLDL were estimated from Cord blood sample. Results: Out of 150 study subjects, 117 (78%) were born at term, while 33 (22%) were late pre-term neonates. 129 (86%) of the newborns under the study were AGA while 21 (14%) were found to be small for gestational age. 78 (52%) were Male and 72 (48%) were Female. There was a statistically significant difference (p<0.05) between the Term newborns & late preterm newborns with respect to the observed values for Total cholesterol (p<0.05), Triglycerides (p=0.17), HDL (p=0.04), LDL (p<0.05) as well as VLDL (p=0.17). Mean values for TC, triglycerides, HDL, LDL, and VLDL were on higher sides in SGA newborns compared to AGA newborns but the difference between mean values for Total Cholesterol. Difference between mean values of Total Cholesterol (p=0.023), Triglycerides (p=0.039), HDL (p=0.002) & VLDL (p=0.039) were found to be statistically significant (p<0.05) between Males & Females. Conclusion: Cord blood lipid profile values for TC, HDL, and LDL significantly higher ( p<0.05) in late preterm neonates compared to term neonates & were on higher sides in female neonates.

Background: Uterine fibroid is a common concern  due to associated heavy menstrual bleeding and  anemia negatively affecting women's life. The prevalence of uterine fibroid in India is upto 20-30% in reproductive females. Though surgical treatment still remains the mainstay of the treatment, medical methods had evolved over the years with the advent of many effective oral drugs. Methods: This comparative, interventional study  conducted in the Gynaecological outpatient department of Nil Ratan Sircar Medical College and Hospital, Kolkata from March 2020 to August 2021. This study total of 21 patients in each group i.e. 42 women aged 20-50 years with leiomyoma uterus on USG who were fulfilling the inclusion and exclusion criteria were included in this study. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: Age of the treated patients ranged between 33 to 50 years and maximum number of patients were in the age group between 41 to 45 years (40.5%). Maximum numbers of patients belonged to lower socioeconomic status; 38.1% and 47.6%. In both groups maximum fibroids were intramural in location; (61.9%) and (71.4%). Maximum number of patients had solitary fibroids (54.8%). Mean age of women in Mifepristone group & Ormeloxifene group were 39.76 ± 3.820 years and 41.48 ± 4.966 years respectively. The baseline mean Hb was 9.46 ± 0.45 gm% and 9.48 ± 0.39 gm% in the mifepristone group & ormeloxifene group respectively. The baseline mean PBAC score was 226.84 ± 28 and 213.16 ± 32.02 in the mifepristone group & ormeloxifene group respectively. The baseline mean fibroid size was 5.91 ± 1.54 cm and 5.38 ± 1.34 cm in the mifepristone group & ormeloxifene group respectively. The baseline mean fibroid volume was 72.43 ± 23.44 cc and 73.19 ± 21.56 cc in the mifepristone group & ormeloxifene group respectively. The baseline mean RI was 0.53 ± 0.16 and 0.58 ± 0.18 in the mifepristone group & ormeloxifene group respectively. The baseline mean ET was 7.03 ± 1.37 mm and 7.9 ± 1.87 mm in the mifepristone group & ormeloxifene group respectively. Conclusions: Mifepristone is more efficacious for the medical management of uterine fibroids as it significantly decreases the uterine fibroid size and volume along with reduction of menstrual blood.

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

Introduction: Hypertension is a condition in which the blood flows through the blood vessels with a force greater than normal. Patient with hypertension have an increased prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance, and the prevalence of type 2 diabetes is increasing in epidemic proportions worldwide. Several trials involving patients with hypertension or cardiovascular disease have suggested that agents that block or inhibit the renin angiotensin system that is ACE inhibitors and ARBs decrease the incidence of new-onset type 2 diabetes. However, the exact role of these agents in diabetes prevention has not yet been fully elucidated. Blocking angiotensin II decreases proinflammatory mediators and the oxidative stress.  Material and Methods: This is a prospective and observational was conducted in the outpatient Department (OPD) of General Medicine and Department of Pharmacology at Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre -A Post Graduate Institute (SIMS), Hyderabad from April 2018 to March 2019. In 100 prediabetic hypertensive outpatients, 78 prediabetic hypertensive outpatients [45 males, 33 females mean age = 49.85±10.35] continued for a period of 12 months. The patients were recruited with following inclusion and exclusion criteria. Fasting blood sugar test: a blood sugar level from 100 to 125mg/dL (5.6 to 6.9mmol/L) is considered as Pre-diabetes, this is sometime referred to as impaired fasting glucose (IFG). Results: In our study 78 cohorts of hypertensive Prediabetic patients on ACE /ARBs were followed for one year and at the end of the study when all the parameters were compared at first visit /baseline with that of third visit /at the end of 12 months in both of the ARB (Telmisartan) and ACEI (Ramipril) group, it was observed that there is decrease in the mean and standard deviation of the different parameters included in the study i.e., SBP(mm Hg), DBP(mm Hg), FBG(mg/dl), OGGT(mg/dl) and HbA1c(%).In Telmisartan and Ramipril groups on the final visit at the end of 12 months, compared to the first visit or at base line, there is no significant difference in the p values of the different parameters i.e., SBP(mm Hg), DBP(mm Hg), FBG(mg/dl), OGGT(mg/dl) and HbA1c. Conclusion:  In the present study it was observed that in hypertensive pre-diabetes patients, the beneficial effect of RAAS Inhibitors is more marked if the therapy started with initial rise diastolic and systolic blood pressure, especially at a relatively younger age.

Background: Clavicle is one of the most fractured bones in the body comprising 45% of all shoulder bone fractures. Of the surgical options, open reduction, and internal fixation of clavicle with plating and closed reduction and fixation with TENS facilitates stable fixation allowing early mobilization and reducing non-union and mal-union. This study compares functional and radiological outcome of clavicle fractures treated by plating and fractures treated by TENS. Methods: This study was conducted in the Department of Orthopaedics in Government General Hospital, Kadapa from February 2023 to August 2023. In this study, 60 patients volunteered for study. Functional outcome and radiological outcome in 3 months’ post-operative period. Of them, 30 patients were selected for plate fixation and 30 patients selected for TENS. Of these patients, 46 were male and 14 females (23:7). The age group was 18 to 42 years with an average age of 27.7 years. All patients underwent surgery immediately after the fracture, on the same day or the next day. Mobilization of the limb and moderate physiotherapy started on 2nd post-operative day. In 5 patients, mobilization was delayed due to low pain threshold and was started after 1 week. At 3 months’ post-operative period, all the patients were evaluated radiologically by RUS (Radiographic Union Score) adapted from Whelan et al, and functionally by Nottingham clavicle score. Results: Overall results were, for plating, out of 30 Nottingham score >90% in 18(60%), 80-90% in 9(30%), 70-80% in 2(6.67%) and 60-70% in 1(3.33%) of patients. RUS was 4 in 20(66.67%), 3 in 6(20%) and 2 in 4(13.33%) of patients with fractures treated by plating. Of the patients, who were treated by TENS, out of 30 patients, Nottingham score >90% in 16(53.33%), 80-90% in 10(33.33%), 70-80% in 1(3.33%) and 60-70% in 3(10%). RUS was 4 in 14(46.67%), 3 in 12(40%) and 2 in 4(13.33%). Conclusion: Both the plate fixation and TENS gave good results in patients but functional outcome score by Nottingham and radiological score by RUS were slightly better for Plate fixation compared with TENS in our study.

Background: Coronary artery disease (CAD) imposes a substantial global burden, with millions affected. It remains a leading cause of morbidity and mortality, straining healthcare systems and necessitating proactive prevention and management efforts. Aims and Objectives: The present study aimed to study the prevalence OF Coronary Artery Disease among young Indian adults. Materials and Methods: The present study included 100 non cardiac patients attending the General Medicine OPD of Osmania General Hospital, Hyderabad. After obtaining consent, all the patients underwent detailed history taking, thorough clinical examination and necessary investigations. Data was collected in MS Excel, analyzed and presented as tables and figures. Results: Equal numbers of male and female patients were present in the study. The patients considered for the study fell into two (2) age groups, 20 – 30 years and 30 – 40 years. Both the age groups had almost equal no. of patients. Dyslipidemia was the most common risk factor in our study with 38% of the study population being dyslipidemic, followed by Hypertension (23%), Diabetes (21%), Sedentary Lifestyle (18%), Smoking (13%) and Obesity (9%). Family History of CAD was noted in 6% of study population. Conclusion: The current research highlights a notable occurrence of coronary artery disease (CAD) risk factors among the urban population in India. Consequently, urgent action is necessary to promote awareness about these risk factors, enabling proactive management of individuals at heightened risk for CAD in the future.

Aim and objectives: To analyze the anatomical and functional single ventricle lesions receiving Fontan circulation and morbidity and mortality in patients who underwent surgery. Material and Methods : All data from Case records : Patient demographics, Diagnosis, Surgeries Performed, OT records, and follow up record collected and analyzed in excel spread sheet. Continuous data was presented as Mean and Standard Deviation, categorical data as percentages, between 2011 and 2020.  Results:  In this study, there are 20 patients in which most common diagnostic presentation in this study group is Tricuspid atresia with pulmonary stenosis. Mean age group at which the Fontan procedure was performed is 11 years (all the patients are above 4 years of age) with slight female predominance. All the patients showed increased haemoglobin and haematocrit values. All the patients are in sinus rhythm with good Ejection fraction with normal venous return. Among which 7 cases required cardiac arrest due to dense adhesions or distorted anatomy due to previous procedure. 2 cases among those 7 cases required circulatory arrest and 1 case died on POD 4 due to Low cardiac output syndrome and the other case recovered. Among 20 patients, 6 patients underwent Non-Fenestrated Extracardiac Fontan procedure and 14 patients underwent Fenestrated Extracardiac Fontan procedure, of which Fenestrated Fontan procedures were showed improved outcomes compared to Non-Fenestrated Fontan procedure. In this study group, 13 patients underwent primary closure and 7 patients underwent delayed closure. 3 patients underwent Re-exploration. In this study, 3 patients developed Renal impairment post-operatively with significant morbidity. There patients were managed with the peritoneal dialysis and gradual improvement was found in 2 patients and 1 patient died on POD 3. The mean ICD duration is 13.9 days. In this study group, all the cyanotic congenital heart conditions with low SpO2 showed improvement after the Fontan procedure. The Mean SpO2 in this study group is 94%. The overall survival rate of this study group is 75% with a mean follow-up period of 5.5 years. Conclusion : After Fontan completion procedure with good outcomes after Extra-cardiac Total cavo-pulmonary connection with ePTFE conduit. Patients need to be followed up for long term. The multidisciplinary approach is most beneficial in proving good outcomes. The increasing quantity of the adult Fontan patients creates challenges for adult.

Introduction: India's traditional culture of abstinence from alcohol is facing challenges with the rapid proliferation of alcohol-related establishments and changing lifestyle choices. Alcohol consumption is a growing public health concern globally, associated with various health issues and socioeconomic consequences. Despite its significant impact, alcohol misuse has not received adequate recognition as a public health issue in India. This study aimed to investigate the prevalence of alcohol consumption and its associated risk factors in the rural field practice area of RIMS, Raichur, which is an underexplored region in the context of alcohol use. Methods: A cross-sectional study was conducted over six months, starting in January 2022, and involving 512 individuals in the rural field practice area of RIMS, Raichur. A multistage proportional sampling method was employed, and a semi-structured questionnaire was used to collect data on socio-demographic factorsand alcohol-related behaviors. Participants aged 30 and above, residing in the study area for at least one year, and willing to participate were included. Pregnant women were excluded for ethical reasons. Results: The study found that 18.20% of the participants reported alcohol consumption, while 81.80% abstained from alcohol. Age, gender, occupation, and education were significant determinants of alcohol consumption. Individuals aged 30-40 had the highest prevalence of alcohol use (22.73%), with males being more likely to consume alcohol (14.61%) than females (3.59%). Unskilled workers (10.32%) and illiterate individuals (14.04%) had higher rates of alcohol consumption. The study also revealed associations between alcohol use and health-related factors such as diabetes (51.9% prevalence among participants with diabetes), tobacco use (48.23% prevalence among tobacco users), BMI status, and physical activity levels. Conclusion: This study contributes valuable insights into the prevalence and risk factors of alcohol consumption in a rural context, shedding light on the extent of alcohol use in this underrepresented region. The findings emphasize the need for targeted public health interventions and policies to address the specific challenges posed by alcohol use in rural India. Understanding these patterns can help promote responsible alcohol use and mitigate potential health and social consequences in rural communities.

Background: During menstrual cycle the females undergo continuous variations in serum concentrations of female sex hormones. Moreover, the females in medical colleges struggle with lot of problems such as lifestyle, regular clinical duties and handling patients which create huge stress and affect their reproductive life. The oscillations in the hormonal levels found in different phases of menstrual cyclecause fluctuations in some of the physiological parameters like Peak expiratory flow rate (PEFR) which assess pulmonary function and muscle strength. Aims and objectives: This study aims to study the variation of PEFR, muscle strength and work done in different phases of menstrual cycle in medical students. Materials and methods: A total of 100 MBBS female students with regular menstrual cycle participated in the study. Participants were studied for 2 consecutive cycles in 3 phases of menstrual cycle. PEFR, work done and muscle strength were tested during each phase. Peak expiratory flow meter was used to measure PEFR. Muscle strength was measured using handgrip dynamometer and work done was obtained from Mosso’s ergograph. Data were statistically analyzed using repeated measures ANOVA and paired t- test. P<0.05 was considered significant. Results:  PEFR was significantly higher in the luteal phase of menstrual cycle as compared to the menstrual and follicular phase as observed in other studies in general population. Muscle strength and work done were observed higher in follicular phase as compared to menstrual and luteal phase, however the difference was not statistically significant. Conclusion:The observed improved PEFR in luteal phase may be due tohyperventilation and bronchodilation effect of progesterone on pulmonary function. Muscle strength and work done does not show significant variations during different phases of menstrual cycle.

Introduction: Since the introduction of technology such as ultrasonography and Peripheral Nerve Stimulator (PNS), Peripheral Nerve Blockade (PNB) has become an appropriate outpatient anaesthetic. When compared to central neuraxial blockade, it has the advantage of providing surgical anaesthetic with superior cardiorespiratory stability. PNBs reduce the need for postoperative analgesics, reduce the incidence of nausea, shorten the time spent in the post anesthesia care unit, and boost patient and surgeon satisfaction. Materials and Methods: 120 patients undergoing lower limb orthopaedic procedure were allocated randomly into two groups. The study was single-blinded, randomised clinical trial. Group A (n=60) received spinal anaesthesia and Group B (n=60) received sciatic-femoral nerve block (Anterior approach). Both Genders (Male/Female), Age- 65 yrs.-75 yrs, Body weight- 40 kg -70 kg, ASA Physical status- II, III, Patients with controlled co-morbid conditions were included in the study. Results: Study result showed no statistically significant differences in demographic parameters and duration of operation in between the groups (Table 1). Mean time of onset of sensory block was later in Group - B (Mean 11.40 mins.) than in Group A (Mean 4.65 mins.) and this was statistically significant (P <0.005, Table 2). Mean time of onset of motor block was later in Group B (Mean 16.30) than in Group A and this was statistically significant (P < 0.005, Table 2). Mean time of duration of sensory block was greater in Group B (518.5) than in Group A (165.24) and this was statistically significant (P < 0.005, Table 2). Conclusion: we observed that duration of sensory block, motor block and post-operative analgesia were more prolonged in case of sciatic-femoral nerve block than spinal anaesthesia. Sciatic-femoral block (Anterior approach) was associated with stable haemodynamic, lesser complications and is better tolerated by patient with good satisfaction scale compared to spinal anaesthesia. So, we can conclude that sciatic-femoral nerve block (Anterior approach) is a better alternative than spinal anaesthesia in case of high risk geriatric patients undergoing lower limb orthopaedic procedure.

Background: Females constitute a significant proportion of the healthcare community. An integral component that forms a part of the difficult work environment of health workers is both the long hours that they have to put in donning and doffing PPE kits. This also affects female workers, who also have to endure the psychophysiological changes and difficulties associated with menstruation while continuing to perform their clinical duties. Aims and objectives: The purpose of this study was to shed light on the difficulties faced by the female frontline workers who had to don PPE suits while menstruating. This study also focused on assessing if there has been any impact of the usage of PPE kits on their menstrual habits during this pandemic. Methodology: The study's methodology involved using a self-made questionnaire that five experts validated. The final sample size was calculated to be 264. A total of 309 individuals participated in our study. a total of 21 questions to evaluate the difficulties faced by female health care workers wearing PPE kits during the time of menstruation using inclusion and exclusion criteria. The collected data was entered into Microsoft Excel and analyzed by chi-square testing. Results: The study found that a significant number of female frontline health workers experienced fatigue (94.5%), sweating (88.9%), discomfort (85.4%), staining of undergarments (61.7%), pain (59.3%), itching in the genital area (50.6%), fainting or giddiness (50.6%), and chafing in the groin region (50%) while menstruating in PPE. It was also observed that a significant change had occurred in the menstrual hygiene habits concerning frequency of bathing (79.1%), number of sanitary pads, tampons, and menstrual cups used (68.4%), use of painkillers (47.8%), use of home remedies to alleviate pain (37.5%), and administration of medicines to delay menstruation (24.5%). Conclusion: This study found that difficulties like sweating, fatigue, discomfort when wearing pads, tampons, or cups, staining of undergarments, pain, itching in the genital area, fainting or giddiness, and chafing in the groin region were extremely common. Hence, it is recommended that appropriate measures be taken by the hospital administration to allay the difficulties faced by the female frontline health workers.

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

Introduction: Breast abscess is a painful condition that usually appears as a lump and is brought on by infection. Since it's one of the most prevalent medical conditions affecting women, it's critical to understand the most recent developments in isolated bacteria and antibiotics that can be applied empirically. The aim of present study is to evaluate the role of different antibiotics in breast abscess, efficacy of empirical antibiotic therapy and to find out the microbiology of the disease. Material and methods: The present ambispective study was conducted at E.S.I.C. Medical College and Hospital among females presented with breast abscess for a period of 2 years. Total cases selected were 160 based on inclusion and exclusion criteria. Statistical analysis was done using SPSS version 25.0. Level of significance was kept at p<0.05. Results: Maximum were in age group of <30 years (47.5%). Most common symptoms were pain (100%) and redness (85%). Examining subjects revealed that maximum 85% of subjects had Mastitis. The most common mycobacteria in abscess was MRSA (30%), followed by E.coli (15%). Linzolid was mostly susceptible with MRSA, Amikacin with E.coli and S.typhi, Gentamycinmycin/tetra with S.aureus. Conclusion: The majority of breast abscess cases involved the isolation of methillin-resistant Staphylococcus aureus. When choosing an empirical treatment for a breast abscess, understanding the microbiological profile and antibiogram of the bacteria is crucial.

Background: Cardiorenal syndrome type 1 (CRS1) represents a critical medical condition characterized by the rapid deterioration of cardiac function leading to acute kidney injury (AKI), posing significant healthcare challenges. Understanding this complex syndrome is crucial for improving patient care. Material and Methods: We conducted a one-year cross-sectional observational study at the Department of Medicine, Indira Gandhi Medical College, Shimla, enrolling consecutive patients with acute heart failure (AHF). We defined CRS1 as the rapid worsening of cardiac function leading to AKI and employed the Framingham Criteria for HF diagnosis. AKI was assessed using the AKIN classification. Various clinical, laboratory, and echocardiographic parameters were examined, and statistical analysis was performed. Results: Among the 92 AHF patients, 15 (16.3%) met the criteria for CRS1, while 77 (83.7%) did not experience kidney injury (NCRS1). Shortness of breath was the most common presenting symptom (93.47%). Patients with CRS1 had significantly lower total leukocyte counts (TLC) but no significant differences in other hematological or biochemical parameters. Dilated cardiomyopathy (DCMP) was a significant predisposing factor for CRS1, while other factors, including smoking, diabetes, and hypertension, did not contribute significantly. Medications for AHF management showed no significant impact on CRS1 development. Patients with CRS1 had higher mortality rates and longer hospital stays, with DCMP and Rheumatic Heart Disease (RHD) being major contributors to mortality. Conclusion: CRS1 is more prevalent in females and the elderly, presenting with shortness of breath and often triggered by infections. Lower TLC and DCMP are associated with CRS1 development. Smoking, diabetes, and hypertension appear unrelated to CRS1. Medications for AHF management showed no significant influence. DCMP emerges as a key underlying etiology, with CRS1 patients experiencing higher mortality rates and extended hospital stays, highlighting the need for tailored management strategies.

Objective: To evaluate the surgical outcomes of decompressive craniectomy in patients with cerebral venous sinus thrombosis (CSVT) at our institution. Methods: We conducted a retrospective analysis of 396 CSVT cases admitted to our institution. Among these, 45 (11.3%) underwent decompressive craniectomy. We assessed demographic data, clinical presentation, risk factors, Glasgow Coma Scale (GCS) scores upon presentation, and radiologic findings in relation to venous sinus and cerebral lobe involvement. Results: Of the 45 patients who underwent decompressive craniectomy, 26 (57.7%) were female and 19 (42.3%) were male. The mean age of incidence was 34 years, with a notable predominance in patients below 40 years (69%). The predominant presenting symptoms were headache (93.3%), altered sensorium (88.8%), focal motor deficit (60%), and convulsion (48%). Identified risk factors included chronic alcohol intake (31%), smoking (37%), postpartum status (30%), dehydration (51%), anemia (26%), homocystinemia (17.7%), and oral contraceptive pill usage (15%). In terms of GCS, 57.7% presented with scores between 8-12, while 22.2% had scores below 8. Radiologic findings revealed involvement of two or more sinuses in 21 patients. Specific sinus involvements were: superior sagittal (11 patients), sigmoid (7 patients), and transverse (6 patients). Regarding lobe involvement, the distribution was: parietooccipital (13 patients), frontal (10 patients), frontoparietal (14 patients), and temporoparietal (8 patients). Conclusion: Decompressive craniectomy serves as a crucial intervention in selected CSVT cases. Our study presents an institutional experience emphasizing demographics, clinical presentations, risk factors, and radiologic findings in patients undergoing this surgical intervention for CSVT.

Background: Diabetes mellitus is the most common disorder among endocrine disorders that are associated with hypomagnesemia. So far many studies have shown that Mg levels are lower in diabetic patients. According to CARDIA Study (Coronary Artery Risk Development in young Adults) there was an inverse relationship between Mg intake and the incidence of diabetes. Mg depletion may cause an insulin-resistant state, poor glycemic control and disordered lipid metabolism in diabetic patients. Furthermore, poor glycemic control in diabetic patients is a well-known risk factor for Mg depletion. Serum Mg depletion has been reported in diabetic patients who had advanced retinopathy and poor glycemic control. It has been shown that diabetic patients, hypomagnesemia has been associated with poor glycemic control and urine albumin excretion and complications Material And Methods This study was conducted for 1 year in the outpatient department of General Medicine, A. J. Institute of Medical Sciences and Research Centre, Mangalore starting from September 2019 to August 2020. Hospital based Observational study was conducted among 117 individuals. Diabetic patients were observed and serum magnesium levels were monitored. 23 patients were observed to have hypomagnesemia and the rest 92 were found to have normal serum magnesium levels. The results were analyzed using student ‘t’ test. Results The mean age in the hypomagnesemia group was 61.92 SD + .8.76, and in those with normal magnesium levels it was 60. 79 years SD + 8.90 years. In the hypomagnesemia group 52% were females and 48% were males and in those who had normal magnesium levels, 31.52%were females and 68.48% were males. 64 % in hypomagnesemia group and 12.77%, in the normal magnesium group had complications. The mean potassium in the normal magnesium group was 4.606 mEq/dl, hypomagnesemia group was 3.096 mEq/dl. The mean sodium in the normal magnesium group was 133.48 mEq/dL and in the hypomagnesemia group was 130.03 mEq/dL. Conclusion Prevalence of hypomagnesemia in diabetics is 25%. Prevalence of hypomagnesemia is significantly higher in patients with diabetic complications. Hypomagnesemia is significantly associated with glycemic control and potassium levels. No significant association was found to exist between hypomagnesemia, age and gender.

Chronic kidney disease is a silent epidemic of the 21 centuries. Surveys have suggested that as many as 16% of the adult population have CKD1. The most common, non –renal, chronic disorder in patients with ESRD are gastro intestinal disorders2, accompanying ESRD including those receiving renal replacement therapy. Among upper gastrointestinal lesions caused by chronic kidney disease gastritis, esophagitis, gastric ulcer are the most prevalent lesions. Here an attempt is being made to study the upper gastro intestinal changes in chronic kidney disease and evaluate their relationship with the stage of CKD or GFR. Methodology: We conducted a cross sectional study on 50 patients of, who are diagnosed to have chronic kidney disease and being presented to opd and admission in Navodaya Medical College and Research Center, Raichur over a period of one year. All patients with chronic kidney disease who underwent upper gastrointestinal endoscopy were included in the study. Results: 50 patients were included in the study with mean age and males 28 and 22 females. Among 50 patients 42 patients manifested with upper-gastrointestinal lesion among them erosive gastritis 13(26%) is most common upper gastrointestinal lesion followed by gastro esophageal reflux disease with or without duodenitis 8 (16%), duodenal ulcer ,gastric ulcer 4(8%) each, pangastritis 3(6%), GERD with gastritis, erosive duodenitis, erosive esophgitis, pale gastric mucosa 2(4%) each, angiodysplasia and hiatus hernia 1(2%) each. Conclusion: Majority of the patients with chronic kidney disease have upper gastrointestinal involvement on endoscopic evaluation. Erosive gastritis is the most common lesion Esophageal and duodenal involvement are less common than the gastric lesions. Upper gastrointestinal findings are frequently observed in chronic kidney disease patients on dialysis. Early diagnosis and management of these upper gastrointestinal lesions in CKD can reduce mortality and morbidity and prevent fatal complication like massive upper gastrointestinal bleed.

Background: Perforated hollow viscus is characterized by loss of gastrointestinal wall integrity with subsequent leakage of enteric contents. Aim: The aim was to conduct diagnosis and treatment of non-traumatic hollow viscus perforation and the principles of management that have evolved through years will be addressed. Materials and Methods: This study was done in the Department of General Surgery. A total number of 50 cases were included in this study, which satisfied the inclusion and exclusion criteria. Results: Most common age group involved is in 3rd  to 4th  decade in the present study. Male preponderance (82%) was seen, with a male to female ratio was 4.6:1. The time lapse between onset of symptoms and presentation at the hospital was more than 24 hours in 24% of the study population. Abdominal pain was the most consistent symptom and was seen in 100% of the study population in the present study followed by  vomiting (52%) and fever (46%). Distended abdomen was seen in 46% of study population in the present study. Tenderness was seen in all the cases and is more prominent at the site of perforation. Guarding/rigidity and absent bowel sounds were seen in 92% of the study population. Sensitivity of imaging in detecting gas under diaphragm was 72% by USG abdomen and 80% by plain radiography. Benign  causes  of  gastrointestinal  perforation  constituted  majority  of  non- traumatic gastrointestinal perforations. Perforated peptic ulcers were responsible for 68% of non-traumatic gastrointestinal perforations. Peptic   ulcer   perforation   (68%)   is   the   major   cause   of   gastrointestinal perforation in the present study followed by appendicular (24%) and typhoid (4%) perforations. Most  common  site  for  non-traumatic  gastrointestinal  perforations  in  the present study was duodenum (48%) followed by appendix (24%) and pre- pyloric region of stomach (20%). Simple closure with omental patch was the operative procedure done for all cases of peptic ulcer perforation and appendicectomy for appendicular perforation. Ileal perforations secondary to typhoid perforation were treated with resection and end-to-end anastomosis in the present study. Colonic perforation was managed with Hartmann’s procedure. Most  common  complication  in  this  study  was  SSI  (34%),  followed  by respiratory  infection  (22%).  Burst  abdomen  was  seen  in  2%  of  cases. Mortality in the present study was 8% and was due to septicaemia. Conclusion: There were many risk factors for increased morbidity and mortality which includes older age group, delayed presentation and features of shock, so, aggressive resuscitation and early meticulous surgery is required to decrease morbidity and mortality in hollow viscus perforation cases.

Introduction: World Health Organization clinically defines a stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’. Hypomagnesaemia leads to neuromuscular hyperirritability, tremors, increased vascular resistance, coronary vasospasm and hypertension. Hypomagnesaemia triggers vasoconstriction enhancing vascular endothelial injury and hence leads to atherosclerosis. Subjects and Methods: It was a case control study, undertaken in the Department of Medicine in S Nijalingappa medical college and HSK Hospital during the period of July 2021–December 2022. 30 patients with acute ischemic cerebral stroke fulfilling the inclusion criteria were selected. 2 ml venous sample for serum magnesium level was taken within 24 hours. Magnesium levels in patients after acute cerebral ischemic stroke were documented in patients, receiving standard management protocol of ischemic stroke. The correlation co-efficient of Hypomagnesaemia with modified Rankin Scale Score was calculated. Results: The mean age of patients was 45-80 years, 36 (60 %) patients were male and 24 (40 %) were females and there was male preponderance. The mean serum magnesium levels were measured. The present study observed a statistically significant correlation between modified Rankin Scale score measured at three months and serum magnesium level. Conclusion: It was concluded through the results of this study that Hypomagnesaemia in the body can cause more severe ischemic stroke.

Introduction: For centuries, alcohol use has been a significant social and health issue globally. based on a January 2015 WHO report.Each year, alcohol abuse leads to 3.3 million fatalities. Economic position, cultural background, educational attainment, physical and psychological health, geography, religion, and other environmental conditions are just a few of the elements that have been found to have an impact on alcohol consumption patterns. India’s alcohol consumption varies greatly by area. Alcoholic liver disease (ALD) can present with steatosis, liver cirrhosis, or any combination of these symptoms. Cirrhosis or hepatitis only affect 15–25% of long-term heavy alcohol users. Materials and Methodology: The Inpatients Department of General Medicine at PGIMER & CH, Bhubaneswar, Odisha, India, is the site of this hospital-based observational questionnaire study. Every hospitalised patient with liver illness at our facility who has ever used alcohol was tested. After obtaining their informed consent, the patients were questioned. Patients and their families were requested to provide a thorough personal and family history. Every patient's use of alcohol, including native alcoholic beverages, was recorded and converted to an average weekly gram intake. To confirm the diagnosis, every standard examination as well as supplementary research were conducted. The patient's data was gathered using a pre-made proforma. Including the specifics such age, gender, marital status, employment, yearly income, eating habits, drinking pattern, age at which drinking began, and amount of time spent drinking. The modified Kuppuswamy Scale was used to assess socioeconomic class. Results: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group.  Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week. Conclusions: The research comprised 186 patients, with a median age of 46 years. Of them, 139 (74.7%) were men, and the male to female ratio was 3:1. Compared to rural populations (39.24%), urban populations have a higher prevalence of alcoholic liver disease (60.75%). Alcoholic liver disease affects people in the Lower Socioeconomic Class (50.53%) more than in any other group.  Men consume alcohol at higher rates (>700 gm/wk), and married individuals use alcohol at significantly higher rates. When a female consumes 140–280 grammes of alcohol per week for ten to fifteen years, she is at a significantly earlier risk of developing alcoholic liver disease than a guy who consumes more than fifteen years of alcohol at a rate of >700 grammes per week

Introduction: Surgical site infections (SSIs) continue to be one of the most common complications in conventional surgery. Various risk factors for the development of poor wound healing have been identified. An SSI is defined as an infection occurring within 30 days of surgery that meets the following criteria: (1) the diagnosis consists of the infection of an anatomic plane by one of the following manifestations: collection, inflammatory signs (pain, edema, tenderness, redness), dehiscence, or positive culture; and (2) classification according to the anatomic plane as follows: superficial incisional SSI, infection of the skin and subcutaneous tissue; deep incisional SSI, infection of the deep soft tissue (fascia and muscles); and organ/space SSI, infection of the organ/space. Objectives: A) To compare the incidence of superficial SSI in surgical incisions closed with coated polyglactin 910 suture with triclosan versus incisions closed with coated polyglactin 910 suture without triclosan. B) To study the time frame between surgery and development of SSI. C) To determine which bacteria is commonly associated with SSI after surgical closure. Material and Methods: This is a Randomized, prospective, open, single centre controlled study was conducted in the Department of General surgery, B.J Government Medical College and Sassoon general Hospital, Pune over a period of 1 year. Institutional Ethical Committee permission was obtained prior to commencement of the study. Intra-operative data was collected. It included the method of painting and draping, duration of the surgery, antibiotics received during surgery. intra-operative findings, wound class and subcutaneous tissue sutured with coated Polyglactin 910 suture with/without triclosan. Results: Mean age of case in Non-TCS group was 37.9 years, whereas mean age of TCS group was 36.8 years. P value of 'Student's t test for comparison of age distribution in Non-TCS and TCS groups was not significant. This assured the age matching of the two groups. 40 males and 33 females were included in Non-TCS group: 34 males and 30 females were included in TCS group. The Chi-square test was applied to observe the sex matching in two groups. P value was not significant, assuring the sex matching of two groups. Maximum number of case (40%) operated in Non-TCS group were Class II wounds, whereas maximum number of case (42%) operated in TCS group were Class I wounds. Least number of case, i.e., 9% in Non-TCS group and 8% in TCS group belonged to Class IV wounds. Conclusion: In our study, the incidence of Superficial SSI rate after surgery has been observed to be reduced with the use of triclosan coated suture (coated Polyglactin 910 suture with triclosan), but it was not totally eliminated. The pathogens cannot be completely eliminated from the site of surgery, but they can be minimized. Antimicrobial coated suture is a promising novel method to achieve the goal of least Surgical Site Infection (Superficial SSI) rates. Large scale trials are needed to further demonstrate the evidence of efficacy of antimicrobial (triclosan) coated suture material (coated Polyglactin 910 suture with triclosan) in reducing SSIS. More research is needed together with improved compliance with already established measures.701-706701-706

Introduction: In today's demanding academic landscape, childhood leisure takes a backseat, impacting values and societal characteristics. Leisure, encompassing relaxation, enjoyment, and intrinsic motivation, plays a vital role in positive development, humanization, and interpersonal relationships. Its utilization varies based on location, parental education, and socioeconomic factors, involving physical activities, media engagement, and arts participation. Methodology: This cross-sectional study, conducted over a two-year period in Berhampur, Ganjam, aimed to explore the relationship between leisure activities and childhood obesity in both government and private schools. A total of 400 students participated, and the study assessed the quantity and quality of leisure time, correlating these factors with Body Mass Index (BMI). Result: The study identified an alarming prevalence of obesity (11.5%) and overweight (13%) among students, with private schools exhibiting a higher prevalence of obesity (22.3%) than government schools (8.3%). Males showed a higher prevalence of overweight and obesity compared to females, possibly influenced by cultural expectations. Discussion: A significant relationship between physical inactivity and BMI was observed, underscoring the crucial role of physical activity in obesity prevention. The findings emphasize the urgent need for interventions promoting physical activity to combat the rising prevalence of obesity among school children. Encouraging structured play and discouraging excessive screen time are vital components of fostering a healthy lifestyle. Conclusion: Prevention remains paramount, with the adoption of a healthy lifestyle, reduced sedentary time, regular exercise, and a nutritious diet being key strategies. Routine screening for overweight individuals is essential for timely interventions. Schools, parents, and pediatricians play pivotal roles in addressing this emerging health issue, highlighting the importance of a collaborative approach to promote and maintain a healthy lifestyle among school children.

Introduction: Adverse drug reactions (ADR) are an important aspect of drug therapy and can be a major setback in clinical practice. An ADR is defined by the World Health Organization (WHO) as ‘a response to a medicine which is noxious and unintended, and which occurs at doses normally used in man. The safety of drugs used in patients of an adult age group cannot be extrapolated to a pediatric age group. The pharmacokinetics and pharmacodynamics of many commonly used drugs vary significantly between these two age groups of patients2.  Adverse drug reactions (ADRs) in children can have a relatively more severe effect when compared to adults. Thus, the ADRs can lead to significant morbidity among children.3 An increase in the number of drugs and self-medication with various medications have enhanced the occurrence of adverse drug reactions in recent times, especially in pediatric population. Material & Methods: This was a prospective, observation based, non-interventional study was Conducted in Dept. of Pediatrics, SCB Medical college and SVPPGIP, Cuttack which are two institutions under one department. This Department is a tertiary care center for pediatric patients in our state. Our institution is an approved ADR Monitoring Center (AMC) under Pharmacovigilance programme of India (Pvpi). ADRs were confirmed by the clinicians based on temporal relationship between start of drug and reaction, withdrawal of drug leading to decrease severity or abolition of reaction (dechallenge), exclusion of other causes etc. Sensitization of doctors in various seminar were done for spontaneous ADR reporting in Suspected Adverse Drug Reaction Reporting Forms by health care professionals. Results: Out of total 350 cases, dermatological system was most commonly involved i.e. 207 cases (59. 14%).This is followed by involvement of central nervous system 46 number of cases (13.14%). The GI system was involved in 34 cases i.e. (9.71%). Most of the ADRs were due to Antibiotics, these drugs are involved in 198 (56.57%) cases. Commonest antibiotics causing ADRs were Ofloxacin involving 26 cases (13.13%) of antibiotics followed by Ceftriaxone and cefixime comprising 22 cases (11.11%) and 14 cases (7.07%) respectively of total antibiotics used. A single drug as a possible causative agent of ADR,177 such cases were reported which constituted 50.57% of the total ADRs. Sometimes these agents were used with other drugs but Dechallenge test ruled out the probability of other drugs involvement. Out of 177, 110 drugs caused ADRs when used alone i.e. 31.4 % drug reactions were caused by monotherapy. Conclusion: Our study showed varied range of ADRs with higher reports in male children compared to females and maximum reports of ADRs obtained in age group 5-10 Years. Dermatological ADRs have highest incidence out of all the ADRs and FDE is most frequent among dermatological ADRs. Antibiotics were the commonest suspected agent in the reported ADRs. This study also exposed high occurrence of over-the-counter prescription to the pediatric age group causing ADRs (20.87%) of total ADRs and 12% of total serious ADRs. Incidence of serious ADRSs were more where multiple drugs were the suspected causative agents of ADRs. Various atypical ADRs were also observed due to active monitoring. Hence this study further emphasizes the need of proactive Pharmacovigilance, restriction of over-the-counter medications and increasing awareness among health care professionals, patients and public, for rational use of antibiotics, avoiding multidrug therapy and FDCs to reduce the incidence of ADRs especially in pediatric age groups.

Background: Pulmonary function tests fulfil a pivotal role in respiratory medicine. They are used to diagnose airways obstruction, assess its severity and prognosis, delineate risk factors, detect early lung disease, and monitor for normal lung growth and lung function decline. Also many prediction equations are based on small numbers of subjects, using data collected decades ago so that changes in Spiro metric methodology and secular trends may affect the applicability to present day measurements. Materials and methods: This is a prospective study conducted for 6 months taking subjects. Total 90 subjects of age group 14 to 19 years were included in the study. A simple random sampling method was used to include subject for the study. Total number of subjects studied in each group was decided depending on the total population of the group in the locality. Data was collected from all willing volunteer subjects. However, the result obtained from the subjects coming under the exclusion criteria is excluded from the final calculation. Lung function parameters including FVC, FEV1 and FEV1/FVC were mainly used in our study. Result: Anthropometric and spirometry data for the 90 subjects who participated in spirometry testing is displayed. The mean Body mass index (BMI) for females was 24.2 and 25.2 for males. In females, the annual decrease in height was 0.19 cm/year (CI 0.13– 0.24, r2 = 0.27, F = 48.8, p < 0.001), whereas the annual decrease in males was 0.14 cm/year (CI 0.08–0.19, r2 = 0.15, F = 26.0, p < 0.001). Conclusion: Several CVD-linked proteins were associated with FEV1 and FVC but not with FEV1/FVC ratio, suggesting that the relationships are mainly with lung volume, not airflow obstruction. That increased levels of several proteins are associated with better lung function warrants further studies.

Background: Type I Diabetes Mellitus is the most common endocrine-metabolic disorder of childhood and adolescent. Diabetic ketoacidosis is a potentially life-threatening complication among children, characterized by triad of hyperglycemia, ketosis and academia, accounting for majority of hospital admissions and deaths related to Diabetes in children.  Early diagnosis and prompt management substantially reduces the mortality. Objectives: This study was done to evaluate clinical profile, severity, complications and immediate outcome of patients admitted in PICU with Diabetic Ketoacidosis. Results: Out of 30 children included in our study, 70% were females(n21) and 30% were males(n9). Newly diagnosed diabetics accounted for 17 (56.5%) of the patients. The common presenting complaints of DKA in our study was altered sensorium (100%), rapid breathing (93%), vomiting (80%) and abdominal pain (73%) followed by polyuria (63%), polydipsia (60%), weight loss (50%) and fever (40%). Amongst all 30 cases, 20 patients (66%)had moderate dehydration meanwhile 10(33.3%) had severe dehydration. Complications like Hypokalaemia (20%), other electrolyte imbalance (16%) like hypocalcaemia, hyponatremia, superadded infection (26%) like upper and lower respiratory tract infection, acute febrile illnesses were commonly encountered in our study and 11(36%) cases of DKA were not associated with any complications. Out of 30, 5 (16%) children had mild DKA, 13(43%) children had moderate DKA and 12 (40%) children have severe DKA. In our study, all patients recovered and were shifted to ward with mortality of 0%. Conclusion: DKA was most prevalent in newly diagnosed IDDM cases. Infections was the most common precipitating factor. No lethal complications were recorded in our study.

Background: Skull base (SB) injuries happens mostly either in the thinnest or the least resistant part of skull base. The lateral lamella of cribriform plate is one of the common sites of injury during endoscopic anterior skull base surgeries. The anterior ethmoidartery (AEA) visualization is considered as a significant anatomical landmark in such surgeries. Studies correlating their positional relation with morphology of olfactory fossa remain limited. This study aims to look into the relation of AEA to that of SB in different types of olfactory fossa morphology. Materials and methods: A surveying radiological study was conducted on 90 coronal CT images from patients who were exposed to paranasal CT imaging in a tertiary care teaching hospital. The examination included all CT images as well as an indication of sinusitis. The exclusion being changed skull base anatomy as a result of previous surgical intervention, injury, or tumour, and age less than 18 years. RadiAnt Dicom viewer was used to inspect the images. [8] The position of AEA in relation to SB was identified in the bone window of coronal CT scans. On each side, it was divided as at SB or below SB. the longitudinal distance from AEA to SB was evaluated separately. Depending up on the distance of AEA from SB, 3 groups were sectioned as follows: set A - < 2.5 mm, set B – 2.5 to 5 mm and set C - > 5 mm. Result: In our present study of 90 patients, number of male patient was 58 (64.4%) whereas number of female patient was 32 (35.6%) [Table 1]. Age of patient was from 18 years to 80years. anterior ethmoidal artery canal was seen in 30% (27) scan. Most of those were complete type.  Anterior ethmoidal foramen was seen in 90% (81) of CT scan. Supraorbital pneumatisation was seen in 40% (36) scan [Table 2]. Conclusion: It was concluded that notch which was present in the medial wall of orbit was a very good landmark to locate anterior ethmoidal artery and it was found in 98% of cases and in 28% of CT scan supraorbital pneumatisation was found which has a very close relationship with visualization of anterior ethmoidal artery canal.

Introduction: India is the second most populated country in the world, with children under the age of 14 making up around 28.6% of the total population [1]. Children under the age of five make up 20% of India's population. It has been shown that children's mortality and morbidity are inversely correlated with their age. The national average for U-5, newborn, and neonatal death rates is 50, 41, and 29 per 1000 live births, respectively, according to NFHS 4[1]'s most current figures.Twenty-one percent of U-5 child mortality occur in India alone. The purpose of Millennium Development purpose 4 (MDG4) is to reduce the rate of under-five mortality by 66% from 1990 to 2015.Neonatal causes account for 4% of U-5MR cases worldwide, followed by pneumonia (17%), diarrhoea (9%), malaria (7%), and other conditions such as meningitis, AIDS, measles, and injuries (24%). Malnutrition is a factor in 45% of U-5 mortality. These death rates serve as sensitive gauges for more than just health.Material and Method: This observational study was conducted in a tertiary care teaching hospital from November 2018 to October 2020 on 28 days to 5 years old children admitted in pediatric ward. Before enrolling the patient, the inclusion and exclusion criteria are applied and Institutional Ethical Committee approval was taken. Informed consent was obtained from the parents.All the information about the diseased child, demographic characteristics, feeding status, immunisation, socioeconomic status was recorded. Nutritional status of the patient and anemia status was recorded and detailed study of disease profile and cause of mortality were recorded in the case record sheet, all children of both sexes, aged 28 days to 5 years, admitted in the pediatric ward of the teaching hospital and parents willing to participate in the study, were included.  Result:Hence, it is possible that the prevalence of malnutrition might vary depending on the criterion used. The study conducted by Kamran Ahmad et al. found a noteworthy correlation between feeding practises and malnourishment. There is a noteworthy correlation between them in children under five, according to several research conducted in hospitals and communities. Families, especially mothers, need to be made aware of the nutritional needs of their children and how to provide a healthy meal at home using inexpensive, readily accessible foods. It is the responsibility of healthcare professionals to advise parents on the value of family planning, birth spacing, vaccinations, exclusive breastfeeding until the child is six months old, and when to wean their child.Conclusion: Present study concludes pneumonia is the leading cause of death i.e. (30.5%) followed by CNS infection (27.7%), malaria (19.4%), diarrhea (11.1%) respectively.Similarly the morbidity of under- five hospitalised children are the conditions like pneumonia (32.5%), malaria (16.7), CNS infection (16.4%), diarrhea(12%) respectivelyMorbidity and mortality in under- five children are more associated with malnutrition. Maximum number of cases in hospitalised under five children are having moderate acute malnutrition (i.e. 49.5%) and severe acute malnutrition in 13.7% cases. Among the mortality maximum percentage of cases (72%) are having MAM and 14% of cases having SAM.

Background: Cardiovascular disease (CVD) has become a major public health problem and leading cause of mortality in developing countries. Cardiovascular risk assessment approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs. so that immediate preventive measures or action can be taken to reduce the risk. Aim: The present study was conducted to assess the CVD (myocardial infarction or stroke) risk by utilizing the WHO/ISH risk charts (non-cholesterol based/ noninvasive chart) in a tribal population of Nasik, India. Methods: This was a cross-sectional community-based study conducted in the rural health training center of the tertiary Healthcare Institute Nashik on 110 participants. The WHO/ISH risk prediction chart for South-East Asia Region D (SEAR D) was used for calculating the 10-year cardiovascular risk. Results: Among total 110 study participants, 83 (75.5%) were in the mild-risk (<10%) category. The 10-year risk of myocardial infarction and stroke is comparable among both sexes (Male- 24.4%, female – 25%), type of occupation (Farmer 24.4%, Non-farmer group – 24.6%), and educational status (Up to secondary level – 25%, above secondary education – 23.3%). Risk factors such as advancing age, three generation family, Tobacco addiction, Family History of Diabetes, Stress, high blood pressure (Both SBP & DBP) and raised random blood sugar level were found to be significantly associated with increased risk of the major cardiovascular event. Conclusion: WHO/ISH chart is a best useful tool in identifying CVD risk. This can further help in planning and implementing targeted interventions amongst identified high risk population in tribal population.

Introduction: Amniotic fluid embolism (AFE) is remarkably infrequent yet carries a high mortality rate when it occurs. Here we report a case of AFE which was complicated by cardiac arrest, severe acute respiratory distress syndrome, and disseminated intravascular coagulopathy that was treated via our Mobile ECMO program. Case presentation: A 29-year-old gravid female at 40.5 weeks of gestation who experienced sudden hemodynamic instability secondary to AFE during labor. The patient exhibited a generalized tonic-clonic seizure, which was followed by pulseless electrical activity, necessitating emergent delivery via cesarean section of a healthy neonate. The patient’s condition continued to worsen and she suffered multiple cardiac arrest events, hypoxemia, and massive uterine bleeding. Due to hemodynamic compromise, the mobile extracorporeal membrane oxygenation (ECMO) team was activated and the patient was placed on a veno-arterial (VA ECMO) circuit. Subsequently, the patient developed abdominal compartment syndrome and required a bedside exploratory laparotomy. Following this intervention, the patient's hemodynamics stabilized, her cardiac and respiratory function improved, and VA ECMO was able to be removed on the fourth day. The patient remained neurologically intact and eventually was transferred to a rehabilitation facility. Discussion: Despite recent advances in prenatal care, AFE remains a significant and potentially fatal complication of parturition. Early recognition and prompt treatment are important, and refractory cardiopulmonary collapse can be supported with VA ECMO. The mobile ECMO program increases access to this life saving technology. Conclusion: Our report underscores the efficacy of ECMO as a therapeutic modality for AFE and the benefit of mobile ECMO in expanding access for this life saving technology.

Introduction: The World Health Organization (WHO) definition of stroke is: “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”. The pathological background for stroke may either be Thrombotic or hemorrhagic disturbances of the cerebral blood circulation. Thrombotic cerebral infarction results from the atherosclerotic obstruction of large cervical and cerebral arteries, with ischemia in all or part of the territory of the occluded artery. Hyperhomocysteinemia has been emerging as an independent risk factor for atherosclerosis. Several workers opined that moderately elevated plasma Homocysteine (Hcy) concentration might be an independent risk factor for cerebrovascular disease including stroke and transient ischaemic attack. Material and Methods: The study is a hospital based observational study was conducted in the Department of General Medicine at ACSR Government Medical College, Nellore from Dec 2022 to October 2023. 31 patients with thrombotic stroke(cases) and 31 subjects without thrombotic stroke (controls) and other comorbid conditions that affect serum homocysteine were included in the study. Venous blood samples were collected in tubes containing disodium EDTA. Homocysteine assay is based on the measurement of co-substrate conversion product. Results: In the present study, the mean age ± SD of cases was 55.03±14.51. The mean age of males was 51.68±13.45 and the mean age of females was 60.33±15.11. The mean age in control group was 51.22±13.77. The mean serum homocysteine level in the present study, in cases was 25.98±11.95. The mean homocysteine level in males was 7.83±14.29. The mean in females was 23.05±5.67. The mean homocysteine level in control group was 7.19±3.51. Mean homocysteine level of cerebral ischemic stroke females was 14.86 ± 5.34. The mean homocysteine level in controls was 7.428 ± 4.091. The mean homocysteine level in controls was 12.30± 4.68. The mean cholesterol of the cases was167.67±40.68. The mean LDL in the study was 89.74±27.38. The mean HDL was 38.48±10.92. Conclusions: Serum homocysteine levels were significantly higher in those paients with stroke when compared to those without stroke. Apparently, Serum homocysteine level is an independent risk factor for thrombotic stroke.

Introduction: The composition of the normal human ocular surface flora includes Staphylococcus epidermidis, Staphylococcus aureus, and diphtheroids. There are several factors that may alter the composition of ocular surface flora: age, dry eye, immunosuppressive medication and medical illnesses such as diabetes mellitus. Patients in the intensive care unit (ICU) frequently have impaired ocular defence mechanisms as a result of metabolic derangements, mechanical ventilation, sedation, paralysis and decreased level of consciousness. Dry eye is one of the major risk factors of infectious keratitis. Intensive care unit (ICU) patients are susceptible to a number of ophthalmic conditions that may result in visual loss. Aims and Objectives: To evaluate the Conjunctival Swab Culture among Patients admitted to the Intensive Care Unit who are on ventilators. Materials and Methods: Inclusion Criteria :1. All patients aged 18-65 years admitted to RICU for a time period >48 hours were included. 2. Neonates in NICU. Exclusion criteria: Patients who presented with ocular surface disorders prior to admission in RICU. Results: In this study, a total of 28 patients were taken. Among these are 16 males, 4 females and 8 neonates. In this study, 8 cases positive for Gram-positive cocci were seen in singles, pairs, tetrads and clusters in the right eye and 7 cases in the left eye. Coagulase-negative staphylococci were isolated in 6 cases in the right eye and 4 cases in the left eye. Conclusion: ICU medical and nursing staff are primarily concerned with life-threatening conditions; therefore, the ocular signs and symptoms may be missed, leading to serious ocular complications, including corneal ulceration and infectious keratitis. For these reasons, meticulous eye care with regular cleaning of the eyes, installation of lubricating drops and ointments, and consultation from an ophthalmologist in case of a suspected infection [8,9] are recommended.

Background: Hypokalemia, a common electrolyte disorder, poses substantial risks to various organ systems, necessitating effective identification of its underlying causes. The association between hypokalemia and hypomagnesemia, prevalent in clinical studies, underscores the need for comprehensive exploration in diverse populations, including limited Indian data. Methodology: A cross-sectional descriptive study was conducted at MKCG Medical College and Hospital, Berhampur, involving 154 participants aged 18 and above with hypokalemia (serum potassium <3.5 meq). Serum magnesium levels were analyzed (defining hypomagnesemia as <1.7 mg/dl) from August 2021 to November 2022. Statistical analysis employed R software, encompassing t-test, chi-square, and Pearson correlation. Results: Among 154 subjects (78 females, 76 males, mean age 45 +/- 09 years), the mean magnesium and potassium levels were 1.5825 and 2.8265, respectively. Hypomagnesemia occurred in 61.7% of hypokalemic patients. The mean magnesium levels for hypomagnesemia and normal magnesium groups were 3.1158 and 2.77, respectively. No significant correlation (p = 0.102) was observed between hypokalemia and hypomagnesemia. Discussion: Our findings indicated a higher frequency of hypomagnesemia in hypokalemic patients. Variations in reported associations between magnesium and potassium levels among studies highlight population heterogeneity. The discussion emphasizes the role of magnesium deficiency in exacerbating hypokalemia and underscores the importance of timely recognition and treatment. Conclusions: Hypomagnesemia is prevalent in hospitalized patients with hypokalemia, emphasizing the necessity for increased clinical awareness. Larger-scale investigations are recommended to explore the interconnected occurrence of these disturbances and evaluate the clinical utility of routine magnesium measurement in hypokalemic patients. Further research with expanded cohorts is encouraged for a comprehensive understanding of electrolyte imbalances.

Background: Hematological and inflammatory markers play a crucial role in assessing and differentiating between granulomatous and non-granulomatous lymphadenitis. Lymphadenitis refers to the inflammation of lymph nodes, and it can be categorized based on the presence or absence of granulomas. Granulomatous lymphadenitis is characterized by the formation of granulomas, which are aggregates of immune cells, particularly macrophages, that are surrounded by lymphocytes. Non-granulomatous lymphadenitis, on the other hand, lacks the formation of granulomas. Inflammatory markers play a crucial role in assessing and distinguishing between granulomatous and non-granulomatous lymphadenitis. These markers are substances in the blood that are elevated in response to inflammation. Here's an overview of the role of inflammatory markers in these two types of lymphadenitis. Materials and methods: This is a prospective study was conducted in the Department of Pathology, Tertiary Care Teaching Hospital over a period of 1 year. The study included 160 patients sample neck mass cases. Research participants were categorized as granulomatous and reactive lymphadenitis according to their cytological report. Samples were collected in tubes containing ethylenediaminetetraacetic acid and analyzed by automated blood count according to hospital procedures. An automated hematological analyzer was used to measure hematological parameters. We studied parameters such as TLC(Total leucocyte count), DLC(Differential Leucocyte Count), NLR(Neutrophil Lymphocyte Ratio), PLR(Platelet Lymphocyte Ratio). CRP was measured on a semi-automated analyzer 300, and ESR by the Westergren method. Result: In our study, out of a total of 160 cases, 80 were classified as granulomatous and 80 cases as reactive lymphadenitis. In the studied population, there were 64.5% females and 35.5% males. In our study found a female preponderance in both study groups as indicated. The average age of the study group was 29.59±0.95 in granulomatous lymphadenitis and 28.36±18.65 in non-granulomatous. All laboratory parameters in the two groups of lymphadenitis are shown in Table 4 indicating differences in their mean values. Hematological parameters such as NLR, PLR and CRP were significantly increased in patients of granulomatous disease and showed statistical significance with disease severity (P<0.001) where as other parameters such as TLC, ESR was not significant. Conclusion: Hematological and biochemical parameters like NLR, PLR, and CRP can give us some indication before FNAC for the presence of granulomatous and non-granulomatous lymphadenitis. It will help the treating doctor think methodically about early case identification and avoid diagnostic delays in situations like tuberculosis, especially at the primary care level.

Background: Diabetes mellitus (DM) is a chronic endocrine metabolic condition that is mainly avoidable and non-communicable, resulting in millions of deaths, crippling complications, and incalculable human anguish each year. It constantly exhibits three key abnormalities: resistance to insulin action in peripheral tissues, particularly muscle and adipose tissue, reduced insulin secretion, and increased glucose synthesis by the liver. Objectives: 1. To estimate the value of serum adenosine deaminase (ADA) in patients with uncomplicated type 2 diabetes mellitus through a Cross sectional study. 2. To determine any correlation exists between serum ADA and blood glucose values. Material & Methods: Study Design:  Hospital-based, cross sectional study. Study area: The study was conducted in the Department of General Medicine, Siddhartha medical college, Vijayawada. Study Period: September 2022 to August 2023. Study population: Individuals with uncomplicated type 2 diabetes mellitus including both male and female, of age group 30-70 years attending to the hospital. Sample size: Study consisted a total of 100 subjects. (50 cases and 50 controls). Study tools and Data collection procedure: A pre-structured and pre-tested proforma was used to collect the data. Informed consent was taken from all cases and control subjects. A detailed clinical history and physical examination was an integral part of the methodology. Relevant investigations (blood urea, serum creatinine, lipid profile, urine protein, ECG, Fundoscopy etc.) were done before selection of subjects for the study. For all the subjects standing height and weight were measured. BMI was calculated as per the formula: Weight (Kg)/Height(meters)2. Results: In the present study the mean ADA in study group is 40.60±8.65 and in the control group is 19.75±2.65. In the present study the mean FBS in study group is 172.24±76.47 and in the control group is 82.34±10.77. Conclusion: Serum levels of ADA were found to be significantly higher in type 2 diabetics when compared to controls. A very large correlation was found to exist between serum ADA and blood glucose values. Statistical association was found between serum ADA and the long term index of glycemic control, HbA1c. Body Mass Index, Age, Sex, duration of diabetes was not found to significantly influence the ADA level.

Background: As we all know that Stroke is becoming an important cause of disability and premature death in low-income and middle-income countries like India, affecting largely the poorer sections of the society driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors which impoverish their families further. Therefore, our study was planned to evaluate the risk factors and their prognostic value in patients of ischemic stroke in our setup? Research Question: What are the risk factors and their prognostic value in the patients of ischemic stroke?The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one-year observational study was conducted during the period from October 2022 to September 2023 on about 100 Ischemic Stroke cases admitted during the above period in the department of General Medicineby studying their socio-demographic profiles, associated risk factors, assessment of the degree of severity in association with risk factors, clinical course and outcome, etc. Results: Among the total study subjects 61% were male and 39% were female and it was observed that the distribution of the disease was more as age advances and it was also noticed that the severity of the disease was more among males when compared to females. Among all the study subjects 55% had hypertension followed by 45% had diabetes mellitus, 34% had history of smoking, 26% had history of regular alcohol intake, 23% had dyslipidemia, 13% had heart disease, 6% had hypercoagulable states,10% had history of TIA, 6% had history of migraine, 3% had history of OC pills usage and 2% had family history of stroke. Hypertension, Diabetes and smoking were the common risk factors present in the majority of the study subjects. Regarding the outcome of the disease the disability and mortality was more among the study subjects who had hypertension and diabetes when compared to non-hypertensive and non-diabetic study subjects significantly(P<0.001).

Background: The prevalence of asthma has been rising over the past few decades, making it one of the most prevalent chronic diseases in the world. Although the precise cause of asthma is still unknown, it most likely results from intricate interactions between a number of hereditary and environmental factors. According to the World Health Organisation (WHO), 300 million people worldwide suffer from asthma. The effects of vitamin D as a hormone have drawn more attention recently. Every component of the immune system seems to be regulated by vitamin D, with a lack of the vitamin being associated with a number of immunologically based illnesses, including asthma. Therefore, it is beneficial to check serum vitamin D levels in bronchial asthma patients. Aim and objectives: To identify any correlations between vitamin D deficiency and the severity of asthma and the objective of the study is to evaluate the serum 25(OH) D level in patients with mild, moderate, and severe asthma. Material and Methods: This is a cross-sectional observational study, which involved 100 participants between the ages of 15 and 50, of both genders with a mean age of 37.40±9.46 years. They were divided into two groups: Group A (control) consisting of 40 healthy individuals (22 males and 18 females) and Group B consisting of 60 asthmatic patients (34 males and 26 females). Group B was further subdivided into three subgroups (A, B, C), based on FEV1% and symptom severity as per the Global Initiative for Asthma (GINA) guidelines. An assay of serum vitamin D levels by ELISA was performed in both groups. Results: The results of the study demonstrated that asthmatic patients had considerably lower serum vitamin D levels than the control group. Conclusions: There is a significant inverse association between serum vitamin D levels and the severity of asthma symptoms, and vitamin D deficiency is rather common in people with asthma. As a result, when routinely evaluating individuals with asthma, serum vitamin D levels should be taken into account. It could be used to indicate the severity of asthma.

Introduction: UTI is a prevalent condition that affects approximately 40% of the adult population. Clinical Syndrome may be characterized as Asymptomatic Bacteriuria, Uncomplicated Cystitis, Pyelonephritis, Prostatitis, or complicated UTI. The goals of treatment of urinary tract infection are to eliminate the pathogen, to prevent Urosepsis, and to reduce the risk of renal scarring. Objective: To study the culture and sensitivity patterns of urinary tract infections in asymptomatic patients in a tertiary care hospital. Methods: A total of 120 samples were collected from January to June 2023. Identification was conducted by conventional biochemical tests. Antibiotic sensitivity test was analysed by disc diffusion method using different antibiotics and their zone of inhibition was measured. Results: Out of 120 subjects enrolled, 67 were males and 53 females The most common urinary pathogen isolated was E. Coli (64%) sensitive most often (82% sensitivity) to Amikacin. Overall sensitivity of different urinary isolates to amikacin was highest (82%).  Conclusion: Epidemiology and resistance patterns of bacterial pathogens in pediatrics urinary tract infection show large interregional variability, and rates of bacterial resistances are changing due to different antibiotic treatment. Knowledge of spectrum of pathogens and their patterns of drug resistance is indispensable for the empirical section of an effective therapeutic agent prior to availability of culture result.

Introduction: Palpable breast swelling, whether benign or malignant, results from hormonal influences. Most cases are benign. Triple assessment—clinical, histological, and radiological—enables accurate detection and evaluation, guiding effective interventions. The research aimed to compare the patterns of breast swelling in premenopausal and postmenopausal women and identify the most common breast lumps in each group. Methods: One hundred female patients with palpable breast lumps were evenly divided into premenopausal (50 patients) and postmenopausal groups (50 patients). Each patient underwent clinical examination, fine-needle aspiration cytology (FNAC), and core needle biopsy if necessary. Ultrasonography (USG) of the breast was conducted for all patients, and mammograms were performed for selected cases. All postoperative specimens underwent histopathological examination. Results: Among the total 100 patients, 60 were diagnosed with benign breast disease, and 40 had malignant breast disease. In premenopausal women, 82% were diagnosed with benign disease, while in postmenopausal women, 38% had a benign diagnosis. Conversely, premenopausal women showed an 18% incidence of malignant breast disease, while postmenopausal women exhibited a 62% incidence. Among malignant breast diseases, 60% were invasive ductal carcinoma, 32.5% were invasive lobular carcinoma, 5% were invasive medullary carcinoma, and 2.5% were inflammatory carcinoma. Conclusion: The study finds a higher prevalence of malignant breast disease in postmenopausal women, while premenopausal women commonly experience benign breast disease, notably fibrocystic cystic disease. Premenopausal women exhibit a higher percentage of invasive lobular carcinoma than the general population, while postmenopausal women predominantly face invasive ductal carcinoma breast NST/NOS with increased invasive lobular carcinoma.

Background: Cannabis is the generic word for all psychoactive preparations of the Cannabis sativa plant. Delta-9 tetrahydrocannabinol (THC) is the main psychoactive component in cannabis. Cannabis is one of the most often used illegal substances in the world. Cannabis is the fourth most prevalent psychoactive substance in the world, behind coffee, nicotine, and alcohol, with an estimated 200 to 300 million regular users. Objectives: 1. To evaluate sociodemographic profile among persons abusing cannabis. 2. To evaluate problematic domains among persons abusing cannabis. 3. To evaluate withdrawal symptoms among persons who abstain from cannabis. 4. To estimate the distribution of psychiatric comorbidity among persons abusing cannabis. 5. To estimate sociodemographic variables and psychosocial attributes between adolescent and adult-onset of cannabis use. Material & Methods:Study Design:  Hospital based prospective cross-sectional study. Study area:Manasa Psychiatry Hospital, Secunderbad, Telangana. Study Period: August 2022 – August 2023. Study population:  Participants were patients diagnosed with cannabis use disorders who came to the Psychiatry Department. Sample size: Study consisted a total of 40 subjects.  Sampling Technique: Convenience sampling. Study tools and Data collection procedure: After obtaining the written consent from the participants as required by the international ethics committee the following questionnaire was given to all subjects 1. Semi-structured proforma 2. Marijuana problem scale 3. The Cannabis withdrawal scale 4. MINI PLUS structured clinical interview. Results: In our study, those who seek cannabis-related problems were predominantly male i.e. 100%. No females registered for cannabis-related problems during our study period. 75% of people were below 10th standard. 80% of individuals with CUDs were unmarried. 30% were unemployed among persons who presented with CUDs. 92.5% of patients belong to low socioeconomic status. 90% of patients belong to Hinduism. 72.5% of patients belong to urban areas. In our study statistically significant difference in marital status and religion i.e., most of the adolescent-onset cannabis users were unmarried and Hindus. But occupation, place, SES there was no significant difference between these 2 groups. Conclusion: Psychiatric comorbidity is widespread in people who are addicted to cannabis, especially those who seek treatment. Cannabis withdrawal symptoms worsen as the length of cannabis addiction grows. The most common associations with cannabis abusers are comorbid other substance use and a family history of substance use. Adolescents who start using cannabis have lower levels of psychosocial characteristics such as impulsivity, drug-using peer relationships, drug availability in the neighbourhood, and skipping school or job than those who start using cannabis in early adulthood.

Introduction: Urinary   bladder lesions   including both non-neoplastic and neoplastic lesions are disabling. Neoplastic lesions of the bladder are responsible for significant morbidity and mortality throughout the world. Urinary bladder cancer is 2nd most common cancer after prostate cancer in genitourinary system.  Histopathological analysis of cystoscopic bladder biopsy and Transurethral resection of the bladder tumor (TURBT) material are the mainstay for cancer diagnosis. Aim: The aim is to analyze the relative incidence, clinical presentation and spectrum of lesions in the urinary bladder at our institute which is tertiary referral Hospital. Material and Methods: A retrospective study of all urinary bladder specimens which were received in the department of pathology, Osmania General Hospital during a four-year period from Jan 2019 to Feb 2023 was conducted. Clinical data like age, sex, clinical presentation was recorded. Tissues were grossed, bits processed sections stained with Hematoxylin &Eosin, and examined microscopically. Immunohistochemistry was done to confirm the diagnosis. 118 Cases recorded during the 4-year period were analysed. Results: 118 cases were studied during period of 4 years.  Of them    13 cases were benign and 105 cases were malignant. Commonest symptom was hematuria. Most of the benign lesions occurred in the 4th decade, malignant tumors were common in 6th decade. Commonest benign lesion was chronic nonspecific cystitis. Among the neoplastic lesions, urothelial carcinoma was most common tumor seen in 6th decade   predominantly in males, with male to female ratio of 2.5:1. Malignant tumors are more common than benign tumors in the urinary bladder. High grade urothelial carcinoma was the most common malignant tumor encountered which occurred predominantly in males in our study. Tumors are invasive and best evaluated with imaging study’s Conclusion: Urinary bladder lesions are heterogenous and awareness about the risk factors, their various histological features and subtype, risk of recurrence and possible pitfalls can help in accurate and early diagnosis. IHC patterns of molecular subtypes of invasive urothelial carcinoma will enable the identification of case with poor outcome and development of novel biomarker-directed therapies. Therefore, a method to sub type the tumors that is applicable to routine clinical use is necessary.

Objective: To analyze the group of elderly patients diagnosed with COVID-19 with a retrospective cohort study. Methods: The study was conducted in a health institution in Kayseri province in Turkey. In the study, 151 COVID-19 patients were retrospectively analyzed. Chisquare analysis was performed when both independent and dependent variables were categorical. Results: The mean age of the patients was 85.87 years. 61.59% of the patients were female. The most common symptom was fatigue with 73.5%. The most common chronic disease was hypertension. The most common radiologic classification was CO-RADS-1 with 47.6%. The mean incubation period of the disease was 10.25 days. The most common complication was acute renal failure. The mortality rate was 19.21%. Conclusion: We suggested that clinical status at presentation, age, serum CRP, LDH, AST, troponin I and hemoglobin levels are important predictors of the risk of death from COVID-19 and may help identify high-risk COVID-19 cases. 

Introduction: Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide.This disease most often affects the lungs, although other organs are involved in up to one-third of cases.Tuberculous meningitis (TBM) is a non-suppurative inflammatory disease of the dura mater and spinal cord meninges caused by tubercle bacillus. About 5-15% of extrapulmonary tuberculosis involves the nervous system.TBM is a major one of extrapulmonary tuberculosis with involvement of the nervous system and accounts for about 70% of nervous system tuberculosis.Materials and Methods: This is a single centre prospective studywas conducted including the patients who were admitted in Department of General Medicine at Siddhartha Medical College, Vijayawada from November 2022 to October 2023. Patients selected for the study, satisfied all the inclusion and exclusion criteria.Patients attending Medicine OPD, Acute Medical Care are included after satisfying the inclusion criteria and written consent is taken.Initial history was directed towards obtaining the details of duration of the symptoms, night sweats, contact with tuberculosis, seizures, weakness, bowel and bladder disturbances, ear discharge, loss of weight etc.Results:Majority of the patients are in the age group (16-35 yrs) 2nd, 3rd & 4th decades (30 out of 50). Half (50%) of the patients have Glasgow coma scale < 9.25 patients (50%) 16 males, 9 females are in stage III.(Deeply comatose with decerebrate or decorticate posturing, irregular pulse and respiration).Hydrocephalus is the most common finding seen in 56% of cases (All are of communicating variety).Poor functional outcome is seen in 8.33%, 38.46%, 88% of stage I, II & III meningitis respectively.Out of 50 patients CT brain evidence of Hydrocephalus is found in 28 patients.Conclusion:In Tuberculous meningitis duration of illness 3 weeks or more at diagnosis, stage-III meningitis, GCS score less than 9 at admission, presence of focal deficit, and hydrocephalus on neuroimaging are the predictors of poor outcome.Patients can be categorized into high risk and low risk groups depending on the presence or absence of poor prognostic factors.Early diagnosis and prompt initiation of treatment reduces the mortality and morbidity.

Introduction –Sino nasal diseases are a broad category of ailments that include benign and malignant neoplasm as well as inflammatory conditions.Beyond its financial cost, chronic sinusitis has a significant impact on quality of life. The main aim of the study is to assess multi-detector computed tomography's (MDCT) diagnosis accuracy for Sino nasal disorders.

Material and methods: the present study was as prospective study conducted on 50 patients in department of radiology at MNR Medical College & Hospital. Patients underwent CT PNS to evaluate Sino nasal pathologies and incidentally detected PNS lesions on CT brain. The study as carried out over a period of 18 months from September 2019 to March 2021.

Results –The majority of the patients belonged to the 21-30 years of age group (32%) followed by 31-40 years of age (22%). The mean age of patients was 31.06±14.12 years (min.: 6 years; max.: 63 years). Higher female preponderance was observed in our study. The most common clinical presentation of patients was Headache (48%). In our study spectrum of MDCT findings, the most common finding is mucosal thickening, Opacified air sinus, and involved sinus is maxillary sinus followed by anterior ethmoidal, posterior ethmoidal, Sphenoidal, and frontal sinus. In this study distribution of cases with inflammatory etiology most of the cases are simple sinusitis 26 [63%]. Followed by fungal 7 [17%], Sino nasal polyps 3 [8%], and Mucocele 3 [8%] sinusitis with polyps 2 [4%]. 9 cases are neoplastic etiology 5 cases are benign pathology 4 cases are malignant pathology. The most common sinus involved was Maxillary (91.8%) followed by Ant. Ethmoid (81.6%), posterior ethmoid (61.2%), frontal (51%), and sphenoid (42.9%). 46% of patients had Deviated Nasal septum (DNS) - 24% toward the left and 20% toward the left. 33% of patients had concha Bullosa- 14% toward the left; 12% toward the right and 8% toward bilateral. 70% of patients had OMU obstruction; 22% in left; 12% in right and 36% in bilateral. Most of the patients had CT severity grade 4 (36%) followed by Grade 1 (24%); Grade 2 and Grade 3 (18% each). Only 56 histopathology data from patients; 60% had inflammatory causes followed by fungal sinusitis (25%). 28% of patients had Lund MacKay score of less than 5 followed by 16-20 (22%) and 11-15 (20%). Lund-Mackay score. In this study, the final diagnosis in evaluating MDCT has shown 96% sensitivity and 96% specificity in chronic sinusitis. 100% sensitivity and 97% specificity in polyp cases 75% of sensitivity and 100% of specificity in fungal sinus cases. 96 % to 100 % accuracy in evaluating various Sino nasal pathologies. The sensitivity and specificity of CT in diagnosing chronic sinusitis were 98.3% and 97.8% respectively. The sensitivity and specificity of CT in diagnosing fungal sinusitis was 60% and 99.3% respectively. The sensitivity and specificity of CT in diagnosing polyp was 94.4% and 98.1% respectively. The sensitivity and specificity of CT in diagnosing other inflammatory conditions were 90.9% and 99.3% respectively. The sensitivity and specificity of CT in diagnosing benign neoplasm were 90.9% and 99.2% respectively. The sensitivity and specificity of CT in diagnosing malignant neoplasm were 94.1% and 99.3% respectively

Conclusion –MDCT plays indispensable role in detection and diagnosis of various sino nasal lesions. By virtue of its capability of evaluating the detailed normal anatomy and variations, site of origin and extent of a particular lesion and to detect the possible complications, hence act as pre surgical road map. Present scenario MDCT is the best diagnostic modality of choice for evaluation of nasal cavity, paranasal sinuses and for demonstrating for evaluating the chronic diseases and associated complication.

Introduction: Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including the metabolic syndrome. Materials and Methods: A Cross-Sectional Study of a total of 100 patients visiting the Outpatient Department of Dermatology and Venereology of at Nalanda Medical College and Hospital in Patna, for psoriasis was done. The parameters included were age at onset of disease, current age, sex, type of disease, and distribution of lesions. Data and statistical analysis were done. Results: most common age of presentation between 18-43 years, there was a predominance of males, with a male-to-female ratio of 2.41:1, service class affected most followed by business people and house wifes respectively. addiction present in 80% cases and family history positive in 28% subjects. Majority cases were of moderate to severe PASI in our study. Metabolic syndrome was diagnosed in 21 out of 100 cases and 20 out of 100 controls (p-value: 1.000). We did not find any association of psoriasis with metabolic syndrome in our study. Conclusion: Our study refuted any association of psoriasis with metabolic syndrome at the onset of disease activity in Indian patients. The plenty of reports from west approving such an association can be explained by increased risk factors like smoking, alcohol consumption, obesity and stress levels. Further, most such studies have been conducted with patients on treatment, while ours is the study on newly diagnosed patients prior to the initiation of any therapy.

Background & Objectives: Hip pain has different etiologies in adults and children. MRI is the method of choice in characterizing the various disorders and assessing the full extent of osseous, chondral and soft tissue abnormality of the hip joint. This study was aimed to evaluate the diagnostic value of MRI in assessment of painful hip joint. Methodology: This prospective study included 60 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 & STIR WIs, axial T1&T2WIs, axial T1WI and sagittal T1WI after contrast injection. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: The most common pathology for which MRI hip advised was avascular necrosis (AVN) (40%), followed by septic arthritis (20%). Male to female ratio was 2.3:1, their ages ranged from 10 months to 76 years with a mean age of 40 years. In this study most common presentation was pain in hip joint (97%) followed by restricted movement (92%). In the study most common MRI finding of AVN was bone marrow edema (78%) of the lesions followed by joint effusion 63% and Double line sign (58%). In present study, stage 4 with secondary osteoarthritis was the most common stage of AVN present in 43% of the lesions followed by stage 3 31%. The frequency of MRI findings in septic joints was synovial enhancement (91%), joint effusions (91%), erosive bone destruction (67%). In the study most common changes of osteoarthritis is joint space reduction noted in 38% of hips studied. Conclusion: MRI of the hip joint is an informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.

Introduction: Thyroid disorders, affecting approximately 42 million individuals in India, pose significant public health concerns. This study focuses on determining the prevalence of undetected hypothyroidism and associated risk factors among adults in Odisha, India. Methods: A cross-sectional study at SLN Medical College, Odisha, involved 970 participants aged 20-70 years. Demographic data, symptoms, and TSH levels were recorded. Regression analysis assessed risk factors, and Anti-TPO antibodies were tested in a subset. Results: Undetected hypothyroidism prevalence was 16.8%, higher than previous studies. Females exhibited a higher prevalence (19.1%) than males (10.2%). Regression analysis identified gender and symptoms as significant correlates. Anti-TPO positivity was 94.8% in subjects with elevated TSH. Discussion: The prevalence increase suggests a growing health concern. Regional variations and environmental factors, including thyroid disruptors, demand further investigation. The impact on reproductive health emphasizes the need for early detection. Conclusion: Undetected hypothyroidism remains a prevalent issue in Odisha, with autoimmune factors playing a substantial role. Addressing this condition is crucial for enhancing population health and productivity.

Background: This study was conducted to find out CD10 expression in premalignant and epithelial malignant lesions of the colon and rectum with clinicopathological correlation. Methods: This was a hospital-based cross-sectional study conducted 50 biopsy/resected specimens of adenomas (20 cases) and adenocarcinomas (30 cases) who were selected randomly. They underwent H&E staining and IHC for CD10, with the exclusion of non-epithelial tumor samples and submitted to the Department of Surgical Gastroenterology, Department of Surgery, Hi-Tech Medical College and Hospital, from August 2020 to August 2023, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: Among the 50 cases, 35 (70%) >50 years and 15 (30%) <50 years, 28 (56%) were males, and 22 (44%) were females. Location-wise tumours comprise rectum 16 (32%), followed by descending colon 13 (26%), ascending colon 10 (20%), rectosigmoid junction 7 (14%), and transverse colon 4 (8%). The level of CD10 expression slowly rose from adenomas (<10%) to well-differentiated (G1)-adenocarcinomas (10–25%), with the highest level of expression seen in poorly differentiated (G3)-adenocarcinomas (>50%). Conclusion: At every step of the adenoma-carcinoma cascade, CD10 is crucial. Association of CD10 expression with malignant behaviour of colorectal adenocarcinomas and CD10 could be a new biomarker for aggressiveness and prognostic information. When used as a therapeutic target, CD10 will allow for the greatest possible targeting of malignant areas.

Introduction: Corneal ulcers, characterized by epithelial loss, stromal infiltration, suppuration, and inflammation, pose a global health concern, especially in the context of corneal blindness. Infectious keratitis, attributed to microbial agents, is a leading cause of corneal ulcers. This study focuses on the incidence, microbial etiology, and management strategies for corneal perforations arising from infectious keratitis. Objective: To investigate the incidence of corneal perforation in cases of infective keratitis, identify specific microorganism groups associated with corneal perforations, determine appropriate treatment modalities, and assess the prognosis of various interventions in perforated corneal ulcer management. Materials and Methods: A total of 150 patients with infectious perforated corneal ulcers were enrolled. Inclusion criteria covered patients aged 18 to 60 years, irrespective of gender, with infectious etiology. A comprehensive clinical examination, microbiological analysis, and various treatment modalities, including Bandage Contact Lens, Cyanoacrylate Glue, Amniotic Membrane Transplantation, and Corneal Transplantation, were employed. Results: Prevalence is observed in the age group of 25-50 years (70 patients), followed by 50-60 years (53 patients), and 18-25 years (27 patients). There is a significant male preponderance (117 cases) compared to females (33 cases). There is a higher incidence among farmers (44 cases) and laborers (27 cases), suggesting potential occupational risk factors. Paracentral perforations are the most prevalent (71 cases), followed by central (45 cases), and peripheral perforations (34 cases). A total of 132 positive cases indicate a predominantly infectious etiology. There is a higher prevalence of bacterial infections (75 cases), followed by fungal (29 cases), and mixed infections (28 cases). Micro perforations (<1mm) are the most common (68 cases), followed by small (59 cases), and large perforations (23 cases). Bandage Contact Lens (67 cases), Amniotic Membrane Transplantation (45 cases), and Penetrating Keratoplasty (38 cases) are frequently employed. Discussion:   Infectious keratitis, if not promptly managed, poses severe complications. Factors such as occupation, accessibility to medications, and gender influence delayed presentations. Corneal perforation, a consequence of various corneal disorders, requires timely recognition and intervention to prevent vision loss. Treatment modalities include medical approaches, tissue adhesives, and various surgical interventions. Conclusion:  The study underscores the multifaceted approach required for infectious keratitis management. Prompt intervention, gender-specific prevalence, and the efficacy of diverse treatments based on perforation characteristics are highlighted. The findings contribute valuable insights for the effective management of corneal perforations arising from infective keratitis.

Introduction:  Dengue virus is the most common Arbovirus in India. It is transmitted by female mosquito-Aedes aegypti. It is a major public health problem world-wide, especially in tropical and sub-tropical areas and presenting as acute febrile illness. In present study we aimed to compare results of NS1 antigen test and IgM Antibody ELISA in clinically suspected dengue fever patients. Approximately 100-400 million dengue cases occur every year according to World Health Organization (WHO). Hence early diagnosis of dengue is essential to prevent complications and mortality. Materials and Methods: A total of 188 cases with clinically suspicious of dengue fever from the OP/IP patients with <9 days fever were included in the study. Blood samples were collected from all the cases under aseptic conditions. Serum was separated by centrifugation and subjected to detection of dengue NS1 antigen and IgM antibodies by ELISA. Results - Out of 188 samples, 46(24.5%) were positive for dengue infection.  Out of 46(24.5%), NS1 antigen was detected  in 14 (30.5%) samples, IgM antibody was detected in 8 (17.4%) samples, both NS1 &  IgM antibody were present in 24 (52.2%) samples. The sensitivity and specificity of NS1 antigen - 87.5% & 82.5%, for IgM - 80%&79.7%, for NS1 antigen + IgM antibody - 92.3% and 87.6% respectively. Conclusion: NS1 ELISA test method is an effective method for early diagnosis of dengue fever. Early detection is more important to prevent complications of Dengue. The combination of NS1 Ag test and IgM Antibody test by ELISA assay offers most sensitive and cost effective diagnostic tests in India.

Background: managing blunt trauma requires prompt resuscitation of the unstable patient in parallel with physical examination and diagnostic testing to determine the presence or absence of hemoperitoneum and organ injury.  Materials and methods: 60 patients with blunt abdominal trauma who underwent laparotomy in the Department of Surgery, at Government General Hospital, Guntur, from November 2021 to October 2023 were included in the study. Results: Males are most commonly involved than females. Spleen is the most commonly involved solid organ. Jejunum and ileum are the most commonly involved hollow visceral organs. Conclusion: Increase in the sales of vehicles has also increased the incidence of road traffic accidents and thus increasing BAT cases. Measures must be taken to curb the rise in such accidents.

Background:  The prevalence of chronic leg ulcers is increasing at a rapid pace due to lifestyle disorders like diabetes, atherosclerosis. Treatment of chronic leg ulcers is expensive. For a proper treatment of patients with leg ulcers it is important to be aware of the large differential diagnosis of leg ulceration and to effectively manage the conditions Materials and methods: 250 patients with chronic ulcers over leg who presented to the Department of Surgery, Government General Hospital, Guntur, from Sept 2021 to Oct 2023 were included in the study.  Results:  Males were predominant than females and most of the patients were middle to elderly age group. Diabetic foot ulcers were the majority of ulcers, followed by ulcers due to venous insufficiency and arterial occlusion.  Conclusion: A correct diagnosis is neccessary to avoid inappropriate treatment that may cause deterioration of the wound and delay wound healing. With increasing medical technology, newer modalities of treatments for patients with chronic leg ulceration are emerging, so that they can have better quality life.

Background: Accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. Multiple disciplinary approach is usually required for complete healing of chronic ulcers. Methods: A prospective study of 18 months duration was conducted on 50 consecutively admitted cases of chronic leg and foot ulcers in age group of 5-80 years of both genders. A through detailed history and clinical examination was undertaken. Local Symptoms, trophic skin changes and venous insufficiency if any was recorded. Both general and specific treatments were provided. Results: The majority of occurrences occurred in individuals aged 31-50 years, with a male to female ratio of 1.9 to 1 and a rural to urban ratio of 2.57 to 1. The majority of patients, including 76%, were illiterate. Additionally, 56% of the patients were from the lower socioeconomic level. A majority of patients (54%) had habits of smoking, tobacco consumption, or alcoholism. The most common location of the ulcer was the foot, accounting for 52% of instances, followed by the leg at 18%. The majority of ulcers (72%) were caused by trauma, whereas just a small percentage (2%) were due to ischemia. Regarding symptoms, 32% of the cases exhibited wound, pain, and discharge, while 26% showed wound and discharge. 66% of ulcers were found to have secondary infections, whereas the highest percentage of patients, 68%, required a hospital stay of approximately 2 weeks. Complete recovery occurred within around three months in 68% of instances. Conclusions: A correct diagnosis, multidisciplinary approach, optimal treatment and assessment of vascular status can facilitate healing of chronic leg ulcers in nondiabetic cases.

breast cancer accounts for 14% of cancers in Indian women. It is reported that in every four minutes, an Indian woman is diagnosed with breast cancer. Vitamin D deficiency is assumed to be one of the risk factor for breast cancer. Objective: To study the association between vitamin D and risk of breast cancer among postmenopausal women.  Methodology: This was an observational cross sectional study.About 74 females of known breast cancer and 74 healthy females were evaluated. Appropriate statistical analysis was done to find association between vitamin D deficiency and risk of Breast Cancer. Our study demonstrated that number of subjects with Vitamin D level below 20 ng /dl i.e Vitamin D deficiency from the cases, in age group 41 to 50 years are 11, in the age group of 51 to 60 years were 39, in the age group of 61 to 70 years are 19, and in the age group of more than 70 years were 5 in number. The statistical difference between vitamin D levels, in patients having breast cancer and patients not having breast cancer was highly significant (p value 0.0001), showing the strong association between decreased vitamin D level and breast cancer in postmenopausal women. Conclusion: Our study showed that vitamin D and levels were inversely associated with risk of developing breast cancer. Vitamin D helps in prevention of cancer by reducing inflammation, anti-apoptotic, and anti-proliferative property. Vitamin D supplementation are needed in premenopausal women in order to reduce the risk of breast cancer in peri and post menopausal women

Cryptococcus neoformans is a leading cause of adult fungal meningitis and mortality in HIV/AIDS patients. The onset of fungal meningitis typically precedes the detection of serum/plasma cryptococcal antigen (CrAg) by several weeks. Screening for Cryptococcal Antigen (CrAg) and early treatment can significantly prevent the development of fungal meningitis in HIV/AIDS patients. Method: This descriptive cross-sectional study involved 100 antiretroviral therapy (ART) naive patients, comprising 65 males and 35 females, from both ART clinics and Medicine Indoor facilities. Serum/CSF cryptococcal positivity was determined using the Latex agglutination test (Pastorex TM Cryptoplus, BIO-RAD, France) and the Lateral flow assay by IMMY Kit (US FDA approved). CD4 counts were measured using a flow cytometer (Becton-Dickinson FACS count flow cytometer). Results: The prevalence of CrAg positivity in the study was 7% (7/100), with 4% (4/100) exhibiting features of meningitis. Statistical analysis revealed a significant association of antigenemia with demographic features such as age, inpatient status, and symptomatic groups (p-value ≤ 0.05). A low CD4 count (<50) was correlated with a higher seropositivity rate of 33.3% (5/100). Clinical symptoms like headache, vomiting, and fever showed a statistically significant association with cryptococcal antigenemia. Conclusion: The study concludes that cryptococcal antigenemia is more prevalent in ART-naive HIV patients with lower CD4 counts, emphasizing the need for urgent screening and the substitution of antifungal treatment to reduce morbidity and mortality associated with cryptococcal meningitis.

Background: Two subtypes of vulvar squamous cell carcinomas (VSCC) have previously been defined. The more common keratinising type typically occurs in older women (50-70 years), is generally associated with lichen sclerosis and/or differentiated vulvar intraepithelial neoplasia (dVIN), and is often associated with p53 tumor suppressor gene mutations. The other subtype is more common in younger women and primarily associated with human papilloma virus (HPV) infection, and a common precursor is usual-type vulvar intraepithelial neoplasia (uVIN) of the basaloid or warty type. To investigate the prognostic significance of HPV status in vulvar squamous cell carcinomas (VSCC) and to determine whether preoperative determination of p16 or p53 status would have clinical relevance. Materials and methods: This is prospective and descriptive study conducted in the Department of Pathology, Government Medical College, Siddipet over a period of 1 year. Immunohistochemistry was performed by using 5 μm paraffin sections which were deparaffinized in xylene (three times for five minutes) and rehydrated in decreasing concentrations of ethanol (100%, 96%; two times each for ten minutes) followed by washing in deionised H2O for one minute. To unmask the p16 antigen the slides were covered with 0.01 M sodium citrate buffer (pH 6.0) and placed on a hot plate (950C) for 10 minutes. After cooling down the specimens were rinsed briefly in deionised H2O (three times). The specific primary (mouse monoclonal) antibody (p16, clone E6H4) was applied in a dilution of 1:50 overnight at 40C. Result: HPV types and status in correlation with clinical parameters and expression of p16. 70 out of 70 patients with PCV could be evaluated for HPV status. 25 were positive for high-risk HPV and 45 were HPV negative. The majority (16 out of 26, 64%) of HPV-positive patients were positive for HPV16. The others were positive for HPV45 (4 patients, 16%), HPV18 (2 patient, 8%), HPV35 (1 patient), HPV56 (1 patient), and HPV68 (1 patient). Human papillomavirus positivity was significantly correlated with strong p16 expression (p= 0.045). In all, 7 out of the 59 HPV-negative patients were negative for p16 immunostaining, while the remaining 83% showed varying expression: 31 out of 45 (68.9%) showed moderate or strong p16 expression. Conclusion: The vast majority of HPV positive vaginal cancers showed p16 overexpression, suggesting active involvement of HPV in the malignant transformation process. HPV vaccines will help prevent some of the primary female genital cancers associated with HPV type 16. More in-depth studies are needed to understand the molecular carcinogenesis pathway in these p16- negative tumors and to improve outcomes for this population.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Background: In the tropics, scrub typhus is a growing health risk. Acute meningoencephalitis, enteric fever, Kawasaki disease, and dengue can all have similar clinical characteristics. Early intervention and a high index of suspicion help to avoid mortality and morbidity. The preferred medications are Doxycycline or Azithromycin, both intravenous and oral. Aims and objectives: The aim of thepresent study was to present clinical manifestation, laboratoryfindings and treatment outcomes of pediatric scrub typhus ina tertiary care setting. Methods: The present study was prospective observational study. A total of 45 cases detected with positive for Scrub Typhuswere includedin the study. Study was conducted from May to October 2023 in the Department of Paediatric Medicine, RG Kar Medical College, Kolkata, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: A total of 45 cases were detected to be positive for Scrub Typhus. Their age ranged from 1½years to 12 years, mean being 7 ½ years. There was no sex predilection, 21 (47%) were male and 24 (53%) were female. Fever was the chief complaint in all of them. During hospital stay, the average temperature recorded was 101ºF. Eighteen cases presented with exanthematous fever. The rash was erythematous maculopapular, mostly appearing in the limbs and sometimes over the trunk. Eschar was found only in ‘5’ cases case even after thorough searching. Other findings include organomegaly, generalized lymphadenopathy and constitutional symptoms. Conclusion :Scrub typhus do exist around Kolkata in the suburban and rural areas. Hence awareness is very important. They need to be detected early by high index of clinical suspicion and screening test followed by rapid onset of treatment by Azithromycin and Doxycycline.

Background: Red cell distribution width  (RDW) is an important parameter  that has a critical  impact  on the severity of coronary artery disease,  especially  on that  of acute  myocardial  infarctionⁱ(AMI). Objective: study was to assess the correlation between red cell distribution width and left ventricular ejection fraction in patients presenting with acute myocardial infarction.  Methods: Study was conducted on 110 patients admitted at tertiary care centre with acute myocardial infarction satisfying inclusion criteria. Detailed history and clinical examination was done. RDW and other CBC parameters were calculated by an automatic blood counter and measurement of LVEF done by 2D-echocardiography. Results: Out of 110 patients of acute myocardial infarction 86 were male and 24 were female. Both RDW and LVEF are linked in patients of acute myocardial infarctions, as there was statistically significant correlation between high RDW and low LVEF.  Conclusions: It is observed that increase RDW and decrease LVEF were linked together which is statistically significant.

Background:  There are four major acute aortic syndromes 1) aortic rupture,2) aortic dissection,3) intramural hematoma, and 4) penetrating atherosclerotic ulcer. Among them here we are presenting case report on acute aortic dissection. Acute aortic dissection is a life-threatening condition in which a tear occurs in the inner layer of the aorta. Blood rushes through the tear and splits the inner and middle layers. Pulsatile aortic flow then dissects along the elastic lamellar plates of the aorta and creates a false lumen. Death from aortic dissection can be related to rupture of a proximal dissection into the pericardium precipitating cardiac tamponade or bleeding into the pleural space, dissection into the aortic valvular annulus leading to severe aortic regurgitation, obstruction of the coronary artery ostia leading to myocardial infarction, or end-organ failure due to abdominal aortic branch vessel obstruction. Case Report: 45-year-old female patient, nondiabetic, non-hypertensive, no significant past illness history came to emergency department with acute onset substernal pain with left sided chest pain 2-4 hours back with history of two episodes of vomiting at home. She described chest pain in numerical rating scale of 8-9, with character of pain as excruciating pain with doomed feeling, diaphoresis and difficulty in taking deep breath. She also felt slight faintness. On examination patient was conscious, restless, sweating++, she looked acutely ill but nothing specific was detected in her heart and lung sound, Initial vitals at emergency room were stable, pulse rate 120/min, blood pressure 120/84 mm Hg, respiration rate 24/min, body temperature 36.6 , saturation 99%. Electrocardiogram (ECG) was immediately taken which showed normal sinus rhythm with tachycardia, no evidence of ischemic changes. Patient shifted to ICU on ECG monitor, BP monitor, and oximeter. and started with Oxygen, Analgesics, Antiemetics. 

Background: Supraclavicularbrachialplexus blockis used for providing pain relief in upper limb surgeries and has manyadvantagesovergeneralanaesthesia.Alpha-2-adrenergicagonists are chosen with local anaesthetics for their sedative,analgesicand antihypertensive properties. Aim : To  evaluate  the  effects  of  clonidine  and  dexmedetomidine  in  combination  with  ropivacaine  on  peripheral  nerves  during  brachial  plexus  block. Methods :The present study was prospective  comparative  observational  study. A total of 58patients admitted in orthopaedics ward scheduled for upper limb surgeries fulfilling the requisite criteria were included in the study.  Study was conducted from August 2022toSeptember2022 in the Department of orthopaedics, Burdwan Medical College, Burdwan, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results :The mean age of the patients was 31.5 ± 4.2 years in Group C and 33.1 ± 3.9 years in Group D. There were 22 males (37.93%) and 7 (12.07%) females in Group C and 19 males (32.76%) and 10 females (17.24%) in Group D. Group D showed less time for the onset of sensory and motor blocks and more time in duration for sensory and motor blocks. The duration of analgesia was longer in Group D. Comparison of complications showed that, bradycardia and hypotension were found more in Group C than Group D. The vital parameters were comparable in both the groups. Conclusion :Dexmedetomidine prolongs the duration of sensory and motor block and enhances the quality of block as compared with clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

Introduction: Ulcers that do not heal spontaneously through the standard, orderly, timely sequence of repair or on conventional treatment and those persist for more than 6-12 weeks are called as chronic non- healing ulcers. This is a significant health problem and is estimated to affect approximately 2-6 million people in the United States, while its prevalence in the world ranges from 1.9 to 13.1%. The incidence increases with age. 75% of chronic non- healing ulcers are venous ulcers, and the rest is by other causes in comprehensive data. In tropical countries like India, there is a lack of data. A study from one center in India suggests leprosy (40%), diabetes (23%), venous disease (11%), and trauma (13%) as the cause of non healing ulcers. Materials And Methods: This is a Prospective study conducted in the Dermatology Venereology and Leprosy at Tertiary Care teaching Hospital over a period 1 year.All the patients attending to the OPD of Dermatology Venereology and Leprosy who were suffering from chronic non-healing ulcers and satisfying the inclusion and exclusion criteria became the part of the study after taking written consent.patient is explained about the procedure in detail in the local language, and consent is obtained. Results: In this study, out of 30 patients included, the majority of patients are between 46 and 50 years (43.3%), and the mean age of the patients observed was 55.1 years. In this study, out of 30 patients majority were females 16 (53.3%) when compared to males 14 (46.7%).In the present study, the mean area measurement of the ulcer after each sitting of PRF at the end of every week is calculated and it showed a reduction in the mean from 6.068 to 1.729 by the end of 5th week and attained a p-value of <0.001 which is highly significant.In this study, out of 30 patients, the mean percentage improvement in the area of the ulcer at the end of the 5th week is 91.81%. Conclusion: This study authenticates the use of Autologous platelet rich fibrin therapy in the treatment of chronic non-healing ulcers by showing significant improvement in both the size of the wound and the quality of life, vowing to its safety and a being less expensive procedure associated with no or minimal side effects. 

Background: Anaemia is a reduction in the oxygen carrying capacity of the blood resulting in tissue hypoxia.1 Cardiac output at rest is not usually increased in most chronic anaemia until haemoglobin levels fall below 7 g/dL, but abnormal rise in output with exercise may occur with levels as high as 10 g/dL.2 Anaemia is a major public health problem worldwide especially in developing countries like India. Nutritional cause of anaemia continues to predominate as the most common cause of anaemia. Objective of this study is to determine the clinical and laboratory profile of anaemia among patients admitted to our hospital. Methods: Our study was a prospective study in which 50 patients of anemia admitted to Medicine ward at tertiary care Teaching hospital, KRIMS, Karwar were studied for their clinical and laboratory characteristics. Duration of the study was 6 months from July 2021 to december 2021. Results: Anaemia was more common among females (68 % of total patients). Patients in age group 18- 30 years were involved in 46% of subjects. Pallor was the universal finding present in 100% of patients. On systemic examination haemic murmurs on auscultation was the most common finding present in 28% followed by hepatomegaly (18%). Microcytic and dimorphic anaemia constitute the bulk of anaemia. Conclusions: Nutritional anaemia particularly iron deficiency anaemia is the most common cause of anaemia. It tends to affect the working age group and females predominantly. Patients continue to present with severe anaemia to the hospital.

Background:  As we all know that liver has been called the custodian of milieu interior, as such any form of liver disorder will result significant effect on homeostasis and also, numerous pathologies of other systems can affect either directly or indirectly 
on liver. Both acute and chronic heart failure may result in abnormalities of liver. Liver receives 25% of cardiac output, a huge percentage of cardiac output, so fall in cardiac output will result in hepatic hypo perfusion.  Therefore our study was planned to 
evaluate the abnormalities of liver function and its role on assessment of prognosis in Congestive Cardiac Failure patients in our setup. Research Question: What are the abnormalities of various liver function tests in Congestive cardiac failure patients?  The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Eluru, Andhra Pradesh. A one year observational study was conducted during the period from October 2022 to September 2023 on about 75 Congestive cardiac failure cases of varied etiology admitted during the above period in the department of General Medicine by studying their socio demographic profiles, associated causes for Congestive cardiac failure, assessment of liver function by conducting various biochemical tests and the prognosis of the disease etc. and about 20 healthy individuals were taken as controls for comparison of data.  Results: Among the total study subjects ( CHF cases ) males were 58.6% and females  were 41.3% and among controls it was 60% & 40% and regarding age among cases maximum were found between 41 – 70 years age group. And also with regard to etiological cause of CHF Coronary Atherosclerotic Heart disease accounted for 73% followed by RHD 72% Cardiomyopathy 71%, Cor pulmonale 69% and Hypertensive heart disease 57% were observed and with regard to Prognosis out of total 75 cases about 53(71%) of cases were showed abnormal LFT and out of this total about 47 cases showed remission and 44 got responded towards reduction of serum bilirubin on remission. And about 6 showed exacerbation among total 75 cases. Related to LFTs Sr bilirubin, AST, ALT, SAP has showed significant increased levels and Sr albumin showed mild rise in this study

Background:  The majority of extra capsular (trochanteric and sub trochanteric) types of fracture patients are elderly with comorbidities and there is a strong association with osteoporosis and the management of these patients is associated with a huge risk for medical and surgical complications. And also we are aware that the difficulty of treating trochanteric and sub trochanteric fractures stems in part from the fact that this injury pattern is anatomically distinct from other proximal femoral peritrochanteric fractures and in part from the difficult features of femoral shaft fractures and also the surrounding strong muscle forces deform the fracture fragments and make reduction difficult. So the present study was planned to evaluate the functional results of these femur fractures treated with proximal femoral nail.  Research Question: What is the functional outcome of trochanteric and sub trochanteric fractures treated with Proximal femoral nail?  The setting of the study was at department of Orthopedics, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one year observational study was conducted during the period from October 2022 to September 2023 on about 25 trochanteric and sub trochanteric fracture patients  admitted during the above period in the department of Orthopedics by studying their socio-demographic profiles, associated risk factors, types of fracture reduction,  postoperative complications and assessment of the degree of success of fracture reduction with clinical course and outcome, etc. Results: It was observed that female study subjects (56%) were more when compared to males (44%) and maximum number of patients were between 41 – 70 years of age group and the Mean age was 51.1 years. Regarding distribution of complications after surgery, shortening was observed among 12% of patients followed by Greater trochanteric splintering 8%, postop infection 8% and implant failure 4% respectively. With reference to fracture reduction closed reduction was 64% and 36% were limited open reduction and particular to evaluation of results of PFN implantation after surgery about 28% were identified as excellent followed by 40% good, 28% fair and about 4% poor as scored  respectively.  

Background: The incidence and the life expectancy of the diabetic patients have both increased with resulting in the increased prevalence and clinical importance of musculoskeletal alterations in diabetic. Present study was aimed to study correlation between duration of diabetes mellitus and occurrence of rheumatologic manifestations in patients with type II diabetes mellitus. Material and Methods: Present study was cross sectional study, conducted in above 30 years age, either gender, diagnosed cases of Type 2 diabetes mellitus. The control group comprised of subjects without family history of diabetes mellitus, fasting blood sugar values <126mg/dl and postprandial blood sugar values<200. Results: During study period, 100 patients with type 2 diabetes mellitus and 50 non diabetics were included in the study. Mean age for diabetics was 55.3 ± 10 yrs while for control group mean age was 51.3 ± 10 yrs. Out of 100 diabetic pts included in study 66 % were male and 34 % were female. Out of 50 non diabetic control group 35 were male and 15 were female. Majority of diabetic population had 0 - 5 years of duration of disease (52 %) with average duration of disease is 6.7 years. Rheumatological manifestations seen in 31 % pts with type 2 DM and 16% pts without DM. Prevalence of rheumatological manifestations in diabetic population is more in females (47%) as compared to males and it is statistically significant(p- 0. 0126). Majority of diabetic pts with rheumatological manifestations were noted to have 6 -10 years of duration of Diabetes & relation was not significant statistically (p > 0.05). Conclusion: There is no correlation seen with the duration of diabetes and the prevalence of rheumatological manifestations.

Introduction: Parapharyngeal space tumors are rare, accounting for 0.5% of all head &neck tumors. 80% of them are benign. Variety of tumor types can develop in this area, most common are salivary gland neoplasms & neurogenic tumors. Management of these tumors require diligent assessment and planning with due consideration of various anatomical and pathological aspects of the lesion. Several approaches have been described for excision of parapharyngeal space tumors. Transcervical approach is the most commonly used while the advances in endoscopy gave further stimulus to the use transoral route. Aim : The aim of this study is to present our experience with the Transcervical approach & Endoscopy assisted transoral approach (EATA) in the treatment of  parapharyngeal space tumors  and to review the most recent literature about both the approaches. Materials &methods: The study included 7 patients. Patients who underwent removal of parapharyngeal space tumors through transcervical approach & EATA in a tertiary care centre from 2016 to 2023 were retrospectively analyzed and the literature about the outcomes of both the techniques were systematically reviewed. Results : 7 cases of parapharyngeal space tumors were completely excised. Among them 3 cases were operated through transcervical approach and 4 cases through EATA. The mean age was 47.8 years with a male-to-female ratio of 4:3. The mean hospital stay was 3-4 days. Transcervical route was used for post styloid tumors (all 3 Neurofibromas), transoral route was used for pre styloid tumors (all 4 Pleomorphic adenomas). All tumors are benign. One case had postop vocal cord palsy while one case had post operative wound dehiscence. No recurrence was found after a mean followup of 9 months. Conclusion: Contrast CT & MRI are the most useful instruments for choosing the most appropriate surgical approach. Transoral approach is better for Prestyloid & non vascular tumors (benign encapsulated tumour) where as Trans cervical approach is useful for both Pre & Post styloid tumors and Vascular & Non vascular tumors. Complete excision has good prognosis & recurrence rates are rare for benign lesions. 

BACKGROUND:Atherosclerotic renovascular disease is a frequently overlooked condition and potentially correctable disease. It is estimated that approximately 1-5% of people have renovascular disease as an underlying cause of hypertension. It is also frequently associated with decreased renal function. Patients with atherosclerotic renal artery disease are at significantly increased risk for other vascular events, including coronary and cerebrovascular complications. The Atherosclerotic RAS is one of the most common causes of secondary hypertension and its prevalence in hypertensive patients undergoing coronary angiography is low, but substantially higher in patients with established peripheral (50%) and/or coronary artery disease (30%), and elderly population. The purpose of this study is to evaluate the prevalence and predictors of RAS among CAD patients with hypertension who underwent coronary angiography. METHODOLOGY: This is a hospital based cross sectional study which included100 patients presenting to department of cardiology, KGH between 1st July 2021 and 30th June 2023 with a diagnosis of coronary artery disease with Hypertension and who underwent Coronary angiography (CAG). After completion of CAG, Renal angiography (RAG) was done selectively using the same Judgkins right catheter.Data were entered in MS-Excel and analysed in SPSS V25. Descriptive statistics were represented with percentages for qualitative data, Mean with SD for quantitative data. Chi-square test, Fisher Exact test was applied for comparison of proportions. P < 0.05 was considered as statistically significant. CONCLUSION:In the present study(n=100), the prevalence of Renal artery stenosis was significant (19% ) where unilateral involvement was seen in 14% and bilateral RAS in 5%.In our study, patients’ age ranged from 32 to 76 years. Mean age was 53.8 ± 8.15 years. In our study, majority (59%) were males and 41% were females. Males were higher (68%) when compared to females (38%) in patients with RAS.Among the risk factors, smoking and dyslipidemia were higher in patients with RAS, when compared to patients with normal renal arteries, though not statiscally significant. The percentage of patients with Diabetes and obesity were similar in both groups. In our study, the presence of stage 2 hypertension and resistant hypertension are independent variables for the presence of renal artery stenosis in CAD with hypertension patients. The presence of age more than 50 years, stage 2 hypertension at presentation, resistant hypertension and triple vessel disease on coronary angiography serve as independent predictors for renal artery stenosis with statistically significant parameters in patients with coronary artery disease and hypertension in our study. Renal angiography is recommended to screen for ARAS in hypertensive patients with multiple risk factors and multivessel disease to prevent ischemic nephropathy a reversible cause of chronic renal failure.

Background : Stomach carcinoma, the second most prevalent malignancy in Asia, poses a substantial global public health challenge. Gastric adenocarcinoma, comprising over 90% of cases, necessitates optimal treatment modalities, primarily RO resection, to achieve locoregional control. Lymph node metastasis, the primary mode of spread, underscores the importance of meticulous lymphadenectomy. The Japanese Gastric Cancer Association (JGCA) guidelines delineate the critical role of D2 lymphadenectomy in staging and controlling gastric carcinoma. Methodology: This retrospective study, conducted at SCB Medical College & Hospital, assesses the necessity of routine D2 lymphadenectomy in operable cases of gastric carcinoma. Forty-six patients meeting specific criteria underwent detailed workup, including hematological and radiological evaluations. Operable cases underwent gastric resection with D2 lymphadenectomy, targeting a minimum of 16 lymph nodes. Extended resections and palliative procedures were performed as needed. Results: The study comprised 46 patients (56% male, 44% female), aged 55-65 years. Clinical presentations included dyspepsia (63%), weight loss (54.3%), and less common symptoms. Antral growth was predominant (54.3%). Operable cases (87%) underwent successful D2 lymphadenectomy with minimal complications (4% pulmonary complications, 6% wound infections). The majority were stage II and III (77.5%). Two-year follow-up indicated a 5% mortality and recurrence rate. Discussion: Surgical intervention, particularly D2 lymphadenectomy, remains the most effective therapeutic option for gastric carcinoma. Our study aligns with JGCA guidelines, emphasizing the importance of D2 lymphadenectomy in achieving locoregional control. The inadequacy of D1 lymphadenectomy is evident, highlighting the significance of removing an adequate number of lymph nodes. Despite concerns, evidence suggests that the current form of D2 lymphadenectomy is not more hazardous than D1, and maximal lymph node removal correlates with improved long-term survival. Conclusion: Our study underscores the critical role of D2 lymphadenectomy in achieving optimal locoregional control and improving overall survival in gastric carcinoma. The meticulous removal of an adequate number of lymph nodes is imperative, emphasizing adherence to established guidelines for lymphadenectomy.

Introduction: Bacterial keratitis is also often referred to as a 'corneal ulcer'. In practice, these terms are not directly interchangeable because a cornea may harbor a bacterial infection (i.e bacterial keratitis) without having a loss of tissue (an ulcer) and a cornea may have an ulcer without a bacterial infection. Bacterial keratitis is a serious bacterial infection of the cornea which can, in severe cases, cause loss of vision. Materials and Methods: This is a prospective study conducted over a period of six months at the Department of Ophthalmology. Inclusion Criteria: Patients above the age of 18 years presenting with suspected corneal ulceration and having symptoms of pain, redness, watering, photophobia and decreased vision were included in the study. Exclusion Criteria: Patients with typical features of viral infection and healing ulcers were excluded as were Mooren's ulcers, interstitial keratitis, sterile neurotropic ulcers, and any ulcer associated with autoimmune conditions. Results: Total 90 patients were enrolled with a corneal infiltration that was clinically compatible with the diagnosis of bacterial corneal ulcer. Majority of them were male 54 (60%) and female 40%. The age of patients ranged from 1 to >60 years. Majority of 21-40 years age group (41.1%). The keratitis was induced by foreign body particles were most common risk factor 24.4%. Corneal localization of the ulcers was distributed as in 51 (56.6%) patient's central and in 39 (43.3%) peripheral. The diameter of the corneal ulceration was of 1-2 mm in 24 (26.6%), 3-4 mm in 29 (32.2%), 5-6 mm in 21 (23.3%), 7-8 mm in 9 (10.0%) patients, 7 (7.7%) patients had entire corneal involvement. Ulceration depth was less than 1/3 conreal thickness in 46 (51.1%), between 1/3 to 2/3 in 26 (28.8%) patients and over 2/3 in 18 (20.0%) patients. Anterior chamber inflammation was absent in 9 (10%) patients. A1+ to 2+ Tyndall effect with 1+ to 2+ cells were present in 17 (18.8%) patients, and severe anterior chamber inflammation (3+ to 4+ Tyndall effect and cells, with or without hypopyon) was present in 64 (71.1%) patients. Conclusion: Bacterial Corneal ulcers are a vision-threatening ocular emergency. It is imperative that health care providers across specialties work together so that these patients may have the best possible outcome and avoid the many potential complications.

BACKGROUND: Acute Kidney Injury (AKI) is a common medical problem developed in a wide variety of settings including ambulatory outpatients, hospitalized and in critically ill patients. Delay in diagnosis of AKI is associated with increased mortality. Variety of conditions can lead to AKI and many factors can influence the outcome of AKI. METHODS: This hospital based observational study was conducted in the department of medicine, Guwahati Medical College and hospital, Guwahati, Assam, India over a period of one year from 1^st July, 2020 to 30^th June, 2021. A total of 110 patients with AKI were included in the study. Data collection was done by history taking, clinical examination and essential laboratory tests. RESULT: The mean age of the present study group was 44.82 ± 16.9 years. The total number of male patients were 62 (56.4%) and female patients were 48 (43.6%). The majority of patients presented with Oliguria (71.8%). Sepsis was found in 38 patients (34.5%) and was the most common cause of AKI in this study. Majority of patients were treated conservatively accounting to 51.8% of patients in this study. Haemodialysis (HD) done in 41.8 % and peritoneal dialysis done in 6.4% patients. 70% patients recovered completely of AKI and 14.5% recovered partially. Out of 110 patients 17 patients died. CONCLUSION: The present study showed sepsis was the most common cause of AKI followed by acute gastroenteritis. Most common clinical presentation in the study population was oliguria. Most of the patients in the study population recovered completely

BACKGROUND: Acute Kidney Injury (AKI) is a common medical problem developed in a wide variety of settings including ambulatory outpatients, hospitalized and in critically ill patients. Delay in diagnosis of AKI is associated with increased mortality. Variety of conditions can lead to AKI and many factors can influence the outcome of AKI. METHODS: This hospital based observational study was conducted in the department of medicine, Guwahati Medical College and hospital, Guwahati, Assam, India over a period of one year from 1^st July, 2020 to 30^th June, 2021. A total of 110 patients with AKI were included in the study. Data collection was done by history taking, clinical examination and essential laboratory tests. RESULT: The mean age of the present study group was 44.82 ± 16.9 years. The total number of male patients were 62 (56.4%) and female patients were 48 (43.6%). The majority of patients presented with Oliguria (71.8%). Sepsis was found in 38 patients (34.5%) and was the most common cause of AKI in this study. Majority of patients were treated conservatively accounting to 51.8% of patients in this study. Haemodialysis (HD) done in 41.8 % and peritoneal dialysis done in 6.4% patients. 70% patients recovered completely of AKI and 14.5% recovered partially. Out of 110 patients 17 patients died. CONCLUSION: The present study showed sepsis was the most common cause of AKI followed by acute gastroenteritis. Most common clinical presentation in the study population was oliguria. Most of the patients in the study population recovered completely. 

Background: Thyroid hormones play a vital role in regulating female reproductive function, and thyroid disorders are known to disrupt menstrual cycles. Abnormal uterine bleeding (AUB) is a common issue among women seeking gynecological care, with various manifestations including menorrhagia and oligomenorrhea. The relationship between thyroid dysfunction and AUB, particularly hypothyroidism, has been established in clinical observations. Method: This case-control study aimed to investigate the prevalence of hypothyroidism in women experiencing irregular uterine bleeding. Women aged 19-45 with menstrual abnormalities, excluding organic pathologies, were recruited as cases, while age-matched women with normal menstrual cycles served as controls. Thyroid function tests and menstrual pattern assessments were conducted, and data were analyzed using statistical methods. Result: Among the study participants, 22% of the case group had thyroid dysfunction compared to 8% in the control group, indicating a significant difference. Hypothyroidism was the most prevalent type of thyroid dysfunction, with menorrhagia being the most common menstrual pattern observed among women with hypothyroidism and dysfunctional uterine bleeding. Conclusion: The study establishes a notable association between thyroid dysfunction, particularly hypothyroidism, and dysfunctional uterine bleeding. Screening for thyroid function in women presenting with menstrual irregularities could aid in early detection and management of thyroid disorders, potentially improving reproductive health outcomes

Helicobacter pylori is a common and important transmissible bacterial human pathogen. The prevalence of this infection varies world-wide from as low as 10 per cent in developed western nations to higher than 80 per cent among the indigenous populations of many developing countries. H. pylori infection is typically acquired in childhood. The risk of infection is inversely related to the overall sanitary conditions and requires exposure to other infected humans. Contaminated water is often the primary mode of transmission in rural areas without reliable supplies of potable water7,8. However, in regions of higher socio-economic status the risk of infection best correlates with the level of household hygiene. METHODOLOGY The present study was cross sectional in nature. It includes one hundred and fifty eight (158) patients both male and females patients attending OPD at Tertiary care teaching hospital with symptoms suggestive of gastro duodenal diseases, who fulfilled the inclusion and exclusion criteria. The study period was from April 2022 to March 2023. A total of 158 consecutive adult patients who presented to Hospital with symptoms of gastroduodenal diseases and referred for upper gastrointestinal endoscopy. RESULTS: Among the study subjects10.8% were found to be having normal UGI scopy inspite of symptoms suggestive of gastro-duodenal diseases, majority of patients was diagnosed to be having Duodenal ulcer (25.3%), Gastric ulcer (21.5%), and gastric erosions (17.7%). In our study out of 158 study subjects 40 were found to be negative for H-pylori infection. Majority of H-pylori positive patients were found to be having H-pylori density 1+ (44.9%) Even though upper GI Endoscopy was normal, 9 patients were found to be having H-pylori infection. Among 18 Gastric malignancies patients, 8 were negative for H-pylori infection. 80% of the duodenal ulcer patients were found to be having H-pylori infection. 68% of the Gastric ulcer patients were found to be having H-pylori infection. 85.7 % of the gastric erosions patients had H-pylori infection. Conclusion: From Our study, we would like to conclude that age related prevalence is more in relatively younger age group than elderly, and prevalence is more in males. Among the gastro duodenal diseases the prevalence of H.pylori infection is high in duodenal ulcers followed by gastric ulcer. In our study we found that specificity and negative predictive value of Cag-A strain for gastric carcinoma were high and it has practical importance that Cag-A positive H-pylori strains are strongly associated with gastric cancers. In our study we found that specificity and negative predictive value of Ure-C strain for gastric carcinoma were high

Background: Dacryocystorhinostomy (DCR) describes the creation of a functional pathway from the canaliculi into the nose by means of creating an osteotomy and opening the nasolacrimal sac into the nose. It can be performed via an external or endonasal approach.Obstruction of the excretory lacrimal system results in epiphora (tearing). Depending upon the exact cause and location of the obstruction, specific surgical procedures are used.  In longstanding nasolacrimal duct obstruction (NLDO), mucus can accumulate, resulting in a mucocele in the nasolacrimal sac or even acute or chronic dacryocystitis. Lacrimal surgery to restore tear drainage is usually the definitive treatment and involved one of the types of dacryocystorhinostomy.To compare the clinical profile of patients with chronic dacryocystitis (CDC) with and without associated chronic rhinosinusopathies who had been submitted to external dacryocystorhinostomy (EDCR). Materials and methods: One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group Aincluded patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups. Result:A total of 90 patients were included in this study, concerning the gender, there was a predominance of the female with 57 out of 90 patients (63.3%) and males were 33 patients. Age groups of 1-20 years are 5 patients (5.6%) and predominant age in the study was elderly more than 61 years old patients 40%. The clinical characteristics of chronic dacryocystitis are shown in table 3, epiphora was found in 66 patients (73.3%) and absent in 24 patients (26.7%). The discharge by the digital expression of the lacrimal sac was attained in 60 patients (66.7%) and not attained in 30 patients (33.3%). The previous history of exacerbation of chronic dacryocystitis identified as purulent discharge occurred in 15 patients (16.7%) and non-occurrence in 75 patients (83.3%).Conclusion: The physiopathology of the CDC is not fully known. This study reveals a possible influence of CRS on the CDC, emphasizing its action on the exacerbation of the symptoms