European Journal of Cardiovascular Medicine

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.

Introduction- Primary lung epithelial malignancies are the most common neoplasms among all lung masses. Lung carcinoma is the leading cause of death for which a histological or cytological confirmation and categorization of malignancy is required before treatment. It is desirable to have both FNAC or TBNA and biopsy for exact diagnosis. Sometimes, even immunohistochemistry is required to confirm the diagnosis.

Introduction: Some studies have reported an association between ischaemia of the macula as seen on fundus fluorescein angiography (FFA) with diabetic nephropathy in diabetes mellitus. They have further postulated that finding of macular ischaemia on FFA can be used to predict the onset of diabetic nephropathy in diabetes mellitus. This study was undertaken to explore association between macular ischemia and nephropathy in diabetes mellitus in a rural population of Maharashtra. Aims and objectives: To explore for any correlation between ischaemic maculopathy due to diabetes and diabetic nephropathy and to find out whether ischaemic maculopathy can be used as a marker for diabetic retinopathy.

ackground: Diabetes is a major causative risk factor for the development of ACS & the adverse outcome after ACS. ‘Stress hyperglycaemia’ has been defined in different ways by various studies. Transient hyperglycaemia has been recognized as a noticeable feature in ACS and is related to stress (Lakhdar et al., 1984).[1] Glycosylated haemoglobin is thus useful to differentiate between stress hyperglycaemia diabetes mellitus. Glycosylated haemoglobin has more sensitivity and specificity for diagnosing diabetes in acute myocardial infarction patients, than admission hyperglycaemia

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

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

Introduction: 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

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

Background: The kidneys expel uric acid (UA), the byproduct of purine hydrolysis. The enzymes xanthine oxidase and xanthine dehydrogenase are in charge of the generation and breakdown of uric acid. Both enzymes participate in the production of oxygen free radicals, which increases oxidative stress, by catalysing the conversion of hypoxanthine to xanthine, which is the primary enzyme in purine metabolism

Background: Patients with diabetes mellitus (DM), have poor long term glycaemic control, even when fasting glucose concentrations are normal.3,4, Glycosylated haemoglobin (HbA1c) is a useful index of glucose intolerance and hyperglycaemia. HbA1c is an established marker of long-term glycaemic control. HbA1c can be assessed in the non-fasted state and has higher reproducibility than fasting glucose. Aim of the Study: To study the blood levels of HbA1C in patients of Acute Coronary Syndrome at the time of admission and to find out the correlation with the angiographic pattern.

Background: Distal Peripheral Neuropathy (DPNP) is a frequent micro-vascular complication of long-term diabetes and one of the main causes of morbidity and disability due to ulceration and amputation. Our aim is Correlation Study of Peripheral Neuropathy in Impaired Glucose Tolerance and newly diagnosed Type-2 Diabetes Mellitus Methods: A prospective Cohort study was taken among 160 patients. From patients with diagnosis of Impaired Glucose Tolerance& Newly diagnosed case of Type -2 Diabetes Mellitus (DM) attending the OPD and IPD in Department of Medicine at our Medical Hospital. During study period from 1st of Feburary 2021 to 31st August 2022. Results: In the current study, the mean NDS for newly diagnosed diabetic participants was.43, whereas it was.30 for IGT subjects, and it was determined to be non-significant. In the current study, it was determined to be highly significant that the mean Sensory Nerve Conduction Velocity in newly diagnosed diabetes participants was 56.44± 9.85 and in IGT subjects it was 50.35± 10.94. Out of the total 160 study respondents, 32 subjects were having any kind of sensory abnormality in their body. out of these 32 subjects, 23 belongs to new diabetic group while nearly only 9 subjects belong to IGT group. This association was found to be significant with a p value 0.006 Conclusions: The mean Sensory Nerve Conduction Velocity in new diabetic subjects were 56.44± 9.85 and in IGT subjects were 50.35 ± 10.94which was found to be highly significant with a p value<0.001.However, The mean Sensory Nerve Action potential in new diabetic subjects were 7.64± 3.13 and in IGT subjects were 7.52 ± 3.24which was found to be non-significant with a p value 0.79.Patients with DM and pre diabetes are at elevated risk for PN, and PN patients are at increased risk for dm and pre diabetes

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: The platelet count declines and petechiae appear in widespread distribution with spontaneous ecchymoses. Bleeding occurs at mucosal surfaces from the gastrointestinal tract and at venipuncture sites. Objective: to study Correlation between the laboratory features – thrombocytopenia, elevated hepatic enzymes, hyponatremia, high hematocrit and severity of dengue infection. Methods: It is an observational study conducted at a multispeciality teaching Hospital. The study population (cohort) was selected from the hospital inpatients who are admitted in paediatric intensive care unit as well as paediatric ward

Background: The long-term complications of DM have a variety of severe effects on people's quality of life as well as their prospective life, harming both individuals and civilizations. In order to reduce the microvascular and macrovascular complications, glycated haemoglobin (HbA1c), should be maintained below 7% in DMT2 patients. It is possible to predict complications in type 2 DM using the simple, reliable, and affoGlycosylated Haemoglobin and Microvascular, Type 2 Diabetes Mellitus Patientsrdable tests like Mean Platelet Volume (MPV)

Introduction: In India, diabetes is turning into an epidemic as currently, more than 62 million individuals suffer from the disease. To our knowledge, very few studies have evaluated the correlation between lipid profiles and glycated hemoglobin (HbA1c) in newly diagnosed type II diabetes patients with hypertension. The early detection of lipid abnormalities in these patients will help prevent the cardiovascular outcomes

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

Background: Epicardial adipose tissue (EAT) thickness reflects visceral adiposity. Association between visceral obesity and cardiovascular risk was well-established in previous studies. EAT is also associated with coronary artery disease(CAD). Measurement of epicardial adipose tissue (EAT) thickness by echocardiography can be a novel parameter that is inexpensive and easy to obtain and may be helpful not only in cardiovascular risk stratification but also in predicting the severity of CAD. Objective: In this study,we aim to assess the correlation of echocardiographic EAT thickness with the severity& complexity of CAD as denoted by SYNTAX score. Methods: EAT was measured by 2-D echocardiography in 324 patients undergoing coronary angiogram, those who presented with acute coronary syndrome and chronic stable angina. The severity & complexity of CAD was assessed by SYNTAX score from angiography. Results: Epicardial adipose tissue thickness is independently related to coronary artery disease complexity as denoted by SYNTAX scores, and EAT thickness was higher in the high SYNTAX score group. Mean EAT thickness was 10.8± 1.07 mm, 7.8± .87 mm& 3.77± 1.52 mm in the high, intermediate and low Syntax score groups (p<0.0001).At progressivethicknesses (<6, 6–8, and >8 mm), mean Syntax scores were 8.76± 5.45,22.08±4.76,and 31.28±3.22,respectively.EAT thickness had strong and positive correlations with SYNTAXscore(ρ =0.937; p=<0.001)

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

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

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

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

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

Prospective observational study, to formulate a risk scoring system that can predict the risk of amputation in a patient with an infected diabetic foot in patients presenting to the OPD and IPD of Katuri medical college &hospital, Chinakondrupadu, Guntur. Atotalof203patients in the duration from December 1st, 2020, to June 1st, 2022 presented with infected diabetic foot ulcerto our hospital, of which150 were enrolled in the study.

Using the specificity and sensitivity of our 11 risk factors, we constructed a ROC curve according to which our new Risk score had a high prognostic accuracy based on the area under the curve of 0.903, which was higher  than  the International Working Group on the Diabetic Foot (IWGDF) system which was 0.67. The Resultant ROC curve yielded a cut off score of 16.5.

Our study found the risk of amputation increases with the severity of the infection reflected in our study, with the highest incidence rate of 44.7%ofamputations belonged to IDSA grade4. An association between HbA1c levels and Lower extremity amputation can be drawn, with the maximum number of amputations identified in patients with HbA1c≥9.5. A strong correlation between the previous history of diabetic Lower extremity amputation and present amputation. 77.8% of patients who had a history of lower extremity amputation due to diabetes underwent amputations. 68.1 % of patients who underwent amputations had sensory neuropathy in ≥3sites.

A total of 9 patients required re amputation and 26 patients who were our previous amputee subjects required re debridement within a period of 18 months. All the patients who underwent re amputation had a score of>16.5.

Thus our score predicted the need for future amputation in those patients who had a Score of > 16.5.

Limitations of our study are:

1. The effect of our risk factors on major and minor amputations separately were not assessed.
2. The history of the previous lower extremity revascularization procedure was not taken into account while calculating the score.
3. The effects of venous insufficiency on diabetic foot ulcers in this study were not accounted for.
4. The motor neuropathy was not segregated into subsequent grades based on the muscle power

The effects of type 1 and type 2 diabetes was not studied independently

Background: ß-thalassemia is one of the most common autosomal recessive disorder ranging from clinically silent heterogenous thalassemia minor to severe transfusion dependent thalassemia major. Blood transfusion is the primary way of treating thalassemia, but it leads to iron overload and results in serious damage to various organs by depositing in the liver, heart, and various other endocrine glands along with endocrine organ failure. Iron induced liver injury leads to high serum ferritin levels and thus in turn, accounts for the abnormal lipid profile. The purpose of this study is to investigate the lipid profile in ß- thalassemia major patients and their correlation with serum ferritin levels. Methods: 75 ß-thalassemia patients of both sexes ranging from 1-18 years, receiving multiple blood transfusions were included in the present study. Blood samples were withdrawn, analysed for serum ferritin levels and lipid profile and their correlation were assessed. Results: Out of 75 ß-thalassemia major patients, 64% were male and 72% were Sikh by religion. The mean no. of blood transfusions was 128.26±52.89 with average dose and duration of iron chelation was 1177.63±438.47 mg/day and 7.9±3.7 years respectively. The mean value of serum ferritin was 2788.05±1799.22 ng/ml. Mean HDL levels were on the lower side with an average of 21.73±8.56 mg/dl and its correlation with serum ferritin was negative (r=-0.635). The average value of serum total cholesterol and LDL were 116.1±46.15 mg/dl and 59.95±16.72 mg/dl respectively. The mean triglyceride level (TG) was on the higher side with an average of 202.87±91.57 mg/dl and its correlation with serum ferritin was positive (r=+0.845). Conclusion: Raised serum ferritin levels showed low levels of HDL and high levels of total cholesterol, LDL and serum triglycerides. Dyslipidemia in these children can lead to increased risk of atherosclerotic cardiovascular disease

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

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

Background: Low blood platelet counts are a defining characteristic of the illness known as thrombocytopenia. It is the most typical haematological aberration observed in people with chronic liver disease.1 It has been documented in 64%–84% of individuals with various aetiologies of liver cirrhosis or fibrosis.2 Thrombocytopenia has been regarded as one of the key signs of advanced liver disorders as a result. OBJECTIVES: 1. Identifying the correlation of platelet count, spleen size, and their ratio with the presence of esophageal varices in patients with liver cirrhosis without any previous evidence of GI bleeding. 2. Assessing the ability of these parameters as non-invasive tools to predict the presence of esophageal varices. MATERIAL & METHODS:  Study Design: Prospective Observational study. Study area: Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatient. Study Period: January 2019 to December 2020. Study population: Liver cirrhotic Patients attending Dept of Medicine, Dept of medical Gastroenterology, Outpatient department and Inpatients. Sample size: Study consisted a total of 50 subjects. Sampling Technique: Simple random technique. Study tools and Data collection procedure: In this prospective observational study of 50 patients, newly diagnosed patients with liver cirrhosis without a history of gastrointestinal bleeding were included. Relevant clinical parameters were assessed, which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of spleen long axis diameter. Platelet count/ spleen diameter ratio were calculated for all patients. Results: Patients were grouped according to Child-Pugh Classification of Cirrhosis. Majority of study group patients belonged to Child-Pugh class C (66.00%) followed with class B (30.00%). Majority of patients belonged to the category of ratio between 501-1000 (48.00%) followed with<500 (24.00%), 1001-2000 (20.00%) and >2000 (8.00%). CONCLUSION: we conclude that the incidence of thrombocytopenia and lower PC/SD ratio can be used to establish higher grades of varices. It can be used to identify the subset of patients requiring endoscopy for prophylactic management of esophageal varices. It may further reduce the burden on the endoscopy units, avoid unnecessary screening endoscopies and management costs for bleeding varices.

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

Introduction: Diabetes mellitus is one of the most common diseases whose prevalence is on the rise. It is believed that within the next 30 years, the number of diabetic patients will double in comparison to the year 2000.Aims: To Study the effect of impaired blood glucose level on cognitive functions. Materials and Methods: The present study was a Prospective cross-sectional study. This Study was conducted from Dec 2019 to June 2021 at Department of Physiology in association with department of Medicine at tertiary care hospital  Result: In the present study, it was also seen that reduction in mean MMSE score in type2 DM subjects having duration above 5 years was significant when compared to those with duration less than 5 years. It shows that longer duration has an effect over cognitive function. Correlation coefficient between MMSE score and HbA1c was negative in this study, from which it is inferred that increase in HbA1c levels is associated with decrease in MMSE scores. Conclusion: We found that, Effective control needs proper diet, regular exercise, monitoring blood glucose by self and management of medications. A person’s cognitive skill to bring about the above mentioned needs is thus crucial for self-management of diabetes

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

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

Introduction: The current feasibility study is to be analysed for the possibility of establishing a podiatry unit in PMR hospital Hyderabad. This study focuses on the better performance  in means to facilitate the service to the diabetic foot patients. This study is performed with the way of framing close ended questionnaires stating the goal of the study.  Aims: Study also aims to gather opinion of health care staff and patients about need for podiatry services.  Materials and methods: The data gathered with questionnaire is from various participants of sample size approximately 100. Qualitative and quantitative form of analysis are being used in this study. Qualitative analysis is used for purposive sampling and quantitative analysis is used for convenience sampling.  Results: There is statistical significance impact of opinion of patients in the overall experience on foot ulcer treatment towards the overall ease of podiatric equipment availability for the patients for the treatment. Overall experience in management varies high then there is a variation occurring in the other two variables, the seeking support and the availability of podiatry equipment’s.  The significance value in the above regression test, explains about the significance correlation among those variables the preparedness of patients to acquire surgery from same tertiary care centre and overall experience of the patients in management for foot ulcers. Nearly 37% of probability of predictor variable is prevailing to have specific relation on the dependent variable Ease of availability of Prescribed podiatry equipment including removable cast walkers and dressings. Conclusion: The podiatry consists of delivery of services associated to the issues in foot health. The prominent challenge to provide the podiatry-services seems complex and it necessitates on-going variation of role flexibility, knowledge, skills and working practices

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

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality. India suffers the highest loss in potentially productive years of life, due to deaths from CVD.There are various investigations that have been utilised for diagnosis and management of acute coronary syndrome such as troponin ,CK-MB and 2D echo.There are few expensive investigations such as NT pro BNP that have been used as the prognostic factor in acute coronary syndrome.There is thus need of an investigation that can be done in peripheral setting which can be done easily and and has good prognostic value in acute coronary syndrome.  Objective: To study of neutrophil to lymphocyte ratio in acute coronary syndrome and its correlation with outcome Methods: This cross-sectional observational study was conducted in tertiary care hospital in Central India. Patients who were admitted to tertiary care centre with a diagnosis of ACS fulfilling the inclusion criteria were included in the present study. The study was conducted from June 2020 to Nov 2022. Results: Among the patients with N/L≤4, 36.1% had Killip class 1, 36.1% had Killip class 2, 19.4% had Killip class 3 and 8.3% had Killip class 4. Among the patients with N/L>4, 11.1% had Killip class 1, 30.6% had Killip class 2, 29.2% had Killip class 3 and 29.2% had Killip class 4. There was statistically significant difference. The mean CK MB of the patients with N/L≤4 was 570.90±36.29 and the mean CK MB of the patients with N/L>4 was 177.42±107.76. There was statistically significant difference. The mean 2D ECHO EF of the patients with N/L≤4 was 44.16±6.39 and the mean 2D ECHO EF of the patients with N/L>4 was 34.58±5.45. There was statistically significant difference. Among the patients with N/L≤4, all of them survived (100.0%); among the patients with N/L>4 15.3% died and 84.7% survived. There was statistically significant difference. Conclusions: The results of this study revealed that NLR is the strong predictive marker of ACS, so the study recommends using NLR as a good prognostic indicator for predicting short-term MACE and death in ACS patients.

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

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

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

Background: It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause. Cardiovascular diseases are showing an increase among the Indian population. There has been a rapid and significant growth in the measurement of quality of life as an indicator of health outcomes in patients with CVD. In the clinical course of cardiovascular diseases, the interaction between stress and its impact on quality of life will alter and aggravate theclinical condition. Thus, an improvement in health-related quality of life is considered to be important as a primary outcome and overall therapeutic benefit. Most of the patients cannot cope with the stress due to the burden of cardiovascular disorder and require psychiatric intervention. This study will be focusing on the psychological problems faced by these patients and suggest a plan for improving their quality of life. Aims: To assess the quality of life in patients with known cardiovascular disorders i.e. hypertension, congestive cardiac failure and coronary artery disease. Methods: Patients attending Medicine OPD/IPD with a diagnosis of Hypertension, Congestive Cardiac Failure or coronary artery disease who satisfy the inclusion criteria will be selected. Socio-demographic data will be recorded via semi-structured proforma and the WHO Quality of Life Scale (WHOQOLBREF) will be applied. The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 120 patients, 40 patients were selected in each diagnosis of hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The overall mean (SD) HRQOL was observed as 54.65 ± 14.23 with a range between 18.75-81.5. Among them, domain 4 has been observed with the highest score of 14.62 ± 2.3 and 66.54 ± 14.31 with 4-20 TS and 0-100 TS. However, the HRQOL distribution was varied as per different cardiovascular disorders, like highest mean ± SD score was observed with CHD (57.43 ± 13.33), followed by HTN (56.1 ± 14.66) and CAD (50.42 ± 14.04). Conclusion: Cardiovascular disorders are an important public health problem with a significant psychological impact and impact on the QoL of patients. There is a slight male preponderance observed in patients with cardiovascular disorders. QoL was affected in patients with cardiovascular disorders with psychological and physical health domains being primarily affected.

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

Introduction: Chronic otitis media (COM) has been an important cause of middle ear disease since prehistoric times. Despite the valuable contribution of antibiotics, COM remains a common disease and its complications challenge both otologists and radiologists. Chronic otitis media is relatively common and potentially dangerous disease of the ear. It is defined as permanent abnormality of the pars tensa or flaccida, most likely a result of earlier acute otitis media, negative middle ear pressure or otitis media with effusion. Chronic Otitis Media is of two types : Mucosal and Squamosal. COM of all types is associated with erosion of the ossicular chain . The incidence and degree of ossicular destruction is much greater in cases of unsafe CSOM, due to the presence of cholesteatoma and/or granulations. Although bone erosion may occur in COM without cholesteatoma, it is more frequent when the keratinizing epithelium is present. Aims: To compare the preoperative HRCT findings with intra-operative findings in patients with Chronic Otitis Media and to resolve the doubts about the sensitivity and specificity of pre- operative CT scan findings in squamosal COM. Materials and Methods: This is a prospective study of 50 patients done principally at the Institute of Otorhinolaryngology And Head & Neck Surgery, IPGME&R & SSKM Hospital , Kolkata, India in which patients coming with inactive or active squamous Chronic Otitis Media with or without complications, who were planned for different types of mastoid surgeries were included in the study . Result: This study has shown that HRCT imaging of temporal bones for COM accurately depict presence of soft tissue mass in either the external auditory canal or the middle ear subsites, the integrity of the scutum, the integrity of the ossicular chain and erosion of the tegmen or the sigmoid plate. However, the role of HRCT could not be established in predicting the status of the tympanic membrane, the presence of lateral semicircular canal fistula, integrity of the incudostapedial joint. HRCT alone as a diagnostic modality could not predict the nature of soft tissue with statistical significance. Conclusion: Preoperative CT scan is helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. It provides information on anatomical variations and complications. It serves as a road map to assist the surgeon during surgery.

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

Background This study was conducted to compare hippocampal volume in patients with TLE with that of a normal control group, and examine the degree and frequency of reductions in hippocampal volume in patients with prolonged epilepsy. Methods This was a hospital based cross-sectional observational study conducted among 228 patients who presented with epilepsy to the Department of Radio-Diagnosis at Ashwini Neuro-Trauma Center Cuttack, from 2015 to 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results Hippocampal volume distribution in the left lobe as well as the right lobe was found to be significantly lower in epileptic subjects as compared to non-epileptic subjects. Using the Mann-Whitney U Test, the mean rank of left and right hippocampal volume comparisons among the group of subjects was found to be statistically significant. There was a significant difference in duration of seizure between epileptic and non-epileptic groups using the Mann-Whitney U test. It was seen that with an increase in seizure duration, there was a decrease in hippocampal volume, both left and right. The correlation was, however, poor but was found to be statistically significant for both left and right hippocampal volumes. Conclusion The ability of volumetric 3D imaging to predict the presence and laterality of hippocampal atrophy plays an integral role in the evaluation of patients with epilepsy, especially in patients with subtle findings and no perceptible hippocampal atrophy on visual inspection and, should be utilized on a regular basis in clinical practice as it is superior to visual analysis in detecting hippocampal atrophy, which can help in guiding surgical resections.

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

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

Background: Detection of smaller thyroid nodules has significantly increased because of the advent of high-resolution ultrasonography. Therefore, accurate characterization of these nodules has gained importance to avoid unnecessary FNACs and biopsies. Aim: To evaluate role of elastography as an adjunctive tool to TIRADS categories in differentiating benign from malignant thyroid nodules with cytological correlation. Methods: 47 patients with diagnosed thyroid nodules were enrolled. USG was done by two independent observers and TIRADS characterization was done. Following this Shear Wave elastography was done for all these nodules and nodules were characterized as benign or malignant. FNAC for cytological correlation was done. Results: TIRADS alone has a sensitivity of 91.67% and specificity of 91.7%, positive predictive value of 93.3% and negative predictive value of 73.3%. When combined with elastography the sensitivity becomes 77.7% and specificity becomes 93.7%, positive predictive value of 93.3% and negative predictive value of 73.3%. Conclusion: Combined efficacy of elastography with ultrasound estimated TIRADS score increases the diagnostic confidence to label malignant vs benign nodule significantly and thus has potential use to reduce unnecessary FNACs.

Background: High Resolution CT has a potential role in the diagnosis, detection of complications and in predicting clinical recovery of patients or progression of coronavirus disease 2019. Degree and severity of lung involvement can be assessed by 25 point CT severity score. This quantification plays an important role to modify the treatment plan at times in critically ill patients of COVID-19. Objectives: The purpose of the present study is to characterize the typical & atypical HRCT imaging features in patients with COVID-19 infection and to additionally establish a correlation between the CT severity score & clinical lab parameters to facilitate an expeditious management protocol. Materials & Methods: A prospective observation study of 2years duration including 75 patients with RTPCR positive proven COVID-19 disease were evaluated with HRCT and the findings were systematically documented and analysed by experienced radiologists. Results: >90% participants were found to have ground glass opacities  (GGO) on Chest CT,76%hadGGOwithsmoothinterlobularseptalthickening; whereas 64% had GGO with smooth intra lobular septalthickening.54.7% (41/75) patients had severe grade of Covid Pneumonia; followed by moderate(26;34.7) and mild (8; 10.6%). There is positive correlation of Chest CT severity scores with urea, D-dimer, CRP, IL-6 , TLC and ferritin. Conclusion: Better understanding of spectrum of CT findings in COVID-19 pneumonia may help to reach accurate diagnosis in clinically and laboratory equivocal cases. It also aids in prognostication of clinically ill cases and cases with co-morbidities.

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

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

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

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

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

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.

Conclusion: Computed Tomography Angiography (CTA) demonstrated superior diagnostic accuracy and strong correlation with Doppler ultrasonography in the assessment of renal artery stenosis. CTA could serve as an effective alternative or adjunct to Doppler ultrasonography, providing valuable anatomical information and aiding in the clinical evaluation of RAS.

Background:  Over the past few decades, the percentage of patients with end-stage renal disease brought on by diabetes has steadily risen. The most popular biochemical parameter for routinely estimating GFR is serum creatinine level. Notwithstanding the fact that large increases in serum creatinine can occur before 50% of GFR is lost. It has been discovered that cystatin C is a new, promising marker for the early detection of renal diseases. To investigate the connection between microalbuminuria and serum cystatin C for the early detection of renal impairment in type 1 diabetic patients. Methods: From April 2021 to January 2022, a cross-sectional study was carried out at Department of Biochemistry, T R R, Institute of Medical Sciences, Sangareddy, Telangana, India. They were split into two groups, Group I with diabetes diagnosed for less than five years and Group II with diabetes diagnosed for more than five years. The Albumin Creatinine Ratio was used to classify the patients in each group as cases and controls. The levels of serum urea, creatinine, cystatin C, hemoglobin A1c, and urine ACR were estimated. Microsoft Excel was used to conduct the statistical analysis. Results: In the study, 80 patients with type 1 DM were enrolled. Cystatin C levels in cases with type 1 DM lasting longer than five years were found to be statistically significant (0.88±0.43 compared to 0.65±0.38). Over a period of more than five years, a statistically significant positive correlation between cystatin C and ACR (r=0.4, p<0.05) was discovered. According to this, serum levels of cystatin C rise as ACR values rise. There was no noticeable difference in cystatin C levels in patients with type 1 diabetes for less than five years. Conclusion: In patients with Type 1 Diabetes Mellitus who have had the condition for longer than five years, Cystatin C levels in the blood may be utilised as an early sign of renal impairment. However, in our study, patients with Type 1 diabetes who have had the disease for less than five years do not show any significance for Cystatin C.

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 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.

Introduction: Essential hypertension is a common circulatory system disease, which is affected by both genetic and environmental factors, and accounts for more than 40% of the cardiovascular disease total burden. Aim: To study 24 hour sodium and correlation to blood pressure and left ventricular hypertrophy in essential hypertension. Materials and methods: It is Hospital based Analytical Observational Cross-sectional study done in 100 patients comprised of hypertensive individuals presenting to Medicine op and patients admitted under the department who are fulfilling the inclusion and exclusion criteria.  Results: There was a strong positive correlation between Systolic BP , diastolic BP , MAP , duration of HTN (Years) and Urinary Sodium (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of urinary sodium(mmol/L), with the median Urinary Sodium (mmol/L) being highest in the LVHI. There was a significant difference between the various groups in terms of distribution of LVMI.There was a positive correlation between Systolic BP, Diastolic BP, MAP (mmHg) and LVMI (g/m2), and this correlation was statistically significant . There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2) (rho = 0.17, p = 0.084). There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2). Conclusions: Hypertension is one of the preventable causes of cardiovascular mortality. Hypertension can be prevented by modifiable risk factors such as low-salt diet, physical activity, blood sugar control, and smoking cessation.

Background and Objectives: Chronic rhinosinusitis (CRS), a prevalent ENT condition, often presents treatment-resistant cases. Gastroesophageal Reflux Disease (GERD) causing Laryngopharyngeal reflux (LPR) is implicated in its etiology. This study aims to assess LPR prevalence in refractory CRS and the impact of combining proton pump inhibitors (PPIs) with functional endoscopic sinus surgery (FESS). Methods: 50 refractory CRS patients were evaluated, split into study (PPIs + FESS) and control (FESS only) groups in the Department of ENT at a tertiary care medical college in India. CRS indicators were assessed, and post-surgery, study patients received intranasal steroids and PPIs. A 3-month follow-up tracked symptom relief. Result: Majority of refractory CRS patients had LPR, mainly affecting the posterior larynx. Nasal obstruction, discharge, and polyps were common CRS indicators. Study group with PPIs showed greater improvement in symptoms, notably by the third postoperative month. Conclusion: The study highlights a significant link between refractory CRS and GERD. PPIs, when used alongside FESS, offer effective refractory CRS management, emphasizing combined treatment's advantages.

Background: Reference values for serum Mg in adults are well defined but in paediatric patients and more specifically in newborn and preterm infants (lesser than 37 weeks gestation) reference values are either not available or are very limited and still controversial; most laboratories do not provide specific reference intervals for this population. Most of studies are done in preterm newborns exposed to prenatal MgSO4 and few studies done in preterm newborns who are not exposed to prenatal MgSO4 However there is no conclusive study from developing countries which elicits if the same reference interval is equally effective in the Indian population. The Indian women differ from those in developed country in terms of constitution, body surface area etc. which may influence the pharmacodynamic action and its effects in neonates. Aim: To assess serum magnesium levels in preterm newborn who were not exposed to prenatal MgSO4. Objective: We have done study to find out the normal serum magnesium values in preterm neonates at birth and to establish the relationship, if any, of these biochemical values with birth weight, gestational age and maternal BMI. Methods: Present prospective observational study was conducted at Level III b NICU of the Department of Paediatrics and Neonatology, Deenanath Mangeshkar Hospital and Research Centre Pune between January 2022 to December 2022. One hundred sixteen preterm newborns (lesser than 37 weeks of gestational age) were studied to estimate the normative data of serum magnesium level in preterm neonates not exposed to prenatal MgSO4 and its variation with gestational age and weight and maternal BMI. Results were analysed and interpretated. Results: In the present study the mean values of serum magnesium irrespective of birth weight, gestational age and sex were observed as –Serum magnesium 1.97±0.38 mg/dl. Conclusion: In conclusion, our findings add to the evidence that the there is consistent variation of serum magnesium level of preterm neonates who were not exposed to antenatal MgSO4 with respect to birth weight and gestational age and showed inverse relation with both factors. There was no correlation found between gender of babies and maternal BMI.

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: The objective of this study is to assess the subfoveal choroidal thickness (SFCT) in individuals with macular edema (ME) resulting from retinal vein occlusion (RVO). Additionally, the study aims to examine the immediate effects following a solitary intravitreal ranibizumab (IVR) injection. Furthermore, it is important to compare the changes in subfoveal choroidal thickness (SFCT) between central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Methods: This study involved a prospective longitudinal examination of 100 eyes belonging to 100 patients who had not received any prior treatment for retinal vein occlusion. Among these patients, 24 had central retinal vein occlusion (CRVO) and 40 had branch retinal vein occlusion (BRVO). In this study, Spectral-domain optical coherence tomography (SD-OCT) was employed to assess various ocular parameters including peripapillary choroidal thickness (PPCT), subfoveal choroidal thickness (SFCT), peripapillary retinal nerve fiber layer (pRNFL) thickness, and central macular thickness (CMT) in both affected and fellow eyes. Measurements were taken at baseline during the acute phase, as well as at 3 and 9 months following anti-VEGF treatment. The Spectralis HRA-OCT system from Heidelberg was utilized for this purpose. A p-value less than or equal to 0.05 was deemed to be statistically significant. Results: When compared to other eyes in CRVO and BRVO, affected eyes had thicker baseline PPCT and SFCT (p 0.05). At three months following baseline, PPCT in the affected eyes significantly decreased in both groups (p 0.05). PPCT remained stable at 9 months as compared to 3 months (p > 0.05). At 3 months, both groups' affected eyes' SFCT significantly decreased (p 0.05). SFCT decreased in the CRVO patients at 9 months compared to 3 months (p = 0.047), but it remained stable in the BRVO patients (p = 0.850). At any timepoint in both groups, there were no correlations between SFCT and CMT (p > 0.05). At 3 months, there is a correlation between PPCT and pRNFL in CRVO, but no other correlations were discovered during the follow-up. In BRVO, there was no discernible correlation between PPCT and pRNFL. Conclusion: Both in CRVO and BRVO eyes, PPCT and SFCT at diagnosis are significantly thicker compared to the fellow eye, suggesting a possible increase in CT immediately after the occlusion, which is followed by a decrease at an early follow-up stage.

Background: Sepsis is known as a life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Sepsis and septic shock carries high potential mortality rates, resulting in challenge and burden to healthcare system. Variation in the size of red blood cells is represented by RED cell distribution width. It is thought to be elevated when an excess amount of reticulocytes are released into circulation. RDW parameter is provided in the CBC report done by the automated analyzer. It is an inexpensive, routinely available, and rapidly measurable prognostic tool. Methodology- The study was carried out at the ICCU, Department of Medicine of tertiary care center, for period of 15-18 months. 65 patients fulfilling the inclusion and exclusion criteria were considered for the study. RDW value was recorded and it correlation with APACHE II score and mortality among the patients was noted. Data was entered in MS EXCEL spread sheet and analysed with the help of Open epi and spss software. Results- Mean age group of study population among non-survivor patient was 48.64 with SD of 17.26 and of survivor was 39.91 with SD of 16.64. Mean APACHE II score among Group I was 16.333 with SD of 7.711, in Group II was 21.307 with SD of 8.596 and in Group III was 21 with SD of 8.5. 30 days mortality among Group I was 1 (16%) in Group II was 22 (84.62%) and in Group III was 30 (90.91%). Conclusion- RDW value increased in patients with sepsis.

Background: This prospective observational study delves into the intricate realm of Doppler indices in intrauterine growth restriction (IUGR) fetuses, aiming to illuminate their clinical relevance and predictive potential. Fetal growth restriction, a critical concern in maternalfetal medicine, is explored through the lens of Doppler ultrasound, which enables assessment of uteroplacental and fetoplacental blood flow dynamics. By evaluating umbilical arterial (Umb A) Doppler Velocimetry, this study establishes correlations between hypoxemia in IUGR-affected fetuses and abnormal Middle Cerebral Artery (MCA) pulsatility indices. The investigation comprehensively analyzes Doppler indices' performance in predicting perinatal outcomes, utilizing sensitivity, specificity, and diagnostic accuracy assessments. With a focus on both symmetrical and asymmetrical IUGR, this study demonstrates the importance of Doppler imaging in diagnosing growth retardation and predicting adverse outcomes. Findings underscore the significance of combined uteroplacental and fetoplacental assessments and the potential of umbilical artery Doppler in outcome prediction. The implications of abnormal Cerebro umbilical ratio and absent diastolic flow further underscore the utility of Doppler imaging in enhancing high-risk pregnancy surveillance and outcomes.

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: Fetal asphyxia has been a concern since the 19th century when it was first identifiedthat defective oxygen supply is associated with the process of labour. In the present situation the identification of asphyxia is very crucial to initiate need for early active intervention thus reducing the risk of perinatal morbitidy and improve neonatal outcome. Perinatal asphyxia occurs as a result of deprivation of oxygen due to reduced blood supply to brain. Hence the clinical presentation of asphyxia has to be correlated with severity and duration of asphyxia. The complications of perinatal asphyxia are Hypoxemic ischemic encephalopathy which is most severe and common presentation, others include RDS, NEC, hypoglycemia, hypocalcemia, MAS, ATN and multiorgan failure. Material and Methods: This is a prospective study conducted in the Department of Obstetrics & Gynecology at Apollo Institute of Medical Sciences & Research, Chittoor from October 2022 to March 2023. Among these, variations of various parameters in asphyxiated newborn are compared with non-asphyxiated newborn. After separation of the baby, cord blood collected from the placental side and smear made to assess presence of nucleated red blood cells. Acid base status of the newbornalso will be assessed by acid base analysis. Results: About 17% women are in the age group of 16-20years, 12% are in the agegroup of 26-30 years, 4% are in the age group of 31-35years. Majority belong to 21- 25years age group of 65%. Among the 100 pregnant women in the antepartum period, 82% had reactive CTG and 18 % had non reactive CTG. Among the study group of 100 antenatal women, 74% has normal modified biophysical profile. 10% has variation in AFI, 14 % has abnormal CTG and 3 % has abnormality in both AFI and CTG. In my study comparison of group of neonates with reactive vs non-reactive intrapartum CTG was carried out. IP CTG was reactive in 48%, equivoval in 8% and non-reactive in 45%. Conclusion: Together, various parameters can be used as an essential, non invasive approach for early detection of any fetal distress. All the parameters taken in the study are easier to implement in the routine care of antenatal women, are less expensive and they provide a reassuring information regarding the status of the fetus in utero. Hence the study concludes the use of modified biophysical profile in antepartum period, intrapartum CTG and APGAR scores, number of cord blood nucleated RBC and acid base as tools of fetal surveillance in predicting the perinatal outcome.

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: 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.

Conclusion: The study concluded that there is a strong positive strength of association between the gestational age and placental thickness. The thickness of placenta increased with increase in the gestational age and hence could be used as a predictor and a parameter of gestational age prediction when the last menstruation is uncertain or is unknown. The study also found there is strong strength of association between the estimated gestational age by FL, BPD and AC with the placental thickness. Also study documented the positive strength of association of placental thickness with other fetal biometry like FL, BPD and AC.

Background : HIV continues to be a major global public health issue, having claimed 36.3 million [27.2–47.8 million] lives so far. The human immunodeficiency virus (HIV) targets the immune system and weakens people's defense against many infections and some types of cancer that people with healthy immune systems can fight off. Low vitamin D levels have been associated with HIV disease progression and HIV-related complications. Materials and Methods: Cases will be selected from patients presenting to KIMS hospital, IPD section with history Of HIV infection considering the inclusion and exclusion criteria. A total of 110 consecutive patients presenting with HIV positive status, whose inclusion and exclusion criteria are fulfilled are considered for study. It’s a single centered, time- bound prospective study carried out for a period of 2 years. Each patient was evaluated with History, clinical examination, and lab investigations.  Results : In the present study involving 110 HIV patients. The mean CD4+ Count (/cu.mm) was 186.86 ± 104.35 and the mean Viral Load (x103) was 55.20 ± 68.61. vitamin D deficiency was present in 96.4% of population. There was a strong positive correlation between CD4+ Count (/cu.mm) and S. Vitamin D (ng/mL). There was a strong negative correlation between Viral Load (x103) and S. Vitamin D (ng/mL). Conclusion: In this study, with deficiency of Vitamin D level there was positive corelation with CD4 Count causing reduction in CD4 Count and negative correlation with viral load causing increased viral load with reduction in vitamin D levels in HIV affected individuals.

Introduction: OPCAB was designed to reduce complications resulting from cardiopulmonary bypass like stroke, renal complications and myocardial ischemia and to reduce hospital stay, reduce morbidity and mortality. It includes various anatomical distortions of heart using stabilizers and suspensions which needs extensive monitoring techniques. To improve its efficiency neurological monitoring like NIRS and PA cannulation could play a significant role in further reducing such complications. Mixed venous oxygen saturation (SvO2) remains the accepted standard during anesthesia to evaluate the balance of oxygen delivery and consumption, especially during cardiac surgery. Monitoring the ScvO2-SvO2 with conventional PAC gives indirect evidence of myocardial ischemia, after excluding other causes of ischemia in lower body. Materials and Methods:  In this single centred prospective interventional study, 60 patients undergoing elective off pump CABG between March 2018 to March 2020 were taken. Institutional ethical and scientific committee approval was taken (UNMICRC/ANESTH/2017/09) and written informed consent from patients was obtained. Results:  Total 360 patients were enrolled in the study for comparative analysis of regional cerebral oxygen saturation (rScO2), central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) in off pump CABG. Table 1 shows general characteristics of patients. Mean ejection fraction was 45.92 ± 9.23%. Fifty patients had triple vessel disease and 10 had double vessel disease for which 60, 53 and 49 patients had undergone Left anterior descending (LAD), Obtuse marginal (OM) or Diagonal (DG) and Posterior descending artery (PDA) or Right coronary artery (RCA) grafting respectively. Conclusion:  Positioning of the heart for distal anastomoses at lateral and posterior wall was associated with more hemodynamic alteration and increased in inotropic and vasopressor requirement and significant decreased in rScO2, ScvO2 and SvO2. There was significant positive correlation on measured gradient between ScvO2 & SvO2 and rScO2 & SvO2 and rScO2 & ScvO2. ΔrScO2 was found to be highest as compared to ΔSvO2 followed by ΔScvO2.

Background: Hyperlipidemia is a widely observed medical condition that exhibits a strong correlation with the occurrence of coronary heart disease. Certain patients exhibit hesitancy or choose to abstain from the use of lipid-lowering prescription drugs due to concerns over potential adverse pharmacological responses. Objective: The goal of the treatment was to reduce the level Total cholesterol and Triglycerides. Method: This article presents the case report of a 30-year-old male who was diagnosed with Hyperlipidemia and Total cholesterol 207mg/dl Triglycerides 525 mg/dl. He wanted to be treated by Acupuncture with Traditional Chinese Method and following Suoxi Healthy Life Style controlled cholesterol level. Outcomes: For 3 months, electro acupuncture was done once a week   patient’s level of Total cholesterol and Triglycerides. Conclusion: This case showed that electro acupuncture combined   not only effectively reduces Triglycerides, but it also significantly improves cholesterol level of the patient.

Background: This study was conducted to correlate, inflammatory markers with mechanical ventilation and mortality in Covid- 19 patients, IL-6 levels with mechanical ventilation and mortality in Covid-19, and CRP levels with mechanical ventilation and mortality in Covid- 19. Methods: This was a hospital-based descriptive cross-sectional study conducted among 200 cases, considering a 13-point difference in the IL-6 or CRP levels among the patients who needed mechanical ventilation, at the Department of Medicine, Tertiary Care Hospital, Mumbai, over a period of three years, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The CRP levels were significantly higher among the patients with mechanical ventilation when compared to the patients who were not ventilated [103.22 ± 99.04 mg/dl (present) vs. 78.70 ± 75.90 mg/dl (absent) mg/dl]. The IL-6 levels were significantly higher among the patients with mechanical ventilation when   compared to the patients who were not ventilated [432.09 ± 509.95 IU/L (present) vs. 81.79 ± 195.44 IU/L (absent) mg/dl]. The CRP levels were significantly higher among the patients who died when compared to the patients who were alive [137.49 ± 117.35 mg/dl (dead) vs. 74.73 ± 70.61 mg/dl (alive)]. The IL-6 levels were significantly higher among the patients who died when compared to the patients who were alive [491.95 ± 541.59 IU/l (dead) vs. 69.70 ± 156.54 IU/l (alive)]. Conclusion: CRP acts as a fair predictor for mortality in the present study, implying that elevated CRP levels may indicate an increased mortality risk.

Background: It has recently been demonstrated that vitamin D, long thought to be a hormone that regulates calcium and phosphate, is essential for the treatment of a number of non-skeletal illnesses, including cardiovascular disease. Numerous research have been conducted on the connection and potential causal involvement of vitamin D in cardiovascular diseases and the well-known risk factors associated with them. There aren't many research conducted in this region of the world, though. This study's primary goal was to measure the 25-hydroxyvitamin D levels in heart failure patients. Methods: This was a institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from March 2021 to May 2022. Total 100 patients with heart failure and fulfilled the inclusion criteria were included in this study data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism version 5. Result: In present study maximum participants 57 (57%) were from the age group of 61-80 years. Mean age of the participants was 65.38±13.7656l. In our study, 46 (46.0%) patients were Normal BMI, 14 (14.0%) patients were Obese BMI and 40 (40.0%) patients were Overweight BMI. In the present study 100 (100%) of the participants had Exertional Dyspnoea followed by PND and fine crepts 79 (79%) each. Vitamin D ≤30 was present in 88 (88%) off study population and >30 was present in 12 (12%) of study population.  Conclusion: In our study we found that 88 out of 100 study participants were Vit D deficient. It was also found that, 25(OH) Vit D levels had negative correlation with LVEF

Introduction: Kidney disease is defined as an abnormality of kidney structure or function with implications for the health of an individual, which can occur abruptly, and either resolve or become chronic. Chronic kidney disease (CKD) is a general term for heterogeneous disorders affecting kidney structure and function with variable clinical presentation, in part related to cause, severity, and the rate of progression. Aims: To study carotid intimal thickness in different stages of chronic kidney disease. To study the correlation between the carotid artery intimal-medial thickness with lipid profile in Chronic Kidney disease. Materials and Methods: The present study was a cross sectional single centre, observational study. This Study was conducted from Jan 2015 to August 2016 at Department of Medicine of a tertiary care hospital. Result: There was negative correlation of CIMT with eGFR on both sides but statistical significance was not reached. There was no significant correlation with creatinine levels. That majority cases had serum creatinine above 4 mg/dL. Raised and normal CIMT were evident in nearly equal proportions in both right (p=0.839) and left (p=0.939) carotids.  That there was no association of raised CIMT with CKD stage in either right (p=0.932) or left (p=0.886). Association of CIMT with patient management. Patients who were managed by hemodialysis had raised CIMT in higher number of patients (63% on right and 56.4% on left) than those managed conservatively (37% on right and 43.6% on, left).  Conclusion: Raised CIMT is substantially linked with lipid markers in CKD patients. No correlation between elevated CIMT and either CKD stage or renal function measures was found, indicating that CKD stage has little to no effect on elevated CIMT. The CIMT of patients receiving haemodialysis, however, was elevated, indicating a higher risk in this population than in patients receiving conservative therapy.

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.

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.

Introduction: Diabetes mellitus is one of the common non-communicable diseases in India. Dyslipidemia is also associated with diabetes mellitus. Role of vitamin D is described in diabetes mellitus in multiple studies owing to its facilitation/inhibition of transcription factor and immune-modulator property. Aim: to evaluate association of vitamin D level with parameters of fasting lipid profile. Methods: It was an analytical observational case study. Patients of type 2 diabetes mellitus were included in the study. All routine lab parameters were done. Statistical analysis was done by pearson correlation test, fisher’s exact test and ANOVA. Linear regression analysis was also done. Results: 119 patients were included in the study. Vitamin D deficiency was found in 77 patients (64.71%). Negative correlation was present between vitamin D level and HbA1c. Vitamin D deficiency was found to be significantly associated with high HbA1c (p = 0.024). Furthermore, Negative correlation was found between vitamin D level and total cholesterol (r = -0.0134, p = 0.8987), serum triglyceride (r = -0.0310, p = 0.7690) and serum LDL (r = -0.0149, p = 0.8873). Positive correlation was present between vitamin D level and serum HDL (r = 0.0296, p = 0.7782). On ANOVA test, mean values of serum triglyceride in vitamin D deficient, vitamin D insufficient and vitamin D sufficient groups were 206 ± 147.3 mg/dl, 152.78 ± 64 mg/dl and 147.84 ± 72.6 mg/dl respectively. (p = 0.0510), near significant association was found between vitamin D deficiency and increased serum triglyceride level. Conclusion: Vitamin D deficiency in type 2 diabetes mellitus is associated with poor glycemic control. Vitamin D deficiency in type 2 diabetes mellitus may be a risk factor for dyslipidemia.

Background: This study was conducted to evaluate the serum vitamin D levels in patients with type 2 diabetes mellitus with and without nephropathy. Methods: This was a hospital-based cross-sectional case control study conducted among 100 patients who attended OPD and IPD at the Department of Medicine, Dr. B.R. Ambedkar Medical College and Hospital, Bangalore, over a period of 18 months from December 2020 to May 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In comparison between diabetic nephropathy and non-diabetic nephropathy between both groups, a statistically significant difference (p<0.001) was noted between them with regard to serum creatinine, eGFR, UACR and vitamin D levels, suggesting that the diabetic nephropathic group has increased creatinine levels, highly reduced eGFR, highly elevated UACR and significantly decreased vitamin D levels, which are not present in the non-diabetic nephropathy patients. The eGFR and vitamin D levels were compared among the diabetic nephropathic subjects. The eGFR was split into three groups and by the ANOVA test measure, a significant association was obtained between them suggesting decreased eGFR also decreases vitamin D levels. On correlating vitamin D levels with serum creatinine and UACR a statistically significant (p<0.001) strong negative correlation was obtained (0.85 and 0.91) respectively. Conclusion: The study found that individuals with diabetic nephropathy had a higher prevalence of vitamin D insufficiency. However, at more advanced stages of diabetic kidney disease, their severity is more prevalent. Patients with CKD (Chronic Kidney Disease) should get information from health care providers on vitamin D monitoring and its dietary sources.

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: 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: 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.

Aims and objectives:The current study aims to find the correlation of serum CRPlevel with disease morbidity & clinical recovery in patients with acute ischemic stroke Materials and methods: A prospective observational study was conducted in 80 radiologically confirmed cases of acute ischemic stroke admitted in medicine wards at Dr Baba Saheb Ambedkar Hospital,Rohini,New Delhi. Patients were subjected to detailed neurological examination and blood samples were obtained from patients who fulfilled the inclusion and exclusion criteria and blood was send to laboratory for the measurement of serum CRP levels. Results: In this study group, the serum CRP levels on admission were predictive of stroke severity(positively correlated with NIHSS (P = 0.001) as well as outcome(positively correlated with MRS(P =0.001) Conclusion: The serum CRP level on admission can be used to predict severity and outcome in acute ischemic stroke

Abstract:Introduction: COPD is a leading global cause of mortality, expected to rise in prevalence over the next four decades. Patients often find the early hours of the day troublesome, impacting their health-related quality of life (HRQoL). This study aims to address the commonly overlooked issue of morning symptoms in COPD patients, focusing on their severity and correlation with the CAT score and BODE index. The research underscores the significance of understanding and managing morning symptoms to improve the overall well-being of individuals with COPD. Materials and methods: A cross-sectional study involving 128 COPD patients meeting inclusion/exclusion criteria was conducted in hospitals affiliated with Bangalore Medical College & Research Institute. Comprehensive investigations were carried out, and morning symptoms were evaluated using the CDLM questionnaire. Patients were clinically classified into GesEPOC phenotypes and GOLD stages based on FEV1 (%). The severity of COPD was assessed through the BODE index and CAT score, with correlations examined against the CDLM questionnaire. Results: In this study of 128 COPD patients, predominantly males with a mean age of 63 years, the first tertile demonstrated lower CDLM scores, indicating a higher morning impact and more respiratory symptoms. These patients also had lower FEV1%, higher CAT and BODEx scores, and increased exacerbations. Higher CDLM scores were associated with the Non-Exacerbator clinical phenotype of GesEPOC Spanish Classification. Multivariate analysis revealed that lower CDLM scores were independently linked to higher CAT and BODEx scores, lower FEV1%, and increased exacerbations. Conclusion: Evaluation of morning symptoms using capacity of daily living during morning (CDLM) questionnaire revealed there was a strong association with markers of COPD severity. The significant association was found with CAT and BODE index score and GesEPOC phenotypes. The strong negative correlation was learned for CDLM with CAT score and BODE Index score independently. However, the CDLM questionnaire exhibits a ceiling effect, limiting its ability to effectively differentiate between low and high impacts of morning symptoms.

Background: Benign breast disorders are prevalent among young ladies.   The most prevalent manifestation is an asymptomatic mass in the breast.   It is crucial to establish a connection between clinical and pathological findings.   Fibroadenoma is the most prevalent of all benign breast conditions.   The objective was to examine the age distribution of benign breast conditions.   The objective is to investigate various benign breast diseases, analyze their clinical manifestations, and establish correlations with radiological examination, cytology, and histology of breast disorders.Methods: The study conducted in the Department of General Surgery at Sri Aurobindo Medical College and Post Graduate Institute in Indore (M.P.) is a Randomized Observational Prospective study.A study was conducted on patients who were diagnosed as having benign breast disease on clinical examination who sought treatment at the surgery outpatient department or were admitted to the surgical wards at Sri Aurobindo Medical College and Post Graduate Institute in Indore, Madhya Pradesh. From January 1st, 2020 to June 30th, 2021.Results-Majority of the patients were in the age group of 21-30 years (51.28%). The average age of these patients was 28.56 years with range of 14 years to 57 years. Majority of the patients (65.4%) were from urban inhabitance. Most of the cases belonged to Middle (37.17%) and High (32.05%) socio economic status. 60.26% cases were educated upto high school and beyond. The commonest presenting symptom was pain in breast 64.1%.commonest lesion found was fibroadenosis 27.7%. Breast pain was found in 85.18% cases and was the commonest presentation. Sensation of lumpiness was there in 74.07% cases. 81.48% patients had tenderness in their breasts. 74.07% cases had nodularity and 18.51% had a lump in the breast. There were 74.07% cases of cyclical mastalgia and 25.93% cases of acyclicalmastalgia in 50 cases of fibroadenosis. In this study of 49 cases of fibroadenoma, all (100%) presented with lump in breast. Only 2 case (4.76%) presented with pain and tenderness. Conclusion- Fibroadenosis was the most common lesion at 27.7%. Fibroids (26.72%) and mastitis (31.3%) followed. Breast soreness (64.1%) and lump (42.3%) were the most common symptoms. The most common sign was a breast bulge or enlargement (67.79%), followed by soreness (58.97%). Most fibroadenosis patients (59.25%) were in their 30s. Cyclical mastalgia was the most common, at 74.07%.

Background: Hypotension is the most prevalent adverse effect of spinal anaesthesia for caesarean section, which demands specific prevention and treatment interventions. Present study was aimed to study correlation of symphysio-fundal height and abdominal girth with incidence of hypotension in caesarean section following spinal anesthesia.Material and Methods:Present study was single-center, Cross sectional study, conducted in pregnant women of age 19-35 years, height 151-170 cms, full term gestation, undergoing elective and emergency caesarean section under spinal anaesthesia. Results: In present study, total of 87 patients were included. Hypotension was present in 70.1% of the patients. 52.3% of patients with SFH of 32-35cms and 88.4% of patients with SFH of 36-39cms were hypotensive. The p-value was statistically significant (p=0.001). 55.1% of patients with AG of 86-95cms and 89.5% of patients with AG of 96-105cms were found to be hypotensive. Mean total dosage of rescue ephedrine in SFH 32-35cms was 7.91±2.86. Mean total dosage of rescue ephedrine in SFH 36-39cms was 11.05±5.13. Mean total dosage of rescue ephedrine in AG 86-95cms is 8.54±3.86. Mean total dosage of rescue ephedrine in AG 96-105cms is 10.94±5.13. We found negative correlation between SFH and SBP with ‘r’ = -0.389 which is found to be statistically significant and 13.11% patients required atropine. Conclusion: In patients undergoing elective and emergency caesarean section under spinal anaesthesia the symphysiofundal height and abdominal girth showed significant negative correlation with systolic blood pressure.

Introduction: Body mass index (BMI) is the most widely used statistic to determine the prevalence of obesity. BMI is defined by the World Health Organisation as "a simple index of weight-for-height that is commonly used to classify adults as underweight, overweight, or obese." It is calculated as follows: kg/m2, which is the weight in kilogrammes divided by the height in metres squared. For instance, a 70 kg adult who stands 1.75 metres tall will have a BMI of22.9.Material and method: Type 2 diabetes, hypertension, elevated blood cholesterol, and triglycerides, which can result in atherosclerosis, are all made more likely by obesity. Previously thought to be a reservoir of excess energy, adipose tissue is now understood to be a functional, autonomous endocrine organ. Adipokines, a group of bioactive mediators that are expressed by adipose tissue and other biological systems, facilitate communication between the two.The adipokineadiponectin is only released by adipocytes. It is widely distributed in the bloodstream as a 360 kDa high molecular weight multimer and a 180 kDa low molecular weight hexamer.Results: This table shows age and sex distribution of cases and controls. Both cases and controls were divided into two groups according to age i.e. 20-35 years and 36-45 years. Maximum cases are within the range of 20-35 years. Percentage of male is more in comparison to controls.Conclusion: Adipokines are substances released by adipose tissue that regulate a variety of physiological processes throughout the human body by way of systemic circulation. Numerous organs and systems experience a disturbance in homeostasis as a result of adipokinedys regulation in obesity. These include insulin resistance, oxidative stress, endoplasmic reticulum stress, synaptic dysfunction, and cognitive decline.

Introduction: Recent research on Omentin-I and its associations with type II diabetes, the degree of insulin resistance, and obesity is intriguing and has potential for treatment.Adipose tissue is an active endocrine organ that generates many hormones and cytokines called adipokines, such as visfatin, TNF-α, IL-6, and adiponectin[11,12]. These findings are accumulating.These adipokines appear to be key players in the pathophysiology of insulin resistance, diabetes, atherosclerosis, vascular endothelial dysfunction, and inflammation. They also have broad impacts on the metabolism of fats and carbohydrates.Material and method: In partnership with the Department of Endocrinology at the M.K.C.G Medical College Hospital in Berhampur, Odisha, the Department of Biochemistry carried out this clinical investigation. Participants in the study included both inpatient and outpatient visits to the endocrinology department. The period of the clinical investigation was from January 1, 2013, to May 1, 2014.Results: the age distribution of cases and controls. Thirty-four out of fifty cases, or 68% of the cases in the current research, are in the 40–54 age range. whereas 56% of the control group consisted of 28 out of 50 individuals. The two groups' mean ages did not differ significantly (p>0.05).As a result, it was shown that the patient group had considerably greater levels of total cholesterol, triglycerides, and LDC-cholesterol than the control group (p<0.001), and that the patient group had much lower HDL cholesterol.Conclusion: All of the patients had higher fasting insulin levels.The patients were found to have high scores on the HOMA-IR assessment of insulin resistance.In TYPE 2 DM subjects, serum omentin levels were lowered. Blood sugar levels while fasting showed a negative correlation with serum omentin.Omentin serum levels and insulin fasting showed a negative correlation.A negative correlation was found between serum omentin and HOMA-IR.

Background: Chronic stress is increasingly recognized as a significant risk factor for cardiovascular disease (CVD), particularly in the high-pressure environment of modern professional workspaces. This study investigates the correlation between chronic stress levels and the prevalence of cardiovascular disease among working professionals. Objectives: The primary objective is to examine the association between chronic stress and the incidence of cardiovascular disease in a sample of 200 working professionals. The study aims to provide empirical evidence to support or refute the hypothesis that chronic stress is a significant contributor to cardiovascular health risks in this demographic. Methods: We conducted a cross-sectional study involving 200 working professionals from diverse industries. Participants were selected based on specific inclusion criteria and represented a broad range of ages and job roles. Stress levels were quantified using standardized psychological assessment tools, and cardiovascular health was evaluated through medical examinations and health history analysis. Data were analyzed using statistical methods to identify any significant relationships between stress levels and cardiovascular health indicators. Results: The study found a statistically significant correlation between high levels of chronic stress and the prevalence of cardiovascular disease symptoms and diagnoses among the participants. A higher incidence of CVD-related health issues was observed in individuals reporting higher stress levels, even after controlling for other risk factors like age, gender, and lifestyle habits. Conclusions: The findings suggest that chronic stress is a significant risk factor for cardiovascular disease among working professionals. This underscores the need for stress management interventions and policies in professional settings to mitigate this risk. Further longitudinal studies are recommended to explore the causal relationships and the long-term impact of chronic stress on cardiovascular health.

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.

Diabetes mellitus (DM) is a group of metabolic diseases characterised by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Millions of people all over the world are affected by Diabetes Mellitus. Diabetic retinopathy, neovascular glaucoma, cataract, refractory deviations, ptosis, palsy of the oculomotor nerve, and hordeolosis are typical ocular complications in diabetic patients. Recently, problems involving the ocular surface, dryness, in particular, have been reported in diabetic patients. These patients suffer from many corneal complications like superficial punctate keratopathy, corneal ulceration, and persistent epithelial defects. Materials and Methods: A hospital-based study was conducted on 200 patients attending the Department of Ophthalmology, Subbaiah Institute of Medical Sciences Shivamogga from September 2022 to August 2023. A sample of 100 patients with type II diabetes and 100 patients matched controls were studied. First, 100 diabetic and 100 control patients were selected from the patients visiting ophthalmology. Then informed consent, detailed history of each patient were obtained regarding the age, gender, occupation, presenting symptoms, progression, duration of symptoms and associated conditions. Results: The mean age of the control group was 54.54±9.99 years, in diabetics without retinopathy were 53.50± 10.77 years and in diabetics with retinopathy was 56.99 ± 8.40 years. The mean duration of diabetes in diabetics without DR was 3.61 ± 3.16 years, while the duration of diabetes in diabetics with DR was 8.69 ± 5.13 years. The mean values of HbA1c in diabetics with and without DR were 8.17 ± 1.87% and 10.31 ± 2.58% respectively. There was a significant association between the HbA1c levels and the retinopathy in diabetics (p-value < 0.0001). Conclusion: Patients with type II diabetes have a higher prevalence of dry eye than their age-matched controls in our study. Evaluation of diabetic patients using the OSDI questionnaire can help identify dry eye in early stages. A significant association was noted between dry eye disease and the duration of diabetes. A statistically significant correlation was found between HbA1c values and dry eye status in patients with diabetes. 

The escalating prevalence of Type 2 Diabetes Mellitus (T2DM) globally necessitates a deeper understanding of its complex metabolic interactions, particularly concerning homocysteine, a known cardiovascular risk marker. This study aims to elucidate the role of homocysteine in the management of hyperglycemia in T2DM patients. Conducted as a cross-sectional study at Osmania Hospital, Hyderabad, India, it involved 30 T2DM patients without prior cardiovascular disease (CVD) complications and 30 age and sex-matched controls. Participants were subjected to comprehensive blood analyses to measure homocysteine, HbA1C, fasting, and post-lunch blood sugar levels. The study employed an independent sample t-test to determine significant differences in these biochemical parameters between T2DM patients and controls, with a significance threshold set at <0.05 and <0.001. Additionally, Pearson Correlation tests were applied to assess the relationship between homocysteine levels and the glycemic profile of the participants. The findings of this study are pivotal in understanding the interplay between homocysteine and hyperglycemia in T2DM. They offer insights into the potential role of homocysteine in T2DM management and its implications for cardiovascular risk in these patients. The results are expected to contribute to the evolving landscape of T2DM management, highlighting the importance of considering homocysteine levels in the holistic care and treatment strategies for T2DM patients. This study not only adds to the existing body of knowledge but also opens avenues for future research in this domain, particularly in developing targeted interventions for better management of T2DM and associated risks.

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: High sensitive C reactive protein levels (hs-CRP), a classical sensitive systemic inflammatory marker, are associated with short term and long term mortality in patient with acute coronary syndrome (ACS). Aim: The aim of this study was to find out the correlation of hs-CRP with coronary artery disease severity assessed by SYNTAX score (SX score) in patients with acute myocardial infarction (AMI). Methods: This cross sectional study was conducted in the Department of Cardiology, National Heart Foundation Hospital & Research institute, Dhaka, over a period of one year from 01/01/22 to 31/12/22. A total of 165 patients with AMI who underwent coronary angiography (CAG) selected purposively were included after considering inclusion and exclusion criteria. Study population were categorized equally into 3 tertiles according to available hs-CRP values. 33% (n=55) patients were in group A and their hs-CRP level was ≤25.3 mg/L; 33%(n=55) patients were in group B and their hs-CRP range was 25.4-70.6 mg/L; 33% (n=55) were in group C and their hs-CRP level was ≥70.7 mg/L. Baseline characteristics, biochemical variables, left ventricular ejection fraction(LVEF) and coronary artery disease severity by SYNTAX score were then compared among three groups. Results: Patients with raised level of           lllhs-CRP (Group C tertile) had significantly higher SYNTAX score compared with other    two tertiles [mean (±SD) SYNTAX score was 9.0 ± 4.3; 16.2 ± 5.6; 29.7 ± 8.3 respectively; (p <0.05)]. Strong positive correlation (r=0.885) was found between hs-CRP and SYNTAX score, which was statistically significant (p ˂0.05). Logistic regression analysis showed that hs-CRP was independently associated with severity of coronary artery disease assessed by SYNTAX score (OR= 54.883, p ˂0.001). Conclusion:  hs-CRP was a significant independent predictor of coronary artery disease severity  assessed by SYNTAX score in patients presenting with AMI.

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.

Introduction: Acute stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause which may be either ischemic or hemorrhagic in nature. Acute ischemic stroke, most common of the two types, results from prolonged cerebral ischemia leading to cerebral neuronal death. Ischemia Modified Albumin (IMA) is the only ischemic marker which has been approved by Food and Drug Administration(FDA) of United States(US) for early diagnosis of myocardial ischemia. Serum IMA levels and IMA to Albumin ratio(IMAR) were shown to increase in several diseases such as myocardial ischemia, acute stroke, muscle ischemia and bowel ischemia. Aim and Objectives: The aim of the study is to know whether Ischemia Modified Albumin (IMA) level is elevated in acute stroke patients and to compare the IMA levels and IMA to albumin ratio (IMAR) in acute stroke patients with healthy controls. Materials and Methods: Data required for the study were extracted from confirmed cases of Acute stroke (Diagnosed clinically and radiologically) patients attending Emergency and Intensive Care Unit of Neurology Department, GGH, Guntur and age matched normal healthy persons taken as controls. Biochemical parameters for the study were Ischemia Modified Albumin (IMA) estimated by Albumin Cobalt binding method and serum Albumin estimated by Bromo Cresol Green Dye binding method done on Beckman Coulter, Au 480 fully automated biochemistry analyzer. Ischemia Modified Albumin to Albumin Ratio(IMAR) was calculated from the results of both test and control groups. Results: IMA values of acute stroke patients were significantly higher than the control group (P Value <0.001). Mean serum albumin value of control group was higher than that of acute stroke patients. Negative Correlation was seen in Stroke patients between Serum Albumin and IMA (r = - 0.876). Mean IMA to Albumin Ratio(IMAR) of acute stroke patients were significantly higher than the control group (P Value <0.001). Conclusion: Ischemia Modified Albumin(IMA)would be a novel biomarker to support the clinical diagnosis of acute stroke. n this study mean IMA values of Acute Stroke patients were significantly higher than the control group. An arbitrary cut-off of 105.17 U/ml of IMA was chosen based on the ROC Curve analysis in the diagnosis of Acute Stroke patients. Further large scale studies are needed to choose clinically appropriate cut–off for serum IMA levels.

Myocardial bridging, characterized by a segment of the coronary artery tunneled through myocardial tissue, varies significantly in its clinical manifestation and relevance. Despite its frequent observation during coronary angiography, its implications remain controversial. This study aims to clarify the anatomical and clinical significance of myocardial bridging through a comprehensive analysis of human cadavers. Objectives: The primary objectives are to evaluate the prevalence and morphological characteristics of myocardial bridging in a diverse set of human cadavers and to correlate these findings with potential clinical implications, including its role in myocardial ischemia and sudden cardiac death. Methods: A total of 150 cadavers were systematically dissected to examine the presence, location, length, and depth of myocardial bridges over the coronary arteries. Each identified bridge was assessed for arterial involvement and measured for dimensions. The data were then analyzed statistically to determine the prevalence and morphological patterns, followed by a review of clinical records when available to hypothesize the clinical relevance of the findings. Results: Myocardial bridges were observed in 45% of the cadavers, with the most common location being the mid-segment of the left anterior descending artery. The average length and depth of the bridges were significantly associated with the occurrence of severe coronary artery disease in the corresponding vessel. A noteworthy correlation was found between deeper and longer bridges and records of myocardial ischemia or sudden death, suggesting a potential clinical impact. Conclusion: The study confirms the substantial prevalence of myocardial bridging in a general population and provides detailed anatomical descriptions. The correlation between bridge characteristics and adverse cardiac events underscores the clinical significance of thorough cardiovascular assessment and management in patients with diagnosed myocardial bridging. Further research is necessary to understand the pathophysiological mechanisms and to develop effective strategies for risk stratification and treatment.

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: Diabetes mellitus is associated with metabolic, cellular and blood changes.Hematological changes have been reported in diabetes and believed to play a major role in diabetes-associated complications. However, reports are contradicting and data on erythrocyte indices in patients with type 2 diabetic patients in the study area are scarce. In the present study we attempted to determine the relation between Erythrocyte Indices with glycemic status in Type 2 Diabetes Mellitus (T2DM). Materials and methods: In this cross sectional, observational study we studied lab reports of 234 patients who attended the outpatient department and admitted as inpatients in a tertiary care hospital over a period of three months. The study group had 170 patients with, and control group had 64 age and sex matched controls. Random blood glucose, glycated hemoglobin (HbA1c) and Erythrocyte Indices includingHemoglobin (Hb), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin Concentration (MCHC), Mean Corpuscular Hemoglobin (MCH), Packed Cell Volume (PCV), Red Cell Distribution Width (RDW), and Red Blood Cell (RBC) count were measured. Results: Our study revealed no significant differences in majority of erythrocyte indices among T2DM cases and controls. However, there was statistically significant difference in RDW (13.40±7.25 fL vs 23.86±15.53 fL, p =0.0001) between T2DM cases and controls. T2DM, patient with poor glycaemic control (HbA1c ≥ 6.5 gm%) had higher Hb compared to T2DM with good (HbA1 <6.5 gm%) glycaemic control (13.74±2.13 vs 12.79±2.64, p=0.0249). Patient with RBS ≥200 mg/dl had higher Hb compared to patients with RBS <200 mg/dl(14.2±2.3 vs 13.1±2.3, p= 0.0029). Hb and RDW showed significant positive correlation (r=0.1889, p=0.01362) with RBS. Conclusions: The present study shows variations of erythrocyte indices in diabetic patient compared to controls. Hence, haematological changes should be evaluated in all T2DM for effective therapeutic intervention 

Background:  Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and is a major cause of occupational disability. The diagnosis of carpal tunnel syndrome is based on clinical, electrophysiological, and radiographic tests. Ultrasonography is a quick, painless, and cost-effective method for confirming the diagnosis of carpal tunnel syndrome. In this comparative analysis, we examine the effectiveness of these diagnostic methods, scrutinizing their respective strengths and limitations in evaluating carpal tunnel syndrome. Materials and Methods: The present study was a correlational study, which included 60 patients with idiopathic carpal tunnel syndrome and 60 healthy controls. Only 90 wrists were used in the study among these 60 patients. We included all patients whose nerve conduction tests came out positive. Grades were assigned to each patient based on the results of nerve conduction examinations. Studies on motor and sensory nerves were conducted. Individuals with abnormal segmental or comparative tests were defined as having mild disease; those with abnormal digit/wrist sensory nerve conduction velocity and normal distal motor latency were identified as having moderate disease; and those with abnormal or prolonged distal motor latency were classified as having severe disease. Results: Out of the sixty patients, 38 had involvement in both wrists, 12 had involvement in just the right wrist, and 10 had involvement in just the left. Numbness (96.31%) was the most common symptom in the affected wrist, followed by tingling (85.63%), discomfort (75.22%), and weakness (35.67%). While 67% of the wrists had a positive Phalen’s test result, 78% of the wrists had a positive Tinel’s sign. The majority of the patients (88%) had normal vibration and 91% had normal proprioception. We found mild carpal tunnel syndrome in 50 wrists, moderate carpal tunnel syndrome in 31 wrists, while severe form was reported in only 9 wrists. The mean cross-sectional area of the median nerve in mild carpal tunnel syndrome was 8.21±1.55 mm², in moderate carpal tunnel syndrome was 11.09±1.97 mm² while in severe cases it was recorded at 14.85±3.87 mm². While the mean cross-sectional area of the median nerve in the control group was 6.28 ± 1.28 mm². Conclusions: The severity of carpal tunnel syndrome can be accurately assessed using ultrasonography, as there is a strong correlation between the increased cross-sectional area observed on ultrasonography and the severity of the condition in nerve conduction studies. Ultrasonography can be used as a cost-effective alternative to nerve conduction studies when the latter are not available.

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.

The original advice was based on research by Coombs et al. and was a loose 30-minute guideline. The researchers found that the third stage had a log-normal distribution with a mean duration of 6.8 minutes and that only 3.3% of births had a stage lasting more than 30 minutes. The authors calculated that throughout this period, the incidence of PPH, transfusion, dilatation, and curettage remained constant and began to increase after 30 minutes for placentas delivered both mechanically and spontaneously. This is the moment to start MROP, according to Coombs et al.4 This study received additional funding from Urner F & et al. After learning that 3% of newborns experienced problems when the third stage extended more than half an hour, Material and Mothed The baby was born, and the placenta retention cutoff time was thirty minutes later. 164 people who had retained placentas or had been referred for RP were included in this research. The following details were meticulously recorded: age, socioeconomic status, booking status, geographic distribution (rural or urban), gestational age, gravida status, time and place of delivery, mode of administration and duration of use of uterotonic, history of any previous uterine surgeries or procedures performed, history of any previous procedures, and other relevant information. Result In this study, the majority of patients with retained placentas (70.12) and those with low socioeconomic level (73.8%) come from rural areas. This study was similar to one by DAS SR, which found that 71.17% of participants had poor socioeconomic level.  As mothers age, the number of instances with retained placenta increases. In this study, the age group of 31–35 years accounted for 39.02% of the retained placenta instances, whereas the age group of 36–40 years accounted for 21.96%. The group of people aged 26 to 30 made up 31.70%. This was similar to a research by Rizwan N. that found that patients between the ages of 36 and 40 had 13.3% fewer instances than women between the ages of 26 and 30 (36.7%). Conclusion PPH was the most frequent problem, which can be attributed to mishandling the third stage of labour, which results in myometrial exhaustion and the inability to contract, and prolonging the second stage of labour. An abnormally attached placenta can also result in PPH and RP under PAS circumstances. By factors including oxidative stress, chronic inflammation, and impaired placentation maturation, newborn problems like stillbirth and IUGR can be linked to RP. Although the anterior placenta, umbilical cord insertion, and ART techniques have all been proposed as risk factors for RP in previous research, there was no meaningful correlation between these variables and RP in our investigation. For this reason, further studies are required to gather more information and improve comprehension of the recently suggested risk variables.

Background: Clinical scoring systems such as the GRACE , TIMI and HEART score can predict major adverse cardiovascular events, but they cannot be used to demonstrate the degree and severity of coronary artery disease. We investigated the potential of these clinical Score in detecting the existence and severity of coronary artery disease based on SYNTAX score. Methods- cross-sectional study was conducted for a period of 1 years from August 2022 to August 2023.  Association between the scores was established by the Pearson’s linear correlation test while the accuracy of the clinical scores versus SYNTAX score was determined with the ROC curve. Results: A total of 150 patients were enrolled. Median GRACE, TIMI and HEART scores were 95, 4 and 6, respectively, whereas the median SYNTAX was 14. When evaluating the ROC curve, we observed that raised levels of all clinical scores could accurately predict a high SYNTAX score (>32). The association of SYNTAX score with HEART, TIMI, and GRACE scores resulted in an area under the receiver operating characteristic ROC curve (AUC) of 0.811 (95% CI 0.72-0.912, p < 0.01), 0.792 (95% CI 0.641-0.972), and 0.761 (95% CI 0.531 0.791), respectively. Conclusion: The clinical scores presented a positive association with the SYNTAX score. The combined use of HEART and GRACE and TIMI, offers good accuracy for detecting angiographic complexity 

BACKGROUND This study was conductedto assess the BODE index (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) in order to forecast the severity of COPD (Chronic Obstructive Pulmonary Disease) patients' condition and its relationship to pulmonary hypertension.METHODS This was a hospital-based cross-sectional prospective study conducted among 81 patientsclinically diagnosed to have COPD at the Department of General Medicine, Kurnool Medical College, Kurnool, from February 2021 to September 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. RESULTS The majority,i.e., 35.8% of the patients had mild PHT, followed by 33.3% with severe pulmonary hypertension, according to ECHO findings. According to BODE index scoring, 48.1% of COPD patients attending the hospital had mild severity, and 30.9% had severe COPD. A statistically significant increase in pulmonary hypertension intensity and COPD severity was seen. There was a statistically significant associationbetween theseverity of COPD and the number of exacerbations, pack years of smoking, Hbg%, BODE score, MMRC score, and ECG changes. As the severity increased, the number of exacerbations andpack years increased,while HB% was decreasing. No association with BMI, height, or weight was seen. ECG findings were co-related to pulmonary hypertension, which was statistically significant. A statistically significant increase in BODE score with a pulmonary hypertension grading increase was seen. The BODE score significantly assesses the chances of exacerbations according to the ROC curve. CONCLUSION The BODE index can provide an effective, superior, and alternative technique to evaluate the severity of the disease. It may also assist in patient follow-up. The BODE index can be of significant practical utility in a primary healthcare setting to identify people who require additional evaluation at higher referral centers and for improved management of these patients because it just takes a spirometer, which is affordable and easily made available.

Background: Cardiac arrhythmias represent a significant public health concern globally, with serum cholesterol levels being a potential modifiable risk factor. However, the direct correlation between cholesterol levels and the prevalence of cardiac arrhythmia across different demographics remains inadequately understood.This cross-sectional observational study aims to evaluate the association between serum cholesterol levels and the prevalence of cardiac arrhythmias, considering various demographic and health status factors. Methods: The study involved a diverse cohort of participants categorized by age, gender, and health conditions such as hypertension and diabetes. Serum cholesterol levels were classified as desirable (<200 mg/dL), borderline high (200-239 mg/dL), and high (≥240 mg/dL). The prevalence of arrhythmia across these categories and other demographic factors was analyzed. Results: Among the participants, 30% had desirable, 40% had borderline high, and 30% had high cholesterol levels. The overall arrhythmia prevalence was 24%. A significant increase in arrhythmia prevalence was observed with higher cholesterol levels: 6% in desirable, 28% in borderline high, and 43% in high cholesterol levels. Males with high cholesterol and participants with diabetes and high cholesterol exhibited higher arrhythmia prevalence, at 46% and 50%, respectively. Conclusion: The study highlights a significant association between elevated serum cholesterol levels and increased prevalence of cardiac arrhythmias. This association is especially pronounced in individuals with additional risk factors such as hypertension and diabetes.

Aim :To Evaluate the Diagnostic Efficiency of Cystatin C As a marker of Early Renal injury in patients of Type 2 Diabetic in comparison with Creatinine. Materials and Methods : 100 proven cases of type 2 Diabetes categorized into 3 groups. Normoalbuminuria (48), microalbuminuria (32) & macroalbuminuria (20). 50 age and sex matched healthy controls. Fasting plasma glucose(FPG), serum Creatinine, serum Cystatin C, urine dipstick analysis for protein, urine albumin, urine creatinine & calculated UACR were estimated. Glomerular filtration rate was estimated by Cystatin C concentrations according to Chronic Kidney Disease Epidemiology (CKD-EPI) equation and Creatinine eGFR according to Modification of Diet in Renal Disease (MDRD). Results : There was raised levels of FPG , serum Creatinine & serum Cystatin C significantly (p<0.01) with increasing duration of Diabetes. The eGFR of Cystatin C was lower than that of Creatinine eGFR in cases but in controls it was more. The calculated sensitivity of Cystatin C eGFR was 91%,specificity was 94% and overall accuracy(OA) was 92% and these results are better than that of Creatinine eGFR with 84% sensitivity ,88% specificity and 85% OA. The eGFR cystatin c showed higher sensitivity, high specificity & higher accuracy than eGFR creatinine in studied diabetic subjects. Cystatin C showed more significant correlation with Cys C e GFR, (r = −0.99, p<0.001) than serum creatinine e GFR ( r= −0.86,p<0.001) in diabetic patients. Conclusion:The results of present study showed Cystatin C was more sensitive than creatinine thereby making se Cystatin.

Background This study was conducted to assess the correlation between various serum lipid profile components (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL cholesterol, and LDL:HDL cholesterol) and hypertensive retinopathy and its severity. Methods This was a hospital-based cross-sectional clinical study conducted among 100 hypertensive patients attending ophthalmic OPD. The study was undertaken at the Regional Eye Hospital, Kurnool, from November 2017 to October 2019 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results The prevalence of retinopathy increased with the duration of hypertension and showed a significant difference (p<0.0001). Hypertensive retinopathy showed a significant difference (p<0.001) between stages of hypertension. There was a significant difference between the retinopathy group and the non-retinopathy group in various lipid parameters like serum total cholesterol (p < 0.0001), LDL cholesterol (p < 0.0001), serum triglycerides (p = 0.0218) and LDL:HDL ratio (p = 0.0029). The various grades of retinopathy also showed statistically significant differences in various lipid parameters. Higher grades of retinopathy were associated with higher levels of serum total cholesterol (p = 0.035), LDL cholesterol (p = 0.028), serum triglycerides (p = 0.038), and LDL:HDL ratio (p = 0.021). Arcus senilis was higher in the retinopathy group than the non-retinopathy group. There was a significant difference between serum lipid parameters and hypertensive retinopathy (p = 0.045). This shows an association between serum lipid parameters and the prevalence of hypertensive retinopathy. Conclusion Lowering increased serum lipid parameters in hypertensive patients is advisable to preserve sight as well as prevent other end-organ damage. 

Background: Perforative peritonitis is a critical medical condition with a high morbidity and mortality rate. The APACHEII scoring system, a widely used tool in intensive care units, has been studied for its efficacy in predicting outcomes in such cases. Methods: This prospective study evaluated the effectiveness of the APACHEII score in predicting mortality among 60 patients with perforative peritonitis. The sensitivity and specificity of the scoring system were analyzed, with a focus on the correlation between APACHEII scores and patient outcomes. Results: The study found that duodenal perforation was the most common type (43.3%), with a higher incidence in males. Non-survivors had a significantly higher mean age (57.18 years) compared to survivors (40.65 years, p=0.0003). A critical finding was the 100% mortality rate in patients with an APACHEII score of ≥15, indicating high predictive accuracy at this threshold. The sensitivity and specificity of the APACHEII score were both 100% for this cut-off value. Conclusion: The APACHEII scoring system demonstrates high effectiveness in predicting mortality in patients with perforative peritonitis. Its use in clinical settings for prognostic assessments is strongly supported by these findings

Background: Covid 19 still continues to affect millions worldwide. The risk of a new virulent strain is imminent. Covid binds to ACE receptor which is ubiquitous in human tissues. These receptors are highly concentrated in pancreatic islet cells which play a major role in glucose homeostasis. Aim of the work: To evaluate the effect of covid 19 on blood sugar levels and to correlate blood sugar variations with disease severity and inflammatory markers (Ferritin, LDH, ESR, D Dimer, Procalcitonin) in Non diabetic Covid 19 patients. Patients and methods: In this single centre observational study, 400 patients fulfilling the inclusion criteria were enrolled for the study and categorised into asymptomatic, ILI and SARI. Data was collected by clinical examination, case sheets and lab investigations. Blood glucose levels ,HbA1C ,ESR, CRP,LDH,D-DIMER Procalcitonin levels was measured at admission. Data was analysed using IBM-SPSS version 24.Mean and percentage was used in the calculation of incidence of acute diabetes and and sugar levels in different groups.Correlation between the sugar levels and inflammatory markers was done using pearson’s correlation coefficient. P<0.05 was considered significant for all statistical comparision. Results and Conclusion: A total of 400 COVID RTPCR positive non diabetic patients were included in the study. Acute diabetes (RBS>200,HbA1C <6.5) was seen in 2.75%(11) of the patients. Average RBS at admission in asymptomatic, ILI and SARI patients were respectively 103.33,122.95 and 157.9. Correlation between RBS at admission and inflammatory markers was done. Ferritin, LDH and ESR showed a statistically significant correlation with RBS at admission. So RBS at admission becomes a marker of Covid disease severity and hence helps categorising patients early into different severity groups and instilling adequate early treatment and referral

Background: Patient compliance in carrying out blood transfusions is important in the management of people with thalassemia. The family has a strong influence on determining treatment, the support provided is instrumental support, assessment support, informational support and emotional support. To determine the relationship between family support and blood transfusion compliance in children suffering from thalassemia major Method: This research is quantitative research that is correlational in nature. The sampling technique in this research used total sampling, where samples were taken from the entire available population, namely 55 people. This study used measuring instruments in the form of a family support questionnaire and an observation sheet by looking at the thalassemia patient's book in the room. Results: Most or around 90.9% of children with thalassemia are guardians in the Children's Care Room at Pasteur Regional Hospital, Bandung, and receive good family support. Most or around 65.5% of children suffering from thalassemia major in the Children's Care Room at Pasteur Hospital Bandung are obedient to undergoing blood transfusions. Conclusion: There is a relationship between family support and blood transfusion compliance in children with thalassemia in the Children's Care Room at Pasteur Hospital, Bandung, with a p-value of 0.043.

Background: Diabetes mellitus (DM) is a rapidly rising chronic illness in developing countries. Glycosylated hemoglobin (HbA1c) is a widely used tool for diagnosing, screening, and managing patients with diabetes, hence proper interpretation of the HbA1c is crucial. Objectives: To investigate the risk factors affecting type 2 diabetes mellitus HbA1c and their correlation with glycosylated hemoglobin (HbA1c). Material & Methods: Diagnosed patients with type 2 diabetes mellitus during study period were enrolled in this study. Criteria for diagnosis were: HbA1c ≥ 6.5% (48 mmol /mol), Fasting plasma glucose ≥ 126 mg/dL (7.0mmol/L) 2-Hour postprandial plasma ≥ 200 mg/dL (11.1 mmol/L). Demographic data and risk factors associated with diabetes were analysed. Results: Majority of the patients (37%) were 51-70 years age group, predominantly male (63%). Among risk factors assessment, 66.5% were overweight or obese, 53.3% had positive family history of DM, 55.3% were hypertensives, 43.5% had dyslipidemia, 32.7% had a family history of CAD, 39.3% were smokers and 32% were physically inactive. HbA1c were significantly associated with the all these risk factors. Conclusion: Age, higher BMI, family history of DM, smoking, physical inactivity, hypertension, dyslipidemia and history of CVD are positively correlated with the HbA1c level. 

Introduction: On 11^th March 2020 Corona virus disease 2019 is declared a pandemic by WHO. The highly contagious COVID-19 virus has spread across the globe. Illness diagnosis is a key component of patient management and disease control strategies. Thin-section chest CT is more sensitive in detecting abnormal alterations in the lung parenchyma. The CT-pattern of COVID-19 and other viral pneumonias share a lot of similarities. The distribution characteristics of various lung pathologies and involvement of lung lobes were noted three months after treatment has been completed on a follow-up chest CT. Aims and Objectives: To determine any post covid pulmonary sequelae in covid patients. Materials And Methods:  This is a prospective cross sectional descriptive study done in DR. PSIMS & RF, Vijayawada, Andhra Pradesh, India from November 2020 to October 2022. Patients who came with history of covid-19 disease for follow up were included in this study. Serial high resolution axial sections of chest done without intra venous contrast using SIEMEN’s 16 slice CT scanner in the department of Radio-diagnosis Dr. PSIMS& RF. With age, gender distribution, fibrosis, pattern of fibrosis, % Of lung involvement, comparison with acute CT scan if any(% of involvement vs % of sequelae) ,comparison with previous CT scan where ever available, relapse of pneumonia (if any), correlation with treatment taken earlier (actively treated or not), unrelated positive findings to post covid sequelae as study variables. Results: A total of 50 Patients who came to Dr. PSIMS & RF for CT-Chest with history of covid-19 disease for follow up were included in this study. At 6 months of follow-up, most patients with severe or critical disease still had significant persistent lung abnormalities. Lung fibrosis and pneumonia were the most prevalent CT symptoms for patients, followed by mosaic attenuation and ground glass opacities along with some unrelated lung pathologies. Our study shows that residual pulmonary sequelae of COVID-19 were caused by older age and illness severity, both of which were independent variables. Conclusion: It is important for both the radiologists and chest physicians to know the persistent post covid lung changes which play a significant role in diagnosis, treatment and prognosis of any chest illness in these patients in future.

Background: The identification of human remains is a cornerstone of forensic science, especially in situations where traditional identification methods are impractical. The morphological differences in the frontal and maxillary sinuses offer a novel approach for gender determination, providing a unique intersection between forensic science and the clinical expertise of Ear, Nose, and Throat (ENT) surgeons. This study investigates the potential of using frontal and maxillary sinus dimensions as reliable markers for gender differentiation. Materials and Methods: This observational study analyzed 200 anonymized patient records, equally distributed between males and females, aged 18-60 years, who underwent sinus CT scans for reasons unrelated to the study. Measurements of the frontal and maxillary sinuses, including height, width, and volume, were conducted using ImageJ software. The study employed independent t-tests to assess gender differences in sinus dimensions and calculated inter-observer reliability using the Intraclass Correlation Coefficient (ICC) Results: Our findings indicate significant differences in the dimensions of the frontal and maxillary sinuses between genders, with males displaying larger dimensions. High ICC values (0.89 to 0.94) demonstrated excellent measurement reliability. Additionally, there was minimal correlation between sinus dimensions and age, suggesting the utility of these measurements across a broad age range for gender determination. Conclusion: The assessment of frontal and maxillary sinus dimensions presents a viable, non-invasive method for gender determination in forensic contexts. The study highlights the value of integrating ENT surgeons' expertise and advanced imaging techniques in forensic science, potentially revolutionizing identification processes in scenarios where traditional methods are unavailable.

Background: Neck constriction deaths, encompassing strangulation and hanging, present significant challenges for forensic investigations. The intricate nature of injuries involved necessitates a comprehensive evaluation to accurately determine the cause and manner of death. This study explores the current state of forensic assessment of neck injuries from a surgeon's perspective, addressing the complexities of differentiating between homicidal, suicidal, and accidental deaths. Materials and Methods: A mixed-methods approach was utilized, combining quantitative data from 200 forensic case files over the past five years with qualitative insights from semi-structured interviews with ten experienced forensic surgeons. The study involved a retrospective analysis to identify correlations between the type of neck injury and forensic conclusions, alongside thematic analysis of expert interviews to uncover challenges and technological integration in forensic assessments. Results: The majority of neck constriction deaths were male (60%) and within the 18-45 age group (50%), with hanging identified as the predominant method (50%). Soft tissue hemorrhage and skin abrasions/lacerations were prevalent across all cases, while hyoid bone fractures and laryngeal injuries were more common in strangulation, indicating a more direct application of force. Expert interviews highlighted the importance of technological advances, the need for standardization in forensic practice, and the value of interdisciplinary collaboration. Conclusion: The findings underscore the critical role of surgical expertise in interpreting complex neck injuries and the necessity for an interdisciplinary approach in forensic assessments. Continuous advancements in forensic methodologies and technological integration are essential to address the challenges in distinguishing between different manners of death. The study advocates for ongoing education and standardization of practices to enhance the precision and reliability of forensic conclusions.

Introduction: Diabetic cardiomyopathy has been proposed as an independent cardiovascular disease, with causative factors being microvascular disease, autonomic dysfunction, metabolic disorders, interstitial fibrosis, etc. This study will determine any association between diastolic dysfunction and type 2 DM in the asymptomatic subjects and its relation to glucose triad, i.e., HbA1C, fasting blood sugar, and Postprandial blood sugar. Aims and Objectives: To assess the prevalence of diastolic dysfunction in patients with type 2 DM and correlate it with the glucose triad, i.e., HbA1C level, fasting sugar, and Postprandial sugar. Materials and Methods: Inclusion Criteria: 100 Patients between 30- 55 years of age with a history of Type 2 DM for at least 5 years. Exclusion Criteria: Patients with evidence of coronary artery disease, hypertension and valvular disease. The diastolic dysfunction was evaluated using Doppler Echocardiography. Results: In this study, diastolic dysfunction was comparable in patients with fasting blood sugar levels of <100mg/dL (58.33%), 100-125mg/dL (65.31%), and ³ 126mg/dL (51.28%). Diastolic dysfunction was comparable in patients with postprandial blood sugar levels of <140mg/dL (66.67%), 140-199mg/dL (64%), and ³ 200mg/dL (51.22%). A significantly higher number of patients with HbA1C levels between 7-8.49 (84.62%) and HbA1C levels of ³8.5% (66.67%) had diastolic dysfunction. Conclusion: The prevalence of diastolic dysfunction in patients with type 2 DM is 59%. Patients with type 2 DM who have diastolic dysfunction are likely to present with raised FBS levels. Hence, controlling diabetes, viz., glucose triad, i.e., HbA1C, FBS, PPBS, may prevent or postpone diastolic dysfunction in type 2 DM patients.

Background: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and child. This study aimed to investigate the prevalence of thyroid dysfunction among pregnant women and its correlation with obstetric outcomes and risk factors.Methods: A prospective observational study was conducted on 500 pregnant women. Thyroid function tests were performed at enrollment and during each trimester. Data on obstetric outcomes and compliance with treatment were collected. Results: The prevalence of thyroid dysfunction was 5.0%, with hypothyroidism (2.0%), hyperthyroidism (1.0%), subclinical hypothyroidism (1.6%), and subclinical hyperthyroidism (0.4%). No significant association was found between thyroid dysfunction and adverse obstetric outcomes such as preterm birth (20% vs. 9%, OR 2.5, p=0.08) and low birth weight (16% vs. 8%, OR 2.1, p=0.18). Age over 30 years (OR 2.0, p=0.02) and a family history of thyroid disease (OR 3.5, p=0.001) were significant risk factors. Followup results showed a progressive worsening of thyroid function during pregnancy. High compliance with levothyroxine treatment was observed (80%). Conclusion: While the prevalence of thyroid dysfunction in this cohort is in line with global rates, the study highlights the critical need for routine monitoring and management of thyroid function in pregnancy. The findings also emphasize the role of specific risk factors in identifying women at higher risk for thyroid dysfunction.

Introduction: Renal function is evidently modified in both hypothyroidism and hyperthyroidism. However, there is a scarcity of clinical data on the relationship between thyroid disease and renal function. The objective of this study was to evaluate alterations in biochemical indicators of renal function in individuals with thyroid dysfunction and to correlate these measurements with the patient's thyroid hormones. Material and Methods: A total of 25 patients with primary hyperthyroidism and 294 patients with primary hypothyroidism were included as cases. A group of 100 persons who were in good health were selected as controls. Immunoassay was used to evaluate thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). The serum levels of urea, creatinine, and uric acid were measured using an EM-360 autoanalyzer. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) algorithm. Renal function tests were evaluated in all cases. Results: The results of our study showed a significant increase in the average levels of serum urea (36.26±3.69) and uric acid (6.55± 0.34) in patients with hypothyroidism. This increase was statistically significant (p value < 0.001). Similarly, we observed a significant increase (p value < 0.001) in serum urea (29.98±2.17) and uric acid (6.59± 0.34) levels in patients with hyperthyroidism. Nevertheless, hyperthyroid patients exhibited a decrease in serum creatinine levels (0.70± 0.04) compared to the control group, resulting in an increase in estimated glomerular filtration rate (eGFR) (121.55± 5.79). Conversely, the hypothyroid group showed a significant increase in creatinine levels (1.04± 0.05) (p value < 0.001), leading to a decrease in eGFR (102.05± 5.38) compared to the control group. Conclusion: Thyroid dysfunction is linked to abnormal renal function. The clinician should recognize the association between thyroid problems and abnormal kidney function to consider performing a thyroid function test for patients with slightly raised biochemical indicators of renal function during treatment. Monitoring creatinine levels is necessary for people with thyroid disease.

Objective: Determine correlation between perfusion index in index finger and right toe regarding hypotension during spinal anesthesia in parturients undergoing LSCS. Methods: A cohort of 75 parturients (aged 18 to 35 years), scheduled for elective LSCS and classified as ASA-II, underwent intraoperative vital sign monitoring including heart rate, NIBP, respiratory rate, SpO2, and perfusion index measurements from both finger and toe sites. Readings were taken at two-minute intervals until the 15th minute, followed by five-minute intervals until surgery completion. Data were analyzed using SPSS 20.0. Results: Mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). ROC analysis identified baseline cutoffs for predicting hypotension: Finger PI 3.55 and Toe PI 1.85. Spearman’s rank correlation analysis revealed significant correlations between baseline finger perfusion index (>3.5) and hypotension episodes (rs = 0.400, P < 0.000), and baseline toe perfusion index (>1.85) and hypotension episodes (rs = 0.549, P < 0.000), suggesting moderate agreement. Conclusion: Perfusion Index (PI) is a valuable predictor of hypotension in healthy parturients undergoing elective LSCS under subarachnoid block. Continuous toe PI monitoring during spinal anesthesia induction may aid in predicting post-spinal hypotension and assessing aortocaval compression by the gravid uterus.

Introduction: Prevalence of Diabetes Mellitus is rapidly increasing in India. So are its complications, of which nephropathy is very common. Identifying these complications at early stage becomes crucial. One such proposed hypothesis is based on inflammatory markers. Their association with cardiac complications is proven. The current study is planned with this background. Objectives: To assess the serum high sensitivity C reactive protein levels in patients with type 2 diabetes mellitus with diabetic nephropathy and to estimate the levels of serum high sensitivity C reactive protein in different stages of diabetic nephropathy. Methodology: Cross sectional study design was adopted to conduct the study in a government tertiary care setting i.e. K.R. Hospital. Study population included all patients, aged more than 18 years with DM type 2 who visited the study setting (OP /IP). Patients having Congestive cardiac failure, Liver disease, Infections, Autoimmune diseases, organ damage or Cancer or habit-forming drug intake were excluded from the study. Sample size was calculated to be 60. Data was collected using pre-tested, semistructured questionnaire which included detailed history, clinical examination and investigation findings; entered in Excel and analyzed using SPSS. Results: Mean age was 60.23 years. Males constituted 70%. Mean duration of DM was 13.02 years. 40% patients were in DN stage 3. 43% patients had microalbuminuria and 30% had macroalbuminuria. S. Creatinine was elevated in one-third patients. Overall, mean hs-CRP was 9.5 (3.3) mg/L; and mean hs-CRP among patients with DN stage -1, 2, 3 and 4 respectively, were 5.1, 9.0, 12.4 and 13.1 mg/L respectively. The difference between the means was statistically significant. Conclusion: There was a significant correlation between mean Hs CRP levels and clinical stages of the diabetic nephropathy. Also, hs-CRP significantly correlates with elevated PPBS, HbA1C, S. Creatinine, and eGFR levels. Hence hs-CRP may be used as a
marker to assess development and severity of the diabetic complications like diabetic nephropathy.

Conclusion: The present study results may helpful to add knowledge about relation between, BMI, WHR and Handgrip endurance. This may give supportive knowledge to sports physician in their practice.

Conclusions: USG can be used to predict difficult airway preoperatively by measuring soft tissue thickness at neck and Skin to epiglottis distance at the level of Thyrohyoid membrane on USG is a potential predictor of difficult intubation

Background:  Identification and age determination are becoming more and more crucial in today's world due to a number of causes, including contested birth records, premature delivery, legal issues, and the necessity to validate a birth certificate for a variety of reasons (including marriage, employment, immigration, adoption, or school admission). When evaluating growth, different groups have had varying degrees of success utilising dental age, bone age, or a mix of the two. Methods: Only 40 subjects between the ages of 6 and 14 years old were chosen for the study out of a total of 400 screened children. A total of 400 patients aged 6 to 14 years who visited the Outpatient Department of Forensic Medicine, Guntur Medical College Guntur, Andhra Pradesh, India from June 2021 to May 2022 were screened for this cross-sectional study. The Demirjian method was used to calculate dental age. Pearson's and Spearman's correlation tests were used to determine the association between chronological and dental in the study population. Result: In the male group, there was a significant positive association between age, dental age, and all MP3 development stages. With the exception of a substantial but not statistically significant association between dental age and chronological age in the H stage of the MP3 region, the same was true for females. Conclusion: According to the study's findings, all individuals' chronological age, dental age, and skeletal age correlated statistically significantly, with females ageing before males.

Background: Shortcomings of using Apgar score including the subjectivity of elements such as tone, color, and reflex irritability, can lead to significant interobserver variability, also the effect of prematurity of newborn on the Apgar score is not conclusive. Objective: This study sought to examine the predictive ability of NRAS score for mortality and selected short term morbidities and also how Apgar score and NRAS correlate. Materials and Methods: A year-long retrospective and descriptive study was carried out in the MVJ Medical College and Research Hospital, Hoskote, Karnataka, India. The study setting included rural tertiary care teaching hospital with an average of 2000 births/year, with 12 bedded NICU. The study took place between November 2017 and November 2018. Inclusion criteria constituted all new-born babies with birth asphyxia according to WHO definition. Apgar score and Neonatal Resuscitation and Adaptation Score (NRAS) were recorded in parallel at the time of delivery by neonatal resuscitation team members. Short term outcomes included: a) respiratory support at 48 hours in the form of oxygen requirement, invasive or noninvasive ventilation, b) requirement of pressure support and c) seizures. Result: A total of 110 new-borns were assessed for NRAS over the study period of November 2017 to November 2018, and there were 13 deaths in the study population. 8.2% were <34 weeks of gestational age and 42.7% were between 34 and 37 weeks of gestational age and 49.1% were >37 weeks of gestational age. In the cases falling within the low category (0-3) and middle category (4-6) for both APGAR score and NRAS score there was statistically significant correlation (<0.001) and (0.001) at 1 min and 5 min, respectively for the need for respiratory support. In the cases falling within the low category (0-3) and middle category (4-6) for both APGAR score and NRAS score there was statistically significant correlation (<0.001) and (0.001) at 1 min and 5 min, respectively for the need for pressor support. In the low category (0-3) and middle category (4-6) for both APGAR score and NRAS score there was statistically significant correlation (<0.001) and (0.008) at 1 min and 5 min, respectively for seizures.Conclusion: NRAS score have a better predictive ability than Apgar score at both 1 min and 5 min for risk of mortality.

Background: Isolated Left Circumflex (LCX) coronary artery disease is rare and presents distinct myocardial damage patterns. Evaluating ECG and ECHO changes relative to stenosis and left ventricular function is crucial. This study examines electrocardiographic, two-dimensional strain echocardiography with speckle tracking and their correlation with angiographic profiles in ACS patients with LCX disease. Methods: An observational cross-sectional study was conducted in the Department of Cardiology at Mahatma Gandhi Medical College and Research Institute Hospital, Pondicherry. A total of forty-two patients who fulfilled both inclusion and exclusion criteria were analyzed. Data were collected based on age, gender, risk factors, an indication of coronary angiogram with abnormal ECG patterns,2D Echocardiogram, and speckle tracking findings concerning the distribution of stenosis in LCX. Results: Out of 42 cases, 18 cases(62.07%) of central LCX stenosis had significant lateral lead changes in ECG. Out of 17 STEMI cases, 9 cases had lateral lead changes and all 9 cases (100%) had central LCX stenosis. Out of 42 cases, 17 cases(40.5%) had normal LV function. Out of 29 cases of central LCX stenosis, 65.5% of cases(n=19) were presented with RWMA. The mean GLS was -15.82+3.44 which was at the low normal range and RLSlcx was 8.9+3.9 which was significantly reduced. Conclusion: The study found that central stenosis of the proximal left circumflex (LCX) coronary artery was more common than peripheral stenosis. Lateral lead ECG changes were linked to central LCX stenosis, while inferior lead changes were linked to peripheral stenosis. Regional wall motion abnormalities were associated with central stenosis. Despite normal left ventricular function, a significant reduction in regional longitudinal strain (RLS) of the LCX was observed

Background:   In modern era of medical science, patients’ post-anaesthesia recovery has improved mainly because of better monitoring, measures taken intra-operatively to avoid post-operative complications, and better immediate post-anaesthesia care. The present study aimed to know the incidence of postoperative nausea and vomiting, hypothermia and worst pain score in post-surgical patients in recovery room. Materials and Methods: This study was carried out after approval from institutional review board. This is a prospective observational study, conducted on the post-operative patients in the post anaesthesia recovery room in Tata Memorial Hospital, Mumbai for a period of two months. Data was collected from 1,007 patients out of 1,191 elective surgical procedures carried out. Incidence of postoperative nausea and vomiting (PONV), postoperative pain and hypothermia were assessed in the post-operative recovery room. Result: With the cut off value of 35°C, the incidence of hypothermia at ICU admission was 31.4%. There was significant correlation between duration of anaesthesia and hypothermia (p=0.04). Incidence of hypothermia in surface surgeries i.e. breast, head and neck, bone and soft tissue services was 26.3% (162/617) and in cavity surgeries i.e. gastrointestinal, genitourinary, gynaecology and thoracic surgeries was 39.5% (154/390) and in children <12 years was 35.5% (11/31). 6.6% of patients (66/1007) had nausea and 2% (20/1007) had vomiting on ICU admission. There is also no correlation between severe nausea and vomiting with the use of intraoperative antiemetic, duration of anaesthesia. 9.8 % (99/1007) had moderate to severe pain on admission to ICU, 12.1 % (122/1007) after one hour of admission and 2% had severe pain during ICU stay. There was no significant correlation between intra- operative analgesia and post-operative pain score. The study didn’t find any correlation with hypothermia, PONV and worst pain increasing the duration of ICU or hospital stay or affecting the outcome as the p value was >0.05. Conclusion: Incidence of hypothermia in ours study is similar as compared to previous studies. The incidence of severe pain is similar in cancer patients but lower than the patients undergoing general surgical procedures. Rate of re-admission and PONV in a post-surgical patient is very low in our ICU compared to other studies. We need to take further steps in improving the temperature monitoring, to control severe postoperative pain and PONV. Despite of pharmacological advances and known risk factors the incidences of postoperative complications is still higher.

Plasma cell myeloma is neoplastic proliferation of plasma cells with associated M proteins in serum or urine and end organ damage. Its associated with aberrant expression of few markers, which are not expressed by non-neoplastic plasma cells.  The present study attempts to study expression of P53 and CD56 in Plasma cells of Myeloma bone marrow biopsies and to study its correlation with prognostic parameters. Primary objective of the study is to evaluate expression of P53 and CD56 in Plasma cells of Myeloma bone marrow biopsies. Its correlation with prognosis in plasma cell myeloma cases are also included as secondary objective. Case records of all patients diagnosed as Plasma cell myeloma in department of pathology, GMC, Calicut were studied from 1st January 2017 to 31st January 2020.The details of patients with variables like age, sex, Hb, serum calcium, Serum creatinine, lytic bone lesions, serum electrophoresis were collected. Properly fixed decalcified bone marrow trephine biopsies were stained with H&E and assessed for the presence of plasma cell infiltrates and its precursors and binucleated forms. WHO criteria for diagnosis of multiple myeloma were followed.4 μ thick deparaffinized bone marrow biopsies were subjected to p53, CD56 IHC markers. Percentage of p53-positive tumor nuclei in all major foci of bone marrow were used for p53 immunohistochemical scoring system. Cases were considered as CD56 “positive (+)” when a positive membranous expression with or without cytoplasmic staining in 10% or more of neoplastic cells was present. Data were entered in Microsoft Excel and analyzed using SPSS software and statistical tests will be done .In our analysis, patients were primarily distributed in the 51–60 age range (35 percent), the male to female ratio was 1:0.85 and the predominant pattern of involvement being diffuse. The percentage of plasma cells ranged from 10 to more than 80%. We detected an aberrant CD56 expression in myeloma cells in 62% of cases, using immunohistochemical method. Among our CD56- negative cases 81.8% were not in remission. In our study CD56 expression was found to have statistically significant association with serum bone lytic lesions, and presence of M band by serum protein electrophoresis. Using the immunohistochemistry technique, p53 was found in 9% of the cases that were studied. In our study, 72.7 percent of p53 positive individuals were determined to not be in remission, compared to 98.9 percent of p53 negative cases who were. Therefor p53 expression was correlated with poor remission status. In our study, p53 expression in myeloma cells within a group of patients was also correlated with many prognostic clinical and laboratory findings, such as renal insufficiency indicated by elevated creatinine level, bone lytic lesions and presence of M band. p53 antigen positivity and CD56 negativity in myeloma plasma cells, as well as the prevalence of lytic lesions in skeletal surveys and the presence of the M band in electrophoresis, were all associated with poor remission status in MM. Expression of p53 and the absence of the CD56 antigen in malignant plasma cells were associated with the progression of chronic renal failure, which was also associated with a worse prognosis in MM patients due to their higher blood creatinine levels.

Introduction: Macrocytosis is common in various clinical settings and it is found in approximately1.7–3.6% of people admitted forcare for any cause. As we know macrocytic anemia are of two types MA and NMMA. Increased Reticulocyte maturation parameters seen in mostly MA and MDS. Aim: Clinicohaematological correlation of various  reticulocyte maturation parameters in   differential diagnosis of macrocytic anemia. Methods and materials: Prospective study was conducted over 100 samples. The samples were collected and run over 5 part hematology analyzer. Detailed history was obtained from the patients. Full and methodical clinical examination was done in all. Then we look for various RMF. Results: A total of 100 samples (cases -50, controls -50) were  studied. In our study  we took 50  blood    samples of cases in which 05 MDS patients 13 patients with NMMA and 25 patients with MA while 07 DA patients. Out of 13 NMMA patients 09 males and 04 females, out of 05 MDS pt. 04 males and 01 females and in MA 15 males and 10 females. Conclusion: In conclusion it is crucial to differentiate between MA and NMMA. If the iron status, serum cobalamine and folate levels are normal and there is increased value of  IRF and MRV the diagnosis of MDS should be considered. In this scenario the diagnosis of non megaloblastic macrocytic anemia is very rare.

Background: The gut microbiota refers to the distinct microenvironment comprised of various groups of live microorganisms that reside within the human gastrointestinal system. The gut microbiota significantly influences both the physical and mental well-being of humans. Furthermore, it has an impact on one's behavioural changes. An imbalance in the gut microbiota can also result in conditions such as increased intestinal permeability (Leaky Gut Syndrome) and Autism Spectrum Disorders.Probiotics, sometimes known as "good bacteria," enhance gut health and help maintain balance. Foods that are abundant in probiotic bacteria are considered to be the most beneficial for maintaining gut health. Certain traditional Tamil foods and beverages contain a high concentration of probiotics. Incorporating them into one's normal diet will help preserve optimal gut health. The Siddha system is the most ancient therapeutic system, founded on 96 principles and the Trihumoural Theory (vatha, pitha, kaba). According to the Siddha System, the phycophysiological constituents of humans are based on three humours, and each individual has a unique combination of these constituents.Similarly, the gut microbiota is likewise distinct and varies from other microbiotas.A recent study has revealed the correlation between the trihumoural theory and Gut Microbiota. This review paper elucidates the connection between traditional foods, Siddha core philosophy, and Gut Microbiota.

Background:  To explore the association of carotid intima medial thickness (CIMT) with TSH and other biochemical parameters among young adults with thyroid dysfunction. Material methods: Our study included 50 young subjects , 13-39 years, attending endocrinology clinic of our centre for thyroid dysfunction with no associated co-morbidities. BMI, thyroid and biochemical profile was assessed for all. All subjects underwent measurement of right and left CIMT using sonography (linear transducer 7mHz frequency). Statistical methods were then used to analyse the data. Results: CIMT values in our 50 subjects [hypothyroid:n=37 and hyperthyroid:n=13; age: 27.6±7.1 years ] fell in the normal range (Rt=0.53±0.10 mm ; Lt=0.52±0.11 mm).  Hypothyroids had a significantly higher HbA1C (p value;0.038) and Serum cholesterol (p value;0.028) levels as compared to hyperthyroid subjects. When the values for the entire group were studied, CIMT values did not correlate either with TSH or BMI [24.66±4.14 kg/m. sq.]; though it positively correlated with age and HbA1c (particularly right CIMT, correlation coefficient,0.50).  Hyperthyroid subjects had a significant positive correlation of TSH with Rt CIMT(0.750) and S.creatinine (0.780) and a negative correlation with cholesterol (-0.700). On the other hand, in hypothyroids, TSH levels did not significantly correlate with any parameters other than age (-0.38). Conclusion: Higher HbA1c (even in non diabetic range) are associated with higher CIMT among young patients of thyroid dysfunction, making it a useful tool for monitoring cardiovascular risk in conjunction with CIMT, especially in those with hypothyroidism.  

Background: Hypertension and dyslipidemia are the two co-existing and synergizing major risk factors for cardiovascular diseases. The cellular constituents of blood affect blood volume and viscosity, thus playing a pivotal role in regulating blood pressure. Overweight and obesity are critical determinants of adverse metabolic changes including, an increase in blood pressure. Hypertensive retinopathy is among the vascular complications of essential hypertension. It is known that; the autoregulation of the retinal circulation fails as blood pressure increases beyond critical limit. Materials and Methods:The present study was a cross-sectional study, and it was conducted on 100 patients in the Department of Ophthalmology at Tertiary Care Teaching Hospital from January 2022 to December 2023. All the patients were clinically examined& demographic information such as age, sex, residence, and other general and systemic examination information, case history, past medical history, complaints, etc., was collected and recorded in the Proforma prepared for this study purpose. Patients suffering from ocular diseases like chorioretinitis and uveitis willbe excluded from the study. Results: The clinico-demographic & biochemical profile of the patients with retinopathy and without retinopathy. In lipid profile, the mean±SD of serum triglycerides in retinopathy (130.29±40.20) was significantly higher than the mean±SD of serum triglycerides in non- retinopathy (113.16±33.05) [P=0.0384]. Other parameters of lipid profile such as TC (P=0.5966), LDL (P=0.180), HDL (P=0.8017) showed insignificant results while comparing with and without retinopathy. Relationship between the Severity of Hypertension and the Grade of Retinopathy. In the Grade-II retinopathy patients, the number of patients with grade I hypertension were the majority (36.50%). However, there is no statistically significant association between the group of the severity of hypertension and grade of retinopathy (P=0.669, Not Significant). Conclusion:The correlation between serum lipid parameters& hypertensive retinopathy prevalence has been shown. It is possible to consider dyslipidemia as a significant risk factor for the occurrence &seriousness of retinopathy and other failures of the final organ. Multi-organ intervention in hypertension is a norm rather than an anomaly, considering that injury in various areas does not seem to be either synchronous or standardized. A recommendation for ophthalmologists to review lipid parameters in patients with hypertensive retinopathy is our findings' therapeutic effect, which may better classify patients with life-threatening cerebrovascular and carotid artery conditions.

Background: Metabolic syndrome and cardiovascular disease (CVD) significantly contribute to global morbidity and mortality. Framingham Risk score (FRS) is a widely accepted parameter to grade the 10-year risk of heart disease. In this prospective observational study conducted at our tertiary care centre, we investigated patients with metabolic syndrome and analysed them to find the correlation of serum calcium and magnesium with FRS. Methods: We evaluated 288 adult patients who presented with features of metabolic syndrome, at Karnataka Institute of Medical Sciences, Hubballi, over two years from November 2019 to December 2021. Serum calcium and magnesium venous blood samples were obtained on the patient's visit to the hospital. The study was conducted after obtaining clearance from the Institutional Ethics Committee and written informed consent from the study participants. Results: Out of 288 patients included in the study, 168 (58.3 %) were male and 120 (41.7 %) were female. The mean age among the study population was 55.99 years. The prevalence of metabolic syndrome components in the study population was as follows: 82.6% had diabetes 67.4% were obese, 51% had dyslipidaemia, and 88.9% were hypertensive (51.6% of them on treatment.  A significant history of smoking was present in 28.1%. Furthermore, the 10-year CVD risk as assessed by FRS was as follows: 23.6 % had low risk, 37.2 % had intermediate risk and 39.2% had high risk. The corrected serum calcium and magnesium demonstrated a significant association with diabetes, hypertension, cholesterol, and FRS. Patients with high corrected serum calcium levels and low serum magnesium levels exhibited this pattern. Conclusion:Serum magnesium and corrected serum calcium and can be used as indirect indicators of the severity of diabetes and hypertension. Moreover, they can also be used for assessing the 10-year risk of CVD, due to its association with FRS

Introduction: Coronary artery disease (CAD) is one of the commonest causes of mortality and morbidity. The Fibrinogen/Albumin Ratio (FAR) is a newer marker of inflammation that has been shown to be a predictor of short-term prognosis in patients with acute myocardial infarction. Utility of FAR in predicting angiographic severity of CAD and clinical outcomes is not yet clear in Indian patients.  Objective: To study the role of fibrinogen-to-albumin ratio (FAR) as predictor of the angiographic severity of the coronary artery disease, and the short-term prognosis in the patients undergoing coronary angiography. Material and Methods: The present single-centre, prospective, observational study conducted in the Department of Cardiology at a tertiary care teaching institute in north India. A detailed history, physical examination and all routine investigations along with serum albumin, fibrinogen, ECG & 2-D Echo were done for all the patients. Samples were drawn at admission, before angiography. All the patients underwent clinically indicated invasive coronary angiography. SYNTAX SCORE was calculated using an online SYNTAX SCORE calculator. Results: Out of the 237 patients for final analysis, the majority (81.4%) were male. The mean age of the patients was 57 years. The mean fibrinogen level was 397.97 mg/dl, the mean serum albumin level was 4.05 g/dl and the mean FAR was 101.07 mg/g. with FAR below it was considered as low FAR and above it was considered as high FAR. The mean CAG Syntax score was 22.02. Majority of patients (58.6%) had acute coronary syndrome (ACS), while remaining had stable coronary artery disease. Two FAR groups were found to have comparable proportions of patients across the two Syntax score groups (low SS < 23, high SS > 23). The p-value for the correlation between FAR and Syntax Score was not significant (p=0.941). Conclusion: FAR was not found to be associated with CAD severity among Indian patients with stable CAD and ACS in the present study. This study didn’t find any correlation between the FAR and short-term prognosis.

Background: Overweight and obesity are associated with diseases like hypertension, cardiovascular diseases (CVDs), diabetes, endocrinal disordersetc. The product of resting heart rate (HR) and systolic blood pressure (SBP) termed as rate pressure product (RPP) is a very reliable indicator of myocardial oxygen demand. Both heart rate and blood pressure are incorporated in the RPP and indirect index of myocardial oxygen consumption (MVO2). Objective: To determine the correlation between body mass index and rate pressure product. Material and Methods: This cross sectional study was conducted in department of physiology VIMSAR Burla which included 100 study participants (66 males and 34 females). Written consent was taken from each participant. The height and weight was measured according to WHO protocol. BMI was calculated by Quitlet index. SBP was measured by sphygmomanometer after 5 minutes rest with the subject in sitting position. Resting HR was measured by palpating radial artery. RPP was derived using SBP and HR. Statistical analysis was done according to Pearson correlation, unpaired t-test. Result: There was positive correlation (r=0.5310) between BMI and SBP significantly (p=0.032). The correlation between BMI and HR was positive (r=0.443) significantly (p=0.001). There was positive correlation between BMI and RPP (r=0.512) significantly (p=0.002). Conclusion: The positive correlation between BMI and RPP suggested that myocardial workload is increased in overweight and obese people.

Background: Zinc deficiency in Chronic liver disease is associated with decreased albumin levels, reduced absorption, increased levels of IL-6 which may interfere with the zinc transporters, and increased excretion in the urine which also may be related to the use of diuretics in cirrhosis. Despite the fact that zinc deficiency and CLD are closely linked, the routine testing of serum zinc levels in Cirrhotic patients is lacking. Furthermore, the impact of the Child- Pugh scoring system on the prognosis of  Hepatic Cirrhosis patients and serum Zn levels is less known. Thus the present study was planned to solidify the correlation between serum zinc level and severity of cirrhosis by studying the prevalence of zinc deficiency in patients with cirrhosis and by assessing its association with parameters such as alcohol intake, albumin, prothrombin time, bilirubin, ascites, and occurrence of hepatic encephalopathy. Research Question: Is decreased serum zinc levels have an association with child-pughs score towards the development of complications in patients with hepatic cirrhosis in our setup? The setting of the study was at Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondichery.  A one-year observational study was conducted during the period from October 2022 to September 2023 on about 44 Hepatic Cirrhosis patients admitted during the above period in the department of General Medicine by studying their socio-demographic profiles, Serum Zinc levels and their association & correlation with Child-Plugh score to assess severity and with other various biochemical & epidemiological risk factor parameters, etc. Results: Among the total study subjects 88.6% were male and 11.36% were female. It was observed that the burden of the disease was more between 41-60 years of age (66%) and the Mean age was 52 years. Also, it was noticed that the severity was higher among males when compared to females significantly. In addition to this significantly Patients with high Child-Pugh scores were associated with low serum zinc levels. About 16% of the study subjects were developed Hepatic encephalopathy with low serum zinc levels and also Albumin levels were directly proportional to low serum zinc levels significantly and further about 75% of the cases were developed ascites while having significant association with low serum zinc levels. Regarding alcohol consumption nearly 72% of the patients had positive history. It was observed that there was a significant correlation between serum zinc levels and total bilirubin, Prothrombin time, and Sodium levels in the blood.

Background: Hypothyroidism and Type 2 Diabetes Mellitus (T2DM) are prevalent endocrine disorders, and their interplay has garnered significant attention due to potential bidirectional relationships. This study investigates the association of hypothyroidism in T2DM patients, focusing on prevalence, clinical correlations, and implications for management. Materials & Methods: A cross-sectional study was conducted at Hind Institute of Medical Sciences, Uttar Pradesh, involving 50 T2DM patients. Clinical assessments, thyroid function tests, and diabetes parameters were collected. Statistical analyses, including descriptive statistics, odds ratios, and correlation coefficients, were employed to explore associations. Results: Among T2DM patients, 20% exhibited hypothyroidism, emphasizing a noteworthy prevalence. Alterations in thyroid function parameters, including elevated TSH and decreased FT4 and FT3, indicated subclinical hypothyroidism. Glycemic control analyses revealed significant differences in FBG and HbA1c levels between euthyroid and hypothyroid individuals. Odds ratios demonstrated associations between hypothyroidism and age, BMI, and T2DM duration. Medication usage patterns highlighted the necessity of thyroid-specific interventions. Conclusion: This study uncovers a substantial prevalence of hypothyroidism in T2DM patients, emphasizing the intricate relationship between these endocrine disorders. Clinical correlations with age, BMI, and T2DM duration suggest the need for tailored therapeutic approaches. Recognizing the impact on glycemic control, screening strategies, and public health measures may enhance patient outcomes in this complex interplay.

Purpose- Obesity is a fast growing problem not only in developed countries but also in developing countries like India¹. Obesity is a risk factor in development of short stature, school teasing, precocious puberty, hypertension, diabetes, gall bladder disease and coronary heart disease, certain type of cancers and other comorbidities even at early age than usual². Understanding the prevalence trend and factors contributing in developing obesity in adolescent children will be helpful in prevention of obesity and developing comorbidities in later life.

Methods- A cross sectional analytical study conducted in 6 different schools of identified district of western India from 1st July 2022 to 31st June 2023 including school going adolescent children, of age between 10 to 16 years after taking necessary consent. Information regarding various predictors of obesity were taken by predesigned questionnaire, filled by participant along with his/her parentsand  relevant anthropometric measurements were recorded. Detailed analysis of predictors which were present in obese and non- obese group was done and results interpreted.

Results-Incidence of obesity in present study is 12.6%. Most common age of obesity is 16 years (46%) and most common age group is mid-adolescent (90.4%). Obesity and overweight is most common in upper middle class and in urbanc area. Positive correlation had been observed between adolescent obesity and parental obesity, calorie intake >2000kcal/day, eating >2 times snacks/day, >2 times junk food/week, sleeping > 8hrs/day and watching TV for >60 min, physical activity <30 min and light grade of physical activity.

Conclusion-Restricting the calorie intake, food behavioural changes like restricting junk food and snacks consumption, daily physical activity could limit the development of obesity in adolescent age group.

Chronic kidney disease (CKD) is a growing health concern in India, especially due to the increased prevalence of chronic diseases such as diabetes mellitus and hypertension (Mk, 1993). This study evaluates the prognostic significance of key biomarkers in CKD patients, including 24-hour urinary protein, estimated glomerular filtration rate (eGFR), and serum uric acid levels, alongside renal pathology and immunofluorescence findings. By assessing the relationships between these indicators, the research aims to enhance prognostic accuracy, predict CKD progression, and improve patient outcomes in the Indian context. The findings emphasize the importance of a comprehensive evaluation of these prognostic indicators in managing CKD effectively. Introduction: Chronic kidney disease (CKD) affects a substantial portion of the population in Indian subcontinent as well as globally, leading to adverse outcomes if not managed effectively. This paper aims to assess the utility of 24-hour urinary protein, eGFR, uric acid levels, renal pathology, and direct immunofluorescence findings as prognostic indicators in CKD. By exploring the relationships between these markers and disease progression, the study seeks to provide insights for personalized treatment strategies and improved patient care. Materials and Methods: This study was conducted as a retrospective, observational cohort study. Data has been collected from medical records of 50 CKD patients attending the nephrology OPD at MGM Medical college and Hospital, Kamothe, Navi Mumbai from the period of January 2022 to July 2023. Results: The study revealed significant correlations between 24-hour urinary protein, eGFR, uric acid levels, and specific renal pathologies. Higher levels of urinary protein and lower eGFR were robust predictors of CKD progression, while serum uric acid levels showed potential as a marker of disease severity. The findings underscored the importance of a comprehensive evaluation of prognostic indicators in CKD management. Conclusion: In conclusion, this research paper underscores the value of incorporating diverse prognostic indicators in CKD management to enhance diagnostic accuracy and treatment planning. By analyzing the interplay between traditional markers, renal pathology, and immunofluorescence findings, clinicians can refine prognostic models, predict CKD progression, and optimize patient outcomes. The study's insights offer valuable guidance for personalized care and improved prognostication in CKD patients.

Introduction: Hypertension is a prevalent and significant cause of mortality, contributing to 18% of deaths globally. The incidence of essential hypertension escalates with advancing age, and individuals exhibiting higher blood pressure in their youth face an elevated risk of subsequent hypertensive complications. Morphological and physiological alterations in the vasculature have been implicated in the development and persistence of hypertension. This condition elevates the risk of cerebral, cardiac, and renal events. The primary aim of this study was to measure the arterial stiffness index (SI) and reflection index (RI) in both hypertensive subjects and an age-matched control group of normotensive individuals.  Methods: A cross-sectional study involving 200 subjects aged 30 to 60 years was conducted.  Subjects were divided into four groups: Group 1 (control group of healthy individuals) and three hypertensive groups classified by the duration of their illness. Arterial stiffness was assessed using SI and RI, derived from digital volume pulse (DVP) recordings. DVP was measured using a finger pulse photoplethysmography device. The data were analyzed using analysis of variance (ANOVA), with statistical significance defined as P < 0.05 in relation to arterial stiffness indices and hypertension duration. Results: The study found a progressive increase in hypertension prevalence with advancing age and longer hypertension duration. Participants aged 40-49 years exhibited the highest prevalence across all groups. Group I, with normal blood pressure, showed the lowest RI (0.50 ± 0.08) and SI (6.12 ± 0.09). RI and SI increased significantly in Group II, further escalating in Group III. Group IV displayed a slight RI decrease but continued SI increase. ANOVA analysis revealed significant differences in RI and SI among the groups. Pearson correlation analysis showed strong positive correlations between both RI and SI values with the duration of hypertension. Conclusion: The study demonstrates a strong positive correlation between the two arterial stiffness indices, RI and SI, and the duration of hypertension.

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

Objective: - To study CP ratio & its correlation with feto -maternal outcome. Methods: - This was a prospective observational study done in Department of Obstetrics and Gynaecology, MGM Medical college, Indore, over a period of one year. Women > 37-week singleton pregnancy with no known risk factor who had Doppler USG done at the time of labor were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. Results: - Out of 150 low risk term pregnancy who went for USG colour doppler Scan, 14 (9%) patients were having CPR <1 and 136 (90.6%) were having CPR >1. Among 14 patient with CPR <1 , 10 (71%) were delivered by caesarean section as compared to only 6 (4.41%) patients with CPR >1.  Among 14 patient with CPR <1 , 13 (92.86%) had adverse outcome as compared to only 11.76% patients with CPR >1. Conclusion: - Our study found CPR measure to be a very promising tool for optimising the identifcation of at-risk foetus in low-risk AGA pregnancies.

Introduction: FNAC has a pivotal role in the evaluation of breast lesions. Cytological grading systems are being utilized for the categorization of breast lesions. Modified Masood’s scoring System (MMSS) is used to improve the grading system for accurate pre-operative diagnosis. This study aims to assess the effectiveness and accuracy of the Modified Masood Scoring System for evaluating breast lesions and their correlation with histopathological diagnosis. Materials and Methods: This is a prospective study conducted in the Department of Pathology, MGM Medical College, Navi Mumbai which included 40 patients who presented with clinically palpable breast lump and were subjected to FNAC along with histopathological examination. The cytological smears were grouped into four categories according to MMSS. Correlation and concordance analysis between cytological categories and histopathological diagnosis was carried out. Observations and Results: The age of the patients ranged from 17 to 70 years with a mean age of 38.12 years, right-sided breast lesions were more common as compared to the left side. Of the total 40 cases, 27 cases were benign, and 13 cases were malignant on histopathology. The most common benign breast lesion was Fibroadenoma [Figure 1] and the malignant lesion was infiltrating duct carcinoma [Figure 2]. The sensitivity, specificity, Positive predictive value, Negative predictive value, and diagnostic accuracy were 76.9%, 100%, 100%, 90%, and 92.5% respectively. Conclusion: MMSS is simple, cost-effective, easily reproducible, reliable, and can be applied to FNAC aspirates to increase the diagnostic accuracy of Breast Lesions

Introduction: According to WHO, in 2019, diabetes was the ninth leading cause of death with an estimated 1.5 million deaths directly caused by diabetes. In 2014, 8.5% of adults aged18 years and older had diabetes. The crude prevalence of diabetes in adults aged 20years or older in India increased by 39·4% . Key for prevention of the complication among the diabetic patients is prompt and aggressive treatment aimed at maintaining normal blood sugar levels. C-peptide is commonly used in preference to insulin measurement when assessing b-cell function in clinical practice. Age is a factor which is a determinant of functionality of the human body. Hence it needed to assess the effect of aging on the c-peptide levels i.e., the insulin production in the body. Early initiation of the insulin treatment for the patients of diabetes is depended on the c-peptide levels. This necessitates the need to understand the c-peptide levels as a proxy of insulin levels amongst the diabetics and the correlation between theage of the diabetes and the c-peptide levels. Objectives: To estimate the level of C-peptide in patients with newly diagnosed type 2 Diabetes Mellitus and to correlate C-peptide levels in different age groups of newly diagnosed type 2 Diabetics Mellitus. Materials And Methods: The present study is a cross-sectional study conducted in KR Hospital, Mysuru.  Patients who were newly diagnosed with Diabetes Mellitus, who satisfy the inclusion criteria and consented to participants in the study was included inthe study. Detailed history, Examination and investigations were done to the selected study   participants. C-peptide levels was estimated in all the patients. Data was analysed using SPSS software. Results: Around 50% of the patients belonged to the age group of 30-40 years. While21.9% belong to 51-60 years. Mean age was 49.45 years. 5.71% of them fall under 71-80 years of age category. 52.38% of the study participants were males while 47.61%were females. Mean Fasting blood sugars and Post Prandial blood sugars of the newly diagnosed diabetes mellitus study participants are 217.85 mg/dl and 342.42 mg/dlrespectively. The mean glycosylated hemoglobin is 10.71% among the patients.68.57% of the newly detected diabetes mellitus in our study had high c-peptide levelswhile 31.42% of them had low c-peptide levels. Mean c-peptide levels among the study participants is 6.51 ng/ml with standard deviation of 1.14 ng/ml.There was a negative correlation between the age and c-peptide. The decrease in the c-peptide levels indicates low insulin production by thebeta cells of pancreases. Conclusion: The present study concludes that there is a strong negativecorrelation between the c-peptide levels and age among the study participants Thisindicates the true deficiency in the insulin production in our participants which bringthe need for the early initiation of the insulin therapy, at the time of diagnosis in a newlydetected type 2 diabetes mellitus. Hence, c-peptide levels measured at diagnosis orearlier after the diagnosis of diabetes mellitus at any age helps in understanding theinsulin reserve of the patients. Thus, better treatment can be given by seeing the c-peptidelevels to have good control of blood sugar levels and in preventing thecomplication of diabetes mellitus.

Background: Overweight and abdominal obesity pose significant health risks, particularly among medical students who often experience sedentary lifestyles and irregular eating habits. Accurate assessment of visceral fat through anthropometric measurements is essential for effective health management. This study aims to evaluate the relationship between visceral fat and various anthropometric measures to identify the most reliable indicators for early intervention. Aim: To study the correlation between visceral fat and anthropometric measurements Methods: A descriptive cross-sectional study was conducted with 273 medical students aged 18-25 years at NIMS Medical College, Jaipur. Anthropometric data were collected using standardized techniques, and visceral fat was measured using Bio-electrical Impedance Analysis (BIA). Data were analyzed to determine correlations between visceral fat and the anthropometric indices. Result: Significant correlations were observed between visceral fat and all anthropometric measurements. Waist-to-Height Ratio (WHtR) showed the strongest correlation, followed by Waist Circumference (WC) and Waist-to-Hip Ratio (WHR). BMI also correlated moderately with visceral fat. Conclusion: Waist-to-Height Ratio (WHtR) is the most reliable anthropometric measure for assessing visceral fat among medical students. This study highlights the importance of using diverse anthropometric indicators for effective obesity screening and preventive strategies.

Introduction: A significant factor in neonatal mortality and morbidity is birth asphyxia. Signs of asphyxia are linked to about 23% of the 4 million newborn fatalities and 8% of all deaths worldwide that occur in children under the age of 5 each year. Aims: Trans-cranial Doppler evaluation of neonates with birth asphyxia. Correlation between Doppler study findings with clinical outcome Materials & Methods: Sample size was 50, study design was Prospective study. Period of study: from 1st may 2021 to 31st July 2022 and study area: Burdwan medical college & hospital Result: In our study, 44 (88.0%) patients had Whether First Breath Required Stimulation The value of z is 7.6. The value of p is < .00001. The result is significant at p < .05. In our study, 38 (76.0%) patients had Presence of Birth Complication. The value of z is 5.2. The value of p is < .00001. The result is significant at p < .05. In our study, 43 (86.0%) patients had Presence of Birth Complication The value of z is 7.2. The value of p is < .00001. The result is significant at p < .05. Conclusion: We concluded that it has been demonstrated that ultrasonography can be used to evaluate a new born who has asphyxia. The clinical outcome of a neonate receiving hypoxic-ischemic insults is positively connected with the resistant indices of the middle cerebral artery and anterior cerebral artery. Bad clinical outcomes are associated with both extremely high and low RI values.

Background: Hypertension is a leading contributor to the disease burden worldwide. Hypertension, has an incidence of 3-6% among the adult population, with affected individuals at a higher risk of cerebrovascular accidents, ischaemic heart disease and renal failure.  Objective: To determine the prevalence of hypertension in School children aged 9-16 years in Bagalkot. Method: This cross-sectional study was conducted among School Children aged between 9-16 years from schools in Bagalkot. Study period: 1.5 years, Jan 2020- June 2021. Result: The prevalence of prehypertension and hypertension was found to be 11.9% (n=149) and 6.3%(n=79). Prevalence of hypertension increased with increase in age from 5.2% in 13-14 years children to 6.7% in children of 15-16 years age group. This was statistically significant P=0.002 Prevalence of hypertension in male children (6.9%) was more than in female children (5.5%). However, this was not statistically significant. Prevalence of hypertension in the children with positive family history of hypertension was more than in children with no hypertensives in the family. This correlation was statistically significant P=0.002 Prevalence of hypertension had significant correlation with increased daily screen time P=0.02. Conclusion: The current study evaluated school children aged 9-16 years and found that the prevalence of hypertension and prehypertension to be 6.3% and 11.9% respectively. Amount of daily screen time significantly correlated with Obesity. Hypertension correlated significantly with age, amount of daily screen time, positive family history of hypertension

: Introduction: Inferences from most of the studies are limited by the fact that elevated serum Triglycerides were found after the diagnosis of Preeclampsia.  Therefore, this study is done to see if there is any significant elevation of Triglycerides prior to the development of Preeclampsia. Aims: To Find out the Significance of the Association of Early Maternal Hypertriglyceridemia in the Development of Preeclampsia. Materials and methods: It is Prospective Observational study in Department of Obstetrics & Gynaecology in Pregnant women in the early second trimester between 13 - 20 weeks registered for antenatal checkup. Total 300 pregnant women attending the antenatal clinic. 20 patients were lost during the follow up.  Demographic data like age, socioeconomic status and obstetric history along with relevant medical history was recorded on predesigned and pretested proforma. A detailed history, general physical examination including BMI, obstetric examination was done. Results: In this study, out of 280 patients, there is significant correlation between TGL levels and Risk of Preeclampsia. The distribution of patients who developed Preeclampsia is more or less the same with screening in early second trimester. The association between TGL levels and Development of Preeclampsia is statistically significant among the Gestational age group 13- 16 weeks (P=0.013) and 17- 20 weeks (P= 0.000059). The association between TGL levels and Development of Preeclampsia is statistically significant among the age group 21- 29 years (P=0.001) and > 30 years (P= 0.01). The association between TGL levels and Development of Preeclampsia is statistically significant among the Primigravida (P=0.000003) and Multigravida (P= 0.036913). There is significant association between the Triglyceride levels and risk of Preeclampsia among the Primigravida and Multigravida but the Incidence of Primigravida (11.2%) having Preeclampsia as compared to Multigravida (5.1%) is more in this particular study. The association between TGL levels and Development of Preeclampsia is statistically significant among the BMI 18.5 – 24.5 (P=0.001655) and >24.5 – 29.5 (P= 0.009368). Conclusion: The present study shows a consistent positive association between elevated maternal Triglycerides and the risk of Preeclampsia. Therefore, the level of maternal Triglycerides can be used as a screening test in the early second trimester to predict development of Preeclampsia.

Introduction: Tuberculosis prevalence is stable but there have been increased incidents due to increasing incidence of human immunodeficiency virus infection. People living with HIV are more likely than others to become sick with TB. Worldwide, tuberculosis is one of the leading causes of death among people living with HIV. Aims And Objectives: To 1) describe the various clinical manifestations of tuberculosis in people living with HIV and AIDS and correlate it with the degree of immune suppression. 2) correlate CD4 cell count and Tuberculosis spread. MATERIALS AND METHODS: A Prospective and observational study comprising 100 patients admitted to the department of medicine with HIV TB co-infection. Inclusion criteria: Patients who are HIV infected as evidenced by ELISA and with clinical features supported by CBNAAT or ZN stain for AFB. Exclusion criteria: Patients who are HIV-negative and tuberculosis, those who have been diagnosed prior and have already started ATT. Results: In our study, in both the categories of TB cases (Pulmonary & extrapulmonary), the majority of patients had a CD4 count of 301-400 cells/mm3 followed by 201-300 cells/ mm3 in both groups. The CD4 count 101-200 cells/mm3 was present among 8 cases in the pulmonary TB group and 3 patients in the extrapulmonary TB group. Conclusion: Pulmonary TB is more prevalent than extrapulmonary tuberculosis among the range of tuberculosis that can affect people with HIV. The majority of patients had pulmonary tuberculosis if their CD4 count was higher than 200 cells mm3.

This is a cross-sectional study which examines the influence on heart rate variability (HRV) indices in pre-menopausal women and post-menopausal women and also its correlation with menopausal symptoms.  Menopause is characterized by various physiological changes that occur in the reproductive organs and other systems of the body. One change that occurs in the cardiovascular system is modulation of autonomic activity. Menopause causes an imbalance of the autonomic nervous control of the cardiovascular system that shifts toward sympathetic hyperactivity. Material and methods: The study involved 140 women who were divided into two groups, 70 premenopausal women of age group 40-55 years and 70 postmenopausal women of age group 40-55 years. Heart rate variability indices were observed in both groups. Result: The various heart rate variability parameters like SDRR, RMSSD, pRR50, VLF and HF in post-menopausal women was decreased compared to pre-menopausal women. LF and LF/HF ratio in post-menopausal women was increased compared to pre-menopausal women. Also, LF and LF/HF ratio in symptomatic post-menopausal women was increased compared to asymptomatic post-menopausal women. Conclusion: The present study concludes that, menopause shifts the autonomic sympathovagal balance towards sympathetic predominance in post-menopausal women.

Introduction: T2DM is associated with cell-mediated immune responses and abnormal T-lymphocyte function, further linked to insulin deficiency. Hence this study aims to determine the activity of serum total ADA and correlate these parameters with glycemic control, and biochemical variables in type 2 diabetic individuals. Aims and Objectives: Aim: To estimate serum adenosine deaminase and its correlation with glycemic status in diabetes mellitus. Objectives: To estimate the serum adenosine deaminase levels in type 2 diabetes mellitus patients. Inclusion Criteria: Individuals with diagnosed T2DM in the age group 35 to 70 years. Exclusion Criteria: Individuals with a history of tuberculosis, rheumatoid arthritis, viral hepatitis, and HIV and Patients on insulin therapy. Results: In this study, 41 cases were males and 59 were females. ADA activity was significantly higher in uncontrolled (Group C) diabetic patients (55.428±3.736U/L) compared to the controlled (Group B) population (42.63±4.59 U/L) and non-diabetics (22.0581±5.1968 U/L) with p value 0.001. Patients who have a longer duration of diabetes history had higher serum ADA levels than newly diagnosed patients with significant differences, p < 0.001. Conclusion: This study's findings clearly show that Adenosine deaminase (ADA) levels are elevated in type 2 diabetics, and the positive correlation of ADA with higher glycemic control suggests that ADA may serve as a prognostic factor in T2DM. ADA had a significant positive correlation with HbA1c, which is regarded as a good marker for long-term glycemic control.

Background – Cirrhosis of the liver is a frequently encountered disease. The commonly available tests used in assessing the severity of cirrhosis have certain drawbacks. The estimation of serum cholinesterase is useful to assess the severity and prognosis of the disease. Aim – The aim of the study is to compare the level of serum cholinesterase in patients with cirrhosis with other tests of liver function like serum albumin, serum bilirubin, PT INR, MELD and Child Pugh score. Materials and Methods – This was a hospital based observational study conducted for six months between March to August 2016 at Apeksha Critical care and multispecialty hospital private limited Nanded. Patients who were diagnosed with cirrhosis both clinically and by ultrasound were included in the study. The assay for serum cholinesterase was done in all patients. The correlation between the values of serum cholinesterase and serum albumin, bilirubin, INR, Child Pugh and MELD score were analysed. Results – A total of 100 patients were studied. The majority were males ( 80%) in the age group of 41to 50 years.(40%). The most common aetiological factor in this study was alcohol (68%). Of the clinical signs studied 83% had ascites, 72% had icterus, 63% had splenomegaly and 31% had hepatic encephalopathy. On analysis of the laboratory parameters, 71% had a bilirubin level more than 3 and 73% had an INR less than 1.7. The majority of the patients were in Child Pugh class B ( 41%) and 64% had MELD score greater than 15. On analyzing the correlation between serum cholinesterase and other tests of liver function, it was found that there was significant correlation with albumin, bilirubin, INR levels, Child Pugh and MELD score. Conclusion – A significant correlation was found between serum cholinesterase levels and the severity of Cirrhosis.

Introduction: COPD, as defined by GOLD 2023, is a lung condition that is characterised by chronic respiratory symptoms such as dyspnoea, cough, expectoration, and exacerbations. These symptoms are caused by abnormalities in the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema), which result in persistent and often progressive airflow obstruction (1). Airflow blockage is characterised by a forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) of less than 0.70. FEV1 is classified as Mild when it is greater than 80% of the predicted value, Moderate when it is between 50% and 80% of the predicted value, Severe when it is between 30% and 50% of the projected value, and Very Severe when it is less than 30% of the predicted value. In 2019, Chronic obstructive pulmonary disease (COPD) resulted in 3 million fatalities globally, making it the third most common cause of death (2). Cardiovascular diseases (CVDs) are a major health issue that often occurs alongside chronic obstructive pulmonary disease (COPD) and greatly increases the chance of death (3). Ischaemic heart disease (IHD), heart failure, and arrhythmias are often observed as cardiovascular diseases (CVDs) in patients with chronic obstructive pulmonary disease (COPD). The incidence rates of ischaemic heart disease (IHD), heart failure, and arrhythmias in individuals with chronic obstructive pulmonary disease (COPD) range from 19% to 61%, 11% to 31%, and 9% to 16%, respectively, depending on the specific characteristics of the research population (4,5,6). The prevalence of cardiovascular disease (CVD) was much greater in patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. Specifically, 59.7% of COPD patients had CVD, while only 28.5% of non-COPD patients had CVD (7). COPD can cause a range of abnormalities in the structure and blood flow of the heart, which can in turn affect several aspects of the electrocardiogram (ECG). The main causes of ECG changes in patients with COPD are increased airway obstruction, higher pressure on the right side of the heart, displacement of the diaphragm due to excessive inflation of the lungs, rotation of the right side of the heart in a clockwise direction, and changes in body mass index that are associated with clockwise rotation of the QRS-vector in the front of the heart(8,9). The objective of our study was to examine the alterations in electrocardiography among patients with chronic obstructive pulmonary disease (COPD) and to establish a correlation between ECG findings and the severity of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria. Materials And Methods: This is a cross sectional, observational study done in patients who attended OPD and admitted in wards in department of General Medicine and department of Pulmonary Medicine in Maharajah Institute of Medical Sciences, Vizianagaram. Results: In our study most of the patients belong to age group of 51-70 years (73.2%), most common in 61- 70 years (38.6%) with male preponderance (85.3%). 59 of 64 males were smokers and 4 of 11 females has history of smoking. Conclusion: COPD is a common condition in patients with smoking and is associated with ECG abnormalities. RAD (Right Axis Deviation) is the most common ECG change observed in the study.  As the severity of the disease increases, ECG abnormalities become more common. All patients should undergo ECG to prevent cardiovascular morbidity and mortality.

Introduction: A significant contributor to morbidity and death is hypertension. In hypertension, microalbuminuria is thought to be a potent, early, and independent indicator of elevated cardiovascular risk. Micro-Albuminuria shows a strong correlation with left ventricular hypertrophy in hypertensive individuals. This investigation was carried out on both inpatients and outpatients in the Department of General Medicine. Material And Method: A total of 100 Cases admitted in medical wards and those attending medicine outpatient department in Al Ameen Medical College, Athani road, Vijayapura who were recently diagnosed of hypertension. Results: Study was conducted in 100 newly diagnosed hypertensive patients. Out of 100 patients, 70 % patients had Microalbuminuria and 41 % had Left Ventricular Hypertrophy. The relationship between Microalbuminuria and Left Ventricular Hypertrophy was found to be Statistically Significant. Conclusion: In the present study we evaluated the Prevalence of Microalbuminuria and Left ventricular hypertrophy in newly diagnosed hypertensive patients. We found that: 43% were between age group of 40-49 Among 100 patients, 41 patients had LVH and 59 had normal cardiac geometry Among 70 patients with microalbuminuria, 39 patients had Left ventricular hypertrophy showing a significant association between Microalbuminuria and Left ventricular hypertrophy. A significant association was found between Stage of Hypertension with Microalbuminuria and left ventricular hypertrophy. Microalbuminuria is an integrated marker of CV risk and has a statistically significant association with Left ventricular hypertrophy

Introduction: In addition to established risk factors such as smoking, diabetes mellitus, hypertension, homocysteine, C-reactive protein (CRP), fibrinogen, and albumin, coronary artery disease (CAD) is characterised by a chronic inflammatory state. Inflammation plays a significant role in the initiation and progression of atherosclerotic plaque rupture, thrombus formation, and endothelial dysfunction. Two indicators, the fibrinogen to albumin ratio, are altered, and this results in vascular endothelial dysfunction through a variety of mechanisms, including platelet aggregation, thromboxane affinity, and plaque erosion. As a result, FAR has been identified as a new inflammatory marker that is correlated with the severity of coronary artery disease. Materials And Methods: The study included 108 patients who had acute coronary syndrome (ACS) and were admitted to the IPD division of the ICCU at KIMS Hospital. The patients underwent coronary angiography (CAG) while taking into account inclusion and exclusion criteria. Serum fibrinogen and serum albumin were measured at the time of admission, and the fibrinogen to albumin ratio was computed. Written informed consent was obtained from each subject or relative in every case. A detailed clinical history, including complaints, past history, and family history, was also obtained. The angiographic severity of coronary artery disease was assessed using the Gensini risk scoring system. The Chi-square test was employed to evaluate the association between FAR and other risk variables, and the Pearson correlation coefficient was utilised to determine the linear link between Gensini score (GS) and FAR. Results:  108 patients participated in the research; 70 (64.8%) were men and 38 (35.2%) were women. The mean age was 57 years, and the patients' ages varied from 29 to 83 years. Of the 108 patients who had acute coronary syndrome, 51 (47.2%) had diabetes, 65 (60.2%) had hypertension, 7 (6.5%) had a family history of coronary artery disease, and 52 (48.2%) had smoked. 38 (35.2%) patients with coronary angiography (CAG) had single vessel disease (SVD), 63 (58.3%) with double vessel disease (DVD), and 7 (6.5%) with triple vessel disease. The 108 patients who were enrolled in the study were split into three FAR tertiles: low FAR (n = 36; <9), middle FAR (n = 36; <11.8), and high FAR (n = 36; >11.8). Of the 108 patients, ANOVA in one manner, the mean Gensini score for the low FAR group was 34.6, the mean Gensini score for the intermediate FAR group was 38.8 13.8, and the mean Gensini score for the high FAR group was 48.6 16.2 with a statistically significant p <0.001. The pearson correlation coefficient between FAR and Gensini for the 108 patients is 0.446, indicating statistical significance with a p-value of less than 0.001. Conclusion High FAR levels are strongly correlated with angiographic severity of coronary artery disease, as determined by the Gensini risk score method, in individuals with acute coronary syndrome.

Background: Autopsies are done to know the identity, manner, cause of death and approximate time since death. The condition of internal organs can be revealed by Autopsy and is often followed by histopathological examination of tissues from various organs to relate the cause of death with associated pathology and the correlation between the two. The present study was taken to determine lung lesions in relation to age and sex and to identify the histopathological alterations spectrum in lung specimens, irrespective of cause of death and sex. Methods: This study was retrospective and done on 117cases of autopsies in last one year i.e August 2023 to July 2024. The tissue specimens were properly fixed and processed. Routine paraffin sectioning was done followed by staining with Hematoxylene and Eosin (H and E). Special stains were done whenever required. Clinical and postmortem findings, gross and histopathological examination findings were studied. Results: After thorough Histopathological examinations, of total 117 cases. Most commonly affected age group was 30-50 years, followed by age group of >60 years. Majority of diseased were males 83. The predominant finding was chronic venous congestion seen in 36 cases – 30.78% followed by pulmonary edema with 26 cases – 22.22% and changes in interstitium seen in 17 cases – 14.53%. Cause of death was known in 99 cases (84.62%) of pathological lesions. Poisoning, 41 cases (35.04%) was the most common followed by sudden death (11.11%) Conclusion: Autopsy is an important tool useful for identifying, recognizing pathology and pathogenesis of disease regardless of recent advances in diagnostic technology. Autopsy study reveals the true prevalence of infectious diseases and also suggests the need and emphasis of timely diagnosis and treatment of these diseases to reduce mortality due to these diseases.

Background: Background: This study aimed to describe Correlation between Kawasaki disease & MIS-C in Indira Gandhi Medical College, Shimla. Material & Methods: We conducted a cross-sectional study for MIS-C from January to July 2021, in the pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh, in Western Himalayas. All children admitted with a diagnosis of MIS-C were included in the study. Data regarding sociodemographic factors and Kawasaki cases were extracted and analyzed using Epi Info V7 software. Results: In the present study, a total of 31 children diagnosed & admitted as a case of MIS-C were included. Mean age of these patients was 7.12±4.78 years. Among the total 16(51.6%) were males while 15(48.4%) were females. Of, 31 cases of MIS-C, 5 children presented KD. All of them were males. 3 children were less than5 years, while 2 were 6-10 years old. Echo was normal in 4 cases and 1 had low ejection fraction. IVIG was given to all, while LMWH was given to one child. Methylprednisolone in low doses to 4 children, while in 1recieved high dose. Aspirin was given to 4 patients. Oxygen therapy in 3 patients, ventilatory support was given to one child, while inotropic support was given to 2 patients. All 5 patients were discharged after full recovery. Conclusion: Given the frequent overlap of clinical manifestations between MIS-C and those of Kawasaki disease, the majority of patients with hyperinflammatory syndrome have generally been treated with the standard therapeutic protocols used in Kawasaki disease.

Background- Atherosclerotic vascular diseases, major global health burden which comprises cerebrovascular disease and coronary heart disease. For coronary artery disease and cerebrovascular disease, diabetes is considered as an independent risk factor. Since more than 80% of diabetes cases occurs in developing countries so they pose the highest economic burden. HDL levels are low in diabetics then non diabetics. This Low level of HDL is strongly associated with elevated increase risk for CAD in diabetics. Hence it is very important to study the clinical way of presentation of the disease and in which pattern coronary arteries are involved in both patients with diabetes and without -diabetes. Methodology: The present study is a cross-sectional study. This study was conducted on 335 patients with ACS who subsequently underwent coronary angiogram admitted in Department of Cardiology. Patients who matched the inclusion and exclusion criteria were selected randomly during period of approximately one year formed the study group. The severity of involvement of coronary artery is quantitatively assessed by GENSINI score [Angiographic severity score].So in this study we analysed the comparison of coronary artery disease and its influence by change in glycaemic status quantitively .Result- CAD severity was higher in patients with diabetes with mean gensini score of 40.9 followed by pre-diabetics 33.7and non diabetics with 23.8 (p value .001) .The severity of CAD was higher in patients with diabetes for more than 6 years. There was Statistically significant correlation between duration of diabetes and severity of CAD in diabetes. Conclusions: The severity and extent of CAD in diabetics was more compared to non-diabetics. Involvement and occlusion of vessels were more commonly seen in diabetic patients. The incidence of triple vessel or multi-vessel disease was significantly higher in diabetics. Patients with poor glycemic control with elevated levels of HbA1c had diffuse pattern of atherosclerotic disease and high levels of HbA1c mildly correlated with gensini score.

Background: One non-invasive method for measuring EtCO2 (End-Tidal Carbon Dioxide) is capnometry. Despite the creation of a portable colorimetric device for semiquantitative ETCO2 assessment, its primary applications are in emergency care, post-anesthetic recovery, and intensive care. Its accuracy and usefulness for nonincubated patients have not been thoroughly investigated. Methods This was a cross-sectional study carried out in the AIG Hospital, Hyderabad, between 2020 to 2022 involving 100 patients presenting to the emergency department with respiratory distress with a respiratory rate greater than 30/min, use of accessory group of muscles, Spo2%< 90% or abnormal pattern of breathing. PaCO2 was measured using an arterial blood gas analyzer and ETCO2 was measured using capnometry. The data was compiled on a Windows XL spread sheet and analyzed using SPSS version 19. Results: Out of 100 patients males were 74% and females were 26%, with the majority being >60 years old. The study revealed a strong correlation between ETCO2 and paCO2 in patients with respiratory distress in both respiratory and non-respiratory conditions of any age and sex (p=<0.05). The correlation coefficient between ETCO2 and PaCO2 was 0.90 (R2 = 0.81). Conclusion: End-tidal carbon dioxide concentration measurements show a strong correlation with Paco2 values in nonintubated patients who arrive at the emergency room for a range of ailments. In some cases, end-tidal carbon dioxide readings may be adequate indicators of PaCO2 and eliminate the requirement for repeated arterial blood gas analysis

Background: Lung cancer is one of the most frequent cancers and a major cause of cancer death worldwide. Lung cancer accounts for 11.6% of all new cancer cases identified each year and is quickly becoming the most prevalent fatal neoplastic disorder in the world, accounting for 18.4% of all cancer-related fatalities worldwide1. Objectives: 1. To study the clinical profile of newly diagnosed bronchogenic carcinoma patients. 2. To study the clinicopathological correlation among various histological types of bronchogenic carcinoma in the above patients. 3. To study the extrapulmonary manifestations and the prevalence of identifiable paraneoplastic syndromes (if present) in patients with bronchogenic carcinoma. MATERIAL & METHODS: Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Government Medical College, Kadapa.  Study Period:  June 2023 – December 2023. Sample size: The study consisted of 52 subjects. Sampling method: Simple random Sampling Technique. Inclusion criteria: Patients attending hospital, diagnosed with bronchogenic carcinoma in the specified period. Study tools and Data collection procedure: Patients included in the study were selected according to the inclusion and exclusion criteria. After obtaining informed consent, data was gathered from history, objective examination of the patients and lab investigations using a semi-structured questionnaire. The localisation of the tumors was done by chest x-ray, fibre optic bronchoscopy and/or CT scan as required. Tissue diagnosis was obtained by FNAC/ biopsy or other cytology and histopathological examination of the specimen was carried out. The type pattern of paraneoplastic syndromes was noted. Results: COPD (65.38%) and Diabetes (23%) were the common co-morbidities affecting the study population followed by HTN (19.2%). H/O old PTB was noted in 11.5% of the patients and 1 patient (1.9%) had h/o ILD. 2(3.8%) patients had past h/o malignancy. One patient had h/o squamous cell carcinoma of the right ear another patient had cervical cancer and 1 (3.8%) patient had a family history of malignancy (first-degree relative). Conclusion: Lung cancer is a rapidly progressive disease with a very high mortality rate but treatment in the early stage may give a good prognosis. High-risk patients with having smoking history should be evaluated clinic radiologically with high suspicion so that early diagnosis can be made and the quality of life of patients can be improved. Primary lung cancer should always be suspected in a person presenting with unexplained cough for several weeks with other symptoms such as weight loss, and fever with non-resolving collapse-consolidation on chest radiograph.

Background: Intrapartum hypoxia causes fetal suffocation, acidosis, newborn brain damage, long-term morbidity, and mortality.1 As a result, intrapartum fetal monitoring is performed to detect early indicators of fetal hypoxia and to take appropriate action as soon as possible to avoid fetal hypoxia complications. Objectives: 1. To study the correlation between fetal Doppler ultrasound and umbilical cord blood gas analysis in detecting fetal academia.  2.To identify the maternal and obstetric determinants associated with fetal acidemia. MATERIAL & METHODS:  Study Design: Hospital-based prospective observational study. Study area: The study was conducted in the Department of Obstetrics and Gynaecology.  Study Period:  1 year. Sample size:  Using a sample size calculator, expecting a correlation coefficient of r=0.300, the required sample size was calculated to be 85. Study population: During the study period, a total of 92 pregnant women with abnormal fetal Doppler ultrasound findings, meeting the below-mentioned inclusion and exclusion criteria were eventually recruited into this study. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: The institutional ethical committee clearance was obtained. The design and nature of the clinical study were explained to the patients and significant relatives of the patients. Informed consent was obtained from patients. The socio-demographic data was collected and recorded in the specially designed proforma. The socioeconomic class was assessed using the Socio-Economic Status Schedule. The obstetric history data was gathered and recorded in the proforma. All the patients in the sample group (n=92) were subjected to thorough clinical examination which included general physical, systemic examination and pelvic examination. Maternal blood samples for routine laboratory investigations (including tests for acidosis) were sent. Results: There was a significant correlation between gestational age and fetal acidemia (p value=0.0096). A gestational age of 41 weeks or more has a lesser incidence of fetal acidemia. Middle cerebral artery pulsatility index (MCAPI) was significantly associated with fetal academia (p-value of <0.0001). The umbilical artery pulsatility index (UAPI) had a highly significant correlation (p <0.0001) with the umbilical cord blood gas analysis. Conclusion: Based on the statistical analysis of the data, it is safe to assume that fetal Doppler ultrasound can predict the development of fetal acidemia. Two indicators, the Middle cerebral artery pulsatility index and the Umbilical artery pulsatility index, are strong predictors of fetal acidemia. Similarly, determinants like obstetric score, medical comorbidity, general physical examination and status of labour per vaginal examination were also not found to be significantly associated with fetal acidemia.

Background: Hypothyroidism is associated with cardiovascular and pulmonary complications. This study aimed to explore the relationship between Spirometric parameters and left ventricular diastolic dysfunction (LVDD) in hypothyroid patients.

Objective: To investigate the association between Spirometric parameters and left ventricular diastolic dysfunction (LVDD) in patients with hypothyroidism.

Methods: This cross-sectional hospital based study included 100 hypothyroid patients on treatment, divided into two groups: 50 with LVDD and 50 without diastolic dysfunction. Sociodemographic data, biochemical parameters, Spirometric measures, and echocardiographic findings were collected. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and maximal voluntary ventilation (MVV). Echocardiography evaluated left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), E/A ratio, deceleration time (DT), and is ovolumetric relaxation time (IVRT).

Results: Hypothyroid patients with LVDD showed significantly lower values for FVC, FEV1, and PEF compared to those without LVDD. The mean FVC was 2.5 ± 0.5 L in the LVDD group versus 3.2 ± 0.6 L in the non-LVDD group (p < 0.01). FEV1 was 1.9 ± 0.4 L versus 2.5 ± 0.5 L (p < 0.01). PEF was 250 ± 50 L/min versus 320 ± 60 L/min (p < 0.01). Correlation analyses revealed significant associations between spirometric parameters and echocardiographic measures of diastolic function. Multiple regression analysis indicated that reduced spirometric parameters were independently associated with LVDD after adjusting for potential confounders.

Conclusion: The study demonstrated that a significant association between spirometric patterns and LVDD in hypothyroid patients. Our findings reveal that hypothyroid patients with LVDD exhibit markedly reduced spirometric measures, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF), compared to those without diastolic dysfunction indicating restrictive pattern. Reduced lung volumes and airflow rates are indicative of impaired cardiac function, highlighting the importance of integrated evaluation of both pulmonary and cardiac health in this population. Regular spirometric assessment in hypothyroid patients may aid in early identification and management of diastolic dysfunction.

Background: Understanding the correlation between lipid profile, glucose levels, and depression/dementia in post-menopausal women is crucial for developing effective prevention and treatment strategies. Aim: Hence, the aim of this study is to investigate the correlation between lipid profile, urea, creatinine, uric acid, and glucose levels, and depression/dementia in post-menopausal women. Materials & methods: At SMS Medical College and Attached Hospitals in Jaipur, India, researchers from the Departments of Biochemistry and Gynecology and Obstetrics performed a comparative cross-sectional study on one hundred postmenopausal women (PMWs) suffering from depression. The research evaluated cognitive functioning and the degree of depression using the Beck's depressive inventory, respectively. One hundred healthy postmenopausal women served as a control group, and the patients were split into two categories according to their scores.  Results: Depressed PMWs had lower HDL values and higher serum total and LDL cholesterol. They had higher uric acid levels and blood glucose levels. Beck's score showed a strong positive association with total cholesterol, inverse correlation with HDL and LDL, and positive correlation with VLDL. Conclusion: The research indicates a connection between menopause and depression, but additional investigation is necessary to comprehend its root causes. Treatment strategies should concentrate on dietary intake, estrogens, and social support systems.

Background: This study examines the correlation between thyroid function and obesity, an area of increasing clinical interest due to the rising prevalence of both thyroid disorders and obesity worldwide. Previous research has suggested potential links, but findings have been inconclusive, necessitating further investigation. Objectives: The primary objective was to explore the relationship between thyroid function tests and obesity indices in a cross-sectional population. The study aimed to contribute to the understanding of how thyroid function may influence or be influenced by obesity. Methods: We conducted a biochemical cross-sectional study involving 250 participants, selected based on predefined inclusion and exclusion criteria. Thyroid function was assessed using standard thyroid function tests (TFTs), including TSH, T3, and T4 levels. Obesity was evaluated using body mass index (BMI) and waist circumference measurements. Statistical analysis was performed to identify correlations between TFTs and obesity indices. Results: The study found significant correlations between certain thyroid function parameters and measures of obesity. Elevated TSH levels were notably associated with higher BMI and waist circumference. These associations persisted even after adjusting for potential confounders, such as age and gender. Conclusion: Our findings suggest a significant correlation between thyroid function tests and obesity, particularly an association between elevated TSH levels and increased obesity indices. This study enhances the understanding of the interplay between thyroid function and obesity, potentially guiding future clinical management and research.

Background: HbA1c is recommended as the standard laboratory assessment of glycaemic control and efficacy of treatment of patients with type 1 and type 2 diabetes mellitus. However, HbA1c assays give incorrect values in patients with hemoglobinopathies. Hemoglobinopathies interfere with the detection of HbA1c by the HPLC method. HbE disorder is very common in North- Eastern part of India both in tribal and non-tribal populations. Serum fructosamine is estimated to find out the glycaemic status of HbE disease patients instead of HbA1c. Methods: This hospital-based cross-sectional study was conducted in the Department of Medicine, Assam Medical College & Hospital, Dibrugarh for a period of 12 months. A total of 90 diabetic patients were included. Serum Fructosamine and HbA1c were analysed. Results: The results showed that the mean age was 49.83 years with male preponderance (55 %) with male to female ratio of 1.2:1. In our study, in diabetic patients with adult hemoglobin there was a statistically significant correlation between serum fructosamine and HbA1C (r=0.93) and in diabetic patients with HbE trait also, there was a statistically significant strong correlation (r=0.522). Conclusion: It is seen that HbE disorder is prevalent in this part of the country, and the presence of Hemoglobin E causes significant interference in HbA1C measurement. In the presence of HbE disease, serum fructosamine can be used in place of HbA1c to know the glycaemic status of the patient.

Background: Psoriasis is a chronic inflammatory disease associated with an increased risk of cardiovascular diseases (CVD) due to systemic inflammation and metabolic dysregulation. Objective: This study investigates the association between psoriasis and cardiovascular diseases in patients attending Hamdard Institute of Medical Sciences and Research, New Delhi. Methods: A prospective observational study was conducted from January 2023 to May 2024. A sample of 65 psoriasis patients was assessed for cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and metabolic syndrome. Detailed clinical evaluations, blood tests, and ECG were performed. The prevalence of CVD risk factors and the correlation with psoriasis severity were statistically analyzed. Results: Out of the 65 patients (mean age 43.7 years, 60% male), 45 (69%) showed at least one cardiovascular risk factor. Hypertension was observed in 40% of the patients, dyslipidemia in 35%, and metabolic syndrome in 30%. Psoriasis severity (PASI score) was positively correlated with the presence of multiple CVD risk factors (p<0.05). Furthermore, 12% of the patients had a history of cardiovascular events such as myocardial infarction or stroke. The findings indicated a higher prevalence of cardiovascular risk factors in moderate-to-severe psoriasis cases than in mild cases. Conclusions: Psoriasis patients, especially those with severe forms, exhibit a significantly increased risk of cardiovascular diseases. Early cardiovascular screening and management should be integral to psoriasis care to mitigate this risk.

Background: In neuroimaging, Magnetic Resonance Imaging (MRI) is a cornerstone technique that allows clinicians to see fine aspects of brain architecture and pathology with unparalleled clarity. Ring-enhancing lesions (RELs) in the brain pose a particularly difficult diagnostic scenario among the many abnormalities found. Objectives: 1. To differentiate neoplastic from non-neoplastic brain lesions using conventional and advanced MR imaging techniques. 2. To study the characteristic imaging findings of various ring enhancing lesions on MRI.  Material & Methods: Study Design: A prospective hospital-based observational study. Study area: Department of Radio Diagnosis, Subbaiah Institute of medical sciences, Shivamogga, Karnataka. Study Period: 1 year. Study population: All patients referred to the Department of Radio diagnosis with clinically suspected cerebral ring-enhancing lesions. Sample size: The study consisted of 60 subjects. Sampling method: Simple random technique. Results: Out of 60 patients evaluated, Seizures were the most common presenting complaint in 70% of cases. Headache (18%), fever (6.6%), vomiting (15%), ataxia (5%) and motor weakness (6%) were the other presenting complaints. Our findings were compared with the study conducted by ps mahato8 in which headache (57.5%) was the most common symptom followed by seizures (52.5%).  CONCLUSION: From our study, it can be concluded thatMRI is the most sensitive modality in the characterization of intracranial ring-enhancing lesions. MRI being non-invasive and non-radiating is an ideal imaging modality.

Background: Sepsis is a critical condition resulting from a dysregulated immune response to infection, leading to severe organ dysfunction and increased healthcare costs. Early identification of sepsis severity is crucial for effective management. This study investigates the correlation between hypoalbuminemia, arterial blood gas (ABG) pH levels, and the severity of sepsis, as assessed by the Sequential Organ Failure Assessment (SOFA) score, in critically ill patients. Methods: A retrospective analysis was conducted on 100 adult patients admitted to the ICU of a tertiary care hospital in South India from June 2023 to December 2023. Data collected included demographic characteristics, comorbidities, SOFA scores, ABG results, and microbiological cultures. Statistical analyses were performed using descriptive statistics, Chi-square tests, ANOVA, and Pearson’s correlation coefficient, with a significance threshold set at p < 0.05. Results: The majority of patients exhibited acidemia, with a significant inverse correlation between pH levels and SOFA scores (p < 0.001), indicating that lower pH is associated with greater sepsis severity. However, no significant relationship was observed between hypoalbuminemia and SOFA scores (p = 0.566). The most frequently identified pathogens included Klebsiella and E. coli. Conclusion: The study demonstrates that ABG pH levels serve as a valuable early indicator of sepsis severity in critically ill patients. While hypoalbuminemia was prevalent, its correlation with sepsis severity was not statistically significant. These findings underscore the importance of prompt ABG analysis in managing sepsis and suggest the need for further research to elucidate the role of hypoalbuminemia in sepsis outcomes.

Conclusion: The P.I. is useful tool for predicting hypotension in parturient undergoing LSCS under spinal anesthesia .

Background: The data of lower quantitative hepatitis B surface antigen (HBsAg) level were associated with more severe liver fibrosis in HBeAg-positive chronic hepatitis B. This study aimed to analyze correlation between liver fibrosis based on transient elastography and quantitative HBsAg levels in HBeAg-positive chronic hepatitis B patients. Methods: We conducted a cross-sectional study of 52 treatment-naive HBeAg-positive chronic hepatitis B patients. Liver fibrosis was measured using transient elastography, and quantitative HBsAg level was measured using automated Chemiluminescence Enzyme Immunoassay. Results: Quantitative HBsAg levels were highest in the F1 group, followed by F2, F3 and lowest in the F4 group. A strong negative correlation between transient elastography and quantitative HBsAg level was revealed in HBeAg-positive chronic hepatitis B patients (r=-0.706, p=0.000). Quantitative HBsAg levels were found to be higher in the immune-tolerant phase which liver fibrosis was minimal compared to the immune clearance phase which liver fibrosis was more severe. Patients with more severe liver fibrosis showed lower quantitative HBsAg levels. Conclusion: We found a negative correlation between liver fibrosis based on transient elastography and quantitative HBsAg levels in HBeAg-positive chronic hepatitis B.

Background: Acute Coronary Syndrome (ACS) is a predominant cause of mortality, particularly in the elderly population (>60 years). This study aimed to evaluate the correlation between thyroid hormone profiles and the severity of ACS  in old  patients, using Killip classification and TIMI flow grade. Material and Method: This hospital-based cross-sectional study involved 95 patients aged over 60 years, presenting with ACS at Shri B M Patil Medical College. Exclusion criteria included known coronary artery disease, thyroid disorders, use of medications affecting thyroid function, and other conditions impacting thyroid tests. Thyroid profiles were measured within 72 hours of admission using the Electrochemiluminescence method. ACS severity was assessed using the Killip classification and TIMI flow grade. Statistical analysis was performed using JMP SAS 16 Software, with significance set at p<0.05. Results: The mean age of patients was 66.2 years, with 64.2% being male. Chest pain (91.5%) was the most common symptom. Hypertension (50.5%) and diabetes (46.3%) were prevalent comorbidities. ECG indicated STEMI in 64.2% of patients, with positive Troponin I in 85.3%. Single, double, and triple vessel diseases were observed in 31.6%, 42.1%, and 26.3% of cases, respectively. TIMI flow grade 2 was most common (48.4%), and Killip class 2 was the most frequent clinical severity (32.6%). Lower T3 and T4 levels were significantly associated with higher Killip classes, indicating severe ACS, while higher T3 levels correlated with higher TIMI grades, indicating better perfusion. Conclusion: The study found a strong relationship between thyroid hormone levels and the severity of ACS in older people. Lower thyroid hormone levels are related with more severe ACS, implying that thyroid profiling might be an important tool in the risk assessment and treatment of older ACS patients. More study is needed to investigate the underlying processes and corroborate these findings across a variety of clinical contexts.

Purpose:  To compare cardiopulmonary exercise test (CPET) parameters, including VO2, VCO2, respiratory exchange ratio (RER), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), and blood pressure (BP), between COPD smokers and healthy smokers, and to assess their relationship with 6-minute walking distance (6MWD) and spirometric values. Methodology: The study employed an evaluative approach to compare CPET parameters between COPD smokers and healthy smokers. Ethical approval was obtained, and the sample included 50 participants from each group. Data collection involved spirometry, 6-minute walking tests, and CPET using a treadmill under the modified Bruce Protocol. Parameters such as VO2, VCO2, RER, heart rate, and oxygen saturation were measured pre- and post-exercise. Pulmonary function was assessed using spirometry, and the results were analyzed using statistical tests, including Chi-square, with significance determined at p < 0.05. Result: This evaluative study, conducted over 15 months, enrolled 100 participants equally divided between chronic obstructive pulmonary disease (COPD) smokers and healthy smokers, revealing a male predominance (96%). Key findings included significant differences in cardiopulmonary exercise testing (CPET) parameters: COPD smokers had a mean VO2 of 429.20 ± 158.88 ml/min compared to 1569.88 ± 356.74 ml/min in healthy smokers (P < 0.001). Correlation analysis demonstrated a strong relationship between FEV1 (%) and FEV1/FVC (%) (R = 0.906, P < 0.001), while lower oxygen saturation was associated with decreased exercise performance (R ranging from -0.719 to -0.805). Post-CPET assessments showed significantly higher respiratory rates (28.24 ± 1.64 vs. 25.52 ± 3.03, P < 0.01) and heart rates (158.96 ± 7.81 vs. 169.28 ± 7.06, P < 0.01) in COPD smokers, alongside elevated O2 desaturation (9.92 ± 2.23 vs. 1.28 ± 1.05, P < 0.01). Notably, the 6-Minute Walk Distance (6MWD) was significantly lower in COPD smokers with higher smoking indices, with a mean 6MWD of 308.75 ± 49.53 meters for those with a smoking index of 151-250 (P = 0.04), illustrating the adverse effects of smoking exposure on physical performance. Conclusion: Overall, these results highlight the utility of Cardiopulmonary Exercise Testing (CPET) in identifying the underlying causes of exercise limitation and assessing the maximal exercise capacity in COPD patients. In situations where CPET is unavailable, the 6MWD serves as a practical alternative exercise test that closely correlates with CPET parameters, making it a valuable tool for evaluating the functional status of COPD patients.

Background: Hypertension and dyslipidemia are major risk factors for cardiovascular diseases and may also impact retinal microvasculature. This study investigates the correlation between serum lipid profiles and retinal microvascular changes in hypertensive patients. Objective: To assess the association between serum lipid levels and retinal microvascular measurements, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR), in hypertensive patients. Methods: A cross-sectional study was conducted on 100 hypertensive patients. Baseline demographic data, blood pressure, and serum lipid profiles (total cholesterol, LDL, HDL, triglycerides, and VLDL) were recorded. Retinal microvascular measurements were assessed using fundus photography. Pearson correlation and multivariate regression analyses were performed to evaluate the relationship between lipid levels and retinal microvascular changes, adjusted for age, gender, BMI, and blood pressure. Results: Total and LDL cholesterol were negatively correlated with CRAE (r = -0.32, p = 0.002; r = -0.29, p = 0.005) and positively correlated with CRVE (r = 0.28, p = 0.006; r = 0.34, p = 0.001). HDL cholesterol was positively correlated with CRAE (r = 0.35, p = 0.001) and AVR (r = 0.29, p = 0.005). Multivariate analysis confirmed these findings, showing that total cholesterol, LDL, and triglycerides negatively impacted retinal microvasculature, while HDL had a protective effect. Conclusion: Dyslipidemia is associated with retinal microvascular changes in hypertensive patients, suggesting its potential role in hypertensive retinopathy development. Lipid management may help in preserving retinal microvasculature.

Background: The incidence of surgical site infections (SSI) must be determined to help decision-makers better plan and execute surgical care by gauging the severity of the problem. OBJECTIVES: The meta-analysis aims to determine the risk factors for SSI in general surgical patients undergoing appendectomy and to estimate the incidence of SSI in the Indian subcontinent population. Materials And Methods: To find cross-sectional, cohort, Rct’s, and observational studies reporting SSI incidence or prevalence, a systematic review was conducted using PUBMED, MEDLINE, EMBASE, and the Cochrane Library. Excluded were studies with fewer than 40 participants. Two review authors worked independently to extract the data and evaluate its quality. The cumulative incidence of SSI occurring up to 30 days postoperatively was the main outcome. Random effects models were applied when there was a significant amount of heterogeneity. Subgroup and sensitivity analyses of meta-regression were employed to investigate the sources of heterogeneity. Results: 18 studies were included out of the 231 publications retrieved. The meta-analysis included 18 studies covering three countries and 4924 patients. The cumulative incidence of SSI was 5.25% (95% CI 0.4-16.2). There were no data on prevalence identified. SSI rates varied depending on a geographical location, surgical approach, and priority (planned or emergency). A multivariable meta-regression revealed a significant correlation between appendectomy and incidence of SSI (estimate 2.2, 95% CI 1.11-2.42, P =0.019). Conclusion: This systematic review and meta-analysis, which revealed a significant prevalence of SSI following appendectomy is 5.25 per 100 appendectomies. These findings imply that a lower incidence of SSI following appendectomy is linked to less invasive procedures. To reduce the harm caused by SSI, high-quality studies are needed to better understand the patient and associated risk factors.

Introduction: Leprosy is a leading cause of physical disability due to weakness of muscles and loss of sensation. Due to the difference in immune response in the various forms of leprosy, Langerhans cells (antigen presenting cells) in the skin show a graded number in the various forms of leprosy patients. Materials and methods: a total of 44 cases were considered analysed by categorising according to Ridley and Joplin criteria. Paraffin blocks sections were stained with CD1A antibody using green coloured chromosen. Immuno - histochemistry studies where done using UltraVision LP detection system made by ThermoFisher Scientific. The number of epidermal, dermal and hair follicle Langerhans cells were counted. Result: There was no statistical significance between leprosy types on comparing with the dermal LC score. Whereas Mean value of epidermal LC score was significantly less in lepromatous leprosy (LL) (1.78) and was gradually increasing from borderline lepromatous type (BL) (2.44), borderline tuberculoid type(BT) (5.25) to tuberculoid leprosy (TT) (5.50). There was a statistically significant difference in number of Langerhan cells between BL and BT and between LL and TT (p=0.000). Conclusion: Progressive reduction in the number of Langerhans cells from tuberculoid subtype to lepromatous subtype was noted. Atrophy, epitheloid cells, giant cells, and nerve changes was seen more in tuberculoid pole than lepromatous pole. There is a statistically difference in the number of Langerhans cells between BL and BT and between LL and LT.

Introduction: Liver cirrhosis is often associated with altered thyroid function, which may reflect the severity of liver dysfunction. Understanding this relationship can help in predicting disease progression and prognosis in cirrhotic patients. The aim of this study was to demonstrate the relationship between thyroid function tests and the severity of liver function in cirrhosis of the liver. Method: A total of 73 patients diagnosed with cirrhosis of liver based on clinical, biochemical, and radiological findings were included. Results: Majority of the patients belonged to the age group of 41-59 years (63%) with male predominance (79.4%). Alcoholism (84.9%) emerged as the leading cause of liver cirrhosis. Fatigue (73.9%), body ache (57.5%), and dysphagia (54.7%) were the most common clinical symptoms linked to thyroid dysfunction. Using the Child-Pugh classification system, 15 patients were categorized as Child A, 37 as Child B, and 21 as Child C. Hypothyroidism (65.7%) was more prevalent than hyperthyroidism among the patients. Significant correlations were found between T3, FT3, and TSH levels and the severity of liver dysfunction, as classified by the Child-Pugh score (p<0.05). Hepatic encephalopathy (42.85%) was the main complication causing mortality, and all fatal cases (7) had abnormal thyroid profiles. Conclusion: In conclusion, altered T3, FT3, and TSH levels were associated with disease progression in cirrhosis and can serve as valuable indicators for prognosis. These findings suggest that thyroid function tests should be considered in evaluating the severity of liver disease progression and outcome of cirrhosis in affected patients.

Introduction: Hypoxic-ischemic encephalopathy (HIE), a consequence of perinatal asphyxia, is a major cause of pediatric mortality and morbidity, often leading to neurological conditions like cerebral palsy, mental retardation, and epilepsy. This study aimed to assess the presence or absence of a lactate peak on MR spectroscopy (MRS) in relation to HIE severity and neurodevelopmental outcomes in asphyxiated neonates. Objectives: To examine the trend of brain lactate peaks in asphyxiated neonates over the first 3 months and its relationship with neurodevelopmental outcomes at 6 months. The study also sought to determine the correlation between HIE severity at birth and brain lactate peaks observed on MRS. Methods: This prospective observational clinical study was conducted at Dr. S. N. Medical College, Jodhpur, India, in the Department of Pediatrics and Radiology, following IEC approval. The study spanned December 2020 to May 2021. A total of 89 full-term neonates with clinical HIE were stabilized and underwent MRI with MRS. Repeat MRI/MRS was performed after 4-6 weeks if a lactate peak was initially present. Neurodevelopmental outcomes were assessed using the Hammersmith Infant Neurological Examination (HINE) score at 6-7 months. Results: Of the 89 neonates, 49 (55.1%) showed a lactate peak on the first MRS. Follow-up MRS at a mean age of 67.41±7.91 days showed persistent lactate peaks in 12 (31.5%) of these neonates. In total, 79 neonates completed neurodevelopmental follow-up; 22 (53.65%) with an initial lactate peak exhibited developmental delays. Conclusion: Lactate detected on neonatal MRS often persists until 2-3 months in asphyxiated neonates, correlating with poor neurodevelopmental outcomes, growth, and head circumference. Routine MRS alongside MRI is recommended for all asphyxiated neonates to assess and monitor lactate levels.

Introduction: Acute myocardial infarction (MI) is the leading cause of death in globally. Electrocardiogram (ECG) is a pivotal tool for risk stratification due to its affordability, non-invasiveness, and rapid results. The Tpeak-Tend interval shows how repolarization propagates throughout the myocardium and has been linked to dangerous ventricular arrhythmias and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Objective: To study the role of Tpeak-Tend/QT interval ratio as a predicator of in-hospital MACE in patients with STEMI. Methodology: This cross-sectional study was conducted at a tertiary care hospital between September 2022 and February 2024. A total of 87 patients were enrolled, of which 79 patients with STEMI presentation who met the inclusion criteria were included. Further the Tpeak-Tend/QT ratio was calculated, those with Tpeak-Tend/QT ratio < 0.3 were grouped as Group A (n=32), and those with ratio > 0.3 were in group B (n=47) Results: Out of 79 patients in this study, male gender was predominant, in group A, 23 of 32 patients and in group B, 32 of 47 patients were male. The most common age group noted in Group A was 60-70 years and in group B it was 50-60 years. Chest discomfort was the most common presenting symptom in 27 out of 32 patients in group A and 44 out of 47 patients in group B. Further in these patients the occurrence of in-hospital MACE was analysed, it was observed that the commonest MACE was heart failure, seen in 4 of 32 patients in group A and 16 of 47 patients in group B. Conclusion: The study showed a statistically significant correlation (P value = 0.03) between the incidence of in-hospital MACE in STEMI patients and a high Tpeak-Tend/QT ratio (>0.3). Hence Tpeak-Tend/QT ratio > 0.3 on a 12-lead ECG is a non-invasive and dependable predictor of MACE.

Background: The myocardial performance index (MPI) can assist in the non-invasive diagnosis of coronary artery disease (CAD) in patients selected for further management. However, there is limited data on MPI in patients with Acute Coronary Syndrome (ACS), and its relationship with the severity of coronary atherosclerosis in this group remains unclear. This study aims to determine whether MPI can predict the angiographic severity of CAD and to evaluate its association with both systolic and diastolic dysfunction in patients with ACS. Methods: This Hospital Based Analytical Prospective cross-sectional study included a total 155 patients with acute coronary syndrome from December 2022 to May 2024 who underwent coronary angiography. Echocardiography evaluation of Myocardial Performance Index was done by using Pulse wave Doppler evaluation. Angiographic severity was done through Gensini scoring system. The ROC curves were constructed. It was deemed statistically significant when p< 0.001) between the Myocardial Performance Index (MPI) and the Gensini scoring system in the patients with Acute Coronary Syndrome.  Results: In this study, patients were categorized based on low, mid, and high Syntax and Gensini scores. The MPI (Tei Index) exhibited statistically significant positive correlation with the Gensini score. Conclusion: Echocardiographic assessment of the Myocardial Performance Index (MPI) in patients with acute coronary syndrome can serve as a valuable surrogate marker for the detection of severity of coronary artery disease. It also has the potential to predict the complexity of coronary artery disease and guide the necessary interventions.

Background: Age-related cataracts are a leading cause of visual impairment worldwide, with multiple risk factors contributing to their development. Emerging evidence suggests a possible link between oxidative stress-related biomarkers, such as serum uric acid, and cataract formation. Elevated uric acid levels, often associated with systemic oxidative stress, may influence lens opacity, but this association remains underexplored. Objective: This observational study investigates the association between serum uric acid levels and age-related cataract formation, aiming to assess serum uric acid as a potential risk factor for cataracts. Methods: A sample of 100 participants (mean age: 65.3 ± 8.4 years; 45% male, 55% female) was recruited. Participants were grouped into four age categories (50-59, 60-69, 70-79, and 80+). Serum uric acid levels were measured, and cataract presence was documented. Correlation and logistic regression analyses assessed the association between serum uric acid levels, age, and cataract presence. Results: Cataract prevalence was 58%, increasing by age group: 32% (50-59 years), 60% (60-69 years), 72% (70-79 years), and 80% (80+ years). Participants with cataracts had higher mean serum uric acid levels (6.1 ± 1.3 mg/dL) compared to those without (5.4 ± 1.4 mg/dL, p < 0.05). Correlation analysis indicated a moderate positive association between serum uric acid and cataract formation (r = 0.42, p < 0.05). Logistic regression showed each 1 mg/dL increase in uric acid increased cataract risk by 1.2-fold (OR = 1.2, 95% CI: 1.1–1.5, p < 0.05). Conclusion: Elevated serum uric acid levels are significantly associated with age-related cataract formation, highlighting its potential role in cataract risk. Further studies are recommended to explore interventions targeting uric acid reduction

Introduction: Iron deficiency anemia (IDA) is a major public health issue, particularly in developing countries like India, where malnutrition and limited access to healthcare exacerbate the problem. In the Sub-Himalayan region, the coexistence of IDA with deficiencies in Vitamin B12 and folic acid poses an additional challenge to healthcare providers. This study focuses on the prevalence of these combined deficiencies and aims to shed light on the complex interplay between iron, Vitamin B12, and folic acid metabolism in anemia. Aims: To assess the prevalence of iron deficiency anemia among patients in a tertiary care hospital in the Sub-Himalayan region Materials and Methods: This is a cross-sectional observational study conducted at a tertiary care hospital in the Sub-Himalayan region of India. The study was carried out over a period of 1 year, focusing on patients diagnosed with anemia.100 Patients were included in this study.  Result: In our study, 5 (5.0%) patients had Normal Range, 13 (13.0%) patients had Mild Deficiency, 15 (15.0%) patients had Moderate Deficiency and 67 (67.0%) patients had Severe Deficiency. The value of z is 9.1335. The value of p is < .00001. The result is significant at p < .05. In our study, 1 (1.0%) patient had Alfa thalassemia trait, 1 (1.0%) patient had Beta thalassemia trait, 1 (1.0%) patient had HbE carrier, 7 (7.0%) patients had HbE disease, 14 (14.0%) patients had HbE trait and 76 (76.0%) patients had Normal Pattern in HPLC. Conclusion: This study demonstrates a strong correlation between iron deficiency anemia and deficiencies in Vitamin B12 and folic acid in the Sub-Himalayan region of India. The coexistence of these deficiencies complicates the management of anemia and necessitates a more comprehensive diagnostic approach. The findings underline the need for nutritional interventions and public health strategies to address these deficiencies in resource-limited settings.

Introduction: Hypoxic-ischemic encephalopathy (HIE), a consequence of perinatal asphyxia, is a major cause of pediatric mortality and morbidity, often leading to neurological conditions like cerebral palsy, mental retardation, and epilepsy. This study aimed to assess the presence or absence of a lactate peak on MR spectroscopy (MRS) in relation to HIE severity and neurodevelopmental outcomes in asphyxiated neonates. Objectives: To examine the trend of brain lactate peaks in asphyxiated neonates over the first 3 months and its relationship with neurodevelopmental outcomes at 6 months. The study also sought to determine the correlation between HIE severity at birth and brain lactate peaks observed on MRS. Methods: This prospective observational clinical study was conducted at Dr. S. N. Medical College, Jodhpur, India, in the Department of Pediatrics and Radiology, following IEC approval. The study spanned December 2020 to May 2021. A total of 89 full-term neonates with clinical HIE were stabilized and underwent MRI with MRS. Repeat MRI/MRS was performed after 4-6 weeks if a lactate peak was initially present. Neurodevelopmental outcomes were assessed using the Hammersmith Infant Neurological Examination (HINE) score at 6-7 months. Results: Of the 89 neonates, 49 (55.1%) showed a lactate peak on the first MRS. Follow-up MRS at a mean age of 67.41±7.91 days showed persistent lactate peaks in 12 (31.5%) of these neonates. In total, 79 neonates completed neurodevelopmental follow-up; 22 (53.65%) with an initial lactate peak exhibited developmental delays. Conclusion: Lactate detected on neonatal MRS often persists until 2-3 months in asphyxiated neonates, correlating with poor neurodevelopmental outcomes, growth, and head circumference. Routine MRS alongside MRI is recommended for all asphyxiated neonates to assess and monitor lactate levels.

Background: Over the past fifty years, significant lifestyle and environmental changes have led to an increase in metabolic syndrome (MetS), a cluster of metabolic risk factors including hypertension, central obesity, impaired glucose tolerance, low HDL, and elevated triglycerides. MetS has been shown to negatively impact reproductive health and fertility. Obesity, a common component of MetS, is associated with hormonal imbalances and ovulatory dysfunction, potentially leading to diminished ovarian reserve and reproductive challenges. This study investigates the prevalence of MetS among infertile women with diminished ovarian reserve and explores correlations between MetS components and reproductive outcomes. Method: A cross-sectional observational study was conducted from January to December 2023 in the Department of Medicine at MGM College and MY Hospital, Indore. The study involved 298 women aged 20–40 years with primary infertility, recruited through the endocrine and infertility OPDs. Data collection included demographic and clinical information, medical history, laboratory investigations, and sonographic ovarian reserve assessments. The modified Asian NCEP ATP III criteria were applied to define MetS, and statistical analysis was performed using SPSS-25, with a p-value < 0.05 considered significant. Results: Among the participants, 36.9% (n=110) had metabolic syndrome. Elevated waist circumference (≥80 cm) was found in 70.1%, while 64.1% had high fasting triglycerides (≥150 mg/dL). Obesity (BMI ≥ 25 kg/m²) was observed in 52.7% of women. A significant association was noted between MetS components, particularly BMI and waist circumference, and primary infertility in women with diminished ovarian reserve.  Conclusion: This study reveals a high prevalence of metabolic syndrome (36.9%) in women with primary infertility, highlighting the significant impact of obesity and metabolic risk factors on reproductive health. Lifestyle modifications targeting metabolic syndrome components could potentially enhance reproductive outcomes. Early identification and management of modifiable risk factors may improve fertility outcomes in women with MetS.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver conditions characterized by excess fat accumulation in the liver, occurring in individuals with minimal or no alcohol consumption. It has become a major global health concern due to its increasing prevalence, particularly in conjunction with metabolic disorders like type 2 diabetes mellitus (T2DM). NAFLD encompasses a range of liver pathologies from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and hepatocellular carcinoma. Aims: To study nonalcoholic fatty liver disease in type 2 diabetes mellitus patients. To study the correlation between glycemic control (FBS) and duration of diabetes with ALT/SGPT levels. Materials & methods: For eighteen months beginning in July 2022 and ending in December 2023, researchers from Katihar Medical College and Hospital in Katihar carried out this cross-sectional study. Study population 100.v Result: Out of the 60 people who tested positive for NAFLD, 30 had cholesterol levels below 150 mg/dl, 17 had levels between 150 and 199 mg/dl, and 13 had values of 200 mg/dl or more. Among the 40 people who tested negative for NAFLD, 33 had levels below 150 mg/dl, 6 had levels between 150 and 199 mg/dl, and 1 had levels of 200 mg/dl or more. A statistically significant link between increased cholesterol levels and the existence of NAFLD was indicated by the Chi- square test, which generated a value of 12.17650 with a P value of 0.002. Conclusion: NAFLD affects 60% of diabetics, with the highest incidence in women aged 41-50. Obesity and elevated Alanine Aminotransferase levels significantly influence NAFLD risk. Regular testing and targeted therapies for weight and metabolism control are recommended to reduce NAFLD severity.

Objective: This study is aimed to assess the coronary sinus blood flow by transthoracic echocardiography in acute MI patients undergoing coronary angiography and comparing the coronary sinus flow pre and post percutaneous coronary intervention. Methods: The present hospital based prospective cross sectional descriptive study was conducted at KAHER University Hospital, Belgaum from January 2023 to June 2024 among 150 adult patients with acute coronary syndrome. Details on demographics, patient characteristics, laboratory parameters were recorded. Echocardiography parameters taken on admission were compared with the parameters post thrombolysis and post revascularization and was correlated with the severity of CAD and the success of revascularization Result: most of the patients were males. The patient population has a mean age of 60 years with a standard deviation of 11.29 years. The average Body Mass Index (BMI) is 27.61, suggesting that the population is, on average, slightly overweight, with a standard deviation of 4.68. The average diameter of the coronary sinus (CS) is 0.85 cm, with a standard deviation of 0.2 cm. Coronary Sinus Blood Flow (CSBF) per beat has a mean of 3.03 mL, with a standard deviation of 1.52 ml. On admission, the mean CSBF per minute is 218.63 mL, with a standard deviation of 93.64 mL. After Percutaneous Coronary Intervention (PCI), the mean CSBF significantly increases to 372.05 mL per minute, with a standard deviation of 126.15 ml, reflecting the effectiveness of PCI in improving coronary blood flow in this patient group. Overall, these results demonstrate that PCI significantly improves coronary blood flow in patients across all these categories, with the most substantial increases observed in those with STEMI-AWMI in the current study. Conclusion: Non-invasive evaluation of CSBF using transthoracic echocardiography is technically feasible in all patients undergoing PCI.It is a potentially simple, repeatable, cost-effective, non-cumbersome imaging modality for the assessment of CSBF in patients with CAD, and especially for those with AWMI. It can also be used to assess the effectiveness of treatment in patients with CAD. Results reflect hemodynamically significant changes in total coronary blood flow.

In the first part of this study the Schneider (S), Weine (W), and Long-Axis (LA) techniques are used for comparing the measurement of canal curvature. One hundred mandibular first and second molar teeth were selected. Radiographs were taken after inserting size 10 K-files into the mesiobuccal root canals. The radiographic findings were digitized on a computer, and the three different curvature angles were measured from drawings of the same root canal and compared statistically. ANOVA showed that there were significant differences between the curvature angle values determined using each technique (p  0.001). In the second part of this study the term “canal access angle” (CAA) was introduced and it was defined by examining the morphology of canal curvature. Canal length, curvature distance (y), curvature height (x), Schneider angle, and the newly defined CAA were evaluated statistically. Using a multiple regression analysis, the CAA was significantly related to x (p  0.001) and y (p  0.005). There was a positive correlation (r 0.74) between the CAA and curvature height (x). The results indicated that the CAA is a more effective way of evaluating the root canal curvature

Background: Diabetes is increasingly prevalent in India, with over 62 million diagnosed cases. Studies suggest a complex interaction between diabetes and thyroid disorders, impacting glucose tolerance and insulin sensitivity. This study aimed to investigate the prevalence and types of thyroid dysfunction among type 2 diabetes mellitus (T2DM) patients in India, given limited data on the subject. Methods: This cross-sectional study was conducted at the Sri Aurobindo Institute of Medical College over 18 months, from September 2022 to February 2024. A sample of 130 patients with T2DM was recruited, excluding individuals with a known history of thyroid dysfunction or those on medications affecting thyroid function. Patients underwent clinical assessments and laboratory investigations for fasting blood sugar, postprandial blood sugar, HbA1c, and thyroid profiles. Thyroid dysfunction was categorized as hypothyroidism, hyperthyroidism, subclinical hypothyroidism, or euthyroid. Results: Among the 130 T2DM patients, 85.4% exhibited normal thyroid function, while 14.6% displayed thyroid abnormalities. Subclinical hypothyroidism was the most common (7.7%), followed by hypothyroidism (5.4%) and hyperthyroidism (1.5%). Thyroid dysfunction was more prevalent among female patients, who constituted 70.8% of the sample. A significant correlation was observed between blood glucose levels (fasting and postprandial), HbA1c, and TSH levels (p<0.05), though perfect correlations indicated potential data inconsistencies. Conclusion: Thyroid disorders, especially subclinical hypothyroidism, are relatively common in individuals with T2DM, particularly among women. The presence of thyroid dysfunction correlates with poor glycemic control, suggesting a need for routine thyroid screening in diabetic patients to enable early intervention and improve metabolic outcomes.

Background: Endothelial dysfunction marks the initial phase of atherosclerosis, a condition that leads to the thickening and stiffening of arterial walls, particularly in the aorta. This increased arterial wall thickness and stiffness result in higher arterial resistance, subsequently reducing the aortic propagation velocity (APV). This study aims to explore the relationship between APV, a relatively under-researched echocardiographic parameter, and the presence and severity of coronary artery disease (CAD) in patients experiencing acute coronary syndrome (ACS). The study is aimed.  Objective:  To assess the aortic propagation velocity and correlate it with the severity of cad using syntax score in patients presenting with acute coronary syndrome. Methods: A prospective observational study conducted in Department of Cardiology of Jawaharlal Nehru Medical College, KAHER, Belgaum between January 2O23 to December 2O23. Patients with confirmed ACS diagnosis according to fourth universal definition of acute myocardial infraction were eligible to participate in the study.  Result: A total of 292 study participants were included in this study. Among the 292 study participants, 49.7% (n=145) were in the CAD group and 5O.3% (n=147) were in the non-CAD group. The mean age of the study participants was 57.27 ± 13.4O years. Among study participants, 68.97% were male and 31.O3% were female. The mean ejection fraction in CAD and Non-CAD groups were 49 ±9.94 and 58.O6 ±6.86 respectively. The mean SYNTAX scores I of study participants in CAD group was 18.42 ±13.15. The mean SYNTAX score II PCI and SYNTAX score II CABG were 34.78 ±13.75 and 25.7 ±13.O2 respectively.  The mean AVP average in CAD group and non-CAD group were 44.32 ±33.93 and95.8 ±34.15 respectively. The prevalence of diabetes and hypertension among the study participants in CAD group were 6O.69% and 45.52% respectively. Prevalence of substance abuse like smoking, tobacco and alcohol were present in 41.38%, 46.21% and 33.1% respectively. Chest pain, dyspnoea, palpitations, and syncope were present in 89.66%, 49.66%, 1.38% and 1.38% of study participants respectively. Positive correlation of AVP was present in variables like SYNTAX Score I (p<O.O5), SYNTAX Score II CABG (p<O.O5), SYNTAX Score II PCI (p<O.O5), HbA1c (p<O.O5) and age (p<O.O5). The prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) among the study participants in CAD group were 4O.69%, 2O.69% and 38.62% respectively. The ROC curve shows 84.8% of sensitivity and 1OO% of specificity in predicting CAD by APV value. The area under the curve was O.912 (p<O.O5). Conclusion: The study showed that APV can significantly predict the CAD. This technique offers a practical, non-invasive, and cost-effective echocardiographic approach for detecting or screening coronary artery disease (CAD). It may also prove useful in assessing comorbidities associated with CAD, aiding in risk stratification, and identifying individuals at high risk for CAD. Given its predictive accuracy and potential clinical utility, APV could be integrated into routine cardiovascular assessments, particularly for patients presenting with symptoms like chest pain or those with significant risk factors. However, the study underscores the need for further large-scale, multicenter studies to validate APV’s effectiveness and confirm its applicability as a screening tool for CAD in broader populations. These future studies would help refine APV's role in clinical practice and enhance its value in preventing and managing coronary artery disease.

Background: An understanding of musculoskeletal anatomy is crucial for medical students as it underpins effective diagnosis and management of various clinical conditions. Despite its importance, many students lack sufficient knowledge, potentially leading to diagnostic errors. This study assesses the knowledge and awareness of musculoskeletal anatomy among medical students across multiple institutions to identify gaps and propose improvements. Materials and Methods: A multi-institutional, cross-sectional study involving 500 students from five institutions was conducted. A validated questionnaire, consisting of a 50-item multiple-choice test and a Likert scale survey, evaluated knowledge and self-perceived confidence across pre-clinical, clinical, and postgraduate levels. Data were analyzed using SPSS, including chi-square tests, ANOVA, and Pearson correlation. Results: The study demonstrated a progression in knowledge scores across academic levels, with mean scores increasing from 24.7 in pre-clinical students to 38.6 in postgraduate students. There were significant differences in performance between institutions, with variations linked to the use of different teaching methodologies. Mixed methods, combining cadaveric dissection, digital simulations, and clinical integration, yielded the highest mean score of 37.2. The correlation between self-perceived confidence and actual knowledge was moderate to strong (r = 0.54 overall), with confidence increasing alongside academic progression. Conclusion: The study highlights gaps in early anatomy education and inconsistencies across institutions. A multi-modal, integrated approach is recommended for enhancing student proficiency, providing essential insights for optimizing anatomy curricula.

Background: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality worldwide. Risk stratification in acute coronary syndrome (ACS) plays a crucial role in predicting patient outcomes and guiding therapeutic decisions. The GRACE (Global Registry of Acute Coronary Events) and SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) scores are two well-established tools for evaluating risk in ACS patients, but their correlation has not been fully explored. Objective: This study aims to evaluate the correlation between the GRACE risk score and the SYNTAX score in patients with ACS, and to assess the predictive ability of these scores in guiding clinical decisions, particularly in revascularization strategies. Methods: A prospective observational study was conducted in the Cardiology Department of Jawaharlal Nehru Medical College, Belagavi, from January 2023 to June 2024. A total of 249 ACS patients were enrolled. The GRACE risk score was calculated for each patient based on clinical parameters, while the SYNTAX score was determined through coronary angiography. The correlation between the two scores was assessed, and their ability to predict the severity of CAD and guide treatment strategies was evaluated. Results: The mean age of the participants was 60.02 ± 10.99 years, with the majority of patients aged between 46 and 65 years. The study revealed a significant correlation between the GRACE risk score and the SYNTAX score. A higher GRACE score was associated with more severe coronary artery disease, as reflected by higher SYNTAX scores. The ROC analysis demonstrated that the GRACE score had a predictive capacity for severe CAD (SYNTAX score ≥32) with an area under the curve of 0.696 (p=0.001). Additionally, the study found that the combination of GRACE and SYNTAX scores provided a more accurate stratification of patients for revascularization procedures. Conclusion: The GRACE risk score and SYNTAX score are significantly correlated in patients with ACS and can complement each other in guiding clinical decision-making. This combined risk assessment approach is valuable for identifying high-risk patients and determining the most appropriate revascularization strategy. Further research is needed to refine these tools and explore their potential in personalized medicine for ACS patients.

Heart failure (HF) is a significant cardiovascular condition associated with high morbidity and mortality. Iron deficiency is prevalent among HF patients and has been linked to worsened outcomes. Recent studies suggest that correcting iron deficiency may enhance functional capacity and reduce hospitalizations. Additionally, red cell distribution width (RDW) has emerged as a cost-effective prognostic marker in HF. This study aims to explore the relationship between iron parameters—including serum ferritin, total iron-binding capacity (TIBC), and RDW—and the severity of heart failure in patients diagnosed with heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).  Material and Methods: A cross-sectional study was conducted at a tertiary care center, enrolling 180 adult patients diagnosed with heart failure through echocardiography. Data on demographics, clinical history, symptoms, and iron profiles (serum iron, ferritin, TIBC, and RDW) were collected. The severity of heart failure was classified using the New York Heart Association (NYHA) criteria. Statistical analysis was performed using SPSS version 21.0, with descriptive statistics, ANOVA, and Student’s ttests applied to assess significant differences.  Results: The cohort had a mean age of 58.36 years, with 62.8% diagnosed with HFrEF. Serum iron, ferritin, and TIBC levels significantly decreased with increasing severity of HF (p < 0.05). RDW exhibited a notable upward trend correlating with NYHA classification (p < 0.001). There were no significant differences in TIBC and unsaturated iron-binding capacity across severity levels. A significant negative correlation was observed between patient age and RDW (r = -0.316, p < 0.003).  Conclusion: The findings highlight that heart failure is associated with significant alterations in serum iron parameters, especially as HF severity increases. RDW serves as an effective and economical prognostic marker, suggesting that screening for iron deficiency in HF patients may improve clinical outcomes and reduce rehospitalization rates.

Background: Cigarette smoking is a leading cause of preventable respiratory morbidity and mortality. Small airway obstruction is an early manifestation of smoking-related lung damage and often precedes overt airflow limitation detectable by spirometry. Impulse Oscillometry (IOS) is a noninvasive tool that measures respiratory mechanics and offers potential advantages in detecting early small airway dysfunction in smokers. Methods: A cross-sectional observational study was conducted in the Department of Respiratory Medicine, SAIMS PGI, involving 96 smokers aged 18–60 years with a smoking history of ≥10 pack-years. Participants underwent detailed clinical evaluation, spirometry, and IOS testing. IOS parameters, including resistance at 5 Hz (R5), resistance at 20 Hz (R20), reactance at 5 Hz (X5), and R5–R20, were analyzed and compared with spirometry parameters such as FEV₁ and FVC. Statistical analysis evaluated the correlation between smoking intensity (pack-years) and airway obstruction. Results: The study included 96 smokers (mean age 55.2 ± 10.4 years; 70 males, 26 females) with an average smoking history of 30.5 ± 15.6 pack-years. IOS detected significant increases in R5 (6.2 ± 1.5 cm H2O/L/s) and R20 (4.5 ± 1.0 cm H2O/L/s), along with a decrease in X5 (-0.5 ± 0.4 cm H2O/L/s) compared to normal ranges (p < 0.001). These abnormalities were observed even in smokers with normal spirometry. Correlation analysis revealed a significant association between pack-years and IOS parameters (p < 0.05). Conclusion: Impulse Oscillometry is a sensitive and noninvasive tool for early detection of small airway obstruction in smokers. By detecting changes undetectable by spirometry, IOS offers potential for earlier diagnosis and intervention, reducing the risk of progression to chronic obstructive pulmonary disease.

Background: Acute coronary syndromes (ACS) are the primary cause of death worldwide and includes Unstable angina (UA), Non-ST segment elevation (NSTEMI) and ST segment elevation myocardial infarction (STEMI). The standard diagnostic test for ACS is currently troponins. Increased levels of Gamma glutamyl transferase (GGT) may indicate the oxidative stress inside the coronaries which further increases the atherosclerotic plaque formation. Assessing GGT levels in relation to the severity of ACS and its association with major adverse cardiovascular events (MACE) is the current goal. Methodology: 80 participants with ACS who were more than 18 years old participated in the current cross-sectional study, which was conducted in a tertiary hospital between December 2023 and August 2024. Hepatobiliary diseases, drug consumption such as barbiturates, phenytoin, and anti-tubercular medications, and history of alcohol intake in less than 24 hours were the exclusion criteria. Physical examination along with electrocardiography (ECG), a complete blood count, renal and hepatic function tests, GGT, troponin-I were done. Additional testing was performed, including coronary angiography (CAG) and echocardiography. A two-tailed approach was used for all statistical tests, and a p-value of less than 0.05 was considered statistically significant.  Results: The study consisted of sample size of 80 with 52(65%) males and 28(35%) females. Majority (61.25%) of the people at presentation had at-least one of the comorbidities. Majority (56.25%) of the people had no risk factors at the time of presentation. The mean, median and standard deviation of GGT were 78.3IU/L, 68IU/L and 45.592IU/L respectively. The study consisted mainly of STEMI patients i.e., 49 (61.3%) followed by NSTEMI (25%) and UA (13.8%). Majority of the people with STEMI had serum GGT levels more than 70IU/L. The major adverse cardiovascular outcomes were found in 8 patients (10%). The majority of the people with MACE had serum GGT levels above 70IU/L. Death (37.5%) was the predominant MACE among them. The study showed significant correlation of GGT values with both CAG and troponin-I levels. Serum GGT and ACS were shown to be significantly correlated in the study with p-value of 0.005. A substantial correlation between serum GGT and MACE was also discovered in the current investigation, with a p-value of 0.02. Conclusion: We observed significant correlation with ACS severity and GGT levels along with the association between serum GGT and MACE. Increment of GGT levels in UA in this trial may also help with the early start of therapy and serve as a predictor for future difficulties. GGT is therefore a useful and affordable marker for ACS severity prediction, early therapy initiation and to predict MACE during the hospital stay.

Background: Inadequate postoperative pain management remains a significant challenge, negatively impacting patient outcomes and satisfaction. Preoperative patient education has emerged as a potential strategy to improve postoperative pain management outcomes. Objective: To investigate the impact of a structured preoperative patient education program on postoperative pain intensity, analgesic consumption, patient satisfaction, and functional recovery in adult patients undergoing elective surgery. Methods: A prospective, single-center, randomized controlled trial was conducted with 120 adult patients undergoing elective surgery. Participants were randomly allocated to either the intervention group, receiving a structured preoperative patient education program, or the control group, receiving standard care. Outcomes were assessed at 24, 48, and 72 hours after surgery. Results: The intervention group had significantly lower postoperative pain intensity scores at 24 hours (3.8 ± 1.6 vs. 4.9 ± 1.8; p=0.001), 48 hours (2.5 ± 1.3 vs. 3.7 ± 1.5; p<0.001), and 72 hours (1.6 ± 1.0 vs. 2.8 ± 1.2; p<0.001) compared to the control group. Analgesic consumption was significantly lower in the intervention group at all time points (p<0.001). The proportion of patients "very satisfied" with pain management was significantly higher in the intervention group (46.7% vs. 25.0%; p=0.03). Functional recovery scores were significantly higher in the intervention group at all time points (p<0.001). Conclusion: A structured preoperative patient education program significantly reduces postoperative pain intensity and analgesic consumption while improving patient satisfaction and functional recovery compared to standard care in adult patients undergoing elective surgery.

Introduction: The gonial angle of the mandible is the angle formed between the ramus line and the mandibular line where the ramus line is a tangent to the posterior border of the mandible and the mandibular line is the lower border of the mandible through the gnathion. It is also known as the anatomical angle of the mandible. This angle should not be confused with the medico-legal angle of the mandible. Alterations in this angle have been noted when compared with age, sex, and dental status of a person. Aim: To derive the relation between the angle of the mandible and the sex, age, and dental status of an individual. Methodology: A total of 105 subjects have been included in the study and have been divided into five groups on the basis of chronological age. The data is analyzed by physico-forensic anthropometry. The gonial angle was measured by the scale of a protractor and the angle was recorded in degrees. Results: The gonial angle is found to be varying with the type of dentition and also with age and sex. The present study shows a significant decrease in the gonial angle (127.9375 to 113.8235 in females and 120.2222 to 115.8333 in males) with age but is found to be increasing in certain cases. Those certain cases include edentulous people (130). The average measure of the angle is more in females (121.3509) as compared to males (120.125). With the loss of teeth, the bone undergoes remodelling and consequently, an increase in size is seen. Conclusion: The present study concludes that the gonial angle of the mandible can serve as a forensic parameter and scientific growth scale, which guides for age, sex, and dental status assessment. Also, it is considered to be an important parameter while dealing with class 2 and class 3 malocclusion.

Background: Ultrasonography is a non-invasive technique that provides reliable measurements of gallbladder dimensions, which are essential for assessing its structural integrity. Objective: To evaluate the normal dimensions of the gallbladder in healthy adults in Jalpaiguri, India, using ultrasonography, and to establish reference values based on age, sex, and body mass index (BMI). Method: A cross-sectional study was conducted from June 2023 to June 2024 at Jalpaiguri Government Medical College, Jalpaiguri. A total of 100 healthy adults (50 males and 50 females) were enrolled. Gallbladder length, width, and wall thickness were measured using ultrasonography. Correlations between gallbladder dimensions and demographic factors such as age, sex, and BMI were analyzed. Result: The average gallbladder length was 7.3 cm (±1.2 cm), width was 3.8 cm (±0.6 cm), and wall thickness was 2.3 mm (±0.4 mm). No significant difference was observed between males and females in terms of gallbladder dimensions. A positive correlation was found between BMI and gallbladder dimensions, with obese individuals presenting larger gallbladders. Gallbladder length was slightly higher in individuals aged 40 and above, constituting 35% of the study population. The largest gallbladder measurements were observed in the 35-45 age group, with an average length of 8.2 cm. Conclusion: This study provides normative data for gallbladder dimensions in the Indian population, emphasizing the need for population-specific reference ranges for accurate diagnosis of gallbladder-related conditions.