Background: The second most common cancer and the main cause of death from cancer worldwide is lung cancer. The stage of the cancer, mutation, and histological type all affect the prognosis and course of treatment. There is no adequate data about histological subtypes lung cancer in our area. The aim of this study is to evaluate the smoking status, histological subtypes, clinicoepidemiological profile, and interdependencies among those suffering from lung cancer. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India. From May 2, 2021, until May 7, 2022. Histopathologicaly confirmed lung cancer patients were studied. The data was collected by using a semi-structured proforma, and SPSS 20 was used for analysis. Results: The mean age of the patients (n=124) was 63.42 + 9.11 (SD) years. The common symptoms were cough (71.8%), breathlessness (62.9%), chest pain (35.5%), and loss of weight (31.5%). Among the patients 86.3% are males and 80.6% are smokers. Adenocarcinoma was the commonest histopathological subtype (45.9%) followed by squamous cell carcinoma (37.9%), small cell carcinoma (10.5%) and other neuroendocrine tumors (5.6%). Squamous cell carcinoma was the commonest subtype among males (42.1%) and smokers (44.6%). Adenocarcinoma remained commonest among females (82.3%) and non-smokers (87%). Cough was significantly higher in squamous cell and small cell carcinomas (p=0.04). Dyspnea remained the most prevalent symptom in adenocarcinoma (64.9%). Conclusion: Adenocarcinoma was the commonest subtype. Squamous cell carcinoma had higher prevalence among males and smokers; adenocarcinoma was higher among females and non-smokers. The commonest symptom was cough. Cough was significantly higher in squamous cell and small cell carcinomas. Dyspnoea was the most prevalent symptom in adenocarcinoma. Keywords: Lung cancer, Smoking, Adenocarcinoma, Squamous cell carcinoma, small cell carcinoma.

Background: Skin is the largest organ of the body and is constantly harmed by a variety of environmental factors resulting in various kinds of neoplastic and non-neoplastic skin lesions. Among the non-neoplastic skin lesions, infective skin lesions are very commonly encountered in India, possibly due to the hot and humid environment, and lack of general awareness regarding infectious diseases. Very few studies, if any, have been conducted in the Garhwal region regarding infective skin lesions. Hence, present study was carried out to determine the spectrum of infective skin lesions. Aim and Objective: Present study was carried out to understand the spectrum of various skin lesions in correlation with age, sex and type of clinical lesion at a tertiary care hospital in Garhwal region. Materials and Methods: Study Design: Non-interventional, cross-sectional, retrospective study was carried out from January 2022 to December 2023, on all skin biopsies diagnosed as infective skin lesions in the department of pathology, Veer Chandra Singh Garhwali institute of medical sciences and research irrespective of age and sex. Results: Out of the 63 cases studies, leprosy was the most common infective skin lesion followed by tubercular dermatoses. Male predominance was present, with the most commonly encountered age group being 41-50 years. Presence of a hypopigmented patch was the most common clinical finding. Conclusion: Leprosy was the most common infective skin lesion encountered in our study followed by tubercular dermatoses. Due to the wide range of clinical presentation in infective skin diseases, histopathological examination is necessary to make an accurate diagnosis. Keywords: Infective skin lesions, leprosy, tubercular dermatoses.

Introduction: The utilization of laparoscopy in managing abdominal trauma, either diagnostically or therapeutically, has been on the rise. However, its comparative outcomes with conventional laparotomy, especially concerning therapeutic management, remain unclear. Methods: This retrospective cohort study involved patients from trauma center of an Indian medical college. 78 patients who underwent laparoscopic interventions for abdominal trauma were included in the laparoscopy group (LP group). Another 78 patients who underwent laparotomy (LT group) were matched based on baseline characteristics, causes of injury, and hemodynamic parameters. Perioperative clinical parameters and short-term survival were compared between these two groups. Results: Baseline characteristics were similar between the LP and LT groups. The most common cause of trauma was traffic accidents, and the predominant surgical intervention was bowel repair/resection. Operation time did not significantly differ between the two groups, while the post-operative complication rate was slightly lower in the LP group without statistical significance. Opioid use was lower in the LP group compared to the LT group. Additionally, hospital stay was significantly shorter in the LP group. One patient in the LT group died due to an intra-abdominal abscess and multiple organ dysfunction syndrome 20 days postoperatively, whereas all patients in the LP group recovered and were discharged. Conclusion: Laparoscopy is deemed feasible and safe for treating hemodynamically stable abdominal trauma patients when performed by experienced surgeons. Laparoscopy appears to offer advantages such as reduced pain and quicker recovery while maintaining similarly favorable clinical outcomes compared to conventional laparotomy. Keywords: Abdominal trauma, hemodynamically stable, laparoscopy, laparotomy

Background: Cardiac troponins (cTn) are specific biomarkers of myocardial injury and have a well-established role in guiding the management of chest pain.5,6 An elevated troponin-I (cTnI) has also been associated with a poor prognosis in critical illness, pulmonary embolism, cardiac and non-cardiac surgery, stroke, and end-stage renal disease. Materials and Methods: This study was conducted in Department of Medicine in RBM Hospital & Shree Jagannath Pahadia Medical College, Bharatpur, Rajsthan. This cases control study was included 100 control and 250 cases. The duration of study was over a period of one year. Results: Among the 250 cases examined, 96 tested positive for Troponin-I, while the remaining cases tested negative. Among the Troponin-I positive cases, 64 were male and 32 were female, indicating a higher predominance of Troponin-I positivity among males. Significant differences (p < 0.01) were observed in these variables between the cases & control groups. Conclusion: The present study shows in the patients who developed chest pain due to cardiac event as confirmed by positive troponin-I test were having lipid parameters in the risk level as suggested by ATP III. Keywords: Troponin-I (cTnI), Myocardial injury, Biomarkers.

Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd’s ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. Keywords: Diabetes co-morbidity, Symptom score, treatment outcome.

Background: Medical undergraduates having lack of interpersonal skills may lead to severe deficiencies in health services. Currently these were not being trained or assessed at workplace for their behavior and communication skills during their medical curriculum. During this study, mini-CEX (mini clinical evaluation exercise) was used as a work place based assessment (WPBA) tool to assess the interpersonal skills of interns and providing them concurrent feedback. The aim of this study was to evaluate and improving the interpersonal skills of interns posted in orthopedic department during their rotatory internship while assessing the acceptability, feasibility and effectiveness of mini-CEX assessment as a tool. Materials and Methods: This prospective and interventional study was conducted in department of orthopedics of our hospital settings between July to November of 2022. The forty interns who participated in this study were on rotatory internship in our department and 06 volunteered faculty members were also included. The mini-CEX form as assessment tool structured by American Board of Internal Medicine was used in this study. Each intern undergone six rotatory assessment sessions, on mini-CEX forms with each of the faculty comprising a total of 240 sessions. Participants at the end of their internship submitted their perceptions on an anonymous validated questionnaire which contains both open ended and closed ended questions (Likert 5-point scale). Statistical Analysis: The descriptive data having frequencies were analyzed using Microsoft Excel software. Thematic analysis was used for qualitative data of open ended questions. Results: Most of interns (36/90%) and all included faculty members had shown that mini-CEX assessment tool has encouraged them and helpful in improving their communication skills. On comparison of their first through 6th encounters, interns had shown improvement in their mean min-CEX score for skill development and competencies with improvement in communication skills. This improvement was statistically significant. (p<0.05). Conclusion: Our study had shown that mini-CEX as WBPA too is an acceptable, effective as well as feasible method for assessing the interpersonal skills of interns in clinical settings. Keywords: interns, interpersonal, encounters, skills.

Background: To study the efficacy of teriparatide therapy in surgically corrected comminuted fractures. Materials and Methods: Prospective observational study was conducted in 50 patients of either gender who are skeletally mature presenting with comminuted fracture or nonunion after surgical correction, without comorbidities who are medically fit for taking the teriparatide are included in study. Results: One third of the patients belonged to the age group of 30-39 years and 40-49 years. 82% of the study population were males, 18% of them were females. 70% of the study population were injured on the right side, 30% of them were injured on the left side. 76% of the study population lower limbs were injured, 30% of them had injury on the upper limbs. 74% of the study population had Road Traffic Accident. 36% of the study population had fracture of femur. 6% of them had fracture of both tibia and fibula. 2% of them had fracture of both radius and ulna. Only one patient had fracture neck of humerus. 42% of the study population showed signs of radiological union after 3-4 months of drug administration, followed by within 3 months (30%), 5-6 months (20%). 92% of the study population had achieved complete radiological union at the end of one year follow up. 44% of the study population showed complete radiological union after 7-9 months of drug administration. Complete range of movements was achieved in 52% of the study population. The range of movements was increased in 40% of the study population. 8% of the study population had restricted movements at the end of the study period. 56% of the study population had experienced side effects. 52% of the study population had nausea, 28% of them had dizziness and 18% had hypercalcemia. Conclusion: The present study concluded that the efficacy of teriparatide in surgically treated comminuted fracture healing cases is 92%. The drug was tolerated well with minor side effects like nausea and dizziness. Keywords: Teriparatide, comminuted fracture, Radiological union.

Background: Acute appendicitis is one of the most frequent cause of pain abdomen. Acute Appendicitis can present as complicated or uncomplicated. Complication are abscess, gangrene, perforation. Most common cause of Appendicitis is luminal obstruction by appendicolith. Appendicolith is also known as faecolith/ stercolith/ coproliths is composed of faecal concretions or pellets, calcium phosphates, bacteria and epithelial debris and can lead to luminal obstruction followed by appendicitis. They are seen in 10% of patient with acute appendicitis. Objective: To study any association between appendicolith and its effect on recovery of patient with appendicitis. Materials and Methods: This is prospective study carried out from January 2021 to December 2023 in Command Hospital and Military hospital Jammu in all patients of Acute Appendincitis. Data was collected in terms of age, sex, presentation, TLC score, USG/CT, Mantrls score, surgery done, intra op finding, appendicolith seen or not and histopathology. Results: Out of 170 patients who underwent appendicectomy, 139 patients were more than 20 years of age (81%). Following appendicetomy, appendicolith was found 33patient (19.41%).11 patients were less than 20 years of age (33%).There were 36 female patients (21%) of appendicitis.139 patient presented in acute phase (82%) and operated upon. Rest were operated as cold cases as int appendicectomy. Lap appendicectomy was done in 143 cases (84.1%). Rest was open appendicectomy. Acute appendicitis was found in 9 cases with appendicolith (33%).Complicated appendicitis was found in 24 cases with appendicolth (72.7%). Conclusion: Appendicolith is commonly present in more than 20-year age group. Mantrls score is higher in appendicitis with appendicolith. TLC is also more than 10000 in majority of patients with appendicolith. Majority patient presented in acute stage and were operated upon. Presence of appendicolith was associated with higher TLC, higher Mantrls score and complicated intraop and HPE finding. Keywords: Acute appendicitis, Appendicolith, TLC, HPE finding, HPE finding.

Background: Aims: To find the ideal drug combinations which can be used during day care surgeries and procedures. This study was conducted to valuate and compare the efficacy, and haemodynamic stability of ketamine and entanyl combination with propofol. Also compared were the incidence of side effect, the time of awakening and recovery time. The discharge criteria in both groups was also compared. Materials and Methods: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I or II, were divided into two groups of 25 each. They underwent elective ERCP of approximately 1 hour duration. Group I received Propofol- ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system) and discharge status (by modified post anaesthetic discharge scoring system) were recorded and compared in two groups. Results: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol- fentanyl group as compared to Propofol-ketamine group. The recovery time in group II was longer than group I. Discharge criteria is significantly earlier in group I. Conclusion: Both Profol- ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia, but recovery and smooth discharge was seen with propofol fentanyl group. Keywords: Propofol, Fentanyl, Ketamine, Day care surgery, ERCP, Endoscopic proceedures.

Background: Dexmedetomidine and Clonidine, both α2-adrenergic agonists, are commonly used in cardiac surgery for their hemodynamic stabilizing properties. However, comparative data on their efficacy in cardiac valvular surgeries remain limited. Materials and Methods: We conducted a prospective randomized controlled study involving 60 patients undergoing elective cardiac valvular surgeries between September 2019 and August 2020. Patients were randomized to receive either Clonidine or Dexmedetomidine. Intra-operative hemodynamics, anesthetic requirements, and post-operative recovery times were compared between the two groups. Results: Dexmedetomidine demonstrated superior efficacy in reducing heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure compared to Clonidine. Patients receiving Dexmedetomidine required lower doses of inhalational anesthetics, opioids, and muscle relaxants. Additionally, Dexmedetomidine was associated with shorter durations of mechanical ventilation (398.00 ± 51.47 vs. 475.67 ± 35.15 minutes, P < 0.0001) and length of stay in the post-operative ICU (53.90 ± 3.75 vs. 60.60 ± 3.78 hours, P < 0.0001) compared to Clonidine. Conclusion: Dexmedetomidine offers superior intra-operative hemodynamic stability, reduced anesthetic requirements, and faster post-operative recovery compared to Clonidine in patients undergoing cardiac valvular surgeries. Keywords: Dexmedetomidine, Clonidine, Cardiac surgery, Hemodynamics, Anesthetic requirements, Post-operative recovery.

Background: Mobile health applications are a relatively new phenomenon in the healthcare industry, but their use is expanding rapidly for both general health and specific medical needs. Objective: To compare the utilization of the health apps among patients visiting pharmacies and health stores hospital and it awareness among people. Materials and Methods: A cross-sectional descriptive study was conducted with the general population who were using mobile health apps in the state between January 2023 to June 2023. The participants in the study were recruited from retail pharmacies and health stores located in different areas in the cities. Clients visiting the pharmacies and health stores were approached and invited to participate in the study, and those who agreed were interviewed. The inclusion criteria included smartphone owners who were using health-related apps, of age ≥ 18 years old, and those who could speak the English language. Results: Out of 270 individuals, 52% of the sample were male and 48% were female, and the mean age (SD) of participants was 29.74 (11.74). In this study, 31% of the participants reported using their health apps on a daily basis, 40% at least once weekly, and 25% monthly. The main benefits of mobile health apps were tracking of health status (49%), followed by motivation (24%) and gaining knowledge about health and fitness (20%). The main issues reported by the participants included inaccuracy of the app (12.5%), inconvenience (5%), and not being user-friendly (8%). Conclusion: These apps inspired the participants to keep up their wellbeing and exercise while assisting them in tracking and better managing their health. To ensure evidence-based and efficient app use to achieve the desired health outcomes, further opportunities for improvement have been found. Keywords: Digital health, digital patients, health apps, mhealth, teleconsultation.

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. Keywords: Dexmedetomidine, esmolol, modified Electroconvulsive therapy, hemodynamic parameters.

The co-occurrence of retroperitoneal liposarcoma and a giant colonic diverticulum poses diagnostic challenges due to their uncommon nature and overlapping clinical presentations. Here, we present a unique case report of a 76-year-old female with hypertension and myasthenia gravis who presented to Vishesh Jupiter Hospital, Indore and diagnosed with retroperitoneal liposarcoma complicated by a giant colonic diverticulum detailing its presentation, diagnostic journey and management strategies. Keywords: Retroperitoneal liposarcoma, Giant Colonic Diverticulum.

Background: To evaluate and compare efficacy of laparoscopic cholecystostomy and interval cholecystectomy versus open cholecystectomy in cases of difficult gallbladder. Materials and Methods: This study will be conducted in Department of General surgery, Kamineni Hospital, Hyderabad between October 2012 to December 2014. The facilities, expertise and the necessary Infrastructure are available in this hospital. A comparative observational study, which included 40 patients of difficult gallbladder who needs cholecystectomy. Ethics committee’s permission has been taken. Results: In the present study, there were difficulties associated with Laparoscopic cholecystostomy like subjecting the patient to a second surgery, carrying a drain, longer hospital stay and increased expenditure. Laparoscopic cholecystostomy followed by Interval chole- cystectomy was safe with less postoperative morbidity associated with faster patient recovery and satisfaction as documented by less postoperative pain, earlier resumption of oral feeds, earlier full mobilization and discharge home, as well as lesser complication rate with least possible scar. Conclusion: In conclusion, the study supports the view that laparoscopic cholecystostomy followed by interval cholecystectomy is safer and efficacious and offers definitive advantages over open conversion and should be an available option for all patients requiring emergency cholecystectomy. Keywords: Cholecystectomy, Laproscopic, Gall Bladder, VAS, Postoperative.

Background: To study the effect of nebulised 3% saline on hospitalized children aged 4weeks to 2 years with acute bronchiolitis with regard to decrease in respiratory distress and duration of hospital stay. Materials and Methods: This was a hospital based prospective interventional non blinded controlled trial done in the age group of 4 weeks to 2 yrs admitted with acute bronchiolitis with a Respiratory Distress Assessment Instrument (RDAI)score of 4 to 15 [on a scale of 0 (mild) to 17 (severe)] in a teritiary care centre. Results: The most common presenting complaint in our study was cold which was present in 43 (76.79%) cases followed by cough in 41 (73.21%). This was followed by hurried breathing in 31 (55.36%). Wheeze was present in 29(51.79%) cases and fever in 28 (50%). The two groups were comparable with respect to baseline characteristics. The number of children who improved with treatment in Study group was 19(63.3%) and in control group was 11(36.70%). When compared to control group, there was statistically significant (p=0.015) improvement in the study group. This showed that the nebulised 3% saline nebulisation was useful in symptomatic improvement in the clinical condition of significantly more number of children. There was significant reduction in RDAI scores and improvement in saturation after 6hr, 12hr and 24hrs of initiation of treatment in Study group. Conclusion: The present study concluded that there was significant decrease in Respiratory rate and RDAI scores with the use of 3% NS nebulisation. The duration of hospital stay was less and the time required for change of treatment was more in Study group, but statistical significance could not be established. Keywords: Bronchiolities, RDAI Score, NS nebulisation, wheeze.

Background: Empyema thoracis is a life-threatening complication of pneumonia in children, especially below 5 years of age. The treatment outcomes depend upon the nutritional state of the child and provision of medical care to administer appropriate antibiotics. This study was done with an aim to evaluate the risk factors and outcomes of children with empyema thoracis. Materials and Methods: A total of 100 children who presented to the OPD with empyema thoracis, over a period of 18 months were included in the study. Results: Majority of the children were below 5 years of age and most of them were males. Most of the participants belonged to lower socio-economic status. Anemia was the most commonly associated risk factor. ICD was removed within 1 week. Conclusion: Early initiation of antibiotics along with ICD tube placement can allievate the immediate clinical or delayed complication. Keywords: empyema thoracis, pediatric, pneumonia.