In present study 200 cases of acute pancreatitis were evaluated and following conclusions were made. MDCT is an excellent imaging modality in diagnosis of acute pancreatitis with depiction of pancreas, peri pancreatic changes and also associated complications. No significant correlation seen between pancreatic enzymes and severity of pancreatitis. Significant correlation with modified CT severity index and length of hospital stay, interventions, organ failure is noted. MCTSI is good indicator for outcome of patient especially with the organ failure and also length of stay. CECT with modified CT severity index shows good correlation with grading of severity of pancreatitis and extent of disease process. CT is the most sensitive and specific imaging modality for the evaluation of acute pancreatitis and its complications. Keywords: MDCT, MCTSI, CECT, Pancreatitis.

Background: Patient safety is the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. One of the outcomes frequently analysed in studies addressing this theme is the occurrence of adverse events. This study was conducted to assess anaesthesia related peri-operative adverse events. Materials and Methods: This study comprised of 100 anaesthetic procedures in all. The subjects had been asked for consent. The adverse events were noticed. Statistical analysis had been conducted using SPSS software. Results: The most common adverse event was perioperative cardiac arrest observed in 29 subjects, followed by unexpected difficult airway seen in 16 subjects. Perioperative pulmonary aspiration was noticed 10 subjects. Stroke/coma was seen in 9 subjects and malignant hyperthermia was seen in 3 subjects. Total 67 complications had been observed. Conclusion: The most common perioperative complication was cardiac arrest followed by unexpected difficult airway. Other complications were pulmonary aspiration, stroke or coma, and malignant hyperthermia. Keywords: Anaesthesia, Complications, Cardiac Arrest.

Background: The synovium, a soft tissue lining diarthrodial joints, tendon sheaths, and bursae, plays a pivotal role in various arthritides. This study aims to evaluate the histopathological spectrum of synovectomy and synovial biopsies, assessing their diagnostic value in neoplastic, granulomatous diseases, and infections. Materials and Methods: This cross-sectional descriptive study was conducted in the Department of Pathology at Siddhartha Medical College, Vijayawada, from January 2021 to January 2023. A total of 100 synovectomies and synovial biopsies, obtained via open or arthroscopic methods, were included. Samples were fixed in 10% buffered formalin, processed, and stained using hematoxylin and eosin and special stains as necessary. Clinical, demographic, histopathological, radiological, and serological data were reviewed. Results: The study revealed a higher prevalence of synovial lesions in individuals aged 51-70 years (38%) and 71-90 years (32%), with females predominantly affected (60%). Inflammatory joint diseases comprised 40% of cases, with chronic nonspecific synovitis (18%) being the most common. Septic arthritis (10%), tuberculous synovitis (6%), and rheumatoid arthritis (6%) were also notable. Degenerative joint diseases accounted for 22% of cases, including osteoarthritis (10%), gout (3%), pseudogout (3%), ochronosis (2%), and avascular necrosis (5%). Tumor and tumor-like lesions constituted 37% of cases, with giant cell tumor of the tendon sheath (15%) and synovial chondromatosis (8%) being prominent. Conclusion: The study emphasizes the diagnostic value of histopathological examination in early and ambiguous cases of synovial pathology. The prevalence of inflammatory, degenerative, and tumor-like conditions reflects the necessity for comprehensive evaluation in managing joint diseases. Keywords: Synovium, histopathology, synovectomy, synovial biopsy, arthritis, inflammatory joint disease.

Background: Dengue fever is a prevalent mosquito-borne viral illness with potential complications, including thrombocytopenia. Objective: This study aimed to investigate the relationship between platelet indices and the presence of thrombocytopenia in individuals diagnosed with dengue fever. Materials and Methods: A total of 100 dengue-confirmed cases were enrolled, and their platelet count, platelet distribution width (PDW), and plateletcrit (PCT) were measured during the acute phase of the disease. Results: The findings of this study revealed a substantial incidence of thrombocytopenia among the participants, aligning with the well-established association between dengue infection and platelet reduction. Notably, a modest but significant correlation was demonstrated between PDW and PCT and the severity of thrombocytopenia. Subgroup analysis based on dengue virus serotypes unveiled varying patterns of platelet indices, hinting at potential differences in disease pathogenesis. Conclusion: The results of this study underscore the potential utility of platelet indices as informative markers for assessing the degree of thrombocytopenia in dengue fever cases. The observed correlations between platelet count, PDW, and PCT provide insights into the complex interplay between platelet dynamics and dengue infection. Further prospective investigations are warranted to elucidate the underlying mechanisms driving these correlations, which could contribute to enhanced understanding, diagnosis, and management of dengue-associated thrombocytopenia. Keywords: Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT) and Platelet Large Cell Ration (P-LCR).

Background: This study aims to investigate the diverse etiologies leading to the need for mechanical ventilation in neonates and to analyze the outcomes associated with this intervention. Materials and Methods: A prospective observational study was conducted on a cohort of 60 neonates admitted to the neonatal intensive care unit (NICU) at Gandhi Hospital during a specified period. Data were collected from medical records, including demographic information, clinical presentation, and diagnostic findings. Etiologies necessitating mechanical ventilation were categorized, and relevant clinical parameters were assessed. Outcomes such as survival rates, duration of ventilation, and potential complications were analyzed. Results: The study included a total of 60 neonates who required mechanical ventilation during the study period. The primary etiologies identified encompassed a range of conditions including respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital anomalies, sepsis, and neurological disorders. Each etiology was further analyzed for its contribution to the need for mechanical ventilation and associated outcomes. The outcomes revealed varying survival rates among different etiological groups. Additionally, the duration of mechanical ventilation was assessed, and potential complications such as ventilator-associated pneumonia, bronchopulmonary dysplasia, and intraventricular hemorrhage were investigated. Conclusion: This study sheds light on the intricate web of etiological factors leading to mechanical ventilation in neonates and provides valuable insights into the associated outcomes. Understanding the diverse challenges faced by neonates requiring mechanical ventilation is crucial for improving clinical management strategies and ultimately enhancing the overall care and survival rates of this vulnerable population. The findings of this study contribute to the existing body of knowledge on neonatal care and may guide future research and clinical practices in the field of neonatology. Keywords: Etiologies, Neonatal Intensive Care Unit (NICU), Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS), Ventilation, BronchoPulmonary Dysplasia(BPD).

Background: To evaluate radiological and functional outcome of malunited distal radial fractures treated with iliac crest bone graft and Volar plating with or without K- wires. Materials and Methods: This is a prospective study conducted on twenty adult patients with distal radial fractures treated at Department of Orthopaedics, Rangaraya Medical College, Kakinada between September 2021 to August 2023. Results: The study included twenty cases of malunited distal radius fractures in adults treated with osteotomy, ipsilateral tri cortical iliac crest bone grafting, and volar Ellis plating over a 12- to 18-month period. Right side (dominant wrist) was involved in 12 (60%) patients and the left side involved in 8(40%) patients. In the present study 13 (65%) patients had union within 2-3 months and 7(35%) patients had union in 3-4monthsThere were no cases of delayed union or non –union. Mean preop DASH score – Mean postop DASH score>25 Excellent Mean preop DASH score–Mean postop DASH score16-25 good Mean preop DASH score–Mean postop DASH score 6-15 fair Mean preop DASH score–Mean postop DASH score≤5 poor. Osteotomy, ipsilateraliliac crest bone grafting and volar Ellis plating demonstrates good reproducible outcomes with minimal risk in appropriately selected cases of Malunion. This technique can provide adequate restoration of normal anatomy and soft tissue and vascular preservation, in addition to minimal patient morbidity, which may facilitatea more rapid return to function. Conclusion: We can conclude that osteotomy, tricortical iliac crest bone grafting, and volar Ellis plating are a simple, reliable, and effective method for restoring normal distal radius radiological parameters, particularly in young adults. Functional end results have a direct relationship with anatomical end results, especially in young adults, though good functional results can be obtained even when anatomical results are poor in elderly people due to innate mobility of the wrist joint. Keywords: Osteotomy, Distal radial fractures, DASH score, volar Ellis plating.

Background: Perianal fistula or fistula-in-ano, is a chronic abnormal communication, usually lined by granulation tissue, which runs outwards from the anorectal lumen (the internalopening) to an external opening on the skin of the perineum and gluteal region. Perianal fistula develops as a result of anorectal sepsis. Ligation of intersphincteric fistula tract (LIFT) is a new sphincter saving method with good result in the management of fistula. Aim of this study: To evaluate the effectiveness and functional outcomes of the LIFT patients operated at Shri Jagannath Medical College and Hospital, Puri, Odisha. Materials and Methods: This prospective study includes 20 patients who were operated for perianal fistulas at during the period of October 2022 to September 2023. Patients of all ages with or without history of recurrence are included. Patients with fistulas due to crohn`s disease, anal cancer and tuberculosis were excluded. A performa with detailed history, clinical presentation, per rectal examination and supportive imaging studies with pre and post-operative status were done for all cases. Results: In this study most of the patients were male and few of them are recurrent fistula with perianal discharge. All the 20 patients with perianal fistula underwent Ligation of intersphinsteric fistula tract (LIFT). Patients were followed for a period of 3 months. Most of the cases healed completely within 2-4 weeks (90%), few cases took 6 weeks for healing (10%). Recurrence of fistula occurs in 5 cases (20%). In recurrent fistula re-recurrence occurs in 2 cases (40%). Conclusion: The LIFT procedure is highly safe and effective means of treatment for perianal fistula with no risk of incontinence, less postoperative pain score and also better for recurrent fistulas. Keywords: Perianal fistula, Anorectal sepsis, LIFT, Recurrence.

Background: Hemorrhoid is very common ano rectal disease causing painless bleeding after defecation. Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain in post-operative period. Aim of this study: is to evaluate to break the “vicious circle” of “pain–sphincteric spasm–pain” with the postoperative use of self-mechanical anal dilation. Materials and Methods: 30 patients undergoing hemorrhoidectomy as suffering from hemorroids were divided randomly in two groups by odd & even method, one group was assigned as dilator group where self-mechanical 33 mm Anal Dilator for 15 mins was used for a period of 02 weeks and in another group no anal dilator used although both had fibre diet amd laxative with sitz bath in post-operative period. Pain, oedema, discharge, bleeding and incontinence was observed on Ist, 3rd, 7th and 15th day. Results: 15 Patients who had undergone self-mechanical anal dilator showed less pain compaired to no dilator group (P<0.05). Bleeding, discharge and oedema was significantly low in both group, faecal incontinence was present in dilator group for 7 days but disappeared on 15th day(P=050). Conclusion: This prospective study confirms that self-mechanical anal dilatation reduce pain after haemorrhoidectomy. No faecal incontinence noticed. Keywords: Hemorrhoids, Hemorrhoidectomy, Self-Mechanical Anal Dilatation, Pain.

Background: Dexmedetomidine, renowned for its sedative, anxiolytic, and opioid-sparing properties, exerts its effects primarily within the locus ceruleus of the brainstem. By diminishing sympathetic outflow, it effectively attenuates stress responses. Despite its growing popularity, optimal dosing remains uncertain, particularly within the Indian population. This study aimed to compare the hemodynamic response attenuation achieved by two dexmedetomidine doses: 0.5 mcg/kg and 1 mcg/kg during laryngoscopy and intubation. Materials and Methods: One hundred elective surgery cases were consecutively enrolled in this prospective study after obtaining informed consent. The patients were randomly allocated into two groups, each comprising 50 cases. Group A received intravenous dexmedetomidine at 0.5 mcg/kg, while Group B received 1 mcg/kg, both diluted with 20 ml of normal saline over a 10-minute infusion using a pump. Hemodynamic responses from both the groups were then recorded. Results: Baseline diastolic blood pressure was comparable between groups, and at 10 minutes post-drug administration, as well as during intubation and 1 minute post-intubation (p>0.05). However, post-intubation diastolic blood pressure was significantly lower in Group B compared to Group A at 3 minutes post-intubation and remained lower through subsequent readings until 10 minutes post-intubation. Similarly, mean arterial pressure was significantly lower in Group B compared to Group A for all readings up to 10 minutes post-intubation. Conclusion: In the context of attenuating the hemodynamic response to laryngoscopy and intubation, this study establishes the superiority of intravenous dexmedetomidine at 1 mcg/kg over 0.5 mcg/kg dosing. The higher dose may be particularly beneficial for patients with a history of myocardial ischemia, hypertension, or cerebrovascular accidents, for whom excessive stress response during laryngoscopy and intubation is undesirable. Caution is advised when administering the 1 mcg/kg dose due to potential bradycardia during drug infusion. Keywords: Anesthesia, Dexmedetomidine, Hemodynamic, Intubation, Laryngoscopy, Sympathetic outflow.

Background: Proximal humerus fractures are defined as fractures occurring at or proximal to the surgical neck of humerus. Various methods are used for treating such conditions with mixed results. The purpose of this study was to assess the outcome of these fractures treated by Crosslinked percutaneous pinning (CLiPP) and Joshi’s External Stabilizing System (JESS) in terms of time of union, functional outcome and complications. Materials and Methods: A prospective comparative study was done in a period of 1 year (2019-2020), which included 30 patients where 15 cases underwent surgery via CLiPP and other 15 cases via JESS. Neer’s 2 and 3 part fractures, skeletally mature patients and patients presented within 3 weeks of presentation were included in the study. After the surgery, patients were followed up at 4 weeks, 6 weeks, 8 weeks, 12 weeks and 6 months and shoulder function was assessed using Constant Murley Score. Results: Time of radiological union by both techniques showed no significant difference. Better functional result was observed by CLiPP group at 3 months whether at 6 months there was not significant difference between them. Excellent results were found in 20% patients with CLiPP group and 13.33% with JESS group. Same percentage (6.67%) of patients showed poor results in both the groups. 2 (13.33%) patients had pin tract infection of each group and 1 (6.67%) patient had pin loosening in JESS group. Conclusion: Both the techniques are cost effective, enables early mobilisation with less soft tissue dissection and provides good results in treating Neer’s 2- and 3-part fractures. CLiPP is better than JESS in terms of better early functional result. Keywords: Proximal humerus fractures, CLiPP, JESS.

Background: Chronic Kidney Disease (CKD) is a prevalent condition with significant morbidity, necessitating comprehensive understanding of its demographic distribution, risk factors, and impact on quality of life. This study assesses the demographics, risk factors, and quality of life among CKD patients attending a dialysis unit at a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted among 100 CKD patients. Data on demographics, education, occupation, economic status, and risk factors were collected. The quality of life was assessed using the SF-12 questionnaire, focusing on physical and mental health components. Results: The majority of patients were male (78%) and aged 41-60 years (62%). A significant portion had no formal education (74%) and belonged to the lower socioeconomic class (59%). Hypertension was the most prevalent risk factor (76%), followed by alcohol consumption (41%), sedentary lifestyle (37%), and tobacco use (34%). The quality of life assessment revealed that physical functioning (28 ± 25.44) and general health (28 ± 23.37) were the worst affected domains in the Physical Health Component. In the Mental Health Component, social functioning (6.5 ± 19.33) and role limitation due to emotional problems (24.12 ± 12.34) were most impacted. The overall quality of life score was 31.33 ± 15.24, indicating significant impairment. Conclusion: CKD patients exhibit a high prevalence of multiple risk factors, especially among lower socioeconomic classes, with substantial impairment in both physical and mental health-related quality of life. These findings highlight the need for targeted interventions to address the multifaceted challenges faced by CKD patients. Keywords: Chronic Kidney Disease, CKD, Dialysis, Quality of Life, Risk Factors, Socioeconomic Status, SF-12, Hypertension.

Background: On 16th January 2021, India began the world’s largest vaccination program for COVID-19. Healthcare workers were the first group to be offered the vaccine, however, vaccine hesitancy emerged as a barrier. Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services. It was listed as one of the ten threats to global health by WHO. The aim of this study was to determine the rate of vaccine acceptance and reasons for vaccine hesitancy among UG (undergraduate) medical students of Bihar. Our study was necessary because UG medical students do not contribute directly to the frontline of healthcare but are exposed to multiple cases of COVID-19 during clinical teachings and they are also the future of any country’s healthcare system. Material and Methods: A cross-sectional study was carried out on the UG medical students of Bihar using an anonymous online survey. The survey link was sent electronically via WhatsApp. All the questions of the survey were closed-ended, in the form of multiple-choice questions and tick boxes. The data was analyzed on SPSS software. Results: Out of 394 responses received, 205 (52.03%) were males, 384 (97.46%) belonged to the age group of 18-25 years. In the bivariate model, attributes like the male sex, being well informed about the vaccines, being at high risk of exposure, and the belief that vaccination can overcome the pandemic were associated with a higher likelihood of accepting the vaccine. Participation of professors in vaccination was the most common source of motivation (209/357; 58.5%) in vaccine acceptors, while insecurity about the efficacy of the vaccines (16/37; 43.2%) was the most common reason among vaccine deniers. Conclusion: We recorded a high vaccine acceptance rate of 90.6% in our study. Further, 78.4% of vaccine deniers believed that they would have accepted the vaccine if they were provided appropriate information on the vaccines prior to the vaccination. Therefore, we reach a conclusion that pre-vaccination orientation sessions aimed at UG medical students will significantly help in addressing their vaccine hesitancy. Keywords: COVID-19, COVID-19 vaccine, Medical students, Vaccine Hesitancy.

Background: According to a report by the World Health Organization (WHO) in 2015, approximately 600 million individuals, equating to nearly one-tenth of the global population, become sick due to consuming contaminated food each year. Furthermore, the report indicates that 420,000 individuals perish annually as a result, leading to the loss of 33 million healthy life years (DALYs). Among these cases, 40% of the burden of foodborne diseases affects children under the age of five, resulting in 125,000 deaths annually. Objectives: To distinguish the attitudes towards food safety practices in urban and rural households based on the WHO Five Keys. Materials and Methods: A cross-sectional study was conducted in Urban and rural households located in the field practice areas of Jawaharlal Nehru medical college in Belagavi Taluka, and District of Karnataka State. The study took place from January 1, 2017, to December 31, 2017. Results: In urban participants, 30.0% were aged 25 to 35 years whereas for rural participants, 35.8% were aged 18 to 25 years. The mean age for urban participants was 37.96 ± 14.9 years, and for rural participants, it was 33.48 ± 13.5 years. The difference in mean ages between urban and rural participants was statistically significant (χ2 = 39.53, p < 0.001). According to Modified B. G. Prasad's Classification of socio-economic status of urban participants, 34.3% of study participants belonged to Class IV whereas in rural participants, 41.3% in Class IV, differences in socio-economic status between urban and rural participants were statistically significant (χ2 = 59.61, p < 0.001). Conclusion: The study underscores the importance of recognizing and addressing the distinctive demographic characteristics between urban and rural populations, which can have implications for healthcare, education, and socio-economic interventions tailored to the specific needs of each community. Keywords: WHO, Urban, Rural, Food, Safety, Household.

Background: HPV infection is a well-known cause of cervical cancer. In India, an estimated 77,348 deaths occur each year (Globocan2020). Less than 1% of girls in India have received the HPV vaccine. (NFHS-5) So, this study is done to analyse perceptions of MBBS students about HPV and the vaccine used to treat it. The Objectives was 1. To assess the knowledge of medical students about human papilloma virus and 2. To assess the knowledge, attitude, and practice of medical students about HPV vaccine. Material and Methods: Cross sectional study was conducted among 250 MBBS Students of GIMS, Kalaburagi, Karnataka. Simple random sampling was used to achieve the required sample size. Data was collected from Nov 2023 to Jan 2024 using a semi-structured questionnaire. Scoring System was used for analysing the knowledge. Data was entered in MS excel and was analysed using SPSS version 26. Results: The response rate of the students was 100 %. 50.4 % of the students had good knowledge of HPV virus and HPV vaccine whereas 23.2% students had very good knowledge of the same. 56.4 % of students agreed that they would get vaccine if it was free. 54.8 % students strongly agreed that would pay for vaccine, 51.6% and 54.8 % of the students strongly agreed that they would recommend it to their friends and their future clients respectively. Only 5.6 % of female students were vaccinated against HPV. Conclusion: Despite good knowledge and attitude, the vaccination coverage was very poor among female medical students and nil among boys. Keywords: Awareness, Human Papillomavirus, Vaccination, Students, Medical.

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood. Asthma is a chronic respiratory disease characterised by episodes of wheeze, cough, and shortness of breath. Hence, the present study was conducted for assessing the Quality of Life and factors affecting it in children diagnosed with Attention – deficit/ hyperactivity disorder versus Bronchial asthma. Materials and Methods: A total of 50 children within the age range of 8 to 16 years were enrolled. Out of these 50 children, 25 were children with recently established diagnosis of ADHD and remaining 25 were children with established diagnosis of Bronchial Asthma. Complete demographic and clinical details of all the subjects was obtained. Pediatric Quality of Life Scale (PedsQL) and Parenting Practices Questionnaire were used. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the subjects of the ADHD group and asthma group was 13.2 years and 14.1 years respectively. Majority proportion of subjects were boys. While comparing the parent’s report of QoL among two study groups, significantly better results were obtained in the Asthma group. However, while comparing the child’s report of QoL among two study groups, non-significant results were obtained. Also, significant correlation was seen among parenting style and QoL. Conclusion: ADHD is a childhood ailment that is equally debilitating as a persistent physical illness such as Asthma. The quality of life for the kid can be greatly enhanced via therapy and an emphasis on parenting approaches. Keywords: Quality of life, Attention-deficit, Bronchial asthma.

Background: Among micronutrients, vitamin B12 (B12) and folate (FA) are critical as they are required in a plethora of metabolic and biological functions. Hence, the present study was conducted for assessing the prevalence of cobalamins and folate deficiency amongst adolescents. Materials & Methods: A total of 500 adolescents were enrolled. Complete demographic and clinical details of all the patients were obtained. A proforma was made, and detailed clinical profile was evaluated. Blood samples were obtained, and serum cobalamin and folate levels were evaluated. Results: A total of 500 adolescents were evaluated. The mean age of the patients was 12.3 years. Prevalence of cobalamins and Prevalence of folate deficiency was 31.8 percent and 28.5 percent respectively. Among boys, cobalamins deficiency was seen in 89 patients while folate deficiency was seen in 63 patients. Among girls, cobalamins deficiency was seen in 70 patients while folate deficiency was seen in 79 patients. Non-significant results were obtained while correlating prevalence of cobalamins and folate deficiency among boys and girls. Conclusion: Our results demonstrate a high prevalence of folate and cobalamin deficiency among adolescents. Key words: Folate, Cobalamin

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, necessitating improved diagnostic and prognostic markers. Immunohistochemical (IHC) markers such as alpha-fetoprotein (AFP), glypican-3 (GPC3), heat shock protein 70 (HSP70), and cytokeratin 19 (CK19) have shown promise in HCC detection and prognosis. However, their utility in clinical practice remains to be fully elucidated. Materials and Methods: We conducted a retrospective study analyzing 129 HCC tissue samples for the expression of AFP, GPC3, HSP70, and CK19 using IHC staining. Clinicopathological parameters, including tumor size, grade, presence of cirrhosis, and patient survival, were correlated with marker expression. Survival analysis was performed using Kaplan-Meier curves and log-rank tests. Results: Our analysis revealed variable expression patterns for AFP, GPC3, HSP70, and CK19 in HCC tissues. AFP and GPC3 exhibited moderate to high expression levels, while HSP70 showed moderate expression, and CK19 demonstrated lower expression. Positive correlations were observed between marker expression and tumor size, grade, and the presence of cirrhosis (p < 0.05). Additionally, higher expression levels of AFP, GPC3, and HSP70 were associated with shorter overall survival and lower survival rates at 1 year and 3 years (p < 0.001). In contrast, lower expression levels of CK19 were associated with better overall survival and higher survival rates. Conclusion: Our study highlights the diagnostic and prognostic potential of AFP, GPC3, HSP70, and CK19 in HCC. These markers exhibit distinct expression patterns and associations with clinicopathological parameters and patient outcomes, underscoring their utility in guiding clinical management decisions. Further validation studies in larger cohorts are warranted to confirm our findings and facilitate the integration of these markers into routine clinical practice. Keywords: Hepatocellular carcinoma, Immunohistochemistry, Alpha-fetoprotein, Glypican-3, Heat shock protein 70, Cytokeratin 19, Prognosis.

Background: Among children, one of the main causes of morbidity and death is acute respiratory infection (ARI). Because of their constantly changing developmental physiology, children are more susceptible to environmental exposures that determine respiratory disorders. On the other hand, children exposed to environmental risk factors also have a higher risk of these diseases when it comes to social determinants of health. Acute respiratory infections (ARIs) are more likely to occur and be fatal due to a number of causes. These included living situations that were subpar, seasonal fluctuations, exposure to indoor and outdoor pollutants, low birth weight, inadequate breastfeeding, malnourishment, inadequate housing arrangements, inadequate sanitation, and limited access to preventative and therapeutic services. Materials and Methods: In Jagdalpur, Chhattisgarh, at the government Medical College and Hospital, the study was carried out. The study had childrens under the age of fifteen as participants. In total, there were 59 samples. A systematic random sample was the sample technique employed. The study informant, the mother of the child, was interviewed using a pretested semi-structured questionnaire. SPSS was used for statistical analysis after three months of data collection. All children below 15 years of age were included in this study. Results: In this study, there were 59 participants; 28 were girls and 31 were boys. Of the thirty-one boys, ten were one to five years old, thirteen were five to ten years old, and eighteen were ten to fifteen years old. Of the twenty-eight girls, six were one to five years old, ten were five to ten years old, and twelve were ten to fifteen years old. There were 40 individuals with upper respiratory tract infections and 19 with lower respiratory tract infections. Ten people had bacterial infections, eleven had mixed ARIs and 38 had viral infections.18 people reported nasal blockage, 14 people had sore throats, 20 people had cough. Conclusion: Environment played a major role in childhood acute respiratory infections. By implementing programs to improve community awareness and economic standing as prevention strategies against childhood ARI. It should be the duty of general practitioners and pediatricians to give caregivers the proper advice on how to take care of their children at home. Keywords: Acute Respiratory Infection, Environmental Factors, Children.

Background: To assess the factors influencing the functional outcomes of Surgery for Hirschsprung’s Disease, and to compare Duhamel and Soave Pullthrough procedures based on Postoperative complications andQuality of life. Materials and Methods: A total number of 30 cases were studiedfrom 2018 to 2021 at Government General Hospital/Guntur Medical College, Guntur, and the follow-up period varied from 6 months to 18 months. This study was done to compare the results of both the Pull through procedures (Duhamel and Soave) with respect to age at definitive procedure, gender, aganglionic segment type, postoperative course, and outcomes of both procedures based on postoperative Complications and Quality of life. The analysed data were compared with other series in the literature and discussed. A master chart dealing with all aspects has been designed and presented. Statistical analysis is done with SPSS VERSION 16 and the Chi square test. Results: Both the Groups was matched and the results was studied regarding Voluntary Bowel movements, Soiling, Constipation, Micturition disturbance, Quality of life, Postoperative Enterocolitis and with features of Bowel Retraction and Perineal Excoriation. Voluntary Bowel movements were present in 80% of study subjects operated by Duhamel procedure compared to 86.7% of study subjects who underwent Soave. Soiling was observed in 6.7% of study subjects who underwent the Duhamel procedure and is 20% with Soave. Constipation was observed in 6.7% of study subjects who underwent the Duhamel procedure and is 13.3% with Soave. Soiling and constipation was a major complaint following Soave surgery than with Duhamel procedure. Constipation was slightly more common in the Soave than Duhamel group (24 percent vs. 4 percent; p=0.04), while the soiling rate was comparable in the Duhamel (21 percent) and Soave (8 percent) groups (p=0.26). 13.3% with Duhamel procedure, and 6.7% with Soave procedure had a history of enterocolitis. Diarrhoea with explosive stool was found to be 13.3% each in study subjects who got operated by Duhamel and Soave procedures, respectively. Bloody stool was among 13.3% of study subjects who got operated by Duhamel procedure, when compared to soave it is only 6.7%. Perineal Excoriation was seen in 20% of subjects with Duhamel procedure compared to 6.7% with Soave. Conclusion: The incidence of voluntary bowl movements, soiling and perennial excoriation is better in soave than Duhamel. Retraction and constipation is more with soave. There was no significant difference between the outcomes of the two procedures, and in the light of the present findings. both the procedures appear similar in terms of efficiency and associated complications. Both the procedures have their own advantages. The Quality of life in patients who underwent Duhamel and Soave procedures appears to be almost similar in our study. Keywords: Pullthrough, Constipation, Soiling, Excoriation, Micturition, Enterocolites.

Background: Laparoscopic cholecystectomy is gold standard procedure for routine gall bladder removal nowadays. It has become the preferred surgery of choice for patients with symptomatic cholelithiasis in the last two decades due to its shorter duration of hospital stay, reduced post operative morbidity and better cosmesis Materials and Methods: A retrospective observational study was done in 75 patients who underwent laparoscopic cholecystectomy in Vydehi Institute of Medical Sciences & Research Centre Bangalore. Patients were divided into 2 groups based on gender and comparison in terms of age of presentation, intra operative complications, duration of surgery, post operative complications, POD 1 pain was done. The duration of hospital stay was also compared Results: The duration of surgery was significantly greater in males (50.65 +/- 8.73) than female group (37.80 +/- 8.78, p < 0.001). Normal anatomy was significantly in greater proportion in females (63.6% ) than males (25.0% , p < 0.001). Intra operative complications such as bile spillage (12.9%), bleeding (6.5%) and bile leak (3.2% ) was significantly more in male than females (p < 0.42). The hospital stay and post op day 1 pain was seen more in males than females. There was no difference between the genders with respect to age (0.118) and post operative complications (p = 0.222) Conclusion: This study suggests that male gender can be a predictor of difficult laparoscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis

Background: To describe Clinical & demographic profile of the patient admitted with poisoning, drug overdose, drug adverse effects and anaphylaxis. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital in Kolhapur, Maharashtra. Medical records of 408 admitted patients were included from May 2018 – Dec 2023 after permission from the Institutional Ethics Committee. Medical records having incomplete details were excluded from the study. Data was collected in predefined proforma. Results: Maximum Patients admitted were of 21 to 30 years of age group with duration of stay up to 4 days. Male (224, 54.90%) were predominant over female (184, 45.09%).Most common diagnosis at admission was poisoning (209, 51.22%), followed by drug adverse effects (115, 28.18%), overdose (57, 19.97%) and drug induced anaphylaxis (27, 6.61%). At early age (up to 40 years) poisoning and drug overdose were common, at middle age (41 to 60 yrs) anaphylaxis was common while at elderly age (51 yrs and more) drug adverse effects were most common. Organophosphorus poisoning is most common with male predominance while household poisoning is commoner in females. Drug induced hypoglycemia is most common drug adverse effect with male predominance followed by drug induced hyponatremia with female predominance. Most common outcome at the time of discharge was complete recovery (283, 69.36%) followed by leave against medical advice (81, 19.85%), and death (31, 7.59 %). Paraquat poisoning is the most common cause of death followed by Organophosphorus. Conclusion: Maximum admissions were from 21 – 30 years of age.Overall males are predominating over female but up to 20 years of age females are more than males.Poisoning and overdose is most common in young generation while in middle age anaphylaxis is common and in old age group drug adverse effects are commonest. Among causes of hospital admissions poisoning is most common in which Organophosphorus poisoning is commonest followed by paraquat poisoning. Keywords: Poisoning, overdose, drug adverse effects, anaphylaxis, pharmacovigilance.

Background: To assess the impact of orally given itopride and levosulpride on non-ulcer dyspepsia. Materials and Methods: A total of 120 patients were divided equally into two groups, with 60 patients in each group. Group A consists of 60 patients. Subjects were randomly allocated to receive a 50 mg dose of itopride hydrochloride, administered three times per day prior to meals. Contrarily, Group B received a 75 mg dose of Levosulpiride, which was likewise administered three times daily prior to meals. The therapy regimen was adhered to for a duration of two weeks, and then continued for a total of three months. This study included individuals between the ages of 18 and 60 (both males and females) who had symptoms of non-ulcer dyspepsia, such as bloating or pain in the upper abdomen, nausea, and heartburn, lasting for a minimum of 12 weeks. Results: After two weeks of therapy, the Itopride group had 46.66% of patients experiencing remarkable or full reduction of symptoms, 30% experiencing moderate relief, 16.67% experiencing little relief, and 6.67% experiencing no improvement. Within the Levosulpiride group, 40% of participants saw significant or total alleviation, 36.67% experienced moderate alleviation, 15% experienced little alleviation, and 8.33% experienced no alleviation. Both medications demonstrated efficacy, however, the Itopride group had a greater proportion of significant or full alleviation. Incidents with negative consequences were documented and compared between the two groups. Within the Itopride group, 13.33% of patients had minor gastrointestinal discomfort, 8.33% experienced headaches, and 3.33% experienced dizziness. Within the Levosulpiride group, 15% of participants had minor gastrointestinal distress, 5% reported headaches, and 8.33% reported dizziness. Both groups saw a comparable occurrence of minor negative effects, while the Levosulpiride group had a significantly greater occurrence of dizziness. Before and after therapy, a series of biochemical tests were performed, including a hemogram, blood urea nitrogen (BUN), serum creatinine, liver function tests (AST, ALT, γ-GT, Alk. Phos), bilirubin, total cholesterol, fasting blood sugar (FBS), and QT-interval. Conclusion: Our investigation showed that both Itopride and Levosulpiride are effective in relieving symptoms of non-ulcer dyspepsia, and they have a comparable safety profile. However, Itopride shown a much higher incidence of persons achieving substantial or complete relief from symptoms. Keywords: Dyspepsia, Itopride, Levosulpiride, Relief.

Background: To assess the functional outcome of PHILOS (proximal humerus internal locking system) plating in proximal humerus fractures. Materials and Methods: Twenty-five displaced fractures of proximal humerus (in twenty-five patients) treated with PHILOS(proximal humerus locking system) plate between MAY 2021 and APRIAL 2023. The study was conducted in department of Orthopedics & Traumatology Government General hospital, Rangaraya Medial College Kakinada, Andhra Pradesh, India. Patients between 18 to 49 yrs age with proximal humerus fractures. Results: The present study was done to evaluate functional out come and complication following surgical management of proximal humerus fracture by locking compression plate. (PHILOS PLATE). In PHILOS (proximal humerus internal locking system system) system of the threaded heads of the screws in the plate itself provides for a construct with angular and axial stability, eliminating the possibility of screw toggling or sliding of the screws in the plate holes. Coupled with a divergent or convergent screw orientation to head of humerus provide improved resistance to pull out and failure of fixation. Also, whereas conventional plating systems depend on compression between the plate undersurface and bone for stability, this is not the case for the locking plates. This lessens the chance of stripping the thread in osteoporotic bone, as the plate/bone interface is not loaded along the screw axis. This also allows for a more biological fixation as the underlying periosteum and blood supply to the fractured regions are much less compressed. Conclusion: In conclusion proximal humerus internal locking system (PHILOS) is mechanically and biologically an advantageous implant in proximal humeral fractures particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization. Keywords: PHILOS, Humerus Fracture, Biological Fixation, Conventional Plating system.

Background: High risk pregnancy is one which is complicated by risk factor that adversely affects the maternal outcome or perintal outcome or both. The antepartum fetal surveillance of high risk pregnancies with Cardiotocographycan effectively help for reducing perintal mortality and morbidity. One of the biophysical methods which is being used extensively in the management of high risk pregnancy is (CTG) Cardiotocography. Aims & Objectives: 1. To assess the benefit of cardiotocography to improve the fetal outcome in high risk pregnancy. 2. To find out the suitable time and mode of delivery of the fetus at risk. Materials and Methods: This is a prospective observational study conducted at Government General Hospital attached to Government Medical College, Kadapa from the month of July 2023 to the month of june 2024. Study includes 100 high risk pregnancies with singleton fetus of 32 weeks or more than 32 weeks of gestation CTG performed within 3 days prior to delivery will be considered for fetal outcome. In all cases detailed history, clinical and obstetric examination USG and alntepartum, intrapartum CTG will be performed and decision for mode of delivary is planned and different Perinatal outcome are assessed as 1 min and 5 min apgar score and NICU admissions. Results: Among 100 high risk pregnancies included in the study the most common risk factor is preeclampsia (25%) followed by oligos (16%). The incidence of non-reactive intrapartum CTG are 33 in number (33%). Out of 100, 43 underwent cesarean section, 54 delivered vaginally and 3 delivered instrumentally. Out of 100 cases one minute apgar was 5-7 in 41 subjects, 8-10 in 58 subjects and <4 in 1 subject. Among the study group 30 (30%) had NICU admissions. Conclusion: CTG is simple, cheap, non invasive cost effective with less training & best screening test to identity patients at a greater risk of intrapartum fetal hypoxia. CTG is effective tool to evaluate fetal condition, to detect fetal distress and there by early intervention to improve the Perinatal outcome. Keywords: Cardiotocography, High risk pregnancies, Perinatal outcome.

Background: The human foot is an extremely robust and intricate anatomical system, that provides an effective flexible surface necessary for weight transfer, shock absorption, ground plane adaptation, and mobility. The normal, pes planus, and pes cavus three types of foot have been suggested based on the structure of the Medial Longitudinal Arch. Aim: Comparison of the Medial Longitudinal Arch of the hilly and plain Garhwalis of the Uttarakhand. Materials and Methods: This study includes 400 individuals. 100 male and 100 female from each region of hilly and Plain Garhwal. The distance from the floor to the navicular tuberosity is measured and marked on the custom-made index card on a non-weight-bearing and weight-bearing individual and then noted with the help of the digital vernier calliper for the Navicular Drop Test. For measuring the Medial Longitudinal Arch Angle, the digital goniometer is placed on the foot with having its one limb placed on the head of the 1st metatarsal other limb is placed on the medial malleolus and the body is placed on the Navicular tuberosity. Results: The flat foot was maximum seen in hilly Garhwali’s in comparison to Plain Garhwali’s according to the Navicular Drop test. According to the Medial Longitudinal Arch Angle, Plain Garhwalis were found with a maximum number of flat feet. Conclusion: The present study follows the hypothesis as it states hilly individuals have flat feet in comparison to plain region individuals according to Navicular Drop. The right foot has the max % of flat feet than the left foot. Keywords: Medial longitudinal arch angle, Navicular height, Navicular drop, Body mass Index, Right foot, Left foot.

Background: Tobacco use is the single leading cause of preventable death globally, killing millions of people annually, more than HIV/AIDS, tuberculosis, and malaria. Tobacco kills 0.8-1.0 million people each year in India and most of these deaths occur in people who are young. India is one of the fewer countries in the world where prevalence for smoking and smokeless tobacco use is high as well as characterized by dual use of tobacco use of both smoking and smokeless tobacco products also contributes to a noticeable proportion. Materials and Methods: This is a descriptive cross-sectional study on pattern of tobacco abuse among the selected population regarding socio-demographic characteristics and their views about the pricing of tobacco products. Study unit was people of either sex, of more than 18 yrs and less than 60 yrs in age residing in Lucknow district and after applying multi-stage random sampling, 640 subjects were selected. Results: the prevalence of tobacco abuse in the urban area was 36.0 %, while 4.3 % were past users whereas in rural areas prevalence of tobacco abuse was found to be 54.1% while11.9 % were past users (p=0.001). Age groups <30 yrs and 46-60 yrs had a greater proportion of subjects abusing tobacco products compared with the age group 30-45 yrs. There was a significant association between sex and tobacco abuse (p<0.001) in both urban and rural areas. Conclusion: It was observed that the prevalence of tobacco abuse was at a significant level, however as per latest GATS-2 findings overall consumption of tobacco products has fallen in both urban and rural India. Stricter tobacco sale and taxation laws needs to be reviewed for a tobacco free society. Keywords: Tobacco, smoking, smokeless, GATS, taxation.

Background: Premenstrual syndrome (PMS) is a group of condition with physical, emotional, cognitive, affective and behavioural symptoms, in absence of organic or underlying psychiatric disease, that occur cyclically during luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation. In India prevalence of PMS ranges from 14.3%–74.4% and these symptoms affect social and interpersonal relationship, health related quality of life, academic performances, daily living activities, occupational productivity. Objectives: To estimate the prevalence and assess the risk factors of PMS among medical undergraduates, GIMS, Kalaburagi. Materials and Methods: This was a cross-sectional study conducted among 240 girl students of Gulbarga institute of medical sciences, Kalaburagi using simple random sampling from May to December 2023. Data were collected using self-administered questionnaire and PMS was assessed by Premenstrual Symptoms Screening Tool (PSST). Data were entered in Microsoft excel sheet and analysed using SPSS version 20. Results: The prevalence of PMS and PMDD was found to be 38% and 7% respectively. Irregular menstrual cycle, dysmenorrhea, family h/o PMS/PMMD, tobacco and alcohol consumption, frequent experience of stress, experience of emotional or physical abuse and BMI were significantly associated with PMS. Conclusion: Incorporating educational modules will aid in providing accurate information, emotional, and medical assistance for women's menstrual health issues and improve their health seeking behaviour and quality of life. Keywords: Premenstrual syndrome, PMS, PMDD, PSST.

Background: Surgeons have always aimed to produce less visible scars, with techniques evolving from simple sutures to advanced materials like absorbable sutures, tapes, and adhesives. Cosmetic outcomes are particularly important in thyroid surgeries, common in women aged 30-40, as these surgeries often involve anterior neck incisions. While suturing is reliable, it requires skill and time, prompting the search for easier alternatives. Octyl-cyanoacrylate adhesives have gained popularity for their diverse applications, including wound closure. This study aims to compare the efficacy of octyl-cyanoacrylate to sub-cuticular sutures in thyroidectomy skin closure to meet patients' cosmetic expectations. Materials and Methods: 60 patients scheduled to undergo thyroidectomy were included in the study after taking a written informed consent. This prospective observational study was conducted in the Department of Surgery, over a period of 1 year. Results: Tissue adhesive (octyl-cyanoacrylate) was found to be better in terms of time required to close the wound, cosmetic appearance of wound and less number of wound related complications. Conclusion: The study concludes that tissue adhesives are better in wound closure during initial 1 month of post-operative period in comparison to suturing. However, over period of time, the cosmetic appearance of suturing is almost on par with tissue adhesives. Keywords: Tissue adhesive, cyanoacrylate, thyroidectomy, neck scar, sub-cuticular sutures.

Background: Chronic Kidney Disease (CKD) is linked to systemic inflammation, which may be influenced by the oral microbiome. This study aimed to compare the oral microbiome of CKD patients with that of healthy individuals and examine its impact on systemic inflammation. Materials and Methods: The study included 100 participants: 50 CKD patients and 50 healthy controls. Microbial diversity indices, dominant phyla distribution, and key genera abundances were assessed using high-throughput sequencing. Systemic inflammation markers, such as C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-α), were measured. Correlation analyses were performed to explore the relationships between microbial abundances and inflammation markers. Results: CKD patients showed significantly lower microbial diversity compared to healthy controls (Shannon Index: 3.2 ± 0.5 vs. 4.1 ± 0.6; Simpson Index: 0.76 ± 0.1 vs. 0.84 ± 0.1). Dominant phyla in CKD patients included Firmicutes (45%), Proteobacteria (30%), Bacteroidetes (15%), and Actinobacteria (10%), while healthy controls had Firmicutes (50%), Bacteroidetes (25%), Actinobacteria (15%), and Proteobacteria (10%). Notable genera differences included higher abundances of Streptococcus and Neisseria in CKD patients and higher abundances of Lactobacillus and Prevotella in healthy controls. Systemic inflammation markers were elevated in CKD patients (CRP: 6.2 mg/L ± 1.2 vs. 2.1 mg/L ± 0.8; IL-6: 8.5 pg/mL ± 1.5 vs. 3.2 pg/mL ± 0.9; TNF-α: 12.4 pg/mL ± 2.1 vs. 5.3 pg/mL ± 1.4). Positive correlation was found between Streptococcus abundance and CRP levels (r = 0.72, p < 0.001), and a negative correlation between Lactobacillus abundance and IL-6 levels (r = -0.65, p < 0.01). Conclusion: CKD patients exhibit altered oral microbiome profiles and increased systemic inflammation. These findings suggest a connection between oral microbiome imbalance and systemic inflammation in CKD, highlighting the importance of further research on potential therapeutic approaches. Keywords: Chronic Kidney Disease, Oral Microbiome, Systemic Inflammation, Microbial Diversity, C-Reactive Protein.

Background: This study aims to compare treatment outcomes in patients with Triple-Negative Breast Cancer (TNBC) and HER2-Positive Breast Cancer, evaluating clinical responses, survival rates, recurrence rates, quality of life (QoL), and adverse events. Materials and Methods: A total of 100 female patients were included, with 50 diagnosed with TNBC and 50 with HER2-Positive Breast Cancer. Data on demographics, treatment regimens, clinical outcomes, survival rates, recurrence rates, QoL scores, and adverse events were collected and analyzed. Results: Mean age was 52.3 ± 9.7 years for TNBC and 54.1 ± 10.2 years for HER2-Positive patients. Surgery was performed in 90% of TNBC and 85% of HER2-Positive patients. Chemotherapy was administered to all patients. Radiation therapy was given to 60% of TNBC and 65% of HER2-Positive patients. Targeted therapy was administered to 10% of TNBC and 95% of HER2-Positive patients. Complete response rates were 20% for TNBC and 35% for HER2-Positive patients. Partial response rates were 40% for TNBC and 45% for HER2-Positive patients. Progressive disease occurred in 15% of TNBC and 10% of HER2-Positive patients. Survival rates at various time points are provided in Table 4. The 1-year overall survival (OS) rate was 80% (40 patients) for TNBC and 90% (45 patients) for HER2-Positive patients. The 2-year OS was 60% (30 patients) for TNBC and 75% (38 patients) for HER2-Positive patients. Local recurrence was 30% for TNBC and 20% for HER2-Positive patients. Distant metastasis occurred in 40% of TNBC and 25% of HER2-Positive patients. Grade 3-4 neutropenia was reported in 25% of TNBC and 20% of HER2-Positive patients. Cardiotoxicity was observed in 5% of TNBC and 10% of HER2-Positive patients. Conclusion: HER2-Positive patients exhibited better clinical outcomes and survival rates than TNBC patients but had a higher incidence of cardiotoxicity. These findings underscore the need for tailored treatment approaches and vigilant monitoring of adverse events. Keywords: Triple-Negative Breast Cancer, HER2-Positive Breast Cancer, Clinical Outcomes, Survival Rates, Recurrence Rates, Quality of Life, Adverse Events.

Background: The challenges faced by the pilgrims who visit the cave are multifaceted. Firstly, the high altitude, rough terrain, harsh weather, lack of adequate health care infrastructure. Secondly the devotees/pilgrims come from all over India and also abroad. So there are different morbidity profiles, different language, lack of social support. Materials and Methods: A prospective study was carried out at SKIMS wherein all pilgrims of Shri Amarnath Ji Yatra who were referred to SKIMS from July-August 2023 were studied for their profile, cost expenditure and outcome of the treatment. Results: Out of total 146 patients received, 21(14.3%) were having cardiac symptoms and among those 21 patients, ten,[10] had to undergo interventional procedures. The stents were placed in 08 patients and dual chamber pacemaker in 02 patients. Conclusion: The present study shows that two groups of patients dominate; one with high altitude pulmonary edema and another with cardiac disease having acute coronary syndrome (ACS). It was seen that HAPE and ACS cases were handled well at the base camp. The no. of referred patients had decreased significantly in present study which may be attributed to better pre yatra health checkup and up gradation of health care facilities enroute Amarnath cave. Keywords: Amarnath ji, Pahalgam, Acute Coronary Syndrome.

Background: Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) worldwide. Identifying the incidence and risk factors for progression to ESRD in patients with diabetic nephropathy is crucial for effective clinical management. Objective: This prospective observational study aimed to determine the incidence and identify risk factors for progression to ESRD in patients with diabetic nephropathy. Materials and Methods: A total of 50 patients with diabetic nephropathy were recruited from 2018 to 2022 and followed for two years. Baseline demographic and clinical characteristics were collected. The primary outcome was progression to ESRD. Multivariate Cox proportional hazards regression analysis was used to identify significant risk factors for progression to ESRD. Results: The mean age of the patients was 60.4 ± 10.2 years, with 30 males (60%) and 20 females (40%). The average duration of diabetes was 15.8 ± 6.7 years. Baseline eGFR was 45.3 ± 12.6 mL/min/1.73 m², and baseline albuminuria was 430 ± 230 mg/g. During the follow-up period, 12 patients (24%) progressed to ESRD. Significant risk factors for progression included lower baseline eGFR (HR: 1.95; 95% CI: 1.12-3.42; p=0.01), higher baseline albuminuria (HR: 1.68; 95% CI: 1.03-2.75; p=0.04), and longer duration of diabetes (HR: 1.22; 95% CI: 1.05-1.41; p=0.02). Blood pressure control had a protective effect but was not statistically significant (HR: 0.75; 95% CI: 0.50-1.12; p=0.16). Glycemic control showed no significant association with progression to ESRD (HR: 0.98; 95% CI: 0.87-1.10; p=0.72). Conclusion: This study highlights the high incidence of progression to ESRD in patients with diabetic nephropathy and underscores the importance of monitoring baseline eGFR, albuminuria, and diabetes duration. Early interventions targeting these risk factors may reduce ESRD progression. Keywords: Diabetic nephropathy, End-stage renal disease, ESRD, Risk factors, eGFR, Albuminuria, Diabetes duration.

Background: To study and make a comparative analysis on knowledge, attitude, and practice pattern regarding eye donation amongst MBBS, BDS, Homeopathy and Nursing students in a tertiary care medical college hospital in Central India. Materials and Methods: It is a population based cross sectional study involving 369 MBBS & Paramedical students. A structured questionnaire including 21 questions divided in three sections assessing knowledge, attitude and practice pattern is noted. Chi square test is done for dependent and independent variables. Test performed at 95% confidence interval with p value <0.05 considered statistically significant. Results: Mean knowledge score was 3.875±2.185. MBBS students had a mean score of 5.150 (SD = 1.400, range 1-9) indicating a higher level of knowledge than other medical courses. Knowledge score among nursing students was the least 2.180 (SD = 2.222, range 0-7). Willingness to donate eyes also showed a significant association with knowledge (χ2=371.471, p<0.001). Conclusion: MBBS students had better knowledge than paramedic students. Higher knowledge is linked to positive attitude towards eye donation. The practice pattern regarding pledging is poor in all the students. Thus, structured eye donation awareness programmes targeting medical and paramedical students are recommended. Keywords: Eye Donation; Medical students; Corneal Blindness; Corneal Transplant; Awareness.

Background: Maternal near-miss known as severe maternal morbidity provides valuable information on obstetric care, hence allowing corrective action to be taken on the identified problems to reduce related morbidity and mortality. This study was conducted aiming to evaluate the maternal near-miss among women in a public tertiary hospital in Klang Valley, Malaysia. Material and Methods: A retrospective study was conducted for two years (from January 2010 until December 2011). Data were retrieved from the labour room and intensive care registry using the World Health Organization (WHO) near-miss evaluation tools based on clinical and management criteria. Results: There were 18 676 deliveries and 18531 live births with 160 near-miss cases and five maternal deaths during the study period. The prevalence of maternal near-miss morbidity was 0.86%, making maternal near-miss Ratio (MNMR) of 8.6 cases per 1,000 live births. Meanwhile, the Maternal Mortality Ratio (MMR) of 27/100 000 live births, the maternal near-miss mortality ratio (MNMMR) obtained was 32:1 and a relatively low mortality index of 3.03%. Hypertensive disorder (61.2%) and major obstetric haemorrhage (30.0%) were the two main causes of maternal near-miss morbidities followed by ICU admissions (20.6%). The hypertensive disorder primarily severe pre-eclampsia was found significantly associated with ICU utilisation (p=0.001). Conclusion: The quality of obstetric care received by maternal near-miss patients in urban Malaysia was optimal with a relatively low mortality index and comparable prevalence of maternal near-miss and mortality worldwide. Hypertensive disorders and obstetrics haemorrhage are the most common maternal morbidities in Malaysia. On top of that, sepsis is also an essential entity that needs to be emphasised in the future. Key words: Obstetrics near-miss, Maternal near-miss, Maternal Health, Maternal Mortalities, Severe Maternal Morbidity.

Background: Otitis media with effusion (OME) is a common childhood otological condition. The middle ear effusion is mucoid or seromucinous in nature, but not purulent. The condition lasts for at least 3 months; this sets it apart from persistent effusion after acute otitis media, which disappears after 2 months in 90% of cases. OME has a high prevalence in children and is responsible for most of the hearing losses in school going age group (5-12 years). Most cases of OME are relatively asymptomatic with nearly 25% discovered incidentally. Despite this apparent absence of symptoms, the potential impact on hearing, speech, language and cognition highlights the need for timely intervention. Aim: To estimate the risk factors associated with OME and to detect different types of microorganisms in the middle ear fluid of children with OME. Materials and Methods: A cross-sectional study was conducted on 458 children presenting with features of OME. A questionnaire was used to determine the risk factors for OME among these children. Otoscopy and tympanometry were used to diagnose and confirm OME. The pure tone average for children with OME was measured. Assessment of risk factors were done in all children. Myringotomy was performed in children with obvious fluid in the middle ear and a sample was sent for culture and sensitivity. Results: OME was highly linked with age less than 9 years in univariate analysis. The mean age of the sample was 8.71 years with the median age being 2.5 years. There are several risk factors related to OME, with nasal allergies (22.9%) and adenoid hypertrophy (22.9%) being the most prevalent. Middle ear fluid was sterile in 74.7% cases whereas 9% of the samples showed Streptococcus pneumoniae & Haemophilus influenzae as the microorganism. Conclusion: Nasal allergies and adenoid hypertrophy were the most common risk factors of OME in children less than 18 years. Otoscopy, tympanometry and pure tone audiometry should be used as screening tools for OME. Middle ear fluid was sterile in majority of cases and hence routine use of antibiotics for treatment of these cases is not recommended. Keywords: Adenoid hypertrophy, Otitis media with effusion, Serous otitis media, Tympanometry.

Background: Home-based prophylaxis is recommended for optimal management of hemophilia. However, barriers limit its implementation in developing countries like India. This study aimed to identify barriers to home therapy in India. Materials and Methods: A qualitative study was conducted through interviews of 20 participants including persons with hemophilia, caregivers, healthcare workers and volunteers. Participants were randomly selected and interviewed using a semi-structured guide. Data was analysed thematically to identify barriers. Results: Four major categories of barriers emerged - technical expertise in self-infusion, logistical challenges of home care, lack of motivation among patients and caregivers, and inadequate advocacy efforts. Difficulties finding veins, fear of improper injection, issues maintaining cold chain, and reluctance to start therapy due to complexity were reported. Discussion: Barriers identified align with previous studies from other developing nations. Addressing skills-training, logistics, motivation and advocacy through targeted interventions like enhanced education, counselling and community engagement can help optimize home therapy uptake. Conclusion: The study provides guidance on key barriers preventing optimal home prophylaxis in India to inform development of context-specific solutions. Keywords: Hemophilia, home therapy, prophylaxis, barriers, qualitative research.

Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in patients with Compound fractures. The purpose of this study was to determine the prevalence and risk factors of PTSD in patients with Compound fractures. A cross-sectional study was conducted in a Tertiary care hospital in India. Consenting patients with Compound fractures, aged 18 years to 70 years, were administered clinician administered PTSD scale (CAPS-5) pre and post operatively upto 6-month period. 109 patients were recruited for the study over 2 years. The prevalence of PTSD was 16.5% (18 of 109 patients). Factors increasing the risk of PTSD were Motor vehicle collision, Poly trauma, Higher VAS scale for pain. Keywords: PTSD, Compound fractures, prevalence, risk factors.

Background: Screen-time is the amount of time a person spends in front of an electronic/digital device such as television, a smartphone, a tablet or a computer. Objective: To study the impact of screen timeon children’s mental and physical health. Materials and Methods: This cross-sectional study was carried out in the Pediatric Outpatient Department to examine screen habits in 280 children between the ages of 1 and 5 years. Results: The study population had a mean age of 40.9 months, with females making up 63.57% of the participants and males accounting for 36.4%. A majority of the study participants belonged to the lower middle-class category, comprising 44.6% of the sample. Older children (48 - 60 months) exhibited higher levels of electronic media exposure compared to younger age groups (12-24 months) (p< 0.001). Minimal high media exposure time was observed in males compared to females (p=0.048). Conclusion: The most commonly used electronic media devices in the population were smartphones (95.7%) and televisions (98.5%). On average, families had 3.37 ± 0.79 electronic media devices. Higher electronic media exposure was noted in the upper and upper-middle socioeconomic groups compared to other socioeconomic categories (p<0.001). Keywords: Screen Time, Neurodevelopment, Sleep, Behavior and Health, Children Aged 1-5 Years.

Background: Thalassemia is a genetic blood disorder in children that results in the production of abnormal hemoglobin, leading to severe anemia and the need for frequent blood transfusions. Without proper management, these transfusions can cause iron overload in the body, which can damage vital organs such as the heart and liver. Therapy with oral iron chelators is crucial for these children, as it helps to remove the excess iron and prevent potential complications. The aim of this study was to assess and compare the effectiveness and safety of oral iron chelators, both when administered alone and in combination, in children with thalassemia who receive several blood transfusions. Materials and Methods: The study was carried out in the Department of Pediatrics, Sri Balaji Medical College and Hospital, over a period of ¬¬¬¬24 months. The study included 75 children with thalassemia who had undergone several transfusions and were receiving daily treatment with iron chelation. Results: The current study included 75 children with thalassemia who had received multiple blood transfusions. For duration of 12 months, they received daily iron chelation therapy with either deferiprone alone (Group 1), deferasirox alone (Group 2), or a combination of the two (Group 3). The serum ferritin levels were found to be reduced in all 3 groups, however the difference was not significant. The hepatic T2- MRI values had increased from baseline to follo-up, however the difference was significant only in Group 3. The reduction of cardiac T2* MRI value was significantly reduced in Group 3 from baseline to follow-up. Conclusion: This study concluded that deferiprone and deferasirox were effective and safe when administered alone in children with thalassemia who had received several transfusions. Keywords: Children, thalassemia, safety, innovative combination, and comparative efficacy.

Background: When an alpha 2 adrenergic agonist and a local anesthetic are coupled, the analgesic effect's quality and endurance are enhanced. While clonidine's effects on local anesthetics have been thoroughly investigated, there aren't many studies that show how epidural dexmedetomidine affects the same. Materials and Methods: The patients were randomly assigned to two groups, one receiving ropivacaine with clonidine (RC) and the other receiving ropivacaine with dexmedetomidine (RD), Group RC was administered 15 ml of 0.75% ropivacaine with 1 microgram per kilogram of clonidine, while group RD was given 15 ml of 0.75% ropivacaine with 1 microgram per kilogram of dexmedetomidine epidurally. Results: The dexmedetomidine group showed significantly improved start (RD-7.53 ± 1.81, RC-10.93 ± 1.96) and duration (RD-317 ± 29.5, RC-285 ± 37) of sensory blockade sedation. Hemodynamic alterations and the start of motor blockage did not differ significantly. Conclusion: Similar to clonidine, dexmedetomidine works as an efficient adjuvant to ropivacaine for epidural anesthesia at doses of 1 ⃬g/kg. Keywords: Clonidine, dexmedetomidine, epidural, ropivacaine.

Background: Road traffic accidents (RTA) are major causes for morbidity, mortality and disability among all age group and people of all socioeconomic status. Considering the increased number of people using motorized vehicle leading to rise in road traffic accidents, our cross-sectional study conducted in a tertiary care hospital in northern Karnataka, India Materials and Methods: A pre-designed semi-structured questionnaire for duration of six months aimed to study the socio demographic profile of road traffic injury victims, to find the antecedent factors influencing the road traffic accidents and also to study the pattern of injury in victims. Results: Total of 516 patients were included in the study. In our study we have found that human error is the most common factor responsible for accident 43.4% followed by drunk and drive 30.6% and most of the accidents occurred in highway 21.1% and drivers are most commonly the victims of accident 69.2%. We have also found that skid is the most common manner of accident. It is very alarming to see that only 33.7% of the participants had valid driving licence. Also, among the people who rode two-wheeler only 7% wore helmet and among persons who drew four-wheeler only 10% wore seat belt. Conclusion: Most participants were male (86%), mostly from rural areas (70.3%), and lived with their families (88%). The findings highlight the need for better road safety measures, stricter traffic regulations, increased public awareness, and improved infrastructure to reduce road traffic accidents. Keywords: Road traffic accidents, Causes, Risk factors, Human error, Drivers.

Background: Women of reproductive age play a crucial role in determining maternal and child health, yet they face significant health challenges such as iron deficiency anemia (IDA) and the double burden of malnutrition. The present study aimed to assess the effect of positive attitudes, subjective norms, perceived behaviour control, and intentions of mothers (15-49 years) on their dietary intake in two districts of India. Materials and Methods: A cross-sectional study was conducted in South-West Delhi and Gurugram, India, among mothers aged 15-49 years. A total of 337 women per district were surveyed using systematic random sampling. Data were collected on socio-economic profiles, healthy eating intentions, and dietary diversity through a semi-structured questionnaire. The dietary diversity score was calculated based on the consumption of at least five out of ten food groups in the past 24 hours. The study employed generalized linear regression models to assess the effects of positive attitude, subjective norms, intentions, and perceived behavioural control on dietary intake, adjusting for age, income, social class, and education. Results: The median age of mothers was 26 years, with a median monthly income of INR 15,000. About 15% of mothers had a dietary diversity score of less than five. All the parameters (positive attitudes, subjective norms, intentions) had positive correlation with dietary intake. There was a 0.19-point increase in the dietary diversity score per one-unit increase in the intentions of the mothers. Conclusion: The study highlights the importance of perceived behavioural control, positive attitudes, subjective norms, and intentions in influencing the dietary intake of mothers. These results highlight the importance of understanding the influence of social and behavioural factors on dietary practices to design effective nutritional interventions and policies. Keywords: Dietary habits, Nutritional status, Behavior, Intentions.

Background: Diabetes mellitus (DM) poses a significant public health challenge in the twenty-first century. With an estimated global prevalence of 537 million in 2021, this figure is expected to rise dramatically. India ranks second after China in the global diabetes epidemic, with millions remaining undiagnosed for years. Lack of awareness, particularly in regions with low socioeconomic status and limited access to quality education, exacerbates the problem, often leading to complications such as retinopathy, nephropathy, and neuropathy. Aim: This study aims to assess the level of awareness and knowledge about DM and its complications, treatment options, lifestyle modifications, and self-monitoring among diabetic patients in Puri, Odisha. Materials and Methods: A hospital-based cross-sectional study was conducted at Shri Jagannath Medical College and Hospital, Puri, Odisha, from August 15 to October 15, 2022. A total of 211 patients with a prior diagnosis of DM participated. Data were collected using a structured questionnaire covering demographic information, knowledge, and awareness of DM. Analysis was performed using SPSS version 22.0, with categorical data presented as percentages and frequencies, and the mean age of diabetes onset expressed as mean ± standard deviation. Results: The study included 211 patients, predominantly aged 51-60 years (24%), with a mean age of 53.3 ± 16.4 years. The prevalence of diabetes was higher in males (55.5%) than females (44.5%). Most participants were from rural areas (59%). Educational levels varied, with 32% having completed high school, 27% middle school, 25% illiterate, and 16% graduates. Regarding awareness, 84% knew diabetes involves elevated blood sugar levels, and 79% recognized common symptoms. However, only 41% were aware of diabetes complications, and 18% knew hypoglycemia symptoms. Discussion: Despite recognizing symptoms and understanding basic disease mechanisms, patients' knowledge about complications and treatment options was limited. Many patients held misconceptions about the disease, including the belief that diabetes could be permanently cured (67%) and that it is caused by excessive sugar intake (84%). These misconceptions highlight the need for better education and awareness programs. Conclusion: The study reveals a significant lack of knowledge and awareness about DM among patients in Puri, Odisha. Misconceptions about the disease and a shift towards alternative medications pose risks for severe complications. There is an urgent need for community-based awareness campaigns and educational initiatives to promote early diagnosis and effective management of diabetes. Keywords: Diabetes mellitus, awareness, knowledge, complications, treatment, lifestyle modifications, Hospital based.

Background: Endometriosis is a chronic estrogen dependent condition involving deposition of ectopic endometrial-like tissue, typically on the ovaries, pelvic peritoneum, and sometimes extra-pelvic regions. Despite being one of the common causes of infertility, endometriosis often remains underdiagnosed and imposes considerable emotional and financial burdens on those affected. Materials and Methods: 80 patients presented to the OPD of Department of Obstetrics and Gynaecology of Shadan Institute of Medical Science, over 12 months period, i.e., from January 2023 to December 2023. Results: The prevalence of endometriosis in present study was 35%. Most of the patients with endometriosis belonged to the age group of 31-40 years. Ovaries, followed by Pouch of Douglas were the most common sites of endometrial implants. Most of the patients had Stage III (moderate) endometriosis. Out of 28 patients, 26 patients underwent laparoscopic ablation and 2 were on conservative treatment. 16 patients reported successful pregnancies after treatment (20%). Conclusion: The study concludes that early detection and management of endometriosis is associated with higher rates of successful conceptions. Keywords: Endometriosis, infertility, adhesions, tubal blocks.

Background: Preterm rupture of membranes (PROM) refers to the breaking of the amniotic sac and leaking of amniotic fluid before labor begins, specifically before 37 weeks of gestation in the case of preterm PROM (PPROM). This condition is associated with several adverse maternal and neonatal outcomes, including infection, preterm birth, and complications related to prematurity. High vaginal swab culture (HVSC) is a diagnostic procedure used to detect and identify microorganisms in the vaginal flora. Owing to the scarce literature on the relationship between HVSC results and feto-maternal outcomes following PROM, this study was conducted to evaluate the same. Materials and Methods: 100 antenatal women who presented to the Labour room in the Department of Obstetrics and Gynaecology, Shadan Institute of Medical Sciences with PPROM and PROM, over 18 months, i.e. from 1st July 2022 to 30th November 2023, were studied. Results: most of the women belonged to 20-30 years of age group. 30% of women had a positive result for high vaginal swab (HVS) culture and sensitivity. The most common organism isolated in present study was E.coli, followed by Klebsiella. Most of the neonates had normal birth weight. 30% of the neonates required NICU admission. Conclusion: Premature rupture of fetal membranes is associated with increased risk of intrauterine infection, and it has been one of the most common causes of perinatal deaths and NICU admissions. Keywords: Preterm rupture of membranes, high vaginal swab, vaginal flora, neonatal sepsis, neonatal NICU.

Background: The study aims to assess the heart rate variability in non-dialysis chronic kidney disease patients. Materials and Methods: This was a cross-sectional study, carried out in the Department of Physiology, Dr RMLIMS, Lucknow. 102 patients in the age group of 30-60 years, having chronic kidney disease but not on dialysis were taken from the OPD of Nephrology. Samples were collected and serum was analyzed for lab parameters like creatinine, and blood urea. eGFR was calculated. HRV of the patient was done in the physiology department. Results: A total of 102 patients fulfilling both criteria were enrolled in the study. The mean age was 45.44±11.13 years. Males constituted of 65.7% of the study population, while female were mere 34.3%. In terms of Blood pressure, SBP and DBP of the study population were 140.92±20.75 mmHg and 82.32±15.13 mmHg. Respiratory rate was 14.28±2.56 breaths per minute. At the first visit, kidney function was accessed using Urea, Creatinine, and eGFR and was recorded as 67.78±33.97 mg/dL, 2.82±1.73 mg/dL, and 36.35±24.58 respectively. Majority of the patients had reduced HRV (73.5%), while the remaining had HRV within the normal range (26.5%). Conclusion: HRV, a non-invasive tool can be used for assessment of autonomic dysfunction in chronic kidney disease who are not on dialysis. Lower HRV has been associated with adverse outcomes in end-stage renal disease (ESRD). Hence the estimation of LF/HF can provide prognostic information on CKD progression and in its management. Keywords: Creatinine, Urea, Heart Rate Variability, Estimated Glomerular Filtration Rate, Chronic Kidney Disease.

Background: Hospital-acquired infections (HAIs) are a significant concern in intensive care units (ICUs), leading to increased morbidity, mortality, and healthcare costs. This study aims to determine the incidence, types, risk factors, and outcomes of HAIs in the ICUs. Materials and Methods: A prospective observational study was conducted, including 100 patients admitted to the ICUs for more than 48 hours. Data on patient demographics, clinical details, and infection monitoring were collected. Statistical analysis, including univariate and multivariate methods, was used to identify risk factors for HAIs. Results: The incidence of HAIs was 30%, with Ventilator-Associated Pneumonia (VAP) being the most common (40%). Other infections included Catheter-Associated Urinary Tract Infections (CAUTIs) (30%), Central Line-Associated Bloodstream Infections (CLABSIs) (20%), and Surgical Site Infections (SSIs) (5%). Significant risk factors for HAIs included prolonged ICU stay (p = 0.02), use of invasive devices (p = 0.01), broad-spectrum antibiotic use (p = 0.03), and comorbidities (p = 0.04). Patients with HAIs had longer ICU stays (15 vs. 8 days, p = 0.01), higher mortality rates (25% vs. 10%, p = 0.03), and more complications (30% vs. 5%, p = 0.02). Conclusion: The study highlights a high incidence of HAIs in ICUs, with significant impacts on patient outcomes. Targeted interventions and stringent infection control measures are essential to mitigate these infections. Keywords: Hospital-acquired infections, Intensive care units, Ventilator-associated pneumonia, Risk factors, Outcomes, Infection control.

Background: Peripheral arterial disease (PAD) generally occurs as a result of progressive narrowing of arteries within the lower extremities and is a manifestation of systemic atherosclerosis. We define PAD with the aid of using the dimension ankle-brachial index (ABI) which is the most accurate tool and determination of ABI is a simple non-invasive procedure that can be easily performed on an outpatient basis. The cut-off point for diagnosis of peripheral arterial disease (PAD) & cardiovascular risk is ABI ≤ 0.90 or ≥ 1.30. Materials and Methods: This cross sectional study involves 47 newly diagnosed hypertensive patients of age between 30-50 years. Anthropometric measurements and ABI of all the patients were done in the research lab of the Physiology department. The ABI measurements were performed by using an automated oscillometric device (Watch BP Office, Microlife, Widnau, Switzerland). In this procedure, the blood pressure was measured simultaneously on both arms followed by both ankles in the supine position. Results: In our study out of 47 patients, 31 (66.0%) were male and 16 (34.0%) were female of mean age 43.79±6.82 years. The prevalence of deranged ABI in the present study was 10.64% according to Right ABI, while it was 6.38% according to Left ABI. A significant correlation was found for ABI in the Right ankle with SBP in the right upper limb (P=0.013) & both right and left lower limb (P˂0.001 & P=0.028 respectively), while a significant correlation was also found for Left ABI with SBP in both right and left upper limbs (P=0.007 & P=0.003 respectively). We also found that 29.8% of the subjects have a low normal value of ABI (i.e., between 0.9-1.1), this is significant, even in asymptomatic patients, for Peripheral Arterial Disease (PAD). Conclusion: So we can conclude that in newly diagnosed hypertensive patients, ABI are valuable tools for early detection of cardiovascular damage. By identifying subclinical changes before symptoms arise, healthcare providers can implement early, targeted interventions to manage hypertension more effectively and reduce the risk of long-term complications. Keywords: Ankle brachial index, newly diagnosed hypertensive patients, peripheral arterial disease.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterized by dopamine deficiency which leads to classical motor dysfunctions. In addition, Parkinson’s disease may include several non-motor impairments, including autonomic and cardiovascular dysfunction. At present clinical diagnostic criteria for Parkinson’s disease are exclusively based on motor symptoms and the treatment for Parkinson’s disease mainly improves motor symptoms. Non motor symptoms, especially autonomic symptoms are still under recognized in clinical practice. The current study aimed to evaluate these autonomic functions by using Heart Rate Variability (HRV) and Composite Autonomic Symptom Score 31 questionnaire (COMPASS 31). Materials and Methods: This cross-sectional study included 137 diagnosed cases of PD. The resting autonomic balance was assessed by HRV test which included frequency domain indices, time domain indices and nonlinear parameters. Non motor symptoms were assessed by using COMPASS 31 questionnaire which evaluated six domains namely orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder and pupillomotor domains. The six domain scores sum to a total score of 0 to 100 with a higher score indicating more severe autonomic symptoms. Results: The participants showed a sympathetic overdrive on assessing with HRV. Among the non-motor symptoms gastrointestinal symptoms were the most common symptoms (95.62%) in Parkinson’s disease patients. Subsequently there was involvement of secretomotor (85.4%), bladder symptoms (71.53%), pupillomotor symptoms (52.55%), orthostatic intolerance symptoms (50.36%) and vasomotor symptoms (13.14%) on evaluating autonomic functions by COMPASS 31 questionnaire. A statistically significant correlation was observed between HF (ms2) and COMPASS 31 questionnaire (p<0.05). Conclusion: The autonomic function tests can be used as a screening tool in outpatient department of Neurology. This could reduce the morbidity of Parkinson’s disease patients as we employ these autonomic function tests as an early intervention for Parkinson’s disease. COMPASS 31 questionnaire can be used in health care centres for early detection of neurodegenerative disorders like Parkinson’s disease which could prevent the disease progression and aid in early treatment plan. Keywords: Parkinson’s disease, neurodegenerative disorder, autonomic function test, HRV, COMPASS 31 questionnaire.

Background: Intercondylar humerus fractures significantly impact patients' quality of life, with traditional treatment methods often resulting in prolonged immobilization and suboptimal recovery. Orthogonal plating has emerged as a technique that may offer enhanced stability, potentially allowing for earlier mobilization and improved outcomes. Material and Methods: A retrospective and prospective analysis was conducted at Indira Gandhi Medical College, Shimla, involving 22 patients with intercondylar humerus fractures treated with orthogonal plating. This study aimed to assess the impact of early mobilization on functional recovery, analyzing range of motion, Mayo Elbow Performance Score (MEPS), and persistent pain at final follow-up. Results: Early mobilization following orthogonal plating showed significant improvements in functional outcomes. The majority of patients (59.1%) achieved a range of motion between 80-100 degrees, and 50.0% reported good MEPS scores. Pain levels were predominantly mild, with 50% of patients reporting no pain at final follow-up. The interval between injury and surgery was inversely related to pain and directly correlated with range of motion and MEPS scores, highlighting the benefits of early surgical intervention and rehabilitation. Conclusion: Orthogonal plating, combined with early mobilization, significantly optimizes functional recovery in patients with intercondylar humerus fractures. This study supports the adoption of early mobilization protocols to enhance the quality of patient outcomes. Keywords: Intercondylar humerus fractures, orthogonal plating, early mobilization, functional recovery, rehabilitation strategies.