Current Issue

Background: Recent TB reports worldwide and from India highlight a demographic shift of TB incidence towards the elderly population. The treatment response and tolerance to treatment regimen in elderly population may differ from younger population as tuberculosis in older individuals. This is due to a multitude of factors including age related co morbidity, poor tolerance to drugs, decreased lung function and chronic underlying inflammation due to aging among many others. These distinct presentations have prompted further research to propose treating tuberculosis in the elderly as a distinct entity. Objectives: To study the elderly TB population through acceptance and response to treatment and compare it to non-elderly (<60yrs age). Material and Methods: The study was conducted in a tertiary care centre- in Bareilly, Uttar Pradesh- India .110 elderly and 91 non elderly pulmonary TB(PTB) patients were included in the study. Various treatment acceptance and responses were studied and compared to the young age group. Results: We observed that the elderly group had a higher incidence of intolerance i.e- 20.91% elderly vs 6.9% adults’ experienced drug-induced liver injury, while 12.73% elderly cases showed symptoms of acute kidney injury, 9.09% aging population experienced joint pain, and 25.45% reported tingling sensations. Adult non elderly group reported more gastrointestinal issues (20% vs 10.99%) and vision disturbances (1.82% vs 1.1%).Outcomes for the treatment were mostly favourable and comparable in both the groups. Majority, i.e. 84% elderly and 86% adults resulted in either cure or completion of treatment, while 13 cases (9.09% elderly and 3.3% adults) unfortunately ended in death. AdditionallyMaterial and Methods: The study was conducted in a tertiary care centre- in Bareilly, Uttar Pradesh- India .110 elderly and 91 non elderly pulmonary TB(PTB) patients were included in the study. Various treatment acceptance and responses were studied and compared to the young age group. Results: We observed that the elderly group had a higher incidence of intolerance i.e- 20.91% elderly vs 6.9% adults’ experienced drug-induced liver injury, while 12.73% elderly cases showed symptoms of acute kidney injury, 9.09% aging population experienced joint pain, and 25.45% reported tingling sensations. Adult non elderly group reported more gastrointestinal issues (20% vs 10.99%) and vision disturbances (1.82% vs 1.1%).Outcomes for the treatment were mostly favourable and comparable in both the groups. Majority, i.e. 84% elderly and 86% adults resulted in either cure or completion of treatment, while 13 cases (9.09% elderly and 3.3% adults) unfortunately ended in death. Additionally, 4.55% cases were classified as treatment failures in elderly compared to 3.3% adults. Conclusion: The study reflects a positive acceptance in the majority for the standard anti tubercular regimen but reflects a poor drug tolerance in the elderly. Despite this comparable and favourable treatment completion/ cure rates were seen. It highlights the effectiveness of standard regimen in both the groups and a need for tailored approach in future for the elderly with poor tolerability.

Background: “The reproductive changes in women exhibit cyclical changes that occur regularly over a period of about one month. This is called menstrual cycle”. Women continually experience fluctuation in estrogen (being higher in follicular phase) and progesterone (being higher in luteal phase) during their menstrual cycle. The cyclic hormonal changes not only bring about changes in the reproductive system but also affects a variety of physiological processes like respiratory system, cardiovascular system and musculoskeletal system. Variation in functional parameters of respiratory system may be related to fluctuation in the hormonal levels during the different phases of menstrual cycle. Aims and objective: Spirometric evaluation of FVC, FEV1, FEV1/FVC, PEFR, FEF25%, FEF50%, FEF75%, FEF25-75% in follicular and luteal phase. And to compare the status of lung function between follicular and luteal phase of menstrual cycle. Material and Methods: 100 young females in age group of 18-24 years having regular menstrual cycle were selected amongst medical students, paramedical students of Gauhati medical college, Guwahati. Spirometric parameters were evaluated in follicular and luteal phase. Results: spirometric evaluation shows FVC, FEV1, FEV1/FVC were significantly higher(p<0.01) in luteal phase than in follicular phase. There was also increased PEFR and FEF25-75% (P<0.01) in luteal phase compared to follicular phase. Conclusion: In the present study, the observed improvement in lung function profiles in the luteal phase compared to follicular phase and with the limitation of measurement of hormonal levels, suggest that progesterone probably involved in increased ventilation during luteal phase. Key Words: Menstrual cycle, progesterone, follicular and luteal phase

Background: Obstructive sleep apnea (OSA), also known as sleep disordered breathing (SDB), is a highly prevalent though under-recognized public health problem. It is characterized by repetitive episodes of upper airway collapse and consequent hypoxemia during sleep and associated with recurrent oxygen desaturation and arousals from sleep. The coexistence of OSA and MS, heightens cardio-metabolic risks. OSA prevalence is higher among patients with MS as reported by many studies. Material and Methods: This prospective cohort study aimed to assess the association between obstructive sleep apnea (OSA) and metabolic syndrome (MS). The study was Conducted in the neurology department of a tertiary care medical college and included 50 patients diagnosed with OSA (Apnea-Hypopnea Index >5/h and daytime symptoms). MS was defined using International Diabetes Federation criteria. Body composition, metabolic parameters, and sleep apnea severity were evaluated. Statistical analysis was performed using SPSS 23.0 with p <0.05 considered as statistically significant. Results: Out of 50 studied cases there were 34 (68%) males and 16 (32%) females. There was a male preponderance with M:F ratio of 1:0.47. The mean age was 51 +/- 12.34 years. Hypertension was significantly more prevalent in severe OSA cases (p=0.020). Dyslipidemia was notably associated with OSA severity and gender, with males showing higher prevalence (p=0.041). AHI ≥10 was significantly correlated with higher Epworth Sleepiness Scale (ESS) scores (p=0.001), and ESS >10 was linked to severe OSA (p<0.01). The STOP-BANG score positively correlated with AHI (p=0.01), indicating its utility in predicting OSA severity. Conclusion: There was a significantly higher incidence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients compared to the general population. There is a need for screening OSA patients for MS to enable early detection and intervention, thereby preventing complications associated with delayed diagnosis. Key Words: Obstructive Sleep Apnea, Metabolic Syndrome, Hypertension, Dyslipidemia.

Background: Fetal biometry (including biparietal diameter, head circumference, abdominal circumference and femur length) is typically used for gestational age estimation but has limitations in cases of fetal anomalies or uncertain dating. Placental thickness can be used as an independent marker for gestational age. It correlates strongly with pregnancy progression and is less affected by fetal abnormalities. This study investigates its utility in the second and third trimesters. Material and Methods: This observational study analyzed the utility of placental thickness as an independent marker for gestational age estimation in 80 pregnant women during their second and third trimesters. In call cases detailed history including menstrual history was obtained. Ultrasound evaluation and placental imaging were conducted to assess placental thickness and characteristics. Placental thickness was measured at the mid-placental level and correlation between placental thickness and gestational age was analysed. SSPS 23.0 software was used for statistical analysis and p value less than 0.05 was taken as statistically significant. Results: The majority of cases enrolled in the study were aged between 18-25 years (37.5%) with a mean age of 27.28 ± 5.20 years. Most pregnancies were between 25-30 weeks of gestation (35.83%), and anterior placental location was most common (46.67%). Placental thickness showed a strong positive correlation with gestational age during 13-24 weeks (R=0.9818) and 25-37 weeks (R=0.9948). This correlation was found to be statistically highly significant (P<0.00001). In late-term pregnancies (38-42 weeks) a moderate negative correlation (R=-0.7135) was observed but it was statistically insignificant (P=0.176). Conclusion: Placental thickness showed a strong positive correlation with gestational age during 13-37 weeks making it a reliable marker for gestational age estimation. However, this relationship weakened and became insignificant in late-term pregnancies (38-42 weeks). Key Words: Gestational Age Estimation, Placental Thickness, Fetal Biometry, Ultrasound.

Background: Diabetes mellitus (DM) is a chronic condition which is characterized by persistent hyperglycemia. Long standing DM may lead to metabolic dysregulation and end-organ damage. Type 2 diabetes mellitus (T2DM) is associated with microvascular and macrovascular complications such diabetic neuropathy and cognitive dysfunction. Cognitive impairment in T2DM is linked to hyperglycemia insulin resistance and neuroinflammation. Material and Methods: This comparative observational study involved 50 Type 2 Diabetes Mellitus (T2DM) patients and 50 age-matched healthy controls. Assessment of cognitive function was done using the Mini-Mental State Examination (MMSE). Demographics, duration of diabetes, presence of other co-morbidities and glycemic control (HbA1c) were recorded. MMSE score was used to assess cognitive function. Both the groups were compared and correlated with diabetes-related factors such as HbA1c and duration of disease. P value less than 0.05 was considered as statistically Significant. Results: Gender and age distributions were comparable in both the groups. Most participants were between 51-60 years of age. Group A (Individuals with T2DM) demonstrated significantly lower MMSE scores across cognitive domains except for registration. The total MMSE score was notably higher in Group B (27.9 ± 2.1) as compared to Group A (25.4 ± 2.2) and the difference was statistically significant (P<0.05). Greater cognitive decline was seen in T2DM patients with Poor glycemic control (HbA1c > 7%) and individuals with longer diabetes duration. Conclusion: Cognitive dysfunction is a common complication of Type 2 Diabetes Mellitus. Early detection and effective management of glycemic levels are crucial to prevent significant cognitive impairment and improve patient outcomes. Regular cognitive assessments should be conducted in individuals with type 2 diabetes mellitus (T2DM), particularly in cases of poor glycemic control or a long duration of the T2DM. Key Words: Cognitive Dysfunction, Diabetic Neuropathy, Glycemic Control, Type 2 Diabetes Mellitus.

Background: Surya Namaskar is a physically and mentally beneficial practice that can have meditative and relaxing effects when done with mindfulness. Practicing Yoga – Surya Namaskar may improve balance by decreasing sympathetic dominance and raising parasympathetic activity. Objectives- Present study was undertaken to understand how Surya Namaskar promotes autonomic balance and contributes to general health by combining physiological tests and subjective measures of well-being. Material and Methods: After taking clearance from institutional ethical committee, this comprehensive study was conducted on sixty healthy volunteers aged 18-22 years. Considering the exclusion &inclusion criteria, they were randomly selected from the Subharti University Campus. Autonomic function tests, including cardiovascular responses to various stimuli, were conducted pre and post-intervention to Surya Namaskar. A series of tests - BP, HR, HRV, HGT, CPT, LST, Valsalva maneuver, Deep breathing test were performed to assess the physiological and biochemical aspects of autonomic function. Results & Conclusion: Our study showed that performing Surya Namaskar for three weeks significantly lowers HR, DBP and SBP. In Time domain measures of HRV the SDNN, RMSSD and CV shows significant improvement, while pNN50 and NN50 were insignificant. On the other hand the frequency domain measures of HRV all are insignificant. In case of Sympathetic reactivity measures HGT is highly significant, CPT is simply significant and LST is non-significant. While considering the Parasympathetic reactivity measures only VM is highly significant. Lastly concluded that Regular practice of Surya Namaskar can be a helpful non-pharmacological intervention for people at risk of hypertension and cardiovascular problems since it improves parasympathetic activity, lowers stress, and decreases sympathetic reactivity when practiced regularl. Key Words: Surya Namaskar, ANS.

Background: Perioperative fluid management plays a critical role in optimizing patient outcomes. Hydroxyethyl Starch (HES) and crystalloid solutions are commonly used for fluid resuscitation in surgical patients. This study aimed to compare the effects of HES and crystalloid solutions on clinical outcomes, including blood glucose levels, postoperative complications, and recovery metrics, in patients undergoing surgery. Material and Methods: A total of 92 patients were enrolled in this prospective, randomized study, with 46 patients receiving HES and 46 receiving crystalloid solutions for fluid resuscitation. Baseline characteristics, intraoperative fluid volumes, postoperative complications, and recovery times were compared between the two groups. Data on blood glucose levels, wound infection, nausea/vomiting, and other complications were also collected. Statistical analysis was performed using independent t-tests and chi-square tests where appropriate. Results: The total volume of fluid administered was significantly higher in the HES group (1051.2 ± 225.3 mL) compared to the crystalloid group (951.1 ± 212.7 mL, p = 0.045). However, there were no significant differences in postoperative outcomes, including blood glucose levels, complication rates (e.g., wound infection, nausea, respiratory distress), and recovery metrics (time to mobilization, oral intake, hospital stay). The incidence of hyperglycemia was higher in the crystalloid group (15.2%) compared to the HES group (8.7%), though the difference was not statistically significant (p = 0.391). Conclusion: The use of HES for perioperative fluid resuscitation results in higher total fluid volumes compared to crystalloid solutions but does not significantly impact postoperative recovery, complication rates, or blood glucose control. Both fluid types appear to be safe and effective, with no notable differences in clinical outcomes. Further research with larger sample sizes is needed to explore long-term effects and patient-specific factors that may influence fluid choice. Key Words: Hydroxyethyl Starch, Crystalloid Solutions, Perioperative Fluid Management, Blood Glucose, Postoperative Complications.

Background: Knee injuries are a common clinical concern, particularly in active and young individuals. Magnetic Resonance Imaging (MRI) has emerged as a valuable, non-invasive diagnostic modality for detecting soft tissue injuries in the knee joint, complementing and sometimes substituting for diagnostic arthroscopy, the gold standard. This study aims to assess the burden of knee injuries and determine the prevalence of specific soft tissue injuries using MRI. Material and Methods: This observational study included 100 patients with recent knee joint trauma presenting to a tertiary healthcare center. MRI findings were analyzed to identify and quantify ligament, meniscal, and other soft tissue injuries. Descriptive statistics were used to summarize the findings. Results: Among the 100 patients, males predominated (76%) with a male-to-female ratio of 2.6:1. The most common age group affected was 21-30 years (32%). Right knee injuries (56%) were more common than left knee injuries (44%). Anterior cruciate ligament (ACL) tears were the most frequently observed injury (64%), followed by medial meniscus tears (32%), medial collateral ligament injuries (25%), and medial patellofemoral ligament injuries (20%). Posterior cruciate ligament (PCL) injuries were less common (9%), with PCL avulsion being the predominant subtype. These findings are consistent with previous studies, including those by Radhakrishnan et al. and Chowdhary et al., which reported similar trends. Conclusion: MRI plays a pivotal role in diagnosing knee joint injuries, providing accurate visualization of ligament and meniscal tears, particularly ACL injuries, which were the most prevalent in this study. The findings reaffirm MRI as an indispensable diagnostic tool for knee trauma management, enabling precise treatment planning and minimizing unnecessary surgical interventions. However, further large-scale, multi-center studies are warranted to enhance the generalizability of the results. Key Words: Knee injuries, MRI, ACL tear, PCL injury, meniscal injuries, soft tissue trauma.

Background: World’s adolescent population is about 1.2 billion. India has the largest adolescent population in the world: 253 million. In India, adolescents (10-19 years) constitute 21.4 percent of the population, comprising one fifth of the total population. The health status of the adolescence is an index of the national investment in the development of its future manpower. Many epidemiological surveys on school going children and adolescents have reported a wide variation (20-33%) in the prevalence of Psychosocial problems. Individual studies illustrated the prevalence of psychosocial problems ranging between 10-40%. Early diagnosis by primary care physicians and prompt referral to the specialist is very important for controlling it. As there are less studies conducted in this area, with this above background there is need for the study. Aims & Objectives: 1. To assess the prevalence of psychosocial problems among adolescents using Youth-paediatric symptom check list. 2.To study factors associated with psychosocial problems. Materials and Methods: This Cross sectional study was conducted in hyderabad, Telangana, India, from government and private schools & colleges by using multistage random sampling, required number of students were selected. A Pre designed, pre tested, structured questionnaire, Youth-paediatric symptom check list was used as study tool. Data was entered using Microsoft Excel 2010 version and analyzed using Epi-Info version 7.2. Results: Out of456, 400 were girls 56 were boys. Among 456 study subjects 103(22.5%) were found to be at risk using YPSC questionnaire. Prevalence of psychosocial problems was 22.5 %( 103) among those the prevalence among girl students and boys students was 25.3%and 68.9% respectively. Among 10 obese study subjects, 4 were having psychosocial problems, Out of 33 overweight study subjects, 8 were having psychosocial problems. Among 158 underweight study subjects 36 were having study subjects. Among 255 study subjects of normal weight 55 were having psychosocial problems. Conclusion: It was found that present study shows significant association between Psycho social problems and Gender, Socioeconomic class and Parents educational status. However no association has been found between Psycho social problems and No. of siblings, BMI. Keywords: Adolescents, Psychosocial, Youth Pediatric Symptom Checklist.

Background: HIV is primarily spread through intravenous drug use while sharing needles and syringes, through heterosexual and intersex sexual contact, through blood and blood products, through breast milk, and occupational exposure to laboratory and healthcare workers. Objectives: 1. To study the spectrum of neurological manifestations in HIV-infected subjects at various levels. 2. To study the correlation of neurological manifestations with CD4 count in these subjects. Material and Methods: Hospital-based prospective cross-sectional study. Study area: Department of General Medicine, Study Period: 1 year. Study population: Patients admitted to the General Medicine Nimra Institute of Medical Sciences wards, Vijayawada, Andhra Pradesh. Sample size: The study consisted of a total of 100 subjects. Sampling Technique: Simple Random sampling. Study tools and Data collection procedure: HIV patients admitted in a tertiary medical college were chosen for the study. A random selection of patients was made in whom a detailed history and clinical evaluation, including the mini-mental score (MMSE), was done after informed consent from the patient or relative. Results: The mean CD4 Count of the patients who expired was 108.38. The mean CD4 count of the patients who improved were 231.78 and 268.60. There is a statistically significant correlation of CD4 count among patients who expired (P-0.003**). There were 10 Patients diagnosed with TB Meningitis. CD4 Count for one Patient was not done as the patient died before blood was taken for CD4 count. The mean CD4 count of patients with TB Meningitis in the study group was 120.88, and the mean CD4 count of patients without neurological manifestations was 225.02. Statistically significant differences in CD4 count were observed between the two groups. (P-0.025*). Conclusion: The incidence of neurological illness in HIV infection in our study was 31%. All patients in our study had a heterosexual transmission of the disease. CNS manifestations in men were more common than in women. Headache and altered mentation were the two common symptoms observed in this study. Tuberculous meningitis was the most common opportunistic infection in our study. No significant CD4 count correlation was found between the patients with neurological manifestations and those without neurological manifestations. Key Words: AIDS, CD4 count, Cryptococcal meningitis, HIV, Tubercular meningitis.

Background: It is important to know where the Mental Foramen is and how its shape changes because that helps doctors find the important oral neurovascular bundle that runs through it. The goal is to look at the mental foramen in dried human mandibles using morphometric and morphological methods. Material and Methods: For this investigation, 60 dried adult human mandibles of an unknown sex with entire teeth and undamaged alveolar boundaries were acquired from the Department of Anatomy, Dr. VRK Women’s Medical College and Research Centre, Aziznagar, Telangana, India. This study was conducted between September 2023 to August 2024. The MF that was witnessed had an oval or spherical shape. Results: During our study, the skull foramen's position and shape mostly stayed the same. The average distance between a group's symphysis menti and skull foramen is very important for therapy. Because there aren't any clear physical clues, it's usually hard to find the mental foramen. In a professional setting, the skull foramen is located near the lower teeth because it can't be seen or felt. Clinically, there are times when patients don't have any reference teeth or their teeth are in the wrong place, which makes it impossible to find the skull foramen in its normal place. Conclusion: This study gives us important new information about how the skull foramen looks in people of different races and demographics. This work will help dental surgeons a lot by giving them accurate measurements of anatomical landmarks that are useful for therapy. Key Words: Human mandible, mental foramen, morphometric.

Background: The spinal column holds up the upper limbs and the trunk, and it also takes a lot of the force that is put on these parts of the body. The study's goal is to see how the normal sizes of the lumbar spinal canal and lumbar vertebral body compare to the measurements taken from x-rays of dry lumbar vertebrae. Materials and Methods: This analysis utilized normal plain anteroposterior and lateral radiographs of the lumbar spine from 50 adult male and female patients. This study was conducted at the Department of Anatomy, Dr. VRK Women’s Medical College and Research Centre, Aziznagar, Telangana, India. Study was conducted between October 2023 to September 2024. The demographic information regarding age and sex of these radiographs was established. Radiographs of both sexes were obtained in a supine position, centered on L3, with an anode-film distance of one meter. Results: The study's goal is to see how the lumbar spinal canal and lumbar vertebral body measurements from people who don't have any symptoms relate to standard measurements taken from dry lumbar vertebrae. For this study, 50 regular plain x-rays and 64 sets of normal lumbar vertebrae were looked at. From L1 to L5, the anteroposterior diameter of the spinal canal got smaller, but the transverse diameter of the spinal canal, the vertebral body, and the anteroposterior diameter of the vertebral body got bigger. In any case, the canal body ratio didn't change. The measures from the radiological group were better than those from the osteological group. Conclusion: It will be beneficial to monitor any evolving patterns in metric measurements if such studies are performed over time in a certain geographic region and subjected to meta-analysis. The baseline criteria's validity must be periodically evaluated. Keywords: Spinal index of jones, radiographic, and osteological.

Background: Neonatal intensive care units (NICUs) play a critical role in improving survival rates and outcomes for vulnerable neonates. However, neonatal morbidity and mortality remain significant challenges, particularly in resource-limited settings. This study aims to analyze the clinical outcomes of neonates admitted to the NICU at PRM Medical College, Baripada, over a two-year period, identifying key predictors of adverse outcomes. Materials and Methods: A retrospective observational study was conducted on 284 neonates admitted to the NICU between January 2022 and December 2023. Data were extracted from medical records, including demographic, clinical, and outcome variables. Key outcomes included mortality, length of NICU stay, and common morbidities. Cross-tabulations and logistic regression were used to identify factors associated with adverse outcomes. Results: Among the 284 neonates, the male-to-female ratio was 1.2:1. Preterm births accounted for 42.3%, while low birth weight (<2500 g) was observed in 58.5% of cases. The overall NICU mortality rate was 15.8%. Respiratory distress syndrome (RDS) (40.8%), neonatal sepsis (28.5%), and perinatal asphyxia (19.7%) were the most common diagnoses. Mortality was significantly higher among preterm neonates (25.4% vs. 8.2%, p<0.01) and those with low birth weight (23.9% vs. 5.7%, p<0.01). Logistic regression revealed preterm birth (adjusted OR: 3.2, 95% CI: 1.6–6.4) and neonatal sepsis (adjusted OR: 2.8, 95% CI: 1.4–5.6) as independent predictors of mortality. Conclusion: This study highlights the high burden of neonatal morbidity and mortality in a tertiary care NICU. Preterm birth and neonatal sepsis were identified as key contributors to adverse outcomes. Strengthening infection prevention measures, improving antenatal care, and enhancing NICU practices could significantly improve neonatal outcomes. Keywords: Neonatal outcomes, NICU, neonatal mortality, preterm birth, neonatal sepsis, PRM Medical College.

Background: Malnutrition remains a critical public health challenge, particularly among children under five years of age. This study aims to assess the nutritional profile and associated factors in under-five children attending SCB Medical College Hospital, Cuttack. Materials and Methods: A cross-sectional study was conducted among 440 children under the age of five years. Anthropometric measurements, dietary intake, and clinical data were collected. Nutritional status was assessed using WHO growth standards. Factors associated with malnutrition were analyzed using chi-square tests and multivariate logistic regression. Results: The prevalence of underweight, stunting, and wasting was 38%, 45%, and 28%, respectively. Severe acute malnutrition was observed in 12% of children. Inadequate dietary diversity was reported in 60% of cases, while 30% had a history of recurrent infections. Multivariate analysis revealed significant associations between malnutrition and factors such as maternal education (OR: 2.6; 95% CI: 1.5–4.3), low socioeconomic status (OR: 3.2; 95% CI: 1.8–5.6), and poor dietary diversity (OR: 2.9; 95% CI: 1.6–4.9). Conclusion: The findings underscore the urgent need for targeted nutritional interventions and improved maternal education to address malnutrition in under-five children. Enhanced healthcare access and community-based programs could mitigate these nutritional deficits. Keywords: Malnutrition, under-five children, dietary diversity, SCB Medical College, maternal education.

Background: Aim: To determine the prognostic value of LRINEC Score for predicting Necrotising fasciitis. Materials and Methods: It is a longitudinal cohort (prognostic) study conducted in the Department of General Surgery in Government Medical College, Kozhikode, Kerala over a period of 18 months from July 2021 to December 2022 in 50 patients with soft tissue infection, requiring admission and at least 48 hours of intravenous antibiotics, coming to the emergency and OPD. The LRINEC score calculated for every patient from the laboratory investigations at the time of admission, was compared with the tissue biopsy report, which is the gold standard test for the diagnosis of Necrotising Fasciitis. Results: The sensitivity and specificity of the LRINEC Score were 73.7% and 71% respectively for predicting Necrotizing Fasciitis. The positive predictive value and the negative predictive value of the score were calculated to be 60.9% and 81.5% respectively. Conclusion: The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score is based on routine laboratory investigations that are readily available, at most centres that can help distinguish Necrotizing Fasciitis from other soft tissue infections. LRINEC scoring system has a better positive predictive value in identifying the onset of necrotizing fasciitis and risk strategizing of the patients with severe soft tissue infections. This score can be used as an adjunct in the management of soft tissue infections especially in secondary care hospitals and may prevent delayed referral to tertiary centres where experienced surgeons, infectious disease and hyperbaric specialists may guide immediate operative and ancillary management, thereby improving the clinical outcome of the patient. Keywords: Necrotising Fasciitis; LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score.

The faecal microbiota, an intricate and diverse community of bacteria found in the gastrointestinal tract, is vital to human well-being. Microbes of this kind, which include fungi, bacteria, viruses, and archaea, support a number of essential functions, including as immune system regulation, vitamin synthesis, and digestion. The faecal microbiota is implicated in various illnesses and is essential to maintaining health. The advancements in bioinformatics and sequencing technology have allowed for a greater understanding of its composition, variety, and functionality. Firmicutes and Bacteroidetes make up the bulk of the bacteria in the gut microbiota, with Actinobacteria, Proteobacteria, Verrucomicrobia, and Fusobacteria following in order of abundance. These bacterial populations are influenced by age, diet, genetics, antibiotic use, and environment; higher diversity is typically associated with better health. Short-chain fatty acids (SCFAs), are produced when firmicutes, such as Lactobacillus and Clostridium, digest food fibers. SCFAs are critical for gut health. Prevotella and other members of the Bacteroidetes family are essential for the breakdown of complex carbohydrates. Similar to Bifidobacterium, actinobacteria are good for gut health, especially in young children. Although they are less common, proteobacteria include dangerous species like Salmonella and Escherichia, while verrucomicrobia—most notably, Akkermansia muciniphila—help to maintain a healthy gut lining and have anti-inflammatory qualities. The gut microbiota is the target of several therapeutic interventions, including antibiotic stewardship, faecal microbiota transplantation (FMT), probiotics, and prebiotics. Prebiotics and probiotics have the power to improve health outcomes by re-establishing microbial balance. The gut microbiota may be precisely altered by novel therapies such as next-generation probiotics, synbiotics, and drugs that target the microbiome. The gut microbiota-brain link, the microbiome-gut-brain axis, and the role of microorganisms in cancer treatment will be the focus of future research. The effectiveness of medicines targeting the microbiota will be improved by personalized medicine approaches that take individual microbial patterns into account. Keywords: Fecal Microbiota, Gut Microbiota, Microbiota-Health Interaction, Short-Chain Fatty Acids (SCFAs), Fecal Microbiota Transplantation (FMT), Microbiota-Targeted Therapies.

Background: Breast cancer is the most common cancer affecting women worldwide, with rising incidences in developing countries, including India. Early and accurate diagnosis is essential for effective treatment; however, limited access to advanced imaging technologies in resource-constrained settings poses a challenge. This study aimed to evaluate and compare the diagnostic accuracy of ultrasonography (USG) and magnetic resonance imaging (MRI) in distinguishing benign from malignant breast lesions, and to assess the potential benefits of combining these modalities. Material & Methods: A prospective study was conducted involving 100 female patients aged 35 and older, presenting with breast lumps or suspicious lesions. Each participant underwent both USG and MRI. Findings were correlated with histopathology results to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of each modality. Results: In this study of 100 patients, most breast cancer cases occurred in the 56–65 age group, with malignant tumors predominantly on the left side and in the upper outer quadrant. MRI demonstrated higher sensitivity (100% vs. 78.05%) and NPV (100% vs. 47.06%) compared to USG, while both modalities showed comparable specificity (88.89%). MRI consistently identified malignant features like spiculated margins, skin involvement, and Type III enhancement curves, indicating more aggressive pathology. The combination of both modalities improved diagnostic accuracy to 89%, highlighting MRI's value in confirming malignancies. Conclusion: MRI proved more effective in identifying malignant lesions, whereas USG offered value due to its accessibility and cost-effectiveness. These findings underscore the diagnostic advantage of MRI and the importance of combining imaging modalities for optimal breast cancer detection, especially in resource-limited settings. Keywords: Breast lesions, Ultrasonography, MRI, breast imaging.

Background: Acquired Immunodeficiency Syndrome (AIDS) is a disease caused by a retrovirus Human Immunodeficiency Virus (HIV). It is characterized by marked immunosuppression which results in opportunistic infections, secondary neoplasms and neurologic manifestations. Objective: Identification of electrolyte disturbances among HIV infected patients and correlation with CD4 counts. Material and Methods: This Prospective cross-sectional study includes all 100 patients infected with HIV Admitted in medicine wards, Al- Ameen Medical College, Athani Road, Vijayapur during a period from November 2018 to May 2020. Both male and female patients were included in this study. Results: The percentage of hyponatremia is 42%. Percentage of hyponatremia for both males and females are 50% each. There is a significant correlation between serum sodium levels and CD4+ cell counts (Pearson correlation is 0.627). Correlation is significant at the p value <0.001 level. Both hypokalemia and hyperkalemia are common with HIV infection. In this study Hypokalemia (21%) more common than hyperkalemia (9%). There is no significant correlation between serum potassium levels and CD4+ cell count (Pearson correlation is 0.094 and p value is 0.355). Hyponatremia is a marker of the severity of HIV- disease but not an independent risk factor for mortality. Hyponatremic HIV patients had a lower CD4 cell Count, a higher prevalence of AIDS and were more frequently hospitalized at first contact compared to normonatremic patients. Conclusion: Hyponatremia, hypokalemia and hyperkalemia are common electrolyte disorders with HIV infected patients. Lower the CD4 Count, higher the risk of opportunistic infections and higher incidence of electrolyte disturbances. Hyponatremia is the most frequent electrolyte abnormality in HIV/AIDS patients. Severe hyponatremia, unlike other electrolyte disorder, is associated with a lower CD4 Count. Keywords: AIDS, HIV, Electrolyte Disturbances

Background: To compare diagnostic accuracy of TVS & MRI and to study the advantages and drawbacks of MRI over TVS. Material and Methods: Prospective analytical study, patient were imaged by TVS first than MRI to look for the various features; These include shape, size, margins, internal architecture (cystic/ solid), structures, absence or extent of metastatic involvement and presence of ascites or peritoneal implants. These features on complete assessment helped to make a diagnosis or at least narrow down the differential diagnosis. Results: Results indicated higher diagnostic capability of MRI for pre-treatment assessment of malignancies, detection of intra-lesional haemorrhage. Regarding the accuracy of TVS and MRI for diagnosis of uterine pathologies, correct evaluation was possible in 88% cases with TVS while 100% cases with MRI. Statistical analysis of these findings revealed 88% sensitivity of TVS while 100 % sensitivity of MRI, in diagnosis of uterine pathologies in case of abnormal uterine bleeding. Conclusion: MRI is relatively safe, non-operator dependent modality with high signal to noise ratio. It is an excellent modality for staging of uterine malignancies, it has superior soft tissue contrast & large field of view. All these features offer a distinct advantage over TVS in assessment of uterine pathologies. Keywords: Uterine malignancies, TVS [Transvaginal Ultrasound], uterine pathologies, MRI [Magnetic Resonance Imaging]

Background: The term "Personal Hygiene" refers to any behaviour that helps one stay healthy and avoid illness, particularly through personal cleanliness. In addition to promoting health and well-being, good hygiene is a major defence against many communicable diseases, including faecal-oral infections. Evaluating medical students' personal hygiene knowledge, attitude, and practice (KAP) in order to spot any gaps, raise awareness, and make sure they acquire the skills and information needed to be healthy role models in both their personal and professional lives in the future. Objectives: To assess the Knowledge, Attitude, and Personal hygiene practices among Undergraduate medical students. To compare the Knowledge, Attitude, and Personal hygiene practices among Undergraduate medical students of 1st and 3rd Professional years. To determine the association of Socio-demographic characteristics with Knowledge, Attitude and Personal Hygiene practices. Material and Methods: A Cross-sectional analytical study was carried out in September and October 2024 among first and final-year Part 1 medical students at private medical college in Eluru city, Andhra Pradesh, using a semi-structured questionnaire that had been pretested and validated. Data was gathered using Google Forms from every student in the relevant batches, and SPSS trial version 29 and Microsoft Excel were used for analysis. We applied the t-test and the chi-square test. Less than p-Value < 0.05 was considered statistically significant. Results: The study assessed the knowledge, attitude, and practices (KAP) regarding personal hygiene among 400 undergraduate medical students from 1st and 3rd Professional Years. The findings revealed that 99% of the participants demonstrated adequate knowledge, 80.5% displayed a positive attitude, and 94.8% reported good hygiene practices. A statistically significant difference was observed in knowledge and practice scores between the two study years (p-value < 0.0001). A positive correlation was observed among knowledge, attitude, and practice scores, with r-values of 0.119, 0.269, and 0.324, respectively (all p-values < 0.0001). Conclusion: Medical students demonstrated a strong foundation in knowledge, attitude, and practices regarding hygiene. The positive correlation between knowledge and practice scores highlights the importance of a strong knowledge base for translating hygiene knowledge into action. Key Words: Attitude, Knowledge, Medical Students, Personal-hygiene, Practice.

Background: The prevalence of caesarean sections is on the rise, observed consistently across both developed and developing nations. Research indicates that infants delivered via C-section may face a higher risk of respiratory issues compared to those born through vaginal delivery. This difference is attributed to the lack of lung compression during delivery and the absence of certain hormonal changes that typically occur in a natural birth process. This study aimed to assess the incidence of respiratory issues in term neonates who underwent elective caesarean sections, with a focus on the relationship to gestational age. Materials and Methods: Our study encompassed all infants delivered via elective caesarean section over the course of one year. A total of 238 cases underwent elective caesarean sections, with only 200 cases included in the analysis. Gestational age was determined based on the last menstrual history. In cases where menstrual history is unavailable, the first trimester scan is utilised for assessment. The gathered information encompassed gestational age, reasons for caesarean section, gender, signs of respiratory complications, and length of hospital stay. Results: The study analysed a total of 200 cases, categorised by gestational age: 57 cases were recorded between 370/7 to 376/7 weeks, 78 cases between 380/7 to 386/7 weeks, 47 cases between 390/0-7 to 396/0-7 weeks, and 18 cases between 400/0-7 to 416/0-7 weeks of gestation. A total of 19 cases were admitted to the NICU, representing 9.5% of the overall admissions. The analysis revealed no statistically significant relationship between gender and gestational age, with a p-value greater than 0.05. In the analysis of respiratory morbidity among the 19 cases, tachypnoea was observed in 17 instances, grunting in 15, and retractions in 16. Additionally, 18 cases necessitated oxygen support for a duration of 4 hours. Conclusion: The likelihood of respiratory complications following elective caesarean delivery is associated with the gestational age of term infants. Elective caesarean sections conducted after 39 weeks of gestation are associated with lower rates of respiratory morbidity compared to those performed between 37 and 39 weeks. These findings suggest that delaying elective caesarean delivery until 39 weeks can be advantageous for newborn health. Keywords: Cesarean Section, Gestational Age, Respiratory Morbidity, Tachypnoea.

Background: Aim: This study aimed to compare the effectiveness and safety of Propofol and Sevoflurane for the maintenance of anesthesia in pediatric patients undergoing short surgical procedures. The focus was on evaluating hemodynamic stability, recovery characteristics, postoperative agitation, and adverse events. Material and Methods: This prospective, randomized, controlled study included 100 pediatric patients aged 2–12 years, classified as ASA physical status I and II, and scheduled for elective short surgical procedures. Patients were randomly assigned to two groups: Group P (Propofol, n=50) and Group S (Sevoflurane, n=50). Group P received a Propofol infusion (6–12 mg/kg/hr IV), while Group S received Sevoflurane (1.5–2.5% inhalation) for anesthesia maintenance. Hemodynamic parameters, recovery times, postoperative agitation (PAED score), and adverse events were assessed. Results: Both groups were comparable in demographic and baseline characteristics (p>0.05). Hemodynamic parameters, including heart rate and mean arterial pressure (MAP), were significantly more stable in Group S (p<0.05). Recovery times, including time to eye opening (6.2 ± 1.8 min vs. 8.5 ± 2.1 min, p<0.001) and time to extubation (7.3 ± 1.9 min vs. 10.8 ± 2.5 min, p<0.001), were shorter in Group S. Postoperative agitation (PAED score: 4.2 ± 0.9 vs. 5.8 ± 1.2, p=0.003) and pain scores (VAS: 2.0 ± 0.8 vs. 2.8 ± 1.0, p=0.017) were lower in Group S. Adverse events were slightly higher in Group P but were not statistically significant. Conclusion: Sevoflurane demonstrated superior hemodynamic stability, faster recovery, lower postoperative agitation, and higher parental satisfaction compared to Propofol in pediatric short surgical procedures. Both agents showed a favorable safety profile, but Sevoflurane emerged as a preferred anesthetic choice for short pediatric surgeries. Keywords: Pediatric Anesthesia, Propofol, Sevoflurane, Hemodynamic Stability, Postoperative Recovery.

Background: Cancer, a group of diseases characterized by uncontrolled cell growth and spread to other parts of the body, remains one of the leading causes of morbidity and mortality worldwide. Objective: The main objective of the study is to find the socio-demographic characteristics and lifestyle factors that are associated with cancer risk among patients attending the Oncology OPD. Material and Methods: This retrospective study was conducted at the Department of Oncology of Government Medical College Mahasamund Chhattisgarh from June 2022 to November 2024. A total of 393 cancer patients were included in the study, who were diagnosed with various types of cancer and had visited the Oncology OPD over the past 2 years and 5 months. Results: Data were collected from 393 patients, the majority of cancer patients were aged between 51 and 70 years (50%), followed by those aged 31 to 50 years (38%). In terms of gender, 50% of the patients were female, while 50% were male. Most patients were married (96%), and a significant proportion had an education level were literate (62%), with the remaining being illiterate (38%). Regarding socioeconomic status, 50% of the patients were from middle-income backgrounds, 30% were from low-income households, and 20% were from high-income groups. Conclusion: It is concluded that socio-demographic factors such as age, gender, marital status, and educational level, along with lifestyle factors like smoking, alcohol consumption, dietary habits, physical activity, and family history, play a significant role in cancer risk. Keywords: Cancer, Patients, Demographic, Social, Characteristics, Mortality.

Background: Complementary and Alternative Medicine (CAM) encompasses various health practices rooted in traditional beliefs and experiences. Despite CAM’s increasing use for managing chronic conditions in India, limited research exists on medical students’ attitudes and practices regarding CAM, particularly in Kerala. Aim: This study aimed to assess the attitudes and practices of medical students towards CAM in a Private Medical College of Kerala. Material and Methods: A cross-sectional study was conducted among 323 MBBS students from four academic years (2020–2023). Data were collected using a pretested self-administered questionnaire covering attitudes and practices related to CAM. Positive and negative attitudes were scored based on responses. Practices were assessed through CAM usage patterns. Data were analyzed using SPSS software, employing descriptive statistics and Chi-square tests, with p<0.05 considered statistically significant. Results: All participants had heard of CAM, primarily through friends and family (35%). While 47% believed CAM to be effective in specific conditions like orthopaedic and skin issues, 39% were skeptical. CAM usage was reported by 73%, with Ayurveda (65%) and Homeopathy (34%) being the most popular modalities. Reasons for non-use included doubts about efficacy (36%) and prolonged treatment duration (31%). Most participants (85%) recognized CAM’s public health benefits, with 61% intending to recommend its use alongside modern medicine. Positive attitudes significantly correlated with higher CAM usage and professional recommendations (p<0.01). Conclusion: The study revealed widespread awareness and mixed perceptions of CAM among medical students. Integrating CAM knowledge into medical education may foster informed decision-making in clinical practice. Keywords: Complementary and Alternative Medicine, Ayurveda, Medical Students, Attitudes and Practices.

Background: Fractures of distal end of radius are very common and form 8-15% of upper limb trauma.[1] It is important to have knowledge of the morphometry of distal radius to treat the fracture of radius and to improve the design of distal radius plates. However the measurements used for evaluation currently are based on western figures. The aim of this study is to report the morphometry of the distal radius in the tribal population of Manipur and also compare it to similar studies of other races and populaion. Materials and Methods: The study was conducted on 142 participants 71 each male and female from August 2020 to November 2022. True anteroposterior and lateral wrist xrays were taken. The radial inclination, radial height, palmer tilt and ulnar variance were measured in the console. Radiographs with no distal radial structural deformities and fused physis were included in the study. Results: The mean value of radial inclination is 22.41 ± 4.810, range 10.1 - 34.2 0. The mean radial height of all the participants is 10.87 ± 1.73 mm. The palmer tilt averaged to 10.42 ± 1.280. The mean ulnar variance of the participants is +0.55 ± 1.27 mm (range: -2.2 to + 3.2mm). Conclusion: The distal radius morphometry varies with different races and ethnicity. This study provided a deep insight into the various distal radius parameters which can be used as reference values for treating distal radius injuries among the tribals of Manipur. Keywords: Distal radius, morphometry, radial inclination, radial height, palmer tilt, ulnar variance.

Background: A growing number of people, particularly those in higher education, are developing unhealthy habits related to excessive use of the internet for purposes such as learning, socialising, and pleasure. Finding out how common internet addiction is among college students and what causes it was the primary goals of this research. Materials and Methods: This cross-sectional survey, which was conducted over a three-month period among students at Department of Psychiatry, Andhra Medical College, Visakhapatnam, India was carried out with the necessary approval from the institutional ethics committee. This study was conducted between October 2023 to September 2024. Participants were selected using stratified random sampling. Results: The study included 500 participants in total. Among them, 160 showed no signs of being addicted to the internet at all, 230 were slightly addicted, 100 were moderately addicted, and 10 were severely addicted. Higher rates of IA were shown to be connected with factors such as being male, living in an urban area, having access to personal electronic devices, and having a heavier academic workload. There was a statistically significant correlation between IA and students who reported experiencing symptoms of anxiety, despair, or poor sleep quality. The two most prevalent activities linked to heavy internet use are social media and online gaming. Conclusion: Findings from the study stress the necessity for focused treatments to combat the alarmingly high rate of internet addiction among university students. Academic pressure, socio-demographic issues, and psychological considerations all have a substantial impact on IA. Keywords: Prevalence, factors, internet addiction, college students.

Background: The incidence of binge drinking is increasing especially among young people; and although this is likely to influence the liver, its particular effects on liver disease are still not fully understood. It is important to understand that ALD represents a spectrum of liver pathology that starts with fatty liver change, which is present in almost all heavy alcohol drinkers and is generally asymptomatic. Twenty percent to 40% of alcoholics develop fibrosis, 10–20% eventually progress to cirrhosis, and 1–2% of cirrhotics are diagnosed with hepatocellular carcinoma every year. Material and Methods: This is a prospective and observational study was conducted over a period of 6 months in the Department of Medicine and Department of Gastroenterology at Gulbarga Institute of Medical Sciences (GIMS). The study was approved by the institutional ethics committee, and written informed consent was obtained from all participants. A total of 160 patients diagnosed with alcoholic liver disease (ALD) were enrolled. Results: Out of 160 patients 58.8% patients had Mild duration of hospital stay and 25.6% patients had Moderate duration of hospital stay. It was found that out of 160 patients 53.3% patients had alcohol as major risk factor while 46.7% patients had alcohol and smoking risk factor. The results showed that out of total patient’s 67.7% patients had other type of alcohol than brandy or whisky. It was found that out of 160 patients 62.5% patients had alcohol periodically while 37.5% patients had alcohol daily. Conclusion: The mortality of patients with severe AAH emphasizes the need for accurate prognostication when managing cases of AAH. Many clinical scores have been studied and used, the most common notable being MELD, MDF and Lille score. While MDF is the oldest and the most popularly used score (MDF > 32) to determine the indication for corticosteroid initiation in AAH, MELD score has been increasingly showing superiority in assessing AAH severity. Keywords: Alcohol Liver pathogenesis Pregnancy Immune modulation Targeted therapy.

Background: The recent surge in respiratory infections caused by Influenza A, Human Metapneumovirus (HMPV), and Mycoplasma pneumoniae in China has raised concerns about global preparedness. This review critically assesses India's readiness to respond to potential outbreaks of these pathogens, examining current infrastructure, capabilities, and areas requiring enhancement. Material and Methods: A systematic review of literature from 2014-2024 was conducted using major databases (PubMed, Scopus, Web of Science, Indian Citation Index) and official reports from national health organizations. The analysis focused on surveillance systems, healthcare infrastructure, research capabilities, and response mechanisms. Results: India has established basic surveillance infrastructure through the Integrated Disease Surveillance Programme (IDSP) and a network of diagnostic laboratories. However, significant challenges persist, including geographic disparities in healthcare access, limited diagnostic capabilities in rural areas, and workforce shortages. The review identified critical gaps in real-time data reporting, laboratory capacity, and emergency response coordination. Research and development efforts, while growing, face constraints in funding and advanced facility availability. Conclusion: While India has made progress in developing preparedness frameworks, substantial enhancements are needed in surveillance systems, healthcare infrastructure, and research capabilities. Key recommendations include strengthening digital surveillance platforms, expanding molecular diagnostic facilities, implementing comprehensive healthcare worker training programs, and establishing sustainable funding mechanisms. A phased approach to implementing these recommendations, with clear short-term (1-2 years), medium-term (2-5 years), and long-term (5-10 years) goals, is essential for building robust preparedness capabilities. Keywords: Disease outbreak preparedness; Influenza A; HMPV; Mycoplasma pneumoniae; India; Public health surveillance; Healthcare infrastructure; Respiratory infections.

Background: Chronic Otitis Media with Effusion (COME) is a persistent inflammatory condition characterized by fluid accumulation in the middle ear without acute infection. Despite various treatment approaches, recurrence and chronicity remain significant challenges. Emerging evidence suggests that Vitamin D, known for its immunomodulatory and anti-inflammatory properties, may play a beneficial role in the management of COME. Aim: This study explores the role of Vitamin D supplementation in the management of Chronic Otitis Media with Effusion, evaluating its impact on effusion resolution, recurrence rates, and associated clinical outcomes. Material and Methods: A randomized controlled trial was conducted involving 100 patients diagnosed with COME. Participants were divided into two groups: one receiving standard treatment (antibiotics and decongestants) and the other receiving standard treatment combined with Vitamin D supplementation (2000 IU/day). Clinical and audiometric evaluations were performed at baseline, 1 month, and 3 months. Outcomes assessed included effusion resolution rates, recurrence rates, and improvements in hearing thresholds. Results: Patients receiving Vitamin D supplementation demonstrated significantly higher effusion resolution rates at 3 months (85%) compared to the standard treatment group (60%, p < 0.05). Recurrence rates were lower in the Vitamin D group (15% vs. 35%, p < 0.05). Audiometric assessments revealed greater improvements in hearing thresholds in the Vitamin D group, with mean improvements of 15 dB compared to 8 dB in the control group (p < 0.05). Conclusion: Vitamin D supplementation appears to enhance the efficacy of standard treatments for Chronic Otitis Media with Effusion, promoting faster effusion resolution, reducing recurrence rates, and improving hearing outcomes. These findings suggest that Vitamin D may serve as a valuable adjunct in the management of COME, warranting further investigation in larger, multicenter trials. Keywords: Vitamin D, Chronic Otitis Media with Effusion, Effusion Resolution, Recurrence Rates, Hearing Improvement, Immunomodulation.

Background: Objective: To examine the CTEV correction outcome through Ponseti method. Materials and Methods: This study aimed to evaluate the functional outcomes of congenital talipes equinovarus (CTEV) correction using the Ponseti method. A sample of 27 infants with idiopathic clubfoot were included, and treatment involved serial casting starting immediately after diagnosis, with weekly follow-ups. In cases of insufficient correction, a percutaneous Achilles tenotomy was performed, followed by a final cast for three weeks. Steen beek braces were prescribed to maintain the correction. The severity of the deformity was measured using the Pirani scoring system both before and after treatment. Results: The study found significant improvement in deformity correction, as reflected by the reduction in the Pirani scores. The pre-treatment mean Pirani score was 5.23 ± 1.03, while post-treatment, it was reduced to 0.13 ± 0.22, with a highly significant p-value of less than 0.001. Minimal treatment-related complications were observed, with only two cases of mild skin irritation. Most of the cases required six to seven casts for complete correction, and all infants followed the post-treatment bracing protocol successfully. Conclusion: The Ponseti method proved to be highly effective in treating idiopathic clubfoot, with significant improvements in deformity correction and minimal complications. The results of this study support the method's efficacy and safety, highlighting its importance as a non-invasive treatment option. Early intervention combined with appropriate bracing is essential for optimal long-term outcomes, and the Ponseti method remains a preferred treatment. Further studies are needed to explore long-term results and potential refinements to the treatment protocol. Keywords: Congenital Talipes Equinovarus (CTEV), Ponseti Method, Clubfoot Correction, Pirani Scoring System, Non-Surgical Treatment.

Background: Pancreatic cancer (PC) represents a significant cause of mortality in developing countries. While Multi-Detector Computed Tomography (MDCT) provides valuable imaging data for staging pancreatic cancer, accurate diagnosis can be challenging due to factors such as fibrosis and inflammation, which can mimic tumor characteristics. Histopathological examination, although considered the gold standard for definitive diagnosis, is invasive and may not always be readily available. This study aimed to characterize the characteristic MDCT imaging features of pancreatic cancer and correlate these findings with histopathological findings to improve diagnostic accuracy. Material and Methods: This retrospective cross-sectional study was carried out involving 23 PC patients treated at A.H Post-graduate Institute of Cancer, Cuttack over two years (January 2023 to December 2024). Only patients with complete medical records and a confirmed histopathological diagnosis were included. Data analysis was performed using IBM SPSS version 26.0. Descriptive statistics were presented through frequency tables and proportions, while chi-square tests were used to evaluate the relationship between CT scan results and histopathological findings. Results: Our study indicated that 60% of patients were male and 56% of patients were between age group 21-40 years. In CT scan, 52% of patients had tumor in the head of the pancreas. Secondary signs were present in 17 (73.9%). Hypo-dense areas were seen in 17 (73.9%) before and 19 (82.6%) after contrast. Histopathology showed 9 (39%) with poorly differentiated adenocarcinoma. Fibrosis and necrosis were also found in 10 (43%) and 6 (26%) patients, respectively. Our study found significant associations between CT and pathological stages (p = 0.00), fibrosis presence and cancer location (p = 0.00), and necrosis with post-contrast density (p = 0.03). Conclusion: This study demonstrates the high diagnostic accuracy of MDCT in characterizing pancreatic cancer, with findings closely correlating with histopathological results. The majority of tumors was located in the pancreatic head and exhibited hypodense areas on imaging. The strong concordance between MDCT findings and histopathology underscores its crucial role as a non-invasive tool for staging and guiding treatment decisions in pancreatic cancer, particularly in resource-constrained settings. Keywords: CT Pattern, Histopathology, Pancreas Cancer, Ethiopia.

Background: Community Acquired Pneumonia (CAP) is still a major burden affecting the morbidity and mortality in infants and children. There are scales available to assess the severity and outcome so that illness prognosis can be changed. This study aimed to assess the role of Acute illness observation scale (AIOS) in predicting illness severity and outcome of community acquired pneumonia. Materials and Methods: A cross sectional study was conducted in a cohort of 360 children between 2 months to 59 months at a tertiary care centre in Kottayam. Children with suspected pneumonia, if satisfying the inclusion criteria, were included in the study after taking informed consent from parents. AIOS scoring was done on each subject on day 1 and day 5 in a reasonably quite state. Pulse oximeter reading, vital signs and respiratory parameters were documented. Results: The study showed that AIOS correlated with the severe clinical signs, abnormal chest X ray, invasive treatment modalities and worse treatment prognosis. Also, the study has assessed the validity measure of AIOS in comparison with IMNCI diagnosis. The sensitivity measure, specificity value and accuracy value of AIOS in measuring pneumonia was 58.95%, 82.85%, 69.4% respectively. The sensitivity measure, specificity value and accuracy value of AIOS in measuring severe pneumonia was 46.4%, 98.6% and 56.38% respectively. Conclusion: The study showed AIOS can be used as a predictor scale to assess severity in community acquired pneumonia. The increased score of AIOS correlates well with abnormal investigations, invasive treatment modalities and worst prognosis. Keywords: Acute illness observation scale, Community Acquired Pneumonia, Integrated Management of Neonatal and Childhood Illness.

Background: Dengue fever, a mosquito-borne viral disease spread by Aedes egypti mosquito has become significant public health challenges globally, especially in developing countries like India. During 2023 epidemic in North Kerala, a total of 3175 cases and 17 deaths were reported. Objectives: This study aims to assess the level of awareness, analyze personal prophylactic measures and environmental factors in prevention of dengue among residents of North Kerala. Materials and Methods: A cross-sectional survey is conducted among 100 households to assess the dengue prevention practices. Data is collected through a structured questionnaire. Surveys were conducted to assess the level of awareness, personal prophylactic measures adopted, biological and chemical controls applied and environmental factors and source reduction methods deployed among residents of North Kerala. Statistical analysis is used to identify the gaps in awareness and correlation between preventive measures and the incidence of disease. Results: The study revealed that while 82% of households were aware of dengue, only 63% could identify key symptoms. Personal prophylactic measures such as mosquito net usage (31%) and practices like wearing protective clothing (12%) were limited, but use of repellents like coils and vaporizers are common. Potential mosquito breeding sites were found in 59% households, mainly in open water containers and discarded items. Despite 90% households storing water only 60% covered containers adequately. Community participation in dengue prevention activities were low with only 25% engaging in awareness campaigns and clean-up drives. These findings highlight gaps in preventive practices, vector control measures and community engagement of dengue. Conclusion: The study highlights significant gaps in preventive practices, vector control measures and community engagement of dengue. Despite high awareness of dengue, mosquito breeding sites persist in many households due to improper water storage and waste management practices. The findings underscore the need for improved public health initiatives, stronger community engagement and better sanitation practices to effectively reduce the risk of dengue transmission in this region. Keywords: Dengue fever; awareness; prevention; mosquito; public health; Kerala; environmental factors.

Background: Aim: Present study aimed to compare the analgesic efficacy of clonidine and Dexmedetomidine as local adjuvant to supraclavicular brachial plexuses block in both bone forearm upper limb surgeries Material and Methods: Prospective double blinded randomized controlled study was conducted at Department of Anaesthesia in 60 ASA I & II patients aged 21-65 yrs. posted for both bone forearm upper limb surgeries. Group C (n=30) - 38ml of 0.25% bupivacaine and 100mcg clonidine, Group B (n=30) – 38 ml of 0.25% bupivacaine and 100 mcg Dexmedetomidine. Demographic data were recorded in both study groups age, sex, anthropometric parameters. study parameters like time of onset and duration of both sensory and motor block, duration of analgesia and number of rescue analgesia in 24 hrs were recorded in both the groups. Results: Both the groups were comparable with respect to age and anthropometric parameters i.e. weight and height. Overall, 58.9% cases were males and 41.1% cases were females with no difference between study groups. Overall duration of sensory block and duration of motor block was also significantly longer in dexmed group as compared to clonidine. No difference was observed between the two groups in terms of pain till 4 hours after surgery. Pain scores were significantly lower in dexmed group as compared to clonidine group from 8th hour onwards till 24 hrs. (p<0.01). Mean time for duration of analgesia was significantly more in dexmed group cases as compared to clonidine group. Mean requirement of rescue analgesics in first 24 hours was also significantly lower in dexmed group. No difference was observed between study groups with regards to heart rate, SBP and DBP at baseline and also during the surgery. Conclusion: We thus conclude that Dexmedetomidine when added to Bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motor block and also the duration of analgesia as compared with clonidine. Keywords: Bupivacaine, Dexmedetomidine, numerical rating scale.

Background: Local anesthetics such as bupivacaine are frequently employed in spinal anesthesia for surgeries involving the lower limbs; however, the duration of spinal anesthesia tends to be quite brief. The duration of action of bupivacaine in spinal anaesthesia can be extended through the incorporation of adjuvants like midazolam, opioids, neostigmine, dexmedetomidine, and clonidine. This study aims to assess and compare the impacts of clonidine and fentanyl when used as intrathecal adjuvants alongside hyperbaric bupivacaine in patients undergoing orthopedic surgery on the lower limbs. Material and Methods: The current study was carried out in the Department of Anaesthesiology and Intensive Care at a Tertiary Care Teaching Institute in India. It involved patients of both genders, aged between 20 and 60 years, classified as ASA I/II, who were scheduled for lower limb orthopedic surgeries. A total of 210 patients were randomly assigned to three groups of 70 to evaluate the duration and quality of analgesia provided by clonidine and fentanyl when used as adjuvants to intrathecal bupivacaine. Results: The findings indicate that there were statistically significant differences in the time taken to achieve the T10 block, the mean time until the first request for analgesia, and the duration of motor block across all three groups. The findings indicated that the group receiving clonidine demonstrated superior outcomes compared to those treated with fentanyl and bupivacaine alone. (P≤0.05). Conclusion: The administration of intrathecal clonidine at a dosage of 37.5 micrograms results in a faster onset and extended duration of both sensory and motor blocks, while also enhancing the duration of analgesia when contrasted with fentanyl at 25 micrograms. Keywords: Clonidine, Dexmedetomidine, Fentanyl, Hyperbaric Bupivacaine

Background: Menopause is characterized by the complete absence of menstruation for twelve months or more. It is a natural physiological change that occurs in middle-aged women, and some of the symptoms associated with menopause can be intense enough to interfere with their everyday activities. Materials and Methods: This was an observational cross-sectional study conducted in Department of Obstetrics and Gynaecology, School of Medical Sciences and Research Medical, Sharda Hospital, Greater Noida, Uttar Pradesh on middle aged females of 40-60 years. Total of 256 females (OPD and IPD) who consented to participate and meeting the required inclusion and exclusion criteria were enrolled for the study. Results and Discussion: Out of 256 middle aged women 126(49.21%) were postmenopausal. Mean age of menopause was 50.08±3.15 years. It was a questionnaire-based study using Menopause Rating Scale which includes 11 symptoms under somatic, psychological and urogenital domains. 3.9% postmenopausal females had very severe MRS score. Joints and muscle discomfort (81.2%) was found to be most prevalent symptoms followed by depressive mood (70.3%). The variations in the type and severity of menopausal status among different studies in different population can be explained by the impact of racial differences on the prevalence and intensity of menopausal symptoms, as well as the average age at menopause and the duration since its onset. Conclusion: The burden of menopausal symptoms has increased owing to increased overall life expectancy. Thereby comes the need of health programmes and medical interventions to cater the unmet needs of menopausal females to enhance the overall quality of life. Keywords: MRS (Menopause Rating Scale), World Health Organisation, HRQoL (Health Related Quality of life), IMS (Indian Menopause Society).

Background: The death rate from chronic renal disease is steadily increasing due to various reasons. The research's emphasis in early disease detection is fascinating. The goal of the current course is to investigate the long-term effects of inflammatory indicators in patients with chronic kidney disease (CKD). Material and Methods: This study measures the plasma levels of high sensitive C-reactive protein (hsCRP), Tumour Necrosis Factor alpha (TNFα), Interleukin-6(IL6) in 400 participants diagnosed with chronic kidney disease. Estimated Glomerular Filtration Rate (eGFR), glucose, urea and creatinine were quantitated for measuring the kidney function. Results: Inflammatory markers frequencies revealed a statistically significance difference (p- value <0.05 between CKD and study population. Chi square p- values of detrimental habits and family history of diabetes and hypertension were statically significant with CKD in males than females. And elevated levels of urea, creatinine and eGFR were associated with increasing the inflammation in function. Mean P- values of hsCRP, TNFα and IL 6 were also strongly associated with CKD. Conclusion: This study provides inflammation in kidney due to the abnormal plasma levels of CRP, TNFα and IL6. Detrimental habits and family history of diabetes and hypertension were also majorly associated with development of CKD in males than females. Additionally, we are determined males were excess amount salt intake in daily life and particularly in females, stress and hypertension were associated with development CKD. Categories: Biochemical Genetics, Allergy/ Immunology Keywords: Enduring offal illness, inflammation, c-reactive protein, TNF Alpha, Interleukin 6.

Background: In India, undernutrition is recognized as a serious health and nutritional issue and a significant contributor to childhood mortality and morbidity. Pre-schoolers being the most vulnerable group in the community, their nutritional condition are a sensitive predictor of community health and nutrition. In order to determine the nutritional status, prevalence, and risk factors for undernutrition in children aged 0–5 years who attend Anganwadi centers (AWC) in the villages of the Medchal district, this study was conducted. Material and Methods: A cross sectional study was carried out among 375 children aged 0-5year in Anganwadi centres of Medchal district during August 2017–November 2017. Demographic data, socioeconomic status, child and mother data were collected. Data was gathered using a pretested questionnaire that was primarily based on the World Health Organization's (WHO) standard questionnaire on infant and young child feeding (IYCF) practices. The Statistical Package for Social Sciences (SPSS version 17.0) was used to analyze the data. To determine how risk factors were related, Binary Logistic Regression analysis was used. A P-value of less than 0.05 was deemed significant. Results: The overall percentage of underweight, wasting and stunting were 29.3%, 16.53% and 45.8% respectively. Independent risk factors associated with underweight were poor maternal education, low maternal Body Mass Index (BMI), lower level of socio-economic class sand low birth weight of the baby. IYCF practices such as starting breastfeeding within 24 hours and exclusively breastfeeding were 62.8% and 81% respectively. Conclusion: The prevalence of undernutrition appears to be high among 0-5 years in the population. Undernutrition was linked to the mother's health and educational attainment. Mothers' education regarding the health state of their children may aid in rectifying. Key Words: Under 5years, Undernutrition, anganwadi centres, nutritional status, wasting, stunting, underweight, BMI, growth faltering.

Background: Jaundice in newborns is a common postnatal issue, generally considered to be harmless. The objective was to assess the effectiveness of transcutaneous bilirubin measurement as a screening method for clinically significant hyperbilirubinemia. Material and Methods: The present study utilized a cross-sectional design conducted within the paediatric department at a Tertiary Care Teaching Institute in India over the course of one year. Following approval from the ethical committee, a total of 80 neonates exhibiting clinical signs of neonatal jaundice, characterised by a yellowish appearance, were included in the study after obtaining consent from their respective parents or guardians. Measurements of neonatal TCB levels and serum bilirubin levels were conducted. Severe hyperbilirubinemia is defined by a bilirubin level exceeding 425 μmol/l. Results: The findings of the current study indicated a higher prevalence among males. There were 50 males and 30 females. A significant 60% of the cases involved full-term normal deliveries, while 40% were delivered via caesarean section. The average total bilirubin concentration was measured at 8.48±2. Seventy-five percent of neonates were breastfed, while only twenty-five percent received formula feeds. Statistical significance was observed for total cord blood (TCB) levels and severe hyperbilirubinemia. Conclusion: The findings of the present study indicate that hyperbilirubinemia is frequently observed in males. The newborn presented with hyperbilirubinemia at the time of delivery. There was a notable statistical relationship observed between TCB levels and the severity of the disease. Key Words: Hyperbilirubinemia, Jaundice, Neonates, Total Serum Bilirubin.

Background: Oral health is integral to overall well-being, yet rural populations often face challenges in accessing adequate dental care. Understanding the knowledge, attitudes, and practices (KAP) of rural patients regarding oral health is critical for developing effective intervention programs. Aim: To evaluate the oral health knowledge, attitudes, and practices of patients visiting dental hospital rural centers in Ludhiana, Punjab. Materials and Methods: This cross-sectional study was conducted by Department of Public Health Dentistry of Christian Dental College and Hospital, Ludhiana. It included 600 patients aged 18–65 years visiting three different rural satellite clinics associated with the institute. Data was collected using a structured questionnaire covering demographic details and oral health KAP. Descriptive and inferential statistical analyses were conducted to assess associations between variables. Results: The majority of participants demonstrated moderate knowledge of oral health, with 60% understanding the role of diet and oral hygiene in preventing dental issues. However, only 35% practiced twice-daily brushing, and floss use was negligible. Barriers to optimal dental care included fear of pain (50%), financial constraints (45%), and lack of awareness (40%). Attitudes were positive overall, with 70% recognizing the importance of dental visits, but regular utilization was limited. Conclusion: Although participants exhibited reasonable oral health awareness, their practices lagged behind. This gap underscores the need for targeted educational initiatives and community-based programs to promote oral hygiene habits and overcome barriers to regular dental care in rural populations. Keywords: Oral health, knowledge, attitude, practices, rural population, dental care, Ludhiana, barriers, oral hygiene, community-based programs.

Background: Tympanoplasty is perhaps the most common surgical procedure performed by ENT surgeons. Though we see many patients with bilateral csom having perforation., we are not doing it on both sides simultaneously due to risk of sensory-neural deafness. Nowadays, highly skilled surgeries like cochlear implant are done on both sides simultaneously. Aim: We are presenting a study of 100 cases (200 ears) of bilateral single sitting tympanoplasties. Its effectiveness and safety. Material and Methods: A total of 100 patients of both sexes with central perforation of tympanic membrane of both ears with mild to moderate conductive hearing loss were included in this study. This is a prospective study. The results were evaluated for the advantages and efficacy of single sitting bilateral type I tympanoplasty. Graft uptake at 6 weeks is considered success. Results: In our study, there were 45 (45.33%) males and 55(54.75%) females. Half of the patients are in of 26 – 45 years age-group. The perforation closure was successful in 94% patients. Mean hearing gain 27.33 dB. None of the patients developed iatrogenic sensorineural hearing loss. The results are comparable with the tympanoplasties performed on one side only. Conclusion: Single sitting bilateral type I tympanoplasty is safe day care procedure with a high success rate. In developing countries like India, it is very useful in shaving resources and adding into the development. Whenever possible bilateral tympanoplasty at one go should be attempted. Keywords: Bilateral tympanoplasty, Bilateral CSOM, Simultaneous Tympanoplasty.

Background: Very few studies are available regarding the causes of severe visual impairment and blindness in India as well as in Telangana State. Purpose: To notice the common causes of severe visual impairment (SVI) and blindness in remote districts of Telangana State. Materials and Methods: This is a cross sectional, retrospective and observational study. A total of 620 patients attended SADAREM camps and were enrolled for this study during the period of 2 years from July 2022 to June 2024. Results: Demographic data was collected as per the BCVA, age, gender, occupation and residence. Most of the patients were belonging to rural areas (78%), Males (62%) were more common than females. Most common causes of blindness were due to various ocular diseases like Corneal (11.77%), Whole globe (20.50%), Vitreoretinal (15.50%), Glaucoma (8.08%), Amblyopia (6.93%). Conclusion: Data obtained from this study can be utilized to design the programmes for the prevention and control of blindness in Telangana State. Keywords: Severe visual impairment (SVI), Blindness, Best corrected visual acuity (BCVA), SADAREM (Software for Assessment of Disabled for Access Rehabilitation and Empowerment) camp.

Hypermature cataract, an advanced stage of cataract, is still an important cause of avoidable blindness especially in rural areas of India. Impact of COVID-19 on health systems worldwide included delayed cataract surgery due to cancellation of elective surgery during the pandemic phase. To study the effect of delay in surgery from the onset of COVID 19 to the hypermature cataract cases at a rural tertiary care center in South India. This was a prospective study of 1997 patients with cataract of which 330 patients had hypermature cataract. COVID-19 was identified as the leading cause of delay, affecting 45.4% of cases. Other factors included reliance on a functional pseudophakic eye (24.2%), lack of awareness (9.1%), absence of caretakers (6.1%), and limited knowledge about free medical camps (9.1%). Gender analysis revealed an almost equal distribution between males (50.9%) and females (49.1%), while age-wise prevalence was highest in the 60–70 years (36.4%) and >70 years (33.9%) age groups. The findings underscore the importance of raising awareness, implementing regular screening programs, and enhancing outreach initiatives to improve access to timely cataract surgeries. Proactive interventions are critical to reducing the burden of hypermature cataract and preventing irreversible blindness in underserved rural communities. Keywords: Hypermature Cataract, COVID-19 Impact, Delayed Cataract Surgery, Rural Healthcare, Community Awareness, Gender Distribution, Age-Wise Prevalence, Preventable Blindness.

Background: Breast lumps are common clinical findings, with etiologies ranging from benign conditions to malignant tumors. Recent studies suggest a potential link between thyroid autoimmunity and breast pathology, particularly in influencing prognosis. This study aimed to evaluate the levels of anti-thyroid peroxidase (anti-TPO) antibodies, thyroglobulin antibodies (TgAb) and thyroid hormone levels in patients with breast lumps and their association with disease prognosis. Material and Methods: A prospective study was conducted involving 100 patients presenting with palpable breast lumps at a tertiary care hospital. Detailed clinical examinations, histopathological evaluations, and thyroid function tests, including anti-TPO antibodies, TgAb, T3, T4, and TSH levels, were performed. Patients were categorized based on the histopathological diagnosis into benign and malignant groups. Data were analyzed for correlations between thyroid markers and prognostic indicators, including tumor size, lymph node involvement, and recurrence over a follow-up period of one year. Results: Among the participants, 40% had benign lesions, while 60% had malignant lumps. Elevated anti-TPO antibody levels (>34 IU/mL) were observed in 65% of malignant cases compared to 25% of benign cases (p < 0.01). Similarly, TgAb levels were significantly higher in malignant cases (mean 120 IU/mL) than in benign cases (mean 40 IU/mL). Thyroid hormone abnormalities, particularly subclinical hypothyroidism, were noted in 30% of the malignant group. Prognostic analysis revealed that patients with elevated anti-TPO and TgAb levels had larger tumor sizes (mean 4.5 cm vs. 3.1 cm, p < 0.05), higher rates of lymph node involvement (55% vs. 25%, p < 0.01), and recurrence rates of 20% compared to 5% in antibody-negative patients. Conclusion: Thyroid autoantibodies, including anti-TPO and TgAb, are significantly associated with malignant breast lumps and poor prognostic features, such as larger tumor size and lymph node involvement. These findings suggest that thyroid autoimmunity may play a role in breast cancer progression and could serve as a potential prognostic biomarker. Keywords: Anti-TPO antibody, Thyroglobulin antibody, Thyroid hormones, Breast lumps, Prognosis, Thyroid autoimmunity, Breast cancer biomarker.

Background: Recent advances in obstetrics and neonatal care has declined the incidence of MSAF in high income countries, but it is still high in low-income countries due to increased incidence of maternal complications and poor fetal monitoring. Several maternal as well as neonatal risk factors have been reported to be associated with MSAF and MAS. Through this study, we aim to study the risk factors, clinical profile, management strategies and outcome of neonates born through MSAF who develop MAS. Material and Methods: A total number of 50 neonates born with MSAF were enrolled in the study after fulfilment of inclusion and exclusion criteria. Neonates were divided into vigorous and non-vigorous groups and those with and without MAS and further subclassified as per severity of MAS. Results: In this study, out of 50(100%) enrolled neonates having MSAF, 32(64%) developed MAS. statistically significant association was seen with pH at birth (marker of birth asphyxia) ≤7.2 and development of MAS and severe MAS (P value=0.01). It was observed that all non-vigorous neonates with severe MAS had to be given ventilatory care, out of which 60% required ventilatory support during 1st hour of life and 40% in 1st 24 hours of life (p value =0.0013). mortality in the present study due to MAS was (9.4%). Conclusion: Meconium-stained amniotic fluid is associated with increased incidence of caesarean section, perinatal asphyxia, lower APGAR score, higher NICU admissions and meconium aspiration syndrome. High risk pregnancies should be identified and both prenatal and postnatal interventions should be taken to reduce occurrence of MSAF. Intensive fetal monitoring and early intervention is required in reducing incidence of MAS. Complications and morbidity is higher in MAS group as compared to MSAF, especially in neonates who are non-vigorous. Keywords: Meconium stained amniotic fluid, meconium aspiration syndrome, fetal monitoring, vigorous, non-vigorous.

Background: Being novel disease, clinical picture of Covid 19 is not completely identified. This study attempts to find out the clinicosocial profile, clinical categorisation based on symptomatology in covid 19 patients admitted during second wave. Aims: To estimate the proportion of clinical symptoms, clinical categorisation and comorbidities in covid 19 patients at the time of admission and to find association between sociodemographic variables and comorbidities status with clinical categorisation based on their symptomatology in a tertiary care hospital during second wave of covid 19 pandemic Material and Methods: A record based cross sectional study was done among 1170 covid 19 patients admitted during second wave in a tertiary care centre of South Kerala. Data collection was done using semi-structured questionnaire and analysis was done using SPSS version 21.0. The quantitative and qualitative variables were expressed in mean and SD and percentage respectively. Association between sociodemographic variables and categorization was analysed using Chi-square test and p value <0.05 was considered statistically significant. Results: Mean age of participants was 54 years and 94.7% residing in rural areas. Common clinical symptoms were fever (71 %), followed by dyspnoea (58.9%). Majority participants belonged to Category B(55.6%) followed by C(39.6%). Age and comorbidity status were statistically associated with clinical categorization. Comparison of clinical categorization revealed increase in category C patients in wave 2 compared to wave 1. Conclusion: Patients of covid 19 second wave were predominantly from productive age group mostly presented with fever and dyspnoea and were categorized with Severe forms of category B & C. Elderly age and presence of lifestyle diseases are associated with presence of severe category of disease. Hence vigilant management is necessary for this vulnerable groups. Key Words: Clinicosocial profile, COVID 19, South Kerala.

Background: Hepatitis A remains a major communicable disease in Kerala, with varying trends across districts and years. The disease has a varied presentation at the time of diagnosis, and it can progress from an accidental finding to life threatening conditions like hepatic failure. Objective: This study aims to examine year-wise and district wise trends in Hepatitis A cases and deaths, identify high risk areas and temporal pattern of disease. Material and Methods: In this study, descriptive statistics, trend analysis, behavioural insights and advanced visualisation has been used. Results: The analysis revealed that districts like Kollam and Malappuram consistently reports the highest number of Hepatitis A cases throughout the study period. The data also shown seasonal peaks in cases, with a marked increase during pre-monsoon and post-monsoon periods. Conclusion: This study provides a detailed analysis of the epidemiological trends of Hepatitis A in Kerala over a ten-year period (2013-2023). The results underscore the need for targeted interventions in high-burden districts such as Kollam and Malappuram. The analysis also revealed seasonal spikes in Hepatitis A cases, predominantly during pre-monsoon and post-monsoon. This study provides data on interplay between climate change, sanitation challenges and disease epidemiology in Kerala. Keywords: Hepatitis A, Kerala, Outbreak investigation, Trend, Climate.

Background: Obesity is a major risk factor for CVD and is usually measured by anthropometric indices like BMI and WHR. However, SAD has been identified as a promising measure of central obesity and visceral fat distribution, especially in individuals with a genetic predisposition to cardiovascular risk factors. This study compares the efficacy of SAD and traditional obesity indices in predicting cardiovascular risk in adults with a family history of CVD. Objective: To assess and compare sagittal abdominal diameter (SAD) with other conventional anthropometric indices, including BMI, WHR, and waist circumference, in the detection of obesity-related cardiovascular risks in adults with a family history of CVD. Material and Methods: This cross-sectional study included 200 adults aged 25–60 years with a family history of CVD. Anthropometric measurements, including SAD, BMI, WHR, and waist circumference, were obtained using standardized methods. Cardiovascular risk markers such as blood pressure, lipid profile, and fasting blood glucose were assessed. Statistical analyses were conducted to determine the associations between anthropometric indices and cardiovascular risk markers. Results: SAD was more correlated with cardiovascular risk markers, as evidenced by blood pressure elevation, r = 0.68; dyslipidemia, r = 0.64; fasting blood glucose, r = 0.61; compared with BMI, r = 0.42, and WHR, r = 0.49. Higher SAD tertile participants exhibited a significantly increased likelihood of heightened cardiovascular risk over those in the lower tertiles (p < 0.001). The study findings indicate that SAD is a better predictor of CVD risk in people with a family history of cardiovascular conditions. Conclusion: Sagittal abdominal diameter outperforms traditional anthropometry in predicting cardiovascular risk among adults with genetically predisposed CVD. In this way, establishing the efficacy of SAD as a potential tool for routine clinical assessments to provide targeted interventions in high-risk populations. Key Words: Sagittal Abdominal Diameter, Cardiovascular Risk, Obesity, Anthropometry, Body Mass Index, Waist-To-Hip Ratio, Family History, Visceral Fat.

Background: Malaria is a significant global health challenge, particularly in tropical and subtropical regions. The accurate detection and species determination of malaria parasites is crucial for effective diagnosis and management. Objective: This study aimed to detect and identify malaria parasites using microscopy, serology, and polymerase chain reaction (PCR), and to evaluate their efficacy by comparing them to microscopy, the gold standard. Material and Methods: Conducted at SCB Medical College, Cuttack, in collaboration with RMRC, Bhubaneswar, this prospective study involved 150 patients from November 2013 to September 2015. Blood samples were examined using thick and thin smears, immunochromatographic tests (ICT), and PCR techniques. Results: The positivity rates for malaria detection were 73.3% (thick smear), 71.3% (thin smear), 69.3% (ICT), and 80.7% (PCR). PCR showed the highest sensitivity (93.2% for P. falciparum and 75.7% for P. vivax) and specificity (100%) compared to other methods. The study highlighted the advantages and limitations of each diagnostic technique, with PCR being the most sensitive and specific but requiring advanced infrastructure. Conclusion: Molecular methods like PCR demonstrate superior accuracy in malaria diagnosis, especially in species determination. However, their high cost and complexity make them less feasible in resource-limited settings. ICT offers a viable alternative for rapid and field-level diagnosis despite certain limitations. This study underscores the need for an integrated diagnostic approach to combat malaria effectively. Key Words: DNA, PCR, ICT.

Background: Infertility, defined as the inability to conceive after 12 months of regular, unprotected intercourse, is a growing global health concern, with ovulatory disorders accounting for a significant proportion of female infertility cases. This study aims to evaluate the incidence and contributing factors of anovulatory infertility among women attending a tertiary care hospital in Eastern India. Material and Methods: This cross-sectional study was conducted over a year, including 100 women unable to conceive after a year of unprotected intercourse. Participants underwent clinical evaluations, including history-taking, physical examinations, and various laboratory tests. Causes of anovulatory infertility were classified based on clinical and laboratory findings. Results: Among the 150 women analyzed, 38 (25.3%) were diagnosed with anovulatory infertility. The mean age of these patients was 29.01±2.89 years. The predominant cause of anovulation was Polycystic Ovary Syndrome (PCOS) (64.7%), followed by hyperprolactinemia (14.2%) and hypothyroidism (7.2%). Secondary anovulation associated with obesity was observed in 13.9% of cases. Hormonal analysis revealed mean FSH levels of 6.5±1.76 IU/mL, LH at 5.91±1.69 IU/mL, and AMH at 7.01±1.99 ng/mL. Discussion: The study highlighted PCOS as the leading cause of anovulatory infertility, consistent with global and regional trends. The findings emphasize the importance of early identification and management of risk factors like obesity and hormonal imbalances to improve fertility outcomes. Conclusion: Anovulatory infertility remains a significant challenge, predominantly driven by PCOS in this cohort. Addressing modifiable risk factors can potentially reduce the incidence of this condition. Keywords: Anovulatory infertility, Polycystic Ovary Syndrome, Ovulatory disorders, Reproductive health, Hormonal imbalance, Eastern India.

Background: Hypertensive disorders during pregnancy, such as pre-eclampsia, can lead to significant ocular changes, including alterations in choroidal thickness. Subfoveal choroidal thickness (SFCT) is an essential parameter that reflects choroidal health and is influenced by systemic vascular changes. This study aimed to evaluate the SFCT in pre-eclamptic women compared to healthy pregnant and non-pregnant individuals and to assess the impact of various clinical variables on SFCT. Material and Methods: A cross-sectional study was conducted with three groups: 40 pre-eclamptic women, 45 healthy pregnant women, and 30 non-pregnant women, all recruited from [Institution Name]. Optical coherence tomography (OCT) was used to measure SFCT at the fovea and additional regions of the retina (temporal and nasal to the fovea). Measurements were taken in the third trimester and one month postpartum for the pre-eclamptic group. Data on systolic and diastolic blood pressure, gestational age, body mass index (BMI), and hemoglobin levels were collected. Statistical analysis included independent t-tests, ANOVA, and multivariate regression models to assess associations and predictors of SFCT. Results: The pre-eclamptic group had significantly thinner SFCT (337.5 ± 49.8 μm) compared to the healthy pregnant group (374.2 ± 44.1 μm) and the non-pregnant group (351.6 ± 34.4 μm). The comparison between pre-eclamptic and healthy pregnant groups was statistically significant (p < 0.001). Postpartum SFCT increased in the pre-eclamptic group, with measurements of 345.2 ± 47.3 μm one week postpartum (p = 0.045) and 358.1 ± 45.2 μm one month postpartum (p = 0.014). Multivariate analysis revealed that systolic blood pressure (β = -0.28, p = 0.001) and hemoglobin levels (β = 0.25, p = 0.001) were significant predictors of SFCT. Diastolic blood pressure and gestational age were also associated with SFCT (p = 0.031 and p = 0.023, respectively). Conclusion: The study demonstrates that pre-eclampsia is associated with significantly thinner SFCT compared to healthy pregnancy and non-pregnancy, indicating systemic effects on ocular vascularity. The postpartum increase in SFCT suggests a normalization process following the resolution of pre-eclampsia. Elevated systolic blood pressure and hemoglobin levels were identified as key predictors of SFCT. These findings underscore the importance of monitoring ocular changes in pregnant women, especially those at risk of hypertensive disorders. Key Words: Subfoveal choroidal thickness, pre-eclampsia, pregnancy, optical coherence tomography, ocular vascular changes.

Background: As ART continues to improve, ensuring that individuals living with HIV can enjoy a high quality of life is becoming a key goal in HIV care. This means not only ensuring viral suppression and longevity but also addressing the psychosocial, emotional, and economic challenges that people living with HIV face. Numerous factors have been associated with quality of life (QOL), including employment, socioeconomic level, education, and gender. Thus, the goal of the current study is to investigate how the quality of life of people living with HIV/AIDS (PLWHA) varies by gender. Material and Methods: From year 2013 to 2014, 211 HIV-positive individuals who were receiving antiretroviral treatment at Rajindra Hospital, GMC Patiala, participated in a cross-sectional study. Patients' sociodemographic traits were examined, and the WHOQOL-HIVBREF questionnaire was used to gauge their quality of life. ANOVA, the student's t-test (independent sample), and the chi-square test were employed for analysis. Results: Of the 211 participants in the study, 106 (50.2%) were male and 105 (49.8%) were female. Women tended to have less advanced HIV disease, as indicated by their CD4 counts; 40.0% of females and 25.5% of males had CD4 counts greater than 500 cells/mm³. However, females had lower overall quality of life (QOL) scores compared to males. Women scored significantly lower than men in several domains: physical (14.16 ± 3.07, p < 0.001), psychological (13.07 ± 2.18, p < 0.000), level of independence (12.47 ± 2.03, p < 0.001), social relationships (14.61 ± 1.89, p < 0.005), and environment (13.25 ± 1.64, p < 0.000). Conclusion: Women had a poor quality of life as compared to men. As women are most economically, culturally, and socially disadvantaged and lack equal treatment acceptance and empowerment, gender sensitive approaches should be enhanced in treatment, care, and support in dealing with PLWHA. Key words: HIV, AIDS, Quality of life, Gender, PLWHA.

Background: Tooth discoloration is a common aesthetic concern, influenced by both intrinsic and extrinsic factors such as age, gender, and lifestyle habits. Understanding the correlation between demographic factors and tooth color can help tailor personalized dental treatment plans. This study aims to examine the relationship between age, gender, and tooth shade in a diverse cohort of individuals. Material and Methods: A cross-sectional study was conducted involving 312 participants, divided into groups based on tooth shade: light, medium, and dark shades. The demographic variables of age and gender were compared across different tooth shade categories. Statistical analysis was performed using Chi-square tests for categorical variables and correlation coefficients (Pearson’s r) to evaluate the relationship between age, gender, and tooth shade. P-values < 0.05 were considered statistically significant. Results: Age was found to be significantly correlated with tooth shade, with older adults exhibiting darker shades (p < 0.001). A negative correlation was observed between younger age (<30 years) and brightness level (r = -0.48, p < 0.001). Gender differences were also significant, with males having darker tooth shades than females (p = 0.041). The correlation between age and tooth shade was moderate (r = 0.52, p < 0.001), and between age and brightness level, it was negative (r = -0.48, p < 0.001). Conclusion: This study demonstrates that age and gender are significant factors influencing tooth shade, with older individuals and males tending to have darker tooth shades. These findings underscore the importance of considering demographic factors when planning aesthetic dental treatments. The results also highlight the role of lifestyle factors, such as smoking, which should be further explored in future studies. Key Words: Tooth discoloration, tooth shade, age, gender, smoking.

Background: Cognitive impairment is a growing public health concern globally, with increasing rates of dementia. Hypertension has been identified as a significant risk factor for cognitive decline, but the relationship between blood pressure and cognitive function remains unclear. This study investigates the association between cognitive function and blood pressure in hypertensive and normotensive individuals. Materials and Methods: This cross-sectional study was conducted as a part of an ICMR-approved STS project in a tertiary care health centre. The study included 180 participants aged 18 years and above. Blood pressure was measured using a calibrated non-mercury LED sphygmomanometer, and cognitive function was assessed using the 30 points Montreal Cognitive Assessment (MoCA) test. Participants were divided into two groups based on blood pressure: normotensive (controls, n= 129) and hypertensive (cases, n=51). Data were analysed using unpaired t-tests and Pearson correlation analysis to assess the relationship between blood pressure parameters (systolic and diastolic) and MoCA scores. Results: The study found a significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP), and MoCA scores between normotensive and hypertensive subjects (p<0.001). A significant negative correlation was observed between both SBP and DBP with MoCA scores (p<0.001). Hypertensive individuals (MoCA score- mean ± SD= 19.84 ± 3.84) exhibited lower cognitive function compared to normotensive individuals (MoCA score- mean ± SD= 25.89 ± 2.75). Conclusion: The study highlights a significant association between elevated blood pressure and cognitive impairment. Elevated systolic and diastolic blood pressure are associated with cognitive impairment. Early intervention and blood pressure control may help prevent or manage cognitive decline, thereby improving quality of life. Keywords: Hypertension, Cognitive function, Montreal Cognitive Assessment (MoCA) test.

Background: Analgesics and sedative agents are routinely used in pediatric intensive care units (PICUs) to ensure comfort, alleviate pain, and reduce anxiety in critically ill children. However, prolonged use of opioids and benzodiazepines, such as midazolam and fentanyl, may lead to withdrawal syndrome (WS). Current literature, predominantly from western settings, lacks validation for Indian PICU setups due to varied inclusion criteria, assessment tools, and protocols. This study aims to determine the incidence of WS in children receiving IV sedoanalgesics and its correlation with the duration of PICU stay and reintubation rates. Material and Methods: This prospective observational study included children aged 1 month to 18 years admitted to the PICU at the Indira Gandhi Institute of Child Health, Bengaluru, between January 2021 and June 2022. Children receiving IV sedoanalgesia for more than 48 hours were assessed for WS using the Withdrawal Assessment Tool-1 (WAT-1). Data on age, weight, sedoanalgesic doses, duration, and outcomes were analyzed using SPSS version 20, with significance set at p<0.05. Results: Among 327 children studied, 119 (36%) developed WS. The median dose and duration of midazolam were 3 µg/kg/min and 7 days, while fentanyl had a median dose of 1.5 µg/kg/min for 7 days, both significantly higher in WS cases (p<0.01). Children sedated for ≥8 days had a 90% incidence of WS, compared to 59% for 6-7 days and 27% for 3-5 days, with no cases reported for <3 days (p<0.001). WS was most frequent among children with central nervous system disorders (19%). Reintubation occurred in 59 cases, with 54 (91%) associated with WS. Clonidine was used for WS management and showed effective symptom resolution. Conclusion: The incidence of WS in children receiving IV sedoanalgesics in the PICU was 36%, with prolonged sedation and higher cumulative doses as significant risk factors. Proper monitoring and individualized sedation protocols are essential to minimize WS and associated complications such as reintubation. Key Words: Withdrawal Syndrome, Pediatric Intensive Care Unit, Midazolam, Fentanyl, Sedoanalgesia, Reintubation.

Background: To evaluate diagnostic accuracy of diffusion-weighted imaging in detection of metastatic lymph nodes in gynecological malignancies. Material and Methods: Thirty patients with gynecological cancer who underwent MRI and histopathological examination were included. The pelvic lymph nodes were grouped into six regions. The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short axis diameter (SAD) and long axis diameter (LAD), ADC max, ADC mean and ADC min. Categorical variables were taken as mean frequency to compare the differences of all criteria between Metastatic Lymph Nodes (MLNs) and non- MLNs. Correlation of quantitative ADC values with histopathological examination result were done to obtain cut off ADC value by ROC curve. Sensitivity, specificity and diagnostic accuracy of DWI were evaluated. Results: The SAD of MLN was significantly greater than that of non- MLN (p=0.001). The differences in LAD between MLN and non- MLN was also significant. The ADC max and ADC mean value of MLN were significantly lower (p<0.05) while ADC min value of MLN was insignificantly lower than those of non-MLN (p>0.05). ADC max had the highest AUC 0.879 with 75% sensitivity and 85.7% specificity. Conclusion: MRI with DWI had potential in diagnosing normal- sized pelvic lymph nodes metastases in patients with gynaecological cancer. The SAD and ADC values of lymph nodes were moderately valuable for detection of normal- sized MLNs as sole indices. Key Words: Onco-imaging, ADC value, metastatic lymph nodes.

Background: Atypical posterior reversible encephalopathy syndrome (PRES) is an uncommon but significant neurological condition. Its association with late postpartum pre-eclampsia occurring without prior signs of hypertension (Denovo) in in vitro fertilization (IVF) pregnancies is extremely rare and awareness of this entity shall help clinician in early diagnosis and management of this life-threatening illness. Case Presentation: A 32-year-old woman, three days postpartum following a twin delivery through IVF, presented with generalized tonic-clonic seizures and altered mental status. She had no history of hypertension or pre-eclampsia during pregnancy or the immediate postpartum period. On admission, her blood pressure was 200/110 mmHg. Magnetic resonance imaging revealed symmetrical vasogenic edema in the bilateral parieto-occipital lobes, consistent with PRES. Laboratory investigations showed mild elevation of lactate dehydrogenase and trace proteinuria, with otherwise normal liver, renal, and coagulation profiles. The patient was diagnosed with late postpartum de novo pre-eclampsia complicated by PRES. The patient received intravenous antihypertensives, magnesium sulphate, and supportive care. Her condition improved within three days, with complete resolution of neurological symptoms and radiological findings. She was discharged on oral antihypertensives and advised regular monitoring. Conclusion: This case highlights the importance of recognizing atypical presentations of pre-eclampsia and PRES, especially in IVF pregnancies. Early diagnosis and prompt management are critical for preventing severe complications and achieving favorable outcomes. This is a rare report of PRES in the context of late postpartum de novo pre-eclampsia following IVF, underscoring the need for heightened clinical awareness. Keywords: Posterior reversible encephalopathy syndrome (PRES), Late postpartum preeclampsia and eclampsia; In vitro fertilisation (IVF), magnetic resonance imaging (MRI), Generalized tonic-clonic convulsions (GTCS), Hypertensive emergency.

Background: The use of haemostatic agents such as tranexamic acid has long been followed in the field of obstetrics and gynaecology, dentistry, coronary by-pass surgeries etc since the past decade which has proven extremely beneficial in controlling the blood loss during the surgeries. The use of tranexamic acid in orthopaedic surgeries on a worldwide scale has increased significantly with positive results in the recent past. The purpose of this study is to assess the beneficial effects of tranexamic acid in improving the overall outcome of the patients undergoing major surgeries around the hip joint. Materials and Methods: In this comparative study, 74 patients who had undergone either total hip arthroplasty or hip hemiarthroplasty between November 2019 to November 2020, were divided into two groups - those who are receiving a single dose of tranexamic acid (15mg/kg body weight) and control group who did not receive the injection at the time of surgery. Blood loss was monitored by amount of blood collected in the suction drain and change in the weight of the mops used during surgery. Blood loss during the surgery and in the post-operative period were recorded. Post-operative change in haemoglobin levels were analysed. Results: In our study comprising of 74 patients 67.57 % in the study were females and 32.43% were males with the age ranginh from 15-70 years. There was a significant difference in the number of units of blood transfused with a p value 0.0179, the mean in the test group was 0.67 SD + 0.39, and the mean in the control group was 1.35SD + 0.63. The requirement of intra operative transfusion was statistically significant, more in the group that did not receive tranexamic acid, p less than 0.05 (p=0.044). There was a significant difference in the number of units of blood transfused in the post-operative period with a p value 0.000214. The requirement of transfusion in the post-operative period was statistically significantly more in the group that did not receive tranexamic acid, p less than 0.05 (p=0.00214). Conclusions: Blood loss during the surgery and post-operative need for blood transfusion was significantly lower in the group who received tranexamic acid pre-operatively compared to the group who did not receive tranexamic acid. Post-operative rehabilitation was significantly better and faster in the group who received tranexamic acid. Keywords: Total hip replacement, Hemiarthroplasty, Tranexamic acid.

Background: The concept of Leadership in Medical Curriculum was recognized in the Graduate Medical Education regulations (GMER) with the vision of a globally relevant Indian Medical Graduate (IMG). According to GMER, Leadership role is to function as a leader and member of the health care team and system with capabilities to collect, analyze, synthesize and communicate health data appropriately. Among the five different roles of IMG, the skills required for attaining competence in Leadership role is more challenging to teach, acquire as well as assess. Acquiring leadership skills requires awareness regarding its significance and readiness to learn. Considering the arising need of a robust framework for inculcating leadership skills in the field of medicine in a developing country like ours, it is the need of the hour to analyse the perception of MBBS students towards Leadership and its curriculum framework. Therefore this study was undertaken to compare the perception of MBBS phase I (First year) and Phase III part 2 (Final year) students regarding leadership curriculum. Materials and Methods: The study was done after clearance from the Institutional Ethical committee. 21-point Questionnaire was formulated and shared via Google forms to the first and final year students. The questionnaire was peer reviewed and validated by a pilot survey. The responses were analysed and compared using two tailed Mann Whitney U test. p value of <0.05 is considered significant. Results: 85 Phase I students and 88 Phase III part 2 students participated in the study. Phase I students were less aware about the leadership curriculum compared to Phase IV. The comparative analysis between the two groups of students shows no significant difference in their opinion on leadership curriculum (p > 0.005). 50% of the Phase III part II students Vs 12.5 % of Phase I students show readiness towards Leadership curriculum. Conclusion: This study proves that the final year students show more readiness to learn for the leadership curriculum. The transition in perception as well as the improvement in awareness towards leadership curriculum substantiates the result. Keywords: IMG, Leadership Curriculum, Medical education

Background: Hypercholesterolemia is a highly prevalent disease condition all over the world, with incidence of more than 10 million cases per year in India. Disorders such as atherosclerosis and Coronary Artery Disease (CAD) are the consequence of hypercholesterolemia. Even though Garlic is found to have beneficial role in reducing cholesterol levels, the potency of raw garlic against standard drug therapy like statins are less studied. Therefore, this study aims to determine the cholesterol lowering efficacy of raw garlic, as an add – on therapy to standard statin therapy. Materials and Methods: This study is a prospective, randomized, open labelled with active controlled 2 arm parallel group. 120 patients were enrolled in this study and randomized to control group [Standard therapy] and Study Group [Garlic along with standard therapy]. The patients of Control Group were given Atorvastatin while those in Study Group were given garlic in addition to Atorvastatin for 8 weeks. Study parameters are Total cholesterol level (mg/dl) and adverse drug effects for the study products. Results: The results collected were analyzed by percentage comparison, mean with standard deviation, Paired T-Test, One-Way ANOVA test and repeated measures of ANOVA. The study shows there is reduction of mean cholesterol values in both the study group (baseline 250.2 ± 44.58 to 8 wks 179.8 ± 26.43 and control group (baseline 235.1 ± 25.31 to 8 wks 181.8 ± 26.50). Percentage of reduction in serum cholesterol level is 70.4% in garlic + statin group compared to statin alone 53.3% (p value- 0.0001). Conclusion: Raw garlic has beneficial effect in lowering serum cholesterol levels when given along with standard statin therapy in hypercholesterolemic patients. Keywords: Raw Garlic, Hypercholesterolemia, Statins, Total Cholesterol.