Vol 14, Issue 3, July-September, 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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