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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Malleolar fractures are one of the most common fractures in orthopedic traumatology. Treatment of these fractures is complicated and challenging as the outcome influences the locomotion; inadequate and improper treatment may result in long-term orthopedic complications and disability. The purpose of this study is to analyze the factors influencing the outcome of operative management of malleolar fractures. Material & Methods: A hospital based prospective study done on twenty patients with malleolar fractures of ankle presenting in department of orthopaedics at JLNMC, Ajmer, Rajasthan, India during one-year period were operated with open reduction and internal fixation by various methods. All patients were assessed clinically, radiologically. The stability of the structures involved at the fracture site, damage to the neighboring structures, mechanism of injury was assessed. Radiologically, tibiofibular clear space of >2 mm and widening of the medial clear space of >2 mm were considered as indicators of syndesmotic instability. Follow-up of cases was done at regular intervals of 6 weeks for a minimum of 6 months and assessed using Biard and Jackson’s ankle scoring system. Results: Out of 20 there were 15 males and 5 females, in 12 patients (60 %) right ankle was involved and in 8 patients (40%) it was left ankle. Functional outcome was assessed using Biard and Jackson’s ankle scoring system at follow-up. 12 (60.0%) showed excellent functional score, while 5 (25%) had good score. Two patients showed fair and one patient showed poor outcome due to infection. Pain was the common complaint in 11 (55%) patients of whom 10 patients had Grade B, i.e., pain with strenuous activities and only one patient had mild pain with activities of daily living. None of the patients had clinical instability. Conclusion: We conclude that anatomical reduction is essential in all malleolar fractures of ankle as it is a weight bearing joint. Open reduction and internal fixation guaranty high standard of reduction besides eliminating the chances of loss of reduction. Keywords: Malleolar Fracture, Open Reduction, Internal Fixation, Functional Outcome, Ankle Joint.

Background: The dermatologic diseases of the external ear draw the attention of various medical specialists, including dermatologists, otorhinolaryngologists, general practitioners, and general and plastic surgeons. The present study was conducted for assessing skin diseases of external ear to older adults. Materials and Methods: This observational study examined 100 patients with external ear lesions. Clinical data including patient age, gender, lesion location, and types of dermatologic disease were extracted from patient medical records. Data analysis was done using SSPS-22 software. Results: In terms of lesion distribution, the majority of lesions were found in the earlobe (26, 26%), followed by postauricular lesions (33, 33%). Helix, concha, tragus, crus of helix, antihelix, and triangular fossa accounted for 18%, 7%, 5%, 5%, 3%, and 3% of the lesions respectively. Regarding disease distribution, the most prevalent condition was benign tumor, accounting for 52% of cases, followed by infectious disease (20%). Premalignant disease and malignant tumor were reported in 6% and 18% of cases, respectively, while non-infectious diseases accounted for 4% of the cases. Conclusion: A significant number of older adults presented with premalignant and malignant diseases, predominantly affecting the antihelix and post auricular region. Keywords: External ear; Skin.

Background: The aim of this study is to determine the clinical profile and imaging features of the pediatric acquired demyelinating disorders of the central nervous system. Materials and Methods: One-year hospital based cross sectional study was done in Department of Radio-diagnosis from January 2021- December 2021. 30 pediatric patients clinically suspected of having demyelination disease were included in the study. The patients were subjected to MRI brain and spine scan. The study population were analysed based on age, gender, clinical history, abnormalities on MRI brain, optic nerve & spine imaging. Results: Among ADEM on follow up scan complete resolution was seen in 50.00 % cases with minor residuals in 6.25% and no follow up scan was done for 43.75% participants. Among MOGAD on follow up scan, complete resolution was seen in 28.57 % cases but minor & moderate residuals were seen in 14.29% cases each (1) and no follow up scan was done for 3 (42.86 %) participants. Among NMOSD on follow up scan 42.86 % (3) cases showed minor residuals and14.29% (1) showed complete resolution. No follow up scan was done for in 3 (42.86 %) participants. Conclusion: In our study, the majority (43.33%) were aged between 7 to 12 years with mild female predominance. The most common diagnosis was ADEM (53.33%) followed by equal distribution of MOGAD & NMOSD. ADEM cases showed lesions in bilateral cerebral hemispheres in an asymmetric distribution with predominant supratentorial brain involvement and majority of the cases showed large lesions. In MOGAD cases, brain parenchyma showed predominantly large lesions in supratentorial distribution. Spinal cord lesion was predominantly LETM with statistically significant involvement of the lumbar spinal cord. In NMOSD cases, statistically significant association was seen with area postrema syndrome and periaqueductal grey matter & area postrema lesions on MRI brain. Spinal cord lesions in NMOSD was predominantly LETM with involvement of the cervical and thoracic spinal cord involvement. Keywords: Pediatric demyelinating disorder, MRI, ADEM, NMOSD, MOGAD.

Background: Nosocomial infections significantly contribute to morbidity and mortality in hospital settings specially by drug resistant bugs. The Methicillin-resistant Staphylococcus Aureus (MRSA) appears to be one of those notorious bacteria. MRSA spreads through contact between healthcare workers (HCWs) and patients. Essential accessories such as stethoscopes, mobile phones, wristwatches, spectacles, and pens are frequently used by HCWs. This study aims to monitor these items for the detection of multidrug-resistant species specially MRSA in a tertiary care center. Materials and Methods: This study was conducted in healthcare workers of 5 different ICUs and 5 Wards in a tertiary care centre north India. A total of 60 healthcare workers participated in the study, with 168 objects including stethoscopes, mobiles, wristwatches, Spectacles, Pen and Vanity Bag being examined. Results: This study found that MRSA and Methicillin-resistant coagulase negative Staphylococcus (MR-CONS) were present in 24.30% of and17.10% of ICU doctor objects respectively and 19.20% and 26.90% in ward doctor objects respectively. For nurse’s objects, 11.70% of MRSA was found in ICUs and 11.10% in wards. No MR-CONS was found in ICU nurse objects, but 22.20% was found in ward nurse objects. This study also found 8.57% of MRSA was present in ICU worker objects and 10% in ward worker’s objects.28.5% MR-CONS was found in ICU worker’s objects, but 20% was found in ward worker’s objects. Conclusion: This study concludes that the significant bacterial contamination present on inanimate objects used by healthcare workers. Implementing stringent hygiene practices of frequently used devices can help reduce the risk of infection transmission within healthcare environments. Keywords: Nosocomial infections, Health‑care workers, multidrug resistance, Staphylococcus spp.

Background: Neonatal seizures, characterized by abnormal electrical activity in the brain, represent a prevalent and distinctly identifiable clinical manifestation indicative of dysfunction within the central nervous system of newborns. The primary objective of this comprehensive study is to employ rigorous and standardized clinical criteria to accurately diagnose neonatal convulsions. Additionally, this study aims to meticulously evaluate the concomitant presence of any underlying biochemical abnormalities that may contribute to or result from the seizure activity. Materials and Methods: This prospective study was conducted over a one-year period, including 75 neonates who presented with seizures to the casualty. Results: In present study, males were predominantly affected. Most of the patients had institutional delivery. Term gestation and normal vaginal delivery were most common. Majority of the babies were appropriate for gestational age and weighed >2.5kg. Tonic seizures were the most common type followed by clonic seizures. Hypoglycaemia was the most common metabolic abnormality. Conclusion: Biochemical abnormalities are frequently observed in neonates presenting with seizures, contributing to the underlying etiology in a significant number of cases. These abnormalities include electrolyte imbalances, hypoglycemia, and metabolic disorders. Early identification and management of these biochemical disturbances are crucial for improving the prognosis and preventing long-term neurological sequelae. Keywords: neonatal seizures, hypoglycaemia, tonic clonic, hyponatremia, and hypocalcemia.

Aim: Preterm delivery is a significant contributor to perinatal morbidity and mortality, prompting numerous studies to explore the associations between maternal lipid levels during pregnancy and the risk of preterm birth. Consequently, the present study aims to evaluate the potential of serum cholesterol levels as an indicator of preterm delivery. Materials & Methods: A total of 100 subjects were enrolled. Complete demographic and clinical details of all the subjects was obtained. Only those subjects were included which had gestational age of between 14 weeks to 20 weeks. All the results were analyzed using SPSS software. Univariate analysis was done using SPSS software. Results: A total of 100 subjects were enrolled. Among these 100 subjects, preterm delivery was seen in 21 percent of the patients while in term delivery was seen in 79 percent of the patients. Mean serum cholesterol levels among preterm and term delivery was 298 mg/dl and 214.9 mg/dl respectively. Mean serum cholesterol levels were significantly higher among patients with preterm delivery. Conclusion: Preterm delivery is linked to higher levels of cholesterol in the maternal serum. Keywords: Cholesterol, Labor, Pregnancy.

Background: Stroke, the second leading cause of death globally, predominantly manifests as ischemic stroke. This review synthesizes current evidence on blood-based protein biomarkers for diagnosing ischemic stroke, aiming to enhance early detection and treatment strategies. Materials and Methods: Adhering to PRISMA guidelines, we systematically searched PubMed, Cochrane, Embase, and Web of Science databases for studies published up to 2024, focusing on blood-based protein biomarkers in ischemic stroke diagnosis. Quality assessment and data extraction were meticulously performed, emphasizing biomarker sensitivity, specificity, and diagnostic value. Results: Our review included 190 studies, highlighting several promising biomarkers such as GFAP, and S100B for their diagnostic accuracy in distinguishing ischemic stroke from other stroke types and healthy controls. Conclusion: Blood-based protein biomarkers demonstrate significant promise for early and accurate ischemic stroke diagnosis. Their integration into clinical practice could revolutionize stroke management, offering a non-invasive, rapid diagnostic tool. However, further large-scale studies are necessary to validate these findings and establish standardized protocols for their clinical application. Keywords: Ischemic stroke, Biomarkers, Protein biomarkers, Stroke diagnosis, Acute Stroke, Neurological Biomarkers, Predictive value of tests, early diagnosis.

Background: Prompt diagnosis and treatment are crucial to prevent long-term disabilities in Monteggia fracture. Treatment varies from closed reduction in children to open reduction and internal fixation in adults. Objectives: The study aims to analyse outcomes and complications across Bado classifications. Material and Methods: Retrospective analysis of 43 Monteggia fracture cases from July 2022 to December 2023 included demographic data, injury mechanisms, surgical details, and follow-up evaluations up to 9 months. Parameters assessed included m-DASH scores, complications, and functional outcomes. Results: Out of 43 patients we got 22, 16, 3 and 2 patients’ with Bado type 1,2,3 and 4 respectively. The m-DASH score at 9 months showed better functional outcome in Type 1 and Type 2 Bado classification patient as compared to Type 3 and Type 4 patient. Conclusions: Timely surgical intervention and individualized approaches are critical for managing Monteggia fractures. Anatomical reduction, implant selection, and complications are essential for optimizing patient outcomes and minimizing long-term disabilities. Keywords: Monteggia fracture, PIN palsy, open reduction, observational, Non-union.

Background: Aim: This research is aimed at the measurement of the functional and radiological out-come of the subjects surgically treated for posterior malleolus fracture. Materials and Methods: The present study includes Adults (age group 18-60 years old) admitted with ankle fractures involving posterior malleolus who have undergone surgical management will be recruited into the study. King George Hospital, Visakhapatnam, AP. Results: In the present study, 40 subjects were added up in to the study, of which 27 being male & 13 female patients. Among the 40 patients 31 sustained injury due to a road traffic accident and 9 due to an accidental fall from height. All the patients were initially investigated with x-rays and CT scans and classified according to Bartonicek classification. All patients were treated surgically & the posterior-malleolus was surgically treated with a buttress-plate or a CC-screw applied either anterior-to-posterior or posterior-to-anterior fashion. The subject reassessment was performed at 4th wk, 6th wk, 12th wk. Also, at 6 months and were assessed clinically by AOFAS score and radiologically using Kristenson criteria. l According to Kristenson grading 32 patients had good out come and 8 patients had fair outcome. According to AOSAF grading 12 patients had excellent out-come while 6 patients had fair outcome and 22 had good out-come functionally. 6 patients had post-operative stiffness while 4 had hardware related soft tissue irritation,2 had deep infection and 2 patients had wound dehiscence. Conclusion: In conclusion, the patients treated operatively for posterior malleolus fracture had excellent to good radiological and functional out-come. The patients who had some degree of ankle stiffness were either due to poor mobilization and physiotherapy either due to deep infection or hardware irritation. Keywords: Malleolus fracture, AOSAF, Radiological, Kristenson criteria, Functional outcome.

Background: The leading cause of death and reduction in years of life with a handicap globally is ischemic heart disease. The mortality rate is greatly decreased when patients with acute myocardial infarction are identified and treated promptly. Cardiovascular biomarkers do play a significant role in the early diagnosis and treatment of patients with ACS, in addition to ECG and other clinical characteristics. Serum Ischemia Modified Albumin (IMA) should be measured within 6 hours of the onset of chest pain, and its results should be correlated with LDH, CK-MB, TGL, T-CHOL, HDL, LDL, and VLDL. Materials and Methods: The INDEX Medical College and Hospital Department of Biochemistry has undertaken this study. One hundred patients with acute coronary syndrome symptoms were included as subjects in the causality study. Their ECG results were correlated and were presented within six hours of the onset of discomfort. One hundred controls, matched for age and sex, served as the control group. Lipid profile, CKMB, LDH, SGOT, and IMA (ACB test) estimation were performed on blood samples. Results: The control and study groups' respective mean IMA values were 36.98±15.7 and 114.87±16.63. Ischemia altered albumin's substantial association with CK-MB, lipid profile, and LDH was demonstrated by Pearson's correlation. Conclusion: The current study's results support earlier research that found the Albumin Cobalt colorimetric assay can discriminate myocardial ischemia patients from non-ischemic patients (p<0.001). The IMA assay offers a quantitative, precise laboratory method for determining the occurrence of an ischemic myocardial event, which includes different kinds of angina. Acute Coronary Syndrome is diagnosed in individuals with continuous myocardial ischemia in the emergency department by measuring modified albumin levels. The diagnostic sensitivity of the procedure is increased by measuring IMA in addition to ECG and other indicators. Keywords: Acute coronary syndrome, IMA, LDH, CPKMB & SGOT.

Background: Chronic non-communicable diseases are assuming greater importance among the adults in both developed and developing countries. The prevalence of chronic disease is showing an upward trend in most countries, and for several reasons this trend is likely to increase. In India, there are estimated 77 million people above the age of 18 years are suffering from diabetes (type 2) and nearly 25 million are prediabetics. More than 50% of people are unaware of their diabetic status which leads to health complications if not detected and treated early. Madras Diabetes Research Foundation (MDRF, Chennai) developed the Indian Diabetes Risk Score (IDRS) as a simple tool to help detect undiagnosed T2DM in the community. Present study was done using MDRF-IDRS to find subjects at high risk of developing Type 2 Diabetes Mellitus. Materials and Methods: A cross-sectional hospital based study was carried out among adults aged 35 years and above in the General medicine OPD by simple random sampling technique. The duration of study was three months from October to December 2022. Data entered in excel and analysed using SPSS® software version 22. To test for differences in the two proportions, Chi-square test is employed. Results: The mean age of participants was 49.24 ± 10.578 years, and majority were females (51%). Overall majority of the participants i.e., 88 (56.8%) were at high risk of developing T2DM, 62 (40%) study participants were at moderate risk and 5 (3.2%) were at low risk of developing T2DM. Conclusion: The MDRF - IDRS is a simple, fast, non-invasive and reliable tool to identify individuals at high risk for T2DM. Our study observed a significant prevalence of modifiable risk factors among participants, such as lack of physical activity and abdominal obesity. Efforts should be made to educate all people to adopt healthy lifestyle for decreasing the prevalence of non-communicable diseases including diabetes. Keywords: Diabetes Mellitus, Non-Communicable Diseases, Indian Diabetic Risk Score.

Background: Adolescent pregnancy, defined by the World Health Organization as pregnancy in girls aged 10-19, remains a significant global health issue, especially in low- and middle-income countries (LMICs). Despite a decline in adolescent birth rates globally, approximately 21 million adolescent pregnancies occur annually in LMICs. This study examines the socio-demographic characteristics and perinatal birth outcomes of adolescent pregnancies in India. Materials and Methods: An observational, cross-sectional comparative study was conducted at the Obstetrics & Gynaecology Department of GGH Vijayawada over two months. The study included 376 antenatal women, divided equally into two groups: adolescents (15-19 years) and adults (>20 years). Data were collected using a pre-tested semi-structured questionnaire covering socio-demographic and obstetric characteristics. Statistical analysis was performed using descriptive statistics, t-tests, and Chi-square tests, with a p-value <0.05 considered statistically significant. Results: Adolescent mothers had a mean age of 17.15 years, whereas 26.46 years was mean age for adult mothers. A higher percentage of adolescent mothers were housewives and had lower total monthly family incomes. Gestational age at delivery was significantly lower for adolescents (36.32 weeks) compared to adults (37.44 weeks). Maternal complications such as anemia (41.5% vs. 27.7%), hypertensive disorders (11.7% vs. 4.8%), preterm deliveries (47.3% vs. 25%), and prolonged labor (55.3% vs. 36.7%) were significantly higher among adolescents. Neonatal outcomes were also poorer for adolescents, with higher rates of low birth weight (38.3% vs. 22.9%), ICU admissions (62.8% vs. 40.4%), and marginally higher instances of neonatal jaundice and sepsis. Conclusion: The study highlights significant socio-demographic and perinatal health disparities between adolescent and adult pregnancies. Adolescent pregnancies are associated with higher risks of maternal and neonatal complications, underlining the need for targeted interventions to address the unique challenges faced by young mothers in India. Improving education, economic opportunities, and access to quality healthcare for adolescents could mitigate these adverse outcomes. Further research and policy attention are required to address the complex factors contributing to adolescent pregnancy and its associated health risks. Keywords: Adolescent Pregnancy, Maternal Outcomes, Perinatal Outcomes.

Background: Diabetes is the leading cause of non-traumatic limb amputations. Diabetic patients tend to have an ongoing atherogenic process in the peripheral arteries, which is more manifest in patients with diabetic foot. This study aims to evaluate the association between diabetic foot and prevalence of peripheral arterial disease. Materials and Methods: This prospective study was conducted by the department of surgery over a period of 1 year and included 100 patients with diabetic foot. Results: The prevalence of peripheral arterial disease in patients with diabetic foot was 54% in this study. The prevalence of PAD was significantly more in male patients, in patients with duration of diabetes >20 years, in patients who have undergone amputation procedures. Conclusion: With the rising prevalence of diabetes and diabetic foot being associated with higher prevalence of peripheral arterial disease in males, and in patients with diabetes above 20 years duration, one must regulary screen at-risk population for PAD. Keywords: Diabetes, diabetes foot, peripheral arterial disease.

Background: Clavicle fractures make up about 3-5% of all adult fractures. The vast majority of fractures, approximately 80%, is located in the midshaft of the clavicle and more than half of these fractures are displaced. In comminuted fracture with single or multiple (segmental or butterfly) pieces in the middle which gets aligned vertically, which given the appearance of ‘Z’ in X-ray. Objective: This study aims to know the functional outcome in comminuted clavicle Z fractures treated with locking contoured J-plate. Materials and Methods: This study was conducted in our institute between January 2016 to January 2023 on 29 patients of mid-third clavicular fracture. Closed comminuted middle third clavicular fracture patients aged between 20 to 60 years were included in the study. Results: Twenty-nine isolated closed comminuted clavicle middle third fracture patients were included in our study as per the inclusion criteria. Their mean age was 32.8 years. All fractures united at a mean duration of 13.2 weeks with more than 90% patients having excellent to good results and none of the patients had poor outcome. Conclusion: We conclude that fixation of comminuted clavicle fractures with contoured locking J – plate gives excellent results, maintaining the length and alignment of the clavicle. Consider ‘Z’ fracture as a separate entity and we advised to manage it surgically to get good functional outcome and early functional recovery. Keywords: Clavicle, J – plate, Comminuted, Z – fracture.

Background: Due to the rise in the incidence of thyroid disorders, the number of patients undergoing thyroidectomies has also increased. This skill demanding surgery is associated with certain permanent post-operative complications, which can be avoided in most of the situations. This study was done to evaluate the post-operative complications occurring in patients who have undergone thyroidectomies in a tertiary care center. Materials and Methods: A total of 75 patients who had undergone thyroidectomies in the Department of Surgery____ over a period of 1 year have been included in this prospective observational study. Results: There was female preponderance in the study, with female: male ratio being 6.5:1. The majority of the patients belonged to 31-40 years of age group. Colloid goitre was the most common pre-operative diagnosis. Hemithyroidectomy was the most commonly performed surgery. Hoarseness of voice was the most common post-operative complications and bleeding during surgery was the most common intra-operative complication. Conclusion: Total thyroidectomy has a higher rate of post-operative complications, especially hypocalcemia (hypoparathyroidism) and hypothyroidism compared to hemi-thyroidectomy. The surgeon must be careful to preserve the nerve and parathyroid glands to avoid such complications which could be permanent. Keywords: Thyroidectomy, post-operative complications, hypocalcemia, Recurrent laryngeal nerve palsy.

Background: Total hip anthroplasty is a commonly performed study these days. The hip joint is subjected to daily stress as it bears the weight of the upper body. Osteoarthritis of the hip may cause irreversible damage. Proximal geometry of the femur, like neck shaft angle and torsion, is important in designing prostheses for a specific population. Materials and Methods: Present study was a descriptive cross sectional study on 50 Dry femora (25 right and 25 left) which were randomly obtained from the Department of Anatomy, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana during the period of August 2022 to December 2022. We included dried, intact and non-pathological femurs and femur with tumor, fracture, trauma and any pathological abnormality were excluded. Anthropometric instruments like Osteometric board, Digital Verneir caliper, Goniometer were used for measurements of parameters. Results & Conclusion: The accuracy and success of the hip replacement surgery demands complete knowledge of the morphometry of the proximal femur which is highly specific among the races, region and gender. Keywords: Femur neck length, neck shaft angle, morphometry.

Background: Heart failure is becoming increasingly prevalent worldwide, especially in emerging nations like India. Newer biomarkers of heart failure, such as Red Cell Distribution Width (RDW), provide valuable insights for heart failure risk assessment and prognosis. RDW measures variability in erythrocyte (red blood cell) size, which indirectly reflects overall cardiovascular health and inflammation. This study assesses the efficacy of RDW as a prognostic indicator of morbidity and mortality among patients with heart failure and compares it with already established. Materials and Methods: This hospital based prospective observational study was carried out from December 2021 to September 2022. A total of 140 patients who presented to the hospital with signs and symptoms of acute heart failure were included. Results: The study included 140 subjects with a mean age of 51.7±16.7 years and a male to female ratio of 1.15:1. Coronary artery disease was the most common cause of heart failure. The mean RDW at admission was 16.7% (SD 2.8%). Subjects were divided into quartiles based on a median RDW of 16.3%, with the 4th quartile having RDW > 18.3%. The mortality rate increased from 8.6% in the 1st RDW quartile to 51.4% in the 4th quartile. High NT PROBNP values (>35000) were found in 45.7% of cases in the 1st RDW quartile and 71.4% in the 4th quartile. Conclusion: Higher RDW values were significantly associated with increased risk of mortality, prolonged hospital stay and correlated with higher NTpro-BNP values. Patients whose RDW decreased during their hospital stay had a better overall prognosis. Keywords: Red cell Distribution Width (RDW), Heart Failure, NTpro BNP, Mortality.

Background: Meconium-stained amniotic fluid (MSAF) is a common obstetric finding that can signal potential fetal distress and complicate labor and delivery. It occurs when the fetus passes meconium, the first stool, into the amniotic fluid before or during labor. MSAF is associated with various maternal and fetal factors, including gestational age, parity, and fetal monitoring results. The impact of MSAF on neonatal outcomes is significant, with meconium consistency (thin vs. thick) playing a crucial role in determining the risk of complications such as meconium aspiration syndrome (MAS). Thick meconium, in particular, is associated with higher morbidity and a greater need for neonatal intensive care unit (NICU) admission. Aims: 1. To evaluate the perinatal outcomes of fetuses affected by meconium aspiration syndrome (MAS).2. To identify the factors responsible for meconium-stained amniotic fluid (MSAF). Materials and Methods: This was a retrospective study was conducted at the Department of OBG & Pediatrics, Government General Hospital & KMC, Kurnool, Andhra Pradesh from November 2023 to April 2024. The study included 300 cases of meconium-stained amniotic fluid (MSAF) and was performed across the labour ward, postnatal ward, and Special Newborn Intensive Care Unit (SNICU). Participants were selected based on specific inclusion criteria: they were either primigravidae or multiparous women, carrying singleton pregnancies in cephalic presentation, and presenting with meconium-stained amniotic fluid. Results: In our study, meconium-stained amniotic fluid (MSAF) was notably more common among primigravidae, with 67.28% of cases observed in first-time mothers compared to 15.20% in multigravidae. Regarding meconium consistency, thin meconium was more prevalent (64.8%) than thick meconium (35.2%). Notably, thick meconium was associated with higher morbidity, as evidenced by 80% of meconium aspiration cases being linked to thick meconium. NICU admissions were more frequent among babies with non-reactive non-stress tests (51.8%) compared to those with reactive tests (13.4%), highlighting a significant association (P = 0.001). Conclusion: Our study underscores several important findings regarding meconium-stained amniotic fluid (MSAF). Primigravidae are more frequently affected by MSAF compared to multigravidae, and emergency cesarean sections are the predominant mode of delivery in such cases. Most MSAF cases involve term babies, diverging from studies suggesting a stronger association with post-term and large-for-gestational-age infants. Thin meconium is more common than thick meconium, but the latter is associated with higher neonatal morbidity, particularly meconium aspiration syndrome. Keywords: Downe’s score, Fetal distress, Meconium staining, Very low birth weight.

Background: Thyroid swelling is a common clinical presentation that can be indicative of benign or malignant conditions, necessitating accurate diagnostic modalities for effective management. Fine-Needle Aspiration Cytology (FNAC) is a minimally invasive procedure that provides cytological analysis, crucial for differentiating between benign and malignant thyroid lesions. Ultrasound of the neck (USG) complements FNAC by offering detailed morphological assessment of thyroid nodules, aiding in the precise localization and characterization of lesions. Materials and Methods: this prospective study was conducted over 1-year period in the Department of Radiology, Katuri Medical College, during which 75 patients with thyroid lesions were included. Results: the study population was a female predominant one. Most of the patients were aged between 21 – 30 years. Most of the patients had hypothyroidism. Most of the swelling were soft in consistency, were >10 mm in size, involving either of the lobes (solitary). FNAC was able to detect both malignant and benign lesions which USG thyroid gland couldn’t. Conclusion: The confluence of morphological data derived from USG and cellular insights obtained from FNAC enables clinicians to make judicious decisions regarding the management of thyroid nodules. This integrative diagnostic strategy is instrumental in the early detection of thyroid malignancies, informing treatment protocols, and optimizing patient prognoses. Hence, the correlation between FNAC and USG findings is fundamental to the efficacious evaluation of thyroid nodules, ensuring precise diagnosis and superior patient care. Keywords: FNAC, Ultrasonography, Thyroid Lesions.

Background: The anal sphincter complex, comprising the internal and external anal sphincters, plays a vital role in maintaining fecal continence, with dysfunction leading to conditions like fecal incontinence and chronic anal pain. Diagnosis and treatment of these dysfunctions are crucial, often involving advanced imaging techniques such as transperineal ultrasonography and MRI. While MRI provides superior soft tissue contrast and detailed anatomical assessments, transperineal ultrasonography offers a cost-effective, non-invasive alternative. The choice between these modalities depends on clinical context, resource availability, and patient-specific factors, highlighting the need for a tailored diagnostic approach. Materials and Methods: all patients with anal dysfunction aged 18 years and above presenting to the Department of Radiology of Katuri Medical College over 12 months’ period were included in the study. Results: most of the patients belonged to younger age group i.e., between 21-40 years. Females were predominantly involved in both groups. Rectovaginal fistula was the most common abnormality observed in present study. MRI showed higher diagnostic accuracy in comparison with trans-perineal ultrasonography. Conclusion: The study concluded that MRI provided a slight edge in diagnostic accuracy over trans-perineal ultrasonography in identifying sphincter abnormalities. Keywords: Trans-perineal ultrasound, MRI perineal area, anal dysfunction, anal sphincter, fistula.

Background: Assessment of quality of care is an important metric in evaluation of universal access to reproductive health. Due to the inefficiency of maternal mortality alone in accurate assessment of the same, a new entity, maternal near miss (MNM) was evaluated to assess morbidity involved in obstetric care. Materials and Methods: The occurrence of such MNM cases was studied at a tertiary care centre and the data related to patient demographics, common causes, pre-existing conditions were collected. Results: Haemorrhage and hypertension were the leading causes of both MNM and maternal mortality. Haemorrhage accounts for 55.74% of near misses and 38.46% of maternal deaths. Hypertension constituted 37.9% of near miss and 30.7% of maternal mortality. Maternal mortality was higher in the third trimester and postnatal period (38.5%). This signifies the need for improvement of quality of care during the puerperal period and postnatal period. The Near Miss to Mortality Ratio in our study was 13.38: 1. A higher ratio correlates to a better survivability of sick cases in the obstetric ICU. Anaemia (54.02%) was the most common underlying cause of MNM. The incidence of which can be decreased by proper antenatal care. Conclusion: Haemorrhage (55.74%) was the leading cause of MNM followed by Hypertensive disorders in pregnancy (37.93%). Anaemia (54.02%) was the most common underlying cause of MNM which indirectly led to other complications. Another ratio, the Mortality Index which represented mortality risk of critical patients was studied which was 6.95 in this study. Keywords: maternal near miss; maternal mortality; severe acute maternal morbidity.

Background: Tuberculosis (TB) is a chronic infectious disease, and its persistent morbidity and mortality burden remains one of the major public health challenges in India. According to estimates provided by the World Health Organization (WHO), there were 10.6 million cases of TB in 2021 globally, 11% of which were in children under the age of 15. Objectives: to know the burden of tuberculosis in under fifteen years age group children, its distribution with respect to age, gender, type of TB. Materials and Methods: A Hospital based Retrospective descriptive study conducted in a tertiary care centre Kurnool, Patient records of children aged less than 15 years of age group who were registered at district tuberculosis centre in the Government General Hospital, Kurnool were collected form January 2017 to December 2021.Collected data was entered in to Microsoft Excel and analysed by using SPPS22 version software. Results: There were 1266 (63.4%) of pulmonary tuberculosis cases and 730 (36.5%) cases of extra pulmonary cases. There was nearly an equal division of pulmonary tuberculosis cases among males 49.2% and females 50.7%. Even there was similar distribution pattern with extra pulmonary cases as males 50.9% and females as 49%. Conclusion: Among all the TB cases 4.6%were children aged under 15 years old. Hence compared to the global estimated report which is 11.3% in 2021 there was under diagnosis in India. Keywords: Paediatric Tuberculosis, Pulmonary Tuberculosis Extra pulmonary tuberculosis, WHO, Mortality

Background: Injudicious usage of antibiotics may lead to severe antimicrobial resistance, which has been highlighted by World Health Day 2011 theme “Antimicrobial resistance: No action today, no cure tomorrow.” Aim: To describe the rational prescription practices in the Kurnool district primary Health centres Materials and Methods: After getting approval from IEC, Kurnool medical college, Kurnool, Permission was obtained from the District Medical & Health Officer, Kurnool District to carry out the study. Before visit to PHC, medical officer of respective PHC was contacted and informed about the visit. Each PHC was visited in person by investigator and using pretested, semi structured questionnaire, Study was conducted among the PHCs of Kurnool District. A total of 600 exit interviews (from each PHC-30 interviews) were conducted among patients, who attended the OPD, on every Monday and Friday. Results: In the current study, on an average12.25 prescriptions had the antibiotics, 7.15 prescriptions had injections, 2.85 prescriptions were encountered with polypharmacy in each PHC. Average consultation time for 50 patients was 92.2 min, and average dispensing time for 50 patients in each PHC was 8973 sec (149.55 min). Average drugs prescribed for 50 patients from each PHC was 88.7 and average drugs dispensed was 80.3. Average drugs adequately labelled were 59.9. All the PHCs included in the study sample had Essential medicines formulary and E-aushadi. Conclusion: It was found in the present study that the prescription practices don't conform to the stipulated guidelines in majority of cases, especially use of antibiotics. Hence there is a need to train the health care providers about the rational use of injections and antibiotics. Keywords: Antibiotics, PHC, Prescription, Rational use.

Background: Sepsis, a common cause of critical illness, is significantly associated with high morbidity, mortality, and often acute kidney injury (AKI), termed sepsis-associated acute kidney injury (SA-AKI) when it occurs in this context. While the link between sepsis and AKI has been explored, the absence of a reproducible and standardized consensus definition has hindered the clarity of available research. Materials and Methods: This retrospective study was conducted in the Department of Emergency Medicine, Kamineni academy of medical sciences and research centre, L.B Nagar, Hyderabad, Telangana, India. over a period of one year, i.e. from Nov 2022-2023. The study included patients aged 18 years and above with diagnosis of sepsis with AKI. Out of the 250 patients who had been diagnosed with sepsis, 150 patients had AKI. Results: Patients with AKI had higher serum creatinine levels than non-AKI group. Presence of septic shock, higher APACHE III score, lower mean arterial pressure, positive blood cultures for bacteria and higher in-hospital mortality are few other parameters which were found at significant levels in patients with AKI. Conclusion: Addressing complications and identifying at-risk patients for early intervention are vital in improving survival rates and outcomes for SA- AKI. Keywords: Sepsis, acute kidney injury, smoker, diabetic, hospital mortality, septic shock.

Background: Percutaneous nephrolithotomy (PCNL) is the first choice for treatment of large renal stone >2 cm. The prone position is the classical position preferred by most surgeons. Aiming to improve patient anesthesia and surgery-related inconveniences of the prone position, Valdivia et al., 1987, described the performance of PCNL with the patient in the supine position. Hence, we aimed to study the safety and efficacy of flank-free modified supine position in PCNL compared to the standard prone position. Materials and Methods: In this prospective study, conducted in Department of Urology, Tirunelveli Medical College, 120 patients with renal stones of size 2-4cm who underwent PCNL were analyzed during the period from June 2022 to June 2023. Patients were divided into two groups of each 60 patients: Group I – PCNL done in prone position Group II – PCNL done in modified flank supine position. Patient’s demographics, size, location and Hounsfield unit of the stone, number of tract, fluoroscopy time, operative time were recorded. Postoperatively drop in haemoglobin; need for blood transfusion, fever, urine leakage, hospital stay, stone-free status, and other complications were assessed. Results: There was no statistically significant difference between the prone and supine positions regarding stone size Hounsfield unit, body mass index and fluoroscopy time. The mean intra operative time was 78.3 min in supine group and 96.7 min in prone group. The mean hemoglobin drop was 1.18 g/dl and 1.24 g/dl in supine and prone position. Fever occurred in 3.3% of cases in each group. Blood transfusion was needed in one patient in prone group. The mean post-operative hospital stay was 4.1 and 3.86 days in supine and prone group. Two patients in each group require relook PCNL. Stone free rate at 1month was 94.5% in supine and 93.2% in prone group. Conclusion: PCNL in the modified supine position proved to be a safe and effective choice compared to the prone position for adult patients with renal calculi. Supine PCNL proved to be less time consuming and quick to perform and comparable to prone PCNL in respect to other operative parameters. Keywords: Supine, Prone, PCNL, renal stone.

Background: Dengue fever, caused by the dengue virus transmitted through Aedes mosquitoes, is a significant global health issue. Early diagnosis is crucial for effective management and reducing morbidity. Leukopenia, a reduction in white blood cell count, is a common hematological finding in dengue patients, but its diagnostic value remains debated. This study aims to evaluate the role of leukopenia as a diagnostic marker for dengue fever and its correlation with clinical outcomes. Materials and Methods: This prospective observational study included 100 patients aged 5 months to 65 years diagnosed with dengue fever in June 2024. Dengue diagnosis was confirmed using the Dengue card test. Patients were categorized based on the presence or absence of leukopenia. Clinical and laboratory parameters, including white blood cell count (WBC), platelet count, and hemoglobin levels, were recorded. The duration of hospital stay, recovery rate, and complications were analyzed. Sensitivity and specificity of leukopenia in diagnosing dengue were calculated, and odds ratios for various factors were assessed using logistic regression. Results: Among the 100 patients, 78 (78%) had leukopenia. The leukopenia group had a significantly lower WBC count (2539.9 ± 828.1 cells/mm³) compared to the non-leukopenia group (5650.9 ± 1329.3 cells/mm³, p<0.0001). Platelet counts and hemoglobin levels did not differ significantly between groups. Patients with leukopenia experienced a longer hospital stay (8.7 ± 2.1 days vs. 6.3 ± 1.6 days, p=0.025) and a lower recovery rate (79.5% vs. 95.5%, p=0.041). Complications such as bleeding and organ failure were more prevalent in the leukopenia group (bleeding: 17.9% vs. 9.1%, p=0.011; organ failure: 7.7% vs. 0.0%, p=0.034). The sensitivity of leukopenia for detecting dengue was 93.3%, while specificity was 68.0%. The odds ratio for leukopenia as a predictor of dengue was 3.51 (95% CI: 0.81 - 6.85, p=0.202). Conclusion: Leukopenia is a highly sensitive marker for dengue fever, though with moderate specificity. It is associated with more severe clinical outcomes, including prolonged hospital stay and higher complication rates. While leukopenia can be a useful diagnostic indicator, it should be used in conjunction with other diagnostic tests for accurate dengue diagnosis and management. Keywords: Dengue fever, leukopenia, sensitivity, specificity, platelet count.

Background: To study the risk factors and management of early pregnancy loss in tertiary care maternity hospital. Materials and Methods: It is a hospital based observational study in tertiary maternity hospital for a period of 2 years in pregnant woman with early pregnancy loss before 12 weeks 6 days of gestational age, both primary and secondary and Singleton pregnancy. Results: The age at which most early pregnancy losses occurred was between 31-35 years followed by >36 years. The occurrence of early pregnancy loss was observed to be more in educated subjects when compared to illiterate subjects. Early pregnancy loss more common in women who were unemployed when compared to employed women. The present study showed that rate of early loss of pregnancy was maximum in those women who were conceiving for the first time compared to women who have conceived before. Majority of the early pregnancy losses occurred in the gestational age of 6 – 9 weeks compared to the other gestational ages in weeks. The major type of abortion that was diagnosed among the subjects was complete abortion followed by incomplete abortion, missed abortion and septic abortion. The majority of subjects were given MVA followed by medical management, D&C and expectant management. Complications followed by management were looked into and it was observed that majority of the subjects had anaemia followed by hypovolemic shock, haemorrhagic shock and septicaemia. The body mass index of the subjects was also looked into and it was observed in the present study that majority of the subjects were obese followed by overweight, normal weight and underweight. Conclusion: Findings of the current study shown that risk factors of miscarriages included age of mother, increased BMI and previous history of miscarriages. All these factors need to be considered while providing antenatal care to mothers to mitigate the risk of miscarriages. Keywords: Pregnancy Loss, Risk Factors, Miscarriages, Antenatal Care.

Background: Thrombocytopenia, characterized by low platelet counts, is a common hematologic condition associated with abnormal bleeding. This study investigates its diverse causes and clinical impact in patients at a tertiary care center, aiming to identify associated morbidity and mortality risks. Early recognition of thrombocytopenia's etiology is crucial for managing bleeding complications effectively. Materials and Methods: This is a descriptive cross-sectional study conducted at Bangalore Medical College and Research Institute aimed to investigate the etiology, clinical profile, morbidity, and mortality of thrombocytopenic patients at a tertiary care hospital in South India. Over a four-month period from April to July 2024, 118 eligible patients from various departments were enrolled based on a platelet count below 1.5 Lakhs/mm³. Data collection involved detailed demographic information, symptomatology related to bleeding manifestations, physical examination, and comprehensive laboratory investigations. Treatment followed standard hospital protocols, including the administration of blood products as clinically indicated. Statistical analysis was performed using SPSS. Results: In this study of 118 patients, 62.7% were male and 37.3% were female, with the most common age group being 18-30 years (33.1%). Most patients (62%) hailed from rural areas. Fever (83.9%) and cough (21.2%) were predominant symptoms, while bleeding manifestations occurred in 38.98% of cases, including petechiae and bleeding gums. Dengue fever (24.5%) and sepsis (16.1%) were the leading diagnoses. Diabetes mellitus and hypertension affected 13.6% and 11% of patients, respectively. Most patients (82.4%) did not require blood products, though 8.4% needed PRBCs and 8.4% required platelet transfusions. Isolated thrombocytopenia (64.4%) was the most common peripheral smear finding. The majority (85.5%) recovered, while 2.6% died primarily due to septic shock while the rest were started on long term treatment based on their diagnosis. Conclusion: In our study, thrombocytopenia predominantly affected young males presenting with fever, fatigue, and myalgia. Dengue emerged as the leading cause, followed by sepsis and malaria, often associated with bleeding. Vitamin B12, and folate deficiencies were common non-infective causes of Thrombocytopenia. Diabetes posed a higher risk for bleeding complications. Isolated thrombocytopenia was the most frequent blood picture observed. While some cases were severe, the majority of patients recovered fully, highlighting a favorable prognosis. Further extensive research is needed to better understand the diverse causes and treatments of thrombocytopenia. Keywords: Thrombocytopenia, Fever, Dengue, Sepsis

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and hyperglycemia. Mean platelet volume (MPV) has been proposed as a potential marker for vascular complications in diabetes. This study aimed to investigate the relationship between MPV and glycated hemoglobin (HbA1c) levels in patients with T2DM. Materials and Methods: This case-control study included 50 patients with T2DM with more than five years duration of diabetes (cases) and 50 healthy individuals (controls). Demographic data, MPV, and HbA1c levels were collected for all participants. The correlation between MPV and HbA1c was analyzed in the case group using Pearson's correlation coefficient. Results: The mean MPV was significantly higher in the T2DM group compared to the control group (10.8 ± 1.2 fL vs. 9.5 ± 0.9 fL, p < 0.001). In the T2DM group, a positive correlation was observed between MPV and HbA1c levels (r = 0.62, p < 0.001). Conclusion: The findings suggest that elevated MPV is associated with higher HbA1c levels in patients with T2DM. MPV may serve as a potential marker for glycemic control and vascular complications in T2DM patients. Further research is warranted to explore the clinical implications of this relationship. Keywords: Type 2 diabetes mellitus, mean platelet volume, glycated hemoglobin, HbA1c, vascular complications.

Background: The acetabulum is a part of hip bone which is cup shaped and is contributed by ilium, ischium and pubis. Measurements of acetabulum are important in determining stability of hip joint, assessment of acetabular dysplasia, diagnosing various clinical conditions and monitoring patient’s recovery. Aims: The aim of the present study was to examine the normal acetabular morphometry and to determine any side and gender variations in the anatomical parameters of the acetabulum. Material and Methods: 200 normal X-rays of pelvis with bilateral hips of males (100) and females (100) of the age group 20-50 years were used in the present study. For each hip, the acetabular diameter and acetabular depth were measured. Results: The overall mean value of acetabular diameter in males was found to be 54.1 + 3.4 mm. The mean values of acetabular diameter in males was found to be 54.3 + 3.6 mm on the right side, while on the left side it was found to be 53.7 + 3.3 mm. The overall mean value of acetabular diameter in females was found to be 53.0 + 3.1 mm. The mean values of acetabular diameter in females was found to be 53.6 + 3.2 on the right side, while on the left side it was found to be 52.4 + 3.1 mm. In males, the mean value of acetabular depth on the right side was found to be 12.5 + 3.3 mm while on the left side it was found to be 12.1 + 3.1 mm making an average acetabular depth of 12.3 + 3.2 mm. In case of females, the mean value of the acetabular depth on the right side was found to be 11.4 + 2.5 mm while on the left side it was found to be 11.2 + 2.6 mm making an average acetabular depth of 11.3 + 2.5 mm. Conclusion: There were significant gender and side variations in Kashmiri population for both the examined anatomical perimeters of acetabulum. Knowledge about the average dimensions of acetabulum will assist in carrying out various surgical procedures like total hip replacement and designing of various prostheses suitably according to need. Keywords: Acetabulum, hip joint, morphometry, acetabular dysplasia, prostheses.

Background: Diagnosing chronic abdominal pain presents a considerable clinical challenge due to its complex and often elusive nature. Laparoscopy, a minimally invasive technique, holds promise not only as a diagnostic tool but also as a therapeutic option for patients suffering from chronic, undiagnosed abdominal pain. This study aims to thoroughly assess the effectiveness of laparoscopy in diagnosing and managing such patients, exploring its potential to uncover underlying causes that other methods might miss. Materials and Methods: 75 patients aged above 18 years with chronic abdominal pain of > 3 months duration were admitted by the Department of Surgery to undergo diagnostic laparoscopy. Results: Most of the patients were females. Younger age group, (30 years) constituted the majority of the patients. Most of the people had abdominal pain since 12-18 months of duration. Post-operative adhesions were the most common cause of chronic abdominal pain, followed by recurrent appendicitis. Most of the patients had positive outcomes (i.e, decrease in abdominal pain). Conclusion: By evaluating the role of laparoscopy, we hope to provide insights into its utility as a vital investigative modality for improving patient outcomes in cases of persistent abdominal pain. Keywords: Chronic abdominal pain, laparoscopy, adhesions, appendicitis, cholecystitis.

Background: Psoriasis is a common chronic inflammatory skin disease with complex pathophysiology. The role of vitamin D has recently arisen in many skin and systemic diseases including psoriasis through its modified effect of inflammatory and immunological mechanisms. Several studies have demonstrated its effects on keratinocytes' proliferation and differentiation, cutaneous immune system, regulating the microbial flora and the response to infective diseases. Materials and Methods: This is a prospective, observational and case-control study was conducted in the Department of Dermatology, American International Institute of Medical Sciences. Clinically diagnosed 186 patients of chronic plaque psoriasis and 63 healthy controls were studied. A detailed history was inquired and clinical examination was done with evaluation of serum vitamin D levels. Clinically diagnosed chronic plaque psoriasis patients and healthy controls of age > 15 years of any sex were included. All patients were subjected to full history taking, clinical examination, and laboratory investigations. Serum vitamin D levels were measured by using enzyme linked immunosorbent assay technique. Results: Among the cases with severe PASI, 26 (97%) had vitamin D deficiency and 1 normal vitamin D level. With moderate disease, 42 (71.9%), 13 (22.1%), and 5 (6%) had deficient, insufficient, and normal levels of vitamin D respectively. Ten (28%), 25 (65.9%), and 4 (8.2%) had a normal, insufficient, and deficient vitamin D in mild disease. A significant negative correlation was found between serum 25(OH) D level and PASI (r= −0.6289, P= 0.01). A receiver operating characteristic curve was performed and an optimal cutoff PASI value of 4.05 (AUC=0.889, P<0.001) was obtained. Above this value, patients had a high risk of vitamin D deficiency with the sensitivity of 84.1% and specificity of 82.4%. Conclusion: It is necessary to bear in mind that vitamin D deficiency is more common in psoriasis patients than controls and that infers the role of vitamin D in the pathogenesis of the disease. Decreased 25 OH vitamin D serum level was found in psoriatic patients. The 25 OH vitamin D serum level may be used as a marker of psoriasis severity and response to treatment. Keywords: Psoriasis, oral vitamin D, treatment.

Background: To assess the effects of immediate vs delayed breast reconstruction on postoperative recovery and quality of life. Material and Methods: The study was conducted using the Health Survey (SF-36), along with clinical and sociodemographic questionnaires. Initially, 90 patients were recruited for the study. All participants were diagnosed with breast cancer and had undergone mastectomy followed by breast reconstruction. Results: Patients who underwent immediate reconstruction reported higher median scores for physical functioning (80, IQR: 70-90) compared to those with delayed reconstruction (75, IQR: 65-85) and mastectomy without reconstruction (70, IQR: 60-80) with a p-value of 0.045. The role physical scores were similarly higher in the immediate reconstruction group (75, IQR: 60-85) than in the delayed reconstruction (70, IQR: 55-80) and mastectomy without reconstruction groups (65, IQR: 50-75), with a p-value of 0.038. In terms of bodily pain, patients with immediate reconstruction had lower pain scores (65, IQR: 50-75) compared to delayed reconstruction (60, IQR: 45-70) and mastectomy without reconstruction (55, IQR: 40-65) with a significant p-value of 0.032. General health scores were highest in the immediate reconstruction group (70, IQR: 60-80), followed by delayed reconstruction (65, IQR: 55-75) and mastectomy without reconstruction (60, IQR: 50-70) with a p-value of 0.041. Vitality scores were also higher in the immediate reconstruction group (60, IQR: 50-70) than in the delayed reconstruction (55, IQR: 45-65) and mastectomy without reconstruction groups (50, IQR: 40-60) with a p-value of 0.039. Social functioning, role emotional, and mental health scores followed similar patterns, all showing statistically significant higher scores for immediate reconstruction compared to the other groups. Patients who underwent immediate reconstruction reported the highest overall quality of life scores (SF-36), faster physical recovery, better mental health, lower postoperative pain, and lower complication rates. Delayed reconstruction showed moderate results across these variables, while mastectomy without reconstruction had the lowest outcomes. All these differences were statistically significant, highlighting the benefits of immediate breast reconstruction in terms of postoperative recovery and quality of life. Conclusion: In conclusion, immediate breast reconstruction offers significant advantages in terms of postoperative recovery, quality of life, and mental health, as supported by the findings in this study and corroborated by multiple other studies. The data strongly suggest that immediate reconstruction should be considered the preferred option when feasible, to enhance patient outcomes and overall well-being. Keywords: Immediate, Delayed, Breast reconstruction, Quality of life.

Background: There are still unacceptablely high perinatal mortality rates, with up to three million stillbirths and three million neonatal deaths occurring annually across the world. Because of the high frequency of anaemia, problems with maternal health care, and unfavourable birth outcomes in Kanpur. In the course of this research, which was carried out in Kanpur city, Uttar Pradesh, India, we looked into the factors that led to perinatal mortality as well as the issues that were experienced by the mothers of these infants. Setting and design: Descriptive cross-sectional study, Ganesh Shanker Vidyarthi Medical College, Kanpur city, Uttar Pradesh, India. Materials and Methods: Total of 212 women were recruited. Data collection focused on sociodemographic and anthropometric factors, as well as reporting of prenatal care and obstetric difficulties during pregnancy, birth outcome (preterm, late, and term), and mode of delivery (normal, caesarean, and stillbirth). Statistical Analysis: Data were expressed as mean (standard deviation) and percentage (%). Chi-square, Student's t-test, and analysis of variance were used to compare measured variables. Results: Overall, 21.2% of subjects had severe anaemia; 12.7% of participants had APH; 9.9% of participants had ante-partum eclampsia; 7.5% of participants had PET; 4.7% of participants had NSPET; and 0% of participants had GDM or IHCP. Overall, 76.4% of participants had TT vaccination; 45.8% of participants had preterm delivery; 1.4% of participants had Rh-negative pregnancy; 0.5% of participants had hypothyroidism; 0% of participants had IUD; 61.3% of participants had COVID vaccination; 6.1% of participants had foetal congenital anomalies; and 0% of participants had heart disease. Conclusion: The prevalence of severe anaemia and maternal anaemia in pregnant women, in addition to APH, preterm eclampsia, PET, and NSPET, is much higher than what is considered acceptable. Keywords: Maternal mortality, Preterm delivery, Anaemia, Maternalcomplications, Perinatal mortality.

Background: Serous ovarian cancer of low grade histology (LGSOC) is a rare ovarian cancer which differs from High grade serous carcinoma (HGSC) in epidemiology, pathogenesis, presentation and prognosis. Due to its rare incidence, LGSOC has been understudied, prompting this retrospective review. The aim is to contribute to the limited pool of data on this histologic subtype by describing the clinico-radiological features, management strategies, and survival outcomes of cases treated at a single cancer care centre. Materials and Methods: This was a retrospective observation study of histologically proven low grade serous ovarian cancers which had undergone surgery during the five-year study period. Hospital records were reviewed to find the demographics, clinical features, tumor characteristics, pathological findings, surgical data, FIGO stage, adjuvant treatment, and survival data of the patients. Results: Only seven cases of LGSOC underwent surgery during the period of study. The mean age of presentation was 51.7 years. 5 cases presented in early stage (FIGO stage IA, IB) and only 2 in advanced stage (FIGO stage IIIB, IVB). Early stage cases underwent primary debulking surgery while 2 advanced cases received chemotherapy (NACT) followed by debulking surgery. 30 months was the median follow-up duration. To date, all patients were alive and only one had recurrence at 25 months post primary treatment. The mean progression free survival (PFS) of the patients was 31.85 months. Conclusion: Optimal debulking surgery aimed at eradicating residual disease appears to be a contributing factor to improve outcome in cases of LGSOC. Given the limited response of these tumors to chemotherapy, it is imperative to explore targeted treatment approaches alongside surgery. Keywords: Low grade serous ovarian cancer (LGSOC), High grade serous cancer (HGSC), Progression free survival (PFS), Debulking surgery.

Background: Adolescence, a key transition from childhood to adulthood, is critical for health issues like anaemia, which affects around 1.62 billion people globally. In India, the National Family Health Survey - 5 reported a 59.1% prevalence among adolescent girls, with 49.4% in Karnataka. Despite government efforts, anaemia remains widespread in rural areas. Aim and Objective: The aim of the study was to assess the prevalence of nutritional anaemia in late adolescent girls in rural areas of Belagavi, evaluate their knowledge about nutrition, and examine the current dietary practices in their households. Materials and Methods: This cross-sectional study, conducted from January to December 2021 in Vantamuri, involved 365 adolescent girls aged 16 to 19. Participants were selected using systematic random sampling from a master list prepared by ASHA. Data were collected through a pre-designed questionnaire covering sociodemographics, knowledge, attitude, and practices. Haemoglobin levels were measured using the cyanmethaemoglobin method. Data analysis included descriptive statistics, bar and pie charts, and various tests (t-test, ANOVA, Chi-square, Fisher's Exact Test) for assessing associations and significance. Results: The distribution of participants showed that the majority were in the 16 to 17 age group (71.78%), and most (91.23%) were Hindus. Additionally, 90% of the participants were below the poverty line. The prevalence of anaemia in the study was 42.19%. Among those with anaemia, 51.3% had mild anaemia, 37.6% had moderate anaemia, and 11.1% had severe anaemia, according to WHO guidelines. About one-third of the participants had some awareness of anaemia, and 20% recognized it as a health problem. The availability and consumption of iron and folic acid in schools were associated with a decreased prevalence of anaemia. Although dietary habits generally did not significantly impact anaemia, excluding milk products and eggs showed a beneficial effect. The study also found a statistically significant decrease in weight and BMI among participants with anaemia. Conclusion: The study identified a high prevalence of anaemia among 16 to 17-year-olds, with most participants below the poverty line. Severity varied, and awareness of anaemia was low. Increased availability of iron and folic acid in schools and excluding milk and eggs from the diet were associated with reduced anaemia. Additionally, anaemia was linked to decreases in weight and BMI. Keywords: Anaemia, Nutrition, Prevalence, Dietary Habits, Adolescent girls.

Background: The early detection of premalignant conditions prevents their progression to an invasive carcinoma which leads to increased quality of life among the patients. lipid profile has been one of the predominant biomarkers for predicting prognosis or monitoring the disease progression from premalignant to malignant. Aims: The study aims to elucidate the correlation between serum lipid profiles and the presence of head and neck cancers, potentially contributing to early diagnosis and improved patient outcomes. Materials and Methods: Total of 60 patients, premalignant-20, malignant-20, control group-20 Histopathological, head and neck malignancy were divided as premalignant, malignant and control group. With proper written informed consent, Fasting blood samples were collected and the lipid profile studied for these parameters: TC, HDL, LDL, VLDL, TGL. Results: These distributions suggest that head and neck malignancies are more prevalent in the middle-aged population, particularly those between 50 and 60 years of age. Total Cholesterol (TC) and High-Density Lipoprotein (HDL) levels were significantly lower in the premalignant and malignant groups compared to the normal group, suggesting their potential as early diagnostic markers. Low- Density Lipoprotein (LDL) levels were notably lower in the malignant group, indicating its specific association with malignancy. Triglycerides (TG) and Very Low-Density Lipoprotein (VLDL) also exhibited significant differences, highlighting their relevance in disease detection. Conclusion: The present study's results demonstrated an inverse association between head and neck cancer and serum lipid profile levels, supporting the idea that lipid profile levels can be used as a diagnostic criterion for cancer early detection. Keywords: Total Cholesterol (TC) and High-Density Lipoprotein (HDL), premalignant conditions.

Background: Ultrasound (USG) guided Supraclavicular (SC) Brachial Plexus Block is the gold standard BLOCK for anaesthesia and post-operative analgesia of upper limb surgeries. The in-plane approach is commonly used for single injection blocks, whereas the Out-of-plane approach is commonly used for blocks with catheter insertion. Objectives: In this study, we will compare the In-Plane/Out-of-Plane approach in USG guided Supraclavicular Brachial Plexus Block for Anaesthesia of below elbow surgeries. Material and Methods: 140 patients scheduled to undergo below elbow surgeries were taken and randomly divided into 2 Groups. Group I (In-Plane) received the USG guided SC Brachial plexus block via In-Plane approach and Group O (Out-of-plane) received the block via Out-of-plane approach. The time from the insertion to removal of the block needle, the number of attempts of manipulation to reach the Brachial Plexus, time required for onset of Sensory and Motor block and complications and side effects (if any) were recorded. Results: The procedural time, number of attempts, motor block, were found to be similar and comparable in both In-Plane/Out-of-Plane Groups. Whereas the Onset of sensory blocks was shorter in the Out-of-plane group. The mean procedural time was 7.57 ±1.62 and 6.84 ±1.62 minutes. The mean onset time for the sensory block was 3.8 ±0.75 and 3.5 ± 0.75 minutes and the motor block was 5.75 ±0.6 and 5.55 ± 0.75 minutes in Group I and Group O respectively. Conclusion: In our study, we have found thatIn-Plane/Out-of-Plane has similar procedural time and motor block. However, onset to sensory block was significantly shorter in Out-of-plane group. The results of our study allows more scope for the Out-of-plane approach. Keywords: USG guided Supraclavicular Brachial plexus block, Out-of-plane approach.

Background: To study and describe the clinical features, laboratory manifestations in patients diagnosed with scrub typhus at a tertiary hospital in Assam. Materials and Methods: A total of 28 patients in whom the diagnosis of scrub typhus was confirmed admitted between 1st January 2021 to 30 September 2022 in Unit 1 of Department of Medicine in AMCH who filled the inclusion and exclusion criteria were analysed. Results: 28 confirmed cases of scrub typhus were studied over a period of 21 months. The mean age of patients was 46±19.1. The female to male ratio was 2.5:1. The maximum number of cases i.e. 14 (50%) patients belong to 20-40 years age group, 27 patients (96.4%) come from rural background with maximum number of patients being farmers and mostly working in paddy field i.e. 15 (53.5%). For the clinical features, 100% patients presented with fever. The average duration of fever was 7±3.1. 20 patients (71.4%) presented with myalgia. Jaundice was seen in 25% cases of cases. Respiratory symptoms seen in 7 cases (25%). Neurological manifestations were seen in 7 cases (25%) where 3 cases (10.7%) cases presented with altered sensorium. Renal symptoms seen in 7 cases (25%). Pedal edema seen in 9 cases (32.1%) Eschar seen in 3 patients (10.7%). Complications of scrub typhus, ARDS was observed in 1 (3.5%) cases, Meningeal signs seen in 2 (7.1%) cases, Decompensated liver disease with Ascites seen in 5 cases (17.8%). ALT and AST raised in 22 (78.5%) and 24 (84.7%) cases respectively. Leucocytosis seen in 30% cases. Ultrasonography shows hepatomegaly in 2 cases (7.1%) splenomegaly in 4 cases (14.2%) hepatosplenomegaly in 2 cases (7.1%) hepatic parenchymal disease with dilated portal vein in 5 (17.8%) cases. 15 cases (53.5%) with raised total bilirubin, 4 cases (14.2%) with Serum Creatinine > 1.6 mg/dl i.e. patients developing AKI. Conclusion: Scrub typhus is prevalent in the northeastern part of India. It mimics infections like malaria, leptospira, dengue, salmonella typhi, pneumonia for which it should be considered as a differential diagnosis in a patient presenting with acute febrile illness associated with or without gastrointestinal symptoms, altered sensorium etc. and with Leucocytosis and thrombocytopenia and elevated liver enzymes. A history patients residing in rural areas and agriculture based occupation should raised the suspicion of the diagnosis being more towards scrub typhus. Keywords: Fever, Orientiatsutsugamushi, scrub typhus, eschar, Rural area, laboratory abnormalities, Doxycycline.

Background: The spleen plays a crucial role within the hematologic and reticuloendothelial systems. The splenic notches located along the superior margin serve as a valuable clinical reference for the palpation of an enlarged spleen. Hence, the present study was conducted for morphometric assessment of cadaveric spleen. Materials & Methods: A comprehensive examination was conducted on 50 formalin-fixed spleens from adult cadavers of both genders, with damaged specimens being excluded from the study. The morphological characteristics of the spleen specimens were meticulously analyzed, and various morphometric parameters were recorded. Measurements of the spleen's length, breadth, and width were taken using Vernier calipers. Additionally, splenic notches were noted along both the superior and inferior margins. The weight of each spleen was determined using an electronic balance. The study also documented the diverse shapes of the spleens. The collected data underwent statistical analysis utilizing SPSS software. Results: Mean length, breath, width and weight were 10.96 cm, 7.85 cm, 4.84 cm and 141.7 gm respectively. On the superior border of the spleen, no notch was seen in 8 percent, one notch was seen in 24 percent of the patients while two notches were seen in 36 percent of the patients respectively. On the inferior border, one and two notches were seen in 24 percent and 20 percent of the patients respectively. No inferior notch was seen on inferior border in 52 percent of the patients. Conclusion: The role of the spleen in the immune response and its function in defending against infections necessitates a conservative management strategy for cases of splenic rupture. A thorough understanding of the spleen's anatomy and physiological functions is crucial for evaluating its significance in various disease processes. Keywords: Cadaveric, Spleen.

Background: Psychiatric morbidity is a significant concern in rural health settings, particularly in areas like Sikar, Rajasthan, where healthcare resources are limited and accessibility to mental health services is constrained. Rural Health Training Centre (RHTC) play a crucial role in providing healthcare services to underserved populations. Understanding the prevalence and types of psychiatric disorders in these settings is essential for developing targeted interventions. Materials & Methods: This cross-sectional study was conducted at RHTC affiliated with Sikar Medical College over six months. The study included 500 patients attending the RHTC, selected based on calculated sample size using a 95% confidence level and 5% margin of error. Data were collected through structured interviews using the General Health Questionnaire (GHQ-12) and the Patient Health Questionnaire (PHQ-9). Socio-economic status was assessed using the Kuppuswamy scale. Results: Out of 500 patients, 24% were diagnosed with psychiatric morbidity. Specific disorders included depression (10%), anxiety (8%), substance abuse (6%), somatization disorders (3%), psychotic disorders (2%), bipolar disorder (1.6%), and PTSD (1%). A significant portion of patients with severe conditions were referred to tertiary care centre. Conclusion: The high prevalence of psychiatric morbidity highlights the urgent need to integrate mental health services into primary healthcare at RHTC. Addressing socio-economic factors, improving mental health infrastructure, and implementing telepsychiatry are essential steps to enhance mental health outcomes in rural areas. Keywords: Psychiatric Morbidity, Rural Health, Mental Health, Rural Training Centre, Sikar, Rajasthan.

Background: In spite of modern criteria of preoperative groundwork, antimicrobial prophylaxis, and operative procedure, postoperative/surgical site wound infections persist as a serious threat. So the aim of this study is Bacteriological Spectrum of Surgical Wound Infections. Materials and Methods: This study was conducted in Department of Microbiology, Heritage Institute of Medical Sciences, Varanasi. The present study was carried out on the patients admitted in surgical wards. This study were included 200 cases. Out of 200, pus samples were 140 and wound swabs 60 were collected. The duration of study was 3 Years. Results: This study included a total of 200 cases of surgical wound infections. Among them, 61% of cases involved patients under the age of 30, while the remaining 39% were from those aged 30 and above. Positive bacterial growth was observed in 42% of the cases, while the rest showed no growth. The most common organisms identified were Pseudomonas (33.4%), followed by Staphylococcus aureus (25%), Escherichia coli (15.4%), Proteus (8.4%), CONS (5.9%), Klebsiella spp. (4.7%), Acinetobacter baumannii complex (3.5%), Enterobacter (2.3%), and Citrobacter spp. (1.1%). Conclusion: Gram negative pathogens are the most common cause of post-operative wound infections, with emergence of drug resistance against commonly used antimicrobial drugs. Keywords: Surgical wounds, Bacterial spectrum, Antimicrobial Resistance.

Background: To evaluate the efficacy of T2-weighted imaging, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI) for detecting prostate cancer in patients with total serum prostate-specific antigen (PSA) levels of 4–10 ng/mL, which is referred to as the “gray zone. Material and Methods: This prospective study included a total of 108 patients with lower urinary tract symptoms (LUTS) and serum PSA between 4 and 10 ng/mL, without abnormal digital rectal examination (DRE) findings of prostate. PIRADS score (V2) was calculated using multi-parametric magnetic resonance imaging (mp-MRI) before TRUS biopsy of prostate. Relationships among PIRADS score, PSA& presence of carcinoma prostate in TRUS biopsy were statistically analyzed. Results: Mp MRI had a sensitivity and specificity of 100% and 84.59 % respectively for overall cancer detection. Whereas, the sensitivity was 100% for clinically significant prostate cancers. The negative and positive predictive values were 85.89% and 78.57%% respectively for overall cancer detection whereas the negative predictive value (NPV) was 72.37 % for clinically significant cancer. Conclusion: Combined T2-weighted imaging, DWI, and DCE-MRI findings appearto be potentially useful for detecting and managing prostate cancer, even for patients with gray-zone PSA levels. Our result shows that use of MpMRI could have avoided 67.59 % of unnecessary biopsies without missing any of cancers. Keywords: Prostate Cancer, Biopsy, PSA, MpMRI, PI-RADS version.

Background: Seasonal influenza poses significant health risks, particularly for high-risk populations, including the elderly and those with chronic health conditions. Vaccination is a primary preventive measure aimed at reducing the incidence of severe outcomes, such as hospitalization. Objective: This study aimed to evaluate the impact of seasonal influenza vaccination on hospitalization rates among high-risk populations. Material and Methods: A total of 100 high-risk individuals were included in this observational study, with 60 participants in the vaccinated group and 40 in the unvaccinated group. Hospitalization rates due to influenza-related complications were compared between the two groups. Relative risk (RR), absolute risk reduction (ARR), and number needed to vaccinate (NNV) were calculated. Subgroup analyses were performed based on age (≥65 years) and presence of chronic health conditions. Results: The hospitalization rate was significantly lower in the vaccinated group (20%) compared to the unvaccinated group (45%). The relative risk of hospitalization for vaccinated individuals was 0.44 (95% CI: 0.26–0.74), indicating a 56% reduction in hospitalization risk. The ARR was 25%, with an NNV of 4. Subgroup analysis revealed consistent results, with the vaccinated group showing lower hospitalization rates across age and chronic health condition subgroups. Adverse events were minimal, with 25% of vaccinated participants reporting mild side effects. Conclusion: Seasonal influenza vaccination significantly reduces the risk of hospitalization in high-risk populations. These findings support the continued promotion of influenza vaccination, especially among vulnerable groups. Keywords: Seasonal influenza, vaccination, hospitalization, high-risk populations, observational study, relative risk, absolute risk reduction, chronic health conditions.

Background: Malnutrition is common in patients with malignancy and is associated with poor treatment outcomes. There is a need for a reliable and valid scoring system to identify patients with poor nutrition status at the time of admission. Aim: The aim of the present study was to determine the effect of preoperative nutritional status on early post-operative outcomes in patients undergoing surgery for Hepato-pancreato-biliary malignancy. Material and Methods: All patients who underwent surgery for HPB malignancy in the Department of Surgical gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad between March 2018 to March 2019 were included. It was a prospective cross-sectional study. Various nutritional indices were calculated which include the Nutritional Risk Index (NRI), Prognostic nutritional index [PNI], Malnutritional Universal screening tool (MUST)and Subjective global assessment (SGA). Patients were considered well-nourished if SGA -A, NRI>100, PNI>50, MUST – 0 (Low risk) Rest were considered malnourished. The effect of nutritional status as defined by the aforementioned parameters was studied on various outcome measures such as morbidity, mortality and Length of hospital stay. Results: A total of 49 patients underwent pancreatic surgery for malignancy during the study period. Malnutrition was seen in a high percentage of the patients undergoing surgery for pancreatic cancer in the present study. It ranged from 42.85% as estimated by NRI to 77.54% as estimated by MUST. All the four nutritional indices NRI, PNI, MUST and SGA were associated with poor post-operative outcomes after pancreatic surgery. Patients with high NRI had a significantly lower incidence of Delayed gastric emptying(DGE) after pancreatic surgery. In the present study, Post-operative pancreatic fistula(POPF) and mortality were significantly higher in malnourished patients (SGA B,C). A total of 24 patients underwent surgery for hepatobiliary malignancy during the study period. Malnutrition was seen in a significant percentage of the patient’s undergoing surgery for hepatobiliary cancer in the present study. It ranged from 29 % as estimated by MUST to 43.83% as estimated by PNI.All four nutritional indices NRI, PNI, MUST and SGA were not associated with significant post-operative complications in patients who underwent hepatobiliary surgery. Conclusion: In patients undergoing pancreatic surgery for malignancy. 1.Malnutrition identified by nutritional indices NRI, PNI, MUST and SGA were associated with increased postoperative complications. 2. MUST was associated with most post-operative complications. 3. Subjective Global Assessment(B&C) patients were associated with increased risk postoperative pancreatic fistula. Keywords: Nutritional Status, Surgery, Hepato-Pancreato-Biliary Malignancy.

Background: There is an increase in the incidence of Colorectal cancer (CRC), especially among young adults. Lynch syndrome is the most common genetic type with predominance of right side cancer and an early age of onset. There is dearth of literature regarding the prevalence of MMR deficiency in colorectal cancers and it's association with outcome in Indian populations. Screening patients using IHC for MMR protein expression offers an economical alternative to select patients requiring genetic testing. Aim: The aim of the present study was to determine the incidence of Mismatch repair deficiency in colorectal cancer patients. Material and Methods: This prospective, cohort study was conducted in the Department of Surgical Gastroenterology, Nizams Institute of Medical Sciences, Hyderabad from October 2019 to November 2021. All patients diagnosed with colorectal cancer were included. Immunohistochemistry for MLH1, MSH2, MSH6, and PMS2 was performed to check MMR gene expression at the protein level. Results: A total of 77 patients with a diagnosis of colorectal cancers were included in the study. The median (range) age of the study group was 52.5 years (17-73 years) with a male preponderance. There were 11 (14%) patients with MMR protein loss. There were 5 (10.4%) patients with deficient MMR above 50 years age. The comparison between patients with deficient MMR and patients with non-deficient MMR showed that the clinical and demographic profile were similar between the groups except, right sided colonic tumours were significantly higher in the MMR deficient group (p =0.011). The patients with deficient MMR had significantly early-stage tumours than patients with non-deficient MMR (p=0.032). Sixteen (20.7%) and 50(64.9%) patients of the study group received neoadjuvant, and adjuvant therapy respectively. On median (IQR) follow up of 20 months (6-27 months), 4 patients (liver, n=2; Nodal, n=1; Anastomotic site, n=1) had a recurrence of the disease, and 6 patients were expired. All deaths were observed in the nondeficient MMR group. Conclusion: The incidence of the MMR deficiency in CRC patients is 14%. The patients with MMR deficiency had significantly more right sided and early stage I & II malignancy. The two year overall survival was similar between two groups Keywords: MMR (Mismatch Repair), Colorectal cancer (CRC).

Background: Fever represents the most prevalent symptomatology encountered in outpatient departments (OPD). Thrombocytopenia is clinically delineated by a platelet count below 150,000 per cubic millimeter (cu.mm). The concurrence of fever and thrombocytopenia constitutes a predominant indication for hospital admission. This study endeavors to systematically evaluate the clinico-etiological profile of patients presenting with the concomitant manifestations of fever and thrombocytopenia. Materials and Methods: This study was conducted in the Department of General Medicine, Katuri Medical College, Guntur over a period of One year June 2021 to May 2022. The study included 150 patients who got admitted with fever and thrombocytopenia. Results: he present study 66.7% are males. Most common age group is between 20-40 years. malaria was the most common cause of fever with thrombocytopenia. 5.3% of the patients had died. Conclusion: Early recognition and prompt treatment are pivotal in patients suffering from fever with thrombocytopenia. Keywords: Clinical profile, laboratory profile, fever, thrombocytopenia, platelet transfusion.

Background: The Prognostic Nutritional Index (PNI) is commonly utilized to assess surgical risk in individuals with gastrointestinal cancers. Aim: This study aimed to analyze PNI values to forecast outcomes across several types of abdominal surgeries, with the goal of identifying high-risk patients to prevent complications and death. Material and Methods: This prospective study included 100 patients, aged 18 to 80 years of both genders, who underwent surgical procedures for abdominal conditions in either emergency or elective settings. The PNI for each patient was determined using the formula: 10 × albumin (g/dl) + 0.005 × total lymphocyte count (per mm³). The patients were divided into two groups based on their PNI: low PNI (PNI < 46) and high PNI (PNI > 46). Statistical analysis was performed using the chi-square test or Fisher's exact test, with a p-value of < 0.05 considered significant. Results: In the present study, Female patients were more likely to have a low PNI. Additionally, there was a higher prevalence of co-morbidities in patients with low PNI, and more of these patients required ICU care. The PNI < 46 group also had longer hospital stays and a higher mortality rate. Conclusion: The Present study concluded that the PNI proved to be a simple and effective biomarker for identifying baseline risk, predicting postoperative complications, and forecasting long-term outcomes in abdominal surgery. Keywords: PNI, Gastrointestinal cancers, ICU, Albumin, Mortality.

Background: Type II diabetes mellitus (T2DM) is a growing global health issue linked to physical as well as psychological challenges. The chronic nature of T2DM, lifestyle demands, and complications contribute to mental health burdens. There is a pressing need to assess psychological well-being of patients with T2DM. Comprehensive care of patients with T2DM should address both physical and psychological well-being in patients. Materials and Methods: This cross sectional study assessed the psychological well-being of 80 T2DM patients at a tertiary care institute using the Diabetes Distress Scale (DDS). Demographic details, diabetes duration, medications, and comorbidities were documented. Participants rated distress levels on a 1-6 scale. Data were analyzed with SPSS software, employing paired t-tests for quantitative data and Chi-square tests for qualitative data. A p-value < 0.05 was considered statistically significant. Results: This study analyzed 80 T2DM patients, revealing a male predominance (65%) and an average age of 54.57 years. The majority were overweight or obese, with a mean BMI of 28.96. Socioeconomic status and education levels varied. Distress levels as assessed by diabetes distress scale ranged from no distress (22.50%) to severe distress (21.25%), with an overall mean DSS score of 3.01. Females, older age, higher BMI, longer diabetes duration, and comorbidities were significantly associated with increased psychological distress. Higher socioeconomic and educational levels correlated with reduced psychological issues, emphasizing the multifactorial nature of diabetes-related psychological burdens. Conclusion: Routine psychological assessment particularly high-risk individuals T2DM patients is crucial for early detection and intervention improving treatment adherence, diabetes management and overall quality of life. Keywords: Type 2 Diabetes Mellitus, Psychological health, mental health, Diabetes Distress scale.

Background: Hypoglycemia is one of the most frequently encountered metabolic problems in, the incidence increases many folds. Many cases being asymptomatic. The absence of symptoms does not rule out CNS injury. In order to prevent brain injury, blood sugars should be monitored in high-risk babies. Aims & Objectives: To screen for Hypoglycemia in exclusively breastfed high-risk neonates and to study its association with birth weight, mode of delivery, gestational age, parity of mother and to determine time of onset of Hypoglycemia. Materials and Methods: 150 neonates where enrolled who were exclusively breastfed high-risk neonates. It included small for gestational age [SGA], low birth weight [LBW], LATE PRETERM, large for gestational age [LGA], Infants of diabetic mother [IDM]. Infants who require NICU admission were excluded. Blood sugars were monitored at 2, 6,12,24,48 and 72 hours of life using glucometer strips. Lab confirmation was done only when levels were less than 25 mg/dl or when symptomatic. Results: The incidence of Hypoglycemia in New-borns with risk factors was found to be 20.8% [32/150]. Among them Hypoglycemia in SGA babies was found to be 31.5% [10/32], in LBW 15.3% [8/52}. incidence was found to be higher in babies born through c-section [28%] than vaginal delivery [10%]. Babies born to primigravida and multigravida mother had 25% & 10.5% incidence respectively. Most babies developed Hypoglycemia at 2 hours of life and none after 48 hours. Conclusion: Incidence of Hypoglycemia is fairly common in high-risk group, most being asymptomatic. Close monitoring is necessary to prevent sequel later in life. Keywords: Hypoglycemia, Multigravida, SGA, NICU, Neonates.

Background: The new accepted gold standard for treating symptomatic gallbladder disease is laparoscopic cholecystectomy. The goal of the current study was to identify some ultrasound preoperative predictor factors that could help surgeons anticipate potential challenges and complications that could arise during a laparoscopic cholecystectomy and necessitate switching to an open procedure. Subjects and Methods: 56 patients of cholelithiasis, selected from surgical OPD of Varun Arjun Medical College &Rohilkhand Hospital, Banthara, Shahjahanpur, Uttar Pradesh, who fulfilled all inclusion and exclusion criteria for the study underwent elective laparoscopic cholecystectomy. Ultrasonography was done pre-operatively on all cases by a single radiologist in the same settings. Results: There is a significant statistical relationship between complicated laparoscopic cholecystectomy and preoperative ultrasonography prediction parameters. The ultrasonic measure for gallstone disease that has been examined the most is the thickness of the gallbladder wall. Ultrasonography is the most accurate method for measuring the thickness of the gallbladder wall. Conclusion: The frequency of prior episodes of cholecystitis, the white blood cell count, the thickness of the gall bladder wall and pericholecystic collection, the quantity of stones, and the transverse diameter of the gall bladder can all be used to predict the difficulty of a laparoscopic cholecystectomy before surgery. Keywords: Calot's triangle, Difficult, Laparoscopic cholecystectomy, Prediction and Preoperative ultrasonographic prediction.

Background: Urinary tract infections (UTIs) are common in elderly patients and present a significant public health concern, particularly due to the increasing prevalence of antibiotic-resistant pathogens. This study aims to assess the prevalence of UTI-causing pathogens and their antibiotic resistance patterns in an elderly population. Materials and Methods: An observational study was conducted on 100 elderly patients (aged 65 and above) diagnosed with UTIs. Urine samples were collected, and pathogens were isolated and identified. Antibiotic susceptibility testing was performed using standard microbiological methods. Data were analyzed to determine the prevalence of specific pathogens and their resistance patterns to commonly used antibiotics. Results: The most frequently isolated pathogen was Escherichia coli (56%), followed by Klebsiella pneumoniae (22%), Proteus mirabilis (10%), Pseudomonas aeruginosa (7%), and Enterococcus faecalis (5%). E. coli exhibited high resistance to ampicillin (90%) and ciprofloxacin (75%), while K. pneumoniae showed significant resistance to amoxicillin-clavulanate (85%) and cephalexin (70%). Multidrug resistance was particularly concerning in K. pneumoniae and P. aeruginosa. Lower resistance rates were observed in E. faecalis. Conclusion: The study reveals a high prevalence of E. coli as the primary UTI pathogen in elderly patients, with significant antibiotic resistance patterns. The findings underscore the need for ongoing surveillance and tailored antibiotic therapy to effectively manage UTIs in this vulnerable population. Keywords: Urinary tract infections, Elderly, Antibiotic resistance, Escherichia coli, Klebsiella pneumoniae, Multidrug resistance.

Background: Despite efforts to reduce premature births, rates continue to rise globally. Focus has primarily been on low-birth-weight infants and deliveries before 34 weeks. Late preterm births pose challenges, yet elective deliveries before 39-40 weeks are common. Present study aimed to assess the short-term clinical outcomes of late-preterm newborns, considering hospital and NICU stays, medical interventions, and maternal health. Material and Methods: A prospective study (Jan 2021-Dec 2022) at Trichy SRM Medical College Hospital on babies born between 34-36 6/7 weeks gestational age. Major anomalies, out-born babies, and stillbirths were excluded. Data on gestational age, maternal health, and neonatal outcomes were collected and analyzed. Results: Among 100 late preterm neonates, 68% were delivered by Caesarean section. Maternal risk factors included gestational diabetes (GDM), hypertension (GHTN), anaemia, and hypothyroidism. Most common indications for preterm labour were spontaneous onset and twin pregnancies. Neonatal outcomes included 29% with respiratory distress, 53% with jaundice, 19% with suspect sepsis, and 1% mortality. Mean hospital and NICU stays were 9.03 and 5.2 days, respectively. Conclusion: Late preterm babies require longer hospital and NICU stays, increased medical interventions, and face higher risks of complications. Effective neonatal care setups are crucial for their management. Managing high-risk mothers is essential to reduce neonatal mortality and morbidity. Key Words: Late preterm, neonatal outcomes, maternal risk factors, NICU, complications.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder. There is dearth of epidemiological data in India. This study aims to understand the sociodemographic and clinical profile of children with autism spectrum disorders. Materials and Methods: Data was collected by Interviewing the parents of previously diagnosed children with ASD from 2-9 years of age using a semi-structured questionnaire. The children who were diagnosed by using INCLEN tool for ASD based on DSM-V criteria were included in the study. The data was collected from 5 multidisciplinary child developmental centers of Continua kids in Delhi NCR region. Descriptive statistical analysis of the data was conducted and presented in percentages/ frequencies. Results: A total of 180 children diagnosed with ASD were included in the study. The findings revealed that children with sociodemographic profile including male gender, nuclear family, and high parental education are at higher risk of being diagnosed ASD. Several risk factors for autistic symptoms were studied including the mode of delivery, presence of exclusive breastfeeding, and early exposure to screen time. The clinical profile studied the severity of ASD symptoms and associated comorbidities sleep problems, behavioral problems and gastrointestinal symptoms in children with autism spectrum disorder. Conclusion: Understanding the sociodemographic and clinical profile helps in better understanding of the need of early intervention services and planning of the same. Understanding the associated risk factor helps in better understanding of the preventable factors which can help with planning of the primordial and primary prevention. Keywords: Autism spectrum disorders, India, risk factors, clinical Profile.

Background: The purpose of this study was to determine the efficacy of pre-operative Intra-Aortic Balloon Pump therapy on peri & post-operative cardiac performance, morbidity & in hospital mortality in high-risk stable patients undergoing CABG as compared to those who did not receive this therapy. Also, to ascertain the optimal timing of IABC insertion in these patients preoperatively. Materials and Methods: It is a retrospective study conducted between July 2022 to June 2024 in which 50 consecutive high-risk coronary artery disease patients undergoing CABG work included. Patients were selected as per inclusion criteria. 21 patients (Group 1) received IABP preoperatively (12 to 24 hours prior to surgery) and 29 patients (Group 2) did not receive this therapy. Their demographic & clinical profiles were studied & intra & postoperative parameters & outcomes were compared & benefits evaluated. Results: Conversion to on pump CABG was more in Group 2 (Non IABP) than Group 1 (IABP Group) (P=0.0401). There was also increased ionotropic requirement postoperatively in Group 2 (P=0.0093). Though there was no hospital mortality in either of the group, but there was prolonged ICU stay in Group 2 patients (P=0.0435). However, this did not translate into significant increase in hospital stay. Conclusion: This study demonstrated that preoperative IABP therapy is an efficient and safe supportive modality which significantly reduces the risk for hemodynamic instability in high-risk patients undergoing CABG. Insertion of IABC, 12 to 24 hours prior to CABG in these patients enables smooth induction of anaesthesia & safe performance of off- pump CABG (OPCAB) & converts high-risk to medium or low risk surgery. Keywords: Intra-aortic Balloon Pump, Coronary Artery Bypass Grafting, Coronary Artery Disease, Off Pump Coronary Artery Bypass.

Background: Nutritional status reflects an individual's health based on nutrient intake and utilization. The nutrition of primary school children is crucial for their growth, development, and long-term health, especially in developing countries like India, where undernutrition due to poor dietary habits and socioeconomic factors can significantly hinder their physical and mental development. The objectives of the study were to assess the health profile and nutritional status of primary school children and study the factors associated with undernutrition. Materials and Methods: A cross-sectional study was carried out with 160 children from a government school in a rural area of Maharashtra. Convenient sampling was used for selecting the participants. Anthropometric measurements, including height and weight, were recorded using standardized instruments. Body Mass Index (BMI) for age, height for age, and weight for age z-scores were computed according to WHO growth standards. Data analysis was performed using Open Epi, employing descriptive statistics and chi-square tests to examine associations between nutritional status and various factors. Ethical approval was granted by the Ethical Review Committee, and informed consent was obtained from the parents or guardians of all participating children. Results and Conclusion: Out of 160 subjects, 22.5% (36) were stunted, and 30.6% (49) experienced wasting. Underweight prevalence was 35.7% (57). The gender distribution included 77 girls (48.1%) and 83 boys (51.9%). Mean age of boy was 7.90 ± 1.49 years and mean age of girl was 7.79 ± 1.56 years, with age ranging from 5 to 11 years. Keywords: Nutritional status, primary school children, health profile.

Breast cancer, one of the most prevalent cancers among women is a significant cause of illness and death globally,[1] accounting for about a quarter (23 %) of all cancers in women.[2] The aim of this study was to assess the 5 year and lifetime breast cancer risk in female population of Kashmir using Gail model and screen high risk patients with clinical examination and/or imaging. This was a cross sectional observational study conducted from March 2022 to August 2024. The data was collected from 500 women whose age fell in the interval of 35-70 years and visited Outpatient department of SKIMS Soura during this time period. The data was collected in a questionnaire form and projected breast cancer risk (calculated risk) was determined using the Gail model. The questionnaire form obtained information about the factors related to breast cancer as age of menarche and first childbirth, having a family history of breast cancer, and having a biopsy. Breast cancer risk was calculated using the National Cancer Institute’s on-line Breast Cancer Risk Assessment Tool (BCRA) or the Gail Risk Assessment Tool (Available at http://www.cancer.gov/bcrisktool/Default.aspx). The assessment of breast cancer risk among the Kashmiri female population revealed that 10% of participants (n=50) were categorized as high risk based on a higher mean five-year risk of ≥1.7. Additionally, 1.6% of the participants (n=8) were classified as high risk due to a higher mean lifetime risk of ≥20. The mean five-year risk of breast cancer among participants was 0.94%, with a standard deviation of 0.54%, ranging from a minimum of 0.2% to a maximum of 3.5%. For lifetime risk, the mean was 9.43%, with a standard deviation of 3.52%, and ranged from 3.3% to 27.7%. The findings indicate a significant proportion of the Kashmiri female population is at an elevated risk for breast cancer. These results underscore the presence of considerable risk within the population that warrants attention.

Background: To compare the efficacy of serum - ascites albumin gradient (SAAG) to AFTP (ascitic fluid total protein) concept in classification of ascites due to portal hypertension and non-portal hypertension. Materials and Methods: It is a retrospective study in which total of 100 patients of ascites were studied. 72 patients had ascites due to portal hypertension and 28 patients had non-portal hypertension cause. Patients aged more than 18 years with ascites proved by ultrasound and not treated with diuretic. They were categorised into 2 groups based on the presence or absence of postal hypertension by ultrasound criteria and endoscopy. Ascitic fluid total protein, Serum and Ascitic fluid albumin was done in all patients. Results: SAAG was in portal hypertensive range in 68 of the 72 patients with portal hypertensive and in non-portal hypertensive range in 26 of the 28 patients in non-portal hypertension causes. AFTP was in portal hypertensive range in 56 of 72 patients hypertension and in non-portal hypertensive range in 25 of the 28 patients non portal hypertension causes. Serum - ascites albumin gradient (SAAG) has efficacy of 94%, and ascitic fluid total protein (AFTP) 81% in classifying ascites of portal hypertension and non-portal hypertension causes. The mean of serum - ascites albumin gradient (SAAG) in portal hypertension is 1.7 and in non-portal hypertension 0.78, and is statistically significant in classifying ascites of portal and non-portal hypertension causes. The mean of ascitic fluid total protein (AFTP) in portal hypertension is 1.90 and in non-portal hypertension 3.41 and is statistically significant but lesser than serum- ascites albumin gradient. Conclusion: A serum ascites albumin gradient >1.1g/dl does suggest of portal hypertension not only in patient with transudate type of ascites but also in cases with high protein concentration. Keywords: Serum - ascites albumin gradient (SAAG), Ascitic fluid total protein(AFTP), portal hypertension, Transudate.

Among the many pregnancy-related medical conditions, gestational diabetes mellitus (GDM) stands out. The well-documented maternal and fetal complications that can occur as a result of untreated GDM are preventable with prompt dietary changes, insulin, and fetal monitoring. Over the course of a year, researchers in Tertiary Health Facility carried out this observational study. The screening and diagnostic procedure for GDM was a one-step test that involved the administration of 75 gms of oral glucose. All of the participants had their fetal and maternal outcomes examined. There was an 11% prevalence of GDM. Major risk factors for developing gestational diabetes mellitus were being 25 years old or older, being overweight, having multiple diabetes, and having a family history of the disease. Compared to the control group, the GDM group had worse maternal and fetal outcomes. Polyhydramnios and recurrent vaginal infections were common maternal problems in the GDM group. Among the GDM group, the rate of caesarean section was increased. There was an increased risk of metabolic problems and macrosomia in babies born to mothers with GDM. Keywords: Gestational diabetes; Fetal monitoring; Fetal deaths; Maternal deaths; Anhydrous glucose; Polyhydramnios.

One of the main characteristics of type 2 diabetes mellitus (T2DM) is insulin resistance, which makes it difficult to maintain glucose homeostasis and avoid complications from the disease. The effectiveness of two well-known pharmaceutical products, semaglutide and exenatide, in treating insulin resistance is compared in this review. Both exenatide and semaglutide, agonists of the glucagon-like peptide-1 (GLP-1) receptor, have shown encouraging outcomes in enhancing glycemic control and lowering cardiovascular risk in individuals with type 2 diabetes. It will also evaluate the effects of each drug on glycemic control, adverse effects, weight loss, cardiovascular outcomes. This review aims to give clinicians and researchers a detailed understanding of the relative advantages and potential considerations when deciding between semaglutide and exenatide in personalised T2DM treatment regimens. Keywords: Type 2 diabetes mellitus, Semaglutide, Exenetide.

Background: Pyelectasis is a common and typically benign finding. Identifying the cases that may progress is crucial for guiding perinatal management and avoiding unnecessary interventions that can lead to increased costs and parental anxiety. Materials and Methods: 300 patients with antenatal scans showing fetal pyelectasis were followed up by the Department of Fetal Medicine and Department of Pediatric Urologyupto 1 month after delivery. The results of antenatal scans were assessed. Results: Amongst the 375 patient records that had fetal pyelectasis on antenatal scans, 75 lost follow-up till delivery. Amongst the 300 patients who had antenatal detected pyelectasis, persistent pyelectasis was seen in 260 patients by end of third trimester; in 125 patients after delivery and in 40 patients after 1 month of birth. Most common cause of persistent pyelectasis observed in the study was vesicoureteric reflux. Surgical intervention was needed in 5.6% patients. Conclusion: Antenatal detection and grading of pyelectasis helps to know which needs subsequent follow up immediately post birth and intervention/procedures as needed on timely basis to prevent ensuing renal damage. Keywords: fetal pyelectasis, fetal urology, ultrasonography, VUR.

Background: Several studies have found a connection between gallstones and unhealthy blood fats. These unhealthy fats can raise the risk of heart problems and strokes. This research examines how common unhealthy blood fats are in people who have had their gallbladders removed. Materials and Methods: We conducted a retrospective analysis of the lipid profiles of 121 patients who underwent cholecystectomy in our department between January 2023 and December 2023. Sociodemographic details and preoperative lipid profile results were obtained from patient information records. Results: Of the 121 patients, 78 (64.5%) were females, and 43 (35.5%) were males. In this study, total cholesterol levels were 172.5 ± 41.94 mg/dl, triglyceride (TG) 165.1 ± 114.06 mg/dl, low-density lipoprotein cholesterol (LDL-c) 110 ± 42.67 mg/dl, and high-density lipoprotein cholesterol (HDL-c) 46.8 ± 12.82 mg/dl. Of the total cases, 102 (84%) presented abnormal lipid values (dyslipidemia), while the remaining 19 patients (15%) had normal lipid profiles. Among the total cases,65.3% of the patients exhibited hypercholesterolemia (values > 200 mg/dl), 72% had hypertriglyceridemia (> 150 mg/dl), 56.2% displayed high levels of LDL-c (> 130 mg/dl), and 36.4% had low levels of HDL-c (< 50 mg/dl).High levels of LDL-c were most commonly observed in male patients (p-value < 0.0001). Conclusion: Patients who have undergone a cholecystectomy or have a history of gallstones should have a complete fasting lipid profile, including HDL and LDL cholesterol levels, as a significant proportion will exhibit abnormal results. Current guidelines suggest that these individuals are at an increased risk of cardiovascular disease and should receive appropriate treatment. Keywords: Lipidprofile, Cholecystectomy, Hyperlipidaemia, Gallstones, Hypercholesterolemia, Hypertriglyceridaemia.

Background: Magnetic resonance imaging (MRI) has become the preferred method for examining perianal fistulas before surgery. This study aimed to evaluate how well MRI can identify different types and severities of perianal fistulas, compare these findings to what was observed during surgery, and determine if MRI can help prevent problems after surgery. Materials and Methods: This study examined the accuracy of MR fistulography in predicting the location and extent of perianal fistulas in 110 patients. The study compared MR fistulography findings with surgical outcomes over 18 months. Results: MRI demonstrated strong concordance with surgical findings in the evaluation of perianal fistulas. The imaging modality accurately identified primary and branched tracts, abscesses, and horseshoe components. Additionally, MRI exhibited high sensitivity (96%), specificity (83%), and positive predictive value (94.5%) for detecting internal openings. Preoperative MRI assessment was associated with a reduced risk of fistula recurrence. Conclusion: Preoperative magnetic resonance fistulography improves diagnostic accuracy in the assessment of fistulous tract anatomy. It precisely delineates the fistula's location in relation to the anal sphincters, accurately identifies internal openings, branch tracts, abscesses, and horseshoe formations. This also contributes to a reduction in postoperative recurrence. Keywords: Preoperative, MRI, Perianal fistula, Intersphincteric, Transsphincteric,Primary Tract.

Background: Benign breast disorders represent a diverse group of conditions characterized by congenital anomalies, inflammatory processes secondary to injury or infection, and deviations from the normal patterns of breast tissue development and involution. Specific examples of these disorders include cystic breast disease, mastalgia, breast cysts, and fibroadenomas. Materials and Methods: This investigation seeks to elucidate the correlation between clinical, histopathological, and imaging features in benign breast diseases. Moreover, the study explores the impact of demographic variables, including age, marital status, religious affiliation, symptom presentation, and diagnostic modalities, on the characteristics of these benign conditions. Results: A total of 132 patients were diagnosed with benign breast disease. The majority of cases occurred in the age range of 31-40 years. Fibroadenoma was the most prevalent benign breast pathology within this age group, followed by fibroadenosis. The primary presenting symptom was a palpable breast mass, often without associated pain. Conclusion: Benign breast conditions represent the preponderance of breast pathology. The majority of benign breast diseases occur during the reproductive years, with fibroadenoma being the most prevalent lesion. A palpable mass is the most common clinical presentation of benign breast diseases. Keywords: Breast lump, Fibroadenoma, Fibroadenosis.

Background: The aim of this study was to compare the changes in body composition, métabolic variables and aerobic capacity induced after intensive versus extensive circuit training in obese adolescents. Materials and Methods : This was an intervention study involving 26 overweight adolescents (15.60 ± 1.43 years old). The study participants were randomly divided into two groups : 13 of them performed the intensive circuit training (ICT) program, while the other 13 underwent the extensive circuit training (ECT) program for 12 weeks and 3 times/week. Body composition, biological markers and aerobic capacity were measured at baseline and 12 weeks after the intervention. Results: Significant improvements in body fat mass (3.87%), body mass index (8.43%), body fat percentage (2.11%), waist circumference (3.79%) and hip circumference (3.29%) were achieved in the post-intervention ICT group. In the same group, a reduction in TC, TG and LDL-C and an increase in HDL-C were observed compared with the ECT group. Maximum oxygen consumption was improved by around 10.69% in the ICT group. Conclusion : extensive circuit training may be particularly useful for improving the body composition, lipid profile and aerobic capacity of obese adolescents. This program may be considered as one of the therapeutic methods for the management of overweight/obese adolescents. Keywords: Intensive circuit training, extensive circuit training, adolescents, obesity, Brazzaville.

Background: A chronic subdural hematoma (SDH) is a collection of liquefied blood in the subdural space that persists for more than three weeks. This condition most commonly affects elderly individuals and often occurs after a minor fall or in association with certain medical conditions. There are several surgical techniques available for treating chronic SDH. The burr hole technique is considered a simple, safe, and effective procedure that requires less time and has better surgical outcomes. This study aimed to evaluate the outcomes of a two-burr hole craniostomy with or without subdural drain placement. Materials and Methods: This retrospective observational study took place at MGM Medical College from November 2022 to August 2024. 50 patients with clinically and radiologically diagnosed chronic subdural hematoma, requiring surgery, were included. Burr hole Craniostomy was performed on all patients. Subdural drain insertion was done after chronic SDH evacuation in 30 patients (Group A), while no subdural drain was placed in the remaining 20 patients (Group B), based on the surgeon's preference and belief. This study investigated demographic data, etiology, clinical presentation of chronic SDH, and post-operative complications after Burr hole surgery. Complications were analyzed separately for Group A and Group B, and both groups were compared. Follow-up ranging from 3 weeks to 6 months was conducted to monitor late complications in both groups. Data analysis was performed using SPSS version 23.0 for Windows. Fisher's exact test was used to calculate the two-tailed P value for significance between the two groups. Two-tailed P values less than 0.05 were considered significant (P<0.05). Results: The mean age group in our study was 60.6 +/- 10.224 years with male preponderance. The most common cause of chronic subdural hematoma in our study was attributed to trauma in 28(56%) patients. The most common clinical symptom noted in our study was a headache and hemiparesis. When the complications were compared in between Group A patients and Group B, it was found that the incidence of recurrent/residual SDH and deep infections were reduced with the use of subdural drains while the incidence of pneumocephalus, post-operative seizures, and intracerebral hematoma was more with use of drain and the results were statistically significant (P<0.05). Conclusion: The use of a subdural drain after surgery not only prevents the recurrence of chronic subdural hematoma but also reduces the incidence of late deep surgical infections at the operative site. This helps to prevent prolonged hospital stays, the need for redo surgery and is cost-effective. However, a few complications that may occur with the use of drains can be managed effectively by conservative management. Keywords: Burrhole, Surgery, chronic subdural hematoma, Subdural drain.

Background: Achieving effective pain control during the postoperative period continues to be a clinically significant issue in facilitating the recovery process. The aim of this prospective randomized double blind placebo controlled study was to evaluate the analgesic efficacy of oral paracetamol and diclofenac sodium sustained-release when administered alone or in combination before elective Otolaryngologic surgery in adults. Materials and Methods: This study include 80 adult patients aged 15-65yrs, they were randomized into four groups as follows n= 20 in Group I, placebo [Vit. C 500mg per oral (PO)]; n=20 in Group II, [Paracetamol 1000mg PO]; n=20 in Group III [Diclofenac sodium sustained release 100mg PO] and n=20 in Group IV, [paracetamol 1000mg and diclofenac sodium sustained-release 100mg PO]. The drug was administered 45min before elective otolaryngologic surgery. All patients received standard anaesthetic technique. During the postoperative period, pain was assessed using visual analogue scale (VAS), requirement of rescue analgesia and side effects. Results: There was significant reduction of postoperative pain in group II, group III and group IV compared to group I and there was no statistically significant difference found between group II, group III and group IV in reducing postoperative pain. There was comparable reduction of postoperative pain between group II and group III with no statistical significance. The time of first rescue analgesia administration was significantly shorter in group I (p =0.004) compared to the other groups, and the total dose of rescue analgesia was statistically significant between the study groups with (p = 0.013), the total dose being maximum in group I. The need for rescue analgesia was reduced to 50% in group IV compared to 15%, 25% and 30% in group I, group II and group III respectively, but no statistical significance found with p=0.1. With respect to side effects, nausea, vomiting and sedation, there was no significant difference between the groups. Conclusion: We conclude that oral premedication with paracetamol 1000mg and diclofenac sodium sustained-release 100mg and their combination provides effective analgesia in the postoperative period after otolaryngologic surgery. The combination provides better opioid sparing effect than either drug given alone. Hence, paracetamol and diclofenac sodium sustained-release (NSAIDs) can be used safely as an alternative to opioids in reducing postoperative pain after otolaryngologic surgery. Keywords: Analgesia; Visual Analogue Scale; Rescue Analgesia; Opioid; Non-opioid

Background: Community-acquired pneumonia (CAP) is one of the most important public health problems worldwide. The assessment of disease severity and outcome prediction is necessary for the allocation of health resources and therapeutic options in the management of CAP. The aim is to study the prognostic value of serum albumin levels in hospitalised patients with community-acquired pneumonia in terms of patient outcome and correlate it with CURB-65 and PSI score. Materials and Methods: It was an observational study. 97 individuals with community-acquired pneumonia were included. CURB-65 and PSI scoring were calculated and compared with serum albumin levels. Serum albumin was also correlated with patient outcome in terms of mortality or duration to clinical stability, ventilator requirement, complications and duration of hospital stay. Results: The study's demographic data showed that most participants were aged 51-60 and 61-70 years, with a male predominance (59.8%). Serum albumin levels, measured at admission, Day 3, and Day 5, showed significant associations with complications like sepsis and respiratory failure. A negative correlation was observed between serum albumin levels and the number of days to reach clinical stability. There was a significant difference between patients who required mechanical ventilation vs those who did not in terms of serum albumin levels (p = 0.012). There was a strong negative correlation between the number of days of hospital Stay and S. Albumin (g/dL) (Day 3), and this correlation was statistically significant (p = <0.001). There was no statistically significant correlation between CURB 65 and S. Albumin. There was a weak negative correlation between PSI and S. Albumin (g/dL) (at admission), and this correlation was statistically significant (p = 0.012). Patients discharged had a higher mean albumin level (2.90) compared to patients who died (2.10), with a statistically significant p-value of 0.018. Conclusion: Serum albumin levels correlated significantly with complications, clinical outcomes, and scoring systems, indicating its potential as a prognostic biomarker. Future research could further explore the therapeutic implications of these findings in improving outcomes for CAP patients. Keywords: CAP, CURB65, Serum Albumin, PSI scoring system.

Background: Rhino-orbito- cerebral Mucormycosis is an invasive fungal infection occurring in immunocompromised patients. Isolated involvement of posterior ethmoid and sphenoid sinus with almost normal looking anterior ethmoids is rare. High index of suspicion is required to identify such patients. Patients present with vague eye complaints like blurring of vision, diplopia, vague headache, retro orbital pain with no nasal complaints. If not diagnosed early it becomes rapidly fatal causing loss of vision and intra cranial involvement. This change in trend of presentation and orbital apex syndrome poses challenges to ENT surgeons. Prompt interventionand aggressive treatment are required to reduce morbidity and mortality associated with the disease. Objectives: The study is aimed to identify the presentation of rhino-orbital Mucor mycosis as isolated involvement of posterior ethmoid and sphenoid sinus.To bring attention towards this changing trend and highlightthe challenges associated with diagnosis of orbital apex syndrome andanalyse various treatment methods used and post-operative sequela Materials and Methods: We studied207patients rhino orbitalmucormycosis admitted in a tertiary care hospital in Telangana during period of 12 months fromdecember 2021 to november2022. A detailed case history including predisposing factors and comorbidities were taken.Diagnostic nasal endoscopy, CECT of nose and paranasal sinuses and MRI orbit scan of orbits and brain was done. Treatment started with injectionliposomal Amphotericin B on admission and surgical debridement of involved structures in nose, paranasal sinuses and orbit was done and tissue sent for KOH mount, fungal culture and histopathology for confirmation and followed up for 18 months. Results: Total 207patients of mucor mycosis with male predilection (2:1). Most common age group is 40-60 years. Patients are being categorised into 4 groups. Group I include 16 patients and treated with liposomal amphotericin B only. Group II includes 74 patients and treated with amphotericin B and FESS.Group III includes 63 patients and treated with intravenous and retrobulbar injection of amphotericin B and underwent FESS. GROUP IV includes 54 patients who underwent FESS and orbital decompression. Conclusion: RCOM is a fatal infection requiring multidisciplinary management. There is a change in presentation of mucor from frank nasal and palatal symptoms to presentingwith eye complaintspredominantly with relative less nasal involvement. Such cases should be investigated thoroughly on keen suspicion , and prompt medical and surgical management should be started early to reduce morbidity and mortality associated with disease. Keywords: Orbital apex syndrome, Rhino orbital Mucormycosis,Liposomal amphotericin B, Diabetes mellitus, Ocular manifestations.

Background: Equipping youth with age-appropriate knowledge about puberty, sexuality, sexually transmitted infections (STIs), and HIV is essential for their overall health and well-being. Proper sex education enables adolescents to prevent unwanted pregnancies, protect themselves from HIV/AIDS, and reduce vulnerability to sexual abuse. This study aimed to explore the knowledge, attitude, and perception of sex education, safe sex, and HIV/STIs among school-going adolescents. Materials and Methods: A school-based cross-sectional study was conducted from July to November 2019 among 11th and 12th-grade students in two co-educational schools in Bilaspur, Chhattisgarh. Using an inclusive sampling technique, 250 adolescents were surveyed using a semi-structured, pretested questionnaire. The data were analyzed using Microsoft Excel. Results: The results showed that 72.8% of participants had heard about sex education, but 74.4% had never attended a class on the topic. Despite this, 82% believed sex education helps in becoming responsible adults, and 70.4% agreed it fosters healthy relationships. Furthermore, 81.2% felt it aids in making important decisions related to sexual behaviour, and 62.8% noted that its absence could lead to sexual violence. Awareness of STIs was high (74%), with 78.8% knowing about HIV and 75.2% aware of contraception. The internet emerged as the primary source of information. Conclusion: Overall, the study discovered that teenagers had a favourable attitude, comprehension, and perspective of STIs/HIV, sex education, and contraception use. Keywords: Sex education, Adolescent, STI, HIV.

Background: The COVID-19 pandemic has raised concerns about the potential risks faced by neonates born to COVID-19 positive mothers. While the risk of vertical transmission of SARS-CoV-2 is considered low, the clinical characteristics and outcomes of these neonates remain under-researched. This study aims to provide a comprehensive analysis of these neonates to guide clinical practices. Material and Methods: This retrospective cohort study was conducted at a tertiary care center in Northern Maharashtra, India, from March 2020 to December 2021. Data were collected from 69 neonates born to COVID-19 positive mothers, focusing on maternal demographics, neonatal clinical characteristics, and outcomes. Neonates were assessed for SARS-CoV-2 infection, respiratory complications, and other clinical parameters. Results: Of the 69 neonates, 10.1% tested positive for SARS-CoV-2. Preterm births accounted for 42.0% of cases, with 60.9% of neonates having a birth weight of less than 2.5 kg. Elevated C-reactive protein (CRP) levels were observed in 56.52% of neonates, and respiratory distress was present in 42.0%. Oxygen saturation levels varied, with 26.1% of neonates experiencing severe hypoxemia. Conclusion: The study highlights the significant proportion of preterm births and respiratory complications in neonates born to COVID-19 positive mothers. While the risk of vertical transmission is low, vigilant monitoring and tailored clinical management are essential. The findings underscore the need for continued research to develop robust guidelines for neonatal care in the context of maternal COVID-19 infection. Keywords: COVID-19, neonates, maternal infection, vertical transmission, neonatal outcomes, respiratory distress, preterm birth.

Background: Hypothyroidism itself contributes to morbidity from osteoporosis, hyperlipidemia, hypercholesterolemia, cardiovascular and neuropsychiatry disease in the population. the prevalence and pattern of thyroid disorders depends on gender, age, ethnic and geographical factors and especially on iodine intake. Still thyroid disorders especially hypothyroidism, both subclinical and overt, contributes significantly to burden of thyroid disorders in India. Aim: The aim of the present study was to assess the proportion of various thyroid disorders in subjects attending a tertiary care center. Materials and Methods: This retrospective hospital based study involved 1227 patients who underwent thyroid function tests (T3, T4 &TSH) in the central clinical biochemistry from sep 2018 to Jan 2019 from Mallareddy Viswavidyapeeth Deemed University Hyderabad. Thyroid function tests were performed on BECKMAN COULTER ACESS. The T3, T4 and TSH levels were also analysed by paramagnetic chemiluminescent immuno assay system. The laboratory’s reference values were TSH: 0.38- 5.33 μIU/ml; T3: 0.87-1.78 ng/dl and T4: 6.09-12.23 μg/dl. Analytical sensitivity was 0.005 μIU/ml for TSH, 0.5 μg/dl for T4, 0.1 ng/dl for T3. Coefficient of variation was < 10% for TSH, T4, T3, and FT3. Hypothyroidism was classified as clinical (overt) if TSH was ≥ 5.33 μIU/ml and T4 ≤ 6.09 μg/dl and subclinical if TSH was ≥ 5.33 μIU/ml T4 was within the reference range. Hyperthyroidism was classified as clinical (overt) if TSH was ≤ 0.38 μIU/ml and T4 ≥ 12.23 μg/dl and subclinical if TSH was ≤ 0.38 μIU/ml and T4 was within the reference range. The data collected was analyzed using Excel 2007, R2.8.0 Statistical Package for Social Sciences (SPSS) for windows version 21.0 (SPSS Inc.; Chicago, IL, USA). Results: Involving 955/1227 subjects (180 males and 775 females) were analyzed for thyroid disorder i.e thyroid function assay.272/1227 subjects were excluded because only TSH was done. The highest number was in the 21-30 age female group (17.82 %) and lowest number in the >60 age group (12.12%). We found 20.39% subjects having thyroid dysfunction in our study population. Out of these, 3.56% were overt hypothyroid, 11.62% were subclinical hypothyroid, 0.83% overt hyperthyroid, 3.97% were found to be subclinical hyperthyroid and 0.41% secondary hyperthyroidism. Discussion: The impact of EQAS apart from the standardisation process can also be immense in the post analytical phase steps by using the proper unit of measurement. Conclusion: Significantly improve the quality of our laboratory practices along with good performances providing confidence in furnishing accurate test reports to the patients. Keywords: Subclinical Hypothyroidism, Euthyroid, Subclinical Hyperthyroidism,Non Thyroid illness.

Nutritional Adequacy is defined as a sufficient intake of essential nutrients needed to fulfil nutritional requirements for optimal health. Good maternal nutrition is important for the health and reproductive performance of women and the health, survival, and development of their children. The study was conducted to assess nutritional adequacy and its sociodemographic correlates among antenatal females attending the ANC clinic. A cross-sectional study was conducted among 400 antenatal females with a gestational age of 24 weeks and beyond attending the ANC clinic of a tertiary hospital in North India, selected by systematic random sampling. Those who gave consent, having a singleton pregnancy, and having no pre-existing illnesses were included. Nutritional Adequacy for energy, protein, calcium, iron, vitamin A, and vitamin D was assessed by Nutrient Adequacy Ratio (NAR) using the 24-hour dietary recall method and subsequently Mean Adequacy Ratio (MAR). The mean NARs of energy and protein were found to be 80.6% and 56%, respectively. The mean NARs of calcium, iron, and vitamin A were 58.2%, 45.1%, and 6.4%, respectively. Vitamin D had a dismally low NAR, i.e., 0.28%. The Mean Adequacy Ratio of all six nutrients was found to be 41.0 ± 11.1, which means requirements for all six nutrients were met in only 41% of females. Maternal age, education, area of residence, occupation, and social class were found to be significant determinants of Nutritional Adequacy. From the study, it was concluded that Nutritional adequacy was met in only 41% of pregnant females, and it was also influenced by socio-demographic factors. Keywords: Nutritional Adequacy, Socio-demographic, Antenatal women, Theme: Maternal Health.

Background: Myelophthisic anemia is a normocytic normochromic anemia that occurs when normal marrow space is infiltrated and replaced by non-hematopoietic or abnormal cell. Causes include acute leukemias, myeloproliferative disorders, plasma cell myeloma, metastasis, storage disorders and granulomas. Aims: To study the cause of anemia with or without bicytopenia or pancytopenia or leucoerythroblastic blood picture. Material and Methods: Present study is retrospective evaluated 40 patients by fufilling the inclusion and exclsion criteria. Bone marrow studies were performed in the patients who presented with anemia as an isolated parameter or with pancytopenia or leukoerythroblastic blood picture on peripheral smear. Retrospective studies were done by collecting the slides of confirmed and already diagnosed cases. Results: Out of 40 cases, 32 cases (80%) were diagnosed as hematological disorders, and 8 cases (20%) were diagnosed as non-hematological disorders. Out of 40 cases presenting as myelophthisic anemia, 35 cases (87.5%) were neoplastic, and 5 (12.5%) cases were non-neoplastic. Conclusion: Bone marrow aspiration and trephine biopsy are commonly used investigations for the study of marrow infiltrations that present as myelophthisic anemia on peripheral smear. Bone marrow studies guide towards diagnosis in patients with anemia or pancytopenia and not responding to treatment. However, genetic studies are required for molecular diagnosis, targeted therapy and prognosis. Key Words: myelophthisic anemia, hematological disorders, leukoerythroblast, leukemia.

Background: Congenital ocular anomalies contribute to a major portion of childhood blindness. Consanguineous marriages are not uncommon in India. They cause various congenital anomalies in a foetus. They also cause Ocular disorders that cause visual impairment in a significant majority of those affected in their early decades of life. The purpose of the study is to describe the distribution of congenital ocular disorders in patients and its association with consanguinity. Materials and Methods: This cross-sectional study includes 45 patients - children in the age group of 0- 15yr with various congenital ocular anomalies. History of any significant antenatal events like prevailing chronic disease, infectious diseases during the antepartum period, History of intake of toxic substances or medications (ocular teratogens) were enquired. Thorough clinical history was obtained and comprehensive ocular examination was done in each case. Results: Out of 45 children the most common ocular congenital anomaly was Retinitis Pigmentosa, with a frequency of 8 cases (17.8%), followed by Congenital ptosis with 7 cases (15.6%) and Congenital cataract with 5 cases (11.1%). Consanguinity was present in 24 cases (53.3%) and absent in 21 cases (46.7%). The p-value for the association between consanguinity and ocular congenital anomalies was 0.016, which is statistically significant at a 5% level of significance. Among the 24 cases with consanguineous parents, 12 cases (50%) had 2nd-degree consanguinity, 11 cases (45.8%) had 3rd-degree consanguinity, and 1 case (4.2%) had 4th-degree consanguinity. For Retinitis Pigmentosa, consanguinity was present in 5 cases (62.5%) and absent in 3 cases (37.5%). The p-value was 0.001, indicating a highly significant association between consanguinity and Retinitis Pigmentosa. For Congenital cataract, consanguinity was present in 4 cases (80%) and absent in 1 case (20%). The p-value was 0.001, indicating a highly significant association between consanguinity and Congenital cataract. Conclusion: The prevalence of congenital anomalies were mostly high in consanguineous marriages compared to non-consanguineous marriages. 2nd and 3rd degree marriages being the most common. Premarital genetic counselling prevents most of the congenital ocular malformations in the children. Keywords: Congenital ocular anomalies, Consanguineous marriages, degree of consanguinity.

Background: The conventional diagnostic approach to Carpal Tunnel Syndrome (CTS) involves routine neurological examinations through clinical methods and neurodiagnostic studies. This study explores the enhanced diagnostic capabilities brought about by the incorporation of high-resolution ultrasonography as a diagnostic method for CTS. It aims to investigate whether the addition of high-resolution ultrasonography can improve diagnostic sensitivity and specificity, surpassing the outcomes achieved solely through routine clinical examinations. Objectives: The primary objectives of this study are to assess the diagnostic efficacy of high-resolution ultrasonography compared to routine neurological examinations for CTS. Specifically, the study aims to determine the impact of incorporating ultrasonography on diagnostic sensitivity and specificity. Additionally, the research aims to explore the role of ultrasonography in identifying secondary causes of CTS, shedding new light on factors that were previously overlooked or underappreciated. Material and Methods: A comprehensive methodology was employed, involving the examination of patients with suspected CTS using both routine neurological examinations and high-resolution ultrasonography. Diagnostic sensitivity and specificity were assessed, and the utility of ultrasonography in unveiling secondary causes of CTS was explored. The study population included patients with a known diagnosis of idiopathic CTS, and the addition of ultrasonography was considered as a modality to provide deeper insights into the condition. Results: The results of this study demonstrate that the incorporation of high-resolution ultrasonography as a diagnostic method for CTS yields higher diagnostic sensitivity and specificity compared to routine clinical methods alone. Moreover, the use of ultrasonography has uncovered previously unrecognized secondary causes of CTS. Before the introduction of ultrasonography, the terminology of secondary CTS lacked significance, with 90% of patients exhibiting idiopathic symptoms. The additional modality of ultrasonography has thus proven to be instrumental in expanding our understanding of the various causative factors contributing to this prevalent entrapment syndrome. Conclusion: In conclusion, this study underscores the enhanced diagnostic capabilities of high-resolution ultrasonography in the evaluation of CTS. The addition of ultrasonography not only improves diagnostic accuracy but also provides valuable insights into the secondary causes of CTS that were previously overlooked. This advancement in diagnostic methodology has significant implications for refining the understanding and management of CTS in clinical practice. Keywords: Carpal Tunnel Syndrome, Ultrasonography, Secondary Causes, Diagnosis, Tertiary Care Centres, Puducherry.

Background: Psychiatric diseases are a worldwide public health issue. Even with improvements in mental health treatment, there are still large differences in the quality and accessibility of services, especially in underserved communities. The goal of the current study was to evaluate the clinical and sociodemographic characteristics of patients undergoing treatment at a recently established mental health facility. Materials and Methods: In this retrospective analysis, case files from mental health patients who saw the outpatient Department of Psychiatry, Dr. VRK Women’s Medical College, Aziznagar, Telangana, India from June 2023 to May 2024. Information was gathered about the clinical profile and sociodemographic profile. When necessary, descriptive statistics were used to analyze the data. Results: During the study period, the outpatient department received a total of 4397 patients. The average age of the attending patients was 39.59 years, with the majority of them being male (46.8%), Hindu (92.7%), and married (72.8%). The data indicated an increase in the number of patients visiting the centres in April and September. The predominant diagnosis was classified under the category of F40, which encompasses neurotic, stress-related, and somatoform disorders, accounting for 44.8% of all diagnoses according to the ICD 10 classification. Conclusion: The prevalence of different illnesses matched the findings in the current literature. There is a noticeable pattern of growth in population counts during the months of April and September. This study will provide valuable insights for predicting and strategising the implementation of mental health services at a tertiary level. Keywords: Psychiatric, clinical profile, sociodemographic profile.

Gallbladder wall thickening is a common yet nonspecific finding that can arise from both benign and malignant conditions.[1] Differentiating between malignancies and benign disorders such as chronic cholecystitis, cholelithiasis, xanthogranulomatous cholecystitis, and Mirizzi syndrome remains challenging due to overlapping imaging features.[2] This case series of five patients (three females, two males; ages 40-75) highlights unusual presentations of gallbladder wall thickening that closely mimicked carcinoma but were ultimately found to be benign. The series underscores the diagnostic challenges and emphasizes the importance of histopathological evaluation in distinguishing benign from malignant conditions. Keywords: Gallbladder Malignancy, Gallbladder Thickening, Cholecystitis, Open Cholecystectomy.

such as rickets and osteomalacia, but the clinical spectrum of hypovitaminosis D extends beyond bone health. It is increasingly linked to a heightened risk of preeclampsia, gestational diabetes, and preterm labor. Preterm labor is defined as the onset of labor before 37 completed weeks of gestation (259 days), counting from the first day of the last menstrual period. Preterm birth is the leading cause of perinatal morbidity and mortality, with significant impacts on maternal health and the emotional and socioeconomic well-being of families. This study aims to evaluate maternal vitamin D status and its association with preterm delivery. Objective: To assess whether there is an association between low serum vitamin D levels and preterm delivery. Materials and Methods: This case control study was done among patients admitted in hospitals attached to Bangalore Medical College and Research Institute with the approval from the institutional ethical committee. Duration of study was February 2021 to August 2022. Results: In the current analysis controlling for age, parity, level of education, religion, booking status and skin color as confounding variables, women with low vitamin D levels had an approximately higher likelihood of preterm delivery as compared with women with normal vitamin D levels It was also observed that 13% of babies born to vitamin D deficient mothers required NICU admission and 4% babies born to vitamin D deficient mothers were still born. There was also no association between maternal vitamin levels and age, parity, gestational age, booking status, clothing or skin colour. Conclusion: Preterm births were associated with higher rates of serum 25-hydroxyvitamin D deficiency than term births. To lessen this unfavourable pregnancy outcome, it is crucial for women to have optimal serum vitamin D levels during pregnancy. To further confirm the contribution of standard prenatal vitamin D supplementation in enhancing maternal and perinatal outcomes, including preterm birth, a sizable, well-designed, multicenter, randomised control trial is needed. Keywords: Parturients, Preterm, Term deliveries, Correlation, Maternal Serum Vitamin D3 Levels.

Background: Double-Hit Lymphoma (DHL) is a rare but highly aggressive subtype of B-cell non-Hodgkin lymphoma, defined by specific genetic abnormalities that distinguish it from other lymphomas. Objectives: The main objective if the study is to collect comprehensive clinical and demographic data from patients diagnosed with Double-Hit Lymphoma (DHL). Materials and Methods: This observational study was conducted at Department of Medicine, Mysore Medical College & Research Institute during March 2023 March 2024. A total of 25 cases of Non-Hodgkin’s Lymphoma (NHL) presenting to K R Hospital were included in the study. The clinical and demographic data of these patients were reviewed. Routine blood investigations, imaging studies including CT or MRI scans, PET scans, and biopsy results were collected. Results: Males constitute 60% of the patients (15 individuals), while females make up the remaining 40% (10 individuals). Regarding clinical features, the majority of patients, 80% (20 individuals), exhibited lymphadenopathy, with the remaining 20% (5 individuals) presenting other symptoms. The peripheral smear results indicate that 72% of patients (18 individuals) had leukocytosis, while 28% (7 individuals) showed other findings. Partial responses were noted in 6 patients, equally divided between males and females. A total of 4 patients showed no response or progression, with an equal split between genders. Conclusion: The present study demonstrates a male-to-female preponderance of 1.5:1 among the 25 patients diagnosed with Double-Hit Lymphoma. The majority of these patients presented with lymphadenopathy, and peripheral smear analysis revealed leukocytosis in most cases, indicating advanced disease. Keywords: Double -Hit Lymphoma, Malignancy.

Background: Shreshtha Knee Expert Treatment Strategy (SKETS) is a 21-day therapy approach involving the traditional Ayurvedic system of medicine in India. Objective: This study assessed the improvement in joint space width (JSW) of the knee osteoarthritis (OA) with 3-week SKETS therapy. Secondary outcomes were change in composite symptom scores (CSS), and scores for crepitus, shin pain, and range of motion (ROM) of the knee joint. Materials and Methods: This exploratory study presents the retrospective analysis of data of 93 patients (170 treated joints) with knee OA treated with Shreshtha Knee Expert Treatment Strategy (SKETS) from four clinics. Joint space width was assessed using ImageJ® software on the digital radiographic images. Symptoms were assessed on a four-point Likert scale of 0=no symptom, 1=mild symptom, 2=moderate symptom, and 3=severe symptom. Results: There was a 75.9% increase in JSW with SKETS therapy after 3 weeks. The mean (SD) joint space increased from 2.57 (0.83) mm at baseline to 4.34 (1.59) after therapy. SKETS therapy significantly (p<0.001) improved the cartilage damage in 77.6% (132/170) joints, and significant improvement in the CSS, and other scores was seen. There was improvement in ROM. Conclusion: SKETS therapy significantly increases the Joint Space Width (JSW) and helps cartilage regeneration in osteoarthritis of the knee. It improves the signs and symptoms of knee osteoarthritis, provides significant pain relief, and has the potential to improve the overall quality of life in osteoarthritis of the knee. Keywords: SKETS, osteoarthritis, joint space width, composite symptom score.

Background: Keratoconus is bilateral ectatic corneal condition wherein the cornea bulges out in form of cone. Detecting early keratoconus is important to prevent permanent damage. The purpose of this study is to measure the various parts and surfaces of the anterior segment of eye using a Scheimpflug rotating camera in combination with a Placido disk tomography to differentiate eyes with keratoconus and normal eyes. Materials and Methods:100 patients comprising of 50 patients with normal eyes and 50 patients with keratoconus were included in this study which was conducted over 1 year in the Department of Ophthalmology. All patients were subjected to scanning by the Sirius Device and measurements were analyzed for differences. Results: Excellent AUROC values were observed in 19 of 24 parameters (K-flat anterior; K-steep anterior; Astigmatism anterior; Asphericity anterior;K-max; K-flat posterior; K –steep posterior; Astigmatism posterior; Asphericity posterior; K- mean posterior; CCT; Si-F; KV-F; BCV-F; Si-b; KV- B; BCV-B; Rbf-f; Rbf- b). Corneal volume measurement was an inefficient parameter; ICA and ACD are poor parameters to differentiate keratoconus from normal eyes. Conclusion: The thickness indices (CCT); aberrometry indices – BCV-f, BCV-b; and elevation indices Rbf-f,Rbf-b are excellent indices to differentiate between keratoconus and normal eyes. Keywords: Keratoconus, Placido disk, Scheimpflug camera, Sirius device, cornea.

Background: Prevalent in 422 million people worldwide, diabetes mellitus has emerged as one of the most prevalent diseases of the twenty-first century.[1] Haematological abnormalities are associated with diabetes mellitus (DM) and are a key cause of micro- and macrovascular problems associated with diabetes.[2] Materials and Methods: A cross-sectional observational study involving 112 individuals diagnosed with type 2 diabetes was carried out. We gathered and examined data on outcomes, biochemical indicators, precipitating variables, clinical aspects, and demographics. Results: The mean age of the patients was 58.4 ± 11.24 years, with a female preponderance (64.28%). Among the 112 diabetic patients, 10 of them were newly detected, 7 were on exclusively Insulin therapy. 20 of them were having HBA1C >8. Among the various hematological indices measured, mean RBC Count was 4.8 mean Hb 12.5, mean WBC count 10571±4710, mean Platelet count 6.01, mean MCHC 31.8±3.21, mean Neutrophil percentage 74.30 ±10.19. There was significant correlation between glycemic control and MCHC with p value <0.0001, as well as between glycemic control and WBC count, glycemic control and percentage of neutrophils. Conclusion: The observation of various hematological parameters in Type 2 Diabetes Mellitus concludes that uncontrolled Diabetes Mellitus is a pro inflammatory state with neutrophilic leucocytosis, reduced MCHC. These hematological disturbances itself can trigger micro and macro vascular complications of Diabetes Mellitus. Keywords: Diabetes Mellitus; HBA 1C; Glycemic Control; Hematological Parameters.

Background: There are many structures which stabilizes the knee amongst which anterior cruciate ligament is one of the most important. It not only helps in preventing the anterior translation of the knee but also helps in counteracting valgus and rotational stress. Open visualization was practiced in older days but arthroscopic approach has become more common due to its small incision, better visualization of intercondylar notch for the operative techniques. It has also other advantages like early mobilization, reduced post-operative pain, fewer adhesions help in early rehabilitations. Materials and Methods: Here is prospective study of 50 patients with ACL injury with or without meniscus injury between the age group 0f 15-50 years. All the patients were operated for ACL reconstruction with hamstring graft and fixed loop end button. Study was conducted in Bapuji hospital and CG Hospital attached to J.J.M.M.C Davanagere from November 2022 to April 2024. Results: During the observed period of time, 50 patients were operated with ACL reconstruction with hamstring graft. Out of 50 patients, 46(92%) patients were male and 4(8%) patients were female. Most of the patients had Sports (44%) as mode of injury followed by RTA (36%). Results were evaluated by IKDC and Lysholm knee scoring scale. Majority of the patients had excellent results 92% and 8% had good results. No patients had fair or poor results. None had complications. Conclusion: This procedure promises stable knee, reduces post-operative morbidity and provides early rehabilitation. The functional outcome is excellent and gallows the patient to return to pre injury level of activity. High success rate has been achieved after this procedure with regard to functional recovery of the patients. Keywords: ACL, Hamstring graft, IKDC, Lysholm knee scoring, End button.

Background: Idiopathic clubfoot is one the oldest and commonest congenital deformities of mankind, ever since man has adopted the posture. It occurs in variable severity and some of the mobile feet are corrected well with manipulation and stretching. Nearly half the feet are rigid and do not show full correction conservative management. The treatment of relapsed, neglected and rigid varieties of club foot is based on corrective operation in the hind foot by posteromedial release and correction of varus heel by calcaneal osteotomy as in metatarsal region by extensive medial release and cuboid osteotomy. However, results are unsatisfactory. Dr. B. B. Joshi advocated a method of controlled, differential distraction which is semi-invasive, more physiological in comparison to any other technique which is more superior. The goal of the study was to analyse the potential outcome of JESS in resistant and neglected CTEV cases. Materials and Methods: We included all the patients of age 1-8 years with resistant and neglected CTEV cases presenting to Bapuji Hospital and Chigateri government hospital attached to J.J.M. Medical College, Davanagere over the period of 1/12/2022 to 15/1 2024- treated with JESS post-operative clinical and radiological correction during the follow up was retrospectively analysed. Results: During the observed time period, 20 feet in 20 patients (mean age: 2 years(range:1-8), male: female:16:4) were treated. Most of them were unilateral (n=17, 85%) followed by bilateral (n=3,15%). Most common type was resistant (n=17,85%) followed by neglected (n=3,15%). Most prevalent post-operative complication was temporary edema (n=13,65%), followed by superficial pin tract infection (n=3, 15%) and loosening of the pins (n=3, 15%) followed by flexion contractures of the toes (n=1, 5%). Clinical and radiologically all the patients were followed up. The average period of follow up was 13.3 months. 35% of the follow up cases had excellent results and 45% of the patient had good outcome. Only 1 patient had poor results. Temporary edema was reduced with anti edema measures. Superficial pin tract infected patients were treated with systemic antibiotics. Conclusion: This procedure is ideally suited for children in whom the club foot deformities remain uncorrected by POP casts and manipulation, as well as recurrent clubfoot. Keywords: Club foot, Neglected and resistant CTEV

Background: Medical education aims to produce a medical graduate who is capable of taking care of health care needs of the society. Interactive teaching learning method is a form of teaching where students are actively involved in the learning process which makes learning more interesting, helps in better retention and promotes higher thinking. Aim and Objective: The aim and objective of study is: (i) to identify acquaintance of interactive teaching methods among undergraduate students, (ii) to assess acceptability of interactive learning methods over lecture. Material and Methods: A descriptive cross-sectional study was conducted focussed on teaching four different topics in Obstetrics and Gynaecology by four interactive methods viz., demonstration (D), flipped classroom (FC), role play (RP) and case-based-learning (CBL). After completion of study pre-validated multiple choice questionnaire was given to 100 undergraduate students of which 25 students each were randomly selected from four different MBBS years. Results: Students’ responses were obtained after voluntary consent to participate in the study. Data was entered in Microsoft Excel sheet and SPSS version 22 and results were obtained. Our study showed that 98% students are aware of the interactive methods. Case based learning (61%) was accepted as the most preferred method followed by demonstration (26%) as most interesting, comprehensive and retentive method. 64% students were inclined to have 1-2 hours of daily interactive session. Conclusion: Students’ are aware of interactive learning and accept the inclusion of innovative interactive methods in their learning session. Key Words: innovative interactive learning, classroom lecture, active learning, passive learning.

Background: Low-grade gliomas (LGGs) are slow-growing brain tumors that can recur and progress despite surgical treatment. Understanding recurrence rates and influencing factors is essential for improving patient outcomes. Material and Methods: The retrospective study was conducted at BRD Medical College, analyzing LGG patients who underwent surgery from January 2018 to December 2023. The impact of resection extent and molecular markers was assessed upon recurrence rates and survival. Results: Of 100 patients, those with gross total resection (GTR) had a lower recurrence rate (19.23%) compared to subtotal resection (35.29%) and biopsy (42.86%). Survival was better in GTR patients (mean OS: 84.2 months). IDH mutation and 1p/19q codeletion were associated with improved survival and lower recurrence. Conclusion: Maximizing tumor resection and considering molecular markers are crucial for reducing recurrence and improving survival in LGG patients. These findings support a comprehensive approach to LGG management. Keywords: Low-grade gliomas, recurrence, surgical resection, molecular markers, survival.

Background: Compound grade 3B shaft tibia fractures pose significant challenges due to the high risk of infection and complications. This study compares the outcomes of single-stage antibiotic nailing versus two-stage surgical procedures (external fixation followed by nailing or plating). Material and Methods: A total of 50 patients with compound grade 3B shaft tibia fractures were randomly assigned to two groups: single-stage antibiotic nailing. The nail was impregnated with antibiotics, specifically vancomycin mixed with bone cement (n=25) and two-stage surgical procedures (n=25). Demographic characteristics, healing time, infection rates, functional outcomes (AOFAS score), hospital stay, and complication rates were analyzed. Results: Demographics and baseline characteristics were comparable between groups. The single-stage group had a significantly shorter healing time (16 weeks vs. 24 weeks, p<0.05) and lower infection rates (8% vs. 24%, p<0.05). Functional outcomes, measured by AOFAS score, were significantly better in the single-stage group (88 vs. 78, p<0.05). The single-stage group also had a shorter average hospital stay (7 days vs. 14 days, p<0.05). Complication rates were lower in the single-stage group (28% vs. 52%, p<0.05). Detailed complications included delayed union (8% vs. 12%), superficial infection (8% vs. 12%), non-union (8% vs. 16%), deep infection (4% vs. 12%), and hardware failure (4% vs. 16%). Conclusion: Single-stage antibiotic nailing impregnated with antibiotics, specifically vancomycin mixed with bone cement demonstrated superior outcomes in terms of healing time, infection rates, functional outcomes, hospital stay, and overall complication rates compared to two-stage surgical procedures. This approach is recommended as a more effective treatment modality for compound grade 3B shaft tibia fractures. Keywords: Compound Grade 3B Tibia Fractures, Single-Stage Antibiotic Nailing, Two-Stage Surgical Procedure, Healing Time, Infection Rate.

Background: To study the association between screen time and sleep quality among teenagers of Jammu province. Materials and Methods: An analytical cross-sectional study was carried out using a questionnaire targeting all accessible adolescents. The study questionnaire covered personal data, medical history, screen use including the type of used devices, duration of use per day and at bedtime, effect of using devices, and family and friends’ influence on using devices. Sleep quality was assessed using Pittsburgh Sleep Quality Index. Results: A total of 220 teenagers fulfilling the inclusion criteria completed the study questionnaire. Teenagers ages ranged from 13 to 19 years with a mean age of 15.5 ± 1.1 years old. Exact of 93 (42.2%), the study adolescents used screens for 6–8 hours daily, 47 (21.3%) use screens for more than 8 hours daily. Most of them are addicted to their smartphones 172 (78%) followed by tablets and computers.55% feel that using devices at bedtime affect your productivity on the next day.63% feel fatigue and drowsiness 54%, which affects their concentration at work 29.4%. A total of 94 (42.7%) of the study adolescents were good sleepers while 126 (57.2%) were poor sleepers.9.5% even require sleeping pills because of poor sleep. Conclusion: The study revealed that teenagers had a high frequency rate and duration of screen use which may exceed 6 hours daily with more than half of them with poor sleep quality, feeling fatigue, daytime sleepiness, and lack of concentration. Keywords: Teenagers, devices addiction, effect, relation, screen use, sleep.

Background: To assess breast feeding and complimentary feeding practices of mothers of children aged 6 months to 2 years. Materials and Methods: A community based cross sectional study design was used for the survey. A house to house survey was done to collect the required data from the participants using a predesigned, pretested semi structured questionnaire. All women with children 6 to 24 months of age, residing in the study areas & giving informed verbal consent were eligible to participate in the study Data pertaining to socio-demographic profile, infants details, maternal details, information regarding breastfeeding practices, and initiation of complementary feeding was collected from the participants. Results: 77.5% mothers had started complementary feeding at the recommended time of six months. The association of initiation of complementary feeding with socio-economic status, birth order, place of delivery and maternal education was found to be statistically significant. 40%mother gave prelactal feed. The association of socio-economicstatus, education levels of mother, working mothers etc were significant factors. In the upper middle class, 87.5% mothers had started complementary feeding at the recommended time. Conclusion: The study has shown that a sizeable number of nursing mothers show poor adherence to WHO recommendations for breastfeeding and infants feeding practices. Intervention and further research should pay attention to factors such as cultural practices, access to and utilization of health care facilities, child feeding education and family planning. Further for properly following recommended breastfeeding practices there is necessity to promote mother’s knowledge about breast feeding. Advice about breast feeding and complementary feeding during antenatal check-ups and postnatal visits might improve feeding practices. Keywords: Family Planning, Breastfeeding Practices, Prelactal feed.

Background: Traditional learning (TL) is teacher-centric and didactic, so likely to be associated with low interest and superficial learning. Case-based learning(CBL) is an inventive, student-focused, facilitator guided instructional approach. The present curriculum being CBME, it is pertinent to integrate and assess the effectiveness of CBL. Objective: To evaluate CBL and TL among Final Year MBBS part I students in Dermatology theory classes. Materials and Methods: The present study is randomized controlled trial with cross over design involving 50 students, categorized into two equal sized groups I and II to receive TL and CBL respectively on the same topic. A week later, the groups were crossed over for the subsequent session. Both the groups were assessed by 15 MCQs with 2 marks each at the end of each session. Students perceptions were assessed by a questionnaire using 5 point Likert scale. Results: After the first session average scores were group I (24) and group II (25.52). After crossover, the average score was better in group I than group II (26.56 Vs 25.36, respectively). The difference in mean scores showed a higher score in Group I(p<0.001) than in Group II(p=0.71) suggesting that CBL possibly enhanced the performance. Majority of students perceived Case Based Learning as more helpful and interesting than Traditional Learning. Conclusion: Case Based Learning amplifies student learning through knowledge retention and improves problem-solving skills. Keywords: Case based learning, Traditional learning, Dermatology.

Background: To study etiology and clinical presentation in patients with neovascular glaucoma in a tertiary institute over a period of two years. Material and Methods: Retrospective observational study amongst patients with neovacular glaucoma to document the etiology and clinical presentation of neovascular glaucoma. Detailed history taking, gross systemic examinations, thorough ocular examinations were done and recorded. Results: A total number of 56 patients with neovascular glaucoma were examined and 33 patients (58.92%) were diabetic and 34 patients (60.71%) were hypertensives. Etiological factors associated with NVG were PDR in 25 cases (44.64%), CRVO in 21 patients (37.50%), chronic RD in 2 patients (3.57%), uveitis in 2 patients (3.57%), in 3 patients (5.35%) cause could not be found and other causes were HRVO, BRVO & aphakia. Most of the patients have BCVA of hand movement only. Examination of opposite eye in 25 patients where PDR being the cause of NVG, NVI was present in 11 and PDR was present in 18 (72%). Characteristic clinical presentations were recorded. Conclusion: Our data establishes that medical conditions such as systemic hypertension, diabetes and ocular conditions like retinal vein and artery occlusions, aphakia and uveitis were associated with NVG. Early identification and treatment of these conditions will prevent neovascular glaucoma. Neovascular glaucoma is a blinding, intractable disease, difficult to manage and very often resulting in permanent visual loss. Key Words: Neovascular, occlusions, intractable, permanent.

Background: GDM is one of the most common medical complications experienced during pregnancy, affecting approximately 10% of all pregnant women. It occurs when the body is unable to produce or use enough insulin, leading to elevated blood sugar levels. While GDM usually resolves after childbirth, it can have serious consequences for both the mother and the baby if not properly managed. Materials and Methods: Study type: This cross-sectional observational study was conducted in the department of Obstetrics and Gynaecology of Government Doon Medical College and Associated Hospital, Dehradun, Uttarakhand. Study period – 1 year Sample size –Number of GDM patients were admitted to our labour room in the duration of 12 months for delivery. All pregnant women with gestational age 24 weeks onwards with attended to OPD and labour room emergency were screened for gestational diabetes, with 50 gm ORAL GLUCOSE CHALLENGE TEST (OGCT). Those antenatal women whose blood sugar level found >/140mg/dl second step of diagnostic 100 gm ORAL GLUCOSE TOLERANCE TEST (OGTT) was conducted on these screen positive antenatal women. All women with gestational age less than 24 weeks, with OGCT value less than 140mg/dl, rescreened between 24 to 28 weeks. All pre-gestational diabetic patient or already known case of diabetic were not included in the study. Results: Total cases of GDM was found to be 332 (4%) in our hospital There were 8316 total deliveries occurred in our hospital during the study period. Total 332 GDM patient’s outcome was measured. Here total 8 patients were noncompliant, 1 patient was admitted to labour room at term pregnancy with decrease foetal movements. IUD was confirmed by the ultrasonography. Rest 7 five patients had uncontrolled blood sugar which is mainly responsible for sudden IUD in case of preterm babies. Among them 213 babies were alive and healthy but 119 babies have significant perinatal outcome. Conclusion: Gestational Diabetes Mellitus (GDM) is a common pregnancy complication that requires vigilant management to prevent adverse maternal and neonatal outcomes. Through early diagnosis, regular monitoring, and appropriate treatment, the impact of GDM can be mitigated, ensuring the well-being of both mother and baby. Keywords: GDM, IUD, OGCT, OGTT, MNT, BMI

Background: Head injury is a leading cause of morbidity and mortality in trauma patients. Frontal sinuses (FS) are air filled structures in the skull that can provide protection to the surrounding structures. Such an effect may be influenced by the variations in the sinus volume. Objectives: To evaluate the effect of the extent of FS pneumatization to the findings of intracranial injury on CT. Materials and Methods: A retrospective study was conducted among patients admitted to the Department of Neurosurgery between September 2021 and August 2023. The participants included all patients referred for CT scan with indication of head injury in the study hospital during the study period. After recruitment, FS volume was measured in Non-contrast CT of the brain; fractures and other associated facial or intracranial injuries were determined from the imaging reports and data on other variables were obtained from the medical records department. The data was then analyzed with a significance level of p<0.05. Results: The study included 120 participants with a mean age of 35.93±11.91 years and involved a slightly higher proportion of females (52.5%). The different variables collected during admission showed that most participants (59.2%) reported a moderate traumatic brain injury (Glasgow Coma Scale score of 9–12) followed by 40.8% of participants with mild traumatic brain injury (Glasgow Coma Scale score of 13-15). The results showed that the mean FS volume was highest among patients who presented with a Marshall score of 2 with 1.55±1.44 cm3 and the difference in scores was found to be statistically significant (p=0.016). The difference of FS volume among patients with and without contusion, traumatic subarachnoid hemorrhage (tSAH), subdural hematoma (SDH) was found to be statistically significant (p<0.05). Conclusion: The results of the present study help conclude that higher FS volume can have a protective affect during craniofacial injuries. Keywords: Trauma, Frontal Sinus, Computer Tomography, Intracranial injury, Outcome.

Background: There are many illnesses that Klebsiella pneumoniae can cause, such as pneumonia, urinary tract infections, bacteremia, and liver abscesses. Historically, K. pneumoniae infections mostly happened to people whose immune systems weren't working well, leading to serious symptoms. Even so, the appearance and spread of hypervirulent strains have made healthy people more likely to get illnesses, even if their immune systems are strong. Materials and Methods: The study was done at the Department of Emergency Medicine, Kamineni Academy of Medical Sciences and Research Centre, L.B Nagar, Hyderabad, Telangana, India, which offers a wide range of medical and surgery services except for burn, maternity, and child care. Every patient with bacteremia is routinely found every day by lab surveillance and is then assessed by an expert in infectious diseases. When the treating doctor thinks that bacteria are in the bloodstream, they take blood samples to grow the bacteria. Results: Also, strains of K. pneumoniae are becoming more and more resistant to medicines, which makes it much harder to treat illnesses caused by these strains. The appearance of microorganisms that are highly pathogenic and immune to antibiotics has sparked a lot of new research. A type of bacteria that is resistant to drugs and an important part of the body's defense system called interleukin-17 have been seen to be spreading around the world. Some other factors have been found to be important in at least one infection model, even though there isn't a lot of research on the topic. But there are a lot of different types of K. pneumoniae strains, and not all aggressive Klebsiella strains play the same important role in every part. A new study has found more virulence factors in K. pneumoniae. It has also given us new information about the key factors that control the pathogen's growth in different tissue sites. It is important to know that many of these genes make proteins that guide transcription and metabolism. Conclusion: More work needs to be done to fully understand and describe these newly found traits, figure out how infections differ between healthy people and people whose immune systems aren't working as well, and find possible treatment targets in the bacteria or the host. Keywords: Phenotypes, oropharynx, bacteraemia, and Klebsiella pneumoniae.

Background: The aim is to study the clinical presentation and management of blunt injuries of abdomen admitted in a tertiary hospital i.e. Government General Hospital, Jayashankar Bhupalpally. Materials and Methods: This is a prospective study conducted in Government General Hospital &, Jayashankar Bhupalpally for a period of 1 yrs (From June 2023 to May 2024). The study comprises of patients in the age group of 13-69years, who sustained blunt abdominal trauma admitted at our hospital. All patients were received in the casualty department and registered as medico legal cases. Patients requiring neurosurgical intervention were not included in this study. Results: In the present study, Blunt abdominal injuries are common. High index of suspicion is necessary to rule out abdominal injury especially in a polytrauma patient. Males are predominantly affected with male to female ratio of 3:1 and the most common age group is 20-29 years Road traffic accident forms the most common mode of injury. Plain erect x ray abdomen is a valuable investigation for diagnosing bowel perforations. Ultrasound examination – FAST helps in identifying solid organ injury and free fluid and is the most important first line investigation to be done. Diagnostic peritoneal lavage.was not done in the present study. The most common organ injury is Spleen and most of the cases were managed conservatively. Liver injuries are second most common all of which were managed conservatively. Mesenteric and bowel injuries are the next common, all were subjected to exploratory laparotomy. Retroperitoneal hematoma was seen in a small proportion of patients and were treated conservatively. Associated extra abdominal injuries like head, thoracic and orthopedic injuries were found which influenced the morbidity. Post operative complications like wound infection, dehiscence, respiratory infections and fecal fistula are common in blunt abdominal trauma. The present study showed a mortality of 8%. Conclusion: This study emphasises on the interval between injury and surgery and the need for early diagnosis and prompt operative treatment to decrease morbidity. Keywords: Blunt abdominal injuries, Diagnosis, Mortality, bowel perforations, USG.

Background: Recent studies suggest that decreased vitamin D level is common in patients with type 2 diabetes mellitus. Low vitamin D may result in early cardiovascular complications in patients with type 2 diabetes mellitus. as vitamin D appears to influence several pathways that have been linked to coronary artery disease, such as inflammation, vascular calcification, proliferation of smooth muscle cells in vascular tissue, myocyte hypertrophy, arterial intimal thickness, renin-angiotensin system, blood pressure control and insulin resistance at periphery. Aim: the aim of this study was to investigate the levels of 25-hydroxy Vitamin in patients with T2DM and in nondiabetic healthy controls and to ascertain the impact of levels on glycemic control in T2DM patients. Materials and Methods: The present study was done at Ayaan Institute of Medical sciences, Hyderabad after getting approval by Institutional Ethics committee of Ayaan Institute of Medical sciences, Hyderabad. Type 2 diabetic patients and controls attending General Medicine Department was recruited into this study. A total of thirty cases, diagnosed as type 2 Diabetes and 120 normal controls during February 2024 to September 2024 were included in the study. Results: In the present study, serum vitamin D, fasting blood sugar, postprandial blood sugar and Glycated Hb has been estimated in type 2 diabetic patients and compared to controls. Serum vitamin D levels are significantly low in diabetic cases as compared to controls. Serum vitamin D levels are very low in uncontrolled cases (Hba1C is high). It has been seen that; there exists inverse relation between glycemic control and vitamin D levels. Thus; it shows the role of vitamin D in pathogenesis of onset of disease and its complications possibly due to antioxidant property. A highly significant correlation was found between serum vitamin D, blood glucose and glycated hemoglobin in type 2 diabetic subjects. Conclusion: The present study suggests that estimating vitamin D and timely supplementing in the deficient cases can provides a better glycemic control; thus delaying the onset of complications in type 2 diabetic subjects. Thus vitamin D has plays its role in the control of glycemia and its complications through its antioxidant properties. Keywords: Diabetes Mellitus, Vitamin D, Hb A1c, Glycemic Control, Antioxidant.

Background: Serological incompatibilities are to be identified prior to any blood product transfusion. Cross matching can be performed by various methods, including rapid saline method, indirect antiglobulin method and gel method which consume different amounts of time. Aims: The present study was taken up to compare various methods of cross matching and to identify pros and cons of different methods. Materials and Methods: The present study is a prospective four-month study taken up in a tertiary care blood center attached to the government general hospital. Cross matching was performed using either of the three methods available based on time period available. Transfusion reactions that occurred after each method of cross matching were recorded. Results: A total of 2776 cross matchings and blood transfusions were done over this period. 12 cases of transfusion reactions were recorded of which highest number occurred in cases of coombs method. Conclusion: Gel method was found to be the easier and safer when compared with other methods. Keywords: Coombs method, Emergency Cross match, Gel card method, incompatibility, Rapid Saline method.

Background: Monitoring glucose levels in flap tissues can be a valuable indicator of flap viability and early detection of flap failure. This study aimed to analyze the utility of intra-flap glucose monitoring in predicting flap outcomes. Material and Methods: A prospective study was conducted on 25 non-diabetic patients undergoing flap surgeries, excluding those with buried flaps or unwilling to participate. Age, sex, indications for surgery, body regions, and flap outcomes were recorded. Mean intra-flap glucose levels were measured at multiple time points up to 72 hours post-surgery and compared between survival and non-survival groups. Results: The study population ranged from 5 to 62 years, with a mean age of 42.84 years. Males constituted 80% of the participants, with trauma being the most common indication for flap reconstruction (68%). Flaps were predominantly axial (68%), followed by random pattern flaps (32%). Complications occurred in 12% of axial and 12.5% of random pattern flaps. The mean glucose levels were significantly higher in the survival group (134.46 mg/dL) compared to the non-survival group (55.38 mg/dL). Glucose levels in the survival group remained consistently elevated, whereas they declined in the non-survival group. Statistical analysis showed a significant difference (p<0.001) between the mean glucose levels of the two groups. All flaps with complications exhibited changes in color, turgor, and pin prick bleeding. Conclusion: Intra-flap glucose monitoring is a reliable method for predicting flap viability. Higher glucose levels are associated with flap survival, providing a potential tool for early intervention in cases of impending flap failure. Key Words: Flap perfusion, glucose monitoring, flap viability, flap failure, trauma reconstruction, flap surgery outcomes.

Background: Caregivers of schizophrenia patients often face substantial physical, emotional, and psychological burdens. Understanding the impact of caregiving and the coping strategies employed by caregivers is crucial for developing targeted interventions to support them. Objective: This study aims to assess the caregiving burden and coping strategies among caregivers of schizophrenia patients, focusing on socio-demographic factors, psychological distress, and coping mechanisms. Material and Methods: A cross-sectional study was conducted among 30 caregivers of schizophrenia patients. Data on socio-demographic characteristics, caregiving burden (assessed using the Family Burden Interview Schedule), and coping strategies (using the Coping Check List) were collected. Psychological distress was measured using the General Health Questionnaire-12 (GHQ-12). Descriptive statistics were used to analyze the data, with results presented as percentages. Results: The majority of caregivers were aged 51–60 years (36.7%), with 63.3% residing in rural areas. Severe psychological distress was reported by 56.6% of caregivers, with a higher proportion among females (83.3%). Significant financial burden (56.7%) and disruptions in routine family activities (66.7%) were common. Positive coping strategies such as problem-solving (80.0%) and religious practices (83.3%) were widely employed, while avoidance strategies were less used (23.3%). Conclusion: Caregivers of schizophrenia patients experience substantial burdens, particularly in terms of psychological distress and financial strain. Constructive coping strategies, such as problem-solving and religious practices, play a significant role in managing these challenges. Targeted support and interventions are essential to reduce caregiver burden and improve their well-being. Key Words: Schizophrenia, caregiver burden, coping strategies, psychological distress, family burden, socio-demographic factors.

Background: To identify the preoperative predictors of difficulty in laparoscopic cholecystectomy and to develop a scoring system on the basis of these observations that may be predictive of difficulty. Materials and Methods: This study included 60 consecutive Laparoscopic cholecystectomies that were studied prospectively over a period of 19 months at Bhagwan Mahaveer Jain Hospital, Bengaluru from June 2015 to December 2016. Standard 4 port LC done in all the cases. Results: A score of <=4 and >= 5 was found to be cut off point to predict easy and difficult LC with sensitivity and specificity, PPV, NPV and accuracy of 96%, 68.6%, 68.6%, 96% and 80% respectively. In our study we found that Age >50 years, H/o Acute cholecystitis, GB wall thickness >4mm, impacted stone in neck of GB, Diabetes Mellitus, total WBC count > 9000 cells/cumm and BMI >27.5 Kg/M2 statistically significant factors to predict difficult LC. Conclusion: The scoring system evaluated in our study is a reliable and useful benchmark to predict difficult cases. However, the small sample size may be an impediment in attaining complete statistical validity. We propose large scale, multicentric studies to validate the scoring methodology and establish its efficacy. Keywords: Pre-operative predictors, Difficult Laparoscopic Cholecystectomy.

Background: The use of amniotic membrane as a biological dressing in case of superficial to deep burns is simple and cheap and can be used instead of our conventional dressing methods. The membrane prevents heat and water loss from the wound, acts as a barrier to bacterial contamination and promotes healing by promoting variety of growth factors. Materials and Methods: In our study we have collected data of all the pediatric patients(30)admitted . Results: we have found satisfactory results, when compared to duration of hospital stay, number of dressings, pain management and is cost effective. Conclusion: This method is very feasible and can be adopted as a modality of treatment for burn wounds. Keywords: Amniotic Membrane, Superficial Burns, Pediatric Patients

Background: Leprosy, or Hansen’s disease, is a chronic infection caused by *Mycobacterium leprae*, presenting with skin and nerve damage, and classified based on clinical and histopathological features. Despite efforts in India through the National Leprosy Eradication Program and multi-drug therapy, the country still records over 100,000 new cases annually, highlighting the need for improved diagnostics and treatment strategies. This study was done to evaluate the correlation between clinical and histological diagnosis of leprosy subtype. Materials and Methods: This prospective study, conducted from March 2022 to February 2024, involved 50 leprosy patients diagnosed through clinical symptoms such as skin lesions and nerve involvement. Each patient underwent detailed clinical and histopathological evaluations, with cases categorized into subtypes using the Ridley-Jopling scale. Results: This study examined 50 untreated leprosy patients, with 74% of participants aged between 21-40 years and a male-to-female ratio of 1.5:1. Lepromatous leprosy was the most common subtype (48%), primarily affecting the back, followed by tuberculoid leprosy (22%), with clinico-histological discrepancies noted in 14% of lepromatous cases. Conclusion: The study concludes the need of implementing histological confirmation of the subtype of leprosy before initiating anti-leprosy treatment. Keywords: Leprosy, Ridley- Jopling classification; Faraco staining; mycobacterium leprae; clinico-histological correlation.

Background: Vitiligo is a chronic skin disorder marked by depigmented patches due to the destruction of melanocytes, influenced by genetic, environmental, and autoimmune factors. Treatments include medical options like corticosteroids and 5-fluorouracil (5-FU), which has shown promise in repigmentation, especially when combined with dermabrasion or microneedling. Although initial studies are encouraging, further research is needed to refine treatment protocols and improve outcomes for patients with resistant vitiligo. Materials and Methods: This one-year study, conducted from July 2023 to June 2024, enrolled 35 patients with stable vitiligo of more than two years’ duration and excluded those with mucosal, actively spreading, or facial vitiligo, among other criteria. The procedure involved dermabrasion followed by the application of 1% 5-fluorouracil cream, with follow-up visits over six months to monitor repigmentation and record any adverse effects. Results: In the study of 35 vitiligo patients, the majority (60%) had vitiligo vulgaris, with 57.1% being female and the mean age of the group was 34.5 years. Most patients (71.4%) achieved complete repigmentation, while 28.57% had partial repigmentation. The most common side effect was pain at the abraded site (91.4%), and other effects included darker repigmentation (45.7%), superficial scarring (11.4%), and secondary infection (5.7%). Conclusion: This study highlights the effectiveness of dermabrasion combined with 1% 5-FU for treating vitiligo, but further research is needed to optimize protocols, assess long-term outcomes, and consider patient-reported measures for comprehensive evaluation. Keywords: Vitiligo, 5- fluoro-uracil, dermabrasion, micro-needling, pigmentation.

Background: To study etiology and clinical presentation in patients with neovascular glaucoma in a tertiary institute over a period of two years. Material and Methods: Retrospective observational study amongst patients with neovacular glaucoma to document the etiology and clinical presentation of neovascular glaucoma. Detailed history taking, gross systemic examinations, thorough ocular examinations were done and recorded. Results: A total number of 56 patients with neovascular glaucoma were examined and 33 patients (58.92%) were diabetic and 34 patients (60.71%) were hypertensives. Etiological factors associated with NVG were PDR in 25 cases (44.64%), CRVO in 21 patients (37.50%), chronic RD in 2 patients (3.57%), uveitis in 2 patients (3.57%), in 3 patients (5.35%) cause could not be found and other causes were HRVO, BRVO & aphakia. Most of the patients have BCVA of hand movement only. Examination of opposite eye in 25 patients where PDR being the cause of NVG, NVI was present in 11 and PDR was present in 18 (72%). Characteristic clinical presentations were recorded. Conclusion: Our data establishes that medical conditions such as systemic hypertension, diabetes and ocular conditions like retinal vein and artery occlusions, aphakia and uveitis were associated with NVG. Early identification and treatment of these conditions will prevent neovascular glaucoma. Neovascular glaucoma is a blinding, intractable disease, difficult to manage and very often resulting in permanent visual loss. Key Words: Neovascular, occlusions, intractable, permanent.

Background: Vancomycin-resistant enterococci are a rapidly evolving bacterium that can cause serious or fatal infections acquired in hospitals, known as nosocomial infections. Therefore, the aim of this study was to determine the presence of enterococci in various clinical samples and assess their resistance to vancomycin, as well as their ability to form biofilms. Materials and Methods: This analysis contained a total of 155 distinct Enterococcus species. The bacteria were isolated and identified using the conventional bacteriological methodology. The antibiotic susceptibility testing was performed in accordance with the recommended guidelines of the clinical laboratory. The biofilm production test using microtiter plate techniques. Results: Among the 155 isolates, Enterococcus faecalis accounted for 68.39% whereas Enterococcus faecium accounted for 31.61%. The urine samples had the highest number of isolates. Vancomycin-resistant Enterococcus was detected in 5.98% of the isolates, with 17.23% of those isolates showing biofilm production. Conclusion: Urine samples exhibiting a high prevalence of enterococci were found to be capable of producing biofilms. The prevalence of antibiotic resistance was greater in enterococcus isolates in comparison to non-biofilm producers. Keywords: Biofilm, vancomycin, Enterococcus faecalis, Enterococcus faecium.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a painful symmetrical peripheral polyarthritis. It affects multiple body organs in addition to joints and surrounding tissues and it is a leading cause of joints deformities and disabilities. Objective: To assess the clinical and spirometric pattern of pulmonary function in subjects with rheumatoid arthritis. Material and Methods: The present study was carried out in the department of General medicine and Orthopedics, KC GENERAL HOSPITAL, Bangalore during the period from January 2019- March 2021. During the period of data collection,120 patients with rheumatoid arthritis were screened as per the inclusion and exclusion criteria. Results: Majority of subjects were belonged to 4thand 5th decade with mean age of 47.2 years. female preponderance was seen in the present study with female: male ratio6.5:1, In this study slightly higher gender ratio was attributed to the exclusion of smokers. 70% of the study subjects had 20 or more joint involvement with symmetrical distal appendicular pattern. Although majority of patients in this study had short duration of illness, very few of the symptomatic patients had active signs of inflammation (15%). PFT revealed 16.7% abnormal patterns, with predominant restrictive pattern than obstructive pattern. Conclusion: RA is a progressive symmetrical autoimmune disease characterized by erosive synovitis. Among the extra articular manifestations of RA, lung and pleura are the frequent sites of involvement. Majority of study population belonged to 4th and 5th decade with mean age 47.2 Pulmonary symptoms were seen in 26.6%. Major symptom was exertional dyspnea. Respiratory system examination was abnormal only in 6.6%, Chest X ray was abnormal in 3.3%. Whereas PFT revealed 16.7% abnormal patterns, with predominant restrictive pattern than obstructive pattern. Keywords: Clinical and Spirometric Pattern, Pulmonary Function, Rheumatoid Arthritis.

Background: Cataract surgery is one of the most common procedures globally, with 0.013% to 0.7% of cases associated with complications such as postoperative infections, including endophthalmitis, which can lead to blindness. These infections often originate from the patient's conjunctival flora, with Staphylococcus aureus and coagulase-negative staphylococci (including Staphylococcus epidermidis) being the most common bacteria found on the ocular conjunctival surface. Materials and Methods: The study involved 118 patients scheduled for cataract surgery at ESIC-MC & PGIMSR Hospital over 6 months. Conjunctival swabs were collected from each patient's eyes before administering any antibiotic drops or local anaesthetics. These samples were inoculated onto blood agar plates and sent to the microbiology laboratory for culture and sensitivity testing. The un-operated eyes served as controls. Bacterial colonies were identified through Gram staining, and biochemical reactions and antibiotic susceptibility patterns were determined using the Kirby-Bauer disc diffusion method. Results: Out of 118 conjunctival swabs received for culture, a total of 63(53.38%) samples yielded growth. Among them, 57(90.06%) showed CoNS as growth which was sensitive to Linezolid & Amikacin (100%), Gentamycin (94.73%), Clindamycin (80.7%), and resistant to Erythromycin (49.13%) Penicillin & Ciprofloxacin (35.09%), Levofloxacin (33.34%), Methicillin (21.05%), followed by Staphylococcus aureus 5 (7.93%) and Citrobacter kosari 1 (1.59%) Conclusion: We conclude that Coagulase-negative Staphylococcus is the most common bacteria isolated from the conjunctiva before cataract surgery. This study may help eye surgeons choose pre- and post-operative antibiotics to avoid post-operative infections. Keywords: Conjunctival flora, Coagulase Negative Staphylococcus, Cataract surgery.

Background: Traditionally long bone diaphyseal fractures are being treated with inter- locking nails. Being minimally invasive, excellent functional outcome. However, some- times these implants fail in form of nail breakage before union. Our study aims at studying cases of nail breakage in long bones, pattern of breakage and their possible causes. Materials and Methods: This is retrospective study carried out at Tertiary hospital between 2009 to 2016. 45 Patients with broken nails in femur, tibia and humerus were included in this study. Broken nails were removed and refixation done. The broken nails were studied to understand the pattern of breakage. Detailed history and x-rays were studied to under- stand the possible causes of the implant failure. Results: Majority of the cases were in the age group 20-40 years with male predominance. There were 25 cases of femur,20 of tibial and 2 cases of humerus IMIL nail breakage respectively. Most of the nail breakage had occurred in cases with fracture of dist al 1/3 shaft of bone (46.67%). most cases of breakage occurred at distal 1/3 nail region (68%). Among the causes of nail breakage, surgeon related causes were found in 14 cases (31.11%), patient related in 7 (15.56%), multifactorial causes in 14 (31.11%) and un-known cause in 10 (22.22%). Conclusion: The IMIL Nail is good treatment option but its breakage is related to mul- tiple factors. The surgeon related factors are most common cause of nail failure. Accurate technique, correct size and choice of implant, good patient compliance are all important to avoid implant failure and achieve good fracture union. Keywords: Long bone fracture; Intramedullary interlocking nail; IMIL nail; Implant failure; Nail breakage.

Background: The most common mechanism for kidney injury is blunt trauma, mainly from falls and automobile accidents. They happen in 5–10% of trauma cases. The majority of individuals with blunt renal injuries who are thermodynamically stable respond well to non-operative management. The gold standard for diagnosing renal trauma is contrast-enhanced computed tomography (CT), which needs to be done on all stable patients who have gross haematuria as well as any patient who presents with microscopic haematuria and hypotension. Additionally, if the results of the physical examination or the mechanism of damage indicate renal injury, a CT scan should be performed. The primary goals were to examine the patient's demographics, identify and ascertain the type of injury and common manner, and assess the effectiveness of different high-grade (grade 4-5) blunt renal injuries and its therapy strategies. Materials and Methods: This was done as prospective observational study in the Tirunelveli Medical College emergency trauma and urology wards, where patients undergoing treatment for kidney injuries are monitored and documented closely. There were 50 subjects in this study. Each participant in this study completed an informed consent form. Through the completion of a specifically created proforma that comprises a thorough clinical history, laboratory and radiographic investigations, clinical assessment, and other information, patients submitted prospective data. Results: Of the 50 participants, 42 were men and 8 were women. 42 were in road traffic accidents, 8 fell down a steep stairway. Twelve subjects had grade 2 injuries, twenty had grade 3 injuries, ten had grade 4 injuries, and six had grade 5 injuries based on AAST-based grading. Two individual sustained a grade 1 injury. 46 patients of the 50 cases had conservative care for their renal damage, whereas two person underwent an emergency nephrectomy. Conclusion: For blunt renal trauma, conservative care was recommended above surgical care. Conservative management of blunt renal trauma without associated abdominal injury is feasible in patients who are hemodynamically stable at presentation. Advancements in imaging techniques and improved critical care have favored the conservative approach for even the severe grade of injuries. Keywords: Blunt renal injury, high grade, conservative management.

Background: Long-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. The past pandemics of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) hint toward a risk of occurrence of "Long-COVID" syndrome, i.e., the persistence of post-discharge symptoms among COVID-19 survivors. Current study aims to assess the prevalence and characteristics of post-COVID-19 manifestations and their effect on the quality of life (QoL) of COVID 19 recovered individuals. Materials and Methods: Cross-sectional study was conducted among 344 adults from the general population with RTPCR -confirmed SARS-CoV-2 infection between May 2020 to November 2020 in the PHC Sokhda of Vadodara district. We identified anosmia, ageusia, fatigue or shortness of breath as most common, persisting symptoms and summarised presence of such long-term health consequences as post-COVID syndrome through questionnaire-based interviews. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue, dyspnoea or depression at six months after diagnosis. Results: Majority experienced at least one post-COVID-19 symptom, with fatigue (91.66%) being the most prevalent post-discharge manifestation. We observed a significant correlation of post COVID-19 symptoms with gender, age, and severity of disease. Conclusion: Our findings emphasize the need for the timely planning of resources and patient-centred services for post-COVID-19 care. Multidisciplinary care along with regular follow-up must be provided to such patients. Keywords: COVID-19, Long-COVID, Polymerase chain reaction, Prevalence, SARS-CoV-2.

Background: To study the clinical presentations, pathological features, morbidity and mortality of patients with carcinoma esophagus who underwent definitive surgery. Materials and Methods: This is a prospective and retrospective study of 89 patients of carcinoma esophagus, who were surgically fit with operable disease and under went a definitive surgical procedure. Patients with carcinoma GEJ were also included. Results: Squamous cell carcinoma is still the most common malignancy in the lower 1/3 of esophagus. Most of the patients were between 41-60 yrs (64%). Smoking and alcohol are the most common risk factors in males (65%). Dysphagia is the most common presenting symptom. Most of the lesions were in the form of ulcerated growths (65%). Intraoperative complications were 5.61%. Anastomotic leak (21%) and the pulmonary complications (24%) were the most common complications. These two were also the most common associated factors with mortality which was 16.85%. Conclusion: Esophageal carcinoma can be managed surgically with reasonable morbidity and mortality if the patient presents early. Keywords: Esophageal adeno carcinoma, Histopathological examination, Squamous cell carcinoma, carcinoma GEJ, trans hiatal esophagectomy.

Background: Scrotal swelling and pain are prevalent in clinical settings, and while a detailed history and physical examination are often initial steps, many cases require additional diagnostic imaging for a comprehensive evaluation. This study aims to assess the effectiveness of ultrasonography (USG), including both grayscale and color Doppler, in diagnosing scrotal diseases. Objective: To evaluate the role of high-resolution real-time grayscale ultrasound and color Doppler imaging in diagnosing various scrotal disorders and to compare their diagnostic efficacy. Materials and Methods: This prospective observational study, conducted at the Department of Radiodiagnosis, Index Medical College Hospital and Research Centre, Indore, included 50 patients referred for scrotal ultrasound and color Doppler imaging due to symptoms such as acute scrotal pain, swelling, redness, or tenderness. The study adhered to institutional ethical guidelines, with written informed consent obtained from all participants. Imaging was performed using GE Voluson S8 and GE Logiq P9 machines with appropriate transducers. The study involved comprehensive clinical evaluation, bimanual palpation, and detailed imaging in various positions and with specific maneuvers for varicocele assessment. Statistical analysis was performed using IBM SPSS version 22.0, with comparisons made using chi-square tests and independent t-tests. Results: Majority of patients were aged 21-40 years, with an average age of 35.74 years. Inflammatory conditions were most common (30%), followed by scrotal hernia (14%). Hydrocele was the most frequent fluid collection, observed in 36.8% of cases, primarily confined to the tunica vaginalis. Hematocele showed more complex internal features than hydrocele. Varicocele was present in 8.8% of cases, with notable vessel enlargement and tortuosity. Orchitis was found in 57.1% of cases, epididymitis in 78.6%, and funiculitis in 14.3%. Inguinoscrotal hernias occurred in 8% of cases. The color flow study was 100% accurate in diagnosing testicular torsion. Conclusion: Ultrasound, particularly with color Doppler, is a highly effective, noninvasive, and cost- efficient modality for evaluating scrotal diseases. It enhances diagnostic accuracy, reduces the need for invasive procedures, and plays a crucial role in distinguishing between conditions requiring emergency surgery and those amenable to medical treatment. Further research comparing grayscale versus color Doppler imaging could provide deeper insights into optimizing scrotal pathology diagnostics. Keywords: Scrotal swelling, pain, ultrasound, color Doppler, testicular torsion, epididymitis, scrotal pathologies.

Background: Perimenopause is a phase that is marked by physiological changes. While these are a natural part of the aging process, they can have various effects on a woman’s health, including an increased risk of cardiac diseases. The autonomic nervous system plays a significant role in various physiological processes, including those that are affected during perimenopause. An association between practicing yoga and a positive effect on autonomic markers has been seen. Therefore, this study aims to determine the effect of 30 minutes of breathing exercise and meditation on heart rate variability in perimenopause women. Materials and Methods: This prospective cohort study, included 82 perimenopausal women in the age group of 40-55 years. The participants practised yoga (30 minutes per day for 12 weeks), that included Brahmari Pranayama, Nadi sodhan kriya, Mool Bandh, and Meditation with Om Ucharan. Linear and Non-Linear parameters of heart rate variability were assessed before and after 12 weeks of yoga. Results: In HRV, the frequency domain showed a significant decrease in LF/HF ratio and non-significant decrease in LF (ms2)(p= 0.061), a significant increase in HF% (p = <0.001), and increase in HF(ms2), Time domain showed an increase in Standard deviation of RR intervals (SDRR), RMSSD(depicting parasympathetic dominance) and a decrease in Average heart rate (depicting sympathetic activity) though non-significant. Conclusion: Three months of daily breathing exercise and meditation improves the HRV in perimenopausal women. It can be said that practicing yoga can attenuate the cardiac autonomic dysfunction induced by hormonal imbalance set up in the perimenopause phase, giving us an opportunity for early intervention before the clinical deterioration of cardiovascular system. Keywords: Perimenopause, Heart rate variability, Yoga, Autonomic function, Cardiovascular disease.

Background: Patients with pre-existing pulmonary disease are at an increased risk of developing postoperative respiratory complications. Perioperative fluid management plays a crucial role in maintaining hemodynamic stability, but excessive fluid administration may exacerbate pulmonary complications. This study aims to investigate the association between perioperative fluid management and the occurrence of postoperative respiratory complications in this vulnerable population. Objective: The aim of this study was to investigate the association between perioperative fluid management and postoperative respiratory complications in patients with pre-existing pulmonary disease. Materials and Methods: This case-control study included 100 patients undergoing major surgery, with 50 patients developing postoperative respiratory complications (case group) and 50 patients without complications (control group). Perioperative fluid management, including intraoperative and postoperative fluid volumes, was compared between the two groups. Postoperative respiratory complications, such as pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS), were analyzed. Logistic regression was used to identify risk factors, and the length of hospital stay was evaluated. Results: Patients in the case group received significantly higher intraoperative fluid volumes compared to the control group (3.2 ± 0.8 vs. 2.6 ± 0.7 liters, p = 0.01). The postoperative fluid volume was also higher in the case group (2.1 ± 0.5 vs. 1.7 ± 0.4 liters, p = 0.03). Respiratory complications occurred exclusively in the case group, with 32% developing pneumonia, 24% atelectasis, and 44% ARDS (p < 0.001). Logistic regression identified higher intraoperative fluid volume (OR = 2.3, 95% CI: 1.4-3.8, p = 0.01) and postoperative fluid volume (OR = 1.8, 95% CI: 1.1-2.9, p = 0.02) as independent risk factors. Patients with complications had a longer hospital stay (12 vs. 7 days, p < 0.001). Conclusion: Excessive perioperative fluid administration is significantly associated with a higher risk of postoperative respiratory complications in patients with pulmonary disease. Careful, goal-directed fluid management strategies are essential to minimize the incidence of pneumonia, atelectasis, and ARDS, improving postoperative outcomes. Keywords: Perioperative fluid management, postoperative respiratory complications, pulmonary disease, pneumonia, acute respiratory distress syndrome, atelectasis.

Background: To assess the correlation of red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) in patients with left ventricular systolic dysfunction (LVSD) and acute ST-segment elevation myocardial infarction (STEMI). Materials and Methods: In this retrospective, hospital-based, observational study, 120 patients admitted with acute STEMI were consecutively included. All the patients underwent echocardiography for the assessment of left ventricle function (ejection fraction, systolic and diastolic functions, and regional wall motion abnormalities). Patients were divided into two groups based on the left ventricle systolic function (LVSD): left ventricle ejection fraction (LVEF)<50% and normal LVEF ≥50%. Hematological (hemoglobin, total leucocyte count, differential leukocyte count, RDW and NLR), renal (serum creatinine and serum urea), lipid parameters (triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein or very-low-density lipoprotein) were measured and their relationship with LVSD were studied. Results: The prevalence of LVSD in the study population was 40.8%. Triglyceride (232.35 ± 64.18 vs 187.75 ± 85.22; P=0.002), cholesterol (155.86 ± 23.57 vs 144.39 ± 26.40; P=0.016), VLDL (46.47 ± 12.84 vs 37.55 ± 17.04; P=0.002), and RDW (14.44 ± 0.64 vs 13.93 ± 1.03; P=0.003) were significantly higher in the LVSD group than the normal LVSD group. RDW was a significant predictor of LVSD at a cut-off of ≥14.05 [area under the curve (AUC): 0.644, 95% CI: 0.547-0.741, P=0.007), with 69.4% sensitivity and 53.5% specificity, while NLR was a non-significant predictor of LVSD (AUC: 0.527, 95% CI=0.421-0.633, P=0.614). Conclusion: The study showed that simple hematological parameters like RDW could be considered as additional markers to assess patients with STEMI. Keywords: Cholesterol; hematologic tests; LV dysfunction; trigylcerides; very low-density lipoproteins. Significance: Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are inflammatory markers and are used as a predictor in different cardiovascular settings. The study shows a significant difference in the RDW values between patients with LVSD and patients with normal LV function. Therefore, RDW could be used as an additional marker to assess patients with STEMI.

Background: External Quality Assessment Scheme (EQAS) involves evaluation of a number of laboratories by an outside agency on the performance of a number of laboratories based on their analytical performance of tests on samples supplied by the external agency. EQAS performance has been shown to reflect the quality of patient specimen testing in a clinical laboratory. Aim: To evaluate our performance in terms of the performance indicators (SDI, VIS) used by the EQAS body. Objective: The main purpose of EQA, beside monitoring and documenting the analytical quality is to identify poor performance to detect analytical errors, and to take corrective actions for the same. Materials and Methods: EQAS results (clinical chemistry, thyroid assay, Hba1c, Urrinary protein and microalbumin monthly programme from CMC–vellore l, for the period from 2016 to 2022 Mallareddy Viswavidyapeeth Deemed University Hyderabad. Results: The yearly summary is based on the overal VIS of 20 chemistry analyte for the study period July 2016 to 2018. 21 chemistry analytes from 2019 onwards. OMVIS of T.Bill was <50 % (excellent) and 48% of other chemistry analytes (very good OMVIS of 50 -100) in 2016 year. 55% in 2017 and 45% in 2018 year. 21 chemistry analytes of OMSDI (acceptable) 0.00-1.00 in 2019 was 60%,85 % in 2020 and 2021 and 65 % in 2022 year. In 2019 thyroid (OMSDI-acceptable 0.00-1.00) 75% in 2020,2021 and 2022. HbA1c (OMSDI-acceptable 0.00-1.00) in 2020 ,2021 and 2022. Discussion: The impact of EQAS apart from the standardisation process can also be immense in the post analytical phase steps by using the proper unit of measurement. Conclusion: significantly improve the quality of our laboratory practices along with good performances providing confidence in furnishing accurate test reports to the patients. Keyword: EQAS: External quality assessment scheme, SDI: standard deviation index, VIS: variance index score

Background: Gestational Diabetes Mellitus (GDM) is associated with increased risks of adverse maternal and fetal outcomes. This study aimed to evaluate these outcomes in pregnancies complicated by GDM. Materials and Methods: A retrospective cohort study was conducted on 100 pregnant women diagnosed with GDM. Maternal outcomes assessed included cesarean section rates, preeclampsia, postpartum hemorrhage, and preterm births. Fetal outcomes measured were birth weight, Apgar scores, neonatal hypoglycemia, and admission to the neonatal intensive care unit (NICU). Data analysis focused on determining the prevalence of these outcomes. Results: Of the 100 women, 45% underwent cesarean sections, while 12% developed preeclampsia, and 8% experienced postpartum hemorrhage. Preterm births occurred in 15% of cases. Among newborns, 22% were macrosomic, and 78% had normal birth weights. Apgar scores ≥7 at 5 minutes were observed in 92% of neonates. Neonatal hypoglycemia affected 18% of infants, and 10% required NICU admission. Comparatively, preterm deliveries had higher rates of cesarean sections (53%), neonatal hypoglycemia (40%), and NICU admissions (33%) than term deliveries. Conclusion: Pregnancies complicated by GDM were associated with increased maternal complications, including higher cesarean section rates and preeclampsia. Fetal outcomes demonstrated a higher prevalence of macrosomia, neonatal hypoglycemia, and NICU admissions, especially in preterm births. Early detection and comprehensive management of GDM are critical for improving both maternal and fetal health outcomes. Keywords: Gestational Diabetes Mellitus, maternal outcomes, fetal outcomes, cesarean section, preeclampsia, neonatal hypoglycemia, preterm birth.

Assessment tools are essential for evaluating nursing students' competencies, particularly in specialized fields like geriatric nursing. This study investigates the assessment tools used during geriatric practicum at selected Kenyan universities, revealing significant inconsistencies and a reliance on unstructured observational assessments. Only 20% of lecturers reported using standardized tools such as the Comprehensive Geriatric Assessment (CGA). These findings underscore the need for standardized evaluation methods to ensure consistency in measuring student competencies across institutions. Keywords: Geriatric nursing, assessment tools, practicum, nursing education, Kenya.

Background: Mental illness contributes significantly to the global disease burden, yet stigma and negative attitudes toward mental health patients persist, even among healthcare professionals. Non-psychiatric junior residents may lack adequate knowledge and hold stigmatizing attitudes, affecting their ability to refer patients for psychiatric care. This study aims to assess the knowledge and attitudes of non-psychiatric junior residents toward mental illness Materials and Methods: This cross-sectional study was conducted over a three-month period, targeting non-psychiatric junior residents from medical colleges across Andhra Pradesh, India. A total of 620 participants completed a questionnaire administered via Google Forms, including the Mental Health Knowledge Schedule (MAKS) and the Mental Illness Clinician’s Attitude Scale (MICA). Data were analyzed using SPSS version 21. Pearson's correlation coefficient was employed to explore the relationship between knowledge and attitudes toward mental illness. Results: The mean MICA score was 48±10.57, indicating negative attitudes toward mental illness. Unfavorable responses were noted in areas such as knowledge-seeking, disclosure of mental illness, and perceived danger posed by psychiatric patients. However, some positive attitudes were observed, such as willingness to work with mentally ill colleagues and belief in patient recovery. The mean MAKS score was 46.82±4.18, with a significant inverse correlation between knowledge and attitudes, suggesting that better knowledge was associated with more positive attitudes. Conclusion: Although knowledge about mental illness among non-psychiatric junior residents is relatively high, stigmatizing attitudes remain prevalent. This underscores the need for educational interventions to address negative attitudes and promote a better understanding of mental health among healthcare providers. Keywords: Mental illness, stigma, non-psychiatric residents, mental health knowledge, attitudes, education, psychiatry.

Background: Dengue is the most widespread Aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life- threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production. Material & Methods: The present study was a cross-sectional observational study which was conducted at private hospital in central India. The study was conducted in between July 2021- December 2023. The sample size for this study was 50. Results: The mean age in group 1 was 25±7, and in group 2 29±8. The mean Baseline PLT * 30X109 /L for group 1 was 57±23, and for group 2, 51±28. Mean of systolic baseline BP (mmHg) for group 1 was 103.55±5.04 and for group 2 was 105.38±18.34 followed by the mean of diastolic baseline BP (mmHg) was 72.83±6.56 and 72.84±12.93. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%). Conclusion: Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia. Keywords: Eltrombopag, Platelets (PLT), Dengue Fever (DF) and Dengue Haemoregic Fever (DHF).

Background: Postoperative respiratory complications are significant contributors to morbidity and mortality in patients undergoing general anesthesia. This study aimed to determine the incidence and identify the risk factors associated with postoperative respiratory complications in a cohort of patients undergoing general anesthesia at a government general hospital. Materials and Methods: A prospective observational study was conducted on 100 patients aged 18-75 years who underwent general anesthesia. Patient demographics, clinical characteristics, and surgical details were recorded. The incidence of postoperative respiratory complications and associated risk factors were analyzed using statistical methods, with significance set at P < 0.05. Results: The incidence of postoperative respiratory complications was 20%. The most common complications were atelectasis (8%), pneumonia (6%), acute respiratory distress syndrome (ARDS) (4%), and prolonged mechanical ventilation (2%). Significant risk factors included advanced age (mean age 55.8 ± 12.7 years in patients with complications, P < 0.01), smoking history (60% in patients with complications, P = 0.04), pre-existing respiratory disease (66.7%, P = 0.02), longer duration of surgery (mean 4.2 ± 1.3 hours, P < 0.01), and higher ASA physical status (ASA III or IV in 70%, P < 0.01). Patients with complications had a longer hospital stay (mean 12.5 ± 4.3 days, P < 0.01). Conclusion: The study highlights a 20% incidence of postoperative respiratory complications, with significant associations with age, smoking, pre-existing respiratory conditions, surgery duration, and ASA status. These findings underscore the need for enhanced perioperative management strategies to mitigate these risks. Keywords: Postoperative respiratory complications, general anesthesia, risk factors, incidence, atelectasis, pneumonia, ASA physical status, morbidity.

within the framework of Competency-Based Medical Education (CBME). Traditional faculty-led methods face challenges due to a shortage of experienced instructors and increasing student numbers. This study evaluates the effectiveness of faculty-guided, postgraduate-led bedside clinical skills training for undergraduate medical students. Material and Methods: A quasi-experimental, one-group pretest-post-test design was employed at SVS Medical College, involving 60 undergraduate medical students. Participants underwent a pre-test and a post-test using Objective Structured Clinical Examination (OSCE) scores, with student satisfaction assessed via a five-point Likert scale survey. Data analysis was performed using SPSS version 23. Results: Significant improvement in clinical skills was observed, with pretest mean scores rising from 2.87 ± 1.03 to 6.15 ± 0.55 (p < 0.005). Student perceptions indicated that 54.9% strongly agreed on the clarity of instruction, and 43.3% expressed satisfaction with the learning environment. Discussion: The findings demonstrate that faculty-guided, postgraduate-led instruction effectively enhances clinical competencies and fosters a supportive learning environment. This approach benefits both undergraduate students and postgraduate instructors, promoting collaborative learning.Conclusion: Faculty-guided, postgraduate-led bedside training significantly improves clinical skills among undergraduates, suggesting it as a viable model for medical education amidst resource constraints. Keywords: Clinical skills training, Competency-Based Medical Education, postgraduate-led instruction, undergraduate medical education, student satisfaction, Objective Structured Clinical Examination.

Background: Respiratory failure is classified into Type 1 (hypoxemic) and Type 2 (hypercapnic), each with distinct causes and presentations. Type 1 results from impaired oxygen transfer, while Type 2 stems from ineffective carbon dioxide clearance. This study explores etiological profiles and outcome in terms of mortality in a tertiary care hospital setting. Materials and Methods: This was a cross sectional study conducted in the department of respiratory medicine of a tertiary care medical institute. 60 patients with type I or type II respiratory failure were included in this study on the basis of a predefined inclusion and exclusion criteria. The duration of study was 18 months. A detailed history and through clinical examination was done in all the cases. Arterial blood gas analysis and other relevant investigations were done in all cases. Etiological profile and outcome in terms of mortality was deteminded in all cases. SPSS 22.0 software was used for statistical analysis and p value less than 0.05 was taken as statistically significant. Results: In this study of 60 patients with respiratory failure, 61.67% were male. Majority of the patients were between 51-60 age group. Type I respiratory failure was more common and was seen in 56.67% of cases, while Type II occurred in 43.33%. Chronic obstructive airway disease (16.67%) was the most common cause followed by pneumonia aspiration, and severe ARDS. The overall mortality rate was 18.33%, with sepsis and multiorgan dysfunction and postoperative respiratory failure showing the highest mortality (50%), while pneumonia had a 14.29 % mortality rate. Despite these challenges, 81.67% of patients were successfully discharged, with several conditions showing 100% survival rates. Conclusion: The most common primary etiological cause of respiratory failure was pneumonia followed by chronic obstructive airway disease. Overall mortality in cases of respiratory failure was 18.33% with highest mortality seen in cases of respiratory failure due to sepsis with multiorgan dysfunction and post-operative respiratory failure. Keywords: Respiratory Failure, Arterial Blood Gas analysis, Pneumonia, Multiorgan Dysfunction.

Background: To study and compare the analgesic efficacy of oral Gabapentin and oral Pregabalin for postoperative pain in patients undergoing abdominal hysterectomy and to assess the incidence of adverse effects of Gabapentin and Pregabalin. Materials and Methods: This is a cross sectional study to compare the effects of pregabalin and gabapentin, as pre-emptive medication before abdominal hysterectomy, for post-operative analgesia. In this study 60 patients undergoing abdominal hysterectomy surgery under spinal anaesthesia were randomized and divided into 2 groups, Group P and Group G. Postoperatively patients were monitored for pain scores by VAS scale, total analgesic requirement, and side effects up to 24 hours. The data obtained was analyzed. Results: Group P patients received 300mg tablets of Pregabalin orally, Group G received 900mg tablets of Gabapentin two hours before surgery. Standard anaesthetic technique was followed in all patients. Patients were observed at 0 hr,2,4,8,12 and 24 hrs post-surgery. Post-operative pain scores (VAS Score) were significantly less in Group P compared to Group G patients. Time of first rescue analgesic was significantly prolonged in Group P patients (178.80 ± 12.53 mins) compared to Group G (168.90 ± 15.40 mins). Mean Tramadol dose (mg) in Gabapentin Group was 263.33 ± 31.984 and in Pregabalin Group was 245.00 ± 37.943. There was significant difference in mean Tramadol dose comparison between two groups. Gabapentin group required higher Tramadol compared to Pregabalin group. The incidence of side effects like nausea, vomiting, dizziness was found to statistically not significant between the two groups. There was no significant difference between the sedation scores between the Group P and Group G patients. Conclusion: Pregabalin (300mg) provides prolonged pain relief compared to Gabapentin(900mg) in the post-operative period. Pregabalin is found to have superior efficacy with respect to quality and duration of analgesia. Keywords: Gabapentin, Pregabalin, Post-Operative Pain.

Background: Distal radius fractures are among the most common fractures, particularly in older adults. Treatment options vary depending on the severity and displacement of the fracture. While conservative management like closed reduction and casting may suffice for simple fractures, surgical intervention is often required for complex fractures. Two common surgical techniques include external fixation using a Solapur frame and percutaneous pinning with K-wires. The aim of this randomized controlled trial was to investigate the functional and radiological outcomes of distal radius fractures treated with Solapur frame fixation versus percutaneous pinning using five K-wires. Materials and Methods: Thirty patients with distal radius fractures that failed closed reduction and casting were randomized into two groups. Surgeons chose between Solapur frame fixation and K-wire pinning. Outcomes were evaluated preoperatively, and at 6 weeks, 3, 6, and 12 months, using the Lyon Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, range of motion, grip strength, and serial radiographic analysis. Generalized linear modeling with repeated measures was used to assess differences in outcomes between the two groups. Results: There were no significant differences in demographic characteristics or fracture severity between groups. Generalized linear modeling showed that K-wire pinning had better outcomes, with patients scoring an average of 11 points lower on the PRWE compared to the Solapur frame group. External fixation was associated with higher pain and disability at 6 weeks and 3 months. Volar locking plates provided significantly better outcomes than both external fixation and dorsal plating (15-point advantage in PRWE scores). Conclusion: Volar locking plates showed superior early postoperative results, with overall recovery equalizing at 1 year. External fixation was associated with more severe preoperative injuries and higher disability early in recovery. Keywords: distal radius fracture, Solapur frame, K-wire pinning, randomized controlled trial, volar locking plates, PRWE score, functional outcome, external fixation.

Background: Maternal mortality remains a critical issue, reflecting the effectiveness of obstetric care and healthcare systems. This study aims to analyze maternal mortality trends, causes, and contributing factors over a 11-year period at MGM and MTH Hospital, Indore. Materials and Methods: A retrospective analysis was performed on hospital records and death summaries for all maternal deaths at MGM and MTH Hospital from January 2013 to December 2023. Data collected included maternal age, parity, booking status, delivery status, residence, referral history, socioeconomic class, admission-to-death interval, and cause of death. Maternal deaths were classified according to the WHO’s International Classification of Diseases, 10th Revision (ICD-10), into direct and indirect obstetric causes. Results: Out of 1,75,128 deliveries, there were 1194 maternal deaths, yielding a Maternal Mortality Ratio (MMR) ranging from 1917.3 to 602, with an average of 960.5 per 100,000 live births. The majority of deaths (59.9%) were referred from peripheral health centers, often arriving with severe complications. The causes of death included direct obstetric causes (64.8%), such as hypertensive disorders, obstetric hemorrhage, and thromboembolism, and indirect causes (27.3%), including severe anemia, jaundice, and heart disease. The most frequent deaths occurred during the postnatal period (517 cases), with significant mortality linked to medical interventions and complications. Conclusion: The study highlights critical areas for improvement in maternal care, including the need for timely referrals, enhanced critical care facilities, and better management of anemia and safe abortion services. Addressing these issues could significantly reduce maternal mortality and improve outcomes for pregnant women. Keywords: Maternal mortality rate (MMR), Indore, Referral cases, Hypertensive disorders, Obstetric hemorrhage, Direct and indirect causes.

Background: Surgical site infection (SSI) after an orthopaedic surgery is devastating for both the patient and surgeon. Use of strict aseptic measures and administration of prophylactic intravenous antibiotics to the patient prior to the surgery and in the post-operative period are the most common measure taken by surgeons to prevent SSI. However, there is no clarity regarding the optimal duration of the antibiotic prophylaxis required. In order to err on the side of caution, surgeons keep patients on a long duration of antibiotic prophylaxis which is prudent but leads to increased cost of treatment and poor patient compliance. That is why, in our study, we compared the short-term vs long-term antibiotic prophylaxis for prevention of SSI. Materials and Methods: Patients with age > 13 years undergoing orthopaedic surgery were randomly divided in to 2 groups. Both groups received IV antibiotics 30 minutes before the time of incision followed by two further prophylactic IV antibiotic dose. The 2nd group received additional oral antibiotics 12 hourly over the next 4 days. Results: Among the 113 patients enrolled, 59 patients received antibiotic prophylaxis for short term while 54 patients got long-term prophylaxis. Comparison between the two groups was done by calculating SH score. Among 59 patients who received 3 prophylactic IV antibiotics only 2 patients developed SSI at a rate of 3.4 % while 54 patients who receive additional oral antibiotics got infected with a rate of 3.7 %. The rate of infection was similar for both the groups. Conclusion: The study shows that there is no significant difference in rate of infection at the post-operative surgical site with short term antibiotic prophylaxis as compared to long-term prophylaxis. Hence, short term prophylaxis can be preferred over long-term prophylaxis as it results in reduced risk of Antibiotic resistance, increased patient compliance and cost effectiveness. Keywords: Surgical site infections, Orthopaedic surgery, Traumatology

Background: The transversus abdominis plane (TAP) block has gained popularity for providing analgesia after abdominal wall surgeries since Rafi introduced it as a landmark technique in 2001. TAP blocks can be performed using ultrasound guidance or placed directly by the surgeon at the end of surgery. With the increasing use of ultrasound in operating rooms, TAP blocks are more frequently utilized in abdominal surgeries. Surgeons can visualize the plane between the internal oblique and transversus abdominis muscles, allowing them to place catheters through the open surgical site into this plane. Materials and Methods: This study was conducted in Department of Anaesthesia at tertiary care facility in Maharashtra University of Health Sciences Pune. This study was done from the period of Nov 2016 to Dec 2018.All ASA grade I to III children between 0 to 10 years of age undergoing upper abdominal surgery after written informed consent. This study was included 19 patients for both group ie ultrasound guided TAP block or surgeon administered TAP block. Results: The results showed a significant difference, with a p-value of less than 0.05, indicating that catheter placement by the surgeon took less time than the ultrasound-guided approach, which consequently affected total operating room time. Parent satisfaction regarding pain relief for their children was consistent across both techniques. Conclusion: This study concludes that, by evaluating operative time, complications, and parent satisfaction, we found that the surgeon performed TAP block is a relatively new tech which has immense potential as it can save time; result in more accuracy and success of the block. Keywords: Ultrasound-Guided TAP Block, Surgeon-Administered TAP Block, Pain score, Abdominal Surgery.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a persistent global health concern due to its role in hospital-acquired infections (HAIs) and its resistance to commonly used antibiotics, particularly beta-lactams. The emergence of MRSA clones in healthcare settings presents a significant challenge to infection control, leading to high morbidity, mortality, and increased healthcare costs. Purpose: This observational study explores the molecular epidemiology of MRSA within a tertiary care hospital, identifying the prevalent MRSA strains, molecular characteristics, and potential risk factors associated with colonization and infection. Materials and Methods: A cross-sectional observational study was conducted over one year at a tertiary care hospital. Clinical specimens were obtained from patients with suspected MRSA infections across various wards. Standard microbiological methods confirmed MRSA presence. Molecular typing, including pulsed-field gel electrophoresis (PFGE) and staphylococcal cassette chromosome mec (SCCmec) typing, was performed to identify genetic relationships between strains. STROBE guidelines were strictly adhered to in designing and reporting the study. Antibiotic susceptibility testing was conducted using the Kirby-Bauer disk diffusion method. Results: Of the 500 clinical specimens collected, 150 were identified as MRSA-positive. Molecular analysis revealed three dominant MRSA clones circulating within the hospital, with SCCmec type IV accounting for the majority of isolates. Prolonged hospitalization, antibiotic use, and ICU admissions emerged as significant risk factors for MRSA acquisition. All isolates exhibited high resistance to commonly used antibiotics, with 100% susceptibility to vancomycin. Conclusion: This study underscores the importance of continuous molecular surveillance of MRSA to control its spread in healthcare settings. Identifying dominant clones and associated risk factors is vital for tailoring infection control measures and optimizing antibiotic stewardship. Keywords: molecular epidemiology, Methicillin-Resistant, Staphylococcus Aureus, Treatment Measures.

Background: The sex and age determination are crucial elements in anthropology and forensic medicine. To determine the age and sex of a person; many statistical methods were developed by using various bone fragments. The femur is the longest bone and it is believed that age variations in this bone with a method can be used in both living and deceased. Aim: to study the morphometric analysis of human femora. Materials and Methods: 50 dry human femora of unknown sex were collected from Department of Anatomy, Kurnool Medical College, Kurnool and different Medical Institutions. The morphometric parameters like maximum length of femur, epicondylar breadth and antero-posterior diameter of midshaft of femora was measured. Results: The maximum length of the femur varies from a minimum of 375 mm to maximum of 475 mm with a mean value of 419.42 mm. The epicondylar breadth of femur varies from a minimum of 66mm to maximum of 91 mm with a mean value of 75.98mm. Middle antero-posterior diameter of femur varies from minimum of 23mm to maximum of 38mm with a mean value of 30.66mm noted in the present study. Conclusion: Individual parameter contributes certain percentage of certainty to decide the sex of unknown femur. Morphometric parameters of the present study to be considered together for the purpose of sex determination of femur to acknowledge its importance. Keywords: Epicondylar, midshaft, maximum length.

Background: Placental MRI and Doppler ultrasound play crucial roles in the risk stratification of high-risk pregnancies, particularly in the context of intrauterine growth restriction (IUGR). Placental Doppler assessments, including measurements of the umbilical artery and middle cerebral artery, provide vital information regarding placental blood flow and fetal well-being, allowing clinicians to identify fetuses at risk for adverse outcomes. MRI offers a complementary approach by providing detailed morphological and functional insights into the placenta, such as changes in thickness, volume, and the presence of lesions, which may not be visible on ultrasound. The integration of both imaging modalities enhances the accuracy of diagnosing placental insufficiency and stratifying the risk of complications in high-risk pregnancies. Materials and Methods: This prospective study was conducted in the Department of Radio-diagnosis over 1-year period. The study included 100 antenatal mothers who were evaluated for fetal growth restriction using ultrasound examination and placental MRI. Results: 64% of the patients were between 29-34 weeks of gestational age. 15% had weight percentile between 5th – 10th and 25% had below 5th percentile of weight according to the gestational age. Presence of co-morbid conditions such as hypertension, diabetes, cardiac illness was associated with higher prevalence of IUGR. Uterine artery and umbilical artery anomalies were more commonly seen in severe IUGR. The Doppler indices were significantly higher in fetuses with restricted growth. Most of the T2 weighed placental images in fetuses with restricted growth were heterogenous and hyperdense. Conclusion: Placental MRI is used in evaluating placental signal intensity ratios and correlating these with fetal morbidity and mortality, highlighting its potential as a diagnostic tool in managing IUGR and improving maternal-fetal outcomes. Keywords: High risk pregnancy, fetal growth restriction, placental MRI, fetal Doppler.

Background: Ultrasonography is a safe, fast, inexpensive, popular, cost- effective, repeatable, non-invasive procedure for investigating thyroid gland and is also a helpful guide for F.N.A.C. Color assisted duplex sonography also helps in accurate estimation of thyroid volume. Aim: To study validity of ultrasonographic diagnosis in relation to Fine Needle Aspiration Cytology (FNAC) diagnosis. Materials and Methods: Cross section study was conducted from June 2023 to May 2024. Based on the inclusion and exclusion criteria, 70 cases of thyroid nodules diagnosed by ultrasound were included in the study. The ultrasound examination was done in the department of Radiology, Rajeev Gandhi Institute of Medical Sciences, Adilabad. These 70 cases which were found to have thyroid nodules on ultrasound were subjected to FNAC for confirmation of ultrasound finding and establishment of final diagnosis. Results: The disorders of thyroid gland are most common in female population compared to male population. Maximum number of patients in our study were encountered in the age group of 31-40 (41%) and 41-50 (25.7%). Patients of solitary thyroid nodule formed the largest proportion of the cases in our study and ultrasound was able to depict successfully solitary thyroid nodule, colloid cyst and multinodularity in our study. In comparison, to other studies our study gave a similar picture in terms of benign lesions being much more common than malignant lesions. In comparision to other studies, we were able to detect malignant nodules with better specificity. The most common benign lesion determined in our study was adenomatous nodules which was the most common benign lesion in many other studies. Ultrasound was able to detect micro calcification in 4 cases and lymph node invasion in 6 cases of our study group which were diagnosed as carcinomatous lesion. On HPE there turned out to be 4 cases of papillary carcinoma, 2 follicular and medullary carcinoma 1 case which was diagnosed as multinodular goiter with degenerative changes turned out to be papillary carcinoma. Conclusion: Ultrasound clearly helps to differentiate between micro and macro calcification and lymphnode involvement. Micro calcification and lymph node involvement are most commonly seen in most of thyroid carcinoma Being a safe, simple, repeatable and without radiation exposure to the patient, it is worthy of being included in routine diagnostic work up. Keywords: Seasonal influenza, vaccination, hospitalization, high-risk populations, FNAC, Thyroid, Multinodular, Papillary Carcinoma, USG.

Background: Iodine deficiency in the postpartum period has the potential to affect neonatal neuropsychointellectual development. In the neonatal period, milk is the only source of iodine. Urinary iodine estimation has been the traditional definitive method for assessment of iodine status in a population including that of neonates. Material and Methods: A total of 57 mothers and their neonates were included in the study. During their third trimester outpatient visit, 5 mL random spot urine samples were collected. After childbirth, approximately 5 ml of manually expressed breast milk samples were collected from the same mothers. Within first 28 days of birth, random urine samples were collected from the neonates. Subsequently the maternal urinary iodine, maternal breastmilk iodine & the neonatal urinary iodine were estimated. Results: The mean maternal urinary iodine level was 157.7±81.56 mcg/L. The mean maternal breast milk iodine levels were 204.5±113.65 mcg/L. The mean neonatal urinary iodine levels were 157.7±81.56mcg/L. There was a significantly positive correlation between maternal urinary iodine and maternal breastmilk iodine (r=0.860;p<0.001). A positive correlation was found between maternal urinary iodine secretion and neonatal urinary iodine secretion (r=0.608, p<0.001). There was a significant positive correlation between Breastmilk iodine and neonatal urinary iodine levels (r=0.567; p<0.001). Conclusion: It was concluded that women who had deficient urinary iodine had low breastmilk iodine levels and like urinary iodine, breastmilk iodine can serve as a proxy marker for thyroid hormone status of the body. Breastfed neonatal iodine status parallels their maternal iodine status and thus their maternal thyroid status since urinary iodine is a marker of thyroid hormonal status. Key Words: Breast milk iodine levels, maternal urinary iodine levels, neonatal urinary iodine levels.

Background: Carotid endarterectomy is the most effective treatment for reducing the risk of stroke in patients with significant carotid stenosis and can be performed under General anaesthesia or Regional anaesthesia. The comorbidities of these patients combined with peri-operative hemodynamic goals pose unique anaesthesia challenges. Aims: To determine the in hospital neurological complications after carotid endarterectomy and its associated risk predictors in patients operated under general and regional anaesthesia. Materials and Methods: This is an observational study conducted in patients who underwent carotid revascularization through carotid endarterectomy. In-hospital neurological complications, focusing on transient ischemic attacks, major and minor strokes, and cranial nerve injuries, with associated risk predictors under general and regional anaesthesia were assessed. Results: Findings showed postoperative events in 25% of patients, including strokes (10%) and nerve injuries (15%). Major strokes occurred in those under general anaesthesia (10%), while nerve injuries were more prevalent under regional anaesthesia (66.7%). Prolonged clamp time correlated with neurological events (p-value 0.056). Preoperative neurological deficits (p-value 0.02), diabetes (p value 0.01), hyperlipidemia (p value 0.01), use of tobacco (p value 0.01), history of coronary artery disease (p value 0.03) were independent risk factors. Conclusion: CEA remains the gold standard, but proactive screening and risk factor management are crucial. General anaesthesia was linked to major strokes, while regional anaesthesia correlated with more cranial nerve injuries. The choice between regional and general anaesthesia remains debatable and one should consider surgeon, anaesthetist and patient preferences, satisfaction, and hospital conditions for the same. Keywords: Carotid endarterectomy, Carotid stenosis, Neurological deficits.

Background: Caesarean sections are one of the most common surgical procedures in obstetrics, and optimal wound closure techniques are crucial for minimizing complications and improving cosmetic outcomes. This comparative study evaluates two skin suturing methods—subcuticular and interrupted suturing—used in repeat Caesarean sections, aiming to assess their impact on scar appearance, post-operative complications, and patient satisfaction. Aim: A Comparative Study to Assess Two Methods of Skin Scar Suturing in Previous Caesarean Section. Material and Methods: A total of 120 patients were randomized into two groups, and outcomes were assessed at 6 weeks post-surgery using the Vancouver Scar Scale (VSS) and a patient satisfaction survey. Results: Group A (subcuticular suturing) had a significantly shorter closure time (7.2 minutes) compared to Group B (11.3 minutes), indicating the efficiency of the continuous suturing method. While post-operative complications were slightly lower in Group A, the differences were not statistically significant. Scar appearance, assessed using the Vancouver Scar Scale, was significantly better in Group A, with lower scores for pigmentation, height, and vascularity. Patient satisfaction was also significantly higher in Group A, with most patients rating their experience as "very satisfied" due to better cosmetic outcomes and fewer post-operative issues. Conclusion: The study concludes that subcuticular suturing should be the preferred method for skin closure in caesarean sections due to its aesthetic and clinical benefits. Future research should include longer follow-up periods to assess long-term scar quality and complications. Key Words: Caesarean section, Skin closure techniques, Subcuticular suturing, Interrupted suturing, Absorbable sutures, non-absorbable sutures, Scar healing.

Background: Diabetes Mellitus, a chronic disease once thought to be uncommon in the developing world, has emerged as an important public health problem. Diabetes is one of the most common non communicable diseases prevalent globally. The rise is associated with economic development, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and changes in other lifestyle patterns. State transport Employees job is stressful because of long hours of stressful travel, irregular eating habits, sleepless nights, shift duties, stresses and overtime working and working on Sunday’s and holidays. Occupational stress can alter blood glucose level in an undesirable manner and can affect the management of dysglycemia and its complication. Aim & Objective: 1. To find out the prevalence of diabetes mellitus in state transport employees. 2. To study the associated risk factors for diabetes mellitus in state transport employees. Materials and Methods: A Cross-Sectional Descriptive study was undertaken in State transport employees at State Transport Bus depot Ambajogai dist. Beed from June 2016 to December 2016 in 327 employees. Results: Results & Conclusion- The overall prevalence of Type 2 Diabetes Mellitus among employees working at State Transport depot employees was 7.34%. Factors like Family history, level of physical activity, Body Mass Index ≥ were found to be significantly associated with Type 2 Diabetes Mellitus. Keywords: Diabetes Mellitus, State, Transport, Employees.

Background: The increasing incidence of overweight and obesity is a major public health concern worldwide. One of the most significant consequences of the obesity epidemic is the rise of metabolic syndrome, a cluster of interrelated metabolic abnormalities that significantly increases the risk of cardiovascular diseases. Though cardiovascular consequences of metabolic syndrome is well known, its effect on lung functions is not fully understood. This study aims to analyse the effects of metabolic syndrome on lung function tests and compare them with healthy individuals. Materials and Methods: This was a case control study conducted in the department of physiology of a tertiary care medical institute. 40 patients fulfilling the criteria for metabolic syndrome were included in this study. 40 healthy individuals with normal body mass index (18.5 and 24.9) were included in this study as control group. Lung function paramaters such as Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC) and The ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC) were determined and compared between both the groups. Results: Lung function parameters, including FEV1, FVC, and FEV1/FVC ratio, were significantly lower in individuals with metabolic syndrome compared to healthy individuals, with all differences being statistically highly significant (p < 0.0001). Respiratory parameters FEV1 and FVC showed negative correlations with systolic and diastolic blood pressure, fasting blood sugar, triglycerides, and waist circumference in individuals with metabolic syndrome, indicating that higher values of these variables were associated with lower lung function. In contrast, HDL cholesterol exhibited a slight positive correlation with FEV1 and FVC, suggesting a beneficial effect on respiratory function. Conclusion: Individuals with metabolic syndrome exhibit significantly reduced lung functions underscoring the adverse effects of metabolic syndrome on respiratory functions. Keywords: Metabolic syndrome, Lung function test, Forced Vital Capacity, Central Obesity.

Background: Human immunodeficiency virus (HIV) is a virus that targets body’s immune system reducing person’s ability to fight off infections. More older people living with HIV (OPLHIV) are living beyond the age of 60 due to the significant extension of life expectancy resulting from HIV treatments. The highest percentage of OPLHIV is seen in low- and middle-income countries (LMIC), and by 2030, this percentage will have more than doubled. Multiple chronic diseases or conditions known to cause by HIV due to chronic inflammation, the use of multiple medications, changes in physical and cognitive abilities, increased vulnerability to stressors, substance abuse, depression, lower education line, financial barriers to treatment adherence pose a great challenge especially among elderly population. Late diagnosis and delay in starting the treatment among them lead to poorer prognoses and shorter survival even after an HIV diagnosis. Till date, there are no guidelines available to specifically address the needs of the elderly HIV infected patient. The present work was conducted to study the Socio demographic, Clinical, Immunological and Virological profile of Elderly HIV patients. Materials and Methods: This hospital based cross-sectional study enrolled 130 HIV positive patients of 60 years and above, admitted in Medicine ward, attending Medicine OPD, Center of Excellence (Coe)ART Centre, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur (RIMS) for a period of 2 years from May 2022 to July 2024 after informed consent. Routine investigations- Complete blood count, liver function test, kidney function test, urine routine examination, X ray chest, ECG were done as per NACO guidelines.CD4 count, and plasma viral load at baseline and at enrolment were documented for immunological monitoring. SPSS (Statistical Package for the Social Sciences software) V. 26 was used for statistical analysis. A P value of <0.05 was taken as significant. Results: The participants in the present study exhibited an average age of 62.71 years (SD ± 4.79), with a majority being male (95,73.07%). Heterosexual transmission was predominant (53.85%).Most participants were Hindu (47.69%), married (73.08%), and predominantly from the lower-middle socio-economic class (46.15%). According to WHO Clinical stages, Stage 1 comprising the majority at 64.62%, followed by Stage 2 at 20.00%, Stage 3 at 10.77%, and Stage 4 at 4.62% in the study. After enrolment, there was statistically significant (p<0.001) increase in mean CD4 count from 92 cells/mm³ at baseline to 639 cells/mm³, suggesting ART efficacy and marked decrease in viral load from a mean of 126,235.61 copies/ml to 2018.39 copies/ml. Notable levels of abnormal SGOT (20%) and SGPT (15%) enzymes also seen in the present study. The study underscores ART's effectiveness in enhancing CD4 counts and reducing viral loads in older HIV patients. Conclusion: The study concludes that there is significant improvement in CD4 count and viral load after ART initiation in older patients. Keywords: HIV/AIDS, ART, CD4 count, viral load, elderly.

Background: Abnormal Uterine Bleeding is one of the most common’ and challenging ‘problems in’ gynecological cases ‘in the’ country. ‘The PALM-COEIN system helps to ascertain the role of multiple pathologies in’ patients with AUB. The accuracy of etiological diagnosis is important for subsequent therapeutic management. Hence, ‘the purpose of this study was to’ analyze and identify the exact ‘etiological factors ‘for ‘abnormal uterine bleeding according to’ the ‘PALM COEIN classification’ so that exact diagnosis leads to correct treatment. Materials and Methods: A total of 125 women with AUB’ from menarche to menopause were studied. ‘A detailed history was obtained and a thorough’ physical’ examination’, per abdomen and vaginal examination were carried out. All routine investigations, pap smear screening, and Ultrasonography were done. An endometrial biopsy or hysterectomy specimen was taken if needed. Results: The mean age of cases was’ 41.58 ± ‘7.4 years with a mean BMI of’ 23.09 ± 2.69 kg/m2. The most common associated symptom was pain abdomen (59.2%) and the most common associated risk factor was hypertension (9.6%). Fibroid uterus (54.4%) was the most common finding on Ultrasonography and on examining endometrial thickness on ultrasound, maximum cases (29.6%) had endometrial thickness between 5-8 mm. According to ‘the PALM COEIN classification. AUB-L’ or Leiomyoma (52%) ‘was the most ‘commonly assigned category in cases followed by AUB-A or adenomyosis (24.8 %). Conclusion: The present study’ concluded that ‘AUB- L was the most common’ etiological factor contributing to’ abnormal uterine bleeding’. Pain abdomen’ is a common’ symptom associated with heavy menstrual bleeding and fibroid uterus is a common cause for AUB. Keywords: AUB, PALM-COEIN, OBG.

Background: Central Serous Chorioretinopathy (CSR) is a retinal disorder characterized by the accumulation of subretinal fluid and can significantly impact vision. The condition's management and outcomes vary with treatment approaches and patient demographics. This study aimed to evaluate the efficacy of laser treatment in CSR and analyze the associated risk factors, patient demographics, and visual outcomes. Materials and Methods: This randomized controlled trial was conducted at a tertiary care hospital. Sixty patients with CSR, meeting specific inclusion and exclusion criteria, were enrolled. Patients were randomly assigned to receive either laser treatment or were placed in a control group. The study involved baseline, 4-week, and 12-week assessments of central macular thickness (CMT) and best-corrected visual acuity (BCVA) using optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Risk factors and demographic data were collected through comprehensive patient history. Results: At baseline, the mean CMT for the control group was 414.6 ± 83.47 μm, while the laser group had a mean of 422.3 ± 92.36 μm (p = 0.736). At 4 weeks, the laser group showed a significant reduction in CMT (257.97 ± 63.61 μm) compared to the control group (309.83 ± 47.71 μm, p = 0.001). At 12 weeks, CMT further decreased in the laser group (215.10 ± 22.08 μm) versus the control group (260.57 ± 38.07 μm, p = 0.000). BCVA also improved significantly in the laser group at both 4 weeks and 12 weeks. Risk factors identified included recent mental stress (38.3%), type A personality (28.3%), and smoking (26.7%). Systemic steroid use was notably linked to bilateral CSR. Conclusion: Laser treatment for CSR significantly reduces central macular thickness and improves visual acuity compared to the control group, with no adverse effects reported. The study underscores the role of managing modifiable risk factors such as stress and steroid use to optimize treatment outcomes in CSR. Keywords: Central Serous Chorioretinopathy, Laser Treatment, Central Macular Thickness, Best-Corrected Visual Acuity, Optical Coherence Tomography.

Background: Nephrotic syndrome is a commonest glomerular disorders in children. Hyperlipidemia is observed during the active phase of the illness and can contribute to atherosclerosis and renal damage. Objectives: To assess the severity and duration of serum lipids abnormalities and their potential as predictor of relapse in childhood nephrotic syndrome. Materials and Methods: Prospective study, conducted in Pediatric Department, Govt. TD Medical college, Alappuzha, included 30 children, aged between 1-12 years. Results: In our study the mean cholesterol and Triglyceride level at admission was high but by the end of 24 weeks Cholesterol and Triglyceride levels were found to be normal. Elevated cholesterol was notably persistent in relapsers. Conclusion: There is no persistent hyperlipidemia in NS at 24 weeks in both first episode and relapse. Elevated cholesterol levels at 6 and 12 weeks were significantly associated with relapse risk. Routine hyperlipidemia treatment is not warranted, but close monitoring and possible extended steroid therapy for high-risk children are recommended. Keywords: Hypercholesterolemia; Dyslipidemia; Nephrotic syndrome; MCNS.

Background: Sensorineural hearing loss (SNHL) is an underappreciated complication in patients with chronic renal failure (CRF). Given the similar pathophysiological mechanisms shared by the kidneys and the auditory system, CRF may contribute to auditory dysfunction. This study aims to assess the prevalence, severity, and associated risk factors for SNHL in CRF patients, particularly focusing on the role of hemodialysis. Materials and Methods: A prospective study was conducted with 100 CRF patients attending to Government general Hospital, Kakinada during a period of 18months from February 2023 to August 2024. Audiometric testing was performed to evaluate SNHL, while data on demographics, renal failure duration, hemodialysis use, and comorbidities were collected. Statistical analysis identified significant predictors of SNHL. Results: SNHL was detected in 56% of patients, with 30% showing mild hearing loss, 16% moderate, and 10% severe or profound hearing loss. Hemodialysis and longer duration of renal failure were significantly associated with higher prevalence of SNHL. Age and dialysis emerged as independent predictors of hearing loss severity. Conclusion: Sensorineural hearing loss is prevalent among CRF patients, especially those on hemodialysis. Regular audiometric screening should be integrated into the management of CRF patients to facilitate early diagnosis and intervention. Keywords: Hemodialysis, SNHL

Background: It is evident that burden of cancer is rising in India. The objective of this study is to estimate the overall population level prevalence of self-reported cancer, its determinants and utilization of health care services among the older adults by the place of residence. Material and Methods: This paper presents the secondary data analysis, using Longitudinal Ageing Study in India (LASI) wave 1 of 2017-18. Data of adults aged ≥ 45 years (60,643 participants) were included in this study for analysis. Results: The overall prevalence of self-reported cancer among older adult was 0.6%. Prevalence was higher among adults above ≥ 60 years (53.7%) of age, compared to adults aged 45-59 years (46.27%). Females had a higher prevalence of cancer (62.72%). Logistic regression analysis found that, overall, Odds Ratio(OR) was higher among for older adults who smoked more than 25 tobacco products per day, residing in urban area [OR=11.47 (1.18 - 111.17), p=<0.05] and among adults who reported family history of cancer in first degree relatives i.e. father [OR=3.70 (2.41- 5.69), p=<0.001] and mother [OR=1.48 (0.81 - 2.72), p=0.21], compared to those who did not have such history. Both in rural and urban areas older adults preferred private health facilities for cancer care services. Conclusion: The prevalence of self-reported cancer was low, varied across states and by place of residence. Smoking tobacco in high doses, and family history of cancer in first degree relatives was significantly associated with cancer, such individuals should be prioritized for cancer screening. Keywords: Cancer, Older adults, Non-Communicable Disease, India, Risk Factors.

Background: Neonates admitted to the Neonatal Intensive Care Unit (NICU) are frequently subjected to painful procedures such as heel pricks, vaccinations, and blood sampling. Effective pain management is essential to prevent long-term developmental and physiological consequences, including alterations in stress response and hypersensitivity to future pain. Pharmacological options for pain relief are limited in this population due to concerns about side effects and toxicity. Non-pharmacological methods, including sucrose administration, non-nutritive sucking (NNS), and facilitated tucking (FT), have gained attention for their safety and efficacy in managing procedural pain in neonates. Materials and Methods: This randomized placebo-controlled trial was conducted at Pragna Children's Hospital NICU in Hyderabad over two years (December 2017 to April 2020). Neonates requiring a heel prick for blood glucose measurement, preterm neonates (>32 weeks), and term neonates with a birth weight over 1500 grams were included. Exclusion criteria comprised infants older than 28 days, those with congenital anomalies, cardiovascular instability, or on ventilator support. A total of 100 participants were randomized into two groups: Group 1 received 24% sucrose, NNS, and FT, while Group 2 received sterile water, NNS, and FT. Primary outcomes were measured using the Premature Infant Pain Profile (PIPP) score, and secondary outcomes included cry duration and adverse events. Data analysis was performed using IBM SPSS version 22, with statistical significance set at p < 0.05. Results: The combination of 24% sucrose, NNS, and FT significantly reduced PIPP scores compared to sterile water, NNS, and FT. Specifically, PIPP scores were lower in the sucrose + NNS + FT group (moderate preterm: 1.25, late preterm: 2.88) compared to the sterile water group (moderate preterm: 4.2, late preterm: 6.15). Crying duration was also significantly shorter in the sucrose group (mean: 1.57 seconds) compared to the sterile water group (mean: 6.33 seconds). No significant differences were observed in adverse events between groups, with only minor events reported. Conclusion: The study concludes that the combination of 24% sucrose, non-nutritive sucking, and facilitated tucking is effective in reducing pain during heel prick procedures in neonates, with minimal adverse effects. This supports the use of sucrose in conjunction with other non-pharmacological techniques for managing procedural pain in neonates. Keywords: Neonatal pain management, sucrose, non-nutritive sucking, facilitated tucking, heel prick, Premature Infant Pain Profile (PIPP), NICU.

Background: Air pollution impacts human health, the environment, and even the global climate with health effects ranging from respiratory illnesses and cardiovascular problems to asthma and even premature death. Materials and Methods: community based cross sectional study was conducted in slum area/resettlement colonies of Gokal Puri, New Delhi by systematic random sampling procedure. A predesigned, pretested, semi-structured questionnaire was used for the community survey. Results: Construction and garbage related pollution are the most commonly reported sources of household pollution. A majority (61.72%) of respondents take precautions based on air quality advisories, such as staying indoors or using masks, reflecting a proactive approach to managing air pollution risks. Conclusion: Health care system is increasingly strained and thus, additional burden due to rising air pollution needs to be prevented by making people aware about the methods of reducing air pollution.. Keywords: Public Health, Personal Protective Interventions, Pollution

Background: Post-operative discomfort secondary to pain can be extremely annoying for both child and their parents, necessitating the excessive use of opioids and NSAIDS which carries numerous undesirable effects. Addition of an adjuvant like midazolam to bupivacaine injected into the caudal space could prolong post-operative analgesia with minimal side effects. The purpose of this study is to compare the efficacy and safety of combination of preservative free midazolam (50 microgram per kg) with 0.25 % bupivacaine vs plain 0.25% bupivacaine into the caudal epidural space for providing postoperative pain relief in children undergoing elective lower abdominal surgeries. Materials and Methods: This is a prospective randomized case control study carried out on 60 children between 2 to 8years of age belonging to American society of anaesthesiologist (ASA)Grade I and II undergoing lower abdominal surgeries under standardized general anaesthesia. Children recruited in the study were randomly allocated into two groups namely, GROUP-B and Group-BM. Children in Froup B received caudal block with 1 ml per kg of plain 0.25% heavy bupivacaine, while those recruited to Group BM received caudal block with 1 ml per kg of 0.25% heavy bupivacaine with 50 microgram per kg of preservative free midazolam. All children were continuously observed in recovery room for two hours after which they are shifted to recovery room. Afterward, the FLACC pain score, Ramsay sedation score and vitals were recorded at regular intervals for up to 24 hours post-surgery. Results: In the immediate postoperative period, the FLACC pain scores in both the groups were initially comparable for first one-hour, Thereafter, children belonging to Group BM had experienced lower pain scores compared to those in Group B. The mean duration of post-operative analgesia in group BM was 12.49 ± 1.19 hours compared to 5.11 ± 0.50 hours for group B which was statistically significant with a p value < 0.05. Furthermore, the Ramsay sedation scores were higher in the Group BM for initial one hour compared to group B without any appreciable difference in adverse effects. Also, there were no significant difference in the hemodynamic parameters in both the groups. Conclusion: To conclude, administration of preservative free midazolam with bupivacaine for caudal epidural block increases the duration of post-operative analgesia without any associate adverse effects compared with plain bupivacaine. Thus, low dose preservative free midazolam can safely be administered as an adjuvant with bupivacaine in the caudal epidural space for prolonging analgesic effects in the postoperative period. Keywords: Bupivacaine, Midazolam, caudal analgesia

Background: Cardiac pacing no doubt, is effective in the treatment of various cardiac conditions but conventional RV apical pacing has detrimental effects on cardiac structure and function. The aim of the study was to study the comparison of effect on alternative RV pacing sites (apical vs mid-septal) on acute hemodynamic (Systolic BP, Diastolic BP and MAP). Materials and Methods: 22 stable patients undergoing EPS ±RFA for PSVT were included in the study. In each patient, the QRS width and axis were measured and the difference between the sinus QRS width at Mid-septum and Apex were compared. Similarly, SBP, DBP and MAP was recorded and compared. QRS width was plotted against ΔSBP for each data. Results: Among the 20 patients taken for the study, the different indications for undergoing cardiac catheterisation were AVRT (35%), AVNRT (50%) and AT (15%). The mean baseline QRS from surface ECG was 62.9±8.6. The mean QRS at Mid-septum after pacing was 138±5.6 and mean QRS at Apex was 154±9.3 respectively. The average increase in QRS after pacing was 74.8±4.3 unit more at apex compared to mid-septum and the difference was statistically significant (P<0.001). The mean baseline SBP, DBP and MAP was 140.7±11.7, 80.4±7.3 and 100.4±8.2 respectively. The mean SBP after pacing at mid-septum was 121.5±10.8 and at apex was 117.9±10.1 respectively and the difference was not statistically significant (p=0.290). The mean DBP after pacing at mid-septum was 76.8±7.3 and at apex was 73.6±7.2 respectively and the difference was also not statistically significant (p=0.163). The mean MAP after pacing at mid-septum was 91.8±8.1 and at apex was 88.3±7.7 respectively and the difference again was not statistically significant (p=0.167). The average baseline PA saturation was 74.42.4 unit. The mean of PA saturation after pacing at mid-septum was 71.1 ± 2.4 and at apex was 67.7 ± 2.1 respectively, the difference was not statistically significant (p=0.051). A significant affirmative correlation (r=-0.67; p=0.001) was found in the QRS duration during pacing in relation to SBP change. However, no significant correlation was established between the pacing site and the SBP change. Conclusion: We therefore conclude that Right Ventricular Pacing at Apex causes significant increase in QRS duration as compared to pacing at Mid-septum but there was no significant effect on SBP, DBP and MAP between the two sites of pacing. However, the study was limited owing to small numbers of patients and only two pacing sites were compared. Besides, the results were limited for acute hemodynamic events only and may not apply to more long term conditions in which adaptive mechanisms may be of help. Despite the shortcomings, we recommend that the ventricular pacing lead should be placed at the site where the paced QRS duration is minimum during permanent pacemaker implantation. This should preferably be at a level of less than 140 ms. Keywords: Right Ventricular Pacing, RV Apical Pacing, Mid-Septal Pacing, Acute Hemodynamics

Background: Local anesthetics along with additives are used to prolong the duration of anaesthesia and analgesia in neuraxial anaesthetic techniques. commonly used additives are vasopressore like adrenaline, opioids etc. A newer class of selective α2 agonists like dexmedetomidine are being used now -a-days for the same. We intended to assess effect of dexmedetomidine addition on the block characterstics of bupivacaine in infraumblical surgeries performed under epidural anaesthesia. Aims and Objectives: our aim was to compare efficacy of 0.5% bupivacaine ,0.5% bupivacaine with dexmedetomidine 0.5mcg/kg in view of sensory and motor block onset &analgesic duration and motor block duration and hemodynamic characteristics. Materials and Methods: Total 60 patients were divided in to two groups. which consists of 30 in each were included in the study. Group A received 20ml of bupivacaine0.5%, group B received bupivacaine 0.5% with 0.5mcg/kg dexmedetomidine to a total volume of 20ml. Results: Group B had statistically significant early onset of sensory 11.53±4 minutes, motor block 15.13±7.12 minutes and prolonged duration of motor block197.2±30.99 minutes and post-operative analgesia 456±26.41 minutes compared to group A. Conclusion: We concluded that dexmedetomidine addition to bupivacaine in epidural anaesthesia Significantly reduces the onset of sensory & motor block ,meanwhile it also extends the duration of analgesia & duration of motor block with minimal hemodynamic effects. Keywords: Dexmedetomidine, Bupivacaine, neuraxial anaesthetic techniques, Hemodynamic. Epidural.

Background: The auditory brainstem response (ABR) is a vital neurophysiological test for assessing auditory function from the cochlea to the brainstem. Preterm infants are particularly vulnerable to auditory dysfunction due to their underdeveloped auditory pathways. Maternal factors, such as age and anemia, may influence ABR outcomes in these high-risk populations. This study investigates the combined effects of maternal age and anemia on ABR results in preterm infants. Materials and Methods: This prospective observational study was conducted at Govt medical college and its associated hospital, Jammu over two years. A total of 120 preterm infants born before 37 weeks of gestation were enrolled. Maternal data, including age and hemoglobin levels, were collected. ABR testing was performed within the first 28 days of life using standard protocols. The study analyzed wave latencies and interpeak intervals in relation to maternal age and anemia severity, using ANOVA and multiple linear regression for statistical evaluation. Results: ABR latencies differed significantly across maternal age groups. Infants of advanced maternal age had longer wave I latency (1.92 ± 0.13 ms vs. 1.85 ± 0.14 ms in adolescents, p = 0.031), wave III latency (4.25 ± 0.19 ms vs. 4.15 ± 0.22 ms, p = 0.025), and wave V latency (6.32 ± 0.26 ms vs. 6.24 ± 0.25 ms, p = 0.046) compared to other groups. Severe maternal anemia was associated with longer wave I latency (2.01 ± 0.18 ms vs. 1.81 ± 0.12 ms in no anemia, p = 0.011), wave III latency (4.34 ± 0.24 ms vs. 4.05 ± 0.18 ms, p = 0.023), and wave V latency (6.41 ± 0.37 ms vs. 6.13 ± 0.22 ms, p = 0.014). Regression analysis indicated that maternal age and anemia were significant predictors of ABR latencies, with β coefficients for maternal age ranging from 0.12 to 0.25 and for maternal anemia ranging from 0.15 to 0.30 (p < 0.05). Conclusion: Maternal age and anemia significantly affect ABR outcomes in preterm infants. Advanced maternal age and severe anemia are associated with delayed ABR latencies, indicating potential auditory and neurodevelopmental issues. These findings underscore the need for early and comprehensive assessments in preterm infants, taking maternal factors into account to guide effective interventions. Keywords: Auditory Brainstem Response, Preterm Infants, Maternal Age, Maternal Anemia, Neonatal Audiology.

Background: Aim: To investigate the levels of high-sensitivity Troponin I (Hs Troponin I) and uric acid in individuals diagnosed with myocardial infarction (MI) and examine their association with patient demographics, clinical features, and outcomes. Materials and Methods: This prospective, observational study was conducted over 12 months at a tertiary care hospital and included 80 patients with acute myocardial infarction (AMI). Eligible patients were between 40 to 80 years of age and presented with MI symptoms, ECG changes, and elevated Hs Troponin I levels. Hs Troponin I levels were measured using high-sensitivity immunoassay, and uric acid levels were analyzed through enzymatic colorimetry. Additional laboratory tests, including lipid profiles and renal function, were conducted to evaluate overall health status. Results: The average age was 63.5 ± 9.8 years, with 65% male participants. Hypertension was present in 70% of patients, and 50% had diabetes. Hs Troponin I levels averaged 3.5 ± 1.8 ng/mL, while uric acid levels averaged 6.8 ± 2.1 mg/dL, both of which were higher in ST-segment elevation MI (STEMI) patients compared to non-STEMI (NSTEMI) patients. Significant positive correlations were observed between Hs Troponin I and uric acid (r = 0.58), LDL cholesterol (r = 0.45), and fasting glucose (r = 0.50), indicating associations between metabolic dysregulation and cardiac injury. Uric acid also correlated with total cholesterol (r = 0.40) and triglycerides (r = 0.38), highlighting its potential link to lipid imbalances. Conclusion: Elevated levels of Hs Troponin I and uric acid were associated with increased myocardial injury and metabolic disturbances in MI patients, especially in STEMI cases. These findings underscore the importance of Hs Troponin I as a marker of cardiac damage and suggest that elevated uric acid levels could indicate underlying inflammatory and metabolic stress, aiding in the risk stratification and management of MI patients. Keywords: Myocardial infarction, Hs Troponin I, Uric acid, STEMI, Metabolic dysregulation.

Background: Aim: To investigate the clinical profile and laboratory findings of pediatric patients diagnosed with Rickettsial fever at a tertiary care hospital. Materials and Methods: This prospective, observational study included 100 children aged 1 to 12 years, presenting with clinical signs of Rickettsial fever over an 18-month period. Demographic data, clinical history, and physical examination findings were systematically recorded. Comprehensive laboratory investigations, including complete blood count, liver function tests, renal function tests, and serological testing (Weil-Felix test and immunofluorescence assay), were performed. Patients were managed with doxycycline or azithromycin, and outcomes were monitored. Statistical analysis was conducted using SPSS software. Results: The mean age of the children was 7.2 ± 3.1 years, with a gender distribution of 55% males and 45% females. Fever (≥5 days) was observed in all cases, with rash present in 80% and eschar in 25%. Hepatomegaly and splenomegaly were noted in 30% and 25% of patients, respectively. Leukocytosis and thrombocytopenia were common laboratory findings, occurring in 45% and 50% of cases. Elevated liver enzymes were detected in 35-38% of patients. The Weil-Felix test was positive in 60% of cases, and the immunofluorescence assay was positive in 40%. The majority (80%) of patients were treated successfully with doxycycline, with a complete recovery rate of 85% and a mortality rate of 5%. Conclusion: This study underscores the variability of clinical presentations and the importance of early diagnosis and treatment of Rickettsial fever in pediatric patients. Prompt antibiotic therapy is effective in most cases, but severe complications can occur, highlighting the need for vigilant monitoring and comprehensive management. Keywords: Rickettsial fever, pediatric patients, clinical profile, laboratory investigations, doxycycline treatment.

Background: The choice of implant in stable trochanteric fractures is DHS however still failures encountered with some subtypes. The helical blade of PFNA is believed to provide stability, impaction, compression as well as rotational control of the fracture in unstable trochanteric fractures. So PFNA is optimal choice of implant in unstable trochanteric fractures in elderly with advantages of intramedullary fixation. Aim: Aim of study was to prospectively evaluate the functional outcome of unstable intertrochanteric fracture fixation with PFNA. Materials and Methods: An observational study was conducted to assess the results of 30 patients of age above 65 years (12 males and 18 females) with unstable trochanteric fractures treated with PFNA during the period from December 2020 to December 2022 were followed up for a period of at least 12months in a tertiary care hospital. we used AO system of classification of fractures. 20, 10 Patients were AO; 31-A2 and A3. 31-A2 was commonest type. Radiological assessment and Functional outcome were measured at one, three, six, 12 months by using modified Harris hip score. Results: All patients’ fractures were healed uneventfully with the follow-up of 12 months. Out of 30 patients, 18 (60%),8 (26.6%), patients excellent, good functional outcome respectively and 20 (66.6%) patients achieved preoperative mobility by the 12 months follow-up, with two(6.6%) patients with complications like one was superficial infection and one was wound gaping but no implant related complication slike cut out. Conclusion: Good results with low complication rate can be achieved with PFNA in unstable trochanteric fractures with good reduction and adequate fixation and acceptable position of hip blade especially in osteoporotic bone. Keywords: Helical blade; PFNA; trochanteric fractures.

Background: To study the incidence and risk factors of deep venous thrombosis with or without Pulmonary Embolism in patients presenting to the Kamineni hospital. Material and Methods: It was a observational study. Patients suspected to suffer from VTE were selected, a detailed history was taken, physical examination was done in all patients and investigated with venous Doppler to diagnose as DVT. Fifty patients were admitted during two-year period. Results: In an observational study, 50 patients were studied during two years period. There were 29 male and 21 female patients. The ratio of male to female was 1.38. In the study of diagnosed venous thromboembolism found ratio of female/male as 1.6, but found males affected more than female Median duration of presentation after onset of symptoms was 4.2 days (range, 120 days). ECG changes related to VTE were seen 17 (34%) patients in which sinus tachycardia was most common in 14(28%) patients. RBBB was found in 5 (10%). S1Q3T3/S in lead LO and T wave inversion in lead III) in 1(2%) patients, other changes, LVH in 3(6%) and old anterior wall MI in 1 patient (2%) were seen. We studied risk factors in our patients and found Protein S deficiency in 19(38%), Protein C deficiency in 18 (36%), Hyperhomocysteinemia 17(34%). Protein S and Protein C deficiency in 18(36%), Protein S, Protein C deficiency and Hyperhomocysteinemia in 4 (8%), Protein S and Hyperhomocysteinemia in 3 (6%) patients. PTE was proved in nineteen patients (38%) patients on CT pulmonary angiography. Massive and sub massive PE was found in 8 (16%) and minor PE in 11(22%) patients. Conclusion: The study concluded that VTE and its manifestations, including DVT and PE, are preventable therefore; a greater awareness of VTE and its risk factors is needed. Given the high incidence of DVT, and potentially life-threatening PE, prompt and accurate recognition of risk factors is crucial for implementing effective prophylaxis and reducing the burden of VTE and its manifestations. Key Words: Pulmonary Embolism, DVT, VTE, Protein C, Hyperhomocysteinemia.

Background: Subclinical hypothyroidism (SCH) is a biochemical condition defined by mildly elevated serum Thyroid stimulating Hormone (TSH) concentrations associated with normal circulating levels of thyroid hormones. Data on SCH in the general pediatric population are scarce; it seems to be a relatively rare condition in children and adolescents (1.7–2.9%), usually characterized by a self-limiting and remitting process with spontaneous normalization or stabilization of TSH values in the majority of cases (up to 88%). Materials and Methods: For this study, 90 Children between the ages of 1 to 18 years with documented hypothyroidism (both subclinical and overt) due to acquired causes, attending a tertiary referral center, were evaluated retrospectively. Evaluation included history as well as clinical, biochemical, and ultrasonography parameters. Exclusion criteria included causes of transient increase in TSH levels without intrinsic defects in thyroid such as those recovering from acute illness and on anticonvulsant therapy. For the same reason, SCH associated with obesity which normalizes with weight loss was also excluded. Results: In this study, out of 90 children, 82 (91.1%) were SCH and 8 (8.9%) were OH. The mean T3 level at start was 4.00±0.64; in the 6th month of follow-up, the mean was 1.88±0.44; in the 12th month of follow-up, the mean was 1.69±0.34 nmol/l. The mean T4 level at start was 11.8±1.99; in 6th month of follow-up, the mean was10.58±1.99; in 12th month of the follow-up, the mean was 9.58±4.18 µg/dl. The mean TSH level at start was 4.88±1.54 in 6th month of the follow-up, the mean was 4.4±1.44, and in 12th month of the following, up mean was 1.68±1.22 mIU/l. A gradual decrease in the levels at follow-up was statistically significant (p<0.001). Conclusion: Subclinical hypothyroidism (SCH) was the most predominant hypothyroid dysfunction found in our studied population. Correction of thyroid dysfunction particularly SCH in early childhood is highly essential to prevent the impairment of psychomotor and cognitive development. Keywords: Hypothyroidism, Subclinical hypothyroidism, Thyroid stimulating Hormone.