Vol 15, Issue 1, January-March, 2025

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Sleep is an important parameter for the maintenance many of the normal physiological processes. World wide sleep insufficiency has risen to alarming levels. Academic stress and clinical responsibilities make medical students more prone for sleep deprivation. Since Vitamin D is intricately associated the process of sleep there could be a probable link between poor sleep quality and vitamin D levels which was examined in this study. Material and Methods: 79 phase 1 medical students were recruited to the study after taking their informed consent. The sleep quality was assessed with a self administered questionnaire; Pittsburgh Sleep Quality Index and a score of more than 5 indicated poor sleep. Serum Vitamin D level was also assessed and were categorized into vitamin D deficient (<20 ng/dl), insufficient (20-29.9 ng/dl) and sufficient (>=30 ng/dl) groups. The correlation between sleep quality score and vitamin D levels the subjects was done using Spearman's rank correlation coefficient. Results: Mean Vitamin D level in the study sample was 22.96 +/- 8.7 with only 12.7% having sufficient vitamin D levels.70.9% of the participants were poor sleepers with a mean sleep quality index of 7.20+/-2.9. Spearman's Correlation Coefficient done to determine the correlation between vitamin D and sleep quality showed a very weak positive correlation with a value of 0.094 which was not statistically significant(p=0.412). Conclusion: The participants showed a high prevalence of low vitamin D levels. The percentage of participants with poor sleep quality index was higher in all categories of vitamin D levels. However, we could not find any correlation between poor sleep quality and vitamin D levels. A larger samples with more objective methods to assess sleep quality might give more insights to this. Key Words: Sleep quality, vitamin D, medical students.

Background: Autoimmune encephalitis is a rare but treatable condition characterized by inflammation of the brain parenchyma, often mediated by autoantibodies targeting neuronal surface antigens. Early diagnosis and treatment are crucial for improving clinical outcomes. Case Presentation: We report a case of a 65-year-old male presenting with subacute altered sensorium, memory loss, and myoclonic spasms. MRI findings revealed bilateral hyperintense lesions in the temporal lobes, and antibody analysis confirmed anti-LGI1 positivity, establishing the diagnosis of autoimmune encephalitis. Management and Outcomes: The patient was treated with oral steroids and immunosuppressants, leading to significant clinical improvement. After two weeks of inpatient therapy, the patient was discharged with advice for routine follow-up. Conclusion: This case emphasizes the importance of recognizing autoimmune encephalitis in elderly patients presenting with subacute neurological symptoms. Early diagnosis and initiation of immunosuppressive therapy can result in excellent outcomes. Key Words: Autoimmune Encephalitis, Anti-LGI1 Antibodies, MRI Temporal Hyperintensity, Immunosuppressive Therapy, Neurological Disorders.

Background: Menorrhagia is a common symptom in adolescents with Von Willebrand Disease (VWD). Combined oral contraceptive pills (OCP's) are the most common treatment modality for menorrhagia. Hypothesis: This study showed response rates of high and low dose estrogen and their use in combination with DDAVP or Amicar in adolescent females with menorrhagia and Type I VWD/ low Von Willebrand Factor (VWF). Materials and Methods: The patient population consisted of 80 menorrhagia patients aged 9-19. Collected data included age of menarche, onset of menorrhagia, follow up duration, severity of menorrhagia including PBAC score, co-morbidities, and family history of bleeding or clotting disorders, blood group, factor VIII coagulant activity, ristocetin cofactor activity and VW Ag level. Results: Study showed 38.5% patients were changed from low dose estrogen combined OCP to high dose (50 mcg EE) OCP, 7.7% were changed from high dose estrogen containing combined OCP to a lower dose OCP and 38.5% patients remained unchanged.11.5% patients were switched from combined OCP to progesterone only pills and 3.8% was switched vice-versa.Patients on combined OCP, 25% were on continuous high dose estrogen containing combined OCP, 30% were on cyclic high dose estrogen containing combined OCP 10% were on continuous low dose estrogen containing combined OCP, and 35% on cyclic low dose estrogen containing combined OCP. Conclusion: Higher dose of estrogen seems to be more effective in controlling menorrhagia in the adolescent population with a low VWF/Von Willebrand disease. Keywords: Von Willebrand Disease, Menorrhagia, Anti-fibrinolytics, DDAVP.

Background: Elevated C-reactive protein levels, which are regulated by IL-6, are linked to COVID-19 severity, and serve as a marker for inflammation, severe complications, and organ dysfunction. This study aimed to explore the level of CRP in the context of COVID-19 pathogenesis and assess how CRP levels change with disease severity. Material and Methods: This prospective observational study included 100 patients with COVID-19 admitted to the isolation ward at GVMCH between February 2021 and January 2020. Patients were categorised based on fever duration prolonged fever (>7 days), saddleback fever, and fever lasting <7 days. Blood samples were collected, and RTPCR-confirmed COVID-19 patients from the isolation ward underwent necessary laboratory investigations. Results: Approximately 58% of the patients were smokers and 26% were alcoholics, with common comorbidities including diabetes (46%) and hypertension (58%), while fever (84%) and headache (64%) were the predominant clinical features. Approximately 16 (16%) patients had prolonged fever, 12 (12%) had saddleback fever, and 72 (72%) had fever for < 7 days. There were significant differences in vital signs between the patients with fever (p<0.01). The prolonged fever group had significantly higher levels of CRP and LDH than the other groups (p=0.01). Additionally, the prolonged fever group exhibited significantly more consolidation (p=0.01). The prolonged fever group also had more cases of hypoxia and ICU admissions than the other groups, with significant differences observed (p=0.01, p=0.05). Conclusion: Patients with COVID-19 and prolonged fever showed higher rates of hypoxia and inflammatory responses than those with saddleback fever, distinct cytokine profiles, and prognostic implications for optimizing hospital resource allocation in increasing cases. Keywords: COVID-19, C-reactive protein, Fever, Inflammation, Cytokine storm.

Background: ARDS is a critical condition with acute hypoxemia. Its diagnosis involves clinical, imaging, and laboratory findings. Its effective management includes addressing underlying causes, supportive care, prone positioning and lung-protective ventilation to improve outcomes and mitigate lung injury. Non-invasive ventilation (NIV) is an essential tool in managing mild to moderate ARDS, improving oxygenation and reducing the need for intubation. NIV failure often occurs due to worsening hypoxemia, respiratory acidosis or increased work of breathing. Delayed intubation after NIV failure is associated with higher mortality rates. Identifying factors associated with NIV failure in ARDS patients is crucial for timely intubation, preventing delayed interventions, and improving overall clinical outcomes. Material and Methods: This was an observational study of patients with ARDS admitted to the ICU of a tertiary care hospital over one year. A total of 60 patients were included, and various demographic, clinical, biochemical and radiological parameters were analyzed. Outcomes such as ICU length of stay, hospital mortality, and other complications were compared between NIV success and failure groups using severity scores and diagnostic tools to identify key predictors of NIV failure. SSPS 23.0 software was used for statistical analysis and a P value less than 0.05 was taken as statistically significant. Results: This study analyzed predictors of NIV failure in 60 ARDS patients. NIV failure was significantly associated with older age (mean 54.02 vs. 42.34 years, P = 0.0003) and comorbidities such as diabetes (66.67% vs. 25.64%, P = 0.002), chronic kidney disease (33.33% vs. 5.13%, P = 0.006), and liver cirrhosis (19.05% vs. 2.56%, P = 0.04). Physiological parameters like elevated heart rate (116.24 vs. 101.32 beats/min, P = 0.0002) and respiratory rate (30.12 vs. 22.88 breaths/min, P < 0.0001) also predicted failure. Severity scores, including higher APACHE II, SOFA, HACOR, and LUS scores were significantly worse in the NIV failure group. Patients with NIV failure had prolonged ICU stays (16.8 vs. 8.5 days, P < 0.0001) and higher hospital mortality (42.86% vs. 5.13%, P = 0.0007). Conclusion: Identifying risk factors for NIV failure in ARDS is vital for timely intervention and improved outcomes. Factors such as Older age, comorbidities, and higher severity scores were associated with increased risk of NIV failure. Prompt identification of these predictors can reduce delays in intubation and mortality. Key Words: Acute Respiratory Distress Syndrome (ARDS), Non-Invasive Ventilation (NIV), Mechanical Ventilation, Risk Factors.

Background: Degenerative osteoarthritis (OA) of the knee is a common condition affecting the elderly, with a prevalence of 28.7% in India. Factors like aging, obesity, and lack of education are primary contributors to the condition. OA results in the progressive degeneration of articular cartilage, causing significant limitations in daily activities such as walking, climbing stairs, and squatting. Although various treatment options exist, there is no clear consensus on the management of different stages of OA. Platelet-rich plasma (PRP) injections have emerged as a promising treatment due to their potential to repair cartilage, reduce pain, and improve joint function. Materials and Methods: This prospective study involved 70 patients with primary knee OA selected randomly from outpatient clinics. Radiographic evaluation confirmed the stage of arthritis. PRP was prepared by collecting 10-20 ml of the patient’s blood, which was centrifuged to separate the plasma. The PRP was injected intra-articularly under aseptic conditions. Pain and functional status were evaluated using the Visual Analog Scale (VAS) and Oxford Knee Score questionnaires before and six months after the procedure. Results: There were 40 (36.67%) females and 30 (63.33%) males with a M:F ratio of 0.75:1. The most common affected age group was 51–60 age group (40.0%). After a single dose of PRP injection in 70 OA knee patients, 84% showed excellent/good pain relief, 12.8% satisfactory and 2.8% poor results at 6 months. Oxford Knee Scores revealed excellent outcomes in 60%, good in 24.28%, satisfactory in 12.85%, and poor in 2.86%. Improvements were statistically significant, with no complications or adverse reactions observed. Conclusion: PRP injections are a safe, simple, and cost-effective outpatient treatment for knee OA. It alleviates pain, improve range of motion and promote cartilage repair by reducing inflammation and enhancing local angiogenesis. While slower acting than steroids PRP is free of harmful local or systemic side effects making it an ideal option for managing knee arthritis at various stages. Keywords: Osteoarthritis, Knee, Platelet-Rich Plasma, Intra-Articular Injections, Functional Outcome.

Background: Patient satisfaction represents an individual's perception of healthcare providers and services. It is considered a proxy indicator of the quality of care in healthcare facilities and serves as an effective measure for evaluating the performance of health services Aim: To assess the level of satisfaction regarding different aspects of health care among patients attending a rural health training centre affiliated to a tertiary care teaching hospital Materials & Methods: An institutional based cross-sectional study was conducted on 360 patients attending daily OPD of RHTC affiliated to a tertiary care teaching hospital using PSQ -18 questionnaire. Systematic random sampling was used. Results: The current study found that approximately 79.18% of participants were satisfied with the services provided at the rural health training centre. The lowest score was in the domain of the time spent with doctor with percentage satisfaction of 65.7%. Conclusion: The results of the present study showed that although the overall satisfaction was high (79.18%) some aspects of services indicated some degree of dissatisfaction which can be improved by use of efficient and skilled manpower utilization. Key words: PSQ-18, Patient Satisfaction, RHTC.

Background: Alcohol relapse is a significant challenge in the treatment of alcohol dependence, with complex interactions between personality traits, stressful life events, and sociodemographic factors. This study aimed to assess the personality profiles, role of stressful life events, and associated factors in patients with alcohol relapse at a tertiary care hospital. Material and Methods: A hospital-based cross-sectional study was conducted among 100 patients diagnosed with alcohol relapse as per ICD-10 criteria at the Institute of Mental Health, Hyderabad. Data were collected using a semi-structured proforma for sociodemographic details, Eysenck Personality Questionnaire (EPQ) for personality traits, Severity of Alcohol Dependence Questionnaire (SADQ) for dependence severity, and Presumptive Stressful Life Events Scale (PSLES) for life events. Statistical analysis was performed using SPSS v29, with a p-value < 0.05 considered significant. Results: The mean age of participants was 39 years (SD ±9.6). Most participants were male (91%) and from a lower socioeconomic class (60%). Stressful life events such as changes in social activities (100%) and sleeping habits (96%) were prevalent. Personality analysis revealed that extroversion (55%) and neuroticism (45%) were more common, with extroversion significantly associated with severe alcohol dependence (21%, p<0.001). The majority of participants (62%) experienced two relapses. Severity of alcohol dependence was positively correlated with the number of relapses and early age of alcohol initiation. Conclusion: Personality traits, stressful life events, and sociodemographic factors play crucial roles in alcohol relapse. Addressing these factors through personalized interventions may improve treatment outcomes. Keywords: Alcohol relapse, personality traits, stressful life events, alcohol dependence, cross-sectional study, Eysenck Personality Questionnaire.

Background: There is a raise in the childhood obesity throughout the country. Hence, there is a need for action to limit the raise. The causative factors have to be explored in detail to develop management techniques. Hence, the present study was undertaken. Aims and objectives: The present study was undertaken to observe the digital screen time with eating behaviour and sleep quality in obese children. Material and Methods: The present observational study recruited a total of 40 obese children of both genders during the study period. Age and gender matched healthy children were also recruited. Mobile screen time was assessed by using the digital wellbeing app from the mobile phones. Average screen time was recorded from the app. Eating attitude test 26 was administered with the help of the parents to assess the eating behaviour of the children. Sleep quality was assessed using the insomnia severity index questionnaire. Stress levels were assessed using the perceived stress scale. Results: Significantly higher screen time was observed in the obese children when compared with the healthy children (P=0.0469). ISI score was significantly higher in the obese children than healthy children (P=0.0064). Eat-26 score was significantly higher in the obese children when compared to the healthy children (P=0.0001). Perceived stress score was significantly higher in the obese children when compared with the healthy children (P=0.0003). Conclusion: The study results presents longer screen time, insomnia, altered eating behaviour and higher levels of stress in the obese children. These causative factors should be considered in the management of the obesity in children. Key Words: Children, Insomnia, Obesity, Screen time, Diet, Physical activity, life style.

Background: A hospital-based observational study was conducted over a 12-month period in a tertiary care hospital in East India. A purposive sample of 120 children (≤15 years) with confirmed dengue (n=68) and malaria (n=52) was included. Data on demographics, clinical presentation, laboratory parameters, hospitalization duration, ICU admission rates, and outcomes were analyzed. Descriptive statistics and comparative analyses were performed using appropriate tests. Results: Dengue was more prevalent in urban areas (p=0.006), whereas malaria predominated in rural regions. Fever, headache, and vomiting were common to both diseases. Myalgia (76.5%) and rash (45.6%) were significantly more frequent in dengue, whereas hepatosplenomegaly (67.3%) and severe anemia (42.3%) were hallmarks of malaria (p<0.05). Severe thrombocytopenia (<50,000/mm³) was more common in dengue (45.6%). ICU admission rates were higher in malaria (26.9%) than dengue (14.7%), with a longer mean hospitalization duration (6.7 vs. 5.2 days, p=0.008). Mortality was 2.5% (3 cases), all in severe malaria. Conclusion: While dengue had a higher prevalence, malaria demonstrated greater severity, with higher ICU admissions and mortality. Early clinical differentiation and risk stratification are crucial for timely interventions. Improved surveillance and management strategies are necessary to reduce the burden of these endemic infections in children. Keywords: Pediatric dengue, malaria, clinical profile, outcomes, tertiary care, thrombocytopenia, ICU admission.

Background: Anaesthesia machines and ventilators are critical equipment in operation theatres, ensuring patient safety and effective surgical outcomes. Presence of ventilators will increase the possibility of wide range of surgeries that can be taken in the particular hospital, Tamil Nadu, being one of India’s most populous states, requires adequate healthcare infrastructure. Aims and Objectives: To assess the availability of anaesthesia machines and ventilators in operation theatres of hospitals in Tamil Nadu. Material and Methods: This study is a cross-sectional analysis conducted in Operation Theatres of Hospitals in Tamil Nadu between September 2023 and December 2023 with sample size of 70. The population consists of Doctors who are all working in operation theatres. Consecutive sampling technique was used. Results: Most of the doctors (37.1%) were participated from district and taluk/Municipality.57.1% of hospitals had the availability of anaesthesia machine. The most common reason for non- availability of anaesthesia machine was Minor OT (36.7%),the second reason for non- availability of anaesthesia machine was budget issues(33.3%).Only 30% of hospitals had the availability of ventilator. The availability of Multipara monitor was 50% in hospitals.44.3% of doctors told that if anaesthesia machine and ventilator was present, it definitely improve the patient safety. More number of district hospitals had ventilator and multipara monitor compared to other location, which was statistically significant. Conclusion: The study highlights a significant gap in the availability of critical medical equipment, such as ventilators and anaesthesia machines, in many hospitals, often due to infrastructure limitations and budget constraints. Addressing these gaps can significantly enhance patient safety and improve surgical outcomes. Keywords: Anaesthesia machines, Ventilators, Operation Theatres.

Background: Laparoscopic Cholecystectomy (LC), despite being the gold standard for the treatment of gallstone disease, requires conversion to Open Cholecystectomy (OC) at times for the safe and successful removal of Gallbladder. The aim of this study was to evaluate conversion rate and risk factors associated with conversion to open cholecystectomy in elective cholecystectomy. Material and Methods: The records of 340 patients who underwent cholecystectomy from 1st January 2023 to 31st December 2023 were reviewed retrospectively. The demographics and clinical information about the patients was obtained from hospital records who required conversion to open cholecystectomy. Inclusion criteria is all patients who underwent elective laparoscopic cholecystectomy at the study site during the study period and exculsion criteria includes patients who had acute cholecystitis, Gall bladder perforation. Relevant medical and operative records were evaluated and appropriate tables and charts were made for record keeping using MS Excel. Results: Conversion to open cholecystectomy was needed in 15 patients (4.4%),of which 53.3% of the cases had acute inflammation of the Calot’s triangle. Female gender, recent acute cholecystitis, diabetes mellitus, hypertension and severity of inflammation were all significantly correlated with an increased conversion rate to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a reliable and safe surgery. With growing experience in laparoscopic technique, it is possible to bring complications and conversion rate to minimum. Distinguishing these risk factors may help to recognize the possibility and need for conversion and may also help to reduce the conversion rate. Keywords: Conversion rate; laparoscopic cholecystectomy; open surgery; risk factors.

Background: HTN is a major contributor to the development of Heart Failure. A growing array of biological pathways which include deleterious mechanisms promoting HF development & progression, as well as compensatory cardio-protective pathways explain the risk of HF. Components of these pathways can be utilised as biomarkers of this condition in order to facilitate the diagnosis, prognostication & potentially direct the management. Aim of the Study: To assess the predictive ability of selected biomarkers like N-terminal Fragment of the medullary natriuretic Peptide (NT-Pro BNP) and High Sensitive C-Reactive Protein (Hs-CRP) for the risk of Heart Failure in Hypertensive patients. The objective of this study was to measure the serum levels of biomarkers with different patho-physiological backgrounds i.e., NT-Pro BNP and Hs CRP in hypertensive patients to give additive prediction value for incident Heart Failure. Material and Methods: A cross-sectional study was done with 100 subjects divided into 2 groups. 50 patients with Hypertension with Overt Heart failure served as (Group 1) and 50 patients with Hypertension without Heart Failure served as (Group 2) in the age group of 40-70 years. Fasting serum NT pro BNP levels, Hs-CRP levels were estimated. Data was analysed using IBM-statistical package for social sciences (SPSS) and Graphpad Prism. Unpaired-t test was performed to test the significance of difference in means of NT pro BNP levels, Hs CRP between the two groups. Pearson’s correlation was done, to study the correlation between serum NT pro BNP, Hs CRP. Results: NT-pro BNP levels are elevated in Group 1 than in Group 2, the Mean ± SD of serum NT pro BNP in group 1 was 1178.29 ± 604.4 pg/ml and in group 2 was 148.17± 74.04 pg/ml. Serum Hs-CRP levels are increased in group 1 than in group 2, the Mean of serum Hs-CRP in group 1 was 5.83 mg/L and in group 2 was 2.35 mg/L. To study the correlation among both parameters within Group-1, Pearson’s correlation was done. No such association is seen among both parameters in HF hypertensive patients (p=0.05). On the basis of receiver operating characteristic (ROC) curve analysis, we found that NT-pro BNP > 328.9 pg/ml,Hs CRP >3.3 mg/L were significant predictors of overt heart failure in patients with hypertension. Conclusion: Heart Failure occurs when Heart cannot pump blood(systolic failure) and when it is not filled(diastolic failure) adequately. HF is a complex syndrome associated with various patho-physiological and biochemical disorders. No single bio-marker can detect the features of HF. Hence the promising biomarkers like NT-pro BNP were chosen relevant to their underlying pathophysiology along with other markers like Hs-CRP in this study for Heart Failure assessment and help in its prognosis. Keywords: Hypertension (HTN), Heart-Failure (HF), NT-pro BNP, Hs CRP.

Background: Patients with chronic kidney disease are at high risk for cardiovascular morbidity due to CKD induced oxidative stress, inflammation and endothelial dysfunction. N-acetyl cysteine supplementation can replenish the anti-oxidants deficit and thus reduce the risk of cardiovascular morbidity in CKD patients. Materials and Methods: 40 patients on maintenance hemodialysis were included in this randomized double blind placebo controlled study and were then divided randomly into 4 groups of 10 members each. 600mg of N-acetyl cysteine (twice daily) was given to group 2 (low flux HD) and group 4 (high flux HD), while placebo was given to group 1 (low flux HD) and group 3 (high flux HD). Biomarkers of oxidative stress (Malondialdehyde (MDA), Nitric oxide (NO) and glutathione), inflammation (highly sensitive C-reactive protein (hs-CRP) and endothelial dysfunction (Augmentation pressures and index) were evaluated at 0, 4 and 12 weeks. Results: The differences in baseline demographic characteristics of all groups were not significant. Patients on high flux hemodialysis (groups 3 and 4) and low flux hemodialysis with NAC (group 2) showed significant reduction in serum MDA and hs-CRP levels, along with significant improvement in serum levels of nitric oxide and glutathione. Group 4 (high flux HD on NAC) showed the most significant changes while group 1 (low flux HD on placebo showed no significant change in any parameters. Conclusion: Patients on high flux hemodialysis show a significant difference in biomarkers of oxidative stress, inflammation and endothelial dysfunction when compared to patient son low flux hemodialysis. These changes are augmented by usage of N-acetyl cysteine. Keywords: N-acetyl cysteine, Hemodialysis, high flux and low flux dialyzer, oxidative stress, Malondialdehyde (MDA), C-reactive protein.

Background: The aim of our study was to assess the duration of ESP block as a post-operative analgesic technique by VAS score. Materials and Methods: The study was conducted in patients at Kaminenei Institute of Medical Sciences, Narketpally, Telangana, India. Total 60 ASA physical grade I, II, patients, satisfying the inclusion criteria, undergoing lumbar spine surgeries were included in the study after obtaining Hospital Ethical Committee approval. Results: The postoperative hemodynamic variables and side effects were monitored. The results showed that average Visual Analogue Score in patients who received Erector spinae plane block was 1.43±0.568 this was significantly lower than those who did not receive the block Multimodal group it was 3.3±0.702 (p<0.01) Further the average time for first analgesic requirement after the administration of ESP block was 900± 135.378 minutes and only 40% members only required was longer in group who received the block than in the Multimodal group 476.74±417.606 minutes among 76.6%. Total analgesic required in 24hours in ESP group was 41.6758.844 mg which is lesser than Multimodal group 105±80.247mg. The postoperative complications like PONV was also less in ESP group when compared to Multimodal group. There was no major complications observed with ESP block. Advantage of ESP block is, that it is distant from all the vital structures like pleura and spinal cord and its sono-anotomy is easily recognisable. There are no structures at risk of needle injury in the immediate vicinity to the site of the block. It provides greater hemodynamic stability and lower requirements for extensive monitoring. Conclusion: Based on the results, we conclude that ESP block decreases the post-operative pain scores and opioid requirements and can be used as excellent component of multimodal analgesia, which is safe and easily performed with no major complications. Keywords: ESP Block, PONV, Visual Anlogue score, Complications, Spinal plane block.

Background: Anaemia in pregnancy is a global problem and Iron Deficiency Anaemia (IDA) being the most common form and it is mostly of nutritional origin. In a country like India, anaemia is frequently severe and contributes to maternal mortality and morbidity. It deserves more attention than what it is currently receiving.Aims and Objectives: To compare the efficacy of Oral Iron (Ferrous sulphate, Carbonyl Iron) versus Parenteral Iron (Iron Sorbitol- intramuscular, Iron Sucrose - intravenous). Materials and Methods: This is a prospective randomised clinical and interventional study done in the Satya sai medical college and year from oct 2022-oct 2024with sample size of 100pregnant women attending the antenatal OP with gestational age of 16 – 34 weeks with Single viable fetus with no obvious ultrasonologic congenital anamolies, haemoglobin between 7 – 10 gm% were recruited in this study with informed consent. A total of hundred women were allotted into two major groups of 50 subjects each. A detailed history including the demography, complaints, period of gestation, diet history, previous obstetric history and drug history. Complete general physical examination was carried out along with other system examination. Apart from routine antenatal profile, stools for ova, cyst and occult blood, serum ferritin (CLIA) were done and diagnosis of Iron deficiency anaemia confirmed. Haematological parameters were analysed by Beckman & Coulter, USA (automated). Initial blood examination was done between 16 and 34 weeks. Final tests were done after 4 weeks of Iron supplements in both groups. Results: Into this study, 100 pregnant women of gestational age 16-34 weeks with moderate Iron deficiency anaemia were recruited. They were divided into two broad groups receiving oral Iron and parenteral Iron. The oral group was again subdivided into those to receive Ferrous sulphate and Carbonyl Iron. The parenteral group was further subdivided into Iron sorbitol and Iron sucrose groups. The response to therapy was noted by mean rise in Haemoglobin at the end of 4 weeks. Iron deficiency anaemia was found to be more prevalent among age group 21-25yrs. Multigravidas were found to be more anaemic compared to primigravidas. With regard of the treatment results of Iron deficiency anaemia, among the oral group (Ferrous/Carbonyl Iron), Carbonyl Iron showed a better mean Hb rise compared to FeSO4.Among the parenteral group, intravenous Iron sucrose showed better and quick response in terms of mean Hb rise compared to intramuscular Iron sorbitol. Overall comparison of all four types of medications together, in terms of mean Hb rise, indicated that intravenous Iron sucrose is found to be superior over others. Apart from mean Hb rise, Iron sucrose administration was also found to be associated with minimal side effects. Keywords: Iron deficiency anemia, Oral Iron, Parenteral Iron.

Background: Pediatric neck masses present diagnostic challenges due to their diverse causes, including infections, congenital anomalies, and tumors. Present study seeks to enhance the understanding of how these conditions present in children, aiming to improve diagnostic accuracy and treatment protocols for better patient outcomes. Material and Methods: This prospective study included 88 pediatric patients diagnosed with neck masses in a medical hospital in South Gujarat, India, between January and December 2023. Clinical examination, imaging, and FNAC were used for diagnosis, with treatment strategies based on the final diagnosis. Results: DNSIs were the most common cause, with most cases treated conservatively. A considerable proportion required institutional management, while fewer cases needed surgical interventions. Conclusion: DNSIs are often managed conservatively, but more severe cases require surgical interventions. Early diagnosis and tailored treatment are crucial to prevent complications. Keywords: Pediatric neck masses, Deep neck space infections, Conservative management.

Background: Microcytic Hypochromic anemia is a common nutritional and hematological disorder among children under five years, especially in rural and semi-urban areas. Chikkamagaluru, Karnataka, being a region with diverse socio-economic and dietary practices, presents an unique opportunity to study the prevalence and determinants of this condition. Objective: To evaluate the prevalence, etiological factors and severity of Microcytic Hypochromic anemia among children under five years in Chikkamagaluru district over a two-year period (December 2022- December 2024). Methods: A cross- sectional study was conducted involving 373 childrens aged 6 months till 5 years. Participants were selected using stratified random sampling from Urban and rural areas of Chikkamagaluru. Hematological parameters, including Hemoglobin levels, Mean Corpuscular Volume (MCV), and Mean Corpuscular Hemoglobin Concentration(MCHC) were assessed. Nutritional history, socio-economic status and dietary habits were collected using structured questionnaires. Peripheral Smear examination was performed for morphological confirmation. Results: Preliminary analysis indicates a significant prevalence among the study population, with higher rates observed in rural areas compared to urban settings. Iron deficiency emerged as a leading cause, followed by other nutritional deficiencies and parasitic infections. Severity was categorized as mild, moderate or severe based on hemoglobin levels with majority falling under mild category (47.7%) Conclusion: Microcytic Hypochromic anemia remains a significant public health challenge among children under the age of five in Chikkamagaluru. Addressing nutritional deficiencies and improving public health public health interventions are essential to reduce its burden. This study underscores the need for region-specific strategies to combat anemia in young children. Keywords: Microcytic hypochromic anemia, children under five, iron deficiency, nutritional anemia.

Background: Aim: This study aimed to evaluate the correlation between hematological parameters and disease severity in patients diagnosed with acute leukemia, focusing on their prognostic significance and utility in clinical risk stratification. Material and Methods: A cross-sectional study was conducted on 90 newly diagnosed acute leukemia patients aged 18 years and older. Data collection included demographic information, clinical history, and laboratory investigations such as complete blood count (hemoglobin, total leukocyte count, platelet count, and differential leukocyte count), peripheral blood smear examination, and bone marrow biopsy. Disease severity was categorized into mild, moderate, and severe based on clinical and laboratory criteria, including blast count, and organ involvement. Statistical analysis was performed using SPSS Version 25.0, with p-values <0.05 considered statistically significant. Results: The mean age increased significantly with disease severity (p=0.045). Hemoglobin levels decreased significantly (p<0.001), while total leukocyte count, Peripheral blood blast percentage, serum LDH, CRP, and ESR levels increased with disease severity (p<0.001 for all). Platelet count showed a significant decline with severity (p<0.001). Bone marrow findings revealed higher blast counts, increased fibrosis. ROC curve analysis showed high predictive accuracy for Peripheral blood blasts (AUC=0.93), total leukocyte count (AUC=0.91), and serum LDH (AUC=0.90). Conclusion: This study demonstrated strong correlations between hematological parameters, biochemical markers, and disease severity in acute leukemia patients. Hemoglobin, total leukocyte count, platelet count, Peripheral blood blasts, serum LDH, CRP, and ESR emerged as reliable indicators of disease severity. These findings emphasize the importance of routine hematological assessments for effective risk stratification, disease monitoring, and personalized treatment strategies. Keywords: Acute leukemia, Hematological parameters, Disease severity, Peripheral blood blasts, Biomarkers.

Background: Effective teaching methods are critical in medical education, particularly in complex subjects like high-risk pregnancy management. Traditional learning (TL) relies on structured lectures, whereas problem-based learning (PBL) promotes active engagement and critical thinking. This study compares the effectiveness of these approaches in knowledge acquisition, clinical skills, and student satisfaction. Material and Methods: A comparative study was conducted among undergraduate medical students at Adesh Institute of Medical Sciences & Research. Participants were randomly assigned to TL or PBL groups, covering identical high-risk pregnancy topics. Pre- and post-test assessments, Objective Structured Clinical Examinations (OSCEs), and satisfaction surveys were used for evaluation. Statistical analysis was performed using paired and independent t-tests, with p<0.05 considered significant. Results: Both groups demonstrated significant knowledge improvement post-intervention (p<0.001). However, the PBL group had a significantly greater increase in post-test scores (74.3±8.7 vs. 65.8±9.1, p<0.001). OSCE results favoured PBL, with higher clinical decision-making (84.8% vs. 66.7%, p=0.003) and communication skills scores (87.6% vs. 60.0%, p<0.001). Student satisfaction was also higher in the PBL group across engagement (88.6% vs. 56.2%, p<0.001) and confidence in application (83.8% vs. 54.3%, p<0.001). Conclusion: Problem-based learning demonstrated superior outcomes in knowledge retention, clinical decision-making, and student satisfaction compared to traditional teaching. Incorporating PBL into medical curricula could enhance learning and skill development in high-risk pregnancy management. Key Words: Problem-based learning, traditional learning, high-risk pregnancy, medical education, clinical skills, student satisfaction.

Background: For patients intubated in critical care units (ICUs), ventilator-associated pneumonia (VAP) is a serious health issue that raises death rates, length of hospital stay, and treatment expenses. Over the course of 12 months, the primary pathogens causing VAP at a tertiary care hospital in UP, India were examined in this study. Objectives: To ascertain the significance of routine pre-VAP endotracheal aspirate (EA) cultures in the effective management of ventilator-associated pneumonia (VAP) and the role colonizers play in the disease's etiology. Material and Methods: During a 12-month period, a prospective observational cohort study was carried out. We looked at 230 individuals who had been on mechanical ventilation for more than 48 hours. Results: 40 of the 230 patients who received mechanical ventilation during their ICU stay developed VAP. In patients on MV, the most frequent pathogens invading the respiratory tract were Acinetobacter spp. (52.5%) and Pseudomonas spp. (30.8%). The most frequent Gram-positive colonizer was Staphylococcus aureus (5%), of which 50% were methicillin-resistant S. aureus (MRSA). The other comparatively less frequent colonizers were Streptococcus pyogenes, Streptococcus pneumoniae, Enterococcus faecalis, and Candida spp. Conclusion: In conclusion, quick care is essential due to the concerning link between VAP and bacteria that are resistant to many drugs. Determining the best suitable method for infection management requires identifying the key pathogens. Keywords: critical care, ventilator-associated pneumonia, mechanical ventilation, Tracheal Aspirates, Resistance

Background: As Medical education is competitive, the long duration of courses and exposure to clinical settings potentially causes mental health issues. Sudden exposure to vast medical curriculum following school education causes stress and pressure among the students,[1] Stress is a perceived imbalance between the demands and capability to respond.[1] Stress is a subjective experience which creates an obstacle in a person’s path of achieving his or her goals. Medical curriculum is very vast and stressful.[2] Considerable degree of psychological morbidity has been reported among medical students ranging from stress, interpersonal problems and suicidal ideation to psychiatric disorders and they tend to have greater psychological distress than the general population,[3] Yoga and meditation have become widely accepted as non-pharmacologic modalities for stress and anxiety reduction as well as general health. Materials and Methods: A cross sectional study done among 300 Undergraduate Medical students and House surgeons of GMC, Mahabubnagar for 2months using semi- structured Questionnaire and data entered in excel and analyzed using SPSS Version20 software. Results: Majority of the study Participants have Moderate levels of stress (74.3%), 11.6% of the study participants perceived Low stress Levels and 14% of the study participants perceived High stress levels and the average Perceived Stress Scale score among the study participants is 20.9. With regards to the attitude towards Meditation in relieving stress, 59.3% of the study participants have taken part in Meditation programs, of them 92.6% have found Meditation helpful. Conclusion: This study shows considerable amount of stress among Medical undergraduates and majority had a positive attitude towards meditation. Keywords: Stress, Undergraduates, Meditation, Attitude.

Background: The "Golden Hour" refer to the critical first hour after the onset of symptoms of myocardial infarction or stroke, during which prompt medical intervention can significantly improve patient outcomes. Golden hour for stroke is 240min and MI is 60min. This study aims to assess the awareness regarding the Golden Hour of myocardial infarction and stroke. Material and Methods: A cross-sectional study was conducted in the field practice area of Government Medical College, Mahabubnagar. Data collection carried out over one month, from June 1, 2024, to June 30, 2024 in a sample size of 200 participants by simple random sampling. pre-designed, semi-structured questionnaire that included questions related to demographic details, awareness of myocardial infarction and stroke symptoms, knowledge of the Golden Hour, and actions to be taken during an emergency. Results: The concept of the Golden Hour, a critical time frame for seeking immediate medical attention after a heart attack or stroke, was understood by 41.7% of participants, while 58.5% lacked this awareness. Among those who knew about the Golden Hour, 71.6% correctly identified it as 60 minutes, but 28.4% did not know the exact time frame. Conclusion: This study highlights critical areas where awareness is lacking and emphasizes the need for enhanced educational efforts to improve the early recognition of heart attack and stroke symptoms, which are vital for reducing morbidity and mortality in the population. Keywords: Golden hour, Myocardial infarction, Stroke

Background: The postoperative care regimens play a crucial role in influencing the long-term results of numerous surgical procedures. Various clinical settings have been used to assess a variety of postoperative therapies aimed at improving cognition and coordination, preventing joint stiffness and muscular atrophy, maximising recovery or functioning, and reducing pain. Now a days mindful mediation is gaining popularity in rehabilitation of post operative patients. mindfulness-based interventions (MBIs) are used for the purpose of relieving pain, they may have a greater impact on physical functioning following surgery. Aims and objectives: To evaluate the role of mindful meditation on post operative TKR/THR patients in post operative rehabilitation phase Material and Methods: This descriptive analytical study was carried out on 105 post operative TKR/THR patients in the department of Orthopaedics Government Medical College, Patiala, India from Sep 2023 to Aug 2024. We used SF- 36 questionnaire to assess the effect of mindful meditation on patients, which allows calculating eight different scores (on a scale of 0 -100), a physical component scale (PCS), and a mental component scale (MCS) summary. Mean Mental (MCS) and Physical (PCS) component summary scores were assessed and compared with healthy people involved in the study. Overall, a higher PCS and MCS score indicates better QOL. Results: out of 124 patients registered, 105 patients with mean age. Were included in the study. SF 36 score was deployed and assessed. The result from this questionnaire showed that mean PCS and mean MCS were significantly higher in patients who were performing mindful meditation compared to the patients in whom mindful meditation was not given and this was statistically significant. Conclusion: Mindful Meditation is a useful adjuvant in post operative patients treated in orthopaedics in both physical dimension as well as Mental dimension of health, but further research is needed in support of our study to make it a usual practice in post operative patients. Key words: Mindful meditation, post-op Rehabilitation, quality of life.

Background: The global incidence of diabetes is escalating at an alarming rate, with over 190 million individuals currently affected worldwide and projections estimating a rise to 324 million by 2025, making diabetes mellitus a critical public health challenge of the century. In India, the prevalence of diabetes is notably high, affecting approximately 20% of urban and 10% of rural populations. Dyslipidemia, a common comorbidity in diabetes mellitus, affects nearly 95% of individuals with the disease, significantly contributing to their absolute risk of major coronary events, including coronary heart disease (CHD). Lipid abnormalities frequently observed in T2DM include elevated levels of total cholesterol, VLDL cholesterol, triglycerides, and a predominance of small, dense LDL particles, along with reduced HDL cholesterol levels. These abnormalities are strongly linked to insulin resistance, hypertriglyceridemia, and remnants of triglyceride-rich lipoproteins, which are highly atherogenic. Lifestyle factors such as diet and exercise, as well as the presence of metabolic syndrome, further exacerbate this dyslipidemic state. The pro-atherogenic properties of small LDL particles, particularly their ability to penetrate arterial walls and undergo oxidation, are closely associated with coronary artery disease (CAD). Aims and Objectives: The primary objective of this study is to determine the prevalence of dyslipidemia in newly diagnosed Type 2 Diabetes Mellitus patients compared to a healthy control population. Material and Methods: A cross-sectional study was conducted at Mediciti Institute of Medical Sciences, a tertiary care teaching hospital, to evaluate Type 2 Diabetes Mellitus (T2DM) patients and healthy controls. Inclusion criteria encompassed individuals aged 30 years and above, of any gender, occupation, socioeconomic status, or religion, with newly diagnosed T2DM based on American Diabetes Association (ADA) criteria, which included HbA1c > 6.5%, fasting blood sugar > 126 mg/dL, or postprandial blood sugar > 200 mg/dL with symptoms of diabetes. Physical parameters such as height, weight, blood pressure, and waist-hip ratio for abdominal obesity were measured. Data collection involved clinical history, physical examinations, and biochemical analysis of lipid profiles and blood sugars using Beckman Coulter AU-680 (TC: CHOD-POD; HDL: HDL reagent; LDL: CHE-CHO; TG: GK, GPO, Peroxidase). Results: The study showed significant differences in lipid profiles, blood pressure, and anthropometric parameters between diabetic and non-diabetic groups. Diabetic males and females exhibited elevated levels of triglycerides, total cholesterol, and low HDL, with diabetic females showing the highest prevalence of dyslipidemia and central obesity. Both systolic and diastolic blood pressure were higher in diabetic groups, and waist-to-hip and waist-to-height ratios were significantly elevated, indicating increased cardiovascular risk in individuals with Type 2 Diabetes Mellitus (T2DM). Discussion: The findings highlight the metabolic disturbances in T2DM, emphasizing the interconnected disruptions in glucose and lipid metabolism. Insulin resistance plays a key

Background: Hypertension is a major global health concern and a leading risk factor for cardiovascular diseases (CVD) and stroke. This cross-sectional randomised clinical study was conducted in the Varanasi district, Uttar Pradesh, India, along the "PanchKoshi marg," a 25 km circular road, around Varanasi district, during the auspicious month of Shrawan (July) in 2024. The primary objective was to identify risk factors affecting blood pressure (BP) and develop a gender-specific predictive model for early diagnosis and preventive interventions. Material and Methods: Blood pressure was measured using a standardized digital BP machine. Body weight, height, pulse rate, and circumferences of chest, waist, and hip were measured by standard procedures. A questionnaire was filled out to record the participant’s demographics, lifestyle habits, family history, physical activity, sleep duration, food habits etc. Statistical analysis was performed by Excel and SPSS software for descriptive statistics, Pearson’s correlation, and regression analysis. Results: A significant population had normal (41.50%) and elevated hypertension (27.20%). Patients with Hypertension Stage 1 (14.50%) and stage-II categories (12.20%) and Hypertensive Crisis (4.70%) were limited. Anthropometric measurements represent the gender-specific variation in SBP. Regression analysis after data stratification for age, gender and severity of hypertension, presents a non-linear relationship between SBP and other variables. However, the low sample size for hip circumference, sleep duration, physical activity and pulse-rate, indicated inconsistent results and emphasised a separate study to have a clear picture. Conclusion: The findings underscore the importance of early detection and management of hypertension to prevent cardiovascular complications in Varanasi, a district, situated in the Northern Indian geographical region. Keywords: Hypertension, Blood pressure, Varanasi, Epidemiology, Heart disease, CVD.

Background: Body image dissatisfaction, exacerbated by social media, has become a growing concern among adolescents and young adults, leading to disordered eating behaviors and mental health challenges. Medical students, in particular, face unique stressors that may amplify these issues. This study aimed to explore the influence of social media usage on body image and eating patterns among medical students at Government Medical College, Nizamabad. Materials and Methods: A cross-sectional study was conducted among 300 undergraduate medical students using a semi-structured questionnaire. The Body Shape Questionnaire (BSQ) and SCOFF Questionnaire were used to assess body shape concerns and eating disorder risk, respectively. Anthropometric measurements were also recorded. Data were analyzed using SPSS version 25. Results: The majority of students (72.0%) reported no concern with their body shape, while 20.0% reported mild concern, 5.3% moderate concern, and 2.7% marked concern. Significant associations were found between body shape perception and disordered eating behaviors, such as self-induced sickness (χ² = 16.2, p < 0.001) and fear of losing control over eating (χ² = 54.4, p < 0.001). Social media usage, particularly exposure to appearance-focused content, was significantly associated with body shape concerns (χ² = 13.7, p < 0.001). Urban residence (χ² = 7.09, p = 0.008) and mother’s employment as a government employee (χ² = 7.94, p = 0.019) were also significant predictors of body shape concerns. Conclusion: This study highlights the significant impact of social media and demographic factors on body image and eating patterns among medical students. Targeted interventions, including awareness programs and culturally sensitive strategies, are needed to promote positive body image and healthy eating behaviors in this population. These findings underscore the importance of addressing body image concerns to improve the mental and physical well-being of medical students. Keywords: Body image, Social media, Eating behaviours, Medical students, Body shape questionnaire (BSQ).

Background: Older population having femur fractures usually have multiple preexisting medical problems that may affect their treatment and outcomes. The Orthopaedic department of SCB medical college provides standardized treatment and enhanced outcomes. The purpose of this study is to determine whether femur fracture patients with specific comorbidities are at risk of worsened perioperative outcomes such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS). Materials & Methods: A total of 210 patients aged 65 years and older who underwent surgery for femur fracture at SCB Medical College from January 2024 to December 31, 2024, were evaluated. Terminally ill patients and those had not given consent were excluded from this study. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Perioperative Outcomes like mortality, TTS, postoperative complications, LOS, functional recovery were analysed. Results: Most patients are with an average age of 80. Patients with higher CCI scores had significantly increased rates of postoperative complications (p < 0.05), longer hospital stays (p < 0.01), and higher 30-day mortality (p < 0.01). Multivariate analysis identified diabetes, chronic kidney disease, and cardiovascular disease as independent predictors of poor outcomes. Conclusion: Fragility and comorbidity expose this geriatric population with femur fracture to higher risk for adverse perioperative outcomes. Preoperative optimization and tailored management strategies are essential to improve outcomes in this vulnerable population. Keywords: femur fractures, comorbidity, perioperative outcomes, diabetes, hypertension, geriatric population.

Background: Neodymium: Yattrium-Aluminum-Garnet (Nd: YAG) laser capsulotomy is a safe technique, performed for making an opening in the opacified posterior capsules. The denser the PCO there is tendency of more energy to be used, Nd: YAG capsulotomy is associated with significant anterior and posterior segment complications. This study is on impact of Nd: YAG laser energy on the rate of complications and a causal relation. Objectives: To find out association between the grade and type of PCO with energy used and its outcome. Materials and Methods: A Q-Switched Nd: YAG laser system with wavelength of 1064 nm and pulse length of <4 ns (2‑3 ns) was employed after full dilatation of pupil capsulotomy of about 4 mm in size was created. Initial setting of 1mJ and subsequent increase of 0.5 mJ as necessary used to make an opening in the posterior capsule and the number of pulses used to create capsulotomy and summated total laser energy was noted in each case. Patients were followed for 6 months each visit patients’ visual acuity, refraction, fundoscopy and IOP were examined and analyzed. Results: Out of 100 patients’ maximum number are in membranous (54%) followed by fibrous (27%) and least is fibro-membranous (19%). Among membranous subtype a greater number of patients belong to Grade 2 PCO (48.1%). Whereas in patients with Fibrous subtype maximum patients presents with Grade 4PCO (59.3%). Maximum energy is required for grade 4 (46.6 mJ) and least is for grade 1(9.7) More energy is required for fibrous (39.2mJ) and least is for membranous (26.7mJ). The complications such as IOP spikes, uveitis, hyaloid face rupture, IOL pitting, CME are common with higher total laser energy levels. Conclusion: Grade and Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas Complications such as IOL pitting, uveitis, IOP elevation, hyaloid face rupture and CME was significantly more common when total laser energy was higher. Key words: Posterior Capsular Opacity, Nd- YAG capsulotomy, Energy used for Capsulotomy.

Background: This study aimed to assess the progression of dry eye disease (DED) in postmenopausal women and evaluate the effectiveness of therapeutic interventions on subjective and objective clinical outcomes over a 12-month follow-up period. Materials and Methods: A prospective cohort study was conducted on 120 postmenopausal women aged 50 years and older with a confirmed diagnosis of DED. Baseline evaluations included demographic data, medical history, and DED assessments using the Ocular Surface Disease Index (OSDI), Tear Break-Up Time (TBUT), Schirmer Test I, and corneal and conjunctival staining. Meibomian Gland Dysfunction (MGD) was graded based on gland expression and morphology. Participants were followed for 12 months, with assessments at baseline, 3 months, 6 months, and 12 months. Statistical analyses were performed to evaluate changes in outcomes over time, with significance set at p < 0.05. Results: The mean age of participants was 58.32 ± 5.45 years, with a mean BMI of 26.75 ± 3.21 kg/m². OSDI scores significantly decreased from 45.25 ± 4.21 at baseline to 28.12 ± 3.85 at 12 months (p < 0.01). TBUT improved from 5.32 ± 0.85 seconds to 8.34 ± 0.92 seconds (p < 0.01), and Schirmer test values increased from 6.42 ± 1.12 mm to 9.02 ± 1.02 mm (p < 0.01). Corneal and conjunctival staining scores decreased from 3.45 ± 0.45 to 1.76 ± 0.33 (p < 0.01). The prevalence of MGD decreased from 55.83 ± 5.12% to 35.83 ± 4.02% (p < 0.01). Conclusion: Significant improvements were observed in both subjective and objective markers of DED in postmenopausal women over 12 months. These findings highlight the importance of comprehensive management strategies in mitigating DED progression and improving ocular surface health and quality of life in this population. Keywords: Dry Eye Disease, Postmenopausal Women, Ocular Surface Disease Index, Tear Break-Up Time, Meibomian Gland Dysfunction.

Background: Paraquat poisoning is a fatal condition due to its toxic effects on the lungs, kidneys, and other vital organs, with limited treatment options available. Early hemoperfusion has been proposed to reduce systemic toxicity and improve survival rates. This study evaluated the efficacy of early hemoperfusion in reducing mortality and complications of paraquat poisoning. Material and Methods: This hospital-based retrospective cohort analysis included 75 patients who had consumed paraquat herbicide and received hemoperfusion during their illness done over 16 months at NRI Medical College and Super Specialty Hospital from June 2022 to October 2023.Patients who underwent hemoperfusion were categorised into the early (<6 h) and delayed (>6 h) groups. Demographics, clinical outcomes, and complications were analysed, and survival rates were compared between the early and delayed intervention groups. Results: Among 75 patients, 64% were male, the age group was 20-30 years (44%), and half (47%) presented to the hospital within 6 h of paraquat ingestion. Moderate paraquat consumption was the most common (40%). Lung injury affected 96% of patients, with 73% developing acute kidney injury (AKI), 30% requiring dialysis, and 63% recovering. Acute liver injury (ALI) was noted in 64% of patients, but recovery occurred in only 36% of patients. Severe respiratory distress led to intubation in 65% of patients, with only 6% extubated. Pulmonary fibrosis was the leading complication (76%) and cause of death (73%). Delayed hemoperfusion beyond 6 hours resulted in 100 percent mortality. Conclusion: Early hemoperfusion is a time-sensitive and effective intervention to reduce mortality and systemic toxicity in paraquat poisoning. A need for prompt intervention and future research to optimise treatment protocols and explore adjunctive therapies. Keywords: Paraquat poisoning, Hemoperfusion, Pulmonary fibrosis, Acute kidney injury.

Background: Renal biopsy remains the cornerstone of definitive diagnosis, prognostication, and therapeutic decision-making in nephrology, offering critical insights into the diverse array of kidney pathologies. This study examines the spectrum of biopsy-proven renal diseases in Southern Indian population. Material and Methods: This retrospective observational study was conducted at NRI General hospital from May 2021 to June 2024.A total of 195 patients included in the study. Demographic data such as age, gender, and comorbidities were recorded from patient medical records. Clinical data, including symptoms, blood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), and urine analysis results, were documented at the time of biopsy. Results: A total of 195 patients were added in the study with an age range of 12 to 71 years and a mean age of 37.38 ± 15.1 years. Male patients accounted for 55 percent, while females comprised 43 percent. Among the patients, diabetes mellitus was present in 20 percent, hypertension in 18 percent, systemic lupus erythematosus in 15 percent, and chronic kidney disease in 10 percent. Nephrotic syndrome showed a positive correlation with membranous nephropathy (ρ = 0.34, p = 0.001) and minimal change disease (ρ = 0.28, p = 0.005). Acute kidney injury was strongly associated with acute interstitial nephritis (ρ = 0.41, p < 0.001). Hypertension was significantly linked to diabetic nephropathy, with an odds ratio of 3.2 (p = 0.003, 95% CI: 1.5–6.8). Conclusion: It is concluded that the spectrum of biopsy-proven renal diseases in this cohort reflects a diverse array of glomerular, tubulointerstitial, and vascular pathologies, with primary glomerular diseases (64.1%)notably IgA nephropathy (22.6%), FSGS (18.5%), and membranous nephropathy (15.9%), dominating the diagnostic methods. Keywords: Renal Biopsy, Nephrotic syndrome, Membrane Nephropathy, Hypertension, systemic lupus erythematosus.

Background: Anemia in heart failure is complex and multifactorial. Anemia is defined when Hb concentration is less than 13 g/dL for men or less than 12 g/dL for women. Iron deficiency in patients with HF is defined as either serum ferritin concentration of <100 ng/mL or 100-299 ng/mL with transferrin saturation (TSAT) <20%. Among CKD patients, absolute iron deficiency is defined when the transferrin saturation (TSAT) is ≤20% and the serum ferritin concentration is ≤100 ng/mL among predialysis and peritoneal dialysis patients or ≤200 ng/mL among hemodialysis patients. Aims: To evaluate patients with anemia and heart failure clinically, laboratory and echocardiography and to reduce subsequent hospitalisations of heart failure by identifying cause of anemia and correcting anemia. Material and Methods: We analysed data from100patients of heart failure (HFrEF)with anemia. Each underwent blood test for hemoglobin, hematocrit, serum ferritin, transferrin saturation, CXR, ECG, echocardiography, NT pro BNP. We classified patients as having mild and moderate and severe anemia with lv systolic dysfunction. The data was entered in Microsoft excel sheet and analysed using percentage. The difference in proportions was tested using chi-square test. Results: Mean age of the patients were between 20-80yrs with 30% of patients between 50-59yrs.Iron deficiency anemia was confirmed by Hb, serum ferritin in 80 patients and Hb, serum ferritin and transferrin saturation in 20 chronic kidney disease patients. The left ventricular ejection fraction was mild LVSD in 50%, moderate LVSD in 30% and severe LVSD in 20% patients. NTPro BNP was elevated in all patients,20% having >900pg/ml. ECG was showing tachycardia in 40% and St-T changes and LVH in 60% patients. CXR showing cardiomegaly in 80%patients. Oral medication was given for 10%patients. IV iron therapy was given for 90%patients and erythropoietin in 20%patients and packed cell transfusion was given in 10%patients. Conclusion: In this group of patients, iron deficiency anemia was commonest cause. Oral iron is poorly absorbed, so administration of intravenous iron therapy (ferric carboxy maltose) is the only viable treatment option, with beneficial effects on most subjective outcomes, including NYHA class, 6MWD, patient global assessment, QoL, and fatigue score. There was improvement in hospitalizations for HF. For patients with CHF with anemia and concomitant chronic kidney disease, treatment with erythropoietic agents and supplemental iron reached hemoglobin to a target of 12 g/dl and improved quality of life. Red blood cell transfusion is recommended under careful monitoring in cases of severe anemia. The therapy must be strictly individualized considering the cost–benefit ratio. Keywords: Hemoglobin, Heart failure, Transferrin saturation (TSAT).

Background: Aims: To compare the recurrence rates and the postoperative morbidity and outcome between Desarda's technique and Lichtenstein's technique for primary unilateral inguinal hernia. Materials and Methods: This is a comparative study conducted from the patients admitted with the diagnosis of unilateral primary inguinal hernia in SVS Medical College & Hospital from June 2017 to June 2020. The patients were subjected to either Lichtenstein or Desarda method of hernia repair. Results: Duration of surgery is insignificant, Recurrence with 3 cases (12%)and Seroma formation is more lichtenstein operated group with 5 cases (20%) with no significance when compared. During the follow up period, at one month and six months, 7(35%) cases and 4(20%) cases persisted to have mild pain respectively in Lichtenstein repair, whereas none of the patients in Desarda repair had any kind of pain which is statistically significant. Two (10%) patients continued to have chronic pain at the end of 1 year in the Lichtenstein group. Time to return to daily activities was 92% in case of desarda repair and 76% in Lichtenstein repair. Time taken to resume normal activities in case of Desarda herniorrhaphy was 88% as compared to Lichtenstein hernioplasty, which is 67%. No complications observed in followup. Conclusions: Desarda repair technique outperforms Mesh repair in terms of operating time. Additionally, the differences in postoperative complications between the two techniques are statistically insignificant. Keywords: Hernia, Lichtenstein Repair, Desarda Repair, Seroma.

Background: Neonatal hearing screening (NHS) is crucial for the early detection of hearing impairments, which can significantly affect language development and cognitive abilities if not addressed promptly. This study evaluates the outcomes of NHS programs focusing on the efficacy of early diagnosis and subsequent interventions. Materials and Methods: A cross-sectional analysis was conducted on a cohort of 200 neonates who underwent NHS. Data were collected on the rates of successful early diagnosis, delayed diagnosis, and missed diagnoses. Additionally, the effectiveness of the interventions was assessed based on improvements in auditory and verbal capabilities. Factors influencing the success rates of interventions and long-term developmental outcomes were also analyzed. Results: Of the neonates screened, 34% were diagnosed successfully at an early stage, 64% experienced delayed diagnosis, and 2% were missed. Interventions following early screenings showed that 41% of neonates improved in auditory capabilities and 42% in verbal capabilities. However, 17% showed no improvements. Key factors contributing to the success of interventions included parental involvement, follow-up compliance, and resource availability. Long-term developmental outcomes indicated that 53% of early-diagnosed neonates displayed better language skills, but 33.5% showed no significant differences in development compared to those with delayed diagnoses. Conclusion: While NHS programs are effective in early detection for a significant portion of neonates, improvements are needed to reduce delayed and missed diagnoses. Enhanced follow-up protocols, increased resource allocation, and greater parental engagement are essential for maximizing the benefits of early interventions. These findings highlight the need for standardized practices and increased accessibility to ensure effective early hearing loss interventions across diverse healthcare settings. Keywords: Neonatal Hearing Screening, Early Diagnosis, Intervention Outcomes.

Background: Febrile seizures are the most common neurological condition in children aged 6 months to 6 years. Zinc deficiency has been proposed as a potential risk factor, but its role remains unclear. This study aimed to evaluate serum zinc levels in children with febrile seizures compared to febrile children without seizures. Material and Methods: A comparative cross-sectional study was conducted on 100 children aged 6 months to 6 years, with 50 children in each group. Serum zinc levels were measured using atomic absorption spectrophotometry. Zinc levels below 0.3 mg/L were classified as deficient. Data on age, gender, socioeconomic status, nutritional status, and seizure type were analyzed, and statistical tests were applied to identify significant associations. Results: The median zinc levels in children with febrile seizures were 146.5 µg/dL (IQR: 101.7–169), compared to 141 µg/dL (IQR: 95.75–180.5) in children without febrile seizures, with no statistically significant difference (p = 0.733). Low zinc levels were more prevalent in older children, females, and those from lower socioeconomic backgrounds in both groups, but these differences were not statistically significant. Children with simple febrile seizures had a higher prevalence of low zinc levels compared to those with complex febrile seizures (85.7% vs. 14.3%, p = 0.657). Conclusion: This study found no significant difference in serum zinc levels between children with febrile seizures and those without. Zinc deficiency may not be a universal risk factor for febrile seizures, but further large-scale studies are needed to clarify its role. Keywords: Febrile seizures, zinc deficiency, serum zinc levels, children, risk factors, nutritional status.

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in children, due to its paucibacillary nature, nonspecific clinical symptoms, and challenges in sample collection. Conventional diagnostic methods, such as smear microscopy and culture, have limitations in pediatric populations. Gene-Xpert MTB/RIF, a rapid molecular diagnostic tool, has emerged as a promising method for detecting Mycobacterium tuberculosis and rifampicin resistance. This study evaluates the utility of Gene-Xpert in diagnosing presumptive TB in children and its correlation with other diagnostic modalities. Material and Methods: This prospective observational study included 44 children with symptoms suggestive of TB, conducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Navi Mumbai, over 18 months. Detailed clinical evaluations, radiological assessments (chest X-ray and CT), Mantoux tuberculin skin test (TST), and microbiological testing (Gene-Xpert MTB/RIF and MGIT culture) were performed. The final diagnosis was categorized into pulmonary and extra-pulmonary TB with and without microbiological confirmation. Statistical analysis included sensitivity, specificity, and p-values for diagnostic correlations. Results: The majority of the study population (63.6%) were aged 6–12 years, with fever (81.8%) and cough (65.9%) as the most common symptoms. Radiological findings showed that 22.7% of chest X-rays and 69.2% of CT scans were suggestive of TB. Gene-Xpert identified TB in 20.5% of cases, with 88.9% drug-sensitive and 11.1% rifampicin-resistant cases. Extra-pulmonary TB without microbiological confirmation was the most common diagnosis (50%). Gene-Xpert demonstrated a higher correlation with CT findings (p = 0.102) compared to chest X-rays (p = 0.56). Conclusion: Gene-Xpert is a valuable diagnostic tool for pediatric TB, particularly for identifying rifampicin resistance. However, its limitations as a rule-out test emphasize the need for a multimodal diagnostic approach that includes clinical evaluation, imaging, and histopathological analysis. Addressing implementation challenges in resource-limited settings is crucial to improve access to this rapid diagnostic method. Keywords: Pediatric tuberculosis, Gene-Xpert MTB/RIF, diagnostic methods, extra-pulmonary tuberculosis, Mantoux test, CT chest, microbiological confirmation.

Background: Stroke remains a leading cause of morbidity and mortality worldwide. Oxidative stress and lipoprotein(a) [Lp(a)] have emerged as critical biomarkers in the pathophysiology of stroke. This systematic review aims to explore the role of oxidative stress markers and Lp(a) levels in stroke patients within tertiary care settings. We analyze recent studies highlighting the interplay between oxidative damage and lipid abnormalities, their diagnostic and prognostic implications, and the potential for targeted interventions. Findings underscore the need for further research to standardize biomarker use in clinical practice. Materials and Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for articles published between 2015 and 2025. Keywords included "oxidative stress markers," "lipoprotein(a)," "stroke," "biomarkers," and "tertiary care." Inclusion Criteria: Studies assessing oxidative stress markers and/or Lp(a) levels in stroke patients, conducted in tertiary care settings, and published in peer-reviewed journals. Exclusion Criteria: Non-human studies, reviews without original data, and studies focusing on other neurological disorders. Data Extraction and Analysis: Data on study design, population characteristics, biomarker levels, diagnostic accuracy, and clinical outcomes were extracted. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Results & Discussion: Malondialdehyde (MDA): Elevated levels of Malondialdehyde (MDA), a lipid peroxidation marker, were consistently reported in ischemic and hemorrhagic stroke patients. MDA correlates with infarct size and neurological deficits. Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPx): Stroke patients exhibited reduced activity of antioxidant enzymes, highlighting impaired oxidative defense mechanisms. 8-Hydroxy-2'-Deoxyguanosine (8-OHdG): This DNA damage marker is significantly elevated in acute stroke and correlates with poor outcomes. Lipoprotein(a) Levels in Stroke: Elevated Lp(a) levels were associated with an increased risk of ischemic stroke, particularly in patients with concurrent cardiovascular risk factors Lp(a) contributes to pro-inflammatory and pro-thrombotic pathways, exacerbating vascular damage in stroke. Studies highlighted the genetic regulation of Lp(a) levels, suggesting variability in susceptibility among different populations. Conclusion: Thorough systematic analysis of studies revealed decrease in level of Glutathione peroxidase(GPx) and superoxide dismutase(SOD). In case of Malondialdehyde(MDA) and Lipoprotein(a), levels were higher in stroke patients in golden period i.e. first 60 minutes as well as in first 24 hours. This shows promising role of reduced Glutathione peroxidase(GPx) and Superoxide dismutase(SOD) in assessing oxidative stress in early ischaemic period of stroke. Similar analysis of studies using Lipoprotein(a) biomarker further gave corroborative evidences of increased levels in stroke patients. On the basis of these studies and findings we can conclude that measurement of these biomarkers give an important clue in identifying risk factors for stroke. Conflict of interest.

Background: Cholecystectomy represents one of the most frequently conducted intraabdominal surgical intervention. Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer. Hence; the present study was conducted to evaluate effectiveness of ropivacaine as a postoperative analgesic in patients undergoing laparoscopic cholecystectomy. Materials & Methods: A total of 40 patients scheduled for laparoscopic cholecystectomy participated in this study. The laparoscopic cholecystectomy procedures were performed by an experienced surgeon, utilizing 20ml of 0.375% Ropivacaine for intraperitoneal instillation at the end of procedure. Postoperative pain was measured using the Visual Analog Scale (VAS), and rescue analgesia was administered to those with a VAS score exceeding 3. The VAS ranged from 0 to 10, where 0 represented no pain and 10 indicated the most severe, intolerable pain. All data were compiled in a Microsoft Excel spreadsheet and analysed using SPSS software. Results: Mean age of the patients was 45.3 years with 62 percent of the patients being males while the remaining were females. Mean duration of procedure was 112.3 minutes. Mean VAS at 0 hours, 2 hours, and 4 hours was 1.56, 2.23 and 2.11 respectively. Number of patients requiring of rescue analgesia at 0 hours, 2 hours and 4 hours was 0 percent, 4 percent and 10 percent of the patients respectively. Conclusion: Laparoscopy-assisted administration of ropivacaine effectively reduces pain levels in patients undergoing laparoscopic cholecystectomy. Key words: Laparoscopic cholecystectomy, Pain, Ropivacaine.

Background: Pancytopenia, a clinico-hematological condition characterized by simultaneous reduction in three major formed blood elements i.e. anaemia (Hb<12g/dL in female, Hb<13g/dL in male), leucopenia (TLC<4000/ml) and thrombocytopenia (Platelets<1.5 lacs/µl). Aims: To study the clinical-hematological profile of the cases of pancytopenia and evaluate the role of bone-marrow aspirate (BMA) and biopsy (BMB) to diagnose and classify them according to Etiology. Material and Methods: The Present study was a hospital based prospective study. A total of 150 cases of pancytopenia were studied between September 2020 to October 2022. Detailed clinical history and physical examination were taken along with Peripheral blood smear examination, Complete Blood Count and BMA. BMB were also performed wherever feasible. Results: Most of the cases were in the age group of 11-20 years with Male: Female of 1.4:1 with age ranging of 2-75 years. BMA and BMB were done in 93 and 57 cases respectively. Most common cause of pancytopenia was Aplastic Anaemia (25.3%) followed by Megaloblastic Anaemia (16.7%). Aplastic anaemia showed concordance of BMA with BMB in only 27 cases out of 38, reflecting BMB is necessary procedure to be done for proper evaluation and diagnosis of Aplastic anemia. Most common cause diagnosed on BMA was megaloblastic anaemia (25) followed by Aplastic Anaemia (21). Conclusion: BMA and BMB are important adjuncts to PBS examination for evaluation of pancytopenias. Along with proper clinical history, clinical examination, general blood picture studies, we need to do BMB procedures also with BMA for proper diagnosis and prognosis of a patient having Pancytopenia, specially in cases of dry tap. Key words: Aplastic Anaemia, Bone marrow, Pancytopenia.

Background: Intertrochanteric fractures are a common type of hip fracture, particularly in the elderly population. The aim of this study was to evaluate union of intertrochanteric fractures of hip treated with proximal femoral nail. Materials and Methods: This prospective study included 45 patients with intertrochanteric fractures treated with PFN at Department of Orthopaedics, GMERS Medical College, Gandhinagar, Gujarat, India. The inclusion criteria comprised patients aged 18-90 years who suffered from intertrochanteric fractures and were undergoing primary or index surgery. Results: The majority of patients were elderly, with 71-80 years being the most common age group. Trivial trauma, often due to domestic accidents, was the leading cause of these fractures. The study demonstrated favorable radiological findings, with 88.88% of patients showing union, and a high success rate of close reduction (88.88%). The procedure was completed within 1 hour in 77.77% of cases. Conclusion: The results suggest that PFN is an effective treatment option for intertrochanteric fractures, particularly in the elderly population. The advantages of PFN include stable fixation, near-perfect reduction, early weight-bearing, and ambulation, shortened hospital stay, and improved rate of union. Keywords: Intertrochanteric Fractures, Proximal Femoral Nail (PFN), Treatment Outcomes, Elderly Population, Hip Fractures.

Background: Diabetes mellitus (DM) is a chronic disease derived from the inadequate production of insulin in the pancreas or from the ineffective use of available insulin and it is a relevant chronic degenerative disorder. The present study was conducted to evaluate early onset of subclinical hearing loss in children with type 1 diabetes mellitus. Materials & Methods: 20 patients between age group of 6-16 years with confirmed diagnosis of Type 1 DM and average disease duration of more than 1 year were enrolled. Another set of 20 subjects which were age and gender matched were included as control group. Audiological assessment of all the subjects was done. Audiological testing was done using pure tone audiometry (PTA) and Otoacoustic emission (OAE). Results: In the present study high frequency SNHL was seen in 10 percent of the children of diabetic group. Among these two subjects, one was male while the other was female. Conclusion: Early identification is significant in affected children so that prompt treatment could be started. Key words: Subclinical, Diabetic, Hearing Loss, Children

Background: Thyroid disorders are the most common endocrinopathies seen in the world. It is estimated that nearly 42 million people in India suffer from thyroid related disorders. Hypothyroidism is prevalent to the extent of 9.45-11.73% among Indian population as reported in a recent survey. Hypothyroidism is a condition where the thyroid gland doesn't produce enough thyroid hormones resulting in weight gain, cold intolerance, tiredness and other metabolic disturbances. Dyslipidemia is commonly encountered in hypothyroidism with high serum Total Cholesterol (TC) levels, elevated Low Density Lipoprotein-Cholesterol (LDL-C) levels and increased triglyceride levels. Non HDL-C includes all the cholesterol in lipoprotein particles that is considered to be atherogenic. Untreated hypothyroidism impairs quality of life and also a potential risk for cardiometabolic complications. Hence early screening and management of hypothyroidism is essential to reduce the cardiometabolic risk. Aims and Objectives: To estimate the levels of Non-HDL-C in hypothyroid patients as compared to normal subjects and to assess its reliability as a simple cost effective biomarker to predict the future cardiovascular risk in hypothyroid patients. Materials And Methods: The present study is Observational- Case control study. This study is conducted in the Department of Biochemistry, Thanjavur medical college, Thanjavur. 70 known hypothyroid patients attending General medicine OPD, TMCH are selected as cases and the corresponding age and gender matched 70 healthy individuals are selected as controls. Total sample size selected for each group is 70. Thyroid profile – TSH, T3, T4 estimation is done by ELISA method. Lipid profile is estimated in ERBA XL640 Fully automated analyzer by enzymatic method. Non- HDL-C (mg/dl) = Total Cholesterol – HDL cholesterol. Statistical Analysis: The data were entered in MS office excel sheet and analyzed using SPSS version 21. Continuous data with normal distribution was expressed as mean with standard deviation. Unpaired ‘t’ test was used to compare the means between the controls and cases. Pearson’s correlation was used to determine the direction and degree of association of N-HDLC with TSH. P <0.05 was considered statistically significant. Results: In the present study it was noted that Non-HDL-C was significantly high in hypothyroid patients (137.57± 40.26) when compared to healthy controls (107.05± 26.38) and the p value is statistically significant. Conclusion: Non-HDL-C significantly predicts cardiometabolic risk factors in patients with hypothyroidism and could be used as a feasible biomarker to assess atherogenic risk in patients with hypothyroidism. Keyword: Hypothyroidism, Dyslipidemia, Non HDL

Background: This study evaluated the condition of referral and quality of transportation of newborns referred to our institution, clinical status at the time of admission and the outcome of these newborns. Materials and Methods: This Hospital-based descriptive type of Prospective Observational study enrolled 256 newborns from the Department of Paediatrics, SMS Medical College, Jaipur from May 2017 to April 2018. All newborns were assessed by a structured case performa relating to pre-transport and intra-transport conditions. The TOPS score of each newborn was recorded on arrival and they were followed concerning their final diagnosis and outcome. Results: The maximum referrals were from government hospitals (75.8%), and most of the referral notes were incomplete (70.56%). The incidence of poor outcomes was directly proportional to the TOPS score on the arrival of the newborn. Conclusion: The neonatal referral system needs to be improved urgently to improve the outcomes of referred newborns. Keywords: neonatal transport, referral, neonatology, TOPS score

Background: The Ministry of Health and Family Welfare in September 2017 has launched a new contraceptive, an injectable contraceptive MPA under Antara program to expand the basket of contraceptive choices to meet the emerging needs of couples. A cross sectional study was conducted in urban and rural area of Indore to assess the Knowledge, attitude and practice of injectable ANTARA (Medroxy progesterone acetate) among 120 beneficiaries from urban and 50 beneficiaries from rural health who are using ANTARA for more than 3 months using predesigned semistructered questionare. This study also analysed the incidence of side effects and drop out rate among the users of ANTARA (injectable MPA). The findings of this study suggest that most of the beneficiaries were using ANATRA as an interval contraceptive after their first child as a spacing method. Beneficiaries opined that complications (like irregular bleeding and amenorrhea) were deterrent and posed a major drawback for its long term uses. Key Words: ANTARA, beneficiaries, health care providers, contraceptive, medroxy progesterone acetate.

Background: Mental disorders were the second leading cause of disease burden in terms of years lived with disability (YLDs) and the sixth leading cause of disability-adjusted life-years (DALYs) in the world in 2017, posing a serious challenge to health systems, particularly in low-income and middle-income countries[1] WHO theme for World Health Day 2017[2]- “Depression—let’s talk”. Sex differentials were observed in the distribution of mental disorders in India. The observed higher prevalence of depressive and anxiety disorders in females than in males has also been reported, which could be related to gender discrimination, violence, sexual abuse, antenatal and postnatal stress, and adverse socio-cultural norms[4]. Material and Methods: AIM: To Study the prevalence of Postpartum depression in urban field practice area of Osmania medical college, Hyderabad, Telangana. Objectives of the study: 1. To study the socio-demographic profile among the study subjects. 2. To Estimate the prevalence of postpartum depression among the study subjects. 3.To determine the risk factors associated with postpartum depression among the study subjects. Results: The present study was conducted among N= 270 postpartum women residing in field practice are of osmania medical college. According to present study The prevalence of postpartum depression was found to be P=33.7%. Conclusion: Maternal age, Lower socio-economic status, Unplanned pregnancy, Lack of support from husband and family contributed for posptpartum depression. Keywords: Postpartum depression, multiparous, Tertiary health care centre.

Background: Mumps is most common outbreak occurring in community. It is an acute viral infection characterized by painful enlargement of salivary glands (most commonly the parotid glands). Mumps is caused by an RNA virus of genus Paramyxovirus in the family paramyxoviridae; only one serotype is known. Most commonly occurring in school going children. Rarely complications like orchitis, oophoritis, Aseptic meningitis may occur. It has excellent prognosis with proper treatment. Though MR Vaccination is given the community epidemics are occurring. Aim and Objectives: The objective of this study is to assess the incidence and clinical pattern of MUMPS Outbreak in 2024 in a Tertiary Care Centre in Mahabubnagar; Telangana. Materials and Methods: This is an observational hospital-based study done in Govt. General Hospital, Mahabubnagar from March 2024 to May 2024. Children presenting with fever, malaise, pain and swelling of parotid and sub maxillary salivary glands are included in our study. Clinical features, laboratory parameters are studied and analysed. Results: Among the 150 cases studied, 95(63.3%) are males and 55(36.6%) females; Among them Vaccinated (90.0%) and unvaccinated (10.0%).Children who required admission are 14 cases. Orchitis a complication occurred in 1 patient. Remaining managed on Out-patient basis.No deaths occurred. Average duration of hospital stay is around 03 to 05 days. Conclusions: Early diagnosis and supportive treatment is corner stone for good recovery in MUMPS. With proper notification and preventive measures the outbreak may be prevented. Strong clinical suspicion, early diagnosis and careful management reduces morbidity and mortality. Key words: MUMPS, Paramyxoviridae, Orchitis, Parotid and Submaxillary salivary glands.

Background: Diabetes mellitus (DM) affects all parts of the eye, but it primarily causes retinal complications which are vision threatening. There is exponential rise in the number of DR patients with the rise in the prevalence of DM. A collaborative strategy for screening and management is crucial in preventing blindness from Diabetic retinopathy. This study was conducted to estimate central macular thickness in patients with type 2 diabetes mellitus without clinical retinopathy. Aim and Objectives: The study aims to compare the Central Macular Thickness (CMT) in patients with Type 2 diabetes mellitus without clinical retinopathy to that of normal controls, assess the relationship between CMT and the duration of diabetes mellitus in these patients, and evaluate the changes in CMT in relation to HbA1c levels in Type 2 diabetic patients. Materials and Methods: A Retrospective case control study included 70 cases and 70 controls. Diabetic patients without clinical retinopathy inclusion criteria were included in the study after proper consent. Results: Showed significant increase in thickness of central macula in type 2 DM patients when compared to normal controls (p=0.003). It shows a moderate positive Correlation between HbA1c levels and CMT in cases compared to controls (p=0.003) with Mean CMT being thicker in patients with high HbA1c. Conclusion: HbA1c and duration of diabetes mellitus is the main factor affecting the mean CMT value. This study also showed that with increase in duration of diabetes there is increase in mean CMT. Keywords: Diabetes mellitus; Central Macular Thickness; CMT; Clinical retinopathy; HbA1c.

Background: Off-Pump coronary artery bypass graft surgery (OPCABG) continues to be the main stay of surgical coronary revascularization for coronary artery disease in India. We evaluated the role of Trimetazidine (TMZ) in prevention of myocardial injury in patients undergoing OPCABG. Material and Methods: A randomized prospective study was carried out to evaluate the efficacy of Trimetazidine in the prevention of myocardial tissue injury by measuring pre-operative and post-operative levels of cardiac troponin I (cTnI) at 8, 24 and 48 hours in patients undergoing elective OPCABG surgery. Seventy patients undergoing elective CABG were included in the study and were randomly (Covariate adaptive randomization) assigned to two groups, TMZ and Control (no TMZ) group. Thirty-five patients, received 80 mg of TMZ once daily in the pre-operative period (started a week before admission), were assigned to the TMZ group and thirty-five patients who did not receive TMZ, were assigned to the control group. Results: In a study involving 150 enrolled cases, it was observed that 24 individuals experienced hypoglycemia within the first 72 hours of life. The occurrence of hypoglycemia observed in our study was 16%. Hypoglycemia occurred more frequently in neonates born to mothers under the age of 30; however, this association was not statistically significant. The incidence of hypoglycemia was observed to be higher in infants born via LSCS. In our research, we analyzed a total of 150 enrolled cases, of which 112 were classified as term, 30 as preterm, and 8 as post term. Our research identified 20 instances classified as small for gestational age (SGA). Among these, 13 were categorized as Term SGA, while 7 were identified as Preterm SGA. Conclusion: Despite similar pre-operative baseline characteristics and pre-operative cTnI values, post- operative cTnI values showed a rising trend in both the groups, with the values peaking at 8 hours and thereafter following a gradual declining trend at 24 and 48 hours. However, the rise in cTnI levels, were significantly higher in the control group as compared to the TMZ group, in the post-operative period. Key Words: TMZ – Trimetazidine, OPCAB - Off pump Coronary Artery Bypass, cTnI - Cardiac Troponin I, CABG - Coronary Artery Bypass Grafting.

Background: Autoimmune hemolytic anemia (AIHA) is a condition, characterized by an accelerated destruction of red blood cells (RBC’s) due to presence of autoantibodies. The destruction predominantly occurs extravascularly particularly in spleen and liver, but may occasionally occur intravascularly. While the clinical course of AIHA is invariably divergent, early recognition and timely intervention can gain a lead point in time and can prevent severe complications. Case report: The present case series describes four unlike cases of AIHA with pluralistic associations—AIH with AIHA, AIHA with Lupus with DVT (LAHPS), AIHA with SLE, idiopathic with no association. All were treated with steroids as the first and prime line agents and kept under regular follow up. Conclusion: The present case series highlights the spectrum of AIHA and the enmeshed conditions, emphasizing their clinical presentations and tailored management strategies. Keywords: SLE (Systemic Lupus Erythematosus), AIH (Auto Immune Hepatitis), LAHPS (Lupus anticoagulant Hypoprothrombinemia Syndrome). Idiopathic

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, requiring precise pre-procedural imaging for successful catheter ablation. Computed Tomography (CT) and Three-Dimensional Rotational Angiography (3DRA) are widely utilized imaging modalities for left atrium (LA) and pulmonary vein (PV) assessment. While both techniques provide comparable anatomical visualization, differences in radiation exposure, contrast agent usage, and procedural guidance impact their clinical utility. This study evaluates the effectiveness of CT and 3DRA in guiding AF ablation and determines which modality offers superior safety and procedural advantages. Objectives: To compare CT and 3DRA in pre-procedural imaging for atrial fibrillation ablation, focusing on their efficacy in LA visualization, procedural accuracy, radiation exposure, and contrast agent requirements. Materials and Methods: A retrospective study was conducted on 200 patients undergoing AF ablation, divided into CT (n = 100) and 3DRA (n = 100) groups. Key parameters, including ejection fraction (EF), LA size, structural heart disease, AF subtypes, and imaging efficiency, were statistically analyzed. Radiation exposure and contrast agent usage were also compared. Results: The study found no statistically significant differences between 3DRA and CT in LA size, EF, and AF subtype distribution (P > 0.05). However, 3DRA demonstrated significantly lower radiation exposure and contrast agent usage compared to CT, making it a safer alternative for certain patient populations. Additionally, 3DRA provided real-time intra-procedural guidance, offering enhanced accuracy during ablation procedures. Focal left atrial tachycardia detection was significantly lower in 3DRA than CT (P = 0.010), suggesting a procedural advantage for 3DRA. Conclusion: Both CT and 3DRA are effective pre-procedural imaging modalities for atrial fibrillation ablation, with CT providing high-resolution anatomical mapping and 3DRA offering lower radiation exposure and real-time procedural guidance. Given the advantages of reduced radiation and contrast agent use, 3DRA may be a preferable option in cases where minimizing patient risk is a priority. Future research should investigate whether long-term procedural success rates differ between these imaging modalities. Keywords: Atrial fibrillation, catheter ablation, computed tomography (CT), three-dimensional rotational angiography (3DRA), left atrium imaging, pulmonary veins, radiation exposure, procedural guidance.

Background: The patella, commonly referred to as the kneecap, is the largest sesamoid bone in the human body. It develops within the tendon of the quadriceps femoris muscle and plays a crucial role in knee joint biomechanics. Positioned subcutaneously on the anterior aspect of the knee joint, the patella is particularly vulnerable to trauma due to its exposure. Additionally, it is subjected to varying mechanical stresses due to different squatting and sitting postures, particularly in populations where deep flexion of the knee is common. Functionally, the patella acts as a protective shield over the femoral condyles, enhancing joint stability and preventing excessive wear of the articular cartilage. Understanding the morphometric characteristics of the patellar articular facets is essential for orthopedic surgeons, as these dimensions directly influence surgical approaches in patellar fractures, knee arthroplasty, and prosthesis design. Furthermore, such anatomical knowledge is vital in forensic sciences for skeletal identification and medico-legal investigations. Aim: The present study aims to measure and analyze the morphometric parameters—including length and width—of the medial and lateral articular facets on the posterior surface of the patella. The findings will provide critical insights into the anatomical variations that may impact orthopedic procedures, prosthesis development, and forensic applications. Materials and Methods: This study was conducted in the Department of Anatomy, SKIMS Medical College, Bemina, Srinagar, using a total of 45 dry human patellae. Among these, 24 were from the right side and 21 from the left side. The dimensions of the medial and lateral articular facets were measured using a digital Vernier caliper with an accuracy of 0.01 mm. The mean values and standard deviations for each parameter were calculated and analyzed statistically to determine variations between right and left patellae. Results: The morphometric analysis of the patellar articular facets yielded the following findings: Lateral Articular Facet: Mean length on the right side: 28.6 mm ± 1.6 mm, Mean length on the left side: 28.2 mm ± 1.7 mm, Mean width on the right side: 23.5 mm ± 1.8 mm, Mean width on the left side: 23.1 mm ± 1.5 mm Medial Articular Facet: Mean length on the right side: 23.8 mm ± 2.1 mm, Mean length on the left side: 23.3 mm ± 1.9 mm, Mean width on the right side: 21.1 mm ± 1.9 mm, Mean width on the left side: 20.2 mm ± 1.8 mm. Conclusion: The present study provides valuable morphometric data on the medial and lateral articular facets of the patella, contributing to the anatomical and clinical understanding of the knee joint. These findings have significant applications in: Orthopedic Surgery – Assisting in patellar reconstruction, fixation of patellar fractures, and surgical planning for knee injuries. 1. Prosthesis Design – Enhancing the accuracy of patellar implants used in total knee replacement (TKR) and patellofemoral unit prostheses. 2. Forensic Anthropology – Aiding in skeletal identification and comparative anatomical studies for medico-legal cases. A precise understanding of these dimensions can optimize surgical outc

Background: Pleural effusion is a common clinical condition with various etiologies, classified as exudative or transudative based on underlying pathophysiology. While Light’s criteria have been the standard diagnostic tool, recent studies suggest that pleural fluid cholesterol (pCHOL) may serve as a more specific biomarker. This study aims to evaluate the diagnostic performance of pleural fluid cholesterol in differentiating pleural effusions and compare its accuracy with traditional biochemical markers. Materials and Methods: This was a cross-sectional study involving 75 patients with clinically diagnosed pleural effusion. Cases were classified into exudative and transudative effusions based on etiological diagnosis, Light’s criteria, and pleural cholesterol levels. Pleural fluid samples were analyzed for protein, lactate dehydrogenase (LDH), and cholesterol, using biuret method (protein), UV spectrophotometry (LDH), and CHOD-PAP enzymatic method (pCHOL). The diagnostic sensitivity, specificity, and accuracy of pCHOL were compared to Light’s criteria. A pCHOL cutoff of 45 mg/dL was used, based on prior literature. Results: Among the 75 cases, 49 (65.3%) were exudates and 26 (34.7%) were transudates. Pleural fluid cholesterol levels were significantly higher in exudates compared to transudates (mean pCHOL: 76.8 ± 15.5 mg/dL vs. 31.05 ± 11.39 mg/dL, p < 0.001). The diagnostic performance of pCHOL (cutoff 45 mg/dL) yielded a sensitivity of 98.5% and specificity of 99.8%, which was superior to the protein ratio (sensitivity 83.2%, specificity 84.9%) and LDH ratio (sensitivity 88.1%, specificity 96.2%). Conclusion: Pleural fluid cholesterol demonstrated excellent diagnostic accuracy, outperforming Light’s criteria in differentiating exudative from transudative effusions. Given its high sensitivity, specificity, and ease of measurement, pCHOL should be considered a primary diagnostic marker in pleural effusion analysis, especially in cases where Light’s criteria are inconclusive. Keywords: Pleural effusion, pleural fluid cholesterol, exudative effusion, transudative effusion, Light’s criteria, lactate dehydrogenase, diagnostic biomarker.

Background: The goal of this analysis is to evaluate the effectiveness of non-mesh tissue repair (Desarda) against mesh repair (lichtenstein). Materials and Methods: It is a prospective randomised controlled trial done Department of General Surgery, study included all patients with inguinal hernias diagnosed clinically and by radiologically examination, patients aged 21 to 60 years who were treated for inguinal hernia over a period of twenty months. Patients were randomly assigned to one of 2 groups. Group I (Control Group): Tension-free Lichtenstein Mesh Repair: Group II: Desarda No Mesh Tissue Repair. Results: The Lichtenstein repair and Desarda procedures of primary inguinal Hernia repair do not differ in the means of procedure, complexity, local complications and pain intensity is higher in Lichtenstein repair compared to Desarda’s repair. The time taken for return to normal nonsternous activity is significantly higher for Lichtenstein group compared to Desarda’s repair. The mean hospital stay is low for Desarda’s repair compared to Lichtenstein repair. The patients are satisfied with the Lichtenstein repair and Desarda’s repair with surgery outcome. There is no recurrence of hernia seen in both groups during follow up period. Conclusion: Desarda’s operation is simple to perform, does not require foreign body like mesh or complicated dissection of the inguinal floor as in bassini and shuoldice. Desarda’s technique is cost effective when compared with Lichtenstein method, so early can do in rural areas. Keywords: Desarda’s repair, Lichtenstein repair, Inguinal hernia.

Malaria is one of the most prevalent human infections worldwide and among the oldest of diseases with far reaching repercussions in human history and remains a major cause of mortality and morbidity. Thrombocytopenia has been reported to be associated with malaria, with an incidence ranging from 24% to 94%, with some studies reporting a higher incidence in vivax malaria as compared to falciparum malaria. Various hypotheses are postulated about the Mechanism of thrombocytopenia in malaria but the exact mechanism is not clear yet. Possible mechanisms include Coagulation Disturbances, Immune mechanisms, Oxidative stress, Bone marrow alteration, Direct damage by parasites, Splenic sequestration. The present study was aimed to evaluate the incidence and severity of thrombocytopenia and to correlate the grade of thrombocytopenia with various species of malaria. We also studied the incidence of bleeding manifestations in malaria. This study was conducted in the Department of Medicine, Hindu Rao Hospital, Malkaganj, Delhi from August 2019 to May 2021. A total of 120 patients who were diagnosed to have Malaria fulfilling all the inclusion and exclusion criteria admitted or treated on Outpatient basis were included in the study. Platelet counts, bleeding manifestation, recovery of platelet counts was studied in these patients. In our study, 82.5% of the patients of malaria had thrombocytopenia. Thrombocytopenia was seen in 86.2% of cases of P. vivax, 68% cases of P.valciparum, 100% cases of Mixed infection There is statistically a significant difference present in mean values of platelet count among types of malaria. There is a statistically significant difference present in grades (severity) among the species (p value 0.004). Keywords: thrombocytopenia; malaria; plasmodium vivax; plasmodium falciparum; mixed.

Background: There is a growing prevalence of upper extremity defects that require reconstruction, largely due to the increased reliance on machinery, a higher rate of automobile accidents, and conflicts involving more frequent use of firearms and explosives. Objectives: 1. To study Aetiology of hand & forearm injuries. 2. To study the role of different flap covers in managing hand & forearm compound defects. Materials and Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Plastic Surgery, Siddartha Medical College, Vijayawada, Andhra Pradesh. Study Period: 1 year. Study population: This cross-sectional study will be conducted on 40 patients presenting with hand & forearm compound defects. Sample size: The study consisted of 40 subjects. Sampling method: Simple random technique. Results: In our study, most of the defects were on the Dorsum of the Hand. About 50% of the patients underwent Groin Flap cover followed by PIA Flap accounting for 18.75%. The other flap procedures in hand defects were Superiorly & Inferiorly based Abdominal Flaps, and Paraumbilical Flaps. One patient underwent Hypogastric with Paraumbilical Flap. Conclusion: In this study of 40 patients with hand and forearm injuries, the most affected age group was 21-30 years, with a male predominance (72.5%). Electric burns (47.5%) and road traffic accidents (42.5%) were the leading causes of injury, with the dorsum of the hand (40%) and distal third forearm (30%) being the most common injury sites. Keywords: upper extremity defects, Paraumbilical Flap, Groin Flap.

Background: To identify factors associated with failed induction encompassing maternal, foetal and sociodemographic factors. Materials and Methods: It is a Observational study done in Department of Obstetrics and Gynaecology for a period of 1 year in 249 subjects with Singleton pregnancy, POG >\= to 37 weeks, Past dates, Pregnancies complicated with medical comorbidities like GDM,HDP and Patients on induction with Dinoprostone 0.5 mg 6th hourly 3 doses alone or f\b oxytocin 1mU to 2mU in incremental doses of 1mU to 4mU every 30 minutes. Results: Mothers with maternal age >30 years were 2.39 times more likely to develop failed induction of labour than those whose age less than 30 years (Similarly, mothers who were primiparous had a 4.53-fold higher chance of a failed induction than mothers who were multiparous. when compared to women with normal, over weight range BMI those with obesity i.e., BMI >30 kg/m2, had a 2.85-fold increased risk of a failed induction of labour. Mothers who had an induction time less than 12 hours had a 0.16-fold lower probability of a failed induction compared to those who had an induction time longer than 12 hours. Compared to women whose foetal weight was less than 2.8 kg, mothers who delivered a weight of more than 2.8 kg had a 3.99 times higher chance of developing failed. When comparing those with a lower bishop score to those with a higher score, the odds of a failure induction were 4.53 times higher. Among induced patients 191 patients had vaginal deliveries and 32 patients underwent lower segment caesarean section with indication being failed induction, 26 patients underwent lower segment caesarean section with indication being meconium stained liquor or foetal distress with either bradycardia or tachycardia. Conclusion: The prevalence of failed induction of labor was relatively high in this study area because more than a quarter of mothers who underwent induction of labor had failed induction. Keywords: Labor induction, failed induction, the outcome of induction, associated factors.

Background: Aim: This study aimed to evaluate the impact of early versus delayed feeding on postoperative recovery and outcomes in patients undergoing gastrointestinal (GI) surgery. Material and Methods: A prospective randomized study was conducted on 120 patients who underwent elective GI surgery at a tertiary care hospital. Patients were randomized into two groups: the Early Feeding Group (EFG), who received oral intake within 24 hours postoperatively, and the Delayed Feeding Group (DFG), who remained nil per os (NPO) for at least 48 hours. Standardized perioperative care was provided to all patients, and outcomes were assessed through clinical observations and statistical analysis using SPSS version 25.0. Results: Patients in the early feeding group had significantly shorter times to first flatus (33.60 ± 5.80 hours vs. 47.10 ± 7.10 hours, p<0.001) and first bowel movement (55.20 ± 6.30 hours vs. 70.50 ± 8.20 hours, p<0.001). The length of hospital stay was significantly reduced in the EFG (6.80 ± 1.20 days) compared to the DFG (8.40 ± 1.50 days, p<0.001). The incidence of postoperative ileus was lower in the early feeding group (8.33% vs. 21.67%, p=0.03). Patient satisfaction scores were also significantly higher in EFG (8.50 ± 1.10 vs. 7.20 ± 1.30, p<0.001). There were no significant differences in anastomotic leak rates, infection rates, or other major complications between the groups. Conclusion: Early feeding after GI surgery is associated with faster recovery, shorter hospital stays, and a lower incidence of postoperative ileus without increasing the risk of complications. These findings support the integration of early nutrition into postoperative care protocols, particularly in the context of enhanced recovery after surgery (ERAS) programs. However, individualized patient assessment remains crucial for ensuring safety in high-risk cases. Keywords: Early feeding, delayed feeding, gastrointestinal surgery, postoperative recovery, enhanced recovery after surgery (ERAS).

Background: Thrombocytopenia is a very common hematological presentation for which a bone marrow examination is often sought. It is defined as platelet count less than 1,50,000/µl. Thrombocytopenia can present in isolation or can be associated with bicytopenia or pancytopenia. The common hematological causes presenting with thrombocytopenia include Immune thrombocytopenic purpura (ITP), Megaloblastic anaemia, Aplastic anaemia, Myelodysplastic syndrome and leukemia. Aim & objective: This study was done to evaluate various causes of thrombocytopenia with an emphasis on alterations in number and morphological features of megakaryocytes in different conditions. Materials and Methods: This study was a retrospective study. Two years data was collected from bone marrow requisition forms. All the cases of thrombocytopenia which were diagnosed on hematology analyser (Platelet count < 1,50,000/ µl); confirmed subsequently by peripheral blood smears were included in the study. Bone marrow aspirate smears and biopsies slides were reviewed. The number and morphological alterations of megakaryocytes were evaluated. Results: Out of 385 cases of thrombocytopenia, isolated thrombocytopenia was observed in 19 cases (4.9%). In the rest cases, thrombocytopenia was observed with bi- or pancytopenia or leucocytosis. The various causes of thrombocytopenia included erythroid hyperplasia (16.8%), megaloblastic anaemia (11.9%), acute leukemia (10.3%), immune thrombocytopenic purpura (8.8%), reactive (5.7%), dual deficiency anaemia (0.7%), hypoplasia (3.1%). The number of megakaryocytes was normal, increased and decreased in 185 (48%), 37 (9.6%) and 163 (42.3%) cases of thrombocytopenia respectively. Dysmegakaryopoiesis was observed in 53 cases that included cases of immune thrombocytopenic purpura, megaloblastic anaemia and myelodysplastic syndrome (MDS). However, only two cases of MDS were included in the study so comparison between MDS and non- MDS conditions could not be assessed. Conclusion: Thrombocytopenia can occur in various clinical conditions. Immune thrombocytopenic purpura can also occur in association with anaemia and leucocytosis as observed in this study. Dysmegakaryopoiesis can also occur in non-MDS conditions. A careful evaluation of number and morphology of megakaryocytes should be done to increase the diagnostic accuracy.

Background: Non urothelial bladder tumors (NUBT) are relatively rare, accounting for approximately 5 % of carcinoma arising at this location. These tumors frequently pose a diagnostic and therapeutic challenge, therefore immunohistochemistry is a useful adjunct to arrive at the conclusive diagnosis. Material and Methods: The objectives of the study were to analyse the clinicopathological and immunohistochemical features of NUBTs. This is a retrospective study of NUBTs diagnosed over a period of five- and half-years. Patients' files were retrieved from the archives. Gross and microscopic features were recorded. Simple percentage and frequencies were used to interpret the data. A panel of IHC was applied in the morphologically challenging cases. Results: A total 17 cases (2.1% of all bladder tumors) of NUBT were found. The age of the study population ranged from 18 to 80 years with a male: female ratio of 1.4:1. The most common presenting symptom was gross hematuria and the most common location was right lateral bladder wall. Muscle invasion was seen in 23.5 % of cases and large areas of necrosis were observed in 35% of the cases. The cases included squamous cell carcinoma (23.5%), adenocarcinoma (secondary and primary: 23.5%), signet ring carcinoma (5.8%), undifferentiated carcinoma (5.8%), neuroendocrine carcinoma (23.5%) and mesenchymal tumors (leiomyoma and leiomyosarcoma 17.6%). Conclusion: NUBTs present with similar clinicoradiological findings as urothelial carcinoma but have different prognostic and therapeutic implications. Combined approach including adequate clinical information, histomorphology and IHC are essential for definite diagnosis. Keywords: Non-urothelial bladder tumors (NUBTs), Histopathology, Immunohistochemistry (IHC), Muscle invasion.

Background: Surgical site infections (SSIs)represent a significant postoperativecomplication followingemergencylaparotomies, leading to increased morbidity, prolonged hospital stay,higher healthcare costs and increased incidence of incisional hernias later on. The dead space in abdominal wounds can accumulate serous fluid, blood that can become a medium for bacterial growth. Subcutaneous suction drainhelps inreducing this risk by minimizing dead space andpreventingaccumulation of fluid and seroma formation. Material and Methods: A Prospective observational case-control study comprising of 104 patients, was conducted in the Department of Surgery, Government Medical College Srinagar over a period of three years from September 2020 to September 2023. A total of 104 patients were included in the study with 52 patientsas cases in whom subcutaneous suction drain was placed and 52 patients as controls in whom no drain was placed. Antibiotic prophylaxis was given to all patients. Surgical site infection (SSI) was diagnosed and graded using the Southampton wound grading system. Results: The incidence of SSI and wound related complicationswere significantly lower in the cases group (23.1 %) compared to the control group ( 48.1%). Hospital stay in subcutaneous drain group was 6.7 (SD 2.93) days as compared to control group where it was 11.2 (SD 3.48) days. Likewise in group A (drain group) wound dehiscence occurred in 9.6% of casesand in group B it was 32.7% . All these parameters were statistically significant (p value-<0.05). Conclusion: Our study demonstrates that subcutaneous suction drain reduces SSI in emergency laparotomies,resulting in shorter hospital stays, and lower rates of wound dehiscence. Keywords: Surgical site infection,emergency, laparotomy,suction drain, dehiscence.

Background: Age estimation is a quintessential step for the identification and profiling of an unknown corpse in Forensic medicine. It is also critical for profiling of the population as i t can provide a new horizon of data on demographics from the bio- statistical context. Objective: To arrive at the regression formula for assessing the age, based on number of osteons and other findings microscopically in the sternal rib and to estimate the age at the t ime of death by using the regression formula. Materials and Methods: The bone samples, used in this study composed of sections which have been taken from the shaft region near the anterior ends of fourth sternal ribs of 69 individuals. After getting proper permission, concurrence and clearance from the Institute Ethical Committee, the samples were selected randomly from the autopsied bodies with known age group at the Sri Ramachandra Institute of Higher Education and Research, Chennai. Results: The number of true osteons, fragmentary osteons, resorption spaces and concentric lamellae kept increasing when the individual ages as per all the previous studies.[47,28,34] The least standard error for estimating age was found in true osteons ( ±3 . 51) followed by resorption spaces (±4 . 71), fragmentary osteons (±5. 19), non- haversian canal (±9 . 14) and then finally by concentric lamellae (±12. 19). The number of Non-Haversian canals tend to reduce with age in a linear fashion which is seen in the previous studies Kerley et al (1965) and Ericksen et al (1991) with coefficient of determination r=- 0. 81. Conclusion: This study i l lustrates the variation in certain microscopic structures of bone are systematically affected by age. Using this conclusion, regression formulae were developed to aid in age estimation from rib. Keywords: Estimation ff Age, Microscopic Examination, Rib.

Background: Doppler velocity study of placental and fetal circulation can provide important Information about fetal wellbeing, thus providing an opportunity to improve fetal outcome. The aim of the study is to know causes of late onset IUGR and its outcome. To asses various causes to reduce mortality. Materials and Methods: 46 singleton pregnancies after 32 weeks of gestation diagnosed as IUGR and were prospectively examined with Doppler ultrasonogrpahy and other factors like age, parity, BMI ,SES and were correlated with maternal and fetal outcome. Results: Of the 46 patients taken in study 65% are primigravida, with 48% being in age group between 19 to 22yrs.65% are with gestational age between 35 to 37. 39% of patients are anemic and 30% are with hypothyroidism.76% were diagnosed at more than 35wks of gestation. In Doppler Umbilical artery was normal in 91% of patients, MCA showed decreased resistance in 59% patients, CPR was abnormal in 52% cases. Mean uterine artery resistance increased in 74% cases.63% of cases delivered male babies. NICU admission is 50%. Neonatal deaths came to 6%. Conclusion: Doppler studies of multiple vessels in the fetoplacental circulation can help in the monitoring of compromised fetus and can help us in optimising the time of delivery and predicting neonatal morbidity and mortality. Age, parity, BMI, SES, Doppler, plays role. In Doppler MCA and CPR are more effective in predicting adverse perinatal outcome than Umbilical arterty in late onset IUGR fetuses This is helpful in determining the optimal time of delivery and prevention of stillbirths after 32wks. Keywords: Doppler; Umbilical artery; Middle cerebral artery; Cerebroplacental ratio.

Background: Polycystic ovary syndrome (PCOS) is the most frequently encountered endocrine disorder occurring in women of reproductive age. We have divided the women with PCOS into four phenotypes and clinical characteristics among the different phenotypes are compared. Materials and Methods: The study was a Cross-sectional, Observational study conducted at South Central Railway Hospital, Secunderabad over a period of 18 months from September 2018 to May 2020. A total of 80 women fulfilling the Rotterdam 2003 diagnostic criteria of PCOS attending Gynaecology and Dermatology clinic outpatient departments satisfying inclusion criteria were recruited for the study. Women with PCOS were divided into four phenotypes according to the clinical characteristics and the prevalence of different phenotypes is established. Results: The most common phenotype in our study is phenotype A (full-blown PCOS) with prevalence of 66.25%(53 patients) which includes all three features: hyperandrogenism, irregular cycles and PCOM on ultrasound, followed by phenotype C 16.25 % (13 patients), phenotype B 11.25 %(9 patients) and phenotype D 6.25% (5 patients). Classic PCOS, Phenotype A represents the most common and severe form of PCOS had significantly higher weight, clinical hyperandrogenism, menstrual irregularities, hirsutism, infertility as compared to rest of the phenotypes. Menstrual irregularities (cycle length >60 days) were significantly more common in phenotype A 42(79.2%) as compared with phenotype B 6 (66.7%) and D 1(20%). Cycle length is normal in Phenotype C. Acne is the second most common manifestation of androgen excess 59 (73.7%). Conclusion: Phenotype A (Classic PCOS) represents the most common form of PCOS with prevalence of 66.25%. These patients presented with higher modified FG score, more severe clinical hyperandrogenism, more pronounced menstrual dysfunction, infertility suggesting a higher risk of adverse metabolic and cardiovascular outcomes in this phenotypic group as compared to rest of the phenotypes. Keywords: Polycystic ovary syndrome (PCOS), phenotypes, hyperandrogenism, menstrual irregularities, Rotterdam criteria, phenotype A, classic PCOS.

Background: Arteriovenous malformations (AVMs) in the mandibular region are exceedingly rare and represent a direct shunting between arteries and veins without intervening capillaries. These lesions are significant due to their potential for severe bleeding and functional impact on the jaw and facial structures. The case involves a young adult who presented with spontaneous bleeding from the right lower molar, highlighting the clinical challenge of diagnosing and managing AVMs in atypical locations. Case Report: A 20-year-old male patient came to the department of otolaryngology with complaints of persistent bleeding from the right lower molar. Diagnostic imaging, including Contrast-Enhanced Computed Tomography (CECT) and Digital Subtraction Angiography (DSA), revealed a high-flow arteriovenous malformation centered in the right parotid region extending into the mandibular ramus. The lesion received predominant arterial feed from branches of the right external carotid artery. Management included embolization followed by surgical ligation of the right external carotid artery branch, which achieved hemostasis and resolution of symptoms. Conclusion: The successful management of this high-flow mandibular AVM required a multidisciplinary approach involving embolization and surgical intervention to control bleeding and prevent further complications. This case underscores the importance of vigilant follow-up and the potential for innovative surgical techniques in the management of complex vascular anomalies in sensitive anatomical regions. Further research and documentation of similar cases will aid in refining treatment strategies and improving patient outcomes. Keywords: Arteriovenous Malformation (AVM), Mandibular Region, High-Flow Vascular Anomaly.1 0.70034/ijmedph.2025.1.125

Background: Undergoing interventions such as joint manipulation, chest radiography, MRI, and CT scanning benefit substantially from the analgesic effects of peripheral nerve blocks. Peripheral nerve blocks ensure that patients remain pain-free during these procedures and mitigate the physiological stress response to pain. Consequently, patients experience a more comfortable hospital stay and demonstrate increased acceptance of surgical procedures due to the absence of pain. This pain-free hospital experience highlights the pivotal role of anesthesiologists in acute pain management. The effective analgesia provided by nerve blocks upon admission obviates the need for additional analgesics, thereby reducing the risk of adverse effects. Aim: To compare the efficacy of ropivacaine 0.2% and ropivacaine 0.2% with inj dexamethasone in providing “Peripheral nerve stimulator “guided axillary block analgesia on arrival. Materials and Methods: The present study was observational, descriptive longitudinal study. The present study was carried out at the department of anaesthesiology and critical care, Pravara Rural Hospital, Loni. Patients of 18-60 yrs age group of either sex belonging to ASA-I, ASA-II GRADE with upper limb fractures ranging from distal humerus to distal phalynx. The primary objective was compare and analyse the onset and duration of sensory analgesia by 0.2% inj ropivacaine alone and with inj ropivacaine 0.2% with inj dexamethasone 8mg in on arrival block while secondary objectives included comparing the multiple hemodyanamic parameters, motor blockade and to check for subsequent side effects after administration of the block. Result: The study showed patients receiving ropivacaine 0.2% alone had faster onset of action as compared to patients receiving ropivacaine 0.2% with 8mg dexamethasone. However duration of analgesia, sensory blockade and VAS score was significantly better in patients receiving ropivacaine 0.2% with inj dexamethasone 8mg than patients receiving inj ropivacaine 0.2% alone. Both the drug formulations had similar heamodynamic effects and there was no significant change. Conclusion: The findings of the present study indicate that the addition of dexamethasone to ropivacaine 0.2%prolonged both the onset and duration of sensory block compared to ropivacaine alone in “on arrival block” These outcomes will assist clinicians in evaluating the efficacy and postoperative pain management of ropivacaine alone versus ropivacaine with dexamethasone. However, further studies are recommended, as this study was conducted at a single centre with a limited sample size. Keywords: Axillary Block, On Arrival Block, Sensory Analgesia, Visual Analogue Score.

Background: Coagulase Negative Staphylococci (CoNS) are a diverse group of Gram-positive bacteria, commonly isolated as normal flora of skin and mucous membranes. The emergence of multidrug resistant strains, particularly methicillin resistance further aggravates the situation. Therefore, the present study was undertaken to predict the potential pathogenicity of the CoNS isolates by characterizing, determining their antibiotic susceptibility pattern, detecting the presence of mecA gene among the Methicillin Resistance Coagulase Negative Staphylococci species (MRCoNS) from various clinical samples. Materials and Methods: The study was a hospital-based prospective study conducted in the Department of Microbiology, NEIGRIHMS, Shillong from May, 2021 to June, 2022. CoNS isolates were identified using conventional microbiological procedures and speciation was done following Kloos and Schleifer’s scheme. Antibiogram was determined by Kirby Bauer’s disk diffusion method and broth microdilution method. Detection of methicillin resistance was performed using Cefoxitin disk diffusion method. MecA gene detection was done among the MRCoNS isolates using real time PCR. Data analysis was done using descriptive statistics. Results: Fifty-three CoNS isolates were identified from different clinical specimens, which included Staphylococcus epidermidis (39.6%) followed by S. simulans (15%), S. haemolyticus (13.2%), S. hominis (9.4%). Most isolates were resistant to penicillin (83%), and least to vancomycin (1.9%). No resistance to linezolid was seen. Methicillin resistance was detected in 34 of the isolates. Out of the 34 isolates identified as MRCoNS by phenotypic methods, mecA gene was detected in 17 isolates by Real- time PCR. Conclusion: CoNS are emerging multidrug resistant pathogens, and hence, studies on their local species distribution and antibiotic sensitivity pattern are very important. The present study will be a guide for the clinicians in establishing their role as significant pathogens and initiate proper antimicrobial therapy. Keywords: CoNS, MRCoNS, PCR, MecA.

Background: Acute kidney injury (AKI) is a complication of perinatal asphyxia seen in 46% of these neonates1,2. Serum creatinine is an unreliable measure in the acute setting3. In order to improve the prevention, early diagnosis and treatment of AKI in new born, an early biomarker of renal injury like Neutrophil Gelatinase-Associated Lipocalin NGAL is required. Materials and Methods: Hospital based Prospective cohort study conducted in NICU, S.V.R.R.G.G.H, Tirupati. Study population are term neonates admitted on day 1 of life with birth asphyxia. Newborns with congenital anomalies, chromosomal abnormalities, suspected IEM, sepsis; babies born to mothers with diabetes, preeclampsia and multiple gestation, and those received nephrotoxic drugs were excluded. Sample size was 40 neonates. For the study participants, history was elicited and physical examination was done. Urine sample for NGAL was collected for all the 40 neonates within 24 hr of life. Serum creatinine and urine output were monitored for AKI. The data was analyzed with Epi info version 7.2.0 software. Results: The prevalence of AKI was found to be 42.5% among term babies with birth asphyxia. ROC curve analysis suggested that a urine NGAL cut off value of 51.53 ng/ml, the test has a sensitivity of 88.2% and the specificity of 91.3%. ROC analysis shows area under the curve (AUC) is more than 0.9 and the p value of less than 0.001 indicates that the test has favourable sensitivity and specificity. 64.7% of asphyxiated neonates had oliguric AKI and 35.3% had non oliguric AKI. Conclusion: High urine NGAL level is significantly associated with the subsequent diagnosis of AKI in asphyxiated neonates. So early measurement of this biomarker in moderate and severely asphyxiated neonates can reliably predict AKI due to birth asphyxia. Key words: Acute Kidney Injury, Neutrophil Gelatinase Associated Lipocalin NGAL, Birth asphyxia, Serum Creatinine.

Background: Seizures produce systemic changes including elevation of white blood cell count and C-reactive protein levels (CRP).However, the frequency & severity of the inflammatory response in different types of paediatric seizures is not well researched. Hence, we aimed to study the frequency and degree of systemic inflammatory response (leucocytosis-neutrophilic, high CRP) in seizures. Materials and Methods: This prospective observational study was conducted over a period of 2years. 100 children aged 6 months to 18 years admitted with seizures to emergency department of MVJMC and RH were included. Complete Blood Counts and CRP were sent along with other relevant investigations. Demographic data along with clinical characteristics, leucocyte count and CRP were recorded and analysed. Results: Majority (58%) of our study participants were aged between 1-5 years. 62% of the children were males. Leucocytosis and elevated CRP were seen respectively in 44% and 75% of paediatric seizures. 78.2% of generalised seizures & 37.5% of focal seizures had raised CRP. Leucocytosis was found in 63% of children with seizures for more than 5 minutes and in status epilepticus. There was no significant difference in occurrence of leucocytosis and raised CRP in paediatric seizures with and without bacterial/central nervous system infection. Conclusion: Paediatric seizures are commonly associated with inflammatory response in form of elevated CRP and leucocytosis. Generalised seizures are more commonly associated with elevated CRP. Prolonged seizures and status epilepticus are associated with leucocytosis. Keywords: Leucocytosis, raised CRP, pediatric seizures, inflammatory response, status epilepticus.

Background: Increasing awareness regarding need of sedation and analgesia for various diagnostic paediatric procedures for better outcome and quality care has led to an increase in the use of paediatric sedation and analgesia (PSA) by paediatricians in their routine practice. Hence, this study was done to evaluate the paediatrician’s choice of agents for sedation and analgesia for various common procedures and their efficacy and safety. Materials and Methods: A prospective observational study was conducted over 2 years. 267 children of the age 6 months to 18 years, who were administered procedural sedation and/or analgesia by paediatricians, were included. Data regarding demographic details, indications for sedation and analgesia, medications used, procedural completion rates and safety of those medications was collected and analysed. Results: The mean age of the study population was 5.27+/-4.00 years. EEG was the most common(34.1%) procedure done under PSA.Oral Trichlofos, IV Midazolam, IV Ketamine either alone or in combination were commonly used for PSA. Completion rate for procedures under PSA was 90.6% and ideal sedation was achieved in 91% of subjects. 3.7% of subjects had adverse events following PSA. They were desaturation and euphoria following Midazolam. Conclusion: Skilled &trained paediatricians are effectively and safely administering sedation and analgesia for common paediatric procedures. Oral Trichlofos, IV Midazolam and IV Ketamine are preferred agents for procedural sedation and analgesia by paediatricians. Adverse events following PSA are transient and can be managed by paediatricians. Keywords: Pediatric sedation, analgesia, paediatrician, adverse events.

Background: To examine the factors that influence the duration of exclusive breastfeeding (EBF) in preterm infants (gestational age ≤34 weeks). Materials and Methods: This study involved 106 preterm infants with a gestational age of ≤34 weeks who attended the well-baby clinic at a corrected age (CA) of six months. Birth details were extracted from hospital records, and feeding information was gathered through personal interviews. Results: The mean duration of EBF was 3.59 months (SD: 2.1), with 36.7% of infants receiving EBF until they reached six months CA. Factors associated with a shorter duration of EBF included operative delivery [adjusted odds ratio (aOR) 3.7 (95% CI: 1.0, 12.7); P = 0.035], delays in initiating tube feeding [aOR 1.5 (95% CI: 1.0, 2.0); P = 0.016], and delays in establishing full oral feeds [aOR 1.0 (95% CI: 1.0, 1.07; P = 0.015]. Conclusion: The prevalence of EBF until six months CA among preterm infants born at or below 34 weeks was 36.7%. Prompt initiation and establishment of full oral feeds could contribute to improving the duration of exclusive breastfeeding. Keywords: EBF, Paediatrics.

Background: Speckle tracking echocardiography (STE) is a non-invasive imaging technique used to assess myocardial function, offering insights into cardiac deformation and remodeling. This study aims to identify predictors of myocardial functional recovery following successful reperfusion of acute ST-elevation myocardial infarction (STEMI), using STE to assess functional recovery markers such as global longitudinal strain (GLS), ejection fraction (EF), and left ventricular (LV) remodeling. Materials and Methods: A total of 80 STEMI patients were randomized into two groups: 40 patients received thrombolysis, and 40 underwent primary PCI. Patients were monitored for post-reperfusion myocardial recovery using STE to measure EF, GLS, mitral annular plane systolic excursion (MAPSE), and LV internal diameters at both end-systole and end-diastole at baseline and at 3-month follow-up. Univariate and multivariate regression analyses were performed to identify significant predictors of myocardial recovery. Results: Primary PCI significantly improved myocardial functional recovery compared to thrombolysis, with a notable increase in EF (53.84% vs. 48.20%) and GLS (-19.54% vs. -14.85%) at 3 months. Additionally, LV internal diameter at end-diastole and MAPSE were identified as important predictors of functional recovery. Early post-reperfusion EF and MAPSE were found to be strongly associated with long-term myocardial recovery. Conclusion: This study demonstrates that early post-reperfusion markers, such as EF, GLS, and LV remodeling, are crucial predictors of myocardial functional recovery after STEMI. Primary PCI was associated with better long-term functional outcomes compared to thrombolysis, emphasizing the importance of early and efficient reperfusion strategies. Speckle tracking echocardiography proves to be an essential tool in evaluating myocardial recovery, potentially guiding clinical decision-making in STEMI management. Keywords: STEMI, Speckle Tracking Echocardiography, Myocardial Recovery, Functional Recovery, Ejection Fraction, Global Longitudinal Strain, Left Ventricular Remodeling, Primary PCI, Thrombolysis.

Background: Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disorder of the gastrointestinal tract influenced by genetic, environmental, immune, and microbial factors. Gut microbiome dysbiosis, characterized by an imbalance between beneficial and pathogenic bacteria, plays a crucial role in disease pathogenesis. This study aimed to investigate microbial alterations, inflammatory biomarkers, and histopathological changes in IBD patients compared to healthy controls, with a focus on differentiating CD from UC. Materials and Methods: This cross-sectional study was conducted over two years at a tertiary healthcare institution in India, enrolling 124 IBD patients (62 CD and 62 UC) and 124 healthy controls, matched for age, sex, and dietary habits. Fecal samples were analyzed using 16S rRNA sequencing (Illumina MiSeq platform) to assess microbial diversity and composition. Inflammatory biomarkers (CRP, ESR, and fecal calprotectin) were measured using immunoturbidimetric and ELISA methods. Colonic biopsy samples were examined histopathologically for crypt distortion, goblet cell depletion, neutrophilic infiltration, granuloma formation, and mucosal ulceration. Statistical analysis was performed using SPSS version 26 and R software, with differences assessed through Mann-Whitney U test, Chi-square test, and multivariate logistic regression. Results: IBD patients exhibited significant gut microbiome dysbiosis, with a decrease in beneficial taxa (Faecalibacterium prausnitzii, Bacteroides, and Prevotella) and an increase in Proteobacteria and Escherichia-Shigella compared to healthy controls (p < 0.05). Alpha diversity indices (Shannon and Chao1) were significantly lower in IBD patients, indicating reduced microbial richness, while beta diversity analysis confirmed distinct microbial clustering. Inflammatory markers were markedly elevated, with higher CRP (18.47 ± 5.92 mg/L), ESR (42.91 ± 7.61 mm/hr), and fecal calprotectin (312.58 ± 87.42 µg/g) in IBD patients compared to controls (p < 0.05). Histopathological differences revealed granuloma formation in 54.71% of CD cases, while UC exhibited more severe crypt distortion (92.47%), goblet cell depletion (87.93%), and mucosal ulceration (88.21%). These findings suggest a strong association between microbial alterations, systemic inflammation, and intestinal tissue damage in IBD. Conclusion: This study confirms that IBD patients experience significant gut microbiome disruptions, heightened inflammatory responses, and distinctive histopathological alterations, with clear differences between Crohn’s disease and ulcerative colitis. The reduction in Faecalibacterium prausnitzii and the enrichment of Proteobacteria and Escherichia-Shigella highlight potential microbial biomarkers for disease progression. Elevated CRP, ESR, and fecal calprotectin reinforce their diagnostic and prognostic value in monitoring disease activity. Histopathological findings provide critical insights into disease differentiation, with granuloma formation being a distinguishing feature of Crohn’s disease. These results emphasize the importance of microbiome-based

Background: Atrial fibrillation (AF) is a prevalent arrhythmia that poses significant risks to cardiovascular health. Direct current cardioversion (DCCV) is a standard method for rhythm control in AF patients. However, complications such as thromboembolic events may arise if atrial thrombus is not ruled out prior to the procedure. Transoesophageal echocardiography (TEE) has emerged as a valuable tool to detect thrombus, ensuring patient safety during DCCV. This study aims to assess the effectiveness and safety of TEE-guided DCCV in patients with AF. Materials and Methods: This observational study was carried out over a one-year period from January 2024 to December 2024, in the Cardiology Department at Kamineni Academy of Medical Sciences and Research Centre, LB Nagar, Hyderabad. A total of 50 patients with persistent or recurrent AF were included. All participants underwent TEE to rule out thrombus in the left atrium or appendage before undergoing DCCV using biphasic synchronized shocks. Patients were monitored for immediate procedural success, complications, and follow-up for AF recurrence at one week, one month, and three months. Statistical analyses were conducted using chi-square and t-tests. Result: The cohort had a mean age of 60.4 years, with 64% males. The TEE-guided DCCV demonstrated a high success rate, with sinus rhythm restoration achieved in 88% of patients. However, 12% of patients experienced failed cardioversion, and 18% had AF recurrence within one month. The procedure was associated with minimal adverse events, including minor bleeding (4%) and one case of pulmonary edema (2%). No major complications such as stroke or esophageal perforation were observed. Conclusion: TEE-guided DCCV is a highly effective and safe approach for rhythm control in AF, with high immediate success rates and minimal procedural complications. Although AF recurrence remains a challenge, TEE-guided cardioversion provides a reliable strategy for managing persistent AF in appropriate patients. Keywords: Atrial fibrillation, direct current cardioversion, transoesophageal echocardiography, sinus rhythm, thromboembolism, recurrence rate.

Background: Reproductive tract infections (RTIs) are a significant health concern, particularly among married women of reproductive age, leading to complications such as infertility and increased vulnerability to sexually transmitted infections (STIs). Objective: This study aims to assess the knowledge, attitudes, and health-seeking behavior regarding RTIs among married women residing in the urban field practice area of a medical college. Materials and Methods: This cross-sectional study was conducted at urban slum areas in the Pune, Maharashtra during January -December 2022. A total of 585 married women of reproductive age, residing within the field practice area of the medical college were included in the study. Data were collected using a pre-tested, structured questionnaire. The questionnaire collected demographic information such as age, education, and income, as well as specific questions about participants' knowledge regarding RTIs. Results: A total of 585 patients were added in the study. The study participants were predominantly in the 25-40 years age group (62%), followed by the 15-24 years group (20%) and the 41-49 years group (18%). Regarding education, 45% of participants had only completed primary school, while 30% had secondary education, and 25% had higher education.40% of participants were able to correctly identify common RTI symptoms, while 60% either incorrectly identified or could not identify the symptoms. Awareness of RTI complications, such as infertility and increased HIV risk, was low, with 70% of participants unaware of these risks. Conclusion: It is concluded that the knowledge of reproductive tract infections (RTIs) among married women of reproductive age in the study area is limited, with a significant number of participants unable to identify common RTI symptoms and unaware of the potential complications. Keywords: Patients, Health, RTIs, STIs, Complications, Infection.