Vol 13, Issue 4, Oct-Dec, 2023

Background: The manifold population of neuroendocrine neoplasms (NENs) arising in the duodenal mucosa and ampullary region has been investigated in several papers, leading to the characterization of various tumor entities according to histological structure, hormonal expression, clinical profile, genetic background, and/or patient outcome [1-3) The duodenal NETs are mainly located in the second part of the duodenum and are usually Single. Even though it is reported in various case series, Multiple neuroendocrine tumour of the first, second and Third part of duodenum is extremely rare and very difficult for a pre op diagnosis and planning. This case is presented to highlight the endoscopic features and therapeutic challenge in the unusual presentation. Clinical Presentation: A 65/M patient was admitted with vague upper abdominal pain and dyspepsia and Vomiting. On OGD he was found to have Unusual multiple umbilicated lesions involving the first, second part of duodenum. Endoscopic diagnosis was Lymphoma / Duodenal carcinoma. The endoscopy biopsy was suggested it to be duodenal carcinoma with neuroendocrine differentiation. In view of existing CKD Patient was investigated with MRI scan and MRI showed multiple polypoidal lesion duodenum first and second part. Patient was worked up and had planned Whipple resection and Histopathology revealed it as neuroendocrine tumour with low grade differentiation. The case is discussed with the stress on unusual endoscopic appearance and rarity of multiplicity. Results: This entity of NETs of duodenum are rare tumours predominantly seen on the second part and single tumour and endoscopic appearance was very unusual. Most were low-grade tumors, ranging from reportedly self-limiting gangliocytic paragangliomas (GPs) to a variety of well-differentiated epithelial neuroendocrine tumors (NETs). This latter category comprised clinically silent or endocrinally active (such as gastrinomas) neoplasms of the duodenum as well as nonfunctioning, somatostatin cell tumors (often called ‘somatostatinomas’ despite their usual lack of clinically relevant signs of endocrine hyperfunction), commonly localized in the ampullary region and often causing biliary or pancreatic duct obstruction and regional lymph node (LN) metastases. A minority of tumors arose in a genetic background, such as gastrinomas in multiple endocrine neoplasia type 1 (MEN1) syndrome and somatostatin cell tumors in type 1 neurofibromatosis [4–6]. In addition to these differentiated, grade 1 or 2, NETs, a few high-grade (grade 3) neuroendocrine carcinomas (NECs) have also been reported [7,8, 9]. Conclusion: Duodenal neuroendocrine tumours are relatively very rare mesenchymal tumour with a unique histological appearance, and it needs to be distinguished from GIST and other gastrointestinal mesenchymal tumours. But this paper highlights an unusual presentation in view of its endoscopic appearance and Multiplicity. Keywords: Duodenal Neuroendocrine Tumors , Low garde, NET multiple.

Background: The uptake of preventive and treatment measures for cancers by the public significantly depends on the level of awareness generated in the population at risk. Cervical cancer is a common preventable cancer and a public health problem of the Indian subcontinent, including the state of Uttar Pradesh, the most populous and geographically diverse part of the country, which is largely unscreened and unvaccinated for the disease, with patients presenting in advanced stages. The cancer awareness measure studies performed most frequently are aimed at women in the eligible age group for screening or healthcare workers, often in a formal setting. Pictorial information is also disseminated as IEC material by various agencies which have not been evaluated for the impact on awareness generation in the public. Awareness programs incur costs and are time consuming, requiring significant human resource. Most cancer awareness measures are meant for public in general, not for the specific population of patient attendants or caregivers and studies on their opinion on devising cancer awareness material could be relevant in terms of understanding and identifying barriers in uptake of screening, early detection and treatment for cervical cancer. Materials and Methods: The cross-sectional qualitative observational pilot survey study was undertaken with the objective of improving the uptake of screening services and understanding the reason for the low uptake of screening for cervical cancer, even when offered to those who accompany patients suffering from the disease. A poster of 70x50 cm was affixed in the gynecological oncology OPD and a survey questionnaire for self-administration was shared with the attendants or family members of the patients attending OPD services in the month of September which is observed as the gynecological cancer awareness month. Results: There were sixty-five respondents with significant participation of male respondents for a gynecological cancer. All respondents found the information important, relevant, thought provoking and there were seven themes generated from the opinions/suggestions shared by them, which could be further utilised for qualitative studies to improve awareness measures and uptake of screening and early detection. Conclusion: Those attending to a patient with cancer may not be adequately aware of the disease causation and availability of prevention strategies, therefore the information material such as that used in this study can be a well-accepted source of information without incurring significant additional costs and time on the healthcare provider while encouraging public participation in improving the IEC material and services. Keywords: Cancer Awareness Measures, Surveys, Cervical Cancer.

Background: Internet has become an indispensable part of our daily lives by being a means for socialization, entertainment and information, but recent dramatic increase in internet use has resulted in its addiction that can have a significant impact on sleep quality. Aim: This study attempt to understand the effect of internet addiction on sleep quality in postgraduate residents. Materials and Methods: A cross sectional study was conducted among 70 postgraduate residents of Rama Medical College, Kanpur by providing self-administered questionnaire containing Internet Addiction Test (IAT) and Pittsburgh sleep quality index (PSQI). Descriptive statistics were used to analyse sociodemographic characteristics, internet addiction and sleep quality. The association between internet addiction and sleep quality was determined by Pearson correlation coefficient using SPSS. Results: Out of 70 students, 19 (27.1%), 32 (45.7%), 15 (21.4%), 4 (5.7%) reported normal, mild, moderate and severe internet addiction respectively. 23 (32.9%) had good sleep quality but 47 (67.1%) were poor sleepers. There was a positive correlation of internet addiction with sleep quality (p-value- 0.005) and its components: subjective sleep quality (p-value 0.006), sleep latency (p-value 0.001), sleep duration (p-value <0.001), sleep efficiency (p-value <0.001), sleep disturbance (p-value 0.016) and daytime dysfunction (p value 0.003), but there was no positive relationship with use of sleep medication (p-value 0.551). Conclusion: Internet addiction was found to be a significant problem for postgraduate residents. Internet addiction was more prevalent among the males and unmarried residents. As the level of addiction increased, sleep quality worsened significantly. Keywords: Internet addiction, Sleep quality, Internet Addiction Test, Pittsburgh sleep quality index.

Background: Kerala, a southern Indian state, demonstrates a relatively high incidence of thyroid dysfunction. However, there is a lack of studies on dyslipidemia in thyroid disorders specific to Kerala. This study aims to generate data on lipid parameter abnormalities in patients with thyroid disorders, encompassing both hypo- and hyperthyroidism, at a tertiary care teaching institute. Materials and Methods: A cross-sectional study was carried out on individuals attending the General Medicine and Endocrinology clinic over a one-year period. Sixty patients with newly diagnosed thyroid dysfunction, comprising 30 with hypothyroidism and 30 with hyperthyroidism, were chosen as cases and compared to 30 age-matched healthy controls. Levels of total cholesterol, triglycerides, Low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), very low density lipoprotein cholesterol (VLDL-C) and LDL/HDL ratio were estimated and compared. Results: Ninety subjects were studied, including 30 with hypothyroidism, 30 with hyperthyroidism, and 30 euthyroid individuals. The majority of patients with thyroid disorders were in the 36-50 age groups, and most individuals with thyroid dysfunction were females. Hypothyroidism was associated with increased total cholesterol and LDL-C, while hyperthyroidism showed decreased total cholesterol, triglycerides, LDL-C, and the LDL/HDL ratio. Conclusion: Screening for lipid profiles is crucial in all patients with thyroid dysfunction, and it is essential to identify and address underlying lipid abnormalities. Keywords: Hypothyroidism, Hyperthyroidism, Lipid profile, Kerala.

Background: Background and Aims: Blood transfusion is the major cause of infectious diseases in recipient due to no screening of donated blood. Aims of current study are to get assessment of the prevalence of diseases in donor’s blood and to create awareness for blood donation among people. Materials and Methods: Blood donors from Vidarbha region of central India, including males and females were screened for the prevalence of five transfusions transmittable infections (TTIs). Donors having age less than 18 years, weight less than 45 Kg and Hemoglobin (Hb) less than 11.5 mg/dl were excluded from the study. Results: Total 0.74 % males and 0 % females were infected with various TTIs whereas HBV, HIV, HCV, and syphilis are the major infections present in blood donors. Conclusion: Prevalence of TTIs at LOWER rate might be due to strict screening practices and voluntary donation from healthy individuals. This study will help to monitor the quality of blood donation and screening practices and to spread awareness among non-donors for the screening of dangerous infectious diseases. Keywords: Blood transfusion, Transfusions transmittable infections, screening, positive and negative.

Background: The Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores are validated for risk stratification in the febrile neutropenia patients. Both these scores have advantages and limitations. This study was conducted to compare the MASCC and CISNE scores with respect to their ability to assign accurate risk stratification and predict outcomes. Materials and Methods: This is a hospital-based prospective study included all-comers fulfilling the eligibility criteria from January 2018 till October 2019. In addition to demographic data, clinical data were obtained prospectively regarding clinical deterioration requiring up-gradation in treatment or death. Both MASCC and CISNE scores were calculated for all the patients and each patient was risk stratified as per the two different scores. Patients could be discharged once there were afebrile and after count recovery and were followed up to 30 days post discharge. Results: A total of 96 febrile neutropenia episodes were included in the study (Total of 92 patients, with 4 patients with a repeat episode of febrile neutropenia). Mean age of the study population was 35 years (range 4 to 75 years). Total 58 (60.42%) episodes were in solid tumors and 38 (39.58%) were in hematological malignancies. With MASCC febrile neutropenia risk index, 63 (65.63%) were low risk and 33 (34.38%) were high risk. With CISNE, 7 (7.29%) were low risk, 72 (75%) were intermediate risk and 17 (17.71%) were high risk. When calculated with MASCC, 15 out of 33 episodes (45.45%) in high risk episodes required upgradation in the level of care and 18 out of 63(28.57%) episodes in low risk episodes required upgradation in the level of care. Whereas with CISNE 8 out of 17(87.5%) episodes in high risk required upgradation in the level of care and 25 out of 72 (34.72%) in intermediate risk required upgradation in the level of care, while none of the low risk required upgradation in the level of care. None of the low risk in CISNE experienced death. In MASCC low risk subset 1 out of 63(1.68%) died. Both MASCC and CISNE predicted outcomes of the febrile neutropenia episode accurately. Conclusion: Both CISNE and MASCC has reasonable discriminatory value in predicting the outcome, however CISNE performed better compared to MASCC in both low and high-risk subsets. Keywords: CISNE, MASCC, Neutropenia, Hemotological Malignancies.

Background: Keloids are common problem with significant recurrence. Despite of many options available, there is no standard acceptable treatment for keloid. This study compares the combinations of triamcinolone acetonide + 5-Fluorouracil versus triamcinolone acetonide + verapamil in the treatment of keloids. Materials and Methods: This is a randomized study for a period of one year. 60 patients were randomly allocated into two groups. Group 1 – TAC + Verapamil, Group 2 – TAC + 5-FU. Intralesional injection was given every 3 weeks till 24 weeks. Results: There was reduction of scar height, vascularity, pigmentation and pliability. Improvement in terms of height, vascularity, pliability was faster with TAC+5FU compared to TAC + Verapamil. Conclusion: TAC+5FU combination were effective in keloids in comparison to TAC +Verapamil. The combination offered the balanced benefits of faster and more effective response. Keywords: Keloid, triamcinolone acetonide, 5-fluoro uracil, Verapamil.

Background: Burns rank among the most prevalent and severe types of injuries. Severe thermal damage patients need to receive expert care right away in order to reduce their risk of morbidity and death. Despite rigorous treatment with topical and parenteral antibiotics, sepsis and burn wound infection cause 50% to 60% of fatalities in burn patients. Aim: To investigate the burn wound bacteriological pattern in patients who come to a tertiary care facility. Materials and Methods: A total of 112 swab culture samples and 56 blood culture samples were obtained for this prospective observational study, which included 56 patients admitted to the burns ward at Government General Hospital. The samples were processed at the laboratory of the institution, government general hospital. Results: 15 samples (28.3%) and 38 samples (71.7%) of the 56 swab culture isolates were gram positive and gram negative, respectively. The major organism identified from 16 (28.50%) of the study's second-week culture samples was the gram-negative bacterium Klebsiella. Conclusion: This study focuses on the microbiological etiology, and microbial analysis of burn wounds, with a particular emphasis on the methodologies for culturing and surveillance of burn wound infections. Keywords: Burn wound, infection, colonization, septicemia, swab.

Background: Mental health is a crucial factor that enables individuals to reach their full potential to lead a productive and healthy life. Although, study of determinants of mental well-being is important at individual level, a broader view of the same can help improve community as a whole. As children are the harbingers of our future, it is paramount to safeguard their mental wellbeing. Materials and Methods: A cross sectional study was conducted among students of 9th -12th class of government and private schools of urban and rural areas of Amritsar. Sample size was calculated using formula N > 4pq/ d2. Data was collected during the period of one year. Pre tested, semi structured questionnaire and DASS -21 scale was used. Chi squared tests were applied and statistical analysis was conducted using Epi-Info. P value <0.05 was considered to be statistically significant. Results: The prevalence of Stress, Anxiety and Depression was found to be 53%, 58% and 54% respectively having significant associations with socio-demographic profile. Conclusion: Stress, anxiety and depression had significant associations with age, religion and caste among the students who participated in this study. Thus, components of socio-demographic profile were noted to have an effect on student’s mental health. Keywords: Stress, anxiety, depression, students, socio-demographic profile.

Background: Primal ovarian germ cells cause ovarian germ cell cancers. They might be benign or cancerous. Approximately 5% of malignant ovarian neoplasms are these tumors. This study examined the quality of life of long-term ovarian germ cell tumor survivors. To compare fertility-preserved and unpreserved life quality. Materials and Methods: The study comprised individuals who had survived Germ cell Tumor Ovary and had undergone a minimum of 2 years of post-treatment follow-up. This study was conducted at the Department of Medical Oncology, NRI Medical College and Hospital, Mangalagiri, Andhra Pradesh, India between December 2021 to November 2022. Results: Ovarian germ cell cancers primarily manifest between adolescence and early adulthood. The majority of individuals in this group are not married or are now in the process of planning their families. The majority of individuals possess a high level of education and have accumulated a significant number of years characterized by productivity and achievement. The objective of this study was to ascertain the characteristics that exhibit the strongest correlation with quality of life outcomes in individuals who have survived ovarian germ cell tumors over an extended period. Additionally, the study aimed to evaluate the influence of fertility preservation treatment on these results. Conclusion: The significance of fertility preservation is once again underscored, highlighting the need for robust endeavors to sustain reproductive capacity throughout the initial surgical intervention. Keywords: Ovarian germ cell cancers, quality of life, and survivors.

Background: Neonatal Adrenal hemorrhage is more common in neonates than in children or adults. The incidence ranges from 1.7 to 2.1 per 1000 births. Because adrenal bleeding may remain asymptomatic, the real occurrence is probably higher. Materials and Methods: In this prospective observational study, we evaluated risk factors and clinical presentations, laboratory and ultra-sonographic findings in 16 new-born babies diagnosed as adrenal hemorrhage with abdominal ultrasonography between January 2018 and July 2021 in Government General Hospital New-born Care Unit (NICU), Srikakulam. Results: The male/female ratio was 2.5. The average age and birth weight at admission were 3 ± 2 days and 2500 ± 600 g, respectively. Out of 16 newborns,10 were term and presented with neonatal jaundice in all, flank mass and anaemia in 7, hypotension in 2and adrenal insufficiency in 2. Adrenal hemorrhage was right sided in 10, left-sided in 3 and bilateral in 3 new-borns. Resolution time of adrenal hemorrhage was a minimum of 6 weeks, maximum of 6 months in ultra-sonographic follow-up. Conclusion: The most common clinical feature in new-borns with Neonatal adrenal hemorrhage was jaundice. Abdominal USG is required to determine adrenal hemorrhage in a newborn with swelling. Serial USG is the best modality for monitoring NAH to prevent unnecessary surgery. Keywords: Neonatal Adrenal Hemorrhage, abdominal ultrasonography, Jaundice.

Background: Gastrointestinal malignancies that manifest as acute abdominal emergencies pose a significant clinical challenge. Understanding their incidence, clinical presentations, and management is essential for improving patient outcomes. Materials and Methods: This prospective observational study was conducted at King George Hospital over a two-year period, from August 2020 to July 2022. The study included 100 adult patients aged 18-85 years admitted with abdominal emergencies, such as perforations, intestinal obstruction, and peritonitis. Patients with malignancy confirmed by histopathological reports were included in the analysis. Results: The study found that acute abdominal emergencies were most prevalent in the age groups of 36–45 and 46–55, with a higher occurrence in males (75%). Large bowel obstruction (30%) and gastric perforation (29%) were the predominant modes of presentation. Among the study population, 24% had malignancies, with a slightly higher incidence in males (58%) than females (42%). The most common site of malignancy was the colon (16 cases), followed by rectal malignancies (4 cases). Most malignancies presented with obstruction (86%) rather than perforation (14%). Causes of small bowel obstruction included ileal stricture (lymphoma), ileo-ileal intussusception, bowel gangrene, and other factors. Large bowel obstruction was primarily due to rectal carcinoma, colon carcinoma, sigmoid volvulus, and non-specific inflammation. Various demographic factors, including age, sex, and site of malignancy, influenced the presentation patterns. Conclusion: This comprehensive study highlights the clinical significance of gastrointestinal malignancies presenting as acute abdominal emergencies. It provides insights into their incidence, clinical presentations, and demographic associations. The findings emphasize the importance of early recognition and prompt management of these emergencies to improve patient outcomes. Keywords: Gastrointestinal malignancies, acute abdominal emergencies, incidence, clinical presentation, management, demographic characteristics, prognosis.

Background: End stage renal disease is a worldwide problem which deteriorates quality of life. Patients with end stage renal disease experience depression due to various reasons. Materials and Methods: A total of 100 patients with end stage renal disease undergoing hemodialysis in the hemodialysis unit of Katuri Medical college and hospital, Guntur were included in the study. Results: 1 Significant level of depression was found in female gender, increasing age, patients on 1-3 years of hemodialysis. Conclusion: End stage renal disease burdens patient not only physicically but mentally also. Increasing rates of depression, anxiety amongst CKD patients’ needs to be tackled with timely interventions like counseling. Keywords: Depression, anxiety, quality of life, chronic kidney disease, dialysis.

Background: Patients undergoing hemodialysis go through tremendous physical, psychological, emotional and financial stress of high order. Because of their dependency and disability, these patients may have suicidal ideations. Materials and Methods: A total of 100 patients with end stage renal disease, undergoing hemodialysis in the dialysis unit of Katuri Medical College and Hospital were included in the study. Results: Significant levels of depression were observed in the female gender. Suicidal intentions were higher in frequency among female patients undergoing HD compared to male patients, but high intent in severity was found among higher percentage of male patients. Conclusion: Early identification and intervention for psychiatric manifestations in patients undergoing hemodialysis is a very crucial factor, which effects compliance of the patient and finale treatment outcome. Keywords: Chronic kidney disease, dialysis, suicide, depression, quality of life.

Background: To use different cytological staining techniques to examine the cytomorphologic aspects of thyroid lesions. Materials and Methods: 100 individuals with adequate aspirates participated in an experimental study carried out at the cytopathology outpatient department. The assignment was finished when the Institutional Ethical Committee granted the necessary authorization. Results: Histopathological correlation was obtained for 25 of the 100 cases in this investigation. For seven cases of Hashimoto's thyroiditis, one case of lymphocytic thyroiditis, six cases of nodular colloid goitre, eight cases of nodular colloid goitre with cystic degeneration, seven cases of follicular neoplasm, and six cases of thyroid papillary carcinoma, histopathological linkage was available. Histopathological studies of those 25 instances showed a correlation with the cytological diagnosis. Three instances that were first diagnosed as follicular neoplasms based on cytology were later identified as follicular carcinomas. Conclusion: A combination of several stains and different fixation procedures will boost the diagnostic accuracy of thyroid lesions. Thus, in order to decrease false positive and false negative results in fine aspiration cytology of thyroid lesions, a range of cytological staining methods can be applied, given appropriate material availability. Keywords: Thyroid lesions, cytochemical staining, Wright Giemsa, pap stain, haematoxylin and eosin.

Background: Spinal cord injury (SCI) is a devastating neurological state producing physical dependency, morbidity, psychological stress and financial burden. For the last 30 years, its global prevalence has increased from 236 to 1298 cases per million populations. Aim and Objectives: The objective of this study was to assess the electrodiagnostic changes in the lower limbs as measured by nerve conduction studies (NCSs) in lower limb in acute SCI patients. Materials and Methods: An observational descriptive study was carried out on 35 patients of acute SCI patients who were between the age of 16 and 65 years by using RMS EMG EP Mark-II. Motor and sensory studies were performed on peroneal tibial, and sural nerve respectively. Parameters recorded were latency, amplitude and conduction velocity. Results: Mean latency of right and left peroneal nerve increase in subsequent follow - up but this change is non- significant. Increment in mean conduction velocity and mean amplitude of peroneal nerve was statistically significant (p=0.003, p=0.004) for right and left respectively; p<0.001 for amplitude of peroneal nerve (right and left both). Mean latency and mean conduction velocity of tibial nerve (right and left) increase with subsequent follow up but this change were non-significant. Increment in mean amplitude of right and left tibial nerve was statistically highly significant (p<0.001, p=0.03 for right, left respectively). Mean latency of right and left sural nerve was increased in subsequent follow up visits but this change was not significant. Increment in mean conduction velocity and mean amplitude was statistically highly significant (p<0.001) for right and left both of sural nerve. Conclusion: It is concluded from this study is that impact of SCI on latency, amplitude and conduction velocity of tibial, peroneal and sural nerve is very detrimental at onset of injury. But with subsequent follow up it has improved significantly, which can be related with recovery of lower limb. Keywords: Nerve conduction studies, spinal cord injury, amplitude, latency, conduction velocity.

Background: To perform liquid-based cytology (LBC) and conventional smears (CS) using fine-needle aspiration for thyroid, breast, and lymph node abnormalities. To evaluate E-PREP's effectiveness in relation to non- gynaecological samples. To contrast E-PREP's benefits and drawbacks for non- gynaecological samples. Materials and Methods: Samples from patients who visited the cytology department for FNAC of thyroid, breast, and lymph node lesions were used in this prospective investigation. gathering patient clinical data, going to the cytology department for FNAC on lesions in the breast, thyroid, and lymph nodes, and getting ready for CSs and LBP. Results: The proportion of satisfactory smears is higher in the Liquid-based preparation, at 51.3%. The proportion of inadequate smears is higher in liquid-based preparations, namely at 68.3%. The P value was calculated using the Pearson Chi-Square test, and the resulting P value was 0.254. Conclusion: The selection between the Conventional technique and LBP relies on the characteristics of the lesion (whether it is solid or cystic) and any additional tests needed for the sample. Every method possesses its own merits and drawbacks. Nevertheless, the integration of two techniques can yield superior smears of higher quality and reduced rates of failure. Keywords: Fine needle aspiration cytology, Conventional smear, Liquid based preparation, thyroid, breast, lymph node.

Background: Tuberculosis (TB), the world health problem has been a dreadful disease that kills about 1.5 million every year while causing illness to around 10 million. Despite TB being a treatable and curable disease by proper diagnosis and medical treatment, stigma stands as a barrier from achieving complete elimination of TB. Objectives: 1) To assess the pattern of stigma present in tuberculosis patients. 2) To correlate stigma pattern with their socio-demographic data for significance. Materials and Methods: Institution based cross sectional study. Sample size was calculated as 80 for the prevalence of 73%. Participants of the study were assessed for stigma using semi-structured, pre-coded and pre-tested questionnaire on the basis of Explanatory Model Interview Catalogue (EMIC). Simple descriptive statistical analysis was done. Results: Almost 76 (95%) shares about their illness to their family seeking an emotional support. Only 24 (30%) were asked to stay away from work or social groups, while 69(86.25%) decided themselves to stay away from work or social groups. These results prove the dominance of self-stigma perceived by the patients over social stigma. 58 (72.5%) answered that their sudden and significant loss of weight made people think that they have other health problems along with TB. Conclusion: Tuberculosis affects the person not only medically, but also psychologically. Therefore, in addition to appropriate medical treatment, psychological support and counselling is also essentioal for better outcome. Keywords: Tuberculosis, Stigma, EMIC scale.

Background: Alopecia areata is an immunologically mediated disorder characterized by focal to diffuse hair loss. AA is hypothesized to be an organ specific autoimmune disease mediated by T lymphocytes directed against the hair follicles. Although genetic predisposition and environmental factors may trigger the initiation of the disease, the exact cause is still unknown. Materials and Methods:100 clinically diagnosed cases of Alopecia Areata attending DVL department, attached to GGH Kurnool, were studied. A detailed proforma was taken, which included- 1) Detailed history including chief complaints related to skin and hair. 2) Complete physical and systemic examination. 3) Relevant investigations were done in patients. A prospective, descriptive study on Alopecia Areata subjects was conducted over a period of 22 months from December 2020 to September 2022, attending the Out-Patient Department of DVL, Government General Hospital attached to Kurnool Medical College, Kurnool. Results: In the present study the incidence of alopecia areata in patients attending DVL outpatient department is 1.9. Conclusion: In the study period of 22 months, percentage of AA cases observed is 1.9% among all cases attending DVL OPD, GGH, Kurnool. Among study subjects, most common age group affected is 20-40 years. In this study, systemic disorders associated with AA are atopy (12%), thyroid abnormalities (11%), diabetes mellitus (5%), hypertension (2%), dental caries (7%), iron deficiencyanaemia (6%), down's syndrome (1%), right maxillary sinusitis (1%), jaundice (1%) and CSOM (1%). Keywords: Alopecia Areata, Dermatological Disorders, DVL.

Background: Evaluation Of Clinical and Radiological Outcome in Thoracolumbar Spine Fractures Fixed by Pedicle Screw. Materials and Methods: This study was conducted on 20 patients with thoracolumbar vertebral fractures who underwent surgical fixation with pedicle screw. Results: In this study19 cases improved, 11 (55%) cases improved by one grade, 7 (35%) by two grades, and 1 (5%) by three grades. 1 (5%) case did not show any improvement. Conclusion: Based on the analysis of the data collected in this study, the pedicle screw and rod fixation remains the implant of choice for the treatment of thoracolumbar fractures. Keywords: Spine, Thoracolumbar Fractures, Pedicle Screws and Rod.

Background: Patellar fractures are common and account for nearly 1% of all bone injuries. The patella is important for extending the knee joint. Several methods have been proposed for internal fixation of a fractured patella. The aim of this study is the clinical evaluation of a modified tension band wire technique for comminuted patellar fracture. Materials and Methods: This study includes 15 patellar fracture cases treated with a modified tension band wiring between October 2022 and October 2023 at Government General Hospital, Nandyal. Results: All cases were operated through a midline anterior vertical skin incision, with 80% achieving excellent results with normal squatting, Grade V quadriceps strength, and total knee range of motion. 20% of cases had difficulty squatting, grade -IV quadriceps strength. and bending restraint. Minimal quadriceps atrophy is observed in 20 percent of cases. Conclusion: Based on the analysis of this study, modified tension band wiring is the gold standard in the treatment of transverse patellar fractures. Keywords: Patella, Fracture, Modified Tension Band Wiring.

Background: Erythema multiforme is an acute self-limited syndrome with distinctive skin lesions, with or without mucosal lesions, which canbe precipitated by various agents. EM minor denotes mild cutaneous syndrome. EM major denotes more severe syndrome, with marked mucosal involvement. Materials and Methods:50 clinically diagnosed cases of erythema multiforme attending DVL department, attached to GGH Kurnool, were studied. A detailed proforma was taken, which included 1). Detailed history including chief complaints related to skin. 2). Complete physical and systemic examination. 3). Relevant investigations were done. Results: In the present study, 50 clinically diagnosed cases of erythema multiforme were enrolled. 31-50 yrs. (40%) age group patientsshowed peak incidence, with slight female preponderance. Incidence of EM minor (84%) was much higher than EM major (16%). Systemic drugs are the main cause for EM minor (50%) and the sole cause for EM major. Among drugs, Sulphonamides (20%) are the commonest cause. Next come Infections (30%) among which Herpes simplex (20%) is most common; followed by Radiotherapy. All cases of EM major showed symmetrical involvement, bullous lesions, erosions over both skin and mucous membranes. EM minor presented with papular lesions, ‘Target’ lesions over extremities. Conclusion: The present study emphasises that EM can be diagnosed clinically. Drugs are the sole cause for EM Major. Keywords: Erythema Multiforme, DVL.

Background: Respiratory tract infections are the most common human illnesses. They causes substantial morbidity and mortality in young children. Acute respiratory infection (ARI) is the major cause of death in children under 5 years in developing countries. Aims & Objectives: To study the clinical, radiological and bacteriological profile of severe pneumonia in children of 1 month to 5 years of age group; To study and identify the risk factors associated with severe pneumonia; To correlate clinical findings with radiological findings in the study sample. Materials and Methods: This is a hospital-based prospective observational study conducted in king George hospital, Visakhapatnam over period of August 2021 to June 2022.100 Children with clinical manifestations of ARI were enrolled in the study. Results: Fever (95%), fast breathing (95%), and cough (93%) are the most common presenting symptoms. Chest retractions (100%), tachypnea (95%), and crepitation’s (85%) are the common presenting signs. Lack of exclusive breastfeeding for 6 months, inadequate immunisation, severe anaemia and severe malnutrition were reported to be the major risk factors for severe pneumonia. Radiological diagnosis of bronchopneumonia was made in 63% of cases; lobar pneumonia in 22% and pneumonia with its complications were seen in 5% of cases. Routine haematological investigations and blood cultures do not give much information about the etiology of pneumonia. Conclusion: The study finally concluded that, among risk factors studied, lack of exclusive breast feeding for 6 months, inadequate immunisation, severe anaemia and severe malnutrition were reported to be the major risk factors for severe pneumonia. On investigations, most of them (66%) had neutrophilia, and 91% had elevated CRP. Routine haematological investigations and blood cultures do not give much information about the etiology of pneumonia. Keywords: Breast Feeding, Severe Anaemia, Neutrophilia, Pneumonia.

Background: There is little research on the application of gamification. Gamification is a strategy that aims to have a beneficial influence on a variety of wellness and health-related situations, not only because it can increase people's engagement and responsibility for their health-related decisions, but also because it can improve healthcare personnel' performance. Objectives: To assess the knowledge, attitude, practices of college students of Indore city towards healthcare gamification apps and to know the behavioural changes brought about by these apps. Materials and Methods: A cross-sectional study of 4 months duration (Oct 2022 – Jan 2023) was conducted among 250 randomly selected students from various colleges of Indore, by using pre-designed pre-tested semi-structured questionnaire. Data entered in MS Excel and analysed by SPSS Software 25.0 (trial version). Results: Mean age of participants was 20 ± 1.35 years. Use of fitness devices were significantly higher in upper and upper-middle socio-economic class (p value 0.007). Daily steps counting (66%), sleep tracking (32%) and calorie burn monitoring (31%) were the most common activities monitored. The following results were statistically significant: Majority, 39.7% female and 47.4% male students used fitness device/ app every day. 72.8% females and 70.2% males were not willing to spend on gamified health tracking. Health benefit was found to be the major factor (86.0% females and 72.8% males) promoting the use of healthcare gamification applications over rewards and competition. 44.9% females and 56.1% males perceived physical health improvement. Conclusion: Healthcare gamification applications for the promotion of digital wellbeing is a breakthrough approach. This study has allowed us to learn more about the various deeper aspects of this process. Keywords: Gamification, Fitness-bands, Mobile Health application.

Background: The total amount of time a person spends in front of a screen like any electronic gadget is called screen time. Excessive screen time is associated with risk of health problems, such as obesity, poor school performance, decreased social interaction and lower physical activity. In today's digital age, it is essential to assess awareness of screen time, particularly in relation to exceeding recommended levels among medical students because they constitute a more susceptible group for harmful health behaviours due to academic, professional, and recreational activities. Objectives: To assess the awareness level of undergraduate medical students regarding excessive screen time and to assess knowledge regarding excessive screen time and its adverse effects on health. Materials and Methods: A cross sectional study of 6 months (April 2023-September 2023) was done among 300 randomly selected Undergraduate medical students aged group 18–24 years in MGMMC, Indore, using pre-designed semi-structured questionnaire. Data were entered in to Microsoft excel sheet and analysed using SPSS 25.0(Trial version). Results: Of 300 Undergraduates medical students, majority were male. Among them 63% under 21 – 24 year old. Majority of participants (55%) belonged to second professional. 74% Students use screen more than three hours/day. The difference in screen time between genders was statistically significant (p-value - 0.041). Among 300 students only 14% students were aware about 20-20-20 rule but never followed the 20-20-20 rule. Conclusion: In our study we found that a higher percentage of males spent excessive time on screens. Majority of the students were aware of the adverse effects of increasing screen time like increased risk of social isolation, poor academic performance, headache, eye problems, emphasizing the importance of taking frequent breaks. Keywords: Excessive screen time, social isolation, physical activity, medical students.

Background: Neonatal health is the key to child survival. Neonatal mortality in India in 2020 was 20.3/1000 live births. Three fourths of these deaths occur in first week of life. Prematurity and LBW, neonatal infections, birth asphyxia and birth trauma account for 78% of all neonatal deaths in India1. Present study was done to know the mortality and morbidity profile of new-borns in NICU of KGH, Visakhapatnam. This knowledge helps in identifying gaps in care practices and improve quality of care in health care facilities. Aims & Objectives: To study and compare the morbidity profile in term and preterm neonates. To evaluates the various causes of mortality in preterm and term neonates Materials and Methods: It is a hospital based prospective observational study. A total of 400 neonates, of them 200 preterm and 200 term babies were enrolled in the study. Maternal details, neonatal details, physical examination, investigations, various morbidities and final outcome were noted in a structured predefined proforma. Results: From this study, among preterm neonates most common causes of mortality were Sepsis(12%),RDS(11.5%),Birth asphyxia (3.5%),DIC (1%) and IVH (0.5%).Among term neonates mortality causes were Birth asphyxia(2.5%), Sepsis (2%),MAS(1.5%), Aspiration pneumonia (1%) and DIC (0.5%).Most common morbidity among preterm neonates were NNJ, RDS, Sepsis, NEC, Hypothermia, Apnea, Hypoglycaemia, Hypocalcemia, Birth asphyxia, Congenital heart diseases & among term neonates causes are Sepsis, Birth asphyxia, seizures, MAS,NNJ, Congenital heart disease, hypoglycaemia, hypocalcemia, bleeding manifestations, NEC, hypothermia. Conclusion: The present study concluded that, High risk pregnancy must be identified in the antenatal period and must be referred to appropriate centre for skilled management. Keywords: Preterm neonates, Seizures, Hypothermia, Morbidity, Mortality.

Background: A comparative study on safety and efficacy and complications of intra caesarean insertion of IUCD and post caesarean insertion of IUCD. Materials and Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Niloufer Hospital, Osmania Medical college hospital, Hyderabad. All patients delivered at, Niloufer Hospital, Osmania Medical College hospital during the study period, fulfilling the inclusion criteria and willing to participate in the study. Mode of delivery is Caesarean section. Results: In our study group, maximum women were within the age group of 18-24 years (55%) followed by 29-30 years. Which found that acceptance of PPIUCD was best within the age bracket of 21-25 years (39.33% and 44%, respectively). The mean age of acceptance as 23.70 years for post-partum copper T insertion, concluding that the acceptance of PPIUCD as contraception was more within the younger age group (≤30 years). Among the PPIUCD acceptors, majority were primi gravida. This shows that PPIUCD is commonly used among women as a short term contraceptive to space out their pregnancies. Multigravida preferring PPIUCD had history of use of PPIUCD in their previous pregnancy. The usage rate increased as these women were comfortable using PPIUCD earlier and PPIUCD removed the need for permanent sterilisation allowing the women to conceive at a later date if necessary. Conclusion: PPIUCD awareness among the study group was insufficient as many mothers were not aware of PPIUCD or its benefits. The overall acceptance rate of PPIUCD is poor. This could be attributed to the fact that many women were unaware and had to be informed about the benefits of PPIUCD only when they were admitted for delivery. Keywords: PPIUCD, Multigravida, Contraceptive, Copper T.

Background: Preterm labour is defined as regular uterine contractions leading to cervical changes before 37completed weeks of gestation and after period of viability. Preterm birth is responsible for 30-40% of neonatal mortality worldwide. Identifying pregnant women at risk of preterm delivery will enable them an easy access to tertiary care centres for further management. Aim: To evaluate serum ferritin levels in preterm labor and perinatal outcome in a tertiary care centre during 2years period from 2019-2022. Objective: To compare the serum ferritin levels in patients of preterm labor and low risk pregnant women with same gestational age. Materials and Methods: A case control study was performed in the department of Obstetrics and Gynecology in Niloufer hospital, Osmania medical college, Hyderabad 2019-2022. Source of samples and data was take from the Department of Obstetrics & Gynecology, Niloufer hospital, Hyderabad and Department of Biochemistry, Osmania medical college/ Osmania General Hospital, Hyderabad. 100 subjects are taken as sample size after obtaining the consent in the study group & divided into 2 groups. Group 1 included women with spontaneous preterm labor and Group 2 included control group- women. Results: Among 50 cases of pre term labour, majority 39 (78.0%) were belonging to pre term (32 to 36 weeks), followed by 18 (18.0%) were in very pre term (28 to 32 weeks). Among 50 cases included in the study, majority of the cases i.e., 31 (62.0%) was delivered by normal vaginal delivery and 19(38.0%) delivered by emergency LSCS.Among50cases, majority of the cases i.e., 49 (98.0%) of the pregnancies ended up with alive babies and 01 (2.0%) had still birth. CRP was positive in 02 (4.0%) cases and negative in 48 (96.0%) of cases. Vaginal swab was negative in all 50 (100%) cases. The mean WBC in cases was 12868.86 ± 3814.83 and in controls was 11057.80 ± 2301.67. Mean WBC levels were higher among cases than controls which is statistically significant in difference of WBC levels between cases and controls. The mean serum ferritin levels were 40.298 ± 19.64 in cases and 20.343 ± 6.82 in controls. The mean serum ferritin levels were significantly higher among cases than controls & in very pre term labour was 35.15 ± 13.87. The mean serum ferritin levels were highest in preterm category followed by very pre term. The mean WBC levels in very pre term labour was 13055.55 ± 2950.47. The mean WBC levels were highest in very preterm followed by preterm &found to be statistically insignificant. Conclusion: Serum ferritin levels are elevated in preterm labor compared to low risk women of same gestational age. Elevated maternal serum ferritin levels in early pregnancy are associated with an increased risk of pre term labour. The usefulness of early pregnancy ferritin levels in identifying women at risk of pre term labour warrants further investigation. Keywords: Serum ferritin, Preterm labor, Term labour, Pregnancy, Hb, CRP.

Background: COVID-19 has been associated with significant morbidity. Post-COVID syndrome is a pathologic entity, in which physical, medical, and cognitive symptoms persist following COVID-19. This study was done to assess such symptoms in patients recovered from COVID-19 infection. Materials and Methods: A total of 100 patients with recent history of COVID-19 infection who presented to Medicine OPD of Government General Hospital, Kakinada, from June 2021 to May 2022 were included in this study. Results: Out of the 100 patients, 65% had post-COVID syndrome. Fatigue was most common complaint (75%), followed by disturbed sleep (60%) and dyspnea (40%). No deaths were observed during the study period. Conclusion: The purpose of this study is to raise awareness regarding the post-COVID syndrome which includes a constellation of unexplained symptoms for which no confirmatory laboratory test exists, thus making it easy to overlook or ignore. Keywords: COVID-19, post covid sequelae.

Background: Acute myocardial infarction is a major diagnosis in hospital admissions. It is a major affliction as it is linked to increased mortality in developed countries and is also becoming a foremost reason for mortality in developing countries. Aim & Objective: The objective of the current study is to examine the relationship between the ST- segment resolution and clinical consequences and acute complications and to determine whether ST- segment resolution can be used as a prognostic marker to assess the adverse outcomes following thrombolysis. Materials and Methods: The current study is a ‗prospective study comprising a sample size of 100 patients who were admitted in the Department of Cardiology, Rangaraya Medical College, Kakinada, during the time period between December 2019 and August 2021. Results: The ‗mean age of the population included in the study is 50.05 ± 9.4 years. Male to female ratio is 4:2 that depicts obvious male gender predominance. The usual presentation observed in 96%of individuals in the current study is chest pain succeeded by sweating and breathlessness. The most frequent risk factor observed in the current study is smoking followed in order by hypertension and diabetes respectively. Anterior wall MI represents 59% of the study population in contrast to the ‗Inferior wall MI which is 41.%. Patients were segregated into 3 categories in accordance with ST-segment resolution after 90minutes following thrombolytic therapy. Forty percent of patients comprised the group of >70% ST- segment resolution (Complete STR), forty-six percent of patients comprised the group of 30-70% ST- segment resolution (Partial STR and 14% patients comprised the group of <30% ST- segment resolution (No STR). Patients showing greater than 70% ST-segment resolution (Complete STR) is closely related to reduced adverse outcomes throughout the hospital stay and lower ‗in- patient mortality ‘. Patients showing less than 30% ST- segment resolution (No STR group) connected to increased adverse events and in-hospital mortality ‘. In-patient mortality is observed in 10% of patients. Cardiogenic shock is the most frequent reason for mortality in 80% patients accompanied by ventricular tachycardia(VT)/ ventricular fibrillation(VF) in 20% patients. Conclusion: The present study concluded that, the percentage of ST-segment resolution 90 minutes subsequent to thrombolysis is a simple and non-invasive method and serves as a prognostic indicator of outcome that aids in risk stratification of patients. Keywords: STEM, Thrombolysis, Tachycardia, Mortality, ECG, Myocardial infraction.

Background: Meningiomas are prevalent intracranial neoplasms that account for 13-25% of all intracranial neoplasms and are located outside the brain tissue. The incidence of asymptomatic meningiomas has risen due to recent advancements in neuroimaging. Materials and Methods: A total of 60 patients were included in this investigation. This study was conducted at the Department of Neurosurgery & Department of Biochemistry, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. This study was conducted between October 2022 to September 2023. These patients were diagnosed with meningiomas based on clinical and radiological characteristics. Results: The study includes the findings of an analysis that was performed on sixty patients who had meningiomas surgically treated prior to the study's completion. According to the epidemiological analysis, meningiomas were most commonly found in patients aged 40–49, with a close second place for patients aged 30-39, when compared to the incidence of these tumours in the 55.9–56.4% age group and the overall Western population, where the incidence increases with age. This was the case when comparing the two age groups. Conclusion: The following findings were based on the findings of the observations made on the patients who participated in the study, and the overall results and conclusions from the study corroborate these findings. Keywords: Algorithm, meningioma, risk variables, surgical outcomes.

Background: Primary spinal tumours, in contrast to cerebral tumours, are predominantly benign. The majority of spinal cord tumours manifest through compression rather than invasion. The objective is to examine the relationship between the clinical symptoms and the microscopic examination of spinal cord tumours. Materials and Methods: Primary spinal tumours, in contrast to cerebral tumours, are predominantly benign. The majority of spinal cord tumours manifest through compression rather than invasion. The objective is to examine the relationship between the clinical symptoms and the microscopic examination of spinal cord tumours. Results: The surgeon often uncovers surprises in the operational field following a comprehensive clinical and radiological examination of spinal cord tumours. This study examined the relationship between clinical, radiological, and pathological spinal cord tumour diagnosis. Clinical diagnosis matched radiological findings at the time for all tumours. Clinical and radiological concordance exceeded for schwannomas. The association of lesion levels in the 30–45 age range was around. Due to nerve root involvement, these tumours were located at the right level. The 45 to 60 age group and the under 15 age group had the lowest tumour correlation. Clinically, lesions matched radiological findings for intramural extarmedullary tumours. Conclusion: The aforementioned study indicates that clinical examination is crucial in diagnosing spinal cord tumours, even in the current era of advanced investigations. Keywords: Clinical, radiological, pathological, and spinal cord correlation.

Background: Health insurance can be extremely useful in preventing debt among individuals seeking it. When any need or emergency arises, insurance can be of great help. In recent years the Indian government has created a number of low-cost health insurance programme for rural residents so that they can be covered by insurance without experiencing undue financial strain. Having an insurance makes it easier for people to access healthcare. Along with the government, Non-Governmental Organization (NGO) implement numerous programs for those who live in poverty. The purpose of this study is to determine the percentage of households with health insurance and an average household’s health spending in rural areas. Objectives: 1. To estimate health insurance coverage and average expenditure on health among household in a rural area. 2. To determine the sociodemographic factors associated with health insurance among households in a rural area. Materials and Methods: A cross sectional study conducted among households residing in a rural area of a medical college over a period of 2 years from January 2021 to January 2023. A pretested self-administered structured questionnaire was used for collecting data. Results and Conclusion: Out of total 370 households, majority of head of households (52.9%) were from age group 41-60 years. Majority of head of households were males (92.16%). Whereas majority of the head of households (88.6%) were Hindu by religion, belonged to nuclear family (68.65%) and belonged to middle socioeconomic class (39.73%). Of the total household 71.6% head of household subscribed for health insurance. This study showed that possession of health insurance was more in males as compared to females. The most common reason for not availing health insurance was preferring investment of money in some other areas. Magnitude of household average expenditure per year in rupees with mean was 2091.89. Keywords: Health insurance, awareness, possession and expenditure on health.

Background: The study aimed to find out the occurrence of allergy among Tuberculosis infected Pediatric patients of age group 5-12 years and to find out the factors associated between allergy and Pediatric tuberculosis. Materials and Methods: The study was conducted as a cross-sectional observational study on 70 children belonging to age group of 5-12 years presenting with Tubercular disease on Anti Tubercular therapy and 70 controls with age and sex matched children seeking care for other illness at Department of Paediatrics, tertiary care centre in central India during the study period of 18 months. Burlingtonent clinical scoring system was used for the assessment of the Allergy in these children. Results: Cases and controls were compared with respect to socio-demographic variables such as age, sex and socioeconomic status. Study reflects no significant assoication between gender and age in the both control and cases ,We reported a negative association between Allergy and Tuberculosis, i.e. the probable Allergy and Allergy very likely was documented in significantly higher proportions of controls as compared to cases (p<0.05). Among various factors, allergy was significantly associated with higher socioeconomic status in patients with Tuberculosis (p<0.05). Conclusion: Those group of patient who are more prone to Allergic condition have less chances of Tubercular infection Vice versa, reduced burden of infectious disease may increase the burden of allergic conditions. Socioeconomic status plays an important role in predisposing an individual to risk of allergies in Tuberculous patients. Keywords: Tuberculosis, allergy, Burlingtonent Clinical Allergy Questionnaire, atopy.

Background: To detect the Usefulness of pulse oximetry monitoring in early detection of CHD in newborns with cyanosis. Materials and Methods: This study was an observational, prospective study conducted in Department of Paediatrics, Siddhartha Medical College, Vijayawada - a tertiary care centre with well-equipped facilities. Study was conducted for 12 months from APRIL 2021–MARCH 2022. 100 cyanotic newborn babies aged 12-48 hours admitted in NICU, department of Paediatrics, were included. The usefulness of pulse oximetry monitoring in early detection of Congenital heart disease (CHD) in newborns with cyanosis is studied. Results: Out of 100 newborns with cyanosis, only 45% were male babies. Majority (57%) of the babies included were delivered by normal vaginal delivery. Majority (78%) of the newborn’s included were born to couples who were distantly related to each other.19% of the newborns were first born child. Nearly one fifth of the newborns were first born child in their family. The mean birth weight is 2.8±0.37kg. 20 % of the newborns were LBW babies. (≤2.5kg) The mean time of oxygen saturation recording was 31.4±3. 6hours. Frequency of newborns with positive result by pulse oximetry were 60%. 80 % of the newborns with cyanosis with positive pulse oximetry result included were having normal study in the echocardiogram. One cyanotic new born had Epstein’s anomaly. The frequency of TA, and TOF group were two each. Three newborns with cyanosis were having TAPVC and four newborns with cyanosis were having TGA as per the echocardiogram. Out of 100 new-borns with cyanosis included, twelve newborns were cyanotic due to cyanotic CHD. Five newborns were cyanotic due to hypothermia. Eight new-borns were cyanotic due to PPHN. Sixty newborns were cyanotic due to respiratory causes and 15 newborns were cyanotic due to CNS related reasons. There is no significant association between CHD and consanguinity in the study. Conclusion: This study indicates that pulse oximetry is a non-invasive, reliable and useful monitoring tool for a nearly detection of CHD especially cyanotic CHDs. Keywords: CHD, Newborns, Pulse oximeter, TGA, TAPVC.

Background: Pediatric shock accounts for significant mortality and morbidity worldwide. Shock approximately occurs in 2% of children admitted to pediatric ICU worldwide as per most western literature. Shock is classified based on severity as compensated or decompensated shock. Etiology based classification of Shock: Hypovolemic shock, Septic shock, cardiogenic shock, Distributive shock, Obstructive shock. The outcome of shock depends on severity at the time of presentation, etiology and resources available for intervention. It is necessary to monitor the patients in shock with clinical and laboratory parameters which guide the therapeutic intervention and defines the outcome. Early recognition and prompt intervention are extremely important in the treatment of all forms of shock. Aims and objectives: To study the Etiology, Severity and outcome of shock in children of age 1 to 10 years. To evaluate the response to treatment in various forms of shock Materials and Methods: Hospital based observational study at PICU, King George Hospital, and Visakhapatnam for a period of one year. All children of age 1 to 10 years admitted with shock were taken detailed history, thorough physical examination and relevant laboratory investigations were done. The final statistical analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. Results: A total of 60 cases were enrolled in the study of which the predominant age group involved was 1 to 3 years. Hypovolemic shock is most common followed by septic and mixed shock. Decompensated shock and compensated shock constituted 63.4% and 36.65% respectively. Most common etiology was Severe acute malnutrition (16.7%) followed by ADD with severe dehydration (13.3%); Dengue (13.3%) and severe Pneumonia (10%). 40% of the patients with shock responded to fluid resuscitation alone and 55% of the patients required inotrope support. Overall mortality rate was 31.7%. Mortality rate was more among the age group of 1 to 3 years. Mortality was highest in mixed followed by septic shock. Conclusion: As the age of the patients increased, the mortality rate decreased and this is statistically significant with p value <0.05. Compensated shock had a survival rate of 100% while only 45% of decompensated shock survived. Abnormal ABG and high S. Lactate levels showed higher mortality. Most cases of decompensated shock leading to mortality were due to sepsis. This indicates the significance of early diagnosis of shock in compensated stage, etiology of shock and its timely management. Keywords: Decompensated shock; septic shock.

Background: Chronic kidney disease (CKD) is a dreadful condition with drastic decline in renal function resulting in renal failure, cardiovascular illness and early mortality. Due to increasing risk factors and life style modifications Chronic Kidney Disease has become a major public health problem worldwide. Aim: To evaluate the changes in hematological parameters in Chronic Kidney disease patients and to correlate peripheral smear findings with the changes in Renal function tests. Materials and Methods: The present prospective study was done over a period of 4 years (November 2019 to October 2023) which included clinically diagnosed cases of Chronic Kidney Disease at S.S. Institute of Medical Sciences and Research centre, Davangere. Brief clinical history with associated predisposing factors were also considered and correlated with complete hemogram. Results: Out of total 220 patients, 70.9% were male and 29.1% were females. Complete hemogram showed Normocytic normochromic anaemia as the most common anemia (65.5%) followed by Normocytic hypochromic anaemia (20%). On Pearson’s correlation, there was a significant negative strength of association between serum creatinine and haemoglobin levels in chronic kidney disease patients. Independent T-test showed a significant rise in mean serum urea level among patients with burr cells on peripheral smear as compared to those without burr cells (p<0.05). Conclusion: Normocytic normochromic anaemia is the most common anemia in chronic kidney disease. The serum creatinine level is inversely correlated with the haemoglobin value and directly correlated with severity of anemia. Also presence of burr cells in the peripheral smear were significantly associated with a higher mean serum urea levels. Keywords: Chronic Kidney Disease, haematological parameters, peripheral smear, burr cells, serum urea, serum creatinine.

Background: Postpartum depression is exhibiting a typical iceberg phenomenon, tip being the visible clinical symptoms and few case detections, beneath are hidden multiple factors causing postpartum depression. The need of the hour is to assess these factors and curb them to reduce the prevalence of postpartum depression. This study estimates the prevalence of postpartum depression and its associated factors in a rural area of Maharashtra. Aim: Aim is to study postpartum depression and its associated factors in a rural area of Maharashtra. Objectives: To estimate the prevalence of postpartum depression in a rural area and to identify the factors associated with postpartum depression. Settings and Design: A community based cross-sectional study conducted in a rural area of Maharashtra from June 2023 to November 2023, calculated sample size was 110. Materials and Methods: Women within the postpartum period of 2 weeks to 6 months and women aged 18 years or older were included in the study after obtaining consent. Interviews were conducted at home in a confidential and non- judgemental manner with Edinburgh postpartum depression scale. Women with a history of psychiatric disorders prior to pregnancy, women with pre-existing chronic medical conditions that may impact mental health or women who had still-birth or neonatal death were not included in the study. Statistical analysis was done using ‘Open Epi Info’ software. Results: The prevalence of postpartum depression in our study was 13% and influencing factors for postpartum depression were elderly mothers (43%, p=0.047), higher education in mothers (50%, 0.016), higher socioeconomic class (50%, p=0.008), working mothers (37.5%, p=0.029), higher birth order (50%, p=0.000*), mode of delivery being C-section (79%, p=0.002), presence of complications such as gestational diabetes mellitus or pregnancy induced hypertension during antenatal period (p=0.015), previous female child (75%, p=0.006), female child as outcome of present pregnancy (75%, 0.024), history of previous abortion (40%, p=0.000*), presence of marital conflict (37.5%, p=0.001), domestic violence (75%, p=0.000*), poor relationship with in-laws (75%, p=0.002) and absence of family involvement in child rearing (59%, p=0.000*). Conclusion: The findings of our study underscore the importance of screening all postpartum women for depression, with a special emphasis on safeguarding women with less social means because they are more vulnerable. Future studies can determine the potential contribution of frontline healthcare providers, such as the accredited social health activists in India who already offer postpartum care in the home, to the screening, identification, and referral of postpartum depression. For a prolonged period, postpartum, regular, mandated screening for postpartum depression in resource-constrained settings is crucial for the early identification and treatment of the undertreated burden of postpartum depression. Keywords: Postpartum depression, Edinburgh postpartum depression scale, domestic violence, caesarean section, screening, mental health.

Background: Nephrotic Syndrome, a common renal disorder in children Is characterizedby massive proteinuria with edema, hypoalbuminemia, and hyperlipidemia. Minimal change nephrotic syndrome (MCNS) accounts for about 80% of idiopathic nephrotic syndrome with good prognosis. Inspite of relapses majority achieve remission by 2nd decade. More than 95% of MCNS respond well to steroid therapy (SSNS). Infections especially UTI frequently predispose to relapses in NS. UTI in children may be unrecognized as it may be asymptomatic mostly in children with nonspecific symptoms. Early identification and prompt treatment of UTI is important for proper management of children with NS. Aims and Objectives: To Study the clinical profile and prevalence of UTI among SSNS children with relapses and to determine the causative microorganisms among SSNS children with UTI and their sensitivity pattern to antibiotics. Materials and Methods: Hospital based observational study in a Tertiary Care Hospital(TCH) over a periodof1year. 70 children of steroid sensitive nephrotic syndrome with relapses of>2years of age were included in the study after taking prior permission from Institute Ethics Committee and a written informed consent from parents/guardian of the patients enrolled in this study. Children with Urinary tract infection. and previously treated with or on antibiotics within 15 days prior to admission and those with anatomical abnormalities of genitourinary tract were excluded from the study. Detailed history was taken regarding demographic details like age of onset, gender, number of relapses, clinical features at the time of admission, chronic illness like Tuberculosis and fungal infections and treatment given and detailed examination was done. Laboratory investigations like Complete blood picture, serum protein, serum cholesterol, Renal function tests, urine examination, urine culture and sensitivity, chest x-ray, Mantoux test and ultrasound abdomen were done as per requirement. Data obtained was tabulated and scientifically analyzed using SPSS 21Version. Results: Out of 70 children with SSNS with relapses, maximum incidence was in the age group of 2-6 years with male: female ratio of 1.5: 1. Common clinical presentations at the time of admission were facial puffiness (100%), abdominal distension (42.9%), pedal edema (37.1%), decreased urine output (28.6%) and burning micturition (27.1%). Common clinical findings were pallor (41.4%), pedal edema (35.7%) and ascites (31.4%). Infections were seen among 48.6% of children and UTI (25.7%) was most common infection, 60% were infrequent relapses (IFR), 40% were frequent relapses (FR) . UTI was more common in frequent relapsers (67.8%). Unimmunized children were at higher risk of developing infections (65%). However, there was no statistically significant association between infection and immunization status. Majority of culture positive (62.5%) SSNS were symptomatic. There was significant association between symptoms & culture sensitivity (p value 0.01). Significant pyuria seen in 83.3% of culture positive SSNS which was statistically significant (p value 0.018). Most common organism isolated was E. Coli (37.5%). A

Background: Vulvovaginal candidiasis (VVC) is the most commonly encountered gynaecological condition worldwide. C. albicans is the most commonly causative pathogen of VVC. However, non-albicans candida species like C. glabrata are also common which usually do not respond to the traditional drugs used for VVC. Hence drug susceptibility testing is important. Materials and Methods: A prospective observational study was done in the Department of Microbiology which included 50 patients with complaints of vaginal discharge. Results: 30% of the study sample had positive growth on SDA. C. glabrata was the most commonly isolated organism. Ketoconazole was the drug with highest resistance. Flucytosine, econazole had highest sensitivity. Conclusion: Identification of appropriate antifungal agent in cases with uncomplicated or recurrent infections is impertinent. Keywords: Candida, vulvovaginal candidiasis, drug susceptibility testing.

Background: Hip fractures in elderly patients are associated with high morbidity and mortality due to postoperative complications. Understanding the risk factors and the effectiveness of various prevention strategies can guide improvements in care. This study is undertaken to investigate the risk factors associated with postoperative complications in elderly patients with hip fractures and evaluate the effectiveness of prevention strategies. Material and Methods: This observational study included 100 elderly patients with hip fractures. We assessed the impact of age, comorbidities, and previous surgical history on postoperative complications. Prevention strategies evaluated included preoperative assessments, Enhanced Recovery After Surgery (ERAS) protocols, and intensive postoperative monitoring. Data were analyzed using chi-square tests and logistic regression to identify significant predictors of complications. Results: The average age of the participants was 68 years, with a predominance of female patients (60%). Complication rates were significantly higher in patients aged 70 and above (48%) compared to those under 70(22%). Patients with multiple comorbidities had a complication rate of 43%, significantly higher than those with one or no comorbid conditions (13%). The most common complications were delirium, surgical site infections, and pulmonary embolism. Implementing preoperative assessments resulted in an 18% decrease in complications, while ERAS protocols and intensive monitoring reduced complication rates by 20% and 24%, respectively. Conclusion: Elderly patients with multiple comorbidities and previous surgical history are at increased risk for postoperative complications following hip fractures. Proactive strategies including preoperative assessments and ERAS protocols significantly reduce these risks. Keywords: Hip fractures, elderly, postoperative complications, comorbidities, ERAS, preoperative assessment, observational study.