Vol 14, Issue 1, Jan-Mar, 2024

Background: Cervical cancer is the second most common cancer in Indian women. In India, cervical cancer contributes to 6-29% of all cancers in women.[1] Late diagnosis results in poor outcomes in the majority of instances of cervical cancer. Cervical carcinoma is the leading cause of mortality (17%) in 30-69 years old women.[1] The aim of this study is to assess the knowledge in Indian women attending oncology Outpatient Department (OPD) at Kurnool medical college and Government General hospital, Kurnool regarding cervical cancer screening and Human Papilloma Virus (HPV) vaccination. The secondary goal of the study was to create awareness among patients attending OPD regarding carcinoma cervix. Materials and Methods: This is a cross sectional study, conducted in 423 women who attended OPD, Department of Oncology, Kurnool Medical college, Kurnool after taking prior permission from hospital ethics committee. After taking informed consent, the questionnaire was provided to the subjects who met inclusion criteria, in the language understandable to them. In case if subject was illiterate, the questionnaire was read aloud by doctor and the responses were recorded. After completion of questionnaire, the doctor shared knowledge regarding etiological factors, screening tests, awareness on vaccination and treatment options available for carcinoma cervix with the patients. Results: Majority of the women have poor knowledge about cervical cancer (75.82% [321/423]) and it’s screening (77.7% [329/423]). Conclusion: Many women lacked knowledge regarding cervical cancer and its screening, which is the reason behind late diagnosis and high mortality. It is the high time to create awareness of cancer cervix, its screening and adoption of prevention measures like vaccination to decrease the burden of disease in India. Keywords: Cervical cancer, HPV, Vaccine, Etiological Factors.

Background: The aim of my study is to assess and compare the efficacy and safety of preoperative administration of pregabalin and tramadol in patients undergoing elective lumbar laminectomy. Materials and Methods: This prospective, randomised, single blinded placebo-controlled study evaluated the efficacy of preoperative administration of pregabalin and tramadol for postoperative pain management in patients undergoing lumbar laminectomy.Seventy-five patients belonging to ASA1 and 2, between 20 to 60 years of either sex, satisfying inclusion criteria were randomised into three groups containing 25 patients each.These drugs were administered to the patients 1 hour before anaesthetic induction. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure were recorded preoperatively(baseline and 1 hour after drug administration), intraoperatively and postoperatively. Respiratory rate and saturation were also recorded preoperatively and postoperatively. Pain scores, anxiety scores, sedation scores were recorded 1 hour after drug administration, after extubation and postoperatively. Fentanyl consumption in the postoperative period and any adverse effects were also noted. The data was analysed using SPSS software version 20. The demographic profiles of the three groups were matched and the baseline hemodynamic variables in all three groups were comparable. Results: The pain scores and anxiety scores were significantly reduced in pregabalin and tramadol groups when compared to the placebo group but the reduction in scores in the pregabalin group is significantly less than that of the tramadol group. The sedation score is higher in tramadol group when compared to placebo and pregabalin; however, there was no significant difference in sedation between pregabalin and tramadol immediately after extubation and at 1 hour postoperatively. The sedation scores remained significantly higher in the pregabalin group when compared to the placebo group. Further the systolic, diastolic and mean arterial blood pressures were significantly lower in the tramadol group when compared to the placebo group at 1 & 3 minute after intubation and after extubation whereas in pregabalin group these parameters were significantly lower than placebo group at 1 minute after intubation and after extubation. Heart rate changes in tramadol and pregabalin groups were significantly lower than the placebo group at 1 & 3 minutes after intubation and at 30, 60 and 120 minutes and after extubation. The mean requirement of fentanyl is significantly lower in pregabalin and tramadol groups when compared to placebo group. Side effects in tramadol and placebo group were significantly higher than the pregabalin group. Conclusion: Pregabalin has a statistically significant effect when compared to placebo, but this effect is less when compared to tramadol.The need for rescue analgesia is in the least in tramadol patients followed by pregabalin and it increases maximum in the placebo group. Keywords: Pregabalin, Tramadol, VAS SCORE, Anxiety, Fentanyl, Lumbar Laminectomy.

Background: The present study is conducted to evaluate the hemodynamic changes during spinal anaesthesia after preloading with infusion fluids as follows. A) 500ml of 6% Hydroxyethyl starch /Hetastarch B) 500ml of polygeline / Haemaccel. Materials and Methods: This is a comparison study and the study will be conducted in 60 ASA I & II adult patients of either sex scheduled to undergo elective daycare surgeries under spinal anaesthesia at Kurnool Medical College, Kurnool. The study will be conducted for a period of 1 year at Department of Anaesthesia in Kurnool Medical College, Kurnool and Government Medical College/GGH, Nandyal. Results: Sixty patients in the age group of 25 - 60 years of ASA Grade I and II scheduled for elective lower limb surgeries were randomly allocated into two groups. Group 1 received 10 ml/kg of Haemaccel, Group 2 received 10 ml/kg of HES 6%, 15 minutes prior to spinal anaesthesia. After a detailed preanaesthetic evaluation and obtaining informed consent, all the patients were premedicated with oral diazepam. Baseline heart rate, systolic blood pressure and diastolic blood pressure were measured in supine position using a mercury sphygmomanometer. All patients were preloaded. After preloading the PR, SBP, DBP and MAP were recorded and all patients were administered spinal anaesthesia under strict aseptic precautions with 3.2 ml of 0.5% of heavy Bupivacaine. The level of analgesia was achieved up to T8 to T10. Pulse rate, systolic, diastolic and mean arterial blood pressure was recorded every 2 minutes for the first 10 minutes, every 5minutes for the next 50 minutes and every 10 minutes till the end of surgery after subarachnoid block. Hypotension - defined as decrease in systolic blood pressure to less than 90 mm of Hg and 70% of the baseline value whichever is greater. Hypotension was treated by vasopressor, repeated as necessary until the blood pressure was increased to >70 % of the baseline value. Bradycardia when encountered was treated with vagolytic agent. The incidence of hypotension in group 1 was 9% and in group 2 was 4%. The requirement of vasopressor ephedrine to counter hypotension was less in group 2 when compared to group 1. Conclusion: Colloids by increasing the plasma oncotic pressure help to expand the plasma volume by remaining intravascularly for a longer time and it also draws fluid into the intravascular space, offset spinal anaesthesia induced hypotension. Present study confirms that 6% HES is better colloid than Haemaccel in preventing hypotension in patients undergoing surgeries under SAB. Keywords: Spinal Anesthesia, Colloids, HES, Hypotension, Arterial Blood Pressure.

Background: Needle stick injuries (NSIs) pose a significant occupational hazard, exposing healthcare workers to the risk of blood borne infections and other associated health complications. Understanding the prevalence and identifying the contributing risk factors is crucial for developing targeted interventions and enhancing safety protocols to mitigate the incidence of such injuries. Aims & Objectives: •To estimate the prevalence of needle stick injuries among healthcare workers of a tertiary care hospital. •To describe the risk factors associated with occurence of Needle Stick Injury. Materials and Methods: The hospital-based cross-sectional study was conducted at Kanyakumari Government Medical College & Hospital for a period of 2 months (August – September 2022). The study population comprised 301 individuals, including consultants, postgraduates, interns, nursing students, staff nurses, paramedical workers, technicians, and cleaning staff. Simple random sampling was employed as the sample technique by using Random number table. Informed consent was obtained from the study participants in the regional language after explaining the purpose of study. Institutional Ethical Committee clearance was obtained before data collection. Data was collected using a pre-tested and semi-structured questionnaire, details about devices involved in recent injuries, factors associated with needle stick injuries, types of injuries, duty timings, time of reporting, and actions taken after injuries were obtained and data were entered into MS EXCEL and analyzed using SPSS version 22.0. Results: Paramedical Workers and Staff Nurses constitute the highest percentages of NSIs at 27% and 12%, respectively. The locations where NSIs frequently occur include the Emergency Ward (26%) and Intensive Care (27%). Hypodermic needles are identified as the primary cause (39%), with procedures (38%) and recapping (22%) being the leading activities linked to NSIs. Lack of awareness about the reporting process is identified as a significant reason, with 6.38% of participant were not aware of the reporting procedures. Conclusion: The study not only highlights the prevalence and characteristics of NSIs among healthcare workers but also emphasizes the importance of understanding reporting barriers. The findings to be reported targeted interventions to enhance occupational safety, improvement in reporting practices ultimately contribute to a safer working environment for healthcare professionals. Keywords: Needle stick injury, Health care workers, Reporting.

Background: The objective was to investigate the correlation between ADC values of DW-MRI and Renal Resistivity Index (RI)of the renal parenchyma in assessing various stages of chronic kidney disease. Materials and Methods: It is a single institutional prospective study in Govt General hospital, Kurnool. Approval got from by institutional ethical committee. The informed consent from the patients and controls have been obtained Patients who came for MRI abdomen and spine both non renal and the renal disorder and to renal Doppler study with normal and elevated renal parameters were identified and included in the study. Results: In our study, there has been steady decreasing trend in ADC values with the decrease in eGFRi .e., with the progression of severity(stage) of CKD. The level of serum creatinine and the stage of chronic kidney disease are inversely correlated with the ADC value, which also demonstrated a decreasing tendency. In conclusion, RI ≥ 0.79 on the renal duplex ultrasonography can be a helpful predictor for renal progression in patients with moderate renal dysfunction, regardless of their ACE inhibitors and ARB as angiotensin receptor blockers usage. Therefore, checking the RI value is helpful when we evaluate kidney ultrasonography in patients with moderate renal dysfunction. Conclusion: The value of the apparent diffusion coefficient can be used as an extra marker to determine the level of renal function. ADC can be used to determine the degree of renal impairment. ADC values continues to decrease with increase in severity (stage) of chronic kidney disease. DWI is recognized as a promising imaging tool that can take part in the assessment of the morphological and functional changes in diffuse renal parenchymal disease, hence playing an important role in the early diagnosis and staging of chronic kidney disease.

Background: Tuberculosis (TB) is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from HIV/AIDS. To control and eliminate TB, drug resistance is a public threat. Hence to assess the treatment outcome and adverse events this study was planned. Objective: To assess the knowledge, perception, level of satisfaction and the quality of life of beneficiaries utilising services of PMNDP. Materials and Methods: A retrospective Cohort study was done on 658 Multidrug resistant TB cases registered in District TB centre, Kurnool and who have completed their treatment by July 2021 after consent. A semi structured questionnaire containing sociodemographic information, treatment outcome and history of adverse drug events was used to collect data by telephonic interview. Descriptive statistics and Chi square, correlation and regression was done in SPSS version 23. Results: Out of 658 patients, 73.86% were male, 68.7% from rural areas, 50.3% on Shorter MDR, 60.2% have Rifampicin resistance. 66.4% were cured and 12.16% death rate was observed. Male, FLQ resistance and Rifampicin resistance are the statistically significant factors determining the unsuccessful treatment outcome in the study participants. Out of the 102 patients interviewed 83(81.37%) reported to have experienced one or more of the adverse events throughout their course of treatment. Conclusion: To tackle high death rate and default rate and increase cure rate periodic counselling needed to motivate resistant cases to adhere and ensure compliance to the longer regimens. Keywords: Multi drug, Outcome, Resistance, Tuberculosis, Treatment.

Background: The nutrient foramina are cavities contain nutrient arteries and peripheral nerves. The present study was done in Department of Anatomy, L.N. Medical College and Research Centre, Bhopal with 100 dry human femurs. there were 149 foramina in 100 femurs. Mean length of femur 435mm, most frequently seen on Linea aspera of femur foramina index mean was 44.3403 for femur. Right side femur foramina index range 28.52-63.86, left side bone foramina index range 30.65-61.42. Information about number, location, position and direction of nutrient foramina important clinically in orthopedic procedures such as joint replacement therapy, fracture repair and preserving blood supply of graft during vascularized bone grafting. Keywords: Nutrient foramina, Femur, Nutrient artery, long bone.

Background: The occurrence of hypertension and diabetes mellitus is rapidly increasing world-wide. Frequently these two conditions coexist which will predispose to an increased risk of premature death due to cardiovascular diseases, stroke and renal diseases. When hypertension and diabetes mellitus coexist, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an existing high-risk population. Objectives: 1) To estimate the prevalence of hypertension among adults with type 2 diabetes mellitus in the rural field practice area of Kanyakumari government medical college. 2) To find out the association of hypertension with socio-demographic and behavioural characteristics of the study population. Materials and Methods: A community based cross-sectional study done between July to August 2021 in the rural field practice area of Rajakamangalam PHC .300 adults who were above 30 years of age and known cases of type 2 diabetes mellitus participated in our study. Informed verbal consent was obtained from them after explaining the purpose of the study. Details regarding the socio-demographic variables and behavioural risk factors were obtained using a pre-structured and pre- tested questionnaire. Height and weight were recorded, and BMI was calculated. Blood pressure was measured with a standard sphygmomanometer, two values taken 30 minutes apart, average of which was taken. Results: The prevalence of hypertension among type 2 diabetic patients was 25.6%. Among them, the prevalence was more in females (56.3%) and highest in the age group >65 years (45.4%). There is a significant association between smoking, alcoholism and physical inactivity with hypertension. 63% of the hypertensives were obese. 61% of the hypertensives had higher salt intake. There was no statistically significant association with obesity and high salt intake. Conclusion: Hypertension was more prevalent among Type 2 diabetes. Smoking, alcoholism and lack of physical activity were found to be significant risk factors. Longer the duration of diabetes, higher is the prevalence of hypertension. Keywords: Diabetes, Hypertension, Adults, Rural area.

Background: To attenuate the intubation response, over the decades many pharmacological and non-pharmacological techniques have been practiced. In this study we have compared topical 10% lignocaine spray after induction of anaesthesia versus intravenous preservative free 2% lignocaine to suppress the intubation response. Materials and Methods: 60 patients posted for surgery under general anaesthesia were randomly divided into two groups after obtaining the written informed consent. The patients were either administered 10% lignocaine spray or loxicard 2% before intubation. Hemodynamic response was observed and tabulated from intubation to 10 minutes after intubation. Results: In our study, we have noticed that there was a decrease in hemodynamic parameter in both the groups. However, the response was more significant in group SP compared to group IV. The p value was less than 0.05. Conclusion: We have concluded that lignocaine 10% spray is better than IV lignocaine to suppress the intubation response without any adverse effects. Keywords: Lignocaine spray, loxicard, haemodynamic.

Background: The incidence of molar pregnancy has demonstrated marked geographic and ethnic differences. This difference in the prevalence across various countries perhaps may depend upon the socioeconomic, genetic, nutritional and other cultural factors. In spite of having a higher prevalence among Asians, still epidemiological characteristics of Gestational Trophoblastic Disease (GTD) or Gestational Trophoblastic Neoplasia (GTN) are difficult to determine secondary to inconsistencies in case definitions and lack of centralised databases. Hence, this study was undertaken to determine the proportion and the clinical profile of women with hydatidiform mole from a South Indian population, where as of now there is limited data to enable us to detect and provide the standard of care for patients with GTN. Materials and Methods: A prospective cohort study between August 2014 to December 2015 and a retrospective review of medical records for the preceding 2 years from the year 2012 to 2014 was conducted in JIPMER to determine the proportion of women with molar pregnancy as well as to study the clinico-epidemiologic profile of hydatidiform mole. The study population comprised of a total of 116 cases, of which, 68 cases belonged to the prospective group and 48 cases to the retrospective group. The patients belonging to the prospective group (68) were followed up for a period of 6 months to note the trend of the β HCG and to detect the occurrence of GTN. The patients in the retrospective group (48) were considered only for analysing the clinical profile of hydatidiform mole, as follow up was not possible for this group of patients. Results: The proportion of molar pregnancy was calculated to be 2.07 per 1000 live births. Majority (59%) of the study population belonged to the age group of 18-23 years. Almost all the patients (98%) belonged to lower socio-economic group. More than one-third (48%) of the patients were nulliparous. It was observed that, greater than half of the patients (56%) presented between 11-15 weeks of amenorrhoea. Majority (76%) of the patients had no previous abortions in their obstetric history. Only 4 (3.45%) patients had previous history of molar pregnancy. Abnormal uterine bleeding was the most common complaint noted in 79% of patients. Nausea and vomiting were noted in 62 patients, out of which 25 (40%) presented with hyperemesis requiring fluid and electrolyte correction. Anaemia was the most common medical complication noted in 55% of patients, followed by hyperthyroidism in 33% and hypertension in 2% patients. Among the 116 patients, 74(64%) had pre-evacuation HCG level more than 2,00,000mIU/ml. Suction evacuation was done in all the cases and 9 (8%) patients required re-evacuation in view of residual vesicular mole on a check scan. Among the 116 patients, histopathology revealed complete mole in 88% patients and partial mole in 12%. In the prospective group, following suction evacuation, 79% of the patients attained remission by the end of 6 months whereas in 13 patients (21%), hCG continued to either plateau or increase following the primary evacuation and they further developed GTN requiring chemotherapy. Out of the 13

Background: Fibroids are the most common benign smooth muscle tumours occurring in reproductive age of women. There is about 1.2-10.7% prevalence of leiomyomas affecting pregnant women. They are usually asymptomatic. Our study objective was to assess prevalence, maternal and foetal complications in fibroid complicating pregnancy. Materials and Methods: An observational study was conducted in tertiary care centre, Government General Hospital, Guntur from June 2023 to December 2023. Convenient sampling was done. All detailed data such as demographic data, maternal age, mode of delivery, obstetrical history, maternal complications, and foetal outcome were recorded. Ethical approval was obtained from institutional ethical committee. Results: In our study, thirty patients were included who had pregnancy with fibroid. The prevalence of fibroid complicating pregnancy in our study was 0.8%. Majority of the women are multigravida (63%), belonged to age group between 20-30 years (70%) and mostly delivered by caesarean section (89%). In most of the cases, the size of the fibroid is more than 5cm (60%), arising from the body of the uterus (97%) and are multiple in number. There was increased incidence of preterm delivery, PROM and malpresentations in our study. Conclusion: Mostly fibroids are asymptomatic, risk increases with increase in size, number and site of the fibroid. So, prompt antenatal care, intrapartum and post-partum surveillance and management helps in combatting these complications. Keywords: Fibroid, PPH, maternal and foetal complications.

Background: Acute hemiparesis in children is a common clinical syndrome presenting. Clinical data combined with neuroimaging are important for accurate diagnosis and management. Weakness may or may not improve over time depending on the cause of hemiparesis. Only limited data is available on improvement pattern especially in india so, this prospective observational study was planned to study the factors that affect hemiparetic children's prognosis and correlate anomalies in neuroimaging to their clinical characteristics. Materials and Methods: A prospective observational study was conducted in Department of Pediatrics, Career institute of medical sciences, Lucknow from September 2020 to August 2023 including children between2 months to 14-year age and presented with complaint of hemiparesis. After prior informed consent, in each eligible child, detailed history, examination and neuroimaging was done. Outcome was noted at discharge which was correlated with their initial presentation and neuroimaging finding. Results: Among total of 65 children, 45 (69.2%) were of infections etiology while 20 (30.8%) were of non-infective cause. Of65 patients, only 60 patients underwent neuroimaging; CT scan in 35(53.8%) patients and MRI in 39(60%) patients, of them abnormalities were detected in 49 patients (81.6%). Hyperventilation and Pupil size abnormality at presentation were significantly associated with the mortality. Altered sensorium and convulsions at presentation were found to be closely related to the findings suggestive of meningo encephalitis on neuroimaging. This correlation was statistically significant. Conclusion: Hyperventilation and Pupil size abnormality are significantly associated with the mortality in Hemiparesis. Further multicentric researches are needed. Keywords: Hemiparesis; muscle power; neuroimaging; prognosis; stroke.

Background: Dengue fever has evolved into a significant global emerging infectious disease and is now recognized as a widespread epidemic spanning over 120 countries. According to the World Health Organization (WHO), approximately two-fifths of the global population residing in tropical and subtropical regions faces a continual risk of contracting this infection. In India, dengue poses a substantial public health challenge and stands as a leading cause of hospitalization amongst all age groups. Materials and Methods: This study was conducted jointly in the Departments of Microbiology at ESI-PGIMSR & ESIC Medical College, Joka, Kolkata, and Jagannath Gupta Institute of Medical Sciences & Hospital (JIMSH), Budge Budge, Kolkata. The duration of study was over a period of two years.The study population comprised of 3946 subjects. Of these, 398 cases were found to be positive for dengue infection. Results: Of the 3946 individuals included in the study, 398 (10.1%) cases were positive for dengue and rest were negative. Of the 398 positive cases, 263 were males and 135 were females. This study showed that of the total positive cases, 113 belonged to age group 31-60 years followed by 0-15 years (88 cases), 61-70 years (79 cases), 16-30 years (72 cases) & >70 years age group (46 cases). It was also seen that most of the cases of dengue were found to be positive during the months from September to November. Conclusion: The study concludes that dengue infection cases are more prevalent during the rainy and post-rainy seasons in the eastern part of India. Keywords: Dengue Virus Infection, Dengue Shock Syndrome (DSS), Dengue Hemorrhagic Fever (DHF), sero-markers.

Background: Breast cancer is a significant global health concern, affecting millions of women each year. The molecular characterization of breast cancer has become crucial for tailoring personalized treatment strategies and predicting patient outcomes. Among the key biomarkers that guide treatment decisions, the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2/neu) play pivotal roles in determining the disease behavior and response to therapy. Understanding HER-2 expressions and hormone receptors is essential for developing treatment strategies and making decisions regarding breast cancer. Aims and Objectives: The study was conducted to determine the prevalence of different subtypes based on the status of ER, PR, and Her2/neu receptors in this specific patient population and to Analyze the correlation between these molecular subtypes and clinicopathological characteristics, such as age, tumor size, grade, and lymph node status. Materials and Methods: This is a Retrospective observational study conducted on 126 cases of breast carcinoma patients in Government General hospital, Kurnool. Slides were prepared from blocks containing cancer tissue, and immunohistochemical staining was done for ER PR & Her2neu expressions. Interpretation of expressions was done using Allred scoring system for ER, PR and the College of American pathologists guidelines for Her2neu expressions. Statistical analysis was performed to determine the statistical significance by applying chi-square test. Results: The majority of the tumors were HER2/neu negative, positive for ER and PR. When it came to ER and PR positive tumors, most of them were Grade I. The current investigation established a correlation between age, tumor grade and ER and PR, but not with tumor size, lymph node status. There was a correlation between ER and PR expression, but not with HER2/neu. Conclusion: Adjuvant hormonal therapy may result in a favorable outcome for cases that test positive for ER and PR. In order to provide prognostic information and therapeutic benefits, hormone receptor assessment is strongly advised for clinical management of breast cancer patients. Keywords: HER2/neu, Hormone Receptor, Breast cancer, Lymphnode, Adjuvent.

Background: Chronic kidney disease is associated with numerous hematological manifestations of which anemia is one such complication which adds further on the morbidity. This study aims to evaluate the clinico-hematological profile of patients with CKD. Materials and Methods: A total of 100 patients with chronic kidney disease undergoing dialysis in the hemodialysis unit of Rangaraya Medical College, Kakinada were included. The study was conducted in the Department of Pathology, Rangaraya Medical College, Kakinada over a period of 2 years. Results: Anemia is the most common hematological manifestation in the study. Normocytic hypochromic anemia was the most common finding in peripheral smear. Majority of the patients had leukocytosis. Thrombocytopenia was found in 48% of patients. Conclusion: CKD causes decreased renal production of erythropoietin which is the major of anemia in them. Measures to correct anemia should be implemented in patients with CKD for better outcomes. Keywords: anemia, chronic kidney disease, leukopenia, thrombocytosis.

Background: Human growth and maturation are continuous processes, and transition from childhood into adulthood is not abrupt, the period of adolescence encompasses rapid changes in physical changes and maturation, and in psychological development. Objective: To study the dietary habit, mean calorie intake and mean protein intake of last 24 hours in the study population. Materials and Methods: The present cross- sectional study was conducted in the field practice areas of Rural Health Training Centre, Jawan and Urban Health Training Centre, Aligarh, of the Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University. Results: Majority of students (91.6%) used to take meals three times a day and only 8.4% used to had meal twice a day, out of them most of them were from rural area. mean calorie and mean protein intake being less in whole age group of 10-19 years than the reference values given by ICMR 2010. Total mean calorie of 10-19 years age group was 1995.09 in urban and 2056.07 in rural area. Total mean protein intake of 10-19 years age group was 44.56 gm/day in urban and 41.44 gm/day in rural area. Conclusion: Overall 98.77% rural and 94.92% urban students were found to be deficit in calorie intake in 24 hours recall method and protein intake was deficit in 84.37% urban and 93.44% rural students. Keywords: Socio-demographic factors, Dietary habit, Calorie intake, Protein intake, Adolescent boys.

Background: The stability of the knee joint is greatly enhanced by the ligaments that surround it. Beginning on the medial aspect of the lateral femoral condyle, the anterior cruciate ligament travels distally and anteriorly until it inserts on the intercondylar eminence. The purpose of this research was to compare the functional results of arthroscopic ACL reconstruction using hamstring versus bone patella tendon autograft. Materials and Methods: The 30 patients included in this study. This was the observational based comparative study conducted at the Department of Orthopedics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. This study was conducted between the December 2022 to November 2023. Results: Bone patellar tendon and hamstring grafts are the most popular choices for ACL restoration. In this study, we assess the functional outcome of ACL restoration using the Hamstring graft, both of which have their advantages and disadvantages. Participants in this study tended to be middle-aged or older. The hamstring group's management is at 31.5 and the bone patellar tendon group at 30.1. A total of approximately 30.8 is the mean. This points to the fact that the majority of participants were youthful and energetic. However, in investigation conducted by Munro. The risk of anterior cruciate ligament tears is eight times higher in female athletes compared to male athletes. Patients in this study suffered injuries in two main ways: road traffic accidents and athletic activities. Here, injuries sustained in motor vehicle accidents make up around 70% of all injuries, whereas injuries sustained in athletic events make up around 30%. Most athletic endeavours do not involve physical contact. RTAs can happen as a result of a direct hit to the knee, an injury sustained while falling from a height, or even a dashboard accident. Conclusion: The results showed that patients younger than 40 years old had superior outcomes after ACL restoration. All of the participants were men; we did not include any females in our study. Keywords: Hamstring, bone patella tendon, autografts, arthroscopic repair

Background: In the beginning of total knee arthroplasty, the procedure was typically reserved for people in their later years who were less active. New evidence suggests that total knee arthroplasty can benefit both younger, more active patients and the elderly. Comparing mobile bearing whole knee arthroplasty with posterior stabilised fixed bearing total knee arthroplasty was the primary goal of the study. Materials and Methods: This study was conducted at the Department of Orthopedics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. This treatment was performed on 100 patients in total, all of whom were invited to the facility for follow-up. This study was conducted between the October 2022 to September 2023. Information about the patients' pre-operative condition was gathered from their outpatient and inpatient medical records. Results: Twenty of the fifty patients had PFC systems and thirty had LCS whole knee systems. Of the patients, 17 had bilateral LCS and 5 had bilateral PFC. For this reason, 73 knees were examined in total. Due to his ineligibility to answer the subjective questions about each system, a patient who had bilateral total knee replacements with PFC on one side and LCS on the other was omitted from the study. Rheumatoid arthritis was identified in 6 cases, while primary osteoarthritis affected 45 patients. Around forty-nine knees were replaced on the left side, while thirty-four were replaced on the right. The average age of patients who had PFC complete knee arthroplasty was 60.46 years, whereas the average age of patients who had LCS whole knee arthroplasty was 57 years. Conclusion: The results suggest that the range of motion after surgery for the LCS group is dependent on the flexion range before surgery, but the PFC group has better range if the joint line remains close to its preoperative status. Greater flexion is possible with a fixed-bearing complete knee replacement. Despite being smaller, PFC's American Knee Society score is superior. Keywords: Total knee arthroplasty, fixed bearings, movable bearings.

Background: There is some debate concerning the posterior cruciate ligament's function in knee replacement surgeries. In theory, the range of motion can be increased and posterior translation can be prevented by femoral rollback, which is achieved by preserving the PCL. Our hospital's Primary Total Knee Replacement procedure is the focus of this prospective comparison of functional outcomes. The ligament was preserved in cases where the knee was used as a sacrifice. Materials and Methods: Total 25 patients were participated in this study. This study was conducted at the Department of Orthopedics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India between November 2022 to October 2023. After and before surgery, patients were evaluated using a scoring system that was developed using the WOMAC Score, the Knee Society Knee Score, and the Functional Knee Score. Results: Clinical and functional knee scores improved significantly for all patients in both groups, according to the functional outcome analysis. With a total Knee Score of 85.80 for the PS group and 75.60 for the CR group, statistical analysis showed a statistically significant difference in the p-value favouring the Cruciate Sacrificing Prosthesis, indicating that it has better functional outcomes. A functional knee score of 99.6 for the CS group and 91.6 for the CR group indicated that all patients had a significant improvement. Based on statistical analysis, no significant difference was found. Conclusion: The functional prognosis after total knee arthroplasty was better in patients who had the posterior cruciate ligament sacrificed than in the maintaining group. This difference is likely due to the fact that the flexion deformity persists in the retaining group. Keywords: Knee Society knee score, posterior cruciate ligament, total knee replacement.

Background: Leucorrhoea or vaginal discharge is one of the very common problem or complaint among female of reproductive age group (15-45) attending to Gynecology and Venereology outpatient department and it is associated with STI/HIV and adverse birth out comes. Objective of the study was isolation identification and to assess the frequency of occurrence of various microbial agents. Materials and Methods: Between July 2023 to December 2023, 125 sexually active women (15-45) age were enrolled from two reproductive health clinics (Gynecology and Venereology) in Government General Hospital, Guntur. The women underwent an interview followed by physical examination. Vaginal swabs are taken and processed for confirmatory diagnosis of Bacterial vaginosis, trichomonal vaginitis and candidal vulvo vaginitis. Results: Among the study group of 125 women, majority of women belongs to urban area (70.4%), low socio-economic group 66.4%, illiterates 62.4% and 21-30 years of age (27%). Among the study group 30.4% were having bacterial vaginosis, 22.4% have vulvo vaginal candidiasis, and 10.4% have vaginal trichomoniasis. Conclusion: Microbial infections of lower genital tract are very common in sexually active women in reproductive age group. Nonspecific vaginosis mostly associated with Gardenella vaginosis, specific vaginosis with Trichomonas vaginosis, candiasis are very frequent. These infections in pregnancy cause adverse birth outcomes. Early and proper diagnosis and timely treatment of infected women including sexual partners is essential in cases of vaginal infections which requires laboratory assistance. Keywords: Leucorrhoea, Reproductive age group.

Background: The aim of treatment in proximal humerus fractures is to achieve a painless and simultaneously functional shoulder. there are several techniques to treat proximal humerus fractures. The aim of the study is to analyse the outcome of proximal humerus fractures treated by internal fixation using philos plating. Materials and Methods: This study was conducted on 50 patients with proximal humerus fractures who underwent surgical fixation with philos plate and were followed for 6 months. Surgical approach chosen as either deltopectoral or deltoid splitting approach based on fracture pattern. Results: The mean age of the patients was 50 years and 56% were male and most of the injuries (64%) were caused by road trafffic accidents. The Functional Outcome will be assessed based on the values of Constant Murley Score obtained after Six months post-surgery and Visual Analouge Scale at six weekly intervals for Six months. The outcome were excellent in 76%, good in 20 % and moderate in 4%. Conclusion: The results demonstrate that internal fixation can be an effective treatment option as evidenced by high union rates and positive functional outcomes. However, careful patient selection and appropriate surgical techniques are crucial for optimal results. Keywords: Proximal humerus, fracture, philos plate

Background: Our aim is to investigate the acetabular component positioning using TAL & its functional outcomes in primary THA as assessed by modified Harris Hip Score (mHHS). Materials and Methods: 30 patients were selected randomly in this prospective study after getting clearance from the research and ethical committee in a Tertiary care centre in North India. All Total Hip Arthroplasty surgeries were performed using direct lateral Hardinge’s approach & used TAL was used as the guide for positioning the acetabular cup. Acetabular version and inclination were assessed using a CT scan and functional outcome was evaluated using mHHS. Results: The mean absolute position of the acetabular cup in our study population included 15.3±5.85 degrees of anteversion and 42.7±5.31 degrees of inclination angle. 86.67% of patients had both acetabular version and inclination within Lewinnek’s “safe zone” with only a single case of post-operative dislocation. The correlation between the cup version and mHHS was significant (p-value=0.028) whereas the correlation between acetabular inclination and mHHS was insignificant (p-value=0.29. Conclusion: TAL is a reliable, inexpensive and patient-specific intra-operative anatomical landmark for the placement of acetabular components with efficacy comparable to that of a mechanical alignment guide (MAG). Keywords: Acetabular cup version; Inclination angle; modified Harris Hip Score; Total Hip Arthroplasty; Transverse Acetabular Ligament.

Background: Twin babies provide a good study model since they have the same GA and are exposed to the same prenatal risk factors. Thus, it helps us to analyze the role of systemic complications in development and progression of ROP in two premature babies exposed to same risk factors. hence, the study was undertaken. The objectives of the study were to determine, profile of ROP in twin babies. Materials and Methods: A prospective interventional clinical study was done from, November 2016 to May 2018 in 100 preterm babies, less than or equal to 32 weeks of gestational age (GA) & less than or equal to 1500 gram of birth weight (BW) at Vani Vilas Hospital attached to Bangalore Medical College and Research Institute, Bangalore. ROP screening was performed by dilated fundoscopy using indirect ophthalmoscope with 20D lens and all babies were followed up till complete vascularisation of the retina. The babies who developed any stage of ROP were taken as cases and the babies who did not have ROP were taken as controls. Results: 100babies/50 pairs (76.92%) satisfied the inclusion criteria and were enrolled in the study. Out of 50 pairs of twins, 10 pairs developed ROP. In our study we found that most commonly identical twins (p 0.001, significant) affected than non-identical twins, smaller baby affected more than larger baby (p 0.007, significant), Male babies affected more than female babies (p 0.07), ROP development between 2nd born and born is 6:4(p 0.37). With regarding to laterality both eyes affected in all 10 babies and stage and zone of affection remains same in both the eyes. In our study, 6 babies (60%) developed zone-2 stage-1 ROP, 3 babies (30%) developed Zone-2 Stage-2 ROP with plus disease & one baby (10%) developed Zone-2 APROP with plus disease. Conclusion: Thorough fundus examination with indirect ophthalmoscopy should be done in all preterm babies as per the guidelines and screening should be intensified in the presence of factors like RDS, oxygen administration. Keywords: Retinopathy of Prematurity; ROP screening; Gestational Age; Birth Weight; Risk Factors of ROP.

Background: In India, about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added each year which results in additional demand for 3.4 Crore dialysis sessions every year. In the 2016 Union Budget, the Government of India announced the National Dialysis Programme, Pradhan Mantri National Dialysis Program (PMNDP) is supported by National Health Mission (NHM) and is providing free-of-cost haemodialysis services to BPL patients and Ayushman card holder. Objective: To assess the knowledge, perception, level of satisfaction and the quality of life of beneficiaries utilising services of PMNDP. Materials and Methods: A cross-sectional study, for one-year in Indore and Ujjain division. Sources of data collection were patients. Predesigned and pre tested questionnaire (based on KDQOL- SF Scale) to assess the quality of life of beneficiaries utilizing services of PMNDP. Results: Responses were collected from 240 patients undergoing dialysis at district hospitals. Majority of the beneficiaries (67.5%) had good perception regarding their own-health status after the dialysis. On physical activities (43.3%) perceived little limitation, and (29.2%) had no limitation during dialysis. We found that (38.8%) felt isolated, irritable, confused, difficulty in concentration, 62.7% perceived no problems and 37.3% had little problems in the sleeping habits during dialysis. Conclusion: While assessing the quality of life of beneficiaries in selected dialysis centres involved in PMNDP, we found that everyone was satisfied from the PMNDP programme as the expenditure was nil. But some of them felt some kind of mental health issues like depression, irritation and difficulty in concentration due to their nephropathy problems and their quality of life seemed to be affected. Keywords: Haemodialysis, Knowledge, level of satisfaction of beneficiaries.

Background: Vitiligo is an acquired disease characterized by progressive skin depigmentation resulting from an autoimmune response targeting epidermal melanocytes. Few studies have shown specific cytotoxic T-lymphocyte response against Melan – A which is the most specific marker of melanocytes. There are also other studies which have confirmed the presence of residual melanocytes even in the vitiliginous skin. Objectives: To evaluate the melanocyte content in lesional, perilesional [within 2 cm] and distant normal skin of non- segmental vitiligo patients. Materials and Methods: A total of 40 cases of non-segmental were enrolled in the study based on the prevelance of vitiligo in India. After taking informed consent, skin biopsy from the lesional, perilesional and normal skin was sent to pathology for immunohistochemical analysis of melanocyte content in the above zones using Melan – A marker. Results: All 40 lesional sites were negative for Melan-A staining. The Melan-A positive melanocytes were reduced in immediate perilesional skin compared to distant normal skin. Paired t-test was applied between perilesional skin and normal skin and the result was statistically significant at p<0.001. Conclusion: Melan-A positive residual melanocytes were not present in the lesional skin in our study as opposed to very few studies which confirmed their presence in the vitiliginous skin even in the long standing cases. But there was significant difference between perilesional and normal skin. Keywords: Vitiligo, Melan – A, Immunohistochemistry, Cytotoxic T lymphocytes.

Background: A branch of the femoral artery that branches out in the popliteal fossa, the popliteal artery supplies blood to the lower extremities. In the popliteal fossa, the popliteal artery reaches the popliteus muscle's inferior border. The purpose of this CT angiography investigation was to identify the various popliteal artery branching patterns in a large population. Materials and Methods: Twenty lower limb specimens were collected from the Department of Anatomy, A.C.S.R. Government Medical College, Nellore, and Government Medical College Ongole, Andhra Pradesh, India. The 10 lower limb specimens were acquired from unclaimed foetal cadavers. This study was done between the January 2021 to December 2023. Results: In this study, all specimens showed that the popliteal artery originated at the same level and in the same way as the femoral artery, which is the common pattern. There was no change in the present investigation regarding the popliteal artery's origin. The popliteal artery length was measured in 40 limbs in a cadaveric investigation. From the adductor opening to the origin of the anterior tibial artery, the average length of the popliteal artery in his study was 191.1mm. The popliteal artery averaged 173.5 mm in length throughout the research. It lines up with principles. Conclusion: The results of the present study's observatory were in good agreement with those of previous studies. Vascular and reconstructive surgeons rely on anatomical understanding of the popliteal artery and its variants. Keywords: Clinical relevance, popliteal artery, branching, popliteal fossa.

Background: A lot of people come to us complaining about erectile dysfunction. These days, even those under the age of 30 frequently deal with the problem of early onset hypertension and diabetes. Material and Methods: The study comprised 70 consecutive patients who were referred from several departments, including general medical outpatient, psychiatry, diabetology, and urology. This study was conducted at the Department of Radiology, Sri Balaji Medical College. Renigunta, Tirupati, Andhra Pradesh, India between March 2023 to Jan 2024. Every patient complained of erectile dysfunction for at least half a year. A thorough clinical history and basic blood chemistry were performed on each subject. Results: These are a few instances of venous and arterial insufficiency patterns associated with erectile dysfunction. The individuals' ages ranged from 22 to 65 years old, with a mean age of 44. The average score of the 70 subjects on the SHIM questionnaire was 14.6. About 30% of the participants had no identified risk factors, despite the fact that diabetes and hypertension were the primary causes in the great majority of instances. Out of 70 participants, 56 responded normally to sildenafil and 59 to papaverine. Papaverine found that 21 individuals taking sildenafil had erectile dysfunction, compared to 18 who did not. Conclusion: Tab. Sildenafil significantly increases blood flow to the penile vasculature, according to the study, suggesting it may be useful as an erectogenic agent in penile Doppler studies when paired with self-tactile stimulation. Keywords: Sildenafil, erectogenic agent, doppler, self-tactile.

Background: Ankle fractures are the second most common fractures in the lower limb, following hip fractures. They account for approximately 10% of all fractures, with an incidence rate of 137 per 100,000 individuals per year our aim is to analyse the radiological and functional outcome of distal tibiofibular syndesmotic injuries associated with ankle injuries treated by open reduction and internal fixation and syndesmotic screws. Materials and Methods: The present study was conducted at Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. In our study, 30 cases of bi malleolar ankle fractures were analysed. Classification used was Lauge-Hansen and Denis Weber classification. Self-fall and twisting injury are the most common mode of injury followed by road traffic accident. Average injury surgery interval was 7 days. Malleolar screw for medial malleolus and plate (one third tubular plate / reconstruction plate) for fibula and trans syndesmotic screws were common mode of fixation. Results: Results were analysed using AOFAS (American Orthopaedic Foot and Ankle Scoring). The scoring was excellent and good in 90% of cases and poor in 10 % of cases. Conclusion: Accurate anatomical reduction and fixation of syndesmotic disruption associated with ankle fractures results in good functional outcome. Keywords: Bimalleolar ankle fractures, Syndesmotic injuries. Lauge – Hansen, Denis Weber, American Orthopaedic Foot and Ankle scoring.

Background: There is some debate concerning the posterior cruciate ligament's function in knee replacement surgeries. In theory, the range of motion can be increased and posterior translation can be prevented by femoral rollback, which is achieved by preserving the PCL. Our hospital's Primary Total Knee Replacement procedure is the focus of this prospective comparison of functional outcomes. The ligament was preserved in cases where the knee was used as a sacrifice. Materials and Methods: Total 25 patients were participated in this study. This study was conducted at the Department of Orthopedics, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India between November 2022 to October 2023. After and before surgery, patients were evaluated using a scoring system that was developed using the WOMAC Score, the Knee Society Knee Score, and the Functional Knee Score. Results: Clinical and functional knee scores improved significantly for all patients in both groups, according to the functional outcome analysis. With a total Knee Score of 85.80 for the PS group and 75.60 for the CR group, statistical analysis showed a statistically significant difference in the p-value favouring the Cruciate Sacrificing Prosthesis, indicating that it has better functional outcomes. A functional knee score of 99.6 for the CS group and 91.6 for the CR group indicated that all patients had a significant improvement. Based on statistical analysis, no significant difference was found. Conclusion: The functional prognosis after total knee arthroplasty was better in patients who had the posterior cruciate ligament sacrificed than in the maintaining group. This difference is likely due to the fact that the flexion deformity persists in the retaining group. Keywords: Knee Society knee score, posterior cruciate ligament, total knee replacement.

Background: Mullerian duct anomalies occur due to the abnormal fusion and canalisation of the mullerian (paramesonephric) duct. In mullerian anomalies uterine anomalies are the most common anomalies. Mullerian anomalies occur in 3-4% of population. Mullerian anomalies have low prevalence as they often remain asymptomatic and undiagnosed. Women with uterine anomalies are associated with a higher incidence of infertility, recurrent pregnancy loss (RPL), preterm labour, FGR, PROM, Malpresentations, retained placenta and increased caesarean section rate. This case series aimed to summarize the prevalence of mullerian anomalies, maternal and perinatal outcome of pregnancy in women with mullerian anomalies. Materials and Methods: This was a case series conducted in tertiary care centre, Government General Hospital, Guntur over a period of seven months (June 2023 to December 2023). Ethical approval was obtained from institutional ethical committee. Out of all the total deliveries, 14 cases of uterine anomalies were studied, either diagnosed before or during pregnancy or as an incidental finding during caesarean section. All detailed data such as demographic data, maternal age, parity, mode of delivery, obstetrical history, obstetric outcome, and foetal outcome were recorded. Results: In our hospital out of 3680 deliveries ,14 pregnancies were identified to have mullerian anomalies. The prevalence of mullerian anomalies in our study was 0.3%. All the cases have undergone caesarean sections. Preterm labour, malpresentations especially breech presentation and foetal growth restriction were common in the study. Conclusion: Mullerian anomalies are asymptomatic or often have subtle gynaecological symptoms. Pregnancy with uterine anomalies have an adverse obstetric outcome and hence require proper counselling and close monitoring during antenatal period and during labour. Asymptomatic course, lack of MRI, and less preference for HSG as it is an invasive procedure are the causes of low rate of pre conceptional diagnosis. Keywords: Mullerian anomalies, preterm, malpresentations, caesarean section, FGR.

Background: Alcohol dependence compromises on the quality of life of not only the individual who is consuming it but also on their family. This study aims to assess the demographic factors which play a role in patients with alcohol dependence. Materials and Methods: A total of 50 patients presenting to the OPD of Department of Psychiatry, Guntur Medical College, Guntur over a period of 18 months were included. The degree of alcohol dependency was assessed using the severity of alcohol dependency questionnaire (SADQ). Results: Middle age group, unemployment, nuclear families have shown to have significantly higher rate of severe alcohol dependence. Conclusion: The study concludes with the fact that the severity of alcohol dependency is significantly influenced by the patient’s social and demographic characterisitics. Keywords: Demographic profile, family, alcohol dependence, SADQ.

Background: Though there have been many studies comparing the combination of hyperbaric bupivacaine with fentanyl for spinal anaesthesia for caesarean section, there is still the requirement for further standardization of doses of these drugs, promising single best combination of drugs in providing optimal anaesthesia and minimal to nil adverse effects. Hence, this is the study of comparison of 3 different doses of hyperbaric bupivacaine which is 8mg, 9mg and 10 mg of 0.5% hyperbaric bupivacaine with fentanyl 15 µg with regards to synergistic effect on sensory and motor block, recovery profile, quality of intra-operative and postoperative analgesia, haemodynamic changes, adverse effects. Materials and Methods: This is a double blinded, prospective comparative study conducted at District Hospital, Bellary, which is a tertiary care hospital. A total of 120 pregnant women of American Society of Anaesthesiologists physical status II posted for caesarean section at DISTRICT HOSPITAL BALLARY were selected on the basis of simple random sampling method. Results: This study has shown that, the onset of analgesia was longer in lower doses of bupivacaine, the duration of analgesia was longer in higher doses. The hemodynamic parameters were comparable in all the three groups. The incidence of adverse effects was higher with higher doses of hyperbaric bupivacaine. Though the onset of sensory analgesia is faster with higher doses of bupivacaine, the incidence of hemodynamic side effects or complications is more was observed. Conclusion: We have concluded that 9mg bupivacaine with 15 micrograms of fentanyl would be an ideal choice for subarachnoid block in parturient coming for caesarean section. Keywords: Caesarean section; Pregnancy; Spinal anaesthesia, hyperbaric bupivacaine.

Background: Fine needle aspiration cytology (FNAC) of thyroid is a low cost, effective, safe diagnostic tool which can aid in evaluation of benign and malignant lesions. The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC) of thyroid nodules standardizes the nomenclature of reporting of thyroid cytological findings. Material and Methods: This prospective study was conducted in Department of Pathology at Osmania General Hospital, Afzalgunj, Hyderabad over a period of 2 years which included 424 patients with thyroid nodules from the Departments of Surgery, Medicine and E.N.T. Results: Females (n= 373) outnumbered males. Lesions belonging to Category – II (Benign) were the predominant ones. Out of 424 samples, 3.5% of them had malignancy. Conclusion: This study concludes that nomenclature according to TBSRTC ensures uniformity in reporting. Keywords: FNAC, thyroid nodule, Bethesda, cytopathology.

Background: Acute coronary syndrome encompasses a group of conditions (STEMI, UA/NSTEMI) characterized by decrease in coronary blood flow. It is responsible for more than one third of deaths in the emergency department. This study was conducted in order to assess the clinical profile of patients presenting with acute coronary syndrome. Material and Methods: A total of 517 patients presenting to the casualty of Kurnool Medical College with ACS between August 2023 to January 2024 were included in this study. Results: Majority of the study participants were males. Chest pain was the most common complaint and majority of the patients presented in Killip class I. STEMI was the most common diagnosis. Conclusion: Males, presence of comorbidities, increased age, and dyslipidaemia are the most common risk factors in patients presenting with ACS. Steps should be taken for primary prevention of risk factors and also to seek immediate medical help in acute chest pain. Keywords: Chest pain, ACS, STEMI, NSTEMI, unstable angina.

Background: HIV and tuberculosis (TB) co-infection is a significant public health challenge, particularly in resource-limited settings. This study aimed to evaluate the effectiveness of highly active anti-retroviral drugs (ART) and factors associated with treatment failure among HIV-TB patients in an Antiretroviral Therapy (ART) Centre in Southern Odisha, India. Material and Methods: A retrospective cohort study was conducted on 162 HIV-TB patients receiving ART between April 2015 and March 2021. Data were collected on socio-demographic characteristics, clinical features, treatment regimens, and outcomes. Treatment failure was defined as a switch to second-line ART due to clinical or immunological failure. Results: Most patients were aged 26-45, married, illiterate, and unemployed. Most had WHO stage 1 disease at ART initiation. Tenofovir-based regimens were commonly used for both first-line and second-line ART. Clinical failure (73.5%) was the primary reason for switching to second-line ART, followed by immunological failure (26.5%). Patients with longer TB co-infection (>6 months) had a higher rate of clinical failure. Second-line ART significantly increased the mean CD4 count from 253.32 to 339.25 cells/mm3 (p=0.000). Conclusion: Clinical failure and longer TB co-infection were associated with switching to second-line ART among HIV-TB patients. Second-line ART effectively improved immune status. Regular monitoring and timely treatment of HIV-TB co-infection are crucial to prevent drug resistance and treatment failure. Keywords: HIV-TB, ART, WHO, HIV/AIDS, DRUG UTILIZATION PATTERN

Background: The disheartening reality sheds light on the tragic consequences that can arise from inaction and inefficiencies in maternal healthcare systems, often leading to devastating outcomes for mothers and their families. Among the multifaceted causes of maternal deaths, one deeply concerning aspect is the phenomenon of "maternal deaths due to delays”. Objective: To explore the pervasive issue of maternal deaths due to delays, distance, different referrals highlighting the discrepancies in the system. Materials and Methods: It was a descriptive cross sectional study done in selected district (Jabalpur, Mandla, Narsinghpur, Katni) of Jabalpur division of Madhya Pradesh, India for a period of 1 year from April 2021 to March 2022. A total of 68 maternal deaths were reviewed out of 324 total maternal deaths in Jabalpur division in 2019-2020. Results: Pathway analysis of the maternal deaths were drawn to illustrate the Referrals of the maternal deaths in various health care facilities. About 42(61%) of the deceased mothers were referred to two facilities. 17(25 %) and 3 (5%) of the deceased mothers were referred to third and fourth health facilities respectively. Major causes of the delays were identified was the No birth preparedness by the family/deceased mother, inadequate referral system and shortage of staff in the facilities, Lack of encouragement from relatives & community members to seek care. Conclusion: The delays require a multi-faceted approach involving improved healthcare infrastructure, increased access to skilled healthcare professionals, community education, removing financial barriers, promoting respectful and patient-centred care, and addressing cultural and societal norms that discourage timely care-seeking. Keywords: Maternal, Death, Delay, Referral, Facilities.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in adolescent to premenopausal women and is also the leading cause of anovulatory infertility. It is defined as the symptoms and signs of androgen excess and ovarian dysfunction after the exclusion of other diseases (including hyperprolactinemia, non-classical congenital adrenal hyperplasia, thyroid disease, hypogonadism, Cushing’s disease, or and rogenproducing tumors). Materials and Methods: This study was conducted in the Department of Obstetrics & Gynaecology at F.H. Medical College and Hospital, Agra. The duration of study was over a period of one year. This cross-sectional study was performed in which a sample size of 175 females by random sampling was considered for the study and a well-validated questionnaire following the Rotterdam criteria for the diagnosis of PCOS was administered. Results: This study found a total of 175 cases of PCOS among the 400 cases. The study's findings indicated a correlation between PCOS and lifestyle choices. Among the 175 cases only 19 cases had appropriate lifestyle and 156 had inappropriate lifestyle. These results suggest a potential link between lifestyle factors and the prevalence of PCOS in the studied population. Conclusion: The findings suggest a higher prevalence of PCOS among young women in the population. While the majority of the population may not currently be affected by PCOS, a considerable percentage is prone to this condition due to inappropriate lifestyle. Keywords: PCOS, Metabolic disorders, Menstrual Cycle, Infertility.

Background: Spinal hypotension in a parturient can occur precipitously and may contribute significantly to regional anesthesia-related maternal mortality. The primary research within the field of obstetric anesthesia has been about the prevention of spinal hypotension. The objective of the present study is to compare the patients not receiving phenylephrine infusion and those receiving prophylactic phenylephrine infusion of 50 µg/min, and those of 100 µg/min. Material and Methods: This prospective randomized comparative study done on 75 ASA Ⅰ and Ⅱ patients, undergoing elective cesarean section under spinal anesthesia, randomly divided into three groups of 25 each, control group (Group-A), phenylephrine-50mcg group (Group-B), and phenylephrine-100mcg group (Group-C). All the patients were preloaded with 500ml of ringer lactate. According to the group, phenylephrine infusion of 50 µg/min or 100 µg/min was started immediately after spinal anesthesia and continued till baseline vitals were achieved. All the vitals are monitored and studied. Results: Demographic variables are comparable among the groups. There was a statistically significant difference in mean heart rates between three groups at 5, 10, and 20 minutes point of time for heart rate. There was a statistically significant difference in systolic, diastolic and mean blood pressure between the three groups from 3 minutes to 25 minutes. Hypotension and nausea were more in the control group than in the phenylephrine-50 and phenylephrine-100 groups. Bradycardia and maternal hypertension were more in the phenylephrine-100 group compared to the other two groups. No significant adverse effects in the both the groups. Conclusion: Prophylactic phenylephrine infusion is an effective and simple method of reducing the incidence and magnitude of spinal hypotension for cesarean delivery compared to the control group. Phenylephrine 50 mcg/min group had comparatively fewer adverse events like hypertension, bradycardia than the phenylephrine 100 mcg/min group. Keywords: Spinal anaesthesia, hypotension, prophylactic vasopressors, phenylephrine, obstetric anaesthesia,

Background: Severe acute maternal morbidity is emerging as an important indicator for evaluating maternal health worldwide. As the load of critically ill obstetrics patients is quite high in our institute, this study was undertaken to provide insights into the quality of obstetric and critical care providence and help modify current policies and strategies. Material and Methods: With purposive sampling, near miss cases were identified using 2000 WHO criteria and compared with maternal mortality indicators. 390 patents were included in the study. For data collection, case files from the medical records department, labor room and ICU records were used. Statistical analysis was done using SPSS version 28.0.2. Observational descriptive statistics, Chi square/Fisher test and Mann-Whitney U Test were applied. Results: From all critically ill obstetric admissions during the study period; 280 near miss cases & 111 maternal deaths were observed, leading to a high mortality index of 28%. The number of deliveries were 9807. The maternal near miss prevalence was 2.8% and maternal death to near miss ratio was 2.5:1. Near miss patients in the 3rd trimester were significantly higher (70%) than in mortality cases (41%). A large bulk were postpartum. (p= 0.009). Conclusion: Haemorrhage and hypertension remain the main causes of severe maternal outcomes with preponderance in the peripartum period. Analysis of near miss cases high-lighten the magnitude of severe maternal outcomes and help develop evidence-based protocols and better utilization of resources at hand. Keywords: Hypertensive disorders, maternal morbidity, maternal near miss, mortality index, postpartum haemorrhage.

Background: The Indian Ministry of Labour and Employment launched a social health protection program called Rashtriya Swasthya Bima Yojana (RSBY) in the year 2008 to provide financial protection from catastrophic health expenses to Below Poverty Line (BPL) households (HHs).[1,5]. Objectives: 1. To find out the awareness regarding Rashtriya Swasthya Bima Yojna among 100 BPL and unorganized workers in the urban population of Indore. 2. To find out the level of utilization of the scheme among card holders. Material and Methods: A community-based study using simple random sampling was conducted among 100 Below Poverty Line (BPL) families and unorganized workers residing in a slum area of Indore city. A pre-tested semi-structured questionnaire was used. Data was entered in excel sheet and analyzed using SPSS software 25.0 (trial version). Chi-square test was applied wherever necessary. Results: Among 100 study participants, 63% were males. Only 35% participants were literate. 79% were married, 20% were widow/widower, and 1% were unmarried. 45% were employed, 30% unemployed and 25% were retired. Majority (52 %) people were between 41-50 years’ age. Only 25% were aware about RSBY. 95% felt it is very important and everyone should have it. 20% of the participants were card holders. 50% of the card holders had never utilized the card. When asked about changes desired in enrolment process, 50% people wanted it to be cashless and 35 % wanted it to be less time taking while 15% people wanted it to be paperless. Association between gender, employment status, literacy and awareness was found significant (p-value<0.05). Conclusion: Awareness and utilization of RSBY in urban slum is low. Therefore, in order to increase awareness about RSBY* more IEC activities should be conducted. Keywords: RSBY- Rasthriya Swasthya Bima Yojana, BPL- Below Poverty Line, awareness, utilization.

Background: Uremic syndrome is Known to invariably involve all systems in the body. The cardiopulmonary status of patient in end stage renal disease need meticulous evaluation and contemplation for perioperative management. safe induction and planning of elective ventilation depends on cardiac function, anemia & pulmonary hypertension along with urine output on the table following vascular anastomosis. This study analysis well defined parameters to formulate recommendation on concrete observation. Materials and Methods: Study: Retrospective, Study period: April 2022 - June 2023, Study population: all patient who presented for PAC for renal transplantation. All patient were on antihypertensive and on hemodialysis, Sample size: 40 patients, All patient has undergone renal transplantation with successfull outcome under general anaesthesia, Patient data: age/sex/pulse BP Parameters analysed: EF /RWMA/ Hb. /RVSP, the ejection fraction indicates LV systolic function, RWMA about LV dilatation and hypokinesia, Anemia the severity is multifactorial and RVSP indicate pulmonary hypertension, Aim: To analyse data documented data for cardiopulmonary status in renal transplant recipients, Objective: • Predict and anticipate specific problems for intraoperative choice of drugs. • Anticipate and plan for elective post-operative ventilation. • Recommendation for further intensive and extended monitoring. Results: • Right ventricle systolic pressure which indicates pulmonary hypertension correlates significantly with hemoglobin with p value of 0.038 • Duration of renal disease categorically correlated with anemia (p 0.9) this parameters may have limitations as duration is subjective • Ejection fraction which denotes LV systolic function correlated with duration of hemodialysis (p 0.5) • 5 patients had global hypokinesia of LV along with anemia and moderate PHT Conclusion: Untreated or Neglected duration of hypertension or protenuria was associated with severe anemia all the effect of end stage disease is due to vascular remodeling & endothelial dysfunction. This is indicated by severe anemia often associated with moderate to severe pulmonary hypertension. Duration of dialysis is related to cardiac dysfunction due to fluid and circulatory volume handling altered by kidney. Keywords: Renal transplant recipients, RVSP, EF.

Background: Head and neck cancers are major public health problems, which can be detected much earlier by various screening methods. Head and neck cancers in India accounted for 30% of all cancers in males except Dibrugarh in Assam (49.6%). Since, no much study have been done on Head and Neck Cancers (HNCs) from this part of the country, this study was conducted to analyse the characteristics and trends of the different HNCs in a Tertiary Care Centre of Arunachal Pradesh, India. Materials and Methods: This is a retrospective observational study conducted in Tomo Riba Institute of Health and Medical Sciences, Naharlagun after obtaining institutional IEC & SRC clearance. Total 536 patients (370 males and 166 female) of head and neck (HNC) were reported in the Population based Cancer Registry (PBCR). The database collected from the PBCR (consists of 8 districts of Arunachal Pradesh) web portal included demographic and clinicopathological information, including age, sex, year of diagnosis, site and types of cancer, histopathological appearance and survival time. Patients were classified on the basis of primary histology morphology (PHM) into squamous cell carcinoma, and others. From mortality reports we calculated the median survival of the patients. Results: Our study showed that the male: female ratio was 2.2:1. Out of the 8 districts of Arunachal Pradesh, Papumpare district reported the highest incidence (44%) and mortality (50%) due to HNC. The median days of survival were 283days or 9.43 months. The commonest age group showing the highest incidence of HNC was the elderly from 61 years and above with a total of 121 cases (22.5%) followed by the age group from 56-60 years (17.7%). Esophageal cancer was the commonest cancer among these two age groups. Squamous cell carcinoma also showed the highest mortality contributing 47% of all the deaths registered. Conclusion: Esophageal cancer was the commonest cancer among these two age groups in our study. The burden of HNC is high, especially among the male population. Further research and policies on improving the uptake of available cancer screening are required for better cancer control and prevention. Keywords: Head and Neck Cancers (HNCs), Pyriform Sinus (PFS), Primary Histology Morphology (PHM), Esophagus Cancer, Squamous Cell Carcinoma, Mortality.

Background: The Neutrophil-lymphocyte ratio (NLR) values have been used as an assessment tool for level of glycemic control in type 2 diabetic patients. Its high value is a predictor of poor diabetic control. The aim of this study to correlate between NLR, HbA1c and Lipid profile among diabetic population. Materials and Methods: This present cross-sectional study was conducted on total 440 subjects, out of which 220 type 2 diabetic patients as cases and 220 healthy controls. Venous blood collected in vial with EDTA as anticoagulant. Glycosylated hemoglobin was measured using HbA1c-Direct, Total WBC, neutrophil, lymphocyte levels, Triglyceride, HDL, LDL and Total cholesterol level were assessed. Correlation between two variables was analyzed using Pearson correlation coefficient. A p value < 0.05 was taken as statistically significant. Results: The mean HbA1C was 4.07 in control and 8.41 in cases and the difference was statistically significant p <0.05. The lipid profile (TC, LDL, TG) was higher in cases as compared to control group & HDL was lower value in cases as compared to control group, which was statistically significant (P<0.001**) in our study. The strong positive correlation between HbA1c and NLR of diabetic patients with a Pearson’s coefficient of correlation 0.454 and p <0.05. There no significant correlation with ESR, TC, HDL, LDL, TG with NLR as p value >0.05 which is statistically non-significant and there was moderate positive correlation between HbA1c and NLR in newly and previously diagnosed diabetic patients with p value <0.001. Conclusion: We concluded that NLR can serve as a marker of long-term diabetic control like glycosylated hemoglobin. NLR can guide the anti-diabetic measures in the resource limited settings and resource limited country like India. Keywords: HbA1c, NLR, Type 2 Diabetes, Lipid profile, ESR.

Background: Deep vein thrombosis (DVT) poses a substantial threat to patients, potentially resulting in permanent disability and significant morbidity and mortality. Current standard management involves anticoagulant therapy, graduated elastic compression stockings, and early ambulation. While thrombolysis has traditionally been reserved for complicated cases, this study aimed to assess the efficacy of thrombolysis in patients with varying presentations of DVT. Materials and Methods: This retrospective study was conducted at a tertiary level hospital (SMS Medical College, Jaipur, Rajasthan) from August 2012 to August 2022. A total of 1289 patients with DVT were enrolled in a single unit of the Department of Cardiovascular and Thoracic Surgery. All patients underwent a combined approach of thrombolysis and anticoagulation, utilizing standard doses of urokinase and streptokinase. Results: In all cases, patients exhibited recovery from DVT, as confirmed by Doppler imaging, with no instances requiring referral for venous filters. Aggressive management incorporating thrombolysis alongside anticoagulation demonstrated complete resolution of DVT in every case. Timely administration of thrombolysis proved effective in preventing the necessity for inferior vena cava (IVC) filters or surgical interventions. Conclusion: This study highlights the efficacy of thrombolysis as an integral component in the comprehensive management of DVT. The findings suggest that a combined approach with anticoagulation and timely thrombolysis can lead to complete resolution of DVT, thus mitigating the need for further interventions such as IVC filters or surgery. Keywords: Deep Vein Thrombosis, Pulmonary Thrombo-Embolism, Post Thrombotic Syndrome, Thrombolysis.

Background: Aim: To assess lipid profile and CRP level in the offspring of diabetes mellitus patients. Material and Methods: 60 offspring of T2DM patients (Group I) and 60 healthy controls (Group II) were selected. Assessment of plasma glucose level, serum hs-CRP, serum cholesterol serum TGs, and high-density lipoprotein (HDL) levels was performed. Results: There were 32 males and 28 females in group I and 30 males and 30 females in group II. The mean age in group I subjects was 36.2 years and in group II was 36.5 years. The mean weight was 60.8 kg in group I and 60.2 kg in group II, height was 1.71 meters in group I and 1.69 meters in group II, BMI was 22.7 Kg/m2 in group I and 22.3 Kg/m2 in group II. The mean waist circumference was 79.2 cm in group I and 74.5 cm in group II, hip circumference was 98.3 in group I and 97.5 in group II, W/H ratio was 0.81 in group I and 0.74 in group II. A significant difference was observed between both groups (P< 0.05). The mean fasting blood sugar level was 165.2 mg/dl in group I and 94.2 mg/dl in group II. The random blood glucose level in group I was 108.2 mg/dl and in group II was 93.6 mg/dl, hs- CRP was 2.9 mg/dl in group I and 1.4 mg/dl in group II, TG was 170.2 and 128.3 in group I and group II, TC was 178.4 mg/dl and 142.6 mg/dl in group I and group II, HDL was 37.2 mg/dl and 55.3 mg/dl in group I and group II, LDL was 108.2 mg/dl in group I and 76.4 mg/dl in group II and VLDL was 36.5 mg/dl in group I and 24.1 mg/dl in group II. A significant difference was observed between both groups (P< 0.05). There was positive correlation of TG (r- 0.24, p< 0.02), TC (r-0.42, p< 0.02), LDL (r-0.41, p< 0.04) and VLDL (r- 0.31, p< 0.04) and negative correlation of HDL (r- -0.23, p< 0.05) with hs-CRP. Conclusion: Children of parents with type II diabetes have elevated levels of high-sensitivity C-reactive protein and a changed lipid profile. Clinicians may be able to intervene early in the course of the disease and stop future complications and outcomes with the support of timely screening and early detection of the increased hs-CRP in the first-degree relatives of T2DM participants. Keywords: CRP, Diabetes, Offspring, HDL

Background: To evaluate information needs and pain assessment in patients with metastatic cancer receiving palliative radiotherapy. To evaluate pre and post radiation quality of life in these patients. Materials and Methods: It is a Prospective study done in 50 Patients with Metastatic Cancers Receiving Palliative Radiotherapy for 2 years in patients age 18-75 in Histologically Confirmed Metastatic Cancers, Patients able to Comprehend and Understand the Questionnaires and ECOG Performance Score 1-3. Results: QOL data from base line to 1st month follow up was available for 50 patients. Base line 1st month follow up with Paired Sample T-test, there was a significant improvement in Global health score (GHS) (p=0.032), Physical functioning (p=0.03), Role functioning score (p=0.02), Emotional functioning score (p=0.016), Cognitive functioning score (p=0.008), Social functional scale shows improvement but statistically not significant (p=0.590). Symptom scales Pain (p=0.03), Fatigue (p=0.02), dyspnea (p= 0.034), appetite loss (p=0.047), diarrhea (p= 0.009) and Insomnia (p=0.018) showed statistically significant improvement. Nausea and vomiting (p=0.189), financial difficulties score (p=0.161) showed improvement but statistically not significant. Constipation showed worsening one month after RT (p=0.497) but statistically not significant. 68% of patients presented with pain. Pain score taken before starting radiotherapy and one month after completion of radiotherapy by using Numeric pain rating scale. Mean pain scale score before RT 4.28, Mean pain scale score after one month RT 1.68, Showed statistically significant improvement in Pain reduction (p=0.000). Conclusion: Patients with metastatic cancers who have received palliative radiotherapy have significant improvement in the Quality of life. Keywords: Metastatic cancers, Palliative radiotherapy, Quality of life, Pain scale score.

Background: Acute leukemia of ambiguous lineage (ALAL) is infrequent in occurrence with research data available only as small case series, thus leading to a diverse approach in the management. Using “Acute lymphoblastic leukemia (ALL)- type” induction therapy along with a tyrosine kinase inhibitor for t (9,22) has achieved higher remission rates with less toxicity compared with the more intensive AML induction chemotherapy in many case series. The role of immunophenotypic and genetic markers in directing chemotherapy and the utility of targeted therapy is still unknown. In current study, 12 patients who were diagnosed with ALAL have been retrospectively analyzed for patient demographics, hematopathological profile and induction outcomes. Among 12 patients, there were 9 male and 3 female. 25% of the patients showed t (9,22) and 16.6% showed other cytogenetic abnormalities. 5 patients showed remission after induction, 5 failed after induction, 1 expired before induction and 1 deferred chemotherapy. 50% of the patients who were started on ALL- type induction chemotherapy have shown good outcomes. Prospective studies are required to establish the best therapeutic approach in this heterogeneous disease. Keywords: acute leukemia, ALL-type induction, ambiguous lineage, Acute leukemia of ambiguous lineage (ALAL).

Background: Pancytopenia is a relatively common hematological entity suggestive of many serious and life threatening illness ranging from simple viral infections to megaloblastic anemia. Drug induceed bone marrow hypoplasia to fatal aplasia and terminal phase of leukemias. The severity of pancytopenia determines management and prognosis sometimes cause cannot be determined. Aim & objectives: To evaluate various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia of adult group. Material and Methods: Fifty patients with a hematological diagnosis of pancytopenia were studied during the period august 2020 to august 2022, in the Department of Pathology, SVS Medical College and Hospital, Mahabubnagar. Results: Out of 50 cases, 34 were males and 16 were females. Most of the patients were in the age group of 41-60 years (54%). Megaloblastic anemia was the most important cause of pancytopenia. Conclusion: This study concluded that most common causes of pancytopenia is megaloblastic anemia followed by aplastic anaemia, hypersplenism and leukaemia. Nutritional anaemia is commonest cause for pancytopenia. This may be due to megaloblastic anaemia or deficiency of iron/vitamin B12/folate combined. Rare causes were infections, myeloproliferative disease and SLE. Bone marrow examination is a single useful investigation which reveals the underlying causes in patients with pancytopenia. Keywords: Bone marrow aspiration; Pancytopenia.

Background: Skin a multifaceted, multilayered and incredibly complex organ, having a plethora of diverse functions, accounts for approximately 15% of the total dry body weight. Dermatological disorders are common all over the world, with a highly variable spectrum of disease process, owing to different ecological factors. Skin disorders are generally diagnosed by the clinical presentation but many diseases have overlapping clinical features, moreover, a single disease may have variable presentations. Therefore, skin biopsy and histopathological examination, which is the gold standard tool for confirming the diagnosis, also aids in patient management and guides the clinician towards appropriate clinical interventions. Our study explores the diversity of the histomorphological spectrum of non-infectious and non-neoplastic lesions of skin in a tertiary health care centre in Garhwal region of Uttarakhand as there is paucity of the studies available in this field in this hilly region. Materials and Methods: A cross sectional observational study of non-infectious benign skin lesions was conducted at Department of Pathology of VCSGGIMS&R Srinagar Garhwal from August 2022 to September 2023. The skin biopsies were received in 10% formalin and after routine tissue processing and staining with hematoxylin and eosin, slides were examined. The clinical features were recorded from requisition forms of patients. The histological features were noted and histopathological diagnosis was made. Results: Out of a total of 117 skin biopsies of non-neoplastic non-infectious skin lesions 56% were females. The age of presentation ranged from 8 months to 84 years. The age group of 31 to 40 years represented the majority of cases. Most common lesions were papulosquamous lesions followed by pigmented lesions. Lichen planus was the most common pathology. Conclusion: A heterogenous histopathological spectrum of non-infectious and non neoplastic lesions was seen in a wide age distribution. Skin biopsy being a simple and inexpensive outpatient procedure provides adequate biopsy material for histopathological examination and confirmation of clinical diagnosis. Keywords: Histopathology, Skin, Non-infectious

The Covid-19 pandemic limitation has led to a variety of psychiatric manifestations in humans. These effects were brought about by insufficient planning and a lack of awareness of the epidemic. Infrastructure, human resources, and steady supply are all important, as is the transportation of medications, food, and surgical supplies for the patients. Managing biomedical waste, which includes collecting and segregating it, comes last, includes its storage and transit. Including the challenges, they face with regards to the disposal of dead bodies. Keywords: Infrastructure, Administration, Equipment, Biomedical waste, planning, challenges.

Scrub typhus is a mite borne disease caused by Orientiatsutsugamushi. Central nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. Eschar helps in early diagnosis but in majority it remains absent. Thus a high degree of clinical suspicion and a positive rapid, diagnostic test remains an important point in the management of scrub typhus as the timely initiation of specific therapy results in complete recovery and fewer complications. Most of the cases respond well to the oral doxycycline. Keywords: Scrub typhus, meningitis, tropical infection, doxycycline

Background: Hemoglobinopathies represent a group of genetic disorders characterized by abnormal hemoglobin production, posing significant clinical and diagnostic challenges. High-Performance Liquid Chromatography (HPLC) has emerged as a reliable tool for the characterization of hemoglobin variants, offering insights into the clinical implications of different genetic mutations. Objectives: This study aims to utilize HPLC to characterize hemoglobin variants and analyze their clinical significance in various hemoglobinopathies. Materials and Methods: Patients presenting with suspected hemoglobinopathies were recruited for the study. Hemoglobin variants were characterized using HPLC, and their clinical implications were assessed. Data were analyzed using appropriate statistical methods to determine the prevalence and clinical significance of different hemoglobin variants. Results: Distinct hematological profiles were observed in patients with different hemoglobinopathies. β-thalassemia major/intermedia exhibited significantly lower hemoglobin levels and altered RBC indices, while sickle cell disease manifested moderate anemia and characteristic abnormalities in RBC morphology. β-thalassemia trait showed microcytic hypochromic features, whereas Hb D Punjab Sickle cell variant exhibited elevated hemoglobin levels alongside abnormal RBC indices. Conclusion: The findings of this study highlight the clinical significance of precise hemoglobin characterization using HPLC in various hemoglobinopathies. Accurate diagnosis and tailored management strategies are essential for improving patient outcomes in hemoglobinopathy care. Continued research in this area is warranted to further enhance our understanding of hemoglobinopathies and optimize diagnostic and therapeutic approaches. Keywords: Hemoglobinopathy, High-Performance Liquid Chromatography, Hemoglobin Variants, β-thalassemia, Sickle Cell Disease.

Background: To compare efficacy between oral lignocaine viscous 2% and oral lignocaine spray 10% in attenuating the hemodynamic response for laryngoscopy & endotracheal intubation prior to general anaesthesia. Materials and Methods: This study was carried out in 60 patients belonging to ASA I& II, aged between 20 to50 years undergoing elective surgeries. The study will be conducted for a period of 1year in Department of Anaesthesia in Kurnool Medical College, Kurnool. Patients who had hypersensitivity to study drug, patients with severe renal, hepatic, respiratory, cardiac disease, neurological, psychiatric disorders, Difficult Airway-Cormack & Lehane grade 3 and 4 were excluded from the study. Divided in to two groups. Group V receives 10ml of 2% or a lignocaine viscous gargle for 5 minutes prior to induction. Group S receives five puffs of oral lignocaine spray 10% prior to induction. The values for HR, SBP, DBP, and MAP, SPO2 were obtained baseline, after induction, immediately after intubation and 1,3,5 and10 minutes after intubation and compared among the groups. Results: In the current study, after induction the mean HEART RATE starts increasing in group S and in group V mean heart rates tart decreasing after induction and slightly raised after immediately after intubation and gradually decreasing till 10 min after intubation. In group S immediately after intubation highest mean heart rate was observed, and start decreasing at 1 minute, 3 minute, 5minute and 10 minute after intubation but not reached baseline level, the mean heart rate between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). In group S mean SBP start increasing immediately after intubation and gradually start decreasing from 1 minute after intubation to 10 minutes after intubation. The mean SBP between two groups from 1 minute after induction to 10 minutes after intubation was significant. (p<0.05). In group V mean DBP start decreasing immediately after intubation and slightly increased immediately after intubation and gradually decreasing till 10 min after intubation. The mean DBP between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). The mean MAP starts increasing in group S till immediately after intubation and gradually start decreasing from 1 minute after intubation to 10 minutes after intubation but reached baseline level at 3minutes.However, in group V mean MAP start decreasing immediately after intubation and slightly increased immediately after intubation and gradually decreasing till 10 min after intubation. The mean MAP between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). After induction the mean SPO2 starts increasing in both groups and reached to 100% in both groups. Conclusion: The study concluded that oral lignocaine viscous 2% was more effective in blunting the haemodynamic response to laryngoscopy and endotracheal intubation than lignocaine spray 10% No significant adverse events occurred during the study. Keywords: Lignocaine, Hemodynamic parameters, MAP, Endotracheal intubation.

Background: Tobacco use is the leading single preventable cause of deaths worldwide. Present study was focused on the cessation of tobacco consumption through a range of behavioural and pharmacological therapies. Material and Methods: Prospective self-control quasi experimental study utilizing WHO 5A’s and 5R’s method of behavioural intervention for tobacco cessation. Results: 150 patients were enrolled for the study. 95 participants successfully quit tobacco, 16 and 9 patients restarted before and after one month and 23 patients did not quit. 8 patients were lost to follow-up. Presence of withdrawal symptoms was significantly associated with reuse of tobacco (p-value 0.0018*). Conclusion: WHO 5A’s and 5R’s method of tobacco cessation counselling was found to be effective in quitting tobacco. Keywords: Behavioural interventions, 5A’s and 5R’s, STAR approach.

Background: Teenage pregnancy is a serious issue in both developed and underdeveloped nations. Causative factors being early puberty, early marriage, sociocultural factors, illiteracy, early sexual activity, lack of knowledge and access to contraception, ignorance, and poverty. Teenage pregnancy has been associated with several adverse consequences, including anaemia, preeclampsia, premature delivery, infants being small for gestational age, low birth weight, and increased neonatal morbidity and mortality. Materials and Methods: A comparative study regarding maternal and perinatal outcome was conducted between 100 cases of primigravidae aged 14- 19-year-old and 100 cases of primigravidae of 20-29-year-old attending Government Maternity Hospital, Tirupati and willing to give written informed consent. All high risk pregnancies were excluded from the study. Results: The mean age in teen age primigravidae found to be 18.1yrs where as it is 24.6yrs in adult primigravidae. There is no significant difference in distribution of unbooked cases in teenage and adult pregnancies. 19% of teenage pregnant women were illiterate compared to only 4% in adult group. 69% of teenage group and 52% of adult group belongs to low socioeconomic status. Majority of study participants are of term gestational age. Teenage pregnancy is an important risk factor for development of anaemia and hypertension incidence being 68% & 27% compared to that of adult group where incidence being 32% & 8% respectively. Preterm and IUGR is a common neonatal outcome observed in teenage pregnancies compared to that of adult pregnancies. 2 IUDs observed in teenage group and no IUDs in adult group. Incidence of failed induction and cephalopelvic disproportion were significantly more associated with teenage primigravidae. Majority of the adult primigravidae adopted for one or other method of contraception. Conclusion: Teenage mothers had numerous complications in pregnancy, anemia, pre-eclampsia, and preterm labor, oligo hydamnios, Thyroid disorders. Higher operational intervention and a higher LSCS rate are also contributing factors in the rise in maternal morbidity. Neonatal morbidity is also more in teenage mothers due to prematurity, low birth weight, and perinatal asphyxia. Stringent rules should be implemented to avoid early marriages and teenage pregnancies. Keywords: Adult Primigravidae, Comparative study, Maternal outcome, Perinatal outcome, Teenage primigravidae.

Background: Dengue virus belongs to the genus Flavivirus and family Flaviviridae. Its nucleus consists of single–stranded positive sense RNA. Dengue fever is an acute mosquito-borne arboviral illness affecting sub-tropical and tropical countries. It is a seasonal and emerging disease. Dengue illness is caused by four serologically related viruses designated as DENV-1 to 4 and ranges from mild symptomatic form to severe dengue haemorrhagic fever (DHF) with or without dengue shock syndrome. Aim & Objectives: Seroprevalence and evaluation of sensitivity and specificity of the immunochromatographic method to that of the ELISA diagnostic method in the detection of dengue fever at Government General Hospital, Nizamabad. Material and Methods: Over a period of one year from March 2021 to Feb 2022, a total of 2084 blood samples from clinically suspected cases of dengue were received in the Department of Microbiology laboratory. The serum was separated and subjected to enzyme immunoassay for detection of both Non-Structural (NS1) antigen and IgM antibodies. Rapid dengue method and NS1&IgM ELISA tests were done for the suspected fever cases. Results: During this study period, a total of 2084 blood samples were processed from suspected dengue cases, out of which 381 (18.22 %) samples were found to be positive by different serological markers like NS1 Antigen (Ag), IgM antibody (Ab), or both NS1 Ag & IgM Ab. The overall seroprevalence rate was found to be 18.22 %. Prevalence of NS1 antigen 113 (77%) (n=145). The sensitivity and specificity of the immunochromatographic method were found to be 93 % and 100 % as compared to the ELISA method. Conclusion: The present study detected NS1 antigen along with IgM Antibodies. The result revealed that both NS1 and IgM have a very high specificity, the sensitivity and specificity of the Immunochromatic method were found to the 93% and 100% respectively as compared to ELISA method. Serological diagnosis should be done in all clinically suspected dengue cases for early initiation of treatment and thereby minimizing mortality. A continuous Sero-epidemiological surveillance control program is needed to overcome future epidemics of dengue, thereby minimizing the complications, outbreaks, and mortality. Keywords: Non-structural (NS) 1 antigen, Arbovirus, ELISA, IgM antibody.

Background: School education is an important part of child's overall growth. But, during the process of attaining school education, children are burdened with heavy back packs which can cause serious health issues. Objectives: The objectives of the study were to assess the knowledge and attitude of school teachers about the ill effects of carrying heavy back packs in children. Materials and Methods: A school based cross sectional study was done among 264 school teachers teaching 6th to 8th standard selected through multistage stratified random sampling technique from selected schools of Kanyakumari district from May 2022 to May 2023. Data collected using a predesigned pre tested and self-administered questionnaire was entered into MS Excel and was analysed using SPSS version 26.0. Results: The results revealed that only 31.8 % of the school teachers knew that the ideal proportion of back packs, 56.4 % knew that the heavy bag packs can cause headache, neck pain and leg pain, 49.2 % knew that it causes shoulder pain and 43.6% knew that it causes back pain in students. For questions on attitude, 20.5 % and 42% of them agreed that heavy back packs can be a reason for tiredness and that it can cause mental stress, respectively. Conclusion: While only half of the participants were knowledgeable about the physical effects of heavy back packs in students, less than half of them were of the attitude that it can have mental and emotional effects. Keywords: Knowledge, attitude, heavy back packs, school teachers, Tamil Nadu.

Background: This single blinded interventional prospective study compares intravenous Ondansetron and Palonosetron in preventing postoperative nausea and vomiting in patients undergoing laparoscopic gynaecological surgeries under general anesthesia. Material and Methods: This study was conducted at Government Kasturba Gandhi Hospital for Women and Children, Madras Medical College, Chennai. Instituitional Ethical committee approval was obtained before preceding the study. Informed Written consent was obtained from all the100 patients who were scheduled to undergo elective laparoscopic gynaecological surgery. Information about the study type, the drug, its benefits and side effects were clearly explained and willingness of the patient to participate in the study was documented. Results: Study population of 100 patients undergoing elective laparoscopic gynecological surgeries were randomly divided into two groups. 50 patients were allotted to group O receiving Ondansetron and 50 patients were allotted to group P receiving Palonosetron. Statistical analysis was done using SPSS package version 17 for windows. To compare intergroup differences, student’s T test was used and for Categorical variables chi square or fisher’s exact test was used. A P value less than 0.05 was considered to be statistically significant. Conclusion: It is concluded that Intravenous Palonosetron is more effective than intravenous Ondansetron in the prevention of post-operative nausea and vomiting. The number and frequency of emetic episodes were significantly reduced. Hence Palonosetron is superior to Ondansetron and it is safe and reliable to use in the prevention of post-operative nausea and vomiting. Keywords: Surgery, nausea, post-Operative vomiting, anaesthetic.

Hemorrhoids are a prevalent ailment among humans, with a prevalence rate ranging from 4% to 36% in the general population. The current investigation was carried out at the Department of General Surgery, Osmania General Hospital, Hyderabad, Telangana, India, over a period of two years from November 2019 to November 2021.This study was a prospective comparison of standard Milligan Morgan haemorrhoidectomy and Suture haemorrhoidopexy for the treatment of grade 3 and 4 haemorrhoids. In this study, we examined the benefits and drawbacks of suture hemorrhoidopexy and open hemorrhoidectomy in 60 patients over a 24-month period. We ensured the safety of the patients throughout the trial. We have identified both the benefits and drawbacks of both strategies. Therefore, it was determined that suture hemorrhoidopexy is a secure procedure with numerous immediate advantages. This procedure is unique and has emerged as a viable alternative to open hemorrhoidectomy. Keywords: Hemorrhoids, Conventional hemorrhoidectomy, Suture hemorrhoidopexy.

Background: Upper Respiratory Tract Illness is mostly caused by viruses in all age groups especially children. It is implicated as a leading cause of mortality amongst the children of the 3rd world countries. Among the viral etiologies common are Parainfluenza virus, Rhino virus, Adeno virus, Respiratory syncytial virus, Human metapneumo virus, Infleunza virus. Laboratory diagnosis of URTI is based on PCR and historical modalities like tissue culture are not done routinely and find use only in reference laboratories and academic institutes. Material and Methods: Throat swab, nasopharyngeal swabs and nasopharyngeal aspirates were collected from patients ( ≤ 3years) and placed inside a viral transport media and transported at 4o C. RNA was extracted and Duplex RtPCR was run. Results: In the paediatric patients the most common age group affected was between 1 -2 years,with a slight female predominace. Majority of the patients presented with features of upper respiratory tract infection. High birth order, Low birth weight, undernutrition, poor socio-economic status appear to be significant risk factors. Conclusion: URTI of viral origin appear to be the most important presentation of ARI in children below 3years of age in the population under study. Demographic factors such as high bith order, low socio-economic background and malnutrition appear to have significant impact on the morbidity due to ARI. Keywords: URTI, ARI, socio-economic status

Background: Laparoscopic cholecystectomy has become the gold standard for the surgical management of gallbladder diseases. This study focuses on the epidemiological profile of 68 patients in North Kerala who underwent laparoscopic cholecystectomy in a tertiary care centre. Material and Methods: A prospective study was conducted among 68 patients who underwent laparoscopic cholecystectomy, from January 1, 2022, to June 30, 2022, at Malabar Medical College Hospital and Research Centre, Kozhikode. Results: The mean age of the patients was 46 years, with a notable female predominance. The mean duration of symptoms, operating time, ICU stay, and hospital stay were 203.1 days (SD-60), 49.67 minutes (SD-1.63), 54.98 hours (SD-9.43), and 2.61 days (SD-1.01), respectively. Histopathological examination revealed that 52.9% exhibited features indicative of acute cholecystitis, 16.2% had xanthogranulomatous cholecystitis, and 30.9% had chronic cholecystitis. In the postoperative period, 5.9% experienced respiratory complications, 1.5% had bile duct injury, and 2.9% developed deep vein thrombosis. Conclusion: This study examines the epidemiological profile and safety of laparoscopic cholecystectomy, offering valuable insights into this domain, contributing essential regional data to the field in alignment with international standards. Keywords: Cholecystitis, Laparoscopic cholecystectomy, Complications, Kerala.

Background: The COVID-19 pandemic declared as a global health emergency by World Health Organisation on March 24 2020, had many impacts on the health of the people especially mental health of children. Objectives: To find the impact of COVID-19 pandemic on mental health and to determine the associated factors among children studying in various schools of Kanyakumari District of Tamil Nadu. Material and Methods: A cross-sectional study was conducted among 400 school children selected through convenient sampling studying in selected schools of Kanyakumari District. A questionnaire covering 4 different domains with minimum score as 0 and maximum as 41, grouped as normal (> 30), borderline (15-30) and abnormal (<15) was used for data collection. The data collected was entered into MS excel and was analysed using SPSS version 26.0. Results: Among the study participants 14 % of adolescents had abnormal mental health status, which was more among girls (15.7%) and around 67.5% of the adolescents had Borderline mental health status, which was more among boys (70.45%) and this association was found to be statistically significant (p < 0.001).Physical health factors domain was the most affected among girls (20.56%) and educational factors were affected the most among boys (19.54%) and these associations were found to be statistically significant. Conclusion: Effective mental health promotion strategies that are tailored to the needs of boys and girls has to be in place starting from schools. Keywords: Mental health, school children, Kanyakumari.

Background: Unprecedented levels of antimicrobial resistance in bacterial isolates have prompted great concerns globally and have imposed significant life threatening risks to several different populations, especially those in intensive care units (ICUs). Among Gram-negative bacteria, Acinetobacter baumannii is notorious as a frequent opportunistic pathogen associated with critically ill patients The objective of the present study is to determine the prevalence and risk factors of Carbapenem Resistant Acinetobacter baumannii (CRAB) infections among patients admitted in ICU in a tertiary care hospital in North East India. Materials and Methods: A total of 215 Acinetobacter baumannii isolates obtained from patients admitted in ICU between 2019-2020 were included in the study, retrospectively. All the isolates were screened for carbapenem resistance by Kirby Bauer Disc Diffusion method and were further subjected for MIC (Minimum Inhibitory Concentration) testing by VITEK 2 automated system. The statistical analysis was done using MedCalc for Windows version 19.1 (Ostend, Belgium). Significance of statistical association had been calculated from standard probability (p- value) using Chi-Square test. Results: Carbapenem resistance was observed in 149 (69%) out of 215 Acinetobacter baumannii isolates. Majority of the resistant isolates had MIC values of ≥16µg/ml and ≤64µg/ml (85.2% for Imipenem and 87.3% for Meropenem). Most common risk factors of infection were mechanical ventilation (56.4%), prolonged ICU stay (44.5%) and multidrug resistance (43.6%). The isolates were highly resistant to Cephalosporins including Ceftazidime (91.9%) and Ceftriaxone (81.2%) whereas they showed maximum sensitivity towards Levofloxacin (54.4%), Aminoglycosides including Gentamicin (53.7%) and Amikacin (53%). Conclusion: This study highlights an increasing trend of carbapenem resistance amongst Acinetobacter baumannii isolates in North East India. Keywords: Acinetobacter baumannii, Intensive Care Unit, Carbapenem resistance.

Background: CTEV is a common congenital condition affecting the lower limbs. Ponseti method is the gold standard line of management. However, due to its lengthy procedure and need for frequent visits, the compliance rate is low. Accelerated Ponseti method has similar efficacy with reduced need for follow-ups. This study evaluates the outcomes of patients treated with accelerated Ponseti method. Material and Methods: A total of 40 patients with CTEV who presented to King George Hospital Visakhapatnam during time period of Aug 2021 to May 2023 were included in this study. Results: A total of 40 patients with CTEV underwent accelerated Ponseti method for correction. Most of the patients had excellent outcomes. There were no poor outcomes. 5 patients had cast related pressure ulcers which subsequently healed. Conclusion: Patients with idiopathic CTEV show better compliance and thereby better outcomes with accelerated Ponseti method. Keywords: CTEV, Ponseti method, deformity, congenital.

Background: Aim: This study is to compare the anti-hypertensive efficacy of Tablet Labetalol and Tablet. Nifedipine in mild preeclampsia. Material and Methods: The study was conducted at the Deccan College of Medical Sciences (Owaisi Hospital and Research Centre and Princess Esra Hospital) both the hospitals attached from January 2021 to June 2022. 100 antenatal women with mild preeclampsia were selected. Informed consent taken. 50 women were given Tablet Labetalol. 50 women were treated with Tablet Nifedipine. Results: This study was conducted on a total of 100 antenatal mild preeclamptic women to compare the anti-hypertensive efficacy of T. Labetalol and T. Nifedipine. The maternal and fetal outcomes were also studied. Patients were divided into two groups 50 each. Group A Received T. Labetalol and group B received T. Nifedipine. Blood pressure and feto maternal status were serially monitored. Termination was done at 37 completed weeks gestation or when the patient progressed to severe preeclampsia. The average dose required for T. Labetalol was 300 mg and 30 mg for T. Nifedipine. In both the groups, all 50 patients had adequate control of blood pressure. Inspite of adequate control the disease progressed in both groups. In group A (T. Labetalol) 14% progressed to severe pre-eclampsia. In group B (T. Nifedipine) 20% progressed to severe pre-eclampsia. Among the babies delivered, in group A 86% were term babies and 8% required SNN admission. In group B 80% were term babies and 10% required SNN admission. Comparing the two groups, group B had significantly higher number of side effects when compared to group A. None of the patients developed grave complications such as HELLP syndrome, pulmonary edema, coagulopathy, postpartum collapse, eclampsia. The maternal mortality was nil. Thus when patients with preeclampsia are identified and treated atan earlier stage the morbidity and mortality associated with preeclampsia can be significantly reduced. Conclusion: From this study it is prudent that both T. Labetalol and T. Nifedipine are equally efficacious in the control of hypertension in mild preeclampsia. Keywords: Preeclmpsia, Labetalol, Nifedipine, HELLP syndrome, Maternal Complications.

Background: Vogt–Koyanagi–Harada (VKH) disease is a rare uveitic entity which could be associated with autoimmune thyroid disease. This report was aimed to investigate with optical coherence tomography for the diagnosis of VKH disease and associated autoimmune thyroid disease confirmed by anti thyroperoxidase (TPO) antibodies. Case study: A 20-year-old young female came with a chief complaint of defective vision both eyes since 1 day. Past history of viral illness, fever since 1 week associated with headache, orbital pain and photophobia. No history of any ocular trauma or ocular surgery in the past. Ophthalmic evaluation revealed visual acuity in both eyes 6/12, fine pigmented keratic precipitates KP’s over corneal endothelium and aqueous grade 1 cells, along with bilateral serous macular detachment, retinal pigment epithelium(RPE) changes and choroidal thickening. Patient is a known case of hypothyroidism and she is on Tab. Thyroxine sodium 50mcg.To exclude any association with other autoimmune disorders, Anti TPO and anti-nuclear antibody(ANA) were done. Thyroid stimulating hormone(TSH) levels were elevated, anti TPO were positive confirming hashimoto’s thyroiditis and ANA weak positive for the exclusion of lupus choroidopathy. Conclusion: VKH, essentially a clinical diagnosis may be associated with other autoimmune disorders like Hashimoto’s, Grave’s disease which need to be evaluated. Visual prognosis depends on early treatment with steroids and immunosuppressants, preventing recurrence of the disease process. This case highlights the importance of evaluation of VKH disease and other associated autoimmune disorders. Keywords: Vogt-Koyanagi-Harada Disease, Hashimoto’s Thyroiditis.

Background: Screen exposure is increasing among children nowadays. The cognitive and emotional development is not fully mature in young children. Violent and mature content can lead to aggressive behavior and psychological disturbances in children. This study aimed to analyze the association between screen exposure time and behavioral health of 6 – 10-year-old children using Strength and Difficulties questionnaire. Material and Methods: This cross-sectional study was done in 400 children attending paediatric OPD. Data was collected from parents regarding screen time during weekdays and weekends. The average screen time was calculated and children were categorized in two groups as those with < 2 hours and those with > 2 hours of screen time. The cut-off of 2 hours was based on IAP screen time and digital wellness guidelines for children more than 5 years. Behavioral health was assessed using Strength and Difficulties score (SDQ) questionnaire completed by parents. Children were categorized as four bands viz. close to average, slightly raised, high, very high. The association between screen exposure time and SDQ scores were analyzed. Results: 172 (43%) of children had screen exposure more than 2 hours. 13% of children had abnormal scores (high and very high band) in SDQ. Children with screen exposure time of more than 2 hours had 3.46 times higher odds of having very high SDQ scores (OR 3.46, 95% CI 1.07 – 11.21, p = 0.03). The association of excessive screen time with very high scores was significant. Conclusion: Screen exposure time was more than the recommended time limit in most of the children. Children with higher screen time > 2 hours had high SDQ scores indicating poor behavioral health. Keywords: Screen exposure time, Strength and Difficulties score, behavioral health.

Background: Laparoscopic surgery is becoming more and more popular since it is less intrusive and has lower morbidity. GA is typically used during laparoscopic surgery because it is considered the best method for achieving excellent muscle relaxation and tolerance to pneumoperitoneum. Laparoscopic surgery under spinal anesthesia is feasible, widely studied, and also avoids the complications of GA. This clinical study was conducted to compare the hemodynamic alterations, surgical conditions and patient acceptance of spinal anaesthesia with general anesthesia. Materials and Methods: The study included 50 patients ASA I and II scheduled for elective lower abdomen laparoscopic procedures, divided into two groups. General anesthesia was given to Group A and spinal anaesthesia to Group B. Results: Demographics are comparable in both groups. In comparison to group B, group A mean heart rate, systolic blood pressure and diastolic blood pressure were all greater. The group B demonstrated excellent hemodynamic stability. Seven of the group B cases reported right shoulder pain and discomfort, managed with iv Propofol, although no case was converted to general anesthesia. 8% of the group B, 32% of the group A experienced postoperative nausea and vomiting. In the initial postoperative period, postoperative discomfort was less severe in Group B, and Group A required more rescue analgesia. Conclusion: Spinal anesthesia for lower abdominal laparoscopic surgery is safe and promising anesthetic technique, with favorable intraoperative surgical circumstances, stable hemodynamics, and postoperative pain management throughout the patient hospital stay. Keywords: General Anaesthesia, Spinal Anaesthesia, Lower Abdominal Laparoscopic Surgeries.

Background: The COVID-19 pandemic disrupted healthcare access and daily routines, potentially impacting diabetes management. This study explored the impact of the pandemic on treatment compliance in diabetic patients in Lucknow, India. Materials and Methods: A cross-sectional study was conducted over the two years with 410 individuals diagnosed with Type 2 Diabetes Mellitus in urban and rural areas of Lucknow. Employing a multistage random sampling technique, data collection occurred through structured interviews. The assessment encompassed demographic characteristics, medication compliance, blood glucose monitoring, and adherence to physical activity. Results: The urban group had a higher proportion of males (46.3%) compared to the rural group (35.8%). Before the pandemic, urban participants adhered more to prescribed diet (85.4% vs. 68.3%), and exercise (47.0% vs. 25.2%) compared to rural participants. Medication compliance (70.4% vs 67.2% Urban; 48.8% vs 24.4% Rural) and Blood Glucose monitoring (71.1% vs 6.6% Urban; 78.0% vs 29.3% Rural) both decreased during the pandemic. Conclusion: The study highlights diverse influences on diabetes prevalence and the vulnerability of diabetic patients during the pandemic, particularly in rural areas. Targeted interventions are needed to address challenges like financial constraints, lack of support, and disruptions to healthcare access. Keywords: COVID-19, Diabetes Mellitus type 2, Lockdown, Treatment Compliance, Glucose Monitoring.

Background: Open defecation remains a public health burden in developing nations. The study aimed to assess social demographic and economic factors influencing sustainability of open defecation-free status among adult residents in Mwingi West Sub-county, Kitui County, Kenya. Materials and Methods: A cross-sectional design was used in this investigation. Both purposive and Stratified Radom multi-stage sampling techniques were utilized to select those who participated in the research. The chi-square test was used for bivariate analysis, and binary logistic regression was used for multivariate analysis. The cut off for statistical significance was p<0.05. Results: The sustainability of open defecation-free status among adult residents in Mwingi West Sub-County, Kitui County was at 75.3%. Study participants aged 35 to 44 years(OR=2.9,95%CI=0.14-0.89), and study respondents who had completed their tertiary education (OR=4,95%CI=0.07-0.81), and the presence of incentives(OR=2.1,95%CI=0.24-0.88) increased the odds of sustaining open defecation-free status while earning below the poverty line(OR=2.7,95%CI=1.49-4.98) and having a peasant type of occupation(OR=5.4,95%CI=2.38-12.50) reduced the odds of open defecation-free status sustainability. Conclusion: The open defecation-free status sustainability among adult residents in Mwingi West Sub-County, Kitui County was at 75.3%. Study participants aged 35 to 44 years and study respondents who had completed their tertiary education and the presence of incentives increased the odds of sustaining open defecation-free status while earning below the poverty line and having a peasant type of occupation reduced the odds of open defecation-free status sustainability. Keywords: Open defecation, Open Defecation Free, Sanitation, and Sustainability.

Background: Gall bladder carcinoma is a relatively rare among the gastrointestinal malignancies, however it is the commonest of the biliary tree malignancies. The presentation and findings are nonspecific at the early stages and lead to delay in diagnosis which in turn culminate in incurable stage of disease at most of the times at final diagnosis. Chronic cholecystitis and xanthogranulomatous cholecystitis are the most common mimics and these two by their shear common incidences present difficulty in diagnosing Ca GB. The objective of this retrospective study is to highlight the importance of morphological patterns of contrast enhancement CT scan in the histopathologically proven cases of carcinoma gall bladder. Review its role in diagnosis, staging and asses for surgical resectability. Materials and Methods: Retrospective study of MDCT scans of 50 subjects of histopathologically proven cases of carcinoma gallbladder. All the subjects underwent dynamic contrast helical CT scans of the abdomen according to standard protocol. Before and after administration of dilute oral and intravenous iodinated contrast agents. Findings were assessed for tumor type, enhancement and staging. Results: Three CT morphological patterns were recognized viz., focal or diffuse wall thickening, polypoidal mass and mass replacing the gall bladder in the GB fossa. Infiltration to the liver and adjacent structures was most reliable indicator of the malignancy. Locoregional spread, lymph nodal involvement and distant metastasis was well delineated compared to ultrasonography. Conclusion: MDCT scan is most effective investigation in recognizing the morphological patterns, diagnosis, spread of the disease and TNM staging of carcinoma gall bladder. Keywords: Gall bladder carcinoma, Computed Tomography, Staging

Background: Colonoscopy is a critical diagnostic and preventative tool in colon health, crucial for the early detection and management of colorectal cancer (CRC), a leading cause of cancer-related mortality globally. Despite its importance, awareness and utilization of colonoscopy are notably low, especially in resource-limited settings. This study, conducted at Shree Krishna Medical College in Muzaffarpur, Bihar, aims to assess colonoscopy awareness, understand perceptions and attitudes towards the procedure, and identify barriers to its uptake among patients and the general community. Materials and Methods: A cross-sectional study involving 400 participants (200 patients visiting for gastrointestinal symptoms or at risk for CRC and 200 community members) was carried out. Stratified random sampling ensured diverse representation across socio-demographic factors. Data collection involved structured interviews and self-administered questionnaires, focusing on demographic details, awareness, sources of information, perceived barriers, and attitudes towards colonoscopy. Ethical approval was obtained from the Institutional Review Board (IRB) of Shree Krishna Medical College. Results: Awareness of colonoscopy was higher among patients (75%) than in the community sample (50%). Healthcare professionals were the primary source of information (50%), with significant reliance on the internet, especially among the community sample (35%). Major barriers to colonoscopy included fear of the procedure and lack of knowledge. Despite these barriers, there was a generally positive attitude towards colonoscopy, with 70% of participants expressing willingness to undergo the procedure in the future. Conclusion: The study highlights a significant gap in colonoscopy awareness and utilization in Muzaffarpur, Bihar. It underscores the need for targeted educational and outreach efforts to improve understanding and acceptance of colonoscopy as a vital component of colorectal cancer prevention. Leveraging healthcare professionals and digital platforms as primary information sources could address the identified barriers and enhance colon health outcomes in the region. Keywords: Colonoscopy, Colorectal Cancer, Awareness, Barriers, Health Education, Bihar.

Background: It has been documented that CRP is probably the best available diagnostic test. CRP elevation in neonates has been documented in non-infectious conditions including meconium aspiration, respiratory distress syndrome, foetal hypoxia and intraventricular haemorrhage. Aim: CRP as a prognostic marker in neonatal septicaemia. Materials and Methods: A study was conducted on 200 neonates clinically suspected cases of septicaemia recruited from the neonatal intensive care unit of Medical College from 1st January 2019 to 31th Dec 2019. Any neonate with signs and symptoms of suspected sepsis, in the form of respiratory distress, apnoea, oxygen dependence, feeding intolerance, poor feeding, hypotension shock, poor peripheral perfusion, tachycardia, lethargy, temperature instability, seizures, altered mental status, skin mottling and unexplained acidosis. Neonates clinically suspected of septicaemia, were tested for serum CRP and also blood culture was done. Positive cultures were the “gold standard” against which the performance of CRP, complete blood count, abnormal white blood cell counts (WBC) and platelets were compared. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP were calculated. Results: Out of 135 patients with blood culture growth, most patients belong to early neonates- 0 to 7 days- age group (60%) and then late neonates- 8 to 28 days- age group (40%). Out of 200 neonates with suspected septicaemia, blood from 135 patients yielded growth from bacterial culture. Blood culture growth has been considered as gold standard for septicaemia. In our study most common organism responsible for neonatal septicaemia was Escherichia coli (31.85%) followed by CoNS (20.74%), Klebsiella pneumoniae (16.29%) and Staphylococcus aureus (9.62%) and rest others. Out of 135 positive blood cultures, serum CRP test was positive in 125 patients, 19 CRP positive but culture negative. In my study Early neonates are 58.33% positive CRP test and 41.66% positive for Late neonates. Out of 200 neonates 94 Term neonates were showing positive Blood culture and 41 Preterm neonates with positive Blood culture. In term and preterm Sensitivity and Specificity of 89.36%, 78.26% and 82%, 100% respectively. Conclusion: We concluded that the sensitivity of CRP was more for diagnosis of septicaemia than other inflammatory markers. Septicaemia is the major and common cause of morbidity and mortality in neonates. The incidence is much higher in the developing world. Early diagnosis and effective treatment are the best way to reduce morbidity and mortality. Keywords: CRP, Blood culture, CoNS, Septicaemia.

Background: Iron deficiency and cyanocobalamin deficiency is a global health problem affecting all age groups of population. The Maternal Mortality Rate (MMR) in Madhya Pradesh is 170 per 1,00,000 live births which is 3rd worst in India following Assam and Uttar Pradesh, so this study was intended to find the prevalence of iron and cyanocobalamin deficiency in this group of reproductive age females and try identifying the determinants leading to their deficiency. Materials and Methods: The research involved a cross sectional study design, utilizing a representative sample of adult females of reproductive age group between 18 to 30 years who visited General Medicine and Gynaecology outpatient department. Results: We observed a 52.5% prevalence of Iron deficiency and 38.5% prevalence of cyanocobalamin deficiency among females of reproductive age group. Among normal weight patients 53% and 29.3% were having iron deficiency and cyanocobalamin deficiency respectively. Under the overweight/obese category 49% and 39.8% had iron and cyanocobalamin deficiency respectively. We found 30% and 25.6% prevalence of iron deficiency among vegetarian and non-vegetarian female of reproductive age group respectively and the prevalence of cyanocobalamin deficiency was 58% and 12.1 % among vegetarian and non-vegetarian females of reproductive age group respectively. 54.3% and 81% Rural patients were having iron and cyanocobalamin deficiency respectively and 49.5% and 64.4% urban patients were having iron and cyanocobalamin deficiency respectively. In this study we also observed that 12.56% patients were deficient for both Iron and cyanocobalamin levels. Conclusion: This study provides valuable insights into the prevalence of poor nutritional status among females of reproductive age group, offering a foundation for the development of targeted healthcare strategies. By understanding the factors contributing to inadequate nutrition, healthcare professionals can tailor interventions to address the unique needs of this population group. Keywords: Iron Deficiency Anaemia (IDA), Cyanocobalamin (Vitamin B12) deficiency, Maternal Mortality Rate (MMR).

An aneurysmal bone cyst is considered to be a locally aggressive tumour arising in the metaphysis of bone and an expansive lytic lesion with hemorrhagic contents and seen on MRI as fluid-fluid levels. Although the benign lesions are considered rare (incidence <1 in 1lac persons per year), several approach to treat these tumours have been presented. We report the case of a 18year old girl diagnosed with aneurysmal bone cyst of the lateral malleolus. The patient was managed initially with Radiofrequnecy ablation(RFA) of the lesion followed by extended curettage and fibular strut grafting enabled the treatment of the lesion without causing recurrence and instability of the ankle joint.

Background: To evaluate changes in lipid profile status in CKD patients on hemodialysis. Materials and Methods: Patients with confirm cases of chronic kidney disease satisfying following inclusion criteria and having exclusion criteria were taken up for the study. The patients underwent a comprehensive clinical and lab investigation for study. Personal characteristics like age, sex, weight height, address was noted. Patients were enquired for presence of family history of chronic kidney disease or whether patient is undergoing dialysis for the chronic kidney disease, presence or absence of diabetes mellitus and endocrine status in patients of chronic kidney disease. Results: There was a statistically significant decrease in high-density lipoprotein (HDL) and an increase in triglycerides (TG) and very-low-density lipoprotein (VLDL) levels in CKD patients on hemodialysis when compared with CKD patients. Conclusion: Earlystage evaluation of dyslipedimia in CKD patients on haemodialysis may reduce the incidence of atherosclerotic cardiovascular diseases [ACVD]. Keywords: Dyslipedimia, CKD, Haemodialysis, Atherosclerotic Cardiovascular Diseases [ACVD].

Background: Acinetobacter baumannii has emerged as an important opportunistic Gram-negative bacterium in health care institutions globally, as it resists desiccation, is hard to eradicate and has numerous intrinsic and acquired mechanisms of drug resistance. Among the resistance mechanisms, the ability to produce carbapenemase enzymes such as metallo-beta-lactamases (MBLs) is one of the most important and frequently observed mechanisms exhibited by A. baumannii. In addition to penicillins, cephalosporins and monobactams (aztreonam), carbapenamases hydrolyse carbapenems, the drugs with high efficacy and broad spectrum of activity against this organism and this has been a cause of worry both to the clinicians as well as the microbiologists. Materials and Methods: This study was conducted in the Department of Microbiology at Jagannath Gupta Institute of Medical Sciences & Hospital, Budge Budge, Kolkata. The duration of study was over a period of one year. Of the various samples from the clinical departments processed for culture in the microbiology laboratory, a total of 400 positive culture isolates were selected for further processing (identification, antibiotic sensitivity test) by standard manual methods. The IMP-EDTA combined disk synergy test was performed on A. baumannii isolates for detection of MBL production, as per CLSI guidelines. Results: Of the 400 isolates included in this study, maximum isolates were from the samples of patients in the age group 21-30 years (160) followed by 31–40 years (102), while the lowest number of isolates (6) were found in the age group of 71–80 years. Of the total isolates, 267 were from male patients and the remaining (133) were from female patients. A total of 145 isolates were identified as Acinetobacter baumannii (ACB). Samples of pus (62), sputum (20), urine (33), endotracheal aspirate (23), blood (4) and others (3) together accounted for all the ACB isolates. Among the 145 isolates of A. baumannii, 50 (34.48%) showed resistance to imipenem and 48 (33.10%) to meropenem, followed by high resistance rates to piperacillin (131; 90.34%), piperacillin/tazobactam (132; 91.03%), ceftazidime (129; 88.96%), cefepime (131; 90.34%), aztreonam (117; 80.68%), gentamicin (118; 81.37%), tobramycin (119; 82.06%), amikacin (107; 73.79%), ciprofloxacin (113; 77.93%), and levofloxacin (113; 77.93%). However, the isolates exhibited 100% sensitivity to tigecycline and polymyxin B. The overall prevalence of metallo-beta-lactamase (MBL) production by Acinetobacter baumannii was found to be 80% in this study. Conclusion: Acinetobacter baumannii has a significant role in nosocomial infections especially due to its propensity to develop antibiotic resistance. It invariably shows a high level of antimicrobial resistance, with a substantial proportion of isolates producing metallo-beta-lactamase enzyme (MBL). This study emphasizes the need for early detection of MBL and stringent infection control practices which act as the best defenses against this organism. Keywords: Metallo-β-lactamase, Acinetobacter baumannii, carbapenamases, ESKAPE, combined disk synergy test.

Background: Immune thrombocytopenia is a condition with low platelet count with unknown etiology. It is mostly seen in pediatric age group and in elderly people. The aim of this study is to assess the clinic-pathological profile of patients with ITP presenting to this tertiary care hospital. Materials and Methods: The above study was conducted over a period of 2 years in the Department of Pathology, Government Medical College and Hospital, Suryapet over 5 years, i.e., from March 2018 to February 2023. A total of 100 patients with ITP were included in the study. Results: Males were more than females in present study. 0-20 years was the commonest age group presenting with ITP. Petechiae were the commonest presentation. The mean platelet volume (MPV) and platelet distribution width (PDW) were inversely proportional to the platelet count. Conclusion: Most of the patients with ITP have a self-limited course and very few actually develop serious bleeding manifestations. There were no deaths or any serious bleeding manifestations reported in this study. Larger sample size is needed to study the clinical spectrum of the patients in present area. Keywords: ITP; platelets, thrombocytopenia; Bone marrow aspiration; anti-platelet antibodies mean platelet volume, platelet distribution width.

Background: Head and neck region is a complex area comprised of multiple anatomical structures ranging from lymph nodes, salivary glands, thyroid and a host of developmental tissues. These lesions range from being infections to malignant and are seen in all age groups. FNAC is inexpensive, safe, outdoor procedure, with rapid reporting. The present study aims to evaluate the diagnostic value of fine needle aspiration cytology in head and neck lesions and to evaluate the pattern of disease in Suryapet, Telangana. Materials and Methods: This is retrospective observational study conducted in Department of Pathology, Government Medical College/ Government General Hospital, Suryapet, Telangana from August 2019 to July 2023 (4 years). Detailed clinical history was taken and FNAC was performed. Results: Out of 547 cases on whom FNAC was done, most of the them were lymph nodes (n = 204; 37.3%) followed by thyroid (n = 144; 26.3%), skin and soft tissue lesions (n =102 18.8%) and from salivary glands (n = 79 ;14.5%). Reactive lymphadenitis, colloid goitre and pleomorphic adenoma were the most common lesions of lymph nodes, thyroid gland and salivary glands respectively. Conclusion: FNAC is simple, rapid, cheap outpatient procedure. It should be used as the first line investigation in the diagnosis of head and neck lesions wherever feasible. Keywords: FNAC, head and neck lesions, lymph nodes, thyroid, salivary glands.

Background: Neonatal sepsis is a systemic infection that found in under one-month newborns. Though a lot advances in medical and surgical fields are available but the rate of morbidity and mortality from neonatal sepsis is still high. Objectives: The objectives of this studyare to determine the frequency of thrombocytopenia in neonatal sepsis. Materials and Methods: The study was a prospective observational cross-sectional study conducted in the Department of Paediatrics of Guntur Medical College and tertiary care centre in Andhra Pradesh, India. Data was obtained from NICU records comprising 1 year, from January 2022 to December 2022. Clinical and laboratory data have been collected from newborns' records, including laboratory reports and case notes during admission. Results: The study comprised 186 infants who met the specified inclusion criteria for the study population. Of 186 newborns, 96 were male (51.61%) and 90 were female (48.38%). According to our study's severity grading, 22.6% of neonates had mild thrombocytopenia, 29.0% had moderate thrombocytopenia, and 48.4% had severe thrombocytopenia. The predominant organisms identified in blood cultures were Staphylococcus aureus in 13 cases (30.23%), followed by Coagulase Negative staphylococcus in 12 cases (27.90%), Klebsiella pneumoniae in 10 cases (23.25%), Pseudomonas spp.in 3 cases (6.97%), Methicillin-resistant Staphylococcus aureus 2 cases (4.65%) cases and followed by Acinetobacter baumannii, Proteus mirabilis, Candida sepsis. Of 186 thrombocytopenic neonates, 88.70% stayed less than 10 days, and 11.3% lasted more than 10 days. Conclusion: Thrombocytopenia was prevalent in sepsis caused by Staphylococcus aureus, Coagulase Negative staphylococci, and Klebsiella pneumonia. Severe thrombocytopenia is strongly linked to a higher risk of serious bleeding and death. An ideal large-scale, prospective multicentre investigation could elucidate several parameters related to death in newborn sepsis. Keywords: Neonate, thrombocytopenia, neonatal intensive care unit, pattern of thrombocytopenia.

Background: Aim: To compare the effects of total intravenous anaesthesia using the propofol-ketamine and propofol-butorphanol combinations. Materials and Methods: Sixty patients of Siddhartha Medical College & Hospital, scheduled to undergo short surgical procedures, with physical status ASAI and ASAII, in the age group 18 - 60 years, of both sexes were randomly selected. They were divided into 2 groups at random and given propofol-ketamine in group PK and propofol-butorphanol in group PB. Propofol 1. 5 mg/kg IV was used to induce in both groups, and propofol 9 mg/kg IV was used for maintainance. Results: In the TIVA approach, maintaining hemodynamic stability, minimising pain from propofol injections, and preventing PONV are controversial issues that cannot be fully resolved. Both systolic and diastolic blood pressure decreased after induction in both groups. Group PB experienced a significant difference in systolic and diastolic blood pressure upon arrival, during induction, and at various points throughout the course of surgery. Group PK did not experience such a significant difference. Instead of ketamine, butorphanol pretreatment reduced pain after a propofol injection. Group PB (propofol-butorphanol) experienced more postoperative sedation than group PK. (propofol –ketamine). PONV: No statistically significant difference existed between the two groups. Conclusion: In conclusion, we discovered that the combination of propofol and ketamine (GroupPK) had the benefit of providing greater hemodynamic stability and postoperative recovery in terms of sedation. Keywords: Ketamine, Propofol, Hemodynamic, Postoperative sedation.

Background: Aim: The aim of this study is to study the etiology, clinical profile and outcome of non-traumatic coma in children admitted to pediatric ward in King George Hospital, Visakhapatnam. Materials and Methods: This prospective observational study was conducted on 75 children who were admitted in the pediatric intensive care unit of King George Hospital, Visakhapatnam, over a period of 18 months i.e. from December 2008 to June 2010. Results: In the present study, CNS infections are the most common causes of non-traumatic coma in children accounting for 56% of cases followed by status epilepticus (20%). Among the CNS infections cerebral malaria is the most common cause (35.7%) followed by TBM and bacterial meningitis. There is no significant sex difference in the incidence of coma. Clinical variables like hypothermia, bradycardia, apnoea, hypotension, non-reacting pupils, absent extra ocular movements, flaccidity associated with high mortality and severe disability. As the Glasgow Coma Scale score is decreasing, mortality rate was progressively increasing. Mortality rate was high in children below the age of 3 years. Mortality was high with CNS infections and infestations followed by toxic metabolic causes. Normal outcome was more with toxic-metabolic causes followed by status epilepticus. Disability was more with CNS infections and infestations followed by post status epilepticus group. Conclusion: The present study concluded that, early recognition of the danger signs and appropriate measures taken early to combat the problem will improve the outcome. Most of the CNS infections are curable, so early institution of appropriate treatment will decrease mortality and disability. Keywords: CNS Infections, epileptic, Mortality, Glasgow Coma Scale, Bacterial meningitis.

Background: To analyse the functional outcome of Antero Posterior compression type of pelvic injuries treated with anterior plating and posterior percutaneous ilio-sacral screw fixation. Materials and Methods: This descriptive study was done in the Orthopaedic department. Patients with APC Type II and APC Type III pelvic injuries admitted to Trichy SRM Medical College Hospital and Research Centre, Trichy have been taken for this study after obtaining their informed, valid written consent. This is a retrospective study done in January 2024. Results: In our study retrospectively we followed 20 cases with an average follow-up of 12 to 20 months ranging from 6 months to 21 months. The functional outcomes of these patients were analyzed with the Majeed outcome scoring system1. This scoring system includes pain, standing, sitting, walking, sexual intercourse, and radiological analysis. Of these 20 cases, 9 patients had excellent, and 8 patients had good results. All these excellent, good-score patients went back to their original job. Fair and poor results are mostly due to old age and associated injuries. Conclusion: Thus in the management of Anteroposterior type of Pelvic injuries, closed reduction and percutaneous ilio-sacral screw for sacroiliac joint and Plating for pubic diastasis provided adequate early stabilization of the pelvis, which is valuable in terms of reducing morbidity and improving long term functional outcome. Keywords: Pelvic fractures, Plating, ileo-sacral screws.

Background: Supracondylar fractures are the most common elbow fractures in children and the most frequent fracture requiring surgery. The peak age for Supracondylar fractures is 5-7 years. Fractures are usually caused by a fall onto an outstretched hand with the elbow in extension. They are reported to be 18% of paediatric fractures. They are also associated with neurovascular injuries and compartment syndrome. Complications like deformity, malunion, and stiffness can also occur. Materials and Methods: This is a retrospective review on displaced supracondylar fractures of the humerus of extension type in 30 children (5-12 years) who were treated at SRI LAKSHMI NARAYANA INSTITUTE OF MEDICAL SCIENCES (SLIMS), PUDUCHERRY from 2022 and 2023 with closed reduction and percutaneous fixation with two K-wires from the lateral side. This study included Gartland type II and III fractures. There was a higher incidence in boys (20 patients,) than in girls (10 patients), and injury was further common on the right elbow (19 patients) than on the left elbow (11 patients). This study included 17 patients with Type II fractures and 13 patients had Type III fractures. 6 patients had emergency treatment for their injuries, 18 patients were treated within 24 hours of being injured, and 6 patients were treated between 24 and 48 hours after the fracture took place. Results: The results were according to Flynn's criteria- excellent in 24 patients, fair in 4 patients, and poor in 2 patients. The reduction was considered sufficient in 25 patients and insufficient in 3 patients. In 2 patients, there was a subsequent loss of reduction. In one patient, the full range of motion was not reached; there was a loss of 5° of flexion and a loss of 8° of extension. There were no cases of nerve injury or compartmental syndrome. In 2 patients, infection developed in the K-wire tract postoperatively. No significant variation in results was found in the patients getting emergency treatment when compared to patients treated within 24 hours or, 24-48 hours after their injuries. Conclusion: So, to conclude, the advantages of fixing K-wires from the lateral side are low occurrence of nerve injury, better stability, and a good range of movements. Divergent pin and parallel pin had better outcomes in supracondylar fractures of humerus. Usage of additional K- wires always provides superior fixation. In order to prevent post-operative Pin tract infection of K-wire, adequate antibiotic support and sterile OT theatres are an absolute mandate. Keywords: Supracondylar distal Humeral fractures, Elbow joint, Humeral fractures.

Background: Acne vulgaris is one of the most common dermatoses, and the relationship between acne and psychological factors has been investigated for many years. Existing lesions in acne patients may worsen with emotional stress, and psychological and psychiatric problems may develop in patients with the exacerbation of the lesions. Materials and Methods: This study was conducted in Department of Psychiatry in United institute of Medical Sciences, Prayagraj, U.P. This study was included total 200 participants. The duration of study was over a period of two year. Results: This study found that clinical variables of acne on social anxiety in which our study found that amongst acne patients having social anxiety majority had acne lesions localized on face, almost all had clinically very severe acne and none of them subjectively perceived their acne lesions as mild. Conclusion: Acne vulgaris has the potential to induce considerable psychological distress and impair social functioning. Keywords: Acne vulgaris, dermatosis, psychological factors, psychiatric.

Background: To study the frequency of genetic abnormalities and their correlation with morphology in cases of AML in western Maharashtra. Materials and Methods: Total 90 cases of AML diagnosed by morphology and immunophenotyping were included. Molecular study was carried out by AML- Multiplex RT-PCR to detect genetic abnormalities. Results: Out of 90 cases, 27 cases showed genetic abnormalities (30%), while 63 cases did not show any abnormality (70%). PML: RARA fusion was the most common abnormality (21.1%) followed by RUNX1::RUNX1T1 fusion (6.7%) and NPM1 mutation (2.2%). Concordance between the cytomorphology and specific genetic abnormality was found in 92.3 % cases. The cytomorphological accuracy in predicting the associated genetic abnormality for AML with PML::RARA fusion was 100% (19/19 cases), for AML with RUNX1::RUNX1T1 fusion 50% (3/6 cases) and 100% (2/2 cases) for AML with NPM1 mutation. Conclusion: Specific genetic abnormalities in AML form a distinct subgroup and are important in diagnosis and management of patients. In our study 30% cases showed genetic abnormalities. High concordance rate of 92.3% between the cytomorphology and specific genetic abnormality stresses the role of cytomorphology as an important tool in the predicting the genetic abnormalities in AML in resource poor settings providing fast and accurate diagnosis, till the cytogenetic and molecular study reports are awaited. This will help the clinical hematologist to start immediate treatment especially for cases of APML which is a medical emergency. Keywords: AML- Acute myeloid leukemia, APML - Acute promyelocytic leukemia, genetic abnormalities, RCA - Recurrent cytogenetic abnormalities.

Background: The successful delivery of a baby at the conclusion of pregnancy relies on the systematic growth of the cervix during the early stages of pregnancy. The cervix experiences anticipatory modifications many weeks before to the initiation of labour. The objective of the study was to examine the correlation between cervical length during the middle stage of pregnancy and the result of labour. Material and Methods: This study is a prospective investigation carried out at the Department of Obstetrics and Gynaecology Government Medical College, Srikakulam, Andhra Pradesh, India. All prenatal women who participated in this study provided informed written consent. This study was conducted between January 2023 to December 2023. Results: This study examined the cervical length of 200 pregnant women using transvaginal ultrasonography between 19 to 24 weeks of gestation, and investigated its relationship with the outcome of labour. An analysis was conducted to examine maternal parameters such as age, body mass index, and socioeconomic status for any potential confounding factors. The studied labour outcomes included the initiation of labour, whether it occurred naturally or was induced, the gestational age at delivery, whether it was preterm or extended beyond 40 weeks, the method of delivery, and the occurrence of a caesarean section owing to unsuccessful induction. Conclusion: Ultrasound equipment is readily available in nearly all prenatal clinics, making its integration into clinical practice simple. Patients who run the risk of having a difficult labour could be referred to higher centres sooner if they are better equipped to handle them. Keywords: cervical length, mid pregnancy, labour outcome.

Background: Breast cancer, comprising 24% of female cancers, is the leading cause of female cancer death globally and the second most common cancer overall. Anemia is prevalent but often undiagnosed in breast cancer patients. Hepcidin, a hepatic peptide hormone, plays a key role in breast carcinoma-related anemia. Considering its pivotal role in iron metabolism, hepcidin-targeting drugs under research may offer novel treatments, potentially improving the quality of life for those with breast carcinoma and anemia. The objectives of this study are to compare serum hepcidin levels in breast carcinoma patients with those having benign breast diseases and to assess serum hepcidin levels in breast carcinoma patients with anemia and those without anemia. Materials and Methods: The present study is a comparative cross-sectional investigation conducted at the Department of Pathology and Biochemistry, Government Medical College, Thrissur, spanning from January 1, 2020, to December 31, 2021. Two groups were selected for the study population: the first group comprised 30 cases of breast carcinoma patients, while the second group comprised 30 cases of benign breast diseases. Results: The mean age for breast carcinoma patients was 51.1 years, compared to 35.8 years for those with benign breast disease. In Group 1, serum hepcidin levels were 45.05 ng/ml, significantly higher than 22.08 ng/ml in Group 2 (p < 0.001). Group 1 further divided into anemic (mean hepcidin: 53.28 ng/ml) and non-anemic (mean hepcidin: 28.6 ng/ml) subgroups, showing significant differences (p < 0.001). Serum hepcidin correlated negatively with RBC indices in both carcinoma (hemoglobin r= -0.830, hematocrit r= -0.813, RBC count r= -0.833) and benign (hemoglobin r= -0.825, hematocrit r= -0.735, RBC count r= -0.633) groups. In the benign group, a weak negative correlation was observed with MCHC (r= -0.385, p= 0.036), and a positive moderate correlation with RDW in the carcinoma group (r= 0.407, p= 0.026). Conclusion: The study identified elevated serum hepcidin levels in breast carcinoma patients, particularly in those with anemia, as opposed to benign cases. Keywords: Serum hepcidin, Breast carcinoma, Anemia.

Background: Ulcers of the lower extremities, particularly in individuals older than 65 years, are a common cause for visits to the podiatrist, or wound care specialist.1 The incidence of ulceration is increasing significantly due to the aging population and increased risk factors for atherosclerotic occlusion such as smoking, obesity, and diabetes. Various other wound therapies have been advocated. However, these methods are more expensive and lack sufficient scientific evidence in their favor. Negative Pressure Wound Therapy (NPWT) is a newer non-invasive adjunctive therapy system that uses controlled negative pressure, using a Vacuum-Assisted Closure (VAC) device, to help promote wound healing by removing fluid from open wounds, preparing the wound bed for closure, reducing edema, and promoting formation and perfusion of granulation tissue. This study aims to evaluate Standard VAC therapy compared with modified method of VAC therapy in the treatment of large infected ulcers in lower socio-economic patients. Materials and Methods: This study was prospective case-control series which was conducted by the Department of Orthopaedics Khaja Bandanawaz Teaching and General Hospital which is a tertiary care hospital. Our study was conducted between July 2022 to January 2023. The study population included 60 patients with crush injuries, deglove injuries, and non-healing lower limb ulcers Wagner grade 2 or 3 admitted in our hospital. It was a randomized case-control study. The study population was ranging from 25- 60 years that included crush injuries, deglove injuries, lower limb ulcers. Patients were randomized either to group A (patients treated with standard VAC therapy) or group B (patients treated with modified method of VAC therapy), with 30 patients in each group. Dressing was kept for over a period of 2–7 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50 days period, whichever was earlier. Treatment success was defined as wound closure within a period of 7 weeks. Results: Granulation tissue appeared in 73 % of patients in both standard VAC group and Modified Method of VAC by the end of week 2 which further reached to 100 % by the end of week 5. Patient satisfaction was excellent in the majority of patients in both standard VAC group Modified Method of VAC group. No patient in our study reported discomfort with the application of pressures greater than 100 mm of Hg. Conclusion: This study has confidently established that the cost of daily consumables, and thus the overall cost, can be reduced by the simple modification described, while still achieving the desired outcome. Keywords: Negative Pressure Wound Therapy (NPWT), Vacuum-Assisted Closure (VAC) device, Wagner grading system, non-healing ulcers treatment, modified vacuum-assisted closure (VAC) therapy, cost effective dressings.

Appendiceal mucocele, an uncommon pathological condition, poses diagnostic hurdles due to its varied clinical presentations. Mucoceles arise from the abnormal buildup of mucus within the appendix, causing distension and potential complications like rupture, peritoneal pseudomyxoma, or malignant progression.[1,2] In this case series, we report on eight exceptional cases of appendiceal mucoceles encountered in the last 35 years, comprising four females and four males, falling within the age range of 50 to 75 years, who sought evaluation and treatment from the General surgery department. Keywords: Appendicitis, Appendix, Appendiceal mucocele, Appendicectomy.

Background: As per World Health Organisation, Polycystic Ovarian Syndrome is a common endocrine disorder and leading cause of anovulation and infertility among females of reproductive age group worldwide. [1,2] Early identification and appropriate management help in improving overall health of women. [5,6] Hence, aim of the present study was to assess and improve knowledge, awareness and perception regarding PCOS among adolescents and young women in Indore city. Materials and Methods: The present cross-sectional study was conducted in Indore, between October and November 2023 among 200 girls of 13-25 years attending schools and colleges in Indore. An informative briefing on PCOS using a PowerPoint presentation was used to improve the basic knowledge of PCOS. A questionnaire-based survey (pre- and post-test) was carried out to identify the level of knowledge and awareness while perception was assessed using 5-point Likert’s scale. Results: Majority study participants were adolescents (76.5%) while rest were young women (23.5%). 79.5% were college-going students residing in hostel (73.5%). 20.50% young and only 3.50% adolescents had knowledge about PCOS. Majority acquired information through school/college teachers (37.5%). 7.50% had already been diagnosed with PCOS. Only 24% had knowledge of PCOS. Knowledge and awareness increased significantly (p-value<0.0001) after educational intervention. Majority perceived PCOS as a serious health condition that affected their self-esteem and body image. Limited education and information (41%), taboo and misconceptions (26.5%), lack of public awareness campaigns (22.5%) were among the significant barriers to awareness. Conclusion: This study underscores the need for comprehensive and targeted efforts to improve awareness, perception, and understanding of PCOS among school-going girls and college-going women. Keywords: Polycystic Ovarian Syndrome (PCOS), knowledge, awareness, perception.

Background: Menstrual abnormalities are common among adolescent girls and can significantly impact their quality of life. Understanding the association between these abnormalities and lifestyle patterns can inform preventive strategies and interventions. This study aimed to investigate the relationship between menstrual abnormalities and lifestyle patterns in adolescent girls. Materials and Methods: A cross-sectional study was conducted among adolescent girls aged 13-19 years. Participants were recruited from schools in urban and rural areas. A structured questionnaire was used to collect data on menstrual patterns and lifestyle factors including diet, physical activity, stress levels, and sleep duration. Menstrual abnormalities assessed included irregular cycles, heavy menstrual bleeding, and dysmenorrhea. Statistical analysis was performed using chi-square tests and logistic regression. Results: Out of the total 500 participants, 35% reported irregular menstrual cycles, 25% experienced heavy menstrual bleeding, and 45% reported dysmenorrhea. Significant associations were found between menstrual irregularities and certain lifestyle factors. Girls with irregular cycles were more likely to consume a diet high in processed foods (p < 0.05). Those experiencing heavy menstrual bleeding had lower levels of physical activity compared to those with normal bleeding patterns (p < 0.01). Higher stress levels were significantly associated with dysmenorrhea (p < 0.001). Sleep duration did not show a significant association with menstrual abnormalities. Conclusion: This study highlights the association between menstrual abnormalities and lifestyle patterns among adolescent girls. Dietary habits, physical activity levels, and stress management appear to play significant roles in menstrual health. Interventions targeting these lifestyle factors may help in preventing and managing menstrual irregularities in this population. Keywords: Menstrual abnormalities, Adolescent girls, Lifestyle patterns, Diet, Physical activity, Stress, Sleep duration.

Background: To study the clinical course and outcome and the role of biochemical markers in patients admitted with diabetic ketoacidosis (DKA). Materials and Methods: It was a prospective (observational), hospital-based study done in all patients of both sexes, who were diagnosed with diabetic ketoacidosis according to ADA* criteria. A detailed history of the participants and laboratory tests including all routine blood investigations like complete hemogram, Blood sugar –random, fasting, postprandial, and HBA1C, serum ketones, Renal function tests, Liver function tests, Arterial blood gas analysis, chest Xray, ECG were done for all the patients at admission and as per the clinical requirement. Results: The present study determined that there was male predominance. GCS score along with APACHE II was helpful in estimating the various elements indicating towards the prognosis of DKA at the time of admission. It was found that various biochemical markers like ketonuria and hyperglycemia mark DKA and maximum patients had mild GCS (13-15). Infection was found to be one of the most predisposing factors of DKA. There was no significant difference in the APACHE II parameters on DKA between deceased and discharged patients. Conclusion: The comparison of APACHE II score among two groups of the patients did not show any significant difference. There was no suitable cut-off point for APACHE II score to predict DKA. APACHE II score cannot be applied in the predicting of DKA in hyperglycemic patients. Keywords: Diabetic Ketoacidosis, APACHE II, Infection. ADA* criteria.

Background: To assess mental disorders using the patient health questionnaire. Materials and Methods: Four hundred ten participants, aged 20 to 60 years were administered structured questionnaires—the PHQ and GHQ to assess mental disorders. Results: The age group 20-30 years comprised 30, 30-40 years had 65, 40-50 years had 105 and 50-60 years had 210 subjects. The difference was significant (P< 0.05). Mental disorders were seen among 330 subjects. Depression was identified in 32, somatoform disorders in 133, panic disorders in 45, general anxiety in 70, alcohol problems in 10, and eating disorders in 40 subjects. The difference was significant (P< 0.05). PHQ- 9 demonstrated mental disorders, in 14 subjects in the age group 20-30 years, 45 in the age group 30-40 years, 76 in the age group 40-50 years, and 195 in the age group 50-60 years. GHQ-12 showed a maximum in the age group 50-60 years (57). It was observed in 140 males and 190 females. Education level was nil in 90, primary in 170 and secondary and above in 70 subjects. Marital status was single in 105 and married in 225 subjects. A significant difference was observed based on PHQ- 9 and GHQ- 12 (P< 0.05). Predictors of psychopathology were subjects who were singles (OR = 0.65), worried about finance (OR = 1.82), worried about family life (OR = 2.70, worried about health (OR = 3.08), and work stressed (OR = 1.17). Conclusion: There was high prevalence of psychopathology. The prevalent mental illnesses include alcohol-related issues, depression and anxiety disorders, and somatoform disorder. The aging population, male sex, and loneliness were the risk factors linked to mental health issues. This study shows that PHQ has a larger false positive value than GHQ. As a screening tool for certain mental diseases, PHQ should be utilized instead of serving as a generic screening instrument for psychiatric morbidity at the population level. Keywords: Psychiatric morbidity, mental, somatoform disorder.

Background: Thyroid dysfunction is linked to a variety of electrolyte issues in a lot of literature. Hyponatraemia is said to result from increased renal water retention mediated by vasopressin in severe hypothyroidism and myxoedema. On the other hand, patients with thyrotoxicosis were noted to have hypokalaemia, hypomagnesaemia, and hypercalcaemia. Therefore, the current study was conducted to evaluate the changes in serum electrolyte levels in hyperthyroid and hypothyroid conditions. Materials and Methods: The present cross-sectional investigation was conducted in the Clinical Chemistry laboratory, namely in the Department of Biochemistry, at GMERS Medical College and General Hospital in Vadnagar, Gujarat. 120 patients made up the study group. Based on their thyroid hormone profile, the patients were classified into two groups: those who were hyperthyroid and those who were hypothyroid. In groups A and B, respectively, there were 60 individuals with hypothyroidism and 60 with hyperthyroidism who had received a diagnosis. After being separated, the serum was immediately used for analysis. Using a Easylyte Electrolyte analyzer, serum electrolyte (Na+, K+) was analyzed. Results: The mean TSH levels for patients with hypothyroidism were 50.10 ± 40.41 and for those with hyperthyroidism were 0.15 ± 0.16, with a statistically significant difference between the two groups. Sodium levels were noticeably greater in patients with hyperthyroidism, and the difference demonstrated a significant statistical difference. Although patients with hyperthyroidism had lower potassium values than those with hypothyroidism, There was no statistically significant disparity observed between the two groups. Conclusion: This means that subclinical hypothyroid and hyperthyroid individuals will likely have electrolyte abnormalities and should have their serum electrolytes evaluated frequently. Additionally, electrolyte abnormalities must be observed. Keywords: Hypothyroidism, Myxoedema, Serum Electrolytes, Thyroid Dysfunction.

Background: Odontogenic sinusitis occurs when the Schneidarian membrane is perforated.14 This can happen in people with maxillary teeth caries and maxillary dental trauma. We carried out a retrospective study to determine the clinical features, etiologic factors, presenting symptoms, therapeutic tools, and radiological findings. We were looking to find the most appropriate diagnostic methods. Materials and Methods: In this retrospective study, we examined the 50 patients who were diagnosed as odontogenic sinusitis in Department of Otorhinolaryngology in RVRS Medical College, Bhilwara, Rajasthan, India during previous two years. Five cases of pansinusitis with nasal polyps were excluded from this study. Thirty-eight of the 45 patients were initially diagnosed in our department (84.44%). Seven patients (15.55%) were referred from a Dental department. The patients were retrospectively analyzed according to medical records, which include sex, age, presenting symptom, etiologic factors, surgical and medical treatment, cultures, and radiological results which include involved sinus and teeth. Results: In our study, the male to female ratio was 25:20, with a higher incidence in men. The age distribution was 10 to above 70 years, with an average age of 45.3 years. Dental extraction-related complications were the most common cause, found in 30 (66.67%) of the 45 patients. The most common presenting symptom was unilateral purulent nasal discharge. This unilateral nasal discharge was found in 30 patients (66.66%). Bony erosion of the involved maxillary sinus was observed in 20 cases (44.45%). The therapeutic modalities included Functional Endoscopic Sinus Surgery (FESS) in 32 cases (71.12%), a Caldwell-Luc operation in 3 cases (6.67%), 3 cases (6.67%) of dental management including dental extractions and dental implant removal, and 7 cases (15.55%) received only antibiotic treatment. Conclusion: We concluded that there were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. Consultation between an otorhinolaryngologist and a dentist before a dental procedure plays a vital role to identify patients who have risk factors for odontogenic sinusitis and should be able to prevent the development of odontogenic sinusitis, because the most common cause of odontogenic sinusitis is iatrogenic. Keywords: Odontogenic sinusitis, Maxillary Sinus, Dental extraction, Dentigerous cyst, Dental caries, Radicular cyst.

Background: Snakebite is a serious medical emergency that needs quick attention. There are over 2500 different species of snakes in the world, however not all of them are poisonous. Poisonous snakes lead to complications like Cellulitis, bleeding, neurological manifestations, AKI (mostly requiring hemodialysis), Respiratory failure, and sometimes even death. Our study aims to study the various presentations, the treatment given and the outcomes of these bites admitted in our hospital. Materials and Methods: The present study was a descriptive cross-sectional study. This Study was conducted from January 2021 to July 2022 at McGann teaching district hospital, Department of general medicine, shimoga institute of medical sciences (SIMS), Shimoga. Total 560 patients were included in this study. Results: We have found that, majority number of patients had [299 (53.3%)] Cellulitis and a smaller number of patients had [105 (18.7%)] Bleeding manifestations. All of patients had received ASV as the treatment and some had received extra treatment in the form of Haemodialysis, blood and blood products, ventilator support and treatment for Cellulitis. Our study done in Malnad region showed that, higher numbers of patients were able to find complete recovery 53%, and very less mortality rate of 0.2% due to timely treatment and interventions, but few developed complications due to late presentations and severity of the snake bite. Conclusion: It was found that many patients were found to present to hospital lately due to traditional medicines which is famous in the locality. The awareness about the first aid measures and the need to present to hospital at the earliest has to be emphasised to the community. Keywords: Cellulitis, Hypersensitivity, Bleeding manifestations and Snakebite.

Background: Buses is the most important mode of transport in India and takes more than 90% of public transport and serve as a cheap and convenient mode of transport for all classes of society. Irregular work timings may contribute to work- related stress along with lack of adequate or continuous sleep, insufficient breaks for rest between shifts, with bad eating habits. Long working hours, inability to attend family and social events, separation from family and friends are among characteristic occupational drawbacks of most occupations, among these people. Objectives: To find the prevalence of health of employees working in Karnataka Road transport corporation, Kolar. Materials and Methods: This was a cross sectional study conducted over a period of 6 months. We included all the KSRTC workers working in Srinivaspura taluks of Kolar districts Karnataka, India. Sample size was calculated to be 130. Results: Study shows that among the 130 KSRTC ,113(87.6%) were males and 17(12.4%) were females. The mean age of the study subjects was 42.4 ± 10.22 years. 10(7.6%) were known hypertensive ,7(5.3%) were known diabetes,14(10.7%) were having both hypertension and diabetes. Conclusion: The periodic appropriate medical examination of the people working in the transport sector is necessary as chronic condition Increase as age advances. As the transport employees work in stressful condition maintain of their health is of priority to prevent acute medical events during their working hours. Keywords: Ksrtc workers, occupational health, stress.

Background: Rashtriya Bal Swasthya Karyakram (RBSK) is a program to improve the overall quality of life of children. It involves screening of children from 0 - 18 years of age for 4 Ds- Defects at birth, Diseases, Deficiencies and Development delays, spanning 32 common health conditions. Scheduling of RBSK team visits was not conveyed to all stakeholders, no mechanism for follow up of children who were given referrals, huge data was enrolled manually, no continuity of data, and stakeholders were unaware about referrals. This often results in inadequate assessment of exact prevalence of health indices related to 4Ds. Materials and Methods: It was a cross sectional study. Children of schools and Anganwadi of UT of DNH & DD were included as study population. The data was collected in the month of August 2023 during the school timings. All children aged 0 - 18 years were included in the study by mass screening of children registered under Angawandis and Schools. The data was collected and analyzed on the novel digital platform e-RBSK portal. Results: Amongst the 4 D’s screened in the Anganwadi children (0-6 years), there was presence of various birth Defects in 33 children, Deficiencies in 151 children, Diseases in 116 children and Developmental delays in 51 children. Among the children and adolescents of age group 6-18 years screened, there was presence of various Defects in 105, Deficiencies in 1108, Diseases in 2360, Developmental delays in 770 and adolescents’ growth issues among 263. Conclusion: The mass screening of beneficiaries in age group 0-18 years had prevalence of various Defects, Deficiencies, Disease and various Developmental Delays. A proper record and follow up of those identified cases will ensure early diagnosis, treatment and management of many health issues. The new digital portal ensures availability of real time data, access of the data to all stakeholders, will help in follow up of the referrals to the field level functionaries, and also following the progress of children longitudinally over a period of time. This initiative of digital school health system (e-RBSK) can be replicated elsewhere in India. Keywords: RBSK, 0-18 years, screening of 4 D’s, Digital School Health Records.

Background: Breast lump is the most common presentation of the breast disease. Fine needle aspiration cytology (FNAC) is a simple, rapid, and safe, method to diagnose both non-neoplastic and neoplastic breast lesions. Aim: To study cyto-morphological pattern of breast lump diagnosed on FNAC in patients of tertiary health care centre and Sub-district hospital and to correlate with its histopathological examination whenever available. Objectives: To segregate benign and malignant cases based on cyto-morphological pattern of breast lump on FNAC. Materials and Methods: A total of 109 patients were included in this study from September 2022 to August 2023. FNAC was performed. Smears were made and stained by Giemsa staining technique and reported. Out of 109 cases 53 cases were sent for histopathological examination. Results: The age range was 15-70 years. Cytological diagnosis included Unsatisfactory/Inadequate, benign breast disease, atypical/probably benign, suspicious for malignancy, malignant. Fibroadenoma and invasive ductal carcinoma were most common among benign and malignant lesions respectively. Of these 109 cases 53 cases were sent for histopathological examination. A total of 18 case were diagnosed to be fibroadenoma proving it to be most common among benign cause whereas 15 cases were diagnosed to be malignant and the most common was found to be Invasive ductal carcinoma. Conclusion: FNAC is an easy and quick method to segregate malignant lesions from benign ones which helps in planning further management of a case. Hence, FNAC should be used as a routine diagnostic procedure for its cost effectiveness, rapid and accurate diagnosis. Keywords: Breast lump, FNAC, Pathology.

Background: Across the globe, laparoscopic cholecystectomy (LC) procedures are performed extensively. Despite their relatively low occurrence rate, a substantial number of patients encounter significant challenges, prompting experts to label it as a "rare but common" problem. This study sought to evaluate different operative factors predicting the difficulty of laparoscopic cholecystectomy. Materials and Methods: This retrospective study examined a cohort of 100 patients diagnosed with cholelithiasis, as confirmed by abdominal ultrasonography (USG) records from the hospital database. Surgical procedures were retrospectively categorised into three groups based on postoperative assessments: easy, difficult, and very difficult, considering factors such as procedural duration, bile/stone spillage, duct injury, and conversion to open cholecystectomy. Upon admission, all patients underwent preoperative risk factor evaluations, and intraoperative findings were documented in their records. Data collected were analysed using SPSS-22 software, with statistical analysis conducted using the Chi-square test. Results: The findings of this study indicate that several factors contribute significantly to the complexity of laparoscopic cholecystectomy procedures. These factors include obesity, comorbid diseases such as Type II diabetes mellitus, prior episodes of acute cholecystitis or pancreatitis, delayed surgery beyond 72 hours following onset of symptoms, increased gallbladder wall thickness, presence of multiple stones, and calculi larger than 1 cm in size. These variables were observed to correlate with an increased likelihood of encountering difficult or very difficult surgical procedures, as documented in the patients' hospital records from admission to discharge. Additionally, the study noted that conversion to open cholecystectomy was necessary in 15% of the cases. Conclusion: Integration of these variables necessitates a thorough assessment and development of a standardised scoring system to predict the likelihood of encountering a challenging laparoscopic cholecystectomy. By accurately predicting the probability of a difficult procedure, surgeons can proactively prepare for potential risk factors and intraoperative complications. Furthermore, such predictive tools can aid in forecasting the likelihood of requiring conversion to an open cholecystectomy, enabling surgeons to make more informed decisions and optimise patient outcomes. Keywords: Cholelithiasis, laparoscopic cholecystectomy, cholecystitis, pain abdomen, difficult cholecystectomy, obesity.

Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear. Materials and Methods: It is a reterospective observational study done in a tertiary care centre. Results: In about 16,898 cases 110 patients had thrombocytopenia (0.65%). The commonest etiology is found to be gestational thrombocytopenia (n=47, 42.8%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=33, 30%). Only 2 patients had immune thrombocytopenicpurpura (ITP) and 6 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=46, 41.8%) underwent spontaneous vaginal delivery. 2 patients (1.8%) had postpartum haemorrhage, 6 (5.4%) had ceserean section wound infection, 3 (2.7%) had disseminated intravascular coagulation (DIC) and 4 (3.6%) had multiorgan failure. 53 patients (48.2%) had platelet count between 1.5-1 lakh, 42 (38.2%) had between 1 lakh – 50.000, 15(13.6%) had <50,000 and none had their platelet count less than 20,000 per cumm. Conclusion: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good. Keywords: DIC, HELLP, Multiorgan failure.

Background: Autism spectrum disorder (ASD) is a complex development condition involving persistent challenges with social communication, restricted interest, and repetitive behaviour. This study was conducted to assess the various clinical profiles of autistic children and the severity of the disease using the Indian Standard Assessment for Autism (ISAA) scale. Materials and Methods: This is a cross-sectional observation study conducted at Department of paediatrics and neuro centre Telangana, India., over 6 months. 101 children diagnosed with autism spectrum disorder were assessed with detailed birth, developmental history, behavioural issues, screen time, and physical examination. Results: Among the total subjects, 88(87.1%) of children (56 - complete & 32 - partial) are experiencing a Lack of social smile, 77(76.2%) of children are experiencing a Lack of joint attention, and all subjects are having a Lack of eye contact in which 39% of children are completely lacking it while 61% of are partially lacking eye contact. 63% of children (60% - complete & 3% - partial) are not responding to their names, 50(49.5%) of children are failed to use gestures, 71(70.2%) of children had no proper/meaningful speech, 44(43.5%) of children are not obeying verbal commands while 57(56.4%) of children are obeying them and in 62(61.3%) of children motor stereotypes are present, 62(61.3%) of children had unusual play habits, 60(59.4%) of children are experiencing lack of imaginative play, in 18(17.8%) children there is a presence of self-injurious behaviour. In 19(18.8%) of children, there is a history of epilepsy, 50(49.5%) of children are experiencing echolalia, 50(49.5%) of children there are sleep issues and 54(53.4%) of children had a lack of fear of danger. 86(85.1%) of children are experiencing restlessness and 45(44.5%) of children insisted on sameness. Conclusion: Autistic children presented with varying clinical features. There is a need for increased awareness about ASD to facilitate early diagnosis and intervention. In the current study most ASD patients are male and with majority of the symptoms and screen addiction and most of the patients are in mild to moderate conditions. Early recognition of symptoms would help in appropriate therapeutic intervention resulting in favourable outcome. Keywords: Autism, Screen watch, ISAA, Speech delay

Background: Coronavirus disease 2019 (COVID-19) is a novel infectious viral disease, with insufficient well-established diagnostic laboratory parameters that could be used to evaluate disease severity and its complications which alters hemodynamics of the body which include thrombocytopenia, thromboembolism or other cardiovascular events and helps to predict clinical prognosis. It is known to cause serious respiratory symptoms and involvement of other body systems such as, neurological and the immune system. We aimed to explore the platelet count and Mean platelet volume (MPV)and related risk factors in patients with COVID-19. Materials and Methods: This is a retrospective, hospital record based, longitudinal study patients who tested RT PCR positive with symptoms of COVID-19. We included both home quarantine and hospitalized patients for whom basic hematological investigations were done. We estimated the platelet count and Mean platelet volume of all the positive patients. Results: Out of 2596 patients were diagnosed of COVID -19 infection 2553(98.34%) patients survived and43 (1.65%) patients died. There is male preponderance of 1609 (62%) and females were 987(38%). Moderate COVID-19 illness was present in 34.82% of all patients; severe illness was seen in 4.58%andmajority of patients were of mild symptoms of about 60.63%. Patients with severe thrombocytopenia were seen in146 patients of5.62%in the study. MPV in our study is increased in severe COVID 19 positive patients. Conclusion: In conclusion, Low platelet count is associated with abnormal coagulation function and increased risk of DIC, severe disease manifestation and increased mortality in patients with COVID-19. In addition, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients. About 45.9% patients are above 60 years of age group. Keywords: Corona virus disease (COVID- 19), Platelet count (PC), Mean platelet volume(MPV), thrombocytopenia.

Background: Healthy development of foetus is dependent on normal placental development. Alteration in the placental development is the main etio-pathological factor for Intra Uterine Growth Retardation (IUGR). Hence, the present study aims to compare the histopathological findings of placenta in IUGR and normal term infants. Materials and Methods: This cross-sectional study was done at a tertiary care hospital for 9 months (June 2023 to February 2024). A total of 100 placentae were included. Fifty normal placentae and Fifty placentae from IUGR pregnancies were included. Results: Fibrin deposition (34%), Increased Syncytial Knotting (22%), Membrane Hyalinization (20%) and Calcification (12%) were seen along with Chorio-amnionitis (in 3 cases) and haemorrhagic Endo-vasculitis (in 3 cases). These changes were seen less in control group. Conclusion: The study findings suggest that chronic ischemia and associated secondary changes probably lead to improper perfusion and IUGR. Therefore, a regular antenatal checkup is the key to diagnosis of IUGR. Keywords: Histopathology, IUGR, Placenta, Foetus, Birth weight.

Background: Otitis media poses a more significant chronic health challenge in low and middle-income nations compared to their high-income counterparts, with Sub-Saharan Africa and South Asia reporting the highest incidence rates. Materials and Methods: This study was conducted in Department of Microbiology in Hind Institute of Medical Sciences, Ataria, Sitapur. The duration of study was over a period of two year. The study population comprised 382 individuals diagnosed with otitis media. Results: This study found that 49.7% of the participants belonged to the age group under 15 years, while the remaining participants were in the age group over 15 years. Among these groups, acute otitis media (AOM) was observed in 65.5% of those under 15 years compared to those over 15 years. The predominant isolates of otitis media were Proteus spp. (86), Pseudomonas spp (62), and S. aureus (78), followed by E. coli, Klebsiella spp., Providencia spp, Serratia spp, Citrobacter spp, and Enterobacter spp. Conclusion: This study concludes that over diagnosis of COM is believed to be common, resulting in inappropriate antibiotic use, which in turn contributes to the development of antibiotic resistance and increases the risk of adverse effects. In cases where observation is chosen as the primary intervention, ongoing management decisions should be made in collaboration with the child's parent or guardian. Keywords: Acute otitis media, Chronic otitis media, Antibiotics, Isolates.

Background: To study feto-maternal outcome in pregnant women with polyhydramnios. Materials and Methods: This prospective study will be carried out in the Department of Obstetrics and Gynaecology, Government Maternity hospital, Tirupati. Pregnant women attending Government Maternity hospital with Gestational age between 22 and 40 weeks, with polyhydromnios (AFI > 25 ) diagnosed using ultrasound during late second and third trimester will be selected .These pregnant women will be closely monitored throughout pregnancy, labour and puerperium for maternal and fetal complications. Results:100 cases of polyhydramnios with foetal and maternal outcome. The majority of the patients in our series were multigravida. The majority of patients were diagnosed at term (more than 37 weeks). Mild polyhydramnios was the most common type. The majority of cases (75%) were idiopathic, while 15% of cases were associated with foetal congenital abnormalities. The most frequent congenital anomaly associated with polyhydramnios was Oesophageal abnormalities. Foetal congenital abnormalities, maternal distress, and severe pre-eclampsia accounted for 18% of cases that required induction. The rate of caesarean sections was 25% as the indications were foetal distress, CPD, unstable lie, compound presentation and prior caesarean section . The three main maternal complications were preterm labour, PROM and maternal distress. Maternal mortality was nil. The percentage of alive babies was 82%, while perinatal deaths were 10%. Conclusion: From this study we conclude that pregnancy with polyhydramnios is a high risk pregnancy which requires proper antepartum care and intensive intrapartum maternal and fetal surveillance for better fetomaternal outcome. Keywords: Polyhydraminos, Foetal distress, CPD, Ultrasound, Perinatal Deaths.

Background: In an era of explosive anaesthetic agents, electro surgical instruments were used only selectively in human surgery. After the introduction of halothane as an anaesthetic agent, diathermy became increasingly used to control bleeding and for dissection of tissue planes. However, it is still infrequently used for making skin incisions. Materials and Methods: This was a randomized controlled trial conducted at Madhubani Medical College and Hospital, Madhubani, Bihar from March 2022 to February 2023. It included 250 patients of either sex above the age of five years with general surgical pathology, who were to undergo surgery. Random distribution of patients was done utilizing the blocked method. These patients were divided into blocks of two with scalpel group given block A and diathermy group block B. The first patient was allocated to block A and the second patient to block B. These patients were admitted to the hospitals and a detailed history was obtained from them especially data related to age, sex, co morbid illness, and any previous surgery. All analysis was done using the SPSS software, version 12.0. Results: A total of 250 patients of different pathologies related to general surgery who completed the follow-up period were finally included in the final analysis. Group A comprised of 133 (50%) patients whose incision was made with a scalpel; including 80 (60.2%) males and 53 (38.8%) females. Mean age of this group of patients was 36.03 years, SD of ± 13.24 years. Amongst the 100 patients of group B whose incision was made with diathermy, there were 85 (85%) males and 15 (15%) females. Mean age of group B patients was 36.52 years, SD ± 12.50 years. Conclusion: Diathermy incision is a safe and expedient technique. It takes less time than scalpel incision and loss of blood is also lower during incision. Diathermy is associated with lesser post-operative pain and complications than the scalpel incision. Diathermy should be method of choice in general elective surgery. Keywords: Diathermy; Scalpel; Complications; Pain, Postoperative.

Background: The objective is to evaluate the various causes of Compressive Myelopathy and to classify the spinal cord compressive lesions based on location into extradural/intradural compartments. Materials and Methods: It is a single institutional prospective study in Govt. General hospital, Kurnool. The informed consent from the patients have been obtained. All patients with suspected compressive myelopahy were identified and included in the study. Results: In our study, the most common cause for compressive myelopathy in our study was extradural compression from trauma (56%), followed by compression secondary to infective spondylitis (25%) and secondary neoplasms/metastasis (4%). Primary intradural tumors {both extramedullary as well as intramedullary tumors} are the most intradural causes of compressive myelopathy. In the case of spine injury, the common site of involvement was the thoracic spine, followed by the cervical spine. Primary neoplasms like neurofibroma and meningioma were more common than secondary neoplasms/metastasis in our study. Conclusion: MR imaging depicts the spinal cord directly, assesses its contour and internal signal intensity characteristics reliably and noninvasively. We can evaluate associated cord edema or contusion and the integrity & early changes in intervertebral discs and ligaments. These can be crucial in the long term prognosis of the patient. This makes MRI an essential modality in assessing soft tissues of the spine and spinal cord. Keywords: Compressive Myelopathy, extra dural, intradural, Mri, spinal tumours.

Background: Aim: To evaluate the effect of addition of Magnesium Sulphate to Ropivacaine in ultrasound guided supraclavicular blocks in terms of the duration of sensory and motor blockade. Materials and Methods: 60 patients divided into 2 equal groups of 30 each, namely Group M (receiving Magnesium Sulphate) and Group N (receiving 0.9% Normal Saline as placebo). Informed consent taken from the patients. Supraclavicular block was performed under ultrasound guidance with the study drugs. The onset and duration of sensory and motor block, postoperative pain relief, VAS score, hemodynamic changes and perioperative complications were assessed. Results: It was found that the primary objective of the study; duration of the sensory and motor block were prolonged with Ropivacaine and Magnesium Sulphate when compared to plain Ropivacaine. Post-operative analgesia was significantly prolonged in Magnesium Sulphate group, which was assessed by the VAS score. Other secondary objectives like hemodynamic variables and perioperative complications did not show any statistically significant difference among the two groups. Conclusion: Hence Magnesium Sulphate added to local anaesthetics for ultrasound guided supraclavicular brachial plexus block provides a better postoperative analgesia. Keywords: Brachial Plexus, Magnesium Sulphate, Supraclavicular, Ropivacaine, Hemodynamics.

Background: Fine needle aspiration cytology (FNAC) is a simple, safe and cost effective procedure for evaluation of salivary gland tumours. Milan system provides standard terminology and provides information about risk of malignancy. Material and Methods: Retrospective study between 2022 and 2023. FNAC was performed using 22/23 gauze needle fixed in isopropyl alcohol and was haematoxylin and eosin stained. Results: According to Milan classification, out of 58 cases 3 cases were Non diagnostic (category1), 19 cases were Non neoplastic (category 2) ,1 case was Atypia (category 3), 30 cases were benign neoplasm (category 4A) and 1 case with salivary gland neoplasm of uncertain malignant potential (category 4B), 1 case with suspicion of malignancy (category 5) and 3 cases were malignant (category 6). Conclusion: With the use of Milan system of classification of salivary gland cytopathology, it is helpful to stratify, providing clue to clinician and assessing risk of malignancy. Keywords: Milan System, Salivary Gland, FNAC, Malignancy

Background: Inflammatory Bowel Disease (IBD) is associated with alterations in gut microbiota, potentially contributing to disease pathogenesis. This study aims to compare the gut microbiota composition between IBD patients and healthy individuals. Materials and Methods: A total of 100 participants, including 50 IBD patients and 50 healthy controls, were recruited. Stool samples were collected, and microbial DNA was extracted. High-throughput 16S rRNA gene sequencing was performed to analyze the microbial composition. Alpha diversity was assessed using the Shannon index, and relative abundances of bacterial phyla and genera were determined. Functional pathways were analyzed to identify differences between the groups. Results: The IBD group exhibited significantly lower microbial diversity, with a median Shannon index of 2.8 compared to 3.6 in healthy controls (p < 0.001). The relative abundance of Firmicutes was reduced in IBD patients (30%) compared to healthy individuals (45%) (p < 0.01), while Proteobacteria were more prevalent in the IBD group (20% vs. 10%, p < 0.001). The beneficial bacterium Faecalibacterium was significantly less abundant in the IBD group (p < 0.001), and Escherichia/Shigella was increased (p < 0.01). Functional analysis revealed reduced butyrate-producing pathways and enriched LPS biosynthesis in IBD patients (p < 0.05 and p < 0.01, respectively). Conclusion: IBD patients exhibit a dysbiotic gut microbiota profile characterized by reduced diversity and alterations in specific bacterial taxa and functional pathways. These findings underscore the potential role of gut microbiota in IBD pathogenesis. Keywords: Inflammatory Bowel Disease, Gut Microbiota, Microbial Diversity, Firmicutes, Proteobacteria, Faecalibacterium, Dysbiosis, 16S rRNA Gene Sequencing.

Background: The occurrence of preterm labor is a substantial clinical challenge for obstetricians worldwide due to its potential to endanger the health and survival of both the mother and the fetus. The purpose of this study was to conduct a comparative analysis of isoxpurine hydrochloride and nifedipine as tocolytic agents for the management of premature labor. Materials and Methods: The Department of Obstetrics & Gynecology conducted a prospective cohort study with 400 pregnant women who experienced preterm labor. This study was done between September 2022 to July 2023. Among a cohort of 200 women who met the criteria for tocolysis, a group of 100 participants received isoxpurine hydrochloride, while the remaining 100 participants were randomly assigned to receive nifedipine. The data collected was subjected to statistical analysis using SPSS 10.0 for Windows 2003. Results: The prevalence of preterm labor was found to be 22%, whilst the prevalence of premature delivery was seen to be 20.9%. Nifedipine demonstrated a twofold greater efficacy compared to isoxpurine hydrochloride as a tocolytic drug, with comparable adverse effects. In the context of premature labor, it has been observed that nifedipine demonstrates greater effectiveness compared to isoxpurine in cases of early diagnosis, as well as in cases of late diagnosis if nifedipine itself is employed. Conclusion: India has a significantly elevated prevalence of premature labor. Nifedipine demonstrates superior efficacy as a tocolytic agent compared to isoxpurine hydrochloride, particularly when initiated promptly at the emergence of initial indications of preterm labor. Keywords: Preterm birth, uterine tocolytics, prematurity nifedipine, Isoxpurine hydrochloride.

Background: To study patients with different types of clinical patterns of adverse cutaneous drug reactions. Materials and Methods: This study population included all patients (both out-patient and in-patient) suffering from adverse cutaneous drug reactions of both sexes and all ages who attended to Bhaskar General Hospital. The study was conducted over a period of one and a half year (January 2016 to July 2017) in the Department of DVL, Bhaskar General Hospital. Results: In this study a total of 50 adverse cutaneous drug reaction (ACDR) cases of which 66% (33) were male and 34% (17) were female were evaluated. Sex ratio of male to female is 1.94:1. The age group with most patients belonged to 41-50 years and the range was 1 year-70 years. The patients who did not avail prescription from a doctor or dentist accounted to 38%. Doctor or dentist prescription was seen in 62% cases. Most of them were on combination or multiple drugs. 22% cases were using unknown medications. The most common route of administration was oral (92%). The most common period of onset of symptoms after drug intake was 1-10 days. Most common type of ACDR was exanthematous type accounting to 20% of cases and the most common suspected drugs were antimicrobials (23 cases). Assessment using Naranjo scale and WHO-UMC causality scale showed ―possible‖ as the major group with cases. All the cases were observed in the recovered or improved categories of outcome. No deaths were noted in the study. Conclusion: The present study concluded that, different causality scales like Naranjo scale and WHO-UMC causality scale were used to assess the cases, and most patients were in the ―possible‖ criteria. Reporting of ACDRs to the pharmacovigilance cell is important for data collection and analysis. With increase in advent of new therapies (like biologics) long term studies regarding the drug reactions is necessary to prevent and manage drug reactions. Keywords: ACDR, Naranjo Scale, UMC, exanthematous type, antimicrobials.

Background: To study the pathology of various non neoplastic and neoplastic lesions of nasal cavity. Materials and Methods: The study was conducted at Department of Pathology, Malla Reddy Institute of Medical Sciences, Suraram during the period from December 2020 to May 2022. Sample size: 50 patients Prior approval obtained from ethical committee. The present study includes cases of sinonasal masses presented to ENT department. Results: A total of 60 Nasal endoscopic biopsy specimens and excision specimens of sinonasal masses were analyzed by histopathological examination. Out of total 60 cases of sinonasal masses. 49 (74.4 %) were non neoplastic lesions. 11 (25.6 %) were neoplastic lesions. 39(65 %) cases were non specific non neoplastic lesions. 10 (16.6%) were specific non neoplastic lesions. 10 (16.6 %) cases were non specific inflammatory polyps. 29 (48.4 %) were allergic polyps. Distribution of non-neoplastic - specific cases includes Rhinosporiodiosis 6 cases (10 %), Mucormycosis 2 cases (3.4 %), Aspergillosis 1 case (1.6 %) and Tuberculous granuloma 1 case (1.6 %). The present study found that Benign neoplastic lesions 8 (13.1 %) cases, Schneiderian papilloma 4 cases (6.6%)., Pleomorphic adenoma 2 cases (3.3%), Haemangioma 1 cases (1.6%) and Schwannoma 1 case (1.6 %). Conclusion: We concluded that histopathological evaluation is mandatory in all cases of nasal masses for accurate diagnosis. In certain cases such as Undifferentiated carcinomas, immunohistochemistry became the ultimate diagnostic technique, so that a correct and timely intervention can be made for patient management. Keywords: Neoplastic lesions, Mucormycosis, Immunohistochemistry, Carcinomas, Benign lesions.

Background: During chemotherapy, patients with cancer face a range of oral risk factors that can impact their oral health. Chemotherapy can lead to a weakened immune system, making patients more susceptible to oral infections and complications. Common oral issues during chemotherapy include mucositis, xerostomia (dry mouth), and taste changes. These oral complications can significantly affect a patient's quality of life and may require specific dental care and management. Objective: To identify the oral manifestations like oral mucositis, dry mouth and loss of taste in patients undergoing chemotherapy treatment. Materials and Methods: In our study, we assessed 72 patients who were undergoing chemotherapy treatment for malignancy. We collected various clinical and pathological data including age, gender, diagnosis of malignancy, and the types of anticancer chemotherapeutic drug treatments administered. The presence and severity of oral mucositis were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale, which is a standard method for grading adverse effects. Additionally, we recorded other related findings such as dry mouth and loss of taste. Results: Of the 72 patients, 46 (63.9%) were male, and 26 (36.1%) females with a mean age of 52.8 years. Most patients about 63% and 83% were diagnosed with dry mouth and loss of taste, respectively and 71% of patients had mucositis. Chemotherapy drugs like Cyclophosphamide, carboplatin, nanoxel, paclitaxel, oxaliplatin, docetaxel and doxorubicin, were directly associated with oral mucositis. Conclusion: Patients undergoing chemotherapy for cancer frequently experience a variety of severe and incapacitating oral dysfunctions. These may include mucositis, xerostomia, and taste disturbances. It is essential for healthcare professionals to address these adverse effects and provide appropriate symptomatic treatment to patients. Despite its significant impact on oral health, chemotherapy's effects are typically temporary. Therefore, close monitoring and management of oral health are crucial for healthcare providers. Keywords: Cancer, chemotherapy, mucositis, xerostomia, oral discomfort.