Current Issue

Background: The second most common cancer and the main cause of death from cancer worldwide is lung cancer. The stage of the cancer, mutation, and histological type all affect the prognosis and course of treatment. There is no adequate data about histological subtypes lung cancer in our area. The aim of this study is to evaluate the smoking status, histological subtypes, clinicoepidemiological profile, and interdependencies among those suffering from lung cancer. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India. From May 2, 2021, until May 7, 2022. Histopathologicaly confirmed lung cancer patients were studied. The data was collected by using a semi-structured proforma, and SPSS 20 was used for analysis. Results: The mean age of the patients (n=124) was 63.42 + 9.11 (SD) years. The common symptoms were cough (71.8%), breathlessness (62.9%), chest pain (35.5%), and loss of weight (31.5%). Among the patients 86.3% are males and 80.6% are smokers. Adenocarcinoma was the commonest histopathological subtype (45.9%) followed by squamous cell carcinoma (37.9%), small cell carcinoma (10.5%) and other neuroendocrine tumors (5.6%). Squamous cell carcinoma was the commonest subtype among males (42.1%) and smokers (44.6%). Adenocarcinoma remained commonest among females (82.3%) and non-smokers (87%). Cough was significantly higher in squamous cell and small cell carcinomas (p=0.04). Dyspnea remained the most prevalent symptom in adenocarcinoma (64.9%). Conclusion: Adenocarcinoma was the commonest subtype. Squamous cell carcinoma had higher prevalence among males and smokers; adenocarcinoma was higher among females and non-smokers. The commonest symptom was cough. Cough was significantly higher in squamous cell and small cell carcinomas. Dyspnoea was the most prevalent symptom in adenocarcinoma. Keywords: Lung cancer, Smoking, Adenocarcinoma, Squamous cell carcinoma, small cell carcinoma.

Background: Skin is the largest organ of the body and is constantly harmed by a variety of environmental factors resulting in various kinds of neoplastic and non-neoplastic skin lesions. Among the non-neoplastic skin lesions, infective skin lesions are very commonly encountered in India, possibly due to the hot and humid environment, and lack of general awareness regarding infectious diseases. Very few studies, if any, have been conducted in the Garhwal region regarding infective skin lesions. Hence, present study was carried out to determine the spectrum of infective skin lesions. Aim and Objective: Present study was carried out to understand the spectrum of various skin lesions in correlation with age, sex and type of clinical lesion at a tertiary care hospital in Garhwal region. Materials and Methods: Study Design: Non-interventional, cross-sectional, retrospective study was carried out from January 2022 to December 2023, on all skin biopsies diagnosed as infective skin lesions in the department of pathology, Veer Chandra Singh Garhwali institute of medical sciences and research irrespective of age and sex. Results: Out of the 63 cases studies, leprosy was the most common infective skin lesion followed by tubercular dermatoses. Male predominance was present, with the most commonly encountered age group being 41-50 years. Presence of a hypopigmented patch was the most common clinical finding. Conclusion: Leprosy was the most common infective skin lesion encountered in our study followed by tubercular dermatoses. Due to the wide range of clinical presentation in infective skin diseases, histopathological examination is necessary to make an accurate diagnosis. Keywords: Infective skin lesions, leprosy, tubercular dermatoses.

Introduction: The utilization of laparoscopy in managing abdominal trauma, either diagnostically or therapeutically, has been on the rise. However, its comparative outcomes with conventional laparotomy, especially concerning therapeutic management, remain unclear. Methods: This retrospective cohort study involved patients from trauma center of an Indian medical college. 78 patients who underwent laparoscopic interventions for abdominal trauma were included in the laparoscopy group (LP group). Another 78 patients who underwent laparotomy (LT group) were matched based on baseline characteristics, causes of injury, and hemodynamic parameters. Perioperative clinical parameters and short-term survival were compared between these two groups. Results: Baseline characteristics were similar between the LP and LT groups. The most common cause of trauma was traffic accidents, and the predominant surgical intervention was bowel repair/resection. Operation time did not significantly differ between the two groups, while the post-operative complication rate was slightly lower in the LP group without statistical significance. Opioid use was lower in the LP group compared to the LT group. Additionally, hospital stay was significantly shorter in the LP group. One patient in the LT group died due to an intra-abdominal abscess and multiple organ dysfunction syndrome 20 days postoperatively, whereas all patients in the LP group recovered and were discharged. Conclusion: Laparoscopy is deemed feasible and safe for treating hemodynamically stable abdominal trauma patients when performed by experienced surgeons. Laparoscopy appears to offer advantages such as reduced pain and quicker recovery while maintaining similarly favorable clinical outcomes compared to conventional laparotomy. Keywords: Abdominal trauma, hemodynamically stable, laparoscopy, laparotomy

Background: Cardiac troponins (cTn) are specific biomarkers of myocardial injury and have a well-established role in guiding the management of chest pain.5,6 An elevated troponin-I (cTnI) has also been associated with a poor prognosis in critical illness, pulmonary embolism, cardiac and non-cardiac surgery, stroke, and end-stage renal disease. Materials and Methods: This study was conducted in Department of Medicine in RBM Hospital & Shree Jagannath Pahadia Medical College, Bharatpur, Rajsthan. This cases control study was included 100 control and 250 cases. The duration of study was over a period of one year. Results: Among the 250 cases examined, 96 tested positive for Troponin-I, while the remaining cases tested negative. Among the Troponin-I positive cases, 64 were male and 32 were female, indicating a higher predominance of Troponin-I positivity among males. Significant differences (p < 0.01) were observed in these variables between the cases & control groups. Conclusion: The present study shows in the patients who developed chest pain due to cardiac event as confirmed by positive troponin-I test were having lipid parameters in the risk level as suggested by ATP III. Keywords: Troponin-I (cTnI), Myocardial injury, Biomarkers.

Background: Despite control strategies, tuberculosis remains a significant public health problem in many countries. Along with effective control measures currently available, it is essential to identify and target the risk factors of developing active TB to tackle the heavy burden of the disease. This study aims to find out the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. Materials and Methods: A case-control study was done to assess the association of clinical and social factors with Tuberculosis and Diabetes mellitus co-morbidity. The study was done from a parent study conducted in South India to study the prevalence of diabetes mellitus among registered tuberculosis patients. Those patients diagnosed with both tuberculosis and diabetes mellitus were taken as cases, and those patients with tuberculosis without diabetes mellitus were taken as controls. Cases and controls were above the age of 15 years. The calculated sample size was 115:345, as there were only 92 cases in the parent study. All were taken. Social factors like age, gender, occupation, and socio-economic status, as well as clinical factors like various symptoms, symptom score, type of tuberculosis, category, and treatment outcome, were studied in this study. Data was coded in Excel and analyzed using SPSS version 16. Chi-square analysis was done to find out the association and odd’s ratio. Results: There was a significant difference in age between cases and controls. All symptoms are significantly higher (Chi-square 27.6p-0.0001) among those who have tuberculosis and diabetes co-morbidity when considering each symptom separately. Extrapulmonary tuberculosis was found more among controls. In this study, it was found that relapse and treatment after default were significantly higher among cases(Chi square 23.4 p-0.000034). Conclusion: A significant difference was found among TB patients with DM as co-morbidity when compared with patients without DM. Uncontrolled diabetes will be one challenge for TB elimination. Hence, periodic screening is necessary to find out DM and the proper measures to be followed to control. Keywords: Diabetes co-morbidity, Symptom score, treatment outcome.

Background: Medical undergraduates having lack of interpersonal skills may lead to severe deficiencies in health services. Currently these were not being trained or assessed at workplace for their behavior and communication skills during their medical curriculum. During this study, mini-CEX (mini clinical evaluation exercise) was used as a work place based assessment (WPBA) tool to assess the interpersonal skills of interns and providing them concurrent feedback. The aim of this study was to evaluate and improving the interpersonal skills of interns posted in orthopedic department during their rotatory internship while assessing the acceptability, feasibility and effectiveness of mini-CEX assessment as a tool. Materials and Methods: This prospective and interventional study was conducted in department of orthopedics of our hospital settings between July to November of 2022. The forty interns who participated in this study were on rotatory internship in our department and 06 volunteered faculty members were also included. The mini-CEX form as assessment tool structured by American Board of Internal Medicine was used in this study. Each intern undergone six rotatory assessment sessions, on mini-CEX forms with each of the faculty comprising a total of 240 sessions. Participants at the end of their internship submitted their perceptions on an anonymous validated questionnaire which contains both open ended and closed ended questions (Likert 5-point scale). Statistical Analysis: The descriptive data having frequencies were analyzed using Microsoft Excel software. Thematic analysis was used for qualitative data of open ended questions. Results: Most of interns (36/90%) and all included faculty members had shown that mini-CEX assessment tool has encouraged them and helpful in improving their communication skills. On comparison of their first through 6th encounters, interns had shown improvement in their mean min-CEX score for skill development and competencies with improvement in communication skills. This improvement was statistically significant. (p<0.05). Conclusion: Our study had shown that mini-CEX as WBPA too is an acceptable, effective as well as feasible method for assessing the interpersonal skills of interns in clinical settings. Keywords: interns, interpersonal, encounters, skills.

Background: To study the efficacy of teriparatide therapy in surgically corrected comminuted fractures. Materials and Methods: Prospective observational study was conducted in 50 patients of either gender who are skeletally mature presenting with comminuted fracture or nonunion after surgical correction, without comorbidities who are medically fit for taking the teriparatide are included in study. Results: One third of the patients belonged to the age group of 30-39 years and 40-49 years. 82% of the study population were males, 18% of them were females. 70% of the study population were injured on the right side, 30% of them were injured on the left side. 76% of the study population lower limbs were injured, 30% of them had injury on the upper limbs. 74% of the study population had Road Traffic Accident. 36% of the study population had fracture of femur. 6% of them had fracture of both tibia and fibula. 2% of them had fracture of both radius and ulna. Only one patient had fracture neck of humerus. 42% of the study population showed signs of radiological union after 3-4 months of drug administration, followed by within 3 months (30%), 5-6 months (20%). 92% of the study population had achieved complete radiological union at the end of one year follow up. 44% of the study population showed complete radiological union after 7-9 months of drug administration. Complete range of movements was achieved in 52% of the study population. The range of movements was increased in 40% of the study population. 8% of the study population had restricted movements at the end of the study period. 56% of the study population had experienced side effects. 52% of the study population had nausea, 28% of them had dizziness and 18% had hypercalcemia. Conclusion: The present study concluded that the efficacy of teriparatide in surgically treated comminuted fracture healing cases is 92%. The drug was tolerated well with minor side effects like nausea and dizziness. Keywords: Teriparatide, comminuted fracture, Radiological union.

Background: Acute appendicitis is one of the most frequent cause of pain abdomen. Acute Appendicitis can present as complicated or uncomplicated. Complication are abscess, gangrene, perforation. Most common cause of Appendicitis is luminal obstruction by appendicolith. Appendicolith is also known as faecolith/ stercolith/ coproliths is composed of faecal concretions or pellets, calcium phosphates, bacteria and epithelial debris and can lead to luminal obstruction followed by appendicitis. They are seen in 10% of patient with acute appendicitis. Objective: To study any association between appendicolith and its effect on recovery of patient with appendicitis. Materials and Methods: This is prospective study carried out from January 2021 to December 2023 in Command Hospital and Military hospital Jammu in all patients of Acute Appendincitis. Data was collected in terms of age, sex, presentation, TLC score, USG/CT, Mantrls score, surgery done, intra op finding, appendicolith seen or not and histopathology. Results: Out of 170 patients who underwent appendicectomy, 139 patients were more than 20 years of age (81%). Following appendicetomy, appendicolith was found 33patient (19.41%).11 patients were less than 20 years of age (33%).There were 36 female patients (21%) of appendicitis.139 patient presented in acute phase (82%) and operated upon. Rest were operated as cold cases as int appendicectomy. Lap appendicectomy was done in 143 cases (84.1%). Rest was open appendicectomy. Acute appendicitis was found in 9 cases with appendicolith (33%).Complicated appendicitis was found in 24 cases with appendicolth (72.7%). Conclusion: Appendicolith is commonly present in more than 20-year age group. Mantrls score is higher in appendicitis with appendicolith. TLC is also more than 10000 in majority of patients with appendicolith. Majority patient presented in acute stage and were operated upon. Presence of appendicolith was associated with higher TLC, higher Mantrls score and complicated intraop and HPE finding. Keywords: Acute appendicitis, Appendicolith, TLC, HPE finding, HPE finding.

Background: Aims: To find the ideal drug combinations which can be used during day care surgeries and procedures. This study was conducted to valuate and compare the efficacy, and haemodynamic stability of ketamine and entanyl combination with propofol. Also compared were the incidence of side effect, the time of awakening and recovery time. The discharge criteria in both groups was also compared. Materials and Methods: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I or II, were divided into two groups of 25 each. They underwent elective ERCP of approximately 1 hour duration. Group I received Propofol- ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system) and discharge status (by modified post anaesthetic discharge scoring system) were recorded and compared in two groups. Results: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol- fentanyl group as compared to Propofol-ketamine group. The recovery time in group II was longer than group I. Discharge criteria is significantly earlier in group I. Conclusion: Both Profol- ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia, but recovery and smooth discharge was seen with propofol fentanyl group. Keywords: Propofol, Fentanyl, Ketamine, Day care surgery, ERCP, Endoscopic proceedures.

Background: Dexmedetomidine and Clonidine, both α2-adrenergic agonists, are commonly used in cardiac surgery for their hemodynamic stabilizing properties. However, comparative data on their efficacy in cardiac valvular surgeries remain limited. Materials and Methods: We conducted a prospective randomized controlled study involving 60 patients undergoing elective cardiac valvular surgeries between September 2019 and August 2020. Patients were randomized to receive either Clonidine or Dexmedetomidine. Intra-operative hemodynamics, anesthetic requirements, and post-operative recovery times were compared between the two groups. Results: Dexmedetomidine demonstrated superior efficacy in reducing heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure compared to Clonidine. Patients receiving Dexmedetomidine required lower doses of inhalational anesthetics, opioids, and muscle relaxants. Additionally, Dexmedetomidine was associated with shorter durations of mechanical ventilation (398.00 ± 51.47 vs. 475.67 ± 35.15 minutes, P < 0.0001) and length of stay in the post-operative ICU (53.90 ± 3.75 vs. 60.60 ± 3.78 hours, P < 0.0001) compared to Clonidine. Conclusion: Dexmedetomidine offers superior intra-operative hemodynamic stability, reduced anesthetic requirements, and faster post-operative recovery compared to Clonidine in patients undergoing cardiac valvular surgeries. Keywords: Dexmedetomidine, Clonidine, Cardiac surgery, Hemodynamics, Anesthetic requirements, Post-operative recovery.

Background: Mobile health applications are a relatively new phenomenon in the healthcare industry, but their use is expanding rapidly for both general health and specific medical needs. Objective: To compare the utilization of the health apps among patients visiting pharmacies and health stores hospital and it awareness among people. Materials and Methods: A cross-sectional descriptive study was conducted with the general population who were using mobile health apps in the state between January 2023 to June 2023. The participants in the study were recruited from retail pharmacies and health stores located in different areas in the cities. Clients visiting the pharmacies and health stores were approached and invited to participate in the study, and those who agreed were interviewed. The inclusion criteria included smartphone owners who were using health-related apps, of age ≥ 18 years old, and those who could speak the English language. Results: Out of 270 individuals, 52% of the sample were male and 48% were female, and the mean age (SD) of participants was 29.74 (11.74). In this study, 31% of the participants reported using their health apps on a daily basis, 40% at least once weekly, and 25% monthly. The main benefits of mobile health apps were tracking of health status (49%), followed by motivation (24%) and gaining knowledge about health and fitness (20%). The main issues reported by the participants included inaccuracy of the app (12.5%), inconvenience (5%), and not being user-friendly (8%). Conclusion: These apps inspired the participants to keep up their wellbeing and exercise while assisting them in tracking and better managing their health. To ensure evidence-based and efficient app use to achieve the desired health outcomes, further opportunities for improvement have been found. Keywords: Digital health, digital patients, health apps, mhealth, teleconsultation.

Background: Modified Electroconvulsive Therapy (ECT) under anesthesia is an important modality in the treatment of severe persistent depression, bipolar disorder and schizophrenia; specially in case resistant to pharmacological therapy; but this procedure has got many side effects, specifically the hemodynamic alteration is markedly observed. Aim: The aim of present study to compare between Dexmedetomidine and esmolol as effective pretreatment regimens on attenuation of hemodynamic parameters during electroconvulsive therapy. Materials and Methods: After getting approval of the study protocol by the institutional ethics committee (H) of Assam Medical College and Hospital, Dibrugarh and getting written informed consent from the patients and their relatives, fifty cases aged between 20-40 years belonging to ASA grade I and II scheduled for ECT are included in the study and grouped in 2 groups of 25 patients each. Group E received IV esmolol 1mg/kg body weight diluted up to 10ml of normal saline and infused within 2 minutes as premedication. Group D received IV Dexmedetomidine 0.5 mcg/kg diluted to 10ml of normal saline and infused within 10 minutes as premedication. Hemodynamic parameters heart rate (HR), systolic blood pressure, diastolic blood pressure and mean blood pressure at baseline (before induction), after study drug infusion and after ECT application were recorded at different time intervals and presented along with demographic data. Statistical analysis was done with SPSS software using student t-test and Chi square test. Results: In this study, the baseline systolic blood pressure, diastolic blood pressure and mean blood pressure was statistically insignificant. The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was significantly decreased in both esmolol and Dexmedetomidine group after drug administration and at 1,3,5 and 10 min post ECT shock. However, the decrease in MAP was statistically insignificant in both the groups after premedication, at 1,3,5,10 minutes of delivery of ECT shock. The mean time of return of spontaneous respiration was statistically insignificant. Conclusion: Based on the present hospital based observational study, we came to the conclusion that an intravenous premedication agent in ECT, both esmolol at a dose of 0.1 mg/kg and Dexmedetomidine at a dose of 0.5 mcg/kg results in attenuation of cardiovascular (HR, BP, MAP) effects but more reduction of hemodynamic parameters were seen in the Dexmedetomidine compared to esmolol. The mean blood pressure however was unaffected. Keywords: Dexmedetomidine, esmolol, modified Electroconvulsive therapy, hemodynamic parameters.

The co-occurrence of retroperitoneal liposarcoma and a giant colonic diverticulum poses diagnostic challenges due to their uncommon nature and overlapping clinical presentations. Here, we present a unique case report of a 76-year-old female with hypertension and myasthenia gravis who presented to Vishesh Jupiter Hospital, Indore and diagnosed with retroperitoneal liposarcoma complicated by a giant colonic diverticulum detailing its presentation, diagnostic journey and management strategies. Keywords: Retroperitoneal liposarcoma, Giant Colonic Diverticulum.

Background: To evaluate and compare efficacy of laparoscopic cholecystostomy and interval cholecystectomy versus open cholecystectomy in cases of difficult gallbladder. Materials and Methods: This study will be conducted in Department of General surgery, Kamineni Hospital, Hyderabad between October 2012 to December 2014. The facilities, expertise and the necessary Infrastructure are available in this hospital. A comparative observational study, which included 40 patients of difficult gallbladder who needs cholecystectomy. Ethics committee’s permission has been taken. Results: In the present study, there were difficulties associated with Laparoscopic cholecystostomy like subjecting the patient to a second surgery, carrying a drain, longer hospital stay and increased expenditure. Laparoscopic cholecystostomy followed by Interval chole- cystectomy was safe with less postoperative morbidity associated with faster patient recovery and satisfaction as documented by less postoperative pain, earlier resumption of oral feeds, earlier full mobilization and discharge home, as well as lesser complication rate with least possible scar. Conclusion: In conclusion, the study supports the view that laparoscopic cholecystostomy followed by interval cholecystectomy is safer and efficacious and offers definitive advantages over open conversion and should be an available option for all patients requiring emergency cholecystectomy. Keywords: Cholecystectomy, Laproscopic, Gall Bladder, VAS, Postoperative.

Background: To study the effect of nebulised 3% saline on hospitalized children aged 4weeks to 2 years with acute bronchiolitis with regard to decrease in respiratory distress and duration of hospital stay. Materials and Methods: This was a hospital based prospective interventional non blinded controlled trial done in the age group of 4 weeks to 2 yrs admitted with acute bronchiolitis with a Respiratory Distress Assessment Instrument (RDAI)score of 4 to 15 [on a scale of 0 (mild) to 17 (severe)] in a teritiary care centre. Results: The most common presenting complaint in our study was cold which was present in 43 (76.79%) cases followed by cough in 41 (73.21%). This was followed by hurried breathing in 31 (55.36%). Wheeze was present in 29(51.79%) cases and fever in 28 (50%). The two groups were comparable with respect to baseline characteristics. The number of children who improved with treatment in Study group was 19(63.3%) and in control group was 11(36.70%). When compared to control group, there was statistically significant (p=0.015) improvement in the study group. This showed that the nebulised 3% saline nebulisation was useful in symptomatic improvement in the clinical condition of significantly more number of children. There was significant reduction in RDAI scores and improvement in saturation after 6hr, 12hr and 24hrs of initiation of treatment in Study group. Conclusion: The present study concluded that there was significant decrease in Respiratory rate and RDAI scores with the use of 3% NS nebulisation. The duration of hospital stay was less and the time required for change of treatment was more in Study group, but statistical significance could not be established. Keywords: Bronchiolities, RDAI Score, NS nebulisation, wheeze.

Background: Empyema thoracis is a life-threatening complication of pneumonia in children, especially below 5 years of age. The treatment outcomes depend upon the nutritional state of the child and provision of medical care to administer appropriate antibiotics. This study was done with an aim to evaluate the risk factors and outcomes of children with empyema thoracis. Materials and Methods: A total of 100 children who presented to the OPD with empyema thoracis, over a period of 18 months were included in the study. Results: Majority of the children were below 5 years of age and most of them were males. Most of the participants belonged to lower socio-economic status. Anemia was the most commonly associated risk factor. ICD was removed within 1 week. Conclusion: Early initiation of antibiotics along with ICD tube placement can allievate the immediate clinical or delayed complication. Keywords: empyema thoracis, pediatric, pneumonia.

Background: While medically supervised abortion adhering to guidelines boasts a success rate of 92-97%, the widespread availability of abortion pills over the counter has led to rampant self-administration, resulting in frequent complications. Despite the perception of unsupervised medical abortion as unsafe, many women utilize it for pregnancy termination and birth spacing. Aim of the Study: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Materials and Methods: Retrospective cross sectional study done in Government Doon Medical College & Hospital between the period of August 2022- july 2023. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected- Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG find-ings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Results: Among the 148 cases of abortion in the study period, 75 patients had self-administered abortion pills. Among these 75 patients 26.6% had consumed abortion pills after the approved time period of 63 days of which 20% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (73.33%) Severe anaemia was found in 37.33% of the patients and 8% of patients presented with shock. The outcome was as follows: 66.66% of the patients were found to have incomplete abortion, 13.33% had failed abortion and 5.22% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 33.33% of the patients whereas 46.66% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 9.33% of the patients whereas 6.66% required transfusion along with medical methods. Conclusion: The study sheds light on the increasing trend of self-administered MTP pill intake among women and underscores the importance of ensuring adequate education, counseling, and support for safe and effective self-administration practices. Further research is warranted to explore the long-term outcomes and implications of self-administered MTP pill intake in diverse healthcare settings. Keywords: Medical termination of pregnancy, Maternal mortality, abortion, complications.

Diarrhea causes an estimated 2.5 million child deaths in developing countries each year. It is the third leading killer of children in India today and is responsible for 13% of all deaths in children less than five years of age and kills an estimated 300,000 children in India each year. Diarrhea is one of the clinical manifestations of zinc deficiency in humans. 25 children (aged 6 months-5 years) of either sex suffering from diarrhea and admitted in paediatric ward and emergency of RDJMMCH, Muzaffarpur were selected for the study. Serum zinc levels were estimated by colorimetric kit method and compared with those of 25 healthy age-matched controls. It was observed that the serum zinc levels were significantly lower in children suffering from diarrhea (39.26 ± 12.18 vs. 78.60 ± 11.63 µg/dl, p<0.05). However, there was a negligible correlation between diarrhea and gender. Thus, diarrhea is associated with an increased loss of zinc in feces so that children with diarrhea would be at an increased risk of zinc deficiency. Zinc supplementation is now being recommended by WHO, UNICEF, and countries around the world for the supportive treatment of all diarrhea episodes among children, and this should be encouraged in routine clinical practice. Keywords: Diarrhea, Zinc, Children, Deficiency, Supplementation.

Background: Diabetes is a micro-macrovascular disorder with debilitating effects on many organs. Pulmonary complications in diabetes mellitus with the loss of pulmonary reserve may become clinically important. The relationship between DM and pulmonary function tests (PFTs) remains important because of potential epidemiological and clinical implications. Aim of the Study: The aim of this study was to measure pulmonary function tests (PFTs) in diabetes mellitus type 2(DMT2) subjects and to determine the correlation of glycosylated haemoglobin (HbA1c) with pulmonary function tests inDMT2 patients. Materials and Methods: This study was conducted in the Department of Physiology, Subharti Medical College in collaboration with Department of Medicine, Chattrapati Shivaji Subharti Hospital, Meerut A total of 100 non-smoker subjects of either sex in the age group of 30-50 years were recruited. The subjects were divided into 2 groups -Group A: 50 having history ofDMT2 and Group B: 50 Normal controls. The selected patients were evaluated by taking detailed history and thorough clinical examination was done. Test for Plasma Glucose and HbA1c was done. Pulmonary function tests was done by Spirometry recording FVC, FEV1,FEV1/FVC ratio and PEFR. The data so collected was subjected to standard statistical analysis. Results: Majority of subjects were between 40-50 years while only 6 were between 50-60 years of age. The sex distribution in both cases and controls was similar. All the respiratory parameters were lesser in subjects with diabetes than non- diabetics except FEV1/FVC ratio which showed slight increase in cases than control. Statistically significant decrease occurred in FVC, FEV1 (P<0.05) & PEFR (P<0.000) while increase in FEV1/FVC ratio was statistically insignificant giving an indication about probable deterioration in lung functions in asymptomatic diabetics. Conclusion: Lung functions need to be checked periodically to assess the severity of impairment in DMT2 patients. Keywords: Pulmonary Function Tests, Diabetes Mellitus Type 2, Glycosylated haemoglobin (HbA1c), complications.

Background: Aims: To study various cutaneous manifestations in early neonates that is within 7 days from the birth, fromAntenatal wards, dermatology outpatient department and Neonatal intensive care unit(NICU). Materials and Methods: It is a cross-sectional study including 150 neonates from OPD of Department of Dermatology, obstetrics and gynecology ward and NICU. Results: The percentage of consanguineous marriage and non – consanguineous marriage in the parents of neonates were seen as 16% and 84% respectively. The commonest cutaneous manifestations found in our study were that of pigmentary type i.e. Mongolian spot amounting to 22% of the cases most commonly over the lumbosacral region. The physiological desquamation was the commonest finding of papulosquamous changes that were seen in our study amounting to 18% of cases. The next commonest condition was of Erythema toxicum neonatorum amounting to 12% of the cases most frequently observed on the trunk. Acrocyanosis amounted to 8% of the cases in this study. The nasal lesions were demonstrated in all the cases of Sebaceous gland hyperplasia amounted to 6% of our case study. 5.3% of the cases were hypertrichosis lanugosa occurring over the shoulder, trunk and limbs. Miliaria accounted for 5.3% of the cases. It was more common in neonates admitted in NICU. Milia was found in 4% of the cases and most commonly occurred in neonates with birth weight >2.5kg. Of the solitary lesions Café au lait macules which were seen in our study amounted only to 2 %. The 2 % of cases wherein vernix caseosa seen were prominently observed in the axilla. Axillary hyperpigmentation amounted to 2 % of the cases. In our study two neonates demonstrated congenital melanocytic nevi amounting to 2 % of the cases. Other skin changes included amounting to 10 % of the total cases. Conclusion: Awareness of cutaneous manifestations in neonates helps us to differentiate between the benign transient lesions from the pathological conditions, so that timely intervention and necessary follow-up may be done where needed as well as to give assurance to the anxious parents. Keywords: Mongolian spot, papulosquamous, Erythema toxicum neonatorum, hypertrichosis lanugosa.

Background: Proper education and menstrual hygiene management facilities form a pathway for the overall growth and development of an adolescent girl. Poor availability of menstrual hygiene facilities in school can have a negative impact on the reproductive health of a girl as well as contribute to school absenteeism, sometimes resulting in school dropout. This study evaluates the various factors associated with school absenteeism during menstruation, and to assess knowledge of reproductive health. Objectives: 1. To assess the various factors affecting school absenteeism among adolescent girls. 2. To assess the availability and quality of sanitation facilities available in school washrooms 3. To evaluate the knowledge and practice of reproductive health in adolescent school going girls. Materials and Methods: A school based cross sectional study was conducted among 505 school girls urban and rural areas (Government and Private schools) in Dehradun, Uttarakhand. A semi-structured, pretested close and open-ended questionnaire was prepared in both Hindi and English language to obtain maximum results. Data Entry was done in MS excel and was analysed in SPSS software. Results: 51.56% girls in urban areas and 31.33% girls in rural areas remained absent from school during menstruation. Despite good level of knowledge of RTI/STIs 21, 48% girls in urban areas and 24.10% girls in rural areas said that they have had infection during or around menstruation. The sanitary facility in rural schools was less than that available in urban areas. Only 34.94% girls in rural areas reported of having soaps available in their school washrooms. Conclusion: Adolescent girls should be given appropriate knowledge regarding menstruation and reproductive health. This study is able to identify the lack of knowledge and hygiene facilities which can be improved in bringing them out of misconceptions and promote menstrual health and hygiene and increase the education among girls. Separate functioning sanitary facilities are necessities that should be in school at all girls empowerment and improvement in reproductive health is to be achieved. Keywords: Adolescent girls, Menstrual hygiene, Practices, School sanitation, School absenteeism, RTI, STI.

Background: The intertwined narrative of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) unfolds like a historical epic, with each chapter revealing new layers of complexity and challenge. This study aims to the prevalence ofdiastolic dysfunction in type 2 diabetes mellitus patients and to study the clinical profile of patients with diastolic dysfunction. Materials and Methods: The study was conducted on 100 patients. Patients with clinical features of acute appendicitis aged between 15 and 65 years were included in this study. he neutrophil Lymphocyte ratio would be obtained by dividing the percentage of neutrophils to the percentage of lymphocytes from the data available from differential leukocyte count. All patients was subjected to ultrasound examination of abdomen. Based on evidence in medical literature diagnostic categories for ultrasound abdomen are as follows. Results: The prevalence of diastolic dysfunction was found to be 59.37%. Within this subset, 5.3% were aged between 30 and 40 years, 17.5% were aged between 41 and 50 years, majority comprising 43.8%, were aged between 51 and 60 years, and around 33.4% were aged between 61 and 70 years. Notably, the majority of individuals with diastolic dysfunction were male, accounting for approximately 52.6% of the cases. Regarding the duration of diabetes among those with diastolic dysfunction, approximately 73.7% had been diagnosed within the past 1 to 10 years, while 22.8% had been diagnosed between 11 and 20 years ago, and only 3.5% had been diagnosed for over 20 years. Furthermore, in terms of body mass index (BMI), the majority fell within the range of 25.0 to 29.9 (50%), followed by 37.5% falling within the range of 18.6 to 24.9. The ejection fraction (EF) levels averaged 58.055.48 in the diastolic dysfunction group and 61.215.04 in the non-diastolic dysfunction group. Conclusion: The findings of this study underscore the multifaceted nature of diastolic dysfunction in the context of diabetes mellitus, emphasizing the need for comprehensive assessment and management strategies to address this significant cardiovascular complication in diabetic patients. Keywords: Ventricular dysfunction, diabetes mellitus, age, Type 2, risk factors, prevalence.

Background: The prevalence of systemic lupus erythematosus (SLE) in the general population ranges from 8 to 180 cases per 100,000 individuals. The female to male ratio varies from 6 to 13 cases in females for every 1 case in males. Several observations suggest an estrogen effect as a potential explanation for this gender difference. In children, the impact of sex hormones is assumed to be minimal, resulting in a female to male ratio of 3 to 1. We report a case series of five male patients who presented at the Kurnool Medical College, Kurnool in the state of Andhra Pradesh and were diagnosed to have lupus nephritis (LN). Male patients with SLE typically present with renal involvement and seizures rather than photophobia and skin manifestations. The prognosis for male patients also appears to be more severe. Therefore, despite the rarity of male patients with lupus, the symptoms are life-threatening, and early detection of the disease is crucial for improving patient outcomes. Keywords: Lupus Erythematous, Estrogen, Seizurs, Photophobia, Luupus Nephritis.

Hypertension is defined as a systolic blood pressure (SBP) of 140 mm Hg or more, or a diastolic blood pressure (DBP) of 90 mm Hg or more. Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increase in economically developing nations. Hypertension affects one in four individuals worldwide. ARBs, CCBs are first line of therapy of hypertension and has out shifted the use of ACEIs. Telmisartan is the preferable ARB, Amlodipine a third generation CCB are commonly prescribed for hypertension in INDIA. Telmisartan has a very high lipophilicity and high volume of distribution which offers advantage of good tissue penetration over other sartans. Amlodipine a DHPs of CCBs is prescribed because of less negative inotropic and high vascular selectivity. The present study comprises of 60 patients (both men and women) of 18 and above age, who are suffering from idiopathic hypertension to know the efficacy of low dose combination therapy of Telmisartan(40mg) with Amlodipine (5mg) against high dose monotherapy of Telmisartan(80mg). In present study, a low dose combination therapy of Telmisartan 40mg + Amlodipine 5mg has demonstrated significantly greater BP reduction in both SBP and DBP compared to high dose monotherapy with Telmisartan 80mg.The combination therapy with Telmisartan 40mg + Amlodipine 5mg is well tolerated with a safety profile similar to the monotherapy with Telmisartan 80mg. Keywords: CCB- Calcium channel blocker, ARB- Angiotensin receptor blocker, SBP-Systolic blood pressure, DBP- Diastolic blood pressure.

Background: Foot defects requiring reconstructive surgery pose significant challenges in plastic and reconstructive surgery. Understanding the demographic characteristics, clinical presentations, surgical interventions, and outcomes of foot reconstruction is essential for optimizing patient care. This prospective observational study aimed to analyze the demographics, clinical presentations, surgical interventions, and outcomes of elective foot reconstruction surgeries. Materials and Methods: Over a 24-month period, 50 cases undergoing elective foot reconstructive surgery were studied. Demographic data, including age, sex, etiology, and comorbidities, were recorded. Clinical characteristics such as foot involvement, defect size, structures exposed, associated fractures, and vascular status were assessed. Surgical interventions and complications, including type of reconstruction and post-operative outcomes, were documented. Functional outcomes and patient satisfaction were evaluated during follow-up. Results: The majority of patients (72%) were aged 18-40 years, with males comprising 84% of the study population. Trauma was the leading etiology (88%) of foot defects, and 22% presented with associated comorbidities. Most defects were right-sided (68%) and ranged from 5-10 cm in size (70%). Bones and tendons were commonly exposed (48%), and 60% of patients had associated fractures. Lateral supramalleolar flap and RSA flap were the most common reconstruction procedures (both 26%). Flap necrosis and donor site morbidity affected 8% and 24% of patients, respectively. Despite challenges, 94% of patients reported satisfaction with the outcome of their reconstruction. Conclusion: Elective foot reconstruction surgeries present complex clinical scenarios. This study provides insights into the demographics, clinical characteristics, surgical interventions, and outcomes of foot reconstruction, aiding in optimizing patient management and improving surgical outcomes. Keywords: Foot reconstruction, plastic surgery, reconstructive surgery, clinical characteristics, surgical interventions, outcomes.

Background: Hemoglobinopathies, a diverse group of genetic disorders affecting hemoglobin synthesis or structure, pose substantial public health challenges worldwide. Understanding their prevalence and spectrum, especially among reproductive-age females, is crucial for planning effective prevention and treatment strategies. Aim: This prospective observational study aimed to investigate the frequency of hemoglobinopathies among reproductive-age females in a rural tertiary care centre in Haryana using high-performance liquid chromatography (HPLC). Materials and Methods: Over the course of one year, 149 females aged 15 to 45 years were included in the study. Blood samples were collected and analysed using HPLC to identify haemoglobin abnormalities. Results: Haemoglobin HPLC analysis revealed haemoglobinopathies in 14.1% of cases, with β-thalassemia trait being the most prevalent (11.4%). Other hemoglobinopathies identified included HbD Punjab trait and HbE trait. Haematological indices provided insights into different parameters across various hemoglobinopathies. Conclusion: Hemoglobinopathies represent a significant healthcare challenge in India, particularly among women of reproductive age. This study emphasizes the importance of screening for carriers using haemoglobin HPLC, as it facilitates the provision of tailored counselling and management strategies to alleviate the impact of these disorders. Keywords: Haemoglobinopathies, reproductive-age group, blood disorder, Anaemia, haemoglobin.

Background: Extensor tendon injuries are common and can significantly impact hand function. The treatment and management of these injuries vary widely, influencing the functional outcomes. To evaluate the efficacy of different management protocols (early active mobilization vs. immobilization) in the repair of uncomplicated isolated extensor tendon injuries and to assess the outcomes based on the Total Active Range of Motion (TAM). Materials and Methods: This prospective analytical study included all cases of extensor tendon injuries treated in the Department of Plastic and Reconstructive Surgery. Patients were assigned to either an early active mobilization/physiotherapy protocol or to immobilization due to non-compliance based on specific criteria. The primary outcome measure was the improvement in TAM as suggested by the American Society for Surgery of the Hand. Results: A total of 66 patients with 100 tendon injuries were included. The majority were males (87.8%), with the most affected age group being 10-30 years (77%). The index finger was the most frequently injured. Outcomes showed 70% of tendons had good to excellent recovery. Early active mobilization yielded fewer complications and better functional outcomes compared to immobilization. Conclusion: Early active mobilization significantly enhances recovery in extensor tendon injuries of the hand. This protocol also demonstrated lower complication rates, making it a preferable treatment strategy in compliant patients. Keywords: Extensor tendon injuries, early active mobilization, immobilization, hand surgery, Total Active Range of Motion (TAM), functional outcomes.

Background: Genetic testing for Breast Cancer (BRCA) gene 1 and 2 mutations in epithelial ovarian cancers is recommended to guide prognosis, adjuvant treatment and prevention of second malignancies in the patient and in the carrier family members or relatives. Prevalence of BRCA and other cancer- causing mutations is not known in most regions in India and is inadequately explored. Main-streaming genetic testing has the potential to increase uptake of testing in patients and identify at-risk carrier population in whom primordial or primary prevention of genetic cancers can be implemented with good outcomes. Materials and Methods: A mixed method study was conducted with aim to explore feasibility of a primary care nurse based genetic counselling modality for ovarian cancer patients, along with exploration of factors affecting its uptake, using a structured objective survey questionnaire followed by key informant interviews to develop qualitative questionnaire for further phase of the study. Results: The uptake of genetic testing among patients was good and among healthy relatives was negligible. The affecting factors were lack of awareness and economic. The qualitative study interview explored reasons for low uptake of tests, satisfaction with the counselling and impact of test results on patients. Conclusion: The pretest counselling was effective and post-test counselling necessitated counselling by specialist oncologist. The uptake of genetic testing was affected by level of awareness and costs. Keywords: Mainstreaming genetic testing, Nurse led counselling, Ovarian cancer.

Background: The proximal humerus is the third most common fractured bone in the body, making up about 4%-5% of all fractures. Incidence occurs mostly after distal radius fractures and hip fractures. Fractures of the proximal humerus are more common among the elderly. Studying the outcomes of proximal humeral nailing fixation for two- and three-part proximal humeral fractures was the primary focus of this prospective observational study. This study was conducted to assess the clinical, radiological and functional outcome of treating Neer 2, 3-part proximal humerus fracture using intramedullary proximal humerus nailing and to know the advantages, disadvantages and complications of the procedure. Materials and Methods: A prospective study was conducted in K A P V govt Medical College& MGMGH, Trichy. This study included the patients with fracture of proximal humerus requiring surgical interventions, after taking their consent, were analyzed clinically and radiologically. All the patients selected for the study were evaluated as per the history & mode of injury, necessary clinical and laboratory investigations. The pre-operative and immediate post-operative X-ray were evaluated. The patients were evaluated clinically and radiologically in their subsequent follow-up every 6 weeks till fracture union and at 1 year after surgery. Results: The time for union (weeks) was 11 to 14 weeks in86.66% of the participants. Most of the patients had follow-up till one year. The mean post op NEER score 75.17 ± 5.85 at 6 weeks, it was 79.63 ± 5.3 at 3 months, it was 83.23 ± 5.28 at 6 months, it was 88.5 ± 5.48 at final score.36.67% and 63.33% of the participants had NEER 2 and 3part type of fracture injury. Among the study population with post-op complication, 10.00% of them had varus malunion, 6.67% of them had rotator cuff injury, 3.33% of them had glenohumeral protrusion. We found that 63.33% of them had excellent outcomes, 26.67% of them had satisfactory outcomes, 10.00% of them had unsatisfactory outcomes. Conclusion: We discovered that individuals with both two and three-part fractures exhibit successful fracture union. Post-operative NEER score was improved with the patients treated. We found that there was a good outcome with a smaller number of complications found in the treatment of proximal humeral nailing. Keywords: Proximal Humerus, NEER scores, Post-operative, Proximal Humerus Nailing.

Background: Lateral neck swellings in ENT have various causes, commonly found in the anterior triangle of the neck. Accurate diagnosis through imaging, FNAC, and biopsy is crucial for appropriate treatment, ranging from conservative management to surgery. Understanding incidence, etiology, pathology, and clinical behaviour is important for effective management and follow- up. Materials and Methods: Institutional Ethical committee approval was obtained and informed consent was taken from the study subjects. Patients with lateral neck swellings underwent clinical examination and FNAC, followed by further investigations based on FNAC reports. Lymph node biopsies were taken for histopathological examination. Management was based on the final diagnosis, and patients were followed up for six months. Results were analyzed and tabulated. Results: In our study of 96 patients, lateral neck masses were most common in individuals aged 46-59, with an equal male-to-female ratio. The majority of cases (82.29%) were from low socioeconomic status. Metastasis in cervical lymph nodes was the most frequent cause of lateral neck swellings, primarily in males aged over 45, and tubercular lymphadenitis was the second most common cause in females aged 18-30. The clinical diagnosis had high sensitivity (87.18%) and specificity (92.98%) for detecting malignant lesions, and these values increased when the histopathological examination was used as the gold standard. Conclusion: To evaluate and manage lateral neck swellings, a multidisciplinary approach is necessary, including medical history, clinical examination, imaging, and pathological investigations like FNAC and HPE. Prompt and accurate diagnosis is critical to prevent morbidity and mortality, and management depends on the underlying cause. Effective management requires close communication between the clinician and the pathologist. Keywords: Cervical Lymphadenopathy; non-thyroid neck swellings; Benign; Malignant; Fine-needle aspiration cytology; Histopathological examination; Neck metastasis; Tuberculosis; Lymphoma.

Background: Neural tube defects, serious birth defects affecting the brain & spine, are a major, preventable public health burden. Aim and Objectives: 1) Periconceptional folic acid intake in any means to prevent NTDs in unplanned pregnancy. 2) To understand the need to implement the fortification of staple food with folic acid. Material and Methods: Total of 10 cases (from March 2022 to March 2023 in KIMS, Koppal) with neural tube defects. Results: Various presentations with neural tube defects were seen in this case series. Unplanned pregnancies and unawareness regarding benefits of folic acid supplementation leading to higher incidence of neural tube defects. Conclusion: New efforts that is implementation of fortification of staple food with folic acid along with practicing primary prevention such as dietary folate intake, periconceptional folic acid intake are needed to implement a combined strategy to reduce the incidence of neural tube defects. Keywords: Neural Tube Defects, Folic Acid, Fortification, Food.

Background: Stroke, a cerebrovascular accident, is prevalent across patient populations and can be a significant cause of morbidity and mortality. Ischemic occlusions contribute to around 85% of casualties in stroke patients, with the remainder due to intracerebral bleeding. Hyperlipidemia is a major contributor to coronary heart disease, but its relationship to stroke is complicated. Hence; the present study was conducted for assessing the role of serum lipid profile as risk factor for development of ischemic stroke. Materials & Methods: A total of 100 patients with ischemic stroke and 100 controls who came for routine medical check-up were enrolled. Complete demographic and clinical details of all the patients was obtained. The diagnosis of stroke was confirmed by taking CT scan of brain. Lipid profile was taken following a 12 hour fasting on the next day of admission. Serum total cholesterol less than200mg/dl, LDL cholesterol<100 mg/dl, triglyceride less than150mg/dl, and HDL more than 40 mg/dl was taken as normal. Data was analyzed using SPSS software. Results: Mean age of the stroke patients and controls was 53.9 years and 55.1 years respectively. Majority proportion of patients of both the study group and control group were males. Significant difference was obtained while comparing TC, LDL-C and HDL-C among the stroke patients and controls. While comparing the dyslipidemia, is was seen that ischemic stroke group had significantly higher proportion of patients with dyslipidemia in comparison to controls. Conclusion: Lipids give significant contribution to stroke risk and that lipid profile assessment must be taken into account in estimating the individual risk of stroke. Key words: Lipid, Ischemic, Stroke.

Background and Objectives: Infertility is a significant concern affecting many couples of reproductive age. This condition arises due to a myriad of factors, and relying solely on pelvic examinations may not adequately detect all infertility-related abnormalities. Therefore, there is a need for additional diagnostic and therapeutic investigations. Transvaginal Ultrasound (TVS) has emerged as a crucial initial step in assessing uterine abnormalities, although numerous studies have established hysteroscopy as the gold standard. The aim of this study was to compare the findings of transvaginal ultrasound with hysteroscopy in evaluating uterine cavity and its abnormalities in infertility patients prior to undergoing in vitro fertilization (IVF). Methods: This prospective, hospital-based study was carried out at a tertiary healthcare facility in India. It involved a cohort of 123 patients experiencing infertility, who were assessed using transvaginal sonography (TVS) followed by hysteroscopy. Data from these evaluations were documented and subjected to statistical analysis using SPSS 20 with significance level set at 5%. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TVS were found to be 82.50%, 73.00%, 91.80%, 66.50%, and 80.50%, respectively. In comparison, hysteroscopy demonstrated sensitivity, specificity, PPV, NPV, and accuracy of 97.50%, 97.90%, 99.50%, 86.50%, and 92.50%, respectively. When both hysteroscopy and TVS were combined for intrauterine pathology evaluation, the values significantly increased to 98.80%, 99.80%, 99.80%, 98.00%, and 95.50%, respectively. Conclusion: Transvaginal ultrasound serves as a sensitive, cost-effective, and non-invasive tool for detecting pelvic pathologies in infertility patients. However, hysteroscopy emerges as a more sensitive method for uterine evaluation. Combining both techniques enhances diagnostic yield in terms of sensitivity and specificity, thus improving overall diagnostic accuracy. Key Words: Ultrasound, Infertility, Hysteroscopy, Uterus

Background: The objective of this study was to assess the impact of obesity on pulmonary functions, such as FEV1/FVC ratio, PEFR, and MVV, in adults aged 26 to 55, comparing those with abdominal obesity against non-obese individuals. Materials and Methods: Over one year, the present cross-sectional study was carried out at the Academy of Medical Sciences in Pariyaram. The study comprised 200 non-obese patients and 200 subjects with abdominal obesity, including both males and females. The study sample comprised individuals between the ages of 26 and 55. Spirometry measurements were conducted on all subjects while they were seated, following the procedures advised by the American Thoracic Society. A proficient technician conducted a spirometry examination in the morning. The pulmonary functions that were evaluated include the FEV1/FVC ratio, PEFR, and MVV. The BMI was determined by recording the weight and height. The statistical analysis was conducted using IBM SPSS for Windows (Version 26.0). An Unpaired t-test was employed to evaluate the PFT of those classified as non-obese and those with abdominal non-obesity. A p-value of less than 0.05 was deemed statistically significant. Results: The participants were categorized into three distinct age groupings, namely 26-35 years, 36-45 years, and 46-55 years. BMI cut-off values of more than 25 kg/m2 were used to divide the participants into two groups: those with abdominal obesity and non-obese. In the abdominal obesity group, 49.5% of the 200 participants were men and 50.5% were women. In the group of non-obese individuals, there was an equal distribution of males and females. The study sample revealed a statistically significant difference in the average FEV1/FVC ratio between individuals with abdominal obesity and non-obese across all age categories. The study observed a decline in mean PEFR levels as individuals aged in both groups. The participants with abdominal obesity and non-obese showed a statistically significant difference in mean PEFR values (p < 0.01). The abdominal obesity group aged 46-55 years exhibited an MVV of 69.58±12.56 L/min. The statistical analysis revealed a significant difference in the average MVV values between individuals with abdominal obesity and non-obese in the age ranges of 26-35, 36-45, and 46-55 years. Conclusion: The results of the study indicated that there was a consistent decrease in lung function measures as individuals aged in both groups. The abdominal obesity group exhibited a notable decrease in FEV1/FVC, PEFR, and MVV when compared to the non-obese group. Keywords: Abdominal obesity, Body mass index, Maximum voluntary ventilation, Peak Expiratory Flow Rates, Pulmonary function tests.

Background: Inadequate biomedical waste management can directly impact health. As per ministry reports, India produces over 62 million tons of waste annually, of which 15% is biomedical waste. Objectives: To assess the awareness of healthcare staff regarding biomedical waste management practices in the selected government hospitals of Madhya Pradesh. To determine the current practices of biomedical waste management in the hospitals. To assess the needle stick injury rate. Materials and Methods: Hospital-based cross-sectional study. The study conducted over a period of 2 months Feb 2024 to March 2024 across two randomly selected government hospitals in Madhya Pradesh. Healthcare staff (doctors, nurses, lab technicians and sanitary staff) involved in handling of biomedical waste were included. Simple random sampling was used to select the study participants in each hospital after allocating proportionate samples for the different staff categories. Data was collected using a pre-tested, semi-structured questionnaire. Results: The assessment found that 52% had moderate knowledge of BMW management while 8% had poor knowledge. Most reported following safe practices with over 80% doing things like 92% wearing gloves and 88% separating BMW. However, sometimes only 63% followed correct hospital waste disposal. 10% reported a needlestick injury in the last year, with individual carelessness and poor needle disposal being the top causes each at 40%. Conclusion: While over half demonstrated moderate knowledge of appropriate BMW procedures, there remains room for improvement as 8% exhibited poor knowledge. Keywords: Biomedical waste; Awareness; Practices; Needlestick injuries; Healthcare workers.

Background: Sleep is a physiological process essential to life. Its quality is strongly related to psychological and physical health and other measures of well-being. Sleep also allows the brain to better process new experiences and knowledge which increases understanding and retention. Aims and Objectives: To find out the percentage of altered sleeping pattern among students preparing for medical entrance. Materials and Methods: Data was collected using a Pre-Designed Semi Structured Questionnaire based on The PSQI (Pittsburgh’s Sleep Quality Index) consists of 19 self-rated question and five question rated by the bed partner or roommate. Data was entered in Microsoft excel spread sheet and analysed using Epi-data software. Chi square test was applied. Results: It was found that 55% of study population is having a sleep quality index score >5 i.e. their sleep quality is poor. There were 43% students who sleep for 6-8 hours, 27.5% who sleep for 4-6 hours, 9% sleep for 7-9 hours and 2.5% sleep >10 hours a day. Conclusion: The prevalence and effect of insufficient sleep is high among the aspirants preparing for medical entrance exams due to increasing competition, due to which they keep on delaying their urge to sleep which in turn is affecting their normal sleep-wake cycle. Also, the students are facing many sleep movement disorders at a very young age. Keywords: Sleeping pattern, Medical entrance, Students, Sleep-cycle.

Background: Understanding the variations in human skull morphology due to age and gender is crucial for applications in forensic anthropology, clinical medicine, and related fields.This study aims to assess the impact of age and gender on various skull morphological parameters across a sample of 50 individuals. Material and Methods: A cross-sectional analysis was performed using high-resolution imaging to measure cranial volume, facial angle, jawbone structure, orbital size, skull length, zygomatic width, and mandibular angle. The sample was balanced for gender with 25 males and 25 females ranging in age from newborns to the elderly (over 60 years). Results: Age-related changes were significant, with cranial volume peaking during late adolescence and decreasing slightly in older age. The facial angle and other parameters expanded or increased until reaching stability in adulthood. Notable gender differences were also observed, where males generally exhibited larger values in nearly all parameters measured. These findings are comprehensively detailed in Tables 1 and 2. Conclusion: The study highlighted significant morphological changes associated with both age and gender. Early life featured rapid growth in most parameters, which stabilized in adulthood and slightly declined in the elderly. Males displayed consistently larger skull dimensions than females. These distinctions are essential for enhancing accuracy in forensic applications and improving anthropological understanding of human skull development. Keywords: Skull morphology, age-related changes, gender differences, cranial volume, forensic anthropology, zygomatic width, mandibular angle.

Background: Inguinal hernia repairs are the one of most common type of surgeries performed worldwide. Surgical treatment of the defect is the only permanent solution. This study was done to evaluate the effectiveness of using pre-peritoneal mesh to repair the defects in patients with bilateral and recurrent inguinal hernias. Materials and methods: this prospective study was conducted including 100 patients presenting with bilateral inguinal hernias or recurrent inguinal hernia to the OPD of Department of surgery of KIMS, Narketpally over a period of 1 year. Results: 98% of the patients were males and majority of the patients were in their middle age group. Most of the patients had groin swelling as the most common presenting complaint. Most of the patients were in occupations involving heavy strength work. Smoking and lifting of heavy weights are the most commonly observed risk factors in present study. Majority of the patients had their procedures finished within 30-45 min. most of the patients had mild post-operative pain and were discharged within 2 days of the procedure. Conclusion: Open pre-peritoneal mesh repair is a cost-effective procedure with few post-operative complications, less requirement of anesthesia and short duration of surgery, early discharge from the hospital. Keywords: Hernia, pre-peritoneal mesh repair, open approach, bilateral, recurrent hernia.

Background: Uromodulin (Tamm–Horsfall protein), the most common protein in normal urine present in a bundant quantity, is increasingly considered as a potential biomarker relevant to kidney function and tubular reserve, chronic kidney disease and hypertension. A reduced number of tubular cells, is paralleled by reduced urinary and serum concentrations of uromodulin. Therefore, uromodulin might represent a promising biomarker for CKD. Aim: To evaluate the use of serum uromodulin as a biomarker in chronic kidney disease patients. Material and Methods: In an observational study, on 100 subjects with 50 normal healthy and 50 with CKD 1 – 5 stages patients attending Nephrology department in a tertiary care hospital for two years were enrolled. Lipid profile, Serum calcium, proteins, creatinine and serum Uromodulin along with e GFR was investigated. Data was analyzed using SPSS 16 and by using t test, ANOVA and correlation coefficients. Results: Mean age of the study participants was 47.47 ± 10.66 years. And 71% were male. On comparison between cases and controls, Serum Uromodulin, calcium, HDL was lower and other lab findings were significantly more in Cases than in controls. Serum Uromodulin was significantly decreased with severity of CKD. Conclusion: A comparative analysis of serum uromodulin with e GFR shows that eGFR is positively correlated with uromodulin. Lower serum uromodulin reflects a decline in kidney function. Thus serum uromodulin is a helpful marker in diagnosis of CKD at a nearly stage. The estimation of serum uromodulin level may aid in early diagnosis of kidney dysfunction and also in predicting the progression of disease. Keywords: Biomarker, Chronic Kidney disease, Renal function, Serum Uromodulin.

Background: Suspected cases of pediatric abuse often involve the administration of anaesthetic drugs, posing significant risks to the well-being of affected children. Understanding the patterns and clinical implications of anaesthetic drug usage in such cases is crucial for effective detection and intervention. This study aimed to analyze the prevalence, types, dosage patterns, clinical presentations, and forensic implications of anaesthetic drug usage in suspected cases of pediatric abuse. Material and Methods: A comprehensive observational study was conducted, involving the analysis of 100 suspected cases of pediatric abuse. Anaesthetic drug usage was meticulously examined, and data were collected regarding the types of drugs administered, dosage patterns, clinical presentations, and forensic implications. Results: Among the suspected cases, 65% exhibited evidence of anaesthetic drug usage, with Propofol being the most prevalent (40%), followed by Ketamine (30%) and Benzodiazepines (20%). High dosage administration was observed in 25% of cases, while 15% involved low dosage administration. Respiratory depression (60%) and CNS depression (45%) were the most common clinical presentations associated with anaesthetic drug usage. Additionally, 45% of cases involved the simultaneous administration of multiple anaesthetic drugs. Forensically, the identification of specific anaesthetic drugs and their dosage patterns served as crucial evidence in cases of suspected pediatric abuse. Conclusion: Anaesthetic drug usage is prevalent in suspected cases of pediatric abuse, with significant clinical and forensic implications. Our findings underscore the importance of vigilance among healthcare providers and the implementation of robust child protection measures to detect and intervene in cases involving anaesthetic drugs. Enhanced awareness and understanding of these patterns are essential for safeguarding the well-being of vulnerable children. Keywords: Pediatric abuse, anaesthetic drugs, prevalence, dosage patterns, clinical presentations, forensic implications.

Background: The physiological and psychological distinctions between children and adults pose challenges for pediatric anesthesia. The backbone of pediatric surgeries has always been general anesthesia; however, toxic consequences, especially in younger children, have prompted a reevaluation of anesthetic procedures. This concern has led to research into alternatives such as regional and neuraxial procedures. The purpose of the study is to investigate how various anaesthetic techniques affect paediatric outcomes. Material and Methods: This is prospective observational research with 120 paediatric patients having surgery that is elective. Patients who underwent general, regional, neuraxial, anaesthetic procedures were divided into 3 groups. Data on demographics, intraoperative parameters, and postoperative results gathered and analysed. Results: A total of 120 study participants were chosen for the study in order to investigate the effects of different anaesthetic techniques. Patients in Group B (regional anaesthesia) experienced 25% less postoperative pain than those in Group A (general anaesthesia) (p < 0.05). On the other hand, Group A saw a 20% greater incidence of emerging delirium than Group B (p < 0.05). Group C (neuraxial procedures) and Group A did not show statistically significant differences in postoperative pain evaluations. Instead, the scores were determined to be similar. Conclusion: Our study unfolds the importance of assessing different anaesthetic procedures in paediatric surgery. While general anaesthesia was associated with a higher incidence of emerging delirium, regional anaesthesia demonstrated improved pain control. Postoperative pain results from neuraxial surgeries were similar to those from general anaesthesia. In order to maximize patient care and outcomes, our data highlight the significance of personalized anaesthetic techniques in paediatric surgery. Keywords: Pediatric anesthesia, Anesthetic techniques, Customized anesthesia, Pediatric surgery, Anaesthesia safety.

Background: Adequate facilities for deliveries and for managing high risk pregnancy cases may not be available at all hospitals along with round the clock working staff. This study was done to identify the types of cases being referred and to study reasons for referral to tertiary care setup for management. Material and Methods: This prospective study was conducted over a period of 3 months in the Department of Obstetrics and Gynaecology, Government Maternity Hospital, Tirupati and included a total of 417 cases who were referred to this tertiary care center for further management. The following variables were analysed like age, birth order, referring facility, reasons for referral. Results: Most of the patients were from rural background. 20-40 years aged women were predominant. Primigravida women were mostly being referred. The maximum number of cases were referred from the nearby area hospitals. Previous history of cesarean section and premature rupture of membranes were the most common reasons for referral. Conclusion: Strengthening of the health care facilities and proper training of the staff so that they can decide when to refer and whom to refer can reduce the maternal mortality and morbidity significantly. Keywords: Pregnancy, Primary health care, Referral system, Tertiary hospital.

Background: Incidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70-80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing ENT surgeries conducted under general anaesthesia. Aim: The objective of the present studyis to compare the intravenous Palonosetron with intravenous Ondansetron for prevention of nausea and vomiting during postoperative period in patients undergoing ENT Surgeries underGeneral Anaesthesia. Material and Methods: This was a randomized double blindclinical study conducted on 60 ASA Grade I&II patients scheduled for ENT Surgeries under General Anaesthesia and were randomlydivided into two groups, Group I and Group II, each consisting of30 patients. Group I received 4 mg of Ondansetron I.V and GroupII received 1.5 mcg/kg of Palonosetron I.V, 30 minutes before theinduction of anaesthesia. The incidences of PONV were recorded within the first 72 hours after surgery at intervals of: 0-12 hours,12-24 hours and 24-72 hours. Episodes of PONV were identifiedby spontaneous complaints by the patients, by direct questioningand by Nausea Scale (Visual Analogue Scale) 0 -10. Results: There were no differences in the demographic databetween the two study groups. The incidence of PONV was significantly less in the palonosetrongroup (5.55%) as compared to the ondansetron group (43.33%), with a lesser need for rescue antiemetic in the palonosetron group (10% vs. 53%). Both the study groups did not have significantadverse effects reflecting that both the drugs were well-tolerated. Conclusion: In conclusion, we have found that Palonosetron at adose of 1.5mcg/Kg IV is safe and well-tolerated and proved more effective than Ondansetron 4 mg IV in the prevention of PONV. Keywords: PONV, Palonosetron, Ondansetron, ENT Surgery.

Background: Postoperative nausea and vomiting (PONV) is a common complication following surgery, with varying incidence across different types of anesthesia. This cross-sectional study evaluates the incidence, severity, duration, and management of PONV in patients undergoing surgery under general, regional, or local anesthesia with sedation. Material and Methods: A total of 100 patients undergoing various surgical procedures were grouped based on the anesthesia received: general anesthesia (n=50), regional anesthesia (n=30), and local anesthesia with sedation (n=20). Incidence, severity (mild, moderate, or severe), duration, and antiemetic management of PONV were assessed. Descriptive statistics were used to analyze the data. Results: PONV incidence was highest in the general anesthesia group, with 28 out of 50 patients (56%) experiencing PONV, compared to 9 out of 30 (30%) under regional anesthesia and 4 out of 20 (20%) under local anesthesia with sedation. The severity of PONV varied, with 18 cases of mild nausea, 7 moderate, and 3 severe vomiting reported in the general anesthesia group. Regional anesthesia yielded 6 mild and 3 moderate cases, while local anesthesia with sedation reported only 4 mild cases. The duration of PONV averaged 6 hours under general anesthesia (range: 2-12 hours), 4 hours under regional anesthesia (range: 1-7 hours), and 2 hours under local anesthesia (range: 1-4 hours). Antiemetics were administered to 34% of patients experiencing PONV under general anesthesia, 22% under regional anesthesia, and none under local anesthesia. Conclusion: General anesthesia is associated with the highest incidence and severity of PONV. Choosing appropriate anesthesia methods and managing risk factors is critical to reducing PONV. Keywords: Postoperative nausea and vomiting, PONV, anesthesia, general anesthesia, regional anesthesia, local anesthesia with sedation.

Background: Passive smoking is associated with around 0.6 million deaths worldwide each year. Over one-third of the population is frequently exposed to cigarette smoke, either directly or indirectly. Smoking by parents in the presence of their children is seen as a serious public health concern. Although the hazards associated with smoking are well established, many parents still choose to smoke around their children. Objectives: The objective of this study was to estimate the prevalence of smokers and to assess the parents’ knowledge and practice about passive smoking. Material and Methods: A community based cross-sectional study was carried out by random selection of 300 subjects from four wards in the urban field practice area of GIMS (Gulbarga institute of medical sciences) Kalaburagi, in October 2023 to January 2024.Data was collected using a pretested, semi-structured questionnaire and were entered and analysed in MS excel 2019. Results and Conclusion: 31%, 58.3% and 10.7% of subjects were having good, average and poor knowledge respectively and 43.7% of subjects were current smokers. Knowledge was significantly associated with age groups, education, occupation and socio-economic status. 58.8% were having satisfactory practices of passive smoking. The aggressive campaigns and programs need to be undertaken to enhance awareness about passive smoking among parents. Keywords: Knowledge, Practice, Passive smoking, Parents Perspective.

Background: Varicella (chickenpox) is a febrile rash illness resulting from a primary infection with the varicella-zoster virus (VZV). The disease is more prevalent in children than adults. Adults when affected manifest severe symptoms. Material and Methods: Following a sudden increase in cases in April 2023, an outbreak investigation and a matched case-control study were conducted, to assess the risk of varicella transmission among hostel inmates of a tertiary care center in Kalaburagi. Based on the clinical diagnosis, 8 cases and 32 controls matched for gender and year of course were chosen. The survey was conducted using an epidemiological case sheet, containing students' sociodemographic profile and clinical history, after obtaining written consent. Data was entered in an Excel sheet and analysed using JAMOVI software. The outbreak was described in terms of time, place, and person using descriptive statistics. The odds ratio was calculated to assess the strength of the association between risk factors and varicella infection. Results: The index case, 22 years old was detected on 7th April,2023 in boys hostel following which 7 more students were affected with a secondary attack rate of 6.93%. Mean (SD) age of cases was 20.13(1.36) years and males (75%) were most commonly affected. Majority (62.5%) presented with moderate lesions with none developing complications. All cases were identified and isolated (mean duration of 12.75(3.93) days) with strict precautions. Personal protective measures usage was significantly protective against varicella among risk factors, with an odds ratio of 0.09 (95% CI 0.01,0.51). Conclusion: With the help of active case finding, isolation, and vaccination campaigns, the outbreak was successfully controlled. Keywords: Varicella Zoster, Outbreak, Hostel, Case-Control study.

Background: Appendicitis is a frequent source of discomfort in the right iliac fossa, sometimes requiring emergency abdominal surgery. Despite clinical, intraoperative, radiographic, and histo-pathological observations, the presence of non-perforating or non-acute types of appendicitis is still questioned. Although appendectomy is considered curative, the scheduling of the procedure remains debatable, particularly in cases of non-acute appendicitis. Aim: To investigate the relationship between clinical, sonological, and histological factors in patients with right iliac fossa pain who underwent appendectomy. Material and Methods: This study was conducted on 30 cases with probable appendicitis who had appendectomy in the department of general surgery. The research included all patients who presented with right iliac fossa discomfort and underwent appendectomy. Results: The mean age was 26.46 with a standard deviation of 3.37. Within the research group, 24 patients had symptoms that indicated they had previously experienced acute appendicitis, whereas 6 patients did not have any indication of such a history. Ultrasonographic probe tenderness was seen in 22 instances, whereas it was not observed in 8 cases. The histopathology report indicated acute illness in 10 instances, accounting for 33.33% of the total, whereas chronic disease was seen in 20 cases, accounting for 66.67%. The research revealed that the ultrasonographic results had a sensitivity of 100% and a specificity of 45.50% when compared to the clinical diagnosis of appendicitis. Among the total of 15 chronic cases, 50% showed no probe discomfort, indicating a poor level of specificity. Out of the 16 patients who had moderate rebound discomfort in the right iliac fossa, indicated by a positive sign, none of them had acute inflammation of the appendix, but all 16 patients had chronic inflammation of the appendix. The investigation revealed that the surgeon's observations exhibited a sensitivity of 100% and a specificity of 90%. The X2 test yielded a P value that was determined to be very significant. Conclusion: Our research supports the suggestion made by others that there are distinct forms of appendicitis - perforating and non-perforating. Furthermore, we found that resolving episodes are indicative of non-perforating appendicitis attacks. It is crucial to identify non-acute/non-perforating variations because if surgical intervention is not performed, it may lead to prolonged symptoms, perforation, and wasteful procedures for other diagnoses. Keywords: Appendicitis, discomfort, right iliac fossa, histo-pathological.

Background: Childhood obesity is a global health challenge. Socioeconomic factors play a significant role in influencing obesity rates, with distinct variations observed between urban and rural communities. Objective: To investigate the influence of socioeconomic factors on childhood obesity rates in urban versus rural communities using an observational approach. Material and Methods: The study sampled 100 children aged 5-15 years, equally divided between urban and rural areas. Childhood obesity prevalence was determined through BMI classification. Data on socioeconomic status (SES), parental education levels, access to nutritional food, and physical activity levels were collected through questionnaires and surveys. Descriptive statistics were used to identify correlations between these factors and obesity prevalence. Results: Obesity Prevalence: Urban children had a higher obesity prevalence (36%) than rural children (28%). Socioeconomic Status: In urban communities, children from lower SES households had a 40% obesity rate compared to 32% in higher SES households. In rural communities, these rates were 36% (lower SES) and 20% (higher SES). Parental Education Levels: Urban children with parents having a high school education or less had a 45% obesity prevalence versus 20% for those with college-educated parents. In rural communities, these rates were 32% and 25%, respectively. Nutritional Food Access: Urban children with limited access to nutritional food had a 40% obesity prevalence compared to 24% for those with good access. Physical Activity Levels: Urban children with less than 60 minutes of daily activity had a 48% obesity prevalence versus 28% for those exceeding 60 minutes. Rural communities showed similar trends. Conclusion: The study highlights the significant impact of socioeconomic factors on childhood obesity rates. Tailored interventions addressing SES disparities, education, food access, and physical activity are crucial for managing obesity in urban and rural settings. Keywords: Childhood obesity, socioeconomic status, parental education, nutritional access, urban-rural comparison.

Background: Herpes Simplex Virus Type 2 (HSV-2) is a prevalent sexually transmitted infection with varying clinical manifestations. Understanding the longitudinal outcomes is crucial for managing and mitigating its impact on individuals and public health. Material and Methods: In this cohort study, 100 participants from the general population were assessed over a defined follow-up period to determine the prevalence, symptomatic status, outbreak frequency, quality of life impact, treatment adherence, and transmission risks. Participants underwent serological testing and completed questionnaires regarding their symptoms, antiviral therapy, and quality of life. Results: Among the 100 participants, 32 tested positive for HSV-2, resulting in a prevalence rate of 32%. Of these, 22 (70%) were symptomatic, while 10 (30%) were asymptomatic. Symptomatic individuals experienced varying outbreak frequencies, with 31% suffering from 4-6 outbreaks annually. Quality of life was significantly impacted in symptomatic individuals across social (64%), psychological (68%), physical (42%), and financial (35%) domains. In the symptomatic group, 75% were on antiviral therapy, which effectively reduced outbreak frequency and severity. Viral shedding was detected in 31% of asymptomatic individuals, while 16% of asymptomatic individuals progressed to symptomatic during follow-up. Two partner transmission cases were recorded. Conclusion: The longitudinal outcomes of HSV-2 infection highlight the varied clinical course and significant psychosocial impact, underscoring the importance of consistent monitoring, individualized management, and effective educational programs to reduce transmission risk and improve patient outcomes. Keywords: Herpes Simplex Virus Type 2, Prevalence, Outbreak Frequency, Quality of Life, Antiviral Therapy, Transmission Risk.

Background: Management of tibial plate fracture represents a challenging problem in developing countries. The objective of the current study is to analyze the functional and radiological outcome of bicondylar plateau fractures treated with dual plating and locking plate. Materials and Methods: This is a randomized controlled prospective study conducted in the Department of Orthopedics and Radiology at Mahatma Gandhi Government Hospital and Govt. K.A.P.V Medical College, Trichy on patients with closed Schatzker Type V and VI undergoing surgical fixation from October 2020 to September 2021. All the eligible subjects were recruited into the study consecutively by convenient sampling till the sample size is reached. Results: Atotal of 20 patients with Type V and VI Schatzker fracture undergoing surgery are divided into two groups with one group undergoing dual plating and the other lateral locking plate. The mean age was 49.1 ± 8.44 years in Dual plating group and 41.1 ± 8.74) years in Locking plate group. In Dual plating group, the functional knee society score was excellent 30%, good for 40% and fair for 30%. In locking plate group, excellent for 40%, good for 40% and fair for 20%. Conclusion: There was no statistically significant difference in functional knee society score and radiological score and outcome between the study groups (p value>0.05). For the treatment of bicondylar tibialplateau fractures, lateral locking plate fixation may yield clinical and radiological outcomes that are comparable to dual locking plate fixation. Keywords: Bicondylar, Tibial Plateau Fracture, Schatzker Types, Malunion, Dual Plating, Lateral Locking Plate.

Background: Anterior cruciate ligament (ACL) is the major stabilizer of the knee. ACL injuries are frequently associated with meniscal injuries. Aim of this study is to compare the concomitant medial and lateral meniscal injuries in patients with anterior cruciate ligament (ACL) injuries. Materials and Methods: A hospital based cross-sectional study conducted with 70 individuals aged 19 to 50 who had ACL injuries. Clinical examinations were performed to identify ACL and other soft tissue injuries of the knee joint, and positive results were further assessed and confirmed by MRI. Results: 64.29% cases of ACL injury were associated with other concomitant soft tissue injuries. Medial meniscal injuries were the most frequent concurrent injury, occurring in 45.71% of cases, while lateral meniscus injuries were the second most prevalent, occurring in 37.14% of instances. It has been determined that there is a statistically significant correlation between the duration of time since trauma and the prevalence of medial meniscus injury. Concomitant injuries were shown to be statistically significantly associated with older age groups and patients who reported later after trauma. Conclusions: Prevalence of concomitant injuries more in patients who presented late after trauma. Prevalence of concomitant medial meniscus injury increases with increasing duration since trauma. However lateral meniscus injury most commonly seen in acute cases. Key words: ACL, meniscus, trauma, age.

Background: Cancer of the uterine cervix is one of the most common cancers among women worldwide and second only to breast cancer in incidence and mortality. Epidemiological and molecular studies have shown that human papillomavirus (HPV) infection is the most important factor for cervical carcinogenesis. The p16INK4a is a cyclin-dependent kinase inhibitor that decelerates the cell cycle by inactivating the cyclindependent kinases involved in the phosphorylation of the retinoblastoma protein (RB). Expression of E6 and E7 oncogenes of high-risk (HR) human papillomavirus (HPV), affecting the RB-p16 pathway, leads to p16 upregulation. Oxidative stress is an imbalance between the prooxidant-antioxidant system. A decrease in the level of antioxidants generated free radicals, which leads to DNA damage, causing dysfunction and disease. It is caused by a disturbed oxidant-antioxidant balance in favor of oxidants, leading to excessive generation of free radicals, particularly reactive oxygen species (ROS), and biological damages. Superoxide anion (O2•−), hydrogen peroxide (H2O2), and hydroxyl radical (• OH) are kinds of ROS that are produced by partial reduction of atmospheric O2. Material and Methods: This study is hospital based study examined at the Department of Pathology and Biochemistry at Tertiary Care Teaching Hospital. On a population of 70 consecutive patients who were diagnosed with PCV, and subsequently treated at Hospital. To get two groups with a significant difference in survival, patients with PCV were divided into short-term survivors (dying within ⩽2 years of diagnosis) and long-term survivors (surviving ⩾8 years after diagnosis). All tumour biopsies were fixed in buffered formaldehyde, paraffin-embedded and diagnosed on haematoxylin and eosin-stained tissue sections. For the present study, four sections from each archived tumour biopsy were prepared and used for histological diagnosis and immunohistochemistry (thickness: 4 μm). Sections for haematoxylin and eosin staining were prepared before and after each section to confirm tumour representativity. Results: HPV types and status in correlation with clinical parameters and expression of p16. Sixty-five out of 70 patients with PCV could be evaluated for HPV status. 16 were positive for high-risk HPV and 49 were HPV negative. The majority (10 out of 16, 62.5%) of HPV-positive patients were positive for HPV16. The others were positive for HPV45 (2 patients, 12.5%), HPV18 (1 patient, 6.2%), HPV35 (1 patient), HPV56 (1 patient), and HPV68 (1 patient). Human papillomavirus positivity was significantly correlated with strong p16 expression (p= 0.045). In all, 9 out of the 49 HPV-negative patients were negative for p16 immunostaining, while the remaining 83% showed varying expression: 3 Conclusion: The vast majority of HPV positive vaginal cancers showed p16 overexpression, suggesting active involvement of HPV in the malignant transformation process. Keywords: Human papillomavirus, Cervical intraepithelial neoplasia (CIN), p16, Ki-67, p63.

Background: Management of post-operative pain has become inevitable with focus on newer methods of pain relief, and one among such methods is preemptive analgesia. Preemptive analgesia with different drugs as a part of a multimodal approach in cases of laparoscopic cholecystectomy is in vogue. This study focuses on the pre-emptive analgesic effect of different doses of Pregabalin on patients posted for laparoscopic cholecystectomy given in the pre-operative period. Material and Methods: A total of 60 ASA grade I and II patients of either sex posted for laparoscopic cholecystectomy were randomly divided into two groups. GROUP A patients received 150mg oral pregabalin, and GROUP B patients received 225mg oral Pregabalin 1.5 hours before surgery. We monitored postoperative VAS scores, intubation response, first rescue analgesia time, total analgesic requirement, RAMSAY sedation score, perioperative hemodynamics, side effects. Results: We have found that there is a significant difference between the two groups with respect to post-operative VAS scores(p<0.05). Though there is a difference between Heart Rate, MAP, Ramsay sedation score, and side effects, the difference is non-significant. Conclusion: Preemptive analgesic effect with 225mg oral pregabalin is a better alternative to pregabalin 150mg with comparable side effects. Keywords: Preemptive analgesia, Pregabalin, VAS score, MAP, Ramsay sedation score.

Background: The present study is undertaken to perform a comparison and evaluation of efficacy of dexmedetomidine and propofol as an appropriate sedative drug for Monitered Anaesthesia Care (MAC) in patients undergoing cataract surgery under day care basis in Bhaskar General hospital. Material and Methods: A total of 60 patients between the age group of 20-75 years were included in the study. They were ASA I, II or III and scheduled for the cataract surgery under MAC. After obtaining approval from the ethical committee and obtaining informed consent, patients were randomly divided into two groups, as group D(n=30) and group P(n=30) to receive dexmedetomidine and propofol respectively. Patients fasted at least 8 hours before operation and did not receive any pre-operative sedative drug. Topical anaesthesia using the sterile 0.5% proparacaine hydrochloride ophthalmic solution was applied to the eye of the patients to be operated. Group D consisted of 30 members with equal male and female distribution. These patients received Dexmeditomidine infusion of 0.6mcg/kg/hr and titrated every 5 minutes to maintain Ramsay sedation scale 3 during the operation and the drug was adjusted by the 0.1mcg/kg/hr. Group P consists of 30 members, with equal male and female distribution. These patients received propofol infusion of 2mg/kg/hr and titrated every 5 minutes to maintain Ramsay sedation scale 3 during the operation and the drug was adjusted by 0.3mg/kg/hr. The infusion was stopped at the end of the surgery in both groups. In the postoperative ward, patients were asked to answer the 11 questions of Iowa satisfaction with anaesthesia scale (ISAS) using a 6-point rating scale at least 1 hour after the operation. It was performed by one anaesthesiologist who was blinded to the group assignment. Results: In the present study, MAP, HR, respiratory rate (RR), and peripheral oxygen saturation (SpO2) were recorded at each time point as follows; T1 = preoperative baseline, T2 = anaesthesia start, T3 and T4 = 5 and 10 min after anaesthesia, T5 = operation start, T6, T7, and T8 = 5, 10, and 15 min during operation, T9 = postoperative value. MAP, HR, RR, SPO2 were compared between the 2 groups, group D and P at various time points from T1-T9 were found not to be statistically significant as p>0.05. ISAS of group D is 53.50 ±2.193 and ISAS of group P is 43.10 ±2.090. The p value between the 2 study groups is 0.0001 which is highly statistically significant. Ramsay sedation scale of 3 was maintained throughout the operation in both the study groups. Conclusion: The study showed that dexmedetomidine seems to be a appropriate sedative drug with better patient satisfaction scores for MAC compared to propofol in patients undergoing cataract surgery. Keywords: Monitered Anaesthesia Care,Propofol, Dexmedetomidine,Iowa Satisfaction with Anaesthesia scale,Ramsay sedation score, Cataract.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease. This study investigates the correlation between various serum biomarkers and disease severity to better understand disease progression. Material and Methods: An observational study was conducted with 100 T2DM participants (52 males, 48 females) aged 40-70. Participants were classified into mild, moderate, and severe categories based on clinical evaluation. Serum biomarkers such as fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), C-reactive protein (CRP), lipid profile, serum creatinine, and microalbuminuria were measured. The correlation between each biomarker and disease severity was assessed using Pearson’s correlation coefficients. Results: Significant positive correlations were observed between FPG (r = 0.68, p < 0.001), HbA1c (r = 0.72, p < 0.001), CRP (r = 0.54, p < 0.01), triglycerides (r = 0.58, p < 0.01), serum creatinine (r = 0.48, p < 0.01), and microalbuminuria (r = 0.63, p < 0.001) with disease severity. In contrast, HDL cholesterol was inversely correlated (r = -0.37, p < 0.05) with severity. Higher levels of these biomarkers were associated with greater disease progression from mild to severe. Conclusion: The study identifies significant correlations between T2DM disease severity and key serum biomarkers. Elevated levels of FPG, HbA1c, CRP, triglycerides, serum creatinine, and microalbuminuria indicate increased disease severity. Conversely, HDL cholesterol is inversely associated. These biomarkers provide critical insights into disease progression and can aid in risk stratification and targeted intervention. Keywords: Type 2 diabetes mellitus, fasting plasma glucose, glycated hemoglobin, C-reactive protein, lipid profile.

Background: Indian population experiences cancers of Lung, Breast, prostate most commonly where the disease is systemic to start with, and a high chance of metastasis to bones. Our institute experience most common radiotherapy emergency of spinal cord compression so regularly that we need to frame a protocol for this cases on priority basis and to save the linac machine time is also so precious. Objectives: To compare the overall response in patients treated with two different fractionation schedules of 4 Gy x 5 fractions versus 3 Gy x 10 fractions for metastatic spinal cord compression. Materials and Methods: It is a prospective comparative study with total number of patients enrolled in the study is 60. After obtaining informed consent, then patients were enrolled in the study. Patients with known biopsy proven tumour presenting with metastatic spinal cord compression causing lower limb motor dysfunction. Results: Results showed that overall response to radiation and ambulatory status of patients post irradiation were similar in both arms. There was no significant difference between the arms. Conclusion: Comparatively no difference in over all response and ambulatory status of patient by different fractionation. In general patients with MSCC have a poor survival and short course fractionation with 4 Gy x 5 fractions can be considered instead of the standard 3 Gy x 10 fractions. Keywords: Bone secondaries, spinal cord compression, palliative radiotherapy,30Gy/10 frctions,20 Gy /five fractions

Background: The diagnosis of acute appendicitis is mostly based on clinical assessment, and prompt action is crucial. Early detection may lead to unnecessary removal of the appendix, while delayed diagnosis can result in complications. Several criteria were periodically examined, but none of them could definitively be considered 100% accurate. Aim: To evaluate the role of total leucoycte count (TLC), absolute neutrophil count (ANC), neutrophil lymphocyte ratio (NLR) and ultrasound abdomen in patients with clinical diagnosis of acute appendicitis. Materials and Methods: The study was conducted on 100 patients. Patients with clinical features of acute appendicitis aged between 15 and 65 years were included in this study. he neutrophil Lymphocyte ratio would be obtained by dividing the percentage of neutrophils to the percentage of lymphocytes from the data available from differential leukocyte count. All patients was subjected to ultrasound examination of abdomen. Based on evidence in medical literature diagnostic categories for ultrasound abdomen are as follows. Results: 86 cases (86%) had histopathologically proven features of acute appendicitis. There were 4 cases (4%) of gangrenous appendix. Congestion of appendix (normal appendix) was seen in 14 cases (14%). 90 Patients (90%) was diagnosed to have acute appendicitis by ultrasonography. Ultrasound could diagnose appendiceal perforation in 6 cases (6%). Probable appendicitis was given in 11 cases (11%) and normal appendix in 7 (7%) of cases. Appendix could not be visualised in 3 cases (3%). Out of the total 90 cases diagnosed as acute appendicitis by ultrasound only 78 cases were histopathologically proven appendicitis. Neutrophil lymphocyte ratio (NLR) categorised as number of cases with NLR between 0 -2.5, 2.5 to 5, 5 – 7.5 and 7.5 and above. There were 17 (17%) ,63 (63%), 12 (12%), 8(8%) cases in each of these cases respectively. Out of the 86 cases of acute appendicitis 16 patients had NLR between 0-2.5 and remaining 70 patients had NLR > 2.5. 49 patients had NLR between 2.5 to 5, 9 patients with NLR between 5 to 7.5 and 8 patients with NLR > 7.5. TLC was elevated in 8 out of the 14 cases of negative appendicectomy. ANC was elevated in 11 out of 14 cases of negative appendicectomy. NLR was elevated in 13 out of 14 cases of negative appendicectomy. There was one case in which all the parameters were normal in the study and histopathology was positive for appendicitis. Conclusion: We concluded that total leucocyte count is a not specific marker for predicting acute appenditicitis, though absolute neutrophil count and neutrophil lymphocyte ratio are better markers for predicting acute appendicitis. Ultrasound of abdomen has 90% accuracy rate in predicting acute appendicitis. Keywords: Total leucoycte count, Absolute neutrophil count, Neutrophil lymphocyte ratio, Ultrasound abdomen, Acute appendicitis.

Background: Uterine rupture is a rare but life-threatening condition in obstetrics. It is the total disruption of the wall of the gravid uterus with or without extrusion of its contents, associated with high maternal and fetal morbidity and mortality. Aims and Objectives: 1. To observe the maternal outcome in the cases of uterine rupture. 2. To observe the fetal outcome in cases of uterine rupture. Materials and Methods: A retrospective study of total of 8 cases (from August 2023 to January 2024) in KIMS KOPPAL diagnosed with uterine rupture and maternal and fetal outcome noted and followed up. Results: Among 8 cases, 7 cases required emergency caesarean section, ICU admission and multiple blood and blood products transfusion whereas one case ended up in maternal mortality. Of the total cases, 2 cases required neonatal ICU admission whereas, remaining 6 cases had neonatal mortality because of complete uterine rupture. Conclusion: Uterine rupture is one of the important reasons for contributing to maternal and neonatal mortality. Identification of the high-risk pregnancies, early diagnosis, immediate referral and prompt management must be undertaken to avoid and reduce adverse feto-maternal outcome. Keywords: Uterine Rupture, Feto-Maternal Outcome, Mortality, Caesarean Section.

Background: Dementia is typically defined as a clinical syndrome of cognitive decline that is sufficiently severe to interfere with social or occupational functioning. Early onset dementia (EOD) patients differ from late onset dementia (LOD) patients on a number of clinical, neuropsychological, neuropathological, and neuroimaging variables. With this background, the current research was done to determine the psychiatric morbidity, substance use, quality of life in persons with early onset and late onset dementia and to compare the differences in above factors between early onset and late onset dementia. Material and Methods: This is a hospital based prospective study done on 50 Patients attending the department of psychiatry, SMS Medical College, Jaipur, Rajasthan, India during one-year period. Study sample had been grouped into two categories as early onset and late onset dementia (25+25) based on the age of onset (< 65). DEMENTIA SEVERITY RATING SCALE will be administered to grade the severity of dementia. Psychiatric comorbidity and substance use were assessed using MINI PLUS INTERNATIONAL NEUROPSYCHIATRY INTERVIEW scale. Quality of life was measured using DEMQOL & DEMQOL proxy scale. Data was entered into excel and analyzed using SPSS v 16.0. Mean and standard deviation were calculated to summarize continuous variables such as age, DSRS scores and DEMQOL scores Number and percentage was used to present the categorical data pertaining to the following distribution of the various socio-demographic variables, types of psychiatric co-morbidities and dementia. Results: Our study showed that the patients in late onset category were significantly older than the other group. However, majority of the patients in early onset were males (64%) and hence a little more half of the patients (52%) were accompanied by their wife. There was statistically significant higher DSRS scores (p<0.05) among those in early onset group on comparison with the late onset group. In line with the DSRS scores, the quality of life as measured by the DEMQOL scale was significantly higher (p<0.05) in late onset dementia group on comparison with early onset dementia group. All the subscales of DEMQOL construct had significantly higher scores in patients with late onset dementia. Conclusion: We concluded that participants with both early and late onset dementia had no significant differences in psychiatric co- morbidities and substance abuse. However, those with early onset dementia had significantly higher DSRS scores and less QOL scores indicating higher functional disabilities and the need for early intervention in this subgroup for better quality of life. Keywords: Early Onset Dementia, Late Onset Dementia, QOL, DEMQOL, DSRS, MINI Plus scale.

Background: Antepartum eclampsia is one of the medical disorders complicating pregnancy and the leading cause of maternal and perinatal mortality as well as morbidity. Aim and Objectives: 1) To evaluate rate of eclampsia in antenatal women attending our hospital. 2) To analyse maternal and perinatal outcome in women with eclampsia. Material and Methods: This retrospective observational study was carried out at a tertiary care institute from Sept 2023 to Feb 2024. Results: Young primigravida is a major high-risk factor in eclampsia. Conclusion: Eclampsia is a preventable risk factor if preeclampsia diagnosed in ANC. Keywords: Eclampsia, Pregnancy Outcome, ANC Care.

Background: Pregabalin is a novel drug that exhibits analgesic, anticonvulsant, and anxiolytic properties by decreasing the levels of neurotransmitters such as glutamate, noradrenaline, serotonin, dopamine, and substance P. Hence, the present study was undertaken to determine the role of oral pregabalin as premedication on attenuation of stress response to laryngoscopy. Materials and Methods: The present study was conducted among 100 patients who underwent elective surgery under general anaesthesia. Patients were randomly assigned in two groups of 50 each. Group P patients were administered oral pregabalin at a dosage of 150 mg, while group C patients were given oral placebo in the form of oral multivitamin tablet. The study recorded heart rate (bpm) and non-invasive measurements of systolic blood pressure (mmHg), diastolic blood pressure (mmHg), and mean arterial pressure (MAP) (mmHg) at various time points. A significance level of P < 0.05 was used to determine statistical significance. The analysis was conducted using the SPSS statistical tool version 20.0 (IBM in Armonk, NY). Results: Heart Rate increased significantly after laryngoscopy and tracheal intubation in all groups (P<0.05). However, the increase in heart rate was significantly lower in pregabalin group compared to the placebo group (P<0.05). Systolic blood pressure was higher from baseline values in control group during laryngoscopy (p = <0.05). Thereafter, this upsurge remained persistent throughout the surgery at all points of time till 10 minutes after laryngoscopy (p <0.05). In the pregabalin group, there was no increment, and the patients were stable at all points of time after giving the study drug with similar trend observed for diastolic and mean blood pressure. Conclusion: Pregabalin effectively reduces the physiological stress response to laryngoscopy. Keywords: Haemodynamic Stress Response; Laryngoscopy; Pregabalin.

Background: Cesarean section is the most frequent obstetric operation that is performed in cases when a vaginal delivery would put the fetus or mother at risk. Hence, the present study was conducted for comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia. Materials & Methods: 50 patients who were planned for a spinal anesthetic elective cesarean delivery were randomized into two study groups: one for ropivacaine and the other for bupivacaine. The process of administering spinal anesthesia was done while seated. Five-minute intervals were used for the assessment of the sensory block levels. The pinprick test was used to gauge the degree of sensory blockage. A visual analog scale (VAS) was used to measure the patients' pain intensity. It ranged from 0 (no discomfort) to 10 (severe pain). Data were presented as frequency, percentages, mean, or standard deviation wherever applicable. Chi square test was used to assess categorical variables between the groups. Results: Both the study groups were comparable in terms of age-wise distribution. Compared to the ropivacaine group, the bupivacaine group had sensory block onset much more quickly. Compared to the bupivacaine group, the ropivacaine group experienced total sensory blockade substantially faster. Non-significant results were obtained while comparing the pain among two study groups. Conclusion: In comparison to bupivacaine, ropivacaine produced a similar and successful clinical profile with a shorter duration of sensory block for elective cesarean sections; nevertheless, the onset time of ropivacaine's sensory blockage was much greater than that of bupivacaine. As a result, ropivacaine may be used during cesarean sections instead of bupivacaine. Keywords: Bupivacaine, Ropivacaine, Caesarean.

Background: Laparoscopic nephrectomy has been increasingly popular as a suitable treatment option for patients who are carefully chosen. It was consistently demonstrated that laparoscopic nephrectomy is equally successful to open surgical extirpation and is more easily tolerated than open surgery. Here we have retrospectively analysed experience of 104 cases of laparoscopic nephrectomy in benign disease over the last 4 years in tribal region of south Rajasthan. Materials & Methods: Between July 2019 to July 2023, we retrospectively collected all data from our database and analysed total patients who underwent laparoscopic simple nephrectomy at our institution for benign kidney pathology. We reviewed demographics, indications, preoperative parameters, peri operative records, hospitalisation, complications and follow up. Results: A total of 104 patients underwent laparoscopic simple nephrectomy for benign pathology. Mean age of the 104 patients underwent laparoscopic simple nephrectomy was (range 18-76 years). Male to female ratio was 46 :58 (44.23% v/s 55.76 %). Mean estimated blood loss was 160ml which ranges from 15ml to 400ml. Mean duration of analgesic requirement was 3.8 days range from 1.5 to 5 days. Mean hospital stay was 3.6 days (range 36 hours to 10 days). 4 out of 104 (3.84%) patients required conversion to open nephrectomy. Conclusion: Laparoscopic nephrectomy has emerged as a significant adjunct to well-established surgical methods. Due to its high level of safety and ability to be consistently replicated, laparoscopic nephrectomy has become the established method of treatment and should be made available to all patients with non-cancerous kidney conditions who are undergoing planned kidney removal surgery. Keywords: Benign Kidney Disease; Laparoscopic Nephrectomy; Renal Calculus Disease; PUJ Obstructive Nonfunctioning Kidney (NFK).

Background: Atherosclerosis, the precursor to many CVD forms, underscores the pivotal role of the vascular endothelium. Endothelial dysfunction, closely tied to conditions like coronary artery disease (CAD), hypertension, and diabetes mellitus, emerges as a critical clinical concern preceding histological signs of atherosclerosis. Within the vascular system, the equilibrium of vasodilatory and vasoconstrictor substances is paramount for vascular tone regulation, with nitric oxide (NO) showcasing significant vasodilatory effects. The endothelial response to increased shear stress results in an active release of vasoactive substances, crucial for vascular homeostasis. In cases of endothelial dysfunction, this delicate balance is disturbed, potentially leading to various vascular pathologies. Materials and Methods: The study's investigational focus revolves around the potential of shear stress assessment in the brachial artery as a surrogate marker for cardiovascular risk. By evaluating shear stress through non-invasive means, the study aims to ascertain its feasibility as a cost-effective screening test for identifying cardiovascular disease risk. Results: The data indicates that the shear stress values at both baseline and during hyperemia phases do not significantly differ between the Control and Case groups. This lack of statistical significance suggests that shear stress may not be a differentiating factor related to endothelial function or vascular health in this study. Other variables or factors may be more influential in distinguishing between the two groups regarding cardiovascular health and endothelial function. Conclusion: The data indicates that the shear stress values at both baseline and during hyperemia phases do not significantly differ between the Control and Case groups. This lack of statistical significance suggests that shear stress may not be a differentiating factor related to endothelial function or vascular health in this study. Other variables or factors may be more influential in distinguishing between the two groups regarding cardiovascular health and endothelial function. Keywords: Brachial Artery, Endothelial Dysfunction, Flow Mediated Dilation, Shear Stress, Hemodynamics.

Background: Low birth weight (LBW) is a global problem particularly in developing countries. Kangaroo mother care is defined as early, prolonged & continuous skin to skin contact between mother and baby. Our aim of this study to compare the Kangaroo mother care (KMC) with conventional method of care (CMC) in the care of low birth weight infants (LBWI) at tertiary care center. Materials & Methods: A hospital based randomized controlled study was conducted in Department of Pediatrics, JNUIMSRC, Jaipur, Rajasthan, India during one-year period. The study population included 80 consecutive singleton intramural neonates with birth weight <2000g. 40 infants who fulfilled the inclusion criteria were selected in each group. Group 1 receiving Kangaroo mother care and Group 2 receiving Conventional method of care in open radiant warmers. For the physiological parameters, the average readings in the KMC and CMC group for each parameter (oxygen saturation, temperature and weight gain) were compared with by unpaired, two-tailed 't' test and chi2 test wherever applicable. The analysis was done using the SPSS version 21.0 for windows. Results: The mean saturation of oxygen was 94.56% whereas in the CMC group it was 92.68% with a ‘p’ value of <0.01 which is statistically significant. The mean daily weight gain in the KMC group was 9.29 grams as against 7.13 grams in the CMC group with a ’p’ value of 0.0001. The mean body temperature in the KMC group was 37.180c as against 37.020c in the CMC group which is not statistically significant. The episodes of hypothermia measured twice a day for one week were 120 in the KMC group (17.15%) as against 160 (22.85%) in the CMC group with relative risk in the CMC group being 1.33 times that in KMC group. Conclusion: We conclude that KMC improves growth in low birth weight infants and has a significant role in protecting the LBW infant from hypothermia, hypoglycemia and sepsis. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all places. Keywords: KMC, CMC, LBW Babies, Hypothermia, Oxygen Saturation.

Background: Though General Anaesthesia has been the choice of Anaesthesia for performing various Urological surgeries from long time, Neuraxial Anaesthesia is also gaining popularity as a choice of technique over last few years. Our study was aimed to compare General Anaesthesia (GA) with Epidural Anaesthesia (EA)in patients posted for urological surgeries. Materials & Methods: After getting approval from Institutional Ethics Committee (H) and informed consent from the patients and attendants, 80 no of patients of ASA I and II age between 18 to 60 years undergoing urological surgeries were grouped in two groups of 40 no of subjects in each. Group GA received conventional General Anaesthesia and Group EA received Epidural Anaesthesia with Ropivacaine 0.75% at a dose of 3mg/kg admixed with 1microgm / kg of Dexmedetomidine. The cardio respiratory parameters, surgeon’s satisfaction, patient’s satisfaction, onset and duration of block and side effects were observed and documented. The data collected were analysed using students t test and chi square test for parametric data and Mann – Whitney U – test for nonparametric data. Value of p<0.05 as considered statistically significant. Results: The demographic data like age, sex, height, weight, bodymass index were comparable. The parameters like duration of surgery and anaesthesia were comparable. Postoperatively the VAS score was statistically significant at 60 minutes. The requirement of first rescue dose was significant statistically. Surgeon’s satisfaction was comparable but the patient’s satisfaction was significant statistically. Haemodynamic parameters like tachycardia, hypertension, bradycardia were statistically significant. Side effects like nausea, vomiting, headache were comparable statistically. Conclusion: Epidural Anaesthesia can be a good alternative and equally effective in patients undergoing major urological surgeries. This procedure can be adapted more confidently in patients where General Anaesthesia is contraindicated. Key words: Epidural Anaesthesia, Ropivacaine, Dexmedetomidine, General Anaesthesia, Urological surgeries.

Background: The prevalence of overweight and obesity has increased substantially across the globe over the last decades especially in the youth. One third of the world’s population can now be categorised as being overweight. Another category of young adults that are going unnoticed are those who are underweight. They should be made aware about the health implications as a result of being physically unfit. Physical inactivity is an established risk factor for cardiovascular disease, cancer, and diabetes etc. Hence it becomes a matter of immense importance to find out the prevalence of physical activity among young adults especially during the pandemic. The purpose of this study is aimed to assess the prevalence of physical activity in underweight, overweight and obese young adults and also to inculcate this routine in their daily lives. Material and Methods: A cross sectional study was done on 260 participants(selected based on inclusion and exclusion criteria) falling in the age group18-25 years studying in different institutions in a district in South Kerala. Physical activity was being assessed using GPAQ version 2 questionnaire. The level of physical activity referred in the questionnaire in each domain was presented as metabolic equivalent (MET). Height, weight, and BMI, of each student along with demographic details was collected. Results: It was found that there was a 40% of study participants follow an almost sedentary lifestyle. It is seen that those who were obese were seen to be highly active (32.4%)compared to other groups. A large percentage individuals falling under the normal BMI category was seen to be either inactive (35.9 %)or following a lifestyle of low activity (29.1%). There was statistically significant association between BMI and physical activity. Conclusion: Almost 40% of the study participants fell in the inactive group while only 24% was found in the highly active group and 13.8% in the moderately active group. Amongst the inactive group majority were female participants. Significant association with inactive group and their BMI was found. Hence our study proves the need to make the youth enlightened about the need to be physically active and encouraging them to improve their activity levels for a healthy future Keywords: MET, GPAQ, BMI, Physical activity

Background: Patient perception and satisfaction regarding services provided in Outpatient Departments (OPDs) are integral components of healthcare quality assessment. Understanding the factors influencing patient satisfaction is essential for improving healthcare delivery and patient outcomes. Material and Methods: This cross-sectional observational study aimed to comprehensively assess patient perception and satisfaction in OPDs. A structured questionnaire, adapted from validated instruments including the Press Ganey Patient Satisfaction Survey, was administered to 467 adult patients attending OPDs in South India. Descriptive statistics, inferential analyses, and regression models were employed to analyze the data. Results: In our study, a total of 467 patients were included, with the majority distributed across the age groups of 31-45 years (42.8%) and 18-30 years (32.1%). A total of 378 patients (80.9%) were satisfied with the overall experience Higher communication quality (β = 0.54, p < 0.001) and perceived cleanliness (β = 0.48, p < 0.001) were associated with greater satisfaction, while longer wait times (β = -0.32, p = 0.003) correlated with decreased satisfaction. Demographic predictors such as gender and educational background also played significant roles, with male patients and those with higher educational attainment reporting higher satisfaction levels. Conclusion: This study underscores the importance of effective communication, reduced wait times, and facility cleanliness in enhancing patient satisfaction within OPDs. Tailoring interventions to address demographic disparities and focusing on improving communication and service efficiency can optimize patient experiences and healthcare delivery in OPD settings. Keywords: Patient satisfaction, Outpatient Departments, Communication quality, Wait times, Cleanliness, Healthcare delivery.

Background: Patient turnover and high-stress environments. In these settings, emergency room doctors play a pivotal role in delivering timely and efficient care to patients with diverse and often critical conditions. However, the demanding nature of emergency medicine, coupled with long working hours, high patient volumes, and exposure to various hazards, poses significant challenges to both patient safety and healthcare provider well-being. Understanding the safety attitudes of doctors working in EDs, particularly in the context of physical violence, is essential for identifying areas of improvement and implementing effective interventions to enhance patient care quality and promote a safer working environment. Material and Methods: A cross-sectional study was conducted among emergency room doctors. Participants were recruited using convenience sampling methods. A self-administered questionnaire was used to collect data, including demographic information and responses to the Safety Attitudes Questionnaire (SAQ), a validated instrument for assessing safety attitudes in healthcare settings. SAQ scores were analyzed using chi-square tests and analysis of variance (ANOVA), to examine differences based on demographic factors and exposure to violence. Results: A total of 73 doctors participated in the study. Significant differences in safety attitudes were observed based on gender (p = 0.0001), age group (p = 0.009), designation (p = 0.0001), and exposure to physical violence/threats (p < 0.0001). Male participants, older age groups, faculty members, and those not exposed to violence exhibited more positive safety attitudes. Overall, the highest mean SAQ scores were observed in Safety Climate (64.29 ± 13.88) and Stress Recognition (63.44 ± 10.79) categories, while the lowest scores were noted in Perceptions of Management (43.75 ± 5.72). Exposure to violence was associated with significantly lower SAQ scores. Conclusion: Improving communication, addressing deficiencies in management perceptions, and implementing strategies to prevent violence are crucial for promoting a positive safety culture and enhancing patient care quality in EDs. Keywords: Emergency department, Safety attitudes, Doctors, Workplace violence, Patient safety.

Background: In healthcare settings, microbial contamination poses a significant threat to patient safety, leading to healthcare-associated infections (HAIs) and increased morbidity and mortality rates. Multidrug-resistant organisms (MDROs) further exacerbate this challenge, necessitating effective decontamination interventions to mitigate their spread. This study aimed to evaluate the efficacy of various decontamination interventions in reducing microbial contamination and MDRO prevalence within hospital environments. Material and Methods: Environmental sampling was conducted across different hospital areas, including intensive care units (ICUs), operating theaters, and patient rooms, before and after the implementation of decontamination interventions. Three decontamination interventions were evaluated: manual cleaning and disinfection, UV germicidal irradiation, and hydrogen peroxide vaporization. Around 400 surface swabs were collected from high-touch surfaces, and microbial load was quantified using culture-based methods and polymerase chain reaction (PCR) for MDRO detection. Results: Our findings revealed significant reductions in microbial contamination and MDRO prevalence following decontamination interventions. MDRO prevalence decreased by 39.4% in ICUs, 38.5% in operating theaters, and 29.0% in patient rooms post-decontamination. Hydrogen peroxide vaporization demonstrated the most significant reduction in MDRO prevalence (50.0%), followed by UV germicidal irradiation (17.2%) and manual cleaning and disinfection (21.2%). High-touch surfaces such as door knobs, bed rails, and bedside tables exhibited substantial reductions in microbial burden post-decontamination. Conclusion: The findings of this study highlight the efficacy of decontamination interventions in reducing microbial contamination and MDRO prevalence within hospital environments. Targeted decontamination strategies, particularly hydrogen peroxide vaporization, show promise in mitigating the spread of resistant pathogens and enhancing patient safety. Keywords: Decontamination, multidrug-resistant organisms, microbial contamination, infection control, hospital environment, healthcare-associated infections.

Background: The increasing prevalence of screen use among children has raised concerns about its potential impact on sleep health. Previous research suggests that excessive screen time may be linked to adverse sleep outcomes, but further investigation is needed to understand this relationship in school-aged children. This study aims to examine the influence of screen time on sleep patterns among school-aged children. Materials & Methods: A cross-sectional study was conducted with a sample size of 100 children (50 boys and 50 girls) aged 6 to 12 years. Data on screen time, sleep duration, sleep quality, bedtime, wake-up time, sleep latency, and daytime sleepiness were collected through questionnaires. Statistical analyses included t-tests, correlation analyses, and multiple regression analyses. Results: The average daily screen time was 3.2 hours, with boys averaging slightly more screen time than girls (3.4 vs. 3.0 hours; p = 0.07). The overall mean sleep duration was 8.1 hours, with children reporting ≥3 hours of screen time per day sleeping significantly less (7.6 hours) compared to those with <3 hours of screen time (8.6 hours; p < 0.01). Children with higher screen time also had lower sleep quality scores (mean = 5.4 vs. 6.8; p < 0.01), later bedtimes (10:15 PM vs. 9:30 PM; p < 0.05), later wake-up times (6:45 AM vs. 6:00 AM; p < 0.05), longer sleep latency (28 vs. 18 minutes; p < 0.01), and higher prevalence of daytime sleepiness (45% vs. 20%; p < 0.05). Correlation analysis showed a significant negative relationship between screen time and sleep duration (r = -0.45; p < 0.01) and a positive relationship between screen time and sleep latency (r = 0.39; p < 0.01). Multiple regression analysis indicated that screen time was a significant predictor of sleep duration (β = -0.38; p < 0.01) and sleep quality (β = -0.42; p < 0.01), controlling for age and gender. Conclusion: Increased screen time is associated with shorter sleep duration, poorer sleep quality, and other negative sleep outcomes among school-aged children. Interventions to reduce screen time may improve sleep health in this population. Keywords: Screen time, sleep patterns, school-aged children, sleep duration, sleep quality, sleep latency, daytime sleepiness.

Background: Type 1 Diabetes Mellitus is a chronic endocrinological condition commonly affecting children and young adults. type 1 diabetes mellitus due to its autoimmune pathogenesis is frequently associated with autoimmunity to other hormones such as thyroid. This study aims to assess the prevalence and profile of thyroid disorders in patients with type 1 diabetes mellitus. Materials and Methods: 150 patients with type 1 diabetes mellitus presenting to the OPD of Department of general medicine, Owaisi Hospital, Deccan Medical College, Hyderabad over 1 year were included in the study. The thyroid hormone profile and presence of thyroid peroxidase antibodies were estimated. Results: The most common thyroid disorder observed in present study is hypothyroidism. Amongst the ones who were tested positive of thyroid peroxidase antibodies, most of them were hypothyroid. No cases of hyperthyroidism were observed in present study. Conclusion: patients with T1DM are at increased risk of developing other autoimmune endocrinological conditions such as autoimmune thyroid disorders. Screening for thyroid disorders in T1DM patients and their timely management will prevent complications related to dysregulated thyroid hormone and glucose metabolism. Keywords: Thyroid, hypothyroid, autoimmunity, type 1 diabetes mellitus.

Background: Compared to other common causes of stroke, cerebral venous and dural sinus thrombosis is a rare disease that can be hard to spot. General cerebrovascular thrombosis and symptoms that aren't linked to a stroke can both show up. Materials and Method: This case-control study looked at people from both Department of General Medicine, Government Siddhartha Medical College, Vijayawada, Andhra Pradesh, India. The Patients were registered one at a time from March 2023 to February 2024 of the same year, after signing forms giving their permission. All of the patients had cerebral venous thrombosis, which was clinically suspected. Results: The current results showed that the levels of D-dimer were very different between the cases and the controls. Using the assay's set criteria, 44 patients were also found to have a positive test result, which is the same as 14% of the control group. This result is the same as the one from the study that looked at 54 straight people who had headaches that might have been caused by CVT. All of the patients in the emergency room had D-dimer level tests done before they got brain CT or MRI scans. Out of the 54 people who took part in the study, 10 of the 12 with CVT had higher amounts of D-dimer. Conclusion: Finally, these findings show that D-dimer tests can be a useful way to find out if someone has CVT, especially if they have acute or subacute disease. Keywords: Brain venous thrombosis, diagnostic biomarker, plasma D-Dimer.

Background: Aluminum phosphide is a pesticide that is often used to keep grain holding areas clean. It is possible to buy AlP in the form of 3 g pills. There are 56% AlP and 44% ammonium carbonate in each pill. Materials and Methods: We did a prospective case-control study in the Department of General Medicine, Government Siddhartha Medical College, Vijayawada, Andhra Pradesh, India. People who were taken to the hospital because they were poisoned by AlP from a single drug were part of this study. The study began on February 2023 to January 2024. 45 people with a normal body mass index who had not been diagnosed with diabetes mellitus before began the study. The patient's or their family's information about the exposure agent was used to make the determination. Result: Phosphorus overdose happens quickly after AlP is eaten, and most people die within the first 12 to 24 hours, mostly from heart problems. The death rate from AlP overdose is said to be between 60% and 80%, according to reports. The numbers we have for this case series match these numbers. When AlP comes into contact with water, a very deadly gas called phosphine is released. One way that phosphine is harmful is by making free radicals and stopping biochemical enzymes like cytochrome-C oxidase from working. In a rabbit model of AlP poisoning, organs were looked at and the liver, heart, and kidneys all showed clear signs of degeneration. When people are exposed to AlP, it can cause problems in many organs. Conclusion: There needs to be more research done to find out if hyperglycemia-lowering medicine could help treat AIP poisoning. Keywords: Hyperglycemia, aluminium phosphide poisoning, potential prognostic factor.

Background: To study the correlation between the grade of Diabetic Foot Ulcer (DFU) and Optical Coherence Tomography(OCT)-measured volume of macular subfield and neuroretinal rim area in patients attending a tertiary health care center of northern Karnataka. Materials and Methods: A cross-sectional study was carried out on the right eyes of 117 subjects with various grades of DFU consulting a tertiary health care centre of northern Karnataka from August 2022 to August 2023. A detailed history was taken, including demographics. DFU grading was done using the standard Wagner’s classification system of diabetic foot ulcers1. Patients with a previous history of treatment for diabetic retinopathy (DR), like laser photocoagulations and intravitreal anti-VEGF injections, are excluded from the study. Results: The mean age of the patients was 55.63+/- 12.820 years. There were 80 males (68.4%) and 37 females (31.6%). SPSS software version 20 was used to present descriptive statistics for categorical parameters using frequency and percentage. Mean and standard deviation were used for continuous parametric data. Means of different groups were compared using the ANOVA (Analysis of Variance) test. P value< 0.05 was considered statistically significant. P< 0.001 was considered highly statistically significant. Comparison of DFU grade with the OCT-measured volume of the macula (mm3) and neuroretinal rim area (mm2) showed a strong positive correlation with a P value< 0.001 and< 0.05, respectively, which are statistically significant. Conclusion: Our study reports a highly statistically significant correlation between the grades of DFU with the volume of the macula and neuroretinal rim area in all the subjects, thus concluding that patients with DFU have a higher risk of diabetic maculopathy and vice-versa, highlighting the significance of regular screening for both DFU and diabetic maculopathy to prevent serious adverse outcomes of DM. Keywords: Diabetes, Diabetic Foot Ulcer, Maculopathy, neuroretinal rim area.

Colorectal cancer is the third most common oncological disease worldwide. The standard treatment of locally advanced rectal tumors is neo adjuvant radio chemotherapy in combination with surgical resection. The choice of specific treatment algorithm is highly dependent on MRI findings. The aim of this study is to show the potential role of ADC measurements in rectal cancer and their usage in different clinical scenario. For local staging of rectal cancer, the correlation between MRI and histopathology was better when a given standard rectal imaging protocol was used. The standard protocol used in our study was T1 and T2-weighted fast spin echo sequences, Standard T2W imaging in the coronal, axial and sagittal plane of the pelvis. Axial diffusion weighted imaging with a single-shot echo-planar imaging sequence. Furthermore, the staging as assessed by MRI was in good correlation with histopathological analysis. The role of DWI as assessed by our study showed its role in localization of primary tumor and also helped in characterization of lymph node status. Keywords: MRI, DWI, Colorectal cancer, Histopathology.

Background: The aim of the study is to compare the effectiveness of phenylephrine and mephentermine in treating hypotension following spinal anaesthesia. Materials & Methods: This study was conducted at Government Medical College, Nandyala. The Study period was one year. Study population were 60 patients undergoing elective and emergency lower segment cesarean section. After obtaining Institutional Ethical Committee approval, written consent were obtained from all patients included in the study. Results: In the present study, age between Groups by Unpaired t-test were t-value=1.272, p- value=0.208>0.05 which shows no statistical significant difference between Age and Groups. SLA between Groups by Pearson’s chi-squared test. which shows no statistical significant association between SLA at 2 Mins and Groups. In comparison between APGAR at 1 Min with Groups were X2=3.068, p=0.080>0.05 which shows no statistical significant association. between APGR at 1 Min and Groups. Similarly, in comparison between APGAR at 5 Mins with Groups were X2=0.741, p=0.671>0.05 which shows no statistical significant association between APGAR at 5 Mins and Groups. Side effects between Groups by Pearson’s chi-squared test were X2=1.019, p=0.797>0.05 which shows no statistical significant association between Side effects and Groups. Systolic Blood Pressure between Groups by Unpaired t -test were all the time durations of Systolic Blood Pressure with Groups shows no statistical significant difference at p > 0.05 level. Diastolic Blood Pressure between Groups by Unpaired t-test were all the time durations of Diastolic Blood Pressure with Groups shows no statistical significant difference at p > 0.05 level whereas in comparison of Diastolic Blood Pressure at Baseline with Groups were t-value=2.314, p-value=0.024<0.05 which shows statistical significant difference at p < 0.05 level. SPO2 between Groups by Unpaired t-test were all the time durations of SPO2 with Groups shows no statistical significant difference at p> 0.05 level whereas in comparison of SPO2 at 2 mins with Groups were t-value=2.408, p-value=0.023<0.05 which shows statistical significant difference at p < 0.05 level. Heart Rate between Groups by Unpaired t-test were all the time durations of Heart Rate with Groups shows no statistical significant difference at p > 0.05 level whereas in comparison of time durations of Heart Rate at 10 Mins (t-value=3.544, p-value=0.001<0.01), 15 Mins (t-value=3.469,p-value=0.001<0.01), 20 Mins (t-value=2.819,p- value=0.007<0.01), 30 Mins (t-value=3.273,p-value=0.002<0.01) with Groups shows highly statistical significant difference at p < 0.01 level. Conclusion: In conclusion, we found that both vasopressors namely Mephentermine and Phenylephrine are effective in IV bolus form in maintenance of maternal arterial pressure within 20% limit of baseline values. Keywords: Spinal Anesthesia, Mephentermine, Phenylephrine, MAP, APGAR, SPO2.

Background: Maternal health is important for the development of any country in terms of increasing equity and reducing poverty and is important in their own right and is central to solvingeconomic, social and developmental challenges. Hence, maternal mortality is the key indicator ofhealth and socio economic status and development of a community and the whole national system. Aims and objectives: To study the factors responsible for maternal mortality and to analyse the causes and trends in maternal mortality. Materials and Methods: A retrospective study on maternal deaths that occurred in the maternity ward of Government General Hospital, Siddhartha Medical College, Vijayawada during the period ofOne year from January 2022 to December 2022. Covid related deaths excluded. Results: Total 56 maternal deaths occurred during the study period. 52 maternal deaths (92.90%) were unbooked cases, 4 (07.10%) were booked cases. 24 women (42.93%) were primiparous,32(57.07%) were multiparous. 38 women (67.90%) were of 20-24 years age, 8 women (14.33%)wereof 25-29 years age,10 women were (17.80%) were of 30-34 years age. Maternal deaths due to direct causes were 38 (66.92%) and due to indirect causes were 18(33.08%) Hypertensive disorders complicating pregnancy was the leading cause of death followed by hemorrhage in pregnancy. 39(69.64%) maternal deaths occurred after delivery, 8 deaths (14.21%) during 3rd trimester of gestation. Type 1 delay (20.74%), type 2 delay (57.7%) type 3 (21.48%) delays contributed to the maternal deaths. Conclusion: Health education regarding adolescent health, pregnancy, abortion and contraception. Regular antenatal checkup, early identification of risk factors, awareness, timely intervention and referral to higher institute, proper intra natal and post-natal care, multispecialty team management inhigh risk cases are needed to reduce the maternal mortality. Keywords: Maternal Mortality, Hemorrhage, Complicating Pregnancy, Health Education, Antenatal Check-up.

Background: CT scan assesses articular surface depression and comminution. Also, it delineates fracture pattern, size of fracture fragment, shape, and location for surgical planning. A lipohemarthrosis is an indication of an occult fracture. CT scan can alter fracture classification and a treatment plan formulated based on the initial radiographs. The present study was undertaken to identify advantages in management of proximal tibia plateau fracture with help of CT- scan based three column classification. As this is recent advances, outcome of this study will highlight the usefulness of this classification in identification of complex fracture pattern. Materials and Methods: The present study enrolled 56 patients with proximal tibia fractures. Once stabilized, relevant X-rays and CT scan were asked for. Fractures were classified according to Schatzker’s classification and three column classification. The various parameters pre and post surgery were assessed as per three column classification. Data was collected and descriptive statistical methods and expression of results in terms of mean, chi-square test and others using Microsoft excel software with significant p value <0.05 were used for computation of data. Results: We had 43(86%) of patients operated with open technique while 7(14%) of patients were operated with MIPPO technique. Due to complexibility of the fracture (due to more involvement of two columns and three columns patients) we have chosen our first surgical treatment as open reduction and fixation. During 3 column fracture fixation, among total 8 patients in 4 patients 2 plates were used, in 2 patients 3 plates were used and in one patient 4 plates were used. During 2 column fracture fixation, among 15 patients, 2 plates were used in 12 patients and 3 plate was used in1 patient. 92% patients achieve union status within 6 months of the surgery. Conclusion: CT scan-based 3 column categorization for tibial plateau fracture therapy is the study's major goal. Our patients' functional outcomes are acceptable, showing that CT scan-based 3 column categorization can help evaluate fracture pattern and choose a method. Previously employed Schatzker classification never addresses posterior column fracture, limiting articular comprehension and surgical planning. In contemporary era, all tibial plateau fractures necessitate a CT scan as CT scan-based three-column classification simplifies complex fracture care. Keywords: MIPPO Technique; Three Column Classification; Tibial Plateau Fractures.

Background: Atypical eclampsia denotes the onset of seizures after 48 hours of delivery or within 20 weeks of gestation without typical features of Preeclampsia. Aims and Objectives: 1) To detect the features of atypical eclampsia in preeclamptic patients at earlier stages 2) To analyse the maternal outcome in women with atypical eclampsia. Material and Methods: A retrospective case series reported at a tertiary institute from May 2023 to April 2024. Results: Out of the 7 cases studied,1 patient ended up with intracranial hemorrhage, 2 patients had PRES- Posterior Reversible Encephalopathy Syndrome, other 4 patients had no radiological abnormalities. Conclusion: All of the patients had atypical features of Preeclampsia. Thus, early detection of PIH, and other atypical forms help in better management and decreasing overall preeclampsia associated complications. Keywords: Atypical Eclampsia, Proteinuria, Doppler Changes.

Background: The accurate estimation of gestational age is crucial in identifying prematurity and other health problems in newborns and in providing appropriate perinatal care. Although there are numerous methods for measuring gestational age, they are not always applicable. The main purpose of this study was to design a simple method in assessment of gestational age in rural health centre done by low skilled personnel in low resource setting by using anthropometric parameters. Material and Methods: This cross sectional observational study was carried out in 200 babies born in Department of Pediatrics Tertiary Care Teaching Institute of India for the duration of 1 year. The data were collected using semi-structured questionnaire and anthropometric assessment. Results: The mean gestational age among neonates studied is 37.10±2.45 weeks, around 3% were early preterm, 6% were moderate preterm, 22% were late preterm and 68% were term. The mean birth weight is 2.60±0.51 kg in our study, the mean head circumference is 33.80±1.10 cm, and majority of them babies had head circumference 33 cm (Table 2). The mean chest circumference is 31.01±1.25 cm, and majority of the babies, had chest circumference of 30 cm and above, the mean foot length is 7.40±0.50 cm and the mean length of the babies is 48.24 ±1.30. Conclusion: Anthropometeric parameters in combination and as single parameters were a simple and easy tool for assessing gestational age in low resource setting where we can make a quick referral. Analyzing anthropometric measures after delivery allows a quick assessment of infants with unusual growth more vulnerable to metabolic complications. Keywords: Anthropometeric Parameters, Gestational Age, Neonates, Preterm.

Background: Patients perceptions of the quality of care and services they receive at a healthcare practice offers practitioners and staff the valuable information and data. Which is a valuable tool for building improvement efforts. One method for collecting information about patient experiences is patient satisfactions surveys. Patient satisfaction also serves as a performance measure for quality of health care. Objectives: (1) To study level of patient satisfaction at Tertiary Care Hospital. (2) To study the different factors affecting patient satisfaction. (3) To recommend the measures for improvement of services. Materials & Methods: A cross-sectional study conducted out in Tertiary Care hospital in Indore district M.P. over 3 months. The subjects included 200 OPD patients selected by simple random sampling. Pre designed semi structured questionnaire were administered to the study participants. Data was entered into Microsoft Excel and analyzed by using SPSS Software 25.0. Necessary appropriate statistical tests were applied. Results: 67% patient were completely satisfied with behavior of consultant however 28.9% were partially satisfied. While with hospital staff only 54.5% patients were satisfied with their behavior. As for as supply of medicine only 58% of patients think that they got all the medicine from hospital. Regarding investigations 77.2 % patients think that investigations recommended by the doctor are available in hospital but only 59.3% patient received their report timely and 68 % patient got relief from the medicine provided by the hospital. Conclusion: As per the study results majority of patients were satisfied with the hospital services like behavior of consultant, investigations and diagnostic facilities as well as relief from the medicine supplied by but only half of the study subjects were satisfied with medicine availability and staff behavior hence efforts should be made in this area to improve patient satisfaction. Keywords: Patient satisfaction, Quality of health care, Tertiary Care Hospital.

Background: Helicobacter pylori infection is one of the most common cause of chronic gastritis in India and world-wide. There are lots of ongoing research in white light endoscopic and narrow band imaging appearances to diagnose helicobacter pylori infection. In this study we aimed to find out the efficacy of white light endoscopy and narrow band imaging (NBI) in diagnosing H pylori infection. Material and Methods: A total of 127 patients were included in our study after fulfilling the inclusion and exclusion criteria. Clinical history was taken thoroughly with demographic profile like age, sex, BMI, comorbidities and biochemical parameters. The patients were then subjected to esophagogastroduodenoscopy initially by white light imaging and later by narrow band imaging. Values and findings were recorded after attaining informed consent. Results: Out of the total 127 patients, 82 were H pylori positive. Of these 78 (61.40%) were males and 49(38.60%) were females. The percentage of H pylori infection rate was almost equal in both above and below 50 years age group, with slightly more below 50 years. The diagnostic accuracy of standard and NBI endoscopy are 82.68% and 89.76% respectively. For gastric atrophy accuracy of Standard and NBI endoscopy was 57.28% and 57.48% respectively. For Intestinal metaplasia it was 66.14% and 88.98% respectively. Conclusion: Narrow band imaging is an advanced tool to help in enhanced detection of gastritis caused by Helicobacter pylori and gastric precancerous condition like intestinal metaplasia, Keywords: Endoscopy, Narrow-band imaging, Helicobacter pylori, Gastric atrophy, Intestinal metaplasia, Body mass index.

Background: The perception of body image, particularly among young adults, plays a pivotal role in shaping their life perspectives. The capability to quantify body perception could facilitate the development of interventions aimed at assisting this demographic. Materials & Methods: An observational cross-sectional study was conducted with 266 volunteers aged 18-25. Participants’ height and weight were recorded, and they completed a Google form on their cellphones. The form included the Body Image Assessment Scale–Body Dimensions (BIAS-BD) Scale. Body Surface Area (BSA) and Body Mass Index (BMI) were computed. Participants selected their Perceived, Desired, and Ideal Body Images from the BIAS-BD Scale’s contour drawings. The Actual Body Image (ABI) was determined by correlating the participant’s BMI to the BIAS-BD scale. A novel metric, Body Image Perception Error (BIPE), was calculated as the difference between Perceived and Actual Body Images, indicating underestimation, correct estimation, or overestimation of body image. Data were analyzed using Excel and DATA Tab software. Results: Body images can be underestimated, accurately estimated, or overestimated. The Body Image Perception Error (BIPE), the difference between Perceived and Actual Body Images, helps identify factors contributing to these perceptual errors. As BMI and weight decrease, BIPE transitions from underestimation to accurate estimation to overestimation, suggesting thinner individuals overestimate their weight, while heavier ones underestimate it. The Actual Body Image (ABI) correlates with this finding. As BIPE transitions from underestimation to overestimation, the sizes of perceived, desired, and ideal body images increase, indicating that perception errors influence desired and ideal body images. As height increases in males, BIPE transitions from underestimation to overestimation, suggesting taller males perceive themselves to be larger than they are. Conclusion: BIPE can be used to identify body image disorders, formulate public health interventions, and guide educational programs on body image. Keywords: BIPE, BIAS-BD, Body Image Perception.

Background: The emergence of multidrug-resistant (MDR) organisms, particularly those producing Extended Spectrum Beta-Lactamases (ESBL) and AmpC beta-lactamases, is a global threat, often leading to the failure of beta-lactam therapy. This study aimed to establish the prevalence and co-production of ESBL and AmpC among Escherichia coli and Klebsiella spp. isolates in a tertiary care hospital in North Karnataka. Materials & Methods: A hospital-based cross-sectional study was conducted at KIMS Koppal from July 2021 to December 2021. A total of 100 non-repetitive E. coli and Klebsiella spp. isolates resistant to third-generation cephalosporins or MDR were collected from various clinical samples. ESBL production was confirmed using ceftazidime/clavulanic acid and cefotaxime/clavulanic acid discs, while AmpC production was suggested by resistance to cefoxitin and susceptibility to cefepime. Results: Of the 100 isolates of E.coli 38 were ESBL producers , 13 were AmpC producers, 9 were detected as co-producers of ESBL and AmpC and from 100 isolates of Klebsiella spp 24 were ESBL producers (ESBL Producers- 38% E. coli and 24% Klebsiella spp.), and 8 were AmpC producers, 6 were co-producers of ESBL and AmpC (Amp C producers 13% E. coli and 8% Klebsiella spp.). Co-production of ESBL and AmpC was observed in 9% E. coli and 6% Klebsiella spp. High-risk groups included patients with prolonged hospital stays, prior antibiotic use, and underlying chronic conditions such as diabetes and immunosuppression. The study highlighted the need for routine screening and cautious use of carbapenems. Conclusion: The prevalence of ESBL and AmpC producers in North Karnataka underscores the importance of targeted infection control measures and appropriate antibiotic stewardship to mitigate the spread of MDR organisms. Keywords: ESBL, AmpC, E. coli, Klebsiella spp., multidrug resistance, North Karnataka, tertiary care hospital, antibiotic stewardship.

Background: Breast milk is the ideal complete food for infants. It is uncontaminated and contains all the vital nutrients and antibodies required for the survival of the child for the first few months of their lives. This study was done with an aim to assess the knowledge, attitude, and breastfeeding practices of mothers in tribal villages and also to assess the perinatal outcomes of these practices. Materials and Methods: A cross-sectional observation study was conducted in the tribal village Buttyagudem project of Eluru by the Department of pediatrics, Alluri Sitaramaraju Academy of Medical sciences, Eluru, over a period of 1 year. A total of 357 tribal mothers were included in the study. Results: Prelacteal feed is practiced by13.7% of tribal mothers.5.3% didn’t give colostrum. 68.6% of mother initiated breastfeeding within first hour of delivery. 95% of tribal women exclusively breast feed their infants. Continued breast feeding at 1 year is 93.8% and 96.2% up to 2 years of age. Conclusion: This cross-sectional study concludes that the breastfeeding practices prevalent in the tribal villages of Eluru district need improvement which can be done by implementation of breast feeding groups and support system for educating the women about good practices. Keywords: Breastfeeding, tribal women, nutrition, infant, cultural practices.

Background: Exclusive breastfeeding upto 6 months of age ensures provision of adequate fluids and nutrition to the infant. This study was conducted with an aim to assess the knowledge, attitude, factors influencing exclusive breastfeeding practices in women of urban areas. Materials and Methods: This cross-sectional observational study was conducted by the department of pediatrics, Alluri Sitaramaraju Academy of Medical Sciences, Eluru, Andhra Pradesh over a period of 1 year. This included 449 mothers residing in the urban slums of Eluru town. Results: Prelacteal feed is very common in urban area 6.9% of mothers didn’t give colostrum. 42.7% initiated breastfeeding within 1st hour of delivery. Conclusion: Breastfeeding practices vary according to local cultures. Promotion of institutional deliveries will have positive impact on early breast feeding behaviou, along with antenatal sensitization about feeding colostrums and exclusive breast feeding. Keywords: Breastfeeding, urban slums, exclusive breastfeeding, ICDS.

Background: A disorder known as varicose veins is characterized by elongated, dilated and convoluted veins in the legs. Blood flow via this damaged valve reverses, which is its defining feature. Pregnancy, extended standing, female sex and a history of phlebitis are risk factors for varicose veins. The Trendelenberg procedure, vein stripping, stab avulsion, subfascial endoscopic perforator surgery, sclerotherapy and minimally invasive techniques including radiofrequency ablation and endovenous laser therapy are among the several treatment options for varicose veins. Objectives: To derive conclusions about efficacy of treatment in Perforator incompetence between stab avulsion, foam sclerotherapy and subfascial ligation. Material and Methods: This study is single centre prospective single blinded randomized control trial on patients with varicose veins up to CEAP classification 2 in Kanyakumari Government Medical College Hospital, Asaripallam for 3 months. Results: The study which was conducted among 45 patients with majority of male patients. Foam sclerotherapy is associated with lesser incidence of wound infection, hematoma formation, post-operative pain, scar /pigmentation and less recurrence rates than subfascial ligation and stab avulsion group. Conclusion: Foam sclerotherapy is associated with lesser incidence of wound infection, hematoma formation, post-operative pain, scar /pigmentation and less recurrence rates. Keywords: Stab avulsion, sclerotherapy, subfascial ligation, varicose veins.

Background: Diabetic Nephropathy is a major micro vascular completion of Diabetics mellitus and the most common cause of End Stag age Renal Disease (ESRD). Serum sialic acid, an acute phase reactant and acute phase reactants are considered as indicators of microvascular angiopathy. Microalbuminuria is a predictor of incipient nepropathy in Diabetic patients. Aim: The study was under taken to evaluate Serum Sialic acid and Microalbuminuria levels and to assess to correlation of serum sialic acid and Microalbuminuria in Diabetic Nephropathy patients. Materials & Methods: The study population consis of two groups. Group-I, 50 clinically dignosed cases of Diabetic Nephropathy. Group-II, 50 individulas with age and sex matched healthy persons were taken as controle. Blood samples were anylised for Fasting blood sugar, blood urea, and serum creatinine, glycated HbA1C and serum sialic acid levels. Urine samples were analysed for microablbumin levels. Results: Serum Sialic acid levels were found to be significantly increased in Diabetic Nephropathy comparative controls. Serum sialic acid level was statistically correlated with glycated HbA1C, blood urea, serum creatinine and urinary microalbumin. Conclusion: Estamition of Serum sialic acid levels will help in early prediction and prevention of microvascular complecations like Diabetic Nephropathy. Keywords: Diabetic Nephropathy, End Stag age Renal Disease (ESRD).

Background: Ectopic pregnancy, defined as the implantation of a blastocyst outside the endometrial lining of the uterus, is a significant global contributor to maternal mortality during the first trimester. Histopathological examination of ectopic pregnancy specimens plays a crucial role in both diagnosis and the identification of underlying factors that predispose a woman to this condition. While fallopian tube implantation accounts for over 95% of ectopic pregnancies, the etiology is likely multifactorial, with numerous risk factors potentially contributing. This study investigates the risk factors associated with ectopic pregnancy within our specific population, with a particular focus on the potential association between ectopic pregnancy, chronic salpingitis, and salpingitis isthmica nodosa. Material and Methods: This study retrospectively analysed 50 surgically resected fallopian tube specimens obtained over a two-year period. The specimens encompassed patients of all age groups. Routine histopathological techniques were employed for processing, with detailed examination of Hematoxylin and Eosin stained slides. Additionally, a comprehensive review of patient medical records was conducted to extract detailed clinical history and assess potential risk factors. Results: The present study included a total of 50 cases confirmed through histopathological analysis. Chronic salpingitis emerged as the most frequently identified histopathological finding. Furthermore, analysis of patient medical history revealed that a prior history of tubal sterilization and pelvic inflammatory disease (PID) were the most prevalent risk factors. Conclusion: In conclusion, the present study demonstrates that chronic salpingitis is the most frequently encountered histopathological finding in patients with tubal ectopic pregnancy. This observation is further strengthened by the association identified between chronic salpingitis and a prior clinical diagnosis of pelvic inflammatory disease (PID). Keywords: Ectopic Pregnancy, Tubal gestation, Chronic Salpingitis, Salpingitis Isthimica Nodosa, Pelvic Inflammatory Disease.

Background: Chronic ulceration of the lower leg is a common ailment that occurs often in those over the age of 60. The prevalence of ulceration is increasing because to the aging population and heightened risk factors for atherosclerotic occlusion, such as smoking, obesity, and diabetes. Ulcers are characterized as sores that penetrate through all layers of tissue and have a propensity to heal slowly. Typically, the sluggish healing process is not just determined by the depth and size of the wound, but rather by an underlying pathogenetic element that must be eliminated in order to promote recovery. The primary factors contributing to this issue include venous valve insufficiency, lower extremity vascular disease, and diabetes. Less common causes include infection, vasculitis, skin cancers, and ulcerating skin illnesses including pyoderma gangrenosum. Aim: To determine the clinicopathological characteristics of ulcers on the lower limb and developing effective management strategies. Materials and Methods: A total of 100 patients with lower leg ulcers were included in this research, all of whom attended the surgery outpatient department and were subsequently admitted to the surgery ward. The research included patients who expressed their willingness to participate, patients who were experiencing any kind of lower leg ulcers, and patients aged between 18 and 65 years. Results: Among the 12 patients in our research who had varicose veins, the ulcers were determined to have a venous origin. Out of the patients included in our research, 8 individuals had symptoms of Raynaud's phenomenon. Additionally, the ulcers seen in these patients were shown to have an arterial origin. Among the 33 patients in our research who had loss of feeling, the primary causes of ulcers were diabetes, followed by arterial and venous factors. Our investigation found that 10 individuals had a lack of peripheral pulses, with arterial reasons being the primary factor contributing to the development of ulcers, followed by venous factors. Out of the total number of patients in our research, 43 of them had hypertension. The main causes of ulcers were diabetes, followed by an equal number of ulcers caused by arterial and venous factors. Out of the 58 patients in our research, the primary cause of ulcers was diabetes, followed by venous and arterial factors. Among the 65 patients in our research, a history of smoking was present. Our research included 45 patients who had surgical debridement. In our research, 15 individuals had amputation. Conclusion: Our clinic's pathological examination highlights the need of a comprehensive, interdisciplinary approach to diagnosing and treating lower leg ulcers, in addition to contributing to the growing body of knowledge on this topic. Keywords: Clinicopathological, Ulcers, Lower limb.

Background: The study was done to compare the efficacy of Video laryngoscopy with direct laryngoscopy among adults undergoing endotracheal intubation. Materials and Methods: Patients undergoing elective surgery under general anaesthesia were randomly allocated into two groups. Group VL underwent endotracheal intubation by a video laryngoscope (King Vision®) and group DL underwent endotracheal intubation by a direct laryngoscope (Macintosh). Success rates, number of attempts, duration of laryngoscopy, incidence of hypoxia and dental trauma, oesophageal intubation, Percentage of Glottic Opening (POGO), instances of failed intubation and hemodynamic parameters were assessed in both groups. Results: The mean number of intubation attempts was slightly higher in the DL group, but there was no significant variation between the two groups. (DL - 1.33 vs VL – 1.2, p = 0.231) Similarly, there was no statistically significant difference in the mean duration of laryngoscopy between the two groups. (DL – 26±4.2670 seconds vs VL – 24.83±4.0350 seconds, p = 0.28). One patient in the DL group experienced hypoxia, and another patient in the same group suffered dental trauma. A statistically significant difference was observed in oesophageal intubation rates between the two groups. (DL - 11 vs VL – 3, p = 0.01) Additionally, there was a significant variation in the mean POGO score between the DL and VL groups. (DL - 38.43±27.6402 vs VL – 58.7±34.8110, p = 0.01). Conclusion: In the operating room setting, video laryngoscopy enhanced intubation success rates and offered a clearer view of the larynx, although the improvement was not statistically significant. Additionally, it effectively reduced the incidence of oesophageal intubation compared to direct laryngoscopy. Keywords: Endotracheal Intubation,Laryngoscopy, POGO Score, Hemodynamic Parameters.

Background: The present study aimed to evaluate and compare the shear bond strength (SBS) of self-etch primer (SEP) and the conventional acid etching procedure for bonding orthodontic brackets (OB). Materials and Methods: A 0.1% thymol solution was used to collect and preserve 20 recently extracted human premolars. A total of 20 stainless steel maxillary premolar brackets were used. Both groups used the Transbond XTTM Light Cure Adhesive system (3M Unitek) to evaluate two distinct approaches to enamel preparation before bonding by providing a consistent bonding sequence. The experimental group (n=10) used Transbond Plus SEP, a sixth-generation adhesive composite developed for orthodontic bonding. The control group (n=10) used the conventional etchant, TransbondTM XT Light Cure adhesive primer, and paste. The SBS was evaluated using an Instron Universal Testing Machine. The external experimental setting had a 50% humidity level and a room temperature of 32°C. A specially designed clamp was employed to secure and link each acrylic block to the crosshead, ensuring stability. The bracket was firmly attached by threading a 21-gauge stainless steel wire of sufficient length through the base of the bracket aperture. The wire was fastened to the upper limb of the device at the other end. The acrylic block was oriented such that the bracket slot formed a perpendicular angle with the floor. The computer measured the SBS of the bonding material as the amount of force at which the bond failure occurred. The force required for bond dissociation was quantified in Newtons and tabulated for each subgroup. The analysis was performed using SPSS version 25.0. The unpaired t-test was employed to ascertain the significant differences in SBS between the two groups. The statistical test of significance was set at p<0.05. Results: The control group endured a mean SBS of 9.669 ± 1.129 MPa, while the one-step self-etch primer/adhesive group demonstrated an average SBS of 6.927 ± 0.736 MPa. The samples in Group 2 exhibited a higher SBS in comparison to the samples that were bonded using a SEP in Group 1. Conclusion: Both groups exhibited SBS that was deemed clinically acceptable. By limiting the number of stages involved in bonding the OB to the teeth, practitioners could conserve time and decrease the risk of inaccuracies and contamination during the bonding process. Keywords: Adhesive system, Bond failure, Orthodontic brackets, Self-etch primer, Shear bond strength.

The treatment of a chronic posterior dislocation of the shoulder is often determined by the size of the associated impression fracture of the humeral head. Recurrent instability secondary to humeral head defect in contrast to anterior dislocations is quite common. Depending on the size of the defect and the duration of dislocation, the different treatment options are described. The procedures of choice when the bone defect is between 25% and 50% of the articular surface of the head include autologous bone graft or allograft or subscapularis tendon or lesser tuberosity transfer. In neglected cases in which patients undergo surgery more than 3 weeks after injury, no standard accepted treatment for this injury exists. This article presents three treatment options; two are modifications of the McLaughlin technique and the other using an allograft cap for patients with neglected locked posterior dislocation of the shoulder. Using these techniques, the shapes of the humeral head were nearly restored. Postoperative rehabilitation included immobilization of the shoulder with an external rotation brace for 6 weeks followed by progressive passive, active-assisted, and active range of motion and rotator cuff strengthening exercises for another 6 weeks. These techniques resulted in pain-free range of motions, stable shoulders, and good joint congruency. Keywords: Reconstruction of neglected chronic locked posterior shoulder dislocation, Modification of the McLaughlin technique, Allograft cap.

Background: Diabetes mellitus, a chronic metabolic disorder characterized by hyperglycemia, affects millions of people worldwide. The study aims to identify key risk factors contributing to the development and progression of diabetic foot in patients with PAD. Material and Methods: Patients admitted and seen in the outpatient department for diabetic foot ulcers between October 2023 and January 2024 in the Department of General Surgery, at Sri Lakshmi Narayana Institute of Medical Sciences Puducherry India, were included in this study. Results: The prevalence of peripheral arterial disease (PAD) among the study population is represented as 36%, indicating that over one-third of the patients with diabetic foot ulcers also have PAD. The mean age of patients with PAD was 42.17 years, slightly higher than the 41.35 years for those without PAD, though this difference was not statistically significant. The site of arterial narrowing or occlusion was categorized into several regions: aorto-iliac, iliac, femoral, femoro-popliteal, and popliteal. Among the 36 patients with PAD, 3 patients (8.3%) had aorto-iliac narrowing or occlusion, 4 patients (11.1%) had iliac involvement, 7 patients (19.4%) had femoral involvement, 12 patients (33.3%) had femoro-popliteal involvement, and 10 patients (27.9%) had popliteal involvement. Conclusion: According to the findings of this study, the percentage of individuals who have diabetic foot who have peripheral artery disease is approximately 36%. Keywords: Diabetic foot, Peripheral arterial disease.

Background: Ultrasound-guided procedures have been increasingly utilized in patients for perioperative analgesia, one such method is ilioinguinal/iliohypogastric (II/IH) nerve block for surgical procedures like hernioplasty. Material and Methods: Forty-five adults aged 18 to 60 years with the American Society of Anesthesiologists grade I or II were included in the study. After spinal anaesthesia, patients of Group A received USG-guided IIN/IHN block using 22ml of 0.25% levo-bupivacaine with Dexmeditomedine 0.75ug/kg, and those in Group B received IIN/IHN block using 22 mL of 0.25% levobupivacaine with 1ug/kg Dexmeditomedine. VAS score between the two groups, time to first rescue analgesia were the primary objectives; total analgesic consumption, hemodynamic effects, and other side effects were also evaluated. Results: The mean VAS score of Group B is less than that of Group A, with a significant P-value (<0.05). The time for the first rescue analgesia of Group B (1050±98min) is more than that of Group A (789 ± 66min) with a significant p-value (<0.05). The mean values of sedation scores between the two groups did not show any significant difference, p values(p>0.05). The mean value of the mean arterial pressure heart rate of group B is less than that of group A in the post-operative period, with a significant p-value (<0.05). Conclusion: Post-op analgesia with 0.25% Bupivacaine with Dexmeditomedine 1mcg/kg given via ilioinguinal/iliohypogastric nerve block has a longer duration of action, less total analgesic consumption than 0.25% Bupivacaine with 0.75 mcg/kg Dexmeditomedine but with significant, bradycardia as a side effect. Keywords: Ultrasound, Ilioinguinal/iliohypogastric nerve, Inguinal surgery, levo- Bupivacaine, Dexmeditomedine.

Background: Tuberculosis (TB) is the world's serious public health issue with a burden of estimated 8.7 million new cases and 1.4 million deaths annually. A significant problem in isolated and rural areas is the diagnosis and treatment of tuberculosis. Aims & Objectives: To evaluate the diagnostic accuracy of the GeneXpert MTB/RIF assay for the detection of M. tuberculosis along with the sensitivity & resistance for the rifampicin in pulmonary and extra pulmonary specimens and to compare it with conventional techniques. To access diagnostic usefulness of Gene Xpert MTB/RIF assay technique in management of tuberculosis. Material & Methods: A cross sectional Study was conducted at tertiary care hospital Ahmedabad from 1 August 2021 to 30 November 2021 with enrollment of 616 total samples. The samples were subjected to Ziehl-Neelsen (ZN) staining, GeneXpert MTB/RIF (Cepheid, Sunnyvale, US) assay. Results: Total no. of samples were 616 included both pulmonary & extra pulmonary. Out of total samples, 516 samples were pulmonary (sputum, Broncho-alveolar lavage & gastric aspiration) & 100 samples were extra pulmonary (pleural fluid, cerebrospinal fluid &ascitic fluid). Out of 516 pulmonary samples 256 (49.21%) had shown Mycobacterium Tuberculosis detected by Gene Xpert. Out of this 256 samples, 84 (32.81%) samples were found AFB smear negative & 172 (67.18%) samples were AFB smear positive. Out of 516 Pulmonary samples 260 (50.38%) had not shown Mycobacterium Tuberculosis by Gene Xpert. Out of this 260 samples, 252 (96.92%) samples were AFB smear negative & 08 (3.07%) samples were found AFB smear positive. Out of total 256 positive samples, 232 (90.90%) samples were sensitive for rifampicin and 24(9.37%) samples shown resistance. Conclusion: Gene Xpert is better tool for identification of mycobacterium tuberculosis and rifampicin sensitivity from the same sample within 2 hrs. Compared to microscopy it detects 34% more no. of cases with higher specificity. Keywords: Tuberculosis (TB),Multi drug resistance (MDR),Extended drug resistance (XDR).

Background: Aims and Objectives: 1. To detect Hearing loss, among patients with Type 2 Diabetes Mellitus based on age, gender and duration of diabetes and glycemic control. 2. To assess hearing loss using pure tone audiometry and also serial tuning fork tests. Materials and Methods: A total of 100 patients with type 2 diabetes, aged 35 to 70 years, were randomly selected to participate. All patients underwent clinical ear examinations and were referred for full audiological evaluation. Results: Of the 100 patients with diabetes,61% of patients are in the age group of 45-65 with male preponderance. 70 patients had SNHL, out of which 63.3% had moderate-moderately severe severity of hearing loss 63% of patients had diabetes duration of more than 15 years. Conclusion: Hearing loss is an underestimated comorbid condition in diabetic patients that needs frequent audiometric assessments and management. Early detection and treatment of diabetes and strict glycemic control prevent SNHL. Audiometry should be considered a routine test for diabetic patients by healthcare workers. Interventions should be aimed at controlling factors that may cause morphological and functional changes in the cochlea are critical in managing diabetic hearing damage. Keywords: Diabetes mellitus, hearing loss, incidence, risk factors.

Background: Chronic otitis media is the chronic inflammation of mucoperiosteal lining of middle ear cleft characterized by ear discharge, a permanent perforation of tympanic membrane and impairment in hearing. It is less common now than in pre antibiotic days and is usually less severe. But due to poor hygiene, low socioeconomic conditions and poor nutrition, it does still take up considerable amount of clinic time and operating time dealing with chronic otitis media or sequelae of previous otitis media. In Tubotympanic type, there may be a persisting perforation in tympanic membrane usually starts in childhood as a result of recurring infection spreading via Eustachian tube to tympanic cavity. Surgical intervention is the treatment of choice for closure of perforation and Tympanoplasty is the most commonly done surgery. Aim and Objectives: To compare graft uptake in Dry and Wet ears. To compare hearing improvement in dry and wet ears postoperatively. Materials and Methods: It is a hospital based prospective observational study done from March 2021 to August 2022 with 60 Subjects -30 dry ears and 30 wet ears in department of ENT, Government ENT hospital, Andhra medical college, Visakhapatnam. Results: Mean age was 30.06 +_ 12.28 years in dry ears and in wet ears was 29.93 +_ 12.40 years in wet ears respectively. Males were 33 and females were 27 in this study. Right ears were affected in 31 cases and left ears were affeceted in 19 cases . There were 10 cases which had bilateral CSOM. There were 63 % of small, 59 % of medium, 36 % of large sized central perforations. Bilateral involvement was seen in 39 % of cases in this study. The graft uptake was 97 % in dry ears and 90 % in wet ears. Hearing improvement was 93.3 % in dry ears and was 87 % in wet ears respectively. There was no significance statistically between the two groups in terms of graft uptake and hearing improvement. Conclusion: The graft uptake was 97 % in dry ears and 90 % in wet ears. Hearing improvement was 93.3 % in dry ears and was 87 % in wet ears respectively. There was no significance statistically between the two groups in terms of graft uptake and hearing improvement. Therefore presence of discharge at the time of surgery doesn’t have any effect on outcome of the Type 1 Tympanoplasty. Keywords: Tympanoplasty, Chronic suppurative otitis media (CSOM), chronic middle ear (ME).

Background: The Latarjet procedure is commonly employed to treat recurrent anterior shoulder dislocations. This study aims to evaluate the functional outcomes, complications, and patient satisfaction following this surgical intervention. Materials and Methods: A prospective study was conducted on 20 patients who underwent the Latarjet procedure between July 2018 and March 2020 at the Government General Hospital, Kakinada. Patient demographics, mechanisms of injury, interval between dislocations and surgery, and glenoid bone loss were recorded. Functional outcomes were assessed using the ROWE score and quick DASH score. Subjective outcomes, range of motion, and pain levels were also evaluated. Results: The majority of patients (60%) were aged 18-25 years. The mean interval between initial dislocation and recurrence was 2-5 years for 45% of patients. Road traffic accidents and sports injuries were the primary mechanisms of injury. Glenoid bone loss was greater than 20% in 16 cases. Post-operatively, 95% of patients reported stable shoulders, with significant improvements in pain levels and range of motion. The ROWE score indicated excellent results in 40% of cases and good results in 35%. The mean quick DASH score improved from 47.96 pre-operatively to 14.48 at 6 months follow-up. Radiographic analysis showed proper screw placement and bony union in 90% of cases. Complications included one case each of infection, implant failure, and arthrosis, all in a single patient, with no cases of recurrent dislocation. Conclusion: The Latarjet procedure provides stable and functional outcomes for patients with recurrent anterior shoulder dislocations. The procedure is effective in reducing pain and improving shoulder stability and range of motion, with a low complication rate. Keywords: Latarjet procedure, shoulder dislocation, glenoid bone loss, ROWE score, quick DASH score, surgical outcomes, complications, shoulder stability.

Background: The traditional or conventional viva-voce examination often does not satisfy the standards of parameters such as validity, reliability, and reproducibility. Objectively structured viva-voce examination (OSVV) can maintain an undeviating pattern of questions and ameliorate the conventional assessment tool of viva-voce. Aim & objectives: Considering the shortfalls and biases of traditional viva this study was organized to compare the structured & conventional method of viva-voce examination for assessment of students in Physiology and to obtain the perceptions of students and teachers about objectively structured viva voce. Materials and Methods: This study was conducted as part of the formative assessment covering topics included in first Physiology internal assessment exam. Four sets of (A, B, C, D) structured viva question bank was prepared. Lottery system was adopted for drawing the question card, which was drawn by students themselves. A total of 20 questions (each of 2 marks) were asked. Questions were from three levels of difficulty easy questions, difficult questions and very difficult questions. Two examiners assessed the students by OSVV. Equal time of 8 minutes was given to each student. Examiner 3 assessed the same students by conventional viva. Feedback of students and teachers at the end of both viva sessions obtained about the OSVV. Statistical analysis: paired sample t-test and Kappa statistics. Result: There is significant difference between the scores of OSVV and Traditional viva (p<0.05). Excellent/Substantial agreement (k=0.7696) was found between the two examiners as regards allotment of marks in OSVV. Strikingly students with extremely good (>75% score) or extremely poor (<25% score) performance were flawlessly proclaimed by both OSVV and traditional viva-voce. No statistically significant difference was found between the scores given by examiners who took OSVV and traditional viva for these extreme scorers. Majority of students strongly agree and agree with OSVV in terms of well-organized system (78%), covers most of the topics from syllabus (87.4%), unbiased and from all difficulty levels (75%), useful in enhancing performance (89%), better than traditional viva (75%). Conclusion: Objectively structured viva-voce is a reliable, objective and convenient tool and positive perception toward OSVV in terms of its acceptability as an assessment tool. Keywords: Objectively structured viva-voce, Traditional viva-voce, Physiology, 1st year MBBS Students’ perception.

Background: Spontaneous bacterial peritonitis is a common and potentially lethal complication of cirrhotic ascites. Spontaneous infections in cirrhosis account for 33% of all bacterial infections in cirrhosis. Cirrhotic patients with an ascitic fluid total protein concentration <1 g/dl are prone for spontaneous bacterial peritonitis (SBP). The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient (SAAG) in chronic liver disease patients. Aim of the study: To study the ascitic fluid protein and SAAG in SBP patients with chronic liver disease (CLD). Materials and Methods: This was a prospective study conducted for a period of 1year from 1st June 2022 to 31st May 2023. A total of 80 patients more than 18years of age with chronic liver disease with ascites were included in this study. Patients having had a peritoneal paracentesis with in last 2 weeks for cardiac reasons, malignancy, tubercular peritonitis, pancreatic ascites, congestive heart failure, acute viral hepatitis and secondary peritonitis were excluded. Detailed history, examination and relevant investigations were done. Around 10ml of ascitic fluid was sent for analysis for all patients. Based on investigations, patients were divided into two groups: Group A-without SBP and Group B-with SBP. The SAAG was calculated by subtracting the serum albumin level from the ascites fluid albumin level. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007. Results: Out of 80 patients, 43 (53.75%) patients belonged to group A and 37 (46.25%) patients belonged to group B. In group A, 41 (95.34%) were male and 2 (4.65%) were female and in group B, 35 (94.59%) were male and 2 (5.40%) were female. The mean age of the patients in group A was 52 ± 4 years and in group B was 53 ± 6 years. The most common risk factor in both groups was alcohol followed by NASH, hepatitis B and hepatitis C. The most common clinical presentation in both groups was distension of abdomen followed by yellowish discoloration of eyes and swelling of feet. The serum albumin levels in Group B were lesser than group A with the values of 2.54±0.33 g/dl and 3.35±0.36 g/dl, which was statistically significant with p value of 0.0026. The ascites albumin levels were also lower in group B compared to group A with values of 0.43±0.23 g/dl and 0.91±0.31 g/dl, which was statistically very significant with p value of <0.001. But SAAG value was higher in group A compared to group B (2.45±0.01 and 2.09±0.47). This difference was statistically significant (p 0.0016). The mortality rate was higher in group B compared to group A (56.75% v/s 18.60%). Conclusion: The development of spontaneous bacterial peritonitis in chronic liver disease patients is directly proportional to ascitic fluid albumin and SAAG ratio. The mortality rate was higher among patients who developed SBP. As patients with low ascitic fluid albumin are prone for SBP, it can be prevented by prophylactic use of antibiotics and diuresis. Keywords: Chronic liver disease, SAAG, Spontaneous bacterial peritonitis.

Background: The skin is a complex organ and has many functions. If there is imbalance in this skin functions, it will result in various skin diseases. Skin diseases are common in developing countries, prevalent among all age groups. Histopathological examination of skin biopsy is necessary for accurate diagnosis and to guide dermatologist for deciding appropriate management. Aims and Objectives: Present study was carried out to understand Histopathological analysis of various Non-Infectious Skin Lesions. In relation with age and sex distribution. To correlate with clinical diagnosis. Time period-From April 2022 to March 2024. Materials and Methods: Inclusion Criteria-All Non-Infectious skin lesions irrespective of age and sex diagnosed via histopathological study Exclusion Criteria-Infectious skin lesions and neoplastic lesions of the skin. Attaining Skin punch biopsy specimen’s formalin fixed, Paraffin embedded, Staining with eosin andhematoxylin. Results: In the present study, a total of 86 biopsies were taken from the study group of patients and studied in the Department of Pathology. Various parameters were tabulated and compared with other studies. Conclusion: In this study, Papulosquamous diseases are the most common skin diseases encountered followed by Vesicobullous diseases.The most common of these groups being Psoriasis followed by lichen planus and pemphigus vulgaris followed by Pemphigus Foliaceous respectively. This study showed a definite male preponderance with maximum patients in their fourth decade (31-40 years). Overall clinico-histopathological correlation found in the present study is 100%. Keywords: Histopathological study, skin biopsies, Non infectous, Papulosquamous diseases, vesiculobullous lesions, Connective Tissue Diseases.

Background: A variety of biomarkers have been used to assess the prognosis of urinary bladder neoplasm (UBN). In the present study role of two novel biomarkers (HER2/neu and CD10) were studied by immunohistochemistry (IHC) as prognostic markers for UBN. Materials & Methods: This prospective study included 30 newly diagnosed cases of UBN. Bladder cystoscopy was performed in patients clinico-radiologically suspected of UBN; cytological and biopsy samples were taken from the suspicious area. Cytomorphological features and diagnosis was correlated with histopathology on biopsy, resected specimen and typing and grading of tumor. Expression of HER2/ neu and CD10 were correlated with grade and stage of the tumor. Complete routine urine examination including cytospin smear for malignant cells were also studied. Results: Overall HER2 /neu expression was present in 14 cases (46.7%) with 2+ and 3+ immunoreactivity in 13(43.3%) and 1(3.3%) case respectively. CD10 expression was noted in 13 (43.3%) patients, +1 in 11 (36.7%) and +2 in two cases (6.7%) cases, there was no +3 expression. The remaining 17 (56.7%) patients were negative for CD 10 expression. Conclusion: A significant direct association was observed between HER2/neu over expression with both increasing grade of carcinoma (p=0.00), and depth of tumor invasion (0.042). CD10 expression with histologic grade and stage (p=0.05) was not statistically significant. Keywords: Urinary bladder neoplasm, HER2/neu, CD10, Prognostic biomarkers, immuno-histochemistry, urinary bladder cytology.

Background: Study Centre: Osteoarthritis (OA) of the knee is a prevalent degenerative joint disease causing significant pain and disability, impacting the quality of life of millions worldwide. Non-surgical interventions are crucial for managing symptoms and improving joint function in patients with knee OA. Objectives: This study aims to evaluate the effectiveness of non-surgical interventions for osteoarthritis (OA) of the knee, focusing on pain reduction, improvement in joint function, and patient satisfaction. Materials and Methods: An observational analysis was conducted on 100 patients with knee OA. Patients were divided into four treatment groups: physical therapy (n=30), corticosteroid injections (n=25), hyaluronic acid injections (n=20), and lifestyle modifications (n=25). Outcomes were assessed over a 6-month period using standardized pain and function scales, alongside patient satisfaction surveys. Results: The average age of patients was 60 years, ranging from 45 to 75 years, with a gender distribution of 60% female and 40% male. The average BMI was 28.5 kg/m². Significant pain reduction was reported by 60% of patients receiving physical therapy, 70% receiving corticosteroid injections, 65% receiving hyaluronic acid injections, and 40% following lifestyle modifications. Improvement in joint function was noted in 55% of patients receiving physical therapy, 65% receiving corticosteroid injections, 60% receiving hyaluronic acid injections, and 35% following lifestyle modifications. Patient satisfaction was highest among those receiving corticosteroid injections (75%), followed by physical therapy (70%), hyaluronic acid injections (70%), and lifestyle modifications (50%). Minimal adverse effects were reported across all treatments, with temporary joint pain in 10% of corticosteroid injection recipients and mild swelling in 15% of hyaluronic acid injection recipients. Conclusion: Corticosteroid injections provided the highest pain relief and patient satisfaction among non-surgical interventions for knee OA. Physical therapy and hyaluronic acid injections also showed significant benefits. Lifestyle modifications were the least effective but still beneficial. Tailored treatment plans are essential to optimize outcomes for OA patients. Keywords: Osteoarthritis, Knee, Non-surgical interventions, Physical therapy, Corticosteroid injections, Hyaluronic acid injections.

Background: To detect and assess the prevalence of common intestinal parasites in stool samples. Materials and Methods: 846 stool samples collected in the Department of Microbiology in the last 8 months were studied and common intestinal parasites in stool samples were identified. Results: Maximum cases were detected in age group 11-20 years in 34%, 21-30 years in 11%, 31-40 years in 25%, 41-50 years in 15%, 50-60 years in 10% and >60 years in 5% samples. A significant difference was observed (P< 0.05). Type of parasites identified was Giardia lamblia in 3%, Ascaris lumbricoides in 0.28%, Entamoeba histolytica in 12%, Entamoeba coli in 1.8%, and Taenia in 1%. A significant difference was observed (P< 0.05). The sensitivity of different parasitic examination methods used was 51% in zinc sulphate centrifugal floatation, 67% in formol-ether concentration, 37% in simple salt floatation, 39% in routine wet and iodine mount, and formol-ether concentration in 62%. A non- significant difference was observed (P> 0.05). Conclusion: Entamoeba histolytica, Entamoeba coli, Giardia lamblia, Ascaris lumbricoides, and Taenia were identified as common parasites. Keywords: Entamoeba histolytica, Stool, Parasites.

Background: Palliative care is an approach that improves the quality of life of patients and their families. Quality of life is a broad ranging concept incorporating in a complex way the persons' physical health, psychological state, level of independence, social relationships, personal beliefs and their relationships to salient features of the environment. Early integration of palliative care for patients with advanced cancers showed clinical benefits in survival and improvement in quality of life. Worldwide, only about 14% of people who need palliative care currently receive it. The need for palliative care was found to be 6.21/1,000 population in India. In Andhra Pradesh, due to increased demand and fewer resources integrated palliative care services are yet to be developed in many centres and reach those in need. The main objective of this study is to audit our institutional experience since the initiation of delivering palliative care services and home care services through which quality of life is improved in cancer patients. This is a descriptive study conducted by analyzing data retrospectively from the registers between March 2023 and February 2024. Material and Methods: At Government General Hospital, Guntur, palliative care services were started in the Department of Oncology in March 2023, and home care visits since April 2023. The palliative care team at our institution includes Oncologists, Anesthetists, Nurses, Physiotherapists, Social workers, and Counselors who were specially trained. Since the beginning of palliative care services, the team provided pain management, wound care, tracheostomy care, colostomy care, etc. to various patients. Also, bereavement counseling is provided to family members of patients. The services are extended to debilitating patients within the Guntur district in the form of home visits with end-of-life care. Patients from other districts are given care by the village health clinics managed by Mid-level health providers (MLHPs) who are trained by our team. Results: A total of 744 patients were included in the study. Of which 692(93%) were registered under pain and palliative care hospital services from the beginning of March 2023 till February 2024. Home visits and end-of-life care included a total of 52(7%). The median age of the patients was 53 years (SD: 39-67 years). Males and females were of equal percentage. Gastrointestinal & hepatobiliary cancers constituted the highest percentage of patients under our palliative care with 25.94 % followed by Head and neck cancers (25%), breast (13.98%), lung (13.04%), gynecological malignancies (12.09%) and other malignancies cumulatively constituted 9.95%. However, less than fifty percent patients were available as lost to follow up for review assessment of the distress scoring system. Conclusion: With the increasing burden of cancer patients, there is an increase in the need for multidisciplinary management in which palliative care services play an important role. Providing these services to patients within the hospital and extending them with home visits is one of the first of its kind in Government set up in the state of Andhra Pradesh. We as a team are

Background: Several studies worldwide have studied the correlation between subclinical hypothyroidism (SCH), and metabolic syndrome (MetS), but have reported inconsistent findings. Objectives: To assess the correlation between SCH and MetS in a population. Materials & Methods: This cross-sectional study was conducted at the SGT hospital, Gurugram and analyzed all thyroid function tests conducted between January 2019, to December 31, 2021. A predesigned checklist was used to collect data about patients’ characteristics such as age, gender, nationality, TSH, FT4 level, and MetS components. Results: The study was performed at the department of Medicine in the SGT medical college, hospital& research institute, Budhera, Gurgaon, Haryana, India during December 2018 to May 2020. 150 subjects were included in the study – 100 patients of metabolic syndrome and 50 healthy controls. Data was retrieved and analysed. The observations are presented under 4 sections. Conclusion: The study demonstrated that the prevalence of SCH is similar between both genders but increases with age. MetS components were abnormal in patients aged >50 years and in males with SCH. SCH and MetS components were found to be correlated, and thus monitoring these variables in patients with SCH is advisable. Keywords: Body mass index, cardiovascular risk factors, diabetes, dyslipidemia, hypertension, metabolic syndrome, obesity, subclinical hypothyroidism.

Background: The COVID-19 pandemic has posed unprecedented challenges worldwide, necessitating a comprehensive understanding of knowledge, attitudes, and practices (KAP) among populations to inform effective public health interventions. This study aims to assess KAP regarding COVID-19 among individuals in urban areas of Muzaffarnagar city, Uttar Pradesh, India. Materials and Methods: A community-based cross-sectional study was conducted between July 2022 and November 2022. Purposive sampling was used to recruit 428 participants aged 18 years and above, proficient in Hindi. Data were collected using a semi-structured questionnaire covering demographics, COVID-19-related KAP. Descriptive and inferential statistical analyses were conducted to unveil patterns and associations. Results: Participants exhibited a robust understanding of COVID-19, with high knowledge scores across various domains, including symptoms, modes of transmission, and preventive measures. Positive attitudes towards the severity of the pandemic and trust in public health authorities were prevalent, although concerns about personal and societal impacts persisted. While adherence to preventive behaviours such as hand hygiene and mask-wearing was generally high, compliance with quarantine guidelines was suboptimal. Demographic factors such as age, education, and occupation significantly influenced KAP scores. Conclusion: This study provides valuable insights into KAP dynamics related to COVID-19 among urban populations in Muzaffarnagar city, Uttar Pradesh, India. The findings underscore the importance of targeted interventions to address knowledge gaps, promote positive attitudes, and enhance adherence to preventive measures. Tailored strategies considering demographic nuances are essential for effective pandemic control and mitigation of socio-economic impacts. Keywords: COVID-19, knowledge, attitudes, practices, urban population, India.

Background: The COVID-19 pandemic has posed unprecedented challenges worldwide, impacting individuals' lives across various domains. Understanding the perceptions and experiences of urban residents during the pandemic is crucial for informing targeted interventions and support systems to mitigate its adverse effects. Materials and Methods: This cross-sectional study aimed to explore the perceptions and experiences of individuals residing in urban areas during the COVID-19 pandemic. A total of 405 participants from Muzaffarnagar city, Uttar Pradesh, India, were included in the analysis. Demographic data were collected, and participants completed a questionnaire assessing perceived effects of the pandemic across different domains. Qualitative interviews were conducted to further explore participants' experiences and coping strategies. Descriptive statistics and thematic analysis were used to analyze the data. Results: Age distribution showed that 63.0% were under 45 years old and 37.0% were over 45. Participants reported varying levels of perceived effects, including financial strain, job insecurity, social isolation, disruptions in education, and mental health challenges. However, positive outcomes such as strengthened familial bonds, personal resilience, and community solidarity were also acknowledged. Demographic factors such as age, marital status, and occupation were associated with variations in perception scores. Younger participants and those not married reported more negative perceptions, while married individuals and those employed reported higher perception scores. Conclusion: This study highlights the multifaceted impact of the COVID-19 pandemic on urban residents, emphasizing the importance of considering socio-demographic factors in understanding individuals' experiences and responses. The findings underscore the need for targeted interventions and support systems to address the diverse challenges posed by the pandemic and promote resilience and well-being within urban populations. Keywords: COVID-19, pandemic, urban residents, perceptions, experiences, socio-demographic factors, qualitative analysis, resilience, interventions.

Background: Varicose veins of the lower limbs are a prevalent peripheral vascular disease affecting a significant portion of the adult population. Despite its common occurrence, many patients seek medical attention only after complications arise. This study aims to evaluate the clinical presentations, management strategies, and outcomes of patients with varicose veins to improve treatment protocols and patient outcomes. Materials and Methods: This prospective, hospital-based study was conducted over 24 months and included 60 patients admitted to the Department of General Surgery at a tertiary care hospital. Patients aged 20-75 years with primary varicose veins were randomly selected. Exclusions were made for those with recurrent varicose veins, deep venous thrombosis, secondary varicosities, pregnancy-associated varicose veins, and those with abdominal masses. Data collection involved detailed clinical examinations, routine and special investigations, pre-operative and post-operative management, and follow-ups. Results: The study included 60 patients, predominantly males (88.33%), with an age range of 21-75 years. The highest incidence was observed in the 41-50 years age group (31.67%). The clinical classification using the CEAP system revealed that 36.67% of patients were in Class 2, and 20% had active venous ulcers (Class 6). Occupations involving prolonged standing, such as farming (26.67%) and daily wage labor (21.67%), were identified as significant risk factors. The left limb was more frequently affected (50%) compared to the right (31.67%). Venous incompetence primarily involved the great saphenous system (70%) and was confirmed using duplex ultrasound. Surgical interventions, including sapheno-femoral flush ligation and stripping, were performed, with 43.33% undergoing the former procedure. Post-operative complications included seroma (10%) and wound infections (6.67%), with a recurrence rate of 6.67%. Long-term follow-up indicated improved quality of life and functional outcomes for most patients. Conclusion: Varicose veins predominantly affect middle-aged males engaged in occupations requiring prolonged standing. Accurate clinical and duplex ultrasound assessments are crucial for effective management. Surgical intervention, particularly sapheno-femoral flush ligation and stripping, yields significant symptomatic and cosmetic improvements. Despite the effectiveness of surgery, long-term follow-up is essential to monitor and manage recurrences and complications. Keywords: Varicose veins, Lower limbs, Peripheral vascular disease

The study aimed to evaluate the expression of the proliferation marker Ki-67 in squamous cell carcinoma of the cervix and its correlation with age, parity, hormonal status, Broder’s grading, and clinical staging. The cross-sectional study included 65 biopsy/hysterectomy-proven cases of squamous cell carcinoma. The mean age of the patients was 53 years, and all cases showed Ki-67 expression (100% positivity). The study found a statistically significant correlation between the Ki-67 score and age (p=0.046) as well as Broder’s tumor grading (p=0.00). However, there was no association of the Ki-67 score with parity, hormonal status, and FIGO clinical staging. The findings suggest that Ki-67 expression may serve as an adverse prognostic marker in cervical invasive squamous cell carcinoma. Keywords: Squamous cell carcinoma, cervical carcinoma, Ki-67, Broder’s grading, Clinical stage.

Background: Splenectomy, the surgical removal of the spleen, has become integral in managing pediatric hematological and oncological conditions. Traditionally performed through open surgery, splenectomy has evolved with minimally invasive techniques like laparoscopy. Laparoscopic splenectomy (LS) offers benefits including reduced pain, shorter hospital stays, and improved cosmetics. Indications for LS in children have expanded, encompassing various splenic pathologies. Despite challenges in pediatric application, studies show LS efficacy with lower morbidity. This study aims to comprehensively compare LS and open splenectomy (OS) outcomes in pediatric patients, guiding optimal surgical approaches. Materials and Methods: A retrospective analysis was conducted on pediatric patients (<18 years) who underwent LS or OS for various indications between June 2013 and May 2023 among pediatric patients in general surgery department at tertiary care hospital, Andaman and Nicobars Islands. Demographic data, operative details including operative time, blood loss, and approach type, postoperative outcomes, and complications were collected and compared between the two groups. Statistical analysis was performed using independent t-tests, and chi-square tests. Results: A total of 82 pediatric patients were included in the analysis, with 41 patients in each group (LS and OS). The mean age was 9.6 years in the LS group and 9.9 years in the OS group (p = 0.686). LS was associated with significantly shorter operative time (LS: 122.4 ± 33.6 minutes vs. OS: 145.7 ± 44.3 minutes, p = 0.009) and reduced blood loss (LS: 192.8 ± 90.8 mL vs. OS: 288.3 ± 118.6 mL, p = 0.011) compared to OS. However, intraoperative complications rates were similar between LS and OS groups (LS: 9.8% vs. OS: 12.2%, p = 0.728). Postoperatively, both groups demonstrated comparable rates of overall complications (LS: 14.6% vs. OS: 19.5%, p = 0.557), with LS associated with a significantly shorter postoperative length of stay (LS: 4.5 ± 1.5 days vs. OS: 6.0 ± 2.0 days, p = 0.0002). Conclusion: Our study demonstrates that LS offers advantages over OS in terms of shorter operative time, reduced blood loss, and shorter postoperative length of stay in pediatric patients undergoing splenectomy. However, both approaches exhibit comparable safety profiles in terms of intraoperative and postoperative complications. Keywords: Laparoscopic splenectomy, open splenectomy, pediatric patients, operative details, postoperative outcomes, complications.

Background: Distal radius fractures consist of 20 percent of all fractures presenting to the emergency. The unstable fracture patterns require surgical intervention to get optimum functional outcomes. Among the various treatment like pin and plaster, external fixators and internal fixation with plates, Joshi’s external stabilizing system (JESS) is an effective and economical option for treating unstable distal radius fractures. Using cost effective methods enables more patients to get standard care, especially in a government hospital setting. Materials and Methods: This prospective observational study evaluates the functional outcomes of using JESS distractor, in 76 patients coming to Government Medical College Kottayam during February 2013 to July 2014 with unstable distal end of radius fractures. Functional outcomes were measured with the Gartland & Werley score and the modified Mayo score at three-month, six month, one year and ten year follow-up. Results: 62 patients (81.6%) had good to excellent results at 10 years’ follow-up. Eight patients developed pin tract infection, thirteen patients developed Chronic regional pain syndrome and there was late collapse of the fracture in eight patients. K-wire supplementation was done in 28 patients for distal radio ulnar joint instability and radial styloid fractures. There was no need for re-operation in any of the patients. Although early outcomes at 3 months were not satisfactory, functional outcomes at 1 year and 10 years were comparable to other methods of treating unstable distal radius fractures like volar plating. Conclusion: JESS distractor is an effective and economical treatment option for treating unstable distal end of radius fractures. Keywords: Distal radius fracture, JESS, Dynamic external fixator.

Background: Major Depressive Disorder (MDD) poses a significant global health burden, necessitating effective treatment strategies. Current therapies, while prevalent, often exhibit delayed onset of action and limited efficacy, underscoring the need for novel interventions. Objective: This multicenter, double-blind, randomized controlled trial aimed to assess the efficacy and safety of Rejiyana® capsules, a combination of acetyl-L-carnitine (ALCAR) and agmatine, as adjunctive therapy in individuals with MDD receiving standard care. Materials and Methods: A total of 120 participants aged 18-65 years with diagnosed MDD were randomized into two groups: Rejiyana® + standard care or standard care alone, for 12 weeks. Efficacy was evaluated using standardized depression scales (HAM-D17, MADRS) and global impression assessments (CGI). Safety assessments included adverse event monitoring and blood pressure measurements. Results: Both treatment groups demonstrated significant reductions in depression severity over 12 weeks, with Rejiyana® + standard care group showing a trend towards greater improvement, particularly among male patients. Remission rates and clinical efficacy were notable in the Rejiyana® + standard care group. Changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores favored the Rejiyana® + standard care group, indicating superior efficacy. CGI scores reflected progressive clinical improvement in both groups throughout the treatment phase. Blood pressure reductions were significant in the Rejiyana® + standard care group compared to standard care alone. Conclusion: Rejiyana® capsules, comprising acetyl-L-carnitine (ALCAR) and Agmatine, demonstrated efficacy as adjunctive therapy for MDD, resulting in significant reductions in depressive symptoms and improvements in overall clinical status. The combination therapy was well-tolerated, suggesting its potential as a safe and effective treatment option for MDD. Further research is warranted to validate these findings and elucidate optimal dosing and long-term effects. Keywords: Major Depressive Disorder, adjunctive therapy, acetyl-L-carnitine, agmatine, randomized controlled trial, depression severity, treatment efficacy, safety assessment.

Background: Lumbar radiculopathy is affecting a significant number of populations (up to 30%) with continuous experience of persistent pain for one year or more and there is an unmet medical need for the development of treatments that are both safer and more efficacious in addressing chronic neuropathic conditions and associated pain. The aim of the study was to evaluate efficacy and safety of Juviana® Plus as adjunctive therapy for chronic pain. Materials and Methods: This was an open label study conducted across multiple centers in patients with persistent lumbar radiculopathy indication. Patients underwent three visits at day 0, day 30 and day 90. Pain intensity was assessed using VAS and NRS scale at each visit. In addition of quality-of-life assessment as impacted by pain over QoL scale. Adverse events were recorded throughout the study duration. Results: Baseline characteristics such as demographic, BMI, obesity, pain duration, herniation level, herniation type, pain location and concurrent medications, were recorded for participants baseline profile. After three-month treatment, patients experienced a statistically significant reduction is pain. Mean VAS and NRS scores respectively reduced from 5.53 and 5.41 to 0.53 and 0.48 at end of the study compared to baseline visit. Quality of life improved significantly. Conclusions: Juviana® Plus significantly reduced pain in lumbar radiculopathy patients who are partial or non-responders to first-line treatments and found to be safe and tolerable as no AE reported with any possible relation with study drug. However, further research is needed to confirm its long-term efficacy and safety. Keywords: Lumbar radiculopathy, Juviana® Plus, VAS, NRS, Quality of life.

Background: The male is solely responsible for about 20% and is a contributing factor in another 30% to 40% of all infertility cases. Overall, the male factor is contributory in about 50% of all cases of infertility. The aim of the study is to highlight unaddressed factors contributing to unexplained/idiopathic male infertility and to assess the effectiveness and safety of Oligonorm®, a novel formulation containing D-Aspartic Acid, Ubiquinol, and Betaine, in enhancing male fertility parameters. Materials and Methods: This was a 16-week randomized, double blind, clinical trial comparing Oligonorm® with a comparative therapy (Ubiquinol Acetate, L-Carnitine, Lycopene, Astaxanthin, Zinc, and Vitamins). A total 100 male participants aged between 25 to 45 years diagnosed with infertility or subfertility, including Asthenospermia, Azoospermia, Oligospermia, or Teratospermia, were enrolled and randomized to either the Oligonorm® (a synergistic blend of D-Aspartic Acid, Ubiquinol acetate, and Betaine) group (n=50) or the comparative group (n=50). The study evaluation includes sperm parameters (count, motility, viability, and capacitation), hormonal status assessment (serum testosterone levels) and adverse event surveillance throughout the study conduct. Results: Oligonorm® exhibited significant increase in sperm count (baseline: 12.2 million/mL, Week 12: 28.0 million/mL), live sperm percentage (baseline: 37.1%, Week 12: 73.7%) and testosterone (baseline: 332 ng/dL, Week 12: 690 ng/dL) compared to baseline. Oligonorm® group showed significant improvement in semen volume (baseline: 3.1 mL, Week 12: 3.6 mL), sperm motility, sperm-hyaluronic acid binding and acrosome reaction compare to comparative group. Dead sperm percentage declined in Oligonorm® group (baseline: 60.4%, Week 12: 26.3%). It exhibited a favourable safety profile with no notable adverse events. Overall, Oligonorm® significantly improved multiple male fertility parameters, suggesting its potential as a comprehensive solution for male infertility. The synergistic effects of D-Aspartic Acid, Ubiquinol acetate, and Betaine in Oligonorm® contributed to enhanced sperm count, semen volume, motility, viability, sperm capacitation, and testosterone levels. Conclusion: This study provides robust evidence supporting the efficacy and safety of Oligonorm® in improving male reproductive health. The positive impact on various sperm parameters suggests Oligonorm®'s potential as a promising intervention for male infertility. Further research is warranted to validate these findings and explore the long-term effects of Oligonorm® on male reproductive health. Keywords: Sperm capacitation, idiopathic male fertility, infertility, male fertility, Oligonorm®, sperm count, sperm motility, unexplained male fertility.

Background: Diabetes mellitus has been found to be a progenitor of peripheral arterial disease (PAD) in various epidemiological studies. Whether chronic hyperglycemia per se or altered levels of intermediate conventional risk factors in these people are responsible for increased risk of PAD, is a matter of debate. There is little data about the profile of peripheral arterial disease in people with treatment naive diabetes and prediabetes in Asian population. Objectives: The study aimed to determine the frequency of early PAD among people with newly detected treatment naive diabetes and prediabetes attending a tertiary care public hospital. The study further aimed to determine the risk factors associated with peripheral arterial disease and to investigate whether such risk factors in these people might help to explain their increased risk of PAD. Materials and Methods:65 consecutive people with treatment naive type 2 diabetes (T2DM) with an equal number of people with prediabetes, attending a tertiary care centre, diagnosed as per standard criteria, were enrolled in a non-randomised prospective design. The presence of peripheral arterial disease was determined by ankle-brachial index (ABI). Risk factor analysis for peripheral arterial disease in both the groups was carried out. Statistical significance was considered with p value of <0.05. Results:7(10.8%) people among newly diagnosed treatment naïve type 2 diabetes and 2 (3.1%) with prediabetes had PAD (ABI score<0.9), age (p <0 .001), high plasma glucose/HbA1c (p<0.001), BMI (p<0.001), total cholesterol (p <0.001), albuminuria and hypertension (p<0.001), were found to be strongly associated with early vasculopathy. Conclusion: Peripheral arterial disease is a frequent complication among newly diagnosed treatment naive people with T2DM and to a lesser extent in people with prediabetes. Various anthropometric, clinical, biochemical and metabolic factors in people with hyperglycemia could account for increased frequency of PAD in these people. Keywords: Diabetes, Pre-Diabetes, Peripheral arterial disease,Treatment naive Diabetes.

Background: To study the correlation between lipid and thyroid Profile with different types of nephrotic syndrome in children between 1 to12yrs. And also study the association between serum albumin with lipid profile and TSH. Materials and Methods: It was a cross sectional study. Study was conducted at Department of paediatrics, GEMS Medical College & Hospital Srikakulam. All cases of nephritic syndrome which includes1episode, relapse, SDNS, SRNS and remission between age group of 1 to 12yrs. 40 cases of nephritic syndrome between1to12yrs.Which include all type of nephrotic syndrome. Results: Most common age group of presentation is 6 to 10yrs 24cases (60%), followed by 1 to 5yrs 12 cases (30%), 11 to 12yrs 4 cases (10%). Mean age of presentation is 6.9 yrs. Males (63%) are affected more than females (37%) but no significant gender difference of all parameters. There is increased serum cholesterol (mean= 344.30mg/dl), LDL (mean=234.650mg/dl)), VLDL (mean=61.625mg/dl), Triglycerides (mean304.025mg/dl) and normal or borderline HDL (mean 46.07mg/dl). Serum cholesterol compared to first episode elevated in relapse cases. Serum cholesterol in SRNS cases shows statistically significant elevation compared to other types. LDL values compared to first episode were elevated in relapse cases which was found out to be statistically insignificant. LDL values in SRNS cases shows statistically significant elevation compared to first episodes and SDNS cases. Serum T3, T4, TSH were found to be within normal limits. But TSH values compared to remission were significantly elevated in first episode. Conclusions: There is a negative relation between serum albumin and cholesterol and the correlation is statistically insignificant (p=0.35) while the negative relation between albumin and TSH is statistically significant (p=0.003). Keywords: Nephrotic syndrome, TSH, Albumin, Cholesterol, SRNS, SDNS.

Background: To use cord blood TSH as a marker for screening of congenital hypothyroidismin term neonates. Materials and Methods: It was a Prospective observational study. The study will be conducted on all term inborn delivered in hospital from over a period of 18 months from September 2020 to April 2022. The study was conducted at Department of Neonatology and Paediatrics, GEMS Medical College & Hospital, Srikakulam. Results: A total of 625 study subjects out of which 53.1% (n=332) were female and 46.9% (n=293) were male subjects showing a female predominance. Out of 625 subjects 13 patients were suspected for congenital hypothyroidism. In our study 65.8% (n=411) mothers undergone Caesarean Section and 34.2% (n=214) have Normal Vaginal Delivery. Our study has revealed that the mean body weight of the studycases born was 2.89 kg ranging from 2.5kg to 3.3kg. The mean body weight in 68.96% (n=431) study subjects ranged between 2.51kg to 3.00kg, whereas, 31.04% (n=194) subjects weighed between 3.01-3.50 kg. In the suspected subjects the mean body weight is 2.79 kg ranging from 2.5kg to 3.3 kg. As far as maternal age is concerned it is noticed in our study that the mean age of all the mothers was 28.29 years, ranging from 21 years to 34 years, and the mean age of mothers of suspected patients is 29.54 years, ranging between 27 years to 32 years. The mean TSH at 3rd day after birth is noted to be 3.5 mU/L, ranging from 5 to 7.6 mU/L. As we have considered the cut of TSH value to be greater than 20 mU/L, our study resulted in 0/625 patients with congenital hypothyroidism. Conclusions: To conclude, we can safely use a cut off of cord blood TSH value of>20 mU/L for the purpose of screening for congenital hypothyroidism. Large population-based studies are required to establish normative values for cord blood TSH in our country. Keywords: TSH, Hypothyroidism, Body weight, Maternal Age, Congenital.

Background: India has made continuously significant progress in improving the health conditions of its rural population. The healthcare facilities of a country determine the health seeking behaviour of the population. Objective: To explore the Socio-demographic distribution, health seeking behaviour & its determinants among defined rural population. Materials and Methods: A community based Cross sectional study was conducted from January 2024 to May 2024. By door to door survey and by using systematic random sampling techniques, houses were selected randomly and 1004 study participants were considered for the study. The data was analysed by means, proportions and Chi-square test. p value less than 0.05(p<0.05) at 95% confidence interval, was consider for significant, SPSS Version 23 Statistical Software was used to analyse the data. Results: A total of 1004 people participated in the study, which included 81.57% males and 18.43% females. Public health care facilities were preferred by around 75% participants. The cost of treatment, personal attention, ante natal care services, family planning services and immunization services was found to be statistically significant (p<0.001). Conclusion: Awareness must be generated among the rural population regarding the health problems, health programmes, schemes and hygienic and health seeking behaviour. Keywords: Rural population, Socio demographic profile, health seeking behaviour.

Background: Assess the correlation of meningioma surface factor on pre-operative imaging with WHO grade of meningioma. Objective: Atypical and anaplastic meningiomas account for 20% of all meningiomas. An irregular shape of meningioma has been associated with higher grade histology. However, this subjective allocation does not allow quantification of comparisons. An objective parameter, like surface factor could substantially influence the aggressiveness towards a more aggressive resection strategy. Materials and Methods: A prospective study on meningioma was concluded at the Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjung Hospital from May 2022 to May 2024. A demographic and tumor volumetric assessment in terms of age, gender, WHO grade and volumetric parameters like volume, surface area and surface factor was assessed. A comparison of the volumetric parameters like volume, surface area and surface factor were also done as per the grade of the meningioma. Result: A total of 76 patients were included in the study, 90.79% had a WHO grade I, 6.58% a WHO grade II, and 2.63% a WHO grade III meningioma. Calculation of SF demonstrated a significant difference in SFs between WHO grade I (0.79±0.03) and WHO grade II/III (0.70±0.02) meningioma (p<0.0001). Multivariate analysis identified SF as an independent prognostic factor for WHO grade. (95% CI 0.279-5.247). Conclusion: SF is a mathematical model to objectively quantify the irregularities in the shape of meningioma based on pre-operative MRI. This study revealed significant differences between the SFs of WHO grade I and grade II/III meningiomas and demonstrated that SF is an independent prognostic factor for WHO grade. Keywords: Surface factor, WHO Grade, surface irregularity

The zoonotic illness known as rabies is one of the oldest and deadliest diseases that has ever been discovered in the history. It is estimated that over 20,000 people in India pass away each year as a result of rabies infections brought on by Lyssavirus viruses. This accounts for roughly a third of the 61,000 fatalities that are attributed to rabies globally. Infection with rabies is a difficult clinical challenge that is defined by fast neurological degeneration and results in death in every single case. Fortunately, it has been shown that the administration of anti-rabies immunoglobulin, post-exposure rabies vaccine, and wound care in a timely manner may considerably reduce the likelihood of contracting rabies. Despite the fact that the recorded occurrences of real prophylaxis failures are exceedingly few in comparison to the millions of post-exposure prophylaxis that are administered yearly all over the globe, we are documenting two such rare case reports that were encountered at our hospital and ultimately resulted in the death. Keywords: Bite, Rabies, Encephalitis.

Background: NST requires little upkeep and is affordable, reproducible, safe, and simple to operate. NST is a useful tool for investigating condition of fetus in utero in low risk as well as high risk pregnancies. Assessing the role of antenatal NST in improving perinatal outcomes in high-risk pregnancies is the aim of the study. Materials and Methods: A total of 150 pregnant women were enrolled in this prospective experiment, with 75 participants in group A (high-risk pregnancy) and 75 participants in group B (low-risk pregnancy). A non -stress test was performed for a duration of 20 min, if the test results were negative or uncertain, an extra 20 min of prolonged CTG was performed. Fetal stimulation was also performed. The NST was conducted before to the onset of labor. Result: Among the individuals in the high-risk group, around 60% displayed "reactive" NST tracings, while in the low-risk group, this percentage was 83%. The LSCS (Lower Segment Cesarean Section) technique was employed for childbirth in around 38% of the high-risk group and 16% of the low-risk group. Approximately 27% of individuals at high risk and 11% of participants at low risk were found to have amniotic fluid with meconium staining. Conclusion: The present study demonstrates a significant disparity in Apgar scores and NICU admissions between the reactive and nonreactive NST cohorts. Hence, judicious utilization of NST will unquestionably assist in promptly detecting fetuses in jeopardy, thereby averting unnecessary delays in intervention. Keywords: Fetal outcomes, non-stress test, high risk pregnancies.

Background: Binocular single vision can only be established if both eyes are ametropic and orthophoria. To have binocular single vision, both retinas must have normal point-to-point correspondence, with the fovea serving as the primary corresponding points. While both eyes may appear to have developed normally anatomically, ambylopia can result when the physiological development of one eye's visual acuity is disrupted. Materials and Methods: This was the cross-sectional, 25 children were taken for the study at Department of Ophthalmology, REH, Kakatiya Medical College, Warangal, Telangana, India, from June 2022 to May 2023. Participants are between the ages of 5 and 15 that will be used. If a potential participant appears to meet all inclusion and exclusion criteria, they will be contacted about participating in the study. Results: In our investigation, we found that amblyopia was more prevalent in the younger age group than in the older age group. In this research, slightly more boys than girls were tested. Patients who visited our OPD most frequently reported visual discomfort, followed by ocular deviation, when their concerns were properly analyzed. Fewer yet reported both asthenopia and vision difficulties. Conclusion: The findings of this research highlight the critical necessity of community ophthalmology in the fight against amblyopia. In recent decades, there has been growing acceptance of the concept of avoidable blindness, which encompasses both preventable and curable forms of blindness. Keywords: Clinical study, partial occlusion therapy, amblyopia, children.

Background: The present study aimed to determine the antibiotic susceptibility pattern of uropathogenic Escherichia coli (E.coli) in our region along with detection of prevalence of ESBL producers and biofilm production. This study is also evaluating colistin resistance among uropathogenic Escherichia coli. Materials & Methods: A total of 100 Escherichia coli isolates were obtained from mid stream urine samples. Each sample was inoculated within 4 hr on CLED agar and incubated at 370 C aerobically for 16-18 hr. All the isolates which were resistant to ceftazidime and cefotaxime were further tested for ESBL production by confirmatory phenotypic double disc synergy method using ceftazidime, ceftazidime-clavulanic acid and cefotaxime, cefotaxime-clavulanic acid discs. More than 5mm increase in zone diameter for cetfazidime or cefotaxime tested in combination with clavulanic acid versus its zone when tested alone confirmed an ESBL producing organism. Results:In the present study, out of 100 cases, higher incidence of E.coli was observed among females (58%) than in males (42%).Majority of the E.coli isolates were sensitive to chloramphenicol (90%), nitrofurantoin (72%) and ertapenem (69%) and imipenem (58%). High resistance was detected with cefotaxime (90%) ciprofloxacin (90%), ampicillin(83%) and ceftazidime (72%).Carbapenems showed low resistance when compared to other group of drugs.53% of E.coli isolates were ESBL producers by double disc synergy method. No colistin resistance was observed. Conclusion:Drug resistance in uropathogenic E.coli (UPEC)is increasing, which leads to increased morbidity, mortality and economic burden on patients, hence the need for appropriate antibiotic use with a local antibiotic policy and establishment of antimicrobial stewardship in every healthcare facility. Keywords: Antibiotic susceptibility, uropathogenic E.coli, colistin resistance, disc elution method, ESBL.

Rationale: Cervical French-door laminoplasty can enlarge the volume of the cervical vertebral canal and thus has become an effective and safe treatment for multilevel cervical disc herniation and cervical stenosis. Some post-surgery complications exist, such as reduction of cervical alignment and local kyphosis. However, aggravation of cervical disc herniation at the surgical level during short- term follow-up has not been discussed. Additionally, spontaneous disappearance of herniated disc pulposus is a common phenomenon in the lumbar region but is relatively rare in the cervical region. Patient concerns: We evaluated a group of 10 patients who Presented with history of paraesthesia and weakness in the upper and lower limbs. The sensations and muscle strength of both upper and lower limbs were decreased. The radiological findings showed that the Pavlov ratios from C3-5 were decreased obviously. Osteophytes as well as spinal cord compression were observed at C3/4, C4/5, and C5/6 in the index patient Diagnoses: Considering the symptoms and clinical examinations, the index patient was diagnosed with cervical stenosis. Interventions: We performed cervical French-door laminoplasty at C3-C5 to enlarge the space of the cervical vertebral canal. Outcomes: At 1-month post-surgery follow-up, the patients showed obvious improvement in paraesthesia and weakness in the upper limbs. The cervical disc herniation at C3/4 was aggravated. However, on further follow up the symptoms were relieved, and is too early to comment on herniated cervical disc at C3/4 which spontaneously disappears without any special treatment. Lessons: We suggest that the attachment points of deep muscles in the neck region should be carefully protected during this surgery. Patients who undergo cervical French-door laminoplasty should pay attention to their cervical position and perform neck exercises to train their neck muscles. MRI is an important imaging method to observe dynamic changes in herniated discs for patients with cervical disc herniation. Abbreviations: FSU = functional spinal unit, MRI = magnetic resonance imaging, ROM = range of motion, SDHNP = spontaneous disappearance of the herniated nucleus pulposus. Keywords: Aggravated disc herniation, cervical disc disappearance, cervical disc herniation, cervical laminoplasty, disc regression.

Background: Sex determination in identification of human remains is one of the most important components in forensic identification and it is a major task in medico-legal investigation. Aim: Morphometric analysis of index finger and ring finger and comparing with height weight and BMI Material and Methods: Present study was carried out on400 individuals of both sexes. Length of index and ring fingers and the ratios between them were estimated. Results: The mean length of Index finger of male was 7.049 cm and female 6.521 cm. The mean length of ring finger was in male and female were following 7.20 & 6.722 cm. The mean height of male was 170.7 and in female 158.5, weight of male 65.36 and female 48.41 where as both male and female BMI was 22.8 & 19.80. Conclusion: Morphometric measurements of ring fingers and index finger and comparing it with height and weight of subject, the index finger and ring finger length ratio in males is greater than in females which is insignificant. In males’ height was greater than the height of females. Weight and BMI of the males were greater than that of the females. In males out of all the anthropometric parameters, only BMI was significantly correlated with index finger length. In males no anthropometric parameters- was significantly correlated with ring finger length. In females neither index nor ring finger showed any significant co- relation with all the three anthropometric parameters. Keywords: Human identification, Forensic science, Sex determination, Index/ring finger.

Background: The Institute of Medicine defines quality health care as “the degree to which health care services for individuals and population increase the likelihood of desired health outcomes and are consistent with current medical knowledge”. A quality indicator is a measure that assesses essential elements of the healthcare system, capable of being uniformly applied and compared across different environments and periods. Patient’s treatments are directly affected by the reports from the laboratory, so reducing errors and adopting a quality control system are a priority in laboratories. Quality assurance of laboratory testing in three phases has continuously gained attention among healthcare professionals. Within the hematology laboratory context, these quality indicators are crucial in overseeing laboratory performance, underscoring the necessity of regular evaluations to gauge the laboratory's effectiveness. Aim: To study quality indicators in a hematology laboratory in three phases of testing to improve the quality of health care services. Material and Methods: 50000 consecutive samples received for hematological investigations in the central laboratory at a tertiary care hospital were taken into study. Seven quality indicators such as sample rejection rate, sample redo rate, turnaround time, critical values, corrected reports rate, internal quality check rate and concordance in EQAS were assessed in three phases of testing - pre-analytical, analytical and post-analytical. Results: Out of 50000 samples processed in hematology laboratory, sample rejection rate was 1.3%, sample redo rate was 1.24%, corrected report rate was 10.9% & 2.6% before and after validation respectively. The turnaround time for routine, critical and urgent samples were 6hrs,1.5hrs and 2.5hrs respectively. The IQC failure rate was 2.5% and values of EQAS were within consensus. In 94.3% cases, clinicians were informed about critical values. Regular quality checks were done to improve quality of laboratory services by implementing corrective action and preventive action (CAPA) whenever necessary. Conclusion: Laboratory testing forms the integral and essential part of health delivery system. Therefore, it is necessary to have regular quality checks to improve the quality of laboratory services. Keywords: Quality indicators, hematology, quality control.

Background: Cancer of the cervix is a major burden on women’s health worldwide. Cervical cancer is the second most common cancer in women worldwide, following cancer of the breast in developing countries, however it is the most common cancer among women. Aim and Objectives: To analyse the knowledge, attitude, and practice related to cervical Pap smears among women attending a teaching hospital. Materials and Methods: A Community based cross sectional study conducted at KIMS teaching hospital, Koppal (from August 2023 to January 2024). A structured questionnaire was used to conduct face to face interviews that assessed the demographic details of the participants along with the knowledge and attitude of the participants. The collected data was then analysed and results Results: The present study included 100 participants of which majority belonged to the age group between 30-39 years (32%) and resided in rural regions (71%). With regard to knowledge, the results obtained show that less than half of the participants had previous heard of PAP smears (42%) while 56% had previous knowledge of cervical cancer (54%). When asked about who they would like to conduct the PAP smear, most of the participants reported to want it to have it done at a women’s clinic (37%) followed by a gynaecologist (36%). A great proportion (62%) agreed to the need for conducting cervical cancer awareness programs. Most of the participants (68%) believed that PAP smears were not a reliable tool for the early detection of cervical cancer. Most of the participants have not undergone screening for cervical cancer (89%). Conclusion: The results of the present study show that the knowledge and practice toward cervical cancer and Pap smears but showed favourable attitude which can be helpful in improving the uptake of Pap smears among women. Keywords: Knowledge, Attitude, Practice, Pap smear, Cervical cancer.

Background: Low back pain is a huge health problem in all countries and is most commonly treated in primary healthcare settings. Caudal epidural injection is one of the commonly used minimally invasive modalities in the management of acute as well as chronic low backache conditions. Hence; under the light of above-mentioned data, the present study was undertaken for assessing efficacy of caudal Epidural injection in treating patients with chronic low back pain. Materials & Methods: A total of 50 patients were enrolled. All the patients received dose normal saline 10 ml + bupivacaine (0.5%) 8 ml + methylprednisolone (80mg) 2 ml. Inclusion criteria for the present study included age between 20 to 60 years, Back pain with no relief after twelve weeks of conservative therapy, Magnetic resonance imaging (MRI) evidence of herniated nucleus pulposus at level corresponding with symptoms like radicular pain and clinical findings. The main points recorded included Age, sex, Oswestry Disability Index (ODI) score, Visual Analouge Scale (VAS) score, clinical and MRI diagnosis. Three caudal epidural injections were given at an interval of three weeks and on each visit ODI and VAS score was recorded in the case sheet. Results: Mean VAS at pre-injection, post-third injection, 3 months, 6 months, 9 months and 1 year was 6.8, 4.4, 4.0, 3.6, 3.7 and 3.5 respectively. There was a significant reduction in mean VAS at different time intervals. Mean ODI score at pre-injection, post-third injection, 3 months, 6 months, 9 months and 1 year was 43.2, 35.3, 25.2, 18.3, 30.7 and 31.2 respectively. There was a significant reduction in mean ODI at different time intervals. Conclusion: Caudal epidural injections were effective in providing pain relief in patients with low back pain. After time period of 6 months post-third injection, decline in the efficacy of caudal epidural injections started appearing. Keywords: Chronic Low Back Pain, Caudal, Epidural.

Background: Lesions of Thyriod gland are very common and enlargement of thyroid gland indicates the presence of an underlying disease. FNAC can be used as a triage to distinguish between various types of Thyroid lesions, as it is a simple and economical procedure. Materials and Methods: This study was carried out in the Department of Pathology, in the newly established Government Medical College and Hospital, Rajamahendravaram, Andhra Pradesh, India. A total 62 patients presenting with Thyroid enlargement were subjected to FNAC procedure of the taking history and doing general and local examination. Smears were prepared, stained and Cytological Diagnosis was made. Result: Most of the patients presenting with Thyromegaly were in the age group of 31-40years. The most common lesion diagnosed was Adenomatous Goitre. Malignancies formed 8.06% of all cases. Conclusion: FNAC is a rapid and economic technique to diagnose the etiology of various types of Thyroid Lesions and also to classify the lesions as NonNeoplastic and Neoplastic. It also reduces the need for unnecessary surgical intervention in many cases, as diagnosis can be made easily by Cytomorphological examination. Keywords: Cytology, Thyroid, Goitre, Carcinoma.

Background: Endotracheal intubation is used to administer general anesthesia, requiring sufficient muscle relaxation. Suxamethonium is still utilized as a muscle relaxant, particularly for the specific purpose of endotracheal intubation. This study evaluated the conditions under which Rocuronium, a non-depolarizing neuromuscular blocking drug, is used for tracheal intubation. Materials and Methods: A randomized trial was undertaken on a cohort of 200 patients who were classified as ASA I and II. The patients were randomized to two groups for elective procedures using a randomization process. Suxamethonium is classified under Group I. Rocuronium is categorized as a part of Group II. Results: Group I, which administered Suxamethonium, exhibited significantly superior intubating conditions in comparison to Group II, which administered Rocuronium, within a duration of 60 seconds. Both factors in both groups showed an increase after reaching the highest point at 1 minute, and then gradually returned to their normal values. Conclusion: Rocuronium can serve as a substitute when suxamethonium is not appropriate for swift intubation. However, it should not be administered in cases when there is an expected challenging airway. Keywords: Suxamethonium, rocuronium bromide, endotracheal intubation, ASA.

Background: Sleep duration has been suggested to influence metabolic rate, yet the relationship remains unclear. This study aims to explore the correlation between sleep duration and metabolic rate in young adults. Material and Methods: An observational study was conducted with 100 young adults (55 males, 45 females) aged 18-30 years. Participants reported their sleep duration, and resting metabolic rate (RMR) was measured. Sleep duration was categorized into short (<6 hours), normal (6-8 hours), and long (>8 hours) sleepers. Pearson correlation, ANOVA, and linear regression analyses were performed to assess the relationship between sleep duration and metabolic rate. Results: The average sleep duration was 7.2 hours (SD = 1.3). The mean RMR was 1500 kcal/day (SD = 200). A weak positive correlation was found between sleep duration and RMR (r = 0.22, p < 0.05). ANOVA showed significant differences in RMR among sleep duration groups (F (2, 97) = 3.82, p < 0.05). Post-hoc Tukey HSD test indicated long sleepers had significantly higher RMR than short sleepers (p < 0.05). Linear regression revealed that sleep duration accounted for 5% of the variance in RMR (R² = 0.05, F (1, 98) = 5.12, p < 0.05), with the equation: RMR = 1370 + 18 × Sleep Duration. Conclusion: This study demonstrates a weak but significant positive correlation between sleep duration and metabolic rate in young adults. Longer sleep duration is modestly associated with a higher metabolic rate, suggesting that adequate sleep may contribute to maintaining metabolic health. Further research is needed to elucidate underlying mechanisms and long-term effects. Keywords: Sleep duration, metabolic rate, young adults, resting metabolic rate, correlation analysis, ANOVA, linear regression.

Background: Adequate nutrition in early childhood is crucial for optimal cognitive development. This observational study investigates the impact of early childhood nutrition on cognitive outcomes among children aged 3 to 5 years. Material and Methods: The study included 100 participants, evenly split between boys and girls, from diverse socio-economic backgrounds. Nutritional status was assessed using standardized dietary recall methods, categorizing participants into three groups: Well-Nourished (WN; n=40), Moderately Malnourished (MM; n=35), and Severely Malnourished (SM; n=25). Cognitive development was evaluated at baseline and after six months using standardized tests assessing language development, memory, problem-solving skills, and motor coordination. Results: Initial cognitive scores revealed significant differences among the groups. The WN group had the highest mean scores across all cognitive domains (Language Development: 88 ± 4.5, Memory: 86 ± 5.2, Problem-Solving: 84 ± 4.8, Motor Coordination: 82 ± 5.1, Overall Cognitive Score: 85 ± 4.9). The MM group showed intermediate scores, while the SM group had the lowest scores. After six months, all groups demonstrated improvement, with the WN group showing the greatest gains (Overall Cognitive Score: 90 ± 4.3). Paired t-tests indicated significant improvements within each group (p < 0.05), and ANOVA confirmed significant differences in cognitive development based on nutritional status (F = 8.95, p < 0.01). Conclusion: Early childhood nutrition significantly influences cognitive development. Well-nourished children exhibit superior cognitive outcomes, highlighting the need for targeted nutritional interventions in malnourished populations to support cognitive growth and development. Keywords: Early Childhood Nutrition, Cognitive Development, Malnutrition, Observational Study, Nutritional Status, Cognitive Outcomes, Developmental Assessment.

Background: End Stage Renal Disease (ESRD) is a result of several NCDs. According to Global Burden of Disease study, chronic kidney disease was the 9th leading cause of death in India. Government of India launched National Dialysis Program (PMNDP) in 2016. This study is being carried out in cooperation with health care providers and their patients. Objective: To assess awareness and perception of health care providers involved in PMNDP. Materials and Methods: A cross-sectional study, for one-year in Indore and Ujjain division. Sources of data collection were health care providers. Predesigned questionnaire to assess the awareness and perception of health care providers serving the facilities of PMNDP. Results: Responses were collected from all health care providers who serving the dialysis at district hospitals. As per health care providers (78.6%) faced patient load in dialysis centre like 1-10/day and rest (21.4%) faced like 10-20/day. Majority of the health care providers (92.8%) faced patient load in dialysis centre and some of them (7.2%) faced malfunctioning of dialysis machine as per the health care providers. Staff was available in every district of dialysis centre. Majority of the health care providers (67.8%) strongly agreed, and (32.2%) agreed that reducing salt, oil, spice intake with increasing protein and fibre food in diet with regular exercise and maintain personal hygiene benefitted the patient’s undergoing dialysis. Conclusions: This study demonstrates the impact of Health care providers awareness and perception towards the patients in the under-utilization of PMNDP as a dialysis modality. These findings demonstrate a need for increased health care providers education, awareness towards the beneficiary’s undergoing dialysis. Keywords: Haemodialysis, awareness, perception of health care providers.

Background: ABO-hemolytic disease of newborns (HDN) is a condition where there is an incompatibility between the blood types of the mother and fetus. It is the most common and leading cause of neonatal jaundice caused by maternal and fetal ABO incompatibility, mainly seen in neonates of blood group A or B born to mothers of blood group O. With the introduction of Rh immune globulin (RhIg), the incidence of Rh D allo-immunization has decreased over the last few decades. Consequently, hemolytic disease of newborns due to ABO incompatibility and other alloantibodies have now emerged as a significant cause of HDN. Aim: To assess the severity and clinical outcome of ABO HDN in our settings. Material and Methods: Routine investigations were raised from the neonatology department after the delivery of the neonate for direct Coombs test (DCT), and ABO blood grouping was sent to the immuno-hematology laboratory of the Transfusion Medicine department. From May to July 2018, there were 4 cases of ABO–HDN diagnosed. In all cases, mothers were of blood group O, so their serum IgG titer was performed for anti-A and anti-B. The treatment and clinical outcomes of all four cases were analyzed. Results: Forward grouping for all neonates was B+ve, except one A+ve. In all four cases, the Mother serum anti-A titer ranged from 1:512 to 1:1024; similar results were seen for anti-B. Titre was also performed on neonate eluate samples ranging from 1:128 to 1:1024 for anti-A and 1:512 to 1:1024 for anti-B. Conclusion: ABO-HDN incidence is 15-17% in the Indian population. ABO-HDN should be suspected in neonates with blood type A or B born to mother blood type O with indirect Coombs test negative. Most of the cases of ABO-HDN had benign clinical outcomes without the need for exchange transfusion. The intervention of choice was phototherapy, which was also done in all cases except one. Keywords: Hemolytic disease of the fetus/newborn, ABO-incompatibility, neonatal jaundice, alloantibodies, eluate, direct and indirect coombs test, phototherapy, exchange transfusion.

Background: This investigation aims to evaluate the outcomes of titanium elastic intramedullary nailing in paediatric long bone diaphyseal fractures. Material and Methods: 30 individuals with fractures of diaphysis of the humerus, femur, tibia, humerus, or both forearm bones made up the study's sample who were admitted to Andhra Medical College between August 2020 and August 2022 and who met the inclusion and exclusion criteria. Results: In the present study, between August 2020 and August 2022, 30 patients had titanium elastic nailing at the Andhra Medical College in Visakhapatnam for diaphysis fractures of femur (12), tibia (9), humerus (3), & both bone forearms (06). Children and teens between the ages of 6 and 15 were involved in the study. 76.6% of the patients were between the ages of 6 and 10 and 46.6% were between ages of 11 and 15, with an average age of 10.3 years. 67 percent of the cases were boys. The median period from trauma to surgery was 3.96 days, with surgery performed on 11 (36.6%) patients in less than two days, on 7 (23.3%) patients in three to four days, and on 3 patients in 5-7 days later (10 percent). Most fracture procedures (27 cases; 90%) were finished in 30 to 90 minutes. An operation took, on average, 59.9 minutes to complete. 9.26 days on average were spent in the hospital. With a 12.1 week average time to union, 24 patients (or 80%) were able to complete the process in within 3 months. Within 12 weeks, functional loading for the upper limb and unsupported full weight bearing walking for 22 (73.33 percent of the patients) both started. All of the patients in the current study exhibited full ranges of motion in the hip, ankle, elbow, wrist, and forearm, however two (6.66%) of them had slight limitations in knee flexion and forearm supination after 12 weeks. Three persons (10%) reported having pain where the nail was inserted during the follow-up examination; however, by end of the 12-week followup, all these cases had vanished. Conclusion: The present study concluded that, the use of TENS is a safe, minimally-invasive, and physeal protective option for children with lengthy bone shaft fractures that must be stabilised permanently. Keywords: TENS, Bone Diphyseal Fracture, Humerus, Femur.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint pain, swelling, and stiffness that predominantly affects women. Hypothyroidism, a common autoimmune comorbidity in patients with RA, involves an underactive thyroid gland and can affect RA disease activity, functional impairment, and quality of life. The objective of this study is to investigate the associations between disease activity, functional impairment, and quality of life in Rheumatoid Arthritis (RA) patients with and without hypothyroidism. Materials and Methods: This cross-sectional study enrolled 100 RA patients at Integral Institute of Medical Sciences, Lucknow, from October 2022 to October 2023. Participants were categorized into groups with/without hypothyroidism. Demographic data, Disease Activity Score (DAS 28-CRP), Health Assessment Questionnaire (HAQ), and Short form-36 (SF-36) were collected and analysed using independent t-tests, Mann-Whitney U tests, and Pearson's correlation. Results: RA patients with hypothyroidism were younger (mean age 34.08 ± 3.86 years) compared to those without hypothyroidism (mean age 44.92 ± 12.18 years; p < 0.001). They also showed a higher BMI (31.24 ± 1.14 vs. 29.49 ± 3.41; p = 0.014). Disease activity varied significantly, with hypothyroid patients more often in high disease activity states (p < 0.001, Chi-square test) and non-hypothyroid patients more often in low disease activity states (100% below the DAS 28-CRP score of 2.6; p = 0.001). The SF-36 revealed lower scores in the physical functioning, role-physical, and role-emotional domains among hypothyroid patients (p ≤ 0.035). Functionally, hypothyroidism correlated with worse HAQ scores across most domains (p ≤ 0.001 for DG, arising, eating, and reaching). Conclusion: RA patients with hypothyroidism exhibit significantly higher disease activity, worse functional impairment, and a reduced quality of life than those without hypothyroidism. These findings underscore the need for comprehensive management strategies that integrate thyroid function monitoring and management into RA care to improve patient outcomes. Keywords: Rheumatoid arthritis, hypothyroidism, disease activity, functional impairment, quality of life, DAS 28-CRP, HAQ, and SF-36 scores.

Background: Female genital tuberculosis is an important cause of infertility in developing nations. However, the disease burden remains largely undetected due to its variable clinical presentation and lack of sensitive diagnostic tests. Objective: To determine the prevalence of genital tuberculosis in women with infertility. Design: Prospective cross sectional cohort study. Study population: Two hundred four women with primary and secondary infertility. Materials and Methods: This study was conducted in Department of obstetrics and gynaecology at Government medical college Srinagar, India. A total of 204 patients were included in the study. All the 204 study participants underwent diagnostic/therapeutic hysteroscopy-laparoscopy for evaluation of infertility. Endometrial curettings of patients suspected of having genital tuberculosis were sent for TB evaluation via AFB staining, Culture, Gene- xpert and HPE. Cultures were incubated for 8 weeks before declaring a sample negative. Results: Of all 204 study participants, 70 endometrial curettings were sent for TB evaluation, 6 samples (8.57%) were positive on ZN staining, 4(5.7%) positive by gene-xpert, 3(4.28%) positive on culture, with an overall prevalence of 8.5%. Conclusion: Female genital tuberculosis is an important cause of infertility in developing nations. Screening for genital TB needs to be a part of evaluation of infertility and menstrual abnormalities. Most of the patients present in advanced stage and treatment outcomes, particularly with regard to infertility, are poor. Early diagnosis and correct treatment is vital to avoid complications and to restore fertility. Keywords: Infertility, tuberculosis, female genital tuberculosis.

Management of Necrotizing Fasciitis requires liberal fasciotomy in most cases. These fasciotomy wounds require a long time to heal completely using conventional methods. The authors used early NPWT to cut short this healing time, in a wide variety of challenging cases obtaining excellent results. This case series highlights five such cases. Keywords: Negative pressure wound therapy, Vacuum dressing, Necrotizing Fasciitis, Fasciotomy.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily affecting joints, with systemic implications. Vitamin D, beyond its role in calcium homeostasis and bone health, has immunomodulatory properties. Emerging evidence suggests a link between vitamin D deficiency and RA severity. Objectives: This study aims to: i) Assess serum 25-hydroxyvitamin D levels in RA patients compared to healthy controls.ii)Analyze biochemical markers associated with vitamin D metabolism in both groups.iii)Investigate the correlation between vitamin D levels and RA disease severity. Material and Methods: A case-control study was conducted over 12 months at an outpatient clinic affiliated with Rangaraya Medical College, Kakinada. The study included 100 participants: 50 RA patients diagnosed per American College of Rheumatology criteria and 50 age- and sex-matched healthy controls. Exclusion criteria included other autoimmune diseases, chronic inflammatory conditions, and current vitamin D supplementation. Baseline demographic and clinical data were collected, along with serum levels of 25-hydroxyvitamin D, calcium, phosphate, parathyroid hormone (PTH), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Statistical analyses included independent t-tests, Pearson correlation, and multivariate regression. Results: RA patients exhibited significantly lower serum 25-hydroxyvitamin D levels (15.4 ± 5.2 ng/mL) compared to controls (28.6 ± 6.3 ng/mL, p < 0.001). They also had elevated PTH, CRP, and ESR levels, and reduced serum calcium. A significant negative correlation was found between vitamin D levels and RA disease activity (DAS28, r = -0.42, p = 0.003). Multivariate regression identified RA duration, DAS28 score, serum calcium, PTH, and CRP as independent predictors of vitamin D deficiency. Conclusion: RA patients show significant vitamin D deficiency, correlating with disease severity. Monitoring and addressing vitamin D levels may be crucial in managing RA. Keywords: Rheumatoid arthritis, Vitamin D, 25-hydroxyvitamin D, Disease activity, Immunomodulation.

Background: Ventilator-associated pneumonia (VAP) is one among the most common hospital acquired infections in the intensive care unit (ICU).VAP is often diagnosed late because of unawareness of health care staff about VAP prevention bundle. Timely detection of VAP and initiation of appropriate antibiotic treatment is necessary as delay in diagnosis will affect patient’s prognosis and emergence of multi drug resistant pathogens. Aim of the present study was to investigate the microbiological profile of VAP caused by aerobic bacteria and their antibiotic susceptibility patterns in ICU patients. Material and Methods: A cross sectional study conducted for a period of one year from 01/05/2022 to 31/04/2023.135 endotracheal aspirates collected from patients admitted in various ICUs of M.E.S Medical College Hospital who were on mechanical ventilator for more than 48 hrs & suspected for VAP were included in the study. Isolates were identified from the samples using conventional methods. Antimicrobial susceptibility testing done by Kirby - Bauer disc diffusion method as per latest CLSI guidelines. Results: Out of 276 patients, 135 were on mechanical ventilator for more than 48 hours.105 samples showed culture positive and 111 bacterial isolates were obtained. Majority of the isolates were gram negative which are multi drug resistant. Conclusion: VAP is a problem in the ICU setting due to multi drug-resistant pathogens. Clinicians should take preventive measures to minimize the incidence of VAP by focusing on the modifiable risk factors. An effective antimicrobial policy has to be initiated based on the resistance pattern of the pathogens prevalent in the respective Intensive care Unit. Keywords: Ventilator associated penumonia, Klebsiella pneumoniae, Acinetobacter baumanii.

Background: Thrombocytopenia results from four processes: Artifactual Thrombocytopenia, Deficient platelet Production, Accelerated platelet destruction and Abnormal distribution or pooling of platelets within the body. Platelet indices (PI) are markers that indicate platelet activation and volume and can help predict platelet size, morphology and proliferation. Material and Methods: This is a 3-month prospective study from January 2024 to March 2024 in which 275 case were found to have Thrombocytopenia. Blood samples collected were analysed in 5-part Aspen 5000 Auto Analyzer. The study was done in the newly established Government Medical College, Rajamahendravaram, Andhra Pradesh, India. Total Platelet Count and Platelet Indices (PI) of all cases were studied and inference was drawn. Results: A Total of 275 cases were analysed. Most of the cases were in the age group of 0-10 years, males were more affected than females. Moderate Thrombocytopenia was found in most of the cases and Sepsis was the most common cause of Thrombocytopenia. Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) showed alteration in most of the cases of Sepsis, whereas Plateletcrit (PCT) was decreased in most cases of Dengue. Conclusion: Platelet indices (PI) are helpful in diagnosing the etiology of thrombocytopenia and also determine the diagnosis and progrosis of a case. They are simple and economical procedures for evaluation of there cases. However, investigations like Reticulated platelets and immature platelet fraction may be more helpful for evaluation of cases of Thrombocytopenia. Keywords: Platelets, Thrombocytopenia, Sepsis, Dengue.

Background: Neonatal meningitis remains a serious infection globally, leading to significant rates of death and illness. In India, the incidence of neonatal sepsis is reported to be 0.5 per 1000 live births. The greatest impact of neonatal sepsis and meningitis is seen in developing nations. The World Health Organization (WHO) estimates about 5 million neonatal deaths annually. This study aims to evaluate and compare the occurrence of meningitis in suspected cases of early and late onset neonatal sepsis. Material and Methods: This observational study was carried out at a specialized neonatal intensive care unit (NICU) over a one-year period. A total of 150 newborns were enrolled, and detailed information regarding demographics, maternal health, and obstetric history was collected from consenting participants. Results: A comparison of patient profiles based on cerebrospinal fluid (CSF) findings was conducted between two groups: group I with normal CSF results (n=108) and group II with CSF indicative of meningitis (n=30). Among the meningitis cases, pathogens identified included S. epidermidis (5.5%), S. hominis (2.5%), other coagulase-negative Staphylococci (CONS) (8%), Enterococcus (5.2%), and group B Streptococcus (2.5%) as gram-positive bacteria, along with Klebsiella pneumoniae (5.5%) and P. aeruginosa (2.5%) as gram-negative bacteria. Conclusion: The study suggests a heightened risk of meningitis in neonatal sepsis cases. Neonatal bacterial meningitis emerges as a significant contributor to illness and mortality in developing nations such as India. Keywords: CSF, Meningitis, Neonatal Sepsis, Neonatal Intensive Care Unit.

Background: The Learner Doctor method (LDM) of clinical training is a learning program that is part of clinical rotations of the MBBS course that is designed to provide medical students a longitudinal immersive learning experience in the care of patients in a supervised setting. Aim & Objectives: To study the perceptions of Learner Doctor Method and identify various challenges and opportunities. Material and Methods: This qualitative study, done from 1st November, 2023– 29th February, 2024, involved Part I undergraduate Medical students in a Medical college. In-person Focus Group Discussions (FGDs) were held. FGD guide was prepared based on the Perceptions, Barriers and areas to improve in LDM. Results: Majority of study participants felt that non-cooperative patients as barrier, Improvements to be done for effective LDM was Increase patient interaction under supervision. Study subjects were able to diagnose the disease and improve their clinical and communication skills. Conclusion: LDM needs improvements in many areas like effective training and supervision, patient interaction and to focus on barriers for successful implementation of LDM. Keywords: Barriers, Focus Group Discussions, LDM, Qualitative study, Thematic analysis.

Background: The mandible is a U – shaped and the only movable bone of the skull. It is the strongest and the largest bone of the face which forms the lower jaw. During routine dental practice all over the world, inferior alveolar nerve block is the commonest procedure done for effective anaesthesia during dental procedures like tooth extraction or placing dental implants onto the lower jaw. Hence the knowledge about the location of the mandibular foramen through which the nerve supplying the teeth of lower jaw passes through is very important to dentists & maxillofacial surgeons. Material and Methods: A total number of 70 dry mandibles were utilized from the department of Anatomy for the study. All the mandibles were cleaned properly for better visualization of features. With the help of digital calipers the morphometric values of mandibular foramen were noted. The position and number of accessory mandibular foramina was also observed. The findings were tabulated and analysed. Results: The present study revealed the presence of accessory mandibular foramina in 10 mandibles. One mandible presented with two accessory foramina on one side of the mandible. The location of mandibular foramen is correlating with the review except from the posterior border. In the posterior border there is a significant difference in the location of the mandible foramen from right side to left side of mandibles. Conclusion: Morphometric anatomical knowledge of mandibular foramen from various nearby anatomical landmarks and number of accessory mandibular foramina is useful to the dental surgeons in their routine practice to do their procedures on the lower jaw with minimal inconvenience to the patients if inferior nerve block done is completely successful. Keywords: Mandibular foramen (MF), accessory mandibular foramen (AMF), lingula.

Background: To study the risk factors, clinical features in young patients presenting with ACS to Cardiology department at tertiary care hospital, in South India. Material and Methods: Prospective Observational study. It was carried out during From December2020 to 31stDecember2021. Hundred Patients with primary diagnosis of ACS will be subjected to thorough medical history taking, full clinical examination, Baseline laboratory investigations, ECG, ECHO, NT-pro-BNP, Hs-Trop I level, Apo B levels, Angiographic data will be attained. Admission clinical data, risk factors, angiographic data, NT-pro-BNP levels, Hs-Trop I level, Apo B levels, Management options taken accordingly, outcomes as in-hospital and one month later MACE will be recorded. Independent predictors of outcome will be identified by logistic regression analysis and incorporated in to study prediction tool. Results: This study showed the role dyslipidemia as most important modifiable risk factor has its pivotal role due to changing food habits and increasing sedentary life style, a more focused and early detection of dyslipidemia in young can prevent deleterious consequences. Common form of ACS in young is STEMI and commonly present with single vessel disease involving LAD causing AWMI, if managed in time young ACS patients have better in hospital to one-month prognosis, further longer duration studies are needed to prognosticate the longer outcomes in young population. There is significant role of Hs Trop I in assessment of the disease burden, progression of the disease and optimizing the treatment options to cut short the course of disease progression according its levels. Conclusion: The present study concluded that there is significant role of Hs Trop I in assessment of the disease burden, progression of the disease and optimizing the treatment options to cut short the course of disease progression according its levels. Keywords: CAD, Hs Trop I, Atherosclerosis, STEMI, ACS.