Current Issue

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

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

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

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

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

Background: To assess serum Anti-mullerian hormone levels pre- and post-operatively in ovarian cysts and to compare serum Anti-mullerian hormone levels pre- and post-operatively after laparoscopic ovarian cystectomy. Materials and Methods: This prospective, observational study was conducted over the period of 18 months in the Department of Obstetrics and Gynecology of a tertiary care institute. The study involved 26 women with ovarian cyst who underwent laparoscopic ovarian cystectomy. Measurement of serum AMH was performed prior to surgery, and 48 hours after laparoscopic cystectomy. Serum AMH levels were compared before and after the surgery and between various types of ovarian cyst. Results: Most of the patients were in the age group of 31–40 years (46.15%). The majority of the patients were nulliparous (57%) and presented with abdominal pain (73.08%). The patients predominantly had normal body mass index (BMI, 65.38%) and CA125 levels (92%). The most prevalent type of cyst was serous cystadenoma (38.46%). AMH decreased significantly from preoperative to postoperative AMH levels (p=0.003). Moreover, postoperatively, the AMH levels decreased significantly in all age, BMI, and parity groups as well as cyst types (p<0.05). However, the mean change in postoperative AMH levels relative to preoperative levels were not significant in terms of age, BMI, and parity groups as well as cyst types (p>0.05). Conclusion: Laparoscopic ovarian cystectomy leads to significant reduction in AMH levels. However, change in AMH levels was not significantly associated with age, BMI, parity, and cyst type. Keywords: Anti - mullerian hormone, laparoscopic ovarian cystectomy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: Ovarian epithelial tumors represent a diverse group of neoplasms arising from the surface epithelium of the ovary. They encompass a spectrum of histological subtypes, ranging from benign to borderline to malignant tumors. Identifying the immunochemical markers, the molecular and histological characteristics of these tumors is crucial for accurate diagnosis, prognostication, and treatment planning. Materials and Methods: A total of 100 patients with epithelial ovarian tumors were included in the study and assessed for immunoexpression of estrogen receptors (ER), progesterone receptors (PR) and Ki67 levels using ALLRED scores and Ki67 proliferative index respectively. Results: Majority of the tumors were benign (60%). Malignant tumors had higher scores of ER, PR and Ki67 expression. Conclusion: Expression of different markers (ER, PR, and Ki-67 index) in different types, stages, and grades of tumors has significant role in management of tumors and predicting treatment response. Keywords: Malignancy, Epithelial tumors, estrogen receptor, progesterone receptor, Ki67.

Background: COPD is a leading cause of death & morbidity worldwide; by virtue of smoking habits of the population & ever increasing outdoor & indoor air pollution, which is more common & accentuated in semiurban or rural areas due to PARALI burning (smoke resulting fromburning of the crop residue) and availability of lesser medical facility as in the rural areas of bharatpur. It is a well known fact that COPD has lot many friends including cardiovascular disease which is one of the chief contributors to COPD morbidity andmortality. Whether as a comorbidity or as resultant to the respiratory disease it has to be optimally and holistically managed so as to give patient more disease free period & increased survival. Sometimes services of cardiologist are not easily available in all corners & the treating physicians may lack the knowledge to address such concomitant issues, so it’s crucial to develop an easily available surrogate marker which can predict Cardiovascular morbidity in COPD patients and timely referrals. CRP is a cheap and easily available such marker, and it has been studied widely in context of COPD but not in context of comorbid cardiac disease in COPD. So this study will serve a gap in this knowledge about use of CRP to predict cardiac disease burden in COPD patient. Materials and Methods: This study was conducted in RBM Hospital of Sh JP Medical college Bharatpur in Sept 2023- August 24 on 100 clinically & spirometrically diagnosed COPD patients presenting to the OPD & IPD of Chest & TB Department. Main objective was to find out any correlation between raised CRP levels with any observed cardiac effects in these COPD patients. Statistical analysis was done by Chi square & student T test. Results: Increased CRP is significantly correlated with right sided cardiac dysfunctions mainly Right Atrial and Right Ventricular enlargements and Cor pulmonale. No correlation was established in raised CRP and Left sided cardiac function. Conclusions: Patients of COPD specially severe and very severe grades should also be screened for presence of cardiac comorbidity as well, as it is the most common cause of morbidity andmortality in COPD patient. In resource limited setting CRP can be used as a surrogate marker of the presence of cardiac disease which requires more specialized care. Key-words: COPD, Systemic inflammation, Cardiac effects, CRP, Cor Pulmonale.

Background: Breast cancer is the most common malignancy among women worldwide, with an increasing incidence linked to lifestyle and metabolic factors. This study aims to evaluate the association between lipid profile parameters and breast cancer in a South Indian population. Materials and Methods: A case-control study was conducted at the Department of General Surgery, Mysore Medical College and Research Institute. Two hundred twenty-six histologically confirmed breast cancer patients and 166 age-matched healthy controls were included. Serum lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were measured after overnight fasting using standard biochemical methods. Results: Breast cancer patients exhibited significantly higher mean TC (209.43 vs. 196.93 mg/dL, p=0.008) and LDL-C levels (123.41 vs. 108.50 mg/dL, p=0.032) compared to controls. No significant difference between the groups was observed in HDL-C levels (p=0.876). Conclusion: This study highlights a significant association between elevated TC and LDL-C levels and breast cancer, suggesting that dyslipidemia may play a role in its pathogenesis. Keywords: Breast cancer, serum lipids, total cholesterol, LDL-C, HDL-C, triglycerides.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Background: The implantation of a human embryo requires a subtle dialogue between the endometrium and the embryo.The aim is to study the effect of the addition of estradiol valerateto ovulation induction drugs on endometrial thickness and to study the pregnancy rate after the addition of estradiol valerate to ovulation induction drugs in PCOS & Non PCOS women. Material and Methods: This study is a prospective observational study. The study spanned over a period of 9 months. The study included all infertile patients who visited the Outpatient Department and underwent ovulation induction during the specified period.The inclusion criteria for participants encompassed individuals aged between 21 and 35 years, with a body mass index (BMI) ranging from 18 to 34.9 kg/m². Primary or secondary infertility cases undergoing ovulation induction with natural conception or intrauterine insemination (IUI) were considered.Participants with Mullerian malformations, primary amenorrhea, hypogonadotropic hypogonadism, premature ovarian failure, and those who had previously undergone unsuccessful IUI/IVF were excluded from the study. Results: The mean age was 28.82 ± 4.43 years. Around 67% of women were infertile for a duration upto 5 years. The mean duration of fertility was 4.72 ± 3.34 years. Majority of patients (64.5%) were in primary infertility group. About 58.1 % women had regular cycles and 41.9 % had irregular cycles. The cause of infertility was female factor in 41.5 % patients and male factor in 25.3 % patients.In PCOS group, irrespective of the endometrial thickness, estradiol valerate supplementation with oral ovulogens showed a comparable pregnancy rate. In the Non-PCOS group, irrespective of the endometrial thickness, estradiol valerate supplementation with oral ovulogens showed a comparable pregnancy rate. Conclusion: The administration of estradiol valerate along with ovulogens showed improvement in endometrial thickness but did not improve the pregnancy rate. Keywords: Endometrial thickness, Estradiol valerate, Letrozole, Ovulation induction.

Background: Stroke is a leading cause of disability and death, with a high burden in South Asia. Electrolyte imbalances, such as hyponatremia and hypokalemia, are common in stroke patients and can worsen outcomes. This study evaluated serum sodium and potassium levels in stroke patients compared to controls. Materials and Methods: A cross-sectional study was conducted on 200 participants, including 100 stroke patients (50 ischemic, 50 hemorrhagic) and 100 controls. Stroke types were diagnosed via CT or MRI scans. Serum electrolytes were analyzed statistically, with a significance level of p < 0.05. Results: Sodium levels were higher in stroke patients (146.03 mEq/L) than controls (138.88 mEq/L, p = 0.001). Potassium levels were lower in stroke patients (3.79 mmol/L) than controls (4.28 mmol/L, p = 0.001). Hemorrhagic stroke patients had higher sodium levels (149.26 mEq/L) than ischemic patients (142.80 mEq/L, p = 0.001). Potassium and chloride showed no significant differences between stroke types. Conclusion: Elevated sodium and reduced potassium levels were significant in stroke patients and varied by stroke type. Early detection and correction of these imbalances are critical for improving outcomes. Keywords: Stroke, Electrolyte Imbalance, Sodium, Potassium, Ischemic Stroke, Hemorrhagic Stroke.

Background: Emergency Peripartum Hysterectomy (EPH) is a life-saving procedure performed in cases of severe obstetric hemorrhage, typically associated with conditions like uterine atony, abnormal placentation, and uterine rupture. The global incidence ranges from 0.035% to 0.54% and is rising due to increasing cesarean deliveries and placental complications. This study aims to evaluate the incidence, risk factors, indications, and outcomes of EPH over a three-year period at a tertiary care center. Materials and Methods: A retrospective study was conducted at KAHERS Jawaharlal Nehru Medical College and Research Centre, Belagavi, reviewing medical records of women who underwent EPH from January 2021 to December 2023. Women with EPH due to obstetric indications were included, while elective hysterectomies, incomplete records, and referrals were excluded. Data analyzed included demographics, obstetric history, indications, complications, and outcomes. Results & Conclusion: Of 22 EPH cases, the majority occurred in women aged 20–29 years (59%), with multiparity being a significant risk factor (86%). Rural residency (59%) and lower socioeconomic status were prevalent. Prior cesarean sections were reported in 77% of cases, with morbidly adherent placenta as the most common indication (68%), followed by placenta previa and uterine atony. Complications included coagulopathy (14%) and significant blood loss (average 1,603 mL). Despite the severity, no maternal deaths were reported, reflecting effective management. These findings emphasize the need for improved antenatal care and early identification of high-risk pregnancies to reduce EPH rates and associated morbidity. Keywords: Emergency Peripartum Hysterectomy, Obstetric Hemorrhage, Morbidly Adherent Placenta, Cesarean Section, Risk Factors, Maternal Morbidity.

Background: Ruptured intracranial aneurysms are a critical cause of subarachnoid hemorrhage (SAH), resulting in high morbidity and mortality. Although surgical clipping is the primary treatment modality—especially in resource-limited settings—the optimal timing of intervention remains contentious. This study evaluated how the timing of surgical clipping influences perioperative parameters, complications, and functional outcomes. Materials and Methods: In this retrospective observational study at a tertiary care center in North India, we analyzed adult patients with radiologically confirmed ruptured intracranial aneurysms who underwent surgical clipping between January 2014 and December 2022. Patients were categorized into three groups based on the interval from rupture to surgery: early (≤72 hours, n = 96), intermediate (4–10 days, n = 96), and delayed (>10 days, n = 97). Baseline demographic, clinical, and aneurysm characteristics were comparable across groups. Primary and secondary outcomes, including 30-day mortality, modified Rankin Scale (mRS) scores at discharge and 3-month follow-up, and perioperative data (surgical duration, blood loss, ICU/hospital stay) were assessed. Multivariable logistic regression was performed to identify independent predictors of favorable outcomes. Results: The time from rupture to surgery significantly differed among the groups (36.4 ± 11.5 hours for early, 168.7 ± 32.5 hours for intermediate, and 243.5 ± 35.7 hours for delayed; p < 0.001). The early clipping group experienced shorter surgical duration and reduced blood loss compared to the delayed group (2.5 ± 0.5 vs. 3.1 ± 0.7 hours and 153.6 ± 53.7 vs. 185.8 ± 64.2 mL, respectively; p < 0.05). Although the proportion of patients achieving favorable mRS scores (≤2) at discharge and at 3 months was higher in the early group (77.1% and 76.0%, respectively) than in the delayed group (64.0% and 60.8%), these differences did not reach statistical significance. Multivariable analysis, however, revealed that early clipping was independently associated with improved outcomes (adjusted OR = 1.85, 95% CI: 1.15–2.93, p = 0.011). Additionally, older age and larger aneurysm size were significant negative predictors, whereas a higher admission Glasgow Coma Scale score was positively associated with favorable recovery. Conclusion: Early surgical clipping (≤72 hours) for ruptured intracranial aneurysms is associated with reduced operative time, lower blood loss, shorter ICU and hospital stays, and improved functional outcomes. These findings support early intervention as a beneficial strategy, particularly in settings with limited neurosurgical resources, though prospective studies are warranted to further delineate optimal patient selection and timing. Keywords: Intracranial Aneurysm, Surgical Clipping, Timing of Surgery, Outcomes, Glasgow Outcome Scale.

Background: First year of college often generates psychological stress among youngsters due to sudden shift in environment. Stress often leads to biochemical changes. One of the consequences of psychological stress may be deviation in the levels of stress markers -sulphated Dehydroepiandrosterone (DHEA-S) and cortisol. Earlier studies investigated psychological stress and DHEA-S and cortisol levels and observed different findings. Studies showed high levels of cortisol and lower levels of DHEA-S in stress. Few studies demonstrated contradicting results. Further some studies do not show any clear association in any direction. The purpose of this study is to investigate whether levels of DHEA-S and cortisol fluctuates in students who reported perceived stress compared to individuals who report less perceived stress at college. Material and Methods: There were 107 participants (53 cases and 54 controls) of age range 19-25 years, selected from the first-year nursing students of Subharti Medical College of Meerut district. Perceived stress scale (PSS 10) was used to measure perceived stress of respondents. Serum DHEA-S and cortisol were estimated by Vitros Fusion 5.1 by Ortho Clinical Diagnostics from Johnson & Johnson USA. Results: In our study mean levels of DHEA-S in cases were 0.66 ± 0.31, Cortisol 103.8 ± 29.8 and PSS were 23.01 ± 2.1. PSS was positively correlated with DHEA-S (r = < 0.05) while there was no significant relation between PSS and Cortisol. Conclusion: This study indicates that stressed individual has markedly higher levels of DHEA-S. No significant correlation was found between perceived stress and cortisol. Keywords: Cortisol, DHEA-S, Perceived stress, PSS.

Background:Paediatric laparoscopy has evolved for the last two decades and has become the standard of care from emergency to elective procedures.Aims and objectives: The present study aimed to evaluate the role of laparoscopic cholecystectomy in paediatric population. Material and Methods: This retrospective study was carried in our institution from 2018-2024 over a period of 07 years. Data reviewed includes patient demographics, clinical presentation, investigation and management of these patients. Results: Thirty patients were included in the study. The age varies from 2.5 – 18 years with the mean age of 9.2 years. The male to female ratio was 12: 18. The commonest presentation was pain right hypochondrium followed by nausea, vomiting and food intolerance. Four patients present with acute cholecystitis and three patients had asymptomatic cholelithiasis. The mean duration of symptoms was 2-12 months (mean 2-8 months). None of the patient had any haemolytic disorder, common bile duct stones or any congenital anomaly of the biliary tree. All patients underwent safe laparoscopic cholecystectomy without any complication. The mean operative time was 64.3 minutes and the mean hospital stay was 26.4 hours. Conclusion:Laparoscopic cholecystectomy for cholelithiasis in children is safe, effective and feasible. The incidence of gallstones in children has increased due to change in dietary habits of children. Key Words:Laparoscopic cholecystectomy, Cholelithiasis, Common bile duct (CBD).

Background: Several studies in literature point to a possible etiological role of Salmonella typhi in pathogenesis of carcinoma gallbladder (Ca GB). By reviewing the literature, it is evident that by eradicating the microbe we can reduce the incidence of microbe related cancers in endemic areas. Aims and objectives: To study the role of Salmonella typhi in etiology of Ca GB by molecular, serology and culture methods and to detect the presence of DNA of Salmonella typhi using Flagellin gene in cells of gallbladder cancer and chronic cholecystitis (CC) by using DNA-PCR. Material and Methods: 74 samples of biopsy tissues of Ca GB and CC were taken from an army hospital. These samples were processed for DNA extraction and real time PCR based on SYBR green chemistry done. Widal’s test and stool culture for S. typhi was also performed for all patients. SPSS statistical software was used for analysis. Results: In Ca GB tissues by PCR, only four cases were positive out of thirty-two patients (12.5 %) compared to two cases out of forty-two (4.7 %) patients of CC (chi square = 0.393). As for Widal’s titre they were positive in only eight out of twenty-six (30.7%) cases in Ca GB patients compared to four out of twenty-eight (14.2%) patients of CC (chi square = 0.303). In Stool culture no case was positive for Salmonella typhi. Conclusion: We found that there is low prevalence of S. typhi gene and antibodies in our patients who are all from defence background and vaccinated against S. typhi. A policy of eradication of microbes by antibiotic therapy and vaccination, may lead to reduction in the incidence of bacteria-induced cancers in areas where S. typhi is endemic. Key Words: Carcinoma gallbladder, chronic cholecystitis, flagellin gene, Salmonella typhi, vaccination.

Background: Urinary stone disease is increasingly common alongside rising obesity, metabolic syndrome, and type 2 diabetes mellitus (T2DM) in industrialized and urban Indian populations. While diabetes is linked to a higher risk of kidney stones, the exact stone composition remains unclear. Diabetic patients tend to excrete more oxalate and uric acid, with lower urine pH, promoting stone formation. Factors such as insulin resistance and altered renal handling of calcium and ammonium contribute to this risk. However, limited data exists on the specific stone composition in diabetic patients. This study aims to explore the prevalence and composition of kidney stones in individuals with T2DM. Materials and Methods: This 12-month cross-sectional study (Jan-Dec 2024) involved 285 patients with upper tract urolithiasis admitted for intervention. Inclusion criteria included patients with upper urinary tract stones willing to participate, while exclusions included those with conditions like coronary artery disease, chronic kidney disease, and metabolic disorders. Data collection involved structured proformas, urine pH and specific gravity meters, blood and urine analyses, imaging studies, and BMI calculations. Stone interventions included PCNL, RIRS, URS, ESWL, or open surgery. Variables analyzed included age, BMI, blood glucose, serum creatinine, urinary oxalate and uric acid, stone characteristics, and hospitalization duration. Ethical approval and informed consent were obtained. Results: During the study period, 285 patients with upper urinary tract calculi were admitted to Rama Medical College's Urology Ward, of which 85 (29.8%) were diabetic and 200 (70.2%) were non-diabetic. Among diabetics, 42.4% were female and 57.6% were male, while in non-diabetics, 34.5% were female and 65.5% were male. Diabetic patients had higher rates of being overweight (67.1%) and obese (15.3%) compared to non-diabetic patients (34.5% overweight, 5.5% obese), with a statistically significant difference (p<0.001). Symptoms like vomiting, fever, and pyuria were more common in diabetic patients. Diabetics also had significantly lower urine pH, higher urinary oxalate excretion, and higher rates of pus cells, RBCs, and radiolucent calculi. Hospital stays were longer for diabetic patients (32.9% stayed ≥3 days) compared to non- diabetics (9.5%). Diabetic patients had significantly higher BMI, mean age, serum uric acid, blood urea, serum creatinine, and calcium values. Urinary oxalate and uric acid values were also significantly higher in diabetics. All differences were statistically significant. Discussion: Urolithiasis is a significant global health issue, with over $2 billion annually spent on treatment in the U.S. Type 2 diabetes mellitus (T2DM), characterized by insulin resistance, is a known risk factor for renal stone formation. Insulin resistance lowers renal ammonium production, reducing urinary pH, which promotes uric acid stone formation. Additionally, T2DM increases urinary calcium excretion, contributing to calcium stone formation. This study, conducted at Rama Medical College, found that 29.8% of 285 patients with upper urinary tract stones were diabetic. Dia

Background: Median nerve arises from the brachial plexus, courses through the arm and forearm to divide into its terminal branches at the distal carpal tunnel. Due to significant differences in the prevalence of median nerve variations, extensive knowledge on the anatomy of the median nerve is essential to avoid iatrogenic nerve injury. The aim of this study was to identify any variations present in the course and division of the median nerve. Materials and Methods: 50 adult upper limb specimens from 25 cadavers were obtained from the Department of Anatomy, Government medical college, Kallakurichi. The arm and forearm were dissected and median nerve was exposed completely and its branches in the palm were noted. Variations, if present were identified and photographed. Results: Normal course and branching pattern of median nerve were noted in 44 cases (88%), bifid median nerve was observed in 6 cases (12%). The recurrent branch to thenar muscles (thenar motor branch) had a normal origin in 47 cases (94%). It arose deep to the flexor retinaculum (transverse carpal ligament) in 3 cases (6%). Communicating branch between lateral and medial branches of median nerve was present in 4 cases (8%). An accessory branch was noted in 2 cases (4%) with bifid median nerve. Conclusion: Anatomical variations in the course of median nerve and its branches are common in the population. Preoperative ultrasound can be done to identify any median nerve variations. In order to avoid iatrogenic injury, an ulnar side approach to carpal tunnel release surgeries is recommended. Keywords: Median nerve, Bifid median nerve, Thenar motor branch, Carpal tunnel release surgeries, Transverse carpal ligament.

Background: Aim: The aim of the present study was to assess the correlation between ultrasound transient elastography (TE) and serum ferritin (SF) in patients of NAFLD. Materials and Methods: All the patients of NAFLD (newly diagnosed or old patients) were included in the current study after applying inclusion and exclusion criteria after taking written and informed consent. A detailed history was obtained and thorough clinical examination was done. These patients were clinically evaluated for NAFLD by doing detailed general examination, systemic examination and then subjected to lab investigations as per protocol. Results: Majority of the patients (26.8%) belonged to 40-49 years of age (26.8%) followed by 30-39 years of age (24.1%). Mean age was 42.86±12.67 years. Out of 112 patients, 55.4% were females and 44.6% were males. 66 patients had hypertension and 38 patients had diabetes mellitus. Mean BMI of the study population was 25.86±3.27. Majority of the patients (42.9%) had BMI 25-29.9 followed by 23-24.9 (25.9%). Out of total study population, 48.2% patients had HbA1c <5.7, followed by >6.4 (31.3%) and 5.7-6.4 (20.5%). Mean ferritin levels in females were 116.66+59.74 ng/mL and Mean ferritin levels in males were 204.14+ 111.90 ng/mL. The difference was statistically significant. Mean ferritin levels in patients with fibrosis grade F0 was 68.53+38.03 ng/mL, F1 was 114.28+29.19 ng/mL, F2 was 153.83+33.88 ng/mL, F3 was 253.21+68.95 ng/mL, and F4 was 389.00+100.72 ng/mL. The difference between grades of fibrosis and mean values of ferritin was also found statistically significant. Conclusion: In this study, a significant relationship was seen between the serum ferritin level and liver stiffness as measured by shear wave elastography in patients with NAFLD, and it can be used as a non-invasive economic option in comparison with liver biopsy and elastography for predicting the severity of liver fibrosis among NAFLD patients in a resource limited setting. Keywords: Ferritin, nonalcoholic fatty liver disease, transient elastography.

Background: Caesarean section, one of the most common obstetric surgeries, frequently involves routine urethral catheterization to minimize bladder injury, urinary retention, and improve surgical field visualization]. With no clear consensus on optimal removal timing, further clinical research is essential to balance patient safety, recovery outcomes, and cost-effective care, especially in resource-limited settings. Materials and Methods: This observational cross-sectional study at Rama Medical College examined urinary tract infection risks in pregnant women undergoing Caesarean section under spinal anesthesia. Participants (n=126) were divided into two groups based on catheter removal timing (6 vs. 24 hours). Urine samples collected pre- and post-catheterization were analyzed for bacteriuria and antibiotic sensitivity. Exclusion criteria included medical comorbidities, prolonged labor, and recent antibiotic use. All patients received intravenous cefuroxime, with early ambulation encouraged and discharge by day three. Those with significant bacteriuria (≥10⁵ CFU) were monitored for 10 days post- discharge. Results: This study compared outcomes between two groups of pregnant women undergoing Caesarean sections based on catheterization duration (6 hours vs. 24 hours). Both groups were similar in age, gestational age, parity, and hemoglobin levels. Group II had a higher BMI and longer ambulation times. Urinary retention was more prevalent in Group I, while Group II had significantly higher rates of urine infection. Group I demonstrated earlier first voiding after catheter removal, while hospital stay durations were the same for both groups. The findings indicate catheterization duration significantly influences urinary outcomes and ambulation times. Discussion: This observational cross-sectional study at Rama Medical College investigated the impact of urinary catheter removal timing on postoperative urinary tract infections (UTIs) and recovery in 126 post-Caesarean section patients. Participants were divided into two groups based on catheter removal timing: 6 hours (Group I) or 24 hours (Group II). Group I had significantly fewer UTIs (3.2% vs. 12.7%) and earlier ambulation (8.94 vs. 10.86 hours). However, urinary retention was higher in Group I (7.9% vs. 0%). Findings align with prior studies, supporting early catheter removal to reduce UTI risk and improve recovery without prolonging hospital stays. Conclusion: This study evaluated 126 post-Caesarean patients, comparing catheter removal at 6 hours (Group I) and 24 hours (Group II). Group II had higher bacteriuria rates (12.7% vs. 3.2%), longer voiding times, and slower ambulation, while Group I experienced more urinary retention. Findings support early catheter removal to reduce UTI risk and improve recovery. Keywords: UTI, Catheter Removal, Bacteriuria.

Background: Lower Abdominal Surgeries are known for reduced postoperative pain and faster recovery. Effective analgesia is essential, and the Transversus Abdominis Plane (TAP) block is an effective regional anesthesia technique. This study compares the postoperative analgesic effects of preoperative versus postoperative TAP blocks. Material and Methods: A prospective, Blinded, randomized controlled study was conducted at a tertiary care center in Gujarat from January to December 2023, involving 80 patients. They were randomly assigned to either a preoperative or postoperative TAP block group. Pain was assessed using Visual Analog Scale (VAS) scores and opioid consumption within 24 hours. Results: Group 1 (preoperative TAP block) had significantly lower VAS scores and consumed fewer opioids than Group 2 (postoperative TAP block) at 6, 12, and 24 hours (p < 0.05). Preoperative TAP blocks resulted in better pain management and quicker analgesic requests. Conclusion: Preoperative TAP blocks offer superior postoperative analgesia compared to postoperative blocks in Lower Abdominal surgeries, leading to improved pain control and reduced opioid consumption. Keywords: Transversus Abdominis Plane (TAP) block, Postoperative analgesia, Visual Analog Scale

Background: To determine the indications of primary Caesarean section in multiparous women, and their maternal and perinatal outcomes. Materials and Methods: The study employed a retrospective observational design to analyse data from multiparous women attending the Modern government maternity hospital(MGMH) over a two-year period from 2022 to 2024. MGMH serves as a tertiary care center for obstetric and gynaecological services. The study population consisted of multiparous women with singleton pregnancies and term gestation. Results: Demographically, a significant portion of the participants is under 25 years old, constituting 54% of the cohort. They mainly hail from the lower and upper-middle socioeconomic classes, with 46% falling into the former and 32% into the latter category. Moreover, 40% of the participants are graduates. Health-wise, prevalent comorbidities include hypothyroidism (14%) and gestational diabetes (10%). Notably, assisted reproductive technologies were utilized in 16% of conceptions. Regarding labor and delivery, 80% of cases underwent emergency LSCS and 20 % patients underwent elective LSCS. The primary reasons for caesarean sections include fetal distress (44%), Oligohydramnios (24%), malpresentations (16%), cephalopelvic disproportion/contracted pelvis (8%), Non progress of labour (4%), placenta previa (4%) Neonatal outcomes indicate that 58% of new-borns did not require NICU admission, while 42% did. Common reasons for NICU admission include respiratory distress syndrome and neonatal jaundice. APGAR scores at 1 minute after birth showed that 62% of new-borns scored above 7, while 38% scored below. At 5 minutes after birth, 80% of new-borns scored above 7 on the APGAR scale, while 20% scored below. Conclusion: This study provides valuable insights into the indications, maternal, and perinatal outcomes of primary caesarean section among multiparous women. The findings underscore the importance of vigilant screening and management of maternal comorbidities, such as hypothyroidism and gestational diabetes, during pregnancy to mitigate adverse pregnancy outcomes. Keywords: Singleton pregnancies, Term gestation, Caesarean section, Gestational diabetes.

Background: Bladder cancer is a prevalent urological malignancy, with accurate preoperative staging being crucial for effective treatment planning. Diffusion-weighted magnetic resonance imaging (DW-MRI) is an emerging imaging modality that enables tumor characterization based on water molecule diffusion properties. This study evaluates the role of DW-MRI in preoperative staging and grading of bladder cancer and its correlation with clinical, radiological, and histopathological findings. Materials and Methods: A prospective cross-sectional diagnostic study was conducted at Rajiv Gandhi Government General Hospital, Chennai, from March 2022 to March 2024. A total of 46 patients with bladder cancer were enrolled, with exclusion criteria including prior transurethral resection of bladder tumor (TURBT), intravesical therapy, systemic chemotherapy, or radiotherapy. All patients underwent DW-MRI of the kidney, ureter, and bladder (KUB) region using a 1.5-T MR system, followed by TURBT or radical cystectomy. Apparent diffusion coefficient (ADC) values were measured and correlated with histopathological staging and grading. Statistical analysis was performed using SPSS software, with a p-value of ≤0.05 considered significant. Results: The study consisted of 42 males (91.3%) and 4 females (8.7%), with a mean age of 59.6 years. Muscle-invasive bladder cancer (MIBC) was observed in 27 (58.7%) patients, while 19 (41.3%) had non-muscle-invasive bladder cancer (NMIBC). Mean ADC values were significantly lower in tumors (1.23 ± 0.18 × 10⁻³ mm²/sec) compared to normal bladder wall (1.91 ± 0.09), seminal vesicles (1.90 ± 0.13), and prostate (1.85 ± 0.11). High-grade tumors exhibited significantly lower ADC values (1.04 ± 0.10) than low-grade tumors (1.36 ± 0.06, p < 0.001). DW-MRI demonstrated excellent accuracy in differentiating T and N stages, with sensitivity and specificity of 94.74% and 100% for T staging and 97.3% and 100% for N staging, respectively. The overall diagnostic accuracy for staging was 97.83%. Conclusion: DW-MRI is a valuable non-invasive imaging tool for preoperative staging and grading of bladder cancer. The strong correlation between ADC values and tumor grade suggests its potential utility in risk stratification. Given its high sensitivity and specificity, DW-MRI may serve as an alternative to contrast-enhanced imaging, particularly for patients with renal impairment, enhancing the accuracy of bladder cancer diagnosis and treatment planning. Keywords: Bladder cancer, diffusion-weighted MRI, apparent diffusion coefficient, tumor staging, tumor grading, urothelial carcinoma.

and almost always present only with features of Non Cirrhotic Portal Hypertension (NCPH), include Non-Cirrhotic Portal Fibrosis (NCPF) and Extra-Hepatic Portal Vein Obstruction (EHPVO).3 Proximal Spleno Renal Shunt (PSRS) is the most commonly performed shunt surgery for these patients.5 Present study was aimed to clinically analyse the short-term and long-term outcomes of patients undergoing proximal splenorenal shunt surgery at a superspecialty hospital. Material and Methods: Present study was Retrospective observational study from prospectively maintained database, conducted in patients who underwent proximal splenorenal shunt surgery (PSRS) done for EHPVO, NCPF, portal biliopathy. Results: In the present study, a total of 30 patients with NCPH were studied. All the 30 patients (100%) had hematemesis in the pre-operative period. After surgery, none of the patients reported to have hematemesis. Preoperatively, 26 (86.7%) of patients had complained of Melena. After PSRS, all the 30 patients reported symptomatic relief from melena. This improvement was found to be highly statistically significant. (p - <0.0001). Pre-operatively, none of the patients revealed any history of hepatic encephalopathy. Post-operatively, in all the patients, there was improvement of anemia and normalization of leucocyte count and majority showed normal platelet count. There was no statistically significant difference between the pre – operative and post – operative liver function statuses except for total and conjugated bilirubin, which showed improvement after shunt surgery. Post-operatively, most of the patients had disappearance of varices and few patients had persistent varices, but reduced to grade I. Conclusion: For patients of NCPH with recurrent GI bleeding and symptoms of hypersplenism and with dilated shuntable splenic vein, PSRS is a safe and effective single time solution with good shunt patency and no further episodes of GI bleeding with low mortality rate and favourable long term outcomes and improved quality of life. Keywords: Non Cirrhotic Portal hypertension (NCPH), Non-Cirrhotic Portal Fibrosis (NCPF), Extra-Hepatic Portal Vein Obstruction (EHPVO), Proximal Spleno Renal Shunt (PSRS)

Background: Fibroids, also called leiomyomas, myomas, leiomyofibromas, fibroleiomyomas, or fibromas, are benign tumors that arise from the myometrium's smooth muscles and the uterine connective tissues that support them. Fibroids, the most common benign tumor in women, affect 40 to 50% of women over the age of 35 and are usually detected in the middle and later stages of the menstrual cycle. According to estimates, 40% of women over 50 who are menstruation experience it. Uterine fibroids' symptoms are frequently signs that a hysterectomy is necessary. Numerous people have more than one fibroid. There are no symptoms in 50% of uterine fibroids patients. Objectives: 1. To observe and study the epidemiology of uterine fibroids. 2. To study and compare the clinic-pathological spectrum in cases of fibroid uterus and to know their pattern of presentation Methods: Study Design: Cross sectional study. Study place: Department of Obstetrics & Gynecology, GITAM medical college, Visakhapatnam. Study Duration: September 2022 to July 2024. Study population: All the patients who were undergoing surgical management after diagnosis with uterine fibroids in GITAM. Study sample: 165 Result: majority of patients (44.2%) are between the ages of 41 to 50 years,74.5% of patients had menstrual disturbances, 20.6% of patients had dysmenorrhea, 12.7% of patients had white discharge per vagina, 35.1% of patients had abdominal pain, 12.7% of patients had mass per abdomen, 1.2% of patients had mass per vagina, 17.6% of patients had urinary problems, 13.3% of patients had infertility, 4.8% of patients had other symptoms.74.5% of patients had menstrual disturbances of which 56.9% of patients had menorrhagia, 9.7% of patients had metorrhagia, 13% of patients had polymenorrhagia, 18.7% of patients had polymenorrhoea and 1.6% of cases had postmenopasual bleeding. majority of patients (47.8%) underwent TAH followed by 33.9% of patients underwent TAH with BSO, 11.5% of patients underwent myomectomy, and 6.7% of cases underwent TAH WITH USO. majority of patients (61.8%) had intramural type of fibroid followed by 15.6% of patients had multiple fibroids, 10.3% of patients had submucous fibroids, 4.8% of patients had cervical fibroids, and subserous fibroids each and 2.4% of women had broad ligament fibroids. majority of patients (69.7%) had proliferative endometrium, majority of patients (72.7%) had chronic cervicitis. Conclusions: There is a higher prevalence of uterine fibroids among women of reproductive age, particularly in their 4th and 5th decade, with rare occurrence before puberty and cessation of growth after menopause, Intramural fibroids were the most frequently encountered type, Microscopic examination revealed that proliferative and simple hyperplastic endometrium were the most common findings. Keywords: leiomyomas, Myomectomy, hysterectomy, TAH, TAH+BSO, TAH+USO.

Background: Psychiatric disorders are common among hospitalized patients, and consultation-liaison psychiatry plays a vital role in addressing the mental health needs of these patients. Despite its importance, there is limited research on the clinical correlates of psychiatric consultations in general hospital settings. This study aimed to explore the demographic, clinical, and referral characteristics, psychiatric diagnoses, interventions provided, and patient/caregiver reactions to psychiatric referrals in a hospital setting. Materials and Methods: This cross-sectional study was conducted at Department of Psychiatry at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), a tertiary medical institute in Rohtak, Haryana. A total of 200 patients who were referred for psychiatric consultations during hospitalization were included. Data were collected through interviews with patients and caregivers, focusing on demographics, reasons for referral, psychiatric diagnoses, interventions, and patient/caregiver reactions. Descriptive statistics were used to analyse the data, and Pearson correlation coefficients were calculated to examine relationships between referral knowledge and other variables. Results: The majority of patients referred for psychiatric consultation were between 31-45 years of age (70.5%), with a higher prevalence of males (59.5%). Most patients received pharmacological treatment (63%), while 22.5% received psychotherapy. A majority (91%) expressed satisfaction with the psychiatric consultation, but 54.5% of caregivers reported inadequate explanation of the referral. Cultural factors played a significant role in the perception of psychiatric symptoms, with 74% of patients attributing symptoms to physical or supernatural causes rather than psychiatric illness. Conclusion: This study highlights the importance of early psychiatric consultation, effective communication about the referral process, and addressing cultural misconceptions regarding psychiatric illnesses. While patient satisfaction with psychiatric consultations was high, there are significant gaps in awareness and education regarding mental health, both for patients and caregivers. Future efforts should focus on improving referral pathways, increasing access to psychotherapy, and reducing stigma related to mental illness in hospital settings. Keywords: Consultation-liaison psychiatry, hospital referrals, depression, cultural perceptions, healthcare communication.

This study is aimed to determine association between HbA1c (Glycosylated Hemoglobin) and Uric acid levels in normal, Pre-Diabetic and Diabetic individuals, both males and females who come for regular health checkup in outpatient basis. Individuals were divided into 3 groups. Group-1 were individuals with HbA1c <5.6 %, Group-2 were individuals with HbA1c between 5.7 – 6.4 % and Group-3 were individuals with HbA1c >6.5%. Serum Uric acid was measured in fully-automated analyser and HbA1c by HPLC analyser. Uric acid causes a series of pathophysiological changes through inflammation, oxidative stress, vascular endothelial injury, and so on and thus subsequently promotes the occurrence and development of diseases. There was a significant correlation observed between Serum Uric acid and HbA1c levels in Pre-Diabetic individuals, thus making it a marker for detection of future Diabetes and by controlling Glucose levels in these individuals the Uric Acid levels can be controlled. There was no significant correlation observed between Serum Uric acid and HbA1c levels in Normal and Diabetic individuals. Thus high Serum Uric acid levels can be an alarm for Pre-Diabetic individuals of landing up with Diabetes in future if not treated on time. Keywords: HbA1c (Glycosylated Hemoglobin), Uric acid(UA), Pre-Diabetic, Type 2 Diabetes mellitus (T2DM), Serum Uric Acid (SUA).

Rhinoscleroma is a long-lasting, progressive inflammatory disorder affecting the upper respiratory tract, linked to the Klebsiella rhinoscleromatis infection. This case series outlines the clinical and pathological characteristics seen in four patients diagnosed with rhinoscleroma at the Deccan College of Medical Sciences in Hyderabad from 2020 to 2024. Each patient exhibited cutaneous symptoms exclusively, and histological analysis confirmed the diagnosis. The patients were treated with a combination of antibiotics. Due to the rarity of rhinoscleroma in Hyderabad, diagnosing it can be quite challenging. This report aims to increase awareness about the disease to facilitate early diagnosis and treatment for those affected. Without proper intervention, rhinoscleroma can result in serious complications, such as involvement of the lower airways. Therefore, early detection and prompt treatment are crucial for reducing the morbidity associated with this condition. Keywords: rhinoscleroma, nose, nasal, scleroma, klebsiella rhinoscleromatis

Background: Needle stick Injury is an inevitable event for hospital staff involved in patient care at a health care facility. One of the most serious threats healthcare workers face during their clinical practice is the possibility of exposure to deadly viruses. The emotional impact of an NSI can be severe and long-lasting, even when a serious infection is not transmitted. Yet the problem of exposure to contaminated blood among health-care workers, especially interns and medical students, has received inadequate attention. In India, relatively few studies have addressed the issue of needle stick injury among medical students. Our study mainly focuses on calculating the magnitude, identifying risk factors and awareness about needle stick injury and post exposure prophylaxis (PEP) being offered in the hospital settings of M R Medical College, Kalaburagi. Materials and Methods: A cross-sectional study was conducted among interns MR Medical College Kalaburagi for period of one month (July - August 2019). Data was collected in the form of self-administered questionnaire include characteristics like cause of the event, cause of injury, Awareness of needle stick injury. The confidentiality of event will be explained to student and assured that the information will be only used for research work. The collected data was entered in Microsoft excel and analysed using SPSS version 20.0. Data was presented as percentages and proportion. Result: Approximately 41.6% of study participants had experienced at least one episode of needle stick injury. Among them, 38.4% reported that needle stick injuries were caused by improper injection practices (negligence). Additionally, 32.5% of study participants had poor awareness regarding needle stick injuries. While 87.2% of study participants were aware of post-exposure prophylaxis (PEP), only 6.4% had actually taken PEP. Furthermore, only 62.4% had received the hepatitis B vaccine, while 38.2% had no knowledge about the vaccine. Conclusion: Approximately 41.6% of study participants reported experiencing at least one episode of needle stick injury. Among them, 38.4% attributed the injuries to improper injection practices, indicating negligence. Additionally, 32.5% of participants demonstrated poor awareness regarding needle stick injuries. This study revealed a high prevalence of NSIs among interns, with many failing to take proper post-exposure actions. It is imperative that health education training programs be introduced for all HCWs, especially young doctors like interns, before they begin their professional careers in clinical practice. This will help ensure the safety and well-being of both healthcare workers and patients. Keywords: Needle Stick Injury, Interns, Blood Borne Disease.

Background: Dengue fever remains a significant public health challenge worldwide, with varying clinical presentations that can escalate to severe forms. Reliable biomarkers are crucial for early prognosis and management. This study explores the utility of serum albumin as a severity and prognostic marker in patients with dengue fever. Materials and Methods: A cohort of 80 patients diagnosed with dengue fever at a tertiary care center in South Gujarat was retrospectively and prospectively analyzed to assess the relationship between serum albumin levels at admission, changes during hospitalization, and clinical outcomes including severity, length of hospital stay, and mortality. Serum albumin levels were measured on admission and subsequently during the patient's hospital stay. The study applied t-tests, ANOVA, and correlation analysis to explore associations between serum albumin levels and clinical outcomes. Results: Lower serum albumin levels at admission were significantly associated with increased severity of dengue fever (p=0.001) and higher mortality rates (p=0.045). A decrease in albumin levels during the hospital stay correlated with prolonged hospitalization (p=0.031) and escalated severity scores (p=0.010). These findings underscore the potential of serum albumin as a prognostic indicator in clinical practice. Conclusion: Serum albumin levels provide valuable prognostic information on the severity and potential outcomes of dengue fever. Regular monitoring of albumin could aid in predicting disease progression and optimizing patient management strategies. Further research is recommended to validate these findings across larger and more diverse populations. Keywords: Dengue Fever, Serum Albumin, Prognostic Marker.

Background: Antimicrobial agents are used extensively in Intensive care units and if used inappropriately, can lead to increase in morbidity, mortality and cost of the treatment. Our Institute is a tertiary care teaching Hospital. Therefore, it becomes important to know about the extent and pattern of Antimicrobial agents’ use and their relation to the other parameters like comorbidities and outcome of the patients Materials and Methods: This observational study was conducted in MICU at tertiary care teaching hospital in Southern Rajasthan for a period of 4 months. Results: Out of 316 patients, 122 (38.6%) were females and 194 (61.3%) were males with a male to female ratio of 1:0.62. Hypertension was the most common co-morbidity in studied patients (81;42.6%), followed by Diabetes (55;28.9%), CAD (29;15.3%) and COPD (26; 13.7%). 291 (92.08%) patients were prescribed AMA and a total of 692 AMA prescriptions were studied. Five most commonly prescribed AMA were Ceftriaxone (27.31%) followed by Piperacillin+ Tazobactam (9.39%), Azithromycin (6.79%), Metronidazole (6.36%) and Artesunate (5.63%). The mean number of AMA prescribed in the patients during ICU stay was 2.00 ± 1.44. Conclusion: Excessive use of Antimicrobial agent’s was observed that could lead to the emergence of resistance. There is an urgent need to create awareness about Antimicrobial stewardship programme and make policies to contain the problem of Antimicrobial resistance (AMR). Keywords: Antimicrobial agents, Prescription pattern, Antimicrobial resistance, Drug utilization study.

Background: Pertrochanteric fractures are common in elderly individuals and typically require surgical intervention for optimal outcomes. The proximal femoral nail (PFN) is a widely used fixation device for these fractures. However, clinical outcomes, recovery milestones, and complications associated with its use remain under scrutiny, particularly concerning fracture type, patient demographics, and post-operative rehabilitation. This study aimed to evaluate the clinical outcomes, complications, and recovery times in patients undergoing PFN fixation for pertrochanteric fractures and to compare these outcomes based on fracture classification and patient gender. Material and Methods: This prospective cohort study included 75 patients with pertrochanteric fractures, treated with PFN fixation. Patients were divided into two groups based on fracture type (Boyd's and Griffin Type 1 and Type 2). Clinical outcomes were assessed using the Modified Harris Hip Score (MHHS), pain and function sub-scores, time to partial weight-bearing, radiological union, and patient satisfaction. Complications were recorded, including medial thigh discomfort, shortening, and infections. Data were analyzed for statistical significance using the Student's t-test and chi-square test. Results: The study found a significant difference in MHHS scores between Type 1 (88.8 ± 5.3) and Type 2 fractures (85.9 ± 7.1, p = 0.041). Pain and function sub-scores also showed significant differences (p = 0.001 and p = 0.004, respectively). Patients with Type 1 fractures had better outcomes in terms of recovery time, with partial weight-bearing achieved at 6.4 ± 2.5 weeks and radiological union at 15.1 ± 1.5 weeks. Gender did not significantly affect the clinical outcomes, though females had a slightly higher incidence of complications such as medial thigh discomfort (6.7% vs. 2.2%) and non-union (3.3% vs. 0%). The average patient satisfaction score was 8.5 ± 1.2, and 80% of patients returned to pre-injury activity levels. Conclusion: The PFN is an effective surgical option for the management of pertrochanteric fractures, providing excellent functional outcomes and low complication rates. Type 1 fractures demonstrated significantly better outcomes compared to Type 2 fractures. Gender did not significantly impact overall recovery, but females had a higher incidence of certain complications. Early weight-bearing and good adherence to post-operative rehabilitation contributed to favorable outcomes. These results support the continued use of PFN fixation for pertrochanteric fractures, though further research into alternative fixation devices and long-term outcomes is warranted. Keywords: Pertrochanteric fractures, Proximal femoral nail, Boyd’s and Griffin classification, Clinical outcomes, Recovery milestones.

Background: Canal wall down mastoidectomy is a surgical procedure aimed at eradicating middle ear disease. The large, open mastoid cavity left behind often leads to various complications. To mitigate these issues, mastoid cavity obliteration has been developed. This technique, using either biological or synthetic materials, has proven effective in reducing complications associated with the open mastoid cavity. Synthetic materials for mastoid obliteration have emerged as a valuable and safe option for patients undergoing canal wall down mastoidectomy. Materials and Methods: Study Design: This prospective study was conducted in the Department of Otorhinolaryngology Great eastern Medical School and hospital Ragolu Srikakulam. The sample comprised 30 patients, divided into two groups: 15 underwent Modified Radical Mastoidectomy with obliteration (Group A), and 15 underwent Modified Radical Mastoidectomy without obliteration (Group B). The study design was a single-center, longitudinal, prospective, parallel, two-group follow-up study. Statistical analysis was performed using Fischer’s Exact Test. The study period spanned from March 2021 to February 2022. Results: The study demonstrated that patients in Group A, who had undergone mastoidectomy with obliteration, experienced a significantly lower incidence of pain, discharge, giddiness, and wax formation compared to those in Group B, who had not undergone obliteration. At the end of the 3-month follow-up period, healing of the cavity, as indicated by epithelialization, was notably better in the obliterated cavities. Additionally, patients with obliterated mastoid cavities required less frequent cavity care, experienced reduced dependence on medical supervision, and had fewer outpatient visits. Conclusion: Mastoid cavity obliteration significantly reduces post-operative complications and improves healing outcomes compared to non-obliterated cavities. The technique also lessens the need for ongoing cavity care and medical visits, making it a beneficial approach for patients undergoing canal wall down mastoidectomy. Keywords: Mastoid Cavity, Mastoidectomy.

Background: Benign Prostatic Hyperplasia (BPH) is a prevalent condition in elderly males, leading to lower urinary tract symptoms (LUTS) that impact the quality of life. Transurethral resection of the prostate (TURP) is the gold standard surgical intervention for BPH. Monopolar TURP (M-TURP) has traditionally been used, but Bipolar TURP (B-TURP) has emerged as a safer alternative, potentially reducing complications such as TUR syndrome, blood loss, and postoperative strictures. This study aims to compare the efficacy and clinical outcomes of B-TURP versus M-TURP. Objectives: To compare the efficacy, safety, and clinical outcomes of B-TURP and M-TURP in patients with BPH in terms of symptom relief, perioperative parameters, and postoperative complications. Materials and Methods: This prospective, comparative study was conducted at Adichunchanagiri Institute of Medical Sciences from November 2023 to November 2024. A total of 86 patients diagnosed with BPH were randomized into two groups: 43 undergoing M-TURP and 43 undergoing B-TURP. Preoperative parameters including IPSS, QoL index, Qmax, hemoglobin, and sodium levels were recorded. Intraoperative and postoperative parameters such as resection time, prostate volume resected, hemoglobin drop, sodium changes, IPSS improvement, and complications were analyzed using statistical tests, considering a p-value <0.05 as significant. Results: Both groups showed significant improvement in IPSS, QoL index, and Qmax postoperatively, with no significant difference between M-TURP and B-TURP. The mean prostate volume resected and resection time were similar in both groups. However, B-TURP demonstrated significantly lower sodium depletion (p<0.001), indicating a reduced risk of TUR syndrome. B-TURP had higher rates of clot retention (14% vs. 7%) and failure to void (23.3% vs. 10%), which were statistically significant (p<0.001). No TUR syndrome was reported in either group. Conclusion: B-TURP offers similar efficacy to M-TURP in terms of symptom relief and uroflowmetry outcomes. It provides a safer alternative by significantly reducing the risk of dilutional hyponatremia, making it preferable for patients with cardiac comorbidities or electrolyte imbalances. Future larger-scale studies with longer follow-ups are recommended to assess long-term functional outcomes and complications. Keywords: Benign Prostatic Hyperplasia, Bipolar TURP, Monopolar TURP, LUTS, TUR Syndrome, Uroflowmetry, IPSS, Quality of Life.

Background: Sacrococcygeal teratoma (SCT) is the most common congenital germ cell tumor, with an incidence of 1 in 35,000-40,000 live births and a female predominance. At birth, the great majority of SCTs are benign. Approximately 70% of SCTs are malignant at the patient age of nine months. Therefore, prompt surgical resection is required and imaging studies play an important role in confirming the diagnosis, demonstrating intra-abdominal extension and effects on adjacent structures. Material and Methods: a) Study was conducted in the Department of Pediatric surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar. All children of less than 14 years of age and presenting to the department with sacrococcygeal teratoma were included. The ultrasonography delineated the size, extent, the shape, consistency solid and cystic components, intralesional calcifications as well as the status of other pelvic and abdominal organs. All patients were subjected to Magnetic resonance imaging (MRI) abdomen and pelvis. Results and Conclusion: A total of 25 children less than 14 years of age with post natal diagnosis of Sacrococcygeal teratoma admitted. The age of patients included in this study ranged from 0.03 (1 day) to 168 months (14 years), with a mean age of 23.68±1.47 months (median age 8 months). Majority (64%) of the patients were aged less than 12 months. The mean age of presentation was 16.48±6.27 months (median 4 months) and in 48% (12 cases) age was less than 12 months. A prenatal diagnosis was found in 8% patients. Among 25 patients’ included in this study, sacral swelling was the most common clinical sign observed in 88% patients (n=22), followed by constipation which was observed in 12 % cases (n=3) and intra-abdominal extension in 8% cases (n=2). The alpha-fetoprotein (AFP) level of the patients ranged between 4.9 to 2479ng/ml. Females are more likely to suffer from sacrococcygeal teratoma. Most of patients had Altman type I, and mature teratoma. Surgery was the mainstay of treatment for Sacrococcygeal Teratomas. Collection at wound site was the most common complication observed in current study (38.46%), followed by wound site infection (23.08%). Serum alpha-fetoprotein is a good diagnostic indicator for recurrence. Patients treated early in life have a better prognosis. Keywords: Sacrococcygeal teratoma (SCT), alpha-fetoprotein (AFP).

Background: Kashmir belongs to the largest goiter belt of world characterized by endemic goiter which is nodular enlargement of thyroid. Thyroid nodules are evaluated by FNAC and categorized into different diagnostic categories based on Bethesda classification. Aims and objective: To study the spectrum of cytomorphology of thyroid lesions according to Bethesda system. Material and Methods: A two year retrospective study was done in the Department of Pathology. A total of 163 cases were retrieved and categorized in diagnostic categories based on Bethesda system of reporting thyroid cytology. Results: It was observed that 57% cases belonged to category I, followed by category VI with 11.6% cases. Category I and V each had 9.8% cases, while as, category III and IV had 3.6% and 7.9% cases respectively. Conclusion: Benign cases were common lesions observed with preponderance of goiter. Papillary carcinoma of thyroid was common malignancy noted. Keywords: Bethesda, cytomorphology, FNAC, Goiter, kashmir, Thyroid lesions.

Dengue is a mosquito-borne viral illness caused by one of the four serotypes of the dengue virus (DENV-1 to DENV-4) belonging to the family Flaviviridae. The virus is transmitted to human via Aedes genus, especially Aedes aegypti. The disease is characterized by fever, rash, joint pains, nausea, vomiting, headache, and retro-orbital pain. The disease severity may vary from mild fever which does not require hospitalization to severe disease with features of dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) requiring intensive care management. Certain biochemical alterations in dengue may help in early diagnosis and predicting the severity. Studies have reported that patients with DHF have elevated levels of transaminases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], amylase, lactate dehydrogenase (LDH), and creatine kinase (CK). The serum LDH levels have been reported to be increased in DF and still higher in DHF and DSS cases. LDH is an intracellular enzyme abundantly found in body tissues, e.g., muscles, liver, placenta, RBCs, and reticuloendothelial system. Its serum levels increase after cell injury. Serum lactate may reportedly be used as a marker of tissue hypoxia caused by systemic hypoperfusion. It has been evaluated as a prognostic marker of various inflammatory states like sepsis, infections, myocardial infarction, malignancies, and cardiopulmonary compromise. It is thought to be a marker of vascular permeability in immune-mediated lung injury. However, studies regarding the use of serum lactate level as dengue severity predictor and diagnostic biomarker of plasma leakage are still scarce, therefore further studies are needed. Keywords: Dengue fever, Lactate Dehydrogenase, Aspartate Transaminase, Alanine Transaminase.

Background: Non-invasive mechanical ventilation (NIMV) can be applied with continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP). The status of consciousness improved faster with AVAPS in patients with COPD who had hypercapnic respiratory failure, while improvements in arterial blood gas (ABG) parameters were similar to the S/T mode. This study aimed to compare the effects of AVAPS and routine S/T modes in NIMV patients admitted to the ED, on their ABG parameters and clinical status. Materials & Methods: A hospital based prospective study done on 60 patients admitted in Respiratory ICU requiring NIV were recruited in the study. Patients were randomly distributed into the three groups of NIV. In group 1, patients were kept ST mode and iVAPS mode was used in group 2. Success rate of various modes applied (Time frame- 12 hours) success is considered when the patient is able to achieve: pH >7.35, decrease in partial pressure of carbon dioxide, PaCO2 (mmHg) by >15-20%, partial pressure of oxygen (PaO2) >60 mmHg, SpO2>90% on fraction of inspired oxygen (FiO2) < 24/minute, no signs of respiratory distress like agitation, diaphoresis or anxiety. Results: The mean age of the 60 patients included in the study was 71.9 ± 12.3 years (age range: 21-92), and 50% (n = 30) were male. In the S/T group, the median GCS was 14 in the evaluation made after 6 hour; a significant difference was found in repeated measurements (P=0.008). In the AVAPS group, the median GCS was 15 (range: 13-15) in the evaluation made after 6 hour; a significant difference was found in repeated measurements (P<0.001). The blood gas parameters were compared and a significant improvement was observed in pH and PaCO₂ values in the follow- up (P>0.005 and P>0.05, respectively). Conclusion: In this study, improvements in blood gas parameters in the AVAPS group were faster compared to the S/T group; however, we did not find any significant difference between the groups in terms of clinical parameters. The AVAPS mode is as effective and safe as BPAP S/T in treating patients with hypercapnic respiratory failure in the ED Keywords: S/T mode, GCS, ABG, BiPAP, PaCO2, AVAPS.

Background: Aim of our study was to evaluate the effect of laparoscopic mini-gastric bypass surgery on blood sugar and HbA1c levels in obese patients with type 2 diabetes mellitus. Material and Methods: The present prospective and observational study was conducted over 40 obese patients with BMI more than 32.5 kg/ m2 with Type 2 Diabetes Mellitus undergoing Laparoscopic MGB at various Zonal and Command hospitals of AFMS during the period from May 2021 to August 2024. Results: BMI and excess weight loss% (EWL%) were found statistically significant during follow up (p=0.001) after 3 and 6 months. Biochemical parameters (Se glucose levels, HbA1c, Se insulin) were reduced significantly over the period (p=0.001). Conclusion: A return to normal levels of glucose, HbA1c, insulin and ideal weight are attained with LMGB in majority of diabetic patients of obesity. The quality of life improves in all patients. There remain some conflicts to be further cleared like long-term (>than 5 years) effects on weight reduction and T2DM remission, late complications. In conclusion, clinical trials in future with prospective design are still required to show its utility and formulate guidelines for LMGB. Keywords: Mini gastric bypass, Type 2 diabetes mellitus, morbid obesity, HbA1c, Serum Insulin, weight loss surgery.

Background: The objective of this study is to investigate the relationship between changes in corneal endothelial cells and central corneal thickness (CCT) after phacoemulsification surgery in both diabetic and non-diabetic individuals. Material and Methods: This prospective study included a total of 80 patients, comprising 40 individuals with diabetes and 40 without, all of whom were undergoing phacoemulsification surgery. Endothelial cell count (ECC), hexagonality (HEX), and coefficient of variation (CV) were evaluated both before and after surgery through the use of specular microscopy. The statistical analysis focused on the relationships between these parameters and central corneal thickness (CCT). Results: The findings indicate that diabetic patients demonstrated positive correlations between ECC and CCT (r = 0.467, p = 0.10) as well as HEX and CCT (r = 0.389, p = 0.22). In contrast, non-diabetic patients exhibited weaker correlations. The coefficient of variation revealed subtle positive trends in both groups. Conclusion: corneas affected by diabetes exhibit increased vulnerability to endothelial stress after undergoing phacoemulsification. Specular microscopy serves as an essential instrument for preoperative assessment, aimed at enhancing surgical results, especially in individuals with diabetes. Keywords: Phacoemulsification, Corneal Endothelium, Central Corneal Thickness.

Background: Menopause is diagnosed retrospectively since its confirmation occurs 12 months after cessation of menstruation. The diagnosis of menopause is confirmed by serum FSH levels ≥ 40 IU/L. Studies have focused on vaginal pH ≥ 4.5 to be diagnostic of menopause, as it is a simple, non-invasive and inexpensive test. Objective: To determine whether vaginal pH can replace serum FSH level as a marker for menopause. Materials and methods: This cross sectional descriptive study was conducted in randomly selected 200 females with menopausal symptoms. Vaginal pH was measured with a pH strip and blood was assayed for serum FSH levels using chemiluminescence technique. Statistical tests were used to determine the correlation between both in diagnosing menopause. Results: The study was conducted on 200 females with menopausal symptoms. Vaginal pH value ≥ 4.5 had a sensitivity of 100%and FSH ≥ 40 IU/L had a sensitivity of 99.36% in detecting post menopausal status. Vaginal pH and FSH were positively associated by Pearson Chi-Square test (p<0.001) and McNemer test (p=0.180). Pearson’s correlation coefficient and Spearman’s rho testshowed that these two parameterswere positively correlated. Conclusion: It was concluded that vaginal pH is simple, accurate and cost effective tool that can be used as an alternative to serum FSH level in diagnosing menopause. Keywords: Menopause, vaginal pH, serum follicle stimulating hormone.

Background: Acute appendicitis is a leading cause of abdominal pain that frequently necessitates emergency surgery. The RIPASA scoring system was developed to enhance diagnostic accuracy, particularly for patients presenting with atypical clinical features. Materials and Methods: This prospective study included 150 patients presenting with right iliac fossa pain over a one-year period. RIPASA scores were calculated, and clinical decisions were made based on the attending surgeon’s judgment. Data on demographics, clinical symptoms, and histopathological outcomes were analyzed to assess the scoring system’s diagnostic performance using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The analysis revealed a sensitivity of 92%, specificity of 63%, PPV of 88%, and NPV of 74%. Most patients (56.6%) scored between 7.5 and 11.5, which strongly correlated with acute appendicitis. Among the 100 patients who underwent surgery, 59% were confirmed to have acute appendicitis, 38% had appendicular perforation, and 3% had a normal appendix. The negative appendectomy rate was 3%. Conclusion: The RIPASA scoring system demonstrates high reliability in diagnosing acute appendicitis, particularly in younger patients. Its use in clinical practice can enhance diagnostic precision, reducing unnecessary surgical procedures and associated complications. Keywords: Acute appendicitis, RIPASA score, diagnostic performance, histopathology, appendectomy.

Background: Dermatoses affecting the palms and soles often occur in conjunction with other skin regions, encompassing a wide range of conditions. These include hyperhidrosis, keratinizing disorders, eczema, and infections caused by viral, fungal, or bacterial pathogens. Additionally, drug reactions and various other conditions can also manifest in this manner, highlighting the complexity and diversity of palmoplantar dermatoses. Materials and Methods: The study comprised of 100 subjects with palmoplantar dermatoses. The procedure of the study had been explained to all the subjects and they were asked to give written consent. The clinical profile of all the subjects had been evaluated and the findings were tabulated. Statistical analysis was conducted using SPSS software. Results: A study of 100 subjects with skin conditions found itching to be the primary complaint, accompanied by varying durations and treatments. The study also reported the prevalence of conditions like psoriasis, eczema, and infections. Conclusion: In this study, the clinical profile of the subjects of palmoplantar dermatoses included pain, redness, irritation, peeling of skin, oedema, burning sensation and itching. The aggravation factors for this condition in the subjects of this study were seasonal variations, trauma, drugs and allergens. Keywords: Palmoplantar Dermatoses, Psoriasis, Eczema, Infections.

Background: Urolithiasis represents a prevalent urological condition that necessitates prompt intervention. Upper ureteric calculi are usually treated by either ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy (ESWL). This study was conducted to analyze the efficacy of ESWL for upper ureteric calculi at a tertiary care hospital. Material and Methods: From January 2023 to June 2023, a total of 57 adult patients with single upper ureteric calculus <2 cms in size and <1500 Hounsfield units were included in the study and underwent primary ESWL at our hospital. The primary objective of the study was the stone-free status, as assessed by plain radiography and non-contrast enhanced computed tomography within three months following the final treatment session. Patients who did not respond after two sessions of ESWL were classified as treatment failures. Descriptive analysis, independent t‑test and Chi‑square test were used for data analysis. Results: 46 out of 57 (80.7%) patients achieved stone free status. On analysis, stone size (p<0.001) and stone density (p<0.001) were found to be significantly higher in patients with ESWL failure. However, patient age (p=0.129), gender (p=0.603), body mass index (p=0.208), stone laterality (p=0.285), nature of disease (p=0.573) and duration of symptoms (p=0.936) showed no statistically significant difference between the groups. Steinstrasse was a complication in 5 (8.77%) patients among whom 2 patients required URSL. Conclusion: ESWL offers an effective, safe, non-invasive method for treating upper ureteric stones less than 2 cms in size with a satisfactory stone-free rate. Stone size and stone density are important predictors of a successful ESWL. Key Words: Extracorporeal shockwave lithotripsy, Hounsfield unit, steinstrasse, upper ureteric calculus.

Background: Peripheral nerve blocks are an important part of multimodal approach to postoperative analgesia. Dexmedetomidine, an α2-adrenergic agonist, when used as adjuvant to local anesthetics in peripheral nerve blocks, improves the speed of onset and duration of analgesia. The aim was to study the effect of dexmedetomidine as an adjuvant to ropivacaine in ultrasound guided adductor canal block for postoperative analgesia following arthroscopic knee surgeries. The time to first rescue analgesic, total consumption of rescue analgesic and Numerical Rating Scale (NRS) score during rest and movement in 24 hours were studied. Material and Methods: A prospective cohort study was conducted in 92 patients, aged 18-60 years, belonging to American Society of Anaesthesiologists (ASA) physical status I and II, scheduled for arthroscopic knee surgery. They were randomly divided into two equal groups using a computer-based random number table. After surgery, soon after reaching the PACU, Group A received ultrasound guided adductor canal block with 15 mL 0.5% ropivacaine and 2 mL dexmedetomidine (1 µg/kg), whereas Group B received 15 mL 0.5% ropivacaine and 2 mL normal saline. The mean time for rescue analgesic, total rescue analgesic consumption, Numerical Rating Scale (NRS) score, haemodynamic parameters and adverse effects (if any) were noted for 24 hours post- operatively. Statistical analysis was done using SPSS version 24. Qualitative data were compared using Chi square test and quantitative data were compared using independent sample t-test. Significance was defined as p < 0.05. Results and Discussion: Group A had significantly prolonged duration of analgesia compared to group B. There was significant difference between mean time for first rescue analgesic between the groups (p < 0.001). Total postoperative analgesic consumption and pain score were less in Group A (p < 0.001) than Group B for the first 24 hours. Conclusion: From this study it was concluded that the use of dexmedetomidine as adjuvant to ropivacaine for ultrasound guided adductor canal block provides superior postoperative analgesia than ropivacaine alone in patients undergoing arthroscopic knee surgery. It also reduces postoperative rescue analgesic consumption and provides better patient satisfaction without significant adverse effects. Keywords: Ropivacaine; Dexmedetomidine; Adductor canal block; Arthroscopic knee surgery; Postoperative analgesia.

Background: Epistaxis, or nose-bleeding, is a frequent health concern, affecting approximately 60% of the population. Epistaxis may be classified as anterior or posterior, with various local and systemic causes. While most nosebleeds resolve spontaneously, severe cases can be life-threatening. The primary treatment strategies include conservative methods like nasal packing and cauterization; however, later, surgical interventions may become necessary. Aim: To study the clinical etiology and management strategies of epistaxis in a tertiary care centre. Material and Methods: A descriptive study was conducted on 100 randomly selected epistaxis patients. Detailed clinical evaluations and necessary investigations were performed. Patients received appropriate treatments, including anterior and posterior nasal packing, cauterization and surgical interventions (e.g., ESPAL, septoplasty) as needed. Data was tabulated and analysed. Results: The study revealed three peaks in the incidence of epistaxis: childhood (<16 years), young adults (21-30 years), and older adults (>51 years). Winter had the highest incidence followed by summer. Most cases were anterior (63%), with primary epistaxis being more prevalent (68%). Hypertension (40%) and diabetes (36%) were common systemic conditions, and trauma was the most frequent secondary cause (9%). Anterior nasal packing (45%) and chemical cauterization (35%) were the most common treatments, with surgical intervention in 10% of cases. Conclusion: This study highlights the clinical patterns of epistaxis and effective management strategies. These findings emphasize the need for targeted interventions, particularly in at-risk groups, and the importance of early diagnosis and management in tertiary care setting. Key words: Epistaxis, Nose bleed, Chemical cauterization, Septoplasty, TESPAL

Background: The aim is to introduce flipped classroom as teaching learning method and to assess its effectiveness for first phase MBBS students. Material and Methods: The present study was conducted after taking institutional ethical clearance and informed consent of the participants. Two hundred fifty first MBBS students participated and were divided into two Groups A and B. Two topics of physiology were taught to both groups using either FC-assisted self-directed learning (SDL) sessions or online lecture classes. A cross-over of groups was done to prevent any bias. Pretest and posttest scores of all topics were assessed using multiple-choice questions (MCQs) and feedback was taken. Program evaluation was done. Results There was no significant difference in performance in pretest MCQ examinations between the two groups. Students of both Groups A and B performed significantly better in posttest MCQ examinations as compared to pretest MCQ examinations. However, the posttest results of the FC group were better. 46.40% strongly agree that there will be increased interest in subject by FC method.47.40% agree that enhancement in learning by FC method .43.30% agree that FC should be preferred teaching learning method .40.20% feel there is improved understanding and course satisfaction.42.30% agree that exam performance will improve by FC method Conclusion Faculty and students provided positive views in support of the sessions. Students were highly satisfied with the program. The flipped classroom approach proves to be a superior teaching method, promoting better academic outcomes and greater student engagement and satisfaction More than 40% students believe that it is a better teaching tool and will improve their performance. Teacher’s feedback is the same but they fear that too much effort and resources are required in this FC method. Keywords: Flipped classroom; medical students; online lectures.

Background: COPD is a progressive third leading cause of mortality that claims 3 million lives globally. [1] Prevalence of COPD in adult aged > 40 years is 9-10% worldwide. [2] In India, it ̓s prevalence ranged between 6.5 – 7.6%.[3] Among the most common risk factors of chronic obstructive pulmonary disease (COPD) are tobacco smoking and biomass exposure. Tobacco induced COPD (COPD-TS) has been widely studied. However, there is limited research comparing it with biomass-induced COPD (COPD-BS) especially in terms of inflammatory biomarkers and lung function test. Aim and Objective: To compare the pulmonary function test result (FEV1, FVC, FEV1/FVC) in COPD patients exposed to tobacco and biomass fuel. To compare the impact of tobacco and biomass exposure on inflammatory biomarkers (IL-6, IL-8, TNF-α and CRP) between these two groups. To analyse the correlation between biomarkers and spirometry values. Materials and Methods: This prospective cross-sectional study was conducted at the department of Pulmonary medicine, VIMSAR Burla in western Odisha from January 2024 to August 20224. Sample size (84) of either sex were examined clinically and the data were collected through “sociodemographic characteristic Questionnaire’s”, Biochemical estimation of CRP by Turbidimetry, IL-6, IL-8, TNF-α by ELISA and PFT by Spiro lab machine. Statistical analysis was performed with SPSS software version 21.0 (SPSS IBM corporation, Armonk. New York). The p-value< 0.05 was taken as statistically significant. Results: A total of 84 clinically diagnosed cases of COPD patients were evaluated. Among these we found 52 number of subjects exposed to tobacco smoker COPD-TS and 32 no exposed to biomass (COPD-BS). The mean age of (COPD-TS) and (COPD-BS) were (53.18± 6.63) and (57.11± 6.77) respectively. The mean pack year of (COPD-TS) was 32.8±6.47 and mean biomass exposed (COPD-BS) hour per year was 285±84.3. The respondents mostly belong to lower economic status in both groups. The mean FEVI (L) of (COPD-BS) and the ratio percentage of FEVI (L) and FVC (L) were higher 1.41±0.26 than (COPD-TS). The level of serum inflammatory biomarkers of the study groups was higher in COPD-TS than COPD-BS group. Moreover, it was positively correlated with the FEVI (L) and highly significant at (p<0.05). Conclusion: Both types of COPD are associated with high levels of systemic inflammation biomarkers. COPD-TS patients have a higher systemic inflammatory status than the patients with COPD-BS, while exposure lead to COPD, the underlying systemic inflammatory responses and pulmonary impairment may vary i.e. higher inflammation and worse lung health in tobacco exposure may be due to its toxic nature. It might benefit some patients from anti-inflammatory treatment along with bronchodilators. Keywords: COPD, CRP, IL-6, IL-8, TNF-α, Lung function test, Tobacco and Biomass.

This report talks about 13 patients who had a serious ear infection caused by fungus, which led to holes in their eardrums. The group included 10 men and 3 women, aged between 18 and 70 years, with an average age of 49. These patients had ongoing ear problems that did not get better with usual treatments. They experienced symptoms like ear discharge, ear pain, and itching. Out of the 13 patients, six had no previous ear issues. Four were sent to specialists by their family doctors, five came from ear doctors, and three came on their own. Treatment included careful cleaning of the ears and one of two types of antifungal medicine. After treatment, nine patients fully recovered, including healing their eardrum holes. However, three patients needed surgery to fix their eardrums. This study shows that fungal ear infections can be hard to diagnose, but with the right medical care, most eardrum holes caused by this infection can heal without needing surgery. Keywords: fungal otitis externa, perforation, ear nfection, antifungals, tympanic membranes, fungal , otitis externa

Background: Chronic suppurative otitis media is characterized by irreversible alterations and a history of persistent ear discharge for longer than three months due to a permanent tympanic membrane defect. It is defined as a chronic inflammation of the middle ear cleft mucosa. Materials and Methods: 78 patients with CSOM, including tubotympanic and atticoantral forms, were examined in this study. Our study included patients of both the sexes with CSOM of all phases, including tubotympanic and atticoantral kinds, who were older than ten years. Results: Fifty-two (66.7%) of the 78 CSOM patients in this study had both CSOM and DNS. Of these 78 individuals, 31 (39.74%) showed a clear link between sinonasal illness and CSOM. Similar bacterial isolates were found in both auditory and nasal culture swabs, suggesting that infections may retrogradely migrate from the nasopharynx to the middle ear through the Eustachian tube. Conclusion: The ipsilateral side's DNS and CSOM were shown to be significantly correlated. DNS was essential to CSOM's persistence. For good postoperative outcomes, we therefore recommend treating nasal disease before undergoing surgery to address ear disease because a thorough assessment of diseases of the nose and paranasal sinuses is crucial. Keywords: The Eustachian tube, chronic suppurative otitis media & DNS.

Background: Distal radius fractures represent a significant portion of orthopedic injuries, accounting for 8-15% of all fractures in adults. These fractures, typically occurring near the wrist, are often caused by domestic falls, road traffic accidents, or sports injuries. Standard treatment involves closed reduction and immobilization using Plaster of Paris (POP) casts, but complications such as re-angulation and re-displacement remain prevalent. This study aims to compare the functional outcomes of two surgical approaches—open reduction and internal fixation (ORIF) with plating versus closed reduction and percutaneous pinning with K-wire fixation (CRPP)—for displaced distal radius fractures. Materials and Methods: This prospective, randomized, comparative study was conducted over an 18-month period, enrolling 60 patients with displaced distal radius fractures who consented to participate. Patients were randomly assigned to either Group-A (ORIF with plating) or Group-B (CRPP with K-wire). Functional outcomes were assessed using the Disabilities of Arm, Shoulder, and Hand (DASH) score at 4, 8, and 12 weeks postoperatively. Radiological assessments and postoperative complications were also monitored throughout the follow-up period. Results: The study revealed a significant difference in functional outcomes between the two treatment groups. At 4 weeks postoperatively, patients in the ORIF group exhibited a markedly lower DASH score (25.3 ± 6.37) compared to those in the CRPP group (75.9 ± 8.69). This trend continued at 8 weeks (ORIF: 19.6 ± 4.52 vs. CRPP: 42.5 ± 7.84) and 12 weeks (ORIF: 13.7 ± 2.99 vs. CRPP: 23.1 ± 2.50), with ORIF showing superior functional recovery. Additionally, the ORIF group had fewer complications, with only 3.3% experiencing non-union, compared to 6.7% in the CRPP group. Conclusion: ORIF with plating resulted in better functional outcomes and fewer complications than CRPP with K-wire fixation for displaced distal radius fractures. The findings suggest that ORIF should be considered as the preferred method for achieving optimal functional recovery, particularly for patients who require a faster return to daily activities. The results of this study contribute to the growing body of evidence favoring ORIF over CRPP for this common injury, offering valuable insights into treatment selection in clinical practice. Key words: Distal radius, K wires. Internal fixation, Plates.

Background: Background Oral cavity is an important and first organ system of alimentary canal which is exposed to environmental agents constantly. It is very common site for both non-neoplastic and neoplastic lesions. In the developing countries like India, squamous cell carcinoma of oral cavity is serious health issues due to habitual chewing of tobacco in various forms including eating of betel nut. It is mostly asymptomatic to start with and diagnosed at advanced stage due to ignorance by the patients. Biopsy is considered gold standard for the diagnosis and proper management. Objective: To study histopathological spectrum of neoplastic and non-neoplastic lesions with reference to age, sex and site. Materials and Methods: This was retrospective study carried out in the department of Pathology, NSCB medical college, Jabalpur for a period of five years. A total of 486 cases were studied. Data Analysis: Statistical analysis was conducted using SPSS 26.0 software. Descriptive statistics were utilized to summarize the distribution of cases by age, sex, lesion type, and site of presentation. Percentages and ratios were calculated to analyze trends and demographic patterns. Results: A total 486 lesions of oral cavity were registered in the data record file. The age of presentation varied from 5 years to 90 years with maximum number of cases in the age group 30 to 40 years. Male preponderance was seen in the lesions involving buccal mucosa. Most frequent presenting lesions were neoplastic lesions 373 (6.7%) and remaining were non-neoplastic 113 (23.3%). In the non-neoplastic lesions, most common lesions were chronic tonsillitis 47 followed by pseudoepitheliomatous hyperplasia lesions 41 and other less common were inflammatory lesions, pyogenic granuloma and mucus retention cyst. In the neoplastic malignant lesions commonest presenting lesion were squamous cell carcinoma 326. Among dysplastic lesions, patients presenting with carcinoma in situ were 6, moderate dysplasia 11 and mild dysplasia were 13. In the benign category commonest presenting tumor were hemangioma 05, followed by papilloma. Buccal mucosa was the most common site 236 (48.6%) for malignant lesion including premalignant lesions. Conclusion: Oral cavity lesions are common in our country but squamous cell carcinoma are increasing in our country with alarming rate and thus it is now serious health issue for the country like India. Malignant lesions are increasing irrespective of age group in central India due to habitual practice of chewing tabacco in different forms. It is diagnosed mostly in advanced stage. Early detection through biopsy is key in breaking chain and management. Keywords: Squamous cell carcinoma, dysplasia, buccal mucosa, malignant, neoplastic.

Objective: To compare the efficacy of Dexamethasone and Methylprednisolone in the treatment of moderate to severe COVID-19 patients. Materials and Methods: A randomized controlled study was conducted over three months at Rajiv Gandhi Government General Hospital (RGGGH), Chennai. A total of 160 patients were enrolled, with follow-up data analyzed for 76 patients in the Dexamethasone group and 74 patients in the Methylprednisolone group. The primary outcome was all-cause mortality, and secondary outcomes included length of hospital stay. The Dexamethasone group received 8 mg IV daily, while the Methylprednisolone group received 80 mg IV twice daily, alongside standard care. Results: There was no significant difference in mortality rates between the two groups. However, the Dexamethasone group exhibited shorter hospital stays (10.21 days vs. 15.09 days, p = 0.05) and faster symptom resolution. A significant reduction in inflammatory markers was observed in the Dexamethasone group, with higher CRP levels noted in the Methylprednisolone group (p < 0.001). Conclusion: While mortality rates were comparable between the groups, Dexamethasone demonstrated superior outcomes in terms of shorter hospital stays and faster recovery, supported by a more favorable inflammatory profile. These findings suggest Dexamethasone may be a more efficient treatment option for moderate to severe COVID-19 patients. Keywords: COVID-19, Clinical Improvement, Corticosteroids, Dexamethasone, Methylprednisolone, RT-PCR.

Background: Hypertension is a significant global health issue, with circadian blood pressure (BP) patterns offering valuable prognostic information regarding cardiovascular risk. This study aimed to investigate the relationship between dipping patterns, BP variability, and demographic factors in hypertensive individuals. Specifically, we focused on the association of reverse dipping with clinical characteristics such as age, duration of hypertension, and comorbidities. Material and Methods: A cross-sectional study was conducted on 120 hypertensive patients (aged 40-70 years) attending a tertiary care hospital between January and December 2023. Ambulatory BP monitoring (ABPM) was used to classify patients into three groups: dippers, non-dippers, and reverse dippers. Demographic and clinical data were collected, including age, gender, BMI, duration of hypertension, comorbidities (diabetes, dyslipidemia), and waist-to-hip ratio. BP measurements were taken over a 24-hour period, and data analysis was performed using SPSS version 26, employing ANOVA for group comparisons and Pearson's correlation for associations. Results: Reverse dippers had the highest mean age (58.7 ± 9.8 years) and longest hypertension duration (8.1 ± 2.7 years). They also had the highest 24-hour systolic (141.2 ± 11.4 mmHg) and diastolic BP (86.5 ± 7.8 mmHg) compared to dippers (p < 0.05). A significant correlation was found between BP variability and comorbidities, with diabetes showing a positive correlation with 24-hour BP measurements (r = 0.368, p = 0.029). Dipping patterns were also influenced by waist-to-hip ratio, with reverse dippers exhibiting greater central obesity (0.94 ± 0.03). BP variability was significantly higher in reverse dippers, indicating a higher risk of cardiovascular complications. Conclusion: The study highlights the clinical significance of dipping patterns in hypertensive individuals, particularly in identifying those at higher risk for adverse cardiovascular outcomes. Reverse dipping is associated with older age, longer duration of hypertension, and comorbidities such as diabetes. These findings suggest the importance of using 24-hour ABPM for comprehensive BP monitoring and early detection of individuals with abnormal dipping patterns who may require more intensive management. Key Words: Hypertension, Ambulatory Blood Pressure Monitoring, Dipping Patterns, Reverse Dipping, Diabetes.

Background: Dental caries is one of the most prevalent chronic childhood diseases, significantly affecting the oral health and overall well-being of children. Early detection and assessment of caries prevalence are crucial for implementing preventive strategies. This study aims to evaluate the prevalence and severity of dental caries among children aged 5 to 10 years in Varanasi district, Uttar Pradesh. Materials and Methods: A cross-sectional study was conducted among 500 school-going children aged 5 to 10 years in urban and rural areas of Varanasi district. The participants were selected using a stratified random sampling method. The dental caries status was assessed using the Decayed, Missing, and Filled Teeth (DMFT/dmft) index, following WHO guidelines. Clinical examinations were performed under natural light using a mouth mirror and probe. Data were analyzed using SPSS software, applying descriptive statistics and the Chi-square test to determine associations between caries prevalence and demographic factors. Results: The overall prevalence of dental caries was found to be 65.4% among the study population. The mean dmft score for primary dentition was 2.8 ± 1.6, while the mean DMFT score for permanent dentition was 1.4 ± 1.1. Caries prevalence was higher in rural areas (70.2%) compared to urban areas (61.5%). Additionally, a significant association was observed between poor oral hygiene practices and increased caries experience (p < 0.05). Conclusion: Dental caries remains a significant oral health concern among 5 to 10-year-old children in Varanasi district. The high prevalence, particularly in rural areas, highlights the need for targeted preventive programs, oral health education, and early interventions to reduce caries burden in this population. Keywords: Dental caries, DMFT index, Pediatric oral health, Prevalence, Varanasi, School children.

Background: Bone tumours include both benign and malignant lesions, making them a diverse category of neoplastic disorders. The right treatment approach and better patient outcomes depend on an accurate diagnosis. When it comes to diagnosing bone tumours, a number of methods are vital. These include radiological imaging, immunohistochemistry, histology, and sophisticated genetic tools. In order to distinguish between benign and malignant bone tumours, this study will assess the diagnost ic value and accuracy of various methods. Materials and Methods: A tertiary care center's one-year data set of patients diagnosed with bone tumours was reviewed in this retrospective analysis. This study was conducted at the department of Pathology, Khaja Bandanawaz University, Kalaburagi, Karnataka, India from the October 2023 September 2024. The data set included clinical, radiological, and pathological information. There was a correlation between histological results and imaging methods like X-ray, MRI, and CT. For a more thorough understanding of cancer cases, immunohistochemical markers were employed. We examined the diagnostic accuracy, specificity, and sensitivity of each method. Results: In all, 120 instances of bone tumours were considered for the research. Radiological imaging had a moderate level of specificity (76%), but a high sensitivity (92%), for identifying cancerous lesions. With a diagnosis accuracy of 98%, histopathology continued to be the gold standard. In difficult cases, immunohistochemistry added diagnostic precision, especially when distinguishing original bone tumours from metastases. Although molecular approaches are not commonly employed, they have been beneficial in clarifying cases where the diagnosis was unclear. There was a considerable improvement in diagnostic certainty when imaging was combined with pathological assessment. Conclusion: The study emphasises the importance of using many diagnostic methods to assess bone tumours. Histopathology is still the foundation of diagnosis, although radiological imaging is essential for early evaluation. Additional specificity is provided in difficult cases by immunohistochemistry and molecular technologies. The best possible care for patients with bone tumours is guaranteed by combining these methods, which allow for precise diagnosis. Keywords: Bone tumors, Diagnostic techniques, Radiology, Histopathology, Immunohistochemistry, Molecular diagnostics

Background: Resistance to different groups of antimicrobials has made the proliferation of extended spectrum β-lactmase (ESBL) producing strains a serious global health concern that has complicated treatment strategies. The high proportion of ESBL producers among the Enterobacteriaceae and the complex molecular epidemiology with diverse types of ESBL genes are alarming. This study was undertaken to identify ESBL production in various bacterial isolates from the BAL (Broncho Alveolar Lavage) fluid in pulmonary infections. Material and Methods: A total of 100 samples were processed, they were initially screened by phenotypic method (Disk diffusion method) and confirmation was done by double disk synergy test (DDST). Results: Out of 100 isolates,51 were culture positive in this ESBL producers were 78.4% (n=40). In the present study, ESBL production was observed as Acientobacter baumannii (83.3%), Klebsiella pneumonia 78.5%, pseudomonas aeruginosa, 75%, E.coli 50% & Enterobacter species (n=1) 100% ESBL production. Conclusion: The frequency of ESBL producing strains among clinical isolates has been steadily increasing. Advance drug resistance surveillance and molecular characteristics of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use. Keywords: BAL fluid, Pneumonia, Double disc synergy test, β-lactamase.

Background: Autonomic function tests play a key role in diagnosing cardiac disorders, which are increasing worldwide in all age groups. To recommend the pupil-to-limbus diameter (PLD ratio) as an autonomic function test, the study should support with large sample size. Hence, the present study was undertaken. Aim and objectives: The present study was undertaken to observe the correlation between the pupil-to-limbus diameter ratio with the blood pressure and pulse rate in normotensive individuals. Materials and Methods: A total of 80 normotensive male and female young adults were part of the study. After obtaining informed consent, the participants underwent a general physical examination where their blood pressure was recorded using a diamond sphygmomanometer, and their pulse rate was recorded manually from the radial artery. Soon after, their eye images were taken and processed to measure the PLD ratio as mentioned in the literature. Results: A positive correlation was observed between the PLD ratio of the right eye with systolic and diastolic blood pressure and pulse rate. However, this was not statistically significant. A negative correlation was observed between the PLD ratio of the left eye with systolic blood pressure. However, this association was not statistically significant. A positive correlation was observed between the PLD ratio of the left eye and with diastolic blood pressure pulse rate. However, this association was not statistically significant. Conclusion: The present study results support the positive correlation between the PLD ratio with systolic, and diastolic blood pressure and pulse rate except for the PLD ratio of the left eye with systolic blood pressure. There is a need for further detailed study in this area. Keywords: Pupil diameter, Autonomic function test, Limbus diameter, Cardiac disorders.

Intermittent fasting (IF) has gained widespread attention as a dietary strategy for improving metabolic health, influencing key parameters such as insulin sensitivity, lipid profiles, inflammation, and energy metabolism. This systematic review evaluates the impact of IF on metabolic health based on recent studies following PRISMA guidelines. A total of 50 peer-reviewed studies published between 2015 and 2024 were analyzed to assess the effects of IF on glucose metabolism, cardiovascular health, obesity, and cellular mechanisms underlying metabolic adaptations. Findings suggest that IF enhances insulin sensitivity by reducing hepatic glucose production, improving pancreatic beta-cell function, and lowering postprandial glucose levels, leading to significant benefits for individuals with insulin resistance and type 2 diabetes. IF also positively affects lipid metabolism, reducing total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol while maintaining or increasing high-density lipoprotein (HDL) cholesterol levels, thereby lowering cardiovascular disease risk. Additionally, IF has been linked to reduced systemic inflammation by lowering pro-inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), along with promoting autophagy, which supports cellular repair and metabolic resilience. Gut microbiota modulation through fasting has shown promising effects, with studies reporting increased beneficial bacterial populations that contribute to improved metabolic regulation and gut health. Weight management benefits of IF include enhanced fat oxidation, appetite hormone modulation, and reductions in visceral adiposity, supporting its role in obesity prevention and treatment. Despite its potential benefits, IF adherence remains a challenge due to variations in individual metabolic responses, hunger regulation, and social eating habits. Future research should focus on long-term adherence strategies, individualized fasting protocols based on genetic and metabolic profiles, and the safety of IF in specific populations such as those with chronic health conditions or hormonal imbalances. Establishing standardized fasting durations and assessing the interplay between IF, physical activity, and dietary composition will be essential to optimizing metabolic health outcomes. Keywords: Intermittent fasting, metabolic health, insulin sensitivity, lipid metabolism, inflammation, energy homeostasis, obesity, PRISMA.

Background: To compare CCT measurements between noncontact pachymetry (Topcon trk-2p) and ultrasonic pachymetry. Materials and Methods: This study was undertaken in the Department of Ophthalmology of Lady Hardinge Medical College and Associated Hospitals from November 2017 to March 2019 after institutional ethical clearance. In this study, 100 cases from 16 year of age and above were enrolled as per inclusion and exclusion criteria after taking written informed consent. Results: Mean age of study subjects was 43.09 ± 12.87 years. There were 33% male and 67% female patients in study. Overall mean CCT value obtained by noncontact pachymetry was 492.54 ± 28.08µm in right eye while mean CCT obtained by ultrasonic pachymetry showed value of 528.37 ± 28.80µm, in right eye. Mean CCT compared between two instruments showed statistically significant P value of < 0.001. Similarly mean CCT value in left eye obtained by noncontact pachymetry was 494.32 ± 27.71µm while mean CCT in left eye obtained by ultrasonic pachymetry showed value of 529.74 ± 29.10µm, which was statistically significant as P value obtained was < 0.001. Hence comparison of mean CCT between noncontact and ultrasonic pachymetry in our study was highly significant. Bland altman plot was in agreement with these results showing mean difference of 35.62µm and Limits of agreement (LOA) = 24.19 to 47.04µm. Hence it was found that noncontact pachymetry takes CCT values thinner by 35.62µm as compared to ultrasonic pachymetry. Mean CCT in right eye of male, by noncontact pachymetry was 497 ± 30.97µm and by ultrasonic pachymetry was 533.61 ± 31.74µm and results were significant P < 0.01. Similarly mean CCT in left eye of male, by noncontact pachymetry was 498.64 ± 30.29µm and by ultrasonic pachymetry was 534.42 ± 31.88µm and differences were significant P < 0.01. Similarly mean CCT in right eye of female, by noncontact pachymetry was 490.34 ± 26.52µm and by ultrasonic pachymetry was 525.79 ± 27.11µm and differences were significant P < 0.01. Similarly mean CCT in left eye of female, by noncontact pachymetry was 492.19 ± 26.32µm and by ultrasonic pachymetry was 527.43 ± 27.59µm and differences were significant P < 0.01. This signifies that difference of mean CCT obtained from both the instruments in male and in female is significant. Five patients(5%) had complaint of discomfort and seven patients(7%) had blurring of vision after ultrasonic pachymetry examination . There was no effect on the Snellen’s visual acuity in all seven patients who had blurring. While no complaint was noticed in patients after taking measurements through noncontact pachymetry. No evidence of epithelial defect was seen after ultrasonic pachymetry examination. Conclusion: Difference in mean CCT obtained by two instruments ultrasonic and noncontact pachymetry was significant. Noncontact pachymetry showed significantly thinner CCT value than ultrasonic pachymetry. Hence CCT value obtained by noncontact pachymetry is not as reliable as CCT obtained by gold standard ultrasonic pachymetry. Keywords: Central corneal thickness, Noncontact pachymetry, ultrasonic pachymetry.

Background: Objective: The study aimed to determine the relationship between gestational diabetes mellitus (GDM), preterm delivery, appearance, pulse, grimace, activity, and respiration (APGAR) score, meconium-stained amniotic fluid (MSAF), low birth weight (LBW), intrauterine fetal demise (IUFD), and neonatal intensive care unit (NICU) admission, among mothers aged 18 to 19 years and mothers over 19 years. Material and Methods: This hospital-based cross-sectional study encompassed 300 (18-19-year-old) adolescent mothers in Group 1. In Group 2, 600 gestationally matched pregnant women (20-30 years) participated. Preterm birth and 75g oral glucose tolerance, LBW, APGAR score ≤7, NICU admission, IUFD, and MSAF were collected. Chi-square and Student t-tests were employed in SPSS at a 5% significance level. Results: The mean age of groups 1 and 2 was 18.64±0.27 years and 24.13±2.04 years, respectively (p<0.0001). The GDM frequency was greater in group 1 (11%) than group 2 (3.5%) (p<0.0001). The frequency of preterm delivery was greater in adolescent women (27%) compared to young adults (19%) (p=0.1). The average birth weight of babies from groups 1 and 2 was 2344±247 and 2843±283 grams, respectively (p<0.0001). Teenage mothers had more LBW babies than older mothers (p=0.18). Pregnant adolescents had 5.33% IUFD, compared to 1.17% in group 2 (p=0.000). The NICU transfer rate was higher for group 1 (8.97% vs. 4.67%) (p=0.02). The APGAR score and MSAF were negligible between the groups. Conclusion: Preterm delivery, LBW, GDM, NICU hospitalization, low APGAR score, and IUFD were most common in Group 1, except for MASF frequency, which was higher in Group 2. Keywords: APGAR, Gestational Diabetes, low birth weight, Teenage pregnancy, Meconium.

Background: Obesity is a critical public health issue of worldwide importance and represents a significant medical and financial challenge for the government.1,2 The existence of an 'obesogenic environment,' characterised by easy access to unhealthy food and limited recreational options, may have contributed to the rise in obesity rates. Objectives: 1) To describe the socio-demographic profile of bank employees in Tirupati. 2) To determine the prevalence of obesity among bank employees in Tirupati. 3) To find out the association of pertinent risk factors associated with obesity. Materials and Methods: Study Design: Cross-sectional Observational study. Study area: Department of Community Medicine & government, private and co-operative banks in Tirupati. Study Period: November 2020 to June 2021. Study population: Bank employees from government, private and co-operative banks in Tirupati were selected as per the sample size requirement. Sample size: The study consisted of a total of 320 cases. Sampling Technique: Stratified proportionate random sampling technique. Results: The prevalence of overweight (53.3%) and obesity (16.5%) is higher among those who are married compared to the prevalence of overweight (23.1%) and obesity (9.2%) among those who are unmarried. The differences are also statistically significant (P <0.001; S). The prevalence of obesity was found to be higher in those with a family history of obesity (33.3%) compared to those without a family history of obesity (10.2%). The differences are also highly statistically significant (P<0.001; S). Conclusion: Based on the current study, it can be deduced that there is a notably high incidence of generalised obesity among bank employees. The significant risk factors linked to obesity included age, job level, marital status, family history of obesity, physical activity levels, and frequent consumption of fried foods. Keywords: Lifestyle Behaviours, bank employees, Body mass index, unhealthy food.

Background: Adjuvants are added to local anaesthetics to increase the duration of block and provide better analgesia. The present study was aimed at comparing dexmedetomidine and dexamethasone as adjuvants to ropivacaine in ultrasound (USG) guided supraclavicular brachial plexus block (SCBPB) in patients undergoing surgery for fracture bone bones (BB)forearm. Materials and Methods: 80 adult patients of age group 18-60 years, belonging to American society of anesthesiologists (ASA) grade I & II undergoing surgery for fracture BB forearm under USG guided supraclavicular block were included in the study. In Group A (n=40), USG guided SCBPB was administered with 24 ml of 0.5% ropivacaine containing 1 mcg/kg dexmedetomidine and in Group B USG guided SCBPB was administered with 24 ml of 0.5% ropivacaine containing 8 mg dexamethasone. The onset and duration of sensory and motor block, VAS score and duration of analgesia was compared in both the groups. Results: The onset of motor and sensory block was comparable in both the groups. The duration of sensory block, motor block and duration of analgesia was significantly prolonged in group A in comparison to group B (p <0.0001, p <0.0001, p<0.0001 respectively). VAS score was significantly lower in group A at 16 hrs (p <0.0001) and the need for rescue analgesia was lower in group A (p = 0.0289). Conclusion: 1mcg/kg dexmedetomidine is superior to 8 mg dexamethasone as an adjuvant to ropivacaine in USG guided supraclavicular brachial plexus block as it provides longer duration of sensory block, motor block and duration of analgesia. Keywords: Dexmedetomidine, dexamethasone, sensory block, motor block, analgesia.

Iron chelation therapy is essential for mitigating iron overload caused by iron deposition in vital organs, such as the liver and heart, following regular blood transfusions. Recent advancements in iron chelation therapy for hematologic disorders have significantly improved clinical outcomes and patient adherence. This review aims to summarize the progress in iron chelation strategies, including novel agents, combination therapies, and alternative approaches, while highlighting their impact on clinical outcomes in transfusion-dependent hematologic disorders. The availability of multiple iron chelators enables the use of combination therapies to target iron deposition in specific organs and enhance overall iron excretion. However, long-term studies utilizing advanced technologies to assess tissue iron levels are necessary to evaluate whether these emerging chelators can match the safety and efficacy of deferoxamine in controlling iron stores and preventing the major complications associated with transfusional iron overload. Keywords: Blood transfusion, chelating agents, transfusional iron overload, Desferrioxamine.

Background: Breast cancer represents the most prevalent form of malignant neoplasm among women globally. High levels of LDH in serum are also measured during neoplastic diseases as a consequence of tissue destruction caused by the cancerous growth. Hence; the present study was conducted for correlational evaluation of serum LDH levels with different TNM staging of carcinoma breast. Materials & Methods: A total of eighty cases of histopathologically confirmed breast carcinoma were included. Blood samples were obtained through venipuncture and collected in sterile plain blood vials. These samples were subsequently sent to the biochemistry laboratory, where serum LDH levels were measured spectrophotometrically using diagnostic kits at various time points, including preoperative and postoperative intervals. The results were documented in a Microsoft Excel spreadsheet and analyzed statistically using SPSS software. Diagnostic kits used for serum LDH: Cobas LDHI2 diagnostic kits by IFCC method. Serum LDH level at various intervals correlated with TNM stage of disease. Results: Out of forty-two (52.5%) patients who were presented in stage III, 81% had high serum LDH value (>201U/L) and 19% had normal serum LDH value (100-200 U/L). In stage II patients mean value of serum LDH at preoperative period was higher than post operatively (257.36±87.76 Vs 230.42±53.97) but was not statistically significant. In stage III and IV follow up mean serum LDH was higher than preoperative levels, but it was not statistically significant. Conclusion: Persistently high level of serum LDH or sudden increase in serum LDH level postoperatively may indicate poor outcome or metastasis. Higher levels of serum LDH in these patients may be an alarming warning sign of recurrence or metastasis. Also, in patients with efficacious treatment responses statistically significant reduction in serum LDH levels were seen in follow up. Thus, establishing prognostic value of serum LDH levels. Key words: Lactate Dehydrogenase, Breast Cancer.

Background: Blood donation is a critical component of healthcare systems worldwide, providing life-saving resources for various medical procedures and emergencies. However, the impact of repeated blood donations on donor’s hematological parameters, particularly red cell indices, remains a subject of ongoing research and concern. This study aims to investigate the differences in red cell parameters between first-time and repeat blood donors. Materials and Methods: A total of 200 voluntary blood donors, aged 19 to 54 years, were categorized based on their lifetime blood donations into five groups: Group 1 (1-5 donations), Group 2 (6-10 donations), Group 3 (11-20 donations), Group 4 (>20 donations), and Group 5 (regular donors deferred due to low hemoglobin). The study evaluated hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hematocrit (HCT), and serum ferritin levels across these groups. Results: Results indicated no significant differences in mean Hb, MCV, MCH, and MCHC levels between the groups, aligning with findings from previous studies by Norashikin et al., Adediran et al., and Alexander et al. However, the mean serum ferritin levels showed statistically significant differences, with Group 1 having 82.37 ng/mL, Group 2 with 118.25 ng/mL, Group 3 with 124.31 ng/mL, Group 4 with 106.11 ng/mL, and Group 5 with 58.09 ng/mL. Additionally, 40% of donors in Group 4 and 36.6% in Group 5 had reduced body iron stores, compared to 16.1% in Group 1. Conclusion: The study highlights the effects of repeated blood donations on red cell parameters by comparing first-time and regular donors. The data indicate no significant differences in overall hemoglobin levels or red cell indices like MCV, MCH, and MCHC between these groups. Therefore, regular monitoring of iron stores and appropriate iron supplementation for donors are recommended to prevent iron deficiency. Keywords: Regular blood donation, red cell parameters, subclinical iron deficiency.

Acute heart failure (AHF) in elderly patients presents unique diagnostic and therapeutic challenges due to comorbidities, polypharmacy, and age-related physiological changes. Managing AHF effectively requires tailored approaches that balance aggressive treatment with frailty considerations. This systematic review evaluates current strategies for AHF management in elderly patients, focusing on the role of Brief Intensive Observation (BIO) units, diagnostic challenges, and therapeutic advancements. A comprehensive literature search was conducted across PubMed, Embase, and Cochrane Library databases, adhering to PRISMA guidelines. Studies published between 2000 and 2024 were reviewed to assess the impact of intensive observation areas on patient outcomes, including mortality, readmission rates, and hospital resource utilization. BIO units have shown promise in optimizing AHF management by reducing emergency department overcrowding, improving triage efficiency, and lowering hospital admission rates. Tailored treatment strategies, including adjusted diuretic dosing, non-invasive ventilation, and early palliative care integration, contribute to improved patient outcomes. However, gaps in evidence remain due to the underrepresentation of elderly patients in clinical trials. Personalized medicine and AI-driven decision support tools are emerging as potential solutions to enhance future AHF management. Intensive observation areas play a crucial role in optimizing AHF care in elderly populations. Future research should focus on refining triage systems, expanding BIO units, and integrating precision medicine to improve outcomes. Addressing these critical aspects will enhance healthcare efficiency and quality of life for aging patients with AHF. Keywords: Acute heart failure, Elderly patients, Systematic review.

Background: Head and neck cancer (HNC) and its treatment significantly impact patients' quality of life (QoL), body image, and occupational status. Post-treatment complications, including physical and psychological distress, often lead to social withdrawal and economic hardships. This study aims to assess the long-term effects of HNC treatment on QoL, body image disturbances, and employment concerns among survivors in a tertiary care center in North India. Materials and Methods: A cross-sectional study was conducted from January 2021 to December 2022 at a tertiary care hospital in North India. Patients aged ≥18 years with histopathologically confirmed HNC who had completed curative treatment at least six months prior were included. Data were collected through structured interviews using validated tools, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and QLQ-H&N35) for QoL assessment and the Body Image Scale (BIS) for body image concerns. Occupational challenges were evaluated through a customized questionnaire. Statistical analysis was performed using SPSS, with comparative analyses and multivariate logistic regression to identify predictors of impaired QoL. Results: The study included 58 patients (mean age: 54.3 ± 11.6 years), with 70.7% being male. Impaired QoL (global health score ≤50) was observed in 48.3% of participants, with physical (62.1%), role (70.7%), and social functioning (65.5%) being most affected. Common post-treatment symptoms included xerostomia (70.7%), taste and smell changes (62.1%), and speech problems (56.9%). Body image disturbances were prevalent, with 65.5% experiencing appearance-related concerns and 58.6% reporting emotional distress. Post-treatment unemployment was high (70.7%), with 67.2% experiencing employment loss, primarily due to physical limitations (61.0%). Multimodal treatment, lower socioeconomic status, and comorbidities were significant predictors of impaired QoL (p<0.05). Conclusion: HNC survivors experience substantial challenges related to QoL, body image, and employment, highlighting the need for multidisciplinary post-treatment support. Rehabilitation programs focusing on physical recovery, psychosocial well-being, and vocational reintegration should be prioritized to improve long-term survivorship outcomes. Keywords: Head and neck cancer, Quality of life, Body image, Occupational concerns, Survivorship, Post-treatment outcomes.

Respiratory distress in neonates is a leading cause of neonatal morbidity and mortality, necessitating prompt diagnosis and intervention. This prospective observational study, conducted at a tertiary care NICU, examined 250 neonates with respiratory distress over two years. The most common etiologies included respiratory distress syndrome (32.8%), transient tachypnea of the newborn (27.2%), meconium aspiration syndrome (14.8%), and pneumonia (18%). Preterm neonates exhibited a higher incidence of RDS, while TTN and MAS were predominant in term neonates. Severity assessment using Downe’s and Silverman-Anderson scores revealed 27.6% with severe distress. Treatment modalities included CPAP (68%), mechanical ventilation (23.6%), and surfactant therapy. The study emphasizes the role of antenatal corticosteroids, maternal infection screening, and evidence-based respiratory management in improving neonatal outcomes. Future research should focus on optimizing ventilation strategies and long-term follow-up to reduce morbidity and mortality associated with neonatal respiratory distress. Keywords: neonates, respiratory distress

Dermatoglyphics, the scientific study of epidermal ridge patterns on fingers, palms, soles, and toes, has emerged as a potential non-invasive biomarker for various genetic and systemic disorders, including cancers. Reproductive cancers, such as breast, ovarian, cervical, and prostate cancers, are among the leading causes of cancer-related morbidity and mortality worldwide. Early detection and risk stratification remain critical for improving patient outcomes. This systematic review aims to comprehensively evaluate the existing evidence on the correlation between dermatoglyphic patterns and reproductive cancers. A thorough search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify relevant studies published up to October 2023. Studies were included if they investigated dermatoglyphic patterns in patients diagnosed with reproductive cancers and compared them with healthy controls. Data extraction and quality assessment were performed using standardized tools. The findings suggest that specific dermatoglyphic patterns, such as increased whorl patterns, altered ridge counts, and atypical palmar flexion creases, may be associated with an increased risk of reproductive cancers. However, the evidence remains limited and heterogeneous, highlighting the need for further large-scale, well-designed studies to validate these findings and explore the underlying genetic and epigenetic mechanisms. This review underscores the potential of dermatoglyphics as a non-invasive tool for early cancer detection and risk assessment. Keywords: Dermatoglyphics, Breast Cancer, Ovarian Cancer, Cervical Cancer.

Background: The study aimed to compare the diagnostic accuracy, reliability, and clinical utility of Immunohistochemistry (IHC) and Molecular Testing (MT) in diagnosing lymphomas. Materials and Methods: This was a comparative, observational study conducted at a tertiary care hospital, including 80 patients with clinically suspected lymphoma. Patients were categorized into two groups: Group A (IHC-based diagnosis) and Group B (MT-based diagnosis, including PCR, FISH, and NGS). Tissue samples were formalin-fixed, paraffin-embedded, and analyzed using standard IHC markers and molecular assays. Diagnostic accuracy metrics such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical analysis was performed using Cohen’s kappa coefficient for concordance and chi-square tests for categorical comparisons. Results: The study found that MT demonstrated significantly higher diagnostic accuracy (93.15%) compared to IHC (85.21%) (p = 0.003). MT also had superior sensitivity (94.58% vs. 86.42%, p = 0.004) and specificity (91.34% vs. 81.67%, p = 0.002). Positive and negative predictive values were significantly higher for MT (p < 0.01). The concordance rate between the two methods was high (MT: 92.40%, IHC: 88.75%), though MT exhibited greater consistency (κ = 0.89 vs. κ = 0.82, p = 0.038). However, MT required a longer turnaround time (8.49 vs. 4.94 days, p = 0.002) and was more expensive (Rs 30,590.91 vs. Rs 27400.87, p = 0.001). Conclusion: While both IHC and MT are valuable in lymphoma diagnosis, MT offers superior diagnostic accuracy, sensitivity, and specificity. However, its higher cost and longer turnaround time may limit accessibility. IHC remains a practical and cost-effective initial diagnostic tool, with MT serving as a confirmatory method in complex cases. Integrating both techniques may optimize diagnostic precision and improve patient management. Keywords: Lymphoma, Immunohistochemistry, Molecular Testing, Diagnostic Accuracy, Sensitivity.

Background: Vitamin D deficiency is increasingly recognized as a factor influencing the clinical outcomes of critically ill patients. This study aims to explore the association between vitamin D deficiency, illness severity, and clinical outcomes in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU). Material and Methods: A total of 102 patients aged 1 to 17 years were enrolled in this prospective observational study. Vitamin D levels were measured, and illness severity was assessed using the PIM 2 score. Mortality rates and other clinical outcomes were compared between vitamin D deficient and non-deficient groups. Results: The study found that 44.1% of patients were vitamin D deficient. Patients with vitamin D deficiency had higher illness severity as indicated by higher PIM 2 scores, a greater need for mechanical ventilation, and a higher incidence of hypocalcemia. Mortality was also higher in the vitamin D deficient group (35.5%) compared to the non-deficient group (1.8%). Conclusion: Vitamin D deficiency is significantly associated with increased illness severity and higher mortality rates in critically ill pediatric patients. Monitoring and correcting vitamin D deficiency may improve clinical outcomes in these patients. Keywords: Vitamin D deficiency, Pediatric Intensive Care Unit, Clinical outcomes.

Background: Angiogenesis is a key component in both neoplastic and inflammatory disorders. But whether it occurs in inflammatory skin disorders such as Lichen Planus is yet to be established. This can be done by evaluating Microvascular density and comparing it to the normal skin. Aims and Objectives: Quantitative comparison of Microvessel density in Lichen Planus lesion and adjoining normal skin by CD34 Immunohistochemical marker and to study characteristic histological features in favor of Lichen Planus diagnosis. Materials and Methods: A case control study was carried out on Quantitative comparison of microvessel density in lichen planus and adjoining normal skin by CD34 immunohistochemical marker in the department of Pathology. Results: Total 30 cases of Lichen Planus were evaluated. M: F ratio was 1.73: 1 In histological features, band of infiltrates and basal cell vacuolation are seen in all the cases. Microvascular density Mean in the lesion was 9.94 compared to 4.84 in the adjacent normal skin. Conclusion: Pathogenesis of Lichen Planus mainly is due to chronic inflammatory disease with probable autoimmune component. MVD is not a characteristic histological feature of Lichen Planus in differentiating from its mimickers. Further studies are recommended based on molecular and genetic pathogenesis of Lichen Planus using ancillary techniques so that targeted therapies can be administered. Keywords: Lichen Planus, Microvascular density, histopathology.

Background: Abnormal blood flow patterns in fetal circulation detected by Doppler ultrasound may indicate poor fetal prognosis. It is also possible that false positive Doppler ultrasound findings could lead to adverse outcomes from unnecessary interventions, including preterm delivery. Aim of the study: To study Doppler study of umbilical artery in high risk pregnancy. Material and Methods: Prospective study done in the department of Obstetrics and gynaecology on 100 women with high risk factors like PIH, IUGR, Oligohydramnios, Rh isoimmunisation, anaemia, twins and post-date, who attended Antenatal clinic and were referred from peripheral hospitals over a period of 2 years i.e., from, June 2022 to November 2024. Results: The study group comprised of patients between the age group 21-35 years. Maximum number of patients were >25 years. Average age was 28 years. This study shows that with increasing maternal age the high risk factors increase and the abnormality in Doppler study also increases.28 out of 52 (53.8%) in abnormal Doppler group were hypertensive compared to 27 out of 48 (56.2%) in normal Doppler group. Oligohydramnios was present in10 of 52 (19.2%) women with abnormal Doppler group, whereas it was15 of 48(31.2 %) women in normal Doppler group. Conclusion: Doppler should be used as a routine investigation as a part of antenatal surveillance in high risk cases like PIH, IUGR and oligohydramnios. Serial Doppler studies should be done to detect the efficacy of medical management given to these patients and more frequently when required to detect improving or deteriorating trend and timely obstetrics intervention in fetal interest. Keywords: Doppler study, umbilical artery.

Background: A prospective study on prevalence of post stroke depression and its association with disability in acute cerebrovascular accident patients. Material and Methods: Prospective and follow up study done during February 2019 to may 2019 in the department of Psychiatry at Osmania medical college, Hyderabad. Results: 100 patients with hemispheric stroke were identified during study period. The mean age of sample 44.42 years and SD of 6.59. There 52 males, 32 females Lesion location based on CT scan was found to be right hemisphere lesion location accounted for 37%, left hemisphere lesion location was found to be 57.1% and bilateral 6%. Site of lesion basal ganglia 23.8%, frontal 3%, internal capsule 23%. Conclusion: PSD associated with increased disability and worse rehabilitation outcome. Therefore there is a urgent need to routinely screen post stroke survivors for depression and treatment should be started. Depression was also related to functional disability The relationship between PSD and disability support the importance of reactive factor. Keywords: Stroke, Depression.

Background: Adolescent depression is a growing public health concern with significant academic, social, and long-term health implications. This study aims to determine the prevalence and causes of mental depression among teenagers aged 13-19 years in Indore, India. Material and Methods: A cross-sectional study was conducted in Indore from October 2023 to March 2024. A total of 210 teenagers were selected using simple random sampling from various educational institutions. The Beck Depression Inventory (BDI) was used to assess depression levels. Data were collected through a pre-designed, semi-structured questionnaire and analyzed using SPSS 25.0. Descriptive statistics were used for frequency distribution, and inferential tests determined associations between depression and socio-demographic factors. A p-value of <0.05 was considered statistically significant. Results: The prevalence of depression among teenagers was significant, with 41.9% exhibiting normal mental status, 25.2% experiencing mild mood disturbances, and 32.9% suffering from borderline to extreme depression. Academic pressure (66.7%) was the leading cause, followed by parental expectations (20.4%), societal norms (24.0%), and emotional distress. Hostel dwellers and medical students showed higher depression levels compared to school students. Females were more likely to experience moderate to severe depression (p=0.041). Suicidal thoughts were reported by 11.9% of participants. Conclusion: This study underscores the urgent need for adolescent mental health interventions, focusing on academic stress management, parental counselling, and emotional well-being programs. Early detection and preventive strategies can mitigate the rising burden of depression among teenagers. Keywords: Adolescent depression, Mental health, Beck Depression Inventory, Academic stress, Suicide risk.

Background: Dengue viral infection is a arboviral disease which is transmitted by Aedes aegypti and Aedes albopictus. Dengue cases are now increasing a global burden, especially in tropical and subtropical countries.1 The patients with dengue fever have high levels of non-structural protein-1 (NS1) protein in their serum after onset till<14 days. The present study was aimed to study the correlation of hematological & biochemical parameters among dengue RTPCR positive cases. Materials & Methods: Total 200 suspected Dengue patients who have less than 2 weeks of fever were enrolled in the study at Fever Clinic, Maa Kamla General Hospital, Ahmedabad from period of 2019-22 Dengue was detected by molecular analysis. Dengue RTPCR was done by TRU PCR 3B Black Bio kits as per standard protocol. Results: Out of 200 dengue like illness cases, a total of 114 (57%) cases were found dengue positive by RTPCR. Among 114 dengue positive cases 82 (71.92 %) were male while 32 (28.07%) were females. Male: female ratio was 2:1 observed. Among 114 dengue positive cases 104 (91.22%) belonged to dengue without warning sign while 10 (8.77%) cases were dengue with warning sign and 3 (2.63%) severe dengue cases were found with No death was observed Conclusion: Dengue infection is now endemic in India and no longer seasonal though the peak incidence remains during the rains. Early and prompt diagnosis with aggressive measures for proper sanitation can greatly limit dengue-afflicted mortality. Keywords: Dengue, RTPCR, Hematological, Biochemical.

Nevus sebaceous is a congenital, hamartomatous lesion characterized by the presence of sebaceous glands, hair follicles, and other skin appendages, typically located on the head or neck. It often presents as a yellowish, hairless, and velvety patch in early childhood and may undergo various changes with age, including the development of nodules or verrucous growths. This case report describes a rare presentation of nevus sebaceous in a pediatric patient, highlighting its clinical features, diagnostic evaluation, and management. The patient presented with an asymptomatic lesion on the nose that had gradually enlarged over time. Histopathological examination confirmed the diagnosis of nevus sebaceous, revealing a mixture of sebaceous glands, hair follicles, and epidermal hyperplasia. The report also discusses the potential for malignant transformation, which, although rare, can occur in long-standing cases. Treatment options, including surgical excision, are reviewed, with emphasis on the importance of monitoring for any changes suggestive of malignant conversion. This case underscores the need for awareness of nevus sebaceous in adult populations and the role of early intervention in preventing complications. Keywords: Differentiation, Hamartoma, Nevus sebaceous, Jadassohn Disease II, Nose.

Background: Eclampsia represents a significant medical concern, posing serious risks and potential life-threatening conditions for pregnant women. Preeclampsia itself is a multifaceted disorder of unclear origin, marked by the onset of hypertension and proteinuria (exceeding 300 mg/24 hours) after the 20th week of gestation. Hence; the present study was conducted for comparative evaluation of vaginal delivery and caesarean section in antepartum eclampsia patients from 34 weeks gestation onwards. Materials & Methods: The participants were randomly assigned to two distinct groups: Group 1 underwent vaginal delivery (n=85), while Group 2 received a caesarean section (n=65). The diagnostic criteria for eclampsia included elevated blood pressure (greater than 140/90 mmHg), significant proteinuria, and convulsions occurring after 20 weeks of gestation. Comprehensive demographic and clinical data were collected from all participants. Convulsions were managed with magnesium sulfate (MgSO4), provided there were no contraindications, and blood pressure was regulated using nifedipine and intravenous labetalol. The mode of delivery was predetermined as either vaginal or caesarean. Outcome was evaluated. Results: Among group 1, IUGR, LBW, need for resuscitation, need for NICU stay and still birth was seen in 23, 8, 15, 21 and 10 subjects respectively. Among group 2, IUGR, LBW, need for resuscitation, need for NICU stay and still birth was seen in 6, 5, 3, 8 and 2 subjects respectively. Among group 1, PPH, renal failure, CVA, pulmonary oedema, fever and electrolyte imbalance was seen in 10, 2, 2, 2, 1, 9 and 2 patients respectively. Among group 2, PPH, and fever was seen in 2 and 1 patient respectively. Incidence of maternal complications was higher among patients of group 1. Also, perinatal outcome was more adverse among patients of group 1. Conclusion: A timely caesarean section in cases of primigravida with eclampsia beyond 34 weeks of gestation and an unfavorable cervix upon admission results in a more favorable feto-maternal outcome compared to conservative obstetric management that involves expectant vaginal delivery. Key words: Vaginal, Delivery, Antepartum eclampsia.

Background: Inappropriate antibiotic prescribing is a major contributor for Antimicrobial Resistance (AMR), a global health challenge. This study utilized a novel digital prescription analytical platform VaidyaRx to analyze prescribing trends with reference to essentiality, use of fixed dose combinations (FDC) and pharmacoeconomic analysis.The study aims to provide data-driven insights into antibiotics prescribing practices Materials and Methods: A descriptive observational study was conducted at a tertiary care hospital by analysing 6906 outpatient prescriptions of 5 major antibiotic prescribing departments, over the period of seven months. The Prescriptions were digitized and analyzed to explore the prescribing trends, and classification of antibiotics, completeness of prescriptions and cost distribution by using the digital platform. Results: Out of total 6906 prescriptions, 1783 (25.8%) contained antibiotics. General surgery had the highest antibiotic prescription (67.7%). Empirical prescribing was universal. 93.8% of antibiotics were prescribed by branded name. The most frequently prescribed antibiotic formulations were ofloxacin and ornidazole (28.1%) and amoxicillin and potassium clavulanate (23.9%). According to WHO AWaRe classification the use was 39.7% Access, 17.9% Watch, and 0.02% Reserve antibiotics category reflecting adherence to stewardship guidelines. Analysis of completeness of antibiotic prescribing showed mentions of 55.5% for dose, 75.4% for frequency, and 82.4% for duration. The cost comparison showed less than 2% difference between NLEM & NON NLEM. Conclusion: General surgery was the leading prescriber of antibiotics, with most prescriptions having FDC therapies and were from the essential medicines list. Ofloxacin and ornidazole was the commonest prescribed combination. The cost comparison showed significant cost advantage in antibiotics prescribed from NLEM. The findings suggest gaps in antibiotic prescribing practices that can be improved through the periodic trainings, promotion of generics and complete documentation practice. The use of the VaidyaRx digital analytical platform enabled online prescribing analysis, facilitating targeted interventions that will be useful for strategizing antibiotic stewardship. Keywords: Antibiotic prescribing trend, digital platform, antibiotic stewardship, WHO AWaRe classification, pharmacoeconomics, NLEM.

Background: The use of electronic gadgets provides the medical students a chance to access a vast amount of medical information, research studies and case studies by healthcare professionals and organizations which can be beneficial for staying updated. However its excess usage has been associated with debilitating health effects such as headache, nausea, ophthalmic and psychological effects. Aim: The study was aimed to assess the usage of electronic gadgets and its effect on mental and physical health of medical students at SKIMS Medical college, Bemina. Materials and Methods: A cross-sectional study was conducted among 100 medical students, out of which 47 were male and 53 were female at SKIMS, medical college, Bemina, who were asked to fill a 11 pointed questionnaire. Results: Majority of students responded to spend about 4-8 hours on gadgets in a day. Out of which 56% participants spent 4-8 hours on internet in a day. Sleep disturbance was responded in 35% students. 43% students responded to develop headache due to excessive usage. Conclusion: Excessive usage of electronic gadgets possess potential negative impact on physical and mental health of medical students. In this regard students need to exercise caution, and strike a balance between online engagement and their academics and professional responsibilities. Keywords: Electronic gadgets, healthcare professionals, medical students, mental health, physical health.

Background: Diarrhea is a leading cause of mortality in infants and children, second only to acute respiratory infections. In developing countries like India, bacterial and parasitic infections predominate over viral causes. Among bacterial pathogens, Escherichia coli (E. coli), Shigella, Salmonella, and Vibrio cholerae contribute significantly to disease burden. Poor sanitation, unsafe water, and inadequate hygiene, especially in rural and urban slum areas, increase morbidity and mortality. Seasonal factors like monsoons and floods further exacerbate outbreaks. Objective: This study investigates the epidemiological trends, clinical manifestations, and antibiotic resistance profiles of bacterial strains isolated from pediatric patients with acute diarrhea at a tertiary care hospital. Materials and Methods: A total of 150 children under five years of age with acute diarrhea (<1 week duration) were enrolled. Stool samples underwent microbiological analysis for pathogen identification, serotyping, and antibiotic susceptibility testing. Genotyping for the bundle-forming pilus was performed to confirm Enteropathogenic E. coli (EPEC). Results: Among the 150 samples, E. coli was identified in 40% of cases. Serotyping revealed EPEC as the predominant strain, with a few Enteroaggregative and Enterohemorrhagic E. coli species. Antibiotic susceptibility testing showed high resistance to cotrimoxazole and ampicillin due to empirical antibiotic use. Conclusion: Despite oral rehydration therapy (ORT), diarrhea remains a major health concern, contributing to malnutrition and poor growth. The high prevalence of antibiotic-resistant E. coli highlights the need for rational antibiotic use and better preventive strategies. Keywords: Enteropathogenic Escherichia coli, paediatric diarrhoea, antibiotic resistance, tertiary care hospital, epidemiology.

Background: This study aimed to find out common otolaryngological causes of snoring in both adults and in children and, to study about the risk factors of snoring in general population. Materials and Methods: Prospective observational study done in 45 children and 67 adults have participated in the study. The general information such as age, sex, BMI, neck circumference, co morbidities are collected. The history was taken, and detailed clinical examination was done in the study participants. Based on age, two different questionnaires were used to enquire about snoring habits. Results: Increasing age is considered as a risk factor for snoring in general population. In this study, it was found that male participants had higher prevalence of snoring. Risk factors associated with snoring are male gender, high BMI, increased neck circumference, co morbidities, addictions. The most common cause in the children was adeno-tonsillar hypertrophy in both boys and in the girls (regardless of gender). Most child snorers can improve by undergoing adenoidectomy and/or tonsillectomy. The clinical findings found in adults are bulky tongue with FTP III/IV, DNS, allergic rhinitis, chronic rhinitis with or without nasal polyps. The most common causes in adults were bulky tongue with FTP class III/IV. In adult males, the second common cause was DNS. In females, second common cause was allergic rhinitis. Based on pediatric child questionnaire, 7 boys and 5 girls are habitual snores. 5 boys and one girl child (2.22%) were at high risk of developing OSA due to associated apnea during sleep. Based on berlin questionnaire used for adults, 25 males and 16 females were habitual snorers. Whereas 14 men and 9 women had high risk of developing OSA. These people had associated apnea during sleep, daytime sleepiness. Conclusion: In adults, both in males and females, obesity is found to be a risk factor in adults. Which in children it was not noticed as a risk factor. Therefore, weight management will alleviate the snoring symptoms in the adults. Keywords: Sleep Disordered Breathing (SDB), Adeno-Tonsillar Hypertrophy (ATH), Pediatric Child Questionnaire (PCQ).

Background: The death toll from gynaecological cancers is disproportionately high due to ovarian cancer. Because of their heterogeneity and similarities to other pelvic tumours, particularly those that originate, diagnosing serous ovarian tumors—one of the most prevalent types—can be challenging. This study seeks to examine the immunohistochemistry expression of p53 in ovarian tumours, particularly in serous tumours that cause alterations. Materials and Methods: A retrospective investigation of 150 ovarian tumour cases, encompassing both benign and malignant serous tumours, was performed using a pathology database during a 5-year duration. This study was conducted at the department of Pathology, ESIC Medical College, Kalaburagi, Karnataka, India from the November 2023 to October 2024. Histological sections were stained using p53 monoclonal antibodies to evaluate immunohistochemical expression. Tumours were classified as serous carcinomas, serous borderline tumours, and serous cystadenomas. The intensity and pattern of p53 expression were compared among tumour types, and relationships with alterations were examined using statistical methods. Results: Serous carcinoma accounted for 50 cases, serous borderline tumours for 30, and serous cystadenomas for 70. In 85% of serous carcinomas, 30% of serous borderline tumours, and 10% of serous cystadenomas, positive p53 staining was noted. Significantly, hyperplastic and atypical alterations were associated with increased p53 expression, and 60% of serous carcinoma cases included. Benign tumours did not cause any noticeable modifications. Because of the strong association between p53 overexpression and cancerous behaviour, it may be useful as a diagnostic tool for serous ovarian tumours. Conclusion: Particularly helpful for distinguishing between benign and malignant serous ovarian tumours, the immunohistochemistry presence of p53 offers important diagnostic information. This could be useful in developing better methods of ovarian cancer early detection and diagnostic procedures. Keywords: Ovarian tumors, serous tumors, p53, immunohistochemistry, changes, malignant ovarian cancer, tumor markers, histopathology.

Background: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance as well as progressive pancreatic beta-cell dysfunction. Persistent hyperglycemia and inflammation associated with T2DM is associated with various endocrine complications including thyroid dysfunction. Altered glucose metabolism, insulin resistance as well as chronic inflammation in T2DM may predispose patients to thyroid hormone imbalances. Materials and Methods: In this comparative observational study, 50 T2DM patients and 50 age-matched healthy controls were evaluated for thyroid function. Demographic data, diabetes duration, and glycaemic control (HbA1c) were recorded. Thyroid function tests (T3, T4, and TSH) were performed for all participants. Individuals were classified into euthyroid and patients with thyroid function abnormalities. Statistical analysis was conducted using the chi-square test for categorical variables and independent t-test for continuous variables. P values less than 0.05 was taken as statistically significant. Results: Gender and age distributions were comparable between the groups. In the T2DM group 64% were euthyroid whereas 34% patients were found to have hypothyroidism (24% subclinical, 10% overt) and 2% had subclinical hyperthyroidism compared to 86% euthyroid and 14% hypothyroid (10% subclinical, 4% overt) among controls (P = 0.019). Mean T3 and T4 levels were significantly lower in T2DM patients (2.88 ± 0.42 pg/mL and 1.10 ± 0.27 ng/dL, respectively) than controls (3.10 ± 0.38 pg/mL and 1.31 ± 0.38 ng/dL; P = 0.0072 and 0.0019, respectively), while TSH levels were significantly higher in T2DM (5.18 ± 1.44 mIU/L vs. 3.07 ± 0.74 mIU/L; P < 0.0001). Furthermore, thyroid dysfunction was significantly associated with poor glycaemic control (HbA1c > 7%) (P = 0.0016). Conclusion: Thyroid dysfunction is more prevalent in T2DM patients compared to healthy individuals and is significantly associated with poor glycaemic control. Routine thyroid screening in T2DM may facilitate early detection and management of thyroid abnormalities, potentially improving metabolic outcomes. Key Words: Thyroid Dysfunction, Type 2 Diabetes Mellitus, Glycaemic Control, Subclinical Hypothyroidism, TSH.

Background: Distal radius fractures are among the most common fractures in adults, particularly in active individuals and the elderly. Comminuted fractures pose a challenge due to their complexity and high risk of complications. External fixation with ligamentotaxis is frequently used to manage these fractures, providing stability and promoting functional recovery. Materials and Methods: This prospective study was conducted from January 2024 to December 2024 over a one-year period in the Department of Orthopedics at Govt Medical College/ Govt General Hospital, Siddipet. Twenty-five adult patients with comminuted distal radius fractures were included. Patients underwent external fixation with ligamentotaxis, and demographic data, mechanism of injury, fracture characteristics, and post-operative outcomes were recorded. The Frykman classification was used to categorize fractures, while functional outcomes were assessed using the modified Gartland-Werley scoring system. Results: The majority of patients were male (76%), aged between 31 and 40 years. Low-impact falls accounted for 68% of injuries, while 32% were due to high-impact road traffic accidents. Post-operative complications included deformity (8%), infection (4%), and various levels of movement restriction. Functional outcomes were favorable, with 16% achieving excellent, 60% good, 16% fair, and 8% poor results based on the Gartland-Werley scoring system. Conclusion: External fixation with ligamentotaxis is effective in managing comminuted distal radius fractures, with most patients achieving satisfactory functional outcomes. However, careful patient selection and surgical technique are essential to minimize complications. This study supports the continued use of this method for complex fractures while underscoring the importance of tailored treatment strategies. Keywords: Distal radius fracture, external fixation, ligamentotaxis, Gartland-Werley scoring, comminuted fracture.

Background: The problem statement with silicosis is that once the fibrosis & scarring of lung tissue starts it is irreversible & causes a lot of DALY & handicap and may lead to a crippling death. There are just a few studies on epidemiological & clinical characterstics of silicosis, but none so in the hub of sand stone mining ie ‘The Dang’ of the Bharatpur zone consisting of Karauli, Dholpur and Bharatpur districts in the eastern part of Rajasthan. Peculiarly it has been seen that silicosis here has devastated entire villages so much so that if a patient walks in from a particular village the diagnosis is already confirmed to silicosis in 90% of cases. These villages have lots of young widows in their 30s. Oxygen concentrator is known to every household. Thanks to APNA GHAR ashram which is doing good in supplying Oxygen concentrator to these terminally ill patients (virtue the Covid 19 pandemic). It has also been seen that silicosis runs in families, & in few cases it seems to have an earlier & aggressive onset in younger siblings. The data in this study throws new light in this area of DANG infested with silicosis, which differs considerably from studies in other locations. Materials and Methods: In this observational study, 200 already Certified silicosis patients attending the OPD or admitted to IPD of the Chest & TB department of Sh JP MC Bharatpur located at RBMH hospital were scrutinized for various epidemiological & clinical characterstics. Results: Mostly the patients were males aged 30-40 years average age (37.4yrs), either smoker or tobacco user, presented with an average of 12.32 years of TDI, after an average of 18.67 yrs of silica exposure in their workplace. Cough, Dyspnea, chest pain and hypoxia were the main sign and symptoms. The mean SPO2 was 94, Mean pt was undernourished with BMI of 17.8, & the mean 6 MWD was 244 meters. Conclusion: Due to Ignorance & poor environment control practices the silicosis in DANG area is a menace, the patient dies young and the families suffer a crippling disease. The Government needs to focus more on preventive & environment control measures & to provide alternative livelihood to the poor in the area who are naturally attracted to this easy job. More research is required on various treatment options and molecular understanding of the disease for its effective control. Keywords: Silicosis, Occupational lung disease, lung fibrosis, PMF, LTOT, DANG area.

Background: The connection between thyroid dysfunction and menstrual irregularities in women of reproductive age is a topic of significant clinical relevance. Thyroid hormones are essential for metabolic regulation and maintaining homeostasis, exerting a substantial influence on the female reproductive system. They play a key role in various reproductive processes, from menarche to menopause, affecting menstrual cycle regulation, fertility, and pregnancy outcomes. Materials and Methods: This study involved two groups: • Group I: Patients with hypothyroidism (n = 232). • Group II: Patients with euthyroidism (n = 178). The study was conducted in the Department of Biochemistry at Career Institute of Medical Sciences, Lucknow, over a period of two years. Results: A total of 410 cases were analyzed, comprising 232 cases of hypothyroidism and 178 cases of euthyroidism. Among these, 352 women did not experience subfertility, while 58 were affected, demonstrating a clear association between thyroid dysfunction and an increased risk of subfertility. Conclusion: These findings highlight the critical role of thyroid function in reproductive health and stress the importance of thyroid screening for women experiencing menstrual irregularities and infertility. Keywords: Hypothyroidism, Oligomenorrhea, Polymenorrhea, Menorrhagia.

Background: Axillary lymph node dissection (ALND) is a critical component of breast cancer surgery, but it is associated with complications such as seroma formation, hematoma, and prolonged drain output. This study compares the efficacy of the Bipolar Vessel Sealing System (BVSS) with conventional techniques in ALND. Materials and Methods: A prospective study was conducted on 60 patients undergoing modified radical mastectomy. Patients were divided into two groups: Group A (BVSS) and Group B (conventional ALND). Outcomes measured included operative time, drain output, duration of drain placement, hospital stay, and postoperative complications. Results: The BVSS group had significantly shorter operative times (58.17 ± 11.17 minutes vs. 125.83 ± 20 minutes, p < 0.0001), reduced drain output (427.23 ± 62.64 mL vs. 737.50 ± 105.99 mL, p < 0.0001), and shorter hospital stays (6.27 ± 0.69 days vs. 10.67 ± 1.74 days, p < 0.0001). Postoperative complications such as hematoma and seroma formation were also significantly lower in the BVSS group. Conclusion: The BVSS is a safe and effective alternative to conventional ALND, reducing operative time, drain output, and postoperative complications, thereby improving patient outcomes. Keywords: Bipolar Vessel Sealing System, Axillary Lymph Node, Breast Cancer

Background: Staphylococcus aureus is the leading cause of nosocomial and community acquired infections globally.The Macrolide - Lincosamide Streptogramin B (MLSB) antibiotics are commonly used to treat MRSA infections. Clindamycin is the most commonly prescribed (MLSB) antibiotics to for MRSA and resulted in Staphylococcal strains acquiring resistance against it. The aim of the study to detect Methicillin resistance and Inducible clindamycin resistance (iMLSB) among S. aureus isolates and to find the effectiveness of commonly used antibiotics and the correlation between Methicillin resistance and Inducible clindamycin resistance. Materials and Methods: A cross sectional study was conducted from October 2023 to December 2023 in the Department of Microbiology, Tertiary care hospital among 200 samples. Staphylococcus aureus isolates were identified and antimicrobial susceptibility test was done by Kirby Bauer’s disc diffusion method. Cefoxitin disc (30 μg) was used to detect Methicillin resistance. CLSI 2023 guidelines were followed for performing the tests and its interpretation. The data collected was entered in MS Excel windowsand the analysis was done through SPSS 16. p value <0.05 is considered as statistically significant. Results: Total 35 staphylococcus isolates were obtained.Among them 14(40%) were MRSA and 21 (60%) were MSSA. The most common phenotype among Erythromycin resistant Staphylococcus aureus isolate were iMLSB 9 (25.7%) followed by MS 8(22.8%). Among Erythromycin sensitive isolates, S phenotype detected in 13(37.1%) of the samples. Conclusion: Our study concluded by stating the prevalence of inducible clindamycin resistance (iMLSB) among S. aureus isolates was 25.7%. Keywords: MRSA -methicilin resistant Staphylococcus aureus, D-test – Double Disc Diffusion test, iCR Inducible clindamycin resistance.

Background: COVID-19, caused by SARS-CoV-2, has significantly impacted maternal and perinatal health. Pregnant women may experience severe complications due to immunological changes. This study aimed to assess the clinical course of COVID-19 during pregnancy and its impact on maternal and neonatal outcomes at a tertiary care centre. Materials and Methods: A prospective observational study was conducted on 1442 COVID-19-positive pregnant women at the Government Raja Mirasudhar Hospital over 12 months. Demographic details, clinical symptoms, comorbidities, obstetric complications, mode of delivery, and neonatal outcomes were also assessed. Investigations included blood tests, imaging, and foetal monitoring. Delivery outcomes, maternal morbidity, and neonatal parameters were recorded. Results: Among the patients, 33.4% were aged 20-30 years, and 35.5% had a BMI of 30-35 kg/m². Antenatal admissions were the most common (51%). Among the deliveries, 24.76% were preterm, 27.12% were term, and 7.00% were postdated. Oxygen support was required in 10.68% of the cases. Myalgia (17.48%) and fever (16.02%) were the most commonly reported symptoms, while 53.33% of patients were asymptomatic. The maternal mortality rate was 0.69%. Low birth weight was observed in 32.66% of the cases. LSCS was performed in 74% of primi gravida and 68% of multigravida cases. Hypothyroidism (51.18%) and anaemia (36.06%) were the most common comorbidities. Antibiotics were administered to 70.94% of the patients, and 53% were unvaccinated. The most common LSCS indication was CPD in Labor (9.50%). Conclusion: COVID-19 during pregnancy increased the rates of LSCS, preterm birth, and neonatal complications. Maternal mortality is associated with pneumonia and respiratory failure, and vaccination reduces the severity of symptoms. Keywords: COVID-19, Pregnancy, Maternal Outcomes, Neonatal Complications, LSCS, Vaccination.

Background: Attention deficit hyperactivity disorder (ADHD) is commonly observed in children as well as adolescents. However, the diagnosis and management of ADHD is still a challenging task in the medical field. Application of vestibular and visual rotational stimulation also showed improvement in children with ADHD. Aim and objectives: The present study was undertaken to observe the impact of four weeks of vestibular stimulation by rocking chair on cognitive functions in children with ADHD. Materials and Methods: A total of 20 children with ADHD were part of the study after obtaining the assent from the parents/ legal guardian. After recording the baseline values, the participants were trained about the rocking chair therapy and then started with the treatment sessions. Each session is for 30 minutes and five sessions in a week for four weeks. The frequency of stimulation is 30 cycles per minute. Spatial and verbal memory test was used to assess the cognitive functions that are memory in specific.[13] 100 pin dexterity test was used to test the motor coordination. Results: There was a significant increase in the spatial memory scores followed by the vestibular stimulation (P=0.0011). Verbal memory scores also improved but it was not statistically significant. There was a significant decrease in the duration of 100 pin dexterity test. However, it was not statistically significant. Conclusion: The study results support that vestibular stimulation through rocking chair has beneficial effects on cognitive functions and motor coordination in the children with ADHD. Further detailed studies are required in this area to recommend the vestibular stimulation by rocking in the management of ADHD. Key words: vestibular system, Rocking chair, Memory, Cognition, motor coordination.

Background: Group B Streptococcus, also known as Streptococcus agalactiae (GBS), is newborns' primary cause of infections.1 GBS predominantly inhabits the genitourinary and gastrointestinal systems of humans; however, when pregnant women colonize it in their vaginal and rectal areas, it increases the risk of health problems for their newborns due to the potential for vertical transmission before, during, and after delivery. Objectives: 1. To study the prevalence of Group B streptococcus vaginal colonization in near-term pregnant women and the isolates' pattern of antibiotic sensitivity. 2. To determine which pregnant women are positive for GBS and to administer intrapartum antibiotic prophylaxis (IPA). Materials and Methods: Study Design: Hospital-based case-control study. Study area: Department of Obstetrics and Gynaecology, Vinayaka Mission’s Medical College. Karaikal, Vinayaka Mission’s Research Foundation (DU), Karaikal, Puducherry, India. Study Period: 1 year. Study population: All pregnant women who meet the study requirements and attend the prenatal clinic with a gestational age between 35 and 38 weeks. Sample size: The study consisted of a total of 220 subjects. Sampling Technique: Simple Random technique. Results: 3 pregnant women are sensitive to erythromycin and ampicillin, accounting for 1.4% of the study population. 2 pregnant women are sensitive to erythromycin, ampicillin, and penicillin, accounting for 0.9% of the study population. 4 pregnant women are sensitive to gentamicin, corresponding to 1.8% of the study population, and 2 patients are sensitive to penicillin, ampicillin, and cefazolin, corresponding to 0.9% of the study population. Conclusion: Group B Streptococcus (GBS) can cause a range of infections in mothers and newborns, from mild to severe. In this study, 3.6% of pregnant women tested positive for GBS, with 62.5% of these cases occurring between 37-38 weeks of pregnancy. Keywords: Group B Streptococcus, colonization, antibiotic prophylaxis.

Background: Lifestyle and dietary habits have changed significantly among populations across the globe. Presently, excessive eating and lack of physical activity are identified as the main factors leading to an imbalance between caloric intake and expenditure, resulting in an accumulation of fat in various areas of the body.[1,2] Objectives: 1. To assess the prevalence of central obesity among bank employees in the study area. 2. To examine the demographic factors (age, gender, education, income, marital status) associated with central obesity. 3. To evaluate the influence of behavioural factors (diet patterns, physical activity, smoking, alcohol consumption, sleep duration) on central obesity. Materials and Methods: Study Design: A cross-sectional observational study was conducted. Study Area: The study was carried out in the Department of Community Medicine and included government, private, and cooperative banks in Tirupati. Study Period: Data collection took place from November 2020 to June 2021. Study Population: Bank employees from government, private, and cooperative banks in Tirupati were selected based on the required sample size. Sample Size: The study included a total of 320 participants. Sampling Technique: A stratified proportionate random sampling technique was used to ensure representation across bank sectors. Results: It was found that the prevalence of central obesity was found to be higher in those consuming fried foods regularly (more than 3 times per week) (41.7%) compared to those who are not consuming fried foods regularly (28.0%). The differences are also statistically significant (P=0.011; S). Conclusion: The study revealed a high prevalence of central obesity among the study population, with 34.7% based on waist circumference and 54.7% based on waist-hip ratio. Central obesity was significantly associated with several demographic, behavioural, and health-related factors. It was more prevalent among older individuals (50+ years), women, and married participants. Keywords: Central obesity, Lifestyle and dietary habits, waist-hip ratio, fried foods.

Background: Neonatal sepsis is one of the leading cause of neonatal mortality and morbidity worldwide. A wide spectrum of organisms cause neonatal sepsis and they are often resistant to multiple antimicrobials which make the treatment very difficult and grave sequelae ensue. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Microbiology and Department of Paediatrics at Government Medical College Hospital,Thiruvallur, over a period of 6 months from April 2023 to September 2023. Blood samples collected for culture and sensitivity from 200 neonates suspected to have clinical sepsis, were processed as per standard procedures. Antibiotic susceptibility pattern of the isolates were determined according to CLSI guidelines. Neonatal and maternal risk factors were analyzed Results: Blood cultures were positive in 17(8.5%) newborns ,out of which 13(76.5%) were EOS and 4(23.5%) were LOS. Of the 17 bacterial isolates, 12(70.6%) were Gram-negative and 5(29.4%) were Gram-positive. Klebsiella pneumoniae and Acinetobacter species were the common organisms isolated. Gram negative isolates were highly sensitive to meropenem. Gram positive isolates were highly sensitive to Vancomycin and linezolid. Prematurity and low birth weight were the most common neonatal risk factors observed . Maternal risk factors observed were Premature Rupture Of Membrane(PROM)>18 hrs, followed by maternal fever and maternal urinary tract Infection. Conclusion: The bacteriological profile of neonatal sepsis keeps changing from time to time and region to region.From this study we were able to determine the common causative bacterial pathogens, their antibiotic susceptibility pattern and the associated risk factors of neonatal sepsis in our hospital. Keywords: neonatal sepsis, bacteriological profile, antibiotic susceptibility, early onset sepsis, late onset sepsis.

Background: Headache is a prevalent yet complex condition with multiple extracranial causes beyond primary brain pathology. Sinusitis, temporomandibular joint (TMJ) dysfunction, cervical spine disorders, vascular abnormalities, middle ear infections, and dental pathologies contribute significantly to headache etiology. This study adopts a holistic imaging approach to identify extracranial causes of headache, emphasizing the role of targeted imaging in diagnosis and management. Materials and Methods: This cross-sectional study was conducted at a tertiary care center, including patients presenting with chronic or recurrent headaches. All participants underwent a detailed clinical evaluation followed by contrast/non-contrast CT head imaging, with extracranial incidental findings systematically assessed. No additional imaging, such as CT PNS, temporal bone, cervical spine, temporomandibular joint, maxillofacial structures, or CT angiography, was performed unless gross extracranial pathology was detected. The frequency of extracranial causes of headache was analyzed, and logistic regression was used to determine associations between imaging findings and headache presentation. Results: Among the study participants, 46.0% were aged 21–40 years, and 56.0% were male. The most common headache-related findings included sinusitis (28.0%), cervical spondylosis (30.0%), TMJ dysfunction (18.0%), and middle ear pathology (15.0%). Frontal headaches were most associated with sinus pathology (57.0%, p = 0.003), while occipital headaches were linked to cervical spine disorders (65.0%, p = 0.001). TMJ dysfunction significantly correlated with jaw discomfort (p = 0.002). Logistic regression revealed that cervical spine pathology (OR: 5.1, 95% CI: 3.0–8.4, p < 0.001) and vascular abnormalities (OR: 4.6, 95% CI: 2.5–7.9, p < 0.001) had the strongest associations with headache. Conclusion: Extracranial causes of headache are significant yet often underdiagnosed contributors to headache burden. A structured, imaging-guided approach enhances diagnostic accuracy and informs targeted management. Incorporating CT head-based evaluations of sinuses, cervical spine, TMJ, and vascular structures should be considered in patients with refractory headaches to identify treatable underlying conditions. Keywords: Headache, extracranial causes, sinusitis, cervical spondylosis, temporomandibular joint dysfunction.

Background: Worldwide, breast cancer is the most often diagnosed cancer in women, and a sizable percentage of cases are early invasive breast cancer. With an emphasis on surgical morbidity, wound complications, functional results, and long-term impacts, this study compares the postoperative complications of MRM versus BCT in patients with early invasive breast cancer. Materials and Methods: Over the course of a year, a prospective observational study was carried out at a tertiary care facility. This study was conducted at the Department of General Surgery, Narayana Medical College, Nellore, Andhra Pradesh, India from January 2024 to December 2024. Two groups, MRM (n=20) and BCT (n=20), were created from a total of 200 patients with Stage I and Stage II invasive breast cancer. Age 30-70 years, tumor size ≤5 cm, solitary lesion, and absence of distant metastases were among the inclusion criteria. Pregnancy, prior breast surgery, neoadjuvant chemotherapy, and multicentric tumors were among the exclusion criteria. Early (≤30 days) and late (>30 days) problems were used to assess postoperative complications. Surgical site infection, seroma, hematoma, lymphedema, discomfort, and upper limb functional impairments were the main consequences evaluated. Results: In the MRM group, 42% of patients experienced early problems, whereas in the BCT group, 28% did so (p=0.03). Twenty percent of MRM cases and ten percent of BCT cases had seroma development (p=0.02). The rate of surgical site infection was 15% in MRM and 8% in BCT (p=0.04). Although there was a little increase in the incidence of hematoma formation in BCT patients (5% vs. 3%), the difference was not statistically significant (p=0.34). The BCT group had higher overall quality of life (QOL) ratings in many areas, such as body image, emotional well-being, and functional outcomes, as measured by the EORTC QLQ-BR23 questionnaire (p<0.01). Conclusion: Early surgery site problems, lymphedema, and functional impairment are more common in MRM patients, while hematoma formation and radiation-induced fibrosis are slightly more common in BCT patients, who otherwise have fewer difficulties. To maximize results, personalized treatment plans are necessary, taking into account patient preferences, tumor features, and anticipated postoperative recovery. Keywords: Early breast cancer, modified radical mastectomy, postoperative complications, lymphedema, seroma.

Background: Menstruation is a natural biological process that occurs in females. In India, restricted access to sanitary hygiene products and a lack of proper sanitary facilities often force individuals to resort to unhygienic methods for managing menstruation. In many developing countries, including India, women often lack awareness about proper menstrual hygiene practices and face difficulties in openly discussing menstruation due to prevailing social taboos. This descriptive study aimed to assess the level of knowledge, attitudes, and practices (KAP) regarding menstrual hygiene among school-going adolescent girls in the urban field practice area of a tertiary care hospital in Shahjahanpur. The research focused on understanding their awareness, perceptions, and hygiene management behaviors to identify gaps and areas for improvement. Materials and Methods: This community-based cross-sectional study was conducted among adolescent girls in the Shahjahanpur district, Uttar Pradesh. The research took place in schools located within the urban field practice area of the Department of Community Medicine, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur. For data collection, a semi-structured, predesigned, and pretested questionnaire was used, and information was gathered through personal interviews. The study included all school-going adolescent girls aged 10 to 19 years who were present on the day of data collection. Results: A total of 220 adolescent girls participated in this study. The majority (65%) were in the 15 to 17-year age group, with an overall average age of 15.67 years. This study revealed that 70.91% of girls had prior knowledge of menstruation before their first period, whereas 29.09% were unaware. Only 15.46% of girls had a celebration for their first menstruation, suggesting that while some families acknowledge menarche as a significant milestone, most do not. Additionally, just 9.09% of girls reported experiencing no social or cultural restrictions. Conclusion: Comprehensive menstrual health programs in schools and communities are essential to educate girls on hygiene, reproductive health, and breaking social taboos. Keywords: Adolescent girls, Menstrual Hygiene, Urban Area, Demographic factors.

significant implications for men's health and quality of life. Insulin resistance (IR) has been identified as a key metabolic factor in ED pathogenesis. The triglyceride-glucose (TyG) index, a simple surrogate marker for IR, has gained attention for its role in predicting metabolic disorders. This study aims to evaluate the association between the TyG index and ED severity in patients without cardiovascular disease. Material and Methods: A prospective observational study was conducted at a tertiary care center in Saurashtra region, Gujarat from January 2023 to December 2023, including 120 male participants (106 with ED and 54 controls). Clinical and biochemical parameters were recorded, and the TyG index was calculated. Logistic regression analysis assessed predictors of ED severity, while ROC curve analysis determined the TyG index cut-off for ED prediction. Results: Patients with ED had significantly higher TyG index values compared to controls (p = 0.003). Logistic regression showed that age, total cholesterol, LDL-C, and the TyG index were significant predictors of ED (p < 0.001). ROC curve analysis identified a TyG index cut-off of 9.13, with 70.8% sensitivity and 65.2% specificity for predicting ED severity. Conclusion: The TyG index is significantly associated with ED severity, reinforcing its potential role as a metabolic marker in ED assessment. Incorporating the TyG index into routine clinical evaluation may aid in early identification and management of ED, particularly in patients without cardiovascular disease. Keywords: Cardiovascular Disease, Insulin Resistance, Triglyceride Glucose Index, Erectile Dysfunction.

Background: The diagnosis and management of the patient with intestinal obstruction is one of the more challenging emergency that a general surgeon can come across. Early diagnosis of obstruction, skillful operative management, proper technique during surgery and intensive postoperative treatment carries grateful results. Objectives: • To study the various causes of intestinal obstruction.• To study the various clinical features of intestinal obstruction. •To study the various surgical procedures and its outcome in relation to etiological factors in intestinal obstruction patients.• Modalities of treatment required. Materials and Methods: In the present study included total number of cases 30. After admission to Narayana Medical College, Nellore, investigations and operative procedures performed were collected from the inpatients, were interpreted. Results: Intestinal obstruction is more common in the age group of 30-60 years than in younger age group. Male and female are in equal ratio. Small bowel obstruction is more common than large bowel obstruction. Four cardinal features of intestinal obstruction are pain abdomen, vomiting, distension and constipation. Plain X-ray abdomen in erect and is most important investigation. Most common etiological factor is postoperative adhesions and next is intestinal tuberculosis with stricture. Malignant obstruction is more common in large bowel than small bowel. Small bowel volvulus is common than large bowel volvulus. Incidence of hernia related to obstruction is decreasing. Intravenous fluids and electrolytes, gastrointestinal aspiration, antibiotics and then appropriate surgery are still the mainstay of the treatment. Conclusion: The present study concluded that Intestinal obstruction with tuberculosis intestine have 9 times more likely to develop postoperative complications, proper anti-tubercular management is necessary to prevent mortality and morbidity. Early operations are mandatory to avoid the development of peritonitis and systemic sepsis associated with multisystem organ failure. Keywords: Small intestine; Large intestine; Bands; Adhesions; Stricture; Malignancy; Hernia, Volvulus; Intussusception; Ultrasonography; CT scan; Colonoscopy; Serum electrolyte; Strangulated internal hernia.

Background: Differentiating malignant from reactive mesothelial cells is challenging, particularly in pleural cytology, due to overlapping cytologic features . This study evaluates the effectiveness of EMA (Epithelial membrane antigen), Desmin and Calretinin in distinguishing mesothelial cells from malignant cells in cytologic effusions and provides a comparative analysis of their diagnostic performance. Material and Methods: This study, conducted at Government Medical College, Thrissur, from January 2017 to June 2018, focused on pleural fluid samples from patients diagnosed with reactive mesothelial cells, atypical mesothelial cell proliferation and metastatic carcinoma.Samples were examined using both cell block and conventional smear methods. Immunohistochemistry (IHC) was performed on cell block sections with markers EMA, Desmin and Calretinin using the immunoenzymatic soluble complex method. Results: The study included 56 patients, with a mean age of 62.9 years, and found that hemorrhagic effusions were most commonly caused by malignancy. The cell block (CB) method demonstrated significantly higher diagnostic efficiency for malignancy (75.5%) compared to conventional smear (46.9%), and combining both methods improved diagnostic accuracy. Immunohistochemistry (IHC) showed strong EMA expression in adenocarcinoma cases with a sensitivity and specificity of 100% .and Desmin positivity was seen in a subset of reactive effusions, with sensitivity and specificity being 36.8% and 89.1% respectively. Conclusion: This study evaluates the use of EMA, Desmin and Calretinin to differentiate mesothelial cells from malignant cells in pleural effusions. It finds that combining smear and cell block methods improves diagnostic yield, with cell block preparation offering better cellular details. EMA shows 100% sensitivity and specificity in identifying malignant cases, while Desmin helps identify reactive mesothelial cells. The combination of EMA and Desmin enhances diagnostic accuracy, making them a reliable panel for challenging effusion cases. Key Words: Immunohistochemistry, Pleural effusion, Mesothelial cells, Malignant cells, Epithelial membrane antigen, Desmin.

Background: Urinary tract infection (UTI) is one of the most frequently reported bacterial infections in the community coming second to respiratory tract infections. Empirical antibiotic therapy is usually applied in the management of UTIs, which has resulted in rapidly emerging antimicrobial resistance in hospitals and the community. Hence, the present study was designed to study the prevalence of uropathogens and to determine their antibiotic resistance patterns in our hospital. Material and Methods: This retrospective study was done among patients attending a tertiary care hospital in eastern part of Uttar Pradesh, from November 2018 to June 2019 with the aim to investigate the prevalence of uropathogens and their antibiotic susceptibility pattern. A total of 1845 urine samples from patients with clinical symptoms of UTI were received in the Microbiology laboratory. All the samples were cultured and identified using conventional biochemical tests and antimicrobial susceptibility was performed by Kirby-Bauer disk diffusion method. Results: Among a total of 1845 urine samples received in laboratory, 366 (19.8%) had significant bateriuria. Majority of the pathogens were isolated from females with isolation rate of 60.4% compared to males with isolation rate of 39.6%. E. coli was the most predominant pathogen isolated from urine samples with prevalence of 41.2% followed by Klebsiella spp. 15.84 %, P. aeruginosa 10.1 %, Enterococcus 9.8 %, S. aureus 8.7 % Acinetobacter 7.1 %, Candida 4.9 %, Citrobacter 1.6 % and Proteus spp. 0.54%. The three most frequently isolated bacteria had sensitivity rates of 70.2% to 100% to Amikacin; 0% to 98.7% to nitrofurantoin; 24.5% to 86.4% to ciprofloxacin and 70.6% to 75.7% to gentamicin. All the Gram negative bacilli were found susceptible to Amikacin whereas, among the Gram positive cocci susceptibility to Amikacin was 97.1% followed by Vancomycin 94.1%, Teicoplanin 83.8%, Levofloxacin 83.8%, Nitrofurantoin 80.9% and Gentamycin 75%. Cephlosporins and Nalidixic acid were resistant to all the isolated pathogens by 50% and more. Conclusion: This study concludes that Gram-negative organisms are the leading cause of UTIs among adult population,in which E.coli is the principal uropathogen. Since most isolates were susceptible to nitrofurantoin and amikacin, they are considered as appropriate antimicrobials for empirical treatment of urinary tract infections. Key Words: Urinary Tract infections, Significant bacteriuria, E. coli.

Background: Cataract remains the leading cause of avoidable blindness worldwide. More than 95% surgeries are done using microsurgical techniques like small incision cataract surgery (SICS) and Extra-capsular cataract surgery (ECCE) techniques with intra-ocular lens implantation (IOL). Modern cataract surgery with a small incision provides excellent clinical results, quick post-operative recovery, and a low risk of complications. Aims and Objectives: To analyze and compare the changes which can affect the tear film post Manual Small Incision Cataract Surgery and clear corneal Phacoemulsification. Materials and Methods: This study was a prospective, comparative study conducted at MMIMSR, Mullana with 100 patients. Subjects were assorted into two groups of 50 patients each who were selected to undergo Manual SICS and phacoemulsification respectively post taking informed consent. Prior to surgery workup was done by slit lamp bio-microscopy. Dry-eye tests [DET] including tear meniscus height [TMH], tear film breakup time [TBUT] and schirmer test [ST], were done to rule out the pre-existing dry eye disorders, and repeated post operatively at 1 week, 1 month and 3 months. All the patients were also evaluated for dry eye symptoms with the help of questionnaire. An ocular surface disease index (OSDI) questionnaire was given to all patients before subjecting them to examination. Results: Majority of subjects (59%) were above 60 years of age and only 41% of subjects were less than 60 years of age. Among the 100 subjects, 54% were females and 46% were males. Male:Female ratio was 1:1.2. Even while SICS and phacoemulsification use different techniques, they both significantly reduced TMH, TBUT, and ST values after one week, one month, and three months. Conclusion: DED is a common condition that can be brought on or made worse by cataract surgery, having a significant impact on patients' QOL. We found that having cataract surgery has the potential to exacerbate dry eye and alter the results of dry eye tests. The negative intra-operative effects of cataract surgery on the ocular surface should be recognised by cataract surgeons, and precautions should be taken to reduce them. Keywords: SICS, Phacoemulsification, Tear film, dry eye

Background: Atherosclerosis is a progressive vascular disease characterized by the deposition of lipids, cholesterol, and cellular debris in the arterial walls, leading to plaque formation. This process triggers an immune response, resulting in chronic inflammation that contributes to plaque progression, arterial narrowing, and impaired blood flow. One of the significant manifestations of atherosclerosis is carotid artery disease (CAD), which involves the accumulation of plaques in the carotid arteries. CAD significantly increases the risk of ischemic stroke, a potentially fatal condition caused by the obstruction of cerebral blood flow. Understanding the relationship between carotid stenosis severity and inflammatory markers can aid in risk assessment and the development of targeted therapeutic interventions. Objectives: This study aims to explore the association between carotid artery stenosis severity and inflammatory biomarkers, with a specific focus on uric acid (UA) and C-reactive protein (CRP). Additionally, it investigates the role of plaque characteristics in influencing inflammation and stenosis progression. Materials and Methods: A prospective observational study was conducted, enrolling 120 patients with carotid stenosis and 118 control subjects without stenosis. Among the patients: 100 individuals had mild carotid stenosis (<60%).20 individuals had severe carotid stenosis (>60%). All participants underwent carotid ultrasonography to assess plaque morphology and classify plaques based on echogenicity into: Echolucent (soft) plaques & Echogenic (hard) plaques. Inflammatory biomarkers, including UA and CRP, were measured, and their association with carotid stenosis severity and plaque morphology was analyzed. Results: Uric Acid (UA) Levels: Patients with mild and severe stenosis exhibited significantly higher UA levels compared to the control group (P<0.01). C-Reactive Protein (CRP) Levels: The severe stenosis group had the highest CRP levels, whereas the control group had the lowest (P<0.01). Risk Prediction: A one-unit increase in UA correlated with a 2.4-fold higher risk of developing carotid stenosis. Plaque Morphology and Inflammation: Soft (non-calcified) plaques were associated with higher CRP levels compared to hard (calcified) plaques. MPV, WBC count, and lymphocyte levels were negatively correlated with stenosis severity. Independent Predictors: Age, UA, and CRP were identified as independent predictors of carotid stenosis progression and severity. Conclusion: Our findings emphasize the critical role of inflammatory biomarkers in predicting carotid stenosis severity and plaque vulnerability. Elevated CRP and UA levels were strongly associated with increased stenosis severity and the presence of soft, unstable plaques, which have a higher risk of rupture and subsequent stroke. Elevated CRP and UA levels strongly correlated with soft plaques, suggesting their potential role in early detection and stroke risk prediction. Incorporating these biomarkers into routine clinical practice may improve carotid stenosis risk stratification and guide early intervention strategies. Keywords: Atherosclerosis, Carotid Artery Disease, Caro

Background: The COVID-19 pandemic has significantly impacted global health, revealing pronounced differences in disease outcomes across various demographic groups. By analyzing biochemical and hematological parameters, we seek to gain insights into the pathophysiological processes that underpin the increased risk faced by older individuals and men and to identify potential biomarkers that could guide clinical management and therapeutic strategies. Objective: This study aimed to investigate the effects of age and gender on COVID-19 infection severity by analyzing biochemical and hematological parameters in older men. Materials and Methods: A retrospective analysis was conducted on 422 COVID-19 patients (230 survivors, 192 non-survivors) admitted to a tertiary care center in South India between 2020 and 2021. Key parameters including D-Dimer, Creatinine, LDH, Ferritin, CRP, Platelet Count, Absolute Neutrophil Count, and Absolute Lymphocyte Count were analyzed. The study compared these parameters across age groups, genders, and between survivors and non-survivors. Results: The mean age of non-survivors (60.91±13.82 years) was significantly higher than survivors (47.55±19.75 years). Males constituted 63.5% of total cases and had a higher proportion among non-survivors (69.3%) compared to survivors (58.7%). Older survivors showed significantly higher levels of D-Dimer, Ferritin, and CRP. In non-survivors, most parameters did not differ significantly between age groups. Gender-specific differences were observed in several parameters, with males showing elevated levels of certain biomarkers in both survivor and non-survivor groups. Conclusion: The study confirms that older age and male gender are associated with increased COVID-19 severity and mortality. Specific biochemical and hematological parameters, particularly in older individuals and males, may serve as important indicators for disease progression and outcome. These findings emphasize the need for age and gender-specific approaches in COVID-19 management and prognosis. Keywords: COVID-19 severity, Age factors, Gender differences, Biochemical markers.

Background: Alcohol Dependence Syndrome has harmful consequences not only on the patient with Alcohol Dependence Syndrome but also on the family. The wife of the patient who is the key member in such a family is most vulnerable to have considerable Psychiatric disorders. The psychopathology in wives of patients with Alcohol Dependence Syndrome is a largely neglected area in psychiatric research. Aim of the study is to assess the psychological well-being of the wives of patients with Alcohol Dependence Syndrome, to evaluate the frequency and nature of Psychiatric disorders prevalent in wives of patients with Alcohol Dependence Syndrome and to study the socio demographic variables. Materials and Methods: A total of 60 wives of patients with Alcohol Dependence Syndrome were evaluated. The Psychological wellbeing was assessed using the Psychological Well Being Index Scale. The severity of psychopathology was assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. A semi-structured profoma was used to assess the Sociodemographic profile in wives of Alcohol Dependence Syndrome. Results: On screening with the Psychological Well Being Index scale it was found that 72% of the wives of patients with alcohol dependence syndrome were suffering from psychological distress. This 72% of the wives were assessed for the prevalence of Psychiatric disorders using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. The results revealed that wives were suffering considerable psychiatric disorders. 43% of them were suffering from Depression of a moderate category, 12% with mild depressive episode, and 3% with severe depressive episode. 6 % had severe Anxiety disorder 8% and had moderate Anxiety disorder. Depression is the most common diagnosis in the wives of patients with Alcohol Dependence Syndrome. Conclusion: The present study concludes that the wives of patients with Alcohol Dependence Syndrome have significant psychiatric morbidity, as most them were subjected to constant psychological distress because of the husband’s behavior due to alcoholism. To achieve good results in the De-addiction treatment, it is always beneficial to pay attention to the psychological well-being of the wives and treat the psychiatric morbidity in them effectively, because they play an important role in the De-addiction treatment. Keywords: Wives of patients with Alcohol Dependence Syndrome, Psychological wellbeing, Psychiatric morbidity.

Background: Menopause is a crucial physiological transition in women, leading to biochemical and metabolic changes, particularly affecting trace element metabolism. Iron (Fe), zinc (Zn), and selenium (Se) are essential micronutrients involved in enzymatic antioxidant defense, immune regulation, and bone metabolism. However, data on their variations in postmenopausal women, especially in the South Indian population, remains limited. Objective: This study aimed to compare serum Fe, Zn, and Se levels between premenopausal and postmenopausal women and assess their variations with advancing postmenopausal age in a South Indian population. Materials and Methods: A cross-sectional study was conducted over nine months (January–September 2024) at a tertiary care center in Hyderabad, Telangana, India. A total of 200 women, comprising 100 premenopausal (30–45 years) and 100 postmenopausal (46–75 years) participants, were recruited. Postmenopausal women were defined as those with amenorrhea for at least one year and not on hormone replacement therapy (HRT) or other menopause-related treatments for at least six months. Blood samples were collected via venipuncture, and serum Fe, Zn, and Se levels were measured using ELISA-based and spectrophotometry-based assays. Data were analyzed using Student’s t-test, with p < 0.05 considered statistically significant. Results: No statistically significant differences in Fe, Zn, and Se levels were observed between premenopausal and postmenopausal women. However, trends with advancing postmenopausal age were noted. Serum Fe levels progressively increased with age, except for a transient decline in the 56–60 years group, suggesting potential Fe accumulation in older women. Serum Zn levels significantly increased after 61 years, likely due to bone resorption and metabolic adaptations. Conversely, serum Se levels consistently declined with age, indicating a potential deficiency risk that may contribute to increased oxidative stress and associated health complications. Conclusion: Although no significant menopausal differences were observed in Fe, Zn, and Se levels, age-related fluctuations suggest the need for regular nutritional monitoring and dietary interventions. Increased Fe levels in older postmenopausal women necessitate routine Fe monitoring to prevent oxidative damage, while Zn supplementation may support bone and immune health. The declining Se levels highlight the need for increased dietary intake through Se-rich foods such as seafood and Brazil nuts to counteract oxidative stress. Encouraging physical activity can also help regulate metabolism and micronutrient utilization. These findings emphasize the importance of targeted nutritional strategies to mitigate menopause-related oxidative stress and health risks in South Indian postmenopausal women. Keywords: Menopause, Iron (Fe), Zinc (Zn), Selenium (Se), Postmenopausal Women, Oxidative Stress, Nutritional Monitoring, Micronutrient Deficiency, Bone Metabolism, Hyderabad, South Indian Population.

Background: Airway complications are more common in child subjects compared to adults following extubation. IV (intravenous) lignocaine is efficacious in preventing the response to extubation. However, existing literature data is scarce concerning the use of intracuff lignocaine in micro-cuff endotracheal tubes. Aim: The present study aimed to comparatively assess the incidence of cough post-extubation in intracuff air and intracuff lignocaine in pediatric subjects during tracheal extubation. The study was conducted in our institute within a time frame of last 2 years. Materials and Methods: The study assessed 240 subjects aged 5-12 years who were undergoing surgeries under general anesthesia. They were randomly divided into two groups of 120 subjects each where Group I subjects were given intracuff air and Group II subjects intracuff 2% lignocaine. Following general anesthesia, the airway was secured with age-appropriate microcuff endotracheal tube. This was followed by cuff inflation with air/lignocaine based on the group to reach a cuff pressure of 10cm H2O. In both groups, the incidence of hemodynamic changes, apnea, laryngospasm, desaturation, and cough was assessed following extubation. Results: The study results showed that post-extubation cough incidence was significantly higher in Group I with our inflation compared to Group II where 2% intracuff lignocaine was used with p=0.03. Two subjects from the air Group (Group I) had laryngospasm compared to no subject depicting laryngospasm from the lignocaine group. In Group I, a significant increase in the heart rate was seen at all times from 1-5 minutes following extubation from baseline, and it was significantly higher compared to the lignocaine group with p<0.05. Conclusion: The present study concludes that post-extubation cough incidence is significantly lower with the use of intracuff lignocaine compared to the use of intracuff air in child subjects undergoing elective surgeries. Keywords: cuff inflation, pediatric subjects, air inflation, laryngospasm lignocaine inflation, post-extubation.

Background: HELP (head-elevated laryngoscopy position) with the 25 degrees back up has been advocated for better visualization of the glottis, however, it is still concerning for ergonomic discomfort which hinders its global adoption. Aim: The present study was aimed at comparing the posture and comfort of anesthesiologists during tracheal intubation and laryngoscopy in a supine position with 25 25-degree backup. The study was conducted in our institute within a time frame of last 2 years. Materials and Methods: The study assessed 96 subjects with normal airways aged 18-60. The included subjects were randomly divided into two groups. Anesthesiologists performed intubation and laryngoscopy in a supine HELP position and a 25-degree backup HELP position. The anesthesiologists' posture was assessed by measuring the angles of their knee, back, elbow, wrist, and neck. A Likert scale was used to assess subjective comfort. Results: The study showed that both the positions depicted comparable comfort and posture of anesthesiologist with p=0.642 and 0.917 respectively. Also, significant improvement was seen as 25 degrees backup HELP position improved Cormack–Lehane grades with grade 1 in 68% and 31% in the supine HELP group with p=0.01. Tracheal intubation time and hemodynamic stability depicted no significant difference in the two groups with p=0.115 and 0.473 respectively. No complication was seen in either group. Conclusion: The present study concludes that the comfort and posture of anesthesiologists during tracheal intubation and laryngoscopy are similar in 25-degree backup and supine positions in subjects that have easy airways. Keywords: 25° Backup, ergonomics, intratracheal laryngoscopy, head elevated laryngoscopy position, patient positioning, posture, tracheal intubation.

Background: Pediatric intensive care units (PICUs) are pivotal in reducing morbidity and mortality among critically ill children through advanced monitoring and treatment. The implementation of various illness scoring systems like PIM 3, PRISM IV, P-MODS, and PELODS helps in assessing disease severity and predicting outcomes. However, the effectiveness of these systems varies, highlighting the need for ongoing evaluation to enhance healthcare delivery in PICUs. Aim & Objective: This study aims to evaluate the predictive performance of the PRISM IV and PIM 3 scoring systems in determining mortality rates among patients admitted to a PICU. Materials and Methods: Conducted as a prospective observational study over 12 months, the study included children aged 1 month to 18 years, excluding those with early discharge or death. The PIM 3 and PRISM IV scores were calculated upon admission. Data was recorded and analyzed using SPSS, focusing on variables such as age, gender, and score outcomes. Statistical significance was considered at p < 0.05. Results: The study revealed age-specific mortality variations, with the highest in children aged 2-5 years. Males exhibited slightly lower mortality than females. Maximum mortality was seen in the haematological cases. PRISM IV (AUC=0.866) and PIM 3 (AUC=0.818) both are good prognostic indicators and no significant difference was found between the two scores. PRISM IV is more sensitive while PIM 3 is more specific to compare the mortality. Conclusion: The findings of this study affirm the critical role of tailored scoring systems such as PRISM IV and PIM 3 in predicting the mortality in intensive care settings. Keywords: Pediatric intensive care, critically ill, PRISM IV, PIM 3.

Background: The morbidity patterns among school-going children are influenced by several factors, including socio-economic status, environmental conditions, dietary habits, hygiene practices, and access to healthcare services. Objective: The main objective of the study is to find the morbidity and health status of school going children in Lucknow District, India. Material and Methods: This cross-sectional study was conducted at rural area of Lucknow. The study was conducted among 150 school-going children, carefully selected from different age groups and grade levels. A stratified random sampling technique was used to ensure representation from diverse socio-economic backgrounds and school environments. Results: Data were collected from 150 participants, with a mean age of 9.39 ± 2.95 years, and a slightly higher proportion of females (54%) compared to males (46%). The average weight of the children was 25.3 ± 4.5 kg, and the mean height was 123.8 ± 12.1 cm. Regarding nutritional status, 66% of the children had a normal BMI, while 15% were underweight, 12% were overweight, and 7% were classified as obese. The most common health issues reported were related to dental health, with 33 children (22%) affected by teeth and gum problems, followed by eye conditions (18%) and ear, nose, and throat issues (15%). Respiratory problems were reported by 12% of the children, while gastrointestinal issues were more prevalent among females (11%) compared to males (9%). A single case of cardiovascular issues (1%) was found in a female participant. Conclusion: It is concluded that morbidity remains a significant concern among school-going children, with a high prevalence of respiratory infections, gastrointestinal diseases, and nutritional deficiencies. Key words: Health Status, School Going Children.

Background: Benign vocal cord lesions are frequently observed. Addressing these lesions is crucial for the restoration of vocal function and the enhancement of the quality of life for patients dealing with vocal cord complications. Traditional excision methods often result in unintended thermal injury to surrounding tissues. Coblation asserts that it reduces injury to surrounding tissues because of its non-thermal approach. This study aimed to evaluate the effectiveness of traditional microlaryngeal excision using Coblation for benign vocal cord lesions. Materials and Methods: Fifty-two cases with dysphonia and VLS suggestive of benign vocal cord lesion attending department of ENT were recruited. Participants were randomly divided in to two groups Group A cases were managed with conventional microlaryngoscopy excision and group B were managed with coblation. Preoperative checkup and Postoperative assessment were conducted by using videolaryngoscopic findings, GRBA score and voice handicap index by follow up at one week, one month and at three months was conducted. Results: Both study groups consistently identified polyps, with group A reporting 46.15% and group B reporting 42.30%. 34.61% of Group A and 30.76% of Group B exhibited vocal nodules. 19.23% of cases in group A and 26.92% of cases in group B exhibited cysts. The average voice handicap index levels and GRBAS scores at 1 month and 3 months were statistically significant (p<0.05). Conclusion: The overall Voice Handicap Index showed improvement after surgery in both groups, with the conventional technique yielding a more favourable response and statistically significant results. The GRBAS score additionally reinforces traditional approaches. Coblation demonstrates improved surgical ease, reduced blood loss, and shorter operation duration; nonetheless, the estimation of blood loss remains inadequate. Keywords: Benign vocal cord lesions, Coblation, Conventional microlaryngeal excision, Efficacy.

Background: Academic achievement holds significant importance in today's competitive world, shaping a child's capabilities and their future contributions to society. Educational institutions play a crucial role in shaping student outcomes, as academic success frequently mirrors the Caliber of instruction provided. This study examines the elements that affect academic performance, with a particular emphasis on scholastic backwardness in school-aged children. Focused on investigating the health, school, and home-related elements that influence academic achievement in children attending school. Materials and Methods: This cross-sectional study was conducted over 18 months among 550 students aged 11-16 years in six schools in Sangareddy region. Data were collected through questionnaires and screenings for visual and hearing problems. Statistical analysis included chi-square tests and unpaired t-tests, with significance set at p<0.05. Results: In school, 64.7% of students reported access to a library, while 65.1% indicated receiving encouragement from their teachers. In terms of technology usage, 45.5% of students reported engaging with electronic devices for 1-2 hours daily, while 4.9% exceeded 3 hours. In the home environment, 55.3% of students reported having a designated study area, whereas 40.5% indicated receiving academic support from family members. Health issues were notable, with 9% of students reporting vision impairments and 2.9% indicating hearing impairments. The findings indicated a correlation between improved academic performance and several factors: being female, having a higher socioeconomic status, maintaining a smaller family size, access to library resources, receiving encouragement from teachers, and benefiting from a supportive home environment. Conversely, low academic performance correlated with increased use of electronic devices, vision and hearing problems, parental illiteracy, and family disruptions. Conclusion: Academic performance is influenced by a complex interplay of demographic, school, home, and health-related factors. Interventions should address these areas to improve educational outcomes for children. Keywords: Academic Performance, Scholastic Backwardness, Socioeconomic Status, School Environment, Home Environment, Health Issues.

Background: Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that causes chronic sinonasal symptoms. Fungal rhinosinusitis (FRS), caused by a fungus, has become more common in recent years, lowering quality of life. Nonetheless, the pathogenesis, etiology, and successful treatment remain controversial. This study sought to determine the prevalence of fungal sinusitis in relation to chronic rhinosinusitis and sinonasal polyposis in patients undergoing functional endoscopic sinus surgery (FESS). Materials and Methods: A total of 98 people with clinically and radiologically confirmed sinusitis who had symptoms for more than three months prior to receiving FESS were included. We analyzed nasal tissue, sinus secretions, and allergy mucus samples from patients having Functional Endoscopic Sinus Surgery (FESS). The obtained specimen sample underwent culture and direct microscopy using 10% potassium hydroxide. We performed a microscopic examination using a lactophenol cotton blue mount to investigate fungal morphology. Results: Nasal obstruction was the most common clinical symptom, occurring in 30% of cases, followed by nasal secretion (16%), headache (13%), sneezing (10%), cough (9%), hyposmia (9%), fatigue (5%), allergic rhinitis (4%), and asthma (4%). Favorable cultural results were observed in 21.42% of cases. Aspergillus fumigatus was the most frequently found fungus at 14.28%, followed by A. flavus at 6.12% and Mucor at 1.02% (see Table 3). Fungal proliferation was detected in 21 cases, as demonstrated by culture and KOH mount. Conclusion: Finally, endoscopic sinus surgery and antifungal therapy are the most common treatments for fungal sinusitis. Due to the rising occurrence of paranasal sinus infections, otolaryngologists must incorporate fungal infections into their usual practice. Fungal sinusitis often manifests as unilateral paranasal sinus involvement. The maxillary sinus is the most usually affected paranasal sinus in fungal rhinosinusitis because its ostium is located lower in the middle meatus, allowing bacteria easy access. Keywords: Chronic rhinosinusitis, fungal sinusitis, Functional endoscopic sinus surgery (FESS), Aspergillus.

Background: The transition from paper to e-assessments needs to translate well across all involved stakeholders to bring about an effective change. Therefore, the present study was planned to elucidate perceptions of medical students and educators regarding e- assessments. This study was designed to assess the perceptions of medical students and medical educators regarding e- assessments in medical education Materials and Methods: Post approval from institutional research committee, the validated google form questionnaire was administered to phase I and phase II MBBS students and medical teaching faculty of AIMSR, Hyderabad. It was divided into two components of knowledge and attitude towards e assessments and Likert score was applied. A pilot study was done involving five students and five medical educators for validation. Suggestions for improvement of questionnaire were incorporated before administration. The responses were documented and analysed using percentages and mean by unpaired’ test. Results: Both the groups had a fair knowledge about e-assessments. Majority felt that it was a fast and error free assessment method but had scope for cheating. Conclusions: The e-assessments can complement overall assessments. They can test mostly knowledge-based questions and not skills. It should not be used for high stakes or summative examinations. Keywords: e-assessments, perception, medical students and educators.

Objectives: The aim of this study to know the clinical presentation of the patients with chronic hepatitis-C, prevalence of complications of chronic hepatitis C like cirrhosis (compensated or decompensated), hepatocellular carcinoma at the time of diagnosis and to know the biochemical and radiological profile of patients with chronic hepatitis C at the time of diagnosis. Materials and Methods: Descriptive observational study conducted over a period of year from 1st Dec 2019 to Nov 2020 on the patients diagnosed with HCV. Clinical, Biochemical and Radiological data was collected. Results: Maximum patients were in 21-30 years of age group and mean age was 42.31±17.25 years. Out of 342 patients, 241 patients (70.47%) were males and 101(29.53%) patients were females. Out of total 342 patients, 256 (74.85%) were non-cirrhotic, 70 (20.47%) were compensated cirrhotic and 16 (4.68%) were decompensated cirrhotic. Conclusion: In the present study, majority of patients were young, predominately affecting males, detected incidentally and non-cirrhotic. Easy accessibility and free treatment provided by Punjab Government is the reason for most patients getting an early diagnosis of HCV at the asymptomatic stage. In the present study, only 16 patients out of 342 HCV patients were found to have decompensation. This highlights the importance of detecting and initiating treatment at an early stage under Mukh Mantri Punjab Hepatitis-C Relief Fund (MMPHCRF). Keywords: Hepatitis C, Prevalence, Complications, Cirrhosis.

Background: Urinary tract infections (UTIs) are common these days. If left untreated, these infections can ascend to the upper urinary tract, involving the ureters and kidneys, potentially leading to significant renal damage. Hence; the present study was conducted for analysis of sociodemographic profile of urinary tract infections among females at a tertiary care hospital. Materials & Methods: An evaluation was conducted involving 200 female participants. The inclusion criteria for this study required that subjects present to the urology department with a primary complaint of urinary tract infection (UTI). Comprehensive demographic information and medical histories were collected from all participants. Additionally, the past medical histories of these individuals were documented separately. Urine samples were collected from each patient and subsequently sent to a central laboratory for culture analysis. Participants were categorized into upper, middle, and lower socioeconomic classes based on the Modified Kuppuswamy scale. Results: A total of 200 patients were evaluated. 34.5 percent of the subjects were of less than 30 years of age. 85.5 percent of the subjects were of rural residence. 49.5 percent of the subjects were of lower class while 44.5 percent and 6 percent of the subjects were of middle class and upper class respectively. 37.5 percent, 28.5 percent and 25 percent of the subjects had education upto postgraduation level, upto graduation level and upto secondary education respectively. 37.5 percent of the subjects were illiterate. 74.5 percent of the subjects were married. Conclusion: Urinary tract infection (UTI) refers to the invasion of microbial pathogens within the urinary system. This condition manifests through a diverse array of symptoms, which can vary from mild dysuria to severe complications such as bacteremia or sepsis. In numerous developing nations, disparities in healthcare access contribute to socioeconomic health inequalities. Individuals with lower socioeconomic status are more likely to experience a higher incidence of UTIs. Key words: Urinary Tract Infection, Sociodemographic.

Background: Dyslipidemia and poor glycemic control in type 2 Diabetes mellitus (T2DM) pose an increased the risk of cardiovascular disease (CVD). As atherogenic index of plasma (AIP) and castelli risk indices I & II were potential markers of adverse cardiovascular events, we planned a study to evaluate the relationship between these indices with HbA1c among T2DM participants. Materials and Methods: An observational cross-sectional study was conducted among the type 2 diabetes patients. The study period was between September 2023 and February 2024. HbA1c, fasting blood glucose and lipid profile parameters were analysed and Atherogenic index of plasma (AIP) and castelli risk indices I & II were calculated. Statistical Analysis: Data was analyzed using SPSS software. The descriptive variables were expressed as mean and standard deviation. Student t test was used to compare two independent groups. Correlation of Atherogenic index of plasma (AIP) and castelli risk indices I & II with HbA1c was performed by pearson’s correlation coefficient. P value of < 0.05 was considered statistically significant. Results: A total of 173 study subjects were included in the study. The mean HbA1c of the study subjects with good and poor glycemic control were 6.6±0.3% and 10.3± 2.5% respectively. Our study reported a significant higher concentration of Triglycerides, Total cholesterol (TC), Low density lipoprotein (LDL), Very low density lipoprotein (VLDL) and a low concentration of High density lipoprotein (HDL) in individuals with poor glycemic control. Correlation analysis showed a significant moderate positive correlation between HbA1c and castelli risk index I (r= 0.598); strong positive correlation between HbA1c and castelli risk index II (r= 0.616); very strong positive correlation between HbA1c and atherogenic index of plasma (r= 0.964). Conclusion: High values of atherogenic index of plasma and castelli risk indices proves an increased atherogenic risk in individuals with poor glycemic control. Keywords: Atherogenic index of plasma, Cardiovascular disease, Castelli risk index, Glycemic control, Type 2 diabetes mellitus.

Background: The common carotid arteries with their terminal branches provide the major source of arterial blood to the head, neck and brain. Among the arterial branches in the human body, the carotid bifurcation is particularly important to avoid fatal mix-up with internal carotid artery which supplies blood to the brain. A profound knowledge of variations of the common carotid artery such as its branching pattern is essential during catheter insertion to carotid arteries, carotid endarterectomy, intraarterial chemotherapy for head and neck cancers and in radical neck surgeries to avoid fatal complications. Objectives: i) To study the origin of right and left common carotid artery. ii)To study the level of termination of right and left common carotid arteries with reference to the upper border of thyroid cartilage. Iii)To study the branching pattern of right and left common carotid arteries. Iv) To observe the variations. Materials and Methods: A comprehensive cadaveric study of origin and termination of common carotid arteries was carried out in the Department of Anatomy, J.J.M. Medial College, Davangere: The study included a total number of 54 common carotid artery specimens (46 males, 8 females) in total of 27 embalmed cadavers in the Department of Anatomy, J.J.M. Medical College. Bilateral head and neck regions and thoracic regions were dissected in these cadavers following the methodology given in Cunningham’s manual for the dissection of common carotid arteries. A detailed study was done regarding the origin of right and left common carotid arteries, their length, level of origin, level of termination, pattern of termination and any additional branches apart from terminal branches. Measurements and photographs were taken after dissection. Results: In the present study, 18.5% left common carotid arteries showed variations in origin. Out of these, 11.1% originated as a branch of brachiocephalic trunk, 3.7% showed bicarotid trunk originating from arch of aorta, which divided into right and left common carotid arteries. 1.9% of common carotid artery specimens showed trifurcation with the origin of ascending pharyngeal artery at the termination. 44.4% specimens terminated above the level of upper border of thyroid cartilage. 51.9% specimens showed additional branches, superior thyroid artery being the commonest (40.7%). Conclusion: The present study, showed that left common carotid artery variations (81%) were more compared to right common carotid artery variations (59.2%). The present study adds new information regarding the frequency of occurrence of different variations of the common carotid arteries. This will be useful during head and neck surgeries, angiographies and other surgeries involving common carotid arteries and in thyroid surgeries to avoid fatal complications. Keywords: Common carotid arteries, brachiocephalic trunk, higher bifurcation, additional branches.

Background: Supraclavicular brachial plexus block (SCBPB) is a commonly used regional anesthesia technique for upper limb surgeries. The effectiveness of local anesthetics like bupivacaine can be enhanced with adjuvants such as fentanyl and magnesium sulphate (MgSO₄). However, the comparative efficacy of these agents remains under evaluation. Aim: This study aims to compare the effectiveness of fentanyl (50 µg) and MgSO₄ (150 mg) as adjuvants to 0.375% bupivacaine in SCBPB, focusing on sensory and motor blockade onset, duration, postoperative analgesia, and adverse effects. Material and Methods: A total of 90 patients undergoing upper limb surgery were randomly divided into three groups: Group B (Control): 0.375% bupivacaine + saline, Group F (Fentanyl): 0.375% bupivacaine + fentanyl (50 µg), Group M (Magnesium): 0.375% bupivacaine + MgSO₄ (150 mg). Onset and duration of sensory and motor blockade, postoperative analgesia duration, and adverse effects were recorded. Results: Fentanyl significantly reduced the onset time of sensory and motor blockade compared to the control and magnesium groups (p < 0.05). Magnesium prolonged the duration of sensory and motor blockade, as well as postoperative analgesia, compared to fentanyl and control groups (p < 0.05). Adverse effects were mild, with the fentanyl group showing a higher incidence of sedation. Conclusion: Both fentanyl and MgSO₄ improve the efficacy of SCBPB. Fentanyl provides a rapid onset of anesthesia, while MgSO₄ prolongs the duration of analgesia. MgSO₄ may be preferable for prolonged postoperative pain relief, whereas fentanyl is useful when a quicker onset is desired. Keywords: Regional anesthesia, brachial plexus block, fentanyl, magnesium sulphate, bupivacaine.

Background: Cigarette smoking is a significant public health issue, especially among adolescents, with long-term implications for both physical and mental well-being. In many regions of India, smoking among school-going adolescents has become a growing concern due to its association with various risk factors, including peer pressure, family dynamics, socio-economic status, and access to tobacco products. Aims and Objectives: The purpose of this study was to assess the prevalence of adolescent current cigarette smoking behavior and to investigate the individual and social factors, which influence them both to and not to smoke. Material and Methods: A cross-sectional study was conducted among school-going adolescents in South Rajasthan. Following the acquisition of written informed consent, participants were asked to complete a questionnaire. Results: Approximately 11.9% of adolescents were identified as current smokers. The analysis highlighted key influences on adolescent smoking behavior, including the smoking habits of parents and peers, which significantly increased the likelihood of smoking. Moreover, adolescents with tendencies toward self-harm were found to be at higher risk of smoking. In contrast, adolescents whose parents were actively engaged in supervising their leisure activities were less likely to pick up the habit, emphasizing the importance of parental involvement in prevention efforts. Conclusion: Our findings highlight the urgent need for targeted interventions to prevent adolescents from falling prey to tobacco addiction and becoming lifelong consumers of the tobacco industry. Parents play a critical role in this effort—those who smoke are encouraged to quit, as doing so benefits not only their own health but also significantly reduces the likelihood of their children adopting the habit. Key words: Cigarette, Adolescent, smoking, social environment.

Background: Vitamin D deficiency has become increasingly prevalent due to modern lifestyle changes, reduced sun exposure, and altered dietary habits. Beyond its well-established role in calcium metabolism and bone health, vitamin D has been implicated in immune regulation and respiratory health. Bronchial asthma, a chronic inflammatory airway disease characterized by airway hyperresponsiveness and reversible airflow obstruction, has been hypothesized to have a potential association with vitamin D levels. Objective: Given the immunomodulatory role of vitamin D, this study aimed to evaluate and compare serum 25-hydroxy vitamin D [25(OH)D] levels in individuals diagnosed with bronchial asthma and a healthy control group to explore potential associations between vitamin D status and pulmonary function. Materials and Methods: This case-control study included a total of 100 participants, comprising 50 patients with bronchial asthma and 50 healthy control subjects. Serum 25(OH)D levels were measured in both groups to determine vitamin D status. Additionally, a trained respiratory specialist assessed airway reversibility, peak flowmetry, and spirometry in all participants to evaluate pulmonary function. The primary outcome measures included: Forced expiratory volume in the first second (FEV1), Peak expiratory flow rate (PEFR) & Airway reversibility testing. The collected data were statistically analyzed using t-tests, one-way analysis of variance (ANOVA), and chi-square tests in Stata software (version 11) to determine the significance of differences and correlations. Results: The mean age (±SD) of participants in the asthma group and control group was 49.12 ± 16.12 years and 46.3 ± 16.80 years, respectively (P=0.388), indicating no significant difference in age distribution. Prevalence of vitamin D deficiency was notably high in both groups, affecting 70% of asthmatic patients and 64% of healthy controls, suggesting a widespread deficiency irrespective of disease status. The mean (±SD) serum 25(OH)D levels were 17.2 ± 15.1 ng/mL in the asthma group and 17.0 ± 16.4 ng/mL in the control group (P=0.660), indicating no statistically significant difference in vitamin D levels between the two groups. A positive correlation (r=0.3) was observed between vitamin D levels and FEV1, suggesting that individuals with higher serum 25(OH)D levels may have better lung function. However, this correlation was modest and warrants further investigation. Conclusion: Our findings indicate that there was no significant difference in serum vitamin D levels between patients with bronchial asthma and healthy controls. Despite no significant difference between groups, the widespread vitamin D deficiency (≥ 70%) highlights an urgent need for public health intervention. Additionally, the positive correlation between vitamin D levels and pulmonary function (FEV1) suggests that vitamin D may play a role in maintaining lung function. While this study does not establish a causal relationship between vitamin D deficiency and asthma severity, it supports the growing interest in vitamin D as a potential modifiable factor in respiratory health. Future clinical trials should evaluate vi

Background: Aim: This study aimed to evaluate and compare the efficacy of topical versus systemic corticosteroids in the treatment of chronic rhinosinusitis (CRS), focusing on symptom improvement, endoscopic findings, radiographic changes, quality of life (QoL), and adverse effects. Materials and Methods: This was a prospective, randomized, comparative clinical trial conducted at a tertiary care hospital over 12 months. A total of 110 patients with CRS, diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria, were enrolled. Patients were randomly assigned to two groups: Group A (Topical Steroid Group, n=55), which received intranasal corticosteroid spray (e.g., fluticasone or mometasone), and Group B (Systemic Steroid Group, n=55), which received oral prednisolone with saline nasal irrigation for 8 weeks. Results: Both treatment groups showed significant improvements in SNOT-22 scores, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores over the 8-week period. Group B (systemic steroids) showed slightly better improvement in SNOT-22 scores, with a p-value of 0.021 at 8 weeks. Similarly, the systemic steroid group exhibited greater improvement in endoscopic and radiographic findings. Regarding QoL, 76.36% of Group A and 81.82% of Group B patients reported improvement. The systemic steroid group, however, had a higher incidence of adverse effects, with 14.55% of patients reporting systemic side effects compared to 0% in Group A (p=0.008). Conclusion: Both topical and systemic corticosteroids are effective in managing chronic rhinosinusitis, with systemic corticosteroids offering more rapid symptom relief and superior outcomes in severe cases, particularly those with nasal polyps. However, they are associated with a higher risk of adverse effects. Topical corticosteroids provide effective long-term management with fewer side effects but may be less effective in severe cases. The choice of treatment should be based on disease severity and patient tolerance. Keywords: Chronic rhinosinusitis, corticosteroids, topical steroids, systemic steroids, quality of life, adverse effects.

Background: The altering trend observed in the age at menarche among girls is being globally addressed. Researchers from over the world continue to intrigue the relationship of anthropometric measurements to menarcheal age. The timing of menarche is influenced by genetics, social status and nutritional status (e.g., height, weight and body mass index [BMI]) and impacts future health (e.g., obesity and breast cancer). A high or low BMI can be a risk factor for menstrual disorders including irregular menstrual cycles, absence of menstruation and menstrual pain. The study aims to evaluate the correlation between BMI and the age at menarche among young females and to determine the correlation with the length of the cycle and duration of the menses. Materials and Methods: A cross-sectional study was conducted among 90 randomly selected female medical students who gave history of regular menstrual cycle. Data on age at menarche, duration of menses, length of the cycle, history of dysmenorrhea, were collected using a questionnaire. Height and weight were assessed, and BMI was calculated. Subjects were classified into four groups, underweight (<18.5), normal (18.5 - 24.99), overweight (25 - 29.99), obese (≥30) according to WHO standards. Data was analysed and presented as mean, median, and standard deviation. Statistical analysis was done using SPSS software. A P value <0.05 was considered significant. Results: The mean age of attaining menarche among the study participants was 12.50±1.432 years. Based on the BMI distribution, the majority of participants had a normal BMI category of 45 (50%) with mean BMI of 22.29±5.019. The mean BMI increased while the mean age of attaining menarche decreased (p<0.001). The menstrual cycle length was significantly prolonged while the duration of cycle was significantly reduced in overweight and obese groups in comparison with normal BMI class (p<0.05). Conclusion: The present study suggests that females with higher BMI had an early menarche. The study also reveals that as BMI increases, females tend to have a longer menstrual cycle with shorter duration of menses. Consequently, adolescent girls have to be given healthy and balanced nutrition, which leads to maintenance of their normal BMI and regulates their menstrual cycle. Keywords: Body Mass Index, Menarche, Menstrual Cycle, Correlation.

Background: Night shift workers are required to stay awake when their circadian rhythm is preparing them for sleep, and to sleep when it is preparing them for wakefulness. Disruptions to the circadian rhythm due to sleep deprivation can lead to deleterious effects on normal neurophysiological functioning. Abnormalities in visual evoked potentials (VEP) can reflect subclinical involvement of visual pathway functioning. Materials and Methods: Sixty healthy female shift workers at SMIMS, aged 20-40 years, were divided into two groups: Group I - Day shift workers and Group II - Night shift workers. The amplitude and latency of the P100 wave of VEP were recorded. Results were expressed as Mean±SD. Statistical significance between study groups was determined using SPSS version 16.0 software, applying the unpaired student 't' test. Results: A statistically significant increase in the latency of the P100 wave was observed in female night shift workers compared to day shift workers. No significant reduction was observed in the amplitude of the P100 wave between the groups. Conclusion: The study concluded that night shifts significantly affect sleep patterns, which can lead to the development of various diseases. Keywords: Sleep, Night shifts, Visual evoked potentials, P100 wave, Visual pathway, Insomnia.

Background: Epilepsy represents a prevalent neurological condition, exhibiting a lifetime prevalence of 1% among children. The occurrence of emotional and behavioral issues, such as attention deficit/hyperactivity disorder, autistic spectrum disorders, aggression, and atypical social behavior, is notably higher in children with epilepsy, significantly impacting their quality of life. This study was undertaken to evaluate the prevalence of emotional and behavioral issues among children with epilepsy who are receiving care at a tertiary hospital in Sangareddy. Materials and Methods: Ninety-four children with history of two or more unprovoked generalized or focal seizures with abnormal EEG findings between 6 to 12 years of age were included. Child Behaviour Checklist (CBCL) scoring formats were used to assess the behavioural problems in children. Results: Behavioral changes were observed in 53.06% of boys and 48.90% of girls and the cumulative behavioral alterations was seen in 51.06%. The observed behavioral changes demonstrate a significant correlation with anti-seizure therapy and seizure control, EEG findings and CT/MRI findings and with seizure type. The common behavioural problem observed in 18.08% of participants was anxiety and depression, followed by internalization in 18.08%, externalization in 14.90%, rule breaking in 10.63%, aggression in 6.38%, strange social behavior in 5.31%, physical problems in 5.31%, sleep problems in 4.25%, and withdrawal in 2.12%. Conclusion: Children with epilepsy are more likely to exhibit behavioral abnormalities if their seizures are uncontrolled, last for a long time, or are of a certain kind. This emphasizes the need of screening for these issues in children receiving epilepsy therapy in order to identify them early and then manage them to enhance the result. Keywords: Epilepsy, children, Behavioral problems, Child Behaviour Checklist (CBCL) scoring.

Background: The ability of the conduction of the motor and sensory nerves were evaluatedby Nerve conduction studies. The aim of the study is to To establish the normative data for conduction velocity of motor and sensory division of median nerve in population of Trichy, South India. Materials and Methods: This Prospective cross sectional study was conducted among healthy individuals in a Tertiary care hospital, Trichy for a period of 18 months. The study participants fulfilling the inclusion and the exclusion criteria were included in the study throughout the study period. The final attained sample 200. The demographic data like name, age of the patient, were analysed. Anthropometric measurements & Nerve conduction study were performed at the clinical physiology laboratory in the hospital. The data collected will be entered in the MS Excel and statistical analysis done through SPSS 23.P value <0.05 is considered as statistically significant. Results: The mean age of the study group in males was found to be 28.10 ± 8.77 years,in females was found to be 26.79 ± 6.79 years. The left hand median motor latency in males were found to be more than females and it was found to be 2.68 ± 0.41ms. This value was statistically significant ( p value < 0.05 ). The right and left hand median sensory latency was found to be more in males compared to females and it was found to be statistically significant ( p value < 0.05). Conclusion: The average motor and sensory nerve parameters are almost same with the other existing studies. Keywords: Nerve conduction study, sensory nerve, motor nerve, latency, velocity, CAMP, SNAP.

Background: Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths among women worldwide. Anaplastic lymphoma kinase is a gene belonging to the tyrosine kinase family, associated with various cancers, including triple negative breast cancer. Materials and Methods: A total of 75 cases with triple negative breast cancer were included in this retrospective study. The study was conducted in the Department of Pathology, Malla Reddy Medical College for Women over a period of 2 years, i.e. from January 2022 to January 2024. Results: The mean age of the study population was 53.6 years. Invasive ductal carcinoma was the most common diagnosis. 30.6% of the study population showed ALK expression. Conclusion: Triple negative breast cancer is associated with poor prognosis. Determining the levels of ALK immunoexpression will aid in the initiation of treatment with ALK inhibitors in patients with triple negative breast cancer. Keywords: triple negative breast cancer, anaplastic lymphoma kinase, immunoexpression.

Background: Gastric cancer is one of the leading causes of cancer related deaths. Immunoexpression of Bcl-2 and Ki67 levels are used to assess the prognosis and aggressiveness of tumor. Materials and Methods: A total of 50 cases with gastric cancer who were operated in Mallareddy medical college for women over a period of 2 years were included. The immunoexpression levels of Bcl-2 and Ki67 were assessed. Results: Bcl-2 and Ki67 levels were higher in higher grades of gastric adenocarcinoma. Conclusion: Bcl-2 and Ki67 owing to its anti-apoptotic and pro-proliferative action respectively, are indicators of tumor aggressiveness. Keywords: Bcl-2, Ki67, Gastric adenocarcinoma, Immunotyping.

Background: Chronic kidney disease (CKD) is an increasingly prevalent public health challenge, primarily due to its progressive nature and adverse clinical outcomes, including end-stage renal disease (ESRD), cardiovascular complications, and increased mortality. The most common underlying causes of CKD include diabetes mellitus (DM) and hypertension (HTN), which contribute to glomerular damage and progressive decline in renal function. Early detection and accurate assessment of renal function are crucial for timely intervention and slowing disease progression. Traditionally, serum creatinine (SCr) has been the most widely used biomarker for assessing kidney function. However, it has limitations, including its dependence on muscle mass, age, and diet, which may result in delayed detection of renal impairment, particularly in early CKD stages. Among newer biomarkers, serum cystatin C (SCysC) has gained attention as a more sensitive and reliable marker for detecting early renal dysfunction. Unlike creatinine, cystatin C is freely filtered by the glomerulus, produced at a constant rate by all nucleated cells, and is independent of muscle mass and dietary protein intake, making it a promising marker for renal function assessment. Objectives: The primary aim of this study was to evaluate and compare the efficacy of serum cystatin C (SCysC) and serum creatinine (SCr) in detecting renal dysfunction in patients with CKD and apparently healthy controls. Additionally, the study sought to assess the correlation of both markers with estimated glomerular filtration rate (eGFR) to determine their diagnostic utility. Materials and Methods: This case-control study was conducted at a tertiary care hospital and included 120 clinically diagnosed CKD patients and 40 healthy controls. The study population was categorized based on CKD stages according to eGFR values derived from the CKD-Epidemiology Collaboration (CKD-EPI) equation. Serum creatinine (SCr) levels were measured using the modified Jaffe’s method, a widely used colorimetric assay for creatinine estimation. Serum cystatin C (SCysC) levels were estimated using the particle-enhanced immunoturbidimetric method, a highly sensitive and specific immunoassay. Estimated glomerular filtration rate (eGFR) was calculated for all participants using the CKD-EPI formula, which is considered a reliable tool for assessing kidney function. Statistical analysis was performed using the Mann-Whitney U test for comparing SCr and SCysC levels between cases and controls. Pearson’s correlation test was used to analyze the relationship between renal function markers (SCr and SCysC) and eGFR. A P-value of <0.05 was considered statistically significant. Results: SCysC and SCr levels were significantly higher in CKD patients than in controls (P < 0.001). In early-stage CKD (Stages 1 and 2), SCr levels were within the normal range, while SCysC was elevated in 96.8% of cases, indicating higher sensitivity of SCysC for detecting early kidney dysfunction. Among Stage 3 CKD patients, SCr was elevated in 79.3%, whereas SCysC was elevated in 100%. In advanced CKD (Stages 4 and 5), both markers were significantly elevated in all cases. SC

Background: In modern India, snakebite is still an underappreciated cause of accidental mortality, especially in rural areas where people are more likely to fall prey to quacks utilizing traditional healing practices than to seek treatment from modern medical professionals. Treatment outcomes would be more promising if the patient was swiftly recognized and treated based on many clinical variables, such as manner of presentation, timing of medical intervention, species recognition, and analysis of a series of consistently identified bites. The objective is to study the clinical profile of the patients of snake bites. Materials and Methods: This cross sectional observational study was conducted on all suspected cases with signs and symptoms suggestive of venomous snake bite admitted in medicine department to analyze the epidemiology of snake bite envenomation cases in this part of state and to study the clinical profile of snake bite envenomation. Results: The highest incidence of snake bite was seen in the age group of 21-30 years, mean age was 37.80 years. The Majority 59(59%) were males and 41(41%) were females. Labourers had an incidence 23% and agricultural farmers had 20% incidence. Incidence of snake-bite in plain area was high (66%), while only 33% patients were from hilly area. Bites were more common on distal parts of body. Higher incidence seen in lower extremities (64%). Identification of snake was difficult for most of the patients (45%).37% were vipers and 11% cobra. There was a predominance of non-toxic bites (55%) followed by neurotoxic bites (27%) and vasculotoxic bites (18%).Fang mark (85%) was most common local sign followed by the immediate pain at the bite site (84%). Conclusions: One of the most frequent risks is snakebite, particularly in rural areas where agriculture is the primary industry. The transmission of knowledge about easily accessible, efficient treatment modalities could significantly reduce the morbidity and death linked to treatment by quacks or traditional snake bite healers, as snake bites are largely a rural employment danger. Key-words: Snake bites, venomous, vasculotoxic, neuroparalytic, non-poisonous.

Background: Cardiovascular diseases are the leading cause of mortality globally, accounting for one-third of all deaths. Coronary artery variations can complicate procedures like coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). This study aims to evaluate LCA variations, including branching patterns, proximal lengths, angles of division, and dominance, in patients with acute coronary syndromes (ACS). Material and Methods: This cross-sectional study was conducted at GSL Medical College, East Godavari District, Andhra Pradesh, over one year (January–December 2014). A total of 234 coronary angiograms were analyzed. Patients aged 40–60 years presenting with ACS (Acute coronary syndrome) were included, while those with valvular heart disease, severe vessel tortuosity, or previous CABG were excluded. Parameters studied included branching patterns, angles of division, proximal lengths of LCA branches, and coronary dominance. Data were analyzed using SPSS, with p < 0.05 considered statistically significant. Results: Branching Patterns: Bifurcation (82.9%) was more common than trifurcation (17%). Angles of Division: The mean angle of division between AIA (anterior interosseous artery) and CX (The circumflex artery) in bifurcation patterns was 156.4° ± 16.4°. Angles in bifurcation patterns were significantly larger than in trifurcation (p < 0.0001). No significant differences were found between male and female angles. Proximal Lengths: The average lengths of LCA, AIA, RM, and CX were 10 mm, 25 mm, 32 mm, and 19 mm, respectively. No correlation was found between proximal artery lengths and branching patterns due to limited quadrification cases. Conclusion: This study highlights critical anatomical variations in LCA branching patterns, angles, and lengths. Awareness of these variations is essential for minimizing procedural complications in CABG and PCI, enhancing outcomes in patients with ACS. Keywords: Coronary artery variations, Left Coronary Artery, Angiography, Acute Coronary Syndrome, Bifurcation, Trifurcation, Coronary dominance.

Background: In the last three decades, laparoscopic adrenalectomy has become the gold standard for surgery for adrenal gland diseases. Majority of adrenalectomies are currently performed using robotic & laparoscopic approaches. Surgery for adrenal gland truly reaps the benefits of minimally invasive techniques because of location & anatomy. This study aims to demonstrate single centre experience with laparoscopic transperitoneal adrenalectomies. Materials and Methods: Pre-operative, intra-operative, post-operative data of 10 patients who underwent laparoscopic adrenalectomies from March 2023 to December 2024 were collected & analyzed retrospectively. Results: A total of 10 patients underwent laparoscopic adrenalectomy during this period. Statistical analysis was performed using SPSS version 26. Mean age of patients was 41.7 years, surgical approach was laparoscopic transperitoneal, one case required conversion to open, mean tumor size was 6.15cm, most common histology was adrenocortical adenoma, mean duration of hospital stay was 4.1 days. There were no intra operative &post-operative complications. Conclusion: Safe outcomes are achievable with laparoscopic adrenalectomy in low volume centre with trained and dedicated surgeons, anesthesiologists and endocrinologists. Keywords: Laparoscopic adrenalectomy(LA), conversion to open, post-operative complications.

Background: The liver is the largest wedge shaped abdominal viscera. It weighs approximately 2% of body weight in adult. It is anatomically divided into right and left lobes. The knowledge of normal and variant Anatomy of liver is important during radiological investigation and surgery. Variations in the liver morphology can be either congenital or acquired. Materials and Methods: This Descriptive study was conducted in 40 adult human cadaveric liver obtained from routine dissection done by under graduate and post graduate students in the Department of Anatomy, Government T. D. Medical College, Alappuzha. Intact human cadaveric liver with no obvious damage were studied and liver with any damage were excluded. Results: Based on Netter’s classification, type1 (normal) was observed in 11 (27.5%) specimens, type 2 in 7 (17.5%) and type 4 in 9 (22.5%) liver specimens. Type 5 (reidel’s lobe) was observed in only one (2.5%) specimen. Type 6 was seen in 7 (17.5%) specimens and type 7 in 16 (40%) specimens. No liver with complete atrophy of the left lobe was observed. Accessory fissures were observed in 26 right lobes (65%). Accessory lobes of right lobe were noticed in 3 specimens. Diaphragmatic grooves (40%) and deep renal impressions (17.5%) were seen as the features of right lobe. Accessory fissures and accessory lobes of left lobe were noticed in 15% and 5% respectively. Elongated (22.5%) and hypoplastic left lobes (17.5%) were also noticed. In the present study, mean transverse diameter of right and left lobes were 8.22±1.08cm and 7.43±1.58cm respectively. Mean vertical diameter of right lobe was 12.29±2.17cm and that of left lobe was 12.14±3.28cm. Conclusion: The knowledge of normal and variant Anatomy of liver is important during radiological investigation and surgery. Variations in the liver morphology can be either congenital or acquired. Awareness of these variations would help both the surgeons and radiologists to avoid misdiagnosis of cases and unnecessary surgical complications. This study also helps to enlighten the knowledge of anatomists to facilitate teaching. Keywords: Variations of liver, Right lobe, Left lobe, Accessory fissures, Accessory lobes, Riedel’s lobe.

Introduction: The immediate postpartum period is an ideal time to guide women towards appropriate family planning methods in order to prevent unintended pregnancy[1]. PPIUCD is a long-lasting method of contraception, convenient, safe, effective, reversible, coitus user friendly option available to the postpartum mothers[2]. Despite all these benefits, the acceptance rate and utilization of immediate PPIUCD have been found to be very low. The aim of the present study was to find out the rate of utilization of post-partum intra uterine contraceptive device and factors associated with the acceptance and refusal among women delivering at a tertiary care hospital located in the district of Anand in Central Gujarat. Materials and Methods: This was a prospective analytical study conducted in the Department of Obstetrics and Gynaecology, Pramukh Swamy Medical college in Karamsad, Gujarat, India between Oct 2020 to June 2021. The study included 350 pregnant women, full filling the WHO medical eligibility criteria, who were admitted to the labour room of our hospital. All women enrolled in the study were interviewed using a pre-designed questionnaire. Results: In our study, majority of cases were primipara. Out of 350 participants, only 19 (5.4%) have accepted PPIUCD. The univariate analysis shows that parity has a significant correlation with the acceptance of PPIUCD but the level of education did not show a significant correlation. The main reason for acceptance of PPIUCD was given as spacing of pregnancy. Most common reason for refusal was denial by husband (33.53%). Conclusion: The study highlights the impact of husband and parents in law in the acceptance of PPIUCD. Public health programmes for PPIUCD should target not only the postpartum female but also her husband and family. Counselling during antenatal visits may help to increase the uptake of PPIUCD. Keywords: PPIUCD, tertiary care hospital Central Gujarat, factors affecting acceptance and refusal of PPIUCD.

Background: Tonsillectomy is one of the most common operations in general otolaryngology and produces severe pain on the first postoperative day. This study assesses the efficacy of percutaneous peristyloid glossopharyngeal block by ultrasound guided technique for acute post tonsillectomy pain. Materials and Methods: This longitudinal comparative study, after approval of the research protocol by the hospital ethics committee and obtaining personal informed consent, a total of 60 adult patients of either sex aged between 18 and 60 years of American Society of Anesthesiologists (ASA)grade 1 and 2 who were undergoing elective tonsillectomy surgeries and receiving general anesthesia were selected. After surgery they received bilateral GNB with 0.25% bupivacaine (group G), or no intervention (Group C) using ultrasound guided technique. The outcomes were time to first analgesic requirement, pain at rest and during swallowing. Results: The intensity of pain was assessed at rest after the interval of 1 hour, 3 hours, 6 hours, 9 hours and 12 hours following post operative (after tonsillectomy operation) administration of glossopharyngeal nerve (GPN) block, This difference in the intensity of post tonsillectomy pain between the control group and GPN block group at rest was found to be statistically significant (p< 0.001). For treating the post operative pain, this difference in the requirement of number of intravenous paracetamol doses (given as rescue analgesic on patient demand) between the control group and GPN block group was found to statistically significant (p< 0.001). Therefore the post operative administration of glossopharyngeal nerve (GPN) block is useful in reducing the post operative pain following tonsillectomy operation. Conclusion: The post-operative ultrasound guided administration of glossopharyngeal nerve (GPN) block via the styloid process is helpful and safe method in reducing the post operative pain following tonsillectomy operation. Key words: glossopharyngeal nerve block, ultrasound guided, tonsillectomy, styloid process.

Background: The problem of Malnutrition, defined as a pathological state resulting from an absolute or relative deficiency or excess of one or more essential nutrients, remains a public health problem since many years. Out of the four categories of malnutrition, the over nutrition is also rising on an alarming stage. In our country Chandigarh is fourth richest state/Union Territory (UT) amongst Indian states/UTs as classified by economic status. The aim of the study, therefore, was to find out the prevalence of overnutrition (overweight and obesity) over the years in the form of trends amongst the families of medical undergraduate students at GMCH- 32 Chandigarh. Materials and Methods: This cross-sectional study was conducted over a year at Adichunchanagiri The practical note-book (manual) in which students are supposed to write the details of their own families are frequently checked by demonstrators in the field itself. The nutritional status was measured by calculating body mass index (BMI). It was compared with the data from previous records and data from national family health survey (NFHS) -5. From a sub sample the average per capita income of the families was calculated. Results: Across three block years of 2000-2004(I), 2005-2008(II) and 2015-2019(III), overweight among males first decreased from 32.4% in block year I to 28% in block year II and then increased to 37.7% in block year III. In case of females, however, the overweight increased continuously through all three block years, from 24.4% to 30.1% to 33.3%. The reverse was true for obesity. Obesity increased constantly for all three block years in males but in case of females there was slight decrease from block I to II. The overnutrition (overweight + obesity), for males decreased slightly from 35% in the block year 2000-2004 to 34% in block year 2005-2008 and than increased sharply to 45.1% in the block year 2015-2019. The similar figures for females were 30.7%, 36% and 43.9% for the same block years respectively. However, there was only little increase in block years 2000-2004 to 2005-2008. Conclusion: Thus, we see that there has been an eventual increase in overweight, obesity and overnutrition among both genders over the years. Keywords: Nutritional status, overweight, obesity, Trends, Families, Undergraduates.

Background: It was reported that BMI is associated with the cortical volume in the prefrontal cortex. Aims and Objectives: The present study was undertaken to compare the cognitive functions in normal and obese school children. Materials and Methods: A total of 40 male and female obese children and 40 age and gender matched healthy children after obtaining the assent from the parents and guardians. Spatial and verbal memory test was administered as mentioned in the literature. Recording of auditory and visual reaction time was performed using the Reaction time apparatus manufactured by the Anand agencies, Pune. Results: There was a significant decrease in the spatial memory scores in the obese children when compared with the healthy children. Verbal memory scores also significantly less in obese children when compared to healthy children. Visual reaction time for red and green light was significantly longer in obese children compared to the healthy children. Auditory reaction time for high pitch was significantly longer in obese children compared to healthy children. Conclusion: The study results support that the cognitive functions are comparatively decreased in the obese children. Hence, the cognitive functions have to be considered in the management of the obesity. Further detailed studies are required in this area. Keywords: Reaction time, Cognition, Obesity, Memory, School children.

Background: Air pollution has been linked to respiratory diseases, but its effects on oxygenation and acid-base balance in patients with chronic obstructive pulmonary disease (COPD) and asthma remain unclear. Short-term and long-term exposure to air pollutants, such as particulate matter (PM2.5) and nitrogen dioxide (NO₂), may have different physiological impacts on these patients. This study evaluates the comparative effects of short-term vs. long-term exposure to air pollution on arterial blood gas (ABG) parameters, including oxygenation (PaO₂, SaO₂) and acid-base balance (pH, PaCO₂, HCO₃⁻). Materials and Methods: A total of 150 patients (75 COPD and 75 asthma) were recruited and divided into short-term (exposure <1 month) and long-term (exposure >1 year) air pollution exposure groups. Air quality data were obtained from local monitoring stations, and patient exposure was estimated based on residential proximity to pollution sources. ABG analysis was performed to assess oxygenation and acid-base parameters. Statistical analysis was conducted using independent t-tests and ANOVA to compare differences between groups. Results: Patients with long-term air pollution exposure exhibited significantly lower PaO₂ (65.4 ± 4.2 mmHg) and SaO₂ (89.3 ± 2.1%) compared to short-term exposure (PaO₂: 78.6 ± 3.8 mmHg, SaO₂: 94.1 ± 1.8%; p < 0.05). Acid-base imbalance was more pronounced in the long-term group, with lower pH (7.33 ± 0.05) and higher PaCO₂ (50.2 ± 3.7 mmHg) compared to the short-term group (pH: 7.40 ± 0.03, PaCO₂: 44.8 ± 3.2 mmHg; p < 0.05). HCO₃⁻ levels were also significantly higher in long-term exposure cases, indicating a compensatory metabolic response. Conclusion: Long-term exposure to air pollution has a more detrimental impact on oxygenation and acid-base balance in COPD and asthma patients compared to short-term exposure. The findings highlight the need for preventive strategies and pollution control measures to mitigate respiratory complications in vulnerable populations. Keywords: Air pollution, COPD, asthma, oxygenation, acid-base balance, arterial blood gas, particulate matter, nitrogen dioxide.

Background: Self-medication is a prevalent practice worldwide, contributing to improper medication use, delayed diagnosis, and antimicrobial resistance. This study aims to assess the prevalence, patterns, and influencing factors of self-medication in urban Bareilly, India. Materials and Methods: A community-based cross-sectional study was conducted in the urban service area of Rohilkhand Medical College and Hospital. A total of 389 households were surveyed using systematic random sampling, with one adult participant per household. Data were collected through face-to-face interviews using a structured questionnaire. Results: The prevalence of self-medication was 80% among respondents. The practice was most common among individuals aged 18–25 years and those with higher education levels. The primary reasons cited were the perception that ailments were minor (77%) and ease of access to medications. The most common sources of medication information were family and friends (44%), followed by pharmacists (33%). Headaches (70.4%) and fever (66.56%) were the most frequent symptoms treated. Analgesics and antipyretics were the most commonly used drugs (59%). Additionally, 12% of self-medicating participants reported experiencing adverse effects. Conclusion: Self-medication is highly prevalent in urban Bareilly, posing significant public health concerns. While it provides quick relief for minor ailments, it increases the risk of inappropriate drug use and adverse reactions. Regulatory oversight, public awareness, and health education campaigns are necessary to promote safer medication practices. Keywords: Self-medication, prevalence, urban health, medication misuse, public health, Bareilly, India.

Background: Soft tissue tumors constitute a large and heterogeneous group of neoplasms. Clinically soft tissue tumors range from benign, self limited lesions to intermediate grade to highly Aggressive. Most of soft tissue tumors are benign, while few of them are malignant in nature. Aims and Objectives: To assess the histopathological pattern of various soft-tissue tumors. Materials and Methods: Prospective study was conducted for a period of 2 years in the Department of Pathology, Mamata academy of medical sciences, Bachupally, Hyderabad, Telangana. A total of 165 samples from patients with soft-tissue tumors, including both benign and malignant tumors were analyzed and classified primarily as per the WHO classification of soft-tissue tumors. Results: Most of the cases 41-50years age group 55(33.3%) Adipocytic tumors were most common constitutung 57.5% and next common was vascular tumors consituting 15,1% tumors. Most common benign soft tissue tumor reported was Lipoma (57.5%) followed by Hemangioma (25.1%). Conclusion: Overall soft-tissue tumors are a rare category of tumors with benign tumors vastly outnumbering malignant tumors. . Proper examination of the gross specimen and careful sampling of the tumor is required for the correct diagnosis. Hematoxylin- and Eosin-stained sections remain very important for the diagnosis of soft-tissue tumors along with immunohistochemistry and molecular markers. Keywords: Soft-tissue; Immunohistochemistry.

Background: There is marked increase in the prevalence of diabetes not only in India but around the world. Both glucotoxicity and lipotoxicity is believed to play a major role in the pathophysiology of diabetes progression and development of complication. Dyslipidaemia has been recognized as a major cardiovascular risk factor. The objective of the study was to study prevalence and pattern of dyslipidaemia in type 2 diabetes mellitus patients attending outpatient department of Non-Communicable Disease clinic of civil hospital, Silchar, Assam. Materials and Methods: This was a cross-sectional study carried out among 100 Type 2 diabetic mellitus patients attending outpatient department of Non-Communicable Disease clinic of civil hospital, Silchar, Assam. Study population included known as well as newly diagnosed type 2 diabetic patients more than 20 years of age. Results: The prevalence of dyslipidaemia among type 2 diabetic individuals was 90% among males and 87.5% among females. Proportion of mixed dyslipidaemia, combined dyslipidaemia and isolated single parameter dyslipidaemia among males were 16.7%, 48.3% and 25% respectively. Among females the figure for the same stands out to be 20%, 45% and 22.5% respectively. The most common combined dyslipidaemia among males was high TG and low HDL (26.7%) whereas in females it was high TG and high LDL affecting 20% of females. Low HDL with 13.3% was the common single parameter dyslipidaemia in males and in females it was high LDL contributing to 12.5%. Conclusion: The high prevalence of dyslipidaemia among type 2 diabetes mellitus study subjects remarks the need for early screening with complete lipid profile and not just individual lipid fraction. For better treatment outcome the use of anti-diabetic drug and lipid lowering drug should go hand-in-hand. Keywords: Type 2 Diabetes Mellitus, Dyslipidaemia, Prevalence.

Background: To compare the safety and efficacy of ranibizumab and brolucizumab injections in both comparision groups diagnosed with neovascular age related macular degeneration (nAMD) at the end of 6 months from the onset of treatment. Materials and Methods: A prospective cross sectional comparative study in patients attending retina out patient department ophthalmology 60 patients who meet the study criteria during the period of 18 months from the time of approval. Age >=50 in Active subfoveal choroidal neovascularization. All patients completed 6 months follow up. Therefore 60 eyes of 60 patients with a follow up period of 6 months were included in the analysis. 3 doses of injection given at interval of 1 month Results: Our study has more number of males than females in ranibizumab group (group 1) and comparatively mild higher side on males than females in brolucizumab (group 2). In group 1 mean age was in years 62.35±7.87years In group 2 mean age was in years 58±5.1 years. In group 1 majority of patients are of age group 50-60 years In group 2 majority of patients are of age group 50-60 years. Best corrected visual acuity in who received Ranibizumab injection improved from baseline to till end of 6 months is significant. (p<0.0001) In AMD cases treated with Ranibizumab the foveal thickness improved from baseline to till end of 6 months is significant. Conclusion: Intravitreal Ranibizumab and brolucizumab have almost similar visual outcome .Intravitreal brolucizumab is more effective in reducing foveal thickness showing better anatomical result compared with ranibizumab. Keywords: Neovascular Age Related Macular Degeneration (nAMD), Ranibizumab, Brolicizumab.

Background: Aims: To study the effect of dexmedetomidine in attenuating the arterial pressure increase due to CO2 pneumoperitoneum in patients posted for elective laparoscopic cholecystectomy undergoing general anaesthesia. Materials and Methods: 62 Prospective observational study in 60 patients of age 18-60 years ASA 1 & 2 of both sex undergoing elective laparoscopic cholecystectomy under general anaesthesia are selected. Group A: 30 patients receiving normal saline IV infusion 10 minutes before pneumoperitoneum. Group B: 30 patients receiving IV dexmedetomidine (0.5μ/kg IV bolus followed by IV infusion of 0.5 μ /kg/hr) 10 minutes before pneumoperitoneum. Results: We observed, that the systolic, diastolic and mean arterial pressure increased abruptly after induction of pneumoperitoneum and this response sustained during the entire pneumoperitoneum period in the control group (Group A). Dexmedetomidine group (group B) hemodynamic responses like heart rate and blood pressure levels to the induction of pneumoperitoneum were effectively blunted when compared to the control group (Group A). p Value <0.05 significant in HR, SBP, DBP, MAP during the entire duration of pneumoperitoneum and post extubation. Conclusion: We conclude that intravenous administration of dexmedetomidine as an adjunct before induction of CO2 pneumoperitoneum in laparoscopic cholecyctectomy effectively attenuates the arterial pressure increase arising due to pneumoperitoneal response by suppressing central sympathetic outflow. Keywords: End Tidal Carbondioxide(Pet CO2), Dexmedetomidine, Laparoscopic cholecyctectomy.

Background: Medical education necessitates interactive learning strategies to ensure effective comprehension of complex subjects. Peer-Assisted Learning (PAL), wherein students learn from each other under faculty supervision, has gained recognition in medical education. It enhances active participation, knowledge retention, and critical thinking. Aim: To assess the impact of Peer-Assisted Learning (PAL) on knowledge retention, engagement, and confidence levels of first-year MBBS students in Department of Biochemistry. Objectives: 1. Compare PAL with traditional lecture-based learning. 2. Analyze students’ conceptual understanding before and after PAL implementation. 3. Evaluate student engagement, motivation, and satisfaction with PAL. 4. Assess the role of PAL in enhancing communication and teamwork skills. 5. Determine faculty perceptions regarding PAL's feasibility in medical education. Materials and Methods: A quasi-experimental study was conducted on 200 first-year MBBS students of year 2023-24 at Dr. VMGMC, Solapur. The students were randomly divided into two groups: 1. Group A (PAL Group): 100 students engaged in peer-assisted learning. 2. Group B (Control Group): 100 students received traditional lectures. Assessment tools included: 1. Pre-test & Post-test for knowledge retention. 2. Student Feedback Questionnaire for engagement analysis. 3. Faculty Observations for teaching effectiveness. 4. Statistical Analysis using paired t-tests and Chi-square tests. Results: The PAL group exhibited a significant improvement in knowledge retention and student engagement. The post-test scores showed a higher mean improvement in the PAL group than in the control group (p<0.001). Conclusion: PAL enhances learning, confidence, and communication skills in medical students. The findings suggest PAL should be integrated into Biochemistry education as a complementary approach. Keywords: Peer-Assisted Learning (PAL), Medical education.

Scrofuloderma, a cutaneous manifestation of tuberculosis, is an uncommon but clinically significant presentation of mycobacterial disease. It usually results from the direct extension of Mycobacterium tuberculosis from an underlying infected lymph node or osseous structure to the overlying skin. The condition is characterized by chronic granulomatous inflammation, leading to skin abscesses, ulcers, and fistulae. Due to its nonspecific clinical features, scrofuloderma often poses significant diagnostic challenges, as it can mimic other dermatological or infectious conditions. This case report outlines the clinical progression of a patient diagnosed with scrofuloderma in a tertiary care hospital. It highlights the diagnostic challenges faced during evaluation and describes the comprehensive use of investigative tools to confirm the diagnosis. Furthermore, this report discusses the management plan, focusing on the efficacy of a tailored antitubercular treatment regimen. Keywords: Chronic granulomatous inflammation, scrofuloderma, cutaneous manifestation, tuberculosis.

Background: The building construction sector is one of the main job providing sector in India which mainly relies on unorganised labour. Thiruvananthapuram district in the state of Kerala is also no different from that. The dust generated at the work sites impairs their health. The health of the workers and the productivity in job is also closely related. Aim: To assess the pulmonary function test of unorganised building construction workers in Nedumangad thaluk of Thiruvananthapuram district. Materials and Methods: A descriptive study was conducted by interviewing the building construction workers. The collected data was filled in a questionnaire at the construction sites. They were asked to come to a nearby Medical college within one month where their pulmonary function test was conducted and recorded. Results: Out of 79 workers who did PFT, 60 persons had normal PFT while 19 had abnormal PFT. Among that 14 had obstructive pattern, 2 had restrictive and 3 had mixed type. Positive association was found between abnormal PFT results with non-usage of protective mechanism and smoking. Conclusion: Smoking and non-usage of protective mechanism can cause abnormal lung function in construction workers. Keywords: Building construction workers, unorganised sector, pulmonary function test.

Background: Effective teaching methods in medical education are essential for improving skill acquisition, retention and engagement. Traditional "see one, do one" approaches may overwhelm students leading to suboptimal learning and recall. Peyton’s Four-Step Approach (PFSA) offers a structured alternative, breaking procedures into phases of demonstration, deconstruction, comprehension and performance. Its application in preclinical physiology practicals remains underexplored. This study evaluates the effectiveness of Stepwise Teaching versus Traditional Teaching in physiology practicals focusing on clinical examinations and hematology skills among first-year MBBS students. Materials and Methods: A quasi-experimental study was conducted with 150 students from two medical colleges distributed into Stepwise (n=75) and Traditional (n=75) groups. Pre- & post-tests assessed knowledge gain, while OSPE measured practical performance. Likert-scale surveys evaluated student engagement and satisfaction. Data were analyzed using SPSS 26 employing independent,paired t-tests and Mann-Whitney U tests, with p<0.05 as significant. Results: The Stepwise group outperformed the Traditional group in post-test scores (79.09 ± 7.07 vs 69.90 ± 7.23, p<0.001, d=1.29) and OSPE scores (80.76 ± 4.68 vs 72.00 ± 5.12, p<0.001, d=1.57). Student feedback favored Stepwise Teaching in clarity, engagement and overall satisfaction (p<0.05). Conclusion: Stepwise Teaching enhances procedural skills, knowledge retention and confidence in medical students. While resource intensive its structured format provides a clear learning pathway. Future studies should explore long-term retention and scalability, integrating blended learning for broader implementation in medical education. Keywords: Stepwise Teaching, Peyton’s Four-Step Approach, Medical Education, Skill Acquisition, OSPE, Active Learning.

Background: Surgical site infections (SSIs) remain a major postoperative concern in obstetrics and gynecology, despite modern surgical techniques and the use of antibiotic prophylaxis. SSI is one of the most common complications encountered in surgery. These infections impose a heavy burden on both the patient and the healthcare system. Objectives: This study aimed to determine the incidence of SSI in patients who underwent caesarean sections and hysterectomies between January 2024 and December 2024 at PIMS Hospital(Walayar). Additionally, independent risk factors and management strategies were identified. Materials and Methods: Patients who had caesarean sections, whether elective or emergency, were assessed for wound infections. Out of 72 deliveries, 42 (58.3%) were caesarean sections. Among them, 30 (71.4%) were elective cases, while 12 (28.5%) were emergency procedures. The age of patients who underwent caesarean section ranged from 19 to 37 years. In the same period, 140 hysterectomies were performed for various gynecological conditions, with patient ages ranging from 40 to 80 years. Among these, 103 (73.57%) were total abdominal hysterectomies (TAH), while 37 (26.4%) were vaginal hysterectomies (VH). All hysterectomies were planned procedures, performed with proper preoperative care, antibiotic coverage, blood transfusion availability and efficient nursing support. Results: Of the 42 caesarean section cases, 5 patients developed SSI (11.9%). Among 140 hysterectomy cases, 15 patients (10.7%) developed wound infections. Thus the overall incidence of SSI for both procedures during the study period was observed in 20 patients (22.6%) within a 30-day postoperative observation period. The study identified higher SSI rates in caesarean patients with maternal age extremes (≤19 and >35 years), obesity, gestational diabetes mellitus (GDM) and high parity (>2). SSIs were more frequent in emergency caesarean cases and prolonged labor (>24 hours). Among hysterectomy patients, infections were more common in obese women, those with excessive blood loss and those with preoperative anemia or diabetes. The mode of hysterectomy (TAH vs. VH) did not show a significant difference in SSI rates. Laparoscopic hysterectomy was not performed. Conclusion: Despite adequate perioperative and postoperative care SSIs remain a persistent challenge in surgical practice. Increased awareness among healthcare professionals regarding risk factors and early preventive measures can help reduce SSIs, ultimately improving surgical outcomes. Keywords: Surgical site infections, Caesarean section, Hysterectomy, Risk factors, Treatment.

Background: A crucial indicator of musculoskeletal health, functional ability and general physiological resilience is hand grip strength (HGS). Although there is ample evidence of gender differences in grip strength little is known about the connection between hand dimensions, autonomic stress responses, and pain perception. By examining sex-based differences in hand anthropometry, HGS and physiological reactions to cold stress this study provides a greater understanding of how these factors are related to one another. Materials and Methods: In this cross-sectional study 200 healthy persons between the ages of 18 and 24 (100 men and 100 women) took part. Vernier callipers were used to measure hand length and breadth and a JAMAR Hydraulic Hand Dynamometer was used to measure HGS. Using blood pressure, pain threshold and pain tolerance measurements, the Cold Pressor Test (CPT) assessed autonomic reactivity and pain perception. Pearson correlation and independent t-tests were used in the statistical analyses significance was defined at p < 0.05. Results: In accordance with their bigger hand dimensions males had a greater HGS (38.2 ± 4.5 kg) than females (31.2 ± 3.8 kg). Males had higher systolic blood pressure increases (+35.3 mmHg vs. +18.7 mmHg in females) and stronger pain tolerance (29.2 ± 5.0 s vs. 18.5 ± 4.3 s) according to CPT responses. Females showed a considerably lower pain threshold suggesting heightened susceptibility to stress caused by cold. Conclusion: These results support the idea that gender specific variations in hand form and autonomic responses shape HGS as a multifactorial biomarker. The study emphasises the necessity of taking sex into account while conducting ergonomic treatments stress tests and physical performance evaluations. Key Words: Hand Anthropometry, Grip Strength, Autonomic Reactivity.

Background: Diabetes is the most common disorder with ocular and renal manifestations. Renal disease and ocular complications in diabetes are frequently disturbing and destined to become one of the challenging problems of the future. This study is an attempt to access the ocular status, complications associated with CRF. It is intended to highlight the importance of ocular examination, to screen patients for any potential visual threat, so that necessary treatment or advice can be given, before they become irreversibly visually impaired. Material and Methods: This is a hospital based prospective study done on 30 patients who were diagnosed end stage renal disease of diabetic etiology with or without hypertension. The onset of end stage renal disease was restricted to be less than six months. Patients with concomitant eye disease were also rejected. Patients underwent regular hemodialysis of once a week. The type of dialysis is bicarbonate, and few patients underwent acetone dialysis. Where acidosis is present only bicarbonate dialysis is done. Results: Majority of the patients were in the age group 55-60 yrs, accounting to about 60%-men 33.33% & women 26.66%. Most of the patients were women, accounting for 56.66% of the total. 4 eyes with severe NPDR had progressed to very severe NPDR. Combined retinopathy was present in 12 Patients of the total. Grade I & Grade II were the majority. Drop in visual acuity in two eyes was due to hard exudates near the macula. 9 eyes that underwent photocoagulation were found to improve in visual acuity of 1-2 line. Conclusion: Better understanding of importance of control of hypertension, improvement in hemodynamic monitoring, increased accessibility of dialysis units has improved the quality of life of people on dialysis and provide an opportunity for timely ophthalmological intervention. Keywords: Hypertension, Type II diabetes, Visual acquity, Renal disease.

Background: Psoriatic arthritis (PsA), a member of the spondyloarthritis (SpA) family is a chronic inflammatory arthritis with heterogeneous presentation. Treatment with NSAIDs, I/A steroid and csDMARDs had been the backbone of management of PsA for many years. The aim of this study to compare the efficacy and safety of oral apremilast versus oral methotrexate in patients with psoriasis arthritis patients at tertiary care center. Materials and Methods: This was a hospital based prospective comparative study done on 20 diagnosed cases of psoriasis arthritis at Department of Dermatology of Government Medical College, Barmer, Rajasthan, India during one-year period who gave written informed consent for the treatment were enrolled into two groups to receive 16 weeks of treatment with either oral Apremilast or oral Methotrexate. The patients were divided into two groups of 10 each, A and B. Group A was treated with oral methotrexate (15mg per week) and Group B was treated with oral Apremilast (After the patient completed the starter pack, for maintenance 30 mg tablets was given per orally twice daily) and were evaluated every 4 weeks for a period of 16 weeks and the last follow-up was at 24th weeks. Results: Among the 20 patients, M:F ratio was 1.85: 1, [65% (13) males and 35% (7) females], mean age of onset was 39.56 years and mean duration of disease was 13.4 years. The % of improvement in patients at the end of 16 weeks in the other group was 60% such that a difference noticed was of around 10%. PDI in group A patients treated with oral methotrexate was 36.79±2.79 at the baseline while in group B it was 38.36±2.12 out of total score of 45. At the end of treatment that is after 16 weeks, the PDI became 17.52±3.26 in group A was statistically significant (p<0.05) as compared to patients in group B which was 20.15±2.83. Conclusion: On comparing the two drugs, methotrexate was comparatively better tolerated and had better efficacy and safety. More studies are required to further prove the efficacy of Apremilast in treatment of this disorder. Keywords: Apremilast, Methotrexate, Psoriasis arthritis, PDI, PASI.

Background: It is well known that working in an intensive care unit (ICU) may be somewhat stressful. More than the physical labor, the psychological aspect of caring for critically sick patients causes extreme mental stress for all ICU healthcare personnel.[1,2] This involves talking about end-of-life concerns and disclosing deaths, particularly in an unexpected circumstance, to the patient's family and relatives. It also entails discussing the danger of death.[3,4] Aim: To study stress and burnout among Healthcare workers in Intensive Care Unit (I.C.U.). Materials and Methods: This was a cross sectional study, the sample taken will include all doctors (Faculties, Senior Residents and Junior residents) and nurses working in the I.C.U. of Santosh Medical College and Hospital, Ghaziabad by using sample size 62 by using the following psychiatric scales: 1. Semi structured proforma for Socio demographic data. 2. Cohen Perceived Stress Scale. 3. Maslach Burnout Inventory Scale (MBI). 4. Oldenburg Burnout Inventory (OBI). Results: The finding of this study suggests moderate to severe intensity of burnout and stress among Intensive care unit healthcare workers irrespective of gender, age group and socioeconomic status. Conclusion: The psychological welfare and work satisfaction of healthcare professionals can be enhanced by routinely evaluating burnout in them, modifying risk factors, and halting the transmission of infection to patients and oneself. High-burnout Health Care Professionals may benefit from psychological counseling to practice coping mechanisms and make lifestyle adjustments. Keywords: Stress, Burnout, Coping skills.

(GFC) therapy, a modified platelet-rich plasma (PRP) technique for the management of androgenetic alopecia. Materials and Methods: The study includes 15 patients (9 males and 6 females, mean age: 33.06), presenting with the complaint of androgenetic alopecia from December 2023 to June 2024 were treated with subcutaneous injections of GFC in the scalp. A total of 3 injections were administered 4 weeks apart, and the patients were followed up for 24 weeks. Results: The treatment outcomes were assessed by taking global macroscopic photographs, trichoscopic photomicrographs, and by performing a hair pull test after 24 weeks of therapy and compared to the baseline. To determine the safety of the treatment, the incidence of any adverse event was recorded throughout the study period. The patient’s self-satisfaction was assessed using a survey-based questionnaire at the end of the study period. The global macroscopic photographs showed a significant improvement in hair growth post-GFC therapy in all 15 patients. These findings were supported by trichoscopic photomicrographs, in which a pronounced improvement in hair density along with a decrease in the shaft diameter variability. Hair pull test was found to be negative in 100% of patients 4 months post-therapy. The therapy was found to be well tolerated with high patient satisfaction (80%). Conclusions: Hence, GFC therapy was found to have a promising role in the management of androgenetic alopecia in both male and female patients. Key-words: Androgenetic alopecia, GFC, Growth factor concentrate, Platelet-rich plasma technique, Global macroscopic photographs, Trichoscopic photomicrographs, Hair pull test.

Background: People with HIV appear to have a greater likelihood of disorders of the thyroid. During HIV infections, overt clinical manifestations are less common, whereas subtle changes in thyroid function are found more commonly in several studies. Objective: To study the prevalence of thyroid dysfunction in people with HIV/AIDS. (PLWHA) and to compare thyroid dysfunction in pre-ART HIV individuals with individuals on HAART. Materials and Methods: This Cross Sectional Study was conducted in Department of Medicine, Andhra Medical College, and King George Hospital, Visakhapatnam in collaboration of ART centre and Department of Biochemistry. Duration of the study was July 2021 to June 2022. Results: Majority of thyroid abnormality was found in the age group of 25 –35 years. There was a significant inverse correlation between CD 4count and Thyroid abnormalities. Heterosexual route was the common route of transmission. Tuberculosis was the most common opportunistic infection. Thyroid abnormality, especially subclinical hypothyroidism, was common in the HAART group. Conclusion: Thyroid abnormality, especially subclinical hypothyroidism, was common in the HAART group. Screening of thyroid parameters is warranted in this population in view of the increasing prevalence in the Study Population. Keywords: Thyroid abnormality, People Living with HIV/AIDS, HAART.

Background: Aim: This study aimed to compare the efficacy of corticosteroid injections (CSIs) versus platelet-rich plasma (PRP) therapy in treating rotator cuff tendinopathy, focusing on pain relief, functional recovery, and range of motion improvements. Materials and Methods: A total of 90 patients with unilateral or bilateral rotator cuff tendinopathy were randomly assigned to either the CSI group (n=45) or the PRP group (n=45). Both groups received their respective treatments under standardized conditions. The primary outcome measure was pain severity, assessed by the Visual Analog Scale (VAS), while secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley Score (CMS), range of motion (ROM), and adverse events. Follow-up assessments were conducted at 6 weeks, 12 weeks, and 6 months after treatment. Results: Both groups showed significant improvement in pain severity, functional outcomes, and ROM over time. However, the PRP group demonstrated significantly greater improvements in VAS scores at 6 and 12 weeks, as well as in ASES and CMS scores at all time points. The PRP group also exhibited superior ROM improvements at 6 weeks, 12 weeks, and 6 months. The incidence of adverse events was significantly lower in the PRP group, with fewer cases of mild pain at the injection site and no infections. Conclusion: Platelet-rich plasma (PRP) therapy was found to be more effective than corticosteroid injections in treating rotator cuff tendinopathy, providing faster and more sustained improvements in pain, functional recovery, and range of motion. Additionally, PRP therapy was associated with fewer adverse events, suggesting it may be a preferable option for long-term management of this condition. Keywords: Rotator Cuff Tendinopathy, Platelet-Rich Plasma, Corticosteroid Injections, Pain Reduction, Functional Recovery.

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

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

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

Background: Tendon transfer techniques are commonly used to restore wrist and finger extension in patients with radial nerve palsy. However, there is limited data comparing the outcomes between patients with high versus low radial nerve palsy. This study aims to evaluate the outcomes of tendon transfer surgery in patients with radial nerve palsy, focusing on wrist extension and functional outcomes. Objectives: To evaluate the effectiveness of the Jones Transfer Technique in restoring hand function in patients with radial nerve palsy, to compare the post-surgical wrist extension and functional outcomes of tendon transfer in patients with high versus low radial nerve palsy. Materials and Methods: A prospective study was conducted at a tertiary care center between 2023 and 2025.17 had high radial nerve palsy, and 3 had low radial nerve palsy. Post-surgical wrist extension was measured as a continuous variable, and functional outcomes were classified using the Bincaz scale. Statistical analyses were performed using an independent samples t-test for wrist extension and a Chi-square test for outcome classification. Results: The mean wrist extension achieved was significantly higher in the high radial nerve palsy group (25.6°) compared to the low radial nerve palsy group (18.3°) with a t-value of 2.83 (p < 0.05). The Chi-square test revealed a significant association between the type of radial nerve palsy and the functional outcomes (Chi-square = 9.62, p < 0.05). Patients with high radial nerve palsy had better functional outcomes, with 8 patients achieving Excellent results, compared to 2 in the low radial nerve palsy group. Conclusion: Tendon transfer surgery significantly improves wrist extension in patients with high radial nerve palsy, and these patients tend to achieve better functional outcomes compared to those with low radial nerve palsy. The results underscore the importance of stratifying patients based on the severity of radial nerve palsy when planning surgical interventions. Keywords: Tendon transfer; Radial nerve injury; PIN injury.

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

Background: Intestinal obstruction is a common and potentially dangerous medical condition that necessitates prompt diagnosis and treatment. This retrospective study aims to analyze the patterns and outcomes of intestinal obstruction at a tertiary care hospital in Central India to enhance understanding and improve management strategies. Materials and Methods: A retrospective review was conducted of 125 patients diagnosed with intestinal obstruction at a tertiary care hospital in Central India. Data were collected from medical records covering demographic information, clinical presentation, etiology, management strategies, and outcomes from January 2020 to December 2021. Results: The majority of patients were male (60%, n=75), with a mean age of 47.2 years (SD=15.6). Clinical presentation was predominantly acute, with symptoms of vomiting (64%) and constipation (36%). The primary causes of obstruction were adhesions (44%), hernias (24%), and tumors (32%). The location of obstructions was more common in the small intestine (68%). Management strategies were divided between conservative (44%) and surgical (56%), with a complication rate of 28%. The average hospital stay was 8.2 days (SD=3.6). Statistical analysis indicated significant associations between gender and management type (p=0.045), onset of symptoms (p=0.033), and management outcomes (p=0.041). Conclusion: Intestinal obstruction in this rural tertiary care setting predominantly affects middle-aged males and is most commonly managed surgically. The high rate of surgical intervention and the significant complication rate underscore the need for improved diagnostic and management protocols. Future research should focus on prospective studies and include more diverse settings to validate these findings and reduce complications. Keywords: Intestinal Obstruction, Rural Healthcare, Surgical Management.

Background: Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by non-scarring hair loss, significantly affecting patients' psychological well-being and quality of life. This study aims to evaluate the clinical presentations of alopecia areata and correlate them with histological findings to enhance diagnostic accuracy and guide therapeutic decisions. Materials and Methods: A cross-sectional, observational study was conducted at Gandhi Medical College for two and half years. One hundred patients with patchy hair loss were enrolled based on predefined inclusion and exclusion criteria. Clinical evaluations included history taking, dermatological examination, and laboratory investigations. Scalp biopsies were performed for histopathological assessment in selected patients. Results: The majority of patients (42%) were aged 21–30 years, with a male-to-female ratio of 58:42. At onset, 85% presented with a single patch of hair loss, and 75% had a duration of less than six months. Eighty percent were asymptomatic, while 20% reported mild itching. Histopathological examination revealed peribulbar lymphocytic infiltrate in acute cases and increase in telogen hair, decrease in anagen hair indicative of chronic disease in others. Nail involvement was noted in 38% of patients. Conclusion: This study emphasizes the heterogeneous nature of alopecia areata, underscoring the importance of integrated clinical and histopathological evaluations for effective diagnosis and management. Keywords: Alopecia Areata, Histopathology, Clinical study.

Background: Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD) are both associated with an increased risk of suicidal thoughts. Understanding the differences in incidence and correlates of suicidal thoughts among these disorders is crucial for targeted interventions. Materials and Methods: This cross-sectional study compared the incidence and prevalence of suicidal thoughts in 120 patients, with 60 diagnosed with MDD and 60 with OCD, recruited from a psychiatric outpatient unit. Suicidal thoughts were assessed using standardized questionnaires, and the severity of each disorder was quantified through clinical evaluations. Results: The incidence of suicidal thoughts was significantly higher in patients with MDD (56.7%) compared to those with OCD (31.7%), with P values of 0.002 indicating strong statistical significance. Similarly, the prevalence of suicidal thoughts was also higher in the MDD group (66.7%) than in the OCD group (40.0%), with P values of 0.001. A correlation analysis showed that higher severity of disorder symptoms was associated with an increased frequency of suicidal thoughts, with correlation coefficients of 0.62 for MDD and 0.48 for OCD. Demographic and clinical factors such as age, gender, duration of illness, and comorbid anxiety were also analyzed, revealing a significant prevalence of comorbid anxiety in MDD patients compared to those with OCD. Conclusions: This study demonstrates a notably higher incidence and prevalence of suicidal thoughts in patients with MDD compared to those with OCD. The findings highlight the need for healthcare providers to carefully monitor and address suicidal thoughts particularly in patients with severe depressive symptoms and comorbid anxiety. Keywords: Major Depressive Disorder, Obsessive-Compulsive Disorder, Suicidal Thoughts.

Background: Hip fractures in the elderly are associated with high morbidity, functional decline, and prolonged hospital stays. Traditional postoperative management often involves restricted movement, whereas early mobilization (within 24–48 hours post-surgery) has been proposed to enhance recovery and reduce complications. This study compares early mobilization with traditional care to determine its impact on functional recovery, hospital stay, and postoperative outcomes. Materials and Methods: This retrospective, observational, comparative study included 50 patients (25 females, 25 males) undergoing hip fracture surgery at Tertiary care hospital from January 2020 to December 2021. Patients were categorized into two groups: Early Mobilization Group (EMG, n=25) and Traditional Care Group (TCG, n=25). Data on demographics, functional recovery (Modified Barthel Index), length of hospital stay (LOS), time to independent ambulation, postoperative complications, pain scores, readmission rates, and mortality were analyzed. Statistical comparisons were performed using Student’s t-test, Chi-square test, and multivariate regression analysis. Results: Functional recovery was significantly better in the EMG group at both 6 weeks (MBI: 72.5 ± 10.2 vs. 65.1 ± 11.6, p<0.001) and 3 months (MBI: 86.4 ± 7.8 vs. 79.2 ± 9.3, p<0.001). The EMG group had a significantly shorter LOS (5.7 ± 1.9 vs. 8.2 ± 2.3 days, p<0.001) and achieved independent ambulation earlier (10.8 ± 2.1 vs. 14.3 ± 2.7 days, p<0.001). Postoperative complications, including deep vein thrombosis (4% vs. 12%, p=0.035) and pneumonia (8% vs. 16%, p=0.022), were lower in the EMG group. No significant differences were found in mortality or readmission rates. Conclusion: Early mobilization significantly improves functional recovery, reduces hospital stay, and lowers postoperative complications without increasing adverse outcomes. This study supports the implementation of early mobilization protocols for better postoperative rehabilitation in hip fracture patients. Keywords: Hip fracture, early mobilization, traditional care, functional recovery, postoperative rehabilitation, elderly patients, length of hospital stay, complications.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint with multiple etiologies, one of which may be thyroid dysfunction. This study aims to evaluate the prevalence and types of thyroid dysfunction in women presenting with AUB. Materials and Methods: In this cross-sectional study, 120 women with AUB were screened for thyroid dysfunction at a tertiary care center. Thyroid function tests (TSH, Free T3, and Free T4) were performed, and the presence of hypothyroidism, subclinical hypothyroidism, and hyperthyroidism was assessed. Results: Of the 120 women studied, 38 (31.7%) had some form of thyroid dysfunction. Hypothyroidism was the most prevalent condition, found in 24 women (20.0%), followed by subclinical hypothyroidism in 11 women (9.2%), and hyperthyroidism in 3 women (2.5%). The prevalence of thyroid dysfunction was significantly higher in women with AUB compared to general population estimates. Additionally, a significant correlation was found between the severity of thyroid dysfunction and the patterns of AUB. Conclusion: Thyroid dysfunction is prevalent among women with AUB, with hypothyroidism being the most common disorder. These findings underscore the importance of screening for thyroid dysfunction in women presenting with menstrual irregularities. Addressing thyroid health could improve patient outcomes and reduce the burden of AUB. Keywords: Abnormal Uterine Bleeding, Thyroid Dysfunction, Hypothyroidism.

Rectal adenocarcinoma can present atypically, mimicking benign conditions such as ischiorectal abscess, leading to diagnostic delays. We report a case of a 55-year-old male with chronic perianal swelling, burning defecation, and significant weight loss. MRI revealed a multilobulated inter-sphincteric collection, initially managed as an ischiorectal abscess. Histopathological examination of the drained material identified moderately differentiated adenocarcinoma. PET-CT confirmed localized disease without metastasis. This case highlights the importance of suspecting malignancy in chronic perianal conditions and emphasizes the role of histopathology and multidisciplinary care in achieving timely diagnosis and management to improve patient outcomes. Keywords: Rectal cancer, ischiorectal abscess, adenocarcinoma, fistula-in-ano, perianal swelling.

Background: To utilize the WHO QOL questionnaire to evaluate and compare the quality of life (QOL) of users of Copper-T 380-A to those of levonorgestrel-releasing intrauterine contraceptive devices (LNG IUCD). Materials and Methods: This was part of the prospective comparative study. Every woman seeking contraception at the Obstetrics & Gynecology OPD received counselling. A thorough examination was performed on people who agreed to have an IUCD inserted; those who chose copper-T were assigned to Group-A, while those who chose LNG IUCD were assigned to Group-B. At baseline and six months, these patients' quality of life was evaluated using the WHOQOL-BREF questionnaire. Women between 18 to 45 years those who are willing to choose an intrauterine device (Copper T 380 A or LNG IUCD) for contraception were included. Women with Pregnancy or suspicion of pregnancy, Current or recurrent pelvic inflammatory disease, 48 hours - 4 weeks since parturition or abortion, Undiagnosed genital tract bleeding, Genital tract malformations, genital tract malignancy, breast cancer, adnexal mass, history of hydatidiform mole in previous pregnancy were excluded. Using an online sample size calculator for trials (https://clincalc.com/stats/samplesize.aspx), a sample size of 98 (49 women in each group with an allocation ratio of 1:1) was determined. Results: Quality of life (QOL) assessment was done by the WHO Quality of Life- BREF (WHO QOL-BREF) questionnaire, which is an abbreviated WHO QOL questionnaire. Assessment is done at baseline and 6 months. The questionnaire comprises 26 items that measure the four broad domains: Physical health, Psychological health, Social relationship and Environment. There was no significant difference in baseline physical, psychological, Social Relationships and Environment health score between Cu T and LNG IUCD users. A significant increase was seen in all four health scores at 6 months when compared to baseline in LNG IUCD users, p-value (<.0001). Conclusion: Our study compared the quality of life among Cu T 380 A and LNG IUCD users at the time of insertion and at 6 months of insertion. There was no effect on the overall quality of life in Cu-T 380 users. However, the use of LNG IUCD significantly improved the quality of life parameters (physical, physiological and environmental domains). This improvement in quality of- life in LNG IUCD users may be attributed due to the reduction that was observed in menstrual blood loss and dysmenorrhea as observed after 6 months of use of the LNG IUCD. Keywords: Levonorgestrel-releasing intrauterine contraceptive devices, Copper-T380-A,WHOQOL-BREF questionnaire

Background: CVDs are the most important public health problem because they cause so many illnesses and deaths around the world. The goal of this study was to find out how strong an independent risk factor link there is between higher plasma homocysteine levels and the chance of coronary heart disease. Materials and Methods: A case-control study was done in the Deccan College of Medical Science, Owaisi Hospital and Research Center, Hyderabad, Telangana, India. From July 2023 to June 2024, this study was done. The study had 100 volunteers between the ages of 25 and 60. There were 100 newly diagnosed patients with coronary heart disease as cases and 100 healthy people of the same age and gender who had never had CHD as controls. Results: Our results are the same as those of a related study that looked at the average amount of homocysteine. A different case-control study clearly shows that having high homocysteine levels is linked to a higher chance of heart disease, which supports the results of this investigation. Our results back up what other studies have found: that people with coronary heart disease have higher amounts of homocysteine in their plasma. Plasma homocysteine levels were very different between people with coronary heart disease and healthy controls. However, only a few studies have shown that the amounts of homocysteine in the plasma of people with CAD and people who did not have CAD were the same. Conclusion: Plasma homocysteine was much higher than controls. Logistic regression strongly links hyperhomocysteinemia to coronary heart disease. The above findings imply that plasma homocysteine levels can predict coronary heart disease. Keywords: Homocysteine, risk factor, coronary heart disease, and cardiovascular diseases.

Background: Accurate characterization of brain tumors and precise preoperative planning are critical for maximizing tumor resection while preserving critical brain functions. Conventional imaging techniques, though effective in identifying tumor margins, often fail to provide detailed insights into white matter tract involvement. Diffusion Tensor Imaging (DTI) has emerged as a powerful tool for evaluating white matter integrity, offering unique advantages in surgical planning for brain tumors. Objective: This study aims to evaluate the role of DTI in characterizing white matter involvement in brain tumors, focusing on its ability to classify tract alterations into displacement, edema, infiltration, and disruption. The study also assesses the statistical differences between benign and malignant tumors in terms of tract involvement and explores DTI’s utility in guiding surgical interventions. Materials and Methods: A cohort of 32 patients with intracranial neoplasms underwent advanced MR imaging, including DTI and 3D tractography. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were analyzed to classify tract involvement and visualize disruptions using color-coded maps and tractography techniques. Results: White matter tracts showed distinct patterns of alteration based on tumor type. Displacement was more common in benign tumors, while malignant tumors exhibited higher incidences of disruption and infiltration. Statistical analysis revealed significant differences in tract involvement between tumor types (P < 0.05). DTI provided critical visual and quantitative insights into tumor-tract relationships, aiding in surgical decision-making. Conclusion: DTI significantly enhances preoperative planning by delineating white matter tracts and their involvement with brain tumors. It allows for the differentiation between benign and malignant tumors and provides actionable information for tailoring surgical approaches. Future research should focus on integrating DTI with other advanced imaging modalities and validating its impact on long-term surgical outcomes. Keywords: Diffusion Tensor Imaging, Brain Tumors, Preoperative Planning, White Matter Tracts, Tractography, Fractional Anisotropy, Apparent Diffusion Coefficient, Tumor Infiltration, Neurosurgery, Advanced MRI Techniques.

Background: To investigate the elevated LDH level in patients with acute intestinal obstruction and bowel viability in PESIMSR, December 2020–June 22. Materials and Methods: In the present study, estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted to surgical wards of PES hospital from December 2020 to August 2022. LDH was estimated in all the cases preoperatively on the day of admission. Results: The total number of patients who presented with obstruction is 45 out of which 25 were found to have elevated LDH which is about 55.56%. Out of 25 patients who presented with elevated LDH and 20 patients were found to have gangrenous bowel. Most commonly pain is associated with vomiting is 84% followed by abdominal distension at 40%, obstipation at 36%, pyrexia at 24%, blood in stools at 8%, and diarrhea at 4%. All the patients were given broad-spectrum antibiotics and injection metronidazole for 7 days. 5 patients developed wound infections and were treated according to the wound culture and sensitivity. Conclusion: From this study, it is evident that ischemic changes in any part of the bowel can cause an elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost-effective, and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centers where the diagnostic facilities are limited. The pre-operative estimation of serum LDH levels in patients presenting with features of acute intestinal obstruction helps in identifying the patients who undergo intestinal ischemia and gangrene at the earliest which makes early intervention possible and helps in reducing the morbidity and mortality due to bowel gangrene. Keywords: LDH, Bowel Obstruction, Gangrene, Abdominal distension, Metronidazole.

Background: Aim and objective: To study the fetomaternal outcomes of various causes of jaundice in pregnancy. Materials and Methods: Prospective observational study- conducted in Department of OBSTETRICS and GYNAECOLOGY, GUNTUR MEDICAL COLLEGE, from SEPTEMBER 2022 to SEPTEMBER 2024, a total of 2 years period. Informed consent was taken. Detailed history, demographic data recorded, physical examination and necessary investigations were done. Results: The incidence of jaundice in our study was 0.34%. Out of 55 cases of jaundice complicating pregnancy 47 were treated and discharged in healthy condition. There were 8 cases of maternal mortality. The causes of maternal mortality were viral hepatitis leading to fulminant hepatitis in 3 cases, HELLP syndrome complicated by DIC in 3 cases, AFLP in 1 case and acute kidney injury in 1 case. Two pregnancies resulted in abortion, 15 cases had stillbirth, 18 cases had preterm delivery and there were 10 neonatal deaths within 1 week of delivery. The total perinatal mortality of 25 cases. Conclusion: The causes of jaundice in pregnancy were often complex and clinically challenging. A team approach with consultation and referrals to gastroenterologist, general physician and radiologist helps optimise the management. Jaundice in pregnancy is best handled at tertiary hospital with requisite experience and expertise. Keywords: Obstetricians, gastroenterologists, Pregnancy.

Background: Aim: The aim of this study was to compare the efficacy, safety, and patient outcomes associated with supraglottic airway devices (SGADs) versus endotracheal intubation (ETI) in outpatient anesthesia procedures. Materials and Methods: This prospective, randomized controlled trial included 100 adult patients aged 18-65, scheduled for elective outpatient surgery under general anesthesia. Participants were randomly assigned to the SGAD group (50 patients) or the ETI group (50 patients). Insertion time, ease of insertion, hemodynamic stability, complications, postoperative recovery, and patient satisfaction were the primary and secondary outcomes assessed. Statistical analysis was performed using SPSS version 25.0. Results: The SGAD group demonstrated significantly shorter insertion times (12.3 ± 3.2 seconds) compared to the ETI group (22.7 ± 5.4 seconds, p < 0.01). Ease of insertion was also significantly easier in the SGAD group (mean score 1.4 ± 0.6) compared to the ETI group (mean score 2.2 ± 0.8, p < 0.01). There were fewer complications in the SGAD group, including a lower incidence of sore throat (4% vs. 20%, p = 0.04) and hoarseness (4% vs. 16%, p = 0.04). The SGAD group also had significantly faster recovery times (12.5 ± 3.0 minutes vs. 20.4 ± 4.5 minutes, p < 0.01) and higher patient satisfaction (4.5 ± 0.5 vs. 3.8 ± 0.7, p < 0.01). Conclusion: This study demonstrates that SGADs are superior to ETI in outpatient anesthesia due to their faster insertion times, easier placement, fewer complications, and quicker recovery. Patients also reported higher satisfaction with SGADs. SGADs represent a safer, more efficient, and more comfortable airway management option for outpatient procedures. Keywords: Supraglottic airway devices, endotracheal intubation, outpatient anesthesia, insertion time, patient satisfaction.

Background: Salivary gland neoplasms are uncommonly found tumors. Although histopathology is the gold standard modality for diagnosis, immunohistochemical markers such as p63 and Ki67 are used to differentiate between malignant and benign lesion and also aid in managing these neoplasms. Materials and Methods: 50 cases of salivary neoplasms were included in this cross-sectional study which was conducted in the Department of Pathology, Malla Reddy Medical College for Women from November 2022 to October 2024. Results: The P value calculated for association between malignant salivary gland tumors and ki67 expression was found to be statistically significant. The association between benign salivary gland tumors and p63 expression was statistically significant. Conclusion: This study highlights that pleomorphic adenoma is the most common benign salivary gland tumor, while mucoepidermoid carcinoma is the most frequent malignant one, with Ki67 and p63 expressions showing significant differences between benign and malignant tumors.. Keywords: Salivary gland neoplasms, benign tumors, malignant tumors, pleomorphic adenoma, mucoepidermoid carcinoma, Ki67 expression, p63 expression.

Background: Prostate cancer is one of the commonest cancers and cancer related morbidity and mortality in males. Early identification of type of biomarkers like ER β and Ki67 can identify the aggressiveness of tumor and guide in targeted chemotherapy. Materials and Methods: this observational study was done in the Department of ¬¬Pathology, Malla Reddy Medical College for Women, over a period of 1 year, i.e. from August 2023 to July 2024. A total of 50 patients, consisting of 25 patients with BPH and 25 patients with prostate cancer were included in this study. Results: levels of ER β expression were found to be higher in patients with BPH and a small proportion of patients with prostatic cancer. ER β was predominantly expressed from the secretory epithelium. High levels of Ki67 were predominantly expressed in patients with prostate cancer and reduced levels of ki67 were expressed in patients with BPH. Conclusion: Understanding the intricacies of estrogen signaling in prostate cancer may provide insights into novel therapeutic strategies and improve patient outcomes. Keywords: prostate, benign prostatic hypertrophy, prostate cancer, ER β, ki67, immunotyping.

Background: Several studies have demonstrated an association between vitamin D deficiency and increased risk of autoimmune diseases. In patients with Ankylosing Spondylitis few authors have noted an inverse relationship between serum 25-hydroxyvitamin D [25(OH)D] and disease activity. But these results are not consistent across all studies and some authors report no significant association between them. Aim and Objectives: Aim: To evaluate the relationship between 25(OH)D deficiency and disease activity in patients with axial spondyloarthritis (axSpA). Objectives: 1) To review and extract data from medical records of patients with axSpA, focusing on 25(OH)D levels and disease activity (ASDAS-CRP score). 2) To analyse the relationship between 25(OH)D levels and disease activity indices, identifying trends or significant associations. Materials and Methods: This is a cross-sectional retrospective study based on the electronic medical records of our hospital. Serum 25(OH)D level and ASDAS-CRP score of axSpA patients documented during their visit in clinic were retrieved and statistical analysis was done. Results: A total of 49 subjects with axSpA were included. 25(OH)D deficiency was associated with high disease activity (ASDAS-CRP ≥ 2.1) when compared to those with normal 25(OH)D levels (p = .026). Mean ASDAS-CRP was higher amongst individuals with 25(OH)D deficiency (M = 2.27 ± 0.60) compared to individuals with normal 25(OH)D levels (M = 1.77 ± 0.50), [t (47) = 3.0174, p = .004]. A weak negative correlation was noted between 25(OH)D level and disease activity (rs = -0.3265, p = 0.02). Conclusions: This study demonstrates 25(OH)D deficiency is associated with high disease activity in axSpA patients but there was weak negative correlation. Further prospective and interventional studies are needed to evaluate a potential causal relationship, as vitamin D supplementation may be a cost-effective adjunctive intervention to mitigate disease activity in axSpA. Key-words: Ankylosing spondylitis; axial spondyloarthritis; serum 25-hydroxyvitamin D; vitamin D deficiency; ASDAS.

Background: Identification of human remains has been a major problem for the medico-legal system. There are many instances of human remains where the only remains available for identification will just be a skull. Forensic facial reconstruction is the process of recreating the face from the skeletal remains of an individual whose identity is unknown. Facial reconstruction includes the combined use of artistry, forensic science, anthropology, osteology and anatomy. Ultrasonography, CT, CBCT, and MRI have been used for facial reconstructions and facial soft tissue thickness measurements in the literature. The facial soft tissue thickness of South east Indian population using MRI have not been documented in the literature till date. Aims & Objectives: The present study was aimed to measure the facial soft tissue thickness in different anatomical landmarks to establish baseline data that may help in forensic facial reconstruction and in the other facial reconstructive procedures in South East Indian population. Material and Methods: The study consisted of 60 MRI images of southeast Indian adults between ages of 18 and 70 years during the period from March 2021 to October 2021. The age and gender of the subjects were collected before the examination and ascertained all were representatives of racially and socially homogenous population, MRI images has been utilized to measure the 12 different landmarks in mid facial region. Radi Ant DICOM Viewer (64 bit) software was used to measure soft tissue thickness. Results: Facial soft tissue thickness is more in males than females in many anatomical landmarks. There was significant differences noted between soft tissue thickness values among the different age groups. Conclusion: Our compiled data set of FSTT is important in understanding craniofacial characteristics of southeast Indian population. The data achieved in the present study can be used for the forensic facial reconstruction and in the other facial reconstructive procedures. Keywords: Facial soft tissue thickness, MRI, Forensic facial reconstruction.

Background: Acute Kidney Injury (AKI) is a critical complication in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), which often results in poor outcomes. Traditional biomarkers such as serum creatinine (SCr) are not suitable for the early detection of AKI, especially in COPD patients with muscle wasting. This study assesses the effectiveness of serum Cystatin C and urinary Microalbumin as early biomarkers for AKI in AECOPD patients admitted to a Respiratory Intensive Care Unit (RICU). Materials and Methods: Over a period of one year, from May 2023–May 2024, a prospective cross-sectional study was performed at a tertiary care hospital. Sixty-five AECOPD patients were included by excluding patients who already had chronic kidney disease and other confounding diseases. Serum Cystatin C and urinary Microalbumin levels were measured at admission. AKI was diagnosed using KDIGO guidelines. Statistical analysis was done with ROC curves to assess biomarker predictive accuracy. Results: The prevalence of AKI was 24.6%. Serum Cystatin C and urinary Microalbumin levels were significantly higher in AKI patients (p < 0.001). ROC analysis showed AUC values of 0.890 for Cystatin C (cutoff: 1 ng/µL; sensitivity: 87.5%, specificity: 93.9%) and 0.802 for Microalbumin (cutoff: 29.74 mg/L; sensitivity: 68.8%, specificity: 100%). AKI patients had higher mortality (37.5% vs. 2%) and required more mechanical ventilation (68.8% vs. 24.5%) and dialysis (18.8% vs. 0%) compared to non-AKI patients. Conclusion: Serum Cystatin C and urinary Microalbumin are effective early biomarkers for AKI in AECOPD patients. Their integration into clinical practice could enable timely intervention, improving patient outcomes. Further multicenter studies are needed to validate these findings. Keywords: Acute Kidney Injury, Chronic Obstructive Pulmonary Disease, Serum Cystatin C, Urinary Microalbumin, Biomarkers, AECOPD.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with systemic complications, including neurocognitive decline. Recent evidence suggests that individuals with T2DM exhibit an increased risk of cognitive impairment, potentially leading to dementia. However, the extent and nature of cognitive decline among individuals with T2DM compared to non-diabetic controls remain an area of ongoing research. Objective: This study aims to assess the impact of T2DM on cognitive function by comparing cognitive performance between individuals with T2DM and age-matched non-diabetic controls. Materials and Methods: A comparative observational study was conducted with a sample size of 300 participants (150 T2DM patients and 150 non-diabetic controls) aged 40-75 years. Participants were recruited from outpatient endocrinology and neurology clinics. Standardized neuropsychological tests, including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and Trail Making Test (TMT), were administered to evaluate cognitive domains such as memory, executive function, attention, and processing speed. Glycemic control markers (HbA1c levels) were also assessed to examine potential correlations between hyperglycemia and cognitive impairment. Results: Preliminary findings indicate that individuals with T2DM exhibited significantly lower scores in memory recall, attention, and executive function compared to controls. A strong negative correlation was observed between HbA1c levels and cognitive performance, suggesting that poor glycemic control may exacerbate cognitive deficits. Conclusion: This study highlights the adverse impact of T2DM on cognitive function, with implications for early screening and intervention strategies. Routine cognitive assessments in diabetic patients may facilitate timely interventions to mitigate the risk of cognitive decline. Keywords: Type 2 Diabetes Mellitus, Cognitive Decline, Neuropsychological Assessment, Glycemic Control, Executive Function, Memory Impairment, Observational Study.

Background: Circumcision is a surgical procedure performed for therapeutic, prophylactic, and hygienic reasons. In adults it is commonly used to treat pathological phimosis caused by scarring and fibrosis. Traditional surgical methods like dorsal slit and sleeve resection are effective for treatment of phimosis but have complications such as bleeding and poor cosmetic outcomes. The V flap method is a relatively newer technique that preserves the inner foreskin and frenulum thereby enhancing postoperative sensitivity and providing better cosmetic results. It also reduces complications and recovery time. However, limited studies and lack of standardized guidelines highlight the need for further research on its safety, efficacy and long-term outcomes. Materials and Methods: This prospective study was conducted at Government Stanley Medical College Chennai. The purpose of study was to evaluate the V-flap circumcision method for phimosis. Male patients having phimosis were included in this study on the basis of a predefined inclusion and exclusion criteria. Penile block anesthesia was used for surgery in all cases. An inverted T-incision and V-flap technique was used. chromic catgut sutures were used for closure. Postoperative care included antibiotics, analgesics. Follow-up visits were done at 1, 2, and 4 weeks to assess healing, complications, and patient satisfaction. Data was analyzed using Chi-square and ANOVA tests. SPSS Version 23 was used for statistical analysis. A p-value of <0.05 was considered statistically significant. Results: This study included 30 male patients aged 14 to 30 years (mean age: 21.23 ± 4.54) with phimosis who underwent V-flap circumcision. The mean surgery duration was 30.02 ± 4.4 minutes. No complications occurred in 22 (80%) cases, while 5 (16.66%) reported skin color discrepancy, and 3 (10%) had suture line bleeding. No visible scars were noted. Significant postoperative improvements were observed in urinary symptoms (spraying of urine, dysuria), pain during erections and sexual intercourse, inflammation (swelling, redness, foul-smelling discharge), and psychological impacts (anxiety, embarrassment), with p-values < 0.05. Overall, the V-flap method effectively relieved multiple symptoms and enhanced patient satisfaction. Conclusion: V Flap method of circumcision is a simple, safe and effective method with a comparable outcome to the Dorsal slit method but with reduced incidence of erection related complications. Keywords: Circumcision, Phimosis, V-flap method, Postoperative outcomes.

Background: Thyroid swelling is a common clinical finding in surgical practice. The causes of such swellings range from benign conditions like multinodular goiter to malignant lesions such as papillary carcinoma. Thyroid swellings are more commonly seen in females due to hormonal influences. It is important to differentiate between benign and malignant thyroid lesions because of obvious implications in terms of management. High-resolution ultrasonography and FNAC are essential diagnostic tools for evaluation of thyroid swellings. Cytology and histopathology provides definitive diagnosis. This study aims to analyze clinical presentation and cytological diagnosis of thyroid swelling in adults. Materials and Methods: This prospective observational study was conducted at Government Stanley Medical College, Chennai. The purpose of the study was to analyze clinical presentation and FNAC findings in patients presenting with thyroid swelling. 50 Adults aged 18 years and above presenting with thyroid swelling and willing to provide informed consent were included in this study. Pregnant women, patients with prior thyroid malignancy or surgery, those with uncontrolled chronic diseases or on medications affecting thyroid function were excluded. Demographic details, clinical findings, thyroid function tests, high-resolution ultrasound and FNAC was done in all cases. Data was analyzed using SPSS (version 23.0). P value <0.05 was considered statistically significant. Results: Thyroid swellings were more common in females (72%) with a male-to-female ratio of 1:2.57. The mean age of male and female patients was 39.6 +/- 13.2 and 41.4 +/- 14.3 years respectively. The most common clinical presentation was swelling only (42%), followed by swelling with pain (28%). Majority of cases were euthyroid (70%). Ultrasound findings revealed colloid goitre as the most common condition (20%) followed by multinodular goitre (16%). Histopathological analysis confirmed colloid goitre (20%) as the most frequent diagnosis followed by multinodular goitre (16%) and follicular adenoma (14%). Conclusion: Thyroid swellings were more common in females. Majority of the cases were found to have benign pathology with colloid goitre being the most prevalent diagnosis. Most patients were euthyroid and swelling without other symptoms was the most common presentation. FNAC was effective in distinguishing benign from malignant lesions underscoring its diagnostic value. Keywords: Thyroid swelling, Colloid goitre, Fine needle aspiration cytology, Ultrasonography.

Background: The most commonly accepted method of contraception in India is Female sterilisation or tubal ligation. The most common method used for female sterilisation is Modified Pomeroy’s technique. Sterilisation failures occur rarely. The aim of the study is to find the prevalence of female sterilisation failure in the tertiary care centre. Materials and Methods: This Retrospective study was conducted among women who had reported or referred as tubal sterilisation failure to the family welfare department at Institute of Obstetrics and Gynaecology and Government Hospital for women and children, Egmore and Institute of Social Obstetrics and Government Kasturba Gandhi Hospital for Women and Children, Triplicane for a period of 10 years from (2011-2020).The study participants fulfilling the inclusion and the exclusion criteria were included in the study throughout the study period. The final attained sample is 528. The demographic data like age of the patient, parity, method of sterilisation, time of sterilisation, concurrent or interval ,mode of presentation ,gestational age at time of sterilisation and time interval from post tubal ligation to conception were analysed. The data collected will be entered in the MS Excel and statistical analysis done through SPSS 23.P value <0.05 is considered as statistically significant. Results: The total number of sterilizations performed in last 10 years was 29752..The failure rate was 2.5% in the last year whereas 0.9% in the year 2018.The overall prevalence rate was 1.8%. Majority sterilisation failure were presented as Intrauterine (57%) followed by Ectopic (43%). Majority of the failure cases were from Medical College hospital (40.9%). In our study majority of the study participants were in 26-30 years of age group 347(65.7%).Most of the study participants presented at 5-6 weeks of gestation. Majority of the sterilisation failure were reported between 1-5 years 340(64.4%).The most common comorbidity reported was Diabetes Mellitus.Age category and comorbidity were found to be statistically stignificant with mode of presentation. Most of the sterilisations surgeries were done by Junior residents 186(35.2%) and majority of them had 2-5 years of experience 186(35.2%).Majority of the study participants underwent sterilization during their postpartum period 260(49.2%). Conclusion: The study concludes that Female sterilisation method is a permanent method but still failure is possible with minimal chances which is due to recanalization. Proper counselling given to the patients regarding risk of failure and by improving the standards of procedures can prevent the failures and complications due to it. Keywords: Sterilisation failure, Pomeroy’s technique, recanalization, tubal ligation.

Background: Anemia is a prevalent condition among children, particularly in developing countries, where it poses significant challenges to health and development. Understanding its incidence and clinical characteristics in different age groups is crucial for targeted interventions. Objective: This study aimed to evaluate the incidence and clinical profile of anemia in children aged 1 to 14 years attending a tertiary care hospital, focusing on the severity, types, and associated factors. Materials and Methods: A prospective observational study was conducted over six months, including 120 children diagnosed with anemia based on hemoglobin levels (<11 g/dL) using WHO criteria. Demographic details, clinical symptoms, and laboratory investigations, including complete blood count (CBC), peripheral smear, and iron studies, were recorded. Data were analyzed to assess the distribution of anemia severity, etiology, and associated clinical features. Results: The incidence of anemia in children attending the hospital was 38%. Among the 120 children included, mild anemia was observed in 40%, moderate anemia in 45%, and severe anemia in 15%. Microcytic hypochromic anemia was the most common type (70%), followed by normocytic normochromic anemia (25%) and macrocytic anemia (5%). Nutritional deficiencies, particularly iron deficiency, were identified as the leading cause (80%), with infections and chronic diseases accounting for 15% and 5%, respectively. Clinical features included pallor (95%), fatigue (75%), and developmental delay (20%). Conclusion: Anemia remains a significant health concern among children, with iron deficiency as the predominant cause. Early diagnosis and management are essential to reduce the burden of anemia and its complications. Keywords: Anemia, Children, Iron Deficiency, Nutritional Anemia, Tertiary Care Hospital, Pediatric Anemia, Microcytic Hypochromic Anemia.

Background: NST is simple, cheap, non-harmful, easily repeated, and cost effective with low maintenance profile. NST is a very effective method to investigating the intrauterine growth retardation (IUGR), late pregnancy, premature birth, multiple pregnancy, Rh sensitivity, diabetes, liver disease, decreased bowel movements, oligohydramnios etc. Objectives were to evaluate the efficacy and role of antenatal NST in improving perinatal outcome in high-risk pregnancies. Materials and Methods: A prospective cohort study was done on 200 antenatal women with one or more risk factors for a period of 1 year to evaluate the perinatal outcome by NST is used for predicting perinatal outcome, it has high sensitivity for APGAR Score, NICU admission and low birth weight of the baby. Results: Distribution of high risk cases according to last NST pattern total number of reactive cases are 121(60.5%) and non reactive cases are 79(39.5%). In reactive NST pattern (121) cases, 41 cases had normal delivery (33.8%). 71 cases had caesarean section (58.6%). Among the non reactive NST patients (79) 11 had normal delivery (13.9%), 64 has caesarean section (81%). Correlation of last NST pattern with perinatal outcome, Reactive category 12 cases (9.9%) had low birth weight and 17.72% (14 cases) had low birth in Non reactive cases, 8 cases (6.6%) had meconium staining with reactive NST and 9 cases (11.39%) had meconium staining with non-reactive NST. 1 case (0.8%) had perinatal death in reactive cases and 5 had non-reactive NST category ie., 6.32%. predictability of abnormal NST for fetal distress in labor are sensitivity 23.14%, specificity 12.66%, positive predictive value 28.87 %and negative predictive value of 9.71% Similarly predictability of abnormal NST for APGAR <6 are sensitivity 85.95. specificity 2658. positive predictive value 64.20 and NPV- 55.26. LBW had sensitivity 90, specificity 17.72, PPV 62.6 and NPV 53.8. NICU admission in non-reactive NST pattern found out to have sensitivity 51.2, specificity 32.9, PPV- 53.9 and NPV-30.5. In meconium stained liqour, sensitivity 6.6, specificity 88.6, PPV-47, NPV 38.2, perinatal death. Sensitivity -0.8, specificity 93, PPV-16.7, NPV-38. Conclusion: Present study reveals significant difference between reactive and nonreactive NST in terms of Apgar scores and NICU admissions in both the groups. Hence judicious use of NST will certainly help in timely identification of at-risk fetuses thereby avoiding unnecessary delay in intervention. Keywords: Non-stress test (NST), Bad obstetrics history(BOH), Cardio tocogrphy(CTG).

Background: The prevalence of abnormal uterine bleeding (AUB) is estimated to be 11-13% in the general population. AUB affects 10-30-% of reproductive age group women and upto 50% of women in perimenopausal age group. Hysteroscopy has emerged as a useful diagnostic procedure that is safe, with a low incidence of clinically significant complications. The accuracy of diagnosis based on hysteroscopic visualization is high for endometrial cancer, but only moderate for other endometrial diseases. Objectives: To evaluate the diagnostics validity of hysteroscopy in evaluation of abnormal uterine bleeding and its correlation with histopathological findings. Materials and Methods: The present descriptive observational study was carried out in department of OBGY involving 85 women of the reproductive age group that underwent hysteroscopy for AUB during the study period from January to December 2024. Results: We included total 85 perimenopausal women presented with AUB. Majority of the women were from 41-45 years age group i.e., 44(51.8%). Commonly observed symptoms were dysmenorrhea in 58.8% and pain abdomen in 18.5%. Sensitivity, specificity, PPV and NPV of hysteroscopy for diagnosing secretory endometrium was 84.6%, 86.3%, 51% and 98.6% respectively. For diagnosing proliferative endometrium, agreement between hysteroscope and HPR was found in 27 patients. Conclusion: Sensitivity, specificity, PPV and NPV of hysteroscopy for diagnosing secretory endometrium was 84.6%, 86.3%, 51% and 98.6% respectively. For diagnosing proliferative endometrium, agreement between hysteroscope and HPR was found in 27 patients. Key words: Diagnostic validity of hysteroscopy, abnormal uterine bleeding, perimenopausal women, histopathological correlation.

Background: Corona virus disease caused by severe acute respiratory syndrome corona virus-2(SARS-COV2) created a huge impact on police department. This has created impact on their physical and mental health. Almost 900 policemen died in our country due to covid 19. Aims and Objectives: To know the stress level among police personnel during lockdown. To know the impact of stress on their physical and mental health. Materials and Methods: Study Design-Community based cross sectional study. Study period -1-month (15/9/2021-15/10/2021) Study population- All police officers doing work in police department. Study tool: pre- designed, pre- validated, semi-structured questionnaire. Inclusion Criteria-All police persons who are willing to give written informed consent and those present at the time of study. Exclusion criteria-All police persons who are not willing to give informed written consent and those absent at the time of study. Sampling method – Convenient sampling. Statistical analysis- SPSS version22. Sample size-100(approximately). Results: Almost 57%males and 42%females were included. On a whole,54% are not able to sleep properly.69% felt being distracted from family and 75% were facing increased work load. Conclusion: Police personnel in our country faced so many problems in our country during lock down. Government has to take many steps such as increased wages, compensations, providing health facilities at low cost etc. Key words: Stress, police, health.

The objective of the study was to evaluate the nutritional status of liver cirrhosis patients by the Visceral Proteins (Albumin, Prealbumin and Transferrin) as assessment method of the nutritional status. and their correlation with severity of Liver cirrhosis according to Child Pugh classification. One hundred fifty cirrhotic subjects of either sex ranging in age from 20–70 years were included in the study, and the results were compared with 50 age- and sex-matched healthy control subjects. All cirrhotic subjects were assessed for severity of disease as mild (Child A), moderate (Child B), and severe (Child C) as per Child-Pugh classification. Visceral Proteins (Albumin, Prealbumin and Transferrin) were used for assessment of Nutritional Status, measured in all the subjects. Serum Albumin, Prealbumin and Transferrin were significantly decreased in Cirrhotic Subjects as compared to the healthy Controls. Enrolled 150 Cirrhotic patients were further segregated into three groups Child A, B & C according to the severity of their liver disease as assessed by the Child-Pugh classification. The concentration of Serum Albumin, Prealbumin and Transferrin were decreased with advancement of liver disease and the difference among Child Pugh groups was statistically significant. When further Child Pugh groups were compared a statistically significant difference was found within the groups (Child A-B, A-C and B-C) for Albumin, Prealbumin and Transferrin. There was significant negative correlation between Albumin, Prealbumin, and Transferrin with Child –Pugh Score. Among the various Visceral Proteins (Albumin, Prealbumin, Transferrin) used for nutritional assessment, the prevalence of malnutrition assessed in cirrhotic patients was highest with prealbumin. Hence prealbumin is a better tool for assessment of nutritional status in cirrhotic patient. Evaluation of the nutritional status of these patients should be a part of the routine outpatient clinic checkup, regardless of the etiology of the disease, so that appropriate nutritional intervention can be done to prevent progression of the disease process. However, one single parameter does not serve as the only and best parameter to diagnose malnourished patients or patients with risk for malnutrition. Keywords: Chronic Liver Disease, Protein calorie malnutrition, Child Pugh Turcotte Score, Prealbumin, Transferrin

Background: There are various teaching-learning methods, in, medical education amongst them, now a day's self-directed learning (SDL) is an effective and popular method. In accordance with the promoting of student centric education of National Medical council instead of a teacher centric one. Aim: Aim of the study was to study the effectiveness of self-directed learning (SDL) in a traditional lecture on genetics in the Anatomy Department Method: 100 students of the 1st year M.B.B.S batch of 2023, were given goggle form of 20 MCQ on genetics as pretest of SDL, conducted and assessed. After a period of interval, another goggle form of same MCQ given as post test of SDL, data was collected, assessed and result prepared. Result: The result indicates a significant improvement of the performance of undergraduate students that followed the teaching model. ‘Mean’ value of the pre-test was 9.29. Standard deviation (SD) of the pre-test 2.94. Standard deviation (SD) of the posttest 3.30. ‘Mean’ difference was 3.12. t Value was 7.30. p value was <0.001. Mean score increased by 3.12 units from pre SDL to post SDL teaching, with 95% confidence interval of 2.97 to 3.97. High t value (7.30) and p value is <0.001 suggesting statistically significant difference. Therefore the teaching model of SDL appears to be effective in enhancing student learning outcome. Conclusion: SDL is an effective model in medical education. Keyword: Anatomy, teaching method, self-directed learning, medical education.

Aim of the study is to address this gap by evaluating the correlation between the molecular detection of MTB using CBNAAT and specific radiological findings on CT thorax in presumptive PTB cases. Patients were included if they exhibited symptoms suggestive of PTB, such as a persistent cough lasting more than 2 weeks, fever exceeding 4 weeks, significant weight loss, hemoptysis, or any abnormalities identified on a chest radiograph Presumptive TB patients who took HRCT thorax were categorised into 4 radiological categories. Later their CBNAAT results were reviewed and the data was analysed. majority of patients (37.7%) fall within the 51–60 years. 39 (73.6%) were male. CT grading shows Definite active (45.3%), Probably active (26.4%), Indeterminate active (9.4%), and probably inactive (18.9%) groups. The overall CBNAAT results revealed that 75.5% (40 out of 53) of the patients tested positive for Mycobacterium tuberculosis, while 24.5% (13 out of 53) were negative. A significant association (p < 0.001) between CBNAAT results and the CT grading categories of pulmonary tuberculosis. Key-words: Pulmonary tuberculosis, Cartridge Based Nucleic Acid Amplification Test, chest computed tomography

Background: Percutaneous nephrolithotomy (PCNL) is the preferred surgical approach for managing complex renal stones, with the choice of calyceal access—upper or lower—playing a critical role in procedural success and complication rates. The upper calyceal approach offers improved stone clearance but carries higher risks, especially in supracostal punctures, whereas lower calyceal access is safer but may have lower stone-free rates. Despite several comparative studies, an optimal access strategy remains debated. Objectives: This study aims to compare upper and lower calyceal access in PCNL for complex renal stones by evaluating patient demographics, operative parameters, stone clearance rates, complications, and overall surgical outcomes. Materials and Methods: A retrospective analytical study was conducted on patients undergoing PCNL at Adichunchanagiri Institute of Medical Sciences between January 2024 and December 2024. Inclusion criteria comprised patients aged ≥18 years with radiopaque complex renal calculi, normal urinary tract anatomy, and a single calyceal puncture for PCNL. Data were collected on demographics, stone characteristics, operative details, and postoperative outcomes, including stone-free rates (SFRs), complications, and hospital stay duration. Statistical analyses included Chi-square and t-tests, with significance set at p<0.05. Results: The study included 100 patients (Upper access: 46, Lower access: 54). The mean stone size and hemoglobin drop were comparable (p>0.05). The upper calyceal access group achieved a higher success rate (91.3% vs. 75.93%, p<0.001) and a greater stone clearance rate (86.96% vs. 75.93%). However, complications were significantly higher in the upper access group (p<0.05), particularly in supracostal punctures. Hospital stay did not differ significantly between groups. Conclusion: Upper calyceal access in PCNL enhances stone clearance and success rates but is associated with a higher complication risk, particularly with supracostal punctures. Lower calyceal access, though safer, has lower stone-free rates. The choice of access should be individualized based on patient risk factors to optimize outcomes. Keywords: Percutaneous nephrolithotomy, calyceal access, stone clearance, complications, supracostal puncture, renal calculi, PCNL outcomes.

Background: Context: In the current era of hospital attacks and medical lawsuits, effective communication is a must. Instead of clinical incompetence, poor communication was the main complaint made by patients to the authorities. This study therefore attempts to comprehend medical undergraduates' attitudes toward learning communication skills. Aim: It aims to study the sociodemographic factors, to assess the attitude towards learning communication skills and to find correlation between both in first year MBBS students and medical interns. Settings and Design: This is a cross-sectional observational study conducted at a Government Medical College in Maharashtra. Materials and Methods: For this study, a semi structured proforma was prepared to gather sociodemographic details and a 26-item validated communication skills attitude scale (CSAS) developed by Rees and Sheard was utilized. Data collection was done via convenient sampling from 192 participants after obtaining consent from the participants. Statistical analysis used: Data analysed by SPSS Version 28:0. Variables expressed by using frequency, Percentage (%), mean and SD. Unpaired t-test and one way ANOVA used where appropriate. p-value < 0.05 considered as significant. Results: There was a decline in positive attitude between 1st year MBBS students and medical interns with increase in negative attitude scores. Amongst the variables evaluated, correlation was found with age and number of family members. Conclusions: Communication skills is a lifelong learning process with repetitive sensitization required for honing it. Measures towards inculcating this practice in daily clinical rotation needs to be taken for efficient physician-patient interactions. Key-words: communication skills, attitude, medical students, medical interns.

Background: After breast conservative surgery (BCS) and whole-breast radiotherapy (WBRT) along with tumor bed boost is recommended especially in patients at high risk. However, the standard techniqueof the boost volume irradiation have not been well defined. Aim: To evaluate and compare dosimetric parameters and cosmetic outcomes in carcinoma breast patients, post-breast-conservative surgery undergoing radiotherapy boost to tumor bed with photons vs. electrons. Materials and Methods: It was an institutional-based prospective randomized study done in carcinoma breast patients from November 2018 to April 2020 (18 months). All carcinoma breast patients who fulfilled inclusion criteria and exclusion criteria during this period were included in the study. Results: In the present study,the mean age for the total (32) study population was around 49.3 years. Of those patients who were treated with photons (50%), the mean age was 47.6 years, and for the remaining 50% of the patients who were treated with electrons, the mean age was 51.1 years. In our study, out of 32 patients, 5 (15.6%) patients presented with T1N0M0, i.e. stage I, of which two of them treated with photons and three were treated with electrons. 19 (59.4%) patients presented with T2N0M0, i.e., stage IIA of which 8 of them were treated with photons and 11 were treated with electrons.8 (25%) patients presented with T2N1M0, i.e., Stage IIB of which 6 of them treated with photons and two were treated with electrons. In our study, out of 32 patients, 17 (53.12%) patients became positive for both E.R. & P.R. receptors. Only 5 (15.6%) patients became positive for HER2NEU receptors. At the end of radiotherapy in our study, grade 1 reactions were seen in 8 patients in photons arm and six patients in electrons boost arm. Grade IIreactions were observed more in the electrons arm, i.e., nine members and eight members in photons arm. Radiation conformity index (RCI) in Electron was 1.13 and with 3DCRT was 1.017. Dose homogeneity index (DHI) in Electron was 0.93 and with 3DCRT was 0.94. Heart mean V10 for PHOTONS was 7.3% and for ELECTRONS was 16.4%. This difference was statistically significant, as p is less than 0.05 (0.001). At 6 months follow-up, a good (grade I) cosmetic score was noticed in eight patients (32%) of electron boost arm and in six patients (24%) of 3DCRT boost arm. Moderate (grade II) cosmetic scores were seen in 13 (52%) of electron boost patients and in 14 (56%) of 3DCRT boost patients. Bad scores (grade III) were seen in four (16%) and five (20%) patients, respectively. Conclusion: The present study concluded that the photons group showed better coverage than electrons dosimetrically in terms of PTV, but the coverage of electrons is also within the tolerance limits for tumor bed boost in early breast cancer patients who underwent BCS. There is slight increased acute skin toxicity with electrons, but overall skin, subcutaneous toxicities are similar in both groups. Keywords: Breast Cancer, Cosmetic score, Photons, Electrons, Breast conservation Surgery.

Regenerative biomaterials progressed into essential in tissue engineering and regenerative therapies, offering innovative solutions to bolster the body’s intrinsic healing capabilities. These advanced materials are designed to interact intricately with biological systems, delivering therapeutic benefits through various mechanisms. One of the critical therapeutic properties of regenerative biomaterials is biocompatibility, which ensures minimal immune response and promotes seamless integration with host tissues. This is paramount in reducing inflammation and enhancing the longevity of implants and grafts. Another crucial characteristic is bioactivity, which facilitates cell adhesion, proliferation, and differentiation, all crucial for effective tissue repair and regeneration. These materials often incorporate bioactive molecules that stimulate cellular activities and support the formation of new tissue. Biodegradability is equally important, allowing the materials to degrade safely within the body over time, eliminating the need for secondary surgical removal and reducing patient morbidity. Regenerative biomaterials also exhibit excellent mechanical properties, providing necessary structural support to damaged tissues while they heal. This includes appropriate strength and elasticity that mimic natural tissues, ensuring stability and function. Osteoconductivity and osteoinductivity are crucial for bone regeneration, offering a framework for new bone formation and inducing the differentiation of progenitor cells into osteoblasts, respectively. These properties make them ideal for orthopedic and dental applications. Both autologous and allogeneic graft therapies are utilized for osteogenic regeneration present substantial limitations, prompting the exploration of alternative methodologies. One promising approach involves isolating and expanding harvesting mesenchymal stem cells (MSCs) from the patient and inoculating them onto porous, tridimensional scaffolds. During ex vivo cultivation, exposure to signalling molecules within the medium induces MSCs to differentiate into osteogenic cells. This bioengineered tissue can subsequently be the prosthetic apparatus was precisely positioned at the location of the defect, where it facilitates osteogenesis as the scaffold undergoes progressive biodegradation.[1] Moreover, these biomaterials can promote angiogenesis, enhancing blood supply to the healing tissue and improving nutrient and oxygen delivery, which is critical for tissue repair. Antimicrobial properties are also significant, reducing the risk of post-surgical infections and improving overall patient outcomes. Controlled release systems embedded within these substrates ensure the protracted dispensation of growth factors, thereby optimizing the reparative milieu and bolstering protracted tissue regeneration. The flexibility and effectiveness of regenerative biomaterials make them ideal for a variety of medical applications, including orthopedics, dentistry, plastic and reconstructive surgery, cardiology, and neurology. Continuous advancements in this field hold substantial promise for improving patient outcomes and revolutionizing the approach