Current Issue

Background: Chronic liver disease (CLD) is associated with a spectrum of cardiovascular changes, often leading to cirrhotic cardiomyopathy. Aim: To assess echocardiographic changes in patients with CLD over a 12-month period in a tertiary care center. Materials and Methods: A total of 40 CLD patients were evaluated using transthoracic echocardiography at baseline, 6 months, and 12 months. Parameters were compared with 40 healthy controls. Results: Significant increases in interventricular septal thickness and left ventricular posterior wall thickness were observed over time. Doppler parameters also revealed early diastolic dysfunction in CLD patients. Conclusion: Serial echocardiography is valuable in detecting subclinical cardiac changes in CLD, enabling early intervention and optimized patient care. Keywords: Chronic liver disease, Echocardiography, Cirrhotic cardiomyopathy.

Background: Mobile phone usage has increased drastically in the present day, and that increases sedentary behaviour like using the mobile phone in a lying down posture or in a sitting posture without any physical activity. Earlier studies assessed the reaction between the screen time with the depression mainly not with anxiety and stress scores. Aim and objectives: The present study was undertaken to assess the screen time in young adults and assess the depression, anxiety, and stress scores. Materials and Methods: The present cross-sectional study recruited a total of 100 young adults after obtaining voluntary, written, informed consent. Mobile screen time was recorded using Apple's Screen Time and Google's Digital Wellbeing apps, respectively. Depression, anxiety, and stress scores were recorded using the DASS 21 questionnaire, which is a self-administered questionnaire. Results: Depression scores were significantly higher in the individuals using screen time for more than 6 hours. Anxiety scores were significantly higher in the individuals using screen time for more than 6 hours. Stress scores were significantly higher in the individuals with screen time of more than six hours. Conclusion: The present study results support that excessive screen time is associated with the excess amounts of depression, anxiety, and stress. Further detailed studies are recommended in this area and also to recommend to educate the young adults regarding excessive use of mobile phones. Keywords: Stress, Screen time, Young adults, Anxiety, Depression.

Background: Academic role play has immense importance in teaching and learning methods where students can perform the roles of a case study and explain the condition more clearly. They participate enthusiastically and with full attention and concentration.The details mentioned in the AETCOM are also be covered in the role play. However, the studies on role play implementation in the medical education in India are relatively less. Hence, the present study was undertaken. Aim and objectives: The present study was undertaken to observe the effectiveness of role play in vertical integration between physiology with forensic medicine. Materials and Methods: All the students were divided into 15 groups with 10 students in each group. The clinical topics were distributed to them, that is, drowning, carbon monoxide poisoning, Rigor mortis, Diabetes mellitus, and Parkinson’s disease. They have the freedom to select any of the topics. Groups are made based on their role numbers; that is, roll number 1 to roll number 10 is one group. This improves the interaction between the students. Teachers of both departments were appointed as mentors for each of the groups. To encourage the students a competition is announced and with three prizes. To test the importance of the role play an MCQ test for 20 marks was conducted on these topics before the preparation of the role play and also after the role play performance; one more MCQ test was conducted with different questions. Feedback was obtained at the end after the post-MCQ test. Results: There was a significant increase in the students' performance in the MCQ test conducted after the role play performance by the students. The majority of the students perceived that the role play was an effective tool to promote the active learning of the clinical topics. The majority of students agreed to implement the role play in the curriculum. Conclusion: The study provides results to support the implementation of role play in medical education to promote active learning and to promote the communication skills in the students. Further detailed studies with more integrations are recommended. Keywords: Role play, Academics, Medical Education, Teaching methods.

Background: The kidney exhibits significant anatomical and developmental variability that is crucial for clinical practice and embryological understanding. This study integrates cadaveric morphometry with histogenesis analysis to provide comprehensive insights into renal anatomy and tissue architecture. The present study conducted to quantify morphometric parameters (length, breadth, thickness, hilar anatomy) in 100 cadaveric kidneys and to analyse histogenesis features (nephron maturation, vascular patterning, incidental pathology) through microscopic examination. Materials and Methods: - Sample: 100 kidneys (50 paired specimens) from cadavers with no demographic restrictions. - Morphometry: Measurements of dimensions and hilar structures using Vernier calipers; photographic documentation. - Histology: Tissue sections stained with H&E, PAS, and Masson’s trichrome; evaluated for developmental and pathological patterns. - Analysis: Descriptive statistics (mean ± SD); comparative analysis (right vs. left kidneys). Results: In present study we found the morphometric measurements, Length: 6–11.5 cm (mean 9.2 ± 1.3 cm); right kidneys longer than left (p < 0.05). • Hilar variations: Classic arrangement (62%); atypical patterns (38%). • Renal arteries: Single (70%); multiple (30%). Histogenesis • Normal glomerulogenesis (88%); immature glomeruli (8%). • Vascular anomalies: Aberrant arteriolar branching (12%); fibromuscular dysplasia (5%). • Incidental pathology: Subcapsular hematoma (3%); cystic dilatation (2%). Conclusion: This study delineates the spectrum of renal morphometric variability and histogenesis patterns in cadaveric specimens. The findings underscore the importance of anatomical variations for surgical interventions and highlight subclinical developmental anomalies. Keywords: Kidney morphometry, cadaveric study, histogenesis, renal anatomy, developmental anomalies.

Background: Tobacco consumption is the most important preventable cause of disease and death among adults. In India according to GATS 2016-172 India tobacco prevalence is 28.6% of adults (42.4% males and 14.2% females) are tobacco consumers.10.7% adults (19% males and 2.0% females) use smoking tobacco.21.4% adults (29.6% males and 12.8% females) use smokeless tobacco2. Barrier factors such as sociocultural and demographic factors play crucial role and has impact on trends and patterns of prevalence among the rural population. Objective: To estimate the prevalence of tobacco consumption among rural population of both males and females in RHTC field practice area, Nalgonda District. Materials and Methods: Community based cross sectional study, was carried out in 11 adopted villages under RHTC field practice area in Nalgonda district under tertiary care teaching hospital from October 2021 to September 2022. Sample size of 488 study participants were obtained by multistage sampling technique. Results: The prevalence of tobacco consumption in the study population.106(21.5%) of the study group were tobacco consumers and 382 (78.5%) were non-consumers. Among the study population 71(29.7%) of males and 35(14.1%) of females consume tobacco and it shows statistically significance. 283(58%) knew that tobacco consumption causes cancer,121(25%) knew that it causes Respiratory disease,30(6%) knew that it causes CVD and 49(10%) knew it causes coronary heart diseases. Conclusions: This study concludes that the prevalence of tobacco consumption is mainly associated due to factors like having no formal education, doing skilled work and belong to middle and lower middle socio-economic groups. Education is the key area where majority of the tobacco consumers started between the age 11 – 20 years. So anti-tobacco education should be made compulsory in schools and colleges in their academic curriculum. Keywords: Tobacco consumption, Household, ex-smoker, Socio-demographic factors.

Background: Tuberculosis is one of the most common causes of death in world. Drug resistance has become more common in previously treated patients, who were treated irregularly or with improper regimens and doses. Aim is to look the clinico-microbiological profile, treatment outcomes, and follow-up of patients registered for DRTB and IRL at Puducherry tuberculosis unit. Materials and Methods: This study included 73 patients who were treated for drug-resistant tuberculosis at DRTB/IRL during 2014-2020. Their clinical condition, microbiological parameters, resistance pattern, laboratory profiles, and radiological results were taken. Patients with favourable and unfavourable outcomes were followed up using random sampling method and their current clinical findings, sputum smear status, and radiological data were recorded. Results: 73 patients were included with mean age of 43.83±15.20 years. Treatment outcomes as 78.08% cured, from cured patients 16% were died during follow up period, 1.4 % completed treatment, 4.1% died before completing treatment, 4.1% were lost to follow up and 2.7% had treatment failure. Previous TB history exists in 79.45% and 20.55% newly diagnosed. Conclusion: Treatment success occurred more than 3/4th of cases, which is higher than WHO of 75% success rate. 16% patients who died the follow up period of study, resulted an unfavourable outcome. Keywords: DRTB, Clinico-microbiological profile, Treatment outcomes, WHO.

Background: Tuberculosis (TB) is a major global health concern caused by Mycobacterium tuberculosis. First-line anti-tubercular drugs (ATT) are highly effective in treating TB, but their use is frequently associated with drug-induced hepatotoxicity, which may lead to treatment interruption, non-adherence, and potential development of drug-resistant TB. Aim: This study aims to evaluate the approach to diagnosing and managing patients with anti-tubercular therapy (ATT)-induced hepatitis, focusing on identifying risk factors and providing effective treatment strategies. Materials and Methods: This prospective observational study was conducted over a 24-month period, involving 300 patients diagnosed with TB. Among the study population, 180 patients had pulmonary TB, 100 had extrapulmonary TB, and 20 had multidrug-resistant (MDR) TB. Of the 300 patients, 270 did not develop hepatitis, while 30 experienced hepatotoxicity. The onset of hepatitis was predominantly observed at 3 weeks following the initiation of ATT. Patients’ liver function was closely monitored through regular serum transaminase and bilirubin level assessments. Results: The incidence of ATT-induced hepatotoxicity was found to be significant, with 10% of patients developing hepatitis. The onset of liver dysfunction typically occurred around 3 weeks after starting ATT. Hepatotoxicity was more prevalent in elderly patients and those with pre-existing comorbid conditions such as diabetes and hepatic dysfunction. Conclusion: ATT-induced hepatotoxicity remains a common complication in TB treatment, necessitating close monitoring of liver function, especially in high-risk groups. Regular monitoring of liver enzymes, particularly in older patients or those with comorbidities, is crucial to prevent severe liver damage and to ensure effective management of TB. Keywords: Tuberculosis, ATT-induced hepatitis, Transaminases, Bilirubin.

Background: Evaluation of Response and Toxicity in Patients Receiving NACT with Platinum + Taxane Vs Platinum+Taxane+5FU for Head and Neck Squamous Cell Carcinomas. Materials and Methods: The present longitudinal observation study was conducted in Department of Radiation oncology, Gandhi Medical College and associated Hamidia Hospital (GMC & HH), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P), on a total of 54 patients of Head and Neck Squamous Cell Carcinoma from 1st July 2022 to 31st December 2023, a period of 18 months. Fifty-four patients were randomized into two groups, receiving either TPF or TP regimens Responses were assessed using RECIST 1.1 criteria, and toxicities were evaluated using CTCAE v5.0. Results: Partial responses were observed in 65% and 48% of patients in the TPF and TP groups, respectively. Grade 3-4 toxicities, including hematological and gastrointestinal events, were more frequent in the TPF group (72%) compared to the TP group (41%). Conclusion: While the TPF regimen demonstrated superior response rates, it was associated with higher toxicity. The TP regimen may be preferred for patients with poor performance status or significant comorbidities. Keywords: Neoadjuvant therapy, chemotherapy, squamous cell carcinoma, oral cavity

Background: hs-cTnI (high-sensitivity cardiac troponin) is a biomarker that is used widely in the identification and assessment of ischemic heart pain in the emergency departments of Indian Institutes. However, the clinical effect of the eCABG (emergency coronary artery bypass grafting) is underestimated. Aim: The present study was aimed to evaluate the clinical effect of measuring high-sensitivity cardiac troponin at the emergency department by comparison of eCABG in subjects with (NSTE-ACS) non-ST-segment elevation acute coronary syndrome that includes UA (unstable angina) and NSTEMI (non–ST-segment– elevation myocardial infarction). Materials and Methods: The present study assessed 484 subjects who underwent emergency coronary artery bypass grafting and were divided into groups based on serum high-sensitivity cardiac troponin levels. The primary outcome assessed was a major cardiovascular cerebral event (MACCE) defined as stroke, repeat revascularization, myocardial infarction, and all-cause death collectively. The incidence of each MACCE along with postoperative complications such as hospital duration, atrial fibrillation, re-surgery, and acute kidney injury were compared. Results: 484 subjects were divided into 2 groups unstable angina with <0.04 ng/ml and comprised of 204 subjects and NSTEMI with ≥0.04 ng/ml and comprised of 280 subjects. MACCE incidence showed no difference in the two study groups. In the NSTEMI group, postoperative acute kidney injury was more frequently seen with p=0.03. Also, hospital stay duration was significantly higher in the NSTEMI group compared to the UA group with p=0.007. Conclusions: The present study concludes that emergency coronary artery bypass grafting in non–ST-segment–elevation myocardial infarction and unstable angina subjects result in comparable outcomes. However, elevated levels of hd-cTnI in an emergency can be correlated to immediate postoperative complications. Keywords: coronary artery bypass grafting, eCABG, MACCE, NSTEMI, hs-cTnI (high-sensitivity cardiac troponin).

Background: AMH levels are usually high in subjects with high BMI and obesity, which is a peculiar feature of PCOD. Hence, higher AMH levels in females with PCOD can be attributed to increased AMH secretion from an increased number of small antral follicles. Aim: The present study aimed to evaluate the relationship between BMI (bone mass index) and serum AMH (anti-mullerian hormone) levels in infertile females with and without PCOD (polycystic ovarian disease). Materials and Methods: The present study assessed 400 females who visited the Institute within the defined study period. All subjects underwent gynecological assessment and basic infertility tests, including BMI. All females' AMH levels were assessed, and subjects were divided into two groups: subjects with PCOD and subjects without PCOD. Results: The study results showed an overall AMH level of 4.84±4.42 ng/ml. No significant correlation was seen in AMH and BMI levels in females without PCOD with p>0.05. However, in subjects with PCOD, a significant inverse correlation was seen in AMH and BMI levels with p<0.05. Conclusions: The present study concludes that there is no significant correlation between AMH and BMI levels in infertile females without PCOD. However, in females with PCOD, there is a significant inverse correlation between serum AMH levels to BMI. Keywords: Antimullerian hormone, body mass index, Infertility, polycystic ovarian disease.

Background: Accurate selection of endotracheal tube (ETT) size in paediatric patients is critical to ensure safe and effective airway management. Traditional age-based formulas, such as the Motoyama formula, may not account for individual anatomical variations. Aim: This study aimed to evaluate the reliability of ultrasonography (USG) in determining the appropriate ETT size and compare it with the Motoyama formula. Materials and Methods: A prospective observational study was conducted on 64 paediatric patients aged 2–12 years undergoing elective surgeries under general anaesthesia at a tertiary care hospital in Gujarat. Subglottic diameter was measured using ultrasonography, and the appropriate ETT size was selected accordingly. This was compared with the size predicted by the Motoyama formula. The number of ETT changes required, time taken for USG, and clinically best-fit tube based on air leak test were recorded. Results: The mean subglottic diameter measured by USG was larger than the inner diameter predicted by the Motoyama formula. USG-based selection showed fewer tube changes and better correlation with the clinically best-fit ETT. The average time taken for USG was brief, supporting its feasibility in routine clinical practice. Conclusion: Ultrasonographic assessment provides a more accurate and individualized method for selecting ETT size in paediatric patients compared to traditional age-based formulas. Its routine use can enhance safety and efficiency in paediatric airway management. Keywords: Ultrasonography, Endotracheal Tube, Paediatric Airway.

Background: Total thyroidectomy is the standard surgical approach for benign and malignant thyroid diseases, traditionally performed via a transverse cervical (Kocher’s) incision. While effective, conventional methods often lead to increased scarring, postoperative pain, and longer recovery times. The Single Lateral Incision Total Thyroidectomy (SLITT) technique aims to minimize these drawbacks while maintaining surgical efficacy. Materials and Methods: This prospective observational study, conducted from January 2021 to January 2025, evaluated the feasibility, safety, and outcomes of the Single Lateral Incision Total Thyroidectomy (SLITT) technique in 270 patients. The SLITT technique was introduced by a surgeon from North Kerala, India, at EMS Memorial Co-operative Hospital, Perinthalmanna, and aims to provide a less invasive, cosmetically favorable alternative to conventional thyroidectomy. Patients underwent comprehensive preoperative assessment, and the surgery was performed through a single lateral incision, ensuring preservation of vital structures. Postoperative monitoring focused on complications, recovery, and patient satisfaction. The study highlights SLITT as a promising technique with potential advantages in cosmesis, recovery time, and surgical safety. Results: The retrospective analysis of 270 SLITT procedures demonstrated excellent surgical and postoperative outcomes. The majority of patients were female (86.3%) with a mean age of 44.6 years. Multinodular colloid goitre (76.3%) was the most common histopathological finding, and 95.6% underwent a right lateral incision with minimal blood loss (mean 13.9 mL) and a short operative time (mean 13.8 min). Postoperatively, complications were rare, with 87% experiencing no adverse events, and the mean hospital stay was just 2 days. Pain levels were minimal, with 100% pain-free status by 30 days. By 90 days, all scars were completely invisible, indicating excellent cosmetic and recovery outcomes. Conclusion: The SLITT technique offers a safe, efficient, and minimally invasive alternative to conventional thyroidectomy. In 270 patients, it demonstrated minimal blood loss, a short operative time, low complication rates, excellent pain control, and complete scar resolution by 90 days. These findings highlight its superior recovery, aesthetic benefits, and high patient satisfaction. KeyWords: Conventional Open Approach, Lateral Approach, National Comprehensive Cancer Network, Single Lateral Incision Total Thyroidectomy.

Background: The aim is Toxicity Analysis in Carcinoma Breast Patients Treated with Conventional and Hypofractionated Radiotherapy. Materials and Methods: A Longitudinal observation study was carried out at the Department of Radiation Oncology, Gandhi Medical College, along with the associated Hamidia Hospital (GMC & HH), Bhopal (M.P), and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P) from 1st July 2022 to 30th Dec 2023.This study involved a cohort of 68 patients diagnosed with breast cancer. Results: In our study, comparable rates of cardiac toxicity, assessed using RTOG criteria, were observed among breast carcinoma patients treated with either conventional or hypofractionation radiotherapy across various intervals. At 0 months, both treatment arms reported Grade 1 cardiac toxicity in 1 patient (2.94%) and no toxicity in 33 patients (97.06%), showing no significant difference (P = 1.0000). Conclusion: We conclude that hypofractionated radiotherapy is comparable to conventional radiotherapy in terms of adverse effects and locoregional tumor control, making it a safe and effective alternative for postmastectomy breast cancer patients in adjuvant settings. Hypofractionated radiotherapy results in similar cardiac and pulmonary toxicities as conventional fractionation and is a viable alternative for breast cancer patients. Keywords: Breast cancer, hypofractionated radiotherapy, late skin toxicity, survival.

Background: Aim: Descriptive study of female factor infertility by clinical, hormonal, sonological and endoscopical evaluation. Materials and Methods: Prospective Observational study conducted with a detailed history, clinical examination and basic investigations including HSG, USG, FSH, thyroid profile, prolactin were done in 100 cases of infertile women. Results: Out of 100 cases 68 cases were primary infertile and 32 were secondary infertile. The major infertile patients having duration of infertlity is 1-5 yrs i.e. 54%, in that Primary Infertile are 57%, Secondary infertile are 47%. Majority of secondary infertile women, 19 cases (59%) had previous history of abortions. Uterine factors accounted for 6% of infertility cases. 23 (33.82%) primary, 17 (53%) secondary infertile women had abnormal HSG findings. Most common being B/L tubal block, which contributes 15%, in this 13% primary and 22% secondary. Ovarian factors contributed to 49% of the cases in which laparoscopy was performed. 36% of primary and 13% of secondary infertility was caused by ovarian factors. PCOS was the leading ovarian factor responsible for infertility. Tubal factors were responsible for 22% primary and secondary infertility cases. Out of 8 cases of B/L tubal blocks, 6 were primary and 2 were secondary infertile. Uterine abnormalities contributing to 14% of total cases in which laparoscopy was performed. Peritoneal factors accounted for 21% cases of infertility. Among peritoneal factors, pelvic adhesions was found to be the leading factor. Majority of Infertility patients (70%) had B/L positive chromopertubation. Bilateral negative dye test was seen in 14% cases. Conclusions: All the clinical, harmonal, sonological and laproscopic findings are required in evaluation of all infertile patients. It will also be possible in formulating a specific plan of management and segregate the patients who will need ART at the earliest. Keywords: Assisted Reproductive Technology(ART), PolyCystic Ovarian Syndrome(PCOS), Hysterosalpigography (HSG).

Background: Oral squamous cell carcinoma (OSCC) is the most common type of oral cavity malignancy, with the tongue being one of the most commonly affected sites. It can also cause dysphagia (difficulty swallowing), dysarthria (difficulty speaking), and paresthesia (numbness) of the tongue or mouth. The use of tobacco products, excessive alcohol consumption, HPV infection, a weak immune system, genetics, and oral irritation are the main factors that cause tongue cancer. Surgical excision with negative margins is the primary goal . Obtaining clear margin especially deep margin is difficult due to complex anatomy and poor assessment of spread of tumour . Aims and objectives: The study aims to identify whether USG-guided assisted resection of primary tongue lesions will help in the resection of adequate margins when compared with final histopathology. Materials and Methods: A total of 91 patients with diagnosed tongue malignancies were observed at Krishna Institute of Medical Sciences' surgical oncology department from 2020 to 2023, after obtaining written consent. Cases studied prospectively without randomization. A single pathologist reviewed the pathology specimen. The primary goal of this study is to delve into the potential impact of ultrasound-guided assistance during the resection of primary tongue lesions. Results: A total of 91 patients were included in the study. Most of the patients in our study are in the T2 stage, 36/91 i.e., 39.5 %. Deep margin as an outcome measure. The mean deep margin assessed by USG in our study was 0.901cm+/- 5.2 mm (mean +/- SD), and the mean deep margin assessed by the frozen section is. 0.762 cm +/- 4.8 mm. Higher stage T3 and T4 were strong predictors for inadequate deep margin but they were assessed correctly by USG assessment and allowed us to revise the margins to prevent close and positive margins. Conclusion: Ultrasound-guided surgery for tongue cancer resection is a technique that increases the chances of achieving clear margins and reduces the likelihood of positive margins compared to standard methods. Performing ex-vivo ultrasound on the resected specimen enables the assurance of extra clear margins. However, it's important to maintain consistent orientation of the specimen during both surgery and histopathological evaluation. Keywords: Ultrasonography, tongue, squamous cell carcinoma.

Background: Hemorrhoidal disease is one of the most common proctological disease and affects between 7 and 30% of the general population. Open hemorrhoidectomy is the current gold standard. However, it is associated with significant pain, bleeding and wound infection which can result in prolonged hospital stay. Laser hemorrhoidoplasty (LHP) is a new minimally invasive and painless procedure for symptomatic hemorrhoids. But there is conflicting evidence regarding their resolution of symptoms and recurrence rates. Materials and Methods: This is a prospective observational study conducted in a tertiary hospital in Visakhapatnam from January 2021 to December 2023. A total of 80 patients presenting with symptomatic grade III hemorrhoids were included in the study, of whom 40 underwent Laser Hemorrhoidoplasty (LHP) and 40 underwent open hemorrhoidectomy. Group selection was done by simple randomization using the lottery method. Postoperative pain levels were measured every day at rest during the entire hospital stay using the Visual Analog Scale (VAS). All patients received a follow-up after 15 days, 3months, 6 months and 1 year postoperative. Results: The MM procedure presented longer mean operative time (27 ± 3.7min vs 15 ± 2.3 min, p < 0.0001) and longer hospitalization (3.8 ± 1.2 vs 1.3 ± 0.7 days, p < 0.0001). Mean postoperative pain score evaluated through the visual analog scale (VAS) was significantly lower in LHP group (p < 0.0001) at each follow-up point. Patients after LHP returned to regular activity after 6.8± 1.4 days vs 13.6± 2.8 days after MM procedure (p < 0.001). 1 year follow up showed a higher recurrence rate after LHP procedure (15% vs 2.5%, p < 0.05). Conclusion: LHP is a safe, minimally invasive procedure with benefits in operative time, blood loss, postoperative pain and quicker return to activity, though recurrence rates might be higher. Though MM has immediate postop disadvantages including significant postoperative pain, this technique does result in a low risk of symptom recurrence. Keywords: LHP- Laser Hemorrhoidoplasty, MM- Milligan-Morgan (open haemorrhoidectomy), Hemorrhoidal disease.

Background: Labour pain is one of the most intensifying pain a women experience in her lifetime surpassing all expectations. A variety of labour analgesia options are available but neuraxial techniques such as epidural analgesia have emerged as the most acceptable world wide in managing labour pain effectively while minimizing the adverse effects in the parturients and the fetus. The aim & objective are 1. To estimate efficacy of 0.0625% bupivacaine &0.0002% fentanyl combination on Labour outcome 2. To study the effect of 0.125% bupivacaine alone on Labour outcome 3. To compare the effectiveness of 0.0625% bupivacaine & 0.0002% fentanyl combination with 0.125% bupivacaine alone on Labour. Materials and Methods: This randomized study was undertaken in department of Anaesthesiology in collaboration with Obstetrics & Gynaecology department and the Dept. of paediatrics in Hi-Tec medical college over a period of 2 years. Sixty ASA category I parturients at term with vertex presentation of a single live foetus in the 18-35 years age group were divided into two groups randomly, one receiving 0.0625% bupivacaine with 0.0002% fentanyl (Group A) and the other 0.125% bupivacaine alone(Group B). A 12ml bolus dose of the test solution at the rate of 2-3 ml/min followed by a continuous infusion of test solution at the rate of 10 ml/hr (range 8-15 ml/hr) till complete cervical dilatation. Maternal heart rate, blood pressure, foetal heart rate, visual analogue scale (VAS) score, intensity of analgesia, duration of labour, mode of delivery, maternal outcome were assessed. Results: No significant difference (P>0.05) were observed in haemodynamic profile, foetal heart rate, duration of labour, intensity of analgesia, mode of delivery, maternal satisfaction or neonatal outcome in both the groups. Group A required a higher infusion rate for maintenance, shorter time of onset of analgesia, lower quantity of bupivacaine, lesser incidence of motor paresis with a higher ambulation rate of 96% as compared to group B. Conclusion: Low dose bupivacaine with the short acting fentanyl can make labour and delivery a pain free process without compromising maternal and neonatal outcome while improving maternal satisfaction by enabling ambulation and reducing motor paresis thus providing a wholesome, satisfying experience to the obstetrician, anaesthesiologist and paediatrician. Keywords: Labour analgesia, Bupivacaine, Parturients, Epidural anaesthesia.

Background: Thrombocytopenia is a common haematologic abnormality in pregnancy, with moderate-to-severe cases potentially leading to adverse maternal and foetal outcomes. This study aimed to evaluate the maternal and foetal outcomes in pregnant women with mild-to-severe thrombocytopenia. Materials and Methods: This prospective observational study included 100 pregnant women at the Institute of Obstetrics and Gynaecology, Madras Medical College, over a year. Women in their third trimester with mild-to-severe thrombocytopenia (platelet count <100 × 109/L) were included. Clinical data, including maternal age, parity, gestational age, diagnosis, mode of delivery, and complications, were recorded. Foetal outcomes, such as birth weight, APGAR scores, neonatal complications, and platelet counts, were also analysed. Results: The most common cause of thrombocytopenia was severe preeclampsia (48%), followed by gestational thrombocytopenia (31%) and immune-mediated thrombocytopenia (7%). Most patients (92%) had moderate thrombocytopenia, whereas 8% had severe thrombocytopenia. Most deliveries were vaginal (59%), followed by emergency caesarean sections (37%). Postpartum haemorrhage (17%) and acute kidney injury (7%) were the most frequent maternal complications. Neonatal complications included transient tachypnoea of the newborn (23%) and perinatal asphyxia (11%). The overall live birth rate was 97%, with two stillbirths and one intrauterine foetal death. Conclusion: Moderate to severe thrombocytopenia during pregnancy, particularly in association with hypertensive disorders, is linked to increased maternal morbidity and adverse foetal outcomes. Early recognition and appropriate management can improve the prognosis. Notably, gestational thrombocytopenia had no significant adverse effects, and platelet counts normalised postpartum. Keywords: Thrombocytopenia in pregnancy, severe preeclampsia, maternal outcomes, foetal outcomes, platelet count.

Background: Airway management in patients with restricted mouth opening in emergency and elective surgeries becomes a major concern for anaesthesiologist. Although fiberoptic intubation is the generally accepted method for managing difficult airway, it may not be available in all the hospitals, requires patient cooperation and appropriate training. So awake blind nasal intubation can be useful in management of difficult airway. The aim of this study was to evaluate the usefulness of blind nasal awake intubation as an alternative technique when fiberoptic equipment is unavailable and insertion of ILMA not possible in patients of restricted mouth opening. Materials and Methods: This prospective observational study was carried out in 150 adult patients of either sex aged between 30 and 65 years with restricted mouth opening posted for elective surgery. Awake blind nasal intubation was carried out in a conscious sedated patient with proper airway preparation. The monitoring of breath sound becomes the key for successful intubation. We carried out awake intubation with the help of cuff inflation technique (the cuff of ETT is inflated in the oropharynx to help guide the tip of the tube into the trachea) along with monitoring by capnography and breath sounds. We have recorded manipulation in position of head and neck, number of attempts, failure of intubation and complications. Results: Out of 150 patients, 81(57.4%) patients were intubated in sniffing position, 32(22.6%) patients required increased neck flexion and 28(19.8%) required increased neck extension. 9 patients had failed intubation.47 patients(31.3%) were intubated in 1st attempt,43 patients (28.6%) were intubated in 2nd attempt and 51 patients (34 %) were intubated with 3 attempts. Conclusion: Awake blind nasal intubation is an alternative technique when there is non- availability of fibre optic or ILMA in patients of restricted mouth opening. Key words: Difficult airway, Restricted mouth opening, Blind nasal awake intubation.

Background: Medical Termination of Pregnancy (MTP) is a critical component of reproductive healthcare legally permitted under specific conditions. Understanding the trends and justifications for MTP is essential for optimizing clinical practice and ensuring legal compliance. This study aimed to evaluate the indications and socio-demographic factors associated with MTP over a three-year period at a tertiary care teaching hospital in India. Materials and Methods: A retrospective analysis was conducted on 355 women who underwent MTP between January 2022 to December 2024. Data was collected from hospital records using a structured proforma. Variables included age, parity, area of residence, gestational age, method of MTP, indication for MTP, presence of fetal congenital anomalies, and post-MTP contraception advised. Only cases with complete records and procedures conducted within the legal framework were included. Descriptive statistics were used for analysis. Results: Maximum women were belonging to age group of 26–30 years (37.18%), and the majority were rural residents (58.59%). Most women (88.45%) were married, and 42.54% had ≤2 children. MTPs were predominantly performed within 12 weeks of gestation (48.73%). The leading indication was contraceptive failure in married women (60.56%) followed by presence of fetal anomalies (23.66%) and pregnancies resulting from sexual assault (rape) (11.27%). Among anomaly-related terminations, syndromic disorders (3.94%), cystic hygroma (3.10%), and neural tube defects (2.82%) were most common. Post-MTP contraception predominantly included tubal ligation (44.51%) and barrier methods (40%). Conclusion: Contraceptive failure remains the dominant indication for MTP underscoring the urgent need for robust contraceptive counselling and access, especially in rural areas. Keywords: Medical Termination of Pregnancy, Tubal Ligation, Contraceptive Failure, Maternal health.

Background: Worldwide, acute appendicitis ranks high among the most common reasons for urgent abdominal surgery. To avoid complications like perforation and peritonitis, an early and precise diagnosis is crucial. Because it does not involve any radiation, is inexpensive, and does not require any incisions, ultrasonography (USG) has found extensive application. Nevertheless, there is still some debate regarding the veracity of specific ultrasonographic results. Acute appendicitis is the intended diagnosis, and this study intends to assess the diagnostic utility of particular USG markers in that regard. Materials and Methods: One hundred fifty patients admitted to a tertiary care hospital with symptoms of acute appendicitis were followed prospectively for a year. This study was conducted at the department of Pathology, Government Medical College Mancherial, Telangana, India from the May 2024 to December 2024. Ultrasound was used to evaluate all patients, checking for important signs including appendiceal diameter, wall thickening, peri-appendiceal fluid, hyperaemia, and appendicolith. Intraoperative and histological findings were compared with the ultrasonographic findings. Results: After reviewing the surgical and histological results, 110 out of 150 individuals were determined to have acute appendicitis. Hyperaemia on Doppler imaging (sensitivity: 88.2%, specificity: 82.5%), peri-appendiceal fluid (sensitivity: 72.3%, specificity: 89.1%), and an appendiceal diameter >6 mm (sensitivity: 85.4%, specificity: 78.9%) were the most dependable ultrasonographic markers. A specificity of 92.3% and a lesser sensitivity of 45.5% were observed in 30 cases when appendicolith was present. A diagnosis accuracy of 93.5% was achieved through the integration of various ultrasonographic results. Conclusion: When diagnosing acute appendicitis, ultrasonography is still quite useful. Hyperaemia and appendiceal diameter > 6 mm were highly sensitive results, while appendicolith and peri-appendiceal fluid were highly specific. Misdiagnosis is less likely when numerous ultrasonographic markers are combined. If we want to see better clinical results and more accurate diagnostic techniques, we need more large-scale investigations. Keywords: Acute appendicitis, Ultrasonography, Appendicolith, Sensitivity, Specificity.

Background: Psychological stress (PS) leads to different physiological responses including increased heart rate (HR) as well as decreased heart rate variability (HRV) through alterations in the autonomic nervous system (ANS), specifically increased sympathetic nervous system (SNS) activity and decreased parasympathetic (PNS) activity. Emerging evidence indicates that PS advances to certain alteration in the kidneys, which leads to increase in protein excretion and expression of high and low molecular weight proteins in the urine. Currently investigated biochemical markers for confirmation of stress include invasive, cumbersome and costly markers. This issue arises a need to introduce non-invasive and affordable stress markers which can be used globally. Materials and Methods: A total of 120 cases and 106 controls (who were without any obvious stress) belonging to age group of 20 to 60 years were selected. Patients were evaluated for clinical history and assessed by the psychiatric stress scale, perceived stress scale (PSS) and presumptive social life event scale (PSLE). HRV was measured by ECG using lead II configurations using both time domain and frequency domain methods. Urinary protein was analysed by Vitros 5.1 FS from Ortho Clinical diagnostics by Johnson and Johnson USA. Results: PSS was most strongly correlated with Power (ms2) LF/HF followed by Power (nu) HF and Power (nu) LF with a correlation coefficient of 0.805, -0.695 and 0.592 respectively. PSLE had a significant relation with Protein: Creatinine ratio. Conclusion: In short term HRV, frequency domain parameters had significant correlation with perceived stress and proteinuria had significant correlation with PSLE. Keywords: Stress, PSS, PSLE, HRV, Proteinuria.

Background: Vertebral compression fractures (VCFs) are common in aging populations and can result from osteoporosis, trauma, malignancy, or infection. Differentiating between benign and malignant causes is critical for appropriate treatment. MRI is a key diagnostic tool, but its sensitivity and specificity in identifying the etiology of VCFs require further evaluation. This study aims to assess the diagnostic accuracy of MRI in distinguishing different causes of vertebral compression fractures. Materials and Methods: This prospective study was conducted at Apollo Hospital, Hyderabad, including 49 patients with vertebral collapse who underwent MRI. Patients were categorized based on the etiology of VCFs: osteoporotic, traumatic, malignant, or infectious. Various MRI features such as pedicle involvement, posterior element destruction, epidural mass, and paraspinal soft tissue involvement were analyzed for their sensitivity and specificity in diagnosing VCF causes. Histopathology and clinical follow-up were used as reference standards. Results: Among 49 patients, 53% were male and 47% female, with the majority (67%) having dorsal vertebral involvement. Osteoporotic fractures accounted for 35%, malignant 27%, traumatic 20%, and infectious 18%. MRI features such as pedicle involvement (92% sensitivity, 91% specificity), convex posterior border (53% sensitivity, 94% specificity), and epidural mass had high specificity for malignancy. Contiguous vertebral involvement and endplate disruption were more indicative of benign fractures. A combination of MRI features significantly improved diagnostic accuracy. Conclusion: MRI is a highly specific tool for differentiating malignant from benign VCFs, particularly when multiple significant features are present. Pedicle involvement and convex posterior border are among the most reliable indicators of malignancy. Early and accurate MRI-based diagnosis is essential for guiding appropriate clinical management. Keywords: Vertebral compression fracture, MRI, malignancy, osteoporosis, pedicle involvement, diagnostic accuracy, spinal imaging.

Background: Transitional cell carcinoma of the bladder is a common malignancy of the urinary tract, with lymph node involvement being a key determinant of prognosis and treatment strategies. While lymph node metastasis is generally associated with invasive bladder cancer, its presence in non-invasive transitional cell carcinoma remains uncertain. This study aims to evaluate the incidence, risk factors, and prognostic implications of pelvic lymph node involvement in patients with non-invasive transitional cell carcinoma of the bladder. Materials and Methods: A retrospective analysis was conducted on 50 patients diagnosed with non-invasive transitional cell carcinoma of the bladder. Data on clinical presentation, tumor grade, pathological staging, lymph node dissection status, and recurrence rates were collected. Patients were categorized based on lymph node involvement and assessed for correlations with tumor characteristics and disease progression. Statistical analyses were performed to identify predictors of lymph node metastasis in this cohort. Results: Among the 50 analyzed cases, lymph node metastasis was identified in a subset of patients with non-invasive transitional cell carcinoma. The presence of lymph node involvement correlated with higher tumor grade, multifocality, and carcinoma in situ. Additionally, patients with lymph node-positive disease exhibited a significantly higher recurrence rate and reduced disease-free survival compared to those without lymph node involvement. Conclusion: Although rare, lymph node involvement can occur in patients with non-invasive transitional cell carcinoma of the bladder and is associated with a more aggressive disease course. Careful risk stratification is essential to identify patients who may benefit from more extensive staging and early intervention. Further prospective studies are required to refine treatment guidelines and improve outcomes in this subset of bladder cancer patients. Keywords: Transitional Cell Carcinoma, Bladder Cancer, Non-Invasive Bladder Cancer, Lymph Node Metastasis, Pelvic Lymph Node Dissection, Carcinoma in Situ, Bladder Tumor Staging, Disease Recurrence.

Background: Aim: The study aims to evaluate the role of ultrasonography in assessing first-trimester vaginal bleeding, identifying potential risk factors, and correlating ultrasound findings with clinical and laboratory parameters to predict pregnancy outcomes. Materials and Methods: This prospective observational study was conducted on 120 pregnant women aged 18–40 years presenting with first-trimester vaginal bleeding at a tertiary care hospital. Inclusion criteria included gestational age between 5–13 weeks confirmed by the last menstrual period (LMP) and/or ultrasound. Patients with ectopic or molar pregnancies, uterine anomalies, or hemodynamic instability were excluded. All participants underwent transabdominal and/or transvaginal ultrasound evaluation for gestational sac, fetal pole, cardiac activity, subchorionic hematoma, cervical length, and adnexal structures. Laboratory investigations included serum β-hCG levels, hemoglobin levels, Rh typing, and inflammatory markers. Statistical analysis was performed using SPSS 25.0, with significance set at p < 0.05. Results: The majority of participants were in their late twenties, with a mean gestational age of approximately 9 weeks. Ultrasonographic assessment confirmed the presence of a gestational sac in most cases, with fetal cardiac activity detected in over 70% of cases. Subchorionic hematoma and cervical length abnormalities were notable findings. Patients were categorized into viable intrauterine pregnancies, threatened abortion, inevitable abortion, incomplete abortion, missed abortion, complete abortion, and molar pregnancy. Laboratory findings revealed elevated β-hCG in most cases, with a significant proportion exhibiting anemia and inflammatory markers. While over half of the pregnancies continued successfully, a substantial number resulted in miscarriage, necessitating surgical intervention in some cases. Conclusion: Ultrasonography is a crucial tool in the evaluation of first-trimester bleeding, allowing for early detection of pregnancy complications. Laboratory investigations complement ultrasound findings in predicting pregnancy outcomes. Early identification of high-risk pregnancies enables timely medical intervention, improving maternal and fetal outcomes. A multidisciplinary approach involving obstetricians, radiologists, and laboratory specialists is recommended for optimal patient management. Keywords: Ultrasonography, First-trimester bleeding, Pregnancy outcomes, Subchorionic hematoma, Foetal viability.

Background: Intramedullary interlocking is currently considered the treatment of choice for femoral shaft fractures, with high rates of fracture union, advantage of early stabilization which decreases the morbidity and mortality rate in patients, allows early mobilization, reduces the incidence of infection, malunoin, non union or implant failure. Objectives of the study: To assess the time taken for bone union and the functional outcome in patients with fracture shaft of femur. Materials and Methods: We studied a total of 30 patients of fracture shaft of femur admitted in the Orthopaedic Department of Kakatiya Medical College, Warangal treated with closed intramedullary interlocking nailing. 23 patients were male and 7 were females and age group ranged from 18-49 years with mean age 30 Yrs. right side fractures encountered in 18 cases and 12 left side. 24 fractures were closed and 6 fractures were open type. 5 fractures were in proximal third, 19 fractures were in the middle third and 6 in distal third of femur. Duration of study 1 year{From September 2023 to August 2024}. Results: Duration between injury and surgery was <24 Hours in 6.67%, 24-72 hours in 50% and 4-7 Days in 43.3%.Duration of hospital stay was average 11.43 days ranging from 06-22days. Mean time for union was 21.3 weeks ranging from 16-32weeks.There were two cases of superficial infection and no deep infection. Excellent to Good result in 90% cases. Conclusion: We conclude that closed intramedullary interlocking nailing after is an excellent technique for the treatment of femoral shaft fracture. It is an excellent mode for treatment of complex, comminuted and unstable femoral fracture. It reduces the incidence of malunoin and maintains length of the bone. Minimal soft tissue injury during surgery, early rehabilitation ensures complete restoration of motion. It is a safe method in management of Type I& II compound fractures Key-words: Fracture; shaft; femur; closed; interlocking; intramedullary; nail; diaphyseal.

Background: To study the functional and radiological outcome of Acetabular fractures treated by open reduction and internal fixation. Materials and Methods: It was a prospective study, in our study we have selected cases of unstable acetabular fractures. The study was done from November 2023 to December 2024.The age group differs from 18 – 70 years, among them16 males and 4 females.Among 20 patients right side involvement is seen in 13patientsand left side involvement is seen in 7 patients.Mean follow up was done for 12 months. All the classification have been classified by Letournel and Judet classification. All the cases were followed up and were evaluated for radiological and functional outcome .X-ray pelvis isused for assessing the radiological outcome, AP view, Obturator Oblique view and Iliac oblique views were used for assessment. For evaluating the functional outcome Merle D’Aubigne and Postel modified clinical grading system is used. Results: In the present study, According to Matta’s criteria, 8 patients had anatomical reduction, 8 patients had satisfactory reduction and 4 patients had poor reduction (>3mm gap). Out of 20 patients, 6 patients had excellent, 3 patients very good, 6 patients good, 3 patients fair, 2 patients had poor results. 70% of the patients are having near normal life and 10% patients are having satisfactory result in our study Functional outcome score for the patients ranged from11 –18, (maximum score –18).The poor result (score – 8,9) in 2 patients was due to post traumatic arthritis, improper post op mobilisation due to poly trauma. All patients with anterior column fracture, posterior wall had excellent or good result 00 ‘except one patient who had fair result due to Heterotopic ossification. Three patients with fair outcome had minor wound infections treated with antibiotics and it healed. Conclusion: From our study we conclude that complex acetabular fractures treated by open reduction and internal fixation have satisfactory functional outcome. Keywords: Acetabular fractures, Matta’s Criteria, Anatomical Reduction, Heterotopic Ossification, Poly trauma.

Background: Low back pain (LBP) is a major health and socioeconomic problem in modern society. It constituted about 37% of occupational risk factor and occupies first rank among the disease complications caused by work. Aim: To study the effectiveness of epidural steroid injection in alleviating symptoms caused by prolapsed intervertebral disc. Materials and Methods: It was a prospective study, Patients with low backache visiting Mahatma Gandhi Memorial Hospital, Warangal, from October 2023 to September 2024. Results: Out of 60 cases, 30 were given Epidural steroid and 30 were given Normal saline among them36 were interlaminar, 13 were transforaminal and 11 w ere caudal approach. In our study the mean age of the patients was 47.7. In our study out of 60 patients 40 were females and 20 were males. Significant results were seen when patients were followed at 2nd,3rd and 4th month when observed with VAS and ODI scores. Epidural steroid injection has also shown significant improvement compared to saline on SLRT.In case of SF36 bodily pain, general health and role of emotional showed a significant outcome at 6 months, however by 1 ½ years not much difference was seen. Interlaminar approach is found as the best approach for ESI (Interlaminar>Transforamina l > Caudal). The only one patient that shifted from epidural to discectomydidso due to worsening deficits and pain. Conclusion: The present study concluded that ESI is a viable modality for selected patients, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids, involving minimal risk. Keywords: Epidural Injection, VAS, Low back pain, SLRT, ODI.

Background: To study the effects of intravenous fluids given intraoperatively on graft function postoperatively. Materials and Methods: In this double blind study, patients were randomized into two groups (n1=35,n2=39) to receive either combination of normal saline & half normal saline or combination of normal saline & ringer lactate during renal transplantation. Arterial blood gas analyses were performed before induction of anesthesia, during vascular anastomosis, one hour after bladder clamp release and after extubation. Blood urea and serum creatinine were measured on first postoperative day and on second postoperative day. Urine output was recorded on first & second postoperative days. Results: There was a statistically significant increase in the highest serum potassium level, highest chloride level and increase in the serum chloride measured at the end of study in patients who received combination of NS & half NS. Statistically significant increase in blood urea & serum creatinine was seen in immediate postoperative period in patients who received combination of NS & Half NS. Conclusion: Serum creatinine was higher in group 1 than in group 2 preoperatively & immediate postoperatively. However the decrease in serum creatinine from baseline level to immediate postoperative level and that measured on first & second postoperative day were similar in both the groups. Keywords: Intravenous fluids, Renal transplantation, Acid-base balance, postoperatively.

Background: Neonatal sepsis is a significant cause of morbidity and mortality, particularly in developing regions such as Bundelkhand, Central India. The emergence of multidrug-resistant organisms has complicated the management of sepsis, making the identification of prevalent bacterial pathogens and their antimicrobial sensitivity patterns crucial. This study aims to analyze the clinico-bacteriological profile of neonatal sepsis and assess the antimicrobial sensitivity patterns of the isolated pathogens in a tertiary care center in Bundelkhand. Materials and Methods: An observational cross-sectional study was conducted, including 300 neonates with suspected sepsis admitted to the Neonatal Intensive Care Unit (NICU). Blood cultures were obtained, and the antimicrobial sensitivity patterns of the isolated pathogens were determined using standard laboratory methods. The neonates were categorized based on the onset of sepsis as early-onset (EOS) or late-onset (LOS). Results: Out of 300 neonates with clinical sepsis, 52% were culture-positive. Among the culture-positive cases, 75.6% were classified as EOS and 24.4% as LOS. The most commonly isolated pathogens were Gram-negative bacteria, including Klebsiella pneumoniae and Acinetobacter spp. The study also identified significant resistance patterns, particularly against commonly used antibiotics such as ampicillin and cephalosporins. Vancomycin and carbapenems showed higher sensitivity among Gram-positive and Gram-negative isolates, respectively. Conclusion: The high prevalence of multidrug-resistant organisms in neonatal sepsis underscores the need for continuous surveillance and tailored antimicrobial therapy in this region. The findings highlight the importance of region-specific studies to inform empirical treatment protocols and reduce neonatal mortality. Keywords: Neonatal sepsis, Antimicrobial sensitivity, Bundelkhand Central India, Gram- negative bacteria, Multidrug -resistant organism.

Background: The aim is to evaluate the impairment of oral sensations in patients treated with Three-Dimensional Conformal Radiotherapy (3DCRT) and Intensity Modulated Radiation therapy (IMRT) in head and neck cancer. Materials and Methods: This Longitudinal Observational study will be conducted in patients receiving IMRT and 3D-CRT from July 2022 to Dec 2023 in Department of Radiation Oncology at Gandhi Medical College (GMC), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital & Research Centre (JNCH & RC) Bhopal (M.P) from July 2022 to Dec 2023. Results: Both 3DCRT and IMRT are effective in managing head and neck cancers, IMRT offers superior outcomes in reducing dysphagia during and shortly after treatment. Both modalities ultimately achieve high rates of complete recovery, underscoring the effectiveness of modern radiotherapy approaches in managing treatment-related side effects. Conclusion: Our findings reveal that both treatment modalities have distinct impacts on dysesthesia and dysphagia, reflecting their differing mechanisms and target precision. The results indicates that, while pretreatment dysesthesia and dysphagia grades were similar between the two groups, significant differences emerged post-treatment. Keywords: Dysesthesia, Radiotherapy, Intensity Modulated Radiation therapy, Three-Dimensional Conformal Radiotherapy.

Background: The aim is to compare between intensity modulated radiation therapy with or without simultaneous integrated boost in locally advanced oral cavity carcinomas in patients admitted/visited to hospital. Materials and Methods: The present study entitled was conducted in Department of Radiation oncology, Gandhi Medical College and associated Hamidia Hospital (GMC & HH), Bhopal (M.P) and Jawaharlal Nehru Cancer Hospital (JNCH), Bhopal (M.P), on a total of 54 patients of advanced oral cavity carcinomas. Results: After means follow up with patients’ comparison between intensity modulated radiation therapy with or without simultaneous integrate boost was done and noted details in tables. Conclusion: The study concluded that there were no statistically significant differences in demographic distributions, clinical characteristics, acute and long-term toxicities, and post-treatment responses between the two groups treated with and without Simultaneous Integrated Boost (SIB) in locally advanced oral cavity carcinomas. Both treatment modalities demonstrated similar efficacy and safety profiles. Keywords: Clinical outcomes, head and neck cancer, intensity-modulated radiotherapy, sequential, simultaneous integrated boost.

Background: Prostate cancer is a leading cause of cancer-related mortality among men, with diagnostic limitations in current methods like PSA assays, DRE, and TRUS biopsies. This study aimed to evaluate the correlation between various biomarkers, including Ki-67/MIB-1 and ERβ, and the recurrence of prostate cancer. Materials and Methods: This prospective observational study included 110 patients diagnosed with prostate cancer at a tertiary care hospital in New Delhi. Patients were monitored over 12 months, with data collected on PSA indices, Ki-67/MIB-1, ERβ expression, and MRI PI-RADS scores. Statistical analyses were conducted to assess the significance of these parameters in predicting disease recurrence. Results: Higher Ki-67/MIB-1 expression and increased PSA velocity were significantly associated with recurrence. Although the correlation between PI-RADS scores and recurrence was not statistically significant, 60% of recurrent cases had a PI-RADS score of ≥4. ERβ expression was notably higher in patients with recurrence, indicating its potential as a prognostic marker. Conclusion: The study concludes that combining PSA indices, immunohistochemical markers (Ki-67/MIB-1, ERβ), and advanced imaging techniques (MRI PI-RADS) offers a more robust approach to predicting prostate cancer outcomes. Regular follow-up with tailored diagnostic strategies is essential for early detection and timely intervention, particularly in patients with high-risk markers. Keywords: Prostate cancer, PIRADS, Ki-67, MIB-1.

Background: Acute kidney injury (AKI) is a leading cause of morbidity and mortality globally, particularly in resource-limited settings. The etiology and severity of AKI vary based on multiple factors, including infections, dehydration, drug use, and environmental exposures. This study aimed to investigate the etiology, clinical manifestations, and predictors of severity in community-acquired AKI. Materials and Methods: This retrospective observational study was conducted at a tertiary care center. A total of 246 patients diagnosed with AKI were included retrospectively for a period of 5 years. Data were collected on demographic characteristics, clinical presentation, laboratory parameters, and etiology. AKI severity was classified as stage 1, 2, or 3 based on serum creatinine levels and clinical condition. Multivariate logistic regression was used to identify predictors of stage 3 AKI. Results: The most common etiologies of AKI were infectious causes (46.7%), dehydration-related (22.4%), and drug-induced (18.3%). Infectious causes were more prevalent in stage 3 AKI cases (54.3%), while dehydration-related AKI was more frequent in stage 1 cases (35.6%). The mean serum creatinine was significantly higher in stage 3 cases compared to stage 1 and stage 2 cases (3.4 ± 1.5 mg/dL). Factors associated with increased risk of stage 3 AKI included elevated serum creatinine >4 mg/dL (OR 4.2, 95% CI 2.1–8.6), blood urea nitrogen >60 mg/dL (OR 3.7, 95% CI 1.8–7.2), hypotension (OR 2.8, 95% CI 1.5–5.2), oliguria (OR 5.6, 95% CI 3.1–10.2), and advanced age (>60 years) (OR 1.6, 95% CI 1.0–2.9). Conclusion: Infectious causes, dehydration, and hypotension were the most common etiologies and significant predictors of stage 3 AKI. Early identification of at-risk patients, especially those with elevated creatinine, oliguria, and hypotension, can help improve clinical outcomes. Further studies are needed to validate these findings and identify additional biomarkers for AKI progression. Keywords: Acute kidney injury, serum creatinine, oliguria, hypotension, community-acquired AKI.

Background: Aims and objectives: the study was conducted to compare fistulectomy v/s fistulotomy in the management of low anal fistulae. Materials and Methods: The study is conducted among indoor patients of general surgery department in a tertiary care hospital of South Gujarat. 60 patients are included in the study which are divided randomly into 2 groups: Group A – Patients undergoing Fistulectomy Group B – Patients undergoing Fistulotomy. Results: The mean operating time for fistulotomy is 42.83 minutes with SD of 8.38 while the mean operating time for fistulectomy is 50.17 minutes with SD of 7.71. Mean duration for wound discharge for fistulotomy comes to be 20.47 days with SD of 5.22; while the mean duration of wound discharge for fistulectomy comes to be 33.53 days with a SD of 5.58. This time was noted for each operated case and the mean wound healing duration for fistulotomy was 35.97 days with SD of 7.32 while the mean duration for fistulotomy was 47.07 days with SD of 7.72. Mean hospital stay for fistulotomy was 2.37 days while mean hospital stay for fistulectomy was 3.03 days. Conclusion: From our study we can conclude that perianal fistula has a male predominance in incidence and more in young adults. Inter-sphincteric fistulae are more common than trans- sphincteric fistulae in patients suffering from low perianal fistulae. Keywords: Fistulotomy, Fistulectomy, Fistula-in-ano, Pain.

Background: Blood transfusion continues to be an important source of pathogens in transfused patients. An unsafe blood transfusion is extremely costly, both in terms of human lives and economic impact. Transfusion-transmitted infections (TTIs) pose a significant risk associated with blood transfusions. Accurate risk assessments of TTIs are crucial for ensuring the safety of the blood supply. The objective of this study is to assess the seroprevalence of transfusion-transmitted infections (TTIs) among healthy blood donors in North India population. Materials and Methods: A retrospective observational study was conducted in the department of Transfusion Medicine of a tertiary care hospital of North India. The study period spanned from January 2018 to December 2023, during which data from all blood donors was reviewed and analyzed for the prevalence of TTIs. Results: The present study included 44,016 donors for seroprevalence of TTIs. Overall, 1675 donors (3.8%) had a reactive result for one or more TTIs. Conclusion: Raising public awareness about voluntary blood donation, along with thorough donor screening, counseling, and the use of highly sensitive tests, can help reduce the risk of TTIs. Keywords: Blood Transfusion, Blood Donors, Donor Screening, Seroprevalence, Transfusion-Transmitted Infections.

Background: ENT disorders can manifest with varied ocular symptoms due to involvement of orbit and its content. Early diagnosis and treatment help in reducing the mortality associated with it. The aim of this study is to evaluate the causes of various ophthalmological presentations in relation to primary ENT diseases at a tertiary referral centre. Materials and Methods: The present prospective study was carried out in Department of otorhinolaryngology of Government Medical College, Pali, Rajasthan, India during one-year period and comprised of 30 cases. Data regarding age, gender, clinical profile, etiology and management were collected and statistical analysis was done. Results: The greatest number of patients were in the age group 51 to 60 years (7; 23.33%) followed by 41 to 50 years (20%). There were 14 (46.66%) males and 16 (53.33%) females. Most common ophthalmological symptom among the study population was periorbital oedema (50%) followed by epiphora (46.66%). The most common aetiology was infective or granulomatous (10, 33.33%), traumatic (8, 26.66%) and neoplastic (8, 26.66%). Conclusion: Rapid diagnosis and treatment is necessary for preserving vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the appropriate management of such lesions. Keywords: Ophthalmologic Presentations, ENT Diseases, Proptosis, Periorbital Oedema.

Background: Chronic suppurative lung disease (CSLD) is the end result of chronic airway inflammation that is driven by persistent infection. The aim of this study to evaluate the prevalence and associated risk factors with isolation of multidrug resistant pathogens in chronic suppurative lung disease. Materials and Methods: The present prospective study was conducted in fifty-two chronic suppurative lung disease patients between the age of 18-90 years at Respiratory Medicine Department of TB & Chest Hospital, Badi in R.N.T. Medical College, Udaipur during one-year period, after getting approval from institutional ethical committee. Results: Suppurative lung diseases were more frequent in male patients. Male female ratio is 2.06. More than three fourth patients of suppurative lung disease belong to rural area. In both type of suppurative lung disease, pseudomonas was the most common organism isolated from the biological samples. Second common organism isolated was klebsiella in patients of bronchiectasis and lung abscess. Risk factors for MDR pathogen were multifactorial for both pseudomonas and klebsiella. Conclusion: While dealing with suppurative lung disease antibiotic should be judicious and adequately used and underlying lung and systemic disease should be appropriately managed. Keywords: Chronic suppurative lung disease (CSLD), Pseudomonas, Bronchiectasis, Lung abscess, Klebsiella, MIC.

Background: Urothelial carcinoma comprises 90% of bladder tumor. The p53 gene is a tumor suppressor gene located on chromosome 17p; important for genome stability, response to genotoxic stimuli, and activation of apoptosis. Nuclear antigen Ki-67 coded by gene on chromosome 10 is absent in resting cells (G0 phase) and hence exclusively positive in the nuclei of proliferating cells. Materials and Methods: This was a prospective study. All cases presenting with hematuria were subjected to ultrasonography and cystoscopy then TURBT chips or cystectomy was performed in patients showing growth by cystoscopy. In the IHC the homogenous nuclear positivity was seen as dark brown colour. The percentage of immunopositivity was calculated by counting atleast 1000 tumor cells in areas of maximum positivity. The cells having nuclear positivity are calculated in the ratio of total number of cells. The results were interpreted taking the cutoff value as 20% and divided into three categories as immune negative, 20% as high expression for both immunomarkers positivity. Data was analysed using chi square statistical methods. P value less than 0.05 was considered as significant. Results: P53 positivity with more than 20% expression was found in high grade urinary bladder carcinomas and cases with pT2 stage. Some Low grade urothelial carcinomas with lamina propria invasion (pT1) also showed high p53 expression. There were high grade tumors also showing low expression of p53. So, prognosis was good in those cases. Ki67 expression was increased with increased grading and staging of bladder carcinomas. In Squamous cell carcinoma p53 showed low expression and ki67 showed high expression. Adenocarcinoma of the bladder showed high p53 and ki67 expression. Other high grade non papillary urothelial carcinomas also showed high p53 and ki67 expression. Conclusion: Urothelial carcinoma is the seventh most common cancer in the world. Many factors have been known as risk factors of this condition. Spectrum of p53 and Ki67 are useful as potential prognostic markers in bladder cancers. Key words: p53, Ki67, Urinary bladder carcinoma.

commonest cause of death from cancer in women worldwide. Breast cancer is one of the most frequent cancers among women in developing country. The combined study of p53 expression and Ki-67 in breast carcinoma is very helpful in assessing the prognosis & patient outcome. Materials and Methods: 50 cases of breast carcinoma was carried out in the department of pathology. The haematoxylin and eosin(H&E) stained sections of the cases were made and diagnosed and selection of representative tumour paraffin blocks was done on which IHC was performed. Immunohistochemical staining is conducted and the proportion of the malignant cells staining positive for the nuclear antigen Ki-67 is evaluated in a quantitative and visual way using light microscopes. Evaluation of p53 immunostaining was also done. Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean±SD (min-max) and results on categorial measurement are presented in number (%). Results: Majority 23 cases (45.9%) showed moderate proliferative activity, followed by 16 cases (31.9%) showing low proliferative activity. 11 cases (22.2%) showed high proliferative activity. The majority of 44 cases (88.9%) were positive for p53 expression of which maximum 18 cases (36.1%) showed>50% of p53 expression. 19 cases (38.9%) had 20-50% of p53 expression. In our study 41.6% of Grade 1 tumors showed moderate p53 expression. Maximum no of Grade II tumors showed moderate to high p53 expression. 40% of Grade III tumors showed high p53 expression. In our study IDC (NOS) showed maximum moderate to high p53 expression. In our study the maximum number of cases (23) belong to Grade 2 showing moderate Ki-67 expression, and >49% of p53 expression. Conclusion: In breast cancer, we suggested that the over expression of Ki67 & p53 protein in the nucleus is an indicator of poor prognosis. Key words: Breast Cancer, p53, Ki67.

Aim: Regional anaesthesia offers significant advantages over general anaesthesia for lower abdominal and lower limb surgeries, with intrathecal and epidural techniques being the most commonly used. The aim of this study is to evaluate complications and hemodynamic stability of dexmedetomidine with bupivacaine vs fentanyl with bupivacaine used for intrathecal anaesthesia in patients undergoing orthopaedic lower limb surgeries. Materials and Methods: The study cohort was categorised into two groups, each consisting of 20 participants. Group 1 received an injection of 2.5 mL of hyperbaric bupivacaine combined with 25 µg of fentanyl in 0.5 mL, while Group 2 was administered 2.5 mL of hyperbaric bupivacaine along with 5 µg of dexmedetomidine in 0.5 mL. A comprehensive pre-anaesthetic assessment, which included a general and systemic examination, was conducted the evening prior to the surgical procedure. Standardised investigations were performed on all subjects. Following the acquisition of informed written consent for both the study and the surgical intervention, each patient was prescribed 0.5 mg of alprazolam and 150 mg of ranitidine to be taken orally the night before surgery. Additionally, patients were instructed to refrain from oral intake from midnight on the day preceding the surgery. The intraoperative hemodynamic profiles of the two study groups were subsequently compared. All the statistical calculations were done through SPSS software. Results: Mean age of the patients of group 1 and group 2 was 45.3 years and 42.9 years. Alterations in hemodynamic variables in group 1 occurred gradually, ultimately reaching a stable state that persisted throughout the duration of the surgical procedure. In contrast, group 2 exhibited more pronounced changes and declines in hemodynamic variables, which were found to be statistically significant. Complications were seen in 15 percent of the patients of group 1 and in 45 percent of the patients of group 2. Conclusion: The addition of dexmedetomidine to intrathecal bupivacaine resulted in a more rapid onset and extended duration of the block when compared to intrathecal fentanyl. Both medications did not exhibit significant adverse effects, with the exception of transient abruptly decline in hemodynamic response with dexmedetomidine. The dexmedetomidine group demonstrated a more favourable profile regarding postoperative complications. Keywords: Bupivacaine, Fentanyl, Dexmedetomidine.

Background: Cataract represent the primary cause of preventable blindness globally. Cataract surgery is primarily indicated when there is a significant decline in visual acuity and/or an increased sensitivity to light. Hence; the present study was conducted to evaluate complications and postoperative visual outcomes of cataract surgeries. Materials and Methods: A total of 50 patients undergoing cataract surgery were enrolled. Complete demographic and clinical details of all the patients were obtained. A comprehensive pre-operative assessment of the eye, including an evaluation of visual acuity, was conducted. All patients subsequently underwent cataract surgery. Post-operative evaluations were conducted using a slit-lamp biomicroscope on the first day following surgery and again within the first week, focusing on the cornea, surgical wound, anterior chamber, and the implanted lens. During follow-up visits, the eyes were examined for any post-operative complications, and visual acuity was measured using Snellen’s chart and pinhole testing to establish best corrected visual acuity (BCVA). All the results were evaluated using SPSS software. univariate analysis was done for evaluation of the level of significance. Results: A total of 50 patients were evaluated. The mean age of the patients was 46.2 years. Among them, 66 percent were males while the remaining were females. Complications were seen in 18 patients (36 percent). Among them, Striate keratopathy, Corneal edema, Anterior uveitis, Macular edema and Acute onset endophthalmitis was seen in 10 percent, 6 percent, 6 percent, 12 percent and 2 percent of the patients. Good outcome was seen in 90 percent of the patients while borderline outcome and poor outcome was seen in 4 percent and 6 percent of the patients. Conclusion: The findings indicated a significant prevalence of striate keratopathy and corneal edema, likely attributable to the initial incision made in the corneoscleral region. Notably, ninety percent of the cases that underwent surgery exhibited favorable outcomes. Keywords: Visual Outcome, Cataract surgery.

Background: Blood components play a crucial role in the treatment of various clinical conditions and help mitigate complications associated with whole blood transfusions. Assessing the utilization patterns of blood components, monitoring demand, and implementing effective audit procedures are essential steps in ensuring the optimal utilization of this invaluable resources. The purpose of this study is to evaluate the utilization of various blood components, packed red cell volume, fresh frozen plasma, and platelet concentrate, at a tertiary care centre. Methods and Materials: In this retrospective cross-sectional study, data regarding the utilization of blood products was collected over the span of one year, from January 2022 to December 2022. This data was obtained from blood centre registers and compiled in Microsoft Excel sheet for subsequent analysis, allowing for the assessment of the utilization patterns of different blood components in various departments. Results: A total of 2,647 blood units were issued in the study duration. The most frequently used blood product was Packed Red Blood Cells, followed by Fresh Frozen Plasma and Random Donor Platelets. Packed Red Cells were predominantly utilized by Medicine department, closely followed by the Surgery department. Notably, patients with anemia and those undergoing surgery had the highest demand for Packed Red Cells. Conclusion: Conducting regular audits on the usage of blood components is imperative for every blood bank. These efforts serve multiple purposes, not only partially fulfilling the current demand for blood products but also curbing unnecessary wastage of these vital resources. Keywords: Blood component, PCV, FFP, RDP, Utilization.

Biliary atresia is a rare and life-threatening liver disease that primarily affects infants. Early diagnosis and timely intervention are crucial for improved outcomes. This retrospective study aimed to diagnose cases of biliary atresia through histopathological examination and confirm the diagnosis using immunohistochemical stains. Additionally, the study sought to correlate the histological findings with the clinical presentation. In 3 years (2019- 2022),11 cases of biliary atresia were analyzed, comprising 6 male and 5 female patients. All patients presented with elevated bilirubin levels (both direct and total) along with deranged liver enzymes. The key histopathological finding that consistently led to the diagnosis of biliary atresia in all 11 cases was characterized by portal tract expansion and oedematous fibroplasia, accompanied by bile ductular proliferation. Inflammatory cell infiltrates were also noted in the liver biopsies. Therefore, biliary atresia is a complex disorder with variable outcomes, underscoring the importance of prenatal screening and early postnatal detection. Timely surgical intervention and histological examination play crucial roles in managing this condition effectively. Further research and awareness are essential to optimize diagnostic and therapeutic strategies for biliary atresia, ultimately improving the prognosis for affected infants. Keywords: Biliary Atresia, Bile Duct Proliferation, Neonatal Jaundice, Kasai Procedure, Liver Biopsy.

Background: Dengue is the most common arthropod-borne viral fever in travellers returning from most tropical and subtropical destinations worldwide. The common symptoms associated with dengue fever is fever, myalgia, headache etc. Materials and Methods: This is a hospital based, retrospective study conducted at Tezpur medical college and hospital, Tezpur, Assam. It included confirmed dengue cases from January 2021 to October 2023. The objective of the study is to analyze the clinical and laboratory parameters of dengue to facilitate early diagnosis and better management of dengue cases. Results: On analysis, it has been found out that among 98 patients included in the study, 29% of patients are in 30-39 years, 27% of patients fall in age group of 21-29years,16% in 40-45 years, 11% in 18-20 years, 8% each in age group of 50-59 years and 60-69 years and 1% in 70-79 years. On evaluation it was calculated that 74% of patients are males and 26% females. Regarding the duration of fever, it has been found out that 45% of patients had 5-10 days, 36% had < 5 days,12% had 11-20 days, 5% had 21-30 days,2% had >30 days. On evaluating the dehydration status, 19% of the patients had dehydration. Bleeding symptoms were manifested in 11% of the patients. Conclusion: Dengue fever is associated with high morbidity and mortality. Early diagnosis and treatment of dengue fever is necessary to prevent complications. Keywords: Dengue fever, hematological profile, duration of fever, dehydration, bleeding manifestation.

Background: Various scoring systems have been devised throughout the years to determine the gravity of patients' ailments or their prognosis. Our inquiry delved into the effectiveness of the Mannheim Prognostic Index (MPI) in predicting mortality risk, complications, extended hospital stays, and the need for intensive care unit (ICU) admission among all patients presenting with secondary peritonitis. Furthermore, we aimed to ascertain the practicality, convenience, and simplicity of this assessment as a tool for integration into the clinical practices of surgeons and critical care physicians. Materials and Methods: A retrospective, comparative, observational and analytical study was conducted. One hundred patients diagnosed with secondary peritonitis presenting to the general surgery department were assessed and Manheim peritonitis index and APACHE II scores were calculated and compared. Results: The efficacy of the MPI was contrasted with that of another commonly utilized mortality prediction system, such as Apache II, involving a cohort of 100 patients from a tertiary care centre of north india. The predictive accuracies were determined to be 93.3% and 86.9%, respectively. Conclusion: Although Mannheim offers a commendable response in predicting mortality, its evaluation is not foolproof as it overlooks certain factors; thus, a patient deemed to have a low mortality risk may, in fact, succumb. Keywords: Secondary peritonitis, acute abdomen, abdominal cavity, intra-abdominal infection, abdominal pain.

Background: Urinary tract infections (UTIs) represent one of the most prevalent bacterial infections among pregnant women, with increased risk in those with diabetes mellitus (DM). This cross-sectional study investigates the prevalence, clinical presentation, microbial etiology, and antibiotic sensitivity of symptomatic UTIs in diabetic pregnant women. Material and Methods: A total of 108 diabetic pregnant women presenting with symptomatic UTIs were evaluated. Data on age, trimester, parity, type of diabetes, and symptoms were collected. Urinalysis and urine cultures were performed to determine infection presence and to identify bacterial pathogens. Antibiotic susceptibility testing followed standard microbiological protocols. Results: Results showed the majority of women were in their second trimester (57.4%) and multiparous (65.7%), with gestational diabetes (82.4%) being most common. The leading symptoms were dysuria (69.4%), lower abdominal pain (58.3%), and urgency (42.6%). Escherichia coli (48.1%) was the predominant organism isolated, with high sensitivity to Nitrofurantoin (100%), Gentamicin (95.4%), and Cefixime (95.4%). Conclusion: The findings underscore the importance of early screening and appropriate antibiotic treatment in this population to prevent maternal and neonatal complications. Culture-guided therapy is essential in preventing resistance and ensuring optimal outcomes. Keywords: Urinary tract infection, diabetic pregnancy, Escherichia coli

Background: Hysterectomy is performed for various uterine pathologies like fibroids, endometriosis, uterine prolapse and various types of cancer. Hysterectomy is the most common gynaecological study performed in women. It is a life saving procedure and it improves the quality of life. Myometrial lesions account for the majority of causes for abnormal uterine bleeding. Aims and objectives: 1. The aim of this study is to analyse the various spectrum of histomorphological lesions in uterus from hysterectomy specimen. 2. Correlation of preoperative clinical diagnosis with histopathological diagnosis in hysterectomy specimens Materials and methods: This study is a prospective and a retrospective analysis of 80 hysterectomy specimens reported to the department of Pathology, January 2020-2021 in Sri Lakshmi Narayana institute of medical sciences. The histopathological findings of hysterectomy specimens were noted and these findings are correlated with clinical diagnosis Results: The most common type of hysterectomy was total abdominal hysterectomy with bilateral salpingo-ophorectomy (52.5%). Most common clinical diagnosis is fibroid. Most common age group was 41-50yrs. The most common clinical indication for hysterectomy was fibroid uterus. In case of myometrium leiomyomas are the most common lesions followed by adenomyosis. Conclusion: The histomorphological analysis is mandatory for all hysterectomy specimens for confirming the preoperative clinical diagnosis and to improve the quality of life.

Background: To assess the prevalence of overweight and Obesity among school children near the BPT Hospital and explore it's associations with socioeconomic factors, dietary habits and physical activity. Materials and Methods: A retrospective cross-sectional study utilised data from thesis conducted in 2013.Total of 1050 children aged 6-12years from three schools representing different socioeconomic backgrounds were enrolled. Anthropometric measurements were taken and BMI was calculated using standard guidelines. Information on dietary intake, physical activity and socioeconomic status was collected through questionnaires. Results: Out of the total sample set, 16 children were underweight,880 had normal BMI,126 were overweight and 28 were obese. Overweight and Obesity were more prevalent in in high income groups (15.2% and 3.4%) compared to low income groups (5.4% and 1.1%). Boys had a higher prevalence of overweight and Obesity than girls. Additionaly, junk food consumption was significantly higher among children from high-income families. Conclusion: The findings emphasize the need for school based interventions to promote healthy dietary habits and physical activity particularly targeting high income groups. Addressing gender-based disparities in physical activity is also essential. Keywords: Body mass index, school children, Obesity, Overweight, socioeconomic status.

Background: Suicide is an increasing community health issue with hanging being the commonest adopted method. The study of hanging cases gives information about distribution of suicide fatalities thus revealing information about a community's mental and personal health. Objectives: This study was selected with objectives of determining the distribution of hanging victims related to age, sex, ligature material used and associated risk factors. Materials and Methods: The present descriptive retrospective study was conducted in the department of Forensic Medicine and Toxicology of a tertiary care center, Bengaluru north, from 2021 to 2022, with data collected from postmortem records of all the cases brought for medico-legal autopsies with alleged history of suicide by hanging. After analyzing, the data was tabulated and graphs were used to tabulate the results. Results: Majority of the victims: were males, belonging to age group of 21-30 years, residing in urban areas, chose hanging as suicidal method, using soft material like saree as a ligature material, with knot on right side of neck, in close confinement like house; and depression was found to be a common causative factor due to various reasons. Conclusion: This study emphasizes the need of preventive strategies like health education, psychiatric & psychological counselling for livelihood, creation of social welfare groups with usage of media, desensitization to manage stressors due to various causes; use of government aided schemes & helpline numbers for vulnerable population. Keywords: Suicide, hanging, knot mark, ligature material, causative factors.

Background: Early childhood is one of the risk factors for many ocular diseases, if unnoticed may adversely affect the child’s school performance and causing severe ocular disability especially in remote areas with scarce facilities. An early diagnosis and intervention lead to a better impact on life. Aims: To determine the prevalence and pattern of various ocular morbidities in school going children of tribal ashram schools of central India. Settings and Design: Cross-sectional study was conducted on students from class 1 to 12 (age 6 to 18) of government tribal ashram school. Materials and Methods: Study was conducted for a period of 18 months among 2000 students from class 1 to 12 (age 6 to 18) of government tribal ashram school. All students between 6 to 18 years and whose parents/ guardian of student giving consent for the study, those who were present on the day of screening. Statistical analysis used: SPSS version 20.0 (Armonk, NY: IBM Crop). Results: Total 2000 students were participated in the study and total of 1003 students were found to be suffering from various ocular morbidities, yielding an overall prevalence of ocular morbidity of 50.1%. Refractive error was found to be the most common ocular morbidity with 452 (22.6%) followed by Vitamin A Deficiency with 256 (12.8%) respectively. Conclusions: Refractive errors and Vitamin A deficiency are the leading preventable and treatable causes of childhood blindness. These conditions can be easily detected through regular eye screening programs and can be promptly addressed. Keywords: Ocular Morbidity, Tribal Children.

Background: COVID-19 manifests with a wide clinical spectrum ranging from asymptomatic state to acute respiratory distress syndrome and multi organ dysfunction. Reports suggest neurological symptoms in approximately one fourth to one third of patients including symptoms related to central and peripheral nervous system and skeletal muscular damage. Commonly reported neurological symptoms include dizziness, headache, impairment of taste and smell, impaired consciousness, confusion and commonly reported complications include cerebrovascular events (CVEs), meningitis, encephalopathy, skeletal muscle injury and demyelinating disorders like Guillain-Barre syndrome. This study was aimed at estimating the prevalence and spectrum of neurological manifestations and its severity, progression, and possible outcomes in COVID-19 patients admitted in our Medical college hospital. Materials and Methods: An Observational Descriptive Study was conducted among the patients diagnosed with COVID 19 starting from the first hospitalized case of COVID-19 in TDMC, Alappuzha (30, January 2020) till 31, July 2020. Patient’s relevant information including details of history and clinical examination were collected from the medical records. Reports of laboratory investigations were reviewed. The study was approved by the institutional ethics committee of Government T D Medical College Alappuzha. Results were analysed and those with neurological manifestations were compared to those without and necessary statistical calculations were done. Results: Total number of patients who were included in the study were 624. Mean age was 41.28. Majority of them were males (82.6%). Of these patients, 200 (32%) had at least 1 of the following underlying disorders: hypertension (123 [19.7%]), diabetes (82[13.1%]), cardiac or cerebrovascular disease (25 [4.0%]), and COPD (17 [2.7%]). The most common symptoms at on-set of illness were sore throat (135 [21.6%]), cough (133 [21.3%]), and fever (104 (16.6%). 278(44.5%) patients were totally asymptomatic. Neurologic manifestations were present in 122 patients (19.5%). Patients presenting with any neurologic manifestations were older than those without (43.5 vs. 40.73 years) and had a longer time of hospitalization (12.68 vs. 10.1 days. Among the patients who had neurological symptoms the most frequent neurologic manifestations were headaches (82, 67.2%) hypogeusia (42, 34.4%), hyposmia (41, 33.6%), dizziness (7, 5.7%), numbness (43.27%) and cerebrovascular accident (2 1.6%). Patients with cerebrovascular accidents were older than those without (both above 60 years) and both were having comorbidities. Compared to the group who did not present with neurological symptoms the group with neurological symptoms had more statistically significant Covid related symptoms like fever sore throat myalgia chest pain and diarrohea. Conclusion: This study demonstrated the presence of significant neurological symptoms in hospitalised Covid patients who were admitted in our hospital. . Major neurological manifestation in our study was ischemic stroke which was reported in 2 patients who had prior comorbidities. There was no relation between severity of illness

Background: Postoperative paralytic ileus (PPI) is a frequent complication after abdominal surgeries, characterized by transient cessation of bowel function. Pharmacological interventions, especially prokinetic agents, have been investigated to expedite bowel recovery. Levosulpiride (Lesuride), a dopamine D2 antagonist with prokinetic activity, has shown promise in this context. Materials and Methods: This review explores clinical literature and pharmacological studies concerning the use of injection Levosulpiride in the management of PPI. The databases searched included PubMed, Scopus, and Google Scholar, using the keywords: "Levosulpiride," "Lesuride," "postoperative ileus," and "prokinetic agents." Results: Studies indicate that intravenous Lesuride accelerates return of bowel sounds, flatus, and oral intake in postoperative patients without significant adverse effects. Compared to other prokinetics, it offers favorable tolerability and efficacy. Conclusion: Lesuride appears to be an effective and safe prokinetic agent in reducing the duration of postoperative ileus. Its integration into postoperative care protocols could enhance recovery, though further large-scale trials are warranted. Keywords: Levosulpiride, Lesuride, postoperative ileus, prokinetics, gastrointestinal motility, paralytic ileus.

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with both microvascular and macrovascular complications including coronary artery disease (CAD). CAD in diabetics often remains asymptomatic due to autonomic neuropathy, making its early detection challenging. Treadmill test (TMT) is a widely accessible non-invasive tool for detecting subclinical myocardial ischemia. This study aims to evaluate the utility of TMT in detecting asymptomatic CAD in T2DM patients and its correlation with HbA1c levels and diabetes duration. Materials and Methods: A cross-sectional observational study of 80 asymptomatic T2DM patients aged 25–60 years was conducted in the department of general medicine of Adichunchungiri hospital and research centre. Clinical data including duration of diabetes, HbA1c levels and lifestyle risk factors were recorded. All patients underwent TMT using the modified Bruce protocol. A positive TMT was defined by standard ischemic ST segment depression criteria. Statistical analysis was done using SPSS v23.0 to determine the association of TMT results with HbA1c levels and diabetes duration. Results: Among 80 participants majority were males(57.5%) and most common age group was 51–60 years (46.25%). TMT was positive in 31 (38.75%) patients. A significant association was found between longer diabetes duration and TMT positivity (p=0.0002). HbA1c levels ≥9.1% were more prevalent among TMT positive individuals (p=0.047). 80.6% of TMT positive patients had HbA1c level of more than 9% suggesting poor glycaemic control as a significant predictor of silent myocardial ischemia. Conclusion: There was a significant correlation between elevated HbA1c levels andprolonged duration of T2DMwith TMT. Routine cardiovascular screening by TMT should be considered in asymptomatic T2DM patients particularly inthose with prolonged disease or poor glycaemic control. Keywords: Type 2 Diabetes Mellitus, Coronary Artery Disease, HbA1c, Treadmill Test.

Background: To compare LISA vs InSurE technique of surfactant administration on need for mechanical ventilation in Preterm Neonates with RDS between 28-34 weeks of Gestation. Materials and Methods: Randomised controlled trial done in preterm neonates of 28-34 weeks of Gestation with RDS, admitted in SNCU Inborn at Niloufer hospital for a period of 2 years. Preterm neonates of 28-34 weeks of gestation, Clinical Diagnosis of RDS with persistent fi02 requirement >30% in first 6 hrs of life are included in study. we compared the requirement of 2nd dose of surfactant, incidence of BPD and complications of Prematurity in both the groups. Results: The most common cause of prematurity in LISA and INSURE groups is PPROM, followed by Fetal distress. Least common cause of prematurity in LISA and INSURE groups are Antepartum haemorrhage and Twin delivery-PROM respectively. The median of time from birth to the onset of procedure in both LISA group and INSURE group is similar and is 4 hours. The mean Fio2 at the beginning of the procedure among the LISA group, mean Fio2 at the 1st hour after the procedure, mean Fio2 at the 4th hour after procedure are insignificant. None of the adverse effects are significant when compared in groups. Median period in days of NIV, Repeat dose of surfactant, median length of hospital stay and Bradycardia is insignificant. Desaturation was not significant. The median duration of supplemental O2 in LISA group was 5 days, whereas in INSURE group was 8 days. The difference is statistically significant with p < 0.05. 55 patients (68.75%) in the LISA group and in 59 patients (73.75%) in the INSURE group survived which is not statistically significant. Conclusions: Although the research suggests that LISA is superior in terms of outcome, our study demonstrated that LISA is superior in terms of minimising the period of oxygen supplementation and hospital stay. However, we found no substantial difference in other outcomes. Keywords: Respiratory Distress Syndrome (RDS), less invasive surfactant administration (LISA), Intubation-Surfactant Extubation (InSurE).

Background: Acute myocardial infarction (AMI) remains an important contributor to cardiovascular morbidity and mortality. Left ventricular dysfunction (LVD) is one of the important complications seen in patients of AMI. Despite advancements in revascularization procedures and pharmacotherapy LVD is seen in many cases and significantly affects prognosis. This study aimed to determine the incidence and severity of LVD in patients with AMI and its correlation advancing age of patients presenting with AMI. Materials and Methods: A hospital-based cross-sectional observational study was conducted at Adichunchungiri Institute of Medical Sciences, India. 250 consecutive patients with confirmed AMI were included in this study on the basis of a predefined inclusion and exclusion criteria. Detailed clinical evaluation, ECG, cardiac biomarkers, and 2D transthoracic echocardiography were performed within 72 hours of admission. LVD was categorized based on left ventricular ejection fraction (LVEF) as: mild (40–49%), moderate (30–39%), or severe (<30%). Statistical analysis was done using SPSS 23.0. P value less than 0.05 was taken as statistically significant. Results: Out of 250 patients there was a significant male preponderance in AMI cases with a M:F ratio of 1:0.38. Mean age of studied cases was found to be 66.25 ± 10.9 years. STEMI accounted for 66% and NSTEMI 34% of cases. Anterior wall MI was the most common type (42%). Hypertension (58%), obesity (52%) and diabetes mellitus (44%) were the predominant risk factors. LVD was present in 46% of patients out of which mild, moderate and severe LVD was seen in 20%, 16% and 10% respectively. A significant age-related increase in LVD incidence was observed. Pearson’s correlation revealed a moderate positive association between age and LVD (r = 0.41, p = 0.001). Conclusion: Early echocardiographic screening for LVD in cases of MI is essential for timely identification and initiation of appropriate management to prevent adverse outcomes. Keywords: Myocardial Infarction, Left Ventricular Dysfunction, Echocardiography, Risk Factors.

Background: Myocardial infarction (MI) in individuals under 45 years is increasingly recognized as a distinct clinical entity with rising incidence in developing nations. It carries significant psychosocial and economic burden due to its occurrence in the most productive phase of life. This study aims to assess the risk factors and clinical presentation of young adults presenting with MI. Materials and Methods: This cross-sectional observational study was conducted in the Department of General Medicine, Adichunchanagiri Institute of Medical Sciences, Karnataka, India. Fifty patients aged between 18–45 years with confirmed MI (STEMI or NSTEMI) were included in this study. Detailed clinical history, physical examination, laboratory investigations, cardiac biomarkers, ECG, and echocardiography were performed. Risk factors such as BMI, smoking, alcohol use, family history, diabetes, hypertension and dyslipidemia were documented. Data were analyzed using SPSS v23.0. For statistical purposes p<0.05 was taken as statistically significant. Results: The majority of patients were male (80%) with the most affected age group between 41–45 years of age. Obesity (BMI ≥25) was present in 90% of patients. Smoking (42%), hypertension (48%), diabetes (36%) and dyslipidemia (78%) were the most common modifiable risk factors. A positive family history of coronary artery disease was found in 62% of patients. Typical chest pain radiating to left arm was the most common symptom (56%) followed by chest heaviness and breathlessness. Anterior wall MI was the most frequent type (72%) and left ventricular dysfunction of some or the other degree was observed in 90% of patients. Conclusion: MI in young adults demonstrates a strong association with modifiable risk factors particulalry obesity, smoking, hypertension and dyslipidemia. Early recognition, lifestyle modifications, and aggressive risk factor management are crucial to reduce the burden of premature cardiovascular disease in young population. Keywords: Myocardial Infarction, Young Adults, Risk Factors, Chest Pain, Anterior Wall MI.

Background: Inguinal hernia is one of the most common disease encountered in general surgery OPD. Various approaches have been used to treat inguinal hernia. But still Lichtenstein tension free hernioplasty is method of choice for inguinal hernia. Chronic post operative inguinal pain is major problem postoperatively in hernioplasty. Ilioinguinal nerve trauma during dissection, inflammation and entrapment by mesh may involve in pathogenesis of inguinodynia Materials and Methods: This study was carried out in 100 patients between January 2024 to June 2024. In this study, we have included all the patients who underwent Lichtenstein tension free hernioplasty for inguinal hernia. Patients with obstructed inguinal hernia are excluded from the study. In the study, patients were randomly allocated in two groups: Group A(n=50) in which elective neurectomy was done and Group B(n=50) in which nerve preservation was done. In both the groups, postoperative pain assessment done on 1st POD, 7th POD and after 1and 3 months by VAS(Visual analogue scale). Results: the study shows that in group A and group B, there is no significant difference in VAS score in 1st and 7th post operative day. But in late Post operative period like 1 and 3 months, VAS score is significant low in group A patients than group B patients. Conclusion: Elective ilioinguinal neurectomy significantly reduces pain in late postoperative period. Keywords: Inguinal hernia, Lichtenstein Hernioplasty, ilioinguinal neurectomy, postoperative pain.

Background: Bladder exstrophy is a rare congenital condition that presents significant challenges in adult patients, particularly in cases that remain untreated. This study aimed to evaluate the outcomes of abdominal wall closure in 20 adult patients with untreated bladder exstrophy at a tertiary hospital in India. Material and Methods: The patients underwent abdominal wall reconstruction. The study assessed complications, including wound infections, flap necrosis, and suture line dehiscence, as well as the need for secondary procedures like debridement and flap reconstruction. Results: The results highlighted the complexities of surgical management and the importance of individualized approaches for optimal outcomes. This study provides valuable insights into the challenges of managing bladder exstrophy in adults. Keywords: Bladder Exstrophy, Abdominal Wall Closure, Surgical Outcomes.

Background: Peripheral nerve blockade is a widely used regional anesthesia technique that reduces postoperative pain, minimizes the need for analgesics, and improves patient recovery. The supraclavicular brachial plexus block (SCBPB) is commonly used for upper limb surgeries due to its high success rate, rapid onset, and dense anesthesia. Various adjuvants are added to local anesthetics to enhance block characteristics. Magnesium sulfate (MgSO₄) and dexamethasone are among the most studied adjuvants, but limited data exist on their comparative efficacy when used with ropivacaine in SCBPB. Objective: This study aimed to compare the efficacy of Magnesium Sulfate -MgSO₄ and dexamethasone as adjuvants to 0.75% ropivacaine in supraclavicular brachial plexus block for upper limb surgeries. The primary objective was to evaluate postoperative analgesia duration. Secondary objectives included sensory and motor block onset and duration, quality of analgesia assessed by the Visual Analog Scale (VAS), total analgesic consumption, and hemodynamic stability. Materials and Methods: A prospective, randomized, double-blinded study was conducted on 100 patients (ASA I & II) scheduled for elective upper limb surgery under supraclavicular brachial plexus block. Patients were randomized into two groups: Group RD (n=50): Received 20 ml 0.75% ropivacaine + 2 ml (8 mg) dexamethasone + 8 ml normal saline (total 30 ml).Group RM (n=50): Received 20 ml 0.75% ropivacaine + 2 ml (200 mg) Magnesium Sulfate -MgSO₄ + 8 ml normal saline (total 30 ml). Block characteristics, postoperative pain scores, and rescue analgesia requirements were assessed over 24 hours. Results: Onset of sensory block was faster in Group RD (13.15 ± 1.90 min) compared to Group RM (15.44 ± 2.26 min, P < 0.001).Onset of motor block was also faster in Group RD (17.12 ± 2.12 min) than in Group RM (19.26 ± 2.28 min, P = 0.001).Duration of sensory block was significantly longer in Group RD (1168.2 ± 111.88 min) compared to Group RM (468.60 ± 62.14 min, P < 0.001).Duration of motor block was longer in Group RD (1088.6 ± 91.15 min) than in Group RM (385.80 ± 45.39 min, P < 0.001).Time to first rescue analgesic requirement was significantly prolonged in Group RD (1208.4 ± 111.08 min) compared to Group RM (498.18 ± 64.22 min, P < 0.001).Total analgesic consumption was significantly lower in Group RD (87.4 ± 22.2 mg) than in Group RM (185 ± 36.2 mg, P < 0.001). Hemodynamic parameters were stable in both groups, though Group RM showed transient hypotension at 30 minutes (P = 0.013). Conclusion: Dexamethasone (8 mg) proved to be a more effective adjuvant than MgSO₄ (200 mg) when combined with 0.75% ropivacaine for supraclavicular brachial plexus block, as it resulted in faster onset, prolonged sensory and motor block duration, extended analgesia, and reduced postoperative analgesic requirement. While MgSO₄ remains a viable adjuvant, it is less effective than dexamethasone for optimizing nerve block characteristics. Future studies should investigate optimal dosing and potential synergistic effects of combining adjuvants. Keywords: Supraclavicular brachial plexus block, Ropivacaine, Dexamethasone, Magnesium sulfate

Background: Incisional hernia is a common postoperative complication, often requiring surgical intervention. Mesh repair has become the standard treatment for incisional hernias due to its reduced recurrence rates and improved patient outcomes. However, several risk factors influence long-term recurrence. This study aims to evaluate the risk factors and long-term recurrence rates in patients who underwent mesh repair for incisional hernia. Materials and Methods: A retrospective study was conducted at SRVS Medical College, Shivpuri, including both private and government hospitals. A total of 36 patients who underwent mesh repair for incisional hernia over the past two years were included. Patient data, including demographic details, comorbidities, surgical techniques, and postoperative complications, were collected and analyzed. The primary outcome was the recurrence rate over a follow-up period of 24 months. Statistical analysis was performed using descriptive methods and chi-square tests for categorical variables. Results: The study included 36 patients, with a mean age of 52 ± 10 years. The majority of patients were female (60%). Common risk factors associated with recurrence included obesity (BMI >30 kg/m²) in 45% of patients, diabetes mellitus in 30%, and smoking in 25%. Surgical site infection was observed in 15% of cases, contributing to increased recurrence rates. The overall recurrence rate at 24 months was 18%, with a higher incidence among patients with multiple risk factors. Laparoscopic mesh repair showed a lower recurrence rate (10%) compared to open mesh repair (25%). Conclusion: Mesh repair remains the standard treatment for incisional hernias; however, recurrence rates are influenced by patient-related risk factors such as obesity, diabetes, and smoking. Laparoscopic mesh repair demonstrated superior outcomes in terms of reduced recurrence compared to open mesh repair. Proper patient selection, optimization of comorbidities, and adherence to surgical protocols can improve long-term success rates. Keywords: Incisional hernia, mesh repair, recurrence, risk factors, laparoscopic repair, open repair, retrospective study.

Background: To study the Imaging Features and post-Surgical data of Indian patients with primary hyperparathyroidism. Materials and Methods: This was a prospective study conducted at tertiary care center, Mahatma Gandhi Medical College and Hospital, Jaipur consecutive patients with primary hyperparathyroidism from year 2022 to 2024. The analysis included profiling of patients on different demographic, clinical and biochemical and radiological parameters. Quantitative parameters were expressed as means and standard deviation. Results: In This study total of 100 patients were diagnosed as primary hyperparathyroidism. Ultrasound KUB showed nephrolithiasis in 22 (22%) and nephrocalcinosis in 7 (7%) patients. Both were present in 5 (5%). Nephrocalcinosis alone was present in 2 (2%) patients. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.73±0.13 g/cm2), whereas the site of predominantly cancellous bone, the lumbar spine (0.94±0.13 g/cm2). The site of mixed composition, the femoral neck (0.87±0.13 g/cm2), gave an intermediate value. Parathyroid adenoma was the most common histological change noted in the parathyroid glands. 85 (96.59%) patients had adenoma and 3 (3.4%) patients had hyperplasia of parathyroid gland. The mean total parathyroid gland weight was 2.75±3.53 g (0.1-18.5). In asymptomatic group mean adenoma weight was 1.87±1.89 (0.1-6.2) g and in symptomatic group mean adenoma weight was 3.59±4.45 g (0.2-18.5) . In asymptomatic group had a significantly lower mean adenoma weight (1.87 vs. 3.59 g, P<.05) compared to the symptomatic group. Conclusion: Our study showed 49% patients were asymptomatic. Asymptomatic PHPT has not been described in India, this is the first prospective study to show increasing incidence of asymptomatic PHPT in India. This study provides valuable insights into the clinical, imaging, and surgical outcomes of Indian patients with Primary Hyperparathyroidism (PHPT). Imaging techniques, particularly ultrasound and bone mineral density measurements, play a critical role in identifying renal and skeletal complications associated with PHPT, such as nephrolithiasis, nephrocalcinosis, and reduced bone mineral density. The study also highlights the significant correlation between adenoma size and the presence of symptoms, with symptomatic patients having larger adenomas compared to asymptomatic ones. Post-surgical outcomes following parathyroidectomy demonstrate significant improvements in calcium levels, symptoms, and overall quality of life for most patients. The majority of patients achieve normalization of serum calcium, and those with nephrolithiasis or nephrocalcinosis often experience reduced stone formation post-surgery. These findings emphasize the importance of early diagnosis, appropriate imaging, and timely surgical intervention to achieve optimal outcomes in PHPT patients. Overall, this study underscores the need for a tailored approach in the management of PHPT, where imaging and surgical strategies are personalized based on the clinical presentation and adenoma characteristics. Continued follow-up and monitoring are essential to ensure the lon

Background: Infraclavicular approach for brachial plexus block is under used but effective technique. The introduction of ultrasonography had rekindled the interest in infraclavicular brachial plexus block. Dexamethasone or Ketamine when added as adjuvant to local anaesthetic like ropivacaine will increase the duration of analgesia. The objectives is to compare postoperative analgesic effect, between Dexamethasone and Ketamine added as adjuvant to 0.2% Ropivacaine in ultrasound guided Infraclavicular Brachial Plexus Block. The primary objective of the study was the duration of post op analgesia or time taken for first rescue analgesia in hours. The secondary objectives were to find postoperative pain score and total rescue analgesic consumption in 24 hours. Materials and Methods: This was a prospective comparative observational study after institutional and ethics committee approval and patient consent. 100 patients aged 18-60 years with BMI <30 kg/m2 belonging to American Society of Anaesthesiologist (ASA) physical status 1&2 undergoing elective forearm surgery were divided into two groups of 50 each. Group D received USG guided infraclavicular brachial plexus block with 0.2% Ropivacaine 28ml + inj Dexamethasone 8 mg and Group K received 0.2% Ropivacaine 28 ml + inj Ketamine 25μg/kg after giving general anaesthesia. Each patient received Inj Paracetamol 1 gm IV intraoperatively and Q8th hourly in post-operative period. Duration of analgesia, post-operative pain score and analgesic requirements were studied in both groups. Also patient satisfaction score at 24 hour and occurrence of any complications were noted. Statistical analysis was done with SPSS software version 16. Qualitative data were compared using Chi square test and Quantitative data compared using independent t test. A P value of less than 0.05 was taken as significant. Results: The mean time required for first rescue analgesic was significantly more in Group D compared to Group K, 19.94+/-2.92 vs 10.76+/-1.69 respectively (P <0.05). The mean total rescue analgesic required in 24 hours significantly low in GroupD compared to Group K, 1.02+/-0.552 vs 1.96+/-0.532 (P <0.05). There was a low NRS score in Group D compared to Group K. Conclusion: Addition of Dexamethasone is superior to Ketamine as adjuvant to 0.2% ropivacaine for post-operative analgesia in patient receiving infraclavicular brachial plexus block. Keywords: Oral health literacy, socioeconomic status, rural population, Jaipur, Health Literacy in Dentistry (HeLD), Oral Health Impact Profile (OHIP-14), quality of life.

Background: Gestational diabetes mellitus (GDM) is a frequent metabolic complication of pregnancy, affecting both maternal and fetal outcomes. One of the major fetal concerns associated with GDM is abnormal intrauterine growth, particularly macrosomia. Ultrasound provides a non-invasive and reliable method to monitor fetal growth trajectories in real-time. Understanding the correlation between GDM and fetal biometry is critical for guiding perinatal management. To evaluate the correlation between gestational diabetes mellitus and fetal growth patterns as measured by ultrasonographic parameters, and to assess the prevalence of abnormal fetal growth among GDM pregnancies. Materials and Methods: A cross-sectional analytical study was conducted over a period of 12 months at a tertiary care hospital. A total of 120 pregnant women between 24–36 weeks of gestation were included. Among them, 60 were diagnosed with GDM based on IADPSG criteria and 60 were normoglycemic controls. All participants underwent standardized ultrasound examinations to measure biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW). Fetal growth categories—small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA)—were defined using WHO fetal growth charts. Statistical analysis included chi-square tests and Pearson correlation. Results: The prevalence of LGA fetuses was significantly higher in the GDM group (41.7%) compared to the control group (13.3%) (p < 0.001). GDM pregnancies had higher mean AC (mean: 31.4 ± 2.5 cm vs. 28.9 ± 2.2 cm; p < 0.01) and EFW (mean: 2,900 ± 450 g vs. 2,500 ± 390 g; p < 0.01). Positive correlations were found between fasting blood glucose levels and AC (r = 0.43) and EFW (r = 0.40). Other parameters such as BPD and FL did not differ significantly between the groups. Conclusion: Gestational diabetes is significantly associated with increased fetal growth, especially in terms of abdominal circumference and estimated fetal weight. Ultrasound biometry, particularly AC and EFW, serves as a sensitive tool for monitoring growth patterns in GDM pregnancies. Early detection of abnormal fetal growth via ultrasonography may aid in timely clinical decision-making and improved neonatal outcomes. Keywords: Gestational diabetes mellitus, fetal growth, ultrasonography, macrosomia, abdominal circumference, estimated fetal weight, pregnancy, fetal biometry.

Background: Antepartum eclampsia remains a critical obstetric emergency, especially in low- and middle-income settings. It is associated with high maternal and perinatal morbidity and mortality. Timely identification and management of eclampsia are vital to improving outcomes. This study aims to assess the spectrum of maternal and fetal outcomes in patients diagnosed with antepartum eclampsia. To evaluate the maternal and fetal outcomes associated with antepartum eclampsia and to identify common clinical presentations and complications in a tertiary care setting. Materials and Methods: A hospital-based cross-sectional observational study was conducted from January to December 2023 in the Department of Obstetrics and Gynecology at a tertiary care center. A total of 120 pregnant women diagnosed with antepartum eclampsia were enrolled based on predefined inclusion and exclusion criteria. Detailed clinical assessments, laboratory investigations, and maternal and fetal outcomes were recorded. Data were analyzed using SPSS version 26.0, and associations were assessed using chi-square and t-tests where appropriate. Results: Out of 120 cases, the majority (72.5%) were primigravidae, and 68.3% were between 20–30 years of age. Seizures were the initial presenting symptom in 89.2% of cases. The most frequent maternal complications were HELLP syndrome (15.8%), acute renal injury (10.0%), and pulmonary edema (6.7%). Maternal mortality was observed in 4.2% of cases. On the fetal side, 35.8% were preterm births, 28.3% were low birth weight (<2.5 kg), and the perinatal mortality rate was 18.3%. Emergency cesarean section was performed in 52.5% of cases, and vaginal delivery occurred in 45.8%. Magnesium sulfate was used in all cases for seizure control. Conclusion: Antepartum eclampsia continues to contribute substantially to adverse maternal and fetal outcomes. Young, primigravida women are particularly at risk. Comprehensive antenatal care, early diagnosis, and prompt multidisciplinary intervention remain pivotal in reducing morbidity and mortality associated with this condition. Keywords: Antepartum eclampsia, maternal outcomes, fetal outcomes, seizures in pregnancy, perinatal mortality, obstetric emergency, magnesium sulfate.

Background: Schizophrenia is a long-lasting and debilitating mental health disorder that affects individuals globally. Recent studies by the World Health Organization (WHO) indicate that over 21 million individuals around the world are living with Schizophrenia.[1] Objectives: 1. To determine the frequency of attempts of suicide in schizophrenia. 2. To study and compare the various risk factors of suicide attempts in patients with schizophrenia. 3. To compare differences in the clinical and socio-demographic profile with and without suicide attempts in patients with schizophrenia. 4. To evaluate the relationship of severity, type and duration of schizophrenic illness among patients with and without suicide attempts. Materials and Methods: Study Design: Hospital-based descriptive cross-sectional study. Study area: The study was conducted in the Department of Psychiatry, in a tertiary care teaching hospital. Study Period: 1 year. Study population: Participants were male and female patients diagnosed with Schizophrenia who came to the Psychiatry Department. Sample size: The study consisted of a total of 100 subjects. (27 attempted and 73 not attempted). Sampling Technique: convenience sampling method. Results: The mean score on the SAPS (positive symptoms scale) was 17.33 (SD - 7.68) for non-attempters, compared to 21.93 (SD - 9.20) for those with suicide attempts. The difference was statistically significant (P = 0.01) in the test. Conclusion: Suicide remains a significant risk for individuals with schizophrenia, particularly during the acute phases of the illness. Key risk factors include younger age, female gender, low income, alcohol use, and unemployment. Early identification, aggressive intervention, and sustained care beyond clinical recovery are crucial in mitigating this risk. Effective strategies involve treating depressive symptoms, improving treatment adherence, and maintaining vigilance, especially after significant losses. Keywords: Schizophrenia, Suicide, Calgary depression scale for Schizophrenia (CDSS).

Background: STIs pose a major health, social and economic problem worldwide, predominantly in developing countries like India. Aim and objective: To assess the patterns of STIs seen over the past 10 years based on the syndromic approach in a STD clinic of Tertiary care hospital. Materials and Methods: This is a retrospective study on patients who attended the Department of Dermatology and Venereology STD clinic, Government Medical College, Anantapur, from January 2014 to December 2023. Cases during 2021 was incomplete due to COVID 19, hence excluded. Patients examined clinically and diagnosed based on Syndromic approach. Results: The most common STDs affected age group was 21–30 years (52.63%), and were female (76.15%), The decreasing trend of STDs except Cervical vaginal discharge, Lower abdominal pain over period was observed. Of all the STDs attending STI clinic, CVD was most common (53.81%), followed by Lower abdominal pain (15.25%), and other STIs (15.71%). The most common STD noted was other STDs like balanoposthitis in males (45.26%) and Cervical vaginal discharge in females (70.61%). Conclusion: Though decreasing trend in STDs observed, Cervical vaginal discharge and Lower abdominal pain increased. Hence awareness of STIs, early diagnosis and treatment initiation and partner treatment could decrease the burden of STDs. Keywords: Sexually transmitted infections, Tertiary, Trends.

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health problem globally. It is associated with a range of metabolic and endocrine disturbances including thyroid dysfunction and dyslipidemia. Both conditions independently contribute to cardiovascular risk and glycaemic instability. The co-existence of thyroid dysfunction and lipid abnormalities in T2DM patients is being extensively study. This study aims to assess the prevalence and pattern of thyroid dysfunction and dyslipidemia in T2DM patients compared to healthy controls and analyze their association with glycaemic control. Materials and Methods: A comparative case-control study was conducted in the department of medicine of Adichunchanagiri Institute of Medical Sciences. 40 known cases of T2DM patients (Group A) and 40 healthy individuals (Group B) were included in this study on the basis of a predefined inclusion and exclusion criteria. Participants underwent detailed laboratory assessments including fasting and postprandial blood sugar, HbA1c, lipid profile and thyroid function tests (T3, T4, TSH). For statistical purposes P value less than 0.05 was taken as significant. Results: Thyroid dysfunction was significantly more common in diabetics (35%) than controls (12.5%) (p=0.0339). Most common thyroid function abnormality was found to be subclinical hypothyroidism. Thyroid dysfunction was observed in 90% of diabetics with poor glycemic control (HbA1c >7%), compared to only 16.7% in those with good control (p<0.0001). Dyslipidemia was more prevalent in T2DM patients (60%) than in controls (30%) (p=0.0129). Additionally, 90% of poorly controlled diabetics had dyslipidemia versus 50% in well-controlled individuals (p=0.0315). Conclusion: T2DM patients exhibit a significantly higher prevalence of thyroid dysfunction and dyslipidemia compared to healthy individuals. Routine screening for thyroid function and lipid profile in T2DM patients is recommended. Keywords: Type 2 Diabetes Mellitus, Thyroid Dysfunction, Dyslipidemia, Glycaemic Control, Subclinical Hypothyroidism.

Background: Post-operative pulmonary complications encompasses almost any complication occurring in the respiratory system following anaesthesia and surgery. The respiratory system takes upto 6weeks to return to its pre-operative state following general anaesthesia and major surgeries. Post-operative pulmonary complications are as prevalent as cardiac complications and contribute equally to morbidity, mortality and length of hospital stay. Objective: To study of pre-operative hematological abnormalities and its effects on post-operative pulmonary complications following thoracic surgeries. Materials and Methods: This Hospital based Prospective Observational Study was conducted at the Department of Pulmonary Medicine and Department of Cardio- Thoracic Surgery in Victoria Hospital, Bangalore Medical College and Research Institute (BMCRI), Bangalore. Results: Postoperative pulmonary complications were seen in 20.5% of patients (16/78). The following factors were statistically significant in patients who developed postoperative pulmonary complications, when compared to ‘No complications’ group: a. ASA Class > II (p= 0.023) b. Lower Body Weight (Mean = 50.06±7.9kg, p = 0.038) c. Lower BMI (Mean :19.82±2.48 kg/m2, p = 0.024) d. Lower Pre-operative SpO2 (Mean = 94.94±3.34 %, p= 0.023) e. Preoperative Tachycardia (Mean: 107.06±20.5 bpm, p = 0.044) f. Lower pre-operative Systolic blood pressure (SBP Mean: 109.63±11.3 mmHg) g. Pre-operative Anemia Mean Hemoglobin = 10.03±2.2g%, p = <0.001) h. Elevated WBC counts (TLC = 12479.31±6272.57 cells/ cumm, p = 0.028) i. Lower Serum Albumin levels (Mean = 3±0.86 g/dL, p= 0.001) j. Smokers who quit smoking within 8weeks of Surgery (p = 0.003) Conclusion: We conclude in our study that Multiple factors, which include, ASA Class > II, Lower BMI, Lower Body weight, Lower SBP, Lower Hemoglobin, Lower Serum Albumin levels and elevated WBC counts are statistically significant in the development of POPCs. Keywords: Thoracic Surgery. Post-operative pulmonary Complications, Elevated WBC counts, Serum Albumin levels.

Background: The present study was undertaken to evaluate the diagnostic utility of cholesterol in pleural fluid to differentiate transudates from exudates and to compare the diagnostic efficacy of pleural fluid cholesterol with that of Light’s criteria. Thus, simplifying the diagnostic procedure and lowering the cost. Materials and Methods: The present study was conducted on 120 patients with clinical and radiological evidence of pleural effusion, in the Department of Respiratory Medicine, Rajarajeswari Medical College, Bangalore & Katuri Medical College and Hospital, Guntur, Andhra Pradesh over a period of one and a half years, from August 2023 to January 2025. Results: The present study include total of 120 cases were enrolled in the study. All cases underwent thorough clinical and radiological examination. Thoracentesis was performed and pleural fluid analyzed for biochemical, pathological and microbiological parameters. Based on clinical/ aetiological diagnoses, the cases were classified as 100 exudates and 20 transudates. Light’s criteria was applied to the same 120 cases and 118 exudates and 2 transudates were found. Pleural fluid Cholesterol ≥ 60 mg/dl was taken as the cut-off to differentiate exudates from transudates. With this criteria 95 exudates and 25 transudates were found. The sensitivity was 86%, specificity 55%, PPV 91%, NPV 44% and The efficacy was 81%, which was similar to Light’s criteria. Conclusion: Thus pleural fluid Cholesterol is a useful parameter in differentiating exudates from transudates. It is simple, cost-effective and does not require a simultaneous blood sample. It has a high diagnostic efficacy and hence can be used as a routine test in pleural fluid analysis. Keywords: Pleural Fluid, Cholesterol, PPV, NPV, Exudates, Transdutes, Light’s criteria.

Background: Laparoscopic procedures have emerged as the preferred standard of care for a majority of surgical conditions and are extensively employed in daycare surgeries. Beyond the surgical technique itself, the choice of anesthetic agents significantly influences favorable clinical outcomes. This study aimed to evaluate intraoperative hemodynamic parameters and recovery profiles associated with the use of desflurane and sevoflurane. Materials and Methods: This randomized controlled trial involved 60 patients, divided equally between two groups: one receiving desflurane and the other sevoflurane. Participants aged between 18 and 45 years underwent laparoscopic cholecystectomy at a tertiary care center in central India. Approval from the institutional ethics committee was obtained, along with informed consent from all patients. Hemodynamic parameters were monitored both preoperatively and intraoperatively, while the time to spontaneous breathing, extubation, and postoperative complications were documented for both groups. Results: The demographic profiles and baseline characteristics of the two groups were comparable, with most participants being female in both groups. The study did not reveal any significant differences in hemodynamic parameters between the groups. The desflurane group demonstrated a 1.73-fold faster achievement of spontaneous breathing and a 1.4-fold faster extubation time compared to the sevoflurane group. No notable postoperative complications were observed in either group, and the average duration of hospital stay was similar across both groups. Conclusion: This study concludes that desflurane and sevoflurane exhibit comparable hemodynamic profiles during laparoscopic cholecystectomy. However, desflurane demonstrates superiority in facilitating earlier recovery of spontaneous breathing, responsiveness to verbal commands or eye-opening, as well as faster extubation times. Keywords: Intraoperative hemodynamic parameters, recovery characteristics, desflurane, sevoflurane, laparoscopic cholecystectomy.

Background: Abnormal uterine bleeding (AUB) in perimenopausal women is a common clinical challenge that may indicate underlying endometrial pathology. Aim: This study aimed to evaluate the diagnostic role of endometrial thickness and volume, measured by transvaginal three-dimensional ultrasound, in predicting abnormal endometrial histopathology. Materials and Methods: A prospective observational study was conducted on 60 perimenopausal women with AUB at a tertiary hospital in for a period of 1 year. Endometrial thickness and volume were measured using 3D transvaginal ultrasound, followed by histopathological evaluation. Results: Endometrial thickness and volume were significantly higher in cases with malignancy and hyperplasia with atypia compared to benign pathologies (p < 0.001). The combination of both parameters improved diagnostic sensitivity. Conclusion: Endometrial thickness and volume measured by 3D ultrasound serve as reliable predictors of endometrial pathology in perimenopausal AUB, supporting their use in clinical decision-making. Keywords: Abnormal uterine bleeding, Endometrial thickness, 3D transvaginal ultrasound.

Background: Emotional intelligence (EI) plays a crucial role in managing mental and behavioral disorders like depression and suicidal tendencies among youth particularly high-pressure environments like medical education. Parenting style is one of the factors that can influence emotional intelligence. Objectives: 1) To assess the level of emotional intelligence, perceived parenting styles among first year undergraduates. 2)To analyse the relationship between emotional intelligence and perceived parental bonding. Materials and Methods: Cross-sectional study among consented first year medical undergraduates. Emotional Quotient Self-Assessment scale and Parental Bonding Instrument study tools were used. Analysis was done using SPSS18. Descriptive statistics, t-test, Chi-square test, Fisher’s exact test, Spearman’s correlation test were applied. Results: Out of 143 first year students 60(42.0%) were males and 83(58.0%) were females. Mean age of total participants was found to be 18.83±1.10 years. Majority of the students were having poor total EI scores and in all six domains of EI. The mean score of total EI score was 104.69±15.657, and of perceived parental bonding scores like mother care, mother protection, father care, and father protection were 27.34±7.15,14.90±5.87,25.68±8.38 and 14.63±5.99 respectively. Father and mother care scores were significantly higher among females than males (P 0.000), while Father and mother protection scores were significantly higher among males than females (P 0.000). Those with higher father protection scores had significantly lower emotional intelligence {self-awareness (P 0.017) and social competency (P 0.020)}. Males had affectionless control parenting (58.3%, 68.3% from Mother and Father respectively). Females had optimal parenting {(49.3%) from mother and affectionate constraint parenting (38.6%) from father} (P 0.000). Conclusion: Maximum number of students had poor EI scores. Though perceived parenting style would not have much influence on overall emotional intelligence, it may impact domains like self-awareness and social competency. Keywords: Emotional Intelligence, Parenting style, Perceived parental bonding, medical students.

Background: Organophosphorus poisoning (OPP) remains a significant public health concern in developing nations, particularly among agricultural communities. This study examines the clinico-epidemiological profile of OPP patients at a tertiary care hospital in Western Maharashtra. Materials and Methods: A prospective observational study was conducted from November 2022 to October 2023, including 228 adult OPP patients. Data on demographics, clinical presentation, poisoning severity (Peradeniya scale), and outcomes were analysed using descriptive and inferential statistics. This study aims to assess the clinico-epidemiological profile, severity, outcomes, reasons, and seasonal trends of organophosphorus poisoning in adults admitted to a tertiary care hospital. Results: 69.3% patients of OPP were adults (21-40 yrs old) predominantly male (62.72%), and from rural areas (76.32%). Suicidal intent accounted for 92.54% of cases, primarily linked to socioeconomic stressors. Chlorpyrifos (65.79%) was the most common agent, with ingestion (91.67%) as the main exposure route. Clinical features included miosis (89.91%), fasciculations (82.46%), and respiratory depression (3.51%). Moderate-to-severe poisoning (84.65%) necessitated ventilatory support in 82.89% of cases. Outcomes revealed 73.68% cases completely recovered, 16.67% residual disability, and 9.65% mortality. Early hospital arrival (<3 hours) and pre-hospital treatment significantly improved survival (p<0.05). Conclusion: OPP disproportionately affects young rural males, with high suicidal intent and severe complications. Strengthening pesticide regulations, mental health services, and rural healthcare access is critical to reducing morbidity and mortality. Keywords: Organophosphorus poisoning, POP Scale, Pesticide, Seasonal trends, Suicidal poisoning.

Background: The goals of mechanical ventilation (MV) are to maintain proper gas exchange and to replace the respiratory muscles, which may become overworked in cases of acute respiratory failure, either fully or partially. The objective is to study the comparison of Diaphragmatic thickness fraction (DTF) vs Diaphragmatic Excursion (DE) by USG for Diaphragmatic dysfunction Assessment. Materials and Methods: This prospective observational study was conducted among the Patient presumed to mechanically ventilate for a prolonged period greater than 7 days in the Department of Anaesthesia at GSVM Medical College and associated LLRH Kanpur over 15 months from January 2023 to March 2024. Results: At admission, the diaphragmatic thickness fraction was significantly lower in the failure weaning group (83.54±4.0%) compared to the successful weaning group (86.43±4.1%; p=0.044). The diaphragmatic excursion did not differ significantly between the groups at admission (1.29±0.08 cm vs. 1.29±0.08 cm; p=0.889), but significant differences were observed during SIMV mode with spontaneous breath (0.93±0.13 cm vs. 1.20±0.07 cm; p<0.001) and subsequent transitions (p<0.001 for both). Conclusion: A straightforward technique for assessing DE and the thickness of the muscle in the zone of apposition is diaphragm ultrasound. This method is safe, extremely practicable, and reproducible on the same patients. Evaluation of DTF and DE using diaphragm ultrasonography in M-mode is a novel technique. Keywords: Diaphragmatic thickness fraction, Diaphragmatic Excursion, USG, Diaphragmatic dysfunction Assessment.

Background: Aim: This study aims to compare the efficacy and safety of traditional insulin therapy versus GLP-1 receptor agonists (GLP-1 RAs) in managing type 2 diabetes mellitus (T2DM), focusing on glycemic control, weight changes, lipid profile, and adverse events. Materials and Methods: A comparative observational study was conducted at a tertiary care hospital, involving 110 patients with T2DM randomized into two groups: Insulin Therapy Group (n=55) and GLP-1 RA Group (n=55). Patients were monitored for 36 weeks, with assessments at 4, 12, 24, and 36 weeks. Primary outcomes included changes in HbA1c, fasting blood glucose (FBG), and postprandial blood glucose (PPG). Secondary outcomes measured BMI, lipid profile, hypoglycemia incidence, and other adverse effects. Results: At 36 weeks, HbA1c reduction was significantly greater in the GLP-1 RA group (6.8% ± 0.4) compared to the insulin group (7.3% ± 0.5, p=0.001). Similarly, FBG and PPG levels were significantly lower in the GLP-1 RA group (FBG: 121.8 ± 15.7 mg/dL vs. 136.4 ± 17.2 mg/dL, p=0.002; PPG: 165.2 ± 19.8 mg/dL vs. 184.6 ± 22.4 mg/dL, p=0.001). The GLP-1 RA group also showed greater weight reduction (BMI: 26.7 ± 3.1 vs. 28.1 ± 2.9, p=0.001) and improved lipid profile, with significant decreases in LDL (p=0.004) and triglycerides (p=0.002). Hypoglycemia was more common in the insulin group (32.73%) than in the GLP-1 RA group (10.91%, p=0.002), whereas nausea (21.82%), vomiting (14.55%), and diarrhea (12.73%) were more frequent in the GLP-1 RA group. Conclusion: GLP-1 receptor agonists demonstrated superior glycemic control, weight loss benefits, and improved lipid parameters compared to insulin therapy, with a lower incidence of hypoglycemia. However, gastrointestinal side effects were more common with GLP-1 RAs, potentially affecting patient adherence. These findings support GLP-1 RAs as a preferred alternative to insulin therapy in overweight or cardiovascular-risk patients with T2DM. Keywords: Type 2 diabetes mellitus, GLP-1 receptor agonists, insulin therapy, glycemic control, adverse events.

Background: Hypertension is increasingly prevalent among young adults, yet its risk factors remain underexplored in this demographic. This study aims to determine the prevalence and associated risk factors of hypertension among young adults, focusing on lifestyle, metabolic, and genetic influences. Materials and Methods: A cross-sectional study was conducted among 140 young adults aged 18–35 years at a tertiary care hospital. Participants were selected using stratified random sampling, ensuring diverse demographic representation. Data collection included structured questionnaires on demographic details, lifestyle behaviors, dietary habits, family history of hypertension, smoking, alcohol consumption, and stress levels. Anthropometric measurements (BMI, waist-to-hip ratio) and biochemical assessments (fasting blood glucose, lipid profile) were conducted. Blood pressure was measured using a digital sphygmomanometer as per American College of Cardiology (ACC)/AHA 2017 guidelines. Results: Hypertension was prevalent in 34.3% of participants, with an additional 28.6% categorized as having elevated blood pressure. Males exhibited a higher prevalence (55.7%) than females (44.3%). Obesity was a significant risk factor, with hypertensive individuals having a higher BMI (27.1 ± 3.4 kg/m²) and waist-to-hip ratio (0.92 ± 0.08, p<0.001). High fasting blood glucose (102.5 ± 12.7 mg/dL, p=0.004) and total cholesterol (195.6 ± 17.2 mg/dL, p=0.001) were associated with hypertension. Behavioral risk factors such as smoking (37.5% vs. 11.5%, p=0.002), alcohol consumption (43.8% vs. 19.2%, p=0.008), low physical activity (62.5% vs. 26.9%, p<0.001), high salt intake (72.9% vs. 36.5%, p<0.001), and high perceived stress (52.1% vs. 23.1%, p=0.003) were significantly associated with hypertension. Logistic regression confirmed that obesity (OR=3.5, p<0.001), family history of hypertension (OR=2.2, p=0.028), smoking (OR=2.7, p=0.014), high salt intake (OR=3.9, p<0.001), low physical activity (OR=2.5, p=0.006), and high perceived stress (OR=2.0, p=0.031) were independent predictors of hypertension. Conclusion: Hypertension is highly prevalent among young adults, with modifiable lifestyle factors playing a crucial role. Obesity, smoking, alcohol consumption, high salt intake, low physical activity, and stress were key contributors, while genetic predisposition also played a role. Early screening, lifestyle modifications, and public health interventions are essential to mitigate hypertension risk and prevent long-term cardiovascular complications. Keywords: Hypertension, Young Adults, Risk Factors, Obesity, Lifestyle Modification.

Background: Noninvasive ventilation is an important involvement for managing acute-on-chronic respiratory failure in non-COPD patients, reducing the need for invasive mechanical ventilation. However, a significant proportion of patients’ involvement in NIV failure, leading to dishonoured consequences. Early identification of failure risk factors is critical to optimising patient management and improving survival rates. Materials and Methods: This observational study was shown in the respiratory intensive care unit of a medical college hospital in India. The study was conducted from April, 2024 to March, 2025. This observational study analysed 60 non-COPD patients receiving NIV. Clinical and physiological parameters, as well as heart rate, respiratory rate, Glasgow Coma Scale score, arterial blood gases, and ventilator situations, were recorded at baseline and 1–2, 12, and 24 hours after NIV beginning. Odds ratios for NIV failure was calculated, and 1000 bootstrap samples were used to validate results. Results: The NIV failure rate was 13.3%, with a hospital mortality rate of 10.0%. Patients who failed NIV had significantly higher heart rates at all time points (P < 0.01), lower GCS scores at 12h and 24h (P = 0.02), insistently lower pH levels (P < 0.01), and significantly reduced PaO₂/FiO₂ ratios at 12h and 24h (P < 0.03). The highest risk of NIV failure was observed at 12 hours (OR: 2.14, 95% CI: 1.52–3.02), with bootstrap analysis confirmative these results. Conclusion: The study has concluded that that early monitoring of non-invasive ventilation (NIV) is crucial for predicting failure in patients with acute-on-chronic respiratory failure. Keywords: Noninvasive ventilation, NIV failure, Acute-on-chronic respiratory failure, PaO₂/FiO₂ ratio, Glasgow Coma Scale, Arterial blood gases, Respiratory monitoring.

Background: Soft tissue reconstruction of the distal one-third of the leg is a significant challenge due to the region's poor vascularity, limited soft tissue, and close proximity to bone and tendons. Free tissue transfer, while considered the gold standard, may not be feasible in patients with comorbidities or poor vascular status. The turnover distally based peroneus brevis muscle flap has emerged as a reliable, local alternative for coverage of small to medium-sized defects in the lateral and central lower leg. Materials and Methods: This prospective study included 18 patients with soft tissue defects in the lower third of the leg, managed using the turnover distally based peroneus brevis muscle flap. Parameters recorded included patient demographics, comorbidities, etiology of the defect, anatomical site, defect size, chronicity, operative times, complications, management, and postoperative hospital stay. All flaps were covered with split-thickness skin grafts and patients were followed for flap viability and functional outcome. Results: The mean patient age was 60.2 years, with a male predominance (66.7%). Common comorbidities included diabetes mellitus (38.9%) and hypertension (27.8%). Most defects were due to wound gaping following orthopedic internal fixation (72.2%), primarily involving the lateral malleolus (83.3%). The average defect size was 37.6 cm². Mean tourniquet time was 36.7 minutes, and average operative duration was 63.4 minutes. Flap survival was 100%, with no total losses. Partial skin graft loss occurred in 27.8% of cases; one required regrafting, while others healed conservatively. Mean hospital stay was 7.2 days, with no donor site morbidity observed. Conclusion: The turnover distally based peroneus brevis muscle flap is a reliable, safe, and efficient reconstructive option for lateral and midline defects of the lower third of the leg. It offers excellent outcomes with minimal morbidity, especially in patients where microsurgical procedures are contraindicated or impractical. Its consistent anatomy, ease of harvest, and suitability for comorbid patients make it an ideal addition to the reconstructive surgeon’s armamentarium. Keywords: Peroneus brevis muscle flap, lower third leg defect, soft tissue reconstruction, turnover flap, local flap, orthopedic wound complications, Achilles tendon coverage, flap surgery in diabetic foot.

Background: The aim is to compare the outcome of mechanical method of induction in second trimester intrauterine fetal death in previously scarred uterus. Materials and Methods: A hospital-based cross-sectional analytical study. The study population consisted of 50 multigravida with second-trimester intrauterine fetal death with previously scarred uterus. Modern Government Maternity hospital, Petaburj, Hyderabad, India. All multigravida with second-trimester intrauterine fetal death with previously scarred uterus. The sampling technique used for the present study was a convenient sampling technique. All the eligible patients satisfying the inclusion criteria were selected. Results: In the present study, About 52% were lower middle class, 12% were upper middle class, 32% were belonged to middle class socio economic class as per Modified Kuppuswamy scale. About 42% were graduate, 32% were plus two, 16% were postgraduate and 10% were educated up to 10th standard. Almost 78% were working and 22% were not working. Induction to abortion time in hrs shows that the mean time was 16.2 (2.1) hours.. 16% had incomplete abortion, 8% had febrile morbidity, 6% had haemorrhage, 4% had ruptured uterus and 20% treatment failure. 10% of the patient underwent hysterotomy. About 24% were admitted to MICU. Conclusion: Therefore this study concludes that mechanical method of induction can be a safer option considering the dreaded complications associated with operative interventions like hysterotomy. Keywords: Intra uterine fetal deaths, Kuppuswamy scale, Haemorrhage, Induction of abortion, Hysterotomy.

Background: Head trauma is a significant cause of morbidity and mortality across all age groups globally. The Glasgow Coma Scale (GCS) is a rapid and widely accepted tool to assess consciousness level in trauma patients. Computed Tomography (CT) plays a pivotal role in identifying structural brain injuries. Understanding the relationship between GCS and CT findings is essential for clinical decision-making and prognosis. Materials and Methods: This cross-sectional study included patients of all ages presenting with head trauma at a tertiary care hospital. GCS scores were recorded at admission, and CT scans were performed within the first 6 hours. CT findings were categorized into types of intracranial hemorrhage, fractures, midline shift, cerebral edema, and other pathologies. Statistical correlation was evaluated between GCS score ranges and CT abnormalities. Results: CT scans revealed that 65 patients (72.2%) had abnormal findings, while 25 (27.8%) had normal scans. The most common abnormality was subdural hematoma (13.3%), followed by epidural hematoma (11.1%), contusions (11.1%), and subarachnoid hemorrhage (8.9%). Other significant findings included intracerebral hemorrhage, cerebral edema, and midline shift. Among patients with severe GCS (3–8), 19 (95%) had abnormal CT findings. In contrast, only 16 (35.6%) patients in the mild GCS category (13–15) showed abnormalities on CT. This trend supports a strong inverse relationship between GCS score and the likelihood of pathological findings on CT scan. Conclusion: CT imaging findings show a significant correlation with GCS scores in head trauma patients. Lower GCS is associated with more severe CT abnormalities, emphasizing the role of early imaging in low-GCS patients regardless of age. Keywords: Head injury, Computed tomography, Glasgow Coma Scale, Traumatic brain injury, CT findings.

Background: The aim is to compare the maternal and fetal outcome in women with singleton pregnancies having amniotic fluid index AFI ≤ 5cm, to those having AFI 6-20cm matched with age and parity. Materials and Methods: This is a prospective comparative study conducted on 100 pregnant women with 50 women with AFI≤ 5cm. and 50 women with AFI 6-20 cm. between gestational age 32-42 weeks. The two groups are matched with age and parity. This is done over aperiod from October 2017 to September 2019 in the department of Obstetrics and Gynaecology in Kamineni Institute of Medical Sciences, Narketpally. Results: In the present study mean age in the study group was 23.18±3.22 years and in the control group was 23.3±3.27 years. The present study includes 62% were primipara and 38% were multipara in both study group and control group. Both study group and control group are matched with parity. In the present study non reactive NST was seen in 36% in study group when compared to 14% in control group, this difference is statistically significant (p<0.05). In the present study 90% of cases underwent LSCS in study group when compared to 60% in control group, this difference is statistically significant (p<0.05). In the present study emergency LSCS in study group (64.4) when compared to control group (40%), this difference is statistically significant(p<0.05). The present study shown fetal distress as an indicator of LSCS was 33.3% in study group and 16.6% in control group, this difference is not statistically significant(p>0.05). APGAR score ≤7 at 5 min was 16% in study group and 4% in control group, this difference is statistically significant (p<0.05). In the present study newborns admitted in NICU was34% in study group and 16% in control group, this difference is statistically significant (p<0.05). In the present study, 34% of newborn babies admitted in NICU due to different reasons in study group, birth asphyxia was present in 6% of newborns, meconium aspiration syndrome was present in 4% of newborns, respiratory distress syndrome was present in 14% of newborns, very low birth weight was present in 10% of newborns. In control group 16% of newborns admitted in NICU, 2% had meconium aspiration syndrome, 6% had respiratory distress syndrome, 8% had hyperbilirubinemia. Conclusion: From this study, it can be concluded that oligohydramanios is a high risk pregnancy and proper antepartum care, intensive fetal surveillance and intrapartum care are required in patient with oligohydramnios. Every case of oligohydramnios needs careful antenatal evaluation, counselling, individualization, decisions regarding time and mode of delivery. Continuous intrapartum fetal monitoring and good neonatal care are necessary for better perinatal outcome. Keywords: Amniotic fluid index, NST, oligohydramnios, antepartum care, LSCS, NICU.

Background: Pain on injection is a common and distressing side effect of propofol. Various methods have been explored to minimize this discomfort. This study aimed to evaluate the effectiveness of normal cold saline (4°C) as a carrier fluid in reducing the incidence and severity of propofol-induced pain compared to room temperature saline. Materials and Methods: A randomized controlled study was conducted on 100 patients divided into two groups of 50 each. Group C received 10 ml of cold saline, while Group R received saline at room temperature prior to propofol administration. Pain scores, postoperative recall, and heart rate changes were recorded and analyzed. Results: Group C showed a significantly lower incidence and severity of pain compared to Group R. Postoperative recall of pain was also reduced in Group C, along with more stable heart rate readings, indicating reduced nociceptive stress. Conclusion: Cold normal saline is a simple, effective, and safe method to reduce propofol-induced pain, improving overall patient comfort during induction. Keywords: Propofol, Injection pain, Cold saline.

Background: Thyroid nodules are a typical symptom of autoimmune thyroiditis (AIT), which is more often known as Hashimoto's thyroiditis. This inflammatory disorder affects the thyroid gland. Because sonographic characteristics of benign and malignant nodules in AIT overlap, clinically differentiating between the two is difficult. The purpose of this study is to enhance diagnosis accuracy and suggest proper care by correlating sonographic characteristics of thyroid nodules with histological findings in patients diagnosed with AIT. Materials and Methods: A prospective investigation was performed on 60 patients identified with autoimmune thyroiditis using clinical, serological, and sonographic criteria. This study was conducted at the Department of Pathology, Government Medical College Mancherial, Telangana, India from April 2024 to December 2024. All patients had high-resolution thyroid ultrasonography to assess nodule features, including echogenicity, margins, calcifications, vascularity, and morphology. Fine-needle aspiration cytology (FNAC) or surgical biopsy was conducted for histological verification. Sonographic observations were evaluated against histological diagnoses to determine sensitivity, specificity, and predictive value for malignancy. Results: Nodules were found in 60 of the patients. The sonography of twenty-four nodules revealed characteristics that could indicate cancer, including hypoechogenicity, microcalcifications, uneven borders, a form that was taller than wide, and intranodular vascularity. Of the nodules examined, histopathology revealed that ten (12.2%) were cancerous, with papillary thyroid carcinoma being the most common type. Microcalcifications and uneven margins were the two sonographic findings that were most predictive of cancer. Ultrasonography had a sensitivity of 90% and a specificity of 78.3% when it came to identifying tumors. There was a definite relationship between sonographic suspicion and histological diagnosis. Conclusion: One important non-invasive method for evaluating thyroid nodules in autoimmune thyroiditis patients is sonographic examination. There are a number of sonographic characteristics that can accurately indicate cancer and help determine if FNAC or surgery is necessary. On the other hand, a conclusive diagnosis can only be made with histological confirmation. Keywords: Autoimmune thyroiditis, Hashimoto’s thyroiditis, thyroid nodules, ultrasonography, histopathology, fine-needle aspiration cytology.

Background: Accurate intraoperative diagnosis of female genital tract (FGT) lesions is crucial for guiding surgical management, especially in cases involving suspected malignancy. Frozen section (FS) analysis offers rapid preliminary diagnosis; however, its reliability depends on its correlation with final histopathology (HP), the gold standard. Materials and Methods: This retrospective study was conducted over 14 months at Siddhartha Medical College, Vijayawada, involving 31 cases of FGT lesions that underwent both FS and HP evaluation. Tissue samples were analyzed using standard cryostat and H&E staining techniques. Diagnostic concordance between FS and HP was assessed, and discrepancies were reviewed for contributing factors. Results: FS and HP diagnoses were concordant in 28 out of 31 cases (90.3%). Discrepancies in three cases involved challenges in differentiating granulosa cell tumor from serous carcinoma, adenomatous polyp from endometrial hyperplasia with atypia, and borderline from malignant seromucinous tumors. Factors influencing diagnostic discordance included sampling limitations, freezing artifacts, and interpretative challenges. Conclusion: FS is a highly effective intraoperative diagnostic tool for benign and borderline FGT lesions, showing strong concordance with HP. However, its limitations in identifying invasive malignancies necessitate cautious interpretation, particularly in complex or ambiguous cases. Incorporating adjunct techniques and expert consultation can enhance diagnostic accuracy and surgical outcomes. Keywords: Frozen section, Histopathology, Female genital tract lesions, Diagnostic accuracy, Ovarian tumors, Endometrial pathology.

Background: The clinical effectiveness of transfused blood components is influenced by their quality at the time of administration. Storage-induced changes in red blood cells (RBCs) and platelets, known as storage lesions, may impair transfusion efficacy. This study aimed to investigate the effects of storage duration on RBC integrity and platelet function. Materials and Methods: An observational laboratory-based study was conducted in the Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, over one year. A total of 160 blood component units were analyzed, comprising 80 packed red blood cell units and 80 platelet concentrates. RBCs were evaluated on Days 1, 21, and 42 for plasma-free hemoglobin, potassium, LDH, pH, and 2,3-DPG levels. Platelet units were assessed on Days 1, 3, and 5 for aggregation response, CD62P expression, pH, swirling, and post-processing yield. Data were analyzed using repeated measures ANOVA and t-tests. Results: RBCs showed a significant rise in hemolysis indicators and potassium levels by Day 42, with over 57% of units exceeding the hemolysis threshold. 2,3-DPG levels declined by 85%. Platelets demonstrated a drop in aggregation capacity and swirling scores, with CD62P expression increasing to 42.9%. Functional platelet recovery dropped to 67.7% by Day 5. Conclusion: Prolonged storage adversely affects both RBC and platelet quality, potentially compromising transfusion efficacy. These findings highlight the need for timely utilization, enhanced monitoring, and refined transfusion strategies. Keywords: Red blood cell storage, platelet function, storage lesion, hemolysis, CD62P, 2,3-DPG, transfusion quality.

Background: Upper gastrointestinal (UGI) lesions are commonly encountered in clinical practice and range from benign inflammatory conditions to malignancies. Histopathological evaluation of endoscopic biopsies provides definitive diagnosis, guides treatment, and facilitates early detection of neoplastic changes. Materials and Methods: This observational, cross-sectional study was conducted at the Department of Pathology, Esic Medical College, from March 2023 to February 2024. A total of 110 patients who underwent UGI endoscopic biopsies were included. Biopsies were obtained from the esophagus, stomach, and duodenum and subjected to histopathological examination. Relevant clinical, endoscopic, and demographic data were analyzed. Results: The most commonly biopsied site was the stomach (59.1%), followed by the esophagus (27.3%) and duodenum (13.6%). Chronic gastritis (25.5%) was the most frequent diagnosis, followed by H. pylori-associated gastritis (13.6%) and intestinal metaplasia (9.1%). Malignant lesions accounted for 13.6% of all cases, with gastric adenocarcinoma being the most common. Esophageal biopsies had the highest malignancy rate (20%). H. pylori was detected in 35.4% of gastric biopsies. Concordance between endoscopic and histopathological findings was highest in suspected malignancies (90.9%). Conclusion: Histopathological analysis of endoscopic biopsies reveals a wide spectrum of UGI lesions and plays a critical role in detecting early malignancy, even when endoscopic findings are non-specific. Routine biopsy remains essential for diagnosis, particularly in high-risk patients. Keywords: Upper gastrointestinal tract, endoscopy, histopathology, gastric cancer, H. pylori, chronic gastritis, biopsy, esophageal carcinoma, intestinal metaplasia.

Background: According to WHO Pneumonia is the single largest infectious disease India accounting for 20% of those deaths and has higher burden of childhood pneumonia. Neutrophil to lymphocyte ratio (NLR) and Platelet lymphocytic ratio (PLR) reflect systemic inflammation. These ratios were used to evaluate the severity of infectious diseases. The objective is to hematological parameters and derived hematological ratios like neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in children with pneumonia and to study the correlation of these ratios to severity of pneumonia in children. Materials and Methods: Children fulfilling the eligibility criteria were included in the study after written informed consent. Required data were noted in proforma. Complete Blood Picture and other required investigations were done. Patients were classified as pneumonia or severe pneumonia as per WHO classification. Hematological parameters and ratios (NLR and PLR) were analyzed in children with pneumonia and severe pneumonia. Results: In the study 74.8% had pneumonia and 25.2% had severe pneumonia. Mean Neutrophil to Lymphocyte Ratio among subjects with Pneumonia was 1.36 ± 0.54 and in subjects with severe pneumonia was 1.42 ± 0.33(p value 0.574). Mean Platelet to Lymphocyte ratio among subjects with pneumonia was 87.05 ± 29.33 and in subjects with severe pneumonia was 43.66 ± 19.76(p value <0.001). There was significant difference in in Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte ratio between two groups. Conclusion: The combination of NLR and PLR has a higher value in evaluating the severity of children with pneumonia, which can be useful for treatment of the pneumonia. Keywords: Neutrophil to lymphocyte ratio (NLR), Platelet to lymphocyte ratio (PLR), Pnuemonia.

Background: Among high-risk females, doppler assessment of uterine circulation might help estimate preeclampsia and small for gestational age infants compared to risk prevalence and assessment. Hence, risk prediction in these complications can improve outcomes with proper antenatal surveillance. The present study was aimed at assessing the association of abnormal uterine artery Doppler waveform in high-risk pregnancies and subsequent adverse pregnancy outcomes. Materials and Methods: In high-risk pregnant females, uterine artery Doppler was done in 18-24 weeks and reported to the Institute within the defined study period. The presence of bilateral uterine artery notching and PI (pulsatality index) >1.45 were taken as abnormal Doppler waveforms. Outcomes assessed were intrauterine fetal death, abruption, SGA (small for gestational age <10th centile, and preeclampsia. Results: Doppler assessment was done in 230 high-risk pregnant females where abnormal Doppler waveforms were seen in 34.8% of females. Preeclampsia and small for gestational age infants were seen in 26.95% (n=62) and 36.52% (n=84) subjects respectively with 70% and 76% females with abnormal Doppler waveform. Negative predictive value (NPV), PPV (positive predictive value), specificity, and sensitivity of bilateral uterine artery notching and PI >1.45 in preeclampsia prediction was 88%, 55%, 78.57%, and 70% respectively with p<0.0001 and for SGA prediction was 86.67%, 80%, 89.04%, and 76.19% respectively (p<0.0001). Conclusion: The present study concludes that uterine artery Doppler waveform analysis in mid-trimester for high-risk pregnant females leads to a high negative predictive value. Hence, females having normal Doppler waveform are not likely to result in adverse pregnancy outcomes. Keywords: Abnormal doppler, preeclampsia, pulsatility index, small for gestational age, uterine artery doppler, uterine artery notching.

Background: Sudden sensorineural hearing loss (SSNHL) is a rapid-onset otologic emergency characterized by an unexplained hearing loss of ≥30 dB over three contiguous frequencies within 72 hours. Despite multiple treatment modalities available, an optimal therapeutic approach remains uncertain. The objective is to evaluate and compare the effectiveness of systemic corticosteroids, intratympanic steroid injections, and adjunctive hyperbaric oxygen therapy (HBOT) in improving hearing outcomes in patients with idiopathic SSNHL. Materials and Methods: A prospective, randomized clinical study was conducted at a tertiary care center from March 2024 to February 2025. A total of 132 patients with idiopathic SSNHL were enrolled and divided into three treatment groups: Group A (n=44): Systemic corticosteroids (oral prednisone 1 mg/kg/day for 10 days with taper), Group B (n=45): Intratympanic dexamethasone (4 mg/mL, administered 3×/week for 2 weeks), Group C (n=43): Combined systemic corticosteroids and HBOT (daily 100% oxygen at 2.4 ATA for 60 minutes over 15 sessions). Pure-tone audiometry (PTA) was performed at baseline, 2 weeks, and 1 month. Hearing recovery was assessed using Siegel’s criteria. Results: The results demonstrated a significant improvement in hearing across all three study groups. Group C exhibited the highest proportion of complete or partial hearing recovery at 72%, in comparison to 61% in Group A and 58% in Group B, with this difference being statistically significant (p < 0.05). Furthermore, early initiation of therapy specifically within seven days of symptom onset was strongly associated with better hearing outcomes (p < 0.01). Importantly, no serious adverse effects were noted in any group; however, a small proportion (8%) of patients undergoing intratympanic therapy experienced mild, transient vertigo. Conclusion: While all treatment modalities demonstrated efficacy in managing SSNHL, combination therapy with systemic steroids and HBOT was superior in terms of hearing recovery. Early diagnosis and prompt initiation of treatment remain critical. Further multicentric studies with larger cohorts are needed to validate these findings and support the integration of HBOT into standard treatment protocol. Keywords: Sudden sensorineural hearing loss; SSNHL; corticosteroids; intratympanic steroid; hyperbaric oxygen therapy; hearing recovery; clinical study; otology; randomized controlled trial.

Background: HIV-induced immunodeficiency frequently leads to opportunistic infections including Pneumocystis jiroveciii pneumonia (PJP). lactate dehydrogenase (LDH) levels are usually elevated in cases of PJP. The purpose of this study was to assess the predictive value of LDH in PJP patients as well as its link with HIV progression as measured by CD4+ lymphocyte counts. Materials and Methods: A prospective observational study was carried out over a two-year period at the Kamineni Academy of Medical Sciences and Research Centre in Hyderabad, India. 51 HIV-positive patients with PJP were included in this study on the basis of a predefined inclusion and exclusion criteria. Comprehensive pathological and radiological assessments were carried out including a complete blood profile, LDH levels, renal and liver function tests, viral load and CD4/CD8 counts. HRCT chest imaging and arterial blood gas analysis was also done. The relationship between LDH levels and CD4 counts was analysed with an emphasis on LDH as a prognostic marker. Results: The average CD4 count for the patients was 130.47 ± 48.39 cells/mm³. LDH levels showed a substantial negative correlation with CD4 counts (p < 0.001). The study found that LDH levels >372 U/L had 100% sensitivity and 89.20% specificity in predicting adverse outcomes, resulting in a 27.5% mortality. Youden's index (J=0.9189) revealed >372 U/L as the best LDH threshold, resulting in an 82.4% positive and 100% negative predictive value. Conclusion: LDH can be a valuable diagnostic tool, especially in situations where invasive testing is impossible or risky. This is important in resource poor setting in developing countries including India. Keywords: CD4/CD8, HIV, Lactate Dehydrogenase, Liver Function Test, Pneumonia, Pneumocystis jiroveciii pneumonia.

Background: Programmed death-ligand 1 (PD-L1) plays a crucial role in immune evasion mechanisms and has been widely studied in malignancies. However, its expression in tuberculous pleural effusion (TPE) remains unclear. This study aims to evaluate the diagnostic and prognostic significance of PD-L1 expression in TPE and compare it with malignant pleural effusion (MPE). Materials and Methods: A prospective comparative study was conducted on X patients with pleural effusion, including Y cases of TPE and Z cases of MPE. Pleural fluid samples were collected and analyzed for PD-L1 expression using immunohistochemistry. Clinical parameters, biochemical markers, and cytological findings were documented. Statistical analysis was performed to determine the association of PD-L1 expression with disease diagnosis and prognosis. Results: PD-L1 expression was detected in A% of TPE cases and B% of MPE cases. The mean PD-L1 expression level was significantly higher in MPE compared to TPE (p < 0.05). Among TPE patients, higher PD-L1 expression correlated with prolonged treatment duration and increased inflammatory response. In MPE, elevated PD-L1 levels were associated with poor prognosis and reduced survival rates. Sensitivity and specificity analyses indicated that PD-L1 could serve as a potential biomarker for distinguishing between TPE and MPE. Conclusion: PD-L1 expression varies significantly between TPE and MPE, suggesting its potential utility as a diagnostic and prognostic biomarker. Its differential expression may aid in distinguishing benign from malignant pleural effusions, contributing to more precise clinical management. Further studies are warranted to validate these findings. Key Words: PD-L1, Tuberculous pleural effusion, Malignant pleural effusion, Immunohistochemistry, Prognostic biomarker, Diagnostic marker.

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant concern due to its potential complications, including pyelonephritis, preterm labor, and low birth weight. Early detection and treatment are essential for preventing adverse maternal and fetal outcomes. This study aims to assess the prevalence, microbial profile, and antibiotic sensitivity of ASB among pregnant women attending a tertiary care hospital in North Maharashtra. Materials and Methods: This hospital-based observational study included 150 pregnant women attending the antenatal clinic. Participants were selected using simple random sampling, and those with symptomatic urinary tract infections or recent antibiotic use were excluded. Midstream urine samples were collected and analyzed for bacterial growth. Isolated organisms were identified using conventional biochemical methods, and antibiotic sensitivity testing was performed according to CLSI guidelines. Data were analyzed using SPSS software, with chi-square tests applied to determine associations. Results: The prevalence of ASB was highest in the 20-25 years age group (74%), among primigravidae (52.7%), and in the second trimester (70%). Most participants (60%) belonged to the lower socioeconomic class. Escherichia coli (84%) was the predominant pathogen, followed by Klebsiella pneumoniae (8%). Nitrofurantoin exhibited the highest sensitivity (59.3%), while resistance was noted against ciprofloxacin and cefotaxime. Hygiene and occupation showed significant associations with ASB (p < 0.05), while gravida, trimester, and water consumption were not statistically significant. Conclusion: ASB is prevalent among pregnant women, particularly in those with lower socioeconomic status and poor hygiene. Screening during early pregnancy and targeted antibiotic treatment are essential to reduce complications. Keywords: Asymptomatic bacteriuria, pregnancy, Escherichia coli.

Background: The present study was designed to compare the effects of thiopentone, propofol and midazolam in patients undergoing modified electroconvulsive therapy. Materials and Methods: Patients were randomly divided into three groups of 35 each: Group A = inj. Sodium thiopentone (2.5%) 5mg/kg, Group B = inj. Propofol 2mg/kg and Group C = inj. Midazolam 0.2mg/kg. Results and Conclusion: We concluded from our study that, propofol in dosage of 2 mg/kg body weight intravenously can be safely used for modified ECT because of rapid induction, early recovery, better hemodynamic, fewer side effects, uncompromised therapeutic outcome without much rise in serum potassium makes propofol as an agent of choice for the procedure. Keywords: Thiopentone, Propofol, Midazolam, Modified Electroconvulsive Therapy.