Current Issue

Background: Parent-child communication is a foundational element in building a healthy and supportive family dynamic. It involves the exchange of thoughts, feelings, and information between parents and their children, playing a crucial role in the emotional, social, and cognitive development of the child. From early childhood through adolescence, the nature and methods of communication evolve, requiring parents to adapt their approaches to meet the changing needs of their children. Whether through words, body language, or actions, how parents communicate with their children significantly impacts their self-esteem, emotional regulation, and relationships with others. Aim and Objectives: To determine the level of communication between parent and their adult children and to assess how the level of communication between parents and their children affects a child’s mental health. Materials and Methods: A cross-sectional study was conducted between October and December 2023 among 230 randomly selected students aged 18 to 25 from various colleges in the Indore district who gave consent, using a pre-designed, semi-structured, pre-tested questionnaire. Data entered in Microsoft Excel was analysed using SPSS software 25.0 (trial version). Results: Mean Parent-Adolescent Communication Scale (PACS) score of medicos was 65.86±5.94 and non-medicos was 67.56±6.38, which was statistically significant. The mean Perceived Stress Scale (PSS) score among medicos was 20.99±5.21 and that of non-medicos was 20.66±5.11. Spearman’s correlation between PACS and PSS was statistically significant among young adults. Mean PACS score of males was 67.46±5.98 and that of females was 66.03±6.35. Mean PSS score among males was 19.25±5.46 and that of females was 22.25±4.42, which was statistically significant. Mean PACS score of severe PSS category participants was 64.45±5.51, moderate PSS category participants was 66.36±6.08, and that of mild PSS category participants was 73.17±3.85, which was statistically significant (p <0.05). Conclusion: The correlation between PACS and PSS scores was found to be statistically significant (p-value<0.001) among young adults suggesting that, both parent-child communication and perceived stress are associated. So, better communication will help to reduce the stress in the personal lives of young adults. Keywords: Parent-Child Communication, Mental Health, PACS, PSS.

Background: Penile fracture is the traumatic rupture of tunica albuginea. It is a urological emergency that occurs almost exclusively due to blunt trauma of erect penis. Diagnosis is mostly based on clinical history and physical examination. Aim: To study the presentation and management of patients with penile fracture. Materials and Methods: This retrospective study was conducted in Government Medical College Srinagar in the department of surgery over a period of 3 years. Total of 65 patients with fracture penis were included in the study. Clinico-etiological profile, management and outcome were recorded on a preformed proforma designed for the purpose. Results: The age group involved was 17-55 years with mean age of 36 yrs. 37 (56.9%) were married and 28 (43.1%) were unmarried. The most frequent mechanisms of injury was sexual intercourse observed in 40 patient, masturbation in 17 patients and in 7 patients fracture occurred because of trauma to erect penis (rolling over erect penis). In one patient the exact cause could not be elucidated. 17 patients recalled a popping sound. Penile swelling was seen in 56 patients with pain in 53, deformity in 55 and ecchymosis in 50 patients. Diagnosis was made clinically and was confirmed on surgical exploration. Repair of tunica defect was done. One urethral injury was encountered which was primarily repaired. Outcome was excellent and all patients regained complete penile function except 6 patients, at 2 months follow up. Out of 65 cases treated surgically, 4 patients had wound infection, and 12 had palpable nodule at the site of fracture and 1 patient had depression. Conclusion: Penile fracture is a clinical diagnosis requiring early exploration and surgical repair to ensure better functional and morphological outcomes. Keywords: Penile fracture, Management, Outcomes, Erectile dysfunction, rupture of corpora cavernosa.

Background: Diabetes mellitus is a prevalent metabolic disorder characterized by chronic hyperglycemia, leading to complications affecting various organs, particularly the kidneys. This study aims to assess the correlation between glycemic control, as indicated by HbA1c levels, and renal function, measured through blood urea and serum creatinine levels, in diabetic patients with controlled diabetes compared to healthy controls. Materials and Methods: A comparative case-control study was conducted involving 300 patients with well-controlled diabetes and 100 healthy age-matched controls. Key biochemical parameters, including fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, blood urea, and serum creatinine, were analyzed. Statistical analysis was performed using Student's t-test to compare the two groups. Results: Among the diabetic cases, 84 (28%) had elevated urea levels, 90 (30%) showed increased creatinine, and 126 (42%) had elevated levels of both. Males exhibited higher creatinine values than females, likely due to greater muscle mass. A significantly higher levels of FBS, PPBS, HbA1c, blood urea, and serum creatinine was observed in diabetic patients as compared to controls (p < 0.001). Conclusion: Elevated blood urea and serum creatinine levels in diabetic patients are indicative of renal impairment. There is a significant correlation between poor glycemic control and kidney function deterioration. Regular monitoring of these parameters is crucial for the early detection and management of diabetic nephropathy, emphasizing the importance of glycemic control in preserving renal health. Keywords: Diabetes mellitus, blood urea, serum creatinine, HbA1c, renal impairment, diabetic nephropathy.

Background: Blood transfusion is vital in trauma, surgery, and chronic care, but it poses a risk of transmitting infections like hepatitis B, hepatitis C, HIV, syphilis, and malaria. These infections often originate from asymptomatic donors and can spread through contaminated blood or improper handling during transfusion. Materials and Methods: A retrospective study was conducted at the Model Blood Centre of SVRRGGH in Tirupati, aimed to ensure safe blood transfusion by rigorously screening all donations for transfusion-transmitted infections (TTIs) following national protocols. Results: The five-year study at the Model Blood Bank, Tirupati, recorded 35,080 blood donations, with a significant gender disparity, as 97% of donors were male. The overall prevalence of infectious markers was 1.68%, with Hepatitis B (1.4%) being the most common infection, followed by HIV (0.14%), HCV (0.04%), syphilis (0.011%), and malaria (0.06%). Conclusion: The study emphasize the importance of rigorous screening protocols to ensure the safety of blood donations, especially considering the higher rate of infection in voluntary donors. Keywords: Blood donation; HIV, HbsAg, HCV, transfusion transmitted infections.

Background: Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. objectives were to compare the post- operative pain scores, intravenous opioid analgesic requirements and length of postoperative stay of the two groups of women. Material and Methods: Present Prospective Randomized Controlled Trial was conducted at Department of Anaesthesiology, G.M.E.R.S Medical College and Hospital Sola, Ahmedabad. Sixty patients were scheduled for elective laparoscopic gynecologic surgery. At the end of the surgery, the patients were divided into two groups. RSB group (GROUP A): Patients received USG guided Bilateral Rectus Sheath Block with 20 ml of 0.25% Ropivacaine on each side (n=30). Control Group (GROUP B): Patients who did not receive the RSB block and were given Injection Tramadol on demand for post-operative analgesia as per institutional protocol(n=30). Analgesic efficacy of RSB block in laparoscopic gynecologic surgery was assessed by time to first requirement of rescue analgesic drug (Tramadol), VAS scores, and total dose requirement of Tramadol in 24 hrs. Results: RSB block increases the duration of time to first rescue analgesic drug with significant difference between RSB group and the CONTROL group. There is a significant decrease in the VAS score in the postoperative period in the RSB group as compared to the control group. It also reduces the total Analgesic requirement in the first 24 hours with significant difference between both groups. Conclusion: USG guided Bilateral Rectus Sheath block when compared with a standard general anaesthetic is associated with a significant decrease of systemic analgesics demand and is a good choice for postoperative pain management in surgery involving the anterior abdominal wall like laparoscopic gyneclogical surgery as a part of multimodal analgesia. Key Words: Laparoscopic Gynecologic Surgery, Rectus sheath block, Ropivacaine, Tramadol.

Background: Age related hearing loss is a major public health issue, Multiple variables have been evaluated that contribute to hearing loss with aging. Aim: To study Age related Hearing loss among patients above 60 years of age with comorbidities. Materials and Methods: A cross sectional study of 100 elderly patients with and without various co-morbidities were investigated by pure tone audiometry to assess the hearing loss and the pure tone thresholds were compared among the various subgroups and the following results were obtained. Results: Majority of the elderly study subjects belonged to 71-80 years (41%) followed by 34% in 61– 70-year age group. Majority of the study subjects were male (64%). The male to female ratio was 1.7:1. The most common comorbidity present was Diabetes mellitus (28%), followed by hypertension (24%) and dyslipidaemia (18%). Smoking constituted 14% and alcohol habit was present in 16% study subjects Sensorineural hearing loss was observed in all the patients under the study. The degree of hearing loss increased as age progresses in both the normal and patients with comorbidities. The hearing loss maintained a linear progression amongst all studied groups. Conclusion: There is a definitive increase in hearing thresholds in patients of Diabetes mellitus, Hypertension, Dyslipidaemia, Smoking when compared to the normal whereas amongst alcohol consumers the hearing threshold was better when compared to the normal patient. Keywords: Hearing loss (HL), Dyslipidaemia, Smoking, Diabetes mellitus, Hypertension.

Background: Neurological complications are common in paediatric HIV patients, with neuro-imaging playing a crucial role in early detection and management. This study aims to evaluate the spectrum of MRI neuro-imaging findings in HIV-positive children and correlate these findings with their CD4 counts. Materials and Methods: A Cross sectional descriptive study was conducted in the Department of Radiodiagnosis, of an urban tertiary care teaching hospital. The study included thirty consecutively enrolled HIV infected children up to 15 years of age having neurological manifestations, attending paediatric OPD as well as those admitted to the paediatric ward at this tertiary care hospital from Dec 2021 till Nov 2023. Results: None of the children were less than 01 year of age in our study. In 21 (70 %) cases, there were T2 and FLAIR hyperintense white matter lesions noted suggestive of HIV encephalopathy. Out of these 21 cases, 11 (52.3 %) patients had white matter lesions in periventricular location, 6 (28.5 %) in deep white matter and 4 (19 %) in both periventricular and deep white matter. 15 (71.4%) out of these patients diagnosed as HIV encephalopathy had associated cerebral atrophy. Out of total 30 cases studied, only two patients (6.6 %) had focal intra-cranial lesions and only one (3.3 %) patient had chronic ischemic infarct in left MCA territory with ectasia of M1 segment of right middle cerebral artery. Both the patients with focal intra-cranial lesions were diagnosed as tuberculomas based on imaging findings, CSF studies and serological markers. Patients with HIV encephalopathy presented with varied neurological manifestations & were more commonly associated with severe degree of immune suppression as indicated by low CD4 counts. This association was found to be statistically significant (as indicated by p value of <0.05 in Fisher exact test). Conclusion: This study highlights the range of neurological abnormalities in HIV-positive children and emphasizes the association between lower CD4 counts and more pronounced MRI findings. Early detection of these abnormalities in children with declining CD4 levels could aid in timely clinical interventions and improve the management of neurological complications in paediatric HIV. Keywords: HIV-positive children, Neuro-imaging, Magnetic Resonance Imaging (MRI), CD4 counts.

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a significant pathogen in intensive care units (ICUs), causing severe infections that are difficult to treat due to resistance to carbapenems. Understanding the risk factors associated with CRKP infections is essential to prevent their spread and improve outcomes. Materials and Methods: An observational study was conducted with 100 ICU patients diagnosed with Klebsiella pneumoniae infections. Data on antibiotic use, duration of ICU stay, use of mechanical ventilation, and other clinical variables were analyzed. Statistical tests, including chi-square and logistic regression, were applied to assess risk factors for CRKP infections. Results: Of the 100 patients, 45 had CRKP infections. Significant risk factors included prior carbapenem use, prolonged ICU stay, mechanical ventilation, and central venous catheter use. Mortality was significantly higher among CRKP-infected patients (35%) compared to non-CRKP patients (10%). Conclusion: CRKP infections in ICU patients are strongly linked to prior antibiotic use, invasive procedures, and prolonged hospitalization. Effective infection control and antibiotic stewardship are critical to reducing CRKP infections in ICUs. Keywords: Risk Factors, Carbapenem-Resistant, Klebsiella Pneumoniae, Infectious disease, Intensive Care.

Background: Hyperandrogenism and insulin resistance are seen in polycystic ovary syndrome (PCOS) which are also known risk factors for dry eyes. Dry eye is a potential comorbidity present in patients with PCOS. Aim: To find correlation between dry eye disease (DED) and PCOS. Materials and Methods: A total of 50 women with polycystic ovary syndrome (PCOS) and 50 healthy controls were included in the study. They were then subjected to a complete ophthalmic evaluation which included tear film break-up time, Schirmer’s test and Ocular Surface Disease Index (OSDI) questionnaire scoring. Results: Correlation between DED and PCOS was found to be statistically significant in both TBUT and OSDI score while Schirmer’s test was found to be statistically insignificant. Conclusion: PCOS has a positive correlation with DED and hence regular eye check-ups are advisable for patients with PCOS. Keywords: Polycystic ovary syndrome, dry eye disease, TBUT, OSDI, Schirmer’s test.

Background: During the first thousand days of life (from conception to the second year), the brain, goes through 90% of its important development. This period is pivotal for cognitive, immune, digestive, and metabolic development, with long-term implications for health and productivity. Many parents are ignorant of the fact that in order to promote good synaptogenesis and overall brain development, their children need certain foods and stimulation. The IAP-Early Childhood Development (ECD) module aims to address this gap through structured parental interventions. To evaluate the impact of the IAP-ECD module on the growth and developmental outcomes of infants aged 0-2 years in Sangareddy district. Materials and Methods: One hundred term healthy babies (≤1 week old) were participated in this prospective experimental study; fifty were born intramurally at MNR Medical College (intervention group), and fifty were born extramurally (control group). The intervention group received neuronal stimulation education through the IAP-ECD module, with eight scheduled well-child visits for growth and development monitoring. The control group attended standard health check-ups. Growth metrics (weight, height, head circumference) and developmental quotients were assessed using the Denver Developmental Screening Test II (DDST-II) and Developmental Assessment Scales for Indian Infants (DASII). Results: The intervention group exhibited significantly higher mean weight, height, and head circumference (p<0.05). Developmental quotients in gross motor, fine motor, language, and social communication domains were also significantly higher in the intervention group at 6, 12, and 18 months (p<0.05). Exclusive breastfeeding rates increased within the intervention group, with a notable reduction in formula feeding and sickness episodes compared to controls. Conclusion: The IAP-ECD module improves the development and growth of newborns through specific dietary and neuronal stimulation. These findings advocate for integrating structured parent education and early developmental interventions in order to help children thrive in the first thousand days of life. Keywords: Early Childhood Development, Brain Development, Infant Growth, Developmental Quotient, Parent Education, Synaptogenesis.

Background: India contributes to a significant number of neonatal mortality in the world, around 25% of the world total. In India neonatal mortality rate contributes significantly to Infant mortality rate and therefore under five mortality rate. Region and cause specific interventions should be planned after detailed analysis of outcome trends in newborn and feedback from healthcare workers to reduce neonatal mortality. This study aimed to find out the outcome and mortality pattern and its causes in Level II special care neonatal Unit in a medical college to plan targeted interventions further. Materials and Methods: This is a retrospective study done on 1950 newborns who were admitted in special newborn care unit over one-year period of time (30/09/2023 to 30/09/2024) in department of Paediatrics of Rani Durgawati medical college (UP). Results: 1950 neonates (Male: Female,1:1.15) were admitted over 1-year period in which 350 Inborn and 1600 outborns were admitted,750(38%) of newborns were premature (delivery before term and low birth weight). The trends in mortality showed a decline over year (The decline was more in outborn than inborn neonates), Among them respiratory distress syndrome and Prematurity being a big contributor to mortality. Rate of successful discharges showed an inclined trend. However, the trends in etiology of death was uniform over the year with respiratory distress syndrome (45%), Perinatal Asphyxia/HIE (25%), prematurity (20%), Sepsis (5%) and congenital malformations (5%) being the chief contributor Extremely preterm newborn had highest case fatality rate around 70%. Conclusion: Our study shows the trends are encouraging but only for term newborns but they also may be insufficient to meet the target of SDG 3.2. For extremely preterm/very low birth weight and newborns having hyaline membrane disease, the trends are not encouraging and these High-risk newborns need to receive better management with advance targeted interventions. Keywords: neonatal mortality, SNCU, preterm, SDG, perinatal asphyxia.

The study aimed to determine the positivity and common clinical features of the influenza virus among hospitalized pediatric patients. The investigation was conducted from December 2022 to November 2023, during which 310 nasopharyngeal swabs were collected from pediatric patients admitted with acute respiratory symptoms (categorized as Category C according to the Ministry of Health and Family Welfare, MOHFW guidelines). These samples were processed following standard protocols. Viral RNA was extracted, and real-time reverse transcriptase polymerase chain reaction (r RT-PCR) was performed to detect the presence of the influenza virus. Subsequent r RT-PCR assays were conducted for subtyping influenza virus types A and B. The clinical histories of the patients were also documented. Out of the 310 samples, 23 (7.42%) tested positive for influenza virus A or B. Further subtyping revealed that 03/310 (0.97%) were positive for A H1N1, 17/310 (5.48%) were positive for A H3N2, and 03/310 (0.97%) were positive for B Victoria. Among the positive influenza cases, fever was the most prominent clinical feature observed in all patients. Other common clinical symptoms included cough, breathlessness, and sore throat. The findings underscored the importance of early detection, prompt treatment, and effective management of complications to reduce the burden of influenza epidemics. At the public health level, the study highlighted the need for continuous surveillance to monitor any resurgence of the infection that could potentially lead to further epidemics or pandemics. The unpredictable nature of influenza virus evolution continues to pose challenges to vaccine strategies and pandemic preparedness, emphasizing the importance of ongoing research and vigilance in addressing this significant health threat. Keywords: RT PCR, Influenza, H1N1, H3N2, Nasopharyngeal swab, respiratory illness.

Background: India is world’s diabetes Capital. The prevalence of Type 2 Diabetes Mellitus is expected to rise more rapidly in the future in India and 40 other countries because of increasing obesity and reducing activity levels and other life style changes. It is well established that coronary artery disease is a major complication of diabetes mellitus, representing the ultimate cause of death in more than half of all patients with this disease. In this study we made an effort to know the cardiac changes present in the patients of Type 2 Diabetes, who do not have any symptoms relating to cardiovascular system and to demonstrate the presence of silent myocardial ischemia in asymptomatic patients of Type-2 Diabetes Mellitus. Materials and Methods: 60 Type 2 diabetes patients for more than one year duration with age 40-70 yrs who do not have any complaints relating to cardiovascular system were included in this study. All were assessed with detailed history, clinical examination and relevant investigation including resting ECG and Treadmill test. Patients with H/O myocardial infarction, uncontrolled blood pressure and other chronic diseases were excluded from the study. Results: In the 60 diabetes patients in Present study, 32 patients were males and remaining 28 were Females. None of our patients showed Resting. ECG and 2D ECHO changes. 11 patients from Present study group showed inducible ischemia in the Treadmill test. Hypertriglyceridemia which is a common risk factor associated with coronary artery disease was found in 31 patients (51.66%) in Present study group. Conclusion: This study shows that type 2 diabetes patients especially of longer duration should undergo cardiac evaluation even though they do not have any symptoms relating to cardiovascular system. Keywords: 2 Diabetes Mellitus, silent myocardial ischemia, Hypertriglyceridemia, Coronary artery disease, cardiovascular disease.

Background: The lymph node ratio (LNR), defined as the ratio of positive lymph nodes to the total number of dissected lymph nodes, has emerged as a potential prognostic indicator in oral squamous cell carcinoma (OSCC). This study aimed to evaluate the prognostic significance of LNR in predicting outcomes, including overall survival (OS) and disease-free survival (DFS) in OSCC patients. Materials and Methods: A retrospective analysis was conducted on 241 patients with histologically confirmed OSCC who underwent surgical resection with curative intent and cervical lymph node dissection. Patients were categorized into two groups based on LNR: low LNR (≤0.20) and high LNR (>0.20). Survival analysis was performed using Kaplan-Meier curves, and Cox proportional hazards regression models were used to identify prognostic factors for OS and DFS. Receiver Operating Characteristic (ROC) curve analysis was conducted to assess the prognostic accuracy of LNR. Results: Patients with a high LNR had significantly worse survival outcomes compared to those with a low LNR. The 3-year OS rate was 42.4% in the high LNR group versus 78.7% in the low LNR group (p < 0.001), while the 3-year DFS rate was 35.2% versus 70.5%, respectively (p < 0.001). Multivariate analysis confirmed high LNR as an independent predictor of poor OS (HR: 1.72, 95% CI: 1.21–2.43, p = 0.002) and DFS. Other significant factors included age, histological grade, depth of invasion, perineural invasion, and lymphovascular invasion. ROC curve analysis showed that LNR had a high prognostic accuracy for predicting survival outcomes. Conclusion: The LNR is a significant prognostic factor in OSCC, providing additional information beyond the traditional TNM staging system. Incorporating LNR into routine pathological assessment may improve risk stratification and guide treatment planning, particularly for patients at higher risk of recurrence and poorer survival. Keywords: Oral squamous cell carcinoma(OSCC), Lymph node ratio(LNR), Prognostic factor(PF), Survival analysis(SA), Overall survival(OS), Disease-free survival(DFS), Cox regression analysis(CRA).

Background: Birth control or contraception and reproductive health have become an essential part of women’s health, by which we can prevent unwanted pregnancies, and family planning is achieved by using highly effective and safe methods of contraception. Over the past few decades, a high growth was seen in the use of contraceptives in the developing countries also and they have been associated with a decrease in the number of unintended pregnancies, and by the effect of it, we achieved reduction in maternal mortality by approximately 40%. Objective: To assess the awareness and contraceptive practices of women attending immunisation clinic of a tertiary care institute. Materials and Methods: This cross-sectional study was conducted in women aged 20-40 years attending immunisation clinic of the department of Community Medicine of a tertiary care hospital of Kashmir. Results: Majority (89.0%) of women belonged to age group 25-34 years. 70% of participants were literate. Majority (85%) of them were homemaker by occupation. 83.0% of participants belonged to Middle-Class. 38.0% of participants had two children. Majority of participant’s husband were literate (88%). 67% of participants were aware regarding different contraceptives. Out of 400 only 180 (45%) of the participants were currently practicing contraceptives. In majority (91%) of participants the decision on fertility were taken by both husband and wife. In our study, Age (p=0.031), Education (p=0.020), SES (p=0.007), Parity (p=0.001) and husbands Education(p=0.002) of the participants was found out to be Statistically Significant with the practice of Contraception. Conclusion: In the present study, we found that majority of the participants were literate and they had awareness about Contraceptives but the Contraceptive Practice was low. Keywords: Contraceptive Practices, Family Planning, Hospital.

Background: Our study aimed to assess medical students' knowledge and attitudes toward the HPV vaccine as well as the effects of a brief educational intervention. This was done because there is a lack of knowledge about the potential of human papillomavirus (HPV) vaccination in India, even among medical personnel. Materials and Methods: A cross-sectional study was conducted in a government teaching hospital. Participants were given a 22-item questionnaire about their understanding and acceptance of the HPV vaccine both before and after an educational intervention. An informative group lecture served as the intervention. Results: In August 2022, a total of 168 students were surveyed, followed by a lecture on the same day. The same students were asked to fill out the same questionnaire again in October, which was 3 months after the intervention. The results showed that after the intervention, 97.3%(138/142) of the participants recognized HPV as a sexually transmitted infection, compared to 92.9%(156/168) before, (p < 0.05). Additionally, awareness of HPV affecting all genders increased from 81.5%(137/168) to 95.2%(135/142), (p < 0.01). The participants also demonstrated a better understanding of HPV's association with various cancers. Furthermore, awareness of the vaccine's availability for all genders increased from 75.6%(127/168) to 87.5%(124/142), (p < 0.01) and the willingness to receive the vaccine significantly rose from 76% (114/150) to 92.4% (118/128), (p < 0.01). These findings highlight the positive impact of educational interventions on HPV-related knowledge and attitudes among medical students. Conclusion: In conclusion, the study demonstrated a significant improvement in medical students' knowledge and attitudes towards the HPV vaccine following an educational intervention. To enhance HPV vaccination rates, targeted awareness campaigns, education, and improved accessibility are essential in reducing the burden of HPV-related diseases and preventing cervical cancer. Addressing these challenges will help achieve broader vaccine acceptance and protect the population from the consequences of HPV infection. Further studies are needed to evaluate and standardize HPV education programs in India. Keywords: Human papillomavirus (HPV), Medical students, HPV vaccine, Educational intervention, Vaccine attitude, Vaccine acceptability.

Background: Breastfeeding is the foundation of a newborn’s nutrition. Breastfeeding needs to be initiated and promoted, and awareness should be created. The family members, mainly the husband, may play a central role in the quality of breastfeeding the baby receives. Fathers’ psychological and practical support influences initiation and duration of breastfeeding. Materials and Methods: This is a prospective questionnaire based study involving fathers of babies who are born in Cloudnine hospital Jayanagar, Bengaluru. On day 3 of life, fathers were given prestructured, self administered questionnaire involving knowledge, attitude and practices towards breast feeding. Babies were followed up in outpatient department for weight loss exclusive breast feeding. Results: In our study, we had total 215 participants. It was apparent in our observation that larger portion of our study population had good knowledge, positive attitude and right practices towards breast feeding. Exclusive breast feeding was 83.3% and significant weight loss (10%) was only 6.0%. We found that good knowledge, attitude and practice of father towards breast feeding was shown to influence exclusive breast feeding with a p value of <0.05. While good attitude was associated with reduced significant weight loss with a p value of <0.05. Conclusion: Good knowledge attitude and practice of father towards breast feeding had positive influence on exclusive breast feeding. While positive attitude of father towards breast feeding showed to be associated reduced significant weight loss. Keywords: Exclusive breast feeding, Father’s perspective, Significant weight loss in neonates.

Background: Malnutrition remains as an important public health issue in both developed and developing countries significantly affecting under- five children. Globally, the overall rate of stunting, wasting and under- weight as 22.3 %, 6.8 % and 5.6 % with overall global rate of 40 % stunting in tribal children. The District Level Household Survey (DLHS) reports suggest the overall prevalence rates of above indicators were as 32.2%, 18 %, 6.8 % and 28.7 % respectively in Chamarajanagar district in State of Karnataka. Objectives: To assess the nutritional status of the children of 12- 23 months age in the tribal settlements of Chamarajanagar district and to determine the factors associated with malnutrition status among these tribal children. Materials and Methods: After obtaining the ethical clearance, a cross- sectional study was conducted in the months of January- December 2023 using 33 × 6 Cluster sampling method with a sample size of 198, the data were collected regarding 201 children in their tribal settlements with written consent using a pre- tested questionnaire included with the socio- demographic details and the measurements such as weight, length, head circumference and mid- upper arm circumference. The nutritional assessment was done using WHO Anthro-plus software. The SPSS software version 21 was used for statistical analysis to find the association of nutritional status with socio- demographic variables by using Chi- Square test, Independent- T test, ANOVA. Results: The overall prevalence of stunting, wasting, severe wasting and under- weight were as 45%, 12.9 %, 6.4 % and 18.9 % respectively. The statistical significances were found among the immunization status with stunting as well as wasting, gender of the child with wasting, head circumference and gender of child, weight of child and the taluk name, weight and MUAC as well as taluk name, weight of child and mother’s age in group. Conclusion: From this study, it can be concluded that the stunting was found more prevalent among tribal children with association of factors such as gender of child, mother’s age, Taluk name, immunization status was found to be in statistical significance with the nutritional status. Keywords: Nutritional Status, Prevalence, Children.

Background: There exists literature that supports the positive correlation between the CD4+ count by flow cytometry and by TLC. However, some studies oppose this concept and correlations. Hence, there is a strong need to determine the correlation. Objective: The present study was undertaken to observe whether the absolute lymphocyte count can be used as a predictor of CD4 count in HIV-infected patients on treatment. Materials and Methods: A total of 135 HIV positive individuals (diagnosis based on serology, PCR) were part of the study after obtaining written informed consent. The blood samples were collected as per standard protocol. Sysmex-K21 was used to assess the complete blood count and total leucocyte count. CD4+ count was performed using a flow cytometry device. Results: A positive correlation was observed between the CD4+ count and WBC count, absolute lymphocyte count, and lymphocyte percentage. Conclusion: The study results support that the absolute lymphocyte count predicts CD4 count in HIV-infected patients on treatment. However, further detailed studies with larger sample sizes and involving multiple centers are recommended. Keywords: Absolute lymphocyte count, Immunity, HIV patients.

Background: Primary intramedullary nailing in open fracture fulfils the objective of stable fixation, biomechanical stability, minimal soft tissue damage, less healing time and early rehabilitation, early weight bearing. As there is data lacking on this, we decided to do this study to assess the clinical outcome of open type 1 and type 2 (Gustilo Anderson) tibia fracture treated with intramedullary interlocking nailing beyond golden hours with respect to, time taken for healing, achievement of range of motion of ankle and knee. Materials and Methods: A longitudinal study was done from January 2021 to December 2022 on a total of 30 participants at the Department of Orthopedics at the Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India. Results: The mean age in the study was 35.26 SD +/- 10.4 years. We noted that evening time the injuries of tibia were more common. We had a positive correlation between the CRP and the degree of contamination of the wound. Males were suffered more than females, 1 case had pain at knee, 4 cases had ankle and screw site pain and 1 case had superficial infection,2 cases had delayed union, 53.33% had excellent outcome, 43.33% had good outcome, 3.33% had fair outcome. At admission the mean m rust score was 5.03 SD +1.47 and at the final follow up mean m rust score was 22.97SD +3.65. Conclusion: Primary nailing is very useful in the management of open tibia fractures which is treated beyond golden period with a very minimal complication rate and an acceptable clinico- radiological outcome. The results were also found to be satisfactory in terms of the time required for healing and the Range of motion achieved. Keywords: Complication, Primary nailing, Golden hour, Tibial Fracture.

Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Migraine which is a major health issue among people of age group 14 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7% (around 1 in 7 people). I Chronic Migraine affects about 2% of world population 2 with female and make ratio 3:1.3 It is a widespread, chronic and intermittently disabling disorder characterized by recurrent headaches with or without aura. The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or has part of his vision blanked out. It is also called as “sick headache” because nausea and vomiting occasionally accompany the excruciating pain which lasts for as long as three days. Suppressing migraine pain with NSAIDS and analgesics gives short term relief and the pain can rebound. Dependence on medicines decreases the body’s natural pain relief mechanism and long-term dependence can damage kidneys, liver or other vital organs. Ayurveda believes in treating the disease at its root cause from within. Therefore, treatments focus on balancing the vitiated Doshas in the digestive and nervous systems. This can be achieved by avoiding triggering factors and prescribing doshic specific diet, stress management, herbal formulas, lifestyle modification Panchakarma, Kriyakalpa and other holistic modalities to create a balanced physiology. Keywords: Migraine, Tridosha, Ayurvedic Therapies.

Background: Acromioclavicular (AC) joint dislocation is common among athletes and participants in contact sports, accounting for approximately 12% of shoulder girdle injuries. While the majority of AC joint injuries can be effectively managed conservatively, high-grade dislocations and certain cases of type 3 dislocations require surgical intervention. Over the years, numerous operative techniques have been developed. The aim of this study is to assess the functional outcomes of using an Endobutton in the management of AC joint dislocations. Aims and Objectives: To evaluate the clinical and radiographic results of patients diagnosed with Acromioclavicular joint dislocation treated with open reduction and internal fixation with Endobutton. Objectives of The Study: To prospectively assess the reduction and AC joint stability. To identify complications related with this procedure. To assess the functional status using DASH Score. Materials and Methods: A total of 25 patients with acute AC joint dislocation were treated using either a double Endobutton or a combination of one Endobutton and a suture anchor. Patients were assessed pre-operatively and at 3, 6, and 12 months post-operatively using the DASH and CONSTANT scoring systems. Additionally, X-ray evaluations were conducted. Results: Of the 25 patients, 22 (88%) were male and 3 (12%) were female, with a mean age of 34.56 years (range: 18–60 years). The right shoulder was operated on in 18 patients (72%) and the left in 7 patients (28%). Rockwood type 3 dislocations were diagnosed in 17 patients (68%), and type 5 in 8 patients (32%). At the final follow-up, the mean DASH score was 3.36 ± 2.07, and the mean CONSTANT score was 96.6 ± 2.63. Post-operative X-rays showed good reduction of the AC joint dislocation. Complications included 1 case of superficial infection and 2 cases of loss of reduction. Conclusion: The use of a double Endobutton or a combination with a suture anchor provides both vertical and horizontal stability to the AC joint. The Endobutton technique minimises implant-related complications and eliminates the need for further surgery to remove the implant. The double Endobutton construct with No. 5 Ethibond closely replicates the coracoclavicular (CC) ligament, resulting in excellent functional outcomes. AC joint reconstruction using the Endobutton allows for early functional recovery and a full range of shoulder movement. Keywords: Acromioclavicular Joint, Dislocation, Endobutton, Shoulder.

Background: Sexual abuse is now a days common among children. So it is important to create awareness among them to reduce the incidence. Aim: The aim of this study is to evaluate the effectiveness of health education regarding good and bad touch among 6 to 10 year children. Setting and design: 6 to 10 year children in Thoothukudi district. Subject and method: It is a quasi-experimental study conducted among 6 to 10 years children in primary schools. Result: The study evaluation showed that the health education on good touch and bad touch has a positive effect over the children. The comparative study among rural and urban children showed that the urban children had a better overview about good touch and bad touch. Conclusion: Children should be made aware of good touch and bad touch from early age itself. Parents and teachers should be educated about the importance of talking such topics with children. Keywords: Good touch, bad touch, child abuse

Background: Healthcare workers are at elevated risk of several diseases in comparison to other occupations since they are exposed to a variety of potentially harmful conditions. Many healthcare providers frequently overlook needle stick injuries, this route predominantly facilitates the transmission of severe blood-borne diseases such as Hepatitis B, Hepatitis C, and HIV, etc.; Objectives: 1. To study the prevalence of occupational injuries among healthcare workers in tertiary care hospital in Tamil Nadu. 2. To explore the patterns of occupational injuries among healthcare workers. Materials and Methods: A cross-sectional study was carried out among 200 healthcare workers in a Tertiary care hospital in Tamil Nadu. The participants were interviewed using a predesigned semi-structured questionnaire. Data was compiled in MS Excel and analyzed and analyzed using SPSS v25.0. Results: The prevalence of occupational injuries among healthcare workers (N=200) was found to be 66%. Among all occupational injuries, needle stick injury was more common. The occupation and hours of shift (12 hrs) were found to be statistically significant with occupational injuries. Only 21.2% of injuries were reported. Injuries were more often during the morning shift inwards and while doing procedures. Conclusion: The study shows a high prevalence of occupational injuries among doctors, the most common being needle stick injury, emphasizing the importance of implementing safe measures to handle sharps to prevent transmission of infection. Keywords: Occupational injuries, Needle stick injury, Health care workers.

Background: From conservative cast and braces to internal fixation with nailing, plating and screw, the treatment of humeral fractures has seen significant advancements in addressing their complications. Aim and Objective: The study aimed to assess the practicality of using the MIPPO technique for treating fractures in the distal humeral shaft. Materials and Methods: Patients with a midshaft humerus fracture were included in the study. The study included a total of 25 patients. The fractures were treated by using a 4.5mm narrow Dynamic compression plate (DCP) for reduction and fixation. X-rays of the humerus were taken on the first day after surgery and then at follow-up appointments at 1 month, 3 months, 6 months, and 12 months. The procedure's clinical and functional outcomes were evaluated using the MEPI score for the elbow and UCLA score for the shoulder. Results: Among the 25 patients, it was observed that the majority of them, specifically 18 patients, had fractures on their dominant side. The average operative time was determined to be 85 minutes. At 6 months, almost all (23 out of 25) patients had an excellent MEPI score. There was no significant difference in MEPI scores over time (p>0.05). All patients had an excellent or good UCLA score at 6 months. The UCLA scores did not show any significant difference over time (p>0.05). Conclusion: We found that anterior bridge plating through MIPO of humeral shaft fractures improved radiological, clinical, and functional outcomes (MEPI scores, UCLA scores, and range of motion). The technique is complex and takes a long time to learn, but the results are good and reproducible. Keywords: Anterior Bridge Plating, Humerus Diaphyseal Fractures, Dynamic compression plate, Minimally invasive plate osteosynthesis.

Background: Diabetes mellitus (DM) has become a global health concern, with type 2 diabetes mellitus (T2DM) accounting for the vast majority of cases. While the cardiovascular complications of T2DM are well-recognized less attention is given to other systemic effects such as hearing loss. Emerging evidence suggests that T2DM contributes to subtle auditory dysfunction primarily due to microangiopathy and neuropathy affecting the cochlea and auditory nerve. These early changes in hearing are often undetected without audiometric screening. This study aims to evaluate the prevalence and severity of hearing impairment in T2DM patients. Materials and Methods: This comparative observational study was conducted in the Department of General Medicine and ENT at a tertiary care medical college. A total of 50 patients diagnosed with type 2 diabetes mellitus (Group A) were enrolled based on predefined inclusion and exclusion criteria, alongside 50 age-matched healthy individuals (Group B) as controls. Demographic data, medical history, and comorbidities were recorded for both groups. A detailed ENT examination was performed to rule out ear conditions affecting hearing. Audiometric testing, including air and bone conduction, was conducted at frequencies ranging from 250 to 8000 Hz using a pure tone audiometer. Data were analyzed using SPSS software, with a p-value of <0.05 considered statistically significant. Results: Patients with type 2 diabetes mellitus (T2DM) had significantly higher systolic (149.82 mmHg vs. 140.15 mmHg, P = 0.0016) and diastolic (90.76 mmHg vs. 85.34 mmHg, P < 0.0001) blood pressure compared to healthy controls. Fasting blood sugar, triglycerides, waist circumference, and BMI were also elevated, while HDL cholesterol was lower in the diabetic group (P < 0.0001 for all). Bone and air conduction hearing thresholds were consistently higher in T2DM patients across all tested frequencies for both ears, demonstrating significant auditory impairment compared to controls (P < 0.05 for all frequencies). Conclusion: Patients with type 2 diabetes mellitus (T2DM) were found to have significant auditory impairment as evidenced by higher bone and air conduction thresholds compared to healthy controls. Regular hearing screenings in T2DM patients, particularly those with poor glycaemic control, are crucial for early detection and prevention of further hearing loss, thereby improving patient outcomes and quality of life. Keywords: Type 2 Diabetes Mellitus, Audiometry, hearing loss, screening.

Background: Varicose veins, a key feature of chronic venous insufficiency, are dilated, twisted veins that commonly affect the lower limbs and are more prevalent in women and older adults. Treatment has shifted from vein stripping to minimally invasive procedures like Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA), both of which are effective, though RFA may offer quicker recovery and less post-operative pain. Materials and Methods: This prospective hospital-based study compared the efficacy and safety of Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) for treating varicose veins over a one-year period in 100 patients, aged 18-65, classified under the CEAP system. Both procedures involved thermal ablation of the vein, with EVLA using laser energy and RFA using radiofrequency, followed by routine post-operative care and follow-up to assess outcomes such as vein occlusion, symptom relief, and complication rates. Results: The study included 100 patients with varicose veins, divided equally into two groups: EVLA (Group A) and RFA (Group B), with most participants being male and aged 31-40 years, classified primarily as CEAP C2. Both procedures showed similar outcomes, with slightly longer procedure times and higher post-operative pain in the EVLA group, though neither of the differences were statistically significant, and both treatments achieved high success rates with no evidence of venous reflux at 1 and 3 months post-procedure. Conclusion: Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) are highly effective and safe treatments for varicose veins, with similar anatomical success rates and no significant differences in post-operative complications. Although EVLA had slightly longer procedure times and higher post-operative pain levels, both treatments effectively eliminated venous reflux, making them viable options for varicose vein management. Keywords: Varicose veins, endovenous laser ablation, radiofrequency ablation, RFA, EVLA.

Background: Neuraxial anesthesia remains the preferred choice for Caesarean deliveries across the world. Hypotension is the physiologic consequence and perhaps the most common complication of neuraxial anesthesia in obstetric patients. In this study, we compared the effectiveness of vasopressors, ephedrine versus phenylephrine in the treatment of hypotension after spinal anesthesia and also the fetal outcome. Materials and Methods: Patients aged group between 18-and 35 years posted for elective cesarean section with term pregnancy were allocated randomly to the two groups, Group-1 (E) Ephedrine and Group-II (P) Phenylephrine. Changes in maternal blood pressure, heart rate, and saturation were monitored and noted till the end of the surgery. The total dose of vasopressor and number of boluses used, total volume of fluids infused, the time of spinal anesthesia given, the delivery of the fetus, and the duration of the procedure were documented. Umbilical artery cord blood for determination of the acid-base status of the fetus. APGAR scores 1 min and 5 min of delivery of all newborns were noted and a score of <8 was considered low. Results: In our study, all patients in the two groups were comparable concerning age, height, weight, gestational age, and ASA status. The differences observed in baseline values of mean arterial blood pressure and saturation between the two groups were statistically insignificant. Also, there was a statistically insignificant difference between the duration of surgery, the total volume of fluid used intra-operatively, and the time of spinal to the delivery of the fetus in both groups. Further in my study, it was observed that there was a statistically significant difference in mean arterial blood pressure between the two groups up to 20 minutes post spinal anesthesia, but beyond the 25th minute, there was no statistical difference in mean arterial blood pressure between the two groups till the end of the surgery. Conclusion: The use of phenylephrine or ephedrine to correct maternal hemodynamic changes during spinal block for cesarean section does not show any marked difference in the outcome. The effect on fetal pH fetal acid-base status is comparable with both groups. The results of my study show that phenylephrine and ephedrine are both efficient and suitable vasopressors for the treatment of hypotension following spinal block in patients undergoing cesarean section. Keywords: Cesarean deliveries, hypotension, spinal anesthesia, vasopressors.

Background: In the MICU high mortality rates highlight the need for effective treatment planning. Red Cell Distribution Width (RDW) is a crucial marker, reflecting red blood cell size variability. Elevated RDW is linked to poor outcomes in acute conditions such as heart failure, pancreatitis, pulmonary embolism, and sepsis. Monitoring RDW can help in prognosis and guiding treatment decisions. Materials and Methods: This study aims to access the prognosis of patients admitted in medical intensive care unit based on RDW values. Conducted at GIMS Hospital Kalaburgi, this a Prospective Interventional Study from August 2022 to January 2024. A total of 161 patients were included, via simple random sampling method. Results: In a study of 161 MICU patients (103 males, 58 females), 57.7% died and 42.2% survived. Higher RDW levels at admission and day 1 were associated with increased mortality. Prolonged hospital stay also correlated with elevated RDW values, indicating RDW as a significant prognostic marker. Conclusion: The study shows that RDW is a strong predictor of prognosis and hospital stay duration in MICU patients. Higher RDW levels correlate with poorer outcomes and longer stays. This can guide appropriate care and enable better prognostic counseling for patient attendants, improving overall treatment management. Keywords: Medical Intensive Care Unit, Red Ccell Distribution Width (RDW), Prognosis, Acute heart failure, Sepsis, Pancreatitis, Pulmonary embolism, Acute renal failure, Stroke, Influenza.

Background: Mesenteric ischemia (MI) is a life-threatening condition caused by decrease in blood flow to the intestines, leading to ischemia and potential necrosis of bowel tissue. Early diagnosis and intervention, including revascularization or bowel resection, are critical for improving survival, as MI is associated with high morbidity and mortality if left untreated. Materials and Methods: A retrospective study was conducted in the Department of Surgery, NRI Medical College and Hospital including 30 patients with mesenteric ischemia. Results: The study of 30 patients with mesenteric ischemia (MI) found that most were middle-aged males, with hypertension (55.5%) and diabetes (29.6%) as common risk factors. Surgical interventions, including resection and anastomosis (40%), were frequently required due to severe cases, evidenced by 33.3% having gangrenous bowel loops. One death was reported. Conclusion: Mesenteric ischemia is a surgical emergency and needs prompt detection so as to prevent gangrene of intestines. Keywords: Mesenteric ischemia, SMA occlusion, CT, bowel resection.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder characterized by inattention, hyperactivity, and impulsiveness. It often persists into adulthood, leading to various challenges in education, relationships, and family functioning. Treatment typically involves behavior therapy and medications, with a focus on addressing both symptoms and associated difficulties. Materials and Methods: It was an interventional study conducted in a tertiary care hospital wherein children with ADHD and their parents were recruited pragmatically in three treatment arms i.e. parent training, pharmacotherapy and a combined group. Parent training was given using a module in a group setting over six sessions. In the pharmacotherapy group, Atomoxetine was given and in combined group, the above two treatment modalities were combined. P values less than 0.05 was taken as statistically significant. Results: Parent training was effective in reducing ADHD symptoms and parental stress. Furthermore a combined intervention was more effective. Conclusions: Parent training intervention mediates improvement in childhood ADHD comparable to pharmacotherapy and reduces parental stress moreover a combined intervention was more effective and feasible in a resource crunch nation like India. Conclusion: The study found that both pharmacotherapy and parent training effectively manage ADHD in children, with the combined approach showing the greatest improvement. Parent training also reduced parental stress, emphasizing its role in a multimodal ADHD management strategy. Keywords: Attention Deficit Hyperactivity Disorder, Parent Training, Pharmacotherapy, Quality of Life.

Background: Immunobullous Disorders (IBD) represent a group of chronic autoimmune blistering diseases of the skin and mucous membranes. IBD equally affects the mental status of a patient along with physical status, thus hampering the quality of life (QOL). Measuring the QOL is important in the evaluation of nonclinical aspects of disease. This study is carried out to know the impact of IBD on the QOL of patients. Materials and Methods: A comparative cross-sectional study was conducted at the Department of Dermatology, Venereology and Leprosy in a tertiary care hospital. A total of 44 patients (22 in each group) diagnosed with pemphigus and pemphigoid clinically, histologically, and immunologically were recruited in the study. Dermatology life quality index (DLQI) questionnaire was used to assess the QOL of the patients. Statistical analysis was performed using the chi-square test and unpaired t-test. Results: Overall mean DLQI score was 16.05 ± 7.3 and individual mean DLQI scores were 11.6 ± 5.1 and 17.8 ± 4.8 for bullous pemphigoid group and pemphigus vulgaris group respectively. P value <0.001 which indicates a significant difference in mean DLQI scores between the two groups. Impact on QOL is higher in pemphigus group when compared to bullous pemphigoid group. Conclusion: IBD significantly impairs the QOL of patients. QOL of patients of the pemphigus group is more impaired when compared to the pemphigoid group. Therefore, consideration should be given to the patient's QOL along with clinical status for an effective care and patient satisfaction. Keywords: Bullous Pemphigoid, Pemphigus Vulgaris, Quality of Life, Skin Diseases, Vesiculobullous.

Background: Diabetes mellitus (DM) is a common metabolic disorder characterized by hyperglycemia due to either insulin insufficiency or resistance. It is associated with both micro- and macro-vascular complications, including coronary artery disease, peripheral vascular disease, diabetic nephropathy, retinopathy, and neuropathy. These complications contribute to increased morbidity and mortality, imposing financial burdens on both society and families. Mean Platelet Volume (MPV) has been studied as a marker for platelet activation, which plays a role in thrombosis and inflammation. This study aims to assess the relationship between MPV and diabetic microvascular complications. Materials and Methods: This observational study was conducted over 12 months at PESIMSR, Kuppam, among 126 Type 2 Diabetes Mellitus patients. After ethical clearance, purposive sampling was employed. The study assessed MPV in correlation with fasting blood glucose (FBS), postprandial plasma glucose (PPBS), glycosylated hemoglobin (HbA1c), body mass index (BMI), and the duration of diabetes. Exclusion criteria included patients with type 1 diabetes mellitus, gestational diabetes, chronic kidney disease, malignancy, and patients on antiplatelet/antithrombotic therapy. Data were analyzed using SPSS (Version 23), with statistical significance set at p < 0.05. Results: Among the 126 patients, the majority (60.3%) were males, and the predominant age group was 51-60 years. Diabetic retinopathy was observed in 33.3% of uncontrolled diabetic males and females, particularly in those with diabetes duration greater than 10 years. A significant correlation was found between MPV and HbA1c levels. The mean MPV was 7.8 ± 0.82 in patients with HbA1c 6.5-8, 8.87 ± 1.07 in patients with HbA1c 8-10, and 11.65 ± 1.16 in patients with HbA1c >10. The correlation between MPV and diabetic complications, particularly retinopathy and proteinuria, was statistically significant. Conclusion: MPV demonstrates a significant correlation with diabetic microvascular complications and can be used as a potential early marker for uncontrolled diabetes. Larger multicentric studies with longer follow-up are necessary to further validate the use of MPV as a diagnostic tool for diabetic complications. Keywords: Mean Platelet Volume, Type 2 Diabetes Mellitus, Microvascular Complications, Diabetic Retinopathy, HbA1c.

Background: Acute ST-segment elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality. Electrocardiography (ECG) plays a pivotal role in identifying the culprit vessel, which is essential for timely intervention. This study aims to determine the correlation between ECG and coronary angiography (CAG) in localizing the culprit vessel in STEMI. Materials and Methods: This observational study was conducted at a rural tertiary care hospital in India. A total of 107 patients diagnosed with STEMI were enrolled. Data were collected on demographic profiles, ECG findings, and CAG results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various ECG markers were compared to CAG findings, which served as the gold standard. Results: Proximal LAD occlusion was the most common finding (42.1% of patients), followed by proximal RCA occlusion (15%). The ECG criteria for RCA occlusion (ST elevation in lead L3>L2) had a sensitivity of 92.31% and specificity of 91.36%. The specificity of ST elevation >1mm in lead V4R for diagnosing proximal RCA occlusion was 95.60%, with a PPV of 69.23%. Conclusion: ECG provides a reliable, non-invasive method for predicting the location of the culprit vessel in STEMI. However, it must be used in conjunction with other diagnostic tools like CAG for accurate localization, especially in settings with limited access to angiography. Keywords: STEMI, Electrocardiography, Coronary angiography.

Background: The nasal cavity and paranasal sinuses play a crucial role in respiration, filtration, and humidification, influencing various clinical conditions. This study aims to analyze the morphometric dimensions of the human nasal cavity and paranasal sinuses in a sample of 50 individuals, focusing on anatomical variations, symmetry, and gender-based differences. Understanding these measurements is critical for clinical practices such as surgery, diagnostic imaging, and the treatment of sinus disorders. Materials and Methods: A cross-sectional study was conducted over six months, where computed tomography (CT) scans were used to measure the dimensions of the nasal cavity and paranasal sinuses. Parameters such as length, width, and height of the nasal cavity, as well as the volumes of the frontal, maxillary, ethmoid, and sphenoid sinuses, were assessed. Statistical analysis was performed to compare differences between left and right nasal cavities and between genders. Results: The average length of the nasal cavity was 5.6 cm (± 0.4), while the width and height were 2.5 cm (± 0.3) and 3.1 cm (± 0.2), respectively. Significant gender differences were observed in frontal and maxillary sinus volumes, with males having larger volumes (p < 0.05). Anatomical variations, such as deviated nasal septum (20%) and concha bullosa (16%), were prevalent. No significant asymmetry was found between the left and right nasal cavities. Conclusion: This study provides essential morphometric data on the nasal cavity and paranasal sinuses, contributing to better clinical management of sinus-related conditions. The findings highlight the importance of considering gender-based differences in anatomical assessments. Keywords: Nasal cavity, paranasal sinuses, morphometry, anatomy, sinus volume, gender differences, anatomical variations.

Background: To study the spectrum of ear, nose and throat manifestations in patients diagnosed with COVID-19 infection over 1-month duration. Materials and Methods: It is observational prospective study (January to June 2021) conducted in 200 COVID -19 positive patients for a period of 6 months. All patients who tested COVID antigen (RAT/RT-PCR) positive admitted at Northern Railway Central Hospital or advised home isolation in follow-up of COVID-OPD, were taken in this study. Results: Majority (83.5%) of patients were treated as out-patients i.e. had mild COVID-19 infection (home isolated). The most common presenting symptom in patients with covid-19 was found to be fever (76%) followed by shortness of breath (22.5%). 13.5% patients were asymptomatic. The most common ENT manifestation as the presenting symptom of covid-19 was found to be dry cough (8%) followed by anosmia & ageusia (6.5%) each. Majority of patients (56%) had at least one ENT symptom during COVID-19 illness. The commonest ENT symptom on follow-up over a period of 4 weeks was found to be ageusia (33%) followed by anosmia (28%) and dry cough (27%). It was found that the inflammatory markers in covid-19 patients with positive ENT symptoms were elevated in the first 2 weeks and normalized by the 4th week in majority of patients. Elevated levels of inflammatory markers were found to be significantly associated with ENT symptoms like odynophagia, dry cough, sore throat, hyposmia and headache. Conclusion: We conclude that the Otorhinolaryngological manifestations are not rare symptoms of COVID- 19 disease, especially in mild or moderate form of the disease. ENT symptoms usually appear initially and may precede the development of severe COVID- 19 disease. Keywords: COVID-19, Anosmia, Ageusia, Inflammatory markers, SARS COV-2, Olfactory Dysfunction.

Background: NAAT is a molecular Amplification technology that targets amplifies and detect genetic material (RNA/DNA) of a pathogen highly sensitive and specific for viral nucleic acid. NAAT reduces the window period of HIV, HBV, and HCV by early detection of viral genome. Testing is molecular technique for screening blood donors to reduce the risk of transfusion transmitted infections, providing an additional layer of blood safety. Aims & Objectives: To evaluate the overall NAAT yield of HBV, HCV and HIV in blood donors; and further, to observe the distribution patterns of NAAT reactive cases, with respect to donor age, gender, occupation, residence (urban/rural), first time and repeat, voluntary, family and replacement donors. Materials and Methods: This retrospective analysis was conducted in the Department of Immunohematology and Blood Transfusion, over a three-year period from January 2019 to December 2022, at tertiary care medical institute of rohilkhand region. Serological screening was performed on 29,524 Whole blood donors. Those found non - reactive were subjected to NAAT testing which comprised 28,318 numbers of donors. All blood units were tested after meeting inclusion and exclusion criteria for donor selection and deferral. Preliminary serological screening was performed by Electro-chemiluminescence technology while molecular testing was performed on mini-pool NAAT testing platform. NAAT yield was calculated for Hepatitis B, C and HIV. Results: Out of 28,318 sero-negative samples subjected to nucleic acid testing, 45 samples were found reactive with an overall NAAT yield of (1:629), HBV reported the highest NAAT yield (1:885) followed by HCV (1:2360) and HIV (1:28,318). In males overall NAAT yield was 1:614. Overall NAAT yield was highest in urban blood donors than rural blood donors (1:608 vs 1:767). NAAT yield was highest among replacement donors than voluntary donors(1:548vs1:716). NAAT yield was highest in older age group (56-65 yrs) and lowest in younger age group 18-25 yrs (1:150 vs 1:890). Conclusion: NAAT is more sensitive and specific in detection; it detects both window period and occult infection. NAAT-PCR can be used as an adjunct to Elisa test. Considering the high prevalence of viral infection, the no. of transfusions and high proportion of component separation, in INDIA implementation of NAAT will be an important step towards providing safe blood. Keywords: Nucleic acid testing, Minipool, Chemiluminescence, Blood center.

Background: The advent of antibiotics has significantly transformed the landscape of surgical procedures by effectively managing and preventing complications arising from infections. The present study was conducted to evaluate prescription pattern of antibiotics used postoperatively in patients undergoing obstetrical, gynecological and general surgeries. Materials and Methods: The study encompassed the case records of all patients over the age of 18 who were admitted to the wards of the Gynecological, Obstetrical (OBG) and General Surgery departments for surgeries. Data collected included patient age, surgical indications, prescribed antibiotics, and their usage patterns. The results were documented in a Microsoft Excel spreadsheet and subsequently analyzed statistically using SPSS software. Results: A total of 200 patients were evaluated. Among them, 100 were enrolled who was admitted to OBG department and 100 who were admitted to surgery department. Among gynecological patients, Ceftriaxone, Ceftriaxone with sulbactam, Gentamycin, Amikacin, Metronidazole, Amoxycillin and clavulanic acid, Amoxycillin and other drugs were used in 31 percent, 19 percent, 28 percent, 6 percent, 39 percent, 15 percent, 9 percent and 5 percent of the patients respectively. among surgery patients, Cefuroxime, Metronidazole, Amoxycillin and clavulanic acid, Amoxycillin, Gentamicin, Clindamycin, Amikacin, Ciprofloxacin and Piperacillin-tazobactam were prescribed in 33 percent, 41 percent, 18 percent, 12 percent, 27 percent, 18 percent, 15 percent, 15 percent and 12 percent of the patients respectively. Conclusion: It is advisable to explore the fundamental causes behind the prescription of antibiotics for diagnoses that do not warrant such treatment, alongside the formulation and execution of antibiotic stewardship programs, as these strategies are essential for enhancing antibiotic prescribing practices. Keywords: Gynecological, Surgery, Antibiotics.

Background: Laparoscopic cholecystectomy represents a minimally invasive surgical approach for the excision of a pathological gallbladder. Dexmedetomidine is commonly used in anesthesia practice as well. Nalbuphine belongs to mixed agonist-antagonist class of opioids (ĸ-agonist and μ-antagonist) with better features such as prolonged duration of analgesia while avoiding the side effects. Hence, the present study was conducted for assessing and comparing the efficacy of intraperitoneal administration of dexmedetomidine and nalbuphine as adjuncts to ropivacaine for post-operative pain relief in patient undergoing laparoscopic cholecystectomy. Materials and Methods: Present study was conducted in Department of Anaesthesiology, Maharshi Vishwamitra Autonomous State Medical College, Ghazipur, Uttar Pradesh, India. A total of 45 patients who were scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia were enrolled. The participants were randomly divided into three groups, each consisting of 10 individuals. In Group 1, patients were administered a 50 ml solution containing 49 ml of 0.25% ropivacaine combined with 1 mcg/kg of dexmedetomidine. Group 2 received a 50 ml solution comprising 49 ml of 0.25% ropivacaine along with 5 mg of nalbuphine, while Group 3 was given a 50 ml solution that included 0.25% ropivacaine and 10 mg of nalbuphine. Postoperative pain was evaluated using the Visual Analog Scale (VAS). All data were analyzed using SPSS software. Chi-square test and ANOVA test were used for evaluation of level of significance. Results: Mean age of the patients of group 1, group 2 and group 3 was 43.2 years, 40.9 years and 41.7 years respectively. Mean BMI among patients of group 1, group 2 and group 3 was 23.7 Kg/m2, 24.1 Kg/m2, and 23.9 Kg/m2 respectively. Group 2 was associated with maximum pain as assessed by VAS. Comparing the VAS among three study groups at 2 hours and 4 hours, significant results were obtained. Conclusion: The administration of 0.25% ropivacaine combined with dexmedetomidine at a dosage of 1 mcg/kg in comparison to nalbuphine yielded the most favorable outcomes in patients. Keywords: Laparoscopic Cholecystectomy, Dexmedetomidine, Nalbuphine.

Background: Sepsis accounts for nearly 70% of all instances of acute respiratory distress syndrome (ARDS). Dexmedetomidine, a highly selective α2-adrenergic agonist, stands out as a distinctive sedative compared to γ-aminobutyric acid receptor agonists. Hence; the present study was conducted to analyze the effect of dexmedetomidine on ventilator free days and mortality in sepsis patients receiving mechanical ventilation. Materials and Methods: A total of 100 patients who were aged 20 years or older, had sepsis, and needed mechanical ventilation for at least 24 hours were included in the present study. Mechanical ventilation encompassed both invasive and noninvasive methods. Sepsis was characterized as a systemic inflammatory response syndrome resulting from an infection. All participants were randomly assigned to receive either a sedation protocol incorporating dexmedetomidine or one that excluded it. Sedation was sustained throughout the mechanical ventilation period or as required. The co-primary outcomes assessed were 28-day mortality and the number of ventilator-free days. All data were systematically recorded in a Microsoft Excel spreadsheet and subsequently analyzed using SPSS software. Results: Overall, 28-day mortality was seen in 14 percent and 22 percent of the patients of Dexmedetomidine Group and Non-Dexmedetomidine Group respectively. Median ventilator free days among patients of Dexmedetomidine Group and Non-Dexmedetomidine Group was 21 days and 19 days respectively. Median ICU stay among patients of Dexmedetomidine Group and Non-Dexmedetomidine Group was 8 days and 9 days respectively. Non-significant results were obtained while comparing the outcome among the two study groups. Conclusion: In patients who necessitate mechanical ventilation, the administration of dexmedetomidine, in contrast to its absence, did not yield a statistically significant enhancement in either mortality rates or the number of days free from ventilation. Keywords: Dexmedetomidine, Ventilator, Sepsis.

Background: Nonalcoholic fatty liver disease (NAFLD) is an emerging worldwide problem and its association with other metabolic pathologies. Metabolic derangements are suggested to be the main cause of NAFLD. As thyroid hormone is the main regulator of energy metabolism, there may be a link between NAFLD and thyroid function. This is a prospective study to analyze the relationship and the trend of thyroid function with severity of non-alcoholic fatty liver disease at newly established tertiary care center. Materials and Methods: The present hospital based cross sectional study was proposed to be undertaken with a total number of 50 patients above 20 years of age of NAFLD diagnosed by ultrasonography whole abdomen, attending the department of medicine, Government Medical college, Barmer, Rajasthan, India during one-year period. Detailed history and clinical examinations were conducted on all patients, and they underwent routine investigations and thyroid function tests (free T3, free T4, and TSH). The statistical tests applied for analysis were Pearson’s chi-square test, test and one-way analysis of variance. Results: The present study consisted of 50 patients having Non-alcoholic fatty liver disease diagnosed on ultrasonography, 48% were having grade 1, 42% were having grade 2 and 10% were having grade 3 fatty liver. In the present study, 58% were having normal FT3 levels and 42 % patients had low FT3 levels which showed no significant relationship with increasing grades of fatty liver (P>0.05). Free T4 levels showed inverse relationship with increasing grades of fatty liver (P<0.05*). 18% of patients with NAFLD had hypothyroidism (4% subclinical and 14% overt hypothyroid) and a more percentage of patients with grade 2 and 3 fatty liver had hypothyroidism. Conclusion: We concluded that free T4 and serum TSH levels had significant correlation with increasing grades of fatty liver. Hence, a statistically significant association was found between hypothyroidism and NAFLD. Keywords: Hypothyroidism, Nonalcoholic Fatty Liver Disease (NAFLD), TSH, Free T4, Free T3.

This case report describes a patient with recurrent esophageal stricture suspected to be secondary to tuberculosis (TB). The patient, who had a history of pulmonary TB, presented with symptoms of dysphagia and was found to have esophageal stricture and ulceration. Despite multiple interventions, the patient's condition progressed, leading to a fatal outcome. This case highlights the challenges in diagnosing and managing esophageal strictures in the context of TB and emphasizes the need for a multidisciplinary approach. Keywords: Tuberculosis, Recurring Esophageal, Stricture.

Background: India has the largest number of school-going children in the world. Morbidities among adolescents of both government and private school may differ and so need to be studied simultaneously. Therefore the present study was conducted to identify pattern of morbidities among adolescents attending public and private schools in Agra city of Uttar Pradesh. Materials and Methods: An observation cross-sectional study was conducted among 480 school-going adolescents in age group of 10-19 years studying in selected government and private schools in urban Agra. A multistage random sampling technique was applied to draw the required sample size. Appropriate statistical tests were applied. Results: Only 30.8% of school-going adolescents have no morbidity at present; while rest 69.2% has one or more morbidities. Mean number of morbidities among study participants was 1.30±1.18 with a range of 0-6. Anemia (43.33%), dental caries (18.54%), refractive errors (11.04%), acne (9.37%), upper and lower respiratory tract infection (6.87% and 4.58% respectively), gingivitis (6.04%), allergic rhinitis (5.83%), Chronic Supportive Otitis Media (5.62%) and fungal infection of skin (4.58%) were common morbidities. Conclusion: Regular health check-up of school-going adolescent is the need of the hour as more than 2/3rd of them have at least one or more morbidities at present. Anemia (43.33%), dental caries (18.54%), and refractive errors (11.04%) are top three morbidities; and if detected earlier through school-health services, can easily be managed by effective preventive and curative services. Keywords: School-going adolescent, morbidity, public school, private school.

Background: Organophosphorus (OP) compounds have gained significant importance globally. Although these compounds were discovered nearly a century ago, they continue to be widely utilized as insecticides worldwide. The aim of this study was to evaluate the serum creatine phosphokinase (CPK) levels in cases of OP poisoning. Materials and Methods: The present study was conducted on a sample of 60 patients who were admitted to the Department of General Medicine, Katuri Medical College, Guntur, AP exhibiting a documented history and clinical manifestations consistent with organophosphate poisoning. The study was conducted between April 2023 and September 2024. Results: Organophosphorus compounds are commonly used in acts of self-harm due to their easy availability. The main factors contributing to fatalities include the specific toxic compound involved, the severity of the poisoning, the promptness of treatment, and the availability of critical care facilities. While acetylcholinesterase plays an essential role, its inhibition leads to overstimulation of muscarinic and nicotinic receptors. This overstimulation causes a rapid onset of cholinergic crisis, which is the key clinical indicator of OP poisoning. Diagnosis is typically confirmed through patient history and supportive monitoring. Conclusion: The study found that following appropriate treatment, serum creatine phosphokinase levels returned to normal, alongside an improvement in the patient’s clinical condition. Optimizing the dosage and duration of atropine and pralidoxime therapy remains crucial, especially as higher doses are often required in severe poisoning cases. Keywords: Serum creatine phosphokinase, organophosphorus poisoning, predictive study.

Background: Benign endometrial pathology can cause significant gynecological morbidity which can affect the quality of life. Endometrial hyperplasia, endometrial polyp and disordered proliferative endometrium are the most common benign endometrial pathologies. Besides estrogen, metabolic disorders may also induce the occurrence and development of these proliferative lesions. Aim: This study was conducted with the aim to investigate metabolic syndrome and its components as risk factors for benign endometrial pathology. Materials and Methods: A case control study was conducted over a period of two years in the department of Obstetrics and Gynaecology, Mallareddy Medical College for Women, Hyderabad. Women presenting with abnormal uterine bleeding were included in the study and endometrial biopsy was done. Women with benign endometrial pathology constituted the case group and those with normal endometrial biopsy formed the control group. Waist circumference, blood pressure, fasting blood glucose and serum lipid profile were measured in both the groups and were compared using unpaired t test and chi-square tests. Results: A total of 97 and 211 women constituted the case and the control group respectively. These groups were again divided into two subgroups, premenopausal and postmenopausal groups, based on their menopausal status. Both the groups were comparable with respect to age and parity. Metabolic syndrome and some of its individual components like central obesity, high serum triglyceride level, low HDL cholesterol level and impaired blood glucose were found as risk factors for benign endometrial pathology whereas hypertension, high total cholesterol and high LDL cholesterol levels were not found to be associated with the occurrence of benign endometrial pathology. Conclusion: Continued efforts to make lifestyle interventions to control metabolic risk factors may reduce the prevalence of endometrial pathology and prevent the disease progression. Keywords: Benign endometrial pathology, Endometrial hyperplasia, Endometrial polyp, Metabolic syndrome.

Background: Spinal anaesthesia has become popular because of the simplicity of the procedure, profound sensory analgesia, adequate muscle relaxation, less operative blood loss and minimal pre-operative preparation. Relatively newer local anaesthetic amide Ropivacaine have gained popularity due to their lower cardiotoxicity and neurotoxicity. Present study was done with an aim to compare the effects of intra thecal hyperbaric Ropivacaine and Bupivacaine in regards to onset, regression, duration of sensory & motor blockade. Materials and Methods: 102 patients of ASA I to ASA III physical status undergoing elective lower abdominal and lower limb surgery under spinal anaesthesia were recruited and randomized based on computer generated randomized control table. Group R received 3ml 0.75% hyperbaric Ropivacaine (n=51) and Group B received 3ml 0.5% hyperbaric Bupivacaine (n=51) intrathecally. Onset and regression of sensory & motor blockade along with its level were monitored intraoperatively. Haemodynamic variation and presence of side effects were noted. Total duration of blockade and time to receive first rescue analgesia was noted postoperatively. Results: Present study demonstrated that Group R had slower sensory onset (R= 5.2 ± 0.65) vs B= 4.3 ± 1.1) mins and took more time for sensory blockade to reach T10 level (R = 6.0 ± 0.86) vs (B= 5.0 ± 0.22) mins & mean time taken for sensory blockade to reach peak level in Group R was also longer (R= 7.78 ± 0.33 vs B = 6.53 ± 0.78) mins (P<0.001). The time taken for onset of motor blockade i.e to attain a modified bromage scale of 1 was longer (R= 6.0 ± 0.78 vs B= 5.0± 0.67) mins and modified bromage scale 3 was comparable in group R and group B (R = 8.0 ± 0.67 vs B= 7.0 ± 0.77) mins (P<0.001) respectively. There was a significant mean difference in systolic and diastolic blood pressure and heart rate at 2min, 5 min, 10 min, 15 min, 20 min, 25min and 30 min between two group R and group B (P <0.05). Conclusion: Hyperbaric Ropivacaine had a slower onset of sensory, motor blockade, with early regression. It is more cardiostable with lesser side effects and shorter duration of analgesia. It provides patient and surgeon satisfaction comparable to bupivacaine, and hence ropivacaine is better option in short duration surgery. Keywords: Hyperbaric Bupivacaine, hyperbaric Ropivacaine, Lower Limb Surgeries, Spinal anaesthesia.

Background: Heart rate variability (HRV) is an emerging marker for cardiovascular health. This study explores the association between HRV and blood pressure control in hypertensive patients. To evaluate the relationship between HRV parameters and the control of blood pressure in patients diagnosed with hypertension. Materials and Methods: A cross-sectional study was conducted with 100 hypertensive patients (52 males and 48 females), aged 55.6 ± 10.2 years. Participants were classified into well-controlled and poorly controlled blood pressure groups based on standard criteria. HRV parameters, including SDNN and RMSSD, were measured and analyzed. Correlation analysis was performed to assess the relationship between HRV and blood pressure. Results: The study found that patients with well-controlled blood pressure had significantly higher HRV values. The mean SDNN in the well-controlled group was 42.3 ms, compared to 30.1 ms in the poorly controlled group (p < 0.01). Similarly, the mean RMSSD was 34.7 ms in the well-controlled group versus 25.5 ms in the poorly controlled group (p < 0.01). There was a moderate positive correlation between SDNN and systolic blood pressure (r = 0.45, p < 0.001) and between RMSSD and diastolic blood pressure (r = 0.38, p < 0.001). Conclusion: Higher HRV is associated with better blood pressure control in hypertensive patients. HRV may serve as a valuable non-invasive marker for monitoring hypertension. Further studies are warranted to understand the underlying mechanisms and clinical applications. Keywords: Heart rate variability, blood pressure control, hypertension, SDNN, RMSSD, cross-sectional study, cardiovascular health.

Background: To evaluate the clinic radiological profile and the efficacy of CT/USG guided FNAC in evaluation and diagnosis of various thoracic/chest lesions. Materials and Methods: The study is carried out in patients with thoracic lesions diagnosed by chest radiographs, CT or MRI scans done by the Department of Respiratory Medicine and other clinical departments of RMCH Bareilly. Results: Non-small cell lung cancer (NSCLC) accounts for the majority (approximately 85 percent) of lung cancers with the remainder as mostly small cell lung cancer (SCLC). Out of these 50 cases, a total of 41 (82%) were malignant. In present study, malignancy rates were found to be significantly higher in patients aged >50 years (70.7%) as compared to majority of benign cases aged <50 years (55.5%). most of the cases presented with cough and breathlessness, followed by expectoration and chest pain. Smoking habit was found to be quite prevalent in malignant group (80.9%) as compared to benign group (22.2%) and showed a significant association with malignancy. Right side was more commonly involved as compared to left side, the FNAC procedure was guided by USG in 48/50 (96%) cases whereas in 2 cases it was guided by CT. primarily USG was used as the modality of choice for guiding the FNAC biopsy. Conclusion: Guided FNAC is a useful modality for evaluation of chest masses. It was found to be a safe, relatively less complicated, adequate and reasonably accurate technique as observed in previous studies too. Keywords: Clinico radiological features, chest lesion, efficacy of CT/ USG guided FNAC, lung masses.

Background: Displaced radial neck fractures in the pediatric population can be treated with retrograde intramedullary nailing of the radius (the Métaizeau technique). Present Study has been designed with the primary objective of determining whether or not the Metaizeau technique is effective in the treatment of radial neck fractures in children. Materials and Methods: At Zydus Hospital in Dahod, we performed a retrospective analysis of the clinical records and radiographs of 20 pediatric patients who received treatment for displaced radial neck fractures. Fractures were classified according to Metaizeau classification. The subjects were classified into four groups based on the Mayo elbow performance score (MEPS). Radiographs were taken at the time of the initial management, after six weeks (the time of consolidation), and at the time of the most recent follow-up (the final follow-up). Results: Thirteen patients had Judet type 3 fractures and seven patients had Judet type 4a. Based on the clinical evaluation criteria mentioned above, we recorded 8 excellent, 5 good, 1 fair results for type 3 fractures at the final follow up. For type 4 fractures, we had 5 excellent, 2 good and 1 fair results. At final follow-up, there were 19 (95%) excellent or good results, and 1 (5%) fair result. Conclusion: Through the utilization of the Métaizeau technique, with the elastic stable intramedullary nailing method, it is possible to fulfill all of the requirements for minimally invasive bone surgery. Keywords: Intramedullary nail, Mayo elbow performance score, Metaizeau Technique, Pediatric Radial Neck Fractures.

Background: Covering raw areas post burns or trauma utilizes the technique of skin grafting. in this prospective comparative study which was conducted in the Department of Plastic and Reconstructive Surgery patients with raw areas caused by burns or trauma, the outcomes between split-thickness skin grafts (STSG) and full-thickness skin grafts (FTSG) were compared. Materials and Methods: The study enrolled 40 patients, equally divided into two groups: Group A received STSG and Group B received FTSG. Patients were included if they had raw areas resulting from deep partial-thickness or third-degree burns covering less than 30% of the body surface area. The grafts were harvested from the thigh, and both donor and recipient sites were assessed for pain, itching, pigmentation, and other parameters using the Patient and Observer Scar Assessment Scale (POSAS). Results: Of the 40 patients, 19 in the STSG group experienced complete graft uptake, while 1 patient had partial uptake. In the FTSG group, 15 patients experienced complete uptake, 3 had partial uptake, and 2 experienced graft rejection. STSG was associated with higher pain, itching, and pigmentation at the donor site compared to FTSG (P < 0.05). However, FTSG showed better outcomes in texture and pliability at the recipient site (P < 0.05). Conclusion: STSG provides higher rates of graft uptake but is associated with more discomfort at the donor site. FTSG offers superior aesthetic and functional results at the recipient site, making it preferable for areas where cosmesis and mobility are crucial. Keywords: Split-thickness skin graft, full-thickness skin graft, burns, trauma, wound healing, scar assessment.

Background: Foot and ankle reconstruction is a complex procedure aimed at restoring function and aesthetics following trauma or disease. Reverse peroneal artery flaps (RPAFs) have gained prominence as an effective option for lower limb reconstruction, especially in cases involving soft tissue defects. This study evaluates the effectiveness and complications associated with the use of RPAFs in foot and ankle reconstruction. Materials and Methods: A prospective study was conducted over two years, from May 2022 to April 2024 in the Department of Plastic Surgery at NRI Medical College, Guntur. Twenty-five patients with soft tissue defects in the lower leg, ankle, or foot were included, following strict inclusion and exclusion criteria. Reverse peroneal artery flaps were harvested and rotated to cover defects. Patients were followed for two years to assess outcomes, including flap viability, healing, and patient satisfaction. Results: Out of 25 patients, 19 were males, and 6 were females, with a majority aged below 21 years. The procedure demonstrated high success rates, with most patients showing positive outcomes. Complications included marginal necrosis in three cases and sub-flap collections in two cases. There were no cases of graft rejection, and overall patient satisfaction was high. Conclusion: Reverse peroneal artery flaps are a reliable option for foot and ankle reconstruction, offering high success rates and minimal complications. Close monitoring of flap viability and postoperative care ensures favorable long-term outcomes. Keywords: Reverse peroneal artery flap, foot reconstruction, ankle reconstruction, soft tissue defects, post-operative complications.

Background: To evaluate the usefulness of uterine artery Doppler screening in the Second-trimester gestation women for predicting the risk for preeclampsia, and to identify sensitivity, and specificity of the doppler indices- Notching, and Pulsatility Index (PI). Materials and Methods: This study is aprospective, observational study in 250 second-trimester gestation women (20-24 weeks) in the Department of Antenatal Clinic, KGH Hospital, (Tertiary Health Care Centre) Triplicane, and Institute of Obstetrics and Gynaecology, Egmore, Chennai, India from February 2019 to December 2022. After consent, and fulfilling inclusion criteria, the study participant's gestational age, antenatal investigation, BMI, blood pressure, clinical markers, Proteinuria, impaired uterine artery flow, Uterine Artery Doppler (UAD), and preeclampsia status were observed and recorded. Results: A total of 250 women between 20-24 weeks in the second trimester were selected for this study. Doppler imaging was used to identify prediction of the risks of Preeclampsia with the help of tools notching and pulsatility index. Out of the 250 participants in the study, 192 women had negative notching, whereas 58 women had positive notching. The proportion within notching was 94.8% in the 192 notching negative study individuals, the percentage within preeclampsia was 90.1% and the total percentage was 72.8% in the preeclampsia-absent study subjects. Out of the 58 study participants who met the inclusion criteria, 34.5% of the preeclampsia absentees had notched, and 9.9% had preeclampsia, for a total percentage of 8.0%. Preeclampsia accounted for 100.0% of the 250 cases, while the overall rate within notching was 100%. The specificity: 0.90099 (95% CI: 0.84-0.93), false negative: 0.052083 (95% CI: 0.02-0.09), and false positive: 0.344828 (95% CI: 0.22-0.48) are the correlations between notching and preeclampsia. A significant association was found between preeclampsia, and notching (χ2=104.433, p-value-<0.000). The aggregate proportion of the % within PI among the 250 cases was 100.0%. There was a 100.0% total percentage of preeclampsia. An insignificant association was found between PI and preeclampsia. Conclusion: Our study participants who were in their second trimester showed a strong association between notching and preeclampsia. Notching during the second trimester had a sensitivity of 79% (95% CI between 64% and 89%) and a specificity of 90% (95% CI between 84% and 93%). With a p-value of less than 0.000, 65% of the data had a positive predictive value and 94% had a negative predictive value (χ2=104.433). Preeclampsia and PI were not significantly correlated. Doppler is an important tool for forecasting preeclampsia in high-risk second-trimester women. Keywords: Second-trimester, Impaired Uterine Artery Flow (IUAF), Gestation, Uterine Artery Doppler (UAD), Preeclampsia, Notching, Pulsatility Index (PI).

Background: Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. Candida onychomycosis affects fingernails more often and is accompanied by paronychia. Diagnosis is primarily based upon KOH examination, culture and histopathological examinations of nail clippings and nail biopsy. Various treatment modalities including topical, systemic and surgical have been used. Topically, drugs (ciclopirox and amorolfine nail lacquers) are delivered through specialized transungual drug delivery systems ensuring high concentration and prolonged contact. Commonly used oral therapeutic agents include terbinafine, fluconazole, and itraconazole. Materials and Methods: This is a prospective study was conducted among Patients suffering from onychomycosis randomly selected from Dermatology Outpatient Department. Patients age group from 18 to 60 years with Toenail or fingernail fungal infection were included. Clinical types of onychomycoses can be: Total dystrophic onychomycosis, proximal subungual onychomycosis, Distal and lateral subungual onychomycosis, Superficial white onychomycosis. Results: Patients included in the study were 81 (90%) females and 9 males (10%). Nine of our patients (40%) were found to have onychomycosis associated with chronic paronychia. Nine of our patients (10%) were found to have onychomycosis associated with chronic paronychia. Other predisposing factors such as family history of fungal nail infection were detected in 8 patients (8.9%) and patients who received intermittent short courses of topical and/or systemic antifungal treatment over the long course of their disease were 5 (5.6%). As regards the different clinical presentations, the most prevalent was distal-lateral subungual onychomycosis (90%) followed by total dystrophic onychomycosis accounting for (8.9%) and the least common was proximal subungual onychomycosis representing only one (1.1%) patient. Fungal isolates in the present study were grouped into Yeast 91.1% (82/90), non-dermatophyte mould infection in 4.4% (4/90) while dermatophyte infection was detected in 4.4% (4/90) only. The results revealed mycological clearance (by culture and KOH) in 72 out of 90 (80%) patients at one month followup while no response to treatment was detected in 18 patients (20%). Conclusion: Onychomycosis prevalence worldwide and the ineffectiveness of conventional treatments have led current research to focus on novel approaches to enhance drug diffusion trough the nail plate. Many important results have already been achieved either by modifying topical formulations or by applying physical techniques that modify the nail plate itself. However, many challenges still exist and further researches are necessary for the development of effective and safe treatments for onychomycosis. Keywords: Onychomycosis, fungal infection, nail, ungual penetration.

Background: Study done to evaluate incidence and outcome of thrombocytopenia in pregnant women. Materials and Methods: This study was a hospital-based prospective observational research conducted over one year. The study included pregnant women who attended the antenatal clinic at the Department of Obstetrics and Gynecology. Blood samples were collected from all participants, and platelet counts were measured using both manual and automated methods. A total of 121 cases were selected based on their platelet counts at the time of admission for detailed analysis. Results: Incidence of thrombocytopenia was 39.67% of the cases (48 cases). Obstetric causes are largely driven by hypertensive disorders, especially preeclampsia accounting for 15.70% of all cases (19 cases). Massive haemorrhage and pulmonary edema are among the most frequent morbidities, affecting around 9%–10% of cases each. These are critical complications that require prompt intervention. Perinatal outcomes reveal that while 50.41% of newborns had no morbidity, there is a concerning rate of complications such as FGR, birth asphyxia, and severe thrombocytopenia. The presence of stillbirth and intrauterine death, though lower in percentage, is still significant. Conclusion: Gestational and obstetric causes of thrombocytopenia is the most common cause of thrombocytopenia during pregnancy, but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes. Keywords: Hemolysis elevated liver enzymes and low platelets, Gestational thrombocytopenia, Thrombocytopenia in pregnancy.

Background: Breastfeeding confers both short-term and long-term benefits to the child. It reduces infections and mortality, improves mental and motor development. Infant feeding practices have a major role in determining the nutritional status of a child. Materials and Methods: The study is a cross-sectional design conducted at the Immunization Clinic of GIMS and UHTC in Gadag. A total of 400 infants and young children aged 0-24 months were selected through convenient sampling. The inclusion criteria consisted of children aged 0-24 months whose parents gave consent to participate, while children over 2 years old were excluded. The study period was from April to July, 2018. The study instruments included a baby weighing machine to measure weight and a measuring tape to assess height. Results: The study reveals that the majority of children fall within the age range of 0-6 years (45.7%) and 7-12 years (46.7%). There is a slight female predominance, with 56.0% of participants being female and 44.0% male. Education levels among mothers vary significantly, with the highest percentage having completed high school (44.4%). The distribution of families shows a diverse socio-economic background, with the largest segments being middle class (30.1%). An overwhelming 86.8% of women attended more than three antenatal care (ANC) visits during their pregnancies, indicating a commendable level of adherence to prenatal care. The study also found that there is no statistically significant association between the mode of milk feeding (breastfeeding or bottle-feeding) and the weight-for-age of the children in the study. Overall, the findings suggest a diverse demographic profile among participants, with a strong emphasis on maternal education and prenatal care. The study highlights the importance of early childhood development and the role of maternal health in influencing child outcomes. Conclusion: In our study there was no much difference noted in nutrition status among bottle- and breast-fed children, but there was a significant difference with number of infection episodes among bottle- and breast-fed children. Keywords: Bottle Feeding, Nutritional Status, Infants, Young Children.

Background: Loneliness is one of the fastest-growing psychosocial health concerns in the modern age. It is the distress that results from discrepancies between ideal and perceived social relationships. Satisfaction with life is not a measure of happiness towards life but of attitude towards life and subjective wellbeing. Life dissatisfaction has shown to have an effect on the risk of suicide, which also makes this a composite health indicator. Materials and Methods: A cross-sectional survey design was employed for this study. The study population consisted of young adult college students aged 19 to 25 years. The study took place from March to August, 2018.The sample size was determined using the formula for prevalence studies. A convenient sampling method was employed to select young adults between the ages of 19 and 25 who were willing to participate and able to provide informed consent. Individuals with diagnosed psychiatric disorders were excluded from the study. Participants who were unavailable, unwilling to provide complete data, or absent on the day of data collection were also excluded. Results: The study found that a majority of participants, 89.4% (261 individuals), reported experiencing moderate levels of loneliness. Additionally, a significant proportion of participants, 22.6%, reported being highly satisfied with their lives, while the majority, 75.7%, reported being satisfied overall. Interestingly, the largest age group represented in the study was individuals in their 20s, accounting for 44.18% of the sample. Furthermore, the analysis revealed that there is no statistically significant association between class and satisfaction levels, as indicated by a p-value greater than 0.05. Similarly, the association between age group and loneliness severity was found to be not significant. Conclusion: The findings of this study underscore the importance of addressing loneliness as a public health issue among young adults in Karnataka. Interventions focusing on mental health support, social connectedness, and community engagement are essential to enhance life satisfaction and reduce loneliness in this population. Overall, these findings shed light on the prevalence of loneliness and satisfaction levels among participants, with implications for future research and interventions in this area. Keywords: UCLA Loneliness Scale, Satisfaction with Life Scale (SWLS), Young Adults.

Background: The present study aimed to study Risk factors, Demographic profile of patients of Influenza A, H1N1 attending the tertiary care centre of Kashmir, North India. Materials and Methods: The present study was carried out at Government Medical College and associated Hospitals Srinagar, Department of Microbiology. Patients with symptoms of Influenza like illness (ILI) attending outpatient department of SMHS and chest diseases hospital as well as hospitalized cases in the month of February 2019, were recruited. 128 Patients of all age groups were included in the study. Clinical specimens of nasopharyngeal and throat swabs (nasal swab/TS) were collected. Results: Out of total 46 influenza positive cases, majority 39% patients belonged to 41-60 years age group followed by 21-40 years (26%), 61-80years (19.5%), 0-20years (10%) and least fraction of patients 4.3% belonged to 81-100 years. 58.6% patients were males while 31.3% patients were females. Hypertension was the chief predisposing factor 10.1% for influenza followed by diabetes mellitus 7.8%. From the 46 influenza patients, 23.9% patients were vaccinated and 76% were non vaccinated. 78.2% patients were reported in IPD and 21.7% cases were reported in OPD. 17 cases of CAP were reported in IPD and 3 cases reported in OPD. 56.5% patients had severe acute respiratory infections and 43.4% patients had influenza like illness. Conclusion: Despite the fact that the H1N1 pandemic has concluded, epidemics serve as a perpetual reminder of the underlying threat. The sole method of minimizing the disease progression and associated mortality appears to be vaccination, early recognition of the disease, and prompt initiation of treatment. Keywords: Co‑morbidity, H1N1, Pandemic, Swine flu, Tertiary Care Center.

Background: The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, not just the absence of illness or disability, allowing individuals to lead socially and economically productive lives. A WHO expert panel has suggested that anaemia should be diagnosed when haemoglobin levels fall below 13g/dl in adult men, 12g/dl in non-pregnant adult women, and below 11g/dl in pregnant women. Anaemia during pregnancy is typically due to iron deficiency. WHO estimates that two billion people worldwide are affected by anaemia, with around 50% of cases caused by iron deficiency. Anaemia is linked to several maternal and foetal complications, including reducing a woman's ability to cope with blood loss during or after childbirth. It is also associated with low birth weight, premature delivery, intrauterine growth retardation, and higher perinatal mortality. Aim: To assess the association of various socioeconomic and demographic factors on anaemia and the degree of anaemia found in pregnant mothers at RHC. Objectives: 1. To assess the influence of social and economic status and factors influencing anaemia in pregnant mothers using B.G. Prasad classification. 2. To assess the influence of demographic factors like parity, education, occupation, etc. on anaemia in pregnant mothers. 3. To assess the utilization of various ANC services being provided at RHC especially the use of iron and folic acid tablets. Materials and Methods: This is a longitudinal prospective observational study conducted in a field practice area. The study was undertaken at a RHTC under Tertiary Care Teaching Hospital. All the pregnant women who were anaemic i.e. whose Hb levels were less than 11g/dl (according to WHO classification) and who had no other comorbidities who visited the RHTC for the first time were included in the study. All pregnant women whose Hb levels were below 11g/dl and who visited the RHTC for the first time for various antenatal services during the study period were included in the study.All anaemic pregnant women in any trimester of pregnancy were included in the study. Results: Table shows the level of anaemia among the 178 subjects included in the study divided according to the WHO classification of anaemia in pregnancy.It shows that 61 participants (34.26%) had mild anaemia, 98(55.05%) mothers had moderate anaemia whereas 19(10.6%) had severe type of anaemia.According to table 7 of the 178 pregnant anaemic mothers, 39(21.91%) were taking iron and folic acid tablets regularly, 66(37.07%) were taking iron and folic acid tablets irregularly whereas 73(41.01%) were not taking any iron and folic acid tablets.Of the 178 participating anaemic pregnant mothers, 123(69.10%) visited ANC units 1-2 times and 55(30.89%) visited ANC units 3 or more times. As seen in table 8, of the 123 pregnant mothers with anaemia who visited the ANC unit 1-2 times in the present pregnancy, 41(33.33%) had mild anaemia, 67(54.47%) had moderate anaemia and 15(12.19%) had severe anaemia. Keywords: Anaemic, Pregnant Mothers, RHC.

Background: The indications for endoscopy have increased enormously as it has matured from a purely diagnostic procedure to a therapeutic subspecialty. Number of studies has been done to compare propofol and dexmedetomidine for sedation for outdoor endoscopy procedure in patients with impaired liver function. In recent years, dexmedetomidine has been used as an alternative to propofol in providing sedation. Study Design: Open-label Randomised Controlled Trial. Aims: In this study we aim to compare haemodynamic, respiratory and safety profile of dexmedetomidine with propofol for ERCP in patients with impaired liver function. Materials and Methods: A total of 50 patients of American Society of Anaesthesiologists grade II aged 18 to 60 years were divided into two groups (25 each) depending upon the use of the drug under investigation in accordance with randomized, open label, controlled trial. In patients receiving propofol a bolus of 1mg /kg were given then propofol infusion was started at 1mg/kg/hr for maintenance of sedation whereas in patients receiving dexmedetomidine a loading dose of 1mcg /kg was given over 10 mins then infusion was started at 0.5mcg/kg/hr. The changes in the heart rate (HR), systolic blood pressure (SBP) diastolic blood pressure (DBP) and mean arterial blood pressure (MAP), respiratory rate and oxygen saturation(SpO2) were noted before during and after recovery from sedation during ERCP and analysed statistically. Results: Our study showed no significant difference in Heart rate, systolic blood pleasure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR) and oxygen saturation (SpO2) in the dexmedetomidine group when compared with propofol group. But incidences of complications are less in Propofol group when compared with dexmedetomidine group. Conclusion: No significant difference found in sedation with Propofol and dexmedetomidine during ERCP in haemodynamic and respiratory parameters but safety profile of Propofol is better than dexmedetomidine in impaired liver function. Keywords: Haemodynamic, Respiratory, Safety Profile, Sedation, Dexmedetomidine, Propofol.

Background: Septal deviation is a prevalent condition that impacts both nasal aesthetics and functionality, often necessitating surgical intervention. Advances in rigid endoscopy have introduced new endoscopic techniques, which are increasingly replacing traditional methods. This study aimed to compare endoscopic and conventional septoturbinoplasty procedures using both objective and subjective data to evaluate the advantages offered by endoscopic techniques in nasal septal surgery. Materials and Methods: This prospective comparative study involved 60 patients, with 30 undergoing endoscopic septoturbinoplasty and the other 30 receiving conventional septoturbinoplasty. The study assessed outcomes based on improvements in nasal symptoms measured through subjective questionnaires, operation time, and postoperative complications. Results: Preoperative NOSE questionnaire scores averaged 68.32±13.5 for the conventional group and 63.53±15.7 for the endoscopic group. Postoperatively, the scores were 7.43±8.2 for the conventional group and 5.35±6.1 for the endoscopic group. Additionally, the endoscopic technique demonstrated shorter operative times and fewer postoperative complications compared to the conventional method. Conclusion: Both conventional and endoscopic techniques effectively correct septal deviations, as evidenced by significant improvements in patient symptom scores following surgery. However, endoscopic septoturbinoplasty offers advantages, including reduced operation time and a lower rate of complications. Keywords: Endoscopic Septoturbinoplasty, Conventional Septoturbinoplasty, Nasal Septum Deviation, Mucosal Injury, Nasal Obstruction, Surgical Outcomes, Endoscopic Surgery Efficacy, Surgical Technique Evaluation.

Background: Immunobullous Disorders (IBD) represent a group of chronic autoimmune blistering diseases of the skin and mucous membranes. IBD equally affects the mental status of a patient along with physical status, thus hampering the quality of life (QOL). Measuring the QOL is important in the evaluation of nonclinical aspects of disease. This study is carried out to know the impact of IBD on the QOL of patients. Materials and Methods: A comparative cross-sectional study was conducted at the Department of Dermatology, Venereology and Leprosy in a tertiary care hospital. A total of 44 patients (22 in each group) diagnosed with pemphigus and pemphigoid clinically, histologically, and immunologically were recruited in the study. Dermatology life quality index (DLQI) questionnaire was used to assess the QOL of the patients. Statistical analysis was performed using the chi-square test and unpaired t-test. Results: Overall mean DLQI score was 16.05 ± 7.3 and individual mean DLQI scores were 11.6 ± 5.1 and 17.8 ± 4.8 for bullous pemphigoid group and pemphigus vulgaris group respectively. P value <0.001 which indicates a significant difference in mean DLQI scores between the two groups. Impact on QOL is higher in pemphigus group when compared to bullous pemphigoid group. Conclusion: IBD significantly impairs the QOL of patients. QOL of patients of the pemphigus group is more impaired when compared to the pemphigoid group. Therefore, consideration should be given to the patient's QOL along with clinical status for an effective care and patient satisfaction. Keywords: Bullous Pemphigoid, Pemphigus Vulgaris, Quality of Life, Skin Diseases, Vesiculobullous.

Background: Glaucoma is one of the leading causes of blindness in India. In cases of glaucoma increased intraocular pressure (IOP) is the primary modifiable risk factor. Ocular surface disease (OSD) in these patients results from impaired tear film function and long-term use of antiglaucoma medications. This effect is significant in medications containing benzalkonium chloride (BAK) as a preservative. BAK, though cost-effective, can cause allergic reactions, inflammation, and epithelial damage. Alternative preservatives like Purite® and SofziaTM help mitigate these effects. Reducing the number of medications or using preservative-free options can alleviate OSD and improve patient outcomes. Materials and Methods: An Analytical cross-sectional study to compare the prevalence of ocular surface disease in 61 glaucoma patients and 61 non-glaucoma patients on long-term topical anti-glaucoma medications. The study parameters evaluated include the Ocular surface disease index questionnaire (OSDI) and using the Schirmer 1 test and Tear break-up time (TBUT), ocular surface staining score (OSS) with fluorescein and lissamine green. Results: The prevalence of dry eye disease among glaucoma cases was significantly high at 60.7% compared to 19.7% in the non- glaucoma patients (p<0.01). A marginal tear break-up time (TBUT) was observed in 60.7% of glaucoma patients. Mild to moderate tear deficiency on Schirmer’s test was observed in 60.7% of glaucoma patients, while mild to moderate ocular surface disease severity on OSDI was seen in 54.1% (mild) and 6.6%(moderate) of glaucoma patients. Abnormal Ocular surface staining score is seen in 45.9% of glaucoma patients. Conclusion: The presence of dry eye disease in this population is associated with the duration of glaucoma, the number of drugs and the presence of Benzalkonium chloride (BAK) as a preservative in anti-glaucoma drugs. Screening can detect dry eye in glaucoma patients early thus decreasing disease severity and increasing drug compliance. Keywords: Ocular surface disease, Glaucoma, OSDI, OSS, TBUT, BAK, Schirmer.

Background: Diabetes mellitus (DM) is a common metabolic disorder characterized by hyperglycemia due to either insulin insufficiency or resistance. It is associated with both micro- and macro-vascular complications, including coronary artery disease, peripheral vascular disease, diabetic nephropathy, retinopathy, and neuropathy. These complications contribute to increased morbidity and mortality, imposing financial burdens on both society and families. Mean Platelet Volume (MPV) has been studied as a marker for platelet activation, which plays a role in thrombosis and inflammation. This study aims to assess the relationship between MPV and diabetic microvascular complications. Materials and Methods: This observational study was conducted over 12 months at PESIMSR, Kuppam, among 126 Type 2 Diabetes Mellitus patients. After ethical clearance, purposive sampling was employed. The study assessed MPV in correlation with fasting blood glucose (FBS), postprandial plasma glucose (PPBS), glycosylated hemoglobin (HbA1c), body mass index (BMI), and the duration of diabetes. Exclusion criteria included patients with type 1 diabetes mellitus, gestational diabetes, chronic kidney disease, malignancy, and patients on antiplatelet/antithrombotic therapy. Data were analyzed using SPSS (Version 23), with statistical significance set at p < 0.05. Results: Among the 126 patients, the majority (60.3%) were males, and the predominant age group was 51-60 years. Diabetic retinopathy was observed in 33.3% of uncontrolled diabetic males and females, particularly in those with diabetes duration greater than 10 years. A significant correlation was found between MPV and HbA1c levels. The mean MPV was 7.8 ± 0.82 in patients with HbA1c 6.5-8, 8.87 ± 1.07 in patients with HbA1c 8-10, and 11.65 ± 1.16 in patients with HbA1c >10. The correlation between MPV and diabetic complications, particularly retinopathy and proteinuria, was statistically significant. Conclusion: MPV demonstrates a significant correlation with diabetic microvascular complications and can be used as a potential early marker for uncontrolled diabetes. Larger multicentric studies with longer follow-up are necessary to further validate the use of MPV as a diagnostic tool for diabetic complications. Keywords: Mean Platelet Volume, Type 2 Diabetes Mellitus, Microvascular Complications, Diabetic Retinopathy, HbA1c.

Background: Platelet-to-Lymphocyte Ratio (PLR) has emerged as an inflammatory marker in various conditions, including acute ischemic stroke (AIS). This study explores the correlation between PLR and the National Institutes of Health Stroke Scale (NIHSS) in patients with AIS to predict stroke severity and outcomes. Materials and Methods: A cross-sectional observational study was conducted in PES Hospital, Kuppam, from October 2023 to March 2024. Sixty-five AIS patients were enrolled. Their PLR values were calculated and correlated with NIHSS scores to assess stroke severity. Results: Among the participants, 58.5% were older than 60 years, and 58.5% were male. A significant portion had comorbidities such as diabetes (53.9%) and hypertension (56.9%). The median platelet count was 265,100 cells/mm³, mean absolute lymphocytes were 2,323.8 cells/ml, and mean PLR was 134.9. Higher PLR values were significantly associated with severe stroke (NIHSS 16-42, p=0.002). Conclusion: PLR is a potential prognostic marker in AIS, correlating with stroke severity as measured by NIHSS. This easily obtainable and cost-effective marker could enhance early prognostic assessment in clinical settings. Keywords: Platelet-to-Lymphocyte Ratio, Acute Ischemic Stroke, NIHSS, Stroke Severity.

Background: Acute ST-segment elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality. Electrocardiography (ECG) plays a pivotal role in identifying the culprit vessel, which is essential for timely intervention. This study aims to determine the correlation between ECG and coronary angiography (CAG) in localizing the culprit vessel in STEMI. Materials and Methods: This observational study was conducted at a rural tertiary care hospital in India. A total of 107 patients diagnosed with STEMI were enrolled. Data were collected on demographic profiles, ECG findings, and CAG results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various ECG markers were compared to CAG findings, which served as the gold standard. Results: Proximal LAD occlusion was the most common finding (42.1% of patients), followed by proximal RCA occlusion (15%). The ECG criteria for RCA occlusion (ST elevation in lead L3>L2) had a sensitivity of 92.31% and specificity of 91.36%. The specificity of ST elevation >1mm in lead V4R for diagnosing proximal RCA occlusion was 95.60%, with a PPV of 69.23%. Conclusion: ECG provides a reliable, non-invasive method for predicting the location of the culprit vessel in STEMI. However, it must be used in conjunction with other diagnostic tools like CAG for accurate localization, especially in settings with limited access to angiography. Keywords: STEMI, Electrocardiography, Coronary angiography.

Background: Diabetes mellitus presents unique challenges in Pediatric populations, necessitating careful consideration of insulin regimens. This study aims to compare the effects of neutral protamine Hagedorn (NPH) combined with regular insulin (R) versus glargine (G) with regular insulin on anthropometric measures and glycemic control in children with type 1 diabetes mellitus (T1DM). Materials and Methods: In a prospective, comparative study conducted at SVS Medical College, Mahabubnagar, 50 pediatric patients aged 2-18 years with T1DM were randomized to receive either NPH + R (n=28) or G + R (n=22) insulin for six months. Baseline and follow-up assessments included weight, height, body mass index (BMI), and HbA1C levels. Paired t-tests were used to compare changes within each group. Results: Patients on NPH + R exhibited significant weight gain (26.7 kg to 28.3 kg, p=0.001) and height increase (128.9 cm to 131.7 cm, p<0.001), while BMI changes were not significant (15.1 to 15.4, p=0.239). The HbA1C level decreased from 10.7% to 9.6% (p=0.023). Conversely, the G + R group showed no significant changes in weight (30.9 kg to 31.7 kg, p=0.123), height (140.9 cm to 139.0 cm, p=0.679), or BMI (15.9 to 15.8, p=0.875), but significant reductions in HbA1C (10.4% to 9.3%, p<0.001) were observed. Conclusion: This study demonstrates that NPH + R insulin is associated with significant increases in weight and height compared to G + R insulin, which, while effective for glycemic control, does not impact growth parameters. These findings suggest that insulin regimen choice in pediatric diabetes management should consider both metabolic control and growth outcomes. Keywords: Type 1 Diabetes mellitus, Insulin Regimens, Pediatric Endocrinology, Glycemic Control, Anthropometric Measures, NPH Insulin, regular, glargine.

Background: Septal agenesis (SA) and the "pseudo-septum" phenomenon are rare midline abnormalities identified in fetal MRI, often posing diagnostic challenges. Accurate differentiation between true SA and pseudo-septum is critical for prenatal counselling and management. This study aims to characterize the imaging features of true SA and pseudo-septum in fetal MRI and analyse their association with other central nervous system (CNS) anomalies and postnatal outcomes. Materials and Methods: A total of 79 fetuses with suspected midline anomalies underwent detailed MRI assessments at a tertiary care centre in India. The presence of true SA and pseudo-septum was evaluated, along with associated findings like ventriculomegaly and corpus callosum agenesis. Diagnostic accuracy metrics for MRI were calculated using histopathological and clinical follow-up as gold standards. Statistical comparisons were performed to analyse associations between SA, pseudo-septum, and neurodevelopmental outcomes. Results: True SA was confirmed in 29 cases (36.7%), while 21 cases (26.6%) were identified as pseudo-septum. Ventriculomegaly was more frequent in pseudo-septum cases compared to true SA (66.7% vs. 31.0%, OR: 4.2, p=0.004). The sensitivity and specificity of MRI for diagnosing SA were 81.0% and 69.2%, respectively, with an overall accuracy of 77.2%. Postnatal outcomes showed a trend toward higher rates of neurodevelopmental delay in true SA cases (31.0% vs. 9.5%, p=0.051), although this did not reach statistical significance. Conclusion: This study highlights the diagnostic challenges posed by the pseudo-septum phenomenon in differentiating true SA. While fetal MRI remains a reliable tool, the presence of pseudo-septum and ventriculomegaly requires careful interpretation to avoid misdiagnosis. Enhanced imaging protocols and further research into the long-term outcomes of these conditions are essential to improve prenatal care and clinical management in resource-limited settings. Keywords: Septal agenesis, Pseudo-septum, Fetal MRI, Ventriculomegaly, Central nervous system anomalies, Prenatal diagnosis, Neurodevelopmental outcomes.

Background: Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. Organophosphate compounds avidly bind to cholinesterase molecules and share a similar chemical structure. Hence this study is done to find out the pattern of poisoning and effect of treatment in acute organophosphate poisoning cases needing mechanical ventilation. Materials and Methods: The study was conducted in the department of Anaesthesiology, Bapuji Hospital and Chigateri general Hospital attached to JJM Medical College, Davangere, Karnataka. A total of 50 patients were selected based on inclusion and exclusion criteria. All the patients demographic, clinical hematological data were collected and analyzed. Statistical Package for Social Sciences (SPSS 20.0) version used for analysis. Results: In this study maximum number of patients had age between 31-40 years. Males are more than females. House wife and farmer are more in number compared to other occupations. The most common mode of poisoning is suicide and maximum number had mild severity. 3 had Diabetes mellitus and 1 had COPD. 12 patients had GCS 6. Maximum number of patients had pulse rate >60. 16 patients had SPO2 89 % ,others had less. 14 patients had 6 days hospital stay. Maximum number of patients were given pralidoxime within 6 hours. Conclusion: This study results concluded that age, mode of exposure, severity of symptoms and initiation of treatment can reduce the morbidity and mortality. Keywords: Atropine, Organophosphate, Poisoning, GCS, SPO2, Pulse rate, Blood pressure, Pralidoxime.

Background: The increasing prevalence and worsening health effects of junk food consumption have made it a major global public health concern. Even though its detrimental effects on health are common across all age groups, they are particularly high among teenagers in both developed and developing countries.[1] Objective: The study aims to evaluate the relationship between junk food consumption and obesity in adolescents aged 10 to 19 years, while also assessing their knowledge of the harmful effects of junk food on health. Materials and Methods: 180 students participated in a cross-sectional study. Each student was given pretested semi structured questionnaire on junk food consumption after giving informed consent. Study was conducted in selected government and private school of Indore district among school going adolescent of age group (10-19 years) for duration of six months from July - December 2022. Data analysis was performed using SPSS version 25.0 (Trial version). Results: The study sample consisted of 180 participants aged 10-19 years with mean height and weight of 1.54±0.15 and 53.88±11.18 respectively. Based on BMI 24.44% were overweight/Pre obese and 6.66% adolescents were obese. 59.44% students eat junk food and majority of them prefer salty snacks (66.21%), unhealthy food consumption in various BMI groups were noted and there were significant differences found i.e. salty snacks, sweetened beverages and fast-food consumption were found significant (p<0.05). 33.33% obese and 74.40% non-obese participants had adequate knowledge of harmful health effects of junk food consumption (p<0.05). Conclusion: There has been a noticeable increase in adolescent obesity; therefore, schools, families and communities must address the dietary determinants of obesity. Health education in schools should encompass teaching students about healthy food habits. Parents should teach their children the importance of eating a balanced diet and to avoid junk food. Keywords: Adolescent, Consumption, Junk food, Obesity, BMI.

Background: Mucormycosis refers to fungal infections caused by members of the Zygomycetes in the order of Mucorales. Rapid progression of invasive Mucormycosis results from its predilection for angioinvasion, which lead to cavernous sinus thrombosis and/or internal carotid artery encasement, cerebral infarctions, mycotic abscesses and aneurysms, and haematogenous dissemination follow tissue necrosis and thrombosis of blood vessels, such as the ophthalmic artery, results in the clinical presentation of proptosis, unilateral painful ophthalmoplegia and rapidly deteriorating vision.[1] Purpose: The aim of this study is to observe and evaluate the causes of vision loss in Mucormycosis patients. Materials and Methods: In this study cause of vision loss is assessed by using various entity like vision by Snellen chart and counting fingers, anterior segment examination by pen torch light, posterior segment examination by indirect ophthalmoscopy and MRI. Results: On examine 294 eyes of the patients the following result were observed, visual acuity was 6/6-6/60 in 43.33%,6/24-6/60 in 18.14%,5/60-3/60 in 12.04%,2/60-HM in 6.11% and PL negative 20.37%. The cause of DOV were corneal haze (due to exposure keratopathy), uveitis, disc oedema, RD, exudative DR, CRAO, optic atrophy, cortical blindness, vitreous haemorrhage, cataract. Conclusion: Mucormycosis is life threatening infection present with acute sinusoid, nonspecific ophthalmic, or cerebral symptoms but morbidity load can be decreased by early diagnosis and intervention. There were many causes of vision loss in Mucormycosis patient, CRAO was the major cause of vision loss in Mucormycosis concluded by this study. Keywords: Mucormycosis, Vision loss, Causes, Observe.

Background: Organophosphate compounds are commonly used for agriculture and household purposes. Due to easy availability OP poisoning is most common. The amount of consumption and duration is the major factors for mortality. The present study aimed to evaluate the survival pattern in patients with acute organophosphate poisoning on mechanical ventilator. Materials and Methods: Department of Anaesthesiology and ICU, Bapuji Hospital, Chigateri General Hospital attached with JJM medical College, Davangere, Karnataka. A total of 50 OP cases were included in the study based on inclusion and exclusion criteria. All the patient’s demographic, biochemical and clinical data was collected and analyzed. Results: The study observed that out of 50 maximum number (40) were recovered and 10 was expired. Elders are more in expired group and youngers are more in survival group. Males are more in expired group. Farmers are more exposed to OP and mortality is high. Expired group showed low SPO2 and recovered group showed high SPO2. Recovered group showed more duration of hospital stay than expired group. It was observed that initiation of treatment was late in expired group than survival group. Pseudocholine esterase levels are high in survival group than expired group. Conclusion: The study results were concluded that survival rate is low in patients with old age with other comorbidities. The initiation antidote and supportive majors can decrease the mortality rate in OP poising patients. Keywords: Organophosphate, poisoning, mortality, SPO2, Blood pressure, pseudocholine esterase.

Background: Aims: To determine the types of acute kidney injury in patients with liver cirrhosis and identify the precipitating causal (risk) factors for Acute Kidney Injury in patients with liver cirrhosis. Materials and Methods: It is descriptive, observational study in Department of General Medicine, in acute kidney injury among liver cirrhosis patient for a period of 15 months. Patients above 18 years of age with clinical features of decompensated liver cirrhosis are selected. Results: In this study on the basis of ICA AKI criteria, Incidence of AKI was found to be 43.6%. Out of total AKI population maximum had Pre Renal type of AKI followed by HRS AKI, and Intrinsic Renal AKI. No case of Post Renal AKI was diagnosed. Our study had male predominance, with incidence of AKI found more in middle aged population and among overall patients Alcohol was the predominant cause of Liver cirrhosis. The risk factors for AKI are older age, oliguria, low MAP, Hepatic Encephalopathy, Sepsis and shock There are higher chances of mortality in liver cirrhosis patients those who have AKI. Conclusion: AKI was common among patients with liver cirrhosis with high in-patient mortality. Identification of these precipitants and independent predictors of AKI may lead to prompt and targeted treatment with reduction in patient mortality. Keywords: Acute Kidney Injury, Non- alcoholic fatty liver disease, Chronic liver disease.

Heart disease is a leading cause of mortality worldwide, and early detection is crucial for improving patient outcomes. This study proposes a cloud-based Enhanced Cascaded Convolution Neural Network (CCNN), architecture combined with advanced machine learning algorithms for early heart disease detection. The E-CNN model is designed to handle large datasets efficiently, leveraging cloud-based resources to enhance computational speed and scalability. The Cleveland heart disease dataset is pre-processed to validate missing values and increase prediction accuracy. The study also examines the feasibility of employing a quantum machine learning (QML) framework via cloud computing to categorize cardiac conditions, using techniques such as support vector machine (SVM), artificial neural network (ANN), and K-nearest neighbors (KNN). Experimental results show that the E-CNN achieves an 99.2%, precision of 99.4 %, recall of 99.5%, and F1 score of 75%. and Kappa score of 98%. The quantum support vector machine (QSVM) method demonstrates superior performance with an accuracy of 85%, precision of 79%, recall of 90%, and F1-score of 84%. The Bagging QSVM model exhibits outstanding performance, with perfect scores across all critical performance measures. The study highlights the potential of ensemble learning methods, such as bagging, for improving the accuracy of quantum method predictions. The proposed cloud-based E-CNN architecture and QML framework offer promising solutions for real-time, remote analysis of health data, assisting in preventive healthcare and early detection of heart disease. Keywords: Cloud-Based, Efficient Convolutional Neural Network (E-CNN), Machine Learning, Heart Disease Detection, Early Detection, Quantum Machine Learning (QML), Bagging QSVM.

Background: Laparoscopic cholecystectomy (LC) is now the gold standard treatment of symptomatic gallstones. Our study aims to assess the prevalence of port-site infection in laparoscopic cholecystectomies, associated factors, and the most common organism causing port-side infections. Materials and Methods: This is a retrospective institute-based study including all laparoscopic cholecystectomies in our institute during two years period from 1 May 2022 to 30 April 2024. This study includes a total of 847 laparoscopic cholecystectomies. Patients who developed PSI swabs were taken for culture and sensitivity in all. Excisional biopsies for chronic discharging sinuses were done and sent for histopathological studies. Results: PSI was found in 27/847 patients (3.19%). According to the site of port infection, 22 patients (81.48%) developed an infection at the epigastric port, 4 patients (14.81%) developed an infection at the umbilical port and only 1 patient (3.70%) developed an infection at the lateral port. About the results of swab culture and histopathology of tissue samples, 16 patients (59.26%) were infected by Gram–ve bacteria, 3 patients (11.11%) were infected by Gram +ve bacteria, 8 patients (29.63%) with no growth. In the patients with deep infection, tissue was sent for histopathology out of six patients 3 showed granulomatous lesion (11.11%) and 3 with inflammatory lesion. Conclusion: Port site infection is very problematic It is important that instruments should be cleaned thoroughly after each surgery and should be sent for ethylene trioxide sterilization It is important to prevent any spillage during retrieval of gallbladder. Keywords: Gallbladder, Laparoscopic cholecystectomy, Port site infection.

Background: Neonatal jaundice is a commonly seen clinical condition globally, including in India seen in nearly 60% of subjects born at term and 80% of neonates born pre-term in their first week of life and is the most common cause of readmission in neonates. Aim: The present study aimed to assess the predictive value of umbilical cord blood albumin level for developing neonatal jaundice in healthy neonates born at term and the usefulness of cord blood albumin for predicting subsequent significant neonatal jaundice development. Materials and Methods: The present study assessed 200 healthy term neonates where cord blood albumin level was estimated at birth. Estimation of total serum bilirubin was done for all the neonates at birth. Estimation of total serum bilirubin was done in all the neonates with clinically suspected jaundice at the age of 72-96 hours. The neonates were divided into three groups I, II, and III depending on cord albumin levels of <2.8g/dL, 2.8-3.3 g/dL, and >3.3 g/dL respectively. The main outcome assessed was concerning serum bilirubin ≥17 mg/dL, exchange transfusion, and the need for phototherapy. Results: Groups I, II, and III had 42, 70, and 88 newborns respectively. In Group I, 85.7% (n=36) neonates had total bilirubin of >17 mg/dL, among which 76.19% (n=32) needed phototherapy, and 9.52% (n=4) subjects required exchange transfusion. In Group II. 65.7% (n=46) neonates developed jaundice whereas phototherapy was needed in 34.2% (n=24) neonates and no subjects needed exchange transfusion. In Group III, 34.09% (n=30) neonates developed jaundice here 2.2% (n=2) subjects needed phototherapy, and no subjects needed exchange transfusion which depicted a statistically significant difference with p<0.001. Conclusion: The present study concludes that cord blood albumin level of ≤2.8g/dL is a significant risk factor for the development of neonatal hyperbilirubinemia that needs early intervention, whereas, cord blood albumin >3.3 g/dL is usually the safe criteria for early discharge. Keywords: Albumin, Cord blood albumin, Hyperbilirubinemia, jaundice, Neonatal jaundice.

Background: Invasive candidiasis (IC) is a life-threatening infection with high morbidity and mortality, particularly among immunocompromised and critically ill patients. Understanding patient characteristics, microbiological profiles, and clinical outcomes is essential for improving treatment strategies. Objective: This study aimed to assess the clinical outcomes and microbiological characteristics of patients diagnosed with invasive candidiasis. Material and Methods: A single-center observational study was conducted on 100 patients with confirmed IC. Data on demographics, underlying conditions, infection sources, Candida species isolated, antifungal susceptibility, and clinical outcomes were collected. Multivariate analysis was used to identify risk factors for mortality. Results: Of the 100 patients, 54% were male, with a mean age of 60 years (±15). Bloodstream infections were the most common site (68%), with Candida albicans isolated in 47% of cases. Antifungal susceptibility testing showed that 92% of C. albicans isolates were susceptible to fluconazole, while 56% of C. glabrata isolates were resistant. The overall mortality rate was 35%, and ICU admission significantly increased mortality risk (p < 0.05). Risk factors for mortality included age >65 years, ICU admission, and infection with fluconazole-resistant C. glabrata (p < 0.05). Conclusion: Invasive candidiasis remains a serious health concern, particularly for older patients and those admitted to the ICU. The high fluconazole resistance observed in C. glabrata underscores the need for targeted antifungal therapies. Effective management strategies should focus on early diagnosis and species-specific antifungal treatments to improve patient outcomes. Key Words: Invasive candidiasis, Candida species, antifungal susceptibility, clinical outcomes, fluconazole resistance, risk factors.

Background: Uterine fibroids or leiomyomas are benign smooth muscle tumours of the uterus, found in approximately 20–50% of women of reproductive age and many are asymptomatic. The main objectives of this study were to assess the obstetric outcome in pregnancy with fibroid, its complications and management. Materials and Methods: This was a prospective observational study following confirmed diagnosis of uterine fibroids from ultrasonography with continuing pregnancy. The study conducted over two years pried from January 2022 to December 2023. All demographic information, baseline characteristics, Obstetric outcome- mode of delivery, complications and management and the foetal outcome- abortions, low birth weight, term or preterm, and associated complications and Neonatal intensive care (NICU)admissions. were noted. Results: Out of 6142 antenatal visits, 54 cases were identified with uterine fibroids during pregnancy, incidence being 0.8%. Majority belonged to age group between 25-30 years were about 31 (57%), 32 (59.2%) were primigravida, 18 (33.3%) had BMI more than 25 kg/m2, 8 (14.81%) had spontaneous miscarriages, 46 cases (85%) continued pregnancy, among them 28 (51.8%) underwent Lower segment caesarean section (LSCS), 18(33.27%) vaginal deliveries. 15 (32.6%) had pain abdomen, low birth weight (LBW) seen in 16 (34%) of deliveries. Conclusion: Pregnancy with uterine fibroids associated with various untoward obstetric outcomes. Pre-conceptional counselling, frequent antenatal visits and multidisciplinary team approach for planning delivery in tertiary care centres is essential for safe maternal and foetal outcome. Key Words: Fibroid uterus, Pregnancy, Miscarriage, LSCS, Low birth weight, NICU.

Background: The perfusion index serves as a valuable tool for evaluating perfusion dynamics and is currently under consideration as a non-invasive approach to identify the potential onset of hypotension after a subarachnoid block (SAB). The current study sought to investigate the relationship between baseline perfusion index in parturients and the extent of hypotension experienced during spinal anaesthesia for Caesarean delivery, as well as to determine if baseline perfusion index could serve as a predictor for this hypotension. Material and Methods: A group of 30 expectant mothers scheduled for elective caesarean delivery was chosen for the study. The perfusion index was assessed while the participants were in a supine position, utilising a designated pulse oximeter probe affixed to the left index finger of each parturient to maintain consistency in the recorded PI values. Maternal non-invasive blood pressure, heart rate, and perfusion index were documented at one-minute intervals from the time of spinal injection until delivery, followed by recordings at two-and-a-half-minute intervals until the conclusion of the surgical procedure. Results: The findings indicate a notable reduction in systolic arterial pressure (SAP) following spinal injection in parturients, regardless of whether they had high or low baseline pulse indices (PI). However, those with elevated baseline PI experienced more pronounced decreases in SAP at the 4, 5, and 6-minute marks post-injection compared to their counterparts with lower baseline PI. Parturients exhibited significant reductions in mean arterial pressure (MAP) following spinal injection, regardless of whether they had high or low baseline perfusion index (PI). Notably, those with elevated baseline PI experienced a more pronounced drop in MAP five minutes post-injection compared to their counterparts with lower baseline PI. Conclusion: The study found that baseline PI measured at the finger is associated with the extent of arterial pressure reduction during spinal anaesthesia for Caesarean delivery. A baseline PI cut-off point of 3.5 may serve as a useful indicator for identifying parturients who are at risk for hypotension in this context. Key Words: Caesarean Section, Hypotension, Mean Arterial Pressure, Perfusion index.

Background: Non-healing wounds represent a significant clinical challenge, particularly in patients with underlying comorbidities such as diabetes, peripheral vascular disease and malnutrition. This study aims to assess the clinical, bacteriological and laboratory parameters associated with non-healing wounds in a South Indian population to identify factors influencing prolonged wound healing. Materials and Methods: A total of 100 patients with non-healing wounds were included in this observational study. Detailed clinical data, including comorbidities, wound characteristics, and bacteriological profiles, were collected. Laboratory parameters such as white blood cell (WBC) count, haemoglobin (Hb), serum albumin, blood glucose, and C-reactive protein (CRP) levels were analysed to determine their correlation with wound healing times. Bacteriological cultures were obtained to identify the most common pathogens. Patients were categorized into two groups based on wound healing times: ≤8 weeks and >8 weeks. Results: The mean age of the patients was 55.4 ± 12.6 years, with 60% being male. Diabetes mellitus was the most common comorbidity, present in 70% of patients. Diabetic foot ulcers were the predominant wound type, accounting for 50% of cases. The most common bacterial isolates were Staphylococcus aureus (40%) and Pseudomonas aeruginosa (25%). Significant correlations were found between delayed healing (>8 weeks) and elevated WBC counts (11,500 ± 2,000 cells/µL, p < 0.01), lower haemoglobin levels (10.2 ± 1.8 g/dL, p = 0.02), reduced serum albumin (3.4 ± 0.6 g/dL, p < 0.01), elevated blood glucose levels (180 ± 25 mg/dL, p < 0.01) and higher CRP levels (12.0 ± 3.5 mg/L, p < 0.01). These laboratory markers of infection, anaemia, and malnutrition were strongly associated with prolonged wound healing. Conclusion: Non-healing wounds are associated with several clinical and laboratory abnormalities, it includes elevated WBC counts, anaemia, poor nutritional status, hyperglycaemia and systemic inflammation. In this study diabetic foot ulcers were the major cause for non – healing wounds. A multidisciplinary approach aimed at infection control, nutritional support and glycemic status is essential to improve wound healing outcomes. Further research is needed to explore novel therapeutic interventions for chronic wound management. Keywords: Non-healing wounds, wound healing, diabetic foot ulcers, laboratory markers, inflammation

Background: Port site infection following laparoscopic surgeries is a troublesome complication nowadays. It has corroded the advantages of minimal access surgery. Objectives: The study aimed to understand the cause of port site infection and how to manage the port site infection after laparoscopic surgery. Materials and Methods: Twenty-eight patients who underwent laparoscopic surgeries and developed port site infection were included in the study between Jan. 2020 to Jan. 2024. Data regarding patient demographics, type of surgery, prior treatment and management of port site infections obtained from hospital record and was reviewed. The port site infections were divided into two groups. Early within first week of surgery and delayed after 4-6 weeks of surgery. Chronic wounds were classified into two types, tubercular mycobacterium TMs and non-tubercular mycobacterium NTMs. Results: In the present study the male to female ratio was 10:18(n=28). The mean age was 46.3 years, range 26-72 years. The index surgery was lap. Cholecystectomy (n=16), followed by lap. Appendectomy (n=7), lap. Ovarian cystectomy (n=3) and lap. Varicocelectomy (n =2). 07 patients had prior history of ATT intake out of which 05 patients had completed ATT before surgery. 09 patients were treated with excision of sinus tract and ATT. 07 patients were treated with oral antibiotics as per culture sensitivity. 12 Patients were treated with combination of Ciprofloxacin and Clarithromycin for 3 months for NTMs. All patients responded well to oral antibiotics and no patient had relapse or recurrent infection. The mean follow up was 32 months. Conclusion: Port site infections have corroded the advantages of minimal access surgery (MAS). Drug resistant mycobacteria are difficult to treat. Aggressive treatment with excision of sinus tract and oral antibiotics are effective. Sterilization should be improved, proper microbiological methods should be employed and utmost care of aseptic techniques in Operation Theatre is very important. Keywords: Port site infection (PSI), Minimal access surgery, Tubercular mycobacterium (TMs), Non tubercular mycobacterium (NTMs), Ethylene oxide (ETO), Plasma sterilization, Minimal access surgery (MAS).

Background: Cervical Spinal cord is considered an important Organ at risk while Radiotherapy of head and neck cancer (HNC). Thus when the tolerance dose is exceeded for spinal cord it is important to look for symptoms of demyelination. Objective: To assess post radiotherapy demyelination of Spinal cord in HNC Patients in whom tolerance dose for spinal Cord were exceeded. Material & Methods: This prospective observational study was conducted on 485 patients receiving radiotherapy for treatment of HNC. In patients whom the doses for spinal cord exceeds tolerance dose of 50 Gy were then assessed for demyelination. Patients showing symptoms of demyelination were examined and Magnetic Resonance Imaging (MRI) to assess extent of damage was obtained and conservatively managed. Results: Only 80 patients received dose greater than 50 Gray (Gy) to more than 10 cm length of spinal cord. Of these 12 patients developed demyelination which was confirmed on MRI and managed conservatively with Vit.B12 supplementation and pregabaline. Among these10 patients recovered while 2 patients had irreversibly damaged cord. Main reasons for exceeding tolerance dose include locally advanced disease extending to posterior triangle in 80 % patients, progression of disease in 10 % which required additional doses to the gross tumor and Positive margins in 10 % patients for which additional boost doses needed to be delivered. Conclusions: Demyelination is a debilitating late sequel of Radiotherapy and adversely affect quality of life of the patient and care should be taken while planning radiotherapy so that tolerance doses are not exceeded. Keywords: Radiotherapy, Demyelination, Spinal cord, Myelopathy, Head and Neck cancer.

Background: Renal cell carcinoma (RCC) is the most common malignant renal tumor, exhibiting various histopathological subtypes with distinct prognoses and treatment responses. This study aims to analyze the histopathological profiles, grading, and staging of renal tumors in nephrectomy specimens, along with demographic correlations, to provide insights that could guide clinical management. Material and Methods: This retrospective study analyzed 200 nephrectomy specimens collected over a 2-year period (from January 2021 to December 2022) at a tertiary care hospital. Data on tumor type, grade, stage, necrosis, and vascular invasion were recorded. Tumor types were classified according to the 2016 WHO/ISUP system, and staging was assessed using the TNM classification. Statistical analyses included chi-square tests to examine correlations between tumor characteristics, grade, and stage, with significance set at p < 0.05. SPSS (25.0) was used for analysis. Results: The predominant tumor subtype was clear cell RCC (65%), followed by papillary RCC (15%) and chromophobe RCC (10%). Clear cell RCC had a significant male predominance (69.2%) and was most frequently seen in patients aged 60 or older. There was a notable correlation between tumor grade and stage, with higher-grade tumors more likely to present at advanced stages (p < 0.01). Pathological features such as necrosis and vascular invasion were observed more frequently in higher-grade clear cell RCC (34.6% and 38.5%, respectively), indicating an aggressive profile. Chromophobe RCC displayed the least necrosis and vascular invasion, reflecting its generally favorable prognosis. Conclusion: The study confirms clear cell RCC as the most prevalent subtype, with significant male predominance and a higher incidence in older age groups. A strong association between higher tumor grade and advanced stage underscores the importance of histopathological grading in RCC prognosis and treatment planning. Findings support tailored management strategies, with aggressive treatment approaches for high-grade tumors and nephron-sparing options for lower-grade, indolent subtypes. Further multicenter studies are recommended to enhance the generalizability of these findings and evaluate long-term outcomes. Key Words: Renal cell carcinoma, nephrectomy, histopathology, tumor grade, tumor stage, clear cell RCC, papillary RCC, chromophobe RCC.

Background: To study the prevalence and pattern of current use of contraceptives among currently married women of 15-49 years of age in a rural area of Thrissur district and to study the unmet need for family planning among these females and to identify the reasons. Material and Methods: A community based cross sectional study was conducted among 240 currently married women of 15-49 years of age in Tholur Community Health Centre area, which is the rural field practicing area of Dept of Community Medicine, Govt Medical college, Thrissur district. Cluster sampling technique with probability proportionate to size was used taking subcentres as cluster. 40 study participants were selected from the updated eligible couple register of each of the six subcentres by simple random sampling and the investigator went to each of the participant’s house. Results: A total of 240 patients participated in this study. The mean age of the study was30.6 ± 5.78 years.62.1% were Hindus followed by 36.7% Christians. Majority (72.1%) had received education of higher secondary level or above and 204 (85.8%) were house wives. 109(45.4%) belonged to upper middle class and 88 (36.7%) belonged to middle class. More than half (57.5%) belonged to nuclear family. The mean age at marriage was 21.41± 2.9 years, which was higher than the legal age for marriage in India. Majority (50.4%)were with two living children. The contraceptive prevalence was 62.9% (95% CI : 56.5,69.0).The most commonly used contraceptive method was tubectomy (32.9%) which was similar to that of India and Kerala NFHS-4 data. Among those who were using contraception,9.3% reported side effects during use. Among this 50% reported menorrhagia during IUCD use. The unmet need for family planning was17.5%, which includes 10.4% for spacing and 7.1% for limiting. The reasons for unmet need were don’t feel it necessary (38.1%), fear of side effects (33.3%), Religious reasons (16.7%). Age group, religion, type of family, socioeconomic status were found to have statistically significant association with contraceptive use. While the contraceptive use was highest among those with 2 children (78.9%) it was lowest among those (39.5%) with one or no children. The difference was statistically significant (p=0.001). Contraceptive use was higher among those with male children (68.6%) than those without a male child (49.3%). The difference was statistically significant (p=0.005). Women who desired to have more children was found to have significantly lower contraceptive use than who didn’t want to have children (P=0.001). Conclusion: The mean age of the study was30.6 ± 5.78 years. Majority (62.1%) were Hindus followed by 36.7% Christians. Majority (72.1%) had received education of higher secondary level or above. 85.8% were house wives. 45.4% belonged to upper middle class and 36.7% belonged to middle class. More than half (57.5%) belonged to nuclear family. The contraceptive prevalence was 62.9% (95% CI : 56.5,69.0).The most commonly used contraceptive method was tubectomy (32.9%). Key Words: Family planning, Contraceptive practices, Unmet need.

Background: Infections involving sterile body fluids, such as cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids, can lead to severe complications if untreated or improperly managed. Increasing antimicrobial resistance in these infections poses a critical challenge to patient care, especially in resource-limited settings like India. This study aims to assess the bacteriological profile and antibiotic susceptibility patterns of pathogens isolated from sterile body fluids in a tertiary care hospital, providing insights for empiric therapy optimization. Material & Methods: This cross-sectional study was conducted on 661 sterile body fluid samples collected from patients with suspected infections at a tertiary care hospital in India from March 2022 to February 2024. Samples underwent Gram staining, culture on selective media, and standard biochemical tests for bacterial identification. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method, with interpretations based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Data on patient demographics, clinical history, isolated pathogens, and resistance profiles were recorded and analyzed. Descriptive statistics were used to summarize prevalence rates, while chi-square tests were employed for comparing resistance rates, with significance set at p<0.05. Results: The most frequently isolated pathogens in our study were Staphylococcus aureus (13.4%), Klebsiella pneumoniae (14.5%), and Escherichia coli (13.0%), with notable resistance observed to commonly used antibiotics, including methicillin in S. aureus (45.5%) and third-generation cephalosporins in K. pneumoniae (58.3%) and E. coli (61.9%). Gram-positive bacteria showed high resistance to penicillin, while gram-negative isolates had a substantial prevalence of extended-spectrum beta-lactamase (ESBL) producers. The overall incidence of multidrug-resistant (MDR) organisms was high, emphasizing the need for targeted antibiotic stewardship strategies. Conclusion: This study highlights the high prevalence of MDR pathogens in sterile body fluid infections, necessitating cautious empiric antibiotic selection. Findings underscore the importance of implementing routine antibiotic susceptibility testing and hospital-based antibiograms to enhance infection control practices and reduce treatment failures. Establishing effective antimicrobial stewardship programs is critical in limiting resistance trends and improving patient outcomes in resource-constrained healthcare settings. Key Words: Sterile body fluids, antibiotic resistance, multidrug-resistant organisms, tertiary care hospital, Staphylococcus aureus, Klebsiella pneumoniae.

Background: Protein-energy malnutrition is a significant health issue for children under five in India. Severe acute malnutrition (SAM) is marked by a weight-for-height/length below -3 Z-scores, a mid-upper arm circumference under 11.5 cm, or the presence of nutritional bipedal oedema. SAM can directly lead to child mortality or indirectly elevate fatality rates by worsening outcomes of common childhood illnesses. Aim: This study assesses the nutritional status of children with SAM admitted to a Nutritional Rehabilitation Center (NRC). Material and Methods: A descriptive, observational, hospital- and community-based longitudinal study was conducted from July 2022 to June 2023 at the NRC in the Department of Paediatrics at Baba Raghav Das Medical College, Gorakhpur, UP. SAM children admitted to the NRC, along with their caregivers, were included. Statistical analysis was performed using SPSS. Results: Among SAM patients, most were aged 1-2 years (35.6%), male (61%), from rural areas (81%), Hindu (93%), and belonged to the OBC caste (54%). The majority were underweighted at admission (86.4%), but this reduced by discharge (28.8%). Skin changes were common at admission (22%), and bleeding gums were rare at discharge (1.7%). On follow-up, 33.9% were still underweight, with minimal cases of oedema and bleeding gums. Conclusion: SAM children in this study were predominantly male, aged 1-2 years, with illiterate caregivers. The NRC provided effective care, reducing severe wasting and oedema rates from admission to discharge. Recommendation: The NRC at BRD Medical College Gorakhpur offers effective clinical, nutritional, and counselling support for malnourished children. Key Words: Nutrition, Rehabilitation Center, Caregivers, Malnourished, Children.

Background: Diabetic foot ulcers (DFUs) are a common complication of diabetes and present significant challenges in wound management. Alginate filler dressings, derived from seaweed, offer a moist wound environment that may enhance healing compared to conventional saline dressings. This study aimed to compare the efficacy of alginate filler dressings with conventional saline dressings in promoting wound healing in patients with DFUs. Materials and Methods: A randomized controlled trial was conducted with 95 patients having DFUs, randomly assigned to Group A (Alginate, n=47) and Group B (Saline, n=48). Patients in Group A received alginate filler dressings, while Group B received conventional saline dressings. The primary outcome measured was the time to complete wound healing over 12 weeks. Secondary outcomes included pain levels during dressing changes, frequency of dressing changes, and the rate of infection. Data were analyzed using Kaplan-Meier survival analysis and other appropriate statistical tests. Results: At 12 weeks, 89% of patients in the alginate group achieved complete healing, compared to 73% in the saline group (Log-Rank p=0.04). The mean time to complete healing was significantly shorter in Group A (36.4 ± 8.2 days) compared to Group B (43.8 ± 10.1 days, p=0.001). Group A reported lower mean VAS pain scores during dressing changes (3.2 ± 1.1) compared to Group B (4.5 ± 1.3, p=0.001). The alginate group also required fewer dressing changes per week (2.3 ± 0.5 vs. 5.1 ± 0.8, p<0.001). Infection rates between the groups were not significantly different (p=0.182). Conclusion: Alginate filler dressings demonstrated a significant advantage in promoting faster wound healing, reducing pain, and minimizing the frequency of dressing changes compared to conventional saline dressings in the management of DFUs. While both dressings had comparable infection rates, alginate dressings may provide a more efficient and patient-friendly option for DFU care, especially in resource-limited settings. Keywords: Diabetic foot ulcers, alginate filler dressings, saline dressings, wound healing, randomized controlled trial, pain management.

Background: Acute appendicitis is a common surgical condition and the one of the leading causes of acute surgical abdomen. Diagnosis of acute appendicitis is routinely done on the basis of analysis of WBC count, CRP levels, ESR and procalcitonin (PCT) levels. In present study, the serum levels of CRP were correlated with the histopathology of the removed appendix to study predictive value of serum C- reactive protein in diagnosis of acute appendicitis. Materials and Methods: Present study was conducted in 50 patients with possibility of acute appendicitis, underwent appendicectomy. The histopathology report was considered as the final diagnosis. CRP more than 10 mg/dl was considered to be positive. Results: In present study total 50 patients were included. Male to female ratio was 1.28:1, most common age group was 21-30 years (48%) followed by 11-20 years (22%). Abdominal pain (92%), McBurney tenderness (78%), vomiting (72%), were the most common common signs and symptoms noted in present study. On histopathology examination, inflamed appendix (54%) was most common finding, others were gangrenous appendix (24%), perforated appendix (6%) and normal appendix (18%). In present study diagnostic efficacy of serum CRP was sensitivity (82.5%), specificity (80%), positive predictive value (94.2%), negative predictive value (53.31%), diagnostic accuracy (82%). Conclusion: Serum CRP estimation is useful adjunct in diagnosis of acute appendicitis along with clinical diagnosis. Serum CRP value should be interpreted in combination with clinical findings. Keywords: Serum CRP levels, acute appendicitis, diagnosis.

Background: Dengue fever (DF), a mosquito-borne viral infection, is a significant public health issue in India, characterized by recurrent outbreaks and a wide range of clinical presentations. The disease can progress to severe forms such as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), which increase the risk of morbidity and mortality. This study aims to analyze the clinical, laboratory, and diagnostic findings in adult dengue patients. Objective: To evaluate the clinical symptoms, complete blood count (CBC) abnormalities, liver and renal function tests (LFT and RFT), and imaging results in adult patients with dengue fever to enhance diagnostic accuracy and assess potential markers of disease progression. Materials and Methods: A prospective observational study was conducted from September 2023 to January 2024 at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla. Forty adult patients with suspected dengue were included based on positive laboratory tests (NS1 antigen, IgG, or IgM). Patients were monitored for clinical symptoms, and their CBC, LFT, RFT, ECG, X-ray, and ultrasonography results were systematically recorded. Data were analyzed using descriptive statistics, and ethical approval was obtained. Results: Among the 40 patients, the male-to-female ratio was 35:5, with an average age of 39.4 years. High-grade fever (100%), myalgia, headache, and arthralgia (90%) were the most common symptoms. Thrombocytopenia was observed in 77.5% of patients, while 67.5% showed leukopenia. Elevated AST and ALT levels were seen in 92.5% and 70% of patients, respectively. Sinus bradycardia was noted in 25% of patients, pleural effusion in 22.5%, and ascites in 12.5%. One patient died from myocarditis, while the remaining 39 recovered. Discussion: The findings align with other studies, with high fever and myalgia being the predominant symptoms. Although thrombocytopenia was common, it did not always correlate with bleeding tendencies. Liver function abnormalities, such as elevated AST and ALT, were observed in most patients. The presence of sinus bradycardia, pleural effusion, and ascites provided additional insight into the disease's pathophysiological impact. Conclusion: This study highlights the importance of monitoring CBC, liver function, and imaging results in dengue patients. Early identification of laboratory markers and appropriate interventions can help reduce the risk of severe outcomes. However, the small sample size and potential underreporting of cases limit the generalizability of the findings. Further studies with larger populations are needed to confirm these observations and improve dengue management strategies. Keywords: Dengue fever, thrombocytopenia, liver function tests, sinus bradycardia, pleural effusion, ascites, myocarditis.

Background: Chronic otitis media (COM) is a persistent ear disease characterized by middle ear infection, often resulting in a ruptured tympanic membrane and drainage. Cholesteatoma, a severe complication of chronic suppurative otitis media (CSOM), requires timely diagnosis for effective management. High-resolution computed tomography (HRCT) is a crucial tool for diagnosing cholesteatoma, assessing disease extent, and identifying bony erosions in the temporal bone. Objective: This study aimed to evaluate the diagnostic accuracy of HRCT in detecting cholesteatoma and its associated complications in patients with CSOM. Material and Methods: A descriptive observational study was conducted at Index Medical College Hospital and Research Centre, including 50 patients with suspected primary or recurrent cholesteatoma. All patients underwent HRCT, and findings were correlated with intra-operative and histopathological examination results. Sensitivity, specificity, positive predictive value and negative predictive value of HRCT were calculated. Results: Of the 62 temporal bones identified as diseased, HRCT demonstrated a sensitivity of 100%, specificity of 88.2%, PPV of 92.2%, and NPV of 100% in detecting cholesteatoma. HRCT findings included soft tissue density in the epitympanum in 95.2% of cases, with common bony erosions of the incus (61.2%), malleus (58.1%), and scutum (54.8%). False positives were observed in five cases, with granulation tissue, cholesterol granuloma, and wax misdiagnosed as cholesteatoma. Conclusion: HRCT provides excellent sensitivity and high specificity for diagnosing cholesteatoma and associated bony erosions, making it an invaluable tool in the pre-operative assessment and management of CSOM. However, its inability to differentiate between cholesteatoma and similar soft tissue lesions poses some diagnostic challenges. Key Words: Chronic otitis media, cholesteatoma, high-resolution computed tomography (HRCT), temporal bone, bony erosion, temporal bone cholesteatoma.

Background: Ovarian masses present a significant challenge in gynecology, necessitating accurate differentiation between benign and malignant lesions for effective patient management. This study aims to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) in distinguishing between benign and malignant ovarian masses. Material and Methods: A cross-sectional study was conducted at Department of Radiology, Index Medical College Hospital and Research Centre, Indore involving 60 female patients with ovarian masses diagnosed via pelvic ultrasound. Patients underwent MRI, including both plain and contrast sequences, and findings were compared to histopathology results. Results: The age range of patients was 18 to 80 years, with an average age of 41.4 ± 10.2 years. The most common clinical presentation was lower abdominal pain (88%). The most frequently observed tumor was mucinous cystadenoma (15%). MRI demonstrated a sensitivity of 93.33% and specificity of 68.89% for detecting malignancy, with a positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 96.88%. Significant differences were noted in the presence of solid components (P=0.010) and contrast enhancement (P=0.005) between malignant and benign tumors. Conclusion: MRI is an effective diagnostic tool for differentiating between benign and malignant ovarian tumors, particularly due to its high sensitivity and strong NPV. The findings support the incorporation of MRI into preoperative decision-making. Future studies should focus on standardizing imaging parameters to further enhance diagnostic accuracy. Key Words: Ovarian masses, magnetic resonance imaging, benign tumors, malignant tumors, diagnostic efficacy, sensitivity, specificity.

Background: Vaginal bleeding during the first trimester of pregnancy is a common occurrence, affecting 20-25% of pregnant women and potentially indicating serious complications such as abortion, ectopic pregnancy, and molar pregnancy. This study aimed to evaluate the role of transvaginal ultrasonography (TVS) in diagnosing the causes of vaginal bleeding in early pregnancy. Material and Methods: A cross-sectional study was conducted at Index Medical College Hospital and Research Centre, Indore, involving 60 pregnant patients referred for TVS due to bleeding in the first trimester from September 2023 to February 2024. Inclusion criteria comprised patients presenting with vaginal bleeding during the first trimester who consented to participate. Clinical data were collected, followed by TVS using a 7-12 MHz transducer. Statistical analysis was performed using IBM SPSS version 22.0. Results: Among 2307 obstetric admissions, 60 cases (2.6%) with first-trimester bleeding were analyzed. The majority of patients were aged 21-25 years (48.4%) and primarily multigravida (66.7%). The most frequent clinical diagnosis was threatened abortion (48.3%), followed by incomplete abortion (26.7%) and missed abortion (10%). Ultrasound findings indicated incomplete abortion in 30% of cases and a viable pregnancy in 13%. There was a significant disparity between clinical and ultrasound diagnoses, with ultrasound showing 100% sensitivity across all cases. Management included conservative treatment in 21.7% of patients, while 53.3% underwent manual vacuum aspiration. Conclusions: TVS proved to be a reliable and non-invasive tool for diagnosing causes of first-trimester vaginal bleeding, with high sensitivity and accuracy. This study emphasizes the critical role of ultrasound in guiding management decisions and optimizing patient care in early pregnancy complications Keywords: First trimester bleeding, Ultrasound, Abortions.

Background: Neonates possess a finely tuned adaptation system that regulates blood sugar levels within a safe range during extrauterine life. Nevertheless, specific intrauterine risk factors can disrupt this adaptive system, resulting in hypoglycemia during the early post-natal period. This research was conducted at a tertiary care hospital in Gujarat to investigate the incidence of hypoglycemia and the associated risk factors. Material and Methods: A total of 150 newborns participated in this study. All newborns who were promptly transferred to their mothers post-delivery, regardless of whether the birth was vaginal or via caesarean section, were included in the study after securing parental consent. Capillary blood sugar levels were monitored at 1, 3, 6, 12, 24, 48, and 72 hours after birth. Neonates exhibiting capillary blood glucose levels below 40 were classified as hypoglycemic. All infants experiencing hypoglycemia underwent thorough assessments to identify various intrauterine and post-natal risk factors. Results: In a study involving 150 enrolled cases, it was observed that 24 individuals experienced hypoglycemia within the first 72 hours of life. The occurrence of hypoglycemia observed in our study was 16%. Hypoglycemia occurred more frequently in neonates born to mothers under the age of 30; however, this association was not statistically significant. The incidence of hypoglycemia was observed to be higher in infants born via LSCS. In our research, we analysed a total of 150 enrolled cases, of which 112 were classified as term, 30 as preterm, and 8 as post term. Our research identified 20 instances classified as small for gestational age (SGA). Among these, 13 were categorised as Term SGA, while 7 were identified as Preterm SGA. Conclusion: Hypoglycaemia frequently occurs in the post-natal ward, particularly among high-risk neonates, those born via LSCS deliveries, and first-time mothers who may lack confidence in breastfeeding. Monitoring capillary blood glucose in these instances can identify numerous asymptomatic hypoglycemic neonates. Timely and appropriate management can avert the onset of symptoms and help prevent both early and delayed neurological complications. Key Words: Capillary Blood Glucose, Hypoglycaemia, Neonates, Preterm.

Background: According to the World Health Organization (WHO), adolescence is defined as the period between ages 10 and 19 for all individuals, encompassing both married and unmarried groups. Worldwide, there are roughly 1.2 billion adolescents, representing one-fifth of the global population, with numbers steadily increasing. During this phase, adolescents may attain up to 35% of their adult body weight and experience a height increase ranging from 11% to 18% of their eventual adult height. Adolescence is marked by a rapid increase in blood volume, leading to significantly higher iron requirements. During this period, boys and girls are at a greater risk of iron deficiency anemia due to accelerated growth. Adolescent girls, in particular, require additional iron to support menstruation alongside growth and development. Iron deficiency anemia can hinder cognitive and behavioral growth, negatively affecting academic performance. The objective of the present study was to estimate the prevalence of anaemia and its associated risk among adolescent girl in urban area of Katihar. Material and Methods: It is a community based cross-sectional observational study and this study was undertaken among adolescent girls (10-19 years) in Sharifganj of Katihar district, Bihar. The sample size of the present study was 315. Data was collected by using a predesigned and pretested proforma, about socio-demographic characteristics, and other contributory risk factors in relation to anaemia, by oral questionnaire method. Results: The overall prevalence of anaemia among the adolescent girls was found to be 168 (53.33%). Out of 168 adolescent girls the number of severe, moderate and mild anaemic girls were 13 (7.75%), 59 (35.11%) and 96 (57.14%) respectively. The prevalence of anaemia was found to be 117 (56.52%) and 49 (54.44%) in the underweight and normal BMI respectively. Conclusion: A high prevalence of anaemia was found in this study. Adolescent girls are particularly vulnerable to anaemia, and as they grow older, this health challenge often persists, negatively affecting the well-being of women. This continued health issue raises the risk of maternal and neonatal complications, as well as child mortality. Keywords: Adolescent, Anaemia, Urban Area, Risk factor.

Background: Delayed contrast enhancement in cardiac magnetic resonance (CMR) imaging plays a pivotal role in assessing myocardial tissue characteristics in non-ischemic cardiomyopathy (NICM). This study aims to explore the various patterns of late gadolinium enhancement (LGE) observed in NICM patients and their correlation with clinical outcomes. The study identifies distinct morphological and distributional variations, including diffuse, patchy, subepicardial, mid-wall, and subendocardial enhancement. Recognizing these patterns enhances diagnostic accuracy and improves prognostic evaluations in NICM, ultimately guiding therapeutic strategies for better patient management. Objective: The primary aim of this prospective study is to evaluate the patterns of delayed contrast enhancement in NICM patients using CMR imaging. Material & Methods: A total of 40 NICM cases were included in this study, conducted in the Department of Radiodiagnosis at G.S.V.M. Medical College, Kanpur, from September 2022 to July 2024. Patients were selected in collaboration with LPS Institute of Cardiology based on clinical and echocardiographic criteria. Cardiac MRI was performed on a 3T machine and the images were qualitatively analyzed for abnormal myocardium. Results: The mean age of patients in this study was 58 years. Of the total, 30 (75%) had dilated cardiomyopathy (DCM), 5 (12.5%) had myocarditis, 3 (7.5%) had restrictive cardiomyopathy (RCM), and 2 (5%) had sarcoidosis. Among the DCM patients, mid-wall enhancement was seen in 10 (33.33%). In the myocarditis group, 2 (40%) patients showed a subepicardial pattern of enhancement. Both sarcoidosis patients exhibited involvement of the subendocardium, mid-wall, and subepicardium. Additionally, one (33.3%) patient with RCM demonstrated subendocardial enhancement. A significant association was found between enhancement patterns and the underlying pathologies (p=0.0001). Conclusions: LGE CMR is becoming an indispensable tool for detecting, characterizing, and differentiating various cardiomyopathies. By classifying delayed myocardial enhancement based on its precise anatomical location, it is possible to distinguish between non-ischemic and ischemic (infarct-related) cardiomyopathies. When clinical suspicion is high, delayed-enhanced cardiac MRI can facilitate early detection and prompt management of cardiomyopathies, improving patient outcomes. Keywords: LGE - late gadolinium enhancement, NICM - non-ischemic cardiomyopathy, CMR - cardiac magnetic resonance, DCM - dilated cardiomyopathy, RCM - restrictive cardiomyopathy.

Background: The subarachnoid block was the dominant form of neuraxial anesthesia in the 20th century. The ensuing anesthesia is predictable, occurs rapidly, and is associated with profound muscle relaxation. The addition of opiates like the lipophilic opioid fentanyl to local anesthetics varies many of its clinical effects after intrathecal administration. Materials and Methods: The study was designed to compare the efficacy of intrathecal fentanyl along with bupivacaine and bupivacaine alone and their effect on prolonging the duration of postoperative analgesia in lower segment cesarean section without any adverse effects on the fetus, determined clinically by apgar scoring. Patients were randomly divided into two groups i.e., group FB and group B consisting of 25 patients each. GROUP Patients in group FB were given 8.5mg of Bupivacaine plus 25µg (0.5ml) of Fentanyl. GROUP B- Received 8.5mg of Bupivacaine plus 0.5ml of normal saline to adjust the final volume to 2.2ml. The demographic and pre-anesthetic hemodynamic data were comparable in both groups. Results: In our study, all patients in the two groups were comparable concerning age, height, weight, gestational age, and ASA status. In both the groups, the mean onset of sensory block occurred between 2 minutes and 3 minutes in most of the patients (76%) and the maximum level of sensory blockade at T4 is achieved in 5 to 7 minutes. This observation shows that the addition of fentanyl to Bupivacaine does not influence Bupivacaine's sensory block. In this study, we also did not observe respiratory depression. In our research shivering was not seen in the Fentanyl group but 12% of patients in the Bupivacaine group had shivering. In the Bupivacaine group, two patients had hypotension and one patient had bradycardia. Other complications with intrathecal Fentanyl in group FB were bradycardia (12%) and nausea (12%) but none of the patients had vomiting, and two patients had hypotension. In our study, the mean duration of 2 segment regression time in Group FB was 100 minutes, and in Group B was 94.8 minutes. There was no difference in the duration of 2 segment regression in both the groups. Conclusion: In conclusion, Fentanyl 25µg does not enhance the onset and duration of sensory block produced by 8.5mg of hyperbaric intrathecal Bupivacaine. Fentanyl, however, prolongs postoperative analgesia and lowers the incidence of shivering. The incidence of pruritus is high, but it is usually mild. Fentanyl 25µg along with 8.5 mg Bupivacaine is very much safer than other opioids like morphine which has more postoperative complications like intense, intermittent respiratory depression. Keywords: Bupivacaine, Cesarean Deliveries, Fentanyl, Postoperative analgesia, Spinal Anesthesia.

Background: Proximal one-third tibial fractures present unique challenges for surgical fixation. This study evaluates the efficacy and outcomes of the suprapatellar approach for intramedullary nailing in managing these fractures. Material and Methods: Thirty patients with proximal one-third tibial fractures, treated between December 2020 and December 2022 at Prathima Institute of Medical Sciences, were retrospectively analyzed. Inclusion criteria were skeletally mature patients (≥20 years) with closed or segmental fractures. Patients underwent intramedullary nailing through a suprapatellar approach. Outcomes assessed included clinical, functional, radiological results, and complications. The Lower Extremity Functional Scale (LEFS) measured functional recovery, and radiographic evaluations monitored fracture union. Results: The study population had a mean age of 43.4 years (SD ± 15.18), with 70% males. Most injuries occurred on the right side (76.66%) due to road traffic accidents (73.33%). Radiological union was achieved in 73.33% of patients within 12-14 weeks. The average union time was 18.86 weeks (SD ± 8.09). LEFS scores indicated excellent functional outcomes in 80% of cases, with minimal complications, including proximal screw infection and nonunion in 6.66% and malunion in 3.33%. Conclusion: The suprapatellar approach for intramedullary nailing in proximal tibial fractures is effective, providing high union rates and favorable functional outcomes with minimal complications. This approach demonstrates its value as a reliable option for managing proximal tibial fractures, particularly in terms of patient recovery and alignment maintenance. Key Words: Suprapatellar approach, intramedullary nailing, proximal tibial fracture, fracture union, functional outcome, complications, Lower Extremity Functional Scale (LEFS).

Background: Cervical spondylodiscitis is a rare but potentially life-threatening infection characterized by inflammation of the vertebrae and discs, leading to significant morbidity and neurological complications. The aim of this study was to evaluate the outcomes of surgical intervention in patients with cervical spondylodiscitis, focusing on improvements in pain and neurological status. Material and Methods: A retrospective randomized controlled study was conducted in the Department of Orthopaedics at Rajshree Medical Research Institute, Bareilly (U.P) including 30 patients who underwent anterior surgical intervention between June 2022 and September 2023. Inclusion criteria encompassed patients with cervical spondylodiscitis presenting with neurological deficits, spinal instability, or myelopathy. Preoperative and postoperative assessments utilized the Visual Analogue Scale (VAS), the Modified McCormick Scale, and radiological evaluations. Statistical analyses were performed using SPSS software. Results: The cohort comprised 60% females and 40% males, with a mean age of 50 years. Postoperative evaluations indicated significant improvements, with mean VAS scores decreasing from 8.29 at presentation to 1 at 3, 6, and 12 months (p < 0.001). The Modified McCormick Scale also demonstrated significant postoperative improvement. Ten patients required re-exploration due to complications, primarily in those with comorbidities such as diabetes and chronic kidney disease, but subsequently showed marked improvements in pain scores. Conclusion: Surgical intervention for cervical spondylodiscitis significantly enhances patient outcomes, as reflected in reduced pain and improved neurological function. This study highlights the necessity for timely surgical intervention and careful management of comorbid conditions to optimize recovery and reduce complications, advocating for proactive strategies in treating infectious spondylodiscitis. Keywords: Cervical spondylodiscitis, surgical intervention, Visual Analogue Scale (VAS), neurological outcomes, Modified McCormick Scale, morbidity.

Background: 40 % of all ischemic events remain classified as cryptogenic. pAF is often suspected in cases of cryptogenic stroke. Most relevant complication of AF is stroke and this risk is similar in pAF and permanent AF. Patients with AF and ischemic stroke need anticoagulation and it cuts down the risk for recurrent stroke by nearly 2/3rd. Thus the identification of pAF by NT-proBNP is highly relevant in patients with ischemic stroke and sinus rhythm. Aims & Objectives: To determine diagnostic accuracy of NT-proBNP for pAF. Material and Methods: Patients with acute cerebral ischemia were included. NT-proBNP were measured within 72 hrs after stroke. Patients free from AF at presentation received 3 days cardiac rhythm monitoring or holter monitoring. Mean values of NT-proBNP were compared between patients with AF and sinus rhythm (SR) at presentation; and patients with pAF and no-AF using t-test. Receiver operating curves were used to test the ability of NT-proBNP values to identify patients with paroxysmal AF. Results: 200 patients were included (67 with AF and 133 with SR). Among 133 patients with SR at presentation 13 patients were found to have pAF. Mean NT-proBNP values in patients with AF, pAF, no-AF were 2202.3, 1108.3 and 399.84 pg/dl respectively (p value < 0.001). Receiver operator characteristic (ROC) curve constructed for stroke of defined etiology had area under curve (AUC) of 0.92. Another ROC curve constructed for patients with pAF had AUC of 0.89. The optimal cutoff level of NT-proBNP in our study was 334.5 pg/ml with sensitivity of 100 % and specificity of 65.1 % for predicting pAF. Conclusion: In our study 6.5 % patients developed pAF during cardiac rhythm monitoring and NT-proBNP had good accuracy in predicting the presence of pAF in patients with cryptogenic stroke and these patients can be considered for prolonged cardiac rhythm monitoring. Key Words: Cryptogenic stroke, Paroxysmal AF, BNP

Background: The retroperitoneal space is home to a variety of masses, which can be primary or secondary, neoplastic or non-neoplastic. Accurate diagnosis using imaging techniques is crucial for effective management. This study aims to evaluate the spectrum and characteristic imaging features of solid and cystic retroperitoneal masses using contrast-enhanced computed tomography (CECT), correlating these findings with histopathology. Material and Methods: In this prospective cross-sectional study, 30 patients with suspected retroperitoneal masses underwent CECT. Imaging features were assessed, and results were correlated with pathological findings. Results: This study involved patients aged 1 to 75 years, predominantly male (66.7%). Primary retroperitoneal masses made up 35.7% of cases, with lymphomas and liposarcomas being the most common types. Among secondary retroperitoneal masses, 42.1% were of pancreatic origin, followed by renal (31.6%), adrenal (21.1%), and aortic (5.2%) masses. Cystic lesions, primarily pancreatic pseudocysts, accounted for 30% of cases. In terms of vascularity, 43.3% of lesions were hypo- or non-vascular. Most lesions (66.6%) showed heterogeneous enhancement on CT scans. The overall accuracy of CT in diagnosis was 86.7%, with 84.6% accuracy for malignant lesions and 88.2% for non-malignant ones. Conclusion: CECT is effective in evaluating retroperitoneal masses, providing valuable information for diagnosis and management. Characteristic imaging features, combined with clinical information, enhance diagnostic accuracy, aiding in differentiating between various types of lesions. The study underscores CT's effectiveness in differentiating between malignant and non-malignant retroperitoneal masses, making it a valuable tool for accurate diagnosis and management. Keywords: Retroperitoneal masses, contrast-enhanced computed tomography, imaging features, histopathology, neoplastic lesions, vascularity, enhancement patterns.

Background: Diabetes Mellitus, particularly Type 2, is rapidly increasing in India, presenting significant public health and economic challenges. This study evaluates the out-of-pocket expenditure incurred by patients with diabetes, highlighting the financial burden associated with managing this chronic condition. Material & Methods: In this single-center observational study, we analyzed 75 cases of diabetes from January 2024 to June 2024. Patients aged 18 years and older were included, while those with gestational diabetes, severe complications, or other chronic diseases were excluded. Data on direct and indirect costs related to diabetes management were collected through structured interviews and questionnaires. Results: Our findings revealed that the mean expenditure on diabetes treatment was ₹1730.67 (USD 20.77) per month, which constituted an average of 64.76% of the participants' per capita income. A significant proportion of patients reported treatment costs exceeding their monthly income, indicating a substantial economic burden. Conclusions: The study underscores the pressing need for improved healthcare policies and financial support systems to mitigate the economic challenges faced by diabetes patients. Enhancing access to affordable treatment options and comprehensive health insurance can play a vital role in alleviating the financial strain, ultimately improving patient outcomes and quality of life. Keywords: Diabetes Mellitus, Out-of-Pocket Expenditure, Economic Burden, Healthcare Policy.

Background: Ketamine is used mainly for induction and maintenance of anesthesia-producing dissociative anesthesia. Studies have shown that even with known cases of intrauterine asphyxia, excellent APGAR scores have been achieved in neonates. Objective: To study fetal outcomes using Ketamine as a pre-spinal agent in caesarian sections. Material and Methods: 80 full-term women who were undergoing caesarian section were divided into two groups A and B. A Group (receiving Ketamine) and B Group (receiving Placebo) by using a basic randomization technique of consecutive numbers— the prospective Randomized case-control trial. The patients falling into Odd sequencing numbers were categorized under A Group and received low dose Ketamine IV 0.25mg/kg diluted to 10ml with sterile water while even sequencing numbered were B Group and received placebo. At the delivery, APGAR scores of the newborn were assessed at 1st and 5th minutes and the time of onset of breastfeeding was also calculated. Results: APGAR scoring at 1st minute in the case and control group were 7.20 and 6.875, the t-test had a value < 0.05 which was significant. The 5th minute APGAR scoring on the other hand was 9 and 8.5 for cases and controls respectively which had a test value of <0.05 which was significant. The time of onset of breastfeeding in the case and control group were 98.125 min and 113.625 min respectively which had a considerable value <0.05. Conclusion: Ketamine given to the mother as a prespinal anesthetic does not show a significant improvement in the 1st and 5th minute APGAR scoring and ease of induction of breastfeeding. Key Words: Ketamine, pre-spinal, neonatal outcome, cesarean section.

Background: Tuberculosis (TB) remains the world’s leading cause of death from an infectious agent with approximately 10 million cases and 1.25 million deaths in 2023. The COVID-19 pandemic caused disruption and hampered TB care. Objectives: This study aims to estimate the impact of the pandemic on TB enrolment, diagnosis, treatment adherence, and treatment outcomes in the Hapur district of India. Material & Methods: This research is a retrospective cohort study based on secondary data from the ‘Nikshay’ portal. Patients enrolled in the second and third quarters of 2020 (Q2 & Q3) were classified as the “exposed cohort,” while patients enrolled during the same quarters in 2018 were designated as the "non-exposed cohort." We compared the two groups in terms of enrolment, demographic variables, comorbidities, diagnostic methodologies, and treatment outcomes. Statistical significance was established at p < 0.05 for all analyses. Results: We observed a significant drop in TB case enrolment initially, followed by an increase during the intra-COVID period. There was a marked increase in the reliance on radiological methods for diagnosis, and we noted a 10.5% rise in the number of patients who completed their treatment compared to those in the pre-COVID period of 2018. Additionally, there was a decrease in the number of patients lost to follow-up (LTFU) and those classified as “unevaluated,” indicating better adherence to TB management strategies. We also found an increase in the percentage of the population opting for public healthcare facilities to access treatment. Conclusion: Our findings indicate that the anti-tuberculosis campaign in the Hapur district has continued to perform adequately, demonstrating that it is feasible to maintain TB care even amid significant disruptions.. Key Words: Tuberculosis, Pre-COVID-19, Intra-COVID-19, Nikshay, NTEP, Treatment Outcomes.

Background: ICU patients are at high risk for severe infections due to invasive procedures, immunocompromised conditions, and prolonged hospital stays. Identifying pathogens, tracing infection sources, and understanding antimicrobial resistance patterns are essential for effective infection control and treatment strategies. Materials and Methods: This cross-sectional study was conducted over one year at the Department of Microbiology, Mallareddy Medical College for women. Patients aged over 15 with confirmed or suspected sepsis were included, excluding those with prior antibiotic use or no clinical suspicion of sepsis. Blood samples were collected aseptically, cultured on diverse media, and pathogen identification employed morphological and biochemical assays. Results: A significant prevalence of antimicrobial resistance was noted among ICU pathogens, particularly in nosocomial bloodstream infections. Major pathogens identified included Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, with resistance trends highlighting the need for tailored treatment strategies. Additionally, fungal infections were isolated and analyzed. Conclusion: This study underscores the importance of stringent infection control, appropriate antimicrobial use, and regular resistance monitoring in ICUs. Findings provide insight into effective management strategies and reinforce the need for ongoing pathogen surveillance and targeted therapies to improve ICU patient outcomes. Keywords: ICU infections, sepsis, antimicrobial resistance, pathogen identification, nosocomial infections, blood culture, infection control.

Background: The foramen magnum is the largest foramen in the skull. It is a wide opening in the posterior cranial fossa connecting the cranial cavity with the vertebral canal. It allows the passage of vital structures of brain through it. It is oval in shape, wider behind and the largest diameter is antero-posterior. It contains lower end of medulla oblongata, meninges, cerebro-spinal fluid, vertebral arteries and veins, and spinal accessory nerve. The dimensions of the foramen magnum are clinically important because the vital structures passing through it may endure compression such as in cases of foramen magnum herniation, foramen magnum meningiomas and foramen magnum achondroplasia. The present study was conducted to evaluate morphological morphometric analysis of foramen magnum. Materials and Methods: We are conducted study with 67 adult dry skulls. We have measured anterior- posterior diameter and traverse diameter of foramen magnum. Antero-posterior diameter was measured from basion to opisthion in the sagittal plane. Transverse diameter was measured perpendicular to antero-posterior diameter at maximum point in coronal plane. We have observed shapes of foramen magnums and categorized as round, oval, tetragonal, pentagonal. Results: We found round shaped, oval shaped, tetragonal shaped and pentagonal were found. We found anteroposterior diameter of foramen magnum was 35.72+3.42mm with range of 28- 42mm, transverse diameter was 31.36+2.26mm with range of 23-34 and index of foramen magnum was 1.26+0.12mm with range of 1.16- 1.42mm. Conclusion: The present study findings may be helpful neurosurgeons, anaesthetists and radiologists. These variations have become significant because of newer imaging techniques such as computed tomography and magnetic resonance imaging in the field of diagnostic medicine. This study will also be a help to forensic medicine experts. Keywords: Foramen Magnum, Medulla, Vertebral artery, Basilar Artery.

Background: Polycystic Ovarian Syndrome, is a disorder that impacts various aspects of health. One such less-explored angle is the mental health issues faced by these individuals. This study explores the prevalence and severity of Anxiety and Depression among women with PCOS. Materials and Methods: This is a cross-sectional comparative study on women diagnosed with PCOS, to evaluate the depression and anxiety symptoms using PHQ 9 and HAM A. Results: 27% of the PCOS population fell in the category of mild depression, 20%, 22%, 21% had moderate, moderately severe and severe depression respectively. On the other hand, 50% belong to the mild severity (≤17) on the HAM-A scale. 23%,11%, and 16% suffered from mild to moderate, moderate to severe and severe anxiety respectively. Most (72%) of patients are 21-25 years old. The study's participants are mostly unmarried (83%) and residents of urban areas (89%). Among the population studied the undergraduates contributed the highest (75%) and maximum (76%) showed no link with family history. The body mass index of these patients varied from <17 to ≥30.0 in the following percentages- 3% (thin), 37% (normal weight), 22% (Overweight), and 33% (Obese). 47% of females reported the duration since diagnosis to be between 1-5 years. Conclusion: A significant number of patients with PCOS had co morbid anxiety and depression. Awareness about the prevalence of Anxiety and Depression in patients with PCOD would help in early detection and better management of psychiatric wellbeing. Keywords: Polycystic Ovarian Syndrome, Anxiety, Depression, Hamilton Anxiety Rating Scale.

Central venous catheterization (CVC) is crucial in paediatric care but presents unique challenges, including malpositioning. This series discusses four cases highlighting complications and management strategies. An infant with congenital cardiac anomalies required repositioning of a PICC line due to jugular malposition. A preterm neonate's CVC was found extravascular, necessitating removal under surgical supervision. Additional cases involved misplacement in the subclavian vein and overlying the right ventricle, both successfully corrected. These instances underscore the importance of proper technique, monitoring, and the use of diagnostic tools to enhance patient safety and minimize complications associated with CVC insertion in children.

Background: Chronic liver disease (CLD) is a complex and multifaceted condition characterized by persistent liver injury, inflammation, and fibrosis, often leading to cirrhosis and its associated complications, including liver failure and hepatocellular carcinoma (HCC). The liver is uniquely susceptible to various forms of injury due to its central role in metabolism and detoxification, and understanding the molecular mechanisms underlying CLD is critical for developing effective interventions. One important aspect of this pathology is the dysregulation of liver-enriched transcription factors (LETFs), including hepatocyte nuclear factor (HNF) 4α and HNF1α, which are integral to maintaining hepatocyte function and overall liver homeostasis. Objective: This review aims to elucidate the multifaceted role of LETFs in chronic liver disease, with a specific focus on their correlations with clinical, biochemical, and histopathological parameters. By examining the existing literature, we seek to provide a comprehensive overview of the current understanding of LETFs and their implications for the diagnosis and treatment of CLD. Material & Methods: A systematic literature review was conducted utilizing PubMed and other relevant biomedical databases, focusing on studies that examine LETF expression levels and their associations with CLD in human subjects. Key inclusion criteria included peer-reviewed articles published in English, studies involving adult populations, and research focusing on the roles of LETFs in various stages of liver disease. Results: The findings from this review indicate that downregulation of LETFs, particularly in advanced stages of liver disease, correlates significantly with increased fibrosis and impaired liver function. This underscores their potential utility as diagnostic and prognostic markers in clinical practice. Conclusions: Given their central role in liver function, LETFs may serve as valuable non-invasive biomarkers for assessing the progression of chronic liver disease and targets for therapeutic intervention. Further research is necessary to validate these findings and explore the clinical applicability of LETF modulation in the management of liver disease. Keywords: Liver-enriched transcription factors, Chronic liver disease, Biomarkers, Hepatocyte nuclear factor, Chronic hepatitis, Cirrhosis, Hepatocellular carcinoma

Background: There is an insufficient data on the relationship between Insulin Resistance with hematological parameters in pre-diabetic population. Objective: To establish or analyze relationship between IR and hematological parameters in Pre-diabetes who are at risk of developing type 2 DM. To find out whether the association between hematological parameters and pre-Diabetic states are stronger in women and men. Materials and Methods: A cross-sectional study on 200 patients was conducted in the medicine outpatient unit of HAHC Hospital, Jamia Hamdard Tertiary care centre. Pre-diabetic patients were selected as per the ADA criteria and sera from healthy individuals will serve as control. Results: There was insignificant correlation between HOMA-IR and WBC of the hematological parameters. Hematological changes in diabetes can be caused by several factors including increased production of reactive oxygen species (ROS) and the formation of advanced glycation end products (AGEs) as a result of long-term hyperglycaemia. Conclusion: The alterations in hematological parameters could be included as a new and indirect marker of the IR. This study focuses on hematological parameters as surrogate markers for identifying IR in Pre-diabetes stage in both males and females. Keywords: IR- Insulin resistance, DM- diabetes mellitus, HOMA - Homeostasis model of assessment, RBC- Red blood cell count, WBC – White Blood Cell, HB- Hemoglobin, MCH - Mean corpuscular Hb, MS- Metabolic syndrome, TNF-α-Tumor necrosis factor α, IL-6-interleukin-6, NF¬κB-nuclearfactor-kappaB.

Background: Varicose veins result from venous valve incompetence, causing blood pooling and increased pressure, with approximately 20-25% of women and 10-15% of men affected. This study compares the outcomes of managing varicose veins through radiofrequency ablation (RFA) and surgical vein stripping. Materials and Methods: This one-year prospective study at SVS Medical College and Hospital compared complications and recovery between high ligation and stripping versus radiofrequency ablation (RFA) for treating GSV varicosities in 100 patients. Results: The study included 100 patients with varicose veins, 60 of whom underwent high ligation and stripping (HL/S), while 40 received radiofrequency ablation (RFA). Complications were more frequent in the HL/S group, with a higher incidence of bruising, wound infections, and lymphocele, while RFA patients experienced more "pulling" sensations and skin burns but had significantly shorter hospital stays and lower pain scores. Both procedures had a 100% success rate in vein closure and symptom resolution, with ulcers healing in an average of 8.67 weeks. Conclusion: Radiofrequency ablation is the preferred option for varicose veins owing to its short duration of hospital stay, lower rate of complications and thereby having lower morbidity. Keywords: Varicose veins, radio-frequency ablation, High ligation surgery, complications.

Background: The thyroid gland plays a crucial role in metabolism regulation, and in India, with thyroid disorders being the second most common endocrine disorder early detection of malignancy potential is crucial. This study aims to categorize thyroid nodules using the Thyroid Imaging Reporting and Data System (TIRADS) and correlate ultrasound features with pathological findings to assess malignancy risk. Materials and Methods: This prospective study, conducted from April 2023 to March 2024, analyzed 100 thyroid nodules using ultrasonography and fine needle aspiration cytology (FNAC) to assess malignancy risk. Statistical analysis was performed to evaluate the sensitivity, specificity, and predictive value of ultrasound features, with nodules classified using the Thyroid Imaging Reporting and Data System (TIRADS). Results: Most of the patients being female and aged between 20-40 years. The majority of nodules were benign, with characteristics such as wider-than-taller shape, iso- or hyperechogenicity, mixed content, and smooth margins indicating a lower risk of malignancy, while taller-than-wider shape, marked hypoechogenicity, microcalcifications, and microlobulated margins were strongly associated with malignancy. Conclusion: Ultrasound examination is highly effective in assessing the malignant potential of thyroid nodules by identifying key features such as nodule shape, echogenicity, calcifications, and margins. It provides a non-invasive, real-time evaluation that significantly aids in distinguishing between benign and malignant nodules, often guiding the need for further diagnostic procedures. Keywords: Thyroid lesions; malignancy; ultrasound examination; TIRADS scoring system.

Background: The International system for reporting serous fluid cytopathology is a very effective weapon in the hands of pathologists and clinicians to become more comprehensive and approachable in cases of serous fluid related diseases. The International System classifies serous fluid cytopathology in five groups: 1. Non –Diagnostic, 2. Negative for malignancy, 3. Atypia of unknown significance, 4. Suspicious for malignancy, 5. Malignant. Materials and Methods: In Pathology department of Santosh medical college, Ghaziabad we took total 200 cases of pleural and ascitic fluid from 2022. Cell blocks were prepared wherever needed and immunohistochemistry was also applied as per need. Results: Out 200 cases, 77 were pleural fluids and 123 were ascitic fluids. Out of which 0.5% cases were in non-diagnostic, 85.5% cases were in Negative for malignancy, 6% cases were in Atypia of unknown significance, 5% cases were in Suspicious for malignancy, and 3% cases were in Malignant category. ROM was also calculated which turned out to be 0% in Non –Diagnostic, 0% in Negative for malignancy, 0% in Atypia of unknown significance, 20% in Suspicious for malignancy, and 100% in Malignant category. For calculation of risk of malignancy (ROM), histopathology and radiological tools clinical follow up were used. Our results justify the use of TIS classification for reporting serous fluid cytopathology as a connecting platform for clinicians and pathologists for benefit of patients. Conclusion: The TIS system proposed a tiered scheme which places the effusion cytology into well-defined categories, and therefore has lesser chances of false-positive and false-negative cases. Despite there being heterogenicity and morphological overlap between different categories, TIS caters to the need of cytopathologists because beside being a simple, easy, and user-friendly system, it has the benefit of risk stratification and ROM for each category and it provides a standardized terminology for better communication among pathologists and clinicians. Keywords: Serous fluid, pleural fluid, ascitic fluid, TIS, cancer, cytology, cancer.

Background: The humerus is the long bone of the upper arm. Given that the head of the humerus articulates with the glenoid cavity of the shoulder joint, the humerus is crucial for abduction of the arm and thus the basic motion of lifting the arm. Despite its crucial function, the humerus remains one of the most commonly fractured bones in the body. These fractures typically either occur due to blunt trauma or pathologic risk factors, such as metastatic bone diseases or osteoporosis. The morphometric study of humeral bone is of great importance, given its clinical significance and in forensic practice to estimate length of long bones. Materials and Methods: The present study was conducted with 74 dry adult human humeri. For measuring humerus, we have used anthropometric board and vernier clippers was used for measuring segments. Each humerus was studied for the humerus segmental morphometric analysis. In present study we have measured segments of humeri and length of humeri. Results: Out of 74 humeri 44 were right and 30 were left. We found, maximum length of humerus was 304.2±24.3mm on right and left was 302.84±22.6mm. there was no significant difference between measurements of segments of right and left humeri. All the measurements were analysed and expressed in Mean+SD. Conclusion: The present study findings may be helpful in practice of forensic medicine, anthropology and orthopaedic surgeons. Humeral bone knowledge may be helpful to understand fractures and surgeries in should regions for clinicians. Keywords: Humerus, Head of Humerus, Shoulder joint, Fracture of humerus.

Background: Intraoperative squash/crush cytology is an important tool for intraoperative diagnosis of CNS tumors. This is an easy, fast and cost‐effective method that offers important information for diagnosis, prognosis, and subsequent management. The most common form of intracranial neoplasms are primary central nervous system (CNS) tumors, most commonly Meningioma. Histopathological examination remains the gold standard for tumor typing followed by immunohistochemistry. Intraoperative consultation by squash cytology helps in improving the quality of surgical procedures. Aim and Objectives: 1. To study the Intraoperative squash cytology and immunohistopathological correlation. 2. To study the relevance of squash cytology in diagnosis of CNS tumors and its immediate surgical management. Material and Methods: The study was conducted in the Department of Pathology at Subharti Medical College, Chhatrapati Shivaji Subharti Hospital, Meerut, focusing on intraoperative squash cytology and immunohistopathological correlation of CNS tumors and tumor-like lesions. The study included 60 cases. Crush smears were prepared and stained using various staining methods. The study aimed to provide a diagnosis within half an hour, allowing the neurosurgeon to plan for immediate surgical intervention. Immunohistochemical markers like IDH 1 and p53 were used for further analysis. Results: The study reveals high diagnostic accuracy for gliomas, meningiomas, and epidermoid tumors, indicating the effectiveness of current diagnostic practices. Variable concordance for hemangiomas and other less common tumors marks the complexity of CNS tumor pathology and the need for meticulous histopathological evaluation. The majority of cases fell into WHO Grade 1 (57.14%), with no significant association between age group and sex. The analysis of cyto-histopathological and clinico-pathological correlations revealed a high diagnostic accuracy for common CNS tumors like gliomas and meningiomas. 95 % of cases showed a positive correlation between cyto and histopathogical findings. Conclusion: Intraoperative squash cytology is an effective tool in the diagnosis of CNS tumor & tumour like lesions. This diagnostic method can help neurosurgeons to optimize their surgical approach as it’s a quick diagnostic method when compared with histopathological & IHC analysis. When compared with frozen technique it is relatively cheap & easy to perform. It can be an asset in outskirts & developing hospital setup for operating on CNS tumours. Key Words: CNS tumours, Squash cytology, Meningioma, Glioma, IHC.

Background: HBV genotyping is essential for understanding disease progression and guiding antiviral treatment, yet molecular epidemiological data on HBV is limited in this region. This study aims to support diagnostic advancements and personalized treatments by evaluating various HBV genotypes and immune responses. Aim & Objectives: The study's findings will reveal genotype prevalence and associated clinical and demographic factors, aiding in targeted preventive measures Material & Methods: A prospective, cross-sectional study was conducted over 18 months (February 2021 to July 2022) at Narayana Medical College and Hospital, Jamuhar, Sasaram, Bihar, in collaboration with RMRIMS (ICMR), Patna, India. Results: During the research period, out of 926 patients, 50 patients screened positive by RDT out of which 31 were males & 19 females. Viral Load was > 20,000IU/ml in 26 patients with a positive viral load which is 52% of the total positive for the virus. Maximum samples were positive for genotype D. Conclusion: The current investigation identified the existence of two unique HBV genotypes, D and B, among the HBV seropositive individuals in Bihar. Notably, genotype D was shown to be the most frequent. Keywords: Hepatitis B Virus, Genotype, Viral Load, National Viral Hepatitis Control Program.

Background: This study aimed to assess the prevalence and public health impact of multidrug-resistant tuberculosis (MDR-TB) in low-income communities, with a focus on identifying key risk factors, symptom burden, and socioeconomic consequences. Materials and Methods: A cross-sectional study was conducted among 200 participants in community health centers and public hospitals located in underserved urban slums and rural areas. Participants were selected based on clinical suspicion of TB or a history of prior TB treatment. Data collection included clinical and laboratory assessments, drug susceptibility testing, and structured interviews. Primary outcomes were MDR-TB prevalence, symptom burden, and time to diagnosis and treatment initiation. Secondary outcomes examined socioeconomic impacts, treatment adherence, adverse events, and household transmission. Results: MDR-TB prevalence was found to be 30% among participants, with significant associations observed with prior TB treatment, contact with TB-infected individuals, and comorbid conditions (p<0.05). The average time to diagnosis and treatment initiation was 15.3 and 20.5 days, respectively. Socioeconomic impacts included a decrease in employment from 40% to 27.5% and a reduction in average household income by INR 2,250. Quality of life improved following treatment, but adverse events were reported by 33.3% of participants, and 7.5% experienced secondary household transmission. Conclusion: MDR-TB poses a significant public health and socioeconomic challenge in low-income communities. The findings highlight the urgent need for targeted interventions, improved diagnostic access, and comprehensive support systems to reduce MDR-TB transmission and support affected individuals. Keywords: Multidrug-resistant tuberculosis, public health impact, low-income communities, socioeconomic burden, drug resistance.

Background: The study aimed to compare the safety and efficacy of intrathecal fentanyl and butorphanol as adjuvants to 0.5% heavy bupivacaine in patients undergoing lower limb orthopedic surgeries. Material and Methods: A prospective, randomized, double-blind study was conducted with 140 patients aged 18-60 years scheduled for elective lower limb orthopedic surgeries under spinal anesthesia. Patients were randomly divided into two groups of 70 each. Group F received 15 mg of 0.5% heavy bupivacaine with 25 µg fentanyl intrathecally, while Group B received 15 mg of 0.5% heavy bupivacaine with 1 mg butorphanol. The total volume of intrathecal injection was standardized to 3.5 mL for both groups. Hemodynamic parameters and block characteristics were monitored at regular intervals, and adverse effects were recorded. Results: Group F demonstrated a faster onset of sensory (4.1 ± 1.2 minutes) and motor block (6.5 ± 1.3 minutes) compared to Group B (5.3 ± 1.4 minutes and 7.2 ± 1.5 minutes, respectively), with statistically significant differences (p < 0.001 for sensory and p = 0.03 for motor). The duration of sensory and motor blocks was also significantly longer in Group F (145.6 ± 20.5 minutes and 130.3 ± 18.6 minutes, respectively) compared to Group B (130.8 ± 22.7 minutes and 115.4 ± 19.8 minutes, p < 0.001 for both). Group F had a longer time to first analgesic request (220.4 ± 30.2 minutes) and lower VAS scores for pain (1.8 ± 0.5) than Group B (195.3 ± 28.7 minutes and 2.1 ± 0.6, p < 0.001 and p = 0.02, respectively). Hemodynamic stability was maintained in both groups, with no significant differences in heart rate or blood pressure at any time point. Pruritus was more frequent in Group F (14.29%) compared to Group B (2.86%, p = 0.02), while other adverse effects were comparable between groups. Conclusion: Intrathecal fentanyl as an adjuvant to 0.5% heavy bupivacaine provided faster onset, longer duration of blocks, and superior analgesia compared to butorphanol, though it was associated with a higher incidence of pruritus. Both drugs maintained stable hemodynamic profiles, demonstrating their safety and effectiveness for spinal anesthesia in lower limb orthopedic surgeries. Keywords: Intrathecal fentanyl, Butorphanol, Bupivacaine, Lower limb orthopedic surgery, Spinal anesthesia.

Background: The scrotum is a fibromuscular cutaneous bag that houses the testicles, epididymis, and the lowest half of the spermatic cord. Pathological conditions affecting these structures include congenital, simple inflammatory, and neoplastic diseases Scrotal swelling and pain are frequently encountered in clinical practice. Although to reach a diagnosis in some patients, history and physical examination are adequate, but some additional studies are essential for complete evaluation of their symptoms. The clinical examination is not so specific. The study shows the application of Gray-scale sonography, Color Doppler flow imaging (CDFI) and Power Doppler (PD) in the diagnosis of swelling, malposition, torsion, trauma, varicocele, hydrocele, cyst, mass, and atrophy. Materials and Methods: A total of 55 patients from all age groups with symptoms related to scrotal disease have been included in this study. Gray-scale sonography, CDFI and PD sonography of scrotal lesions were carried out. Results: A good correlation was seen in the comparison of scrotal lesions between sonography (Gray scale, CDFI, and PD) and histopathology/ treatment response. Conclusion: High-resolution sonography, along with color Doppler flow imaging and power Doppler should be used as the first-line investigation in the evaluation of scrotal pathologies. Color Doppler flow Imaging and power Doppler add useful information and complement gray-scale sonography in reaching a correct diagnosis. Keywords: CDFI, Gray-scale sonography, Power Doppler, Scrotum, Testis.

Background: Stroke, a condition characterized by the sudden disruption of blood flow to the brain, is commonly associated with aging populations. Objective: The main objective of the study is to find the juvenile stroke and its insights from radiological imaging. Materials and Methods: This study was conducted at Dept of Radiology, Saraswati Institute of Medical College Hapur UP, India during Nov 2023 to April 2024. A total of 55 patients were included in the study. Patients age <18 years of age, have a clinically confirmed stroke, and present radiological evidence of either ischemic or hemorrhagic stroke were included in the study. Patients with transient ischemic attacks (TIA) that lacked radiological confirmation or those with incomplete medical or imaging records were excluded. Results: The study included 55 patients, comprising 30 males (54.5%) and 25 females (45.5%). The average age of the patients was 12.4 years (range: 3–17 years). Ischemic stroke was the most common type, accounting for 70.9% (39/55) of cases, while hemorrhagic stroke constituted 29.1% (16/55). Among the clinical presentations, the most frequent symptoms were sudden weakness or hemiparesis (60%), followed by severe headache (25%), seizures (20%), and altered consciousness (15%). Conclusion: It is concluded that radiological imaging plays a pivotal role in the diagnosis, management, and follow-up of juvenile stroke, offering precise insights into stroke types and underlying etiologies. Advanced modalities like MRI, DWI, SWI, and MRA significantly enhance diagnostic accuracy and guide targeted interventions. Keywords: Juvenile Stroke, Radiological imaging.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition that can be prevented and treated, defined by ongoing respiratory symptoms and restricted airflow resulting from abnormalities in the alveoli or airways, typically due to significant exposure to harmful particles or gases.1,2 Aim and Objectives: This study aimed to compare the prognostic value of three different scoring methods of Acute exacerbation of COPD(AECOPD) : DECAF score , BAP65 score, CAUDA70 score in predicting outcome and mortality in the patient with AECOPD. Material and Methods: Study Design: Prospective hospital-based observational study. Study area: The study was conducted in the Department of Pulmonary Medicine in MVJ MC AND RH. Study Period: 1 year from June 2023- June 2024. Study population: The present study involved 100 cases of chronic obstructive pulmonary disease with acute exacerbation. Sample size: The study consisted of 100 subjects. Sampling method: Simple random Sampling Technique. All these patients with exacerbation of COPD underwent routine clinical, radiological and laboratory assessment and appropriate treatment was initiated as decided by the treating clinician. Investigations followed standard of care. All the data needed for the proposed scoring systems were collected from patients, hospital records. Results: 29.2% died with score >3, 33.3% died with score 0-1, 37.5% died with score>2, There is a significant association between mortality and BAP 65 score. Among the study subjects 14.3% had score>3, 57.1% had score >2, 28.6% had score0-1. 34.8% readmission with score 0-1, 65.2% readmission with score 2 There is a significant association between BAP 65, DECAF, CAUDA70 and 30 day readmissions. Conclusion: Our findings imply that a straightforward clinical prediction tool that incorporates indices that are frequently available at the time of hospital admission will help stratify patients with AECOPD into risk categories that are clinically relevant, which may help clinicians manage these patients. In conclusion, we propose that the DECAF, BAP 65, and CAUDA 70 scores all play a part in clinical practice. Keywords: BAP65 score, COPD mortality and mechanical ventilation, DECAF score.

Effective physician-patient communication is integral to patient satisfaction, adherence to treatment, and improved health outcomes. Recognizing its importance, the Kalamazoo Consensus Statement (KCS) identified seven essential elements of physician-patient communication. This review explores the role of these elements in medical education, their practical application in clinical settings, and the tools developed for communication skills assessment. It also discusses challenges in integrating communication training into curricula and highlights the critical need for consistent practice and reinforcement of these skills throughout medical training. Keywords: Physician-patient communication, Kalamazoo Consensus Statement, Medical education, Communication skills assessment.

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal, abdominal and laparoscopic route. Vaginal hysterectomy ranks as one of the least and minimally invasive types of hysterectomies, and it has better outcomes and fewer complications when compared to other types. This study assesses the intraoperative and postoperative complications of vaginal hysterectomy. Material & Methods: This hospital based retrospective observational study was carried out from March 2023 to March 2024. A total of 105 patients who underwent vaginal hysterectomy were included in this study. Age, parity, associated medical conditions like anaemia, diabetes, hypertension, thyroid disorders, indications for vaginal hysterectomy, intraoperative complications like excessive blood loss, bladder, bowel or ureteric injuries, conversion to TAH, postoperative complications like vault infection, subacute intestinal obstruction, VVF, RVF, stress urinary incontinence and vault prolapse were analysed. Results: Our study included 105 patients. Majority were in the age between 40 – 49 years (69%). AUB (L)was the commonest indication for vaginal hysterectomy (60%). There was no excessive blood loss for any patient and none needed blood transfusion. Bladder injury occurred in 1 case (0.9%), Subacute intestinal obstruction occurred in 1 case (0.9%), conversion to TAH in 2 cases (1.8%). 2 cases (1.8%) developed vault cellulitis, whereas 3 cases (2.7%) developed stress urinary incontinence. Conclusions: In majority of the cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 4 days in 85.7% of cases which indicates early discharge of the patient. Post-operative complications such as vault cellulitis(1.8%) and stress urinary incontinence(2.7%) were seen only in few cases. So, Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and postoperative morbidity. Therefore, vaginal hysterectomy should be considered as the primary route for all hysterectomies unless contraindicated. Keywords: Vaginal hysterectomy, intraoperative complications, postoperative complications.

Background: Post Partum Haemorrhage (PPH) is the most feared obstetric emergency . It can kill even a healthy woman if unattended1. 38% of maternal deaths are due to obstetric hemorrhage, of which PPH accounts for 25% cases.[2,3] Mismanagement of labor is the major risk factor for PPH.14 million women suffer PPH globally, out of which 25.7% occur in India. Aims and objectives: 1.To study the incidence of PPH and its predisposing factors. 2.To study the maternal morbidity and mortality associated with PPH. Material & Methods: This is a retrospective study conducted in the Department of Obstetrics and Gynaecology at Dr.PSIMS& RF for a period of 6months from November 2023 to April 2024 on 16 women who had PPH(out of 281 deliveries). Results: 56.25% had normal vaginal deliveries.43.75% underwent caesarean section. 81.25% were primiparae and 18.79% were multiparae. 37.5% had anaemia ,6.25% had preeclampsia,12.5% had twin gestation and prolonged labour was observed in 18.75%. Atonic PPH was managed medically in 44.4% women with vaginal delivery and 28.5% who underwent caesarean section. 56.25% had blood transfusion and hypovolemic shock was seen in 6.25% cases. Conclusions: Progression of postpartum haemorrhage from compensated to decompensated stage is very rapid and easily overlooked. It is a significant contributor for maternal mortality and morbidity. Hence prediction, early recognition and intervention are crucial for management of severe PPH and improving clinical outcome. Keywords: Postpartum haemorrhage, Atonic PPH, Traumatic PPH, Maternal morbidity and Maternal mortality.

Background: Accuracy in diagnosing ovarian lesions with an intraoperative frozen section is very important for the evaluation of ovarian tumors so that the appropriate surgical procedures can be selected. Aims and Objectives: The primary aim of our study was to accurately distinguish benign, borderline and malignant ovarian neoplasms using frozen section. Material and Methods: A total of fifty oophorectomy and cystectomy specimens received intraoperatively were studied using the frozen section. Thereafter the same specimens were fixed in 10% buffered formalin for conventional Histopathology. After comparing the results of both the sensitivity, specificity, positive predictive value and negative predictive values were calculated. Results: Out of a total number of 50 cases, 34 (68%) were benign, 5 (10%) were borderline and 11 (22%) were malignant. The maximum number of patients were in the age group of 55-65 years. The sensitivity and specificity of the Benign, Borderline and Malignant ovarian tumors were 97%, 60%, 100% and 93.3%, 97.7%, 100% respectively. Conclusion: The overall accuracy of the intraoperative frozen section for diagnosing ovarian tumors is 94%. Therefore, the frozen section serves as an important diagnostic tool and plays a very important role in deciding the course of surgery to be performed. Key Words: Frozen section, ovarian tumors, serous, borderline.

This study investigates the impact of the cadaveric oath and bioethics on medical students’ ethical development and professional identity. The cadaveric oath serves as a pivotal ritual in medical education, instilling respect for the human body and a commitment to ethical practice. Additionally, the integration of bioethics into the curriculum enhances students’ ability to navigate complex moral dilemmas encountered in clinical settings. A quantitative analysis involving 200 medical students revealed high levels of awareness and positive attitudes towards both the cadaveric oath and bioethics. The findings highlight the significance of these components in shaping empathetic, responsible healthcare professionals, emphasizing the need for continued focus on ethical education in medical training. Key Words: Cadaveric Oath, Bioethics, Medical Education, Ethical Development.

Background: ‘Dry eye’ - a common ailment, can be caused by conditions affecting the ocular surface, environmental factors such as low humidity, wind and underlying systemic conditions such as rheumatoid arthritis, Vitamin A deficiency, and postmenopausal women on estrogen therapy. Material & Methods: 70 patients aged between 18 – 60 years with dry eyes, attending the ophthalmology OPD were included in this study. The visual acuity of the study participants was assessed followed by examination of the anterior segment and posterior segment of the eye using 90D spherical lens. Schirmer’s test and Tear Film Breakup Time (TFBT) were done to assess the production of tears and tear film integrity. Results: The majority of participants were aged 51-60, with a male predominance (61.4%) and middle-class socioeconomic status (42.85%). Common complaints included eye irritation (31.4%) and foreign body sensation (25.7%). Significant ocular findings were arcus senilis (62.86%) and immature cataracts (77.14%). Comorbidities, particularly diabetes (58.57%) and hypertension (22.857%), showed a mild to moderate correlation with tear instability (mean TBUT: 8.8 and 8.6 seconds, respectively). Environmental factors like screen time and hot air exposure were associated with lower TBUT scores. However, p-values for correlations with TBUT and DED severity were non-significant (comorbidities p = 0.98, environmental factors p = 0.52). Conclusion: DED is a multifactorial condition with interplay of systemic disorders, aging and environmental factors. Identifying the causative factor and addressing it is the cornerstone of DED management. Key Words: Dry eye disease, tear break-up time, Schirmer’s test, comorbidities, environmental factors.

Background: Necrotizing Fasciitis (NF) is a rapidly progressive infection characterized by severe tissue necrosis and systemic toxicity. Identifying the causative pathogens through accurate microbiological diagnosis is critical for initiating appropriate antibiotic therapy. This study compares the bacterial profiles obtained from tissue biopsy culture and pus culture in NF to determine the superior diagnostic method. Material and Methods: A prospective study was conducted involving 80 patients diagnosed with NF. Simultaneous tissue biopsy and pus cultures were obtained from each patient for microbiological analysis. Pathogen identification and antibiotic sensitivity patterns were recorded and analyzed. The study employed a minimum sample size of 80, calculated based on previous studies. Statistical analysis was performed using SPSS version 26 to determine the agreement between the two methods. Results: Tissue biopsy culture showed higher microbial growth (95%) compared to pus culture (90%). The most commonly identified pathogens were Klebsiella species and Methicillin-Sensitive Staphylococcus Aureus (MSSA). A 93.75% agreement was observed between the two methods, but tissue biopsy detected more anaerobic organisms. Antibiotic sensitivity revealed high efficacy of Ciprofloxacin, Piperacillin-Tazobactam, and Meropenem against the isolated pathogens. Conclusion: Tissue biopsy culture is a more reliable diagnostic method for detecting the causative pathogens in NF, especially anaerobic organisms, and should be preferred over pus culture for guiding targeted antibiotic therapy. Key Words: Necrotizing Fasciitis, Tissue Biopsy Culture, Pus Culture, Klebsiella species, Methicillin-Sensitive Staphylococcus Aureus, Antibiotic Sensitivity, Pathogen Identification, Statistical Package for the Social Sciences (SPSS).

Background: Low back pain (LBP) is a prevalent musculoskeletal issue contributing significantly to disability and economic costs. The lumbar facet joints, which stabilize spinal segments during movement, can degenerate with age, causing lumbar osteoarthritis (OA). This degeneration, particularly at the L4-L5 and L5-S1 levels, often triggers pain. Facet joint injections (FJI) are a common intervention, yet their effects on spinopelvic alignment and functional outcomes in lumbar OA remain underexplored. Objective: To evaluate the effects of FJI at different lumbar levels on spinopelvic parameters and functional outcomes in patients with lumbar OA, and to analyze the relationship between changes in these parameters and functional outcomes. Materials and Methods: A prospective study was conducted at MKCG Medical College, Berhampur, including 144 patients with lumbar OA unresponsive to conservative treatment. Patients were divided into Group 1 (two-level FJI at L4-L5 and L5-S1) and Group 2 (five-level FJI from L1 to S1). Injections were administered with fluoroscopic guidance using a mixture of lidocaine and triamcinolone acetonide. Functional outcomes were assessed using the Oswestry Disability Index (ODI) before and three months post-injection, alongside radiographic measurements of spinopelvic parameters (pelvic incidence, sacral slope, and pelvic tilt). Statistical analyses included paired and independent t-tests, with correlations assessed via Pearson’s coefficient. Results: Of the 164 patients, 97 were female, with a mean age of 60.6 ± 6.4 years. Group 2 showed a significant reduction in ODI scores post-injection (p = 0.009) and in pelvic tilt (p = 0.021), while Group 1 demonstrated no significant changes. Correlation analysis revealed a moderate positive association between ODI changes and pelvic tilt (r = 0.576, p = 0.013), indicating that greater improvements in functional outcomes were associated with pelvic tilt adjustments. Discussion: The findings suggest that multilevel FJI offers enhanced functional outcomes and adjustments in spinopelvic alignment, particularly pelvic tilt, compared to two-level FJI. These results align with previous studies showing that FJI can impact lumbar alignment, with implications for functional improvement in lumbar OA. Limitations include a short follow-up duration and lack of direct pain intensity assessment beyond ODI. Conclusion: Multilevel FJI in lumbar OA patients significantly improves functional outcomes and reduces pelvic tilt, potentially influencing lumbar alignment and facet joint orientation. These insights suggest that broader lumbar levels should be targeted in FJI for meaningful clinical improvements, with future research needed to refine patient-specific FJI approaches. Keywords: Lumbar osteoarthritis, low back pain, facet joint injection, spinopelvic parameters, Oswestry Disability Index, lumbar alignment, pelvic tilt.

Background: Injuries among the children are an emerging public health problem. Accidental injuries are one of the leading causes of death, hospitalization, and disability across the World. Under-five children are more at risk for domestic accidents because of their normal curiosity, impulsiveness, and desire to master new skills and children imitate adult behavior from an early age, and boys are more likely to have accidents than girls. AIM: To estimate the prevalence of unintentional domestic injuries among under 5 children attending pediatric OPD at Urban Health training centre of SCB MCH, Jobra, Cuttack. Materials and Methods: This is a Facility based cross-sectional study was conducted in the Urban Health Training Centre (UHTC), SCB MCH Cuttack, Jobra from November 2021- January 2022. Under 5 children attending pediatric OPD with their parents/caregivers willing to give consent were included. Under 5 children with history of any psychiatric illness, Intentional/self-inflicted injuries, Assaults, outdoor accidents were excluded. Interview of the study participants were conducted using a pre-designed, pre-tested, semi-structured questionnaire, translated in local language (Odia). Results: The present study revealed a prevalence of 37 (36.63%) domestic unintentional injuries among under 5 children. Most common injuries reported were falls (62.16%)followed by sharp injuries (27.02%) among both males and females. Most common place of occurrence of injuries in the house reported were living room, followed by kitchen and bathroom. Most of the injuries were reported in afternoon followed by evening. Out of total 37(36.63%) injured under 5 children, 26(70.2%) received first aid at home within 1 hour of injury in the form of Band aid, anti-septic ointment, Dettol, cold compress etc, remaining 11 (29.72%) were rushed to UHTC, Jobra for first aid and treatment within 24 hours of injury. Conclusion: Falls were the most common mechanism of injury in both the areas and majority of the injuries took place at home and its premises. Factors like child’s gender and place of residence affected the occurrence of unintentional injuries in children. This shows that the understanding of such factors is crucial in developing and implementing childhood prevention strategies. Keywords: Children, Urban health training centre, Unintentional domestic injuries.

Background: Suicide is a leading cause of unnatural death worldwide, with gender-specific factors influencing its prevalence. Women are particularly vulnerable, with social and physiological factors, including hormonal changes during the menstrual cycle, potentially contributing to suicidal ideation and behavior. Previous studies have shown mixed results on the association between menstrual cycle phases and suicide attempts. Aim: This study aims to examine the relationship between menstrual cycle phases and suicide among women of reproductive age, specifically focusing on variations in age, marital status, time of attempt, and method used. Materials and Methods: This cross-sectional observational study was conducted at MKCG Medical College and Hospital, Berhampur, Odisha, India, involving 140 female suicide victims aged 15 to 45 years. Data were collected from police requisitions, inquest reports, and interviews with close associates, including demographic details, marital status, and menstrual history. Histological examination of endometrial tissue was used to determine menstrual phase at the time of death. Statistical analysis was performed using R software, with a Chi-square test applied for variable comparisons, considering p < 0.05 as significant. Results: Among the victims, the age group 18-30 years (51.4%) had the highest suicide rate. Married women constituted 60% of cases. The primary methods of suicide included burns (48.6%), poisoning (28.6%), and hanging (22.9%), with 60.7% occurring between 6 a.m. and 6 p.m. Histologically, 64.2% of women were in the secretory phase, especially the late secretory phase, at the time of suicide. Marital status showed a significant association with menstrual phase (p < 0.001), as did age (p = 0.012), though time of attempt was not statistically significant. Discussion: The findings suggest a significant association between the secretory phase of the menstrual cycle and suicide, particularly among married women. Hormonal fluctuations during this phase may exacerbate depressive symptoms, possibly leading to an increased risk of suicidal behavior. Although this study aligns with previous findings, it contrasts with research that links suicidal behavior with the proliferative phase. Conclusion: This study supports an association between suicide attempts and the late secretory phase of the menstrual cycle, with significant links to marital status and age. Further research is essential to explore hormonal and biological influences on suicide among young adult married women and the timing of attempts in relation to menstrual phases. Keywords: Suicide, menstrual cycle, reproductive age, secretory phase, marital status, hormonal influence, Odisha.

Background: Stroke, world’s second-most common cause of morbidity, is a devastating illness in itself. When complicated metabolic issues, the outcomes in stroke begin to significantly differ. One such important metabolic derangement is electrolyte imbalance, an important coexisting finding seen in stroke patients. Our study focusses on serum electrolyte levels in acute stroke, and their correlation with stroke severity as well as clinical outcomes in acute stroke patients. Materials and Methods: The present study was a hospital based prospective observational study and was carried out on 110 patients presenting with symptoms of Acute Stroke from March 2021- July 2022. The patients were followed up for a period of 3 months after getting discharged from the hospital; lost to follow up were contacted telephonically. Serum electrolyte levels were measured at the time of admission. Estimation of Severity of stroke was done using National Institute of Health Stroke Scale (NIHSS) and Clinical outcome of the study was analysed according to data collected. Results: Hemorrhagic stroke was seen 31.8% and ischemic stroke was seen in 68.2%. 15 subjects (13.6%) showed hyponatremia while 34 subjects (30.9%) had hypernatremia and the remaining 61 subjects (58.5%) had normal sodium levels. Hypernatremia was more common in hemorrhagic stroke (37%) than in ischemic stroke (28%). 29 subjects (26.4%) showed hypokalaemia while 7 subjects (6.4%) had hyperkalaemia and the remaining 74 subjects (67.2%) had normal potassium levels. Hypokalemia was more common in hemorrhagic stroke (42.9%) than ischemic stroke (18.7%). 4 subjects (3.6%) showed hypochloraemia while 38 subjects (34.6%) had hyperchloremia and the remaining 68 subjects (61.8%) had normal chloride levels. Hyperchloremia was seen in both ischemic (25 subjects out of 75, 33.3%) and hemorrhagic stroke (13 subjects out of 35, 37.1%). Electrolyte imbalances overall were found to be unrelated to stroke severity or outcomes at 3 months and the difference was not statistically significant. A higher number of patients with sodium imbalance expired (7 out of 15 i.e 46.6% in the hyponatremia group, 13 out of 34 ie 38.2 % in hypernatremia group; compared to 16 out of 61 i.e 26.2 % in the normal sodium group); this difference though did not show a statistical significance. Conclusion: Electrolyte disturbance is a frequently encountered problem in acute stroke patients, particularly those with a brain stem stroke. The incidence of electrolyte derangements in acute stroke patients appears to be high and, on the other hand, severe stroke cases are found to have the highest rates of dysnatremia, dyskalemia and dyschloremia. Presence of sodium imbalance was found to be related to a higher mortality in stroke patients, though this difference failed to achieve a statistical significance. Moreover, the overall outcomes in the surviving patients were unchanged at three months. Hypernatremia and hypokalemia were more common in hemorrhagic stroke (37%, 42.9%) as compared to ischemic stroke (28%,18.7). Keywords: Acute stroke, hypernatremia, hyponatremia, hyperkalemia, hypokalemia.

Diabetes Mellitus is a metabolic disorder affecting almost all the organs of the body. Study has been done to find out the association of diabetes with many disorders like as retinopathy, nephropathy, neuropathy, cardio vascular, and peripheral vascular diseases but very less number of studies are done on effect of diabetes on Lung Functions. The present study was done keeping that in view in a medical college and hospital located in Sourthern Odisha, a state in India. Material & Method- The study was done on 40 male tribal patients suffering from Type 2 Diabetes Mellitus(T2DM) whose Pulmonary Function Tests(PFT) were done and were compared with 40 normal male taken as control who were age, height and weight matched from the same tribal community. Result- It was seen that the PFT parameters of Case group with diabetes patients were significantly reduced in comparison to healthy control. Conclusion- Diabetes can lead to pulmonary complications, mainly restrictive type. Keywords: Diabetes Mellitus, Pulmonary Function Tests.

Background: To evaluate the analgesic effect of ropivacaine in comparison with bupivacaine in femoral nerve block (FNB) for positioning of patient for neuraxial block in patients with inter- trochanteric fractures of femur. Design: The study was a prospective single blind two arm randomized clinical trial. Setting: Materials and Methods: This study was conducted in Dr Balabhai Nanavati Hospital, (Mumbai) a 352 bedded multi-specialty hospital with 12 operation theatres that caters to a large number of patients from different parts of Mumbai as well as Maharashtra. Participants: All patients of ASA grade I, II & III for Routine and emergency surgeries who gave written informed consent in the age group 25 to 80 years with inter-trochanteric fractures of femur. The patients were randomly allocated into two groups of 30 each. Group A – receiving 0.5 % 20 ml bupivacaine, Group B – receiving 0.5% 20 ml ropivacaine. Interventions: Femoral nerve block to patients either with ropivacaine or bupivacaine. Primary outcome: measures the pain score during patient positioning and the time of onset and peak of sensory block. Results: The difference between the mean onset times of sensory block between the two groups was not statistically significant. (p value of 0.0896). Patients in group B (receiving ropivacaine) had a mean onset time of the sensory block of 3.57 mins and in group A (receiving bupivacaine) it was 3.93 mins. The difference in the mean time taken to achieve the peak of sensory block between the two groups was statistically significant. (P value was less than 0.0001) the mean time taken to achieve the peak of the sensory block in group B (receiving ropivacaine was 17.47 mins as compared to 22.53 mins. in group A (receiving bupivacaine). At the peak of the sensory block the difference of the mean pain scores between the two groups was not statistically significant. (p value of 0.8003) the mean of the pain scores (NRS) for group A (receiving bupivacaine) was 2.00 while the mean of the pain scores(NRS)for group B (receiving ropivacaine) was 2.03. During positioning for neuraxial block the difference of the mean pain scores between the two groups was not statistically significant. (p value of 0.8003) the mean of the pain scores for group A (receiving bupivacaine) was 2.00 while for group B(receiving ropivacaine) was 2.03. The hemodynamic parameters i.e pulse rate, systolic and diastolic blood pressures and oxygen saturation were stable throughout the study duration and were comparable to their baseline values. These parameters were also comparable between the two study groups i.e group A & B. Conclusions: 0.5% 20ml of ropivacaine in femoral nerve block is a safe dose allowing anesthetist to produce a fast onset of sensory block, providing quicker and favourable positioning to conduct neuraxial block. Both the drugs have stable hemodynamic profile without any adverse effects or complication so either of the two drugs could be used for peripheral Key Words: Inter-trochanteric fracture, femoral block, Ropivacaine, Bupivacaine.

Background: Chronic liver disease (CLD) patients with abrupt deterioration of hepatic function with associated extrahepatic organ failures is defined as acute on chronic liver failure (ACLF). The triggering incidents most common being alcohol followed by drug-induced injury, viral hepatitis, bacterial infections, hypoxia-related injury and major surgical procedures. An acute triggering event inflicts damage upon hepatocytes, leading to the accumulation of inflammatory cytokines leading to cascade of events resulting in further injury to the liver when hepatocyte regeneration fails (liver decompensation), compromised immune function and render them to infections, multi-organ failure, and eventual mortality. Studies regarding in hospital course and mortality for ACLF patients are very few in this region. Hence, this study was conducted to evaluate the clinical profile of ACLF patients, assessment of the in-hospital course, mortality and outcome and to determine the factors affecting the outcome. Materials and Methods: This study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal from May 2022 to July 2024. All patients with chronic liver disease fulfilling the Asian Pacific Association for the Study of Liver criteria for ACLF, admitted in the Department of Medicine, were enrolled. On the day of admission (within 24hours), severity of liver disease was assessed and routine blood investigations, ultrasound whole abdomen, ascitic fluid analysis, upper GI endoscopy were done. Child Pugh Score, Model for End Stage Liver Disease-Na, Sequential Organ Failure Assessment and EASL- CLIF (European Association for the study of Liver-Chronic liver failure) consortium criteria were used. Outcome or mortality were compared among survivors and non – survivors of ACLF.A p value <0.05 was considered significant. Results: A total of 70 ACLF patients were enrolled. The mean age of patients were 45.25±7.9 years with majority being males 63 (89.9%). Jaundice is detected in all patients (100%) and alcohol is the most common etiology of CLD found in 59 patients (84.1%).The most common acute insult precipitating ACLF was bacterial infection (34.3%){Spontaneous bacterial peritonitis followed by active alcoholism (32.9%)}. In our study, anemia and thrombocytopenia were present in 60(85.7%) and 52 (25.7%) patients respectively. Majority of patients belonged to Child Pugh class C (64%).There was significant association between a higher MELD score and mortality (p<0.05), 58 patient (82.6%) survived and 12 (17.4%) died with the mean duration of hospital stay of 11.7±4 days. The most common organ failure was cerebral failure (25.7%) (grade II hepatic encephalopathy). ACLF grade 0,1,2,3 were present in 15(21.7%), 29(42%), and 19 (27.5%) patients respectively. There was significant association between ACLF grade and outcome, 66.7% of the non-survivors were in ACLF grade 3 (p<0.05). Conclusions: Majority of the patients had multi-organ failure at the time of admission (42%) and was significantly associated with mortality (p<0.05). Key Words: chronic liver disease, MELD –Na score, ACLF, in hospital, outcome, mortality.

Background: Malnourishment is the scourge of the developing countries like India. Nutrition is important in many physiological processes like wound healing. In patients posted for surgery, their nutritional status plays an important part in the post-operative wound healing and prevention of complications like wound gaping and leakage from anastomosis. In this study we try to establish the relation between four nutritional indices and their effect on the postoperative wound healing and there by the duration of hospital stay. To study the nutritional factors affecting wound healing. Materials and Methods: This prospective study was conducted by selection of random 35 cases posted for major elective surgery during the period from March 2022 to March 2024 in Department of General Surgery, SRM. Results: The analysis subsequently concentrated on handgrip strength across each SGA category. The study revealed a significant correlation between handgrip strength and SGA classification. Notably, class A exhibited a higher median handgrip strength than classes B and C, both preoperatively and postoperatively. The preoperative handgrip strength for class A was 33 kg (27.26 – 42), while for class B it ranged from 23.56 to 36, and for class C from 17 to 23. The postoperative handgrip strength for class A was 17.44 – 41, for class B 19.58 – 29.58, and for class C 13 – 17. The disparities in handgrip strength among the classes were statistically significant (p<0.0001 preoperatively and p=0.0003 postoperatively). The hospital food provided significantly lower total energy (1268.8 kcal) and protein (32.6 g) than the predicted requirements (1560 kcal (1488 – 1809) and 72 g (61.67 – 80) respectively) (p<0.0001). Conclusion: Our study concludes that the preoperative nutritional state of the patient significantly influences postoperative wound healing. An inadequate preoperative condition predisposes individuals to several problems, including as wound dehiscence and leakage. Keywords: Hypoalbuminemia; Hemoglobin, Lymphocyte count, Body Mass Index.

Background: Lumbar disc prolapse and lumbar canal compromise or narrowing are common causes of low back pain and neurological deficits. Magnetic Resonance Imaging (MRI) is widely used for diagnosis, but overreliance on imaging can lead to overdiagnosis. Central and lateral recess compromise (LRS) have different clinical presentations, and failure to adequately address LRS can lead to poor outcomes. This study aimed to evaluate the correlation between clinical symptoms and MRI findings in patients with lumbar disc prolapse and compromise, with a focus on central and lateral compromise. Materials and Methods: This observational study included 30 patients diagnosed with lumbar canal compromise or narrowing at the Hassan Institute of Medical Sciences. Clinical symptoms, MRI findings, and functional outcomes were assessed. The Oswestry Disability Index (ODI) was used to evaluate functional status. MRI findings were classified using Bartynski’s classification for lateral recess compromise. Patients were followed up at 2, 4, 8, and 12 weeks. Results: The study included 18 males (60%) and 12 females (40%) with a mean age of 52.3 years. All patients presented with low back pain, while 70% had radiculopathy and 40% had motor weakness. MRI revealed that 60% had central canal compromise, 40% had lateral recess compromise, and 50% had neural foramen compromise. The mean ODI score for the cohort was 46.8, with central compromise patients showing higher disability (mean ODI 52.4) than those with lateral compromise (mean ODI 40.3). Significant improvement in ODI scores was observed over 12 weeks. Conclusion: This study demonstrated a significant correlation between clinical and radiological findings in lumbar canal compromise. Central compromise was more associated with motor weakness and greater functional impairment, while lateral recess compromise correlated with radiculopathy. Bartynski’s classification was effective in grading LRS severity and guiding treatment. MRI remains a critical diagnostic tool, but clinical evaluation and functional assessment are essential for comprehensive management The MRI correlation of central and lateral canal diameters of each patient proved to be highly effective method of determining the outcomes. Keywords: Lumbar disc prolapse, lumbar canal compromise, lateral recess compromise, MRI, Oswestry Disability Index.

Background: WHO has estimated that around 300 million individuals are subjected to pesticide poisoning annually, leading to roughly 200,000 deaths each year in developing nations. C reactive protein is well known as an inflammatory indicator that is elevated in injury, trauma, infection, cancer and autoimmune diseases. However very little is known about the role of CRP on acute poisoning. Objective of The Study: 1. To assess the severity and prognosis of acute organophosphorus poisoning by C-Reactive Protein. Materials and Methods: It is a prospective, observational study conducted from August 2022 to July 2024 at GIMS, Kalaburagi. Sample size included 100 individuals who were hospitalized due to organophosphorus poisoning to GIMS hospital during the study period. Patients were reviewed daily until discharge or death. C-Reactive Protein (CRP) levels were measured at admission, 72 hours post-admission and on day 7 or day of discharge /death. Results: The mean CRP levels of the expired patients were significantly higher than those of the live patients at admission, at 72 hours and at discharge (p<0.001). Conclusion: In conclusion, the present study revealed that changes in CRP was associated with the prediction of AOPP prognosis. Patients with severe acute organophosphorus pesticide poisoning show elevated levels of C-reactive protein, which play a significant role in predicting the severity and prognosis of the condition. Keywords: Organophosphorus poisoning, C reactive protein.

Background: Humeral shaft fractures, constituting 1-3% of all fractures, often pose significant challenges in management due to anatomical and functional considerations. Failed osteosynthesis remains a critical issue, demanding effective revision strategies for achieving union and restoring function. Material and Methods: A retrospective review was conducted on 12 patients with failed osteosynthesis of humeral shaft fractures treated at a tertiary care center over two years. Causes of failure were categorized into re-trauma and mechanical failure. Revision surgery involved plating with iliac crest bone grafting in 11 cases, and an additional fibular strut graft in one complex case. Surgical approaches included posterior and anterolateral methods, with radial nerve exploration performed as necessary. Outcomes were assessed based on union time, complications, and follow-up results. Results: Bone union was achieved in all cases within an average of 6.5 months. One patient experienced postoperative radial nerve palsy, which fully resolved within three months. No infections were reported. Revision surgery proved effective in addressing mechanical failures and enhancing structural stability. Conclusion: Revision osteosynthesis, utilizing meticulous surgical techniques and bone grafting, demonstrates favorable outcomes in managing failed humeral shaft fractures. The study highlights the importance of approach selection, radial nerve preservation, and patient-specific planning in achieving optimal results. Further research with larger sample sizes is needed to refine revision protocols. Key Words: Humeral shaft fracture, Osteosynthesis, Bone grafting, Revision surgery, radial nerve.

Background: Osteoarthritis (OA) is a major cause of global disability, especially in India, with symptomatic knee OA projected to rise due to aging and obesity. In areas lacking health facilities, there's a need for community-based diagnostic approach to enable early treatment. This study estimated the prevalence of knee OA among adults aged 50 years and above in villages of Tamil Nadu, India and also assessed quality of life and prevalence of depression among the affected. Material and Methods: This community-based cross-sectional study was done among 300 adults aged 50 years and above. Ten villages with thirty subjects being selected from each village by simple random sampling. The American College of Rheumatology (ACR) clinical criteria questionnaire was used to diagnose knee OA. Among the participants with knee OA, severity, side of involvement, duration of knee pain, use of aids and history of treatment were assessed. Other tools included Likert pain scales, Patient Health Questionnaire (PHQ)-9 for depressive symptoms and Quality of life Questionnaire-Arthritis Impact Measurement Scale-2- (AIMS 2 SF). Results: The prevalence of knee OA was 27% (95% CI 21.9% - 32.0%). knee OA was found to be more common in females (adjusted OR 2.21; 95% CI 1.21 to 4.03). Quality of life was worse among those above 60years with OA (adjusted OR 4.21, 95% CI 1.4 – 12.0) compared to younger ages. After adjusting for confounders, BMI ≥25 kg/m2 (adjusted OR 6.67, 95% CI 3.6-12.3) and depression (adjusted OR 3.26, 95% CI 1.4–7.2) were significantly associated with knee OA. Conclusion: Knee OA is a common problem among older adults and is associated with poor mental health and obesity. Early diagnosis in the community is needed to provide treatment measures at the earliest to improve quality of life, especially among the ageing population. Key Words: Knee osteoarthritis, quality of life, depression, obesity.

Background: Adiponectin, a protein from adipose tissue, regulates glucose levels and metabolic processes. It's higher in lean individuals and lower in obesity-prone ones. Understanding adiponectin levels and their correlations with anthropometric parameters could predict obesity-related metabolic dysfunction and disease risk. Aim and Objectives: The aim of this study was to evaluate the association between serum adiponectin concentrations and anthropometric indices and lipid profiles among normal and obese male. Material and Methods: In this cross sectional observational study of 60 male patients (30 normal weight, BMI 18.5- 22.9 kg/m² and 30 obese, BMI≥ 25kg/m²), participants were included which presented in medicine department. Anthropometric measurements like age, height, weight, BMI, Waist circumference, hip circumference, waist to hip ratio, were taken from each participant and serum adiponectin were measured using an enzyme-linked immunoassay. Fasting glucose and lipid profile levels determined by the glucose oxidize and enzymatic methods, were measured from overnight fasting samples respectively. Results: Mean serum adiponectin concentration significantly decreased with obesity (p<0.05). Although adiponectin showed a significant negative correlation with BMI (r=-0.622), WC (r=-0.486), WHR (r=-0.420), SBP (r=-0.314), DBP (r=-0.266), VLDL (r=-0.328) levels, LDL (r=-0.264), and positively correlation with serum HDL, FBS, HC in all subjects and has no statistical significance. Conclusion: Our results suggested that adiponectin had an inverse correlation with adiposity indices and unfavourable lipid profiles. Key Words: Adiponectin, BMI, Obese, Lipid profile, Anthropometric indices

Background: The humerus is the long bone of the upper arm. Given that the head of the humerus articulates with the glenoid cavity of the shoulder joint, the humerus is crucial for abduction of the arm and thus the basic motion of lifting the arm. Despite its crucial function, the humerus remains one of the most commonly fractured bones in the body. These fractures typically either occur due to blunt trauma or pathologic risk factors, such as metastatic bone diseases or osteoporosis. The morphometric study of humeral bone is of great importance, given its clinical significance and in forensic practice to estimate length of long bones. Materials and Methods: The present study was conducted with 74 dry adult human humeri. For measuring humerus, we have used anthropometric board and vernier clippers was used for measuring segments. Each humerus was studied for the humerus segmental morphometric analysis. In present study we have measured segments of humeri and length of humeri. Results: Out of 74 humeri 44 were right and 30 were left. We found, maximum length of humerus was 304.2±24.3mm on right and left was 302.84±22.6mm. there was no significant difference between measurements of segments of right and left humeri. All the measurements were analysed and expressed in Mean+SD. Conclusion: The present study findings may be helpful in practice of forensic medicine, anthropology and orthopaedic surgeons. Humeral bone knowledge may be helpful to understand fractures and surgeries in should regions for clinicians. Keywords: Humerus, Head of Humerus, Shoulder joint, Fracture of humerus.

Background: Postpartum hemorrhage (PPH) is a significant cause of maternal morbidity and mortality, especially in resource-constrained settings. The study compares the effectiveness of two doses of oral misoprostol (400µg and 600µg) with intramuscular oxytocin (10 IU) in managing the third stage of labor. The objective is to determine the efficacy, safety, and side effects of each intervention, aiming to identify a suitable alternative in environments where oxytocin’s storage requirements pose challenges. Material and Methods: A prospective, randomized case-control study was conducted on 300 pregnant women in labor, divided into three groups. Group A1 received 400µg of misoprostol, Group A2 received 600µg, and Group B received 10 IU of intramuscular oxytocin. Blood loss was measured using a calibrated drape, and maternal and fetal parameters were closely monitored. Primary outcomes included PPH incidence and drug side effects, while secondary outcomes covered total blood loss, hemoglobin drop, and third-stage labor duration. Results: The average blood loss was lowest in the oxytocin group (208.25 ml), with slightly higher values in the misoprostol groups (218.25 ml for 600µg and 235.75 ml for 400µg). PPH incidence did not significantly differ among groups. Notably, adverse effects, particularly pyrexia and shivering, were more common in the misoprostol groups, with higher frequencies observed in the 600µg group. Conclusion: Oral misoprostol presents a viable option for managing the third stage of labor, particularly where oxytocin storage is problematic. However, its increased side effects, especially at higher doses, suggest a careful balance in dose selection. Oxytocin remains preferable where available and feasible for storage. Keywords: Postpartum hemorrhage, misoprostol, oxytocin, third stage of labor, maternal mortality.

Background: Platelets play a major role in inflammation, thrombosis and atherogenesis. Platelet size and function is measured by Mean platelet volume (MPV). Platelet activity is accentuated in acute ischemic stroke due to blood vessel occlusion that leads to ischemia, endothelial damage. MPV has been identified as independent predictor of stroke in high-risk individuals and in carotid atherosclerosis. Platelet indices panel is readily available in hemogram and can be used with cost effectiveness. In South Asian population very few studies are available on this association. Present study conducted to study association between MPV and acute ischemic stroke and its correlation with clinical severity and carotid artery disease. Materials and Methods: This case control study was done in department of neurology of NRI Medical college. 150 cases of acute ischemic stroke patients and age and sex matched controls were considered. Patients on antiplatelet drugs were excluded from study. CT/MRI brain imaging done. Modified Rankin score(MRS) and NIHSS score were noted during admission. Carotid artery Doppler study was used to measure the carotid intima media thickness(IMT) and percentage of stenosis. Results: MPV was significantly higher in acute ischemic stroke patients (12.8 +/- 1.2) compared to controls (9.29+/-0.7). Platelet count was 1.93 in cases and 1.84 in controls. MPV was significantly higher in patients with high MRS scores. MPV in small infarct group is 10.47+/-0.9 and in large infarct group is 12.79+/-1.47. MPV in normal IMT(<1mm) group is 10.31+/-1.06 and in IMT >1mm with mild stenosis group is 11.32+/-1.36 and in moderate to severe stenosis group is 12.8+/-1.2. Conclusion: MPV and platelet count was higher in patients with acute ischemic stroke and it correlates with clinical severity. In this study there is significant association between mean platelet volume and carotid intima media thickness. Keywords: Platelets, MPV, MRS score, NIHSS score.

Background: Chronic Kidney Disease (CKD) entails a gradual decline in kidney function over time. Pruritus, or uremic pruritus, is common in advanced CKD patients on dialysis, severely affecting their quality of life. It impacts around 20% of CKD patients and 40% of those with end-stage renal disease, varying in distribution and severity. Uremic pruritus is linked to depressive symptoms and reduced quality of life (QoL). Despite its high prevalence and significant impact, pruritus effects are not well understood, particularly in our local context. This study estimated the prevalence of uremic pruritus in CKD patients undergoing hemodialysis and evaluated its impact on their quality of life. Materials and Methods: Conducted at two nephrology units in Amritsar, India, this multicenter cross-sectional study included 200 CKD patients on hemodialysis. The 5-D itch scale, Patient Health Questionnaire-9 (PHQ-9), and Dermatology Life Quality Index (DLQI) were used to assess pruritus, depressive symptoms, and quality of life, respectively. Data analysis involved independent samples t-test, ANOVA, and Spearman's rank-order correlation. Results & Conclusion: The prevalence of uremic pruritus was 63%. CKD duration exceeded 2 years in 51% of cases, significantly correlating with itch scores. According to the DLQI, itching affected 60% of patients' lives, and the PHQ-9 indicated that about 90% of patients experienced depression. The study found a significant association between CKD duration, impaired QoL, depression, and pruritus intensity and severity. Therefore, to enhance quality of life and reduce depressive symptoms, physicians must properly manage uremic pruritus. Keywords: Chronic Kidney Disease, uremic pruritus, hemodialysis, depression, quality of life.

Background: Post-partum haemorrhage is defined as blood loss from the genital tract, exceeding 500ml within 24hours of vaginal delivery and 1000ml during caesarean section. It is also now a day defined as any blood loss that has a potential to produce or produces hemodynamic instability. Massive obstetric haemorrhage is a major cause of maternal mortality and morbidity worldwide. Aims: Aim of study is to know its risk factors, associated morbidity and mortality and its burden on maternal health and health care system. Materials and Methods: This was observational study conducted in department of Obstetrics & Gynaecology. in total 460 patients 143 included in our study were admitted in department and those referred from primary and community health centre admitted in tertiary care center with primary diagnosis of postpartum hemorrhage. Pregnant lady delivered at patient had major primary post-partum haemorrhage (more than 1000ml blood loss). Results: In our study total 460 patients 143 had PPH all including booked and referred cases, so incidence was 31%. Highest number of cases i.e. 65 (45.45%)out of 143 were in 21-25 years age group. Incidence of PPH in relation to parity was primipara 56.64%. PPH was noted in 54 vaginal deliveries and 89 caesarean sections. The most common risk factor for PPH is anemia, followed by multiparity and preeclampsia. Main cause of PPH in this study was uterine atony i.e. 70.6% and 2 nd common cause was traumatic 22% cases. Among the cases studied, 80 cases responded to uterotonics and uterine massage only, in 34 cases balloon tamponade was effective in controlling PPH, 17 cases needed compression sutures, in 8 cases uterine artery ligation was done and hysterectomy was done in 1 case. Development of acute severe anemia due to PPH in our study was found to be 51.7%. Hypovolumic shock and DIC was found in 21.6% and 3.5% of cases with PPH. 92.3 % cases blood and blood products transfusion given. 3.5v % cases had maternal death due to haemorrhage. Conclusion: The present study concluded that anaemia is the major risk factor contributing to PPH, followed by multiparty and preeclampsia. Early identification of risk factors and treatment of preventable ones like anaemia, implementation of prevention strategies should be mainstay of management. Avoidance of delay in identification and transfer, identification of high-risk cases and timely transfer and referral to higher centres. Keywords: Postpartum haemorrhage, Maternal morbidity and mortality, Peripartum hysterectomy, Disseminated intravascular coagulation.

Background: Knee osteoarthritis (OA) affects approximately 260 million people worldwide and is a common cause of disability. Effective and safe medical treatments are needed. Currently, no approved disease-modifying drugs exist, and non-operative therapies are associated with only small to moderate benefits and may have serious adverse effects. Platelet-rich plasma (PRP) is a safe autologous blood product containing high levels of growth factors and cytokines with potential to alter biological processes implicated in OA pathogenesis and symptoms. Objective: The aim of this study is to determine the clinical efficacy of Intraarticular PRP injection in early osteoarthritis of knee joint. Materials and Methods: A prospective, single blinded, randomized control trial in 100 Patients of Karnataka Medical College & Research Institute, Hubballi with early (Grade 1 and 2 Kellgren-Lawrence classification) osteoarthritis of knee joint in patients between 40 – 65 years of age treated with platelet rich plasma injection. Demographic data, history, Clinical examination and details of investigations will be recorded in the study proforma. Results: Intraarticular PRP was injected into 100 patients. The most common age group involved in study is 56-60 years (28%) with 54 (54%) patients were male and M:F ratio of 1.17. There is a statistically significant difference between the mean values of VAS, KOOS, WOMAC and OK Scores at 6 months compared to baseline scores without any serious adverse effect. Conclusion: The outcomes of this study showed that the use of PRP injections for treating OA (Grade 1 and 2 Kellgren-Lawrence classification) were shown to be successful in terms of improving functional results and diminishing pain intensity. PRP holds a promising, effective, better solution in the management in OA knee. Keywords: Osteoarthritis, VAS, WOMAC, KOOS, OKS, Kellgren Lawrence Classification, Platelet rich plasma.

Background: India is committed to achieve United Nations Decade of Healthy Ageing (2021-2030) and life expectancy is also increasing due to rapid demographic change. Hence it is pertinent to have a view of the burden of illnesses in the rural geriatric population where health infrastructure is insufficient. Objective: To assess the period prevalence of the various morbidities and associated risk factors in older adults in the rural field practice area of badagaon block of Jhansi district, Uttar Pradesh. Materials and Methods: A cross-sectional analytical study was conducted among 400 rural geriatric population from June 2023 to May 2024 in rural field practice area of badagaon-block using systematic random sampling. Data was collected through house-to-house survey by pretested predesigned structured schedule along with MNA (mini nutritional status) for nutritional status of these geriatrics. Results: Among the 400 study population, 247 (61.8%) were female and 262 (65.6%) were in the age group of 60-69 years. Morbidity was present in 305(76.2%). Out of n=305, locomotive arthritis disorders was highest (27.5%) followed by ophthalmic illness (cataract) in 24.5%, endocrine noncommunicable disorder (diabetes) in 13.5%, hypertension in 17%, hearing loss in 5%, respiratory ailments (COPD and asthma) in 16% and less than 1% were neoplasm, chronic kidney and chronic liver disease. The relation of literacy level, occupation and social classification with chronic illness was found to be statistically significant. Conclusion: Geriatric population suffered from multiple co-morbidities, predominantly musculoskeletal disorders, ophthalmic disorders, hypertension and diabetes The significant predictors or risk factors for the occurrence of chronic illness in these elderly are education, social class, occupation and age. Keywords: Geriatric/ Rural/ Morbidity/ Nutritional Assessment.

Background: Stress is an inevitable part of college student’s life. Previous studies have estimated prevalence of stress among professional course and medical students, but few have explored nonprofessional students in north Gujarat region. Aims: To estimate prevalence of stress among college students, correlate stress level with their coping measures and to compare stress level between professional and non-professional course students. Settings and Design: Cross sectional descriptive study was done among 232 including 117 professional and 115 nonprofessional course undergraduate students from randomly selected six colleges of a non-metro city of north Gujarat from April to September 2019. Material and Methods: Students were assessed using self-report student stress inventory (SSI), general health questionnaire-28 (GHQ-28) and Burnout prevention assessment (BPA).Statistical analysis used:Data was subjected to descriptive and inferential statistical analysis. Results: The prevalence of mild and moderate stress was 68.9% and 31% respectively. Stress did not significantly differ among professional and nonprofessional students. Stress had negative correlation with adaptive coping measures. (P < 0.0001, correlation coefficient r = -0.2375 for SSI; P < 0.0001, correlation coefficient r = -0.2936 for GHQ-28) Conclusion: The prevalence of moderate to severe stress is 31% among all college students. Stress is equally experienced by professional and nonprofessional course students. Adaptive coping is associated with stress reduction for optimal functioning in important areas of college student’s life. Keywords: Stress, college student.

Background: Prostate cancer is now a leading cause of cancer death among adult males, but it can be completely cured if detected in early stage. Prostate Specific Antigen (PSA) level estimation has become a popular method for screening prostatic carcinoma as it is easy to perform and is cost effective. Aim: To evaluate various histopathological types of Prostatic lesions and to correlate these with serum prostate specific antigen levels. Material & Methods: The present study is a prospective study of 1.5 year period done from 1st July 2022 to Dec 2023 in the Department of Urology, National institute of medical science and research (NIMS Hospital), Jaipur. Prostatic tissues of 120 patients were collected through transurethral resection (TURP), trans rectal biopsy and open prostatectomy for histopathological examination. Serum samples for biochemical analysis (S.PSA) were collected and estimated in biochemistry department. Then values of serum PSA were correlated with histopathological diagnosis. The cut off value of serum PSA was set at 4ng/ml. Results: Out of total 120 patients 89 (74.1%) have benign disease, 25(20.8%) had malignant disease and 6(5%) had Prostatic intraepithelial neoplasia. 60.8% of patients had raised PSA above 4ng/ml. 96% of malignant cases had serum PSA >4ng/ml and only 4% of malignancy had PSA within 4ng/ml. Out of total malignancy 96% were adenocarcinoma. The sensitivity and specificity of serum PSA in detecting malignancy were 93.5% and 50.5% respectively. Conclusions: Serum prostate specific antigen is highly sensitive but less specific in diagnosing prostate cancer. Due to its high sensitivity and low cost it can be reliably used as a screening test for early detection of prostate cancer. Keywords: Adenocarcinoma prostate, Benign prostatic hyperplasia, Prostatitis, Serum prostate specific antigens.

Background: The combined spinal-epidural (CSE) technique involves the injection of medication into the subarachnoid space while simultaneously placing a catheter into the epidural space during the same procedure. This study aims to compare the effectiveness of combined spinal epidural anaesthesia with spinal anaesthesia in patients undergoing lower abdominal surgery. Material and Methods: In this prospective, randomised, comparative, case control study Total 60 patients of either gender between age groups of 20 to 60 years, having ASA -I and ASA II physical status undergoing lower abdominal surgery were randomly divided into two groups of 30 patients each. Group C-Patients received sequential combined spinal epidural anaesthesia. The patients in group S, Spinal needle 23 G is introduced into the subarachnoid space at L3-L4 interspace and 3cc of Bupivacaine heavy 0.5% injected after aspiration of free flow of cerebrospinal fluid. The onset of sensory analgesia at T10 level, Maximum sensory level achieved, time required to achieve maximum sensory level, Time of onset of motor block, Duration of motor block, duration of analgesia, Inadequate spinal effect/prolonged surgery supplement by top up dose, no of patients requiring rescue analgesia in 1st 24 hour and side effects were observed. Results: The average duration of surgery showed no significant difference. The duration of surgery was similar for both groups. In Group C, the highest sensory level reached was T4 in one patient, accounting for 3.33%, while 21 patients achieved a sensory level of T6. In Group S, the highest sensory level recorded was T4 in one patient. In group S, 43.33% of participants required rescue analgesic three times, while in group C (combined spinal epidural), this was the case for 10 patients, accounting for 33.33%. The requirement for postoperative analgesic doses is lower in Group C compared to Group S. There was a significant difference between the two groups regarding the need for rescue analgesics in the first 24 hours. Conclusion: Combined spinal epidural anaesthesia using the single shot spinal epidural technique in patients who are undergoing lower abdominal surgeries provides effective prolong postoperative analgesia, prolong duration of analgesia, and achieved the required level of anaesthesia by using local anaesthetic in conjunction with an epidural catheter without causing any adverse effects. Key Words: Epidural Anaesthesia, Lower Abdominal Surgery, Spinal Anaesthesia, Spinal-Epidural (CSE) Technique.

Background: Depression and anxiety are the two most common mental health problems during childhood and adolescence. The present study was carried out to study the physical and psychosocial problems of school going adolescents along with predisposing factors for the same. Material and Methods: The study was conducted amongst 569 students (278 boys and 291 girls) of the adolescent age group (10-19 years) attending 3 schools in urban and rural Ahmedabad during the time period of January- February 2024. Using pre-tested, pre-designed questionnaire, students were personally interviewed regarding the mental and psychosocial health problems faced by them. General information like weight and height was taken and blood pressure was measured. Results: Out of 569 study subjects, 48.86% were males and 51.14% were female. Out of the total study subjects, 12.31% were falling in the category of overweight/obesity and 15.49% children were underweight. 77.69% of subjects were physically active for at least 1 or more than 1 hour per day. Majority of the normal weight children (68%) had better physical activity as compared of obese and overweight children. Pain in abdomen was found in 30% of children and constipation was seen in 33% children with junk food intake of more than 4 days. Conclusion: The physical and psychosocial health of the school going adolescents depend on the multitude of factors including the socio-cultural mileu. The importance of healthy diet, physical exercise, limitation of screen time and building emotional resilience should be incorporated during adolescents age group by parents and teachers. Key Words: Adolescents, BMI, Height, Psychosocial Health.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by persistent airflow limitation, which has a significant impact on patients' physical and mental health. Anxiety and depression are prevalent comorbidities in COPD patients, contributing to poor quality of life and worsening clinical outcomes. This study aimed to evaluate the prevalence of anxiety and depression in COPD patients, explore their associations with spirometric patterns, exercise capacity, and dyspnea severity, and examine their impact on disease management and quality of life. Material and Methods: A cross-sectional study was conducted with 200 COPD patients aged 40–80 years, diagnosed based on clinical and spirometric criteria. Participants underwent spirometry, 6-minute walk distance (6MWD) testing, and assessment of anxiety and depression using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Clinical data, including oxygen saturation, mMRC dyspnea scale, and disease history, were also collected. Statistical analyses were performed to determine associations between anxiety, depression, and clinical variables such as spirometry patterns, exercise capacity, and dyspnea grades. Results: The study found that 28.5% of participants had mild anxiety, 15.5% had moderate anxiety, and 11.0% had severe anxiety. Similarly, 20.5% had mild depression, 12.0% had moderate depression, and 5.5% had severe depression. Anxiety was more common in patients with obstructive spirometry patterns (53.5%, p=0.023) and lower 6MWD (<149 meters, 83.3%, p=0.008). Severe dyspnea (mMRC grade 4) was associated with higher anxiety (87.5%, p=0.000) and depression (50.0%, p=0.054). Significant correlations were observed between reduced exercise capacity and higher anxiety and depression levels, highlighting the role of physical limitations in exacerbating psychological symptoms. Conclusion: Anxiety and depression are prevalent in COPD patients and are strongly associated with disease severity, including spirometric patterns, exercise capacity, and dyspnea. The findings suggest that psychological distress in COPD patients is closely linked to physical impairments and should be considered in the management of the disease. Routine screening for anxiety and depression, along with integrated care that addresses both respiratory and mental health, is recommended to improve overall patient outcomes and quality of life. Key Words: Chronic Obstructive Pulmonary Disease (COPD), Anxiety, Depression, Spirometry, 6-Minute Walk Distance.

Background: To study the histopathological spectrum of endometrial biopsy in cases of Abnormal uterine bleeding (AUB) and its association with thyroid status. Material and Methods: It was a hospital based prospective observational study conducted in the Department of Pathology, Northern Railway Central Hospital, New Delhi. A total of 250 patients who presented with abnormal uterine bleeding were included in the study and their histopathological examination was conducted on the endometrial samples obtained. The data pertaining to all the clinical details, physical examination and investigations including thyroid function tests were collected. The patients were classified based on their thyroid function into euthyroid, subclinical hypothyroidism, hypothyroidism, and hyperthyroidism. The clinical data including the age, thyroid status, and histopathological findings, were analyzed using statistical methods to identify any significant association. Results: A total of 250 patients in different age groups with a mean age of 44.41 years were included in the study. The findings indicated that the majority of the patients were euthyroid, thyroid dysfunction was identified in only 20% of the patients, with hypothyroidism being the most common thyroid dysfunction seen in 10% of the patients. In the present study 30.8% had proliferative endometrium, followed by secretory endometrium in 28%, disordered proliferative endometrium in 14.4% and endometrial polyp was seen in 8.4% of the patients. Endometrial hyperplasia without atypia was found in 6.4% which was more common in hypothyroid group compared to the other thyroid groups, suggesting a possible link, although it was not found to be statistically significant. Conclusion: Thyroid dysfunction, particularly hypothyroidism, was prevalent among women with AUB, however no statistically significant association was found in our study, and thus its direct impact on endometrial histopathology remained unclear. The study highlighted the need for further investigation into the underlying mechanisms by which thyroid disorders may influence the abnormal bleeding pattern, and it was suggested that the thyroid function should be routinely assessed in women with AUB. Future studies with larger sample sizes and more rigorous statistical analysis are warranted to better understand the relationship between thyroid dysfunction and endometrial pathology with the aim to optimize treatment and reduce invasive procedures. Keywords: Endometrial histopathology, Thyroid function test, Abnormal uterine bleeding.

Hypertension(HTN) is a chronic condition associated with various complications leading to increase in morbidity and mortality. There are variations noted in hypertension management among different age groups and geriatric population is more prone for adverse events due to the altered pharmacokinetics and pharmacodynamics. Thus our study aimed to study the prescription pattern of antihypertensives among elderly population. Materials and methods: A non-interventional, prospective, observational study of prescription pattern of elderly hypertensive patients conducted in a tertiary care hospital. Results: A total of 220 prescriptions were studied, majority of the prescriptions had more than one drug combination therapy for hypertension. The most common mono therapeutic agent used were Calcium channel blockers (CCBs), most common two drug combination used was CCB + Diuretic, most common 3 drug combination used was CCB + Angiotensin receipt blocker (ARB) + Diuretic and most common four drug combination used was CCB + ARB + Diuretic + Beta blocker. Most common agent used in patients with diabetes along with HTN was ARBs and in patients with ischaemic heart disease (IHD) along with HTN, CCBs were preferred. Conclusion: Our study showed that two drug combination (were most preferred among elderly population and among the mono therapeutic agents CCBs were the most preferred. Diabetes is the most common co morbidity among hypertensives. Keywords: Antihypertensive Agents, Hypertension, Geriatric Patients

Background: Infants with early onset sepsis (EOS) usually present with respiratory distress and pneumonia. Early recognition is very important but is notoriously difficult as the clinical signs of sepsis mimic almost every other neonatal problem. PCT has been shown to be useful not only in the diagnosis but also monitoring the prognosis and response to treatment of patients with neonatal sepsis. This study aims to evaluating procalcitonin as an early or first line marker in the diagnosis of neonatal septicemic infection. Materials & Methods: A hospital based observational study done on neonates suspected to have neonatal sepsis based on their clinical symptoms and risk factors admitted NICU in SPMCHI and attached group of hospital SMS Medical College, Jaipur during one year period after approval of institutional ethical committee. The procalcitonin level of 0.5 ng/ml was considered as abnormal. The cut off point of the diagnostic test was determined by ROC curve analysis. Apart from Serum procalcitonin level, complete blood count with Absolute neutrophil count, CRP, Blood culture, serum calcium, serum phosphorus serum urea, serum creatinine, serum bilirubin, SGOT, SGPT blood sugar of neonate was investigated. Data was collected and then subjected to statistical evaluation. Results: Our study showed that overall mean age of patients was 2.21±2.236 days, in proven sepsis cases was 2.02 ± 2.34 days, in suspected sepsis cases was 2.46± 2.38 days and serum procalcitonin positive cases was 2.01 ± 2.26 days. The S PCT level (> 0.5 ng/ml) positive 58 cases out of 61 shows sensitivity 96.66%, S PCT (< 0.5 ng/ml) Negative seen in 91 cases out of 93 shows specificity 96.80% and PPV 95.08% and NPV was 97.80%. A plot ROC curve (AUC= 0.827), the prevalence of disease 39.60% at admission and cut off value was >0.5 ng/ml with a statistically significant (p<0.001**). Out of 154 study population maximum cases were sterile (60.93%) in blood culture, in proven sepsis (61 cases) most commonly isolated organism was staphylococcus aureus (32.79%) followed by klebsiella (19.67%). Conclusion: We concluded that a competent diagnostic marker also needs to have a reasonably high specificity and a good positive predictive value, preferably better than 85%, in order to minimize unnecessary use of antibiotics in false positive cases. On comparing single, combination of two or more than two sepsis markers PCT alone had highest sensitivity (96.66%) and negative predictive value (97.80%). Keywords: Neonatal Sepsis, Serum Procalcitonin, EOS, LOS, Culture.

Background: Patients with end-stage liver disease (ESLD) show increased morbidity and mortality. The Model for End-stage Liver Disease (MELD) score is the preferred tool to predict 3-month survival in patients with ESLD. The aim of this study to investigate the serum ferritin level as a prognostic factor of mortality in patient’s with end stage of liver disease. Materials & Methods: A hospital based retrospective study of patients with end stage liver disease who were admitted to department of gastroenterology in SMS hospital and medical college during one year period. Demographic, clinical and biochemical markers were recorded. All other biochemical data were recorded within 24 h of the highest serum level of ferritin found in the patient’s EMR to ensure valid correlation with other biochemical and clinical parameters. Spearman rank correlation coefficient was used to assess the association of various parameters with serum ferritin, and a comparison of correlation coefficient was performed between the three groups. Results: The MELD score was significantly different between the three groups and with the rise in ferritin concentration there was an increase seen in the MELD score the median MELD score being 15, 20, and 24 in patients with serum ferritin <200 ng/mL, 200–400 ng/mL and more than 400 ng/mL respectively. The predictors which were significantly on univariate analysis were ferritin (p <0.0001), MELD score (<0.001**). Age and gender, were not significant on univariate analysis as predictors of 15 and 30 day mortality. Conclusion: We concluded that clearly reflect the prognostic significance of raised ferritin in patients with decompensated cirrhosis, however larger prospective trials are needed to validate these findings. Keywords: Decompensated Liver Cirrhosis, Mortality, MELD Score, Serum Ferritin.

Background: Emotional intelligence is the ability to monitor one's emotions and feelings and those of others, to distinguish between them, and to use this information to guide one's thoughts and actions. A growing body of evidence suggests that highly emotionally intelligent student groups have better academic performance, better emotional awareness, and relationship management. We set forward to determine if any such positive relation exists among medical students. Materials and Methods: A descriptive cross-sectional study was conducted on 384 undergraduate medical students of GMC Pali using a pre-tested pre validated Emotional Intelligence self – assessment checklist, which assess six domains of emotional intelligence, namely, self-awareness, self- confidence, self-control, empathy, motivation and social competency. The data was tabulated and analysed using SPSS 22.0 (IBM Corp., Armonk, NY, USA). Results: More than 65% of medical students scored below 20 for all the components of emotional intelligence, while more than 15% of students scored below 15 for components of EI, Participants with urban background and nuclear family have higher values of EI components, however, not found to be significant. Statistically significant positive correlation was found between most of components (self-awareness, empathy, self-confidence, motivation and social competency) of EI and academic performance of students (p –value <0.05). Regression analysis showed that self- confidence and social competency improved with consecutive batches and academic success, but motivation was influenced by academic performance only. Thematic analysis emerging from the Focused Group Discussion with students also highlighted the role of parents, family, gender, age and peer motivation in EI, which is important for transition of a medical student to a medical graduate. Conclusions: Emotional management affects the academic performance of medical students. There should be strategies to improve the emotional intelligence of the students so that it can aid in their academic performance. Keywords: Emotional Intelligence, Medical Students, Academic Performance.

Background: Immunization is a vital public health intervention that significantly reduces the burden of vaccine-preventable diseases among children under five. Despite free immunization services through programs like India's Universal Immunization Programme (UIP), families often incur out-of-pocket (OOP) expenditures, which can be a substantial financial burden, particularly in economically disadvantaged regions. This study aims to explore and compare the OOP expenditures incurred by families for immunization in rural and urban areas of Maharashtra. Materials and Methods: A cross-sectional study was conducted in Maharashtra, with a sample of 140 participants, divided equally between urban and rural areas. Participants were selected through systematic random sampling, and data were collected using a structured questionnaire. The questionnaire covered demographic details, immunization history, healthcare access, and OOP expenditures. Statistical analysis was conducted using SPSS version 26. Results: The study revealed significant differences in OOP expenditures between urban and rural participants. Urban families faced higher costs across various categories, including travel, registration, vaccines, drugs, and loss of wages. The total OOP expenditure was significantly higher for urban participants, with an average of Rs. 1200 compared to Rs. 820 for rural participants. Conclusion: The study highlights the critical need to address disparities in healthcare access and OOP expenditures for immunization between urban and rural populations. Urban families face significant financial and logistical barriers, underscoring the need for policy interventions to improve accessibility and affordability of immunization services in urban areas. Keywords: Immunization, Out-of-pocket expenditures, Rural-urban disparity, Healthcare access, Maharashtra, Public health intervention.

Background: Occupational health risks are (indeed) inherent in several industries, including sugar manufacturing. Workers in this field confront (chronic) exposure to dust and various chemical by-products. This study investigates pulmonary function impairments among sugar factory workers in Tamil Nadu; it focuses on the prevalence, types and risk factors associated with respiratory health issues. However, the complexities of these risks are multifaceted and it’s crucial to understand (the) implications of long-term exposure. Although the data is compelling, more research is needed, because the health of these workers is paramount. Materials and Methods: A cross-sectional study (conducted among 272 sugar factory workers) had participants who possessed at least one year of employment. Data collection involved semi-structured interviews and spirometry tests that measured Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and FEV1/FVC ratios. Workers were classified into exposure levels (based on their job roles) and logistic regression was performed to analyze risk factors. However, this approach has its limitations. Although the sample size is adequate, the findings may not be generalizable to all sugar factory workers because of potential confounding variables. Results: The occurrence of pulmonary impairments stands at 27.9%, with restrictive impairments being the most prevalent (15.1%), followed by obstructive (9.9%) and mixed (2.9%) types. Interestingly, the prevalence of impairment escalated with dust exposure: it was 14.1% for mild exposure, 27.1% for moderate and 42.3% for severe exposure. Prolonged employment (>15 years) and smoking, combined with inconsistent use of respiratory protective devices, significantly elevated the risk of impairment. However, this multifactorial scenario underscores the need for better protective measures, because the consequences can be detrimental to health. Although some individuals may underestimate these risks, the data clearly suggests a strong correlation. Conclusion: Workers in the sugar industry face a significant risk of developing pulmonary impairments because of chronic exposure to dust. Enhanced protective measures are crucial; however, routine health screenings and education on respiratory health are also necessary to mitigate risks. Findings indicate that targeted interventions are needed to safeguard worker health in high-risk occupational settings. Although these measures could be effective, their implementation can be challenging. This is particularly important because the health consequences may be severe, thus emphasizing the urgency of addressing these concerns. Keywords: Pulmonary function, sugar factory workers, occupational disease, dust exposure.

Background: There is a significant incidence of hospitalization due to community-acquired pneumonia in adults, which is a prevalent and potentially fatal illness. As the most prevalent infectious killer on a global scale, it ranks sixth in terms of mortality rates. Materials and Methods: This was a prospective, observational, cross-sectional study conducted at the Emergency Department of Mazumdar Shaw Multi Specialty Hospital, Narayana Health City, Bangalore, Karnataka, India. It was a two-year study, specifically from January 2017 to December 2018. The study included all persons (aged over 18 years) exhibiting signs and symptoms of pneumonia. Results: Out of 60 individuals enrolled in the research, 46 (or 76.67%) were treated for pneumonia. Positive USG results were found in 45(97.83%) of the 46(76.67%) pneumonia patients, while positive CXR results were found in 43(93.47%). Following the completion of the 2×2 table and statistical analysis, we determined that the USG had a sensitivity of 97.83%, a specificity of 92.86%, and PPV and NPV values of 97.83% and 92.86%, respectively. The PPV for CXR was 97.73% and the NPV was 81.25%; the specificity was 92.86% and the sensitivity was 93.48%. Reissig et al. found that LUS had a sensitivity of 93% and a specificity of 98% when it came to diagnosing CAP.[44] Another study by Cortellaro et al. indicated that bedside LUS had a sensitivity of 98%, while CXR had a sensitivity of 67%. Conclusions: The aforementioned study concludes that patient disposition can be diminished if ultrasound findings are incorporated into the diagnosis. Key Words: Ultrasound, pneumonia, pneumothorax, diagnosis, disposition.

Background: Coronary artery disease is a leading global health burden, with fibrinolysis proving to reduce mortality in acute myocardial infarction. This study aimed to identify the success rate of thrombolysis in ICCU and the impact of various factors on the success of thrombolysis, including age, sex, alcohol consumption, smoking, hypertension, diabetes mellitus, location of MI, and the time interval between the onset of chest pain and initiation of thrombolytic therapy. Material and Methods: This observational prospective cohort study included 95 patients at Government Vellore Medical College and Hospital, from May 2018 to April 2019. Patients were divided into two groups based on the success or failure of thrombolysis. Factors such as age, sex, alcohol consumption, smoking, systemic hypertension, diabetes mellitus, location of MI, and the time interval between the onset of chest pain were analysed. Results: The overall success rate of thrombolysis was 56 (58.95%) and the failure was 39 (41.05%). The mean age group was 58.28±10.90. There were no significant differences in age, sex, or location of MI between the successful and failed thrombolysis groups (p>0.05). The window period had a significant relationship with the success of thrombolysis, with patients presenting within 4 h having a better success rate than those presenting later (p=0.001). There were no significant differences in hypertension, diabetes, smoking, and alcohol consumption between the success and failure of thrombolysis (p>0.05). Conclusion: The window period significantly influenced the success of thrombolysis, with higher success rates observed in patients presenting within 4 hours of symptom onset and didn’t have a significant impact on thrombolysis success. Key Words: Acute Myocardial Infarction, Thrombolysis, Streptokinase, Coronary Artery Disease, ICCU, Time Window.

Background: To determine the correlation between clinical and histopathological changes in pterygium patients and to investigate its relevance in recurrence of the pterygium. Material and Methods: A total of 50 patients with pterygium who underwent excision with conjunctival auto graft, were subjected to histopathological study and the results were correlated to clinical findings prospectively. Prior to surgery, clinical features of pterygium such as redness, fleshiness, extent over the cornea was recorded and grading was done using slit lamp biomicroscopy. Post operatively the pterygium specimens were investigated by haematoxylin-eosin(H&E) and (VVG) Verhoeff’s- van Gieson’s elastic stain to look for epithelial and stromal changes. All the patients were followed up clinically post operatively for 3 months to look for recurrence of pterygium and their histopathological relevance were studied. Results: This study examined 50 patients (88% female, mean age 51±12.4) undergoing pterygium surgery. Indications for surgery included cosmetic concerns (56%), astigmatism >2D (30%), recurrent redness/pain (10%), and pre-cataract surgery (4%). Pterygium severity: 16% grade 1, 70% grade 2, 14% grade 3, with a mean length of 3.32±1.26 mm and width of 3.92±1.15 mm. Redness was observed in 22% (grade 1), 64% (grade 2), and 16% (grade 3); fleshiness in 18% (grade 1), 52% (grade 2), and 30% (grade 3). Significant correlations were found between pterygium grade, redness, fleshiness, and astigmatism >2D (p<0.01, p=0.03). Histopathology revealed epithelial hyperplasia (94%), atrophy (38%), pigmentation (58%), and goblet cell hyperplasia (12%). Vascular density averaged 8.30±2.09 vessels/HPF. Stromal inflammation, hemorrhage, elastosis, and elastotic degeneration were prevalent (82%, 100%, 98%, and 96%, respectively). One recurrence occurred after 2 months. Conclusion: Our study highlights the significant clinical and histopathological findings associated with pterygium, emphasizing the correlation between features such as redness, fleshiness, and vascularity with histopathological changes like stromal inflammation and elastosis. The non-carcinogenic nature of pterygium was confirmed, as no dysplasia was observed. Moreover, histopathological evaluation of excised tissues is crucial, as it may reveal underlying ocular surface squamous neoplasia or concurrent malignancies. These findings underscore the importance of tailored treatment strategies and ongoing surveillance for improved management of pterygium. Keywords: Pterygium, Eye Disorders.

Background: Hemorrhagic transformation (HT) in acute ischemic stroke (AIS) is a critical complication that worsens prognosis. Identifying associations between serum lipid profiles and HT risk may improve predictive accuracy and patient outcomes. Materials and Methods: This retrospective cohort study included 200 AIS patients, analyzing demographic characteristics, BMI, and fasting lipid profiles. The study assessed correlations between total cholesterol, LDL, triglycerides, HDL, and the triglyceride to HDL ratio (TG/HDL) with the incidence of HT. Statistical analysis involved t-tests and chi-square tests to evaluate significance, with p < 0.05 considered significant. Results: The mean age of patients was 56.7 ± 7.1 years, with a male predominance (59%). HT occurred in 28.5% of cases. Patients with HT showed significantly lower mean LDL (157.3 ± 31.2 mg/dL) and HDL (40.0 ± 6.3 mg/dL) compared to non-HT patients. Additionally, HT patients had a higher TG/HDL ratio (4.8 ± 1.3) than non-HT patients (4.4 ± 0.7), with p-values <0.05. Higher BMI and older age also correlated with increased HT risk. Conclusion: Low HDL levels, higher TG/HDL ratio, and obesity were significantly associated with HT in AIS patients, suggesting these lipid parameters could serve as useful markers in identifying HT risk. Targeting lipid management may improve outcomes in high-risk patients. Keywords: Acute ischemic stroke, hemorrhagic transformation, lipid profile, HDL, TG/HDL ratio, Serum cholesterol.

Background: Until recently, management strategies of birth asphyxia were supportive and not targeted toward the processes of ongoing injury. In view of conflicting reports about the role of magnesium in birth asphyxia and due to the paucity of Indian studies, the present study was undertaken in BLDEA Medical College University Hospital, Bijapur, India over a period of 2years and 6 months. Objective: To study the outcome and complications of term asphyxiated neonates in the first 10 days of life who are supplemented with Magnesium. Material and Methods: Randomized case control study on 85 term neonates with birth asphyxia (45 cases and 40 controls). All the term neonates with Apgar score of 3 or less at 1minute and 6 or less at 5 minutes were included in the study. Cases had received Magnesium Sulphate intravenous infusion at a dose of 250 mg/kg in the first hour of life and 2 additional doses of 125 mg/kg at intervals of 24 hours. Serum Magnesium was estimated at birth and then on 12, 24, 48 and 72 hours of life in both groups. Results: Mean number of convulsions was 4.6 in cases and 7.2 in control group. Time interval between the first and last convulsion was less in cases as compared to control group. Duration of Oxygen supplementation and NICU stay were significantly shorter in cases. Direct breast feeding was able to initiate early in cases as compared to controls group. Significant differences in Magnesium level were seen in cases after supplementation. Clinical or Serum Magnesium toxicity were not detected in any of the cases. There was no difference in the incidence of complications among the two groups. Conclusion: Decrease in the number of convulsions and duration of convulsion shows the neuroprotective effect of Magnesium in treatment of birth asphyxia. In the present study magnesium supplementation regimen was not associated with toxicity. Key Words: Birth Asphyxia, Magnesium supplementation, Neuroprotection.

Topical corticosteroids (TCSs) are fundamental for managing various dermatological conditions because of their anti-inflammatory properties. This document outlines the appropriate use of TCS, emphasizing the balance between therapeutic benefits and potential risks. The introduction addresses the global prevalence of skin diseases, highlighting the significant impact on quality of life and the importance of TCS in symptom relief. However, misuse due to misdiagnosis, poor communication, and nonmedical influences is a concern. Common skin conditions effectively treated with TCS are categorized on the basis of the effectiveness of the corticosteroids. Proper prescription practices involve thorough consultation, tailored treatment, specific application techniques, and supervised usage. It is crucial to avoid prolonged use, improper occlusion, and application to infected skin or for skin-lightening purposes. Healthcare recommendations for selecting the right TCS focus on potency classification and factors influencing the choice, such as age, lesion location, and skin characteristics. The document highlights the importance of understanding dosage calculations via the fingertip unit (FTU) method and the variability in TCS absorption across different anatomical sites. Awareness of adverse effects, both local (e.g., skin atrophy, rosacea) and systemic (e.g., adrenal suppression, Cushing’s syndrome), is crucial. Strategies to address steroid phobia include patient education, individualized counselling, proper application demonstrations, open communication, and regular monitoring. In conclusion, appropriate TCS use requires precise prescription practices, patient education, and adherence to guidelines. This comprehensive approach ensures optimal therapeutic outcomes while minimizing risks, effectively addressing the needs of patients with diverse skin conditions. Healthcare professionals must balance the benefits and risks of TCS, providing evidence-based guidance to enhance patient care. Keywords: Topical corticosteroids, inflammation, fingertip unit, application, dosage, potency, steroid phobia.

Background: To evaluate the impact of admission hyperglycemia on in-hospital mortality and morbidity in non-diabetic AMI patients. Materials and Methods: This study was conducted on 70 non-diabetic AMI patients. Patients were categorized based on admission glucose levels into normoglycemic, mild hyperglycemia, and severe hyperglycemia groups. In-hospital mortality, major adverse cardiovascular events (MACE), and length of stay were analyzed. Results: Severe hyperglycemia was associated with significantly higher in-hospital mortality (18%) compared to mild hyperglycemia (4%) and normoglycemia (2%). The incidence of MACE, including heart failure and arrhythmias, was also higher in the severe hyperglycemia group. A dose-dependent relationship was observed between admission glucose levels and adverse outcomes. Conclusion: Admission hyperglycemia is a significant prognostic factor in non-diabetic AMI patients, with severe hyperglycemia linked to increased mortality and morbidity. Early detection and management of hyperglycemia are essential for improving patient outcomes. Keywords: Hyperglycemia, non-diabetic AMI, outcomes.

Background: The aim of this study was to evaluate and compare the use of daily low dose cisplatin versus weekly Cisplatin concurrently with radiation in locally advanced squamous cell carcinoma of head and neck. Materials and Methods: It is a Double arm prospective study done for 2 years in 50 Patients who have histologically proven head and neck cancers were selected randomly and allotted to each arm. 25 cases in weekly cisplatin arm and 25 cases in low dose daily cisplatin arm. Age 20- 60 years No previous chemotherapy or radiotherapy No other comorbidities in whom Biopsy proven newly diagnosed squamous cell carcinoma of the head & neck ECOG 0-1 with Primary tumor sites oropharynx, oral cavity, larynx, hypopharynx, locally advanced squamous cell carcinoma (stage II, III, IVA) are included in study. Results: In the trial arm the complete response was seen in 84% and in the control arm the complete response was seen in 80%. partial response was seen in 16% of trial arm while 20% had partial response in control arm. The results are showing enough to infer that daily low dose cisplatin is as efficacious as weekly cisplatin. Toxic effects were less incident in the low dose daily cisplatin over all when compared to weekly cisplatin. P value was also significant to back up that statement. Dermatitis and mucositis was less seen in trail arm. Conclusion: The low dose daily cisplatin had another advantages in our study. Daily chemotherapy allowed us to see the patients daily and asses for toxicity in early stage and opportunity to talk to the patients allowing us to better implement some precautionary measures in preventing toxicities and maintain the nutritional status of the patient. So there by the overall toxicity was less in low dose daily cisplatin arm while having the same efficacious as weekly cisplatin in terms of tumor. Keywords: Squamous cell carcinoma, Chemotherapy, low dose cisplatin, radiotherapy.

Background: Microalbuminuria, a marker of microvascular and endothelial dysfunction, is associated with increased cardiovascular risk and mortality in non-diabetic patients with acute myocardial infarction. This study aimed to investigate the prevalence of microalbuminuria in non-diabetic patients with acute myocardial infarction (both STEMI and NSTEMI) and to study the association between microalbuminuria and other risk factors. Material and Methods: This hospital-based cross-sectional study included 100 patients treated at the Government Vellore Medical College between October 2017 and September 2018. The patient details and covers the history of age, sex, comorbidities, personal habits, clinical examination, BMI calculation, and investigations, such as blood sugar, lipid profile, renal function tests, urine analysis, ECG, Troponin T, and echocardiography. Results: Of the 100 patients, 61 (61%) were males and 39 (39%) were female. Of the patients, 55% had cholesterol levels (205.7±36.9) >200 mg/dL, with 50.82% males and 61.54% females. A BMI >25 was observed in 67% (26.1±2.4) of the patients, with 72.13% males and 58.97% females. Triglyceride levels >150 mg/dL were noted in 57 patients (160.3±34), 59.02% males and 58.97% females. Among the 51 (51%) patients who smoked, all 51 smokers were male. Microalbuminuria (ACR ≥ 30 mg/g) was present in 64% of the patients, with significant differences in cholesterol, BMI, and triglycerides between the ACR groups (p = 0.0005, p = 0.02, p = 0.0004). Conclusion: Microalbuminuria was prevalent in 64% of patients with acute myocardial infarction, with higher rates in younger patients. It is strongly associated with dyslipidaemia, elevated cholesterol, triglycerides, and high BMI but can occur independently of BMI, smoking, and cholesterol levels. Keywords: Microalbuminuria, Acute Myocardial Infarction, Non-diabetic, Dyslipidaemia, Endothelial dysfunction.

Background: Pancytopenia is a condition assessed by decreased all three blood components including anemia, thrombocytopenia, and leukopenia below the normal range. However, existing literature data is scarce concerning pancytopenia in Pediatric subjects. Aim: The present study aimed to assess the etiopathological and clinical profile of pancytopenia in Indian child subjects aged 1-18 years. Material and Methods: The present study assessed 130 subjects in the age range of 1-18 years within the defined study period in the Pediatric Department of the Institute. After final inclusion, clinical and etiopathological characteristics were assessed in all the study subjects. Data gathered were analyzed statistically. Results: The most common presenting complaints were fatigue and fever in 90% and 54% of subjects. The most common physical finding was pallor, splenomegaly, and pedal edema in 100%, 38%, and 18% of subjects respectively. Bone marrow cellularity showed hypocellular, hypercellular, and normocellular marrow in 62%, 31%, and 7% of subjects respectively. For etiology, megaloblastic anemia was reported in 30% of subjects followed by malignancies in 30% of subjects with sepsis, aplastic anemia, acute myeloid leukemia, acute lymphocytic leukemia, multiple myeloma, and myelodysplastic syndrome in 8%, 14%, 9%, 9%, 3%, and 9% subjects respectively. Rare causes of pancytopenia seen in study subjects were dengue, malaria, and disseminated tuberculosis reported in 3%, 9%, and 6% of study subjects respectively. Conclusion: The present study concludes that the most common etiology of pancytopenia is nutritional, which is megaloblastic anemia, followed by malignancies and aplastic anemia. Keywords: Bone marrow, Children, leukemia, Megaloblastic anemia, Pancytopenia.

Background: Aims: The aim is to study the indications of blood transfusion and maternal outcome in obstetrics. Material and Methods: It is a prospective, observational study with a duration of 12 months, conducted on 100 patients. Pregnant women and postnatal mothers of age group from 18 to 40 years, Incomplete miscarriage, Anaemia, Antepartum, haemorrhage, Postpartum haemorrhage, Ectopic pregnancy are included in study. Results: The 21 to 30 years age group constituted the highest percentage among the study subjects. Primiparous and multiparous women constituted 30% and 70%, Lower-middle class patients were in majority (44%), followed by Lower class (40%) and least were upper middle class patients (16%). Majority of the study population belonged to Second Trimester (42%), followed by Third Trimester (40%) and First Trimester (15%). Pre-transfusion Hb and Post-transfusion Hb, majority (57% and 86%) of the patients were having Hb percentage between 7 to 9.9 gm% moderate anaemia was in high percentage (28%), targeting a haemoglobin level of more than 11 g/dL or complete resolution of anaemia may be preferred in those with an objection to blood products or at high risk for blood transfusions. Abruption cases were in high percentage (17%) and least is Placenta Previa (1%). Caesarean section rate in our study was 39%, Antenatal cases with six visits were 19%, followed by four visits 16% and five visits 16%. Emergency LSCS cases were in majority (26%), followed by undelivered ones (22%). 96% of cases requiring blood transfusion has no blood transfusion related complications but 7% of cases were observed with surgical site infection. Conclusion: Adequate blood inventory always allays obstetrician’s apprehension of blood availability. At the same time since in a country like India where demand is always more than supply. Keywords: Caesarean Section(CS), Placenta Previa, Haemoglobin Level, Blood Transfusion.

This observational study examines the factors influencing home deliveries in Malegaon Corporation, Maharashtra. The study used a case-control design, comparing mothers who delivered at home with those in healthcare facilities, focusing on maternal perceptions, antenatal care (ANC), and healthcare infrastructure. Data were collected using semi-structured questionnaires and home visits involving 250 mothers, healthcare workers, and traditional birth attendants (TBAs). Results show that home deliveries are significantly associated with family insistence, transportation delays, fear of hospitals, and inadequate ANC visits. Mothers who delivered at home reported fewer ANC visits and were less likely to have undergone critical health screenings compared to those who opted for institutional deliveries. Additionally, negative healthcare worker attitudes and a lack of postnatal care (PNC) services further contributed to home deliveries. The study highlights the need for targeted interventions, including improved transportation infrastructure, enhanced ANC and PNC services, and trust-building measures to reduce home deliveries and improve maternal health outcomes. Keywords: Home delivery, Malegaon Corporation, antenatal care, postnatal care, maternal health, transportation barriers, healthcare infrastructure.

Background: Spinal cord injury (SCI) refers to damage to the spinal cord due to traumatic or non-traumatic causes resulting in sensory or motor deficits with bladder and bowel dysfunction. Chronic SCI is often associated with a risk of developing complications. The study highlights the fact that these patients are prone to sudden medical problems and emergency situations due to their injury, which can have a substantial impact on their quality of life and functional independence. Hence awareness of the various medical emergencies along with their diagnosis and timely management is necessary to avert further complications and mortality. Material and Methods: Eight patients with spinal cord injury, during the past two years have been included in this retrospective case series. These patients were admitted for neurorehabilitation and were found to develop spinal cord injury-related complications during their hospitalization. Results: Out of eight patients, two were having sepsis with quick sequential organ failure assessment (qSOFA) score of two for which they were stabilized and given intensive care The complications included Heterotopic Ossification, urosepsis, Autonomic Dysreflexia, Appendicitis, grade four Pressure Injuries with sepsis, and Pneumonia. All patients received timely identification, accurate diagnosis, and prompt treatment, in conjunction with the standard neurorehabilitation protocol. As a result, they all achieved favorable functional recovery. Conclusion: When SCI patients show clinical evidence of fever, increased spasticity, bladder symptoms, decreased range of motion of any large joint, deranged baseline vitals or laboratory reports, differential diagnoses should be kept in mind while trying to search etiology or precipitating factors. Early diagnosis and treatment must be carried out in order to reduce morbidity and avoid mortality as they may have altered or absent sensations below their level of injury, making it challenging to recognize medical emergencies in a timely manner. The importance of preventing, early diagnosing, and effectively treating these complications cannot be overemphasized, as it can improve the patient’s survival, community participation, and overall health-related quality of life. Key Words: spinal cord injury, physical medicine and rehabilitation, emergency medicine, intensive care, pressure injury, autonomic dysreflexia, sepsis.

Background: Metacarpal fractures are among the most common hand injuries, accounting for a significant proportion of trauma cases. These fractures present unique challenges in terms of functional recovery and management due to the intricate anatomy and biomechanics of the hand. Early diagnosis and appropriate treatment are crucial to restoring optimal function. Objective: To analyze the patterns, clinical presentations, and outcomes of metacarpal fractures among 55 patients managed at a tertiary care center, and to evaluate the effectiveness of current management strategies. Materials and Methods: This prospective observational study included 55 patients diagnosed with metacarpal fractures over 12 months. Patients were assessed clinically and radiographically to determine fracture patterns, mechanisms of injury, and associated factors. Treatment modalities included conservative management, closed reduction, and surgical fixation based on fracture severity. Outcomes were measured using the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score at follow-up intervals. Results: The majority of fractures involved the fifth metacarpal (47.3%), with direct trauma being the most common mechanism of injury (60%). Conservative management was successful in 67% of cases, while surgical intervention was required in 33%. Functional outcomes were favorable, with 85% of patients achieving excellent or good QuickDASH scores. Factors such as delayed presentation and associated injuries influenced recovery. Conclusion: Metacarpal fractures, predominantly involving the fifth metacarpal, can be effectively managed with conservative or surgical approaches, depending on the severity. Early intervention and individualized treatment planning are essential to achieve optimal functional outcomes. Keywords: Metacarpal fractures; Fifth metacarpal; Conservative management; Surgical fixation; Functional outcomes; QuickDASH score.

Background: Polycystic ovary syndrome (PCOS) is a common and complicated endocrine-metabolic disorder of unknown etiology that affects, according to different diagnostic criteria, 5–20% of women of reproductive age worldwide. Up to 80% of women with PCOS present with overweight or obesity. This study aims to investigate the association between food habits and suspected cases of PCOS in female medical students of western India. Material and Methods: An observational, cross-sectional study was conducted in medical college attached with tertiary care teaching hospital from August 2024 to September 2024. All female medical students from second year to final year were included in this study. All female students were contacted and data was collected on pre- designed and pre – tested questionnaire for prevalence of PCOS and food habits of medical students. Results: In the present study 23 suspected cases of PCOS from total 151 study participants were observed. Among 23 suspected cases of PCOS, 14 cases were already diagnosed by gynecologist. Eating outside food in PCOS and non PCOS participants were 82.61% and 86.71% respectively. Consumption of sugar content was high in P COS group as compared to non PCOS group. Consumption of fiber rich food in PCOS and non PCOS group was 69.57% and 77.34% respectively. Conclusion: This study provide evidence to support association between food habits and cases of PCOS. We observed that high sugar containing food consumption and low fiber intake in PCOS participants. Keywords: Cross-Sectional Study, Food habits, Medical students, Polycystic ovary syndrome (PCOS).

Background: Aims: To evaluate effectiveness of Jigsaw method of learning over faculty demonstration in teaching functional anatomy. Setting: Department of Anatomy, Government Medical College Kollam. Design: Quasi experimental study. Material and Methods: Study was conducted on 110 phase 1 MBBS students who were divided into two groups and were given two different teaching learning interventions – faculty demonstration and Jigsaw technique. Two Objective Structured Practical Examinations (OSPE) were conducted. Student perception regarding both methods were taken. Statistical Analysis Used: Independent t test. Results: Students who were in the Jigsaw group scored better in OSPE (difference in means was statistically significant, p value 0.003). Students were more satisfied with the Jigsaw method in terms of ease of understanding and retaining the topic, being interesting and interactive, increasing critical thinking skills and improving communication skills. Conclusion: Jigsaw method is a better method of teaching functional anatomy and can be recommended for teaching anatomy for undergraduates as it increases the student involvement and thus more effective in acquiring and retaining knowledge. Keywords: Jigsaw, peer learning, Anatomy teaching, critical thinking.

Background: Laparoscopic repair of ventral hernias has gained popularity in last few decades because of lower infection rate, shorter hospital stay and quicker return to work1. Previously, IPOM plus was widely considered the standard laparoscopic procedure for ventral hernias2 . This study is aimed at clinical results in terms of postoperative pain, hospital stay, return to daily activities and cost benefit analysis of new technique Extended Totally Extraperitoneal Repair (eTEP-RS) compared to IPOM Plus for midline ventral hernias. Material and Methods: Data from consecutive patients requiring minimally invasive hernia repair was collected from January 2022 to march 2024 in a tertiary care hospital in Visakhapatnam. A total of 50 patients presenting with ventral hernias were included in the study, of whom 25 underwent IPOM Plus and 25 underwent eTEP-RS repairs. 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 and 6 months postoperative. Results: Patient demographics showed no differences in terms of gender, age and comorbidity. Hernia size was similar for both groups. The mean intraoperative duration among the IPOM Plus and eTEP-RS groups was 66.4 ± 14.3 min and 168.4 ± 17.2 min respectively, with a significant statistical difference (<0.001). Pain severity on postoperative day 1, day 3 and day 7 is significantly less in e TEP group (<0.001). The eTEP group had a shorter hospital stay compared with the IPOM group(<0.001). There was no significant difference concerning the incidence of seroma, SSI’s and postoperative ileus between the groups. Return to regular work was significantly faster in eTEP-RS group. Overall treatment cost is significantly lower in the e-TEP RS group. Conclusion: eTEP-RS shows significant lower postoperative pan, better functional recovery and is cost effective compared to IPOM plus technique. But it requires steep learning curve and longer operative time. Keywords: Extended View Total Extraperitoneal Repair- Rives-Stoppa (etep-rs); Intraperitoneal Onlay Mesh Repair (IPOM Plus); laparoscopic ventral hernia repair

Background: Hypertension is a significant global health challenge and a leading contributor to chronic kidney disease (CKD). Its impact on glomerular filtration rate (GFR), a key indicator of renal function, highlights the importance of early detection and management to prevent irreversible renal damage. This study investigates the prevalence of hypertension and its association with GFR decline in patients attending Palace Hospital,Thrissur. Objective: To assess the prevalence of hypertension and its correlation with GFR among patients and evaluate the risk factors contributing to renal dysfunction. Material and Methods: A prospective study was conducted over 12 months at Palace Hospital, Thrissur with 100 patients aged 30–75 years. Patients were evaluated for blood pressure, renal function tests, and GFR using the CKD-EPI equation. Hypertension was categorized according to the American College of Cardiology guidelines, and GFR was stratified into stages of CKD. Data on comorbidities, demographic profiles, and laboratory findings were analyzed to explore the relationship between hypertension and GFR. Results: The prevalence of hypertension was 38%, with 54% of hypertensive patients exhibiting reduced GFR (<60 mL/min/1.73 m²). A significant inverse correlation (r = -0.68, p < 0.001) was observed between blood pressure levels and GFR. Age ≥60 years, uncontrolled hypertension, and diabetes mellitus were identified as significant risk factors for GFR decline. Hypertensive patients in CKD stages 3–5 accounted for 40% of the cohort. Conclusion: Hypertension significantly impacts GFR, with a high prevalence of CKD in hypertensive patients. Early detection and control of hypertension are critical to preserving renal function and preventing progression to end-stage renal disease (ESRD). Keywords: Hypertension, Glomerular Filtration Rate, Chronic Kidney Disease, Renal Dysfunction, Blood Pressure, CKD-EPI Equation.

Background: Highly active antiretroviral therapy (HAART) is the mainstay of treatment for those infected with Human immunodeficiency virus (HIV). The prospect of maintaining patients on long term HAART may be restricted by a heterogeneous collection of unexpected metabolic abnormalities including hyperglycemia. Patients on HAART are at increased risk of developing diabetes than those who are treatment naïve. Hyperglycemia has been mentioned as the side effect of protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and Integrase strand transfer inhibitors (INSTIs) have been shown to increase insulin resistance and reduce insulin secretion. NRTIs were also reported with increased risk of diabetes in a recent study, mechanism not well understood. The effects of HAART on glucose metabolism among PLHIV in Manipur remain largely unknown. The present study was conducted to evaluate the prevalence of hyperglycemia among HIV patients on HAART and to correlate hyperglycemia in different HAART regimens and according to the duration of anti retro viral therapy (ART). Materials and Methods: A cross sectional study was conducted from 1st December, 2022 to 31st November, 2023 in the Department of Medicine, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur. HIV positive patients on HAART admitted in Medicine ward, attending Medicine OPD and CoE ART Centre, RIMS, Imphal were included in the study. All the routine examination was done as per NACO recommendation. Blood investigations included fasting blood sugar (FBS), kidney function test (KFT), complete blood count (CBC) and lipid profile. Data collected were analyzed using SPSS-version-26. A P value of <0.05 was taken as significant. Results: A total of 151 patients who has received HAART for at least 6 months were enrolled. The mean age of patients in the study was 46.25 ± 10.8 years. Majority 105 (69.5%) were in HIV stage 1, maximum patients114(75.4%) had CD4 count in range 200-399 and most of them 122(80.8%), had undetectable viral load. The commonest ART regimen 128(84.8%) was TLD (Tenofovir, lamivudine, dolutegravir). Majority of the study subjects did not experience hyperglycemia (82.8%) and had FBS levels of normal range (70-125 mg/dL). Only 17.22% of individuals have FBS >125 mg/dL. There was a statistically significant association between hyperglycaemia and ART duration (p < 0.001) while not significant with the ART regimen (p = 0.773). Conclusion: This study concludes the duration of ART treatment is associated with an increased risk of hyperglycaemia, with longer treatment durations corresponding to higher rates of hyperglycaemia. The findings emphasize the need for vigilant metabolic monitoring and tailored ART regimens to mitigate the risk of hyperglycemia and related complications. Keywords: Hyperglycemia, pre- diabetes, Diabetes Mellitus, HAART regimen.

Background: Otomycosis or Fungal otitis externa is a commonest condition encountered in ENT practice. It is a superficial fungal infection of the external ear canal that sometimes leads to complications involving the middle ear. The condition is worldwide in distribution, but is more common in humid tropical and sub-tropical regions. As this condition is more common in our region, as the climatic condition predispose to otomycosis. Hence, this present study is taken to know the predisposing factors and common fungal isolates seen in patients with otomycosis visiting our hospital. Aims and objective: To Study the predisposing factors and common fungal isolates seen in patients with otomycosis in our region. Materials and Methods: The present study was conducted on 150 clinically diagnosed cases of otomycosis attending the ENT OPD for a period of one year. Ear discharge specimens were collected on two sterile cotton swabs. Direct Examination of the specimen was carried out by Gram stain and 10% KOH Preparation. All specimens were inoculated on Sabouraud Dextrose Agar. Identification of fungi was done as per standard protocol. Results: Out of 150 patients fungal isolates were found in 134 cases (89.33%). The highest incidence was noted in the age group of 31-40 years, more prevalent in females (61.19%), with unilateral distribution more on right ear. Pain in the ear was commonest symptom (98.50%) followed by itching (95.52 %) and Most common fungi isolated were Aspergillus Flavus, Aspergillus Niger and Aspergillus Fumigatus followed by Candida Species. Conclusion: It is concluded from our study that otomycosis is one of the commonest condition seen with prevalence varying with climatic conditions, but warm humid environment support their growth, and the human ear canal is ideal for their proliferation. It occurs in men and women of all ages and is usually a unilateral disease. Aspergilli were considered as predominant fungi for Fungal otitis externa. The study also concludes that patients have to be educated not to use unsterile materials to clean the ears which will be effective in prevention of Fungal otitis externa. Keywords: Fungal otitis externa, Aspergillus, Candida, External Auditory Canal, Otalgia.

Background: Hearing loss is the most common congenital factor seen in 0.1–0.2% infants. Many healthcare settings use both OAEs and BERA in a two-step screening process to maximize the detection of potential hearing impairments. There are very few studies from India, which have compared OAE and BERA as a screening modality for detection of hearing loss in children. With the aim of establishing some guidelines regarding the protocols for hearing loss assessment and preventive measures, the present study has been undertaken to compare OAE with BERA done simultaneously, in the diagnosis of pediatric hearing loss. Materials and Methods: This is a hospital based observational descriptive study conducted on 300 newborn infants of NICU and indoor and outdoor infants in SP Medical College & Hospital, Bikaner during one-year period. In the present study, DPOAEs were used to screen for the presence of normal versus abnormal hearing [pass/refer]. If the results were “pass” [OAEs are present ≥ 6 dB above the noise floor for the majority of test frequencies] then no follow up OAE was done. The absence of emissions with DPOAE was considered as “refer” result. Irrespective of “pass” or “refer” result children were subjected for BERA test. Results: Among 300 infants, the first stage of screening was conducted for 236 babies with distortion product otoacoustic emission who did not have any risk factors. Out of 236 infants, 22 had a ‘refer’ in 1st OAE screening. 2 patients had type B tympanogram depicting that middle ear effusion was present. One patient was lost to follow up. 11 infants had ‘refer’ in the 1st OAE screening out of 64 infants who had risk factors. 3 patients had type B tympanogram depicting that middle ear effusion was present. Out of 11 patients 3 had refer in the 2nd OAE. Among 64 high risk babies, 3 (4.68%) babies were deaf and among 236 babies with no associated risk factors 1 (0.43%) was deaf. On application of Chi-Square Test this difference was significant statistically with a p value of 0.0064, thus making strong the need for a screening process for deafness in high risk associated births. Conclusion: All high-risk children should be screened with BERA early so that children with hearing loss identified and taken care for that. Screening programs should not only include newborn screening, but also screening in later periods based on the risk factors. Keywords: BERA, OAE, Infants, NICU, Hearing loss.

Background: A spectrum of congenital anomalies known as spinal dysraphism is characterized by an incomplete fusion of the spine's midline mesenchymal, bony, or neural parts. MRI is the preferred imaging technique for identifying and diagnosing spinal dysraphism. Aim: To study the role of magnetic resonance imaging for the evaluation of spinal dysraphism. Materials and Methods: It was a prospective study. This study was performed on patients with clinically suspected spinal dysraphism who referred for MRI spine to the department of Radio-diagnosis and imaging, Kurnool medical college and GGH during the period from February2021-October 2022. In the present study cases of the spine abnormalities and spinal cord malformations are included. Results: The present prospective study of 30 patients with a clinical suspicion of spinal cord malformations had a female predominance with the age group of 0-30 years accounting for 93% of the cases. Cutaneous markers were seen in 57.14% of cases of CSD with DDS and hypertrichosis being the commonest cutaneous markers. The commonest location for spinal involvement was the lumbar region followed by the thoracolumbar region. In the present study, OSD were more commonly seen than closed spinal dysraphism. The commonest open spinal dysraphism observed was a meningomyelocele, which commonly presented with a vertebral defect and mass. The commonest closed dysraphism observed in this study is intradural lipoma followed by diastematomyelia which again had a female preponderance. The associated abnormalities studied were: Tetheredcord, syringohydromyelia, and Chiari malformation. Tetheredcord was most commonly associated with meningomyelocele and diastematomyelia followed by spinal lipomas. Syringohydromyelia was most commonly associated with myelomeningocele, followed by tetheredcord and diastematomyelia. In our study, all the cases of Chiari malformations are associated with open spinal dysraphism. Of all the vertebral anomalies, spina bifida was the commonest followed by hemivertebra and butterfly vertebra in equal proportions. In 50%(n=8) cases of meningomyeloceles (n=16) was associated with hydrocephalus and these patients were planned for ventriculoperitoneal shunt. Conclusion: MRI is the investigation of choice for characterizing the anomalies of spinal cord and associated soft tissues in spinal dysraphism. MRI clearly identifies and characterizes the nature of neural tissue protruding through the dysraphic spine in Meningomyelocele, Myelocele and Meningocele. Keywords: MRI, Dysraphism, Meningomyelocele, Syringohydromyelia, Chiari malformations, Cutaneous markers.

Background: Postoperative shivering is a common complication in patients undergoing spinal anaesthesia. This randomized controlled trial aimed to evaluate and compare the effectiveness of intravenous tramadol and pethidine in managing postoperative shivering in patients receiving spinal anaesthesia. Materials and Methods: This study included 80 patients undergoing elective surgeries under spinal anaesthesia. Participants were randomly assigned to receive either 1 mg/kg intravenous tramadol (Group I) or 0.5 mg/kg intravenous pethidine (Group II). Postoperative shivering intensity was graded, and medications were administered upon reaching a grade 2 or 3. The primary outcome was the reduction in shivering duration, and secondary outcomes included recurrence rate and adverse reactions. Results: The tramadol group had a significantly shorter duration of shivering compared to the pethidine group (5.88 ± 4.88 minutes vs. 7.11 ± 4.78 minutes, p=0.003). The recurrence rate was also lower in the tramadol group (15% vs. 35%, p=0.001). Both groups had no significant differences in vital signs, including heart rate, blood pressure, and oxygen saturation. Adverse effects were minimal and comparable between groups. Conclusion: Intravenous tramadol is more effective than pethidine in reducing postoperative shivering duration and recurrence in patients undergoing spinal anaesthesia. Both drugs are safe with minimal side effects, but tramadol may be the preferred option for managing this complication. Keywords: Postoperative shivering, tramadol, pethidine, spinal anaesthesia, randomized controlled trial, recurrence rate.

Background: Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique aiming to open the “closed box” represented by the non-expandable skull in cases of refractory intracranial hypertension. Hence, DC should be considered in patients with malignant middle cerebral artery infarction as well as large cerebral infarction with clinical deterioration. The present study is to plan to evaluate the effectiveness of decompressive craniectomy in ischaemic infarct. Materials and Methods: This is a non-randomized, prospective, single institute, observational study done on 30 patients in the department of Neurosurgery at the G. R. Medical College between January 2019 and June 2020. All admitted patients with life threatening intracranial infarction indicated to undergo Decompressive Craniectomy on the basis of clinical assessment (National Institute of Health Stroke Scale), Glasgow coma scale [GCS]) and neuroimaging (computed tomography head or MRI Brain) were prospectively enrolled. Details of demographics including age, sex, address, contact number, detailed history of event, presenting symptoms and signs, risk factors for stroke, blood pressure, GCS and NIHSS score, laboratory parameters and imaging findings (type of stroke, arterial territory involved, midline shift) were noted. Results: A total of 30 patients were enrolled. Most common age group was 61-65 years of age (24%) and 26-30 years of age (24%). Variable studies are Age, gender, onset of symptoms to decision of surgery, co-morbidities, etiology of stroke, pre-operative clinical signs and symptoms based on MRS, NIHSS, GCS, Hemisphere involved based on dominance, Imaging data like arterial territory involved, MLS and uncal herniation. Among these variables, uni-variate analysis showed age > 45 years and presence hypertension showed significant association (p <0.05) with poor outcome at the time of discharge. Conclusion: Careful individualized patient selection and surgery may improve the functional outcome for these patients. Furthermore, the possibility of long term cognitive and physical dependence needs to be discussed with the patients and their families before deciding upon decompressive hemicraniectomy as most of the patients receive home-based care through family members and local physicians in their long term follow up. Keywords: Decompressive Hemicraniectomy, NIHSS, GCS, MRS, CT scan, Intracranial ischemic infarct.

Background: Preeclampsia is a disorder of pregnancy associated with new onset hypertension, which occurs most often after 20weeks of gestation and frequently near term. Delivery is the ultimate cure for severe preeclampsia & eclampsia, because of the worsening of fetal & maternal status. A high incidence of perinatal morbidity and mortality is primarily related to premature birth, uteroplacental insufficiency, and low birth weight. The aim of the study is to evaluate the Feto-Maternal Outcome of severe Preeclampsia. Materials & Methods: This is a prospective analytical study done on 72 patients who are admitted in obstetrics gynaecology, at Jhalawar Medical College, Jhalawar, Rajasthan, India during one-year period. The study was done on the cases of severe preeclampsia fulfilling inclusion and an exclusion criterion’s who are admitted in labour room. Patient's detailed history, symptoms and signs of severe preeclampsia, imminent eclampsia was noted. General and Obstetric examination were carried out. Details regarding mode of termination and indication for termination, intraoperative, postpartum complications were noted. Neonatal assessment was done by paediatrician. Fetal and Maternal complications were noted. Follow up of Mother and Neonate were done upto discharge. Results: Out of the 72 patients in the present study, the maximum (55.55%) cases were in the age group of 25 to 34 years, most (51.38%) of them were Primigravida and most of the cases were ≥37 weeks of pregnancy (72.23%). The incidence of preeclampsia was higher in registered cases (83.33%). Only 38.03% delivered by normal vaginal delivery. While 61.97% delivered by C-Section. Twin pregnancy is one of the risk factors for preeclampsia. Out of the total 4.16% had twin pregnancy. One of the most important risk factors is previous history of hypertension which was seen in 5.55% females. Out of the total 97.18% were live birth and 2.72% died intrauterine in our study. Out the total 12 admitted in NICU respiratory distress syndrome was the most common reason (41.66%), 33.33% of them were shifted to NICU because of severe IUGR and 25% shifted due to asphyxia. Conclusion: This study thus confirms the manifestations of preeclampsia as a cause of both significant maternal and perinatal morbidity and mortality. Keywords: Fetomaternal outcome, Pre-eclampsia, Perinatal outcome, Outcome.

Background: Paraumbilical hernias pose significant health risks if left untreated, particularly in populations with high prevalence rates due to risk factors such as obesity and multiparity. Surgical repair is the standard treatment, with options including Mayo repair and mesh repair. This study makes an attempt to evaluate the incidence, clinical features, operative techniques and postoperative outcomes like recurrence and complications. It compares the modern technique of prosthetic mesh repair and suture repair of umbilical and paraumbilical hernias. Materials & Methods: This is a hospital based randomized controlled trial. 40 patients of umbilical and Paraumbilical hernia admitted in department of General Surgery, AIMS, Rajsamand, Rajasthan during one-year period. Surgical procedures done were Mayo’s repair and Prosthetic mesh repair. Twenty patients were selected for particular procedure randomly. Patients who underwent Mayo’s repair and 20 patients who underwent polypropylene mesh repair. Results: In this current series of 40 patients the majority of the patients belong to the age group 21-40 years of age. The major proportion of cases was women 67.5%. Age distribution in Mesh is 42.28±14.56 years; age distribution in mayo’s is 40.85±11.99 years. The commonest mode of presentation was with pain and swelling at the umbilical region. The main complaints in 15% of the patient were pain and tightness of the abdominal wall which was more in Mayo’s repair. Our study showed that there was no recurrence with mesh repair but 1 case had recurrence out of 20 Mayo’s repair (after 11 months). Conclusion: Prosthetic mesh repair is a technique with good postoperative outcome, low recurrent rate and excellent patient satisfaction. It could become the gold standard in adult umbilical and paraumbilical hernia repair, in the future. Keywords: Paraumbilical Hernia, Umbilical Hernia, Mayo’s Repair, Mesh Repair, Recurrence.

Background: To study the various ECG and echocardiographic pattern alterations that occur in cerebrovascular accidents and determine whether these alterations have any bearing on prognosis. Material and Methods: Within 24 hours of admission, an ECG and 2D echo were performed on 100 individuals who had suffered an acute stroke. Follow-up was conducted in the hospital to determine each patient's prognosis. Results: The most frequent ECG abnormalities seen in the brain infarct group were U-waves (51.47%), prolonged QTc (36.76%), T wave inversion (30.88%), and ST segment depression (30.88%). The most frequent anomalies in hemorrhagic stroke cases were U-wave (56.26%) and ST depression (56.26%). The most frequent 2D echo abnormality in both stroke types—that is, infarct and hemorrhage groups—was left ventricular dysfunction (23.53% and 56.26%, respectively). Mortality was high in patient with abnormal ECG (79%) (p>0.5). 79% of patients Survived with abnormal ECG. So was statistically insignificant (p>0.5). Patients with aberrant 2D echocardiography had a significant mortality rate (90.91) (p<0.001). Conclusion: QTc prolongation, ST segment depression, and U-waves are common ECG abnormalities in hemorrhagic strokes. U waves and QTc prolongation are the two most prevalent ECG abnormalities in ischemic stroke. The most prevalent 2D echocardiographic abnormality in stroke patients is left ventricular dysfunction. There is little predictive importance to ECG abnormalities in stroke patients. When predicting mortality in CVA, left ventricular dysfunction has predictive importance. Key Words: Stroke, Cerebrovascular accident, 2D echocardiography.

Background: Anastomotic leak is a highly concerning condition following intestinal anastomosis. The incidence of anastomotic leak ranges from 0.5% to 30% in the literature, with a resultant death rate of 10% to 15%. Numerous risk factors are recognized as being connected with it. This study aimed to identify and assess these predisposing characteristics. Materials and Methods: An observational study was conducted in the Department of General Surgery, Trichy SRM Medical College Hospital & Research Centre, Tamil Nadu, India, from May 2022 to May 2024. This study encompassed all patients who received hand-sewn gastrointestinal anastomosis, both in elective and emergency contexts. 60 cases were examined. Results: Nine percent of cases of post-operative anastomotic leakage resulted in a fatality rate. Leakage was associated (p=0.02) with increasing age, and 74% of patients had leaks were male. Anastomotic dehiscence was significantly associated with the following risk factors: diabetes mellitus (p=0.05), pallor (p=0.01), low hemoglobin (p=0.003), altered TLC count (p=0.007), low blood protein (p=0.001), low albumin (p=0.001), and longer surgery times (p=0.02). Predisposing factors that were not statistically significant included blood creatinine levels, hyperbilirubinemia, peritoneal cavity pollution, elective or emergency procedures, and the length of the anastomosis process. Conclusion: This study identified and evaluated the various risk factors linked to anastomotic leaks, determining that age, sex, anemia, sepsis, hypoproteinemia, hypoalbuminemia, and prolonged operative time are significant. We concluded that managing these factors will reduce the likelihood of anastomotic dehiscence. Keywords: Anastomotic leak, Dehiscence, Intestinal anastomosis, Risk factors, Anaemia, Hypoalbuminemia.

Background: Breast Carcinoma is one of the most common neoplasms in females. In India, it is the second most common cancer after cervical cancer. Most of the breast lesions usually present as a lump in the breast. Screening and early diagnosis of different neoplastic and non-neoplastic breast lesions is important for prompt intervention. Materials and Methods: This is retrospective study done in the department of pathology, in a tertiary care centre. A total of 154 cases of breast lesions were classified as neoplastic and non-neoplastic lesions. The neoplastic lesions were classified based on WHO classification of tumors of the breast. Results: Out of 154 cases, 152 cases (98.70%) were female. The peak age of the occurrence of the breast lesions was seen in the age group of 21-30 years (29.87%). The most common clinical presentation was breast lump 94 cases (61.03%). Right side was the predominant side noted in 76 cases (49.35%). Benign lesions were seen in the 113 cases (73.37%), out of which Fibroadenoma 79 cases (51.29%) was the most common lesion. Among the 35 cases (22.72%) of malignant lesions, 33 cases (N=33), (21.42%) were of Invasive Ductal Carcinoma (IDC). IDC of Grade II according to Nottingham grading system was the most common grade seen in 14 cases (42.42%). Axillary dissection was done in 27 cases (N=27), out of which 13 cases (48.14%) were positive for malignancy. On Immunohistochemistry, maximum cases of malignancy showed Estrogen Receptor (ER), Progesteron Receptor (PR) positivity and Human Epidermal Receptor 2 (HER2) Negativity in 12 cases (36.36%). Conclusion:The spectrum of breast lesions with clinico-radiological- pathological correlation provides beneficial information and helps in proper diagnosis and adequate treatment. Female education for self-breast examination, screening malignancies and awareness programs should be implemented and encouraged for reduction of morbidity and mortality. Keywords: Breast lump, Fibroadenoma, IDC, Nottingham grading system.

Background: Mesenteric lymphadenopathy is a notable finding in children presenting with abdominal pain. It may be associated with a wide spectrum of underlying aetiologies that may range from benign infections to more serious inflammatory or neoplastic conditions. Accurate identification of the etiology is essential for appropriate management and improving outcomes. Recognizing specific causes enables targeted treatment ensuring timely intervention that reduces morbidity and complications in the pediatric population. Materials and Methods: This cross-sectional observational study included 80 children aged 2-12 with recurrent abdominal pain and mesenteric lymphadenopathy. Demographic details, clinical history, and ultrasound (USG) evaluation were done. On ultrasound lymph node size, shape, location, echogenicity, free fluid, bowel wall thickening and signs of appendicitis were assessed. Diagnostic tests included complete blood count, CRP, ESR, blood culture, Widal test, Mantoux test, chest X-ray, urine and stool cultures. Abdominal CT or MRI was done in selected cases. For statistical purposes P value less than 0.05 was taken as statistically significant. Results: In this study of 80 children with mesenteric lymphadenopathy, 57.5% were boys and 42.5% were girls with a male-to-female ratio of 1:0.73. Abdominal pain characteristics varied, with 35% experiencing pain lasting 31–60 minutes, mainly localized to the umbilical region (20%) and right iliac fossa (15%). Most children were aged between 6–10 years. Etiological diagnosis showed bacterial infections in 37.5% of cases, primarily urinary tract infections (66.7%), followed by tuberculosis and enteric fever (16.7% each). Viral infections accounted for 12.5%. Miscellaneous causes were observed in 47.5% out of which predominantly functional abdominal pain (65.8%) was most common followed by constipation (21.1%) and gastrointestinal infections (13.2%). Conclusion: Early identification and thorough evaluation of mesenteric lymphadenitis in pediatric abdominal pain is important for accurate diagnosis thereby enabling appropriate treatment and preventing complications which may be seen in cases of delayed diagnosis. Keywords: Abdominal Pain, Children, Imaging, Ultrasound, Mesenteric lymph nodes.

Background: Microvascular complications such as diabetic neuropathy (DN), retinopathy (DR), and nephropathy (DN) are common in type 2 diabetes mellitus (T2DM) and may impact cardiac function. This study aimed to assess the relationship between microvascular complications and cardiac dysfunction in asymptomatic T2DM patients. Materials and Methods: A cross-sectional study was conducted with T2DM patients divided into two groups: those with and without microvascular complications. Various parameters, including anthropometric data, glycemic control (HbA1c), blood pressure, renal function (24-hour urine protein), and echocardiographic measures (e.g., left ventricular ejection fraction, stroke volume), were compared between the two groups. Results: Patients with microvascular complications had higher BMI (24.05 vs. 19.54, p<0.05), poorer glycemic control (HbA1c 9.83% vs. 8.77%, p<0.05), and elevated blood sugar levels (FBS: 166.57 mg/dL vs. 124.94 mg/dL, p<0.05). Proteinuria was significantly higher in this group (153.42 mg vs. 61.01 mg, p<0.05). Systolic dysfunction was more prevalent in the microvascular complications group (85.19% vs. 38.89%, p<0.05). Echocardiographic findings showed smaller left atrial (LA) volume, left ventricular end-diastolic (LVED) volume, and left ventricular end-systolic (LVES) volume, along with a lower left ventricular ejection fraction (50.78% vs. 56.64%, p<0.05). Additionally, stroke volume, fractional shortening, and cardiac index were lower in the microvascular complications group. Conclusion: Microvascular complications in T2DM are associated with significant cardiac dysfunction. Early detection and management of these complications including strict glycemic control are crucial to prevent cardiovascular issues in diabetic patients. Further studies should investigate the causal relationships and therapeutic interventions for this high-risk population. Keywords: Diabetic Cardiomyopathy, Microvascular Complications, Type 2 Diabetes Mellitus, Systolic Dysfunction, Echocardiography.

Background: The anatomy of paranasal sinuses is very complicated. Evaluation of the location and extent of sinonasal diseases by radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Plain radiography, computed tomography and magnetic resonance imaging are applied in evaluating the sinuses. Computed tomography is considered the radiologic method of choice in completely delineating the normal anatomy and anatomical variants of the paranasal sinuses and it is extremely useful in the pre-operative planning of endonasal surgeries. Keeping in view the potency of CT scans the present study has been undertaken to assess the anatomic variations of the paranasal sinuses by means of CT scans in patients. Material and Methods: The prospective non-randomized study was conducted in the department of Ear, Nose & Throat, GSVM Medical College and LLR & Associated Hospitals, Kanpur from January 2018 to October 2019. Total 50 patients between 15-50 years of age and with chronic rhinosinusitis not responding to three weeks of medical treatment were included in the study. The routine investigations like CBC, ESR,RBS,LFTs, KFTs, Serum electrolyte and X-ray PNS water views were conducted on the patients of study group during this period along with the CT PNS. Results: 50 Patients between 15-50 years of age were included in the study. Out of 50 patients, 32 (64%) were males, while 18 (36%) were females. Most of the patients ie. 40 % were found to belong in the age group of 15-20 years. Out of 50 patients 5(10%) patients presented with complications as a result of nasal surgery. As per the study out of 50 patients 45(90%) have shown improvement after nasal surgery. Conclusion: Computed Tomography of the paranasal sinuses has improved the visualization of paranasal sinus anatomy and has allowed greater accuracy in evaluating paranasal sinus disease. It evaluates the osteomeatal complex anatomy which is not possible with plain radiographs. Key Words: Chronic Rhinosinusitis (CRS), Paranasal sinus(PNS), Computed Tomography (CT).

Background: Birth Preparedness & Complication Readiness (BPCR) is an efficient and economical way of preventing Maternal Mortality and Morbidity in a developing country like India. Understanding and practising this strategy will enable the antenatal period as well as delivery and postnatal period with less complications for a woman. The study aims to measure the level of awareness about BPCR among Postnatal women. Material and Methods: The study was conducted as a Hospital based cross sectional study among Postnatal women delivered in Govt Thoothukudi Medical College Hospital. Data was collected from the post-natal mothers by interview method using pretested, prevalidated, semi-structured questionnaire comprising of socio demographic details and components of Birth Preparedness & Complication Readiness. Results: Of the 217 Postnatal women who participated in the study,54% were well prepared. Awareness of danger signs of pregnancy was 69.5% while awareness on danger signs on labour and postpartum period were 59.45% and 57.1% respectively. Conclusion: The study suggests that increasing awareness of BPCR through health education campaigns can significantly contribute to ensuring safer outcomes during and after pregnancy. Key Words: Birth Preparedness, Complication Readiness, Postnatal Women.

Background: To study the functional outcome following Total Hip Arthroplasty in various disorders of hip and efficacy of Primary Total Hip Arthroplasty by clinical and radiological signs in post-operative period. Material and Methods: This study was conducted in Department of Orthopaedics in patients presenting to the OPD and emergency for a period of 2 years were operated upon using cemented, uncemented and hybrid Total Hip Arthroplasty. Age ≥ 50 yrs of all primary osteoarthritis of the hip joint, avascular necrosis of hip with osteoarthritis, neglected cases of fracture neck of femur, failed hemiarthroplasty of hip and Secondary osteoarthritis due to healed infections are included in study. Results: 20 hips were operated for 17 patients for avascular necrosis (7 hips), fracture neck of femur (2 hips), ankylosing spondylitis (2 hips), failed hemiarthroplasty (3 hips) and osteoarthritis (6 hips). Harris hip score was used for evaluation of functional outcome which was on an average 35.88 (21-57) preoperatively and 91.05 (75-97) postoperatively. Age of patients ranges from 50-67 years. There is no pain in 94% of patients postoperatively and slight pain in 6% patients. No limp is present in 60% and slight limp in 40% of patients. The femoral component was in neutral alignment in 16 hips (80%), in less than 10o valgus in 2 hips (10%) and less than 10o varus in 2 hips (10%). No shift in the position of any femoral component or any crack in the cement mantle was seen. Postoperative superficial infection was seen in 1 patient. One hip had a lengthing of 1 cm. One hip had anterior dislocation. One patient with bilateral THR had a complication of DVT which was treated with anti-coagulants. Excellent results were achieved in 70% of patients, good results in 24% of patients postoperatively. Full weight bearing was achieved on 2nd postoperative day in all patients. Cemented THR is more cost efficient when compared to uncemented THR. Conclusion: It is concluded that in properly selected cases, THA offers a good procedure currently available for hip joint pathologies in selected patients. The Harris Hip Score significantly improved in these patients. Key Words: Total Hip Arthroplasty, Radiographic teardrop, Congenital Dislocation of Hip, Cemented Acetabular.

Background: Intraoperative penile erection during anesthesia is a significant complication that can disrupt surgical procedures, especially in pediatric patients. Dexmedetomidine, a selective alpha-2 adrenergic agonist, has been proposed as a solution due to its sedative and sympatholytic properties, but limited studies have evaluated its effectiveness in preventing and treating penile erection during pediatric surgeries. Aim: To evaluate the role of intravenous dexmedetomidine for prevention and treatment of intraoperative penile erection in pediatric patients. Material and Methods: The study involved male patients aged 1-14 with ASA grade I or II who underwent elective non-urological procedures. Patients were divided into three groups: Group I received no dexmedetomidine, Group II received 0.5 µg/kg dexmedetomidine preoperatively, and Group III received 0.5 µg/kg dexmedetomidine if a penile erection occurred intraoperatively. Hemodynamic parameters were recorded at baseline and throughout surgery, and post-operative sedation was monitored using the Ramsay Sedation Score. Results: Intraoperatively, 16.7% of patients in Group I had an erection of the penis, 0% in Group II and 100% in Group III. After treatment, only 3.15% of patients in Group III had a sustained penile erection. Significant differences in postoperative pain scores were observed, with Group I showing increased scores at all-time intervals compared to Group II and Group III (p < 0.001). The occurrence of problems, including bradycardia and hypotension, was similar in Groups II and III (p > 0.05), but slightly increased in Group III. Conclusion: Dexmedetomidine is effective in preventing and managing penile erections in pediatric patients undergoing non-urological surgeries. Preoperative administration reduces penile erection incidence and provides post-operative pain management. However, caution is advised due to potential bradycardia and hypotension risks. Keywords: Dexmedetomidine, Intraoperative Penile Erection, Pediatric Anesthesia, Post-Operative Pain, Ramsay Sedation Score.

Background: Chronic kidney disease (CKD) is frequently accompanied by cardiovascular complications, including left ventricular hypertrophy (LVH), a significant risk factor for adverse cardiovascular outcomes. Objective: To evaluate the relationship between proteinuria, estimated glomerular filtration rate (eGFR), and left ventricular mass index (LVMI) in CKD patients. Materials and Methods: A prospective cross-sectional study was conducted at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, from September 2022 to September 2023. The study included 100 CKD patients, aged 18 years or older, managed with medical therapy alone, excluding those on hemodialysis. Data collected included serum creatinine, urine protein-to-creatinine ratio (PCR) for proteinuria, and LVMI measured through 2D echocardiography. Demographic and clinical data were obtained via structured interviews and laboratory evaluations. Descriptive statistics summarized demographic data. Pearson’s correlation coefficient and Chi-square tests were used to assess associations between LVMI and variables, including eGFR and PCR, with a significance level set at p < 0.05. Results: The mean age of participants was 65.17 ± 11.56 years, with 66% males. Hypertension (83%) and diabetes (51%) were the most common comorbidities. Moderate to severe LVH was observed in 57% of patients. A significant association between proteinuria (PCR) and LVMI (p = 0.014) was found, with higher PCR levels corresponding to increased LVMI. However, no statistically significant association was observed between eGFR stages and LVMI (p = 0.453). Conclusion: Proteinuria is significantly associated with LVH in CKD patients, emphasizing its importance as a marker for cardiovascular risk. Conversely, eGFR did not show a significant relationship with LVMI, suggesting that factors beyond renal function may influence LVH in CKD Keywords: Chronic kidney disease, proteinuria, glomerular filtration rate, left ventricular hypertrophy, cardiovascular risk.

Background: Pancreatic diseases, such as chronic pancreatitis and pancreatic cancer, pose diagnostic challenges due to their subtle progression and complex pathology. Conventional CT imaging often lacks the precision necessary for early detection. Dual-energy computed tomography (DECT), with its enhanced contrast-to-noise ratio (CNR) and ability to perform iodine mapping, offers potential for improved diagnostic accuracy in pancreatic pathologies. Materials and Methods: This cross-sectional observational study included 42 patients with known or suspected pancreatic lesions at the Department of Radiodiagnosis, A.J. Institute of Medical Sciences, Mangalore. Patients underwent DECT scans using the Siemens SOMATOM go Top system. Post processing monoenergetic images were acquired at 50 keV and 60 keV and compared with conventional 120 kVp images with respect of image quality and confidence in detecting pancreatic lesion by calculating Contrast to Noise ratio [CNR]. Results: Out of 42 patients, 79% had abnormal pancreatic findings, with chronic calcific pancreatitis being the most prevalent (23.8%). The mean DECT value at 50 and 60 keV in patients with suspected pancreatic lesions in this study found to be 0.54 ± 0.36 and 0.46 ± 0.32 (Mean ± SD) respectively. The mean Conventional CT value at 120 keV in patients with suspected pancreatic lesions in this study found to be 0.31± 0.26(Mean ± SD). DECT at 50 keV showed significantly higher CNR compared to conventional CT at 120 keV (p < 0.001). DECT exhibited high sensitivity (90.9%) and specificity (88.8%) for detecting pancreatic lesions. Conclusion: DECT provides enhanced diagnostic accuracy compared to conventional CT, particularly lower kiloelectron volt monochromatic energy images. This improvement has the potential to reduce morbidity and mortality associated with pancreatic diseases. Keywords: Chronic pancreatitis, contrast-to-noise ratio, dual-energy CT, iodine mapping, pancreatic lesions, ROC analysis.

Background: This study aims to compare the efficacy of CT and nasal endoscopy findings for the evaluation of CRS in patients with persistent complaints despite appropriate medical therapy. Aim: To correlate the clinical features and nasal endoscopic features in the diagnosis of rhinosinusitis. Material & Methods: The present study was conducted in the department of ENT, PES Institute of Medical Sciences & Research (PESIMSR), Kuppam, Andhra Pradesh, India. It was a Hospital-based Cross-sectional study, involved 88 participants studied for a period of 2 years from September 2019 to September 2021. Patients with symptoms of rhino sinusitis-Facial pain, headache, nasal obstruction, nasal discharge and decrease sense of smell. Results: In the present study participants maximum of 36.4% were between 25-34 years of age and a minimum of 4.5% are among 55-64 years of age-group and the mean age was found to be 36.03±9.7yearsand lowest age of 16 years and the highest age recorded was 59years. Among the patient’s maximum of 56.8% were having acute sinusitis followed by 11.4% sub-acute and 31.8% as the chronic type of sinusitis. A maximum of 54.5% had nasal obstruction followed by 53.4% with nasal discharge the least symptom was hyposmia or anosmia as 3.4%. Among the study participants maximum of 54.5% had a headache as a minor symptom followed by the heaviness of the head and the least were with lethargic symptoms. Maximum of 46.6% presented with excessive sneezing followed by postnasal drip and watering of the eye. On endoscopy, 63.6% of the participants had mucosal congestion and 36.4% had no mucosal congestion.51.1% had thin and clear mucosal discharge and 29.5% had thick purulent discharge and only 19.3% had no mucosal discharge. Among the study participants, it was found that a maximum of 37.5% of acute sinusitis had mucosal congestion followed by 20.5% of chronic sinusitis and least of 5.7% of sub-acute sinusitis patients had mucosal congestion compared to sub-acute and chronic sinusitis and the difference was found to be highly significant with P-value 0.01. Conclusions: Nasal endoscopy has essential role in accurately diagnosing this pathology, which includes anatomical variations as well as polypoid changes in the mucosa. DNE is outpatient procedure, relatively economic with no radiation hazards, aids in early diagnosis and medical management of CRS. Keywords: Chronic Rhinosinusitis, Computerised Tomography, Diagnostic Nasal Endoscopy.

Background: Chronic rhinosinusitis (CRS) significantly impacts quality of life, with symptoms like nasal obstruction and facial pain persisting over 12 weeks. Endoscopic sinus surgery (ESS) is a favored intervention for CRS refractory to medical management, with partial middle turbinectomy (PMT) often considered to enhance surgical outcomes by reducing postoperative adhesions. However, PMT’s influence on sinus physiology and potential complications remains debated. Materials and Methods: A prospective study of 70 CRS patients, aged 18-50, was conducted from August 2023 to July 2024. Patients were divided into two groups: Group 1 underwent ESS with PMT, and Group 2 had ESS without PMT. Data on symptoms, endoscopy, and CT findings were collected and analyzed postoperatively over 12 weeks to assess outcomes. Results: Group 1 demonstrated greater symptom relief, with nasal obstruction reduced to 14.3% versus 34.3% in Group 2 (p=0.0021), and nasal discharge decreased to 22.9% compared to 42.8% in Group 2 (p=0.008). Facial pain improved across both groups, though differences were statistically insignificant. Conclusion: PMT in ESS shows promise in enhancing symptom relief for CRS, particularly for nasal obstruction and discharge. This suggests PMT may be beneficial as an adjunct technique for improving postoperative outcomes in CRS management. Keywords: Chronic rhinosinusitis, endoscopic sinus surgery, partial middle turbinectomy, nasal obstruction, nasal discharge, postoperative outcomes.

Background: The evaluation of specific biomarkers can offer valuable insights into the prognosis and treatment outcomes for colorectal carcinoma (CRC). This study investigates the correlation between carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) levels with CRC stage at presentation and clinical outcomes, alongside fecal occult blood test (FOBT) variations and tumor response rates over time. Materials and Methods: A cohort of 38 CRC patients was prospectively followed. Biomarker levels (CEA, CA 19-9) were measured at baseline, three months, six months, and one-year post-treatment. Tumor response was assessed using RECIST criteria, and survival outcomes were analyzed using Kaplan-Meier survival analysis. FOBT positivity rates were also tracked to examine associations with disease progression and response to therapy. Results: Most participants (63.2%) were male, with a median age of 61-70 years. CEA levels >5 ng/mL at baseline were significantly associated with advanced disease stage and poorer outcomes (P = 0.002), aligning with findings in prior literature. CA 19-9 levels were notably elevated in metastatic cases at six months but showed inconsistent correlation with survival outcomes. Complete tumor response rates increased significantly from 31.6% at three months to 47.4% at one year. Patients with elevated baseline CEA levels (>100 ng/mL) demonstrated a lower mean survival of 10.4 months compared to 12.0 months in those with ≤5 ng/mL (P = 0.0014). Conclusion: CEA serves as a reliable prognostic marker for CRC progression and survival, while CA 19-9 may have value in combination with other indicators. Elevated FOBT rates at different time points correlated with changes in tumor burden, suggesting its utility in monitoring disease response. These findings support the integration of biomarker analysis in routine CRC prognosis and treatment monitoring. Keywords: Colorectal carcinoma, carcinoembryonic antigen, carbohydrate antigen 19-9, fecal occult blood test, survival analysis.

Background: Marathon running is an endurance sport that requires substantial physical and mental commitment, attracting participants with diverse motivations. While prior research has explored these motivations, there is a need for more detailed qualitative and quantitative analysis to fully understand these factors. This study aims to investigate the motivational factors influencing marathon runners, using both qualitative interviews and the Motivations of Marathoners Scales (MOMS). Material and Methods: A mixed-method approach was employed in this study, combining qualitative interviews with the Motivations of Marathoners Scales (MOMS) to assess motivational factors. Eighty-seven marathon runners (aged 30-55, 57% male [n = 50], 43% female [n = 37]) were recruited from various running clubs and marathon events across the country. Participants ranged from novice to experienced runners, with running experience spanning 1 to 15 years. Semi-structured interviews were conducted to explore personal narratives, while MOMS was used to quantify motivational dimensions, including personal goal achievement, psychological coping, physical health, and social interaction. Data from the interviews were analyzed using thematic analysis, and MOMS scores were statistically analyzed to identify key motivational patterns. Results: Thematic analysis revealed five primary motivational factors: personal achievement (75.9%, n = 66), psychological well-being (67.8%, n = 59), social influence (56.3%, n = 49), health benefits (71.3%, n = 62), and escape from daily routine (48.3%, n = 42). MOMS results indicated that personal goal achievement had the highest mean score (M = 4.5, SD = 0.7), followed by psychological coping (M = 4.2, SD = 0.8). A significant correlation (r = 0.68, p < 0.01) was found between social influence and sustained marathon participation. Conclusion: The findings underscore the multifaceted motivations behind marathon running, with personal achievement and psychological well-being being the most prominent. These insights suggest that training programs and motivational strategies should be tailored to these diverse motivational needs, potentially enhancing marathon participation and performance. Keywords: Endurance Sports, Marathon Running, Motivation, Physical Health, Psychological Well-being, Qualitative Research, Social Influence.

The objective of this study was to compare uptake and hearing improvement in patients operated by Underlay or Interlay technique of Endoscopic Tympanoplasty. This is a retrospective study conducted at Northern Railway Central Hospital, New Delhi in patients operated in a 5 years duration. A total of 134 patients with Chronic Otitis Media who were operated by either Underlay or Interlay Endoscopic Tyrnpanoplasty were retrospectively analyzed. Graft Uptake and Hearing Improvement was recorded 6 months after surgery and the two groups were compared. Tragal Perichondrium was harvested by Transcanal approach, was used as the graft material in all cases. The graft Uptake rate was 90.7% in the Underlay group and 98.5% in the Interlay group, in our study. The difference in the graft uptake rate in the two groups was statistically significant. The hearing improvement in terms of ABG closure was seen in both the groups, the difference in improvement in the two groups was not statistically significant. Keywords: Endoscopic Tympanoplasty, Chronic Otitis Media, Tragal Perichondrium, Underlay technique, Interlay technique.

India, it accounts for approximately 500,000 new cases annually.[2] Over 90% of cases is predominantly contributed by oral squamous cell carcinoma (OSCC), with major risk factors including tobacco and alcohol use. The condition has a substantial influence on patients' quality of life, including communication and nutrition. Most patients present with advanced stages, which results in low survival rates. Our study intends to assess the demographic profile, lifestyle habits, and clinical manifestations of oral cancer among railway patients from northern region with the goal of highlighting the burden and informing preventive initiatives. Aim and Objectives: The study aims to assess the incidence of oral and oropharyngeal malignancies in patients at NRCH ENT OPD, evaluate exposure duration to individual and combined risk factors, and analyse the clinicopathological staging at presentation Material and Methods: A Cross sectional study study done on 100 patients over the age of 18 years, who were biopsy proven to have carcinoma of oral cavity or oropharynx or referred to us from other centers following diagnosis of the disease from AUG 2017 to APRIL 2019. Conclusion: Most participants were from age 51-60, with a higher prevalence among males. Common presenting symptoms included pain, non-healing ulcers, and difficulty swallowing. Main risk factors identified were tobacco chewing, smoking, and alcohol consumption, with longer durations of use. Most patients presented at T4 stage, and many had comorbidities like hypertension and diabetes. Key Words: Oral cancer, Oropharyngeal cancer.

Background: Post-operative fever being common after orthopaedic surgery can be due to infectious or non-infectious causes. Identifying infectious cause early is very important to start antimicrobial therapy. Routine investigations (CBC, CRP) are non-specifically raised even in Non-infectious fevers. However, Procalcitonin levels has been found to be a reliable marker specifically raised only when there is an infectious process occurring within the body. Procalcitonin levels have been a reliable marker to identify infections after other major surgeries (Cardiac, Abdominal and Neurosurgeries). The reliability of serum procalcitonin to diagnose infections after orthopaedic surgeries has not been established and studies are lacking. Thus, we assess the reliability of serum procalcitonin to diagnose infections after orthopaedic surgeries in this study. Material and Methods: We performed a study on 58 patients developing fever within 14 days post orthopaedic surgery. Conventional Biomarkers (CBC, CRP) and Serum procalcitonin was sent for on day 0, day 1 and day 3 after onset of fever. To confirm fever due to infectious cause blood culture and other supportive investigations were sent on the day of onset of fever. We compared the conventional biomarkers to serum procalcitonin and studied the trend of these biomarkers. Using this data, the accuracy of serum procalcitonin in diagnosing infectious fevers after orthopaedic surgery was assessed. Results: Of the total number of patients studied (n=58), 33 patients were allocated into the Non-infectious fever group and 25 patients were allocated into the infectious group after complete clinical and laboratory and radiological evaluation. The area under ROC curve for procalcitonin on Day 3 (0.837) was the highest among all parameters while CRP on day 3 (0.610) had a significantly lesser area under the ROC curve. Procalcitonin had a sensitivity of 80% and specificity of 64% on Day 0 and it showed highest sensitivity of 84% and specificity of 96% on Day 3 for Cut off value of ≥ 0.25 ng/ml. Conclusion: Procalcitonin is more accurate than other biomarkers (WBC Counts, CRP) in diagnosing post-operative fever due to infection. Procalcitonin is more sensitive (84%) and specific (96%) to differentiate post-operative fever due to infection and fever due to non-infectious causes (Systemic inflammatory response syndrome - SIRS) with cut-off value of ≥ 0.25 ng/ml on Day 3. Keywords: Orthopaedic surgery, Post operative fever, Procalcitonin, Infection, Sepsis, ROC curve.

Background: To compare the efficacy and safety of newer approved oral anticoagulant rivaroxaban with conventionally used aspirin in prevention of Venous Thromboembolism (VTE) following major orthopedic surgeries. Material and Methods: 50 patients who were operated for spine, pelvis and lower limb surgeries were randomized into two groups A and B. Group A received 150 mg of acetylsalicylic acid (Aspirin) and Group B received 10 mg of Rivaroxaban daily for a period of 35 days. Follow up was performed at 2, 4 and 6 weeks and evaluated clinically, radiologically (Venous Doppler study) and with necessary investigations. Outcomes of interest included, incidence of deep vein thrombosis, pulmonary thromboembolism, incidence of major bleeding, clinically relevant bleeding, minor bleeding, and wound complications like hematoma, infections and myocardial infarction, stroke, readmissions, re-operations and mortality. Results: There were no significant differences between two groups with respect to any outcome measures like deep vein thrombosis (DVT), pulmonary thromboembolism, local complications, systemic complications, bleeding, readmission to hospital, reoperation, or death (p > 0.05) between groups. Conclusion: Aspirin was found to be equally efficient and safe when compared to Rivaroxaban in chemoprophylaxis of Venous Thromboembolism (VTE) following major orthopedic surgeries. Keywords: Venous Thromboembolism (VTE), Rivaroxaban, Aspirin.

Background: Phlebotomy, also known as blood letting or venesection and is the preferred treatment for blood disorders in which the red blood cells are removed. Therapeutic phlebotomy (TP)is indicated as an integral component of treatment of medical conditions. It is the cheapest and most effective method for removal of blood. Aim and objective: Determine effect of TP by recording the pre and post Hb, Hct and blood plasma volume and various indications for TP. Material and Methods: We conducted a retrospective study of the therapeutic phlebotomy procedure in 131 patients, covering 286 episodes. Clinical details were recorded to evaluate improvement, and changes in hemoglobin, hematocrit, and plasma volume were determined by comparing pre- and post-procedure blood volumes. Results: Most common indication observed was polycythemia vera under evaluation (45%). Pre and post TP, Hb and Hct values were recorded in 45 patients. Mean decrement in Hb was 4.20 ± 0.10 g/dL and Hct was 11.96 %, with significant variability among patients. Plasma volume was increased by 0.30 cum2 and there is progressive increase in plasma volume from baseline in relation to frequency of TP. Conclusion: Therapeutic phlebotomy is effective and minimally invasive treatment that reduces Hb, Hct, total blood volume and expands plasma volume. IHBT department should manage patients actively, while ensuring proper education and communication during follow-ups. Keywords: TP- therapeutic phlebotomy, Hb – hemoglobin, Hct – hematocrit, PV- plasma volume, EPO- erythropoietin level.

Background: Maternal near-miss (MNM) cases, which involve women who survive severe pregnancy-related complications, provide critical insights into maternal health care quality. This study aims to analyze the etiology and management of MNM in a tertiary care setting in Thrissur, Kerala, over a one-year period. Materials and Methods: A retrospective observational study was conducted on MNM cases admitted to the Jubilee Mission Medical College from January to December 2023. Data were collected from hospital records, including patient demographics, clinical presentations, comorbidities, and interventions. Statistical analyses, including chi-square and T-tests, were performed to determine associations between variables. Results: Out of 50 cases reviewed, hemorrhage (42%) and hypertensive disorders (30%) were the primary causes of MNM. Most cases occurred in late preterm to term gestational ages, with 74% referred from other centers. Significant associations were noted between young age, late gestational age, and the necessity of ICU care. Management strategies varied by case complexity and included massive blood transfusions and emergency hysterectomies. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of MNM. Improving early identification, strengthening primary and secondary care, and ensuring prompt referrals are essential for reducing severe maternal morbidity. Keywords: Maternal near-miss, hemorrhage, hypertensive disorders, tertiary care, multidisciplinary approach.