European Journal of Cardiovascular Medicine

Background and Objectives: Despite advancements in minimally invasive gynecological surgery, surgical site infections (SSIs) continue to be a significant cause of postoperative morbidity. Although the incidence of SSIs is reduced with laparoscopic hysterectomy than with open surgeries, they can happen, which can lengthen a patient's hospital stay and drive up healthcare expenses. The purpose of this prospective study was to examine surgical site infections after laparoscopic hysterectomy and to identify their prevalence, causes, microbiological profile, and clinical consequences. Materials and Methods: This prospective observational study was carried out in a tertiary care hospital over one year, involving 50 women receiving elective laparoscopic hysterectomy for benign gynecological conditions. This study was conducted at the Department of Gynecology, Surabhi institute of Medical sciences, Siddipet, Telangana, India from the April 2021 To March 2022. Patients were monitored for 30 days postoperatively for the emergence of SSIs, categorized according to established criteria. Information about demographic factors, comorbidities, surgical details, perioperative antibiotic prophylaxis, and postoperative results was collected. Microbiological examination was conducted for infected cases.  Results: The overall incidence of surgical site infections was 12%, with 6 patients out of 50 developing such illnesses. Four patients, or 8%, had superficial incisional SSIs, and two patients, or 4%, had deep incisional SSIs; no organ or space infections were detected. Compared to non-infected patients, patients with SSIs had an average age of 52.3 ± 6.1 years. Prevalence of diabetes mellitus (66.7% vs. 22.7%, p = 0.03), body mass index (BMI) of 30 kg/m² or higher (50% vs. 18.2%, p = 0.04), and surgical time (83.3% vs. 31.8%, p = 0.01) were all substantially linked to the development of surgical site infections (SSIs). After Escherichia coli (33.3% of the time), Staphylococcus aureus (50%) was the most frequently isolated bacteria. The average length of time a patient stayed in the hospital after surgery was 7.2 ± 1.6 days for patients with surgical site infections, compared to 3.9 ± 1.2 days for patients without infections. Conclusion: A total of 12% of patients who underwent laparoscopic hysterectomy developed an infection at the surgical site, most commonly a superficial incisional infection. Many factors increased the likelihood of complications, including advanced age, obesity, diabetes mellitus, and a lengthy surgical procedure. Additional strategies to decrease the occurrence of surgical site infections (SSIs) following laparoscopic hysterectomy include early detection of high-risk patients, rigorous adherence to perioperative infection control protocols, and management of co-morbid conditions.

Background: Digital eye strain (DES) has become common in adolescents because of sustained near work on smartphones and other screens. Reduced blink rate during screen viewing may worsen ocular-surface symptoms. Objectives: To determine the prevalence of DES symptoms and evaluate associations between daily screen time, blink rate, and DES symptom severity in adolescents. Methods: A cross-sectional observational study was conducted among 100 adolescents. Screen exposure (hours/day), continuous use without breaks, and primary device were recorded using a structured questionnaire. Spontaneous blink rate (blinks/min) was measured during a standardized on-screen viewing task. DES symptoms were captured using a five-item symptom score (range 0–20), and severity was categorized as mild (1–7), moderate (8–14), and severe (15–20). Associations were tested using ANOVA/χ², Pearson correlation, and multivariable linear and logistic regression. Results: Mean age was 15.2 ± 1.6 years; 56% were males. Mean daily screen time was 4.3 ± 1.9 hours/day, and 48% reported >4 hours/day. DES symptoms were present in 67%. Blink rate declined across screen-time strata (15.4 ± 3.6, 13.1 ± 3.1, and 10.9 ± 2.8 blinks/min in the low, moderate, and high screen-time groups, respectively; p < 0.001). Screen time correlated positively with symptom score (r = 0.52, p < 0.001) and negatively with blink rate (r = −0.46, p < 0.001). On multivariable analysis, screen time independently predicted higher symptom scores (β = 0.89 per hour; 95% CI: 0.54–1.24; p < 0.001), while higher blink rate was protective (β = −0.37 per blink/min; 95% CI: −0.58 to −0.16; p = 0.001). Screen time >4 hours/day increased the odds of DES (adjusted OR = 4.6; 95% CI: 1.8–11.7; p = 0.002). Conclusion: Higher screen exposure in adolescents was associated with reduced blink rate and greater DES symptom burden. Behavioral strategies promoting regular breaks and conscious blinking may help mitigate DES

Purpose: The study's primary objective is to compare the conventional dose of bupivacaine and a low dose of bupivacaine-fentanyl spinal anaesthesia in maintaining hemodynamic stability in patients undergoing TURP with a satisfactory sensory blockade.  Methodology: Patients posted for elective TURP surgery were divided into two groups of 47 each. Group F (n=47) consisted of patients who received low-dose bupivacaine–fentanyl spinal anaesthesia [bupivacaine 5 mg with fentanyl 25mcg+ normal saline 0.5 ml]. And group B (n=47) consisted of patients who received a conventional dose of bupivacaine [bupivacaine 75 mg + normal saline 0.5 ml]. A combined spinal epidural technique was used. The peak dermatomal level of sensory block, the time to reach this level, motor blockade at the time of reaching peak sensory level, time to two-segment regression, and time to S2 sensory regression were recorded. Motor blockade was assessed with a Bromage scale(0=no motor block,1=hip blocked,2=hip and knee blocked,3=hip, knee, and foot blocked). Duration of motor block was considered as the time when Bromage score returned to zero. The pain was assessed every 10 minutes from the beginning of surgery using a 10-cm visual analogue pain scale. Adverse effects if any were recorded. Outcome variables were the level of segmental spinal block and any adverse events like a decrease in BP or decrease in Heart rate.  Results: The peak sensory level attained in both groups was similar and adequate for surgery but the time to reach peak level was found to be significantly faster with the conventional dose. Two-segment regression difference and duration between the groups were not found to be statistically significant though the S2 regression was found to be faster in the conventional dose group and statistically significant. This was even though a lower dose was used in group B. The occurrence of hemodynamic instability (hypotension, bradycardia) was more in group B compared to group F, in which patients received low-dose bupivacaine (1mg) combined with 25mcg fentanyl. The occurrence of hypotension was 42.6% in group A compared with 29.8% in group B. The occurrence of bradycardia was 23.4% in group B compared with 12.8% in group F.Sensory block was adequate for all surgery in both groups.  Conclusion: Low-dose bupivacaine with fentanyl spinal anaesthesia used in TURP cases decreases the occurrence of hemodynamic instability (hypotension and bradycardia) in elderly patients while providing adequate sensory block for the procedure

Myocardial bridging, characterized by a segment of the coronary artery tunneled through myocardial tissue, varies significantly in its clinical manifestation and relevance. Despite its frequent observation during coronary angiography, its implications remain controversial. This study aims to clarify the anatomical and clinical significance of myocardial bridging through a comprehensive analysis of human cadavers. Objectives: The primary objectives are to evaluate the prevalence and morphological characteristics of myocardial bridging in a diverse set of human cadavers and to correlate these findings with potential clinical implications, including its role in myocardial ischemia and sudden cardiac death. Methods: A total of 150 cadavers were systematically dissected to examine the presence, location, length, and depth of myocardial bridges over the coronary arteries. Each identified bridge was assessed for arterial involvement and measured for dimensions. The data were then analyzed statistically to determine the prevalence and morphological patterns, followed by a review of clinical records when available to hypothesize the clinical relevance of the findings. Results: Myocardial bridges were observed in 45% of the cadavers, with the most common location being the mid-segment of the left anterior descending artery. The average length and depth of the bridges were significantly associated with the occurrence of severe coronary artery disease in the corresponding vessel. A noteworthy correlation was found between deeper and longer bridges and records of myocardial ischemia or sudden death, suggesting a potential clinical impact. Conclusion: The study confirms the substantial prevalence of myocardial bridging in a general population and provides detailed anatomical descriptions. The correlation between bridge characteristics and adverse cardiac events underscores the clinical significance of thorough cardiovascular assessment and management in patients with diagnosed myocardial bridging. Further research is necessary to understand the pathophysiological mechanisms and to develop effective strategies for risk stratification and treatment.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health concern associated with significant morbidity and mortality. Cardiac involvement, particularly left ventricular dysfunction (LVD), has gained attention as a common comorbidity in COPD patients. This prospective study aimed to elucidate the relationship between COPD and LVD, exploring incidence, predictors, clinical implications, and potential interventions. Methods: A cohort of 300 COPD patients, aged 40 years and older, underwent baseline assessments and regular follow-up visits over 24 months. Echocardiography, spirometry, and clinical data were collected. Predictors of LVD were identified using Cox proportional hazards models. Longitudinal changes in left ventricular ejection fraction (LVEF) and clinical outcomes were analyzed. Results: Over 24 months, LVD incidence increased from 0% at baseline to 28.3%. Age (HR 1.08 per year), current smoking (HR 2.15 vs. never smokers), and severe COPD (HR 3.20, GOLD Stage 4 vs. Stage 1) were significant predictors of LVD. LVEF declined progressively (from 57.8% to 52.2%). LVD was associated with higher hospitalizations (58.3% vs. 33.3%), mortality (25% vs. 8.3%), and exacerbations (133.3% vs. 62.5%) compared to non-LVD patients. Conclusion: This study reveals the dynamic relationship between COPD and LVD. Age, smoking, and disease severity were identified as predictors of LVD. The decline in LVEF over time and its impact on clinical outcomes underscore the clinical relevance of LVD in COPD patients. Comprehensive management

Background: Persistent inflammation of the middle ear and mastoid cavity that manifests as recurrent ear discharge or otorrhoea due to a tympanic membrane perforation is known as chronic suppurative otitis media [1]. Objectives:  1) To categorize active chronic suppurative otitis media into tubotympanic and atticoantral disease. 2) To find out microbiological organisms responsible for both these categories (tubotympanic and atticoantral) and their sensitive drugs by culture and sensitivity report. Material & Methods: Study Design: Prospective Hospital based observational study. Study area: Department of E.N.T, Narayana Medical College and Hospital, Nellore, Andhra Pradesh. Study Period: June 2021 – May 2022.   Study population: Patients with CSOM of all age groups and both sexes attending the Narayana Medical College and Hospital, were selected randomly for the study. Sample size: study consisted a total of 50 cases. Sampling method: Simple random method. Results: Majority of pseudomonas infection showed mucopurulant type of discharge (50%) followed by S. aureus (33.33%). Purulent discharge was common in Pseudomonas (37.5%) and S. Aureus (37.5%). Mucoid discharge was common in Klebsiella (16.67%) followed by pseudomonas (27.78%) infection. It is interesting to know that 100% of no growth had mucoid discharge. Chi square was used to find the association between bacteria and discharge; and it was found not significant. Conclusion:  Out of 50 cases, 56 ears were examined, 51 pathogenic organisms were isolated. Only aerobic bacteria were isolated in the present series. P. aeruginosa was the most common organism isolated 23 (41.07%), followed by S. aureus 15 (26.79%), Klebsiella 5 (8.93%), E. coli 3 (5.36%), Proteus 3 (5.3%), Acinetobacter 1 (1.79%). No growth was found in 5 (8.93%) and commensal was found in 1 (1.8%) of discharge. Cf was the most effective antibiotic followed by Ak, G, Ce. In both TTD, AAD, no anaerobic organisms were cultured.

Background:  Tympanoplasty1 is a surgical procedure to eradicate the disease in the middle ear and to reconstruct the hearing mechanism with or without tympanic membrane grafting. While Myringoplasty3 is a surgical procedure in which the reconstructive procedure is limited to repair of tympanic membrane perforation assuming that middle ear ossicles are functioning normally, eustachian tube is patent, and the patient has a good cochlear reserve. Objectives: 1. To evaluate pre and postoperative audiological status in Type I Tympanoplasty. 2. To evaluate the audiological outcome by using different graft materials 3. To study the effect of time taken for graft uptake on the audiological outcome. 4. To study the effect of Valsalva maneuver on the audiological outcome. Material & Methods: Study Design: Prospective Hospital based observational study. Study area: Department of E.N.T, Narayana Medical College and Hospital, Nellore, Andhra Pradesh. Study Period: October 2021 – March 2022.   Study population:  Patients with CSOM tubo tympanic disease who underwent Type 1 tympanoplasty by underlay technique in the Department of ENT. Sample size: study consisted a total of 60 cases. Sampling method: Simple random method. Study tools and Data collection procedure: All the patients who presented with symptoms and signs suggesting tubotympanic type CSOM were submitted to an assessment protocol, based on a guided history taking, specific physical exam (otoscopy), and subjected to audiogram. During history taking, the patients were questioned about disease onset, and if they had undergone previous otologic surgeries. A detailed proforma was filled for each patient with regard to history, clinical examination, investigations, surgical procedures, postoperative period &follow up visits. Audiological evaluation (pure tone audiometry) done preoperatively, 3 months & 6 months after surgery and the results were tabulated. Results: The audiological improvement (average audiological gain) is more with temporalis fascia (11.4 dB) when compared to tragal perichondrium (9.71 dB) and tragal perichondrium with cartilage graft (8.62 dB). Audiological benefit was found to correlate with the time taken for graft take up, as the time taken for graft uptake increases, the hearing gain was found to decrease post operatively. Conclusion: In this series considerable improvement has been achieved in hearing in majority of cases (93.34%). Audiological outcomes are better for temporalis fascia followed by tragal perichondrium and tragal perichondrium with cartilage. Incorporation of valsalva maneuver may add some benefit postoperatively on surgical outcome. Type of surgical approach has no influence on audiological outcome in the present study.

Background: Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients. Materials and methods: Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively. Result: A total of 70 patients were studied which included 45 males and 25 females. Out of these mild AA was seen in 15 males and 10 females, moderate AA was found in 30 males and 15 females. We did not get any cases of alopecia totalis (AT), alopecia universalis (AU) or ophiasis. Conclusion: Women with hair loss can benefit from higher ferritin levels

Background: Acne scarring commonly seen in young adults causes marked psychological distress. Commonly used procedural treatments for post‑acne scarring have limited efficacy. This prospective, randomized study was undertaken to evaluate the efficacy and adverse effects offractional CO2 laser, microneedling, and platelet‑rich plasma (PRP) in post‑acne scarring. Materials and methods: This are a prospective, descriptive and hospital-based study. Total of 140 cases were enrolled in study carried out for 1 year in the Department of Dermatology at tertiary health centre and medical college with subsequent follow up of up to six months. Prior to the study, an institutional ethical committee clearance was obtained. Patients with acne scars under the groupings of a score > 3 points on Global Acne Scarring Classification Scale were enrolled. Result: Out of 70 patients treated with fractional CO2 laser, 01 patients had satisfactory response i.e. 1.4% improvement in point score, majority of patients had very good response 36 i.e. 51.5% improvement in point score, 26 patients were in the good response category 37.1% improvement in point score) and patients had excellent results. The objective score was calculated for derma roller therapy, and the results indicated that the baseline mean objective score which was 28.99±2.20 was reduced to 18.85±1.85 after the treatment. This difference was found to be highly significant with p value as 0.000. The reduction in the objective scores was found to be 39.69% Conclusion: Fractional Co2 laser resurfacing is more efficacious than micro needling with longer down time interfering with daily activity of patients and mandatory avoidance of sun exposure in post treatment period are the limiting factors

Introduction: Acute appendicitis (AA) is a common abdominal emergency with a lifetime prevalence of about 7 %. As the clinical diagnosis of AA remains a challenge to emergency physicians and surgeons, imaging modalities have gained major importance in the diagnostic work-up of patients with suspected AA in order to keep both the negative appendectomy rate and the perforation rate low. Materials and methods: This is a prospective study was conducted in the Department of Radiology at Dr. VRK Women's Medical College, Teaching Hospital and Research Center Hyderabad, Our standard protocol is that all adult patients suspected of appendicitis receive an ultrasound as their first imaging test, either by an emergency physician or a radiologist. The test characteristics of conclusive and inconclusive ultrasound exams were compared with a pragmatic gold standard. Result: In our study, most of the subjects were 11-15 years i.e., out of 90 (55.55%), followed by 6-10 years, i.e., 39 out of 90 (43.3%). In our study shows that all the cases presented with pain in the right iliac fossa and clinical suspicion of acute appendicitis which were the selection criteria for the present study. Acute appendicitis symptoms were (45.85), right ureteric colic (12.2%), pelvic inflammatory disease (7.7%), ovarian cyst (1.1%) and intestinal ascariasis (1.1%). 30% of cases were inconclusive.  Irrespective of the pathology, vomiting was found to be present in 62.2% of the cases. Murphy’s triad of symptoms i.e. pain in abdomen, vomiting and fever held good in the diagnosis of acute appendicitis in our study. Tenderness in right iliac fossa was the most common sign elicited in all the cases (100%). Conclusion: Ultrasound sensitivity and the rate of visualization of the appendix on US varied across sites and appeared to improve with more frequent use. US had universally high sensitivity and specificity when the appendix was clearly identified. Other diagnostic modalities should be considered when the appendix is not definitively visualized by US

Objective: The introduction and use of antiretroviral therapies (ART) has revolutionized the management and treatment of Human Immunodeficiency Virus (HIV)/acquired immunodeficiency syndrome (AIDS). HIV/ AIDS globally resulting in increased life expectancy. Current treatment guidelines by WHO recommend the use of a combination of at least 3 ARV drugs which include: 2 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) combined with 1 medication from either of the 2 remaining classes; the Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) or the Protease Inhibitors (PIs). Micronutrients and electrolytes deficiencies are prevalent among HIV-infected populations. The use of Highly Active Antiretroviral Therapy (HAART) on the other hand has been shown to increase the life expectancy of HIV infected individuals. The present study was designed to determine the effects of HAART on serum micronutrients and electrolytes concentrations in HIV positive patients. Materials and Methods: A prospective randomized controlled clinical study was conducted in the with 231 HIV+ adults with low plasma zinc levels (<0.75 μg/ml), randomly assigned into zinc (12 mg of elemental zinc for women and 15 mg for men) or placebo, for 18 months. The primary endpoint was immunological failure. HIV-viral load and CD4+ cell count were determined every 6 months. Questionnaires, pill-counts, plasma zinc and C-reactive protein (hsCRP) were used to monitor adherence with study supplements and ART. Intent-to-treat analysis utilized multiple-event analysis, treating CD4+ cell count <200 cells/mm3 as recurrent immunological failure event. Cox proportional-hazard models and the general-linear model were used to analyze morbidity and mortality data. Results: Severe, moderate and mild malnutrition were detected in 15%, 38% and 24% of human immunodeficiency virus infected individuals respectively. Compared with the healthy control group, serum level of zinc and selenium in the human immunodeficiency virus infected subjects were significantly lower (P = 0.01 and P = 0.02 respectively). Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: ART treatment did not complement zinc status in HIV infection while improving CD4+ T-cell count, hence the need to consider supplementation

Introduction: One of the most common types of fractures seen in orthopedic treatment is a crack or break in the shaft of the femur. In individuals who have sustained high intensity trauma, a fracture of the shaft of the femur is a major source of morbidity and mortality. Materials and methods: There were 20 people total who participated in the study. This study was a prospective research study that took place in Department of Orthopedics, Government Medical College, Ongole, Andhra Pradesh, India. There are roughly 8 men for every female. The time frame for the research was from May 2021 to April 2022. Results: The survey involved 20 people, with men making up 72% and women 28%. At least 88% of the population is under the age of 50. The majority of femur fractures occurred in the middle one-third of the thigh, and car accidents were the most prevalent cause of injury. Within 24 hours of injury, 76% of patients were seen. Fractures in most patients healed completely between 12–14 weeks clinically, and within 16–18 weeks radiologically. After 10 weeks, patients could begin light weight bearing, and by 16 weeks, they could handle their whole-body weight. Conclusion: In the fracture of the shaft of the femur that we saw, interlocking nailing had a very low complication rate and produced great results in terms of the patient's ability to function.

Introduction: In this study, percutaneous suturing for the treatment of acute Achilles tendon (AT) rupture was compared to open reconstruction for the treatment of chronic AT rupture. Materials and methods: We conducted a prospective comparison research at Department of Orthopaedics, Guntur Medical College, Guntur, Andhra Pradesh, India, between March 2021 to February 2022. Patients having a primary diagnosis of total Achilles tendon rupture were included in the analysis. Twenty-five patients were given advice on their treatment choices and encouraged to return in a year for follow-up. Results: Results of multivariate and univariate logistic regression methods are used. Comparable gram-positive and gram-negative bacterial growth was seen in this study of pleural space infections. pH, loculation, positive stain, culture, fever, and serum albumin were all statistically significant in their own right when analysed in isolation. After doing a multivariate analysis, we found that pH, loculation, and serum albumin were significant predictors of tube thoracostomy success or failure. Conclusion: Comparing open repair for chronic AT rupture to percutaneous suturing following acute AT rupture, one may find similar clinical and functional results, but a thicker tendon.

Objectives The present study was designed to evaluate the nootropic activity of ethanolic extract of Triticum aestivum (TAE) on stressed wistar albino rats. Materials and methods- Effect of TAE was studied on acute restraint stress and chronic unpredictable stress induced rats.

Background: Hypoxic ischemic encephalopathy (HIE) refers to the CNS dysfunction associated with Perinatal Asphyxia (PA) which is an important causes of permanent damage to CNS tissue. MRI imaging methods attributes to better understanding of pathological events and disease progression that may provide decision regarding intervention. MRI has a higher sensitivity and is extremely valuable in assessing the extent of hypoxic-ischemic brain damage during the early postnatal period and later infancy. It is also more specific which clearly differentiates fluid filled cavities, oedema, gliosis and hemorrhage. On this background this study was undertaken to evaluate the MRI changes of all grades of HIE patients. They were also followed up at different time intervals for upto 1 year to correlate the MRI changes and neurodevelopmental outcome

Fibromyalgia is a disorder causes chronic pain throughout the body with general fatigue, sleeping disorder and Cognitive difficulties as most common symptoms. ML and AI the potential glimmers for future presumed to have the ability to process complex datasets outside the sphere of human capabilities. Later transforming the data analysis into clinical insight that assists doctor’s planning and leading to improved results, better diagnosis, cost-effective care, and ultimately better treatment. Here we try to provide a Machine Learning base application using most effective logarithms and image processing classifiers, better coordination between latest trending technologies and healthcare leverage the field of Rheumatology.

Background: A novel COVID-19 has been recently identified as the severe acute respiratory illness COVID-19 which has accounted for more than 300,000 infected people worldwide. However, the world health organization WHO announced that the disease represents a serious issue to worldwide public health. Aim: The study aims at reviewing and discussing current knowledge on COVID-19 in Saudi Arabia including diagnosis, causes, and methods of controlling coronavirus disease. Method and Design: Pooled design is adopted, and 562 confirmed COVID-19 cases are included in the analysis reported between March 2nd, 2020 to March 23rd, 2020. Results: The result showed that the majority of the identified cases resulted from contact tracing and returning from different countries. The study provides additional evidence for an effective method used by the Saudi Arabia Health Ministry (MOH) to help patients recover from COVID-19. Conclusion: COVID-19 evidence to show several signs and symptoms such as fever, dry cough and respiratory syndrome. However, several methods used in health sector in order to monitor and control the disease.

A new coronavirus, called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), emerged in late December 2019, Wuhan (Hubei, China). The disease, now known as COVID-19, has spread rampant and has given rise to a pandemic world that has precipitated draconian measures to limit its transmission. COVID-19 has demonstrated a wide spectrum of clinical manifestations, from asymptomatic or paucisymptomatic forms, to severe viral pneumonia with respiratory failure, multi-organ and systemic dysfunction, and high morbidity and mortality. The body's hyper inflammatory response has been associated, along with the possible direct effects of SARS-CoV-2 on organs throughout the body via ACE2. Disseminated intravascular coagulation is another common complication. The inflammatory response caused by COVID-19 in the lung due to the virus itself developing pneumonia, followed by cytokine storm and hemophagocytic syndrome causes a hyper coagulation state manifesting small and large vein and arterial thrombosis and likely DEC. Many hyper coagulation biomarkers such as D-dimer, elevated cytokines such as Il-6, and inflammation parameters such as C reactive protein support this clinical picture. Anticoagulant treatment with heparin and anti platelet should always be ordered.

Rupture of pulmonary abscess and subsequent pleural empyema with pneumothorax is unusual acute chest pain cause. Brief history, physical examination, simple chest X-ray makes rupture of pulmonary abscess to pleural cavity quickly recognizable. Patient vital signs can deteriorate rapidly, thus depending on findings chest tube placement is crucial and can be lifesaving. In this report we present clinical case of 56 male who presents to rural Emergency Department (ED) complaining worsening dyspnea and sharp severe pain in right chest side, one month ago he was treated in the hospital for Community Acquired Pneumonia.

Background and objectives: The present study evaluates the effect of essential oils of Rosmarinus officinalis and Populus alba on experimentally cutaneous heat-induced burn injury in rat.Materials and Methods: For this purpose, the acute toxicity test was carried out on Wistar rats that received intraperitoneally gradual doses (0.5to 7 ml /Kg) of the both essential oils. Then, Second-degree burn wounds were induced in five groups (N=5 in each). The percentage of wound healing were assessed on 5, 10, 15, 20 and 25 days. In the other hand, wound surface was monitored and photographed during the period of treatment. Results and Conclusion: The essential oil of Populus alba and even Rosmarinus officinalis have no acute toxicity in rats.

Aim: A clinical, demographic, biochemical and outcome profile of diabetic ketoacidosis in children with type 1 diabetes mellitus. Material and methods: This Prospective observational study was carried out in the Department of Paediatrics, Shantabaa Medical College and General Hospital, Amreli in Gujaratfor the period of 9 months, after taking the approval of the protocol review committee and institutional ethics committee. 50 DKA patients admitted during the study period. All those patients aged from 6 months to 14 years with Type 1 D.M. with DKA.