European Journal of Cardiovascular Medicine

Background: Evidence regarding the advantages of laparoscopic appendectomy (LA) over open appendectomy (OA) in complicated appendicitis is mixed. This prospective study evaluates operative and early recovery outcomes for both approaches. Materials and Methods: Between January 2024 and December 2024, 120 patients with complicated appendicitis at Department of General Surgery, Gulbarga Institute of Medical Sciences, Kalaburagi, underwent either LA (n = 60) or OA (n = 60). Outcomes included operative time, length of hospital stay, surgical site infection, intra-abdominal abscess, time to normal activity, postoperative pain scores, and readmissions. Data were analyzed using chi-square and independent t-tests. Results: LA required longer operative time (74.2 ± 15.6 vs 66.5 ± 13.8 minutes, p = 0.002) but reduced hospital stay (4.3 ± 1.2 vs 6.1 ± 1.8 days, p < 0.001). Surgical site infections occurred less frequently in LA (6.7%) than OA (20.0%, p = 0.03). Recovery was faster in LA (8.2 ± 2.4 vs 12.6 ± 3.1 days, p < 0.001), with lower pain scores on day 1 (3.2 ± 1.1 vs 5.1 ± 1.4, p < 0.001). Intra-abdominal abscess (p = 0.47) and readmission (p = 0.65) rates were similar. Conclusion: Despite longer operative duration, LA provides significant recovery advantages and lower wound infection risk in complicated appendicitis, supporting its wider use in suitable patients.

Introduction: Aim And Objective: To measure the transverse diameter of Right Common Femoral Vein before spinal anesthesia and assess its association with Post Spinal hypotension in patients posted for elective cesarean section. Methods: 60 pregnant women aged 18 – 24 years posted for Elective Cesarean Section chosen for our study. Transverse diameter of right common femoral vein was measured in supine position using ultrasound prior to spinal anaesthesia. Hypotension was defined as a drop in systolic arterial pressure by more than 20 percent from baseline. Patient and obstetric characteristics with respect to postspinal hypotension were studied. Result: A Longer transverse diameter [>11.8 mm] was associated with occurrence of postspinal hypotension Conclusion: Transverse diameter of common femoral vein can aid in predicting parturients at risk of hypotension before spinal anaesthesia.

Background: Air pollution has emerged as a significant public health threat, particularly affecting children due to their developing respiratory systems. This study investigates the association between ambient air quality and pulmonary function among schoolchildren in southern India, where industrial expansion and vehicular emissions contribute to deteriorating air conditions. Materials and Methods: A cross-sectional observational study was conducted from January 2024 to December 2024 among 400 schoolchildren aged 8–14 years at the Department of Community Medicine, Kanyakumari Medical Mission Research Centre, Muttum, Tamil Nadu. Lung function was assessed using spirometry, measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), and Peak Expiratory Flow Rate (PEFR). Daily Air Quality Index (AQI) data were retrieved from regional pollution control board sensors. Children were categorized based on residential exposure to AQI levels: good (AQI < 50), moderate (51–100), and unhealthy (>100). Statistical analysis included ANOVA, Pearson’s correlation, and multiple linear regression. Results: Children exposed to AQI > 100 had significantly lower mean FEV₁ (1.36 ± 0.42 L) compared to those in the AQI < 50 group (1.72 ± 0.37 L, p < 0.001). Mean PEFR was also reduced (190.6 ± 45.2 L/min vs 242.3 ± 40.8 L/min, p < 0.001). A significant negative correlation (r = -0.47, p < 0.001) was observed between AQI and FEV₁.

Conclusion: Poor air quality is strongly associated with reduced lung function in children. These findings emphasize the urgent need for community-level interventions and policy reforms to mitigate air pollution exposure in school environments.

Introduction: Obesity and physical inactivity are major public health concerns, associated with increased risk of cardiovascular disease and mortality. Autonomic nervous system (ANS) dysfunction, characterized by altered autonomic modulation, contributes to these conditions. Heart rate variability (HRV), a non-invasive measure of ANS activity, has been linked to body mass index (BMI) and exercise. Over the past two decades, a notable connection has been established between the autonomic nervous system and cardiovascular mortality, including the risk of sudden cardiac death^1-4. The most widely used method to classify weight status and risk of disease is the body mass index (BMI), which is equal to weight/ height in kg/m². Central (primarily visceral) obesity (high ratio of the circumference of the waist to the circumference of the hips [waist-to-hip ratio], >0.9 in women and 1.0 in men) is independently associated with a higher risk for metabolic syndrome, diabetes mellitus, hyperandrogenism in women, and cardiovascular disease. The prevalence of obesity has increased dramatically over the past 3 decades⁵. Aim And Objectives: Study of Heart rate variability in normal adult v/s overweight/obese adult during pre and post exercise period. Material And Methods: A case control study was conducted from 2023-2024 on 170 subjects. Study was conducted in Department of Physiology to examine HRV by computerized Physiograph (Exercise physiology system -Ad company) & stationary bicycle Ergometer (Viva Fitness Company). Result And Conclusion: Elevated BMI is linked to increased sympathetic activity and reduced parasympathetic tone, both at rest and in response to physical stress. These autonomic alterations may contribute to the higher incidence of cardiovascular diseases observed in individuals with elevated BMI. The significant correlations between BMI and HRV indices in the elevated BMI group further underscore the impact of excessive body weight on autonomic regulation. Heart rate variability indices in group I (Normal BMI) before and after exercise: For SDNN, the correlation coefficients (Rho) are -0.164 at rest and -0.106 post-exercise, with p-values of 0.132 and 0.333, indicating no significant relationship. RMSSD shows a significant negative correlation with BMI at rest (Rho = -0.372, p<0.01*), but a non-significant positive correlation post-exercise (Rho = 0.028, p=0.802). pNN50% correlates negatively with BMI at rest (Rho = -0.133, p=0.255) and post-exercise (Rho = -0.187, p=0.087), though the later approaches significance. Heart rate variability indices in group II (elevated BMI) before and after exercise: At rest, SDNN has a strong positive correlation with BMI (Rho = 0.730, p<0.01*), indicating that higher BMI is associated with increased SDNN. RMSSD and pNN50% also show significant positive correlations with BMI at rest (Rho = 0.221, p=0.043* and Rho = 0.533, p<0.01* respectively). Conversely, post-exercise, these correlations diminish, with RMSSD (Rho = 0.127, p=0.248) and pNN50% (Rho = 0.169, p=0.122) showing non-significant relationships. LF shows a significant negative correlation with BMI at rest (Rho = -0.251, p=0.021*), while post-exercise, this correlation is more pronounced and negative (Rho = -0.548, p<0.01*). HF exhibits significant positive correlations with BMI both at rest (Rho = 0.347, p=0.001*) and post-exercise (Rho = 0.544, p<0.01*). The LF/HF ratio shows a significant negative correlation with BMI in both conditions (Rho = -0.246, p=0.023* at rest; Rho = -0.638, p<0.01* post-exercise).

Introduction: The mortality rate of breast cancer varies proportionally with age. In India, the average age of developing breast cancer has shifted over the last few decades and younger women are being affected. In view of the above, present study was undertaken to study the incidence of various types of breast cancer according to age and histopathological grade was noted at the time of diagnosis of breast cancer.  Materials and Methods: The present retrospective study was comprised of 100 cases of breast cancer reported at KD Medical College, Hospital & Research Center, Mathura. The material was derived from the files of the department. The information comprised of demographic characteristics, such as age, site of lesion and histo-pathological characteristics. The specimens were selected from mastectomy specimens received from surgical department for routine histopathological examinations. Data so obtained was analyzed and expressed as number and percentage as required. Results: Peak incidence of breast carcinoma was during fifth decade of life, followed by fourth decade of life. Mean age at diagnosis of breast carcinoma was 45.66 years. Age of youngest patient was 25 years (2 cases), whereas oldest patient was 72 years of age. Most common carcinoma of all age groups was infiltrating duct carcinoma. All cases of 3rd , 7th and 8th decade of life were of infiltrating duct carcinoma. Infiltrating duct carcinoma was most common in 5th decade. Infiltrating lobular carcinoma was most common in 4th decade. Infiltrating duct carcinoma and lobular carcinoma was most common in 5th decade. One case of infiltrating duct carcinoma and mucinous carcinoma was present in 5th decade (age 42 years) One case of papillary carcinoma was present in 6th decade (age 55 years). Most of breast carcinomas were of G2 histopathological grade (65%). Gl: G2:G3 ratio was about 1:5:1.5 i e. 2:10:3. Conclusion: The present study concludes that the peak incidence of breast cancer is in the 5th decade followed by 4th decade. Mean age of developing breast cancer revealed was 45.6 years. Infiltrating duct carcinoma was the most common histological type, comprising of 86% of all cases. Most common histopathological grade was G2.

Introduction: Inguinal hernia repair is a common surgical procedure with ongoing debate over the optimal technique. Mesh repair has been widely adopted due to lower recurrence rates, but concerns about complications and patient outcomes persist. This study compares clinical outcomes between mesh and non-mesh inguinal hernia repair techniques. Aim: To compare the clinical outcomes of mesh versus non-mesh techniques in inguinal hernia repair surgery. Methods: A prospective observational study was conducted on 200 patients undergoing inguinal hernia repair at a tertiary care center. Patients were equally divided into mesh (n=100) and non-mesh (n=100) groups. Baseline demographics, recurrence rates, postoperative pain, complications, recovery time, and patient satisfaction were assessed over a one-year follow-up. Statistical analysis was performed to evaluate differences. Results: Baseline characteristics were comparable between groups. Recurrence rates were significantly lower in the mesh group (3.0%) compared to the non-mesh group (12.0%) (p=0.013). Mesh repair patients reported less postoperative pain (VAS 3.8 vs. 4.5; p=0.0003) and earlier return to routine work (12.7 vs. 15.1 days; p<0.0001). Patient satisfaction scores were higher in the mesh group (8.7 vs. 7.9; p=0.0002) with significantly less chronic pain (9.0% vs. 19.0%; p=0.033). Early complications were comparable. Conclusion: Mesh repair offers superior outcomes in terms of lower recurrence, reduced postoperative pain, faster recovery, and greater patient satisfaction. It is recommended as the preferred technique for inguinal hernia repair in appropriate patients.

Background: Maxillofacial cancer surgery constitutes a large part of surgical oncology practice in India. The combined utilization of opioids and NSAIDs result in additive or synergistic analgesia by acting through different mechanisms. Present study was aimed to compare the analgesic efficacy between intravenous fentanyl and intravenous fentanyl with diclofenac sodium infusion during mandibular surgeries in a tertiary care cancer centre. Material and Methods: The present study was a Prospective, Randomized Control study conducted in 246 ASA I and II patients aged between 18-65 years, undergoing elective mandibular surgeries under general anaesthesia. Patients were randomly assigned to 2 groups with 123 patients in each group. Group 1 received 100ml normal saline after induction of anaesthesia and Group 2 received Inj. diclofenac sodium 1mg/kg in 100ml normal saline after induction of anaesthesia. Results: The study populations were similar and comparable in terms of demographic parameters such as Age, Gender and ASA physical status. In our study, baseline mean values of heart rate, systolic blood pressure, diastolic blood pressure and Mean Arterial Blood Pressure were comparable. Even though the values of SBP, DBP, MAP in the intraoperative and postoperative period and VAS score in the postoperative period in study group were statistically higher compared to the control group at few time intervals, they were within <20% of the baseline values and <4 for VAS and hence there was no need of any rescue analgesics in the study group both intraoperatively and postoperatively. IV Diclofenac Sodium 1mg/kg when given as an infusion effectively reduced the requirement of Fentanyl as a rescue analgesic when compared to control group. Conclusion: Administration of single dose of intravenous Diclofenac sodium post induction augments the intraoperative as well as postoperative analgesic effect of Fentanyl without any added morbidity in patients subjected to mandibular surgeries.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a proven therapy in high- and intermediate-risk patients with severe aortic stenosis. Yet, its application among low-risk populations is still under investigation, especially in countries with limited resources. The present study is conducted to evaluate the procedural and long-term efficacy of TAVR in low-risk patients at a tertiary care facility in Northern India. Methods: An intention-to-treat prospective observational study was performed at Rajshree Medical College and Hospital, Bareilly, Uttar Pradesh, among 84 low-risk patients undergoing TAVR from January 2020 to December 2022. Patients were assessed for a median duration of 28 months. Primary endpoints were procedural success, survival, and improvement in New York Heart Association (NYHA) functional class. Secondary endpoints were stroke, pacemaker implantation, rehospitalization, and structural valve deterioration. Results: The procedural success rate was 98.8% without in-hospital mortality. Overall survival at 3-year follow-up was 94.0%. There was significant functional capacity improvement, with 88% of patients in NYHA Class I or II versus 75.8% of patients in Class III or IV at baseline. Stroke developed in 2.4% of patients and new pacemaker implantation in 4.8%. No structural valve deterioration occurred during follow-up. Conclusion: TAVR in well-screened low-risk patients shows outstanding safety and long-term clinical success, validating its increasing application as a first-line treatment for severe aortic stenosis. These results are consistent with global data and promote wider consideration of TAVR in low-risk populations, particularly in developing healthcare systems.

Background: Orthopedic surgeries are associated with significant perioperative risks, particularly in elderly patients with comorbidities. Optimizing perioperative anesthesia care can reduce complications and enhance outcomes. Objective: To evaluate the role of perioperative anesthesia care in reducing intraoperative and postoperative complications in orthopedic patients. Methods: This prospective observational study was conducted on 200 orthopedic surgery patients over 12 months. Patients were divided into two groups: Group A received standardized perioperative anesthesia care, including preoperative risk stratification and postoperative pain protocols; Group B received routine care. Outcomes such as complications, length of stay, pain scores, and patient satisfaction were compared. Results: Group A showed a significant reduction in postoperative complications (15% vs. 28%, p=0.014), lower pain scores (mean VAS 2.9 vs. 4.7, p<0.001), shorter hospital stay (mean 3.2 vs. 5.1 days, p=0.002), and higher satisfaction scores. Conclusion: Structured perioperative anesthesia care significantly reduces complications, enhances pain control, and improves overall recovery and satisfaction in orthopedic patients

The Menstrual Cycle shows a constant change in the levels of estrogen and progesterone in the body. This might influence the quality of sleep. To investigate this, a 10 item Questionnaire was prepared covering various aspects of an individuals Menstrual cycle including number of days, painful Menstrual cycle, heavy menstrual bleed etc. The Sleep Quality Scale was also used. It is a 28 item Questionnaire detecting acute sleep problems. 115 women were interviewed based on these questionnaires through Google forms, after taking informed consent. The responses were interpreted and analyzed using MS Excel. Factors like Clots in menses, Increased bleeding duration/Intensity (HMB), Absence of Menstruation (Dysmenorrhea), Painful periods and Vaginal Discharge found to increase the score of acute sleep disturbances.  There could have been lack of generalisability in this study for it was conducted on a limited population only inclusive of women in the menstrual age group. Further studies on similar grounds can be conducted on larger populations inclusive of post-menopausal women as well, to get a comprehensive understanding on how the hormones influence the sleep cycle.

Background: Hypertension and obesity are common comorbidities in patients with type 2 diabetes mellitus (T2DM) and are associated with an increased risk of cardiovascular and microvascular complications. This cross-sectional study is aimed to investigate the association between body mass index (BMI) and hypertension in patients with T2DM. Methods: A total of 100 patients with T2DM were included in the study. Demographic and clinical data, including BMI, blood pressure measurements, and laboratory investigations, were collected. Participants were classified as underweight, normal weight, overweight, or obese based on BMI categories. Hypertension was defined according to the American College of Cardiology guidelines. Logistic regression analysis was performed to evaluate the association between BMI and hypertension, adjusting for potential confounders. Results: The mean age of participants was 58.5 ± 11.2 years, and 55% were male. The prevalence of hypertension increased significantly with increasing BMI categories, from 20% in the underweight group to 64% in the obese group (p < 0.001). Compared to the normal weight group, the overweight group had 2.67 times higher odds of hypertension (95% CI: 1.12-6.35, p = 0.027), while the obese group had 6.21 times higher odds (95% CI: 2.38-16.21, p = 0.0002). Conclusions: Overweight and obesity are the significant risk factors for hypertension in patients with T2DM. Effective strategies to control weight can keep a check on hypertension thus reducing the risk of cardiovascular and microvascular complications in patients with T2DM.

Background: Heart failure (HF) is a major cause of morbidity and mortality worldwide, with recurrent hospitalizations imposing a significant healthcare and economic burden. Identifying risk factors associated with frequent hospitalizations may aid in optimizing management strategies. Methods: This prospective observational study was conducted at a tertiary care center in Maharashtra, enrolling 150 patients with HF. Baseline characteristics, comorbidities, laboratory parameters, echocardiographic findings, medication adherence, and triggers for decompensation were analyzed. Patients were categorized into recurrent HHF (≥2 hospitalizations) and non-recurrent HHF (≤1 hospitalization) groups. Statistical analyses, including logistic regression, were performed to identify independent predictors of recurrent HHF. Results:  Recurrent HHF was observed in 46 (30.7%) patients. Independent predictors of recurrent HHF included lower left ventricular ejection fraction (LVEF) (OR: 1.12 per 5% decrease, p=0.002), chronic kidney disease (OR: 2.45, p=0.005), atrial fibrillation (OR: 2.17, p=0.03), NTproBNP ≥ 3000 pg/mL (OR: 1.89, p=0.02), poor medication compliance (OR: 2.78, p=0.003), lack of diuretic use (OR: 2.31, p=0.008), and absence of beta-blocker therapy (OR: 1.96, p=0.02). Mortality was significantly higher in the recurrent HHF group (17.4% vs. 1.0%, p=0.001). Conclusion:  Recurrent HF hospitalizations are associated with multiple clinical and therapy related factors, including lower LVEF, comorbidities, elevated NTproBNP, and poor adherence to HF therapy. Targeted interventions focusing on optimizing guideline-directed medical therapy, improving medication adherence, early risk stratification and preventing triggers for decompensation may help reduce hospital readmissions and improve patient outcomes.

Background:  Sickle cell disease (SCD) is the most common monogenic disorder, although the diversity and heterogenicity of clinical presentations render estimations of disease severity unpredictable. This cross-sectional study aimed to determine if laboratory markers could serve as indicators of SCD severity. Methodology: This study was a cross sectional observational study done in a tertiary medical college in central India from 1^stOctober 2022 to September 2023 on 180 patients with sickle cell disease. Observation And Results: In our study we observed a positive significant association between the number of hospitalizations and emergency visits with white blood cells (WBC) (R = 0.231, R = 0.206), respectively. Similarly, positive significant associations were found between the number of hospitalizations and emergency visits with platelets (R = 0.383, R = 0.266), respectively. Conversely, negative significant relationships were found between the number of hospitalizations and emergency visits (ER) with hemoglobin (Hb) F (R = -0.258, R = -0.253), respectively. Additionally, significant negative relationships were found between Hb F (R = -0.213) and the frequency of ICU admission. Only the number of hospitalizations and emergency visits annually were significantly predicted with P values of 0.021 and 0.038, respectively. Moreover, an increase in WBC was found to significantly increase the chance of undergoing splenectomy by 23.02%.  Conclusions: In SCD,Inflammatory markers are valuable tools for better risk stratification and could be translated into developing new therapeutic strategies and modifying the treatment paradigm

Background:  This cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) of patients with rotator cuff tears towards arthroscopic shoulder surgery (ASS), based on the hypothesis that the knowledge of the procedure among patients would be sufficient, which in turn might influence their practice and attitude. Methodology: This study was a cross-sectional observational study done in a tertiary medical college in central India from 1^stOctober 2022 to September 2024 on 588 patients with rotator cuff tear. Observation And Results: In our study we observed that out of 588 patients included, 50%(294) had undergone ASS. Lower education level and monthly income, shorter weekly exercise time and shorter disease duration were identified as independent risk factors for the KAP total score. Structural equation modelling revealed a direct positive effect of knowledge on attitude, but neither knowledge nor attitude influenced practice scores. Conclusions: Patients with rotator cuff tears demonstrated relatively poor knowledge, a neutral attitude and moderate practice towards ASS, highlighting the need for patient education and counselling to enhance understanding and decision-making regarding ASS.

Background:  Post-surgical inflammatory responses significantly influence wound healing and overall surgical outcomes. Understanding the pathological mechanisms underlying these inflammatory processes is crucial for optimizing patient recovery and minimizing complications. This study aims to assess the intensity and characteristics of post-surgical inflammatory responses and their implications for wound healing and surgical outcomes. Materials and Methods: A prospective study was conducted involving 60 patients undergoing elective surgeries across various surgical specialties. Blood samples and tissue biopsies were collected at baseline (pre-surgery), 24 hours, 72 hours, and 7 days post-surgery. Histopathological analysis, inflammatory biomarker assays (C-reactive protein, IL-6, TNF-α), and wound healing assessments were performed. Inflammatory response scores were calculated based on cellular infiltration, edema, and tissue necrosis. Statistical analysis was conducted using ANOVA and Pearson's correlation to determine associations between inflammatory markers and wound healing efficiency. Results: Patients exhibited a significant elevation in inflammatory biomarkers post-surgery, with peak levels recorded at 24 hours (CRP: 35.2 ± 6.1 mg/L, IL-6: 90.4 ± 12.5 pg/mL, TNF-α: 65.7 ± 8.9 pg/mL). Histopathological analysis revealed substantial neutrophil infiltration and tissue edema within the first 72 hours, gradually transitioning to macrophage-dominant infiltration by day 7. Patients exhibiting lower inflammatory marker levels (CRP < 25 mg/L, IL-6 < 70 pg/mL, TNF-α < 50 pg/mL) demonstrated superior wound healing scores (P < 0.05) compared to those with higher levels. A positive correlation was observed between elevated inflammatory markers and delayed wound healing. Conclusion: The intensity of post-surgical inflammatory responses plays a pivotal role in determining wound healing efficiency and surgical outcomes. Elevated levels of inflammatory biomarkers are associated with delayed healing and increased complication rates. Targeted interventions to modulate inflammation may improve surgical recovery and patient outcomes.

Background: Congenital Heart Diseases (CHDs) are the most common congenital anomalies, contributing significantly to neonatal morbidity and mortality. Early detection of CHDs is crucial for timely intervention and improved clinical outcomes. Genetic markers have emerged as potential diagnostic tools for early identification of CHDs in neonates. This study aimed to evaluate the efficacy of specific genetic markers in the early detection of CHDs among neonates. Materials and Methods: A prospective case-control study was conducted over 24 months in a tertiary care hospital. A total of 150 neonates were enrolled, comprising 75 diagnosed with CHDs (case group) and 75 healthy neonates (control group). Blood samples were collected from all participants within 24 hours of birth. Genetic analysis focused on detecting mutations and polymorphisms in genes commonly associated with CHDs, including GATA4, NKX2-5, and TBX5, using Polymerase Chain Reaction (PCR) and sequencing techniques. Statistical analysis was performed using SPSS software, with a p-value of <0.05 considered significant. Results: The frequency of mutations in GATA4, NKX2-5, and TBX5 genes was significantly higher in the case group (45%, 40%, and 35%, respectively) compared to the control group (5%, 7%, and 4%, respectively) (p < 0.001). Sensitivity and specificity of GATA4 mutations in detecting CHDs were 90% and 85%, respectively. Combined analysis of all three genetic markers improved diagnostic accuracy to 92%. Conclusion: The findings suggest that genetic markers such as GATA4, NKX2-5, and TBX5 are effective in the early detection of congenital heart diseases in neonates. Incorporating genetic screening into neonatal screening protocols could enhance early diagnosis and facilitate timely interventions, potentially improving clinical outcomes. Further studies with larger sample sizes are warranted to validate these findings.

Anemia of Chronic Disease (ACD), also referred to as anemia of inflammation, is a prevalent condition characterized by reduced erythropoiesis and impaired iron metabolism, commonly associated with chronic inflammatory disorders, infections, autoimmune diseases, and malignancies (1). Unlike iron-deficiency anemia, ACD is marked by adequate or elevated iron stores with diminished availability for erythropoiesis due to the inhibitory effects of inflammatory cytokines on iron mobilization and erythropoietin production (2,3).

The pathogenesis of ACD involves increased hepcidin levels, which inhibit iron release from macrophages and reduce intestinal iron absorption, contributing to functional iron deficiency despite adequate body iron stores (4). Additionally, inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) negatively impact erythropoietin response, further exacerbating anemia (5,6).

Management of ACD aims at correcting anemia, improving quality of life, and minimizing the need for blood transfusions. Traditional treatment approaches include iron supplementation (IS), either oral or intravenous, to replenish iron stores and enhance erythropoiesis (7). However, the efficacy of IS is often limited by impaired iron absorption and utilization due to persistent inflammation (8).

Erythropoiesis-Stimulating Agents (ESA), such as epoetin alfa and darbepoetin alfa, have emerged as effective alternatives for enhancing erythropoiesis by stimulating bone marrow activity and increasing hemoglobin levels (9). Despite their efficacy, the use of ESAs is associated with potential adverse effects, including thromboembolic events and increased cardiovascular risks (10).

Comparative studies evaluating the efficacy of IS and ESA in managing ACD have reported varying outcomes. Some studies suggest superior efficacy of ESA in achieving target hemoglobin levels, while others emphasize the importance of optimizing iron status for improved response (11,12). Nevertheless, there is a lack of consensus regarding the most effective treatment strategy, necessitating further investigation.

The present study aims to compare the efficacy of iron supplementation and erythropoiesis-stimulating agents in managing ACD, assessing their impact on hemoglobin levels, serum ferritin, and transferrin saturation over a 12-week period.

Background: Self-medication for cardiovascular conditions is a growing concern due to the potential risks of drug interactions, incorrect dosages, and delayed professional treatment. Understanding the knowledge and practice of self-medication among individuals is essential for public health interventions. Objectives: To assess the knowledge and practice of self-medication for cardiovascular conditions and its associated risks among individuals. Methods: A cross-sectional study was conducted with a sample of 200 participants. Data were collected using a structured questionnaire focusing on knowledge, practice, and risk perception of self-medication for cardiovascular diseases (CVDs). Descriptive and inferential statistics were applied to analyze the data. Results: Among the participants, 65% reported self-medicating for cardiovascular symptoms. The most commonly used medications were aspirin (45%) and beta-blockers (30%). Knowledge regarding proper dosage and potential risks was inadequate in 58% of participants. A significant correlation was observed between education level and self-medication practices (p < 0.05). Conclusion: A substantial proportion of individuals engage in self-medication for cardiovascular conditions despite limited knowledge of associated risks. Public health interventions and awareness campaigns are needed to mitigate these risks.

Background: Borderline oligohydramnios in pregnancies without any foetal or maternal abnormalities, that is Isolated oligohydramnios may be due to inadequate fluid intake orally. Some patients might have poor compliance in home-based setting. Therefore, this study was conducted to assess the improvement in AFI and perinatal outcome following maternal oral hydration therapy in home and hospital settings. Methods: This prospective study was conducted in the Department of Obstetrics and Gynaecology in Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram during period from 1^st February 2023 to 31^th January 2024 (1 year).  50 cases of isolated borderline oligohydramnios (other high-risk pregnancy conditions not present) were included in the study (25 in home group and 25 in hospital group). Results: The two groups are similar in profile and baseline findings. When compared to the home group, the hospital group's AFI considerably improved. Conclusion: In cases of oligohydramnios, maternal oral hydration therapy is an easy, safe, noninvasive, and efficient way to increase the volume of amniotic fluid; but, long-term, continuous therapy is necessary to optimize the neonatal outcome. It is advised to implement supervised hydration therapy due to low compliance to home-based treatment

Background: Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time. Materials and methods: A retrospective study was conducted in the Department of Plastic Surgery at GMC NAGPUR from January 2023 to December 2024 and the data of 12 patients who had DSWI out of 214 patients who underwent median sternotomy. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality. Result: The early group had 5 patients, while the late group had 7 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant ( p = 0.001). The average duration from the presentation of DSWI to definitive surgery was found to be 16.28 days in the early group and 88.36 days in the late group.  Conclusion: There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs

Background: In the recent era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy in a tertiary care centre in Central India. Method: It is a descriptive cross-sectional study done among 200 patients at the Department of Surgery of a tertiary care centre from June, 2022 to May, 2024. Successive patients who underwent elective laparoscopic cholecystectomy during the study period were included. Standard 4 port laparoscopic technique was used for the laparoscopic cholecystectomy and sub-costal Kocher incision was used for the open cholecystectomy respectively. After data collection, entry and analysis were done in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 200 patients, the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was 5 (2.5%) (0.65-4.11 at 95% Confidence Interval).Conclusion: This study showed that the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was lower when compared to similar studies conducted in similar settings.

Background: The clinical profile of patients with hypertensive emergencies presenting to the emergency medicine department in developing countries is poorly understood. This study aimed to evaluate presentation modes, clinical profile, spectrum of target end-organ damage and prognosis during the first 48 hours in an emergency medicine department. Hypertensive emergencies accounted for over one-fourth of all medical emergencies. Severe blood pressure elevations are classified as hypertensive emergencies with acute or ongoing end-organ damage and hypertensive crisis without target end-organ damage. Distinguishing between these is crucial for formulating therapeutic plans. In a hypertensive emergency, the goal is to reduce blood pressure immediately, not necessarily to normal ranges, to prevent or limit target end-organ damage, with the aim of lowering blood pressure within 24 hours. This study evaluated the clinical profile of hypertensive emergencies. Objectives: a) To study the modes of presentation, clinical profile and spectrum of target end organ damage b) To aid prompt diagnosis and effective management of hypertensive emergencies. c) To improve the prognosis of hypertensive crisis. Methodology: About 100 patients with elevated blood pressure admitted to the SS Institute of Medical Sciences and Research Center, Davangere, from December 2012 to June 2014 were studied. All patients above 18 years of age with hypertensive crisis were selected and subjected to a detailed history, physical examination and biochemical tests. The patients were followed up for 48 hours after admission to the emergency medicine department. Complete data were collected using a specially designed proforma, which was then subjected to statistical analysis. Results: Of the 100 patients, 78 recovered and 22 experienced in-hospital mortality. All 22 patients presented with blood pressure > 200/110 mmHg at the time of admission and target end-organ damage was present, including intracranial haemorrhage (14) and left ventricular failure (8). In our study, the in- hospital mortality rate of patients with hypertensive emergencies was 22%. Conclusion: The majority of patients presenting with hypertensive emergencies were in their fifth and sixth decades of life. Males have a higher chance of developing hypertensive emergencies than females. Known hypertensives are at higher risk of target end-organ damage during hypertensive emergencies

Introduction: Iron deficiency anemia (IDA) is a significant concern among blood donors due to the potential impact on donor health and blood supply quality. This study assesses the prevalence of IDA in a cohort of blood donors, with a focus on gender differences and the efficacy of current screening practices. Methods: This cross-sectional study was conducted at a tertiary care center, including 74 blood donors (56 females and 18 males). Participants underwent screening for iron deficiency using standard hematological parameters, including hemoglobin and serum ferritin levels. Results: The prevalence of iron deficiency among female donors was 39.29% (95% CI: 26.79% - 51.79%), significantly higher than the 33.33% (95% CI: 11.11% - 55.56%) observed in male donors. The overall effectiveness of pre-donation screening in identifying iron deficiency was high, with a detection rate of 99.56% (95% CI: 90.91% - 100.00%) among those screened. Conclusions: Iron deficiency remains a prevalent issue among blood donors, particularly in females. The high rate of detection through pre-donation screening suggests that current methods are effective, but continuous monitoring and tailored interventions, such as iron supplementation and adjusted donation intervals, are recommended to manage iron levels in blood donors effectively. Further research is needed to refine screening techniques and develop gender-specific strategies to address this issue.

Background Cardiac implantable electronic devices (CIEDs) are life-saving interventions, but complications such as pocket infections and erosions pose significant clinical and economic challenges, particularly in resource-limited settings. Objective: This study evaluates the incidence, risk factors, microbial profile, and outcomes of management strategies for pacemaker pocket complications at Assam Medical College, Dibrugarh, India. Methods: A retrospective analysis was conducted on 1,056 patients who underwent pacemaker implantation between January 2022 and July 2024. Data on demographics, comorbidities, device types, and outcomes were collected for 33 patients (3.1%) who developed pocket complications. Infections were classified per EHRA guidelines into localised (Grade A) and systemic (Grade B). Management approaches included explantation, conservative strategies, and debridement with reimplantation. Results: The mean age of patients with pocket complications was 69.3 years, with a male-to-female ratio of 2.3:1. Diabetes (48%), hypertension (55%), and COPD (33%) were common risk factors. Box changes had the highest erosion rate (5.06%). Most pus cultures showed no microbial growth (82%), followed by Staphylococcus aureus (12%). Device explantation and reimplantation were the most successful strategies, with 87.5% favourable outcomes. Conservative management had limited success, with reinfections in 5 of 6 patients. Conclusion: Pacemaker pocket infections are a significant concern, particularly in populations with high comorbidities and limited healthcare access. While device explantation and reimplantation offer the best outcomes, conservative approaches are less effective and should be reserved for select cases. Strengthening perioperative care and follow-up protocols is essential to reduce the burden of these complications.

Objectives: To study the clinical feature, aetiology, electrophysiological profile of peripheral neuropathy in a tertiary care hospital at Guntur. Materials and Methods: 85 cases of chronic peripheral neuropathy over a period of 12 months were studied in detail including presenting complaint, clinical examination, electro physiological studies and other relevant investigations.  Results: The affected age group was 18 yrs to 75 yr. There is male predominance with male to female ratio of 2.4:1. Out of 85 cases, both sensory and motor complaints in 51 (60%) cases, 31 cases (36.47%) are pure sensory and 3 (3.52%) cases are pure motor. urinary symptoms in 5 (5.88%) cases, cranial nerve involvement in 3(3.52%) cases, peripheral nerve thickening in 2 (2.35%) cases and Dysautonomia in one case. Clinically, Polyneuropathy in 56 (65.88%) cases, mononeuritis multiplex in 13(15.29%) cases, poly radiculo neuropathy in 12 (14.11%) cases and   mono neuropathy in 4 (4.70%) cases. Electro physiologically, 73 cases (85.8%) have involvement of both upper and lower limbs, only lower limbs involved in 12 (14.1%) cases. Electrodiagnostic studies showed axonal pattern in 59 (60%) cases, demyelination pattern in 26 (40%) cases. Etiologically, 29 cases (34.11%) have Diabetes, Impaired glucose tolerance seen in 5(5.88%) cases, immune mediated neuropathy in 21 (24.70%), CIDP in 12 (14.11%) cases, connective tissue diseases in 9 (10.58%) cases, 12 (14.11%)cases of infectious 6 cases (7.05%) were of hereditary, 6 cases (7.05%) were of alcohol related, 3 cases(3.52%) of paraneoplastic, drug induced in 2 (2.35%) cases, in  6 cases (7.05%)  we could not find cause. Out of 31 cases of pure sensory neuropathy, 9 patients (10.58%) were diabetic, leprosy in 5 (5.88%) cases, impaired glucose tolerance in 4 (4.7%) patients, 2 (2.35%) patients were alcohol related, 1 each (1.17%) for rheumatoid arthritis, HIV neuropathy, leflunomide induced neuropathy, celiac disease, metabolic cause and cryptogenic. Among 3 pure motor neuropathy one case (1.17%) was motor CIDP, 2 cases (2.35%) were of hereditary neuropathy. Conclusion: Peripheral neuropathy is more common among 30 to 70 years age, with male preponderance. Majority have distal symmetrical motor sensory poly neuropathy. Diabetes is the most common cause for chronic peripheral neuropathy, followed by immune mediated neuropathy. Hansens neuropathy more common infective neuropathy.

Background: Bradycardia is a recognized complication during spinal anaesthesia (SA), although its incidence and associated risk factors remain variable across studies. This study aimed to assess the incidence of bradycardia during SA and identify its association with demographic, clinical, and pharmacological factors. Methods: A prospective observational study was conducted involving 300 patients aged over 16 years, classified as ASA I or II, undergoing elective lower abdominal surgeries under SA. Data collected included demographics, comorbidities, medications, and intraoperative parameters. Bradycardia was monitored throughout the perioperative period, and statistical analyses were performed using SPSS. Results: Bradycardia occurred in 16% of patients. A higher incidence was noted in individuals aged >50 years (64.6%), those with cardiovascular comorbidities, history of syncope or anaemia, and patients on beta blockers or calcium channel blockers. Nausea and vomiting were also significantly associated. No significant associations were found with gender, BMI, intraoperative fluid volume, or bupivacaine dose. Conclusion: Bradycardia during spinal anaesthesia was significantly linked to older age, cardiovascular comorbidities, specific medications (beta blockers and CCBs), and symptoms such as nausea and vomiting. Awareness of these risk factors allows early intervention and better perioperative management, reducing the likelihood of adverse outcomes.

Background Cardiac dysfunction is an emerging concern among children living with HIV/AIDS (CLHA), yet research in the Indian context remains limited. This study aims to assess the prevalence, spectrum, and diagnostic efficacy of cardiac evaluation methods in CLHA aged 2–12 years. Materials and Methods This study included 52 CLHA, all of whom had acquired HIV through perinatal transmission. Participants underwent clinical evaluations, CD-4 cell count measurements, and cardiac assessments, including electrocardiography (ECG), chest X-ray, and echocardiography (ECHO). The presence and types of cardiac abnormalities were documented and analyzed. Results Cardiac dysfunction was prevalent in 69.2% of CLHA, with higher rates observed in advanced clinical stages. No statistically significant correlation was observed with sex; however, cardiac dysfunction showed a positive association with poor nutritional status, anemia, and low CD-4 cell counts. ECHO revealed common cardiac abnormalities such as right ventricular dysfunction, tricuspid and mitral regurgitation, and dilated cardiomyopathy. ECG abnormalities were observed in 57.6% of cases, with sinus tachycardia being the most frequent finding. Chest X-rays demonstrated low sensitivity and specificity for early detection of cardiac dysfunction. Conclusions Cardiac dysfunction is common among CLHA, particularly in advanced stages of HIV. ECHO is the most reliable tool for detecting early and subclinical cardiac changes. Routine ECHO screening for all CLHA, irrespective of symptoms, is recommended to enable early intervention and improve outcomes.

Background: Ischemic stroke is a major cause of morbidity and mortality worldwide, with a strong association with atherosclerosis and dyslipidemia. Carotid artery plaque formation is a critical factor in stroke pathophysiology, and its evaluation through Doppler ultrasound provides valuable insights into disease progression. This study aims to assess the relationship between ischemic stroke, lipid profile, and carotid artery plaque characteristics. Materials and Methods: A total of 100 ischemic stroke patients, aged 45–75 years, were included in this hospital-based cross-sectional study. Patients underwent lipid profile analysis, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG). Carotid Doppler ultrasound was performed to assess plaque presence, morphology, and degree of stenosis. Statistical analysis was conducted to determine correlations between lipid parameters and carotid plaque severity. Results: Among the patients, 70% had hyperlipidemia, with a mean LDL level of 150 ± 20 mg/dL and HDL of 38 ± 5 mg/dL. Carotid artery plaques were detected in 65% of cases, with 40% exhibiting significant stenosis (>50%). A strong positive correlation (r = 0.72, p < 0.01) was observed between LDL levels and plaque severity. Patients with TC > 200 mg/dL had a 3.5-fold increased risk of severe carotid plaque formation. Conclusion: The study highlights a significant association between dyslipidemia and carotid artery plaque formation in ischemic stroke patients. Routine lipid monitoring and carotid Doppler evaluation can aid in early detection and risk stratification, potentially reducing stroke recurrence through targeted lipid-lowering therapies.

Background: Dilated cardiomyopathy (DCM) is a primary myocardial disease with dilation of the left ventricle and systolic dysfunction, resulting in high morbidity and mortality. The purpose of the present study was to compare the clinical, echocardiographic, and electrocardiographic profiles of patients with DCM. Methods: A prospective observational study was carried out for one year in the Department of General Medicine, SVRRGGH, Tirupati. Sixty patients diagnosed with DCM according to clinical, echocardiographic, and electrocardiographic criteria were recruited. Demographic data, clinical presentation, electrocardiographic findings, echocardiographic indices, and risk factors were recorded and analyzed through SPSS version 20. Results: The study population consisted mainly of males (63%) aged 53.2 years on average. The most frequent symptoms were dyspnea (100%), easy fatigability (83%), and pedal edema (70%). Echocardiography showed severe left ventricular dilatation (mean LVIDd: 60.81 mm) with decreased ejection fraction (mean EF: 28.6%). Valvular regurgitation (64%), pericardial effusion (30%), and pulmonary hypertension (24%) were common. Electrocardiography demonstrated left axis deviation (46%), left ventricular hypertrophy (38%), and increased QRS duration (>0.10 sec) in 67% of the cases. Alcoholic DCM was responsible for 15% of the cases. Conclusion: DCM occurs mostly in elderly individuals with a male predominance and marked functional impairment. Echocardiographic evidence of left ventricular enlargement and decreased ejection fraction are important prognostic determinants. Prompt recognition and control of modifiable risk factors, including alcohol intake, may enhance patient outcomes.

Background: Chronic kidney disease (CKD) is associated with significant electrolyte imbalances and cardiac complications. Hemodialysis plays a crucial role in correcting these abnormalities; however, rapid shifts in serum electrolytes can lead to ECG changes, increasing the risk of arrhythmias. This study aims to evaluate the frequency of different ECG abnormalities in CKD patients and analyze electrolyte changes after dialysis. Methods: A cross-sectional study was conducted at a tertiary care medical center on 200 patients with end-stage renal disease (ESRD) undergoing hemodialysis. Patients above 12 years of age meeting the inclusion criteria were enrolled. Exclusion criteria included ischemic heart disease, atrial fibrillation, left ventricular hypertrophy, left bundle branch block (LBBB), and antiarrhythmic medication use. Pre- and post-dialysis blood samples were analyzed for serum levels of potassium, calcium, magnesium, sodium, bicarbonate, urea, and creatinine. A 12-lead ECG was recorded before and after dialysis to assess changes in P wave amplitude, QRS complex, T wave, PR interval, QT interval, ST depression, and QT dispersion. Results: The majority of patients were males (66%), hypertensive (65%), and aged 51-60 years (22%). Hemodialysis led to significant changes in serum sodium (p<0.001), calcium (p<0.05), potassium (p<0.001), magnesium (p<0.05), bicarbonate (p<0.001), urea (p<0.001), and creatinine (p<0.05). Significant ECG changes included reductions in QT interval (p<0.001) and QT dispersion (p<0.001), and increased QRS amplitude (p<0.001).

Conclusion: Hemodialysis significantly alters electrolyte levels and induces ECG changes, highlighting the need for continuous cardiac monitoring in CKD patients undergoing dialysis.

Introduction: Diabetes and hypertension are the primary factors contributing to chronic kidney disease (CKD) on a global scale. Majority patients with CKD die due to cardiovascular events before reaching ESRD due to both traditional and non-traditional risk factors. Present study was aimed to study prevalence of cardiovascular changes on 2D echocardiography in chronic kidney disease patients. Material and Methods: Present study was prospective, cross sectional study, conducted in patients of age > 12 years with known chronic kidney disease. Results: Among 100 patients, mean age was 54.41 ± 11.97 years. The study constituted 63% of males, and 37% of females. Common etiological factors for chronic kidney disease noted were hypertension (70 %) followed by diabetes (35 %), obstructive uropathy (32 %), polycystic kidney disease (25 %) & NSAID (20 %). Stage I [>90]CKD was seen in 0% of the study population. Stage II [60-89], stage III [30-59], stage IV [15-29] and stage V [<15] CKD was seen in 3%, 13%, 33% and 51% of the study population respectively. ECG findings were normal in 40% of the study population. LVH, Tachycardia, Tall T waves and arrhythmias was seen in 30%, 10%, 15% and 5% of the study population 2d echocardiography findings were normal in 30% and abnormal in 70% of the study population. LV hypertrophy was seen in 70% cases, Fractional Shortening [FS](<30%) was seen in 8% cases, LVEF(<60%) was seen in 25% cases, E/A ratio (<0.75 or >1.8) was seen in 62% cases, Pericardial effusion (<10mm) was seen in 11% cases, Valvular calcification was seen in 6% cases and Mitral regurgitation was seen in 7% cases Conclusion: Cardiac abnormalities are prevalent across all stages of CKD, with significant increases in both systolic and diastolic dysfunction, LVH, and valvular heart disease as the disease progresses.

Introduction: Background and Objectives: Early clinical exposure (ECE) in anatomy integrates theoretical knowledge with clinical applications, enhancing students' understanding and interest in the subject. Traditional methods of anatomy teaching primarily focus on theoretical lectures and cadaveric dissections, which may not always provide an immediate clinical correlation. To bridge this gap, ECE has been introduced as an innovative teaching approach to improve the learning experience of medical students. This study aims to evaluate the perception of first-year medical students regarding ECE in anatomy and its impact on their understanding, retention, and overall interest in the subject. Methods: A cross-sectional study was conducted among 150 first-year medical students at B J Government Medical College, Pune, Maharashtra. A structured questionnaire was used to assess students' perceptions regarding ECE in anatomy. The questionnaire included Likert scale-based questions focusing on various aspects such as knowledge enhancement, retention, interest, and challenges faced by students. The collected data were analyzed using descriptive and inferential statistics, including percentages, mean values, and chi-square tests to determine statistical significance. Results: The majority of students (85%) agreed that ECE significantly enhanced their understanding of anatomical concepts, providing a clearer and more practical perspective on theoretical knowledge. About 78% of the students believed that ECE contributed to better knowledge retention, as exposure to clinical scenarios helped reinforce learning. Additionally, 82% of students expressed an increased interest in anatomy due to the interactive and application-based nature of ECE. However, 20% of students reported facing challenges in correlating theoretical knowledge with clinical scenarios, indicating the need for structured guidance and support. Furthermore, 15% of students cited time constraints as a limiting factor in fully benefiting from ECE sessions. Conclusion: ECE in anatomy is perceived positively by students, as it enhances comprehension, retention, and interest in the subject. The integration of clinical exposure in anatomy teaching provides an effective method to bridge the gap between theoretical knowledge and practical application. However, challenges such as difficulty in correlating theoretical knowledge with clinical cases and time constraints need to be addressed for its successful implementation. Future improvements in ECE should focus on providing structured guidance, increasing interactive learning opportunities, and optimizing the curriculum to ensure an effective and enriching learning experience.

Background: Type 2 diabetes mellitus (T2DM) is a global health concern, with microvascular complications such as diabetic nephropathy contributing to significant morbidity. Glycated haemoglobin (HbA1c) is a glycemic control marker, while albuminuria is an early indicator of renal dysfunction. Their interplay remains a crucial factor in diabetes management. Methods: This cross-sectional study included 150 patients with T2DM at Sheth V. S. General Hospital, Ahmedabad. Data collection included demographic parameters, disease duration, biochemical markers (HbA1c, lipid profile, serum creatinine, urine albumin-creatinine ratio), and complications such as neuropathy, retinopathy, and hypertension. Results: Among the participants, 66.6% had normoalbuminuria, 24% had microalbuminuria, and 9.3% had macroalbuminuria. Higher HbA1c levels (>7%) were significantly associated with microalbuminuria (75%) and macroalbuminuria (50%) (p<0.05). Dyslipidemia was prevalent, with 75% of microalbuminuric patients having total cholesterol >200 mg/dL. Hypertension was significantly linked to albuminuria (p=0.0382). Retinopathy was more frequent in microalbuminuric patients (p=0.0305). Conclusion: Poor glycemic control, dyslipidemia, and hypertension were strongly associated with albuminuria in T2DM patients. Early screening and aggressive management strategies targeting glycemic and lipid control may help mitigate renal complications

Introduction: Umbilical cord is foetal lifeline and it is a structure that connects the foetus to placenta. Umbilical cord and placenta acts as a mirror which reflects intra uterine status of the foetus. The aim of study to identify the relationship between the umbilical cord diameter and birth weight. Methods: This is a cross-sectional study conducted in Anatomy department in collaboration with gynaecology department at government Medical college, on 100 freshly delivered placenta with cord which are obtained from labour room of our hospital. Results: Mean cord diameter of intrauterine growth retardation (IUGR) babies is 1.68 and mean cord diameter is normal babies is 1.86. And SD of IUGR is 0.14 and normal babies is 0.17. This difference is considered to be statistically significant (P< 0.0001) This study shown that the umbilical cords of IUGR foetuses are smaller than those of normal gestational age foetuses. Conclusions: The umbilical cord diameter (UCD) could serve as an important indicator of fetal growth, well-being, and perinatal outcome. Umbilical cord small in diameter associated with IUGR Babies with large diameter are associated with macrosomic baby or large for gestational age.

Background Thrombocytopenia, defined as a platelet count below 150,000/cmm, is a frequent hematological condition with potentially life-threatening consequences. It can result from either hyperdestructive thrombocytopenia (increased platelet breakdown) or hypoproductive thrombocytopenia (decreased platelet production). Bone marrow examination is the gold standard for differentiating these causes, but it is invasive. Recent advances in automated hematology analyzers have enabled the measurement of platelet indices such as MPV (Mean Platelet Volume), PDW (Platelet Distribution Width), and P-LCR (Platelet Large Cell Ratio), which may help in distinguishing thrombocytopenia subtypes in a non-invasive manner. Methods This prospective cross-sectional study included 80 thrombocytopenic patients, classified into two groups: 49 with hypoproductive thrombocytopenia and 31 with hyperdestructive thrombocytopenia. Additionally, 20 age- and sex-matched healthy individuals served as a control group. All patients underwent clinical evaluation, CBC (Complete Blood Count) analysis using an automated hematology analyzer (Sysmex XN-1000), peripheral smear examination, and bone marrow aspiration where necessary. Platelet indices (MPV, PDW, and P-LCR) were measured and correlated with the underlying cause of thrombocytopenia. Results Statistical analysis showed significant differences in platelet indices between the two groups. Patients with hyperdestructive thrombocytopenia (e.g., Immune Thrombocytopenic Purpura) had significantly higher MPV, PDW, and P-LCR compared to those with hypoproductive thrombocytopenia. ROC (Receiver Operating Characteristic) curve analysis established cutoff values for these indices, which demonstrated good sensitivity and specificity in differentiating thrombocytopenia subtypes. A strong correlation was observed between MPV and PDW in both groups. Conclusion Platelet indices, particularly MPV, PDW, and P-LCR, provide valuable insights into the etiology of thrombocytopenia. These indices can serve as reliable, cost-effective, and non-invasive alternatives to bone marrow examination for differentiating hypoproductive from hyperdestructive thrombocytopenia. Their routine use in clinical practice may improve diagnostic accuracy and patient management, reducing the need for invasive procedures

Background: Regional anaesthesia and in particular brachial plexus block, is very useful for patients undergoing upper limb surgeries. It offers sympathetic blockade, better postoperative analgesia and fewer side-effects compared to general anaesthesia. Supraclavicular approach provides a denser block to upper arm elbow and forearm. Aim: The present study aimed to evaluate the effect of adding Dexamethasone to 0.75% Ropivacaine for supraclavicular block with consideration to the onset and duration of sensory and motor blockade, hemodynamic variables, postoperative analgesia and complications. Materials and methods: A prospective observational comparative study was conducted in 60 ASA I & II patients undergoing upper limb surgeries. They were divided into two groups of 30 each. Group (R) received Ropivacaine (0.75%) 28 ml+ Inj. Normal Saline 2ml. Group (RD) received ropivacaine (0.75%) 28 ml+ Inj. Dexamethasone 2ml (8mg).Demographic data, hemodynamic variables, onset and duration of sensory and motor blockade, total rescue analgesics consummation, post-operative VAS, side effects and patient satisfaction were recorded. Results: Demographic, haemodynamic and surgical characteristics were similar in both the groups. The mean onset of sensory and motor block were similar in both the groups. The mean duration of sensory and motor blockage were longer in group RD (P<0.05) and Post operative analgesia and total rescue analgesics were higher in group RD compared to group R. Both these data were highly significant statistically. Conclusion: Ropivacaine (0. 75%) with Dexamethasone can be safely used in supraclavicular brachial plexus block and it has prolonged duration of anaesthesia as well as prolonged post-operative pain relief in comparison with Ropivacaine alone without any side effects.

Background: Medication adherence is critical in achieving glycemic control among diabetic patients. Non-adherence remains a major barrier to effective diabetes management, particularly in resource-limited settings. Objectives: To assess the prevalence of medication adherence and identify associated behavioural factors among diabetic patients attending a tertiary healthcare hospital, using the MYMAAT-21 tool and HbA1c% levels. Methods: A cross-sectional observational study was conducted among 205 diabetic patients aged 18–60 years. Medication adherence was assessed using the 21-item Malaysia Medication Adherence Assessment Tool (MYMAAT-21). Patients were classified as adherent (score > 95) or non-adherent (score ≤ 95). HbA1c% values were used to assess glycemic control. Statistical analyses included Chi-square tests, odds ratios, and a diagnostic accuracy evaluation of MYMAAT-21. Results: Good medication adherence was observed in 55.6% of patients. A significant association was found between adherence and glycemic control (χ² = 71.54, p< 0.001), with adherent patients being 19.88 times more likely to have HbA1c < 8%. MYMAAT-21 demonstrated 89.0% sensitivity and 71.1% specificity. Key behavioural reasons for non-adherence included missed follow-ups, reducing medication when feeling better, and forgetfulness. Conclusion: Nearly half of the diabetic patients demonstrated suboptimal adherence. MYMAAT-21 is a useful screening tool, and addressing behavioural barriers through patient education and structured follow-up is essential for improving adherence and metabolic outcomes.

Aim:  To review the causes of IUD and classify the causes into maternal, fetal and placental causes and further classify causes by relevant condition at death by ICD-PM classification.We intend to observe the causes of and demographic factors contributing to the burden of IUD.Using this data, the areas of action can be identified and measures can be formulated to reduce a significant number of perinatal mortalities.

Study design: prospective observational study

Study period : 1 year

 Study population -All IUD cases admitted in the department of obstetrics and gynecology of Government medical College srikakulam during the study period.

Study is conducted after taking approval from the  Hospital ethics committee.

Methodology: This is an observational study of data collected over one year (January 2024-December 2024) from a tertiary care centre in SRIKAKULAM India. The maternal demographic characteristics and causes of IUD were studied. The causes of IUD were classified into maternal, fetal and placental causes and relevant condition at death based on ICD-PM  classification.

Results: In a study of 55 intrauterine deaths (IUDs), the majority of mothers (50.9%) were aged 20-25 years. Among them, 25.45% were primigravida and 54.54% were second gravida. Notably, 54.8% had three or more antenatal visits, while 94.54% were unbooked cases referred to GGH. Maternal conditions, including pre-eclampsia and diabetes, accounted for 58.18% of IUDs, with 87.27% occurring in the antepartum period. Of the IUD babies, 47.27% were female and 52.72% male; 65.45% were macerated and 34.54% fresh. Fetal causes contributed to 25.45% of cases, with prematurity noted in 76.36%. Four IUDs involved non-viable congenital abnormalities, and one case involved fetal demise in a twin pregnancy due to selective growth restriction. According to ICD-PM classification, hypertensive diseases were the most common maternal cause (75%), followed by gestational diabetes (18.75%).

Background: Inguinal hernia repair is a common surgical procedure performed worldwide. Anesthesia choice, either spinal or local, plays a critical role in patient outcomes, postoperative recovery, and complication rates. This study aims to compare the efficacy, safety, and patient satisfaction between spinal anesthesia (SA) and local anesthesia (LA) in patients undergoing inguinal hernia repair. Materials and Methods: A prospective randomized clinical trial was conducted involving 120 patients scheduled for elective inguinal hernia repair. Patients were randomly assigned to receive either spinal anesthesia (Group SA, n = 60) or local anesthesia (Group LA, n = 60). Parameters assessed included intraoperative pain (measured by Visual Analog Scale), postoperative pain, recovery time, complications, and patient satisfaction. Statistical analysis was performed using SPSS version 25.0, with p-values < 0.05 considered significant. Results: The mean intraoperative pain score was significantly lower in the SA group (2.1 ± 0.5) compared to the LA group (3.8 ± 0.7) (p < 0.001). Postoperative pain scores at 6 hours were also lower in the SA group (1.9 ± 0.4) compared to the LA group (3.2 ± 0.6) (p < 0.001). However, the recovery time was significantly shorter in the LA group (45 ± 10 minutes) than in the SA group (120 ± 15 minutes) (p < 0.001). Complication rates were higher in the SA group (15%) compared to the LA group (5%) (p < 0.05). Patient satisfaction was significantly better in the LA group (90%) compared to the SA group (75%) (p < 0.05). Conclusion: Local anesthesia offers better patient satisfaction, faster recovery, and fewer complications compared to spinal anesthesia for inguinal hernia repair. However, spinal anesthesia provides superior intraoperative pain control. Local anesthesia may be a preferred choice for selected patients where rapid recovery and minimal complications are desired.

Background The management of glycemic control in critically ill patients admitted to the Intensive Care Unit (ICU) presents significant challenges, particularly when oral antidiabetic drugs (OADs) are discontinued. This study aims to evaluate the impact of discontinuation of OADs on glycemic control in ICU patients and identify factors associated with poor glycemic control during hospitalization. Materials and Methods A prospective cohort study was conducted over a 6-month period in the ICU of a tertiary care hospital. A total of 200 adult patients with type 2 diabetes mellitus (T2DM) who were admitted to the ICU and had their OADs discontinued upon admission were enrolled. Blood glucose levels were monitored daily, and glycemic control was assessed using mean blood glucose levels and HbA1c values at admission and discharge. Insulin therapy was initiated as required based on standard glycemic management protocols. Patient data, including demographics, comorbidities, type of OADs used, and ICU treatment modalities, were recorded and analyzed.  Results The mean age of the study population was 58 ± 12 years, with a male-to-female ratio of 1.5:1. At admission, the average HbA1c was 8.5% ± 1.2%, indicating poor glycemic control prior to hospitalization. The mean blood glucose levels during ICU stay were significantly higher in patients who were previously managed with sulfonylureas (220 ± 45 mg/dL) compared to those on metformin (190 ± 38 mg/dL) or DPP-4 inhibitors (185 ± 36 mg/dL). Insulin therapy was required in 75% of patients during their ICU stay. Poor glycemic control (mean blood glucose >200 mg/dL) was associated with prolonged ICU stay (average 12 ± 3 days) compared to patients with better control (average 8 ± 2 days).  Conclusion Discontinuation of OADs in ICU patients leads to suboptimal glycemic control, particularly among those previously managed with sulfonylureas. Effective glycemic management protocols, including timely initiation of insulin therapy, are essential for improving clinical outcomes and reducing ICU stay duration in diabetic patients. Future studies should focus on establishing guidelines for the safe transition from OADs to insulin therapy in critically ill patients.

Background: Enhanced Recovery After Surgery (ERAS) protocols have gained recognition as evidence-based perioperative care approaches aimed at minimizing surgical stress, accelerating recovery, and reducing postoperative complications. In colorectal surgery, these protocols have been increasingly adopted to improve patient outcomes. This study aims to evaluate the effectiveness of ERAS protocols in reducing postoperative complications in colorectal surgery. Materials and Methods: A prospective, randomized controlled trial was conducted over a period of 12 months involving 200 patients undergoing elective colorectal surgery at a tertiary care hospital. The patients were randomly assigned into two groups: ERAS group (n=100) and conventional care group (n=100). The ERAS group received care based on standardized ERAS protocols including preoperative counselling, optimized fluid management, multimodal analgesia, early mobilization, and dietary advancements. Postoperative complications were assessed over a 30-day follow-up period. Statistical analysis was performed using the Chi-square test and independent t-test, with significance set at p < 0.05. Results: The incidence of postoperative complications was significantly lower in the ERAS group (20%) compared to the conventional care group (40%) (p = 0.002). The average length of hospital stay was reduced in the ERAS group (5.2 ± 1.4 days) versus the conventional care group (7.8 ± 2.1 days) (p < 0.001). Additionally, patient satisfaction scores were higher in the ERAS group (8.7 ± 1.1) compared to the conventional group (6.3 ± 1.5) (p < 0.001). No significant differences were observed in the incidence of readmission rates between the groups (p = 0.67). Conclusion: The implementation of ERAS protocols in colorectal surgery significantly reduces postoperative complications and hospital stay, while enhancing patient satisfaction. This evidence supports the routine adoption of ERAS protocols to improve clinical outcomes in colorectal surgical patients.

Background: Metabolic Syndrome (MetS) is a cluster of conditions including obesity, hypertension, dyslipidemia, and insulin resistance, which significantly increase the risk of cardiovascular diseases (CVD). Emerging evidence suggests that gut microbiota plays a pivotal role in regulating metabolic homeostasis and inflammatory responses. This study aimed to evaluate the impact of gut microbiota modulation through dietary interventions and probiotics on inflammatory markers and cardiovascular risk in patients with MetS. Materials and Methods: A total of 120 adult patients diagnosed with MetS, aged between 30 and 65 years, were randomly divided into three groups: Group A (Dietary intervention), Group B (Probiotic supplementation), and Group C (Control - standard care). Interventions were administered over a 12-week period. Serum inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured pre- and post-intervention. Cardiovascular risk was assessed using lipid profiles and arterial stiffness indices. Statistical analysis was performed using ANOVA and paired t-tests, with a significance level set at p < 0.05. Results: Following the intervention, Group A exhibited a significant reduction in CRP (from 4.8 ± 0.6 mg/L to 3.2 ± 0.5 mg/L, p < 0.01), IL-6 (from 12.5 ± 1.2 pg/mL to 9.3 ± 1.1 pg/mL, p < 0.01), and TNF-α (from 18.6 ± 2.1 pg/mL to 14.8 ± 1.8 pg/mL, p < 0.01). Similar trends were observed in Group B with reductions in CRP (from 4.7 ± 0.7 mg/L to 3.4 ± 0.6 mg/L, p < 0.05), IL-6 (from 12.4 ± 1.3 pg/mL to 10.1 ± 1.0 pg/mL, p < 0.05), and TNF-α (from 18.4 ± 2.0 pg/mL to 15.0 ± 1.7 pg/mL, p < 0.05). However, Group C showed no significant changes. Lipid profiles improved significantly in Groups A and B compared to the Control group. Conclusion: The modulation of gut microbiota through dietary interventions and probiotic supplementation significantly reduces inflammatory markers and improves cardiovascular risk profiles in patients with MetS. These findings highlight the potential of gut microbiota-targeted therapies as an adjunctive approach for managing MetS and reducing CVD risk.

Background: Hypothyroidism is a common endocrine disorder that disrupts metabolic processes, including lipid metabolism, increasing cardiovascular risk. Thyroid hormones (T3, T4) regulate lipid homeostasis, and their deficiency leads to dyslipidemia. This study evaluates lipid profile alterations in geriatric hypothyroid patients and examines the correlation between thyroid-stimulating hormone (TSH) levels and lipid parameters. Methods: A cross-sectional observational study was conducted at Pt. B.D. Sharma PGIMS, Rohtak, over one year. A total of 100 geriatric patients (≥60 years) diagnosed with hypothyroidism were included. Medical history was recorded, and biochemical assessments of lipid profiles and TSH levels were performed. The lipid parameters analyzed were triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C). Pearson correlation was used to assess associations between TSH and lipid parameters using SPSS version 21. Results: The mean levels were: TG 182.44 ± 44.67 mg/dL, TC 171.40 ± 37.32 mg/dL, HDL-C 55.76 ± 17.99 mg/dL, LDL-C 83.76 ± 24.11 mg/dL, and VLDL-C 33.92 ± 14.33 mg/dL. A significant positive correlation was observed between TSH and VLDL-C (r = 0.261, p = 0.009), while other lipid parameters showed no significant correlation with TSH. Conclusion: Geriatric hypothyroid patients exhibit dyslipidemia, particularly elevated TG, TC, and LDL-C. The significant association between TSH and VLDL-C highlights thyroid dysfunction’s role in lipid metabolism. Routine lipid assessment is crucial for cardiovascular risk management in hypothyroid patients. Further research is needed to explore underlying mechanisms and targeted interventions.

Background: Understanding individual learning preferences can be helpful when study strategies and learning styles match and learning is easy. Investigating the relationship between gender and VARK learning styles is crucial for understanding how gender may influence cognitive processing and learning preferences. This will inform the development of more inclusive and effective educational strategies. Material and Methods: Healthy undergraduate student volunteers (18-22 years), who are willing to participate in the study were included. A total of 144 participants including 55 males and 89 females participated in the study. All the participants were asked to fill out a pre-designed VARK questionnaire. Results: Absolute scoring of VARK learning styles in all undergraduate students (n=144) of the study population shows that kinesthetic styles are preferred the most by undergraduate students at 32% followed by auditory style at 30%. Conclusion:  Our preliminary data reveal a diverse range of learning styles among undergraduate students, highlighting that the standard lecture format does not address the needs of all learners. Notably, the study found no significant gender differences in VARK learning styles or modalities.

Background: William Cole introduced the term "stroke" in 1689.1 A stroke is a neurological injury resulting from a sudden localized interruption in the central nervous system. This interruption can arise from intracerebral bleeding, subarachnoid haemorrhage, or cerebral infarction.2 The World Health Organization characterizes a stroke as a rapid onset of clinical symptoms due to a specific disruption in cerebral function.  Objectives: • To find the serum levels of vitamin D in patients with acute stroke and without stroke. • To find out the association between vitamin D and acute ischaemic stroke. Material & Methods: Study Design: Observational Case-Control study.   Study area:  The study was conducted in a Teaching hospital AIMSR & District headquarters hospital, Chittoor. Study Period: 1 year.   Study population: This study included a total of 120 subjects out of which 60 are cases (acute ischaemic stroke) and 60 are controls. Sample size: The study consisted of a total of 120 cases. Results: Among the cases, 28 participants (46.7%) were classified as deficient in vitamin D, 27 participants (45%) were classified as insufficient, and 5 participants (8.3%) were classified as having sufficient levels of vitamin D. The p-value associated with serum vitamin D levels was less than 0.001, indicating a significant difference in the distribution of vitamin D levels between cases and controls. Conclusion: In conclusion, this study found significant differences in serum vitamin D levels and other risk factors, such as hypertension, diabetes, TLC, and FBS, between acute ischemic stroke patients and healthy controls. Lower vitamin D levels in stroke cases suggest a potential link between vitamin D deficiency and increased stroke risk, highlighting its role as a modifiable risk factor.

Introduction: Pediatric patients, because of their anatomical differences in airway compared to adult poses many challenges during endotracheal intubation. One such challenge is, in selecting the proper sized endotracheal tube for intubation. Use of inappropriate size of ETT can cause significant morbidity and mortality. To avoid excessive airway instrumentation, repeated laryngoscopies and minimizing risk of trauma, the preanesthetic assessment of tracheal diameter is important to select appropriate ETT size estimation. Visualization of pediatric airway with the help of USG can enable anaesthesiologist to better predict ETT size. Hence, we undertook this study to assess the accuracy of USG guided tracheal diameter measurement in predicting ETT size in pediatric patients and its comparison with that determined by age based formula. Methods: After institutional ethical committee clearance, a total of 50 pediatric patients of either sex aged between 2 and 6 years were included in this prospective observational study, who underwent elective surgery under general anaesthesia. Laryngoscopy and endotracheal intubation were done with predetermined sized ETT estimated by USG. ETT size was considered optimal when the cuff leak test was negative. The comparison was done between the size of ETT calculated by USG guided subglottic diameter, age related formula for accuracy of prediction for proper ETT size after cuff leak test. Result: Agreement between actual ETT inserted and ETT estimation by age-based formula and ultrasonography was calculated by using kappa statistics. Agreement between actual ETT inserted and ETT measured by age based formula was weak (52.18%) and kappa value was 0.394 but agreement between actual ETT inserted and ETT measured by USG is strong ( 88% ) and the kappa value is 0.853. Conclusion: Determination of endotracheal tube size by ultrasound is a good predictor of proper sized endotracheal tube in pediatric age group when compared with age based formula.

Introduction: Leprosy or Hansen disease is a slowly progressive infection caused by Mycobacterium leprae that mainly involves skin, peripheral nervous system, upper respiratory tract, eyes and testes. Leprosy is one of the oldest debilitating diseases, still there are no tools to diagnose subclinical infections and to culture the bacteria. Analysis of epidemiological data, clinical features and histopathological features and their interpretation plays a very crucial role in early diagnosis, treatment, disability prevention and most importantly elimination of social stigma in society pertaining to disease. Adequate clinical information combined with histopathology and bacteriological index help in diagnosis and classification of different types of leprosy there by in management of cases. Objectives: 1. To study the age and sex distribution among cases with Hansen’s disease.  2. To study the Spectrum of Clinical and Demographic features of Histopathologically proven Hansen’s disease cases and classify according to Ridley-Jopling classification. Methods: In the present study, the skin biopsies of cases clinically diagnosed or suspected of Hansen’s disease submitted to the Department of Pathology, Karnataka Institute of Medical sciences, Hubballi, over a period of 3 years (1 year retrospective and 2years prospective study) between July 2019 to June 2022, were studied. Paraffin blocks are prepared followed by staining the 5-micron thickness sections with haematoxylin and eosin with standard techniques as observed in Department of Pathology, KIMS, Hubballi. Various clinical and histopathological spectrum of skin lesions in Hansen’s disease were studied and classified according to Ridley-Jopling classification. Results: Majority of the patients, that is 72 (25.4%) cases were in age interval of 31-40 years. Least incidence of leprosy cases was observed in the age group of 71- 80 years accounting to 5 (1.8%) cases. Male to female ratio of 1.9:1. Borderline Tuberculoid Leprosy (BT) was the most common type of leprosy, accounting to 130 (45.7%) cases which was followed by Indeterminate Leprosy (IL) in 42 (14.8%) cases. Conclusions: This study concludes that correlation of clinical features, histopathological findings and bacterial index is very essential for arriving at diagnosis and proper typing of leprosy, which in turn prevents disability and drug resistance.

Background: Regular blood donation has been suggested to impact lipid profiles favorably, potentially reducing the risk of cardiovascular diseases. This study assesses the lipid profiles of regular blood donors compared to first-time donors. Methods: A hospital-based cross-sectional study was conducted among 60 voluntary blood donors, divided into two groups: regular donors (n=30) and first-time donors (n=30). Lipid parameters, including total cholesterol, triglycerides, LDL, and HDL, were analyzed. Results: Regular donors had lower total cholesterol (181.6 mg/dl) than first-time donors (194.2 mg/dl). Triglyceride levels were marginally higher in first-time donors (171.8 mg/dl) than regular donors (160.4 mg/dl). LDL levels were (118.7 mg/dl) in first time donors compared to regular donors (111.3 mg/dl), while HDL was slightly lower in regular donors (42.3 mg/dl) than first-time donors (42.6 mg/dl). Statistical significance was observed in some parameters, indicating possible beneficial effects of regular blood donation on lipid profiles. Conclusion: Regular blood donation may lead to subtle improvements in lipid profiles, potentially reducing cardiovascular risk. Further studies with larger sample sizes and longer follow-up are warranted.

Background: Recent concerns about "virtual autism" necessitate investigation of relationships between screen exposure, parent-child interaction, and autism-like symptoms in young children. Methods: Case-control study of 240 children aged 1-4 years (120 cases with autism-like symptoms, 120 controls) examining screen time patterns, parent-child interaction, and developmental outcomes. Results: Case group showed significantly higher daily screen time (148.5 ± 67.3 vs. 92.4 ± 45.6 minutes, p<0.001) and lower parent-child interaction time (74.6 ± 38.2 vs. 128.4 ± 51.7 minutes, p<0.001). Logistic regression revealed increased risk with higher screen time (OR=1.02, 95% CI: 1.01-1.03) and lower parent-child interaction quality (OR=0.41, 95% CI: 0.29-0.57). Parent-child interaction quality significantly moderated screen time effects (interaction term OR=0.99, p=0.022). Conclusions: Findings support association between excessive screen exposure and autism-like symptoms, highlighting parent-child interaction's protective role. Results inform evidence-based guidelines for screen use in early childhood.

Background Fat embolism syndrome (FES) is a rare yet potentially life-threatening complication of trauma, often characterized by respiratory distress, neurological dysfunction, and petechial rash. However, cerebral fat embolism (CFE) can present in isolation or with delayed onset, leading to diagnostic challenges and an increased risk of misdiagnosis. Methods This case series describes five patients diagnosed with CFE, each exhibiting different clinical patterns. Two patients presented with classic FES, while three patients had atypical neurological presentations, including delayed symptoms, non-long bone fractures, and masked presentations due to sedation and ventilation. Results MRI brain findings were consistent with cerebral fat embolism in all cases, demonstrating characteristic T2/FLAIR hyperintensities and the star field pattern indicative of microvascular embolization. Supportive ICU management, oxygen therapy, and seizure control led to full neurological recovery in all patients. Conclusion CFE should be considered in trauma patients with unexplained neurological deterioration, even in the absence of traditional FES criteria such as long bone fractures or respiratory distress. Early MRI screening and prompt supportive care play a critical role in reducing morbidity and improving patient outcomes.

Background: Thalassemia minor is a common hereditary hemoglobinopathy that may impact pregnancy outcomes despite being traditionally considered a benign carrier state. This study evaluates the maternal and neonatal complications associated with thalassemia carrier pregnancies in a tertiary care setting. Methods: A prospective observational study was conducted at a tertiary care hospital, comparing 100 pregnant women with thalassemia minor to 100 non-carrier controls. Maternal outcomes, including anaemia, gestational diabetes mellitus (GDM), hypertensive disorders, postpartum haemorrhage (PPH), and mode of delivery, were assessed. Neonatal outcomes such as low birth weight (LBW), intrauterine growth restriction (IUGR), preterm birth, NICU admissions, and perinatal mortality were evaluated. Logistic regression analysis adjusted for maternal BMI, gestational age, and anaemia severity.

Results:

• Anaemia was significantly more prevalent in thalassemia carriers (78% vs. 18%, p < 0.001), with a fourfold increased risk of severe anaemia (OR = 4.52, p < 0.001).
• Caesarean section rates were significantly higher in carriers (42% vs. 30%, p = 0.040).
• IUGR risk was significantly elevated in thalassemia carriers (24% vs. 10%, OR = 2.88, p = 0.010), and LBW was more frequent (38% vs. 22%, p = 0.020).
• NICU admissions were higher among carrier neonates (15% vs. 8%), though not statistically significant (p = 0.080).

Conclusion: Thalassemia minor is associated with a higher risk of anaemia, IUGR, LBW, and caesarean section, emphasizing the need for enhanced prenatal screening, haematological monitoring, and individualized obstetric care. Early detection and multidisciplinary management can mitigate adverse pregnancy outcomes in this population.

Most common cystic lesions in the sellar-suprasellar region are Craniopharyngioma and Rathke’s cyst^1,3. Also the most common lesions to have calcification in the sellar-suprasellar region are Craniopharyngiomas^2,3. Pituitary macroadenoma is very rarely known to have cystic and/or calcification changes³. It is of significance to differentiate pre-operatively between Craniopharyngioma and Pituitary macroadenoma, especially with significant suprasellar extension, to make decisions regarding surgical approach^1,2. The precise incidence of pituitary macroadenoma associated with both significant cystic component and calcification could not be found in literature. Microscopic calcification is more common than radiologically evident calcification, occurring in 5.4–25% of the cases. Also, calcification in context to pituitary adenoma is known to be associated with hormone secreting pituitary tumors, unlike our case where it was associated with non-hormone secreting pituitary adenoma.

We describe a rare case of non-functional Pituitary macroadenomaassociated with significant cystic component and macroscopic calcification.

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are one of the most rare high grade malignancies which usually affect extremities or trunk. Incidence is 1/Lac population per year. Intra-cranial MPNSTs (affecting commonly Cranial Nerves VIII &VII) are even rarer and only few case reports or short case series are found in literature. Orbital region intra-cranial MPNSTs are rare to the extent that only few case reports are described. In Henderson’s series of 764 Orbital region tumors only 2 were MPNSTs while in Kennedy’s series of 820 cases no MPNSTs was found. Intra-cranial MPNSTs are usually sporadic arising de novo. The second most common mode of origin is from pre-existing schwannomas whereas malignant transformation from pre-existing benign neurofibroma is extremely rare. As per the largest review of all reported cases of intra-cranial MPNSTs by Benedicte L’ Heureux and IssamSaliba, out of 60 cases 36 were sporadic, 16 arose from Schwannoma, only 06 arose from pre-existing benign Neurofibroma and there were only 4 cases of intra-cranial MPNSTs in association with NF-1. Moreover, only 3 cases are reported in literature where MPNSTs arose from benign neurofibroma in the orbital region. To describe the rarity of our case, as per the literature search, it is only the fourth reported case of malignant transformation of benign Neurofibroma in the orbital region and only the fifth case of NF-1 associated intra-cranial MPNSTs. Usual age of occurrence is around 50 years whereas incidence of affecting before 20 years is 1/Million population per year. We present  an extremely rare case of NF-1 affected  16 years old boy with large orbital region MPNSTs arising from pre-existing benign neurofibroma of the V CN with no prior history of irradiation. Complete excision should be the goal of Surgery which is the mainstay of treatment. However, due to the tenacious nature of tumor and intimate relation with critical neurovascular structures, this may not always be feasible. The reported incidence of gross total resection in intra-cranial MPNSTs is 15-20 %. When such tumors cannot be excised completely, high dose radiation is a useful adjunct

Background: Diabetes mellitus (DM) is epidemic in India and showing sharp increase. DM patients have twice the risk of mortality as compared with non-DM patients, due to micro-and macro vascular complications of diabetes. Aim: This study aimed to assess the Systemic Immune Inflammation index (SII), Systemic Inflammation Response Index (SIRI) in T2DM patients. Materials and methods: A cross-sectional study design was conducted at Department of Biochemistry and Department of General Medicine, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru, Karnataka, India. A total of 200 subjects were recruited in this study. Among them, 100 were type 2 diabetes mellitus patients and 100 were non-diabetic subjects. Under aseptic conditions, fasting venous blood samples and post-prandial samples were collected, allowed to stand for 1 hour and centrifuged at 3000 rpm for 10 minutes to obtain serum sample. The serum sample was used for the estimation of fasting and post-prandial glucose, urea, creatinine by using commercially available auto analyzer kits. EDTA samples were used for complete blood count (CBC) analysis. SII, SIRI, NLR and PLR were calculated from CBC values. Blood pressure and BMI were recorded, in addition to family history and lifestyle parameters. Statistical Analysis: The results were expressed in mean and standard deviation. Categorical variables were expressed in percentages. Mann-Whitney U test was used for continuous non-normally distributed variables. P value <0.05 was considered as significant. Results: In this study, mean age (55.1±11.5 years) and BMI (26.5±3.1 kg/m²) was significantly high in T2DM cases than non-diabetics. Significant increase in blood pressure [(systolic (SBP) 120.1±7.3 mmHg), diastolic (DBP) (80.1±2.6 mmHg)], fasting blood sugar (FBS) (155.2±50.2 mg/dl), post-prandial blood sugar (PPBS) (248.2±80.2 mg/dl), urea (30.6±6.2 mg/dl), creatinine (1.2±0.1 mg/dl) and neutrophil count (68.6±10.9 %) was observed in T2DM cases compared with non-diabetic subjects. Significant decrease in lymphocytes (25.1±9.7 %) observed in T2DM cases. The inflammatory markers such as SII (14.9±4.5), SIRI (27.5±6.1), NLR (5.1±1.5) and PLR (0.21±0.02) were significantly increased in T2DM cases than non-diabetic subjects. Conclusion: This study results may conclude that increased values of SII, SIRI, NLR and PLR in T2DM and indicates systemic inflammation and may be associated with pathogenesis of the T2DM.

Background & Aims: Post-thoracotomy pain in pediatric patients is challenging to manage, affecting postoperative recovery, ventilation, and opioid consumption. Caudal Epidural (CE) has been a traditional approach, but Serratus Anterior Plane Block (SAPB) has gained attention as a viable alternative. This study compares the efficacy, opioid requirements, and safety of SAPB vs. CE in pediatric thoracotomy patients. Methods: This randomized controlled trial was conducted at a tertiary care hospital on 32 pediatric patients (6 months–7 years) undergoing thoracotomy. Patients were randomized into: SAPB Group (n=16): Ultrasound-guided SAPB using 0.125% Bupivacaine (0.4 ml/kg) + Dexmedetomidine (2 μg/kg), CE Group (n=16): Caudal Epidural using 0.125% Bupivacaine (1.25 ml/kg) + Dexmedetomidine (2 μg/kg). Primary Objectives: Total fentanyl consumption (24 hours), Time to first rescue analgesia. Secondary Objectives: Intraoperative fentanyl requirement, FLACC pain scores, Hemodynamic stability & complications Results:  SAPB significantly reduced fentanyl consumption (1.81±0.48 µg/kg) compared to CE (3.38±0.70 µg/kg, p=0.001). Time to first rescue analgesia was prolonged in SAPB (237.88±62.68 min) vs. CE (126.69±20.65 min, p=0.001). No major complications were reported in either group. Conclusion: SAPB is a safe and effective alternative to CE for post-thoracotomy pain in pediatric patients, providing longer-lasting analgesia and reduced opioid consumption.

Introduction: Heart failure (HF) remains a significant cause of morbidity and mortality worldwide. This study explores the association between proportional pulse pressure (PPP) and the severity of HF categorized by left ventricular ejection fraction (LVEF) using echocardiography. Material and Methods: The study included a sample size of 92 patients, with findings indicating a statistically significant relationship between lower PPP and reduced LVEF. PPP was found to be an effective non-invasive marker of arterial compliance and cardiovascular function, particularly in patients with heart failure with reduced ejection fraction (HFrEF). Patients with a lower PPP exhibited higher levels of cardiac dysfunction, indicating that PPP could be a useful tool for risk stratification and prognosis determination. Results: The study highlights that patient with reduced LVEF consistently demonstrated lower PPP values, with a significant inverse correlation between these two parameters (p < 0.001). The results suggest that proportional pulse pressure can serve as a cost-effective and reliable parameter in assessing heart failure severity, particularly in resource-limited settings where access to advanced diagnostic tools such as echocardiography is limited. Conclusion: Given its simplicity and ease of measurement, PPP could be incorporated into routine clinical practice to enhance early detection and improve treatment strategies for HF patients. Future research should explore the longitudinal impact of PPP measurements on HF management and outcomes.

Background: The Mallampati test is used to evaluate the airway to predict difficult laryngoscopy and intubation. The sitting position is the standard for this test, but it has limited practical utility due to its low sensitivity and moderate specificity in predicting difficult intubation and laryngoscopy. The supine position, on the other hand, may improve its efficacy.This test, as a standard, when conducted with a patient in a sitting position, exhibits limited practicality due to its relatively low sensitivity and specificity in predicting difficult tracheal intubation (DTI). It is hypothesized that MMT, when performed with a patient lying supine, may improve its efficacy as a predictor of DTI, this prospective observational study was conducted involving 100 adult patients requiring general endotracheal anaesthesia. During pre-anaesthetic evaluation, MMT was performed in the sitting position as a standard (sitting MMT). Subsequently, independent observers recorded the MMT in the supine position (supine MMT) before administering general anaesthesia. The sitting and supine MMT were correlated with Cormack and Lehane grades using the Chi‑ square test. Diagnostic performance metrics, including the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive values (PPV) and negative predictive values, were employed to assess the predictive capabilities of MMT in both positions and found as resultant both MMT in the sitting and supine positions demonstrated strong predictive capabilities for DTI, with areas under the ROC, respectively. While sitting in the MMT position exhibited higher sensitivity, supine MMT demonstrated a superior PPV. After completion of the study, we concluded, MMT, when conducted with a patient in a supine position emerges as an alternative and are liable predictor for predicting DTI.  

Introduction: Tuberculosis can significantly affect the hematopoietic system, leading to various hematological abnormalities like anemia, leukocytosis, and changes in platelet counts, which can be valuable in diagnosis and monitoring treatment response. Method: This prospective study conducted in PDU medical college and hospital, Rajkot, Gujarat from April 2021 to March 2022. Blood sample sent to clinical laboratory, Department of pathology, where peripheral smear was prepared from EDTA sample and data evaluated. Total 850 patient’s samples were studied in this study. Data collected includes patients diagnosed with Pulmonary tuberculosis, Extra pulmonary tuberculosis and MDR tuberculosis. hematological parameters like hemoglobin (HB), RBC count, RDW, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin  concentration (MCHC), total leucocyte count (TLC), differential leukocyte count (DLC), platelet count with the help of automated hematology analyzer. Result: Maximum numbers of cases found in 3^rd decade followed by 5^th decade and 4 th decade. Anemia was frequently encountered in patients with tuberculosis (70.24%).Among anemic patients most patients (51.09%) have moderate degree of anemia with Hemoglobin level between 7 - 10 gm/dl and (38.02%) have mild degree of anemia with hemoglobin level between 10.1 - 12.9 for male and 10.1 - 11.9 for female. Only few patients (10.89%) have severe degree    of    anemia with hemoglobin level between <7 gm/dl. Normocytic Normochromic anemia was the most common type of anemia (52.60%). Followed by hypochromic microcytic anemia (42.04%).Increased ESR is the commonest finding associated with tuberculosis (92.35%) Leucocytosis occurred in (43.18%) cases, among them (72.20%) cases show Neutrophilia while (24.79%) cases show Lymphocytosis. Most cases have normal platelet count but thrombocytosis was seen in (32.47%) cases. Conclusion: These types of hematological abnormalities are quite common in patients with tuberculosis and physicians must maintain a high index of suspicion for diagnosis of tuberculosis in patients with these abnormalities

Background: Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Objective: To assess the bleeding and cardiovascular outcomes associated with DAPT in patients with varying degrees of baseline thrombocytopenia undergoing PCI. Methods: A prospective cohort study was conducted at a tertiary care hospital, enrolling 368 patients with thrombocytopenia undergoing PCI. Patients were stratified into mild (100,000– 150,000/mm³), moderate (50,000–100,000/mm³), and severe (30,000–50,000/mm³) thrombocytopenia. Outcomes included bleeding complications (BARC criteria), major adverse cardiovascular events (MACE), in-hospital mortality, and post-PCI complications. Univariate and multivariate models were used for analysis. Results: Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion: Moderate and severe thrombocytopenia are independent predictors of bleeding and cardiovascular events in patients on DAPT post-PCI. These findings emphasize the need for stratified management in this high-risk group. 

Background & Aims: Frailty is increasingly recognized as a significant factor affecting outcomes in patients with liver cirrhosis. However, its prevalence, biochemical associations, and impact on hospitalization remain underexplored. This study aimed to assess the burden of frailty in cirrhosis patients, its association with disease severity (CTP score), laboratory parameters, and hospitalization duration. Methods: A prospective observational study was conducted among 100 patients with cirrhosis at a tertiary care center. Frailty was assessed using the FRAIL scale, and patients were categorized as frail (score ≥3) or non-frail (score <3). Liver function tests, haematological parameters, and CTP classification were recorded. Statistical comparisons were performed using t-tests, Mann-Whitney U tests, ANOVA, and Kruskal-Wallis tests, with a significance level of p < 0.05. Results: Frailty was highly prevalent (84%) among cirrhosis patients. Frail patients had significantly lower hemoglobin (p < 0.001), lower albumin (p = 0.044), higher bilirubin (p < 0.001), and higher INR (p < 0.001). Hospital stay duration was significantly longer in frail patients (p < 0.001). Disease severity correlated with frailty, as confirmed by ANOVA (p < 0.001) and Kruskal-Walli’s test (p < 0.001), indicating that frailty worsens with advancing cirrhosis (CTP classification). Conclusion: Frailty is highly prevalent in cirrhosis and is associated with worse biochemical parameters, prolonged hospitalization, and advanced disease severity. Given its modifiable nature, frailty assessment should be integrated into routine cirrhosis management to improve risk stratification and patient outcomes. Early interventions, including nutritional therapy and prehabilitation programs, may mitigate frailty's impact on cirrhosis progression. 

Introduction: Chronic kidney disease is classified into five stages based on the estimated glomerular filtration rate (eGFR), with stage 1 being the mildest and stage 5 representing end-stage renal disease (ESRD). Microalbuminuria is typically detected in the early stages of CKD and is defined as a urinary albumin-to-creatinine ratio (ACR) between 30 and 300 mg/g. It is indicative of glomerular injury and endothelial dysfunction, reflecting increased permeability of the glomerular filtration barrier. The pathophysiology of microalbuminuria in CKD involves multiple factors, including glomerular hypertension, podocyte injury, and inflammation. Persistent microalbuminuria is associated with a decline in renal function and an increased risk of cardiovascular events, making it an important marker for risk stratification and therapeutic monitoring in CKD patients.  Material and Methods:  This  is an Observational or cross-sectional study was conducted among CKD patients from outpatient clinics or hospitals, Index Medical College. Patients diagnosed with CKD stages 1–5, based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Demographic and Clinical Data: Collect information on age, gender, duration of CKD, comorbidities, medications, and lifestyle factors. Quantify urinary albumin excretion using spot urine samples or 24-hour urine collections. Normalize results to urinary creatinine concentration. Spot urine samples or 24-hour urine collections will be used to quantify urinary albumin excretion. Urinary albumin concentration will be measured using an immunoturbidimetric assay. Results Mean Urinary Albumin (mg/g creatinine) is 145.6 mg/g creatinine, SD: 85.3 and 24-hour Urinary Albumin (mg/day) is 320.4 mg/day, SD: 150.2. Both Urinary Albumin Measures Increase with CKD Progression: Urinary albumin (mg/g creatinine) rises from 45.2 mg/g (Stage 1) to 380.5 mg/g (Stage 5). 24-hour urinary albumin excretion shows a similar increase from 85.3 mg/day (Stage 1) to 600.5 mg/day (Stage 5). The rate of albumin increase is mild in Stages 1 & 2 but becomes steep in Stages 3-5. Urinary Albumin (mg/g creatinine) has a correlation of r=0.65r = 0.65r=0.65 (p < 0.001). 24-hour Urinary Albumin (mg/day) has an even stronger correlation of r=0.70r = 0.70r=0.70 (p < 0.001).  Conclusion This study demonstrates a significant negative correlation between antioxidant status and microalbuminuria in CKD patients, consistent with previous research. The findings highlight the role of oxidative stress in CKD progression and suggest that interventions targeting oxidative stress may help reduce microalbuminuria and slow disease progression

Background This study was conducted to evaluate effect of dexmedetomidine to reduce the stress induced hyperglycaemia and adverse effects in patients undergoing laparoscopic surgeries Materials and methods: A randomized controlled clinical trial was undertaken on 76 patients with 38 patients in each group D and C over 2 years (January 2021 to December 2022).  Result: A total of 76patients were studied. We studied fresh capillary blood glucose levels using glucostrip test at various time intervals: at baseline (before Dexmedetomidine bolus), at 30 min after induction, 1hr, 2hr, 3hr and 6 hr from beginning of surgery. Baseline level of blood glucose in both groups were comparable. Themeanbloodglucoselevelsincontrolgroupwereraisedfrombaselinewhichis106.7±4.4 as compared to 98.3 ± 4.7 in dexmedetomidine group. At 1hr mean blood sugar level in group D was 95.9 ± 4.4 Vs 113.8 ± 5.6 in group S. At2 hr mean blood sugar levels in group D was98.3 ±5.7 Vs118.7±4.8 in group S.At 3 hr, mean blood sugar levels in group D was 103.2 ±5.2 as compared to 121.6 ±5.1 in control group. This rise in both the groups could be due to response to extubation. There was continuous rise in blood sugar in control group at all time intervals and was statistically significant. Blood sugar levels was well controlled in Dexmedetomidine group. Conclusion: Use of IV Dexmedetomidine in patients undergoing laparoscopic surgeries was successful inattenuatingthehyperglycaemicresponseasamarkerofstressresponse during surgery and immediate postoperative period.

Background Pleural effusion is an abnormal accumulation of fluid in the pleural space, commonly seen in pediatric patients secondary to infections, cardiac conditions, or renal diseases. It presents a significant challenge in pediatric healthcare due to varied etiologies, diagnostic complexities, and treatment approaches. The study aims to evaluate the clinical presentation, etiological factors, and management modalities of pleural effusion in children. Materials And Methods This is a prospective observational study conducted at a tertiary care hospital over a period of one year. A total of 236 pediatric patients (aged >1 month to 12 years) with radiologically confirmed pleural effusion were included. Clinical presentation, laboratory findings, radiological assessments, and management strategies, including antibiotics, ICD (Intercostal Drainage), and surgical interventions, were analyzed. Data was evaluated using appropriate statistical methods. Results The incidence of pleural effusion in pediatric patients during the study period was 2.36%, with the highest prevalence noted in the 1–5 years age group, accounting for 45.3% of cases. Males were more commonly affected than females, with a male-to-female ratio of 1.23:1. Fever (93.6%) and cough (91.9%) were the most frequently observed symptoms, followed by breathlessness (77.9%) and chest pain (31.4%). The most common clinical sign noted was tachypnea (77.5%). Most cases (54.2%) presented with right-sided effusions, while 39.4% had left-sided effusions, and 6.4% had bilateral involvement. Among the identified etiologies, pneumonia was the leading cause (58.1%), followed by congestive cardiac failure (19.9%), dengue (9.7%), tuberculosis (5.5%), and renal conditions (6.8%). Pleural fluid analysis revealed that 90.4% of the cases were exudative, and microbiological studies identified Staphylococcus aureus as the most frequently isolated pathogen (17.8%), followed by Streptococcus pneumoniae (9.6%). In terms of management, 69.5% of patients were successfully treated with medical therapy alone, while 24.5% required intercostal drainage tube insertion. Surgical intervention, including thoracotomy and decortication, was performed in 5.9% of cases. Among the surgically managed cases, mortality was higher (35.7%) compared to those managed conservatively. The overall outcome was favorable, with 93.4% of patients discharged after successful treatment. However, 5.9% of cases resulted in mortality, primarily due to severe complications and delayed presentation. Two patients (0.8%) opted for discharge against medical advice. Conclusion Pleural effusion in children is primarily secondary to pneumonia and is most common in the early childhood years. Early diagnosis through imaging and microbiological analysis plays a crucial role in management. Most cases can be managed with antibiotics, but a significant proportion require ICD placement, especially in post-pneumonia effusions. Surgical intervention is reserved for complicated cases. Timely and appropriate intervention ensures favorable outcomes with minimal complications.

Background: Medical education has undergone significant advancements over the past decade, necessitating curriculum adaptations to accommodate students with diverse learning abilities. This is particularly crucial for supporting mediocre and slower learners who are often at risk of academic failure. Objective : The study aimed to enhance the medical curriculum by implementing weekend exam-based formative assessments. Students were grouped based on their performance, and tailored teaching, learning, and evaluation strategies were employed to create a more effective and engaging educational environment. Methods: A prospective, questionnaire-based study was conducted involving second-year MBBS students and faculty members. Students were divided into four performance-based groups according to their weekend exam results. Customized study sessions were designed for each group, utilizing diverse teaching and evaluation methodologies. Results: The approach fostered a competitive attitude among high-performing students while reducing stress and increasing interest among mediocre and slower learners. Positive feedback from students indicated improved engagement and reduced dropout rates. However, the initiative imposed additional workload on faculty due to extended hours and increased evaluation responsibilities. Conclusion: Weekend exam-based formative assessments, coupled with performance-based grouping, demonstrated potential in enhancing medical education by fostering better learning outcomes and engagement. Despite logistical challenges for faculty, this innovative approach could significantly contribute to producing competent Indian Medical Graduates.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder with a rapidly increasing global prevalence, contributing significantly to morbidity and mortality. Poor glycemic control is a key factor leading to severe complications, particularly cardiovascular diseases (CVD). This study assesses demographic distribution, glycemic control, diabetes duration, management strategies, and cardiovascular risk factors among diabetic patients. Aim: To evaluate glycemic control, management strategies, and the prevalence of cardiovascular risk factors among diabetic patients attending a tertiary care hospital. Methods: A cross-sectional study was conducted among 100 diabetic patients. Data on demographic characteristics, mean HbA1c levels, duration of diabetes, management approaches, and cardiovascular risk factors were collected and analyzed using SPSS software. Results: Of the study population, 63% were male and 57% were aged 41–60 years. The mean HbA1c was 8.2, indicating poor glycemic control. Most patients (61%) had diabetes for over five years, and 56% required both oral hypoglycemic agents (OHA) and insulin. The most prevalent cardiovascular risk factors were dyslipidemia (63%), hypertension (41%), and a high-risk CVD category (37%). Tobacco use and alcohol consumption were observed in 19% and 29% of the patients, respectively. Conclusion: The study highlights poor glycemic control and a high prevalence of cardiovascular risk factors among diabetic patients, emphasizing the urgent need for targeted interventions. Multidisciplinary diabetes management, including early lifestyle modifications, optimal pharmacological strategies, and regular monitoring, is crucial in reducing diabetes-related complications. Future research should explore individualized intervention strategies and their long-term impacts on glycemic control and cardiovascular risk reduction.

Background Total Shoulder Arthroplasty (TSA) is a well-established procedure for managing end-stage shoulder arthritis. However, predicting postoperative outcomes remains challenging. Arthroscopic evaluation prior to TSA allows for a detailed assessment of intra-articular structures, which may provide valuable prognostic information. This study aims to assess the role of arthroscopic evaluation in predicting postoperative functional and clinical outcomes of TSA. Materials and Methods This prospective cohort study included 100 patients (mean age: 62 ± 8 years) undergoing TSA. All patients underwent preoperative arthroscopic evaluation to assess rotator cuff integrity, glenoid morphology, and cartilage condition. Functional outcomes were measured using the Constant-Murley Score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score preoperatively and at 6 and 12 months postoperatively. Pain levels were assessed using the Visual Analog Scale (VAS). Statistical analysis was performed to determine the correlation between arthroscopic findings and postoperative outcomes. Results Patients with intact rotator cuffs had significantly higher postoperative CMS (78 ± 5) and ASES scores (85 ± 4) compared to those with partial or full-thickness tears (CMS: 65 ± 6, ASES: 72 ± 5; p < 0.05). Severe glenoid erosion was associated with inferior outcomes, with an average CMS of 60 ± 7 and ASES score of 68 ± 6. Pain levels improved significantly in all patients, with VAS scores decreasing from 7.5 ± 1.2 preoperatively to 2.3 ± 1.0 at 12 months (p < 0.001). Conclusion Arthroscopic evaluation before TSA provides valuable insights into intra-articular pathology, enabling better prediction of postoperative outcomes. Patients with intact rotator cuffs and minimal glenoid erosion demonstrated superior functional recovery and pain relief. Preoperative arthroscopy may aid in surgical planning and patient counselling to optimize TSA outcomes.

Background: Recurrent miscarriages and perinatal deaths pose significant challenges to reproductive health, impacting couples both physically and emotionally. Assessing the reproductive performance of such couples can provide valuable insights into pregnancy outcomes, risk factors, and potential interventions to improve fetal survival rates. Materials and Methods: A prospective observational study was conducted on 150 couples with a history of at least one miscarriage or perinatal death. Clinical and demographic data were collected, including maternal age, body mass index (BMI), obstetric history, and underlying medical conditions. Participants underwent hormonal profiling, genetic testing, and ultrasound evaluations to assess uterine and fetal health. Pregnancy outcomes, including live birth rate, miscarriage rate, and perinatal complications, were analyzed over a follow-up period of 12 months. Statistical analysis was performed using chi-square and logistic regression tests, with a significance level set at p < 0.05. Results: Of the 150 couples, 80% achieved pregnancy within the study period. The live birth rate was 65%, while 20% experienced recurrent pregnancy loss, and 15% had preterm deliveries. Factors such as advanced maternal age (>35 years), obesity (BMI > 30), and thrombophilic disorders were significantly associated with adverse pregnancy outcomes (p < 0.01). Couples receiving targeted medical interventions, including progesterone support and low-dose aspirin therapy, had improved pregnancy outcomes (p < 0.05). Conclusion: Couples with previous miscarriages and perinatal deaths face an increased risk of adverse pregnancy outcomes. Early identification and management of risk factors, including maternal health optimization and medical interventions, can enhance reproductive performance and fetal survival rates. Comprehensive counseling and personalized treatment approaches are essential for improving pregnancy success in this population.

Background: In 2018, ovarian carcinoma ranked as the eighth most common cancer diagnosed and the leading cause of cancer death in women. High-grade serous carcinoma is the most common histological type seen among malignant cases. A diverse group of neoplasms is seen in the ovary with variable clinical, morphological, and histological features, so assessing the nature of ovarian neoplasms further assists in the treatment of the disease. Aim: This study was conducted to assess the different histopathological variants of ovarian neoplasms according to the latest 2020 World Health Organization (WHO) classification of ovarian tumors. Further analysis of the frequency, age and distribution of various ovarian tumors is assessed. Materials and methods: A retrospective study was conducted in the Department of Pathology at GMC CHANDRAPUR The data of the patients from the past one years, from January 2022 to December 2022, were retrieved and assessed. Gross and microscopic findings, including clinical details of patients with ovarian masses, were analyzed from the previous records. Result: A total of 23 cases of ovarian neoplasms on histopathology were analyzed. The age range was 15-74 years. The types of specimens received were those of total abdominal hysterectomy, salphingoopherectomy, and unilateral or bilateral ovarian cystectomy. The most common presentation was an abdominal mass, followed by pain in the abdomen. The majority of the tumors were benign (91%), malignancy was observed in 9% of cases, and borderline tumors were seen in 4.3% of cases. Epithelial tumors were the commonest tumors, accounting for 73.9%, followed by germ cell tumors (21.7%). Serous cystadenoma was the commonest benign tumor, followed by mature teratoma and serous cystadenocarcinoma. Conclusion: Ovarian neoplasms usually present with a variety of clinicomorphological and histological features. The most common neoplasm observed in the ovary is surface epithelial tumors, which are benign lesions that commonly affect reproductive age groups. Newer advancements like immunohistochemistry (IHC) and genetic studies have made the diagnosis easier and more precise. However, in institutes with limited resources, a histopathological study is still the gold standard in the diagnosis and prognostic evaluation of these tumors.

Introduction: Breast cancer is the most frequently occurring cancer in women. It has been reported Hepatocyte Growth Factor (HGF) is the cause of many biological events of cancer like cell proliferation, movement, invasiveness, angiogenesis and morphogenesis. Estimation of serum HGF in many other solid carcinomas has indicated to be a good prognostic marker. Objectives: To estimate serum HGF level in breast carcinoma. To correlate the serum HGF with known clinicopathological prognostic factors of invasive breast carcinoma. Methods: Pre-operative estimation of serum HGF by ELISA was carried out in patients with invasive breast carcinoma undergoing surgery. Serum samples from normal women and benign breast disease with age and sex-matched volunteers were used as control samples. Gross and microscopic features of the mastectomy specimen were studied. The serum HGF levels were correlated with the known clinicopathological factors of invasive breast carcinoma to note its significance. Results: Serum HGF was significantly elevated preoperatively in invasive duct carcinoma cases as compared to benign breast disease and normal control samples (p- value<0.0001). The serum HGF level on correlation show statistical significance in cases positive for desmoplasia and tubule formation of MBR score. Association of desmoplasia with increase in HGF levels may also be due to secretion of HGF by stromal components like fibroblasts and myofibroblasts which are found abundant in tumor area. Conclusion: Thus, the preoperative level of serum HGF has reflected the severity of invasive breast cancer in our study and is useful to pick up the high-risk patients for more aggressive treatment. 

Purpose of the Review:Venous Thromboembolism is a complication in which blood clots and blocks a vein. Most of the time either it is underdiagnosed or misdiagnosed and becomes serious because of late diagnosis. It encompasses two interrelated conditions such as deep vein thrombosis and pulmonary embolism. Deep vein thrombosis is a significant concern in hospitalized patients and contributes to long hospital stays, morbidity and mortality. The most appropriate inflammatory biomarker for diagnosis and therapeutics in venous thromboembolism remains unclear and is under exploratory condition. The role of molecular markers in the pathophysiology of venous thrombo embolism expands the knowledge of mechanistic action and therapeutic targets. Detection of biomarkers associated with VTE and recurrence of VTE has been explored but limited to few markers like D-dimer, C reactive protein, protein C & S etc. Recent findings: Present study reviewed a total of 44 differentially expressed proteins majorly lipoproteins, glycoproteins, inflammatory proteins and few cytosolic proteins, which were considered as potential biomarker for VTE manifestation. Protein-protein interaction confirmed by a Search tool (STRING) and revealed that CRP, IL6, IL8, IL17, selectin family, JAK-STAT group and tissue factor proteins including VWF proteins are significantly interconnected in disease manifestation, thrombus formation and endothelial cell activation, platelet aggregation, and coagulation.  Summary: The current review and protein protein interaction analysis bring together shreds of evidence of differential expression of protein biomarkers associated with venous-thromboembolism by their function and protein-protein interaction involved in coagulation. 

Background: Neonatal sepsis remains a leading cause of morbidity and mortality among newborns, requiring early diagnosis and appropriate antimicrobial therapy. This study aims to evaluate the bacteriological profile and antimicrobial sensitivity patterns of blood culture isolates in neonates with sepsis admitted to the Neonatal Intensive Care Unit (NICU) at GGH, Guntur. Methods :A prospective observational study was conducted on 150 neonates diagnosed with sepsis. Blood culture samples were analyzed to identify causative organisms and their antimicrobial susceptibility patterns. Clinical, maternal, and neonatal risk factors were documented. Statistical analysis was performed using SPSS v16, with significance set at p < 0.05. Results: Among the 150 neonates, late-onset sepsis (60%) was more common than early-onset sepsis (40%). Klebsiella (60.7%) was the predominant pathogen, followed by Staphylococcus aureus (22%), Pseudomonas (9.3%), and Acinetobacter (8%). Prematurity (44.6%) and perinatal asphyxia (36%) were significant neonatal risk factors. CRP positivity (89.3%) was observed in most cases. Antibiotic resistance was highest for ampicillin and cefotaxime, while piperacillin/tazobactam and meropenem were effective against Gram-negative isolates. Vancomycin remained effective against Staphylococcus aureus. Overall mortality was 21.3%, with Klebsiella infections associated with the highest fatality rate. Conclusion: Neonatal sepsis is primarily caused by Gram-negative bacteria, with Klebsiella and Staphylococcus aureus being the most common pathogens. The study highlights the increasing resistance to first-line antibiotics, emphasizing the need for regular antimicrobial surveillance and targeted therapy to improve neonatal outcomes

Background: Microlaryngeal surgery is a stressful short surgical procedure for diagnosis and treatment of airway disorders, which produces an intense cardiovascular stimulation during suspension laryngoscopy. The study compared propofol and etomidate as hypnotics in microlaryngeal surgery combined with jet ventilation. They observed more stable anaesthesia and better recovery with propofol group than etomidate group. The study compared propofol and methohexital for total intravenous anaesthesia in microlaryngeal surgery. They observed cardiovascular stability with propofol than methohexitone in microlaryngeal surgery. Another study shown that sevoflurane and remifentanil effectively maintained cardiovascular stability than sevoflurane and alfentanil in patients undergoing microlaryngeal surgery. MATERIAL AND METHODS: This is a prospective study conducted in patients undergoing microlaryngeal surgery in the department of anesthesiology at Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga. A total of 60 adult daycare patients belonging to the American Society of Anaesthesiologist grade I or II were included in the study. Patients were divided into two groups named as propofol group (group P) and sevoflurane group (group s) of 30 each by computer randomization tables. Patients aged 18 to 60 years of ASA grade I and II posted for microlaryngeal surgery under general anaesthesia were included in the study.  RESULTS:Heart rate before and after premedication in Sevoflurane group and Propofol group was nearly equal. There was decrease in heart rate following induction with both propofol (71.63 ± 6.49) which is statistically significant than sevoflurane (76± 2.99). There is good control of Heart rate after intubation in Sevoflurane group when compared to Propofol group. Which was statistically significant (p<0.001). There is decrease in Mean arterial pressure at 3min , 5min ,15 min , 20 min and 25 min time intervals in Sevoflurane group which is statically significant ( P < 0.05) when compared to Propofol group except at 10 min and 30 min where the mean arterial pressure in Propofol group similar to the sevoflurane group. CONCLUSION: Sevoflurane is a better agent compared to propofol, for micro laryngeal surgeries due to stable hemodynamic properties and faster recovery. Post-operative nausea and vomiting is less in patients receiving Propofol than Sevoflurane.

Background: Intercostal drain (ICD) insertion is a common procedure for managing pleural collections, but complications such as vascular injury can lead to catastrophic bleeding. This case highlights an iatrogenic pulmonary artery injury following ICD insertion and its successful surgical management. Case Report:A 70-year-old male with a history of pulmonary tuberculosis, coronary artery disease, and diabetes presented with breathing difficulty. Three days prior, a pigtail catheter was inserted for pneumothorax with pleural effusion at a local hospital, which was later replaced with an ICD due to improper drainage. Following ICD insertion, 600 mL of blood drained suddenly, leading to hemodynamic instability. The patient was transferred to our hospital in shock with tachycardia (HR 120/min) and hypotension (BP 80/46 mmHg). Emergency chest X-ray showed the ICD positioned near the right hilum. A CT thorax with pulmonary angiogram revealed the ICD misplacement within the right pulmonary artery, causing occlusion of lobar and segmental branches.Emergency thoracotomy was planned after multidisciplinary discussions. Anesthesia concerns included hemodynamic instability, advanced age, pulmonary tuberculosis, and coronary artery disease. The patient was managed under general anesthesia with a double-lumen tube for one-lung ventilation. Surgical exploration confirmed ICD penetration into the right pulmonary artery. Purse-string sutures were placed, and the ICD was carefully removed. Hemostasis was achieved without requiring cardiopulmonary bypass. Postoperatively, the patient was extubated after 8 hours, stabilized, and discharged following an uneventful recovery. Discussion: Pulmonary artery injury from ICD placement is rare but potentially fatal. Preoperative imaging, meticulous anesthetic management, and surgical expertise contributed to the successful outcome. Unlike previously reported cases requiring cardiopulmonary bypass, this patient was managed without it. This case underscores the importance of proper ICD placement techniques and the role of multidisciplinary collaboration in managing such emergencies.

Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality, necessitating rapid and accurate diagnostic techniques for early detection and targeted antimicrobial therapy. Conventional blood culture methods have limitations due to prolonged turnaround times, which can delay treatment decisions. Rapid molecular diagnostic techniques (RMDTs) offer a promising alternative by providing quicker pathogen identification and antimicrobial resistance detection. This study evaluates the clinical outcomes of RMDTs in general medicine wards compared to conventional diagnostic methods. Methods: A prospective, observational study was conducted in the general medicine wards of a tertiary care hospital over six months. A total of 200 patients with suspected BSIs were included. Blood samples were analyzed using both conventional blood culture methods and a rapid molecular diagnostic platform. Primary outcomes measured included time to pathogen identification, duration of empirical antibiotic therapy, length of hospital stay, and 28-day mortality rate. Secondary outcomes assessed the appropriateness of antimicrobial therapy adjustments based on RMDT results. Statistical analysis was performed using the chi-square test and Kaplan-Meier survival analysis, with a significance threshold of p < 0.05. Results: The mean time to pathogen identification was significantly lower with RMDTs (6 ± 2 hours) compared to conventional blood cultures (48 ± 6 hours) (p < 0.001). The duration of empirical antibiotic therapy was reduced in the RMDT group (4.2 ± 1.1 days) versus the conventional group (6.8 ± 1.5 days) (p < 0.05). Hospital stay was also shorter in patients diagnosed using RMDTs (9.5 ± 2.3 days) compared to conventional methods (12.7 ± 3.1 days) (p = 0.03). The 28-day mortality rate was lower in the RMDT group (12%) than in the conventional group (18%), though not statistically significant (p = 0.08). Conclusion: The implementation of RMDTs in general medicine wards significantly reduces the time to pathogen identification, leading to earlier optimization of antimicrobial therapy and shorter hospital stays. Although mortality reduction was observed, further large-scale studies are required to establish the impact on overall patient survival. Integrating RMDTs into routine clinical practice may enhance patient outcomes and antimicrobial stewardship.

Context: Motor skills are an essential component of our daily lives allowing us to perform various activities with ease, any impairment in our motor functioning significantly impacts our day-to-day activities. Previous studies demonstrate that pranayama and exercise improve motor skills Aims: to assess the immediate effects of pranayama and cardiovascular exercise on fine motor skills and compare their effects. Methods and Material: 60 healthy young adults were included. They were divided into two groups as pranayama and exercise groups. The pranayama group underwent 10 minutes of anulom vilom pranayama and the exercise group underwent 15 mins of brisk walking. Fine motor skills were assessed before and after the interventions. The O’Connor Tweezer Dexterity test was used to assess fine motor functioning. Results: A significant improvement was detected between pre intervention and post intervention scores following pranayama and exercise (p<0.001). On examining the mean improvements between the two groups, it was observed that pranayama caused a larger improvement in fine motor performance as compared to the exercise group. Conclusions: Fine motor performance shows an improvement immediately following a short session of pranayama or exercise, with pranayama showing a greater improvement

Background: Ocular tuberculosis is one of the rare presentations of extrapulmonary tuberculosis (TB). But its diagnosis is difficult because the ocular fluids have lower retrieval ratio of mycobacterium tuberculosis and the biopsy is risky. Moreover, ocular TB mimics various pathologies. However, early start of anti-tuberculous treatment (ATT) for diagnosed cases is necessary to prevent relapses to decrease morbidity as well as to save involvement of other essential organs, in case the immunity of patient lowers. The ocular tissue has to be saved from TB as well as its drug reactions. Materials and methods: This was a retrospective case series in which the spectrum of nine different presentations of ocular TB cases in sixteen subjects with twenty-one eyes were demonstrated from January 2022 to June 2023. The basis of diagnosis was positive Mantoux test and prompt reaction to ATT. Results: Phylectenular conjunctivitis was the commonest presentation in 25% of patients and 56% were with extraocular manifestations like dacryoadenitis, anterior scleritis, anterior episcleritis and phlyctenules conjunctivitis. 69% of patients were without comorbidities. Male to female ratio was 1:3. Among intraocular lesions like optic neuritis, orbital cellulitis, serpiginous like choroiditis, retinal vasculitis and anterior uveitis, optic atrophy was seen in 43% of patients. Conclusion: A very high degree of suspicion is needed for diagnosis and early start of ATT. TB case finding needs more effective modalities to confirm treatment until it is eradicated. Clinical trial registration number - CTRI/2023/08/056010

Background: Coronary artery bypass grafting in patients with reduced left ventricular function remains a surgical challenge. Inotropes may improve hemodynamics in patients with low cardiac output syndrome. This study testifies the hypothesis that prior optimization with Levosimendan produces beneficial hemodynamic effects during and after off- pump CABG (OPCAB) in patients with low ejection fraction compared with Dobutamine. Methods: This is a prospective and randomized study was conducted Department of Cardiothoracic surgery at Yashoda hospital, Secunderabad. Total 100 patients of which 50 patients were randomized to Dobutamine group and 50 patients to Levosimendan group. All-cause mortality, haemodynamic improvement at the end of the drug infusion and Major adverse cardiac and cerebrovascular events (MACCEs) were analysed. Results: The mean age of the patients was 55.56±7.73 in Dobutamine group and 55.24±7.99 in Levosimendan group (p=0.83). The baseline characteristics were compared between the groups and were found to be statistically insignificant. Intraoperative characteristics were analysed between the groups. Significant difference were observed between the groups in the usage of grafts (Dobutamine 3.38±0.85 vs Levosimendan 3.68±0.68) , p=0.05. One (2%) mortality was observed in Dobutamine group and none in Levosimendan group (p=0.31) with no statistically significant difference between the groups. Atrial fibrillation occurred more in Dobutamine group (22%) compared to Levosimendan group (8%) (p=0.04), means of Ventilator support (p=0.03), means of ICU (p=0.002) and hospital stay (p=0.04) were more in Dobutamine group compare to Levosimendan group. MAP (P=0.0001), MPAP (0.0001) and mPCWP (0.0001) showed significant differences favouring the use of Levosimendan over Dodutamine after 12 hrs of infusion. Conclusion: Pre-treatment with Levosimendan in patients undergoing surgical myocardial revascularization with left ventricular dysfunction resulted in lower postoperative mortality, a shorter length of Ventilator support, ICU stay and hospital stay with significant improvement in cardiac indices compared with Dobutamine treatment.

Background: Vascular complications are a major concern in Type 2 Diabetes Mellitus (T2DM), with obesity being a significant risk factor. However, non-obese individuals with T2DM also experience vascular complications, suggesting the involvement of other pathogenic mechanisms. This study evaluates and compares vascular complications in non-obese and obese T2DM patients. Materials and Methods: A total of 200 T2DM patients were included in the study, with 100 categorized as obese (BMI ≥ 30 kg/m²) and 100 as non-obese (BMI < 25 kg/m²). Vascular complications, including peripheral arterial disease (PAD), diabetic retinopathy, and nephropathy, were assessed using Doppler ultrasound, fundoscopic examination, and urine albumin-to-creatinine ratio. Glycemic control was evaluated using HbA1c levels, while lipid profiles and inflammatory markers were also analyzed. Results: Obese T2DM patients exhibited a significantly higher prevalence of vascular complications compared to non-obese patients (PAD: 45% vs. 30%; diabetic retinopathy: 50% vs. 35%; nephropathy: 40% vs. 25%). HbA1c levels were comparable between the groups (8.2% ± 1.3 vs. 7.9% ± 1.1, p = 0.08). However, obese patients demonstrated elevated inflammatory markers (CRP: 6.8 ± 2.1 mg/L vs. 4.2 ± 1.5 mg/L, p < 0.05) and dyslipidemia. Conclusion: Obesity in T2DM is associated with a higher prevalence of vascular complications, likely due to increased inflammation and dyslipidemia. However, non-obese T2DM patients also experience significant vascular risks, highlighting the need for comprehensive cardiovascular risk assessment beyond BMI.

Background: Periodontal diseases are primarily caused by bacterial infections, leading to inflammation and destruction of periodontal tissues. Scaling and root planing (SRP) is the gold standard for non-surgical periodontal therapy. Adjunctive therapies, such as probiotics and antibiotics like tetracycline, have been explored to enhance treatment outcomes. This study aims to compare the clinical efficacy of probiotics and tetracycline as adjuncts to SRP in managing chronic periodontitis. Materials and Methods: A total of 60 patients diagnosed with chronic periodontitis were randomly divided into three groups: Group A (SRP + probiotics), Group B (SRP + tetracycline), and Group C (SRP alone). Clinical parameters, including Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL), were recorded at baseline and after 12 weeks. Probiotics were administered as a daily oral supplement, while tetracycline was prescribed in standard dosages. Statistical analysis was conducted using ANOVA and post-hoc tests, with significance set at p<0.05. Results: At 12 weeks, both adjunctive groups showed significant improvements compared to SRP alone (p<0.05). Group A demonstrated a reduction in PPD (from 5.2 mm to 3.1 mm) and CAL gain (from 4.8 mm to 3.0 mm), while Group B exhibited a similar reduction in PPD (from 5.3 mm to 3.0 mm) and CAL gain (from 4.9 mm to 2.9 mm). However, fewer adverse effects were observed in the probiotics group compared to the tetracycline group. Conclusion: Both probiotics and tetracycline as adjuncts to SRP effectively improved periodontal health. However, probiotics demonstrated comparable clinical outcomes with fewer adverse effects, suggesting their potential as a safer alternative to antibiotics in periodontal therapy.

Background: Pain after thyroid surgery is typically of moderate intensity and short duration. NSAIDs may be ineffective for adequate analgesia and increase post-operative bleeding risk. Opioid analgesics cause postoperative nausea, vomiting and postoperative respiratory depression. The block offers effective preemptive analgesia for thyroid surgeries perioperatively. OBJECTIVE: To compare the postoperative analgesic efficacy in Ultrasound v/s Landmark technique for bilateral superficial cervical plexus block. METHODS: After ethical committee approval, double-blind clinical study was conducted on 46 Patients aged 18 to 65 years, ASA I & II, undergoing elective thyroid surgery after meeting inclusion and exclusion criteria. Study Drug: Inj. 0.25% Bupivacaine 12ml + 2mg Dexamethasone on each side- total volume 25ml. Group A- Ultrasound ultrasound-guided superficial cervical plexus block (n=23). Group B- Landmark-guided superficial cervical plexus block (n=23). Intra-op hemodynamics, time of rescue analgesia, nausea, vomiting, pain while swallowing, and patient’s vital parameters like HR, SBP, DBP, MBP noted at induction, incision, end of resection, extubation and VAS scores at 0,2,4,8, 12,16,20,24 hours. CONCLUSION :The study concluded that Ultrasound-guided bilateral superficial cervical plexus blocks resulted in lower VAS scores, reduced need for additional analgesics, more stable intra-operative haemodynamics, and lower incidence of PONV compared to Landmark technique.

Background: Aging is associated with a decline in pulmonary function, leading to reduced respiratory efficiency and increased susceptibility to respiratory disorders. Yogic exercises and deep breathing techniques have been shown to improve pulmonary function and overall respiratory health. This article explores the physiological effects of these practices on lung function in older adults. Findings suggest that regular yogic breathing exercises enhance lung capacity, improve oxygen exchange, and promote better respiratory muscle function. The physiological mechanisms underlying these benefits include improved lung compliance, enhanced vagal tone, and reduced oxidative stress. These adaptations highlight the role of yoga-based interventions in maintaining pulmonary health in aging populations.

Background: Cerebrovascular accidents (CVAs), also called as strokes, considered as second leading cause of death and disability globally. The pathological mechanism of stroke may be either ischemic and hemorrhagic disturbances of the cerebral blood circulation. Hypercholesterolemia is also a known risk factor for stroke. Aim: This study aimed to assess the lipid profile of stroke patients and to compare the lipid profile of hemorrhagic stroke and ischemic stroke in patients admitted to Akash hospital, Devanahalli, Bengaluru rural, Karnataka, India. Materials and methods: This cross-sectional observational study conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Karnataka, India. In this, a total of 112 patients with new onset ischemic and hemorrhagic stroke, confirmed by CT/MRI and presented within 24 hours of onset of stroke admitted in Akash hospital. Blood samples were collected, centrifuged to obtain serum sample. The obtained serum was used for biochemical analysis of total cholesterol (cholesterol oxidase/peroxidase), triglycerides (glycerol phosphate oxidase/peroxidase), HDL-C (HDL-C- Direct) were estimated by using Cobas C111 Biochemistry fully auto analyzer. LDL-C and VLDL-C were calculated by Frieldwald’s formula. Detailed history, physical and clinical examination was done for all the study subjects. Results: In this study, males were 63 (56.2%) and females were 49 (43.8%). 68 (60.7%) cases were above 60 years of age, 28 (25%) were 51-60 years of age, Among the comorbidities, hypertension 42 (37.5%) emerges as the most prevalent. In this study, 88 (78.6%) cases were with infarcts and 24 (21.4%) cases were hemorrhagic. Majority of subjects were non-smokers 58 (51.8%) and smokers were 54 (48.2%). In this study, lipid profile parameters were compared between hemorrhage and infarcts. Serum cholesterol (196.88±21.40) levels were significantly increased in haemorrhagic stroke compared with infarcts. Lipid profile parameters were compared between smokers and non-smokers, significant differences were observed in LDL (smokers 94.4±20.3 mg/dL vs non-smoker 104.96±22.9 mg/dL). Similarly, lipid profile parameters were compared between diabetic and non-diabetic subjects, significant increase was observed in total cholesterol (diabetic 192.8±31.4 mg/dL vs non-diabetic 178.8±30.0 mg/dL), Triglycerides (diabetics 132.6±18.6 mg/dL vs non-diabetic 121.9±36.0 mg/dL). Conclusion: In a comparison of lipid profiles between patients with hemorrhagic stroke and ischemic stroke, statistically significant differences were observed as raised total cholesterol levels. In comparison of lipid profiles between smokers and non-smoker significant differences were observed in increased LDL among non-smokers. Decreased HDL was seen in all the stroke patients. In the comparison of lipid profiles between Diabetic and non-diabetic stroke patients, increased total cholesterol and triglyceride levels among the diabetic group.

Background and objective: Thyroid function abnormalities are a recognized comorbid condition associated with tuberculosis. Research has been conducted on how second-line anti-tuberculosis drugs affect thyroid function. However, there is very limited research on baseline thyroid dysfunction in newly diagnosed MDR/RR TB patients. Method: Baseline thyroid function report of 51 microbiologically confirmed newly diagnosed MDR/RR TB patients including both pulmonary and extra pulmonary cases from September 2022 to June 2024 who reported to MY hospital, Indore, were documented from DRTB register. All the cases were more than 18 years old. Result: 17.64 % of our study population showed hypothyroidism. 13.72 % of patients had subclinical hypothyroidism and 3.91 % of patients had clinical hypothyroidism. Conclusion: Incidence of hypothyroidism was significantly more in MDR/RR TB patients in comparison to general population. Subclinical hypothyroidism was also more commonly associated in MDR/RR TB patients. So, hypothyroidism especially subclinical hypothyroidism is a serious concern associated with MDR/RR TB patients and this can also get deteriorated with 2nd line anti tubercular therapy. So proper monitoring of such issue and management is very important.

Background: Prescription writing is a critical skill for medical practitioners, ensuring accurate communication of treatment plans, minimizing medication errors, and maintaining legal accountability. However, studies indicate that inadequate training often leads to prescription errors, particularly among interns. Objective: To evaluate the knowledge and competence of prescription writing among interns at Konaseema Institute of Medical Sciences, Amalapuram. Materials and Methods: A cross-sectional study was conducted among medical interns after obtaining approval from the Institutional Ethics Committee. Interns were asked to write prescriptions for a specified ailment. A validated set of 18 questions, reviewed by experts, was used to assess their knowledge and competence in prescription writing. Results: The study identified significant deficiencies in prescription writing among interns. Notably, 28.99% of prescriptions lacked the patient's gender, while 25.36% did not mention the patient’s age. Additionally, 31.16% of prescriptions were missing the doctor's signature, raising concerns about accountability and legal validity. A substantial 60.14% of prescriptions failed to specify the method of administration. The most frequently omitted detail was the time of administration, missing from 65.94% of prescriptions. Conclusion: The findings indicate that interns lack adequate awareness and competence in proper prescription writing. Regular training sessions on prescription writing should be conducted before the start of internships to enhance their proficiency and ensure patient safety.

Background: Anaemia in pregnancy, particularly iron deficiency anaemia, is a significant global health concern associated with adverse maternal and perinatal outcomes. This study aims to compare the maternal and fetal outcomes in anaemic pregnancies with iron deficiency and non-anaemic pregnancies. Methods: A prospective randomized case-control study was conducted involving 200 pregnant women (100 anaemic and 100 non-anaemic) at KIMS & RF, Amalapuram. Anaemia was classified into mild, moderate, and severe based on hemoglobin levels. Maternal and fetal outcomes were assessed and compared between the two groups. Results: The anaemic group had significantly higher rates of preterm birth (8% vs. 2%), postpartum hemorrhage (7% vs. 1%), and maternal morbidity (17.5% vs. 2%) compared to the non-anaemic group. Fetal outcomes were worse in the anaemic group, with higher rates of stillbirth (3% vs. 0%), early neonatal death (4% vs. 0%), low birth weight (22% vs. 3%), and neonatal morbidity (17.5% vs. 6%). Neonatal complications such as respiratory distress syndrome (3% vs. 1%) and meconium aspiration syndrome (10% vs. 1%) were also more prevalent in the anaemic group. Conclusion: Anaemia, particularly iron deficiency anaemia, significantly impacts maternal and fetal health, leading to higher maternal morbidity, preterm births, and adverse fetal outcomes. Early diagnosis and treatment of anaemia in pregnancy are crucial to improve both maternal and neonatal health

Background: Teenage pregnancy poses significant health risks for both mothers and neonates, and it is associated with higher rates of maternal and neonatal morbidity and mortality. This study compares the maternal and perinatal outcomes between teenage primigravidae (15–19 years) and adult primigravidae (20–29 years) in a hospital setting.To assess and compare maternal and perinatal outcomes between teenage and adult primigravidae. Methods: A prospective hospital-based study was conducted at the Department of Obstetrics and Gynecology, KIMS, Amalapuram, from December 2019 to September 2021. The study included 80 teenage and 160 adult primigravidae. Data were collected on sociodemographic characteristics, antenatal care, complications, delivery outcomes, and neonatal health. Statistical analysis was performed using descriptive methods and p-values were considered significant at <0.05. Results: Teenage primigravidae had significantly higher rates of antenatal complications (71.3% vs. 16.3%) compared to adults. Common complications included anemia (71.3%), pre-term labor (26.2%), and pregnancy-induced hypertension (17.5%). Hemoglobin levels were significantly lower in teenage mothers (9.56 g%) than in adults (11.12 g%). The cesarean section rate was higher among teenage mothers (45%) compared to adults (20.6%), with fetal distress as the main indication. Teenage mothers also had higher rates of pre-term births (27.5% vs. 6.3%) and low birth weight babies (42% vs. 15.4%). Neonatal morbidity, including birth asphyxia, NICU admissions, and hyperbilirubinemia, was also more common in the teenage group. Conclusion: Teenage pregnancies are associated with higher maternal and neonatal risks, including more complications during pregnancy, labor, and delivery. Enhanced antenatal care and educational interventions are essential for improving outcomes for adolescent mothers.

Background: Uterine fibroids are the most common benign tumors of the female genital tract, frequently requiring surgical intervention. This study investigates the clinical and pathological spectrum of fibroid uterus in patients undergoing hysterectomy. Methods:: A prospective observational study was conducted on 100 patients diagnosed with fibroid uterus, who underwent hysterectomy at the Department of Obstetrics and Gynecology, KIMS, Amalapuram, between December 2019 and October 2021. Data on demographic features, clinical symptoms, surgical procedures, and histopathological findings were collected and analyzed. Results: The mean age of the study population was 42.06 ± 7.21 years, with the majority in the 31–40 years (42%) and 41–50 years (40%) age groups. Menstrual disturbances were the most common symptoms (77%), with menorrhagia reported in 54.5% of cases. Severe anemia (42.8%) was found in 42% of patients. Surgical interventions primarily included total abdominal hysterectomy (43%) and total abdominal hysterectomy with bilateral salpingo-oophorectomy (29%). Intramural fibroids (61%) were most prevalent, followed by multiple fibroids (16%). Histopathological analysis showed proliferative endometrium in 67% of cases. Chronic cervicitis (86%) was the most frequent associated pelvic pathology. Conclusions: The study highlights the high prevalence of menstrual disturbances, anemia, and intramural fibroids in patients with fibroid uterus. Surgical management, particularly hysterectomy, remains the most common treatment. Histopathological findings provide insights into the pathological changes associated with fibroid uterus. These results can inform clinical management strategies for women with uterine fibroids.

Background: Cesarean section (CS) is a widely performed obstetric procedure, with variations in surgical technique aimed at improving maternal and fetal outcomes. This study compares exteriorization of the uterus versus in situ repair during CS in terms of surgical and postoperative outcomes. Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynecology, Konaseema Institute of Medical Sciences, Amalapuram, involving 200 patients undergoing CS. Participants were randomized into two groups: exteriorization (n=100) and in situ repair (n=100). Demographic data, intraoperative parameters, postoperative recovery, and neonatal outcomes were compared using statistical analysis. Results: The exteriorization group had a significantly shorter surgical duration (59.09 ± 10.46 min vs. 66.15 ± 11.72 min, p < 0.0001) and less blood loss (postoperative hemoglobin: 10.28 ± 1.28 g/dl vs. 9.76 ± 0.89 g/dl, p = 0.001). However, postoperative pain scores were higher on day 1 (6.69 ± 0.84 vs. 5.43 ± 0.74, p < 0.0001), with increased analgesic use. Hospital stay, febrile morbidity, and infection rates were similar between groups. Neonatal outcomes were comparable, with no difference in 1-minute APGAR scores, though the 5-minute APGAR score was slightly higher in the in situ group (p = 0.005). Conclusion: Exteriorization of the uterus offers reduced surgery time and blood loss but is associated with higher immediate postoperative pain. Given the similar maternal and neonatal outcomes between techniques, the choice of approach should be tailored to individual patient conditions and surgeon preference.

Background: Determining the sex of unknown skeletal remains is a significant challenge in forensic anthropology and medicolegal investigations. The sacrum, a key pelvic bone, exhibits sexual dimorphism due to structural and functional differences between males and females. This study employs morphometric analysis and ROC curve evaluation to identify the most reliable parameters for sex estimation in a population from Bihar, India. The findings aim to enhance the accuracy of sex determination in fragmented or incomplete skeletal remains, offering valuable insights for forensic and anthropological applications. Materials and Methods: This cross-sectional observational study included 100 dry adult human sacra obtained from the Department of Forensic Medicine and Toxicology at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India, as well as other medical institutions in the state. Among the 100 desiccated adult human sacra, 50 were male and 50 were female. Morphometric measurements were conducted using a digital vernier caliper. Statistical analysis was conducted utilizing GraphPad version 8.4.3. Morphometric measures of male and female sacra were analyzed using Student’s t-test. An examination of the receiver operating characteristic (ROC) curve was conducted to determine the optimal cut-off values for each parameter. Results: The mean sacral length from the promontory to the apex of the sacrum was higher in males than in females (p < 0.0001), whereas the sacral index was higher in female sacra relative to male sacra (p < 0.0001). Moreover, the average height of the first posterior sacral foramina (PSF) was significantly greater in male sacra bilaterally (p < 0.05). The area under the curve in ROC analysis was 0.884 for the sacral index and 0.869 for the sacral length. Conclusion: This study noted the sacral index as the most important morphometric parameter for determining the sex of sacra. The height of the S2 body, the height of the first anterior sacral foramina, and the height of the first PSF can be assessed with an accuracy of 60-73% when just a portion of the sacrum is accessible for sex determination. This study highlights the importance of sacral morphometric characteristics in sex determination, particularly in forensic situations where the skull and pelvis are fractured or absent.

Antiphospholipid syndrome (APS) is an acquired prothrombotic state characterised by antiphospholipid antibodies in the setting of thrombosis and/or obstetric complications. APS may be associated with other autoimmune diseases. In APS autoantibodies are directed against phospholipid-binding proteins. Thrombosis can occur in any organs involving both macro and microvasculature. We recently encountered a young female patient, a known case of APS with near complete occlusion of the middle and distal third of the left subclavian artery and proximal axillary artery on anticoagulation, antiplatelet and immunosuppressant presenting with uvula thrombosis.

Background: Contraceptive use plays a vital role in preventing unintended pregnancies and promoting maternal and child health. However, despite the availability of various contraceptive methods, misconceptions and socio-cultural factors often hinder their proper use, particularly in rural areas.This study aims to assess the knowledge, attitude, and practices regarding contraceptive use among married women of reproductive age attending a family planning clinic. It seeks to identify factors influencing the acceptance and utilization of contraception. Methods: A cross-sectional study was conducted among 200 married women attending a family planning clinic in the Department of Obstetrics & Gynaecology at Konaseema Institute of Medical Sciences, Andhra Pradesh, for six months. Data were collected using a pre-designed proforma, which included questions on socio-demographic characteristics, knowledge, attitude, and practices related to contraceptive use. Results: The majority of participants (92%) were aware of at least one contraceptive method. The most commonly known methods were oral contraceptive pills (OCPs), intrauterine contraceptive devices (IUCDs), and condoms. However, only 77% were using or willing to use contraception, and just 41% used it correctly. ASHA workers (41.5%) and television (40%) were the primary sources of information. The most preferred methods were OCPs (39%) and natural methods (15.5%). Common reasons for non-use included myths, side effect concerns, and husband opposition. A significant association was found between educational status and contraceptive knowledge (p < 0.0002). Conclusion: While knowledge of contraceptive methods is widespread, correct usage remains low. Myths and misconceptions play a significant role in non-use. Educational interventions, particularly through healthcare workers, are essential to improve contraceptive use and correct application, especially in rural areas.

Introduction: Humerus is the largest and longest bone of upper limb. Long bones get their blood supply from the nutrient, periosteal, metaphyseal and epiphyseal arteries. Long bones consist of outer cortex and inner medulla. Outer cortex and metaphysis are supplied by periosteal and metaphyseal arteries. The medulla and inner half of the cortex of the shaft of long bones are supplied by nutrient artery. The nutrient artery enters the shaft through the nutrient foramen leading into nutrient canal. The medullary arterial system plays an important role in revascularization of the necrotizing cortex and the uniting callus at the fracture site. The knowledge of nutrient artery of long bone is important in surgical procedures like bone grafting and bone transplantation. On the basis of this knowledge, the number, location of nutrient foramen is important for surgeons in preventing the intra operative injury of nutrient artery and also in medicolegal practice. Materials and methods: The present study was conducted in the Department of Anatomy and department of Forensic Medicine, Guntur Medical College , Guntur for a period of three months from August 2024 in 120 dry adult humeri after the approval of Institutional Ethics Committee.Among these right - 64 and left - 56 were included in the study Results: In the present study, out of 120 humerus single nutrient foramen is seen in 104 bones, double in 14 bones, triple in 2 bones. In 108 humerus bones nutrient foramen is seen on antero-medial surface , in 11 bones on posterior surface and in 1 bone on antero-lateral surface. Conclusion: The Present study concludes that most of the humerus bones consist of single nutrient foramen on antero-medial surface of shaft of humerus. Deviation to normal, nutrient foramen is also  seen on antero-lateral surface , posterior surface of shaft of humerus. In  some humerus, double or triple nutrient foramen is also seen.So the anatomical knowledge regarding the number, location, direction of nutrient foramen is helpful for Orthopaedic surgeons in internal fixation, fracture repair, bone graft , joint replacement therapy and vascularized bone micro surgery and decreases the chances of damage to nutrient artery

Background: Caesarean section (CS) is a widely performed surgical procedure for childbirth, particularly in complicated pregnancies. While necessary in certain medical situations, its overuse has raised concerns regarding maternal and neonatal health. This study aimed to assess the knowledge, attitude, and perception of pregnant women towards CS at KIMS Medical College, Amalapuram. Methods: A cross-sectional study was conducted among 110 pregnant women attending the antenatal clinic at KIMS Medical College over a three-month period. Data was collected using a structured questionnaire assessing socio-demographic factors, obstetric history, and women's knowledge, attitudes, and perceptions regarding CS. Statistical analysis was performed using IBM SPSS software. Results: The majority of participants (55%) were aged 22-29 years, with 58% residing in rural areas. 62% demonstrated good knowledge of CS, with 87% believing it saves neonatal lives and 84% acknowledging its life-saving potential for mothers. 59% of participants had a positive attitude towards CS, with 80% expressing willingness to undergo CS if medically indicated. 61% had a positive perception of CS, although concerns about back pain (71%) and the cost (78%) were prevalent. Conclusion: The study found that pregnant women generally possessed good knowledge, a positive attitude, and a favorable perception of CS. However, there is a need for targeted educational interventions to further enhance understanding and reduce misconceptions, particularly regarding the risks and benefits of CS.

Background: Dexmedetomidine acts on the rostral ventrolateral medulla (RVLM, cardiovascular regulatory centre), downregulating the neuronal activity of the RVLM. It is highly lipid soluble, has a strong meningeal penetration, and is easily absorbed by the brain and spinal cord after being administered via the epidural route. In order to assess and compare the haemodynamic profiles of bupivacaine alone and in conjunction with modest doses of dexmedetomidine, a prospective research study was conducted on patients undergoing orthopaedic surgery. Methods: This was a prospective randomized study carried out over a period of 18 months involving 60 patients aged 20-55 years of ASA grade I & II scheduled for elective. Group D patients were administered 18 ml of 0.5% isobaric bupivacaine with 0.5 µg/kg dexmedetomidine. Group P patients were administered 18 ml of 0.5% isobaric bupivacaine with normal saline, volume made equivalent to that of dexmedetomidine. HR, RR, SBP, DBP, MAP, and SpO2 were recorded intra-operatively every 5 minutes for the first 60 minutes, then every 15 minutes till the end of surgery, and thereafter every 30 minutes till the time for rescue analgesia. Sedation score was assessed periodically. Results: Both groups were comparable with regards to age, weight, height distribution and ASA grading. There was no statistically significant difference in oxygen saturation levels of both groups. From 25 minutes after induction till 300 minutes, the mean heart rate in group D was lower than in group P. This difference was statistically significant (p<0.05). The mean systolic, diastolic and mean blood pressures were significantly lower in the D group compared to the P group at various study points. Conclusion: The addition of dexmedetomidine, an alpha-2 agonist, to the local anesthetic solution for the conduct of a lumbar epidural block in the dose of 0.5 mcg/kg provides a stable hemodynamic milieu during elective lower limb surgeries with good block characteristics, improved sedation scores and enhanced postoperative analgesia.

Background: Cardiac dysfunction is a significant contributor to mortality in thalassemia patients. This study aims to assess the correlation between iron overload and cardiac function in multitransfused β-thalassemia patients. Method: This observational study was conducted on patients enrolled at the Thalassemia Unit. Fifty patients with multitransfused β-thalassemia major were included. All investigations were performed pre-transfusion, including hemoglobin measurements, serum ferritin levels, and echocardiograms. T2* MRI was conducted whenever feasible with parental consent and financial counseling. Results: No patient exhibited systolic dysfunction. However, diastolic dysfunction was observed in 4% (n=2) of the patients, while another 4% (n=2) had indeterminate diastolic function. No significant correlation was found between serum ferritin and echocardiographic parameters. Additionally, there was no significant correlation between myocardial perfusion imaging (MPI) by tissue Doppler imaging (TDI) and serum ferritin levels (r=0.040, p value=0.7823). Furthermore, no significant correlation was observed between T2* heart values and serum ferritin levels (r=0.351, p value=0.219). Conclusion: Serum ferritin does not correlate with cardiac iron overload, liver iron overload, or cardiac or liver dysfunction. Therefore, it should not be used to determine cardiac or liver siderosis. This finding should be considered when treating these patients.

Introduction: Spinal dysraphism, a congenital disorder affecting the spine, poses significant morbidity and mortality worldwide. It is estimated that one to three per 1000 live births are affected globally. The exact cause of spinal dysraphism remains a topic of ongoing research, with contributions from genetics, nutrition, environment, and other factors. This review aims to summarize the current understanding of spinal dysraphism, its classification, diagnosis, treatment, and management, as well as emerging trends in prenatal screening and imaging techniques. Methods: The purpose of this study is to investigate the relationship between spinal dysraphism and associated cutaneous lesions. A standardized inclusion criteria were applied to select eligible cases of open spinal dysraphism, lumbosacral swelling, and various cutaneous lesions. MRI examinations were conducted on selected patients to assess the signal intensities of lesion in T1-W, T2-W, and FLAIR sequences, with specific criteria for diagnosing different types of spinal dysraphism based on the presence or absence of these lesions. Results: The results of the study analyzing 100 cases of spinal dysraphism using 1.5 T MRI revealed that 65% of patients had open spinal dysraphism, while 35% had closed spinal dysraphism. Myelomeningocele was the most common lesion in open spinal dysraphism (98.46%), predominantly affecting the lumbosacral region.  In closed spinal dysraphism, spinal lipomas were the most prevalent (45.71%). Tethering of the cord was observed in 78% of all cases. Vertebral anomalies were common, with spina bifida present in 86% of cases, primarily in the lumbosacral spine. Syrinx was found in 40% of cases, and Chiari II malformation was present in 69.23% of open spinal dysraphism cases. Conclusion: This review highlights differences in spinal dysraphism between males and females, with higher incidence rates in females. Lipoma of the spine is most common form of spinal dysraphism. MRI is a cornerstone in diagnosing soft tissue anomalies in spinal dysraphism due to its multiplanar capabilities, lack of radiation, and superior contrast abilities, enabling early detection and improved treatment outcomes for patients.

Background: The dietary pattern in any population is an indicator for the general well-being and the extent of their risks to have lifestyle disorders. These include diabetes mellitus, dyslipidaemia, hypertension, and coronary heart disease, which are the main cause of death worldwide. Medical students; representing part of the young age population of the community, and as future doctors, for different reasons are prone to eating unhealthy foods and to have bad health habits during their college years which might affect their wellbeing and increase the risk of lifestyle disorders. Materials and Methods: The objective of this study is to access the dietary pattern of first year medical students of SMS Medical College Jaipur, Rajasthan and how it affects their nutritional status. This is a cross-sectional study which involved 100 medical students of SMS Medical College campus. A 100 objective self-administered questionnaire and 24 recall method was used for data collection. Results : In this study, the entire respondents, 100 %, were aware of what a balanced diet is, majority of them have a good dietary habit, as 38 % eat twice daily, 45 % 3 times daily, while 5% eat more than three times daily. Their diet was mainly fast foods, fries, snacks, and soft drinks. This, thus, affected their nutritional status, with 17 % having poor dietary habit, 31% with moderate dietary habit and 52 % with good dietary habit. 22 % of the respondents being overweight, 64% were of normal weight and 14% are underweight. Conclusion: This study showed that while the respondents were aware of what a balanced diet is, they rarely consumed a balanced meal. Thus, it is imperative to not only educate them, but also, formulate a strategy to ensure the implantation and practice of eating a balanced meal, so as to not only forestall lifestyle disorders, but also to be able to educate their patients in the future, creating a healthy community and nation at large. The usual lifestyle of food tickets and meal in the university should be resuscitated especially within the study population.

Background: Stress cardiomyopathy (SCM) or broken heart syndrome or apical ballooning syndrome is a rare cardiac disorder characterized by transient, reversible left ventricular dysfunction. We report a case of stress cardiomyopathy and shock ina 37-year-oldfemale with alleged history of suicidal attempt with hanging. She presented with hypotension, tachycardia, and hypoxia. Requiring one session of prone ventilation and inotropes for hemodynamic instability. Two-dimensional echocardiography (2D Echo) showed hypokinesia of distal interventricular septum and the apex of the left ventricle with reduced ejection fraction. CT coronary angiogram revealed normal coronary arteries. Clinically she improved, shock resolved, and repeat 2D Echo showed improved left ventricular function. She got extubated and shifted out of ICU in a stable condition.

Background: Thyrotoxicosis is a clinical syndrome caused by excessive circulating thyroid hormones, leading to a hypermetabolic state. This study aims to evaluate the clinical profile of thyrotoxicosis patients and review its various etiologies. Methods: A prospective study was conducted on 50 patients of either sex, age more than 12 years, who fulfill the criteria for diagnosis of hyperthyroidism. A detailed clinical examination, routine investigations, thyroid profile, ultrasound of the neck, and thyroid scans were performed as needed. Results: Thyrotoxicosis was more prevalent in the younger population (<40 years), with a mean age of 41.12 years. A female predominance was observed. The most frequently reported symptoms included palpitationss, hand tremors, weight loss, nervousness, and dyspnea. Cardiovascular manifestations were common, with palpitations, dyspnea, arrhythmia, and heart failure being the most frequently observed. Tachycardia and atrial fibrillation were the most prevalent cardiovascular signs. Electrocardiographic changes correlated with thyroid hormone levels, indicating that increased Free T3 and Free T4 levels and decreased TSH levels were directly associated with heart rate and rhythm changes. Additionally, 32% of patients had elevated pulmonary hypertension, which showed potential reversibility with anti-thyroid treatment. Conclusion: Early diagnosis and identification of the etiology of thyrotoxicosis may help in reversing the condition and preventing complications. Appropriate treatment strategies should be implemented to manage cardiovascular manifestations and other systemic complications associated with thyrotoxicosis.

Background: Tuberculosis (TB) remains a significant global health problem with potential cardiovascular involvement in approximately 2% of cases. This study aimed to evaluate the cardiovascular manifestations in pulmonary TB patients without pre-existing cardiac disease and assess changes following anti-tubercular therapy. Methods: This prospective descriptive study included 72 newly diagnosed sputum-positive pulmonary TB patients aged ≥18 years. Participants underwent comprehensive clinical examination, laboratory testing, electrocardiography, and echocardiography at baseline, during the post-intensive phase, and after completion of anti-tubercular therapy. Patients with pre-existing cardiovascular conditions, other pulmonary diseases, or extra-pulmonary TB were excluded. Results: The study population had a mean age of 43.64±15.00 years with male predominance (61.1%). Electrocardiographic abnormalities were observed in 59% of patients, with sinus tachycardia (50%), ST segment elevations (5.6%), and T wave inversions (9.7%) as common findings. Echocardiographic abnormalities were present in 23.6% of patients, including pulmonary hypertension (13.9%), right ventricular hypertrophy/dilation (11.1%), left ventricular systolic dysfunction (9.8%), and pericardial effusion (5.6%). Following anti-tubercular therapy, significant improvements were observed in tachycardia (reduced to 13.9%, p=0.000), ST segment elevations (complete resolution, p=0.045), and left ventricular systolic dysfunction (reduced to 5.6%, p=0.028), with complete resolution of pericardial effusion.Conclusion: Pulmonary tuberculosis can induce various cardiovascular abnormalities detectable through electrocardiography and echocardiography, even in patients without pre-existing cardiac disease. Most of these abnormalities improve significantly with anti-tubercular therapy, highlighting the importance of cardiac evaluation in TB patients and the role of effective treatment in reversing TB-associated cardiac manifestations.

Introduction: Artificial intelligence (AI) has increased application in the field of medicine in the recent days. The use of AI in other fields like finance, diagnosis and treatment is gaining importance. It is applied along with many other branches of medicine like pathology and radiology in giving better care to the patients. This study was done to assess knowledge on AI among medical undergraduate students who have increased access to the technology these days and to assess the use of this in various aspects in their education and providing care to the patients. Materials and methods: In a tertiary care teaching hospital, a cross-sectional study was conducted in undergraduate medical students, to assess their knowledge and use of AI in the medical field using a self-designed, semi-structured questionnaire. Results were expressed in frequencies or percentages. Results: In this study, 158 (63.2%) of the students have knowledge on the use of AI in medical field and among them many use Chat GPT as the source. The knowledge on the other modalities of AI was 31.6% among these students. AI was used mainly for studying followed by assignments and research work. Conclusion: This study shows that there was wide variation in the knowledge and practice of AI in medical field among the study participants. Medical students in this study use AI mainly for studying and their assignments rather than on increasing their knowledge on patient care.

Background: Neonatal sepsis remains a significant cause of morbidity and mortality in neonates, particularly in developing countries. Despite advances in neonatal care, the burden of neonatal sepsis persists, necessitating novel preventive strategies. Probiotics have emerged as a potential intervention to enhance neonatal gut health and immunity, thereby reducing the incidence of sepsis. Objective: This study aims to evaluate the efficacy of probiotic supplementation in preventing neonatal sepsis among preterm and low-birth-weight neonates admitted to a tertiary care centre. Methods: A prospective, randomized controlled trial was conducted over six months at a tertiary care center. A total of 500 neonates were enrolled, with 250 assigned to the probiotic group and 250 to the control group. Neonates in the probiotic group received Lactobacillus rhamnosus GG (LGG) and Bifidobacterium breve orally once daily for 28 days. The primary outcome was the incidence of neonatal sepsis, diagnosed based on clinical signs, blood cultures, and inflammatory markers (CRP >10 mg/L, Procalcitonin >2 ng/mL). Secondary outcomes included hospital stay duration, mortality rate, and adverse effects. Results: Neonates receiving probiotics demonstrated a 54.5% relative risk reduction in neonatal sepsis compared to the control group (p < 0.001). Inflammatory markers were significantly lower in the probiotic group (CRP: 8.6 ± 3.2 vs. 15.4 ± 4.1 mg/L, p < 0.001; Procalcitonin: 1.8 ± 0.7 vs. 3.2 ± 1.2 ng/mL, p < 0.001). The probiotic group also had a significantly shorter hospital stay (15.2 ± 3.1 vs. 20.5 ± 4.2 days, p < 0.001). Mortality was lower in the probiotic group (4% vs. 9%, p = 0.03), with a sepsis-related mortality reduction of 55.6%. Probiotics were well-tolerated, with no cases of probiotic-associated infections or severe adverse effects. Mild feeding intolerance occurred in 6% of probiotic neonates vs. 4% in controls (p = 0.32, not significant). Conclusion:  Probiotic supplementation significantly reduces the incidence of neonatal sepsis, lowers inflammatory markers, shortens hospital stay, and improves survival outcomes. Given these findings, probiotics should be considered as apreventive strategy in high-risk neonates. However, further multicentre trials are warranted to confirm these results and establish standardized probiotic protocols in neonatal intensive care.

Introduction: Neonatal sepsis is one of the major causes of morbidity and mortality in the newborn, more so in the developing countries. The incidence of neonatal sepsis has been reported to be 30/1000 live births according to National Neonatal Perinatal Database. Certain neonatal characteristics are predictive of Early Onset Neonatal Sepsis (EOS). The objectives of this study were to perform haematological tests for detection of neonatal sepsis and to evaluate the validity of single and combined haematological parameters in case of proven septicaemia. Methods: 95 neonates admitted to NICU with signs suggestive of sepsis or who developed signs of sepsis while in the ward, were included in the present study. The neonatal sepsis screen included Total Leukocyte Count (TLC), raised micro- ESR, CRP. I/T Ratio>0.2, remained significant markers for early diagnosis of culture positive EOS(P<0.5) .  Results: Out of 95 newborns presenting with EOS, 46(48.4%) had positive blood culture. EOS was seen predominantly in preterm, males, LBW neonates. Among the various neonatal haematological parameters raised Micro–ESR, I/T Ratio >0.2 significant markers for early diagnosis of culture positive EOS (p<0.5). Conclusion: It is critical to diagnose sepsis early on and to rule out sepsis to avoid unnecessary antibiotic use. In predicting early onset newborn sepsis, a high index of suspicion combined with simple, cost-effective haematological screening measures is a sensitive and satisfactory approach.

Background: Transfusion of blood and its products is one of the important pillars in the treatment of patient in Emergency Department. Methods: The study is Cross Sectional study over a period of 12 months from March 2021 to February 2022. A total of 348 cases were assessed from Emergency Department (Casualty) of SAIMS Hospital, Indore. Results: Out of 348 cases,most common indication for transfusion was massive blood loss due to roadside accident in 167(47.98%) patients, followed by heart disease patient on antiplatelet medication in 128(36.78%) patients followed by Hemato-oncological disease patients 31(8.9%) and then patients with chronic anemia 22 (6.33%).180(51.72%)patients received RCC transfusion, 105(30.17%)patients received platelet transfusion and 63(18.10%)patients received FFP transfusion. The most common indication for RCC transfusion was Anaemia due to massive blood loss, for PC transfusion was Thrombocytopenia due to Heart failure and DIC and for FFP is Hypoproteinemia. Transfusion was done in patients with Hb <7g/dl even if they had no co-morbidities. Patients with co-morbidities transfused at Hb between 7-10g/dl. 267(76.72%) patients had a pre-transfusion Hb of 5-7g/dl, 73(20.97%) patients had pre-transfusion Hb of 8-10 g/dl and 8(2.29%) patients had a Hb of 11-12 g/dl. Most of the patients Post Transfusion Hb were around 11-12 g/dl. When patients pre-transfusion Hb was 5-7 g/dl, 3-4 units of RCC transfused and when it was 8 -10 g/dl,2-3 units of RCC transfused. Conclusion: For better utilisation and to reduce wastage of blood and blood products, a protocol has to be formulated.

Background: Family accommodation in obsessive-compulsive disorder (OCD) is a prevalent yet under-researched phenomenon that significantly impacts the quality of life (QoL) of caregivers. This study investigates the relationship between family accommodation and QoL in caregivers of adult OCD patients. Methods: A cross-sectional analysis was conducted among 150 caregivers of OCD patients recruited from tertiary psychiatric center. Validated instruments, including the Family Accommodation Scale (FAS) and the World Health Organization Quality of Life-Brief (WHOQOL-BREF), were employed. Data analysis employed descriptive and inferential statistics. Results: Caregivers with higher levels of family accommodation exhibited significantly lower QoL scores, particularly in the psychological (p < 0.01) and social domains (p < 0.05). Key predictors of family accommodation included patient symptom severity (Y-BOCS scores) and caregiver burden. A strong inverse correlation was observed between FAS scores and WHOQOL-BREF scores (r = -0.72, p < 0.01). Conclusion: Interventions aimed at reducing family accommodation have the potential to enhance caregivers’ QoL. Psychoeducational programs tailored specifically for caregivers are essential for comprehensively addressing this issue.

Background: Epilepsy is associated with significant psychiatric and cognitive comorbidities. This cross-sectional study evaluates the prevalence of cognitive impairment (CI) and psychiatric disorders in 100 individuals with epilepsy (PWE) attending a tertiary neurology clinic in India. Methods: Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination-III (ACE-III). Psychiatric morbidity was evaluated using the Mini-International Neuropsychiatric Interview (MINI). Results: CI was identified in 66% (MoCA <26) and 90% (ACE-III <83) of participants. Psychiatric comorbidities were present in 17%, with major depressive disorder (64.7%) and social anxiety disorder (35.3%) being most prevalent. CI correlated with lower education (p<0.001), unemployment (p=0.001), polytherapy (p=0.03), and longer epilepsy duration (p<0.001). No significant association was found between CI and psychiatric morbidity (p=0.12). Conclusion: High rates of CI and psychiatric disorders highlight the need for routine screening and multidisciplinary care in epilepsy management.

Background: This cross-sectional investigation examined parenting approaches and coping mechanisms among caregivers of children with Attention-Deficit/Hyperactivity Disorder (ADHD) in Hyderabad, India, focusing on socioeconomic and clinical correlates. Methods: Participants included 100 caregivers (60 mothers, 40 fathers) of children aged 6–14 years diagnosed with ADHD per DSM-5 criteria. Validated instruments—Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), Parenting Style Questionnaire, and Brief COPE Inventory—were administered. Data were analyzed using Pearson correlations and multivariate regression models.  Results: Authoritarian parenting predominated (70%), followed by permissive (20%) and authoritative styles (10%). Emotion-focused coping (e.g., self-blame) was prevalent (65%), while problem-focused strategies were underutilized (15%). Socioeconomic status positively correlated with adaptive parenting (r = 0.209, p = 0.039), and treatment adherence predicted authoritative approaches (r = 0.455, p < 0.001). Older caregivers favored adaptive coping (r = 0.258, p = 0.010), whereas familial psychiatric histories were linked to maladaptive patterns (r = -0.405, p = 0.016).  Conclusion: Findings underscore the need for culturally tailored interventions to promote authoritative parenting and problem-focused coping, particularly in low-resource settings.

Background: Antenatal depression (AD) significantly affects maternal and fetal health. Despite its profound impact, AD remains underdiagnosed in many resource-limited settings, including India. This study aimed to assess the prevalence of antenatal depression and its associated risk factors among pregnant women attending a tertiary care hospital in Hyderabad. Methods: A cross-sectional, hospital-based study was conducted at Gandhi Medical College & Hospital, Secunderabad, Telangana, from November 2020 to June 2022. The study included 300 pregnant women who completed the Edinburgh Postnatal Depression Scale (EPDS). A score ≥13 indicated antenatal depression. Risk factors, including sociodemographic and psychosocial determinants, were evaluated using the Hurt, Insult, Threaten, Scream (HITS) tool and the Presumptive Stressful Life Events Scale (PSLES). Results: The prevalence of antenatal depression was 13.3% among the 300 participants. Significant risk factors included intimate partner violence (HITS score >10, p < 0.001) and experiencing stressful life events as measured by PSLES (p = 0.047). Sociodemographic variables, including age, education, socioeconomic status, type of family, and obstetric factors, were not statistically significant. Conclusion: Antenatal depression is prevalent among pregnant women in Hyderabad, with intimate partner violence and stressful life events being significant predictors. Routine screening and timely psychosocial interventions during antenatal care are vital to ensure better maternal and fetal outcomes.

Background: Infective endocarditis (IE) is a multifaceted disease characterized by cardiac involvement and a spectrum of systemic complications affecting multiple organs. With an annual incidence reaching up to 10 cases per 100,000 individuals in the general population, IE remains a formidable clinical challenge. Despite advancements in diagnosis and management, the condition continues to carry a significant burden, with mortality rates soaring as high as 30% within the first 30 days. Staphylococcus aureus is the most common causative microorganism. The prognosis of this disease depends on prompt and accurate diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. Diagnosis of IE is usually based on modified Duke criteria. There are multiple modalities to assess infective endocarditis with trans-thoracic echocardiography (TTE) being the first-line modality. The improved temporal and spatial resolution of electrocardiographically (ECG) synchronized cardiac CT has resulted in increasing use of CT in the setting of IE.

Background: The term aneurysm is derived from the Greek word ἀνεύρυσμα, meaning dilatation or widening [1]. An abdominal aortic aneurysm (AAA) is a widening of the abdominal aorta and is generally defined as a dilatation beyond a diameter of 3.0 cm. Due to the asymptomatic nature of most Aneurysms, diagnosis is commonly a result of screening or during routine examination with abdominal palpation. MATERIAL &METHODS:   During a routine cadaveric dissection of the abdomen in the anatomy wet lab for medical students of St, James School of Medicine, Anguilla, an abnormal finding was seen in a 77-year-oldfemale cadaver. RESULTS: The aneurysm was fusiform in shape (Fig. 1) and was found to be unruptured.  Its location was found between origin of renal arteries and the aortic bifurcation into common iliac arteries. CONCLUSION: A thorough knowledge of the anatomy and pathophysiology of aneurysms is required for successful endo-vascular grafts and good prognosis in unruptured cases.

Keywords: AAA(Abdominal aortic aneurysm), Aortic wall Thickening, Fusiform

Background: Alcohol consumption is a significant public health concern, contributing to injuries and fatalities worldwide. In medico-legal cases, assessing alcohol intoxication is crucial for forensic and clinical decision-making. Breath alcohol analyzers offer a rapid, non-invasive method for estimating blood alcohol concentration (BAC), potentially replacing traditional blood alcohol testing. This study compares the effectiveness of breath alcohol analysis with blood alcohol testing in emergency department medico-legal investigations and explores the association of alcohol levels with the severity and nature of injuries. Materials and Methods: A cross-sectional analytical study was conducted in the Emergency Department of a tertiary care hospital over two years. A total of 246 medico-legal cases were included. Breath alcohol levels were assessed using the AlcoMate Premium (Model AL 7000) breathalyzer. The study recorded socio-demographic data, injury characteristics, and alcohol levels. Statistical analysis was performed using SPSS software to determine correlations between alcohol consumption, injury severity, and other risk factors. Results: Among 246 medico-legal cases, 205 (83.3%) were males and 41 (16.7%) were females. Breath alcohol analysis was positive in 49 cases (19.92%), with a higher prevalence among males (22.0%) compared to females (9.8%). Road traffic accidents (RTA) were the most common type of injury (71.1%), followed by accidental injuries (16.3%) and burns (4.1%). Breath alcohol positivity was significantly associated with RTAs (75.5%) and assault cases (4.1%). The majority of alcohol-positive cases (73.46%) had a BAC of <0.3%, while 26.53% had levels >0.3%. Breath alcohol positivity was more frequent in the 21-30 age group (46.9%). Smokers had a significantly higher likelihood of being alcohol-positive (OR = 3.31, 95% CI: 1.73-6.31, p = 0.0003). Most alcohol-related medico-legal cases occurred between 6 PM and 6 AM (63.5%). Conclusion: Breath alcohol analysis is a rapid and effective screening tool for detecting alcohol intoxication in emergency department medico-legal cases. Its non-invasive nature and ease of use make it preferable to blood alcohol testing. The study highlights a strong association between alcohol consumption and RTAs, particularly among young males and smokers. Implementing routine breath alcohol screening in emergency settings could aid in injury prevention and medico-legal documentation.

Background: Alcohol consumption is a significant public health concern, contributing to various forms of injuries and medico-legal cases. Blood Alcohol Concentration (BAC) is commonly measured to assess the influence of alcohol on injury severity and clinical outcomes. Breath alcohol analyzers provide a non-invasive, rapid method for estimating BAC. This study aimed to assess alcohol levels using a breath alcohol analyzer in medico-legal cases reporting to the casualty of a tertiary care hospital and to evaluate its association with injury severity and socio-demographic factors. Materials and Methods: A cross-sectional analytical study was conducted in the Emergency Department of a tertiary care hospital over two years. A total of 246 medico-legal cases were analyzed, and breath alcohol levels were measured using a handheld breath alcohol analyzer (AlcoMate Premium Model AL 7000). Data on age, gender, occupation, smoking status, time of incident, nature, and severity of injuries were collected and statistically analyzed using SPSS software. Results: Among the 246 medico-legal cases, 205 (83.3%) were males, and 41 (16.7%) were females. A total of 49 (19.92%) cases tested positive for breath alcohol, with a higher proportion among males (22.0%) than females (9.8%). The majority of alcohol-positive cases (46.93%) were aged 21–30 years. The most common injury type among alcohol-positive cases was road traffic accidents (75.5%), followed by accidental injuries (10.2%). Breath alcohol positivity was significantly associated with smoking (OR = 3.31, 95% CI: 1.73–6.31, p = 0.0003). Of the alcohol-positive cases, 57.14% sustained simple injuries, while 42.8% had grievous injuries. The highest proportion of cases (63.5%) occurred between 6 PM and 6 AM. Conclusion: The study found a significant association between alcohol consumption and injury severity, particularly in road traffic accidents and assault cases. Young adults and service-class individuals were the most affected groups. Breath alcohol analysis is an effective, non-invasive tool for rapid alcohol estimation in medico-legal cases. The findings highlight the need for stricter regulations on alcohol use, especially in high-risk populations, and the integration of alcohol screening into emergency department protocols.

Background: Introduction: India's National Program for Control of Blindness, initiated in 1976, aimed to reduce blindness to 0.3% by 2020. However, approximately 4.9 million are blind and 32.9 million visually impaired, primarily due to untreated refractive errors and colour vision deficiency, significantly impacting children's education and quality of life. Regular vision screenings enable early intervention and educational adjustments tailored to affected students' needs. Objective: To determine the prevalence of visual impairment and colour blindness among primary school going children in the rural areas of Barpeta District. Materials and Methods: A descriptive, cross-sectional study was conducted among 1,324 school children aged 11 to 15 in Barpeta. Five government schools with high enrollments were selected. Students were assessed for refractive errors and colour blindness, with referrals made for those needing ocular care. Parents and school authorities were informed, and a list of affected students was provided to the District Early Intervention Centre for follow-up actions. Results: Gender distribution was observed as 52% being boys and 48% girls. Most were identified as Hindu (85%), and 76.9% came from nuclear families. Socioeconomic analysis revealed 34.4% were from lower middle class. Alarmingly, 85.2% had never undergone an eye examination, with a 2.7% prevalence of colour blindness, more common in boys. Conclusion: The study highlights the urgent need for targeted interventions to improve eye health awareness and access to examinations for school children, particularly those from lower socioeconomic backgrounds, impacting their academic performance and well-being.

Background: During our routine cadaver dissection in the dissection hall, we met with a case of lower division of sciatic nerve. Inspired by this, we checked the other limb of the cadaver. There also, we found a lower division of sciatic nerve, but at a slightly different level. This led us to the study on sciatic nerve division in previously dissected specimens.A study on variations in the division of sciatic nerve in forty specimen reveals that, while it typically splits into the tibial and common peroneal nerves at the superior angle of the popliteal fossa, which is  at the junction of the middle and lower 3rds of the thigh, significant anatomical variations can occur, including higher divisions within the pelvis or thigh, where the nerve splits before exiting the piriformis muscle, potentially causing complications during injecting local or regional anaesthesia to block the nerve; during surgical procedures; or contributing to conditions like piriformis syndrome due to nerve compressions. These variations are important to consider, for accurate diagnosis and treatment of sciatic nerve related pathologies. Many lower division cases were also found in cadavers.

Background: Thrombocytopenia in adults is a common condition frequently encountered in day care and indoor patients. Its etiology can be various conditions. Clinical manifestations can be subtle to life threatening. Hence determining the exact cause of thrombocytopenia is necessary to prevent any untoward outcome. Materials and Methods: The present study attempts to determine the various causes of thrombocytopenia in adults by collecting data from 120 patients from July 2022 to December 2022. Final diagnosis was made by complete blood count, manual platelet count by peripheral blood smear, malarial parasite antigen, Widal test, dengue serology, Coombs test, abdominal ultrasound. Result: The most common cause of thrombocytopenia in adults was found to be malaria (27.5%) followed by dengue (25%) and megaloblastic anemia (20%). The other causes were found to be leukemia (14.2%), septicemia (3.3%), chronic liver disease (2.5%), enteric fever (2.5%), aplastic anemia (1.7%), hypersplenism (1.7%), myelofibrosis (0.8%) and drug induced (0.8%). Conclusion: Our study found that malaria and dengue were the most common causes of thrombocytopenia both of which are caused due to mosquitoes. Megaloblastic anemia was the third most common cause, which is most commonly caused by due to nutritional deficiency of vitamin B12 and folate. All these causes are potentially preventable.

Background: The identification of individuals, whether living or deceased, is a fundamental aspect of forensic science, relying on unique physical attributes such as fingerprints and blood groups. Fingerprints, formed by epidermal ridges during fetal development, remain unchanged throughout life, making them a reliable tool for personal identification. Similarly, blood groups, determined by specific antigens on red blood cells, provide another stable biological marker. This study explores the relationship between primary fingerprint patterns, gender, and ABO and Rh blood groups among healthcare workers in Eastern India, aiming to enhance forensic identification methods and contribute to the development of local biometric databases. Materials and Methods: This cross-sectional observational study included 200 medical students aged 18 years and above from the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. Participants with known ABO and Rh blood groups and clear, legible fingerprints were enrolled after obtaining informed consent. Fingerprints were collected using the ink method and classified into loops, whorls, and arches, while blood groups were determined using Karl Landsteiner's conventional method. Data were analyzed using GraphPad version 8.4.3; the P-value<0.05 was taken as statistically significant. Results: The study included 200 participants (54% male, 46% female), with blood group B +ve being the most common (36%) and A -ve the least (1%). Loops were the predominant fingerprint pattern (55.8%), followed by whorls (34.65%), arches (6%), and composites (3.55%), with no significant gender differences (p=0.42). Analysis by blood groups revealed loops as the most common pattern across all ABO and Rh groups, with no statistically significant differences in distribution (p>0.05). These findings suggest a consistent prevalence of loops and whorls across genders and blood groups, highlighting their potential utility in forensic identification. Conclusion: This study finds that loops are the most common fingerprint pattern in both genders, followed by whorls, with composites being the least common in Eastern India. The distribution of primary fingerprint patterns is associated with the ABO blood group but not with gender or the Rh blood group. This relationship can enhance the accuracy of personal identification, making it possible to predict an individual's ABO blood group from their fingerprint pattern.

Background: In this study we evaluated the utility of RAPID score in Parapneumonic effusion and empyema. Both of which are most common causes of exudative pleural effusion and this score was developed by Rahman et al by using multicentre intrapleural trial 1[MIST1 and MIST2]. Most of the patients with parapneumonic effusion usually recovers but mortality rate still around 10% along with long hospital stay, surgical interventions requirement, morbidity (3‑month follow up) despite of advances in treatment specially in empyema cases. For this reason, this study was done as there is no such study have done by anyone in our knowledge specially in India. After calculating RAPID score in pleural infection then patients were stratified in the different risk categories and association was compared with these risk categories with different variables. Methods: This is a prospective study at tertiary in which clinical utility of RAPID score in pleural infection in INDIAN population where tuberculosis infection is predominant. Baseline RAPID score was calculated on admission and stratified into risk category according to RAPID score. Primary outcome both mortality and morbidity, secondary outcome need of surgical interventions, length of hospital at 3‑months in different risk category. Results: Overall, 120 patients were included in this study. Mortality was 7 (5.83%) in our study. Total 17 (14.17%) patients needed surgery and length of hospital study was compared in all three categories of RAPID score. Total 26 (21.67%) patients had <7 days and 94 (78.33%) >7 days hospital stays. Most common organism isolate was mycobacterium tuberculosis. RAPID score was compared in Tubercular And non‑tubercular organisms. Conclusion: Prognostic utility of RAPID score is well established especially in non‑tubercular organisms. Here, in our study management utility of RAPID score also found useful. It performs good some aspects in tubercular aetiology.

Background: COPD (Chronic Obstructive Pulmonary Disease) is a chronic inflammatory illness. Air trapping and gradual airflow limitation are two consequences of these pathological alterations that can directly result in dyspnoea and other hallmark symptoms, as well as a decline in health. The CAT is a useful tool for assessing a patient's health and the severity of their COPD symptoms. CAT is a patient-completed questionnaire; certain issues including subjectivity and unilaterally are unavoidable during the assessment. We aim to study the relationship between COPD Assessment Test (CAT) score and severity of Airflow obstruction in stable COPD patients and to determine whether higher CAT score correlates with the frequency of COPD exacerbation. Method: Hospital based cross-sectional observational study conducted among 131 patients, age range between 43 to 90 years, in all stable COPD patients. Assessment was done by CAT (COPD assessment test) score and severity of airflow obstruction by spirometry in the Department of Respiratory Medicine, from January 2023 to December 2024. Results: Mild airflow obstruction was found in 46.6% of cases, moderate in 42.7%, severe in 10.7%, and none had very severe obstruction. The severity distribution was significantly related to gender, history of childhood respiratory infections, disease impact level based on CAT scores, and frequency of exacerbations. Higher CAT scores correlated with more severe airflow obstruction. Patients with a "very high" CAT score had a significantly higher prevalence of severe airflow obstruction (P-value < 0.05). A significant relationship was observed between the frequency of exacerbations and both the CAT scores and airflow obstruction severity. Patients with more frequent exacerbations exhibited higher CAT scores and more severe airflow obstruction (P-value < 0.05).There was a significant inverse relationship between the CAT score levels and the mean FEV1 (% predicted), indicating that a higher disease impact level correlates with worse lung function (P-value < 0.05). Conclusion: The importance of regularly using CAT scores in clinical practice to better understand the severity of COPD and to tailor treatment plans according to individual patient risk factors, such as age, gender, smoking history, and past respiratory health. This approach can help improve disease management and outcomes for COPD patients

Background: Perinatal asphyxia is the second leading cause of neonatal mortality after infection, accounting for around thirty percent of all deaths globally. The current study was designed to comprehensively investigate the cardiac dysfunction associated with perinatal hypoxia and its relationship to hypoxic ischemic encephalopathy. MATERIAL & METHOD: This prospective observational study was carried from January 2019 to December 2020 in the NICU of the Department of Paediatrics, civil hospital Ahmedabad, Gujarat, after approval by Institutional ethical committee (IEC). All newborns (intramural and extramural) admitted in NICU with history of perinatal asphyxia within first 72 hours of life were included. Myocardial dysfunction was evaluated using clinical examination, electrocardiogram, echocardiography (2D &M mode) and cardiac enzymes (CPK MB, CPK total &troponin I). RESULT  : Present study enrolled 135 neonates, among them 28.1% were female and 71.8% were male, out of which 14.8% neonates developed mild HIE, 37.7% neonates developed moderate HIE and 47.4% had severe HIE. Significant positive correlation was seen between the levels of the cardiac markers and the degree of adverse outcome in terms of HIE staging. 2D echo showed that patients with valvular regurgitation and pulmonary hypertension had more adverse outcome and chances of these findings being there increased with the severity of HIE grading. On assessing the outcome of the patients with HIE a positive correlation between the adverse outcome and raised cardiac marker levels were seen.82.6% of the patients who developed valve regurgitation and 90.9% who developed pulmonary hypertension expired. CONCLUSION:  Myocardial dysfunction was found in 53.3% of patients, Significant Positive Correlation was seen between the levels of the cardiac markers and the degree of adverse outcome in terms of HIE staging. Functional 2D ECHO done at bedside can be a reliable tool to diagnose and monitor the clinical progress of patients.

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality globally, with arrhythmias representing a frequent and significant complication. These arrhythmias, which can range from benign to life-threatening, are closely associated with the severity of myocardial injury and contribute to poor short- and long-term outcomes. This prospective observational study aimed to investigate the incidence, types, and outcomes of arrhythmias in patients with AMI admitted to the intensive coronary care unit at SVRRGGH, Tirupati. A cohort of 100 patients was assessed based on clinical features, ECG evidence, blood biomarkers, and imaging. The study found that the majority of patients were aged 41-70 years, with a significant male predominance (83%). Lifestyle factors such as smoking and alcohol use were common, and hypertension and diabetes were prevalent comorbidities. The most common type of myocardial infarction was Inferior Wall Myocardial Infarction (INFWMI). Arrhythmias, particularly ventricular premature contractions (VPCs), were observed in a significant number of patients, with spontaneous resolution noted in some cases. The study highlighted the relationship between the location of the myocardial infarction and the occurrence of specific arrhythmias, with no significant correlation found between MI type and mortality. Additionally, factors such as age, gender, and comorbidities influenced arrhythmic patterns and outcomes. These findings suggest that arrhythmias in AMI patients can often resolve spontaneously but require careful monitoring and timely intervention. The study underscores the importance of personalized treatment strategies and further research to refine management techniques and improve patient outcomes, particularly for those with high-risk factors such as comorbidities and lifestyle behaviors.

Background: Aim: This study aimed to determine the prevalence, severity, and contributing factors of iron deficiency anemia among school-aged children (6-14 years). The findings provide insights into anemia prevalence and its correlation with iron deficiency, emphasizing the need for preventive interventions. MATERIALS AND METHODS: This observational study was conducted in the Department of Pediatrics over one year (January 1, 2024 – December 31, 2024). A total of 150 children were enrolled from outpatient pediatric clinics and school health programs. Demographic data, dietary habits, and clinical history were collected using a structured questionnaire. Laboratory investigations included a Complete Blood Count (CBC), serum ferritin, serum iron, total iron-binding capacity (TIBC), and a peripheral blood smear. Anemia classification was based on WHO criteria. Statistical analysis was performed to evaluate the association between anemia and various demographic and clinical parameters. RESULTS: The prevalence of anemia among the participants was 45.33%, with mild anemia in 35.82%, moderate anemia in 50.75%, and severe anemia in 13.43% of anemic children. Age and gender did not show a significant effect on hemoglobin levels (p > 0.05). Serum ferritin levels indicated that 10.00% of children had iron deficiency, highlighting that other factors, such as vitamin deficiencies or infections, may contribute to anemia. CONCLUSION: Iron deficiency anemia remains a significant health concern among school-aged children, affecting nearly half of the study population. While iron deficiency plays a role, other nutritional and health-related factors may contribute to anemia. The study underscores the importance of early screening, dietary interventions, and public health initiatives to mitigate the impact of anemia on children's health and academic performance

Background: Non-traumatic small intestinal perforation is a critical surgical emergency associated with significant morbidity and mortality. The study aims to evaluate its clinical presentation, surgical management, and postoperative outcomes. Methods: A descriptive observational study was conducted on patients presenting with non-traumatic small bowel perforation. Demographic data, clinical presentation, laboratory and radiological findings, intraoperative observations, surgical interventions, and postoperative outcomes were analyzed. Results: The study included 40 patients, with a mean age of 36.36 years. The most affected age group was 31-40 years (40%). Unlike most studies reporting male predominance, this study observed a higher incidence in females (54%). Abdominal pain (100%) was the most common symptom, followed by fever (82%), vomiting (68%), and abdominal distension (68%). Pneumoperitoneum was observed in 84% of cases on abdominal X-ray. Single perforations (58%) were most common, with the majority occurring within 100 cm of the ileocecal junction (72%). Primary repair was performed in 12% of cases, resection with anastomosis in 30%, and stoma formation in 58%. The most common postoperative complication was wound infection (58%), followed by anastomotic leakage (26%) and respiratory complications (46%). The overall mortality rate was 10%, with delayed presentation significantly impacting outcomes. The predominant etiology was typhoid (40%), followed by tuberculosis (26%) and non-specific causes (26%). Conclusion: Early diagnosis, aggressive resuscitation, and appropriate surgical decision-making significantly influence outcomes in non-traumatic small bowel perforation. Stoma formation in high-risk cases helped reduce morbidity and mortality. Optimizing patient care with timely intervention remains crucial in improving survival rates.

Background: Non-invasive ‘Multi-detector Computed Tomography’ (MDCT) of abdomen is a primary imaging modality to look for small bowel pathologies with additional assessment of extraluminal structures.A Contrast Enhanced CT (CECT)study using diluted iodine and mannitol have been used to achieve bowel distension, improve image quality, and facilitate the diagnosis of bowel wall abnormalities. An ideal endoluminal contrast agent should provide uniform intraluminal attenuation, high contrast between bowel wall and luminal content, minimal mucosal absorption with maximum distension, no significant artifact formation or adverse effects. The purpose of this study is to compare quantitatively and qualitatively using the diluted mannitol and diluted iodine-based diatrizoate meglumine as oral endoluminal contrast agents. Materials and methods: A prospective comparative study done for a period of 2 years involving 108 subjects for analysis of the bowel by two endoluminal contrast agents, viz. diluted mannitol and iodine with an objective to compare their performance. Imaging was done using 128-slice MDCT and study was performed after the administration of oral and intravenous contrast. The images were analyzed for maximum bowel distension, bowel distension uniformity, mucosal fold/ wall visibility and homogeneity of luminal contents for mannitol and iodine groups. MS Excel and SPSS version 23 (IBM SPSS Statistics) were used to analyse data.  Results: The mean of maximum and average bowel distension with the mannitol group was significantly higher compared to the iodine group. Similarly, greater number of cases showing excellent uniformity in bowel distensibility, mucosa fold visibility and homogeneity of luminal contents were noted among the mannitol group in all quadrants, compared to the iodine group. Conclusion: Oral diluted mannitol performs better than iodine solution as an oral contrast agent for evaluating small and large bowel loops both quantitatively and qualitatively. The diluted mannitol was also better tolerated, and had fewer mild side effects.

Background: It was discovered that thyroid hormones, which are classified as catabolic hormones, control several metabolic processes, such as lipid synthesis, mobilization, and breakdown. Thyroid hormones significantly affect lipoprotein metabolism as well as some CVD risk factors, thus influencing the overall CVD risk. Objectives: To find relation between abnormal thyroid functions and lipid levels Methods: It is a Cross-sectional study. Analysis of Total Cholesterol, Triglycerides and HDL Cholesterol was made using a fully automated Biochemistry analyzer. Serum T3, T4, and TSH were analyzed using Chemiluminescence assay. Correlation of Thyroid hormone and lipid ration were done. Results: Majority of them (39.2%) were 41-50 years age group, with female predominance (62.7%). Mean serum levels of TC, TG VLDL, LDL cholesterol and LDL/HDL ratio indicated significantly higher among hypothyroid group as compared to euthyroid group, whereas mean HDL level were significantly lower in hypothyroid group as compared to euthyroid group (p<0.05). Mean serum levels of TC, TG, VLDL, LDL cholesterol and LDL/HDL ratio were significantly lower among hyperthyroid group as compared to euthyroid  group (p<0.05), whereas mean HDL level were significantly higher in hyperthyroid group (p<0.05). Conclusion: Screening for lipid profiles is crucial in all patients with thyroid dysfunction, and it is essential to identify and address underlying lipid abnormalities

Introduction: Thalassemia is a group of genetic disorders characterized by an imbalance in alpha and beta globin chain production, leading to hypochromic, microcytic red blood cells with a shorter half-life and resulting anemia. AIM: To evaluate lipid profile changes, carotid intimal medial thickness, age correlation, and duration from first blood transfusion with atherosclerotic changes in beta thalassemia major cases compared to controls. Methodology: This case-control study was conducted in the Department of Paediatrics, JLN Medical College, Ajmer, from February 2023 until the completion of the required sample size. Result: Our study found that beta thalassemia major cases had significantly higher triglyceride, VLDL, serum ferritin, serum iron, CIMT, and AIP levels, while cholesterol, HDL, LDL, and hemoglobin levels were lower compared to controls. These findings suggest an increased risk of atherosclerosis and cardiovascular complications in thalassemia patients, aligning with previous studies. Conclusion: Our study concluded that serum ferritin, serum iron, triglycerides, cholesterol, and duration since the first blood transfusion significantly correlate with increased CIMT in thalassemia patients, indicating a strong link between iron overload and atherosclerotic changes, highlighting the need for early intervention to prevent disease progression.

Background: Inclisiran inhibits PCSK9 production by mimicking body’s process of RNA interference mechanism and is targeted towards the hepatocytes by binding to GalNac leading to greater uptake of LDL-C by the hepatocytes. This study aims to assess the efficacy and safety of Inclisiran in 16 Indian ASCVD patients from day 0 to day 90. Methods: The study included 16 Indian patients with documented ASCVD treated with Inclisiran in addition to oral LLTs. ESC 2019 recommendation for risk stratification was performed to classify the patients into different risk categories and the LDL-C goals appropriate to each risk categories were set as benchmark to be achieved. The patients were followed up-to 90 days and lipid profile was checked prior to the initiation of Inclisiran and at day 90. Results: The mean age of patients included was 53 years contributed by 13 males and 3 females. All the patients received maximally tolerated oral lipid lowering therapies post discharge. Inclisiran was administered in these patients who were unable to achieve the guideline recommended LDL-C targets despite being administered with maximally tolerated oral LLTs. The baseline mean LDL-C value observed in the patients was 124.5 mg/dl prior to initiation of Inclisiran. The mean LDL-C reduction was found to be 66.2% from the baseline in a span of 3 months. 5 out of 7 extreme risk patients achieved the ESC guideline recommended LDL-C target of < 40 mg/dl, 9 out of 9 very high-risk patients achieved < 55mg/dl. Conclusion: Inclisiran 284mg SC offered an effective and safe LDL-C reduction without any adverse CV events reported during the study period.

Background: Herlyn- Werner- Wunderlich (HWW) syndrome is a rare congenital anomaly of the Mullerian and Mesonephric ducts characterised by a triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis.1 Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. Etiology is unknown. Incidence is 0.1%–3.8%. We present a case report of this rare syndrome of HWW syndrome in a 38 years old, nulligravida, came to OBGYN - OPD at KIMS & RF, Amalapuram, with primary infertility. On examination, cervix found deviated to left side, with blind vaginal dimpling on right side, which was confirmed byMRI & diagnostic hysterolaparoscopy. The diagnosis was made by usg- abdomen and pelvis, MRI, diagnostic hysterolaparoscopy. It was noted the uterine didephys with incompletely obstructed hemivagina on right side and absence of Ipsilateral right kidney. Chromopertubation (CPT)done through the visible left sided cervical OS shown spillage at left sided fallopian tube, no spillage on right sided fallopian tube.

Background: Deep vein thrombosis (DVT) is a significant complication following venous interventions. While these procedures are essential for various medical conditions, the risk of DVT remains a concern. Prophylactic anticoagulation is widely used to mitigate this risk, yet its effectiveness and associated challenges require further investigation.  Aim: This study aims to assess the incidence of DVT following venous interventions and evaluate the impact of prophylactic anticoagulation in preventing DVT. Methods: A prospective observational study was conducted at a single tertiary care center. Patients undergoing venous interventions, including central venous line (CVL) placement, temporary pacemaker (TPM), permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy pacemaker (CRT-P), were included. Patients received prophylactic anticoagulation based on institutional protocols. The incidence of DVT was assessed using clinical evaluation and Doppler ultrasonography.  Results: The most common indication for venous intervention  was PPM 30%, followed by CVL and TPM 25% each, then CRT-P  15%, least was ICD 5%. The most common site of venous catheter insertion was  left subclavian vein 50%, followed by right femoral vein 30%, least  was internal jugular vein 20%.   Out of the total study population, the incidence of post-procedural DVT was found to be very low at 0.5%. The use of prophylactic anticoagulation was associated with a significant reduction in DVT occurrence.  Conclusion:  Venous interventions pose a minimal risk for DVT when appropriate prophylactic anticoagulation is administered. The results reinforce the importance of thromboprophylaxis in preventing post-intervention thrombotic complications. However, multicentric studies with larger sample sizes are warranted to validate these findings further. 

Background & Objectives: Peripheral Arterial Disease (PAD) is a common and severe complication in diabetic patients, often leading to significant morbidity and mortality. Early detection of PAD in asymptomatic patients is crucial for preventing severe outcomes such as ulcers and amputations. The study aims to compare the effectiveness of Pulse Oximetry and Ankle Brachial Index (ABI) in detecting PAD among asymptomatic diabetic patients. Methods: A cross-sectional study was conducted involving asymptomatic diabetic patients. Participants underwent both Pulse Oximetry and ABI tests, followed by Duplex Ultrasonography of the Lower Limb arteries, which served as the reference standard. The sensitivity, specificity, and predictive values of Pulse Oximetry and ABI were calculated and compared. Results: Pulse Oximetry demonstrated a sensitivity of 84.6% and specificity of 73.9% in detecting PAD, whereas ABI showed a sensitivity of 83.3% and specificity of 71.9%. The combination of both tests improved the overall diagnostic accuracy, with the combined sensitivity and specificity reaching 70.47% and 91.77% respectively. Interpretation & Conclusion: Pulse Oximetry is a useful, non-invasive tool for the initial screening of PAD in asymptomatic diabetic patients, especially when used in combination with ABI. The combination enhances early detection, potentially reducing the risk of severe complications and improving patient outcomes.

Background & Objectives: OSMF is a high risk potentially malignant disorder caused due to areca nut (AN). Reactive oxygen species (ROS) produced during auto oxidation of A poly-phenols in the betel quid chewer’s saliva, are crucial in the initiation and promotion of oral cancer and are countered by salivary antioxidants .With scanty literature on their role in OSF, salivary enzymatic antioxidant catalase and non- enzymatic antioxidant uric acid were planned to be evaluated. Materials & Method: The study comprised of 30 OSMF subjects subdivided into 10 each of stages I, II and III as per Pindborg’s clinical classification and 30 controls. Salivary CAT activity and UA levels using ELISA and automated biochemistry auto analyzer respectively were evaluated and obtained data statistically analyzed. Results: Classical features of OSMF were observed with increasing number of subjects experiencing oral mucosal burning as OSMF advanced. A statistically insignificant decreased salivary catalase activity (1.42±2.42 ng/dl v/s1.48±1.92 ng/dl) and statistically significant (p < 0.05) decreased salivary uric acid levels (2.85±2.31 md/dl v/s 4.18±2.19 md/dl) in OSMF subjects compared to controls was noted, both of which decreased linearly from stage I to stage III OSF. Interpretation and Conclusion: Decreased salivary antioxidants, catalase and uric acid in OSF reflect their augmented consumption by increased reactive oxygen species produced during areca nut and tobacco chewing.

Background: Central corneal thickness (CCT) is a crucial parameter in ophthalmology due to its importance as an indicator of corneal physiological status, influencing intraocular pressure (IOP) reading and the evaluation of risks associated with eye disorders like glaucoma and keratoconus. Aim: The present study aimed to determine CCT to age, gender, refractive errors, and axial length among patients visiting tertiary care center in South India. Materials & methods: An observational, prospective study was conducted at Sri Venkateshwara Medical College Hospital and Research Centre in Puducherry to examine the correlation between CCT with age, gender, refractive errors, and axial length among patients visiting the ophthalmology outpatient department. The study included participants aged 20 to 70 years who received standard ophthalmologic evaluations with a sample size of 100 eyes (55 patients). The study was approved by the Institutional Ethics Committee. Ophthalmologic evaluation, including acuity assessment, refraction assessment, axial length measurement, and central corneal thickness measurement was done. Results: The mean CCT varies among different age groups, with the highest values in the 20-30 age group (562.14 ± 32.4 microns), followed by the 41-50 age group (546.88 ± 21.56 microns), the 51-60 age group (537.12 ± 34.89), and the 61-70 age group (543.56 ± 34.87 microns). The mean CCT in males is 540.64 ± 23.7.2 microns, while in females it is 547.76 ± 34.21 microns. The mean CCT in low myopia is 530.23 ± 48.2 microns, moderate myopia is 560.56 ± 45.43 microns, high myopia is 562.88 ± 33.71 microns, hypermetropia is 542.12 ± 27.61 microns. The average axial length was 23.47± o.80 mm among males, and 23.20±0.57 mm among females. Conclusion: The study concludes that CCT varies significantly by age, gender, refractive errors, and axial length. CCT significantly decreases with age. No significant difference in CCT was found among myopia, hypermetropia, and emmetropia. We found no statistically significant correlation between CCT and axial length. Understanding regional differences can improve eye care and intraocular pressure measurements.

Background: Intrathecal administration of local anaesthetic drug for spinal anaesthesia can achieve adequate sensory and motor blockade required for lower limb orthopaedic surgeries. However, the traditionally used drug bupivacaine has been associated with severe cardiovascular and CNS toxicity. Newer long-acting local anaesthetics, levobupivacaine and ropivacaine due to their three-dimensional structure seem to have lesser toxic effects on the central nervous system and the cardiovascular system. Through our study we intend to clinically compare the efficacy of 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Materials and methods:  A prospective, randomized, double blinded, clinical, parallel arm study was conducted including a total of 70 patients posted for lower limb orthopaedic surgery. The patients were randomly divided into 2 groups of 35 patients each. Group A received 15 mg 0.5% (3ml) hyperbariclevobupivacaine for spinal anaesthesia. Group B received 22.5 mg 0.75% (3ml) hyperbaricropivacaine for spinal anaesthesia. The total duration of analgesia along with time taken for onset and regression of sensory block and motor block was recorded and statistical analysis was performed. The two groups were also compared based on peri-operative hemodynamic parameters and adverse effects encountered. Results & conclusion: The findings in the 2 groups were comparable regarding duration of analgesia, the maximum dermatomal height of sensory block and the time required to achieve maximum dermatomal height. However, hyperbaric 0.75% ropivacaine was found to produce faster onset as well as regression of sensory and motor block compared to hyperbaric 0.5% levobupivacaine.

Background: Chronic obstructive pulmonary disease (COPD) significantly impacts cardiac function, particularly affecting the right ventricle, left ventricle, and pulmonary vasculature. Cardiovascular complications contribute substantially to COPD-related mortality. Echocardiography provides a non-invasive and effective method for evaluating cardiac changes in COPD patients. To analyze the cardiac alterations associated with COPD using echocardiography and to determine the correlation between echocardiographic findings and COPD severity based on GOLD classification. Materials and Methods: This prospective observational study was conducted over 16 months at the Department of Respiratory Medicine, MIMS, Vizianagaram. A total of 50 COPD patients aged above 40 years were enrolled. Exclusion criteria included active tuberculosis, HIV, terminal cancer, hepatic or renal diseases, and pregnancy. Patients underwent clinical evaluation, electrocardiography (ECG), spirometry, arterial blood gas (ABG) analysis, and echocardiography. Data were analyzed for associations between echocardiographic findings and COPD severity. Results: Echocardiographic findings revealed that 24% of patients had pulmonary hypertension, 24% had increased right ventricular (RV) thickness (>0.5 mm), and 20% had left ventricular diastolic dysfunction (LVDD). The mean ejection fraction did not significantly differ between patients with and without pulmonary hypertension (61.6% vs. 60.5%). Echocardiographic abnormalities were more frequent in severe and very severe COPD cases. Conclusion: COPD is associated with significant cardiovascular changes, including pulmonary hypertension, RV hypertrophy, and LV dysfunction. Routine echocardiographic screening every six months is recommended to detect early cardiac complications and improve clinical outcomes.

Background: This study assesses the knowledge, awareness, and preparedness of non-medical graduates in Ghaziabad City regarding Cardiopulmonary Resuscitation (CPR). It identifies knowledge gaps and sources of information to recommend strategies for improving CPR proficiency among this demographic. Methods: A quantitative research design was employed, utilizing an observational approach. A purposive sampling technique was applied to select 101 non-medical graduates from Ghaziabad. Data collection was conducted via a structured questionnaire developed using Google Forms. Statistical analysis was performed using IBM SPSS, incorporating descriptive statistics and regression analysis. Results: The findings indicate that 88.12% of participants had received CPR training, yet only 25.74% correctly identified the initial step in CPR. A significant portion (74.26%) mistakenly believed that CPR begins with 30 chest compressions instead of checking for breathing. 86.14% of respondents had encountered situations requiring CPR, and 89.11% reported performing CPR. However, 27.72% refrained from performing CPR due to discomfort, and 25.74% cited a lack of knowledge. Awareness of Automated External Defibrillators (AEDs) was limited, with 46.53% unfamiliar with the device. Conclusion: Although CPR training is widespread, critical knowledge gaps persist in understanding correct procedures. There is a need for structured and practical training programs tailored for non-medical graduates to improve their competency and confidence in performing CPR. Public health initiatives should focus on bridging the knowledge gap and promoting AED awareness to enhance emergency response effectiveness.

Background: The choice of vascular access in PCI affects procedural success, complications, and outcomes. Radial access (RA) is preferred for reduced bleeding and faster recovery, while femoral access (FA) remains crucial for complex cases. This study compares the impact of RA versus FA on procedural and clinical outcomes. Methods: A prospective observational study was conducted at a tertiary care hospital, over one year of period, enrolling 228 patients undergoing PCI. Patients were categorized into RA-PCI (n = 115) and FA-PCI (n = 113) groups based on access strategy. Primary outcomes included 30-day major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes assessed procedural efficiency (fluoroscopy time, contrast volume), access-site complications (bleeding, hematoma), and recovery parameters (ambulation time, hospital stay) Results: RA-PCI had lower fluoroscopy time (11.4 ± 3.8 min vs. 14.7 ± 4.2 min, p < 0.001), contrast use (130.5 ± 18.3 mL vs. 148.7 ± 22.1 mL, p < 0.001), and procedure duration (37.2 ± 6.1 min vs. 42.8 ± 7.4 min, p = 0.002). RA-PCI also had fewer major bleeding events (2.6% vs. 8.0%, p = 0.03), lower hematoma rates (3.5% vs. 10.6%, p = 0.02), shorter ambulation time (3.1 ± 0.9 h vs. 8.4 ± 2.3 h, p < 0.001), and reduced hospital stay (1.7 ± 0.5 days vs. 2.6 ± 0.8 days, p < 0.001). MACCE at 30 days was lower in RA-PCI (6.1% vs. 11.5%) but not statistically significant (p = 0.08). Conclusion: RA-PCI offers better procedural efficiency, fewer bleeding complications, and faster recovery than FA-PCI. While MACCE rates were lower with RA, significance was not reached. These findings support a radial-first approach, with further studies needed for long-term validation.

Introduction: The spleen is the haemo - lymphatic organ of the reticulo-endothelial system and is the commonest organ to get enlarged in infections. Spleen can have many anatomical variations pertaining to its notches, weight, length, breadth and thickness. This anatomical knowledge is important for Surgeons, Radiologists and Anatomists. Aim of the study: Morphometric analysis of adult human cadaveric spleens was done in this study and compared with the available literature. Material and Methods: This present study was done on 40 formalin fixed human adult cadaveric spleens of both the sexes obtained from cadavers during routine dissection for undergraduate students in PESIMSR ,Kuppam A.P The spleens were carefully examined to determine the presence of splenic notches , clefts, weight, length measured between two poles , breadth measured between superior and inferior borders and thickness between two surfaces Results : In this study out of 40 cadaveric spleens 26 spleens were observed to have the notch on their superior borders. There were no notches in 5 spleens. 2 spleens were having notch in the superior border along with the cleft in there inferior border. 1 spleen had notch only in the intermediate border. Only one spleen was found to have notch only in the inferior border. The weights of the 40 spleens were recorded and it was ranging from 20.39g to 328.96g. One spleen with the least weight was 24.6g and the largest one was measuring 328.96g. The length of the spleens was ranging from 6.4cm to 12.1cm. The breadth of the spleens was ranging from 3.7cm to 9.5cm. The thickness of the spleen was ranging from 1.3cm to 5.5cm. Conclusion: The finding of the present study contributes significantly to the existing literature on splenic morphology, highlighting the importance of spleen’s size its notches and weight.

Background: Direct laryngoscopy and tracheal intubation can result in severe effects such as tachycardia, hypertension, cardiac ischaemia, and cerebral haemorrhage.Clonidine is an α-2 adrenergic receptor agonist that exerts a central sympatholytic action. Clonidine premedication mitigates the haemodynamic stress reactions associated with direct laryngoscopy and tracheal intubation. Pregabalin, a gabapentinoid, seems to exert an inhibitory effect on neuronal excitability.

Aim: The purpose of this study was to compare the effect of oral pregabalin 150 mg & oral clonidine 0.2 mg given 90 minutes before surgery, on haemodynamic stress response resulting from laryngoscopy and endotracheal intubation. Materials and Method:The present study was a prospectiveobservational randomizedcomparativestudy performed conducted for a period of one year in a tertiary care centre. The study comprised 60 patients classified as ASA I and II, scheduled for diverse elective operations under general anaesthesia. The participants were randomised into two groups, A and B, each consisting of 30 patients: the Pregabalin group (Group A) and the Clonidine group (Group B). Group A received premedication with 150 mg of capsaicin pregabalin, whereas Group B was administered 0.2 mg of clonidine. Subsequently, the haemodynamic parameters including heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial pressure(MAP) were compared between the two groups during induction, laryngoscopy, and intubation.Result wasanalysed using SPSS 20.0 version and the association was tested using t test. A p value less than 0.05 was considered statistically significant.  Results:  Administration of oral clonidine 0.2 mg 90 minutes before to surgery mitigated sympathetic stimulation and catecholamine responses during laryngoscopy and tracheal intubation. Our investigation revealed that the increase in HR, SBP, DBP, and MAP after laryngoscopy and endotracheal intubation was considerably lower in the Clonidine group compared to the Pregabalin group. The Clonidine group exhibited superior haemodynamic stability throughout surgery compared to the pregabalin group. Conclusion: When compared to oral pregabalin, oral clonidine substantially reduces the sympathetic responses that occur during laryngoscopy and endotracheal intubation, while simultaneously preserving the stability of the cardiovascular system during surgery.

Background: Fournier's gangrene is a severe form of necrotizing fasciitis of the perineum and genitalia, typically caused by a polymicrobial infection.Most individuals with Fournier's gangrene also associated with comorbid conditions, such as diabetes, alcoholism, and other related disorders.The Fournier’s Gangrene Severity Index (FGSI) is a valuable prognostic tool for predicting mortality and survival outcomes in patients with Fournier’s gangrene. Reconstructive interventions are required when significant tissue defects arise from extensive tissue damage. AIM:To study the etiology, microbiological factors and reconstructive procedures performed in patients with Fournier’s gangrene, and to assess the outcomes and mortality rates of Fournier’s gangrene based on the Fournier’s Gangrene Severity Index (FGSI). Results:Among 40 patients treated at KMCH from May 2022 to May 2024. Most commonly occurred in the fourth and fifth decades of life, with a mean age of 50.2 years. The mean age for deceased patients was 63 years, significantly higher than the 48.3 years among survivors. The male-to-female ratio was 34:6.The most common source of infection was genitourinary (40%), followed by anorectal (27.5%) and 20% of cases being idiopathic. Diabetes mellitus (47.5%) was the most prevalent comorbidity, followed by chronic alcoholism (22.5%) and HIV (10%). Polymicrobial infections were seen in 80% of cases, with E. coli (47%),streptococci (41.1%), and Klebsiella (35.3%) being the most frequently isolated pathogens. Bacteroides were the most common anaerobes (8.9%). In most cases, the infection was confined to the genitalia (52.9%). The Fournier’s Gangrene Severity Index (FGSI) was a reliable predictor of survival, with a score above 10.5 associated with 100% mortality, while a score below 10.5 correlated with 93.3% survival. Conclusion: Fournier’s gangrene (FG) predominantly affects middle-aged and elderly males, with genitourinary infections as the most common source. Diabetes mellitus is the leading comorbidity, and infections are typically polymicrobial. Early diagnosis, repeated debridement, and reconstructive procedures for tissue loss are essential for improving survival outcomes. Despite aggressive treatment, mortality remains significant. The Fournier’s Gangrene Severity Index (FGSI) is a key predictor of survival, with higher scores correlating to increased mortality

Background: Breast cancer is the most common cancer amongst women with no regional variation and the second most cancer worldwide. Stromal contribution to progression of cancer will identify specific signals which promotes growth, differentiation, invasion and ectopic survival of tumour cells. Stromal cells in breast carcinoma express CD10 which can cleave the matrix and help tumour invasion and metastasis. Methods:Study group comprised 30 casesthat were subjected to histopathological examination using routine haematoxylin and eosin stain, and further confirmation was made by immuno-histochemical staining for CD10 of breast carcinoma diagnosed on 14-gaugecore needle biopsy specimen. Results :Among 30 cases, the 19 cases 0ut of 30 (63.3%) with Intraductal breast carcinoma (Not specific type) with extensive in situ component was clearly highlighted by strong CD10 positivity in myoepithelial cells.8 out of 30 cases (26%) cases showing weak positive results and 3 cases (10%) showed negative results. Conclusion :Strong CD10 positivity is significantly associated with lymphovascular invasion in the patients. Lymphovascular invasion is an independent prognostic marker which is associated with worse clinical outcome in breast cancer. Core needle biopsy should be an important part of preoperative work up and along with the traditional panel of markers, CD10 can put up routinely as a prognostic marker in all breast cancer patients.

Background: A Complete Blood Count (CBC) and Peripheral Blood Picture (PBP) are essential diagnostic tools in assessing the severity and outcomes of dengue infection. Dengue, a mosquito-borne viral illness caused by the dengue virus (DENV), can range from mild dengue fever (DF) to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CBC and PBP provide critical information about hematological changes that correlate with disease progression and severity. The objective is to observe the trends of recovery of white blood cells (WBCs) and platelets in dengue fever  Materials and Methods: This is a prospective and cross-sectional study conducted in the Department of Pathology at Uma Nath Singh Autonomous State Medical College, Jaunpur, Uttar Pradesh over period of 1 year. Patients diagnosed with dengue fever, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS) based on WHO criteria were included. Cases confirmed by serological tests (NS1 antigen, IgM/IgG ELISA) or RT-PCR. Patients with recorded laboratory parameters, including hemoglobin, hematocrit, white blood cell count, platelet count, and peripheral blood smear findings were included. Results : A total of 560 patient data were analyzed in this study, comprising 280 males and 280 females. The mean age of the study population was 34.2 years, with a standard deviation of 13.7, and the age range was between 16 and 84 years. Among these patients, 245 did not develop DHF during hospitalization, while 315 progressed to DHF in the ward. During the acute febrile phase (Days 2–3) of the illness, leucopenia (WBC < 5000 cells/mm³) was observed in 72.4% of the patients. The average WBC counts for DF and DHF patients were 4.22 and 4.57, respectively. Neutrophil counts showed mean values of 2.85 in DF patients and 3.21 in DHF patients. Lymphocyte counts were lower in DHF patients, with a mean of 0.92 compared to 1.07 in DF patients.Conclusion: In conclusion, DF is an increasing, global problem with a growing footprint on millions of lives. At this time, monitoring decreases in hemoglobin and increases in WBC counts, particularly neutrophils, through routine CBC testing in hospitalized patients with suspected DF may identify those young children at higher risk of severe

Background: Venous malformations (VMs) are the most common slow-flow congenital vascular anomalies, comprising approximately 70% of vascular malformations. Percutaneous sclerotherapy is the preferred treatment, but the optimal sclerosing agent remains uncertain. Bleomycin and Polidocanol are commonly used due to their efficacy and favorable safety profiles, while their combination as Bleomycin-Polidocanol Sclerotherapy (BPS) has been proposed to enhance treatment outcomes. This study compares the efficacy and safety of BPS versus Bleomycin or Polidocanol alone in pediatric patients with VMs. Methods A prospective, comparative study was conducted on 60 pediatric patients (aged 1 month to 12 years) with VMs. Patients were randomly assigned into two groups: BPS (n=30) and Bleomycin or Polidocanol alone (n=30). Sclerotherapy was performed under ultrasound guidance, with multiple sessions as required. Clinical improvement, treatment response, recurrence, and adverse events were recorded. Statistical analysis was conducted, with p-values <0.05 considered significant. Results Both groups demonstrated comparable outcomes. Complete resolution was observed in 50% of the BPS group and 43% of the Bleomycin or Polidocanol group (p=0.59). Partial improvement rates were 40% and 47%, respectively (p=0.60). Recurrence was reported in 13% of BPS patients and 17% of Bleomycin or Polidocanol patients (p=0.71). Adverse event rates were similar, with pain (33.3% vs. 30%), swelling (43.3% vs. 40%), and skin hyperpigmentation (30% vs. 26.7%) being the most common. No statistically significant differences were noted between groups. Conclusion BPS and Bleomycin or Polidocanol alone were equally effective and safe in the treatment of pediatric VMs. Both approaches resulted in similar symptom resolution, recurrence, and complication rates. This study suggests that either method can be chosen based on clinician preference, lesion characteristics, and patient-specific considerations. Further research with larger sample sizes and extended follow-up is warranted to optimize treatment protocols.

Background: This research investigates the perceptions of medical educators regarding the teaching of AETCOM to undergraduate MBBS students at a tertiary care hospital. Using a qualitative methodology, data were collected through semi-structured interviews with 15 faculty members across various departments. Thematic and content analyses were employed to uncover recurring patterns and quantify key themes. The findings highlighted both the transformative potential and the systemic barriers of AETCOM. Faculty members recognized its role in enhancing professionalism, empathy, and communication skills among students. However, challenges such as curriculum overload, lack of structured faculty training, resource constraints, and cultural misalignment were frequently cited. The study concludes with actionable recommendations, including structured faculty training programs, integration of AETCOM into clinical practice, and the cultural adaptation of teaching materials to better align with Indian healthcare settings. These recommendations aim to bridge gaps in AETCOM implementation, ultimately fostering holistic medical education.

Background: This study is carried out to assess the effect of  fenugreek (methi) on  blood pressure , blood  sugar , serum cholesterol and serum triglycerides in non insulin dependent diabetes  mellitus.Methods:A total of 10 patients of noninsulin dependent diabetes mellitus was taken to study the effect of fenugreek in their blood sugar,serum triglycerides and serum cholesterol level .Initially a detailed clinical examination of patients was carried out and all the drugs were discontinued for 2 weeks(washout period).All the patients were administered 2.5gm of methi powder twice a day after food with a glass of water daily for 2 months.Conclusion:We concluded that fenugreek has hypoglycaemic effect in mild NIDDM and no significant effect in severe NIDDM.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized for its ability to capture circadian variations in blood pressure, which are pivotal for managing patients with acute heart failure (AHF). This observational study investigates the utility of ABPM in a clinical setting to correlate blood pressure patterns with clinical outcomes in patients admitted with AHF. Methodology: This prospective observational cohort study was conducted at a tertiary care center, encompassing a sample of 100 patients diagnosed with AHF. ABPM was employed 24 hours prior to discharge post initial stabilization to monitor blood pressure fluctuations over a 24-hour period. Data were analyzed to correlate these fluctuations with clinical parameters including heart failure severity and cardiac structural changes, as evidenced by echocardiographic data. Results: The study findings highlighted that NYHA Class III or IV at admission was significantly higher in HFmrEF risers (96.2%) compared to non-risers (88.9%) (p = 0.02).  ABPM measurements showed that HFpEF patients had the highest average 24-hour SBP (124.9 ± 17.8 mmHg), followed by HFmrEF (112.4 ± 15.2 mmHg) and HFrEF (102.8 ± 13.9 mmHg). HFpEF patients had the highest prevalence of nocturnal hypertension (52.7%), followed by HFmrEF (34.1%) and HFrEF (27.4%). The differences were significant (p=0.01). The differences in LVEF between the AHF groups were statistically significant, with HFpEF showing the best heart function and HFrEF showing the worst. Conclusion: ABPM provides valuable insights into the prognostic implications of blood pressure variability in patients with AHF. The data suggests that ABPM should be considered as part of the routine assessment in AHF patients to better tailor therapeutic interventions and potentially improve clinical outcomes.

Background and Aim: Low birth weight (LBW) is a significant public health concern, particularly in developing regions, as it is associated with increased neonatal morbidity and mortality. Early detection of LBW can improve outcomes by enabling timely interventions. This study aimed to assess the correlation between head circumference (HC) and foot length (FL) with birth weight in neonates, and to determine the more reliable indicator for detecting LBW.  Material and Methods: A hospital-based cross-sectional study was conducted at a tertiary care center in South Gujarat, involving 122 live-born neonates with LBW. The study evaluated the correlation between HC and FL with birth weight, using Pearson’s correlation and ROC curve analysis to determine the most effective indicator. Results: The study found a strong correlation between HC and birth weight (R = 0.84), with HC showing higher sensitivity and accuracy compared to FL. FL demonstrated a moderate correlation with birth weight (R = 0.49), with lower specificity. The ROC curve analysis confirmed HC’s superior ability to predict LBW.   Conclusion: Both HC and FL are valuable anthropometric indicators for detecting LBW. HC is a more reliable predictor, offering higher sensitivity and accuracy, while FL provides a useful alternative in resource-limited settings.

Background:  Sepsis-related mortality remains high due to delayed diagnosis and suboptimal treatment strategies. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a known marker which prognosticates heart failure, but its role in sepsis prognosis is less explored. Objectives: This study aimed to evaluate the prognostic significance of NT-proBNP levels as an in-hospital severity indicator in patients with sepsis. Methods: This hospital-based prospective cross-sectional study was carried out at Silchar Medical College and Hospital, Assam, over one year, including 100 patients diagnosed with sepsis. Patients were assessed for demographic details, clinical parameters and laboratory investigations, including NT-proBNP levels, measured using the VITROS 5600 autoanalyzer. The primary result measured was in-hospital mortality at the end of 28 days. The prognostic value of NT-proBNP was compared with other clinical parameters and SOFA scores. Results: The study population comprised 49% males and 51% females, with no significant gender differences in outcomes. Elevated NT-proBNP levels were correlated with higher mortality, with non-survivors showing mean levels of 32,630.83 pg/mL compared to 9,005.16 pg/mL in survivors. Elevated NT-proBNP levels were linked with higher SOFA scores and greater severity of organ dysfunction. The ROC curve for NT-proBNP demonstrated an AUC of 0.84, indicating good predictive power. Logistic regression analysis confirmed NT-proBNP and SOFA scores as significant predictors of mortality, with each unit increase in SOFA score increasing odds of mortality by approximately 70% (p < 0.001). Conclusions: NT-proBNP levels are a valuable prognostic marker for assessing the severity and predicting outcomes in septic patients. Integrating NT-proBNP measurements into clinical practice can enhance early risk stratification, allowing for timely therapeutic strategies to enhance sepsis patient outcomes.

Background: The burden of diabetes, particularly diabetic foot complications, is a growing concern globally. This study aimed to assess the knowledge and attitude towards diabetic foot care among primary caregivers of diabetic patients. A mixed-method approach, combining a cross-sectional survey and qualitative analysis, was conducted at a tertiary care hospital in India. The study included 403 participants, majority being females and married and belonging to the age group of 28-37years with high school education. Results revealed that participants displayed good knowledge and positive attitudes towards diabetic foot care. Significant associations were found between age groups, gender, marital status, education levels, and religious affiliations with knowledge levels. Education emerged as a key factor influencing awareness of diabetic foot complications and preventive measures. These findings underscore the importance of tailored education and interventions for promoting diabetic foot care awareness among primary caregivers.

Background: Tuberculosis (TB) remains a major global health challenge, with the World Health Organization (WHO) estimating 10 million new cases and 1.4 million deaths annually due to TB. Despite advances in healthcare, the burden of pulmonary tuberculosis (PTB) is particularly significant in developing nations,  where socio-economic factors, including poverty and malnutrition, exacerbate disease incidence. One of the major complicating factors in the management of TB is the rising prevalence of Type II diabetes mellitus (T2DM), a condition that is often intertwined with TB and further complicates its treatment and prognosis. Methodology: This study is a prospective, randomized clinical trial conducted over a 12-month period. With sample size of 50 patients diagnosed with both pulmonary tuberculosis and Type II diabetes mellitus were enrolled. The patients were randomized into two groups● Group A (Control group): Received standard antitubercular therapy (ATT) for 6 months.● Group B (Intervention group): Received standard ATT plus Levofloxacin (500 mg daily) for 6 months.  Results: A total of 50 patients were enrolled in the study, divided into two groups:● Group A (Control group, n = 25) received standard ATT for six months.● Group B (Intervention group, n = 25) received standard ATT plus Levofloxacin (500 mg daily) for six months. Patients in the intervention group, who received Levofloxacin in addition to standard ATT, experienced a faster time to sputum conversion and a significantly larger reduction in cavity size compared to the control group. CONCLUSION: This study demonstrates that Levofloxacin as an add-on to standard antitubercular therapy significantly enhances treatment outcomes in pulmonary tuberculosis patients with Type II diabetes. The drug appears to improve both the microbiological and clinical recovery of these patients, making it a valuable addition to TB treatment regimens in such complicated cases.

Introduction And Aim: Distal radius fractures are the most common upper limb fractures treated in emergency rooms, accounting for over 16% of all fractures. These fractures have a bimodal age distribution, with high-energy trauma common in younger patients and low-energy trauma more prevalent in the elderly. Treatment approaches for distal radius fractures involve conservative management, which was historically the primary approach, and surgical intervention, now recognized as beneficial for certain patient groups. Patient-specific considerations include pursuing anatomic reduction for younger patients and high-demand elderly patients, while focusing on joint movement for low-demand elderly patients, reserving surgery forseverely displaced intra-articular fractures or median nerve compression.The objective of this study is to analyze and compare the functional outcomes of distal radius fractures treated with volar locking plates versus dual plating, with a focus on evaluating joint congruity, assessing the restoration of normal or near-normal wrist range of motion, and determining the time required for fracture union. Materials And Methods: In this observational study conducted over a period of 2years, 40 patients in the age group of  18 to 75 years with distal end  bicolumnar radius fracture who requires operative fixation were  alternatively treated with volar locking plate and dual plating. Joint congruity, time required for union and restoration of normal or near normal range of movements at wrist were assessed usingGartland and werley scoring system postoperatively. Results: Demographic data was comparable between 2 groups. joint movements , time required for union  were excellent in both groups, duration of hospital stay and less complications in volar locking plate compared to Dual locking plate. Conclusion: This study demonstrates that both dual plating and volar locking plate techniques are effective in treating unstable bicolumnar distal radius fractures, with excellent radiological and clinical outcomes. While both techniques show similar results, volar locking plate is preferred due to its advantages, including shorter operative time, reduced blood loss, and lower risk of complications. However, long-term follow-up is necessary to confirm these findings.

Preterm birth remains a significant global health challenge, with increasing incidence despite advances in medicine. It accounts for approximately 70% of neonatal deaths, 36% of infant deaths, and 25-50% of cases of neurological impairment in children. This study aimed to identify maternal risk factors and neonatal outcomes associated with preterm deliveries in KIMS & RF, Amalapuram. A cross-sectional study was conducted over a period of 1-year from December-2023 to December 2024 among 110 pregnant women attending  antenatal opd and labour room  at KIMS&RF, Amalapuram.Detailed histories and obstetrical examinations were undertaken, neonatal outcomes were analysed using SPSS software.The incidence of preterm birth was 27.5%, categorized into late preterm (19.75%), moderate preterm (3.75%), very preterm ( 10%) and extremely preterm (1.5%).More commonly observed in women who were underweight(34.54%) compared to women who were overweight (9.08%). More commonly observed in unbooked  cases (76.36%) when compared to booked cases(23.63%). Neonates delivered preterm had significantly lower Apgar scores at 1 and 5 minutes compared to term babies. Maternal risk factors included anemia, hypertensive disorders of pregnancy, PPROM and UTI. Poor neonatal outcomes, such as low birth weight, low APGAR scores, IUGR, respiratory morbidity were observed.

Syphilis is a treponemal infection which is a major public health issue. This can be tested serologically by syphilis rapid diagnostic test (RDT) which can be easily used in remote areas to evaluate syphilis. However single test is insufficient to diagnose syphilis .This study aims to assess the diagnostic value of syphilis rapid diagnostic test (RDT) in diagnosing syphilis and to evaluate the efficacy of Treponema pallidum Haemagglutination Assay (TPHA) and Flourescent  Treponemal Antibody-Absorption Test to confirm the diagnosis of Syphilis. The Study was conducted in (Sexually transmitted diseases) STD Outpatient department, at a Tertiary Care Hospital, Hyderabad from 05 Feb 2024 to 12 January 2025.

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality globally. Serum lipid profiles play a crucial role in ASCVD risk assessment, but the predictive value of traditional and non-traditional lipid markers requires further investigation. Objectives: This study aims to determine the relationship between serum lipid profiles (total cholesterol, LDL-C, HDL-C, triglycerides) and ASCVD risk. Secondary objectives include analyzing lipid ratios (TC/HDL-C, LDL-C/HDL-C) as predictors, evaluating the role of non-traditional lipid markers, and identifying demographic and lifestyle factors influencing lipid profiles and ASCVD risk. Methods: This observational study included 100 adults (30–70 years) without pre-existing ASCVD, recruited from a single-center healthcare facility. Baseline demographic, lifestyle, and biochemical parameters were recorded. Lipid profiles, lipoprotein(a), apolipoproteins, fasting glucose, and HbA1c were assessed. Participants were followed for six weeks to monitor incident ASCVD events. Data were analyzed using SPSS and R software, with logistic regression applied for risk assessment. Results: The mean ASCVD risk score was 10.3 ± 4.7%. Elevated LDL-C (132.5 ± 21.6 mg/dL) and unfavorable lipid ratios correlated with higher ASCVD risk. Incident ASCVD events occurred in 15% of participants, including myocardial infarction (7%), stroke (4%), and peripheral arterial disease (4%). Lipoprotein(a) and apolipoproteins showed potential value in risk stratification. Conclusion: Dyslipidemia and unfavorable lipid ratios significantly predict ASCVD risk. Non-traditional lipid markers may enhance risk assessment. Routine lipid monitoring and targeted interventions are essential for early prevention.

Background: Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women globally, with early detection playing a key role in reducing its impact. The current study evaluates the diagnostic accuracy of Pap smear and colposcopy in detecting cervical lesions, compared with histopathology as the gold standard. Objectives: To correlate Pap smear and colposcopic findings with histopathological diagnosis in patients with unhealthy cervix, and to assess the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of both screening methods. Methods: This prospective observational study was conducted from December 2019 to September 2021, involving 100 women with abnormal cervical findings attending the Obstetrics and Gynaecology department of KIMS, Amalapuram. Participants underwent Pap smear and colposcopy, followed by colposcopy-directed biopsy for histopathological examination. Data analysis included calculation of diagnostic performance metrics. Results: Among the study participants, 58% were in the 40–49 years age group, with the majority having studied up to 10th grade (38%). Most women (71%) attained menarche between 12–13 years. The sensitivity and specificity of Pap smear and colposcopy were found to be significantly correlated with histopathological findings, with a higher detection rate for CIN in women with prolonged marital duration and lower socio-economic status. The study found that Pap smear and colposcopy, when combined, offer enhanced diagnostic performance. Conclusion: Pap smear and colposcopy are reliable methods for the early detection of cervical lesions, with histopathology confirming their diagnostic accuracy. This study highlights the need for routine screening, particularly among high-risk groups, to reduce the incidence of cervical cancer.

Background: Cardiovascular diseases (CVDs) are among the leading causes of mortality worldwide, with a significant burden in rural areas due to limited healthcare access and awareness. Poor oral health has been linked to an increased risk of CVDs, highlighting the importance of dental care in managing cardiovascular conditions. This study aims to assess the prevalence of dental treatment in individuals with CVDs residing in rural areas of the Varanasi district and to evaluate the correlation between oral health and cardiovascular conditions. Materials and Methods: A cross-sectional study was conducted among 500 individuals diagnosed with cardiovascular diseases in rural areas of Varanasi. Participants were selected using a stratified random sampling method. Clinical oral examinations were performed to assess periodontal status, dental caries, and treatment needs. Data on sociodemographic factors, medical history, and oral health behavior were collected through structured questionnaires. The association between oral health status and cardiovascular conditions was analyzed using chi-square tests and logistic regression models. Results: Out of 500 participants, 65% exhibited poor oral hygiene, 42% had moderate to severe periodontitis, and 30% had untreated dental caries. Only 25% had undergone professional dental treatment in the past year. A significant association was observed between periodontitis and CVD severity (p < 0.05). Awareness regarding oral health and its link to cardiovascular disease was low among 70% of the participants. Logistic regression analysis indicated that individuals with severe periodontitis had a 2.5 times higher risk of worsening cardiovascular conditions compared to those with good oral hygiene. Conclusion: The study highlights a high prevalence of untreated dental conditions among individuals with CVDs in rural areas of Varanasi. The findings emphasize the need for integrating oral health promotion into cardiovascular disease management programs. Increasing awareness, improving accessibility to dental care, and implementing preventive strategies can help reduce the oral health burden in this vulnerable population.

Background: This study aimed to evaluate the effectiveness of a low dose of hyperbaric ropivacaine administered with and without fentanyl via intrathecal injection in elderly patients undergoing mesh hernioplasty. Method: Eighty patients were randomly assigned to two groups of 40. Group RP received 2ml of 15mg hyperbaric Ropivacaine (0.75%) combined with 0.2ml normal saline (total volume of 2.2ml), while Group RF received 2ml of 15mg hyperbaric Ropivacaine (0.75%)  with 10ug of fentanyl (also total 2.2ml), both administered intrathecally. The onset, duration, quality of sensory-motor block, and any side effects were recorded for both groups. Results: The onset of sensory-motor block was significantly early in the RF group compared to the RS group (p<0.05). In terms of peak sensory dermatome level, 80% of patients in the RF group reached T8, compared to 65% in the RS group. Additionally, the duration of sensory-motor block was significantly longer with prolonged postoperative analgesia in the RF group (p<0.05), with better overall anesthesia quality reported. Both groups maintained hemodynamic stability with no difference in side effect between both group. Conclusion: The findings of our study strongly support the use of a low dose of hyperbaric ropivacaine combined with fentanyl for spinal anesthesia in elderly patients undergoing mesh hernioplasty. This combination offers rapid onset, superior quality of anesthesia, and a lack of side effects, reinforcing its effectiveness in elderly patients.

Introduction: Sex determination of unknown skeletal remains come across in forensic or archeological situations, is one of the prime tasks of experts like forensic anthropologists and bioarcheologists involved in such examinations. In a study carried out on morphometric studies of x-rays of the sternum, sex determination of a sufficient certainty was possible using measurement of length and breadth obtained from x-rays of the human sternum if a wide range of dispersion is given. The given relations and formula are valid only when measuring the sternum of adults.  Method: This study has been conducted on the total 100 subjects, 50 male (02-15 yrs) and 50 female (02-15 yrs) of healthy living children from general population of north India as well as in and around the Lucknow of Uttar Pradesh. Result: The inter correlation between variables in 02-15 yrs is summarized in Table 3 and 4. Pearson correlation analysis showed a significant and negative (inverse) correlation of length of manubrium with BMI (r=-0.32, p<0.05), length of mesosternum with age (r=-0.30, p<0.05) and height (r=-0.31, p<0.05), and length of sternum with age (r=-0.42, p<0.01). On the basis of observation and result in my present study it was fully supported and agree of the previous researchers,  who has done the work in measurement of sternum bone in cadaver and skeletal of human, because they told that the sterna has distinguish in different zone of India, as well as it is shorter than European country. Conclusion: The significant and negative correlation was found between length of manubrium and length of mesosternum while a significant and positive correlation between length of mesosternum and length of sternum respectively.

Background: HIV/AIDS has still maintained its 21st century risk. The overall rate of new HIV infections continues to decline in several countries especially the developing countries. The aim of this study was to identify the degree of HN manifestation in HIV-infected patients based on age, gender and CD4 count at a tertiary hospital in India. Materials and Methods:This was a descriptive cross-sectional study conducted at a tertiary hospital inIndia involving HIV-infected patients who attended HIV clinics from July 2022 to January 2023. Convenient sampling was employed to get study participants, and 400 patients were recruited in the study. Data were collected through a questionnaire from patients, and results were analyzed using SPSS version 20. Results: 136 (34%) of 200 HIV-infected patients had ENT manifestations. The most affected age group was 0–9 years. ENT manifestations were more prevalent in females (23.5%) than in males (10.5%). Those with CD4 count less than 200cells/µL also it was a high prevalence (56.3%). Conclusion:This study observed that one-third of the studied HIV population had ENT manifestations. All medical practitioners should be aware of ENT manifestations in HIV-infected patients in order to assure early and appropriate intervention.

Background: Children from tribal communities face unique socio-cultural and environmental challenges that can significantly impact their emotional and behavioral well-being. Limited access to healthcare, poverty, and parental substance use contribute to increased psychological distress in these populations. Despite the growing recognition of childhood mental health concerns, there is a lack of studies assessing emotional and behavioral issues in tribal children using validated screening tools like the Pediatric Symptom Checklist-17 (PSC-17). Objectives: This study aimed to evaluate the prevalence of emotional, behavioral, and attention problems among tribal children using the PSC-17. Additionally, it sought to identify socio-demographic factors associated with these psychosocial problems to inform appropriate intervention strategies.Methods: A cross-sectional observational study was conducted in the tribal communities of Chamarajanagar District between May 2023 and December 2024. A total of 146 children aged 4 to 17 years were assessed using the PSC-17, a parent-reported screening tool. Sociodemographic data, including parental education, socioeconomic status, and parental substance use, were collected. Statistical analysis was performed using SPSS, with chi-square tests applied to examine associations between socio-demographic factors and psychosocial issues. Results: Emotional problems were observed in 2.7% of children, behavioral problems in 2.1%, and attention problems in 4.8%. Paternal alcoholism and substance abuse were significantly associated with emotional (p < 0.001) and behavioral problems (p = 0.002). Attention problems were significantly associated with male gender (p = 0.011). Other socio-demographic factors, including socioeconomic status and family structure, were not significantly associated with emotional or behavioral issues. Conclusion: The study highlights the influence of parental substance use on emotional and behavioral difficulties in tribal children. Attention problems were more prevalent in males, reinforcing gender-based differences in mental health concerns. Early identification and intervention programs, particularly targeting families affected by substance abuse, are essential for promoting child mental health in tribal communities.

Background: This study investigates the impact of water, sanitation, and hygiene (WASH) practices on stunting in children aged 6 months to five years. In India, the burden of stunting is compounded by the widespread prevalence of poor WASH practices. According to NFHS-5, only 58.6% of households have access to improved sanitation facilities, and 49.8% practice safe disposal of child feces. Furthermore, handwashing with soap and water is practiced by only 60.6% of households, highlighting significant gaps in hygiene behaviors. These deficiencies are particularly pronounced in rural areas and among marginalized populations, where access to basic WASH infrastructure is often limited. Material and Methods: The study was conducted over 12 months in the outpatient department of pediatrics at a tertiary care hospital in India. A total of 230 children aged 6 months to five years and their caregivers participated. Data collection involved structured questionnaires on household water sources, sanitation facilities, hand hygiene practices, and caregiver knowledge of gastrointestinal diseases. Anthropometric measurements, including height and weight, were taken using standard procedures, and z-scores were calculated using WHO AnthroPlus software. Results: Key findings indicate that children from households with inadequate WASH practices exhibited higher rates of stunting. Significant associations were found between caregiver hand hygiene, toilet type, and knowledge of gastrointestinal diseases with stunting outcomes. Conclusion: The study highlights the need for targeted public health interventions to improve WASH practices, promoting better child growth outcomes.